Cornblatt BA, Lencz T, Smith CW, Olsen R, Auther AM, Nakayama E et al. Can antidepressants be used to treat the schizophrenia prodrome? Results of a prospective, naturalistic treatment study of adolescents. J Clin Psychiatry 68: 546-557

Recognition and Prevention (RAP) Program, Department of Psychiatry Research, The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, NY 11004, USA.
The Journal of Clinical Psychiatry (Impact Factor: 5.14). 05/2007; 68(4):546-57. DOI: 10.4088/JCP.v68n0410
Source: PubMed

ABSTRACT This study reports the results of a prospective, naturalistic treatment study of adolescents considered to be in the prodromal (i.e., prepsychotic) phase of schizophrenia.
Forty-eight adolescents (mean age = 15.8 years) participating in the initial phase of the Recognition and Prevention (RAP) program (1998-2005) were included in the current report. Individuals were selected from the overall sample (N = 152) if they had: (1) displayed attenuated positive symptoms, (2) been treated pharmacologically for at least 8 weeks, and (3) been followed up for at least 6 months (mean follow-up = 30.5 months).
Two types of medication were naturalistically prescribed: antidepressants (N = 20) or second-generation antipsychotics (N = 28), with polypharmacy common. The 2 treatment groups did not differ in baseline symptom profiles, with the exception of disorganized thinking, which was more severe in second-generation antipsychotic-treated adolescents. Twelve of the 48 adolescents (25%) developed a psychotic disorder, with all converters having been prescribed second-generation antipsychotics. There were no conversions among antidepressant-treated adolescents (log-rank chi(2) = 7.36, df = 1, p = .007). Treatment outcome, however, was confounded, since 11 of the 12 converters were nonadherent. Adolescents, in general, were more likely to be nonadherent to second-generation antipsychotics (61%, 17/28) than to antidepressants (20%, 4/20; chi(2) = 7.86, p = .005). Improvement in 3 of 5 positive symptoms over time was significant (p < .001) and similar for both medications. Disorganized thought, however, did not improve regardless of treatment.
Nonrandom assignment limits comparisons between antidepressants and anti-psychotics in this study. However, with follow-up, a number of adolescents meeting criteria for prodromal schizophrenia were successfully treated with antidepressants. At present, a substantial number of false positives among the antidepressant-treated subgroup cannot be ruled out. However, the findings suggest that, in some cases, it might be preferable to begin treatment with antidepressants and progress to antipsychotics once symptoms intensify, since adherence to the latter is difficult to maintain.

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    • "Negative symptoms group into two factors, one involving diminished expression of affect and alogia and the second involving avolition, including anhedonia and asociality (Fusar-Poli et al., 2014b). Antidepressants may have a potential benefit for ARMS individuals , as they may target their negative attenuated psychotic symptoms (Cornblatt et al., 2007; Fusar-Poli et al., 2007). These studies indicate that antidepressant treatments in ARMS individuals can impact their longitudinal outcomes. "
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    Clinical neuroimaging 04/2015; 22. DOI:10.1016/j.nicl.2015.04.016 · 2.53 Impact Factor
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    • "The prevalent social dysfunction in CHR patients has been described as non-responsive to pharmacological treatment (Cornblatt et al. 2007a) yet improvement has been observed in some patients, suggesting remediation may be possible (Niendam et al. 2007). Antidepressants may have efficacy not only in treating depressive symptoms in CHR patients but also in preventing the onset of psychosis (Cornblatt et al. 2007b). Case reports suggest efficacy for cognitive behavioral therapy (CBT) in treating negative symptoms in both schizophrenia (Perivoliotis & Cather, 2009) and its putative clinical risk states (Kimhy & Corcoran, 2008). "
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    • "Of course, having said this, early, prodromal intervention strategies must take into consideration that a person diagnosed as having a high risk to develop schizophrenia may cause social stigma and augment stress that can worsen through the side-effects of pharmacological intervention. However, it seems there is evidence of the overweighing positive effect of early intervention of the development of psychotic states (McGorry et al. 2002; McGlashan et al. 2003; Cornblatt et al. 2007; Hafner et al. 2004). While task of early identification seems critical, initial prodrome seems to have been particularly elusive to systematic characterization (Møller and Husby 2000). "
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