First-episode schizophrenia A window of opportunity for optimizing care and outcomes

ArticleinPostgraduate Medicine Spec No:5-19 · October 2006with22 Reads
Source: PubMed
Abstract
The pernicious course of schizophrenia has spurred efforts to identify and effectively treat this condition as early as possible. This assertive therapeutic stance is supported by epidemiologic data suggesting a substantial time lag between onset of illness and therapeutic intervention, and by neurobiologic data suggesting that brain changes present in first-episode psychosis are comparable to those in chronic schizophrenia. The proposal that atypical antipsychotic medications may prevent illness deterioration and/or be a restorative intervention is an appealing, but as yet unproven, hypothesis. Major challenges to maximizing treatment outcomes in first-episode schizophrenia include optimizing timing and effectiveness of pharmacologic interventions, service coordination, and access to care. We present data on the onset and presentation of first-episode schizophrenia and emerging findings about the neurobiology of first episodes, review nonpharmacologic and pharmacologic management, and summarize clinical research data on use of atypical antipsychotics in first-episode patients.
    • "The main findings of present study were (1) IL-18 levels were not significantly increased in these first episode and drug naïve schizophrenic (FES) patients, (2) we found significantly lower cognitive scores on the RBANS total score and nearly all of its subscales except for the Visuospatial/Constructional index in FES than normal controls, and (3) IL-18 was associated with the Visuospatial/ Constructional index of the RBANS in schizophrenia. The study of FES is particularly advantageous in understanding the neurobiology of schizophrenia in part because of the opportunity to minimize the potential impact of confounds, such as illness duration, medication effects, and the psychiatric and medical comorbidities that are associated with chronicity of illness (Buckley and Evans, 2006). In this study, we recruited a large sample of FES patients to establish the correlation between serum IL-18 and cognitive impairments in schizophrenia. "
    [Show abstract] [Hide abstract] ABSTRACT: Alterations in the inflammatory and immune systems have been documented to occur from the earliest stages of schizophrenia, and have been associated with neurodevelopmental changes. Cognitive impairment is a core feature in the pathology of schizophrenia, and recent studies showed a significant increase in serum IL-18 in schizophrenia, and a putative role of IL-18 in neuroprogression and thus neurocognitive defects. The purpose of this study was to examine the association of IL-18 with cognitive deficits in schizophrenia. We recruited 77 first episode and drug naïve schizophrenic patients and 75 healthy control subjects and examined the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and serum IL-18 in both groups. Schizophrenic symptoms were assessed using the positive and negative syndrome scale (PANSS). We found that IL-18 levels were non-significantly higher in patients than controls (206.0±92.9pg/ml vs 193.2±41.8pg/ml, p=0.28). Cognitive scores on the RBANS and nearly all of its five subscales (all p<0.05) except for the Visuospatial/Constructional index (p>0.05) were significantly lower in schizophrenic patients than normal controls. For the patients, IL-18 was positively associated with the Visuospatial/Constructional domain of cognitive deficits in schizophrenia. Our findings suggest that cognitive deficits occur during the acute stage of a schizophrenic episode, and IL-18 may be involved in Visuospatial/Constructional deficits of these patients.
    Full-text · Article · Mar 2013
    • "These findings support oxidative stress as a component in the psychopathology of schizophrenia. Studies of first-episode schizophrenic patients allow us to minimize confounds, such as illness duration, medication effects, and the psychiatric and medical comorbidities that are associated with chronic illness (Buckley and Evans, 2006)Contents lists available at SciVerse ScienceDirect "
    [Show abstract] [Hide abstract] ABSTRACT: Excessive free radical production or oxidative stress may be involved in the pathophysiology of schizophrenia as evidenced by increased superoxide dismutase (SOD) activities, a critical enzyme in the detoxification of superoxide radicals. This study compared plasma SOD activities in 78 never-medicated first-episode and 100 medicated chronic schizophrenia patients to 100 healthy control subjects and correlated these SOD activities with the Positive and Negative Syndrome Scale (PANSS) among the schizophrenic patients. We found that both first-episode and chronic patients had significantly increased plasma SOD activities compared to controls, and that chronic schizophrenic patients on antipsychotic medication had significantly higher SOD activities than first episode schizophrenic patients. Plasma SOD activities were also negatively correlated with positive symptoms of schizophrenia, but only in first-episode patients. Thus, oxidative stress appears to be greater in first episode schizophrenic patients with fewer positive symptoms and may become greater as schizophrenia becomes more chronic, although we cannot exclude the possibility that chronic antipsychotic treatment may increase SOD activities and presumed oxidative stress in schizophrenia.
    Full-text · Article · Aug 2011
    • "j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / l o c a t e / p n p and Evans, 2006). Only a few studies have reported the oxidative stress in first-episode patients with schizophrenia (Reddy et al., 2003; Chittiprol et al., 2010). "
    [Show abstract] [Hide abstract] ABSTRACT: Excessive free radical production leading to oxidative stress may be involved in the pathophysiology of schizophrenia. Determination of total antioxidant status (TAS) provides an index of the sum of activities of all antioxidants. However, there have been few systematic studies to examine the relationship between TAS levels and psychopathology in first-episode and drug-naive patients with schizophrenia. TAS levels were determined in the plasma of 60 never-medicated first-episode patients with schizophrenia and 68 healthy control subjects. The schizophrenia symptomatology and the depressive symptoms were assessed by the positive and negative syndrome scale (PANSS) and the Hamilton rating scale for depression (HAMD). The results showed that TAS levels were significantly lower in first-episode patients with schizophrenia than in healthy control subjects (159.8 ± 45.8 U/ml vs 211.4 ± 46.8 U/ml, F=39.5, df=1, 126, p < 0.001). A trend toward significant inverse correlation between TAS levels and PANSS negative subscore was observed (r = 0.25, df=60, p = 0.06). Our results suggest that oxidative stress occurs in an early course of schizophrenia and may have an important role in pathogenesis and perhaps, negative symptomatology of schizophrenia.
    Full-text · Article · Mar 2011
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