Prediction of functional remission in first-episode psychosis: 12-month follow-up of the randomized-controlled trial on extended early intervention in Hong Kong A Randomized Controlled Trial of Clinician-Supported Problem-Solving Bibliotherapy for Family Caregivers of People With First-Episode Psychosis Predicting first-episode psychosis patients who will never relapse over 10 years. A randomized controlled trial of bibliotherapy for carers of young people with first-episode psychosis. Long‐term maintenance and effects of exercise in early psychosis Ten-year follow-up of the OPUS specialized early intervention trial for patients with a first episode of psychosis. Distress, Psychotic Symptom Exacerbation, and Relief in Reaction to Talking about Trauma in the Context of Beneficial Trauma Therapy: Perspectives from Young People with Post-Traumatic Stress Disorder and First Episode Psychosis. Two-year diagnostic stability in early-onset first-episode psychosis. Stress hormones and verbal memory in young people over the first 12 weeks of treatment for psychosis First-episode psychosis at the West Bologna Community Mental Health Centre: results of an 8-year prospective study. Recovery in remitted first-episode psychosis at 7 years of follow-up of an early dose reduction/discontinuation or maintenance treatment strategy: long-term follow-up of a 2-year randomized clinical trial. Patterns of referral in first-episode schizophrenia and ultra high-risk individuals: results from an early intervention program in Italy Pituitary volume and early treatment response in drug-naïve first-episode psychosis patients Study protocol for a randomised controlled trial of CBT vs antipsychotics vs both in 14–18-year-olds: Managing Adolescent first episode Psychosis: a feasibility study (MAPS) Views of early psychosis clinicians on discontinuation of antipsychotic medication following symptom remission in first episode psychosis. Predictors of schizophrenia spectrum disorders in early-onset first episodes of psychosis: a support vector machine model Evaluating verbal learning and memory in patients with an at-risk mental state or first episode psychosis using structural equation modelling Increased Prefrontal Cerebral Blood flow in First-Episode Schizophrenia Following Treatment: Longitudinal Positron Emission Tomography Study Ethyl-eicosapentaenoic acid in first-episode psychosis: a randomized, placebo-controlled trial.
BACKGROUND Functional remission ( FR ) is an intermediate and necessary step toward recovery , but is understudied in first-episode psychosis ( FEP ) . We aim ed to examine the rate and predictors of FR in FEP patients in the context of a r and omized-controlled trial ( RCT ) comparing a 1-year extension of early intervention ( Extended EI , 3-year EI ) with step-down psychiatric care ( SC , 2-year EI ) . METHODS One hundred sixty Chinese patients were recruited from a specialized EI program for FEP in Hong Kong after they have completed this 2-year EI service , r and omly allocated to Extended EI or SC , and followed up for 12 months . Assessment s on premorbid adjustment and personality , clinical profiles , functioning , and treatment characteristics were conducted . FR was operationalized as simultaneous fulfillment of attaining adequate functional levels ( measured by Social and Occupational Functioning Scale and Role Functioning Scale ) and competitive employment at 6 and 12 months . Data analysis was based on 156 subjects who completed follow-up functional assessment s. RESULTS Thirty-one ( 19.9 % ) patients achieved FR status . Multivariate binary regression analysis showed that female gender , lower degrees of premorbid schizoid-schizotypal traits , Extended EI treatment condition , lower levels of positive symptoms at intake , and better baseline functioning independently predicted FR . CONCLUSION This is the first RCT providing supportive evidence to an extension of EI service beyond 2-year treatment duration on further enhancing the likelihood of FR attainment in FEP . Our findings that only approximately 20 % of patients achieved FR indicate an unmet therapeutic need for promoting sustained adequate functional improvement in the early stage of psychotic illness Family interventions for first-episode psychosis ( FEP ) are an integral component of treatment , with positive effects mainly on patients ’ mental state and relapse rate . However , comparatively little attention has been paid to the effects of family interventions on caregivers ’ stress coping and well-being , especially in non-Western countries . We aim ed to test the effects of a 5-month clinician-supported problem-solving bibliotherapy ( CSPSB ) for Chinese family caregivers of people with FEP in improving family burden and carers ’ problem-solving and caregiving experience , and in reducing psychotic symptoms and duration of re-hospitalizations , compared with those only received usual outpatient family support ( UOFS ) . A r and omized controlled trial was conducted across 2 early psychosis clinics in Hong Kong , where there might be inadequate usual family support services for FEP patients . A total of 116 caregivers were r and omly selected , and after baseline measurement , r and omly assigned to the CSPSB or UOFS . They were also assessed at 1-week and 6- and 12-month post-intervention . Intention-to-treat analyses were applied and indicated that the CSPSB group reported significantly greater improvements in family burden and caregiving experience , and reductions in severity of psychotic symptoms and duration of re-hospitalizations , than the UOFS group at 6- and 12-month follow-up . CSPSB produces moderate long-term benefits to caregivers and FEP patients , and is a low-cost adjunct to UOFS BACKGROUND Although relapse in psychosis is common , a small proportion of patients will not relapse in the long term . We examined the proportion and predictors of patients who never relapsed in the 10 years following complete resolution of positive symptoms from their first psychotic episode . METHOD Patients who previously enrolled in a 12-month r and omized controlled trial on medication discontinuation and relapse following first-episode psychosis ( FEP ) were followed up after 10 years . Relapse of positive symptoms was operationalized as a change from a Clinical Global Impression scale positive score of <3 for at least 3 consecutive months to a score of ⩾3 ( mild or more severe ) . Baseline predictors included basic demographics , premorbid functioning , symptoms , functioning , and neurocognitive functioning . RESULTS Out of 178 first-episode patients , 37 ( 21 % ) never relapsed during the 10-year period . Univariate predictors ( p ⩽ 0.1 ) of patients who never relapsed included a duration of untreated psychosis ( DUP ) ⩽30 days , diagnosed with non-schizophrenia spectrum disorders , having less severe negative symptoms , and performing better in logical memory immediate recall and verbal fluency tests . A multivariate logistic regression analysis further suggested that the absence of any relapsing episodes was significantly related to better short-term verbal memory , shorter DUP , and non-schizophrenia spectrum disorders . CONCLUSIONS Treatment delay and neurocognitive function are potentially modifiable predictors of good long-term prognosis in FEP . These predictors are informative as they can be incorporated into an optimum risk prediction model in the future , which would help with clinical decision making regarding maintenance treatment in FEP Caring for young people with first-episode psychosis ( FEP ) is challenging and can adversely affect carer well-being , with limited evidence -based support material s available . We aim ed to examine whether completion of a self-directed problem-solving bibliotherapy among carers of young people with FEP led to a better experience of caring , less distress and expressed emotion , and better general health than carers who only received treatment as usual ( TAU ) . A r and omized controlled trial was conducted across two early-intervention psychosis services in Melbourne , Australia . A total of 124 carers were r and omized to problem-solving bibliotherapy intervention ( PSBI ) or TAU and assessed at baseline , 6-week and 16-week follow-up . Intent-to-treat analyses were carried out and indicated that recipients of PSBI had a more favorable experience of caring than those receiving TAU , and these effects were sustained at both follow-up time points . Across the other measures , both groups demonstrated improvements by week 16 , although the PBSI group tended to improve earlier . The PSBI group experienced a greater reduction in negative emotional evaluations of the need to provide additional support to young people with FEP than the TAU group by week 6 , while the level of psychological distress decreased at a greater rate from baseline to 6 weeks in the PSBI compared with the TAU group . These findings support the use of problem-solving bibliotherapy for first-time carers , particularly as a cost-effective adjunct to TAU Abstract Aim The aims of this study were to examine if people with first‐episode psychosis ( FEP ) are able to continue adhering to exercise after a supervised intervention and to explore if the benefits of exercise can be sustained . Methods Twenty‐eight persons with FEP took part in a 10‐week exercise intervention that provided each participant with twice‐weekly accompaniment to exercise activities of their own choice , of whom 20 were re‐assessed 6 months after the intervention . Long‐term adherence to exercise  was assessed , and measures of psychiatric symptoms , physical health , neurocognition and social functioning were administered at baseline , post‐intervention and 6‐month follow‐up . Results During the supervised intervention , participants achieved 124.4 min of moderate‐to‐vigorous exercise per week . After 6 months , physical activity levels had decreased significantly ( P = 0.025 ) and only 55 % of participants had continued to exercise weekly . Repeated‐ measures analysis of variance found that the significant improvements in psychiatric symptoms and social functioning observed immediately after the intervention were maintained at 6 months ( P = 0.001 ) . However , post hoc analyses showed that symptomatic reductions were only maintained for those who continued to exercise , whereas symptom scores increased among those who had ceased exercising . Previously observed improvements in waist circumference and verbal memory were lost by 6 months . Conclusion Long‐term exercise participation is associated with significant benefits for symptoms , cognition and social functioning in FEP . However , adherence to unsupervised exercise is low . Future research should explore the effectiveness of ‘ step‐down ’ support following supervised interventions , and aim to establish sustainable methods for maintaining regular exercise in order to facilitate functional recovery and maintain physical health INTRODUCTION Specialized early intervention programs such as The Danish OPUS treatment are efficient in treating patients with a first episode of psychosis ( FEP ) at least after 2 and 5 years . Few studies have examined long-term outcomes of these interventions . AIM To examine the effect of 2 years of OPUS vs treatment as usual ( TAU ) within an FEP cohort , 10 years after inclusion into the OPUS trial . METHODS From 1998 to 2000 , participants were r and omized to OPUS or TAU .  Ten years later , we conducted comprehensive interviews and performed register-based follow-up on all participants in national Danish registers . We analyzed participants according to the intention-to-treat principle . RESULTS Of the 547 participants included in the study , 347 ( 63.4 % ) took part in this follow-up . While there was evidence of a differential 10-year course in the development of negative symptoms , psychiatric bed days , and possibly psychotic symptoms in favor of OPUS treatment , differences were driven by effects at earlier follow-ups and had diminished over time . Statistically significant differences in the course of use of supported housing were present even after 8 - 10 years . There were no differences between OPUS and TAU regarding income , work-related outcomes , or marital status . CONCLUSION Most of the positive short-term effects of the OPUS intervention had diminished or vanished at this long-term follow-up . We observed a clear tendency that OPUS treatment leads to fewer days in supported housing . There is a need for further studies investigating if extending the intervention will improve outcomes more markedly at long-term follow-ups BACKGROUND Of young people with first episode psychosis ( FEP ) , over half report exposure to childhood trauma and consequent co-morbid post-traumatic stress disorder ( PTSD ) or symptoms . Currently no evidence -based interventions exist for PTSD in FEP . Clinicians report concerns that trauma-focused interventions with young people with FEP could result in distress and symptom exacerbation . Scant research suggests that talking about trauma in therapy can be distressing for some people . AIMS To explore young people 's reactions to a trauma-focused treatment for PTSD in FEP . METHOD Semi-structured interviews were conducted with eight participants ( age 18 - 27 years ) with co-morbid PTSD and FEP , after completing a trauma-focused intervention .  Transcripts were analysed using an interpretative phenomenological approach . Participants ' baseline and end-of-treatment PTSD and psychotic symptoms were assessed . RESULTS Three themes related to participants ' reactions were identified from the analysis : ( 1 ) distress in session ; ( 2 ) feeling relieved in and out of session ; and ( 3 ) symptom exacerbation out of session . All but one participant reported experiencing increased distress in session . Four participants described PTSD , psychotic symptoms and /or suicidal ideation worsening in immediate reaction to talking about trauma in therapy sessions . 86 % of participants showed improvement in their PTSD and psychotic symptoms at end of treatment . All participants described the intervention as beneficial and worthwhile . CONCLUSIONS Results suggest that feelings of distress are to be expected from individuals with PTSD and FEP during trauma-focused treatment .  Psychotic and PTSD symptom exacerbation can occur in PTSD treatment in FEP . Clinicians should be aware of , plan for , and clearly inform their clients of treatment risks BACKGROUND Only one study has used a prospect i ve method to analyze the diagnostic stability of first psychotic episodes in children and adolescents . The Child and Adolescent First-Episode Psychosis Study ( CAFEPS ) is a 2-year , prospect i ve longitudinal study of early-onset first episodes of psychosis ( EO-FEP ) . AIM To describe diagnostic stability and the variables related to diagnostic changes . METHODS Participants were 83 patients ( aged 9 - 17 years ) with an EO-FEP consecutively attended . They were assessed with a  structured interview ( Kiddie-Schedule for Affective Disorders and Schizophrenia , Present and Lifetime version ) and clinical scales at baseline and after 2 years . RESULTS The global consistency for all diagnoses was 63.9 % . The small group of bipolar disorder had high stability ( 92.31 % ) as did the group with schizophrenia spectrum disorders ( 90.00 % ) . Depressive disorder had lower stability ( 37.50 % ) and the lowest values were for psychotic disorder not otherwise specified ( 11.76 % ) and brief psychotic disorder (0%).The most frequent diagnostic shift was to schizophrenia spectrum and bipolar disorders . One group of patients did not meet the criteria for any diagnosis at follow-up . Independent predictors of change to schizophrenia spectrum disorders were lower scores on the Children 's Global Assessment Scale ( CGAS ) and the Hamilton Depression Rating Scale . Predictors of not having a diagnosis at follow-up were the CGAS and the Strauss-Carpenter Outcome Scale . CONCLUSIONS Global diagnostic stability was 63.9 % . Bipolar and schizophrenia spectrum disorders were the most stable diagnoses , while depressive disorder and other psychosis the least stable . Psychosocial functioning at baseline was a good predictor of diagnosis at follow-up . These data show the need for longitudinal follow-up in EO-FEP before a stable diagnosis is reached AIMS Memory impairment in psychosis may be mediated through detrimental effects of hypothalamic-pituitary-adrenal ( HPA ) axis function . This study prospect ively investigated the relationship between cortisol , sulphate dehydroepi and rosterone ( DHEA(S ) and cortisol : DHEA(S ) ratio and memory in 35 first-episode psychosis ( FEP ) patients during the first 12 weeks of treatment and 23 healthy controls ( HC ) . METHODS Morning blood sampling  and  tests of attention , working memory and verbal memory occurred at baseline and 12-week follow-up . RESULTS FEP and HC groups did not significantly differ in levels of cortisol , DHEA(S ) or their ratio at baseline or over 12-weeks . The FEP group performed significantly below HC on all cognitive measures at baseline and over 12-weeks . Cortisol levels were unrelated to cognition in both groups . At baseline , DHEA(S ) was positively associated with attention in HCs , but negatively associated with attention in FEP participants . Change in DHEA(S ) was negatively associated with change in memory over 12-weeks in both groups . At 12-weeks , there was a negative correlation between the cortisol : DHEA(S ) ratio and attention in both groups . CONCLUSIONS These findings are mostly in contrast to findings in chronic schizophrenia . Investigation at different illness phases and over longer-follow-up periods is required to determine the complex relationship between HPA-axis and memory functioning in psychosis BACKGROUND Research mostly conducted in the UK and northern Europe has established that there are high rates of first-episode psychosis ( FEP ) in large cities and immigrant population s ; moreover , psychosis has been found to be associated with cannabis use and early trauma . The present study aim ed to evaluate the incidence rate of FEP and the distribution of several risk factors ( e.g. age , ethnicity , substance abuse ) in Bologna , Italy . METHOD The Bologna FEP ( BoFEP ) study is an 8-year prospect i ve study . All FEP patients , 18 - 64 years old , consecutively referred to the West Bologna Community Mental Health Centre ( CMHC ) from 2002 to 2009 were evaluated . Sociodemographic information , migration history and clinical data were collected through an ad-hoc schedule . Psychiatric diagnoses were recorded using the Schedule for Clinical Assessment of Neuropsychiatry ( SCAN ) . RESULTS The overall incidence rate ( IR ) in the BoFEP study was 16.4 per 100 000 person-years [ 95 % confidence interval ( CI ) 13.9 - 18.9 ] . The incidence was higher in young people , men and migrants ( MI ) . CONCLUSIONS The IR of FEP found by the Bologna study is lower than that found by other European studies . However , as in other studies , the incidence was higher in certain groups . This heterogeneity has implication s for policy and mental health service development , and for underst and ing the aetiology of psychosis IMPORTANCE Short-term outcome studies of antipsychotic dose-reduction/discontinuation strategies in patients with remitted first-episode psychosis ( FEP ) showed higher relapse rates but no other disadvantages compared with maintenance treatment ; however , long-term effects on recovery have not been studied before . OBJECTIVE To compare rates of recovery in patients with remitted FEP after 7 years of follow-up of a dose reduction/discontinuation ( DR ) vs maintenance treatment ( MT ) trial . DESIGN Seven-year follow-up of a 2-year open r and omized clinical trial comparing MT and DR . SETTING One hundred twenty-eight patients participating in the original trial were recruited from 257 patients with FEP referred from October 2001 to December 2002 to 7 mental health care services in a 3.2 million- population catchment area . Of these , 111 patients refused to participate and 18 patients did not experience remission . PARTICIPANTS After 7 years , 103 patients ( 80.5 % ) of 128 patients who were included in the original trial were located and consented to follow-up assessment . INTERVENTION After 6 months of remission , patients were r and omly assigned to DR strategy or MT for 18 months . After the trial , treatment was at the discretion of the clinician . MAIN OUTCOMES AND MEASURES Primary outcome was rate of recovery , defined as meeting the criteria of symptomatic and functional remission . Determinants of recovery were examined using logistic regression analysis ; the treatment strategy ( MT or DR ) was controlled for baseline parameters . RESULTS The DR patients experienced twice the recovery rate of the MT patients ( 40.4 % vs 17.6 % ) . Logistic regression showed an odds ratio of 3.49 ( P = .01 ) . Better DR recovery rates were related to higher functional remission rates in the DR group but were not related to symptomatic remission rates . CONCLUSIONS AND RELEVANCE Dose reduction/discontinuation of antipsychotics during the early stages of remitted FEP shows superior long-term recovery rates compared with the rates achieved with MT . To our knowledge , this is the first study showing long-term gains of an early-course  DR strategy in patients with remitted FEP . Additional studies are necessary before these results are incorporated into general practice . TRIAL REGISTRATION is rct n.org Identifier : IS RCT N16228411 Purpose This study set out to investigate the patterns of referral in a sample ( n = 206 ) of patients having first-time access to an Italian comprehensive program that targets the early detection of and early intervention on subjects at the onset of psychosis . The primary goal of the study was to investigate the duration of untreated illness ( DUI ) and /or the duration of untreated psychosis ( DUP ) in the sample since the implementation of the program . Method Data on pathways of referrals prospect ively collected over a 11-year period , from 1999 to 2010 ; data referred to patients from a defined catchment area , and who met ICD-10 criteria for a first episode of a psychotic disorder ( FEP ) or were classified to be at ultra-high risk of psychosis ( UHR ) according to the criteria developed by the Personal Assessment and Crisis Evaluation ( PACE ) Clinic in Melbourne . Changes over time in the DUI and DUP were investigated in the sample . Results Referrals increased over time , with 20 subjects enrolled per year in the latter years of the study . A large majority of patients contacted a public or private mental health care professional along their pathway to treatment , occurring more often in FEP than in UHR patients . FEP patients who had contact with a non-psychiatric health care professional had a longer DUP . Over time , DUP and DUI did not change in FEP patients , but DUI increased , on average , in UHR patients . Conclusions The establishment of an EIP in a large metropolitan area led to an increase of referrals from people and agencies that are not directly involved in the mental health care system ; over time , there was an increase in the number of patients with longer DUI and DUP than those who normally apply for psychiatric services BACKGROUND An early response to antipsychotic treatment in patients with psychosis has been associated with a better course and outcome . However , factors that predict treatment response are not well understood . The onset of schizophrenia and related disorders has been associated with increased levels of stress and hyper-activation of the hypothalamic-pituitary-adrenal ( HPA ) axis . This study examined whether pituitary volume at the onset of psychosis may be a potential predictor of early treatment response in first-episode psychosis ( FEP ) patients . METHODS We investigated the relationship between baseline pituitary volume and symptomatic treatment response over 12 weeks using mixed model analysis in a sample of 42 drug-naïve or early treated FEP patients who participated in a controlled dose-finding study of quetiapine fumarate . Logistic regression was used to examine predictors of treatment response . Pituitary volume was measured from magnetic resonance imaging scans that were obtained upon entry into the trial . RESULTS Larger pituitary volume was associated with less improvement in overall psychotic symptoms ( Brief Psychiatric Rating Scale ( BPRS ) P=0.031 ) and positive symptoms ( BPRS positive symptom subscale P=0.010 ) . Regardless of gender , patients with a pituitary volume at the 25th percentile ( 413 mm(3 ) ) were approximately three times more likely to respond to treatment by week 12 than those at the 75th percentile ( 635 mm(3 ) ) ( odds ratio=3.07 , CI : 0.90 - 10.48 ) . CONCLUSION The association of baseline pituitary volumes with early treatment response highlights the importance of the HPA axis in emerging psychosis . Potential implication s for treatment strategies in early psychosis are discussed Background Adolescent-onset psychosis is associated with more severe symptoms and poorer outcomes than adult-onset psychosis . The National Institute for Clinical Excellence ( NICE ) recommend that adolescents with first episode psychosis ( FEP ) should be offered a combination of antipsychotic medication ( APs ) , cognitive behavioural therapy ( CBT ) and family intervention ( FI ) . The evidence for APs in treating psychosis is limited in adolescents compared to adults . Nevertheless , it indicates that APs can reduce overall symptoms in adolescents but may cause more severe side effects , including cardiovascular and metabolic effects , than in adults . CBT and FI can improve outcomes in adults , but there are no studies of psychological interventions ( PI ) in patients under 18 years old . Given this limited evidence base , NICE made a specific research recommendation for determining the clinical and cost effectiveness of APs versus PI versus both treatments for adolescent FEP . Methods / design The current study aim ed to establish the feasibility and acceptability of conducting such a trial by recruiting 14–18-year-olds with a first episode of psychosis into a feasibility prospect i ve r and omised open blinded evaluation ( PROBE ) design , three-arm , r and omised controlled trial of APs alone versus PI alone versus a combination of both treatments . We aim ed to recruit 90 participants from Early Intervention and Child and Adolescent Mental Health Teams in seven UK sites .  APs were prescribed by participants ’ usual psychiatrists . PI comprised st and ardised cognitive behavioural therapy and family intervention sessions . Discussion This is the first study to compare APs to PI in an adolescent population with FEP . Recruitment finished on 31 October 2018 . The study faced difficulties with recruitment across most sites due to factors including clinician and service-user treatment preferences . Trial registration Current controlled trial with IS RCT N , IS RCT N80567433 . Registered on 27 February 2017 AIMS Discontinuation of antipsychotics following remission in first episode psychosis ( FEP ) is a contentious area of practice . We aim ed to investigate the views of early psychosis clinicians on this important clinical question . METHODS We design ed an 11 question online survey on medication discontinuation following remission of symptoms in FEP . The question naire was distributed to early intervention team workers in Engl and and Wales via members of the National Early Psychosis Network who were requested to distribute it to their teams . RESULTS We received 172 question naire responses ; 37 % were nurses , 33 % doctors , 11 % psychologists and 19 % were other allied health professionals . The average years of experience in psychiatry was 16.9 . 75.4 % of respondents thought that greater than 60 % of patients would like to be considered for guided medication reduction/discontinuation . Only 31.4 % of respondents said that medication should be continued for over a year following remission . 61.4 % of respondents felt that the quality of life of individuals was better in those who stop medication following remission . There was a significant difference in the response of professional groups to this question . 82.6 % of respondents said they would be happy to support their patients in participating in a r and omized trial of grade d antipsychotic reduction/discontinuation versus maintenance medication . CONCLUSIONS The views of clinicians regarding prophylactic antipsychotic medication following remission in FEP are much less conservative than those in current guidelines ; concern was expressed by many about the impact of antipsychotic medication on quality of life . A r and omized trial of maintenance antipsychotic medication versus grade d reduction/discontinuation is feasible and has considerable clinician support Identifying early-onset schizophrenia spectrum disorders ( SSD ) at a very early stage remains challenging . To assess the diagnostic predictive value of multiple types of data at the emergence of early-onset first-episode psychosis ( FEP ) , various support vector machine ( SVM ) classifiers were developed . The data were from a 2-year , prospect i ve , longitudinal study of 81 patients ( age 9–17 years ) with early-onset FEP and a stable diagnosis during follow-up and 42 age- and sex-matched healthy controls ( HC ) . The input was different combinations of baseline clinical , neuropsychological , magnetic resonance imaging brain volumetric and biochemical data , and the output was the diagnosis at follow-up ( SSD vs. non-SSD , SSD vs. HC , and non-SSD vs. HC ) . Enhanced recursive feature elimination was performed for the SSD vs. non-SSD classifier to select and rank the input variables with the highest predictive value for a diagnostic outcome of SSD . After validation with a test set and considering all baseline variables together , the SSD vs. non-SSD , SSD vs. HC and non-SSD vs. HC classifiers achieved an accuracy of 0.81 , 0.99 and 0.99 , respectively . Regarding the SSD vs. non-SSD classifier , a combination of baseline clinical variables ( severity of negative , disorganized symptoms and hallucinations or poor insight ) and neuropsychological variables ( impaired attention , motor coordination , and global cognition ) showed the highest predictive value for a diagnostic outcome of SSD . Neuroimaging and biochemical variables at baseline did not add to the predictive value . Thus , comprehensive clinical /cognitive assessment remains the most reliable approach for differential diagnosis during early-onset FEP . SVMs may constitute promising multivariate tools in the search for predictors of diagnostic outcome in FEP Background Verbal learning and memory are impaired not only in patients with a first episode of psychosis ( FEP ) but also – to a lower extent – in those with an at-risk mental state for psychosis ( ARMS ) . However , little is known about the specific nature of these impairments . Hence , we aim ed to study learning and memory processes in ARMS and FEP patients by making use of structural equation modelling . Methods  Verbal learning was assessed with the California Verbal Learning Test ( CVLT )  in 98 FEP patients , 126 ARMS patients and 68 healthy controls ( HC ) as part of the Basel early detection of psychosis ( FePsy ) study . The four-factorial CFA model of Donders was used to estimate test performance on latent variables of the CVLT and growth curve analysis was used to model the learning curve . The latter allows disentangling initial recall , which is strongly determined by attentional processes , from the learning rate . Results The CFA model revealed that ARMS and FEP patients were impaired in Attention Span , Learning Efficiency and Delayed Memory and that FEP patients were additionally impaired in Inaccurate Memory . Additionally , ARMS-NT , but not ARMS-T , performed significantly worse than HC on Learning Efficiency . The growth curve model indicated that FEP patients were impaired in both initial recall and learning rate and that ARMS patients were only impaired in the learning rate . Conclusions Since impairments were more pronounced in the learning rate than the initial recall , our results suggest that the lower scores in the CVLT reported in previous studies are more strongly driven by impairments in the rate of learning than by attentional processes Objective : Cognitive deficits , particularly those related to executive function and behavioural control , are a core feature of patients with schizophrenia and implicate disturbances of the prefrontal cortex ( PFC ) . Consistent with this , functional imaging studies have identified abnormalities of PFC activity in chronically affected patients . The objective of the current study was to investigate executive-control related neural activity from first onset of the illness through to symptom stabilization . Method : The authors examined eight neuroleptic-naïve first-episode psychosis ( FEP ) patients within 3 days of first presentation and eight healthy agepremorbid-IQ , and gender-matched controls ( CTL ) . All FEP patients were later confirmed with a diagnosis of schizophrenia . Subjects underwent H2 - 15O positron emission tomography ( PET ) while performing the Stroop interference task that has previously been shown to engage the PFC in healthy sample s. In a double-blind paradigm , FEP patients were r and omly treated with either haloperidol or risperidone for 8 weeks , after which CTLs and all but one of the FEP patients were re-scanned . Results : Behaviorally , there was no change in task performance from baseline to follow up for either the FEPs or CTLs . However , there were significant changes in functional activation in both groups across the same period . For CTLs , task-performance was associated with greater recruitment of posterior brain regions at follow up compared to baseline , while for FEP this involved greater recruitment frontal regions . Concurrently , FEP also showed significant improvement in positive symptomatology . Conclusions : These findings suggest that disturbances of the PFC often seen in FEP may be , at least partially , associated with acute symptom expression . However , it is still unclear whether this increase in frontal activity is due to symptom stabilization per se , the effects of medication , a lack of neurophysiological ‘ learning ’ with experience/ practice , or a combination of these factors . In the context of the CTLs performance , we interpret the patient findings as reflective of greater neurophysiological effort required for task accomplishment relative to the learned , more automated , processing apparent in the CTLs OBJECTIVE To investigate if ethyl-eicosapentaenoic acid ( E-EPA ) augmentation improves antipsychotic efficacy and tolerability in first-episode psychosis ( FEP ) . METHOD We performed a 12-week , r and omized , double-blind , placebo-controlled trial of 2-g E-EPA augmentation in 80 FEP patients . Sixty-nine patients were eligible for analysis ; a post hoc analysis was computed for a subgroup of nonaffective FEP patients ( N = 53 ) . The first participant was included in November 2000 and the last participant completed the trial in August 2003 . Primary outcome measures were symptom change scores and time to first response , while tolerability measures and cumulative antipsychotic dose were secondary outcome measures . RESULTS Analysis of covariance controlling for baseline symptoms found no significant mean difference between E-EPA and placebo at week 12 for symptom change scores . Cox regression analysis revealed a significant treatment by diagnosis interaction ( p = .024 ) for time to first response favoring E-EPA in nonaffective psychosis . Post hoc analysis for cumulative response rates further confirmed a higher response rate at week 6 ( 42.9 % [ 15/35 ] vs. 17.6 % [ 6/34 ] for all participants , p = .036 ; 54.2 % [ 13/24 ] vs. 17.2 % [ 5/29 ] for the nonaffective psychosis subset , p = .008 ) ; however , the difference at week 12 was no longer significant . Analysis of secondary outcome measures revealed that E-EPA-augmented participants needed 20 % less antipsychotic medication between weeks 4 through 6 ( p = .03 ) , had less extrapyramidal side effects in the initial 9 weeks ( p < .05 for all participants and for all timepoints ) , and reported less constipation ( p = .011 ) and fewer sexual side effects ( p = .016 ) than those treated with antipsychotic medication alone . CONCLUSION The findings suggest that E-EPA may accelerate treatment response and improve the tolerability of antipsychotic medications . However , it was not possible to demonstrate a sustained symptomatic benefit of E-EPA in early psychosis , possibly due to a ceiling effect , since a high proportion of first-episode patients already achieve symptomatic remission with antipsychotic medication alone . Further controlled trials in nonaffective early psychosis seem warranted . TRIAL REGISTRATION Australian Clinical Trials Registry identifier 12605000267651 ( http://actr.org.au )
However , mechanistic studies found significant improvements in hippocampal neuronal health and brain glutathione .
CONCLUSION There is preliminary evidence that taurine improves outcomes in FEP , whereas effects of omega-3 and antioxidant vitamins/amino-acids are inconsistent ; perhaps mainly benefitting patients with high levels of oxidative stress .
AIM The effects of nutrient-based treatments , including adjunctive vitamin or antioxidant supplementation , have been explored extensively in long-term schizophrenia .
However , no systematic evaluation of trials in " first-episode psychosis " ( FEP ) has been conducted , despite the potential benefits of using these treatments during the early stages of illness .
Therefore , we aim ed to review all studies examining efficacy , tolerability and the biological mechanisms of action , of nutrient supplementation in FEP .