First episode psychosis

Verma, S. K. et al. (2005). Plasma risperidone levels and clinical response in patients with first-episode psychosis. /. Clin. Psychopharmacol, 25(6), 609-11. 

Hirayasu, Y., Shenton, M. E., Salisbury, D. F. etal. Subgenual cingulate cortex volume in first-episode psychosis. Am. J. Psych. 156 1091-1093,1999. 

Selection of an antipsychotic should be based on (1) the need to avoid certain side effects, (2) concurrent medical or psychiatric disorders, and (3) patient or family history of response. Fig. 71-1 is an algorithm for management of first episode psychosis. 

Patients whose first episodes of mania or bipolar depression occur between ages 30 to 60 years appear to have clearer episodes of mood disorder, have mania characterized by euphoria and irritability (rather than irritability alone), and be less likely to develop substance addiction (though they may engage in substance abuse as part of their acute episodes). Although psychosis occurs frequently and can be severe, in such late-onset cases confusion with other disorders is usually not a problem. Finally, this more classical presentation is generally responsive to lithium (Carlson, 2000). 

Loebel AD, Lieberman JA, Alvir JMJ, et al Duration of psychosis and outcome in first-episode schizophrenia. Am J Psychiatry 149 1183-1188, 1992... 

Zhang-Wong J, Zipursky RB, Beiser M, et al Optimal haloperidol dosage in first-episode psychosis. Can J Psychiatry 44 164—167, 1999... 

McGorry, P.D., Yung, A.R., Phillips, LJ., et al. Randomized controlled trial of interventions designed to reduce the risk of progression to first-episode psychosis in clinical sample with subthreshold symptoms. Arch. Gen. Psvchiatrv 59(10), 921-928, 2002. 

Norman, R.M.. Townsend, L.. Malla. A.K. Duration of untreated psychosis and cognitive functioning in first-episode patients. Br. J. Psychiatry 179, 340-345, 2001. 

There was significant weight gain in 12 drug-naive patients with a first-episode of psychosis who took olanzapine for 3-4 months (mean dose 10.7 mg/day)... 

Oosthuizen PP, Emsley RA, MaritzJS, et al. Incidence of tardive dyskinesia in first-episode psychosis patients treated with low-dose haloperidol. J Clin Psychiatry. 2003 64 1075-1080. 

Surprisingly there is only one placebo controlled trial conducted with people experiencing their first episode of psychosis. It took place at Northwick Park hospital in London and was published in 1986 (see Figure 6.1) (Crow et al. 1986). Relapse was defined as readmission to hospital or need for resumption of antipsychotic treatment. Follow-up... 

Lehtinen, V., Aaltonen, J., Koffert, T., Rakkolainen, V., Syvalahti, E. 2000, Two-year outcome in first-episode psychosis treated according to an integrated model. Is immediate neuroleptisation always needed , Eur.Psychiatry, vol. 15, no. 5, pp. 312-320. 

Marshall, M., Lewis, S., Lockwood, A., Drake, R., Jones, P., Croudace, T. 2005, Association between duration of untreated psychosis and outcome in cohorts of first-episode patients a systematic review, Arch.Gen.Psychiatry, vol. 62, no. 9, pp. 975-983. 

McGorry, P. D., Yung, A. R., Phillips, L. J., Yuen, H. P., Francey, S., Cosgrave, E. M., Germano, D., Bravin, J., McDonald, T., Blair, A., Adlard, S., Jackson, H. 2002, Randomized controlled trial of interventions designed to reduce the risk of progression to first-episode psychosis in a clinical sample with subthreshold symptoms, Arch.Gen.Psychiatry, vol. 59, no. 10, pp. 921-928. 

Lieberman, J., Tollefson, G., Zipursky, G., Zipursky, S., Sharma, T., Kahn, R., et al. (2005b). Antipsychotic drug effects on brain morphology in first-episode psychosis. Archives of General Psychiatry, 62, 361-370. 

These findings of impaired hippocampal activation during memory retrieval in chronic patients with schizophrenia have now been complemented by a study of hippocampal-based encoding of memory in first-episode psychosis (FEP) patients (Achim et al., 2007). While some hippocampal functions remained intact, the FEP patients demonstrated a selective deficit to engage hippocampal-dependent relational binding when presented with arbitrary stimulus pairs, resulting in poorer subsequent recognition performance. 

AchimAM, Bertrand MC, Sutton H, Montoya A, CzechowskaY, et al. 2007. Selective abnormal modulation of hippocampal activity during memory formation in first-episode psychosis. Arch Gen Psychiatry 64 999-1014. 

Pantelis C, Velakoulis D, Suckling J, McGorry P, Phillips L, et al. 2000. Left medial temporal volume reduction occurs during the transition from high-risk to first-episode psychosis. Schizophr Res 41 35. 

Wood SJ, Velakoulis D, Smith DJ, Bond D, Stuart GW, et al. 2000. A longitudinal study of hippocampal volume in first episode psychosis and chronic schizophrenia. Schizophr... 

Sumich A, Chitnis XA, Fannon DG, O Ceallaigh S, Doku VC, et al. 2002. Temporal lobe abnormalities in first-episode psychosis. Am J Psychiatry 159(7) 1232-1235. 

Berger GE, Wood SJ, Wellard RM, Proffitt TM, Mcconchie M, et al. 2008. Ethyl-eicosapentaenoic acid in first-episode psychosis. A lh-mrs study. Neuropsychopharmacology 33(10) 2467-2473. 

Wood SJ, Berger G, Velakoulis D, Phillips LJ, Mcgorry PD, et al. 2003. Proton magnetic resonance spectroscopy in first episode psychosis and ultra high-risk individuals. Schizophr Bull 29 831-843. 

Zabala A, Sanchez-Gonzalez J, Parellada M, Moreno DM, Reig S, et al. 2007. Findings of proton magnetic resonance spectometry in the dorsolateral prefrontal cortex in adolescents with first episodes of psychosis. Psychiatry Res 156 33-42. 

Penn DL, Waldheter EJ, Perkins DO, Mueser KT, Lieberman JA. 2005. Psychosocial treatment for first-episode psychosis A research update. Am J Psychiatry 162(12) 2220-2232. 

Olanzapine has been compared with haloperidol in cannabis-induced psychosis (54), schizoaffective disorder (55), first-episode psychosis (56), and treatment-resistant schizophrenia (57) the two last studies were reanalyses of data from large clinical trials promoted by the manufacturers, Eli Lilly. In all cases olanzapine was better than haloperidol at reducing BPRS scores, but in patients with cannabis-induced psychotic disorders they were similar. Increased appetite was consistently reported more often in olanzapine-treated patients and extrapyramidal signs more often in those treated with haloperidol. 

Sanger TM, Lieberman JA, Tohen M, Grundy S, Beasley C Jr, Tollefson GD. Olanzapine versus haloperidol treatment in first-episode psychosis. Am J Psychiatry 1999 156(1) 79—87. 

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