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Biomedical subjects

David Whitehorn

Publications and source records attributed to David Whitehorn.

7 recordsLinked to original sources
PubMed2006

Olfactory identification deficits in first-episode psychosis may predict patients at risk for persistent negative and disorganized or cognitive symptoms.

OBJECTIVE: One-third of patients with a schizophrenia spectrum disorder have a measurable olfactory identification deficit at first examination. The authors studied the relationship of this deficit to symptom remission after 1 year of treatment. METHOD: Fifty-eight patients naive to antipsychotic medication who entered the Nova Scotia Early Psychosis Program were symptomatically rated with the Positive and Negative Syndrome Scale (PANSS) (at baseline and 1 year). At baseline, the University of Pennsylvania Smell Identification Test (UPSIT) was also completed. Remission was determined for four symptom factors derived from the PANSS (positive, negative, cognitive/disorganized, and anxiety/depression). Patients with and without remission were compared on UPSIT scores. RESULTS: Patients with nonremission of negative and cognitive/disorganized symptoms had significantly lower baseline UPSIT scores compared with patients with remission. UPSIT scores were unrelated to remission of positive or anxiety/depression symptoms. CONCLUSIONS: UPSIT scores can be used to identify patients at risk for persistent negative and disorganized/cognitive symptoms.

Adult↗
PubMed2005

Treatment of a first episode of psychotic illness with quetiapine: an analysis of 2 year outcomes.

BACKGROUND: The first episode of a psychotic disorder provides a unique opportunity to initiate optimal treatment but when a new medication becomes available, little data exist to guide the appropriate use in this population. OBJECTIVES: The objectives were to determine the optimal doses and titration of quetiapine for this group and to measure outcomes (including symptom response, social functioning, mood alterations, motor symptoms, metabolic parameters and cognitive functioning) over 2 years of treatment with quetiapine. DESIGN: Thirty nine subjects with a first episode of psychosis referred to the Nova Scotia Early Psychosis Program in Halifax, Canada, were invited to participate in this study. Standardized clinical, laboratory, and neuropsychological assessments were performed at baseline and following treatment with quetiapine at intervals out to 2 years. RESULTS: Quetiapine was effective in treating the psychotic and mood symptoms while not causing extra-pyramidal signs or symptoms (EPSS). Pre-existing motor dysfunction improved. No anticholinergic medications were required. Several domains of cognitive function also improved (sustained attention, the number of perseverative errors, visuomotor speed and sequencing, verbal fluency and verbal memory). Weight gain was observed along with increases in cholesterol levels but there was no glucose dysregulation. CONCLUSIONS: The results of this two year, naturalistic study of people with a first episode of psychosis indicated that quetiapine was well tolerated and effective for this population. Significant improvements in cognitive functioning also provided evidence for potential longer-term benefits of early and optimal treatment with this agent. However, monitoring metabolic parameters, as recommended for other atypicals, is likely prudent.

Adolescent↗
PubMed2004

The relationship of neuropsychological test performance with the PANSS in antipsychotic naïve, first-episode psychosis patients.

BACKGROUND: Chronic schizophrenia patients have been sampled for factor analytic studies to identify the factor structure of the Positive and Negative Syndrome Scale (PANSS). Many of these studies have identified a cognitive factor, which may provide useful information about patients for whom formal neuropsychological testing is unavailable. However, the relationship between the clinically rated cognitive factor and performance-based cognitive test scores has not been thoroughly examined, particularly in patients who are early in the course of illness. OBJECTIVES: The validity of the PANSS cognitive factor was examined in a sample of antipsychotic naïve, first-episode psychosis patients and the PANSS items that best predicted cognitive functioning were identified. METHOD: PANSS scores and performance on a battery of cognitive tests from the baseline assessment of a clinical trial of 167 neuroleptic naïve patients with schizophrenia-like illnesses were analyzed. RESULTS: Factor analysis revealed a five-factor model that was consistent with previously described factor models from samples of chronically treated patients. There were modest correlations (less than r=0.44) between the derived cognitive factor and six of the neuropsychological test variables (Wisconsin Card Sorting Test total errors and number of categories correctly sorted, WMS-R immediate and delayed recall scores, Category Fluency total score, and WAIS-R digit symbol). Five PANSS items (P6, N5, N6, G2, and G10) were identified that predicted global cognitive functioning; however, 66% of the variance in cognitive functioning remained unexplained. CONCLUSIONS: A PANSS cognitive factor can be identified in first-episode, neuroleptic naïve patients. However, clinical ratings of cognitive deficits lack sensitivity and specificity and thus should not be relied upon fully.

Adult↗
PubMed2004

Hospitalization in the first year of treatment for schizophrenia.

OBJECTIVE: To determine the rates of hospitalization during the first year of treatment for schizophrenia, using an epidemiologic sample. METHOD: We examined inpatient and outpatient administrative databases in the province of Nova Scotia for cases of schizophrenia (ICD-9 code 295 or 298) newly diagnosed during the years 1995 to 1998. We noted the diagnosis site (that is, inpatient or outpatient) and hospitalizations in the year following diagnosis. We also established links to the clinical database maintained by the Nova Scotia Early Psychosis Program (NSEPP). RESULTS: Over the 4-year period, we identified 434 unique cases from an at-risk population of 320,000 (yielding a yearly average age-specific incidence rate of 3.3/10,000), of whom 119 had received care from the NSEPP. Of the cases, 54% were initially diagnosed while they were inpatients. In the year following diagnosis, the overall hospitalization rate, excluding initial hospitalizations, was 17%. Patients who were initially diagnosed while inpatients had a higher rate of hospitalization in the first year of treatment (25% vs 7%), compared with those initially diagnosed while outpatients. This relation was also present among patients who received care from the NSEPP. CONCLUSIONS: Of newly diagnosed patients with schizophrenia, 46% were not hospitalized at the time of initial diagnosis. Of all patients, 17% required hospitalization during the first year of treatment, excluding an initial hospitalization, if present. Hospitalization rates in the first year were higher among patients initially hospitalized and among those with a rural residence. Patients requiring hospitalization during the first year form an important target group for improved interventions.

Adolescent↗
PubMed2002

Neuromotor dysfunction in early psychosis.

Neuromotor dysfunction, particularly extrapyramidal signs and symptoms (EPSS), plays an important role in the assessment and treatment of patients in the early stages of psychotic disorders such as schizophrenia. By blocking dopamine D2 receptors, antipsychotic medications can produce EPSS, including tardive dyskinesia. EPSS is also observed in a third or more of patients first presenting with a psychotic disorder, prior to initiation of antipsychotic pharmacotherapy. This suggests that abnormalities in neuromotor control may be an integral component of the brain mechanisms associated with psychosis. Atypical antipsychotic agents can alleviate psychosis without inducing EPSS. Preexisting EPSS may be corrected.

Akathisia, Drug-Induced↗