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Biomedical subjects

Jean Addington

Publications and source records attributed to Jean Addington.

11 recordsLinked to original sources
PubMed2003

Randomized trial of olanzapine versus placebo in the symptomatic acute treatment of the schizophrenic prodrome.

BACKGROUND: The prodromal phase of schizophrenic disorders has been described prospectively. The present study aimed to determine the short-term efficacy and safety of olanzapine treatment of prodromal symptoms compared with placebo. METHODS: This was a double-blind, randomized, parallel-groups, placebo-controlled trial with fixed-flexible dosing conducted at four sites. Sixty patients met prodromal diagnostic criteria, including attenuated psychotic symptoms, as determined by structured interviews. Olanzapine 5-15 mg daily or placebo was prescribed for 8 weeks. RESULTS: In the mixed-effects, repeated-measures analysis, the treatment x time interaction for the change from baseline on the Scale of Prodromal Symptoms total score was statistically significant, and post hoc analyses revealed that the olanzapine-placebo difference reached p<.10 by week 6 and p<.05 at week 8. Ratings of extrapyramidal symptoms remained low in each group and were not significantly different. Olanzapine patients gained 9.9 lb versus.7 lb for placebo patients (p<.001). CONCLUSIONS: This short-term analysis suggests olanzapine is associated with significantly greater symptomatic improvement but significantly greater weight gain than is placebo in prodromal patients. Extrapyramidal symptoms with olanzapine were minimal and similar to those with placebo. Future research over the longer term with more patients will be needed before recommendations can be made regarding routine treatment.

Adolescent↗
PubMed2003

Cognitive functioning in first episode psychosis: initial presentation.

This first part of a longitudinal study examined the initial cognitive performance of 312 individuals who recently presented with a first episode (FE) of psychosis. All attend a comprehensive first episode program. Deficits on a wide range of cognitive tests were observed, suggesting impairment similar to that seen in those with an established schizophrenia illness. There was no evidence to support differences in cognition among the different schizophrenia spectrum diagnostic groups.

Acute Disease↗
PubMed2003

Patterns of premorbid functioning in first-episode psychosis: initial presentation.

Premorbid functioning in first-episode psychosis has been reported to be associated with poorer outcome. We assessed premorbid functioning in a sample of 306 subjects newly admitted to an early-psychosis program. Using cluster analyses, we identified four patterns: stable-good, stable-moderate, deteriorating and poor-deteriorating. Results were that relative to the stable-good group, the deteriorating and the poor-deteriorating groups had more negative symptoms, poorer social functioning and some evidence of poorer cognitive functioning. The deteriorating group had increased positive symptoms compared to the stable-good group. These results suggest that prior to the onset of the acute psychosis those who have poor social and interpersonal functioning premorbidly present initially with increased social impairment and negative symptoms compared to those who have better premorbid functioning.

Adolescent↗
PubMed2003

Symptom outcome 1 year after admission to an early psychosis program.

OBJECTIVE: To determine the change in positive, negative, and depressive symptoms after 1 year in an early psychosis program. METHOD: One hundred and eighty subjects were included from the first 257 admissions for a first episode of psychosis to a comprehensive early psychosis program. Most had a diagnosis of schizophrenia or schizophreniform disorder. Subjects were assessed on admission to the program and at 3, 6, and 12 months after admission. All 180 subjects completed the 1-year assessment. Assessment measures included the Positive and Negative Syndrome Scale and the Calgary Depression Scale for Schizophrenia. RESULTS: There was a clinically and statistically significant improvement in positive symptoms by 3 months, depression increased at 3 months but significantly improved by 12 months, and negative symptoms changed little over the first year. CONCLUSIONS: The differential changes in symptoms in the first year after admission have implications for treatment.

Adult↗
PubMed2003

Weight gain in first-episode psychosis.

OBJECTIVE: To examine the extent of weight gain in the first year of treatment in an early psychosis program. METHOD: Subjects were 114 individuals who had experienced a first episode of psychosis and had completed 1 year in a comprehensive first-episode program. Weight and body mass index were calculated on entry to the program and at 6 and 12 months. Most of the subjects were all being prescribed second-generation antipsychotics. RESULTS: Significant increases in mean weight were observed in these young individuals over the course of the first year of treatment. CONCLUSIONS: If we are to work toward optimum treatment for first-episode subjects then potential weight gain needs to be addressed at the beginning of treatment and monitored during treatment.

Adult↗
PubMed2003

Substance use and cognition in early psychosis.

OBJECTIVE: To determine the relation between substance use and cognition in individuals experiencing their first episode of psychosis. DESIGN: Prospective cross-sectional and longitudinal study. SETTING: An Early Psychosis Treatment and Prevention Program, an outpatient clinic in a psychiatry department at a university-affiliated hospital. PARTICIPANTS: Individuals with a psychotic illness who were admitted to an Early Psychosis Program; 266 patients were assessed at initial presentation, 159 at 1 year and 90 at 2 years. Most were outpatients. MEASURES: The effects of substance use (alcohol, cannabis, hallucinogens, cocaine, stimulants) on cognition were assessed. Substance use was determined by DSM-IV criteria, and the Case Manager Rating Scale was used to determine the level of substance use. A comprehensive cognitive battery of tests was used, and the Positive and Negative Syndrome Scale for schizophrenia was administered to all subjects to determine levels of positive and negative symptoms. RESULTS: Overall, both cross-sectionally and longitudinally, there were no significant associations between cognitive functioning and the use of various substances. Substance use was associated with higher positive symptoms. CONCLUSIONS: Individuals with psychotic disorders who show mild-to-moderate abuse of substances, in particular alcohol and cannabis, do not exhibit more cognitive impairment than those who do not do use the substances. However, substance use may have other detrimental effects on the process of the psychotic illness.

Adolescent↗
PubMed2003

The prodromal stage of psychotic illness: observation, detection or intervention?

Accurate identification of individuals in the earliest symptomatic stages of psychosis offers perhaps the best hope for more effective treatment strategies. Recently, research clinics have been set up to identify and possibly treat individuals who are seen as being at high risk of a psychotic disorder. However, there have been concerns about beginning treatment at this stage. We need to address these concerns so that individuals who are at risk of psychosis come to no harm, yet the development of potential interventions is not delayed. This article briefly reviews some of the newer developments and concerns in this area of psychosis research.

Antipsychotic Agents↗
PubMed2002

Double-blind, placebo-controlled comparison of the efficacy of sertraline as treatment for a major depressive episode in patients with remitted schizophrenia.

The effectiveness of selective serotonin reuptake inhibitors for depression in remitted schizophrenia has not been clearly demonstrated. A randomized, double-blind, prospective placebo-controlled study was performed of 48 subjects meeting DSM-IV criteria for both schizophrenia in remission and for a major depressive episode. Twenty-seven patients were randomized to placebo and 21 to sertraline. All subjects had a 1-week anticholinergic phase before randomization. The treatment duration was 6 weeks. Sertraline was started at 50 mg/day; this could be increased to 100 mg after 4 weeks for an inadequate response. There were no statistically significant differences in symptoms between the two groups at randomization. There were no differences in outcome between treatment groups. In both groups, between 40% and 50% of subjects showed a 50% reduction in depression score. This study does not provide support for the efficacy of sertraline in the treatment of depression in remitted schizophrenia. The small sample size limits the strength of the conclusions that can be drawn from this study. The study design called for a sample size of 96 on the basis of an expected placebo response rate of 30%. Recruitment for the study was difficult because of the placebo design. The placebo response was 50%. Clinicians and patients underestimate the strength of the placebo response and may overestimate the risk of participating in such a study. Testing the efficacy of widely accepted but poorly evaluated treatments should be a research priority. Future studies require a larger sample size and longer duration of treatment.

Adolescent↗
PubMed2002

Assessment of premorbid function in first-episode schizophrenia: modifications to the Premorbid Adjustment Scale.

Studies have found Cannon-Spoor's Premorbid Adjustment Scale (PAS) to be a useful measure of premorbid function and an effective predictor of outcome in patients with chronic schizophrenia. Despite its widespread use, the applicability and reliability of the scale for use with young patients who experience their first episode of schizophrenia have not been thoroughly examined. We review the studies that used the PAS to assess premorbid function in patients with either chronic or first-episode schizophrenia. Difficulties that have been encountered with the use of the PAS in first-episode patients are presented, and modifications that have been made to the scale by various research groups are described. Finally, we make recommendations to enhance the use of the PAS when evaluating patients who have experienced their first episode of schizophrenia.

Chronic Disease↗
PubMed2002

Cognitive functioning in first-episode schizophrenia.

OBJECTIVE: To compare the cognitive functioning of a sample of patients experiencing their first episode of schizophrenia with that of patients with an established schizophrenia illness. DESIGN: Cross-sectional and longitudinal study. SETTING: The Calgary Early Psychosis Treatment and Prevention Program and an outpatient clinic in a department of psychiatry at a university-affiliated hospital. PARTICIPANTS: One hundred and eleven patients who were experiencing their first episode of schizophrenia and 76 outpatients with an established schizophrenia illness. MEASURES: The Positive and Negative Syndrome Scale for schizophrenia was administered to all subjects to determine levels of positive and negative symptoms. Executive functioning, information processing, visual memory, and immediate and delayed verbal memory were assessed. RESULTS: There were limited differences between the 2 groups in terms of cognitive functioning. Although the first-episode patients demonstrated generally superior scores, their performance was impaired. CONCLUSIONS: These results support the findings of previous studies suggesting that first-episode patients demonstrate cognitive impairments similar to those of patients with an established schizophrenia illness.

Adult↗