Therapeutic Considerations in Individuals at Clinical Risk for Developing Psychosis

Current Treatment Options in Psychiatry

Volumn 1, Issue 2, 2014, Pages 134-148

  Singh, Fiza ^a,b   DeJoseph, Meriah ^a   Cadenhead, Kristin S ^a,b  

^a VA SAN DIEGO HEALTHCARE SYSTEM   (United States)

^b UNIVERSITY OF CALIFORNIA   (United States)

Author keywords

Antidepressants; Antipsychotics; Clinical high risk (CHR); Cognitive training; Diet; Glutamate modulators; Lifestyle; Minocycline; Neurofeedback; Omega 3 fatty acids; Oxytocin; Psychosis; Psychotherapy; Staging

Indexed keywords

EID: 85065158760     PISSN: None     EISSN: 21963061     Source Type: Journal    
DOI: 10.1007/s40501-014-0009-2     Document Type: Review

References (62)

1. Cannon TD, Cadenhead K, Cornblatt B, Woods SW, Addington J, Walker E, et al. Prediction of psychosis in youth at high clinical risk: a multisite longitudinal study in North America. Arch Gen Psychiatry. 2008;65(1):28–37. doi:10.1001/archgenpsychiatry.2007.3.
2. Mason O, Startup M, Halpin S, Schall U, Conrad A, Carr V. Risk factors for transition to first episode psychosis among individuals with ‘at-risk mental states’. Schizophr Res. 2004;71(2–3):227–37. doi:10.1016/j.schres.2004.04.006.
3. Yung AR, Phillips LJ, Yuen HP, McGorry PD. Risk factors for psychosis in an ultra high-risk group: psychopathology and clinical features. Schizophr Res. 2004;67(2–3):131–42. doi:10.1016/S0920-9964(03)00192-0.
4. Yung AR, Stanford C, Cosgrave E, Killackey E, Phillips L, Nelson B, et al. Testing the ultra high risk (prodromal) criteria for the prediction of psychosis in a clinical sample of young people. Schizophr Res. 2006;84(1):57–66. doi:10.1016/j.schres.2006.03.014.
5. Yung AR, Phillips LJ, Yuen HP, Francey SM, McFarlane CA, Hallgren M, et al. Psychosis prediction: 12-month follow up of a high-risk (“prodromal”) group. Schizophr Res. 2003;60(1):21–32.
6. Riecher-Rossler A, Gschwandtner U, Aston J, Borgwardt S, Drewe M, Fuhr P, et al. The Basel early-detection-of-psychosis (FEPSY)-study–design and preliminary results. Acta Psychiatr Scand. 2007;115(2):114–25. doi:10.1111/j.1600-0447.2006.00854.x.
7. Kaur T, Cadenhead KS. Treatment implications of the schizophrenia prodrome. Curr Top Behav Neurosci. 2010;4:97–121.
8. Klosterkotter J, Schultze-Lutter F, Bechdolf A, Ruhrmann S. Prediction and prevention of schizophrenia: what has been achieved and where to go next? World Psychiatry. 2011;10(3):165–74.
9. Agius M, Goh C, Ulhaq S, McGorry P. The staging model in schizophrenia, and its clinical implications. Psychiatr Danub. 2010;22(2):211–20.
10. Chien WT, Leung SF, Yeung FK, Wong WK. Current approaches to treatments for schizophrenia spectrum disorders, part II: psychosocial interventions and patient-focused perspectives in psychiatric care. Neuropsychiatr Dis Treat. 2013;9:1463–81. doi:10.2147/NDT.S49263ndt-9-1463.
11. Elis O, Caponigro JM, Kring AM. Psychosocial treatments for negative symptoms in schizophrenia: current practices and future directions. Clin Psychol Rev. 2013;33(8):914–28. doi:10.1016/j.cpr.2013.07.001.
12. Clark CM. Psychosocial treatments for schizophrenia. Clin Schizophr Relat Psychoses. 2013:1–30. doi:10.3371/CSRP.CL.061213.
13. Mueser KT, Deavers F, Penn DL, Cassisi JE. Psychosocial treatments for schizophrenia. Annu Rev Clin Psychol. 2013;9:465–97. doi:10.1146/annurev-clinpsy-050212-185620.
14. Mitchell AJ, Vancampfort D, De Herdt A, Yu W, De Hert M. Is the prevalence of metabolic syndrome and metabolic abnormalities increased in early schizophrenia? A comparative meta-analysis of first episode, untreated and treated patients. Schizophr Bull. 2013;39(2):295–305. doi:10.1093/schbul/sbs082. Systematic review of literature, critical appraisal, and meta-analysis of metabolic complications in schizophrenia. Both diabetes and pre-diabetes are uncommon in early illness, smoking is elevated after diagnosis. Authors suggest prevention of cardiovascular risk accumulation rather than waiting to address it in later stages of illness when it is more difficult to treat.
15. Mitchell AJ, Vancampfort D, Sweers K, van Winkel R, Yu W, De Hert M. Prevalence of metabolic syndrome and metabolic abnormalities in schizophrenia and related disorders–a systematic review and meta-analysis. Schizophr Bull. 2013;39(2):306–18. doi:10.1093/schbul/sbr148.
16. Samele C, Patel M, Boydell J, Leese M, Wessely S, Murray R. Physical illness and lifestyle risk factors in people with their first presentation of psychosis. Soc Psychiatry Psychiatr Epidemiol. 2007;42(2):117–24. doi:10.1007/s00127-006-0135-2.
17. Fisher M, Loewy R, Hardy K, Schlosser D, Vinogradov S. Cognitive interventions targeting brain plasticity in the prodromal and early phases of schizophrenia. Annu Rev Clin Psychol. 2013;9:435–63. doi:10.1146/annurev-clinpsy-032511-143134. This article provides a summary and detailed descriptions of cognitive psychotherapy and cognitive training in early phases of schizophrenia.
18. Corcoran C, Walker E, Huot R, Mittal V, Tessner K, Kestler L, et al. The stress cascade and schizophrenia: etiology and onset. Schizophr Bull. 2003;29(4):671–92.
19. Walker EF, Brennan PA, Esterberg M, Brasfield J, Pearce B, Compton MT. Longitudinal changes in cortisol secretion and conversion to psychosis in at-risk youth. J Abnorm Psychol. 2010;119(2):401–8. doi:10.1037/a0018399. In this large multicenter prospective study, the authors examined cortisol levels at baseline and relationship between cortisol and symptom severity, as well the relationship between cortisol and conversion to psychosis. The results indicate increased baseline cortisol that correlate with increased symptom severity and indicate increased conversion risk. This study supports the emerging hypothesis regarding impaired hypothalamic-pituitary function in psychosis and has important treatment implications.
20. Walker EF, Trotman HD, Pearce BD, Addington J, Cadenhead KS, Cornblatt BA, et al. Cortisol levels and risk for psychosis: initial findings from the North American prodrome longitudinal study. Biol Psychiatry. 2013;74(6):410–7. doi:10.1016/j.biopsych.2013.02.016.
21. Aiello G, Horowitz M, Hepgul N, Pariante CM, Mondelli V. Stress abnormalities in individuals at risk for psychosis: a review of studies in subjects with familial risk or with “at risk” mental state. Psychoneuroendocrinology. 2012;37(10):1600–13. doi:10.1016/j.psyneuen.2012.05.003.
22. Addington J, Case N, Saleem MM, Auther AM, Cornblatt BA, Cadenhead KS. Substance use in clinical high risk for psychosis: a review of the literature. Early Interv Psychiatry. 2013. doi:10.1111/eip.12100. The authors examined the relationship between substance use disorders and conversion to psychosis. This review reveals that cannabis is a significant risk factor for at risk populations, though the prevalence of other substance use is low. In addition, there is significant variability in prevalence depending on the study reported.
23. Kristensen K, Cadenhead KS. Cannabis abuse and risk for psychosis in a prodromal sample. Psychiatry Res. 2007;151(1–2):151–4. doi:10.1016/j.psychres.2006.10.001.
24. McGorry PD, Nelson B, Phillips LJ, Yuen HP, Francey SM, Thampi A, et al. Randomized controlled trial of interventions for young people at ultra-high risk of psychosis: twelve-month outcome. J Clin Psychiatry. 2013;74(4):349–56. doi:10.4088/JCP.12m07785.
25. McGlashan TH, Zipursky RB, Perkins D, Addington J, Miller T, Woods SW, et al. Randomized, double-blind trial of olanzapine versus placebo in patients prodromally symptomatic for psychosis. Am J Psychiatry. 2006;163(5):790–9. doi:10.1176/appi.ajp.163.5.790.
26. Ruhrmann S, Schultze-Lutter F, Klosterkotter J. Early detection and intervention in the initial prodromal phase of schizophrenia. Pharmacopsychiatry. 2003;36 Suppl 3:S162–7. doi:10.1055/s-2003-45125.
27. Woods SW, Tully EM, Walsh BC, Hawkins KA, Callahan JL, Cohen SJ, et al. Aripiprazole in the treatment of the psychosis prodrome: an open-label pilot study. Br J Psychiatry Suppl. 2007;51:s96–101. doi:10.1192/bjp.191.51.s96.
28. Cornblatt BA, Lencz T, Smith CW, Olsen R, Auther AM, Nakayama E, et al. Can antidepressants be used to treat the schizophrenia prodrome? Results of a prospective, naturalistic treatment study of adolescents. J Clin Psychiatry. 2007;68(4):546–57.
29. Capper EA, Marshall LA. Mammalian phospholipases A(2): mediators of inflammation, proliferation and apoptosis. Prog Lipid Res. 2001;40(3):167–97.
30. Amminger GP, Schafer MR, Papageorgiou K, Klier CM, Cotton SM, Harrigan SM, et al. Long-chain omega-3 fatty acids for indicated prevention of psychotic disorders: a randomized, placebo-controlled trial. Arch General Psychiatry. 2010;67(2):146–54. doi:10.1001/archgenpsychiatry.2009.192.
31. Berger GE, Wood SJ, Wellard RM, Proffitt TM, McConchie M, Amminger GP, et al. Ethyl-eicosapentaenoic acid in first-episode psychosis. A 1H-MRS study. Neuropsychopharmacol Off Publ Am Coll Neuropsychopharmacol. 2008;33(10):2467–73.
32. Frangou S, Lewis M, Wollard J, Simmons A. Preliminary in vivo evidence of increased N-acetyl-aspartate following eicosapentanoic acid treatment in patients with bipolar disorder. J Psychopharmacol. 2007;21(4):435–9. doi:10.1177/0269881106067787.
33. Addington J, Epstein I, Liu L, French P, Boydell KM, Zipursky RB. A randomized controlled trial of cognitive behavioral therapy for individuals at clinical high risk of psychosis. Schizophr Res. 2011;125(1):54–61. doi:10.1016/j.schres.2010.10.015.
34. Hutton P, Taylor PJ. Cognitive behavioural therapy for psychosis prevention: a systematic review and meta-analysis. Psychol Med. 2014;44(3):449–68. doi:10.1017/S0033291713000354.
35. Granholm E, Holden J, Link PC, McQuaid JR, Jeste DV. Randomized controlled trial of cognitive behavioral social skills training for older consumers with schizophrenia: defeatist performance attitudes and functional outcome. Am J Geriatr Psychiatry. 2013;21(3):251–62. doi:10.1097/JGP.0b013e31823e2f70.
36. Emmerson LC, Granholm E, Link PC, McQuaid JR, Jeste DV. Insight and treatment outcome with cognitive-behavioral social skills training for older people with schizophrenia. J Rehabil Res Dev. 2009;46(8):1053–8.
37. Granholm E, McQuaid JR, McClure FS, Link PC, Perivoliotis D, Gottlieb JD, et al. Randomized controlled trial of cognitive behavioral social skills training for older people with schizophrenia: 12-month follow-up. J Clin Psychiatry. 2007;68(5):730–7.
38. O’Brien MP, Zinberg JL, Bearden CE, Daley M, Niendam TA, Kopelowicz A, et al. Psychoeducational multi-family group treatment with adolescents at high risk for developing psychosis. Early Interv Psychiatry. 2007;1(4):325–32. doi:10.1111/j.1751-7893.2007.00046.x.
39. O’Brien MP, Miklowitz DJ, Candan KA, Marshall C, Domingues I, Walsh BC, et al. A randomized trial of family focused therapy with populations at clinical high risk for psychosis: effects on interactional behavior. J Consult Clin Psychol. 2013. doi:10.1037/a0034667.
40. Bird V, Premkumar P, Kendall T, Whittington C, Mitchell J, Kuipers E. Early intervention services, cognitive-behavioural therapy and family intervention in early psychosis: systematic review. Br J Psychiatry. 2010;197(5):350–6. doi:10.1192/bjp.bp.109.074526.
41. Uzenoff SR, Penn DL, Graham KA, Saade S, Smith BB, Perkins DO. Evaluation of a multi-element treatment center for early psychosis in the United States. Soc Psychiatry Psychiatr Epidemiol. 2012;47(10):1607–15. doi:10.1007/s00127-011-0467-4.
42. Meyer U. Developmental neuroinflammation and schizophrenia. Prog Neuro-Psychopharmacol Biol Psychiatry. 2011. doi:10.1016/j.pnpbp.2011.11.003.
43. Muller N, Krause D, Dehning S, Musil R, Schennach-Wolff R, Obermeier M, et al. Celecoxib treatment in an early stage of schizophrenia: results of a randomized, double-blind, placebo-controlled trial of celecoxib augmentation of amisulpride treatment. Schizophr Res. 2010;121(1–3):118–24. doi:10.1016/j.schres.2010.04.015.
44. Laan W, Grobbee DE, Selten JP, Heijnen CJ, Kahn RS, Burger H. Adjuvant aspirin therapy reduces symptoms of schizophrenia spectrum disorders: results from a randomized, double-blind, placebo-controlled trial. J Clin Psychiatry. 2010;71(5):520–7. doi:10.4088/JCP.09m05117yel.
45. Levkovitz Y, Mendlovich S, Riwkes S, Braw Y, Levkovitch-Verbin H, Gal G, et al. A double-blind, randomized study of minocycline for the treatment of negative and cognitive symptoms in early-phase schizophrenia. J Clin Psychiatry. 2010;71(2):138–49. doi:10.4088/JCP.08m04666yel.
46. Feifel D, Shilling PD, Belcher AM. The effects of oxytocin and its analog, carbetocin, on genetic deficits in sensorimotor gating. Eur Neuropsychopharmacol J Eur Coll Neuropsychopharmacol. 2012;22(5):374–8. doi:10.1016/j.euroneuro.2011.09.004.
47. Pedersen CA, Gibson CM, Rau SW, Salimi K, Smedley KL, Casey RL, et al. Intranasal oxytocin reduces psychotic symptoms and improves theory of mind and social perception in schizophrenia. Schizophr Res. 2011;132(1):50–3. doi:10.1016/j.schres.2011.07.027.
48. Averbeck BB, Bobin T, Evans S, Shergill SS. Emotion recognition and oxytocin in patients with schizophrenia. Psychol Med. 2011;42(2):1–8. doi:10.1017/S0033291711001413.
49. Feifel D, Macdonald K, Nguyen A, Cobb P, Warlan H, Galangue B, et al. Adjunctive intranasal oxytocin reduces symptoms in schizophrenia patients. Biol Psychiatry. 2010;68(7):678–80. doi:10.1016/j.biopsych.2010.04.039.
50. Patil ST, Zhang L, Martenyi F, Lowe SL, Jackson KA, Andreev BV, et al. Activation of mGlu2/3 receptors as a new approach to treat schizophrenia: a randomized Phase 2 clinical trial. Nat Med. 2007;13(9):1102–7. doi:10.1038/nm1632.
51. Kinon BJ, Zhang L, Millen BA, Osuntokun OO, Williams JE, Kollack-Walker S, et al. A multicenter, inpatient, phase 2, double-blind, placebo-controlled dose-ranging study of LY2140023 monohydrate in patients with DSM-IV schizophrenia. J Clin Psychopharmacol. 2011;31(3):349–55. doi:10.1097/JCP.0b013e318218dcd5.
52. Sacchi S, Rosini E, Pollegioni L, Molla G. D-amino acid oxidase inhibitors as a novel class of drugs for schizophrenia therapy. Curr Pharm Des. 2013;19(14):2499–511.
53. Javitt DC. Glycine transport inhibitors in the treatment of schizophrenia. Handb Exp Pharmacol. 2012;213:367–99. doi:10.1007/978-3-642-25758-2_12.
54. Wykes T, Steel C, Everitt B, Tarrier N. Cognitive behavior therapy for schizophrenia: effect sizes, clinical models, and methodological rigor. Schizophr. Bukk. 2008;34(3):523–37.
55. Adcock RA, Dale C, Fisher M, Aldebot S, Genevsky A, Simpson GV, Nagarajan S, Vinogradov S. When top-down meets bottom-up: auditory training enhances verbal memory in schizophrenia. Schizophr. Bull. 2009;35(6):1132–41. doi:10.1093/schbul/sbp068.
56. Bechdolf A, Wagner M, Ruhrmann S, Harrigan S, Putzfeld V, et al. Preventing progression to first-episode psychosis in early initial prodromal states. Br. J. Psychiatry 2012;200(1):22–9.
57. Sulzer J, Haller S, Scharnowski F, Weiskopf N, Birbaumer N, Blefari ML, et al. Real-time fMRI neurofeedback: progress and challenges. Neuroimage. 2013;76:386–99. doi:10.1016/j.neuroimage.2013.03.033.
58. Birbaumer N, Ruiz S, Sitaram R. Learned regulation of brain metabolism. Trends Cogn Sci. 2013;17(6):295–302. doi:10.1016/j.tics.2013.04.009.
59. Weiskopf N. Real-time fMRI and its application to neurofeedback. Neuroimage. 2012;62(2):682–92. doi:10.1016/j.neuroimage.2011.10.009.
60. Ruiz S, Lee S, Soekadar SR, Caria A, Veit R, Kircher T, et al. Acquired self-control of insula cortex modulates emotion recognition and brain network connectivity in schizophrenia. Hum Brain Mapp. 2013;34(1):200–12. doi:10.1002/hbm.21427. The authors used a real-time functional neuroimaging paradigm to train 9 schizophrenia patients to reduce hemodymanic response in their insular cortices. In this 2-week training paradigm, results indicated a learning response at the level of brain function and increased accuracy in emotion recognition.
61. Wisdom JP, Manuel JI, Drake RE. Substance use disorder among people with first-episode psychosis: a systematic review of course and treatment. Psychiatr Serv. 2011;62(9):1007–12. doi:10.1176/appi.ps.62.9.1007.
62. Correll CU, Hauser M, Auther AM, Cornblatt BA. Research in people with the psychosis risk syndrome: a review of the current evidence and future directions. J Child Psychol Psychiatry. 2010;51(4):390–431. This article provides a historical perspective on the study of prodromal schizophrenia and a summary of major research findings. Also includes a list of ongoing studies in clinically high risk populations.