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5. The clinical characterization of the patient with primary psychosis aimed at personalization of management

Author

Maj, M. (Mario), van Os, J. (Jim), De Hert, M. (Marc), Gaebel, W. (Wolfgang), Galderisi, S. (Silvana), Green, M. F. (Michael F.), Guloksuz, S. (Sinan), Harvey, P. D. (Philip D.), Jones, P. B. (Peter B.), Malaspina, D. (Dolores), McGorry, P. (Patrick), Miettunen, J. (Jouko), Murray, R. M. (Robin M.), Nuechterlein, K. H. (Keith H.), Peralta, V. (Victor), Thornicroft, G. (Graham), van Winkel, R. (Ruud), Ventura, J. (Joseph), Maj, M. (Mario), van Os, J. (Jim), De Hert, M. (Marc), Gaebel, W. (Wolfgang), Galderisi, S. (Silvana), Green, M. F. (Michael F.), Guloksuz, S. (Sinan), Harvey, P. D. (Philip D.), Jones, P. B. (Peter B.), Malaspina, D. (Dolores), McGorry, P. (Patrick), Miettunen, J. (Jouko), Murray, R. M. (Robin M.), Nuechterlein, K. H. (Keith H.), Peralta, V. (Victor), Thornicroft, G. (Graham), van Winkel, R. (Ruud), and Ventura, J. (Joseph)

Abstract

The current management of patients with primary psychosis worldwide is often remarkably stereotyped. In almost all cases an antipsychotic medica­tion is prescribed, with second-generation antipsychotics usually preferred to first-generation ones. Cognitive behavioral therapy is rarely used in the vast majority of countries, although there is evidence to support its efficacy. Psychosocial interventions are often provided, especially in chronic cases, but those applied are frequently not validated by research. Evidence-based family interventions and supported employment programs are seldom implemented in ordinary practice. Although the notion that patients with primary psychosis are at increased risk for cardiovascular diseases and diabetes mellitus is widely shared, it is not frequent that appropriate measures be implemented to address this problem. The view that the management of the patient with primary psychosis should be personalized is endorsed by the vast majority of clinicians, but this personalization is lacking or inadequate in most clinical contexts. Although many mental health services would declare themselves “recovery-oriented”, it is not common that a focus on empowerment, identity, meaning and resilience is ensured in ordinary practice. The present paper aims to address this situation. It describes systematically the salient domains that should be considered in the characterization of the individual patient with primary psychosis aimed at personalization of management. These include positive and negative symptom dimensions, other psychopathological components, onset and course, neurocognition and social cognition, neurodevelopmental indicators; social functioning, quality of life and unmet needs; clinical staging, antecedent and concomitant psychiatric conditions, physical comorbidities, family history, history of obstetric complications, early and recent environmental exposures, protective factors and resilience, and internalized stigma. For

Published
2021

19. Comparison of the Heritability of Schizophrenia and Endophenotypes in the COGS-1 Family Study

Author

Light, G., primary, Greenwood, T. A., additional, Swerdlow, N. R., additional, Calkins, M. E., additional, Freedman, R., additional, Green, M. F., additional, Gur, R. E., additional, Gur, R. C., additional, Lazzeroni, L. C., additional, Nuechterlein, K. H., additional, Olincy, A., additional, Radant, A. D., additional, Seidman, L. J., additional, Siever, L. J., additional, Silverman, J. M., additional, Sprock, J., additional, Stone, W. S., additional, Sugar, C. A., additional, Tsuang, D. W., additional, Tsuang, M. T., additional, Turetsky, B. I., additional, and Braff, D. L., additional

Published
2014
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27. The Consortium on the Genetics of Endophenotypes in Schizophrenia: Model Recruitment, Assessment, and Endophenotyping Methods for a Multisite Collaboration

Author

Calkins, M. E., primary, Dobie, D. J., additional, Cadenhead, K. S., additional, Olincy, A., additional, Freedman, R., additional, Green, M. F., additional, Greenwood, T. A., additional, Gur, R. E., additional, Gur, R. C., additional, Light, G. A., additional, Mintz, J., additional, Nuechterlein, K. H., additional, Radant, A. D., additional, Schork, N. J., additional, Seidman, L. J., additional, Siever, L. J., additional, Silverman, J. M., additional, Stone, W. S., additional, Swerdlow, N. R., additional, Tsuang, D. W., additional, Tsuang, M. T., additional, Turetsky, B. I., additional, and Braff, D. L., additional

Published
2006
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46. Relatives' expressed emotion and non-verbal signs of subclinical psychopathology in schizophrenic patients.

Author

Woo, Stephanie M., Goldstein, Michael J., Nuechterlein, Keith H., Woo, S M, Goldstein, M J, and Nuechterlein, K H

Subjects
PEOPLE with schizophrenia, EMOTIONS, PATHOLOGICAL psychology, SCHIZOPHRENIA, SYMPTOMS, FAMILIES
Abstract

Background: Previous research has generally found that variations in relatives' affective attitudes (expressed emotion; EE) towards a schizophrenic family member could not be accounted for by differences in the severity or form of the patient's symptomatology. These findings have been based on clinicians' ratings of psychopathology in patients.Method: To approach the question from a different perspective, videotaped interactions between a patient and family members, obtained four to five weeks after hospital discharge, were coded for subclinical signs of psychopathology expressed by the patient. The Behavioral Subclinical Rating Scale (BSRS) was developed to compare subclinical levels of non-verbal and paralinguistic symptoms expressed by patients from both high- and low-EE families.Results: Highly significant differences were found in the BSRS data. Patients from high-EE families showed more hostile and unusual behaviour with relatives than those from low-EE homes, who, in contrast, showed more anxious behaviour.Conclusion: These data suggest that a complex transactional model is necessary to understand how family attitudes evolve during the course of a relatives' schizophrenic disorder. [ABSTRACT FROM AUTHOR]

Published
1997
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47. Life events and schizophrenic relapse after withdrawal of medication.

Author

Ventura, Joseph, Nuechterlein, Keith H., Hardesty, Jean Pederson, Gitlin, Michael, Ventura, J, Nuechterlein, K H, Hardesty, J P, and Gitlin, M

Subjects
PEOPLE with schizophrenia, LIFE change events, DRUG withdrawal symptoms, DISEASE relapse, ENVIRONMENTAL engineering, PATIENTS
Abstract

Research with schizophrenic out-patients has shown that antipsychotic medication reduces relapse rates. This protective factor may operate partially by raising the threshold for relapse in the face of environmental stressors such as life events and high levels of familial expressed emotion. A prospective, longitudinal design was employed in the monthly collection of life-events data with 23 recent-onset schizophrenic out-patients. In a between-subjects ANOVA, a significantly higher frequency of independent life events was found in the month prior to a relapse for ten patients on medication, as compared with the analogous month for 13 drug-free patients. These findings suggest that neuroleptic medication may produce a prophylactic effect by raising a patient's threshold of vulnerability to relapse. [ABSTRACT FROM AUTHOR]

Published
1992
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48. Glucose metabolic rate in normals and schizophrenics during the Continuous Performance Test assessed by positron emission tomography.

Author

Buchsbaum, Monte S., Nuechterlein, Keith H., Haier, Richard J., Wu, Joseph, Sicotte, Nancy, Hazlett, Erin, Asarnow, Robert, Potkin, Stephen, Guich, Steven, Buchsbaum, M S, Nuechterlein, K H, Haier, R J, Wu, J, Sicotte, N, Hazlett, E, Asarnow, R, Potkin, S, and Guich, S

Subjects
PEOPLE with schizophrenia, GLUCOSE, METABOLISM, SCHIZOPHRENIA, POSITRON emission tomography, CONTINUOUS performance test, GLUCOSE metabolism, CEREBRAL cortex, COMPARATIVE studies, DEOXY sugars, FRONTAL lobe, RESEARCH methodology, MEDICAL cooperation, PSYCHOLOGICAL tests, RADIOPHARMACEUTICALS, RESEARCH, RESEARCH funding, VISUAL perception, EVALUATION research
Abstract

Local cerebral uptake of glucose labelled with fluorine-18 was measured by positron emission tomography in 13 patients with schizophrenia and 37 right-handed volunteers. Patients received no medication for a minimum of 31 days and a mean of 30 weeks. The subjects were administered the labelled deoxyglucose just after the beginning of a 32-minute sequence of blurred numbers as visual stimuli for the Continuous Performance Test. In normal controls, task performance was associated with increases in glucose metabolic rate in the right frontal and right temporoparietal regions; occipital rates were unchanged. Patients with schizophrenia showed both absolutely and relatively reduced metabolic rates in the frontal cortex and in the temporoparietal regions compared with normal controls. [ABSTRACT FROM AUTHOR]

Published
1990
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49. The initial onset of schizophrenia and family expressed emotion. Some methodological considerations.

Author

Mintz, L I, Nuechterlein, K H, Goldstein, M J, Mintz, J, and Snyder, K S

Abstract

The relationships between duration of schizophrenic illness before first hospital admission, expressed emotion in key relatives, and illness course have yielded conflicting reports. This study examined the issue from a methodological perspective in a sample of first-episode schizophrenic patients. A 'best estimate' of illness onset, based on a compilation of all sources, was compared with an estimate based on parental report. Parental estimates suggested that the children of high-EE parents had been ill for significantly longer, but this difference was not confirmed by the best estimate. In most cases, the ill children of high-EE parents were living at home before hospital admission and their parents' estimates of duration were quite accurate. In the few cases in which the child was living away from home, high-EE parents strikingly overestimated duration. Children of low-EE families were more likely to be living away from home, but this factor did not explain the consistent underestimates of duration made by their parents. Although duration of illness did not relate to EE, successful engagement in out-patient before in-patient treatment was more common among children from low-EE families. [ABSTRACT FROM AUTHOR]

Published
1989
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