The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness

https://onlinelibrary.wiley.com/doi/pdf/10.1002/wps.20446

Improving outcomes of first-episode psychosis: an overview

https://onlinelibrary.wiley.com/doi/pdf/10.1002/wps.20693

Dopamine and glutamate in schizophrenia: biology, symptoms and treatment

Clozapine is the most effective antipsychotic for the 25% to 33% of people with schizophrenia who are treatment resistant, but not all people achieve response. Using data from a previously published clozapine systematic review and meta-analysis, we explored the proportion of people who achieved response and examined the absolute and percentage change in Positive and Negative Syndrome Scale (PANSS) scores. Overall, 40.1% (95% confidence interval [CI], 36.8%-43.4%) responded, with a mean reduction in PANSS of 22.0 points (95% CI, 20.9-23.1), a reduction of 25.8% (95% CI, 24.7%-26.9%) from baseline. These reductions are clinically meaningful. A 40% response rate to clozapine suggests that 12% to 20% of people with schizophrenia will be ultra-resistant.

https://journals.sagepub.com/doi/pdf/10.1177/0706743717718167

Clozapine Response Rates among People with Treatment-Resistant Schizophrenia: Data from a Systematic Review and Meta-Analysis

Importance Schizophrenia is associated with alterations in mean regional brain volumes However, it is not known whether the clinical heterogeneity seen in the disorder is reflected at the neurobiological level, for example, in differences in the interindividual variability of these brain volumes relative to control individuals Objective To investigate whether patients with first-episode schizophrenia exhibit greater variability of regional brain volumes in addition to mean volume differences Data Sources Studies that reported regional brain volumetric measures in patients and controls by using magnetic resonance imaging in the MEDLINE, EMBASE, and PsycINFO databases from inception to October 1, 2016, were examined Study Selection Case-control studies that reported regional brain volumes in patients with first-episode schizophrenia and healthy controls by using magnetic resonance imaging were selected Data Extraction and Synthesis Means and variances (SDs) were extracted for each measure to calculate effect sizes, which were combined using multivariate meta-analysis Main Outcomes and Measures Relative variability of regional brain volumetric measurements in patients compared with control groups as indexed by the variability ratio (VR) and coefficient of variation ratio (CVR) Hedges g was used to quantify mean differences Results A total of 108 studies that reported measurements from 3901 patients (1272 [326%] female) with first-episode schizophrenia and 4040 controls (1613 [399%] female) were included in the analyses Variability of putamen (VR, 113; 95% CI, 103-124; P  = 01), temporal lobe (VR, 112; 95% CI, 104-121; P  = 004), thalamus (VR, 116; 95% CI, 107-126; P P −5 ) volume was significantly greater in patients, whereas variability of anterior cingulate cortex volume was lower (VR, 089; 95% CI, 081-098; P  = 02) These findings were robust to choice of outcome measure There was no evidence of altered variability of caudate nucleus or frontal lobe volumes Mean volumes of the lateral ( g  = 040; 95% CI, 029-051; P g  = 043; 95% CI, 026-059; P g  = −046; −065 to −026; P g  = −026; 95% CI, −043 to −010; P  = 005), frontal lobe ( g  = −031; 95% CI, −044 to −019; P  = 001), hippocampus ( g  = −066; 95% CI, −084 to −047; P g  = −022; 95% CI, −036 to −009; P  = 001), and thalamus ( g  = −036; 95% CI, −057 to −015; P  = 001) were lower in patients There was no evidence of altered mean volume of caudate nucleus or putamen Conclusions and Relevance In addition to altered mean volume of many brain structures, schizophrenia is associated with significantly greater variability of temporal cortex, thalamus, putamen, and third ventricle volumes, consistent with biological heterogeneity in these regions, but lower variability of anterior cingulate cortex volume This finding indicates greater homogeneity of anterior cingulate volume and, considered with the significantly lower mean volume of this region, suggests that this is a core region affected by the disorder

/pdf/heterogeneity-and-homogeneity-of-regional-brain-structure-in-2c7e5c5oo9.pdf

Heterogeneity and Homogeneity of Regional Brain Structure in Schizophrenia: A Meta-analysis.

Objective:Research and clinical translation in schizophrenia is limited by inconsistent definitions of treatment resistance and response. To address this issue, the authors evaluated current approaches and then developed consensus criteria and guidelines.Method:A systematic review of randomized antipsychotic clinical trials in treatment-resistant schizophrenia was performed, and definitions of treatment resistance were extracted. Subsequently, consensus operationalized criteria were developed through 1) a multiphase, mixed methods approach, 2) identification of key criteria via an online survey, and 3) meetings to achieve consensus.Results:Of 2,808 studies identified, 42 met inclusion criteria. Of these, 21 studies (50%) did not provide operationalized criteria. In the remaining studies, criteria varied considerably, particularly regarding symptom severity, prior treatment duration, and antipsychotic dosage thresholds; only two studies (5%) utilized the same criteria. The consensus group identified minimu...

Treatment-Resistant Schizophrenia: Treatment Response and Resistance in Psychosis (TRRIP) Working Group Consensus Guidelines on Diagnosis and Terminology.

William T. Carpenter

Papers

Treatment-Resistant Schizophrenia: Treatment Response and Resistance in Psychosis (TRRIP) Working Group Consensus Guidelines on Diagnosis and Terminology.