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Biomedical subjects

Donald Addington

Publications and source records attributed to Donald Addington.

At least 19 recordsLinked to original sources
PubMed2006

The association of insight with psychotic symptoms, depression, and cognition in early psychosis: a 3-year follow-up.

Recent research has begun to examine the level of insight following a first episode of psychosis since this may have implications for outcome. Insight was investigated in 278 individuals consecutively admitted to a comprehensive early psychosis treatment program. Insight, symptoms and cognition were assessed on admission and after one, two and three years. Sixty percent had good insight at baseline and this improved significantly to 80% at one year. Insight remained good at years 2 and 3 with 78.6% and 82.8%, respectively, having good insight. A comparison of those with good to those with poor insight revealed that at each assessment point those with poor insight had significantly higher ratings on positive, negative and general psychopathology symptoms (all at p<0.001). Additionally those with good insight had significantly higher levels of depression at baseline (p=0.001). With respect to cognition when using a composite cognitive factor there was a significant advantage for the good insight group at one year (p=0.01). Overall results show that a significant proportion of individuals have good insight following a first episode of psychosis. For this group depression may be a significant concern at least upon initial presentation. Those with poor insight have increased symptoms throughout the first three years and possibly poorer cognitive functioning.

Adolescent↗
PubMed2006

Substance misuse and cognitive functioning in early psychosis: a 2 year follow-up.

High comorbidity exists between substance use and psychosis. Since substance use has been shown to negatively impact cognitive functioning in the general population, there is concern about the impact of substance use on already compromised cognitive functioning. However, the literature regarding the effects of substance use on cognition in early psychosis patients is inconclusive. The purpose of this study was to examine the relationship between substance misuse and cognitive functioning in a first episode psychosis sample for 2 years following admission to a specialized early psychosis program. One hundred and eighty-three subjects were assessed at baseline, 147 at 1 year and 116 at 2 years using the Case Manager Rating Scale (CMRS) for substance use and a comprehensive cognitive battery. Approximately 50% of subjects engaged in substance misuse at baseline, which did decrease over follow-up. At baseline, the cognitive performance of patients with both mild use and misuse was significantly better than non-users. These same patients demonstrated better performance at follow-up. These results do not provide evidence for a negative impact of substance use on cognition.

Adult↗
PubMed2006

Diagnostic stability over one year in first-episode psychosis.

Results of first-episode psychosis studies have shown that the diagnosis of schizophrenia is more stable across time than other diagnoses within the psychosis spectrum disorders. The objective of this study was to determine the diagnostic stability in a sample of first-episode patients and to determine the factors that predicted a diagnostic shift. Two hundred and twenty-eight individuals presenting for treatment with a first episode of non-affective psychosis were diagnosed at baseline and at one-year follow-up. Symptoms, functioning and cognition were also assessed. The overall consistency of diagnoses was 68% with an increase to 89% when schizophreniform was excluded. Schizophrenia was found to have the highest prospective consistency (95%), schizophreniform was less stable (36%) with shifts towards schizophrenia and other psychotic disorders were the least stable with a prospective consistency of 62%. Schizophrenia had the largest influx of cases at follow-up with a retrospective consistency of 63%. Schizophrenia can be reliably diagnosed at the initial assessment. There are clinical implications for dealing with the risk of shifting diagnosis for those who present with schizophrenia spectrum and other psychotic disorders.

Adolescent↗
PubMed2006

Facial affect recognition: a mediator between cognitive and social functioning in psychosis?

BACKGROUND: Facial affect recognition has been implicated in the relationship between cognition and social functioning. This 1-year longitudinal study tested the hypothesis that facial affect recognition mediates the relationship between cognitive and social functioning. METHOD: Three groups were included: 50 first-episode of psychosis (FE) subjects, 53 multi-episode schizophrenia subjects (ME) and 55 non-psychiatric controls (NPC). Subjects were assessed on two facial affect recognition tasks, a comprehensive cognitive battery and a measure of social functioning. FE subjects were assessed on admission to a comprehensive FE program and 1 year later. The ME and NPC groups had two assessments 1 year apart. RESULTS: Both the FE and ME subjects were clearly impaired relative to NPCs in cognition, social functioning and facial affect recognition. There were significant associations among facial affect recognition, cognition and social functioning in all three groups. For ME and FE subjects, but not NPCs, there was evidence that facial affect recognition did partially mediate the relationship between cognitive and social functioning. CONCLUSION: This study provides some first steps in understanding the complex relationship between cognition and outcome and has potential implications for the design of remediation strategies.

Adult↗
PubMed2006

Randomized, double-blind trial of olanzapine versus placebo in patients prodromally symptomatic for psychosis.

OBJECTIVE: This study assessed the efficacy of olanzapine in delaying or preventing conversion to psychosis and reducing symptoms in people with prodromal symptoms of schizophrenia. METHOD: This randomized trial occurred at four North American clinics in the Prevention Through Risk Identification, Management, and Education project. Outpatients received olanzapine (5-15 mg/day, N=31) or placebo (N=29) during a 1-year double-blind treatment period and no treatment during a 1-year follow-up period. Efficacy measures included the conversion-to-psychosis rate and Scale of Prodromal Symptoms scores. RESULTS: During the treatment year, 16.1% of olanzapine patients and 37.9% of placebo patients experienced a conversion to psychosis, a nearly significant difference. The hazard of conversion among placebo patients was about 2.5 times that among olanzapine-treated patients, which also approached significance. In the follow-up year, the conversion rate did not differ significantly between groups. During treatment, the mean score for prodromal positive symptoms improved more in the olanzapine group than in the placebo group, and the mixed-model repeated-measures least-squares mean score showed significantly greater improvement between weeks 8 and 28 with olanzapine. The olanzapine patients gained significantly more weight (mean=8.79 kg, SD=9.05, versus mean=0.30 kg, SD=4.24). CONCLUSIONS: A significant treatment difference in the conversion-to-psychosis rate was not demonstrated. However, these results may be influenced by low power. The nearly significant differences suggest that olanzapine might reduce the conversion rate and delay onset of psychosis. Olanzapine was efficacious for positive prodromal symptoms but induced weight gain. Further treatment research in this phase of illness is warranted.

Adolescent↗
PubMed2006

One-year stability of diagnosis in first-episode nonaffective psychosis: influence of sex.

OBJECTIVE: To determine whether sex influences the frequency and direction of diagnostic change 1 year after a first episode of nonaffective psychosis. METHOD: The subjects (n = 228) were individuals diagnosed with schizophrenia and other psychoses according to DSM-IV criteria at baseline and at 1 year. RESULTS: When diagnostic shifts occurred, men mainly shifted toward schizophrenia (84.6%), which was associated with more severe symptoms. In contrast, 72% of women in whom a diagnostic shift occurred shifted away from a schizophrenia spectrum disorder toward mood disorder. A shift to mood disorder in women was associated with an early age of illness onset. CONCLUSIONS: At initial presentation, nonaffective first-episode psychosis studies may underestimate the number of men and overestimate the number of women who will eventually receive a schizophrenia diagnosis.

Adult↗
PubMed2006

Serum monitoring of antipsychotic drug levels during concomitant administration of sertraline and antipsychotic medication.

OBJECTIVE: To assess whether pharmacokinetic drug interactions occur when sertraline is added to antipsychotic medications. METHOD: Forty-eight patients with remitted DSM-IV schizophrenia and comorbid major depression were randomized to placebo for 6 weeks or sertraline 50 mg for 4 weeks followed by sertraline 50 mg to 100 mg for 2 weeks for nonresponders. Treatment with the patients' usual antipsychotic continued. Weekly clinical outcome assessments occurred for 6 weeks, and serum samples for drug monitoring were collected at Weeks 1, 5, and 6. Serum concentrations of sertraline and antipsychotics were measured with standard assays. RESULTS: In both placebo- and sertraline-treated groups, most patients displayed minor fluctuations in antipsychotic serum levels over 6 weeks. There was no clinical evidence of drug interactions in the sertraline-treated group. CONCLUSIONS: Clinically significant adverse effects did not occur despite variable antipsychotic serum levels with or without sertraline. Concern about pharmacokinetic interactions should not deter the use of sertraline for depression in individuals with schizophrenia.

Adolescent↗
PubMed2006

Influence of social perception and social knowledge on cognitive and social functioning in early psychosis.

BACKGROUND: Social cognition has been implicated in the relationship between cognition and social functioning. AIMS: To test the hypothesis that social cognition mediates the relationship between cognitive and social functioning. METHOD: This was a 1-year longitudinal cohort study comparing three groups: 50 people with first-episode psychosis, 53 people with multi-episode schizophrenia and 55 people without psychiatric disorder as controls. Participants were assessed on social perception, social knowledge, interpersonal problem-solving, cognition and social functioning. RESULTS: There were significant associations between social cognition, cognition and social functioning in all three groups. Deficits in social cognition were stable over time. In the first two groups, controlling for social cognition reduced the relationship between cognitive and social functioning. CONCLUSIONS: This study provides some evidence that social cognition mediates the relationship between cognitive and social functioning.

Adult↗
PubMed2005

The role of family work in early psychosis.

In keeping with the current clinical and research focus on early intervention and the rapid increase worldwide of programs for those experiencing a first episode of psychosis, the development of services for families has to be an integral part of any comprehensive program. Families can and do play a major role in the recovery from a first episode of psychosis. However, without support from and an alliance with professionals, they may find it difficult to see their way through the maze of emotions and challenges that inevitably accompany the first episode. This paper will briefly review the literature describing the impact of a first episode of psychosis on families. Secondly, to support the need for family work, we report on 2-year effectiveness study data that demonstrates that over time families show improvement in their psychological well-being and their experience of caregiving. To design an optimal family program within a first episode service we need to be sensitive to the phase and stage of the illness and have outcomes measured against the goals articulated for first episode family programs. Thus, thirdly we will describe a recovery model that has its origins in the Calgary First Episode Program and has since been expanded for use in the First Episode Psychosis Program in Toronto, Canada.

Age Factors↗
PubMed2005

Three-year outcome of family work in an early psychosis program.

At the initial presentation to a first-episode of psychosis program, family members were experiencing distress and difficulties. The purpose of the study was to assess the effectiveness of individualized family intervention integrated within a comprehensive treatment program for first episode psychosis. Participants were the family members of individuals who had presented with a first episode of psychosis. Family members were assessed with the Psychological General Well-Being Scale and the Experience of Caregiving Inventory (ECI). Patient data included assessment of positive and negative symptoms, depression, quality of life, and substance use. Assessments were conducted over a three-year period. Over time families demonstrated improved psychological well-being and ECI scores. The most significant predictor of poor psychological well-being was the family's appraisal of the impact of the illness on themselves and not the severity of symptoms or impaired functioning. This family intervention embedded within a treatment program proved to be highly acceptable and effective.

Adult↗
PubMed2005

The course of cognitive functioning in first episode psychosis: changes over time and impact on outcome.

This three year longitudinal study examined the cognitive performance of 247 individuals who recently presented with a first episode of psychosis. Using a comprehensive battery of cognitive tests, we assessed cognition at baseline, 1 year and 2-year follow-ups. Assessments also included positive and negative symptoms, depression, social outcome and substance use. There were several significant improvements in cognition over the two-year period which were usually matched by improvements in a matched non-psychiatric control group. Regression analyses demonstrated that after controlling for symptoms cognitive impairment accounted for 4-6% of the variance in social functioning. Our results suggest that impaired cognition exists in the very early stages of a psychotic illness and that there is no decline over time. Secondly, our results suggest that, although related, poor social functioning deficits may be independent of cognitive impairment. Finally there are implications for improved methodology in the assessment of both cognitive and social functioning.

Adolescent↗
PubMed2005

Outcome of a first episode of psychosis in adolescence: a 2-year follow-up.

Symptomatic and functional outcome and cognitive functioning were examined in adolescents experiencing their first episode of psychosis. The adolescents (n=69) were assessed and compared with adults (n=69), all presenting for treatment for the first time to a specialized Early Psychosis Program. Assessments were conducted at the initial presentation, and at 1- and 2-year follow-ups. Assessments included positive and negative symptoms, depression, number of relapses, substance use, cognitive functioning, age-appropriate productivity (employment or being in school) and quality of life. Adolescents showed both symptomatic and functional improvement over 2 years of optimal treatment. Positive and negative symptoms predicted outcome at 2 years. Compared with adults, the adolescents had similar clinical and functional outcomes but used more cannabis and had an increased number of relapses. These adolescents are doing relatively well following their first episode and reinforce the need to address cannabis use as an integral part of a comprehensive treatment program.

Adolescent↗
PubMed2005

Performance measures for early psychosis treatment services.

OBJECTIVE: This study examined the feasibility of identifying performance measures for early psychosis treatment services and obtaining consensus for these measures. The requirements of the study were that the processes used to identify measures and gain consensus should be comprehensive, be reproducible, and reflect the perspective of multiple stakeholders in Canada. METHODS: The study was conducted in two stages. First a literature review was performed to gather articles published from 1995 to July 2002, and experts were consulted to determine performance measures. Second, a consensus-building technique, the Delphi process, was used with nominated participants from seven groups of stakeholders. Twenty stakeholders participated in three rounds of questionnaires. The degree of consensus achieved by the Delphi process was assessed by calculating the semi-interquartile range for each measure. RESULTS: Seventy-three performance measures were identified from the literature review and consultation with experts. The Delphi method reduced the list to 24 measures rated as essential. This approach proved to be both feasible and cost-effective. CONCLUSIONS: Despite the diversity in the backgrounds of the stakeholder groups, the Delphi technique was effective in moving participants' ratings toward consensus through successive questionnaire rounds. The resulting measures reflected the interests of all stakeholders.

Canada↗
PubMed2004

Insight in early psychosis: a 1-year follow-up.

Insight was investigated in 180 individuals consecutively admitted to a comprehensive early psychosis treatment program. Insight was assessed on admission and after 3, 6 and 12 months. Insight improved significantly over 12 months, and was negatively correlated with both positive and negative symptoms, and positively correlated with depressive symptoms at admission. There were no associations with cognition.

Adolescent↗
PubMed2004

Substance misuse at presentation to an early psychosis program.

BACKGROUND: Substance misuse is a significant problem in schizophrenia. The purpose of this study was to examine the prevalence and correlates of substance misuse in individuals with a first episode of psychosis at the time they first present for treatment. METHOD: The first 357 consecutive admissions to a comprehensive early psychosis program were included. Assessment measures were the Positive and Negative Syndrome Scale, the Calgary Depression Scale for Schizophrenia, the Quality of Life Scale, the Case Manager Rating Scale and the Premorbid Adjustment Scale. RESULTS: Forty-four percent of the sample, the majority of whom used alcohol or cannabis, met diagnostic criteria for substance abuse/dependence. The prevalence was significantly higher than in the general population. Substance misuse was significantly associated with male gender, young age and age of onset. CONCLUSIONS: This study confirms the high rates of substance misuse, in particular cannabis, in first-episode psychosis. Implications for treatment are addressed.

Adult↗