PMID- 30176881 OWN - NLM STAT- MEDLINE DCOM- 20190618 LR - 20190618 IS - 1471-244X (Electronic) IS - 1471-244X (Linking) VI - 18 IP - 1 DP - 2018 Sep 3 TI - First-episode psychosis in treatment-resistant schizophrenia: a cross-sectional study of a long-term follow-up cohort. PG - 274 LID - 10.1186/s12888-018-1853-1 [doi] LID - 274 AB - BACKGROUND: Approximately one-third of schizophrenia patients eventually develop treatment-resistant schizophrenia (TRS). Although the time course of TRS development varies from patient to patient, the details of these variations have not been clarified. The present study compared the duration of time required to achieve control of the first-episode psychosis (FEP) between patients who went on to develop TRS and those who did not, in order to determine whether a bifurcation point exists for the transition to TRS. METHODS: The present study included 271 schizophrenia patients. Based on the clinical assessment, each patient was assigned to a TRS (n = 79) or Non-TRS group (n = 182). Clinical factors relating to FEP treatment such as the duration of initial hospital admission and the degree of improvement were retrospectively identified. RESULTS: There was no significant difference in the duration of initial hospital admission (defined as the time from treatment introduction to successful discharge) between the two groups (mean of 87.9 days for TRS vs. 53.3 days for Non-TRS). The degree of improvement during initial hospital admission of the TRS group was significantly lower than that of the Non-TRS group (Global Assessment of Functioning (GAF) of 50 points for TRS vs. 61 points for Non-TRS). Approximately half of the TRS patients showed an acute onset pattern and longer hospital admission (mean 169 days) for their FEP. The other half of TRS patients needed no hospital admission, indicating an insidious onset pattern with no clear psychotic episode and treatment introduction without hospital admission. CONCLUSIONS: Future TRS patients can have difficulty in improvement during their FEP. There appear to be two distinct patterns for the development of TRS. One pattern is characterized by refractory positive symptoms and a longer period to control the first psychosis; the other shows latent or insidious onset and poor response to the initial treatment. FAU - Kanahara, Nobuhisa AU - Kanahara N AD - Division of Medical Treatment and Rehabilitation, Center for Forensic Mental Health, Chiba University, 1-8-1 Inohana, Chuou-ku, Chiba-shi, Chiba, 260-8670, Japan. kanahara@faculty.chiba-u.jp. AD - Department of Psychiatry, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuou-ku, Chiba, 260-8670, Japan. kanahara@faculty.chiba-u.jp. FAU - Yamanaka, Hiroshi AU - Yamanaka H AD - Department of Psychiatry, Chiba Psychiatric Medical Center, 5 Toyosuna, Mihama-ku, Chiba, 261-0024, Japan. FAU - Suzuki, Tomotaka AU - Suzuki T AD - Department of Psychiatry, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuou-ku, Chiba, 260-8670, Japan. AD - Department of Psychiatry, Koutoku-kai Sato Hospital, 948-1 Kunugizuka, Nanyo City, Yamagata, 999-2221, Japan. AD - Kokoro Clinic Monzen-nakacho, Ikkou Building 1F, 1-3-5 Tomioka, Koutou-ku, Tokyo, 135-0047, Japan. FAU - Takase, Masayuki AU - Takase M AD - Department of Psychiatry, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuou-ku, Chiba, 260-8670, Japan. AD - Division of Psychiatry Research, The Zucker Hillside Hospital, 75-59 263rd St, Glen Oaks, NY, 11004, USA. FAU - Iyo, Masaomi AU - Iyo M AD - Department of Psychiatry, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuou-ku, Chiba, 260-8670, Japan. LA - eng PT - Journal Article DEP - 20180903 PL - England TA - BMC Psychiatry JT - BMC psychiatry JID - 100968559 RN - 0 (Antipsychotic Agents) SB - IM MH - Adult MH - Antipsychotic Agents/therapeutic use MH - Cohort Studies MH - Cross-Sectional Studies MH - Female MH - Follow-Up Studies MH - Hospitalization MH - Humans MH - Male MH - Psychotic Disorders/*psychology/*therapy MH - Retrospective Studies MH - Risk Factors MH - Schizophrenia/*therapy MH - *Schizophrenic Psychology MH - Secondary Prevention/methods MH - *Severity of Illness Index PMC - PMC6122618 OTO - NOTNLM OT - Antipsychotic OT - First-episode psychosis OT - Negative symptoms OT - Positive symptoms COIS- ETHICS APPROVAL AND CONSENT TO PARTICIPATE: The present study was approved by the ethics committees of the Chiba University Graduate School of Medicine (Chiba), Chiba Psychiatric Medical Center (Chiba), and Koutoku-kai Sato Hospital (Yamagata). Written informed consent to participate in the study was obtained from each patient or his/her guardian. CONSENT FOR PUBLICATION: Not applicable. COMPETING INTERESTS: Dr. Kanahara reports honoraria from Otsuka, Dainippon Sumitomo, Janssen and Meiji Seika Pharma. Dr. Takase reports honoraria from Otsuka and received grant support from SENSHIN Medical Research Foundation. Dr. Iyo received consultant fees from Janssen, Eli Lilly, Otsuka, Meiji Seika Pharma and reports honoraria from Janssen, Eli Lilly, Otsuka, Meiji Seika Pharma, Astellas, Dainippon Sumitomo, Ono, Mochida, MSD, Eisai, Daiichi-Sankyo, Novartis, Teijin, Shionogi, Hisamitsu and Asahi Kasei. Dr. Yamanaka and Dr. Suzuki declare no conflicts of interest. PUBLISHER'S NOTE: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. EDAT- 2018/09/05 06:00 MHDA- 2019/06/19 06:00 PMCR- 2018/09/03 CRDT- 2018/09/05 06:00 PHST- 2018/05/15 00:00 [received] PHST- 2018/08/16 00:00 [accepted] PHST- 2018/09/05 06:00 [entrez] PHST- 2018/09/05 06:00 [pubmed] PHST- 2019/06/19 06:00 [medline] PHST- 2018/09/03 00:00 [pmc-release] AID - 10.1186/s12888-018-1853-1 [pii] AID - 1853 [pii] AID - 10.1186/s12888-018-1853-1 [doi] PST - epublish SO - BMC Psychiatry. 2018 Sep 3;18(1):274. doi: 10.1186/s12888-018-1853-1.