September 13, 2007

Report on UC Davis' 2nd Annual Conference on Psychotic Disorders

Following is a report on the UC Davis 2nd Annual Conference on Psychotic Disorders (pdf). The conference took place last Thursday at UC Davis, September 6, 2007. Special thanks to Linda May, PhD, MFT, Case Manager, at UCSF - Langley Porter for her reporting on this conference.

This full day conference held in Sacramento, California provided several informative updates. To summarize just a few of them:

Pharmacotherapy of Schizophrenia in the Post-C.A.T.I.E. and Post-C.U.T.L.A.S.S. Eras by Stephen R. Marder, MD, Director of Section on Psychosis, School of Medicine at UCLA.

Dr. Marder’s presentation sought to present information from the NIMH studies that could translate to everyday uses for patients and families. These large studies have provided information relevant to questions regarding first vs. second generation antipsychotic (See previous news on the CATIE studies here). While earlier works have assumed the improved efficacy and lessened side effects of second generation anti-psychotics, by the late 1990’s this assumption began to be questioned. While there is general information regarding medications, it is not uncommon that each patient must be addressed on an individual basis regarding his/her response to medications initially and over time. Multiple guidelines regarding monitoring medications must be followed. The goal is to help the patient live better. It may not be possible to eliminate all symptoms. There is a ceiling as to what antipsychotic can do. Sometimes the best course is psychosocial treatment (cognitive behavioral treatment) along with medication management. This cognitive behavioral treatment can improve coping strategies to live better with psychosis.

Negative Symptoms, Cognition and Functional Outcomes in Schizophrenia by William T. Carpenter, Jr., MD, Director of Maryland Psychiatric Research Center

Dr. Carpenter traced for the audience the transitions diagnostically in the Diagnostic and Statistical Manual of Mental Disorders. The current DSM-IV has added back in negative symptoms in the construct for schizophrenia. Historically the focus on psychosis had led to some neglect of the other core elements, notably negative symptoms. Persistent cognitive deficits and negative symptoms need to be addressed and treated. Medications tend to have no effect or a modest impact on these areas. Part of the treatment is to identify and treat causes of these impairments. The causes may be psychosis, depression, demoralization, drug induced, and non-optimal social/intellectual stimulation due to the impact of the illness. Treatment can include supported employment, cognitive behavioral treatment, cognitive remediation, and social skills training. Dr. Carpenter also noted the importance of early interventions in the disease course.

The Use of Early Detection and Intervention Strategies to Present Psychosis in Adolescents and Young Adults by Cameron S. Carter, MD, Endowed Professor in Schizophrenia Research, University of California, Davis.

Dr. Carter outlined the usual course of schizophrenia, and how to improve outcomes. The EDAPT Clinic (Early Diagnosis and Preventative Treatment of Psychotic Illness) at Davis seeks to understand and treat refractory symptoms (cognitive deficits and negative symptoms) at the earliest possible phase of intervention. Research supports the increased likelihood of improved outcome and prevention of complications as hospitalization, school failure, substance abuse, disability and unemployment with an early intervention approach. Dr. Carter reported that EDAPT is one of 5 sites chosen across the nation to participate in the Early Detection and Intervention to Prevent Psychosis (EDIPP) funded by the Robert Wood Johnson Foundation.

He noted also the cognitive remediation study “Randomized clinical trial of intensive computer-based cognitive remediation in first-episode schizophrenia” being jointly conducted by UCSF and UCD. Impaired cognition is a strong predictor of disability in schizophrenia, and hence an important area for treatment investigation. Patients with a recent diagnosis, between the ages of 16 and 30, can contact their closest site (UCSF 415-476-7278 or UC Davis 916-734-0512) for further information regarding this study.


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