NEW YORK (Reuters Health) – In patients with early-onset psychosis, negative symptoms at first episode – lack of motivation, problems with social interaction, and the like – predict multiple antipsychotic treatment failure, researchers report.
“In children and adolescents with psychosis, negative symptoms should be carefully assessed already at first presentation and should make clinicians think about carefully optimizing current pharmacological and non-pharmacological strategies for these patients,” Dr. Laura Pina-Camacho from School of Medicine, Universidad Complutense, Madrid, Spain, told Reuters Health by email.
Dr. Pina-Camacho and colleagues used a machine-learning Natural Language Processing (NLP) approach to extract data from electronic health records and to examine whether negative symptoms at first episode of psychosis predicted antipsychotic treatment failure in 638 patients (mean age, 16) with early-onset psychosis. Schizophrenia was the diagnosis in more than half of the patients.
Multiple treatment failure (MTF) was defined as starting a third trial of a novel antipsychotic because of insufficient response, intolerable adverse effects, nonadherence, or other reasons during a 5-year follow-up from first presentation or before age 18 (whichever came first).
In all, 124 patients (19.3%) developed MTF, according to the January 24 Schizophrenia Bulletin online report.
Of the MTF subgroup, 52.4% had presented with two or more negative symptoms, most commonly with emotional withdrawal.
In adjusted Cox regression models, negative symptoms were associated with a 62% increased risk of MTF during the follow-up period.
Treatment failure among patients with negative symptoms appeared to be driven by a combination of insufficient treatment response and emergence of intolerable adverse effects.
Other factors independently associated with MTF included black ethnicity, older age at first presentation, comorbid diagnoses of autism spectrum disorder, and having a first-degree relative with a psychotic disorder.
“In early-onset psychosis (EOP), negative symptoms at first episode are prevalent and may help identify a subset of children at higher risk of responding poorly to antipsychotics,” the researchers conclude.
“This study also provides evidence for the feasibility of using NLP tools to extract clinically meaningful information from real-world patients’ electronic health records,” Dr. Pina-Camacho said. “The ability to use quick, automated tools to extract information from a large number of patient records has wide-reaching clinical implications and may be useful in identifying subsets of EOP populations that can be fast-tracked to more efficacious interventions.”
Dr. Inmaculada Baeza from the Hospital Clinic of Barcelona’s Institute of Neuroscience, in Spain, who has examined persistent negative symptoms in first-episode psychosis, told Reuters Health by email, “Negative symptoms in patients with early-onset psychosis are linked to worse outcomes than (for) those patients without them.”
“We should pay attention to negative symptoms and try to employ all the therapeutic methods that we can to improve the outcomes of the patients with them,” she said.
SOURCE: http://bit.ly/2sCFMEg
Schizophr Bull 2018.
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