| Abstrakt: |
Background Despite advances in pharmacologic and psychosocial treatment of psychotic disorders, most of the affected individuals is still not able to resume previous levels of functioning. The first psychotic episode is a promising period for the development of new therapeutic strategies. The difficulty in early identification, engagement to treatment and side effects are an overlapping phenomena, composing a complex framework for intervention planning. The identification of clinical and biological markers that predict response and indicate better treatments could modify this framework, contributing to the individualization of the treatment. In the last decades, we are watching an increase in studies on early stages of psychosis, but few studies have been conducted in low- and middle-income countries. In 2012, a partnership between schizophrenia research centers in São Paulo, Brazil, proposed a center for research and assistance in the early stages of psychosis, the Grupo de Apoio às Psicoses Iniciais (GAPi), linked to the Universidade Federal de São Paulo. Herein, we describe the study protocol and the clinical and socio-demographic characteristics of our sample. Methods The participants are antipsychotic-naïve first episode psychosis (AN-FEP) individuals, aged between 18 and 35. At the time of admission, the patient signs a consent form, has the blood collected and then undergoes an initial clinical evaluation consisting of the application of the Structured Clinical Interview for DSM-IV (SCID-I). We collect sociodemographic and clinical data such as age of onset of illness, number of hospitalizations, family history of psychosis and history of medications. Individuals who meet inclusion criteria are invited to make a complementary evaluation consisting of PANSS, Calgary Depression Scale for Schizophrenia (CDSS), Addiction Severity Index, Fagerström Test for Nicotine Dependence, CGI-S, and GAF. After inclusion, patients are followed up in the outpatient clinic of the GAPi, and reassessments are performed periodically. All the patients are initially medicated with risperidone and managed by a team of physicians, neuropsychologists and occupational therapists. Group care and family care are also proposed. Results Along the 6 years of the project, we have already interviewed more than 400 patients. The majority are single (76.7%) male individuals (62.6%), with a mean age of 24.2 years. 70.6% live with parents or spouse, while 9.6% live alone. The mean annual income was US$ 2,179. 62.8% has completed the high school and 35.3% were unemployed at the time of first evaluation. 47.7% had migrated at least once and 37.6% had family history of psychosis. The median DUP is 47.5 days. 22.2% of the patients reported previous use of cannabis, 45.4% used it for the first time with 15 years old or less and 53.0% did not use it at the last 30 days before admission. At baseline, 74.0% of the patients was diagnosed with a non-affective psychosis, 17.0% with an affective psychosis and 9.0% with a substance induced psychosis. At baseline, the mean scale scores are: PANSS total score: 91.2 (SD: 21.7); CDSS: 2.5 (4.4) and GAF: 41.3 (23.5). After two months treatment: PANSS total score: 64.6 (23.1); CDSS: 2.2 (3.8) and GAF: 59.0 (16.9). 61.0% of the patients achieved treatment response (considering an improvement of at least 30% on PANSS total score). Discussion As far as we know, this is the biggest Latin American cohort of AN-FEP patients. We aim to make GAPi a reference center in the identification and treatment of the initial stages of psychosis as well as to foment and stimulate the discussion about the adoption of specific strategies for the early treatment in psychiatry in Brazil. [ABSTRACT FROM AUTHOR] |
