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Patient Scenario 1 - Treating First-Episode Psychosis

1 Treating first-episode psychosis

Footage from the Janssen EMEA Medical Education Satellite Symposium, 26th ECNP Congress, October 2013

Philip McGuire discusses neurobiology aspects of patients experiencing a first psychosis episode. He shows excessive dopamine activity is seen prior to clinical symptoms, and further elevation towards the first episode. Importantly, it is shown to be a presynaptic abnormality, while drugs act post-synaptic by blocking the D2 receptor. These drugs still can have a positive effect, and at much lower concentrations than required for chronic patients, as is shown by imaging.

Silvana Galderisi continues to show clinical data substantiating that although we can treat positive symptoms, current treatment has little effect on persistent negative symptoms (PNSs). Patients with PNSs also more often discontinue treatment. Current treatment options are thus limited, but early intervention and keeping patients in programs is important for best outcome.

Andreas Schreiner notes early treatment can be effective, but relapse rates are high – irrespective of the duration of treatment received or the length of the remission period. High discontinuation rates of anti-psychotics, often on patient initiative. Suggests to consider long acting anti-psychotic treatment earlier – in first episode patients. Trial shows good clinical effects and very much lower relapse rates. Stopping treatment still causes relapse. Not yet in guidelines.

Martin Lambert speaks on integrated care models. Networks that work together to provide integrated care are needed, including an ambulant team. All required expertise is available in the team. Shared decision making used in those patient capable to do this.

A discussion follows these presentations.

Footage comes from the Janssen EMEA Medical Education Satellite Symposium, 26th ECNP Congress, October 2013 Speakers: Chair/Moderator: W Wolfgang Fleischhacker, Austria Panel: Philip McGuire, UK Silvana Galderisi, Italy Martin Lambert, Germany Andreas Schreiner, Germany.