EFFECTIVENESS OF THE COMBINED ANTIPSYCHOTIC AND BRAIN SYNCHRONIZATION THERAPY IN FIRST EPISODE PSYCHOSIS

Abstract

Psychotic disorders are among the most disabling medical conditions with a lifetime prevalence of almost 3%. First Episode Psychosis is the first appearance of full blown psychotic symptoms, which are the prominent presence of delusions and/or hallucinations and/or disorganized speech and/or disorganized behavior (including catatonia) with no insight concerning the nature of these symptoms, denoting a broad impairment in one's capacity to perform critical judgments of reality. Unfortunately, the typical first psychotic episode goes undiagnosed and untreated for 1 to 2 years, which some studies suggest may allow schizophrenia to progress.

The pathophysiological basis of schizophrenia is complex, and remains incompletely understood. Many theories raised to explain the pathophysiology underlying the development of psychosis; it is likely that the disease process is multifactorial and complex.

Patients with a first episode of psychosis have inflammatory like immunological function during early phases of the illness. Several markers of neurobiological changes including dynamic changes in brain structure in the frontal and temporal regions, neurochemical alterations in dopamine and glutamate and evidence for neuro-inflammation through microglial activation.

At the time of first psychotic symptoms, neurobiological processes underlying schizophrenia have already been ongoing for many years. Although increased DA synthesis may be the final common pathway to psychosis, hypofunction of the NMDA receptors, associated decreased GABA-ergic signalling and increased proinflammatory status of the brain may be important mechanisms underlying cognitive dysfunction.

BST is highly effective in psychotic symptoms associated with a broad range of neuropsychiatric conditions. However, the mechanism remains poorly understood particularly with regard to antipsychotic effects. Moreover, BST is an effective and safe intervention used in patients with first-episode psychosis and can be considered an early psychosis intervention.

The study was performed at the Institute of Psychiatry, Ain Shams University. It was designed aiming to assess whether the severity of first episode psychosis is decreasing by antipsychotic-BST combined therapy and whether BST-antipsychotic combined therapy is better than antipsychotic medications used alone.

Our study was carried from June 2015 until December 2015 during which the study included 65 patients all of them were males. The study was conducted on 2 stages. The first stage made of 50 first episode patients treated with BST-antipsychotic combined therapy (BST receivers) and severity of symptoms and treatment response, will be assessed by Brief Psychiatric Rating Scale, Positive and Negative Syndrome Scale and Clinical Global Impression. The second stage will include another 15 first episode patients allocated to a group treated with antipsychotic medications only (BST non-receivers) and the severity of symptoms and treatment response will be compared to the BST receivers.

We found that the percentage of change in the BPRS, PANSS and CGI, from before to after treatment was higher in subjects treated with BST-antipsychotic combined therapy than in subjects treated with antipsychotic medications only. We also found that the mean PSS in subjects treated with combined therapy was higher at admission and lower at discharge, than subjects treated with antipsychotic medications only, indicating that BST is particularly effective in positive symptoms. Moreover, general psychopathology of PANSS, which represents the unspecific symptoms, as tension, anxiety, and depression, showed greater improvement with the combined therapy denoting superiority of BST or the combined therapy over antipsychotics alone in treating anxiety, depression and other comorbid symptoms.

Finally, BST-antipsychotic combined therapy proved to improve the severity of psychotic symptoms in more than antipsychotic medications used alone in the acute treatment of first episode psychosis patients