Chaque forme pharmaceutique présente ses propres avantages et inconvénients acheter du amoxil
mais n'ont pas d'effets néfastes pour l'organisme dans son ensemble.
Clinical practice in early psychosis
Managing incomplete recovery
during first episode psychosis
While the vast majority of young people who
resistance. Thus concerted effort is required to
develop a first episode of psychosis respond well
address incomplete recovery from psychosis
to initial treatment and have a remission of their
early. These will consider the contribution of
symptoms, some young people will continue
illness-, person- and treatment-related factors
to experience symptoms and thus show signs
to the observed poor response to treatment,
of early treatment resistance. Because early
and suggest treatment modifications to achieve
treatment response is thought to be one of the
recovery as soon as possible.
strongest predictors of subsequent outcome,1,2
preventing enduring symptoms of psychosis
This clinical practice point is designed
and associated impaired social functioning
to help clinicians understand:
should be the primary aim of treatment for
• why it is important to address
first episode psychosis (FEP).
Prolonged recovery during the early phases of
• the principles for effective treatment
psychotic illness may have important biological
• how to use evidence-based
and psychosocial consequences, such as:
pharmacological and psychological
ongoing disruption to social, interpersonal and
strategies to address incomplete
vocational functioning; demoralisation due to
recovery in everyday clinical practice.
the experience of powerlessness, fear, isolation;
and development of continued treatment
What is incomplete recovery?
As clinicians, you always Failure to respond to treatment for psychosis has
been traditionally referred to as ‘treatment resistance'.
want to minimise the distress
Research in this field has been hampered by a lack of
of psychotic symptoms [for
consistent definitions of the concept and validated
assessment instruments. The term ‘treatment
young people] … this means
resistance' has been used particularly to describe
actively managing incomplete failure of positive psychotic symptoms to remit
following pharmacological treatment with antipsychotic
medication. This narrow focus on positive symptoms
has stemmed from the traditionally poor recognition
EPPIC, Orygen Youth Health Clinical Program
of other symptoms that affect outcome in psychosis
(e.g. cognitive symptoms) or the belief that certain
Clinical experience has shown that managing
symptom domains were unresponsive to medication
long-term persistent psychosis or treatment resistance
(e.g. negative symptoms). Hence treatment response
is challenging and not always successful so focusing
has been, in the past, largely evaluated on the basis of
on early incomplete recovery is paramount to maximise
effect on positive symptoms, which is a limited view
recovery and avoid persistent illness. This is achieved
that ignores important outcome dimensions like social
by identifying non-adherence, adapting and
and vocational functioning.3
augmenting treatment regimens as early as possible
using individually-focused, comprehensive assessment
However, as treatment outcome goals in psychosis
research have broadened to include functional recovery
and quality of life, the definition of treatment response
and resistance have been reviewed and modified, and
the term ‘incomplete recovery' was deemed more
'Clinically, the broader notion of ‘incomplete recovery'
adapting and augmenting
may be useful, as it acknowledges the presence of
disability in functional and psychosocial aspects that
treatment regimens early
is persistent despite adequate treatment, referring to
psychotherapeutic and psychosocial interventions as
well as antipsychotic medication. Further, unlike the
rather negative label of ‘treatment resistance', the term
‘incomplete recovery' also recognises the potential
and formulation can help
for a better therapeutic outcome.'4
manage incomplete recovery.
It is important to note that there are two types
of incomplete recovery: 1. Treatment resistance, which refers to situations
where people are receiving appropriate evidence-
The prevalence and predictors
based treatments but are inadequately responding
to the treatments and consequently have persistent
of incomplete recovery
symptoms and disability.
The reported prevalence of incomplete recovery from
2. Resistance to treatment, which refers to the
first episode psychosis (FEP) varies (due to varying
situations where people have access to treatment
definitions) but estimates range between 5–45%.3
but are non-adherent or are disengaged.
For schizophrenia specifically, it is estimated that
20–30% of individuals do not respond sufficiently
This description highlights the importance of
to an initial trial of antipsychotic trial8 and treatment
considering treatment engagement and adherence
resistance at 12 months is evident in at least 10%
when incomplete recovery is observed.
Both types of incomplete recovery need to be
addressed in order to maximise rates of recovery
Research has found the following risk factors
in young people with early psychosis.
of incomplete recovery from FEP:10• longer untreated duration of psychosis (DUP)• poorer premorbid functioning
The importance of addressing
• severe symptoms
• ongoing substance abuse
It is crucial to address incomplete recovery in early
• cognitive deficits
psychosis because there is evidence that links
early treatment response to favourable outcomes.
For example, evidence suggests that early recognition
• non-adherence with medication
of treatment resistance and subsequent treatment
• poor response in first 6–12 weeks
adaptation are related to a greater likelihood of
remission,5 and that remission at 3 months of both
• disengagement from the early psychosis service
positive and negative psychotic symptoms is related
• male gender.
to good functional recovery at 2 year follow-up.6
Further, early response to treatment is the strongest
Encouragingly, there is evidence that engagement
predictor of remission and recovery in first episode
with a comprehensive early psychosis treatment
service is a good prognostic indicator.11
Principles for managing incomplete
Interventions for incomplete recovery
recovery in FEP
Based on the principles outlined above, a range of
There are a number of broad principles that clinicians
strategies are used to manage incomplete recovery
can use to manage incomplete recovery. These are
from FEP. These will be described in further detail
based on the fundamental principles of the early
below, along with appropriate examples or practical
psychosis model. A key principle is for services
tips where possible.
to work to reduce DUP because research has
demonstrated that this will reduce the prevalence of
Prioritise engagement with the young person
incomplete recovery. Promoting early identification
Establishing a good therapeutic relationship with young
of psychosis, and providing easy and rapid access to
people is fundamental in successfully treating early
appropriate services are mechanisms for reducing DUP.
psychosis. This is particularly important where recovery
Once a person is linked into an early psychosis service,
is slow or incomplete. These young people may have
it is essential that the service is able to assess and
more difficulty than usual in engaging with the treating
begin treatment without delay.
team due to ongoing symptoms or social or cultural
barriers that may also be influencing their recovery.
Significant efforts need to be made by clinicians to
Incomplete recovery should be
engage young people who are experiencing incomplete
identified as early as possible, ideally
recovery so that they can develop a collaborative
by 3 months after commencing
shared understanding of the factors contributing
treatment. This allows clinicians to consider
to their mental ill-health.
the situation prior to symptoms becoming entrenched and the potential to avoid possible toxic effects of ongoing psychosis. Young
Case scenario: Maha
people who continue to experience psychotic symptoms after 3 months of treatment should
Maha, a 21-year-old female of Iranian
be identified in case review and/or supervision
background, has been coming to the service
meetings, and plans made for review and
for 5 months. She continues to experience
auditory hallucinations and believes that she is
being monitored by cameras in her house and
neighbourhood. Maha has been very guarded
in therapy sessions and unwilling to discuss the
As with all cases of early psychosis, but especially
nature of her auditory hallucinations, merely
where there is slower than expected recovery, it is
nodding in agreement to the question ‘Do you
essential to instil hope and convey a sense of optimism
that things will improve. Demoralisation in the face
of continuing psychosis is a significant risk and
Slowly, Maha's case manager began to build a
complicates recovery-focused treatment.
rapport with her by being warm and interested
in her life. They discussed Maha's relationship
After detection of incomplete recovery, a comprehensive
with her recently-deceased mother. Eventually,
review of the case assessment and formulation should
Maha was able to disclose that she was hearing
be undertaken with the aim of gaining a thorough
her mother's voice telling her not to take her
and extensive understanding of the young person,
medication as it would make her sick, and not
their history, their experience of treatment to date,
to talk to mental health workers because they
their social and cultural contexts, and their hopes
were untrustworthy. Maha revealed that she
and aspirations. It is important to look for, and treat
had never taken her prescribed antipsychotic
any comorbidities, and check that all appropriate
investigations have been conducted. This enables
a review of diagnosis and the adequacy of the
After psychoeducation about the nature
treatment provided so far, and to ensure that any illness
of psychotic symptoms using first-person
factors or barriers to treatment effectiveness can be
accounts, Maha accepted her case manager's
identified and addressed. Special consideration of
suggestion of a carefully monitored, 3-month
substance use is important as this is a very common
trial of antipsychotic medication.
factor in incomplete recovery from FEP.
Similarly, the crucial role of family and other social
Ensure that the appropriate
connections in supporting a young person's recovery
pharmacotherapy is being used
should be remembered. Clinicians need to engage with
It is important to review the use of antipsychotic
families, friends and other significant supports to enlist
medication when considering incomplete recovery.
their help to understand the young person's difficulties
Medication that the young person has been prescribed
and strengths. These strengths can then be harnessed
for psychosis and its effectiveness needs to be
with the support from family and friends.
reviewed to ensure that they have received adequate
doses of appropriate medication. It is recommended
Ensure a thorough assessment
that young people with FEP are prescribed an initial
has been completed
second generation antipsychotic medication (SGA)
Detecting incomplete recovery should be a trigger
for 6 weeks and then, if psychotic symptoms have not
for a comprehensive review of the initial assessment
remitted, switched to another SGA. For a more detailed
of the young person and their progress to date.
explanation of the recommended pharmacological
This will include ensuring that all appropriate
treatments in FEP, please see the ENSP manual:
physical investigations have been conducted and
Medical management in early psychosis: a guide
results reviewed to eliminate any physical cause
for medical practitioners.
for psychosis. Psychometric testing may assist in
understanding the young person, and it is essential that
Target medication non-adherence
a thorough understanding of the young person's social
It is important to review young people's adherence
circumstance, including family functioning is obtained.
to their medication regimen when managing
Similarly, a detailed developmental history is required
incomplete recovery because non-adherence with
so that a complete picture of the young person's
pharmacotherapy is extremely common in all branches
situation can inform decisions about interventions
across the entire biopsychosocial spectrum. Finally,
the diagnosis and therefore the appropriateness of
Non-adherence with pharmacotherapy has particular
treatments prescribed to date should be reviewed
risks in psychosis and is often the reason behind
following comprehensive evaluation of the
cases of incomplete recovery, as illustrated in the
case example of Maha above. Considerable research
has been devoted to trying to find ways to improve
adherence with prescribed medications, and is a topic
that receives less time and attention from clinicians
When incomplete recovery has been detected it is important that
than it warrants. A range of factors have been shown
to influence medication adherence (see Table 1),
clinicians ensure a comprehensive
and it is important to consider each individual's
biopsychosocial assessment has been
situation when choosing interventions. Collaborating
conducted. This should be reviewed,
with young people using a shared decision-making
updated and improved to allow treatment
approach to de-stigmatise mental health treatment
recommendations to be re-evaluated.
and empowering them to take responsibility for their
wellbeing is an important part of effectively managing
Table 1. Factors associated with non-adherence to medication in psychotic illness12-14
Beliefs about treatment
Service contact frequency
Continuity of care
Access to different
Interventions for non-adherence fall into two broad
However, there is ongoing debate about the efficacy of
categories: pharmacological and psychosocial.
LAIs with recent evidence from randomised controlled
trials failing to indicate a superiority of LAIs over oral
medication in reducing relapse rates or promoting
Addressing non-adherence to prescribed antipsychotic
recovery.15 This is in contrast to several naturalistic
medication requires optimising pharmacotherapy
studies that have demonstrated superiority for LAIs in
by working with the young person to find the best
reducing rehospitalisation rates.12 It has been suggested
medication to treat their symptoms while minimising
that people do not stay on LAIs for very long and that
any side effects, this includes finding the lowest
this may partially explain these results. Given their
effective dose. This means that there must be close
uncertain superiority, it is imperative that LAIs only
communication and collaboration between the young
be used with young people with early psychosis with
person, the treating team and other significant supports
their fully informed consent and where there is a good
to understand the overall effect of the medication.
clinical reason to do so.
Clinicians should also consider the young person's
attitude and preferences regarding medication. Using
Psychosocial interventions for non-adherence
a shared decision-making approach will help find the
Psychological interventions targeting non-adherence
best treatment for the young person and enhance
to medications include: psychoeducation, cognitive–
adherence to this. For more information, please see
behavioural therapy (CBT) and motivational
the clinical practice point Shared decision making.
interviewing. Results of studies investigating the
effectiveness of these interventions have been mixed,
Long-acting injectable (LAIs) antipsychotic
with some studies showing benefits of treatment on
medications were developed as the ideal remedy for
adherence, treatment acceptance and insight but
poor adherence in psychotic disorders and proposed to
others failing to do so. Multifaceted interventions
offer the following benefits over oral medication:12
combining CBT, family interventions and community-
• reduced family conflict around taking medication
based approaches appear to be the most successful.16
• guaranteed delivery of medication• stable blood levels• clear signalling of non-adherence.
Persistent positive symptoms
Beyond pharmaceutical agents, there is considerable
The majority of work in incomplete recovery
interest, research activity and emerging support for
in psychosis has been around persistent positive
the use of anti-inflammatory agents such as aspirin,
psychotic symptoms because this was how the
N-acetylcysteine (NAC) and omega-3 fatty acids
concept was originally defined. There was also a lack
(fish oil) to augment antipsychotic treatments.18,19
of recognition of the other symptoms of psychosis:
functional outcomes and symptoms beyond positive
Persistent positive psychotic symptoms are usually
difficult for young people to cope with and can lead
to feeling hopeless and disillusioned with treatment.
A common response to incomplete remission of
There may be the sense that things will never
positive psychotic symptoms is to increase the dose
improve, and powerful feelings of loss about both
of antipsychotic medication or to introduce a second
their future and former self. It is extremely important
antipsychotic agent. However, evidence suggests
that clinicians convey a sense of hope for recovery
that an increase in antipsychotic dose above a
and enhance coping strategies with every young
moderate level is of little benefit, and currently, there
person. Collaboratively exploring the young person's
is no support for the efficacy of using combinations
experience of psychosis in a non-judgmental manner
of antipsychotic medications, thus antipsychotic
engages them and reassures them that their problems
monotherapy is strongly preferred.17 Instead, when
are being taken seriously.
response to an antipsychotic medication is considered
Psychological therapy for persisting positive psychotic
suboptimal, it is recommended that the antipsychotic
symptoms aims to foster the belief that it is possible
medication be changed to one with a different receptor
to manage and tolerate psychotic symptoms. Further,
profile that may be better suited to the individual.
therapy can assist young people to gain awareness
It is also recommended that clozapine be introduced
of, and control over, things that trigger or exacerbate
early in the course of incomplete recovery from
symptoms. These may be internal or external events
psychosis. Clozapine should be considered when
that the young person can learn to exert an influence
symptoms persist despite the sequential use of two
over and, therefore, regain some power over their
SGAs (at effective doses) for at least 6–8 weeks.
Clozapine has been shown to be effective for both
Psychological therapy for persistent positive psychotic
positive and negative persistent symptoms of
symptoms draws on psychoeducation, CBT principles
psychosis. While many antipsychotic medications
and the personal meaning of psychosis for the
are thought to have ‘mind-dulling' effects linked
individual. Components include:
with negative symptoms, clozapine does not seem
to have this effect. In addition, there is a low risk
• developing a strong therapeutic relationship between
of extrapyramidal side effects from clozapine.
the therapist and the young person
• developing a thorough understanding of the young
person's history, illness onset, beliefs, aspirations,
explanatory model of psychosis, and the impact of
Although clozapine is considered the most efficacious of antipsychotic
the psychotic illness
available, its use is restricted to
• providing psychoeducation about substance use,
those with incomplete response or intolerance
other comorbidities, psychotic symptoms and the
of other antipsychotic medications due to the
interactions between them
risk of agranulocytosis. Agranulocytosis is
• discussing the stress–vulnerability model
an acute disease characterised by a dramatic
of psychosis and normalising explanations
decrease in the production of granulocytes
of psychotic experiences
(mature white blood cells) which means that
• developing coping strategies (both cognitive and
the body is susceptible to infections. This
behavioural) for positive psychotic symptoms
risk requires haematological monitoring on
• working with beliefs about psychotic symptoms
a weekly basis for the first 6 months, and
to reduce their impact, and examining alternative
monthly thereafter, to ensure that clozapine
can continue to be used safely.
• using behavioural experiments to test explanations
and develop better awareness and management
of emotional arousal
• working to understand the personal relevance
and meaning of symptoms.
Persistent negative symptoms
Persistent negative symptoms have received less
Careful and thorough psychological assessment
attention than positive symptoms but are beginning
of persistent negative symptoms will help clinicians
to be the focus of research efforts. Hovington et al
formulate the psychological factors underpinning the
found that persistent negative symptoms are present in
negative symptoms and provide treatment targets.
about 27% of people with FEP.20 However, the authors
Social withdrawal may be an understandable, self-
noted that definitions of persistent negative symptoms
protective reaction to overwhelming anxiety, blunting
varied and included: severity, duration and aetiology,
may be to avoid distress, and there may be strong
thus hampering efforts to characterise this problem
avoidance in the face of continuing positive psychotic
and develop appropriate treatments. It is important to
symptoms. Demoralisation and hopelessness can
assess and treat persistent negative symptoms as they
be due to fear, guilt, shame, and stigma can underlie
are consistently associated with poor functioning 1 year
extreme inactivity. All of these may manifest
after beginning treatment.
as negative symptoms and be targeted within
Although there are currently no widely accepted
The relationship and rapport between the clinician and
medications for negative symptoms, considerable
young person is paramount; therefore, session length,
research is being undertaken and promising
pace, location and frequency may need to be adapted
suggestions are emerging. Amisulpride has the
when severe negative symptoms are present to cope
most evidence supporting its effectiveness as an
with response latency and cognitive deficits.
antipsychotic monotherapy to treat negative
Developing a formulation that incorporates a
symptoms.21 The other strategy commonly employed
hypothesis about the negative symptoms forms the
is to add one of a number of promising agents as an
basis of therapy, and provides the framework and
adjunct to the currently used antipsychotic treatment.
rationale for interventions. Clinicians should repeatedly
Modest evidence supports the use of adjunctive
communicate a sense of optimism and realistic hope
antidepressant therapy, and there is limited but
for recovery when working with young people around
growing evidence for other agents (minocycline,
modafinil, armodafinil and galantamine, see Arango,
Garibaldi and Marder for review).21 There are also
Elements that can be included in psychological work to
non-pharmacological experimental treatments being
address negative symptoms are presented in Box 1.
developed such as transcranial magnetic stimulation
and direct current stimulation with some initial
promising findings. The treatment of negative
Box 1. Components in psychological
psychotic symptoms is a rapidly advancing field
work to help manage negative
and stronger recommendations are likely to appear
symptoms of psychosis
in the near future.
The following components can be included to
Clinical experience at EPPIC in Melbourne suggests
manage negative symptoms of psychosis:
the following steps in approaching persistent negative
• enhancing knowledge of self as distinct from
symptoms in FEP.
the psychotic illness (e.g. what else is the
1. Carefully assess whether persisting positive
young person about?)
symptoms are responsible for the appearance of
• recognising personal strengths and identity
negative symptoms. For example, ongoing paranoia
may explain inactivity and reluctance to leave the
• challenging self-defeating beliefs
home. It is important to review whether there has
• addressing stigma about mental illness
been an initial response to treatment, or whether
• gradually increasing exposure to anxiety
positive symptoms are persisting.
provoking and challenging situations
2. Check for extrapyramidal side effects as these can
• enhancing coping skills repertoire
include slowing of mind and activity.
• building structure and pleasurable activities
3. Check for depression and treat if present using
gradually into daily routine
psychological or pharmacological therapy, or both.
• addressing comorbidities such as depression,
4. Consider treating depression even if not clearly
post-traumatic stress disorder and substance
present. Antidepressant medications have shown
efficacy for negative symptoms, and depression
may be present but undetected.
5. Trial amisulpride as substitute or additional
Persistent negative symptoms are the hardest
to deal with because they usually involve low motivation and
energy. You have to get to know the young person and their
history really well. You need to talk to their family so that you
can try to tap into things they have enjoyed … and get them
doing those things again. You have to be really positive about
them recovering but also let them know that it takes time.
EPPIC, Orygen Youth Health Clinical Program
TREAT encourages the early detection of incomplete
Case management tasks that address quality and
recovery through the clinical review system from
meaningfulness of life are also important in combatting
3 months after service entry and the monitoring
persistent psychotic symptoms (both positive and
of those considered to be at risk. Presenting the
negative). People need to have adequate housing and
case to the panel at approximately 6 months of
finances, and meaningful activities to be fully healthy,
persistent symptoms facilitates a comprehensive
and it is likely that this is also integral to achieving
case and treatment review. This also supports the
recovery from psychosis. Moreover, under the broader
treating team to implement assertive and systematic,
banner of psychosocial interventions, very recent
guideline-concordant treatment. Recommendations
evidence is emerging about the benefits of physical
are made regarding ongoing treatment across the
exercise for people with enduring psychosis. Positive
biopsychosocial domains with the aim of accelerating
results for an exercise intervention have been reported
recovery. This may include expanding the treatment
by Kahn and Sommer.22
team to include senior clinical specialists (e.g. family
specialist or a senior clinical psychologist), which helps
develop expertise in working with complex cases.
Service-level response – the TREAT
The TREAT review ensures that all components
example from EPPIC, Melbourne
of comprehensive treatment for FEP have been
provided to young people and their families, and
With the overarching goal of providing early
problem-solves where this has not yet been achieved.
intervention for psychosis to minimise disability
There are opportunities for further TREAT reviews
and maximise recovery, EPPIC has found it valuable
so that progress can be monitored and clinicians
to develop a specialised subprogram to address
are supported in helping the young person.
incomplete recovery. Termed the Treatment Resistance
Early Assessment Team (TREAT), this subprogram
Experience has demonstrated that it is helpful to
developed a framework for managing young people
have all cases of persisting psychosis presented to
who experienced prolonged recovery from FEP.
the TREAT meeting regardless of the putative cause
TREAT comprises a multidisciplinary team of senior
of the ongoing psychosis. It is important that the
clinicians with expertise and interest in the biological,
review process is routine for the service, supported
psychological and social aspects of persistent psychotic
by management and experienced as supportive and
collegial by the treating clinicians.
I was seeing a young man, Jack, who
did not seem to be getting better – he still
Incomplete recovery is an important focus for early
had auditory hallucinations and was not
psychosis services because early treatment response
leaving his house except for appointments.
is predictor of outcome. Enduring psychosis increases
I discussed his lack of progress with
the risks of greater functional impairment and damage
his doctor and we decided to ask the
to social relationships. Incomplete recovery should be
TREAT panel to review his case. We both
detected as early as possible so that concerted efforts
attended the meeting and presented our
can be made to review and adjust treatment offered
to avoid developing entrenched persistent psychosis.
assessment, formulation and the treatment
It is recommended that early psychosis services
he had had since first coming to the service
consider how to detect incomplete recovery in their
6 months ago. The TREAT panel noted
young people and how best to support clinicians
the over-protectiveness of Jack's mother
to help their young people recover.
and suggested that she be offered some
sessions with the family worker. It was
also recommended that Jack's medication
be changed as he did not seem to be
responding to quetiapine.
The doctor and I felt supported by the
senior clinicians at TREAT, and Jack had
improved (although he still had many
problems) when we returned for another
TREAT review after 3 months.
EPPIC, Orygen Youth Health Clinical Program
talks about Jack and the TREAT experience
1. Correll CU, Malhotra AK, Kaushik S et al. Early prediction of antipsychotic response
17. Dold M and Leucht S. Pharmacotherapy of treatment-resistant schizophrenia:
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a clinical perspective. Evid Based Mental Health
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2. Leucht S, Busch RB, Kissling W et al. Early Prediction of Antipsychotic Nonresponse
18. Berk M, Malhi GS, Gray LJ et al. The promise of N-acetylcysteine in
Among Patients With Schizophrenia. J Clin Psychiatry
2007; 68: 352-360.
neuropsychiatry. Trends Pharmacol Sci
2013; 34: 167-77.
3. Pantelis C and Lambert TJR. Managing patients with "treatment-resistant"
19. Sommer IE, van Westrhenen R, Begemann MJ et al. Efficacy of anti-inflammatory
schizophrenia. Medical Journal of Australia
2003; 178: S63-S66.
agents to improve symptoms in patients with schizophrenia: an update. Schizophr
4. Barnes TRE and Dursun S. Treatment resistance in schizophrenia. Psychiatry
2014; 40: 181-91.
20. Hovington C, Bodnar M, Joober R et al. Identifying persistent negatice symptoms
5. Lambert M, Naber D, Schacht A et al. Rates and predictors of remission and
in first episode psychosis. BMC Psychiatry
2012; 12: 1-11.
recovery during 3 years in 392 never-treated patients with schizophrenia. Acta
2008; 118: 220-9.
21. Arango C, Garibaldi G and Marder SR. Pharmacological approaches to treating
negative symptoms: a review of clinical trials. Schizophr Res
2013; 150: 346-52.
6. Cassidy CM, Norman R, Manchanda R et al. Testing definitions of symptom
remission in first-episode psychosis for prediction of functional outcome at 2 years.
22. Kahn RS and Sommer IE. The neurobiology and treatment of first-episode
2010; 36: 1001-8.
schizophrenia. Mol Psychiatry
2015; 20: 84-97.
7. Schennach-Wolff R, Jäger M, Mayr A et al. Predictors of response and remission in
the acute treatment of first-episode schizophrenia patients — Is it all about early
response? European Neuropsychopharmacology
2011; 21: 370-378.
The EPPIC National Support Program of Orygen, The National
8. Hasan A, Falkai P, Wobrock T et al. World Federation of Societies of Biological
Centre of Excellence in Youth Mental Health, has produced this
Psychiatry (WFSBP) Guidelines for Biological Treatment of Schizophrenia, part
document as part of its work to support the implementation of
1: update 2012 on the acute treatment of schizophrenia and the management of
treatment resistance. World J Biol Psychiatry
2012; 13: 318-78.
the EPPIC model within headspace, the National Youth Mental
9. Edwards J, Cocks J, Burnett P et al. Randomized Controlled Trial of Clozapine and
Health Foundation, in Australia.
CBT for First-Episode Psychosis with Enduring Positive Symptoms: A Pilot Study.
Schizophr Res Treatment
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10. ENSP Medical Management Writing Group. Medical management in early psychosis:
a guide for medical practitioners.
Orygen Youth Health Research Centre, 2014.
This information is provided for general educational and
11. Addington J, Leriger E and Addington D. Symptom outcome one year after
admission to an early psychosis program. Can J Psychiatry
2003; 48: 204-7.
information purposes only. It is current as at the date of
publication and is intended to be relevant for all Australian
12. Kane JM, Kishimoto T and Correll CU. Non-adherence to medication in patients
with psychotic disorders: epidemiology, contributing factors and management
states and territories (unless stated otherwise) and may not be
strategies. World Psychiatry
2013; 12: 216-26.
applicable in other jurisdictions. Any diagnosis and/or treatment
13. Lacro JP, Dunn LB, Dolder CR et al. Prevalence of and risk factors for medicarion
decisions in respect of an individual patient should be made based
nonadherence in patients with schizophrenia: A comprehensive review of recent
on your professional investigations and opinions in the context of
literature. J Clin Psychiatry
2002; 63: 892-909.
the clinical circumstances of the patient. To the extent permitted
14. Velligan DI, Weiden PJ, Sajatovic M et al. The expert consensus guideline series:
Adherence problems in patients with serious and persisitent mental illness.
by law, Orygen, The National Centre of Excellence in Youth
J Clin Psychiatry
2009; 70: 1-46.
Mental Health, will not be liable for any loss or damage arising
15. Haddad PM, Kishimoto T, Correll CU et al. Ambiguous findings concerning
from your use of or reliance on this information. You rely on your
potential advantages of depot antipsychotics: in search of clinical relevance.
own professional skill and judgement in conducting your own
Curr Opin Psychiatry
2015; 28: 216-21.
health care practice. Orygen, The National Centre of Excellence
16. Barkhof E, Meijer CJ, de Sonneville LM et al. Interventions to improve adherence
to antipsychotic medication in patients with schizophrenia--a review of the past
in Youth Mental Health, does not endorse or recommend any
decade. Eur Psychiatry
2012; 27: 9-18.
products, treatments or services referred to in this information.
Orygen, The National Centre of Excellence in Youth Mental Health is the world's leading research and knowledge translation organisation focusing on mental ill-health in young people.
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Jorge Zepeda Patterson, economista y «No era el primer hombre que moría en bra- sociólogo, hizo maestría en la Flacso (Facultad zos de Milena, pero sí el primero que lo hacía VALIDA COMO PRUEBA DE COLOR Latinoamericana de Ciencias Sociales) y estu- por causas naturales. Aquellos a los que había EXCEPTO TINTAS DIRECTAS, STAMPINGS, ETC. dios de doctorado en Ciencia Política en la
3 – 7 September 2007 Hobart, Tasmania AUSTRALIA THE ORGANISERS OF THE 6th INTERNATIONAL PENGUIN CONFERENCE GRATEFULLY ACKNOWLEDGE THE FOLLOWING SPONSORS AND SUPPORTERS OF THE CONFERENCE. Sponsors Supporters 3 – 7 September 2007 Hobart, Tasmania AUSTRALIA