Depresja psychotyczna – Zapobieganie i profilaktyka

Depresja psychotyczna
Zapobieganie i profilaktyka

Depresja psychotyczna, jako ciężka forma zaburzenia depresyjnego (MDD), charakteryzuje się obecnością objawów psychotycznych, takich jak urojenia i halucynacje, co wymaga kompleksowego podejścia profilaktycznego. Kluczowym elementem jest zapobieganie nawrotom epizodów depresyjnych, które predysponują do rozwoju objawów psychotycznych. Farmakoterapia podtrzymująca, zwłaszcza terapia skojarzona lekiem przeciwdepresyjnym i przeciwpsychotycznym, jest rekomendowana jako leczenie pierwszego rzutu, potwierdzone przez wytyczne APA (2010), NICE (2009) oraz Brytyjskiego Towarzystwa Psychofarmakologicznego. Lit, stosowany w dawkach monitorowanych, jest skuteczny w profilaktyce ciężkiej, epizodycznej depresji jednobiegunowej z objawami psychotycznymi, zwłaszcza przy co najmniej dwóch epizodach w ciągu 5 lat. Terapia elektrowstrząsowa (ECT) pozostaje efektywną metodą leczenia ostrych epizodów, jednak wymaga kontynuacji farmakoterapii w celu zapobiegania nawrotom. Dodatkowo, suplementacja długołańcuchowymi kwasami omega-3 (700 mg EPA i 480 mg DHA dziennie) wykazuje potencjał w redukcji ryzyka progresji do psychozy u osób z podprogowymi objawami psychotycznymi, przy minimalnym ryzyku działań niepożądanych.

Profilaktyka depresji psychotycznej

Farmakologiczne strategie profilaktyczne
Elektrowstrząsy w profilaktyce nawrotów
Interwencje psychologiczne i psychospołeczne
Wczesna identyfikacja i interwencja
Modyfikacja czynników ryzyka
Ograniczenia obecnych badań i przyszłe kierunki
Podsumowanie zaleceń profilaktycznych
Kolejne rozdziały

Profilaktyka depresji psychotycznej

Depresja psychotyczna jest ciężką postacią zaburzenia depresyjnego (MDD), charakteryzującą się występowaniem objawów psychotycznych, takich jak urojenia, halucynacje oraz zaburzenia psychomotoryczne. Ze względu na swoją złożoność oraz nasilenie objawów, profilaktyka tego schorzenia stanowi istotne wyzwanie kliniczne. Kluczowym elementem w zapobieganiu depresji psychotycznej jest przede wszystkim zapobieganie nawrotom epizodów depresyjnych, ponieważ to właśnie one „otwierają drzwi” do rozwoju towarzyszących im objawów psychotycznych.¹²

Farmakologiczne strategie profilaktyczne

Profilaktyka farmakologiczna odgrywa kluczową rolę w zapobieganiu nawrotom depresji psychotycznej. Według dostępnych danych, kontynuowanie leczenia przeciwdepresyjnego istotnie zmniejsza ryzyko nawrotu tak długo, jak jest ono podtrzymywane.³ W przypadku pacjentów z depresją psychotyczną, obecne wytyczne wskazują na kilka skutecznych strategii:

Terapia litem

Lit jest skutecznym lekiem w profilaktyce depresji jednobiegunowej, szczególnie w przypadku depresji melancholicznej oraz depresji z urojeniami, wykazującej wyraźnie epizodyczny przebieg.⁴ Badania wskazują, że lit stanowi efektywną opcję profilaktyczną dla starannie wyselekcjonowanych pacjentów z depresją jednobiegunową i jest bezpieczny, gdy przepisywany jest w zalecanych dawkach/poziomach stężenia litu w osoczu oraz przy regularnym, dokładnym monitorowaniu.⁵

Wskazania do profilaktyki litem obejmują ciężką, wyraźnie epizodyczną depresję jednobiegunową, która nie reaguje na leczenie przeciwdepresyjne. Istotnym kryterium praktycznym do rozpoczęcia profilaktyki litem jest wystąpienie 2 epizodów depresji w ciągu 5 lat, szczególnie w przypadku ciężkiej depresji z objawami psychotycznymi, wysokim ryzykiem samobójczym oraz zwłaszcza u pacjentów, u których można podejrzewać występowanie bipolarnego podłoża choroby.⁶ Terapia podtrzymująca litem jest zdecydowanie zalecana w długoterminowym leczeniu wybranych pacjentów z depresją jednobiegunową ze względu na silne dowody potwierdzające jej skuteczność w zapobieganiu epizodom oraz unikalne działanie przeciwsamobójcze.⁷

Terapia skojarzona przeciwdepresyjna i przeciwpsychotyczna

Kombinacja leku przeciwdepresyjnego i przeciwpsychotycznego jest najczęściej przepisywanym schematem po zakończeniu terapii elektrowstrząsami (ECT) w celu zapobiegania nawrotom depresji psychotycznej u pacjentów leczonych wcześniej z jej powodu.⁸ Przegląd Cochrane wykazał, że połączenie leku przeciwdepresyjnego z przeciwpsychotycznym jest skuteczniejsze w leczeniu depresji psychotycznej niż monoterapia lekiem przeciwdepresyjnym, monoterapia lekiem przeciwpsychotycznym lub placebo.⁹

Aktualne wytyczne Amerykańskiego Towarzystwa Psychiatrycznego (2010), NICE (2009) oraz Brytyjskiego Towarzystwa Psychofarmakologicznego zalecają kombinację leku przeciwdepresyjnego i przeciwpsychotycznego jako leczenie pierwszego rzutu w farmakoterapii depresji psychotycznej.¹⁰ Warto jednak zaznaczyć, że terapia skojarzona może prowadzić do zwiększonej liczby działań niepożądanych, dlatego ważne jest monitorowanie terapii pod kątem skutków ubocznych oraz zaprzestanie stosowania leku przeciwpsychotycznego tak szybko, jak to możliwe.¹¹

Według badań, olanzapina wydaje się być skuteczna i bezpieczna dla pacjentów z depresją psychotyczną. Jej wyjątkowy profil farmakologiczny może czynić ją szczególnie użyteczną w leczeniu depresji psychotycznej, zarówno w monoterapii, jak i w połączeniu z lekami przeciwdepresyjnymi.¹²

Kwasy omega-3 jako obiecująca opcja profilaktyczna

Długołańcuchowe wielonienasycone kwasy tłuszczowe omega-3 (n-3 PUFA) są niezbędne dla rozwoju i funkcjonowania układu nerwowego. Jako kluczowe składniki błon komórek mózgowych, odgrywają one istotną rolę w utrzymaniu zdrowia mózgu i zapobieganiu zaburzeniom psychicznym.¹³ Badania kliniczne sugerują, że kwasy omega-3 mogą zmniejszać nasilenie depresji oraz redukować ryzyko progresji do zaburzeń psychotycznych u osób z podprogowymi stanami psychotycznymi.¹⁴

W badaniu wiedeńskim wykazano, że 12-tygodniowa interwencja z zastosowaniem kapsułek z olejem rybim (zawierających 700 mg kwasu eikozapentaenowego i 480 mg kwasu dokozaheksaenowego dziennie) w porównaniu z kapsułkami placebo znacząco zmniejszyła ryzyko progresji do zaburzenia psychotycznego podczas całego okresu obserwacji.¹⁵ Skumulowany wskaźnik konwersji do psychozy w długoterminowej obserwacji wynosił 9,8% (4/41) badanych w grupie przyjmującej kwasy omega-3 PUFA i 40% (16/40) badanych w grupie placebo.¹⁶

Ponieważ kwasy omega-3 PUFA nie mają klinicznie istotnych działań niepożądanych i są uważane za ogólnie korzystne dla zdrowia, są one idealne do wskazanej profilaktyki psychozy.¹⁷ Badanie to, pierwsze tego rodzaju, sugeruje, że kwasy omega-3 PUFA mogą stanowić realną długoterminową strategię profilaktyczną z minimalnym związanym ryzykiem u młodych osób o bardzo wysokim ryzyku psychozy.¹⁸

Elektrowstrząsy w profilaktyce nawrotów

Terapia elektrowstrząsowa (ECT) jest skuteczna w leczeniu ostrych epizodów depresji psychotycznej.¹⁹ Może stanowić najszybszą metodę leczenia, jednak konieczna jest kontynuacja terapii, często obejmująca leki przeciwdepresyjne, aby zapobiec nawrotowi objawów.²⁰ Brakuje jednak odpowiednio zaawansowanych badań, które bezpośrednio oceniałyby skuteczność farmakoterapii przeciwpsychotycznej w zapobieganiu nawrotom depresji psychotycznej po terapii elektrowstrząsowej.²¹

Interwencje psychologiczne i psychospołeczne

Chociaż nie zidentyfikowano konkretnych dowodów dotyczących interwencji psychologicznych specyficznie dla osób z depresją psychotyczną, eksperci sugerują, że interwencje psychologiczne prowadzone przez praktyków z doświadczeniem i specjalistycznym szkoleniem w pracy z osobami z psychozą i depresją mogą być również skuteczne w przypadku depresji psychotycznej.²² Psychologowie opracowali już protokoły specjalnie zaprojektowane dla osób zagrożonych rozwojem psychozy, a skuteczność tych psychoterapii prawdopodobnie szybko poprawi się w nadchodzących latach.²³

Wczesna identyfikacja i interwencja

Badania wskazują, że wczesna identyfikacja osób zagrożonych rozwojem zaburzeń psychotycznych jest kluczowa dla skutecznej profilaktyki. Według nowego badania, prawie 75% młodych osób z zaburzeniem psychotycznym miało co najmniej jedną wizytę w placówce zdrowia psychicznego w ciągu trzech lat przed pierwszą diagnozą tego zaburzenia.²⁴

Czynniki takie jak wcześniejsze przyjęcia do szpitala związane ze zdrowiem psychicznym, wizyty na oddziale ratunkowym oraz wcześniejsza diagnoza zaburzenia związanego z używaniem substancji mogą wskazywać na zwiększone ryzyko zaburzenia psychotycznego.²⁵ Celem jest zwiększenie zrozumienia, kto jest zagrożony psychozą i, co najważniejsze, jak złagodzić to ryzyko poprzez wcześniejszą interwencję.²⁶

Modyfikacja czynników ryzyka

Najbardziej produktywnym podejściem do profilaktyki psychozy jest unikanie ekspozycji na czynniki zwiększające ryzyko.²⁷ Dlatego jako początkowy krok w kierunku uniwersalnej profilaktyki pierwotnej, zalecane są kampanie zdrowia publicznego mające na celu edukowanie młodych ludzi o szkodliwości regularnego używania marihuany o wysokiej potencji.²⁸

Dla osób o wysokim ryzyku rozwoju zaburzeń psychotycznych, na przykład tych, które mają rodzinną historię schizofrenii, unikanie narkotyków, takich jak marihuana i alkohol, może pomóc w zapobieganiu lub opóźnianiu wystąpienia tych schorzeń.²⁹

Strategie, które mogą pomóc zapobiegać depresji w ogólności, obejmują:³⁰

Podejmowanie kroków w celu kontrolowania stresu, zwiększenia odporności i podniesienia samooceny
Kontakt z rodziną i przyjaciółmi, szczególnie w czasach kryzysu
Podjęcie leczenia przy najwcześniejszych oznakach problemu
Rozważenie długoterminowego leczenia podtrzymującego w celu zapobiegania nawrotom objawów

Ograniczenia obecnych badań i przyszłe kierunki

Istnieją ograniczone dowody na temat najskuteczniejszych interwencji w leczeniu depresji psychotycznej.³¹ Brak dowodów dotyczących interwencji psychologicznych lub psychospołecznych stosowanych samodzielnie lub w połączeniu z farmakoterapią stanowi dalsze ograniczenie.³² Warto zauważyć, że żadne z badań nad depresją psychotyczną nie przedstawiło danych z obserwacji długoterminowych, co stwarza niepewność co do trwałości korzyści klinicznych.³³

Badacze sugerują, że depresja psychotyczna jest niedostatecznie badana, niedodiagnozowana i niedostatecznie leczona. Skojarzone leczenie lekami i ECT okazały się skuteczne, ale potrzebne są dalsze badania, aby ustalić, jak długo należy przyjmować leki przeciwpsychotyczne.³⁴

Przegląd Cochrane, choć wskazuje na skuteczność leczenia skojarzonego, nie był w stanie odpowiedzieć na kilka kluczowych pytań. Obejmują one ocenę względnych zalet leków przeciwpsychotycznych i/lub przeciwdepresyjnych w porównaniu z ECT lub ketaminą w leczeniu ostrej fazy, a także określenie, które terapie są najlepsze do długoterminowego utrzymania i zapobiegania nawrotom.³⁵

Podsumowanie zaleceń profilaktycznych

W przypadku depresji psychotycznej, zalecenia profilaktyczne obejmują:³⁶³⁷³⁸

Długoterminową profilaktykę farmakologiczną, zwłaszcza u pacjentów z historią nawrotów
Terapię skojarzoną lekiem przeciwdepresyjnym i przeciwpsychotycznym jako leczenie pierwszego rzutu
Rozważenie terapii litem, szczególnie w przypadku ciężkiej, epizodycznej depresji jednobiegunowej z cechami psychotycznymi
Terapię elektrowstrząsową z następczym leczeniem farmakologicznym podtrzymującym
Modyfikację czynników ryzyka, w tym unikanie substancji psychoaktywnych
Wczesną interwencję przy pierwszych objawach pogorszenia stanu psychicznego
Regularne monitorowanie stanu psychicznego i dostosowywanie terapii

Ostatecznie wybór strategii profilaktycznej powinien być dostosowany do indywidualnych potrzeb pacjenta, z uwzględnieniem historii choroby, czynników ryzyka, preferencji oraz bilansu korzyści i ryzyka związanego z poszczególnymi metodami leczenia.³⁹

Kolejne rozdziały

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Materiały źródłowe

#1 Depression With Psychotic Features | Charlie Health
https://www.charliehealth.com/post/depression-with-psychotic-features
Depression with psychotic features is a severe form of major depressive disorder (MDD) that includes psychotic symptoms, such as delusions, hallucinations, and psychomotor impairment. […] A leading consideration when treating MDD with psychotic features is âensuring the prevention of major depression recurrence/relapse as this âopens the doorâ to the associated psychotic features,â explains Rebecca Holland, PMHNP-BC, a Psychiatric Nurse Practitioner with Charlie Health. […] Timely access to care is also ânecessary for the safety of the person experiencing MDD with psychosis and safety of others exposed to the person experiencing the psychotic depression symptoms and diagnosis,â adds Valentine. […] When itâs established that someone has depression with psychosis, itâs essential to connect them with appropriate and timely care.
#2 Re: Psychotic depression | The BMJ
https://www.bmj.com/content/345/bmj.e6994/rr/639153
I did however want to comment on a couple of aspects. […] A major clinical problem with recurrent depression, especially if severe or psychotic, is the risk of relapse, and slow, incomplete, or even lack of, recovery in a subsequent episode. There is good evidence that continuing treatment with antidepressants reduces relapse risk substantially for as long it is continued. […] Unfortunately without continuing treatment Rebecca remains at very high risk of future relapse given the duration and severity of episodes, at least 4 serious recurrences and a hinted at family history of depression. […] In the end it is of course the choice of the patient but we must sure that this is informed by the best evidence which is that in this situation is indefinite prophylaxis proves the best hope remaining in remission. […] Addressing stigma is extremely important but it is vital to treat the illness as effectively as possible because in the end staying well has to be the fundamental goal.
#3 Re: Psychotic depression | The BMJ
https://www.bmj.com/content/345/bmj.e6994/rr/639153
I did however want to comment on a couple of aspects. […] A major clinical problem with recurrent depression, especially if severe or psychotic, is the risk of relapse, and slow, incomplete, or even lack of, recovery in a subsequent episode. There is good evidence that continuing treatment with antidepressants reduces relapse risk substantially for as long it is continued. […] Unfortunately without continuing treatment Rebecca remains at very high risk of future relapse given the duration and severity of episodes, at least 4 serious recurrences and a hinted at family history of depression. […] In the end it is of course the choice of the patient but we must sure that this is informed by the best evidence which is that in this situation is indefinite prophylaxis proves the best hope remaining in remission. […] Addressing stigma is extremely important but it is vital to treat the illness as effectively as possible because in the end staying well has to be the fundamental goal.
#4 Lithium in the episode and suicide prophylaxis and in augmenting strategies in patients with unipolar depression | International Journal of Bipolar Disorders | Full Text
https://journalbipolardisorders.springeropen.com/articles/10.1186/s40345-017-0080-x
According to many studies mostly dating back to the 1970/1980s, lithium is efficacious in the prophylaxis of unipolar depression particularly depression with melancholia and delusional depression and showing a clearly episodic course. […] We conclude that lithium is an effective prophylactic treatment for carefully selected patients with unipolar depression and is safe when prescribed in recommended doses/plasma lithium levels and with regular, careful monitoring. […] We propose that lithium prophylaxis can be indicated in patients with unipolar depression and that the occurrence of 2 episodes of depression within 5 years is a practical criterion for starting lithium prophylaxis particularly in severe depression with psychotic features and high suicidal risk. […] Lithium is an effective prophylactic treatment in selected patients with unipolar depression in its classic form.
#5 Lithium in the episode and suicide prophylaxis and in augmenting strategies in patients with unipolar depression | International Journal of Bipolar Disorders | Full Text
https://journalbipolardisorders.springeropen.com/articles/10.1186/s40345-017-0080-x
According to many studies mostly dating back to the 1970/1980s, lithium is efficacious in the prophylaxis of unipolar depression particularly depression with melancholia and delusional depression and showing a clearly episodic course. […] We conclude that lithium is an effective prophylactic treatment for carefully selected patients with unipolar depression and is safe when prescribed in recommended doses/plasma lithium levels and with regular, careful monitoring. […] We propose that lithium prophylaxis can be indicated in patients with unipolar depression and that the occurrence of 2 episodes of depression within 5 years is a practical criterion for starting lithium prophylaxis particularly in severe depression with psychotic features and high suicidal risk. […] Lithium is an effective prophylactic treatment in selected patients with unipolar depression in its classic form.
#6 Lithium in the episode and suicide prophylaxis and in augmenting strategies in patients with unipolar depression | International Journal of Bipolar Disorders | Full Text
https://journalbipolardisorders.springeropen.com/articles/10.1186/s40345-017-0080-x
In our view, lithium prophylaxis is indicated in severe, clearly episodic unipolar depression that failed to respond to antidepressant medication. […] We propose that in unipolar depression, the occurrence of 2 episodes of depression within 5 years is a practical criterion for starting lithium prophylaxis particularly in severe depression with psychotic features high suicidal risk and particularly in such patients in whom a bipolar background can be suspected. […] Lithium maintenance therapy is strongly recommended for the long-term management of selected patients with unipolar depression since there is strong evidence for its episode-preventing efficacy and unique anti-suicidal effects.
#7 Lithium in the episode and suicide prophylaxis and in augmenting strategies in patients with unipolar depression | International Journal of Bipolar Disorders | Full Text
https://journalbipolardisorders.springeropen.com/articles/10.1186/s40345-017-0080-x
In our view, lithium prophylaxis is indicated in severe, clearly episodic unipolar depression that failed to respond to antidepressant medication. […] We propose that in unipolar depression, the occurrence of 2 episodes of depression within 5 years is a practical criterion for starting lithium prophylaxis particularly in severe depression with psychotic features high suicidal risk and particularly in such patients in whom a bipolar background can be suspected. […] Lithium maintenance therapy is strongly recommended for the long-term management of selected patients with unipolar depression since there is strong evidence for its episode-preventing efficacy and unique anti-suicidal effects.
#8
https://journals.lww.com/psychopharmacology/fulltext/2021/03000/pharmacotherapy_prescriptions_for_relapse.18.aspx
Electroconvulsive therapy (ECT) is effective in the treatment of acute episodes of psychotic depression. However, no adequately powered studies have directly investigated the efficacy of antipsychotic pharmacotherapy in relapse prevention of psychotic depression after ECT. […] The combination of an antidepressant plus an antipsychotic was the most commonly prescribed regimen at the completion of ECT for relapse prevention in patients with psychotic depression acutely treated with ECT. Although this report offers a view of the clinical practice of 4 academic medical centers, it also points to the need of randomized controlled trials on continuation pharmacotherapy after treatment of psychotic depression with ECT.
#9 The best drug treatment for psychotic depression: Antidepressants, antipsychotics or both combined? Commentary Onâ¦ Cochrane Corner | BJPsych Advances | Cambridge Core
https://www.cambridge.org/core/journals/bjpsych-advances/article/best-drug-treatment-for-psychotic-depression-antidepressants-antipsychotics-or-both-combined-commentary-on-cochrane-corner/AFCF12F304391C14F97796BBB919C9B7
The review found that the combination of an antidepressant plus an antipsychotic is more effective in psychotic depression than antidepressant monotherapy, antipsychotic monotherapy or placebo. […] Current guidelines are also in line with this conclusion, with the American Psychiatric Association (2010), NICE (2009) and the British Association of Psychopharmacology all recommending combination antidepressant plus antipsychotic treatment as first-line pharmacological treatment in psychotic depression. […] This review gives clear evidence that combination treatment should be used as first-line therapy where pharmacological treatment is considered. However, it was not able to answer some key questions. These include assessing the relative merits of antipsychotics and/or antidepressants v. ECT or ketamine in acute treatment, and which treatments are best for long-term maintenance and prevention of recurrence.
#10 The best drug treatment for psychotic depression: Antidepressants, antipsychotics or both combined? Commentary Onâ¦ Cochrane Corner | BJPsych Advances | Cambridge Core
https://www.cambridge.org/core/journals/bjpsych-advances/article/best-drug-treatment-for-psychotic-depression-antidepressants-antipsychotics-or-both-combined-commentary-on-cochrane-corner/AFCF12F304391C14F97796BBB919C9B7
The review found that the combination of an antidepressant plus an antipsychotic is more effective in psychotic depression than antidepressant monotherapy, antipsychotic monotherapy or placebo. […] Current guidelines are also in line with this conclusion, with the American Psychiatric Association (2010), NICE (2009) and the British Association of Psychopharmacology all recommending combination antidepressant plus antipsychotic treatment as first-line pharmacological treatment in psychotic depression. […] This review gives clear evidence that combination treatment should be used as first-line therapy where pharmacological treatment is considered. However, it was not able to answer some key questions. These include assessing the relative merits of antipsychotics and/or antidepressants v. ECT or ketamine in acute treatment, and which treatments are best for long-term maintenance and prevention of recurrence.
#11 Psychotic depression – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK583078/
For adults with psychotic depression what are the relative benefits and harms of psychological, psychosocial, pharmacological and physical interventions alone or in combination (as first-line treatment or relapse prevention)? […] The aim of this review is to identify the most effective first-line treatment or relapse prevention strategy for adults with psychotic depression. […] The committee therefore agreed to review the evidence for first-line treatment and relapse prevention of psychotic depression in the current evidence report, and the evidence for further-line treatment of psychotic depression is considered in the context of a broader evidence base in Evidence review D. […] The committee agreed that the combination of an antidepressant and an antipsychotic may lead to increased side effects and that it was therefore important to monitor the combination for side effects and discontinue the antipsychotic as soon as possible.
#12 Olanzapine Response in Psychotic Depression
https://www.psychiatrist.com/jcp/olanzapine-response-psychotic-depression/
Psychotic depression is more common than is generally realized, occurring in an estimated 16% to 54% of depressed patients. […] the purpose of this study was to assess the safety and efficacy of olanzapine in the treatment of psychotic depression. […] Olanzapine appears to be effective and safe for patients with psychotic depression. Further prospective studies are warranted to ascertain whether olanzapine’s unique pharmacologic profile may make it particularly useful for the treatment of psychotic depression either alone or in combination with antidepressants.
#13 Lipid Biology for Prediction and Prevention of Psychotic Disorders and Persistent Depression in Young People : Find an Expert : The University of Melbourne
https://findanexpert.unimelb.edu.au/project/100326-lipid-biology-for-prediction-and-prevention-of-psychotic-disorders-and–persistent-depression-in-young-people
My vision for the next 5 years is to establish -3PUFAs as a first-line treatment for indicated prevention of psychosis and persistent depression, as an alternative to conventional antidepressants for the treatment of moderate-to-severe depressive symptoms in adolescents and to build capacity in this area by training the next generation of researchers. […] Background: Clinical trials suggest that long-chain omega-3 polyunsaturated fatty acids (n-3 PUFAs) (fish oil) may reduce depression. […] IMPORTANCE: A promising treatment to prevent onset and improve outcomes in patients at ultrahigh risk for psychosis is dietary supplementation with omega-3 polyunsaturated fatty acids (PUFAs). […] Long-chain omega-3 polyunsaturated fatty acids (PUFAs) are essential for neural development and function. As key components of brain cell membranes, they play a crucial role in maintaining brain health and preventing mental disorders.
#14 Longer-term outcome in the prevention of psychotic disorders by the Vienna omega-3 study | Nature Communications
https://www.nature.com/articles/ncomms8934
Long-chain omega-3 polyunsaturated fatty acids (PUFAs) are essential for neural development and function. […] We have previously shown that a 12-week intervention with omega-3 PUFAs reduced the risk of progression to psychotic disorder in young people with subthreshold psychotic states for a 12-month period compared with placebo. […] Here we show that brief intervention with omega-3 PUFAs reduced both the risk of progression to psychotic disorder and psychiatric morbidity in general in this study. […] A recent meta-analysis in 2,502 at-risk individuals found that the cumulative rate of transition to psychosis increased over time, with 18%, 22%, 29% and 36% developing a psychotic disorder by 6 months, 1, 2 and 3 years, respectively. […] Since omega-3 PUFAs have no clinically relevant adverse effects and are considered generally beneficial to health, they are ideal for indicated prevention of psychosis.
#15 Longer-term outcome in the prevention of psychotic disorders by the Vienna omega-3 study | Nature Communications
https://www.nature.com/articles/ncomms8934
Here we report the longer-term efficacy of a 12-week intervention with fish oil capsules (providing omega-3 PUFAs, that is, 700mg of eicosapentaenoic acid and 480mg of docosahexaenoic acid daily) versus placebo capsules (matched in appearance and flavour with the active treatment) in individuals at ultrahigh risk for psychosis. […] We show that omega-3 PUFAs significantly reduced the risk of progression to psychotic disorder during the entire follow-up period. […] The cumulative conversion rate to psychosis at the longer-term follow-up was 9.8% (4/41) of subjects in the omega-3 PUFA group, and 40% (16/40) of subjects in the placebo group. […] The overall psychiatric morbidity during the follow-up period was also significantly lower in the omega-3 PUFA group. […] This is the first study to show, to the best of our knowledge, that a 12-week intervention with omega-3 PUFAs prevented transition to full-threshold psychotic disorder and led to sustained symptomatic and functional improvements in young people with an at-risk mental state for 7 years (median).
#16 Longer-term outcome in the prevention of psychotic disorders by the Vienna omega-3 study | Nature Communications
https://www.nature.com/articles/ncomms8934
Here we report the longer-term efficacy of a 12-week intervention with fish oil capsules (providing omega-3 PUFAs, that is, 700mg of eicosapentaenoic acid and 480mg of docosahexaenoic acid daily) versus placebo capsules (matched in appearance and flavour with the active treatment) in individuals at ultrahigh risk for psychosis. […] We show that omega-3 PUFAs significantly reduced the risk of progression to psychotic disorder during the entire follow-up period. […] The cumulative conversion rate to psychosis at the longer-term follow-up was 9.8% (4/41) of subjects in the omega-3 PUFA group, and 40% (16/40) of subjects in the placebo group. […] The overall psychiatric morbidity during the follow-up period was also significantly lower in the omega-3 PUFA group. […] This is the first study to show, to the best of our knowledge, that a 12-week intervention with omega-3 PUFAs prevented transition to full-threshold psychotic disorder and led to sustained symptomatic and functional improvements in young people with an at-risk mental state for 7 years (median).
#17 Longer-term outcome in the prevention of psychotic disorders by the Vienna omega-3 study | Nature Communications
https://www.nature.com/articles/ncomms8934
Long-chain omega-3 polyunsaturated fatty acids (PUFAs) are essential for neural development and function. […] We have previously shown that a 12-week intervention with omega-3 PUFAs reduced the risk of progression to psychotic disorder in young people with subthreshold psychotic states for a 12-month period compared with placebo. […] Here we show that brief intervention with omega-3 PUFAs reduced both the risk of progression to psychotic disorder and psychiatric morbidity in general in this study. […] A recent meta-analysis in 2,502 at-risk individuals found that the cumulative rate of transition to psychosis increased over time, with 18%, 22%, 29% and 36% developing a psychotic disorder by 6 months, 1, 2 and 3 years, respectively. […] Since omega-3 PUFAs have no clinically relevant adverse effects and are considered generally beneficial to health, they are ideal for indicated prevention of psychosis.
#18 Longer-term outcome in the prevention of psychotic disorders by the Vienna omega-3 study | Nature Communications
https://www.nature.com/articles/ncomms8934
The results in the non-transitioned group emphasize the longer-term preventive and therapeutic effect in some of the participants who received omega-3 PUFAs. […] The finding that supplementation with omega-3 PUFAs prevented the onset of psychotic disorder and reduced rates of non-psychotic Axis I disorders offers hope there may be alternatives to psychopharmacological treatment as early interventions in young people at risk for psychosis and raises questions regarding the potential mechanisms of action explaining these effects. […] Omega-3 PUFAs may therefore reduce conversion in subjects at risk for psychosis by preventing the pathophysiological changes associated with the increase in striatal dopamine. […] This first of its kind trial suggests that omega-3 PUFAs may offer a viable longer-term prevention strategy with minimal associated risk in young people at ultrahigh risk of psychosis.
#19
https://journals.lww.com/psychopharmacology/fulltext/2021/03000/pharmacotherapy_prescriptions_for_relapse.18.aspx
Electroconvulsive therapy (ECT) is effective in the treatment of acute episodes of psychotic depression. However, no adequately powered studies have directly investigated the efficacy of antipsychotic pharmacotherapy in relapse prevention of psychotic depression after ECT. […] The combination of an antidepressant plus an antipsychotic was the most commonly prescribed regimen at the completion of ECT for relapse prevention in patients with psychotic depression acutely treated with ECT. Although this report offers a view of the clinical practice of 4 academic medical centers, it also points to the need of randomized controlled trials on continuation pharmacotherapy after treatment of psychotic depression with ECT.
#20 Psychotic Depression: Symptoms, Causes, Diagnosis, and Treatment
https://www.verywellmind.com/psychotic-depression-1066607
Psychotic depression involves having symptoms of severe depression along with psychosis. This condition involves the usual symptoms of depression, such as depressed mood, appetite changes, and loss of interest in activities previously enjoyed. […] Treatments that may help include medications and electroconvulsive therapy. […] There is currently no federally approved treatment for psychotic depression. However, the American Psychiatric Association (APA) recommends either the combination of an antidepressant and antipsychotic or electroconvulsive therapy (ECT) as the first-line treatment for psychotic depression. […] ECT may be the most rapid treatment, but ongoing treatment, which often includes antidepressants, is needed to prevent a recurrence of symptoms. […] Researchers suggest that psychotic depression is understudied, underdiagnosed, and undertreated. Combination medication treatments and ECT have been shown to be effective, but further research is needed to establish how long antipsychotic medications need to be taken.
#21
https://journals.lww.com/psychopharmacology/fulltext/2021/03000/pharmacotherapy_prescriptions_for_relapse.18.aspx
Electroconvulsive therapy (ECT) is effective in the treatment of acute episodes of psychotic depression. However, no adequately powered studies have directly investigated the efficacy of antipsychotic pharmacotherapy in relapse prevention of psychotic depression after ECT. […] The combination of an antidepressant plus an antipsychotic was the most commonly prescribed regimen at the completion of ECT for relapse prevention in patients with psychotic depression acutely treated with ECT. Although this report offers a view of the clinical practice of 4 academic medical centers, it also points to the need of randomized controlled trials on continuation pharmacotherapy after treatment of psychotic depression with ECT.
#22 Psychotic depression – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK583078/
The committee discussed the evidence for ECT in the treatment of psychotic depression. […] The committee discussed that no evidence on psychological interventions for people with psychotic depression had been identified. […] The committee agreed that psychological interventions delivered by practitioners with experience and specialist training in working with people with psychosis and depression may also be effective for psychotic depression. […] There is limited evidence on the most effective interventions for the treatment of psychotic depression. […] The lack of evidence for psychological or psychosocial interventions alone or in combination with pharmacological is a further limitation. […] The committee noted that none of the studies on psychotic depression reported any followup data.
#23 Prediction and prevention of the first psychotic episode: new directio | TCRM
https://www.dovepress.com/prediction-and-prevention-of-the-first-psychotic-episode-new-direction-peer-reviewed-fulltext-article-TCRM
With this purpose in mind, the present analysis intends to review the research on this topic, taking into account the complex relationships linking the assessment of the risk of developing psychosis with the identification of efficacious prevention strategies. […] The first issue deals with the efficacy/tolerability profiles of the different intervention strategies, which should be addressed in a framework of prognosis, rather than of diagnosis. […] To date, the literature seems to delineate some possible clinical targets and future developments of the available prevention strategies. […] The rationale of omega-3 PUFA therapy suggests that this approach may be particularly indicated for UHR individuals showing omega-3 deficits or an evident psychopathological decline. […] Psychologists have already developed protocols specifically designed for individuals at risk of developing psychosis and, in general, the efficacy of these psychotherapies is supposed to rapidly improve in the next few years. […] The use of pharmacological drugs in prevention therapy has often been questioned on the basis of cost/benefit and ethical issues, particularly when antipsychotic therapies were taken into consideration for the treatment.
#24 Potential targets for prevention and early identification of psychotic disorders | ScienceDaily
https://www.sciencedaily.com/releases/2024/06/240621172354.htm
A new study found that nearly 75 per cent of young people with a psychotic disorder had at least one mental health service visit within the three years prior to their first diagnosis of the disorder. […] „Our findings suggest that these factors — prior mental health-related hospital admissions and emergency department visits, and prior diagnosis of substance use disorder — may indicate increased risk for a psychotic disorder,” says Dr. Nicole Kozloff, Co-Director of the Slaight Family Centre for Youth in Transition at CAMH. […] The goal is to increase understanding of who is at risk for psychosis and, most importantly, how to mitigate that risk via earlier intervention. […] This research underpins a key pillar of CAMH’s new strategic plan, Get Upstream, which aims to position the hospital at the forefront of early mental illness identification, prevention strategies, and timely access to high-quality care.
#25 Potential targets for prevention and early identification of psychotic disorders | ScienceDaily
https://www.sciencedaily.com/releases/2024/06/240621172354.htm
A new study found that nearly 75 per cent of young people with a psychotic disorder had at least one mental health service visit within the three years prior to their first diagnosis of the disorder. […] „Our findings suggest that these factors — prior mental health-related hospital admissions and emergency department visits, and prior diagnosis of substance use disorder — may indicate increased risk for a psychotic disorder,” says Dr. Nicole Kozloff, Co-Director of the Slaight Family Centre for Youth in Transition at CAMH. […] The goal is to increase understanding of who is at risk for psychosis and, most importantly, how to mitigate that risk via earlier intervention. […] This research underpins a key pillar of CAMH’s new strategic plan, Get Upstream, which aims to position the hospital at the forefront of early mental illness identification, prevention strategies, and timely access to high-quality care.
#26 Potential targets for prevention and early identification of psychotic disorders | ScienceDaily
https://www.sciencedaily.com/releases/2024/06/240621172354.htm
A new study found that nearly 75 per cent of young people with a psychotic disorder had at least one mental health service visit within the three years prior to their first diagnosis of the disorder. […] „Our findings suggest that these factors — prior mental health-related hospital admissions and emergency department visits, and prior diagnosis of substance use disorder — may indicate increased risk for a psychotic disorder,” says Dr. Nicole Kozloff, Co-Director of the Slaight Family Centre for Youth in Transition at CAMH. […] The goal is to increase understanding of who is at risk for psychosis and, most importantly, how to mitigate that risk via earlier intervention. […] This research underpins a key pillar of CAMH’s new strategic plan, Get Upstream, which aims to position the hospital at the forefront of early mental illness identification, prevention strategies, and timely access to high-quality care.
#27 Prevention of psychosis: moving on from the at-risk mental state to universal primary prevention
https://pmc.ncbi.nlm.nih.gov/articles/PMC7893507/
The value of services for those with the At Risk Mental State for Psychosis (ARMS) continues to be disputed. […] We consider that the most productive approach for psychosis prevention is avoiding exposure to risk-increasing factors. […] Therefore, as an initial step towards a strategy for universal primary prevention, we advocate public health campaigns to educate young people about the harms of regular use of high potency cannabis. […] We conclude that ARMS Clinics are never likely to make major inroads into preventing the majority of people who develop psychosis. An approach which could have a greater effect is to focus on avoiding the risk factors which increase the risk of the illness. […] Therefore, as an initial step towards universal primary prevention, we suggest major campaigns to educate young people about the harms of regular use of high potency cannabis.
#28 Prevention of psychosis: moving on from the at-risk mental state to universal primary prevention
https://pmc.ncbi.nlm.nih.gov/articles/PMC7893507/
The value of services for those with the At Risk Mental State for Psychosis (ARMS) continues to be disputed. […] We consider that the most productive approach for psychosis prevention is avoiding exposure to risk-increasing factors. […] Therefore, as an initial step towards a strategy for universal primary prevention, we advocate public health campaigns to educate young people about the harms of regular use of high potency cannabis. […] We conclude that ARMS Clinics are never likely to make major inroads into preventing the majority of people who develop psychosis. An approach which could have a greater effect is to focus on avoiding the risk factors which increase the risk of the illness. […] Therefore, as an initial step towards universal primary prevention, we suggest major campaigns to educate young people about the harms of regular use of high potency cannabis.
#29 Psychotic Disorders: Types, Symptoms, Diagnosis, Treatment
https://www.webmd.com/schizophrenia/mental-health-psychotic-disorders
Can Psychotic Disorders Be Prevented? […] No. But the sooner treatment starts, the better. It helps to prevent symptoms. Seeking help as soon as possible can help the person’s life, family, and relationships. […] […] For people who are at high risk for psychotic disorders, such as those who have a family history of schizophrenia, avoiding drugs such as marijuana and alcohol may help to prevent or delay these conditions.
#30 Depression (major depressive disorder) – Symptoms and causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/depression/symptoms-causes/syc-20356007
There’s no sure way to prevent depression. However, these strategies may help. […] Take steps to control stress, to increase your resilience and boost your self-esteem. […] Reach out to family and friends, especially in times of crisis, to help you weather rough spells. […] Get treatment at the earliest sign of a problem to help prevent depression from worsening. […] Consider getting long-term maintenance treatment to help prevent a relapse of symptoms.
#31 Psychotic depression – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK583078/
The committee discussed the evidence for ECT in the treatment of psychotic depression. […] The committee discussed that no evidence on psychological interventions for people with psychotic depression had been identified. […] The committee agreed that psychological interventions delivered by practitioners with experience and specialist training in working with people with psychosis and depression may also be effective for psychotic depression. […] There is limited evidence on the most effective interventions for the treatment of psychotic depression. […] The lack of evidence for psychological or psychosocial interventions alone or in combination with pharmacological is a further limitation. […] The committee noted that none of the studies on psychotic depression reported any followup data.
#32 Psychotic depression – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK583078/
The committee discussed the evidence for ECT in the treatment of psychotic depression. […] The committee discussed that no evidence on psychological interventions for people with psychotic depression had been identified. […] The committee agreed that psychological interventions delivered by practitioners with experience and specialist training in working with people with psychosis and depression may also be effective for psychotic depression. […] There is limited evidence on the most effective interventions for the treatment of psychotic depression. […] The lack of evidence for psychological or psychosocial interventions alone or in combination with pharmacological is a further limitation. […] The committee noted that none of the studies on psychotic depression reported any followup data.
#33 Psychotic depression – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK583078/
The committee agreed that this created uncertainty about the sustainability of clinical benefits. […] The committee also noted that none of the studies on psychotic depression reported any quality of life or functioning outcomes. […] The committee discussed the costs associated with the treatment of people with depression with psychotic symptoms, including costs of inpatient care in psychiatric wards and, potentially, of Accident and Emergency visits.
#34 Psychotic Depression: Symptoms, Causes, Diagnosis, and Treatment
https://www.verywellmind.com/psychotic-depression-1066607
Psychotic depression involves having symptoms of severe depression along with psychosis. This condition involves the usual symptoms of depression, such as depressed mood, appetite changes, and loss of interest in activities previously enjoyed. […] Treatments that may help include medications and electroconvulsive therapy. […] There is currently no federally approved treatment for psychotic depression. However, the American Psychiatric Association (APA) recommends either the combination of an antidepressant and antipsychotic or electroconvulsive therapy (ECT) as the first-line treatment for psychotic depression. […] ECT may be the most rapid treatment, but ongoing treatment, which often includes antidepressants, is needed to prevent a recurrence of symptoms. […] Researchers suggest that psychotic depression is understudied, underdiagnosed, and undertreated. Combination medication treatments and ECT have been shown to be effective, but further research is needed to establish how long antipsychotic medications need to be taken.
#35 The best drug treatment for psychotic depression: Antidepressants, antipsychotics or both combined? Commentary Onâ¦ Cochrane Corner | BJPsych Advances | Cambridge Core
https://www.cambridge.org/core/journals/bjpsych-advances/article/best-drug-treatment-for-psychotic-depression-antidepressants-antipsychotics-or-both-combined-commentary-on-cochrane-corner/AFCF12F304391C14F97796BBB919C9B7
The review found that the combination of an antidepressant plus an antipsychotic is more effective in psychotic depression than antidepressant monotherapy, antipsychotic monotherapy or placebo. […] Current guidelines are also in line with this conclusion, with the American Psychiatric Association (2010), NICE (2009) and the British Association of Psychopharmacology all recommending combination antidepressant plus antipsychotic treatment as first-line pharmacological treatment in psychotic depression. […] This review gives clear evidence that combination treatment should be used as first-line therapy where pharmacological treatment is considered. However, it was not able to answer some key questions. These include assessing the relative merits of antipsychotics and/or antidepressants v. ECT or ketamine in acute treatment, and which treatments are best for long-term maintenance and prevention of recurrence.
#36 The best drug treatment for psychotic depression: Antidepressants, antipsychotics or both combined? Commentary Onâ¦ Cochrane Corner | BJPsych Advances | Cambridge Core
https://www.cambridge.org/core/journals/bjpsych-advances/article/best-drug-treatment-for-psychotic-depression-antidepressants-antipsychotics-or-both-combined-commentary-on-cochrane-corner/AFCF12F304391C14F97796BBB919C9B7
The review found that the combination of an antidepressant plus an antipsychotic is more effective in psychotic depression than antidepressant monotherapy, antipsychotic monotherapy or placebo. […] Current guidelines are also in line with this conclusion, with the American Psychiatric Association (2010), NICE (2009) and the British Association of Psychopharmacology all recommending combination antidepressant plus antipsychotic treatment as first-line pharmacological treatment in psychotic depression. […] This review gives clear evidence that combination treatment should be used as first-line therapy where pharmacological treatment is considered. However, it was not able to answer some key questions. These include assessing the relative merits of antipsychotics and/or antidepressants v. ECT or ketamine in acute treatment, and which treatments are best for long-term maintenance and prevention of recurrence.
#37 Lithium in the episode and suicide prophylaxis and in augmenting strategies in patients with unipolar depression | International Journal of Bipolar Disorders | Full Text
https://journalbipolardisorders.springeropen.com/articles/10.1186/s40345-017-0080-x
In our view, lithium prophylaxis is indicated in severe, clearly episodic unipolar depression that failed to respond to antidepressant medication. […] We propose that in unipolar depression, the occurrence of 2 episodes of depression within 5 years is a practical criterion for starting lithium prophylaxis particularly in severe depression with psychotic features high suicidal risk and particularly in such patients in whom a bipolar background can be suspected. […] Lithium maintenance therapy is strongly recommended for the long-term management of selected patients with unipolar depression since there is strong evidence for its episode-preventing efficacy and unique anti-suicidal effects.
#38 Re: Psychotic depression | The BMJ
https://www.bmj.com/content/345/bmj.e6994/rr/639153
I did however want to comment on a couple of aspects. […] A major clinical problem with recurrent depression, especially if severe or psychotic, is the risk of relapse, and slow, incomplete, or even lack of, recovery in a subsequent episode. There is good evidence that continuing treatment with antidepressants reduces relapse risk substantially for as long it is continued. […] Unfortunately without continuing treatment Rebecca remains at very high risk of future relapse given the duration and severity of episodes, at least 4 serious recurrences and a hinted at family history of depression. […] In the end it is of course the choice of the patient but we must sure that this is informed by the best evidence which is that in this situation is indefinite prophylaxis proves the best hope remaining in remission. […] Addressing stigma is extremely important but it is vital to treat the illness as effectively as possible because in the end staying well has to be the fundamental goal.
#39 Re: Psychotic depression | The BMJ
https://www.bmj.com/content/345/bmj.e6994/rr/639153
I did however want to comment on a couple of aspects. […] A major clinical problem with recurrent depression, especially if severe or psychotic, is the risk of relapse, and slow, incomplete, or even lack of, recovery in a subsequent episode. There is good evidence that continuing treatment with antidepressants reduces relapse risk substantially for as long it is continued. […] Unfortunately without continuing treatment Rebecca remains at very high risk of future relapse given the duration and severity of episodes, at least 4 serious recurrences and a hinted at family history of depression. […] In the end it is of course the choice of the patient but we must sure that this is informed by the best evidence which is that in this situation is indefinite prophylaxis proves the best hope remaining in remission. […] Addressing stigma is extremely important but it is vital to treat the illness as effectively as possible because in the end staying well has to be the fundamental goal.