"New pharmacologic approaches to early psychosis: Taking aim at the hippocampus"
VUMC Psychiatry and Behavioral Sciences
Objectives:
The activity is designed to help the learner:
1. Describe evidence of hippocampal atrophy, clinical correlates, and associated molecular factors during early psychosis
2. Explain the current debate about whether antipsychotics promote or prevent hippocampal atrophy
3. Explain the rationale for a trial of citalopram in early psychosis and describe the results
4. Explain the rationale for a trial of levetiracetam in early psychosis and describe preliminary results
About the Speaker:
Donald C. Goff, MD
Director, Nathan Kline Institute for Psychiatric Research
Marvin Stern Professor and Vice Chair for Research
Psychiatry Department, NYU Grossman School of Medicine
Summary
An important model for early psychosis suggests that hippocampal activity at rest is increased in early psychosis and associated with hippocampal atrophy. The increased hippocampal activity may drive psychosis and the hippocampal volume loss may be associated with a poor clinical course. In treatment naïve schizophrenia patients we found significant hippocampal atrophy during the first 8 weeks of antipsychotic treatment associated with duration of untreated psychosis (DUP) and markers of inflammation, oxidative stress and reduced brain neurotrophic factor (BDNF); no additional atrophy was observed during 12 months of maintenance treatment. To correct a possible deficit of BDNF in early psychosis, we conducted a trial of citalopram in stabilized first episode patients and observed improvement in negative symptoms compared to placebo in patients with long DUP but no effect on hippocampal volume. We are now studying whether levetiracetam might attenuate elevated hippocampal activation in early psychosis as a potential protective treatment to reduce psychosis and protect against hippocampal atrophy. Results of a pilot placebo-controlled dose-finding trial will be presented.
CME/CE credit for Psychiatry Grand Rounds is only available during the live feed time and for a brief time immediately following. The code for this week's session is displayed at the opening and closing of the meeting and also in the Chair's Office Zoom Account Name during the meeting.
For CME/CE information about this session, please visit:
https://zoom.us/j/98313399711
This talk is sponsored by the
Luton Lecture Fund
Department of Psychiatry and Behavioral Sciences
This educational activity received no commercial support.