Scott Woods1, Jean Addington2, Carrie Bearden3, Kristin Cadenhead4, Tyrone Cannon1, Barbara Cornblatt5, Daniel Mathalon6, Diana Perkins7, Larry Seidman8, Ming Tsuang4, Elaine Walker9, McGlashan Thomas1; 1Yale University, 2University of Calgary, 3UCLA, 4UCSD, 5Zucker Hillside Hospital, 6UCSF, 7UNC, 8Harvard University, 9Emory University
Antidepressants (ADs) are commonly used in DSM-5 Attenuated Psychosis Syndrome (APS) and other clinical high-risk syndrome (CHR) patients (Woods et al Schizophr Res 2013), but there is a dearth of efficacy data. The observational NAPLS-2 study offered an opportunity to investigate outcomes of community practice in this population. NAPLS-2 CHR patients were evaluated at baseline and six-monthly intervals with the Scale Of Psychosis-risk Symptoms (SOPS), SCID, the Calgary Depression Scale for Schizophrenia (CDSS), and the Global Assessment of Functioning (GAF). Six-month outcomes were described according to a “course specifier” classification (Woods et al Schizophr Res 2014). 360 CHR patients enrolled in the first half of NAPLS-2; 106 met APS criteria, were AD-naive at baseline, and completed 6-month assessment. 27 of these began AD during the first six months; average AD duration was 3.1±2.5 months. AD starters had higher baseline scores on CDSS (p<0.001) and were somewhat more likely to have comorbid current major depression (p=0.105). Six-month outcomes for AD starters vs nonstarters were: psychosis 4 vs 10%, progression 52 vs 53%, persistence 30 vs 19%, and remission 15 vs 18% (gamma=0.134, p=0.466). CDSS change did not differ between groups (F=0.1, p=0.806), nor did SOPS or GAF scores. Available data from the full NAPLS-2 and partial NAPLS-3 samples will be presented. Community selection of APS patients to begin AD medication appeared driven by depression severity and diagnosis, but AD starts seemed to confer little benefit. Randomized studies are needed.
