GAPi: A description of the initiative for early psychosis intervention in Latin America and the short- to medium-term outcomes in early psychosis patients

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Cavalcante, Daniel A. ; Noto, Mariane ; Cerqueira, Raphael de O. ; Costa, Giovany Oliveira ; Coutinho, Luccas ; Malinovski, Fernando ; Fonseca, Ana Olivia ; Santoro, Marcos Leite ; Ota, Vanessa ; Cordeiro, Quirino ; Bressan, Rodrigo A. ; Belangero, Sintia ; Gadelha, Ary ; Noto, Cristiano

• Document type: Journal article
• Source: ASIAN JOURNAL OF PSYCHIATRY; v. 98, p. 8-pg., 2024-06-14.

Abstract

Introduction: Schizophrenia is a debilitating disorder that affects a significant proportion of the population and leads to impaired functionality and long-term challenges. The first episode of psychosis (FEP) is a critical intervention stage for improving long-term outcomes. The GAPi program was established in Sao Paulo, Brazil to provide early intervention services and evaluate biomarkers in individuals with FEP. This article delineates the objectives of the GAPi program, detailing its innovative research protocol, examining the clinical outcomes achieved, and discussing the operational challenges encountered during its initial decade of operation. Methods: The study comprised a prospective cohort of antipsychotic-na & iuml;ve individuals with first-episode psychosis aged between 16 and 35 years. Participants were recruited from a public psychiatric facility in Sao Paulo. Emphasizing the initiative's commitment to early intervention, clinical assessments were systematically conducted at baseline and at two months, one year, two years, and five years of treatment to capture both short- and medium-term outcomes. Various assessment tools were utilized, including structured interviews, symptom scales, the Addiction Severity Index, and functional assessments. Results: A total of 232 patients were enrolled in the cohort. Among them, 65.95 % completed the 2-month followup. Most patients presented with schizophrenia spectrum disorders, followed by bipolar disorder and major depressive disorder with psychotic features. Treatment response rates and remission rates were evaluated at different time points, with promising outcomes observed. The program also assessed socio-demographic factors, substance use, family history, and genetic and biomarker profiles, providing valuable data for research. Discussion: The GAPi program has emerged as the largest ongoing cohort of antipsychotic-na & iuml;ve first-episode psychosis in Latin America, contributing to the understanding of early psychosis in low- and middle-income countries. Despite operational challenges, the program has demonstrated efficacy in reducing the duration of untreated psychosis and in improving clinical outcomes. A multidisciplinary approach, including pharmacological treatment, psychosocial interventions, and family involvement, has been instrumental in enhancing treatment adherence and long-term prognosis. Conclusion: The GAPi program represents a valuable model for early intervention in first-episode psychosis and provides insights into the pathophysiology, treatment, and long-term outcomes of individuals with schizophrenia and related disorders. Continued research and resource allocation are essential for addressing operational challenges and expanding early intervention services in low- and middle-income countries. (AU)

• FAPESP's process: 16/19462-2 - MiRNA role in schizophrenia: from genome until protein
• Grantee: Gabriela Xavier
• Support Opportunities: Scholarships in Brazil - Doctorate (Direct)
• FAPESP's process: 17/20059-0 - The use of polygenic score as a tool to determine the risk of schizophrenia
• Grantee: Fernanda Talarico
• Support Opportunities: Scholarships in Brazil - Master
• FAPESP's process: 14/07280-1 - Search for genetic markers of risk, progression and response to treatment
• Grantee: Síntia Iole Nogueira Belangero
• Support Opportunities: Regular Research Grants
• FAPESP's process: 15/03683-7 - Analysis of telomeric length in children and adolescents at risk for mental disorders
• Grantee: Gabriela Xavier
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• FAPESP's process: 18/00955-4 - Study of the effect of obstructive sleep apnea on the telomere length and its associated mechanisms
• Grantee: Priscila Farias Tempaku
• Support Opportunities: Scholarships in Brazil - Doctorate
• FAPESP's process: 10/08968-6 - Investigation of genetic and epigenetic markers: a translational approach for schizophrenia treatment
• Grantee: Síntia Iole Nogueira Belangero
• Support Opportunities: Regular Research Grants