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Dongxia L, Li M, Yingying F. Can neurocognition, brain neurotrophic factor, triglyceride, and total cholesterol predict suicidal ideation in first-episode Han Chinese patients with schizophrenia? Brain Behav 2024; 14:e3499. [PMID: 38680078 PMCID: PMC11056701 DOI: 10.1002/brb3.3499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 03/10/2024] [Accepted: 04/03/2024] [Indexed: 05/01/2024] Open
Abstract
OBJECTIVE Previous studies have suggested that the suicide rate of patients with schizophrenia is high. This study investigates factors influencing suicidal ideation in first-episode schizophrenia patients, focusing on cognitive function, brain-derived neurotrophic factor (BDNF), triglyceride (TG), and total cholesterol (TC) in patients with first-episode schizophrenia. METHODS A total of 123 patients with first-episode schizophrenia and 38 healthy controls were included in the study. The patients were divided into suicidal and nonsuicidal ideation groups based on the Beck Scale for Suicidal Ideation, and they were assessed with Positive and Negative Syndrome Scale (PANSS). Cognitive function was assessed using the Chinese version of the MATRICS consensus cognitive battery (MCCB) and the serum BDNF, TG, and TC were detected. The main statistical methods include t-test, χ2 test, multivariate logistic regression analysis, receiver operating characteristic (ROC) curve analysis, and the DeLong test. RESULTS 26.02% of patients exhibited suicidal ideation. Higher PANSS and TC levels were risk factors, while higher MCCB scores and BDNF levels were protective factors. ROC analysis indicated AUCs of 0.630, 0.724, and 0.762 for serum BDNF, PANSS, and MCCB, respectively, with a combined AUC of 0.870. CONCLUSION Serum BDNF level, PANSS score, and MCCB score can be used as auxiliary predictors of suicidal ideation in schizophrenic patients. Combining these three indicators can effectively predict suicidal ideation in schizophrenic patients.
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Affiliation(s)
- Li Dongxia
- Wuhan Mental Health CenterWuhan Psychological HospitalWuhan CityChina
| | - Ma Li
- Wuhan Mental Health CenterWuhan Psychological HospitalWuhan CityChina
| | - Feng Yingying
- Wuhan Mental Health CenterWuhan Psychological HospitalWuhan CityChina
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Lundin NB, Blouin AM, Cowan HR, Moe AM, Wastler HM, Breitborde NJK. Identification of Psychosis Risk and Diagnosis of First-Episode Psychosis: Advice for Clinicians. Psychol Res Behav Manag 2024; 17:1365-1383. [PMID: 38529082 PMCID: PMC10962362 DOI: 10.2147/prbm.s423865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 03/07/2024] [Indexed: 03/27/2024] Open
Abstract
Early detection of psychotic-spectrum disorders among adolescents and young adults is crucial, as the initial years after psychotic symptom onset encompass a critical period in which psychosocial and pharmacological interventions are most effective. Moreover, clinicians and researchers in recent decades have thoroughly characterized psychosis-risk syndromes, in which youth are experiencing early warning signs indicative of heightened risk for developing a psychotic disorder. These insights have created opportunities for intervention even earlier in the illness course, ideally culminating in the prevention or mitigation of psychosis onset. However, identification and diagnosis of early signs of psychosis can be complex, as clinical presentations are heterogeneous, and psychotic symptoms exist on a continuum. When a young person presents to a clinic, it may be unclear whether they are experiencing common, mild psychotic-like symptoms, early warning signs of psychosis, overt psychotic symptoms, or symptoms better accounted for by a non-psychotic disorder. Therefore, the purpose of this review is to provide a framework for clinicians, including those who treat non-psychotic disorders and those in primary care settings, for guiding identification and diagnosis of early psychosis within the presenting clinic or via referral to a specialty clinic. We first provide descriptions and examples of first-episode psychosis (FEP) and psychosis-risk syndromes, as well as assessment tools used to diagnose these conditions. Next, we provide guidance as to the differential diagnosis of conditions which have phenotypic overlap with psychotic disorders, while considering the possibility of co-occurring symptoms in which case transdiagnostic treatments are encouraged. Finally, we conclude with an overview of early detection screening and outreach campaigns, which should be further optimized to reduce the duration of untreated psychosis among youth.
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Affiliation(s)
- Nancy B Lundin
- Early Psychosis Intervention Center, Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
| | - Alexandra M Blouin
- Early Psychosis Intervention Center, Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
| | - Henry R Cowan
- Early Psychosis Intervention Center, Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | - Aubrey M Moe
- Early Psychosis Intervention Center, Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
- Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - Heather M Wastler
- Early Psychosis Intervention Center, Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
| | - Nicholas J K Breitborde
- Early Psychosis Intervention Center, Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
- Department of Psychology, The Ohio State University, Columbus, OH, USA
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Malinowski F, Noto C, Cavalcante D, Belangero S, Ziebold C, Bressan R, Gadelha A. Urban distance to mental healthcare units and public transport increases duration of untreated psychosis in first-episode patients. Int J Soc Psychiatry 2023; 69:1938-1948. [PMID: 37332226 DOI: 10.1177/00207640231180825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
BACKGROUND There is a growing interest in environmental and social determinants of mental health. However, how distance to healthcare and public transportation affect illness is neglected in schizophrenia research. Here, we are interested in how the availability of mental healthcare and the ways to reach it may be associated with psychosis. AIMS We aim to investigate the association between distances to healthcare units and subway stations and duration of untreated psychosis (DUP) and greater initial severity in an antipsychotic-naïve first episode of psychosis (FEP) sample. METHOD Using 212 untreated FEP patients' data, we calculated the distances from their residences to the places of interest. Diagnoses comprehended schizophrenia spectrum disorders, depressive and bipolar affective disorders, and substance-induced disorders. Linear regressions were performed with distances as independent variables, DUP and Positive and Negative Syndrome Scale (PANSS) scores as dependent variables. RESULTS Longer distance to emergency mental healthcare was related to longer DUP (95% CI: p = .034, B = 0.152) and higher total PANSS (95% CI: p = .007, B = 0.0189); longer distance to community mental healthcare units was related to longer DUP (95% CI: p = .004, B = 0.0204) and higher total PANSS (95% CI: p = .030, B = 0.152). Moreover, a longer distance to the closest subway station predicted longer DUP (95% CI: p = .019, B = 0.170). CONCLUSION Our results indicate that poor healthcare access is related to longer DUP and higher initial PANSS scores. Future research should investigate how investments in mental health access and actions to improve public transport access could impact DUP and treatment outcomes in psychosis patients.
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Affiliation(s)
- Fernando Malinowski
- Laboratório Interdisciplinar de Neurociências Clínicas (LiNC), Departamento de Psiquiatria, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
- Programa de Esquizofrenia (PROESQ), Departamento de Psiquiatria, EPM-UNIFESP, São Paulo, SP, Brazil
| | - Cristiano Noto
- Laboratório Interdisciplinar de Neurociências Clínicas (LiNC), Departamento de Psiquiatria, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
- Programa de Esquizofrenia (PROESQ), Departamento de Psiquiatria, EPM-UNIFESP, São Paulo, SP, Brazil
- Grupo de Atenção às Psicoses Iniciais (GAPi), Departamento de Psiquiatria, EPM-UNIFESP, São Paulo, SP, Brazil
| | - Daniel Cavalcante
- Laboratório Interdisciplinar de Neurociências Clínicas (LiNC), Departamento de Psiquiatria, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
- Grupo de Atenção às Psicoses Iniciais (GAPi), Departamento de Psiquiatria, EPM-UNIFESP, São Paulo, SP, Brazil
| | - Síntia Belangero
- Laboratório Interdisciplinar de Neurociências Clínicas (LiNC), Department of Morphology and Genetics, EPM-UNIFESP, São Paulo, SP, Brazil
| | - Carolina Ziebold
- Laboratório Interdisciplinar de Neurociências Clínicas (LiNC), Departamento de Psiquiatria, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Rodrigo Bressan
- Laboratório Interdisciplinar de Neurociências Clínicas (LiNC), Departamento de Psiquiatria, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
- Programa de Esquizofrenia (PROESQ), Departamento de Psiquiatria, EPM-UNIFESP, São Paulo, SP, Brazil
| | - Ary Gadelha
- Laboratório Interdisciplinar de Neurociências Clínicas (LiNC), Departamento de Psiquiatria, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
- Centro de Pesquisa e Inovação em Prevenção de Transtornos Mentais e Uso de Álcool e Outras Drogas (CEPIPREV), EPM-UNIFESP, São Paulo, SP, Brazil
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Starzer MSK, Hansen HG, Hjorthøj C, Speyer H, Albert N, Nordentoft M. Predictors of Mortality Following a Schizophrenia Spectrum Diagnosis: Evidence From the 20-Year Follow-up of the OPUS Randomized Controlled Trial. Schizophr Bull 2023; 49:1256-1268. [PMID: 37527479 PMCID: PMC10483333 DOI: 10.1093/schbul/sbad111] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
BACKGROUND AND HYPOTHESIS The life expectancy of patients diagnosed with schizophrenia is 10-12 years lower than in the general population and the mortality gap seems to be worsening. Many of these deaths might be avoidable. We aimed to determine mortality rates and causes of death after a first-episode psychosis, and to examine if clinical characteristics at baseline or during illness could predict mortality. STUDY DESIGN The OPUS study was a randomized controlled trial of 578 patients first diagnosed with schizophrenia spectrum disorders. Patients were clinically assessed after 2, 5, 10, and 20 years. Information about time and cause of death was obtained from the Danish Cause of Death Register. Hazard ratios were used to assess predictors of death. STUDY RESULTS In total, 82 (14.4%) participants died during 20 years of follow-up. The most common cause of death was suicide (27%). At baseline employment (HR 0.47 P = .049), psychotic disorder other than schizophrenia (HR 0.36, P = .017), and longer duration of untreated psychosis (HR 0.57 P = .042) predicted lower mortality while substance use predicted higher mortality (HR 2.56, P < .001). During follow-up, symptom remission without antipsychotic medication and recovery predicted lower mortality (HR 0.08 P = .013 and HR 0.21, P = .028) while substance use (HR 3.64 P < .001), and all chronic illnesses predicted increased risk. CONCLUSIONS There is an increased risk of early mortality in schizophrenia compared to the background population, and there is an urgent need for new efforts to improve the disparities in health that lead to this increased mortality.
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Affiliation(s)
- Marie Stefanie Kejser Starzer
- Copenhagen Research Center for Mental Health – CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Helene Gjervig Hansen
- Copenhagen Research Center for Mental Health – CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Carsten Hjorthøj
- Copenhagen Research Center for Mental Health – CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - Helene Speyer
- Copenhagen Research Center for Mental Health – CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nikolai Albert
- Copenhagen Research Center for Mental Health – CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Mental Health Centre Amager, University Hospital of Copenhagen, Denmark
| | - Merete Nordentoft
- Copenhagen Research Center for Mental Health – CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Gohar SM, Hegelstad WTV, Auestad B, Haahr UH, Joa I, Johannessen JO, Larsen TK, Opjordsmoen S, Rund BR, Røssberg JI, Simonsen E, Friis S, Melle I. Association between early suicidal trajectories in first-episode psychosis and 10-year follow-up: TIPS registry-linked study. Lancet Psychiatry 2023; 10:528-536. [PMID: 37353264 DOI: 10.1016/s2215-0366(23)00156-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/24/2023] [Accepted: 04/27/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Although the risk of suicidality is high in first-episode psychosis, patterns and individual variability in suicidal thoughts and behaviours over time are under-researched. We aimed to identify early trajectories of suicidality over a 2-year follow-up, assess their baseline predictors, and explore associations between those trajectories and later suicidality. METHODS This longitudinal follow-up study was a part of the Early Treatment and Intervention in Psychosis (TIPS)study. Participants, linked to Norwegian and Danish death registries, were recruited from four catchment areas (665 000 inhabitants) in Norway and Denmark (both inpatient and outpatient). We included participants aged 15-65 years, with an intelligence quotient of more than 70, willing to give informed consent, and with a first episode of active psychotic symptoms. Individuals with comorbid neurological or endocrinal disorders, or those with contraindications to antipsychotics, were excluded. Growth mixture modelling was used to identify trajectories of suicidal thoughts and behaviours over the first 2 years. Multinomial logistic regression was applied to examine the baseline predictors of those trajectories and their associations with suicidality at 10-year follow-up. FINDINGS A total of 301 participants were recruited from Jan 1, 1997, to Dec 31, 2000. Of the 299 with completed suicidality data at baseline, 271 participated in 1-year follow-up, 250 in 2-year follow-up, 201 in 5-year follow-up, and 186 at 10-year follow-up. At baseline, 176 (58%) were male, 125 (42%) were female. The mean age was 27·80 years (SD 9·64; range 15-63). 280 (93%) participants were of Scandinavian origin. Four trajectories over 2 years were identified: stable non-suicidal (217 [72%]), stable suicidal ideation (45 [15%]), decreasing suicidal thoughts and behaviours (21 [7%]), and worsening suicidal thoughts and behaviours (18 [6%]). A longer duration of untreated psychosis (odds ratio [OR] 1·24, 95% CI 1·02-1·50, p=0·033), poorer premorbid childhood social adjustment (1·33, 1·01-1·73, p=0·039), more severe depression (1·10, 1·02-1·20, p=0·016), and substance use (2·33, 1·21-4·46, p=0·011) at baseline predicted a stable suicidal ideation trajectory. Individuals in the stable suicidal ideation trajectory tended to have suicidal thoughts and behaviours at 10-year follow-up (3·12, 1·33-7·25, p=0·008). Individuals with a worsening suicidal trajectory were at a higher risk of death by suicide between 2 and 10 years (7·58, 1·53-37·62, p=0·013). INTERPRETATION Distinct suicidal trajectories in first-episode psychosis were associated with specific predictors at baseline and distinct patterns of suicidality over time. Our findings call for early and targeted interventions for at-risk individuals with persistent suicidal ideation or deteriorating patterns of suicidal thoughts and behaviours, or both. FUNDING Health West, Norway; the Norwegian National Research Council; the Norwegian Department of Health and Social Affairs; the National Council for Mental Health and Health and Rehabilitation; the Theodore and Vada Stanley Foundation; the Regional Health Research Foundation for Eastern Region, Denmark; Roskilde County, Helsefonden, Lundbeck Pharma; Eli Lilly; Janssen-Cilag Pharmaceuticals, Denmark; a National Alliance for Research on Schizophrenia and Depression Distinguished Investigator Award and The National Institute of Mental Health grant; a National Alliance for Research on Schizophrenia & Depression Young Investigator Award from The Brain & Behavior Research Foundation; Health South East; Health West; and the Regional Centre for Clinical Research in Psychosis.
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Affiliation(s)
- Sherif M Gohar
- The Early Treatment and Intervention in Psychosis Study (TIPS) Centre for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway; Department of Public Health, Faculty of Health Sciences, Network for Medical Sciences, University of Stavanger, Stavanger, Norway; Department of Psychiatry, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Wenche Ten Velden Hegelstad
- The Early Treatment and Intervention in Psychosis Study (TIPS) Centre for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway; Department of Social Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Bjørn Auestad
- Research Department, Stavanger University Hospital, Stavanger, Norway; Department of Mathematics and Physics, University of Stavanger, Stavanger, Norway
| | - Ulrik Helt Haahr
- Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark
| | - Inge Joa
- The Early Treatment and Intervention in Psychosis Study (TIPS) Centre for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway; Department of Public Health, Faculty of Health Sciences, Network for Medical Sciences, University of Stavanger, Stavanger, Norway
| | - Jan Olav Johannessen
- The Early Treatment and Intervention in Psychosis Study (TIPS) Centre for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway; Department of Public Health, Faculty of Health Sciences, Network for Medical Sciences, University of Stavanger, Stavanger, Norway
| | - Tor Ketil Larsen
- The Early Treatment and Intervention in Psychosis Study (TIPS) Centre for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway; Institute of Psychiatry, University of Bergen, Bergen, Norway
| | - Stein Opjordsmoen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Bjørn Rishovd Rund
- Department of Psychology, University of Oslo, Oslo, Norway; Vestre Viken Hospital Trust, Drammen, Norway
| | - Jan Ivar Røssberg
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Erik Simonsen
- Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Svein Friis
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ingrid Melle
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; NORMENT Centre, Oslo University Hospital, Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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Liu J, Zhao K, Zhou S, Hong L, Xu Y, Sun S, Tong S, Huang L, Liu J, Wang J, Li N, Lou M, Tang W, Cai Z. Suicidal ideation in Chinese adults with schizophrenia: associations with neurocognitive function and empathy. BMC Psychiatry 2023; 23:311. [PMID: 37138258 PMCID: PMC10155378 DOI: 10.1186/s12888-023-04739-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 03/31/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Suicidal ideation is common among people diagnosed with schizophrenia spectrum disorders and may be related to neurocognitive, social cognitive, and clinical variables. This study aimed to investigate the relationships between suicidal ideation and both neurocognitive function and empathy. METHODS The sample for this cross-sectional study comprised 301 schizophrenic patients aged 18-44 years. All participants were administered the Beck Scale for Suicide Ideation-Chinese Version (BSI-CV), the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), the Interpersonal Reactivity Index (IRI), and the Positive and Negative Syndrome Scale (PANSS). The demographic and clinical data of the patients were also collected. RESULTS In total, 82 patients reported suicidal ideation. Compared to patients without suicidal ideation, patients with suicidal ideation showed significant differences in the IRI-Personal Distress subscale, PANSS-General Psychopathology symptom scores, and suicide attempts. Moreover, there were moderating effects of neurocognitive function and empathy on the relationship between suicide attempts and suicidal ideation. CONCLUSIONS These results indicate that the personal distress component of empathy, general psychopathology symptoms and suicide attempts are independent risk factors for suicidal ideation in Chinese adults with schizophrenia. Moreover, neurocognitive function may also be related to suicidal ideation through a moderating relationship. In order to reduce suicidal ideation among patients with schizophrenia, early screening of empathy and neurocognitive function is essential.
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Affiliation(s)
- Jie Liu
- School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Ke Zhao
- Lishui Second People's Hospital Affiliated to Wenzhou Medical University, Lishui, China
| | - Siyao Zhou
- School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Lan Hong
- School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yao Xu
- School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Shiyu Sun
- School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Siyu Tong
- School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Liandan Huang
- The Affiliated Kangning Hospital of Wenzhou Medical University Zhejiang Provincial Clinical Research Center for Mental Disorder, 325000, Wenzhou, China
| | - Jiahong Liu
- The Affiliated Kangning Hospital of Wenzhou Medical University Zhejiang Provincial Clinical Research Center for Mental Disorder, 325000, Wenzhou, China
| | - Jieqiong Wang
- The Affiliated Kangning Hospital of Wenzhou Medical University Zhejiang Provincial Clinical Research Center for Mental Disorder, 325000, Wenzhou, China
| | - Na Li
- School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Mengbei Lou
- School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Wei Tang
- School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang, China.
- The Affiliated Kangning Hospital of Wenzhou Medical University Zhejiang Provincial Clinical Research Center for Mental Disorder, 325000, Wenzhou, China.
| | - Zhengmao Cai
- The Affiliated Kangning Hospital of Wenzhou Medical University Zhejiang Provincial Clinical Research Center for Mental Disorder, 325000, Wenzhou, China.
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Nymoen M, Biringer E, Hetlevik Ø, Thorsen O, Assmus J, Hartveit M. The impact of referral letter quality on timely access to specialised mental health care: a quantitative study of the reliability of patient triage. BMC Health Serv Res 2022; 22:735. [PMID: 35655302 PMCID: PMC9161652 DOI: 10.1186/s12913-022-08139-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 05/25/2022] [Indexed: 11/24/2022] Open
Abstract
Background Patients referred to specialised mental health care are usually triaged based on referral information provided by general practitioners. However, knowledge about this system’s ability to ensure timely access to and equity in specialised mental health care is limited. We aimed to investigate to the degree to which patient triage, based on referral letter information, corresponds to triage based on a hospital specialist’s consultation with the patient, and whether the degree of correspondence is affected by the quality of the referral letter. Methods We gathered information from three specialised mental health centres in Norway regarding patients that were referred and offered health care (N = 264). Data consisted of triage decisions for each patient (i.e., the hospital specialist’s assessment of maximum acceptable waiting time), which were determined on the basis of a) referral information and b) meeting the patient. Referral letter quality was evaluated using the Quality of Referral information-Mental Health checklist. The reliability of priority setting and the impact of referral letter quality on this measure were investigated using descriptive analyses, binary logistic regression and Nadaraya-Watson kernel regression. Results In 143 (54%) cases, the triage decision based on referral information corresponded with the decision based on patient consultation. In 70 (27%) cases, the urgency of need for treatment was underestimated when based on referral information compared with that based on information from patient consultation. Referral letter quality could not explain the differences between the two triage decisions. However, when a cut-off value of 7 on the Quality of Referral information-Mental Health scale was used, low-quality letters were found more frequently among patients whose urgency of need was underestimated, compared with those whose need was overestimated. Conclusions Deciding the urgency of patient need for specialised mental health care based on referral information is a reliable system in many situations. However, the possibility of under- and overestimation is present, implying risks to patient safety and inappropriate use of resources. Improving the content of referral letters does not appear to reduce this risk when the letters are of acceptable quality. Trial registration NCT01374035.
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Bradford DW, Austin K, Nelson SM, Merrill S, Bowersox NW. Predictors of High-Intensity Psychiatric Service Utilization by Veterans Health Administration Patients With Early Psychosis. Psychiatr Serv 2022; 73:287-292. [PMID: 34346728 DOI: 10.1176/appi.ps.202000802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE People with early episode psychosis (EEP) have more negative care outcomes than do people with later episode psychosis (LEP), including higher levels of high-intensity psychiatric service use. It is unclear whether these differences are best explained by clinical differences between these two groups or whether people with EEP have specific treatment needs. An assessment of the treatment needs of patients with EEP can help inform the implementation of national treatment programming designed to provide better care to this group. METHODS Administrative data were used to compare characteristics of Veterans Health Administration patients who had EEP (i.e., a psychotic diagnosis, diagnosis history of ≤4 years, and age ≤30 years; N=4,595) with those with LEP (i.e., a psychotic diagnosis, longer diagnosis history, and older age; N=108,713) who received care during a 1-year evaluation period. The authors generated logistic regressions to assess the potential impact of EEP status on the likelihood of receipt of emergency department (ED) and inpatient psychiatric admissions while controlling for other patient characteristics. RESULTS Patients with EEP had elevated psychiatric comorbidity and mental health severity yet received equivalent outpatient mental health services. Patients with EEP were more likely to have had an ED visit for the treatment of a mental health condition and inpatient psychiatric admissions; this pattern persisted in analyses that controlled for group differences. CONCLUSIONS Patients with EEP have unique mental health treatment needs. The development and implementation of EEP-specific treatments could help address these needs and reduce the number of patients using higher levels of psychiatric services within large health care systems.
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Affiliation(s)
- Daniel W Bradford
- Psychosocial Rehabilitation and Recovery Services (Bradford) and Serious Mental Illness Treatment Resource and Evaluation Center (Austin, Nelson, Merrill, Bowersox), Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs Central Office, Washington, D.C.; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina (Bradford); Department of Psychiatry, University of Michigan, Ann Arbor (Nelson, Bowersox)
| | - Karen Austin
- Psychosocial Rehabilitation and Recovery Services (Bradford) and Serious Mental Illness Treatment Resource and Evaluation Center (Austin, Nelson, Merrill, Bowersox), Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs Central Office, Washington, D.C.; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina (Bradford); Department of Psychiatry, University of Michigan, Ann Arbor (Nelson, Bowersox)
| | - Sharon M Nelson
- Psychosocial Rehabilitation and Recovery Services (Bradford) and Serious Mental Illness Treatment Resource and Evaluation Center (Austin, Nelson, Merrill, Bowersox), Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs Central Office, Washington, D.C.; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina (Bradford); Department of Psychiatry, University of Michigan, Ann Arbor (Nelson, Bowersox)
| | - Stephanie Merrill
- Psychosocial Rehabilitation and Recovery Services (Bradford) and Serious Mental Illness Treatment Resource and Evaluation Center (Austin, Nelson, Merrill, Bowersox), Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs Central Office, Washington, D.C.; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina (Bradford); Department of Psychiatry, University of Michigan, Ann Arbor (Nelson, Bowersox)
| | - Nicholas W Bowersox
- Psychosocial Rehabilitation and Recovery Services (Bradford) and Serious Mental Illness Treatment Resource and Evaluation Center (Austin, Nelson, Merrill, Bowersox), Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs Central Office, Washington, D.C.; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina (Bradford); Department of Psychiatry, University of Michigan, Ann Arbor (Nelson, Bowersox)
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Vázquez-Bourgon J, Gómez-Revuelta M, Mayoral-van Son J, Labad J, Ortiz-García de la Foz V, Setién-Suero E, Ayesa-Arriola R, Tordesillas-Gutiérrez D, Juncal-Ruiz M, Crespo-Facorro B. Pattern of long-term weight and metabolic changes after a first episode of psychosis: Results from a 10-year prospective follow-up of the PAFIP program for early intervention in psychosis cohort. Eur Psychiatry 2022; 65:e48. [PMID: 35971658 PMCID: PMC9486831 DOI: 10.1192/j.eurpsy.2022.2308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background People with psychosis are at higher risk of cardiovascular events, partly explained by a higher predisposition to gain weight. This has been observed in studies on individuals with a first-episode psychosis (FEP) at short and long term (mainly up to 1 year) and transversally at longer term in people with chronic schizophrenia. However, there is scarcity of data regarding longer-term (above 3-year follow-up) weight progression in FEP from longitudinal studies. The aim of this study is to evaluate the longer-term (10 years) progression of weight changes and related metabolic disturbances in people with FEP. Methods Two hundred and nine people with FEP and 57 healthy participants (controls) were evaluated at study entry and prospectively at 10-year follow-up. Anthropometric, clinical, and sociodemographic data were collected. Results People with FEP presented a significant and rapid increase in mean body weight during the first year of treatment, followed by less pronounced but sustained weight gain over the study period (Δ15.2 kg; SD 12.3 kg). This early increment in weight predicted longer-term changes, which were significantly greater than in healthy controls (Δ2.9 kg; SD 7.3 kg). Weight gain correlated with alterations in lipid and glycemic variables, leading to clinical repercussion such as increments in the rates of obesity and metabolic disturbances. Sex differences were observed, with women presenting higher increments in body mass index than men. Conclusions This study confirms that the first year after initiating antipsychotic treatment is the critical one for weight gain in psychosis. Besides, it provides evidence that weight gain keep progressing even in the longer term (10 years), causing relevant metabolic disturbances.
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10
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Nagata K, Kitaoka K, Kawamura M. Experiences and perceptions of people living with schizophrenia in Japan: A qualitative study. Nurs Health Sci 2021; 23:782-791. [PMID: 34558776 DOI: 10.1111/nhs.12880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 11/28/2022]
Abstract
This descriptive study used a qualitative inductive approach to investigate the subjective experiences and perceptions of people with schizophrenia living in the community during times of difficulty and how they coped. We conducted semi-structured interviews with nine community-dwelling people with schizophrenia and used the KJ method developed by Kawakita Jiro to structure the data obtained. We identified 10 symbols with his method: bewilderment at the onset; helplessness and longing for death; solitude linked to death; precarious daily life; relationships at risk; fear of being stigmatized; pillars of emotional support; will to overcome; hope to never give up; and living with the illness. The results suggest that community mental health nurses should provide support so their patients can continue to have pillars of emotional support and the will to overcome difficulties, as well as continue to use their coping methods, even when experiencing many difficulties. It is important that nurses understand and share in their patients' difficult experiences and hopes when providing support toward their recovery.
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Affiliation(s)
- Kyoko Nagata
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Kazuyo Kitaoka
- Department of Nursing, Faculty of Health Sciences, Komatsu University, Komatsu, Japan
| | - Midori Kawamura
- Faculty of Nursing & Social Welfare Sciences, Department of Nursing Science, Fukui Prefectural University, Fukui, Japan
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11
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Vázquez-Bourgon J, Mayoral-van Son J, Gómez-Revuelta M, Juncal-Ruiz M, Ortiz-García de la Foz V, Tordesillas-Gutiérrez D, Ayesa-Arriola R, Bioque M, Crespo-Facorro B. Treatment Discontinuation Impact on Long-Term (10-Year) Weight Gain and Lipid Metabolism in First-Episode Psychosis: Results From the PAFIP-10 Cohort. Int J Neuropsychopharmacol 2020; 24:1-7. [PMID: 32840607 PMCID: PMC7816683 DOI: 10.1093/ijnp/pyaa066] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 08/02/2020] [Accepted: 08/21/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Patients with a first episode of psychosis (FEP) are at higher risk of gaining weight and presenting metabolic disturbances, partly related to antipsychotic exposure. Previous studies suggest that treatment discontinuation might have a positive impact on weight in schizophrenia. The aim of this study was to evaluate the effect of treatment discontinuation on weight and metabolic changes in a FEP cohort. METHODS A total of 209 FEP patients and 57 healthy controls were evaluated at study entry and prospectively at 10-year follow-up. Anthropometric measures and, clinical, metabolic, and sociodemographic data were collected. RESULTS Patients discontinuing antipsychotic treatment presented a significantly lower increase in weight and better metabolic parameter results than those still on antipsychotic treatment at 10-year follow-up. CONCLUSIONS Treatment discontinuation had a positive effect on the weight and metabolic changes observed in FEP patients; however, this effect was not sufficient to reaching a complete reversal to normal levels.
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Affiliation(s)
- Javier Vázquez-Bourgon
- Department of Psychiatry, University Hospital Marqués de Valdecilla - Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain,Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Madrid, Spain,Department of Medicine and Psychiatry, School of Medicine, University of Cantabria, Santander, Spain,Correspondence: Javier Vázquez-Bourgon, MD, PhD, Department of Psychiatry, University Hospital Marques de Valdecilla. Avda.Valdecilla s/n, Santander 39008, Spain ()
| | - Jaqueline Mayoral-van Son
- Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Madrid, Spain,Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocio-IBiS, Sevilla, Spain
| | - Marcos Gómez-Revuelta
- Department of Psychiatry, University Hospital Marqués de Valdecilla - Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain,Department of Medicine and Psychiatry, School of Medicine, University of Cantabria, Santander, Spain
| | - María Juncal-Ruiz
- Department of Psychiatry, Hospital Sierrallana - Instituto de Investigacion Marques de Valdecilla (IDIVAL), Torrelavega, Spain,Department of Medicine and Psychiatry, School of Medicine, University of Cantabria, Santander, Spain
| | - Víctor Ortiz-García de la Foz
- Department of Psychiatry, University Hospital Marqués de Valdecilla - Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - Diana Tordesillas-Gutiérrez
- Department of Psychiatry, University Hospital Marqués de Valdecilla - Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain,Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Madrid, Spain,Department of Medicine and Psychiatry, School of Medicine, University of Cantabria, Santander, Spain
| | - Rosa Ayesa-Arriola
- Department of Psychiatry, University Hospital Marqués de Valdecilla - Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain,Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Madrid, Spain,Department of Medicine and Psychiatry, School of Medicine, University of Cantabria, Santander, Spain
| | - Miquel Bioque
- Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Madrid, Spain,Barcelona Clínic Schizophrenia Unit, Hospital Clínic de Barcelona, Universitat de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Benedicto Crespo-Facorro
- Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Madrid, Spain,Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocio-IBiS, Sevilla, Spain
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12
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Liang CS, Bai YM, Hsu JW, Huang KL, Ko NY, Chu HT, Yeh TC, Tsai SJ, Chen TJ, Chen MH. The Risk of Sexually Transmitted Infections Following First-Episode Schizophrenia Among Adolescents and Young Adults: A Cohort Study of 220 545 Subjects. Schizophr Bull 2020; 46:795-803. [PMID: 32060532 PMCID: PMC7344918 DOI: 10.1093/schbul/sbz126] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Young people are disproportionately affected by sexually transmitted infections (STIs). The risk of STIs in young people following first-episode schizophrenia is unknown. This study using Taiwan's National Health Insurance Research Database enrolled 44 109 adolescents and young adults with first-episode schizophrenia and 176 436 age- and sex-matched controls without schizophrenia from 2001 through 2009 and followed to the end of 2011. New-onset STIs were identified. Survival analysis was performed. Cox regression analysis was used to examine the effects of comorbid substance use disorder (SUD), schizophrenia medications, and schizophrenia severity. The E value for causality of evidence was calculated. We found that young people had a higher risk of STIs following first-episode schizophrenia compared with controls without schizophrenia (hazard ratio [HR] = 2.35, 95% CI = 2.08-2.64); these STIs included human immunodeficiency virus (HIV) (3.70, 2.60-5.28) and syphilis (5.35, 3.96-7.23). They also showed a disproportionate distribution of STIs, with an increased proportion of syphilis (20.4% vs 8.2%) and HIV (9.1% vs 6.0%). When presenting with SUD, the risks of HIV (11.00, 7.02-17.25) and syphilis (9.11, 6.16-13.47) were further increased. The severe schizophrenia group had an extremely high risk of syphilis (41.26, 27.69-61.47) and HIV (7.50, 3.85-14.62). Schizophrenia medications may provide beneficial effects against contracting STIs (0.77, 0.68-0.89). We concluded that following first-episode schizophrenia, young patients are at higher risk of STIs, particularly HIV and syphilis. The risk further increased when subjects presented with SUD or severe schizophrenia. Importantly, antipsychotic treatment may lower the risk of STIs.
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Affiliation(s)
- Chih-Sung Liang
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, Taipei, Taiwan,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Ya-Mei Bai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan,Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ju-Wei Hsu
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan,Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Kai-Lin Huang
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan,Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Nai-Ying Ko
- Department of Nursing, College of Medicine, National Cheng Kung University and Hospital, Tainan, Taiwan
| | - Hsuan-Te Chu
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, Taipei, Taiwan
| | - Ta-Chuan Yeh
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan,Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan,Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan,Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan,To whom correspondence should be addressed; Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Sec. 2, 11217 Taipei, Taiwan; tel: 886-2-28344012, fax: 886-2-28344012, e-mail:
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13
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Fountoulakis KN, Moeller HJ, Kasper S, Tamminga C, Yamawaki S, Kahn R, Tandon R, Correll CU, Javed A. The report of the joint WPA/CINP workgroup on the use and usefulness of antipsychotic medication in the treatment of schizophrenia. CNS Spectr 2020; 26:1-25. [PMID: 32594935 DOI: 10.1017/s1092852920001546] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This is a report of a joint World Psychiatric Association/International College of Neuropsychopharmacology (WPA/CINP) workgroup concerning the risk/benefit ratio of antipsychotics in the treatment of schizophrenia. It utilized a selective but, within topic, comprehensive review of the literature, taking into consideration all the recently discussed arguments on the matter and avoiding taking sides when the results in the literature were equivocal. The workgroup's conclusions suggested that antipsychotics are efficacious both during the acute and the maintenance phase, and that the current data do not support the existence of a supersensitivity rebound psychosis. Long-term treated patients have better overall outcome and lower mortality than those not taking antipsychotics. Longer duration of untreated psychosis and relapses are modestly related to worse outcome. Loss of brain volume is evident already at first episode and concerns loss of neuropil volume rather than cell loss. Progression of volume loss probably happens in a subgroup of patients with worse prognosis. In humans, antipsychotic treatment neither causes nor worsens volume loss, while there are some data in favor for a protective effect. Schizophrenia manifests 2 to 3 times higher mortality vs the general population, and treatment with antipsychotics includes a number of dangers, including tardive dyskinesia and metabolic syndrome; however, antipsychotic treatment is related to lower mortality, including cardiovascular mortality. In conclusion, the literature strongly supports the use of antipsychotics both during the acute and the maintenance phase without suggesting that it is wise to discontinue antipsychotics after a certain period of time. Antipsychotic treatment improves long-term outcomes and lowers overall and specific-cause mortality.
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Affiliation(s)
- Konstantinos N Fountoulakis
- 3rd Department of Psychiatry, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Hans-Jurgen Moeller
- Department of Psychiatry, Ludwig Maximilian University of Munich, Munich, Germany
| | - Siegfried Kasper
- Universitätsklinik für Psychiatrie und Psychotherapie, Medizinische Universität Wien, Vienna, Austria
| | - Carol Tamminga
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Shigeto Yamawaki
- Center for Brain, Mind and KANSEI Sciences Research, Hiroshima University, Hiroshima, Japan
| | - Rene Kahn
- Department of Psychiatry and Behavioral Health System, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rajiv Tandon
- Department of Psychiatry, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, USA
| | - Christoph U Correll
- Department of Psychiatry, Northwell Health, The Zucker Hillside Hospital, Glen Oaks, New York, USA
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Afzal Javed
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
- Pakistan Psychiatric Research Centre, Fountain House, Lahore, Pakistan
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14
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Wang W, Zhou Y, Wang J, Xu H, Wei S, Wang D, Wang L, Zhang XY. Prevalence, clinical correlates of suicide attempt and its relationship with empathy in patients with schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2020; 99:109863. [PMID: 31931089 DOI: 10.1016/j.pnpbp.2020.109863] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/06/2020] [Accepted: 01/09/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Previous studies have shown that cognitive impairment plays a key role in suicide, an important factor leading to premature death in schizophrenia (SCZ) patients. Empathy has received extensive attention recently; however, the relationship of empathy with suicide in schizophrenia is still unknown. The main aim of this study was to investigate the prevalence of suicide attempts and its association with empathy and other characteristics in Chinese chronic SCZ patients. METHODS The suicide attempt data, together with demographic characteristics and clinical variables were collected from 627 chronic inpatients with schizophrenia. We utilized the Positive and Negative Syndrome Scale (PANSS) for the psychopathological symptoms, and the Interpersonal Reactivity Index (IRI) for affective and cognitive empathy in this study. RESULTS We found a suicide attempt rate of 11.3% in chronic SCZ patients. Compared to non-attempters, suicide attempters were more likely to be women, had younger age and higher education levels, as well as higher positive symptoms and depressive factor score, but lower negative symptoms of PANSS (all p < .05). Moreover, after controlling the confounding factors, suicide attempters scored higher in Personal Distress subscale of IRI (F1, 455 = 5.446, p = .020) than non-attempters. CONCLUSIONS The prevalence of suicide attempt is high in chronic SCZ patients. Its risk factors include some demographic and clinical variables. Moreover, suicide attempters experienced stronger personal distress, suggesting that stronger empathy may be a risk factor of suicide.
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Affiliation(s)
- Wenjia Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yongjie Zhou
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China; Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China
| | - Jiesi Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Hang Xu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Shuochi Wei
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Dongmei Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Li Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Xiang Yang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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15
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Trends in the incidence and DALYs of schizophrenia at the global, regional and national levels: results from the Global Burden of Disease Study 2017. Epidemiol Psychiatr Sci 2020; 29:e91. [PMID: 31928566 PMCID: PMC7214712 DOI: 10.1017/s2045796019000891] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
AIM Schizophrenia is a serious health problem worldwide. This systematic analysis aims to quantify the burden of schizophrenia at the global, regional and national levels using the Global Burden of Disease Study 2017 (GBD 2017). METHODS We collected detailed information on the number of incidence cases, disability-adjusted life years (DALYs) and age-standardised incidence rate (ASIR) and age-standardised rate of DALYs (ASDR) during 1990-2017 from GBD 2017. The estimated annual percentage changes (EAPCs) in the ASIR and in the ASDR were calculated to quantify the temporal trends in the ASIR and ASDR of schizophrenia. RESULTS Globally there were 1.13 million (95% uncertainty interval [UI] = 1.00 to 1.28) incident schizophrenia cases and 12.66 million (95% UI = 9.48 to 15.56) DALYs due to schizophrenia in 2017. The global ASIR decreased slightly from 1990 to 2017 (EAPC = -0.124, 95% UI = -0.114 to -0.135), while the ASDR was stable. The number of incident cases, DALYs, ASIR and ASDR were higher for males than for females. The incident rate and DALYs rate were highest among those aged 20-29 and 30-54 years, respectively. ASIR and ASDR were highest in East Asia in 2017, at 19.66 (95% UI = 17.72 to 22.00) and 205.23 (95% UI = 153.13 to 253.34), respectively. In 2017, the ASIR was highest in countries with a high-moderate sociodemographic index (SDI) and the ASDR was highest in high-SDI countries. We also found that the EAPC in ASDR was negatively correlated with the ASDR in 1990 (P = 0.001, ρ = -0.23). CONCLUSION The global burden of schizophrenia remains large and continues to increase, thereby increasing the burden on health-care systems. The reported findings should be useful for resource allocation and health services planning for the increasing numbers of patients with schizophrenia in ageing societies.
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16
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Wilson R, Gaughran F, Whitburn T, Higginson IJ, Gao W. Place of death and other factors associated with unnatural mortality in patients with serious mental disorders: population-based retrospective cohort study. BJPsych Open 2019; 5:e23. [PMID: 31068233 PMCID: PMC6401542 DOI: 10.1192/bjo.2019.5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Patients with serious mental disorders have poorer healthcare outcomes at the end of life and are at greater risk of dying from unnatural causes.AimsTo explore place of death and demographic and clinical correlates of unnatural causes of death in patients with serious mental disorders. METHOD Routinely collected patient data were used to explore bivariate and adjusted associations between covariates and natural/unnatural cause of death. RESULTS In multivariable analysis (n = 1029), dying at home (odds ratio (OR) = 1.87, 95% CI 1.03-3.40), 'other' locations (OR = 16.50, 95% CI 7.57-36.00), younger age (OR = 17.26, 95% CI 8.28-36.00) and a diagnosis other than schizophrenia spectrum disorder (OR = 1.69, 95% CI 1.04-2.73) were correlates of unnatural cause of death. CONCLUSIONS Deaths from unnatural causes were high and more likely to occur at home and non-healthcare settings. Unnatural causes of death were higher in younger patients with non-schizophrenia spectrum disorder diagnoses.Declaration of interestF.G. has received support or honoraria for CME, advisory work and lectures from Bristol-Myers Squibb, Janssen, Lundbeck, Otsuka, Roche, and Sunovion, and has a family member with professional links to Lilly and GSK, including shares.
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Affiliation(s)
- Rebecca Wilson
- Research Associate,Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing,Midwifery & Palliative Care, King's College London,UK
| | - Fiona Gaughran
- Lead Consultant/Senior Lecturer,Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London; and National Psychosis Unit, South London and Maudsley NHS Foundation Trust, UK
| | - Tara Whitburn
- Consultant in Palliative Medicine,Barts Health NHS Trust, Macmillan Palliative Care Team,St Bartholomew's Hospital,UK
| | - Irene J Higginson
- Head of Department,Head of Division and Director of Cicely Saunders Institute, Cicely Saunders Institute of Palliative Care,Policy and Rehabilitation,Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care,King's College London,UK
| | - Wei Gao
- Reader in Statistics and Epidemiology, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care,King's College London,UK
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17
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Moe AM, Rubinstein EB, Gallagher CJ, Weiss DM, Stewart A, Breitborde NJ. Improving access to specialized care for first-episode psychosis: an ecological model. Risk Manag Healthc Policy 2018; 11:127-138. [PMID: 30214330 PMCID: PMC6121768 DOI: 10.2147/rmhp.s131833] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Psychotic spectrum disorders are serious illnesses with symptoms that significantly impact functioning and quality of life. An accumulating body of literature has demonstrated that specialized treatments that are offered early after symptom onset are disproportionately more effective in managing symptoms and improving outcomes than when these same treatments are provided later in the course of illness. Specialized, multicomponent treatment packages are of particular importance, which are comprised of services offered as soon as possible after the onset of psychosis with the goal of addressing multiple care needs within a single care setting. As specialized programs continue to develop worldwide, it is crucial to consider how to increase access to such specialized services. In the current review, we utilize an ecological model of understanding barriers to care, with emphasis on understanding how individuals with first-episode psychosis interact with and are influenced by a variety of systemic factors that impact help-seeking behaviors and engagement with treatment. Future work in this area will be important in understanding how to most effectively design and implement specialized care for individuals early in the course of a psychotic disorder.
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Affiliation(s)
- Aubrey M Moe
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA,
| | - Ellen B Rubinstein
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Colin J Gallagher
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - David M Weiss
- Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - Amanda Stewart
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA,
| | - Nicholas Jk Breitborde
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA,
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18
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Chan SKW, Chan SWY, Pang HH, Yan KK, Hui CLM, Chang WC, Lee EHM, Chen EYH. Association of an Early Intervention Service for Psychosis With Suicide Rate Among Patients With First-Episode Schizophrenia-Spectrum Disorders. JAMA Psychiatry 2018; 75:458-464. [PMID: 29617517 PMCID: PMC6145768 DOI: 10.1001/jamapsychiatry.2018.0185] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
IMPORTANCE Patients with schizophrenia have a substantially higher suicide rate than the general public. Early intervention (EI) services improve short-term outcomes. However, little is known about the association of EI with suicide reduction in the long term. OBJECTIVE To examine the association of a 2-year EI service with suicide reduction in patients with first-episode schizophrenia-spectrum (FES) disorders during 12 years and the risk factors for early and late suicide. DESIGN, SETTING, AND PARTICIPANTS This historical control study compared 617 consecutive patients with FES who received the 2-year EI service in Hong Kong between July 1, 2001, and June 30, 2003, with 617 patients with FES who received standard care (SC) between July 1, 1998, and June 30, 2001, matched individually. Clinical information was systematically retrieved for the first 3 years of clinical care for both groups. The details of death were collected up to 12 years from presentation to the services. Data analysis was performed from October 30, 2016, to August 18, 2017. MAIN OUTCOMES AND MEASURES Suicide rate during 12 years was the primary measure. The association of the EI service with the suicide rates during years 1 through 3 and years 4 through 12 were explored separately. RESULTS The main analysis included 1234 patients, with 617 in each group (mean [SD] age at baseline, 21.2 [3.4] years in the EI group and 21.3 [3.4] years in the SC group; 318 male [51.5%] in the EI group and 322 [52.2%] in the SC group). The suicide rates were 7.5% in the SC group and 4.4% in the EI group (McNemar χ2 = 5.55, P = .02). Patients in the EI group had significantly better survival (propensity score-adjusted hazard ratio, 0.57; 95% CI, 0.36-0.91; P = .02), with the maximum association observed in the first 3 years. The number of suicide attempts was an indicator of early suicide (1-3 years). Premorbid occupational impairment, number of relapses, and poor adherence during the initial 3 years were indicators of late suicide (4-12 years). CONCLUSIONS AND RELEVANCE This study suggests that the EI service may be associated with reductions in the long-term suicide rate. Suicide at different stages of schizophrenia was associated with unique risk factors, highlighting the importance of a phase-specific service.
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Affiliation(s)
- Sherry Kit Wa Chan
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | - Stephanie Wing Yan Chan
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Herbert H. Pang
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Kang K. Yan
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Christy Lai Ming Hui
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Wing Chung Chang
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | - Edwin Ho Ming Lee
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Eric Yu Hai Chen
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
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19
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Langeveld J, Bjørkly S, Evensen J, Joa I, Johannessen JO, Larsen TK, Melle I, Opjordsmoen S, Røssberg JI, Rund BR, Simonsen E, Vaglum P, Velden WT, McGlashan T, Friis S. A 10-year follow-up study of violent victimization in first episode psychosis: Risk and protective factors. Psychiatry Res 2018; 259:545-549. [PMID: 29172178 DOI: 10.1016/j.psychres.2017.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 09/26/2017] [Accepted: 11/03/2017] [Indexed: 11/19/2022]
Abstract
Violent victimization in persons with severe mental illness has long-term adverse consequences. Little is known about the long-term prevalence of victimization in first episode psychosis, or about factors affecting victimization throughout the course of illness. To assess the prevalence of violent victimization during a 10-year follow-up period in a group of first episode psychosis (FEP) patients, and to identify early predictors and risk factors for victimization. A prospective design was used with comprehensive assessments of violent victimization, treatment variables and functioning at baseline and during 10-year follow-up. A clinical epidemiological sample of FEP patients (n = 298) was studied. FEP patients in our study were at a 3.5 times greater risk of victimization as compared to the normal population. During the 10-year follow-up period, 23% of subjects fell victim to one or more violent assaults. Victimized patients were younger and reported less occupational activity. At 10-year follow-up, victimization was associated with more concomitant drug use, alcohol misuse and violent behavior, but not with a worse clinical or functional outcome. Treatment programs should focus on risk factors for victimization and develop behavioral alternatives to mitigate risk in FEP patients.
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Affiliation(s)
- Johannes Langeveld
- Center for Clinical Psychosis Research, TIPS, Stavanger University Hospital, 4008 Stavanger, Norway; Department of Research and Development, Rogaland A-senter, 4028 Stavanger, Norway.
| | - Stål Bjørkly
- Molde University College, PO.Box 2110, 6402 Molde, Norway; Division of Mental Health and Addiction, Oslo University Hospital, P.O. 4959 Nydalen, N-0424 Oslo, Norway
| | - Julie Evensen
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. 4959 Nydalen, N-0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, P.O. 1171 Blindern, 0318 Oslo, Norway
| | - Inge Joa
- Center for Clinical Psychosis Research, TIPS, Stavanger University Hospital, 4008 Stavanger, Norway; Network for Medical Sciences, Faculty of Social Sciences, University of 4036 Stavanger, Norway
| | - Jan Olav Johannessen
- Center for Clinical Psychosis Research, TIPS, Stavanger University Hospital, 4008 Stavanger, Norway; Network for Medical Sciences, Faculty of Social Sciences, University of 4036 Stavanger, Norway
| | - Tor Ketil Larsen
- Center for Clinical Psychosis Research, TIPS, Stavanger University Hospital, 4008 Stavanger, Norway; Department of Clinical Medicine, University of Bergen, Jonas Lies vei 65, 5021 Bergen, Norway
| | - Ingrid Melle
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. 4959 Nydalen, N-0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, P.O. 1171 Blindern, 0318 Oslo, Norway
| | - Stein Opjordsmoen
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. 4959 Nydalen, N-0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, P.O. 1171 Blindern, 0318 Oslo, Norway
| | - Jan Ivar Røssberg
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. 4959 Nydalen, N-0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, P.O. 1171 Blindern, 0318 Oslo, Norway
| | - Bjørn Rishovd Rund
- Department of Psychology, University of Oslo, P.O. 1094 Blindern, 0317 Oslo, Norway; Vestre Viken Hospital Trust, 3004 Drammen, Norway
| | - Erik Simonsen
- Psychiatric Research Unit, Region Zealand, Faelledvej 6, 4200 Slagelse, Denmark; University of Copenhagen, P.O. box 2177, Copenhagen, Denmark
| | - Per Vaglum
- Department of Behavioral Sciences in Medicine, University of Oslo, P.O. 1130 Blindern, 0318 Oslo, Norway
| | - Wenche Ten Velden
- Center for Clinical Psychosis Research, TIPS, Stavanger University Hospital, 4008 Stavanger, Norway
| | - Tom McGlashan
- Department of Psychiatry, Yale University School of Medicine, Yale Psychiatric Research at Congress Place, 301 Cedar St., New Haven, CT 06519, USA
| | - Svein Friis
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. 4959 Nydalen, N-0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, P.O. 1171 Blindern, 0318 Oslo, Norway
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20
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Sampogna G, Fiorillo A, Luciano M, Del Vecchio V, Steardo L, Pocai B, Barone M, Amore M, Pacitti F, Dell'Osso L, Di Lorenzo G, Maj M. A Randomized Controlled Trial on the Efficacy of a Psychosocial Behavioral Intervention to Improve the Lifestyle of Patients With Severe Mental Disorders: Study Protocol. Front Psychiatry 2018; 9:235. [PMID: 29930520 PMCID: PMC6001842 DOI: 10.3389/fpsyt.2018.00235] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 05/15/2018] [Indexed: 01/21/2023] Open
Abstract
UNLABELLED Patients with severe mental disorders die on average 20 years prior to the general population. This mortality gap is mainly due to the higher prevalence of physical diseases and the adoption of unhealthy lifestyle behaviors.The LIFESTYLE trial aims to evaluate the efficacy of a new psychosocial group intervention (including psychoeducational, motivational, and problem-solving techniques) focused on healthy lifestyle behavior compared to a brief educational group intervention in a community sample of patients with severe mental disorders. The trial is a national-funded, multicentric, randomized controlled trial with blinded outcome assessments, which is carried out in six outpatient units of the Universities of Campania "Luigi Vanvitelli" in Naples, Bari, Genova, L'Aquila, Pisa, and Rome-Tor Vergata. All patients are assessed at the following time points: baseline (T0); 2 months post-randomization (T1); 4 months post-randomization (T2); 6 months post-randomization (T3); 12 months post-randomization (T4); and 24 months post-randomization (T5). T1 and T2 assessments include only anthropometric tests. The BMI, a reliable and feasible anthropometric parameter, has been selected as primary outcome. In particular, the mean value of BMI at 6 months from baseline (T3) will be evaluated through a Generalized Estimated Equation model. The work hypothesis is that the LIFESTYLE psychosocial group intervention will be more effective than the brief educational group intervention in reducing the BMI. We expect a mean difference between the two groups of at least one point (and standard deviation of two points) at BMI. Secondary outcomes are: the improvement in dietary patterns, in smoking habits, in sleeping habits, physical activity, personal and social functioning, severity of physical comorbidities, and adherence to medications. The expected sample size consists of 420 patients (70 patients for each of the six participating centers), and they are allocated with a 1:1 ratio randomization, stratified according to center, age, gender, and educational level. Heavy smoking, sedentary behavior, and unhealthy diet pattern are very frequent and are associated with a reduced life expectancy and higher levels of physical comorbidities in people with severe mental disorders. New interventions are needed and we hope that the LIFESTYLE protocol will help to fill this gap. TRIAL REGISTRATION NUMBER 2015C7374S.
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Affiliation(s)
- Gaia Sampogna
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mario Luciano
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Valeria Del Vecchio
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Luca Steardo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Benedetta Pocai
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marina Barone
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Francesca Pacitti
- Section of Psychiatry, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giorgio Di Lorenzo
- Department of System Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Mario Maj
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
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