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Ferrara M, Curtarello EMA, Gentili E, Domenicano I, Vecchioni L, Zese R, Alberti M, Franchini G, Sorio C, Benini L, Little J, Carozza P, Dazzan P, Grassi L. Sex differences in schizophrenia-spectrum diagnoses: results from a 30-year health record registry. Arch Womens Ment Health 2024; 27:11-20. [PMID: 37730924 DOI: 10.1007/s00737-023-01371-8] [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: 08/01/2023] [Accepted: 09/08/2023] [Indexed: 09/22/2023]
Abstract
This study investigated sociodemographic and clinical differences between the sexes in individuals affected by schizophrenia-spectrum disorders (SSD) who accessed outpatient mental health services. Within a retrospective cohort of 45,361 outpatients receiving care in Ferrara (Italy) from 1991 to 2021, those with a SSD diagnosis were compared between the sexes for sociodemographic and clinical characteristics before and after the index date (when the ICD-9: 295.*diagnosis was first recorded) to assess early trajectory, age and type of diagnosis, and severity of illness indicated by medication use, hospitalization, and duration of psychiatric care. Predictors of discharge were also investigated. Among 2439 patients, 1191 were women (48.8%). Compared to men, women were significantly older at first visit (43.7 vs. 36.8 years) and at index date (47.8 vs. 40.6) with peak frequency at age 48 (vs. 30). The most frequent last diagnosis recorded before the index date was delusional disorder (27.7%) or personality disorder (24.3%) in men and depression (24%) and delusional disorder (30.1%) in women. After the index date, long-acting antipsychotics and clozapine were more frequently prescribed to men (46.5% vs. 36.3%; 13.2% vs. 9.4%, p < 0.05) and mood stabilizers and antidepressants to women (24.3% vs. 21.1%; 50.1% vs. 35.5%; p < 0.05). Women had fewer involuntary admissions (10.1% vs. 13.6%) and were more likely to be discharged as the time under care increased (p = 0.009). After adjusting for covariates, sex was not a significant predictor of discharge. Our study confirmed that sex differences exist in clinical and sociodemographic characteristics of outpatients with SSD and that gender considerations might influence the rapidity of diagnosis and medications prescribed. These findings highlight the need to implement a women-tailored approach in specialist care programs for psychoses.
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Affiliation(s)
- Maria Ferrara
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy.
- Integrated Department of Mental Health and Pathological Addictions, Ferrara, Italy.
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
| | | | - Elisabetta Gentili
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
- Department of Engineering, University of Ferrara, Ferrara, Italy
| | - Ilaria Domenicano
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Ludovica Vecchioni
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Riccardo Zese
- Department of Engineering, University of Ferrara, Ferrara, Italy
| | - Marco Alberti
- Department of Engineering, University of Ferrara, Ferrara, Italy
| | - Giorgia Franchini
- Department of Mathematics, University of Modena and Reggio Emilia, Modena, Italy
| | - Cristina Sorio
- Integrated Department of Mental Health and Pathological Addictions, Ferrara, Italy
| | - Lorenzo Benini
- Integrated Department of Mental Health and Pathological Addictions, Ferrara, Italy
| | - Julian Little
- School of Epidemiology and Public Health Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Paola Carozza
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Paola Dazzan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre (BRC), London, UK
| | - Luigi Grassi
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
- Integrated Department of Mental Health and Pathological Addictions, Ferrara, Italy
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Yang W, Wang B, Ma S, Wang J, Ai L, Li Z, Wan X. Optimal Look-Back Period to Identify True Incident Cases of Diabetes in Medical Insurance Data in the Chinese Population: Retrospective Analysis Study. JMIR Public Health Surveill 2023; 9:e46708. [PMID: 37930785 PMCID: PMC10660214 DOI: 10.2196/46708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 08/23/2023] [Accepted: 09/26/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND Accurate estimation of incidence and prevalence is vital for preventing and controlling diabetes. Administrative data (including insurance data) could be a good source to estimate the incidence of diabetes. However, how to determine the look-back period (LP) to remove cases with preceding records remains a problem for administrative data. A short LP will cause overestimation of incidence, whereas a long LP will limit the usefulness of a database. Therefore, it is necessary to determine the optimal LP length for identifying incident cases in administrative data. OBJECTIVE This study aims to offer different methods to identify the optimal LP for diabetes by using medical insurance data from the Chinese population with reference to other diseases in the administrative data. METHODS Data from the insurance database of the city of Weifang, China from between January 2016 and December 2020 were used. To identify the incident cases in 2020, we removed prevalent patients with preceding records of diabetes between 2016 and 2019 (ie, a 4-year LP). Using this 4-year LP as a reference, consistency examination indexes (CEIs), including positive predictive values, the κ coefficient, and overestimation rate, were calculated to determine the level of agreement between different LPs and an LP of 4 years (the longest LP). Moreover, we constructed a retrograde survival function, in which survival (ie, incident cases) means not having a preceding record at the given time and the survival time is the difference between the date of the last record in 2020 and the most recent previous record in the LP. Based on the survival outcome and survival time, we established the survival function and survival hazard function. When the survival probability, S(t), remains stable, and survival hazard converges to zero, we obtain the optimal LP. Combined with the results of these two methods, we determined the optimal LP for Chinese diabetes patients. RESULTS The κ agreement was excellent (0.950), with a high positive predictive value (92.2%) and a low overestimation rate (8.4%) after a 2-year LP. As for the retrograde survival function, S(t) dropped rapidly during the first 1-year LP (from 1.00 to 0.11). At a 417-day LP, the hazard function reached approximately zero (ht=0.000459), S(t) remained at 0.10, and at 480 days, the frequency of S(t) did not increase. Combining the two methods, we found that the optimal LP is 2 years for Chinese diabetes patients. CONCLUSIONS The retrograde survival method and CEIs both showed effectiveness. A 2-year LP should be considered when identifying incident cases of diabetes using insurance data in the Chinese population.
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Affiliation(s)
- Wenyi Yang
- Institute of Basic Medical Sciences, Chinese Academy of Medical Science, Beijing, China
- School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Baohua Wang
- Chinese Center for Disease Control and Prevention, National Institute for Prevention and Control of Chronic Noncommunicable Diseases, Beijing, China
| | - Shaobo Ma
- Weifang Medical Insurance Center, Weifang, China
| | - Jingxin Wang
- Institute of Basic Medical Sciences, Chinese Academy of Medical Science, Beijing, China
- School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Limei Ai
- Institute of Basic Medical Sciences, Chinese Academy of Medical Science, Beijing, China
- School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Zhengyu Li
- Department of Clinical Medicine, Qingdao University Medical College, Qingdao, China
| | - Xia Wan
- Institute of Basic Medical Sciences, Chinese Academy of Medical Science, Beijing, China
- School of Basic Medicine, Peking Union Medical College, Beijing, China
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Multidimensional analysis of adult patients’ care trajectories before a first diagnosis of schizophrenia. SCHIZOPHRENIA 2022; 8:52. [PMID: 35854023 PMCID: PMC9261102 DOI: 10.1038/s41537-022-00256-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 04/21/2022] [Indexed: 11/09/2022]
Abstract
For patients at high-risk for developing schizophrenia, a delayed diagnosis could be affected, among many reasons, by their patterns of healthcare use. This study aims to describe and generate a typology of patients’ care trajectories (CTs) in the 2 years preceding a first diagnosis of schizophrenia, over a medico-administrative database of 3712 adults with a first diagnosis between April 2014 and March 2015 in Quebec, Canada. This study applied a multidimensional approach of State Sequence Analysis, considering together sequences of patients’ diagnoses, care settings and care providers. Five types of distinct CTs have emerged from this data-driven analysis: The type 1, shared by 77.6% of patients, predominantly younger men, shows that this group sought little healthcare, among which 17.5% had no healthcare contact for mental disorders. These individuals might benefit from improved promotion and prevention of mental healthcare at the community level. The types 2, 3 and 4, with higher occurrence of mental disorder diagnoses, represent together 19.5% of the study cohort, mostly middle-aged and women. These CTs, although displaying roughly similar profiles of mental disorders, revealed very dissimilar sequences and levels of care providers encounters, primary and specialized care use, and hospitalizations. Surprisingly, patients of these CTs had few consultations with general practitioners. An increased attentiveness for middle-aged patients and women with high healthcare use for mental disorders could help to reduce delayed diagnosis of schizophrenia. This calls for further consideration of healthcare services for severe mental illness beyond those offered to young adults.
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Rantala MJ, Luoto S, Borráz-León JI, Krams I. Schizophrenia: the new etiological synthesis. Neurosci Biobehav Rev 2022; 142:104894. [PMID: 36181926 DOI: 10.1016/j.neubiorev.2022.104894] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 08/25/2022] [Accepted: 09/25/2022] [Indexed: 10/31/2022]
Abstract
Schizophrenia has been an evolutionary paradox: it has high heritability, but it is associated with decreased reproductive success. The causal genetic variants underlying schizophrenia are thought to be under weak negative selection. To unravel this paradox, many evolutionary explanations have been suggested for schizophrenia. We critically discuss the constellation of evolutionary hypotheses for schizophrenia, highlighting the lack of empirical support for most existing evolutionary hypotheses-with the exception of the relatively well supported evolutionary mismatch hypothesis. It posits that evolutionarily novel features of contemporary environments, such as chronic stress, low-grade systemic inflammation, and gut dysbiosis, increase susceptibility to schizophrenia. Environmental factors such as microbial infections (e.g., Toxoplasma gondii) can better predict the onset of schizophrenia than polygenic risk scores. However, researchers have not been able to explain why only a small minority of infected people develop schizophrenia. The new etiological synthesis of schizophrenia indicates that an interaction between host genotype, microbe infection, and chronic stress causes schizophrenia, with neuroinflammation and gut dysbiosis mediating this etiological pathway. Instead of just alleviating symptoms with drugs, the parasite x genotype x stress model emphasizes that schizophrenia treatment should focus on detecting and treating possible underlying microbial infection(s), neuroinflammation, gut dysbiosis, and chronic stress.
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Affiliation(s)
- Markus J Rantala
- Department of Biology, University of Turku, FIN-20014 Turku, Finland.
| | - Severi Luoto
- School of Population Health, University of Auckland, 1023 Auckland, New Zealand
| | | | - Indrikis Krams
- Institute of Ecology and Earth Sciences, University of Tartu, 51014 Tartu, Estonia; Department of Zoology and Animal Ecology, Faculty of Biology, University of Latvia, 1004, Rīga, Latvia
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Stewart AJ, Patten SB, Fiest KM, Williamson TS, Wick JP, Ronksley PE. 10-Year Trends in Healthcare Spending among Patients with Schizophrenia in Alberta, Canada. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:723-733. [PMID: 35244485 PMCID: PMC9449136 DOI: 10.1177/07067437221082885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Schizophrenia is characterized by high levels of disability often resulting in increased healthcare utilization and spending. With expanding healthcare costs across all healthcare sectors, there is a need to understand how healthcare spending has changed over time. We conducted a population-based study using administrative health data from Alberta, Canada, to describe changes in medical complexity and direct healthcare spending among patients with schizophrenia over a 10-year period. METHODS A serial cross-sectional study from January 1, 2008, to December 31, 2017, was conducted to determine changes in demographic characteristics, medical complexity, and costs among all adults (18 years or older) with schizophrenia. Total healthcare spending and sector-specific costs attributable to hospitalizations, emergency department visits, practitioner billings, and prescriptions were calculated and compared over time. RESULTS Over the 10-year period the contact prevalence of patients with schizophrenia increased from 0.6% (n = 16,183) to 1.0% (n = 33,176) within the province. There was a marked change in medical complexity with the number of patients living with 3 or more comorbidities increasing from 33.0% to 47.3%. Direct annual healthcare costs increased 2-fold from 321 to 639 million CAD (493 million USD) with a 7-fold increase in medication expenditures over the 10-year time frame. As of 2017, spending on pharmaceutical treatment surpassed hospitalizations as the leading spending category in this population. CONCLUSIONS Healthcare spending among patients with schizophrenia continues to increase and may be partially attributable to growing rates of multimorbidity within this population. Although promising second-generation antipsychotic medications have entered the market, this has resulted in considerable changes in the distribution of healthcare spending over time. These findings will inform policy discussions around resource allocation and efforts to curb health spending while also improving care for patients with schizophrenia.
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Affiliation(s)
- Andrew J Stewart
- Department of Community Health Sciences, Cumming School of Medicine, 2129University of Calgary, Calgary, Canada
| | - Scott B Patten
- Department of Community Health Sciences, Cumming School of Medicine, 2129University of Calgary, Calgary, Canada.,Department of Medicine, Cumming School of Medicine, 2129University of Calgary, Calgary, Canada
| | - Kirsten M Fiest
- Department of Community Health Sciences, Cumming School of Medicine, 2129University of Calgary, Calgary, Canada
| | - Tyler S Williamson
- Department of Community Health Sciences, Cumming School of Medicine, 2129University of Calgary, Calgary, Canada
| | - James P Wick
- Department of Medicine, Cumming School of Medicine, 2129University of Calgary, Calgary, Canada
| | - Paul E Ronksley
- Department of Community Health Sciences, Cumming School of Medicine, 2129University of Calgary, Calgary, Canada
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Health resource utilization and cost before versus after initiation of second-generation long-acting injectable antipsychotics among adults with schizophrenia in Alberta, Canada: a retrospective, observational single-arm study. BMC Psychiatry 2022; 22:444. [PMID: 35780116 PMCID: PMC9250716 DOI: 10.1186/s12888-022-04075-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 06/17/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Long-acting injectable (LAI) antipsychotics, along with community treatment orders (CTOs), are used to improve treatment effectiveness through adherence among individuals with schizophrenia. Understanding real-world medication adherence, and healthcare resource utilization (HRU) and costs in individuals with schizophrenia overall and by CTO status before and after second generation antipsychotic (SGA)-LAI initiation may guide strategies to optimize treatment among those with schizophrenia. METHODS This retrospective observational single-arm study utilized administrative health data from Alberta, Canada. Adults (≥ 18 years) with schizophrenia who initiated a SGA-LAI (no use in the previous 2-years) between April 1, 2014 and March 31, 2016, and had ≥ 1 additional dispensation of a SGA-LAI were included; index date was the date of SGA-LAI initiation. Medication possession ratio (MPR) was determined, and paired t-tests were used to examine mean differences in all-cause and mental health-related HRU and costs (Canadian dollars), comprised of hospitalizations, physician visits, emergency department visits, and total visits, over the 2-year post-index and 2-year pre-index periods. Analyses were stratified by presence or absence of an active CTO during the pre-index and/or post-index periods. RESULTS Among 1,211 adults with schizophrenia who initiated SGA-LAIs, 64% were males with a mean age of 38 (standard deviation [SD] 14) years. The mean overall antipsychotic MPR was 0.39 (95% confidence interval [CI] 0.36, 0.41) greater during the 2-year post-index period (0.84 [SD 0.26]) compared with the 2-year pre-index period (0.45 [SD 0.40]). All-cause and mental health-related HRU and costs were lower post-index versus pre-index (p < 0.001) for hospitalizations, physician visits, emergency department visits, and total visits; mean total all-cause HRU costs were $33,788 (95% CI -$38,993, -$28,583) lower post- versus pre-index ($40,343 [SD $68,887] versus $74,131 [SD $75,941]), and total mental health-related HRU costs were $34,198 (95%CI -$39,098, -$29,297) lower post- versus pre-index ($34,205 [SD $63,428] versus $68,403 [SD $72,088]) per-patient. Forty-three percent had ≥ 1 active CTO during the study period; HRU and costs varied according to CTO status. CONCLUSIONS SGA-LAIs are associated with greater medication adherence, and lower HRU and costs however the latter vary according to CTO status.
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Baltazar L, De Benedictis L, Abdel-Baki A, Lalonde P, Lesage A. Long term course and outcome of first episode schizophrenia: a 27-to-31-year follow-up. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1319-1328. [PMID: 34762145 DOI: 10.1007/s00127-021-02185-8] [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] [Received: 03/11/2021] [Accepted: 10/31/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE To describe long term clinical and functional outcomes of schizophrenia in a developed country. METHOD Long term longitudinal study of clinical and functional outcomes of incidence cohort of all consecutive admissions for a first hospitalization for schizophrenia between 1983 and 1987 in Montreal, Canada (n = 142). Data collection was conducted at admission, 5 years, 10-16 years and 27-31 years follow-up by reviewing hospital charts and government linked health administrative databases. RESULTS One fifth of patients were never re-hospitalized and 35% were still in contact with the same catchment area psychiatric services. Thirty-four (24%) died on average at 45.5 years. Fourteen (9.9%) died by suicide; half of them did so 10 years after their first hospitalization. Over 20% were exposed to clozapine and nearly 50% to long-acting injectable antipsychotic medication. There were no inmates; an estimated one fifth might be inferred to be living in supervised residential settings and the rest lived alone or with family. Approximately three quarters of the patients under 65 were receiving social assistance benefits at study's end. From 15 to 25% might have been employed (supported or competitive employment). CONCLUSION This study confirms that the long-term course of schizophrenia is heterogenous and mostly positive with most patients living in the community, although a significant proportion need long term support and an important proportion experience premature death. To mitigate the persistent suicide risk and to respond to their need for support, continuous mental health professional's involvement is required for many.
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Affiliation(s)
- Lori Baltazar
- Hôpital Rivières des Prairies, Département de psychiatrie, Université de Montréal, Montréal, Québec, Canada. .,Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, 7401 rue Hochelaga, Montréal, Québec, H1N 3M5, Canada.
| | - Luigi De Benedictis
- Institut Universitaire en Santé Mentale de Montréal, Département de psychiatrie, Université de Montréal, Montréal, Québec, Canada
| | - Amal Abdel-Baki
- Centre Hospitalier Universitaire de Montréal, Département de psychiatrie, Université de Montréal, Montréal, Québec, Canada
| | - Pierre Lalonde
- Institut Universitaire en Santé Mentale de Montréal, Département de psychiatrie, Université de Montréal, Montréal, Québec, Canada
| | - Alain Lesage
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Département de psychiatrie, Université de Montréal, Montréal, Québec, Canada
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8
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Rotenberg M, Tuck A, Anderson KK, McKenzie K. The Incidence of Psychotic Disorders and Area-level Marginalization in Ontario, Canada: A Population-based Retrospective Cohort Study. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:216-225. [PMID: 33896210 PMCID: PMC8935600 DOI: 10.1177/07067437211011852] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND There is limited Canadian evidence on the impact of socio-environmental factors on psychosis risk. We sought to examine the relationship between area-level indicators of marginalization and the incidence of psychotic disorders in Ontario. METHODS We conducted a retrospective cohort study of all people aged 14 to 40 years living in Ontario in 1999 using health administrative data and identified incident cases of psychotic disorders over a 10-year follow-up period. Age-standardized incidence rates were estimated for census metropolitan areas (CMAs). Poisson regression models adjusting for age and sex were used to calculate incidence rate ratios (IRRs) based on CMA and area-level marginalization indices. RESULTS There is variation in the incidence of psychotic disorders across the CMAs. Our findings suggest a higher rate of psychotic disorders in areas with the highest levels of residential instability (IRR = 1.26, 95% confidence interval [CI], 1.18 to 1.35), material deprivation (IRR = 1.30, 95% CI, 1.16 to 1.45), ethnic concentration (IRR = 1.61, 95% CI, 1.38 to 1.89), and dependency (IRR = 1.35, 95% CI, 1.18 to 1.54) when compared to areas with the lowest levels of marginalization. Marginalization attenuates the risk in some CMAs. CONCLUSIONS There is geographic variation in the incidence of psychotic disorders across the province of Ontario. Areas with greater levels of marginalization have a higher incidence of psychotic disorders, and marginalization attenuates the differences in risk across geographic location. With further study, replication, and the use of the most up-to-date data, a case may be made to consider social policy interventions as preventative measures and to direct services to areas with the highest risk. Future research should examine how marginalization may interact with other social factors including ethnicity and immigration.
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Affiliation(s)
- Martin Rotenberg
- Department of Psychiatry, University of Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Andrew Tuck
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Kelly K Anderson
- Department of Epidemiology and Biostatistics, The University of Western Ontario, London, Ontario, Canada.,Department of Psychiatry, The University of Western Ontario, London, Ontario, Canada
| | - Kwame McKenzie
- Department of Psychiatry, University of Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Lesage A, Courteau J, Brodeur S, Stip E, Fleury MJ, Courteau M, Roy MA, Vanasse A. Urbanicity, Schizophrenia and Equitable Specialist Services Allocation. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:160-161. [PMID: 34482764 PMCID: PMC8892047 DOI: 10.1177/07067437211040606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Alain Lesage
- Research Centre, Institut universitaire en santé mentale de Montréal
(IUSMM), Montréal, Quebec
- Département de Psychiatrie et d’Addictologie, Université de Montréal,
Montréal, Quebec
| | - Josiane Courteau
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier
universitaire de Sherbrooke (CRCHUS), Sherbrooke, Quebec
| | - Sébastien Brodeur
- Département de Psychiatrie et Neurosciences, Université Laval, Québec, Quebec
| | - Emmanuel Stip
- Département de Psychiatrie et d’Addictologie, Université de Montréal,
Montréal, Quebec
- Department of Psychiatry and Behavioral Science, College of Medicine and
Health Science, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Marie-Josée Fleury
- Douglas Mental Health University Institute, McGill University, Montréal,
Quebec
- Department of Psychiatry, McGill University, Montréal, Quebec
| | - Mireille Courteau
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier
universitaire de Sherbrooke (CRCHUS), Sherbrooke, Quebec
| | - Marc-André Roy
- Département de Psychiatrie et Neurosciences, Université Laval, Québec, Quebec
- Centre de Recherche CERVO, Québec, Quebec
| | - Alain Vanasse
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier
universitaire de Sherbrooke (CRCHUS), Sherbrooke, Quebec
- Département de médecine de famille et de médecine d’urgence, Université de
Sherbrooke, Sherbrooke, Quebec
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10
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Lee SW, Yang JM, Moon SY, Yoo IK, Ha EK, Kim SY, Park UM, Choi S, Lee SH, Ahn YM, Kim JM, Koh HY, Yon DK. Association between mental illness and COVID-19 susceptibility and clinical outcomes in South Korea: a nationwide cohort study. Lancet Psychiatry 2020; 7:1025-1031. [PMID: 32950066 PMCID: PMC7498216 DOI: 10.1016/s2215-0366(20)30421-1] [Citation(s) in RCA: 153] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/26/2020] [Accepted: 08/26/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Evidence for the associations between mental illness and the likelihood of a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test result and the clinical outcomes of COVID-19 is scarce. We aimed to investigate these associations with data from a national register in South Korea. METHODS A nationwide cohort study with propensity score matching was done in South Korea using data collected from the Health Insurance Review and Assessment Service of Korea. We defined mental illness as present if one of the relevant ICD-10 codes was recorded at least twice within 1 year for an outpatient or inpatient. Severe mental illness was considered as non-affective or affective disorders with psychotic features. We included all patients aged older than 20 years who were tested for SARS-CoV-2 through services facilitated by the Korea Centers for Disease Control and Prevention, the Health Insurance Review and Assessment Service of Korea, and the Ministry of Health and Welfare, South Korea. We investigated the primary outcome (SARS-CoV-2 test positivity) in the entire cohort and the secondary outcomes (severe clinical outcomes of COVID-19: death, admission to the intensive care unit, or invasive ventilation) among those who tested positive. FINDINGS Between Jan 1 and May 15, 2020, 216 418 people were tested for SARS-CoV-2, of whom 7160 (3·3%) tested positive. In the entire cohort with propensity score matching, 1391 (3·0%) of 47 058 patients without a mental illness tested positive for SARS-CoV-2, compared with 1383 (2·9%) of 48 058 with a mental illness (adjusted odds ratio [OR] 1·00, 95% CI 0·93-1·08). Among the patients who tested positive for SARS-CoV-2, after propensity score matching, 109 (8·3%) of 1320 patients without a mental illness had severe clinical outcomes of COVID-19 compared with 128 (9·7%) of 1320 with a mental illness (adjusted OR 1·27, 95% CI 1·01-1·66). INTERPRETATION Diagnosis of a mental illness was not associated with increased likelihood of testing positive for SARS-CoV-2. Patients with a severe mental illness had a slightly higher risk for severe clinical outcomes of COVID-19 than patients without a history of mental illness. Clinicians treating patients with COVID-19 should be aware of the risk associated with pre-existing mental illness. FUNDING National Research Foundation of Korea.
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Affiliation(s)
- Seung Won Lee
- Department of Data Science, Sejong University College of Software Convergence, Seoul, South Korea
| | - Jee Myung Yang
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sung Yong Moon
- Department of Data Science, Sejong University College of Software Convergence, Seoul, South Korea
| | - In Kyung Yoo
- Department of Gastroenterology, CHA University School of Medicine, Seongnam, South Korea
| | - Eun Kyo Ha
- Department of Pediatrics, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - So Young Kim
- Department of Otorhinolaryngology, Head and Neck Surgery, CHA University School of Medicine, Seongnam, South Korea
| | - Un Min Park
- School of Stomatology, Capital Medical University, Beijing, China
| | - Sejin Choi
- Seoul Detention Center, Ministry of Justice, South Korea
| | - Sang-Hyuk Lee
- Department of Psychiatry, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
| | - Yong Min Ahn
- Department of Psychiatry and Behavioral Science, Institute of Human Behavioral Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea
| | - Hyun Yong Koh
- FM Kirby Neurobiology Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Dong Keon Yon
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea; Armed Force Medical Command, Republic of Korea Armed Forces, Seongnam, South Korea.
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Sommer IE, Tiihonen J, van Mourik A, Tanskanen A, Taipale H. The clinical course of schizophrenia in women and men-a nation-wide cohort study. NPJ SCHIZOPHRENIA 2020; 6:12. [PMID: 32358572 PMCID: PMC7195359 DOI: 10.1038/s41537-020-0102-z] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 03/12/2020] [Indexed: 11/09/2022]
Abstract
Gender differences in schizophrenia have been reported in different aspect of the course of disease and may urge special clinical interventions for female patients. Current literature provides insufficient information to design guidelines for treating women with schizophrenia. We aim to quantify the clinical course of schizophrenia in men and women on premorbid hospitalizations and prescription drugs, age at diagnosis, pharmacological treatment, comorbidity, number of re-hospitalizations, and mortality. Our nationwide cohort study included all patients admitted for the first time to hospital during 2000-2014 for schizophrenia or schizo-affective disorder in Finland. Gender differences were compared with logistic regression, by calculating incidence rates, and mortality was assessed with Cox proportional hazard model. We included 7142 women and 9006 men with schizophrenia/schizo-affective disorder and found that both women (71%) and men (70%) had often been hospitalized for another psychiatric disorder in the 5 years before diagnosis. In women, the last psychiatric hospitalization before schizophrenia/schizo-affective diagnosis was often for mood disorders (62%, OR 2.56, 95% CI 2.28-2.87). Men were diagnosed earlier (mean 34.4 [SD12.6] vs. 38.2 [SD 13.8]) with peak incidence around 22, while incidence in women declining only slowly between age 18 and 65. During ten years follow-up, 69.5% of both genders needed at least one re-hospitalization, with slightly more hospitalizations in women. Women were less often prescribed clozapine or long-acting antipsychotics. Mortality was lower in women (HR = 0.54, 95% CI 0.50-0.60), with fewer suicide and cardiovascular deaths, but more cancer deaths. These results suggest a diagnostic delay for women, which might be shortened by screening women aged 20-65 participating in affective disorder programs. As number of hospitalizations is not lower for women, clinicians should take care not to undertreat women with schizophrenia.
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Affiliation(s)
- Iris E Sommer
- Rijksuniversiteit Groningen (RUG), University Medical Center Groningen (UMCG), Department of Biomedical Sciences of Cells and Systems, Groningen, Netherlands.
| | - Jari Tiihonen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
- Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden
| | - Anouk van Mourik
- Rijksuniversiteit Groningen (RUG), University Medical Center Groningen (UMCG), Department of Biomedical Sciences of Cells and Systems, Groningen, Netherlands
| | - Antti Tanskanen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
| | - Heidi Taipale
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
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12
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Marzona I, Proietti M, Vannini T, Tettamanti M, Nobili A, Medaglia M, Bortolotti A, Merlino L, Roncaglioni MC. Sex-related differences in prevalence, treatment and outcomes in patients with atrial fibrillation. Intern Emerg Med 2020; 15:231-240. [PMID: 31243639 DOI: 10.1007/s11739-019-02134-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 06/18/2019] [Indexed: 12/15/2022]
Abstract
To analyze sex-related differences about AF prevalence, use of OAC and outcomes focusing on the older age classes. We used administrative data of the Lombardy Region, describing period prevalence, use of OAC and outcomes from 2002 to 2014 for all patients diagnosed with AF. AF prevalence over the 2002-2014 period was higher in males than in females (2.7% vs. 2.1%, p < 0.001), increasing with age. From 2003 to 2014, not treated AF patients decreased mostly in males (from 40.3 to 33.7% with respect to 43.7-39.8% in females). Age-stratified adjusted logistic regression analysis found that females were more likely treated with OAC when < 65 years in 2003 (OR 1.51, 95% CI 1.35-1.69) and in 2014 (OR 1.32, 95% CI 1.13-1.53); contrariwise, were less likely treated with OAC when age ≥ 75 years, in 2003 (OR 0.92, 95% CI 0.86-0.98) and in 2014 (OR 0.77, 95% CI 0.72-0.81).Adjusted Cox regression analysis confirmed that female AF patients had a higher risk of stroke (HR 1.18, 95% CI 1.14-1.21) and a lower risk of major bleeding (HR 0.83, 95% CI 0.80-0.86), while, had a lower risk for all-cause death (HR 0.82, 95% CI 0.80-0.83). AF prevalence was higher in male than in female patients, while thromboembolic risk was higher in female. Older female patients were under-treated with OAC particularly in recent years. Over long-term follow-up, female had a higher risk of stroke and a lower risk of major bleeding and all-cause death.
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Affiliation(s)
- Irene Marzona
- Laboratory of Cardiovascular Prevention, Department of Cardiovascular Research, Istituto di Ricerche Farmacologiche "Mario Negri" IRCCS, Via Giuseppe La Masa 19, 20156, Milan, Italy.
| | - Marco Proietti
- Department of Neuroscience, Istituto di Ricerche Farmacologiche "Mario Negri" IRCCS, Milan, Italy
| | - Tommaso Vannini
- Laboratory of Cardiovascular Prevention, Department of Cardiovascular Research, Istituto di Ricerche Farmacologiche "Mario Negri" IRCCS, Via Giuseppe La Masa 19, 20156, Milan, Italy
| | - Mauro Tettamanti
- Department of Neuroscience, Istituto di Ricerche Farmacologiche "Mario Negri" IRCCS, Milan, Italy
| | - Alessandro Nobili
- Department of Neuroscience, Istituto di Ricerche Farmacologiche "Mario Negri" IRCCS, Milan, Italy
| | | | | | - Luca Merlino
- Regional Health Ministry, Lombardy Region, Milan, Italy
| | - Maria Carla Roncaglioni
- Laboratory of Cardiovascular Prevention, Department of Cardiovascular Research, Istituto di Ricerche Farmacologiche "Mario Negri" IRCCS, Via Giuseppe La Masa 19, 20156, Milan, Italy
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13
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Cho SJ, Kim J, Kang YJ, Lee SY, Seo HY, Park JE, Kim H, Kim KN, Lee JY, Sohn JH. Annual Prevalence and Incidence of Schizophrenia and Similar Psychotic Disorders in the Republic of Korea: A National Health Insurance Data-Based Study. Psychiatry Investig 2020; 17:61-70. [PMID: 31995973 PMCID: PMC6992854 DOI: 10.30773/pi.2019.0041] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 10/17/2019] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE We conducted this study to address the incidence and prevalence of schizophrenia and similar psychosis in South Korea with Health Insurance Review and Assessment (HIRA) database. METHODS We used HIRA database, which includes diagnostic information of nearly all Korean nationals to collect number of cases with diagnosis of schizophrenia and schizophrenia-similar disorders (SSP), including schizophreniform, acute/transient psychotic disorders, schizoaffective disorders, and other/unspecific nonorganic psychosis (ICD-10 codes F20/23/25/28/29) between 2010 and 2015. The annual prevalence and incidence were calculated using the population data from the Korean Statistical Office. RESULTS The 12-month prevalence of SSP of Korea between 2010 and 2015 were 0.48-0.66%. The 12-month prevalence of schizophrenia were 0.40-0.52%; The annual incidence rates (IR) of SSP between 2010 and 2015 were 118.8-148.7 per 100,000 person-year (PY). For schizophrenia, IR per 100,000 PY were 77.6-88.5 between 2010 and 2015. CONCLUSION The 12-month prevalence found in the present study was higher than that reported in community-based epidemiologic studies in South Korea but similar to those from other countries. The annual incidence of SSP and schizophrenia was found to steadily increase and was higher than that of other countries. The high incidence rate observed in the current study needs to be studied further.
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Affiliation(s)
- Sung Joon Cho
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jungmee Kim
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yeon Ju Kang
- Seoul Mental Health Welfare Center, Seoul, Republic of Korea
| | - Seung Yeon Lee
- Seoul Mental Health Welfare Center, Seoul, Republic of Korea
| | - Hwo Yeon Seo
- Institute of Public Health and Medical Service, Seoul National University Hospital, Seoul, Republic of Korea.,Jongno-gu Community Mental Health Welfare Center, Seoul, Republic of Korea
| | - Jee Eun Park
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Haebin Kim
- Department of Psychiatry, Kyung Hee University Hospital, Seoul, Republic of Korea.,Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyoung-Nam Kim
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Institute of Public Health and Medical Service, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jin Yong Lee
- Department of Public Health and Community Medicine, Seoul Metropolitan Government, Seoul National University Boramae Medical Center, Seoul, Republic of Korea.,Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jee Hoon Sohn
- Institute of Public Health and Medical Service, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
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14
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Lesage A, Vanasse A, Potvin S, Dumais A. Retraction: Caractérisation des premiers épisodes de schizophrénie à partir de bases de données administratives de santé jumelées. [Characterization of First Episodes of Schizophrenia from Combined Administrative Databases]. Beaudoin, M., Potvin, S., Dellazizzo, L., Surprenant, M., Lesage, A., Vanasse, A., Ngamini-Ngui, A.† et Dumais, A. Santé mentale au Québec. 2018 Fall ; 43(2) : 83-105.PMID : 32338687. SANTE MENTALE AU QUEBEC 2019. [PMID: 33270396 DOI: 10.7202/1058611ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This corrects the article DOI: https://doi.org/10.7202/1058611ar.
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Anderson KK, Norman R, MacDougall AG, Edwards J, Palaniyappan L, Lau C, Kurdyak P. Estimating the incidence of first-episode psychosis using population-based health administrative data to inform early psychosis intervention services. Psychol Med 2019; 49:2091-2099. [PMID: 30311590 DOI: 10.1017/s0033291718002933] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Discrepancies between population-based estimates of the incidence of psychotic disorder and the treated incidence reported by early psychosis intervention (EPI) programs suggest additional cases may be receiving services elsewhere in the health system. Our objective was to estimate the incidence of non-affective psychotic disorder in the catchment area of an EPI program, and compare this to EPI-treated incidence estimates. METHODS We constructed a retrospective cohort (1997-2015) of incident cases of non-affective psychosis aged 16-50 years in an EPI program catchment using population-based linked health administrative data. Cases were identified by either one hospitalization or two outpatient physician billings within a 12-month period with a diagnosis of non-affective psychosis. We estimated the cumulative incidence and EPI-treated incidence of non-affective psychosis using denominator data from the census. We also estimated the incidence of first-episode psychosis (people who would meet the case definition for an EPI program) using a novel approach. RESULTS Our case definition identified 3245 cases of incident non-affective psychosis over the 17-year period. We estimate that the incidence of first-episode non-affective psychosis in the program catchment area is 33.3 per 100 000 per year (95% CI 31.4-35.1), which is more than twice as high as the EPI-treated incidence of 18.8 per 100 000 per year (95% CI 17.4-20.3). CONCLUSIONS Case ascertainment strategies limited to specialized psychiatric services may substantially underestimate the incidence of non-affective psychotic disorders, relative to population-based estimates. Accurate information on the epidemiology of first-episode psychosis will enable us to more effectively resource EPI services and evaluate their coverage.
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Affiliation(s)
- Kelly K Anderson
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
- Department of Psychiatry, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Ross Norman
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
- Department of Psychiatry, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Arlene G MacDougall
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
- Department of Psychiatry, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Jordan Edwards
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Lena Palaniyappan
- Department of Psychiatry, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Cindy Lau
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Paul Kurdyak
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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16
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Prevalence of psychotic disorders and its association with methodological issues. A systematic review and meta-analyses. PLoS One 2018; 13:e0195687. [PMID: 29649252 PMCID: PMC5896987 DOI: 10.1371/journal.pone.0195687] [Citation(s) in RCA: 255] [Impact Index Per Article: 42.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 03/27/2018] [Indexed: 01/29/2023] Open
Abstract
Objectives The purpose of this study is to provide an updated systematic review to identify studies describing the prevalence of psychosis in order to explore methodological factors that could account for the variation in prevalence estimates. Methods Studies with original data related to the prevalence of psychosis (published between 1990 and 2015) were identified via searching electronic databases and reviewing manual citations. Prevalence estimates were sorted according to prevalence type (point, 12-months and lifetime). The independent association between key methodological variables and the mean effect of prevalence was examined (prevalence type, case-finding setting, method of confirming diagnosis, international classification of diseases, diagnosis category, and study quality) by meta-analytical techniques and random-effects meta-regression. Results Seventy-three primary studies were included, providing a total of 101 estimates of prevalence rates of psychosis. Across these studies, the pooled median point and 12-month prevalence for persons was 3.89 and 4.03 per 1000 respectively; and the median lifetime prevalence was 7.49 per 1000. The result of the random-effects meta-regression analysis revealed a significant effect for the prevalence type, with higher rates of lifetime prevalence than 12-month prevalence (p<0.001). Studies conducted in the general population presented higher prevalence rates than those carried out in populations attended in health/social services (p = 0.006). Compared to the diagnosis of schizophrenia only, prevalence rates were higher in the probable psychotic disorder (p = 0.022) and non-affective psychosis (p = 0.009). Finally, a higher study quality is associated with a lower estimated prevalence of psychotic disorders (p<0.001). Conclusions This systematic review provides a comprehensive comparison of methodologies used in studies of the prevalence of psychosis, which can provide insightful information for future epidemiological studies in adopting the most relevant methodological approach.
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17
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Addington D, Anderson E, Kelly M, Lesage A, Summerville C. Canadian Practice Guidelines for Comprehensive Community Treatment for Schizophrenia and Schizophrenia Spectrum Disorders. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:662-672. [PMID: 28886669 PMCID: PMC5593248 DOI: 10.1177/0706743717719900] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The objective of this review is to identify the features and components of a comprehensive system of services for people living with schizophrenia. A comprehensive system was conceived as one that served the full range of people with schizophrenia and was designed with consideration of the incidence and prevalence of schizophrenia. The system should provide access to the full range of evidence-based services, should be recovery oriented, and should provide patient-centred care. METHOD A systematic search was conducted for published guidelines for schizophrenia and schizophrenia spectrum disorders. The guidelines were rated by at least 2 raters, and recommendations adopted were primarily drawn from the National Institute for Clinical Excellence (2014) Guideline on Psychosis and Schizophrenia in adults and the Scottish Intercollegiate Guidelines Network guidelines on management of schizophrenia. RESULTS The recommendations adapted for Canada cover the range of services required to provide comprehensive services. CONCLUSIONS Comprehensive services for people with schizophrenia can be organized and delivered to improve the quality of life of people with schizophrenia and their carers. The services need to be organized in a system that provides access to those who need them.
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Affiliation(s)
- Donald Addington
- 1 Department of Psychiatry, Hotchkiss Brain Institute, Foothills Hospital, University of Calgary, Calgary, Alberta
| | | | - Martina Kelly
- 3 Department of Family Medicine, University of Calgary, Calgary, Alberta
| | - Alain Lesage
- 4 Department of Psychiatry, Faculty of Medicine, Université de Montréal, Montreal, Québec
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18
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Carrier JD, Blais L, Cohen A, Courteau J, Roberge P, Larouche A, Grignon S, Fleury MJ, Lesage A, Demers MF, Roy MA, Delorme A, Vanasse A. Amorcer un traitement antipsychotique en schizophrénie : la situation au Québec de 1998 à 2006. SANTE MENTALE AU QUEBEC 2017. [DOI: 10.7202/1040245ar] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Contexte Cet article vise à décrire les facteurs associés à la prescription d’antipsychotiques par un psychiatre plutôt qu’un omnipraticien, la prescription d’un antipsychotique de seconde plutôt que de première génération, la prescription d’une multithérapie d’antipsychotiques et le non-renouvellement de la prescription initiale.
Méthodologie Il s’agit d’une étude pharmacoépidémiologique observationnelle avec analyses secondaires d’une banque de données médicoadministratives (RAMQ). Les données disponibles portaient sur un échantillon exhaustif des personnes adultes ayant reçu un diagnostic de schizophrénie et ayant obtenu un antipsychotique couvert par le régime public d’assurance médicaments de 1998 à 2006. Les résultats de régression logistique multiple sont rapportés.
Résultats Parmi les 16 225 personnes éligibles, 46,2 % étaient des femmes et 70 % étaient bénéficiaires d’une aide financière. La clientèle des psychiatres était plus jeune et plus atteinte au niveau de la santé mentale. La multithérapie était associée aux hospitalisations pour psychose, au faible statut socio-économique et à un âge entre 35 et 64 ans. Les antipsychotiques de seconde génération ont pris une place importante au cours de la période à l’étude. Le non-renouvellement était associé à l’abus de substances et était moins fréquent suite à une hospitalisation pour trouble mental.
Conclusions Malgré les limites liées à l’utilisation de données administratives, l’utilisation d’une banque de données exhaustive provenant autant de médecine générale que de spécialité permet à cette étude de brosser un portrait populationnel pertinent pour connaître la situation réelle du traitement incident de la schizophrénie au Québec de 1998 à 2006, une période caractérisée par l’introduction des antipsychotiques de seconde génération.
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Affiliation(s)
- Jean-Daniel Carrier
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier de l’Université de Sherbrooke (CHUS), Québec, Canada
- Département de psychiatrie, Université de Sherbrooke, Québec, Canada
| | - Lucie Blais
- Faculté de pharmacie, Université de Montréal, Québec, Canada
- Centre de recherche, Hôpital du Sacré-Coeur de Montréal, Québec, Canada
- Chaire pharmaceutique AstraZeneca en santé respiratoire, Montréal, Québec, Canada
| | - Alan Cohen
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier de l’Université de Sherbrooke (CHUS), Québec, Canada
- Département de médecine de famille et de médecine d’urgence, Université de Sherbrooke, Québec, Canada
| | - Josiane Courteau
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier de l’Université de Sherbrooke (CHUS), Québec, Canada
- Département de médecine de famille et de médecine d’urgence, Université de Sherbrooke, Québec, Canada
| | - Pasquale Roberge
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier de l’Université de Sherbrooke (CHUS), Québec, Canada
- Département de médecine de famille et de médecine d’urgence, Université de Sherbrooke, Québec, Canada
| | - Annie Larouche
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier de l’Université de Sherbrooke (CHUS), Québec, Canada
| | - Sylvain Grignon
- Département de psychiatrie, Université de Sherbrooke, Québec, Canada
| | - Marie-Josée Fleury
- Université McGill, Montréal, Québec, Canada
- Institut universitaire en santé mentale Douglas, Montréal, Québec, Canada
| | - Alain Lesage
- Centre de recherche de l’Institut universitaire en santé mentale de Montréal, Québec, Canada
| | | | - Marc-André Roy
- Département de psychiatrie et de neurosciences, Université Laval, Québec, Canada
- Centre de recherche CERVO, Québec, Canada
| | - André Delorme
- Département de psychiatrie, Université de Montréal – Direction de la santé mentale, ministère de la Santé et des Services sociaux du Québec, Canada
| | - Alain Vanasse
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier de l’Université de Sherbrooke (CHUS), Québec, Canada
- Département de médecine de famille et de médecine d’urgence, Université de Sherbrooke, Québec, Canada
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Quantin C, Collin C, Frérot M, Besson J, Cottenet J, Corneloup M, Soudry-Faure A, Mariet AS, Roussot A. [Study of algorithms to identify schizophrenia in the SNIIRAM database conducted by the REDSIAM network]. Rev Epidemiol Sante Publique 2017; 65 Suppl 4:S226-S235. [PMID: 28576380 DOI: 10.1016/j.respe.2017.03.133] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 03/15/2017] [Accepted: 03/15/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The aim of the REDSIAM network is to foster communication between users of French medico-administrative databases and to validate and promote analysis methods suitable for the data. Within this network, the working group "Mental and behavioral disorders" took an interest in algorithms to identify adult schizophrenia in the SNIIRAM database and inventoried identification criteria for patients with schizophrenia in these databases. METHODS The methodology was based on interviews with nine experts in schizophrenia concerning the procedures they use to identify patients with schizophrenia disorders in databases. The interviews were based on a questionnaire and conducted by telephone. RESULTS The synthesis of the interviews showed that the SNIIRAM contains various tables which allow coders to identify patients suffering from schizophrenia: chronic disease status, drugs and hospitalizations. Taken separately, these criteria were not sufficient to recognize patients with schizophrenia, an algorithm should be based on all of them. Apparently, only one-third of people living with schizophrenia benefit from the longstanding disease status. Not all patients are hospitalized, and coding for diagnoses at the hospitalization, notably for short stays in medicine, surgery or obstetrics departments, is not exhaustive. As for treatment with antipsychotics, it is not specific enough as such treatments are also prescribed to patients with bipolar disorders, or even other disorders. It seems appropriate to combine these complementary criteria, while keeping in mind out-patient care (every year 80,000 patients are seen exclusively in an outpatient setting), even if these data are difficult to link with other information. Finally, the experts made three propositions for selection algorithms of patients with schizophrenia. CONCLUSION Patients with schizophrenia can be relatively accurately identified using SNIIRAM data. Different combinations of the selected criteria must be used depending on the objectives and they must be related to an appropriate length of time.
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Affiliation(s)
- C Quantin
- Service de biostatistiques et d'information médicale (DIM), université Bourgogne Franche-Comté, CHRU Dijon, 21000 Dijon, France; Inserm, CIC 1432, Dijon University Hospital, Clinical Investigation Center, clinical epidemiology/clinical trials unit, 21000 Dijon, France; Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, université Paris-Saclay, 94800 Villejuif, France.
| | - C Collin
- Direction scientifique et de la stratégie européenne, Agence nationale de sécurité du médicament et des produits de santé, pôle épidémiologie des produits de santé, 143/147, boulevard Anatole-France, 93285 Saint-Denis cedex, France
| | - M Frérot
- Service de biostatistiques et d'information médicale (DIM), université Bourgogne Franche-Comté, CHRU Dijon, 21000 Dijon, France
| | - J Besson
- Service de biostatistiques et d'information médicale (DIM), université Bourgogne Franche-Comté, CHRU Dijon, 21000 Dijon, France
| | - J Cottenet
- Service de biostatistiques et d'information médicale (DIM), université Bourgogne Franche-Comté, CHRU Dijon, 21000 Dijon, France
| | - M Corneloup
- Service de santé publique et médecine sociale, CHU de Dijon, 21000 Dijon, France
| | - A Soudry-Faure
- Unité de soutien méthodologique, DRCI, University Hospital of Dijon, 21000 Dijon cedex, France
| | - A-S Mariet
- Service de biostatistiques et d'information médicale (DIM), université Bourgogne Franche-Comté, CHRU Dijon, 21000 Dijon, France
| | - A Roussot
- Service de biostatistiques et d'information médicale (DIM), université Bourgogne Franche-Comté, CHRU Dijon, 21000 Dijon, France
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- Réseau national pour la validation des algorithmes utilisés pour identifier des cas de pathologies dans le programme de médicalisation des systèmes d'information (PMSI)
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Zongo FE, Moisan J, Grégoire JP, Lesage A, Dossa AR, Lauzier S. Association between community pharmacy loyalty and persistence and implementation of antipsychotic treatment among individuals with schizophrenia. Res Social Adm Pharm 2016; 14:53-61. [PMID: 28077240 DOI: 10.1016/j.sapharm.2016.12.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 12/08/2016] [Accepted: 12/26/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Non-adherence is a major obstacle to optimal treatment of schizophrenia. Community pharmacists are in a key position to detect non-adherence and put in place interventions. Their role is likely to be more efficient when individuals are loyal to a single pharmacy. OBJECTIVE To assess the association between the level of community pharmacy loyalty and persistence with and implementation of antipsychotic drug treatment among individuals with schizophrenia. METHODS A cohort study using databases from the Quebec health insurance board (Canada) was conducted among new antipsychotic users insured by Quebec's public drug plan. Level of community pharmacy loyalty was assessed as the number of pharmacies visited in the year after antipsychotics initiation. Persistence was defined as having an antipsychotic supply in the user's possession on the 730th day after its initiation and implementation as having antipsychotics in the user's possession for ≥80% of the days in the second year after antipsychotics initiation (among persistent only). Generalized linear models were used to estimate adjusted prevalence ratios (aPR) and 95% confidence intervals (95%CI). RESULTS 6,251 individuals were included in the cohort and 54.1% had their drug prescriptions filled in >1 pharmacy. When compared to those who had their prescriptions filled in a single pharmacy, those who had their prescriptions filled in ≥4 different pharmacies were 22% more likely to be non-persistent (aPR = 1.22; 95%CI = 1.10-1.37) and 49% more likely to have an antipsychotic for <80% of the days (aPR = 1.49; 95%IC = 1.28-1.74). CONCLUSION This first exploration of community pharmacy loyalty in the context of severe mental illness indicates that this healthcare organisation factor might be associated with antipsychotics persistence and implementation. Identification of individuals with low community pharmacy loyalty and initiatives to optimize community pharmacy loyalty could contribute to enhanced persistence and implementation.
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Affiliation(s)
- Frank E Zongo
- Chair on Adherence to Treatments, Université Laval, 1050 chemin Ste-Foy, Québec, QC, Canada; CHU de Québec-Université Laval Research Centre, Population Health and Optimal Health Practices Research Unit, 1050 chemin Ste-Foy, Québec, QC, Canada; Faculty of Pharmacy, Université Laval, 1050 Avenue de la Médecine, Québec, QC, Canada
| | - Jocelyne Moisan
- Chair on Adherence to Treatments, Université Laval, 1050 chemin Ste-Foy, Québec, QC, Canada; CHU de Québec-Université Laval Research Centre, Population Health and Optimal Health Practices Research Unit, 1050 chemin Ste-Foy, Québec, QC, Canada; Faculty of Pharmacy, Université Laval, 1050 Avenue de la Médecine, Québec, QC, Canada
| | - Jean-Pierre Grégoire
- Chair on Adherence to Treatments, Université Laval, 1050 chemin Ste-Foy, Québec, QC, Canada; CHU de Québec-Université Laval Research Centre, Population Health and Optimal Health Practices Research Unit, 1050 chemin Ste-Foy, Québec, QC, Canada; Faculty of Pharmacy, Université Laval, 1050 Avenue de la Médecine, Québec, QC, Canada
| | - Alain Lesage
- Centre de Recherche Fernand-Seguin, Hôpital Louis-H. Lafontaine, Unité 218, 7331 Rue Hochelaga, Montréal, QC, Canada
| | - Anara Richi Dossa
- Chair on Adherence to Treatments, Université Laval, 1050 chemin Ste-Foy, Québec, QC, Canada; CHU de Québec-Université Laval Research Centre, Population Health and Optimal Health Practices Research Unit, 1050 chemin Ste-Foy, Québec, QC, Canada; Faculty of Pharmacy, Université Laval, 1050 Avenue de la Médecine, Québec, QC, Canada
| | - Sophie Lauzier
- Chair on Adherence to Treatments, Université Laval, 1050 chemin Ste-Foy, Québec, QC, Canada; CHU de Québec-Université Laval Research Centre, Population Health and Optimal Health Practices Research Unit, 1050 chemin Ste-Foy, Québec, QC, Canada; Faculty of Pharmacy, Université Laval, 1050 Avenue de la Médecine, Québec, QC, Canada.
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Bagley SC, Altman RB. Computing disease incidence, prevalence and comorbidity from electronic medical records. J Biomed Inform 2016; 63:108-111. [PMID: 27498067 DOI: 10.1016/j.jbi.2016.08.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 08/02/2016] [Accepted: 08/03/2016] [Indexed: 12/23/2022]
Abstract
Electronic medical records (EMR) represent a convenient source of coded medical data, but disease patterns found in EMRs may be biased when compared to surveys based on sampling. In this communication we draw attention to complications that arise when using EMR data to calculate disease prevalence, incidence, age of onset, and disease comorbidity. We review known solutions to these problems and identify challenges for future work.
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Affiliation(s)
- Steven C Bagley
- Department of Genetics, Stanford University, School of Medicine, MSOB, X-211, 1265 Welch Road, MC 5479, Stanford, CA 94305-5479, USA.
| | - Russ B Altman
- Departments of Bioengineering and Genetics, Stanford University, Shriram Room 209, MC 4245, 443 Via Ortega Drive, Stanford, CA 94305-4145, USA.
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Lesage A, Rochette L, Émond V, Pelletier É, St-Laurent D, Diallo FB, Kisely S. A Surveillance System to Monitor Excess Mortality of People With Mental Illness in Canada. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2015; 60:571-9. [PMID: 26720826 PMCID: PMC4679166 DOI: 10.1177/070674371506001208] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 04/01/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Outcome measures are rarely available for surveillance and system performance monitoring for mental disorders and addictions. Our study aims to demonstrate the feasibility and face validity of routinely measuring the mortality gap in the Canadian context at the provincial and regional levels using the methods and data available to the Canadian Chronic Disease Surveillance System (CCDSS) of the Public Health Agency of Canada. METHODS We used longitudinal data from the Quebec Integrated Chronic Disease Surveillance System, which also provides aggregated data to the CCDSS. This includes data from the health insurance registry physician claims and the hospital discharge abstract for all mental disorder diagnoses (International Classification of Diseases [ICD]-9 290-319 or ICD-10 F00-F99). Patients were defined as having had received a mental disorder diagnosis at least once during the year. Life expectancy was measured using Chiang's method for abridged life tables, complemented by the Hsieh method for adjustment of the last age interval. RESULTS We found a lower life expectancy among psychiatric patients of 8 years for men and 5 years for women. For patients with schizophrenia, life expectancy was lowered by 12 years for men and 8 years for women. Cardiovascular disease and cancer were the most common causes of premature death. Findings were consistent across time and regions of the province. Lower estimates of the mortality gap, compared with literature, could be explained by the inclusion of primary care patients and methods. CONCLUSIONS Our study demonstrates the feasibility of using administrative data to measure the impact of current and future mental health plans in Canada provided the techniques can be replicated in other Canadian provinces.
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Affiliation(s)
- Alain Lesage
- Professor, Department of Psychiatry, University of Montreal, Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, Quebec; Invited Psychiatric Expert, Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Quebec, Quebec
| | - Louis Rochette
- Statistician, Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Quebec, Quebec
| | - Valérie Émond
- Head, Chronic Disease Surveillance Unit, Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Quebec, Quebec
| | - Éric Pelletier
- Epidemiologist, Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Quebec, Quebec
| | - Danielle St-Laurent
- Scientific Director, Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Quebec, Quebec
| | - Fatoumata Binta Diallo
- Research Coordinator, Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, Quebec
| | - Stephen Kisely
- Professor, Queensland Centre for Health Data Services, University of Queensland, Brisbane, Australia
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Simeone JC, Ward AJ, Rotella P, Collins J, Windisch R. An evaluation of variation in published estimates of schizophrenia prevalence from 1990─2013: a systematic literature review. BMC Psychiatry 2015; 15:193. [PMID: 26263900 PMCID: PMC4533792 DOI: 10.1186/s12888-015-0578-7] [Citation(s) in RCA: 184] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 07/28/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND There is a lack of consistency in findings across studies on the prevalence of schizophrenia, and no recent systematic review of the literature exists. The purpose of this study is to provide an updated systematic review of population-based prevalence estimates and to understand the factors that could account for this variation in prevalence estimates. METHODS MEDLINE, Embase, and PsycInfo databases were searched for observational studies describing schizophrenia prevalence in general populations from 2003-2013 and supplemented by studies from a prior review covering 1990-2002. Studies reporting prevalence estimates from specialized populations such as institutionalized, homeless, or incarcerated persons were excluded. Prevalence estimates were compared both across and within studies by factors that might contribute to variability using descriptive statistics. RESULTS Sixty-five primary studies were included; thirty-one (48 %) were from Europe and 35 (54 %) were conducted in samples of ≥50,000 persons. Among 21 studies reporting 12-month prevalence, the median estimate was 0.33 % with an interquartile range (IQR) of 0.26 %-0.51 %. The median estimate of lifetime prevalence among 29 studies was 0.48 % (IQR: 0.34 %-0.85 %). Prevalence across studies appeared to vary by study design, geographic region, time of assessment, and study quality scores; associations between study sample size and prevalence were not observed. Within studies, age-adjusted estimates were higher than crude estimates by 17 %-138 %, the use of a broader definition of schizophrenia spectrum disorders compared to schizophrenia increased case identification by 18 %-90 %, identification of cases from inpatient-only settings versus any setting decreased prevalence by 60 %, and no consistent trends were noted by differing diagnostic criteria. CONCLUSIONS This review provides updated information on the epidemiology of schizophrenia in general populations, which is vital information for many stakeholders. Study characteristics appear to play an important role in the variation between estimates. Overall, the evidence is still sparse; for many countries no new studies were identified.
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Affiliation(s)
| | | | - Philip Rotella
- Evidera, 430 Bedford Street, Suite 300, Lexington, MA, 02420, USA.
| | - Jenna Collins
- Evidera, 430 Bedford Street, Suite 300, Lexington, MA, 02420, USA.
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Anderson KK, Cheng J, Susser E, McKenzie KJ, Kurdyak P. Incidence of psychotic disorders among first-generation immigrants and refugees in Ontario. CMAJ 2015; 187:E279-E286. [PMID: 25964387 DOI: 10.1503/cmaj.141420] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2015] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Evidence suggests that migrant groups have an increased risk of psychotic disorders and that the level of risk varies by country of origin and host country. Canadian evidence is lacking on the incidence of psychotic disorders among migrants. We sought to examine the incidence of schizophrenia and schizoaffective disorders in first-generation immigrants and refugees in the province of Ontario, relative to the general population. METHODS We constructed a retrospective cohort that included people aged 14-40 years residing in Ontario as of Apr. 1, 1999. Population-based administrative data from physician billings and hospital admissions were linked to data from Citizenship and Immigration Canada. We used Poisson regression models to calculate age- and sex-adjusted incidence rate ratios (IRRs) and 95% confidence intervals (CIs) for immigrant and refugee groups over a 10-year period. RESULTS In our cohort (n = 4,284,694), we found higher rates of psychotic disorders among immigrants from the Caribbean and Bermuda (IRR 1.60, 95% CI 1.29-1.98). Lower rates were found among immigrants from northern Europe (IRR 0.50, 95% CI 0.28-0.91), southern Europe (IRR 0.60, 95% CI 0.41-0.90) and East Asia (IRR 0.56, 95% CI 0.41-0.78). Refugee status was an independent predictor of risk among all migrants (IRR 1.27, 95% CI 1.04-1.56), and higher rates were found specifically for refugees from East Africa (IRR 1.95, 95% CI 1.44-2.65) and South Asia (IRR 1.51, 95% CI 1.08-2.12). INTERPRETATION The differential pattern of risk across ethnic subgroups in Ontario suggests that psychosocial and cultural factors associated with migration may contribute to the risk of psychotic disorders. Some groups may be more at risk, whereas others are protected.
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Affiliation(s)
- Kelly K Anderson
- Departments of Epidemiology and Biostatistics, and Psychiatry (Anderson), Western University, London Ont.; Institute for Clinical Evaluative Sciences (Anderson, Cheng, Kurdyak), Toronto, Ont.; Centre for Addiction and Mental Health (Cheng, McKenzie, Kurdyak), Toronto, Ont.; Mailman School of Public Health (Susser), Columbia University, New York, NY; Department of Psychiatry (McKenzie, Kurdyak), University of Toronto, Toronto, Ont.
| | - Joyce Cheng
- Departments of Epidemiology and Biostatistics, and Psychiatry (Anderson), Western University, London Ont.; Institute for Clinical Evaluative Sciences (Anderson, Cheng, Kurdyak), Toronto, Ont.; Centre for Addiction and Mental Health (Cheng, McKenzie, Kurdyak), Toronto, Ont.; Mailman School of Public Health (Susser), Columbia University, New York, NY; Department of Psychiatry (McKenzie, Kurdyak), University of Toronto, Toronto, Ont
| | - Ezra Susser
- Departments of Epidemiology and Biostatistics, and Psychiatry (Anderson), Western University, London Ont.; Institute for Clinical Evaluative Sciences (Anderson, Cheng, Kurdyak), Toronto, Ont.; Centre for Addiction and Mental Health (Cheng, McKenzie, Kurdyak), Toronto, Ont.; Mailman School of Public Health (Susser), Columbia University, New York, NY; Department of Psychiatry (McKenzie, Kurdyak), University of Toronto, Toronto, Ont
| | - Kwame J McKenzie
- Departments of Epidemiology and Biostatistics, and Psychiatry (Anderson), Western University, London Ont.; Institute for Clinical Evaluative Sciences (Anderson, Cheng, Kurdyak), Toronto, Ont.; Centre for Addiction and Mental Health (Cheng, McKenzie, Kurdyak), Toronto, Ont.; Mailman School of Public Health (Susser), Columbia University, New York, NY; Department of Psychiatry (McKenzie, Kurdyak), University of Toronto, Toronto, Ont
| | - Paul Kurdyak
- Departments of Epidemiology and Biostatistics, and Psychiatry (Anderson), Western University, London Ont.; Institute for Clinical Evaluative Sciences (Anderson, Cheng, Kurdyak), Toronto, Ont.; Centre for Addiction and Mental Health (Cheng, McKenzie, Kurdyak), Toronto, Ont.; Mailman School of Public Health (Susser), Columbia University, New York, NY; Department of Psychiatry (McKenzie, Kurdyak), University of Toronto, Toronto, Ont
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25
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Kim YJ, Lee E, Lee HS, Kim M, Park MS. High prevalence of breast cancer in light polluted areas in urban and rural regions of South Korea: An ecologic study on the treatment prevalence of female cancers based on National Health Insurance data. Chronobiol Int 2015; 32:657-67. [DOI: 10.3109/07420528.2015.1032413] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Laliberté V, Joseph L, Gold I. A Bayesian Approach to Latent Class Modeling for Estimating the Prevalence of Schizophrenia Using Administrative Databases. Front Psychiatry 2015; 6:99. [PMID: 26217241 PMCID: PMC4491595 DOI: 10.3389/fpsyt.2015.00099] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Estimating the incidence and the prevalence of psychotic disorders in the province of Quebec has been the object of some interest in recent years as a contribution to the epidemiological study of the causes of psychotic disorders being carried out primarily in UK and Scandinavia. A number of studies have used administrative data from the Régie de l'assurance maladie du Québec (RAMQ) that includes nearly all Quebec citizens to obtain geographical and temporal prevalence estimates for the illness. However, there has been no investigation of the validity of RAMQ diagnoses for psychotic disorders, and without a measure of the sensitivity and the specificity of these diagnoses, it is impossible to be confident in the accuracy of the estimates obtained. This paper proposes the use of latent class analysis to ascertain the validity of a diagnosis of schizophrenia using RAMQ data.
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Affiliation(s)
| | - Lawrence Joseph
- Department of Epidemiology and Biostatistics, McGill University , Montreal, QC , Canada
| | - Ian Gold
- Department of Psychiatry, McGill University , Montreal, QC , Canada ; Department of Philosophy, McGill University , Montreal, QC , Canada
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27
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Iyer SN, Malla AK. Intervention précoce pour la psychose : concepts, connaissances actuelles et orientations futures. ACTA ACUST UNITED AC 2014. [DOI: 10.7202/1027840ar] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cet article fournit un survol de la logique de l’intervention précoce pour psychose, de ses fondements théoriques et de la littérature essentielle sur le concept. L’intervention précoce repose sur l’hypothèse de la période critique, qui vient accentuer l’importance des premiers stades de la maladie, et sur les résultats d’études dans le domaine, qui suggère que la durée d’une psychose non traitée en influence le pronostic. L’intervention précoce facilite l’accès à un traitement spécialisé adapté à la phase de la maladie par un processus de recommandations médicales plus ouvert, des délais rapides et l’éducation du public et des praticiens sur la psychose. L’intervention précoce, qui dure généralement deux ans à partir du dépistage, comprend une prise en charge intensive et des médicaments antipsychotiques à faible dose. L’accent est mis sur le fonctionnement social, l’intervention familiale, l’attention précoce aux troubles connexes ainsi qu’une alliance thérapeutique entre le jeune et sa famille. Selon les données scientifiques disponibles, une telle intervention donne de meilleurs résultats que les soins typiquement offerts. Les critiques du concept visent la qualité des études en sa faveur, sa mise en oeuvre, la répartition des ressources en intervention précoce et son utilité pour les personnes présentant un risque élevé de psychose. En termes de disponibilité et d’élaboration de politiques en intervention précoce, le Royaume-Uni détient une avance certaine, alors que le Canada se situe au milieu, et les États-Unis au bas de l’échelle. Au Québec, les résultats varient et d’autres études et investissements sont nécessaires. Récemment, le concept d’intervention précoce a servi d’exemple à des mesures plus importantes visant la transformation des soins de santé mentale des jeunes, ce qui constitue une toute nouvelle percée au Canada.
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Affiliation(s)
- Srividya N. Iyer
- Auteure-ressource, Professeure adjointe, Département de psychiatrie, Université McGill, Montréal, Canada
- Coordonnatrice du Programme d’évaluation, d’intervention et de prévention des psychoses de Montréal, Institut universitaire en santé mentale Douglas, Montréal, Canada
| | - Ashok K. Malla
- Programme d’évaluation, d’intervention et de prévention des psychoses de Montréal (PEPP-Montréal), Institut universitaire en santé mentale Douglas, Montréal, Canada
- Département de psychiatrie, Université McGill, Montréal, Canada
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Hogerzeil SJ, van Hemert AM, Rosendaal FR, Susser E, Hoek HW. Direct comparison of first-contact versus longitudinal register-based case finding in the same population: early evidence that the incidence of schizophrenia may be three times higher than commonly reported. Psychol Med 2014; 44:3481-3490. [PMID: 25066605 DOI: 10.1017/s003329171400083x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The incidence of schizophrenia is commonly estimated by screening for psychosis among subjects presenting to psychiatric services. This approach (using a first-contact sampling frame) cannot account for cases that did not meet criteria for schizophrenia at first contact. We compared the usual approach directly with a register-based approach (using a longitudinal sampling frame) that also includes subjects initially diagnosed with other non-schizophrenic disorders. METHOD We compared data from the Longitudinal Psychiatric Register (LPR) of The Hague over 1980-2009 with data previously collected in a first-contact study, and applied both methods to calculate the incidence of schizophrenia for subjects aged 20-54 years in the same catchment area and over the same period (October 2000 to September 2005). We reconstructed treatment pathways and diagnostic histories up to the end of 2009 and performed sensitivity analyses. RESULTS The LPR identified 843 first onsets of schizophrenia, corresponding to a treated incidence rate (IR) of 69 per 100,000 person-years [95% confidence interval (CI) 64-74]. The first-contact study identified 254 first onsets, corresponding to a treated IR of 21 per 100,000 person-years (95% CI 18-23). Two-thirds of the difference was accounted for by subjects treated for other disorders before the onset of psychosis, and by patients in older age groups. CONCLUSIONS The incidence of schizophrenia was three times higher in a longitudinal register study than in a high-quality first-contact study conducted in the same population. Risk estimates based only on first-contact studies may have been affected by selection bias.
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Affiliation(s)
- S J Hogerzeil
- Parnassia Psychiatric Institute,The Hague,The Netherlands
| | - A M van Hemert
- Parnassia Psychiatric Institute,The Hague,The Netherlands
| | - F R Rosendaal
- Department of Clinical Epidemiology,Leiden University Medical Center,The Netherlands
| | - E Susser
- Department of Epidemiology, Mailman School of Public Health,Columbia University,New York, NY,USA
| | - H W Hoek
- Parnassia Psychiatric Institute,The Hague,The Netherlands
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Ngamini Ngui A, Apparicio P, Fleury MJ, Grégoire JP, Moisan J, Lesage A, Vanasse A. Disentangling the influence of neighborhood and individual characteristics on early residential mobility among newly diagnosed patients with schizophrenia: a multilevel analysis. Soc Psychiatry Psychiatr Epidemiol 2014; 49:1569-78. [PMID: 24789455 DOI: 10.1007/s00127-014-0883-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 04/14/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Early residential mobility of schizophrenic patients may relate to discontinuity of treatment and adverse outcome. However, factors influencing early residential mobility of these patients are still poorly examined. The aim of this study was to disentangle the influence of individual and neighborhood characteristics on early residential mobility of schizophrenic patients. METHODS The study used administrative data of 13, 400 individuals newly diagnosed with schizophrenia in Quebec between 2001 and 2002. These individuals were nested in 163 different health territories. Multilevel analyses were used to assess the contribution of individual and neighborhood characteristics on early residential mobility. RESULTS The final model indicates that at the individual level, being men, wonder patients and physical comorbidity increased the likelihood of early residential mobility whereas older patients were less likely to migrate earlier. The health territory level explains about 7 % of the variation of early residential mobility and variables influencing residential mobility at this level are the fourth and the third quartiles of the population density. CONCLUSIONS Factors influencing early residential mobility of schizophrenic patients are located at both individual and neighborhood levels. This suggests that policies targeting only one-level factors are unlikely to significantly delays early residential mobility.
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Affiliation(s)
- André Ngamini Ngui
- Centre de réadaptation en dépendance de Montréal, Institut Universitaire, Montreal, Canada,
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30
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Brouwers FM, Courteau J, Cohen AA, Farand P, Cloutier L, Asghari S, Vanasse A. Beta-blockers are associated with increased risk of first cardiovascular events in non-diabetic hypertensive elderly patients. Pharmacoepidemiol Drug Saf 2014; 23:1139-46. [PMID: 25045055 DOI: 10.1002/pds.3675] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 06/03/2014] [Accepted: 06/03/2014] [Indexed: 11/07/2022]
Abstract
PURPOSE Although treatment should be considered for elderly patients with hypertension (HTN), the effectiveness of beta-blockers (BBs) compared with other medications is less clear. This study's objective is to assess the relative effectiveness of BBs in elderly primary prevention patients with uncomplicated HTN. METHODS This is a population-based nested case-control study. The cohort is composed of 94,844 elderly patients followed through 2009 and diagnosed with HTN between 2000 and 2004, without recent antecedents of diabetes, renal disease, or cardiovascular disease (CVD). Individuals with a CVD outcome were considered cases, and controls were matched to cases according to age, sex, date of cohort entry, and comorbidity index. Patients whose treatment included a BB were compared with patients on other HTN drug(s). RESULTS The BB use by patients was associated with an increased risk for CVD events (odds ratio (OR) = 1.36, 95%CI: 1.31-1.40) compared with patients using antihypertensive therapies without BBs. Sensitivity analyses suggest that this increased risk is not due to differences in prescription patterns on the basis of perceived disease severity. CONCLUSIONS In real-world settings, antihypertensive therapies that include BBs are associated with less effective prevention of adverse outcomes in elderly hypertensive patients in primary prevention compared with antihypertensive therapies without BBs. Pending further studies, we recommend caution when prescribing BBs in primary prevention except when otherwise indicated.
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Affiliation(s)
- Frederieke M Brouwers
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke, Quebec, Canada
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Saha S, Whiteford H, McGrath J. Modelling the incidence and mortality of psychotic disorders: data from the second Australian national survey of psychosis. Aust N Z J Psychiatry 2014; 48:352-9. [PMID: 24270308 DOI: 10.1177/0004867413513341] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES The aim of this study was to model estimates related to (a) the incidence of psychotic disorders and (b) the mortality associated with these disorders based on a large, population-based prevalence study. METHODS Data were drawn from the second national survey of adults with psychotic disorders conducted in seven Australian catchment areas during March to December 2010. To generate incidence rate estimates, we identified recent onset cases recruited as part of the prevalence study and then imputed population-based incidence rates using a set of conservative assumptions. Similarly, for mortality rates, we identified individuals who had died after being identified as 'screen-positive' for psychosis, but prior to full clinical assessment. Using a set of conservative assumptions, we then used these estimates to infer population-based mortality rates. RESULTS Based on our models, we estimated that the incidence rate for psychotic disorders was 28 cases per 100,000 population. The rate estimates were significantly higher in males than females, with an overall male:female ratio of 1.57:1. Incidence rate estimates peaked in the youngest age group (18-24 years). The adjusted mortality rate estimated during the whole period of observation was 12.5 per 1000 persons, with a standardised mortality ratio of 5.5. CONCLUSIONS Using treated prevalence data and observed deaths with appropriate algorithms, we were able to impute incidence and mortality rates for psychotic disorders consistent with the published literature. While the second national survey of psychotic disorders was not designed to identify mortality, our estimates provide a stark reminder of the increased mortality associated with these disorders.
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Affiliation(s)
- Sukanta Saha
- 1Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Australia
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Jörgensen L, Allebeck P, Dalman C. Prevalence of psychoses in Stockholm County--a population-based study using comprehensive healthcare registers. Nord J Psychiatry 2014; 68:60-5. [PMID: 23472654 DOI: 10.3109/08039488.2013.772234] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Major variations in the prevalence of schizophrenia and other psychoses have been reported in different geographical areas, partly explained by the methodology used as well as characteristics of the area. AIMS The purpose of this study was to estimate the 1-year prevalence of schizophrenia (ICD-10 F20) and non-affective psychoses (ICD-10 F20-F29) in Stockholm County using population-based health records from inpatient and outpatient care. METHODS Psychiatric outpatient and inpatient healthcare data during the period 1997 to 2006 in Stockholm County was collected from mental health facilities in a defined geographical area covering almost one million adult inhabitants. Data included 13,561 individuals with ICD-10 diagnoses of non-affective psychoses, their contacts with healthcare and demographic variables constituting the Stockholm Non-Affective Psychoses-registry. RESULTS The 1-year prevalence was 6.7/1000 for non-affective psychoses and 3.7/1000 for schizophrenia. The estimates were markedly stable during the study period, years 2000-2005. However, a substantial variation in the 1-year prevalence between areas in Stockholm County was noted (range 3.5/1000-13.2/1000). The 1-year prevalence was correlated to the proportion of immigrants as well as the proportion of individuals receiving social welfare benefits, in the area. An increase in the proportion of individuals only visiting outpatient care was seen. CONCLUSION The 1-year prevalence of schizophrenia was 3.7/1000 and approximately twice as high for non-affective psychoses. The estimates were stable over time but varied substantially between local areas, corresponding to social and demographic factors.
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Affiliation(s)
- Lena Jörgensen
- Public Health Epidemiology, Department of Public Health Sciences, Karolinska Institutet and Centre for Epidemiology and Community Medicine, Stockholm County Council , Stockholm , Sweden
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Beaudet N, Courteau J, Sarret P, Vanasse A. Improving the selection of true incident cases of low back pain by screening retrospective administrative data. Eur J Pain 2013; 18:923-31. [DOI: 10.1002/j.1532-2149.2013.00437.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2013] [Indexed: 11/08/2022]
Affiliation(s)
- N. Beaudet
- The PRIMUS Group, Clinical Research Centre Etienne-Le Bel; CHUS; Sherbrooke Canada
- Department of Family and Emergency Medicine; Faculty of Medicine and Health Sciences; Université de Sherbrooke; Canada
- Department of Physiology and Biophysics; Faculty of Medicine and Health Sciences; Université de Sherbrooke; Canada
| | - J. Courteau
- Department of Family and Emergency Medicine; Faculty of Medicine and Health Sciences; Université de Sherbrooke; Canada
| | - P. Sarret
- Department of Physiology and Biophysics; Faculty of Medicine and Health Sciences; Université de Sherbrooke; Canada
| | - A. Vanasse
- The PRIMUS Group, Clinical Research Centre Etienne-Le Bel; CHUS; Sherbrooke Canada
- Department of Family and Emergency Medicine; Faculty of Medicine and Health Sciences; Université de Sherbrooke; Canada
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Community pharmacy loyalty among individuals with schizophrenia. Res Social Adm Pharm 2013; 9:806-16. [DOI: 10.1016/j.sapharm.2013.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 01/17/2013] [Accepted: 01/19/2013] [Indexed: 11/20/2022]
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Dealberto MJ. Are the rates of schizophrenia unusually high in Canada? A comparison of Canadian and international data. Psychiatry Res 2013; 209:259-65. [PMID: 23433871 DOI: 10.1016/j.psychres.2013.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Revised: 09/26/2012] [Accepted: 01/09/2013] [Indexed: 10/27/2022]
Abstract
Two major risk factors for schizophrenia are present in Canada, high latitude and a large and growing immigrant population. Consequently, one would expect unusually high rates of schizophrenia and an increase in these rates over time. This systematic review tests these two hypotheses. Searches of electronic databases were performed through 2011. Out of 45 studies 12 fulfilled all the inclusion criteria. The means of Canadian and international rates were compared by one-tailed unequal variance t-test. Trends with time in Canadian rates were tested by the Spearman rank correlation coefficient. Prevalence and incidence rates in Canada were significantly higher than those in international studies. Rates increased over time, with a significant increase for prevalence and a trend for incidence. This rise was supported by historical data, recent hospital admission data, and the only Canadian cohort study. The findings of elevated rates in Canada and their increase over time give concern due to the serious personal, social, and financial burden of schizophrenia. These results, based on a small number of studies, warrant confirmation by specially designed studies. They could explain the discrepant results of the risk associated with immigration in Canadian studies.
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Affiliation(s)
- Marie-José Dealberto
- Department of Community Health and Epidemiology, Carruthers Hall, Queen's University, Kingston, Ontario, Canada K7L 3N6.
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Anderson KK, Fuhrer R, Wynant W, Abrahamowicz M, Buckeridge DL, Malla A. Patterns of health services use prior to a first diagnosis of psychosis: the importance of primary care. Soc Psychiatry Psychiatr Epidemiol 2013; 48:1389-98. [PMID: 23429939 DOI: 10.1007/s00127-013-0665-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 02/04/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE The observed association between treatment delay and poor outcomes in first-episode psychosis has led to an interest in the topography of symptom development preceding the onset of psychosis and associated help-seeking behaviors. We estimated the extent to which socio-demographic, clinical, and health service indicators are associated with patterns of service use for mental health reasons preceding a first diagnosis of psychosis. METHODS Population-based administrative data from physician billings, hospitalizations, and public health clinics were used to identify incident cases of schizophrenia-spectrum psychosis among individuals aged 14-25 years in Montréal. Mental health contacts in the 4 years preceding the index diagnosis were analyzed. RESULTS Thirty-two percent of cases had no contact with services for a mental health reason preceding the index diagnosis, and nearly 50% received the index diagnosis of psychosis in the emergency department. Individuals in contact with primary care had a reduced likelihood of contact with the emergency department and inpatient services (OR = 0.15, 0.06-0.39) and of receiving the index diagnosis in the emergency department (OR = 0.36, 0.24-0.54), but also had a longer time to contact with a psychiatrist (HR = 0.32, 0.23-0.45). CONCLUSIONS Improving access to primary care may reduce the burden on emergency departments and inpatient units; however, primary care providers may need additional training in the symptoms of early psychosis and referral protocols. Given the limitations associated with using clinical samples from specialized services, population-based administrative data are an important source of information for understanding patterns of health services use preceding a first diagnosis of psychosis.
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Affiliation(s)
- Kelly K Anderson
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montréal, QC, H3A 1A2, Canada
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Annual incidence rate of schizophrenia and schizophrenia spectrum disorders in a longitudinal population-based cohort study. Soc Psychiatry Psychiatr Epidemiol 2013; 48:1357-65. [PMID: 23340770 DOI: 10.1007/s00127-013-0651-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Accepted: 01/04/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Longitudinal incidence studies of schizophrenia spectrum disorders (SSD) performed in mental health service organizations are prone to confounding factors not found in research performed in the general population. OBJECTIVES To estimate the incidence rates (IRs) over a 10-year period of SSD (broadly defined) and schizophrenia (narrowly defined) in the general population and to analyze associated risk factors. METHODS A cohort study (1996-2006) in a large general practitioners research database was conducted with longitudinal medical records of 350,524 patients throughout the Netherlands. Cases of SSD were identified and classified by systematic review of medical records. Age- and gender-specific IRs were calculated per calendar year, date of birth, degree of urbanicity and deprivation. RESULTS Overall IR of SSD in this population was 22/100,000 person years (PY) (95% CI 19-24). IR of schizophrenia was 12/100,000 PY (95% CI 10-14). Period prevalence was 3.5 per 1,000 PY. IRs were higher in men compared to women, had a peak at age 15-25 years, decreasing rapidly after 25 years by 40% per 10 years. IRs of SSD were significantly higher in urban areas, irrespective of deprivation. No association was found between IRs of SSD and living in deprived areas or month of birth. There was no significant time trend of the IR during the period under study. CONCLUSIONS IRs of SSD are higher in urban areas, independent of social deprivation. Age- and gender-specific differences in IR were found. The magnitude of these differences was larger in narrowly defined schizophrenia than in SSD.
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Brouwers FM, Courteau J, Grégoire JP, Moisan J, Lauzier S, Lesage A, Fleury MJ, Vanasse A. The adequacy of pharmaceutical treatment of schizophrenia in Quebec varies with age, but is not influenced by sex or neighbourhood deprivation. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2013; 58:456-65. [PMID: 23972107 DOI: 10.1177/070674371305800804] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Though high discontinuation rates for antipsychotics (APs) by patients with schizophrenia are frequently reported, the percentage of patients receiving pharmaceutical treatment for schizophrenia in routine practice in accordance with international clinical guidelines is unknown. Further, it is unknown if these rates are influenced by levels of neighbourhood deprivation or by a patient's age or sex. Our study aims to investigate if inequalities in AP treatment could be observed between patients living in neighbourhoods with the highest levels of material and social deprivation and those with the lowest deprivation levels, between patients from different age groups, or between men and women. METHODS We conducted a secondary analysis of medical-administrative data of a cohort of adult patients in the province of Quebec with a medical contact for schizophrenia in a 2-year period (2004-2005). We assessed the proportion of patients that filled at least 1 prescription for an AP and received adequate pharmaceutical treatment, defined as being in possession of APs at least 80% of the time as outpatients during a 2-year follow-up period. RESULTS Among the 30 544 study patients, 88.5% filled at least 1 prescription for an AP, and 67.5% of the treated patients received adequate treatment. Though no clinically significant differences were observed by deprivation or sex, younger age was associated with lower proportions of patients receiving adequate treatment (46% of treated patients aged between 18 and 29 years, compared with 72% aged between 30 and 64 years, and 77% aged 65 years and over). CONCLUSIONS In Quebec's routine practice, over 70% of treated patients aged 30 and over received adequate pharmacological treatment, regardless of sex or neighbourhood socioeconomic status. In contrast, in patients aged between 18 and 29 years this percentage was 47%. This is a discouraging finding, especially because optimal treatment in the early phase of disease is reported to result in the best long-term outcomes.
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Affiliation(s)
- Frederieke M Brouwers
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec
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Ngamini Ngui A, Cohen AA, Courteau J, Lesage A, Fleury MJ, Grégoire JP, Moisan J, Vanasse A. Does elapsed time between first diagnosis of schizophrenia and migration between health territories vary by place of residence? A survival analysis approach. Health Place 2013; 20:66-74. [PMID: 23376731 DOI: 10.1016/j.healthplace.2012.12.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 12/10/2012] [Accepted: 12/10/2012] [Indexed: 11/17/2022]
Affiliation(s)
- André Ngamini Ngui
- Groupe PRIMUS, Centre de recherche clinique Étienne-Le Bel, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, QC, Canada, J1H 5N4.
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Anderson KK. Health service registry data in psychiatric epidemiology: challenges for definition and interpretation: an editorial comment to: Okkels et al.'s 'changes in the diagnosed incidence of early onset schizophrenia over four decades' (1). Acta Psychiatr Scand 2013; 127:9-10. [PMID: 23240595 DOI: 10.1111/j.1600-0447.2012.01916.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Anderson KK, Fuhrer R, Abrahamowicz M, Malla AK. The incidence of first-episode schizophrenia-spectrum psychosis in adolescents and young adults in montreal: an estimate from an administrative claims database. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2012; 57:626-33. [PMID: 23072954 DOI: 10.1177/070674371205701007] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE There has been increasing interest in the psychiatric literature on research and service delivery focused on first-episode psychosis (FEP), and accurate information on the incidence of FEP is crucial for the development of services targeting patients in the early stages of illness. We sought to obtain a population-based estimate of the incidence of first-episode schizophrenia-spectrum psychosis (SSP) among adolescents and young adults in Montreal. METHODS Population-based administrative data from physician billings, hospitalizations, pharmacies, and public health clinics were used to estimate the incidence of first-episode SSP in Montreal. A 3-year period (2004-2006) was used to identify patients with SSP aged 14 to 25 years. We used a 4- to 6-year clearance period to remove patients with a history of any psychotic disorder or prescription for an antipsychotic. RESULTS We identified 456 patients with SSP, yielding a standardized annual incidence of 82.9 per 100 000 for males (95% CI 73.7 to 92.1), and 32.2 per 100 000 for females (95% CI 26.7 to 37.8). Using ecologic indicators of material and social deprivation, we found a higher-incidence proportion of SSP among people living in the most deprived areas, relative to people living in the least deprived areas. CONCLUSIONS Clinical samples obtained from psychiatric services are unlikely to capture all treatment-seeking patients, and epidemiologic surveys have resource-intensive constraints, making this approach challenging for rare forms of psychopathology; therefore, population-based administrative data may be a useful tool for studying the frequency of psychotic disorders.
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Khan BK, Woolley JD, Chao S, See T, Karydas AM, Miller BL, Rankin KP. Schizophrenia or neurodegenerative disease prodrome? Outcome of a first psychotic episode in a 35-year-old woman. PSYCHOSOMATICS 2012; 53:280-4. [PMID: 22284422 DOI: 10.1016/j.psym.2011.04.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Revised: 04/24/2011] [Accepted: 04/25/2011] [Indexed: 11/30/2022]
Affiliation(s)
- Baber K Khan
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
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