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Mongkonkansai J, Parapan P, Srinuan M, Thepnoo T, Khoklang S, Yimthiang S, Mahaboon J, Madardam U. Predicting the work ability of security guards at a university in Nakhon Si Thammarat province, Thailand. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2024; 30:486-495. [PMID: 38351578 DOI: 10.1080/10803548.2024.2318952] [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] [Indexed: 03/13/2024]
Abstract
Objectives. The number of security guards in universities has increased significantly. This study aimed to predict work ability of university security guards. Methods. A cross-sectional study of 97 university security guards in Thailand was performed. Data were collected through interviews using a questionnaire covering social demographics, behavioral health and work ability. The data were analyzed using χ2 tests and logistic regression models. Results. The average work ability index (WAI) score was 38.1 ± 3.8, with 65.0% of participants scoring 'good'. Social support significantly influenced the WAI (p = 0.004). Those with insufficient support were 4.3 times more likely to show poor work ability. Mental health also impacted the WAI (p = 0.006); those with poor mental health were 4.7 times at risk. Additionally, work experience affected the WAI (p = 0.039). Those with ≥5 years of experience showed reduced work ability compared to their less-experienced counterparts (adjusted odds ratio 0.4; 95% confidence interval [0.20, 0.96]). Conclusions. Supervisors should provide social support and offer rewards and commendations to enhance employees' abilities, health behaviors and management of underlying diseases. Additionally, organizations should prioritize health and safety in the workplace to ensure their employees are healthier and perform their tasks more effectively.
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Jones N, Tong L, Pagdon S, Ebuenyi ID, Harrow M, Sharma RP, Rosen C. Using latent class analysis to investigate enduring effects of intersectional social disadvantage on long-term vocational and financial outcomes in the 20-year prospective Chicago Longitudinal Study. Psychol Med 2024:1-13. [PMID: 38523254 DOI: 10.1017/s0033291724000588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
BACKGROUND Class and social disadvantage have long been identified as significant factors in the etiology and epidemiology of psychosis. Few studies have explicitly examined the impact of intersecting social disadvantage on long-term employment and financial independence. METHODS We applied latent class analysis (LCA) to 20-year longitudinal data from participants with affective and non-affective psychosis (n = 256) within the Chicago Longitudinal Research. LCA groups were modeled using multiple indicators of pre-morbid disadvantage (parental social class, educational attainment, race, gender, and work and social functioning prior to psychosis onset). The comparative longitudinal work and financial functioning of LCA groups were then examined. RESULTS We identified three distinct latent classes: one comprised entirely of White participants, with the highest parental class and highest levels of educational attainment; a second predominantly working-class group, with equal numbers of Black and White participants; and a third with the lowest parental social class, lowest levels of education and a mix of Black and White participants. The latter, our highest social disadvantage group experienced significantly poorer employment and financial outcomes at all time-points, controlling for diagnosis, symptoms, and hospitalizations prior to baseline. Contrary to our hypotheses, on most measures, the two less disadvantaged groups did not significantly differ from each other. CONCLUSIONS Our analyses add to a growing literature on the impact of multiple forms of social disadvantage on long-term functional trajectories, underscoring the importance of proactive attention to sociostructural disadvantage early in treatment, and the development and evaluation of interventions designed to mitigate ongoing social stratification.
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Affiliation(s)
- Nev Jones
- School of Social Work, University of Pittsburgh, Pittsburgh, PA, USA
| | - Liping Tong
- Advocate Aurora Health, Downers Grove, IL, USA
| | - Shannon Pagdon
- School of Social Work, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ikenna D Ebuenyi
- School of Health & Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Martin Harrow
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Rajiv P Sharma
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Cherise Rosen
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
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3
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Affiliation(s)
- Martin Harrow
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Thomas H Jobe
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Liping Tong
- Advocate Aurora Health, Downers Grove, IL, USA
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4
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Affiliation(s)
- Joseph M Pierre
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Michael F Zito
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Yvonne S Yang
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Stephen R Marder
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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Abstract
BACKGROUND Studies that examine course and outcome in psychosis have reported considerable heterogeneity in terms of recovery, remission, employment, symptom presentation, social outcomes, and antipsychotic medication effects. Even with demonstrated heterogeneity in course and outcome, prophylactic antipsychotic maintenance therapy remains the prominent practice, particularly in participants with schizophrenia. Lack of efficacy in maintenance antipsychotic treatment and concerns over health detriments gives cause to re-examine guidelines. METHODS This study was conducted as part of the Chicago follow-up study designed as a naturalistic prospective longitudinal research study to investigate the course, outcome, symptomatology, and effects of antipsychotic medication on recovery and rehospitalization in participants with serious mental illness disorders. A total of 139 participants with 734 observations were included in the analysis. GEE logistic models were applied to adjust for confounding factors measured at index hospitalization and follow-ups. RESULTS Our data show that the majority of participants with schizophrenia or affective psychosis experience future episodes of psychosis at some point during the 20-year follow-up. There was a significant diagnostic difference between groups showing an increase in the number of future episodes of psychosis in participants with schizophrenia. Participants with schizophrenia not on antipsychotics after the first 2 years have better outcomes than participants prescribed antipsychotics. The adjusted odds ratio of not on antipsychotic medication was 5.989 (95% CI 3.588-9.993) for recovery and 0.134 (95% CI 0.070-0.259) for rehospitalization. That is, regardless of diagnosis, after the second year, the absence of antipsychotics predicted a higher probability of recovery and lower probability of rehospitalization at subsequent follow-ups after adjusting for confounders. CONCLUSION This study reports multiple findings that bring into question the use of continuous antipsychotic medications, regardless of diagnosis. Even when the confound by indication for prescribing antipsychotic medication is controlled for, participants with schizophrenia and affective psychosis do better than their medicated cohorts, strongly confirming the importance of exposing the role of aiDSP and antipsychotic drug resistance.
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Affiliation(s)
- Martin Harrow
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Thomas H Jobe
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Liping Tong
- Advocoate Aurora Health, Downers Grove, IL, USA
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6
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Drosos P, Johnsen E, Bartz-Johannessen CA, Larsen TK, Reitan SK, Rettenbacher M, Kroken RA. Trajectories of response in schizophrenia-spectrum disorders: A one-year prospective cohort study of antipsychotic effectiveness. World J Psychiatry 2022; 12:521-532. [PMID: 35433321 PMCID: PMC8968498 DOI: 10.5498/wjp.v12.i3.521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/14/2021] [Accepted: 01/29/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Antipsychotic drugs remain the mainstay of schizophrenia treatment; however, their effectiveness has been questioned, and it is not possible to predict the response to a specific antipsychotic drug in an individual patient. Thus, it is important to compare the effectiveness of the various antipsychotics and search for possible response predictors.
AIM To investigate the effectiveness of antipsychotic drugs, we examined response trajectories and predictors for belonging to different trajectory groups.
METHODS The Bergen-Stavanger-Innsbruck-Trondheim (BeSt InTro) trial compared the effectiveness of three atypical antipsychotics-amisulpride, aripiprazole, and olanzapine-in a prospective, semirandomized, rater-blind, head-to-head design. Adult participants with a schizophrenia spectrum disorder diagnosis, according to international classification of diseases, Tenth Revision (ICD-10) F20–29, were included. Participants were followed for a period of 12 mo, with assessments at baseline; after one, three and six weeks; and after three, six, nine and 12 mo. A latent class mixed model was fitted to our data. The three-trajectory model based on the Positive and Negative Syndrome Scale (PANSS) total score reduction was found to have adequate fit, and the study drugs, as well as various demographic and clinical parameters, were tested as predictors for belonging to the different trajectory groups.
RESULTS Overall, 144 participants were included, and 41% completed the 12-mo study period. The largest trajectory group, consisting of 74% of participants, showed a PANSS total score reduction of 59% from baseline to 12 mo (Good response group). A trajectory group comprising 13% of participants had their PANSS total score reduced by 82.5% at 12 mo (Strong response group), while the last response trajectory group comprising 13% of the participants had a PANSS total score reduction of 13.6% (Slight response group). The largest part of the total reduction for the Good and Strong response groups occurred at six weeks of treatment, amounting to 45% and 48% reductions from baseline, respectively. The use of amisulpride predicted belonging to the Strong response group, while unemployment, depression, and negative psychotic symptoms at baseline increased the chance of belonging to the Slight response group, indicating a poor response to antipsychotic drug treatment.
CONCLUSION Most of the participants (87%) had a good outcome after one year. Amisulpride users, more often than aripiprazole and olanzapine users, belonged to the response trajectory group with a strong response.
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Affiliation(s)
- Petros Drosos
- TIPS-Network for Clinical Research in Psychosis, Clinic For Adult Mental Health, Stavanger University Hospital, Stavanger 4011, Norway
- NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen 5036, Norway
- Department of Clinical Medicine, University of Bergen, Bergen 5007, Norway
| | - Erik Johnsen
- NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen 5036, Norway
- Department of Clinical Medicine, University of Bergen, Bergen 5007, Norway
| | | | - Tor Ketil Larsen
- TIPS-Network for Clinical Research in Psychosis, Clinic For Adult Mental Health, Stavanger University Hospital, Stavanger 4011, Norway
- Department of Clinical Medicine, University of Bergen, Bergen 5007, Norway
| | - Solveig Klæbo Reitan
- Institute for Mental Health, St Olav's University Hospital, Trondheim 7030, Norway
- Department of Mental Health, Norwegian University of Natural Science and Technology, Trondheim 7491, Norway
| | - Maria Rettenbacher
- Department of Psychiatry and Psychotherapy, Medical University Innsbruck, Innsbruck 6020, Austria
| | - Rune Andreas Kroken
- NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen 5036, Norway
- Department of Clinical Medicine, University of Bergen, Bergen 5007, Norway
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7
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Mackey C. Moving Beyond Current Treatment: Responding to Extreme States With Compassion and Dignity. JOURNAL OF HUMANISTIC PSYCHOLOGY 2022. [DOI: 10.1177/00221678221078659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Newer research around extreme experiences is showing that recovery is far more prevalent than has been represented in the past. In addition, some aspects that have traditionally been considered the first line of treatment are now being found to be less effective than once believed or even harmful. However, approaches that combine new information, compassion, and that restore dignity to the individual are finally being recognized as the underpinnings of successful outcomes. Individuals who have gone through an extreme state deserve to learn about the impact of cultural aspects and childhood experiences on such. They should be reminded that many will experience positive growth from the extreme state itself. It should be normalized how frequently these experiences arise throughout the world and how often people do recover. It is important for individuals to understand the beneficial impact of enhancing relationships and connections in their daily life and of fostering empowerment for themselves and their choices. By incorporating research findings and inviting the individual to seek out a meaningful life, as determined by themselves, people can and do recover from these experiences.
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Affiliation(s)
- Chelsea Mackey
- Vantage Point Center for Psychotherapy, Sacramento, CA, USA
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8
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Okada H. Identifying subgroups based on self-assessment of ability in patients with schizophrenia and its relationship with vocational outcomes. Hong Kong J Occup Ther 2022; 35:35-43. [PMID: 35847185 PMCID: PMC9279875 DOI: 10.1177/15691861221075715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 01/08/2022] [Indexed: 11/21/2022] Open
Abstract
Background/Objectives People with schizophrenia have defective self-assessment of ability (i.e., loss of introspective accuracy [IA]). Although previous studies grouped people according to the degree of IA, the clinical features of these subgroups have not been clarified. Additionally, the determinants of outcomes depending on self-assessment remain unknown. We aimed to identify the clinical features that can help distinguish these subgroups and whether the determinants of vocational outcomes differed between the groups. Methods The self-assessment ability of 100 people with schizophrenia was examined and categorized as accurate, over-, or under-estimators. Multiple discriminant analysis was also performed. After demonstrating statistical validity, the relative effects of positive and negative symptoms, cognitive function, and level of IA on vocational outcomes were also examined for each subgroup. Results The symptoms that particularly explained the differences between these subgroups were positive and negative (expressing factors) symptoms: p < .001. Using the determinants of vocational outcomes in each subgroup, the over-estimator subgroup was characterized by positive symptoms: p = .025, the under-estimator group, by the underestimation of their own ability: p = .042, and the accurate estimator group, by cognitive function: p = .006. Conclusion Reduced IA can be a core mediator of various symptoms. Thus, tailoring the target and strategy of interventions for vocational outcomes according to the accuracy and quality of IA is important in clinical settings.
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Affiliation(s)
- Hiroki Okada
- Department of Rehabilitation of Sciences, Hokkaido University, Sapporo, Japan
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9
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Chen Y, Womer FY, Feng R, Zhang X, Zhang Y, Duan J, Chang M, Yin Z, Jiang X, Wei S, Wei Y, Tang Y, Wang F. A Real-World Observation of Antipsychotic Effects on Brain Volumes and Intrinsic Brain Activity in Schizophrenia. Front Neurosci 2022; 15:749316. [PMID: 35221884 PMCID: PMC8863862 DOI: 10.3389/fnins.2021.749316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/30/2021] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe confounding effects of antipsychotics that led to the inconsistencies of neuroimaging findings have long been the barriers to understanding the pathophysiology of schizophrenia (SZ). Although it is widely accepted that antipsychotics can alleviate psychotic symptoms during the early most acute phase, the longer-term effects of antipsychotics on the brain have been unclear. This study aims to look at the susceptibility of different imaging measures to longer-term medicated status through real-world observation.MethodsWe compared gray matter volume (GMV) with amplitude of low-frequency fluctuations (ALFFs) in 89 medicated-schizophrenia (med-SZ), 81 unmedicated-schizophrenia (unmed-SZ), and 235 healthy controls (HC), and the differences were explored for relationships between imaging modalities and clinical variables. We also analyzed age-related effects on GMV and ALFF values in the two patient groups (med-SZ and unmed-SZ).ResultsMed-SZ demonstrated less GMV in the prefrontal cortex, temporal lobe, cingulate gyri, and left insula than unmed-SZ and HC (p < 0.05, family-wise error corrected). Additionally, GMV loss correlated with psychiatric symptom relief in all SZ. However, medicated status did not influence ALFF values: all SZ showed increased ALFF in the anterior cerebrum and decreased ALFF in posterior visual cortices compared with HC (p < 0.05, family-wise error corrected). Age-related GMV effects were seen in all regions, which showed group-level differences except fusiform gyrus. No significant correlation was found between ALFF values and psychiatric symptoms.ConclusionGMV loss appeared to be pronounced to longer-term antipsychotics, whereby imbalanced alterations in regional low-frequency fluctuations persisted unaffected by antipsychotic treatment. Our findings may help to understand the disease course of SZ and potentially identify a reliable neuroimaging feature for diagnosis.
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Affiliation(s)
- Yifan Chen
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
- Early Intervention Unit, Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Fay Y. Womer
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Ruiqi Feng
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
- School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, China
| | - Xizhe Zhang
- Early Intervention Unit, Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
- Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Yanbo Zhang
- Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, China
| | - Jia Duan
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
- Early Intervention Unit, Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Miao Chang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
- School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, China
| | - Zhiyang Yin
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Xiaowei Jiang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Shengnan Wei
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yange Wei
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
- Early Intervention Unit, Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yanqing Tang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
- *Correspondence: Yanqing Tang,
| | - Fei Wang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
- Early Intervention Unit, Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China
- Fei Wang,
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Wand T, Glover S, Paul D. What should be the future focus of mental health nursing? Exploring the perspectives of mental health nurses, consumers, and allied health staff. Int J Ment Health Nurs 2022; 31:179-188. [PMID: 34679235 DOI: 10.1111/inm.12947] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/26/2021] [Accepted: 10/08/2021] [Indexed: 12/11/2022]
Abstract
The landscape of mental health care and service delivery is changing, as is our understanding of the underlying causes for mental distress. It is now apparent that biogenic explanations have been overstated and instead experiences of trauma and adversity constitute the main contributor to people's experiences of mental health challenges. The shortcomings of treatments traditionally used in mental health care are also evident, and with a contemporary focus on person-centred care, the utility of diagnostic labels has been called into question. Taking all this into consideration, this study sought to explore, what should be the future focus of mental health nursing? Three separate focus groups were conducted. One with a sample of senior clinical mental health nurses, one with a sample of consumer representatives and another with allied health professionals. The common theme across all three focus groups was the centrality of the therapeutic role of mental health nurses (MHNs). Consumers and allied health participants, in particular, advocated for a de-emphasis on medications, psychiatric diagnoses, and custodial practices. The MHNs role in health promotion, working collaboratively with consumers, being hopeful, understanding the individual perspective, and appreciating the social determinants of mental health were all highlighted in framing the future focus of MHN practice.
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Affiliation(s)
- Timothy Wand
- Emergency Department, Royal Prince Alfred Hospital, University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
| | - Suzanne Glover
- Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Diane Paul
- Northern Sydney Local Health District, Sydney, New South Wales, Australia
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11
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Yen K, Liu CC, Lin YT, Chien YL, Hsieh MH, Liu CM, Hwang TJ, Liao WH, Hwu HG. Discontinuing Antipsychotic Medication After Remission from First-Episode Psychosis: A Survey of Psychiatrists' Attitudes in Taiwan. Neuropsychiatr Dis Treat 2022; 18:465-475. [PMID: 35261544 PMCID: PMC8898187 DOI: 10.2147/ndt.s339866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/26/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patients in remission after first-episode psychosis are inclined to discontinue antipsychotic treatment, which may lead to higher risk of relapse and unfavorable outcomes. Paradoxically, also there are evidences suggesting that certain patients may stay well in drug-free condition. Psychiatrists' views towards this dilemma might affect their approaches to these patients, and discrepant attitudes are noted between Western and Asian clinicians. This study aimed to examine psychiatrists' attitudes about discontinuing antipsychotic medications after remission from first-episode psychosis. METHODS Psychiatrists were recruited for this study using convenience sampling. A cross-sectional survey was conducted using a set of questionnaires comprising nine items for attitudes toward medication discontinuation, six vignettes for probing psychiatrists' practice in designated clinical scenarios, and a list of criteria that may affect their responses. RESULTS Responses were provided by 118 psychiatrists, two-thirds men, mean age 39.8 ± 10.1 years and mean experience 12.7 ± 9.7 years. Half of the participants endorsed that fewer than 20% of the remitted patients should stop medication completely; the majority advised that an observation period of 1 year or longer is necessary while discontinuing medication. The majority would not initiate discussion with patients about discontinuing medication. Responding to two case vignettes, those who endorsed that more patients could stop antipsychotics were also more inclined to discuss it with patients, but not consistently in response to the other four case vignettes. Taiwan psychiatrists expressed a wide range of decision-making considerations for discontinuing antipsychotics. CONCLUSION The majority of Taiwan psychiatrists thought it was not feasible to stop medications completely but were willing to consider this option. Once being presented with actual clinical scenarios, many participants hesitated to discontinue antipsychotic medications for various reasons. The proactive attitude of psychiatrists towards conducting clinical trials to test the feasibility of medication discontinuation may help to provide better reference for this clinical dilemma.
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Affiliation(s)
- Ko Yen
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Chen-Chung Liu
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Psychiatry, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Yi-Ting Lin
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Ling Chien
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ming H Hsieh
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chih-Min Liu
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tzung-Jeng Hwang
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wei-Hsiang Liao
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hai-Gwo Hwu
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
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12
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Fukuura Y, Shigematsu Y. The Work Ability of People with Mental Illnesses: A Conceptual Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910172. [PMID: 34639474 PMCID: PMC8508570 DOI: 10.3390/ijerph181910172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/24/2021] [Accepted: 09/25/2021] [Indexed: 11/16/2022]
Abstract
Continuous employment is an important goal for many people with mental illnesses. However, job retention and absenteeism remain significant problems that deter their attempts at gaining financial independence, expanding interpersonal relationships, and developing self-esteem. Although there is consensus on the necessity of their proactive treatment and social participation, such support is currently underwhelming. Therefore, this study analyzes the conceptual framework for work ability of people with mental illnesses. We performed our investigations using Rodgers' evolutionary conceptual analysis, targeting literature published from 1978 to 2020. Our search yielded 1420 articles in the Scopus inventory and 199 in PubMed. After exclusions, 13 articles remained. Using the same keywords in Google Scholar, we included 31 articles in our analysis. The attributes of work ability included the ability to self-manage, adaptability, the ability to dedicate oneself to work, and the ability to formulate plans. These were developed through a reiterative process. This study notes the importance of adjusting the work environment according to the patients' condition. Therefore, the ability to cope with stress and workload, as well as active self-adjustment, are crucial skills that nurses can help develop after assessing the patient's daily life. Furthermore, they can foster multidisciplinary collaboration and follow-up systems after employment.
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Affiliation(s)
- Yoshitomo Fukuura
- Department of Nursing, Graduate School of Medicine, Kurume University, Kurume 830-0003, Fukuoka-ken, Japan
- Correspondence:
| | - Yukako Shigematsu
- Department of Nursing, School of Nursing, Kurume University, Kurume 830-0003, Fukuoka-ken, Japan;
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13
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Ballesteros A, Sánchez Torres AM, López-Ilundáin J, Mezquida G, Lobo A, González-Pinto A, Pina-Camacho L, Corripio I, Vieta E, de la Serna E, Mané A, Bioque M, Moreno-Izco L, Espliego A, Lorente-Omeñaca R, Amoretti S, Bernardo M, Cuesta MJ. The longitudinal effect of antipsychotic burden on psychosocial functioning in first-episode psychosis patients: the role of verbal memory. Psychol Med 2021; 51:2044-2053. [PMID: 32326991 DOI: 10.1017/s003329172000080x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Previous literature supports antipsychotics' (AP) efficacy in acute first-episode psychosis (FEP) in terms of symptomatology and functioning but also a cognitive detrimental effect. However, regarding functional recovery in stabilised patients, these effects are not clear. Therefore, the main aim of this study is to investigate dopaminergic/anticholinergic burden of (AP) on psychosocial functioning in FEP. We also examined whether cognitive impairment may mediate these effects on functioning. METHODS A total of 157 FEP participants were assessed at study entry, and at 2 months and 2 years after remission of the acute episode. The primary outcomes were social functioning as measured by the functioning assessment short test (FAST). Cognitive domains were assessed as potential mediators. Dopaminergic and anticholinergic AP burden on 2-year psychosocial functioning [measured with chlorpromazine (CPZ) and drug burden index] were independent variables. Secondary outcomes were clinical and socio-demographic variables. RESULTS Mediation analysis found a statistical but not meaningful contribution of dopaminergic receptor blockade burden to worse functioning mediated by cognition (for every 600 CPZ equivalent points, 2-year FAST score increased 1.38 points). Regarding verbal memory and attention, there was an indirect effect of CPZ burden on FAST (b = 0.0045, 95% CI 0.0011-0.0091) and (b = 0.0026, 95% CI 0.0001-0.0006) respectively. However, only verbal memory post hoc analyses showed a significant indirect effect (b = 0.009, 95% CI 0.033-0.0151) adding premorbid IQ as covariate. We did not find significant results for anticholinergic burden. CONCLUSION CPZ dose effect over functioning is mediated by verbal memory but this association appears barely relevant.
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Affiliation(s)
- Alejandro Ballesteros
- Red de Salud Mental de Navarra, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNa), Pamplona, Spain
| | - Ana M Sánchez Torres
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNa), Pamplona, Spain
| | - Jose López-Ilundáin
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNa), Pamplona, Spain
| | - Gisela Mezquida
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), August Pi I Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Antonio Lobo
- Department of Medicine and Psychiatry, Zaragoza University, Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Ana González-Pinto
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- BIOARABA Health Research Institute, OSI Araba, University Hospital, University of the Basque Country, Vitoria, Spain
| | - Laura Pina-Camacho
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IISGM, CIBERSAM, Madrid, Spain
| | - Iluminada Corripio
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Psychiatry Department, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Eduard Vieta
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Unidad de Trastornos bipolares y depresivos, Hospital Clínic, Universidad de Barcelona, IDIBAPS, Barcelona, Spain
| | - Elena de la Serna
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Department of Child and Adolescent Psychiatry and Psychology, Clínic Institute of Neurosciences, Hospital Clínic de Barcelona, 2017SGR881, Spain
| | - Anna Mané
- Hospital del Mar Medical Research Institute (IMIM), CIBERSAM, Autonomous University of Barcelona, Barcelona, Spain
| | - Miquel Bioque
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), August Pi I Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Lucía Moreno-Izco
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNa), Pamplona, Spain
| | - Ana Espliego
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IISGM, CIBERSAM, Madrid, Spain
| | - Ruth Lorente-Omeñaca
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNa), Pamplona, Spain
| | - Silvia Amoretti
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), August Pi I Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Miguel Bernardo
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), August Pi I Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Manuel J Cuesta
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNa), Pamplona, Spain
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14
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Rubio JM, Taipale H, Tanskanen A, Correll CU, Kane JM, Tiihonen J. Long-term Continuity of Antipsychotic Treatment for Schizophrenia: A Nationwide Study. Schizophr Bull 2021; 47:1611-1620. [PMID: 34129663 PMCID: PMC8530382 DOI: 10.1093/schbul/sbab063] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Schizophrenia often requires long-term treatment with antipsychotic medication. This study aims to measure the continuity of antipsychotic treatment over the course of illness in schizophrenia, as well as factors involved in the interruption of treatment. For this, we followed up a national cohort of first-episode psychosis patients in Finland for up to 18 years. Stratified Cox proportional hazards regressions were conducted for "within-participant" risk of discontinuation of subsequent treatments compared to the first, and by specific antipsychotic compared to oral olanzapine, the most prescribed antipsychotic in this cohort. Adjusted hazard ratios (aHRs) and 95% confidence intervals (95% CIs) were calculated. Among 3343 participants followed up for a mean of 8 years (SD = 4.93), the median number of continuous treatment episodes was 6 (interquartile range [IQR] = 3-11) with a median duration of 11.4 months (IQR = 5.3-25.6). In the first year after diagnosis, the incidence rate of treatment discontinuation was 30.12 (95% CI = 29.89-30.35) events per 100 participant-years, decreasing to 8.90 (95% CI = 8.75-9.05) in the 10th year. The risk of discontinuation progressively decreased over successive treatment episodes (aHR = 0.30; 95% CI = 0.20-0.46 for episodes after the 15th compared to the first). Individuals were 67% less likely to interrupt treatment with long-acting injectable than oral antipsychotics (aHR = 0.33; 95% CI = 0.27-0.41). Treatment for schizophrenia over the long term is often characterized by recurrent cycles of interruptions and reintroductions of antipsychotic medication, which is typically not recommended by management guidelines. Greater utilization of long-acting injectable formulations earlier in the course of illness may facilitate the continuity of antipsychotic treatment in schizophrenia.
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Affiliation(s)
- Jose M Rubio
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA,Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA,Institute of Behavioral Science, The Feinstein Institute for Medical Research, Manhasset, NY, USA,To whom correspondence should be addressed; Research Division—Ambulatory Care Pavilion (PRA-17), Zucker Hillside Hospital, Glen Oaks, NY 11004 , USA; tel: 718-470-5912, fax: 718-343-1659, e-mail:
| | - Heidi Taipale
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland,School of Pharmacy, University of Eastern Finland, Kuopio, Finland,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Antti Tanskanen
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Christoph U Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA,Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA,Institute of Behavioral Science, The Feinstein Institute for Medical Research, Manhasset, NY, USA,Department of Child and Adolescent Psychiatry, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - John M Kane
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA,Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA,Institute of Behavioral Science, The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Jari Tiihonen
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden
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15
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Herbener ES, Harrow M. Course and symptom and functional correlates of passivity symptoms in schizophrenia: an 18-year multi-follow-up longitudinal study. Psychol Med 2021; 51:503-510. [PMID: 31839019 DOI: 10.1017/s0033291719003428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Change in the experience of oneself may lay the groundwork for the development of additional hallucinations and delusions in individuals with schizophrenia. However, to date, the course and symptom and functioning correlates of passivity symptoms (cf. thought insertion, thought withdrawal) have not been measured consistently over long periods of time. Information on the course and correlates of passivity symptoms is essential for developing models of their contribution to schizophrenic illness. METHOD Eighty-two individuals diagnosed with schizophrenia or schizoaffective disorder were recruited at an index hospitalization and reassessed at three or more follow-ups over the following 18 years. RESULTS The results indicate that a small group of participants report passivity symptoms at all follow-ups, many reported passivity symptoms at some follow-ups, and the majority of individuals never reported passivity symptoms. The prevalence of passivity symptoms was similar to that for delusions of reference and persecutory delusions. Notably, when individuals did experience passivity symptoms, they also had a greater number of additional psychotic symptoms than individuals without passivity symptoms. Further, the presence of passivity symptoms was associated with work impairment at some assessments. CONCLUSIONS Passivity symptoms present episodically, at a similar rate as delusions of reference and persecutory delusions, and when present, they are associated with having a higher number of additional psychotic symptoms, as well as having some impact on work functioning. These results suggest that passivity symptoms may increase vulnerability to additional psychotic symptoms and greater work impairment.
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Affiliation(s)
- Ellen S Herbener
- Department of Psychology, University of Illinois at Chicago, 1007 W Harrison St., Chicago, IL60607, USA
- Department of Psychiatry, University of Illinois at Chicago, 1601 W Taylor St., Chicago, IL60612, USA
| | - Martin Harrow
- Department of Psychiatry, University of Illinois at Chicago, 1601 W Taylor St., Chicago, IL60612, USA
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16
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Rubio JM, Malhotra AK, Kane JM. Towards a framework to develop neuroimaging biomarkers of relapse in schizophrenia. Behav Brain Res 2021; 402:113099. [PMID: 33417996 DOI: 10.1016/j.bbr.2020.113099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/16/2020] [Accepted: 12/27/2020] [Indexed: 12/31/2022]
Abstract
Schizophrenia is a chronic disorder that often requires long-term relapse-prevention treatment. This treatment is effective for most individuals, yet approximately 20-30 % of them may still relapse despite confirmed adherence. Alternatively, for about 15 % it may be safe to discontinue medications over the long term, but since there are no means to identify who those individuals will be, the recommendation is that all individuals receive long-term relapse-prevention treatment with antipsychotic maintenance. Thus, the current approach to prevent relapse in schizophrenia may be suboptimal for over one third of individuals, either by being insufficient to protect against relapse, or by unnecessarily exposing them to medication side effects. There is great need to identify biomarkers of relapse in schizophrenia to stratify treatment according to the risk and develop therapeutics targeting its pathophysiology. In order to develop a line of research that meets those needs, it is necessary to create a framework by identifying the challenges to this type of study as well as potential areas for biomarker identification and development. In this manuscript we review the literature to create such a framework.
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Affiliation(s)
- Jose M Rubio
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA; Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA; The Feinstein Institute for Medical Research, Center for Psychiatric Neuroscience, Manhasset, NY, USA.
| | - Anil K Malhotra
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA; Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA; The Feinstein Institute for Medical Research, Center for Psychiatric Neuroscience, Manhasset, NY, USA
| | - John M Kane
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA; Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA; The Feinstein Institute for Medical Research, Center for Psychiatric Neuroscience, Manhasset, NY, USA
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17
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Liu CC, Liu CM, Chien YL, Lin YT, Hsieh MH, Hwang TJ, Hwu HG. Challenging the Minimum Effective Antipsychotic Dose During Maintenance: Implications From 10-Year Follow-Up of First Episode Psychosis. Front Psychiatry 2021; 12:714878. [PMID: 34557119 PMCID: PMC8453020 DOI: 10.3389/fpsyt.2021.714878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/31/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Contradictory messages regarding the necessity of long-term antipsychotic treatment after first episode psychosis arouse deliberations in clinical practice. We explored if there is an alternative beyond the dichotomy of maintenance treatment and discontinuation of medications. Methods: We conducted a retrospective observational study by reviewing medical records at the study hospital of a cohort of patients since their participation in an early psychosis study starting from 2006, with special interests in patients able to maintain good functioning under treatment with a low antipsychotic dose. Results: Of the 81 patients with first-episode psychosis, 55 patients (67.9%) had follow-up information for longer than 5 years. The majority (n = 46, 83.6%) had non-affective psychosis, 20 patients (36.4%) had full-time employment/education by the time of their latest visit; among them, 15 patients received dosage of antipsychotics no more than the minimum effective dose [chlorpromazine equivalent (CPZE) dose, 200 mg/day]. Besides, 10 of 55 patients (18.2%) only received very low dose antipsychotics (CPZE < 50 mg/day) during maintenance, which was significantly correlated to good functioning. Being male, having a history of hospitalization, and being on clozapine therapy were correlated to poorer functioning. Antipsychotic-free status was achieved only in two non-psychotic patients. Conclusions: A substantial proportion of patients could achieve good functioning under low-dose antipsychotic maintenance after first-episode psychosis, even if they could not completely withdraw antipsychotics in the long term. Optimizing the balance between preventing relapse and preserving functioning by fine-tuning antipsychotic dosage during maintenance is a challenge warranting more clinical attention.
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Affiliation(s)
- Chen-Chung Liu
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Psychiatry, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Chih-Min Liu
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Ling Chien
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Ting Lin
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ming H Hsieh
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tzung-Jeng Hwang
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hai-Gwo Hwu
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
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18
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Isohanni M, Jääskeläinen E, Miller BJ, Hulkko A, Tiihonen J, Möller H, Hartikainen S, Huhtaniska S, Lieslehto J. Medication management of antipsychotic treatment in schizophrenia—A narrative review. Hum Psychopharmacol 2020. [DOI: 10.1002/hup.2765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Matti Isohanni
- Center for Life Course Health Research University of Oulu Oulu Finland
| | | | - Brian J. Miller
- Department of Psychiatry Augusta University Augusta Georgia USA
| | - Anja Hulkko
- Center for Life Course Health Research University of Oulu Oulu Finland
| | - Jari Tiihonen
- Karolinska Institutet Stockholm Sweden
- University of Eastern Finland Kuopio Finland
| | | | - Sirpa Hartikainen
- Kuopio Research Center of Geriatric Care School of Pharmacy University of Eastern Finland Kuopio Finland
| | - Sanna Huhtaniska
- Center for Life Course Health Research University of Oulu Oulu Finland
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19
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Zito MF, Marder SR. Rethinking the risks and benefits of long-term maintenance in schizophrenia. Schizophr Res 2020; 225:77-81. [PMID: 31806525 DOI: 10.1016/j.schres.2019.10.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/28/2019] [Accepted: 10/30/2019] [Indexed: 11/26/2022]
Abstract
This review addresses the risks and benefits of long-term maintenance antipsychotic treatment for patients that extends beyond two years. It focuses on framing discussions with patients who are recovering from a first episode. For these patients the evidence strongly supports the benefits over the risk for the first two years. However, both the clinical side effects of antipsychotics and the possible long-term effects of dopamine blocking drugs on the brain require a more nuanced discussion beyond this initial period. In most cases, the decision will be to continue antipsychotics but to consider strategies for mitigating the risks of drugs. This review provides information about the relative risks of dose reduction and intermittent treatment.
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Affiliation(s)
- Michael F Zito
- Semel Institute for Neuroscience at UCLA and the VA Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, USA
| | - Stephen R Marder
- Semel Institute for Neuroscience at UCLA and the VA Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, USA.
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20
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Hata T, Kanazawa T, Hamada T, Nishihara M, Yoneda H, Nakajima M, Katsumata T. The 12-year trend report of antipsychotic usage in a nationwide claims database derived from four million people in Japan. J Psychiatr Res 2020; 127:28-34. [PMID: 32450360 DOI: 10.1016/j.jpsychires.2020.05.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/01/2020] [Accepted: 05/11/2020] [Indexed: 01/08/2023]
Abstract
The current study aimed to describe the use of antipsychotics to clarify the gap between clinical guidelines and health care practice in Japan. We used data from the JMDC Claims Database (JMDC Inc., Tokyo, Japan), a nationwide claims database, from 2005 to 2016. Antipsychotics were defined as drugs coded as N05A with the Anatomical Therapeutic and Chemical (ATC) codes. We described the annual changes in proportions based on the number of patients prescribed any antipsychotics. From the database of 4,081,102 people, the data of 12,382 patients was extracted by applying the following exclusion criteria: no use of antipsychotics, missing the prescription date or dose, inpatients, prescribed antipsychotics only for use as needed, prescribed only injectable antipsychotics except for long-acting injections (LAIs), without schizophrenia as the primary disease, not exceeding 75 mg/day chlorpromazine equivalent, and less than 18 years old. The use of second-generation antipsychotics (SGA) has been expanding, while the use of first-generation antipsychotics has been decreasing. Aripiprazole accounted for the highest proportion of prescribed antipsychotics (31.9%) in 2016. Even though clozapine is categorized as a SGA, it accounted for a paltry 0.2%. The proportion of prescribed antipsychotics accounted for by LAIs was less than 5%. Although the use of antipsychotics for schizophrenia in Japan mostly corresponds to various clinical guidelines, limited use of clozapine and LAIs was identified. Further research focusing on the factors affecting the prescription of these underused antipsychotics may help advance the pharmacological therapy of schizophrenia.
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Affiliation(s)
- Takeo Hata
- Department of Pharmacy, Osaka Medical College Hospital, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan; Drug Metabolism and Toxicology, Faculty of Pharmaceutical Sciences, Kanazawa University, Kakuma-Machi, Kanazawa, Ishikawa, 920-1192, Japan.
| | - Tetsufumi Kanazawa
- Department of Neuropsychiatry, Osaka Medical College, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan; Melbourne Dementia Research Centre, The Florey Institute of Neuroscience and Mental Health, 30 Royal Parade, Parkville, VIC, 3052, Australia
| | - Takeshi Hamada
- Department of Pharmacy, Osaka Medical College Hospital, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan
| | - Masami Nishihara
- Department of Pharmacy, Osaka Medical College Hospital, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan
| | - Hiroshi Yoneda
- Department of Neuropsychiatry, Osaka Medical College, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan
| | - Miki Nakajima
- Drug Metabolism and Toxicology, Faculty of Pharmaceutical Sciences, Kanazawa University, Kakuma-Machi, Kanazawa, Ishikawa, 920-1192, Japan
| | - Takahiro Katsumata
- Department of Pharmacy, Osaka Medical College Hospital, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan
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21
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Abstract
Studies of antipsychotic medication, which are increasingly prescribed for a broad range of problems and circumstances, rarely ask the people who take them to describe their experiences with the drugs. In this study, 650 people, from 29 countries, responded, in an online survey, to "Overall in my life antipsychotic medications have been _____?" and "Is there anything else you would like to say, or emphasise, about your experiences with antipsychotic drugs?" Of the total participants, 14.3% were categorized as reporting purely positive experiences, 27.9% had mixed experiences, and 57.7% reported only negative ones. Negative experiences were positively correlated with age. Thematic analysis identified 749 negative, 180 positive, and 53 mixed statements. The 2 positive themes were "symptom reduction" (14) and "sleep" (14), with the majority (153) unspecified. The 4 negative themes (besides "unspecified"-191) were: "adverse effects" (316), "interactions with prescriber" (169), "withdrawal/difficult to get off them" (62), and "ineffective" (11). The adverse effects included: weight gain, emotional numbing, cognitive dysfunction, sedation, akathisia, effects on relationships, and suicidality. "Interactions with prescriber" included lack of information about withdrawal effects, support, or discussion of alternatives. The only mixed theme was "short-term good, long-term bad" (28). Open questions can add to findings from methodologies focused on symptom reduction. Clinicians should pay more attention to the need for respectful and collaborative patient-prescriber relationships. At the point of prescription, this must include providing the full range of information about antipsychotics, including potential benefits and harms, difficulties withdrawing, and information on alternatives treatments such as psychological therapies.
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Affiliation(s)
- John Read
- Department of Psychology, University of East London – Stratford Campus, London, UK,To whom correspondence should be addressed; University of East London – Stratford Campus, Water Lane, London E15 4LZ; tel: +44 (0)208 223 4943, e-mail:
| | - Ann Sacia
- Department of Psychology, University of East London – Stratford Campus, London, UK
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22
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Fountoulakis KN, Moeller HJ, Kasper S, Tamminga C, Yamawaki S, Kahn R, Tandon R, Correll CU, Javed A. The report of the joint WPA/CINP workgroup on the use and usefulness of antipsychotic medication in the treatment of schizophrenia. CNS Spectr 2020; 26:1-25. [PMID: 32594935 DOI: 10.1017/s1092852920001546] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This is a report of a joint World Psychiatric Association/International College of Neuropsychopharmacology (WPA/CINP) workgroup concerning the risk/benefit ratio of antipsychotics in the treatment of schizophrenia. It utilized a selective but, within topic, comprehensive review of the literature, taking into consideration all the recently discussed arguments on the matter and avoiding taking sides when the results in the literature were equivocal. The workgroup's conclusions suggested that antipsychotics are efficacious both during the acute and the maintenance phase, and that the current data do not support the existence of a supersensitivity rebound psychosis. Long-term treated patients have better overall outcome and lower mortality than those not taking antipsychotics. Longer duration of untreated psychosis and relapses are modestly related to worse outcome. Loss of brain volume is evident already at first episode and concerns loss of neuropil volume rather than cell loss. Progression of volume loss probably happens in a subgroup of patients with worse prognosis. In humans, antipsychotic treatment neither causes nor worsens volume loss, while there are some data in favor for a protective effect. Schizophrenia manifests 2 to 3 times higher mortality vs the general population, and treatment with antipsychotics includes a number of dangers, including tardive dyskinesia and metabolic syndrome; however, antipsychotic treatment is related to lower mortality, including cardiovascular mortality. In conclusion, the literature strongly supports the use of antipsychotics both during the acute and the maintenance phase without suggesting that it is wise to discontinue antipsychotics after a certain period of time. Antipsychotic treatment improves long-term outcomes and lowers overall and specific-cause mortality.
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Affiliation(s)
- Konstantinos N Fountoulakis
- 3rd Department of Psychiatry, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Hans-Jurgen Moeller
- Department of Psychiatry, Ludwig Maximilian University of Munich, Munich, Germany
| | - Siegfried Kasper
- Universitätsklinik für Psychiatrie und Psychotherapie, Medizinische Universität Wien, Vienna, Austria
| | - Carol Tamminga
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Shigeto Yamawaki
- Center for Brain, Mind and KANSEI Sciences Research, Hiroshima University, Hiroshima, Japan
| | - Rene Kahn
- Department of Psychiatry and Behavioral Health System, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rajiv Tandon
- Department of Psychiatry, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, USA
| | - Christoph U Correll
- Department of Psychiatry, Northwell Health, The Zucker Hillside Hospital, Glen Oaks, New York, USA
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Afzal Javed
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
- Pakistan Psychiatric Research Centre, Fountain House, Lahore, Pakistan
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Abstract
PURPOSE OF REVIEW Recently, it has been questioned whether the re-emergence of psychotic symptoms following antipsychotic discontinuation or dose reduction is attributable to underlying psychotic vulnerability or to rebound effects of chronic use of antipsychotic medication. It was repeatedly shown that relapse rates are high after discontinuation of maintenance treatment. A potential contributing factor could be the increase in density of postsynaptic dopamine D2 receptors in the striatum and the higher affinity of D2 receptors for dopamine after chronic blockade. RECENT FINDINGS To date, little clinical evidence is available for the mechanisms involved in postsynaptic striatal D2 receptor up-regulation after use of antipsychotic medication, and most knowledge comes from animal studies. SUMMARY Further research is needed to investigate whether antipsychotic medication causes neuroadaptations leading to a dopamine supersensitive state in humans, how long such hypersensitive states may last and what differences exist between high and low D2 affinity antipsychotic drugs. Further, information is needed on discontinuation schedules that provide optimal protection for relapse during hypersensitive periods.
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Bogers JPAM, Hambarian G, Michiels M, Vermeulen J, de Haan L. Risk Factors for Psychotic Relapse After Dose Reduction or Discontinuation of Antipsychotics in Patients With Chronic Schizophrenia: A Systematic Review and Meta-analysis. ACTA ACUST UNITED AC 2020. [DOI: 10.1093/schizbullopen/sgaa002] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Abstract
High doses of antipsychotics in patients with chronic schizophrenia might lead to more severe side effects and possibly hamper recovery, but dose reduction carries the risk of psychotic relapse. It would be helpful to establish risk factors for relapse during dose reduction. We systematically searched MEDLINE, EMBASE, and PsycINFO from January 1950 through June 2019 and reviewed studies that reported on relapse rates (event rates [ERs]) after dose reduction or discontinuation of antipsychotics in cohorts of patients with chronic schizophrenia. We calculated ERs (with 95% CIs) per person-year and sought to identify potential risk factors, such as patient characteristics, dose reduction/discontinuation characteristics, and study characteristics. Of 165 publications, 40 describing dose reduction or discontinuation in 46 cohorts (1677 patients) were included. The pooled ER for psychotic relapse was 0.55 (95% CI 0.46–0.65) per person-year. The ER was significantly higher in inpatients, patients with a shorter duration of illness, patients in whom antipsychotics were discontinued or in whom the dose was reduced to less than 5 mg haloperidol equivalent, studies with a short follow-up or published before 1990, and studies in which relapse was based on clinical judgment (ie, rating scales were not used). Clinicians should consider several robust risk factors for psychotic relapse in case of dose reduction in chronic schizophrenia.
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Affiliation(s)
- Jan P A M Bogers
- High Care Clinics and Rivierduinen Academy, Mental Health Services Rivierduinen, Leiden, the Netherlands
| | - George Hambarian
- Rivierduinen Academy, Mental Health Services Rivierduinen, Leiden, the Netherlands
| | - Maykel Michiels
- Rivierduinen Academy, Mental Health Services Rivierduinen, Leiden, the Netherlands
| | - Jentien Vermeulen
- Department of Psychiatry, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry, Amsterdam University Medical Center, Amsterdam, the Netherlands
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25
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Achieving the Lowest Effective Antipsychotic Dose for Patients with Remitted Psychosis: A Proposed Guided Dose-Reduction Algorithm. CNS Drugs 2020; 34:117-126. [PMID: 31741178 DOI: 10.1007/s40263-019-00682-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Continuing antipsychotic treatment in patients with schizophrenia under clinical remission remains controversial. Even though the mainstream opinion declares an outweighed balance against medication discontinuation, recent reviews and critiques suggest that some patients may remain symptom free and well functioning after stopping antipsychotics, but few predictors can identify who can try medication discontinuation, whilst no guidelines exist for reducing medication to reach the lowest effective dose safely. Analyzing the findings from studies employing different methodologies, adopting evidence from pharmacodynamic research, and observing dose reduction in stable patients, as well as taking inspiration from the metaphor of the Cantor set in natural philosophy, we introduce an alternative solution and propose a guided dose-reduction algorithm that follows a set of clear precautions and instructions. The algorithm recommends only a fraction (no more than 25%) of the dosage to be reduced at a time, with at least a 6-month stabilization period required before reducing another 25% of the dose. Patients are empowered to actively participate in decision making when they are ready for further dose tapering, or should they retreat to a previous dosage if warning signs of a relapse re-emerge. An intermittent or irregular dosing schedule can be used to adapt this algorithm to real-world practice. Our preliminary findings suggest that patients with remitted psychosis can do well along this path. We anticipate that this approach can help optimize the risk-benefit ratio and instill a hope in patients with schizophrenia that they can maintain in stable remission under a lower antipsychotic dose without an increased risk of relapse.
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26
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Sisek-Šprem M, Gradiški IP, Žaja N, Herceg M. The longitudinal course of schizophrenia: testosterone and progression of the negative symptoms. Nord J Psychiatry 2020; 74:147-154. [PMID: 31651218 DOI: 10.1080/08039488.2019.1681509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: The longitudinal course of schizophrenia shows a high level of heterogeneity with testosterone as a possible factor in the variety of clinical outcomes.Aim: Evaluation of the course of schizophrenia in male patients over an eight-year period and of the possible testosterone effects on changes in clinical features.Subjects and methods: The initial study population consisted of 120 male schizophrenic patients (aged 18-40) hospitalized in the University Psychiatric Hospital Vrapce in 2009. Patients were classified into nonaggressive (control, n = 60) and aggressive (n = 60) groups. In 2017, we reassessed 85 patients (67,5%) from the initial sample. Symptoms of schizophrenia were determined using the Positive and Negative Syndrome Scale (PANSS) and compared with the total serum testosterone level taken at the inclusion in the study. The distribution of values for individual variables was determined using the Smirnov-Kolmogorov test; for all further analyses, the appropriate non-parametric test was used.Results: The control group showed a statistically significant negative correlation between testosterone and negative PANSS. The initial PANSS scores, compared to those at the follow-up, showed a statistically significant reduction in positive and general symptoms in all groups, with the greatest reduction in the control group.Conclusion: We found a reduction in positive and general symptoms of schizophrenia among all patients and no changes in negative symptoms. Inverse correlation between testosterone and negative symptoms was found only in the control group, but there was no testosterone influence on the progression of any PANSS subscales.
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Affiliation(s)
| | | | - Nikola Žaja
- University Psychiatric Hospital Vrapče, Zagreb, Croatia
| | - Miroslav Herceg
- University Psychiatric Hospital Vrapče, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
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27
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Tirfessa K, Lund C, Medhin G, Selamu M, Birhane R, Hailemichael Y, Fekadu A, Hanlon C. Impact of integrated mental health care on food insecurity of households of people with severe mental illness in a rural African district: a community-based, controlled before-after study. Trop Med Int Health 2020; 25:414-423. [PMID: 31925844 DOI: 10.1111/tmi.13370] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the impact of integrated mental health care upon food insecurity (FI) in households of people with severe mental illness (SMI) in a rural Ethiopian district, and to investigate mediation by improved work impairment and discrimination. METHODS A community-based, controlled before-after study was conducted. People with probable SMI were identified in the community, diagnosed by primary healthcare workers, with diagnostic confirmation from a psychiatric nurse. Households of a person with SMI were matched to control households. District-wide integration of mental health care was implemented. Change in FI status over 12 months of follow-up was measured using the Household Food Insecurity Access Scale. Multivariable models were used to assess improvement in FI. Direct and indirect mediators of change in FI status were modelled using path analysis. RESULTS A total of 239 (81.8%) people with SMI and 273 (96.5%) control households were assessed after 12 months. Maintenance of food security or improvement in food insecurity status was observed in 51.5% of households of a person with SMI vs. 39.7% of control households (adjusted risk ratio 1.41: 95% CI 1.11, 1.80). Reduction in symptom severity was indirectly associated with improved FI status via an impact on reducing work impairment and discrimination (P < 0.001). CONCLUSIONS Improving access to mental health care may reduce food insecurity in households of people with SMI. Optimising engagement in care and adding interventions to improve work functioning and tackle discrimination may further reduce food insecurity.
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Affiliation(s)
- Kebede Tirfessa
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,College of Education and Behavioral Studies, Kotebe Metropolitan University, Addis Ababa, Ethiopia
| | - Crick Lund
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK.,Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
| | - Girmay Medhin
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Medhin Selamu
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Rahel Birhane
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Abebaw Fekadu
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Centre for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Global Health & Infection Department, Brighton and Sussex Medical School, Brighton, UK
| | - Charlotte Hanlon
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK.,Centre for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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28
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Veselinović T, Scharpenberg M, Heinze M, Cordes J, Mühlbauer B, Juckel G, Habel U, Rüther E, Timm J, Gründer G. Disparate effects of first and second generation antipsychotics on cognition in schizophrenia - Findings from the randomized NeSSy trial. Eur Neuropsychopharmacol 2019; 29:720-739. [PMID: 30981585 DOI: 10.1016/j.euroneuro.2019.03.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 01/25/2019] [Accepted: 03/27/2019] [Indexed: 12/15/2022]
Abstract
Cognitive impairment represents a core feature of schizophrenia. Uncertainty about demonstrable benefits of available antipsychotics on cognition remains an important clinical question relevant to patients' quality of life. The aim of our multi-center, randomized, double-blind "Neuroleptic Strategy Study" (NeSSy) was to compare the effectiveness of selected antipsychotics, conventionally classified as second- (SGAs) (haloperidol, flupentixol) and first generation antipsychotics (FGAs) (aripiprazole, olanzapine, quetiapine), on quality of life in schizophrenia. The effects on cognitive deficits represented a secondary outcome. We used an innovative double randomization for assignment of treatment group, and followed the patients with a neurocognitive test-battery upon six and 24 weeks of treatment. Psychopathology and quality of life were assessed using CGI, PANSS and SF-36. Assessment of cognitive performance was conducted in 114 of the 136 randomized patients. The SGA group (N = 62) showed beneficial effects of small to moderate effect size on cognition during the initial six weeks of treatment (executive functions, verbal fluency) and at 24 weeks (executive functions, working memory). In contrast, the FGA group (N = 52) showed moderately improved executive function, but a decline in verbal fluency at six weeks, with significant declines of moderate to large effect size in executive function, verbal learning and memory, and verbal fluency at 24 weeks. Our study indicates that SGAs present an advantage over FGAs regarding cognitive function during a medium-term treatment for schizophrenia. The results further emphasize a distinction between progression to detrimental effects of FGAs with prolonged treatment in contrast to more persistent cognitive benefits with SGA treatment.
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Affiliation(s)
- Tanja Veselinović
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany.
| | - Martin Scharpenberg
- Competence Center for Clinical Trials - Biometry, University of Bremen, Bremen, Germany
| | - Martin Heinze
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School, Immanuel Klinik, Rüdersdorf, Germany
| | - Joachim Cordes
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Bernd Mühlbauer
- Competence Center for Clinical Trials - Biometry, University of Bremen, Bremen, Germany; Department of Pharmacology, Klinikum Bremen Mitte, Bremen, Germany
| | - Georg Juckel
- Department of Psychiatry, LWL University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Ute Habel
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Eckart Rüther
- Department of Psychiatry and Psychotherapy, University of Göttingen, Göttingen, Germany
| | - Jürgen Timm
- Competence Center for Clinical Trials - Biometry, University of Bremen, Bremen, Germany
| | - Gerhard Gründer
- Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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29
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Morioka H, Ijichi S, Ijichi N, Ijichi Y, King BH. Developmental social vulnerability as the intrinsic origin of psychopathology: A paradigm shift from disease entities to psychiatric derivatives within human diversity. Med Hypotheses 2019; 126:95-108. [DOI: 10.1016/j.mehy.2019.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/01/2019] [Accepted: 03/21/2019] [Indexed: 12/28/2022]
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30
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Haram A, Jonsbu E, Hole T, Fosse R. Dialogue therapy in psychosis: A philosophical-ethical approach. NORDIC PSYCHOLOGY 2019. [DOI: 10.1080/19012276.2019.1586570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Annbjørg Haram
- Department of Psychiatry, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Egil Jonsbu
- Department of Psychiatry, Møre and Romsdal Hospital Trust, Ålesund, Norway
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Torstein Hole
- Clinic of Medicine and Rehabilitation, Møre and Romsdal Hospital Trust, Ålesund, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Roar Fosse
- Division of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway
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31
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Yeisen RA, Bjørnestad J, Joa I, Johannessen JO, Opjordsmoen S. Psychiatrists' reflections on a medication-free program for patients with psychosis. J Psychopharmacol 2019; 33:459-465. [PMID: 30676216 DOI: 10.1177/0269881118822048] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Based on a collective action from a number of Norwegian user organizations for mental health, the Norwegian government demanded the regional health authorities to establish a medication-free treatment option for patients with severe mental illnesses. This change in governmental health policy has several direct implications, including making antipsychotic medication to a greater extent optional for patients with active psychosis. AIMS The sim of this study was to investigate psychiatrists' reflections on the public medication-free program and how they think it will affect patients' adherence to antipsychotics generally. METHOD We used a thematic analytic approach within an interpretative phenomenological framework. Consecutively semi-structured qualitative interviews were conducted with 23 psychiatrists (16 female, with 4-35 years of specialist experience). RESULTS Thematic analysis revealed four main interrelated themes. Psychiatrists considered medication-free treatment as an unscientific option for a stigmatized patient group; they believed that the advent of such a program is due to proposals from some dissatisfied users and their supporters and not from the majority of patients; in spite of active psychotic symptoms and lack of insight, patients had a crucial impact on choice of treatment and accordingly on adherence to medication; and psychiatrists reported that they in spite of governmental instructions utilized professionalism against unscientific ideology. CONCLUSIONS Despite all the internal and external pressure that the psychiatrists reported being exposed to, this did not affect their professional integrity in medical decisions based on guidelines, expertise and research studies. They believed that this treatment option would exacerbate negative attitudes towards medication and further worsen already existing adherence issues.
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Affiliation(s)
- Rafal Ah Yeisen
- 1 Stavanger Hospital Pharmacy, Western Norway Pharmaceutical Trust, Stavanger, Norway.,2 Network for Clinical Psychosis Research, Stavanger University Hospital, Stavanger, Norway
| | - Jone Bjørnestad
- 3 Centre for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway
| | - Inge Joa
- 2 Network for Clinical Psychosis Research, Stavanger University Hospital, Stavanger, Norway.,4 Faculty of Health Science, University of Stavanger, Stavanger, Norway
| | - Jan Olav Johannessen
- 2 Network for Clinical Psychosis Research, Stavanger University Hospital, Stavanger, Norway.,4 Faculty of Health Science, University of Stavanger, Stavanger, Norway
| | - Stein Opjordsmoen
- 2 Network for Clinical Psychosis Research, Stavanger University Hospital, Stavanger, Norway.,5 Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,6 Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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32
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Bjornestad J, Lavik KO, Davidson L, Hjeltnes A, Moltu C, Veseth M. Antipsychotic treatment – a systematic literature review and meta-analysis of qualitative studies. J Ment Health 2019; 29:513-523. [DOI: 10.1080/09638237.2019.1581352] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Jone Bjornestad
- Department of Social Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Kristina O. Lavik
- Department of Psychiatry, District General Hospital of F⊘rde, F⊘rde, Norway
| | | | - Aslak Hjeltnes
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Christian Moltu
- Department of Psychiatry, District General Hospital of F⊘rde, F⊘rde, Norway
| | - Marius Veseth
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
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33
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Affiliation(s)
- Timothy Wand
- University of Sydney and Sydney Local Health District, Camperdown, New South Wales, Australia
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34
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Fu S, Czajkowski N, Torgalsbøen AK. Cognitive, Work and Social Outcomes in Fully Recovered First-Episode Schizophrenia: On and Off Antipsychotic Medication. Psychiatry 2019; 82:42-56. [PMID: 30608217 DOI: 10.1080/00332747.2018.1550735] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE This study examined the development in cognition, work, and social functioning in a group of fully recovered first-episode schizophrenia (FES) patients across six-eight years and inspected whether changes in outcome were similar when individuals were off medication as when they were on medication. METHOD Ten out of 28 participants were identified as fully recovered by the eighth follow-up. Assessments were conducted yearly, apart from the first year, when assessments were conducted every six months. Cognition was assessed with MATRICS Consensus Cognitive Battery. Functional outcomes were obtained through Global functioning: Social and Global functioning: Role. Information from semistructured interviews were also gathered. Data were analyzed with linear multilevel models. RESULTS There were steady improvements in cognition, social, and role functioning among the patients, but the changes were significantly larger when individuals were off antipsychotic medications than on medications for processing speed and work functioning. T-tests showed that unmedicated participants were not healthier than medicated participants at baseline. The most common reason for discontinuing medication treatment was negative side effects. Instead, many of the participants highlighted the use of active coping mechanisms for maintaining recovery. CONCLUSIONS The findings challenge some of the views about medication treatment of FES patients. For a subgroup of FES patients, continuous medication treatment is not necessary for maintaining low levels of symptoms. These patients show sustained good functioning once fully recovered. Due to a small sample size, these results may not be generalized to the general FES population and need to be replicated with studies of larger sample sizes.
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35
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Bergström T, Seikkula J, Alakare B, Mäki P, Köngäs-Saviaro P, Taskila JJ, Tolvanen A, Aaltonen J. The family-oriented open dialogue approach in the treatment of first-episode psychosis: Nineteen-year outcomes. Psychiatry Res 2018; 270:168-175. [PMID: 30253321 DOI: 10.1016/j.psychres.2018.09.039] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 08/03/2018] [Accepted: 09/17/2018] [Indexed: 10/28/2022]
Abstract
Open Dialogue (OD) is a family-oriented early intervention approach which has demonstrated good outcomes in the treatment of first-episode psychosis (FEP). Nevertheless, more evidence is needed. In this register-based cohort study the long-term outcomes of OD were evaluated through a comparison with a control group over a period of approximately 19 years. We examined the mortality, the need for psychiatric treatment, and the granting of disability allowances. Data were obtained from Finnish national registers regarding all OD patients whose treatment for FEP commenced within the time of the original interventions (total N = 108). The control group consisted of all Finnish FEP patients who had a follow-up of 19-20 years and who were guided to other Finnish specialized mental healthcare facilities (N = 1763). No difference between the samples was found regarding the annual incidence of FEP, the diagnosis, and suicide rates. Over the entire follow-up, the figures for durations of hospital treatment, disability allowances, and the need for neuroleptics remained significantly lower with OD group. Findings indicated that many positive outcomes of OD are sustained over a long time period. Due to the observational nature of the study, randomized trials are still needed to provide more information on effectiveness of approach.
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Affiliation(s)
- Tomi Bergström
- Department of Psychology, University of Jyväskylä, Jyväskylä, Finland.
| | - Jaakko Seikkula
- Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
| | - Birgitta Alakare
- Department of Psychiatry, Länsi-Pohja healthcare district, Kemi, Finland
| | - Pirjo Mäki
- Department of Psychiatry, Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland; Department of Psychiatry, Oulu University Hospital, Oulu, Finland
| | | | - Jyri J Taskila
- Department of Psychiatry, Länsi-Pohja healthcare district, Kemi, Finland
| | - Asko Tolvanen
- The Methodology Center for Human Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Jukka Aaltonen
- Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
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36
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Steingard S. Five Year Outcomes of Tapering Antipsychotic Drug Doses in a Community Mental Health Center. Community Ment Health J 2018; 54:1097-1100. [PMID: 30074116 DOI: 10.1007/s10597-018-0313-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 07/28/2018] [Indexed: 11/25/2022]
Abstract
There is evidence that many individuals are on higher doses of antipsychotic drug than is required for optimal functioning yet there are limited guidelines on how to reduce them. This paper reports on 5 year outcomes for sixty-seven individuals who received treatment at a community mental health center and were offered the opportunity to gradually reduce their doses of antipsychotic drug in collaboration with the treating psychiatrist. Over a period of 6 months, the author invited patients who were clinically stable and able to participate in discussions of potential risks and benefits to begin gradual dose reductions. Initially, 40 expressed interest in tapering and 27 declined. The groups did not differ in age, sex, race, or diagnosis. The group who chose to taper began on significantly lower doses. Most patients succeeded at making modest dose reductions. At 5 years, there were no significant differences in the two outcomes measures, rate of hospitalization and employment status. Many patients were able to engage in these discussions which did not result in widespread discontinuation of drug. This is a naturalistic, small study of a topic that warrants further research.
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Affiliation(s)
- Sandra Steingard
- Howard Center, University of Vermont Larner College of Medicine, 300 Flynn Avenue, Burlington, VT, 05401, USA.
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37
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Volavka J, Vevera J. Very long-term outcome of schizophrenia. Int J Clin Pract 2018; 72:e13094. [PMID: 29691957 DOI: 10.1111/ijcp.13094] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 03/28/2018] [Indexed: 01/01/2023] Open
Abstract
PURPOSE The principal aim is to review recent data concerning the very long-term outcome of schizophrenia and schizophrenia spectrum disorders. We examine factors that influence outcome, including therapeutic interventions. METHOD PubMed and Scopus databases were searched for papers published between 2008 and 2017 reporting on prospective studies of schizophrenia or schizophrenia spectrum with a follow-up period ≥5 years with adequate outcome information. Additional publications were found in reference lists and authors' reference libraries. RESULTS The average proportion of patients with symptomatic remission at follow-up ranged between 16.4% in never-treated patients to 37.5% in patients who were systematically treated with antipsychotics. Good outcomes at follow-up were observed in schizophrenia and schizophrenia spectrum patients on low doses of antipsychotics and in patients with no pharmacological treatment at that time. Early detection and intensive treatment of the first episode as well as the availability of continued psychosocial treatment and support over subsequent years appeared associated with better outcomes. CONCLUSION The long-term outcome of schizophrenia is highly variable, depending on access to mental healthcare, early detection of psychosis and pharmacological treatment. Recent data support the effectiveness of low-dose antipsychotic treatment for long-term maintenance in some patients. A proportion of first-episode schizophrenia patients, perhaps 20%, do not need long-term maintenance antipsychotic treatment. That proportion may be higher in schizophrenia spectrum patients. The reasons why these patients do not need the long-term treatment are not well understood. Methods to predict the membership in this subgroup are not yet good enough for clinical use in individual patients.
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Affiliation(s)
- Jan Volavka
- Department of Psychiatry, Faculty of Medicine and University Hospital in Pilsen, Charles University, Pilsen, Czech Republic
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - Jan Vevera
- Department of Psychiatry, Faculty of Medicine and University Hospital in Pilsen, Charles University, Pilsen, Czech Republic
- Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
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38
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Correll CU, Rubio JM, Kane JM. What is the risk-benefit ratio of long-term antipsychotic treatment in people with schizophrenia? World Psychiatry 2018; 17:149-160. [PMID: 29856543 PMCID: PMC5980517 DOI: 10.1002/wps.20516] [Citation(s) in RCA: 164] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The long-term benefit-to-risk ratio of sustained antipsychotic treatment for schizophrenia has recently been questioned. In this paper, we critically examine the literature on the long-term efficacy and effectiveness of this treatment. We also review the evidence on the undesired effects, the impact on physical morbidity and mortality, as well as the neurobiological correlates of chronic exposure to antipsychotics. Finally, we summarize factors that affect the risk-benefit ratio. There is consistent evidence supporting the efficacy of antipsychotics in the short term and mid term following stabilization of acute psychotic symptoms. There is insufficient evidence supporting the notion that this effect changes in the long term. Most, but not all, of the long-term cohort studies find a decrease in efficacy during chronic treatment with antipsychotics. However, these results are inconclusive, given the extensive risk of bias, including increasing non-adherence. On the other hand, long-term studies based on national registries, which have lower risk of bias, find an advantage in terms of effectiveness during sustained antipsychotic treatment. Sustained antipsychotic treatment has been also consistently associated with lower mortality in people with schizophrenia compared to no antipsychotic treatment. Nevertheless, chronic antipsychotic use is associated with metabolic disturbance and tardive dyskinesia. The latter is the clearest undesired clinical consequence of brain functioning as a potential result of chronic antipsychotic exposure, likely from dopaminergic hypersensitivity, without otherwise clear evidence of other irreversible neurobiological changes. Adjunctive psychosocial interventions seem critical for achieving recovery. However, overall, the current literature does not support the safe reduction of antipsychotic dosages by 50% or more in stabilized individuals receiving adjunctive psychosocial interventions. In conclusion, the critical appraisal of the literature indicates that, although chronic antipsychotic use can be associated with undesirable neurologic and metabolic side effects, the evidence supporting its long-term efficacy and effectiveness, including impact on life expectancy, outweighs the evidence against this practice, overall indicating a favorable benefit-to-risk ratio. However, the finding that a minority of individuals diagnosed initially with schizophrenia appear to be relapse free for long periods, despite absence of sustained antipsychotic treatment, calls for further research on patient-level predictors of positive outcomes in people with an initial psychotic presentation.
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Affiliation(s)
- Christoph U Correll
- Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, NY, USA
- Hofstra Northwell School of Medicine, Hempstead, NY, USA
- Feinstein Institute for Medical Research, Manhasset, NY, USA
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Jose M Rubio
- Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, NY, USA
- Hofstra Northwell School of Medicine, Hempstead, NY, USA
- Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - John M Kane
- Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, NY, USA
- Hofstra Northwell School of Medicine, Hempstead, NY, USA
- Feinstein Institute for Medical Research, Manhasset, NY, USA
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Harrow M, Jobe TH. Long-term antipsychotic treatment of schizophrenia: does it help or hurt over a 20-year period? World Psychiatry 2018; 17:162-163. [PMID: 29856562 PMCID: PMC5980604 DOI: 10.1002/wps.20518] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Martin Harrow
- Department of Psychiatry, University of Illinois at Chicago, College of Medicine, Chicago, IL, USA
| | - Thomas H Jobe
- Department of Psychiatry, University of Illinois at Chicago, College of Medicine, Chicago, IL, USA
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