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Dong S, Schneider-Thoma J, Bighelli I, Siafis S, Wang D, Burschinski A, Schestag K, Samara M, Leucht S. A network meta-analysis of efficacy, acceptability, and tolerability of antipsychotics in treatment-resistant schizophrenia. Eur Arch Psychiatry Clin Neurosci 2024; 274:917-928. [PMID: 37526675 PMCID: PMC11127860 DOI: 10.1007/s00406-023-01654-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/17/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVE Clozapine is considered as the standard treatment for this subgroup, but the evidence is not unequivocal. There are several potential alternatives being used because of the possible adverse effects of clozapine. We aimed to examine the efficacy and adverse events of different antipsychotics in treatment-resistant schizophrenia by performing a network meta-analysis. METHODS We searched the Cochrane Schizophrenia Group register for randomized-controlled trials (up to March 06, 2022) and MEDLINE (up to January 20, 2023). We included blinded and open studies and participants with a broad definition of treatment resistance. The primary outcome was overall symptoms of schizophrenia; secondary outcomes were response to treatment, positive and negative symptoms of schizophrenia, discontinuation, side effects, quality of life, and functioning. The study was registered in Open Science Framework ( https://osf.io/9nf2y/ ). RESULTS We included 60 studies involving 6838 participants in the network meta-analysis. In the primary outcome, clozapine and olanzapine were more efficacious than risperidone, haloperidol, fluphenazine, sertindole, chlorpromazine, and quetiapine (range of mean SMDs, - 0.11 to - 0.48). The difference between clozapine and olanzapine was trivial and uncertain (SMD - 0.05, 95% CI, - 0.21 to 0.11). The result of other efficacy outcomes as well as subgroup and sensitivity analyses were consistent with the primary analysis. Clozapine and olanzapine were associated with more weight gain, and clozapine was associated with more sedation events compared to many other antipsychotics. CONCLUSIONS Clozapine remains the gold standard for patients with treatment-resistant schizophrenia. Olanzapine seems to be second-best and could be tried before switching to clozapine.
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Affiliation(s)
- Shimeng Dong
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Ismaningerstr. 22, 81675, Munich, Germany
| | - Johannes Schneider-Thoma
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Ismaningerstr. 22, 81675, Munich, Germany
| | - Irene Bighelli
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Ismaningerstr. 22, 81675, Munich, Germany
| | - Spyridon Siafis
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Ismaningerstr. 22, 81675, Munich, Germany
| | - Dongfang Wang
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Ismaningerstr. 22, 81675, Munich, Germany
| | - Angelika Burschinski
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Ismaningerstr. 22, 81675, Munich, Germany
| | - Kristina Schestag
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Ismaningerstr. 22, 81675, Munich, Germany
| | - Myrto Samara
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Ismaningerstr. 22, 81675, Munich, Germany
- Department of Psychiatry, Faculty of Medicine, University of Thessaly, Larisa, Greece
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Ismaningerstr. 22, 81675, Munich, Germany.
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de Girolamo G, Andreassen OA, Bauer M, Brambilla P, Calza S, Citerà N, Corcoy R, Fagiolini A, Garcia-Argibay M, Godin O, Klingler F, Kobayashi NF, Larsson H, Leboyer M, Matura S, Martinelli A, De la Peña-Arteaga V, Poli R, Reif A, Ritter P, Rødevand LN, Magno M, Caselani E. Medical comorbidities in bipolar disorder (BIPCOM): clinical validation of risk factors and biomarkers to improve prevention and treatment. Study protocol. Int J Bipolar Disord 2024; 12:15. [PMID: 38703295 PMCID: PMC11069492 DOI: 10.1186/s40345-024-00337-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 04/24/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND BIPCOM aims to (1) identify medical comorbidities in people with bipolar disorder (BD); (2) examine risk factors and clinical profiles of Medical Comorbidities (MC) in this clinical group, with a special focus on Metabolic Syndrome (MetS); (3) develop a Clinical Support Tool (CST) for the personalized management of BD and medical comorbidities. METHODS The BIPCOM project aims to investigate MC, specifically MetS, in individuals with BD using various approaches. Initially, prevalence rates, characteristics, genetic and non-genetic risk factors, and the natural progression of MetS among individuals with BD will be assessed by analysing Nordic registers, biobanks, and existing patient datasets from 11 European recruiting centres across 5 countries. Subsequently, a clinical study involving 400 participants from these sites will be conducted to examine the clinical profiles and incidence of specific MetS risk factors over 1 year. Baseline assessments, 1-year follow-ups, biomarker analyses, and physical activity measurements with wearable biosensors, and focus groups will be performed. Using this comprehensive data, a CST will be developed to enhance the prevention, early detection, and personalized treatment of MC in BD, by incorporating clinical, biological, sex and genetic information. This protocol will highlight the study's methodology. DISCUSSION BIPCOM's data collection will pave the way for tailored treatment and prevention approaches for individuals with BD. This approach has the potential to generate significant healthcare savings by preventing complications, hospitalizations, and emergency visits related to comorbidities and cardiovascular risks in BD. BIPCOM's data collection will enhance BD patient care through personalized strategies, resulting in improved quality of life and reduced costly interventions. The findings of the study will contribute to a better understanding of the relationship between medical comorbidities and BD, enabling accurate prediction and effective management of MetS and cardiovascular diseases. TRIAL REGISTRATION ISRCTN68010602 at https://www.isrctn.com/ISRCTN68010602 . Registration date: 18/04/2023.
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Affiliation(s)
- Giovanni de Girolamo
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
| | - Ole A Andreassen
- Norwegian Center for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Institute of Clinical Medicine, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Stefano Calza
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Nicholas Citerà
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Rosa Corcoy
- Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
- CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 28029, Madrid, Spain
| | - Andrea Fagiolini
- Department of Molecular and Developmental Medicine, Division of Psychiatry, University of Siena School of Medicine, Siena, Italy
| | - Miguel Garcia-Argibay
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Ophélia Godin
- Fondation FondaMental, Créteil, France
- Univ Paris Est Créteil, INSERM U955, IMRB, Translational NeuroPsychiatry Laboratory, Créteil, France
| | - Florian Klingler
- Deutsche Gesellschaft Für Bipolare Störungen (DGBS) E.V, Hamburg, Germany
| | - Nene F Kobayashi
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
| | - Henrik Larsson
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Marion Leboyer
- Fondation FondaMental, Créteil, France
- Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Créteil, France
| | - Silke Matura
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
| | - Alessandra Martinelli
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Víctor De la Peña-Arteaga
- Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
- CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 28029, Madrid, Spain
| | - Roberto Poli
- Department of Mental Health, Psychiatric Unit of Cremona General Hospital, Azienda Ospedaliera di Cremona, Cremona, Italy
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
| | - Philipp Ritter
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
| | - Linn N Rødevand
- Norwegian Center for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Institute of Clinical Medicine, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Marta Magno
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Elisa Caselani
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
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Agid O, Crespo-Facorro B, de Bartolomeis A, Fagiolini A, Howes OD, Seppälä N, Correll CU. Overcoming the barriers to identifying and managing treatment-resistant schizophrenia and to improving access to clozapine: A narrative review and recommendation for clinical practice. Eur Neuropsychopharmacol 2024; 84:35-47. [PMID: 38657339 DOI: 10.1016/j.euroneuro.2024.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/08/2024] [Accepted: 04/10/2024] [Indexed: 04/26/2024]
Abstract
Clozapine is the only approved antipsychotic for treatment-resistant schizophrenia (TRS). Although a large body of evidence supports its efficacy and favorable risk-benefit ratio in individuals who have failed two or more antipsychotics, clozapine remains underused. However, variations in clozapine utilization across geographic and clinical settings suggest that it could be possible to improve its use. In this narrative review and expert opinion, we summarized information available in the literature on the mechanisms of action, effectiveness, and potential adverse events of clozapine. We identified barriers leading to discouragement in clozapine prescription internationally, and we proposed practical solutions to overcome each barrier. One of the main obstacles identified to the use of clozapine is the lack of appropriate training for physicians: we highlighted the need to develop specific professional programs to train clinicians, both practicing and in residency, on the relevance and efficacy of clozapine in TRS treatment, initiation, maintenance, and management of potential adverse events. This approach would facilitate physicians to identify eligible patients and offer clozapine as a treatment option in the early stage of the disease. We also noted that increasing awareness of the benefits of clozapine among healthcare professionals, people with TRS, and their caregivers can help promote the use of clozapine. Educational material, such as leaflets or videos, could be developed and distributed to achieve this goal. The information provided in this article may be useful to improve disease burden and support healthcare professionals, patients, and caregivers navigating the complex pathways to TRS management.
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Affiliation(s)
- Ofer Agid
- Centre for Addiction and Mental Health, University of Toronto, Canada
| | - Benedicto Crespo-Facorro
- Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocío-IBiS-CSIC, Sevilla, Spain, Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Sevilla, Spain
| | - Andrea de Bartolomeis
- University of Naples Federico II, Department of Neuroscience, Reproductive Science, and Odontostomatology. Laboratory of Molecular and Translational Psychiatry. Unit of Treatment Resistant Psychosis, Naples, Italy; Staff Unesco Chair at University of Naples Federico II, Italy
| | | | - Oliver D Howes
- IoPPN, King's College London, De Crespigny Park, London, United Kingdom; Institute of Clinical Sciences (ICS), Faculty of Medicine, Imperial College London, Du Cane Road, London, United Kingdom
| | - Niko Seppälä
- Wellbeing Services in Satakunta, Department of Psychiatry, Pori, Finland and Medical Consultant, Viatris, Finland
| | - Christoph U Correll
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, New York, United States; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, New York, United States; Charité - Universitätsmedizin Berlin, Department of Child and Adolescent Psychiatry, Augustenburger Platz 1, Berlin 13353, Germany; German Center for Mental Health (DZPG), Partner Site Berlin, Berlin, Germany.
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Parabiaghi A, Monzio Compagnoni M, D’Avanzo B, Caggiu G, Galbussera AA, Tettamanti M, Fortino I, Barbato A. Association of Antipsychotic Polypharmacy and Two-Year All-Cause Mortality: A Population-Based Cohort Study of 33,221 Italian Continuous Users. J Clin Med 2024; 13:2073. [PMID: 38610838 PMCID: PMC11012528 DOI: 10.3390/jcm13072073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/23/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Differences in survival between patients treated with antipsychotic monotherapy vs. polytherapy are debated. This study aimed to examine the association of antipsychotic polytherapy with 2-year all-cause mortality in a population-based cohort. Methods: Data were retrieved from healthcare databases of four local health units of Lombardy, Italy. Subjects aged 18-79 years who received continuous antipsychotic prescriptions in 2018 were identified. Overall survival among patients with antipsychotic monotherapy vs. polytherapy was compared. A multivariate Cox PH model was used to estimate the association between antipsychotic therapy, or antipsychotic use (continuous vs. non-continuous), and all-cause mortality. Adjustments were made for the presence of metabolic disturbances, total antipsychotic dosage amount (olanzapine equivalent doses), age, and sex. Results: A total of 49,875 subjects receiving at least one prescription of antipsychotics during 2018 were identified. Among the 33,221 patients receiving continuative antipsychotic prescriptions, 1958 (5.9%) experienced death from any cause at two years. Patients with continuous antipsychotic use had a 1.13-point increased mortality risk compared with non-continuous users. Patients treated with antipsychotic polytherapy showed an adjusted mortality risk increased by 17% (95% CI: 2%, 33%) compared to monotherapy. Conclusions: The study highlights the potential risks associated with antipsychotic polypharmacy, emphasizing the importance of optimizing drug prescriptions to improve patient safety and reduce mortality rates in individuals receiving antipsychotic therapy.
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Affiliation(s)
- Alberto Parabiaghi
- Unit for Quality of Care and Rights Promotion in Mental Health, Istituto di Ricerche Farmacologiche “Mario Negri”-IRCCS, 20156 Milan, Italy; (A.P.); (A.B.)
| | - Matteo Monzio Compagnoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy;
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy
| | - Barbara D’Avanzo
- Laboratory for Assessing Quality of Care and Services, Istituto di Ricerche Farmacologiche “Mario Negri”-IRCCS, 20156 Milan, Italy;
| | - Giulia Caggiu
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy;
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy
- Department of Mental Health and Addiction Services, ASST Lecco, 23900 Lecco, Italy
| | - Alessia A. Galbussera
- Laboratory of Geriatric Epidemiology, Istituto di Ricerche Farmacologiche “Mario Negri”-IRCCS, 20156 Milan, Italy; (A.A.G.); (M.T.)
| | - Mauro Tettamanti
- Laboratory of Geriatric Epidemiology, Istituto di Ricerche Farmacologiche “Mario Negri”-IRCCS, 20156 Milan, Italy; (A.A.G.); (M.T.)
| | - Ida Fortino
- Directorate General for Health, Lombardy Region, 00144 Milan, Italy
| | - Angelo Barbato
- Unit for Quality of Care and Rights Promotion in Mental Health, Istituto di Ricerche Farmacologiche “Mario Negri”-IRCCS, 20156 Milan, Italy; (A.P.); (A.B.)
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5
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Fountoulakis KN, Karakatsoulis GN, Abraham S, Adorjan K, Ahmed HU, Alarcón RD, Arai K, Auwal SS, Berk M, Bjedov S, Bobes J, Bobes-Bascaran T, Bourgin-Duchesnay J, Bredicean CA, Bukelskis L, Burkadze A, Cabrera Abud II, Castilla-Puentes R, Cetkovich M, Colon-Rivera H, Corral R, Cortez-Vergara C, Crepin P, De Berardis D, Zamora Delgado S, Lucena DD, Sousa AD, Stefano RD, Dodd S, Priyanka Elek L, Elissa A, Erdelyi-Hamza B, Erzin G, Etchevers MJ, Falkai P, Farcas A, Fedotov I, Filatova V, Fountoulakis NK, Frankova I, Franza F, Frias P, Galako T, Garay CJ, Garcia-Álvarez L, García-Portilla MP, Gonda X, Gondek TM, Morera González D, Gould H, Grandinetti P, Grau A, Groudeva V, Hagin M, Harada T, Hasan TM, Azreen Hashim N, Hilbig J, Hossain S, Iakimova R, Ibrahim M, Iftene F, Ignatenko Y, Irarrazaval M, Ismail Z, Ismayilova J, Jakobs A, Jakovljević M, Jakšić N, Javed A, Kafali HY, Karia S, Kazakova O, Khalifa D, Khaustova O, Koh S, Kopishinskaia S, Kosenko K, Koupidis SA, Kovacs I, Kulig B, Lalljee A, Liewig J, Majid A, Malashonkova E, Malik K, Malik NI, Mammadzada G, Mandalia B, Marazziti D, Marčinko D, Martinez S, Matiekus E, Mejia G, Memon RS, Meza Martínez XE, Mickevičiūtė D, Milev R, Mohammed M, Molina-López A, Morozov P, Muhammad NS, Mustač F, Naor MS, Nassieb A, Navickas A, Okasha T, Pandova M, Panfil AL, Panteleeva L, Papava I, Patsali ME, Pavlichenko A, Pejuskovic B, Pinto Da Costa M, Popkov M, Popovic D, Raduan NJN, Vargas Ramírez F, Rancans E, Razali S, Rebok F, Rewekant A, Ninoska Reyes Flores E, Rivera-Encinas MT, Saiz P, Sánchez de Carmona M, Saucedo Martínez D, Saw JA, Saygili G, Schneidereit P, Shah B, Shirasaka T, Silagadze K, Sitanggang S, Skugarevsky O, Spikina A, Mahalingappa SS, Stoyanova M, Szczegielniak A, Tamasan SC, Tavormina G, Tavormina MGM, Theodorakis PN, Tohen M, Tsapakis EM, Tukhvatullina D, Ullah I, Vaidya R, Vega-Dienstmaier JM, Vrublevska J, Vukovic O, Vysotska O, Widiasih N, Yashikhina A, Prezerakos PE, Smirnova D. Somatic multicomorbidity and disability in patients with psychiatric disorders in comparison to the general population: a quasi-epidemiological investigation in 54,826 subjects from 40 countries (COMET-G study). CNS Spectr 2024; 29:126-149. [PMID: 38269574 DOI: 10.1017/s1092852924000026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
BACKGROUND The prevalence of medical illnesses is high among patients with psychiatric disorders. The current study aimed to investigate multi-comorbidity in patients with psychiatric disorders in comparison to the general population. Secondary aims were to investigate factors associated with metabolic syndrome and treatment appropriateness of mental disorders. METHODS The sample included 54,826 subjects (64.73% females; 34.15% males; 1.11% nonbinary gender) from 40 countries (COMET-G study). The analysis was based on the registration of previous history that could serve as a fair approximation for the lifetime prevalence of various medical conditions. RESULTS About 24.5% reported a history of somatic and 26.14% of mental disorders. Mental disorders were by far the most prevalent group of medical conditions. Comorbidity of any somatic with any mental disorder was reported by 8.21%. One-third to almost two-thirds of somatic patients were also suffering from a mental disorder depending on the severity and multicomorbidity. Bipolar and psychotic patients and to a lesser extent depressives, manifested an earlier (15-20 years) manifestation of somatic multicomorbidity, severe disability, and probably earlier death. The overwhelming majority of patients with mental disorders were not receiving treatment or were being treated in a way that was not recommended. Antipsychotics and antidepressants were not related to the development of metabolic syndrome. CONCLUSIONS The finding that one-third to almost two-thirds of somatic patients also suffered from a mental disorder strongly suggests that psychiatry is the field with the most trans-specialty and interdisciplinary value and application points to the importance of teaching psychiatry and mental health in medical schools and also to the need for more technocratically oriented training of psychiatric residents.
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Affiliation(s)
- Konstantinos N Fountoulakis
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki Greece, Thessaloniki, Greece
| | - Grigorios N Karakatsoulis
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki Greece, Thessaloniki, Greece
| | - Seri Abraham
- Pennine Care NHS Foundation Trust, Heywood, UK
- Manchester Metropolitan University, Manchester, UK
- Core Psychiatry Training, Health Education England North West, Manchester, UK
| | - Kristina Adorjan
- Department of Psychiatry, Ludiwig-Maximilians-University, Munich, Germany
| | - Helal Uddin Ahmed
- Child Adolescent and Family Psychiatry, National Institute of Mental Health, Dhaka, Bangladesh
| | - Renato D Alarcón
- Section of Psychiatry and Mental Health, Universidad Peruana Cayetano Heredia, Facultad de Medicina Alberto Hurtado, Lima, Peru
- Department of Psychiatry and Psychology, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Kiyomi Arai
- School of Medicine and Health Science, Institute of Health Science Shinshu University, Matsumoto, Japan
| | - Sani Salihu Auwal
- Department of Psychiatry, Bayero University, Kano, Nigeria
- Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Michael Berk
- IMPACT - The Institute for Mental and Physical Health and Clinical Translation, Deakin University, School of Medicine, Barwon Health, Geelong, Australia
- Orygen The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - Sarah Bjedov
- Department of Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Julio Bobes
- Psychiatry Area, Department of Medicine, University of Oviedo, Oviedo, Spain
- Department of Psychiatry, Hospital Universitario Central de Asturias, Oviedo, Spain
- ISPA, INEUROPA, CIBERSAM, Oviedo, Spain
| | - Teresa Bobes-Bascaran
- ISPA, INEUROPA, CIBERSAM, Oviedo, Spain
- Mental Health Center of La Corredoria, Oviedo, Spain
- Department of Psychology, University of Oviedo, Oviedo, Spain
| | - Julie Bourgin-Duchesnay
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Groupe Hospitalier Nord Essonne, Orsay, France
| | - Cristina Ana Bredicean
- Department of Neuroscience, Discipline of Psychiatry, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Laurynas Bukelskis
- Clinic of Psychiatry, Institute of Clinical Medicine, Medical Faculty, Vilnius University, Vilnius, Lithuania
| | - Akaki Burkadze
- Mental Hub, Tbilisi, Georgia
- NGO Healthcare Research and Quality Agency, Tbilisi, Georgia
| | | | - Ruby Castilla-Puentes
- Janssen Research and Development, Johnson & Johnson, American Society of Hispanic Psychiatry and WARMI Women Mental Health, Cincinnati, OH, USA
| | - Marcelo Cetkovich
- Institute of Translational and Cognitive Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Hector Colon-Rivera
- APM Board Certified in General Psychiatry and Neurology, Addiction Psychiatry, & Addiction Medicine, UPMC, DDAP, Philadelphia, PA, USA
| | - Ricardo Corral
- Department of Teaching and Research, Hospital Borda, Buenos Aires, Argentina
- University of Buenos Aires, Buenos Aires, Argentina
| | | | - Piirika Crepin
- Sanitaire and Social Union for Accompaniment and Prevention, Center of Ambulatory Psychiatry of Narbonne and Lezigan, Narbonne, France
| | - Domenico De Berardis
- Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "G. Mazzini", ASL Teramo, Teramo, Italy
- School of Nursing, University of L'Aquila, Italy
- Department of Neuroscience and Imaging, School of Psychiatry, University of Chieti, Chieti, Italy
| | - Sergio Zamora Delgado
- Child and Adolescent Psychiatry Department, Hospital Luis Calvo Mackenna, Santiago, Chile
| | - David De Lucena
- Departamento de Fisiología e Farmacología, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
| | - Avinash De Sousa
- Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
- Desousa Foundation, Mumbai, Maharashtra, India
| | - Ramona Di Stefano
- Department of Biotechnological and Applied Clinical Sciences, Section of Psychiatry, University of L'Aquila, L'Aquila, Italy
| | - Seetal Dodd
- IMPACT - The Institute for Mental and Physical Health and Clinical Translation, Deakin University, School of Medicine, Barwon Health, Geelong, Australia
- Orygen The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, Melbourne, Australia
- University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | - Livia Priyanka Elek
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Anna Elissa
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia
| | - Berta Erdelyi-Hamza
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Gamze Erzin
- Department of Psychiatry, Ankara Dışkapı Training and Research Hospital, Ankara, Turkey
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Martin J Etchevers
- Faculty of Psychology, University of Buenos Aires (UBA), Buenos Aires, Argentina
| | - Peter Falkai
- Department of Psychiatry, Ludiwig-Maximilians-University, Munich, Germany
| | - Adriana Farcas
- Centre of Neuroscience, Queen's University, Kingston, Ontario, Canada
| | - Ilya Fedotov
- Department of Psychiatry and Narcology, Ryazan State Medical University n.a. Academician I.P. Pavlov, Ryazan, Russia
| | - Viktoriia Filatova
- State Budgetary Institution of the Rostov Region "Psychoneurological Dispensary", Rostov-on-Don, Russia
| | | | - Iryna Frankova
- Medical Psychology, Psychosomatic Medicine and Psychotherapy Department, Bogomolets National Medical University, Kyiv, Ukraine
| | - Francesco Franza
- "Villa dei Pini" Psychiatric Rehabilitation Center, Avellino, Italy
- Psychiatric Studies Centre, Provaglio d'Iseo, Italy
| | | | - Tatiana Galako
- Department of Psychiatry, Medical Psychology and Drug Abuse, Kyrgyz State Medical Academy, Bishkek, Kyrgyz Republic
| | - Cristian J Garay
- Faculty of Psychology, University of Buenos Aires (UBA), Buenos Aires, Argentina
| | - Leticia Garcia-Álvarez
- ISPA, INEUROPA, CIBERSAM, Oviedo, Spain
- Department of Psychology, University of Oviedo, Oviedo, Spain
| | - Maria Paz García-Portilla
- Psychiatry Area, Department of Medicine, University of Oviedo, Oviedo, Spain
- ISPA, INEUROPA, CIBERSAM, Oviedo, Spain
- Mental Health Center of La Ería, Oviedo, Spain
| | - Xenia Gonda
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Tomasz M Gondek
- Specialty Training Section, Polish Psychiatric Association, Wroclaw, Poland
| | | | - Hilary Gould
- Department of Psychiatry, University of California San Diego, San Diego, USA
| | - Paolo Grandinetti
- Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "G. Mazzini", ASL Teramo, Teramo, Italy
| | - Arturo Grau
- Child and Adolescent Psychiatry Department, Hospital Luis Calvo Mackenna, Santiago, Chile
- Universidad Diego Portales, Santiago, Chile
| | - Violeta Groudeva
- Department of Diagnostic Imaging, University Hospital Saint Ekaterina, Sofia, Bulgaria
| | - Michal Hagin
- Forensic Psychiatry Unit, Abarbanel Mental Health Center, Bat Yam, Israel
| | - Takayuki Harada
- Faculty of Human Sciences, Education Bureau of the Laboratory Schools, University of Tsukuba, Tokyo, Japan
| | - Tasdik M Hasan
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
- Public Health Foundation, Dhaka, Bangladesh
| | - Nurul Azreen Hashim
- Department of Psychiatry, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Jan Hilbig
- Clinic of Psychiatry, Institute of Clinical Medicine, Medical Faculty, Vilnius University, Vilnius, Lithuania
| | - Sahadat Hossain
- Department of Public Health and Informatics, Jahangirnagar University, Dhaka, Bangladesh
| | - Rossitza Iakimova
- Second Psychiatric Clinic, University Hospital for Active Treatment in Neurology and Psychiatry "Saint Naum", Sofia, Bulgaria
| | - Mona Ibrahim
- Okasha Institute of Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Felicia Iftene
- Department of Psychiatry, Queens University, Kingston, ON, Canada
| | - Yulia Ignatenko
- Education Center, Mental Health Clinic No. 1 named after N.A. Alexeev of Moscow Healthcare Department, Moscow, Russia
| | - Matias Irarrazaval
- Ministry of Health, Millenium Institute for Research in Depression and Personality, Santiago, Chile
| | - Zaliha Ismail
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Jamila Ismayilova
- National Mental Health Center of the Ministry of Health of the Republic of Azerbaijan, Baku, Azerbaijan
| | - Asaf Jakobs
- Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY, USA
- New York Medical College, Valhalla, NY, USA
| | | | - Nenad Jakšić
- Department of Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Afzal Javed
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Warwick Medical School, University of Warwick, Coventry, UK
- Pakistan Psychiatric Research Centre, Fountain House, Lahore, Pakistan
| | | | - Sagar Karia
- Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
| | | | - Doaa Khalifa
- Okasha Institute of Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Olena Khaustova
- Medical Psychology, Psychosomatic Medicine and Psychotherapy Department, Bogomolets National Medical University, Kyiv, Ukraine
| | - Steve Koh
- Department of Psychiatry, University of California San Diego, San Diego, USA
| | - Svetlana Kopishinskaia
- International Centre for Education and Research in Neuropsychiatry (ICERN), Samara State Medical University, Samara, Russia
- Kirov State Medical University, Kirov, Russia
| | - Korneliia Kosenko
- Department of Psychiatry, Drug Abuse and Psychology, Odessa National Medical University, Odessa, Ukraine
| | - Sotirios A Koupidis
- Occupational and Environmental Health Sector, Public Health Policy Department, School of Public Health, University of West Attica, Athens, Greece
| | - Illes Kovacs
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Barbara Kulig
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | | | - Justine Liewig
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Groupe Hospitalier Nord Essonne, Orsay, France
| | - Abdul Majid
- Department of Psychiatry, SKIMS Medical College, Srinagar, India
| | - Evgeniia Malashonkova
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Groupe Hospitalier Nord Essonne, Orsay, France
| | - Khamelia Malik
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia
| | - Najma Iqbal Malik
- Department of Psychology, University of Sargodha, Sargodha, Pakistan
| | - Gulay Mammadzada
- Department of Psychiatry, Azerbaijan Medical University, Baku, Azerbaijan
| | | | - Donatella Marazziti
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
- Unicamillus, Saint Camillus International University of Health Sciences, Rome, Italy
- Brain Research Foundation onus, Lucca, Italy
| | - Darko Marčinko
- Department of Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Stephanie Martinez
- Department of Psychiatry, University of California San Diego, San Diego, USA
| | - Eimantas Matiekus
- Clinic of Psychiatry, Institute of Clinical Medicine, Medical Faculty, Vilnius University, Vilnius, Lithuania
| | - Gabriela Mejia
- Department of Psychiatry, University of California San Diego, San Diego, USA
| | - Roha Saeed Memon
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | | | | | - Roumen Milev
- Department of Psychiatry, Queens University, Kingston, ON, Canada
| | - Muftau Mohammed
- Department of Clinical Services, Federal Neuropsychiatric Hospital, Kaduna, Nigeria
| | - Alejandro Molina-López
- General Office for the Psychiatric Services of the Ministry of Health, Mexico City, Mexico
| | - Petr Morozov
- Department of Postgraduate Education, Russian National Research Medical University n.a. N.I. Pirogov, Moscow, Russia
| | - Nuru Suleiman Muhammad
- Department of Community Medicine, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Filip Mustač
- Department of Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Mika S Naor
- Sackler School of Medicine New York State American Program, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Amira Nassieb
- Okasha Institute of Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Alvydas Navickas
- Clinic of Psychiatry, Institute of Clinical Medicine, Medical Faculty, Vilnius University, Vilnius, Lithuania
| | - Tarek Okasha
- Okasha Institute of Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Milena Pandova
- Second Psychiatric Clinic, University Hospital for Active Treatment in Neurology and Psychiatry "Saint Naum", Sofia, Bulgaria
| | - Anca-Livia Panfil
- Compartment of Liaison Psychiatry, "Pius Brinzeu" County Emergency Clinical Hospital, Timisoara, Romania
| | - Liliya Panteleeva
- Department of Medical Psychology, Psychiatry and Psychotherapy, Kyrgyz-Russian Slavic University, Bishkek, Kyrgyz Republic
| | - Ion Papava
- Department of Neuroscience, Discipline of Psychiatry, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Mikaella E Patsali
- School of Social Sciences, Hellenic Open University, Patras, Greece
- Department of Internal Medicine, Nicosia General Hospital, Nicosia, Cyprus
| | - Alexey Pavlichenko
- Education Center, Mental Health Clinic No. 1 named after N.A. Alexeev of Moscow Healthcare Department, Moscow, Russia
| | - Bojana Pejuskovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinical Department for Crisis and Affective Disorders, Institute of Mental Health, Belgrade, Serbia
| | - Mariana Pinto Da Costa
- South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
| | - Mikhail Popkov
- Department of the Introduction to Internal Medicine and Family Medicine, International Higher School of Medicine, Bishkek, Kyrgyz Republic
| | | | - Nor Jannah Nasution Raduan
- Department of Psychiatry, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Francisca Vargas Ramírez
- Child and Adolescent Psychiatry Department, Hospital Luis Calvo Mackenna, Santiago, Chile
- Universidad Diego Portales, Santiago, Chile
| | - Elmars Rancans
- Department of Psychiatry and Narcology, Riga Stradins University, Riga, Latvia
- Riga Centre of Psychiatry and Narcology, Riga, Latvia
| | - Salmi Razali
- Department of Psychiatry, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Federico Rebok
- Servicio de Emergencia, Acute inpatient Unit, Hospital Moyano, Buenos Aires, Argentina
- Argentine Institute of Clinical Psychiatry (IAPC), Buenos Aires, Argentina
| | - Anna Rewekant
- General Psychiatry Unit I, Greater Poland Neuropsychiatric Center, Kościan, Poland
| | | | - María Teresa Rivera-Encinas
- Centro de Investigación en Salud Pública, Facultad de Medicina, Universidad de San Martín de Porres, Instituto Nacional de Salud Mental "Honorio Delgado - Hideyo Noguchi", Lima, Perú
| | - Pilar Saiz
- Psychiatry Area, Department of Medicine, University of Oviedo, Oviedo, Spain
- ISPA, INEUROPA, CIBERSAM, Oviedo, Spain
- Mental Health Center of La Corredoria, Oviedo, Spain
| | | | - David Saucedo Martínez
- Department of Psychiatry, Escuela Nacional de Medicina, TEC de Monterrey, Servicio de geriatría. Hospital Universitario "José Eleuterio González" UANL, Monterrey, Nuevo León, Mexico
| | - Jo Anne Saw
- Department of Psychiatry, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Görkem Saygili
- Department of Cognitive Science and Artificial Intelligence, Tilburg University, Tilburg, The Netherlands
| | - Patricia Schneidereit
- Klinik für Allgemeine Psychiatrie und Psychotherapie Ost, Psychiatrische Institutsambulanz, Klinikum am Weissenhof, Weissenhof, Germany
| | - Bhumika Shah
- DY Patil Medical College, Navi Mumbai, Maharashtra, India
| | - Tomohiro Shirasaka
- Department of Psychiatry, Teine Keijinkai Medical Center, Sapporo, Japan
| | | | - Satti Sitanggang
- Psychiatric Unit, Pambalah Batung General Hospital, South Kalimantan, Amuntai, Indonesia
| | - Oleg Skugarevsky
- Department of Psychiatry and Medical Psychology, Belarusian State Medical University, Minsk, Belarus
| | - Anna Spikina
- Saint Petersburg Psychoneurological Dispensary No. 2, Saint Petersburg, Russia
| | - Sridevi Sira Mahalingappa
- Derbyshire Healthcare NHS Foundation Trust, The Liasion Team, Royal Derby Hospital, Derby, Derbyshire, UK
| | - Maria Stoyanova
- Second Psychiatric Clinic, University Hospital for Active Treatment in Neurology and Psychiatry "Saint Naum", Sofia, Bulgaria
| | - Anna Szczegielniak
- Department of Psychiatric Rehabilitation, Department of Psychiatry and Psychotherapy, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Poland
| | - Simona Claudia Tamasan
- Compartment of Liaison Psychiatry, "Pius Brinzeu" County Emergency Clinical Hospital, Timisoara, Romania
| | - Giuseppe Tavormina
- Psychiatric Studies Centre, Provaglio d'Iseo, Italy
- European Depression Association and Italian Association on Depression, Brussels, Belgium
- Bedforshire Center for Mental Health Research, University of Cambridge, Cambridge, UK
| | | | | | - Mauricio Tohen
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of New Mexico, Albuquerque, Nm, USA
| | - Eva Maria Tsapakis
- "Agios Charalambos" Mental Health Clinic, Heraklion, Crete, Greece
- 1st Department of Academic Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Greece
| | - Dina Tukhvatullina
- Centre for Global Public Health, Institute of Population Health Sciences, Queen Mary University of London, London, UK
| | - Irfan Ullah
- Kabir Medical College, Gandhara University, Peshawar, Pakistan
| | - Ratnaraj Vaidya
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | | | - Jelena Vrublevska
- Department of Psychiatry and Narcology, Riga Stradins University, Riga, Latvia
- Riga Centre of Psychiatry and Narcology, Riga, Latvia
- Institute of Public Health, Riga Stradins University, Riga, Latvia
| | - Olivera Vukovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Department of Research and Education, Institute of Mental Health, Belgrade, Serbia
| | - Olga Vysotska
- Educational and Research Center - Ukrainian Family Medicine Training Center, Bogomolets National Medical University, Kyiv, Ukraine
| | - Natalia Widiasih
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia
| | - Anna Yashikhina
- International Centre for Education and Research in Neuropsychiatry (ICERN), Samara State Medical University, Samara, Russia
- Department of Psychiatry, Narcology, Psychotherapy and Clinical Psychology, Samara State Medical University, Samara, Russia
| | - Panagiotis E Prezerakos
- Department of Nursing, University of Peloponnese, Laboratory of Integrated Health Care, Tripoli, Greece
| | - Daria Smirnova
- International Centre for Education and Research in Neuropsychiatry (ICERN), Samara State Medical University, Samara, Russia
- Department of Psychiatry, Narcology, Psychotherapy and Clinical Psychology, Samara State Medical University, Samara, Russia
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Bowersox NW, Smith CM, Austin K, Bradford DW, Browne J, Nelson SM, Szymanski BR, Glynn SM. Mortality and suicidality in veterans health administration patients with newly-identified early episode psychosis. Schizophr Res 2024; 264:362-369. [PMID: 38219412 DOI: 10.1016/j.schres.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 12/15/2023] [Accepted: 01/01/2024] [Indexed: 01/16/2024]
Abstract
Within the Veterans Affairs (VA), management of self-harm is a major clinical priority. However, there is limited information on risks for self-harm among VA patients with emerging psychotic disorders relative to VA patients with other emerging mental health conditions. Using information from fiscal years 2010 through 2018, a national cohort of VA patients 30 or younger was classified based on mental health diagnoses into three groups: 1) early episode psychosis (EEP), 2) non-early episode psychosis mental health (non-EEP MH), or 3) no mental health (no MH). Analyses focused on cohort members' risk for all-cause mortality, suicide mortality, and non-fatal suicide attempts (NFSA) during the year following initial diagnosis of mental health conditions (or first year of VA care, for the no MH group). In unadjusted analyses, the EEP group had elevated rates of all-cause mortality, suicide mortality, and NFSA relative to the non-EEP MH and no MH groups and the non-EEP MH had elevated rates of all-cause mortality, suicide mortality, and NFSA relative to the no MH group. After adjusting for demographics and care receipt, EEP status was unrelated to all-cause mortality but associated with increased suicide mortality risk and NFSA. Non-EEP MH status was associated with reduced risk of all-cause mortality but increased risk for NFSA. In the year following first diagnosis, VA patients with EEP are at increased risk for suicide mortality and self-harm even after accounting for other risk factors. Clinical services targeting this crucial time can help promote safety for this vulnerable group.
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Affiliation(s)
- Nicholas W Bowersox
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs Central Office, Washington, DC, USA; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Colin M Smith
- Duke Hubert-Yeargan Center for Global Health, Durham, NC, USA
| | - Karen Austin
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs Central Office, Washington, DC, USA
| | - Daniel W Bradford
- Office of Mental Health and Suicide Prevention, Department of Veterans Affairs Central Office, Washington, DC, USA; Duke University Medical Center, Durham, NC, USA
| | - Julia Browne
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Sharon M Nelson
- Center for Evaluation and Implementation Resources, VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA; Psychology Department, Pennsylvania State University, University Park, PA, USA
| | - Benjamin R Szymanski
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs Central Office, Washington, DC, USA
| | - Shirley M Glynn
- VA Greater Los Angeles Healthcare System at West Los Angeles, Los Angeles, CA, USA; Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
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Chen YL, Chen PY, Pan CH, Chen PH, Su SS, Tsai SY, Chen CC, Kuo CJ. Prevalence and 3-year incidence of physical illnesses after schizophrenia diagnosis: Comparison with general population. Schizophr Res 2024; 264:272-279. [PMID: 38198879 DOI: 10.1016/j.schres.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 12/16/2023] [Accepted: 01/01/2024] [Indexed: 01/12/2024]
Abstract
AIM People with schizophrenia are at a greater risk of poor physical health than the general population. This study investigated the annual incidence of physical illnesses after a new schizophrenia diagnosis, which has rarely been investigated in the literature. METHODS The authors collected data from Taiwan's National Health Insurance Research Database from January 1, 1996, to December 31, 2013, and enrolled 1910 patients with newly diagnosed schizophrenia cases aged 10-40 years and 7640 age- and sex-matched controls from the general population. They estimated the 1-year prevalence and annual incidence rate ratio (IRR) of specified physical diseases across 3 years in the schizophrenia group compared with the controls. RESULTS Several physical illnesses were prevalent within 1 year of schizophrenia diagnosis. Regarding incident physical illnesses, patients had a moderate to strong risk of numerous physical illnesses (IRR > 3.0: ischemic heart disease, cerebrovascular disease, diabetes mellitus, and cancer; IRR 1.8-3.0: other forms of heart disease, vein and lymphatic diseases, pneumonia, chronic hepatic disease, and ulcer disease) within the first year after schizophrenia diagnosis. The IRRs of most physical illnesses declined over 3 years, except for that of cerebrovascular disease, which significantly increased (IRR > 3.0) over the 3 years after schizophrenia diagnosis. Cerebrovascular disease had a significant incidence risk (IRR > 3) persistently across the 3 years. CONCLUSION Various comorbid physical illnesses can occur in the early stages of schizophrenia. Clinicians should consider these vulnerabilities to physical illnesses during the evaluation of patients with newly diagnosed schizophrenia by attempting to prevent, screen for, and manage them.
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Affiliation(s)
- Yi-Lung Chen
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan; Department of Counseling Psychology, Chinese Culture University, Taipei, Taiwan
| | - Po-Yu Chen
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Chun-Hung Pan
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan; Department of Psychology, National Chengchi University, Taipei, Taiwan
| | - Pao-Huan Chen
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Sheng-Shiang Su
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Shang-Ying Tsai
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chiao-Chicy Chen
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan; Department of Psychiatry, Mackay Medical College, Taipei, Taiwan
| | - Chian-Jue Kuo
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan.
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8
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Nomura N, Misawa F, Fujii Y, Takeuchi H. Mortality in patients with schizophrenia in Japan. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-023-02592-z. [PMID: 38245575 DOI: 10.1007/s00127-023-02592-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 11/19/2023] [Indexed: 01/22/2024]
Abstract
PURPOSE Patients with schizophrenia have a higher mortality risk than the general population. However, no recent studies have investigated mortality in patients with schizophrenia in Japan. Therefore, we conducted a retrospective study to evaluate excess mortality and risk factors for mortality in patients with schizophrenia in Japan. METHODS We included patients diagnosed with schizophrenia or schizoaffective disorder at Yamanashi Prefectural Kita Hospital between January 1, 2013, and December 31, 2017. Standardized mortality ratios (SMRs) were used to compare mortality rates between patients with schizophrenia and the general population. Logistic regression analysis was performed to estimate risk factors associated with mortality. RESULTS Of the 1,699 patients with schizophrenia (893 men and 806 women), 104 (55 men and 49 women) died during the study period. The all-cause SMR (95% confidence interval [CI]) was 2.18 (1.76-2.60); the natural- and unnatural-cause SMRs were 2.06 (1.62-2.50) and 5.07 (2.85-7.30), respectively. Men (adjusted odds ratio [OR] = 2.24, 95% CI = 1.10-4.56), age (adjusted OR = 1.12, 95% CI = 1.09-1.16), and barbiturate use (adjusted OR = 8.17, 95% CI = 2.07-32.32) were associated with the risk of mortality. CONCLUSION The mortality rate remains high in patients with schizophrenia in Japan. Further studies are needed to evaluate mortality trends in this population.
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Affiliation(s)
- Nobuyuki Nomura
- Department of Psychiatry and Psychotherapy, Section Evidence-Based Medicine, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaningerstr. 69, 81675, Munich, Germany.
- Department of Neuropsychiatry, Yamanashi Prefectural Kita Hospital, Yamanashi, Japan.
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Fuminari Misawa
- Department of Neuropsychiatry, Yamanashi Prefectural Kita Hospital, Yamanashi, Japan
| | - Yasuo Fujii
- Department of Neuropsychiatry, Yamanashi Prefectural Kita Hospital, Yamanashi, Japan
| | - Hiroyoshi Takeuchi
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
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Yeh LL, Lee WC, Kuo KH, Pan YJ. Antipsychotics and Mortality in Adult and Geriatric Patients with Schizophrenia. Pharmaceuticals (Basel) 2023; 17:61. [PMID: 38256894 PMCID: PMC10819180 DOI: 10.3390/ph17010061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/20/2023] [Accepted: 12/27/2023] [Indexed: 01/24/2024] Open
Abstract
Patients with schizophrenia have a high mortality risk, and the role of antipsychotic medications remains inconclusive. In an aging society, older patients with schizophrenia warrant increased attention. This study investigated the association of antipsychotic medication dosages with mortality in patients with schizophrenia by using data from Taiwan's National Health Insurance Research Database from 2010 to 2014. This study included 102,964 patients with schizophrenia and a subgroup of 6433 older patients in addition to an age- and sex-matched control group. The findings revealed that among patients with schizophrenia, the no antipsychotic exposure group had the highest mortality risk (3.61- and 3.37-fold higher risk for overall and cardiovascular mortality, respectively) in the age- and sex-adjusted model, followed by the high, low, and moderate exposure groups. A similar pattern was observed in the older patients with schizophrenia. High exposure to antipsychotics was associated with the highest risks of overall and cardiovascular mortality (3.01- and 2.95-fold higher risk, respectively). In conclusion, the use of antipsychotics can be beneficial for patients with schizophrenia with recommended exposure levels being low to moderate. In older patients, high antipsychotic exposure was associated with the highest mortality risk, indicating that clinicians should be cautious when administering antipsychotic medications to such patients.
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Affiliation(s)
- Ling-Ling Yeh
- Graduate School of Humanities and Social Sciences, Dharma Drum Institute of Liberal Arts, New Taipei City 208, Taiwan;
| | - Wei-Chen Lee
- Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan;
| | - Kuei-Hong Kuo
- Division of Medical Imaging, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Yi-Ju Pan
- Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan;
- Department of Chemical Engineering and Materials Science, Yuan Ze University, Taoyuan City 320, Taiwan
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10
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Baruth JM, Bateman DR, Kovacs RJ, Bateman PV, Pazdernik VM, Santivasi WL, Dunlay SM, Lapid MI. Cardiac healthcare disparities and electrocardiography (ECG) differences in schizophrenia at end of life. Schizophr Res 2023; 262:60-66. [PMID: 37925752 DOI: 10.1016/j.schres.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 09/11/2023] [Accepted: 10/22/2023] [Indexed: 11/07/2023]
Abstract
Schizophrenia is associated with early mortality of 15 to 20 years, and 80 % of deaths are due to cardiovascular disease with a three-times greater risk of sudden-cardiac-death. While lifestyle, medications, genetics, and healthcare disparities are contributing factors, the etiology of this complex process is not fully understood. The aim of this study is to examine cardiac-related healthcare utilization and electrocardiogram (ECG) outcomes in schizophrenia at the end of life (EOL). A cohort of individuals with schizophrenia (SG) (n = 610, ≥50 years) were identified retrospectively from a unified clinical data platform and measures of cardiovascular healthcare utilization were evaluated within a 12-month period prior to death. Similarly, a control group (n = 610) was randomly identified and matched by gender (53 % females) and age of death (72.8 ± 12.4 years). Statistical methods included Cochran-Mantel-Haenszel and mixed-effects logistic & linear regression tests with adjustments for match strata and marital status, race, age, and gender as covariates. Results indicate that SG was more likely to be unmarried, unemployed, or from minority groups (all p < 0.001), and more likely to have diabetes and/or cardiovascular disease (p < 0.001). SG was less likely to receive an ECG (p = 0.001) or cardiac catheterization procedure (p < 0.001). SG had a greater mean QTc (447.2 ms vs. 434.6 ms; p = 0.001) and were twice as likely to have "prolonged QT" on ECG report (p = 0.006). In conclusion, SG had reduced likelihood of cardiac-related healthcare interventions, and despite greater likelihood of prolonged QTc, a recognized biomarker of cardiac risk, ECG was less likely at EOL. Given greater cardiac comorbidity and risk of sudden cardiac death in schizophrenia, improved practice guidelines are needed.
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Affiliation(s)
- Joshua M Baruth
- Dept. of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
| | - Daniel R Bateman
- Dept. of Behavioral Health, Indiana University, Indianapolis, IN, USA
| | | | | | | | - Wil L Santivasi
- Center for Palliative Care, Department of Medicine, Duke University, Durham, NC, USA
| | - Shannon M Dunlay
- Dept. of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Maria I Lapid
- Dept. of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
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11
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Chan JKN, Correll CU, Wong CSM, Chu RST, Fung VSC, Wong GHS, Lei JHC, Chang WC. Life expectancy and years of potential life lost in people with mental disorders: a systematic review and meta-analysis. EClinicalMedicine 2023; 65:102294. [PMID: 37965432 PMCID: PMC10641487 DOI: 10.1016/j.eclinm.2023.102294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 11/16/2023] Open
Abstract
Background Mental disorders are associated with premature mortality. There is increasing research examining life expectancy and years-of-potential-life-lost (YPLL) to quantify the disease impact on survival in people with mental disorders. We aimed to systematically synthesize studies to estimate life expectancy and YPLL in people with any and specific mental disorders across a broad spectrum of diagnoses. Methods In this systematic review and meta-analysis, we searched Embase, MEDLINE, PsychINFO, WOS from inception to July 31, 2023, for published studies reporting life expectancy and/or YPLL for mental disorders. Criteria for study inclusion were: patients of all ages with any mental disorders; reported data on life expectancy and/or YPLL of a mental-disorder cohort relative to the general population or a comparison group without mental disorders; and cohort studies. We excluded non-cohort studies, publications containing non-peer-reviewed data or those restricted to population subgroups. Survival estimates, i.e., life expectancy and YPLL, were pooled (based on summary data extracted from the included studies) using random-effects models. Subgroup analyses and random-effects meta-regression analyses were performed to explore sources of heterogeneity. Risk-of-bias assessment was evaluated using the Newcastle-Ottawa Scale. This study is registered with PROSPERO (CRD42022321190). Findings Of 35,865 studies identified in our research, 109 studies from 24 countries or regions including 12,171,909 patients with mental disorders were eligible for analysis (54 for life expectancy and 109 for YPLL). Pooled life expectancy for mental disorders was 63.85 years (95% CI 62.63-65.06; I2 = 100.0%), and pooled YPLL was 14.66 years (95% CI 13.88-15.98; I2 = 100.0%). Disorder-stratified analyses revealed that substance-use disorders had the shortest life expectancy (57.07 years [95% CI 54.47-59.67]), while neurotic disorders had the longest lifespan (69.51 years [95% CI 67.26-71.76]). Substance-use disorders exhibited the greatest YPLL (20.38 years [95% CI 18.65-22.11]), followed by eating disorders (16.64 years [95% CI 7.45-25.82]), schizophrenia-spectrum disorders (15.37 years [95% CI 14.18-16.55]), and personality disorders (15.35 years [95% CI 12.80-17.89]). YPLLs attributable to natural and unnatural deaths in mental disorders were 4.38 years (95% CI 3.15-5.61) and 8.11 years (95% CI 6.10-10.13; suicide: 8.31 years [95% CI 6.43-10.19]), respectively. Stratified analyses by study period suggested that the longevity gap persisted over time. Significant cross-study heterogeneity was observed. Interpretation Mental disorders are associated with substantially reduced life expectancy, which is transdiagnostic in nature, encompassing a wide range of diagnoses. Implementation of comprehensive and multilevel intervention approaches is urgently needed to rectify lifespan inequalities for people with mental disorders. Funding None.
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Affiliation(s)
- Joe Kwun Nam Chan
- LKS Faculty of Medicine, Department of Psychiatry, The University of Hong Kong, Hong Kong, China
| | - Christoph U. Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Child and Adolescent Psychiatry, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Corine Sau Man Wong
- LKS Faculty of Medicine, School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Ryan Sai Ting Chu
- LKS Faculty of Medicine, Department of Psychiatry, The University of Hong Kong, Hong Kong, China
| | - Vivian Shi Cheng Fung
- LKS Faculty of Medicine, Department of Psychiatry, The University of Hong Kong, Hong Kong, China
| | - Gabbie Hou Sem Wong
- LKS Faculty of Medicine, Department of Psychiatry, The University of Hong Kong, Hong Kong, China
| | - Janet Hiu Ching Lei
- LKS Faculty of Medicine, Department of Psychiatry, The University of Hong Kong, Hong Kong, China
| | - Wing Chung Chang
- LKS Faculty of Medicine, Department of Psychiatry, The University of Hong Kong, Hong Kong, China
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China
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12
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Lock SK, Legge SE, Kappel DB, Willcocks IR, Helthuis M, Jansen J, Walters JTR, Owen MJ, O'Donovan MC, Pardiñas AF. Mediation and longitudinal analysis to interpret the association between clozapine pharmacokinetics, pharmacogenomics, and absolute neutrophil count. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:74. [PMID: 37853043 PMCID: PMC10585000 DOI: 10.1038/s41537-023-00404-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 10/10/2023] [Indexed: 10/20/2023]
Abstract
Clozapine is effective at reducing symptoms of treatment-resistant schizophrenia, but it can also induce several adverse outcomes including neutropenia and agranulocytosis. We used linear mixed-effect models and structural equation modelling to determine whether pharmacokinetic and genetic variables influence absolute neutrophil count in a longitudinal UK-based sample of clozapine users not currently experiencing neutropenia (N = 811). Increased daily clozapine dose was associated with elevated neutrophil count, amounting to a 133 cells/mm3 rise per standard deviation increase in clozapine dose. One-third of the total effect of clozapine dose was mediated by plasma clozapine and norclozapine levels, which themselves demonstrated opposing, independent associations with absolute neutrophil count. Finally, CYP1A2 pharmacogenomic activity score was associated with absolute neutrophil count, supporting lower neutrophil levels in CYP1A2 poor metabolisers during clozapine use. This information may facilitate identifying at-risk patients and then introducing preventative interventions or individualised pharmacovigilance procedures to help mitigate these adverse haematological reactions.
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Affiliation(s)
- Siobhan K Lock
- Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Sophie E Legge
- Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Djenifer B Kappel
- Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Isabella R Willcocks
- Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | | | - John Jansen
- Leyden Delta B.V., Nijmegen, The Netherlands
| | - James T R Walters
- Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Michael J Owen
- Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Michael C O'Donovan
- Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Antonio F Pardiñas
- Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK.
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13
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So YK, Chan CY, Fung SC, Lui TT, Lau FC, Chan KW, Lee HM, Lui SY, Hui LM, Chen E, Chang WC. Rates and correlates of medication non-adherence behaviors and attitudes in adult patients with early psychosis. Soc Psychiatry Psychiatr Epidemiol 2023:10.1007/s00127-023-02563-4. [PMID: 37833425 DOI: 10.1007/s00127-023-02563-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/28/2023] [Indexed: 10/15/2023]
Abstract
PURPOSE Literature on antipsychotic medication adherence in early psychosis primarily assessed adherence behaviors and focused on young patients. There is a paucity of research investigating negative medication attitude and its determinants in the early illness course, particularly in older-aged sample. We aimed to examine prevalence and correlates of medication non-adherence behaviors and negative medication attitudes separately in adult patients with early psychosis. METHODS One hundred ninety-nine Chinese early psychosis patients aged 26-55 years who had received three-year treatment for first psychotic episode in Hong Kong were examined. Assessments encompassing socio-demographics, premorbid adjustment, clinical and treatment profiles, self-stigma and therapeutic alliance were conducted. Patients were evaluated with Medication Compliance Questionnaire, which is a modified Chinese-translated version of Medication Adherence Rating Scale and includes items measuring adherence behaviors and attitudes towards medications. RESULTS Rates of medication non-adherence and negative attitude towards medications were 38.7% and 50.8%, respectively. Multivariate regression analysis showed that more severe positive symptoms, greater self-stigma and negative medication attitude were independently associated with medication non-adherence. Negative attitude towards medications was significantly associated with younger age, higher educational attainment, diagnosis of other psychotic disorders, poorer insight, greater self-stigma and less satisfaction with communication with healthcare staff, which represented an index reflecting suboptimal therapeutic alliance. CONCLUSION Antipsychotic non-adherence and negative medication attitudes are frequently observed in adult early psychosis patients. Our findings indicate that poor insight, elevated self-stigma and suboptimal therapeutic alliance may constitute potential treatment targets for promoting medication adherence and rectifying negative medication attitudes in the early illness stage.
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Affiliation(s)
- Yuen Kiu So
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Ching Yui Chan
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Shi Cheng Fung
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Tsz Ting Lui
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Fu Chun Lau
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Kit Wa Chan
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong
| | - Ho Ming Lee
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Sai Yu Lui
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Lai Ming Hui
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Eric Chen
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong
| | - Wing Chung Chang
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong.
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong.
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14
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Anmella G, Amoretti S, Safont G, Meseguer A, Vieta E, Pons-Cabrera MT, Alfonso M, Hernández C, Sanchez-Autet M, Pérez-Baldellou F, González-Blanco L, García-Portilla MP, Bernardo M, Arranz B. Intestinal permeability and low-grade chronic inflammation in schizophrenia: A multicentre study on biomarkers. Rationale, objectives, protocol and preliminary results. SPANISH JOURNAL OF PSYCHIATRY AND MENTAL HEALTH 2023:S2950-2853(23)00040-6. [PMID: 38591828 DOI: 10.1016/j.sjpmh.2023.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 08/21/2023] [Accepted: 09/18/2023] [Indexed: 04/10/2024]
Abstract
BACKGROUND Altered intestinal permeability and low-grade chronic inflammation disrupt the integrity of the blood-brain barrier (microbiota-gut-brain axis), probably playing a role in the pathophysiology of schizophrenia-spectrum disorders. However, studies assessing the microbiota-gut-brain axis are inconsistent. This article describes the rationale, objectives, protocol, and presents descriptive results for a new project. METHODS The sample of this study came from an observational, cross-sectional and multisite study including four centers in Spain (PI17/00246) recruiting adult patients with DSM-5 schizophrenia-spectrum disorders at any stage of the disease. The aims of the project are to assess the interrelation between intestinal permeability and low-grade chronic inflammation in schizophrenia-spectrum disorders and the role of peripheral biomarkers, diet, exercise, metabolic syndrome, disease severity and functioning as well as cognition. Assessments included the following variables: (1) anthropometric, (2) intestinal permeability, diet, and physical exercise, (3) clinical and functional, (4) neuropsychological and cognitive reserve, and (5) peripheral biomarkers from blood. RESULTS A total of 646 patients were enrolled (257, 39.7% female). Mean age was 43.2±13.6 years, illness duration 15.1±11.5 years. 55.8% consumed tobacco. Positive PANSS score was 13.68±6.55, and 20.38±8.69 in the negative symptoms. CGI was 4.16±2.22 and GAF was 60.00±14.84. CONCLUSION The results obtained by this project are expected to contribute toward the understanding of the physiopathology of schizophrenia-spectrum disorders. This will likely aid to personalize treatments in real-world clinical practice, potentially including variables related to intestinal permeability and inflammation.
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Affiliation(s)
- Gerard Anmella
- Bipolar and Depressive Disorders Unit, Hospital Clínic de Barcelona, Institute of Neuroscience, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Barcelona Clinic Schizophrenia Unit, Hospital Clínic de Barcelona, Institute of Neuroscience, University of Barcelona, IDIBAPS, Spain
| | - Silvia Amoretti
- Bipolar and Depressive Disorders Unit, Hospital Clínic de Barcelona, Institute of Neuroscience, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Barcelona Clinic Schizophrenia Unit, Hospital Clínic de Barcelona, Institute of Neuroscience, University of Barcelona, IDIBAPS, Spain; Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain
| | - Gemma Safont
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Department of Psychiatry, Hospital Universitari Mutua de Terrassa, Universitat de Barcelona, Barcelona, Spain
| | - Ana Meseguer
- Bipolar and Depressive Disorders Unit, Hospital Clínic de Barcelona, Institute of Neuroscience, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Barcelona Clinic Schizophrenia Unit, Hospital Clínic de Barcelona, Institute of Neuroscience, University of Barcelona, IDIBAPS, Spain
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clínic de Barcelona, Institute of Neuroscience, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain
| | - Maria Teresa Pons-Cabrera
- Bipolar and Depressive Disorders Unit, Hospital Clínic de Barcelona, Institute of Neuroscience, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Barcelona Clinic Schizophrenia Unit, Hospital Clínic de Barcelona, Institute of Neuroscience, University of Barcelona, IDIBAPS, Spain
| | - Miqueu Alfonso
- Department of Psychiatry, Hospital Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Carla Hernández
- Department of Psychiatry, Hospital Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Monica Sanchez-Autet
- Department of Psychiatry, Hospital Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Ferran Pérez-Baldellou
- Department of Psychiatry, Hospital Universitari Mutua de Terrassa, Universitat de Barcelona, Barcelona, Spain
| | - Leticia González-Blanco
- Department of Psychiatry, University of Oviedo, Servicio de Salud Mental del Principado de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), INEUROPA, Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Oviedo, Spain
| | - Maria Paz García-Portilla
- Department of Psychiatry, University of Oviedo, Servicio de Salud Mental del Principado de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), INEUROPA, Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Oviedo, Spain
| | - Miquel Bernardo
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Barcelona Clinic Schizophrenia Unit, Hospital Clínic de Barcelona, Institute of Neuroscience, University of Barcelona, IDIBAPS, Spain.
| | - Belén Arranz
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Department of Psychiatry, Hospital Parc Sanitari Sant Joan de Déu, Barcelona, Spain
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15
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Yang Z, Takeuchi H, Yee JY, See YM, Tang C, Ng BT, Lee J. Once-daily versus divided dosing regimens of clozapine: A cross-sectional study in Singapore. Schizophr Res 2023:S0920-9964(23)00354-7. [PMID: 37833207 DOI: 10.1016/j.schres.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/12/2023] [Accepted: 10/02/2023] [Indexed: 10/15/2023]
Abstract
INTRODUCTION Clozapine is recognized as the gold standard medication for treatment-resistant schizophrenia. Despite the general recommendation of administering in a divided dosing regimen, clozapine is often prescribed once daily at night in clinical practice. This study aims to compare patient characteristics, psychiatric symptoms, side effects, and plasma concentration of clozapine between once-daily dosing and divided dosing regimens. METHODS This cross-sectional study included 159 participants with treatment-resistant schizophrenia or schizoaffective disorder. Participant's demographic information, anthropometric data, and medical history were collected. Their psychiatric symptoms, cognition, functioning, and side effects were evaluated. RESULTS Once-daily dosing regimen was associated with younger age and competitive employment. Lower clinical symptom severity, better functioning and cognitive performance were observed in the once-daily dosing group. Lower daily dose of clozapine, trough plasma concentrations of clozapine and norclozapine were also significantly associated with once-daily dosing regimen. CONCLUSION The study results support once-daily dosing of clozapine as a viable option to selected patients in clinical practice, as no association of severe symptoms or side effects were associated with once-daily dosing regimen. More studies are needed to examine the relationship between clinical outcomes and clozapine dosing regimen.
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Affiliation(s)
- Zixu Yang
- Research Division, Institute of Mental Health, Singapore
| | - Hiroyoshi Takeuchi
- Department of Neuropsychiatry, Keio University School of Medicine, Japan
| | - Jie Yin Yee
- Research Division, Institute of Mental Health, Singapore
| | - Yuen Mei See
- Research Division, Institute of Mental Health, Singapore
| | - Charmaine Tang
- Department of Psychosis, Institute of Mental Health, Singapore
| | - Boon Tat Ng
- Department of Pharmacy, Institute of Mental Health, Singapore
| | - Jimmy Lee
- Department of Psychosis, Institute of Mental Health, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
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16
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Ormond C, Ryan NM, Heron EA, Gill M, Byerley W, Corvin A. Ultrarare Missense Variants Implicated in Utah Pedigrees Multiply Affected With Schizophrenia. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2023; 3:797-802. [PMID: 37881554 PMCID: PMC10593875 DOI: 10.1016/j.bpsgos.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/31/2023] [Accepted: 02/03/2023] [Indexed: 02/17/2023] Open
Abstract
Background Recent work from the Schizophrenia Exome Sequencing Meta-analysis (SCHEMA) consortium showed significant enrichment of ultrarare variants in schizophrenia cases. Family-based studies offer a unique opportunity to evaluate rare variants because risk in multiplex pedigrees is more likely to be influenced by the same collection of variants than an unrelated cohort. Methods Here, we examine whole genome sequencing data from 35 individuals across 6 pedigrees multiply affected by schizophrenia. We applied a rigorous filtering pipeline to search for classes of protein-coding variants that cosegregated with disease status, and we examined these for evidence of enrichment in the SCHEMA dataset. Additionally, we applied a family-based consensus approach to call copy number variants and screen against a list of schizophrenia-associated risk variants. Results We identified deleterious missense variants in 3 genes (ATP2B2, SLC25A28, and GSK3A) that cosegregated with disease in 3 of the pedigrees. In the SCHEMA, the gene ATP2B2 shows highly suggestive evidence for deleterious missense variants in schizophrenia cases (p = .000072). ATP2B2 is involved in intracellular calcium homeostasis, expressed in multiple brain tissue types, and predicted to be intolerant to loss-of-function and missense variants. Conclusions We have identified genes that are likely to increase schizophrenia risk in 3 of the 6 pedigrees examined, the strongest evidence being for a gene involved in calcium homeostasis. Further work is required to examine other classes of variants that may be contributing to disease burden.
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Affiliation(s)
- Cathal Ormond
- Neuropsychiatric Genetics Research Group, Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
| | - Niamh M. Ryan
- Neuropsychiatric Genetics Research Group, Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
| | - Elizabeth A. Heron
- Neuropsychiatric Genetics Research Group, Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
| | - Michael Gill
- Neuropsychiatric Genetics Research Group, Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
| | - William Byerley
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California
| | - Aiden Corvin
- Neuropsychiatric Genetics Research Group, Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
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17
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Laforgue EJ, Istvan M, Chaslerie A, Artarit P, Vallot G, Jolliet P, Grall-Bronnec M, Victorri-Vigneau C. Characterization of antipsychotic utilization before clozapine initiation for individuals with schizophrenia: an innovative visualization of trajectories using French National Health Insurance data. Epidemiol Psychiatr Sci 2023; 32:e59. [PMID: 37723967 PMCID: PMC10539739 DOI: 10.1017/s2045796023000732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 08/23/2023] [Accepted: 09/03/2023] [Indexed: 09/20/2023] Open
Abstract
AIMS Despite recommendations to initiate clozapine after two unsuccessful trials of antipsychotics, clozapine is underprescribed and initiated too late. The aim of this study was to describe different antipsychotic treatment sequences in the 36 months before the initiation of clozapine and to characterize clusters of treatment trajectories. METHODS Using the French National Health Insurance database, a historical cohort study of the population in an area in western France was performed. The data from all new users of clozapine with a diagnosis of schizophrenia or schizoaffective disorder in the period of 2017-2018 were evaluated. All outpatient reimbursements for antipsychotics during the 36 months before clozapine initiation were analysed. Successive reimbursements for identical treatments were grouped into treatment trials (TTs), and different trajectories were clustered using a state sequence analysis. RESULTS The results showed 1191 TTs for 287 individuals. The mean number of TTs per individual was 3.2. Risperidone, aripiprazole and haloperidol were the main treatments delivered. The frequencies of antipsychotics used differed between monotherapies and combination therapies. A three-cluster typology was identified: one cluster (n = 133) of 'less treated' younger individuals with fewer TTs and shorter TT durations; a second cluster (n = 53) of 'more treated' individuals with higher numbers of TTs and combinations of antipsychotics; and a third cluster (n = 103) of 'treatment-stable' older individuals with longer TT durations. CONCLUSIONS The results indicate that the median number of TTs during the 36 months before clozapine prescription was higher than the two recommended. The different trajectories were associated with individual characteristics and treatment differences, suggesting that additional studies of clinical parameters are needed to understand barriers to clozapine prescription.
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Affiliation(s)
- Edouard-Jules Laforgue
- CHU Nantes, Service de Pharmacologie Clinique, Nantes Université, Nantes, France
- CHU Nantes, INSERM, MethodS in Patient-Centered Outcomes and HEalth ResEarch, SPHERE, INSERM, Methods in Patient-Centered Outcomes and Health Research, SPHERE, Nantes Université, Univ Tours, Nantes, France
| | - Marion Istvan
- CHU Nantes, Service de Pharmacologie Clinique, Nantes Université, Nantes, France
- CHU Nantes, INSERM, MethodS in Patient-Centered Outcomes and HEalth ResEarch, SPHERE, INSERM, Methods in Patient-Centered Outcomes and Health Research, SPHERE, Nantes Université, Univ Tours, Nantes, France
| | - Anicet Chaslerie
- Medical Department, Regional Health Insurance Pays de la Loire, Nantes, France
| | - Pascal Artarit
- Medical Department, Regional Health Insurance Pays de la Loire, Nantes, France
| | - Geneviève Vallot
- Medical Department, Regional Health Insurance Pays de la Loire, Nantes, France
| | - Pascale Jolliet
- CHU Nantes, Service de Pharmacologie Clinique, Nantes Université, Nantes, France
- CHU Nantes, INSERM, MethodS in Patient-Centered Outcomes and HEalth ResEarch, SPHERE, INSERM, Methods in Patient-Centered Outcomes and Health Research, SPHERE, Nantes Université, Univ Tours, Nantes, France
| | - Marie Grall-Bronnec
- CHU Nantes, INSERM, MethodS in Patient-Centered Outcomes and HEalth ResEarch, SPHERE, INSERM, Methods in Patient-Centered Outcomes and Health Research, SPHERE, Nantes Université, Univ Tours, Nantes, France
- CHU Nantes, UIC Psychiatrie et Santé Mentale, Nantes Université, Nantes, France
| | - Caroline Victorri-Vigneau
- CHU Nantes, Service de Pharmacologie Clinique, Nantes Université, Nantes, France
- CHU Nantes, INSERM, MethodS in Patient-Centered Outcomes and HEalth ResEarch, SPHERE, INSERM, Methods in Patient-Centered Outcomes and Health Research, SPHERE, Nantes Université, Univ Tours, Nantes, France
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18
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Eder J, Simon MS, Glocker C, Musil R. [Weight gain and treatment with psychotropic drugs : Background and management]. DER NERVENARZT 2023; 94:859-869. [PMID: 37672085 DOI: 10.1007/s00115-023-01534-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/21/2023] [Indexed: 09/07/2023]
Abstract
Psychotropic drug-induced weight gain (PIWG) is a well-known and frequent side effect which is relevant for the prognosis of patients. Individual medications have varying risks for the occurrence of PIWG, and at the same time there are individual risk factors on the part of patients, such as age, gender, metabolic and genetic factors. As the metabolic changes in the context of PIWG result in increased mortality in the long term, it is important to prevent PIWG by appropriate prevention and to intervene in a targeted manner if PIWG has already occurred. Appropriate monitoring is therefore essential. This article provides an overview of underlying mechanisms, risk constellations and possible countermeasures.
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Affiliation(s)
- J Eder
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität (LMU) München, Nußbaumstraße 7, 80336, München, Deutschland
| | - M S Simon
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität (LMU) München, Nußbaumstraße 7, 80336, München, Deutschland
| | - C Glocker
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität (LMU) München, Nußbaumstraße 7, 80336, München, Deutschland.
| | - R Musil
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität (LMU) München, Nußbaumstraße 7, 80336, München, Deutschland
- Oberberg Fachklinik Bad Tölz, Bad Tölz, Deutschland
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Falkai P, Schwaiger R, Schmitt A, Röll L, Maurus I. Sports Therapy for Schizophrenia Psychoses: from the Idea to the Guideline. DAS GESUNDHEITSWESEN 2023; 85:S212-S217. [PMID: 37751760 DOI: 10.1055/a-2129-7421] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
Schizophrenia psychoses can be treated much better today due to the introduction of antipsychotics about 70 years ago in conjunction with the implementation of specific psychotherapies. However, current treatment options are still limited in the area of negative symptoms and disease-associated cognitive deficits. In the last 15 years, randomised controlled trials (RCTs) have been able to show that physical training and especially endurance training could represent a comprehensive complementary treatment approach and could lead to a significant improvement in positive, but especially also in negative symptoms and cognitive deficits. As a result, sports therapy for schizophrenia psychoses has found its way not only into the national treatment guidelines of the German Society for Psychiatry, Psychotherapy, Psychosomatics and Neurology (DGPPN), but also into European recommendations such as those of the European Psychiatric Association (EPA). With the introduction of the "Living guideline" format (here an update takes place at least once a year), a broader implementation in health care will be easier in the future. Based on a narrative review, this paper describes the process of implementing sports therapy for schizophrenia psychoses from its beginnings to its incorporation into guidelines and can be applied analogously to other forms of therapy.
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Affiliation(s)
- Peter Falkai
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
- Max Planck Institute of Psychiatry, Munich, Germany
| | - Rebecca Schwaiger
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
| | - Andrea Schmitt
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
- Laboratory of Neurosciences (LIM-27), Institute of Psychiatry, University of São Paulo (USP), São Paulo, Brazil
| | - Lukas Röll
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
| | - Isabel Maurus
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
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Berger SJ, Hofer A. [Safety aspects during treatment with clozapine: : Adverse effects, titration, and therapeutic drug monitoring - a narrative review]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2023; 37:122-129. [PMID: 37349671 PMCID: PMC10491532 DOI: 10.1007/s40211-023-00474-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 05/19/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND According to current guidelines, clozapine should be used as a third step in treatment resistant schizophrenia (TRS). In everyday clinical practice, however, it is frequently used at a much later stage, which leads to a significant deterioration of prognosis. The first part of this narrative overview focuses on the most frequent side effects of clozapine, on the relevance of slow titration, and on specific aspects of therapeutic drug monitoring (TDM). MATERIAL AND METHODS Medline, the Guideline for the use of clozapine 2013 of the Netherlands Clozapine Collaboration Group, and the S3 Guideline for Schizophrenia of the German Association for Psychiatry, Psychotherapy and Psychosomatics were searched for relevant literature, the last query dating from April 28th, 2023. RESULTS Despite its unique efficacy clozapine is underused in clinical practice and prescription varies between and within countries. Next to hematological, metabolic, and vegetative side effects, clozapine induced inflammation manifesting in the form of pneumonia or myocarditis, which is mainly associated with rapid titration, represents a major clinical challenge with CRP monitoring being of particular relevance. In this context, it also has to be noted that sex, smoking behavior, and ethnic origin impact clozapine metabolism, thus requiring personalized dosing. CONCLUSION Slow titration when possible, TDM, and CYP diagnostics when appropriate increase patient safety during treatment with clozapine and thus the likelihood of early prescription of this compound in TRS.
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Affiliation(s)
- Stefan J Berger
- Department für Psychiatrie, Psychotherapie, Psychosomatik und Medizinische Psychologie, Univ.-Klinik für Psychiatrie I, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich
| | - Alex Hofer
- Department für Psychiatrie, Psychotherapie, Psychosomatik und Medizinische Psychologie, Univ.-Klinik für Psychiatrie I, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich.
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21
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Sentissi O, Zosso G, Cogordon A, Chillà C. The effects of a group-based intervention through physical activities and dietary changes in young patients with severe psychiatric disorders: a pilot study. Front Sports Act Living 2023; 5:1197925. [PMID: 37674637 PMCID: PMC10478101 DOI: 10.3389/fspor.2023.1197925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/02/2023] [Indexed: 09/08/2023] Open
Abstract
Background and objectives The present study aims to investigate the effect of the 4-F (Fit, Fun, Feel, and Food) group-based program on physical, clinical, and biological outcomes in young patients suffering from severe psychiatric disorders. Methods A pilot study with a naturalistic design was conducted to investigate the effect of a group-based intervention on young patients. Results A descriptive analysis revealed that out of the 61 outpatients initially enrolled in the program, with a mean age of 26.9 years old (±6.1, 60% men), 71% were overweight or obese. Paired T-tests for the difference between T0 and T1 were used to evaluate the evolution of the outcomes. The 24 patients who completed the full program showed no significant decrease in weight or body composition. Despite the limitations, the main findings of this study were the significant improvement in muscular endurance and coordination (from T0 (M = 13.65, SD = ±1.93) compared to T1 (M = 12.49, SD = ±1.81), [t(20) = 3.072, p < 0.05] and the general increase in mental well-being from baseline to the end of the program according to the type of psychopathology [F(3,10) = 4.25, p < .05]. A slight modification in eating behavior, with a tendency towards a decrease in TFEQ hunger levels, was also noticed. The ANCOVA showed no difference in outcomes between the groups based on diagnosis. Conclusion Despite its limitations and the small sample size, this pilot study provides valuable insights, demonstrating the feasibility of the program and its positive impact on physical well-being and improved mental health in young patients with psychiatric disorders, sedentary behavior, and unhealthy lifestyles. These encouraging results warrant further research in controlled, larger population samples to deepen our understanding of the potential effects of such interventions.
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Affiliation(s)
- Othman Sentissi
- Adult Psychiatric Division, Ambulatory Psychiatric Centre (Cappi Jonction), University Hospitals of Geneva, Geneva, Switzerland
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Gabrielle Zosso
- Adult Psychiatric Division, Ambulatory Psychiatric Centre (Cappi Jonction), University Hospitals of Geneva, Geneva, Switzerland
| | - Anouck Cogordon
- Adult Psychiatric Division, Ambulatory Psychiatric Centre (Cappi Jonction), University Hospitals of Geneva, Geneva, Switzerland
| | - Chiara Chillà
- Adult Psychiatric Division, Ambulatory Psychiatric Centre (Cappi Jonction), University Hospitals of Geneva, Geneva, Switzerland
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22
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Chen WY, Chen PH, Pan CH, Su SS, Tsai SY, Chen CC, Kuo CJ. Clozapine and its protective effect on all-cause, natural, and suicide mortality in patients with schizophrenia: A nationwide cohort study in Taiwan. Schizophr Res 2023:S0920-9964(23)00240-2. [PMID: 37479588 DOI: 10.1016/j.schres.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 07/23/2023]
Abstract
AIM Clozapine is indicated as the last-line agent for the treatment of refractory schizophrenia due to its side effects. This study included an Asian schizophrenia population and investigated the effect of clozapine on the risks of all-cause, natural, and suicide mortality. METHODS This study included a large-scale schizophrenia inpatient cohort derived from the National Health Insurance Research Database from January 1, 2001, to December 31, 2019 (n = 43,025). Of them, we selected those who received clozapine (clozapine cohort, n = 5800). From those who never used clozapine, we selected two individuals for each patient in the clozapine cohort by matching by age, sex, and the year of the index date (ratio: 1:2, control cohort, n = 11,583). The clozapine and nonclozapine control cohorts together were defined as the study cohort (n = 17,383). Multivariate Cox proportional-hazards regression with a time-dependent model was performed to investigate the effect of individual antipsychotic agents on mortality. RESULTS All individual first-generation antipsychotics were not associated with mortality risk. However, most individual second-generation antipsychotics exerted protective effects against all-cause and natural mortality. Furthermore, only clozapine and risperidone were significantly associated with a low risk of suicide mortality. Only clozapine exhibited a dose-dependent relationship with all-cause, natural, and suicide mortality. CONCLUSIONS This study provides robust evidence supporting the strong protective effect of clozapine on all-cause, suicide, and natural mortality risks in an Asian population. Under close monitoring, clozapine use can be advantageous in patients with schizophrenia who are at a high risk of suicide.
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Affiliation(s)
- Wen-Yin Chen
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan; School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Pao-Huan Chen
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chun-Hung Pan
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan; Department of Psychology, National Chengchi University, Taipei, Taiwan
| | - Sheng-Siang Su
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Shang-Ying Tsai
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chiao-Chicy Chen
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan; Department of Psychiatry, Mackay Medical College, Taipei, Taiwan
| | - Chian-Jue Kuo
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan.
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23
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Meyer JM, Correll CU. Increased Metabolic Potential, Efficacy, and Safety of Emerging Treatments in Schizophrenia. CNS Drugs 2023; 37:545-570. [PMID: 37470979 PMCID: PMC10374807 DOI: 10.1007/s40263-023-01022-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 07/21/2023]
Abstract
Patients with schizophrenia experience a broad range of detrimental health outcomes resulting from illness severity, heterogeneity of disease, lifestyle behaviors, and adverse effects of antipsychotics. Because of these various factors, patients with schizophrenia have a much higher risk of cardiometabolic abnormalities than people without psychiatric illness. Although exposure to many antipsychotics increases cardiometabolic risk factors, mortality is higher in patients who are not treated versus those who are treated with antipsychotics. This indicates both direct and indirect benefits of adequately treated illness, as well as the need for beneficial medications that result in fewer cardiometabolic risk factors and comorbidities. The aim of the current narrative review was to outline the association between cardiometabolic dysfunction and schizophrenia, as well as discuss the confluence of factors that increase cardiometabolic risk in this patient population. An increased understanding of the pathophysiology of schizophrenia has guided discovery of novel treatments that do not directly target dopamine and that not only do not add, but may potentially minimize relevant cardiometabolic burden for these patients. Key discoveries that have advanced the understanding of the neural circuitry and pathophysiology of schizophrenia now provide possible pathways toward the development of new and effective treatments that may mitigate the risk of metabolic dysfunction in these patients. Novel targets and preclinical and clinical data on emerging treatments, such as glycine transport inhibitors, nicotinic and muscarinic receptor agonists, and trace amine-associated receptor-1 agonists, offer promise toward relevant therapeutic advancements. Numerous areas of investigation currently exist with the potential to considerably progress our knowledge and treatment of schizophrenia.
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Affiliation(s)
- Jonathan M Meyer
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
| | - Christoph U Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
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Southern J, Elliott P, Maidment I. What are patients' experiences of discontinuing clozapine and how does this impact their views on subsequent treatment? BMC Psychiatry 2023; 23:353. [PMID: 37217959 DOI: 10.1186/s12888-023-04851-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 05/07/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Discontinuing what is considered the most effective treatment for treatment-resistant schizophrenia may precipitate feelings of failure or a relapse of illness. Clozapine treatment is discontinued for a variety of reasons, including non-adherence, intolerance, or lack of efficacy. Patients' experiences of discontinuing the "best" treatment and the impact on perceptions of subsequent antipsychotic treatment are important in developing an understanding of the factors affecting people's treatment choices. This study is the first of its type, seeking to explore people's perspectives on clozapine discontinuation. METHOD Semi-structured interviews with sixteen patients who had received clozapine and discontinued treatment-thirteen males and three females, age range: thirty-two to seventy-eight years old-were audio-recorded and transcribed. A modified inductive approach to analysis, based on grounded theory, was taken to identify commonalities and differences in patients' perceptions. RESULTS The three main themes identified from participants' experiences were: (1) positive and negative effects of treatment; (2) feelings of agency, being the capacity to make decisions about treatment and act independently; (3) choice of treatment in the future. Participants exhibited agency in making choices about medication, including risking relapse, while attempting self-management of medication effects. Different participants perceived the same side effect as beneficial or intolerable. Variation in subsequent treatment choices was reported, with some participants favouring depot (long-acting) injections. A participant was frightened when not told about clozapine's side effects, which led to the participant not being engaged in future treatment decisions. Others, despite suffering serious adverse effects, retained positive perceptions of clozapine; they experienced despair at finding an effective alternative. CONCLUSIONS Experiences with clozapine discontinuation evoked powerful emotions and resulted in clozapine being the benchmark for other treatments. Knowledge, agency, and being in control were important to participants in relation to treatment. Personal perceptions of treatments or beliefs about illness could lead to non-adherence. People value the clinician listening to their experiences to better understand their perspective, enabling concerns about medication to be addressed through true shared decision making. TRIAL REGISTRATION NHS Health Research Authority and Health and Care Research Wales, IRAS Project ID 225753, Research Ethics Committee (REC) reference: 18/NW/0413, 25/06/2018.
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Affiliation(s)
- Jennifer Southern
- Aston University, Birmingham, B4 7ET, England.
- Cheshire and Wirral Partnership NHS Foundation Trust, Chester, CH2 1BQ, England.
| | - Phil Elliott
- Cheshire and Wirral Partnership NHS Foundation Trust, Chester, CH2 1BQ, England
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Markiewicz-Gospodarek A, Markiewicz R, Borowski B, Dobrowolska B, Łoza B. Self-Regulatory Neuronal Mechanisms and Long-Term Challenges in Schizophrenia Treatment. Brain Sci 2023; 13:brainsci13040651. [PMID: 37190616 DOI: 10.3390/brainsci13040651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/04/2023] [Accepted: 04/11/2023] [Indexed: 05/17/2023] Open
Abstract
Schizophrenia is a chronic and relapsing disorder that is characterized not only by delusions and hallucinations but also mainly by the progressive development of cognitive and social deficits. These deficits are related to impaired synaptic plasticity and impaired neurotransmission in the nervous system. Currently, technological innovations and medical advances make it possible to use various self-regulatory methods to improve impaired synaptic plasticity. To evaluate the therapeutic effect of various rehabilitation methods, we reviewed methods that modify synaptic plasticity and improve the cognitive and executive processes of patients with a diagnosis of schizophrenia. PubMed, Scopus, and Google Scholar bibliographic databases were searched with the keywords mentioned below. A total of 555 records were identified. Modern methods of schizophrenia therapy with neuroplastic potential, including neurofeedback, transcranial magnetic stimulation, transcranial direct current stimulation, vagus nerve stimulation, virtual reality therapy, and cognitive remediation therapy, were reviewed and analyzed. Since randomized controlled studies of long-term schizophrenia treatment do not exceed 2-3 years, and the pharmacological treatment itself has an incompletely estimated benefit-risk ratio, treatment methods based on other paradigms, including neuronal self-regulatory and neural plasticity mechanisms, should be considered. Methods available for monitoring neuroplastic effects in vivo (e.g., fMRI, neuropeptides in serum), as well as unfavorable parameters (e.g., features of the metabolic syndrome), enable individualized monitoring of the effectiveness of long-term treatment of schizophrenia.
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Affiliation(s)
| | - Renata Markiewicz
- Department of Neurology, Neurological and Psychiatric Nursing, Medical University of Lublin, 20-093 Lublin, Poland
| | - Bartosz Borowski
- Students Scientific Association at the Department of Human Anatomy, Medical University of Lublin, 20-090 Lublin, Poland
| | - Beata Dobrowolska
- Department of Holistic Care and Management in Nursing, Medical University of Lublin, 20-081 Lublin, Poland
| | - Bartosz Łoza
- Department of Psychiatry, Medical University of Warsaw, 02-091 Warsaw, Poland
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Wilkinson ST, Trujillo Diaz D, Rupp ZW, Kidambi A, Ramirez KL, Flores JM, Avila-Quintero VJ, Rhee TG, Olfson M, Bloch MH. Pharmacological and Somatic Treatment Effects on Suicide in Adults: A Systematic Review and Meta-Analysis. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:197-208. [PMID: 37201149 PMCID: PMC10172559 DOI: 10.1176/appi.focus.23021006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Background Suicide is a public health crisis. We conducted a systematic review and meta-analysis of the effects of psychopharmacologic and somatic therapies on suicide risk. Methods A systematic search of MEDLINE for studies evaluating the effects of pharmacologic (excluding antidepressants) or somatic interventions on suicide risk was conducted. Studies were included if they used a comparison group, reported on suicide death, assessed a psychopharmacological or somatic intervention, and included adults. Study quality was assessed using the Newcastle-Ottawa scale. Fifty-seven studies were included from 2940 reviewed citations. Results In bipolar disorder, lithium was associated with a reduction in the odds of suicide compared to active controls (odds ratio [OR] = .58, p = .005; k = 12) and compared to placebo/no lithium (OR = .46, p = .009; k = 9). In mixed diagnostic samples, lithium was associated with a reduction in the odds of suicide compared to placebo/no lithium (OR = .27, p < .001; k = 12), but not compared to active controls (OR = .89, p = .468; k = 7). In psychotic disorders, clozapine was associated with a reduction in the odds of suicide (OR = .46, p = .007; k = 7). Associations between suicide death and electroconvulsive therapy (OR = .77, p = .053; k = 11), non-clozapine antipsychotics in bipolar disorder (OR = .73, p = .090; k = 6) and antipsychotics in psychotic disorders (OR = .39, p = .069; k = 6) were not significant. There was no consistent relationship between antiepileptic mood stabilizers and suicide. There were insufficient studies to meta-analyze associations of suicide risk with vagus nerve stimulation, transcranial magnetic stimulation, magnetic seizure therapy, or transcranial direct current stimulation. Conclusion Lithium and clozapine have consistent data supporting protective effects against suicide in certain clinical contexts.Reprinted from Depress Anxiety 2022; 39:100-112, with permission from John Wiley and Sons. Copyright © 2022.
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Affiliation(s)
- Samuel T Wilkinson
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Ramirez, Flores, Rhee, Bloch); Interventional Psychiatric Service, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Bloch); Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA (Diaz, Kidambi, Ramirez, Avila-Quintero, Bloch); Family and Community Medicine, University of Kentucky College of Medicine, Hazard, Kentucky, USA (Rupp); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA (Olfson)
| | - Daniel Trujillo Diaz
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Ramirez, Flores, Rhee, Bloch); Interventional Psychiatric Service, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Bloch); Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA (Diaz, Kidambi, Ramirez, Avila-Quintero, Bloch); Family and Community Medicine, University of Kentucky College of Medicine, Hazard, Kentucky, USA (Rupp); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA (Olfson)
| | - Zachary W Rupp
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Ramirez, Flores, Rhee, Bloch); Interventional Psychiatric Service, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Bloch); Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA (Diaz, Kidambi, Ramirez, Avila-Quintero, Bloch); Family and Community Medicine, University of Kentucky College of Medicine, Hazard, Kentucky, USA (Rupp); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA (Olfson)
| | - Anubhav Kidambi
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Ramirez, Flores, Rhee, Bloch); Interventional Psychiatric Service, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Bloch); Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA (Diaz, Kidambi, Ramirez, Avila-Quintero, Bloch); Family and Community Medicine, University of Kentucky College of Medicine, Hazard, Kentucky, USA (Rupp); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA (Olfson)
| | - Karina L Ramirez
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Ramirez, Flores, Rhee, Bloch); Interventional Psychiatric Service, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Bloch); Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA (Diaz, Kidambi, Ramirez, Avila-Quintero, Bloch); Family and Community Medicine, University of Kentucky College of Medicine, Hazard, Kentucky, USA (Rupp); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA (Olfson)
| | - José M Flores
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Ramirez, Flores, Rhee, Bloch); Interventional Psychiatric Service, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Bloch); Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA (Diaz, Kidambi, Ramirez, Avila-Quintero, Bloch); Family and Community Medicine, University of Kentucky College of Medicine, Hazard, Kentucky, USA (Rupp); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA (Olfson)
| | - Victor J Avila-Quintero
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Ramirez, Flores, Rhee, Bloch); Interventional Psychiatric Service, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Bloch); Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA (Diaz, Kidambi, Ramirez, Avila-Quintero, Bloch); Family and Community Medicine, University of Kentucky College of Medicine, Hazard, Kentucky, USA (Rupp); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA (Olfson)
| | - T Greg Rhee
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Ramirez, Flores, Rhee, Bloch); Interventional Psychiatric Service, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Bloch); Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA (Diaz, Kidambi, Ramirez, Avila-Quintero, Bloch); Family and Community Medicine, University of Kentucky College of Medicine, Hazard, Kentucky, USA (Rupp); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA (Olfson)
| | - Mark Olfson
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Ramirez, Flores, Rhee, Bloch); Interventional Psychiatric Service, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Bloch); Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA (Diaz, Kidambi, Ramirez, Avila-Quintero, Bloch); Family and Community Medicine, University of Kentucky College of Medicine, Hazard, Kentucky, USA (Rupp); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA (Olfson)
| | - Michael H Bloch
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Ramirez, Flores, Rhee, Bloch); Interventional Psychiatric Service, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Bloch); Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA (Diaz, Kidambi, Ramirez, Avila-Quintero, Bloch); Family and Community Medicine, University of Kentucky College of Medicine, Hazard, Kentucky, USA (Rupp); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA (Olfson)
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Verdoux H, Quiles C, de Leon J. Risks and benefits of clozapine and lithium co-prescribing: A systematic review and expert recommendations. Schizophr Res 2023:S0920-9964(23)00126-3. [PMID: 37002013 DOI: 10.1016/j.schres.2023.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/16/2023] [Accepted: 03/17/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVES To identify the risks and benefits of clozapine‑lithium co-prescription. METHODS Articles published in English or French were identified with a MEDLINE, Web of Sciences and PsycINFO search, from inception through January 2023, using the term 'clozapine' in combination with 'lithium'. Data were synthesized narratively. RESULTS Of the 67 articles included in the review, more than half (n = 38, 56.7 %) were focused on clozapine-related blood dyscrasia. A body of evidence drawn from case reports and retrospective chart studies highlights the potential benefits of lithium prescription for clozapine-related neutropenia, since this strategy may avoid clozapine discontinuation or allow its rechallenge. The most documented adverse drug reactions (ADRs) associated with clozapine‑lithium co-prescription are neurotoxic events, which may be prevented or detected early by clinical, electroencephalographic and therapeutic drug monitoring. Causality assessment cannot be established for other reported ADRs occurring during clozapine‑lithium co-prescription. The benefits of the combined prescription on psychotic and/or mood symptoms are poorly documented. CONCLUSION The risks and benefits of clozapine‑lithium co-prescription require further exploration as the combination might significantly contribute to reducing underprescription or premature discontinuation of clozapine.
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Affiliation(s)
- Hélène Verdoux
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team pharmacoepidemiology, UMR 1219, F-33000 Bordeaux, France.
| | - Clélia Quiles
- Centre Hospitalier Charles Perrens, F-33000 Bordeaux, France
| | - Jose de Leon
- Mental Health Research Center at Eastern State Hospital, Lexington, KY, USA; Institute of Neurosciences, University of Granada, Granada, Spain; Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Apostol Hospital, University of the Basque Country, Vitoria, Spain; Psychiatry and Neurosciences Research Group (CTS-549), USA
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[Current aspects on the antipsychotic treatment of older people with schizophrenia spectrum disorders]. Z Gerontol Geriatr 2023; 56:107-112. [PMID: 36847861 DOI: 10.1007/s00391-023-02173-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND From a geriatric perspective, the use of antipsychotic drugs (AP) is associated with significant risks in addition to their known effects. These include unfavorable interactions with geriatric syndromes, such as immobility and risk of falling, and potentially increased mortality, at least in certain patient groups. With reference to this the current state of knowledge on treatment with AP in older people with schizophrenia spectrum disorders is summarized with a focus on the typical multimorbidity of geriatric patients. METHODS Narrative review with special consideration of guidelines and consensus papers from German speaking countries and a PubMed-supported literature search for current systematic reviews and meta-analyses. RESULTS Antipsychotic agents are an essential part of a comprehensive treatment concept for schizophrenia with well-documented evidence. In geriatric patients adaptations under gerontopharmacological aspects are necessary. A sufficient data basis for evidence-based recommendations for the treatment of multimorbid and frail geriatric patients does not exist. CONCLUSION An effective and as safe as possible treatment with AP requires a careful risk-benefit assessment, combined with an individual adaptation regarding the substance applied, dose and treatment duration in an interdisciplinary/multiprofessional context.
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Daniel P, Rajaree KM, Rudy L, Jafor S, Prasad S, Avanthika C, Jhaveri S. Myocarditis in patients on long-term antipsychotics -mechanism, management and recent updates. Heliyon 2023; 9:e13930. [PMID: 36923851 PMCID: PMC10008991 DOI: 10.1016/j.heliyon.2023.e13930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 12/17/2022] [Accepted: 02/15/2023] [Indexed: 02/25/2023] Open
Abstract
Objective Clozapine is the first atypical antipsychotic drug and was frequently cited as the most effective antipsychotic for treatment-resistant schizophrenia, but it is associated with a concert of significant cardiotoxic side effects. Clozapine-induced Myocarditis (CIM) is diagnosed based on the combination of clinical symptoms, laboratory investigations, radiological findings, and sometimes biopsy. The literature on CIM management and clinical consensus on the best course of action is mixed. Methodology An all-language literature search on Medline, Cochrane, Embase, and Google Scholar until April 2022. The following search strings and Medical Subject Heading (MeSH) terms were used: "CIM," "clozapine," "cardiotoxicity," and "myocarditis." We explored the literature on CIM for its pathophysiology, diagnosis, monitoring, and management. Results The clinical features of CIM may be highly variable, ranging from asymptomatic disease to fulminant heart failure, and cessation of medication was the mainstay treatment of CIM, followed by supportive therapy. Other antipsychotics have also been linked with cardiotoxic side effects. Conclusion Despite being the most effective antipsychotic, clozapine is associated with a cardiotoxic side effect. Current literature suggests that these antipsychotic-related cardiotoxic events impact the treatment selection for schizophrenia and other psychotic disorders, and they must be kept in mind while designing new treatment protocols in the future.
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Affiliation(s)
| | | | - Luna Rudy
- Gardner Neuroscience Institute, University of Cincinnati, Cincinnati, Ohio, USA
| | - Sadeque Jafor
- Al Mostaqbal Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Sakshi Prasad
- Faculty of Medicine, National Pirogov Memorial Medical University, 21018, Vinnytsya, Ukraine
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Hurley K, O’Brien S, Halleran C, Byrne D, Foley E, Cunningham J, Hoctor F, Sahm LJ. Metabolic Syndrome in Adults Receiving Clozapine; The Need for Pharmacist Support. PHARMACY 2023; 11:pharmacy11010023. [PMID: 36827661 PMCID: PMC9964454 DOI: 10.3390/pharmacy11010023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/20/2023] [Accepted: 01/21/2023] [Indexed: 01/27/2023] Open
Abstract
People who are diagnosed with treatment resistant schizophrenia (TRS) are likely to have clozapine as a therapeutic management option. There is a high prevalence of metabolic syndrome in patients receiving clozapine. To mitigate against this, monitoring of weight, waist circumference, lipid profile, glycated haemoglobin (HbA1c), fasting blood glucose (FBG) and blood pressure (BP) is recommended. The aims of this study were to examine the prevalence of metabolic syndrome and whether any variables were correlated with its development, and to highlight any opportunities for the pharmacist to offer support. This study was conducted in an urban hospital and its associated Clozapine Clinic in Cork, Ireland. A retrospective audit assessed the prevalence of metabolic syndrome using the International Diabetes Federation (IDF) criteria. Patients were eligible for inclusion if they were aged 18 years or more, registered with the Clozapine Clinic, and had the capacity to provide informed consent. All data were entered into Microsoft® Excel ® (Microsoft Corporation) and further statistical analysis was undertaken using R, t-tests, Fisher's Exact Test and Mann-Whitney U tests as appropriate, and p ≤ 0.05 was considered statistically significant. Of 145 patients (32% female; mean age (SD) 45.3 (±11.7) years; 86.2% living independently/in family home), nearly two thirds (n = 86, 59.3%) were diagnosed with metabolic syndrome. The mean age of participants with metabolic syndrome was 44.4 years (SD = 10.8), similar to the 46.6 years (SD = 12.8) for those without. Variables that were identified to be statistically significantly associated with metabolic syndrome included waist circumference, weight, triglycerides, high density lipoprotein-cholesterol (HDL-C), BP, FBG and HbA1c. The high incidence of metabolic syndrome in this patient population highlights the need for continued physical health monitoring of these patients to ameliorate the risk of developing metabolic syndrome.
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Affiliation(s)
- Kathleen Hurley
- Pharmacy Department, Mercy University Hospital, T12 WE28 Cork, Ireland
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, T12 K8AF Cork, Ireland
- North Lee Mental Health Services (NLMHS), T12 WE28 Cork, Ireland
| | - Sinead O’Brien
- St Mary’s Health Campus, St Mary’s Campus, Gurranabraher, T23 TH9D Cork, Ireland
| | - Ciaran Halleran
- Pharmacy Department, Mercy University Hospital, T12 WE28 Cork, Ireland
| | - Derina Byrne
- Pharmacy Department, Mercy University Hospital, T12 WE28 Cork, Ireland
| | - Erin Foley
- North Lee Mental Health Services (NLMHS), T12 WE28 Cork, Ireland
| | | | - Fionnuala Hoctor
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, T12 K8AF Cork, Ireland
| | - Laura J. Sahm
- Pharmacy Department, Mercy University Hospital, T12 WE28 Cork, Ireland
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, T12 K8AF Cork, Ireland
- Correspondence:
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Masdrakis VG, Baldwin DS. Prevention of suicide by clozapine in mental disorders: systematic review. Eur Neuropsychopharmacol 2023; 69:4-23. [PMID: 36640481 DOI: 10.1016/j.euroneuro.2022.12.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/21/2022] [Accepted: 12/27/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Previous research has investigated the efficacy of clozapine in reducing suicidality in patients with schizophrenia and schizoaffective disorder. We aimed to systematically review published evidence, including studies concerning clozapine administration to treat: (a) refractory suicidality in other mental disorders, including bipolar disorder and borderline and other personality disorders; and (b) refractory cases of non-suicidal self-injury. METHOD We performed a PUBMED-search (last day: July 17, 2022) of English-language studies, combining the keywords "clozapine", "suicidality", and "suicide" with various psychopathological terms (e.g. "schizophrenia"). All duplications were eliminated. RESULTS Fifty-one studies were eligible for inclusion in the review. Most studies suggest a superior anti-suicide effect of clozapine in schizophrenia/schizoaffective disorder, compared to other antipsychotics, or no antipsychotic therapy, which is not due to the close monitoring of patients for blood dyscrasias. No consensus exists as to whether other antipsychotic drugs share this effect. Discontinuation of clozapine is associated with increases in suicidality. Reductions in refractory suicidality/NSSI are observed in clozapine-treated patients with bipolar disorder or borderline personality disorder, but the evidence is limited. Potential biological underpinnings of the anti-suicide effect of clozapine include its unique profile of modulation of brain neurotransmitters; its non-selectivity for neurotransmitter receptors; specific genetic and hormonal factors; effects on neuroinflammation; and ability to elicit epileptiform activity. CONCLUSION The superior anti-suicide effect of clozapine in schizophrenia/schizoaffective disorder patients is well established. It may have a role in severe and refractory cases of suicidality and non-suicidal self-injury in patients with bipolar disorder or borderline personality disorder, but the level and quality of supporting evidence is limited.
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Affiliation(s)
- Vasilios G Masdrakis
- National and Kapodistrian University of Athens, School of Medicine, First Department of Psychiatry, Eginition Hospital, 74 Vas. Sofias Avenue, 11528 Athens, Greece
| | - David S Baldwin
- University Department of Psychiatry, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, United Kingdom; University Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
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Russo M, Ignjatovic-Ristic D, Cohen D, Arenliu A, Bajraktarov S, Dzubur Kulenovic A, Injac Stevovic L, Maric N, Novotni A, Jovanovic N. Clozapine prescription rates in Southeast Europe: A cross-sectional study. Front Psychiatry 2023; 14:1123246. [PMID: 37113539 PMCID: PMC10126685 DOI: 10.3389/fpsyt.2023.1123246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 01/25/2023] [Indexed: 04/29/2023] Open
Abstract
Introduction International reports indicate that clozapine is under prescribed. Yet, this has not been explored in Southeast European (SEE) countries. This cross-sectional study investigates clozapine prescription rates in a sample of 401 outpatients with psychosis from Bosnia and Herzegovina, Kosovo by United Nations resolution, North Macedonia, Montenegro and Serbia. Methods Descriptive analysis was used to explore clozapine prescription rates; daily antipsychotic dosage was calculated and converted into olanzapine equivalents. Patients receiving clozapine were compared to those not receiving clozapine; next those that were on clozapine monotherapy were compared to those who were on clozapine polytherapy regime. Results It was showed that clozapine was prescribed to 37.7% of patients (with cross-country variation: from 25% in North Macedonia to 43.8% in Montenegro), with average dose of 130.7 mg/daily. The majority of patients on clozapine (70.5%) were prescribed at least one more antipsychotic (the most frequent combination was with haloperidol). Discussion Our findings suggested that clozapine prescription rate in SEE outpatients is higher than in Western Europe. The average dose is significantly below the optimal therapeutic dosage recommended by clinical guidelines, and clozapine polytherapy is common. This might indicate that clozapine is prescribed mainly for its sedative effect rather than antipsychotic. We hope that this finding will be taken up by relevant stakeholders to address this non-evidence-based practice.
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Affiliation(s)
- Manuela Russo
- Unit for Social and Community Psychiatry, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
- Centre for Implementation Science, Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- *Correspondence: Manuela Russo,
| | | | - Dan Cohen
- MHO North-Holland North, Heerhugowaard, Netherlands
| | - Aliriza Arenliu
- Department of Psychology, University of Pristina, Pristina, Kosovo by United Nations Resolution
| | | | | | | | - Nadja Maric
- Faculty of Medicine, Institute of Mental Health, University of Belgrade, Belgrade, Serbia
| | - Antoni Novotni
- University Clinic of Psychiatry, Skopje, North Macedonia
| | - Nikolina Jovanovic
- Unit for Social and Community Psychiatry, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
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Behavioral Health Emergencies. PHYSICIAN ASSISTANT CLINICS 2023. [DOI: 10.1016/j.cpha.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Could psychedelic drugs have a role in the treatment of schizophrenia? Rationale and strategy for safe implementation. Mol Psychiatry 2023; 28:44-58. [PMID: 36280752 DOI: 10.1038/s41380-022-01832-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 10/02/2022] [Accepted: 10/07/2022] [Indexed: 01/07/2023]
Abstract
Schizophrenia is a widespread psychiatric disorder that affects 0.5-1.0% of the world's population and induces significant, long-term disability that exacts high personal and societal cost. Negative symptoms, which respond poorly to available antipsychotic drugs, are the primary cause of this disability. Association of negative symptoms with cortical atrophy and cell loss is widely reported. Psychedelic drugs are undergoing a significant renaissance in psychiatric disorders with efficacy reported in several conditions including depression, in individuals facing terminal cancer, posttraumatic stress disorder, and addiction. There is considerable evidence from preclinical studies and some support from human studies that psychedelics enhance neuroplasticity. In this Perspective, we consider the possibility that psychedelic drugs could have a role in treating cortical atrophy and cell loss in schizophrenia, and ameliorating the negative symptoms associated with these pathological manifestations. The foremost concern in treating schizophrenia patients with psychedelic drugs is induction or exacerbation of psychosis. We consider several strategies that could be implemented to mitigate the danger of psychotogenic effects and allow treatment of schizophrenia patients with psychedelics to be implemented. These include use of non-hallucinogenic derivatives, which are currently the focus of intense study, implementation of sub-psychedelic or microdosing, harnessing of entourage effects in extracts of psychedelic mushrooms, and blocking 5-HT2A receptor-mediated hallucinogenic effects. Preclinical studies that employ appropriate animal models are a prerequisite and clinical studies will need to be carefully designed on the basis of preclinical and translational data. Careful research in this area could significantly impact the treatment of one of the most severe and socially debilitating psychiatric disorders and open an exciting new frontier in psychopharmacology.
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Correll CU, Bitter I, Hoti F, Mehtälä J, Wooller A, Pungor K, Tiihonen J. Factors and their weight in reducing life expectancy in schizophrenia. Schizophr Res 2022; 250:67-75. [PMID: 36368280 DOI: 10.1016/j.schres.2022.10.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 09/07/2022] [Accepted: 10/30/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Schizophrenia is associated with a wide range of socioeconomic and health-related problems, as well as 10-25 potential life-years lost. While lifestyle choices, comorbidities, and choice of medication are associated with schizophrenia disease burden and mortality, real-world evidence on the impact of these factors on expected life-years among patients with schizophrenia is limited. METHODS In this study, register-based, nationwide data from patients with schizophrenia in Finland during 1972-2015 were analysed to determine influential factors associated with mortality and to demonstrate their impact on expected life-years in patients with schizophrenia. RESULTS Factors reducing all-cause mortality were use of antipsychotics: HR 0.46 (95 % CI: 0.45, 0.47), ever use of lipid-modifying agents: HR 0.71 (95 % CI 0.68, 0.73), antidepressants HR 0.87 (95 % CI 0.85, 0.90), and lithium HR 0.90 (95 % CI 0.86, 0.95). Factors increasing all-cause mortality were cardiovascular disease: HR 2.41 (95 % CI: 2.34, 2.49), liver disease: HR 1.98 (95 % CI: 1.78, 2.21), renal disease: HR 1.63 (95 % CI:1.56, 1.70), diabetes: HR 1.40 (95 % C:1.35, 1.45), history of switching antipsychotics: HR 1.39 (95 % CI: 1.35, 1.44), longer duration of previous hospitalisations HR 1.96 (95 % CI: 1.90, 2.02), history of substance abuse HR 1.38 (95 % CI: 1.30, 1.46), and ever use of benzodiazepines HR 1.12 (95 % CI: 1.09, 1.16). CONCLUSIONS The results from this study could serve to motivate clinicians to support and encourage patients to adhere to antipsychotic treatment and achieve a healthier lifestyle, which could, in turn, increase the expected life-years of patients with schizophrenia.
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Affiliation(s)
- Christoph U Correll
- 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; Charité Universitätsmedizin Berlin, Department of Child and Adolescent Psychiatry, Berlin, Germany.
| | - István Bitter
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | | | | | | | - Katalin Pungor
- Janssen-Cilag, Medical Affairs EMEA, Dusseldorf, Germany
| | - Jari Tiihonen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland; Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden; Neuroscience Center, Helsinki, Finland
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Mortality in Schizophrenia-Spectrum Disorders: Recent Advances in Understanding and Management. Healthcare (Basel) 2022; 10:healthcare10122366. [PMID: 36553890 PMCID: PMC9777663 DOI: 10.3390/healthcare10122366] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022] Open
Abstract
Schizophrenia is a life-shortening disease and life expectancy in patients may be 15-20 years shorter than in the general population, with increasing longevity gap over time. Premature mortality in schizophrenia-spectrum disorders is mainly due to preventable natural causes, such as cardio-vascular disease, infections, respiratory tract diseases and cancer, alongside suicide, homicide and accidents. There is a complex interplay of factors that act synergistically and cause physical morbidity to patients and subsequent mortality. Smoking, alcohol/substance abuse and sedentary life style, alongside disease-related factors, such as metabolic abnormalities and accelerating aging contribute to physical morbidity. Moreover, the symptomatology of psychosis and stigma may limit patients' access to quality medical care. Interventions to promote physical health in those patients should be multifaceted, and should target all patient-related modifiable factors, but also should address service-related healthcare disparities. Long-term antipsychotic use (including clozapine and long-acting injectables) is associated with substantially decreased all-cause mortality, including suicide and cardiovascular mortality, in patients with schizophrenia despite the well-known cardiometabolic adverse effects of second-generation agents. Integrated care may involve co-location of physical and mental health services, liaison services, shared protocols and information sharing systems, and has emerged as a way to address the physical health needs of those patients. Interventions to address mortality in schizophrenia and related syndromes should take place as early as possible in the course of the patients' treatment, and could be an integral component of care delivered by specialized early intervention services.
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Antipsychotic drug prescription sequence analysis in relation to death occurrence and cardiometabolic drug usage: A retrospective longitudinal study. THE EUROPEAN JOURNAL OF PSYCHIATRY 2022. [DOI: 10.1016/j.ejpsy.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Thornicroft G, Sunkel C, Alikhon Aliev A, Baker S, Brohan E, El Chammay R, Davies K, Demissie M, Duncan J, Fekadu W, Gronholm PC, Guerrero Z, Gurung D, Habtamu K, Hanlon C, Heim E, Henderson C, Hijazi Z, Hoffman C, Hosny N, Huang FX, Kline S, Kohrt BA, Lempp H, Li J, London E, Ma N, Mak WWS, Makhmud A, Maulik PK, Milenova M, Morales Cano G, Ouali U, Parry S, Rangaswamy T, Rüsch N, Sabri T, Sartorius N, Schulze M, Stuart H, Taylor Salisbury T, Vera San Juan N, Votruba N, Winkler P. The Lancet Commission on ending stigma and discrimination in mental health. Lancet 2022; 400:1438-1480. [PMID: 36223799 DOI: 10.1016/s0140-6736(22)01470-2] [Citation(s) in RCA: 105] [Impact Index Per Article: 52.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 07/19/2022] [Accepted: 07/28/2022] [Indexed: 02/07/2023]
Affiliation(s)
- Graham Thornicroft
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK; Centre for Implementation Science, King's College London, London UK.
| | | | - Akmal Alikhon Aliev
- National Institute of Mental Health (Czechia), WHO Collaborating Centre for Public Mental Health Research and Service Development, Klecany, Czechia
| | - Sue Baker
- Mind international, London, UK; Changing Minds Globally, London, UK
| | - Elaine Brohan
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK
| | | | - Kelly Davies
- Centre for Implementation Science, King's College London, London UK
| | - Mekdes Demissie
- College of Health Sciences and Medicine, School of Nursing and Midwifery, Haramaya University, Ethiopia; Centre for Innovative Drug Development and Therapeutic Studies for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Ethiopia
| | | | - Wubalem Fekadu
- Department of Psychiatry, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Petra C Gronholm
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK; Centre for Implementation Science, King's College London, London UK
| | - Zoe Guerrero
- National Institute of Mental Health (Czechia), WHO Collaborating Centre for Public Mental Health Research and Service Development, Klecany, Czechia
| | - Dristy Gurung
- Centre for Implementation Science, King's College London, London UK; Transcultural Psychosocial Organization (TPO), Kathmandu Nepal
| | - Kassahun Habtamu
- Addis Ababa University, School of Psychology, Addis Ababa, Ethiopia
| | - Charlotte Hanlon
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK; WHO Collaborating Centre for Mental Health Research and Training, King's College London, London UK; Department of Psychiatry, School of Medicine, College of Health Sciences Addis Ababa University, Addis Ababa, Ethiopia
| | - Eva Heim
- Institut de Psychologie, University of Lausanne, Lausanne, Switzerland
| | - Claire Henderson
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK
| | | | | | - Nadine Hosny
- Institut de Psychologie, University of Lausanne, Lausanne, Switzerland
| | | | | | - Brandon A Kohrt
- Division of Global Mental Health, George Washington University, Washington DC, USA
| | - Heidi Lempp
- Institute of Psychiatry, Psychology and Neuroscience, and Academic Department of Rheumatology, King's College London, London UK
| | - Jie Li
- Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | | | - Ning Ma
- Institute of Mental Health, Peking University, Beijing, China
| | - Winnie W S Mak
- Department of Psychology, Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Akerke Makhmud
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK; Centre for Implementation Science, King's College London, London UK
| | - Pallab K Maulik
- George Institute for Global Health, New Delhi, India; University of New South Wales, Sydney, NSW, Australia
| | - Maria Milenova
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK; Centre for Implementation Science, King's College London, London UK
| | | | - Uta Ouali
- Razi Hospital and El Manar Medical School, University of Tunis, La Manouba, Tunisia
| | - Sarah Parry
- South London and the Maudsley NHS Foundation Trust, London, UK
| | | | - Nicolas Rüsch
- Department of Psychiatry II, Ulm University and BKH Günzburg, Ulm, Germany; Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Bezirkskrankenhaus Günzburg, Günzburg, Germany
| | - Taha Sabri
- Taskeen Health Initiative, Karachi, Pakistan
| | - Norman Sartorius
- Association for the Improvement of Mental health Programs, Geneva, Switzerland
| | | | | | - Tatiana Taylor Salisbury
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK
| | - Norha Vera San Juan
- Health Service and Population Research Department, King's College London, London UK
| | - Nicole Votruba
- and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Petr Winkler
- National Institute of Mental Health (Czechia), WHO Collaborating Centre for Public Mental Health Research and Service Development, Klecany, Czechia
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Suh SB, Lee N, Kim J, Kim S, Jang S, Park JK, Lee K, Choi SY, Kwon HJ, Lee CH. Metformin ameliorates olanzapine-induced obesity and glucose intolerance by regulating hypothalamic inflammation and microglial activation in female mice. Front Pharmacol 2022; 13:906717. [PMID: 36313357 PMCID: PMC9596779 DOI: 10.3389/fphar.2022.906717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 09/26/2022] [Indexed: 11/16/2022] Open
Abstract
Olanzapine (OLZ), a widely used second-generation antipsychotic drug, is known to cause metabolic side effects, including diabetes and obesity. Interestingly, OLZ-induced metabolic side effects have been demonstrated to be more profound in females in human studies and animal models. Metformin (MET) is often used as a medication for the metabolic side effects of OLZ. However, the mechanisms underlying OLZ-induced metabolic disturbances and their treatment remain unclear. Recent evidence has suggested that hypothalamic inflammation is a key component of the pathophysiology of metabolic disorders. On this background, we conducted this study with the following three objectives: 1) to investigate whether OLZ can independently induce hypothalamic microgliosis; 2) to examine whether there are sex-dependent differences in OLZ-induced hypothalamic microgliosis; and 3) to examine whether MET affects hypothalamic microgliosis. We found that administration of OLZ for 5 days induced systemic glucose intolerance and hypothalamic microgliosis and inflammation. Of note, both hypothalamic microglial activation and systemic glucose intolerance were far more evident in female mice than in male mice. The administration of MET attenuated hypothalamic microglial activation and prevented OLZ-induced systemic glucose intolerance and hypothalamic leptin resistance. Minocycline, a tetracycline derivative that prevents microgliosis, showed similar results when centrally injected. Our findings reveal that OLZ induces metabolic disorders by causing hypothalamic inflammation and that this inflammation is alleviated by MET administration.
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Affiliation(s)
- Sang Bum Suh
- University of Ulsan College of Medicine, Seoul, South Korea
| | - Nayoung Lee
- Department of Biomedical Science, Hallym University, Chuncheon, South Korea
| | - Jaedeok Kim
- Department of Biomedical Science, Hallym University, Chuncheon, South Korea
| | - Saeha Kim
- Department of Biomedical Science, Hallym University, Chuncheon, South Korea
| | - Sooyeon Jang
- Department of Biomedical Science, Hallym University, Chuncheon, South Korea
| | - Jong Kook Park
- Department of Biomedical Science, Hallym University, Chuncheon, South Korea
| | - Keunwook Lee
- Department of Biomedical Science, Hallym University, Chuncheon, South Korea
| | - Soo Young Choi
- Department of Biomedical Science, Hallym University, Chuncheon, South Korea
| | - Hyung-Joo Kwon
- Department of Microbiology, College of Medicine, Hallym University, Chuncheon, South Korea
| | - Chan Hee Lee
- Department of Biomedical Science, Hallym University, Chuncheon, South Korea
- Program of Material Science for Medicine and Pharmaceutics, Hallym University, Chuncheon, South Korea
- *Correspondence: Chan Hee Lee,
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Kitchen D, Till A, Xavier P. Routine clozapine assay monitoring to improve the management of treatment-resistant schizophrenia. BJPsych Bull 2022; 46:267-270. [PMID: 33910673 PMCID: PMC9768514 DOI: 10.1192/bjb.2021.36] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
AIMS AND METHOD Routine therapeutic drug monitoring in clozapine therapy has previously not been considered justifiable. Using observational data, the clinical utility of annual clozapine assay monitoring is explored within a large mental health trust. RESULTS After the introduction of routine monitoring, the rate of clozapine assays rose to 2.3 per patient per year, with a consistent reduction in high-risk clozapine assays (<0.1 mg/L or >1.0 mg/L or any result more than 24 months old). High-risk assays are associated with a mortality rate of 31.6 deaths per 1000 patients, more than twice that of those within the target range (0.35-0.60 mg/L and conducted within the past 12 months) (P = 0.048). CLINICAL IMPLICATIONS Routine clozapine assay monitoring has significant clinical utility. Our simple but targeted approach can be readily implemented to reduce the number of patients with high-risk clozapine assay levels, potentially reduce all-cause mortality and provide optimal treatment for those with treatment-resistant schizophrenia.
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Affiliation(s)
- David Kitchen
- Mersey Care NHS Foundation Trust, Liverpool, UK.,Mersey Internal Audit Agency, Liverpool, UK
| | - Alex Till
- Health Education England (North West), Liverpool, UK
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Torii-Goto A, Yoshimi A, Tashiro Y, Ukigai M, Matsumoto A, Ozaki N, Noda Y. A Reactive Metabolite of Clozapine Induces Hematopoietic Toxicity in HL-60 Cells Undergoing Granulocytic Differentiation through Its Effect on Glutathione Metabolism. Biol Pharm Bull 2022; 45:1232-1237. [DOI: 10.1248/bpb.b22-00045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Aya Torii-Goto
- Division of Clinical Sciences and Neuropsychopharmacology, Faculty and Graduate School of Pharmacy, Meijo University
| | - Akira Yoshimi
- Department of Psychiatry, Nagoya University Graduate School of Medicine
| | - Yuko Tashiro
- Division of Clinical Sciences and Neuropsychopharmacology, Faculty and Graduate School of Pharmacy, Meijo University
| | - Mako Ukigai
- Division of Clinical Sciences and Neuropsychopharmacology, Faculty and Graduate School of Pharmacy, Meijo University
| | - Aoi Matsumoto
- Division of Clinical Sciences and Neuropsychopharmacology, Faculty and Graduate School of Pharmacy, Meijo University
| | - Norio Ozaki
- Department of Psychiatry, Nagoya University Graduate School of Medicine
| | - Yukihiro Noda
- Division of Clinical Sciences and Neuropsychopharmacology, Faculty and Graduate School of Pharmacy, Meijo University
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Joe P, Clemente JC, Piras E, Wallach DS, Robinson-Papp J, Boka E, Remsen B, Bonner M, Kimhy D, Goetz D, Hoffman K, Lee J, Ruby E, Fendrich S, Gonen O, Malaspina D. An integrative study of the microbiome gut-brain-axis and hippocampal inflammation in psychosis: Persistent effects from mode of birth. Schizophr Res 2022; 247:101-115. [PMID: 34625336 PMCID: PMC8980116 DOI: 10.1016/j.schres.2021.09.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/17/2021] [Accepted: 09/20/2021] [Indexed: 12/20/2022]
Abstract
The mechanism producing psychosis appears to include hippocampal inflammation, which could be associated with the microbiome-gut-brain-axis (MGBS). To test this hypothesis we are conducting a multidisciplinary study, herein described. The procedures are illustrated with testing of a single subject and group level information on the impact of C-section birth are presented. METHOD Study subjects undergo research diagnostic interviews and symptom assessments to be categorized into one of 3 study groups: psychosis, nonpsychotic affective disorder or healthy control. Hippocampal volume and metabolite concentrations are assessed using 3-dimensional, multi-voxel H1 Magnetic Resonance Imaging (MRSI) encompassing all gray matter in the entire hippocampal volume. Rich self-report information is obtained with the PROMIS interview, which was developed by the NIH Commons for research in chronic conditions. Early trauma is assessed and cognition is quantitated using the MATRICS. The method also includes the most comprehensive autonomic nervous system (ANS) battery used to date in psychiatric research. Stool and oral samples are obtained for microbiome assessments and cytokines and other substances are measured in blood samples. RESULTS Group level preliminary data shows that C-section birth is associated with higher concentrations of GLX, a glutamate related hippocampal neurotransmitter in psychotic cases, worse symptoms in affective disorder cases and smaller hippocampal volume in controls. CONCLUSION Mode of birth appears to have persistent influences through adulthood. The methodology described for this study will define pathways through which the MGBA may influence the risk for psychiatric disorders.
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Affiliation(s)
- Peter Joe
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA.
| | - Jose C Clemente
- Icahn School of Medicine at Mount Sinai, Department of Genetics and Genomic Sciences, New York, NY, USA
| | - Enrica Piras
- Icahn School of Medicine at Mount Sinai, Department of Genetics and Genomic Sciences, New York, NY, USA
| | - David S Wallach
- Icahn School of Medicine at Mount Sinai, Department of Genetics and Genomic Sciences, New York, NY, USA
| | | | - Emeka Boka
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA
| | - Brooke Remsen
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA; Icahn School of Medicine at Mount Sinai, Department of Genetics and Genomic Sciences, New York, NY, USA
| | - Mharisi Bonner
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA
| | - David Kimhy
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA
| | - Deborah Goetz
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA
| | - Kevin Hoffman
- Perelman School of Medicine, University of Pennsylvania, Department of Psychiatry, Philadelphia, PA, USA
| | - Jakleen Lee
- Icahn School of Medicine at Mount Sinai, Department of Genetics and Genomic Sciences, New York, NY, USA
| | - Eugene Ruby
- University of California, Los Angeles, Department of Psychology, Los Angeles, CA, USA
| | - Sarah Fendrich
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA; Perelman School of Medicine, University of Pennsylvania, Center for Health Care Incentives & Behavioral Economics, Philadelphia, PA, USA
| | - Oded Gonen
- NYU Langone Medical Center, Department of Radiology, New York, NY, USA
| | - Dolores Malaspina
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA
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43
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de Boer N, Cahn W. Antipsychotic-induced weight gain: Is the weight over? New guidelines needed. Acta Psychiatr Scand 2022; 146:185-189. [PMID: 35951775 DOI: 10.1111/acps.13485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Nini de Boer
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Wiepke Cahn
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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Kim G, Rim SJ, Jo M, Lee MG, Park SJ, Park S. The Cumulative Effect of Antipsychotic Usage on Mortality in Schizophrenia: A Nationwide Population-based Cohort Study in Korea. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2022; 20:573-577. [PMID: 35879042 PMCID: PMC9329102 DOI: 10.9758/cpn.2022.20.3.573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/21/2022] [Accepted: 04/10/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Gyurin Kim
- Department of Research Planning, Seoul, Korea
| | | | - Minkyung Jo
- Department of Research Planning, Seoul, Korea
| | - Min Geu Lee
- Department of Research Planning, Seoul, Korea
| | - Se Jin Park
- Department of Research Planning, Seoul, Korea
| | - Subin Park
- Mental Health Research Institute, National Center for Mental Health, Seoul, Korea
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45
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Meepring S, Gray R, Li Y, Ho G, Chien WT, Bressington D. Cardiometabolic health risks, lifestyle behaviours and quality of life in people diagnosed with early psychosis - A cross-sectional study. J Psychiatr Ment Health Nurs 2022; 29:578-591. [PMID: 34854171 DOI: 10.1111/jpm.12809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/11/2021] [Accepted: 11/26/2021] [Indexed: 12/27/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: People diagnosed with schizophrenia have poor cardiometabolic health, with elevated 10-year cardiovascular disease risk (CVD-R) scores and low quality of life (QOL). There is a lack of understanding about CVD-R scores in people diagnosed with early psychosis and no studies have quantified CVD-R using the QRISK® 3 calculator in this client group. Establishing potential relationships between modifiable lifestyle behaviours/treatment characteristics with CVD-R or QOL may identify targets for early intervention. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This is the first study to quantify the individual 10-year CVD-R of people diagnosed with early psychosis utilising the QRISK® 3 calculator. This is also the first study to investigate relationships between QOL and CVD-R and lifestyle factors in a cohort of Thai people diagnosed with early psychosis. We observed low levels of physical health-related QOL and high levels of CVR-R despite participants reporting relatively positive lifestyle behaviours. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The cardiometabolic health state of this client group warrants as much attention as for those with an enduring severe mental illness; early preventative interventions are warranted. It may be useful to routinely quantify the CVD-R of people diagnosed with early psychosis using the QRISK® 3 calculator, even in the absence of immediate concerns about lifestyle behaviours. Mental health nurses should utilise evidence-based approaches such as increasing activity levels, dietary counselling and behaviour change interventions to mitigate poor physical health in this client group. ABSTRACT: Introduction People diagnosed with schizophrenia have poor cardiometabolic health, with elevated 10-year cardiovascular disease risk (CVD-R) scores and poor quality of life (QOL). There is lack of understanding of these issues in early psychosis. Aims To quantify CVD-R in people diagnosed with early psychosis and profile their obesity prevalence, lifestyle behaviours and QOL. Secondary aim was to explore associations between lifestyle behaviours/treatment characteristics and CVD-R/QOL. Method Baseline data from 81 RCT participants were used to profile cardiometabolic health risks (QRISK® 3, BMI and waist circumference). Participants self-reported lifestyle behaviours and QOL. Relationships between modifiable treatment/lifestyle factors and QOL/CVD-R were explored. Results Participants' relative risk for CVD over 10 years was 1.93 times higher than healthy counterparts; 39% also had an obese BMI and physical QOL was poor. No significant associations were observed between CVD-R or QOL with treatment characteristics and lifestyle factors. Discussion Despite positive lifestyle behaviours, participants had elevated CVD-R scores and poor physical health-related QOL. Quantifying CVD-R with QRISK® 3 may highlight the need for health promotion interventions. Implications for practice Mental health professionals should be aware that elevated CVD-R exists in the context of relatively healthy lifestyle behaviours and utilise evidence-based interventions to address these issues.
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Affiliation(s)
| | - Richard Gray
- La Trobe University, Melbourne, Victoria, Australia
| | - Yan Li
- The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Grace Ho
- The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Wai-Tong Chien
- The Chinese University of Hong Kong, Hong Kong, Hong Kong
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Miyamoto S, Ntege EH, Chinen Y, Goto T, Shirakawa J, Goto S, Kawano T, Shimizu Y, Nakanishi K, Nakamura H. An unusual case of oral surgical management in a patient with isovaleric acidemia and schizophrenia: A case report. Biomed Rep 2022; 17:64. [PMID: 35815189 PMCID: PMC9260163 DOI: 10.3892/br.2022.1547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/09/2022] [Indexed: 11/06/2022] Open
Abstract
Oral/dental surgical care in patients with chronic medical comorbidities, such as isovaleric acidemia (IVA), can be challenging. In addition to technical complications, different comorbidities also present a complex range of concerning factors/challenges, which can increase the incidence of morbidity and mortality associated with surgery. IVA, a congenital error of metabolism, is a rare organic acidemia with a predisposition towards acute acidosis and life-threatening metabolic decompensation during stressful conditions, such as prolonged fasting and surgery. In addition, schizophrenia, a major neurological disorder, can result in manifestation of severe dental or periodontal conditions, including pericoronitis. The condition is associated with significant risk factors of postoperative complications, such as dangerous behaviors and adverse interactions between antipsychotic drugs and anesthetic agents. A case of comorbid dental disease with two coexisting chronic and life-threatening medical conditions, one of which is rare, is an unusual encounter in oral/dental surgery that is seldomly published. Moreover, implementing a safe and effective surgical intervention in such patients requires several informed considerations. However, only a few reported experiences or guidelines exist, reporting appropriate perioperative management strategies to minimize risks. Hence, in this case report, our experience of managing one of these rare encounters of a 20-year-old man who suffered from bilaterally partially erupted third molars, associated with chronic pericoronitis and dental caries of both the maxilla wisdom teeth with coexisting IVA and schizophrenia comorbidities is described. Additionally, the presentation and anticipated complications of the comorbid disorders of the patient are briefly reviewed. In this case, the pericoronitis and dental caries were treated by surgically removing the impacted third molars and the antagonist maxilla wisdom teeth under regional anesthesia and application of antibiotics for 3 days. The patient recovered without any postoperative complications after 1 year of follow-up.
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Affiliation(s)
- Sho Miyamoto
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Edward Hose Ntege
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Yasutsugu Chinen
- Department of Child Health and Welfare (Pediatrics), Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Takahiro Goto
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Jumpei Shirakawa
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Shimpei Goto
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Toshihiro Kawano
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Yusuke Shimizu
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Koichi Nakanishi
- Department of Child Health and Welfare (Pediatrics), Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Hiroyuki Nakamura
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
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47
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Hung SK, Kou HW, Wu KH, Chen SY, Li CH, Lee CW, Hung YY, Gao SY, Wu PH, Hsieh CH, Chaou CH. Does medical disparity exist while treating severe mental illness patients with acute appendicitis in emergency departments? A real-world database study. BMC Psychiatry 2022; 22:488. [PMID: 35864481 PMCID: PMC9306199 DOI: 10.1186/s12888-022-04141-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 07/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with severe mental illness (SMI) have a shorter life expectancy and have been considered by the World Health Organization (WHO) as a vulnerable group. As the causes for this mortality gap are complex, clarification regarding the contributing factors is crucial to improving the health care of SMI patients. Acute appendicitis is one of the most common indications for emergency surgery worldwide. A higher perforation rate has been found among psychiatric patients. This study aims to evaluate the differences in appendiceal perforation rate, emergency department (ED) management, in-hospital outcomes, and in-hospital expenditure among acute appendicitis patients with or without SMI via the use of a multi-centre database. METHODS Relying on Chang Gung Research Database (CGRD) for data, we selectively used its data from January 1st, 2007 to December 31st, 2017. The diagnoses of acute appendicitis and SMI were confirmed by combining ICD codes with relevant medical records. A non-SMI patient group was matched at the ratio of 1:3 by using the Greedy algorithm. The outcomes were appendiceal perforation rate, ED treatment, in-hospital outcome, and in-hospital expenditure. RESULTS A total of 25,766 patients from seven hospitals over a span of 11 years were recruited; among them, 11,513 were excluded by criteria, with 14,253 patients left for analysis. SMI group was older (50.5 vs. 44.4 years, p < 0.01) and had a higher percentage of females (56.5 vs. 44.4%, p = 0.01) and Charlson Comorbidity Index. An analysis of the matched group has revealed that the SMI group has a higher unscheduled 72-hour revisit to ED (17.9 vs. 10.4%, p = 0.01). There was no significant difference in appendiceal perforation rate, ED treatment, in-hospital outcome, and in-hospital expenditure. CONCLUSIONS Our study demonstrated no obvious differences in appendiceal perforation rate, ED management, in-hospital outcomes, and in-hospital expenditure among SMI and non-SMI patients with acute appendicitis. A higher unscheduled 72-hour ED revisit rate prior to the diagnosis of acute appendicitis in the SMI group was found. ED health providers need to be cautious when it comes to SMI patients with vague symptoms or unspecified abdominal complaints.
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Affiliation(s)
- Shang-Kai Hung
- grid.454211.70000 0004 1756 999XDepartment of Emergency Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan City, 333 Taiwan
| | - Hao-Wei Kou
- grid.454211.70000 0004 1756 999XDepartment of Surgery, Division of General Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, 333 Taiwan
| | - Kai-Hsiang Wu
- grid.454212.40000 0004 1756 1410Department of Emergency Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi County, 613 Taiwan ,grid.418428.3Department of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, Chiayi County, 613 Taiwan
| | - Shou-Yen Chen
- grid.454211.70000 0004 1756 999XDepartment of Emergency Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan City, 333 Taiwan ,grid.145695.a0000 0004 1798 0922Graduate Institute of Clinical Medical Sciences, Division of Medical Education, College of Medicine, Chang Gung University, Taoyuan City, 333 Taiwan
| | - Chih-Huang Li
- grid.454211.70000 0004 1756 999XDepartment of Emergency Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan City, 333 Taiwan ,grid.145695.a0000 0004 1798 0922Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan City, 333 Taiwan
| | - Chao-Wei Lee
- grid.454211.70000 0004 1756 999XDepartment of Surgery, Division of General Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, 333 Taiwan ,grid.145695.a0000 0004 1798 0922Graduate Institute of Clinical Medical Sciences, Division of Medical Education, College of Medicine, Chang Gung University, Taoyuan City, 333 Taiwan ,grid.145695.a0000 0004 1798 0922College of Medicine, Chang Gung University, Guishan, Taoyuan City, 333 Taiwan
| | - Yu-Yung Hung
- grid.415011.00000 0004 0572 9992Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung City, 813 Taiwan
| | - Shi-Ying Gao
- grid.454211.70000 0004 1756 999XDepartment of Emergency Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan City, 333 Taiwan
| | - Po-Han Wu
- grid.454212.40000 0004 1756 1410Department of Emergency Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi County, 613 Taiwan
| | - Chiao-Hsuan Hsieh
- grid.454211.70000 0004 1756 999XDepartment of Emergency Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan City, 333 Taiwan
| | - Chung-Hsien Chaou
- Department of Emergency Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan City, 333, Taiwan. .,College of Medicine, Chang Gung University, Guishan, Taoyuan City, 333, Taiwan. .,Chang-Gung Medical Education Research Centre, Chang-Gung Memorial Hospital, No. 5, Fusing St., Guei-shan Township, Taoyuan City, 333, Taiwan.
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48
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Correll CU, Agid O, Crespo-Facorro B, de Bartolomeis A, Fagiolini A, Seppälä N, Howes OD. A Guideline and Checklist for Initiating and Managing Clozapine Treatment in Patients with Treatment-Resistant Schizophrenia. CNS Drugs 2022; 36:659-679. [PMID: 35759211 PMCID: PMC9243911 DOI: 10.1007/s40263-022-00932-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2022] [Indexed: 12/14/2022]
Abstract
Treatment-resistant schizophrenia (TRS) will affect about one in three patients with schizophrenia. Clozapine is the only treatment approved for TRS, and patients should be treated as soon as possible to improve their chances of achieving remission. Despite its effectiveness, concern over side effects, monitoring requirements, and inexperience with prescribing often result in long delays that can expose patients to unnecessary risks and compromise their chances of achieving favorable long-term outcomes. We critically reviewed the literature on clozapine use in TRS, focusing on guidelines, systematic reviews, and algorithms to identify strategies for improving clozapine safety and tolerability. Based on this, we have provided an overview of strategies to support early initiation of clozapine in patients with TRS based on the latest evidence and our clinical experience, and have summarized the key elements in a practical, evidence-based checklist for identifying and managing patients with TRS, with the aim of increasing confidence in prescribing and monitoring clozapine therapy.
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Affiliation(s)
- C U Correll
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.,Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
| | - Ofer Agid
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | | | - Andrea de Bartolomeis
- Section on Clinical Psychiatry and Psychology, Laboratory of Molecular and Translational Psychiatry and Unit of Treatment Resistant Psychosis, University of Naples Federico II, Naples, Italy
| | - Andrea Fagiolini
- Department of Molecular Medicine, University of Siena, Siena, Italy
| | - Niko Seppälä
- Department of Psychiatry Satasairaala, Harjavalta, Finland
| | - Oliver D Howes
- Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK.
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Data Quality of Automated Comorbidity Lists in Patients With Mental Health and Substance Use Disorders. Comput Inform Nurs 2022; 40:497-505. [PMID: 35234709 PMCID: PMC9262752 DOI: 10.1097/cin.0000000000000889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
EHRs provide an opportunity to conduct research on underrepresented oncology populations with mental health and substance use disorders. However, a lack of data quality may introduce unintended bias into EHR data. The objective of this article is describe our analysis of data quality within automated comorbidity lists commonly found in EHRs. Investigators conducted a retrospective chart review of 395 oncology patients from a safety-net integrated healthcare system. Statistical analysis included κ coefficients and a condition logistic regression. Subjects were racially and ethnically diverse and predominantly used Medicaid insurance. Weak κ coefficients ( κ = 0.2-0.39, P < .01) were noted for drug and alcohol use disorders indicating deficiencies in comorbidity documentation within the automated comorbidity list. Further, conditional logistic regression analyses revealed deficiencies in comorbidity documentation in patients with drug use disorders (odds ratio, 11.03; 95% confidence interval, 2.71-44.9; P = .01) and psychoses (odds ratio, 0.04; confidence interval, 0.02-0.10; P < .01). Findings suggest deficiencies in automatic comorbidity lists as compared with a review of provider narrative notes when identifying comorbidities. As healthcare systems increasingly use EHR data in clinical studies and decision making, the quality of healthcare delivery and clinical research may be affected by discrepancies in the documentation of comorbidities.
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50
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Holden J, Begum M. Successful rechallenge after clozapine-associated myocarditis. BMJ Case Rep 2022; 15:e248909. [PMID: 35550318 PMCID: PMC9109022 DOI: 10.1136/bcr-2022-248909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2022] [Indexed: 11/03/2022] Open
Abstract
Clozapine is a highly effective medication used in management of treatment-resistant schizophrenia. Clozapine-associated myocarditis (CAM) is a rare but increasingly recognised complication of clozapine titration. Following an episode of CAM, clinicians can face a challenging dilemma of balancing the risks of recurrent myocarditis against the harms of ongoing psychosis. We describe the case of a woman in her 60s who developed acute myocarditis during clozapine titration and was then cautiously rechallenged with a successful outcome.
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Affiliation(s)
- John Holden
- Psychiatry, NHS Ayrshire and Arran Woodland View, Irvine, UK
| | - Milia Begum
- Psychiatry, NHS Ayrshire and Arran Woodland View, Irvine, UK
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