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Nguyen-Thi PT, Vo TK, Le HT, Nguyen NTT, Nguyen TT, Van Vo G. Translation from Preclinical Research to Clinical Trials: Transdermal Drug Delivery for Neurodegenerative and Mental Disorders. Pharm Res 2024:10.1007/s11095-024-03718-x. [PMID: 38862719 DOI: 10.1007/s11095-024-03718-x] [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: 12/23/2023] [Accepted: 05/19/2024] [Indexed: 06/13/2024]
Abstract
Neurodegenerative diseases (NDs), particularly dementia, provide significant problems to worldwide healthcare systems. The development of therapeutic materials for various diseases has a severe challenge in the form of the blood-brain barrier (BBB). Transdermal treatment has recently garnered widespread favor as an alternative method of delivering active chemicals to the brain. This approach has several advantages, including low invasiveness, self-administration, avoidance of first-pass metabolism, preservation of steady plasma concentrations, regulated release, safety, efficacy, and better patient compliance. Topics include the transdermal method for therapeutic NDs, their classification, and the mechanisms that allow the medicine to enter the bloodstream through the skin. The paper also discusses the obstacles and potential outcomes of transdermal therapy, emphasizing the benefits and drawbacks of different approaches.
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Affiliation(s)
| | - Tuong Kha Vo
- Department of Sports Medicine, University of Medicine and Pharmacy (VNU-UMP), Vietnam National University Hanoi, Hanoi, 100000, Vietnam
| | - Huong Thuy Le
- Faculty of Pharmacy, Ton Duc Thang University, Ho Chi Minh City, 700000, Vietnam
| | - Nhat Thang Thi Nguyen
- Faculty of Chemical Engineering, Industrial University of Ho Chi Minh City, Ho Chi Minh City, 71420, Vietnam.
| | - Thuy Trang Nguyen
- Faculty of Chemical Engineering, Industrial University of Ho Chi Minh City, Ho Chi Minh City, 71420, Vietnam
| | - Giau Van Vo
- Degenerative Diseases Program, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, 92037, USA.
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Cai C, Kozma C, Patel C, Benson C, Yunusa I, Zhao P, Reeder G, Narasimhan M, Bank RL. Adherence, health care utilization, and costs between long-acting injectable and oral antipsychotic medications in South Carolina Medicaid beneficiaries with schizophrenia. J Manag Care Spec Pharm 2024; 30:549-559. [PMID: 38824623 DOI: 10.18553/jmcp.2024.30.6.549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
BACKGROUND Schizophrenia and schizoaffective disorder require long-term antipsychotic treatment with antipsychotic medications, but poor medication adherence can lead to increased health care utilization and costs. Long-acting injectable antipsychotics (LAIs) offer potential therapeutic advantages in that they require less frequent dosing and improved medication adherence. South Carolina has the highest adoption of LAIs among US states, making it an ideal population for comparing the effectiveness of LAIs vs oral antipsychotics (OAPs) in treating schizophrenia or schizoaffective disorder. OBJECTIVE To evaluate the effect of LAIs compared with OAPs on medication adherence, health care resource utilization, and costs among South Carolina Medicaid beneficiaries with schizophrenia or schizoaffective disorder. METHODS South Carolina Medicaid beneficiaries with at least 1 claim for an LAI or OAP between January 1, 2015, and December 31, 2018, aged 18 to 65, with at least 2 claims with diagnoses of schizophrenia or schizoaffective disorder were included. Propensity scores (PSs) were calculated using logistic regression adjusting for confounders and predictors of the outcome. We estimated the "average treatment effect on the treated" by employing PS-weighted t-tests and chi-square tests. RESULTS A total of 3,531 patients met the inclusion criteria, with 1,537 (44.5%) treated with LAIs and 1,994 (56.5%) treated with OAPs. In PS-weighted analyses, the LAI cohort had a greater proportion of days covered than the OAP cohort with a 365-day fixed denominator (69% vs 64%; P < 0.0001), higher medication possession ratio with a variable denominator while on therapy (85% vs 80%; P < 0.0001), and higher persistence (82% vs 64%; P < 0.0001). The average number of inpatient visits and emergency department visits did not significantly differ between cohorts (0.28 hospitalizations, P = 0.90; 3.68 vs 2.96 emergency department visits, P = 0.19). The number of outpatient visits, including visits for medication administration, were greater in the LAI cohort (23.1 [SD 24.2]) vs OAP (16.9 [SD 21.2]; P < 0.0001); however, including the costs for medication administration visits, outpatient costs (per member) were approximately $2,500 lower in the LAI cohort (P < 0.0001). The number of pharmacy visits was greater in the OAP cohort (LAI 21.0 [SD 17.0] vs OAP 23.0 [SD 15.0]; P = 0.006). All-cause total costs were greater in the LAI cohort ($26,025 [SD $29,909]) vs the OAP cohort ($17,291 [SD $25,261]; P < 0.0001) and were driven by the difference in pharmaceutical costs (LAI $15,273 [SD $16,183] vs OAP $4,696 [SD $10,371]; P < 0.0001). CONCLUSIONS Among South Carolina Medicaid beneficiaries, treatment with LAIs for schizophrenia or schizoaffective disorder was associated with greater medication adherence rates. Patients using LAIs had higher drug costs and total costs, but lower outpatient and total nondrug costs compared with those using OAPs.
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Affiliation(s)
- Chao Cai
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy
| | - Chris Kozma
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy
| | - Charmi Patel
- University of South Carolina, Columbia; Janssen Scientific Affairs, LLC, a Johnson & Johnson Company, Titusville, NJ
| | - Carmela Benson
- University of South Carolina, Columbia; Janssen Scientific Affairs, LLC, a Johnson & Johnson Company, Titusville, NJ
| | - Ismaeel Yunusa
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy
| | - Pujing Zhao
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy
| | - Gene Reeder
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy
| | | | - Robert L Bank
- South Carolina Department of Mental Health, Columbia
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Sanz P, Tur N, Lana F. Mentalization-based approach for schizophrenia spectrum disorders: a psychotherapeutic proposal for evolved schizophrenic trajectories and serious mental disorders. Front Psychiatry 2024; 15:1240393. [PMID: 38779549 PMCID: PMC11109361 DOI: 10.3389/fpsyt.2024.1240393] [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: 06/14/2023] [Accepted: 04/16/2024] [Indexed: 05/25/2024] Open
Abstract
There is a growing interest in psychotherapeutic approaches to pre-psychotic high-risk states or first-episode psychosis, where mentalization-based treatment has shown its utility. This article presents a mentalization-based approach for the treatment of those individuals diagnosed with an evolved schizophrenia spectrum disorder, whose characteristics make them especially inaccessible to reflective psychotherapeutic treatment. A synthesis of the conceptual frameworks that justify the needs for technical modification of the mentalization-based treatment foundational techniques is carried out, followed by the proposal of adaptations, with a focus in self-agency and patient-therapist dyad. Therapeutic interventions are outlined, including illustrative examples. The mentalizing approach presented here holds promise for future research and treatment opportunities for patients with evolved schizophrenia and other serious mental disorders.
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Affiliation(s)
- Pedro Sanz
- Programa de Trastorno Mental Grave, Area de Gestión Clínica de Psiquiatria y Salud Mental (AGCPSM), Hospital 12 de Octubre, Madrid, Spain
| | - Nuria Tur
- Servicio de Psiquiatria, Unidad del Niño y Adolescente, Hospital Clínico San Carlos, Madrid, Spain
| | - Fernando Lana
- Instituto de Neuropsiquiatría y Adiciones (INAD), Centro Emili Mira y Hospital del Mar, Parc de Salut Mar, Barcelona, Centro de Investigación en Red de Salud Mental (CIBERSAM), Departamento de Psiquiatría, Universidad Autónoma de Barcelona, EspañaIMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
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Rivelli A, Fitzpatrick V, Nelson M, Laubmeier K, Zeni C, Mylavarapu S. Real-world predictors of relapse in patients with schizophrenia and schizoaffective disorder in a large health system. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2024; 10:28. [PMID: 38424086 PMCID: PMC10904733 DOI: 10.1038/s41537-024-00448-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/14/2024] [Indexed: 03/02/2024]
Abstract
Schizophrenia is often characterized by recurring relapses, which are associated with a substantial clinical and economic burden. Early identification of individuals at the highest risk for relapse in real-world treatment settings could help improve outcomes and reduce healthcare costs. Prior work has identified a few consistent predictors of relapse in schizophrenia, however, studies to date have been limited to insurance claims data or small patient populations. Thus, this study used a large sample of health systems electronic health record (EHR) data to analyze relationships between patient-level factors and relapse and model a set of factors that can be used to identify the increased prevalence of relapse, a severe and preventable reality of schizophrenia. This retrospective, observational cohort study utilized EHR data extracted from the largest Midwestern U.S. non-profit healthcare system to identify predictors of relapse. The study included patients with a diagnosis of schizophrenia (ICD-10 F20) or schizoaffective disorder (ICD-10 F25) who were treated within the system between October 15, 2016, and December 31, 2021, and received care for at least 12 months. A relapse episode was defined as an emergency room or inpatient encounter with a pre-determined behavioral health-related ICD code. Patients' baseline characteristics, comorbidities and healthcare utilization were described. Modified log-Poisson regression (i.e. log Poisson regression with a robust variance estimation) analyses were utilized to estimate the prevalence of relapse across patient characteristics, comorbidities and healthcare utilization and to ultimately identify an adjusted model predicting relapse. Among the 8119 unique patients included in the study, 2478 (30.52%) experienced relapse and 5641 (69.48%) experienced no relapse. Patients were primarily male (54.72%), White Non-Hispanic or Latino (54.23%), with Medicare insurance (51.40%), and had baseline diagnoses of substance use (19.24%), overweight/obesity/weight gain (13.06%), extrapyramidal symptoms (48.00%), lipid metabolism disorder (30.66%), hypertension (26.85%), and diabetes (19.08%). Many differences in patient characteristics, baseline comorbidities, and utilization were revealed between patients who relapsed and patients who did not relapse. Through model building, the final adjusted model with all significant predictors of relapse included the following variables: insurance, age, race/ethnicity, substance use diagnosis, extrapyramidal symptoms, number of emergency room encounters, behavioral health inpatient encounters, prior relapses episodes, and long-acting injectable prescriptions written. Prevention of relapse is a priority in schizophrenia care. Challenges related to historical health record data have limited the knowledge of real-world predictors of relapse. This study offers a set of variables that could conceivably be used to construct algorithms or models to proactively monitor demographic, comorbidity, medication, and healthcare utilization parameters which place patients at risk for relapse and to modify approaches to care to avoid future relapse.
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Affiliation(s)
- Anne Rivelli
- Advocate Aurora Research Institute, Milwaukee, IL, USA.
- Advocate Aurora Health, Milwaukee, IL, USA.
| | - Veronica Fitzpatrick
- Advocate Aurora Research Institute, Milwaukee, IL, USA
- Advocate Aurora Health, Milwaukee, IL, USA
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Benster LL, Weissman CR, Stolz LA, Daskalakis ZJ, Appelbaum LG. Pre-clinical indications of brain stimulation treatments for non-affective psychiatric disorders, a status update. Transl Psychiatry 2023; 13:390. [PMID: 38097566 PMCID: PMC10721798 DOI: 10.1038/s41398-023-02673-2] [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: 11/11/2022] [Revised: 11/14/2023] [Accepted: 11/17/2023] [Indexed: 12/17/2023] Open
Abstract
Over the past two decades noninvasive brain stimulation (NIBS) techniques have emerged as powerful therapeutic options for a range of psychiatric and neurological disorders. NIBS are hypothesized to rebalance pathological brain networks thus reducing symptoms and improving functioning. This development has been fueled by controlled studies with increasing size and rigor aiming to characterize how treatments induce clinically effective change. Clinical trials of NIBS for specific indications have resulted in federal approval for unipolar depression, bipolar depression, smoking cessation, and obsessive-compulsive disorder in the United States, and several other indications worldwide. As a rapidly emerging field, there are numerous pre-clinical indications currently in development using a variety of electrical and magnetic, non-convulsive, and convulsive approaches. This review discusses the state-of-the-science surrounding promising avenues of NIBS currently in pre-approval stages for non-affective psychiatric disorders. We consider emerging therapies for psychosis, anxiety disorders, obsessive-compulsive disorder, and borderline personality disorder, utilizing transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), and magnetic seizure therapy (MST), with an additional brief section for early-stage techniques including transcranial focused ultrasound stimulation (tFUS) and transcranial alternating current stimulation (tACS). As revealed in this review, there is considerable promise across all four psychiatric indications with different NIBS approaches. Positive findings are notable for the treatment of psychosis using tDCS, MST, and rTMS. While rTMS is already FDA approved for the treatment of obsessive-compulsive disorder, methodologies such as tDCS also demonstrate potential in this condition. Emerging techniques show promise for treating non-affective disorders likely leading to future regulatory approvals.
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Affiliation(s)
- Lindsay L Benster
- Joint Doctoral Program in Clinical Psychology, SDSU/UC San Diego, San Diego, CA, USA.
| | - Cory R Weissman
- Department of Psychiatry, UC San Diego School of Medicine, San Diego, CA, USA
| | - Louise A Stolz
- Department of Psychiatry, UC San Diego School of Medicine, San Diego, CA, USA
| | - Zafiris J Daskalakis
- Joint Doctoral Program in Clinical Psychology, SDSU/UC San Diego, San Diego, CA, USA
- Department of Psychiatry, UC San Diego School of Medicine, San Diego, CA, USA
| | - Lawrence G Appelbaum
- Joint Doctoral Program in Clinical Psychology, SDSU/UC San Diego, San Diego, CA, USA
- Department of Psychiatry, UC San Diego School of Medicine, San Diego, CA, USA
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Singh P, Nawaz S, Seiber EE, Bryant I, Moon K, Wastler H, Breitborde NJ. ED Visits for Schizophrenia Spectrum Disorders During the COVID-19 Pandemic at 5 Campus Health Systems. JAMA Netw Open 2023; 6:e2349305. [PMID: 38150255 PMCID: PMC10753394 DOI: 10.1001/jamanetworkopen.2023.49305] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/10/2023] [Indexed: 12/28/2023] Open
Abstract
Importance Although substantial research has reported grave population-level psychiatric sequelae of the COVID-19 pandemic, evidence pertaining to temporal changes in schizophrenia spectrum disorders in the US following the pandemic remains limited. Objective To examine the monthly patterns of emergency department (ED) visits for schizophrenia spectrum disorders after the onset of the COVID-19 pandemic. Design, Setting, and Participants This observational cohort study used time-series analyses to examine whether monthly counts of ED visits for schizophrenia spectrum disorders across 5 University of California (UC) campus health systems increased beyond expected levels during the COVID-19 pandemic. Data included ED visits reported by the 5 UC campuses from 2016 to 2021. Participants included persons who accessed UC Health System EDs had a diagnosis of a psychiatric condition. Data analysis was performed from March to June 2023. Exposures The exposures were binary indicators of initial (March to May 2020) and extended (March to December 2020) phases of the COVID-19 pandemic. Main Outcomes and Measures The primary outcome was monthly counts of ED visits for schizophrenia spectrum disorders. International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnosis codes, categorized within Clinical Classification Software groups, were used to identify ED visits for schizophrenia spectrum disorders and all other psychiatric ED visits, from the University of California Health Data Warehouse database, from January 2016 to December 2021. Time-series analyses controlled for autocorrelation, seasonality, and concurrent trends in ED visits for all other psychiatric conditions. Results The study data comprised a total of 377 872 psychiatric ED visits, with 37 815 visits for schizophrenia spectrum disorders. The prepandemic monthly mean (SD) number of ED visits for schizophrenia spectrum disorders was 519.9 (38.1), which increased to 558.4 (47.6) following the onset of the COVID-19 pandemic. Results from time series analyses, controlling for monthly counts of ED visits for all other psychiatric conditions, indicated 70.5 additional ED visits (95% CI, 11.7-129.3 additional visits; P = .02) for schizophrenia spectrum disorders at 1 month and 74.9 additional visits (95% CI, 24.0-126.0 visits; P = .005) at 3 months following the initial phase of the COVID-19 pandemic in California. Conclusions and Relevance This study found a 15% increase in ED visits for schizophrenia spectrum disorders within 3 months after the initial phase of the pandemic in California across 5 UC campus health systems, underscoring the importance of social policies related to future emergency preparedness and the need to strengthen mental health care systems.
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Affiliation(s)
- Parvati Singh
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus
| | - Saira Nawaz
- Center for Health Outcomes and Policy Evaluation Studies, College of Public Health, The Ohio State University, Columbus
| | - Eric E. Seiber
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus
| | - Ian Bryant
- Department of Economics, University of Cincinnati, Cincinnati, Ohio
| | - Kyle Moon
- Center for Health Outcomes and Policy Evaluation Studies, College of Public Health, The Ohio State University, Columbus
| | - Heather Wastler
- Early Psychosis Intervention Center, Department of Psychiatry and Behavioral Health, College of Medicine, The Ohio State University, Columbus
| | - Nicholas J. Breitborde
- Early Psychosis Intervention Center, Department of Psychiatry and Behavioral Health, College of Medicine, The Ohio State University, Columbus
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Carreno-Davidson JT, Faller TN, Richardson MD, Roy TC. Behavioral Health-related Reasons for Permanent Duty Limitation Profiles in the U.S. Army: Population-Based Data from 2017 to 2019. Mil Med 2023; 188:444-449. [PMID: 37948224 DOI: 10.1093/milmed/usad183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/20/2023] [Accepted: 05/10/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION When warfighters are unable to fight, they are formally removed from battle through temporary or permanent duty limitation profiles. This study uses a population-based data repository to characterize permanent behavioral health (BH)-related profiles across the army for an identified 2-year period. The absolute risk of a permanent duty limitation for specific BH categories was also examined. MATERIALS AND METHODS This study utilized a retrospective population-based design to identify all new BH diagnoses across the U.S. Army. Service members identified as having a new BH diagnosis were tracked for 12 months following the diagnosis to determine the recommendation of a permanent duty limitation profile. RESULTS From 2017 to 2018, 16% (n = 102,440) of service members received a "new" BH diagnosis. Less than 10% (9.5%; n = 9,752) of soldiers diagnosed with a BH disorder were issued a permanent BH-related duty profile within 12 months of the initial diagnosis. The absolute risk of a permanent profile was highest for soldiers diagnosed with a psychotic or delusional disorder (42%; n = 324) followed by dissociative or somatoform disorders (26%; n = 178) and eating disorders (23%; n = 108). CONCLUSIONS Military regulations dictating medical readiness and retention standards reflect both the standards required for mission readiness and a layer of medical protection for the service member. This study provides important information on the relationship between a new BH diagnosis and the likelihood that a service member will be referred for a retirement evaluation.
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Affiliation(s)
- Jamie T Carreno-Davidson
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, MA 01760, USA
| | - Theresa N Faller
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, MA 01760, USA
- Department of Mental Health, John Hopkins University, Baltimore, MD 21205, USA
| | - Melissa D Richardson
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, MA 01760, USA
| | - Tanja C Roy
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, MA 01760, USA
- Operational Health Services, Army Public Health Center, Aberdeen Proving Ground, MD 21010, USA
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Lin D, Pilon D, Morrison L, Shah A, Lafeuille MH, Lefebvre P, Benson C. A Cross-Sectional Study of Patient Out-of-Pocket Costs for Antipsychotics Among Medicaid Beneficiaries with Schizophrenia. Drugs Real World Outcomes 2023; 10:471-480. [PMID: 37289413 PMCID: PMC10491554 DOI: 10.1007/s40801-023-00376-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Patient affordability is an important nonclinical consideration for treatment access among patients with schizophrenia. OBJECTIVE This study evaluated and measured out-of-pocket (OOP) costs for antipsychotics (APs) among Medicaid beneficiaries with schizophrenia. METHODS Adults with a schizophrenia diagnosis, ≥ 1 AP claim, and continuous Medicaid eligibility were identified in the MarketScan® Medicaid Database (1 January 2018-31 December 2018). OOP AP pharmacy costs ($US 2019) were normalized for a 30-day supply. Results were descriptively reported by route of administration [ROA; orals (OAPs), long-acting injectables (LAIs)], generic/branded status within ROAs, and dosing schedule within LAIs. The proportion of total (pharmacy and medical) OOP costs AP-attributable was described. RESULTS In 2018, 48,656 Medicaid beneficiaries with schizophrenia were identified (mean age 46.7 years, 41.1% female, 43.4% Black). Mean annual total OOP costs were $59.97, $6.65 of which was AP attributable. Overall, 39.2%, 38.3%, and 42.3% of beneficiaries with a corresponding claim had OOP costs > $0 for any AP, OAP, and LAI, respectively. Mean OOP costs per patient per 30-day claim (PPPC) were $0.64 for OAPs and $0.86 for LAIs. By LAI dosing schedule, mean OOP costs PPPC were $0.95, $0.90, $0.57, and $0.39 for twice-monthly, monthly, once-every-2-months, and once-every-3-months LAIs, respectively. Across ROAs and generic/branded status, projected OOP AP costs per-patient-per-year for beneficiaries assumed fully adherent ranged from $4.52 to $13.70, representing < 25% of total OOP costs. CONCLUSION OOP AP costs for Medicaid beneficiaries represented a small fraction of total OOP costs. LAIs with longer dosing schedules had numerically lower mean OOP costs, which were lowest for once-every-3-months LAIs among all APs.
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Affiliation(s)
- Dee Lin
- Janssen Scientific Affairs, LLC., Titusville, NJ USA
| | - Dominic Pilon
- Analysis Group, Inc., 1190 avenue des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montreal, QC H3B 0G7 Canada
| | - Laura Morrison
- Analysis Group, Inc., 1190 avenue des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montreal, QC H3B 0G7 Canada
| | - Aditi Shah
- Analysis Group, Inc., 1190 avenue des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montreal, QC H3B 0G7 Canada
| | - Marie-Hélène Lafeuille
- Analysis Group, Inc., 1190 avenue des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montreal, QC H3B 0G7 Canada
| | - Patrick Lefebvre
- Analysis Group, Inc., 1190 avenue des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montreal, QC H3B 0G7 Canada
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Patel C, Pilon D, Morrison L, Holiday C, Lafeuille MH, Lefebvre P, Benson C. Continuity of care among patients newly initiated on second-generation oral or long-acting injectable antipsychotics during a schizophrenia-related inpatient stay. Curr Med Res Opin 2023; 39:1157-1166. [PMID: 37461233 DOI: 10.1080/03007995.2023.2237833] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/06/2023] [Accepted: 07/14/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Maintaining continuity of care after schizophrenia-related hospitalization is challenging for patients and healthcare providers and systems. Prior evidence suggests that second-generation long-acting injectable antipsychotics (SGLAIs) may reduce the risk of treatment nonadherence and readmission versus oral atypical antipsychotics (OAAs). Therefore, quality measures were compared between patients initiated on SGLAIs and OAAs in the United States. METHODS Adults newly initiated on an SGLAI or OAA during a schizophrenia-related inpatient stay were identified in HealthVerity databases (01/2015-12/2020); the index date was the hospital discharge date. Patients had continuous health insurance coverage for pharmacy and medical services for 6 months pre-admission and post-discharge from the inpatient stay and ≥1 pharmacy or medical claim (i.e. treatment as indicated by the observed insurance claims) for an antipsychotic other than the index SGLAI or OAA in the 6 months pre-admission. Antipsychotic use and adherence, and schizophrenia-related readmissions and outpatient visits were compared during the 6-month period post-discharge. Characteristics between cohorts were balanced using inverse probability weights. RESULTS Post-discharge, only 36.9% and 40.7% of weighted SGLAI (N = 466) and OAA (N = 517) patients had ≥1 pharmacy or medical claim for the antipsychotic initiated during the inpatient stay, among whom SGLAI patients were 4.4 times more likely to be adherent to that antipsychotic compared to OAA patients (p < .001). Additionally, SGLAI patients were 2.3 and 3.0 times more likely to have a pharmacy or medical claim for and be adherent to any antipsychotic relative to OAA patients (including index antipsychotic; all p < .001). Within 7 and 30 days post-discharge, 1.7% and 13.0% of SGLAI patients and 4.1% and 12.6% of OAA patients had a readmission. Further, SGLAI patients were 51% more likely to have an outpatient visit compared to OAA patients (p = .044). CONCLUSIONS Less than half of patients initiated on antipsychotics during a schizophrenia-related inpatient stay continued the same treatment post-discharge. However, SGLAI patients were more likely to be adherent to the initiated antipsychotic and to have an outpatient visit, which may suggest improved continuity of care post-discharge relative to OAA patients.
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Affiliation(s)
- Charmi Patel
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
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Caballero J, Xu J, Hall DB, Chen X, Young HN. Racial and ethnic differences in patterns of use and discontinuation of long-acting injectable antipsychotics using Medicaid claims data. Ment Health Clin 2023; 13:183-189. [PMID: 37860586 PMCID: PMC10583257 DOI: 10.9740/mhc.2023.08.183] [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: 12/23/2022] [Accepted: 05/23/2023] [Indexed: 10/21/2023] Open
Abstract
Introduction In general, racial and ethnic differences exist in antipsychotic prescription practices. However, little is known about such differences between individual long-acting injectable (LAI) antipsychotic formulations, specifically. This study's primary objective was to determine racial and ethnic differences among LAI antipsychotic use. Secondary objectives were to identify if discontinuation rates differed between agents and by race or ethnicity. Methods International Classification of Diseases, 10th edition (ICD-10) codes were used to identify patients with schizophrenia and related disorders (18-64 years) who received an LAI antipsychotic between 2016 and 2020 using Merative Multi-State Medicaid databases. Using National Drug Code numbers for LAI antipsychotics, pharmacy claims were identified and data analyzed. Cochran-Mantel-Haenszel tests and odds ratio estimators were used to investigate conditional association between race or ethnicity and medication, while controlling for age, sex, health plan, and prescription year. Kaplan-Meier survival curves were examined, and stratified log-rank tests were conducted to compare the time until discontinuation distributions by race or ethnicity. Results The analysis included 37 712 patients. Blacks received an LAI first-generation antipsychotic more often than Whites (OR: 1.64, 95% CI: [1.56, 1.73], Hispanics (OR: 1.46, 95% CI: [1.21, 1.75]) and others (OR: 1.44, 95% CI: [1.20, 1.73]). Aside from fluphenazine decanoate showing earlier discontinuation rates for Whites over Blacks (P = .02), no significant differences in discontinuation across race or ethnicity were identified. Discussion Despite no significant differences in second-generation antipsychotic LAI discontinuation rates between Blacks and other racial or ethnic groups, Blacks received second-generation antipsychotic LAIs significantly less often than other groups. Further studies are needed to determine why differences may be occurring.
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Affiliation(s)
- Joshua Caballero
- (Corresponding author) Associate Professor – Limited Term, Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, Athens, Georgia,
| | - Jianing Xu
- PhD Student, Department of Statistics, Franklin College of Arts and Sciences, University of Georgia, Athens, Georgia
| | - Daniel B. Hall
- Professor and Director, Statistical Consulting Center, Department of Statistics, Franklin College of Arts and Sciences, University of Georgia, Athens, Georgia
| | - Xianyan Chen
- Senior Academic Professional, Department of Statistics, Franklin College of Arts and Sciences, University of Georgia, Athens, Georgia
| | - Henry N. Young
- Department Head and Kroger Professor, Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, Athens, Georgia
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Phelps H, Lin D, Keenan A, Raju A, Huang D, Cheng CY, Benson C. Budget impact of introducing once-every-6-months paliperidone palmitate in US health care plans. J Manag Care Spec Pharm 2023; 29:303-313. [PMID: 36840957 PMCID: PMC10387930 DOI: 10.18553/jmcp.2023.29.3.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
BACKGROUND: In the United States, most patients with schizophrenia have Medicaid coverage. Antipsychotic treatments are the cornerstone of schizophrenia management; most patients are treated with daily oral antipsychotics but struggle with medication adherence. Evidence suggests that medication adherence is inversely correlated with dosing frequency. Once-monthly paliperidone palmitate (PP) has been demonstrated to improve adherence compared with oral antipsychotics; transitioning to once-every-3-months PP (PP3M) further improved adherence. In 2021, once-every-6-months PP (PP6M) was approved by the US Food and Drug Administration to provide even longer between-dose intervals. Public health stakeholders who aim to improve medication adherence are interested in understanding how introducing PP6M to the formulary will impact the budget. OBJECTIVE: To evaluate the budget impact of introducing PP6M to the formulary from the perspectives of a hypothetical US multistate health care payer and state Medicaid programs using California, Georgia, and Ohio as examples. METHODS: The budget impact model was developed from a payer perspective, comparing the reference scenario (without PP6M in the market) with a new scenario (with PP6M). The study population included patients with schizophrenia who were eligible to receive PP6M. Market shares were assigned to the reference and new market scenarios. Efficacy was measured by the relative risk of relapse while receiving treatment. Adherence effects were included in the model and affected costs of treatment and relapse rates. A deterministic 1-way sensitivity analysis was performed. RESULTS: Base-case results for a multistate payer with 1 million members demonstrate that adding PP6M to the market results in total incremental plan-level costs ranging from $7,747 in year 1 to $11,501 in year 5. Increased drug costs were offset by administration and relapse cost savings ($105 and $881 in year 5, respectively). The average incremental cost per treated patient per year was stable at $180.06 for each year, and the incremental cost per member per month stayed below $0.01 for each year. The results of the model from the state-level Medicaid scenarios are broadly similar to those of the multistate base-case perspective. The 1-way sensitivity analysis demonstrated the model is most sensitive to the per-package costs of PP6M and PP3M, along with the proportion of patients fully adherent with PP3M. CONCLUSIONS: The budget impact of introducing PP6M as a treatment option is minimal. With the expected cost offsets from reduced administration and relapse costs due to adherence benefits, these results suggest that PP6M can be a viable treatment option from a clinical and a budgetary perspective. DISCLOSURES: This study was funded by Janssen Scientific Affairs, LLC. The study sponsor provided funds to Xcenda and ApotheCom for medical writing, editorial support, and submission of the manuscript. Hilary Phelps was an employee of Janssen Global Services, LLC, at the time of the development and finalization of the manuscript. Alex Keenan is an employee of Janssen Global Services, LLC, and holds stock in Johnson & Johnson, Inc. Dee Lin and Carmela Benson are employees of Janssen Scientific Affairs, LLC, and hold stock in Johnson & Johnson, Inc. Aditya Raju was an employee of Xcenda at the time of the development and finalization of the manuscript, and Danmeng Huang is an employee of Xcenda, a health care consulting firm that was contracted by Janssen Scientific Affairs, LLC. Chih-Yuan Cheng is an employee of Janssen NV.
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Affiliation(s)
| | - Dee Lin
- Janssen Scientific Affairs, LLC, Titusville, NJ
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12
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Lin C, Zhang X, Jin H. The Societal Cost of Schizophrenia: An Updated Systematic Review of Cost-of-Illness Studies. PHARMACOECONOMICS 2023; 41:139-153. [PMID: 36404364 DOI: 10.1007/s40273-022-01217-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Schizophrenia imposes a substantial economic burden on society. This updated systematic review aims to collate the latest societal cost of schizophrenia across countries by reviewing recent cost-of-illness (COI) studies. METHODS An electronic search was conducted across several databases (MEDLINE, Embase, PsycINFO, Cochrane Database of Systematic Reviews, Health Management Information Consortium, and System for Information on Grey Literature) to identify COI studies published from 2016 to 2022. Two independent reviewers selected studies for inclusion. The cost components and estimates reported by included studies were descriptively summarised. All costs were converted to US dollars (2022 values). Study quality was assessed using a checklist adapted from Larg & Moss. RESULTS Twenty-four studies were included (5 from the update review and 19 from the original review), of which only two were conducted for low- and middle-income countries (LMICs). Widespread methodological heterogeneity among included studies was observed. The annual societal cost per person varied from US$819 in Nigeria to US$94,587 in Norway. Productivity losses accounted for 32-83% of the overall societal cost, whilst direct healthcare cost made up 11-87%. The reporting quality of included studies varied. CONCLUSION This review highlights the substantial economic burden of schizophrenia and a lack of COI studies for LMICs. Recommendations on future research, and good practices on improving the methodological and reporting quality of COI research for schizophrenia are provided.
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Affiliation(s)
- Claire Lin
- King's Health Economics (KHE), Institute of Psychiatry, Psychology and Neuroscience, King's College London, The David Goldberg Centre, Box 024, London, SE5 8AF, UK
| | - Xiaoyu Zhang
- King's Health Economics (KHE), Institute of Psychiatry, Psychology and Neuroscience, King's College London, The David Goldberg Centre, Box 024, London, SE5 8AF, UK
| | - Huajie Jin
- King's Health Economics (KHE), Institute of Psychiatry, Psychology and Neuroscience, King's College London, The David Goldberg Centre, Box 024, London, SE5 8AF, UK.
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Barendse MEA, Lara GA, Guyer AE, Swartz JR, Taylor SL, Shirtcliff EA, Lamb ST, Miller C, Ng J, Yu G, Tully LM. Sex and pubertal influences on the neurodevelopmental underpinnings of schizophrenia: A case for longitudinal research on adolescents. Schizophr Res 2023; 252:231-241. [PMID: 36682313 PMCID: PMC10725041 DOI: 10.1016/j.schres.2022.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 11/08/2022] [Accepted: 12/10/2022] [Indexed: 01/21/2023]
Abstract
Sex is a significant source of heterogeneity in schizophrenia, with more negative symptoms in males and more affective symptoms and internalizing comorbidity in females. In this narrative review, we argue that there are likely sex differences in the pathophysiological mechanisms of schizophrenia-spectrum disorders (SZ) that originate during puberty and relate to the sex-specific impacts of pubertal maturation on brain development. Pubertal maturation might also trigger underlying (genetic or other) vulnerabilities in at-risk individuals, influencing brain development trajectories that contribute to the emergence of SZ. This review is the first to integrate links between pubertal development and neural development with cognitive neuroscience research in SZ to form and evaluate these hypotheses, with a focus on the frontal-striatal and frontal-limbic networks and their hypothesized contribution to negative and mood symptoms respectively. To test these hypotheses, longitudinal research with human adolescents is needed that examines the role of sex and pubertal development using large cohorts or high risk samples. We provide recommendations for such studies, which will integrate the fields of psychiatry, developmental cognitive neuroscience, and developmental endocrinology towards a more nuanced understanding of the role of pubertal factors in the hypothesized sex-specific pathophysiological mechanisms of schizophrenia.
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Affiliation(s)
- M E A Barendse
- Department of Psychiatry and Behavioral Sciences, UC Davis, CA, USA
| | - G A Lara
- Department of Psychiatry and Behavioral Sciences, UC Davis, CA, USA
| | - A E Guyer
- Department of Human Ecology, UC Davis, CA, USA; Center for Mind and Brain, UC Davis, CA, USA
| | - J R Swartz
- Center for Mind and Brain, UC Davis, CA, USA
| | - S L Taylor
- Division of Biostatistics, Department of Public Health Sciences, UC Davis, CA, USA
| | - E A Shirtcliff
- Human Development and Family Studies, Iowa State University, Ames, IA, USA
| | - S T Lamb
- Department of Psychiatry and Behavioral Sciences, UC Davis, CA, USA
| | - C Miller
- Department of Psychiatry and Behavioral Sciences, UC Davis, CA, USA
| | - J Ng
- Department of Psychiatry and Behavioral Sciences, UC Davis, CA, USA
| | - G Yu
- Department of Psychiatry and Behavioral Sciences, UC Davis, CA, USA
| | - L M Tully
- Department of Psychiatry and Behavioral Sciences, UC Davis, CA, USA.
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Kotzeva A, Mittal D, Desai S, Judge D, Samanta K. Socioeconomic burden of schizophrenia: a targeted literature review of types of costs and associated drivers across 10 countries. J Med Econ 2023; 26:70-83. [PMID: 36503357 DOI: 10.1080/13696998.2022.2157596] [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: 12/14/2022]
Abstract
AIMS Schizophrenia has the highest median societal cost per patient of all mental disorders. This review summarizes the different costs/cost drivers (cost components) associated with schizophrenia in 10 countries, including all cost types and stakeholder perspectives, and highlights aspects of disease associated with greatest costs. MATERIALS AND METHODS Targeted literature review based on a search of published research from 2006 to 2021 in the United States (US), United Kingdom (UK), France, Germany, Italy, Spain, Canada, Japan, Brazil, and China. RESULTS Sixty-four published articles (primary studies and literature reviews) were included. Comprehensive data were available on costs in schizophrenia overall, with very limited data for individual countries except the US. Most data is related to direct and not indirect costs, with extremely scarce data for several key cost components (adverse events, suicide, long-term care). Total schizophrenia-related per person per year (PPPY) costs were $2,004-94,229, with considerable variability among countries. Indirect costs were the main cost driver (50-90% of all costs), ranging from $1,852 to $62,431 PPPY. However, indirect costs are not collected systematically or incorporated in health technology assessments. Total schizophrenia-related PPPY direct costs were $4,394-31,798, with inpatient cost as the main cost driver (∼20-99% of direct costs). Intangible costs were not reported. Despite limited evidence, total schizophrenia-related costs were higher in patients with than without negative symptoms, largely due to increased costs of medication and medical visits. LIMITATIONS As this was not a systematic review, prioritization of studies may have resulted in exclusion of potentially relevant data. All costs were converted to USD but not corrected for inflation or subjected to a gross domestic product deflator. CONCLUSIONS Direct costs are most commonly reported in schizophrenia. The substantial underreporting of indirect and intangible costs undervalues the true economic burden of schizophrenia from a payer, patient, and societal perspective.
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Li P, Benson C, Geng Z, Seo S, Patel C, Doshi JA. Antipsychotic utilization, healthcare resource use and costs, and quality of care among fee-for-service Medicare beneficiaries with schizophrenia in the United States. J Med Econ 2023; 26:525-536. [PMID: 36961119 DOI: 10.1080/13696998.2023.2189859] [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: 01/11/2023] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND No research to date has examined antipsychotic (AP) use, healthcare resource use (HRU), costs, and quality of care among those with schizophrenia in the Medicare program despite it serving as the primary payer for half of individuals with schizophrenia in the US. OBJECTIVES To provide national estimates and assess regional variation in AP treatment utilization, HRU, costs, and quality measures among Medicare beneficiaries with schizophrenia. METHODS Cross-sectional descriptive analysis of 100% Medicare claims data from 2019. The sample included all adult Medicare beneficiaries with continuous fee-for-service coverage and ≥1 inpatient and/or ≥2 outpatient claims with a diagnosis for schizophrenia in 2019. Summary statistics on AP use; HRU and cost; and quality measures were reported at the national, state, and county levels. Regional variation was measured using the coefficient of variation (CoV). RESULTS We identified 314,888 beneficiaries with schizophrenia. About 91% used any AP; 20% used any long-acting injectable antipsychotic (LAI); and 14% used atypical LAIs. About 28% of beneficiaries had ≥1 hospitalization and 47% had ≥1 emergency room (ER) visits, the vast majority of which were related to mental health (MH). Total annual all-cause, MH, and schizophrenia-related costs were $23,662, $15,000 and $12,109, respectively. Among those with hospitalizations, 18.4% and 27.3% had readmission within 7 and 30 days and 56% and 67% had a physician visit and AP fill within 30 days post-discharge, respectively. Overall, 81% of beneficiaries were deemed adherent to their AP medications. Larger interstate variations were observed in LAI use than AP use (CoV: 0.21 vs 0.02). County-level variations were larger than state-level variations for all measures. CONCLUSIONS In this first study examining a national sample of Medicare beneficiaries with schizophrenia, we found low utilization rates of LAIs and high levels of hospital admissions/readmissions and ER visits. State and county-level variations were also found in these measures.
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Affiliation(s)
- Pengxiang Li
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Zhi Geng
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sanghyuk Seo
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | - Charmi Patel
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | - Jalpa A Doshi
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
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Dickson MC, Nguyen MM, Patel C, Grabich SC, Benson C, Cothran T, Skrepnek GH. Adherence, Persistence, Readmissions, and Costs in Medicaid Members with Schizophrenia or Schizoaffective Disorder Initiating Paliperidone Palmitate Versus Switching Oral Antipsychotics: A Real-World Retrospective Investigation. Adv Ther 2023; 40:349-366. [PMID: 36348142 PMCID: PMC9643895 DOI: 10.1007/s12325-022-02354-4] [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: 09/01/2022] [Accepted: 10/07/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Long-acting injectable antipsychotic agents have been suggested to improve adherence and patient outcomes in schizophrenia or schizoaffective disorder. The purpose of this study was to assess medication use patterns (i.e., medication adherence, persistence), hospital and emergency department readmissions, and total direct medical costs of Oklahoma Medicaid members with schizophrenia or schizoaffective disorder switching from an oral antipsychotic (OAP) to once-monthly paliperidone palmitate (PP1M) or to another OAP (OAP-switch). METHODS A historical cohort analysis was conducted from 1 January 2016 to 31 December 2020 among adults aged ≥ 18 and ≤ 64 years with schizophrenia or schizoaffective disorder who were previously treated with an OAP. The first claim for PP1M or a new OAP defined the study index date. Members who transitioned from PP1M to 3-month formulation (PP3M) were included (i.e., PP1M/PP3M). Proportion of days covered (PDC), 45-day treatment gaps, 30-day readmissions to hospitals or emergency department, and total direct medical costs were assessed using multivariable, machine-learning least absolute shrinkage, and selection operator (Lasso) regressions controlling for numerous demographic, clinical, mental health, and provider characteristics. RESULTS Among 295 Medicaid members meeting full inclusion criteria, 183 involved PP1M/PP3Ms (44 PP1M cases transitioned to PP3M) and 112 involved an OAP-switch. The multivariable-adjusted odds of readmission were significantly associated with a 45-day treatment gap (p < 0.05) and non-adherence (i.e., PDC < 80%) (p < 0.05). Relative to PP1M/PP3Ms, the multivariable analyses also indicated that OAP-switch was associated with an 18.5% lower PDC, 92.3% higher number of 45-day treatment gaps, and an approximately 90% higher odds of all-cause 30-day readmission (p < 0.05). The adjusted pre- to post-index change in cost was approximately 49% lower for OAP-switches versus PP1M/PP3Ms (p < 0.001), although unadjusted post-index costs did not differ between groups (p = 0.440). CONCLUSION This real-world investigation of adult Medicaid members with schizophrenia or schizoaffective disorder observed improved adherence and persistence with fewer readmissions with PP1M/PP3Ms versus OAP-switches.
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Affiliation(s)
- Matthew C. Dickson
- College of Pharmacy, The University of Oklahoma Health Sciences Center, 1110 North Stonewall Ave, Oklahoma City, OK 73117 USA
| | - Michael M. Nguyen
- College of Pharmacy, The University of Oklahoma Health Sciences Center, 1110 North Stonewall Ave, Oklahoma City, OK 73117 USA
| | - Charmi Patel
- Janssen Scientific Affairs, LLC, Titusville, NJ USA
| | | | | | - Terry Cothran
- Oklahoma Health Care Authority, Oklahoma City, OK USA
| | - Grant H. Skrepnek
- College of Pharmacy, The University of Oklahoma Health Sciences Center, 1110 North Stonewall Ave, Oklahoma City, OK 73117 USA
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Nita IB, Ilie OD, Ciobica A, Hritcu LD, Dobrin I, Doroftei B, Dobrin R. Reviewing the Potential Therapeutic Approaches Targeting the Modulation of Gastrointestinal Microflora in Schizophrenia. Int J Mol Sci 2022; 23:ijms232416129. [PMID: 36555774 PMCID: PMC9784651 DOI: 10.3390/ijms232416129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/13/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
Schizophrenia (SCZ) is a severe brain disorder characterized by an intriguing clinical panel that has begun to gain interest due to its particular phenotype. Having considered the role of gut microflora in psychiatry, the latest discoveries might offer further insight into the underlying mechanisms. Thus, we aimed to offer an updated overview of the therapeutic potential of microorganism-derived supplements alongside dedicated protocols that target the re-establishment of the host's eubiosis. Based on combinations of specific keywords, we performed searches in four databases (PubMed/Medline, ISI Web of Knowledge, Scopus, and ScienceDirect) for the established interval (2018-2022) and identified twenty two eligible cases, restricted only to human patients' experiences. Up until the writing of this manuscript, it has been revealed that the administration of specific lactic acid bacteria strains (Lactobacillus and Bifidobacterium), or those combined with vitamin D and selenium, maintain the integrity of the gut flora, preventing antagonistic effects including inflammation, antipsychotic-related body weight gain (olanzapine) and other metabolic dysfunctionalities. However, there are multiple antipsychotics that exert a potent effect upon gut flora, influencing a plethora of pathways and creating a dysbalance ratio between beneficial and opportunistic pathogens. Risperidone, amisulpride, and clozapine are just a few examples, but the current literature is unfortunately inconsistent and reported data is contradictory, which is why we support additional studies in this context. Moreover, we further argue the utility of studying how distinct controlled substances influence microbial communities, considering that ketamine is proved to alleviate depressive-like behavior as opposed to amphetamine and phencyclidine, which are known substances to trigger SCZ-like symptoms in experimental models. Probiotics may be regarded as the most consequential vehicle through which the gut flora can be successfully influenced, in adequate doses exerting a beneficial role as an alternative approach to alleviate SCZ symptoms.
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Affiliation(s)
- Ilinca-Bianca Nita
- Department of Medicine III, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, no 16, 700115 Iasi, Romania
| | - Ovidiu-Dumitru Ilie
- Department of Biology, Faculty of Biology, “Alexandru Ioan Cuza” University, Carol I Avenue, no 20A, 700505 Iasi, Romania
| | - Alin Ciobica
- Department of Biology, Faculty of Biology, “Alexandru Ioan Cuza” University, Carol I Avenue, no 20A, 700505 Iasi, Romania
| | - Luminita-Diana Hritcu
- Internal Medicine Clinic, Faculty of Veterinary Medicine, University of Life Sciences “Ion Ionescu de la Brad”, Mihail Sadoveanu Street, no 3, 700490 Iasi, Romania
- Correspondence: (L.-D.H.); (B.D.)
| | - Irina Dobrin
- Department of Medicine III, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, no 16, 700115 Iasi, Romania
- Institute of Psychiatry “Socola”, Bucium Street, no 36, 700282 Iasi, Romania
| | - Bogdan Doroftei
- Department of Medicine VIII, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, no 16, 700115 Iasi, Romania
- Correspondence: (L.-D.H.); (B.D.)
| | - Romeo Dobrin
- Department of Medicine III, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, no 16, 700115 Iasi, Romania
- Institute of Psychiatry “Socola”, Bucium Street, no 36, 700282 Iasi, Romania
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Płaza O, Gałecki P, Orzechowska A, Gałecka M, Sobolewska-Nowak J, Szulc A. Pharmacogenetics and Schizophrenia-Can Genomics Improve the Treatment with Second-Generation Antipsychotics? Biomedicines 2022; 10:biomedicines10123165. [PMID: 36551925 PMCID: PMC9775397 DOI: 10.3390/biomedicines10123165] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/19/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022] Open
Abstract
Schizophrenia (SCZ) is a complex psychiatric disorder of multifactorial origin, in which both genetic and environmental factors have an impact on its onset, course, and outcome. Large variability in response and tolerability of medication among individuals makes it difficult to predict the efficacy of a chosen therapeutic method and create universal and precise guidelines for treatment. Pharmacogenetic research allows for the identification of genetic polymorphisms associated with response to a chosen antipsychotic, thus allowing for a more effective and personal approach to treatment. This review focuses on three frequently prescribed second-generation antipsychotics (SGAs), risperidone, olanzapine, and aripiprazole, and aims to analyze the current state and future perspectives in research dedicated to identifying genetic factors associated with antipsychotic response. Multiple alleles of genes involved in pharmacokinetics (particularly isoenzymes of cytochrome P450), as well as variants of genes involved in dopamine, serotonin, and glutamate neurotransmission, have already been identified as ones of significant impact on antipsychotic response. It must, however, be noted that although currently obtained results are promising, trials with bigger study groups and unified protocols are crucial for standardizing methods and determining objective antipsychotic response status.
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Affiliation(s)
- Olga Płaza
- Department of Psychiatry, Faculty of Health Sciences, Medical University of Warsaw, Partyzantów 2/4, 05-800 Pruszków, Poland
- Correspondence:
| | - Piotr Gałecki
- Department of Adult Psychiatry, Medical University of Łódź, Aleksandrowska 159, 91-229 Łódź, Poland
| | - Agata Orzechowska
- Department of Adult Psychiatry, Medical University of Łódź, Aleksandrowska 159, 91-229 Łódź, Poland
| | - Małgorzata Gałecka
- Department of Psychotherapy, Medical University of Łódź, Aleksandrowska 159, 91-229 Łódź, Poland
| | - Justyna Sobolewska-Nowak
- Department of Adult Psychiatry, Medical University of Łódź, Aleksandrowska 159, 91-229 Łódź, Poland
| | - Agata Szulc
- Department of Psychiatry, Faculty of Health Sciences, Medical University of Warsaw, Partyzantów 2/4, 05-800 Pruszków, Poland
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Montazer M, Ebrahimpour-Koujan S, Surkan PJ, Azadbakht L. Effects of Fish-Oil Consumption on Psychological Function Outcomes in Psychosis: A Systematic Review and Dose-Response Meta-Analysis of Randomized Controlled Trials. Adv Nutr 2022; 13:2149-2164. [PMID: 36166847 PMCID: PMC9879727 DOI: 10.1093/advances/nmac083] [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: 02/07/2022] [Revised: 06/22/2022] [Accepted: 07/25/2022] [Indexed: 02/02/2023] Open
Abstract
Research on the effects of fish oil on clinical symptoms and psychosocial functioning in people with psychosis has been inconsistent. We conducted this systematic review and meta-analysis to summarize the available data on the effects of oral intake of fish oil on psychological functioning in patients with psychosis. Three online databases including PubMed, Scopus, and Web of Science were searched to identify relevant studies published by April 2021. The exposure was oral fish-oil supplementation. The Positive and Negative Syndrome Scale (PANSS), the Brief Psychiatric Rating Scale (BPRS), and the Global Assessment of Functioning (GAF) were our outcome measures. Seventeen randomized clinical trials involving 1390 patients were included. No change in PANSS was observed following oral fish-oil intake [weighted mean difference (WMD): -0.87; 95% CI: -16.99, 15.26; P = 0.92]. In a nonlinear dose-response analysis, a significant inverse association was observed between <10 wk of fish-oil supplementation and PANSS (WMD: -10; P-nonlinearity = 0.02). Although analysis of 4 studies showed a nonsignificant reduction in BPRS after fish-oil intake (WMD: -2.990; 95% CI: -6.42, 0.44; P = 0.08), a nonlinear dose-response analysis revealed significant inverse associations between dose (>2200 mg/d) and duration of fish-oil supplementation (<15 wk) with BPRS score (WMD: -8; P-nonlinearity = 0.04). Combined effect sizes from 6 randomized clinical trials showed significant increases in GAF after oral administration of fish oil (WMD: 6.66; 95% CI: 3.39, 9.93; P < 0.001). In conclusion, we did not find any significant changes in PANSS and BPRS scores following fish-oil supplementation. Nevertheless, oral fish-oil intake significantly contributed to improvement in GAF scores. This is the first meta-analysis to examine the effects of fish oil on the psychological functioning scores of PANSS, BPRS, and GAF simultaneously.
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Affiliation(s)
- Mohsen Montazer
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Soraiya Ebrahimpour-Koujan
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran,Autoimmune Bullous Disease Research Center, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Pamela J Surkan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Martin A, Bessonova L, Hughes R, Doane MJ, O'Sullivan AK, Snook K, Cichewicz A, Weiden PJ, Harvey PD. Systematic Review of Real-World Treatment Patterns of Oral Antipsychotics and Associated Economic Burden in Patients with Schizophrenia in the United States. Adv Ther 2022; 39:3933-3956. [PMID: 35844007 PMCID: PMC9402774 DOI: 10.1007/s12325-022-02232-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 06/17/2022] [Indexed: 11/29/2022]
Abstract
Background Schizophrenia is a chronic mental disorder associated with substantial morbidity and mortality affecting 0.25–1.6% of adults in the USA. Antipsychotic treatment is the standard of care for schizophrenia, but real-world treatment patterns and associated costs have not been systematically reviewed. Objective We conducted a systematic review to summarize treatment patterns and associated costs related to oral antipsychotic treatment of patients with schizophrenia in the USA. Data Sources We searched Medline (via PubMed) and Embase to identify relevant observational studies published from January 1, 2008, to June 1, 2018; costs were converted to 2018 US dollars. Study Eligibility Observational, real-world studies reporting on patterns of treatment and/or associated costs for adult patients with schizophrenia treated with oral antipsychotics in the USA were included. Results Eighty-one studies were identified. Frequently prescribed oral second-generation antipsychotics were olanzapine (up to 50.9%), risperidone (up to 40.0%), and quetiapine (up to 30.7%). Suboptimal adherence was common across studies. Antipsychotic switching occurred in about half of patients, while antipsychotic combination therapy occurred in nearly 30%; all were associated with increased medication-related costs. Mean annual direct medical costs differed by treatment, with reported costs of $17,115 to $26,138 for patients treated with olanzapine, $18,395 for risperidone, and $17,656 to $28,101 for quetiapine. Limitations This systematic review is limited by the variations in definitions of schizophrenia-related clinical terms used between studies and by the inclusion of studies focused on only the US health care system. Conclusions In the treatment of schizophrenia, suboptimal adherence, antipsychotic switching, and antipsychotic augmentation were all associated with high costs of care in comparison to patients who were adherent and did not require antipsychotic switching or augmentation. These findings illustrate the need for the development of new treatments that address efficacy and adherence challenges of currently available therapies. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-022-02232-z. Schizophrenia is a debilitating mental disorder that affects up to 1.6% of adults in the USA. Antipsychotic medications reduce symptoms of the disease, but many patients with schizophrenia are not fully adherent or choose to discontinue treatment entirely, increasing their risk of hospitalization. In others, efforts to achieve better symptom control or to avoid intolerable side effects may result in switching antipsychotic medications or adding additional medications, leading to higher medical treatment costs. The magnitude of these cost increases is unclear. This study sought to assess medical costs associated with antipsychotic treatment adherence, switching, and adding additional antipsychotics. We reviewed 81 studies published from January 2008 through June 2018 examining treatment adherence in patients with schizophrenia. We calculated rates of adherence, switching, and adding antipsychotics, as well as associated medical costs. Overall adherence to antipsychotic treatment was less than 50%, with up to 50% of patients switching medications and up to 29% adding an additional antipsychotic medication to their current treatment. Patients who were not treatment adherent incurred annual medical costs of $10,316 compared with $5723 in patients who were adherent. The costs of immediate or delayed switching of antipsychotic medications ranged from $21,922 to $28,232, while costs of adding an additional antipsychotic ranged from $24,045 to $29,344. These data suggest that suboptimal medication adherence, along with high rates of patient discontinuation and medication switching, lead to higher treatment costs in the management of patients with schizophrenia.
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Affiliation(s)
- Amber Martin
- Evidera, 500 Totten Pond Road, Waltham, MA, 02451, USA
| | - Leona Bessonova
- Alkermes, Inc, 852 Winter Street, Waltham, MA, 02451-1420, USA
| | - Rachel Hughes
- Evidera, 500 Totten Pond Road, Waltham, MA, 02451, USA
| | - Michael J Doane
- Alkermes, Inc, 852 Winter Street, Waltham, MA, 02451-1420, USA.
| | | | | | | | - Peter J Weiden
- Alkermes, Inc, 852 Winter Street, Waltham, MA, 02451-1420, USA
| | - Philip D Harvey
- University of Miami Miller School of Medicine, 1600 NW 10th Avenue, Miami, FL, 33136, USA
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Unemployment, homelessness, and other societal outcomes in patients with schizophrenia: a real-world retrospective cohort study of the United States Veterans Health Administration database : Societal burden of schizophrenia among US veterans. BMC Psychiatry 2022; 22:458. [PMID: 35804314 PMCID: PMC9264584 DOI: 10.1186/s12888-022-04022-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 05/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The burden associated with schizophrenia is substantial. Impacts on the individual, healthcare system, and society may be particularly striking within the veteran population due to the presence of physical and mental health comorbidities. Disease burden is also influenced by a complex interplay between social determinants of health and health disparities. The objective of the current study was to compare non-healthcare societal outcomes between veterans with and without schizophrenia in the United States Veterans Health Administration (VHA). METHODS A retrospective cohort study was conducted using the VHA database (01/2013-09/2019; study period). Veterans with schizophrenia (≥2 diagnoses of ICD-9295.xx, ICD-10 F20.x, F21, and/or F25.x during the study period) were identified; the index date was the earliest observed schizophrenia diagnosis. Veterans with schizophrenia were propensity score-matched to those without schizophrenia using baseline characteristics. A 12-month baseline and variable follow-up period were applied. The frequency of unemployment, divorce, incarceration, premature death, and homelessness were compared between the matched cohorts using standardized mean difference (SMD). Risk of unemployment and homelessness were estimated using logistic regression models. RESULTS A total of 102,207 veterans remained in each cohort after matching (91% male; 61% White [per AMA]; median age, 59 years). Among veterans with schizophrenia, 42% had a substance use disorder and 30% had mental health-related comorbidities, compared with 25 and 15%, respectively, of veterans without schizophrenia. Veterans with schizophrenia were more likely to experience unemployment (69% vs. 41%; SMD: 0.81), divorce (35% vs. 28%; SMD: 0.67), homelessness (28% vs. 7%; SMD: 0.57), incarceration (0.4% vs. 0.1%; SMD: 0.47), and premature death (14% vs. 12%; SMD < 0.1) than veterans without schizophrenia. After further adjustments, the risk of unemployment and of homelessness were 5.4 and 4.5 times higher among veterans with versus without schizophrenia. Other predictors of unemployment included Black [per AMA] race and history of substance use disorder; for homelessness, younger age (18-34 years) and history of mental health-related comorbidities were additional predictors. CONCLUSION A greater likelihood of adverse societal outcomes was observed among veterans with versus without schizophrenia. Given their elevated risk for unemployment and homelessness, veterans with schizophrenia should be a focus of targeted, multifactorial interventions to reduce disease burden.
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22
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Eken A, Akaslan DS, Baskak B, Münir K. Diagnostic Classification of Schizophrenia and Bipolar Disorder by Using Dynamic Functional Connectivity: an fNIRS Study. J Neurosci Methods 2022; 376:109596. [DOI: 10.1016/j.jneumeth.2022.109596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 02/26/2022] [Accepted: 04/08/2022] [Indexed: 11/27/2022]
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Hakami T. Clinical characteristics and treatment outcomes of patients with newly diagnosed schizophrenia: A 4-year single-center experience in Saudi Arabia. Neuropsychopharmacol Rep 2022; 42:199-204. [PMID: 35318823 PMCID: PMC9216363 DOI: 10.1002/npr2.12247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 02/25/2022] [Accepted: 03/02/2022] [Indexed: 11/10/2022] Open
Abstract
Objectives Understanding how local “psychiatry clinic” characteristics shape research findings is essential for applying research into evolution, outcomes, and costs of mental health. However, a paucity of “psychiatry clinics” details has implications for the interpretation and utilization of this research. Methods We reviewed data of 746 patients with new‐onset schizophrenia on antipsychotic monotherapy seen over four years in an “adult psychiatry clinic” at Jazan Health, Saudi Arabia. Protocol‐driven interviews and investigations were recorded prospectively and extracted from the medical records for the study. Summary statistics and logistic regression analyses were applied to assess patients' characteristics and outcomes. Results The median patient age was 32 (IQR 27‐39) years. Of patients, 589 (79.0%) were male, and 679 (91.0%) had a low‐level education. The median follow‐up duration was 51.4 (IQR 27.4‐96.3) weeks. The most used initial antipsychotic drugs were olanzapine (48.8%), haloperidol (13.9%), and aripiprazole (11.3%). The numbers of patients who retained the initial drug at 24 and 52 weeks were 539 (72.3%) and 325 (43.6%), respectively. The initial drug was changed in 246 (33.0%) patients. The median time to initial drug change was 43.9 (IQR 14.8‐85.0) weeks. The logistic regression demonstrated that male sex (P < 0.004), young adult age group (P < 0.027), predominant positive symptoms (P < 0.021), treatment with haloperidol (P < 0.024), and khat use (P < 0.006) were significant factors for drug change. Conclusions This clinical records study demonstrated substantial individual variations in characteristics and in responding to initial antipsychotic medication. Insight into these findings will facilitate the planning for comprehensive research programs.
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Affiliation(s)
- Tahir Hakami
- The Department of Clinical Pharmacology, The Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
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24
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Hui KK, Endo R, Sawa A, Tanaka M. A Perspective on the Potential Involvement of Impaired Proteostasis in Neuropsychiatric Disorders. Biol Psychiatry 2022; 91:335-345. [PMID: 34836635 PMCID: PMC8792182 DOI: 10.1016/j.biopsych.2021.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 08/05/2021] [Accepted: 09/01/2021] [Indexed: 11/19/2022]
Abstract
Recent genetic approaches have demonstrated that genetic factors contribute to the pathologic origins of neuropsychiatric disorders. Nevertheless, the exact pathophysiological mechanism for most cases remains unclear. Recent studies have demonstrated alterations in pathways of protein homeostasis (proteostasis) and identified several proteins that are misfolded and/or aggregated in the brains of patients with neuropsychiatric disorders, thus providing early evidence that disrupted proteostasis may be a contributing factor to their pathophysiology. Unlike neurodegenerative disorders in which massive neuronal and synaptic losses are observed, proteostasis impairments in neuropsychiatric disorders do not lead to robust neuronal death, but rather likely act via loss- and gain-of-function effects to disrupt neuronal and synaptic functions. Furthermore, abnormal activation of or overwhelmed endoplasmic reticulum and mitochondrial quality control pathways may exacerbate the pathophysiological changes initiated by impaired proteostasis, as these organelles are critical for proper neuronal functions and involved in the maintenance of proteostasis. This perspective article reviews recent findings implicating proteostasis impairments in the pathophysiology of neuropsychiatric disorders and explores how neuronal and synaptic functions may be impacted by disruptions in protein homeostasis. A greater understanding of the contributions by proteostasis impairment in neuropsychiatric disorders will help guide future studies to identify additional candidate proteins and new targets for therapeutic development.
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Affiliation(s)
- Kelvin K Hui
- Center for Autophagy Research, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; Howard Hughes Medical Institute, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ryo Endo
- Laboratory for Protein Conformation Diseases, RIKEN Center for Brain Science, Wako, Saitama, Japan
| | - Akira Sawa
- Department of Psychiatry, John Hopkins University School of Medicine, Baltimore, Maryland; Department of Neuroscience, John Hopkins University School of Medicine, Baltimore, Maryland; Department of Biomedical Engineering, John Hopkins University School of Medicine, Baltimore, Maryland; Department of Genetic Medicine, John Hopkins University School of Medicine, Baltimore, Maryland; Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Motomasa Tanaka
- Laboratory for Protein Conformation Diseases, RIKEN Center for Brain Science, Wako, Saitama, Japan.
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25
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Price GD, Heinz MV, Nemesure MD, McFadden J, Jacobson NC. Predicting symptom response and engagement in a digital intervention among individuals with schizophrenia and related psychoses. Front Psychiatry 2022; 13:807116. [PMID: 36032242 PMCID: PMC9403124 DOI: 10.3389/fpsyt.2022.807116] [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: 11/01/2021] [Accepted: 07/27/2022] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Despite existing work examining the effectiveness of smartphone digital interventions for schizophrenia at the group level, response to digital treatments is highly variable and requires more research to determine which persons are most likely to benefit from a digital intervention. MATERIALS AND METHODS The current work utilized data from an open trial of patients with psychosis (N = 38), primarily schizophrenia spectrum disorders, who were treated with a psychosocial intervention using a smartphone app over a one-month period. Using an ensemble of machine learning models, pre-intervention data, app use data, and semi-structured interview data were utilized to predict response to change in symptom scores, engagement patterns, and qualitative impressions of the app. RESULTS Machine learning models were capable of moderately (r = 0.32-0.39, R2 = 0.10-0.16, MAE norm = 0.13-0.29) predicting interaction and experience with the app, as well as changes in psychosis-related psychopathology. CONCLUSION The results suggest that individual smartphone digital intervention engagement is heterogeneous, and symptom-specific baseline data may be predictive of increased engagement and positive qualitative impressions of digital intervention in patients with psychosis. Taken together, interrogating individual response to and engagement with digital-based intervention with machine learning provides increased insight to otherwise ignored nuances of treatment response.
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Affiliation(s)
- George D Price
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States.,Quantitative Biomedical Sciences Program, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Michael V Heinz
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States.,Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Matthew D Nemesure
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States.,Quantitative Biomedical Sciences Program, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | | | - Nicholas C Jacobson
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States.,Quantitative Biomedical Sciences Program, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States.,Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States.,Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
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Patel C, Pilon D, Gupta D, Morrison L, Lafeuille MH, Lefebvre P, Benson C. National and regional description of healthcare measures among adult Medicaid beneficiaries with schizophrenia within the United States. J Med Econ 2022; 25:792-807. [PMID: 35635250 DOI: 10.1080/13696998.2022.2084234] [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: 10/18/2022]
Abstract
AIMS Provide the first national description across the US of variations in healthcare measures in 2018 among Medicaid beneficiaries with schizophrenia. MATERIALS AND METHODS Adult beneficiaries with ≥2 diagnoses for schizophrenia, and continuous enrollment with consistent geographical data in all of 2018 were identified from Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files (TAF) data for 45 of 50 states. Antipsychotic (AP) utilization rates, including long-acting injectable APs (LAIs), quality metrics, and all-cause healthcare resource utilization and costs for claims submitted to Medicaid were reported nationally and by state. Pearson correlation evaluated associations between LAI utilization and total healthcare costs at state and county levels. RESULTS Across the US 688,437 patients with schizophrenia were identified. The AP utilization rate was 51% (state range: 24-77%), while the LAI utilization rate was 13% (range: 4-26%). The proportion of patients adherent to any AP was 56% (range: 19-73%). Within 30 days post-discharge from an inpatient admission, 22% (range: 8-58%) of patients had an outpatient visit, and 12% (range: 4-48%) had a readmission. The proportion of patients with ≥1 inpatient admission and ≥1 emergency room visit was 34% (range: 19-82%) and 45% (range: 20-70%). Per-patient-per-year total healthcare costs averaged $32,920 (range: $717-$93,972). At the county level, a weak negative correlation was observed between LAI utilization and total healthcare costs. LIMITATIONS This study included Medicaid beneficiaries enrolled with pharmacy and medical benefits, including beneficiaries dually eligible for Medicare; results cannot be generalized to the overall schizophrenia population or those with other payer coverage. CONCLUSIONS In 2018, half of beneficiaries with schizophrenia did not submit any claims for APs to Medicaid, nearly half had an emergency room visit, and one-third had an inpatient admission. Moreover, healthcare measures varied considerably across states. These findings may indicate unmet treatment needs for Medicaid beneficiaries with schizophrenia.
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Affiliation(s)
- Charmi Patel
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
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27
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Zhdanava M, Starr HL, Totev TI, Lefebvre P, Shah A, Sheng K, Pilon D. Impact of COVID-19 Pandemic on Prescribing of Long-Acting Injectable Antipsychotics for Schizophrenia: Results from a United States Prescriber Survey. Neuropsychiatr Dis Treat 2022; 18:2003-2019. [PMID: 36101838 PMCID: PMC9464453 DOI: 10.2147/ndt.s379985] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/26/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To describe changes due to the COVID-19 pandemic in the prescribing of long-acting antipsychotics (LAI) for schizophrenia, patient outcomes, and patient and healthcare provider (HCP) attitudes regarding COVID-19 vaccination in the United States (US). METHODS An anonymous online survey was administered to US-based LAI prescribers with a psychiatry specialty in May 2021. Information on prescriber and clinical practice characteristics, LAI prescribing, patient outcomes, and attitudes toward COVID-19 vaccination was collected and described. RESULTS Of the 401 LAI prescribers meeting survey criteria, 64.6% reported that LAI prescribing remained unchanged (increase: 19.2%, decrease: 14.0%). The majority did not switch patients from LAIs to oral antipsychotics (OAP; 63.3%) or to LAI formulations with lower frequency of administration (68.1%); most prescribers switched the same number of patients from OAPs to LAIs during the pandemic as in previous practice (65.1%). Half of LAI prescribers (50.1%) reported antipsychotic adherence as unchanged among most patients; 44.6% reported symptom control/relapse frequency as unchanged. Most prescribers believed their patients with schizophrenia should be prioritized for COVID-19 vaccination (74.1%) and encouraged all patients to obtain a COVID-19 vaccine (84.0%). However, 64.1% of prescribers reported hesitancy among some patients about vaccines' safety; 51.4% reported that some patients were willing to be vaccinated despite the hesitancy, 48.6% indicated that some patients perceived COVID-19 vaccines as safe, effective, and important. CONCLUSION LAI prescribing and prescriber-reported antipsychotic adherence in patients with schizophrenia remained largely unchanged approximately one year after the start of COVID-19. Focused efforts to overcome patients' COVID-19 vaccine hesitancy are warranted.
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Affiliation(s)
| | - H Lynn Starr
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | | | | | - Aditi Shah
- Analysis Group, Inc., Montréal, QC, Canada
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Zhdanava M, Starr HL, Lefebvre P, Totev TI, Shah A, Sheng K, Pilon D. Understanding the Health System Conditions Affecting the Use of Long-Acting Injectable Antipsychotics in the Treatment of Schizophrenia in Clinical Practice: A US Healthcare Provider Survey. Neuropsychiatr Dis Treat 2022; 18:1479-1493. [PMID: 35910684 PMCID: PMC9326898 DOI: 10.2147/ndt.s369494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/30/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To describe factors that enable the routine use of long-acting injectable antipsychotics (LAIs) for appropriate patients in the current clinical practice, including changes in LAI prescribing due to the COVID-19 pandemic and expectations for prescribing in 2021 in the United States (US). METHODS Frequent LAI prescribers recruited from a nationwide panel in 2020 completed an online survey regarding practice characteristics, perspectives on healthcare system conditions enabling routine use of LAIs, and prescribing patterns and changes in patterns during the COVID-19 pandemic. RESULTS Of 408 prescribers who completed the survey, 77.7% were physicians and 59.1% had ≥10 years of psychiatry practice. More than half of frequent prescribers (57.1%) reported treating >20% of their patients with schizophrenia with LAIs. The American Psychiatric Association (APA) guideline was followed by 64.0% of prescribers. Most prescribers identified poor adherence to antipsychotics as a circumstance when LAIs are recommended (94.9%) and patient/caregiver involvement in treatment decisions as a key factor impacting the decision to prescribe LAIs (97.3%). Most prescribers reported that LAI prescribing rates were unchanged in 2020 (59.8%). Similar proportions of prescribers expected no change (44.1%) or an increase (42.9%) in LAI prescribing rates in 2021. The number of patients followed, cost of treatment, and availability of staff to administer LAIs were the main driving factors identified by prescribers expecting an increase in LAI prescribing rates. CONCLUSION LAIs were commonly recommended to patients with poor adherence, and patient/caregiver involvement was an important factor affecting prescribers' treatment decisions. LAI prescribing rates remained unchanged during the COVID-19 pandemic in 2020.
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Affiliation(s)
| | - H Lynn Starr
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | | | | | - Aditi Shah
- Analysis Group, Inc, Montréal, Quebec, Canada
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29
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Okusaga OO, Kember RL, Peloso GM, Peterson RE, Vujkovic M, Mitchell BG, Bernard J, Walder A, Bigdeli TB. History of Suicide Attempts and COVID-19 Infection in Veterans with Schizophrenia or Schizoaffective Disorder: Moderating Effects of Age and Body Mass Index. Complex Psychiatry 2021; 392:1789-1795. [PMID: 35128521 PMCID: PMC8805065 DOI: 10.1159/000521230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 11/27/2021] [Indexed: 12/11/2022] Open
Abstract
Introduction Relative to the general population, patients with schizophrenia or schizoaffective disorder have higher rates of suicide attempts and mortality from COVID-19 infection. Therefore, determining whether a history of suicide attempt is associated with COVID-19 in patients with schizophrenia or schizoaffective disorder has implications for COVID-19 vulnerability stratification in this patient population. Methods We carried out cross-sectional analyses of electronic health records of veterans with a diagnosis of schizophrenia or schizoaffective disorder that received treatment at any United States Veterans Affairs Medical Center between January 1, 2020, and January 31, 2021. We used logistic regression to estimate unadjusted and adjusted (including age, sex, race, marital status, body mass index (BMI), and a medical comorbidity score) odds ratios (ORs) for COVID-19 positivity in suicide attempters relative to nonattempters. Results A total of 101,032 veterans (mean age 56.67 ± 13.13 years; males 91,715 [90.8%]) were included in the analyses. There were 2,703 (2.7%) suicide attempters and 719 (0.7%) patients were positive for COVID-19. The association between history of suicide attempt and COVID-19 positivity was modified by age and BMI, such that the relationship was only significant in patients younger than 59 years, and in obese (BMI ≥30) patients (adjusted OR 3.42, 95% CI 2.02–5.79 and OR 2.85, 95% CI 1.65–4.94, respectively). Conclusions Higher rates of COVID-19 in young or obese suicide attempters with a diagnosis of schizophrenia or schizoaffective disorder might be due to the elevated risk for the infection in this subgroup of patients.
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Affiliation(s)
- Olaoluwa O Okusaga
- Mental Health Care Line, Michael E. DeBakey VA Medical Center, Houston, Texas, USA.,Menninger Department of Psychiatry, Baylor College of Medicine, Houston, Texas, USA
| | - Rachel L Kember
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Gina M Peloso
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Roseann E Peterson
- Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Mariana Vujkovic
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA.,Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Brian G Mitchell
- Mental Health Care Line, Michael E. DeBakey VA Medical Center, Houston, Texas, USA.,Menninger Department of Psychiatry, Baylor College of Medicine, Houston, Texas, USA
| | - Jared Bernard
- Mental Health Care Line, Michael E. DeBakey VA Medical Center, Houston, Texas, USA.,Menninger Department of Psychiatry, Baylor College of Medicine, Houston, Texas, USA
| | - Annette Walder
- Center for Innovations in Quality, Effectiveness and Safety (IQuEST), Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Tim B Bigdeli
- VA New York Harbor Healthcare System, Brooklyn, New York, USA.,Department of Psychiatry and Behavioral Sciences, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
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Asiimwe E, DeFraites E, Feher C. Refractory pain in a schizophrenic patient on clozapine. BMJ Case Rep 2021; 14:e246574. [PMID: 34711627 PMCID: PMC8557286 DOI: 10.1136/bcr-2021-246574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2021] [Indexed: 11/04/2022] Open
Abstract
A 36-year-old man with schizophrenia, on two times per day clozapine, presented with a 2-year history of diffuse intermittent body pain.Per chart review-and on presentation-his physical examination had been consistently unremarkable, without point-tenderness elicited at any major muscle groups or focal neurological deficits. Workup for myopathy, neuropathy and supratherapeutic clozapine levels had similarly been unrevealing.Given that prior interventions had been unsuccessful in alleviating these symptoms, we queried whether clozapine might have been contributory. As a result, we adopted a previously described strategy of scheduling the bulk of patients' medication during non-waking hours.At 1-month follow-up, the patient reported about a 50% improvement in his symptoms. At 6-month follow-up, this improvement in symptoms had been sustained.Our findings add to the limited anecdotal reports of this side effect whose true prevalence remains unknown. Timely recognition has the potential to promote adherence to therapy among patients in the maintenance phase.
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Affiliation(s)
- Edgar Asiimwe
- Department of Internal Medicine, UCLA, Los Angeles, California, USA
| | - Emily DeFraites
- Department of Psychiatry, UCLA, Los Angeles, California, USA
| | - Csilla Feher
- Psychiatry, Department of Veterans Affairs Los Angeles, Los Angeles, California, USA
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Pilon D, Patel C, Lafeuille MH, Zhdanava M, Lin D, Côté-Sergent A, Rossi C, Joshi K, Lefebvre P. Prevalence, incidence and economic burden of schizophrenia among Medicaid beneficiaries. Curr Med Res Opin 2021; 37:1811-1819. [PMID: 34281472 DOI: 10.1080/03007995.2021.1954894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To estimate the prevalence, incidence and economic burden of schizophrenia among Medicaid beneficiaries. METHODS Annual prevalence and incidence of schizophrenia among adult Medicaid beneficiaries were estimated during 2012-2017, by state and across six states (IA, KS, MS, MO, NJ and WI). The pooled estimate of the economic burden of schizophrenia was obtained during 1998Q1-2018Q1 across six states; adults with ≥2 diagnoses of schizophrenia were matched 1:1 to schizophrenia-free controls. The last observed schizophrenia diagnosis (schizophrenia cohort) or the last service claim (control cohort) with ≥12 months of continuous Medicaid enrollment before/after it defined the index date. Healthcare resource utilization (HRU) and costs ($2018 USD) incurred 12 months post-index were compared between cohorts. The economic burden of schizophrenia was also evaluated among young adults (18-34 years). RESULTS Annual prevalence of schizophrenia ranged between 2.30% and 2.71% and annual incidence between 0.31% and 0.39% during 2012-2016. In 2017, only states with the highest incidence and prevalence rates (KS, MS, MO) had data, resulting in higher prevalence (4.01%) and incidence (0.52%). For the economic burden, adults with schizophrenia (N = 158,763) had higher HRU and incurred $14,087 higher healthcare costs versus controls (mean: $28,644 vs. $14,557), driven by $4677 higher long-term care costs (all p < .001). Young adults with schizophrenia incurred $14,945 higher healthcare costs versus controls, driven by $3473 higher inpatient costs (p < 0.001). CONCLUSIONS Annual prevalence and incidence of schizophrenia varied by state but remained stable over time. Adults with schizophrenia incurred greater HRU and costs relative to adults without schizophrenia; the burden appeared comparable among young adults.
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Affiliation(s)
| | - Charmi Patel
- Janssen Scientific Affairs LLC, Titusville, NJ, USA
| | | | | | - Dee Lin
- Janssen Scientific Affairs LLC, Titusville, NJ, USA
| | | | | | - Kruti Joshi
- Janssen Scientific Affairs LLC, Titusville, NJ, USA
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Jung YS, Kim YE, Go DS, Yoon SJ. The prevalence, incidence, and admission rate of diagnosed schizophrenia spectrum disorders in Korea, 2008-2017: A nationwide population-based study using claims big data analysis. PLoS One 2021; 16:e0256221. [PMID: 34383865 PMCID: PMC8360527 DOI: 10.1371/journal.pone.0256221] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 08/02/2021] [Indexed: 11/19/2022] Open
Abstract
This study estimated the prevalence and incidence rate of schizophrenia, schizotypal, and delusional disorders (SSDD) in Korea from 2008 to 2017 and analyzed the hospital admission rate, re-admission rate, and hospitalization period. It used the Korean nationwide National Health Insurance Service claims database. SSDD patients who had at least one visit to Korea's primary, secondary, or tertiary referral hospitals with a diagnosis of SSDD, according to the International Classification of Diseases, 10th Revision (ICD-10), were identified as SSDD cases if coded as F20-F29. Data were analyzed using frequency statistics. Results showed that the 12-month prevalence rate of SSDD increased steadily from 0.40% in 2008 to 0.45% in 2017. Analysis of the three-year cumulative prevalence rate of SSDD showed an increase from 0.51% in 2011 to 0.54% in 2017. In 2017, the five-year cumulative prevalence rate was 0.61%, and the 10-year cumulative prevalence rate was 0.75%. The hospital admission rate among SSDD patients decreased from 2008 (30.04%) to 2017 (28.53%). The incidence of SSDD was 0.05% and no yearly change was observed. The proportion of SSDD inpatients whose first hospital visit resulted in immediate hospitalization was 22.4% in 2017. Epidemiological indicators such as prevalence, incidence, and hospitalization rate play an important role in planning social and financial resource allocation. Therefore, efforts to produce more accurate epidemiological indicators are very important and this study's findings could have a significant social impact.
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Affiliation(s)
- Yoon-Sun Jung
- Department of Public Health, Graduate School, Korea University, Seoul, Korea
| | - Young-Eun Kim
- Department of Big Data Strategy, National Health Insurance Service, Wonju, Korea
| | - Dun-Sol Go
- Department of Health Care Policy Research, Korea Institute for Health and Social Affairs, Sejong, Korea
| | - Seok-Jun Yoon
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea
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Pilon D, Patel C, Lafeuille MH, Zhdanava M, Lin D, Côté-Sergent A, Rossi C, Lefebvre P, Joshi K. Economic burden in Medicaid beneficiaries with recently relapsed schizophrenia or with uncontrolled symptoms of schizophrenia not adherent to antipsychotics. J Manag Care Spec Pharm 2021; 27:904-914. [PMID: 34185557 PMCID: PMC10391021 DOI: 10.18553/jmcp.2021.27.7.904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: Patients with schizophrenia struggle with disease relapses and uncontrolled symptoms, which can either result in or be a result of non-adherence to antipsychotics (APs). The economic burden of such patients is hypothesized to be substantial. OBJECTIVE: To evaluate the economic burden of recently relapsed schizophrenia or of uncontrolled symptoms of schizophrenia with non-adherence to APs in Medicaid beneficiaries. METHODS: Adults with ≥ 2 schizophrenia diagnoses and controls without schizophrenia were identified in Medicaid data (1997Q1-2018Q1) from Iowa, Kansas, Mississippi, Missouri, New Jersey, and Wisconsin. The index date was the last observed schizophrenia diagnosis (cohort with schizophrenia) or the last service claim (control cohort) with ≥ 12 months of continuous Medicaid enrollment before and after it. Cohorts were matched 1:1 using propensity scores. After matching, two subgroups were identified among adults with schizophrenia: (1) patients with schizophrenia and a recent relapse (≥ 1 schizophrenia-related inpatient or emergency department claim ≤ 60 days before or on the index date) and (2) patients with uncontrolled symptoms of schizophrenia (≥ 2 schizophrenia-related hospitalizations) and non-adherence to APs (proportion of days covered < 80%) in the 12-month pre-index period. Previously matched controls were then subset to patients in each subgroup and their matched pairs without schizophrenia, thus maintaining the 1:1 matching ratio. Healthcare resource utilization (HRU) and costs ($2018 USD) in the 12-month post-index (observation) period were compared between matched pairs using adjusted regression models. RESULTS: Among 158,763 patients with schizophrenia, 18,771 (11.8%) had a recent relapse (mean age 50.5 years; 48.6% female, 51.4% male) and 13,697 (8.6%) were not adherent to APs and had uncontrolled symptoms of schizophrenia (mean age 47.1 years; 48.0% female, 52.0% male). During the observation period, patients with recently relapsed schizophrenia and those non-adherent to APs with uncontrolled symptoms of schizophrenia had significantly higher HRU relative to their controls without schizophrenia. Patients with recently relapsed schizophrenia had mean total healthcare costs $21,862 higher relative to their controls ($37,424 vs $15,563), driven by $8,486 higher mean long-term care costs (all P < 0.001). Patients non-adherent to APs with uncontrolled symptoms of schizophrenia had adjusted mean total healthcare costs $20,787 higher relative to their controls ($38,337 vs $15,241), driven by $8,019 higher adjusted mean inpatient costs (all P < 0.001). Additional total healthcare costs incurred by patients with recently relapsed schizophrenia and those of patients non-adherent to APs with uncontrolled symptoms of schizophrenia exceeded by 55.2% and 47.6%, respectively, incremental total healthcare costs incurred by all patients with schizophrenia ($14,087). CONCLUSIONS: Patients with recently relapsed schizophrenia and those non-adherent to AP therapy with uncontrolled symptoms of schizophrenia incurred higher HRU and costs relative to patients without schizophrenia. Additional healthcare costs of these subgroups of patients with schizophrenia appeared higher than in the overall population with schizophrenia. DISCLOSURES: This study was supported by Janssen Scientific Affairs, LLC. The sponsor was involved in the study design, data collection, data analysis, manuscript preparation, and publication decisions. Pilon, Lafeuille, Zhdanava, Côté-Sergent, Rossi, and Lefebvre are employees of Analysis Group, Inc., a consulting company that has provided paid consulting services to Janssen Scientific Affairs, LLC, which funded the development and conduct of this study and manuscript. Patel, Joshi, and Lin are employees of Janssen Scientific Affairs, LLC and stockholders of Johnson & Johnson. Part of the material in this manuscript has been presented at the US Psych Congress, October 3-6, 2019, San Diego, CA, and at the Virtual ISPOR Meeting, May 18-20, 2020.
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Affiliation(s)
| | | | | | | | - Dee Lin
- Janssen Scientific Affairs, LLC, Titusville, NJ
| | | | | | | | - Kruti Joshi
- Janssen Scientific Affairs, LLC, Titusville, NJ
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McQuillan TJ, Franco JR, Sorg EM, Baller E, Quijije N, Rozental TD. Understanding and Addressing Psychiatric Comorbidities and Upper-Extremity Trauma: Surgeons in a Multidisciplinary Care Model. J Hand Surg Am 2021; 46:328-334. [PMID: 33637395 DOI: 10.1016/j.jhsa.2021.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/23/2020] [Accepted: 01/14/2021] [Indexed: 02/02/2023]
Abstract
Psychiatric disorders are a common cause of disability and represent an important risk factor for upper-extremity trauma. The review provides an overview of psychiatric illnesses as both contributors and sequelae of 4 major injury patterns: self-inflicted wrist lacerations, self-amputation, upper-extremity fractures, and burns. The authors develop a multidisciplinary model for upper-extremity surgeons to care for patients with psychiatric disorders, with an overview of capacity assessment, optimal psychiatric comanagement, and collaboration with allied health professionals.
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Affiliation(s)
| | | | - Emily M Sorg
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Erica Baller
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Nadia Quijije
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Tamara D Rozental
- Department of Orthopaedic Surgery, Harvard Medical School, Beth Israel Deaconess, Boston, MA.
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Lin D, Pilon D, Zhdanava M, Joshi K, Lafeuille MH, Côté-Sergent A, Vermette-Laforme M, Lefebvre P. Medication adherence, healthcare resource utilization, and costs among Medicaid beneficiaries with schizophrenia treated with once-monthly paliperidone palmitate or once-every-three-months paliperidone palmitate. Curr Med Res Opin 2021; 37:675-683. [PMID: 33507838 DOI: 10.1080/03007995.2021.1882412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Antipsychotics with reduced dosing frequency may improve adherence and clinical outcomes for patients with schizophrenia. This study compared treatment patterns, healthcare resource utilization (HRU), and costs between Medicaid beneficiaries with schizophrenia treated with once-monthly paliperidone palmitate (PP1M) and those who transitioned to once-every-three-months paliperidone palmitate (PP3M). METHODS Adults with schizophrenia were identified in a four-state Medicaid database (18 May 2014 to 31 March 2019). The index date was the first PP3M claim (PP3M cohort), or a random PP1M claim (PP1M cohort), following ≥4 months of continuous PP1M treatment among patients with ≥12 months of continuous Medicaid enrollment pre- and post-index. Adherence (proportion of days covered by the index treatment ≥80%), persistence (no gap >90/30 days in the PP3M/PP1M supply), HRU, and costs were compared during the 12-month post-index period between cohorts matched 1:1. RESULTS Among 2374 patients identified, 374 remained in each cohort after matching (mean age 42 years; 30.5% female). Compared to the PP1M cohort, the PP3M cohort was 2.39 times more likely to be adherent (p < .001), 4.63 times more likely to be persistent (p < .001), 33% less likely to have ≥1 hospitalization (p = .011), and 32% less likely to have ≥1 day with home care services (p = .012). Mean annual medical costs were similar between cohorts ($24,970 in the PP3M cohort and $25,736 in the PP1M cohort; p = .854). CONCLUSIONS Medicaid beneficiaries who transitioned to PP3M had higher adherence and persistence, and a reduced likelihood of hospitalization relative to those who continued treatment with PP1M. The results suggest potential clinical value to transitioning eligible patients to PP3M.
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Affiliation(s)
- Dee Lin
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | | | | | - Kruti Joshi
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
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Pesa J, Patel C, Rotter D, Papademetriou E, Potluri R, Benson C. Economic burden to commercial payers of young adults with schizophrenia in Colorado. J Med Econ 2021; 24:1194-1203. [PMID: 34666605 DOI: 10.1080/13696998.2021.1996381] [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: 10/20/2022]
Abstract
AIMS The primary objective was to examine direct costs and health resource utilization (HRU) among commercially insured young adults with schizophrenia (SCZ) in Colorado. MATERIALS AND METHODS The Colorado All-Payer Claims Database, covering approximately 76% of the insured Colorado population was used. Members aged 18-34, with and without SCZ, having commercial insurance were included. All-cause, mental health (MH) related and non-MH related per patient per month (PPPM) costs and per hundred patients per month (PHPPM) HRU were compared between an SCZ cohort and a propensity score matched non-SCZ cohort before and after index date up to 48 months. RESULTS Five hundred and one patients with SCZ and 2,510 matched individuals without SCZ were included. HRU and costs were higher for SCZ patients both pre- and post-index date. Pre-index, there were 32.3 (24.0 MH; 8.4 non-MH) PHPPM more office visits; 2.1 (2.7 MH) PHPPM more admissions; 104.8 (67.02 MH; 37.7 non-MH) PHPPM more prescriptions in the SCZ cohort (all p<.01). After index date, the SCZ cohort had 89.6 (81.3 MH; 9.2 non-MH) more PHPPM office visits, 7.2 (6.1 MH; 0.9 non-MH) PHPPM more admissions, and 181.6 (123.1 MH; 58.6 non-MH) PHPPM more prescriptions (all p<.001). All-cause costs in the pre-index period were $457 PPPM ($373 MH) higher for the SCZ cohort (p<.001). In the post-index period, all-cause costs for the SCZ cohort were $1,687 PPPM ($1,258 MH; $412 non-MH) higher (all p<.001). Approximately, 40% of patients with SCZ were on commercial insurance after four years compared with approximately 75% in the non-SCZ cohort. LIMITATIONS This study was based on data from a single state, thus may not be generalizable to other states. CONCLUSIONS Healthcare costs and HRU for young adults diagnosed with SCZ are significantly more burdensome to commercial payers than matched patients without SCZ, both before and after an official SCZ diagnosis.
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Affiliation(s)
| | - Charmi Patel
- Janssen Pharmaceuticals, LLC, Titusville, NJ, USA
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Warner AR, Shen GC, Hamilton JE, Lavagnino L, Lane SD. Customizing Early Intervention Treatment for Psychosis in the UTHealth - Harris County Psychiatric Center. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2021; 58:469580211049030. [PMID: 34622697 PMCID: PMC8511937 DOI: 10.1177/00469580211049030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
High-need, high-cost patients include those with diagnosed serious mental illnesses (e.g., schizophrenia; SMI). They often delay or fail to seek treatment. If they receive treatment, care is often sought from generalist settings (e.g., primary care or emergency medicine) or is suboptimal due to the provision of limited, non-evidence-based intervention and lack of communication, integration, and coordination among providers. This results in high aggregate costs and poor outcomes. Value-based health care requires care coordination to address the medical and social needs of this population. We describe a unique early intervention program for SMI that emanates from an inpatient setting: The Early Onset Treatment Program (EOTP) at the University of Texas Health Science Center at Houston-Harris County Psychiatric Center. The EOTP offers free, phase-specific, multidisciplinary treatment to young adults without health insurance with the aim of improving their long-term outcomes and reducing the rate of rehospitalization. An evaluation of the EOTP indicates program participants were significantly less likely to be rehospitalized at six months (4.73 times less likely) and at 12 months (3.5 times less likely) than a comparison group (p <.001), and participants' scores of symptomatology and disability significantly decreased following treatment.
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Affiliation(s)
- Alia R Warner
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, 12340University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Gordon C Shen
- Department of Management, Policy, and Community Health, School of Public Health, 12340University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jane E Hamilton
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, 12340University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Luca Lavagnino
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, 12340University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Scott D Lane
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, 12340University of Texas Health Science Center at Houston, Houston, TX, USA
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Dillinger RL, Kersun JM. Caring for caregivers: Understanding and meeting their needs in coping with first episode psychosis. Early Interv Psychiatry 2020; 14:528-534. [PMID: 31452318 DOI: 10.1111/eip.12870] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 11/16/2018] [Accepted: 08/06/2019] [Indexed: 11/30/2022]
Abstract
AIM The first episode of psychosis is a challenging time for both patients and those who care for them. Although literature on treatment is plentiful, literature on how to best support caregivers is more scarce. This review was undertaken to better understand the caregiver experience, determine which interventions most effectively alleviate their burden and examine which other factors may affect outcomes. METHODS Articles were retrieved from PubMed and OVID using the following search terms: first episode psychosis (FEP), schizophrenia, caregiver, intervention and burden in various combinations. Only peer-reviewed articles germane to FEP caregiver experience and interventions written in English were included. RESULTS Caregivers can experience grief, guilt and anxiety during this time. While concerned for their loved one, their own lives take a back seat and their mental and physical health are adversely affected. Some are better prepared to cope and are typically warm, decisive, confident and optimistic. Their families are organized and flexible. Others are less prepared and are more likely to have poor self-esteem, use avoidant coping strategies and be overly critical. Their families are controlling and have difficulty with communication and balance. These caregivers stand to benefit most from interventions. CONCLUSIONS Effective interventions incorporate psychoeducation, problem solving strategies, peer support and clinician guidance. A higher level of interaction with facilitators and peers is associated with better results. Benefits include decreases in caregiver burden, depressive and anxious symptoms and feelings of shame and isolation. Although the literature has yet to isolate the key factors of a successful intervention, this review provides practical suggestions for clinicians and further illustrates the need for more research.
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Affiliation(s)
| | - Jonathan M Kersun
- Department of Psychiatry, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
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Engemann K, Pedersen CB, Agerbo E, Arge L, Børglum AD, Erikstrup C, Hertel O, Hougaard DM, McGrath JJ, Mors O, Mortensen PB, Nordentoft M, Sabel CE, Sigsgaard T, Tsirogiannis C, Vilhjálmsson BJ, Werge T, Svenning JC, Horsdal HT. Association Between Childhood Green Space, Genetic Liability, and the Incidence of Schizophrenia. Schizophr Bull 2020; 46:1629-1637. [PMID: 32415773 PMCID: PMC8496913 DOI: 10.1093/schbul/sbaa058] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Childhood exposure to green space has previously been associated with lower risk of developing schizophrenia later in life. It is unclear whether this association is mediated by genetic liability or whether the 2 risk factors work additively. Here, we investigate possible gene-environment associations with the hazard ratio (HR) of schizophrenia by combining (1) an estimate of childhood exposure to residential-level green space based on the normalized difference vegetation index (NDVI) from Landsat satellite images, with (2) genetic liability estimates based on polygenic risk scores for 19 746 genotyped individuals from the Danish iPSYCH sample. We used information from the Danish registers of health, residential address, and socioeconomic status to adjust HR estimates for established confounders, ie, parents' socioeconomic status, and family history of mental illness. The adjusted HRs show that growing up surrounded by the highest compared to the lowest decile of NDVI was associated with a 0.52-fold (95% confidence interval [CI]: 0.40 to 0.66) lower schizophrenia risk, and children with the highest polygenic risk score had a 1.24-fold (95% CI: 1.18 to 1.30) higher schizophrenia risk. We found that NDVI explained 1.45% (95% CI: 1.07 to 1.90) of the variance on the liability scale, while polygenic risk score for schizophrenia explained 1.01% (95% CI: 0.77 to 1.46). Together they explained 2.40% (95% CI: 1.99 to 3.07) with no indication of a gene-environment interaction (P = .29). Our results suggest that risk of schizophrenia is associated additively with green space exposure and genetic liability, and provide no support for an environment-gene interaction between NDVI and schizophrenia.
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Affiliation(s)
- Kristine Engemann
- Section for Ecoinformatics and Biodiversity, Department of Bioscience, Aarhus University, 8000 Aarhus C, Denmark,Center for Biodiversity Dynamics in a Changing World (BIOCHANGE), Aarhus University, 8000 Aarhus C, Denmark,Centre for Integrated Register-Based Research, CIRRAU, Aarhus University, 8210 Aarhus V, Denmark,Big Data Centre for Environment and Health, Aarhus University, 8210 Aarhus V, Denmark,To whom correspondence should be addressed; Section for Ecoinformatics and Biodiversity, Department of Bioscience, Aarhus University, Ny Munkegade 114, 8000 Aarhus C, Denmark; tel: +45-87154316; fax: +45-87154323; e-mail:
| | - Carsten Bøcker Pedersen
- Centre for Integrated Register-Based Research, CIRRAU, Aarhus University, 8210 Aarhus V, Denmark,Big Data Centre for Environment and Health, Aarhus University, 8210 Aarhus V, Denmark,National Centre for Register-Based Research, Aarhus BSS, Department of Economics and Business Economics, Aarhus University, 8210 Aarhus V, Denmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus University, 8210 Aarhus V, Denmark
| | - Esben Agerbo
- Centre for Integrated Register-Based Research, CIRRAU, Aarhus University, 8210 Aarhus V, Denmark,National Centre for Register-Based Research, Aarhus BSS, Department of Economics and Business Economics, Aarhus University, 8210 Aarhus V, Denmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus University, 8210 Aarhus V, Denmark
| | - Lars Arge
- Center for Massive Data Algorithmics, MADALGO, and Department of Computer Science, Aarhus University, 8200 Aarhus N, Denmark
| | - Anders Dupont Børglum
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus University, 8210 Aarhus V, Denmark,Department of Biomedicine and Center for Integrative Sequencing, iSEQ, Aarhus University, 8000 Aarhus C, Denmark,Center for Genomics and Personalized Medicine, Aarhus University and Aarhus University Hospital, 8000 Aarhus C, Denmark
| | - Christian Erikstrup
- Big Data Centre for Environment and Health, Aarhus University, 8210 Aarhus V, Denmark,Department of Clinical Medicine, Aarhus University, 8200 Aarhus N, Denmark
| | - Ole Hertel
- Big Data Centre for Environment and Health, Aarhus University, 8210 Aarhus V, Denmark,Department of Environmental Science, Aarhus University, 4000 Roskilde, Denmark
| | - David Michael Hougaard
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus University, 8210 Aarhus V, Denmark,Department for Congenital Disorders, Statens Serum Institut, 2300 Copenhagen S, Denmark
| | - John J McGrath
- National Centre for Register-Based Research, Aarhus BSS, Department of Economics and Business Economics, Aarhus University, 8210 Aarhus V, Denmark,Queensland Brain Institute, The University of Queensland, St Lucia, QLD, Australia,Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia
| | - Ole Mors
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus University, 8210 Aarhus V, Denmark,Psychosis Research Unit, Aarhus University Hospital Psychiatry, 8200 Aarhus N, Denmark
| | - Preben Bo Mortensen
- Centre for Integrated Register-Based Research, CIRRAU, Aarhus University, 8210 Aarhus V, Denmark,National Centre for Register-Based Research, Aarhus BSS, Department of Economics and Business Economics, Aarhus University, 8210 Aarhus V, Denmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus University, 8210 Aarhus V, Denmark
| | - Merete Nordentoft
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus University, 8210 Aarhus V, Denmark,Mental Health Centre Copenhagen, Capital Region of Denmark, Copenhagen University Hospital, 2100 Copenhagen Ø, Denmark
| | - Clive Eric Sabel
- Big Data Centre for Environment and Health, Aarhus University, 8210 Aarhus V, Denmark,Department of Environmental Science, Aarhus University, 4000 Roskilde, Denmark
| | - Torben Sigsgaard
- Big Data Centre for Environment and Health, Aarhus University, 8210 Aarhus V, Denmark,Department of Public Health, Aarhus University, 8000 Aarhus C, Denmark
| | - Constantinos Tsirogiannis
- Center for Massive Data Algorithmics, MADALGO, and Department of Computer Science, Aarhus University, 8200 Aarhus N, Denmark
| | - Bjarni Jóhann Vilhjálmsson
- National Centre for Register-Based Research, Aarhus BSS, Department of Economics and Business Economics, Aarhus University, 8210 Aarhus V, Denmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus University, 8210 Aarhus V, Denmark
| | - Thomas Werge
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus University, 8210 Aarhus V, Denmark,Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen N, Denmark,Institute of Biological Psychiatry, Copenhagen Mental Health Services, 4000 Roskilde, Denmark
| | - Jens-Christian Svenning
- Section for Ecoinformatics and Biodiversity, Department of Bioscience, Aarhus University, 8000 Aarhus C, Denmark,Center for Biodiversity Dynamics in a Changing World (BIOCHANGE), Aarhus University, 8000 Aarhus C, Denmark
| | - Henriette Thisted Horsdal
- Big Data Centre for Environment and Health, Aarhus University, 8210 Aarhus V, Denmark,National Centre for Register-Based Research, Aarhus BSS, Department of Economics and Business Economics, Aarhus University, 8210 Aarhus V, Denmark
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Miley K, Hadidi N, Kaas M, Yu F. Cognitive Training and Remediation in First-Episode Psychosis: A Literature Review. J Am Psychiatr Nurses Assoc 2020; 26:542-554. [PMID: 31578909 PMCID: PMC7863980 DOI: 10.1177/1078390319877952] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND: Neurocognitive and social cognitive impairments are core characteristics of psychotic disorders, which are present in the first episode of psychosis (FEP) and strongly predict poor social functioning. Addressing cognitive impairments through cognitive training and remediation (CTR) may be a crucial component of recovery-oriented treatment. AIMS: The objectives of this review were to (1) evaluate the CTR theoretical basis and intervention components and (2) examine the effects of CTR on cognition and social functioning in FEP. METHOD: A combined search of Ovid Medline, Embase, and Psych Info databases was conducted using keywords. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Quality and risk of bias were assessed using established instruments. RESULTS: Ten randomized controlled trials were included in this review and had an overall fair to poor quality. CTR interventions in FEP utilize a range of theoretical backgrounds, with most including a focus on higher order cognitive processes. Varied doses and intervention components are used. All but one study found improvements in at least one cognitive domain. Global cognition, verbal learning, and memory and executive function were most commonly improved. Three studies found an effect on a range of functional outcomes. CONCLUSIONS: A broad range of CTR interventions have promising effects for addressing cognitive impairments in FEP. Evidence of functional impact is less consistent. Further research is needed in FEP on CTR targeting sensory and perceptual processes, and to identify CTR intervention targets and treatment components that will lead to robust improvements in cognition and functioning.
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Affiliation(s)
- Kathleen Miley
- Kathleen Miley, MSN, PMHNP-BC, University of Minnesota, Minneapolis, MN, USA
| | - Niloufar Hadidi
- Niloufar Hadidi, PhD, APRN, University of Minnesota, Minneapolis, MN, USA
| | - Merrie Kaas
- Merrie Kaas, PhD, PMHCNS-BC, University of Minnesota, Minneapolis, MN, USA
| | - Fang Yu
- Fang Yu, PhD, GNP-BC, University of Minnesota, Minneapolis, MN, USA
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Lin C, Strauss R, Hong J, Hamper JG, Hoy ES, Lazar AA, Kroon L. Impact of a pharmacist-administered long-acting injectable antipsychotic service in a supermarket-based community pharmacy on medication adherence. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2019. [DOI: 10.1002/jac5.1159] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Christine Lin
- Department of Clinical Pharmacy, School of Pharmacy; University of California; San Francisco California
- Albertsons Companies; Pleasanton California
| | | | - Jenny Hong
- Albertsons Companies; Pleasanton California
| | | | | | - Ann A. Lazar
- Department of Epidemiology and Biostatistics; University of California; San Francisco California
- Department of Preventive and Restorative Dental Sciences; University of California; San Francisco California
| | - Lisa Kroon
- Department of Clinical Pharmacy, School of Pharmacy; University of California; San Francisco California
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Pollak RM, Murphy MM, Epstein MP, Zwick ME, Klaiman C, Saulnier CA, Mulle JG. Neuropsychiatric phenotypes and a distinct constellation of ASD features in 3q29 deletion syndrome: results from the 3q29 registry. Mol Autism 2019; 10:30. [PMID: 31346402 PMCID: PMC6636128 DOI: 10.1186/s13229-019-0281-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 06/20/2019] [Indexed: 12/21/2022] Open
Abstract
Background The 1.6 Mb 3q29 deletion is associated with neurodevelopmental and psychiatric phenotypes, including increased risk for autism spectrum disorder (ASD) and a 20 to 40-fold increased risk for schizophrenia. However, the phenotypic spectrum of the deletion, particularly with respect to ASD, remains poorly described. Methods We ascertained individuals with 3q29 deletion syndrome (3q29Del, “cases,” n = 93, 58.1% male) and typically developing controls (n = 64, 51.6% male) through the 3q29 registry (https://3q29deletion.patientcrossroads.org). Self-report of neuropsychiatric illness was evaluated for 93 cases. Subsets of participants were evaluated with the Social Responsiveness Scale (SRS, n = 48 cases, 56 controls), Social Communication Questionnaire (n = 33 cases, 46 controls), Autism Spectrum Screening Questionnaire (n = 24 cases, 35 controls), and Achenbach Behavior Checklists (n = 48 cases, 57 controls). Results 3q29Del cases report a higher prevalence of autism diagnoses versus the general population (29.0% vs. 1.47%, p < 2.2E− 16). Notably, 3q29 deletion confers a greater influence on risk for ASD in females (OR = 41.8, p = 4.78E− 05) than in males (OR = 24.6, p = 6.06E− 09); this is aligned with the reduced male:female bias from 4:1 in the general population to 2:1 in our study sample. Although 71% of cases do not report a diagnosis of ASD, there is evidence of significant social disability (3q29Del SRS T-score = 71.8, control SRS T-score = 45.9, p = 2.16E− 13). Cases also report increased frequency of generalized anxiety disorder compared to controls (28.0% vs. 6.2%, p = 0.001), which is mirrored by elevated mean scores on the Achenbach diagnostic and statistical manual-oriented sub-scales (p < 0.001). Finally, cases show a distinct constellation of ASD features on the SRS as compared to idiopathic ASD, with substantially elevated Restricted Interests and Repetitive Behaviors, but only mild impairment in Social Motivation. Conclusions Our sample of 3q29Del is significantly enriched for ASD diagnosis, especially among females, and features of autism may be present even when an ASD diagnosis is not reported. Further, the constellation of ASD features in this population is distinct from idiopathic ASD, with substantially less impaired social motivation. Our study implies that ASD evaluation should be the standard of care for individuals with 3q29Del. From a research perspective, the distinct ASD subtype present in 3q29Del is an ideal entry point for expanding understanding of ASD. Electronic supplementary material The online version of this article (10.1186/s13229-019-0281-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rebecca M Pollak
- 1Genetics and Molecular Biology, Laney Graduate School, Emory University, Atlanta, USA
| | - Melissa M Murphy
- 2Department of Human Genetics, School of Medicine, Emory University, Atlanta, USA
| | - Michael P Epstein
- 2Department of Human Genetics, School of Medicine, Emory University, Atlanta, USA
| | - Michael E Zwick
- 2Department of Human Genetics, School of Medicine, Emory University, Atlanta, USA.,3Department of Pediatrics, School of Medicine, Emory University, Atlanta, USA
| | - Cheryl Klaiman
- 3Department of Pediatrics, School of Medicine, Emory University, Atlanta, USA.,4Marcus Autism Center, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, USA
| | - Celine A Saulnier
- 3Department of Pediatrics, School of Medicine, Emory University, Atlanta, USA
| | | | - Jennifer G Mulle
- 2Department of Human Genetics, School of Medicine, Emory University, Atlanta, USA.,5Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA.,Whitehead 305M, 615 Michael Street, Atlanta, GA 30322 USA
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Editorial for Special Issue: Neuroproteomics. Proteomes 2019; 7:proteomes7020024. [PMID: 31159207 PMCID: PMC6630506 DOI: 10.3390/proteomes7020024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 05/27/2019] [Indexed: 11/17/2022] Open
Abstract
Recent advances in mass spectrometry (MS) instrumentation [...].
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Cai Q, Patel C, Kim E, Connolly N, Tunceli O, El Khoury AC. Factors Associated with the Initiation of Long-Acting Injectable Paliperidone Palmitate Versus Aripiprazole Among Medicaid Patients with Schizophrenia: An Observational Study. Adv Ther 2019; 36:858-869. [PMID: 30848442 DOI: 10.1007/s12325-019-00913-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Factors underlying the selection of antipsychotics for patients with schizophrenia are poorly understood. This study investigated variables associated with initiation of treatment with the long-acting injectables paliperidone palmitate (LAI-PP) and aripiprazole LAI (LAI-AP) in Medicaid patients with schizophrenia. METHODS Adults with at least one medical or pharmacy claim for LAI-PP or LAI-AP from 1 January 2013 to 31 December 2016 were selected from the IBM® MarketScan® Medicaid Database. The date of the first LAI-PP or LAI-AP claim was the index date. Patients who had at least two medical claims, on different days, for a schizophrenia diagnosis and at least 12 months of continuous health plan enrollment prior to index date were included in the analysis. Multivariable logistic regression was performed to determine the factors associated with the initiation of LAI-PP versus LAI-AP. RESULTS Of included patients, 5501 initiated LAI-PP and 1449 initiated LAI-AP. Patients more likely to initiate LAI-PP versus LAI-AP were older, male, or African American (all p < 0.01). Patients with obesity (odds ratio [OR] 0.84; 95% confidence interval [CI] 0.71, 0.98), post-traumatic stress disorder (OR 0.76; 95% CI 0.63, 0.92), or prior oral antipsychotic use (OR 0.66; 95% CI 0.55, 0.79) were less likely to initiate LAI-PP; whereas, patients with nonorganic psychoses (OR 1.35; 95% CI 1.18, 1.55) or prior use of other injectable antipsychotics (OR 1.26; 95% CI 1.09, 1.47) were more likely to initiate LAI-PP versus LAI-AP. Patients with at least two all-cause hospitalizations were 1.37 times more likely to initiate LAI-PP vs LAI-AP (OR 1.37; 95% CI 1.18, 1.60). CONCLUSION Factors associated with initiating LAI-PP and LAI-AP differed. Notably, patients who initiated LAI-PP had greater prior use of medical services than LAI-AP patients. Understanding prescribing practices may help optimize treatment strategies and improve disease management. FUNDING Janssen Scientific Affairs, LLC.
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Affiliation(s)
- Qian Cai
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA.
| | - Charmi Patel
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | - Edward Kim
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | | | - Ozgur Tunceli
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
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Diviant JP, Vigil JM, Stith SS. The Role of Cannabis within an Emerging Perspective on Schizophrenia. MEDICINES 2018; 5:medicines5030086. [PMID: 30096776 PMCID: PMC6164121 DOI: 10.3390/medicines5030086] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 07/06/2018] [Accepted: 07/31/2018] [Indexed: 12/15/2022]
Abstract
Background: Approximately 0.5% of the population is diagnosed with some form of schizophrenia, under the prevailing view that the pathology is best treated using pharmaceutical medications that act on monoamine receptors. Methods: We briefly review evidence on the impact of environmental forces, particularly the effect of autoimmune activity, in the expression of schizophrenic profiles and the role of Cannabis therapy for regulating immunological functioning. Results: A review of the literature shows that phytocannabinoid consumption may be a safe and effective treatment option for schizophrenia as a primary or adjunctive therapy. Conclusions: Emerging research suggests that Cannabis can be used as a treatment for schizophrenia within a broader etiological perspective that focuses on environmental, autoimmune, and neuroinflammatory causes of the disorder, offering a fresh start and newfound hope for those suffering from this debilitating and poorly understood disease.
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Affiliation(s)
- Jegason P Diviant
- Department of Psychology, University of New Mexico, Albuquerque, NM 87131, USA.
| | - Jacob M Vigil
- Department of Psychology, University of New Mexico, Albuquerque, NM 87131, USA.
| | - Sarah S Stith
- Department of Economics, University of New Mexico, Albuquerque, NM 87131, USA.
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Niendam TA, Tully LM, Iosif AM, Kumar D, Nye KE, Denton JC, Zakskorn LN, Fedechko TL, Pierce KM. Enhancing early psychosis treatment using smartphone technology: A longitudinal feasibility and validity study. J Psychiatr Res 2018; 96:239-246. [PMID: 29126059 DOI: 10.1016/j.jpsychires.2017.10.017] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 10/02/2017] [Accepted: 10/18/2017] [Indexed: 11/26/2022]
Abstract
Smartphone applications that promote symptom tracking and self-management may improve treatment of serious mental illness (SMI). Although feasibility has been established in chronic adult outpatient or inpatient SMI samples, no data exist regarding implementation of smartphone technology in adolescent and young adult populations as part of early psychosis (EP) outpatient care. We implemented a smartphone "app" plus clinician Dashboard as an add-on treatment tool in the University of California, Davis Early Psychosis Program. Participants completed daily and weekly surveys examining mood, symptoms, and treatment relevant factors via the app for up to 14 months. Clinicians discussed symptom ratings and surveys during regular treatment sessions using the Dashboard. We report methodological details of the study, feasibility metrics, and analyses of the validity of measuring symptoms via self-report using mobile health (mHealth) technology in comparison to gold-standard clinician-rated interviews based on a comprehensive longitudinal analysis of within-person data. Results demonstrate that integrating mHealth technology into EP care is feasible and self-report assessment of symptoms via smartphone provides symptom data comparable to that obtained via gold-standard clinician-rated assessments.
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Affiliation(s)
- Tara A Niendam
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, United States
| | - Laura M Tully
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, United States.
| | - Ana-Maria Iosif
- Department of Public Health Sciences, Division of Biostatistics, University of California, Davis, United States
| | - Divya Kumar
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, United States
| | - Kathleen E Nye
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, United States
| | - Jennifer C Denton
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, United States
| | - Lauren N Zakskorn
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, United States
| | - Taylor L Fedechko
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, United States
| | - Katherine M Pierce
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, United States
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Caregiver burden in schizophrenia following paliperidone palmitate long acting injectables treatment: pooled analysis of two double-blind randomized phase three studies. NPJ SCHIZOPHRENIA 2017; 3:23. [PMID: 28751663 PMCID: PMC5532271 DOI: 10.1038/s41537-017-0025-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 06/22/2017] [Accepted: 06/26/2017] [Indexed: 11/09/2022]
Abstract
The pooled analysis of two double-blind, randomized, multicenter, phase-3 studies evaluated predictors of improvement or worsening of schizophrenia-related caregiver burden following paliperidone palmitate long-acting injectables (1-monthly [PP1M] and 3-monthly [PP3M]) treatment. Caregivers were offered to complete the involvement evaluation questionnaire (involvement evaluation questionnaire; 31-item scale). Total, 1498 caregivers (intent-to-treat open-label analysis set, n = 1497; mean [SD] age: 51.5 [13.02] years, 27 countries) were included: 49% were parents and >50% caregivers spent >32 hours/week in caregiving. Majority of caregivers with considerable burden (n = 1405; mean [SD] baseline involvement evaluation questionnaire scores: 28.4 [15.07]) improved significantly from baseline to end-of-study (n = 756; mean [SD] change from open-label baseline to double-blind endpoint in long-acting injectable scores:−8.9 [14.73]); most improvements were seen in urging followed by worrying, tension, and supervision domains (mean [SD] change from open-label baseline to double-blind endpoint in involvement evaluation questionnaire scores, urging: −3.7 [6.45]; worrying:−2.6 [5.11]; tension:−2.3 [4.84]; supervision: −1.3 [3.69]). Improvements significantly correlated with relapse status, patient age, and age of diagnosis (p < 0.001) while long-acting injectable use at baseline, number, and duration of prior psychiatric hospitalizations (<24 months) had no significant correlation. Caregiver burden was significantly improved for patients on prior oral antipsychotics post-switching to long-acting injectable, with less impact on leisure days and hours spent in caregiving (p < 0.001). Family members of patients with schizophrenia experience considerable caregiver burden. Switching from oral antipsychotic to long-acting injectable can provide meaningful and significant improvement in caregiver burden. Switching from oral to long-acting injectable antipsychotic medication improves overall caregiver burden. The physical, emotional and financial toll of providing care for patients with schizophrenia is often underestimated. Poor adherence to conventional oral antipsychotics is a major cause of symptomatic relapse in patients and of stress for carers. Srihari Gopal and colleagues at Janssen Pharmaceuticals have pooled data from two large studies involving 1498 caregivers across 27 countries. They found that administration of either 1- or 3-monthly long-acting injectable antipsychotics not only eased the burden of daily dosing and patient compliance, but also had a positive impact on the stress conditions of caregivers. Using the Involvement Evaluation Questionnaire to measure caregiver burden, the authors showed that the switch in drug formulation decreased the need to urge patients to self-care and the hours spent caregiving.
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Németh B, Molnár A, Akehurst R, Horváth M, Kóczián K, Németh G, Götze Á, Vokó Z. Quality-adjusted life year difference in patients with predominant negative symptoms of schizophrenia treated with cariprazine and risperidone. J Comp Eff Res 2017; 6:639-648. [PMID: 28511548 DOI: 10.2217/cer-2017-0024] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
AIM Our study aimed at estimating differences in quality-adjusted life year (QALY) gain for patients with predominant negative symptoms of schizophrenia treated with cariprazine compared with risperidone. MATERIALS & METHODS A Markov model was built, based on the Mohr-Lenert approach and data derived from clinical trials, to estimate potential QALY gains of patients. RESULTS Patients had higher probability of reaching better health states treated with cariprazine compared with risperidone. In the model, this resulted in an estimated QALY gain of 0.029 per patient, after 1 year of treatment. CONCLUSION Cariprazine, which showed clinically meaningful improvement in the symptoms, and personal and social performance, can also provide significant QALY gain in the treatment of patients with predominant negative symptoms of schizophrenia compared with risperidone.
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Affiliation(s)
| | | | - Ron Akehurst
- School of Health & Related Research, The University of Sheffield, UK
| | - Margit Horváth
- Business Development Department, Gedeon Richter Plc., Budapest, Hungary
| | - Kristóf Kóczián
- Business Development Department, Gedeon Richter Plc., Budapest, Hungary
| | - György Németh
- Medical Division, Gedeon Richter Plc., Budapest, Hungary
| | - Árpád Götze
- Business Development Department, Gedeon Richter Plc., Budapest, Hungary
| | - Zoltán Vokó
- Syreon Research Institute, Budapest, Hungary.,Department of Health Policy & Health Economics, Eötvös Loránd University, Budapest, Hungary
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Abstract
BACKGROUND Cost-of-illness (COI) studies provide useful information on the economic burden that schizophrenia imposes on a society. OBJECTIVES This study aims to give a general overview of COI studies for schizophrenia and to compare the societal cost of schizophrenia across countries. It also aims to identify the main cost components of schizophrenia and factors associated with higher societal cost to improve the quality and reporting of COI studies for schizophrenia. METHODS We performed an electronic search on multiple databases (MEDLINE, Embase, PsycINFO, Cochrane Database of Systematic Reviews, Health Management Information Consortium [HMIC] and the System for Information on Grey Literature [openSIGLE]) to identify COI studies of schizophrenia published between 1996 and 2016. The primary outcome of this review was societal cost per schizophrenia patient, by cost component. All costs were converted to $US, year 2015 values. RESULTS We included 19 studies in this review. The annual societal cost per patient varied from $US5818 in Thailand to $US94,587 in Norway; whereas the lifetime societal cost per patient was estimated to be $US988,264 in Australia (all year 2015 values). The main cost drivers were direct healthcare costs and productivity losses. Factors associated with higher individual costs included patient demographics, severity of disease and methods used to calculate the costs of productivity losses and comorbidities. CONCLUSIONS This review highlights the large economic burden of schizophrenia. The magnitude of the cost estimates differs considerably across countries, which might be caused by different economic conditions and healthcare systems and widespread methodological heterogeneity among COI studies. Proposed recommendations based on this review can be used to improve the consistency and comparability of COI studies for schizophrenia.
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Affiliation(s)
- Huajie Jin
- King's Health Economics (KHE), Institute of Psychiatry, Psychology and Neuroscience at King's College London, Box 024, The David Goldberg Centre, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK.
| | - Iris Mosweu
- King's Health Economics (KHE), Institute of Psychiatry, Psychology and Neuroscience at King's College London, Box 024, The David Goldberg Centre, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
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Hernandez M, Barrio C. Families and medication use and adherence among Latinos with schizophrenia. J Ment Health 2016; 26:14-20. [PMID: 27690706 DOI: 10.1080/09638237.2016.1222061] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Medication nonadherence among Latinos with schizophrenia represents a significant treatment obstacle. Although some studies have examined patient and family perceptions of adherence, few have examined these perceptions together. However, such knowledge can provide a deeper understanding of how family processes may contribute to or impede adherence among underserved groups such as Latinos. AIMS This study explored perceptions of medication and adherence among Latinos with schizophrenia and key family members. METHOD Purposive sampling was used to collect data from 34 participants: 14 patients with schizophrenia receiving community-based mental health services in an urban public setting and 20 key family members. Informed by grounded theory, semistructured interviews were analyzed by bilingual-bicultural team members. RESULTS Salient themes emerged indicating facilitators of and obstacles to medication use. Specifically, challenges centered on medication side effects, autonomy and choice, and illness insight, whereas facilitators focused on family support and holistic views of treatment and empowerment. CONCLUSIONS Because the majority of Spanish-speaking Latinos with schizophrenia live with family, it is important to examine family factors that may influence medication use. Findings suggest that patient and family perceptions of medication should be examined as part of the treatment process, particularly regarding issues of autonomy and choice.
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Affiliation(s)
- Mercedes Hernandez
- a School of Social Work, University of Southern California , Los Angeles , CA , USA
| | - Concepción Barrio
- a School of Social Work, University of Southern California , Los Angeles , CA , USA
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