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Deo AJ, Castro VM, Baker A, Carroll D, Gonzalez-Heydrich J, Henderson DC, Holt DJ, Hook K, Karmacharya R, Roffman JL, Madsen EM, Song E, Adams WG, Camacho L, Gasman S, Gibbs JS, Fortgang RG, Kennedy CJ, Lozinski G, Perez DC, Wilson M, Reis BY, Smoller JW. Validation of an ICD-Code-Based Case Definition for Psychotic Illness Across Three Health Systems. Schizophr Bull 2024:sbae064. [PMID: 38728421 DOI: 10.1093/schbul/sbae064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
BACKGROUND AND HYPOTHESIS Psychosis-associated diagnostic codes are increasingly being utilized as case definitions for electronic health record (EHR)-based algorithms to predict and detect psychosis. However, data on the validity of psychosis-related diagnostic codes is limited. We evaluated the positive predictive value (PPV) of International Classification of Diseases (ICD) codes for psychosis. STUDY DESIGN Using EHRs at 3 health systems, ICD codes comprising primary psychotic disorders and mood disorders with psychosis were grouped into 5 higher-order groups. 1133 records were sampled for chart review using the full EHR. PPVs (the probability of chart-confirmed psychosis given ICD psychosis codes) were calculated across multiple treatment settings. STUDY RESULTS PPVs across all diagnostic groups and hospital systems exceeded 70%: Mass General Brigham 0.72 [95% CI 0.68-0.77], Boston Children's Hospital 0.80 [0.75-0.84], and Boston Medical Center 0.83 [0.79-0.86]. Schizoaffective disorder PPVs were consistently the highest across sites (0.80-0.92) and major depressive disorder with psychosis were the most variable (0.57-0.79). To determine if the first documented code captured first-episode psychosis (FEP), we excluded cases with prior chart evidence of a diagnosis of or treatment for a psychotic illness, yielding substantially lower PPVs (0.08-0.62). CONCLUSIONS We found that the first documented psychosis diagnostic code accurately captured true episodes of psychosis but was a poor index of FEP. These data have important implications for the case definitions used in the development of risk prediction models designed to predict or detect undiagnosed psychosis.
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Affiliation(s)
- Anthony J Deo
- Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Rutgers-Robert Wood Johnson Medical School, Piscataway, NJ, USA
- Psychiatric Evaluation of Adolescent and Child Experiences (P.E.A.C.E.) Program, Rutgers University Behavioral Health Care, Piscataway, NJ, USA
| | - Victor M Castro
- Research Information Science and Computing, Mass General Brigham, Somerville, MA, USA
| | | | - Devon Carroll
- Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- College of Nursing, University of Rhode Island, Providence, RI, USA
| | - Joseph Gonzalez-Heydrich
- Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Tommy Fuss Center for Neuropsychiatric Disease Research, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- Early Psychosis Investigation Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - David C Henderson
- Boston Medical Center, Boston, MA, USA
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Daphne J Holt
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston MA, USA
| | - Kimberly Hook
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Rakesh Karmacharya
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Chemical Biology and Therapeutic Science Program, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Schizophrenia and Bipolar Disorder Program, McLean Hospital, Belmont, MA, USA
| | - Joshua L Roffman
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston MA, USA
| | - Emily M Madsen
- Psychiatric & Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Eugene Song
- Psychiatric & Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | | | | | | - Jada S Gibbs
- Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Rebecca G Fortgang
- Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Chris J Kennedy
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | | | - Daisy C Perez
- Boston Medical Center, Boston, MA, USA
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Marina Wilson
- Psychiatric & Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Ben Y Reis
- Predictive Medicine Group, Harvard Medical School, Boston, MA, USA
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA, USA
| | - Jordan W Smoller
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Psychiatric & Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute, Cambridge, MA, USA
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Birnbaum ML, Garrett C, Baumel A, Germano NT, Sosa D, Ngo H, John M, Dixon L, Kane JM. Examining the Effectiveness of a Digital Media Campaign at Reducing the Duration of Untreated Psychosis in New York State: Results From a Stepped-wedge Randomized Controlled Trial. Schizophr Bull 2024; 50:705-716. [PMID: 38408135 PMCID: PMC11059796 DOI: 10.1093/schbul/sbae018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
BACKGROUND AND HYPOTHESIS Longer duration of untreated psychosis (DUP) predicts worse outcomes in First Episode Psychosis (FEP). Searching online represents one of the first proactive step toward treatment initiation for many, yet few studies have informed how best to support FEP youth as they engage in early online help-seeking steps to care. STUDY DESIGN Using a stepped-wedge randomized design, this project evaluated the effectiveness of a digital marketing campaign at reducing DUP and raising rates of referrals to FEP services by proactively targeting and engaging prospective patients and their adult allies online. STUDY RESULTS Throughout the 18-month campaign, 41 372 individuals visited our website, and 371 advanced to remote clinical assessment (median age = 24.4), including 53 allies and 318 youth. Among those assessed (n = 371), 53 individuals (14.3%) reported symptoms consistent with psychotic spectrum disorders (62.2% female, mean age 20.7 years) including 39 (10.5%) reporting symptoms consistent with either Clinical High Risk (ie, attenuated psychotic symptoms; n = 26) or FEP (n = 13). Among those with either suspected CHR or FEP (n = 39), 20 (51.3%) successfully connected with care. The campaign did not result in significant differences in DUP. CONCLUSION This study highlights the potential to leverage digital media to help identify and engage youth with early psychosis online. However, despite its potential, online education and professional support alone are not yet sufficient to expedite treatment initiation and reduce DUP.
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Affiliation(s)
- Michael L Birnbaum
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA
- The Feinstein Institute for Medical Research, Manhasset, NY, USA
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | | | - Amit Baumel
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | - Nicole T Germano
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA
| | - Danny Sosa
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA
| | - Hong Ngo
- Department of Psychiatry, New York State Psychiatric Institute, New York, NY, USA
| | - Majnu John
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA
- The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Lisa Dixon
- Department of Psychiatry, New York State Psychiatric Institute, New York, NY, USA
| | - John M Kane
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA
- The Feinstein Institute for Medical Research, Manhasset, NY, USA
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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Bakola M, Peritogiannis V, Kitsou KS, Gourzis P, Hyphantis T, Jelastopulu E. Length of hospital stay in involuntary admissions in Greece: a 10-year retrospective observational study. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02653-x. [PMID: 38684516 DOI: 10.1007/s00127-024-02653-x] [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: 08/31/2023] [Accepted: 03/07/2024] [Indexed: 05/02/2024]
Abstract
PURPOSE The treatment of mental disorders has shifted from inpatient wards to community-based settings in recent years, but some patients may still have to be admitted to inpatient wards, sometimes involuntarily. It is important to maintain the length of hospital stay (LoS) as short as possible while still providing adequate care. The present study aimed to explore the factors associated with the LoS in involuntarily admitted psychiatric patients. METHODS A ten-year retrospective chart review of 332 patients admitted involuntarily to the inpatient psychiatric ward of the General University Hospital of Ioannina, Northwestern Greece, between 2008 and 2017 was conducted. RESULTS The mean LoS was 23.8 (SD = 33.7) days and was relatively stable over the years. Longer-stay hospitalization was associated with schizophrenia-spectrum disorder diagnosis, previous hospitalizations and the use of mechanical restraint, whereas patients in residential care experienced significantly longer LoS (52.6 days) than those living with a caregiver (23.5 days) or alone (19.4 days). Older age at disease onset was associated with shorter LoS, whereas no statistically significant differences were observed with regard to gender. CONCLUSION While some of our findings were in line with recent findings from other countries, others could not be replicated. It seems that multiple factors influence LoS and the identification of these factors could help clinicians and policy makers to design more targeted and cost-effective interventions. The optimization of LoS in involuntary admissions could improve patients' outcomes and lead to more efficient use of resources.
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Affiliation(s)
- Maria Bakola
- Department of Public Health, Medical School, University of Patras, Rio, 26500, Patras, Greece
| | - Vaios Peritogiannis
- Mobile Mental Health Unit of the Prefectures of Ioannina and Thesprotia, Society for the Promotion of Mental Health in Epirus, Ioannina, Greece
| | | | - Philippos Gourzis
- Department of Psychiatry, Medical School, University of Patras, Patras, Greece
| | - Thomas Hyphantis
- Department of Psychiatry, Division of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Eleni Jelastopulu
- Department of Public Health, Medical School, University of Patras, Rio, 26500, Patras, Greece.
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Benson NM, Yang Z, Fung V, Normand SL, Keshavan MS, Öngür D, Hsu J. Medical and Psychiatric Care Preceding the First Psychotic Disorder Diagnosis. Schizophr Bull 2024; 50:437-446. [PMID: 37606279 PMCID: PMC10919781 DOI: 10.1093/schbul/sbad125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
BACKGROUND Individuals with psychotic symptoms experience substantial morbidity and have shortened life expectancies; early treatment may mitigate the worst effects. Understanding care preceding a first psychotic disorder diagnosis is critical to inform early detection and intervention. STUDY DESIGN In this observational cohort study using comprehensive information from the Massachusetts All-Payer Claims Database, we identified the first psychotic disorder diagnosis in 2016, excluding those with historical psychotic disorder diagnoses in the prior 48 months among those continuous enrollment data. We reviewed visits, medications, and hospitalizations 2012-2016. We used logistic regression to examine characteristics associated with pre-diagnosis antipsychotic use. STUDY RESULTS There were 2505 individuals aged 15-35 years (146 per 100 000 similarly aged individuals in the database) with a new psychotic disorder diagnosis in 2016. Most (97%) had at least one outpatient visit in the preceding 48 months; 89% had a prior mental health diagnosis unrelated to psychosis (eg, anxiety [60%], depression [60%]). Many received psychotropic medications (77%), including antipsychotic medications (46%), and 68% had a visit for injury or trauma during the preceding 48 months. Characteristics associated with filling an antipsychotic medication before the psychotic disorder diagnosis included male sex and Medicaid insurance at psychosis diagnosis. CONCLUSIONS In this insured population of Massachusetts residents with a new psychotic disorder diagnosis, nearly all had some healthcare utilization, visits for injury or trauma were common, and nearly half filled an antipsychotic medication in the preceding 48 months. These patterns of care could represent either pre-disease signals, delays, or both in receiving a formal diagnosis.
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Affiliation(s)
- Nicole M Benson
- Psychotic Disorders Division, McLean Hospital, Belmont, MA, USA
- Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Zhiyou Yang
- Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Vicki Fung
- Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Sharon-Lise Normand
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
- Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Matcheri S Keshavan
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Dost Öngür
- Psychotic Disorders Division, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - John Hsu
- Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
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5
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Deo AJ, Castro VM, Baker A, Carroll D, Gonzalez-Heydrich J, Henderson DC, Holt DJ, Hook K, Karmacharya R, Roffman JL, Madsen EM, Song E, Adams WG, Camacho L, Gasman S, Gibbs JS, Fortgang RG, Kennedy CJ, Lozinski G, Perez DC, Wilson M, Reis BY, Smoller JW. Validation of an ICD-code-based case definition for psychotic illness across three health systems. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.28.24303443. [PMID: 38464074 PMCID: PMC10925367 DOI: 10.1101/2024.02.28.24303443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Background and Hypothesis Early detection of psychosis is critical for improving outcomes. Algorithms to predict or detect psychosis using electronic health record (EHR) data depend on the validity of the case definitions used, typically based on diagnostic codes. Data on the validity of psychosis-related diagnostic codes is limited. We evaluated the positive predictive value (PPV) of International Classification of Diseases (ICD) codes for psychosis. Study Design Using EHRs at three health systems, ICD codes comprising primary psychotic disorders and mood disorders with psychosis were grouped into five higher-order groups. 1,133 records were sampled for chart review using the full EHR. PPVs (the probability of chart-confirmed psychosis given ICD psychosis codes) were calculated across multiple treatment settings. Study Results PPVs across all diagnostic groups and hospital systems exceeded 70%: Massachusetts General Brigham 0.72 [95% CI 0.68-0.77], Boston Children's Hospital 0.80 [0.75-0.84], and Boston Medical Center 0.83 [0.79-0.86]. Schizoaffective disorder PPVs were consistently the highest across sites (0.80-0.92) and major depressive disorder with psychosis were the most variable (0.57-0.79). To determine if the first documented code captured first-episode psychosis (FEP), we excluded cases with prior chart evidence of a diagnosis of or treatment for a psychotic illness, yielding substantially lower PPVs (0.08-0.62). Conclusions We found that the first documented psychosis diagnostic code accurately captured true episodes of psychosis but was a poor index of FEP. These data have important implications for the development of risk prediction models designed to predict or detect undiagnosed psychosis.
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Affiliation(s)
- Anthony J. Deo
- Department of Psychiatry and Behavioral Sciences, Boston Children’s Hospital, Harvard Medical School, Boston, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
- Department of Psychiatry, Rutgers-Robert Wood Johnson Medical School, Piscataway, NJ
- Rutgers University Behavioral Health Care, Piscataway, NJ
| | - Victor M. Castro
- Research Information Science and Computing, Mass General Brigham, Somerville, MA
| | | | - Devon Carroll
- Department of Psychiatry and Behavioral Sciences, Boston Children’s Hospital, Harvard Medical School, Boston, MA
- University of Rhode Island, Providence, RI, USA
| | - Joseph Gonzalez-Heydrich
- Department of Psychiatry and Behavioral Sciences, Boston Children’s Hospital, Harvard Medical School, Boston, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
- Tommy Fuss Center for Neuropsychiatric Disease Research, Boston Children’s Hospital, Harvard Medical School, Boston, MA
- Early Psychosis Investigation Center, Boston Children’s Hospital, Harvard Medical School, Boston, MA
| | - David C. Henderson
- Boston Medical Center, Boston MA
- Boston University Chobanian & Avedisian School of Medicine, Boston MA
| | - Daphne J. Holt
- Department of Psychiatry, Harvard Medical School, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston MA
| | - Kimberly Hook
- Harvard T.H. Chan School of Public Health, Boston, MA
| | - Rakesh Karmacharya
- Department of Psychiatry, Harvard Medical School, Boston, MA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA
- Chemical Biology and Therapeutic Science Program, Broad Institute of MIT and Harvard, Cambridge, MA
- Schizophrenia and Bipolar Disorder Program, McLean Hospital, Belmont, MA
| | - Joshua L. Roffman
- Department of Psychiatry, Harvard Medical School, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston MA
| | - Emily M. Madsen
- Psychiatric & Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Eugene Song
- Psychiatric & Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - William G. Adams
- Boston Medical Center, Boston MA
- Boston University Chobanian & Avedisian School of Medicine, Boston MA
| | | | | | - Jada S. Gibbs
- Rutgers New Jersey Medical School, Newark, New Jersey 07103
| | - Rebecca G. Fortgang
- Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychology, Harvard University, Cambridge, MA
| | - Chris J. Kennedy
- Department of Psychiatry, Harvard Medical School, Boston, MA
- Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | | | - Daisy C. Perez
- Boston Medical Center, Boston MA
- Boston University Chobanian & Avedisian School of Medicine, Boston MA
| | - Marina Wilson
- Psychiatric & Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Ben Y. Reis
- Predictive Medicine Group, Harvard Medical School, Boston, MA
- Computational Health Informatics Program, Boston Children’s Hospital, Boston, MA
| | - Jordan W. Smoller
- Department of Psychiatry, Harvard Medical School, Boston, MA
- Psychiatric & Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute, Cambridge, MA
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Youn S, Guadagno BL, Byrne LK, Watson AE, Murrihy S, Cotton SM. Systematic Review and Meta-analysis: Rates of Violence During First-Episode Psychosis (FEP). Schizophr Bull 2024:sbae010. [PMID: 38412435 DOI: 10.1093/schbul/sbae010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND Most people with psychotic disorders will never commit an act of violence. However, the risk of violence committed by people with schizophrenia is higher than the general population. Violence risk is also known to be highest during the first episode of psychosis compared to later stages of illness. Despite this, there have been no comprehensive reviews conducted in the past 10 years examining rates of violence during FEP. We aimed to provide an updated review of the rate of violence in people with FEP. STUDY DESIGN Meta-analytical techniques were used to identify pooled proportions of violence according to severity (less serious, serious, severe) and timing of violence (before presentation, at first presentation, after presentation to services). STUDY RESULTS Twenty-two studies were included. The pooled prevalence was 13.4% (95% CI [9.0%-19.5%]) for any violence, 16.3% (95% CI [9.1%-27.4%]) for less serious violence, 9.7% (95% CI [5.4%-17.0%]) for serious violence and 2.7% for severe violence, regardless of time point. The pooled prevalence of any violence was 11.6% (95% CI [6.8%-18.9%]) before presentation, 20.8% (95% CI [9.8%-38.7%]) at first presentation and 13.3% (95% CI [7.3%-23.0%]) after presentation to services. CONCLUSION Overall, rates of violence appear to be lower in more recent years. However, due to the high between-study heterogeneity related to study design, the findings must be interpreted with consideration of sample characteristics and other contextual factors. The prevalence of violence remained high at all-time points, suggesting that more targeted, holistic, and early interventions are needed for clinical FEP groups.
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Affiliation(s)
- Sarah Youn
- Orygen, 35 Poplar Road, Parkville, Melbourne, Victoria 3052, Australia
- Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Melbourne, Victoria 3052, Australia
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, Victoria 3220, Australia
| | - Belinda L Guadagno
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, Victoria 3220, Australia
| | - Linda K Byrne
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, Victoria 3220, Australia
- Faculty of Psychology, Counselling and Psychotherapy, The Cairnmillar Institute, 391-393 Tooroonga Road, Hawthorn East, Victoria 3123, Australia
| | - Amity E Watson
- Orygen, 35 Poplar Road, Parkville, Melbourne, Victoria 3052, Australia
- Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Melbourne, Victoria 3052, Australia
| | - Sean Murrihy
- Orygen, 35 Poplar Road, Parkville, Melbourne, Victoria 3052, Australia
- Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Melbourne, Victoria 3052, Australia
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Melbourne, Victoria 3010, Australia
| | - Sue M Cotton
- Orygen, 35 Poplar Road, Parkville, Melbourne, Victoria 3052, Australia
- Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Melbourne, Victoria 3052, Australia
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7
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Ranchoff BL, Jeung C, Zeber JE, Simon GE, Ericson KM, Qian J, Geissler KH. Transitions in health insurance among continuously insured patients with schizophrenia. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2024; 10:25. [PMID: 38409218 PMCID: PMC10897200 DOI: 10.1038/s41537-024-00446-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/06/2024] [Indexed: 02/28/2024]
Abstract
Changes in health insurance coverage may disrupt access to and continuity of care, even for those who remain insured. Continuity of care is especially important in schizophrenia, which requires ongoing medical and pharmaceutical treatment. However, little is known about continuity of insurance coverage among those with schizophrenia. The objective was to examine the probability of insurance transitions for individuals with schizophrenia who were continuously insured and whether this varied across insurance types. The Massachusetts All-Payer Claims Database identified individuals with schizophrenia aged 18-64 who were continuously insured during a two-year period between 2014 and 2018. A logistic regression estimated the association of having an insurance transition - defined as having a change in insurance type - with insurance type at the start of the period, adjusting for age, sex, ZIP code in the lowest quartile of median income, and ZIP code with concentrated poverty. Overall, 15.1% had at least one insurance transition across a 24-month period. Insurance transitions were most frequent among those with plans from the Marketplace. In regression adjusted results, individuals covered by the traditional Medicaid program were 20.2 percentage points [pp] (95% confidence interval [CI]: 24.6 pp, 15.9 pp) less likely to have an insurance transition than those who were insured by a Marketplace plan. Insurance transitions among individuals with schizophrenia were common, with more than one in six people having at least one transition in insurance type during a two-year period. Given that even continuously insured individuals with schizophrenia commonly experience insurance transitions, attention to insurance transitions as a barrier to care access and continuity is warranted.
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Affiliation(s)
- Brittany L Ranchoff
- School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA.
| | - Chanup Jeung
- School of Public Health, State University of New York at Albany, Albany, NY, USA
| | - John E Zeber
- School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Gregory E Simon
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Keith M Ericson
- National Bureau for Economic Research, Cambridge, MA, USA
- Boston University Questrom School of Business, Boston, MA, USA
| | - Jing Qian
- School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Kimberley H Geissler
- Department of Healthcare Delivery and Population Sciences, UMass Chan Medical School-Baystate, Springfield, MA, USA
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8
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Saavedra JL, Crisanti A, Lardier DT, Tohen M, Lenroot R, Bustillo J, Halperin D, Friedman B, Loewy R, Murray-Krezan C, McIver S. The Cascade of Care for Early Psychosis Detection in a College Counseling Center. Psychiatr Serv 2024; 75:161-166. [PMID: 37554003 DOI: 10.1176/appi.ps.20230005] [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: 08/10/2023]
Abstract
OBJECTIVE Programs for early detection of psychosis help identify individuals experiencing emerging psychosis and link them with appropriate services, thereby reducing the duration of untreated psychosis (DUP). The authors used the cascade-of-care framework to identify various care stages between screening and enrollment in coordinated specialty care (CSC) and to determine attrition at each stage, with the goal of identifying points in the referral process that may affect DUP. METHODS Project partners included a college counseling center and CSC program. All college students seeking mental health services at a counseling center between 2020 and 2022 (N=1,945) completed the Prodromal Questionnaire-Brief (PQ-B) at intake. Students who met the distress cutoff score were referred for a phone screening. Those who met criteria on the basis of this screening were referred for assessment and possible enrollment into CSC. RESULTS Six stages in the cascade of care for early detection were identified. Of the students who completed the PQ-B as part of intake (stage 1), 547 (28%) met the PQ-B cutoff score (stage 2). Counselors referred 428 (78%) students who met the PQ-B cutoff score (stage 3), and 212 (50%) of these students completed the phone screening (stage 4). Seventy-two (34%) students completed a CSC eligibility assessment (stage 5), 21 (29%) of whom were enrolled in CSC (stage 6). CONCLUSIONS The cascade-of-care framework helped conceptualize the flow within a program for early psychosis detection in order to identify stages that may contribute to lengthier DUP. Future research is warranted to better understand the factors that contribute to DUP at these stages.
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Affiliation(s)
- Justine L Saavedra
- Department of Psychiatry and Behavioral Sciences (Saavedra, Crisanti, Lardier, Tohen, Lenroot, Bustillo, Halperin, Friedman) and Student Health and Counseling (McIver), University of New Mexico, Albuquerque; Weill Institute for Neurosciences, University of California San Francisco, San Francisco (Loewy); Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh (Murray-Krezan)
| | - Annette Crisanti
- Department of Psychiatry and Behavioral Sciences (Saavedra, Crisanti, Lardier, Tohen, Lenroot, Bustillo, Halperin, Friedman) and Student Health and Counseling (McIver), University of New Mexico, Albuquerque; Weill Institute for Neurosciences, University of California San Francisco, San Francisco (Loewy); Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh (Murray-Krezan)
| | - David T Lardier
- Department of Psychiatry and Behavioral Sciences (Saavedra, Crisanti, Lardier, Tohen, Lenroot, Bustillo, Halperin, Friedman) and Student Health and Counseling (McIver), University of New Mexico, Albuquerque; Weill Institute for Neurosciences, University of California San Francisco, San Francisco (Loewy); Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh (Murray-Krezan)
| | - Mauricio Tohen
- Department of Psychiatry and Behavioral Sciences (Saavedra, Crisanti, Lardier, Tohen, Lenroot, Bustillo, Halperin, Friedman) and Student Health and Counseling (McIver), University of New Mexico, Albuquerque; Weill Institute for Neurosciences, University of California San Francisco, San Francisco (Loewy); Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh (Murray-Krezan)
| | - Rhoshel Lenroot
- Department of Psychiatry and Behavioral Sciences (Saavedra, Crisanti, Lardier, Tohen, Lenroot, Bustillo, Halperin, Friedman) and Student Health and Counseling (McIver), University of New Mexico, Albuquerque; Weill Institute for Neurosciences, University of California San Francisco, San Francisco (Loewy); Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh (Murray-Krezan)
| | - Juan Bustillo
- Department of Psychiatry and Behavioral Sciences (Saavedra, Crisanti, Lardier, Tohen, Lenroot, Bustillo, Halperin, Friedman) and Student Health and Counseling (McIver), University of New Mexico, Albuquerque; Weill Institute for Neurosciences, University of California San Francisco, San Francisco (Loewy); Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh (Murray-Krezan)
| | - Dawn Halperin
- Department of Psychiatry and Behavioral Sciences (Saavedra, Crisanti, Lardier, Tohen, Lenroot, Bustillo, Halperin, Friedman) and Student Health and Counseling (McIver), University of New Mexico, Albuquerque; Weill Institute for Neurosciences, University of California San Francisco, San Francisco (Loewy); Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh (Murray-Krezan)
| | - Bess Friedman
- Department of Psychiatry and Behavioral Sciences (Saavedra, Crisanti, Lardier, Tohen, Lenroot, Bustillo, Halperin, Friedman) and Student Health and Counseling (McIver), University of New Mexico, Albuquerque; Weill Institute for Neurosciences, University of California San Francisco, San Francisco (Loewy); Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh (Murray-Krezan)
| | - Rachel Loewy
- Department of Psychiatry and Behavioral Sciences (Saavedra, Crisanti, Lardier, Tohen, Lenroot, Bustillo, Halperin, Friedman) and Student Health and Counseling (McIver), University of New Mexico, Albuquerque; Weill Institute for Neurosciences, University of California San Francisco, San Francisco (Loewy); Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh (Murray-Krezan)
| | - Cristina Murray-Krezan
- Department of Psychiatry and Behavioral Sciences (Saavedra, Crisanti, Lardier, Tohen, Lenroot, Bustillo, Halperin, Friedman) and Student Health and Counseling (McIver), University of New Mexico, Albuquerque; Weill Institute for Neurosciences, University of California San Francisco, San Francisco (Loewy); Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh (Murray-Krezan)
| | - Stephanie McIver
- Department of Psychiatry and Behavioral Sciences (Saavedra, Crisanti, Lardier, Tohen, Lenroot, Bustillo, Halperin, Friedman) and Student Health and Counseling (McIver), University of New Mexico, Albuquerque; Weill Institute for Neurosciences, University of California San Francisco, San Francisco (Loewy); Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh (Murray-Krezan)
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9
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West ML, Sharif S. Cannabis and Psychosis. Psychiatr Clin North Am 2023; 46:703-717. [PMID: 37879833 DOI: 10.1016/j.psc.2023.03.006] [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: 10/27/2023]
Abstract
Psychosis and cannabis use may overlap in multiple ways in young people. Research suggests that cannabis use increases risk for having psychotic symptoms, both attenuated (subthreshold) and acute. Cannabis use may also exacerbate psychosis symptoms among young people with underlying psychosis risk and psychotic disorders. Although there are suggestions for treating co-occurring psychosis and cannabis use in young people (e.g., incorporating cannabis use assessment and treatment strategies into specialized early psychosis care), there are many gaps in clinical trial research to support evidence-based treatment of these overlapping concerns.
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Affiliation(s)
- Michelle L West
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Health Sciences Building, 1890 N Revere Court, Mailstop F443, Aurora, CO 80045, USA.
| | - Shadi Sharif
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Health Sciences Building, 1890 N Revere Court, Mailstop F443, Aurora, CO 80045, USA
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10
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Ortiz-Orendain J, Gardea-Resendez M, Castiello-de Obeso S, Golebiowski R, Coombes B, Gruhlke PM, Michel I, Bostwick JM, Morgan RJ, Ozerdem A, Frye MA, McKean AJ. Antecedents to first episode psychosis and mania: Comparing the initial prodromes of schizophrenia and bipolar disorder in a retrospective population cohort. J Affect Disord 2023; 340:25-32. [PMID: 37506772 PMCID: PMC10883376 DOI: 10.1016/j.jad.2023.07.106] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/15/2023] [Accepted: 07/23/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVE We aim to compare the psychiatric antecedents of schizophrenia (SZ) and bipolar disorder (BD). METHODS Using the Rochester Epidemiology Project, we searched for residents of Olmsted County that had a diagnosis of SZ or BD. We confirmed each case using DSM-5 criteria and obtained the psychiatric antecedents. RESULTS We identified 205 cases with first episode psychosis or mania (SZ = 131; BD = 74). The mean age at first visit for mental health reasons was 12.3 ± 6.3 years for SZ and 13.9 ± 5.6 years for BD. The duration of the initial prodrome (time from first mental health visit to first episode) was similar for both groups (SZ 8.3 ± 6.2 years vs BD 7.3 ± 5.9 years). We found that SZ and BD have overlapping antecedents, but SZ was more common in males and in foreign born and had more learning deficits before the first episode. BD was more common in white population and had higher rates of depressive and adjustment disorders prior to first episode. BD also had more affective symptoms, nightmares, and panic attacks before the first episode. Both groups had similarly high rates of substance use (SZ 74 % vs BD 74.3 %), prescription of antidepressants (SZ 46.6 % vs BD 55.4 %) and stimulants (SZ 30.5 % vs BD 22.9 %). CONCLUSIONS The psychiatric antecedents of SZ and BD usually start during adolescence, overlap, and present in unspecific ways. The initial prodromes are more alike than distinct. Further studies are encouraged to continue looking for specific factors that distinguish the antecedents of these two disorders.
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Affiliation(s)
| | - Manuel Gardea-Resendez
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA; Department of Psychiatry, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Santiago Castiello-de Obeso
- Department of Experimental Psychology, University of Oxford, Oxford, UK; Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | | | - Brandon Coombes
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Peggy M Gruhlke
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Ian Michel
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
| | | | - Robert J Morgan
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Aysegul Ozerdem
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Mark A Frye
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Alastair J McKean
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA.
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11
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Kalin NH. New Insights Into Psychotic Disorders. Am J Psychiatry 2023; 180:779-781. [PMID: 37908098 DOI: 10.1176/appi.ajp.20230755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Affiliation(s)
- Ned H Kalin
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison
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12
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Oluwoye O, Lissau A, Stokes S, Selloni AT, James N, Amiri S, McDonell MG, Anglin DM. Study protocol for a multi-level cross-sectional study on the equitable reach and implementation of coordinated specialty care for early psychosis. Implement Sci Commun 2023; 4:90. [PMID: 37553719 PMCID: PMC10410783 DOI: 10.1186/s43058-023-00476-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 07/25/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Approximately 115,000 young adults will experience their first episode of psychosis (FEP) each year in the USA. Coordinated specialty care (CSC) for early psychosis is an evidence-based early intervention model that has demonstrated effectiveness by improving quality of life and reducing psychiatric symptoms for many individuals. Over the last decade, there has significant increase in the implementation of CSC programs throughout the USA. However, prior research has revealed difficulties among individuals and their family members accessing CSC. Research has also shown that CSC programs often report the limited reach of their program to underserved populations and communities (e.g., ethnoracial minorities, rural and low socioeconomic neighborhoods). Dissemination and implementation research focused on the equitable reach and implementation of CSC is needed to address disparities at the individual level. METHODS The proposed study will create a novel integrative multi-level geospatial database of CSC programs implemented throughout the USA that will include program-level data (e.g., geocoded location, capacity, setting, role availability), provider-level data (race, ethnicity, professional credentials), and neighborhood-level census data (e.g., residential segregation, ethnic density, area deprivation, rural-urban continua, public transit time). This database will be used to characterize variations in CSC programs by geographical location and examine the overall reach CSC programs to specific communities. The quantitative data will be combined with qualitative data from state administrators, providers, and service users that will inform the development of dissemination tools, such as an interactive dashboard, that can aid decision making. DISCUSSION Findings from this study will highlight the impact of outer contextual determinants on implementation and reach of mental health services, and will serve to inform the future implementation of CSC programs with a primary focus on equity.
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Affiliation(s)
- Oladunni Oluwoye
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA, 99210-1495, USA.
| | - Ari Lissau
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA, 99210-1495, USA
| | - Sheldon Stokes
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA, 99210-1495, USA
| | - Alexandria T Selloni
- Department of Psychology, City College of New York, City University of New York, New York, USA
| | - Najé James
- Department of Psychology, City College of New York, City University of New York, New York, USA
| | - Solmaz Amiri
- Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
- Institute for Research and Education to Advance Community Health, Washington State University, 1100 Olive Way, Ste 1200, Seattle, WA, 98101, USA
| | - Michael G McDonell
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA, 99210-1495, USA
| | - Deidre M Anglin
- Department of Psychology, City College of New York, City University of New York, New York, USA
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13
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Bansal P, Saini B, Sharma A, Bansal PD, Moria K, Saini S, Singh B. Short-term Clinical Outcome of Previously Untreated and Treated Schizophrenia and Impact of Duration of Untreated Psychosis. Indian J Psychol Med 2023; 45:366-373. [PMID: 37483578 PMCID: PMC10357906 DOI: 10.1177/02537176221141614] [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] [Indexed: 07/25/2023] Open
Abstract
Background Duration of untreated psychosis (DUP) is an important modifiable factor affecting schizophrenia outcomes. A dearth of research in India on untreated versus treated schizophrenia warrants further research. Methods This was a longitudinal study in a tertiary hospital over 2 years. Inpatients diagnosed with schizophrenia (N = 116), aged 18-45, were divided into untreated and treated groups. Diagnostic confirmation, severity assessment, and clinical outcome were done using ICD-10 criteria, Positive and Negative Syndrome Scale (PANSS), and Clinical Global Impression (CGI) scale. Follow-up was done at 12 and 24 weeks. DUP was measured, and its association with the outcome was assessed. Results Final analysis included 100 patients, 50 each of previously untreated and treated. Untreated patients had lower age and duration of illness (DOI), but higher DUP (p < .001). Treated patients showed much improvement on CGI-I at 12 weeks (p = .029), with no difference at 24 weeks. PANSS severity comparison showed no difference, and both groups followed a declining trend. In untreated patients, age of onset (AoO) was negatively correlated with severity (except general symptoms at baseline) at all follow-ups ('r' range = -0.32 to -0.49, p < .05), while DOI showed a positive correlation with negative and general symptoms at 12 weeks (r ~ 0.3, p < .05). Treated patients showed inconsistent and lower negative correlation between AoO and PANSS, with no correlation between severity and DOI. The mean sample DUP was 17.9 ± 31.6 weeks; it negatively correlated with education (r = -0.25, p = .01) and positively with PANSS severity ('r' range = 0.22 to 0.30, p < .05) at all follow-ups, especially negative symptoms. Patients with no or minimal improvement on CGI at 24 weeks had higher DUP (Quade's ANOVA F[1,98] = 6.24, p = .014). Conclusion Illness variables in untreated schizophrenia affect severity, which has delayed improvement than treated schizophrenia. Higher DUP is associated with negative symptoms of schizophrenia.
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Affiliation(s)
- Priyanka Bansal
- Dept. of Psychiatry, Government Medical College, Patiala, Punjab, India
| | - Bhavneesh Saini
- Dept. of Psychiatry, Government Medical College, Patiala, Punjab, India
| | - Arvind Sharma
- Dept. of Psychiatry, GGSMCH, Faridkot, Patiala, Punjab, India
| | - Pir Dutt Bansal
- Dept. of Psychiatry, GGSMCH, Faridkot, Patiala, Punjab, India
| | | | - Sumit Saini
- Dept. of Psychiatry, GGSMCH, Faridkot, Patiala, Punjab, India
| | - Baltej Singh
- Dept. of Community Medicine, GGSMCH, Faridkot, Punjab, India
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14
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Association between Arachidonic Acid and the Risk of Schizophrenia: A Cross-National Study and Mendelian Randomization Analysis. Nutrients 2023; 15:nu15051195. [PMID: 36904193 PMCID: PMC10005211 DOI: 10.3390/nu15051195] [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: 01/10/2023] [Revised: 02/20/2023] [Accepted: 02/24/2023] [Indexed: 03/08/2023] Open
Abstract
Polyunsaturated fatty acids (PUFAs), especially long-chain PUFAs (LCPUFAs), are crucial for both the structural and functional integrity of cells. PUFAs have been reported to be insufficient in schizophrenia, and the resulting cell membrane impairments have been hypothesized as an etiological mechanism. However, the impact of PUFA deficiencies on the onset of schizophrenia remain uncertain. We investigated the associations between PUFAs consumption and schizophrenia incidence rates through correlational analyses and conducted Mendelian randomization analyses to reveal the causal effects. Using dietary PUFA consumption and national schizophrenia incidence rates in 24 countries, we found that incidence rates of schizophrenia were inversely correlated with arachidonic acid (AA) and ω-6 LCPUFA consumption (rAA = -0.577, p < 0.01; rω-6 LCPUFA = -0.626, p < 0.001). Moreover, Mendelian randomization analyses revealed that genetically predicted AA and gamma-linolenic acid (GLA) were protective factors against schizophrenia (ORAA = 0.986, ORGLA = 0.148). In addition, no significant relationships were observed between schizophrenia and docosahexaenoic acid (DHA) or other ω-3 PUFAs. These findings show that the deficiencies of ω-6 LCPUFAs, especially AA, are associated with schizophrenia risk, which sheds novel insight into the etiology of schizophrenia and a promising diet supplementation for the prevention and treatment of schizophrenia.
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15
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West ML, Sharif S. Cannabis and Psychosis. Child Adolesc Psychiatr Clin N Am 2023; 32:69-83. [PMID: 36410907 DOI: 10.1016/j.chc.2022.07.004] [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: 11/20/2022]
Abstract
Psychosis and cannabis use may overlap in multiple ways in young people. Research suggests that cannabis use increases risk for having psychotic symptoms, both attenuated (subthreshold) and acute. Cannabis use may also exacerbate psychosis symptoms among young people with underlying psychosis risk and psychotic disorders. Although there are suggestions for treating co-occurring psychosis and cannabis use in young people (e.g., incorporating cannabis use assessment and treatment strategies into specialized early psychosis care), there are many gaps in clinical trial research to support evidence-based treatment of these overlapping concerns.
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Affiliation(s)
- Michelle L West
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Health Sciences Building, 1890 N Revere Court, Mailstop F443, Aurora, CO 80045, USA.
| | - Shadi Sharif
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Health Sciences Building, 1890 N Revere Court, Mailstop F443, Aurora, CO 80045, USA
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16
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Chubarovsky VV, Vanchakova NP, Zun SA, Parashchenko AF, Kolyago OO, Potapov IV, Savchenkov VA, Ushkalova AV. [Therapy of asthenic disorders after psychotic conditions in patients with cognitive impairment: results of an observational non-interventional program]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:81-87. [PMID: 37966444 DOI: 10.17116/jnevro202312310181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
OBJECTIVE An observational non-interventional study was conducted to obtain data on the efficacy and safety of Prospekta in the treatment of postpsychotic asthenia in patients with cognitive impairment (CI). MATERIAL AND METHODS We selected 69 patients aged 18-75 years with asthenic disorders that developed after suffering psychotic conditions and CI, who were prescribed Prospekta. At four visits (at baseline, after 2, 4 and 8 weeks), the doctor collected complaints, anamnesis, examined the patient, assessed the severity of asthenia on the MFI-20 (The Multidimensional Fatigue Inventory-20) scale, CI - on the MMSE (The Mini-mental state examination). Concomitant diseases and maintenance therapy of the underlying disease were recorded, and the safety of treatment with Prospect was evaluated. At the last visit, the doctor's clinical impression was assessed using the CGI-I (Clinical Global Impression - Global Improvement Scale). RESULTS The analysis included data from 69 patients (mean age 45.7 years), of which 27 (33.4%) were women. Prospekta reduced the severity of asthenia on the MFI-20 scale from 85.7±6.6 to 51.6±7.1 points, including general asthenia, mental and physical asthenia, and contributed to an increase in activity and motivation (p<0.001). 8-week treatment with Prospekta improved cognitive function on the MMSE scale from 25.7±3.7 to 28.8±1.5 points (p<0.001). There was no effect of the drug on blood pressure, heart rate. 76 adverse events (AEs) were detected in 22 patients, of which 62 AEs (82%) were of mild severity, 14 AEs (18%) were of moderate severity. A causal relationship of AEs with taking Prospekta, according to doctors, was absent in 48 (63%) cases. CONCLUSION Prospekta is an effective and safe drug for the treatment of asthenic disorders that have developed after suffering psychotic conditions in patients with CI.
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Affiliation(s)
- V V Chubarovsky
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - N P Vanchakova
- Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia
| | - S A Zun
- Kirov Military Medical Academy, St. Petersburg, Russia
| | | | - O O Kolyago
- Blokhin National Medical Research Center of Oncology, Moscow, Russia
- Mental Health Research Center, Moscow, Russia
| | - I V Potapov
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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17
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Pokowitz EL, Stiles BJ, Thomas R, Bullard K, Ludwig KA, Gleeson JF, Alvarez-Jimenez M, Perkins DO, Penn DL. User experiences of an American-adapted moderated online social media platform for first-episode psychosis: Qualitative analysis. Digit Health 2023; 9:20552076231176700. [PMID: 37252256 PMCID: PMC10214093 DOI: 10.1177/20552076231176700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 05/02/2023] [Indexed: 05/31/2023] Open
Abstract
Objectives The current study sought to qualitatively characterize the experiences of American users in a recent open trial of the Horyzons digital platform. Methods In total, 20 users on Horyzons USA completed semistructured interviews 12 weeks after their orientation to the platform and addressed questions related to (1) the platform, (2) their online therapist, and (3) the peer workers and community space. A hybrid inductive-deductive coding strategy was used to conduct a thematic analysis of the data (NCT04673851). Results The authors identified seven prominent themes that mapped onto the three components of self-determination theory. Features of the platform itself as well as inter- and intra-personal factors supported the autonomous use of Horyzons. Users also reflected that their perceived competence in social settings and in managing mental health was increased by the familiarity, privacy, and perceived safety of the platform and an emphasis on personalized therapeutic content. The behaviors or traits of online therapists as perceived by users and regular contact with peers and peer support specialists satisfied users' need for relatedness and promoted confidence in social settings. Users also described aspects of Horyzons USA that challenged their satisfaction of autonomy, competence, and relatedness, highlighting potential areas for future iterations of the platform's content and interface. Conclusions Horyzons USA is a promising digital tool that provides young adults with psychosis with the means to access tailored therapy material on demand and a supportive digital community to aid in the recovery process.
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Affiliation(s)
- Elena L Pokowitz
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Bryan J Stiles
- Department of Psychology and
Neuroscience, University of North Carolina at Chapel
Hill, Chapel Hill, NC, USA
| | - Riya Thomas
- Department of Psychology and
Neuroscience, University of North Carolina at Chapel
Hill, Chapel Hill, NC, USA
| | - Katherine Bullard
- Department of Psychology and
Neuroscience, University of North Carolina at Chapel
Hill, Chapel Hill, NC, USA
| | - Kelsey A Ludwig
- Department of Psychology and
Neuroscience, University of North Carolina at Chapel
Hill, Chapel Hill, NC, USA
| | - John F Gleeson
- School of Behavioural and Health
Sciences, Australian Catholic
University, Melbourne, VIC, Australia
| | - Mario Alvarez-Jimenez
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health,
University of Melbourne, Melbourne, VIC, Australia
| | - Diana O Perkins
- Department of Psychiatry, University of
North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - David L Penn
- Department of Psychology and
Neuroscience, University of North Carolina at Chapel
Hill, Chapel Hill, NC, USA
- School of Behavioural and Health
Sciences, Australian Catholic
University, Melbourne, VIC, Australia
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18
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Ferrara M, Franchini G, Funaro M, Cutroni M, Valier B, Toffanin T, Palagini L, Zerbinati L, Folesani F, Murri MB, Caruso R, Grassi L. Machine Learning and Non-Affective Psychosis: Identification, Differential Diagnosis, and Treatment. Curr Psychiatry Rep 2022; 24:925-936. [PMID: 36399236 PMCID: PMC9780131 DOI: 10.1007/s11920-022-01399-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE OF REVIEW This review will cover the most relevant findings on the use of machine learning (ML) techniques in the field of non-affective psychosis, by summarizing the studies published in the last three years focusing on illness detection and treatment. RECENT FINDINGS Multiple ML tools that include mostly supervised approaches such as support vector machine, gradient boosting, and random forest showed promising results by applying these algorithms to various sources of data: socio-demographic information, EEG, language, digital content, blood biomarkers, neuroimaging, and electronic health records. However, the overall performance, in the binary classification case, varied from 0.49, which is to be considered very low (i.e., noise), to over 0.90. These results are fully justified by different factors, some of which may be attributable to the preprocessing of the data, the wide variety of the data, and the a-priori setting of hyperparameters. One of the main limitations of the field is the lack of stratification of results based on biological sex, given that psychosis presents differently in men and women; hence, the necessity to tailor identification tools and data analytic strategies. Timely identification and appropriate treatment are key factors in reducing the consequences of psychotic disorders. In recent years, the emergence of new analytical tools based on artificial intelligence such as supervised ML approaches showed promises as a potential breakthrough in this field. However, ML applications in everyday practice are still in its infancy.
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Affiliation(s)
- Maria Ferrara
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, via Fossato di Mortara 64/A, Ferrara, Italy.
- Department of Psychiatry, Yale School of Medicine, 34 Park Street, New Haven, CT, USA.
| | - Giorgia Franchini
- Department of Physics, Informatics and Mathematics, University of Modena and Reggio Emilia, Via Campi 213/B, Modena, Italy
- Department of Mathematics and Computer Science, University of Ferrara, Via Macchiavelli 33, Ferrara, Italy
| | - Melissa Funaro
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, 333 Cedar St., New Haven, CT, USA
| | - Marcello Cutroni
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, via Fossato di Mortara 64/A, Ferrara, Italy
| | - Beatrice Valier
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, via Fossato di Mortara 64/A, Ferrara, Italy
| | - Tommaso Toffanin
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, via Fossato di Mortara 64/A, Ferrara, Italy
| | - Laura Palagini
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, via Fossato di Mortara 64/A, Ferrara, Italy
| | - Luigi Zerbinati
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, via Fossato di Mortara 64/A, Ferrara, Italy
| | - Federica Folesani
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, via Fossato di Mortara 64/A, Ferrara, Italy
| | - Martino Belvederi Murri
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, via Fossato di Mortara 64/A, Ferrara, Italy
| | - Rosangela Caruso
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, via Fossato di Mortara 64/A, Ferrara, Italy
| | - Luigi Grassi
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, via Fossato di Mortara 64/A, Ferrara, Italy
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Huang CL, Tsai IJ, Lee CWS. Risk of psychosis in illicit amphetamine users: a 10 year retrospective cohort study. EVIDENCE-BASED MENTAL HEALTH 2022; 25:163-168. [PMID: 35165118 PMCID: PMC10231478 DOI: 10.1136/ebmental-2021-300300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 12/18/2021] [Indexed: 11/04/2022]
Abstract
QUESTION Amphetamine use is a risk factor for psychosis, which imposes a substantial burden on society. We aimed to investigate the incidence of psychosis associated with illicit amphetamine use and whether rehabilitation treatments could influence the psychosis risk. STUDY SELECTION AND ANALYSIS A retrospective cohort study was conducted using the population based Taiwan Illicit Drug Issue Database (TIDID) and the National Health Insurance Research Database (NHIRD), from 2007 to 2016. We identified 74 601 illicit amphetamine users as the amphetamine cohort and 2 98 404 subjects as the non-amphetamine cohort. The incidence rate of newly diagnosed psychosis was the main outcome. Cox proportional hazards models were applied to assess the effects of amphetamine, and the Kaplan-Meier method was used to estimate the cumulative psychosis incidence curves. FINDINGS Illicit amphetamine users were 5.28 times more likely to experience psychosis than those without illicit drug use records. The risk was higher for subjects with multiple arrests for amphetamine use. A greater hazard ratio (HR) magnitude was observed in female patients. We also observed a significant decrease in the risk of psychosis in patients receiving rehabilitation treatments during deferred prosecution (adjusted HR 0.74, 95% CI 0.61 to 0.89). CONCLUSIONS Illicit amphetamine use was associated with an increased incidence of psychosis. The risk was identified across all age groups, particularly in women and in those arrested multiple times, and was inversely correlated with rehabilitation treatments for amphetamine misuse.
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Affiliation(s)
- Chieh-Liang Huang
- Tsaotun Psychiatric Centre Ministry of Health and Welfare, Nan-Tou County, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - I-Ju Tsai
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Cynthia Wei-Sheng Lee
- Centre for Drug Abuse and Addiction, China Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
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20
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Benson NM, Yang Z, Weiss M, Fung V, Moran LV, Öngür D, Hsu J. Identifying Diagnoses of Schizophrenia Spectrum Disorder in Large Data Sets. Psychiatr Serv 2022; 73:1210-1216. [PMID: 35440163 PMCID: PMC9582046 DOI: 10.1176/appi.ps.202100696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Objective The authors used a large clinical data set to determine which index diagnoses of schizophrenia spectrum disorder were new diagnoses. Methods Using the Massachusetts All-Payer Claims Database (2012–2016), the authors identified patients with a schizophrenia spectrum disorder diagnosis in 2016 (index diagnosis) and then reviewed patients’ care histories for the previous 12, 24, 36, and 48 months to identify previous diagnoses. Logistic regression was used to examine patient characteristics associated with the index diagnosis being a new diagnosis. Results Overall, 7,217 individuals ages 15–35 years had a 2016 diagnosis of schizophrenia spectrum disorder; 67.7% had at least 48 months of historical data. Among those with at least 48 months of care history, 23% had no previous diagnoses. Diagnoses from inpatient psychiatric admissions or among female or younger patients were more likely to represent new diagnoses, compared with diagnoses from most other diagnosis locations or among males or older age groups, and outpatient diagnoses were less likely to represent new diagnoses than were most other diagnosis settings. Reviewing 48 instead of 12 months of data reduced estimated rates of new diagnoses from 112 to 66 per 100,000 persons; historical diagnoses were detected for 61% and 77% of patients with 12 or 48 months of care history, respectively. Conclusions Examining multiple years of patient history spanning all payers and providers is critical to identifying new schizophrenia spectrum disorder diagnoses in large data sets. Review of 48 months of care history resulted in lower rates of new schizophrenia spectrum disorder diagnoses than previously reported.
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Affiliation(s)
- Nicole M. Benson
- McLean Hospital, Harvard Medical School, Belmont, MA
- Mongan Institute, Massachusetts General Hospital, Boston, MA
| | - Zhiyou Yang
- Mongan Institute, Massachusetts General Hospital, Boston, MA
| | - Max Weiss
- Mongan Institute, Massachusetts General Hospital, Boston, MA
| | - Vicki Fung
- Mongan Institute, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | | | - Dost Öngür
- McLean Hospital, Harvard Medical School, Belmont, MA
| | - John Hsu
- Mongan Institute, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
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21
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Ignatova D, Krasteva K, Akabalieva K, Alexiev S. Post-COVID-19 psychosis: Cotard's syndrome and potentially high risk of harm and self-harm in a first-onset acute and transient psychotic disorder after resolution of COVID-19 pneumonia. Early Interv Psychiatry 2022; 16:1159-1162. [PMID: 34796667 PMCID: PMC8653068 DOI: 10.1111/eip.13254] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/20/2021] [Accepted: 11/07/2021] [Indexed: 01/23/2023]
Abstract
AIM This report aims to illustrate the possibility of an acute onset of psychosis after COVID-19 infection in a patient without previous history of psychiatric disorders and to highlight the need for early screening and intervention in such cases. METHODS Clinical presentation of a case, followed by clinical discussion and literature review of the effect of the new coronavirus SARS-CoV-2 and its impact on mental health in terms of neuropsychiatric conditions. RESULTS We present a case of acute and transient psychotic disorder following complete recovery of COVID-19 bilateral pneumonia. The patient has no prior psychiatric history and presents with acute onset, disorganized behaviour, Cotard's delusion and a potentially high risk of psychotic homicide and suicide. CONCLUSION Early intervention and treatment with antipsychotic medication are of crucial importance for the effective treatment and complete recovery of these patients.
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Affiliation(s)
- Desislava Ignatova
- Department of Psychiatry and Medical Psychology, Faculty of Medicine, Medical University - Sofia, Bulgaria.,Clinic of Psychiatry, University Hospital Alexandrovska, Sofia, Bulgaria
| | - Kristina Krasteva
- Clinic of Psychiatry, University Hospital Alexandrovska, Sofia, Bulgaria
| | - Katerina Akabalieva
- Department of Psychiatry and Medical Psychology, Faculty of Medicine, Medical University - Sofia, Bulgaria.,Clinic of Psychiatry, University Hospital Alexandrovska, Sofia, Bulgaria
| | - Spiridon Alexiev
- Department of Psychiatry and Medical Psychology, Faculty of Medicine, Medical University - Sofia, Bulgaria.,Clinic of Psychiatry, University Hospital Alexandrovska, Sofia, Bulgaria
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22
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Hafeez D, Yung AR. Early persistence of psychotic-like experiences in a community sample of adolescents. Early Interv Psychiatry 2021; 15:1575-1583. [PMID: 33283458 DOI: 10.1111/eip.13096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 09/22/2020] [Accepted: 11/14/2020] [Indexed: 01/20/2023]
Abstract
AIMS Psychotic-like experiences (PLEs) are common in adolescents. Their persistence may confer increased susceptibility to psychotic disorder. The early evolution of transient to persistent PLEs is not well known. This study aimed to investigate the early persistence of PLEs (over 6-12 months) in a community sample of adolescents and examine baseline and longitudinal associations of early persistent PLEs. METHODS Five hundred and ninety Year 10 students were administered the community assessment of psychic experiences (CAPE) to measure PLEs at baseline and at follow up 6-12 months later. Persistent PLEs were defined as those present at or above the 90th centile at both time points. Independent variables of depression, psychological distress and functioning were all measured at both baseline and follow up. Self-esteem, personality and suicidality were assessed at follow up. RESULTS The study found 5.1% of participants had early persistent PLEs. Persistence was associated positively with depression and distress at both time points, neuroticism and openness at baseline and suicidality at follow up. Persistence was negatively associated with functioning at both time points, agreeableness at baseline and self-esteem at follow-up. Only depression remained significantly associated at both time points when accounting for other variables. Thus, depressive symptoms may account for changes in other domains and be a predictor of early PLEs persistence. CONCLUSIONS These results reinforce the importance of monitoring and assessing PLEs in young people especially when associated with depression. Further research is required to investigate PLE persistence over longer periods with increased measurement intervals.
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Affiliation(s)
- Danish Hafeez
- School of Medical Sciences, The University of Manchester, Manchester, UK
| | - Alison R Yung
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia.,School of Health Sciences, The University of Manchester, Manchester, UK
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23
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Kopelovich SL, Stiles B, Monroe-DeVita M, Hardy K, Hallgren K, Turkington D. Psychosis REACH: Effects of a Brief CBT-Informed Training for Family and Caregivers of Individuals With Psychosis. Psychiatr Serv 2021; 72:1254-1260. [PMID: 34015942 DOI: 10.1176/appi.ps.202000740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Psychosis Recovery by Enabling Adult Carers at Home (Psychosis REACH) is a training for families of individuals with psychosis that consists of recovery-oriented psychosis psychoeducation, caregiver self-care, and skills training informed by cognitive-behavioral therapy for psychosis (CBTp). The authors assessed the effects of a 1-day and a 4-day training on the natural supports (i.e., family and other caregivers) of individuals with psychotic disorders. METHODS Attendees of a 1-day (N=168) and a 4-day (N=29) Psychosis REACH training were surveyed at three timepoints: pretraining, posttraining, and 4-month follow-up. Longitudinal changes across the full sample were evaluated by paired-sample t tests or a one-way repeated-measures analysis of variance (ANOVA). Two-way mixed ANOVAs were conducted with training condition, time, and the training condition × time interactions entered into the model. RESULTS Reductions were noted in self-perceived depression, anxiety, negative aspects of the caregiving experience, and expressed emotion. Trainees also showed more prosocial attitudes toward psychosis immediately and at 4 months after the training. CONCLUSIONS This evaluation of the launch of Psychosis REACH in the United States suggests that the training can improve the mental health, attitudinal, and relational outcomes of family and caregivers of individuals with psychosis. Given the dearth of CBTp and family interventions for psychosis in mental health services in the United States, short-term, intensive training that supplements clinical services has intuitive appeal as a means of surmounting the barriers that have plagued family interventions.
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Affiliation(s)
- Sarah L Kopelovich
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Kopelovich, Stiles, Monroe-DeVita, Hallgren); Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California (Hardy); Northumberland Tyne and Wear National Health Service Foundation Trust, Newcastle Upon Tyne, United Kingdom (Turkington)
| | - Bryan Stiles
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Kopelovich, Stiles, Monroe-DeVita, Hallgren); Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California (Hardy); Northumberland Tyne and Wear National Health Service Foundation Trust, Newcastle Upon Tyne, United Kingdom (Turkington)
| | - Maria Monroe-DeVita
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Kopelovich, Stiles, Monroe-DeVita, Hallgren); Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California (Hardy); Northumberland Tyne and Wear National Health Service Foundation Trust, Newcastle Upon Tyne, United Kingdom (Turkington)
| | - Kate Hardy
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Kopelovich, Stiles, Monroe-DeVita, Hallgren); Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California (Hardy); Northumberland Tyne and Wear National Health Service Foundation Trust, Newcastle Upon Tyne, United Kingdom (Turkington)
| | - Kevin Hallgren
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Kopelovich, Stiles, Monroe-DeVita, Hallgren); Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California (Hardy); Northumberland Tyne and Wear National Health Service Foundation Trust, Newcastle Upon Tyne, United Kingdom (Turkington)
| | - Douglas Turkington
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Kopelovich, Stiles, Monroe-DeVita, Hallgren); Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California (Hardy); Northumberland Tyne and Wear National Health Service Foundation Trust, Newcastle Upon Tyne, United Kingdom (Turkington)
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24
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Esque J, Rasmussen A, Spada M, Gopalan P, Sarpal D. First-Episode Psychosis and the Role of the Psychiatric Consultant. J Acad Consult Liaison Psychiatry 2021; 63:32-35. [PMID: 34325090 DOI: 10.1016/j.jaclp.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Timely recognition and treatment of first-episode psychosis (FEP) is paramount. Studies suggest a significant relationship between longer duration of untreated psychosis and poorer functional outcomes. Limited data exist that characterize how treatment for FEP is initiated by consultation-liaison psychiatric services. We conducted a systematic review of FEP treatment by a consultation-liaison service at a large academic medical tertiary care. Approach to care was reviewed including recommendations for clinical assessment and management. METHODS Psychiatric consultations performed at a tertiary academic center were reviewed to identify potential FEP cases during a 12-month period. Patients of ages 15-49 years, for whom the diagnostic assessment was concerning for possible FEP, were included. Demographic features and management were summarized. RESULTS A total of 3365 new psychiatric consults were conducted during our study period. Of these, 28 were identified as having symptoms consistent with possible FEP (0.83% of total sample). However, only 12% were referred to coordinated specialty care for psychosis after discharge from an inpatient medical or psychiatric hospital. CONCLUSIONS The results of our systemic chart review indicate that workup, management, and disposition recommendations for FEP patients seen by consultation-liaison services are variable, suggesting a need for a standardized, evidence-based approach in the medical setting.
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Affiliation(s)
- Jacquelin Esque
- Department of Psychiatry, University of Pittsburgh Medical Center, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA.
| | - Amy Rasmussen
- Department of Psychiatry, University of Pittsburgh Medical Center, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Meredith Spada
- Department of Psychiatry, University of Pittsburgh Medical Center, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Priya Gopalan
- Department of Psychiatry, University of Pittsburgh Medical Center, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Deepak Sarpal
- Department of Psychiatry, University of Pittsburgh Medical Center, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA
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25
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The impact of study design on schizophrenia incidence estimates: A systematic review of Northern European studies 2008-2019. Schizophr Res 2021; 231:134-141. [PMID: 33839371 DOI: 10.1016/j.schres.2021.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 03/01/2021] [Accepted: 03/28/2021] [Indexed: 11/22/2022]
Abstract
The best estimates of the incidence of schizophrenia range more than 25-fold from 3 to 80 per 100,000 person-years. To what extent do differences in study design explain this wide variation? We selected all studies published between 2008-2019 reporting the incidence of schizophrenia in general populations of Northern Europe. We identified 17 estimates covering 85 million person-years and more than 15,000 individual cases. The estimates ranged from 4-72 per 100,000 person-years (median 30; interquartile range 13-41). We classified the estimates in terms of three study design factors (coverage of services, time frame, and diagnostic quality) and two population factors (urbanicity and age). A meta-regression model of the three design factors, using the two population factors as covariates, explained 91% of between-study variation. Studies performed in general psychiatric services reported similar estimates [incidence rate ratio 1.12 (95% confidence interval 0.88 to 1.43)] to those performed in specialized services. But studies applying a cumulative time frame to diagnosis reported fourfold higher estimates [4.04 (3.14 to 5.2)] than those applying a first-contact time frame. And studies based on clinical diagnoses reported lower estimates [0.55 (0.43 to 0.72)] than those based on standardized research diagnoses. The three study design factors by themselves explained 67% of between-study variation. When comparing incidence rates from different populations, distorsions arising from differences in study design can eclipse differences caused by schizophrenia risk factors, such as gender, age or migrant status.
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26
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Landi G, Leuci E, Quattrone E, Azzali S, Pellegrini C, Pellegrini P, Pelizza L. The 'Parma-Early Psychosis' programme: Characterization of help-seekers with first episode psychosis. Early Interv Psychiatry 2021; 15:380-390. [PMID: 32307896 DOI: 10.1111/eip.12968] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 02/06/2020] [Accepted: 04/02/2020] [Indexed: 12/12/2022]
Abstract
AIM Research on early psychosis paradigm has demonstrated the importance of early intervention (EI) in reducing illness severity and persistence. From January 2013, the Parma Department of Mental Health developed a specific care pathway [the 'Parma-Early Psychosis' (Pr-EP) programme] as a diffused EI infrastructure aimed to offer an evidence-based protocol of care to help-seekers with a first episode psychosis (FEP). Aim of this study was to investigate sources of referral, drop-out rate, sociodemographic and clinical characteristics of patients enrolled in the Pr-EP programme during the first 6 years of activity. METHODS Participants (n = 279) were individuals (aged 12-54 years) completing an ad-hoc socio-demographic/clinical schedule. RESULTS At baseline, the most frequent diagnoses were schizophreniform disorder (30.5%) and schizophrenia (29.4%). Only 31 (11.1%) subjects dropped out during the first year of treatment. FEP participants were mainly referred by general practitioners (36.9%) and emergency room/general hospital (28.7%). FEP individuals who were referred by emergency room/general hospital showed a higher percentage of current suicidal ideation compared to those entering the Pr-EP protocol through other sources of referrals. CONCLUSIONS EI in FEP help-seekers within Italian public mental health services is feasible and desirable, also in adolescence, where the risk of falling through the child-adult service gap is high.
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Affiliation(s)
- Giulia Landi
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Emanuela Leuci
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Emanuela Quattrone
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCSS di Reggio Emilia, Reggio Emilia, Italy
| | - Clara Pellegrini
- Psychiatric Unit, Department of Medicine and Surgery, Università di Parma, Parma, Italy
| | - Pietro Pellegrini
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
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27
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Bommersbach T, Rhee TG, Stefanovics E, Rosenheck R. Estimated Proportions and Characteristics of National Survey Respondents Reporting New Diagnoses of Schizophrenia or Other Psychoses in the Past Year as Compared With Prior Years. J Nerv Ment Dis 2021; 209:65-70. [PMID: 33141782 DOI: 10.1097/nmd.0000000000001259] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Epidemiologic data on first-episode psychosis is limited due to the infrequency of cases in the general population. This study uses the National Epidemiologic Survey on Alcohol and Related Conditions-III (N = 36,309) to examine population-based estimates of early psychosis based on adults who report a first-time diagnosis of schizophrenia from a doctor in the past year and compares them with those receiving diagnoses in previous years. Altogether, 60 respondents reported past-year schizophrenia (170 per 100,000) or 6.7% of 901 with any reported schizophrenia. Mean age was 41.4 ± 2.1, and they reported significantly higher rates of any past-year substance use disorder (44.7%) than individuals diagnosed in previous years (27.7%), specifically alcohol use disorder. Compared with other samples (many of which excluded older adults), this study suggests that early psychosis may affect older populations more than previously recognized, but comorbidity with substance use disorders showed similar elevations.
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28
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Petrović-van der Deen FS, Cunningham R, Manuel J, Gibb S, Porter RJ, Pitama S, Crowe M, Crengle S, Lacey C. Exploring indigenous ethnic inequities in first episode psychosis in New Zealand - A national cohort study. Schizophr Res 2020; 223:311-318. [PMID: 32948382 DOI: 10.1016/j.schres.2020.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/21/2020] [Accepted: 09/08/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION First episode psychosis (FEP) disproportionately affects rangatahi (young) Māori, the Indigenous people of New Zealand, but little is known about factors contributing to this inequity. This study describes a cohort of rangatahi Māori and young non-Māori with FEP, and explores ethnic differences in incidence rates, and the contribution of deprivation, urbanicity and substance use. METHODS Māori and young non-Māori, aged 13-25 at the time of the first recorded psychosis-related diagnoses, were identified from within Statistics NZ's Integrated Data Infrastructure (IDI), between 2009 and 2012. To estimate age-standardised FEP incidence rates, the population-at-risk was estimated using IDI-based usual resident population estimates for 2009-2012, stratified by ethnicity and single year of age. Poisson regression models were used to estimate ethnic differences in FEP incidence adjusted for age, gender, deprivation, and urban-rural area classification. RESULTS A total of 2412 young people with FEP (40% Māori, 60% non-Māori) were identified. Māori were younger, and more likely to live in deprived and rural communities and be diagnosed with schizophrenia. Substance induced psychosis was uncommon. The unadjusted age-standardised FEP incidence rate ratio was 2.48 (95% CI: 2.29-2.69) for rangatahi Māori compared with young non-Māori. While adjusting for age, sex, deprivation and urban rural area classification reduced ethnic differences in incidence, rangatahi Māori were still more than twice as likely to have been diagnosed with FEP compared to young non-Māori. CONCLUSIONS This study confirms previous findings of elevated rates of psychosis among rangatahi Māori. The difference in rates between Māori and non-Māori were attenuated but remained after adjustment for deprivation and urbanicity.
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Affiliation(s)
- Frederieke S Petrović-van der Deen
- Department of Public Health, University of Otago Wellington, PO Box 7343, Newtown, Wellington 6242, New Zealand; Māori/Indigenous Health Institute (MIHI), University of Otago Christchurch, PO Box 4345, Christchurch 8140, New Zealand
| | - Ruth Cunningham
- Department of Public Health, University of Otago Wellington, PO Box 7343, Newtown, Wellington 6242, New Zealand
| | - Jenni Manuel
- Māori/Indigenous Health Institute (MIHI), University of Otago Christchurch, PO Box 4345, Christchurch 8140, New Zealand
| | - Sheree Gibb
- Department of Public Health, University of Otago Wellington, PO Box 7343, Newtown, Wellington 6242, New Zealand
| | - Richard J Porter
- Department of Psychological Medicine, University of Otago Christchurch, PO Box 4345, Christchurch 8140, New Zealand; Canterbury District Health Board, PO Box 1600, Christchurch 8140, New Zealand
| | - Suzanne Pitama
- Māori/Indigenous Health Institute (MIHI), University of Otago Christchurch, PO Box 4345, Christchurch 8140, New Zealand
| | - Marie Crowe
- Department of Psychological Medicine, University of Otago Christchurch, PO Box 4345, Christchurch 8140, New Zealand
| | - Sue Crengle
- Department of Preventive and Social Medicine, University of Otago, Dunedin School of Medicine, PO Box 56, Dunedin 9054, New Zealand
| | - Cameron Lacey
- Māori/Indigenous Health Institute (MIHI), University of Otago Christchurch, PO Box 4345, Christchurch 8140, New Zealand; Department of Psychological Medicine, University of Otago Christchurch, PO Box 4345, Christchurch 8140, New Zealand; Canterbury District Health Board, PO Box 1600, Christchurch 8140, New Zealand.
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Lizano P, Dhaliwal K, Lutz O, Mothi SS, Miewald J, Montrose D, Keshavan M. Trajectory of neurological examination abnormalities in antipsychotic-naïve first-episode psychosis population: a 1 year follow-up study. Psychol Med 2020; 50:2057-2065. [PMID: 31451118 DOI: 10.1017/s0033291719002162] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Neurological Examination Abnormalities (NES) are quantified by measuring subtle, partially localizable (cerebello-thalamo-prefrontal cortical circuit) and heritable neurological signs comprising sensory integration, motor coordination and complex motor sequencing that are associated with first-episode psychosis (FEP). A few studies have evaluated NES longitudinally and as a predictor for diagnostic and response classification, but these studies have been confounded, underpowered and divergent. We examined (1) baseline and longitudinal NES differences between diagnostic and year 1 response groups; (2) if NES predicts diagnostic and response groups and (3) relationships between clinical variables and NES measures in antipsychotic-naïve FEP. METHODS NES and clinical measures were obtained for FEP-schizophrenia (FEP-SZ, n = 232), FEP non-schizophrenia (FEP-NSZ, n = 117) and healthy controls (HC, n = 204). Response groups with >25% improvement in average year 1 positive and negative symptomatology scores were classified as responsive (n = 97) and <25% improvement as non-responsive (n = 95). Analysis of covariance, NES trajectory analysis and logistic regression models assessed diagnostic and response group differences. Baseline and longitudinal NES relationships with clinical variables were performed with Spearman correlations. Data were adjusted for age, sex, race, socioeconomic status and handedness. RESULTS Cognitive perceptual (COGPER) score was better than repetitive motor (REPMOT) at differentiating FEP-SZ from FEP-NSZ and distinguishing responders from non-responders. We identified significant group-specific associations between COGPER and worse GAF, positive and negative symptomatology and some of these findings persisted at 1-year assessment. CONCLUSION NES are an easy to administer, bedside-elicited, endophenotypic measure and could be a cost-effective clinical tool in antipsychotic-naïve FEP.
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Affiliation(s)
- Paulo Lizano
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Kiranpreet Dhaliwal
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Olivia Lutz
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Jean Miewald
- Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, PA, USA
| | - Debra Montrose
- Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, PA, USA
| | - Matcheri Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Oluwoye O, Cheng SC, Fraser E, Stokes B, McDonell MG. Family Experiences Prior to the Initiation of Care for First-Episode Psychosis: A Meta-Synthesis of Qualitative Studies. JOURNAL OF CHILD AND FAMILY STUDIES 2020; 29:2530-2541. [PMID: 32863696 PMCID: PMC7454997 DOI: 10.1007/s10826-019-01695-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVES This study systematically reviewed existing qualitative evidence of family members' experiences prior to the initiation of mental health services for a loved one experiencing their first episode of psychosis (FEP). METHODS A meta-synthesis review of published peer-reviewed qualitative studies conducted between 2010 and 2019 were included. Keyword searches were performed in four electronic databases and the reference lists of primary manuscripts. Two independent reviewers used the Critical Appraisal Skills Programme (CASP) qualitative checklist to assess methodological quality of each study. RESULTS A total of 365 articles were initially identified and 9 were articles identified in a secondary review and literature search. A total of 21 met inclusion criteria. Of those included in this review 169, mothers were the primary family to recall experiences. The meta-synthesis identified four major themes related to family member experiences prior to the initiation of mental health services for FEP: the misinterpretation of signs, the emotional impact of FEP on family members, the effect of stigma on family members, and engaging with resources prior to mental health services for FEP. CONCLUSIONS Additional research is needed to develop healthy communication strategies that effectively deliver educational information about psychosis. This meta-synthesis also identified the need to understand help-seeking behaviors among families of those with FEP in effort to reduce the duration of untreated psychosis and improve pathways to care often initiated by a family member.
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Affiliation(s)
- Oladunni Oluwoye
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Sunny Chieh Cheng
- Department of Nursing and Healthcare Leadership, University of Washington, Tacoma, WA, USA
| | - Elizabeth Fraser
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Bryony Stokes
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Michael G. McDonell
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
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Baranyi G, Cherrie M, Curtis SE, Dibben C, Pearce J. Changing levels of local crime and mental health: a natural experiment using self-reported and service use data in Scotland. J Epidemiol Community Health 2020; 74:806-814. [PMID: 32503890 PMCID: PMC7577093 DOI: 10.1136/jech-2020-213837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/24/2020] [Accepted: 04/28/2020] [Indexed: 11/16/2022]
Abstract
Background This study contributes robust evidence on the association between mental health and local crime rates by showing how changing exposure to small area-level crime relates to self-reported and administrative data on mental health. Methods The study sample comprised 112 251 adults aged 16–60 years, drawn from the Scottish Longitudinal Study, a 5.3% representative sample of Scottish population followed across censuses. Outcomes were individual mental health indicators: self-reported mental illness from the 2011 Census and linked administrative data on antidepressants and antipsychotics prescribed through primary care providers in the National Health Service in 2010/2012. Crime rates at data zone level (500–1000 persons) were matched to the participants’ main place of residence, as defined by general practitioner patient registration duration during 2004/2006, 2007/2009 and 2010/12. Average neighbourhood crime exposure and change in area crime were computed. Covariate-adjusted logistic regressions were conducted, stratified by moving status. Results In addition to average crime exposure during follow-up, recent increases in crime (2007/2009–2010/2012) were associated with a higher risk of self-reported mental illness, among ‘stayers’ aged 16–30 years (OR=1.11; 95% CI 1.00 to 1.22), and among ‘movers’ aged 31–45 years (OR=1.07; 95% CI 1.01 to 1.13). Prescribed medications reinforced these findings; worsening crime rates were linked with antidepressant prescriptions among young stayers (OR=1.09; 95% CI 1.04 to 1.14) and with antipsychotic prescriptions among younger middle-aged movers (OR=1.11; 95% CI 1.01 to 1.23). Conclusion Changing neighbourhood crime exposure is related to individual mental health, but associations differ by psychiatric conditions, age and moving status. Crime reduction and prevention, especially in communities with rising crime rates, may benefit public mental health.
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Affiliation(s)
- Gergő Baranyi
- Center for Research on Environment, Society and Health, School of GeoSciences, University of Edinburgh, Edinburgh, UK
| | - Mark Cherrie
- Center for Research on Environment, Society and Health, School of GeoSciences, University of Edinburgh, Edinburgh, UK
| | - Sarah E Curtis
- Center for Research on Environment, Society and Health, School of GeoSciences, University of Edinburgh, Edinburgh, UK.,Geography Department, Durham University, Durham, UK
| | - Chris Dibben
- Center for Research on Environment, Society and Health, School of GeoSciences, University of Edinburgh, Edinburgh, UK
| | - Jamie Pearce
- Center for Research on Environment, Society and Health, School of GeoSciences, University of Edinburgh, Edinburgh, UK
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van der Ven E, Susser E, Dixon LB, Olfson M, Gilmer TP. Racial-Ethnic Differences in Service Use Patterns Among Young, Commercially Insured Individuals With Recent-Onset Psychosis. Psychiatr Serv 2020; 71:433-439. [PMID: 31931683 DOI: 10.1176/appi.ps.201900301] [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] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to investigate racial-ethnic differences in use of mental health services and antipsychotic medication in the year following the recent onset of a psychotic disorder and to examine the role of household income as a proxy for socioeconomic status. METHODS Deidentified administrative claims data from the OptumLabs Data Warehouse were used to identify 8,021 commercially insured individuals ages 14 through 30 with a recent-onset psychotic disorder (January 1, 2011, through December 31, 2015). The authors compared mental health service use among African-American (11.5%), Hispanic (11.0%), and non-Hispanic white (77.4%) individuals during the year following an index diagnosis and adjusted these analyses for household income. RESULTS The probability of any use of outpatient mental health services was lower among African-American (67.4%±1.4%) and Hispanic individuals (66.5%±1.5%) compared with non-Hispanic white patients (72.3%±0.6%; p<0.05 for each comparison). Among those who used services, African-American and Hispanic individuals had fewer mean outpatient mental health visits per year compared with non-Hispanic whites (9.7±0.7 and 10.2±0.7 versus 14.3±0.5, respectively, p<0.001 for each comparison). These racial-ethnic differences in service use remained after adjustment for household income. CONCLUSIONS Among young, commercially insured individuals using outpatient services following an index diagnosis of psychotic disorder, African Americans and Hispanics received less intensive outpatient mental health care than their non-Hispanic white counterparts. Amid the upsurge of early intervention programs, special attention should be paid to increasing access to mental health services for racial-ethnic minority groups.
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Affiliation(s)
- Els van der Ven
- Mailman School of Public Health, Columbia University, New York (van der Ven, Susser); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); New York State Psychiatric Institute, New York (Susser, Dixon, Olfson); Vagelos College of Physicians and Surgeons, Columbia University, New York (Dixon, Olfson); Department of Family Medicine and Public Health, University of California, San Diego, and OptumLabs, Cambridge, Massachusetts (Gilmer)
| | - Ezra Susser
- Mailman School of Public Health, Columbia University, New York (van der Ven, Susser); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); New York State Psychiatric Institute, New York (Susser, Dixon, Olfson); Vagelos College of Physicians and Surgeons, Columbia University, New York (Dixon, Olfson); Department of Family Medicine and Public Health, University of California, San Diego, and OptumLabs, Cambridge, Massachusetts (Gilmer)
| | - Lisa B Dixon
- Mailman School of Public Health, Columbia University, New York (van der Ven, Susser); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); New York State Psychiatric Institute, New York (Susser, Dixon, Olfson); Vagelos College of Physicians and Surgeons, Columbia University, New York (Dixon, Olfson); Department of Family Medicine and Public Health, University of California, San Diego, and OptumLabs, Cambridge, Massachusetts (Gilmer)
| | - Mark Olfson
- Mailman School of Public Health, Columbia University, New York (van der Ven, Susser); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); New York State Psychiatric Institute, New York (Susser, Dixon, Olfson); Vagelos College of Physicians and Surgeons, Columbia University, New York (Dixon, Olfson); Department of Family Medicine and Public Health, University of California, San Diego, and OptumLabs, Cambridge, Massachusetts (Gilmer)
| | - Todd P Gilmer
- Mailman School of Public Health, Columbia University, New York (van der Ven, Susser); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); New York State Psychiatric Institute, New York (Susser, Dixon, Olfson); Vagelos College of Physicians and Surgeons, Columbia University, New York (Dixon, Olfson); Department of Family Medicine and Public Health, University of California, San Diego, and OptumLabs, Cambridge, Massachusetts (Gilmer)
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Oluwoye O, Reneau H, Stokes B, Daughtry R, Venuto E, Sunbury T, Hong G, Lucenko B, Stiles B, McPherson SM, Kopelovich S, Monroe-DeVita M, McDonell MG. Preliminary Evaluation of Washington State's Early Intervention Program for First-Episode Psychosis. Psychiatr Serv 2020; 71:228-235. [PMID: 31847738 PMCID: PMC7207512 DOI: 10.1176/appi.ps.201900199] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Early intervention programs are designed to address the needs of youths experiencing first-episode psychosis (FEP). Washington State developed New Journeys, a network of coordinated specialty care programs for FEP. In this study, the authors have outlined components of the New Journeys model and preliminary findings since its initial implementation. METHODS Youths and young adults diagnosed as having psychosis (N=112) completed measures at and after intake on a range of mental health assessments and functional outcomes for the first 12 months of treatment. Administrative data including state-funded emergency department and psychiatric hospitalizations were assessed 24 months before and after intake. Generalized estimating equations were used to assess change over time on multiple measures of mental health status. RESULTS Compared with their condition at intake, clients had significant decreases in symptoms of anxiety (β=-2.48, p<0.001), psychotic experiences (β=-3.37, p<0.05), and clinician-rated psychotic symptoms (β=-1.47, p<0.05) during treatment. Additionally, quality of life (β=-5.95, p<0.001) and school attendance (odds ratio=1.42, p<0.05) significantly improved during treatment. Administrative data indicated that postintake, clients were less likely to visit the emergency department for psychiatric reasons (β=0.22, p<0.05), utilize community psychiatric inpatient services (β=0.31, p<0.001), and utilize public assistance (β=0.71, p<0.05) compared with 24 months before intake. CONCLUSIONS New Journeys clients experienced improved clinical and functional outcomes during their first year of treatment, and rates of state-funded service utilization decreased during their treatment.
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Affiliation(s)
- Oladunni Oluwoye
- Behavioral Health Innovations (Oluwoye, Reneau, Stokes, McDonell) and Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine (Oluwoye, McPherson, McDonell), Washington State University, Spokane; Youth and Family Behavioral Health Section, Washington State Health Care Authority, Olympia (Daughtry, Venuto); Research and Data Analysis Division, Washington State Department of Social and Health Services, Olympia (Sunbury, Hong, Lucenko); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Stiles, Kopelovich, Monroe-DeVita); Providence Medical Research Center, Providence Health Care, Spokane (McPherson)
| | - Hailey Reneau
- Behavioral Health Innovations (Oluwoye, Reneau, Stokes, McDonell) and Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine (Oluwoye, McPherson, McDonell), Washington State University, Spokane; Youth and Family Behavioral Health Section, Washington State Health Care Authority, Olympia (Daughtry, Venuto); Research and Data Analysis Division, Washington State Department of Social and Health Services, Olympia (Sunbury, Hong, Lucenko); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Stiles, Kopelovich, Monroe-DeVita); Providence Medical Research Center, Providence Health Care, Spokane (McPherson)
| | - Bryony Stokes
- Behavioral Health Innovations (Oluwoye, Reneau, Stokes, McDonell) and Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine (Oluwoye, McPherson, McDonell), Washington State University, Spokane; Youth and Family Behavioral Health Section, Washington State Health Care Authority, Olympia (Daughtry, Venuto); Research and Data Analysis Division, Washington State Department of Social and Health Services, Olympia (Sunbury, Hong, Lucenko); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Stiles, Kopelovich, Monroe-DeVita); Providence Medical Research Center, Providence Health Care, Spokane (McPherson)
| | - Rebecca Daughtry
- Behavioral Health Innovations (Oluwoye, Reneau, Stokes, McDonell) and Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine (Oluwoye, McPherson, McDonell), Washington State University, Spokane; Youth and Family Behavioral Health Section, Washington State Health Care Authority, Olympia (Daughtry, Venuto); Research and Data Analysis Division, Washington State Department of Social and Health Services, Olympia (Sunbury, Hong, Lucenko); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Stiles, Kopelovich, Monroe-DeVita); Providence Medical Research Center, Providence Health Care, Spokane (McPherson)
| | - Elizabeth Venuto
- Behavioral Health Innovations (Oluwoye, Reneau, Stokes, McDonell) and Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine (Oluwoye, McPherson, McDonell), Washington State University, Spokane; Youth and Family Behavioral Health Section, Washington State Health Care Authority, Olympia (Daughtry, Venuto); Research and Data Analysis Division, Washington State Department of Social and Health Services, Olympia (Sunbury, Hong, Lucenko); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Stiles, Kopelovich, Monroe-DeVita); Providence Medical Research Center, Providence Health Care, Spokane (McPherson)
| | - Tenaya Sunbury
- Behavioral Health Innovations (Oluwoye, Reneau, Stokes, McDonell) and Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine (Oluwoye, McPherson, McDonell), Washington State University, Spokane; Youth and Family Behavioral Health Section, Washington State Health Care Authority, Olympia (Daughtry, Venuto); Research and Data Analysis Division, Washington State Department of Social and Health Services, Olympia (Sunbury, Hong, Lucenko); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Stiles, Kopelovich, Monroe-DeVita); Providence Medical Research Center, Providence Health Care, Spokane (McPherson)
| | - Grace Hong
- Behavioral Health Innovations (Oluwoye, Reneau, Stokes, McDonell) and Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine (Oluwoye, McPherson, McDonell), Washington State University, Spokane; Youth and Family Behavioral Health Section, Washington State Health Care Authority, Olympia (Daughtry, Venuto); Research and Data Analysis Division, Washington State Department of Social and Health Services, Olympia (Sunbury, Hong, Lucenko); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Stiles, Kopelovich, Monroe-DeVita); Providence Medical Research Center, Providence Health Care, Spokane (McPherson)
| | - Barbara Lucenko
- Behavioral Health Innovations (Oluwoye, Reneau, Stokes, McDonell) and Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine (Oluwoye, McPherson, McDonell), Washington State University, Spokane; Youth and Family Behavioral Health Section, Washington State Health Care Authority, Olympia (Daughtry, Venuto); Research and Data Analysis Division, Washington State Department of Social and Health Services, Olympia (Sunbury, Hong, Lucenko); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Stiles, Kopelovich, Monroe-DeVita); Providence Medical Research Center, Providence Health Care, Spokane (McPherson)
| | - Bryan Stiles
- Behavioral Health Innovations (Oluwoye, Reneau, Stokes, McDonell) and Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine (Oluwoye, McPherson, McDonell), Washington State University, Spokane; Youth and Family Behavioral Health Section, Washington State Health Care Authority, Olympia (Daughtry, Venuto); Research and Data Analysis Division, Washington State Department of Social and Health Services, Olympia (Sunbury, Hong, Lucenko); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Stiles, Kopelovich, Monroe-DeVita); Providence Medical Research Center, Providence Health Care, Spokane (McPherson)
| | - Sterling M McPherson
- Behavioral Health Innovations (Oluwoye, Reneau, Stokes, McDonell) and Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine (Oluwoye, McPherson, McDonell), Washington State University, Spokane; Youth and Family Behavioral Health Section, Washington State Health Care Authority, Olympia (Daughtry, Venuto); Research and Data Analysis Division, Washington State Department of Social and Health Services, Olympia (Sunbury, Hong, Lucenko); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Stiles, Kopelovich, Monroe-DeVita); Providence Medical Research Center, Providence Health Care, Spokane (McPherson)
| | - Sarah Kopelovich
- Behavioral Health Innovations (Oluwoye, Reneau, Stokes, McDonell) and Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine (Oluwoye, McPherson, McDonell), Washington State University, Spokane; Youth and Family Behavioral Health Section, Washington State Health Care Authority, Olympia (Daughtry, Venuto); Research and Data Analysis Division, Washington State Department of Social and Health Services, Olympia (Sunbury, Hong, Lucenko); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Stiles, Kopelovich, Monroe-DeVita); Providence Medical Research Center, Providence Health Care, Spokane (McPherson)
| | - Maria Monroe-DeVita
- Behavioral Health Innovations (Oluwoye, Reneau, Stokes, McDonell) and Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine (Oluwoye, McPherson, McDonell), Washington State University, Spokane; Youth and Family Behavioral Health Section, Washington State Health Care Authority, Olympia (Daughtry, Venuto); Research and Data Analysis Division, Washington State Department of Social and Health Services, Olympia (Sunbury, Hong, Lucenko); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Stiles, Kopelovich, Monroe-DeVita); Providence Medical Research Center, Providence Health Care, Spokane (McPherson)
| | - Michael G McDonell
- Behavioral Health Innovations (Oluwoye, Reneau, Stokes, McDonell) and Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine (Oluwoye, McPherson, McDonell), Washington State University, Spokane; Youth and Family Behavioral Health Section, Washington State Health Care Authority, Olympia (Daughtry, Venuto); Research and Data Analysis Division, Washington State Department of Social and Health Services, Olympia (Sunbury, Hong, Lucenko); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Stiles, Kopelovich, Monroe-DeVita); Providence Medical Research Center, Providence Health Care, Spokane (McPherson)
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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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Gilmer TP, van der Ven E, Susser E, Dixon LB, Olfson M. Service Use Following First-Episode Schizophrenia Among Commercially Insured Youth. Schizophr Bull 2020; 46:91-97. [PMID: 31292650 PMCID: PMC7145606 DOI: 10.1093/schbul/sbz031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To investigate patterns of mental health service and antipsychotic use following a first-episode schizophrenia (FES) and to examine the role of the treatment setting in which individuals are first diagnosed. METHOD Analysis of de-identified administrative claims data from the OptumLabs Data Warehouse was used to identify 1450 privately insured youth and young adults aged 14 through 30 with FES from January 1, 2011 through December 31, 2015. Regression analysis was used to estimate the use of mental health services during the year following FES, by type of service and by site of index diagnosis. RESULTS In the year following FES, 79.7% of youth received outpatient mental health services and 35.8% filled a prescription for antipsychotic medication. Among service users, mean outpatient visits were 15.9 and mean antipsychotic fills were 8.3. Youth who received an index diagnosis of FES in an inpatient setting were more likely to fill an antipsychotic medication than youth with FES in other settings. Youth who received an index diagnosis of FES during a specialty mental health outpatient visit had greater use of outpatient mental health than youth who received their diagnosis during a primary care visit. CONCLUSIONS Despite evidence-based guidelines supporting outpatient psychosocial care and antipsychotic treatment for FES, one-fifth of this cohort did not use outpatient services and the majority did not fill any prescriptions for antipsychotic medications during the year following FES. Our findings provide renewed urgency to ongoing efforts to accelerate early identification and care coordination for youth with FES.
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Affiliation(s)
- Todd P Gilmer
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA,Division of Health Policy, Vice Chair for Academic Affairs, Department of Family Medicine and Public Health, University of California, San Diego,To whom correspondence should be addressed; Department of Family Medicine and Public Health, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0725; tel: 858-534-7596, e-mail:
| | - Els van der Ven
- Mailman School of Public Health, Columbia University, New York, NY,School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, Netherlands
| | - Ezra Susser
- Mailman School of Public Health, Columbia University, New York, NY,New York State Psychiatric Institute, New York, NY
| | - Lisa B Dixon
- New York State Psychiatric Institute, New York, NY,Vagelos College of Physicians & Surgeons, Columbia University, New York, NY
| | - Mark Olfson
- Mailman School of Public Health, Columbia University, New York, NY,New York State Psychiatric Institute, New York, NY,Vagelos College of Physicians & Surgeons, Columbia University, New York, NY
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Coleman KJ, Yarborough BJ, Beck A, Lynch FL, Stewart C, Penfold RS, Hunkeler EM, Operskalski BH, Simon GE. Patterns of Health Care Utilization Before First Episode Psychosis in Racial and Ethnic Groups. Ethn Dis 2019; 29:609-616. [PMID: 31641328 PMCID: PMC6802164 DOI: 10.18865/ed.29.4.609] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Objective To compare patterns of health care utilization associated with first presentation of psychosis among different racial and ethnic groups of patients. Design The study was a retrospective observational design. Setting The study was conducted in five health care systems in the western United States. All sites were also part of the National Institute of Mental Health-funded Mental Health Research Network (MHRN). Participants Patients (n = 852) were aged 15 - 59 years (average 26.9 ± 12.2 years), 45% women, and primarily non-Hispanic White (53%), with 16% Hispanic, 10% non-Hispanic Black, 6% Asian, 1% Native Hawaiian/Pacific Islander, 1% Native American/ Alaskan Native, and 12% unknown race/ethnicity. Main Outcome Measures Variables examined were patterns of health care utilization, type of comorbid mental health condition, and type of treatment received in the three years before first presentation of psychosis. Methods Data abstracted from electronic medical records and insurance claims data were organized into a research virtual data warehouse (VDW) and used for analysis. Results Compared with non-Hispanic Whites, Asian patients (16% vs 34%; P=.007) and non-Hispanic Black patients (20% vs 34%; P=.009) were less likely to have a visit with specialty mental health care before their first presentation of psychosis. Conclusions Early detection of first episode psychosis should start with wider screening for symptoms outside of any indicators for mental health conditions for non-Hispanic Black and Asian patients.
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Affiliation(s)
- Karen J. Coleman
- Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena, CA
| | | | - Arne Beck
- Kaiser Permanente Colorado Institute for Health Research, Denver, CO
| | - Frances L. Lynch
- Kaiser Permanente Northwest Center for Health Research, Portland, OR
| | | | | | - Enid M. Hunkeler
- Kaiser Permanente Northern California Division of Research (Emeritus), Oakland, CA
| | | | - Gregory E. Simon
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
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Yarborough BJ, Yarborough MT, Cavese JC. Factors that hindered care seeking among people with a first diagnosis of psychosis. Early Interv Psychiatry 2019; 13:1220-1226. [PMID: 30485673 PMCID: PMC6538479 DOI: 10.1111/eip.12758] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 09/14/2018] [Accepted: 11/04/2018] [Indexed: 01/24/2023]
Abstract
AIM Evidence-based treatment can improve psychosis outcomes, but service providers need to understand and address the reasons people experiencing first episode psychosis avoid or delay care seeking. The goal of this study was to identify reasons care seeking might be postponed, from the points of view of patients, caregivers and health care professionals in a large health care delivery system, in the United States, without an early psychosis intervention program. METHODS About 22 patients who had received an initial psychosis diagnosis and 10 of their caregivers were interviewed about their experiences and pathways to care. Additionally, 15 administrator or clinician key informants with responsibility for psychosis services were interviewed and asked to describe ways that they thought early psychosis identification and treatment engagement could be improved. All interviews were transcribed, coded and analysed together using thematic analysis. RESULTS Some patients did not perceive their early psychotic experiences as concerning because they were familiar. Among those concerned, the desire to make sense of their experiences and avoid detection or stigma caused some to conceal symptoms or isolate themselves. Caregivers who observed withdrawal often attributed it to typical adolescent behaviour, which led to treatment delays. Legal and privacy protections led to delays among young adults. CONCLUSIONS To attract individuals to early psychosis services, outreach and engagement programs should help individuals and caregivers recognize their experiences as opportunities for care, and design and market services that promote sense-making, offer hope and reduce stigma and system-level privacy-related barriers to care engagement.
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Affiliation(s)
- Bobbi J Yarborough
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
| | - Micah T Yarborough
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
| | - Julie C Cavese
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
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Anderson KK, Norman R, MacDougall AG, Edwards J, Palaniyappan L, Lau C, Kurdyak P. Estimating the incidence of first-episode psychosis using population-based health administrative data to inform early psychosis intervention services. Psychol Med 2019; 49:2091-2099. [PMID: 30311590 DOI: 10.1017/s0033291718002933] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Discrepancies between population-based estimates of the incidence of psychotic disorder and the treated incidence reported by early psychosis intervention (EPI) programs suggest additional cases may be receiving services elsewhere in the health system. Our objective was to estimate the incidence of non-affective psychotic disorder in the catchment area of an EPI program, and compare this to EPI-treated incidence estimates. METHODS We constructed a retrospective cohort (1997-2015) of incident cases of non-affective psychosis aged 16-50 years in an EPI program catchment using population-based linked health administrative data. Cases were identified by either one hospitalization or two outpatient physician billings within a 12-month period with a diagnosis of non-affective psychosis. We estimated the cumulative incidence and EPI-treated incidence of non-affective psychosis using denominator data from the census. We also estimated the incidence of first-episode psychosis (people who would meet the case definition for an EPI program) using a novel approach. RESULTS Our case definition identified 3245 cases of incident non-affective psychosis over the 17-year period. We estimate that the incidence of first-episode non-affective psychosis in the program catchment area is 33.3 per 100 000 per year (95% CI 31.4-35.1), which is more than twice as high as the EPI-treated incidence of 18.8 per 100 000 per year (95% CI 17.4-20.3). CONCLUSIONS Case ascertainment strategies limited to specialized psychiatric services may substantially underestimate the incidence of non-affective psychotic disorders, relative to population-based estimates. Accurate information on the epidemiology of first-episode psychosis will enable us to more effectively resource EPI services and evaluate their coverage.
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Affiliation(s)
- Kelly K Anderson
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
- Department of Psychiatry, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Ross Norman
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
- Department of Psychiatry, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Arlene G MacDougall
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
- Department of Psychiatry, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Jordan Edwards
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Lena Palaniyappan
- Department of Psychiatry, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Cindy Lau
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Paul Kurdyak
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Radigan M, Gu G, Frimpong EY, Wang R, Huz S, Li M, Nossel I, Dixon L. A New Method for Estimating Incidence of First Psychotic Diagnosis in a Medicaid Population. Psychiatr Serv 2019; 70:665-673. [PMID: 31138057 DOI: 10.1176/appi.ps.201900033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Early intervention programs for first-episode psychosis (FEP) require population-based methods to identify individuals with FEP. This study adapted a previously published method to estimate incidence of first psychotic diagnosis in a state Medicaid program. Secondary aims were to examine demographic and service patterns associated with a first psychotic diagnosis in Medicaid. METHODS A retrospective, population-based study of New York State Medicaid data was conducted to identify first occurrence of psychotic diagnosis among persons ages 15-35 between January 1, 2013, and December 31, 2017 (N=31,606). Age-stratified incidence rates (IRs) were calculated by demographic characteristics, first-diagnosis type, and service-related characteristics. Review of charts from OnTrackNY and Medicaid managed care organizations (MCOs) was conducted to confirm identified cases. Initial IRs and confirmation rates were used to estimate adjusted IRs. RESULTS Age-stratified IRs varied by demographic, diagnostic, and service-related characteristic. IRs of FEP were higher for persons ages 15 to 25 relative to persons ages 26-35 if the first provider was an acute behavioral health emergency or inpatient setting (rate ratio=1.286; 95% confidence interval=1.24-1.33). Case confirmation rates were 90% for OnTrack NY and 53% for the MCOs. Adjusted annual IR of first diagnosis of psychosis was 272 per 100,000. CONCLUSIONS Incidence of first psychotic diagnosis in this Medicaid population was higher than previously found in insured populations. Future work will focus on algorithm refinements and piloting outreach. Administrative data algorithms may be useful to providers, Medicaid MCOs, and state Medicaid authorities to support case finding and early intervention.
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Affiliation(s)
- Marleen Radigan
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Radigan, Gu, Frimpong, Wang, Huz, Li); New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Nossel, Dixon)
| | - Gyojeong Gu
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Radigan, Gu, Frimpong, Wang, Huz, Li); New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Nossel, Dixon)
| | - Eric Y Frimpong
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Radigan, Gu, Frimpong, Wang, Huz, Li); New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Nossel, Dixon)
| | - Rui Wang
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Radigan, Gu, Frimpong, Wang, Huz, Li); New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Nossel, Dixon)
| | - Steven Huz
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Radigan, Gu, Frimpong, Wang, Huz, Li); New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Nossel, Dixon)
| | - Mengxuan Li
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Radigan, Gu, Frimpong, Wang, Huz, Li); New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Nossel, Dixon)
| | - Ilana Nossel
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Radigan, Gu, Frimpong, Wang, Huz, Li); New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Nossel, Dixon)
| | - Lisa Dixon
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Radigan, Gu, Frimpong, Wang, Huz, Li); New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Nossel, Dixon)
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Anderson D, Choden T, Sandseth T, Teoh T, Essock SM, Harrison ME. NYC START: A New Model for Securing Community Services for Individuals Hospitalized for First-Episode Psychosis. Psychiatr Serv 2019; 70:644-649. [PMID: 31084293 DOI: 10.1176/appi.ps.201800385] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The New York City (NYC) Board of Health amended the city's health code to require hospitals to report to the Department of Health and Mental Hygiene when individuals ages 18-30 are hospitalized for first-episode psychosis (FEP). This study examined the implementation of NYC START, a program that meets patients hospitalized with FEP to offer a voluntary, 3-month critical time intervention provided by social workers and peer specialists to connect individuals to appropriate community mental health services after discharge. METHODS Service logs completed by program staff were summarized to determine the mean number of contacts received per client per week, types of services provided by social workers and peer specialists, survival analyses of time to discharge from NYC START, and connection rates with community mental health services. RESULTS Of the 285 clients who accepted NYC START services in 2016, 87% attended an initial mental health appointment after hospital discharge and 78% completed at least 3 months of the program. Consistent with the program model, contacts were most frequent in clients' first week in NYC START, with a mean of 2.5±1.4 contacts, 1.9 of which were with social workers and 0.5 of which were with peer specialists. Social workers provided a mean of 17.3±4.4 client-specific activities per week, and peer specialists provided a mean of 8.5±3.5. CONCLUSIONS NYC START serves as a critical time intervention to connect people hospitalized with FEP to community mental health treatment.
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Affiliation(s)
- Daniel Anderson
- Bureau of Mental Health, New York City Department of Health and Mental Hygiene, New York (Anderson, Choden, Sandseth, Teoh, Harrison); Department of Psychiatry, Columbia University, New York (Essock)
| | - Tsering Choden
- Bureau of Mental Health, New York City Department of Health and Mental Hygiene, New York (Anderson, Choden, Sandseth, Teoh, Harrison); Department of Psychiatry, Columbia University, New York (Essock)
| | - Tracy Sandseth
- Bureau of Mental Health, New York City Department of Health and Mental Hygiene, New York (Anderson, Choden, Sandseth, Teoh, Harrison); Department of Psychiatry, Columbia University, New York (Essock)
| | - Tricia Teoh
- Bureau of Mental Health, New York City Department of Health and Mental Hygiene, New York (Anderson, Choden, Sandseth, Teoh, Harrison); Department of Psychiatry, Columbia University, New York (Essock)
| | - Susan M Essock
- Bureau of Mental Health, New York City Department of Health and Mental Hygiene, New York (Anderson, Choden, Sandseth, Teoh, Harrison); Department of Psychiatry, Columbia University, New York (Essock)
| | - Myla E Harrison
- Bureau of Mental Health, New York City Department of Health and Mental Hygiene, New York (Anderson, Choden, Sandseth, Teoh, Harrison); Department of Psychiatry, Columbia University, New York (Essock)
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Rodrigues R, MacDougall AG, Zou G, Lebenbaum M, Kurdyak P, Li L, Shariff SZ, Anderson KK. Involuntary hospitalization among young people with early psychosis: A population-based study using health administrative data. Schizophr Res 2019; 208:276-284. [PMID: 30728106 DOI: 10.1016/j.schres.2019.01.043] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 01/24/2019] [Accepted: 01/27/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Early psychosis is an important window for establishing long-term trajectories. Involuntary hospitalization during this period may impact subsequent service engagement in people with newly diagnosed psychotic disorder. However, population-based studies of involuntary hospitalization in early psychosis are lacking. We sought to estimate the proportion of people aged 16 to 35 years with early psychosis in Ontario who are hospitalized involuntarily at first admission, and to identify the associated risk factors and outcomes. METHODS Using linked population-based health administrative data, we identified incident cases of non-affective psychosis over a five-year period (2009-2013) and followed cases for two years to ascertain the first psychiatric hospitalization. We used modified Poisson regression to model sociodemographic, clinical, and service-related risk factors, and compared service-related outcomes for cases admitted on an involuntary versus voluntary basis. RESULTS Among 17,725 incident cases of non-affective psychosis, 38% were hospitalized within two years, and 81% of these admissions occurred on an involuntary basis (26% of cohort). Sociodemographic factors associated with an increased risk of involuntary admission included younger age (16-20), and first-generation migrant status. The strongest risk factors were poor illness insight, recent police involvement, and admission to a general (versus psychiatric) hospital. Outcomes associated with involuntary admission included increased likelihood of control intervention use and a shorter length of stay. CONCLUSIONS One in four young people with first-episode psychosis will have an involuntary admission early in the course of their illness. Our findings highlight areas for intervention to improve pathways to care for people with psychotic disorder.
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Affiliation(s)
- Rebecca Rodrigues
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Arlene G MacDougall
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada; Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Guangyong Zou
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada; Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | | | - Paul Kurdyak
- Institute for Clinical Evaluate Sciences, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Lihua Li
- Institute for Clinical Evaluate Sciences, Toronto, ON, Canada
| | | | - Kelly K Anderson
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada; Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada; Institute for Clinical Evaluate Sciences, Toronto, ON, Canada.
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Abstract
Altered mental status is a common chief complaint in the emergency department. The differential diagnosis is vast and the laboratory testing can vary depending on presenting symptoms and examination findings. It is important to remember that changes in mental status can be due to psychiatric causes such as primary psychotic disorders, psychotic episodes, and mood disorders. Initial assessment includes ruling out hypoglycemia and other medical causes. Misdiagnosis at onset is common due to variability of symptoms, overlapping symptoms between diagnoses and other confounding issues, such as substance use, behavioral disorders, and possible developmental delays. After ruling out a medical cause, the patient should be evaluated by a mental health professional to determine psychiatric diagnosis and to dictate further management. [Pediatr Ann. 2019;48(5):e201-e204.].
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Peh OH, Rapisarda A, Lee J. Childhood adversities in people at ultra-high risk (UHR) for psychosis: a systematic review and meta-analysis. Psychol Med 2019; 49:1089-1101. [PMID: 30616701 DOI: 10.1017/s003329171800394x] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Childhood adversities have been reported to be more common among individuals at ultra-high risk (UHR) for psychosis. This paper systematically reviewed and meta-analysed (i) the severity and prevalence of childhood adversities (childhood trauma exposure, bullying victimisation and parental separation or loss) among the UHR, and (ii) the association between adversities and transition to psychosis (TTP). PsycINFO, PubMed and Embase databases were searched for studies reporting childhood adversities among UHR individuals. Only published articles were included. Risk of bias was assessed using Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline (von Elm et al., 2007) and the tool developed by Hoy et al. (2012). Seventeen case-control, cross-sectional and longitudinal studies were included. UHR individuals experienced significantly more severe trauma than controls, regardless of trauma subtype. UHR were 5.5, 2.5 and 3.1 times as likely to report emotional abuse, physical abuse and bullying victimisation, respectively. There was no association with parental separation. However, childhood trauma was not significantly associated with TTP (follow-up periods: 6 months to 15 years), suggesting that trauma alone may not be a sufficient risk factor. Sexual abuse was associated with TTP but this may have been driven by a single large study. Potential confounders and low rates of TTP among UHR are limitations of this review. This is the first meta-analysis that quantitatively summarises the associations between childhood adversities and TTP among UHR, and between specific abuse subtypes and TTP. Specific recommendations have been made to increase the quality of future research. PROSPERO registration no. CRD42017054884.
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Affiliation(s)
- Oon Him Peh
- Research Division,Institute of Mental Health,Singapore
| | | | - Jimmy Lee
- Research Division,Institute of Mental Health,Singapore
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Jongsma HE, Turner C, Kirkbride JB, Jones PB. International incidence of psychotic disorders, 2002-17: a systematic review and meta-analysis. Lancet Public Health 2019; 4:e229-e244. [PMID: 31054641 PMCID: PMC6693560 DOI: 10.1016/s2468-2667(19)30056-8] [Citation(s) in RCA: 147] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/18/2019] [Accepted: 03/26/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The last comprehensive systematic review of the incidence of psychotic disorders was published in 2004. New epidemiological data from different settings now permit a broader understanding of global variation. We examined the variation in psychosis by demographic characteristics and study method. METHODS For this systematic review and meta-analysis, we searched PubMed, Embase, Web of Science, PsycINFO, and bibliographies, and directly contacted first authors. We sought to obtain citations of original research published between Jan 1, 2002, and Dec 31, 2017, on incidence of non-organic adult-onset psychotic disorder. We included papers that were published or in grey literature and had no language restrictions. Data were extracted from published reports, where possible, by sex, age, and ethnic group. Quality of yield was assessed. Data were assessed using univariable random-effects meta-analysis and meta-regression. We registered our systematic review on PROSPERO, number CRD42018086800. FINDINGS From 56 721 records identified, 177 met inclusion criteria. The pooled incidence of all psychotic disorders was 26·6 per 100 000 person-years (95% CI 22·0-31·7). Heterogeneity was high (I2≥98·5%). Men were at higher risk of all psychotic disorders (incidence rate ratio 1·44 [1·27-1·62]) and non-affective disorders (1·60 [1·44-1·77]) than women, but not affective psychotic disorders (0·87 [0·75-1·00]). Ethnic minorities were also at excess risk of all psychotic disorders (1·75 [1·53-2·00]), including non-affective disorders (1·71 [1·40-2·09]). Meta-regression revealed that population registers reported higher rates of non-affective disorders (9·64 [2·72-31·82]), schizophrenia (2·51 [1·24-5·21]), and bipolar disorder (4·53 [2·41-8·51]) than first contact study designs. INTERPRETATION We found marked variation in incidence of psychotic disorders by personal characteristics and place. Some geographical variation could be partially explained by differences in case ascertainment methods. FUNDING None.
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Affiliation(s)
- Hannah E Jongsma
- Department of Psychiatry, University of Cambridge, Cambridge, UK; PsyLife Group, Division of Psychiatry, University College London, London, UK.
| | - Caitlin Turner
- Institute of Public Health, University of Cambridge, Cambridge, UK
| | - James B Kirkbride
- PsyLife Group, Division of Psychiatry, University College London, London, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK; CAMEO, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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Abstract
Objective: This study examines the impact of the transition from ICD-9-CM to ICD-10-CM diagnosis coding on the recording of mental health disorders in electronic health records (EHRs) and claims data in ten large health systems. We present rates of these diagnoses across two years spanning the October 2015 transition. Methods: Mental health diagnoses were identified from claims and EHR data at ten health care systems in the Mental Health Research Network (MHRN). Corresponding ICD-9-CM and ICD-10-CM codes were compiled and monthly rates of people receiving these diagnoses were calculated for one year before and after the coding transition. Results: For seven of eight diagnostic categories, monthly rates were comparable during the year before and the year after the ICD-10-CM transition. In the remaining category, psychosis excluding schizophrenia spectrum disorders, aggregate monthly rates of decreased markedly with the ICD-10-CM transition, from 48 to 33 per 100,000. We propose that the change is due to features of General Equivalence Mappings (GEMS) embedded in the EHR. Conclusions: For most mental health conditions, the transition to ICD-10-CM appears to have had minimal impact. The decrease seen for psychosis diagnoses in these health systems is likely due to changes associated with EHR implementation of ICD-10-CM coding rather than an actual change in disease prevalence. It is important to consider the impact of the ICD-10-CM transition for all diagnostic criteria used in research studies, quality measurement, and financial analysis during this interval.
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Simon GE, Yarborough BJ, Rossom RC, Lawrence JM, Lynch FL, Waitzfelder BE, Ahmedani BK, Shortreed SM. Self-Reported Suicidal Ideation as a Predictor of Suicidal Behavior Among Outpatients With Diagnoses of Psychotic Disorders. Psychiatr Serv 2019; 70:176-183. [PMID: 30526341 PMCID: PMC6520048 DOI: 10.1176/appi.ps.201800381] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Individuals with psychotic disorders are at high risk of suicidal behavior. The study examined whether response to item 9 of the Patient Health Questionnaire (PHQ-9), which asks about thoughts of death or self-harm, predicts suicidal behavior among outpatients with diagnoses of psychotic disorders. METHODS Electronic health records (EHRs) from seven large integrated health systems were used to identify all outpatient visits by adults with a diagnosis of schizophrenia spectrum psychosis or unspecified psychosis from January 1, 2009, to June 30, 2015, during which a PHQ-9 was completed (N=32,982 visits by 5,947 patients). Suicide attempts over the 90 days following each visit were ascertained from EHRs and insurance claims. Suicide deaths were ascertained from state death certificate files. RESULTS Risk of suicide attempt within 90 days of an outpatient visit was .8% among patients reporting no thoughts of death or self-harm and 3.5% among those reporting such thoughts "nearly every day." Over 90 days of follow-up, 47% of suicide attempts occurred among those who reported any recent thoughts of death or self-harm at the sampled visit. Also, 59% of attempts occurred among those reporting thoughts of death or self-harm at the index visit or any visit in the prior year. The number of suicide deaths within 90 days (N=10) was too small to accurately assess the relationship between PHQ-9 item 9 response and subsequent suicide death. CONCLUSIONS Among outpatients with psychotic disorders, response to item 9 of the PHQ-9 accurately identified those at increased short-term risk of a suicide attempt.
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Affiliation(s)
- Gregory E Simon
- Kaiser Permanente Washington Health Research Institute, Seattle (Simon, Shortreed); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Yarborough, Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (Lawrence); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder); Center for Health Services Research, Henry Ford Health System, Detroit (Ahmedani)
| | - Bobbi Jo Yarborough
- Kaiser Permanente Washington Health Research Institute, Seattle (Simon, Shortreed); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Yarborough, Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (Lawrence); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder); Center for Health Services Research, Henry Ford Health System, Detroit (Ahmedani)
| | - Rebecca C Rossom
- Kaiser Permanente Washington Health Research Institute, Seattle (Simon, Shortreed); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Yarborough, Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (Lawrence); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder); Center for Health Services Research, Henry Ford Health System, Detroit (Ahmedani)
| | - Jean M Lawrence
- Kaiser Permanente Washington Health Research Institute, Seattle (Simon, Shortreed); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Yarborough, Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (Lawrence); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder); Center for Health Services Research, Henry Ford Health System, Detroit (Ahmedani)
| | - Frances L Lynch
- Kaiser Permanente Washington Health Research Institute, Seattle (Simon, Shortreed); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Yarborough, Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (Lawrence); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder); Center for Health Services Research, Henry Ford Health System, Detroit (Ahmedani)
| | - Beth E Waitzfelder
- Kaiser Permanente Washington Health Research Institute, Seattle (Simon, Shortreed); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Yarborough, Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (Lawrence); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder); Center for Health Services Research, Henry Ford Health System, Detroit (Ahmedani)
| | - Brian K Ahmedani
- Kaiser Permanente Washington Health Research Institute, Seattle (Simon, Shortreed); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Yarborough, Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (Lawrence); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder); Center for Health Services Research, Henry Ford Health System, Detroit (Ahmedani)
| | - Susan M Shortreed
- Kaiser Permanente Washington Health Research Institute, Seattle (Simon, Shortreed); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Yarborough, Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (Lawrence); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder); Center for Health Services Research, Henry Ford Health System, Detroit (Ahmedani)
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Russ TC, Woelbert E, Davis KAS, Hafferty JD, Ibrahim Z, Inkster B, John A, Lee W, Maxwell M, McIntosh AM, Stewart R. How data science can advance mental health research. Nat Hum Behav 2018; 3:24-32. [DOI: 10.1038/s41562-018-0470-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 10/11/2018] [Indexed: 02/07/2023]
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Elevated allostatic load early in the course of schizophrenia. Transl Psychiatry 2018; 8:246. [PMID: 30420620 PMCID: PMC6232085 DOI: 10.1038/s41398-018-0299-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 06/17/2018] [Accepted: 07/14/2018] [Indexed: 12/19/2022] Open
Abstract
Stress plays a significant role in schizophrenia from disease onset to exacerbation of psychotic symptoms. Allostatic load (AL) is a measure of cumulative stress to the organism. This study is an extension of our previous work on AL and its relationship to brain structures. Here, we further determined whether elevated AL is a function of illness chronicity, or if it is already present early in the course of schizophrenia. AL was compared in schizophrenia patients early in the illness (within 5 years of disease onset), patients with chronic schizophrenia (more than 5 years of illness), and two groups of healthy controls that were age-and sex-matched to the two patient groups. This work is presented with an expanded sample and includes about two-thirds of the participants who were previously reported. We found that patients with early psychosis had significantly elevated AL score compared with their age-matched controls (p = 0.005). Chronic course patients also had elevated AL compared with age-matched controls (p = 0.003). Immune and stress hormone AL subcomponents were nominally higher in early-stage patients compared with controls (p = 0.005 and 0.04, respectively). Greater AL was also associated with more severe positive psychotic symptoms in early-stage patients (r = 0.54, p = 0.01). Elevated levels of allostatic load are already present in the early years of the schizophrenia illness, particularly in patients with more severe psychotic symptoms. AL may be a useful evaluation for the need of early intervention on psychosomatic comorbidity.
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Oluwoye O, Stiles B, Monroe-DeVita M, Chwastiak L, McClellan JM, Dyck D, Cabassa LJ, McDonell MG. Racial-Ethnic Disparities in First-Episode Psychosis Treatment Outcomes From the RAISE-ETP Study. Psychiatr Serv 2018; 69:1138-1145. [PMID: 30152275 PMCID: PMC6395511 DOI: 10.1176/appi.ps.201800067] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study examined racial and ethnic differences in treatment outcomes among participants in a randomized controlled trial of an intervention for first-episode psychosis called NAVIGATE. METHODS Secondary data analyses were conducted for participants randomly assigned to usual community care (N=181) and NAVIGATE (N=223). Generalized estimating equations assessed whether race and ethnicity were associated with psychiatric symptoms and service use (medication management, family psychoeducation, and individual therapy) over a 24-month treatment period, accounting for baseline symptoms, duration of untreated psychosis, and insurance status. RESULTS Among persons in usual community care, non-Hispanic blacks scored significantly higher throughout treatment on measures of positive symptoms (β=2.15, p=.010), disorganized thoughts (β=1.15, p=.033), and uncontrolled hostility (β=.74, p=.027), compared with non-Hispanic whites, and non-Hispanic blacks were less likely than non-Hispanic whites to receive individual therapy (OR=.45, p=.001). Families of Hispanic participants in usual community care were less likely than non-Hispanic white families to receive family psychoeducation (OR=.20, p=.01). For NAVIGATE participants, race and ethnicity were not associated with differences in psychiatric symptoms over time; families of non-Hispanic black participants were less likely than those of non-Hispanic white participants to receive family psychoeducation (OR=.53, p=.009). Hispanic participants in NAVIGATE were more likely than non-Hispanic white participants to receive medication management (OR=2.93, p=.001). CONCLUSIONS In usual community care, non-Hispanic blacks scored higher on measures of psychiatric symptoms and were less likely to receive important services, compared with non-Hispanic whites. In NAVIGATE, racial and ethnic differences in psychiatric symptoms were not evident, although non-Hispanic blacks were less likely than non-Hispanic whites to receive family psychoeducation.
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Affiliation(s)
- Oladunni Oluwoye
- Dr. Oluwoye, Dr. McDonell, and Dr. Dyck are with Washington State University, Spokane. Dr. Oluwoye and Dr. McDonell are with the Initiative for Research and Education to Advance Community Health and the Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, and Dr. Dyck is with the Department of Psychology. Mr. Stiles, Dr. Monroe-DeVita, Dr. Chwastiak, and Dr. McClellan are with the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle. Dr. Cabassa is with the George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis
| | - Bryan Stiles
- Dr. Oluwoye, Dr. McDonell, and Dr. Dyck are with Washington State University, Spokane. Dr. Oluwoye and Dr. McDonell are with the Initiative for Research and Education to Advance Community Health and the Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, and Dr. Dyck is with the Department of Psychology. Mr. Stiles, Dr. Monroe-DeVita, Dr. Chwastiak, and Dr. McClellan are with the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle. Dr. Cabassa is with the George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis
| | - Maria Monroe-DeVita
- Dr. Oluwoye, Dr. McDonell, and Dr. Dyck are with Washington State University, Spokane. Dr. Oluwoye and Dr. McDonell are with the Initiative for Research and Education to Advance Community Health and the Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, and Dr. Dyck is with the Department of Psychology. Mr. Stiles, Dr. Monroe-DeVita, Dr. Chwastiak, and Dr. McClellan are with the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle. Dr. Cabassa is with the George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis
| | - Lydia Chwastiak
- Dr. Oluwoye, Dr. McDonell, and Dr. Dyck are with Washington State University, Spokane. Dr. Oluwoye and Dr. McDonell are with the Initiative for Research and Education to Advance Community Health and the Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, and Dr. Dyck is with the Department of Psychology. Mr. Stiles, Dr. Monroe-DeVita, Dr. Chwastiak, and Dr. McClellan are with the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle. Dr. Cabassa is with the George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis
| | - Jon M McClellan
- Dr. Oluwoye, Dr. McDonell, and Dr. Dyck are with Washington State University, Spokane. Dr. Oluwoye and Dr. McDonell are with the Initiative for Research and Education to Advance Community Health and the Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, and Dr. Dyck is with the Department of Psychology. Mr. Stiles, Dr. Monroe-DeVita, Dr. Chwastiak, and Dr. McClellan are with the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle. Dr. Cabassa is with the George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis
| | - Dennis Dyck
- Dr. Oluwoye, Dr. McDonell, and Dr. Dyck are with Washington State University, Spokane. Dr. Oluwoye and Dr. McDonell are with the Initiative for Research and Education to Advance Community Health and the Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, and Dr. Dyck is with the Department of Psychology. Mr. Stiles, Dr. Monroe-DeVita, Dr. Chwastiak, and Dr. McClellan are with the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle. Dr. Cabassa is with the George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis
| | - Leopoldo J Cabassa
- Dr. Oluwoye, Dr. McDonell, and Dr. Dyck are with Washington State University, Spokane. Dr. Oluwoye and Dr. McDonell are with the Initiative for Research and Education to Advance Community Health and the Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, and Dr. Dyck is with the Department of Psychology. Mr. Stiles, Dr. Monroe-DeVita, Dr. Chwastiak, and Dr. McClellan are with the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle. Dr. Cabassa is with the George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis
| | - Michael G McDonell
- Dr. Oluwoye, Dr. McDonell, and Dr. Dyck are with Washington State University, Spokane. Dr. Oluwoye and Dr. McDonell are with the Initiative for Research and Education to Advance Community Health and the Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, and Dr. Dyck is with the Department of Psychology. Mr. Stiles, Dr. Monroe-DeVita, Dr. Chwastiak, and Dr. McClellan are with the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle. Dr. Cabassa is with the George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis
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Anderson KK, Norman R, MacDougall AG, Edwards J, Palaniyappan L, Lau C, Kurdyak P. Disparities in Access to Early Psychosis Intervention Services: Comparison of Service Users and Nonusers in Health Administrative Data. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:395-403. [PMID: 29562748 PMCID: PMC5971412 DOI: 10.1177/0706743718762101] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE There is a dearth of information on people with first-episode psychosis who do not access specialized early psychosis intervention (EPI) services. We sought to estimate the proportion of incident cases of nonaffective psychosis that do not access these services and to examine factors associated with EPI admission. METHODS Using health administrative data, we constructed a retrospective cohort of incident cases of nonaffective psychosis in the catchment area of the Prevention and Early Intervention Program for Psychoses (PEPP) in London, Ontario, between 1997 and 2013. This cohort was linked to primary data from PEPP to identify EPI users. We used multivariate logistic regression to model sociodemographic and service factors associated with EPI admission. RESULTS Over 50% of suspected cases of nonaffective psychosis did not have contact with EPI services for screening or admission. EPI users were significantly younger, more likely to be male (odds ratio [OR] 1.58; 95% confidence interval [CI] 1.24 to 2.01), and less likely to live in areas of socioeconomic deprivation (OR 0.51; 95% CI 0.36 to 0.73). EPI users also had higher odds of psychiatrist involvement at the index diagnosis (OR 7.35; 95% CI 5.43 to 10.00), had lower odds of receiving the index diagnosis in an outpatient setting (OR 0.50; 95% CI 0.38 to 0.65), and had lower odds of prior alcohol-related (OR 0.42; 95% CI 0.28 to 0.63) and substance-related (OR 0.68; 95% CI 0.50 to 0.93) disorders. CONCLUSIONS We need a greater consideration of patients with first-episode psychosis who are not accessing EPI services. Our findings suggest that this group is sizable, and there may be sociodemographic and clinical disparities in access. Nonpsychiatric health professionals could be targeted with interventions aimed at increasing detection and referral rates.
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Affiliation(s)
- Kelly K. Anderson
- Department of Epidemiology &
Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario,
London, Ontario
- Department of Psychiatry, Schulich School of
Medicine & Dentistry, University of Western Ontario, London, Ontario
- Institute for Clinical Evaluative Sciences,
Toronto, Ontario
| | - Ross Norman
- Department of Epidemiology &
Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario,
London, Ontario
- Department of Psychiatry, Schulich School of
Medicine & Dentistry, University of Western Ontario, London, Ontario
| | - Arlene G. MacDougall
- Department of Epidemiology &
Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario,
London, Ontario
- Department of Psychiatry, Schulich School of
Medicine & Dentistry, University of Western Ontario, London, Ontario
| | - Jordan Edwards
- Department of Epidemiology &
Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario,
London, Ontario
| | - Lena Palaniyappan
- Department of Psychiatry, Schulich School of
Medicine & Dentistry, University of Western Ontario, London, Ontario
- Department of Neuroscience, Schulich School of
Medicine & Dentistry, University of Western Ontario, London, Ontario
- Department of Medical Biophysics, Schulich
School of Medicine & Dentistry, University of Western Ontario, London, Ontario
| | - Cindy Lau
- Institute for Clinical Evaluative Sciences,
Toronto, Ontario
| | - Paul Kurdyak
- Institute for Clinical Evaluative Sciences,
Toronto, Ontario
- Health Outcomes and Performance Evaluation,
Centre for Addiction and Mental Health, Toronto, Ontario
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