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Cuesta MJ, García de Jalón E, Sánchez-Torres AM, Gil-Berrozpe GJ, Aranguren L, Gutierrez G, Corrales A, Zarzuela A, Ibañez B, Peralta V. Additive effects of a family history of schizophrenia spectrum disorders and an environmental risk score for the outcome of patients with non-affective first-episode psychosis. Psychol Med 2024:1-9. [PMID: 38505954 DOI: 10.1017/s0033291724000576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
BACKGROUND First-episode psychotic disorders comprise a heterogeneous phenotype with a complex etiology involving numerous common small-effect genetic variations and a wide range of environmental exposures. We examined whether a family of schizophrenia spectrum disorder (FH-Sz) interacts with an environmental risk score (ERS-Sz) regarding the outcome of patients with non-affective first episode psychosis (NAFEP). METHODS We included 288 patients with NAFEP who were evaluated after discharge from an intensive 2-year program. We evaluated three outcome measures: symptomatic remission, psychosocial functioning, and personal recovery. We analyzed the main and joint associations of a FH-Sz and the ERS-Sz on the outcomes by using the relative excess risk due to interaction (RERI) approach. RESULTS A FH-Sz showed a significant association with poor symptomatic remission and psychosocial functioning outcomes, although there was no significant interaction between a FH-Sz and the ERS-Sz on these outcomes. The ERS-Sz did not show a significant association with poor symptomatic remission and psychosocial functioning outcomes, even though the magnitude of the interaction between ERS-Sz and FH-Sz with the later outcome was moderate (RERI = 6.89, 95% confidence interval -16.03 to 29.81). There was no association between a FH-Sz and the ERS-Sz and personal recovery. CONCLUSIONS Our results provide further empirical support regarding the contribution of FH-Sz to poor symptomatic remission and poor psychosocial functioning outcomes in patients with NAFEP.
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Affiliation(s)
- Manuel J Cuesta
- Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Elena García de Jalón
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
- Mental Health Department, Servicio Navarro de Salud - Osasunbidea, Pamplona, Spain
| | - Ana M Sánchez-Torres
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
- Departament of Health Sciences, Universidad Pública de Navarra (UPNA), Pamplona, Spain
| | - Gustavo J Gil-Berrozpe
- Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Lidia Aranguren
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
- Mental Health Department, Servicio Navarro de Salud - Osasunbidea, Pamplona, Spain
| | - Gerardo Gutierrez
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
- Mental Health Department, Servicio Navarro de Salud - Osasunbidea, Pamplona, Spain
| | - Asier Corrales
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
- Mental Health Department, Servicio Navarro de Salud - Osasunbidea, Pamplona, Spain
| | - Amalia Zarzuela
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
- Mental Health Department, Servicio Navarro de Salud - Osasunbidea, Pamplona, Spain
| | - Berta Ibañez
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
- Methodology Unit, Navarrabiomed - HUN - UPNA, RICAPPS, Pamplona, Spain
| | - Víctor Peralta
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
- Mental Health Department, Servicio Navarro de Salud - Osasunbidea, Pamplona, Spain
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Patel K, Cardno A, Isherwood T. ' Like I said about culture. You don't talk about mental health ' : An interpretative phenomenological analysis of the experience of first-episode psychosis in South Asian individuals. Early Interv Psychiatry 2023; 17:771-783. [PMID: 36639135 DOI: 10.1111/eip.13368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/27/2022] [Accepted: 01/02/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND There is strong evidence of inequalities in mental healthcare access, experiences and outcomes for service users belonging to Black and Asian Minority Ethnic groups experiencing psychosis. Clinicians and academics have speculated that cultural variation in conceptualisations of psychosis, alongside inequitable service provision may explain disparities. There is, however, a dearth of literature exploring this in a South Asian population, despite this ethnic group being the second largest in the United Kingdom. The present study aimed to explore how people from this minority group have experienced and made sense of first-episode psychosis (FEP). METHODS A qualitative approach was used to explore the lived experience and sense-making of South Asian individuals experiencing FEP and accessing early intervention services. Eight people were interviewed using a semi-structured format. The data were analysed using Interpretative Phenomenological Analysis. RESULTS Three superordinate themes were identified in the group analysis: (1) Disconnection from self and others (2) Doubt and dispute (3) Power and shame. CONCLUSIONS Distinctive ethnic, cultural and systemic influences were strongly evident in how people conceptualized their experiences, how they managed their sense-making and where they sought support. Experiences were discussed in the context of power and shame, and this research proposes that socio-cultural context and racialised discourses have an impact on self-concept, the experiences of help-seeking (formal and informal), and fundamentally how services help individuals from marginalized communities.
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Affiliation(s)
- Krisna Patel
- School of Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Alastair Cardno
- Psychological & Social Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Tom Isherwood
- School of Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Wu J, Wang Y, Wang L, Wu H, Li J, Zhang L. Trends and burden in mental disorder death in China from 2009 to 2019: a nationwide longitudinal study. Front Psychiatry 2023; 14:1169502. [PMID: 37333931 PMCID: PMC10274321 DOI: 10.3389/fpsyt.2023.1169502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 04/24/2023] [Indexed: 06/20/2023] Open
Abstract
Objectives We aimed to elucidate trends in the crude mortality rate (CMR), age-standardized mortality rate (ASMR), and burden of mental disorders (MD) in China. Methods A longitudinal observational study was performed using the data of MD deaths in the National Disease Surveillance System (DSPs) during 2009-2019. The mortality rates were normalized using the Segis global population. Trends in the mortality of MDs stratified by age, gender, region, and residency, respectively. The burden of MD was evaluated using age-standardized person years of life loss per 100,000 people (SPYLLs) and average years of life lost (AYLL). Result A total of 18,178 MD deaths occurred during 2009-2019, accounting for 0.13% of total deaths, and 68.3% of MD deaths occurred in rural areas. The CMR of MD in China was 0.75/100,00 persons (ASMR: 0.62/100,000 persons). The ASMR of all MDs decreased mainly due to the decrease in ASMR in rural residents. Schizophrenia and alcohol use disorder (AUD) were the leading causes of death in MD patients. The ASMR of schizophrenia and AUD was higher in rural residents than in urban residents. The ASMR of MD was highest in the 40-64 age group. As the leading causes of MD burden, the SPYLL and AYLL of schizophrenia were 7.76 person-years and 22.30 years, respectively. Conclusion Although the ASMR of all MDs decreased during 2009-2019, schizophrenia and AUD were still the most important causes of death for MDs. Targeted efforts focusing on men, rural residents, and the 40-64 years old population should be strengthened to decrease MD-related premature deaths.
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Li Z, Fu Y, Wang C, Sun H, Hung P. Trends in the availability of community-based psychological counselling services for oldest-old in China, 2005 to 2018. J Affect Disord 2023; 331:405-412. [PMID: 36940823 DOI: 10.1016/j.jad.2023.03.035] [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: 08/28/2022] [Revised: 03/07/2023] [Accepted: 03/14/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Community-based psychological counselling services (CPCS) is crucial for the oldest-old who often faces challenges or are reluctant to seek care at the healthcare settings. This study aims to examine trends in availability of CPCS over time and rural-urban disparities in service availability among nationwide oldest-old in China. METHODS Multiple cross-sectional data were derived from the 2005-2018 Chinese Longitudinal Health Longevity Survey. Service availability was reported by each oldest-old participant or their next-of-kins as having CPCS in one's neighborhood. We used Cochran-Armitage tests to estimate service availability trends and applied sample-weighted logistic regression models to examine its rural-urban disparities. RESULTS Of 38,032 oldest-old, CPCS availability decreased from 6.7 % in 2005 to 4.8 % in 2008/2009, followed by continual increases to 13.6 % in 2017/2018. In 2017/2018, rural oldest-old's neighborhoods had no greater service availability. Oldest-old residing in the Central (6.7 %), Western (13.4 %) and Northeast China (8.1 %) were less likely to report having services locally than their Eastern counterparts (17.8 %). Oldest-old having any disability or living in the nursing homes reported having greater service availability than those without disability or living at home. LIMITATION Service availability might have disrupted during the COVID-19 pandemic. CONCLUSIONS Despite the increasing service availability, as of 2017/2018, only 13.6 % oldest-old in China had reported CPCS availability. It raises concerns on the disproportionate access to and continuity of mental health care, especially for those living the Central, Western China and those living at home. Policy efforts are needed to incentivize service expansion and eliminate disparities in the service availability.
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Affiliation(s)
- Zhong Li
- School of Health Policy and Management, Nanjing Medical University, Nanjing, Jiangsu, China; Institute of Healthy Jiangsu Development, Nanjing Medical University, Nanjing, Jiangsu, China
| | - You Fu
- Department of Review and Investigation, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Chengzhong Wang
- Department of Research Management, Xuzhoushi Center of Disease Control and Prevention, Xuzhou, Jiangsu, China
| | - Hui Sun
- Key Lab of Health Technology Assessment, National Health Commission, School of Public Health, Fudan University, Shanghai, China; Department of Health Technology Assessment Research, Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, China.
| | - Peiyin Hung
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States; Rural and Minority Health Research Center, University of South Carolina, Columbia, SC, United States.
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Chatterjee I, Chatterjee S. Investigating the symptomatic and morphological changes in the brain based on pre and post-treatment: A critical review from clinical to neuroimaging studies on schizophrenia. IBRO Neurosci Rep 2023. [DOI: 10.1016/j.ibneur.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
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Affiliation(s)
- Joseph M Pierre
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Michael F Zito
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Yvonne S Yang
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Stephen R Marder
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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Cuesta MJ, Sánchez-Torres AM, Moreno-Izco L, García de Jalón E, Gil-Berrozpe GJ, Zarzuela A, Peralta V, Ballesteros A, Fañanás L, Hernández R, Janda L, Lorente R, Papiol S, Peralta D, Ribeiro M, Rosero A, Zandio M. Neurocognitive correlates of the varied domains of outcomes at 20 year follow-up of first-episode psychosis. Psychiatry Res 2022; 318:114933. [PMID: 36334328 DOI: 10.1016/j.psychres.2022.114933] [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: 08/08/2022] [Revised: 10/18/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
Little is known about long-term outcomes of the first episode of psychosis (FEP) other than in the symptomatic domain. We hypothesised that cognitive impairment is associated with poorer multi-domain outcomes at a long-term follow-up of FEP patients. We followed-up 172 FEP patients for a mean of 20.3 years. Ten outcome dimensions were assessed (symptomatic, functional and personal recovery, social disadvantage, physical health, suicide attempts, number of episodes, current drug use, chlorpromazine equivalent doses (CPZ), and schizophrenia/schizoaffective disorder final diagnosis). Cognition was assessed at follow-up. Processing speed and verbal memory deficits showed significant associations with poor outcomes on symptomatic, social functioning, social disadvantage, higher number of episodes, and higher CPZ. Significant associations were found between visual memory impairments were significantly associated with low symptomatic and functional recovery, between attentional deficits and a final diagnosis of schizophrenia/schizoaffective disorder, and between social cognition deficits and poor personal recovery.Lower cognitive global scores were significantly associated with all outcome dimensions except for drug abuse and physical status. Using multiple outcome dimensions allowed for the inclusion of the patients' perspective and other commonly neglected outcome measures. Taken together, cognitive impairment in FEP patients is strongly related to poor performance on several outcome dimensions beyond symptomatic remission.
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Affiliation(s)
- M J Cuesta
- Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.
| | - A M Sánchez-Torres
- Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - L Moreno-Izco
- Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - E García de Jalón
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain; Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain
| | - G J Gil-Berrozpe
- Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - A Zarzuela
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain; Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain
| | - V Peralta
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain; Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain
| | - A Ballesteros
- Red de Salud Mental de Álava, Vitoria-Gasteiz, Spain
| | - L Fañanás
- Department of Evolutionary Biology, Ecology and Environmental Sciences, Faculty of Biology, University of Barcelona, Biomedicine Institute of the University of Barcelona (IBUB), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Spain
| | - R Hernández
- CSMIJ Ciutat Vella. Consorci Parc de Salut Mar, Barcelona, Spain
| | - L Janda
- Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain
| | - R Lorente
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - S Papiol
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Spain; Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, 80336, Germany; Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, 80336, Germany
| | - D Peralta
- Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain
| | - M Ribeiro
- Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - A Rosero
- Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain
| | - M Zandio
- Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
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Li XH, Deng SY, Zhang TM, Wang YZ, Wei DN, Wong IYL, Chan CLW, Ran MS. Affiliate stigma of mental illness in family caregivers of persons with mental illness in Hong Kong. Int J Soc Psychiatry 2022; 68:1698-1707. [PMID: 34791960 DOI: 10.1177/00207640211057723] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Affiliate stigma of family caregivers may severely influence family caregiving, early treatment, and recovery of people with mental illness (PMI), and it may be impacted by the knowledge of mental illness and contact with PMI. However, little is known about the correlation between affiliate stigma of family caregivers of PMI and contact in Hong Kong. AIMS This study aimed to investigate affiliate stigma and its influencing factors among family caregivers of PMI in Hong Kong. METHODS A total of 106 family caregivers in Hong Kong participated in the study. The measurements included affiliate stigma, contacts (quantity, quality, and level), knowledge, prejudice, and discriminatory behaviors. Multiple regression analyses were employed. RESULTS The mean score of affiliate stigma scale (ASS) in family caregivers was 2.17 (SD = 0.65). In regression analyses, the results showed that contact quantity and contact level were significantly associated with higher affiliate stigma and its cognitive domain, while contact quality (e.g. positive contact) were significantly associated with lower affiliate stigma and its all domains among family caregivers. The positive relationship between prejudicial attitudes and affiliate stigma was also found. CONCLUSIONS Affiliate stigma is severe among family caregivers of PMI in Hong Kong. The results of this study indicate that contact, especially positive contact, contributes to reducing affiliate stigma among family caregivers of PMI. The results of this study are important for development of health policy on reducing stigma in family caregivers of PMI. The effectiveness of Enhancing Contact Model (ECM) should be examined in future anti-stigma interventions.
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Affiliation(s)
- Xu-Hong Li
- Department of Social Work and Social Administration, University of Hong Kong, China
| | - Shu-Yu Deng
- Department of Social Work and Social Administration, University of Hong Kong, China
| | | | - Yi-Zhou Wang
- Department of Social Work and Social Administration, University of Hong Kong, China
| | - Dan-Nuo Wei
- Department of Social Work and Social Administration, University of Hong Kong, China
| | - Irene Yin Ling Wong
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, USA
| | - Cecilia Lai-Wan Chan
- Department of Social Work and Social Administration, University of Hong Kong, China
| | - Mao-Sheng Ran
- Department of Social Work and Social Administration, University of Hong Kong, China
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Peng MM, Ma Z, Luo W, Hu SH, Yang X, Liu B, Lai-Wan Chan C, Ran MS. Longitudinal impact of caregiver transition and family caregiving on psychiatric symptoms and psychosocial functioning among persons with schizophrenia in rural China. FAMILY PROCESS 2022; 61:1663-1680. [PMID: 34921397 DOI: 10.1111/famp.12743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 10/27/2021] [Accepted: 11/12/2021] [Indexed: 02/05/2023]
Abstract
This study examines the 21-year longitudinal impacts and predictive effects of family caregiver transition and the presence of family caregiving on the clinical status of persons with schizophrenia (PwSs) in a rural area of China. Using panel data derived from the Chengdu Mental Health Project (CMHP), 250 dyads of PwSs and their family caregivers were investigated in 1994 and 2015. The Positive and Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF) were utilized. The generalized linear model (GLM) approach was used. The results of this study showed that more severe symptoms in PwSs were found to be significantly predicted by older age and nonmarried status at baseline. Compared with "spousal caregiving in two waves," the PANSS score was significantly higher in the "transition into sibling caregiving" group. A higher degree of psychosocial functioning was found to be significantly predicted by marital status, shorter duration of illness, and better mental status. Compared with "spousal caregiving in two waves," the GAF score was significantly lower in the "transition into parental caregiving" group. The presence of family caregiving was not a significant predictor of the severity of symptoms or psychosocial functioning in the PwSs. In conclusion, this study shows the 21-year predictive effects of family caregiver transition on the mental status of PwSs but not the presence of family caregiving. Psychosocial interventions and specific guidance should be provided to family caregivers to enhance their quality of caregiving and improve the prognosis of PwSs during long periods of home care.
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Affiliation(s)
- Man-Man Peng
- Institute of Advanced Studies in Humanities and Social Sciences, Beijing Normal University at Zhuhai, Zhuhai, China
| | - Zhiying Ma
- Crown Family School of Social Work, Policy, and Practice, The University of Chicago, Chicago, Illinois, USA
| | - Wei Luo
- Chengdu Xinjin Second People's Hospital, Xinjin, Chengdu, Sichuan, China
| | - Shi-Hui Hu
- Chengdu Mental Health Center, Chengdu, China
| | - Xin Yang
- Guangyuan Mental Health Center, Guangyuan, China
| | - Bo Liu
- Jingzhou Mental Health Center, Jingzhou, China
| | - Cecilia Lai-Wan Chan
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong SAR, China
| | - Mao-Sheng Ran
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong SAR, China.,Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
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Rodolico A, Siafis S, Bighelli I, Samara MT, Hansen WP, Salomone S, Aguglia E, Cutrufelli P, Bauer I, Baeckers L, Leucht S. Antipsychotic dose reduction compared to dose continuation for people with schizophrenia. Cochrane Database Syst Rev 2022; 11:CD014384. [PMID: 36420692 PMCID: PMC9685497 DOI: 10.1002/14651858.cd014384.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Antipsychotic drugs are the mainstay treatment for schizophrenia, yet they are associated with diverse and potentially dose-related side effects which can reduce quality of life. For this reason, the lowest possible doses of antipsychotics are generally recommended, but higher doses are often used in clinical practice. It is still unclear if and how antipsychotic doses could be reduced safely in order to minimise the adverse-effect burden without increasing the risk of relapse. OBJECTIVES To assess the efficacy and safety of reducing antipsychotic dose compared to continuing the current dose for people with schizophrenia. SEARCH METHODS We conducted a systematic search on 10 February 2021 at the Cochrane Schizophrenia Group's Study-Based Register of Trials, which is based on CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, PubMed, ClinicalTrials.gov, ISRCTN, and WHO ICTRP. We also inspected the reference lists of included studies and previous reviews. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing any dose reduction against continuation in people with schizophrenia or related disorders who were stabilised on their current antipsychotic treatment. DATA COLLECTION AND ANALYSIS: At least two review authors independently screened relevant records for inclusion, extracted data from eligible studies, and assessed the risk of bias using RoB 2. We contacted study authors for missing data and additional information. Our primary outcomes were clinically important change in quality of life, rehospitalisations and dropouts due to adverse effects; key secondary outcomes were clinically important change in functioning, relapse, dropouts for any reason, and at least one adverse effect. We also examined scales measuring symptoms, quality of life, and functioning as well as a comprehensive list of specific adverse effects. We pooled outcomes at the endpoint preferably closest to one year. We evaluated the certainty of the evidence using the GRADE approach. MAIN RESULTS We included 25 RCTs, of which 22 studies provided data with 2635 participants (average age 38.4 years old). The median study sample size was 60 participants (ranging from 18 to 466 participants) and length was 37 weeks (ranging from 12 weeks to 2 years). There were variations in the dose reduction strategies in terms of speed of reduction (i.e. gradual in about half of the studies (within 2 to 16 weeks) and abrupt in the other half), and in terms of degree of reduction (i.e. median planned reduction of 66% of the dose up to complete withdrawal in three studies). We assessed risk of bias across outcomes predominantly as some concerns or high risk. No study reported data on the number of participants with a clinically important change in quality of life or functioning, and only eight studies reported continuous data on scales measuring quality of life or functioning. There was no difference between dose reduction and continuation on scales measuring quality of life (standardised mean difference (SMD) -0.01, 95% confidence interval (CI) -0.17 to 0.15, 6 RCTs, n = 719, I2 = 0%, moderate certainty evidence) and scales measuring functioning (SMD 0.03, 95% CI -0.10 to 0.17, 6 RCTs, n = 966, I2 = 0%, high certainty evidence). Dose reduction in comparison to continuation may increase the risk of rehospitalisation based on data from eight studies with estimable effect sizes; however, the 95% CI does not exclude the possibility of no difference (risk ratio (RR) 1.53, 95% CI 0.84 to 2.81, 8 RCTs, n = 1413, I2 = 59% (moderate heterogeneity), very low certainty evidence). Similarly, dose reduction increased the risk of relapse based on data from 20 studies (RR 2.16, 95% CI 1.52 to 3.06, 20 RCTs, n = 2481, I2 = 70% (substantial heterogeneity), low certainty evidence). More participants in the dose reduction group in comparison to the continuation group left the study early due to adverse effects (RR 2.20, 95% CI 1.39 to 3.49, 6 RCTs with estimable effect sizes, n = 1079, I2 = 0%, moderate certainty evidence) and for any reason (RR 1.38, 95% CI 1.05 to 1.81, 12 RCTs, n = 1551, I2 = 48% (moderate heterogeneity), moderate certainty evidence). Lastly, there was no difference between the dose reduction and continuation groups in the number of participants with at least one adverse effect based on data from four studies with estimable effect sizes (RR 1.03, 95% CI 0.94 to 1.12, 5 RCTs, n = 998 (4 RCTs, n = 980 with estimable effect sizes), I2 = 0%, moderate certainty evidence). AUTHORS' CONCLUSIONS: This review synthesised the latest evidence on the reduction of antipsychotic doses for stable individuals with schizophrenia. There was no difference between dose reduction and continuation groups in quality of life, functioning, and number of participants with at least one adverse effect. However, there was a higher risk for relapse and dropouts, and potentially for rehospitalisations, with dose reduction. Of note, the majority of the trials focused on relapse prevention rather potential beneficial outcomes on quality of life, functioning, and adverse effects, and in some studies there was rapid and substantial reduction of doses. Further well-designed RCTs are therefore needed to provide more definitive answers.
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Affiliation(s)
- Alessandro Rodolico
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Catania, Italy
| | - Spyridon Siafis
- Section for Evidence Based Medicine in Psychiatry and Psychotherapy, Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Irene Bighelli
- Section for Evidence Based Medicine in Psychiatry and Psychotherapy, Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Myrto T Samara
- Department of Psychiatry, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | | | - Salvatore Salomone
- Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Eugenio Aguglia
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Catania, Italy
| | - Pierfelice Cutrufelli
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Catania, Italy
| | - Ingrid Bauer
- Section for Evidence Based Medicine in Psychiatry and Psychotherapy, Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Lio Baeckers
- Section for Evidence Based Medicine in Psychiatry and Psychotherapy, Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Stefan Leucht
- Section for Evidence Based Medicine in Psychiatry and Psychotherapy, Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
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Jia N, Li Z, Li X, Jin M, Liu Y, Cui X, Hu G, Liu Y, He Y, Yu Q. Long-term effects of antipsychotics on mortality in patients with schizophrenia: a systematic review and meta-analysis. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2022; 44:664-673. [PMID: 36709510 PMCID: PMC9851750 DOI: 10.47626/1516-4446-2021-2306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 03/28/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To gather current evidence on the impact of antipsychotics on long-term mortality in patients with schizophrenia. METHODS We systematically searched for articles in Embase, PubMed, and PsycINFO reporting the long-term mortality (follow-up > 1 year) of patients with schizophrenia who were using any antipsychotics. We then conducted multiple meta-analyses to determine differences in long-term mortality between different types of antipsychotics. RESULTS We identified 45 articles that provided unadjusted long-term mortality rates, including 46,171 deaths during 2,394,911 person-years. The pooled mortality rate was 9.9 (95%CI = 7.4-12.7) per 1,000 person-years. The unadjusted crude mortality rate of antipsychotic drug users was lower than that of non-users (risk ratio [RR] = 0.546, 95%CI = 0.480-0.621), first-generation antipsychotics caused higher all-cause mortality than second-generation antipsychotics (RR = 1.485, 95%CI = 1.361-1.620), and polypharmacy had better effects than monotherapy on long-term mortality (RR = 0.796, 95%CI = 0.689-0.921). As for the causes of death, heart disease and cardiovascular disease ranked highest among cause-specific mortality (5.6 per 1,000 person-years). CONCLUSION Since antipsychotics had a beneficial effect on long-term mortality in schizophrenia, greater precaution should be taken with patients who do not take them. However, since disease severity, comorbidities, and other confounding factors cannot be fully controlled, further research and verification are needed.
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Affiliation(s)
- Ningning Jia
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Zhijun Li
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Xinwei Li
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Mengdi Jin
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Yane Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Xingyao Cui
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Guoyan Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Yang Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Yang He
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Qiong Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China,Correspondence: Qiong Yu, Jilin University, School of Public Health, Department of Epidemiology and Biostatistics, Changchun 130021, China. E-mail:
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12
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Wang M, Chen L, Tang J, Wei Y, Jin G, Lu X. Access to family resources by families living with schizophrenia: a qualitative study of primary care workers in urban Beijing, China. BMJ Open 2022; 12:e062675. [PMID: 36691176 PMCID: PMC9454069 DOI: 10.1136/bmjopen-2022-062675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 08/05/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES This study aims to investigate the access to family resources by families living with schizophrenia from the perspective of primary care workers in Beijing, and provide evidence for appropriate and effective family resource coordination in primary care. DESIGN Qualitative research using individual in-depth interviews to identify the access to family resources by families living with schizophrenia from the perspective of primary care workers. SETTING This study was conducted from September to December 2021 in six urban community health service centres (CHSCs) in Beijing, China. PARTICIPANTS 3 general practitioners and 10 mental health doctors selected by purposive sampling method from 6 CHSCs in urban Beijing were interviewed. RESULTS Five themes emerged from the insights of the primary care workers: most family resources are non-targeted for families living with schizophrenia, the publicity of family resources is difficult, burdensome application process of family resources, limited available community-based treatment options and stigma hindering effective communication between families and society. CONCLUSIONS It is necessary to simplify the application process of family resources and provide primary care workers with systematic training regarding family resources. More family resources and improved public attitudes should be promoted for patients with schizophrenia and their caregivers.
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Affiliation(s)
- Meirong Wang
- School of General Practice and Continuing Education, Capital Medical University, Beijing, China
- General Department, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Lifen Chen
- Department of Education, Xuanwu Hospital, Beijing, China
| | - Juan Tang
- General Practice, Gong He Community Health Service Center, Beijing, China
| | - Yun Wei
- School of General Practice and Continuing Education, Capital Medical University, Beijing, China
| | - Guanghui Jin
- School of General Practice and Continuing Education, Capital Medical University, Beijing, China
| | - Xiaoqin Lu
- School of General Practice and Continuing Education, Capital Medical University, Beijing, China
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13
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Oedegaard CH, Ruano AL, Blindheim A, Veseth M, Stige B, Davidson L, Engebretsen IMS. How can we best help this patient? Exploring mental health therapists’ reflections on medication-free care for patients with psychosis in Norway. Int J Ment Health Syst 2022; 16:19. [PMID: 35379290 PMCID: PMC8978409 DOI: 10.1186/s13033-022-00529-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 03/16/2022] [Indexed: 11/24/2022] Open
Abstract
Background Since 2015, Norwegian Regional Health Authorities have followed new government policy and gradually implemented medication-free services for patients with psychosis. The aim of this qualitative study was to explore the tension between policy and practice, and how health care workers in Bergen reflect on their role in implementing medication-free treatment. Methods We performed three focus group discussions including 17 therapists working within medication free services, asking about their experiences with this new treatment program. We used Systematic Text Condensation for data analysis. The findings were discussed using Michael Lipsky’s theoretical framework on the role public health workers play in policy implementation. Findings Following Norway’s new policy was challenging for the therapists in our study, particularly balancing a patient’s needs with treatment guidelines, the legal framework and available resources. Therapists had an overarching wish to help patients through cooperation and therapeutic alliance, but their alliance was sometimes fragile, and the therapists worried about patients’ conditions worsening. Conclusions Democratization of treatment choices, with the aim of empowering patients in mental health care, challenges the level of professional discretion given that patients and therapists might have conflicting goals. Balancing the desire to help, professional responsibility, the perceived lack of resources, and certain patient choices created conditions that can leave therapists feeling disempowered in and alienated from their work. Trial registration: N/A. Supplementary Information The online version contains supplementary material available at 10.1186/s13033-022-00529-8.
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14
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Peng MM, Ma Z, Chen SY, Luo W, Hu SH, Yang X, Liu B, Chan CLW, Ran MS. Predictors of family caregiving burden of persons with schizophrenia with and without transition of primary caregivers from 1994 to 2015 in rural China. BJPsych Open 2022; 8:e78. [PMID: 35362401 PMCID: PMC9059613 DOI: 10.1192/bjo.2022.45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 02/01/2022] [Accepted: 02/22/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Little is known about how sociodemographic and clinical factors affect the caregiving burden of persons with schizophrenia (PwSs) with transition in primary caregivers. AIMS This study aimed to examine the predictive effects of sociodemographic and clinical factors on the caregiving burden of PwSs with and without caregiver transition from 1994 to 2015 in rural China. METHOD Using panel data, 206 dyads of PwSs and their primary caregivers were investigated in both 1994 and 2015. The generalised linear model approach was used to examine the predictive effects of sociodemographic factors, severity of symptoms and changes in social functioning on the caregiving burden with and without caregiver transition. RESULTS The percentages of families with and without caregiver transition were 38.8% and 61.2%, respectively. Among families without caregiver transition, a heavier burden was significantly related to a larger family size and more severe symptoms in PwSs. Deteriorated functioning of 'social activities outside the household' and improved functioning of 'activity in the household' were protective factors against a heavy caregiving burden. Among families with caregiver transition, younger age, improved marital functioning, deteriorated self-care functioning, and better functioning of 'social interest or concern' were significant risk factors for caregiving burden. CONCLUSIONS The effects of sociodemographic and clinical correlates on the caregiving burden were different among families with and without caregiver transition. It is crucial to explore the caregiver arrangement of PwSs and the risk factors for burden over time, which will facilitate culture-specific family interventions, community-based mental health services and recovery.
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Affiliation(s)
- Man-Man Peng
- Institute of Advanced Studies in Humanities and Social Sciences, Beijing Normal University at Zhuhai, Zhuhai, China
| | - Zhiying Ma
- Crown Family School of Social Work, Policy, and Practice, The University of Chicago, Chicago, Illinois, USA
| | - She-Ying Chen
- Center for Social Work Study, Institute on Chinese Culture, Health and Public Welfare, Tsinghua University, China
| | - Wei Luo
- Xinjin Second People's Hospital, Xinjin, Chengdu, Sichuan, China
| | - Shi-Hui Hu
- Chengdu Mental Health Center, Chengdu, Sichuan, China
| | - Xin Yang
- Guangyuan Mental Health Center, Guangyuan, Sichuan, China
| | - Bo Liu
- Jingzhou Mental Health Center, Jingzhou, Hubei, China
| | - Cecilia Lai-Wan Chan
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong SAR, China
| | - Mao-Sheng Ran
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong SAR; and Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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15
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Peng MM, Ma Z, Ran MS. Family caregiving and chronic illness management in schizophrenia: positive and negative aspects of caregiving. BMC Psychol 2022; 10:83. [PMID: 35361263 PMCID: PMC8973811 DOI: 10.1186/s40359-022-00794-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 03/24/2022] [Indexed: 02/08/2023] Open
Abstract
Background We aimed to explore the long-term caregiving experiences of family caregivers of people with schizophrenia (PwS) in terms of both positive and negative aspects. Method Utilising a purposive sampling method, we conducted in-depth interviews with 20 family caregivers of persons who had suffered from schizophrenia for more than 20 years. We empirically investigated their retrospective experiences of caregiver-patient interactions during a long period of family caregiving. We audio-recorded and transcribed the interviews into text. We thematically coded and analysed the transcribed text using a four-phase method of theme development. Findings Schizophrenia might not only generate a caregiving burden, affect caregivers’ psychological status, and accordingly influence their coping strategies, but also have short- or long-term patient-related consequences. Discussion Family caregivers should develop their stress management skills to cope with relevant life changes and increase their knowledge of the potential psychological consequences for care recipients resulting from negative caregiving strategies during home-based practice. Care recipients with schizophrenia in a relatively stable status should be empowered to take care of themselves. More effective family-based interventions for psychiatric nursing or individualised training for symptom management should be tailored to serve families’ diverse needs.
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Affiliation(s)
- Man-Man Peng
- Institute of Advanced Studies in Humanities and Social Sciences, Beijing Normal University at Zhuhai, Zhuhai, 519087, China.
| | - Zhiying Ma
- Crown Family School of Social Work, Policy, and Practice, The University of Chicago, Chicago, IL, USA
| | - Mao-Sheng Ran
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong SAR, China. .,Mental Health Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
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16
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Yang LH, Phillips MR, Li X, Yu G, Grivel MM, Zhang J, Shi Q, Ding Z, Pang S, Susser E. Determinants of never-treated status in rural versus urban contexts for individuals with schizophrenia in a population-based study in China. BMC Psychiatry 2022; 22:128. [PMID: 35177017 PMCID: PMC8851815 DOI: 10.1186/s12888-021-03651-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 12/10/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND A goal of China's 2012 National Mental Health Law is to improve access to services and decrease urban versus rural disparities in services. However, pre-reform data is needed for objective evaluation of these reforms' effectiveness. Accordingly, this study compares the pre-reform utilization of medical services for the treatment of schizophrenia in rural and urban communities in China. METHODS In a large community-based study in four provinces representing 12% of China's population conducted from 2001 to 2005, we identified 326 individuals with schizophrenia (78 never treated). Comparing those living in urban (n = 86) versus rural (n = 240) contexts, we used adjusted Poisson regression models to assess the relationship of 'never treated' status with family-level factors (marital status, family income, and number of co-resident family members) and illness severity factors (age of onset, symptom severity and functional impairment). RESULTS Despite similar impairments due to symptoms, rural patients were less likely to have received intensive mental health services (i.e., use psychiatric inpatient services), and appeared more likely to be 'never treated' or to only have received outpatient care. Among rural patients, only having more than four co-resident family members was independently associated with 'never-treated' status (RR = 0.34; 95% CI, 0.12-0.94; p = 0.039). Among urban patients, only older age of onset was independently associated with 'never-treated' status (RR = 1.06; 95% CI 1.02-1.10, p = 0.003). CONCLUSIONS Identifying differential drivers of service utilization in urban and rural communities is needed before implementing policies to improve the utilization and equity of services and to define metrics of program success.
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Affiliation(s)
- Lawrence H. Yang
- grid.137628.90000 0004 1936 8753Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY USA ,grid.21729.3f0000000419368729Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY USA
| | - Michael R. Phillips
- grid.21729.3f0000000419368729Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY USA ,grid.16821.3c0000 0004 0368 8293Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 3210 Humin Road, Shanghai, 201108 People’s Republic of China ,grid.21729.3f0000000419368729Department of Psychiatry, Columbia University, New York, NY USA ,grid.413734.60000 0000 8499 1112New York State Psychiatric Institute, New York, NY USA
| | - Xianyun Li
- grid.414351.60000 0004 0530 7044Beijing Hui Long Guan Hospital, Beijing, China
| | - Gary Yu
- grid.137628.90000 0004 1936 8753Rory Meyers College of Nursing, New York University, New York, NY USA
| | - Margaux M. Grivel
- grid.137628.90000 0004 1936 8753Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY USA
| | - Jingxuan Zhang
- Shandong Provincial Mental Health, Jinan City, Shandong Province China
| | - Qichang Shi
- Tong De Hospital of Zhejiang Province, Hangzhou City, Zhejiang Province China
| | - Zhijie Ding
- The 3rd People’s Hospital of Tianshui City, Tianshui, Gansu Provice China
| | - Shutao Pang
- Qingdao Blood Center, Qingdao City, Shandong Province China
| | - Ezra Susser
- grid.21729.3f0000000419368729Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY USA
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17
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Disease-Related Risk Factors for Caregiver Burden among Family Caregivers of Persons with Schizophrenia: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031862. [PMID: 35162886 PMCID: PMC8835439 DOI: 10.3390/ijerph19031862] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 01/27/2022] [Accepted: 01/31/2022] [Indexed: 12/14/2022]
Abstract
This study aimed to conduct a quantitative synthesis of the clinical correlates of caregiver burden in schizophrenia studies published in the last two decades. Derived from eight electronic databases, this meta-analytic review revisits 34 English articles published from 2000 to 2020 relevant to family caregiver burden in the schizophrenia field. The Newcastle–Ottawa Scale (NOS) was used to assess study quality. The pooled effect sizes of the selected studies ranged from −0.390 to 0.751. The results indicated a significant association between a heavier burden and disease-related risk factors, including more severe symptoms, greater general psychopathology, greater severity of functional impairment, and longer duration of illness. The results show moderating effects of study characteristics (i.e., study quality, participants, and location) on the correlations between these disease-related risk factors and caregiver burden. This review highlights the roles of study characteristics in affecting the inconsistent results for the effects of disease-related risk factors on caregiver burden in families of patients with schizophrenia. Psychosocial interventions are essential for family caregivers of persons with schizophrenia. Future studies incorporating random samples from both high-income and low-to-middle-income countries will be crucial to understand the effects of cultural contexts on caregiver burden in families of persons with schizophrenia.
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18
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Zhao J, Diao J, Li X, Yang Y, Yao Y, Shi S, Yuan X, Liu H, Zhang K. Gender Differences in Psychiatric Symptoms and the Social Functioning of 610 Patients with Schizophrenia in Urban China: A 10-Year Follow-Up Study. Neuropsychiatr Dis Treat 2022; 18:1545-1551. [PMID: 35923298 PMCID: PMC9342654 DOI: 10.2147/ndt.s373923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 07/21/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To explore the different outcomes between male and female patients with schizophrenia after long-term follow-up. PATIENTS AND METHODS Schizophrenia patients were participants in our study. First, two senior psychiatrists collected data on the demographic characteristics and clinical symptoms of patients from the Hospital Information System between February 2009 and January 2010. Second, two other senior psychiatrists called the patients and their guardians between February 2019 and January 2020 to get general information on the patients and assess their psychiatric symptoms and social functioning using the Positive and Negative Syndrome Scale (PANSS) and the Personal and Social Performance (PSP) scale. RESULTS Of the 610 participants, the 306 female participants were younger (48.32 ± 12.99 vs 49.84 ± 12.60) and had received more education (8.08 ± 3.76 vs 7.94 ±3 0.73). After 10 years, women were found to have more outpatient visits than men (20.86 ± 22.21 vs 16.11 ± 16.87, P < 0.05). However, there was no significant gender difference in number of hospitalizations (3.12 ± 5.34 vs 2.77 ± 5.84, P > 0.05). The PANSS scores were lower for both groups at the 10-year follow-up. Women had significantly lower scores than men after the 10-year period (P < 0.05). With regard to social functioning, there was a significant difference in social functioning between baseline scores and 10-year follow-up scores indicating an improvement in social functioning. PSP scores had significantly increased in women (P < 0.01) but not in men (P > 0.05). CONCLUSION Female patients had significantly lower levels of psychiatric symptoms and higher levels of social functioning at 10-year follow-up than male patients. They also reported more outpatient visits, which may have contributed to the gender differences in outcomes. Family members and doctors of patients should urge patients to make regular outpatient visits for better outcomes after hospitalization.
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Affiliation(s)
- Jintao Zhao
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, People's Republic of China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, People's Republic of China
| | - Jian Diao
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, People's Republic of China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, People's Republic of China
| | - Xiaoyue Li
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, People's Republic of China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, People's Republic of China
| | - Yating Yang
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, People's Republic of China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, People's Republic of China
| | - Yitan Yao
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, People's Republic of China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, People's Republic of China
| | - Shengya Shi
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, People's Republic of China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, People's Republic of China
| | - Xiaoping Yuan
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, People's Republic of China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, People's Republic of China
| | - Huanzhong Liu
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, People's Republic of China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, People's Republic of China
| | - Kai Zhang
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, People's Republic of China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, People's Republic of China
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Modeling psychological function in patients with schizophrenia with the PANSS: an international multi-center study. CNS Spectr 2021; 26:290-298. [PMID: 32290897 DOI: 10.1017/s1092852920001091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The aim of the current study was to explore the changing interrelationships among clinical variables through the stages of schizophrenia in order to assemble a comprehensive and meaningful disease model. METHODS Twenty-nine centers from 25 countries participated and included 2358 patients aged 37.21 ± 11.87 years with schizophrenia. Multiple linear regression analysis and visual inspection of plots were performed. RESULTS The results suggest that with progression stages, there are changing correlations among Positive and Negative Syndrome Scale factors at each stage and each factor correlates with all the others in that particular stage, in which this factor is dominant. This internal structure further supports the validity of an already proposed four stages model, with positive symptoms dominating the first stage, excitement/hostility the second, depression the third, and neurocognitive decline the last stage. CONCLUSIONS The current study investigated the mental organization and functioning in patients with schizophrenia in relation to different stages of illness progression. It revealed two distinct "cores" of schizophrenia, the "Positive" and the "Negative," while neurocognitive decline escalates during the later stages. Future research should focus on the therapeutic implications of such a model. Stopping the progress of the illness could demand to stop the succession of stages. This could be achieved not only by both halting the triggering effect of positive and negative symptoms, but also by stopping the sensitization effect on the neural pathways responsible for the development of hostility, excitement, anxiety, and depression as well as the deleterious effect on neural networks responsible for neurocognition.
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20
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Zhao X, Yu YH, Peng MM, Luo W, Hu SH, Yang X, Liu B, Zhang T, Gao R, Chan CLW, Ran MS. Change of poverty and outcome of persons with severe mental illness in rural China, 1994-2015. Int J Soc Psychiatry 2021; 67:315-323. [PMID: 32830571 DOI: 10.1177/0020764020951234] [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: 01/20/2023]
Abstract
BACKGROUND It is unknown whether and how poverty influences the long-term outcome of persons with severe mental illness (SMI). AIMS To explore the change of poverty status in persons with SMI from 1994 to 2015 and examine the impact of poverty status on patients' outcome in rural China. METHOD Two mental health surveys using identical methods and International Classification of Disease (ICD-10) were conducted in 1994 and 2015 in the same six townships of Xinjin County, Chengdu, China. RESULTS The annual net income per person was 19.8% and 100.2% higher for the general population than for persons with SMI in 1994 and 2015 respectively. Compared with 1994 (48.2%), persons with SMI in 2015 had significantly higher rates of poor family economic status (<mean) (65.2%) (p < .001). Persons with SMI in poor family economic status were significantly more likely to be male, unmarried, unable to work, with no family caregivers or a smaller number of family members, and in poor mental status in 1994 and 2015 (p < .05). The risk factors significantly associated with patients' poor mental status included poor work ability, younger age of first onset, never-treated status and poor family economic status. CONCLUSIONS Relative poverty of persons with SMI has become more severe during the rapid socioeconomic development in rural China. Relative poverty of household, poor work ability, younger age of onset and never-treated status are risk factors of poor outcome. Culture-specific, community-based interventions and targeted poverty alleviation programs should improve patients' early identification, treatment and recovery.
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Affiliation(s)
- Xinyi Zhao
- School of Health Humanities, Peking University, Beijing, China
| | - Yue-Hui Yu
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China
| | - Man-Man Peng
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China
| | - Wei Luo
- Xinjin Second People's Hospital, Xinjin, Chengdu, Sichuan, China
| | - Shi-Hui Hu
- Chengdu Mental Health Center, Chengdu, Sichuan, China
| | - Xin Yang
- Guangyuan Mental Health Center, Guangyuan, Sichuan, China
| | - Bo Liu
- Jingzhou Mental Health Center, Jingzhou, Hubei, China
| | - Tin Zhang
- Santai Mental Health Center, Sichuan, China
| | - Ru Gao
- Yaan Fourth People's Hospital, Yaan, Sichuan, China
| | - Cecilia Lai-Wan Chan
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China
| | - Mao-Sheng Ran
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China
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21
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22
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Huhn M, Leucht C, Rothe P, Dold M, Heres S, Bornschein S, Schneider-Axmann T, Hasan A, Leucht S. Reducing antipsychotic drugs in stable patients with chronic schizophrenia or schizoaffective disorder: a randomized controlled pilot trial. Eur Arch Psychiatry Clin Neurosci 2021; 271:293-302. [PMID: 32062728 PMCID: PMC7960583 DOI: 10.1007/s00406-020-01109-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 02/03/2020] [Indexed: 11/28/2022]
Abstract
As the course of schizophrenic disorders is often chronic, treatment guidelines recommend continuous maintenance treatment to prevent relapses, but antipsychotic drugs can cause many side effects. It, therefore, seems reasonable to try to reduce doses in stable phases of the illness or even try to stop medication. We conducted a 26 weeks, randomized, rater blind, feasibility study to examine individualized antipsychotic dose reduction versus continuous maintenance treatment (Register Number: NCT02307396). We included chronic, adult patients with schizophrenia or schizoaffective disorder, who were treated with any antipsychotic drug except clozapine, who had not been hospitalized in the last 3 years and who were in symptomatic remission at baseline. The primary outcome was relapse of positive symptoms. Symptom severity, social functioning and side effects were also examined as secondary outcomes. 20 patients were randomized. Relapse rates in the two groups were not significantly different. No patient had to be hospitalized. One patient in the control group dropped out. The mean reduction of antipsychotic dose in the individualized dose-reduction group was 42%, however only one patient discontinued drug completely. There were no significant differences in efficacy or safety outcomes. This randomized trial provides evidence, that reduction of antipsychotic medication in chronic stable schizophrenic patients may be feasible. The results need to be confirmed in a larger trial with a longer follow-up period.
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Affiliation(s)
- Maximilian Huhn
- Department of Psychiatry and Psychotherapy, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany. .,Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Social Foundation Bamberg, Teaching Hospital of the University of Erlangen, Erlangen, Germany.
| | - Claudia Leucht
- Department of Psychiatry and Psychotherapy, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Ismaningerstr. 22, 81675 Munich, Germany
| | - Philipp Rothe
- Department of Forensic Psychiatry and Psychotherapy, Günzburg District Hospital, University of Ulm, Ludwig-Heilmeyer-Straße 2, Guenzburg, Germany
| | - Markus Dold
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, Austria
| | - Stephan Heres
- Klinik Nord, Isar-Amper-Klinikum München Ost, Munich, Kölner Platz, Haus 7, 80804 Munich, Germany
| | - Susanne Bornschein
- Private Practice for Psychiatry and Psychotherapy, Nymphenburger Str. 139, 80636 Munich, Germany ,Inn-Salzach-Klinikum Wasserburg Am Inn, Gabersee 7, 83512 Wasserburg Am Inn, Germany
| | - Thomas Schneider-Axmann
- Department of Psychiatry and Psychotherapy, University Medical Hospital, Nußbaumstr. 7, 80336 Munich, Germany
| | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, University Medical Hospital, Nußbaumstr. 7, 80336 Munich, Germany ,Department of Psychiatry, Psychotherapy and Psychosomatics of the University Augsburg, Bezirkskrankenhaus Augsburg, Augsburg, Germany
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Ismaningerstr. 22, 81675 Munich, Germany
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Yu YH, Peng MM, Bai X, Luo W, Yang X, Li J, Liu B, Thornicroft G, Chan CLW, Ran MS. Schizophrenia, social support, caregiving burden and household poverty in rural China. Soc Psychiatry Psychiatr Epidemiol 2020; 55:1571-1580. [PMID: 32200431 DOI: 10.1007/s00127-020-01864-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 03/11/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Household poverty associated with schizophrenia has been long described. However, the mechanisms by which schizophrenia may have influenced the economic status of a household in rural communities are still unclear. This study aimed to test an integrated model of schizophrenia, social support and caregiving burden on household poverty in a rural community in China. METHODS A mental health survey using identical methods and ICD-10 was conducted in six townships of Xinjin County (population ≥ 15 years old, n = 152,776), Chengdu, China in 2015. Identified persons with schizophrenia (n = 661) and their caregivers completed a joint questionnaire of sociodemographic information, illness conditions, social support and caregiving burden. Descriptive analysis was applied first to give an overview of the dataset. Then, multivariable regression analyses were conducted to examine the associative factors of social support, caregiving burden and household income. Then, structural equation modeling (SEM) was used to estimate the integrated model of schizophrenia, social support, caregiving burden and household income. RESULTS Households with patient being female, married, able to work and having better social function were better off. Larger household size, higher social support and lower caregiving burden also had salient association with higher household income. The relationship between schizophrenia and household poverty appeared to be mediated by the impacts of schizophrenia on social support and caregiving burden. CONCLUSION There was a strong association between schizophrenia and household poverty, in which social support and caregiving burden may had played significant roles on mediating it. More precise poverty alleviation policies and interventions should focus on supporting recovery for persons with schizophrenia, as well as on increasing social support and on reducing family caregiving burden.
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Affiliation(s)
- Yue-Hui Yu
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Man-Man Peng
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Xue Bai
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Wei Luo
- Xinjin Second People's Hospital, Xinjin, 611432, Chengdu, China
| | - Xin Yang
- Guangyuan Mental Health Center, Guangyuan, 628000, China
| | - Jun Li
- Sichuan Veteran Hospital, Yuantong, Sichuan, China
| | - Bo Liu
- Jingzhou Mental Health Center, Jingzhou, 434000, Hubei, China
| | - Graham Thornicroft
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Cecilia Lai Wan Chan
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Mao-Sheng Ran
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China.
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24
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Ran MS, Xiao Y, Fazel S, Lee Y, Luo W, Hu SH, Yang X, Liu B, Brink M, Chan SKW, Chen EYH, Chan CLW. Mortality and suicide in schizophrenia: 21-year follow-up in rural China. BJPsych Open 2020; 6:e121. [PMID: 33054894 PMCID: PMC7576648 DOI: 10.1192/bjo.2020.106] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Little is known about the trend and predictors of 21-year mortality and suicide patterns in persons with schizophrenia. AIMS To explore the trend and predictors of 21-year mortality and suicide in persons with schizophrenia in rural China. METHOD This longitudinal follow-up study included 510 persons with schizophrenia who were identified in a mental health survey of individuals (≥15 years old) in 1994 in six townships of Xinjin County, Chengdu, China, and followed up in three waves until 2015. Kaplan-Meier survival analysis and Cox hazard regressions were conducted. RESULTS Of the 510 participants, 196 died (38.4% mortality) between 1994 and 2015; 13.8% of the deaths (n = 27) were due to suicide. Life expectancy was lower for men than for women (50.6 v. 58.5 years). Males consistently showed higher rates of mortality and suicide than females. Older participants had higher mortality (hazard ratio HR = 1.03, 95% CI 1.01-1.05) but lower suicide rates (HR = 0.95, 95% CI 0.93-0.98) than their younger counterparts. Poor family attitudes were associated with all-cause mortality and death due to other causes; no previous hospital admission and a history of suicide attempts independently predicted death by suicide. CONCLUSIONS Our findings suggest there is a high mortality and suicide rate in persons with schizophrenia in rural China, with different predictive factors for mortality and suicide. It is important to develop culture-specific, demographically tailored and community-based mental healthcare and to strengthen family intervention to improve the long-term outcome of persons with schizophrenia.
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Affiliation(s)
- Mao-Sheng Ran
- Department of Social Work and Social Administration, University of Hong Kong, China
| | - Yunyu Xiao
- School of Social Work, Indiana University-Bloomington and IUPUI, Indianapolis, USA
| | - Seena Fazel
- Department of Psychiatry, Warneford Hospital, University of Oxford, UK
| | - Yeonjin Lee
- Department of Social Work and Social Administration, University of Hong Kong, China
| | - Wei Luo
- Xinjin Second People's Hospital, Chengdu, China
| | | | - Xin Yang
- Guangyuan Mental Health Center, China
| | - Bo Liu
- Jingzhou Mental Health Center, China
| | - Maria Brink
- Department of Psychiatry, University of Rochester Medical Center, New York, USA
| | | | | | - Cecilia Lai-Wan Chan
- Department of Social Work and Social Administration, University of Hong Kong, China
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Wang M, Jin G, Wei Y, Wang F, Pan Z, Chen L, Lu X. Awareness, utilization and influencing factors of social supports for main informal caregivers of schizophrenia patients: a cross-sectional study in primary care settings in Beijing, China. BMC FAMILY PRACTICE 2020; 21:192. [PMID: 32943006 PMCID: PMC7496203 DOI: 10.1186/s12875-020-01257-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/31/2020] [Indexed: 11/21/2022]
Abstract
Background Most schizophrenia patients are supported by main informal caregivers at home in China. This study aims to investigate the further needs of social supports for main informal caregivers of schizophrenia patients and to analyze influencing factors on the awareness and utilization of social supports in Beijing. The results of this study could potentially act as reference for health professionals to implement appropriate and effective support programs. Methods A mixed-methods approach was used in this study. Awareness, utilization and influencing factors of social supports for main informal caregivers were investigated using questionnaires in 6 urban districts in Beijing. Meanwhile, individual in-depth interviews with 10 main informal caregivers from the urban districts of Beijing were conducted to identify the caregivers’ perspective on social supports and their further needs. Results Quantitative results showed that although the government provided multi-channel resources for schizophrenia patients and their families, awareness and utilization of the resources such as rehabilitation and relevant subsidies were less than 10.0 and 5.0% respectively. Most caregivers in in-depth interviews expressed that they had negative experiences with respect to obtaining social supports, and they emphasized that more support would be needed in terms of financial support, respect, and rehabilitation institutions. Conclusions The awareness and utilization of social supports are low for main informal caregivers of schizophrenia patients. More services and improved public attitudes are needed for schizophrenia patients and their caregivers.
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Affiliation(s)
- Meirong Wang
- School of General Practice and Continuing Education, Capital Medical University, Fengtai district, No. 10, You An Men Wai Xi Tou Tiao, Beijing, 100069, China
| | - Guanghui Jin
- School of General Practice and Continuing Education, Capital Medical University, Fengtai district, No. 10, You An Men Wai Xi Tou Tiao, Beijing, 100069, China
| | - Yun Wei
- School of General Practice and Continuing Education, Capital Medical University, Fengtai district, No. 10, You An Men Wai Xi Tou Tiao, Beijing, 100069, China
| | - Feiyue Wang
- School of General Practice and Continuing Education, Capital Medical University, Fengtai district, No. 10, You An Men Wai Xi Tou Tiao, Beijing, 100069, China
| | - Zhaolu Pan
- School of General Practice and Continuing Education, Capital Medical University, Fengtai district, No. 10, You An Men Wai Xi Tou Tiao, Beijing, 100069, China
| | - Lifen Chen
- Xuan Wu Hospital of Capital Medical University, Beijing, China
| | - Xiaoqin Lu
- School of General Practice and Continuing Education, Capital Medical University, Fengtai district, No. 10, You An Men Wai Xi Tou Tiao, Beijing, 100069, China.
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26
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Li W, Jorm AF, Wang Y, Lu S, He Y, Reavley N. Development of Chinese mental health first aid guidelines for psychosis: a Delphi expert consensus study. BMC Psychiatry 2020; 20:443. [PMID: 32912167 PMCID: PMC7488132 DOI: 10.1186/s12888-020-02840-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 08/27/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Family and friends of a person developing a mental illness or in a mental health crisis can help the person until treatment is received or the crisis resolves. Guidelines for providing this 'mental health first aid' have been developed and disseminated in high-income countries. However, they may not be appropriate for use in China due to cultural and health care system differences. The aim of this study was to use the Delphi expert consensus method to develop culturally appropriate guidelines for a member of the public providing mental health first aid to someone with psychosis in mainland China. METHODS A Chinese-language survey, comprising statements about how to provide mental health first aid to a person with psychosis, was developed. This was based on the endorsed items from the first round of the English-language questionnaire for high-income countries. These statements were rated by two expert panels from mainland China - a mental health professional panel (N = 31) and a lived experience panel (N = 41) - on how important they believed each statement was for a member of the public providing first aid to a person with psychosis in China. There were three Delphi rounds, with experts able to suggest additional items in Round 1. Items had to have at least 80% endorsement from both panels for inclusion. RESULTS Out of 208 statements, 207 were endorsed for inclusion in the Chinese-language guidelines. Eight new statements were also included. Compared to the English-language guidelines, the importance of family involvement was emphasized in the development of the Chinese-language guidelines. CONCLUSIONS While many of the actions in the English-language guidelines were endorsed by Chinese participants, a number of additional items point to the importance of developing culturally appropriate mental health first aid guidelines. These guidelines will form the basis for the development of Chinese Mental Health First Aid course aiming at training members of the public on how to provide first aid to someone with a mental health problem.
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Affiliation(s)
- Wenjing Li
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Level 4, 207 Bouverie Street, Carlton, VIC, 3053, Australia.
| | - Anthony F. Jorm
- grid.1008.90000 0001 2179 088XCentre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Level 4, 207 Bouverie Street, Carlton, VIC 3053 Australia
| | - Yan Wang
- grid.415630.50000 0004 1782 6212Shanghai Mental Health Centre, Shanghai, China
| | - Shurong Lu
- grid.1008.90000 0001 2179 088XThe Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC Australia
| | - Yanling He
- grid.415630.50000 0004 1782 6212Shanghai Mental Health Centre, Shanghai, China
| | - Nicola Reavley
- grid.1008.90000 0001 2179 088XCentre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Level 4, 207 Bouverie Street, Carlton, VIC 3053 Australia
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Oedegaard CH, Davidson L, Stige B, Veseth M, Blindheim A, Garvik L, Sørensen JM, Søraa Ø, Engebretsen IMS. "It means so much for me to have a choice": a qualitative study providing first-person perspectives on medication-free treatment in mental health care. BMC Psychiatry 2020; 20:399. [PMID: 32770965 PMCID: PMC7414551 DOI: 10.1186/s12888-020-02770-2] [Citation(s) in RCA: 12] [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: 08/05/2019] [Accepted: 06/29/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND In 2016, the Western Norway Regional Health Authority started to integrate more evidence-based psychosocial interventions into the existing mental health care, emphasizing the right for persons with psychosis to choose medication-free treatment. This change emerged from the debate on the effectiveness and adverse effects of the use of antipsychotic medication. Aspects beyond symptom reduction, such as interpersonal relationships, increased understanding of one's own pattern of suffering, hope and motivation, are all considered important for the personal recovery process. METHODS This study explores whether these aspects were present in users' descriptions of their recovery processes within the medication-free treatment programme in Bergen, Western Norway. We interviewed ten patients diagnosed with psychosis who were eligible for medication-free services about their treatment experiences. Data were analysed using Attride-Stirling's thematic network approach. RESULTS The findings show a global theme relating to personal recovery processes facilitated by the provision of more psychosocial treatment options, with three organizing subthemes: interpersonal relationships between patients and therapists, the patient's understanding of personal patterns of suffering, and personal motivation for self-agency in the recovery process. Participants described an improved relationship with therapists compared to previous experiences. Integrating more evidence-based psychosocial interventions into existing mental health services facilitated learning experiences regarding the choice of treatment, particularly the discontinuation of medication, and appeared to support participants' increased self-agency and motivation in their personal recovery processes. CONCLUSION Health care in Norway is perhaps one step closer to optimizing care for people with psychosis, allowing for more patient choice and improving the dialogue and hence the interpersonal relationship between the patient and the therapist. Personal patterns of suffering can be explored within a system aiming to support and have a higher level of acceptance for the discontinuation of medication. Such a system requires personal agency in the treatment regimen, with more focus on personal coping strategies and more personal responsibility for the recovery process.
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Affiliation(s)
- Christine H. Oedegaard
- grid.412008.f0000 0000 9753 1393Haukeland University Hospital, Kronstad DPS, Pb 1400, 5021 Bergen, Norway ,grid.7914.b0000 0004 1936 7443Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Pb. 7804, 5020 Bergen, Norway
| | - Larry Davidson
- grid.47100.320000000419368710Department of Psychiatry, Yale Medical School, New Haven, Connecticut USA
| | - Brynjulf Stige
- grid.7914.b0000 0004 1936 7443The Grieg Academy, University of Bergen, Pb. 7800, 5020 Bergen, Norway
| | - Marius Veseth
- grid.7914.b0000 0004 1936 7443Department of Clinical Psychology, University of Bergen, Pb. 7807, 5020 Bergen, Norway
| | - Anne Blindheim
- grid.412008.f0000 0000 9753 1393Haukeland University Hospital, Kronstad DPS, Pb 1400, 5021 Bergen, Norway
| | - Linda Garvik
- Hvite Ørn User Organisation, Thomles gt. 4, 0270 Oslo, Norway
| | | | - Øystein Søraa
- Hvite Ørn User Organisation, Thomles gt. 4, 0270 Oslo, Norway
| | - Ingunn Marie Stadskleiv Engebretsen
- grid.7914.b0000 0004 1936 7443Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Pb. 7804, 5020 Bergen, Norway
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Fountoulakis KN, Moeller HJ, Kasper S, Tamminga C, Yamawaki S, Kahn R, Tandon R, Correll CU, Javed A. The report of the joint WPA/CINP workgroup on the use and usefulness of antipsychotic medication in the treatment of schizophrenia. CNS Spectr 2020; 26:1-25. [PMID: 32594935 DOI: 10.1017/s1092852920001546] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This is a report of a joint World Psychiatric Association/International College of Neuropsychopharmacology (WPA/CINP) workgroup concerning the risk/benefit ratio of antipsychotics in the treatment of schizophrenia. It utilized a selective but, within topic, comprehensive review of the literature, taking into consideration all the recently discussed arguments on the matter and avoiding taking sides when the results in the literature were equivocal. The workgroup's conclusions suggested that antipsychotics are efficacious both during the acute and the maintenance phase, and that the current data do not support the existence of a supersensitivity rebound psychosis. Long-term treated patients have better overall outcome and lower mortality than those not taking antipsychotics. Longer duration of untreated psychosis and relapses are modestly related to worse outcome. Loss of brain volume is evident already at first episode and concerns loss of neuropil volume rather than cell loss. Progression of volume loss probably happens in a subgroup of patients with worse prognosis. In humans, antipsychotic treatment neither causes nor worsens volume loss, while there are some data in favor for a protective effect. Schizophrenia manifests 2 to 3 times higher mortality vs the general population, and treatment with antipsychotics includes a number of dangers, including tardive dyskinesia and metabolic syndrome; however, antipsychotic treatment is related to lower mortality, including cardiovascular mortality. In conclusion, the literature strongly supports the use of antipsychotics both during the acute and the maintenance phase without suggesting that it is wise to discontinue antipsychotics after a certain period of time. Antipsychotic treatment improves long-term outcomes and lowers overall and specific-cause mortality.
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Affiliation(s)
- Konstantinos N Fountoulakis
- 3rd Department of Psychiatry, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Hans-Jurgen Moeller
- Department of Psychiatry, Ludwig Maximilian University of Munich, Munich, Germany
| | - Siegfried Kasper
- Universitätsklinik für Psychiatrie und Psychotherapie, Medizinische Universität Wien, Vienna, Austria
| | - Carol Tamminga
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Shigeto Yamawaki
- Center for Brain, Mind and KANSEI Sciences Research, Hiroshima University, Hiroshima, Japan
| | - Rene Kahn
- Department of Psychiatry and Behavioral Health System, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rajiv Tandon
- Department of Psychiatry, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, USA
| | - Christoph U Correll
- Department of Psychiatry, Northwell Health, The Zucker Hillside Hospital, Glen Oaks, New York, USA
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Afzal Javed
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
- Pakistan Psychiatric Research Centre, Fountain House, Lahore, Pakistan
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29
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Hu N, Sun H, Fu G, Zhang W, Xiao Y, Zhang L, Li W, Li Z, Huang G, Tan Y, Sweeney JA, Gong Q, Lui S. Anatomic abnormalities of hippocampal subfields in never-treated and antipsychotic-treated patients with long-term schizophrenia. Eur Neuropsychopharmacol 2020; 35:39-48. [PMID: 32402652 DOI: 10.1016/j.euroneuro.2020.03.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 03/17/2020] [Accepted: 03/27/2020] [Indexed: 02/08/2023]
Abstract
Hippocampal volume deficits have been reported in chronically-treated schizophrenia patients, however, the longer-term effects of antipsychotic medications on hippocampal anatomy are unclear. This case-control study investigated volume differences in hippocampal subfields of never-treated and antipsychotic-treated patients with long-term schizophrenia. High spatial-resolution T1-weighted magnetic resonance images were collected from 29 never-treated and 40 antipsychotic-treated patients with long-term schizophrenia matched for illness duration (all ≥ 5 years), and 40 demographically-matched healthy controls. Hippocampal subfield volumes were measured using FreeSurfer v6.0, compared across groups and between hemispheres, and correlated with clinical features. Volume reductions were found in both patient groups compared to healthy controls in 8 of 26 hippocampal subfields (Cohen's d = 0.46 - 1.17, P = < .001 - .03), and more diffusely and obviously in never-treated than treated patients (Cohen's d = 0.50 - 0.90, P = < .001 - .04). Greater right-than-left volumes were seen in treated patients and healthy controls in 11 of 13 subfields (T = 2.30 - 7.29, P = < .001 - .03), but not in never-treated patients, in whom the volumes were reduced more on the right than on the left. Subfield volumes were negatively correlated with symptom severity and illness duration, and declined with age in never-treated patients. Findings indicate clinically-relevant and age-related volume reductions in hippocampal subfields of never-treated patients with long-term schizophrenia. Broader and greater subfield deficits in never-treated than treated patients, especially in the right hippocampus, suggest that long-term antipsychotic treatment may benefit hippocampal structures over the longer-term course of illness.
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Affiliation(s)
- Na Hu
- Department of Radiology, West China Hospital of Sichuan University, No 37, Guoxue Alley, Chengdu 610041, China; Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Huaiqiang Sun
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Gui Fu
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China; Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Wenjing Zhang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Yuan Xiao
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Lianqing Zhang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Wenbin Li
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Zhe Li
- Mental Health Center and Psychiatric Laboratory, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, China
| | - Guoping Huang
- Department of Psychiatry, The Mental Health Center of Sichuan, Mianyang, China
| | - Youguo Tan
- Department of Psychiatry, Zigong Mental Health Center, Zigong, China
| | - John A Sweeney
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH, USA
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Su Lui
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China.
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Wei Y, Li W, Zhang L, Zhu JH, Zhu XJ, Ma XY, Dong QL, Zhao WL, Pan WM, Jiang X, Ungvari GS, Ng CH, Xiang YT. Unmedicated patients with schizophrenia in economically underdeveloped areas of China. Asian J Psychiatr 2020; 47:101865. [PMID: 31743835 DOI: 10.1016/j.ajp.2019.101865] [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: 10/04/2019] [Revised: 11/01/2019] [Accepted: 11/01/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Untreated schizophrenia commonly leads to poor prognosis. The medication treatment rate of schizophrenia patients in economically underdeveloped areas of China has not been well-studied. This study aimed to examine the pattern of unmedicated schizophrenia patients in economically underdeveloped rural and urban areas of China. METHOD A total of 4240 schizophrenia patients in Lanzhou (1720 rural and 2520 urban patients) registered in the community mental-health service system in Lanzhou, Gansu province were included. Their socio-demographic and clinical characteristics including medication treatment status were collected and analyzed. RESULTS The proportion of unmedicated schizophrenia patients was 22.5% (n = 953) in the whole sample, with 32.3% (556/1720) in rural and 15.8% (397/2520) in urban patients (X2=161.1, P < 0.001). Multiple logistic regression analyses revealed that unmedicated schizophrenia patients in rural area were more likely to be older (OR=1.02, 95%CI: 1.01-1.03), male (OR=1.35, 95%CI: 1.07-1.71), unmarried (OR=0.71, 95%CI: 0.55-0.91), and have lower educational level (OR=0.39, 95%CI: 0.24-0.65), longer illness duration (OR=1.01, 95%CI: 1.00-1.02) and less frequent admissions (OR=0.46, 95%CI: 0.38-0.54). In contrast, unmedicated patients in urban area were more likely to be older (OR=1.01, 95%CI: 1.00-1.02), unmarried (OR=0.77, 95%CI: 0.61-0.98), employed (OR=2.38, 95%CI: 1.87-3.04), and have lower educational level (OR=0.49, 95%CI: 0.37-0.65), better financial status (OR=0.60, 95%CI: 0.48-0.76) and less frequent admissions (OR=0.81, 95%CI: 0.75-0.87). CONCLUSIONS The rate of unmedicated schizophrenia patients is high in economically underdeveloped areas of China, particularly in rural areas. Effective policies and measures should be implemented urgently to improve the treatment rate in this population.
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Affiliation(s)
- Ying Wei
- Department of Psychiatry, Lanzhou University Second Hospital, Gansu province, China; Lanzhou Centers for Disease Control, Gansu province, China
| | - Wen Li
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao; Center for Cognition and Brain Sciences, University of Macau, Macao
| | - Lan Zhang
- Department of Psychiatry, Lanzhou University Second Hospital, Gansu province, China.
| | - Ju-Hong Zhu
- Department of Psychiatry, Lanzhou University Second Hospital, Gansu province, China
| | - Xiu-Jie Zhu
- Department of Psychiatry, Lanzhou University Second Hospital, Gansu province, China
| | - Xiu-Yun Ma
- Department of Psychiatry, Lanzhou University Second Hospital, Gansu province, China
| | - Qiang-Li Dong
- Department of Psychiatry, Lanzhou University Second Hospital, Gansu province, China
| | - Wen-Li Zhao
- Gansu Centers for Disease Control, Gansu province, China
| | - Wei-Min Pan
- Gansu Centers for Disease Control, Gansu province, China
| | - Xia Jiang
- Gansu Centers for Disease Control, Gansu province, China
| | - Gabor S Ungvari
- Division of Psychiatry, School of Medicine, University of Western Australia, Perth, Australia; University of Notre Dame Australia, Fremantle, Australia
| | - Chee H Ng
- Department of Psychiatry, The Melbourne Clinic and St Vincent's Hospital, The University of Melbourne, Melbourne, Australia
| | - Yu-Tao Xiang
- Department of Psychiatry, Lanzhou University Second Hospital, Gansu province, China; Center for Cognition and Brain Sciences, University of Macau, Macao.
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Moncrieff J, Gupta S, Horowitz MA. Barriers to stopping neuroleptic (antipsychotic) treatment in people with schizophrenia, psychosis or bipolar disorder. Ther Adv Psychopharmacol 2020; 10:2045125320937910. [PMID: 32670542 PMCID: PMC7338640 DOI: 10.1177/2045125320937910] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 06/03/2020] [Indexed: 12/19/2022] Open
Abstract
Most guidelines recommend long-term, indefinite neuroleptic (or antipsychotic) treatment for people with schizophrenia, recurrent psychosis or bipolar disorder, on the basis that these medications reduce the chance of relapse. However, neuroleptics have significant adverse effects, including sexual dysfunction, emotional blunting, metabolic disturbance and brain shrinkage, and patients often request to stop them. Evidence for the benefits of long-term treatment is also not as robust as generally thought. Short-term randomised trials show higher rates of relapse among those whose neuroleptic treatment is discontinued compared with those on maintenance treatment, but they are confounded by adverse effects associated with the withdrawal of established medication. Some longer-term studies show possible advantages of medication reduction and discontinuation in terms of improved social functioning and recovery. Therefore, there is a good rationale for supporting patients who wish to stop their medication, especially given the patient choice agenda favoured by The National Institute for Clinical Excellence (NICE). The major barrier to stopping antipsychotics is an understandable fear of relapse among patients, their families and clinicians. Institutional structures also prioritise short-term stability over possible long-term improvements. The risk of relapse may be mitigated by more gradual reduction of medication, but further research is needed on this. Psychosocial support for patients during the process of reducing medication may also be useful, particularly to enhance coping skills. Guidelines to summarise evidence on ways to reduce medication would be useful. Many patients want to try and stop neuroleptic medication for good reasons, and psychiatrists can help to make this a realistic option by supporting people to do it as safely as possible, with the best chance of a positive outcome.
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Affiliation(s)
- Joanna Moncrieff
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, Fitzrovia, London W1T 7BN, UK
| | - Swapnil Gupta
- Psychiatry, Yale School of Medicine, New Haven, CT, USA
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Peng MM, Chen HL, Zhang T, Yao YY, Li ZH, Long L, Duan QQ, Lin FR, Zen Y, Chen J, Ng SM, Chan CLW, Ran MS. Disease-related stressors of caregiving burden among different types of family caregivers of persons with schizophrenia in rural China. Int J Soc Psychiatry 2019; 65:603-614. [PMID: 31387428 DOI: 10.1177/0020764019866224] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Little is known about the impacts of schizophrenia on different types of caregiving burden. AIM This study aims to examine how the severity of schizophrenia, social functioning and aggressive behavior are associated with caregiving burden across different kinship types. METHOD The analytic sample included 300 dyads of persons with schizophrenia and their family caregivers in Xinjin, Chengdu, China. The 10th edition of the International Classification of Diseases (ICD-10) was utilized to identify the patients, whose symptom severity, social functioning and aggressive behavior were measured. Caregiving burden was estimated using the Burden Scale for Family Caregivers-short (BSFC-s). RESULTS A higher level of burden was significantly associated with female caregivers, larger family size, lower income, worse symptoms, poorer functional status and more aggressive behaviors. Parent caregivers showed greater burden if the patients had better functioning of social interest and concern or more aggression toward property. Mother caregivers showed greater burden than fathers. Spouses tended to perceive greater burden if the patients had better marital functioning, poorer occupational functioning or more aggressive behaviors toward property. Patients attacking others or a father with schizophrenia was related to a higher burden of child caregivers. A heavier burden of other relatives was correlated with patients' more verbal aggression and self-harm. CONCLUSION This study shows the distinct impacts of disease-related factors on the caregiving burden across different kinship types. Our findings have implications for health-care professionals and practitioners in terms of developing more targeted family-based or individualized intervention to ameliorate burden according to kinship types and deal with behavioral and functional problems in schizophrenia.
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Affiliation(s)
- Man-Man Peng
- 1 Department of Social Work & Social Administration, University of Hong Kong, Hong Kong
| | - Hong-Lin Chen
- 2 Department of Social Work, Fudan University, Shanghai, China
| | - Tin Zhang
- 3 Santai Mental Health Center, Sichuan, China
| | | | - Zi-Han Li
- 3 Santai Mental Health Center, Sichuan, China
| | - Lan Long
- 4 Sichuan College of Traditional Chinese Medicine, Mianyang, China
| | - Qing-Qing Duan
- 4 Sichuan College of Traditional Chinese Medicine, Mianyang, China
| | - Fu-Rong Lin
- 5 Xinjin Second People's Hospital, Chengdu, China
| | - Ya Zen
- 5 Xinjin Second People's Hospital, Chengdu, China
| | - Jia Chen
- 6 Panzhihua Third People's Hospital, Panzhihua, China
| | - Siu-Man Ng
- 1 Department of Social Work & Social Administration, University of Hong Kong, Hong Kong
| | - Cecilia Lai-Wan Chan
- 1 Department of Social Work & Social Administration, University of Hong Kong, Hong Kong
| | - Mao-Sheng Ran
- 1 Department of Social Work & Social Administration, University of Hong Kong, Hong Kong
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Peng MM, Zhang TM, Liu KZ, Gong K, Huang CH, Dai GZ, Hu SH, Lin FR, Chan SKW, Ng S, Ran MS. Perception of social support and psychotic symptoms among persons with schizophrenia: A strategy to lessen caregiver burden. Int J Soc Psychiatry 2019; 65:548-557. [PMID: 31359844 DOI: 10.1177/0020764019866230] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Improving patients' perception of social support is significant not only for their re-adaptation to life but also for alleviating caregivers' burden. AIM This study aims to examine an integrated model regarding social support, psychotic symptoms and caregiver burden. METHODS Persons with schizophrenia (N1 = 300) and their family caregivers (N2 = 300) in Xinjin County, Chengdu, China, completed the survey to report their demographics, patients' perception of social support (Duke Social Support Index), psychotic symptoms (Positive and Negative Syndrome Scale) and caregiver burden (Burden Scale for Family Caregivers, Short Version). Structural equation modelling was utilised to test the proposed model. RESULTS The degree of caregiver burden differed significantly within subgroups of patients' gender and education, as well as caregivers' gender, education and employment. Caregiver burden was negatively related to patients' age and household income. Social interaction partially mediated the relationship between instrumental and subjective social support (total effect = 0.451, p < .01). Subjective social support fully mediated the impact of social interaction on psychotic symptoms (total effect = -0.099, p < .05). In the final model, instrumental social support was positively associated with social interaction (p < .001) and increased subjective social support (p < .05). Increased subjective social support showed correlation with a lower degree of psychotic symptoms (p < .01), which was related to a lower level of caregiver burden (p < .001). CONCLUSION This study shows the associations of patients' social support with psychotic symptoms and caregiver burden. Culture-specific psychosocial interventions should be provided for both patients and caregivers to enrich external support and reduce psychotic symptoms and caregivers' burden within the health care environment.
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Affiliation(s)
- Man-Man Peng
- 1 Department of Social Work & Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
| | - Tian-Ming Zhang
- 1 Department of Social Work & Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
| | - Ke-Zhi Liu
- 2 Mental Health Center, Southwest Medical University, Luzhou, China
| | - Ke Gong
- 2 Mental Health Center, Southwest Medical University, Luzhou, China
| | - Chao-Hua Huang
- 2 Mental Health Center, Southwest Medical University, Luzhou, China
| | | | - Shi-Hui Hu
- 3 Chengdu Mental Health Center, Chengdu, China
| | - Fu-Rong Lin
- 4 Xinjin Second People's Hospital, Chengdu, China
| | - Sherry Kit Wa Chan
- 5 Department of Psychiatry, The University of Hong Kong, Pokfulam, Hong Kong
| | - Siuman Ng
- 1 Department of Social Work & Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
| | - Mao-Sheng Ran
- 1 Department of Social Work & Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
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Chen HL, Xiao Y, Liu YJ, Zhang TM, Luo W, Zeng Y, Hu SH, Yang HJ, Yang X, Liu B, Xu MJ, Chan CLW, Conwell Y, Ran MS. Treatment Status of Elderly Patients With Severe Mental Disorders in Rural China. J Geriatr Psychiatry Neurol 2019; 32:291-297. [PMID: 31480980 DOI: 10.1177/0891988719862622] [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: 11/17/2022]
Abstract
This study was performed to compare the treatment status between older (≥65 years) and younger adults (18-64 years) with severe mental illness (SMI) and explore factors associated with treatment status in rural China. Persons with SMI were identified in one mental health survey in 2015 in 6 townships of Xinjin County, Chengdu, China. Logistic regressions were conducted to explore factors associated with treatment status. Older adults with SMI, especially major depressive disorder, reported significantly lower rates of treatment than younger group. Older age, longer duration of illness, and poor mental status were risk factors for never-treated status in these patients. Never-treated status (46.3%) and poor treatment status in these older patients are serious issues. Different treatment statuses in these patients had various influencing factors. It is crucial to develop culture-specific, community-based mental health services to improve early identification, diagnosis, treatment, and recovery of older adults with SMI in rural China.
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Affiliation(s)
- Hong-Lin Chen
- 1 Department of Social Work, Fudan University, Shanghai, China
| | - Yunyu Xiao
- 2 Silver School of Social Work, New York University, New York, NY, USA
| | - Yu-Jun Liu
- 3 Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China
| | - Tian-Ming Zhang
- 3 Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China
| | - Wei Luo
- 4 Xinjin Second People's Hospital, Xinjin, Chengdu, China
| | - Ya Zeng
- 4 Xinjin Second People's Hospital, Xinjin, Chengdu, China
| | - Shi-Hui Hu
- 5 Chengdu Mental Health Center, Chengdu, China
| | | | - Xin Yang
- 6 Guangyuan Mental Health Center, Guangyuan, China
| | - Bo Liu
- 7 Jingzhou Mental Health Center, Jingzhou, Hubei, China
| | - Mei-Jun Xu
- 7 Jingzhou Mental Health Center, Jingzhou, Hubei, China
| | - Cecilia Lai-Wan Chan
- 3 Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China
| | - Yeates Conwell
- 8 Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Mao-Sheng Ran
- 3 Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China
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Fountoulakis KN, Panagiotidis P, Nimatoudis I. The effect of baseline antipsychotic status on the 12-month outcome in initially stabilized patients with schizophrenia. Hum Psychopharmacol 2019; 34:e2712. [PMID: 31486169 DOI: 10.1002/hup.2712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 08/13/2019] [Accepted: 08/19/2019] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Recently, the usefulness of antipsychotics has been challenged. The aim of the study was to measure the real-life effect of antipsychotic treatment on remission and recovery rates in already stabilized patients with schizophrenia after 1 year. MATERIAL AND METHODS The study included 133 stabilized patients with schizophrenia (77 males and 56 females; aged 33.55 ± 11.22 years). The assessment included testing at baseline and after 1 year with the Positive and Negative Syndrome Scale, Calgary Depression Scale, State-Trait Anxiety Inventory, UKU, Extrapyramidal Symptom Rating Scale, and General Assessment of Functioning. RESULTS More patients were on antipsychotics after 1 year (increase by 16.45%). There was an increase in the remission by 75% and in the recovery rate by 66%. It was not possible to predict the outcome on the basis of baseline variables. DISCUSSION There is an accumulating beneficial effect of antipsychotic treatment over a 12-month period; early lack of remission is not prognostic of a poor outcome. There might be different neurobiological mechanisms underlying acute and sustained response. Both remission and recovery are difficult to achieve for patients with schizophrenia and characterize only a minority of patients. Only a very small minority of patients (4.5%) that is impossible to identify a priori would do well without off antipsychotics.
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Affiliation(s)
- Konstantinos N Fountoulakis
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis Panagiotidis
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Nimatoudis
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Zhang TM, Wong IYL, Yu YH, Ni SG, He XS, Bacon-Shone J, Gong K, Huang CH, Hu Y, Tang MM, Cao W, Chan CLW, Ran MS. An integrative model of internalized stigma and recovery-related outcomes among people diagnosed with schizophrenia in rural China. Soc Psychiatry Psychiatr Epidemiol 2019; 54:911-918. [PMID: 30569395 DOI: 10.1007/s00127-018-1646-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 12/04/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE Internalized stigma, an adverse psychological process, severely impedes the lives of people diagnosed with schizophrenia and restricts them from social integration and recovery. The aim of this study was to empirically evaluate an integrative model of relationship between internalized stigma and patients' recovery-related outcomes among people diagnosed with schizophrenia in a rural Chinese community. METHOD A total of 232 people diagnosed with schizophrenia in Xinjin, Chengdu, participated in this study and completed measures of internalized stigma, social interaction, perceived social support, social functioning, and symptoms. The internalized stigma of mental illness scale (ISMI) was used to measure the internalized stigma. Path analysis was used to test the association between internalized stigma and recovery-related outcomes. RESULTS There were no significant differences in mean scores of ISMI by gender, age (18-64 years and ≥ 65 years), education, marital status, or economic capacity. Internalized stigma was negatively associated with perceived social support and social interaction. Furthermore, higher level of internalized stigma was associated with impaired social functioning, and a lower level of social functioning was significantly associated with more severe symptoms. CONCLUSION Internalized stigma is associated with poor social interaction and weakened perceived social support in people diagnosed with schizophrenia, and is linked negatively to outcomes in their recovery. It is essential to tailor interventions related to reducing internalized stigma within a Chinese context and evaluate the effectiveness of anti-stigma intervention on recovery for people diagnosed with schizophrenia.
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Affiliation(s)
- Tian-Ming Zhang
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Irene Yin-Ling Wong
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, USA
| | - Yue-Hui Yu
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Shi-Guang Ni
- Graduate School at Shenzhen, Tsinghua University, Shenzhen, China
| | - Xue-Song He
- School of Society and Public Administration, East China University of Science and Technology, Shanghai, China
| | - John Bacon-Shone
- Social Sciences Research Centre, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, China
| | - Ke Gong
- Department of Psychiatry, Southwest Medical University, Sichuan, China
| | - Chao-Hua Huang
- Department of Psychiatry, Southwest Medical University, Sichuan, China
| | - Yan Hu
- Sichuan Veterans Hospital, Sichuan, China
| | | | - Wan Cao
- Chongqing Medical University, Chongqing, China
| | - Cecilia Lai-Wan Chan
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Mao-Sheng Ran
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China.
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Smartt C, Prince M, Frissa S, Eaton J, Fekadu A, Hanlon C. Homelessness and severe mental illness in low- and middle-income countries: scoping review. BJPsych Open 2019; 5:e57. [PMID: 31530300 PMCID: PMC6611071 DOI: 10.1192/bjo.2019.32] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Despite being a global problem, little is known about the relationship between severe mental illness (SMI) and homelessness in low- and middle-income countries (LMICs). Homeless people with SMI are an especially vulnerable population and face myriad health and social problems. In LMICs, low rates of treatment for mental illness, as well as differing family support systems and cultural responses to mental illness, may affect the causes and consequences of homelessness in people with SMI. AIMS To conduct a systematic, scoping review addressing the question: what is known about the co-occurrence of homelessness and SMI among adults living in LMICs? METHOD We conducted an electronic search, a manual search and we consulted with experts. Two reviewers screened titles and abstracts, assessed publications for eligibility and appraised study quality. RESULTS Of the 49 included publications, quality was generally low: they were characterised by poor or unclear methodology and reporting of results. A total of 7 publications presented the prevalence of SMI among homeless people; 12 presented the prevalence of homelessness among those with SMI. Only five publications described interventions for this population; only one included an evaluation component. CONCLUSIONS Evidence shows an association between homelessness and SMI in LMICs, however there is little information on the complex relationship and direction of causality between the phenomena. Existing programmes should undergo rigorous evaluation to identify key aspects required for individuals to achieve sustainable recovery. Respect for human rights should be paramount when conducting research with this population. DECLARATION OF INTEREST None.
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Affiliation(s)
- Caroline Smartt
- PhD Student, Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Martin Prince
- Professor of Epidemiological Psychiatry and Assistant Principal for Global Health, Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Souci Frissa
- NIHR ASSET Programme Coordinator, Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Julian Eaton
- Co-Director, Centre for Global Mental Health, London School of Hygiene and Tropical Medicine; and CBM International, London, UK
| | - Abebaw Fekadu
- Associate Professor, Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University; Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Ethiopia; and Professor of Global Mental Health, Global Health and Infection Department, Brighton and Sussex Medical School, UK
| | - Charlotte Hanlon
- Reader in Global Mental Health, Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Adjunct Associate Professor, Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University; and Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Ethiopia
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Häfner H. From Onset and Prodromal Stage to a Life-Long Course of Schizophrenia and Its Symptom Dimensions: How Sex, Age, and Other Risk Factors Influence Incidence and Course of Illness. PSYCHIATRY JOURNAL 2019; 2019:9804836. [PMID: 31139639 PMCID: PMC6500669 DOI: 10.1155/2019/9804836] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 03/03/2019] [Indexed: 12/26/2022]
Abstract
The core symptoms of psychosis-delusions, hallucinations, and thought disorders-are not unique to the disorder traditionally called schizophrenia. They occur at the early stages of various brain diseases, too. Psychosis seems to be a preformed pattern of response of the human brain. Most schizophrenia onsets are marked by a prodromal stage extending over several years and producing the maximum of social consequences. Schizophrenia incidence shows a steep increase culminating at age 15 to 25 years in males. In females it reaches a first peak at age 15 to 30 years and a second, flatter peak at menopausal age (44-49 years). Thereafter, incidence declines to a plateau at later ages. Unlike what the findings of most large-scale epidemiological studies applying an upper age limit of 45 to 55 years suggest, schizophrenia is a disorder of all ages. The lifetime risk seems to be the same for both sexes. The lower incidence in premenopausal women is accounted for by the downregulating effect of oestrogen on dopamine receptors. This hormonal protective effect is antagonised by the genetic effect of a high familial load. In the long-term illness course, right-censored to 11.2 years following first admission, the number of psychotic relapse episodes ranges from 0 to 29 with a mean of 3. The positive symptom dimension produces the highest number of relapses and the shortest duration of exacerbations with a mean length of two months. The depressive and negative symptom dimensions show exacerbations extending over nearly six months on average. Following the first illness episode symptom scores decline sharply, reaching a plateau five years after first admission. Negative symptoms come to a plateau after 2 to 3 years in females and after 5 years in males. Depression is the most frequent type of symptom in the long-term course. In the light of these results urgent treatment issues will be discussed.
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Affiliation(s)
- Heinz Häfner
- Schizophrenia Research Group, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, J5, 68159 Mannheim, Germany
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Ran MS, Weng X, Liu YJ, Zhang TM, Yu YH, Peng MM, Luo W, Hu SH, Yang X, Liu B, Zhang T, Thornicroft G, Chan CLW, Xiang MZ. Changes in treatment status of patients with severe mental illness in rural China, 1994-2015. BJPsych Open 2019; 5:e31. [PMID: 31068242 PMCID: PMC6469230 DOI: 10.1192/bjo.2019.13] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Although it is crucial to improve the treatment status of people with severe mental illness (SMI), it is still unknown whether and how socioeconomic development influences their treatment status.AimsTo explore the change in treatment status in people with SMI from 1994 to 2015 in rural China and to examine the factors influencing treatment status in those with SMI. METHOD Two mental health surveys using identical methods and ICD-10 were conducted in 1994 and 2015 (population ≥15 years old, n = 152 776) in the same six townships of Xinjin County, Chengdu, China. RESULTS Compared with 1994, individuals with SMI in 2015 had significantly higher rates of poor family economic status, fewer family caregivers, longer duration of illness, later age at first onset and poor mental status. Participants in 2015 had significantly higher rates of never being treated, taking antipsychotic drugs and ever being admitted to hospital, and lower rates of using traditional Chinese medicine or being treated by traditional/spiritual healers. The factors strongly associated with never being treated included worse mental status (symptoms/social functioning), older age, having no family caregivers and poor family economic status. CONCLUSIONS Socioeconomic development influences the treatment status of people with SMI in contemporary rural China. Relative poverty, having no family caregivers and older age are important factors associated with a worse treatment status. Culture-specific, community-based interventions and targeted poverty-alleviation programmes should be developed to improve the early identification, treatment and recovery of individuals with SMI in rural China.Declaration of interestNone.
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Affiliation(s)
- Mao-Sheng Ran
- Associate Professor,Department of Social Work and Social Administration,University of Hong Kong,China
| | - Xue Weng
- Researcher,Department of Social Work and Social Administration,University of Hong Kong,China
| | - Yu-Jun Liu
- Researcher,Department of Social Work and Social Administration,University of Hong Kong,China
| | - Tian-Ming Zhang
- Researcher,Department of Social Work and Social Administration,University of Hong Kong,China
| | - Yue-Hui Yu
- Researcher,Department of Social Work and Social Administration,University of Hong Kong,China
| | - Man-Man Peng
- Researcher,Department of Social Work and Social Administration,University of Hong Kong,China
| | - Wei Luo
- Doctor,Xinjin Mental Hospital,China
| | - Shi-Hui Hu
- Doctor,Chengdu Mental Health Center,China
| | - Xin Yang
- Doctor,Guangyuan Mental Health Center,China
| | - Bo Liu
- Professor,Jingzhou Mental Health Center,China
| | - Tin Zhang
- Doctor,Santai Mental Health Center,China
| | - Graham Thornicroft
- Professor,Centre for Global Mental Health,Institute of Psychiatry,Psychology and Neuroscience,King's College London,UK
| | - Cecilia Lai-Wan Chan
- Professor,Department of Social Work and Social Administration,University of Hong Kong,China
| | - Meng-Ze Xiang
- Professor,Department of Psychiatry,West China Hospital, Sichuan University,China
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Taylor M, Jauhar S. Are we getting any better at staying better? The long view on relapse and recovery in first episode nonaffective psychosis and schizophrenia. Ther Adv Psychopharmacol 2019; 9:2045125319870033. [PMID: 31523418 PMCID: PMC6732843 DOI: 10.1177/2045125319870033] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 07/22/2019] [Indexed: 12/27/2022] Open
Abstract
Relapse in, and recovery from, schizophrenia has been acknowledged since the disease was first described. In this review the authors summarize the long-term (>100 years) data on relapse and recovery in schizophrenia by reviewing the extant older and modern relevant literature. The authors systematically question the utility of pharmacological and nonpharmacological interventions, with an emphasis on first episode nonaffective psychosis. The method used is a narrative review of earlier meta-analytic and systematic reviews. Antipsychotic medication discontinuation studies suggest a role for prophylactic maintenance treatment in the majority of people with schizophrenia, despite recent debate on this subject. The authors conclude that long-term outcomes, including relapse and recovery rates, have improved in the last 100 years, though prospectively identifying those people who do not require long-term antipsychotic treatment has not yet been possible. Data also suggests that interventions and outcomes during the first 5 years of the disease can influence the long-term schizophrenia trajectory.
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Affiliation(s)
- Mark Taylor
- Brisbane, and University of Queensland, 54 Jephson Street, Toowong, Queensland, 4066, Australia
| | - Sameer Jauhar
- Department of Psychological Medicine, IoPPN, Kings College London, UK
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41
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Lawrie SM. Are structural brain changes in schizophrenia related to antipsychotic medication? A narrative review of the evidence from a clinical perspective. Ther Adv Psychopharmacol 2018; 8:319-326. [PMID: 30344998 PMCID: PMC6180375 DOI: 10.1177/2045125318782306] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 04/20/2018] [Indexed: 01/28/2023] Open
Abstract
Some observational studies and literature reviews suggest that antipsychotic drug use is associated with loss of grey or white matter in patients with schizophrenia, whereas others have contradicted this finding. Here, I summarize and critique the available evidence and put it in the context of clinical practice. This narrative review pools evidence from observational and experimental studies in humans and animals on the relationship between antipsychotic medication use and brain structure and function in patients with schizophrenia. To summarize, the observational evidence in patients with schizophrenia and the experimental evidence in animals suggest that antipsychotic drugs can cause reductions in brain volume, but differ as to where those effects are manifest. The experimental evidence in patients is inconclusive. There is stronger and more consistent evidence that other factors, such as alcohol and cannabis use, are likely causes of progressive brain changes in schizophrenia. Overall, I argue the case against antipsychotics is not proven and the jury is out on any significance of putative antipsychotic-induced brain changes. Taken in the context of strong evidence from clinical trials that antipsychotic drugs have beneficial effects on symptoms, function, relapse and cognition, and observational evidence that treatment normalizes other imaging indices and reduces mortality, the balance of probabilities is that antipsychotic drugs do not cause adverse structural brain changes in schizophrenia.
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Affiliation(s)
- Stephen M Lawrie
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh EH10 5HF, UK
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Ran MS, Xiao Y, Chui CHK, Hu XZ, Yu YH, Peng MM, Mao WJ, Liu B, Chen Eric YH, Chan CLW. Duration of untreated psychosis (DUP) and outcome of people with schizophrenia in rural China: 14-year follow-up study. Psychiatry Res 2018; 267:340-345. [PMID: 29957551 DOI: 10.1016/j.psychres.2018.06.043] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 06/14/2018] [Accepted: 06/16/2018] [Indexed: 10/28/2022]
Abstract
This study aims to examine the relationship between the duration of untreated psychosis (DUP) and 14-year outcomes of schizophrenia in a Chinese rural area. Participants with schizophrenia (n = 510) were identified in an epidemiological investigation of 123 572 people aged 15 years and older in 1994 and followed up in 2008 in Xinjin, Chengdu, China. Longer DUP (>6 months) was common in participants (27.3%). In 1994, participants with DUP ≤ 6 months were more likely to have a significantly lower rate of suicide attempts, shorter duration of illness and higher rate of full remission compared with those with DUP > 6 months. No significant differences were found regarding the rates of survival, suicide, death due to other causes and homelessness between individuals with shorter and longer DUP in 2008. Nevertheless, longer DUP (>6 months) of participants in 2008 was significantly associated with higher mean of PANSS total negative and general mental scores, longer duration of illness and higher rate of live alone in the logistic regression model. Earlier identification, treatment and rehabilitation, and family intervention should be addressed when developing mental health policies and delivering community mental health services.
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Affiliation(s)
- Mao-Sheng Ran
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China.
| | - Yunyu Xiao
- Silver School of Social Work, New York University, New York, United States
| | - Cheryl H K Chui
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong
| | - Xian-Zhang Hu
- Institute of Psychiatry and Neuroscience, Xinxiang Medical University, Henan 453002, China
| | - Yue-Hui Yu
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China
| | - Man-Man Peng
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China
| | - Wen-Jun Mao
- Chengdu Mental Health Center, Chengdu 610036, China
| | - Bo Liu
- Jingzhou Mental Health Center, Jingzhou, Hubei 434000, China
| | - Yu-Hai Chen Eric
- Department of Psychiatry, University of Hong Kong, Hong Kong, China
| | - Cecilia Lai-Wan Chan
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China.
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Cheng JF, Huang XY, Lin MC, Wang YH, Yeh TP. A mental health home visit service partnership intervention on improving patients' satisfaction. Arch Psychiatr Nurs 2018; 32:610-616. [PMID: 30029756 DOI: 10.1016/j.apnu.2018.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 01/03/2018] [Accepted: 03/11/2018] [Indexed: 11/30/2022]
Abstract
AIMS To investigate a partnership intervention of the community-based and hospital-based home visit to improve patients' satisfaction. METHODS A time series quasi-experimental quantitative design was used. The experimental group had "partnership intervention", while the control group maintained routine home visits. Patient satisfaction was measured pre-intervention, six months and 12 months after the partnership intervention. RESULTS Six and 12 months after partnership intervention, in the experimental group, items related to stabilizing disease conditions, improving daily living abilities, enhancing communication ability and providing relevant resources were significantly higher than pre-intervention. However, 12 months after the intervention, the influence of the intervention became weaken. CONCLUSIONS The partnership intervention can significantly improve patients' satisfaction with home visit service.
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Affiliation(s)
- Jui-Fen Cheng
- School of Nursing, China Medical University and Hospital, No.91 Hsueh-Shih Road, North District, Taichung 40402, Taiwan, ROC.
| | - Xuan-Yi Huang
- Department of Nursing, National Taipei University of Nursing and Health Sciences, No.365, Ming-te Road, Peitou Distric, Taipei City 11219, Taiwan, ROC.
| | - Mei-Chu Lin
- Department of Nursing, Tsaotun Psychiatric Center, Ministry of Health and Welfare, Taichung, 161 Yu-Pin Road, Tsaotun Township, Nantou County 54249, Taiwan, ROC
| | - Ya-Hui Wang
- Department of Nursing, Tsaotun Psychiatric Center, Ministry of Health and Welfare, Taichung, 161 Yu-Pin Road, Tsaotun Township, Nantou County 54249, Taiwan, ROC
| | - Tzu-Pei Yeh
- Department of Nursing, China Medical University and Hospital, No.91 Hsueh-Shih Road, North District, Taichung 40402, Taiwan, ROC.
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Volavka J, Vevera J. Very long-term outcome of schizophrenia. Int J Clin Pract 2018; 72:e13094. [PMID: 29691957 DOI: 10.1111/ijcp.13094] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 03/28/2018] [Indexed: 01/01/2023] Open
Abstract
PURPOSE The principal aim is to review recent data concerning the very long-term outcome of schizophrenia and schizophrenia spectrum disorders. We examine factors that influence outcome, including therapeutic interventions. METHOD PubMed and Scopus databases were searched for papers published between 2008 and 2017 reporting on prospective studies of schizophrenia or schizophrenia spectrum with a follow-up period ≥5 years with adequate outcome information. Additional publications were found in reference lists and authors' reference libraries. RESULTS The average proportion of patients with symptomatic remission at follow-up ranged between 16.4% in never-treated patients to 37.5% in patients who were systematically treated with antipsychotics. Good outcomes at follow-up were observed in schizophrenia and schizophrenia spectrum patients on low doses of antipsychotics and in patients with no pharmacological treatment at that time. Early detection and intensive treatment of the first episode as well as the availability of continued psychosocial treatment and support over subsequent years appeared associated with better outcomes. CONCLUSION The long-term outcome of schizophrenia is highly variable, depending on access to mental healthcare, early detection of psychosis and pharmacological treatment. Recent data support the effectiveness of low-dose antipsychotic treatment for long-term maintenance in some patients. A proportion of first-episode schizophrenia patients, perhaps 20%, do not need long-term maintenance antipsychotic treatment. That proportion may be higher in schizophrenia spectrum patients. The reasons why these patients do not need the long-term treatment are not well understood. Methods to predict the membership in this subgroup are not yet good enough for clinical use in individual patients.
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Affiliation(s)
- Jan Volavka
- Department of Psychiatry, Faculty of Medicine and University Hospital in Pilsen, Charles University, Pilsen, Czech Republic
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - Jan Vevera
- Department of Psychiatry, Faculty of Medicine and University Hospital in Pilsen, Charles University, Pilsen, Czech Republic
- Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
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Correll CU, Rubio JM, Kane JM. What is the risk-benefit ratio of long-term antipsychotic treatment in people with schizophrenia? World Psychiatry 2018; 17:149-160. [PMID: 29856543 PMCID: PMC5980517 DOI: 10.1002/wps.20516] [Citation(s) in RCA: 164] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The long-term benefit-to-risk ratio of sustained antipsychotic treatment for schizophrenia has recently been questioned. In this paper, we critically examine the literature on the long-term efficacy and effectiveness of this treatment. We also review the evidence on the undesired effects, the impact on physical morbidity and mortality, as well as the neurobiological correlates of chronic exposure to antipsychotics. Finally, we summarize factors that affect the risk-benefit ratio. There is consistent evidence supporting the efficacy of antipsychotics in the short term and mid term following stabilization of acute psychotic symptoms. There is insufficient evidence supporting the notion that this effect changes in the long term. Most, but not all, of the long-term cohort studies find a decrease in efficacy during chronic treatment with antipsychotics. However, these results are inconclusive, given the extensive risk of bias, including increasing non-adherence. On the other hand, long-term studies based on national registries, which have lower risk of bias, find an advantage in terms of effectiveness during sustained antipsychotic treatment. Sustained antipsychotic treatment has been also consistently associated with lower mortality in people with schizophrenia compared to no antipsychotic treatment. Nevertheless, chronic antipsychotic use is associated with metabolic disturbance and tardive dyskinesia. The latter is the clearest undesired clinical consequence of brain functioning as a potential result of chronic antipsychotic exposure, likely from dopaminergic hypersensitivity, without otherwise clear evidence of other irreversible neurobiological changes. Adjunctive psychosocial interventions seem critical for achieving recovery. However, overall, the current literature does not support the safe reduction of antipsychotic dosages by 50% or more in stabilized individuals receiving adjunctive psychosocial interventions. In conclusion, the critical appraisal of the literature indicates that, although chronic antipsychotic use can be associated with undesirable neurologic and metabolic side effects, the evidence supporting its long-term efficacy and effectiveness, including impact on life expectancy, outweighs the evidence against this practice, overall indicating a favorable benefit-to-risk ratio. However, the finding that a minority of individuals diagnosed initially with schizophrenia appear to be relapse free for long periods, despite absence of sustained antipsychotic treatment, calls for further research on patient-level predictors of positive outcomes in people with an initial psychotic presentation.
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Affiliation(s)
- Christoph U Correll
- Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, NY, USA
- Hofstra Northwell School of Medicine, Hempstead, NY, USA
- Feinstein Institute for Medical Research, Manhasset, NY, USA
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Jose M Rubio
- Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, NY, USA
- Hofstra Northwell School of Medicine, Hempstead, NY, USA
- Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - John M Kane
- Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, NY, USA
- Hofstra Northwell School of Medicine, Hempstead, NY, USA
- Feinstein Institute for Medical Research, Manhasset, NY, USA
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Harrow M, Jobe TH. Long-term antipsychotic treatment of schizophrenia: does it help or hurt over a 20-year period? World Psychiatry 2018; 17:162-163. [PMID: 29856562 PMCID: PMC5980604 DOI: 10.1002/wps.20518] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Martin Harrow
- Department of Psychiatry, University of Illinois at Chicago, College of Medicine, Chicago, IL, USA
| | - Thomas H Jobe
- Department of Psychiatry, University of Illinois at Chicago, College of Medicine, Chicago, IL, USA
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Ran MS, Zhang TM, Wong IYL, Yang X, Liu CC, Liu B, Luo W, Kuang WH, Thornicroft G, Chan CLW. Internalized stigma in people with severe mental illness in rural China. Int J Soc Psychiatry 2018; 64:9-16. [PMID: 29183250 DOI: 10.1177/0020764017743999] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND It is unknown whether there are differences in self-stigma among persons with different types of severe mental illness (SMI) in rural communities. AIM This study was to examine the differences of self-stigma and its correlates in persons with schizophrenia, major depressive disorder or bipolar disorder in a rural community in China. METHODS A total of 453 persons with schizophrenia, major depressive disorder or bipolar disorder in a rural community participated in the study. The Internalized Stigma of Mental Illness (ISMI) was used to measure self-stigma. The t-test and analyses of variance (ANOVA) were used to examine the differences in mean scores of ISMI and subscales among the three diagnoses. Logistic regression was used to explore the contributing factors to the level of self-stigma among the three groups. RESULTS Self-stigma was moderate and severe with 94.7% of the total sample. Persons with schizophrenia had significantly higher mean scores of total ISMI, alienation and discrimination experience than those with bipolar disorders. Lower family income was significantly associated with higher levels of self-stigma in persons with schizophrenia and major depressive disorder. Factors predicting the level of self-stigma among the three groups were various. CONCLUSION Self-stigma is common and severe in persons with schizophrenia, major depressive disorder and bipolar disorder, especially those with lower income status in rural community in China. Persons with schizophrenia may have higher levels of self-stigma than those with bipolar disorder. Individual-level interventions should be developed to reduce self-stigma among persons with SMI in Chinese rural communities.
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Affiliation(s)
- Mao-Sheng Ran
- 1 Department of Social Work & Social Administration, The University of Hong Kong, Hong Kong, China
| | - Tian-Ming Zhang
- 1 Department of Social Work & Social Administration, The University of Hong Kong, Hong Kong, China
| | - Irene Yin-Ling Wong
- 2 School of Social Policy & Practice, University of Pennsylvania, Philadelphia, PA, USA
| | - Xin Yang
- 3 Guangyuan Mental Health Center, Guangyuan, China
| | | | - Bo Liu
- 4 Jingzhou Mental Health Center, Jingzhou, China
| | - Wei Luo
- 5 Xinjin Mental Hospital, Chengdu, China
| | - Wei-Hong Kuang
- 6 Department of Psychiatry, West China Hospital, Sichuan University, Chengdu, China
| | - Graham Thornicroft
- 7 Health Service & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Cecilia Lai-Wan Chan
- 1 Department of Social Work & Social Administration, The University of Hong Kong, Hong Kong, China
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Family history of psychosis and outcome of people with schizophrenia in rural China: 14-year follow-up study. Asian J Psychiatr 2018; 32:14-19. [PMID: 29197709 DOI: 10.1016/j.ajp.2017.11.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 05/07/2017] [Accepted: 11/28/2017] [Indexed: 01/06/2023]
Abstract
OBJECTIVE This study examined the differences in 14-year outcomes of persons with schizophrenia with and without family history of psychosis in a rural community in China. METHODS All participants with schizophrenia (n=510) aged 15 years and older were identified in a 1994 epidemiological investigation of 123,572 people and followed up in 2004 and 2008 in Xinjin County, Chengdu, China. RESULTS Individuals with positive family history of schizophrenia had significantly younger age of first onset than those with negative family history of schizophrenia in 1994 and 2004. Compared with individuals with negative family history of schizophrenia, those with positive family history of schizophrenia had significantly higher rate of homelessness and lower rate of death due to other reasons in 10-year (2004) and 14-year follow-up (2008). There were no significantly differences of mean scores on PANSS, SDSS and GAF in 2008 between positive and negative family history groups. CONCLUSIONS The positive family history of schizophrenia is strongly related to younger age of onset, and may predict a poorer long-term outcome (e.g., higher rate of homelessness) in persons with schizophrenia in the rural community. The findings have implications for further studies on specific family-related mechanisms on clinical treatment and rehabilitation, as well as for planning and delivering of community-based mental health services.
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Vermeulen J, van Rooijen G, Doedens P, Numminen E, van Tricht M, de Haan L. Antipsychotic medication and long-term mortality risk in patients with schizophrenia; a systematic review and meta-analysis. Psychol Med 2017; 47:2217-2228. [PMID: 28397632 DOI: 10.1017/s0033291717000873] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Patients with schizophrenia have a higher mortality risk than patients suffering from any other psychiatric disorder. Previous research is inconclusive regarding the association of antipsychotic treatment with long-term mortality risk. To this aim, we systematically reviewed the literature and performed a meta-analysis on the relationship between long-term mortality and exposure to antipsychotic medication in patients with schizophrenia. The objectives were to (i) determine long-term mortality rates in patients with schizophrenia using any antipsychotic medication; (ii) compare these with mortality rates of patients using no antipsychotics; (iii) explore the relationship between cumulative exposure and mortality; and (iv) assess causes of death. We systematically searched the EMBASE, MEDLINE and PsycINFO databases for studies that reported on mortality and antipsychotic medication and that included adults with schizophrenia using a follow-up design of more than 1 year. A total of 20 studies fulfilled our inclusion criteria. These studies reported 23,353 deaths during 821,347 patient years in 133,929 unique patients. Mortality rates varied widely per study. Meta-analysis on a subgroup of four studies showed a consistent trend of an increased long-term mortality risk in schizophrenia patients who did not use antipsychotic medication during follow-up. We found a pooled risk ratio of 0.57 (LL:0.46 UL:0.76 p value <0.001) favouring any exposure to antipsychotics. Statiscal heterogeneity was found to be high (Q = 39.31, I 2 = 92.37%, p value < 0.001). Reasons for the increased risk of death for patients with schizophrenia without antipsychotic medication require further research. Prospective validation studies, uniform measures of antipsychotic exposure and classified causes of death are commendable.
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Affiliation(s)
- J Vermeulen
- Department of Psychiatry,Academic Medical Center,Amsterdam,The Netherlands
| | - G van Rooijen
- Department of Psychiatry,Academic Medical Center,Amsterdam,The Netherlands
| | - P Doedens
- Department of Psychiatry,Academic Medical Center,Amsterdam,The Netherlands
| | - E Numminen
- Department of Psychiatry,Academic Medical Center,Amsterdam,The Netherlands
| | - M van Tricht
- Department of Psychiatry,Academic Medical Center,Amsterdam,The Netherlands
| | - L de Haan
- Department of Psychiatry,Academic Medical Center,Amsterdam,The Netherlands
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50
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Leucht S, Davis JM. Do antipsychotic drugs lose their efficacy for relapse prevention over time? Br J Psychiatry 2017; 211:127-129. [PMID: 28864750 DOI: 10.1192/bjp.bp.117.201103] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 07/14/2017] [Indexed: 11/23/2022]
Abstract
There is a debate about long-term treatment of schizophrenia with antipsychotic drugs, with some experts suggesting that these drugs should be discontinued. In this issue, Takeuchi et al demonstrated by a meta-analysis of 11 trials that antipsychotic drugs maintained their efficacy for relapse prevention for 1 year, whereas patients on placebo kept getting worse. We consider these findings in the light of the current discussion about possible dose-related brain volume loss, supersensitivity psychosis, the high variability of results in long-term follow-up studies and recent approaches to discontinue antipsychotics in patients with a first-episode. The new findings speak in favour of continuing antipsychotics at the same dose, at least in patients whose condition is chronic, but the topic is complex.
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Affiliation(s)
- Stefan Leucht
- Stefan Leucht, MD, Department of Psychiatry and Psychotherapy, Technische Universitat Munchen, Klinikum rechts der Isar, Munich, Germany; John M. Davis, MD, Psychiatric Institute, University of Illinois at Chicago, Chicago, Illinois and Maryland Psychiatric Research Center, Baltimore, Maryland, USA
| | - John M Davis
- Stefan Leucht, MD, Department of Psychiatry and Psychotherapy, Technische Universitat Munchen, Klinikum rechts der Isar, Munich, Germany; John M. Davis, MD, Psychiatric Institute, University of Illinois at Chicago, Chicago, Illinois and Maryland Psychiatric Research Center, Baltimore, Maryland, USA
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