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Hoertel N, Sánchez-Rico M, Kassm SA, Brami B, Olfson M, Rezaei K, Scheer V, Limosin F. Excess mortality and its causes among older adults with schizophrenia versus those with bipolar disorder and major depressive disorder: a 5-year prospective multicenter study. Eur Arch Psychiatry Clin Neurosci 2025; 275:595-605. [PMID: 38294521 DOI: 10.1007/s00406-023-01752-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/18/2023] [Indexed: 02/01/2024]
Abstract
Excess mortality observed in people with schizophrenia may persist in later life. The specific causes of increased mortality observed in older adults with schizophrenia and the potential influence of psychotropic medications remain partly unknown. We compared 5-year mortality and its causes of older adults with schizophrenia to bipolar disorder (BD) or major depressive disorder (MDD). We used a 5-year prospective cohort, including 564 older inpatients and outpatients with schizophrenia, BD or MDD (mean age: 67.9 years, SD = 7.2 years). Causes of death were cardiovascular disorder (CVD) mortality, non-CVD disease-related mortality (e.g., infections), suicide, and unintentional injury. The primary analysis was a multivariable logistic model with inverse probability weighting (IPW) to reduce the effects of confounders, including sociodemographic factors, duration and severity of the disorder, and psychiatric and non-psychiatric comorbidity. Five-year all-cause mortality among older participants with schizophrenia and with BD or MDD were 29.4% (n = 89) and 18.4% (n = 45), respectively. Following adjustments, schizophrenia compared to MDD or BD was significantly associated with increased all-cause mortality (AOR = 1.35; 95%CI = 1.04-1.76; p = 0.024) and cardiovascular mortality (AOR = 1.50; 95%CI = 1.13-1.99; p = 0.005). These associations were significantly reduced among patients taking antidepressants [interaction odds ratio (IOR) = 0.42; 95%CI = 0.22-0.79; p = 0.008 and IOR = 0.39: 95%CI = 0.16-0.94; p = 0.035, respectively]. Schizophrenia was associated with higher mortality compared to BD or MDD. Cardiovascular diseases explained most of this excess mortality. Exploratory analyses suggested that psychotropic medications did not influence this excess mortality, except for antidepressants, which were associated with significantly reduced between-group difference in all-cause and cardiovascular mortality.
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Affiliation(s)
- Nicolas Hoertel
- Department of Psychiatry, AP-HP Centre, DMU Psychiatrie et Addictologie, Corentin-Celton Hospital, Parvis Corentin Celton, 92130, Issy-les-Moulineaux, France
- INSERM 1266, Psychiatry and Neurosciences Center, Paris, France
- Université Paris Cité, Paris, France
| | - Marina Sánchez-Rico
- Department of Psychiatry, AP-HP Centre, DMU Psychiatrie et Addictologie, Corentin-Celton Hospital, Parvis Corentin Celton, 92130, Issy-les-Moulineaux, France
| | - Sandra Abou Kassm
- Department of Psychiatry, Lebanese University, Faculty of Medical Sciences, Beirut, Lebanon
- Department of Psychiatry, Centre Hospitalier Guillaume Régnier, Rennes, France
| | - Benjamin Brami
- Department of Psychiatry, AP-HP Centre, DMU Psychiatrie et Addictologie, Corentin-Celton Hospital, Parvis Corentin Celton, 92130, Issy-les-Moulineaux, France
- Department of Adult Psychiatry, Laboratory of Neurosciences, University Hospital of Besançon, UBFC, EA-481, Besançon, France
| | - Mark Olfson
- Department of Psychiatry, Columbia University Medical Center/New York State Psychiatric Institute, New York, USA
| | - Katayoun Rezaei
- Department of Psychiatry, AP-HP Centre, DMU Psychiatrie et Addictologie, Corentin-Celton Hospital, Parvis Corentin Celton, 92130, Issy-les-Moulineaux, France.
| | - Valentin Scheer
- Department of Psychiatry, AP-HP Centre, DMU Psychiatrie et Addictologie, Corentin-Celton Hospital, Parvis Corentin Celton, 92130, Issy-les-Moulineaux, France
- Université Paris Cité, Paris, France
| | - Frédéric Limosin
- Department of Psychiatry, AP-HP Centre, DMU Psychiatrie et Addictologie, Corentin-Celton Hospital, Parvis Corentin Celton, 92130, Issy-les-Moulineaux, France
- INSERM 1266, Psychiatry and Neurosciences Center, Paris, France
- Université Paris Cité, Paris, France
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Pop PR, Larsen GS, Thomsen MK, Johansen C, Zachariae R, Rafn BS. Colorectal cancer mortality in persons with severe mental illness: a scoping review with meta-analyses of observational studies. Acta Oncol 2025; 64:358-373. [PMID: 40045534 PMCID: PMC11905152 DOI: 10.2340/1651-226x.2025.42260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2024] [Accepted: 02/13/2025] [Indexed: 03/15/2025]
Abstract
BACKGROUND AND PURPOSE Persons with severe mental illnesses (SMIs) have reduced participation in colorectal cancer (CRC) screening programs, higher odds of advanced stage at diagnosis, and are less likely to receive adequate treatment than the general population. It remains unclear to what extent these factors impact CRC outcomes for persons with SMI. The aim of this scoping review was to describe and quantify CRC mortality for persons with SMI compared with the general population. PATIENTS/MATERIALS AND METHODS We followed the JBI Manual for Evidence Synthesis and PRISMA guidelines in a systematic search of four databases from inception until April 29th, 2024. We included studies that provided CRC mortality estimates for adults with preexisting clinical diagnosis of SMI. We synthesized the results descriptively and pooled the data to estimate the magnitude of the associations. RESULTS Twenty-four original studies were identified with a total of 16.4 million persons. Most studies reported increased CRC mortality for persons with SMI compared with persons without SMI. The meta-analysis demonstrated a 25% increased CRC mortality for persons with SMI (e.g. pooled hazard ratio 1.25; 95% confidence interval 1.13 to 1.39; n = 13,178,161). INTERPRETATION The evidence points consistently to an increased CRC mortality for persons with SMI compared with persons without SMI. Furthermore, this evidence supports the idea that persons with SMI are a heterogenous population, and as such, any future initiatives to improve CRC outcomes for persons with SMI would warrant a tailored approach to potentiate individual resources, to mitigate stigma and structural discrimination.
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Affiliation(s)
- Paula R Pop
- Danish Cancer Society National Research Center for Cancer Survivorship and Treatment Late Effects (CASTLE), Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Gitte S Larsen
- Danish Cancer Society National Research Center for Cancer Survivorship and Treatment Late Effects (CASTLE), Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Mette K Thomsen
- Danish Cancer Society National Research Center for Cancer Survivorship and Treatment Late Effects (CASTLE), Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Christoffer Johansen
- Danish Cancer Society National Research Center for Cancer Survivorship and Treatment Late Effects (CASTLE), Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Robert Zachariae
- 3Danish Breast Cancer Group Center and Clinic for Late Effects (DCCL), Aarhus University Hospital, Aarhus, Denmark; Unit for Psycho-oncology and Health Psychology, Department of Oncology, Aarhus University Hospital, and Department of Psychology and Behavioural Sciences, Aarhus University, Denmark
| | - Bolette Skjødt Rafn
- Danish Cancer Society National Research Center for Cancer Survivorship and Treatment Late Effects (CASTLE), Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
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Solmi M, Croatto G, Fabiano N, Wong S, Gupta A, Fornaro M, Schneider LK, Rohani-Montez SC, Fairley L, Smith N, Bitter I, Gorwood P, Taipale H, Tiihonen J, Cortese S, Dragioti E, Rietz ED, Nielsen RE, Firth J, Fusar-Poli P, Hartman C, Holt RIG, Høye A, Koyanagi A, Larsson H, Lehto K, Lindgren P, Manchia M, Nordentoft M, Skonieczna-Żydecka K, Stubbs B, Vancampfort D, Vieta E, De Prisco M, Boyer L, Højlund M, Correll CU. Sex-stratified mortality estimates in people with schizophrenia: A systematic review and meta-analysis of cohort studies of 2,700,825 people with schizophrenia. Eur Neuropsychopharmacol 2025; 91:56-66. [PMID: 39626570 DOI: 10.1016/j.euroneuro.2024.11.001] [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: 06/12/2024] [Revised: 11/01/2024] [Accepted: 11/04/2024] [Indexed: 02/01/2025]
Abstract
The differential influence of sex on premature mortality in schizophrenia is unclear. This study assessed the differences in all-cause and specific cause mortality risks in people with schizophrenia compared to several control groups stratified by sex. We conducted a PRISMA 2020-compliant systematic review and random-effects meta-analysis of cohort studies assessing mortality relative risk (RR) for people with schizophrenia, comparing by sex. We measured publication bias and conducted a quality assessment through the Newcastle-Ottawa scale. We meta-analyzed 43 studies reporting on 2,700,825 people with schizophrenia. Both males and females with schizophrenia had increased all-cause mortality vs. comparison groups (males, RR=2.62, 95%CI 2.35-2.92; females, RR=2.56, 95%CI 2.27-2.87), suicide (males, RR=9.02, 95%CI 5.96-13.67; females, RR=12.09, 95%CI 9.00-16.25), and natural cause mortality (males, RR=2.11, 95%CI 1.88-2.38; females, RR=2.14, 95%CI 1.93-2.38). No statistically significant differences in sex-dependent mortality risk emerged. There was an age-group-dependent increased mortality risk in females < 40 years vs. >/=40 years old (RR=4.23/2.17), and significantly higher risk of death due to neurological disorders (dementia) in males vs. females (RR=5.19/2.40). Increased mortality risks were often associated with specific modifiable risk factors. The increased mortality risk did not improve over time, calling for more studies to identify modifiable factors, and for better physical healthcare for males and females with schizophrenia.
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Affiliation(s)
- Marco Solmi
- Department of Psychiatry, University of Ottawa, 501 Smyth road, Ottawa, ON, Canada; Department of Mental Health, Ottawa Hospital, Ottawa, ON, Canada; Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany.
| | - Giovanni Croatto
- Mental Health Department, AULSS 3 Serenissima, Mestre, Venice, Italy
| | - Nicholas Fabiano
- Department of Psychiatry, University of Ottawa, 501 Smyth road, Ottawa, ON, Canada
| | - Stanley Wong
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Arnav Gupta
- Department of Internal Medicine, University of Calgary, Calgary, AB, Canada; College of Public Health, Kent State University, Kent, OH, United States
| | - Michele Fornaro
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Dentistry, Federico II University of Naples, Naples, Italy
| | | | | | | | | | - István Bitter
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Philip Gorwood
- Université Paris Cité, INSERM U1266, Institute of Psychiatry and Neurosciences of Paris (IPNP), Paris, France; GHU Paris Psychiatrie et Neurosciences (CMME, Sainte-Anne Hospital), Paris, France
| | - Heidi Taipale
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden; Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland; School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Jari Tiihonen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden; Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom; Solent NHS Trust, Southampton, United Kingdom; Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, United Kingdom; Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, United States; Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Elena Dragioti
- Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Ebba Du Rietz
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Rene Ernst Nielsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark
| | - Joseph Firth
- Division of Psychology and Mental Health, The University of Manchester, Manchester, United Kingdom
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Catharina Hartman
- University of Groningen, University Medical Center Groningen, Interdisciplinary Centre Psychopathology and Emotion regulation, Netherlands
| | - Richard I G Holt
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK and Southampton National Institute for Health Research Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, United Kingdom
| | - Anne Høye
- Department of Clinical Medicine, UiT The Arctic University of Norway and Department of Mental Health and Substance Abuse, University Hospital of North Norway, Tromsø, Norway
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat 08830, Barcelona, Spain; ICREA, Pg. Lluis Companys 23, Barcelona 08010, Spain
| | - Henrik Larsson
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Kelli Lehto
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Peter Lindgren
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden; The Swedish Institute for Health Economics, Lund, Sweden
| | - Mirko Manchia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy; Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Merete Nordentoft
- Mental Health Centre Copenhagen, Department of Clinical Medicine, Copenhagen University Hospital, Denmark
| | | | - Brendon Stubbs
- Centre for Sports Science, University of Vienna, Austria; Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, United Kingdom
| | - Davy Vancampfort
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; University Psychiatric Centre KU Leuven, Kortenberg, Leuven, Belgium
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Michele De Prisco
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Laurent Boyer
- CEReSS-Health Services Research and Quality of Life Center, Aix-Marseille University, France
| | - Mikkel Højlund
- Department of Psychiatry Aabenraa, Mental Health Services in the Region of Southern Denmark, Aabenraa, Denmark; Clinical Pharmacology, Pharmacy, and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany; Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States; Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
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Den J, Nelson N, Klimberg VS. Analysis of the incidence and outcomes of breast cancer in women with schizophrenia. Am J Surg 2025; 239:116050. [PMID: 39547875 DOI: 10.1016/j.amjsurg.2024.116050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 08/20/2024] [Accepted: 10/28/2024] [Indexed: 11/17/2024]
Abstract
OBJECTIVE Breast cancer (BC) is the leading cause of female cancer death in the world and the second leading cause of female cancer death in the U.S, Mortality from breast cancer is even higher in individuals with schizophrenia. The aim of our project was to evaluate the incidence of breast cancer in women with schizophrenia and to compare outcomes between breast cancer patients who were or were not on antipsychotics prior to diagnosis. METHODS This retrospective study used data from the TriNetX database. Women ≥18 years old diagnosed with schizophrenia were identified. The incidence of primary BC diagnosis between January 2011 and December 2023 was evaluated and stratified by ethnicity. We then conducted a retrospective cohort study to compare outcomes of women ≥18 years who did or did not use antipsychotics one year before BC diagnosis. Patients' propensity score was matched based on age, obesity, tobacco use, socioeconomic status, cancer stage, chemoradiation, axillary lymph node dissection (ALND), sentinel lymph node biopsy (SLNB), and hormone therapy use. Outcomes of interest were 5-year overall survival, recurrence, chemotherapy need, and lymphedema. RESULTS 1,398,475 women ≥18 years old with schizophrenia were identified. Breast cancer incidence in these patients was 0.53 % in 2011 and 0.53 % in 2022, with a peak in 2017 (1.29 %). Non-Hispanic patients were diagnosed with BC approximately 1.3 times more than Hispanic patients. The outcomes study included 183,062 matched patients, with 91,531 per cohort. 5-year survival with the Kaplan-Meier analysis was significantly greater in women not on antipsychotics (72 %) compared to those on antipsychotics (60 %), log-rank test p-value <0.0001. The risk of local recurrence (13.4 % versus 22.6 %, p-value <0.0001), chemotherapy need (41.2 % versus 48.4 %, p-value <0.0001), and lymphedema (7.7 % versus 11.5 %, p-value <0.0001) were also significantly lower in women who did not take antipsychotics. CONCLUSION Breast cancer incidence in patients with schizophrenia identified through TriNetX has not experienced a significant uptrend or downtrend over the past decade. Non-Hispanic patients with schizophrenia have a higher incidence of BC than Hispanic patients. Matched breast cancer patients on antipsychotics at least one year prior to diagnosis had higher mortality, recurrence, chemotherapy need, and risk of lymphedema.
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Affiliation(s)
- Jennifer Den
- The University of Texas Medical Branch at Galveston, Department of Surgery, USA.
| | - Nicole Nelson
- The University of Texas Medical Branch at Galveston, Department of Surgery, USA
| | - V Suzanne Klimberg
- The University of Texas Medical Branch at Galveston, Department of Surgery, USA.
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Bouttle K, Ingold N, O’Mara TA. Using Genetics to Investigate Relationships between Phenotypes: Application to Endometrial Cancer. Genes (Basel) 2024; 15:939. [PMID: 39062718 PMCID: PMC11276418 DOI: 10.3390/genes15070939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 07/14/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
Genome-wide association studies (GWAS) have accelerated the exploration of genotype-phenotype associations, facilitating the discovery of replicable genetic markers associated with specific traits or complex diseases. This narrative review explores the statistical methodologies developed using GWAS data to investigate relationships between various phenotypes, focusing on endometrial cancer, the most prevalent gynecological malignancy in developed nations. Advancements in analytical techniques such as genetic correlation, colocalization, cross-trait locus identification, and causal inference analyses have enabled deeper exploration of associations between different phenotypes, enhancing statistical power to uncover novel genetic risk regions. These analyses have unveiled shared genetic associations between endometrial cancer and many phenotypes, enabling identification of novel endometrial cancer risk loci and furthering our understanding of risk factors and biological processes underlying this disease. The current status of research in endometrial cancer is robust; however, this review demonstrates that further opportunities exist in statistical genetics that hold promise for advancing the understanding of endometrial cancer and other complex diseases.
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Affiliation(s)
| | | | - Tracy A. O’Mara
- Cancer Research Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia (N.I.)
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Jacob JR, Palanichamy K, Chakravarti A. Antipsychotics possess anti-glioblastoma activity by disrupting lysosomal function and inhibiting oncogenic signaling by stabilizing PTEN. Cell Death Dis 2024; 15:414. [PMID: 38871731 PMCID: PMC11176297 DOI: 10.1038/s41419-024-06779-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 05/22/2024] [Accepted: 05/28/2024] [Indexed: 06/15/2024]
Abstract
The repurposing of medications developed for central nervous system (CNS) disorders, possessing favorable safety profiles and blood-brain barrier permeability, represents a promising strategy for identifying new therapies to combat glioblastoma (GBM). In this study, we investigated the anti-GBM activity of specific antipsychotics and antidepressants in vitro and in vivo. Our results demonstrate that these compounds share a common mechanism of action in GBM, disrupting lysosomal function and subsequently inducing lysosomal membrane rupture and cell death. Notably, PTEN intact GBMs possess an increased sensitivity to these compounds. The inhibition of lysosomal function synergized with inhibitors targeting the EGFR-PI3K-Akt pathway, leading to an energetic and antioxidant collapse. These findings provide a foundation for the potential clinical application of CNS drugs in GBM treatment. Additionally, this work offers critical insights into the mechanisms and determinants of cytotoxicity for drugs currently undergoing clinical trials as repurposing agents for various cancers, including Fluoxetine, Sertraline, Thioridazine, Chlorpromazine, and Fluphenazine.
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Affiliation(s)
- John Ryan Jacob
- Department of Radiation Oncology, The Ohio State University College of Medicine and Comprehensive Cancer Center, Columbus, OH, 43210, USA
| | - Kamalakannan Palanichamy
- Department of Radiation Oncology, The Ohio State University College of Medicine and Comprehensive Cancer Center, Columbus, OH, 43210, USA.
| | - Arnab Chakravarti
- Department of Radiation Oncology, The Ohio State University College of Medicine and Comprehensive Cancer Center, Columbus, OH, 43210, USA
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Linz S, Jerome-D'Emilia B. Barriers and Facilitators to Breast Cancer Screening for Women With Severe Mental Illness. J Am Psychiatr Nurses Assoc 2024; 30:576-589. [PMID: 36475418 DOI: 10.1177/10783903221140600] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Women with severe mental illness (SMI) are diagnosed with breast cancer at later stages, with greater mortality rates than the general population. Although breast cancer screening is an acknowledged strategy for early breast cancer detection, women with SMI are 32% to 50% less likely to have regular mammography screenings, yet the specific factors related to the disparity in this population have not been determined. AIM The purpose of this study was to identify the barriers and facilitators toward breast cancer screening in women diagnosed with SMI. METHOD In collaboration with a community-based mental health services agency, women aged 40 and older, diagnosed with SMI, and treated at that agency, were identified and asked if they were willing to participate. Fifteen women agreed to be interviewed. An interpretive descriptive approach was utilized to analyze the qualitative data. RESULTS The themes elicited included barriers and facilitators to screening. Barriers found were: Psychiatric Symptoms, Fear, Distrust in the Health care System, and Not my Priority. Among the facilitators were Support, Good Health care Experiences, Make it Easy, Integrated Care, and Self-Care. CONCLUSION Unique to this study was the understanding by participants that physical health needed to be integrated into their mental health care services through direct support and education, primarily because the process of recovery from mental illness itself entailed the increasing ability for self-care, encompassing a focus on both mental and physical health needs and preventive care.
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Affiliation(s)
- Sheila Linz
- Sheila Linz, PhD, PMHNP-BC, RN, Rutgers, The State University of New Jersey, Camden, NJ, USA
| | - Bonnie Jerome-D'Emilia
- Bonnie Jerome-D'Emilia, PhD, MPH, RN, Associate Professor and Director of the RN-BS Program, Rutgers, The State University of New Jersey, Camden, NJ, USA
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Shalev D, Brenner K, Carlson RL, Chammas D, Levitt S, Noufi PE, Robbins-Welty G, Webb JA. Palliative Care Psychiatry: Building Synergy Across the Spectrum. Curr Psychiatry Rep 2024; 26:60-72. [PMID: 38329570 DOI: 10.1007/s11920-024-01485-5] [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] [Accepted: 12/21/2023] [Indexed: 02/09/2024]
Abstract
PURPOSE OF REVIEW Palliative care (PC) psychiatry is a growing subspecialty focusing on improving the mental health of those with serious medical conditions and their caregivers. This review elucidates the current practice and ongoing evolution of PC psychiatry. RECENT FINDINGS PC psychiatry leverages training and clinical practices from both PC and psychiatry, addressing a wide range of needs, including enhanced psychiatric care for patients with serious medical illness, PC access for patients with medical needs in psychiatric settings, and PC-informed psychiatric approaches for individuals with treatment-refractory serious mental illness. PC psychiatry is practiced by a diverse workforce comprising hospice and palliative medicine-trained psychiatrists, psycho-oncologists, geriatric psychiatrists, other mental health professionals, and non-psychiatrist PC clinicians. As a result, PC psychiatry faces challenges in defining its operational scope. The manuscript outlines the growth, current state, and prospects of PC psychiatry. It examines its roles across various healthcare settings, including medical, integrated care, and psychiatric environments, highlighting the unique challenges and opportunities in each. PC psychiatry is a vibrant and growing subspecialty of psychiatry that must be operationalized to continue its developmental trajectory. There is a need for a distinct professional identity for PC psychiatry, strategies to navigate administrative and regulatory hurdles, and greater support for novel clinical, educational, and research initiatives.
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Affiliation(s)
- Daniel Shalev
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, 525 East 68thStreet, Box 39, New York, NY, 10065, USA.
| | - Keri Brenner
- Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - Rose L Carlson
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, 525 East 68thStreet, Box 39, New York, NY, 10065, USA
| | - Danielle Chammas
- Department of Medicine, University of California: San Francisco, San Francisco, CA, USA
| | - Sarah Levitt
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Paul E Noufi
- Department of Medicine, Georgetown University, Baltimore, MD, USA
| | | | - Jason A Webb
- Department of Medicine, Oregon Health and Sciences University, Portland, OR, USA
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Sara G, Lambeth C, Burgess P, Curtis J, Walton R, Currow D. Breast screening participation and degree of spread of invasive breast cancer at diagnosis in mental health service users: A population linkage study. Cancer 2024; 130:77-85. [PMID: 37632356 DOI: 10.1002/cncr.35002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/28/2023] [Accepted: 07/24/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Women living with mental health conditions may not have shared in improvements in breast cancer screening and care. No studies have directly examined the link between reduced screening participation and breast cancer spread in women using mental health (MH) services. METHODS Population-wide linkage of a population cancer register, BreastScreen register, and mental health service data set in women aged 50 to 74 years in New South Wales, Australia, from 2008 to 2017. Incident invasive breast cancers were identified. Predictors of degree of spread (local, regional, metastatic) at diagnosis were examined using partial proportional odds regression, adjusting for age, socioeconomic status, rurality, and patterns of screening participation. RESULTS A total of 29 966 incident cancers were identified and included 686 (2.4%) in women with MH service before cancer diagnoses. More than half of MH service users had regional or metastatic spread at diagnosis (adjusted odds ratio, 1.63; 95% CI, 1.41-1.89). MH service users had lower screening participation; however, advanced cancer was more common even when adjusting for screening status (adjusted odds ratio, 1.53; 95% CI, 1.32-1.77). Advanced cancer was more common in women with severe or persistent MH conditions. CONCLUSIONS Low screening participation rates explain only small part of the risk of more advanced breast cancer in women who use MH services. More study is needed to understand possible mechanisms contributing to more advanced breast cancer in women living with MH conditions. Health systems need strategies to ensure that women living with MH conditions enjoy population gains in breast cancer outcomes.
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Affiliation(s)
- Grant Sara
- System Information and Analytics Branch, NSW Ministry of Health, Sydney, Australia
- Faculty of Medicine and Health, University of NSW, Sydney, Australia
| | - Chris Lambeth
- NSW Biostatistics Training Program, NSW Ministry of Health, Sydney, Australia
| | - Philip Burgess
- Faculty of Public Health, University of Queensland, Brisbane, Australia
| | - Jackie Curtis
- Faculty of Medicine and Health, University of NSW, Sydney, Australia
| | | | - David Currow
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
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10
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Wei Z, Wang Y, Hu L, Wang Y, Li C, Sun L. Incidence, prevalence, and mortality of schizophrenia from 2016 to 2020 in Shandong, China. Psychiatry Res 2024; 331:115612. [PMID: 38039652 DOI: 10.1016/j.psychres.2023.115612] [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: 06/27/2022] [Revised: 11/15/2023] [Accepted: 11/17/2023] [Indexed: 12/03/2023]
Abstract
The epidemiology of schizophrenia has been reported in many countries. However, due to the limitations of those studies, the findings cannot be generalized to other parts of the world, especially in China. In this study, the incidence, prevalence, and mortality of schizophrenia in Shandong, China were calculated using data from the National Severe Mental Disorder Registration System collected between 2016 and 2020 and census data from 2010 to 2020. The overall incidence decreased from 9.61 per 100,000 in 2016 to 4.40 per 100,000 in 2020, the aggregate prevalence was approximately 3.20 per 1000, and the overall mortality ranged from 6.17 per 100,000 to 7.71 per 100,000. The evidence from this study indicated that the incidence, prevalence, and mortality of schizophrenia were higher in rural areas than in urban areas. Females had higher incidence, prevalence, and mortality than males. This study provided epidemiological information on schizophrenia and opened avenues for future research.
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Affiliation(s)
- Zhen Wei
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China; National Health Commission of China (NHC) Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan 250012, China; Institute of Health and Elderly Care, Shandong University, Jinan 250012, China
| | - Yanhu Wang
- Department of Social Mental Health, Shandong Mental Health Center, Jinan 250014, China
| | - Lili Hu
- Department of Social Mental Health, Shandong Mental Health Center, Jinan 250014, China
| | - Yifan Wang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China; National Health Commission of China (NHC) Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan 250012, China; Institute of Health and Elderly Care, Shandong University, Jinan 250012, China
| | - Caifeng Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China; National Health Commission of China (NHC) Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan 250012, China; Institute of Health and Elderly Care, Shandong University, Jinan 250012, China
| | - Long Sun
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China; National Health Commission of China (NHC) Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan 250012, China; Institute of Health and Elderly Care, Shandong University, Jinan 250012, China.
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11
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Tosetti I, Kuper H. Do people with disabilities experience disparities in cancer care? A systematic review. PLoS One 2023; 18:e0285146. [PMID: 38091337 PMCID: PMC10718463 DOI: 10.1371/journal.pone.0285146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 11/15/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Over 1.3 billion people, or 16% of the world's population, live with some form of disability. Recent studies have reported that people with disabilities (PwD) might not be receiving state-of-the-art treatment for cancer as their non-disabled peers; our objective was to systematically review this topic. METHODS A systematic review was undertaken to compare cancer outcomes and quality of cancer care between adults with and without disabilities (NIHR Prospero register ID number: CRD42022281506). A search of the literature was performed in July 2022 across five databases: EMBASE, Medline, Cochrane Library, Web of Science and CINAHL databases. Peer-reviewed quantitative research articles, published in English from 2000 to 2022, with interventional or observational study designs, comparing cancer outcomes between a sample of adult patients with disabilities and a sample without disabilities were included. Studies focused on cancer screening and not treatment were excluded, as well as editorials, commentaries, opinion papers, reviews, case reports, case series under 10 patients and conference abstracts. Studies were evaluated by one reviewer for risk of bias based on a set of criteria according to the SIGN 50 guidelines. A narrative synthesis was conducted according to the Cochrane SWiM guidelines, with tables summarizing study characteristics and outcomes. This research received no external funding. RESULTS Thirty-one studies were included in the systematic review. Compared to people without disabilities, PwD had worse cancer outcomes, in terms of poorer survival and higher overall and cancer-specific mortality. There was also evidence that PwD received poorer quality cancer care, including lower access to state-of-the-art care or curative-intent therapies, treatment delays, undertreatment or excessively invasive treatment, worse access to in-hospital services, less specialist healthcare utilization, less access to pain medications and inadequate end-of-life quality of care. DISCUSSION Limitations of this work include the exclusion of qualitative research, no assessment of publication bias, selection performed by only one reviewer, results from high-income countries only, no meta-analysis and a high risk of bias in 15% of included studies. In spite of these limitations, our results show that PwD often experience severe disparities in cancer care with less guideline-consistent care and higher mortality than people without disabilities. These findings raise urgent questions about how to ensure equitable care for PwD; in order to prevent avoidable morbidity and mortality, cancer care programs need to be evaluated and urgently improved, with specific training of clinical staff, more disability inclusive research, better communication and shared decision-making with patients and elimination of physical, social and cultural barriers.
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Affiliation(s)
- Irene Tosetti
- M.Sc. Public Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom
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12
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Shen J, Wang Q, Lu F, Xu H, Wang P, Feng Y. Prognostic and immunomodulatory roles of schizophrenia-associated genes HTR2A, COMT, and PRODH in pan-cancer analysis and glioma survival prediction model. Front Immunol 2023; 14:1201252. [PMID: 37564635 PMCID: PMC10411190 DOI: 10.3389/fimmu.2023.1201252] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/10/2023] [Indexed: 08/12/2023] Open
Abstract
Background The shortened life expectancy in schizophrenia (SCZ) patients may be correlated with most cancers, yet there is heterogeneity in the studies examining these correlations. This study explored the expression of SCZ-related genes (HTR2A, COMT, and PRODH) in pan-cancer analysis. It helped to enhance the mechanistic understanding of the SCZ-cancer relationship and their immune mechanisms at the genetic level. Additionally, this study established a survival prediction model for glioblastoma and low-grade glioma (GBMLGG). Methods and results SCZ-associated genes (HTR2A, COMT, and PRODH) were subjected to pan-cancer analysis. COX regression analysis and survival analysis were carried out for differentially expressed genes in multiple cancers, and finally, GBMLGG was derived as the focus for further detailed analysis. The immune scores and immune cell infiltration analyses were performed. All three genes were considerably linked with immune infiltration in GBMLGG, consistent with survival analysis. Based on the immunocyte analysis, it was observed that CD8+ T cells might be critically involved in the survival of GBMLGG. Genomic heterogeneity studies identified correlations of three genes with GBMLGG in tumor mutational burden (TMB) and mutant-allele tumor heterogeneity (MATH). HTR2A and COMT were significantly negatively correlated in TMB. Furthermore, it was found that HTR2A had a significant positive correlation with MATH, whereas PRODH had a significant negative correlation with MATH. Accordingly, a survival prediction model was constructed for GBMLGG using these three genes and clinical data, with better results obtained when evaluated in two separate datasets. Finally, gene expression validation and further immunocyte analysis were carried out in the single-cell RNA sequencing (scRNA-seq) data of glioma. Conclusion SCZ-associated genes (HTR2A, COMT, and PRODH) were significantly differentially expressed in the carcinogenesis and survival of multiple cancers. The up or downregulation of gene expression varied across cancer types. In the GBMLGG analysis, upregulation of HTR2A and COMT was significantly positively correlated with carcinogenesis, while the opposite was noted for PRODH. Furthermore, a negative correlation was found between the upregulation of HTR2A and COMT and the survival of GBMLGG, and the opposite was also noted for PRODH. As reflected in the immunocyte analysis, abnormal expression of the three genes might be linked with CD8+ T cell infiltration, which might be critically involved in the survival of GBMLGG patients. The expression of HTR2A and COMT may inversely affect the efficacy of immunotherapy through the TMB pathway and further affect the prognosis of patient survival. The expression of HTR2A might positively indicate the degree of tumor heterogeneity through MATH and further affect the survival and prognosis of patients. The negative correlation of PRODH led to the opposite effect. Finally, the constructed survival prediction model demonstrated good predictive value, which was well validated in scRNA-seq analysis.
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Affiliation(s)
- Jing Shen
- Medical laboratory, The Affiliated Jiangsu Shengze Hospital of Nanjing Medical University, Suzhou, China
| | - Qiang Wang
- Medical laboratory, The Affiliated Jiangsu Shengze Hospital of Nanjing Medical University, Suzhou, China
| | - Fengquan Lu
- Medical laboratory, The Affiliated Jiangsu Shengze Hospital of Nanjing Medical University, Suzhou, China
| | - Hua Xu
- Medical laboratory, The Affiliated Jiangsu Shengze Hospital of Nanjing Medical University, Suzhou, China
| | - Peng Wang
- Suzhou Key Laboratory of Neuro-Oncology and Nano-Bionics, Suzhou, China
| | - Yu Feng
- Medical laboratory, The Affiliated Jiangsu Shengze Hospital of Nanjing Medical University, Suzhou, China
- Medicine and Health, The University of New South Wales, Kensington, NSW, Australia
- Melbourne Medical School, The University of Melbourne, Parkville, VIC, Australia
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Steiling K, Kathuria H, Echieh CP, Ost DE, Rivera MP, Begnaud A, Celedón JC, Charlot M, Dietrick F, Duma N, Fong KM, Ford JG, Gould MK, Holguin F, Pérez-Stable EJ, Tanner NT, Thomson CC, Wiener RS, Wisnivesky J. Research Priorities for Interventions to Address Health Disparities in Lung Nodule Management: An Official American Thoracic Society Research Statement. Am J Respir Crit Care Med 2023; 207:e31-e46. [PMID: 36920066 PMCID: PMC10037482 DOI: 10.1164/rccm.202212-2216st] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Background: Lung nodules are common incidental findings, and timely evaluation is critical to ensure diagnosis of localized-stage and potentially curable lung cancers. Rates of guideline-concordant lung nodule evaluation are low, and the risk of delayed evaluation is higher for minoritized groups. Objectives: To summarize the existing evidence, identify knowledge gaps, and prioritize research questions related to interventions to reduce disparities in lung nodule evaluation. Methods: A multidisciplinary committee was convened to review the evidence and identify key knowledge gaps in four domains: 1) research methodology, 2) patient-level interventions, 3) clinician-level interventions, and 4) health system-level interventions. A modified Delphi approach was used to identify research priorities. Results: Key knowledge gaps included 1) a lack of standardized approaches to identify factors associated with lung nodule management disparities, 2) limited data evaluating the role of social determinants of health on disparities in lung nodule management, 3) a lack of certainty regarding the optimal strategy to improve patient-clinician communication and information transmission and/or retention, and 4) a paucity of information on the impact of patient navigators and culturally trained multidisciplinary teams. Conclusions: This statement outlines a research agenda intended to stimulate high-impact studies of interventions to mitigate disparities in lung nodule evaluation. Research questions were prioritized around the following domains: 1) need for methodologic guidelines for conducting research related to disparities in nodule management, 2) evaluating how social determinants of health influence lung nodule evaluation, 3) studying approaches to improve patient-clinician communication, and 4) evaluating the utility of patient navigators and culturally enriched multidisciplinary teams to reduce disparities.
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14
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Li Z, Zong X, Li D, He Y, Tang J, Hu M, Chen X. Epigenetic clock analysis of blood samples in drug-naive first-episode schizophrenia patients. BMC Psychiatry 2023; 23:45. [PMID: 36650462 PMCID: PMC9843886 DOI: 10.1186/s12888-023-04533-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 01/06/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Schizophrenia (SCZ) is a severe and chronic psychiatric disorder with premature age-related physiological changes. However, numerous previous studies examined the epigenetic age acceleration in SCZ patients and yielded inconclusive results. In this study, we propose to explore the epigenetic age acceleration in drug-naive first-episode SCZ (FSCZ) patients and investigate whether epigenetic age acceleration is associated with antipsychotic treatment, psychotic symptoms, cognition, and subcortical volumes. METHODS We assessed the epigenetic age in 38 drug-naive FSCZ patients and 38 healthy controls by using three independent clocks, including Horvath, Hannum and Levine algorithms. The epigenetic age measurements in SCZ patients were repeated after receiving 8 weeks risperidone monotherapy. RESULTS Our findings showed significantly positive correlations between epigenetic ages assessed by three clocks and chronological age in both FSCZ patients and healthy controls. Compared with healthy controls, drug-naive FSCZ patients have a significant epigenetic age deceleration in Horvath clock (p = 0.01), but not in Hannum clock (p = 0.07) and Levine clock (p = 0.43). The epigenetic ages of Hannum clock (p = 0.002) and Levine clock (p = 0.01) were significantly accelerated in SCZ patients after 8-week risperidone treatment. However, no significant associations between epigenetic age acceleration and psychotic symptoms, cognitive function, as well as subcortical volumes were observed in FSCZ patients. CONCLUSION These results demonstrate that distinct epigenetic clocks are sensitive to different aspects of aging process. Further investigations with comprehensive epigenetic clock analyses and large samples are required to confirm our findings.
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Affiliation(s)
- Zongchang Li
- grid.216417.70000 0001 0379 7164Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital, Central South University, No 139 Renmin Road, Changsha, Hunan 410011 P. R. China ,grid.216417.70000 0001 0379 7164China National Technology Institute on Mental Disorders & Hunan Key Laboratory of Psychiatry and Mental Health, Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, P. R. China
| | - Xiaofen Zong
- grid.412632.00000 0004 1758 2270Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, P. R. China
| | - David Li
- grid.216417.70000 0001 0379 7164Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital, Central South University, No 139 Renmin Road, Changsha, Hunan 410011 P. R. China
| | - Ying He
- grid.216417.70000 0001 0379 7164Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital, Central South University, No 139 Renmin Road, Changsha, Hunan 410011 P. R. China ,grid.216417.70000 0001 0379 7164China National Technology Institute on Mental Disorders & Hunan Key Laboratory of Psychiatry and Mental Health, Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, P. R. China
| | - Jinsong Tang
- grid.13402.340000 0004 1759 700XDepartment of Psychiatry, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, P. R. China
| | - Maolin Hu
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, P. R. China.
| | - Xiaogang Chen
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital, Central South University, No 139 Renmin Road, Changsha, Hunan, 410011, P. R. China. .,China National Technology Institute on Mental Disorders & Hunan Key Laboratory of Psychiatry and Mental Health, Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, P. R. China.
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15
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Grant RK, Brindle WM, Donnelly MC, McConville PM, Stroud TG, Bandieri L, Plevris JN. Gastrointestinal and liver disease in patients with schizophrenia: A narrative review. World J Gastroenterol 2022; 28:5515-5529. [PMID: 36304087 PMCID: PMC9594005 DOI: 10.3748/wjg.v28.i38.5515] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/29/2022] [Accepted: 09/21/2022] [Indexed: 02/06/2023] Open
Abstract
Schizophrenia is a severe mental illness which can have a devastating impact on an individual's quality of life. Comorbidities are high amongst patients and life expectancy is approximately 15 years less than the general population. Despite the well-known increased mortality, little is known about the impact of gastrointestinal and liver disease on patients with schizophrenia. We aimed to review the literature and to make recommendations regarding future care. Literature searches were performed on PubMed to identify studies related to gastrointestinal and liver disease in patients with schizophrenia. High rates of chronic liver disease were reported, with Non-Alcoholic Fatty Liver Disease being of particular concern; antipsychotics and metabolic syndrome were contributing factors. Rates of acute liver failure were low but have been associated with antipsychotic use and paracetamol overdose. Coeliac disease has historically been linked to schizophrenia; however, recent research suggests that a causal link is yet to be proven. Evidence is emerging regarding the relationships between schizophrenia and peptic ulcer disease, inflammatory bowel disease and irritable bowel syndrome; clinical vigilance regarding these conditions should be high. Patients with schizophrenia poorly engage with bowel cancer screening programmes, leading to late diagnosis and increased mortality. Clozapine induced constipation is a significant issue for many patients and requires close monitoring. There is a significant burden of gastrointestinal and liver disease amongst patients with schizophrenia. Better levels of support from all members of the medical team are essential to ensure that appropriate, timely care is provided.
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Affiliation(s)
- Rebecca K Grant
- The Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, United Kingdom
| | - William M Brindle
- The Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, United Kingdom
| | - Mhairi C Donnelly
- The Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, United Kingdom
| | - Pauline M McConville
- General Adult Psychiatry, Royal Edinburgh Hospital, Edinburgh, EH10 5HF, United Kingdom
| | - Thomas G Stroud
- General Adult Psychiatry, Royal Edinburgh Hospital, Edinburgh, EH10 5HF, United Kingdom
| | - Lorenzo Bandieri
- General Adult Psychiatry, Royal Edinburgh Hospital, Edinburgh, EH10 5HF, United Kingdom
| | - John N Plevris
- The Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, United Kingdom
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Wright AE, Sheehan E, Qeadan F, Stalter L, Saeed AI. Preexisting psychological illness and its association with mortality in lung cancer patients with access to support resources. THE CLINICAL RESPIRATORY JOURNAL 2022; 16:750-755. [PMID: 36195278 PMCID: PMC9629994 DOI: 10.1111/crj.13547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 08/22/2022] [Accepted: 09/20/2022] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Diagnosis of lung cancer often results in tremendous stress for most patients, especially in patients with underlying psychological illness. Psychosocial support (consultation with psychologist, psychotherapist, or social worker) referral is considered standard for quality cancer care; however, which patients utilize these resources and how these resources affect patient outcomes remain unclear. OBJECTIVES We aimed to identify which newly diagnosed lung cancer patients accessed available psychosocial resources and assessed how utilization of these resources correlated with treatment and survival outcomes. METHODS Data were collected from National Cancer Institute-designated cancer center at the University of New Mexico. We analyzed lung cancer registry and mortality data at the cancer center and bronchoscopy suite data to retrospectively identify patients diagnosed with lung cancer between 2012 and 2017. We used a logistic regression model to compare psychological support utilization at the cancer center between patients with and without history of psychiatric illness. We used a Cox proportional hazards model to identify individual risk factors for mortality. RESULTS Patients with a previous psychological diagnosis were 2.4 times more likely (odds ratio = 2.443; confidence interval [CI], 1.130-5.284) to utilize psychological resources than patients without a pre-cancer psychological diagnosis. Patients who received psychosocial intervention had a 120.4% higher hazard of dying than those who did not (hazard ratio = 2.204; 95% CI, 1.240-3.917). One-year survival probability among those who did not utilize resources was 62.65% (95% CI, 55.24%-71.06%) and 43.0% (95% CI, 31.61%-58.50%) among those who did. Patients with a previous psychiatric diagnosis were more likely to utilize psychosocial resources within 1 year of lung cancer diagnosis. CONCLUSIONS Patients with previous psychiatric illness are more likely to utilize psychosocial resources at the cancer center after a new diagnosis of lung cancer. Patients who utilize psychosocial interventions have higher 1-year mortality than those who do not.
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Affiliation(s)
- Allison E. Wright
- Department of Internal MedicineUniversity of New MexicoAlbuquerqueNew MexicoUSA
| | - Elyce Sheehan
- Department of Internal Medicine, Division of Pulmonary Critical Care and Sleep MedicineUniversity of New MexicoAlbuquerqueNew MexicoUSA
| | - Fares Qeadan
- Parkinson School of Health Sciences and Public HealthLoyola University ChicagoMaywoodIllinoisUSA
| | - Lily Stalter
- Department of SurgeryUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Ali Imran Saeed
- Department of Internal Medicine, Division of Pulmonary Critical Care and Sleep MedicineUniversity of New MexicoAlbuquerqueNew MexicoUSA,Interventional Pulmonary and Advanced DiagnosticsDignity Health Norton Thoracic InstitutePhoenixArizonaUSA
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Data Quality of Automated Comorbidity Lists in Patients With Mental Health and Substance Use Disorders. Comput Inform Nurs 2022; 40:497-505. [PMID: 35234709 PMCID: PMC9262752 DOI: 10.1097/cin.0000000000000889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
EHRs provide an opportunity to conduct research on underrepresented oncology populations with mental health and substance use disorders. However, a lack of data quality may introduce unintended bias into EHR data. The objective of this article is describe our analysis of data quality within automated comorbidity lists commonly found in EHRs. Investigators conducted a retrospective chart review of 395 oncology patients from a safety-net integrated healthcare system. Statistical analysis included κ coefficients and a condition logistic regression. Subjects were racially and ethnically diverse and predominantly used Medicaid insurance. Weak κ coefficients ( κ = 0.2-0.39, P < .01) were noted for drug and alcohol use disorders indicating deficiencies in comorbidity documentation within the automated comorbidity list. Further, conditional logistic regression analyses revealed deficiencies in comorbidity documentation in patients with drug use disorders (odds ratio, 11.03; 95% confidence interval, 2.71-44.9; P = .01) and psychoses (odds ratio, 0.04; confidence interval, 0.02-0.10; P < .01). Findings suggest deficiencies in automatic comorbidity lists as compared with a review of provider narrative notes when identifying comorbidities. As healthcare systems increasingly use EHR data in clinical studies and decision making, the quality of healthcare delivery and clinical research may be affected by discrepancies in the documentation of comorbidities.
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Correll CU, Solmi M, Croatto G, Schneider LK, Rohani-Montez SC, Fairley L, Smith N, Bitter I, Gorwood P, Taipale H, Tiihonen J. Mortality in people with schizophrenia: a systematic review and meta-analysis of relative risk and aggravating or attenuating factors. World Psychiatry 2022; 21:248-271. [PMID: 35524619 PMCID: PMC9077617 DOI: 10.1002/wps.20994] [Citation(s) in RCA: 330] [Impact Index Per Article: 110.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
People with schizophrenia die 15-20 years prematurely. Understanding mortality risk and aggravating/attenuating factors is essential to reduce this gap. We conducted a systematic review and random-effects meta-analysis of prospective and retrospective, nationwide and targeted cohort studies assessing mortality risk in people with schizophrenia versus the general population or groups matched for physical comorbidities or groups with different psychiatric disorders, also assessing moderators. Primary outcome was all-cause mortality risk ratio (RR); key secondary outcomes were mortality due to suicide and natural causes. Other secondary outcomes included any other specific-cause mortality. Publication bias, subgroup and meta-regression analyses, and quality assessment (Newcastle-Ottawa Scale) were conducted. Across 135 studies spanning from 1957 to 2021 (schizophrenia: N=4,536,447; general population controls: N=1,115,600,059; other psychiatric illness controls: N=3,827,955), all-cause mortality was increased in people with schizophrenia versus any non-schizophrenia control group (RR=2.52, 95% CI: 2.38-2.68, n=79), with the largest risk in first-episode (RR=7.43, 95% CI: 4.02-13.75, n=2) and incident (i.e., earlier-phase) schizophrenia (RR=3.52, 95% CI: 3.09-4.00, n=7) versus the general population. Specific-cause mortality was highest for suicide or injury-poisoning or undetermined non-natural cause (RR=9.76-8.42), followed by pneumonia among natural causes (RR=7.00, 95% CI: 6.79-7.23), decreasing through infectious or endocrine or respiratory or urogenital or diabetes causes (RR=3 to 4), to alcohol or gastrointestinal or renal or nervous system or cardio-cerebrovascular or all natural causes (RR=2 to 3), and liver or cerebrovascular, or breast or colon or pancreas or any cancer causes (RR=1.33 to 1.96). All-cause mortality increased slightly but significantly with median study year (beta=0.0009, 95% CI: 0.001-0.02, p=0.02). Individuals with schizophrenia <40 years of age had increased all-cause and suicide-related mortality compared to those ≥40 years old, and a higher percentage of females increased suicide-related mortality risk in incident schizophrenia samples. All-cause mortality was higher in incident than prevalent schizophrenia (RR=3.52 vs. 2.86, p=0.009). Comorbid substance use disorder increased all-cause mortality (RR=1.62, 95% CI: 1.47-1.80, n=3). Antipsychotics were protective against all-cause mortality versus no antipsychotic use (RR=0.71, 95% CI: 0.59-0.84, n=11), with largest effects for second-generation long-acting injectable anti-psychotics (SGA-LAIs) (RR=0.39, 95% CI: 0.27-0.56, n=3), clozapine (RR=0.43, 95% CI: 0.34-0.55, n=3), any LAI (RR=0.47, 95% CI: 0.39-0.58, n=2), and any SGA (RR=0.53, 95% CI: 0.44-0.63, n=4). Antipsychotics were also protective against natural cause-related mortality, yet first-generation antipsychotics (FGAs) were associated with increased mortality due to suicide and natural cause in incident schizophrenia. Higher study quality and number of variables used to adjust the analyses moderated larger natural-cause mortality risk, and more recent study year moderated larger protective effects of antipsychotics. These results indicate that the excess mortality in schizophrenia is associated with several modifiable factors. Targeting comorbid substance abuse, long-term maintenance antipsychotic treatment and appropriate/earlier use of SGA-LAIs and clozapine could reduce this mortality gap.
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Affiliation(s)
- Christoph U Correll
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- Department of Mental Health, Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Giovanni Croatto
- Mental Health Department, AULSS 3 Serenissima, Mestre, Venice, Italy
| | | | | | | | | | - István Bitter
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Philip Gorwood
- INSERM U1266, Institute of Psychiatry and Neurosciences of Paris (IPNP), Paris, France
- GHU Paris Psychiatrie et Neurosciences (CMME, Sainte-Anne Hospital), Université de Paris, Paris, France
| | - Heidi Taipale
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Jari Tiihonen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
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19
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Ali DH, Shorab E, Hassan GA, elRasheed AH, Soltan MAR, Elrassas H. Long-term observations on the mortality of mentally ill patients admitted to a short-stay psychiatric hospital: 23 years retrospective Egyptian study. MIDDLE EAST CURRENT PSYCHIATRY 2021. [DOI: 10.1186/s43045-021-00160-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Information about mortality patterns in different psychiatric populations is scanty, yet it is vital for designing successful preventive mental health strategies. In this study, we aimed to assess mortality rates and patterns for the patients admitted to Ain Shams University Institute of Psychiatry (ASUIP) with different psychiatric diagnoses from1990 to 2013. All medical records and related registration files were reviewed and investigated for death cases and their possible causes in a retrospective record linkage study. Data were recorded, tabulated, and coded to be used in the Statistical Package for Social Sciences (SPSS) Version 17.
Results
The study identified 57 death cases in 23-years duration with a mortality rate of 3/1000. Mortality rates were more in younger patients and females. Medical comorbidity was reported in 34.8% of them. The most common known causes for death in the current sample were cardiac causes 15.2%, followed by cerebrovascular causes that were 10.9%. However, sudden or unknown causes were the most frequent diagnosis in the sample.
Conclusions
The institute mortality rates were lower than those of the general population during this period. The most common known death causes were cardiovascular problems, which mandates close monitoring of high-risk psychiatric patients with co-morbid cardiac problems. Unknown morality causes represented an unresolved challenge for the current registration system and the quality of care given to patients with serious mental illness.
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20
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Sullivan EDK, Locke LN, Wallin DJ, Khokhar JY, Bragg EM, Henricks AM, Doucette WT. The Impact of Adolescent Alcohol Exposure on Nicotine Behavioral Sensitization in the Adult Male Neonatal Ventral Hippocampal Lesion Rat. Front Behav Neurosci 2021; 15:760791. [PMID: 34858148 PMCID: PMC8632551 DOI: 10.3389/fnbeh.2021.760791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Abstract
Nicotine and alcohol use is highly prevalent among patients with serious mental illness, including those with schizophrenia (SCZ), and this co-occurrence can lead to a worsening of medical and psychiatric morbidity. While the mechanistic drivers of co-occurring SCZ, nicotine use and alcohol use are unknown, emerging evidence suggests that the use of drugs during adolescence may increase the probability of developing psychiatric disorders. The current study used the neonatal ventral hippocampal lesion (NVHL) rat model of SCZ, which has previously been shown to have enhanced nicotine behavioral sensitization and, following adolescent alcohol, increased alcohol consumption. Given how commonly alcohol is used by adolescents that develop SCZ, we used the NVHL rat to determine how exposure to adolescent alcohol impacts the development of nicotine behavioral sensitization in adulthood. Male Sprague-Dawley rats underwent the NVHL surgery or a sham (control) surgery and subsequently, half of each group was allowed to drink alcohol during adolescence. Nicotine behavioral sensitization was assessed in adulthood with rats receiving subcutaneous injections of nicotine (0.5 mg/kg) each day for 3 weeks followed by a nicotine challenge session 2 weeks later. We demonstrate that all groups of rats became sensitized to nicotine and there were no NVHL-specific increases in nicotine behavioral sensitization. We also found that NVHL rats appeared to develop sensitization to the nicotine paired context and that adolescent alcohol exposure blocked this context sensitization. The current findings suggest that exposure to alcohol during adolescence can influence behaviors that manifest in the adult NVHL rat (i.e., context sensitization). Interestingly, nicotine behavioral sensitization levels were not altered in the NVHL groups regardless of adolescent alcohol exposure in contrast to prior reports.
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Affiliation(s)
- Emily D K Sullivan
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States.,Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Liam N Locke
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, United States
| | - Diana J Wallin
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States.,Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Jibran Y Khokhar
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States.,Department of Biomedical Sciences, University of Guelph, Guelph, ON, Canada
| | - Elise M Bragg
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Angela M Henricks
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States.,Department of Psychology, Washington State University, Pullman, WA, United States
| | - Wilder T Doucette
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States.,Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
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21
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Leahy D, Donnelly A, Irwin K, D'Alton P. Barriers and facilitators to accessing cancer care for people with significant mental health difficulties: A qualitative review and narrative synthesis. Psychooncology 2021; 30:2012-2022. [PMID: 34747534 DOI: 10.1002/pon.5848] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/22/2021] [Accepted: 10/26/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Inequities in cancer care contribute to higher rates of cancer mortality for individuals with significant mental health difficulties (SMHD) compared to the general population. The aim of the current systematic review was to identify, appraise and synthesise qualitative evidence of patient and clinician/system barriers and facilitators to cancer screening and treatment for individuals with SMHD. METHODS We conducted a systematic search across three electronic databases in May 2020 and we carried out a second search across five electronic databases in January 2021. A narrative synthesis was conducted across eligible studies. RESULTS We identified the same six studies from both searches, with 133 individuals with SMHD and experiences of cancer care and 102 healthcare professionals. Key barriers to cancer care were related to patients' uncontrolled psychiatric symptoms and the adverse impact of their symptoms on engaging with cancer care; clinician barrier-attitudes included stigmatising attitudes from clinicians and other staff towards individuals with SMHD and systems barrier-fragmentation included the fragmentation of mental health and cancer care delivery. Key patient facilitators to accessing cancer care and completing cancer treatment included being connected with mental health services and controlled psychiatric symptoms. Stronger collaboration among healthcare professionals working across different sectors in addition to the development of a patient navigator role were identified as key facilitators to enhance patient care. CONCLUSIONS Innovative approaches are needed to decrease mental health stigma, foster collaboration across disciplines, and facilitate the integration of timely mental health and cancer care for individuals with SMHD to address the mortality gap.
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Affiliation(s)
- Dorothy Leahy
- Doctoral Programme in Clinical Psychology, School of Psychology, University College Dublin, Dublin, Ireland
| | - Alanna Donnelly
- Doctoral Programme in Clinical Psychology, School of Psychology, University College Dublin, Dublin, Ireland
| | - Kelly Irwin
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Paul D'Alton
- Doctoral Programme in Clinical Psychology, School of Psychology, University College Dublin, Dublin, Ireland
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22
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New D2R partial agonist candidates: an in silico approach from statistical models, molecular docking, and ADME/Tox properties. Struct Chem 2021. [DOI: 10.1007/s11224-021-01742-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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23
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Grassi L, Stivanello E, Belvederi Murri M, Perlangeli V, Pandolfi P, Carnevali F, Caruso R, Saponaro A, Ferri M, Sanza M, Fioritti A, Meggiolaro E, Ruffilli F, Nanni MG, Ferrara M, Carozza P, Zerbinati L, Toffanin T, Menchetti M, Berardi D. Mortality from cancer in people with severe mental disorders in Emilia Romagna Region, Italy. Psychooncology 2021; 30:2039-2051. [PMID: 34499790 PMCID: PMC9290959 DOI: 10.1002/pon.5805] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/17/2021] [Accepted: 08/20/2021] [Indexed: 11/11/2022]
Abstract
Objective To examine cancer‐related mortality in patients with severe mental disorders (SMI) in the Emilia Romagna (ER) Region, Northern Italy, during the period 2008–2017 and compare it with the regional population. Methods We used the ER Regional Mental Health Registry identifying all patients aged ≥18 years who had received an ICD‐9CM system diagnosis of SMI (i.e., schizophrenia or other functional psychosis, mania, or bipolar affective disorders) during a 10‐year period (2008–2017). Information on deaths (date and causes of death) were retrieved through the Regional Cause of Death Registry. Comparisons were made with the deaths and cause of deaths of the regional population over the same period. Results Amongst 12,385 patients suffering from SMI (64.1% schizophrenia spectrum and 36.9% bipolar spectrum disorders), 24% (range 21%–29%) died of cancer. In comparison with the general regional population, the mortality for cancer was about 50% higher among patients with SMI, irrespective if affected by schizophrenia or bipolar disorders. As for the site‐specific cancers, significant excesses were reported for stomach, central nervous system, respiratory, and pancreas cancer with a variability according to psychiatric diagnosis and gender. Conclusions Patients suffering from SMI had higher mortality risk than the regional population with some differences according to cancer type, gender, and psychiatric diagnosis. Proper cancer preventive and treatment interventions, including more effective risk modification strategies (e.g., smoking cessation, dietary habits) and screening for cancer, should be part of the agenda of all mental health departments in conjunction with other health care organizations, including psycho‐oncology.
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Affiliation(s)
- Luigi Grassi
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Elisa Stivanello
- Department of Public Health, Local Health Trust of Bologna, Bologna, Italy
| | - Martino Belvederi Murri
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | | | - Paolo Pandolfi
- Department of Public Health, Local Health Trust of Bologna, Bologna, Italy
| | - Fabio Carnevali
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Rosangela Caruso
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Alessio Saponaro
- General Directorate of Health and Social Policies, Bologna, Italy
| | - Mila Ferri
- General Directorate of Health and Social Policies, Bologna, Italy
| | - Michele Sanza
- Department of Mental Health and Substance Abuse, Local Health Trust of Romagna, Cesena, Italy
| | - Angelo Fioritti
- Department of Mental Health and Substance Abuse, Local Health Trust of Bologna, Bologna, Italy
| | - Elena Meggiolaro
- Psycho-Oncology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Federica Ruffilli
- Psycho-Oncology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Maria Giulia Nanni
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Maria Ferrara
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy.,Department of Psychiatry, Yale University, School of Medicine, New Haven, Connecticut, USA.,Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, New Haven, Connecticut, USA
| | - Paola Carozza
- Integrated Department of Mental Health and Pathological Addictions, Local Health Trust of Ferrara, Ferrara, Italy
| | - Luigi Zerbinati
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Tommaso Toffanin
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Marco Menchetti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Domenico Berardi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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24
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Moreno-Küstner B, Guzman-Parra J, Pardo Y, Sanchidrián Y, Díaz-Ruiz S, Mayoral-Cleries F. Excess mortality in patients with schizophrenia spectrum disorders in Malaga (Spain): A cohort study. Epidemiol Psychiatr Sci 2021; 30:e11. [PMID: 33536113 PMCID: PMC8057505 DOI: 10.1017/s2045796020001146] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 12/01/2020] [Accepted: 12/08/2020] [Indexed: 11/07/2022] Open
Abstract
AIMS There is evidence that patients with schizophrenia spectrum disorders present higher mortality in comparison with the general population. The aim of this study was to analyse the causes of mortality and sociodemographic factors associated with mortality, standardised mortality ratios (SMRs), life expectancy and potential years of life lost (YLL) in patients with schizophrenia spectrum disorders in Spain. METHODS The study included a cohort of patients from the Malaga Schizophrenia Case Register (1418 patients; 907 males; average age 42.31 years) who were followed up for a minimum of 10 years (median = 13.43). The factors associated with mortality were analysed with a survival analysis using Cox's proportional hazards regression model. RESULTS The main causes of mortality in the cohort were circulatory disease (21.45%), cancer (17.09%) and suicide (13.09%). The SMR of the cohort was more than threefold that of the population of Malaga (3.19). The life expectancy at birth was 67.11 years old, which is more than 13 years shorter than that of the population of Malaga. The YLL was 20.74. The variables associated with a higher risk of mortality were age [adjusted hazard ratio (AHR) = 1.069, p < 0.001], male gender (AHR = 1.751, p < 0.001) and type of area of residence (p = 0.028; deprived urban zone v. non-deprived urban area, AHR = 1.460, p = 0.028). In addition, receiving welfare benefit status in comparison with employed status (AHR = 1.940, p = 0.008) was associated with increased mortality. CONCLUSIONS There is excess mortality in patients with schizophrenia spectrum disorders and also an association with age, gender, socioeconomic inequalities and receiving welfare benefits. Efforts directed towards improved living conditions could have a positive effect on reducing mortality.
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Affiliation(s)
- Berta Moreno-Küstner
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Grupo GAP, Facultad de Psicología, Universidad de Málaga, Spain
| | - Jose Guzman-Parra
- Department of Mental Health, University General Hospital of Malaga. Biomedical Research Institute of Malaga (IBIMA), Spain
| | - Yolanda Pardo
- Department of Mental Health, University General Hospital of Malaga. Biomedical Research Institute of Malaga (IBIMA), Spain
| | - Yolanda Sanchidrián
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Grupo GAP, Facultad de Psicología, Universidad de Málaga, Spain
| | | | - Fermin Mayoral-Cleries
- Department of Mental Health, University General Hospital of Malaga. Biomedical Research Institute of Malaga (IBIMA), Spain
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25
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Association between preexisting mental illnesses and mortality among medicaid-insured women diagnosed with breast cancer. Soc Sci Med 2021; 270:113643. [PMID: 33387965 PMCID: PMC9989878 DOI: 10.1016/j.socscimed.2020.113643] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/19/2020] [Accepted: 12/19/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND We investigated the impact of preexisting mental illnesses on all-cause and cause-specific mortality among Medicaid-insured women diagnosed with breast cancer. METHODS Data from the New York State Cancer Registry for 10,444 women diagnosed with breast cancer from 2004 to 2016 and aged <65 years at diagnosis were linked with Medicaid claims. Women were categorized as having depression or a severe mental illness (SMI) if they had at least three relevant diagnosis claims with at least one claim within three years prior to breast cancer diagnosis. SMI included schizophrenia, bipolar disorder, and other psychotic disorders. Estimated menopausal status was determined by age (premenopausal age <50; postmenopausal age ≥50). Hazard ratios (HR) and 95% confidence intervals (95%CI) were calculated with Cox proportional hazards regression, adjusting for potential confounders. RESULTS Preexisting SMI was associated with greater all-cause (HR = 1.36; 95%CI 1.18, 1.57) and cancer-specific (HR = 1.21; 95%CI 1.03, 1.44) mortality compared to those with no mental illnesses. No association was observed between preexisting depression and mortality. Among racial/ethnic subgroups, the association between SMI and all-cause mortality was observed among non-Hispanic white (HR = 1.47; 95%CI 1.19, 1.83) and non-Hispanic Asian/Pacific Islander (HR = 2.59; 95% 1.15, 5.87) women. Additionally, mortality hazards were greatest among women with preexisting SMI that were postmenopausal (HR = 1.49; 95%CI 1.25, 1.78), obese (HR = 1.58; 95%CI 1.26, 1.98), and had documented tobacco use (HR = 1.42; 95%CI 1.13, 1.78). CONCLUSION Women with preexisting SMI prior to breast cancer diagnosis have an elevated mortality hazard and should be monitored and treated by a coordinated cross-functional clinical team.
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26
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Berchuck JE, Meyer CS, Zhang N, Berchuck CM, Trivedi NN, Cohen B, Wang S. Association of Mental Health Treatment With Outcomes for US Veterans Diagnosed With Non-Small Cell Lung Cancer. JAMA Oncol 2021; 6:1055-1062. [PMID: 32496507 DOI: 10.1001/jamaoncol.2020.1466] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Importance Preexisting mental health disorders (MHDs) are associated with increased mortality in people diagnosed with cancer, yet few data exist on the efficacy of interventions to mitigate this disparity. Objective To evaluate the association of participation in mental health treatment programs (MHTPs), housing support programs, or employment support programs with stage at cancer diagnosis, receipt of stage-appropriate treatment, and mortality among patients with a preexisting MHD. Design, Setting, and Participants This retrospective, population-based cohort study included 55 315 veterans in the Veterans Affairs Central Cancer Registry (VACCR) who had newly diagnosed non-small cell lung cancer (NSCLC) from September 30, 2000, to December 31, 2011. Data were analyzed from January 15, 2017, to March 17, 2020. Exposures Mental health disorders, including schizophrenia, bipolar disorder, depressive disorder, posttraumatic stress disorder, and substance use disorder. Main Outcomes and Measures Stage at cancer diagnosis, receipt of stage-appropriate cancer treatment, all-cause mortality, and lung cancer-specific mortality. Results Of 55 315 veterans with a new diagnosis of NSCLC included in the analysis (98.1% men; mean [SD] age, 68.1 [9.8] years), 18 229 had a preexisting MHD, among whom participation in MHTPs was associated with a lower likelihood of being diagnosed in a late stage (odds ratio [OR], 0.62; 95% CI, 0.58-0.66; P < .001), a higher likelihood of receiving stage-appropriate treatment (OR, 1.55; 95% CI, 1.26-1.89; P < .001), lower all-cause mortality (adjusted hazard ratio [AHR], 0.74; 95% CI, 0.72-0.77; P < .001), and lower lung cancer-specific mortality (AHR, 0.77; 95% CI, 0.74-0.80; P < .001). Likewise, participation in housing and employment support programs was associated with similar improvements in all outcomes described above. Conclusions and Relevance In veterans with preexisting MHDs diagnosed with NSCLC, participation in MHTPs and housing and employment support programs was associated with improved lung cancer-related outcomes. This study might be the first to demonstrate significant improvement in cancer mortality for patients with MHDs who participate in MHTPs, housing support programs, or employment support programs. This work supports substantial literature that investment in mental health and social needs can improve health outcomes and highlights the importance of further research to identify, evaluate, and implement interventions to improve outcomes for patients with MHDs who are diagnosed with cancer.
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Affiliation(s)
- Jacob E Berchuck
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Craig S Meyer
- Department of Medicine, School of Medicine, University of California, San Francisco
| | - Ning Zhang
- Department of Medicine, School of Medicine, University of California, San Francisco
| | | | - Neil N Trivedi
- Division of Pulmonary/Critical Care Medicine, San Francisco Veterans Affairs Medical Center and University of California, San Francisco
| | - Beth Cohen
- Department of Medicine, School of Medicine, University of California, San Francisco.,Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Sunny Wang
- Department of Medicine, School of Medicine, University of California, San Francisco.,Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California.,Division of Hematology/Oncology, San Francisco Veterans Affairs Medical Center, San Francisco, California
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Kertes J, Stein Reisner O, Grunhaus L, Neumark Y. The Impact of Smoking Cessation on Hospitalization and Psychiatric Medication Utilization among People with Serious Mental Illness. Subst Use Misuse 2021; 56:1543-1550. [PMID: 34193007 DOI: 10.1080/10826084.2021.1942057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Despite the high prevalence of smoking amongst people with serious mental illness (SMI), referral rates to smoking cessation programs (SCPs) are low. Mental health workers reticence to refer to SCPs has been attributed, in part, to their belief that quitting will have a deleterious effect on their patients' mental health status. Objectives: This study's objective was to determine if participating in a smoking cessation program had an adverse effect on mental health status among people with SMI, measured here by a change in hospitalization occurrence or psychiatric medication utilization. People with SMI who had participated in at least one SCP session in a large health maintenance organization (n = 403) were compared to an age-gender-diagnosis matched sample of SMI smokers (1,209) who had never participated. Results: No change in psychiatric hospitalization occurrence pre- versus post-SCP participation was found among participants (Pre:7.2% vs. Post:5.2, p = 0.2) or nonparticipants (Pre:7.0% vs. Post:6.0%, p = 0.2). Mean defined daily dose (DDD) for anti-psychotic, mood stabilizer, anti-depressant and anxiolytic medications also did not change over time for participants and nonparticipants. However, participants who did not complete the SCP and didn't quit had a 0.35 higher mean DDD for anti-psychotic medications compared with participants who had completed the SCP or quit, and with nonparticipants (p = 0.006), and were the only group to exhibit an increase in mean antipsychotic DDD over time (Pre:1.42, Post:1.63). SCP participation was not associated with hospitalization occurrence or psychiatric medication utilization. Conclusions/Importance: Smoking cessation should be encouraged, with close monitoring during the quit process.
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Affiliation(s)
- Jennifer Kertes
- Department of Health Evaluation & Research, Maccabi HealthCare, Jerusalem, Israel
| | | | - Leon Grunhaus
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yehuda Neumark
- Braun Hebrew University-Hadassah School of Public Health & Community Medicine, Jerusalem, Israel
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Mahar AL, Kurdyak P, Hanna TP, Coburn NG, Groome PA. The effect of a severe psychiatric illness on colorectal cancer treatment and survival: A population-based retrospective cohort study. PLoS One 2020; 15:e0235409. [PMID: 32726314 PMCID: PMC7390537 DOI: 10.1371/journal.pone.0235409] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 06/15/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To identify inequalities in cancer survival rates for patients with a history of severe psychiatric illness (SPI) compared to those with no history of mental illness and explore differences in the provision of recommended cancer treatment as a potential explanation. DESIGN Population-based retrospective cohort study using linked cancer registry and administrative data at ICES. SETTING The universal healthcare system in Ontario, Canada. PARTICIPANTS Colorectal cancer (CRC) patients diagnosed between April 1st, 2007 and December 31st, 2012. SPI history (schizophrenia, schizoaffective disorders, other psychotic disorders, bipolar disorders or major depressive disorders) was determined using hospitalization, emergency department, and psychiatrist visit data and categorized as 'no history of mental illness, 'outpatient SPI history', and 'inpatient SPI history'. MAIN OUTCOME MEASURES Cancer-specific survival, non-receipt of surgical resection, and non-receipt of adjuvant chemotherapy or radiation. RESULTS 24,507 CRC patients were included; 482 (2.0%) had an outpatient SPI history and 258 (1.0%) had an inpatient SPI history. Individuals with an SPI history had significantly lower survival rates and were significantly less likely to receive guideline recommended treatment than CRC patients with no history of mental illness. The adjusted HR for cancer-specific death was 1.69 times higher for individuals with an inpatient SPI (95% CI 1.36-2.09) and 1.24 times higher for individuals with an outpatient SPI history (95% CI 1.04-1.48). Stage II and III CRC patients with an inpatient SPI history were 2.15 times less likely (95% CI 1.07-4.33) to receive potentially curative surgical resection and 2.07 times less likely (95% CI 1.72-2.50) to receive adjuvant radiation or chemotherapy. These findings were consistent across multiple sensitivity analyses. CONCLUSIONS Individuals with an SPI history experience inequalities in colorectal cancer care and survival within a universal healthcare system. Increasing advocacy and the availability of resources to support individuals with an SPI within the cancer system are warranted to reduce the potential for unnecessary harm.
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Affiliation(s)
- Alyson L. Mahar
- Department of Community Health Sciences, Manitoba Centre for Health Policy University of Manitoba, Winnipeg, Manitoba, Canada
- ICES, Toronto, Ontario, Canada
| | - Paul Kurdyak
- ICES, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Timothy P. Hanna
- ICES, Toronto, Ontario, Canada
- Division of Cancer Care and Epidemiology, Department of Oncology, Queen’s University, Kingston, Ontario, Canada
| | - Natalie G. Coburn
- ICES, Toronto, Ontario, Canada
- Department of Surgery, Division of General Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Patti A. Groome
- ICES, Toronto, Ontario, Canada
- Division of Cancer Care and Epidemiology, Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
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End-of-life care among patients with schizophrenia and cancer: a population-based cohort study from the French national hospital database. LANCET PUBLIC HEALTH 2020; 4:e583-e591. [PMID: 31677777 DOI: 10.1016/s2468-2667(19)30187-2] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 09/02/2019] [Accepted: 09/09/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Patients with schizophrenia represent a vulnerable, underserved, and undertreated population who have been neglected in health disparities work. Understanding of end-of-life care in patients with schizophrenia and cancer is poor. We aimed to establish whether end-of-life care delivered to patients with schizophrenia and cancer differed from that delivered to patients with cancer who do not have diagnosed mental illness. METHODS We did a population-based cohort study of all patients older than 15 years who had a diagnosis of advanced cancer and who died in hospital in France between Jan 1, 2013, and Dec 31, 2016. We divided this population into cases (ie, patients with schizophrenia) and controls (ie, patients without a diagnosis of mental illness) and compared access to palliative care and indicators of high-intensity end-of-life care between groups. In addition to unmatched analyses, we also did matched analyses (matched in terms of age at death, sex, and site of primary cancer) between patients with schizophrenia and matched controls (1:4). Multivariable generalised linear models were done with adjustment for social deprivation, year of death, time from cancer diagnosis to death, metastases, comorbidity, and hospital type (ie, specialist cancer centre vs non-specialist centre). FINDINGS The main analysis included 2481 patients with schizophrenia and 222 477 controls. The matched analyses included 2477 patients with schizophrenia and 9896 controls. Patients with schizophrenia were more likely to receive palliative care in the last 31 days of life (adjusted odds ratio 1·61 [95% CI 1·45-1·80]; p<0·0001) and less likely to receive high-intensity end-of-life care-such as chemotherapy and surgery-than were matched controls without a diagnosis of mental illness. Patients with schizophrenia were also more likely to die younger, had a shorter duration between cancer diagnosis and death, and were more likely to have thoracic cancers and comorbidities than were controls. INTERPRETATION Our findings suggest the existence of disparities in health and health care between patients with schizophrenia and patients without a diagnosis of mental illness. These findings underscore the need for better understanding of health inequalities so that effective interventions can be developed for this vulnerable population. FUNDING Assistance Publique des Hôpitaux de Marseille and Aix-Marseille University.
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Weinstein L, LaNoue M, Hurley K, Payton C, Sifri R, Myers R. Feasibility Pilot Outcomes of a Mammography Decision Support and Navigation Intervention for Women With Serious Mental Illness Living in Supportive Housing Settings. J Prim Care Community Health 2020; 10:2150132719867587. [PMID: 31416398 PMCID: PMC6698985 DOI: 10.1177/2150132719867587] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective: People with serious mental illness (SMI) experience
significant disparities in morbidity and mortality from preventable and
treatable medical conditions. Women with SMI have low mammography screening
rates. SMI, poverty, and poor access to care can have a significant effect on a
woman’s opportunity to learn about and discuss breast cancer screening with
health care providers. This study examines the feasibility pilot outcomes of
mammography decision support and patient navigation intervention (DSNI) for
women with SMI living in supportive housing settings. The primary research
question was: Does the DSNI increase knowledge, promote favorable attitudes, and
decrease decisional conflict relating to screening mammography?
Methods: We developed the intervention with the community using
participatory methods. Women (n = 21) with SMI who had not undergone screening
mammography in the past year participated in an educational module and decision
counseling session and received patient navigation over a 6-month period. We
conducted surveys and interviews at baseline and follow-ups to assess
mammography decisional conflict. Results: Among study participants,
67% received a mammogram. The mammogram DSNI was feasible and acceptable to
women with SMI living in supportive housing settings. From baseline to 1-month
follow-up, decisional conflict decreased significantly (P =
.01). The patient navigation process resulted in 270 attempted contacts
(M = 12.86, SD = 10.61) by study staff (phone calls and
emails with patient and/or case manager) and 165 navigation conversations
(M = 7.86, SD = 4.84). A barrier to navigation was phone
communication, with in-person navigation being more successful. Participants
reported they found the intervention helpful and made suggestions for further
improvement. Conclusions: The process and outcomes evaluation
support the feasibility and acceptability of the mammography DSNI. This project
provides initial evidence that an intervention developed with participatory
methods can improve cancer screening outcomes in supportive housing programs for
people with SMI.
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Affiliation(s)
| | | | | | | | - Randa Sifri
- 2 Sidney Kimmel Medical College, Philadelphia, PA, USA
| | - Ronald Myers
- 1 Thomas Jefferson University, Philadelphia, PA, USA
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Caponnetto P, Polosa R, Robson D, Bauld L. Tobacco smoking, related harm and motivation to quit smoking in people with schizophrenia spectrum disorders. Health Psychol Res 2020; 8:9042. [PMID: 32510003 PMCID: PMC7267811 DOI: 10.4081/hpr.2020.9042] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 05/20/2020] [Indexed: 02/06/2023] Open
Abstract
This narrative review focuses on the topic of tobacco smoking amongst people with schizophrenia spectrum disorders. We searched PubMed, PsycInfo and Scopus databases for schizophrenia spectrum disorders and smoking and included articles about the epidemiology of tobacco smoking in people with schizophrenia spectrum disorders, examining the relationship between smoking and mental health. This narrative review describes that a higher prevalence, frequency and impact of both high nicotine dependence and its harmful effects in patients with schizophrenia spectrum disorders compared with those in the general population. Despite several existent theories, the reasons for high smoking rates, the high dependence on nicotine and severity of nicotine withdrawal symptoms are not fully understood. The main aim of this paper is to inform mental health personnel and particularly clinical and health psychologists about the impact and role of tobacco smoking for smokers with schizophrenia spectrum disorders.
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Affiliation(s)
| | | | | | - Linda Bauld
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
- UK Centre for Tobacco & Alcohol Studies, Nottingham, UK
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Takehara T, Tani T, Takiue H, Takeshita R, Iwamaru A, Yamamoto T, Koh H. Outcome of patients with lung cancer and severe psychiatric disorder admitted to a medical psychiatric unit. Mol Clin Oncol 2020; 12:273-277. [PMID: 32064106 DOI: 10.3892/mco.2020.1974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 09/19/2019] [Indexed: 12/25/2022] Open
Abstract
The purpose of the present study was to evaluate the clinical profiles and treatment outcomes of patients with lung cancer admitted to the Medical Psychiatric Unit (MPU), which is built for patients with physical and severe psychiatric disorders. All medical records of patients with lung cancer admitted to the MPU of Tachikawa hospital were reviewed. The clinical outcomes of these patients were retrospectively evaluated between January 2010 and December 2016. A total of 24 patients in the MPU were histologically or cytologically diagnosed with primary lung cancer. Of these, 20 patients had schizophrenia, and 4 patients had a mood disorder. There were 15 patients who were diagnosed using bronchoscopy. The histology indicated adenocarcinoma, squamous cell carcinoma and non-small-cell lung cancer-not otherwise specified were in 11, 8, and 1 patient, respectively, while small-cell lung cancer was indicated in 4 patients. Surgery, chemoradiotherapy, radiotherapy, chemotherapy was performed in 13, 4, 2, 1 and 4 patients, respectively. The median survival time was 76.7 months for patients who underwent surgery, while it was 14.4 months for those who underwent chemoradiotherapy. In the MPU, patients with lung cancer and severe psychiatric disorders could be safely diagnosed, and patients with early-stage lung cancer exhibited long-term survival.
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Affiliation(s)
- Tomohiro Takehara
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo 190-8531, Japan.,Division of Pulmonary Medicine, Department of Internal Medicine, Federation of National Public Service Personnel Mutual Aid Associations, Tachikawa Hospital, Tokyo 190-8531, Japan
| | - Tetsuo Tani
- Division of Pulmonary Medicine, Department of Internal Medicine, Federation of National Public Service Personnel Mutual Aid Associations, Tachikawa Hospital, Tokyo 190-8531, Japan
| | - Hiroyuki Takiue
- Department of Neuropsychiatry, Federation of National Public Service Personnel Mutual Aid Associations, Tachikawa Hospital, Tokyo 190-8531, Japan
| | - Ryo Takeshita
- Division of Pulmonary Medicine, Department of Internal Medicine, Federation of National Public Service Personnel Mutual Aid Associations, Tachikawa Hospital, Tokyo 190-8531, Japan
| | - Arifumi Iwamaru
- Department of Surgery, Federation of National Public Service Personnel Mutual Aid Associations, Tachikawa Hospital, Tokyo 190-8531, Japan
| | - Tatsuya Yamamoto
- Department of Surgery, Federation of National Public Service Personnel Mutual Aid Associations, Tachikawa Hospital, Tokyo 190-8531, Japan
| | - Hidefumi Koh
- Division of Pulmonary Medicine, Department of Internal Medicine, Federation of National Public Service Personnel Mutual Aid Associations, Tachikawa Hospital, Tokyo 190-8531, Japan
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Hwong AR, Irwin KE. Reducing global disparities in cancer screening for people with mental illness. Lancet Psychiatry 2020; 7:4-6. [PMID: 31787584 PMCID: PMC7319861 DOI: 10.1016/s2215-0366(19)30470-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 11/14/2019] [Accepted: 11/18/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Alison R Hwong
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Kelly E Irwin
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA.
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Current state and future perspective of drug repurposing in malignant glioma. Semin Cancer Biol 2019; 68:92-104. [PMID: 31734137 DOI: 10.1016/j.semcancer.2019.10.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/25/2019] [Accepted: 10/28/2019] [Indexed: 01/10/2023]
Abstract
Malignant gliomas are still extremely difficult to treat because complete surgical resection is biologically not feasible due to the invasive nature of these diseases and the proximity of tumors to functionally sensitive areas. Moreover, adjuvant therapies are facing a strong therapeutic resistance since the central nervous system is a highly protected environment and the tumor cells display a vast intra-tumoral genetic and epigenetic variation. As a consequence, new therapeutics are urgently needed but the process of developing novel compounds that finally reach clinical application is highly time-consuming and expensive. Drug repurposing is an approach to facilitate and accelerate the discovery of new cancer treatments. In malignant glioma, like in other cancers, pre-existing physiological pathways that regulate cell growth, cell death or cell migration are dysregulated causing malignant transformation. A wide variety of drugs are clinically used to treat non-cancerous diseases interfering with these malignancy-associated pathways. Repurposed drugs have key advantages: They already have approval for clinical use by national regulatory authorities. Moreover, they are for the most part inexpensive and their side effect and safety profiles are well characterized. In this work, we provide an overview on current repurposing strategies for the treatment of malignant glioma.
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Ni L, Wu J, Long Y, Tao J, Xu J, Yuan X, Yu N, Wu R, Zhang Y. Mortality of site-specific cancer in patients with schizophrenia: a systematic review and meta-analysis. BMC Psychiatry 2019; 19:323. [PMID: 31660909 PMCID: PMC6816203 DOI: 10.1186/s12888-019-2332-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 10/18/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Numerous studies have reported contradicting results on the relationship between cancer mortality and schizophrenia. Our aim is to quantify the mortality rate of common site-specific cancers among patients with schizophrenia and to synthesize the available research evidence. METHODS We performed a systemic search of the PubMed, EMBASE and Web of Science databases. Studies reporting the mortality rate of different cancer in patients with schizophrenia were included. A random-effects model was applied to calculate the pooled relative risks (RRs) with 95% confidence intervals (95%CIs). RESULTS Seven studies consisting of 1,162,971 participants with schizophrenia were included in this meta-analysis. Data regarding mortality risk of breast, colon, lung and prostate cancer among schizophrenia patients were subjected to quantitative analysis. Pooled results showed significant increases in mortality risk of breast cancer (RR = 1.97, 95%CI 1.38-2.83), lung cancer (RR = 1.93, 95%CI 1.46-2.54) and colon cancer (RR = 1.69, 95%CI 1.60-1.80) in patients with schizophrenia compared with those in the general population or control group. The mortality risk of prostate cancer increased in male patients, although no significant difference was detected (RR = 1.58, 95% CI 0.79-3.15). Increased risks of mortality from lung and colon cancer were observed in female patients (RR = 2.49, 95%CI 2.40-2.59 and RR = 2.42, 95%CI 1.39-4.22, respectively) and elevated risks of mortality from lung and colon cancer in male patients (RR = 2.40, 95%CI 2.30-2.50 and RR = 1.90, 95%CI 1.71-2.11, respectively) were detected. CONCLUSIONS Individuals with schizophrenia have a significantly high risk of mortality from breast, colon, and lung cancer.
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Affiliation(s)
- Liwei Ni
- Department of Oncology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004 People’s Republic of China
| | - Jian Wu
- Department of Oncology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004 People’s Republic of China
| | - Yuming Long
- Department of Oncology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004 People’s Republic of China
| | - Jialong Tao
- Department of Oncology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004 People’s Republic of China
| | - Jianhao Xu
- Department of Oncology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004 People’s Republic of China
| | - Xuya Yuan
- Department of Oncology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004 People’s Republic of China
| | - Na Yu
- Department of Oncology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004 People’s Republic of China
| | - Runhong Wu
- Department of Oncology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004 People’s Republic of China
| | - Yusong Zhang
- Department of Oncology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004 People’s Republic of China
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Davis LE, Bogner E, Coburn NG, Hanna TP, Kurdyak P, Groome PA, Mahar AL. Stage at diagnosis and survival in patients with cancer and a pre-existing mental illness: a meta-analysis. J Epidemiol Community Health 2019; 74:84-94. [PMID: 31653661 DOI: 10.1136/jech-2019-212311] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 09/27/2019] [Accepted: 10/06/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Individuals with a pre-existing mental illness, especially those experiencing reduced social, occupational and functional capacity, are at risk for cancer care disparities. However, uncertainty surrounding the effect of a mental illness on cancer outcomes exists. METHODS We conducted a systematic review and meta-analysis of observational studies using MEDLINE and PubMed from 1 January 2005 to 1 November 2018. Two reviewers evaluated citations for inclusion. Advanced stage was defined as regional, metastatic or according to a classification system. Cancer survival was defined as time survived from cancer diagnosis. Pooled ORs and HRs were presented. The Newcastle-Ottawa bias risk assessment scale was used. Random-effects models used the Mantel-Haenszel approach and the generic inverse variance method. Heterogeneity assessment was performed using I2. RESULTS 2381 citations were identified; 28 studies were included and 24 contributed to the meta-analysis. Many demonstrated methodological flaws, limiting interpretation and contributing to significant heterogeneity. Data source selection, definitions of a mental illness, outcomes and their measurement, and overadjustment for causal pathway variables influenced effect sizes. Pooled analyses suggested individuals with a pre-existing mental disorder have a higher odds of advanced stage cancer at diagnosis and are at risk of worse cancer survival. Individuals with more severe mental illness, such as schizophrenia, are at a greater risk for cancer disparities. DISCUSSION This review identified critical gaps in research investigating cancer stage at diagnosis and survival for individuals with pre-existing mental illness. High-quality research is necessary to support quality improvement for the care of psychiatric patients and their families during and following a cancer diagnosis.
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Affiliation(s)
- Laura E Davis
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Emma Bogner
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Natalie G Coburn
- Department of Surgery and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Timothy P Hanna
- Division of Cancer Care & Epidemiology & Department of Oncology, Queen's University, Kingston, Ontario, Canada
| | - Paul Kurdyak
- Centre for Addiction and Mental Health & Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Patti A Groome
- Division of Cancer Care and Epidemiology and Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Alyson L Mahar
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada .,Department of Community Health Sciences, University of Manitoba College of Medicine, Winnipeg, Manitoba, Canada
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Irwin KE, Steffens EB, Yoon Y, Flores EJ, Knight HP, Pirl WF, Freudenreich O, Henderson DC, Park ER. Lung Cancer Screening Eligibility, Risk Perceptions, and Clinician Delivery of Tobacco Cessation Among Patients With Schizophrenia. Psychiatr Serv 2019; 70:927-934. [PMID: 31357921 PMCID: PMC8386131 DOI: 10.1176/appi.ps.201900044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Individuals with schizophrenia experience increased lung cancer mortality and decreased access to cancer screening and tobacco cessation treatment. To promote screening among individuals with schizophrenia, it is necessary to investigate the proportion who meet screening criteria and examine smoking behaviors, cancer risk perception, and receipt of tobacco cessation interventions from psychiatry and primary care. METHODS The authors performed a cross-sectional survey and medical record review with 112 adults with schizophrenia treated with clozapine in a community mental health clinic (CMHC). RESULTS Among older participants (ages 55-77 years) with schizophrenia, 34% met the criteria for lung screening on the basis of smoking history (heavy current or former smokers), and more than half believed they had a low risk of developing lung cancer. Of all participants, 88% had visited their primary care provider (PCP) in the past year; PCPs represented 35 different practices. Only one in three current smokers reported that their PCP or psychiatrist assisted them in obtaining medications for tobacco cessation. CONCLUSIONS Given smoking history, many older adults with schizophrenia have potential to benefit from lung screening, yet most older participants underestimated their lung cancer risk. Although participants regularly accessed care, PCP and psychiatric visits may be missed opportunities to engage patients with schizophrenia in tobacco cessation and decrease preventable premature mortality. Embedding interventions in a CMHC, a centralized access point of care delivery for patients with schizophrenia, may have unique potential to increase uptake of cancer screening and tobacco cessation interventions.
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Affiliation(s)
- Kelly E Irwin
- Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital Cancer Center, Boston (Irwin, Yoon); Schizophrenia Clinical and Research Program (Irwin, Freudenreich), Mongan Institute Health Policy Center (Steffens, Park), Tobacco Research and Treatment Center (Park), and Department of Radiology (Flores), Massachusetts General Hospital, Boston; Erich Lindemann Mental Health Center, Boston (Freudenreich); Department of Medicine, Brigham and Women's Hospital, Boston (Knight); Dana-Farber Cancer Institute, Boston (Pirl); Department of Psychiatry, Boston Medical Center and Boston University, Boston (Henderson)
| | - Eleanor B Steffens
- Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital Cancer Center, Boston (Irwin, Yoon); Schizophrenia Clinical and Research Program (Irwin, Freudenreich), Mongan Institute Health Policy Center (Steffens, Park), Tobacco Research and Treatment Center (Park), and Department of Radiology (Flores), Massachusetts General Hospital, Boston; Erich Lindemann Mental Health Center, Boston (Freudenreich); Department of Medicine, Brigham and Women's Hospital, Boston (Knight); Dana-Farber Cancer Institute, Boston (Pirl); Department of Psychiatry, Boston Medical Center and Boston University, Boston (Henderson)
| | - YooJin Yoon
- Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital Cancer Center, Boston (Irwin, Yoon); Schizophrenia Clinical and Research Program (Irwin, Freudenreich), Mongan Institute Health Policy Center (Steffens, Park), Tobacco Research and Treatment Center (Park), and Department of Radiology (Flores), Massachusetts General Hospital, Boston; Erich Lindemann Mental Health Center, Boston (Freudenreich); Department of Medicine, Brigham and Women's Hospital, Boston (Knight); Dana-Farber Cancer Institute, Boston (Pirl); Department of Psychiatry, Boston Medical Center and Boston University, Boston (Henderson)
| | - Efren J Flores
- Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital Cancer Center, Boston (Irwin, Yoon); Schizophrenia Clinical and Research Program (Irwin, Freudenreich), Mongan Institute Health Policy Center (Steffens, Park), Tobacco Research and Treatment Center (Park), and Department of Radiology (Flores), Massachusetts General Hospital, Boston; Erich Lindemann Mental Health Center, Boston (Freudenreich); Department of Medicine, Brigham and Women's Hospital, Boston (Knight); Dana-Farber Cancer Institute, Boston (Pirl); Department of Psychiatry, Boston Medical Center and Boston University, Boston (Henderson)
| | - Helen P Knight
- Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital Cancer Center, Boston (Irwin, Yoon); Schizophrenia Clinical and Research Program (Irwin, Freudenreich), Mongan Institute Health Policy Center (Steffens, Park), Tobacco Research and Treatment Center (Park), and Department of Radiology (Flores), Massachusetts General Hospital, Boston; Erich Lindemann Mental Health Center, Boston (Freudenreich); Department of Medicine, Brigham and Women's Hospital, Boston (Knight); Dana-Farber Cancer Institute, Boston (Pirl); Department of Psychiatry, Boston Medical Center and Boston University, Boston (Henderson)
| | - William F Pirl
- Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital Cancer Center, Boston (Irwin, Yoon); Schizophrenia Clinical and Research Program (Irwin, Freudenreich), Mongan Institute Health Policy Center (Steffens, Park), Tobacco Research and Treatment Center (Park), and Department of Radiology (Flores), Massachusetts General Hospital, Boston; Erich Lindemann Mental Health Center, Boston (Freudenreich); Department of Medicine, Brigham and Women's Hospital, Boston (Knight); Dana-Farber Cancer Institute, Boston (Pirl); Department of Psychiatry, Boston Medical Center and Boston University, Boston (Henderson)
| | - Oliver Freudenreich
- Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital Cancer Center, Boston (Irwin, Yoon); Schizophrenia Clinical and Research Program (Irwin, Freudenreich), Mongan Institute Health Policy Center (Steffens, Park), Tobacco Research and Treatment Center (Park), and Department of Radiology (Flores), Massachusetts General Hospital, Boston; Erich Lindemann Mental Health Center, Boston (Freudenreich); Department of Medicine, Brigham and Women's Hospital, Boston (Knight); Dana-Farber Cancer Institute, Boston (Pirl); Department of Psychiatry, Boston Medical Center and Boston University, Boston (Henderson)
| | - David C Henderson
- Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital Cancer Center, Boston (Irwin, Yoon); Schizophrenia Clinical and Research Program (Irwin, Freudenreich), Mongan Institute Health Policy Center (Steffens, Park), Tobacco Research and Treatment Center (Park), and Department of Radiology (Flores), Massachusetts General Hospital, Boston; Erich Lindemann Mental Health Center, Boston (Freudenreich); Department of Medicine, Brigham and Women's Hospital, Boston (Knight); Dana-Farber Cancer Institute, Boston (Pirl); Department of Psychiatry, Boston Medical Center and Boston University, Boston (Henderson)
| | - Elyse R Park
- Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital Cancer Center, Boston (Irwin, Yoon); Schizophrenia Clinical and Research Program (Irwin, Freudenreich), Mongan Institute Health Policy Center (Steffens, Park), Tobacco Research and Treatment Center (Park), and Department of Radiology (Flores), Massachusetts General Hospital, Boston; Erich Lindemann Mental Health Center, Boston (Freudenreich); Department of Medicine, Brigham and Women's Hospital, Boston (Knight); Dana-Farber Cancer Institute, Boston (Pirl); Department of Psychiatry, Boston Medical Center and Boston University, Boston (Henderson)
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The impact of severe mental illness on lung cancer mortality of patients with lung cancer in Finland in 1990–2013: a register-based cohort study. Eur J Cancer 2019; 118:105-111. [DOI: 10.1016/j.ejca.2019.06.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 06/05/2019] [Accepted: 06/13/2019] [Indexed: 11/23/2022]
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Tamauchi S, Kajiyama H, Moriyama Y, Yoshihara M, Ikeda Y, Yoshikawa N, Nishino K, Niimi K, Suzuki S, Kikkawa F. Relationship between preexisting mental disorders and prognosis of gynecologic cancers: A case-control study. J Obstet Gynaecol Res 2019; 45:2082-2087. [PMID: 31321830 DOI: 10.1111/jog.14053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 06/23/2019] [Indexed: 11/26/2022]
Abstract
AIM Cancer treatment involves long-term therapy and follow-up, with mental disorders (MD) often affecting the treatment process. Hence, in this study, we retrospectively analyze cases involving gynecologic cancer with MD and clarify the relationship between psychosis and cancer prognosis. METHODS Patients with both gynecologic cancer and MD from January 2003 to August 2016 were recruited in this study. Cases were limited to those whose MD had been diagnosed before their cancer. Control patients without MD were also analyzed. Both cases and controls were adjusted for age, cancer type, and cancer stage. RESULTS A total of 54 patients with gynecologic cancer and MD, as well as 108 controls without MD, were included. The median age of the patients was 52 years. Details regarding cancer type were as follows: 11 ovarian cancers, 26 uterine corpus cancers and 17 cervical cancers. Among these, 25 schizophrenia cases, 15 depressive disorders, 4 bipolar disorders and 10 other MD were recorded. No significant differences in the 5-year survival rate were found between patients and controls. In advanced-stage cervical cancer, however, the prognosis was significantly poor given the low rate of initial treatment completion. Moreover, patients with advanced-stage cervical cancer had significantly lower chemotherapy completion rates compared to those with other gynecologic malignancies. CONCLUSION Mental disorders do not affect the prognosis of gynecologic cancers, except for advanced cervical cancer. Accordingly, improving the low rate of initial treatment completion seems to be a focal point for better prognosis in advanced cervical cancer.
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Affiliation(s)
- Satoshi Tamauchi
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroaki Kajiyama
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshinori Moriyama
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masato Yoshihara
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshiki Ikeda
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobuhisa Yoshikawa
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kimihiro Nishino
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kaoru Niimi
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shiro Suzuki
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Fumitaka Kikkawa
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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40
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Irwin KE, Park ER, Fields LE, Corveleyn AE, Greer JA, Perez GK, Callaway CA, Jacobs JM, Nierenberg AA, Temel JS, Ryan DP, Pirl WF. Bridge: Person-Centered Collaborative Care for Patients with Serious Mental Illness and Cancer. Oncologist 2019; 24:901-910. [PMID: 30696722 PMCID: PMC6656464 DOI: 10.1634/theoncologist.2018-0488] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 11/30/2018] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Individuals with serious mental illness (SMI) experience increased cancer mortality due to inequities in cancer treatment. Psychiatric care at cancer diagnosis may improve care delivery, yet models for integrating psychiatry and cancer care are lacking. We assessed the feasibility and acceptability of a person-centered collaborative care trial for SMI and cancer. SUBJECTS, MATERIALS, AND METHODS We developed the Bridge intervention for patients with SMI (schizophrenia, bipolar disorder, and severe major depression) and cancer. Bridge includes proactive identification of SMI, person-centered care from a psychiatrist and case manager, and collaboration with oncology. We conducted a 12-week, single-group trial in patients with SMI and a new breast, gastrointestinal, lung, or head/neck cancer. We assessed the feasibility of patient identification, enrollment and study completion; evaluated acceptability and perceived benefit with exit interviews with patients, caregivers, and oncology clinicians; and examined change in psychiatric symptoms with the Brief Psychiatric Rating Scale (BPRS). RESULTS From November 2015 to April 2016, 30/33 eligible patients (90.9%) enrolled, and 25/29 (86.2%) completed assessments at all timepoints, meeting feasibility criteria. Of 24 patients, 23 (95.8%) found meeting with the psychiatrist helpful; 16/19 caregivers (84.2%) shared that Bridge addressed key caregiving challenges. Oncology clinicians evaluated Bridge as "very" or "most" useful for 94.3% of patients. Exit interviews with all participant groups suggested that Bridge fostered patient-clinician trust, increased access to psychiatric treatment, and enabled patients to initiate and complete cancer treatment. Psychiatric symptoms on the BPRS improved from baseline to 12 weeks. CONCLUSION Bridge is a feasible and acceptable care delivery model for patients with SMI, their caregivers, and oncology clinicians. Randomized trials are warranted to assess the efficacy of improving cancer outcomes in this underserved population. IMPLICATIONS FOR PRACTICE Serious mental illness affects 13 million U.S. adults who experience increased cancer mortality. To improve outcomes, new models of integrated oncology and mental health care are urgently needed. This study found that it was feasible to identify, enroll, and retain patients with serious mental illness and a new cancer in a trial of integrated mental health and cancer care (Bridge). Patients, caregivers, and oncologists reported that Bridge facilitated the initiation and completion of cancer care. Randomized trials are warranted to investigate the impact on cancer outcomes. Trial procedures may inform consent, engagement, and trial retention for patients with mental illness.
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Affiliation(s)
- Kelly E Irwin
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Schizophrenia Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Elyse R Park
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, Massachusetts
- Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Lauren E Fields
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Amy E Corveleyn
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Joseph A Greer
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Giselle K Perez
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Jamie M Jacobs
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Andrew A Nierenberg
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Jennifer S Temel
- Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - David P Ryan
- Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - William F Pirl
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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41
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Correa-Fernández V, Wilson WT, Kyburz B, O'Connor DP, Stacey T, Williams T, Lam CY, Reitzel LR. Evaluation of the Taking Texas Tobacco Free Workplace Program within behavioral health centers. Transl Behav Med 2019; 9:319-327. [PMID: 29955886 DOI: 10.1093/tbm/iby067] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Despite the health benefits of tobacco control and cessation initiatives, tobacco users with behavioral health disorders (BHDs) have less access to evidence-based tobacco dependence treatment. Academic-community partnerships can help guide the translation of tobacco-related research findings and evidence-based guidelines into real-world applications. Through a comprehensive, evidence-based, multilevel, and multicomponent program, Taking Texas Tobacco Free (TTTF) facilitated the implementation of tobacco-free workplaces at 18 local mental health authorities in Texas, comprising over 250 individual community behavioral health centers. Compared with preprogram implementation, key accomplishments postimplementation include: (1) educated over 5,000 employees (nonclinical staff and providers) on the hazards of tobacco use and benefits of quitting, particularly among people with BHD; providers were additionally trained on the use of evidence based practices (EBPs; i.e. 5A's model, use of pharmacotherapy) to identify and treat tobacco use among people with BHD; (2) providers' significant increase in conducting tobacco-use assessments and using EBPs; (3) significant decrease in nonclinical staff tobacco use; (4) increase in quit attempts among consumers as evidenced by the demand for nicotine replacement therapy; and (5) reach to over 115,000 community members through outreach and education about the benefits of quitting tobacco use and maintaining a healthy lifestyle. TTTF demonstrated that the implementation of a comprehensive tobacco-free workplace program in behavioral health settings is feasible and beneficial, facilitating the capacity building of healthcare professionals and enhancing their resulting engagement in EBPs, and promoting healthier lifestyles among employees, consumers, and community members as a whole.
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Affiliation(s)
- Virmarie Correa-Fernández
- University of Houston, Department of Psychological, Health, and Learning Sciences, Houston, TX, USA.,University of Houston, Health Research Institute, Houston, TX, USA
| | | | | | - Daniel P O'Connor
- University of Houston, Health Research Institute, Houston, TX, USA.,University of Houston, Department of Health and Human Performance, Houston TX, USA
| | | | | | - Cho Y Lam
- Huntsman Cancer Institute and the University of Utah Health, Salt Lake City, UT, USA
| | - Lorraine R Reitzel
- University of Houston, Department of Psychological, Health, and Learning Sciences, Houston, TX, USA.,University of Houston, Health Research Institute, Houston, TX, USA
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42
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Irwin KE, Moy B, Fields LE, Callaway CA, Park ER, Wirth L. Expanding Access to Cancer Clinical Trials for Patients With Mental Illness. J Clin Oncol 2019; 37:1524-1528. [PMID: 30986118 DOI: 10.1200/jco.18.01881] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Kelly E Irwin
- 1 Massachusetts General Hospital, Boston, MA.,2 Harvard Medical School, Boston, MA
| | - Beverly Moy
- 1 Massachusetts General Hospital, Boston, MA.,2 Harvard Medical School, Boston, MA
| | - Lauren E Fields
- 1 Massachusetts General Hospital, Boston, MA.,3 Columbia University, New York, NY
| | | | - Elyse R Park
- 1 Massachusetts General Hospital, Boston, MA.,2 Harvard Medical School, Boston, MA
| | - Lori Wirth
- 1 Massachusetts General Hospital, Boston, MA.,2 Harvard Medical School, Boston, MA
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43
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de Mooij LD, Kikkert M, Theunissen J, Beekman ATF, de Haan L, Duurkoop PWRA, Van HL, Dekker JJM. Dying Too Soon: Excess Mortality in Severe Mental Illness. Front Psychiatry 2019; 10:855. [PMID: 31920734 PMCID: PMC6918821 DOI: 10.3389/fpsyt.2019.00855] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 10/31/2019] [Indexed: 12/12/2022] Open
Abstract
Aims: We aimed to identify baseline predictors of mortality in patients with a severe mental illness (SMI) over a 6-year period and to describe mortality rates as standardised mortality ratios (SMRs). We hypothesised that cardiovascular diseases, older age, cigarette smoking, more severe psychiatric symptoms and more severe psychotropic side effects, and alcohol or drug use were independent risk factors for mortality. Method: Medical examinations were conducted at baseline in a cohort of 322 SMI patients. SMRs were estimated after 6 years and an evaluation was made of the impact of a wide range of variables on survival time. Results: Almost 11% of the SMI patients had died at the end of the study period. All-cause SMRs were 4.51 (95% CI 3.07-5.95) for all SMI patients (4.89, 95% CI 2.97-6.80 for men, and 3.94, 95% CI 1.78-6.10 for women). Natural causes accounted for 86% of excess mortality and unnatural causes for 14%. Cardiovascular disease was a major contributor to this excess mortality. Multivariate Cox regression analyses showed that premature death was associated with a longer history of tobacco use (HR: 1.03, 95% CI 1.02-1.03) and more severe symptoms of disorganisation (HR: 2.36, 95% CI 2.21-2.52). Conclusions: The high SMR and the incidence of cardiovascular disease-related death in SMI patients in our study justify concern. This study underscores the urgent need for interventions to reduce excess mortality in patients with SMI.
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Affiliation(s)
| | - Martijn Kikkert
- Department of Research, Arkin Mental Health Institute, Amsterdam, Netherlands
| | - Jan Theunissen
- Department of Research, GGZ inGeest Mental Health Institute, Amsterdam, Netherlands
| | - Aartjan T F Beekman
- Department of Research, GGZ inGeest Mental Health Institute, Amsterdam, Netherlands.,Department of Psychiatry, VU-University Medical Centre, Amsterdam, Netherlands
| | - Lieuwe de Haan
- Department of Research, Arkin Mental Health Institute, Amsterdam, Netherlands.,Department of Psychiatry, Academic Medical Center, Amsterdam, Netherlands
| | - Pim W R A Duurkoop
- Department of Research, Arkin Mental Health Institute, Amsterdam, Netherlands
| | - Henricus L Van
- Department of Research, Arkin Mental Health Institute, Amsterdam, Netherlands
| | - Jack J M Dekker
- Department of Research, Arkin Mental Health Institute, Amsterdam, Netherlands.,Department of Clinical Psychology, VU-University Medical Centre, Amsterdam, Netherlands
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44
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Kuppili PP, Nebhinani N. Deciphering the paradoxical incidence of cancer in schizophrenia. Australas Psychiatry 2018; 26:624-627. [PMID: 30226103 DOI: 10.1177/1039856218797439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES: The incidence of cancer in schizophrenia has been an area of controversy. The current article aims to provide a commentary outlining the contradictory findings of incidence of cancer in schizophrenia as well as discuss the available theories linking cancer with schizophrenia and address the methodological issues of the studies which could lead to the discrepant findings. METHOD: A literature search was carried out primarily using the electronic database of MEDLINE through PubMed using the search terms 'cancer' and 'schizophrenia'. Google Scholar was used to supplement the search. RESULTS: The findings were inconclusive, with studies documenting increased, decreased as well as no risk of cancer in patients with schizophrenia, compared with the general population. Several methodological limitations exist with regard to measures of assessment, sample size and selection bias. CONCLUSIONS: The association between cancer and schizophrenia remains controversial. Genetic as well as environmental theories exist explaining the paradoxical incidence of cancer in schizophrenia. The methodological factors could contribute to the discrepant findings.
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Affiliation(s)
| | - Naresh Nebhinani
- Associate Professor, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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45
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Piollet I. Pathologie mentale et pathologie cancéreuse : la double peine, la double stigmatisation. PSYCHO-ONCOLOGIE 2018. [DOI: 10.3166/pson-2018-0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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46
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Roberts R, Lockett H, Bagnall C, Maylea C, Hopwood M. Improving the physical health of people living with mental illness in Australia and New Zealand. Aust J Rural Health 2018; 26:354-362. [DOI: 10.1111/ajr.12457] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2018] [Indexed: 01/20/2023] Open
Affiliation(s)
| | - Helen Lockett
- The Wise Group Hamilton New Zealand
- Department of Psychological Medicine The University of Auckland Auckland New Zealand
| | | | - Chris Maylea
- Social and Global Studies Centre RMIT University Melbourne Victoria Australia
| | - Malcolm Hopwood
- Immediate Past president RANZCP Melbourne Victoria Australia
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47
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Al-Nema M, Gaurav A, Akowuah G. Discovery of natural product inhibitors of phosphodiesterase 10A as novel therapeutic drug for schizophrenia using a multistep virtual screening. Comput Biol Chem 2018; 77:52-63. [PMID: 30240986 DOI: 10.1016/j.compbiolchem.2018.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/31/2018] [Accepted: 09/02/2018] [Indexed: 10/28/2022]
Abstract
The major complaint that most of the schizophrenic patients' face is the cognitive impairment which affects the patient's quality of life. The current antipsychotic drugs treat only the positive symptoms without alleviating the negative or cognitive symptoms of the disease. In addition, the existing therapies are known to produce extrapyramidal side effects that affect the patient adherence to the treatment. PDE10A inhibitor is the new therapeutic approach which has been proven to be effective in alleviating the negative and cognitive symptoms of the disease. A number of PDE10A inhibitors have been developed, but no inhibitor has made it beyond the clinical trials so far. Thus, the present study has been conducted to identify a PDE10A inhibitor from natural sources to be used as a lead compound for the designing of novel selective PDE10A inhibitors. Ligand and structure-based pharmacophore models for PDE10A inhibitors were generated and employed for virtual screening of universal natural products database. From the virtual screening results, 37 compounds were docked into the active site of the PDE10A. Out of 37 compounds, three inhibitors showed the highest affinity for PDE10A where UNPD216549 showed the lowest binding energy and has been chosen as starting point for designing of novel PDE10A inhibitors. The structure-activity-relationship studies assisted in designing of selective PDE10A inhibitors. The optimization of the substituents on the phenyl ring resulted in 26 derivatives with lower binding energy with PDE10A as compared to the lead compound. Among these, MA 8 and MA 98 exhibited the highest affinity for PDE10A with binding energy (-10.90 Kcal/mol).
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Affiliation(s)
- Mayasah Al-Nema
- Faculty of Pharmaceutical Sciences, UCSI University, Jalan Menara Gading, Taman Connaught, 56000, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Anand Gaurav
- Faculty of Pharmaceutical Sciences, UCSI University, Jalan Menara Gading, Taman Connaught, 56000, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia.
| | - Gabriel Akowuah
- Faculty of Pharmaceutical Sciences, UCSI University, Jalan Menara Gading, Taman Connaught, 56000, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
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48
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Dalton SO, Suppli NP, Ewertz M, Kroman N, Grassi L, Johansen C. Impact of schizophrenia and related disorders on mortality from breast cancer: A population-based cohort study in Denmark, 1995–2011. Breast 2018; 40:170-176. [DOI: 10.1016/j.breast.2018.06.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 06/01/2018] [Accepted: 06/02/2018] [Indexed: 12/29/2022] Open
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49
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Oakley P, Kisely S, Baxter A, Harris M, Desoe J, Dziouba A, Siskind D. Increased mortality among people with schizophrenia and other non-affective psychotic disorders in the community: A systematic review and meta-analysis. J Psychiatr Res 2018; 102:245-253. [PMID: 29723811 DOI: 10.1016/j.jpsychires.2018.04.019] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 04/20/2018] [Accepted: 04/25/2018] [Indexed: 12/18/2022]
Abstract
INTRODUCTION There is increasing evidence of excess mortality in schizophrenia but less information on other non-affective psychoses. We therefore generated standardised mortality ratios (SMRs) for community-dwelling people with schizophrenia and other non-affective psychoses, relative to the general population, and examined changes to the SMR over time. METHODS We conducted a systematic review in which Pubmed, CINAHL, EMBASE, Google Scholar and PsycINFO were searched for publications that reported SMRs for all-cause mortality among community-dwelling people with schizophrenia and psychotic disorders. Meta-analyses of SMRs were conducted, pooled across genders and then separately by gender. Sub-group analyses were conducted for diagnostic group, global region, decade and risk of study bias. RESULTS We were able to include 34 studies covering 1,724,906 participants. The gender pooled SMR for schizophrenia and psychotic disorders was 3.08 (95%CI 2.88-3.31). Schizophrenia and broader psychotic disorders had similar SMRs. Stratification by decade of observation suggests that the difference in SMR is not declining and may possibly be widening. Analyses showed high levels of heterogeneity. CONCLUSIONS The appearance of a static or widening mortality gap over time between people with schizophrenia and psychotic disorders and the general population is of concern. However, whether it is an increase over time is unclear, as there are insufficient studies to confirm this.
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Affiliation(s)
- Padraig Oakley
- Queensland Centre for Mental Health Research, Brisbane, Australia
| | - Steve Kisely
- Metro South Addiction and Mental Health Service, Brisbane, Australia; University of Queensland School of Medicine, Brisbane, Australia; Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Canada
| | - Amanda Baxter
- Queensland Centre for Mental Health Research, Brisbane, Australia
| | - Meredith Harris
- Queensland Centre for Mental Health Research, Brisbane, Australia; School of Public Health, The University of Queensland, Brisbane, Australia
| | - Jocelyne Desoe
- University of Queensland School of Medicine, Brisbane, Australia
| | - Alyona Dziouba
- University of Queensland School of Medicine, Brisbane, Australia
| | - Dan Siskind
- Queensland Centre for Mental Health Research, Brisbane, Australia; Metro South Addiction and Mental Health Service, Brisbane, Australia; University of Queensland School of Medicine, Brisbane, Australia.
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50
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Ramlakhan JU, Zomorrodi R, Downar J, Blumberger DM, Daskalakis ZJ, George TP, Kiang M, Barr MS. Using Mismatch Negativity to Investigate the Pathophysiology of Substance Use Disorders and Comorbid Psychosis. Clin EEG Neurosci 2018; 49:226-237. [PMID: 29502434 DOI: 10.1177/1550059418760077] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Substance use disorders (SUDs) have a devastating impact on society and place a heavy burden on health care systems. Given that alcohol, tobacco, and cannabis use have the highest prevalence, further understanding of the underlying pathophysiology of these SUDs is crucial. Electroencephalography is an inexpensive, temporally superior, and translatable technique which enables investigation of the pathobiology of SUDs through the evaluation of various event-related potential components, including mismatch negativity (MMN). The goals of this review were to investigate the effects of acute and chronic alcohol, tobacco, and cannabis use on MMN among nonpsychiatric populations and patients with comorbid psychosis. A literature search was performed using the database PubMed, and 36 articles met our inclusion and exclusion criteria. We found a pattern of attenuation of MMN amplitude among patients with alcoholism across acute and chronic alcohol use, and this dysregulation was not heritable. Reports were limited, and results were mixed on the effects of acute and chronic tobacco and cannabis use on MMN. Reports on comorbid SUDs and psychosis were even fewer, and also presented mixed findings. These preliminary results suggest that MMN deficits may be associated with SUDs, specifically alcohol use disorder, and serve as a possible biomarker for treating these common disorders.
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Affiliation(s)
- Jessica U Ramlakhan
- 1 Temerty Centre for Therapeutic Brain Intervention, Division of Mood and Anxiety, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,2 Biobehavioural Addictions and Concurrent Disorders Research Laboratory (BACDRL), Additions Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Reza Zomorrodi
- 1 Temerty Centre for Therapeutic Brain Intervention, Division of Mood and Anxiety, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Jonathan Downar
- 3 Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,4 Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,5 Division of Brain and Therapeutics, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Daniel M Blumberger
- 1 Temerty Centre for Therapeutic Brain Intervention, Division of Mood and Anxiety, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,4 Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,5 Division of Brain and Therapeutics, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Zafiris J Daskalakis
- 1 Temerty Centre for Therapeutic Brain Intervention, Division of Mood and Anxiety, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,4 Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,5 Division of Brain and Therapeutics, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Tony P George
- 2 Biobehavioural Addictions and Concurrent Disorders Research Laboratory (BACDRL), Additions Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,4 Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,5 Division of Brain and Therapeutics, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Michael Kiang
- 1 Temerty Centre for Therapeutic Brain Intervention, Division of Mood and Anxiety, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,4 Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,5 Division of Brain and Therapeutics, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Mera S Barr
- 1 Temerty Centre for Therapeutic Brain Intervention, Division of Mood and Anxiety, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,4 Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,5 Division of Brain and Therapeutics, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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