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Tahmazov E, Bosse J, Glemain B, Nabbe P, Guillou M, Blachier A, Walter M, Lemey C. Impact of Early Intervention for Early Psychosis on Suicidal Behavior-A Meta-Analysis. Acta Psychiatr Scand 2025; 151:127-141. [PMID: 39601245 DOI: 10.1111/acps.13773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 10/16/2024] [Accepted: 11/06/2024] [Indexed: 11/29/2024]
Abstract
INTRODUCTION Early-onset psychotic disorders include the prodromal phase and the first-episode psychosis (FEP). They constitute a high-risk period for suicidal behavior. Early intervention for psychosis (EIP) consists of intervening as early as possible. The effectiveness of early intervention on overall prognosis has been reported in numerous studies, and EIP services are emerging worldwide. Several authors report an improvement in suicidal behavior, but no study has looked at all the data. AIMS OF THE STUDY The aim of work is to study whether early intervention for psychosis has an impact on deaths by suicide and suicide attempts, and study which intervention methods have an impact on suicidal behavior. METHODOLOGY By respecting the PRISMA criteria, previously declared on PROSPERO, by exploring 5 medical databases (PubMed, Cochrane, PsycINFO, Scopus, Embase), from their creation dates, published until 20/02/2023, in English, we carried out a meta-analysis. The articles selected had to deal with the EIP and deaths by suicide or suicide attempts. Our primary outcome is the deaths by suicide and the secondary outcome the suicide attempt. RESULTS The exhaustive search identified a total of 2310 references. Nine articles were included. Their intervention modalities were pharmacotherapy, psychotherapy, case-management, or related services, and psycho-social therapies. Our meta-analysis shows that early intervention for early-onset psychotic disorders is associated with a statistically significant reduction by a third in deaths by suicide (ORa = 0.66 (0.49-0.88), p = 0.005) and by a third in suicide attempts (ORa = 0.66 (0.50-0.86), p = 0.002), with non-significant heterogeneity. Sensitivity analyses excluding the study with statistical difficulties due to the absence of an event and studies with a high risk of bias point in the same direction, that is a statistically significant reduction and non-significant heterogeneity. CONCLUSION The literature shows that early intervention programs are associated with positive impact on deaths by suicide and suicide attempt. This is the first meta-analysis of early intervention in early psychotic disorders and its impact on suicidal risk. The deployment of EIP should be supported worldwide in order to intervene as early as possible and prevent the risk of suicide. TRIAL REGISTRATION PROSPERO CRD42022366976.
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Affiliation(s)
- Elkhan Tahmazov
- URCI University Hospital Department of Adult Psychiatry, Brest, France
| | - Jordan Bosse
- URCI University Hospital Department of Adult Psychiatry, Brest, France
| | - Benjamin Glemain
- Sorbonne University, Inserm, Pierre-Louis Institute of Epidemiology and Public Health, Paris, France
- Public Health Department, Hôpital Saint-Antoine, AP-H. Sorbonne University, Paris, France
| | - Patrice Nabbe
- EA 7479 SPURBO, Primary Care, Public Health, Western Brittany Cancer Registry, University of Western Brittany, Brest, France
- University Department of General Medicine - UFR Brest, Brest, France
| | - Morgane Guillou
- Sorbonne University, Inserm, Pierre-Louis Institute of Epidemiology and Public Health, Paris, France
| | - Athéna Blachier
- URCI University Hospital Department of Adult Psychiatry, Brest, France
| | - Michel Walter
- URCI University Hospital Department of Adult Psychiatry, Brest, France
- Sorbonne University, Inserm, Pierre-Louis Institute of Epidemiology and Public Health, Paris, France
| | - Christophe Lemey
- URCI University Hospital Department of Adult Psychiatry, Brest, France
- Sorbonne University, Inserm, Pierre-Louis Institute of Epidemiology and Public Health, Paris, France
- IMT Atlantique, Lab-STICC, Campus de Brest, Technopôle Brest-Iroise, Brest, France
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Kouakou MR, Cabrera-Mendoza B, Pathak GA, Cannon TD, Polimanti R. Genetically Informed Study Highlights Income-Independent Effect of Schizophrenia Liability on Mental and Physical Health. Schizophr Bull 2024; 51:85-94. [PMID: 38848523 PMCID: PMC11661948 DOI: 10.1093/schbul/sbae093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
BACKGROUND AND HYPOTHESIS Individuals with schizophrenia (SCZ) suffer from comorbidities that substantially reduce their life expectancy. Socioeconomic inequalities could contribute to many of the negative health outcomes associated with SCZ. STUDY DESIGN We investigated genome-wide datasets related to SCZ (52 017 cases and 75 889 controls) from the Psychiatric Genomics Consortium, household income (HI; N = 361 687) from UK Biobank, and 2202 medical endpoints assessed in up to 342 499 FinnGen participants. A phenome-wide genetic correlation analysis of SCZ and HI was performed, also assessing whether SCZ genetic correlations were influenced by the HI effect on SCZ. Additionally, SCZ and HI direct effects on medical endpoints were estimated using multivariable Mendelian randomization (MR). STUDY RESULTS SCZ and HI showed overlapping genetic correlations with 70 traits (P < 2.89 × 10-5), including mental health, substance use, gastrointestinal illnesses, reproductive outcomes, liver diseases, respiratory problems, and musculoskeletal phenotypes. SCZ genetic correlations with these traits were not affected by the HI effect on SCZ. Considering Bonferroni multiple testing correction (P < 7.14 × 10-4), MR analysis indicated that SCZ and HI may affect medical abortion (SCZ OR = 1.07; HI OR = 0.78), panic disorder (SCZ OR = 1.20; HI OR = 0.60), personality disorders (SCZ OR = 1.31; HI OR = 0.67), substance use (SCZ OR = 1.2; HI OR = 0.68), and adjustment disorders (SCZ OR = 1.18; HI OR = 0.78). Multivariable MR analysis confirmed that SCZ effects on these outcomes were independent of HI. CONCLUSIONS The effect of SCZ genetic liability on mental and physical health may not be strongly affected by socioeconomic differences. This suggests that SCZ-specific strategies are needed to reduce negative health outcomes affecting patients and high-risk individuals.
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Affiliation(s)
- Manuela R Kouakou
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Brenda Cabrera-Mendoza
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, CT, USA
| | - Gita A Pathak
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, CT, USA
| | - Tyrone D Cannon
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychology, Yale University, New Haven, CT, USA
- Wu Tsai Institute, Yale University, New Haven, CT, USA
| | - Renato Polimanti
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, CT, USA
- Wu Tsai Institute, Yale University, New Haven, CT, USA
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Wootten JC, Richard L, Lam M, Blanchette PS, Solmi M, Anderson KK. Treatment and Mortality Following Cancer Diagnosis Among People With Non-affective Psychotic Disorders in Ontario, Canada: A Retrospective Cohort Study. Schizophr Bull 2024; 51:75-84. [PMID: 38431887 PMCID: PMC11661958 DOI: 10.1093/schbul/sbae013] [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: 03/05/2024]
Abstract
BACKGROUND AND HYPOTHESIS People with psychotic disorders have a higher risk of mortality following cancer diagnosis, compared to people without psychosis. The extent to which this disparity is influenced by differences in cancer-related treatment is currently unknown. We hypothesized that, following a cancer diagnosis, people with psychotic disorders were less likely to receive treatment and were at higher risk of death than those without psychosis. STUDY DESIGN We constructed a retrospective cohort of cases of non-affective psychotic disorder (NAPD) and a general population comparison group, using Ontario Health (OH) administrative data. We identified cases of all cancers diagnosed between 1995 and 2019 and obtained information on cancer-related treatment and mortality. Cox proportional hazards models were used to compare the probability of having a consultation with an oncologist and receiving cancer-related treatment, adjusting for tumor site and stage. We also compared the rate of all-cause and cancer-related mortality between the two groups, adjusting for tumor site. STUDY RESULTS Our analytic sample included 24 944 people diagnosed with any cancer. People with NAPD were less likely to receive treatment than people without psychosis (HR = 0.87, 95% CI = 0.82, 0.91). In addition, people with NAPD had a greater risk of death from any cause (HR = 1.68, 95% CI = 1.60, 1.76), compared to people without NAPD. CONCLUSIONS The lower likelihood of receiving cancer treatment reflects disparities in accessing cancer care for people with psychotic disorders, which may partially explain the higher mortality risk following cancer diagnosis. Future research should explore mediating factors in this relationship to identify targets for reducing health disparities.
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Affiliation(s)
- Jared C Wootten
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | | | | | - Phillip S Blanchette
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
- ICES Western, London, ON, Canada
- Division of Medical Oncology, Department of Oncology, London Regional Cancer Program, London Health Sciences Centre, Western University, London, ON, Canada
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- Department of Mental Health, Regional Centre for the Treatment of Eating Disorders and On Track: The Champlain First Episode Psychosis Program, The Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Kelly K Anderson
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
- Department of Psychiatry, Western University, London, ON, Canada
- ICES Western, London, ON, Canada
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Cohen S, Goldsmith DR, Ning CS, Addington J, Bearden CE, Cadenhead KS, Cannon TD, Cornblatt BA, Keshavan M, Mathalon DH, Perkins DO, Seidman LJ, Stone WS, Tsuang MT, Woods SW, Walker EF, Miller BJ. Sleep disturbance, suicidal ideation and psychosis-risk symptoms in individuals at clinical high risk for psychosis. Psychiatry Res 2024; 341:116147. [PMID: 39197223 DOI: 10.1016/j.psychres.2024.116147] [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: 02/17/2024] [Revised: 07/02/2024] [Accepted: 08/13/2024] [Indexed: 09/01/2024]
Abstract
Insomnia and suicidal ideation (SI) are common in schizophrenia, including in individuals at clinical high-risk for psychosis (CHR-P). Previous studies have found associations between sleep disturbance, SI, and psychopathology in schizophrenia. We explored these associations in a CHR-P cohort. We leveraged data from CHR-P individuals in the North American Prodrome Longitudinal Studies (NAPLS-3) (n = 688) cohort. We investigated relationships between sleep disturbance (Scale of Prodromal Symptoms [SOPS]; Calgary Depression Scale for Schizophrenia [CDSS], and the Pittsburgh Sleep Quality Index [PSQI]), suicidal ideation (CDSS), and psychosis-risk symptoms. The prevalence of terminal insomnia, sleep disturbance, and SI in NAPLS3 was 25 %, 69 %, and 29 %, respectively. After controlling for potential confounders, multiple indices of sleep disturbance (SOPS, PSQI: OR = 1.05-1.40) were significant indicators of concurrent SI. Terminal insomnia was not associated with conversion to psychosis. Multiple indices of sleep problems were associated with higher total and subscale psychosis-risk symptom scores (β = 0.09-0.39). Sleep problems are prevalent and associated with SI and more severe psychosis-risk symptoms in CHR-P individuals. These findings underscore the importance of designing longitudinal intervention studies to investigate whether the treatment of sleep disturbances may reduce suicidality and symptoms in this population.
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Affiliation(s)
- Simon Cohen
- Department of Psychiatry, Keck School of Medicine of University of Southern California, Los Angeles, CA, United States
| | - David R Goldsmith
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Courtney S Ning
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Jean Addington
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Carrie E Bearden
- Semel Institute for Neuroscience and Human Behavior, Departments of Psychiatry and Biobehavioral Sciences and Psychology, University of California, Los Angeles, CA, United States
| | - Kristin S Cadenhead
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Tyrone D Cannon
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States; Department of Psychology, Yale University, New Haven, CT, United States
| | - Barbara A Cornblatt
- Department of Psychiatry, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Matcheri Keshavan
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Boston, MA, United States
| | - Daniel H Mathalon
- Department of Psychiatry and Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, United States
| | - Diana O Perkins
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Larry J Seidman
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - William S Stone
- Department of Psychology, Emory University, Atlanta, GA, United States
| | - Ming T Tsuang
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Scott W Woods
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Elaine F Walker
- Department of Psychology, Emory University, Atlanta, GA, United States
| | - Brian J Miller
- Department of Psychiatry and Health Behavior, Augusta University, 997 Saint Sebastian Way, Augusta, GA 30912, United States.
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Theis N, Bahuguna J, Rubin JE, Banerjee SS, Muldoon B, Prasad KM. Energy of functional brain states correlates with cognition in adolescent-onset schizophrenia and healthy persons. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2023.11.06.565753. [PMID: 37987003 PMCID: PMC10659315 DOI: 10.1101/2023.11.06.565753] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Adolescent-onset schizophrenia (AOS) is rare, under-studied, and associated with more severe cognitive impairments and poorer outcomes than adult-onset schizophrenia. Neuroimaging has shown altered regional activations (first-order effects) and functional connectivity (second-order effects) in AOS compared to controls. The pairwise maximum entropy model (MEM) integrates first- and second-order factors into a single quantity called energy, which is inversely related to probability of occurrence of brain activity patterns. We take a combinatorial approach to study multiple brain-wide MEMs of task-associated components; hundreds of independent MEMs for various sub-systems are fit to 7 Tesla functional MRI scans. Acquisitions were collected from 23 AOS individuals and 53 healthy controls while performing the Penn Conditional Exclusion Test (PCET) for executive function, which is known to be impaired in AOS. Accuracy of PCET performance was significantly reduced among AOS compared to controls. A majority of the models showed significant negative correlation between PCET scores and the total energy attained over the fMRI. Across all instantiations, the AOS group was associated with significantly more frequent occurrence of states of higher energy, assessed with a mixed effects model. An example MEM instance was investigated further using energy landscapes, which visualize high and low energy states on a low-dimensional plane, and trajectory analysis, which quantify the evolution of brain states throughout this landscape. Both supported patient-control differences in the energy profiles. Severity of psychopathology was correlated positively with energy. The MEM's integrated representation of energy in task-associated systems can help characterize pathophysiology of AOS, cognitive impairments, and psychopathology.
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Affiliation(s)
- Nicholas Theis
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jyotika Bahuguna
- Department of Neuroscience, Laboratoire de Neurosciences Cognitive et Adaptive, University of Strasbourg, France
| | | | | | - Brendan Muldoon
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Konasale M. Prasad
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, PA, USA
- Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
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Ojansuu I, Forsman J, Kautiainen H, Seppänen A, Tiihonen J, Lähteenvuo M. Association of duration of treatment on post-discharge mortality in forensic psychiatric patients in Finland. Front Psychiatry 2024; 15:1372687. [PMID: 39224477 PMCID: PMC11366609 DOI: 10.3389/fpsyt.2024.1372687] [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: 01/18/2024] [Accepted: 07/16/2024] [Indexed: 09/04/2024] Open
Abstract
Background Longer treatment time has been shown to be associated with lower crime recidivism among forensic psychiatric patients, but it is not known if this applies also to mortality. In this study, we aim to research whether treatment time is associated with risk of post-discharge mortality in Finnish forensic psychiatric patients. Materials and methods The study population consisted of 989 patients committed to compulsory forensic psychiatric hospital treatment in Finland from 1980 to 2009 who were released from care by the end of 2018. Each patient included in the cohort was linked with the Statistics Finland register, which includes all data on dates and causes of deaths in Finland. Crude cumulative rate of mortality were estimated using Kaplan-Meier method and compared using logrank-test. Adjusted cumulative rate analyzed using Cox regression model. A possible nonlinear relationship between the treatment time and the hazard of death was assessed by using 3-knot-restricted cubic spline regression. Adjusted models included age, sex, and SUD (substance use disorder) as covariates. Results The mean duration of care was 7.1 (SD 6) years. The duration of treatment variable was divided into tertiles of treatment duration less than 3.5 years, 3.5-7.9 years and equal or more than 8 years. The risk of mortality was highest in the first tertile, and lowest in the last tertile. The risk of mortality was higher for patients suffering from SUD, for patients of male sex and for those released at younger age. Conclusions Longer treatment time is associated with reduced post-discharge mortality in forensic psychiatric patients in Finland. Especially males and individuals with SUD are at higher mortality risk after release, but longer treatment duration may mitigate these risks. Longer periods of hospitalization have to be, however, viewed against the backdrop of institutionalization and loss of self-determination.
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Affiliation(s)
- Ilkka Ojansuu
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
| | - Jonas Forsman
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- The Swedish National Board of Forensic Medicine, Department for Forensic Psychiatry, Stockholm, Sweden
| | - Hannu Kautiainen
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
- Folkhälsan Research Center, Helsinki, Finland
| | - Allan Seppänen
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
| | - Jari Tiihonen
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Markku Lähteenvuo
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
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Kaasgaard DM, Sørensen MK, Christiansen RB, Breum UN, Asiamah N, Friis LBT, Hjorth P. Video consultation and treatment in the community smoking cessation therapy success rates in patients with mental illness: a randomized controlled trial. Nord J Psychiatry 2024; 78:272-280. [PMID: 38385357 DOI: 10.1080/08039488.2024.2318305] [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: 10/17/2023] [Accepted: 02/08/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE Smoking is the single factor with the highest impact on reducing life expectancy of patients with mental illness. Patients experience difficulty in participating in smoking cessation programs but are concerned about the impact of tobacco on their health and finances. Smoking cessation advice via videoconferencing might be an alternative to an ordinary in-person consultation. MATERIAL AND METHOD Randomized controlled trial with follow-up at 6 months. We included patients with diagnoses of schizophrenia and affective disorder from psychiatric outpatient clinics. Intervention 1 involved daily video consultations; intervention 2 was treatment as usual. RESULTS Seventy patients were included. For both/all groups/interventions, rates of smoking cessation were 45% and predictors for a 50% reduction in smoking were antipsychotic medication load [odds ratio (OR) 0.54; p = 0.045] and number of nicotine patches (OR 1.02; p = 0.06). Predictors for a reduction in the number of cigarettes to < 10 were antipsychotic medication load (OR 0.52; p = 0.04), number of nicotine patches (OR 1.01; p = 0.02) and number of cigarettes at baseline [OR 0.95 (p = 0.09); adjusted OR 0.94 (p = 0.02)]. Patients prevented weight gain during the cessation period. CONCLUSION The smoking cessation rate was high. One of the reasons for the high cessation rate was that the intervention was carried out by highly experienced and professionally qualified staff. In addition, we used free nicotine patches to increase the patients' motivation to quit smoking. It is very important that we introduce these results into our clinical work with the patients.
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Affiliation(s)
- Didde Marie Kaasgaard
- Psychiatric Department, Mental Health Services, Region of Southern Denmark, University Hospital of Southern Denmark, Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Mette Knudsgaard Sørensen
- Psychiatric Department, Mental Health Services, Region of Southern Denmark, University Hospital of Southern, Odense, Denmark
| | | | | | - Nestor Asiamah
- Division of Interdisciplinary Research and Practice, School of Health and Social Care, University of Essex, Colchester, UK
- Department of Health Promotion, Africa Centre for Epidemiology, Accra, Accra North, Ghana
| | - Lone Bülow Toft Friis
- Psychiatric Department, Mental Health Services, Region of Southern Denmark, University Hospital of Southern, Odense, Denmark
| | - Peter Hjorth
- Psychiatric Department, Mental Health Services, Region of Southern Denmark, University Hospital of Southern Denmark, Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Vajagathali M, Ramakrishnan V. Genetic predisposition of BDNF (rs6265) gene is susceptible to Schizophrenia: A prospective study and updated meta-analysis. Neurologia 2024; 39:361-371. [PMID: 38616064 DOI: 10.1016/j.nrleng.2024.03.001] [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: 09/08/2021] [Accepted: 10/28/2021] [Indexed: 04/16/2024] Open
Abstract
INTRODUCTION Genetic polymorphism in the BDNF gene has been found to cause neuronal alterations and has been identified as a causal factor for many neuropsychiatric disorders. Therefore, various neurological case-control studies and meta-analyses have been conducted to find the possible link between BDNF and susceptibility to schizophrenia. METHOD This meta-analysis gathered data from 25 case-control studies including a total of 8384 patients with schizophrenia and 8821 controls in order to identify the relationship between the rs6265 single nucleotide polymorphism and the disease, evaluating the combined odds ratio and 95% confidence intervals under 5 different genetic models. Validation followed the "Leave one out" method, and we used the Egger test and Begg's funnel plot to identify publication bias. RESULTS Research into the rs6265 (G/A) polymorphism revealed a non-significant association with schizophrenia in all 5 genetic models; in the subgroup analysis, no association was found between white and Asian populations, with a p value>.05. CONCLUSIONS Overall, the updated meta-analysis revealed that rs6265 exonic polymorphisms do not increase susceptibility to this disease. However, to better understand the pathogenesis of the disease, there is a need for further case-control studies into the BDNF polymorphism including larger sample sizes and different ethnic groups.
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Affiliation(s)
- M Vajagathali
- Human Cytogenetics and Genomics Laboratory, Faculty of Allied Health Sciences, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam 603103, Tamilnadu, India
| | - V Ramakrishnan
- Human Cytogenetics and Genomics Laboratory, Faculty of Allied Health Sciences, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam 603103, Tamilnadu, India.
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Nimmo J, Byrne R, Daskoulidou N, Watkins L, Carpanini S, Zelek W, Morgan B. The complement system in neurodegenerative diseases. Clin Sci (Lond) 2024; 138:387-412. [PMID: 38505993 PMCID: PMC10958133 DOI: 10.1042/cs20230513] [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: 10/31/2023] [Revised: 02/15/2024] [Accepted: 03/01/2024] [Indexed: 03/21/2024]
Abstract
Complement is an important component of innate immune defence against pathogens and crucial for efficient immune complex disposal. These core protective activities are dependent in large part on properly regulated complement-mediated inflammation. Dysregulated complement activation, often driven by persistence of activating triggers, is a cause of pathological inflammation in numerous diseases, including neurological diseases. Increasingly, this has become apparent not only in well-recognized neuroinflammatory diseases like multiple sclerosis but also in neurodegenerative and neuropsychiatric diseases where inflammation was previously either ignored or dismissed as a secondary event. There is now a large and rapidly growing body of evidence implicating complement in neurological diseases that cannot be comprehensively addressed in a brief review. Here, we will focus on neurodegenerative diseases, including not only the 'classical' neurodegenerative diseases such as Alzheimer's disease and Parkinson's disease, but also two other neurological diseases where neurodegeneration is a neglected feature and complement is implicated, namely, schizophrenia, a neurodevelopmental disorder with many mechanistic features of neurodegeneration, and multiple sclerosis, a demyelinating disorder where neurodegeneration is a major cause of progressive decline. We will discuss the evidence implicating complement as a driver of pathology in these diverse diseases and address briefly the potential and pitfalls of anti-complement drug therapy for neurodegenerative diseases.
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Affiliation(s)
- Jacqui Nimmo
- UK Dementia Research Institute Cardiff, Cardiff University, Cardiff CF24 4HQ, U.K
| | - Robert A.J. Byrne
- UK Dementia Research Institute Cardiff, Cardiff University, Cardiff CF24 4HQ, U.K
| | - Nikoleta Daskoulidou
- UK Dementia Research Institute Cardiff, Cardiff University, Cardiff CF24 4HQ, U.K
| | - Lewis M. Watkins
- UK Dementia Research Institute Cardiff, Cardiff University, Cardiff CF24 4HQ, U.K
| | - Sarah M. Carpanini
- UK Dementia Research Institute Cardiff, Cardiff University, Cardiff CF24 4HQ, U.K
| | - Wioleta M. Zelek
- UK Dementia Research Institute Cardiff, Cardiff University, Cardiff CF24 4HQ, U.K
| | - B. Paul Morgan
- UK Dementia Research Institute Cardiff, Cardiff University, Cardiff CF24 4HQ, U.K
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Tahmazov E, Blachier A, Nabbe P, Guillou-Landreat M, Walter M, Lemey C. Effect of early intervention for early-stage psychotic disorders on suicidal behaviours - a systematic review protocol. Front Psychiatry 2024; 15:1359764. [PMID: 38435977 PMCID: PMC10904604 DOI: 10.3389/fpsyt.2024.1359764] [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: 12/21/2023] [Accepted: 01/29/2024] [Indexed: 03/05/2024] Open
Abstract
Background The early stages of psychotic disorders correspond to the early phases of the disease and include the prodromal phase and first-episode psychosis; they constitute a period at high risk of suicidal behaviour. A long duration of untreated psychosis (DUP) is among the risk factors of suicidal behaviour identified in this early period. Many studies have shown the effectiveness of early interventions on the overall prognosis of psychotic disorders in the early stages, and early intervention strategies have been developed and tested worldwide. Several authors reported an improvement in suicidal behaviours; however, all these data have not been systematically analysed yet. The main objective of this systematic review was to collect evidence on the effect on suicidal behaviour of early interventions for patients in the early stages of psychotic disorders. Methods We will carry out a systematic review of the literature according to the PRISMA criteria by searching articles in five databases (PubMed, Cochrane, PsycINFO, Scopus, EMBASE), without restriction on the publication date. The selection criteria are: articles (any type; e.g. prospective, retrospective, controlled or uncontrolled, and literature reviews) on early interventions for psychotic disorders in the early stages with data on suicide attempts, death by suicide, suicidal ideation; articles written in English or French. Exclusion criteria are: articles on suicidal behaviours in patients with psychotic disorders in the early stages, but without early intervention, and articles on early-stage psychotic disorders without data on suicidal behaviours. Discussion If this review confirms the effectiveness on suicidal behaviours of early interventions for young patients with psychotic disorders, the development/implementation of such intervention programmes should be better promoted. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42021237833.
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Affiliation(s)
- Elkhan Tahmazov
- Unité de Recherche Clinique Intersectorielle (URCI), Service hospitalo-universitaire de psychiatrie adulte, Centre Hospitalo-Universitaire (CHU) de Brest, Hôpital de Bohars, Bohars, France
| | - Athéna Blachier
- Unité de Recherche Clinique Intersectorielle (URCI), Service hospitalo-universitaire de psychiatrie adulte, Centre Hospitalo-Universitaire (CHU) de Brest, Hôpital de Bohars, Bohars, France
| | - Patrice Nabbe
- ER 7479 SPURBO, University of Western Brittany, Brest, France
- Department of general practice – University of Western Brittany, Brest, France
| | | | - Michel Walter
- Unité de Recherche Clinique Intersectorielle (URCI), Service hospitalo-universitaire de psychiatrie adulte, Centre Hospitalo-Universitaire (CHU) de Brest, Hôpital de Bohars, Bohars, France
- ER 7479 SPURBO, University of Western Brittany, Brest, France
| | - Christophe Lemey
- Unité de Recherche Clinique Intersectorielle (URCI), Service hospitalo-universitaire de psychiatrie adulte, Centre Hospitalo-Universitaire (CHU) de Brest, Hôpital de Bohars, Bohars, France
- ER 7479 SPURBO, University of Western Brittany, Brest, France
- IMT Atlantique, Lab-STICC, Campus de Brest, Technopôle Brest-Iroise, Brest, France
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11
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Sen P, Prandovszky E, Honkanen JK, Chen O, Yolken R, Suvisaari J. Dysregulation of Microbiota in Patients With First-Episode Psychosis Is Associated With Symptom Severity and Treatment Response. Biol Psychiatry 2024; 95:370-379. [PMID: 38061464 DOI: 10.1016/j.biopsych.2023.10.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/21/2023] [Accepted: 10/23/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND The gut microbiome has been implicated in the pathogenesis of mental disorders where the gut-brain axis acts as a bidirectional communication network. METHODS Herein, we investigated the compositional and functional differences of gut microbiome between patients with first-episode psychosis (FEP) (n = 26) and healthy control participants (n = 22) using whole-genome shotgun sequencing. In addition, we assessed the oral microbiome in patients with FEP (n = 13) and listed their taxonomic diversity. RESULTS Our findings suggest that there is a dysbiosis of gut microbiota in patients with FEP. Relative abundance of Bifidobacterium adolescentis, Prevotella copri, and Turicibacter sanguinis was markedly increased (linear discriminant analysis scores [log10] > 1, and Mann-Whitney U test; false discovery rate-adjusted p values < .05) in the FEP group compared with the healthy control participants. Pathway analysis indicated that several metabolic pathways, particularly deoxyribonucleotide biosynthesis, branched-chain amino acid biosynthesis, tricarboxylic acid cycle, and fatty acid elongation and biosynthesis, were dysregulated in the FEP group compared with the healthy control group. In addition, this preliminary study was able to identify specific gut microbes (at baseline) that were predictive of weight gain in the FEP group at a 1-year follow-up. Bacteroides dorei, Bifidobacterium adolescentis, Turicibacter sanguinis, Roseburia spp., and Ruminococcus lactaris were positively associated (eXtreme gradient boosting, XGBoost regression model, Shapley additive explanations, R2 = 0.82) with weight gain. CONCLUSIONS Our findings may suggest the involvement of gut microbiota in the pathogenesis of psychosis. The benefit of modulation of the gut microbiome in the treatment of psychotic disorders should be explored further.
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Affiliation(s)
- Partho Sen
- Turku Bioscience Centre, University of Turku and Åbo Akademi University, Turku, Finland
| | - Emese Prandovszky
- Stanley Division of Developmental Neurovirology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jarno K Honkanen
- Translational Immunology Program, Research Programs Unit, University of Helsinki, Helsinki, Finland
| | - Ou Chen
- Stanley Division of Developmental Neurovirology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Robert Yolken
- Stanley Division of Developmental Neurovirology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jaana Suvisaari
- Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland; Finnish Institute for Health and Welfare, Helsinki, Finland.
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12
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Sharma A, Basera DS, Suri V, Singh SM. A Study of Hypertension and Related Biophysical and Health-related Lifestyle Behaviors in Patients Suffering from Schizophrenia. Ann Neurosci 2024; 31:28-35. [PMID: 38584984 PMCID: PMC10996874 DOI: 10.1177/09727531231158451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 01/30/2023] [Indexed: 04/09/2024] Open
Abstract
Background Schizophrenia is a life-shortening disease. The standardized mortality ratio has been higher than that of the general population, and it has doubled what it was 3-4 decades ago. This rise is mostly attributed to the increased cardiovascular risk associated with high second-generation antipsychotic (SGA) use. Evidence from the first-generation antipsychotic (FGA) era shows a lower prevalence of hypertension (HTN) but data regarding SGAs is scarce. Purpose The purpose of the study was to assess the prevalence of HTN and related factors using standardized methodology in patients with schizophrenia on treatment with SGAs. Methods A cross-sectional study through convenient sampling was done. Blood pressure, anthropometry, physical activity, and health-related lifestyle factors were assessed using the standard World Health Organization (WHO) methodology of cardiovascular survey methods and the Global Physical Activity Questionnaire (GPAQ) version 2. The prevalence of HTN, obesity, inadequate physical activity, and other demographic and clinical correlates like antipsychotic use, duration of illness, and family history of non-communicable diseases (NCDs) were studied. Results The prevalence of HTN is 20.50%, and it increases with age. SGAs with the use of a single agent are the most common. In total, 45.50% of persons with schizophrenia have a positive family history of a NCD; 22.00% and 07.50% are current tobacco and alcohol users, respectively; and 70% have abdominal obesity, and 54% have generalized obesity. Waist circumference, obesity, and family history of NCDs are significant correlates of HTN. A family history of NCDs is the most significant predictor. Conclusion The prevalence of HTN is lower than that of the general population despite the high prevalence of SGA use, obesity, and inadequate physical activity.
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Affiliation(s)
- Akhilesh Sharma
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Devendra Singh Basera
- Department of Psychiatry, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Vikas Suri
- Department of Internal medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shubh Mohan Singh
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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13
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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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14
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Kouakou MR, Cabrera-Mendoza B, Pathak GA, Cannon TD, Polimanti R. Household income does not affect the pleiotropy of schizophrenia genetic liability with mental and physical health outcomes. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.25.23296085. [PMID: 37808821 PMCID: PMC10557836 DOI: 10.1101/2023.09.25.23296085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Background and Hypothesis Individuals with schizophrenia (SCZ) suffer from comorbidities that substantially reduce their life expectancy. Socioeconomic inequalities could contribute to many of the negative health outcomes associated with SCZ. Study Design We investigated genome-wide datasets related to SCZ (52,017 cases and 75,889 controls) from the Psychiatric Genomics Consortium, household income (HI; N=361,687) from UK Biobank, and 2,202 medical endpoints assessed in up to 342,499 FinnGen participants. A phenome-wide genetic correlation analysis of SCZ and HI was performed, also assessing whether SCZ genetic correlations were influenced by HI effect on SCZ. Additionally, SCZ and HI direct effects on medical endpoints were estimated using multivariable Mendelian randomization (MR). Study Results SCZ and HI showed overlapping genetic correlations with 70 traits (p<2.89×10 -5 ), including mental health, substance use, gastrointestinal illnesses, reproductive outcomes, liver diseases, respiratory problems, and musculoskeletal phenotypes. SCZ genetic correlations with these traits were not affected by HI effect on SCZ. Considering Bonferroni multiple testing correction (p<7.14×10 -4 ), MR analysis indicated that SCZ and HI may affect medical abortion (SCZ odds ratio, OR=1.07; HI OR=0.78), panic disorder (SCZ OR=1.20; HI OR=0.60), personality disorders (SCZ OR=1.31; HI OR=0.67), substance use (SCZ OR=1.2; HI OR=0.68), and adjustment disorders (SCZ OR=1.18; HI OR=0.78). Multivariable MR analysis confirmed that SCZ effects on these outcomes were independent of HI. Conclusions The effect of SCZ genetic liability on mental and physical health may not be strongly affected by socioeconomic differences. This suggests that SCZ-specific strategies are needed to reduce negative health outcomes affecting patients and high-risk individuals.
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15
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Vochoskova K, McWhinney SR, Fialova M, Kolenic M, Spaniel F, Svancer P, Boron P, Okaji Y, Trancik P, Hajek T. Weight and metabolic changes in early psychosis-association with daily quantification of medication exposure during the first hospitalization. Acta Psychiatr Scand 2023; 148:265-276. [PMID: 37528692 DOI: 10.1111/acps.13594] [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: 02/18/2023] [Revised: 05/30/2023] [Accepted: 07/06/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND The most common causes of death in schizophrenia are cardiovascular disorders, which are closely related to metabolic syndrome/obesity. To better understand the development of metabolic alterations early in the course of illness, we quantified daily medication exposure in the first days of the first hospitalization for psychosis and related it to changes in weight and metabolic markers. STUDY DESIGN We recruited participants with first episode psychosis (FEP, N = 173) during their first psychiatric hospitalization and compared them to controls (N = 204). We prospectively collected weight, body mass index, metabolic markers, and exact daily medication exposure at admission and during hospitalization. STUDY RESULTS Individuals with FEP gained on average 0.97 ± 2.26 BMI points or 3.46 ± 7.81 kg of weight after an average of 44.6 days of their first inpatient treatment. Greater antipsychotic exposure was associated with greater BMI increase, but only in people with normal/low baseline BMI. Additional predictors of weight gain included type of medication and duration of treatment. Medication exposure was not directly related to metabolic markers, but higher BMI was associated with higher TGC, TSH, and lower HDL. Following inpatient treatment, participants with FEP had significantly higher BMI, TGC, prolactin, and lower fT4, HDL than controls. CONCLUSION During their first admission, people with FEP, especially those with normal/low baseline BMI, showed a rapid and clinically significant weight increase, which was associated with exposure to antipsychotics, and with metabolic changes consistent with metabolic syndrome. These findings emphasize weight monitoring in FEP and suggest a greater need for caution when prescribing metabolically problematic antipsychotics to people with lower BMI.
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Affiliation(s)
- Kristyna Vochoskova
- National Institute of Mental Health, Klecany, Czech Republic
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Marketa Fialova
- National Institute of Mental Health, Klecany, Czech Republic
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Marian Kolenic
- National Institute of Mental Health, Klecany, Czech Republic
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Filip Spaniel
- National Institute of Mental Health, Klecany, Czech Republic
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Patrik Svancer
- National Institute of Mental Health, Klecany, Czech Republic
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Petra Boron
- Psychiatric Hospital Bohnice, Prague, Czech Republic
| | - Yurai Okaji
- Psychiatric Hospital Bohnice, Prague, Czech Republic
| | - Pavel Trancik
- Psychiatric Hospital Bohnice, Prague, Czech Republic
| | - Tomas Hajek
- National Institute of Mental Health, Klecany, Czech Republic
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Psychiatry, Dalhousie University, Halifax, Canada
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16
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Murphy KA, Daumit GL. Establishing a Care Continuum for Cardiometabolic Conditions for Patients with Serious Mental Illness. Curr Cardiol Rep 2023; 25:193-202. [PMID: 36847991 PMCID: PMC10042919 DOI: 10.1007/s11886-023-01848-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/03/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE OF REVIEW Addressing cardiometabolic risk factors in persons with serious mental illness requires early screening and proactive medical management in both medical and mental health settings. RECENT FINDINGS Cardiovascular disease remains the leading cause of death for persons with serious mental illness (SMI), such as schizophrenia or bipolar disorder, much of which is driven by a high prevalence of metabolic syndrome, diabetes, and tobacco use. We summarize barriers and recent approaches to screening and treatment for metabolic cardiovascular risk factors within physical health and specialty mental health settings. Incorporating system-based and provider-level support within physical health and psychiatric clinical settings should contribute to improvement for screening, diagnosis, and treatment for cardiometabolic conditions for patients with SMI. Targeted education for clinicians and leveraging multi-disciplinary teams are important first steps to recognize and treat populations with SMI at risk of CVD.
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Affiliation(s)
- Karly A. Murphy
- Division of General Internal Medicine, University of California San Francisco School of Medicine, 1701 Divisidero Street, Suite 500, 94117 San Francisco, CA USA
| | - Gail L. Daumit
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD USA
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17
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Kearns Murphy C, Kemps L, McDonough C, McDonough S. Operation recovery: a feasibility study of an 8 week exercise and lifestyle programme within an Irish first episode psychosis service. IRISH JOURNAL OF OCCUPATIONAL THERAPY 2022. [DOI: 10.1108/ijot-03-2022-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose
Early interventions focusing on exercise and lifestyle are important for individuals with a diagnosis of psychosis due to increased risk of poor physical health and reduced life expectancy. This study aims to test the feasibility of a multicomponent lifestyle intervention for individuals with first episode psychosis (FEP).
Design/methodology/approach
Individuals attending an Irish FEP service were invited to engage in an eight-week programme including individual and group exercise sessions, group educational sessions and one dietician consultation. Physical activity, physical health, mental health, cognition and personal goals measures were completed pre- and post-intervention and analysed using descriptive statistics. Feasibility data was collected via a non-standardised participant questionnaire and informal data on completion of measures and engagement with the programme.
Findings
Ten participants with a diagnosis of FEP completed the intervention. Participants were satisfied with the intervention and adherence rates were high for weekly individual gym sessions but lower for group exercise and education sessions. Mean time spent engaging in physical activity increased and sedentary behaviours decreased. Participants indicated increased readiness for change with 90% moving to the action or maintenance stages of change. Participants attained 74% of their personal goals. There were no changes in average body mass index, cognition or mental health. Data relating to blood pressure, blood tests and steps was missing or incomplete.
Originality/value
This study indicates an eight-week exercise and lifestyle programme is feasible and acceptable in a clinical setting. Recommendations relating to satisfaction, clinical markers and resource requirements are made for future studies.
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18
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Antipsychotic drug prescription sequence analysis in relation to death occurrence and cardiometabolic drug usage: A retrospective longitudinal study. THE EUROPEAN JOURNAL OF PSYCHIATRY 2022. [DOI: 10.1016/j.ejpsy.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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19
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Wootten JC, Wiener JC, Blanchette PS, Anderson KK. Cancer incidence and stage at diagnosis among people with psychotic disorders: Systematic review and meta-analysis. Cancer Epidemiol 2022; 80:102233. [PMID: 35952461 DOI: 10.1016/j.canep.2022.102233] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 12/16/2022]
Abstract
Research regarding the incidence of cancer among people with psychotic disorders relative to the general population is equivocal, although the evidence suggests that they have more advanced stage cancer at diagnosis. We conducted a systematic review and meta-analysis to examine the incidence and stage at diagnosis of cancer among people with, relative to those without, psychotic disorders. We searched the MEDLINE, EMBASE, PsycINFO, and CINAHL databases. Articles were included if they reported the incidence and/or stage at diagnosis of cancer in people with psychotic disorders. Random effects meta-analyses were used to determine risk of cancer and odds of advanced stage cancer at diagnosis in people with psychosis, relative to those without psychotic disorders. A total of 40 articles were included in the review, of which, 31 were included in the meta-analyses. The pooled age-adjusted risk ratio for all cancers in people with psychotic disorders was 1.08 (95% CI: 1.01-1.15), relative to those without psychotic disorders, with significant heterogeneity by cancer site. People with psychotic disorders had a higher incidence of breast, oesophageal, colorectal, testicular, uterine, and cervical cancer, and a lower incidence of skin, prostate, and thyroid cancer. People with psychotic disorders also had 22% higher (95% CI: 2-46%) odds of metastases at diagnosis, compared to those without psychotic disorders. Our systematic review found a significant difference in overall cancer incidence among people diagnosed with psychotic disorders and people with psychotic disorders were more likely to present with advanced stage cancer at diagnosis. This finding may reflect a need for improved access to and uptake of cancer screening for patients diagnosed with psychotic disorders.
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Affiliation(s)
- Jared C Wootten
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
| | - Joshua C Wiener
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Phillip S Blanchette
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; ICES Western, London, Ontario, Canada; Division of Medical Oncology, London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada
| | - Kelly K Anderson
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; ICES Western, London, Ontario, Canada; Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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20
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Blood and Urinary Biomarkers of Antipsychotic-Induced Metabolic Syndrome. Metabolites 2022; 12:metabo12080726. [PMID: 36005598 PMCID: PMC9416438 DOI: 10.3390/metabo12080726] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/29/2022] [Accepted: 08/03/2022] [Indexed: 12/15/2022] Open
Abstract
Metabolic syndrome (MetS) is a clustering of at least three of the following five medical conditions: abdominal obesity, high blood pressure, high blood sugar, high serum triglycerides, and low serum high-density lipoprotein (HDL). Antipsychotic (AP)-induced MetS (AIMetS) is the most common adverse drug reaction (ADR) of psychiatric pharmacotherapy. Herein, we review the results of studies of blood (serum and plasma) and urinary biomarkers as predictors of AIMetS in patients with schizophrenia (Sch). We reviewed 1440 studies examining 38 blood and 19 urinary metabolic biomarkers, including urinary indicators involved in the development of AIMetS. Among the results, only positive associations were revealed. However, at present, it should be recognized that there is no consensus on the role of any particular urinary biomarker of AIMetS. Evaluation of urinary biomarkers of the development of MetS and AIMetS, as one of the most common concomitant pathological conditions in the treatment of patients with psychiatric disorders, may provide a key to the development of strategies for personalized prevention and treatment of the condition, which is considered a complication of AP therapy for Sch in clinical practice.
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21
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Mo PKH, So GYK, Lu Z, Mak WWS. The Mediating Role of Health-Promoting Behaviors on the Association between Symptom Severity and Quality of Life among Chinese Individuals with Mental Illness: A Cross-Sectional Study. Psychopathology 2022; 56:194-205. [PMID: 35901786 DOI: 10.1159/000525495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 05/06/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Research has shown that people with mental illnesses (PMI) are found to show poorer lifestyle than the general population. Yet, the effect of their psychiatric symptoms in the association between gender difference, health-promoting behaviors, and quality of life have received little attention. The present study examined the association between symptom severity, health-promoting behaviors, and quality of life among PMI in Hong Kong. Gender difference on the association between these variables was also examined. METHOD A cross-sectional survey was conducted among 591 individuals with DSM-IV-TR Axis 1 diagnosis recruited from the community. RESULTS Results from MANOVA showed that PMI with more severe psychiatric symptoms engaged in a significantly lower level of health-promoting behaviors and reported a lower level of quality of life. Results from structural equation modeling showed that health-promoting behaviors mediated the association between psychiatric symptoms and quality of life. Multigroup analyses showed that the association between psychiatric symptoms and health-promoting behaviors was stronger among female participants, while the association between health-promoting behaviors and quality of life was stronger among male participants. DISCUSSION/CONCLUSION Despite clear evidence suggesting symptom severity to be negatively correlated with quality of life, the underlying mechanism has been less clear. There is a need to promote health-promoting behaviors in order to improve the quality of life of PMI. Gender-specific interventions are warranted.
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Affiliation(s)
- Phoenix K H Mo
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Georgina Y K So
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Zhihui Lu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Winnie W S Mak
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China
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22
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Sommerfeld DH, Brunner AM, Glorioso D, Lee EE, Ibarra C, Zunshine E, Daly RE, Zoumas C, Jeste DV. Improving Healthy Living in Residential Care Facilities: Feasibility, Acceptability, and Appropriateness of Implementing a Multicomponent Intervention for Diabetes Risk Reduction in Adults with Serious Mental Illnesses. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2022; 49:646-657. [PMID: 35113264 PMCID: PMC8820366 DOI: 10.1007/s10488-022-01189-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 11/28/2022]
Abstract
Persons with serious mental illnesses experience high rates of medical comorbidity, especially diabetes. This study examined initial implementation feasibility, acceptability, and appropriateness of a new 6-month Multicomponent Intervention for Diabetes risk reduction in Adults with Serious mental illnesses (MIDAS) among persons in residential care facilities (RCFs). We conducted a mixed-methods study using four types of quantitative and qualitative data sources (administrative data; structured facility-level observations; resident assessments including blood-based biomarkers, 24-h dietary recalls, and self-report physical activity; and focus groups/interviews with staff and participants), to assess evidence of and factors affecting intervention feasibility, acceptability, and appropriateness. It was feasible to provide a high percentage of MIDAS class sessions (mean 50 of 52 intended sessions delivered) and make nutrition-related RCF changes (substitutions for healthier food items and reduced portion sizes). Class attendance rates and positive feedback from residents and staff provided evidence of MIDAS acceptability and appropriateness for addressing identified health needs. The residents who attended ≥ 85% of the sessions had greater improvement in several desired outcomes compared to others. Implementing a fully integrated MIDAS model with more extensive changes to facilities and more fundamental health changes among residents was more challenging. While the study found evidence to support feasibility, acceptability, and appropriateness of individual MIDAS components, some challenges for full implementation and success in obtaining immediate health benefits were also apparent. The study results highlight the need for improving health among RCF populations and will inform MIDAS adaptations designed to improve intervention fit and effectiveness outcomes.
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Affiliation(s)
- David H Sommerfeld
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Amy M Brunner
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Danielle Glorioso
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, 92093, USA
| | - Ellen E Lee
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, 92093, USA
- VA San Diego Healthcare System, San Diego, CA, 92161, USA
| | - Cynthia Ibarra
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, 92093, USA
| | - Elizabeth Zunshine
- Moores Cancer Center, University of California San Diego, La Jolla, CA, 92037, USA
| | - Rebecca E Daly
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, 92093, USA
| | - Christine Zoumas
- Moores Cancer Center, University of California San Diego, La Jolla, CA, 92037, USA
| | - Dilip V Jeste
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, 92093, USA.
- Department of Neurosciences, University of California San Diego, La Jolla, CA, 92093, USA.
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23
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Wong TY, Chan SKW, Cheung C, Lai Ming Hui C, Suen YN, Chang WC, Lee EHM, Chen EYH. Dynamic Patterns of Symptoms and Functioning in Predicting Deliberate Self-harm in Patients with First-Episode Schizophrenia-Spectrum Disorders Over 3 Years. Schizophr Bull 2022; 48:1043-1052. [PMID: 35689554 PMCID: PMC9434452 DOI: 10.1093/schbul/sbac057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Patients with schizophrenia have a significant risk of self-harm. We aimed to explore the dynamic relationship between symptomatology, functioning and deliberate self-harm (DSH) and evaluate the feasibility of developing a self-harm risk prediction tool for patients with first-episode schizophrenia (FES). METHODS Patients with FES (n = 1234) were followed up for 36 months. Symptomatology, functioning, treatment adherence and self-harm information were obtained monthly over the follow-up period. A time-varying vector autoregressive (VAR) model was used to study the contribution of clinical variables to self-harm over the 36th month. Random forest models for self-harm were established to classify the individuals with self-harm and predict future self-harm events. RESULTS Over a 36-month period, 187 patients with FES had one or more self-harm events. The depressive symptoms contributed the most to self-harm prediction during the first year, while the importance of positive psychotic symptoms increased from the second year onwards. The random forest model with all static information and symptom instability achieved a good area under the receiver operating characteristic curve (AUROC = 0.77 ± 0.023) for identifying patients with DSH. With a sliding window analysis, the averaged AUROC of predicting a self-event was 0.65 ± 0.102 (ranging from 0.54 to 0.78) with the best model being 6-month predicted future 6-month self-harm for month 11-23 (AUROC = 0.7). CONCLUSIONS Results highlight the importance of the dynamic relationship of depressive and positive psychotic symptoms with self-harm and the possibility of self-harm prediction in FES with longitudinal clinical data.
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Affiliation(s)
| | - Sherry Kit Wa Chan
- To whom correspondence should be addressed; Room 219, New Clinical Building, Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR; tel: (852) 2255 4488, fax: (852) 2255 1345, e-mail:
| | - Charlton Cheung
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - Christy Lai Ming Hui
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - Yi Nam Suen
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - Wing Chung Chang
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR
| | - Edwin Ho Ming Lee
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - Eric Yu Hai Chen
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR
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24
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Coentre R, Levy P, Góis C, Figueira ML. Metabolic syndrome following a first episode of psychosis: results of a 1-year longitudinal study conducted in metropolitan Lisbon, Portugal. J Int Med Res 2022; 50:3000605221106703. [PMID: 35726606 PMCID: PMC9218473 DOI: 10.1177/03000605221106703] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective We aimed to assess the prevalence and course of metabolic syndrome (MetS) and the associated metabolic parameters during the year following a first episode pf psychosis (FEP). Methods We performed a 1-year longitudinal observation of 60 patients who experienced FEP. MetS was defined using the modified definition of the National Cholesterol Education Program Adult Treatment Panel III. We assessed the metabolic parameters and socio-demographic and psychopathological data for the participants. Results The mean age of the participants was 27.1 years, and 33.3% of them were women. There was an increase in the prevalence of MetS from 6.7% to 11.7% during the year following the baseline assessment during the year following the baseline assessment (p = 0.250). There were also significant increases in the prevalences of abnormal triglyceride concentration, waist circumference, and high-density lipoprotein (HDL)-cholesterol concentration during this period. In addition, there was a considerable worsening of the metabolic profile of the participants. No baseline parameters were identified to be predictors of MetS over the 1-year follow-up period. Conclusions We can conclude that metabolic abnormalities are common in patients with FEP and that these rapidly worsen during the first year following the diagnosis of FEP. Studies on interventions are needed to reduce metabolic risk to cardiovascular diseases following the FEP.
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Affiliation(s)
- Ricardo Coentre
- Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Department of Psychiatry, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - Pedro Levy
- Department of Psychiatry, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - Carlos Góis
- Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Department of Psychiatry, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
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25
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Finlay S, Rudd D, McDermott B, Sarnyai Z. Allostatic load and systemic comorbidities in psychiatric disorders. Psychoneuroendocrinology 2022; 140:105726. [PMID: 35339811 DOI: 10.1016/j.psyneuen.2022.105726] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/16/2022] [Accepted: 03/11/2022] [Indexed: 12/11/2022]
Abstract
Psychiatric disorders are complex, disabling, and chronic conditions that are often accompanied by one or more systemic medical comorbidities. In this narrative review, we provide an overview of the allostatic load concept, which represents a multi-system dysregulation in response to chronic stress and link it to systemic comorbidities associated with psychiatric disorders. We synthesized published literature gathered using Medline (Ovid), Scopus, and PsychInfo and identified a high frequency of systemic comorbidities for both mood and psychotic disorders. The identified cardiovascular, metabolic, and immune comorbidities may represent the result of chronic wear and tear caused by a complex interaction between chronic psychosocial stress, health risk behaviors, pharmacological stressors, and the biological systems involved in the development of allostatic load. These findings support the notion that psychiatric disorders should be re-conceptualized as systemic disorders, affecting the brain and systemic biological pathways in an interconnected fashion to result in systemic comorbidities. We suggest that the multi-systemic and multi-dimensional approach that drives the allostatic load concept should be considered for understanding comorbidities in vulnerable psychiatric patients.
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Affiliation(s)
- Sabine Finlay
- Laboratory of Psychiatric Neuroscience, Centre for Molecular Therapeutics, James Cook University, Townsville, Queensland, Australia; Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia; College of Public Health, Medical & Veterinary Sciences, James Cook University, Queensland, Australia
| | - Donna Rudd
- Laboratory of Psychiatric Neuroscience, Centre for Molecular Therapeutics, James Cook University, Townsville, Queensland, Australia; Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia; College of Public Health, Medical & Veterinary Sciences, James Cook University, Queensland, Australia
| | - Brett McDermott
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Zoltán Sarnyai
- Laboratory of Psychiatric Neuroscience, Centre for Molecular Therapeutics, James Cook University, Townsville, Queensland, Australia; Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia; College of Public Health, Medical & Veterinary Sciences, James Cook University, Queensland, Australia.
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26
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Ali S, Santomauro D, Ferrari AJ, Charlson F. Excess mortality in severe mental disorders: A systematic review and meta-regression. J Psychiatr Res 2022; 149:97-105. [PMID: 35259666 DOI: 10.1016/j.jpsychires.2022.02.036] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/01/2022] [Accepted: 02/28/2022] [Indexed: 12/11/2022]
Abstract
The excess mortality observed in people with severe mental disorders (SMD) has not improved over time and is not captured in estimates of disease burden. This study aimed to improve upon previous analytic approaches to account for potential sources of heterogeneity in pooled mortality estimates. A systematic review of studies examining excess mortality in people with psychotic disorders and bipolar disorder was conducted. PubMed, EMBASE and PsycINFO were searched from January 1, 1980 to 31/12/20. Studies were eligible if they were longitudinal; the study population was diagnosed according to established criteria, not restricted to subgroups and the disorder was primary and not acute or transient; and mortality was reported in comparison to the general population or a control group without SMD. Meta-regression models were used to calculate pooled relative risks (RRs) of all-cause and cause-specific mortality adjusted for study- and population-level covariates. Risk of bias was assessed using an adaptation of the Newcastle-Ottawa scale. A total of 76 studies were included in the analyses. Covariates incorporated into the final models included age, sex, population type and mid-year. The adjusted RR for all-cause mortality in schizophrenia was 2.89 (95% CI 2.50 to 3.34) and 2.51 (95%CI 2.10 to 3.00) for bipolar disorder. There were larger RRs for broader categories of psychotic disorders. Mortality was elevated in each cause of death examined. Most of the heterogeneity between studies could not be accounted for. Future research should investigate underlying causal pathways and find ways to incorporate the excess mortality associated with SMD into global health estimates.
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Affiliation(s)
- Suhailah Ali
- School of Public Health, The University of Queensland, Brisbane, Australia; Queensland Centre for Mental Health Research, Brisbane, Australia.
| | - Damian Santomauro
- School of Public Health, The University of Queensland, Brisbane, Australia; Queensland Centre for Mental Health Research, Brisbane, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Alize J Ferrari
- School of Public Health, The University of Queensland, Brisbane, Australia; Queensland Centre for Mental Health Research, Brisbane, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Fiona Charlson
- School of Public Health, The University of Queensland, Brisbane, Australia; Queensland Centre for Mental Health Research, Brisbane, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
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27
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Lambert AM, Parretti HM, Pearce E, Price MJ, Riley M, Ryan R, Tyldesley-Marshall N, Avşar TS, Matthewman G, Lee A, Ahmed K, Odland ML, Correll CU, Solmi M, Marshall T. Temporal trends in associations between severe mental illness and risk of cardiovascular disease: A systematic review and meta-analysis. PLoS Med 2022; 19:e1003960. [PMID: 35439243 PMCID: PMC9017899 DOI: 10.1371/journal.pmed.1003960] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 03/08/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Severe mental illness (SMI; schizophrenia, bipolar disorders (BDs), and other nonorganic psychoses) is associated with increased risk of cardiovascular disease (CVD) and CVD-related mortality. To date, no systematic review has investigated changes in population level CVD-related mortality over calendar time. It is unclear if this relationship has changed over time in higher-income countries with changing treatments. METHODS AND FINDINGS To address this gap, a systematic review was conducted, to assess the association between SMI and CVD including temporal change. Seven databases were searched (last: November 30, 2021) for cohort or case-control studies lasting ≥1 year, comparing frequency of CVD mortality or incidence in high-income countries between people with versus without SMI. No language restrictions were applied. Random effects meta-analyses were conducted to compute pooled hazard ratios (HRs) and rate ratios, pooled standardised mortality ratios (SMRs), pooled odds ratios (ORs), and pooled risk ratios (RRs) of CVD in those with versus without SMI. Temporal trends were explored by decade. Subgroup analyses by age, sex, setting, world region, and study quality (Newcastle-Ottawa scale (NOS) score) were conducted. The narrative synthesis included 108 studies, and the quantitative synthesis 59 mortality studies (with (≥1,841,356 cases and 29,321,409 controls) and 28 incidence studies (≥401,909 cases and 14,372,146 controls). The risk of CVD-related mortality for people with SMI was higher than controls across most comparisons, except for total CVD-related mortality for BD and cerebrovascular accident (CVA) for mixed SMI. Estimated risks were larger for schizophrenia than BD. Pooled results ranged from SMR = 1.55 (95% confidence interval (CI): 1.33 to 1.81, p < 0.001), for CVA in people with BD to HR/rate ratio = 2.40 (95% CI: 2.25 to 2.55, p < 0.001) for CVA in schizophrenia. For schizophrenia and BD, SMRs and pooled HRs/rate ratios for CHD and CVD mortality were larger in studies with outcomes occurring during the 1990s and 2000s than earlier decades (1980s: SMR = 1.14, 95% CI: 0.57 to 2.30, p = 0.71; 2000s: SMR = 2.59, 95% CI: 1.93 to 3.47, p < 0.001 for schizophrenia and CHD) and in studies including people with younger age. The incidence of CVA, CVD events, and heart failure in SMI was higher than controls. Estimated risks for schizophrenia ranged from HR/rate ratio 1.25 (95% CI: 1.04 to 1.51, p = 0.016) for total CVD events to rate ratio 3.82 (95% CI: 3.1 to 4.71, p < 0.001) for heart failure. Incidence of CHD was higher in BD versus controls. However, for schizophrenia, CHD was elevated in higher-quality studies only. The HR/rate ratios for CVA and CHD were larger in studies with outcomes occurring after the 1990s. Study limitations include the high risk of bias of some studies as they drew a comparison cohort from general population rates and the fact that it was difficult to exclude studies that had overlapping populations, although attempts were made to minimise this. CONCLUSIONS In this study, we found that SMI was associated with an approximate doubling in the rate ratio of CVD-related mortality, particularly since the 1990s, and in younger groups. SMI was also associated with increased incidence of CVA and CHD relative to control participants since the 1990s. More research is needed to clarify the association between SMI and CHD and ways to mitigate this risk.
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Affiliation(s)
- Amanda M Lambert
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Helen M Parretti
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Emma Pearce
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Malcolm J Price
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom.,NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, United Kingdom
| | - Mark Riley
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Ronan Ryan
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | | | - Tuba Saygın Avşar
- Department of Applied Health Research, University College London, London, United Kingdom
| | - Gemma Matthewman
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Alexandra Lee
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Khaled Ahmed
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Maria Lisa Odland
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom.,Department of Obstetrics and Gynecology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Malawi-Liverpool-Wellcome Trust Research Institute, Blantyre, Malawi.,Institute of Life Course and Medical Sciences, University of Liverpool, United Kingdom
| | - Christoph U Correll
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, New York, United States of America.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, New York, United States of America.,Charité Universitätsmedizin Berlin, Department of Child and Adolescent Psychiatry, Berlin, Germany
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ontario, Canada.,Department of Mental Health, The Ottawa Hospital, Ontario, Canada.,Ottawa Hospital Research Institute (OHRI), Clinical Epidemiology Program, University of Ottawa, Ottawa, Ontario, Canada
| | - Tom Marshall
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
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28
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Ryan MC, Hong LE, Hatch KS, Gao S, Chen S, Haerian K, Wang J, Goldwaser EL, Du X, Adhikari BM, Bruce H, Hare S, Kvarta MD, Jahanshad N, Nichols TE, Thompson PM, Kochunov P. The additive impact of cardio-metabolic disorders and psychiatric illnesses on accelerated brain aging. Hum Brain Mapp 2022; 43:1997-2010. [PMID: 35112422 PMCID: PMC8933252 DOI: 10.1002/hbm.25769] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 11/28/2021] [Accepted: 12/28/2021] [Indexed: 12/24/2022] Open
Abstract
Severe mental illnesses (SMI) including major depressive disorder (MDD), bipolar disorder (BD), and schizophrenia spectrum disorder (SSD) elevate accelerated brain aging risks. Cardio‐metabolic disorders (CMD) are common comorbidities in SMI and negatively impact brain health. We validated a linear quantile regression index (QRI) approach against the machine learning “BrainAge” index in an independent SSD cohort (N = 206). We tested the direct and additive effects of SMI and CMD effects on accelerated brain aging in the N = 1,618 (604 M/1,014 F, average age = 63.53 ± 7.38) subjects with SMI and N = 11,849 (5,719 M/6,130 F; 64.42 ± 7.38) controls from the UK Biobank. Subjects were subdivided based on diagnostic status: SMI+/CMD+ (N = 665), SMI+/CMD− (N = 964), SMI−/CMD+ (N = 3,765), SMI−/CMD− (N = 8,083). SMI (F = 40.47, p = 2.06 × 10−10) and CMD (F = 24.69, p = 6.82 × 10−7) significantly, independently impacted whole‐brain QRI in SMI+. SSD had the largest effect (Cohen’s d = 1.42) then BD (d = 0.55), and MDD (d = 0.15). Hypertension had a significant effect on SMI+ (d = 0.19) and SMI− (d = 0.14). SMI effects were direct, independent of MD, and remained significant after correcting for effects of antipsychotic medications. Whole‐brain QRI was significantly (p < 10−16) associated with the volume of white matter hyperintensities (WMH). However, WMH did not show significant association with SMI and was driven by CMD, chiefly hypertension (p < 10−16). We used a simple and robust index, QRI, the demonstrate additive effect of SMI and CMD on accelerated brain aging. We showed a greater effect of psychiatric illnesses on QRI compared to cardio‐metabolic illness. Our findings suggest that subjects with SMI should be among the targets for interventions to protect against age‐related cognitive decline.
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Affiliation(s)
- Meghann C Ryan
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - L Elliot Hong
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Kathryn S Hatch
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Si Gao
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Shuo Chen
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA.,Division of Biostatistics and Bioinformatics, Department of Public Health and Epidemiology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Krystl Haerian
- Department of Clinical Research and Leadership, School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia, USA
| | - Jingtao Wang
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA.,Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Eric L Goldwaser
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Xiaoming Du
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Bhim M Adhikari
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Heather Bruce
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Stephanie Hare
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Mark D Kvarta
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Neda Jahanshad
- Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Thomas E Nichols
- Nuffield Department of Population Health of the University of Oxford, Oxford, UK
| | - Paul M Thompson
- Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Peter Kochunov
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
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29
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Vajagathali M, Ramakrishnan V. Genetic predisposition of BDNF (rs6265) gene is susceptible to Schizophrenia: A prospective study and updated meta-analysis. Neurologia 2022. [DOI: 10.1016/j.nrl.2021.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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30
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McGinty EE, Presskreischer R, Breslau J, Brown JD, Domino ME, Druss BG, Horvitz-Lennon M, Murphy KA, Pincus HA, Daumit GL. Improving Physical Health Among People With Serious Mental Illness: The Role of the Specialty Mental Health Sector. Psychiatr Serv 2021; 72:1301-1310. [PMID: 34074150 PMCID: PMC8570967 DOI: 10.1176/appi.ps.202000768] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
People with serious mental illness die 10-20 years earlier, compared with the overall population, and the excess mortality is driven by undertreated physical health conditions. In the United States, there is growing interest in models integrating physical health care delivery, management, or coordination into specialty mental health programs, sometimes called "reverse integration." In November 2019, the Johns Hopkins ALACRITY Center for Health and Longevity in Mental Illness convened a forum of 25 experts to discuss the current state of the evidence on integrated care models based in the specialty mental health system and to identify priorities for future research, policy, and practice. This article summarizes the group's conclusions. Key research priorities include identifying the active ingredients in multicomponent integrated care models and developing and validating integration performance metrics. Key policy and practice recommendations include developing new financing mechanisms and implementing strategies to build workforce and data capacity. Forum participants also highlighted an overarching need to address socioeconomic risks contributing to excess mortality among adults with serious mental illness.
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Affiliation(s)
- Emma E McGinty
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (McGinty, Presskreischer); RAND Corporation, Pittsburgh (Breslau) and Boston (Horvitz-Lennon); Mathematica, Washington, D.C. (Brown); Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Domino); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Pincus)
| | - Rachel Presskreischer
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (McGinty, Presskreischer); RAND Corporation, Pittsburgh (Breslau) and Boston (Horvitz-Lennon); Mathematica, Washington, D.C. (Brown); Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Domino); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Pincus)
| | - Joshua Breslau
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (McGinty, Presskreischer); RAND Corporation, Pittsburgh (Breslau) and Boston (Horvitz-Lennon); Mathematica, Washington, D.C. (Brown); Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Domino); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Pincus)
| | - Jonathan D Brown
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (McGinty, Presskreischer); RAND Corporation, Pittsburgh (Breslau) and Boston (Horvitz-Lennon); Mathematica, Washington, D.C. (Brown); Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Domino); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Pincus)
| | - Marisa Elena Domino
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (McGinty, Presskreischer); RAND Corporation, Pittsburgh (Breslau) and Boston (Horvitz-Lennon); Mathematica, Washington, D.C. (Brown); Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Domino); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Pincus)
| | - Benjamin G Druss
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (McGinty, Presskreischer); RAND Corporation, Pittsburgh (Breslau) and Boston (Horvitz-Lennon); Mathematica, Washington, D.C. (Brown); Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Domino); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Pincus)
| | - Marcela Horvitz-Lennon
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (McGinty, Presskreischer); RAND Corporation, Pittsburgh (Breslau) and Boston (Horvitz-Lennon); Mathematica, Washington, D.C. (Brown); Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Domino); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Pincus)
| | - Karly A Murphy
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (McGinty, Presskreischer); RAND Corporation, Pittsburgh (Breslau) and Boston (Horvitz-Lennon); Mathematica, Washington, D.C. (Brown); Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Domino); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Pincus)
| | - Harold Alan Pincus
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (McGinty, Presskreischer); RAND Corporation, Pittsburgh (Breslau) and Boston (Horvitz-Lennon); Mathematica, Washington, D.C. (Brown); Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Domino); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Pincus)
| | - Gail L Daumit
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (McGinty, Presskreischer); RAND Corporation, Pittsburgh (Breslau) and Boston (Horvitz-Lennon); Mathematica, Washington, D.C. (Brown); Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Domino); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Pincus)
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Idrus F, Singara T, Sunarto D, Syamsuddin S, Lisal ST. Abnormalities in Glucose Blood Level during Antipsychotic Treatment in Schizophrenia Patients. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Schizophrenia is one of the mental disorder with many problematic issues, in both psychologically and socially. This disease requires provision of long-term antipsychotic therapy, hence could rise other potential health problems. Antipsychotic treatment can cause serious glucometabolic side-effects, including type 2 diabetes and hyperglycemic emergency. Recent attention has also been focused on antipsychotic-induced hyperglycemic emergencies experienced by new users of typical and atypical antipsychotic. Patients treated with atypical APDs have ~10 times higher risk in developing hyperglycaemic emergencies. In our pre-eliminary study, hyperglycemia condition in new patients occurs in four in seven patients who received typical and atypical antipsychotics. This condition is often overlooked and is not routinely evaluated. Moreover, it can develop into diabetes and increase the risk of morbidity and mortality in schizophrenia patients. In this study, we would like to determine the acute effects of metabolic (hyperglycemia) in patients treated with antipsychotic (Risperidone and Haloperidol) Measurement of blood sugar levels was performed in groups treated with haloperidol (N = 15) and treated with risperidone (N = 15). Plasma samples were taken at the beginning of treatment, in week IV, and in week VIII. The measurement of glucose levels was performed after meal and in early morning before breakfast (fasting blood glucose level 8 hours).
Results: The blood sugar level after meals was significantly higher in the Risperidone group compared to the Haloperidol group (p <0.001) after IV and VIII weeks. Meanwhile, the fasting blood sugar level was significantly higher in the Risperidone group compared to the Haloperidol group after VIII weeks of treatment ( p <0.001).
Conclusions: Both antipsychotics can cause an increase in blood sugar levels. Treatment with Risperidone significantly increased the blood sugar levels compared to treatment with haloperidol. Measurement of blood sugar level is needed to monitor the metabolic effect of antipsychotic, especially in patients treated with Risperidone. It is necessary to have dietary regulation and physical activities to prevent undesired metabolic side effects.
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Palmer BW, Shir C, Chang H, Mulvaney M, Hall JMH, Shu IW, Jin H, Lohr JB. Increased Prevalence of Metabolic Syndrome in Veterans with PTSD Untreated with Antipsychotic Medications. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2021; 5:10.1080/00207411.2021.1965398. [PMID: 34711996 PMCID: PMC8547317 DOI: 10.1080/00207411.2021.1965398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Post-Traumatic Stress Disorder (PTSD) is not solely a psychiatric disorder; it also includes significant medical morbidity. Although there is evidence of increased risk of metabolic syndrome (MetS) in PTSD, the interpretation of previous studies is confounded by inclusion of people on antipsychotic medications, which independently cause increased MetS. In this study we investigated whether Veterans with PTSD not treated with antipsychotic medications (n=115) demonstrate increased MetS compared to an age-comparable group of people from the U.S. National Health and Nutrition Examination Survey (NHNES; n=1005). Using standardized criteria (abnormal values in 3 out of the 5 domains of obesity, hypertension, high density lipoprotein, triglyceride and fasting glucose concentrations) we compared the prevalence of MetS across groups. Relative to the NHNES group, a significantly higher proportion of the Veteran PTSD group met criteria for MetS (26.9% vs. 41.7%) with a higher proportion of abnormal values in four out of five MetS domains (excepting glucose). Our results suggest that the elevation of MetS associated with PTSD cannot be fully explained by iatrogenic effects of antipsychotic medication. We suggest that extra attention be devoted to the clinical management of metabolic risk factors for morbidity in patients with PTSD.
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Affiliation(s)
- Barton W. Palmer
- Center of Excellence for Stress and Mental Health; Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Catherine Shir
- School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Hang Chang
- Center of Excellence for Stress and Mental Health; Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Mallory Mulvaney
- Center of Excellence for Stress and Mental Health; Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Joshua M. H. Hall
- Department of Psychiatry, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - I-Wei Shu
- Department of Psychiatry, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Hua Jin
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Department of Psychiatry, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - James B. Lohr
- Center of Excellence for Stress and Mental Health; Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
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Nguyen TT, Hathaway H, Kosciolek T, Knight R, Jeste DV. Gut microbiome in serious mental illnesses: A systematic review and critical evaluation. Schizophr Res 2021; 234:24-40. [PMID: 31495702 PMCID: PMC7056547 DOI: 10.1016/j.schres.2019.08.026] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/19/2019] [Accepted: 08/22/2019] [Indexed: 02/08/2023]
Abstract
Schizophrenia and bipolar disorder (BD) are associated with debilitating psychiatric and cognitive dysfunction, worse health outcomes, and shorter life expectancies. The pathophysiological understanding of and therapeutic resources for these neuropsychiatric disorders are still limited. Humans harbor over 1000 unique bacterial species in our gut, which have been linked to both physical and mental/cognitive health. The gut microbiome is a novel and promising avenue to understand the attributes of psychiatric diseases and, potentially, to modify them. Building upon our previous work, this systematic review evaluates the most recent evidence of the gut microbiome in clinical populations with serious mental illness (SMI). Sixteen articles that met our selection criteria were reviewed, including cross-sectional cohort studies and longitudinal treatment trials. All studies reported alterations in the gut microbiome of patients with SMI compared to non-psychiatric comparison subjects (NCs), and beta-diversity was consistently reported to be different between schizophrenia and NCs. Ruminococcaceae and Faecalibacterium were relatively decreased in BD, and abundance of Ruminococcaceae was reported across several investigations of SMI to be associated with better clinical characteristics. Lactic acid bacteria were relatively more abundant in SMI and associated with worse clinical outcomes. There was very limited evidence for the efficacy of probiotic or prebiotic interventions in SMI. As microbiome research in psychiatry is still nascent, the extant literature has several limitations. We critically evaluate the current data, including experimental approaches. There is a need for more unified methodological standards in order to arrive at robust biological understanding of microbial contributions to SMI.
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Affiliation(s)
- Tanya T Nguyen
- Department of Psychiatry, University of California San Diego, CA, United States of America; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, CA, United States of America.
| | - Hugh Hathaway
- Medical Sciences Division, University of Oxford, Oxford, United Kingdom; Department of Pediatrics, University of California San Diego, CA, United States of America
| | - Tomasz Kosciolek
- Department of Pediatrics, University of California San Diego, CA, United States of America; Małopolska Centre of Biotechnology, Jagiellonian University, Kraków, Poland
| | - Rob Knight
- Department of Pediatrics, University of California San Diego, CA, United States of America; Department of Computer Science and Engineering, University of California San Diego, CA, United States of America; Department of Bioengineering, University of California San Diego, CA, United States of America; Center for Microbiome Innovation, University of California San Diego, CA, United States of America
| | - Dilip V Jeste
- Department of Psychiatry, University of California San Diego, CA, United States of America; Center for Microbiome Innovation, University of California San Diego, CA, United States of America; Department of Neurosciences, University of California San Diego, CA, United States of America; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, CA, United States of America
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Kvarta MD, Chiappelli J, West J, Goldwaser EL, Bruce HA, Ma Y, Kochunov P, Hatch K, Gao S, Jones A, O'Neill H, Du X, Hong LE. Aberrant anterior cingulate processing of anticipated threat as a mechanism for psychosis. Psychiatry Res Neuroimaging 2021; 313:111300. [PMID: 34010783 PMCID: PMC8206034 DOI: 10.1016/j.pscychresns.2021.111300] [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: 12/31/2020] [Revised: 04/26/2021] [Accepted: 05/07/2021] [Indexed: 10/21/2022]
Abstract
Stress and abnormal stress response are associated with schizophrenia spectrum disorder (SSD), but the brain mechanisms linking stress to symptomatology remain unclear. In this study, we used a stress-based functional neuroimaging task, reverse-translated from preclinical studies, to test the hypothesis that abnormal corticolimbic processing of stressful threat anticipation is associated with psychosis and affective symptoms in SSD. Participants underwent an MRI-compatible ankle-shock task (AST) in which the threat of mild electrical shock was anticipated. We compared functional brain activations during anticipatory threat periods from N = 18 participants with SSD (10 M/8F) to those from N = 12 community controls (9 M/3F). After family-wise error correction, only one region, the ventral anterior cingulate cortex (vACC), showed significantly reduced activation compared with controls. vACC activation significantly correlated with clinical symptoms measured by the Brief Psychiatric Rating Scale total score (r = 0.54) and the psychosis subscale (r = 0.71), and inversely correlated with trait depression measured by the Maryland Trait and State Depression scale (r=-0.48). Deficient activation in vACC under stress of anticipated threat may lead to aberrant interpretation of such threat, contributing to psychosis and mood symptoms in SSD. This experimental paradigm has translational potential and may identify circuitry-level mechanisms of stress-related mental illness, leading to more targeted treatment.
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Affiliation(s)
- Mark D Kvarta
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228 , United States.
| | - Joshua Chiappelli
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228 , United States
| | - Jeffrey West
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228 , United States
| | - Eric L Goldwaser
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228 , United States
| | - Heather A Bruce
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228 , United States
| | - Yizhou Ma
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228 , United States
| | - Peter Kochunov
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228 , United States
| | - Kathryn Hatch
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228 , United States
| | - Si Gao
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228 , United States
| | - Aaron Jones
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228 , United States
| | - Hugh O'Neill
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228 , United States
| | - Xiaoming Du
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228 , United States
| | - L Elliot Hong
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228 , United States
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Mittal VA, Ellman LM, Strauss GP, Walker EF, Corlett PR, Schiffman J, Woods SW, Powers AR, Silverstein SM, Waltz JA, Zinbarg R, Chen S, Williams T, Kenney J, Gold JM. Computerized Assessment of Psychosis Risk. JOURNAL OF PSYCHIATRY AND BRAIN SCIENCE 2021; 6:e210011. [PMID: 34307899 PMCID: PMC8302046 DOI: 10.20900/jpbs.20210011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Early detection and intervention with young people at clinical high risk (CHR) for psychosis is critical for prevention efforts focused on altering the trajectory of psychosis. Early CHR research largely focused on validating clinical interviews for detecting at-risk individuals; however, this approach has limitations related to: (1) specificity (i.e., only 20% of CHR individuals convert to psychosis) and (2) the expertise and training needed to administer these interviews is limited. The purpose of our study is to develop the computerized assessment of psychosis risk (CAPR) battery, consisting of behavioral tasks that require minimal training to administer, can be administered online, and are tied to the neurobiological systems and computational mechanisms implicated in psychosis. The aims of our study are as follows: (1A) to develop a psychosis-risk calculator through the application of machine learning (ML) methods to the measures from the CAPR battery, (1B) evaluate group differences on the risk calculator score and test the hypothesis that the risk calculator score of the CHR group will differ from help-seeking and healthy controls, (1C) evaluate how baseline CAPR battery performance relates to symptomatic outcome two years later (i.e., conversion and symptomatic worsening). These aims will be explored in 500 CHR participants, 500 help-seeking individuals, and 500 healthy controls across the study sites. This project will provide a next-generation CHR battery, tied to illness mechanisms and powered by cutting-edge computational methods that can be used to facilitate the earliest possible detection of psychosis risk.
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Affiliation(s)
- Vijay A. Mittal
- Institutes for Policy Research (IPR) and Innovations in Developmental Sciences (DevSci), Departments of Psychology, Psychiatry, Medical Social Sciences, Northwestern University, Evanston, IL 60208, USA
| | - Lauren M. Ellman
- Department of Psychology, Temple University, Philadelphia, PA 19122, USA
| | - Gregory P. Strauss
- Departments of Psychology and Neuroscience, University of Georgia, Athens, GA 30602, USA
| | - Elaine F. Walker
- Department of Psychology and Program in Neuroscience, Emory University, Atlanta, GA 30322, USA
| | | | - Jason Schiffman
- Department of Psychological Science, 4201 Social and Behavioral Sciences Gateway, University of California, Irvine, CA 92697, USA
| | - Scott W. Woods
- Department of Psychiatry, Yale University, New Haven, CT 06519, USA
| | - Albert R. Powers
- Department of Psychiatry, Yale University, New Haven, CT 06519, USA
| | - Steven M. Silverstein
- Center for Visual Science, Departments of Psychiatry, Neuroscience and Ophthalmology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - James A. Waltz
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228, USA
| | - Richard Zinbarg
- Department of Psychology, Northwestern University, Evanston, IL 60208, USA
- The Family Institute at Northwestern University, Evanston, IL 60208, USA
| | - Shuo Chen
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228, USA
| | - Trevor Williams
- Department of Psychology, Northwestern University, Evanston, IL 60208, USA
| | - Joshua Kenney
- Department of Psychiatry, Yale University, New Haven, CT 06519, USA
| | - James M. Gold
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228, USA
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Huang CY, Fang SC, Shao YHJ. Comparison of Long-Acting Injectable Antipsychotics With Oral Antipsychotics and Suicide and All-Cause Mortality in Patients With Newly Diagnosed Schizophrenia. JAMA Netw Open 2021; 4:e218810. [PMID: 33974056 PMCID: PMC8114136 DOI: 10.1001/jamanetworkopen.2021.8810] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Schizophrenia is generally considered to be among the most severe psychiatric disorders because of the excessive mortality associated with it. Research to find means to reduce this excessive mortality is warranted. OBJECTIVE To investigate associations of long-acting injectable antipsychotics (LAIs) with all-cause, natural-cause, and suicide mortality risks as well as the impacts of early use of LAIs in patients with newly diagnosed schizophrenia. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data from the Taiwan National Health Insurance Research Database to construct a population-based cohort of patients with schizophrenia who received oral antipsychotics (OAPs) from January 1, 2002, to December 31, 2017. Within this cohort, the LAI group was defined as patients who switched to LAIs and were prescribed LAIs at least 4 times within 1 year. The LAI group was propensity matched 1:1 to patients who continued receiving OAPs of the same compounds. All patients were followed up until switching the antipsychotic administration route, death, or the end of the study (December 31, 2018), whichever occurred first. Data analysis was performed from January 2002 to December 2018. MAIN OUTCOMES AND MEASURES All-cause mortality, natural-cause mortality, suicide mortality, and suicide attempts. RESULTS In total, 2614 patients who switched to LAIs (median [interquartile range] {IQR} age, 30 [23-39] years) and 2614 who received OAPs (median [IQR] age, 30 [23-39] years) were included (1333 male patients [51.0%] in each group). During the 16-year follow-up period (median [IQR] follow-up of 14 [10-17] years), patients who switched to LAIs had lower risks of all-cause mortality (adjusted hazard ratio [aHR], 0.66; 95% CI, 0.54-0.81), natural-cause mortality (aHR, 0.63; 95% CI, 0.52-0.76), and suicide attempts (incidence rate ratio, 0.72; 95% CI, 0.55-0.93) compared with patients who received the corresponding OAPs. A 47% lower suicide mortality risk (aHR, 0.53; 95% CI, 0.30-0.92) was observed in patients who switched to LAIs within the first 2 years of OAP initiation. CONCLUSIONS AND RELEVANCE These findings suggest that LAI use in patients with newly diagnosed schizophrenia is associated with decreased all-cause mortality and suicide risk. Furthermore, early treatment with LAIs within the first 2 years of OAP initiation was associated with a decrease in suicide mortality risk. Thus, LAI use in the early stage of treatment should be actively considered for patients with newly diagnosed schizophrenia.
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Affiliation(s)
- Cheng-Yi Huang
- Department of Community Psychiatry, Bali Psychiatric Center, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Su-Chen Fang
- Department of Nursing, Mackay Medical College, New Taipei City, Taiwan
| | - Yu-Hsuan Joni Shao
- Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan
- Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei, Taiwan
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Abstract
PURPOSE OF REVIEW The aim of this review was to summarize the recent literature on the clinical symptoms, functioning, outcomes and treatments for older adults with chronic schizophrenia. RECENT FINDINGS The number and proportion of older adults with schizophrenia is rapidly increasing. Schizophrenia is a heterogeneous disorder and older adults with schizophrenia display significant variability in symptom severity, quality of life and overall outcomes. Many achieve stable disease remission, some display persistent nonremission and others experience fluctuating symptoms. Depression is commonly reported, and although rates of suicide are higher when compared with age-matched peers, the excess mortality seen in this population is mainly attributed to natural causes of death. Cognitive decline and reduced illness awareness have important implications for functional status and quality of life. Antipsychotics remain essential in the treatment regimen, although elderly patients with chronic disease may be good candidates for gradual dose reduction. Interdisciplinary treatment approaches as well as nonpharmacologic psychosocial interventions play a critical adjunctive role in the treatment of older adults with schizophrenia. SUMMARY Research focusing on schizophrenia in late life is sparse. Too often, older patients are eliminated from research studies or averaged in with all age groups. Thus, there continues to be gaps in our understanding of modifiable predictors of remission and recovery, and the most efficacious and safest treatment approaches for this age group.
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Salagre E, Grande I, Jiménez E, Mezquida G, Cuesta MJ, Llorente C, Amoretti S, Lobo A, González-Pinto A, Carballo JJ, Corripio I, Verdolini N, Castro-Fornieles J, Legido T, Carvalho AF, Vieta E, Bernardo M. Trajectories of suicidal ideation after first-episode psychosis: a growth mixture modeling approach. Acta Psychiatr Scand 2021; 143:418-433. [PMID: 33501646 DOI: 10.1111/acps.13279] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/08/2021] [Accepted: 01/20/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The period immediately after the onset of first-episode psychosis (FEP) may present with high risk for suicidal ideation (SI) and attempts, although this risk may differ among patients. Thus, we aimed to identify trajectories of SI in a 2-years follow-up FEP cohort and to assess baseline predictors and clinical/functional evolution for each trajectory of SI. METHODS We included 334 FEP participants with data on SI. Growth mixture modeling was used to identify trajectories of SI. Putative sociodemographic, clinical, and cognitive predictors of the distinct trajectories were examined using multinomial logistic regression. RESULTS We identified three distinct trajectories: Non-SI trajectory (85.53% sample), Improving SI trajectory (9.58%), and Worsening SI trajectory (6.89%). Multinomial logistic regression model revealed that greater baseline pessimistic thoughts, anhedonia, and worse perceived family environment were associated with higher baseline SI followed by an Improving trajectory. Older age, longer duration of untreated psychosis, and reduced sleep predicted Worsening SI trajectory. Regarding clinical/functional evolution, individuals within the Improving SI trajectory displayed moderate depression at baseline which ameliorated during the study period, while the Worsening SI subgroup exhibited persistent mild depressive symptoms and greater functional impairment at follow-up assessments. CONCLUSION Our findings delineated three distinct trajectories of SI among participants with FEP, one experiencing no SI, another in which SI might depend on acute depressive symptomatology, and a last subset where SI might be associated with mild but persistent clinical and functional impairments. These data provide insights for the early identification and tailored treatment of suicide in this at-risk population.
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Affiliation(s)
- Estela Salagre
- Bipolar and Depressive Disorders Unit, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Iria Grande
- Bipolar and Depressive Disorders Unit, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Esther Jiménez
- Bipolar and Depressive Disorders Unit, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Gisela Mezquida
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Barcelona, Spain.,Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Madrid, Spain.,Department of Psychiatry, Complejo Hospitalario de Navarra, Instituto de Investigaciones Sanitarias de Navarra (IdiSNa), Pamplona, Spain
| | - Manuel J Cuesta
- Department of Psychiatry, Complejo Hospitalario de Navarra, Instituto de Investigaciones Sanitarias de Navarra (IdiSNa), Pamplona, Spain
| | - Cloe Llorente
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañon, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Sílvia Amoretti
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Barcelona, Spain.,Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Madrid, Spain.,August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Antonio Lobo
- Department of Medicine and Psychiatry, Universidad de Zaragoza, Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
| | - Ana González-Pinto
- Department of Psychiatry, Hospital Universitario de Alava, BIOARABA Health Research Institute, University of the Basque Country, Vitoria, Spain
| | - Juan José Carballo
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañon, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Iluminada Corripio
- Department of Psychiatry, Biomedical Research Institute Sant Pau (IIB-SANT PAU), Hospital Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Norma Verdolini
- Bipolar and Depressive Disorders Unit, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Josefina Castro-Fornieles
- Department of Child and Adolescent Psychiatry and Psychology, Clinic Institute of Neurosciences, Hospital Clínic de Barcelona, 2017SGR881, CIBERSAM, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Teresa Legido
- Neuroscience Group, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Andre F Carvalho
- Department of Psychiatry, University of Toronto, the Centre for Addiction and Mental Health, Toronto, ON, Canada.,The IMPACT (Innovation in Mental and Physical Health and Clinical Treatment) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Miquel Bernardo
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Barcelona, Spain.,Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Madrid, Spain.,August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
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Huang W, Chang CH, Stuart EA, Daumit GL, Wang NY, McGinty EE, Dickerson FB, Igusa T. Agent-Based Modeling for Implementation Research: An Application to Tobacco Smoking Cessation for Persons with Serious Mental Illness. IMPLEMENTATION RESEARCH AND PRACTICE 2021; 2. [PMID: 34308355 DOI: 10.1177/26334895211010664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Implementation researchers have sought ways to use simulations to support the core components of implementation, which typically include assessing the need for change, designing implementation strategies, executing the strategies, and evaluating outcomes. The goal of this paper is to explain how agent-based modeling could fulfill this role. Methods We describe agent-based modeling with respect to other simulation methods that have been used in implementation science, using non-technical language that is broadly accessible. We then provide a stepwise procedure for developing agent-based models of implementation processes. We use, as a case study to illustrate the procedure, the implementation of evidence-based smoking cessation practices for persons with serious mental illness (SMI) in community mental health clinics. Results For our case study, we present descriptions of the motivating research questions, specific models used to answer these questions, and a summary of the insights that can be obtained from the models. In the first example, we use a simple form of agent-based modeling to simulate the observed smoking behaviors of persons with SMI in a recently completed trial (IDEAL, Comprehensive Cardiovascular Risk Reduction Trial in Persons with SMI). In the second example, we illustrate how a more complex agent-based approach that includes interactions between patients, providers and site administrators can be used to provide guidance for an implementation intervention that includes training and organizational strategies. This example is based in part on an ongoing project focused on scaling up evidence-based tobacco smoking cessation practices in community mental health clinics in Maryland. Conclusion In this paper we explain how agent-based models can be used to address implementation science research questions and provide a procedure for setting up simulation models. Through our examples, we show how what-if scenarios can be examined in the implementation process, which are particularly useful in implementation frameworks with adaptive components.
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Affiliation(s)
- Wanyu Huang
- Department of Civil and Systems Engineering, Johns Hopkins University
| | - Chia-Hsiu Chang
- Department of Civil and Systems Engineering, Johns Hopkins University
| | - Elizabeth A Stuart
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health.,Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health.,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health
| | - Gail L Daumit
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health.,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health.,Division of General Internal Medicine, Johns Hopkins University School of Medicine.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health.,Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University
| | - Nae-Yuh Wang
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health.,Division of General Internal Medicine, Johns Hopkins University School of Medicine.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health.,Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University
| | - Emma E McGinty
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health.,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health
| | | | - Takeru Igusa
- Department of Civil and Systems Engineering, Johns Hopkins University.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health.,Department of Applied Mathematics and Statistics, Johns Hopkins University
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40
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Rinne GR, O'Brien MP, Miklowitz DJ, Addington JM, Cannon TD. Depression, family interaction and family intervention in adolescents at clinical-high risk for psychosis. Early Interv Psychiatry 2021; 15:360-366. [PMID: 32232954 PMCID: PMC8175016 DOI: 10.1111/eip.12954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 01/21/2020] [Accepted: 03/15/2020] [Indexed: 11/28/2022]
Abstract
AIM The relationship between family behaviour and depression in adolescents at clinical high risk (CHR) for psychosis remains understudied despite high rates of depression in this population. This study examines the relationship between family problem-solving behaviours and depression in CHR adolescents and the impact of family interventions targeting subthreshold symptoms of psychosis on reducing symptoms of depression over 2-years. METHODS Participants were a subset of the North American Prodrome Longitudinal Study who were randomized to 6-months of family focused therapy for individuals at CHR or family psychoeducational treatment. We evaluated the relationship between communication during family conflict discussion and adolescents' symptoms of depression before treatment. At follow-up assessments the family treatment groups were compared on depression. Finally, we compared those in family treatment with matched controls. RESULTS Adolescents' constructive communication was associated with less severe symptoms of depression before treatment. Symptoms of depression improved for adolescents in both family treatment groups. However, there were no significant group by treatment interactions. When adolescents who participated in either type of family intervention were compared to CHR adolescent controls, symptoms of depression improved for adolescents in treatment and control groups, but there were no significant time by treatment interactions. CONCLUSIONS The communication skills of CHR adolescents are related to both depression and their parents' communication skills pre-treatment. However, reductions in depression over the course of the treatment trial cannot be attributed to family treatment. It is imperative to incorporate interventions that directly target depression into future family treatment studies.
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Affiliation(s)
- Gabrielle R Rinne
- Department of Psychology, Yale University, New Haven, Connecticut, USA
| | - Mary P O'Brien
- Department of Psychology, Yale University, New Haven, Connecticut, USA
| | - David J Miklowitz
- Semel Institute, University of California, Los Angeles, California, USA
| | - Jean M Addington
- Department of Psychiatry, University of Calgary, Calgary, Canada
| | - Tyrone D Cannon
- Department of Psychology, Yale University, New Haven, Connecticut, USA.,Department of Psychiatry, Yale University, New Haven, Connecticut, USA
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41
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McGinty EE, Thompson D, Murphy KA, Stuart EA, Wang NY, Dalcin A, Mace E, Gennusa JV, Daumit GL. Adapting the Comprehensive Unit Safety Program (CUSP) implementation strategy to increase delivery of evidence-based cardiovascular risk factor care in community mental health organizations: protocol for a pilot study. Implement Sci Commun 2021; 2:26. [PMID: 33663620 PMCID: PMC7931551 DOI: 10.1186/s43058-021-00129-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/15/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND People with serious mental illnesses (SMI) such as schizophrenia and bipolar disorder experience excess mortality driven in large part by high rates of poorly controlled and under-treated cardiovascular risk factors. In the USA, integrated "behavioral health home" models in which specialty mental health organizations coordinate and manage physical health care for people with SMI are designed to improve guideline-concordant cardiovascular care for this group. Such models have been shown to improve cardiovascular care for clients with SMI in randomized clinical trials, but real-world implementation has fallen short. Key implementation barriers include lack of alignment of specialty mental health program culture and physical health care coordination and management for clients with SMI and lack of structured protocols for conducting effective physical health care coordination and management in the specialty mental health program context. This protocol describes a pilot study of an implementation intervention designed to overcome these barriers. METHODS This pilot study uses a single-group, pre/post-study design to examine the effects of an adapted Comprehensive Unit Safety Program (CUSP) implementation strategy designed to support behavioral health home programs in conducting effective cardiovascular care coordination and management for clients with SMI. The CUSP strategy, which was originally designed to improve inpatient safety, includes provider training, expert facilitation, and implementation of a five-step quality improvement process. We will examine the acceptability, appropriateness, and feasibility of the implementation strategy and how this strategy influences mental health organization culture; specialty mental health providers' self-efficacy to conduct evidence-based cardiovascular care coordination and management; and receipt of guideline-concordant care for hypertension, dyslipidemia, and diabetes mellitus among people with SMI. DISCUSSION While we apply CUSP to the implementation of evidence-based hypertension, dyslipidemia, and diabetes care, this implementation strategy could be used in the future to support the delivery of other types of evidence-based care, such as smoking cessation treatment, in behavioral health home programs. CUSP is designed to be fully integrated into organizations, sustained indefinitely, and used to continually improve evidence-based practice delivery. TRIAL REGISTRATION ClinicalTrials.gov, NCT04696653 . Registered on January 6, 2021.
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Affiliation(s)
- Emma Elizabeth McGinty
- Johns Hopkins University Bloomberg School of Public Health, 624 N. Broadway, Room 359, Baltimore, MD 21205 USA
| | - David Thompson
- Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21202 USA
| | - Karly A. Murphy
- Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21202 USA
| | - Elizabeth A. Stuart
- Johns Hopkins University Bloomberg School of Public Health, 624 N. Broadway, Room 359, Baltimore, MD 21205 USA
| | - Nae-Yuh Wang
- Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21202 USA
| | - Arlene Dalcin
- Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21202 USA
| | - Elizabeth Mace
- Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21202 USA
| | - Joseph V. Gennusa
- Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21202 USA
| | - Gail L. Daumit
- Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21202 USA
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Identification of a High-risk Subgroup With Malignant Mitral Valve Prolapse Who Are Predisposed to Sudden Cardiac Death: A Review. Crit Pathw Cardiol 2021; 20:31-35. [PMID: 32947378 DOI: 10.1097/hpc.0000000000000242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Mitral valve prolapse (MVP) affects approximately 170 million people worldwide; however, phenotypically, there is a wide variety of heterogeneity. In particular subsets, the incidence of sudden cardiac death is calculated to be 998 per 100,000 person-years, which is significantly increased when compared with the general population of MVP patients. Individuals with high-risk features have been identified as young females with bileaflet MVP and electrocardiogram findings of frequent complex ectopy, ST-T wave changes, and inferior T wave inversions. Supplemental imaging modalities in this subgroup demonstrate redundant leaflets and chordae on 2-dimensional transthoracic echocardiography along with varying severity of mitral annular disjunction. Detailed morphologic assessment by 3-dimensional echocardiography provides a quantitative assessment of annular disjunction along with left ventricular longitudinal and basal circumferential strain patterns. Late gadolinium enhancement on cardiac magnetic resonance imaging identifies diffuse and isolated left ventricle fibrosis involving the fascicles and papillary muscles, which has been visualized in isolation during autopsy. Findings of this review propose that sudden cardiac death as a result of malignant arrhythmias arises from automaticity, complex ectopy, and reentry at the level of the fascicles and papillary muscles. The repetitive mechanical stress provides a nidus for the development of both micro- and macrofibrosis easily identified by late gadolinium enhancement on cardiac magnetic resonance imaging. Escalation to electrophysiology studies and early intervention could provide new targeted lifesaving therapies.
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43
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Isvoranu AM, Abdin E, Chong SA, Vaingankar J, Borsboom D, Subramaniam M. Extended network analysis: from psychopathology to chronic illness. BMC Psychiatry 2021; 21:119. [PMID: 33639891 PMCID: PMC7913444 DOI: 10.1186/s12888-021-03128-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 02/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Understanding complex associations between psychopathology and chronic illness is instrumental in facilitating both research and treatment progress. The current study is the first and only network-based study to provide such an encompassing view of unique associations between a multitude of mental and physical health-related domains. METHODS The current analyses were based on the Singapore Mental Health Study, a cross-sectional study of adult Singapore residents. The study sample consisted of 6616 respondents, of which 49.8% were male and 50.2% female. A network structure was constructed to examine associations between psychopathology, alcohol use, gambling, major chronic conditions, and functioning. RESULTS The network structure identified what we have labeled a Cartesian graph: a network visibly split into a psychopathological domain and a physical health domain. The borders between these domains were fuzzy and bridged by various cross-domain associations, with functioning items playing an important role in bridging chronic conditions to psychopathology. CONCLUSIONS Current results deliver a comprehensive overview of the complex relation between psychopathology, functioning, and chronic illness, highlighting potential pathways to comorbidity.
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Affiliation(s)
- Adela-Maria Isvoranu
- Department of Psychology, Psychological Methods, University of Amsterdam, Nieuwe Achtergracht 129B, 1018 WT, Amsterdam, The Netherlands.
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore, Singapore
| | | | - Denny Borsboom
- Department of Psychology, Psychological Methods, University of Amsterdam, Nieuwe Achtergracht 129B, 1018 WT, Amsterdam, The Netherlands
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44
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McGinty EE, Murphy KA, Dalcin AT, Stuart EA, Wang NY, Dickerson F, Gudzune K, Jerome G, Thompson D, Cullen BA, Gennusa J, Kilbourne AM, Daumit GL. A Model for Advancing Scale-Up of Complex Interventions for Vulnerable Populations: the ALACRITY Center for Health and Longevity in Mental Illness. J Gen Intern Med 2021; 36:500-505. [PMID: 32869192 PMCID: PMC7878664 DOI: 10.1007/s11606-020-06137-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 08/11/2020] [Indexed: 12/17/2022]
Abstract
Many of the most pressing health issues in the USA and worldwide require complex, multi-faceted solutions. Delivery of such solutions is often complicated by the need to reach and engage vulnerable populations facing multiple barriers to care. While the fields of quality improvement and implementation science have made valuable gains in the development and spread of individual strategies to improve evidence-based practice delivery, models for coordinated deployment of numerous strategies to simultaneously implement multiple evidence-based interventions in vulnerable populations are lacking. In this Perspective, we describe a model for this type of comprehensive research-practice translation effort: the Johns Hopkins ALACRITY Center for Health and Longevity in Mental Illness, which is focused on reducing premature mortality in the population with serious mental illness. We describe the Center's conceptual framework, which is built upon an integrated set of quality improvement and implementation science frameworks, provide an overview of the Center's organizational structure and core research-practice translation activities, and discuss our vision for how the Center may evolve over time. Lessons learned from this Center's efforts could inform models to address other critical health issues in vulnerable populations that require multi-component solutions at the policy, system, provider, and patient levels.
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Affiliation(s)
- Emma E McGinty
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Karly A Murphy
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Arlene T Dalcin
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Elizabeth A Stuart
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nae-Yuh Wang
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Kim Gudzune
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Gerald Jerome
- Department of Kinesiology, Towson University, Towson, MD, USA
| | - David Thompson
- Department of Anesthesiology and Critical Care and Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Bernadette A Cullen
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Joseph Gennusa
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Amy M Kilbourne
- Health Services Research and Development Service, Veterans Health Administration, US Department of Veterans Affairs and Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MD, USA
| | - Gail L Daumit
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Lamichhane S, Dickens AM, Sen P, Laurikainen H, Borgan F, Suvisaari J, Hyötyläinen T, Howes O, Hietala J, Orešič M. Association Between Circulating Lipids and Future Weight Gain in Individuals With an At-Risk Mental State and in First-Episode Psychosis. Schizophr Bull 2021; 47:160-169. [PMID: 32609372 PMCID: PMC7825089 DOI: 10.1093/schbul/sbaa087] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Patients with schizophrenia have a lower than average life span, largely due to the increased prevalence of cardiometabolic comorbidities. There is an unmet public health need to identify individuals with psychotic disorders who have a high risk of rapid weight gain and who are at risk of developing metabolic complications. Here, we applied mass spectrometry-based lipidomics in a prospective study comprising 48 healthy controls (CTR), 44 first-episode psychosis (FEP) patients, and 22 individuals at clinical high risk (CHR) for psychosis, from 2 study centers (Turku, Finland and London, UK). Baseline serum samples were analyzed using lipidomics, and body mass index (BMI) was assessed at baseline and after 12 months. We found that baseline triacylglycerols (TGs) with low double-bond counts and carbon numbers were positively associated with the change in BMI at follow-up. In addition, a molecular signature comprised of 2 TGs (TG[48:0] and TG[45:0]) was predictive of weight gain in individuals with a psychotic disorder, with an area under the receiver operating characteristic curve (AUROC) of 0.74 (95% CI: 0.60-0.85). When independently tested in the CHR group, this molecular signature predicted said weight change with AUROC = 0.73 (95% CI: 0.61-0.83). We conclude that molecular lipids may serve as a predictor of weight gain in psychotic disorders in at-risk individuals and may thus provide a useful marker for identifying individuals who are most prone to developing cardiometabolic comorbidities.
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Affiliation(s)
- Santosh Lamichhane
- Turku Bioscience Centre, University of Turku and Åbo Akademi University, Turku, Finland
| | - Alex M Dickens
- Turku Bioscience Centre, University of Turku and Åbo Akademi University, Turku, Finland
| | - Partho Sen
- Turku Bioscience Centre, University of Turku and Åbo Akademi University, Turku, Finland
| | - Heikki Laurikainen
- Department of Psychiatry, University of Turku, Turku, Finland.,Turku PET Centre, Turku University Hospital, Turku, Finland
| | - Faith Borgan
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Hammersmith Hospital, Imperial College London, London, UK
| | - Jaana Suvisaari
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland
| | | | - Oliver Howes
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Hammersmith Hospital, Imperial College London, London, UK
| | - Jarmo Hietala
- Department of Psychiatry, University of Turku, Turku, Finland.,Turku PET Centre, Turku University Hospital, Turku, Finland
| | - Matej Orešič
- Turku Bioscience Centre, University of Turku and Åbo Akademi University, Turku, Finland.,School of Medical Sciences, Örebro University, Örebro, Sweden
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46
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Comorbid physical illnesses in adult outpatients with psychotic disorders: risk factors, psychological functioning, and quality of life outcomes. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1633-1643. [PMID: 33616692 PMCID: PMC8429359 DOI: 10.1007/s00127-021-02034-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/29/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE In contrast to global research, where physical comorbidity in psychotic disorders is established, only a few studies have been conducted in Southeast Asia. With a concerning trend of chronic physical illnesses emerging in adults below the age of 65, an investigation into comorbid chronic physical illnesses in adults diagnosed with psychotic disorders is necessary. This study aims to explore the risk factors, psychological functioning, and quality of life outcomes associated with comorbidity in adults below the age of 65, diagnosed with psychotic disorders, in a multi-ethnic non-Western setting. METHODS Electronic medical records of 364 patients with psychotic disorders who had provided written consent to participate were screened for co-occurring physical conditions. The majority of participants were female (53.7%), Chinese (69%), single (74.5%), and had tertiary and above education (43%). They were approximately 35 years old on average and the mean age of onset for psychosis was 26.7 years old. RESULTS Comorbid physical illnesses were present in approximately a third of adults with psychotic disorders (28%). They typically reported cardiovascular-related diseases, respiratory, and skin conditions. Comorbidity was significantly related to lower physical quality of life. As compared to other types of psychotic disorders, schizophrenia was significantly related to a greater frequency of comorbid physical conditions. Multinomial regression analyses revealed that age, age of onset, Malay and Indian ethnicities were significant factors. CONCLUSION Physical comorbidity in adults below the age of 65 is common, signifying an emerging need to place greater attention into the screening and emphasis on the physical care needs of this age group. Finally, more research is needed to understand the impact of common co-occurring acute and chronic cardiovascular, skin, and respiratory diseases locally.
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Maitra A, Bhattacharyya S, Mukhopadhyay S, Mallick AK, Biswas S, Singh OP. A Randomized Controlled Trial to Compare the Efficacy, Safety and Tolerability of Asenapine versus Olanzapine in Management of Schizophrenia. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2020; 18:587-598. [PMID: 33124591 PMCID: PMC7609212 DOI: 10.9758/cpn.2020.18.4.587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/14/2020] [Accepted: 05/17/2020] [Indexed: 11/18/2022]
Abstract
Objective Schizophrenia is a serious disease characterized by impairment in the perception or expression of reality, leading to occupational and social dysfunction. The use of antipsychotic medication is now universal in the first-line treatment of schizophrenia. This study was undertaken to compare the efficacy of asenapine with a standard atypical antipsychotic, olanzapine in treating this disease. Methods It was designed as a single blind, randomized, controlled, parallel group, single centre Phase IV trial of a newer atypical antipsychotic, asenapine versus existing standard atypical antipsychotic, olanzapine. Total 80 subjects were enrolled as per eligibility criteria.Each recruited subject received daily treatment with the trial medication (Olanzapine 10 mg or Asenapine 10 mg daily) for duration of 12 weeks. BPRS, CGI-S, CGI-I, Laboratory parameters and compliance was assessed and analyzed. Continuous variables were compared by t test and non-parametric data was analyzed by Mann−Whitney U test and Wilcoxon signed rank test. Likely categorical variables were analyzed by chi-square test or Fisher’s exact test, as appropriate. Results The duration of schizophrenia at presentation was comparable in both the treatment groups. There was significant reduction of BPRS score between any two visits of each treatment groups. The decline in CGI-S and CGI-I scores was statistically significant (p < 0.001) when compared between visits of any of the both treatment arms. Adherence to treatment was excellent for all patients. Conclusion Newer atypical antipsychotic asenapine is more effective than standard olanzapine in reducing the symptoms of schizophrenia in this study and further larger studies are to be done.
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Affiliation(s)
- Arpita Maitra
- Department of Pharmacology, Burdwan Medical College, Burdwan, India
| | | | | | | | - Supreeti Biswas
- Department of Pharmacology, Burdwan Medical College, Burdwan, India
| | - Om Prakash Singh
- Department of Psychiatry, Burdwan Medical College, Burdwan, India
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48
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McGinty EE, Stone EM, Kennedy-Hendricks A, Bandara S, Murphy KA, Stuart EA, Rosenblum MA, Daumit GL. Effects of Maryland's Affordable Care Act Medicaid Health Home Waiver on Quality of Cardiovascular Care Among People with Serious Mental Illness. J Gen Intern Med 2020; 35:3148-3158. [PMID: 32128686 PMCID: PMC7661675 DOI: 10.1007/s11606-020-05690-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 01/29/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Nineteen US states and D.C. have used the Affordable Care Act Medicaid health home waiver to create behavioral health home (BHH) programs for Medicaid beneficiaries with serious mental illness (SMI). BHH programs integrate physical healthcare management and coordination into specialty mental health programs. No studies have evaluated the effects of a BHH program created through the Affordable Care Act waiver on cardiovascular care quality among people with SMI. OBJECTIVE To study the effects of Maryland's Medicaid health home waiver BHH program, implemented October 1, 2013, on quality of cardiovascular care among individuals with SMI. DESIGN Retrospective cohort analysis using Maryland Medicaid administrative claims data from July 1, 2010, to September 30, 2016. We used marginal structural modeling with inverse probability of treatment weighting to account for censoring and potential time-dependent confounding. PARTICIPANTS Maryland Medicaid beneficiaries with diabetes or cardiovascular disease (CVD) participating in psychiatric rehabilitation programs, the setting in which BHHs were implemented. To qualify for psychiatric rehabilitation programs, individuals must have SMI. The analytic sample included BHH and non-BHH participants, N = 2605 with diabetes and N = 1899 with CVD. MAIN MEASURES Healthcare Effectiveness Data and Information Set (HEDIS) measures of cardiovascular care quality including annual receipt of diabetic eye and foot exams; HbA1c, diabetic nephropathy, and cholesterol testing; and statin therapy receipt and adherence among individuals with diabetes, as well as HEDIS measures of annual receipt of cholesterol testing and statin therapy and adherence among individuals with CVD. KEY RESULTS Relative to non-enrollment, enrollment in Maryland's BHH program was associated with increased likelihood of eye exam receipt among individuals with SMI and co-morbid diabetes, but no changes in other care quality measures. CONCLUSIONS Additional financing, infrastructure, and implementation supports may be needed to realize the full potential of Maryland's BHH to improve cardiovascular care for people with SMI.
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Affiliation(s)
- Emma E McGinty
- Department of Health Policy and Management , Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Elizabeth M Stone
- Department of Health Policy and Management , Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Alene Kennedy-Hendricks
- Department of Health Policy and Management , Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sachini Bandara
- Department of Health Policy and Management , Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Karly A Murphy
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Elizabeth A Stuart
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michael A Rosenblum
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Gail L Daumit
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Kuo MW, Yeh SH, Chang HM, Teng PR. Effectiveness of oral health promotion program for persons with severe mental illness: a cluster randomized controlled study. BMC Oral Health 2020; 20:290. [PMID: 33109148 PMCID: PMC7590455 DOI: 10.1186/s12903-020-01280-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/09/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of a composite oral health promotion program designed to reduce dental plaque among persons with severe mental illness in a psychiatric institution. METHODS A cluster randomized controlled study was carried out in chronic psychiatric wards of a general hospital in central Taiwan. Sixty-eight eligible male individuals admitted to 2 wards were randomly assigned to an experimental and a control group. Participants in the experimental group underwent an oral health promotion program that consisted of biweekly group education sessions, and a 12-week individual behavioral modification for oral hygiene course. The participants in the control group received usual care only. Dental plaque (measured by the Plaque Control Index) was examined by a single dentist before and after the experiment. Each participant responded to a questionnaire regarding oral health knowledge, attitude and behavior before and after the experiment. RESULTS Fifty-eight individuals completed the study. Before the experiment, the plaque index was similar between the intervention group (68.9; N = 27) and the control group (69.8; N = 31). After the experiment, the plaque index was significantly better in the intervention group than in the control group (42.6 vs. 61.8; P < 0.001). Participants in the intervention group also demonstrated better oral health knowledge, attitude and behavior than those in the control group after the experiment. CONCLUSIONS A composite oral health promotion program using both group education and individual behavioral methods over a 12-week period was effective in both reducing dental plaque and improving the oral health knowledge of persons with severe mental illness in the institution. TRIAL REGISTRATION This study was retrospectively registered in Clinicaltrials.gov, with number NCT04464941, dated 7/7/2020. https://register.clinicaltrials.gov/RD103035018 .
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Affiliation(s)
- Mei-Wen Kuo
- Department of Psychiatry, Chang Bing Show Chwan Memorial Hospital, No. 6, Lugong Rd., Lugang Township, Changhua County, 505, Taiwan, ROC.,Department of Nursing, Chang Bing Show Chwan Memorial Hospital, Changhua County, Taiwan, ROC
| | - Shu-Hui Yeh
- Institute of Long-Term Care, MacKay Medical College, New Taipei City, Taiwan, ROC
| | - Heng-Ming Chang
- Orthodontic and Dental Department, Chang Bing Show Chwan Memorial Hospital, Changhua County, Taiwan, ROC
| | - Po-Ren Teng
- Department of Psychiatry, Chang Bing Show Chwan Memorial Hospital, No. 6, Lugong Rd., Lugang Township, Changhua County, 505, Taiwan, ROC.
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Heald A, Azadbakht N, Geary B, Conen S, Fachim H, Lee DCH, Geifman N, Farman S, Howes O, Whetton A, Deakin B. Application of SWATH mass spectrometry in the identification of circulating proteins does not predict future weight gain in early psychosis. Clin Proteomics 2020; 17:38. [PMID: 33117088 PMCID: PMC7590460 DOI: 10.1186/s12014-020-09299-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 10/05/2020] [Indexed: 01/02/2023] Open
Abstract
Weight gain is a common consequence of treatment with antipsychotic drugs in early psychosis, leading to further morbidity and poor treatment adherence. Identifying tools that can predict weight change in early psychosis may contribute to better-individualised treatment and adherence. Recently we showed that proteomic profiling with sequential window acquisition of all theoretical fragment ion spectra (SWATH) mass spectrometry (MS) can identify individuals with pre-diabetes more likely to experience weight change in relation to lifestyle change. We investigated whether baseline proteomic profiles predicted weight change over time using data from the BeneMin clinical trial of the anti-inflammatory antibiotic, minocycline, versus placebo. Expression levels for 844 proteins were determined by SWATH proteomics in 83 people (60 men and 23 women). Hierarchical clustering analysis and principal component analysis of baseline proteomics data did not reveal distinct separation between the proteome profiles of participants in different weight change categories. However, individuals with the highest weight loss had higher Positive and Negative Syndrome Scale (PANSS) scores. Our findings imply that mode of treatment i.e. the pharmacological intervention for psychosis may be the determining factor in weight change after diagnosis, rather than predisposing proteomic dynamics.
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Affiliation(s)
- Adrian Heald
- Department of Endocrinology, Salford Royal Hospital, Manchester, UK.,Faculty of Biology, Medicine and Health and Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK.,Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, M6 8HD UK
| | - Narges Azadbakht
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, Manchester, UK
| | - Bethany Geary
- Stoller Biomarker Discovery Centre, The University of Manchester, Manchester, UK
| | - Silke Conen
- Division of Medical Education, The University of Manchester, Manchester, UK
| | - Helene Fachim
- Department of Endocrinology, Salford Royal Hospital, Manchester, UK.,Faculty of Biology, Medicine and Health and Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
| | - Dave Chi Hoo Lee
- Stoller Biomarker Discovery Centre, The University of Manchester, Manchester, UK
| | - Nophar Geifman
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, Manchester, UK.,The Manchester Molecular Pathology Innovation Centre, The University of Manchester, Manchester, UK
| | - Sanam Farman
- Mersey Deanery Psychiatry Training Rotation, Manchester, UK
| | | | - Anthony Whetton
- Stoller Biomarker Discovery Centre, The University of Manchester, Manchester, UK.,The Manchester Molecular Pathology Innovation Centre, The University of Manchester, Manchester, UK
| | - Bill Deakin
- Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester, UK
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