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Liu F, Meng Y, Wang R, Shen S, Li P, He F. Combined influence of depression symptoms and ratio of triglyceride to high-density lipoprotein cholesterol on cardiometabolic multimorbidity: Findings from the China Health and Retirement Longitudinal Study 2011-2018. J Affect Disord 2024; 360:242-248. [PMID: 38821370 DOI: 10.1016/j.jad.2024.05.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 05/07/2024] [Accepted: 05/28/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND Previous studies had reported depression symptoms and TG/HDLC ratio may share pathophysiological pathway. The aim was to investigate the combined effects of depression symptoms and TG/HDL-C ratio on the risk of CMM. METHODS This cohort study extracted data from 2011 to 2018 of CHARLS. The CMM event occurred from 2013 to 2018, defined as suffering from more than one of stroke, cardiac events, and diabetes mellitus. Cox proportional hazards regression models were used to assess the association between the baseline combined effects of depression symptoms and TG/HDL-C ratio with incidence of CMM, stroke, cardiac events, and diabetes mellitus. RESULTS A total of 8349 participants (3966 men and 4383 women) were included in the study, with a mean age of 58.5 years. During a 7-year follow-up survey, 370 (4.43 %) participants developed CMM. Compared to individuals with no depression symptoms and low TG/HDLC ratio, the multivariable-adjusted HRs (95%CI) for the new-onset CMM for patients with the depression symptoms alone, high TG/HDLC ratio alone, and depression symptoms and high TG/HDLC ratio were 1.37 (95 % CI = 0.95-1.98), 1.62 (95 % CI = 1.22-2.14), 1.94 (95 % CI = 1.39-2.72), respectively (P < 0.001). LIMITATIONS Firstly, potential confounding factors such as dietary intake and nutrition were not collected at the time of study design. Secondly, exposure to the outcome was self-reported, which may cause recall bias or misclassification. Finally, the population was aged ≥45 years, so the results cannot be generalized to all age groups. CONCLUSION Our findings indicated that patients with depression and high TG/HDLC ratio had a higher risk of developing CMM.
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Affiliation(s)
- Fanghua Liu
- Baoshan Center for Disease Control and Prevention, Shanghai 201901, China
| | - Yang Meng
- Baoshan Center for Disease Control and Prevention, Shanghai 201901, China
| | - Ruirui Wang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Major Chronic Non-communicable Diseases, Suzhou Medical College of Soochow University, Suzhou, China
| | - Suwen Shen
- Department of medical administration, Suzhou Industrial Park Medical and Health Management Center, Suzhou, Jiangsu 215004, China
| | - Pengbin Li
- Baoshan Center for Disease Control and Prevention, Shanghai 201901, China
| | - Fan He
- Baoshan Center for Disease Control and Prevention, Shanghai 201901, China.
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Wang X, Shi J, Jiang X, Wang X. Association of depressive symptoms with cardiovascular events and plasma BNP: A prospective cohort study of the elderly Chinese population. Arch Gerontol Geriatr 2024; 123:105413. [PMID: 38555650 DOI: 10.1016/j.archger.2024.105413] [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: 12/05/2023] [Revised: 02/22/2024] [Accepted: 03/11/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVE To estimate the prevalence of depressive symptoms and to evaluate the associations of mild and significant depressive symptoms with cardiovascular events and plasma BNP levels (which are surrogate endpoints for cardiovascular events) among older adults in a population-based study. METHODS A population-based prospective study of 1,432 elderly people (aged 70-84 years and without cardiovascular disease) was conducted, and the median duration of follow-up for participants with outcomes was 18 weeks. Depressive symptoms were assessed with the 15-item Geriatric Depression Scale (GDS-15). The hazard ratios (HRs) for the time to events and time to death were calculated using the Cox regression analysis. Multiple linear regression models and Spearman rank correlations were used to examine the association of depressive symptoms with Log BNP values. RESULTS The prevalence of mild (GDS-15 scores ≥ 6) and significant (GDS-15 scores ≥ 10) depressive symptoms were 7.3% and 2.0% at baseline, respectively. Older adults with significant depressive symptoms exhibited increased risks of time to death (HR: 12.56; 95% CI: 3.58-43.99) and composite cardiovascular endpoints (HR: 3.46; 95% CI: 1.19-3.75). Significant depressive symptoms were associated with Log BNP levels (β=0.56, P = 0.02). Depressive symptom scores were also associated with Log BNP levels (rs=0.21, P = 0.04) in the older adults with depressive symptoms. CONCLUSIONS Significant depressive symptoms were associated with a higher risk of cardiovascular events and higher BNP levels in the elderly.
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Affiliation(s)
- Xiaoxu Wang
- MOE Key Laboratory of Contemporary Anthropology, School of Life Science and Fudan University Human Phenome Institute, Shanghai 200438, China
| | - Jianming Shi
- Rugao People' s Hospital, Rugao 226500, Jiangsu, China
| | - Xiaoyan Jiang
- Key Laboratory of Arrhythmias, Ministry of Education, Department of Pathology and Pathophysiology, School of Medicine, Tongji University, Shanghai 200438, China
| | - Xiaofeng Wang
- Human Phenome Institute, Zhangjiang Fudan International Innovation Centre, Fudan University, Shanghai 200438, China.
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Chen PH, Hsiao CY, Chiang SJ, Chung KH, Tsai SY. Association of lipids and inflammatory markers with left ventricular wall thickness in patients with bipolar disorder. J Affect Disord 2024; 358:12-18. [PMID: 38705523 DOI: 10.1016/j.jad.2024.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 04/04/2024] [Accepted: 05/02/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Individuals with bipolar disorder (BD) face a high risk of heart failure and left ventricular (LV) dysfunction. Despite strong evidence that high LV relative wall thickness (RWT) is a risk marker for heart failure, few studies have evaluated LV RWT and aggravating factors in individuals with BD. METHODS We recruited 104 participants (52 patients with BD and 52 age- and sex-matched mentally healthy controls) to undergo echocardiographic imaging and biochemistry, high-sensitivity C-reactive protein (hs-CRP), and blood cell count measurements. LV RWT was estimated using the following equation: (2 × LV posterior wall end-diastolic thickness)/LV end-diastolic diameter. Clinical data were obtained through interviews and chart reviews. RESULTS The BD group exhibited a significantly greater LV RWT (Cohen's d = 0.53, p = 0.003) and a less favorable mitral valve E/A ratio (Cohen's d = 0.54, p = 0.023) and LV global longitudinal strain (Cohen's d = 0.57, p = 0.047) than did the control group. Multiple linear regression revealed that in the BD group, serum triglyceride levels (β = 0.466, p = 0.001), platelet-to-lymphocyte ratios (β = 0.324, p = 0.022), and hs-CRP levels (β = 0.289, p = 0.043) were all significantly and positively associated with LV RWT. LIMITATIONS This study applied a cross-sectional design, meaning that the direction of causation could not be inferred. CONCLUSIONS Patients with BD are at a risk of heart failure, as indicated by their relatively high LV RWT. Lipid levels and systemic inflammation may explain this unfavorable association.
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Affiliation(s)
- Pao-Huan Chen
- Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Cheng-Yi Hsiao
- Division of Cardiology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Cardiovascular Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shuo-Ju Chiang
- Division of Cardiology, Department of Internal Medicine, Taipei City Hospital Yangming Branch, Taipei, Taiwan; School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | - Kuo-Hsuan Chung
- Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shang-Ying Tsai
- Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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Correll CU, Arango C, Fagiolini A, Giordano GM, Leucht S, Salazar de Pablo G. Finding the Right Setting for the Right Treatment During the Acute Treatment of Individuals with Schizophrenia: A Narrative Review and Clinical Practice Guideline. Neuropsychiatr Dis Treat 2024; 20:1293-1307. [PMID: 38911102 PMCID: PMC11194005 DOI: 10.2147/ndt.s459450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 05/22/2024] [Indexed: 06/25/2024] Open
Abstract
Background Schizophrenia is most times a chronic and often debilitating illness associated with poor mental health outcomes. Early and effective treatment of schizophrenia in the most appropriate setting can make a significant difference in the long-term recovery. The aim of this narrative review was to provide suggestions and recommendations for effectively managing patients with schizophrenia during acute exacerbations and to enhance awareness and skills related to personalized medicine. Methods A panel of academics and clinicians with experience in the field of psychosis met virtually on July 13th 2023 to narratively review and discuss the research evidence and their clinical experience about the most appropriate acute treatments for patients with schizophrenia. This manuscript represents a synthesis of the panel analysis and discussion. Results First contact is very important for service users, as is finding the most adequate treatment setting. If patients present to the emergency department, which may be a traumatic setting for service users, a dedicated environment with adequate space and specialized mental health support, including personnel trained in de-escalation techniques, is recommended. A well-connected continuum of care is strongly recommended, possibly with seamless links between inpatient units, day hospital services, outpatient facilities and rehabilitation services. Ideally, this should be structured as part of a coordinated step-down service line. Treatment challenges include suboptimal response, side effects, and nonadherence, which is reduced by the use of long-acting injectable antipsychotics. Conclusion Individual circumstances, including age, gender, and presence of hostility/aggression or self-harm, cognitive impairment and negative symptoms, comorbidities (depression, substance use disorders) or associated symptoms (anxiety, insomnia), should be considered when selecting the most appropriate treatment for the acute phase of schizophrenia. Efficacy and feasibility, as well as acceptability and tolerability of treatments, require joint consideration from the early stages of schizophrenia, thereby enhancing the possibility of improved short- and long-term outcomes.
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Affiliation(s)
- Christoph U Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/ Northwell, Hempstead, NY, USA
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
- German Center for Mental Health (DZPG), Partner Site Berlin, Berlin, Germany
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - Andrea Fagiolini
- Department of Molecular Medicine, School of Medicine, University of Siena, Siena, Italy
| | | | - Stefan Leucht
- German Center for Mental Health (DZPG), Partner Site Berlin, Berlin, Germany
- Technical University of Munich, TUM School of Medicine and Health, Department of Psychiatry and Psychotherapy, Munich, Germany
| | - Gonzalo Salazar de Pablo
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
- Child and Adolescent Mental Health Services (CAMHS) South London and Maudsley NHS Foundation Trust London, London, UK
- Department of Child and Adolescent Psychiatry Institute of Psychiatry, Psychology & Neuroscience King’s College London, London, UK
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Jung EJ, Kim DY, Bae HJ, Ko KP. Assessing Regional Disparities and Vulnerability in Stroke Care across Gyeonggi Province: A Focus on Hospital Service Areas. J Stroke Cerebrovasc Dis 2024:107817. [PMID: 38880365 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 06/09/2024] [Accepted: 06/11/2024] [Indexed: 06/18/2024] Open
Abstract
BACKGROUND This study aims to illuminate regional disparities and identify vulnerable areas in stroke care across Gyeonggi Province's hospital service areas. METHODS Using data from the Korea National Cardio-cerebrovascular Disease Management Commission, we included 4,427 acute stroke patients admitted in 2018 to hospitals within Gyeonggi Province. Our evaluation focused on: 1) stroke care quality indicators, including rates of defect-free care, intravenous thrombolysis (IVT), endovascular thrombectomy (EVT), and acute reperfusion therapy (either IVT or EVT); 2) intra-regional treatment rates; and 3) one-year mortality across the province and its 12 hospital service areas. These were compared both with national averages and inter-regionally. Vulnerable areas were pinpointed by evaluating the number of quality indicators falling below the national average and through visual distribution mapping, categorizing each indicator into higher (ranks 1-4), middle (ranks 5-8), and lower (ranks 9-12) tiers. RESULTS Despite fewer qualified stroke centers and specialists, Gyeonggi Province exhibited higher defect-free care rates (84.6% vs. 80.7%), intra-regional treatment rates (57.8% vs. 51.0%), and marginally lower one-year mortality (16.2% vs. 17.3%) compared to national averages. Notable regional disparities were observed; the highest-performing areas for defect-free care and acute reperfusion therapy exceeded the lowest by 1.4 and 3.3 times, respectively. Nine out of twelve areas fell below the national average for EVT rates, seven for IVT and reperfusion therapy rates, and five for intra-regional treatment rates. Pyeongtaek, with all stroke care quality indicators below the national average coupled with the highest one-year mortality, emerges as a critical area needing improvement in acute stroke care. CONCLUSION This study not only exposes the regional disparities in stroke care within Gyeonggi Province's hospital service areas but also identifies areas most vulnerable. Consequently, a customized support strategy for these areas is imperative.
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Affiliation(s)
- En-Joo Jung
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
| | - Do Yeon Kim
- Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital; Gyeonggi Regional Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea; Headquarters for Public Health Care, Seoul National University Bundang Hospital, Seongnam, Korea; Department of Neurology, Gyeonggi Provincial Medical Center Icheon Hospital, Icheon
| | - Hee-Joon Bae
- Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital; Gyeonggi Regional Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kwang-Pil Ko
- Gyeonggi Regional Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea; Clinical Preventive Medicine Center, Seoul National University Bundang Hospital, Seongnam, Korea.
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Kang S, Han M, Park CI, Jung I, Kim E, Jung SJ, Kim SJ, Kang JI. Association between depressive symptoms and cardiovascular diseases in the Korean geriatric population: A nationwide retrospective cohort study. J Affect Disord 2024; 361:182-188. [PMID: 38866251 DOI: 10.1016/j.jad.2024.06.022] [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: 12/29/2023] [Revised: 06/01/2024] [Accepted: 06/05/2024] [Indexed: 06/14/2024]
Abstract
INTRODUCTION Depression has emerged as a modifiable risk factor for cardiovascular disease (CVD). However, evidence on whether depressive symptoms measured using a self-report questionnaire are associated with CVD incidence is scarce. Therefore, we aimed to investigate the association between depressive symptoms and CVD risk using data from national health examinations and insurance claim records. METHODS This retrospective cohort study included participants who underwent the Korean National Screening Program for Transitional Ages at age 66 years between 2007 and 2017. The presence of depressive symptoms was defined as affirmative responses to any of three questions (loss of activities and interests, worthlessness, and hopelessness) selected from the Geriatric Depression Scale. Incident composite CVD event included myocardial infarction, stroke, heart failure, and CVD death. The association between depressive symptoms and CVD risk was evaluated using hazard ratios (HRs) and 95 % confidence intervals (CIs) estimated with Cox proportional hazards models. RESULTS Among 88,765 participants (48.5 % women) aged 66 years, 4036 incident CVD events occurred during a mean follow-up of 6.8 years. Participants with depressive symptoms had a significantly higher risk of CVD than those without depressive symptoms (adjusted HR = 1.16 [95 % CI: 1.07-1.24]). The three individual depressive symptoms showed similar associations with CVD risk (loss of activities and interests, adjusted HR = 1.17 [95 % CI: 1.08-1.26]; worthlessness, 1.15 [1.03-1.29]; hopelessness, 1.13 [1.01-1.26]). LIMITATIONS The study was limited to participants aged 66 years. Despite extensive adjustment for potential confounders and multiple sensitivity analyses, residual confounding and reverse causality could not be ruled out. CONCLUSION The presence of depressive symptoms was associated with an increased risk of CVD. Screening for depressive symptoms in the general population may effectively mitigate the burden of CVD.
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Affiliation(s)
- Sunghyuk Kang
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Minkyung Han
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chun Il Park
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Inkyung Jung
- Division of Biostatistics, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eunwha Kim
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sun Jae Jung
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Center for Psychiatry/Global Health and Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Se Joo Kim
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Jee In Kang
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Cyon L, Kadesjö E, Edgren G, Roos A. Long-term prognosis of low high-sensitivity cardiac troponin T in the emergency department compared with the general population. Heart 2024:heartjnl-2024-323913. [PMID: 38849151 DOI: 10.1136/heartjnl-2024-323913] [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: 01/13/2024] [Accepted: 05/25/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Long-term prognosis associated with low-high-sensitivity cardiac troponin T (hs-cTnT) concentrations in patients with chest pain is unknown. We investigated these prognostic implications compared with the general population. METHODS All first visits to seven emergency departments (ED)s in Sweden were included from 9 December 2010 to 31 August, 2017 by patients presenting with chest pain and at least one hs-cTnT measured. Patients with myocardial injury (any hs-cTnT >14 ng/L), including patients with myocardial infarction (MI) were excluded. Standardised mortality ratios (SMRs) and standardised incidence ratios (SIRs) were calculated as the ratio of the number of observed to expected events. The expected number was computed by multiplying the 1-year calendar period-specific, age-specific and sex-specific follow-up time in the cohort with the corresponding incidence in the general population. HRs were calculated for all-cause mortality and major adverse cardiovascular events (MACE), defined as acute MI, heart failure hospitalisation, cerebrovascular stroke or cardiovascular death, between patients with undetectable (<5 ng/L) and low (5-14 ng/L) hs-cTnT. RESULTS A total of 1 11 916 patients were included, of whom 69 090 (62%) and 42 826 (38%) had peak hs-cTnT concentrations of <5 and 5-14 ng/L. Patients with undetectable peak hs-cTnT had a lower mortality risk compared with the general Swedish population (SMR 0.83, 95% CI 0.79 to 0.87), with lower risks observed in all patients ≥65 years of age, but a slightly higher risk of being diagnosed with a future MI (SIR 1.39, 95% CI 1.32 to 1.47). The adjusted risk of a first MACE associated with low versus undetectable peak hs-cTnT was 1.6-fold (HR 1.61, 95% CI 1.53 to 1.70). CONCLUSION Patients with chest pain and undetectable hs-cTnT have an overall lower risk of death compared with the general population, with risks being highly age dependent. Detectable hs-cTnT concentrations are still associated with increased long-term cardiovascular risks.
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Affiliation(s)
- Love Cyon
- Department of Emergency and Reparative Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Erik Kadesjö
- Department of Emergency and Reparative Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Gustaf Edgren
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Södersjukhuset, Stockholm, Sweden
| | - Andreas Roos
- Department of Emergency and Reparative Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
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Corrao G, Monzio Compagnoni M, Conflitti C, Lora A. Is the long-term poor prognosis of acute myocardial infarction in patients with mental illness mediated through their poor adherence with recommended healthcare? Eur J Public Health 2024; 34:584-591. [PMID: 38268304 PMCID: PMC11161155 DOI: 10.1093/eurpub/ckae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Compared with patients without evidence of psychiatric symptoms, those with mental disorders experience reduced adherence with recommended healthcare and poorer clinical outcomes. This study aimed to evaluate whether the worse prognosis of patients with mental disorders after experiencing acute myocardial infarction could be fully or partially mediated by their reduced adherence to recommended healthcare. METHODS In this retrospective cohort population-based study, 103 389 residents in the Italian Lombardy Region who experienced acute myocardial infarction in 2007-19 were identified. Among them, 1549 patients with severe mental illness (SMI) were matched with five cohort members without evidence of mental disorders (references). Recommended healthcare (cardiac medicaments and selected outpatient services) was evaluated in the year after the date of index hospital discharge. The first occurrences of cardiovascular (CV) hospital admissions and any-cause-death were considered as endpoints. Mediation analysis was performed to investigate whether post-discharge use of recommended healthcare may be considered a mediator of the relationship between healthcare exposure and endpoints occurrence. RESULTS Compared with references, patients with SMI had lower adherence with recommended healthcare and adjusted risk excesses of 39% and 73% for CV hospitalizations and all-cause mortality. Mediation analysis showed that 4.1% and 11.3% of, respectively, CV hospitalizations and deaths occurred among psychiatric patients was mediated by their worse adherence to specific healthcare. CONCLUSION The reduced use of recommended outpatient healthcare by patients with SMI had only a marginal effect on their worse prognosis. Other key factors mediating the prognostic gap between patients with and without mental disorders should be investigated.
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Affiliation(s)
- Giovanni Corrao
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Matteo Monzio Compagnoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Claudia Conflitti
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
- Department of Mental Health and Addiction Services, ASST Lecco, Lecco, Italy
| | - Antonio Lora
- National Centre for Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
- Department of Mental Health and Addiction Services, ASST Lecco, Lecco, Italy
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Paljärvi T, Herttua K, Taipale H, Lähteenvuo M, Tanskanen A, Tiihonen J. Cardiovascular mortality in bipolar disorder: Population-based cohort study. Acta Psychiatr Scand 2024. [PMID: 38826056 DOI: 10.1111/acps.13715] [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] [Received: 02/20/2024] [Revised: 04/26/2024] [Accepted: 05/20/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND Limited evidence base on cause-specific excess cardiovascular disease (CVD) mortality in bipolar disorder (BD) is a barrier to developing preventive interventions aimed at reducing the persistent mortality gap in BD. OBJECTIVE To investigate cause-specific CVD mortality in BD. METHODS We identified all individuals aged 15+ years during 2004-2018 with a diagnosis of BD using Finnish nationwide routine data. Standardised mortality ratios (SMR) with 95% confidence intervals (CI) were calculated using the mortality rates in the general population as weights. RESULTS 53,273 individuals with BD (57% women; median age at BD diagnosis, 40 years), were followed up for 428,426 person-years (median, 8.2 years). There were 5988 deaths due to any cause, of which 26% were due to CVD. The leading cause of absolute excess CVD mortality was coronary artery disease (CAD). The leading causes of relative excess mortality were cardiomegaly (SMR, 4.51; 95% CI, 3.58-5.43), venous thromboembolism (3.03; 2.26-3.81), cardiomyopathy (2.46; 1.95-2.97), and hypertensive heart disease (2.12; 1.71-2.54). The leading causes of absolute CVD mortality showed markedly lower relative excess, including CAD (1.47; 1.34-1.61), ischaemic stroke (1.31; 1.06-1.54), and acute myocardial infarction (1.12; 0.98-1.25). Due to the higher relative excess mortality, structural and functional heart disorders contributed as much as atherosclerotic and ischaemic disorders to the absolute excess mortality. CONCLUSIONS Cardiomyopathy and hypertensive heart disease as the leading causes of relative excess mortality emphasise the contribution of structural and functional heart disorders to the overall excess mortality alongside coronary artery disease. Interventions targeted at these modifiable causes of death should be priorities in the prevention of premature excess CVD mortality in BD.
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Affiliation(s)
- Tapio Paljärvi
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
| | - Kimmo Herttua
- Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Heidi Taipale
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Markku Lähteenvuo
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
| | - Antti Tanskanen
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jari Tiihonen
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Milanović S, Dedic N, Lew R, Burton D, Koblan KS, Camilleri M, Hopkins SC. TAAR1 agonist ulotaront delays gastric emptying of solids in patients with schizophrenia and concurrent metabolic syndrome with prediabetes. Diabetes Obes Metab 2024; 26:2466-2475. [PMID: 38533552 DOI: 10.1111/dom.15569] [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: 02/05/2024] [Revised: 03/05/2024] [Accepted: 03/08/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Metabolic syndrome (MetS), which can be induced or exacerbated by the current class of antipsychotic drugs, is highly prevalent in patients with schizophrenia and presents significant challenges to lifetime disease management. Supported by initial clinical results, trace amine-associated receptor 1 (TAAR1) agonists have emerged as potential novel treatments for schizophrenia. Notably, non-clinical studies have also shown weight-lowering and glucoregulatory effects of TAAR1 agonists, including the investigational agent ulotaront. However, the translatability of these findings to humans has not been adequately assessed. Given that delayed gastric emptying (GE) was identified as a potential mechanism contributing to the metabolic benefits of TAAR1 agonists in rodents, the aim of this study was to evaluate the effect of ulotaront on GE in patients with schizophrenia and concurrent MetS with prediabetes. METHODS Patients with schizophrenia were randomized to receive a single oral dose of ulotaront (150 mg) and their previous antipsychotic (PA) in an open-label, crossover, two-sequence design (NCT05402111). Eligible participants fulfilled at least three of five MetS criteria and had prediabetes defined by elevated glycated haemoglobin (5.7-6.4%) and/or fasting homeostatic model assessment of insulin resistance (i.e. ≥2.22). Following an overnight fast and 4 h post-dose, participants ingested a 99mTc-sulphur colloid radiolabelled egg meal (320 kcal, 30% fat). GE was measured by scintigraphy over 4 h. Endpoints included GE of solids half-time (T1/2) and percentage gastric retention at 1, 2 and 4 h. RESULTS Thirty-one adults were randomized and 27 completed the study. Ulotaront significantly delayed GE of solids [median GE T1/2 ulotaront at 139 min (119, 182) vs. the participant's PA of 124 min (109, 132), p = .006]. A significant increase in gastric retention was seen in the ulotaront versus the PA group at 1 h (80% vs. 75%, p = .015), 2 h (61% vs. 50%, p = .023) and 4 h (17% vs. 7%, p = .002) post-meal. CONCLUSION Ulotaront delayed the GE of solids in patients with schizophrenia and concurrent MetS with prediabetes. Additional studies are needed to assess whether treatment with TAAR1 agonists is associated with weight loss and glucoregulatory improvement.
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Affiliation(s)
| | - Nina Dedic
- Sumitomo Pharma America, Inc., Marlborough, Massachusetts, USA
| | - Robert Lew
- Sumitomo Pharma America, Inc., Marlborough, Massachusetts, USA
| | | | | | | | - Seth C Hopkins
- Sumitomo Pharma America, Inc., Marlborough, Massachusetts, USA
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11
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Yang H, Zhu D, He S, Xu Z, Liu Z, Zhang W, Cai J. Enhancing psychiatric rehabilitation outcomes through a multimodal multitask learning model based on BERT and TabNet: An approach for personalized treatment and improved decision-making. Psychiatry Res 2024; 336:115896. [PMID: 38626625 DOI: 10.1016/j.psychres.2024.115896] [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: 06/26/2023] [Revised: 04/03/2024] [Accepted: 04/05/2024] [Indexed: 04/18/2024]
Abstract
Evaluating the rehabilitation status of individuals with serious mental illnesses (SMI) necessitates a comprehensive analysis of multimodal data, including unstructured text records and structured diagnostic data. However, progress in the effective assessment of rehabilitation status remains limited. Our study develops a deep learning model integrating Bidirectional Encoder Representations from Transformers (BERT) and TabNet through a late fusion strategy to enhance rehabilitation prediction, including referral risk, dangerous behaviors, self-awareness, and medication adherence, in patients with SMI. BERT processes unstructured textual data, such as doctor's notes, whereas TabNet manages structured diagnostic information. The model's interpretability function serves to assist healthcare professionals in understanding the model's predictive decisions, improving patient care. Our model exhibited excellent predictive performance for all four tasks, with an accuracy exceeding 0.78 and an area under the curve of 0.70. In addition, a series of tests proved the model's robustness, fairness, and interpretability. This study combines multimodal and multitask learning strategies into a model and applies it to rehabilitation assessment tasks, offering a promising new tool that can be seamlessly integrated with the clinical workflow to support the provision of optimized patient care.
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Affiliation(s)
- Hongyi Yang
- School of Design, Shanghai Jiao Tong University, Shanghai, China
| | - Dian Zhu
- School of Design, Shanghai Jiao Tong University, Shanghai, China
| | - Siyuan He
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhiqi Xu
- School of Design, Shanghai Jiao Tong University, Shanghai, China
| | - Zhao Liu
- School of Design, Shanghai Jiao Tong University, Shanghai, China.
| | - Weibo Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China; Mental Health Branch, China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, China.
| | - Jun Cai
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Mental Health Branch, China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, China.
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12
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Haran M, Killeen D, Smyth J, McNicholas F. A scoping review of physical activity interventions in youth attending child and adolescent mental health services. Ir J Med Sci 2024; 193:1391-1402. [PMID: 38267797 DOI: 10.1007/s11845-024-03607-7] [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: 08/31/2023] [Accepted: 01/05/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND There has been an international effort to improve physical health in general and in those with mental illness. Physical activity (PA) may be beneficial as an adjunctive treatment for mental health disorders and to improve physical well-being. AIMS The objective of this scoping review is to understand the extent and type of evidence in relation to PA interventions offered in child and adolescent mental health services (CAMHS). Eligibility was determined using the Population, Concept, Context framework. Studies were included if the participants were under 18 years old, attending CAMHS and where PA interventions were offered. METHODS PubMed, MEDLINE, Embase, Cochrane Library, CINAHL, PsycINFO and SportDiscus were searched without language or date restrictions. Titles and abstracts, followed by full texts, were screened by two independent reviewers. Two reviewers carried out data extraction, and discrepancies in any of these processes were resolved in consultation with a third reviewer. RESULTS After 2213 non-duplicate titles and abstracts were screened, 2090 were excluded and 123 full texts were screened. Seventeen studies met inclusion criteria. Included studies demonstrated PA interventions to be effective in reducing depressive symptoms and improving psychosocial functioning. While no study reported significant changes in anthropometric measurements, 2 studies demonstrated increased aerobic fitness. CONCLUSION Evidence that PA interventions are being offered in CAMHS worldwide is limited. Included studies demonstrate potential benefits in depressive symptoms, psychosocial functioning, self-esteem and aerobic fitness in youth attending CAMHS. Future research should identify effective ways to incorporate exercise interventions in CAMHS and evaluate long-term benefits.
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Affiliation(s)
- Maeve Haran
- Lucena Child and Adolescent Mental Health Service (CAMHS), Dublin, Ireland.
- Department of Child and Adolescent Psychiatry, School of Medicine, University College Dublin, Dublin, Ireland.
| | - David Killeen
- Department of Child and Adolescent Psychiatry, Children's Health Ireland at Tallaght, Dublin, D24TN3C, Ireland
| | - Justin Smyth
- Head of Library Services, St John of God's Research Foundation, Saint John of God Hospitaller Services Group, Granada, Stillorgan, Dublin, Ireland
| | - Fiona McNicholas
- Lucena Child and Adolescent Mental Health Service (CAMHS), Dublin, Ireland
- Department of Child and Adolescent Psychiatry, School of Medicine, University College Dublin, Dublin, Ireland
- Department of Paediatric Liaison Psychiatry, Children's Health Ireland (CHI), Dublin, Ireland
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13
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Caspi A, Shireby G, Mill J, Moffitt TE, Sugden K, Hannon E. Accelerated Pace of Aging in Schizophrenia: Five Case-Control Studies. Biol Psychiatry 2024; 95:1038-1047. [PMID: 37924924 PMCID: PMC11063120 DOI: 10.1016/j.biopsych.2023.10.023] [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: 06/22/2023] [Revised: 09/29/2023] [Accepted: 10/21/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND Schizophrenia is associated with increased risk of developing multiple aging-related diseases, including metabolic, respiratory, and cardiovascular diseases, and Alzheimer's and related dementias, leading to the hypothesis that schizophrenia is accompanied by accelerated biological aging. This has been difficult to test because there is no widely accepted measure of biological aging. Epigenetic clocks are promising algorithms that are used to calculate biological age on the basis of information from combined cytosine-phosphate-guanine sites (CpGs) across the genome, but they have yielded inconsistent and often negative results about the association between schizophrenia and accelerated aging. Here, we tested the schizophrenia-aging hypothesis using a DNA methylation measure that is uniquely designed to predict an individual's rate of aging. METHODS We brought together 5 case-control datasets to calculate DunedinPACE (Pace of Aging Calculated from the Epigenome), a new measure trained on longitudinal data to detect differences between people in their pace of aging over time. Data were available from 1812 psychosis cases (schizophrenia or first-episode psychosis) and 1753 controls. Mean chronological age was 38.9 (SD = 13.6) years. RESULTS We observed consistent associations across datasets between schizophrenia and accelerated aging as measured by DunedinPACE. These associations were not attributable to tobacco smoking or clozapine medication. CONCLUSIONS Schizophrenia is accompanied by accelerated biological aging by midlife. This may explain the wide-ranging risk among people with schizophrenia for developing multiple different age-related physical diseases, including metabolic, respiratory, and cardiovascular diseases, and dementia. Measures of biological aging could prove valuable for assessing patients' risk for physical and cognitive decline and for evaluating intervention effectiveness.
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Affiliation(s)
- Avshalom Caspi
- Department of Psychology & Neuroscience, Duke University, Durham, North Carolina; Social, Genetic and Developmental Psychiatry, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, London, United Kingdom; PROMENTA, Department of Psychology, University of Oslo, Oslo, Norway.
| | - Gemma Shireby
- Centre of Longitudinal Studies, University College London, Exeter, United Kingdom
| | - Jonathan Mill
- University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - Terrie E Moffitt
- Department of Psychology & Neuroscience, Duke University, Durham, North Carolina; Social, Genetic and Developmental Psychiatry, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, London, United Kingdom; PROMENTA, Department of Psychology, University of Oslo, Oslo, Norway
| | - Karen Sugden
- Department of Psychology & Neuroscience, Duke University, Durham, North Carolina
| | - Eilis Hannon
- University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
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Meng T, Liu Z, Liu J, Zhang X, Li C, Li J, Wang B, He Y, Fan Z, Xin S, Chen J, Qie R. Multiple coronary heart diseases are risk factors for mental health disorders: A mendelian randomization study. Heart Lung 2024; 66:86-93. [PMID: 38593678 DOI: 10.1016/j.hrtlng.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Previous observational studies have suggested associations between Coronary Heart Disease (CHD) and Mental Health Disorders (MHD). However, the causal nature of these relationships has remained elusive. OBJECTIVE The purpose of this study is to elucidate the causal relationships between eight distinct types of CHD and six types of MHD using Mendelian randomization (MR) analysis. METHODS The MR analysis employed a suite of methods including inverse variance-weighted (IVW), MR-Egger, weighted mode, weighted median, and simple mode techniques. To assess heterogeneity, IVW and MR-Egger tests were utilized. MR-Egger regression also served to investigate potential pleiotropy. The stability of IVW results was verified by leave-one-out sensitivity analysis. RESULTS We analyzed data from over 2,473,005 CHD and 803,801 MHD patients, informed by instrumental variables from large-scale genomic studies on European populations. The analysis revealed a causal increase in the risk of Major Depressive Disorder and Mania associated with Coronary Artery Disease and Myocardial Infarction. Heart Failure was found to causally increase the risk for Bipolar Disorder and Schizophrenia. Atrial Fibrillation and Ischemic Heart Diseases were positively linked to Generalized Anxiety Disorder and Mania, respectively. There was no significant evidence of an association between Hypertensive Heart Disease, Hypertrophic Cardiomyopathy, Pulmonary Heart Disease, and MHD. Reverse MR analysis indicated that MHD do not serve as risk factors for CHD. CONCLUSIONS The findings suggest that specific types of CHD may act as risk factors for certain MHDs. Consequently, incorporating psychological assessments into the management of patients with CHD could be advantageous.
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Affiliation(s)
- Tianwei Meng
- Heilongjiang University of Chinese Medicine, Harbin, 150006, China
| | - Zhiping Liu
- The Second Cardiology Department of the Affiliated Second Hospital of Heilongjiang University of Chinese Medicine, Harbin, 150001, China; Geriatrics, the first affiliated hospital, Heilongjiang University of Chinese Medicine, Harbin, 150040, China
| | - Jiawen Liu
- Heilongjiang University of Chinese Medicine, Harbin, 150006, China
| | - Xiaobing Zhang
- Heilongjiang University of Chinese Medicine, Harbin, 150006, China
| | - Chengjia Li
- Heilongjiang University of Chinese Medicine, Harbin, 150006, China
| | - Jiarui Li
- Heilongjiang University of Chinese Medicine, Harbin, 150006, China
| | - Boyu Wang
- Heilongjiang University of Chinese Medicine, Harbin, 150006, China
| | - Yinxiong He
- Heilongjiang University of Chinese Medicine, Harbin, 150006, China
| | - Zengguang Fan
- Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Jiangxi, 330200, China
| | - Shilong Xin
- Heilongjiang University of Chinese Medicine, Harbin, 150006, China
| | - Jia Chen
- Heilongjiang University of Chinese Medicine, Harbin, 150006, China
| | - Rui Qie
- Geriatrics, the first affiliated hospital, Heilongjiang University of Chinese Medicine, Harbin, 150040, China.
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Ojo OE, Ajayi EA, Ajayi AO, Fadare JO, Dada SA, Olaoye OB. Determinants/Predictors of QT Abnormalities in Patients on Psychotropic Medications in a Nigerian Tertiary Hospital. Cardiovasc Toxicol 2024:10.1007/s12012-024-09873-2. [PMID: 38819736 DOI: 10.1007/s12012-024-09873-2] [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: 03/01/2023] [Accepted: 05/17/2024] [Indexed: 06/01/2024]
Abstract
Cardiovascular disease is a major global burden and a leading cause of premature death among patients with severe mental illness. Over time, research and clinical practice have paid increased attention to the impact of psychiatric medications on cardiac repolarization. In a resource-limited setting, it is common for psychotropic medications to be initiated and maintained in an outpatient setting without baseline or follow up ECG. This study evaluated the determinants and predictors of QT abnormalities among patient taking psychotropic drugs. We conducted a cross-sectional study in a population of 150 psychiatric patients on psychotropics and 75 controls. We studied the effects of various psychotropic drugs on QT dispersion (QTd) and corrected QT interval (QTc) as well as correlation with the types and dosages of psychotropic drugs used. All the subjects had detailed clinical examination and resting electrocardiogram (ECG) at 25 mm/sec done. QTc was determined using Bazett formula and QTd was determined by subtracting shortest from longest QT in 12-lead ECG. The prevalence of prolonged QTc and QTd as well as the mean QTc and QTd were significantly higher in patients than the control group. The mean QTc was significantly higher in patient on typical antipsychotics compared to those on atypical antipsychotics. Age, heart rate and antipsychotic dose in chlorpromazine equivalent were predictors of QTc with the heart rate being the most powerful predictor among them. Psychotropic drugs use is associated with QTc and QTd prolongation with age, heart rate and antipsychotic dose as predictors of QTc.
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Affiliation(s)
- Opeyemi Ezekiel Ojo
- Departments of Medicine/Pharmacology and Therapeutics, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria.
- Cardiology Unit, Departments of Medicine, Ekiti State University Teaching Hospital, PMB 5355, Ado-Ekiti, Ekiti State, Nigeria.
| | | | | | - Joseph Olusesan Fadare
- Departments of Medicine/Pharmacology and Therapeutics, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria
| | | | - Olatunji Bukola Olaoye
- Cardiology Unit, Departments of Medicine, Ekiti State University Teaching Hospital, PMB 5355, Ado-Ekiti, Ekiti State, Nigeria
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16
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Guinart D, Fagiolini A, Fusar-Poli P, Giordano GM, Leucht S, Moreno C, Correll CU. On the Road to Individualizing Pharmacotherapy for Adolescents and Adults with Schizophrenia - Results from an Expert Consensus Following the Delphi Method. Neuropsychiatr Dis Treat 2024; 20:1139-1152. [PMID: 38812809 PMCID: PMC11133879 DOI: 10.2147/ndt.s456163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/27/2024] [Indexed: 05/31/2024] Open
Abstract
Introduction Schizophrenia is a severe mental illness that usually begins in late adolescence or early adulthood. Current pharmacological treatments, while acceptably effective for many patients, are rarely clinically tailored or individualized. The lack of sufficient etiopathological knowledge of the disease, together with overall comparable effect sizes for efficacy between available antipsychotics and the absence of clinically actionable biomarkers, has hindered the advance of individualized medicine in the treatment of schizophrenia. Nevertheless, some degree of stratification based on clinical markers could guide treatment choices and help clinicians move toward individualized psychiatry. To this end, a panel of experts met to formally discuss the current approach to individualized treatment in schizophrenia and to define how treatment individualization could help improve clinical outcomes. Methods A task force of seven experts iteratively developed, evaluated, and refined questionnaire items, which were then evaluated using the Delphi method. Descriptive statistics were used to summarize and rank expert responses. Expert discussion, informed by the results of a scoping review on personalizing the pharmacologic treatment of adults and adolescents with schizophrenia, ultimately generated recommendations to guide individualized pharmacologic treatment in this population. Results There was substantial agreement among the expert group members, resulting in the following recommendations: 1) individualization of treatment requires consideration of the patient's diagnosis, clinical presentation, comorbidities, previous treatment response, drug tolerability, adherence patterns, and social factors; 2) patient preferences should be considered in a shared decision-making approach; 3) identified barriers to personalized care that need to be overcome include the lack of actionable biomarkers and mechanistic similarities between available treatments, but digital tools should be increasingly used to enhance individualized treatment. Conclusion Individualized care can help provide effective, tailored treatments based on an individual's clinical characteristics, disease trajectory, family and social environment, and goals and preferences.
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Affiliation(s)
- Daniel Guinart
- Institut de Salut Mental, Parc de Salut Mar, Barcelona, Spain
- Hospital Del Mar Research Institute, CIBERSAM, Barcelona, Spain
- Department of Psychiatry, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Andrea Fagiolini
- Department of Molecular Medicine, University of Siena School of Medicine, Siena, Italy
| | - Paolo Fusar-Poli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Department of Psychosis Studies, King’s College London, London, UK
- Outreach and Support in South-London (OASIS) Service, South London and Maudsley (Slam) NHS Foundation Trust, London, UK
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University Munich, Munich, Germany
| | | | - Stefan Leucht
- Technical University of Munich, TUM School of Medicine and Health, Department of Psychiatry and Psychotherapy, Munich, Germany
| | - Carmen Moreno
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (LISGM), Madrid, Spain
- Centro de Investigación Biomedica en Red (CIBERSAM), ISCIII, Madrid, Spain
- School of Medicine, Universidad Complutense, Madrid, Spain
| | - Christoph U Correll
- Department of Psychiatry, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Psychiatry, The Zucker Hillside Hospital, New York, NY, USA
- Department of Child and Adolescent Psychiatry, Charité Universitatsmedizin, Berlin, Germany
- German Center for Mental Health (DZPG), Partner Site, Berlin, Germany
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17
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Nordmeyer L, Leikert C, Sannemann L, Keller K, Leminski C, Meixner A, Peltzer S, Werner B, Kuntz L, Pfaff H, Schulz-Nieswandt F, Jessen F, Albus C. Quality of health care for patients with coronary heart disease and comorbid mental disorders: a prospective cohort study. BMC Psychol 2024; 12:288. [PMID: 38783365 PMCID: PMC11112883 DOI: 10.1186/s40359-024-01693-x] [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: 09/07/2023] [Accepted: 03/28/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Coronary heart disease (CHD) is often associated with mental disorders (MDs). Comorbid MDs reduce the quality of life and increase cardiac morbidity and mortality. Nevertheless, there is little and inconsistent research on the management of MDs in CHD patients. To bridge this gap, this study aims to gain insight into the long-term course of MD-related health care for patients with CHD, in order to identify opportunities for care improvement. METHODS In this prospective cohort study, we investigated whether CHD patients with or without expert-rated MD at baseline (N = 364) received different MD-related health care from either their general practitioner (GP) or cardiologist at follow-up, M = 2.7 [2.0-4.0] years later. In the follow-up assessment, N = 131 CHD patients participated and received questionnaires capturing sociodemographic, mental health, and MD-related health care characteristics. Descriptive statistics, t-tests and chi-squared tests were used for analyses. RESULTS We found significant differences in MD-related health care. CHD patients with MD were more likely to be examined psychologically/psychiatrically (MD 55.9%, non-MD 16.7%, p = < .001) and diagnosed with MD (MD 55.9%, non-MD 13.5%, p = .020) by their GP or cardiologist. Recommendations for and responses to requests for psychotherapy were more likely in MD patients compared to non-MD patients (MD 38.7%, non-MD 11.8%, p = .012 and MD 38.5%, non-MD 11.8%, p = .031, respectively). No significant differences were found concerning physicians' active demand for patients' mental health, referral to a specialist for additional diagnostics, provision of information about the diagnosed MD and further treatment options, response to the patients' request for psychopharmacotherapy, help received in finding psychotherapy or psychopharmacotherapy, and actual receipt of these treatments. CONCLUSIONS The results indicate differences in MD-related health care of CHD patients with and without comorbid MD. However, they still highlight the need to further encourage primary care physicians treating CHD to adequately address MDs, provide further diagnostics, support, and information to affected patients. To address this, physicians may benefit from awareness training on the association between CHD and MDs and on appropriate communication with MD patients. TRIAL REGISTRATION German clinical trials register (Deutsches Register Klinischer Studien, DRKS) Registration Number: ID DRKS00022154, date of registration: 02.11.2021.
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Affiliation(s)
- Laura Nordmeyer
- Department of Psychosomatics and Psychotherapy, Faculty of Medicine and Cologne University Hospital, University of Cologne, Cologne, Germany
| | - Charlotte Leikert
- Department of Psychosomatics and Psychotherapy, Faculty of Medicine and Cologne University Hospital, University of Cologne, Cologne, Germany
| | - Lena Sannemann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and Cologne University Hospital, University of Cologne, Cologne, Germany
| | - Kai Keller
- Chair of Quality Development and Evaluation in Rehabilitation, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, Institute for Medical Sociology, Health Services Research and Rehabilitation Science, University of Cologne, Cologne, Germany
| | - Christin Leminski
- Chair of Quality Development and Evaluation in Rehabilitation, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, Institute for Medical Sociology, Health Services Research and Rehabilitation Science, University of Cologne, Cologne, Germany
| | - Adriana Meixner
- Department of Business Administration and Health Care Management, Faculty of Management, Economics and Social Sciences, University of Cologne, Cologne, Germany
| | - Samia Peltzer
- Department of Psychosomatics and Psychotherapy, Faculty of Medicine and Cologne University Hospital, University of Cologne, Cologne, Germany
| | - Belinda Werner
- Faculty of Management, Economics and Social Sciences, Institute of Sociology and Social Psychology (ISS), University of Cologne, Cologne, Germany
| | - Ludwig Kuntz
- Department of Business Administration and Health Care Management, Faculty of Management, Economics and Social Sciences, University of Cologne, Cologne, Germany
- Centre for Health Services Research Cologne (ZVFK), University of Cologne, Cologne, Germany
| | - Holger Pfaff
- Chair of Quality Development and Evaluation in Rehabilitation, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, Institute for Medical Sociology, Health Services Research and Rehabilitation Science, University of Cologne, Cologne, Germany
- Centre for Health Services Research Cologne (ZVFK), University of Cologne, Cologne, Germany
| | - Frank Schulz-Nieswandt
- Faculty of Management, Economics and Social Sciences, Institute of Sociology and Social Psychology (ISS), University of Cologne, Cologne, Germany
| | - Frank Jessen
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and Cologne University Hospital, University of Cologne, Cologne, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Christian Albus
- Department of Psychosomatics and Psychotherapy, Faculty of Medicine and Cologne University Hospital, University of Cologne, Cologne, Germany.
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18
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Kreppke JN, Cody R, Beck J, Brand S, Donath L, Eckert A, Imboden C, Hatzinger M, Holsboer-Trachsler E, Lang UE, Mans S, Mikoteit T, Oswald A, Rogausch A, Schweinfurth-Keck N, Zahner L, Gerber M, Faude O. Cardiorespiratory fitness, perceived fitness and autonomic function in in-patients with different depression severity compared with healthy controls. J Psychiatr Res 2024; 175:437-445. [PMID: 38797040 DOI: 10.1016/j.jpsychires.2024.05.044] [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: 05/02/2023] [Revised: 03/26/2024] [Accepted: 05/20/2024] [Indexed: 05/29/2024]
Abstract
Over 300 million individuals worldwide suffer from major depressive disorder (MDD). Individuals with MDD are less physically active than healthy people which results in lower cardiorespiratory fitness (CRF) and less favorable perceived fitness compared with healthy controls. Additionally, individuals with MDD may show autonomic system dysfunction. The purpose of the present study was to evaluate the CRF, perceived fitness and autonomic function in in-patients with MDD of different severity compared with healthy controls. We used data from 212 in-patients (age: 40.7 ± 12.6 y, 53% female) with MDD and from 141 healthy controls (age: 36.7 ± 12.7 y, 58% female). We assessed CRF with the Åstrand-Rhyming test, self-reported perceived fitness and autonomic function by heart rate variability (HRV). In specific, we used resting heart rate, time- and frequency-based parameters for HRV. In-patients completed the Beck Depression Inventory-II (BDI-II) to self-assess the subjectively rated severity of depression. Based on these scores, participants were grouped into mild, moderate and severe MDD. The main finding was an inverse association between depression severity and CRF as well as perceived fitness compared with healthy controls. Resting heart rate was elevated with increasing depression severity. The time-based but not the frequency-based autonomic function parameters showed an inverse association with depression severity. The pattern of results suggests that among in-patients with major depressive disorder, those with particularly high self-assessed severity scores show a lower CRF, less favorable perceived fitness and partial autonomic dysfunction compared to healthy controls. To counteract these conditions, physical activity interventions may be effective.
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Affiliation(s)
- Jan-Niklas Kreppke
- Department for Sport, Exercise and Health, University of Basel, Basel, Switzerland.
| | - Robyn Cody
- Department for Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | | | - Serge Brand
- Department for Sport, Exercise and Health, University of Basel, Basel, Switzerland; Adult Psychiatric Clinics (UPKE), University of Basel, Basel, Switzerland; Substance Use Prevention Research Center and Sleep Disorder Research Center, Kermanshah University of Medical Sciences (KUMS), Kermanshah 6715847141, Iran; School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran; Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah 6719851115, Iran
| | - Lars Donath
- German Sport University Cologne, Department of Intervention Research in Exercise Training, Cologne, Germany
| | - Anne Eckert
- Adult Psychiatric Clinics (UPKE), University of Basel, Basel, Switzerland
| | - Christian Imboden
- Private Clinic Wyss, Münchenbuchsee, Switzerland; University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Martin Hatzinger
- Psychiatric Services, Solothurn, and Medical Faculty, University of Basel, Switzerland
| | | | - Undine E Lang
- Adult Psychiatric Clinics (UPKE), University of Basel, Basel, Switzerland
| | - Sarah Mans
- Private Clinic Wyss, Münchenbuchsee, Switzerland
| | - Thorsten Mikoteit
- Psychiatric Services, Solothurn, and Medical Faculty, University of Basel, Switzerland
| | - Anja Oswald
- Psychiatric Clinic Sonnenhalde, Riehen, Switzerland
| | | | | | - Lukas Zahner
- Department for Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Markus Gerber
- Department for Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Oliver Faude
- Department for Sport, Exercise and Health, University of Basel, Basel, Switzerland
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19
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Pasman JA, Bergstedt J, Harder A, Gong T, Xiong Y, Hägg S, Fang F, Treur JL, Choi KW, Sullivan PF, Lu Y. Causes and consequences of major depressive disorder: An encompassing Mendelian randomization study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.21.24307678. [PMID: 38826420 PMCID: PMC11142270 DOI: 10.1101/2024.05.21.24307678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
Background Major depressive disorder (MDD) is a prevalent and debilitating disorder that has been associated with a range of risk factors and outcomes. Causal pathways between MDD and other traits can be studied using genetic variants as instrumental variables. Methods A literature review was conducted to identify 201 MDD-associated traits. For 115 traits, there were well-powered genome-wide association study (GWAS) results available that could be used to assess the genetic correlation with MDD. Of these, there were 89 meeting criteria for investigating causal associations in both directions using two-sample Mendelian randomization (TSMR). Of the traits that were not captured by GWAS, 43 could be included as outcomes of MDD using one-sample MR (OSMR). A range of methods and sensitivity tests was applied to gauge robustness of results, together with statistical power analyses to aid interpretation. Outcomes Moderate to strong genetic overlap was found between MDD and most traits. Support for causal effects of MDD liability were found for circadian, cognitive, diet, medical disease, endocrine, functional, inflammatory, metabolic, mortality, physical activity, reproduction, risk behavior, social, socioeconomic, and suicide outcomes. Most associations were bidirectional, although there was less evidence for diet, disease, and endocrine traits causing MDD risk. Results were robust across sensitivity analyses. Interpretation This study provides a systematic overview of traits putatively causally related to MDD, confirming previous findings as well as identifying new associations. Our results highlight the importance of MDD as a risk factor cross-cutting across medical, functional, and psychosocial domains and emphasize the need for concerted efforts at reducing this highly prevalent disorder.
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Affiliation(s)
- Joëlle A. Pasman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Nobels Väg 12, Stockholm, Sweden
- Amsterdam UMC location University of Amsterdam, Department of Psychiatry, Genetic Epidemiology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Jacob Bergstedt
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Nobels Väg 12, Stockholm, Sweden
- Institute of Environmental Medicine, Karolinska Institute, Nobels Väg 12, Stockholm, Sweden
| | - Arvid Harder
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Nobels Väg 12, Stockholm, Sweden
| | - Tong Gong
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Nobels Väg 12, Stockholm, Sweden
| | - Ying Xiong
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Nobels Väg 12, Stockholm, Sweden
| | - Sara Hägg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Nobels Väg 12, Stockholm, Sweden
| | - Fang Fang
- Institute of Environmental Medicine, Karolinska Institute, Nobels Väg 12, Stockholm, Sweden
| | - Jorien L. Treur
- Amsterdam UMC location University of Amsterdam, Department of Psychiatry, Genetic Epidemiology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Karmel W. Choi
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Patrick F. Sullivan
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Nobels Väg 12, Stockholm, Sweden
- Departments of Genetics and Psychiatry, UNC Chapel Hill, NC, USA
| | - Yi Lu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Nobels Väg 12, Stockholm, Sweden
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20
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Hein M, Wacquier B, Conenna M, Lanquart JP, Point C. Cardiovascular Outcome in Patients with Major Depression: Role of Obstructive Sleep Apnea Syndrome, Insomnia Disorder, and COMISA. Life (Basel) 2024; 14:644. [PMID: 38792664 PMCID: PMC11123427 DOI: 10.3390/life14050644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 05/06/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024] Open
Abstract
In this study, the 10-year cardiovascular risk associated with comorbid sleep disorders (insomnia disorder, obstructive sleep apnea syndrome, and COMISA [comorbid insomnia and sleep apnea]) was investigated for patients with major depression. To enable our analysis, 607 patients with major depression were selected from the data register of the Sleep Unit. High 10-year cardiovascular risk was considered present when the Framingham Risk Score was ≥10%. The 10-year cardiovascular risk associated with comorbid sleep disorders has been assessed using logistic regression analyzes. High 10-year cardiovascular risk is significant (40.4%) in patients with major depression. After successive introduction of the different confounders, multivariate logistic regressions showed that for patients with major depression high 10-year cardiovascular risk was significantly associated with COMISA but was not significantly associated with insomnia disorder or obstructive sleep apnea syndrome alone. Thus, these results highlight the existence of a negative synergistic action between insomnia disorder and obstructive sleep apnea syndrome on the 10-year cardiovascular risk in patients with major depression, which demonstrates the importance of researching and treating COMISA to improve the prognosis of this specific population subgroup characterized by higher cardiovascular morbidity and mortality.
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Affiliation(s)
- Matthieu Hein
- Hôpital Universitaire de Bruxelles, Service de Psychiatrie et Laboratoire du Sommeil, Université Libre de Bruxelles, ULB, 1070 Brussels, Belgium; (B.W.); (M.C.); (J.-P.L.); (C.P.)
- Laboratoire de Psychologie Médicale et Addictologie (ULB312), Université Libre de Bruxelles, ULB, 1020 Brussels, Belgium
- Route de Lennik, 1070 Anderlecht, Belgium
| | - Benjamin Wacquier
- Hôpital Universitaire de Bruxelles, Service de Psychiatrie et Laboratoire du Sommeil, Université Libre de Bruxelles, ULB, 1070 Brussels, Belgium; (B.W.); (M.C.); (J.-P.L.); (C.P.)
| | - Matteo Conenna
- Hôpital Universitaire de Bruxelles, Service de Psychiatrie et Laboratoire du Sommeil, Université Libre de Bruxelles, ULB, 1070 Brussels, Belgium; (B.W.); (M.C.); (J.-P.L.); (C.P.)
| | - Jean-Pol Lanquart
- Hôpital Universitaire de Bruxelles, Service de Psychiatrie et Laboratoire du Sommeil, Université Libre de Bruxelles, ULB, 1070 Brussels, Belgium; (B.W.); (M.C.); (J.-P.L.); (C.P.)
| | - Camille Point
- Hôpital Universitaire de Bruxelles, Service de Psychiatrie et Laboratoire du Sommeil, Université Libre de Bruxelles, ULB, 1070 Brussels, Belgium; (B.W.); (M.C.); (J.-P.L.); (C.P.)
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21
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Marinelli R, Parker AG, Levinger I, Bourke M, Patten R, Woessner MN. Resistance training and combined resistance and aerobic training as a treatment of depression and anxiety symptoms in young people: A systematic review and meta-analysis. Early Interv Psychiatry 2024. [PMID: 38710640 DOI: 10.1111/eip.13528] [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: 09/03/2023] [Accepted: 04/08/2024] [Indexed: 05/08/2024]
Abstract
AIM To determine the treatment effect of resistance training in reducing symptoms of anxiety and depression in young people. METHODS We searched MEDLINE, PsychINFO, and PubMed for articles published in English from January 1980 to September 2023 for randomized controlled trials (RCT) that included at least 4 weeks of resistance training, with participants aged 26 years or younger with clinically elevated anxiety and depression symptoms. A random-effects meta-analysis was used to calculate a pooled effect size of resistance training pre-and post-intervention compared to control groups. The quality of evidence was assessed using the Cochrane risk-of-bias 2 (RoB 2) and Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) criteria. RESULTS Ten RCTs involving 376 participants (209 females and 127 males) across educational, clinical, and community based setting were eligible for inclusion in the analysis. Resistance training was associated with a significant reduction in depressive (Hedge's g = -1.06, 95% CI -1.61 to -0.51, p < .001) and anxiety (Hedge's g = -1.02, 95% CI -1.50 to -0.54, p < .001) symptoms. Substantial heterogeneity was observed in the analysis of depression symptoms (I2 = 79%) and anxiety symptoms (I2 = 66%). Six trials had a low risk of bias, four trials showed some concerns. The GRADE analysis demonstrated a high level of certainty for depressive symptoms and a moderate level for anxiety symptoms. CONCLUSION Resistance training is an effective intervention in reducing depression and anxiety symptoms in young people, delivered across a range of settings. Future trials exploring the effect resistance training interventions with long-term follow up are warranted to understand the outcomes.
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Affiliation(s)
- Ryan Marinelli
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Victoria, Australia
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Alexandra G Parker
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Itamar Levinger
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Victoria, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, St Albans, Victoria, Australia
| | - Matthew Bourke
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Rhiannon Patten
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Victoria, Australia
| | - Mary N Woessner
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Victoria, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, St Albans, Victoria, Australia
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22
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Coello K, Holstad Pedersen H, Munkholm K, Lie Kjærstad H, Stanislaus S, Rye Ostrowski S, Faurholt-Jepsen M, Miskowiak KW, Frikke-Schmidt R, Vinberg M, Thorn Ekstrøm C, Lyng Forman J, Vedel Kessing L. A composite immune and vascular stress marker in patients newly diagnosed with bipolar disorder and their unaffected first-degree relatives. Brain Behav Immun 2024; 118:449-458. [PMID: 38508346 DOI: 10.1016/j.bbi.2024.03.029] [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: 10/24/2023] [Revised: 02/15/2024] [Accepted: 03/17/2024] [Indexed: 03/22/2024] Open
Abstract
AIMS Substantial evidence emphasizes immune dysregulation in patients with bipolar disorder (BD). However, whether immune dysregulation is present already in the early illness stages of BD or even precedes development of BD is largely unknown. In this study we compared immune and vascular stress markers in patients newly diagnosed with BD, their unaffected first-degree relatives (UR) and healthy control individuals (HC) and investigated the ability a composite immune and vascular stress marker to discriminate between the three groups of participants. METHODS In a unique sample including 373 patients newly diagnosed with BD, 95 UR and 190 HC, we compared 47 immune and vascular stress markers at the baseline visit in the ongoing longitudinal Bipolar Illness Onset study. For comparison of individual immune and vascular stress markers between groups, we applied linear mixed models, whereas the composite immune and vascular stress marker was investigated using the SuperLearner ensemble-method. RESULTS Compared with HC, patients newly diagnosed with BD had higher levels of the anti-inflammatory interleukin-1 receptor antagonist (IL-1RA) and IL-10, and of the pro-inflammatory IL-6, eotaxin, monocyte chemoattractant protein-1 (MCP-1), MCP-4, Macrophage Derived Chemokine (MDC), and Thymus and Activation-Regulated Chemokine (TARC) in analyses adjusted for sex and age ranging from 26 % higher levels of IL-6 (1.26, 95 %CI: [1.12-1.43], p < 0.001, adjusted p = 0.009) and IL-10 (1.26, 95 %CI: [1.09-1.46], p = 0.002, adjusted p = 0.049), respectively, to 9 % higher eotaxin levels (1.09, 95 %CI: [1.04-1.15], p = 0.001, adjusted p = 0.024). Of these, MDC levels were 12 % higher in BD compared with UR (1.12, 95 %CI: [1.02-1.22], p = 0.001, adjusted p = 0.024). For all other markers, UR showed no difference from patients with BD or HC. Based on a data-driven model, a composite marker including all 47 immune and vascular stress markers, sex, age, BMI, smoking status, and alcohol intake, discriminated patients with BD from HC with a with an area under the receiver operating curve (AUC) of 0.76 (95 % CI: 0.75-0.77) CONCLUSIONS: Higher levels of pro-inflammatory and anti-inflammatory immune markers are present in patients newly diagnosed with BD but not in UR compared with HC, supporting immune dysregulation playing a role in the pathophysiology of BD.
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Affiliation(s)
- Klara Coello
- Copenhagen University Hospital Frederiksberg, Frederiksberg, Denmark.
| | - Helle Holstad Pedersen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Denmark
| | - Klaus Munkholm
- Copenhagen University Hospital Frederiksberg, Frederiksberg, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | | | | | - Sisse Rye Ostrowski
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Maria Faurholt-Jepsen
- Copenhagen University Hospital Frederiksberg, Frederiksberg, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Kamilla Woznica Miskowiak
- Copenhagen University Hospital Frederiksberg, Frederiksberg, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Ruth Frikke-Schmidt
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Clinical Biochemistry, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Maj Vinberg
- Copenhagen University Hospital Frederiksberg, Frederiksberg, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; The Early Multimodular Prevention and Intervention Research Institution (EMPIRI), Mental Health Centre, Northern Zealand, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Claus Thorn Ekstrøm
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Denmark
| | - Julie Lyng Forman
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Denmark
| | - Lars Vedel Kessing
- Copenhagen University Hospital Frederiksberg, Frederiksberg, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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23
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Browne J, Wu WC, Jiang L, Singh M, Bozzay ML, Kunicki ZJ, Bayer TA, De Vito AN, Primack JM, McGeary JE, Kelso CM, Rudolph JL. Lower odds of successful community discharge after medical hospitalization for Veterans with schizophrenia: A retrospective cohort study of national data. J Psychiatr Res 2024; 173:58-63. [PMID: 38489871 PMCID: PMC11082791 DOI: 10.1016/j.jpsychires.2024.03.004] [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: 01/26/2024] [Revised: 02/23/2024] [Accepted: 03/04/2024] [Indexed: 03/17/2024]
Abstract
Medical comorbidity, particularly cardiovascular diseases, contributes to high rates of hospital admission and early mortality in people with schizophrenia. The 30 days following hospital discharge represents a critical period for mitigating adverse outcomes. This study examined the odds of successful community discharge among Veterans with schizophrenia compared to those with major affective disorders and those without serious mental illness (SMI) after a heart failure hospital admission. Data for Veterans hospitalized for heart failure were obtained from the Veterans Health Administration (VHA) and Centers for Medicare & Medicaid Services between 2011 and 2019. Psychiatric diagnoses and medical comorbidities were assessed in the year prior to hospitalization. Successful community discharge was defined as remaining in the community without hospital readmission, death, or hospice for 30 days after hospital discharge. Logistic regression analyses adjusting for relevant factors were used to examine whether individuals with a schizophrenia diagnosis showed lower odds of successful community discharge versus both comparison groups. Out of 309,750 total Veterans in the sample, 7377 (2.4%) had schizophrenia or schizoaffective disorder and 32,472 (10.5%) had major affective disorders (bipolar disorder or recurrent major depressive disorder). Results from adjusted logistic regression analyses demonstrated significantly lower odds of successful community discharge for Veterans with schizophrenia compared to the non-SMI (Odds Ratio [OR]: 0.63; 95% Confidence Interval [CI]: 0.60, 0.66) and major affective disorders (OR: 0.65, 95%; CI: 0.62, 0.69) groups. Intervention efforts should target the transition from hospital to home in the subgroup of Veterans with schizophrenia.
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Affiliation(s)
- Julia Browne
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.
| | - Wen-Chih Wu
- Medical Service, VA Providence Healthcare System, Providence, RI, USA
| | - Lan Jiang
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA
| | - Mriganka Singh
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA
| | - Melanie L Bozzay
- Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Zachary J Kunicki
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Thomas A Bayer
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA; Division of Geriatrics and Palliative Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Alyssa N De Vito
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Memory and Aging Program, Butler Hospital, Providence, RI, USA
| | - Jennifer M Primack
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - John E McGeary
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Catherine M Kelso
- Veterans Health Administration, Office of Patient Care Services, Geriatrics and Extended Care, Washington DC, USA
| | - James L Rudolph
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA; Department of Health Services, Policy & Practice, Brown University, Providence, RI, USA
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24
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Marais BS. South African mental healthcare providers' views about exercise for people with mental illness. S Afr J Psychiatr 2024; 30:2227. [PMID: 38726326 PMCID: PMC11079334 DOI: 10.4102/sajpsychiatry.v30i0.2227] [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: 11/13/2023] [Accepted: 03/18/2024] [Indexed: 05/12/2024] Open
Abstract
Background People living with mental illness (PWMI) have significantly reduced life expectancy compared to the general population, yet mental healthcare providers (MHCPs) do not regularly prescribe exercise, despite its proven health benefits. Aim This study aimed to evaluate South African MHCPs' views regarding exercise for PWMI. Setting A cross-sectional descriptive study conducted across five public sector specialised psychiatric units in Gauteng. Methods Mental healthcare providers were surveyed using the Exercise in Mental Illness Questionnaire - Health Professionals Version. Results Most participants were nurses (49.1%) and doctors (26.2%) and reported no prior formal training in exercise prescription (79.4%). The vast majority (up to 89.7%) agreed regarding the physical benefits of exercise, particularly cardiometabolic benefits. The most common barriers, as perceived by MHCPs, to exercise participation for PWMI were: stigma (56.5%) and medication side effects (56.5%). The majority (76.2%) reported prescribing exercise for PWMI at least 'occasionally'. The method most frequently used was personal discussion (77.3%) and aerobic exercise was most frequently recommended (81.0%). Specific instructions regarding physical activity recommendations however were often not provided. Regarding MHCPs personal exercise habits, only a third (34%) met physical activity guidelines. Most MHCPs (92.1%) indicated an interest in further training regarding exercise for PWMI. Conclusion Mental healthcare providers were supportive of exercise for PWMI. Strategies to address the stigma around mental illness and medication side-effects, to improve training regarding exercise prescription, as well as the exercise habits of MHCPs themselves, and collaboration with exercise professionals and organisations are recommended. Contribution This study provides insight into the views of South African MHCPs regarding exercise for PWMI.
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Affiliation(s)
- Belinda S Marais
- Department of Psychiatry, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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25
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Iturralde E, Rubinsky AD, Nguyen KH, Anderson C, Lyles CR, Mangurian C. Serious Mental Illness, Glycemic Control, and Neighborhood Factors within an Urban Diabetes Cohort. Schizophr Bull 2024; 50:653-662. [PMID: 37597839 PMCID: PMC11059791 DOI: 10.1093/schbul/sbad122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/21/2023]
Abstract
BACKGROUND AND HYPOTHESIS Serious mental illness (SMI) may compromise diabetes self-management. This study assessed the association between SMI and glycemic control, and explored sociodemographic predictors and geographic clustering of this outcome among patients with and without SMI. STUDY DESIGN We used electronic health record data for adult primary care patients with diabetes from 2 San Francisco health care delivery systems. The primary outcome was poor glycemic control (hemoglobin A1c >9.0%), which was modeled on SMI diagnosis status and sociodemographics. Geospatial analyses examined hotspots of poor glycemic control and neighborhood characteristics. STUDY RESULTS The study included 11 694 participants with diabetes, 21% with comorbid SMI, of whom 22% had a schizophrenia spectrum or bipolar disorder. Median age was 62 years; 52% were female and 79% were Asian, Black, or Hispanic. In adjusted models, having schizophrenia spectrum disorder or bipolar disorder was associated with greater risk for poor glycemic control (vs participants without SMI, adjusted relative risk [aRR] = 1.24; 95% confidence interval, 1.02, 1.49), but having broadly defined SMI was not. People with and without SMI had similar sociodemographic correlates of poor glycemic control including younger versus older age, Hispanic versus non-Hispanic White race/ethnicity, and English versus Chinese language preference. Hotspots for poor glycemic control were found in neighborhoods with more lower-income, Hispanic, and Black residents. CONCLUSIONS Poor diabetes control was significantly related to having a schizophrenia spectrum or bipolar disorder, and to sociodemographic factors and neighborhood. Community-based mental health clinics in hotspots could be targets for implementation of diabetes management services.
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Affiliation(s)
- Esti Iturralde
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Anna D Rubinsky
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, United States
- Academic Research Services, Information Technology, University of California San Francisco, San Francisco, CA, United States
| | - Kim H Nguyen
- Department of Medicine, Center for Vulnerable Populations at ZSFG, University of California San Francisco, San Francisco, CA, United States
| | - Chelsie Anderson
- Department of Surgery, University of California San Francisco, San Francisco, CA, United States
| | - Courtney R Lyles
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, United States
- Department of Medicine, Center for Vulnerable Populations at ZSFG, University of California San Francisco, San Francisco, CA, United States
| | - Christina Mangurian
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, United States
- Department of Medicine, Center for Vulnerable Populations at ZSFG, University of California San Francisco, San Francisco, CA, United States
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, United States
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26
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McGrouther CC, Rangan AV, Di Florio A, Elman JA, Schork NJ, Kelsoe J. Heterogeneity analysis provides evidence for a genetically homogeneous subtype of bipolar-disorder. ARXIV 2024:arXiv:2405.00159v1. [PMID: 38745705 PMCID: PMC11092873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Bipolar Disorder (BD) is a complex disease. It is heterogeneous, both at the phenotypic and genetic level, although the extent and impact of this heterogeneity is not fully understood. One way to assess this heterogeneity is to look for patterns in the subphenotype data, identify a more phenotypically homogeneous set of subjects, and perform a genome-wide association-study (GWAS) and subsequent secondary analyses restricted to this homogeneous subset. Because of the variability in how phenotypic data was collected by the various BD studies over the years, homogenizing the phenotypic data is a challenging task, and so is replication. As members of the Psychiatric Genomics Consortium (PGC), we have access to the raw genotypes of 18,711 BD cases and 29,738 controls. This amount of data makes it possible for us to set aside the intricacies of phenotype and allow the genetic data itself to determine which subjects define a homogeneous genetic subgroup. In this paper, we leverage recent advances in heterogeneity analysis to look for distinct homogeneous genetic BD subgroups (or biclusters) that manifest the broad phenotype we think of as Bipolar Disorder. As our data was generated by 27 studies and genotyped on a variety of platforms (OMEX, Affymetrix, Illumina), we use a biclustering algorithm capable of covariate-correction. Covariate-correction is critical if we wish to distinguish disease-related signals from those which are a byproduct of ancestry, study or genotyping platform. We rely on the raw genotyped data and do not include any data generated through imputation. We first apply this covariate-corrected biclustering algorithm to a cohort of 2524 BD cases and 4106 controls from the Bipolar Disease Research Network (BDRN: OMEX). We find evidence of genetic heterogeneity delineating a statistically significant bicluster comprising a subset of BD cases which exhibits a disease-specific pattern of differential-expression across a subset of SNPs. This pattern replicates across the remaining data-sets collected by the PGC containing 5781/8289 (OMEX), 3581/7591 (Illumina), and 6825/9752(Affymetrix) cases/controls, respectively. This bicluster includes subjects diagnosed with bipolar type-I, as well as subjects diagnosed with bipolar type-II. However, the bicluster is enriched for bipolar type-I over type-II and may represent a collection of correlated genetic risk-factors. By investigating the bicluster-informed polygenic-risk-scoring (PRS), we find that the disease-specific pattern highlighted by the bicluster can be leveraged to eliminate noise from our GWAS analyses and improve not only risk prediction, particularly when using only a relatively small subset (e.g., ~ 1%) of the available SNPs, but also SNP replication. Though our primary focus is only the analysis of disease-related signal, we also identify replicable control-related heterogeneity. Covariate-corrected biclustering of raw genetic data appears to be a promising route for untangling heterogeneity and identifying replicable homogeneous genetic subtypes of complex disease. It may also prove useful in identifying protective effects within the control group. This approach circumvents some of the difficulties presented by subphenotype data collected by meta-analyses or 23 andMe, e.g., missingness, assessment variation, and reliance on self-report.
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Affiliation(s)
- Caroline C. McGrouther
- Courant Institute of Mathematical Sciences, New York University, New York, NY, United States of America
| | - Aaditya V. Rangan
- Courant Institute of Mathematical Sciences, New York University, New York, NY, United States of America
| | - Arianna Di Florio
- School of Medicine, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom
| | - Jeremy A. Elman
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States of America
| | - Nicholas J. Schork
- The Translational Genomics Research Institute, Quantitative Medicine and Systems Biology, Phoenix, AZ, United States of America
| | - John Kelsoe
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States of America
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Bakola M, Peritogiannis V, Kitsou KS, Gourzis P, Hyphantis T, Jelastopulu E. Length of hospital stay in involuntary admissions in Greece: a 10-year retrospective observational study. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02653-x. [PMID: 38684516 DOI: 10.1007/s00127-024-02653-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 03/07/2024] [Indexed: 05/02/2024]
Abstract
PURPOSE The treatment of mental disorders has shifted from inpatient wards to community-based settings in recent years, but some patients may still have to be admitted to inpatient wards, sometimes involuntarily. It is important to maintain the length of hospital stay (LoS) as short as possible while still providing adequate care. The present study aimed to explore the factors associated with the LoS in involuntarily admitted psychiatric patients. METHODS A ten-year retrospective chart review of 332 patients admitted involuntarily to the inpatient psychiatric ward of the General University Hospital of Ioannina, Northwestern Greece, between 2008 and 2017 was conducted. RESULTS The mean LoS was 23.8 (SD = 33.7) days and was relatively stable over the years. Longer-stay hospitalization was associated with schizophrenia-spectrum disorder diagnosis, previous hospitalizations and the use of mechanical restraint, whereas patients in residential care experienced significantly longer LoS (52.6 days) than those living with a caregiver (23.5 days) or alone (19.4 days). Older age at disease onset was associated with shorter LoS, whereas no statistically significant differences were observed with regard to gender. CONCLUSION While some of our findings were in line with recent findings from other countries, others could not be replicated. It seems that multiple factors influence LoS and the identification of these factors could help clinicians and policy makers to design more targeted and cost-effective interventions. The optimization of LoS in involuntary admissions could improve patients' outcomes and lead to more efficient use of resources.
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Affiliation(s)
- Maria Bakola
- Department of Public Health, Medical School, University of Patras, Rio, 26500, Patras, Greece
| | - Vaios Peritogiannis
- Mobile Mental Health Unit of the Prefectures of Ioannina and Thesprotia, Society for the Promotion of Mental Health in Epirus, Ioannina, Greece
| | | | - Philippos Gourzis
- Department of Psychiatry, Medical School, University of Patras, Patras, Greece
| | - Thomas Hyphantis
- Department of Psychiatry, Division of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Eleni Jelastopulu
- Department of Public Health, Medical School, University of Patras, Rio, 26500, Patras, Greece.
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Boudriot E, Gabriel V, Popovic D, Pingen P, Yakimov V, Papiol S, Roell L, Hasanaj G, Xu S, Moussiopoulou J, Priglinger S, Kern C, Schulte EC, Hasan A, Pogarell O, Falkai P, Schmitt A, Schworm B, Wagner E, Keeser D, Raabe FJ. Signature of altered retinal microstructures and electrophysiology in schizophrenia spectrum disorders is associated with disease severity and polygenic risk. Biol Psychiatry 2024:S0006-3223(24)01262-9. [PMID: 38679358 DOI: 10.1016/j.biopsych.2024.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 03/30/2024] [Accepted: 04/14/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Optical coherence tomography (OCT) and electroretinography (ERG) studies have revealed structural and functional retinal alterations in individuals with schizophrenia spectrum disorders (SSD). However, it remains unclear which specific retinal layers are affected, how the retina, brain, and clinical symptomatology are connected, and how alterations of the visual system are related to genetic disease risk. METHODS OCT, ERG, and brain magnetic resonance imaging (MRI) were applied to comprehensively investigate the visual system in a cohort of 103 patients with SSD and 130 healthy control individuals. The sparse partial least squares (SPLS) algorithm was used to identify multivariate associations between clinical disease phenotype and biological alterations of the visual system. The association of the revealed patterns with the individual polygenetic disease risk for schizophrenia was explored in a post hoc analysis. In addition, covariate-adjusted case-control comparisons were performed for each individual OCT and ERG parameter. RESULTS The SPLS analysis yielded a phenotype-eye-brain signature of SSD in which greater disease severity, longer duration of illness, and impaired cognition were associated with electrophysiological alterations and microstructural thinning of most retinal layers. Higher individual loading onto this disease-relevant signature of the visual system was significantly associated with elevated polygenic risk for schizophrenia. In case-control comparisons, patients with SSD had lower macular thickness, thinner retinal nerve fiber and inner plexiform layers, less negative a-wave amplitude, and lower b-wave amplitude. CONCLUSIONS This study demonstrates multimodal microstructural and electrophysiological retinal alterations in individuals with SSD that are associated with disease severity and individual polygenetic burden.
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Affiliation(s)
- Emanuel Boudriot
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, 80336 Munich, Germany; Max Planck Institute of Psychiatry, 80804 Munich, Germany
| | - Vanessa Gabriel
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, 80336 Munich, Germany
| | - David Popovic
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, 80336 Munich, Germany; Max Planck Institute of Psychiatry, 80804 Munich, Germany
| | - Pauline Pingen
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, 80336 Munich, Germany
| | - Vladislav Yakimov
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, 80336 Munich, Germany; International Max Planck Research School for Translational Psychiatry (IMPRS-TP), 80804 Munich, Germany
| | - Sergi Papiol
- Max Planck Institute of Psychiatry, 80804 Munich, Germany; Institute of Psychiatric Phenomics and Genomics, LMU Munich, 80336 Munich, Germany
| | - Lukas Roell
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, 80336 Munich, Germany; NeuroImaging Core Unit Munich (NICUM), LMU University Hospital, LMU Munich, 80336 Munich, Germany
| | - Genc Hasanaj
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, 80336 Munich, Germany; Evidence-based psychiatry and psychotherapy, Faculty of Medicine, University of Augsburg, 86156 Augsburg, Germany
| | - Simiao Xu
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, 80336 Munich, Germany
| | - Joanna Moussiopoulou
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, 80336 Munich, Germany
| | - Siegfried Priglinger
- Department of Ophthalmology, LMU University Hospital, LMU Munich, 80336 Munich, Germany
| | - Christoph Kern
- Department of Ophthalmology, LMU University Hospital, LMU Munich, 80336 Munich, Germany
| | - Eva C Schulte
- Institute of Psychiatric Phenomics and Genomics, LMU Munich, 80336 Munich, Germany; Institute of Human Genetics, University Hospital, Faculty of Medicine, University of Bonn, 53127 Bonn, Germany; Department of Psychiatry and Psychotherapy, University Hospital, Faculty of Medicine, University of Bonn, 53127 Bonn, Germany
| | - Alkomiet Hasan
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Faculty of Medicine, University of Augsburg, 86156 Augsburg, Germany; German Center for Mental Health (DZPG), partner site Munich-Augsburg
| | - Oliver Pogarell
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, 80336 Munich, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, 80336 Munich, Germany; Max Planck Institute of Psychiatry, 80804 Munich, Germany; German Center for Mental Health (DZPG), partner site Munich-Augsburg
| | - Andrea Schmitt
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, 80336 Munich, Germany; Max Planck Institute of Psychiatry, 80804 Munich, Germany; German Center for Mental Health (DZPG), partner site Munich-Augsburg
| | - Benedikt Schworm
- Department of Ophthalmology, LMU University Hospital, LMU Munich, 80336 Munich, Germany
| | - Elias Wagner
- Evidence-based psychiatry and psychotherapy, Faculty of Medicine, University of Augsburg, 86156 Augsburg, Germany; Department of Psychiatry, Psychotherapy, and Psychosomatics, Faculty of Medicine, University of Augsburg, 86156 Augsburg, Germany
| | - Daniel Keeser
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, 80336 Munich, Germany; NeuroImaging Core Unit Munich (NICUM), LMU University Hospital, LMU Munich, 80336 Munich, Germany; Munich Center for Neurosciences (MCN), LMU Munich, 82152 Planegg-Martinsried, Germany
| | - Florian J Raabe
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, 80336 Munich, Germany; Max Planck Institute of Psychiatry, 80804 Munich, Germany.
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Castro Monteiro F, de Oliveira Silva F, Josiane Waclawovsky A, Ferreira JVA, de Jesus-Moraleida FR, Schuch FB, Ward PB, Rosenbaum S, Morell R, Carneiro L, Camaz Deslandes A. Physical activity and sedentary behavior levels among individuals with mental illness: A cross-sectional study from 23 countries. PLoS One 2024; 19:e0301583. [PMID: 38669303 PMCID: PMC11051624 DOI: 10.1371/journal.pone.0301583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/19/2024] [Indexed: 04/28/2024] Open
Abstract
People with mental illness tend to present low levels of physical activity and high levels of sedentary behavior. The study aims to compare these levels in mental illness patients, exploring the role of socioeconomic development and treatment setting. This cross-sectional study used accelerometers and the Simple Physical Activity Questionnaire (SIMPAQ) to assess physical activity and sedentary behavior in mental illness individuals living in 23 countries. Two-way ANOVAs were used to evaluate the interaction between socioeconomic development and the treatment settings on physical activity and sedentary behavior. A total of 884 (men = 55.3%) participants, mean age of 39.3 (SD = 12.8), were evaluated. A significant interaction between socioeconomic development and treatment settings was found in sedentary behavior (F = 5.525; p = 0.019; η2p = 0.009; small effect size). Main effects were observed on socioeconomic development (F = 43.004; p < 0.001; η2p = 0.066; medium effect size) and treatment setting (F = 23.001; p < 0.001; η2p = 0.036; small effect size) for sedentary behavior and physical activity: socioeconomic development (F = 20.888; p < 0.001; η2p = 0.033; small effect size) and treatment setting (F = 30.358; p < 0.001; η2p = 0.047; small effect size), showing that HIC patients were more active, while MIC patients were more sedentary. Moreover, despite of inpatients had presented higher levels of physical activity than outpatients, they also spent more time sitting. Socioeconomic development plays an important role in sedentary behavior in patients with mental disorders, warning the need to develop new strategies to reduce these levels in this population.
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Affiliation(s)
| | | | - Aline Josiane Waclawovsky
- Psychiatry Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Federal University of Santa Maria, Santa Maria, Brazil
| | | | | | - Felipe Barreto Schuch
- Psychiatry Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Federal University of Santa Maria, Santa Maria, Brazil
| | - Philip B. Ward
- School of Psychiatry, UNSW Sydney, Australia and Schizophrenia Research Unit, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Simon Rosenbaum
- School of Psychiatry, UNSW Sydney, Australia and Schizophrenia Research Unit, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Rachel Morell
- Mindgardens Neuroscience Network, Sydney Australia Discipline of Mental Health and Psychiatry, UNSW Sydney Australia, Sydney, Australia
| | - Lara Carneiro
- Physical Education Department, College of Education, United Arab Emirates University, Al Ain, Abu Dhabi, United Arab Emirates
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Mendola M, Masi F, Castiglione R, Soriano A, Zazou S, Tonelli F, Carrer P. Mental Disorders Among Healthcare Students Attending a Large University Hospital in Milan, Italy. LA MEDICINA DEL LAVORO 2024; 115:e2024009. [PMID: 38686578 PMCID: PMC11181219 DOI: 10.23749/mdl.v115i2.15168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/29/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND The high incidence rates, treatment difficulties, and tendency to become chronic, which subsequently affects personal and occupational functioning, make mental health disorders among the most important public health concerns. In this context, healthcare university students (HS) appear to be more vulnerable to psychological distress than others. OBJECTIVE Investigate the prevalence of diagnosed mental illness among different groups of HS to detect students who may be psychologically vulnerable and determine whether the implementation of support interventions is necessary. METHODS All HS who had a clinical examination performed by an occupational physician at our occupational health unit between 2021 and 2022 were included in our case series. Data were collected and analyzed as part of the occupational physicians' health surveillance program. RESULTS out of 679 HS (507 females, 172 males, aged 22.2±3.9 mean±s.d) undergone clinical examination at our Occupational Health Unit, 36 (5.3%) reported a diagnosed psychiatric illness, and 20 were receiving pharmacological therapy at the time of the visit. A higher prevalence of psychological disorders has been highlighted in females (6.1% vs 2.9% in males) and students of the mental health sector (11.1%) when compared with others. A fit-to-work judgment with prescription was necessary for 16.7% of students with mental diseases. The presence of psychiatric disorders was associated with underweight (27.8%) and higher smoking habit (44.4%). CONCLUSIONS These results underline the necessity of improving the current health surveillance protocols, which should also evaluate students' psychological fragility and implement effective intervention strategies to promote their health and wellbeing.
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Affiliation(s)
- Marco Mendola
- Occupational Health Unit, Fatebenefratelli Sacco University Hospital, Milan, Italy
| | - Francesco Masi
- School of Occupational Medicine, University of Milan, Milan, Italy
| | | | - Antonio Soriano
- School of Occupational Medicine, University of Milan, Milan, Italy
| | - Safi Zazou
- School of Occupational Medicine, University of Milan, Milan, Italy
| | - Fabio Tonelli
- Occupational Health Unit, Fatebenefratelli Sacco University Hospital, Milan, Italy
| | - Paolo Carrer
- Occupational Health Unit, Fatebenefratelli Sacco University Hospital, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
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Ouanes S, Hashem LA, Makki I, Khan F, Mahgoub O, Wafer A, Dulaimy O, Amro R, Ghuloum S. Mortality in Qatari individuals with mental illness: a retrospective cohort study. Ann Gen Psychiatry 2024; 23:14. [PMID: 38637811 PMCID: PMC11027414 DOI: 10.1186/s12991-024-00499-w] [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] [Received: 05/20/2023] [Accepted: 03/25/2024] [Indexed: 04/20/2024] Open
Abstract
INTRODUCTION There is substantial evidence that people with mental illness have higher mortality rates than the general population. However, most of the studies were from Western countries, and it is not clear whether this finding also applies to Arab countries like Qatar. OBJECTIVES We aimed to explore whether mortality in patients with mental illness in Qatar, is different from those without. METHODS We conducted a retrospective cohort study, including all Qatari nationals deceased in 2017 and 2018, using the list of registered deaths from Hamad Medical Corporation (HMC) Mortuary. We divided the cohort of deceased people into two groups: with and without mental illness. For each of the groups, we collected the age at death, the reported cause of death as well as sociodemographic and clinical data. RESULTS There were 602 registered deaths in 2017 and 589 deaths in 2018. The prevalence of mental illness was 20.4%. Compared to subjects without mental illness, subjects with mental illness surprisingly had higher age at death (median ± IQR = 76.5 ± 22.1 years vs. 62.7 ± 32.9 years; p < .001). This difference persisted even after we controlled for covariates. Individuals with mental illness were more likely to die of an infection (OR = 1.98[1.44;2.71]), or of chronic respiratory disease (OR = 3.53 [1.66;7.52]) but less likely to die because of accidental (OR = 0.21[0.09;0.49]) or congenital causes (OR = 0.18[0.04;0.77]). CONCLUSION Contrary to most previous studies, we did not find that mortality was higher in Qatari individuals with mental illness. Sociocultural factors, free and easy-to-access healthcare, and an enhanced role of mental health professionals in detecting medical comorbidities may explain this finding.
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Affiliation(s)
- Sami Ouanes
- Department of Psychiatry, Hamad Medical Corporation, POBOX 3050, Doha, Qatar
| | - Lien Abou Hashem
- Department of Psychiatry, Hamad Medical Corporation, POBOX 3050, Doha, Qatar
| | - Ibrahim Makki
- Department of Psychiatry, Hamad Medical Corporation, POBOX 3050, Doha, Qatar
| | - Faisal Khan
- Department of Psychiatry, Hamad Medical Corporation, POBOX 3050, Doha, Qatar
| | - Omer Mahgoub
- Department of Psychiatry, Hamad Medical Corporation, POBOX 3050, Doha, Qatar
| | - Ahmed Wafer
- Department of Psychiatry, Hamad Medical Corporation, POBOX 3050, Doha, Qatar
| | - Omer Dulaimy
- Department of Psychiatry, Hamad Medical Corporation, POBOX 3050, Doha, Qatar
| | - Raed Amro
- Department of Psychiatry, Hamad Medical Corporation, POBOX 3050, Doha, Qatar
| | - Suhaila Ghuloum
- Department of Psychiatry, Hamad Medical Corporation, POBOX 3050, Doha, Qatar.
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Malone R, Savage S, Crowley V, Hennessy M, O’Connor P, Kennedy C. Risk Factors and Modifiers for Cardiovascular Disease Assessment of Patients with Heterozygous Familial Hypercholesterolaemia. J Clin Med 2024; 13:2270. [PMID: 38673543 PMCID: PMC11051062 DOI: 10.3390/jcm13082270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/13/2024] [Accepted: 04/07/2024] [Indexed: 04/28/2024] Open
Abstract
Background: The assessment of the risk of cardiovascular disease (CVD) in patients with heterozygous familial hypercholesterolemia (HeFH) is determined by conventional risk factors. However, factors modifying CVD, or risk modifiers, beyond conventional risk factors may inform their CVD risk assessment and the subsequent use of new therapies. This work identifies and characterises patients within a lipid clinic cohort with regards to conventional CVD risk factors and risk modifiers with a focus on those with HeFH. Methods: A study of consecutive adult patients attending our specialist lipid clinic was performed over a six-month period. The patient data recorded included demographics, clinical characteristics, risk factors and risk modifiers, biochemical profiles and genetic testing results. Risk modifiers were identified based on ESC/EAS guidance, and those with HeFH were compared to those without. Results: A total of 370 patients were included. Of these, 98 HeFH patients were identified (26%). Then, 52% of HeFH patients were stratified into the very-high risk category due to the presence of CVD risk factors. Risk modifiers were present in 73%. These included a family history of premature CVD (56%), obesity (28%), a sedentary lifestyle (13%) and a major psychiatric disorder (12%). Compared to the rest of the cohort, those with HeFH were less likely to have hypertension and more likely to have a family history of premature CVD. Conclusions: Half of patients with HeFH are categorised as having very high CV risk. Consideration of risk modifiers, particularly a family history of premature CV disease, increases this very-high-risk category further. This may have implications for the clinical application and access to novel treatments.
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Affiliation(s)
- Richard Malone
- School of Medicine, Trinity College Dublin, D08 W9RT Dublin, Ireland; (R.M.); (M.H.); (P.O.)
| | - Sarah Savage
- Department of Biochemistry Department, St James’s Hospital, D08 W9RT Dublin, Ireland; (S.S.); (V.C.)
| | - Vivion Crowley
- Department of Biochemistry Department, St James’s Hospital, D08 W9RT Dublin, Ireland; (S.S.); (V.C.)
| | - Martina Hennessy
- School of Medicine, Trinity College Dublin, D08 W9RT Dublin, Ireland; (R.M.); (M.H.); (P.O.)
- Department of Pharmacology & Therapeutics, St James’s Hospital, D08 W9RT Dublin, Ireland
| | - Patricia O’Connor
- School of Medicine, Trinity College Dublin, D08 W9RT Dublin, Ireland; (R.M.); (M.H.); (P.O.)
- Department of Pharmacology & Therapeutics, St James’s Hospital, D08 W9RT Dublin, Ireland
| | - Cormac Kennedy
- School of Medicine, Trinity College Dublin, D08 W9RT Dublin, Ireland; (R.M.); (M.H.); (P.O.)
- Department of Pharmacology & Therapeutics, St James’s Hospital, D08 W9RT Dublin, Ireland
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Oldham MA, Kukla B, Walsh P, Lee HB. Sex Differences in Delirium after Coronary Artery Bypass Graft Surgery and Perioperative Neuropsychiatric Conditions: A Secondary Analysis of a Cohort Study. J Geriatr Psychiatry Neurol 2024:8919887241246226. [PMID: 38604978 DOI: 10.1177/08919887241246226] [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: 04/13/2024]
Abstract
BACKGROUND Biological sex influences the risk of depression and cognitive impairment, but its role in relation to postoperative delirium is unclear. This analysis investigates sex differences in delirium risk after coronary artery bypass graft (CABG) surgery and sex-related differences in relation to affective and cognitive symptoms. METHODS This is a secondary analysis of the Neuropsychiatric Outcomes After Heart Surgery (NOAHS) study, a single-site, observational study of a CABG surgery cohort (n = 149). Preoperative characteristics are stratified by sex, and baseline variables that differ by sex are evaluated to understand whether sex modifies their relationships with delirium. We also evaluate sex differences in one-month depression and cognition. RESULTS Female sex is associated with several delirium risk factors, including higher risk of preoperative depression and middle cerebral artery (MCA) stenosis. MCA stenosis was statistically associated with delirium only among women (OR 15.6, 95% CI 1.5, 164.4); mild cognitive impairment (MCI) was associated with delirium only in men (OR 4.6, 95% CI 1.2, 17.9). Other sex-based differences failed to reach statistical significance. Depression remained commoner among women 1 month post-CABG. CONCLUSIONS Women in this CABG cohort were more likely to have depression at baseline and 1 month postoperatively, as well as MCA stenosis and postoperative delirium. Sex might modify the relationship between post-CABG delirium and its risk factors including MCA stenosis and MCI. Cerebrovascular disease deserves study as a potential explanation linking female sex and a range of poor outcomes among women with coronary heart disease.
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Affiliation(s)
- Mark A Oldham
- Department of Psychiatry University of Rochester Medical Center, Rochester, NY, USA
| | - Bennett Kukla
- College of Arts and Sciences, Cornell University, Ithaca, NY, USA
| | - Patrick Walsh
- Department of Psychiatry University of Rochester Medical Center, Rochester, NY, USA
| | - Hochang B Lee
- Department of Psychiatry University of Rochester Medical Center, Rochester, NY, USA
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Wienand D, Wijnen LI, Heilig D, Wippel C, Arango C, Knudsen GM, Goodwin GM, Simon J. Comorbid physical health burden of serious mental health disorders in 32 European countries. BMJ MENTAL HEALTH 2024; 27:e301021. [PMID: 38580438 PMCID: PMC11021748 DOI: 10.1136/bmjment-2024-301021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/22/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Mental health disorders (MHDs) are associated with physical health disparities, but underlying excess risk and health burden have not yet been comprehensively assessed. OBJECTIVE To assess the burden of comorbid physical health conditions (PHCs) across serious MHDs in Europe. METHODS We estimated the relative prevalence risk of PHCs associated with alcohol use disorders (AUD), bipolar disorder (BD), depressive disorders (DD) and schizophrenia (SZ) across working-age populations of 32 European countries in 2019 based on a targeted literature review. Excess physical health burden was modelled using population-attributable fractions and country-level prevalence data. FINDINGS We screened 10 960 studies, of which 41 were deemed eligible, with a total sample size of over 18 million persons. Relative prevalence of PHCs was reported in 54%, 20%, 15%, 5% and 7% of studies, respectively, for SZ, DD, BD, AUD or mixed. Significant relative risk estimates ranged from 1.44 to 3.66 for BD, from 1.43 to 2.21 for DD, from 0.81 to 1.97 for SZ and 3.31 for AUD. Excess physical health burden ranged between 27% and 67% of the total, corresponding to 84 million (AUD), 67 million (BD), 66 million (DD) and 5 million (SZ) PHC diagnoses in Europe. A 1% reduction in excess risk assuming causal inference could result in two million fewer PHCs across investigated MHDs. CONCLUSIONS This is the first comprehensive study of the physical health burden of serious MHDs in Europe. The methods allow for updates, refinement and extension to other MHDs or geographical areas. CLINICAL IMPLICATIONS The results indicate potential population health benefits achievable through more integrated mental and physical healthcare and prevention approaches.
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Affiliation(s)
- Dennis Wienand
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Lena I Wijnen
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Daniel Heilig
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Christoph Wippel
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Gitte M Knudsen
- Neurobiology Research Unit, Copenhagen University Hospital, Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Guy M Goodwin
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Judit Simon
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
- Department of Psychiatry, University of Oxford, Oxford, UK
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Veeneman RR, Vermeulen JM, Bialas M, Bhamidipati AK, Abdellaoui A, Munafò MR, Denys D, Bezzina CR, Verweij KJH, Tadros R, Treur JL. Mental illness and cardiovascular health: observational and polygenic score analyses in a population-based cohort study. Psychol Med 2024; 54:931-939. [PMID: 37706306 DOI: 10.1017/s0033291723002635] [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: 09/15/2023]
Abstract
BACKGROUND Individuals with serious mental illness have a markedly shorter life expectancy. A major contributor to premature death is cardiovascular disease (CVD). We investigated associations of (genetic liability for) depressive disorder, bipolar disorder and schizophrenia with a range of CVD traits and examined to what degree these were driven by important confounders. METHODS We included participants of the Dutch Lifelines cohort (N = 147 337) with information on self-reported lifetime diagnosis of depressive disorder, bipolar disorder, or schizophrenia and CVD traits. Employing linear mixed-effects models, we examined associations between mental illness diagnoses and CVD, correcting for psychotropic medication, demographic and lifestyle factors. In a subsample (N = 73 965), we repeated these analyses using polygenic scores (PGSs) for the three mental illnesses. RESULTS There was strong evidence that depressive disorder diagnosis is associated with increased arrhythmia and atherosclerosis risk and lower heart rate variability, even after confounder adjustment. Positive associations were also found for the depression PGSs with arrhythmia and atherosclerosis. Bipolar disorder was associated with a higher risk of nearly all CVD traits, though most diminished after adjustment. The bipolar disorder PGSs did not show any associations. While the schizophrenia PGSs was associated with increased arrhythmia risk and lower heart rate variability, schizophrenia diagnosis was not. All mental illness diagnoses were associated with lower blood pressure and a lower risk of hypertension. CONCLUSIONS Our study shows widespread associations of (genetic liability to) mental illness (primarily depressive disorder) with CVD, even after confounder adjustment. Future research should focus on clarifying potential causal pathways between mental illness and CVD.
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Affiliation(s)
- R R Veeneman
- Genetic Epidemiology, Department of Psychiatry, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
| | - J M Vermeulen
- Department of Psychiatry, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
| | - M Bialas
- Genetic Epidemiology, Department of Psychiatry, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
| | - A K Bhamidipati
- Genetic Epidemiology, Department of Psychiatry, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
| | - A Abdellaoui
- Genetic Epidemiology, Department of Psychiatry, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
| | - M R Munafò
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- School of Psychological Science, University of Bristol, Bristol, UK
| | - D Denys
- Department of Psychiatry, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
| | - C R Bezzina
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - K J H Verweij
- Genetic Epidemiology, Department of Psychiatry, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
| | - R Tadros
- Cardiovascular Genetics Center, Montreal Heart Institute, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - J L Treur
- Genetic Epidemiology, Department of Psychiatry, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
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Shafi DES, Jørgensen KN, Bjella T, Nesvåg R, Dieset I, Melle I, Andreassen OA, Jönsson EG. Prescriptions of psychotropic and somatic medications among patients with severe mental disorders and healthy controls in a naturalistic study. Nord J Psychiatry 2024; 78:212-219. [PMID: 38306243 DOI: 10.1080/08039488.2024.2305806] [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: 07/13/2023] [Accepted: 01/11/2024] [Indexed: 02/04/2024]
Abstract
PURPOSE Psychotropic and somatic medications are both used in treating severe mental disorders (SMDs). Realistic estimates of the prevalence of use across medication categories are needed. We obtained this in a clinical cohort of patients with SMD and healthy controls (HCs). MATERIALS AND METHODS Prescriptions filled at Norwegian pharmacies the year before and after admittance to the Thematically Organized Psychosis (TOP) study were examined in 1406 patients with SMD (mean age 32.5 years, 48.2% women) and 920 HC (34.1 years, 46.2% women). Using data from the Norwegian Prescription Database (NorPD), the number of users in different anatomical therapeutic chemical (ATC) categories was compared using logistic regression. Population estimates were used as reference data. RESULTS Use of antipsychotics (N05A), antiepileptics (N03A), antidepressants (N06A), anxiolytics (N05B), hypnotics and sedatives (N05C), anticholinergics (N04A), psychostimulants, attention deficit hyperactivity disorder and nootropic agents (N06B) and drugs for addiction disorders (N07B) was significantly more prevalent in patients with SMD than HC. Use of diabetes treatment (A10), antithrombotic drugs (B01), beta blockers (C07), lipid modifiers (C10), and thyroid and endocrine therapeutics (H03) was also more prevalent in patients with SMD, but with two exceptions somatic medication use was comparable to the general population. Among HC, there was low prevalence of use for most medication categories. CONCLUSION Patients were using psychiatric medications, but also several types of somatic medications, more often than HC. Still, somatic medication use was mostly not higher than in the general population. The results indicate that HC had low use of most medication types.
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Affiliation(s)
| | - Kjetil Nordbø Jørgensen
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatry, Telemark Hospital, Skien, Norway
| | - Thomas Bjella
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | | | - Ingrid Dieset
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Acute Psychiatric Department, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ingrid Melle
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ole A Andreassen
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Erik G Jönsson
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet & Stockholm Health Care Services, Stockholm Region, Stockholm, Sweden
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Bergman H, Nilsson T, Andiné P, Degl'Innocenti A, Thomeé R, Gutke A. The use of physical exercise in forensic psychiatric care in Sweden: a nationwide survey. J Ment Health 2024; 33:202-210. [PMID: 33487094 DOI: 10.1080/09638237.2021.1875406] [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: 03/30/2020] [Revised: 09/11/2020] [Accepted: 10/30/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Exercise protects against somatic comorbidities and positively affects cognitive function and psychiatric symptoms in patients with severe mental illness. In forensic psychiatry, exercise is a novel concept. Staff at inpatient care facilities may be important resources for successful intervention. Little is known about staff's knowledge, attitudes and behaviors regarding exercise in forensic psychiatric care. AIMS To translate, culturally adapt and test the feasibility of the Exercise in Mental Health Questionnaire-Health Professionals Version (EMIQ-HP) in the Swedish context, and to use this EMIQ-HP-Swedish version to describe staff's knowledge, attitudes and behaviors regarding exercise. METHOD The EMIQ-HP was translated, culturally adapted, pilot-tested and thereafter used in a cross-sectional nationwide survey. RESULTS Ten of 25 clinics and 239 health professionals (50.1%) participated. Two parts of the EMIQ-HP-Swedish version showed problems. Most participants considered exercise to be a low-risk treatment (92.4%) that is beneficial (99.2%). Training in exercise prescription was reported by 16.3%. Half of participants (52.7%) prescribed exercise and 50.0% of those undertook formal assessments prior to prescribing. CONCLUSIONS Creation of the EMIQ-HP-Swedish version was successful, despite some clarity problems. Exercise appears to be prescribed informally by non-experts in Swedish forensic psychiatric care and does not address treatment goals.
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Affiliation(s)
- Henrik Bergman
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Ethics, Law and Mental Health (CELAM), Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Forensic Psychiatric Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Thomas Nilsson
- Centre for Ethics, Law and Mental Health (CELAM), Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Forensic Psychiatric Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Forensic Psychiatry, National Board of Forensic Medicine, Gothenburg, Sweden
| | - Peter Andiné
- Centre for Ethics, Law and Mental Health (CELAM), Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Forensic Psychiatric Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Forensic Psychiatry, National Board of Forensic Medicine, Gothenburg, Sweden
| | - Alessio Degl'Innocenti
- Centre for Ethics, Law and Mental Health (CELAM), Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Gothia Forum for Clinical Trials, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Roland Thomeé
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Annelie Gutke
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Ward K, Citrome L. Tolerability and safety outcomes of first-line oral second-generation antipsychotics in patients with schizophrenia. Expert Opin Drug Saf 2024; 23:399-409. [PMID: 38467517 DOI: 10.1080/14740338.2024.2328812] [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: 10/04/2023] [Accepted: 03/05/2024] [Indexed: 03/13/2024]
Abstract
INTRODUCTION Antipsychotics are the foundation of pharmacologic treatment for schizophrenia. There are many oral antipsychotics available and given that these medications are generally considered comparably efficacious when titrated to an adequate dose, their varied tolerability, and safety profiles become critically important for medication selection. AREAS COVERED This paper reviews tolerability and safety considerations for first-line second-generation oral antipsychotics currently approved for the treatment of schizophrenia in the USA. Excluded from consideration are clozapine and non-oral formulations. EXPERT OPINION Among antipsychotics, there are many differences in adverse reactions observed in clinical trials, such as variable likelihood to cause sedation vs insomnia, weight gain and abnormalities in glucose/lipid metabolism, hyperprolactinemia, potential for impact on the QT interval, and motoric adverse effects. Additional safety data that can help with medication selection include safety in pregnancy and lactation, and potential for drug-drug interactions. Ultimately, working with patients to personalize treatment by focusing on safety and individual tolerability considerations for various adverse effects can help in building a therapeutic alliance and improving patients' outcomes.
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Affiliation(s)
- Kristen Ward
- Clinical Pharmacy Department, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Leslie Citrome
- Department of Psychiatry and Behavioral Science, New York Medical College, Valhalla, NY, USA
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Lorimer B, Traviss-Turner G, Hill A, Baker S, Gilbody S, Peckham E. Factors associated with low fruit and vegetable consumption among people with severe mental ill health. Soc Psychiatry Psychiatr Epidemiol 2024; 59:725-729. [PMID: 37314491 PMCID: PMC10264868 DOI: 10.1007/s00127-023-02514-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] [Received: 05/24/2023] [Accepted: 06/06/2023] [Indexed: 06/15/2023]
Abstract
Severe mental ill health (SMI) is associated with excess mortality, and poor diet is one associated modifiable risk factor. This study investigated factors associated with low consumption of fruit and vegetables among people with SMI (N = 9914). A total of 8.4% of participants ate no portions per day, while only 15% ate 5 + portions. Individuals who never consumed fruit and vegetables or ate < 5 portions per day were more likely to be male, younger than 65, unemployed, experience poorer general health, or perceive health as unimportant. Poor diet is common among people with SMI and tailored dietary improvement interventions are required.
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Affiliation(s)
- Ben Lorimer
- Department of Health Sciences, University of York, York, UK.
| | | | - Andrew Hill
- School of Medicine, University of Leeds, Leeds, UK
| | - Sarah Baker
- York St John University, York, UK
- York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK
- Hull York Medical School, York, UK
| | - Emily Peckham
- Department of Health Sciences, University of York, York, UK
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Cobb CD, Puzantian T, Shuman M. Board-Certified Psychiatric Pharmacists and Their Potential Role in Addressing Behavioral Health Workforce Shortages. Psychiatr Serv 2024:appips20230303. [PMID: 38532688 DOI: 10.1176/appi.ps.20230303] [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: 03/28/2024]
Abstract
Board-certified psychiatric pharmacists (BCPPs) are doctorate-level, board-certified experts in managing medications for people living with psychiatric disorders, including substance use disorders. BCPPs work as part of an integrated health care team that provides comprehensive medication management focused on optimizing medication-related outcomes and ensuring the safety of the prescribed medications. The authors describe BCPP education and training, settings in which BCPPs practice, and in what roles. Current policies that limit BCPP involvement in behavioral health care and proposed solutions to support the role of BCPPs in addressing behavioral health workforce shortages are discussed.
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Affiliation(s)
- Carla D Cobb
- Capita Consulting, Billings, Montana (Cobb); Keck Graduate Institute, School of Pharmacy and Health Sciences, Claremont, California (Puzantian); Department of Pharmacy, Central State Hospital, and Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville (Shuman)
| | - Talia Puzantian
- Capita Consulting, Billings, Montana (Cobb); Keck Graduate Institute, School of Pharmacy and Health Sciences, Claremont, California (Puzantian); Department of Pharmacy, Central State Hospital, and Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville (Shuman)
| | - Michael Shuman
- Capita Consulting, Billings, Montana (Cobb); Keck Graduate Institute, School of Pharmacy and Health Sciences, Claremont, California (Puzantian); Department of Pharmacy, Central State Hospital, and Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville (Shuman)
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Grosu C, Klauser P, Dwir D, Khadimallah I, Alemán-Gómez Y, Laaboub N, Piras M, Fournier M, Preisig M, Conus P, Draganski B, Eap CB. Associations between antipsychotics-induced weight gain and brain networks of impulsivity. Transl Psychiatry 2024; 14:162. [PMID: 38531873 DOI: 10.1038/s41398-024-02881-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 03/28/2024] Open
Abstract
Given the unpredictable rapid onset and ubiquitous consequences of weight gain induced by antipsychotics, there is a pressing need to get insights into the underlying processes at the brain system level that will allow stratification of "at risk" patients. The pathophysiological hypothesis at hand is focused on brain networks governing impulsivity that are modulated by neuro-inflammatory processes. To this aim, we investigated brain anatomy and functional connectivity in patients with early psychosis (median age: 23 years, IQR = 21-27) using anthropometric data and magnetic resonance imaging acquired one month to one year after initiation of AP medication. Our analyses included 19 patients with high and rapid weight gain (i.e., ≥5% from baseline weight after one month) and 23 patients with low weight gain (i.e., <5% from baseline weight after one month). We replicated our analyses in young (26 years, IQR = 22-33, N = 102) and middle-aged (56 years, IQR = 51-62, N = 875) healthy individuals from the general population. In early psychosis patients, higher weight gain was associated with poor impulse control score (β = 1.35; P = 0.03). Here, the observed brain differences comprised nodes of impulsivity networks - reduced frontal lobe grey matter volume (Pcorrected = 0.007) and higher striatal volume (Pcorrected = 0.048) paralleled by disruption of fronto-striatal functional connectivity (R = -0.32; P = 0.04). Weight gain was associated with the inflammatory biomarker plasminogen activator inhibitor-1 (β = 4.9, P = 0.002). There was no significant association between increased BMI or weight gain and brain anatomy characteristics in both cohorts of young and middle-aged healthy individuals. Our findings support the notion of weight gain in treated psychotic patients associated with poor impulse control, impulsivity-related brain networks and chronic inflammation.
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Affiliation(s)
- Claire Grosu
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Centre for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland.
| | - Paul Klauser
- Service of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
| | - Daniella Dwir
- Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
| | - Ines Khadimallah
- Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
| | - Yasser Alemán-Gómez
- Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
- Connectomics Lab, Department of Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Nermine Laaboub
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Centre for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
| | - Marianna Piras
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Centre for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
| | - Margot Fournier
- Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
| | - Martin Preisig
- Psychiatric Epidemiology and Psychopathology Research Center, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
| | - Philippe Conus
- Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | - Bogdan Draganski
- Laboratory for Research in Neuroimaging LREN, Centre for Research in Neuroscience - Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Neurology Department, Max-Planck-Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Chin B Eap
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Centre for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland.
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.
- Center for Research and Innovation in Clinical Pharmaceutical Sciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva and University of Lausanne, Lausanne, Switzerland.
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Xu H, Liu L, Yang Q, Wang X, Li Z, Liu T, Zhang X. Prevalence and risk factors for abnormal glucose metabolism in first-episode and drug-naïve major depressive disorder outpatients with comorbid anxiety: A cross-sectional study from a large sample of the Chinese Han population. J Affect Disord 2024; 349:400-406. [PMID: 38199404 DOI: 10.1016/j.jad.2024.01.014] [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: 06/07/2023] [Revised: 11/25/2023] [Accepted: 01/03/2024] [Indexed: 01/12/2024]
Abstract
BACKGROUND Both abnormal glucose metabolism and anxiety have been reported to be common in major depressive disorder (MDD). However, few studies have explored glucose disturbances in first-episode and drug-naive (FEDN) MDD patients with anxiety. The purpose of this study was to examine the prevalence and risk factors of glucose disturbance in FEND MDD patients comorbid with anxiety. METHODS 1718 FEDN MDD patients were included in this study. The positive subscale of the Positive and Negative Syndrome Scale (PANSS), Hamilton Anxiety Rating Scale (HAMA), and Hamilton Depression Rating Scale (HAMD) were used to measure psychotic, anxiety and depressive symptoms respectively. Sociodemographic and biochemical indicators were also collected. RESULTS The prevalence of glucose disorders in MDD patients combined with anxiety was 15.7 %, significantly higher than in MDD patients without anxiety symptoms (7.1 %). Glucose disturbances were associated with HAMD score, HAMA score, thyroid-stimulating hormone (TSH), thyroid peroxidase antibody (TPOAb), anti-thyroglobulin (TGAb), total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein (LDL-C), fasting blood glucose (FBG), systolic blood pressure (SBP), diastolic blood pressure (DBP), suicide attempts, and psychotic symptoms. Further logistic regression showed that illness duration, TSH, TGAb, and TPOAb levels were correlates of glucose disturbances in MDD patients with anxiety. LIMITATIONS No causal relationship could be drawn due to the cross-sectional design. CONCLUSIONS Our findings suggest that TSH, TGAb and TPOAb may be promising biomarkers of glucose disturbances in MDD comorbid with anxiety, suggesting the importance of regular assessment of thyroid function parameters for abnormal glucose metabolism prevention.
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Affiliation(s)
- Huixue Xu
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
| | - Liyan Liu
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
| | - Qian Yang
- Department of Psychology, Zhongshan City People's Hospital, China.
| | - Xin Wang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
| | - Zejun Li
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
| | - Tieqiao Liu
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.
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Nakada S, Ho FK, Celis‐Morales C, Pell JP. Schizophrenia and Types of Stroke: A Mendelian Randomization Study. J Am Heart Assoc 2024; 13:e032011. [PMID: 38420769 PMCID: PMC10944050 DOI: 10.1161/jaha.123.032011] [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: 08/02/2023] [Accepted: 11/22/2023] [Indexed: 03/02/2024]
Abstract
BACKGROUND Previous studies suggest an association between schizophrenia and stroke, but no studies have investigated stroke subtypes. We examined potential causal associations between schizophrenia and a range of atherosclerotic, embolic, and hemorrhagic stroke outcomes. METHODS AND RESULTS Two-sample Mendelian randomization analyses were conducted. The summary-level data (restricted to European ancestry) were obtained for schizophrenia and stroke: ischemic stroke, large-artery stroke, small-vessel stroke, cardioembolic stroke, and intracerebral hemorrhage. The associations between schizophrenia and each outcome were analyzed by an inverse variance weighting method primarily and Mendelian randomization Egger, weighted median, and weighted mode subsequently. The presence of pleiotropy was also tested by Cochran Q statistic, I2 index, and Mendelian randomization Egger intercept with scatter and funnel plots. We found associations between schizophrenia and cardioembolic stroke (odds ratio [OR], 1.070 [95% CI, 1.023-1.119]) and intracerebral hemorrhage (OR, 1.089 [95% CI, 1.005-1.180]) using inverse variance weighting. Little evidence of associations with the other stroke subtypes was found. Different Mendelian randomization methods corroborated the association with cardioembolic stroke but not intracerebral hemorrhage. CONCLUSIONS We have provided evidence of a potentially causal association between schizophrenia and cardioembolic stroke. Our findings suggest that cardiac evaluation should be considered for those with schizophrenia.
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Affiliation(s)
- Shinya Nakada
- School of Health and WellbeingUniversity of GlasgowGlasgowUnited Kingdom
| | - Frederick K. Ho
- School of Health and WellbeingUniversity of GlasgowGlasgowUnited Kingdom
| | - Carlos Celis‐Morales
- School of Health and WellbeingUniversity of GlasgowGlasgowUnited Kingdom
- School of Cardiovascular and Metabolic HealthUniversity of GlasgowUnited Kingdom
- Human Performance Laboratory, Education, Physical Activity and Health Research UnitUniversidad Católica del MauleTalcaChile
| | - Jill P. Pell
- School of Health and WellbeingUniversity of GlasgowGlasgowUnited Kingdom
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Carney R, El-Metaal H, Law H, Savage S, Small I, Hann M, Shields G, Shiers D, Carmichael-Murphy P, Jones R, Kimber E, McDonald A, Parker S. Motiv8: a study protocol for a cluster-randomised feasibility trial of a weight management intervention for adults with severe mental illness in secure forensic services. Pilot Feasibility Stud 2024; 10:48. [PMID: 38429815 PMCID: PMC10908020 DOI: 10.1186/s40814-024-01458-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 02/06/2024] [Indexed: 03/03/2024] Open
Abstract
INTRODUCTION People with severe mental illness have physical comorbidities which result in significant reductions in quality of life and premature mortality. Effective interventions are required that are suitable for people in secure forensic mental health services. We conducted pilot work of a multidisciplinary weight management intervention (Motiv8) which showed improvements in physical and mental health and high levels of satisfaction. We aim to test the feasibility of Motiv8 under cluster randomised conditions, with an aim to investigate the acceptability, feasibility and potential effectiveness of this intervention to supplement standard secure care. METHODS AND ANALYSIS A randomised waitlist-controlled feasibility trial of a lifestyle intervention (Motiv8) + TAU compared with TAU (+ Motiv8 waitlist) for adults on secure mental health units will be conducted. Thirty-two people (4 cohorts) will be recruited from secure services in Greater Manchester Mental Health NHS Foundation Trust. Participants will be randomly allocated to Motiv8 or TAU + Motiv8 waitlist. All participants will receive Motiv8 during the trial. Assessor-blinded physical/mental health and lifestyle assessments will be conducted at baseline, 10 weeks (post-intervention/waitlist), and after 12 weeks (post-waitlist intervention/follow-up). Motiv8 is a multidisciplinary intervention including exercise sessions, cooking/nutrition classes, physical health education, psychology sessions, sleep hygiene, peer support and medication review by pharmacy. A nested qualitative study will be conducted with a subsample of participants (n = 10) to explore their experiences of taking part. The analysis will focus on feasibility outcomes and tabulated success indicators of the study (e.g. Recruitment rates, retention rates, follow-up retention and response rates, attendance at sessions, the experience of involvement in the trial and delivery of the intervention, assessment of safety, development of a manualised intervention). Thematic analysis will be conducted through qualitative interviews. The analysis will aim to inform the development of a definitive trial. ETHICS AND DISSEMINATION The trial has been granted ethical approval from the NHS Health Research Authority and adopted onto the UK Clinical Research Network Portfolio. Findings will be disseminated via peer-reviewed publications, professional and public networks, conferences and clinical services. TRIAL REGISTRATION ISRCTN13539285.
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Affiliation(s)
- Rebekah Carney
- Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK.
| | - Hany El-Metaal
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Heather Law
- Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Siobhan Savage
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Ingrid Small
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Mark Hann
- Division of Population Health, Health Services Research, and Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
| | - Gemma Shields
- Division of Population Health, Health Services Research, and Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
| | - David Shiers
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- Psychosis Research Unit, Greater Manchester Mental Health NHS Trust, Manchester, UK
- School of Medicine, University of Keele, Staffordshire, UK
| | - Parise Carmichael-Murphy
- Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Richard Jones
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Elizabeth Kimber
- Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Andrew McDonald
- Lancashire and South Cumbria, NHS Foundation Trust, Preston, UK
- School of Nursing and Midwifery, University of Bolton, Bolton, UK
| | - Sophie Parker
- Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Psychosis Research Unit, Greater Manchester Mental Health NHS Trust, Manchester, UK
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Browne J, Rudolph JL, Jiang L, Bayer TA, Kunicki ZJ, De Vito AN, Bozzay ML, McGeary JE, Kelso CM, Wu WC. Serious mental illness is associated with elevated risk of hospital readmission in veterans with heart failure. J Psychosom Res 2024; 178:111604. [PMID: 38309130 DOI: 10.1016/j.jpsychores.2024.111604] [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: 08/14/2023] [Revised: 01/23/2024] [Accepted: 01/29/2024] [Indexed: 02/05/2024]
Abstract
OBJECTIVE Adults with serious mental illness (SMI) have high rates of cardiovascular disease, particularly heart failure, which contribute to premature mortality. The aims were to examine 90- and 365-day all-cause medical or surgical hospital readmission in Veterans with SMI discharged from a heart failure hospitalization. The exploratory aim was to evaluate 180-day post-discharge engagement in cardiac rehabilitation, an effective intervention for heart failure. METHODS This study used administrative data from the Veterans Health Administration (VHA) and Centers for Medicare & Medicaid Services between 2011 and 2019. SMI status and medical comorbidity were assessed in the year prior to hospitalization. Cox proportional hazards models (competing risk of death) were used to evaluate the relationship between SMI status and outcomes. Models were adjusted for VHA hospital site, demographics, and medical characteristics. RESULTS The sample comprised 189,767 Veterans of which 23,671 (12.5%) had SMI. Compared to those without SMI, Veterans with SMI had significantly higher readmission rates at 90 (16.1% vs. 13.9%) and 365 (42.6% vs. 37.1%) days. After adjustment, risk of readmission remained significant (90 days: HR: 1.07, 95% CI: 1.03, 1.11; 365 days: HR: 1.10, 95% CI: 1.07, 1.12). SMI status was not significantly associated with 180-day cardiac rehabilitation engagement (HR: 0.98, 95% CI: 0.91, 1.07). CONCLUSIONS Veterans with SMI and heart failure have higher 90- and 365-day hospital readmission rates even after adjustment. There were no differences in cardiac rehabilitation engagement based on SMI status. Future work should consider a broader range of post-discharge interventions to understand contributors to readmission.
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Affiliation(s)
- Julia Browne
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.
| | - James L Rudolph
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA; Department of Health Services, Policy & Practice, Brown University, Providence, RI, USA
| | - Lan Jiang
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA
| | - Thomas A Bayer
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA
| | - Zachary J Kunicki
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Alyssa N De Vito
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Memory and Aging Program, Butler Hospital, Providence, RI, USA
| | - Melanie L Bozzay
- Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - John E McGeary
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Catherine M Kelso
- Veterans Health Administration, Office of Patient Care Services, Geriatrics and Extended Care, Washington DC, USA
| | - Wen-Chih Wu
- Medical Service, VA Providence Healthcare System, Providence, RI, USA
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Chung G, Kim HJ. Lifestyle and Health Behaviors Associated with Metabolic Syndrome and Cardiovascular Disease. Metab Syndr Relat Disord 2024; 22:105-113. [PMID: 38011536 DOI: 10.1089/met.2023.0152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Abstract
Background: As the prevalence of cardiovascular disease increases, the socioeconomic burden is expected to increase further. This study aimed to investigate lifestyle and health behaviors related to metabolic syndrome (MetS), myocardial infarction (MI), and stroke prevalence in men and women 50-79 years of age to assess clustering of risk factors. Methods: This study used raw data from the eighth Korea National Health and Nutrition Examination Survey (KNHANES) in 2021. Collected data were analyzed using SPSS 29.0 program. Complex Samples General Linear Model procedure and Complex Samples Logistic Regression procedure were performed. Results: Body mass index of more than 25.0 kg/m2, being a woman, having a middle school education or less, reporting a lower middle economic status, and performing exercise for less than 150 min a week were associated with MetS prevalence. Stress was associated with MI prevalence in men and women. Depression was associated with stroke prevalence in men. Conclusions: This study found that an education on obesity control in men and women is needed to reduce the prevalence of MetS. To reduce the prevalence of MI, stress management is required for men and women. To decrease stroke prevalence, depression management is needed for men.
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Affiliation(s)
- Goeun Chung
- Department of Public Health Medical Service, Jeju National University Hospital, Jeju, Republic of Korea
| | - Hye-Jin Kim
- Department of Nursing, College of Medicine, University of Ulsan, Ulsan, Republic of Korea
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Zhang J, He M, Wang X, Jiang H, Huang J, Liang S. Association of sleep duration and risk of mental disorder: a systematic review and meta-analysis. Sleep Breath 2024; 28:261-280. [PMID: 37642884 PMCID: PMC10954977 DOI: 10.1007/s11325-023-02905-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/03/2023] [Accepted: 08/11/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND The effects of sleep duration on the development of mental illness remain controversial. Therefore, it is necessary to identify the effects of long or short sleep duration on psychological disorders, which could reveal new ways for preventing and treating mental health conditions cheaply. METHODS Identifying published papers was accomplished by using the following five English databases on March 16, 2022: PubMed, MEDLINE, Embase, Web of Science databases, and Scopus. Cross-sectional and cohort studies were considered if they evaluated the association of sleep duration with all kinds of mental illness in adults. We excluded case reports, editorials, narrative reviews, and studies without detailed information on sleep duration. Summary effect-size estimates were expressed as risk ratios (RRs) or odds ratios (ORs) with 95% confidence intervals and were evaluated using random-effect models. Mantel-Haenszel's random-effects model was used to estimate the inconsistency index (I2) and Tau2 index (measurement of heterogeneity). RESULTS A total of 52 studies were included in this analysis, consisting of 14 cohort studies and 38 cross-sectional studies. These studies involved a combined sample size of 1,407,891 participants who met the inclusion criteria. Cohort (adjusted RR = 1.42, 95% CI: 1.26-1.60, P < .001, I2 = 37.6%, Tau2 = 0.014) and cross-sectional studies (adjusted OR = 1.67, 95% CI: 1.57-1.77, P < .001, I2 = 79.7%, Tau2 = 0.060) concluded that short sleep duration increased mental disorder risks. The same conclusions were acquired in the subgroup analysis, especially for depression (adjusted RR = 1.43, 95% CI: 1.24-1.65, P < .001, I2 = 80.4%, Tau2 = 0.082), anxiety (adjusted RR = 1.30, 95% CI: 1.04-1.63, P = .002, I2 = 0.0%, Tau2 = 0.000), and PTSD (adjusted RR = 1.35, 95% CI: 1.04-1.76, P = .022, I2 = 24.1%, Tau2 = 0.013) in cohort studies. The results of subgroup analysis indicated that long sleep duration was not a risk factor for depression (adjusted RR = 1.15, 95% CI: 0.98-1.34, P = .088, I2 = 63.4%, Tau2 = 0.045) and anxiety (adjusted RR = 1.37, 95% CI: 0.93-2.03, P = .114, I2 = 0.0%, Tau2 = 0.000). CONCLUSIONS Short sleep duration, not long sleep duration, is an independent predictor of developing mental disorders, particularly anxiety and depression.
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Affiliation(s)
- Jinhe Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Mengyang He
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Xuan Wang
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Hairong Jiang
- Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China
| | - Jinchang Huang
- Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China.
| | - Sixiang Liang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
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Bertossi F. A Possible Role of Akkermansia muciniphila in the Treatment of Olanzapine-Induced Weight Gain. Cureus 2024; 16:e55733. [PMID: 38463411 PMCID: PMC10921070 DOI: 10.7759/cureus.55733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2024] [Indexed: 03/12/2024] Open
Abstract
Second-generation antipsychotics are mainly used in both acute and long-term treatment of major psychiatric disorders. Although better tolerated than first-generation antipsychotic drugs, they can frequently induce weight gain and metabolic disorders, of these, olanzapine is one of the drugs more likely to induce these side effects. There is consistent evidence of the role of gut microbiota in modulating the gut-brain axis with complex crosstalk with the host involving satiety signaling pathways, food intake behavior, and weight and metabolic regulation. Second-generation antipsychotics induce important gut microbiota modification thus contributing together with the central and peripheral receptors blockade mechanism to weight gain induction and metabolic impairment. These drugs can alter the composition of gut microbiota and induce dysbiosis, often reducing the concentration of Akkermansia muciniphila, a bacterium that is also decreased in patients with diabetes, obesity, metabolic syndrome, or chronic inflammatory diseases. Probiotic administration can be a safe and well-tolerated approach to modulate microbiota and offer an integrative strategy in psychiatric patients suffering antipsychotic side effects. Multiple strain probiotics and Akkermansia muciniphila alone have been administered both in mice models and in clinical populations demonstrating efficacy on antipsychotic-induced metabolic impairment and showing a contribution in reducing induced weight gain. Akkermansia muciniphila can improve several parameters altered by olanzapine administration, such as weight gain, insulin resistance, hyperglycemia, liver function, systemic inflammation, and gut barrier function. Although we do not have jet trials in the psychiatric population, this probiotic may be a complementary approach to treating olanzapine-induced weight gain and metabolic side effects.
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Affiliation(s)
- Francesca Bertossi
- Department of Mental Health, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, ITA
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Godin O, Olié E, Fond G, Aouizerate B, Aubin V, Bellivier F, Belzeaux R, Courtet P, Dubertret C, Haffen E, Lefrere A, Llorca PM, Polosan M, Roux P, Samalin L, Schwan R, Leboyer M, Etain B. Incidence and predictors of metabolic syndrome onset in individuals with bipolar disorders: A longitudinal study from the FACE-BD cohort. Acta Psychiatr Scand 2024; 149:207-218. [PMID: 38268142 DOI: 10.1111/acps.13655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/05/2023] [Accepted: 12/29/2023] [Indexed: 01/26/2024]
Abstract
INTRODUCTION Metabolic syndrome (MetS) is a cluster of components including abdominal obesity, hyperglycemia, hypertension, and dyslipidemia. MetS is highly prevalent in individuals with bipolar disorders (BD) with an estimated global rate of 32.6%. Longitudinal data on incident MetS in BD are scarce and based on small sample size. The objectives of this study were to estimate the incidence of MetS in a large longitudinal cohort of 1521 individuals with BD and to identify clinical and biological predictors of incident MetS. METHODS Participants were recruited from the FondaMental Advanced Center of Expertise for Bipolar Disorder (FACE-BD) cohort and followed-up for 3 years. MetS was defined according to the International Diabetes Federation criteria. Individuals without MetS at baseline but with MetS during follow-up were considered as having incident MetS. A logistic regression model was performed to estimate the adjusted odds ratio and its corresponding 95% confidence interval (CI) for an association between each factor and incident MetS during follow-up. We applied inverse probability-of-censoring weighting method to minimize selection bias due to loss during follow-up. RESULTS Among individuals without MetS at baseline (n = 1521), 19.3% developed MetS during follow-up. Multivariable analyses showed that incident MetS during follow-up was significantly associated with male sex (OR = 2.2, 95% CI = 1.7-3.0, p < 0.0001), older age (OR = 2.14, 95% CI = 1.40-3.25, p = 0.0004), presence of a mood recurrence during follow-up (OR = 1.91, 95% CI = 1.22-3.00, p = 0.0049), prolonged exposure to second-generation antipsychotics (OR = 1.56, 95% CI = 0.99, 2.45, p = 0.0534), smoking status at baseline (OR = 1.30, 95% CI = 1.00-1.68), lifetime alcohol use disorders (OR = 1.33, 95% CI = 0.98-1.79), and baseline sleep disturbances (OR = 1.04, 95% CI = 1.00-1.08), independently of the associations observed for baseline MetS components. CONCLUSION We observed a high incidence of MetS during a 3 years follow-up (19.3%) in individuals with BD. Identification of predictive factors should help the development of early interventions to prevent or treat early MetS.
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Affiliation(s)
- O Godin
- Fondation FondaMental, Créteil, France
- INSERM U955, IMRB, Translational NeuroPsychiatry Laboratory, Université Paris Est Créteil, Créteil, France
| | - E Olié
- Fondation FondaMental, Créteil, France
- Department of Emergency Psychiatry and Acute Care, IGF, University of Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, France
| | - G Fond
- Fondation FondaMental, Créteil, France
- AP-HM, Academic Department of Psychiatry, Resistant Depression Expert Center (FondaMental Foundation), CHU La Conception, Aix-Marseille University, Marseille, France
| | - B Aouizerate
- Fondation FondaMental, Créteil, France
- Centre Hospitalier Charles Perrens, Pôle de Psychiatrie Générale et Universitaire, Laboratoire NutriNeuro (UMR INRAE 1286), Université de Bordeaux, Bordeaux, France
| | - V Aubin
- Fondation FondaMental, Créteil, France
- Pôle de Psychiatrie, Centre Hospitalier Princesse Grace, Monaco, France
| | - F Bellivier
- Fondation FondaMental, Créteil, France
- INSERM UMR-S 1144, Optimisation Thérapeutique en Neuropsychopharmacologie OTeN, Université Paris Cité, Paris, France
- Hôpital Fernand Widal, Département de Psychiatrie et de Médecine Addictologique, AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, DMU Neurosciences, Paris, France
| | - R Belzeaux
- Fondation FondaMental, Créteil, France
- University of Montpellier & Department of Psychiatry, CHU de Montpellier, Montpellier, France
| | - P Courtet
- Fondation FondaMental, Créteil, France
- Department of Emergency Psychiatry and Acute Care, IGF, University of Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, France
| | - C Dubertret
- Fondation FondaMental, Créteil, France
- AHPH, Departement de Psychiatrie, Hopital Louis Mourier, Colombes, France
| | - E Haffen
- Fondation FondaMental, Créteil, France
- UR 481 LINC, Service de Psychiatrie de l'Adulte, CIC-1431 INSERM, CHU de Besançon, Université de Franche-Comté, Besançon, France
| | - A Lefrere
- Fondation FondaMental, Créteil, France
- Pôle de Psychiatrie, Assistance Publique Hôpitaux de Marseille, Marseille, France; INT-UMR7289, CNRS Aix-Marseille Université, Marseille, France
| | - P M Llorca
- Fondation FondaMental, Créteil, France
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal (UMR 6602), Clermont-Ferrand, France
| | - M Polosan
- Fondation FondaMental, Créteil, France
- University of Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France
| | - P Roux
- Fondation FondaMental, Créteil, France
- Centre Hospitalier de Versailles, Service Universitaire de Psychiatrie d'Adulte et d'Addictologie, Le Chesnay, France
- Université Paris-Saclay, Université de Versailles Saint-Quentin-En-Yvelines, DisAP-DevPsy-CESP, INSERM UMR1018, Villejuif, France
| | - L Samalin
- Fondation FondaMental, Créteil, France
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal (UMR 6602), Clermont-Ferrand, France
| | - R Schwan
- Fondation FondaMental, Créteil, France
- Centre Psychothérapique de Nancy, Inserm U1254, Université de Lorraine, Nancy, France
| | - M Leboyer
- Fondation FondaMental, Créteil, France
- INSERM U955, IMRB, Translational NeuroPsychiatry Laboratory, Université Paris Est Créteil, Créteil, France
- AP-HP, Hôpitaux Universitaires Henri Mondor, Département Médico-Universitaire de Psychiatrie et d'Addictologie (DMUIMPACT), Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Créteil, France
| | - B Etain
- Fondation FondaMental, Créteil, France
- INSERM UMR-S 1144, Optimisation Thérapeutique en Neuropsychopharmacologie OTeN, Université Paris Cité, Paris, France
- Hôpital Fernand Widal, Département de Psychiatrie et de Médecine Addictologique, AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, DMU Neurosciences, Paris, France
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Constantinides C, Baltramonaityte V, Caramaschi D, Han LKM, Lancaster TM, Zammit S, Freeman TP, Walton E. Assessing the association between global structural brain age and polygenic risk for schizophrenia in early adulthood: A recall-by-genotype study. Cortex 2024; 172:1-13. [PMID: 38154374 DOI: 10.1016/j.cortex.2023.11.015] [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: 04/28/2023] [Revised: 09/22/2023] [Accepted: 11/23/2023] [Indexed: 12/30/2023]
Abstract
Neuroimaging studies consistently show advanced brain age in schizophrenia, suggesting that brain structure is often 'older' than expected at a given chronological age. Whether advanced brain age is linked to genetic liability for schizophrenia remains unclear. In this pre-registered secondary data analysis, we utilised a recall-by-genotype approach applied to a population-based subsample from the Avon Longitudinal Study of Parents and Children to assess brain age differences between young adults aged 21-24 years with relatively high (n = 96) and low (n = 93) polygenic risk for schizophrenia (SCZ-PRS). A global index of brain age (or brain-predicted age) was estimated using a publicly available machine learning model previously trained on a combination of region-wise gray-matter measures, including cortical thickness, surface area and subcortical volumes derived from T1-weighted magnetic resonance imaging (MRI) scans. We found no difference in mean brain-PAD (the difference between brain-predicted age and chronological age) between the high- and low-SCZ-PRS groups, controlling for the effects of sex and age at time of scanning (b = -.21; 95% CI -2.00, 1.58; p = .82; Cohen's d = -.034; partial R2 = .00029). These findings do not support an association between SCZ-PRS and brain-PAD based on global age-related structural brain patterns, suggesting that brain age may not be a vulnerability marker of common genetic risk for SCZ. Future studies with larger samples and multimodal brain age measures could further investigate global or localised effects of SCZ-PRS.
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Affiliation(s)
| | | | - Doretta Caramaschi
- Department of Psychology, Faculty of Health and Life Sciences, University of Exeter, UK
| | - Laura K M Han
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia; Orygen, Parkville, Australia
| | | | - Stanley Zammit
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK; Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Tom P Freeman
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, UK
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