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Ham E, Hilton NZ, Crawford J, Kim S. Psychiatric inpatient services in Ontario, 2019-2021: a cross-sectional comparison of admissions, diagnoses and acuity during the COVID-19 prerestriction, restriction and postrestriction periods. CMAJ Open 2023; 11:E988-E994. [PMID: 37875314 PMCID: PMC10609896 DOI: 10.9778/cmajo.20220158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic was associated with increased mental health problems in the general population, yet psychiatric hospital admissions decreased. Early evidence suggested that psychiatric admissions normalized within weeks; we sought to examine the longer-lasting impacts on the psychiatric inpatient population beyond this initial period. METHODS We compared Ontario Mental Health Reporting System admission data for patients admitted to 8 psychiatric hospitals in Ontario, Canada, between 3 time periods - before restrictions were imposed (June 22, 2019, to Mar. 16, 2020), during restrictions (Mar. 17 to June 21, 2020) and after restrictions were lifted (June 22, 2020, to Mar. 16, 2021) for changes in involuntary status, diagnoses and clinical presentation using descriptive analysis. For clinical presentation, we extracted scores on 4 Resident Assessment Instrument-Mental Health symptom scales (Depressive Severity Index, Cognitive Performance Scale, Positive Symptoms Scale-Long Version and Social Withdrawal Scale), and 2 behaviour scales (Aggressive Behavior Scale and Violence Sum). RESULTS A cross-sectional sample of 9848 patients was included in the analysis. The mean number of daily admissions decreased 19% from 16.4 (standard deviation [SD] 8.0) before the restriction period to 13.3 (SD 6.1) during the restriction period, and was still 6% below prerestriction levels after restrictions were lifted 15.4 (SD 6.8), with standard error difference of 1.03 (95% confidence interval -0.22 to 2.29). From the pre- to the postrestriction periods, the proportion of involuntary patients increased by 6 percentage points, and the proportions of patients diagnosed with a psychotic disorder or personality disorder increased by 4 percentage points and 1 percentage point, respectively. INTERPRETATION Psychiatric admissions did not fully return to prerestriction levels in absolute rates and patient acuity after COVID-19 restrictions were lifted. Psychiatric services must prepare to appraise and respond to any increased acuity through interventions for patients, workforce planning and mental health support for staff.
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Affiliation(s)
- Elke Ham
- Waypoint Research Institute (Ham, Hilton, Crawford, Kim), Waypoint Centre for Mental Health Care, Penetanguishene, Ont.; Department of Psychiatry (Hilton), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Faculty of Health Sciences (Crawford), Ontario Tech University, Oshawa, Ont.; Psychiatry and Behavioural Neurosciences (Kim), McMaster University, Hamilton, Ont.
| | - N Zoe Hilton
- Waypoint Research Institute (Ham, Hilton, Crawford, Kim), Waypoint Centre for Mental Health Care, Penetanguishene, Ont.; Department of Psychiatry (Hilton), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Faculty of Health Sciences (Crawford), Ontario Tech University, Oshawa, Ont.; Psychiatry and Behavioural Neurosciences (Kim), McMaster University, Hamilton, Ont
| | - Jennifer Crawford
- Waypoint Research Institute (Ham, Hilton, Crawford, Kim), Waypoint Centre for Mental Health Care, Penetanguishene, Ont.; Department of Psychiatry (Hilton), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Faculty of Health Sciences (Crawford), Ontario Tech University, Oshawa, Ont.; Psychiatry and Behavioural Neurosciences (Kim), McMaster University, Hamilton, Ont
| | - Soyeon Kim
- Waypoint Research Institute (Ham, Hilton, Crawford, Kim), Waypoint Centre for Mental Health Care, Penetanguishene, Ont.; Department of Psychiatry (Hilton), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Faculty of Health Sciences (Crawford), Ontario Tech University, Oshawa, Ont.; Psychiatry and Behavioural Neurosciences (Kim), McMaster University, Hamilton, Ont
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Šagud M, Madžarac Z, Nedic Erjavec G, Šimunović Filipčić I, Mikulić FL, Rogić D, Bradaš Z, Bajs Janović M, Pivac N. The Associations of Neutrophil-Lymphocyte, Platelet-Lymphocyte, Monocyte-Lymphocyte Ratios and Immune-Inflammation Index with Negative Symptoms in Patients with Schizophrenia. Biomolecules 2023; 13:biom13020297. [PMID: 36830666 PMCID: PMC9952992 DOI: 10.3390/biom13020297] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 02/08/2023] Open
Abstract
Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), monocyte-lymphocyte ratio (MLR) and systemic immune-inflammation index (SII index) are increasingly used as indicators of inflammation in different conditions, including schizophrenia. However, their relationship with negative symptoms, including anhedonia, is largely unknown. Included were 200 patients with schizophrenia and 134 healthy controls (HC), assessed for physical anhedonia (PA), using the Revised Physical Anhedonia Scale (RPAS), and social anhedonia (SA) by the Revised Social Anhedonia Scale (RSAS). Patients were rated by the Positive and Negative Syndrome Scale (PANSS), the Clinical Assessment Interview for Negative Symptoms (CAINS) and the Brief Negative Symptom Scale (BNSS). Most of the negative symptoms were in a weak to moderate positive correlations with blood cell inflammatory ratios, namely, between NLR and MLR with PANSS negative scale, CAINS, and BNSS, and in male patients, between PLR and PANSS negative scale and CAINS. Fewer correlations were detected in females, but also in a positive direction. An exception was SA, given the negative correlation between its severity and the SII index in females, and its presence and higher PLR in males. While different negative symptoms were associated with subclinical inflammation, the relationship between SA and lower inflammatory markers deserves further exploration.
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Affiliation(s)
- Marina Šagud
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Zoran Madžarac
- Department of Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | | | - Ivona Šimunović Filipčić
- Department of Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | | | - Dunja Rogić
- Department for Laboratory Diagnostics, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Zoran Bradaš
- Department of Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Maja Bajs Janović
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Nela Pivac
- Rudjer Boskovic Institute, 10000 Zagreb, Croatia
- Correspondence:
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McGuckin T, Ferro MA, Hammond D, Stewart S, Maloney-Hall B, Madi N, Porath A, Perlman CM. How High? Trends in Cannabis Use Prior to First Admission to Inpatient Psychiatry in Ontario, Canada, between 2007 and 2017. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:1059-1068. [PMID: 33380219 PMCID: PMC8689428 DOI: 10.1177/0706743720984679] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To examine the trends in cannabis use within 30 days of first admission to inpatient psychiatry in Ontario, Canada, between 2007 and 2017, and the characteristics of persons reporting cannabis use. METHODS A retrospective cross-sectional analysis was conducted for first-time admissions to nonforensic inpatient psychiatric beds in Ontario, Canada, between January 1, 2007, and December 31, 2017, using data from the Ontario Mental Health Reporting System (N = 81,809). RESULTS Across all years, 20.1% of patients reported cannabis use within 30 days of first admission. Use increased from 16.7% in 2007 to 25.9% in 2017, and the proportion with cannabis use disorders increased from 3.8% to 6.0%. In 2017, 47.9% of patients aged 18 to 24 and 39.2% aged 25 to 34 used cannabis, representing absolute increases of 8.3% and 10.7%, respectively. Increases in cannabis use were found across almost all diagnostic groups, with the largest increases among patients with personality disorders (15% increase), schizophrenia or other psychotic disorders (14% increase), and substance use disorders (14% increase). A number of demographic and clinical factors were significantly associated with cannabis use, including interactions between schizophrenia and gender (area under the curve = 0.88). CONCLUSIONS As medical cannabis policies in Canada have evolved, cannabis use reported prior to first admission to inpatient psychiatry has increased. The findings of this study establish a baseline for evaluating the impact of changes in cannabis-related policies in Ontario on cannabis use prior to admission to inpatient psychiatry.
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Affiliation(s)
- Taylor McGuckin
- School of Public Health and Health Systems, University of Waterloo, Ontario, Canada
| | - Mark A Ferro
- School of Public Health and Health Systems, University of Waterloo, Ontario, Canada
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Ontario, Canada
| | - Shannon Stewart
- Faculty of Education, Applied Psychology, Western University, London, Ontario, Canada
| | | | - Nawaf Madi
- Canadian Institute for Health Information, Ottawa, Ontario, Canada
| | - Amy Porath
- Canadian Centre on Substance Use and Addiction, Ottawa, Ontario, Canada
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Little J, Hirdes JP, Perlman CM, Meyer SB. Clinical Predictors of Delayed Discharges in Inpatient Mental Health Settings Across Ontario. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 46:105-114. [PMID: 30284090 PMCID: PMC6327079 DOI: 10.1007/s10488-018-0898-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Delayed discharges constitute an ongoing issue in psychiatric facilities. This study examined clinical predictors of 30-day delayed discharges in all designated inpatient mental health units within Ontario, Canada. Data for 76,184 inpatient episodes were obtained from 68 psychiatric facilities between 2011 and 2013. Risk factors for delayed discharges were analyzed using multivariate logistic regression. Indicators of functional, social, and cognitive impairment positively predicted delayed discharges, while symptoms of mental illness were inversely related. Policy makers and mental health care practitioners may utilize early predictors of delayed discharges to introduce treatment interventions and policies that reduce the risk of delays in mental health settings.
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Affiliation(s)
- Jerrica Little
- University of Waterloo, 200 University Ave West, Waterloo, ON, N2L 3G1, Canada.
| | - John P Hirdes
- University of Waterloo, 200 University Ave West, Waterloo, ON, N2L 3G1, Canada
| | | | - Samantha B Meyer
- University of Waterloo, 200 University Ave West, Waterloo, ON, N2L 3G1, Canada
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Villani ER, Vetrano DL, Damiano C, Paola AD, Ulgiati AM, Martin L, Hirdes JP, Fratiglioni L, Bernabei R, Onder G, Carfì A. Impact of COVID-19-Related Lockdown on Psychosocial, Cognitive, and Functional Well-Being in Adults With Down Syndrome. Front Psychiatry 2020; 11:578686. [PMID: 33192717 PMCID: PMC7655916 DOI: 10.3389/fpsyt.2020.578686] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/02/2020] [Indexed: 12/19/2022] Open
Abstract
People with Down Syndrome (DS) have a high prevalence of physical and psychiatric comorbidities and experience early-onset dementia. With the outbreak of CoVID-19 pandemic, strict social isolation measures have been necessary to prevent the spreading of the disease. Effects of this lockdown period on behavior, mood and cognition in people with DS have not been assessed so far. In the present clinical study, we investigated the impact of CoVID-19-related lockdown on psychosocial, cognitive and functional well-being in a sample population of 46 adults with DS. The interRAI Intellectual Disability standardized assessment instrument, which includes measures of social withdrawal, functional impairment, aggressive behavior and depressive symptoms, was used to perform a three time-point evaluation (two pre-lockdown and one post-lockdown) in 37 subjects of the study sample, and a two time point evaluation (one pre- and one post-lockdown) in 9 subjects. Two mixed linear regression models - one before and one after the lockdown - have been fitted for each scale in order to investigate the change in the time-dependent variation of the scores. In the pre-lockdown period, significant worsening over time (i.e., per year) was found for the Depression Rating Scale score (β = 0.55; 95% CI 0.34; 0.76). In the post-lockdown period, a significant worsening in social withdrawal (β = 3.05, 95% CI 0.39; 5.70), instrumental activities of daily living (β = 1.13, 95% CI 0.08; 2.18) and depression rating (β = 1.65, 95% CI 0.33; 2.97) scales scores was observed, as was a significant improvement in aggressive behavior (β = -1.40, 95% CI -2.69; -0.10). Despite the undoubtful importance of the lockdown in order to reduce the spreading of the CoVID-19 pandemic, the related social isolation measures suggest an exacerbation of depressive symptoms and a worsening in functional status in a sample of adults with DS. At the opposite, aggressive behavior was reduced after the lockdown period. This finding could be related to the increase of negative and depressive symptoms in the study population. Studies with longer follow-up period are needed to assess persistence of these effects.
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Affiliation(s)
- Emanuele Rocco Villani
- Centro Medicina Dell'Invecchiamento, Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy
| | - Davide Liborio Vetrano
- Department of Neurobiology, Aging Research Center, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Cecilia Damiano
- Centro Medicina Dell'Invecchiamento, Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonella Di Paola
- Centro Medicina Dell'Invecchiamento, Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy
| | - Aurora Maria Ulgiati
- Department of Neurology and Alzheimer Research Center, University of Groningen and University Medical Center Groningen, Groningen, Netherlands
| | - Lynn Martin
- Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada
| | - John P Hirdes
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Laura Fratiglioni
- Department of Neurobiology, Aging Research Center, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Roberto Bernabei
- Centro Medicina Dell'Invecchiamento, Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy
| | - Graziano Onder
- Centro Medicina Dell'Invecchiamento, Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| | - Angelo Carfì
- Centro Medicina Dell'Invecchiamento, Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy
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Carfì A, Vetrano DL, Mascia D, Meloni E, Villani ER, Acampora N, Brandi V, Fries BE, Martin L, Bernabei R, Onder G. Adults with Down syndrome: a comprehensive approach to manage complexity. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2019; 63:624-629. [PMID: 30628132 DOI: 10.1111/jir.12588] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 12/04/2018] [Accepted: 12/08/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Down syndrome (DS) is characterised by premature ageing that affects selected organ systems, and persons with this condition can present patterns of co-morbidities and deficits often observed in the older population without DS. However, information on the characteristics of adult persons with DS is limited. The objective of the study is to describe characteristics of adults with DS collected with a standardised, comprehensive assessment instrument. METHODS Cross-sectional study. Four hundred thirty adults with DS (age range 18/75 years) from three countries (Italy, n = 95; USA, n = 175; and Canada, n = 160). A standardised assessment instrument (interRAI intellectual disability) was used to assess sample characteristics. RESULTS Mean age ranged from 35.2 (standard deviation 12.0) years in the US sample to 48.8 (standard deviation 9.0) years in the Canadian sample. Most participants in the Italian and US sample were living in private homes, while more than half of those in the Canadian sample were institutionalised. Prevalences of geriatric conditions, including cognitive deficits, disability in the common activities of daily living, symptoms of withdrawal or anhedonia, aggressive behaviour, communication problems, falls and hearing problems were high in the study sample. Gastrointestinal symptoms, skin and dental problems and obesity were also frequently observed. CONCLUSIONS Adults with DS present with a high level of complexity, which may suggest the need for an approach based on a comprehensive assessment and management that can provide adequate care. Further research is needed to understand better the effectiveness of such an approach in the DS population.
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Affiliation(s)
- A Carfì
- Centro Medicina dell'Invecchiamento, Department of Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - D L Vetrano
- Centro Medicina dell'Invecchiamento, Department of Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - D Mascia
- Centro Medicina dell'Invecchiamento, Department of Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - E Meloni
- Centro Medicina dell'Invecchiamento, Department of Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - E R Villani
- Centro Medicina dell'Invecchiamento, Department of Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - N Acampora
- Centro Medicina dell'Invecchiamento, Department of Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - V Brandi
- Centro Medicina dell'Invecchiamento, Department of Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - B E Fries
- Department of Geriatrics and Palliative Care, Department of Internal Medicine and Department of Health, Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - L Martin
- Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada
| | - R Bernabei
- Centro Medicina dell'Invecchiamento, Department of Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Onder
- Centro Medicina dell'Invecchiamento, Department of Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy
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