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Llorca-Bofí V, Madero S, Amoretti S, Cuesta MJ, Moreno C, González-Pinto A, Bergé D, Rodriguez-Jimenez R, Roldán A, García-León MÁ, Ibáñez A, Usall J, Contreras F, Mezquida G, García-Rizo C, Berrocoso E, Bernardo M, Bioque M. Inflammatory blood cells and ratios at remission for psychosis relapse prediction: A three-year follow-up of a cohort of first episodes of schizophrenia. Schizophr Res 2024; 267:24-31. [PMID: 38513331 DOI: 10.1016/j.schres.2024.03.011] [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: 03/15/2023] [Revised: 02/19/2024] [Accepted: 03/14/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND The clinical course following a first episode of schizophrenia (FES) is often characterized by recurrent relapses, resulting in unfavorable clinical and functional outcomes. Inflammatory dysregulation has been implicated in relapse risk; however, the predictive value of inflammatory blood cells in clinically remitted patients after a FES has not been previously explored. METHODS In this study, we closely monitored 111 patients in remission after a FES until relapse or a three-year follow-up endpoint. The participants were recruited from the multicenter 2EPS Project. Data on inflammatory blood cells and ratios were collected at baseline and at the time of relapse or after three years of follow-up. RESULTS Monocyte counts (OR = 1.91; 95 % CI = 1.07-3.18; p = 0.009) and basophil counts (OR = 1.09; 95 % CI = 1.01-1.12; p = 0.005) at baseline were associated with an increased risk of relapse, while the platelet-lymphocyte ratio (OR = 0.98; 95 % CI = 0.97-0.99; p = 0.019) was identified as a protective factor. However, after adjusting for cannabis and tobacco use during the follow-up, only monocyte counts (OR = 1.73; 95 % CI = 1.03-2.29; p = 0.027) and basophil counts (OR = 1.08; 95 % CI = 1.01-1.14; p = 0.008) remained statistically significant. ROC curve analysis indicated that the optimal cut-off values for discriminating relapsers were 0.52 × 10^9/L (AUC: 0.66) for monocytes and 0.025 × 10^9/L (AUC: 0.75) for basophils. When considering baseline inflammatory levels, no significant differences were observed in the inflammatory biomarkers at the endpoint between relapsers and non-relapsers. CONCLUSION This study provides evidence that higher monocyte and basophil counts measured at remission after a FES are associated with an increased risk of relapse during a three-year follow-up period.
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Affiliation(s)
- Vicent Llorca-Bofí
- Department of Medicine, University of Barcelona, Barcelona, Spain; Department of Psychiatry, Santa Maria University Hospital Lleida, Lleida, Spain; Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, Spain
| | - Santiago Madero
- Department of Medicine, University of Barcelona, Barcelona, Spain; Barcelona Clínic Schizophrenia Unit (BCSU), Neuroscience Institute, Hospital Clínic de Barcelona, Barcelona, Spain.
| | - Silvia Amoretti
- Barcelona Clínic Schizophrenia Unit, Neuroscience Institute, Hospital Clínic of Barcelona, Spain; Bipolar and Depressive Disorder Unit, Neuroscience Institute, Hospital Clínic de Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM) Instituto de Salud Carlos III, Spain; Group of Psychiatry, Mental Health and Addictions, Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Spain; University of Barcelona, Spain.
| | - Manuel J Cuesta
- Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.
| | - Carmen Moreno
- 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.
| | - Ana González-Pinto
- Bioaraba, Alava University Hospital, UPV/EHU, Vitoria, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain.
| | - Dani Bergé
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; Hospital del Mar Medical Research Institute, Universitat Pompeu Fabra, Barcelona, Spain.
| | - Roberto Rodriguez-Jimenez
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; CIBERSAM (Biomedical Research Networking Centre in Mental Health), Spain; Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - Alexandra Roldán
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, IIB-SANT PAU, Barcelona, Spain; CIBERSAM, ISCIII, Spain.
| | - María Ángeles García-León
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain.
| | - Angela Ibáñez
- Department of Psychiatry, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, Spain; Centro de Investigación Biomédica en red en salud Mental (CIBERSAM), ISCIII, Madrid, Spain
| | - Judith Usall
- Research Institute Sant Joan de Déu, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain.
| | - Fernando Contreras
- Psychiatric Service, Bellvitge Universitari Hospital, IDIBELL, CIBERSAM, Spain.
| | - Gisela Mezquida
- University of Barcelona, Spain; Barcelona Clinic Schizophrenia Unit, Hospital Clínic of Barcelona, Neuroscience Institute, Spain; Institut d'Investigacions Biomèdiques, August Pi i Sunyer, Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Instituto de Salud Carlos III, Spain.
| | - Clemente García-Rizo
- Barcelona Clínic Schizophrenia Unit (BCSU), Neuroscience Institute, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Madrid, Spain.
| | - Esther Berrocoso
- Neuropsychopharmacology and Psychobiology Research Group, Department of Neuroscience, University of Cádiz, Cádiz, Spain; Instituto de Investigación e Innovación Biomédica de Cádiz, INiBICA, Hospital Universitario Puerta del Mar, Cádiz, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
| | - Miquel Bernardo
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic, Departament de Medicina, Institut de Neurociències (UBNeuro), Universitat de Barcelona (UB), Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), CIBERSAM, ISCIII, Barcelona, Spain.
| | - Miquel Bioque
- Department of Medicine, University of Barcelona, Barcelona, Spain; Barcelona Clínic Schizophrenia Unit (BCSU), Neuroscience Institute, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en red en salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Spain.
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2
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McCutcheon RA, Taylor D, Rubio J, Nour J, Pillinger T, Murray RM, Jauhar S. Does Slow and Steady Win the Race? Rates of Antipsychotic Discontinuation, Antipsychotic Dose, and Risk of Psychotic Relapse. Schizophr Bull 2024; 50:513-520. [PMID: 37797288 PMCID: PMC11059789 DOI: 10.1093/schbul/sbad139] [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: 10/07/2023]
Abstract
BACKGROUND Antipsychotics are recommended for prevention of relapse in schizophrenia. It is unclear whether increased risk of relapse following antipsychotic discontinuation is predominantly associated with an absolute magnitude of dose reduction or rate of antipsychotic reduction. Establishing the responsible mechanism is important because prolonged withdrawal schedules have been suggested to reduce risk of relapse. STUDY DESIGN Individual patient data from antipsychotic discontinuation studies were obtained. We estimated the occupancy of receptors over time using half-lives and median effective dose ED50 values obtained from pharmacokinetic and receptor occupancy studies. Hazard ratios for relapse events were calculated using Cox proportional hazards models to assess the influence of formulation (oral, 1-monthly, and 3-monthly injections). The change in hazard ratio over time was estimated, and the effect of time-varying covariates was calculated, including rate of occupancy reduction and absolute receptor occupancy. STUDY RESULTS Five studies including 1388 participants with schizophrenia were identified (k = 2: oral, k = 2: 1-monthly injection, k = 1: 3-monthly injection). Withdrawal of long-acting injectable medication did not lead to a lower hazard ratio compared with withdrawal of oral medication, and this included the period immediately following randomization. Hazard ratios were not associated with the rate of decline of receptor occupancy; however, they were associated with reduced absolute occupancy in trials of long-acting injections (P = .038). CONCLUSIONS Antipsychotic discontinuation is associated with an increased risk of psychotic relapse, related to receptor occupancy. Although relapse does not appear to be related to the rate of discontinuation, gradual discontinuation strategies may allow for easier antipsychotic reinstatement in case of symptomatic worsening.
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Affiliation(s)
- Robert A McCutcheon
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - David Taylor
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Jose Rubio
- Department of Psychiatry, Northwell Health, The Zucker Hillside Hospital, Glen Oaks, NY, USA
| | - Joseph Nour
- East London NHS Foundation Trust, London, UK
| | - Toby Pillinger
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Sameer Jauhar
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, London, UK
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3
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Gleeson JF, McGuckian TB, Fernandez DK, Fraser MI, Pepe A, Taskis R, Alvarez-Jimenez M, Farhall JF, Gumley A. Systematic review of early warning signs of relapse and behavioural antecedents of symptom worsening in people living with schizophrenia spectrum disorders. Clin Psychol Rev 2024; 107:102357. [PMID: 38065010 DOI: 10.1016/j.cpr.2023.102357] [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: 03/08/2023] [Revised: 11/03/2023] [Accepted: 11/14/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Identification of the early warning signs (EWS) of relapse is key to relapse prevention in schizophrenia spectrum disorders, however, limitations to their precision have been reported. Substantial methodological innovations have recently been applied to the prediction of psychotic relapse and to individual psychotic symptoms. However, there has been no systematic review that has integrated findings across these two related outcomes and no systematic review of EWS of relapse for a decade. METHOD We conducted a systematic review of EWS of psychotic relapse and the behavioural antecedents of worsening psychotic symptoms. Traditional EWS and ecological momentary assessment/intervention studies were included. We completed meta-analyses of the pooled sensitivity and specificity of EWS in predicting relapse, and for the prediction of relapse from individual symptoms. RESULTS Seventy two studies were identified including 6903 participants. Sleep, mood, and suspiciousness, emerged as predictors of worsening symptoms. Pooled sensitivity and specificity of EWS in predicting psychotic relapse was 71% and 64% (AUC value = 0.72). There was a large pooled-effect size for the model predicting relapse from individual symptom which did not reach statistical significance (d = 0.81, 95%CIs = -0.01, 1.63). CONCLUSIONS Important methodological advancements in the prediction of psychotic relapse in schizophrenia spectrum disorders are evident with improvements in the precision of prediction. Further efforts are required to translate these advances into effective clinical innovations.
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Affiliation(s)
- J F Gleeson
- Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, VIC, Australia.
| | - T B McGuckian
- Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, VIC, Australia
| | - D K Fernandez
- Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, VIC, Australia
| | - M I Fraser
- Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, VIC, Australia
| | - A Pepe
- Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, VIC, Australia
| | - R Taskis
- Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, VIC, Australia
| | - M Alvarez-Jimenez
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - J F Farhall
- Department of Psychology and Counselling, La Trobe University, Melbourne, VIC, Australia
| | - A Gumley
- Glasgow Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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4
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Vila-Barrios L, Carballeira E, Varela-Sanz A, Iglesias-Soler E, Dopico-Calvo X. The Impact of Regular Physical Exercise on Psychopathology, Cognition, and Quality of Life in Patients Diagnosed with Schizophrenia: A Scoping Review. Behav Sci (Basel) 2023; 13:959. [PMID: 38131815 PMCID: PMC10740550 DOI: 10.3390/bs13120959] [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: 09/27/2023] [Revised: 11/01/2023] [Accepted: 11/17/2023] [Indexed: 12/23/2023] Open
Abstract
The presence of less healthy lifestyle habits among individuals diagnosed with schizophrenia which can contribute to the escalation of physical disorders and exacerbation of psychological symptoms is well documented. The present scoping review aims to synthesize and evaluate the available evidence regarding the impact of regular physical exercise on psychopathology, cognition, and quality of life (QoL) in patients diagnosed with schizophrenia. A literature search was performed across Web of Science, SCOPUS, PubMed, and SPORTDiscus for randomized control trials published up to April 2022. Two independent reviewers applied the selection criteria and a third reviewer resolved discrepancies. A total of twelve studies were included, of which nine used endurance training and three used concurrent training (one of these additionally used resistance training). The results reveal benefits of various modalities of supervised regular exercise in the psychopathology of schizophrenia. Furthermore, regular endurance training seems to improve cognitive function in patients with schizophrenia and promote their QoL; however, results are inconclusive with respect to this last variable. The assessment of methodological quality in the reviewed articles indicates a high overall risk of bias, particularly in relation to deviations from intended interventions and the selection of reported results. Furthermore, an assessment of exercise reporting revealed that only 5 out of 19 items were fulfilled in more than 50% of the articles. Future research is needed to evaluate the effects of different training modalities and the optimal dose-response relationship in patients diagnosed with schizophrenia.
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Affiliation(s)
| | - Eduardo Carballeira
- Performance and Health Group, Department of Physical Education and Sport, University of A Coruna, 15179 A Coruña, Spain; (L.V.-B.); (A.V.-S.); (E.I.-S.); (X.D.-C.)
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5
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Ferrara M, Guloksuz S, Hazan H, Li F, Tek C, Sykes LY, Riley S, Keshavan M, Srihari VH. The effect of duration of untreated psychosis (DUP) on the risk for hospitalization after admission to a first episode service. Schizophr Res 2023; 260:198-204. [PMID: 37688984 DOI: 10.1016/j.schres.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 09/11/2023]
Abstract
Engagement with a first episode-psychosis service (FES) reduces the risk of psychiatric hospitalization. However, the role of the duration of untreated psychosis (DUP) in impacting this outcome is disputed. This study aimed to examine whether DUP was an effect modifier of the post-FES reduction of risk of hospitalization, and to explore associations between patients' characteristics and hospitalization post-FES. Individuals aged 16-35 with recent onset (< 3 years) of non-affective psychosis, admitted to the Program for Specialized Treatment Early in Psychosis (STEP), a FES serving the Greater New Haven area, Connecticut, between 2014 and 2019 were included (N = 189). Medical records were queried from 2013 through 2020 for number and duration of psychiatric hospitalizations. Poisson regression models were used to estimate incidence rate ratios for hospitalization rates across all explanatory variables. Negative binomial regression was used to compare the length of stay (LOS) before vs after STEP enrollment. STEP admission was associated with a significant 90 % reduction in the frequency and duration of hospitalizations. This effect was moderated by DUP: with 30-day prolongations in components of DUP (supply, demand, and total) there was less reduction in hospitalizations and LOS after FES enrollment (p < .0001). Only DUP supply (time from first antipsychotic use to STEP admission) differentiated those who were hospitalized during the first year after STEP enrollment from those who were not (median: 35 vs. 15 weeks, p = .003). To fully harness the positive impact of FES on hospitalization, a detailed effort should be pursued to reduce all DUP components.
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Affiliation(s)
- Maria Ferrara
- Yale University School of Medicine, Department of Psychiatry, New Haven, CT, United States of America; University of Ferrara, Department of Neuroscience and Rehabilitation, Ferrara, Italy.
| | - Sinan Guloksuz
- Yale University School of Medicine, Department of Psychiatry, New Haven, CT, United States of America; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Hadar Hazan
- Yale University School of Medicine, Department of Psychiatry, New Haven, CT, United States of America
| | - Fangyong Li
- Yale Center for Analytical Sciences (YCAS), Yale School of Public Health, New Haven, CT, United States of America
| | - Cenk Tek
- Yale University School of Medicine, Department of Psychiatry, New Haven, CT, United States of America
| | - Laura Yoviene Sykes
- Yale University School of Medicine, Department of Psychiatry, New Haven, CT, United States of America
| | - Sarah Riley
- Yale University School of Medicine, Department of Psychiatry, New Haven, CT, United States of America
| | - Matcheri Keshavan
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States of America
| | - Vinod H Srihari
- Yale University School of Medicine, Department of Psychiatry, New Haven, CT, United States of America
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Abu Ershaid JM, Vora LK, Volpe-Zanutto F, Sabri AH, Peng K, Anjani QK, McKenna PE, Ripolin A, Larrañeta E, McCarthy HO, Donnelly RF. Microneedle array patches for sustained delivery of fluphenazine: A micron scale approach for the management of schizophrenia. BIOMATERIALS ADVANCES 2023; 153:213526. [PMID: 37348183 DOI: 10.1016/j.bioadv.2023.213526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/06/2023] [Accepted: 06/13/2023] [Indexed: 06/24/2023]
Abstract
Schizophrenia is a severe chronic mental illness characterised by impaired emotional and cognitive functioning. To treat this condition, antipsychotics are available in limited dosage forms, mainly oral and injectable formulations. Although injectable antipsychotics were designed to enhance adherence, they are invasive, painful and require a healthcare professional to be administered. To overcome such administration issues, extensive research has been focused on developing transdermal antipsychotic formulations. In this work, three microneedle (MN) systems were developed to deliver fluphenazine (FLU) systemically. A decanoic prodrug of FLU called fluphenazine decanoate (FLUD) was used in two of the MN formulations due to its high lipophilicity. FLU-D was loaded into dissolving MNs and nanoemulsion (NE)-loaded MNs. The parent drug FLU was loaded into poly(lactic-co-glycolic acid) (PLGA)-tipped MNs. All MN systems were characterised and evaluated in vitro and in vivo. The in vivo evaluation of the three developed MN systems showed their ability to deliver FLU into the systemic circulation, as the Cmax of FLU-D dissolving MNs was 36.11 ± 12.37 ng/ml. However, the Cmax of FLU-D NE loaded dissolving MNs was 12.92 ± 6.3 ng/ml and for FLU-PLGA tipped MNs was 21.57 ± 2.45 ng/ml. Compared to an intramuscular (IM) injection of FLU-D in sesame oil, the relative bioavailabilities were 26.96 %, 21.73 % and 42.45 % for FLU-D dissolving MNs, FLU-D NE dissolving MNs and FLU-PLGA tipped MNs, respectively. FLU plasma levels were maintained above the minimum human therapeutic limits for a week. Consequently, these various MN formulations are considered to be a viable options for the transdermal delivery of fluphenazine and its prodrug. The three MN systems developed offer patients a user-friendly, painless, and convenient long-acting delivery method for FLU. Reducing dosing frequency and using less invasive drug administration methods can enhance adherence and foster positive therapeutic outcomes. This study demonstrates the capability and adaptability of MNs technology to transport hydrophobic molecules from the skin to the systemic circulation.
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Affiliation(s)
- Juhaina M Abu Ershaid
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK; School of Pharmacy, Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Isra University, Amman 11622, Jordan
| | - Lalitkumar K Vora
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Fabiana Volpe-Zanutto
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK; Faculty of Pharmaceutical Sciences, R. Cândido Portinari, 200 - Cidade Universitária, Campinas, SP 13083-871, University of Campinas, Brazil
| | - Akmal H Sabri
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Ke Peng
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Qonita K Anjani
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Peter E McKenna
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Anastasia Ripolin
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Eneko Larrañeta
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Helen O McCarthy
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Ryan F Donnelly
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK.
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7
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Kasahara-Kiritani M, Saga Y, Wakamatsu A, Wu DBC, Tsai IC. Clinical benefit of second-generation long-acting injectable antipsychotics in preventing re-hospitalization in patients with schizophrenia: A real-world study in Japan. Asian J Psychiatr 2023; 86:103671. [PMID: 37311333 DOI: 10.1016/j.ajp.2023.103671] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/02/2023] [Accepted: 06/06/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND Real-world evidence on the benefits of long-acting injectable (LAI) antipsychotics (AP) in patients with schizophrenia is limited, especially in the employed population in Japan. This study evaluates the effectiveness of LAI AP in preventing re-hospitalization in patients with schizophrenia, including the employed population. METHODS This retrospective, observational, population-based study used the Japan Medical Data Center (JMDC) health insurance claims database to identify patients having schizophrenia before or on the day of the first LAI AP prescription (index date), and receiving LAI AP between April 1, 2012 and December 31, 2019. The number of all-cause, psychiatric-, and schizophrenia-related hospitalizations at baseline (365 days before index date) and during the 1-year follow-up period were evaluated. RESULTS Of the 1692 patients who received LAI AP during the study period, 146 were included (employed: 55 [37.7 %]; dependent: 91 [62.3 %]). The mean age was 37 years; 50.7 % (n = 74) were females. During baseline period, 61 (41.8 %) patients were not hospitalized. During the follow-up period, 67 (45.9 %) patients underwent hospitalization ≤ 7 days; all-cause: 100 (68.7 %); psychiatry-related: 104 (76.2 %); schizophrenia-related: 114 (78.1 %). A higher proportion of patients were hospitalization-free during the follow-up in the employed vs. dependent population: all cause: 69.1 % vs. 61.5 %; psychiatric-related 76.4 % vs. 67.0 %, schizophrenia-related: 87.3 % vs. 71.4 %. CONCLUSION This study demonstrated the effectiveness of LAI AP in preventing hospitalization in Japan. During the follow-up period, patients with schizophrenia receiving LAI AP, including the employed population, had a significant decrease in hospitalization length and re-hospitalization rate compared to baseline.
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Affiliation(s)
- Mami Kasahara-Kiritani
- Integrated Market Access Division, Janssen Pharmaceutical K.K., Chiyoda-ku, Tokyo, Japan.
| | - Yosuke Saga
- Medical Affairs, Janssen Pharmaceutical K.K., Chiyoda-ku, Tokyo, Japan
| | - Akihide Wakamatsu
- Medical Affairs, Janssen Pharmaceutical K.K., Chiyoda-ku, Tokyo, Japan
| | - David Bin-Chia Wu
- Regional Market Access & Government Affairs (Asia Pacific), Janssen Pharmaceutical Companies of Johnson and Johnson, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore; School of Pharmacy, Monash University Malaysia, Malaysia
| | - I-Ching Tsai
- Integrated Market Access Division, Janssen Pharmaceutical K.K., Chiyoda-ku, Tokyo, Japan
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8
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Guo J, Lv X, Liu Y, Kong L, Qu H, Yue W. Influencing factors of medication adherence in schizophrenic patients: a meta-analysis. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:31. [PMID: 37188714 DOI: 10.1038/s41537-023-00356-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 04/13/2023] [Indexed: 05/17/2023]
Abstract
Medication adherence of schizophrenic patients is a growing public health problem. We conducted a meta-analysis on the influencing factors of medication compliance in schizophrenic patients. We searched PubMed, Embase, Cochrane Library, and Web Of Science for relevant articles published up to December 22, 2022. Combined odds ratios (ORs) and 95% confidence intervals (CIs) were used to assess influencing factors. Egger's test, funnel plot, the trim and fill method, and meta-regression analysis were used to assess publication bias. A total of 20 articles were included in the analysis. Twenty influencing factors were divided into seven categories: drug factors (OR = 1.96, 95% CI: 1.48-2.59), problem behavior (OR = 1.77, 95% CI: 1.43-2.19), income and quality of life (OR = 1.23, 95% CI: 1.08-1.39), personal characteristics (OR = 1.21, 95% CI: 1.14-1.30), disease factors (OR = 1.14, 95% CI: 1.98-1.21), support level (OR = 0.54, 95% CI: 0.42-0.70), and positive attitude and behavior (OR = 0.52, 95% CI: 0.45-0.62). This meta-analysis found that drug factors, disease factors, problem behavior, low income and quality of life, and factors related to personal characteristics appear to be risk factors for medication adherence in people with schizophrenia. And support level, positive attitude and behavior appear to be protective factors.
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Affiliation(s)
- Jing Guo
- Department of Psychology, Medical Humanities Research Center, Binzhou Medical University, Yantai, 264003, China
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, 100191, China
- National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China
- NHC Key Laboratory of Mental Health (Peking University), Beijing, 100191, China
| | - Xue Lv
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, 100191, China
- National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China
- NHC Key Laboratory of Mental Health (Peking University), Beijing, 100191, China
- The First Affiliated Hospital of Xinxiang Medical College, Xinxiang, Henan, 453100, China
| | - Yan Liu
- Department of Psychology, Medical Humanities Research Center, Binzhou Medical University, Yantai, 264003, China
| | - Lingling Kong
- Department of Psychology, Medical Humanities Research Center, Binzhou Medical University, Yantai, 264003, China
| | - Haiying Qu
- Department of Psychology, Medical Humanities Research Center, Binzhou Medical University, Yantai, 264003, China.
| | - Weihua Yue
- Department of Psychology, Medical Humanities Research Center, Binzhou Medical University, Yantai, 264003, China.
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, 100191, China.
- National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China.
- NHC Key Laboratory of Mental Health (Peking University), Beijing, 100191, China.
- The First Affiliated Hospital of Xinxiang Medical College, Xinxiang, Henan, 453100, China.
- PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, 100871, China.
- Chinese Institute for Brain Research, Beijing, 102206, China.
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9
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Robinson DG, Suett M, Wilhelm A, Chaijale N, Franzenburg KR, Gandhi S, Cloud B, Mychaskiw M. Patient and Healthcare Professional Preferences for Characteristics of Long-Acting Injectable Antipsychotic Agents for the Treatment of Schizophrenia. Adv Ther 2023; 40:2249-2264. [PMID: 36905498 PMCID: PMC10129959 DOI: 10.1007/s12325-023-02455-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/08/2023] [Indexed: 03/12/2023]
Abstract
INTRODUCTION Studies evaluating patient and healthcare professional (HCP) preferences regarding long-acting injectable (LAI) antipsychotic agent attributes are lacking. METHODS Surveys were administered to physicians, nurses, and patients who had at least two experiences with TV-46000, an investigational subcutaneous LAI antipsychotic agent for the treatment of schizophrenia, as part of the SHINE study (NCT03893825). Survey topics included preferences for route of administration, potential LAI dosing intervals (once-weekly, twice a month, once a month [q1m], every 2 months [q2m]), injection location, ease of use, syringe type, needle length, and need for reconstitution. RESULTS Patients (n = 63) had a mean (SD) age of 35.6 (9.6) years, age at diagnosis of 18 (10) years, and were mostly male (75%). There were 49 HCPs: 24 physicians and 25 nurses. Patients rated "a short needle" (68%), a "choice of [q1m or q2m] dosing interval" (59%), and "injection instead of oral tablet" (59%) as the most important features. HCPs rated "single injection to initiate treatment" (61%), "flexible dosing interval" (84%), and "injection instead of oral tablet" (59%) as the most important features. Subcutaneous injections were rated "easy to [receive/administer]" by 62% of patients and 84% of HCPs. When choosing between subcutaneous injections and intramuscular injections, 65% of HCPs preferred subcutaneous injections and 57% of patients preferred intramuscular injections. It was important to most HCPs to have four dose strength options (78%), a prefilled syringe (96%), and no need for reconstitution (90%). CONCLUSIONS Patients had a range of responses, and on some issues patient and HCP preferences differed. Altogether, this suggests the importance of providing patients with a range of options and the importance of patient-HCP discussions on treatment preference for LAIs.
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Affiliation(s)
- Delbert G Robinson
- Departments of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA.
- Research Department, The Zucker Hillside Hospital, 75-59 263rd Street, Glen Oaks, NY, 11004, USA.
| | - Mark Suett
- Global Medical Affairs, Teva UK Limited, Harlow, UK
| | - Amanda Wilhelm
- North America Medical Affairs, Teva Branded Pharmaceutical Products R&D, Inc., Parsippany, NJ, USA
| | - Nayla Chaijale
- Global Medical Affairs, Teva Branded Pharmaceutical Products R&D, Inc., West Chester, PA, USA
| | - Kelli R Franzenburg
- Global Medical Affairs, Teva Branded Pharmaceutical Products R&D, Inc., West Chester, PA, USA
| | - Sanjay Gandhi
- Global Health Economics and Outcomes Research, Teva Branded Pharmaceutical Products R&D, Inc., West Chester, PA, USA
| | | | - Marko Mychaskiw
- Global Health Economics and Outcomes Research, Teva Branded Pharmaceutical Products R&D, Inc., West Chester, PA, USA
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10
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Simón JA, Utomo E, Pareja F, Collantes M, Quincoces G, Otero A, Ecay M, Domínguez-Robles J, Larrañeta E, Peñuelas I. Radiolabeled Risperidone microSPECT/CT Imaging for Intranasal Implant Studies Development. Pharmaceutics 2023; 15:pharmaceutics15030843. [PMID: 36986704 PMCID: PMC10054269 DOI: 10.3390/pharmaceutics15030843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/02/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
The use of intranasal implantable drug delivery systems has many potential advantages for the treatment of different diseases, as they can provide sustained drug delivery, improving patient compliance. We describe a novel proof-of-concept methodological study using intranasal implants with radiolabeled risperidone (RISP) as a model molecule. This novel approach could provide very valuable data for the design and optimization of intranasal implants for sustained drug delivery. RISP was radiolabeled with 125I by solid supported direct halogen electrophilic substitution and added to a poly(lactide-co-glycolide) (PLGA; 75/25 D,L-Lactide/glycolide ratio) solution that was casted on top of 3D-printed silicone molds adapted for intranasal administration to laboratory animals. Implants were intranasally administered to rats, and radiolabeled RISP release followed for 4 weeks by in vivo non-invasive quantitative microSPECT/CT imaging. Percentage release data were compared with in vitro ones using radiolabeled implants containing either 125I-RISP or [125I]INa and also by HPLC measurement of drug release. Implants remained in the nasal cavity for up to a month and were slowly and steadily dissolved. All methods showed a fast release of the lipophilic drug in the first days with a steadier increase to reach a plateau after approximately 5 days. The release of [125I]I− took place at a much slower rate. We herein demonstrate the feasibility of this experimental approach to obtain high-resolution, non-invasive quantitative images of the release of the radiolabeled drug, providing valuable information for improved pharmaceutical development of intranasal implants.
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Affiliation(s)
- Jon Ander Simón
- Radiopharmacy Unit, Department of Nuclear Medicine, Clinica Universidad de Navarra, University of Navarra, IdiSNA, 31008 Pamplona, Spain
| | - Emilia Utomo
- School of Pharmacy, Queen’s University Belfast, Lisburn Road 97, Belfast BT9 7BL, UK
| | - Félix Pareja
- Radiopharmacy Unit, Department of Nuclear Medicine, Clinica Universidad de Navarra, University of Navarra, IdiSNA, 31008 Pamplona, Spain
| | - María Collantes
- Translational Molecular Imaging Unit (UNIMTRA), Department of Nuclear Medicine, Clinica Universidad de Navarra, 31008 Pamplona, Spain
- Correspondence: (M.C.); (E.L.)
| | - Gemma Quincoces
- Radiopharmacy Unit, Department of Nuclear Medicine, Clinica Universidad de Navarra, University of Navarra, IdiSNA, 31008 Pamplona, Spain
| | - Aarón Otero
- Translational Molecular Imaging Unit (UNIMTRA), Department of Nuclear Medicine, Clinica Universidad de Navarra, 31008 Pamplona, Spain
| | - Margarita Ecay
- Translational Molecular Imaging Unit (UNIMTRA), Department of Nuclear Medicine, Clinica Universidad de Navarra, 31008 Pamplona, Spain
| | - Juan Domínguez-Robles
- School of Pharmacy, Queen’s University Belfast, Lisburn Road 97, Belfast BT9 7BL, UK
- Department of Pharmacy and Pharmaceutical Technology, University of Seville, 41012 Seville, Spain
| | - Eneko Larrañeta
- School of Pharmacy, Queen’s University Belfast, Lisburn Road 97, Belfast BT9 7BL, UK
- Correspondence: (M.C.); (E.L.)
| | - Iván Peñuelas
- Radiopharmacy Unit, Department of Nuclear Medicine, Clinica Universidad de Navarra, University of Navarra, IdiSNA, 31008 Pamplona, Spain
- Translational Molecular Imaging Unit (UNIMTRA), Department of Nuclear Medicine, Clinica Universidad de Navarra, 31008 Pamplona, Spain
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11
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Zabihi Poursaadati M, Maarefvand M, Bolhari J, Hosseinzadeh S, Songhori N, Derakhshan L, Khubchandani J. Caregivers' experiences and perspectives of factors associated with relapse in Iranian people living with schizophrenia: A qualitative study. Int J Soc Psychiatry 2023; 69:86-100. [PMID: 34971526 DOI: 10.1177/00207640211068977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Relapse in People Living with Schizophrenia (PLS) has several reasons and recognizing these can increase the effectiveness of treatment interventions. Formal and informal caregivers are an informed source to reduce relapse in PLS. AIM This study explores the caregivers' perspective in Iran on the factors affecting relapse in PLS. METHOD A total of 28 caregivers (16 formal caregivers and 12 informal caregivers) of PLS were enrolled in our qualitative study. A content analysis was conducted using individual and group, semi-structured in-depth interviews with informal and formal caregivers of PLS. This study was conducted in a hospital, three universities, and a non-governmental organization in Tehran, Iran. RESULTS The majority (69%) of the participants were females. About half of the informal caregivers were over 60 years old and about 40% of the formal caregivers were in the age range of 30 to 40 years. The average number of years of work for informal caregivers was 17.6 years and the average of work experience among the formal caregivers was 14.1 years. Seven key dual themes were identified from data: 'awareness-stigma', 'social support-social exclusion', 'treatment adherence-treatment discontinuation', 'holistic approach - one-dimensional approach', 'supported employment-social dysfunction', 'emotional management in family - family with high emotional expression', and 'access to treatment-treatment gap'. CONCLUSION The results of this research can help practitioners and policymakers to enable evidence-based practices to reduce relapse in PLS by emphasizing and acting on factors identified in our analyses.
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Affiliation(s)
| | - Masoomeh Maarefvand
- Department of Social Work, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Jafar Bolhari
- Spiritual Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Samaneh Hosseinzadeh
- Biostatistics department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Nahid Songhori
- Department of Social Work, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Leili Derakhshan
- Department of Social Work, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Jagdish Khubchandani
- Department of Public Health Sciences, New Mexico University, Las Cruces, NM, USA
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12
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Nooraeen S, Bazargan-Hejazi S, Naserbakht M, Vahidi C, Shojaerad F, Mousavi SS, Malakouti SK. Impact of COVID-19 pandemic on relapse of individuals with severe mental illness and their caregiver's burden. Front Public Health 2023; 11:1086905. [PMID: 36817882 PMCID: PMC9929280 DOI: 10.3389/fpubh.2023.1086905] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 01/05/2023] [Indexed: 02/05/2023] Open
Abstract
Background The implementation of quarantine and social distancing measures to control the COVID-19 pandemic led to restrictions at the community level and most of in-person psychiatric services were discontinued. This situation could affect the psychopathology of the patients and the burden of their caregivers. The aim of this study was to investigate the effects of COVID-19 pandemic on people with severe mental illnesses (SMIs) and their caregivers' burden. Method The study sample consisted of 86 patients with severe mental illness and 86 caregivers. The mental status, relapse rate, and rehospitalization rate of the patients and the general health status and burden of caregivers were investigated in three waves, including before and 3 and 6 months after the COVID-19 pandemic. Results The relapse rate of the patients was 14%, 33.7%, and 43% (p = 0.000) and the rehospitalization rate was 4.7%, 7%, and 10.5% in waves 0, 1, and 2, respectively (p = 0.000). Most of the psychopathological scales increased in three waves (p = 0.000). The caregivers' burden and health condition worsened during the nine months of the study as well (p = 0.000). Conclusion The COVID-19 pandemic led to the exacerbation of symptoms and increased the relapse rate in people with SMIs. It also worsened the caregivers' condition. People with severe mental illnesses (SMIs) and their caregivers are one of the most vulnerable groups on which the COVID-19 pandemic had a marked negative effect.
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Affiliation(s)
- Sara Nooraeen
- Mental Health Research Center, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
| | - Shahrzad Bazargan-Hejazi
- Department of Psychiatry, Charles R. Drew University of Medicine and Science, Los Angeles, CA, United States
| | - Morteza Naserbakht
- Mental Health Research Center, Psychosocial Health Research Institute, Tehran, Iran
| | - Camelia Vahidi
- Andisheh-Salamat-Ravan Mental Rehabilitation Center, Tehran, Iran
| | | | | | - Seyed Kazem Malakouti
- Mental Health Research Center, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran,*Correspondence: Seyed Kazem Malakouti ✉
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13
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Kotzeva A, Mittal D, Desai S, Judge D, Samanta K. Socioeconomic burden of schizophrenia: a targeted literature review of types of costs and associated drivers across 10 countries. J Med Econ 2023; 26:70-83. [PMID: 36503357 DOI: 10.1080/13696998.2022.2157596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIMS Schizophrenia has the highest median societal cost per patient of all mental disorders. This review summarizes the different costs/cost drivers (cost components) associated with schizophrenia in 10 countries, including all cost types and stakeholder perspectives, and highlights aspects of disease associated with greatest costs. MATERIALS AND METHODS Targeted literature review based on a search of published research from 2006 to 2021 in the United States (US), United Kingdom (UK), France, Germany, Italy, Spain, Canada, Japan, Brazil, and China. RESULTS Sixty-four published articles (primary studies and literature reviews) were included. Comprehensive data were available on costs in schizophrenia overall, with very limited data for individual countries except the US. Most data is related to direct and not indirect costs, with extremely scarce data for several key cost components (adverse events, suicide, long-term care). Total schizophrenia-related per person per year (PPPY) costs were $2,004-94,229, with considerable variability among countries. Indirect costs were the main cost driver (50-90% of all costs), ranging from $1,852 to $62,431 PPPY. However, indirect costs are not collected systematically or incorporated in health technology assessments. Total schizophrenia-related PPPY direct costs were $4,394-31,798, with inpatient cost as the main cost driver (∼20-99% of direct costs). Intangible costs were not reported. Despite limited evidence, total schizophrenia-related costs were higher in patients with than without negative symptoms, largely due to increased costs of medication and medical visits. LIMITATIONS As this was not a systematic review, prioritization of studies may have resulted in exclusion of potentially relevant data. All costs were converted to USD but not corrected for inflation or subjected to a gross domestic product deflator. CONCLUSIONS Direct costs are most commonly reported in schizophrenia. The substantial underreporting of indirect and intangible costs undervalues the true economic burden of schizophrenia from a payer, patient, and societal perspective.
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14
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Riera-Molist N, Riera-Morera B, Roura-Poch P, Santos-López JM, Foguet-Boreu Q. A Brief Psychoeducation Intervention to Prevent Rehospitalization in Severe Mental Disorder Inpatients. J Nerv Ment Dis 2023; 211:40-45. [PMID: 35944269 DOI: 10.1097/nmd.0000000000001567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
ABSTRACT The efficacy of medium- to long-term psychoeducation in preventing relapse and hospitalization in people with severe mental disorders (SMDs) is robust. However, the evidence is inconclusive in brief interventions and individual modalities. The aim of this randomized clinical trial in SMD inpatients is to analyze the efficacy of a brief psychoeducation intervention added to treatment-as-usual, in improving the rehospitalization rate at 3 and 6 months after discharge. Fifty-one SMD inpatients were randomized to the intervention ( n = 24) or control group ( n = 27). Low insight and poor medication adherence were the most prevalent risk factors at admission. No significant differences were observed in the rehospitalization rate at 3 and 6 months after discharge. On the overall sample, the number of previous hospitalizations was a rehospitalization predictor at 3 (odds ratio [OR], 1.25; 95% confidence interval [CI], 1.01-1.56; p = 0.04) and 6 months (OR, 1.85; 95% CI, 1.17-2.91; p = 0.009). SMD people require multimodal and persistent approaches focused on insight and medication adherence to prevent rehospitalizations.
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15
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Sun Y, Tong J, Feng Y, Fang H, Jiang T, Zhao L, Wang Q, Yang Y. Attitude and influencing factors of patients with schizophrenia toward long-acting injections: A community-based cross-sectional investigation in China. Front Public Health 2022; 10:951544. [PMID: 36299738 PMCID: PMC9589343 DOI: 10.3389/fpubh.2022.951544] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 09/22/2022] [Indexed: 01/24/2023] Open
Abstract
Background Low prescription rates of antipsychotic long-acting injections (LAIs) may be a major challenge in the prevention and treatment of schizophrenia. However, there are few studies on the usage and attitude toward LAIs among community-based patients with schizophrenia. Methods A large community-based cross-sectional investigation was conducted among 6,336 patients with schizophrenia from Shanghai, China from March 1 to June 30, 2021. The structured Attitude and Status toward Treatment of Community Patients with Schizophrenia Questionnaire (AST-CSQ) was used to investigate the attitude and influencing factors of community-dwelling patients with schizophrenia toward LAIs. Results Among the 6,336 participants, the average age was 49.28 ± 11.23. The rate of agreement to LAI antipsychotics among participants was 3.16% (n = 200). The family financial resources, care ability, and disease course of the LAIs group were less than those of the non-LAIs group. However, the LAIs group had higher immediate family guardianship, social activity, previous hospitalization, number of hospitalization, outpatient adherence, previous antipsychotic use, antipsychotic adherence, and attitude toward oral antipsychotics than the non-LAIs group, with significant differences between the two groups (p < 0.05). Furthermore, age (β = -0.036, OR 0.964, 95% CI 0.947-0.982), marital status (β = 0.237, OR 1.267, 95% CI 1.002-1.602), care ability (β = 0.709, OR 2.032, 95% CI 1.437-2.875), outpatient adherence (β = -0.674, OR 0.510, 95% CI 0.358-0.725), antipsychotic adherence (β = 0.920, OR 2.509, 95% CI 1.092-5.764), and attitude toward oral antipsychotics (β = -1.357, OR 0.258, 95% CI 0.103-0.646) were significant predictors of attitude toward LAI antipsychotics (p < 0.05). Conclusions The community-dwelling patients with schizophrenia in China had a low willingness to use LAIs. Patients of a younger age, more hospitalizations, and a shorter course of disease were prone to be more willing to accept LAIs. The patients' age, marital status, care ability, outpatient adherence, antipsychotic adherence, and attitude toward oral antipsychotics were important predictor of patients' attitudes toward LAIs. Under the global deinstitutionalized management model of mental disorders, these results highlight an urgent problems for public mental health service providers and policy-makers and provide more solutions for them.
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Affiliation(s)
- Yiying Sun
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China,Mental Health Subcentre of Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, China
| | - Jie Tong
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China
| | - Ying Feng
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China,Mental Health Subcentre of Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, China
| | - Haiping Fang
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China,Mental Health Subcentre of Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, China
| | - Tao Jiang
- Shanghai Yangjing Community Health Service Center, Shanghai, China
| | - Liping Zhao
- Shanghai Sanlin Community Health Service Center, Shanghai, China
| | - Qiang Wang
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China,Mental Health Subcentre of Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, China,Qiang Wang
| | - Yi Yang
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China,Mental Health Subcentre of Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, China,*Correspondence: Yi Yang
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Zabihi Poursaadati M, Maarefvand M, Bolhari J, Hosseinzadeh S, Khubchandani J. The design and process of a family and community-based intervention for relapse prevention in people living with schizophrenia in Iran. Int J Soc Psychiatry 2022; 69:587-601. [PMID: 36200283 DOI: 10.1177/00207640221124438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND People living with schizophrenia (PLS) suffer frequent relapse accompanied by emergency room visits, premature mortality, lower quality of life and a substantial social and economic burden on families and health systems. There is a dearth of community-based relapse prevention interventions (RPIs) in Iran. AIMS To determine an ideal model for a community-based RPIs for PLS. METHODS A qualitative study with 27 experts in Iran was carried out to understand the ideal RPIs for PLS and the key components of such interventions. RESULTS In 16 semi-structured interviews and 8 group-discussions, the participants identified six major stages of family and community-based RPIs including preparation, social mobilization, local team formation, design an RPI, implementing the RPI, participatory monitoring, and evaluation of the RPI. CONCLUSIONS Given the suboptimal healthcare systems and lack of professionals and services, PLS in Iran may benefit from family and community-based RPIs. Our findings warrant pilot testing of such initiatives across developing communities like Iran to improve health outcomes of PLS.
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Affiliation(s)
| | - Masoomeh Maarefvand
- Department of Social Work, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Jafar Bolhari
- Spiritual Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Samaneh Hosseinzadeh
- Biostatistics Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Jagdish Khubchandani
- Department of Public Health Sciences, New Mexico University, Las Cruces, NM, USA
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Cai H, Zeng C, Zhang X, Liu Y, Wu R, Guo W, Wang J, Wu H, Tang H, Ge X, Yu Y, Zhang S, Cao T, Li N, Liang X, Yang P, Zhang B. Diminished treatment response in relapsed versus first-episode schizophrenia as revealed by a panel of blood-based biomarkers: A combined cross-sectional and longitudinal study. Psychiatry Res 2022; 316:114762. [PMID: 35940088 DOI: 10.1016/j.psychres.2022.114762] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/31/2022] [Accepted: 08/02/2022] [Indexed: 12/19/2022]
Abstract
There is a paucity of biomarkers for the prediction of treatment response in schizophrenia. In this study, we aimed to investigate whether diminished antipsychotic treatment response in relapsed versus first-episode schizophrenia can be revealed and predicted by a panel of blood-based biomarkers. A cross-sectional cohort consisting of 655 schizophrenia patients at different episodes and 606 healthy controls, and a longitudinal cohort including 52 first-episode antipsychotic-naïve schizophrenia patients treated with the same antipsychotic drugs during the 5-year follow-up of their first three episodes were enrolled. Plasma biomarker changes and symptom improvement were compared between the drug-free phase of psychosis onset and after 4 weeks of atypical antipsychotic drug (AAPD) treatment. In response to treatment, the extent of changes in the biomarkers of bioenergetic, purinergic, phospholipid and neurosteroid metabolisms dwindled down as number of episode and illness duration increased in relapsed schizophrenia. The changes of creatine, inosine, progesterone, allopregnanolone, cortisol and PE(16:0/22:6) were significantly correlated with the improvement of symptomatology. Inosine and progesterone at baseline were shown to be strong predictive biomarkers of treatment response. The results suggest that AAPD treatment response is diminished in the context of relapse, and our findings open new avenues for understanding the pathophysiology of treatment-resistance schizophrenia.
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Affiliation(s)
- Hualin Cai
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Institute of Clinical Pharmacy, Central South University, 139# Renmin Road, Changsha, Hunan 410011, China; Institute of Clinical Pharmacy, Central South University, Changsha, China; International Research Center for Precision Medicine, Transformative Technology and Software Services, Hunan, China.
| | - Cuirong Zeng
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Institute of Clinical Pharmacy, Central South University, 139# Renmin Road, Changsha, Hunan 410011, China; Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Bejing, China; Department of Psychology, University of Chinese Academy of Sciences, Bejing, China
| | - Yong Liu
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China; National Clinical Research Center on Mental Disorders, Changsha, China
| | - Renrong Wu
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China; National Clinical Research Center on Mental Disorders, Changsha, China
| | - Wenbin Guo
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China; National Clinical Research Center on Mental Disorders, Changsha, China
| | - Jianjian Wang
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China; National Clinical Research Center on Mental Disorders, Changsha, China
| | - Haishan Wu
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China; National Clinical Research Center on Mental Disorders, Changsha, China
| | - Hui Tang
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China; National Clinical Research Center on Mental Disorders, Changsha, China
| | - Xiaoping Ge
- Department of Psychiatry, Changsha Psychiatric Hospital, Changsha, China
| | - Yan Yu
- Department of Psychiatry, Changsha Psychiatric Hospital, Changsha, China
| | - Shuangyang Zhang
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Institute of Clinical Pharmacy, Central South University, 139# Renmin Road, Changsha, Hunan 410011, China; Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Ting Cao
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Institute of Clinical Pharmacy, Central South University, 139# Renmin Road, Changsha, Hunan 410011, China; Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Nana Li
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Institute of Clinical Pharmacy, Central South University, 139# Renmin Road, Changsha, Hunan 410011, China; Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Xiaoli Liang
- Department of Psychiatry, Hunan Brain Hospital, 427# Furong Road, Changsha, Hunan 410000, China
| | - Ping Yang
- Department of Psychiatry, Hunan Brain Hospital, 427# Furong Road, Changsha, Hunan 410000, China.
| | - Bikui Zhang
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Institute of Clinical Pharmacy, Central South University, 139# Renmin Road, Changsha, Hunan 410011, China; Institute of Clinical Pharmacy, Central South University, Changsha, China; International Research Center for Precision Medicine, Transformative Technology and Software Services, Hunan, China.
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Alphs L, Baker P, Brown B, Fu DJ, Turkoz I, Nuechterlein KH. Evaluation of major treatment failure in patients with recent-onset schizophrenia or schizophreniform disorder: A post hoc analysis from the Disease Recovery Evaluation and Modification (DREaM) study. Schizophr Res 2022; 248:58-63. [PMID: 35939921 DOI: 10.1016/j.schres.2022.07.015] [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: 02/25/2022] [Revised: 06/24/2022] [Accepted: 07/24/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE A post hoc analysis of the Disease Recovery Evaluation and Modification (DREaM) study was conducted to evaluate time to first major treatment failure (ie, arrest/incarceration or psychiatric hospitalization) in participants with recent-onset schizophrenia or schizophreniform disorder treated with paliperidone palmitate (PP) versus oral antipsychotics (OAPs). METHODS DREaM was an open-label, delayed-start, randomized, multipart trial consisting of: Part I, 2-month oral run-in; Part II, 9-month disease progression phase (PP or OAP); and Part III, 9 months of additional treatment (PP/PP; OAP re-randomized: OAP/OAP or OAP/PP). PP/PP and OAP/OAP comprised the 18-month extended disease progression (EDP) analysis. RESULTS In Part II (PP, n = 78; OAP, n = 157), similar proportions of participants experienced a major treatment failure across groups (PP: 12.8 %; OAP: 13.4 %); no difference in time to first major treatment failure was identified (P = 0.918). Significant differences favoring PP emerged after 9 months; in Part III, no participants in the PP/PP group, 3.5 % of participants in the OAP/PP group, and 15.9 % in the OAP/OAP group experienced a major treatment failure (P = 0.002). In the EDP analysis, 10.2 % (PP/PP) and 25.4 % (OAP/OAP) of participants experienced a major treatment failure (P = 0.045; number needed to treat = 6). Safety results were similar between groups and consistent with the known safety profile of PP in adults with schizophrenia. CONCLUSIONS Initiation of PP during the early stages of schizophrenia spectrum disorders significantly delayed time to hospitalization and arrest/incarceration, outcomes with important personal and economic consequences, compared with OAP during this 18-month study. CLINICALTRIALS gov identifier: NCT02431702.
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Affiliation(s)
- Larry Alphs
- Janssen Scientific Affairs, LLC, 1125 Trenton-Harbourton Rd, Titusville, NJ 08560, USA
| | - Pamela Baker
- Janssen Scientific Affairs, LLC, 1125 Trenton-Harbourton Rd, Titusville, NJ 08560, USA.
| | - Brianne Brown
- Janssen Scientific Affairs, LLC, 1125 Trenton-Harbourton Rd, Titusville, NJ 08560, USA.
| | - Dong-Jing Fu
- Janssen Research and Development, LLC, 1125 Trenton-Harbourton Rd, Titusville, NJ 08560, USA.
| | - Ibrahim Turkoz
- Janssen Research and Development, LLC, 1125 Trenton-Harbourton Rd, Titusville, NJ 08560, USA.
| | - Keith H Nuechterlein
- Departments of Psychiatry and Psychology, University of California at Los Angeles, 300 Medical Plaza, Room 2240, Los Angeles, CA 90095, USA.
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Utomo E, Domínguez-Robles J, Moreno-Castellanos N, Stewart SA, Picco CJ, Anjani QK, Simón JA, Peñuelas I, Donnelly RF, Larrañeta E. Development of intranasal implantable devices for schizophrenia treatment. Int J Pharm 2022; 624:122061. [PMID: 35908633 DOI: 10.1016/j.ijpharm.2022.122061] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/19/2022] [Accepted: 07/26/2022] [Indexed: 12/23/2022]
Abstract
In this work the preparation and characterisation of intranasal implants for the delivery of risperidone (RIS) is described. The aim of this work is to develop better therapies to treat chronic conditions affecting the brain such as schizophrenia. This type of systems combines the advantages of intranasal drug delivery with sustained drug release. The resulting implants were prepared using biodegradable materials, including poly(caprolactone) (PCL) and poly(lactic-co-glycolic acid) (PLGA). These polymers were combined with water-soluble compounds, such as poly(ethylene glycol) (PEG) 600, PEG 3000, and Tween® 80 using a solvent-casting method. The resulting implants contained RIS loadings ranging between 25 and 50%. The obtained implants were characterised using a range of techniques including thermogravimetric analysis (TGA), differential scanning calorimetry (DSC), attenuated total reflectance-Fourier transform infrared (ATR-FTIR), X-ray diffraction (XRD), and Scanning Electron Microscopy (SEM). Moreover, in vitro RIS release was evaluated showing that the addition of water-soluble compounds exhibited significant faster release profiles compared to pristine PCL and PLGA-based implants. Interestingly, PCL-based implants containing 25% of RIS and PLGA-based implants loaded with 50% of RIS showed sustained drug release profiles up to 90 days. The former showed faster release rates over the first 28 days but after this period PLGA implants presented higher release rates. The permeability of RIS released from the implants through a model membrane simulating nasal mucosa was subsequently evaluated showing desirable permeation rate of around 2 mg/day. Finally, following in vitro biocompatibility studies, PCL and PLGA-based implants showed acceptable biocompatibility. These results suggested that the resulting implants displayed potential of providing prolonged drug release for brain-targeting drugs.
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Affiliation(s)
- Emilia Utomo
- School of Pharmacy, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Juan Domínguez-Robles
- School of Pharmacy, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Natalia Moreno-Castellanos
- CICTA, Department of Basic Sciences, Medicine School, Health Faculty, Universidad Industrial de Santander, Cra 27 calle 9, Bucaramanga 680002, Colombia
| | - Sarah A Stewart
- School of Pharmacy, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Camila J Picco
- School of Pharmacy, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Qonita Kurnia Anjani
- School of Pharmacy, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast BT9 7BL, UK; Fakultas Farmasi, Universitas Megarezky, Jl. Antang Raya, No. 43, Makassar 90234, Indonesia
| | - Jon Ander Simón
- Radiopharmacy Unit, Department of Nuclear Medicine, Clinica Universidad de Navarra, University of Navarra, IdiSNA, 31008 Pamplona, Spain
| | - Iván Peñuelas
- Radiopharmacy Unit, Department of Nuclear Medicine, Clinica Universidad de Navarra, University of Navarra, IdiSNA, 31008 Pamplona, Spain
| | - Ryan F Donnelly
- School of Pharmacy, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Eneko Larrañeta
- School of Pharmacy, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast BT9 7BL, UK.
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20
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Zukowska Z, Allan S, Eisner E, Ling L, Gumley A. Fear of relapse in schizophrenia: a mixed-methods systematic review. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1305-1318. [PMID: 35152309 PMCID: PMC9246982 DOI: 10.1007/s00127-022-02220-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 01/06/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Fears of relapse in people diagnosed with schizophrenia have long been recognised as an impediment to recovery and wellbeing. However, the extent of the empirical basis for the fear of relapse concept is unclear. A systematic review is required to collate available evidence and define future research directions. METHODS A pre-registered systematic search (PROSPERO CRD42020196964) of four databases (PubMED, MEDLINE-Ovid, PsycINFO-Ovid, and Cochrane Central Register of Controlled Trials) was conducted from their inception to 05/04/2021. RESULTS We found nine eligible studies. Five were quantitative (4 descriptive and 1 randomised controlled trial), and four were qualitative. The available quantitative evidence suggests that fear of relapse may have concurrent positive relationships with depression (r = 0.72) and suicide ideation (r = 0.48), and negative relationship with self-esteem (r = 0.67). Qualitative synthesis suggests that fear of relapse is a complex phenomenon with behavioural and emotional components which has both direct and indirect effects on wellbeing. CONCLUSIONS Evidence in this area is limited and research with explicit service user and carer involvement is urgently needed to develop new and/or refine existing measurement tools, and to measure wellbeing rather than psychopathology. Nonetheless, clinicians should be aware that fear of relapse exists and appears to be positively associated with depression and suicide ideation, and negatively associated with self-esteem. Fear of relapse can include fears of losing personal autonomy and/or social/occupational functioning. It appears to impact carers as well as those diagnosed with schizophrenia.
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Affiliation(s)
- Zofia Zukowska
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Stephanie Allan
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland.
| | - Emily Eisner
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Prestwich, UK
| | - Li Ling
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Andrew Gumley
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
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21
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Hodson N, Majid M, Vlaev I, Singh SP. Can incentives improve antipsychotic adherence in major mental illness? A mixed-methods systematic review. BMJ Open 2022; 12:e059526. [PMID: 35705342 PMCID: PMC9204416 DOI: 10.1136/bmjopen-2021-059526] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Incentives have been effectively used in several healthcare contexts. This systematic review aimed to ascertain whether incentives can improve antipsychotic adherence, what ethical and practical issues arise and whether existing evidence resolves these issues. DESIGN Systematic review of MEDLINE, EMBASE and PsycINFO. Searches on 13 January 2021 (no start date) found papers on incentives for antipsychotics. Randomised controlled trials (RCTs), cohort studies, qualitative research and ethical analyses were included. Papers measuring impact on adherence were synthesised, then a typology of ethical and policy issues was compiled, finally the empirical literature was compared with this typology to describe current evidence and identify remaining research questions. RESULTS 26 papers were included. 2 RCTs used contingent financial incentives for long-acting injectable antipsychotic preparations. Over 12 months, there were significantly larger increases in adherence among the intervention groups versus control groups in both RCTs. There were no consistently positive secondary outcomes. 39 ethical and practical issues were identified. 12 of these are amenable to empirical study but have not been researched and for 7 the current evidence is mixed. CONCLUSIONS In keeping with other areas of healthcare, antipsychotic adherence can be increased with financial incentives. Payments of 2.5 times minimum wage changed behaviour. The typology of issues reported in this systematic review provides a template for future policy and ethical analysis. The persistence of the effect and the impact of incentives on intrinsic motivation require further research. PROSPERO REGISTRATION NUMBER CRD42020222702.
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Affiliation(s)
- Nathan Hodson
- Mental Health and Wellbeing, Warwick Medical School, Coventry, UK
| | - Madiha Majid
- Mental Health and Wellbeing, Warwick Medical School, Coventry, UK
| | - Ivo Vlaev
- Warwick Business School, Coventry, UK
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22
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Chan SKW, Chan HYV, Liao Y, Suen YN, Hui CLM, Chang WC, Lee EHM, Chen EYH. Longitudinal relapse pattern of patients with first-episode schizophrenia-spectrum disorders and its predictors and outcomes: A 10-year follow-up study. Asian J Psychiatr 2022; 71:103087. [PMID: 35299139 DOI: 10.1016/j.ajp.2022.103087] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/19/2021] [Accepted: 03/09/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study explored the 10-year pattern of relapse of patients with first-episode schizophrenia-spectrum disorders (FES), predictors and outcomes of early and late relapse. METHODS Patients received EIS (N = 148) in Hong Kong between 1 July 2001 and 30 June 2002 were matched with those who entered standard care (N = 148) one year before. Relapse information over 10 years were obtained and 209 patients were interviewed at 10-year follow-up. Predictors of early relapse ([ER] relapse in initial three years) and late relapse group ([LR] relapse in year 4-10) and their differential outcomes were explored. RESULTS Fifty-six patients (26.8%) were relapse-free over 10 years with more EIS patients. Among the relapsed patients, 63.6% were ER patients who had the poorest longitudinal outcomes, including higher suicide attempts, violence episodes, more hospitalization and lower employment, whereas the LR patients do not differ much from the no relapse group. Relapse-free patients required less hospitalization in the first episode and lower antipsychotic dosage. The LR patients had less positive symptoms in year one but longer first-episode hospitalization and higher antipsychotic dosage. CONCLUSIONS Delaying the first relapse may help to improve the long-term outcomes. Good response to antipsychotic medications was associated with relapse-free over long-term. However, sufficient antipsychotic medications with good symptomatic control during the early stage of the illness is crucial for relapse prevention for other patients. These findings highlight illness heterogeneity and the importance in differential use of antipsychotics in relapse prevention.
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Affiliation(s)
- Sherry Kit Wa Chan
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong Special Administrative Region.
| | - Hei Yan Veronica Chan
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Yingqi Liao
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Yi Nam Suen
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Christy Lai Ming Hui
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Wing Chung Chang
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Edwin Ho Ming Lee
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Eric Yu Hai Chen
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong Special Administrative Region
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23
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Zhao M, Ma J, Li M, Zhu W, Zhou W, Shen L, Wu H, Zhang N, Wu S, Fu C, Li X, Yang K, Tang T, Shen R, He L, Huai C, Qin S. Different responses to risperidone treatment in Schizophrenia: a multicenter genome-wide association and whole exome sequencing joint study. Transl Psychiatry 2022; 12:173. [PMID: 35484098 PMCID: PMC9050705 DOI: 10.1038/s41398-022-01942-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 04/15/2022] [Accepted: 04/20/2022] [Indexed: 12/11/2022] Open
Abstract
Risperidone is routinely used in the clinical management of schizophrenia, but the treatment response is highly variable among different patients. The genetic underpinnings of the treatment response are not well understood. We performed a pharmacogenomic study of the treatment response to risperidone in patients with schizophrenia by using a SNP microarray -based genome-wide association study (GWAS) and whole exome sequencing (WES)-based GWAS. DNA samples were collected from 189 patients for the GWAS and from 222 patients for the WES after quality control in multiple centers of China. Antipsychotic response phenotypes of patients who received eight weeks of risperidone treatment were quantified with percentage change on the Positive and Negative Syndrome Scale (PANSS). The GWAS revealed a significant association between several SNPs and treatment response, such as three GRM7 SNPs (rs141134664, rs57521140, and rs73809055). Gene-based analysis in WES revealed 13 genes that were associated with antipsychotic response, such as GPR12 and MAP2K3. We did not identify shared loci or genes between GWAS and WES, but association signals tended to cluster into the GPCR gene family and GPCR signaling pathway, which may play an important role in the treatment response etiology. This study may provide a research paradigm for pharmacogenomic research, and these data provide a promising illustration of our potential to identify genetic variants underlying antipsychotic responses and may ultimately facilitate precision medicine in schizophrenia.
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Affiliation(s)
- Mingzhe Zhao
- grid.16821.3c0000 0004 0368 8293Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai Jiao Tong University, Shanghai, 200030 China ,grid.16821.3c0000 0004 0368 8293School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, 200240 China
| | - Jingsong Ma
- grid.494629.40000 0004 8008 9315School of Engineering, Westlake University, 18 Shilongshan Road, Hangzhou, 310024 Zhejiang Province China ,grid.494629.40000 0004 8008 9315Institute of Advanced Technology, Westlake Institute for Advanced Study, 18 Shilongshan Road, Hangzhou, 310024 Zhejiang Province China
| | - Mo Li
- grid.16821.3c0000 0004 0368 8293Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai Jiao Tong University, Shanghai, 200030 China ,grid.16821.3c0000 0004 0368 8293School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, 200240 China
| | - Wenli Zhu
- The Fourth People’s Hospital of Wuhu, No.1 East Wuxiashan Road, Wuhu, 241003 China
| | - Wei Zhou
- grid.16821.3c0000 0004 0368 8293Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai Jiao Tong University, Shanghai, 200030 China ,grid.16821.3c0000 0004 0368 8293School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, 200240 China
| | - Lu Shen
- grid.16821.3c0000 0004 0368 8293Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai Jiao Tong University, Shanghai, 200030 China ,grid.16821.3c0000 0004 0368 8293School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, 200240 China
| | - Hao Wu
- grid.16821.3c0000 0004 0368 8293Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai Jiao Tong University, Shanghai, 200030 China ,grid.16821.3c0000 0004 0368 8293School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, 200240 China
| | - Na Zhang
- grid.16821.3c0000 0004 0368 8293Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai Jiao Tong University, Shanghai, 200030 China ,grid.16821.3c0000 0004 0368 8293School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, 200240 China
| | - Shaochang Wu
- The Second People’s Hospital of Lishui, No.69 Beihua Road, Lishui, 323020 China
| | - Chunpeng Fu
- The Third People’s Hospital of Shangrao, No.1 Fenghuang East Avenue, Taokan Road, Shangrao, 334000 China
| | - Xianxi Li
- Shanghai Yangpu district mental health center, No.585 Jungong Road, Yangpu District, Shanghai, 900093 China
| | - Ke Yang
- grid.16821.3c0000 0004 0368 8293Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai Jiao Tong University, Shanghai, 200030 China ,grid.16821.3c0000 0004 0368 8293School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, 200240 China
| | - Tiancheng Tang
- grid.16821.3c0000 0004 0368 8293Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai Jiao Tong University, Shanghai, 200030 China ,grid.16821.3c0000 0004 0368 8293School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, 200240 China
| | - Ruoxi Shen
- grid.16821.3c0000 0004 0368 8293Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai Jiao Tong University, Shanghai, 200030 China ,grid.16821.3c0000 0004 0368 8293School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, 200240 China
| | - Lin He
- grid.16821.3c0000 0004 0368 8293Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai Jiao Tong University, Shanghai, 200030 China ,grid.16821.3c0000 0004 0368 8293School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, 200240 China
| | - Cong Huai
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai Jiao Tong University, Shanghai, 200030, China. .,School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, 200240, China.
| | - Shengying Qin
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai Jiao Tong University, Shanghai, 200030, China. .,School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, 200240, China.
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24
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Agid O, Remington G, Fung C, Nightingale NM, Duclos M, Anger GJ. Real-World Utilization Patterns of Long-Acting Injectable Antipsychotics in Canada: A Retrospective Study. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:226-234. [PMID: 34792401 PMCID: PMC8935594 DOI: 10.1177/07067437211055413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: The objective of this study was to analyze the real-world prevalence of long-acting injectable (LAI) antipsychotic use and determine when LAIs are being used in sequencing of antipsychotic medications among Canadian patients with schizophrenia. Methods: This was a retrospective, longitudinal cohort study using Canadian pharmacy prescription data between August 2005 and June 2017. Patients with inferred schizophrenia spectrum disorder were indexed on the date of their first antipsychotic prescription and analyzed for minimum 12 months to track lines of antipsychotic therapy and LAI utilization. Results: A total of 16,300 patients were identified for analysis. 48.2% and 46.0% of index antipsychotic prescriptions were prescribed by a general practitioner/family medicine doctor and psychiatrist, respectively. 1,062 (6.5%) patients used an LAI during the study period. Of those patients, 789 used an LAI within two years of index (74.3% of LAI users; 4.8% of all patients). The majority of LAI use (62.0%) occurred in the third line of therapy or later. 65.0% of patients had tried at least two therapy lines, and most patients reported gaps of six months to one year between treatment lines. Conclusion: Despite their potential to reduce relapse in schizophrenia by improving treatment adherence, this study shows LAIs continue to be under-utilized in Canada. When used, LAIs are positioned late in sequencing of antipsychotic medications, often not initiated until years after diagnosis. Continued preference for oral APs with poor adherence may be negatively impacting prognosis and exacerbating burden of schizophrenia. Efforts should be invested to understand barriers to LAI uptake and advocate for earlier, widespread use of LAIs.
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Affiliation(s)
- Ofer Agid
- Clinician Scientist and Psychiatrist, Centre for Addiction and Mental Health
| | - Gary Remington
- Clinician Scientist and Psychiatrist, Centre for Addiction and Mental Health
| | - Carmen Fung
- Manager of Data & Analytics Centre, 41697Janssen Inc
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25
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Family interventions for relapse prevention in schizophrenia: a systematic review and network meta-analysis. Lancet Psychiatry 2022; 9:211-221. [PMID: 35093198 DOI: 10.1016/s2215-0366(21)00437-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/22/2021] [Accepted: 10/26/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Family interventions are efficacious for relapse prevention in schizophrenia. Multiple different models have been developed. We aimed to compare the efficacy, acceptability, and tolerability of family interventions for relapse prevention in schizophrenia. METHODS In this systematic review and network meta-analysis, we searched for randomised controlled trials that investigated family intervention models aimed at preventing relapse in patients with schizophrenia. We searched EMBASE, MEDLINE, PsycINFO, BIOSIS, CENTRAL, ClinicalTrials.gov, and WHO International Clinical Trials Registry Platform up to Jan 20, 2020 and PubMed up to July 15, 2021. We included blinded and open-label randomised controlled trials in which at least 80% of patients had schizophrenia spectrum disorders. We excluded studies in which all patients were acutely ill, had a concurrent medical or psychiatric disorder, or were prodromal or "at risk of psychosis". Study selection and data extraction were done by two independent reviewers. Data were extracted about overall, positive, negative, and depressive symptoms of schizophrenia, quality of life, adherence, overall functioning, family burden, expressed emotion, and discontinuations due to inefficacy. The primary outcome was relapse, measured with operationalised criteria, psychiatric hospital admissions, or clinical judgement. We did a frequentist, random-effects, network meta-analysis to calculate odds ratios ([ORs]; dichotomous outcomes) or standardised mean differences (continuous outcomes) with 95% CIs. The study protocol was registered with PROSPERO, CRD42020169951. FINDINGS We identified 28 395 studies through the database search and 334 from references of previous studies. We compared 11 family intervention models tested on a total of 90 randomised controlled trials with 10 340 participants (3579 females and 5632 males with sex indicated; median age 31 years [range 14-65]) in the network meta-analysis. Ethnicity data were not available. All interventions, with the exception of crisis-oriented interventions and family psychoeducation with two sessions or fewer, reduced the relapse rate significantly when compared with treatment as usual at the primary timepoint of 12 months. ORs compared with treatment as usual ranged from 0·18 (95% CI 0·12-0·27) for family psychoeducation alone to 0·63 (0·42-0·94) for community-based interventions involving family members. The results were robust in various sensitivity and subgroup analyses. The confidence in the estimates ranged from moderate to very low for different comparisons. INTERPRETATION Almost all family intervention models were efficacious in preventing relapse in schizophrenia. Family psychoeducation alone, without behavioural or skills training, was superior to the more complex models. Our results suggest that in contexts where there are financial constraints, family psychoeducation alone should be implemented. FUNDING German Ministry for Education and Research.
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Olivares JM, Fagiolini A. Long-Term Real-World Effectiveness of Aripiprazole Once-Monthly. Treatment Persistence and Its Correlates in the Italian and Spanish Clinical Practice: A Pooled Analysis. Front Psychiatry 2022; 13:877867. [PMID: 35573364 PMCID: PMC9096029 DOI: 10.3389/fpsyt.2022.877867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/23/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND One of the most significant risk factors for relapse and hospitalization in schizophrenia is non-adherence to antipsychotic medications, very common in patients with schizophrenia. The aim of this analysis was to evaluate the treatment persistence to aripiprazole once-monthly (AOM) and the factors affecting it in the pooled population of two similar studies performed previously in two different European countries. METHODS Pooled analysis of two non-interventional, retrospective, patient record-based studies: DOMINO and PROSIGO. Both analyzed treatment persistence after starting AOM treatment in the real-world setting. The primary variable was persistence with AOM treatment during the first 6 months after treatment initiation. A multivariate Cox regression model was used to evaluate the influence of several baseline characteristics on the persistence. RESULTS The study population comprised 352 patients included in the two studies, DOMINO (n = 261) and PROSIGO (n = 91). The overall persistence with AOM treatment at the end of the 6-month observation period was 82.4%. The multivariate analysis showed that patients with "secondary school" level of education present a 67.4% lower risk of discontinuation within 6 months after AOM initiation when compared with "no/compulsory education patients" (p = 0.024). In addition, patients with an occupation present a 62.7% lower risk of discontinuation when compared with unemployed patients (p = 0.023). Regarding clinical history, patients with a Clinical Global Impression-Severity scale (CGI-S) score ≤3 present a 78.1% lower risk of discontinuation when compared with patients with a CGI-S score ≥6 (p = 0.044), while patients with a time since schizophrenia diagnosis ≤8.4 years present a 52.9% lower risk of discontinuation when compared with the rest of patients (p = 0.039). CONCLUSION The AOM persistence rate observed in this study was 82.4%, which was higher than that reported in clinical trials, aligned with other real-life studies and higher than reported for other long-acting injectable antipsychotics. The persistence rate was high in complex patients, although patients with higher level of education, active occupation, lower initial CGI-S score and shorter time since the diagnosis of schizophrenia appear to be more likely to remain persistent with AOM during the 6 months after initiation.
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Affiliation(s)
| | - Andrea Fagiolini
- School of Medicine, Department of Molecular Medicine, University of Siena, Siena, Italy
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Wang LY, Li MZ, Jiang XJ, Han Y, Liu J, Xiang TT, Zhu ZM. Mediating Effect of Self-Efficacy on the Relationship Between Perceived Social Support and Resilience in Patients with Recurrent Schizophrenia in China. Neuropsychiatr Dis Treat 2022; 18:1299-1308. [PMID: 35799800 PMCID: PMC9255992 DOI: 10.2147/ndt.s368695] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/28/2022] [Indexed: 01/14/2023] Open
Abstract
PURPOSE To explore the mediating effect of self-efficacy on the relationship between perceived social support and resilience in patients with recurrent schizophrenia in China. PATIENTS AND METHODS In this cross-sectional study, a total of 176 patients with recurrent schizophrenia who were hospitalized in a tertiary hospital in Hunan Province, China, completed a general data questionnaire, the Connor Davidson Resilience Scale (CD-RISC), the Perceived Social Support Scale (PSSS) and the General Self-Efficacy Energy Scale (GSES). RESULTS Among the 176 patients, the mean GSES score was 2.02±0.61, the mean PSSS score was 56.77±14.61, and the mean CD-RISC score was 58.06±17.26. Self-efficacy played a partial mediating role between social support and resilience, and the mediating effect accounted for 42.56% of the total effect. CONCLUSION The resilience level of patients with recurrent schizophrenia in China is moderate and needs to be improved. This research revealed that self-efficacy played a part in mediating perceived social support and resilience in patients with recurrent schizophrenia in China. Perceived social support can indirectly affect resilience in patients with recurrent schizophrenia through self-efficacy. Comprehensive interventions in perceived social support and self-efficacy would help to improve the resilience of patients with recurrent schizophrenia.
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Affiliation(s)
- Li-Yi Wang
- College of Nursing, Hunan University of Chinese Medicine, Changsha, Hunan, People's Republic of China
| | - Mei-Zhi Li
- Department of Nursing, Hunan Provincial Brain Hospital, Changsha, Hunan, People's Republic of China
| | - Xiao-Jian Jiang
- College of Nursing, Hunan University of Chinese Medicine, Changsha, Hunan, People's Republic of China
| | - Yang Han
- College of Civil Engineering, Central South University, Changsha, Hunan, People's Republic of China
| | - Juan Liu
- College of Basic Medicine, Ningxia Medical University, Yinchuang, Ningxia, People's Republic of China
| | - Ting-Ting Xiang
- College of Nursing, Hunan University of Chinese Medicine, Changsha, Hunan, People's Republic of China
| | - Zheng-Min Zhu
- College of Nursing, Hunan University of Chinese Medicine, Changsha, Hunan, People's Republic of China
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Wei Q, Ji Y, Gao H, Yi W, Pan R, Cheng J, He Y, Tang C, Liu X, Song S, Song J, Su H. Oxidative stress-mediated particulate matter affects the risk of relapse in schizophrenia patients: Air purification intervention-based panel study. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2022; 292:118348. [PMID: 34637828 DOI: 10.1016/j.envpol.2021.118348] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 10/07/2021] [Accepted: 10/08/2021] [Indexed: 06/13/2023]
Abstract
Particulate matter (PM) exposure increased the risk of hospital admission and was related to symptoms of schizophrenia (SCZ). However, there are limited studies on the relationship between PM exposure and SCZ relapse risk, and the underlying biological mechanisms remain unclear. We designed an air purification intervention study under a 16-day real air purifier scenario and another 16-day sham air purifier scenario, with a 2-day washout period. Twenty-four chronic stable male patients were recruited. The oxidative stress biomarkers were measured including serum catalase (CAT), superoxide dismutase (SOD), total antioxidant capacity (T-AOC), malondialdehyde (MDA), and nitric oxide (NO). The relapse risk was evaluated by the early signs scale (ESS). Linear mixed effect models were fitted to establish the associations between PM exposure and ESS and oxidative stress. Mediation model was performed to explore the mediation effect of oxidative stress on the PM-ESS association. Higher concentrations of PM2.5/PM10 exposure were associated with an elevated risk of relapse of SCZ. For each 10 μg/m3 in PM2.5 concentration, the scores of ESS and subscales of incipient psychosis (ESS-IP), depression/withdrawal (ESS-N), anxiety/agitation (ESS-A), and excitability/disinhibition (ESS-D) were increased by 4.112 (95% CI: 3.174, 5.050), 1.516 (95%CI: 1.178, 1.853), 1.143 (95%CI: 0.598, 1.689), 1.176 (95%CI: 0.727, 1.625) and 0.238 (95%CI: 0.013, 0.464), while logCAT, SOD and T-AOC were reduced by 0.039 U/ml (95% CI: 0.017, 0.060), 1.258 U/ml (95% CI: 0.541, 1.975), and 0.076 mmol/l (95% CI: 0.026, 0.126). In addition, pathways of "PM2.5→T-AOC→ESS-A″ and "PM2.5→T-AOC→ESS-D″ were found, with significant T-AOC mediated effects 15.70% (P = 0.02) and 52.99% (P = 0.04). Our findings suggest that PM may increase the risk of anxiety, depression, excitability, and incipient psychosis behaviors in SCZ patients, while reducing the function of the antioxidant system. The decrease of T-AOC may medicate the PM-ESS association in SCZ.
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Affiliation(s)
- Qiannan Wei
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China; Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, Anhui, 230032, China
| | - Yifu Ji
- Anhui Mental Health Center, Hefei, China
| | - Hua Gao
- Anhui Mental Health Center, Hefei, China
| | - Weizhuo Yi
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China; Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, Anhui, 230032, China
| | - Rubing Pan
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China; Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, Anhui, 230032, China
| | - Jian Cheng
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China; Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, Anhui, 230032, China
| | - Yangyang He
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China; Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, Anhui, 230032, China
| | - Chao Tang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China; Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, Anhui, 230032, China
| | - Xiangguo Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China; Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, Anhui, 230032, China
| | - Shasha Song
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China; Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, Anhui, 230032, China
| | - Jian Song
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China; Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, Anhui, 230032, China
| | - Hong Su
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China; Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, Anhui, 230032, China.
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Jørgensen KT, Bøg M, Kabra M, Simonsen J, Adair M, Jönsson L. Predicting time to relapse in patients with schizophrenia according to patients' relapse history: a historical cohort study using real-world data in Sweden. BMC Psychiatry 2021; 21:634. [PMID: 34933680 PMCID: PMC8690369 DOI: 10.1186/s12888-021-03634-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For patients with schizophrenia, relapse is a recurring feature of disease progression, often resulting in substantial negative impacts for the individual. Although a patient's relapse history (specifically the number of prior relapses) has been identified as a strong risk factor for future relapse, this relationship has not yet been meticulously quantified. The objective of this study was to use real-world data from Sweden to quantify the relationship of time to relapse in schizophrenia with a patient's history of prior relapses. METHODS Data from the Swedish National Patient Register and Swedish Prescribed Drug Register were used to study relapse in patients with schizophrenia with a first diagnosis recorded from 2006-2015, using proxy definitions of relapse. The primary proxy defined relapse as a psychiatric hospitalisation of ≥7 days' duration. Hazard ratios (HRs) were calculated for risk of each subsequent relapse, and Aalen-Johansen estimators were used to estimate time to next relapse. RESULTS 2,994 patients were included, and 5,820 relapse episodes were identified using the primary proxy. As the number of previous relapses increased, there was a general trend of decreasing estimated time between relapses. Within 1.52 years of follow-up, 50% of patients with no history of relapse were estimated to have suffered their first relapse episode. 50% of patients with one prior relapse were estimated to have a second relapse within 1.23 years (HR: 1.84 [1.71-1.99]) and time to next relapse further decreased to 0.89 years (HR: 2.77 [2.53-3.03]) and 0.22 years (HR: 18.65 [15.42-22.56]) for 50% of patients with two or ten prior relapses, respectively. Supplementary analyses using different inclusion/exclusion criteria for the study population and redefined proxies of relapse reflected the pattern observed with the primary analyses of a higher number of prior relapses linked with increased risk of/reduced estimated time to the next relapse. CONCLUSIONS The results suggested a trend of accelerating disease progression in schizophrenia, each relapse episode predisposing an individual to the next within a shorter time period. These results emphasise the importance of providing early, effective, and tolerable treatments that better meet a patient's individual needs.
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Affiliation(s)
| | - Martin Bøg
- H. Lundbeck A/S, Ottiliavej 9, 2500, Valby, Denmark
| | - Madhu Kabra
- Otsuka Pharmaceutical Europe Ltd., Wexham, UK
| | | | - Michael Adair
- H. Lundbeck A/S, Ottiliavej 9, 2500, Valby, Denmark.
| | - Linus Jönsson
- H. Lundbeck A/S, Ottiliavej 9, 2500, Valby, Denmark.,Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
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Bernardo M, Amoretti S, Cuesta MJ, Parellada M, Mezquida G, González-Pinto A, Bergé D, Lobo A, Aguilar EJ, Usall J, Corripio I, Bobes J, Rodríguez-Jiménez R, Sarró S, Contreras F, Ibáñez Á, Gutiérrez M, Micó JA. The prevention of relapses in first episodes of schizophrenia: The 2EPs Project, background, rationale and study design. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2021; 14:164-176. [PMID: 34456031 DOI: 10.1016/j.rpsmen.2021.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/15/2020] [Indexed: 12/16/2022]
Abstract
Up to 80% of first-episode psychosis patients suffer a relapse within five years of the remission. Relapse should be an important focus of prevention given the potential harm to the patient and family. It threatens to disrupt their psychosocial recovery, increases the risk of resistance to treatment and has been associated with greater direct and indirect costs for society. Based on a previous project entitled "Genotype-phenotype and environment. Application to a predictive model in first psychotic episodes" (PEPs Project), the project "Clinical and neurobiological determinants of second episodes of schizophrenia. Longitudinal study of first episode of psychosis" was designed, also known as the 2EPs Project. It aimed to identify and characterize those factors that predict a relapse within the years immediately following a first episode. This project has focused on following the clinical course, with neuropsychological assessments, biological and neuroanatomical measures, genetic adherence and physical health monitoring in order to compare a subgroup of patients with a second episode to another group of patients which remains in remission. The main objective of the present article is to describe the rationale of the 2EPs Project, explaining the measurement approach adopted and providing an overview of the selected clinical and functional measures. 2EPs Project is a multicenter, coordinated, naturalistic, longitudinal follow-up study over three years in a Spanish sample of patients in remission after a first-psychotic episode of schizophrenia. It is closely monitoring the clinical course of the cases recruited to compare the subgroup of patients with a second episode to that which remains in remission. The sample is composed of 223 subjects recruited from 15 clinical centres in Spain with experience of the preceding PEPs Study project, albeit 2EPs being an expanded version with new basic groups in biological research. From the total sample recruited, 63 patients presented a relapse (44%). 2EPs arose to characterize first episodes in an exhaustive, novel and multimodal way, thus contributing towards the development of a predictive model of relapse. Identifying the characteristics of patients who relapse could improve early detection and intervention.
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Affiliation(s)
- Miguel Bernardo
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, Barcelona, Spain; Departament de Medicina, Institut de Neurociències, Universitat de Barcelona, Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.
| | - Silvia Amoretti
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, Barcelona, Spain; Departament de Medicina, Institut de Neurociències, Universitat de Barcelona, Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Manuel Jesús Cuesta
- Departamento de Psiquiatría, Complejo Hospitalario de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, Spain
| | - Mara Parellada
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Servicio de Psiquiatría del Niño y del Adolescente, Hospital General Universitario Gregorio Marañón (IiSGM), Facultad de Medicina, Universidad Complutense, CIBERSAM, Madrid, España
| | - Gisela Mezquida
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, Barcelona, Spain; Departament de Medicina, Institut de Neurociències, Universitat de Barcelona, Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Ana González-Pinto
- Department of Psychiatry, Araba University Hospital, Bioaraba Research Institute, Department of Neurociences, University of the Basque Country, CIBERSAM, Vitoria, Spain
| | - Daniel Bergé
- Department of Neurosciences and Psychiatry, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Antonio Lobo
- Department of Medicine and Psychiatry. Universidad de Zaragoza. Instituto de Investigación Aragón, CIBERSAM, Zaragoza, Spain
| | - Eduardo J Aguilar
- Department of Psychiatry, Hospital Clínico Universitario de Valencia, School of Medicine, Universidad de Valencia, CIBERSAM, Valencia, Spain
| | - Judith Usall
- Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, SantBoi de Llobregat; Fundació Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Iluminada Corripio
- Department of Psychiatry, Biomedical Research Institute Sant Pau (IIB-SANT PAU), Santa Creu and Sant Pau Hospital; Autonomous University of Barcelona (UAB), CIBERSAM, Barcelona, Spain
| | - Julio Bobes
- Área de Psiquiatría, Universidad de Oviedo, Servicio de Salud del Principado de Asturias, Instituto de Neurociencias del Principado de Asturias (INEUROPA), CIBERSAM, Oviedo, Asturias, Spain
| | - Roberto Rodríguez-Jiménez
- Departamento de Psiquiatría, Instituto de Investigación Sanitaria Hospital 12 de Octubre (Imas12), CogPsy-Group, Universidad Complutense de Madrid (UCM), CIBERSAM, Madrid, Spain
| | - Salvador Sarró
- FIDMAG Research Foundation Germanes Hospitalàries, CIBERSAM, Barcelona, Spain
| | - Fernando Contreras
- Psychiatry Department, Bellvitge University Hospital-IDIBELL, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Ángela Ibáñez
- Departamento de Psiquiatría, Hospital Ramon y Cajal, Universidad de Alcalá, IRYCIS, CIBERSAM, Madrid, Spain
| | - Miguel Gutiérrez
- Department of Psychiatry, Hospital Santiago Apóstol, University of the Basque Country, CIBERSAM, Vitoria, Spain
| | - Juan Antonio Micó
- Grupo de Investigación en Neuropsicofarmacología y Psicobiología, Departamento de Neurociencias, Universidad de Cádiz, Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz, INiBICA, Hospital Universitario Puerta del Mar, CIBERSAM, Cádiz, Spain
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Pilon D, Patel C, Lafeuille MH, Zhdanava M, Lin D, Côté-Sergent A, Rossi C, Lefebvre P, Joshi K. Economic burden in Medicaid beneficiaries with recently relapsed schizophrenia or with uncontrolled symptoms of schizophrenia not adherent to antipsychotics. J Manag Care Spec Pharm 2021; 27:904-914. [PMID: 34185557 PMCID: PMC10391021 DOI: 10.18553/jmcp.2021.27.7.904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: Patients with schizophrenia struggle with disease relapses and uncontrolled symptoms, which can either result in or be a result of non-adherence to antipsychotics (APs). The economic burden of such patients is hypothesized to be substantial. OBJECTIVE: To evaluate the economic burden of recently relapsed schizophrenia or of uncontrolled symptoms of schizophrenia with non-adherence to APs in Medicaid beneficiaries. METHODS: Adults with ≥ 2 schizophrenia diagnoses and controls without schizophrenia were identified in Medicaid data (1997Q1-2018Q1) from Iowa, Kansas, Mississippi, Missouri, New Jersey, and Wisconsin. The index date was the last observed schizophrenia diagnosis (cohort with schizophrenia) or the last service claim (control cohort) with ≥ 12 months of continuous Medicaid enrollment before and after it. Cohorts were matched 1:1 using propensity scores. After matching, two subgroups were identified among adults with schizophrenia: (1) patients with schizophrenia and a recent relapse (≥ 1 schizophrenia-related inpatient or emergency department claim ≤ 60 days before or on the index date) and (2) patients with uncontrolled symptoms of schizophrenia (≥ 2 schizophrenia-related hospitalizations) and non-adherence to APs (proportion of days covered < 80%) in the 12-month pre-index period. Previously matched controls were then subset to patients in each subgroup and their matched pairs without schizophrenia, thus maintaining the 1:1 matching ratio. Healthcare resource utilization (HRU) and costs ($2018 USD) in the 12-month post-index (observation) period were compared between matched pairs using adjusted regression models. RESULTS: Among 158,763 patients with schizophrenia, 18,771 (11.8%) had a recent relapse (mean age 50.5 years; 48.6% female, 51.4% male) and 13,697 (8.6%) were not adherent to APs and had uncontrolled symptoms of schizophrenia (mean age 47.1 years; 48.0% female, 52.0% male). During the observation period, patients with recently relapsed schizophrenia and those non-adherent to APs with uncontrolled symptoms of schizophrenia had significantly higher HRU relative to their controls without schizophrenia. Patients with recently relapsed schizophrenia had mean total healthcare costs $21,862 higher relative to their controls ($37,424 vs $15,563), driven by $8,486 higher mean long-term care costs (all P < 0.001). Patients non-adherent to APs with uncontrolled symptoms of schizophrenia had adjusted mean total healthcare costs $20,787 higher relative to their controls ($38,337 vs $15,241), driven by $8,019 higher adjusted mean inpatient costs (all P < 0.001). Additional total healthcare costs incurred by patients with recently relapsed schizophrenia and those of patients non-adherent to APs with uncontrolled symptoms of schizophrenia exceeded by 55.2% and 47.6%, respectively, incremental total healthcare costs incurred by all patients with schizophrenia ($14,087). CONCLUSIONS: Patients with recently relapsed schizophrenia and those non-adherent to AP therapy with uncontrolled symptoms of schizophrenia incurred higher HRU and costs relative to patients without schizophrenia. Additional healthcare costs of these subgroups of patients with schizophrenia appeared higher than in the overall population with schizophrenia. DISCLOSURES: This study was supported by Janssen Scientific Affairs, LLC. The sponsor was involved in the study design, data collection, data analysis, manuscript preparation, and publication decisions. Pilon, Lafeuille, Zhdanava, Côté-Sergent, Rossi, and Lefebvre are employees of Analysis Group, Inc., a consulting company that has provided paid consulting services to Janssen Scientific Affairs, LLC, which funded the development and conduct of this study and manuscript. Patel, Joshi, and Lin are employees of Janssen Scientific Affairs, LLC and stockholders of Johnson & Johnson. Part of the material in this manuscript has been presented at the US Psych Congress, October 3-6, 2019, San Diego, CA, and at the Virtual ISPOR Meeting, May 18-20, 2020.
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Affiliation(s)
| | | | | | | | - Dee Lin
- Janssen Scientific Affairs, LLC, Titusville, NJ
| | | | | | | | - Kruti Joshi
- Janssen Scientific Affairs, LLC, Titusville, NJ
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Lisoway AJ, Chen CC, Zai CC, Tiwari AK, Kennedy JL. Toward personalized medicine in schizophrenia: Genetics and epigenetics of antipsychotic treatment. Schizophr Res 2021; 232:112-124. [PMID: 34049235 DOI: 10.1016/j.schres.2021.05.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 04/30/2021] [Accepted: 05/02/2021] [Indexed: 12/21/2022]
Abstract
Schizophrenia is a complex psychiatric disorder where genetic, epigenetic, and environmental factors play a role in disease onset, course of illness, and treatment outcome. Pharmaco(epi)genetic research presents an important opportunity to improve patient care through prediction of medication side effects and response. In this narrative review, we discuss the current state of research and important progress of both genetic and epigenetic factors involved in antipsychotic response, over the past five years. The review is largely focused on the following frequently prescribed antipsychotics: olanzapine, risperidone, aripiprazole, and clozapine. Several consistent pharmacogenetic findings have emerged, in particular pharmacokinetic genes (primarily cytochrome P450 enzymes) and pharmacodynamic genes involving dopamine, serotonin, and glutamate neurotransmission. In addition to studies analysing DNA sequence variants, there are also several pharmacoepigenetic studies of antipsychotic response that have focused on the measurement of DNA methylation. Although pharmacoepigenetics is still in its infancy, consideration of both genetic and epigenetic factors contributing to antipsychotic response and side effects no doubt will be increasingly important in personalized medicine. We provide recommendations for next steps in research and clinical evaluation.
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Affiliation(s)
- Amanda J Lisoway
- Molecular Brain Science Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Canada
| | - Cheng C Chen
- Molecular Brain Science Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Canada
| | - Clement C Zai
- Molecular Brain Science Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Canada; Department of Psychiatry, University of Toronto, Canada
| | - Arun K Tiwari
- Molecular Brain Science Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Canada
| | - James L Kennedy
- Molecular Brain Science Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Canada; Department of Psychiatry, University of Toronto, Canada.
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Lin D, Pilon D, Zhdanava M, Joshi K, Lafeuille MH, Côté-Sergent A, Vermette-Laforme M, Lefebvre P. Medication adherence, healthcare resource utilization, and costs among Medicaid beneficiaries with schizophrenia treated with once-monthly paliperidone palmitate or once-every-three-months paliperidone palmitate. Curr Med Res Opin 2021; 37:675-683. [PMID: 33507838 DOI: 10.1080/03007995.2021.1882412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Antipsychotics with reduced dosing frequency may improve adherence and clinical outcomes for patients with schizophrenia. This study compared treatment patterns, healthcare resource utilization (HRU), and costs between Medicaid beneficiaries with schizophrenia treated with once-monthly paliperidone palmitate (PP1M) and those who transitioned to once-every-three-months paliperidone palmitate (PP3M). METHODS Adults with schizophrenia were identified in a four-state Medicaid database (18 May 2014 to 31 March 2019). The index date was the first PP3M claim (PP3M cohort), or a random PP1M claim (PP1M cohort), following ≥4 months of continuous PP1M treatment among patients with ≥12 months of continuous Medicaid enrollment pre- and post-index. Adherence (proportion of days covered by the index treatment ≥80%), persistence (no gap >90/30 days in the PP3M/PP1M supply), HRU, and costs were compared during the 12-month post-index period between cohorts matched 1:1. RESULTS Among 2374 patients identified, 374 remained in each cohort after matching (mean age 42 years; 30.5% female). Compared to the PP1M cohort, the PP3M cohort was 2.39 times more likely to be adherent (p < .001), 4.63 times more likely to be persistent (p < .001), 33% less likely to have ≥1 hospitalization (p = .011), and 32% less likely to have ≥1 day with home care services (p = .012). Mean annual medical costs were similar between cohorts ($24,970 in the PP3M cohort and $25,736 in the PP1M cohort; p = .854). CONCLUSIONS Medicaid beneficiaries who transitioned to PP3M had higher adherence and persistence, and a reduced likelihood of hospitalization relative to those who continued treatment with PP1M. The results suggest potential clinical value to transitioning eligible patients to PP3M.
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Affiliation(s)
- Dee Lin
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | | | | | - Kruti Joshi
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
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Simon E, Levin JB, Mbwambo J, Blixen C, Lema I, Aebi M, Njiro G, Cassidy K, Kaaya S, Sajatovic M. Alcohol use in Tanzanians with chronic psychotic disorders and poor medication adherence. S Afr J Psychiatr 2021; 27:1570. [PMID: 33824753 PMCID: PMC8008015 DOI: 10.4102/sajpsychiatry.v27i0.1570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 01/28/2021] [Indexed: 11/01/2022] Open
Abstract
Background The burden of chronic psychotic disorders (CPDs) in sub-Saharan Africa (SSA) is significant. Poorly medically adherent patients are more likely to have worse outcomes and require more resources. However, factors impacting effective treatment of CPD in this population are unclear. Aim Examine the relationship between alcohol use and disease management and compare alcohol risk stratification between the Alcohol Use Disorders Identification Test (AUDIT) and Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in poorly medication adherent Tanzanians with CPD. Setting Muhimbili National Hospital and ambulatory clinics in Dar es Salaam, Tanzania. Methods 100 Tanzanians with CPDs and suboptimal medication adherence were dichotomized into low and moderate-to-high risk alcohol use based on AUDIT scores and compared regarding medication attitudes, adherence and psychiatric symptoms. Patients completed the ASSIST for comparison to AUDIT risk stratification. Results Moderate-to-high risk alcohol users had worse medication attitudes (p < 0.01), medication adherence (previous week, p = 0.01; previous month, p < 0.001), and psychiatric symptoms (p = 0.03). They were younger, predominately male and more likely to have a family history of alcohol abuse. A logistic regression analysis found age, gender and family history of abuse as significant predictors of hazardous alcohol use (p = 0.02, 0.02, < 0.01, respectively). Risk stratification between AUDIT and ASSIST aligned in 85% of participants. Conclusion Alcohol use is an important consideration in treating poorly adherent Tanzanians with CPD. The ASSIST was comparable to the AUDIT in stratifying risky alcohol use with the additional benefit of screening for other substances.
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Affiliation(s)
- Emily Simon
- School of Medicine, Case Western Reserve University, Cleveland, The United States of America
| | - Jennifer B Levin
- Department of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland, The United States of America.,Neurological & Behavioral Outcomes Center, School of Medicine, Case Western Reserve University, Cleveland, The United States of America
| | - Jessie Mbwambo
- Department of Psychiatry and Mental Health, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Republic of Tanzania
| | - Carol Blixen
- Department of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland, The United States of America.,Neurological & Behavioral Outcomes Center, School of Medicine, Case Western Reserve University, Cleveland, The United States of America
| | - Isaac Lema
- Department of Psychiatry and Mental Health, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Republic of Tanzania
| | - Michelle Aebi
- Department of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland, The United States of America.,University Hospitals Cleveland Medical Center, Cleveland, The United States of America
| | - Godwin Njiro
- Department of Psychiatry and Mental Health, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Republic of Tanzania
| | - Kristin Cassidy
- Department of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland, The United States of America.,University Hospitals Cleveland Medical Center, Cleveland, The United States of America
| | - Sylvia Kaaya
- Department of Psychiatry and Mental Health, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Republic of Tanzania
| | - Martha Sajatovic
- Department of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland, The United States of America.,University Hospitals Cleveland Medical Center, Cleveland, The United States of America.,Department of Neurology, School of Medicine, Case Western Reserve University, Cleveland, The United States of America
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Zhdanava M, Lin D, Lafeuille MH, Ghelerter I, Morrison L, Lefebvre P, Joshi K. Antipsychotic Adherence, Resource Use, and Costs Before and After the Initiation of Once-monthly Paliperidone Palmitate Therapy Among Medicaid Beneficiaries With Prior Schizophrenia Relapse. Clin Ther 2021; 43:535-548. [PMID: 33589216 DOI: 10.1016/j.clinthera.2021.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/15/2020] [Accepted: 01/08/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Patients with schizophrenia often struggle with medication adherence and may benefit from the use of a long-acting injectable antipsychotic, including once-monthly paliperidone palmitate (PP1M), which was previously demonstrated to improve outcomes compared with oral antipsychotics. This study assessed the impact of initiating PP1M therapy on medication adherence, health care resource use (HRU), and costs among Medicaid beneficiaries with schizophrenia and a prior schizophrenia relapse. METHODS A 6-state Medicaid database (from quarter 1 of 2009 to quarter 1 of 2018) was used to identify adults with ≥2 schizophrenia diagnoses who started PP1M therapy on or after January 1, 2010. The index date was the first PP1M claim. Patients had ≥12 months of continuous Medicaid enrollment before and after the index date, ≥1 oral antipsychotic claim in the 12 months before the index date, and ≥1 relapse (proxied as a schizophrenia-related inpatient admission or emergency department [ED] visit) during the 12 months before the index date. Generalized estimating equations were used to compare adherence to antipsychotics (proportion of days covered ≥80%), HRU, and costs (reported in 2018 US dollars) in the 12 months after versus before the index date. Sensitivity analyses were conducted (1) accounting for the minimum and cumulative price inflation Medicaid rebates for pharmacy costs of branded psychiatric medications, (2) among patients with ≥2, ≥3, and ≥4 prior schizophrenia-related inpatient admissions or ED visits, (3) among patients not adherent to antipsychotic treatment before the index date, and (4) among patients switching to PP1M directly from oral risperidone or paliperidone. FINDINGS A total of 1725 patients met the study inclusion criteria (mean age, 39.5 years; 43% female). After versus before the index date, patients were 93% more likely to be adherent to antipsychotic treatment (P < 0.01). The likelihood of inpatient admissions and ED visits decreased by 89% and 49% (all P < 0.01) after initiating PP1M therapy. The number of inpatient days decreased by 31% (P < 0.01) and the number of ED visits by 16% (P = 0.03). Pharmacy costs increased by $514 per-patient-per-month (PPPM), whereas medical costs, driven by inpatient costs, decreased by $391 PPPM (all P < 0.01). Sensitivity analyses yielded similar trends. Notably, total health care cost savings of $231 PPPM were observed after accounting for the cumulative Medicaid rebate for costs of branded psychiatric medications (P < 0.01). IMPLICATIONS In Medicaid beneficiaries with relapsed schizophrenia, transitioning from oral antipsychotics to PP1M was associated with improved adherence to antipsychotics and decreased use of inpatient and ED services. Increased pharmacy costs after the initiation of PP1M were offset by decreased medical costs. After applying the cumulative Medicaid rebate, including the price inflation rebate for costs of branded psychiatric medications, initiation of PP1M therapy resulted in statistically significant health care cost savings.
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Affiliation(s)
| | - Dee Lin
- Janssen Scientific Affairs LLC, Titusville, NJ, USA
| | | | | | | | | | - Kruti Joshi
- Janssen Scientific Affairs LLC, Titusville, NJ, USA
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Ma CF, Chan SKW, Chung YL, Ng SM, Hui CLM, Suen YN, Chen EYH. The predictive power of expressed emotion and its components in relapse of schizophrenia: a meta-analysis and meta-regression. Psychol Med 2021; 51:365-375. [PMID: 33568244 DOI: 10.1017/s0033291721000209] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Schizophrenia is a longstanding condition and most patients experience multiple relapse in the course of the condition. High expressed emotion (HEE) has been found to be a predictor of relapse. This meta-analysis and meta-regression examined the association of global EE and relapse specifically focusing on timing of relapse and EE domains. METHODS Random-effects model was used to pool the effect estimates. Multiple random-effects meta-regression was used to compute the moderator analysis. Putative effect moderators including culture, EE measurements, age, length of condition and study quality were included. RESULTS Thirty-three prospective cohort studies comprising 2284 patients were included in the descriptive review and 30 studies were included for meta-analysis and meta-regression. Findings revealed that global HEE significantly predicted more on early relapse (⩽12 months) [OR 4.87 (95% CI 3.22-7.36)] than that on late relapse (>12 months) [OR 2.13 (95% CI 1.36-3.35)]. Higher level of critical comments (CC) significantly predicted relapse [OR 2.22 (95% CI 1.16-4.26)], whereas higher level of warmth significantly protected patients from relapse [OR 0.35 (95% CI 0.15-0.85)]. None of the moderators included significantly change the results. CONCLUSIONS These findings indicate that there is a dynamic interaction between EE-relapse association with time, and CC and warmth are the two important EE domains to influence relapse among patients with schizophrenia. Results also confirmed the foci of family interventions on reducing CC and improving warmth in relationship.
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Affiliation(s)
- Chak Fai Ma
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong SAR
| | - Sherry Kit Wa Chan
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR
| | - Yik Ling Chung
- Department of Psychiatry, Kowloon Hospital, Hong Kong SAR
| | - Siu Man Ng
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR
| | - Christy Lai Ming Hui
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - Yi Nam Suen
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - Eric Yu Hai Chen
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR
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Bernardo M, Amoretti S, Cuesta MJ, Parellada M, Mezquida G, González-Pinto A, Bergé D, Lobo A, Aguilar EJ, Usall J, Corripio I, Bobes J, Rodríguez-Jiménez R, Sarró S, Contreras F, Ibáñez Á, Gutiérrez M, Micó JA. The prevention of relapses in first episodes of schizophrenia: The 2EPs Project, background, rationale and study design. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2020. [PMID: 33020032 DOI: 10.1016/j.rpsm.2020.07.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Up to 80% of first-episode psychosis patients suffer a relapse within five years of the remission. Relapse should be an important focus of prevention given the potential harm to the patient and family. It threatens to disrupt their psychosocial recovery, increases the risk of resistance to treatment and has been associated with greater direct and indirect costs for society. Based on a previous project entitled "Genotype-phenotype and environment. Application to a predictive model in first psychotic episodes" (PEPs Project), the project "Clinical and neurobiological determinants of second episodes of schizophrenia. Longitudinal study of first episode of psychosis" was designed, also known as the 2EPs Project. It aimed to identify and characterize those factors that predict a relapse within the years immediately following a first episode. This project has focused on following the clinical course, with neuropsychological assessments, biological and neuroanatomical measures, genetic adherence and physical health monitoring in order to compare a subgroup of patients with a second episode to another group of patients which remains in remission. The main objective of the present article is to describe the rationale of the 2EPs Project, explaining the measurement approach adopted and providing an overview of the selected clinical and functional measures. 2EPs Project is a multicenter, coordinated, naturalistic, longitudinal follow-up study over three years in a Spanish sample of patients in remission after a first-psychotic episode of schizophrenia. It is closely monitoring the clinical course of the cases recruited to compare the subgroup of patients with a second episode to that which remains in remission. The sample is composed of 223 subjects recruited from 15 clinical centres in Spain with experience of the preceding PEPs Study project, albeit 2EPs being an expanded version with new basic groups in biological research. From the total sample recruited, 63 patients presented a relapse (44%). 2EPs arose to characterize first episodes in an exhaustive, novel and multimodal way, thus contributing towards the development of a predictive model of relapse. Identifying the characteristics of patients who relapse could improve early detection and intervention.
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Affiliation(s)
- Miguel Bernardo
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, Barcelona, Spain; Departament de Medicina, Institut de Neurociències, Universitat de Barcelona, Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.
| | - Silvia Amoretti
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, Barcelona, Spain; Departament de Medicina, Institut de Neurociències, Universitat de Barcelona, Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Manuel Jesús Cuesta
- Departamento de Psiquiatría, Complejo Hospitalario de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, Spain
| | - Mara Parellada
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Servicio de Psiquiatría del Niño y del Adolescente, Hospital General Universitario Gregorio Marañón (IiSGM), Facultad de Medicina, Universidad Complutense, CIBERSAM, Madrid, España
| | - Gisela Mezquida
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, Barcelona, Spain; Departament de Medicina, Institut de Neurociències, Universitat de Barcelona, Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | | | | | - Ana González-Pinto
- Department of Psychiatry, Araba University Hospital, Bioaraba Research Institute, Department of Neurociences, University of the Basque Country, CIBERSAM, Vitoria, Spain
| | - Daniel Bergé
- Department of Neurosciences and Psychiatry, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Antonio Lobo
- Department of Medicine and Psychiatry. Universidad de Zaragoza. Instituto de Investigación Aragón, CIBERSAM, Zaragoza, Spain
| | - Eduardo J Aguilar
- Department of Psychiatry, Hospital Clínico Universitario de Valencia, School of Medicine, Universidad de Valencia, CIBERSAM, Valencia, Spain
| | - Judith Usall
- Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, SantBoi de Llobregat; Fundació Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Iluminada Corripio
- Department of Psychiatry, Biomedical Research Institute Sant Pau (IIB-SANT PAU), Santa Creu and Sant Pau Hospital; Autonomous University of Barcelona (UAB), CIBERSAM, Barcelona, Spain
| | - Julio Bobes
- Área de Psiquiatría, Universidad de Oviedo, Servicio de Salud del Principado de Asturias, Instituto de Neurociencias del Principado de Asturias (INEUROPA), CIBERSAM, Oviedo, Asturias, Spain
| | - Roberto Rodríguez-Jiménez
- Departamento de Psiquiatría, Instituto de Investigación Sanitaria Hospital 12 de Octubre (Imas12), CogPsy-Group, Universidad Complutense de Madrid (UCM), CIBERSAM, Madrid, Spain
| | - Salvador Sarró
- FIDMAG Research Foundation Germanes Hospitalàries, CIBERSAM, Barcelona, Spain
| | - Fernando Contreras
- Psychiatry Department, Bellvitge University Hospital-IDIBELL, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Ángela Ibáñez
- Departamento de Psiquiatría, Hospital Ramon y Cajal, Universidad de Alcalá, IRYCIS, CIBERSAM, Madrid, Spain
| | - Miguel Gutiérrez
- Department of Psychiatry, Hospital Santiago Apóstol, University of the Basque Country, CIBERSAM, Vitoria, Spain
| | - Juan Antonio Micó
- Grupo de Investigación en Neuropsicofarmacología y Psicobiología, Departamento de Neurociencias, Universidad de Cádiz, Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz, INiBICA, Hospital Universitario Puerta del Mar, CIBERSAM, Cádiz, Spain
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Penzenstadler L, Gentil L, Grenier G, Khazaal Y, Fleury MJ. Risk factors of hospitalization for any medical condition among patients with prior emergency department visits for mental health conditions. BMC Psychiatry 2020; 20:431. [PMID: 32883239 PMCID: PMC7469095 DOI: 10.1186/s12888-020-02835-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 08/24/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND This longitudinal study identified risk factors for frequency of hospitalization among patients with any medical condition who had previously visited one of six Quebec (Canada) emergency departments (ED) at least once for mental health (MH) conditions as the primary diagnosis. METHODS Records of n = 11,367 patients were investigated using administrative databanks (2012-13/2014-15). Hospitalization rates in the 12 months after a first ED visit in 2014-15 were categorized as no hospitalizations (0 times), moderate hospitalizations (1-2 times), and frequent hospitalizations (3+ times). Based on the Andersen Behavioral Model, data on risk factors were gathered for the 2 years prior to the first visit in 2014-15, and were identified as predisposing, enabling or needs factors. They were tested using a hierarchical multinomial logistic regression according to the three groups of hospitalization rate. RESULTS Enabling factors accounted for the largest percentage of total variance explained in the study model, followed by needs and predisposing factors. Co-occurring mental disorders (MD)/substance-related disorders (SRD), alcohol-related disorders, depressive disorders, frequency of consultations with outpatient psychiatrists, prior ED visits for any medical condition and number of physicians consulted in specialized care, were risk factors for both moderate and frequent hospitalizations. Schizophrenia spectrum and other psychotic disorders, bipolar disorders, and age (except 12-17 years) were risk factors for moderate hospitalizations, while higher numbers (4+) of overall interventions in local community health service centers were a risk factor for frequent hospitalizations only. Patients with personality disorders, drug-related disorders, suicidal behaviors, and those who visited a psychiatric ED integrated with a general ED in a separate site, or who visited a general ED without psychiatric services were also less likely to be hospitalized. Less urgent and non-urgent illness acuity prevented moderate hospitalizations only. CONCLUSIONS Patients with severe and complex health conditions, and higher numbers of both prior outpatient psychiatrist consultations and ED visits for medical conditions had more moderate and frequent hospitalizations as compared with non-hospitalized patients. Patients at risk for frequent hospitalizations were more vulnerable overall and had important biopsychosocial problems. Improved primary care and integrated outpatient services may prevent post-ED hospitalization.
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Affiliation(s)
- Louise Penzenstadler
- grid.14709.3b0000 0004 1936 8649Douglas Hospital Research Center, Douglas Mental Health University Institute, McGill University, 6875 LaSalle Boulevard, Montréal, Québec, H4H 1R3 Canada ,grid.150338.c0000 0001 0721 9812Hôpitaux Universitaires Genève, Département de psychiatrie, Service d’addictologie, Rue du Grand-Pré 70c, 1202 Geneva, Switzerland
| | - Lia Gentil
- grid.14709.3b0000 0004 1936 8649Douglas Hospital Research Center, Douglas Mental Health University Institute, McGill University, 6875 LaSalle Boulevard, Montréal, Québec, H4H 1R3 Canada ,Institut universitaire sur les dépendances du Centre intégré universitaire de santé et des services sociaux du Centre-Sud-de-l’Île-de-Montréal, 950 Louvain East, Montréal, Québec, H2M 2E8 Canada
| | - Guy Grenier
- grid.14709.3b0000 0004 1936 8649Douglas Hospital Research Center, Douglas Mental Health University Institute, McGill University, 6875 LaSalle Boulevard, Montréal, Québec, H4H 1R3 Canada
| | - Yasser Khazaal
- grid.8515.90000 0001 0423 4662Centre hospitalier universitaire vaudois, Département de psychiatrie, Service de médecine des addictions, Policlinique d’addictologie, Rue du Bugnon 23, 1011 Lausanne, Switzerland ,grid.14848.310000 0001 2292 3357Département de psychiatrie et d’addictologie, Université de Montréal, 2900 bld Eduard-Montpetit, Montréal, Québec, H3T1J4 Canada
| | - Marie-Josée Fleury
- Douglas Hospital Research Center, Douglas Mental Health University Institute, McGill University, 6875 LaSalle Boulevard, Montréal, Québec, H4H 1R3, Canada. .,Institut universitaire sur les dépendances du Centre intégré universitaire de santé et des services sociaux du Centre-Sud-de-l'Île-de-Montréal, 950 Louvain East, Montréal, Québec, H2M 2E8, Canada.
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Khan UA, Parveen U, Hasan N, Ahmed MZ, Saad S, Ahmad FJ, Jain GK. Parenteral Sustained Release Lipid Phase-Transition System of Ziprasidone: Fabrication and Evaluation for Schizophrenia Therapy. Drug Des Devel Ther 2020; 14:2237-2247. [PMID: 32606594 PMCID: PMC7294276 DOI: 10.2147/dddt.s247196] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 05/14/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction Ziprasidone (ZP) is a novel atypical antipsychotic agent effective in the treatment of positive and negative symptoms of schizophrenia with low chances for extrapyramidal side effects (EPs) and cognitive deficits. ZP possesses poor oral bioavailability (~50%), short biological half-life (~2.5 h) and due to extensive first-pass metabolism, a repeated dose is administered which makes the therapy non-adherent, leading to patient non-compliance. Therefore, this is a first report of developing parenteral ZP loaded sustained release phospholipid based phase-transition system (ZP-LPS). Methods The ZP-LPS system was formulated by mixing of biocompatible materials including phospholipid E 80, medium chain triglyceride (MCT) and ethanol. Optimization was done by aqueous titration method using pseudo-ternary phase diagram and dynamic rheological measurements. In vivo depot formation was confirmed by gamma scintigraphy after subcutaneous injection. Biodegradation and biocompatibility studies were performed for its safety evaluation. Finally, the efficacy of the formulation was assessed by Morris water maze (MWM) test and dizocilpine (MK-801) was used to induce schizophrenia in Sprague-Dawley rats. Results Optimized ZP-LPS showed rapid gelation (2 min), highest change in viscosity (~48000 mPa.s) and sustained release of ZP over a period of 1 month. Gamma scintigraphy depicted that the low-viscosity ZP-LPS system undergo rapid in situ gelation. Biodegradation and biocompatibility studies revealed gradual degradation in size of depot over a period of 28 days without any inflammation at the injection site. In MWM test, escape latency, time spent and total distance in target quadrant were significantly improved (p < 0.001) in the ZP-LPS group in comparison to the MK-801 group when evaluated at day 0, day 7 and day 28. However, significant improvement (p < 0.001) was observed only at day 0 in ZP suspension group. Conclusion The overall result indicates that the novel ZP-LPS system is safe, biodegradable, and effective for the management of schizophrenia.
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Affiliation(s)
- Urooj A Khan
- Nanoformulation Research Laboratory, Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India
| | - Uzma Parveen
- Department of Moalejat, School of Unani Medical Education and Research, Jamia Hamdard, New Delhi 110062, India
| | - Nazeer Hasan
- Nanoformulation Research Laboratory, Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India
| | - Mohammad Zubair Ahmed
- Nanoformulation Research Laboratory, Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India
| | - Suma Saad
- Nanoformulation Research Laboratory, Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India
| | - Farhan J Ahmad
- Nanoformulation Research Laboratory, Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India
| | - Gaurav K Jain
- Nanoformulation Research Laboratory, Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India
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Can Cognitive Remediation in Groups Prevent Relapses?: Results of a 1-Year Follow-up Randomized Controlled Trial. J Nerv Ment Dis 2020; 208:362-370. [PMID: 32053567 DOI: 10.1097/nmd.0000000000001146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
International guidelines define relapse prevention for schizophrenia patients as a key therapeutic aim. However, approximately 80% to 90% of schizophrenia patients experience further symptom exacerbation after the first episode. The purpose of this study was to investigate whether group integrated neurocognitive therapy (INT), a cognitive remediation approach, reduces relapse rates in schizophrenia outpatients. INT was compared with treatment as usual (TAU) in a randomized controlled trial. Fifty-eight stabilized outpatients participated in the study with 32 allocated to the INT group and 26 to the TAU group. A test battery was used at baseline, posttreatment at 15 weeks, and a 1-year follow-up. Relapse rates were significantly lower in the INT condition compared with TAU during therapy as well as at follow-up. The relapse rate after therapy was associated with significant reductions in negative and general symptoms, improvements in functional outcome, and overall cognition. Out of these variables, negative symptoms were identified to show the strongest association with relapses after therapy. The primary outcome of this study suggests that INT can prevent relapses in schizophrenia outpatients.
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Yi ZM, Men P, Qu S, Li C, Yu X, Zhai S. Comparative cost-effectiveness of amisulpride and olanzapine in the treatment of schizophrenia in China. Expert Rev Pharmacoecon Outcomes Res 2020; 20:313-320. [PMID: 32293194 DOI: 10.1080/14737167.2020.1752670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Both amisulpride and olanzapine are leading treatments for schizophrenia in China. This study aimed to investigate the long-term cost-effectiveness of amisulpride and olanzapine in the treatment of schizophrenia in China. METHODS A decision-analytic Markov model was developed to simulate the lifetime clinical and economic outcomes of schizophrenia treatment from the healthcare payer perspective. The long-term costs and QALYs were estimated. Sensitivity analyses were performed to explore the impact of variance of parameters on the results. RESULTS Treatment with amisulpride provided an effectiveness gain of 16.59 QALYs at an average cost of USD 25,884 whereas olanzapine resulted in 16.38 QALYs at a cost of USD 34,839 over a lifetime horizon. One-way sensitivity analysis suggested that the most sensitive variable was the unit cost of olanzapine. In a probabilistic sensitivity analysis based on a Monte Carlo simulation with a lifetime horizon, the probability of amisulpride being cost-effective was 99.8% at a willingness-to-pay threshold of USD 9,322, the GDP per capita in China 2018. A scenario analysis with updated olanzapine unit cost suggested an ICER of 7,857 USD/QALY. CONCLUSIONS Amisulpride is likely to be a cost-effective option with increased effectiveness compared with olanzapine in the treatment of schizophrenia patients in China.
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Affiliation(s)
- Zhan-Miao Yi
- Department of Pharmacy, Peking University Third Hospital , Beijing, China.,Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Science, Peking University , Beijing, China.,Institute for Drug Evaluation, Peking University Health Science Center , Beijing, China
| | - Peng Men
- Department of Pharmacy, Peking University Third Hospital , Beijing, China.,Institute for Drug Evaluation, Peking University Health Science Center , Beijing, China
| | - Shuli Qu
- Real-World Insights, IQVIA , Shanghai, China
| | - Chaoyun Li
- Health Economics & Outcome Research, Sanofi , Shanghai, China
| | - Xin Yu
- Department of Psychiatry, Peking University Sixth Hospital , Beijing, China
| | - Suodi Zhai
- Department of Pharmacy, Peking University Third Hospital , Beijing, China.,Institute for Drug Evaluation, Peking University Health Science Center , Beijing, China
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Psychometric evaluation of the illness perception questionnaire for schizophrenia in a Chinese population. Asian J Psychiatr 2020; 50:101972. [PMID: 32109801 DOI: 10.1016/j.ajp.2020.101972] [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: 09/04/2019] [Revised: 01/17/2020] [Accepted: 02/09/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Illness perceptions have been associated with patients' reactions to health threats and further health outcomes. The Illness Perception Questionnaire for Schizophrenia (IPQS)1 has been applied in different contexts. However, the validity and reliability of IPQS remain unknown in mainland China. AIMS AND OBJECTIVES To test the psychometric properties of the Chinese version of IPQS in mainland China. DESIGN A cross-sectional survey. METHODS A total of 200 community-dwelling patients with schizophrenia were surveyed in Beijing, China. The validity and reliability of the instrument were tested. As well as demographic data, the IPQS and the Knowledge About Schizophrenia Test (KAST)2 were also administered. RESULTS Factor analysis was utilised to refine the factor structure of the IPQS. The difference between IPQS and KAST denoted the discriminant validity. The subscale scores among patients of different illness duration, educational attainment, and medication adherence in the past two years were significantly different (P<0.05), indicating the known-group validity of the IPQS. Except for 'personal control' and 'burdensome effect', other subscales were internally consistent. Most of the subscales proved stable over a four-week period. CONCLUSION The Chinese version of IPQS can be used, with some refinements, to assess illness perceptions about schizophrenia for patients in future studies. This will provide empirical evidence for its generalizability and clinical utility and provide deeper insight into Chinese patients' illness perceptions about schizophrenia.
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Leach MJ, Jones M, Bressington D, Jones A, Nolan F, Muyambi K, Gillam M, Gray R. The association between community mental health nursing and hospital admissions for people with serious mental illness: a systematic review. Syst Rev 2020; 9:35. [PMID: 32066507 PMCID: PMC7027066 DOI: 10.1186/s13643-020-01292-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 02/06/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Relapse prevention is an important objective in the management of serious mental illness (SMI). While community mental health nurses (CMHN) might be well-placed to support people with SMI in averting relapse, no systematic reviews have examined this association. AIM To review the evidence from studies reporting an association between CMHN exposure and hospitalisation of persons living with SMI (a proxy for relapse). METHODS Searches were undertaken in ten bibliographic databases and two clinical trial registries. We included studies of patients with SMI, where CMHN was the exposure, and the outcome was relapse (i.e. readmission to a psychiatric inpatient facility). Quality assessment of included studies was completed using two risk-of-bias measures. RESULTS Two studies met the inclusion criteria. Studies were rated as being of low-moderate methodological quality. There was insufficient evidence to conclude that community mental health nursing reduced the risk of admission to psychiatric inpatient facilities. CONCLUSIONS The review found no evidence that CMHN was associated with higher or lower odds of admission to psychiatric inpatient facilities among patients with SMI. The findings of the review point to a need for further research to investigate the impact of CMHN exposure and relapse in people with SMI. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017058694.
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Affiliation(s)
- Matthew J Leach
- Department of Rural Health, University of South Australia, North Terrace, Adelaide, South Australia, 5000, Australia.
| | - Martin Jones
- Department of Rural Health, University of South Australia, 111 Nicholson Avenue, Whyalla Norrie, South Australia, 5608, Australia
| | - Dan Bressington
- School of Nursing, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, SAR, China
| | - Adrian Jones
- Betsi Cadwaladr University Health Board, Wrexham Maelor Hospital, Wrexham, Wales, LL167TD, UK
| | - Fiona Nolan
- Florence Nightingale Foundation, School of Health and Human Science, University of Essex, Wivenhoe Park, Colchester, Essex, CO4 3SQ, UK
| | - Kuda Muyambi
- Department of Rural Health, University of South Australia, 111 Nicholson Avenue, Whyalla Norrie, South Australia, 5608, Australia
| | - Marianne Gillam
- Department of Rural Health, University of South Australia, North Terrace, Adelaide, South Australia, 5000, Australia
| | - Richard Gray
- School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, 3086, Australia
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Allan S, Bradstreet S, McLeod HJ, Gleeson J, Farhall J, Lambrou M, Clark A, Gumley AI. Perspectives of patients, carers and mental health staff on early warning signs of relapse in psychosis: a qualitative investigation. BJPsych Open 2019; 6:e3. [PMID: 31826793 PMCID: PMC7001464 DOI: 10.1192/bjo.2019.88] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Relapse prevention strategies based on monitoring of early warning signs (EWS) are advocated for the management of psychosis. However, there has been a lack of research exploring how staff, carers and patients make sense of the utility of EWS, or how these are implemented in context. AIMS To develop a multiperspective theory of how EWS are understood and used, which is grounded in the experiences of mental health staff, carers and patients. METHOD Twenty-five focus groups were held across Glasgow and Melbourne (EMPOWER Trial, ISRCTN: 99559262). Participants comprised 88 mental health staff, 21 patients and 40 carers from UK and Australia (total n = 149). Data were analysed using constructivist grounded theory. RESULTS All participants appeared to recognise EWS and acknowledged the importance of responding to EWS to support relapse prevention. However, recognition of and acting on EWS were constructed in a context of uncertainty, which appeared linked to risk appraisals that were dependent on distinct stakeholder roles and experiences. Within current relapse management, a process of weighted decision-making (where one factor was seen as more important than others) described how stakeholders weighed up the risks and consequences of relapse alongside the risks and consequences of intervention and help-seeking. CONCLUSIONS Mental health staff, carers and patients speak about using EWS within a weighted decision-making process, which is acted out in the context of relationships that exist in current relapse management, rather than an objective response to specific signs and symptoms.
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Affiliation(s)
- Stephanie Allan
- Student, Glasgow Institute of Health and Wellbeing, University of Glasgow, UK
| | - Simon Bradstreet
- Trial Manager, Glasgow Institute of Health and Wellbeing, University of Glasgow, UK
| | - Hamish J McLeod
- Professor, Glasgow Institute of Health and Wellbeing, University of Glasgow, UK
| | - John Gleeson
- Professor, Australian Catholic University, Australia
| | - John Farhall
- Associate Professor, La Trobe University, Australia
| | - Maria Lambrou
- Research Assistant, Australian Catholic University, Australia
| | - Andrea Clark
- Research Assistant, Glasgow Institute of Health and Wellbeing, University of Glasgow, UK
| | - Andrew I Gumley
- Professor, Glasgow Institute of Health and Wellbeing, University of Glasgow, UK
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El Khoury A, Patel C, Huang A, Wang L, Bashyal R. Transitioning from oral risperidone or paliperidone to once-monthly paliperidone palmitate: a real-world analysis among Veterans Health Administration patients with schizophrenia who have had at least one prior hospitalization. Curr Med Res Opin 2019; 35:2159-2168. [PMID: 31366251 DOI: 10.1080/03007995.2019.1651129] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: To address gaps in the literature on healthcare resource utilization (HRU) and costs among patients with schizophrenia and prior hospitalization who transition from oral risperidone or paliperidone (oral ris/pali) to once-monthly paliperidone palmitate (PP1M) in a real-world setting by comparing treatment patterns, HRU, and costs 12-months pre- and post-transition to PP1M among Veterans Health Administration (VHA) patients affected by schizophrenia who have had ≥1 hospitalization.Methods: VHA patients with schizophrenia (aged ≥18 years) who initiated oral ris/pali, had ≥1 all-cause inpatient stay, and transitioned to PP1M from January 2015-March 2017 were included from the VHA database. The first transition date to PP1M was identified as the index date. Patients were required to have continuous health plan eligibility for 12 months pre- and post-PP1M. Outcomes were compared using the Wilcoxon signed-rank and McNemar's test, as appropriate.Results: The study included 319 patients (mean [SD] age = 51.6 [4.2] years) during 12 months of baseline and follow-up. During pre-PP1M transition, 7.2% of the patients were adherent (proportion of days covered [PDC] ≥ 80%) to oral ris/pali. Post-PP1M transition, 27.6% of the patients were adherent to PP1M. Comparison of HRU outcomes from the pre- to post-PP1M transition revealed significantly lower all-cause inpatient stays (3.5 vs 1.4, p < .0001) and shorter inpatient length of stay (43.4 vs 18.3 days, p < .0001). Similar trends were seen for mental health and schizophrenia-related HRU. Cost outcome comparison indicated significantly lower all-cause inpatient costs ($64,702 vs $24,147, p < .0001), total medical costs ($87,917 vs $56,947, p < .0001), and total costs ($91,181 vs $69,106, p < .0001). A similar trend was observed for mental health and schizophrenia-related costs.Conclusions: Transitioning from oral ris/pali to PP1M may significantly improve HRU and provide potential cost savings in VHA patients with schizophrenia and ≥1 prior hospitalization.
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Affiliation(s)
| | - Charmi Patel
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | | | - Li Wang
- STATinMED Research, Plano, TX, USA
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Ignatova D, Kamusheva M, Petrova G, Onchev G. Costs and outcomes for individuals with psychosis prior to hospital admission and following discharge in Bulgaria. Soc Psychiatry Psychiatr Epidemiol 2019; 54:1353-1362. [PMID: 30929041 DOI: 10.1007/s00127-019-01700-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 03/22/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE To examine the cost of psychotic disorders in Bulgaria prior to hospital admission and following discharge from two perspectives: healthcare and societal; and to evaluate the association between the costs and the patient's characteristics. METHODS 96 individuals with psychosis experiencing psychotic exacerbation and their primary caregivers were evaluated upon the patients' hospital admission. The participants were followed up after 12 months. The costs were evaluated from healthcare and societal perspective using the Client's Sociodemographic and Service Receipt Inventory (CSSRI-EU). The psychopathology, functioning, quality of life and caregiver's burden were measured using standardized instruments. The mean differences in the costs and the associations with the clinical and socio-demographic characteristics of the patients were evaluated. RESULTS The healthcare costs increase from EUR 120.66 (SD = 163.85) at baseline to EUR 177.54 (SD = 136.98) at follow-up. The total cost from societal perspective are up to sixfold higher than the healthcare costs at both assessments [EUR 717.41 (SD = 402.33) and 880.40 (SD = 1592.00), respectively] and do not change significantly. A major shift in the subtypes of costs, and significant associations of the costs with the socio-demographic and clinical characteristics, were found. CONCLUSIONS Psychotic disorders and psychotic exacerbations have high societal costs. The underfunding of mental healthcare in Bulgaria is at the expense of high caregivers' and societal cost. The treatment of psychotic exacerbation is effective and investment in mental healthcare for the improvement of the psychopathology, social functioning, quality of life and the burden of informal care should be viewed as a sustainable investment.
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Affiliation(s)
- Desislava Ignatova
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Medical University Sofia, St. G. Sofiyski 1, 1431, Sofia, Bulgaria.
| | - Maria Kamusheva
- Department of Organization and Economics of Pharmacy, Faculty of Pharmacy, Medical University, Sofia, Bulgaria
| | - Guenka Petrova
- Department of Organization and Economics of Pharmacy, Faculty of Pharmacy, Medical University, Sofia, Bulgaria
| | - Georgi Onchev
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Medical University Sofia, St. G. Sofiyski 1, 1431, Sofia, Bulgaria
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Allan S, Bradstreet S, Mcleod H, Farhall J, Lambrou M, Gleeson J, Clark A, Gumley A. Developing a Hypothetical Implementation Framework of Expectations for Monitoring Early Signs of Psychosis Relapse Using a Mobile App: Qualitative Study. J Med Internet Res 2019; 21:e14366. [PMID: 31651400 PMCID: PMC6838692 DOI: 10.2196/14366] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 07/10/2019] [Accepted: 07/19/2019] [Indexed: 12/16/2022] Open
Abstract
Background Relapse is a common experience for people diagnosed with psychosis, which is associated with increased service costs and profound personal and familial distress. EMPOWER (Early signs Monitoring to Prevent relapse in psychosis and prOmote Well-being, Engagement, and Recovery) is a peer worker–supported digital intervention that aims to enable service users to self-monitor their mental health with the aim of encouraging self-management and the shared use of personal data to promote relapse prevention. Digital interventions have not been widely used in relapse prevention and, therefore, little is currently known about their likely implementation—both within trials and beyond. Objective Seeking the perspectives of all relevant stakeholder groups is recommended in developing theories about implementation because this can reveal important group differences in understandings and assumptions about whether and for whom the intervention is expected to work. However, the majority of intervention implementation research has been retrospective. This study aimed to discover and theoretically frame implementation expectations in advance of testing and synthesize these data into a framework. Methods To develop a hypothetical implementation framework, 149 mental health professionals, carers, and people diagnosed with psychosis participated in 25 focus groups in both Australia and the United Kingdom. An interview schedule informed by the normalization process theory was used to explore stakeholders’ expectations about the implementation of the EMPOWER intervention. Data were analyzed using thematic analysis and then theoretically framed using the Medical Research Council guidelines for understanding the implementation of complex interventions. Results All groups expected that EMPOWER could be successfully implemented if the intervention generated data that were meaningful to mental health staff, carers, and service users within their unique roles. However, there were key differences between staff, carers, and service users about what facilitators and barriers that stakeholders believe exist for intervention implementation in both the cluster randomized controlled trial stage and beyond. For example, service user expectations mostly clustered around subjective user experiences, whereas staff and carers spoke more about the impact upon staff interactions with service users. Conclusions A hypothetical implementation framework synthesized from stakeholder implementation expectations provides an opportunity to compare actual implementation data gathered during an ongoing clinical trial, giving valuable insights into the accuracy of these stakeholders’ previous expectations. This is among the first studies to assess and record implementation expectations for a newly developed digital intervention for psychosis in advance of testing in a clinical trial. Trial Registration ISRCTN Registry ISRCTN99559262; http://www.isrctn.com/ISRCTN99559262
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Affiliation(s)
- Stephanie Allan
- Mental Health and Wellbeing, Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Simon Bradstreet
- Mental Health and Wellbeing, Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Hamish Mcleod
- Mental Health and Wellbeing, Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - John Farhall
- Department of Psychology and Counselling, La Trobe University, Melbourne, Australia
| | - Maria Lambrou
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - John Gleeson
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Andrea Clark
- Mental Health and Wellbeing, Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
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- Mental Health and Wellbeing, Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Andrew Gumley
- Mental Health and Wellbeing, Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
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El-Mallakh RS, Rhodes TP, Dobbins K. The Case for Case Management in Schizophrenia. Prof Case Manag 2019; 24:273-276. [PMID: 31369493 DOI: 10.1097/ncm.0000000000000385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Rif S El-Mallakh
- Rif S. El-Mallakh, MD, received his MS in biology and his MD degrees from the University of Illinois. He completed a medical internship and 1 year of a neurology residency before completing an adult psychiatry residency at the University of Connecticut. Dr El-Mallakh received his board certification in psychiatry in 1990. He spent 3 years as a clinical research fellow with the late Dr Richard Wyatt's Neuropsychiatry Branch Laboratory at the NIMH. He joined the faculty of the Department of Psychiatry at the University of Louisville in 1992, where he is a Professor and Director of the Mood Disorders Research Program, University of Louisville School of Medicine Department of Psychiatry University of Louisville School of Medicine, Louisville, Kentucky. T. Patrick Rhodes, MSSW, LCSW, earned his master's degree from the University of Louisville Kent School of Social Work. For 30 years Patrick has worked in inpatient settings as a case manager and overseen the operations in a transitional housing program and crisis services for adults with severe mental illness (SMI). Currently, he oversees Wellspring supportive services for adults with SMI. Katharine Dobbins, MSSW, LCSW, received her master's degree in Social Work from the University of Louisville Kent School of Social Work. She has more than 35 years of experience in the development, provision, and management of services to the severely mentally ill. Katharine has worked in community mental health, inpatient services, private practice and for the past decade has served as the CEO of Wellspring, Inc., a nonprofit organization in Louisville, Kentucky, which provides supportive housing, crisis stabilization, and a range of recovery services to approximately 1,000 adults with mental illness annually
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Omega-3 consumption and sudden unexpected death in schizophrenia: a "fish" a day keeps heart disease away. Psychopharmacology (Berl) 2019; 236:2285-2286. [PMID: 30806745 DOI: 10.1007/s00213-019-05201-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/13/2019] [Indexed: 02/07/2023]
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Takeuchi H, Siu C, Remington G, Fervaha G, Zipursky RB, Foussias G, Agid O. Does relapse contribute to treatment resistance? Antipsychotic response in first- vs. second-episode schizophrenia. Neuropsychopharmacology 2019; 44:1036-1042. [PMID: 30514883 PMCID: PMC6462044 DOI: 10.1038/s41386-018-0278-3] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 11/13/2018] [Indexed: 01/20/2023]
Abstract
Although some studies have suggested that relapse may be associated with antipsychotic treatment resistance in schizophrenia, the number and quality of studies is limited. The current analysis included patients with a diagnosis of first-episode schizophrenia or schizoaffective disorder who met the following criteria: (1) referral to the First-Episode Psychosis Program between 2003 and 2013; (2) treatment with an oral second-generation antipsychotic according to a standardized treatment algorithm; (3) positive symptom remission; (4) subsequent relapse (i.e., second episode) in association with non-adherence; and (5) reintroduction of antipsychotic treatment with the same agent used to achieve response in the first episode. The following outcomes were used as an index of antipsychotic treatment response: changes in the brief psychiatric rating scale (BPRS) total and positive symptom scores and number of patients who achieved positive symptom remission and 20 and 50% response. A total of 130 patients were included in the analyses. Although all patients took the same antipsychotic in both episodes, there were significant episode-by-time interactions for all outcomes of antipsychotic treatment response over 1 year in favor of the first episode compared to the second episode (50% response rate: 48.7 vs. 10.4% at week 7; 88.2 vs. 27.8% at week 27, respectively). Although antipsychotic doses in the second episode were significantly higher than those in the first episode, results remained unchanged after adjusting for antipsychotic dose. The present findings suggest that antipsychotic treatment response is reduced or delayed in the face of relapse following effective treatment of the first episode of schizophrenia.
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Affiliation(s)
- Hiroyoshi Takeuchi
- 0000 0004 1936 9959grid.26091.3cDepartment of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan ,0000 0000 8793 5925grid.155956.bSchizophrenia Program, Centre for Addiction and Mental Health, Toronto, ON Canada
| | | | - Gary Remington
- 0000 0000 8793 5925grid.155956.bSchizophrenia Program, Centre for Addiction and Mental Health, Toronto, ON Canada ,0000 0001 2157 2938grid.17063.33Department of Psychiatry, University of Toronto, Toronto, ON Canada ,0000 0001 2157 2938grid.17063.33Institute of Medical Science, University of Toronto, Toronto, ON Canada ,0000 0000 8793 5925grid.155956.bCampbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada
| | - Gagan Fervaha
- 0000 0000 8793 5925grid.155956.bSchizophrenia Program, Centre for Addiction and Mental Health, Toronto, ON Canada ,0000 0004 1936 8331grid.410356.5School of Medicine, Queen’s University, Kingston, ON Canada
| | - Robert B. Zipursky
- 0000 0000 8793 5925grid.155956.bSchizophrenia Program, Centre for Addiction and Mental Health, Toronto, ON Canada ,0000 0001 2157 2938grid.17063.33Department of Psychiatry, University of Toronto, Toronto, ON Canada
| | - George Foussias
- 0000 0000 8793 5925grid.155956.bSchizophrenia Program, Centre for Addiction and Mental Health, Toronto, ON Canada ,0000 0001 2157 2938grid.17063.33Department of Psychiatry, University of Toronto, Toronto, ON Canada ,0000 0001 2157 2938grid.17063.33Institute of Medical Science, University of Toronto, Toronto, ON Canada ,0000 0000 8793 5925grid.155956.bCampbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada
| | - Ofer Agid
- Schizophrenia Program, Centre for Addiction and Mental Health, Toronto, ON, Canada. .,Department of Psychiatry, University of Toronto, Toronto, ON, Canada. .,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
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