1
|
Yan W, Pearlson GD, Fu Z, Li X, Iraji A, Chen J, Sui J, Volkow ND, Calhoun VD. A Brainwide Risk Score for Psychiatric Disorder Evaluated in a Large Adolescent Population Reveals Increased Divergence Among Higher-Risk Groups Relative to Control Participants. Biol Psychiatry 2024; 95:699-708. [PMID: 37769983 PMCID: PMC10942727 DOI: 10.1016/j.biopsych.2023.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/14/2023] [Accepted: 09/16/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Accurate psychiatric risk assessment requires biomarkers that are both stable and adaptable to development. Functional network connectivity (FNC), which steadily reconfigures over time, potentially contains abundant information to assess psychiatric risks. However, the absence of suitable analytical methodologies has constrained this area of investigation. METHODS We investigated the brainwide risk score (BRS), a novel FNC-based metric that contrasts the relative distances of an individual's FNC to that of psychiatric disorders versus healthy control references. To generate group-level disorder and healthy control references, we utilized a large brain imaging dataset containing 5231 total individuals diagnosed with schizophrenia, autism spectrum disorder, major depressive disorder, and bipolar disorder and their corresponding healthy control individuals. The BRS metric was employed to assess the psychiatric risk in 2 new datasets: Adolescent Brain Cognitive Development (ABCD) Study (n = 8191) and Human Connectome Project Early Psychosis (n = 170). RESULTS The BRS revealed a clear, reproducible gradient of FNC patterns from low to high risk for each psychiatric disorder in unaffected adolescents. We found that low-risk ABCD Study adolescent FNC patterns for each disorder were strongly present in over 25% of the ABCD Study participants and homogeneous, whereas high-risk patterns of each psychiatric disorder were strongly present in about 1% of ABCD Study participants and heterogeneous. The BRS also showed its effectiveness in predicting psychosis scores and distinguishing individuals with early psychosis from healthy control individuals. CONCLUSIONS The BRS could be a new image-based tool for assessing psychiatric vulnerability over time and in unaffected individuals, and it could also serve as a potential biomarker, facilitating early screening and monitoring interventions.
Collapse
Affiliation(s)
- Weizheng Yan
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science, Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, Georgia; National Institute on Alcohol Abuse and Alcoholism, Laboratory of Neuroimaging, National Institutes of Health, Bethesda, Maryland.
| | - Godfrey D Pearlson
- Department of Psychiatry and Neuroscience, Yale School of Medicine, New Haven, Connecticut
| | - Zening Fu
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science, Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, Georgia
| | - Xinhui Li
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science, Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, Georgia; School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, Georgia
| | - Armin Iraji
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science, Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, Georgia
| | - Jiayu Chen
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science, Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, Georgia
| | - Jing Sui
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science, Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, Georgia; State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Nora D Volkow
- National Institute on Alcohol Abuse and Alcoholism, Laboratory of Neuroimaging, National Institutes of Health, Bethesda, Maryland
| | - Vince D Calhoun
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science, Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, Georgia.
| |
Collapse
|
2
|
Lenk-Adusoo M, Kangro R, Haring L. The risk assessment of imminent inpatient aggression: A cross-cultural validation study of the dynamic appraisal of situational aggression in Estonia. J Psychiatr Ment Health Nurs 2023. [PMID: 38095026 DOI: 10.1111/jpm.13010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 10/17/2023] [Accepted: 11/23/2023] [Indexed: 01/09/2024]
Abstract
INTRODUCTION The reason for this study was void of a data-driven imminent risk assessment instrument for aggression in psychiatry clinics in Estonia. The predictive accuracy of the observer-rated Dynamic Assessment of Situational Aggression (DASA) has been repeatedly demonstrated. However, the research gap remains regarding a deeper conceptual understanding of the underlying latent structure of the DASA. AIM Comprehensively evaluate the psychometric properties of the Estonian DASA version for cross-cultural clinical use. METHOD We used a prospective repeated measure design and collected 6097 risk evaluations from 381 adult inpatients, 151 of whom committed 1013 aggressive incidents during the study. RESULTS The Estonian DASA version has acceptable inter-rater reliability (Kendall's τ = 0.74) and is a useful instrument with excellent predictive validity (AUC = 0.86) for identifying potentially aggressive inpatients. In our sample, the DASA has a bi-factorial structure which explains 83% of the total variance. DISCUSSION The adapted DASA has acceptable validity and reliability indices for measuring imminent aggression risk in adult inpatient units. IMPLICATIONS FOR PRACTICE Evidence-based risk assessment of aggression in psychiatric clinics enhances recognition of the signs of potentially aggressive behaviour in order to apply preventive actions and reduce aggression, thereby improving the quality of the care provided.
Collapse
Affiliation(s)
- Margit Lenk-Adusoo
- Institute of Clinical Medicine, Faculty of Medicine, University of Tartu, Tartu, Estonia
- Department of Nursing and Midwifery, Tartu Health Care College, Tartu, Estonia
| | - Raul Kangro
- Institute of Mathematics and Statistics, University of Tartu, Tartu, Estonia
| | - Liina Haring
- Institute of Clinical Medicine, Faculty of Medicine, University of Tartu, Tartu, Estonia
| |
Collapse
|
3
|
Quistgaard M, Myklebust OLP, Aure T, Austin SF, Berring LL, Vernal DL, Storebø OJ. Psychosocial interventions promoting personal recovery in people with schizophrenia: a scoping review protocol. BMJ Open 2023; 13:e073901. [PMID: 38070925 PMCID: PMC10729100 DOI: 10.1136/bmjopen-2023-073901] [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: 03/24/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Personal recovery is an important aspect for many individuals diagnosed with schizophrenia, as people can live rich, fulfilling lives despite ongoing symptoms. Prior reviews have found several factors to be associated with personal recovery, but a comprehensive overview of the psychosocial interventions aimed at improving personal recovery in schizophrenia is needed. METHODS AND ANALYSIS Key terms relating to personal recovery and psychosocial interventions to promote personal recovery will be searched for in the following databases: PubMed, EMBASE, PsycINFO, CINAHL, MEDLINE, Google Scholar, Web of Science Core Collection and Cochrane. Additionally, a simple search for grey literature will be conducted in The Networked Digital Library of Theses and Dissertations. Two reviewers will individually screen and extract the data, and the selection of sources will be documented in a Preferred Reporting Items for Systematic reviews and Meta-Analyses flow chart. A content analysis will be conducted on the data, and the findings will be presented in tables, and narratively synthesised. Lastly, research gaps will be identified, and recommendations for future research will be proposed. ETHICS AND DISSEMINATION Ethics approval was not required for the development or publishing of this protocol. Findings will be disseminated through conferences, meeting with patient organisations and consumers, and published in a peer-reviewed scientific journal.
Collapse
Affiliation(s)
- Maria Quistgaard
- Psychiatric Research Unit, Psychiatric Services Region Zealand, Slagelse, Denmark
| | | | | | - Stephen Fitzgerald Austin
- Psychiatric Research Unit, Psychiatric Services Region Zealand, Slagelse, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Mental Health Services, East, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lene Lauge Berring
- Psychiatric Research Unit, Psychiatric Services Region Zealand, Slagelse, Denmark
- Institute for Regional Sundhedsforskning (IRS), University of Southern Denmark, Odense, Denmark
| | - Ditte Lammers Vernal
- Psychiatry, Aalborg University Hospital, Aalborg, North Denmark Region, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, North Denmark Region, Denmark
| | - Ole Jakob Storebø
- Psychiatric Research Unit, Psychiatric Services Region Zealand, Slagelse, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
4
|
Patel R, Chan KMY, Palmer EOC, Valko M, Guruswamy G, Ker S, Batra G, Rentería ME, Kollins SH. Associations of comorbid substance use disorders with clinical outcomes in schizophrenia using electronic health record data. Schizophr Res 2023; 260:191-197. [PMID: 37683509 PMCID: PMC10881404 DOI: 10.1016/j.schres.2023.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 07/10/2023] [Accepted: 08/27/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND AND HYPOTHESIS Schizophrenia and comorbid substance use disorders (SUDs) are associated with poor treatment outcomes but differences between the associations of different SUDs with clinical outcomes are poorly characterized. This study examines the associations of comorbid SUDs with clinical outcomes in schizophrenia using a largescale electronic health record (EHR) database. DESIGN Real-world data (RWD) analysis using the NeuroBlu database; de-identified EHR data were analysed. Multivariable logistic regression, Poisson and CoxPH models were used to compare the associations of specific comorbid SUDs with outcome variables. RESULTS Comorbid SUD was significantly different on all outcome measures compared to no SUD (U = 1.44e7-1.81e7, all ps < .001), except number of unique antipsychotics (U = 1.61e7, p = .43). Cannabis (OR = 1.58, p < .001) and polysubstance (OR = 1.22, p = .007) use disorders were associated with greater CGI-S. Cannabis (IRR = 1.13, p = .003) and polysubstance (IRR = 1.08, p = .003) use disorders were associated with greater number of unique antipsychotics prescribed, while cocaine (HR = 1.87, p < .001), stimulants (HR = 1.64, p = .024), and polysubstance (HR = 1.46, p < .001) use disorders were associated with a shorter time to antipsychotic discontinuation. Conversely, alcohol use (IRR = 0.83, p < .001), cocaine use (IRR = 0.61, p < .001), opioid use (IRR = 0.61, p < .001), stimulant use (IRR = 0.57, p < .001) and polysubstance use (IRR = 0.87, p < .001) disorders were associated fewer inpatient days. CONCLUSION Comorbid SUDs were generally associated with greater CGI-S and poorer clinical outcomes in patients with schizophrenia. Treatment strategies should target not only schizophrenia symptoms but also comorbid SUD to improve management of both conditions.
Collapse
Affiliation(s)
- Rashmi Patel
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.
| | | | | | | | | | - Sheryl Ker
- Holmusk Technologies Inc., New York, NY, USA
| | | | | | | |
Collapse
|
5
|
McIntyre RS, Higa S, Doan QV, Amari DT, Mercer D, Gillard P, Harrington A. Place of care and costs associated with acute episodes and remission in schizophrenia. J Manag Care Spec Pharm 2023; 29:499-508. [PMID: 37121252 PMCID: PMC10387981 DOI: 10.18553/jmcp.2023.29.5.499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND: Schizophrenia imposes significant economic burden on patients, families, caregivers, and society. To our knowledge, place of care and associated costs of acute schizophrenia episodes have not been well characterized. OBJECTIVE: To describe the care settings and costs associated with likely acute episodes and untreated remission periods among patients with schizophrenia. METHODS: Adults with schizophrenia were identified using the IBM MarketScan Commercial and Medicare Supplemental databases (2009-2018); claims for capitated benefits plans were excluded. Acute episode index date was defined as at least 1 inpatient schizophrenia claim or outpatient schizophrenia claim (frequency of claim dependent on visit type, such as hospitalization, emergency department, private practice, clinic, urgent care, or laboratory). Mental health-related medical costs (health plan+patient) associated with acute episodes were collected over a 2-month follow-up period and stratified by setting (inpatient vs outpatient); acute episode data were reported in subgroups of patients without or with prior clozapine use, as an indication of disease severity. Remission index date was defined as at least 1 outpatient claim with a schizophrenia diagnosis with no acute episode and no oral or injectable antipsychotic therapy. Remission costs were assessed over a 3-month period. All data were analyzed descriptively. RESULTS: A total of 14,824 patients with schizophrenia met criteria for an acute episode (12,896 [87.0%] without prior clozapine use; 1,427 [9.6%] with prior clozapine use). Most acute episodes were treated in an outpatient setting (all patients, 76.3%; without prior clozapine use, 74.5%; with prior clozapine use, 87.1%). When treated inpatient, mean (SD) episode medical costs were $17,045 ($28,101) for all patients, $16,060 ($22,786) for those without prior clozapine use, and $22,827 ($55,860) for those with prior clozapine use. When treated outpatient, mean (SD) medical costs for acute episodes were $2,478 ($6,961) for all patients, $2,609 ($7,068) for those without prior clozapine use, and $1,770 ($6,560) for those with prior clozapine use. For all patients with acute episodes, regardless of clozapine use, patient-incurred out-of-pocket costs were approximately 30% of total medical costs. For an untreated period of remission, 6,950 patients with schizophrenia met criteria. Total medical costs were $2,399 for these patients over a 3-month period. CONCLUSIONS: The majority of acute schizophrenia episodes were treated in the outpatient setting. For episodes that required inpatient care, inpatient episodes were approximately 7 times more costly than episodes treated in outpatient-only settings. For acute episodes and remission periods, health plans covered most costs; however, there were additional patient-incurred out-of-pocket costs. DISCLOSURES: All authors met the International Committee of Medical Journal Editors authorship criteria. Neither honoraria nor payments were made for authorship. Dr McIntyre has received research grant support from CIHR/GACD/National Natural Science Foundation of China (NSFC) and the Milken Institute; speaker/consultation fees from Lundbeck, Janssen, Alkermes, Neumora Therapeutics, Boehringer Ingelheim, Sage, Biogen, Mitsubishi Tanabe, Purdue, Pfizer, Otsuka, Takeda, Neurocrine, Sunovion, Bausch Health, Axsome, Novo Nordisk, Kris, Sanofi, Eisai, Intra-Cellular, NewBridge Pharmaceuticals, Viatris, AbbVie, Atai Life Sciences. Dr McIntyre is a CEO of Braxia Scientific Corp. Mr Doan, Dr Amari, and Mr Mercer are employees of Genesis Research, which was funded to perform the study. Ms Higa, Dr Gillard, and Dr Harrington were employees of AbbVie at the time of the study and may hold stock. This study was sponsored by AbbVie.
Collapse
|
6
|
Matsunaga M, Li Y, He Y, Kishi T, Tanihara S, Iwata N, Tabuchi T, Ota A. Physical, Psychiatric, and Social Comorbidities of Individuals with Schizophrenia Living in the Community in Japan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4336. [PMID: 36901345 PMCID: PMC10001945 DOI: 10.3390/ijerph20054336] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/25/2023] [Accepted: 02/27/2023] [Indexed: 06/18/2023]
Abstract
The physical, psychiatric, and social comorbidities interfere with the everyday activities of community-dwelling individuals with schizophrenia and increase the risk of their readmission. However, these comorbidities have not been investigated comprehensively in Japan. We conducted a self-reported internet survey in February 2022 to identify individuals aged 20-75 years with and without schizophrenia using a prevalence case-control study. The survey compared physical comorbidities such as being overweight, hypertension, and diabetes; psychiatric comorbidities such as depressive symptoms and sleep disturbances; social comorbidities such as employment status, household income, and social support between participants with and without schizophrenia. A total of 223 participants with schizophrenia and 1776 participants without schizophrenia were identified. Participants with schizophrenia were more likely to be overweight and had a higher prevalence of hypertension, diabetes, and dyslipidemia than participants without schizophrenia. Additionally, depressive symptoms, unemployment, and non-regular employment were more prevalent in participants with schizophrenia than those without schizophrenia. These results highlight the necessity of comprehensive support and interventions addressing physical, psychiatric, and social comorbidities in individuals with schizophrenia in the community. In conclusion, effective interventions for managing comorbidities in individuals with schizophrenia are necessary to enable them to continue to live in the community.
Collapse
Affiliation(s)
- Masaaki Matsunaga
- Department of Public Health, Fujita Health University School of Medicine, Toyoake 470-1192, Japan
| | - Yuanying Li
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya 466-8550, Japan
| | - Yupeng He
- Department of Public Health, Fujita Health University School of Medicine, Toyoake 470-1192, Japan
| | - Taro Kishi
- Department of Psychiatry, School of Medicine, Fujita Health University, Toyoake 470-1192, Japan
| | - Shinichi Tanihara
- Department of Public Health, School of Medicine, Kurume University, Kurume 830-0011, Japan
| | - Nakao Iwata
- Department of Psychiatry, School of Medicine, Fujita Health University, Toyoake 470-1192, Japan
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka 541-8567, Japan
| | - Atsuhiko Ota
- Department of Public Health, Fujita Health University School of Medicine, Toyoake 470-1192, Japan
| |
Collapse
|
7
|
Poyraz Fındık OT, Fadıloğlu E, Ay P, Fiş NP. Emergency mental health care for chi̇ldren and adolescents outside of regular working hours: 7 years outcomes from a tertiary hospital. Asian J Psychiatr 2022; 72:103103. [PMID: 35429785 DOI: 10.1016/j.ajp.2022.103103] [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: 02/28/2022] [Revised: 04/01/2022] [Accepted: 04/02/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE This study aims to define the clinical characteristics and management strategies of children and adolescents presenting with psychiatric crises to the emergency department (ED) of a tertiary health care facility outside of working hours, and to identify predictors of multiple ED visits among them. METHODS From January 2012 to December 2018, retrospective records of patients presenting with psychiatric symptoms to the ED and examined by a child psychiatrist after 5 p.m. on weekdays and for 24 h on weekends and public holidays were analyzed. RESULTS Our sample consisted of 1576 visits and 1364 patient (Female:Male=1.8:1, mean age=14.86 ± 2.72). The most common reason for visits was self-injurious thought or behaviors (SITB), and the most common diagnosis was depression. While depression was statistically more common in girls, attention deficit hyperactivity disorder, autism and/or intellectual disability (ASD/ID), psychotic disorders, and bipolar disorder were more common in boys. The forensic evaluation was the most common reason for visits among children younger than 6 years old. Of visits, 23% transferred to hospitalization. A history of mental health contact was the lowest in depression (37.5%), psychosis (34.1%), and substance use disorders (33%). Of patients, 10.8% had multiple visits. A history of mental health contacts, conduct disorder, ASD/ID, bipolar disorder, psychotic disorder, and dissociative disorder were predictors of multiple visits to ED with psychiatric reasons. CONCLUSION Emergency mental health care outside of regular working hours can be a critical step in the diagnosis and treatment of serious psychiatric disorders in children and adolescents.
Collapse
Affiliation(s)
- Onur Tuğçe Poyraz Fındık
- Istanbul Health and Technology University, Department of Psychology, Guest Lecturer, Istanbul, Turkey.
| | - Eray Fadıloğlu
- Van Training and Research Hospital, Child and Adolescent Psychiatry Clinic, Van, Turkey
| | - Pınar Ay
- Marmara University, Medical Faculty, Department of Public Health, Istanbul, Turkey
| | - Neşe Perdahlı Fiş
- Marmara University, Medical Faculty, Department of Child and Adolescent Psychiatry, Istanbul, Turkey
| |
Collapse
|
8
|
Durmaz O, Büyükçapar A, Arinci B, Inceman C, Akkişi Kumsar N. Investigating differences of medications in hospitalized schizophrenia and schizoaffective disorder patients: impact of substance use. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2077249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Onur Durmaz
- Department of Psychiatry, Erenkoy Mental Health and Neurology Training & Research Hospital, Istanbul, Turkey
| | - Aslı Büyükçapar
- Department of Psychiatry, Erenkoy Mental Health and Neurology Training & Research Hospital, Istanbul, Turkey
| | - Berçem Arinci
- Department of Psychiatry, Erenkoy Mental Health and Neurology Training & Research Hospital, Istanbul, Turkey
| | - Can Inceman
- Department of Psychiatry, Erenkoy Mental Health and Neurology Training & Research Hospital, Istanbul, Turkey
| | - Neslihan Akkişi Kumsar
- Department of Psychiatry, Erenkoy Mental Health and Neurology Training & Research Hospital, Istanbul, Turkey
| |
Collapse
|
9
|
Corbeil O, Essiambre AM, Béchard L, Roy AA, Huot-Lavoie M, Brodeur S, Chandrasena R, Thériault C, Crocker C, Melun JP, Tibbo P, Demers MF, Roy MA. Real-life effectiveness of transitioning from paliperidone palmitate 1-monthly to paliperidone palmitate 3-monthly long-acting injectable formulation. Ther Adv Psychopharmacol 2022; 12:20451253221136021. [PMID: 36405400 PMCID: PMC9666838 DOI: 10.1177/20451253221136021] [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: 05/18/2022] [Accepted: 09/30/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Non-adherence to antipsychotics in schizophrenia is associated with an increased risk of psychotic relapse and hospitalization, a risk that is reduced with the use of long-acting injectable (LAI) antipsychotics. Randomized clinical trials (RCTs) have demonstrated the efficacy of paliperidone palmitate 3-monthly (PP3M) for psychotic relapse prevention in schizophrenia, but it remains poorly documented among individuals treated in real-life settings who can benefit the most out of LAIs. OBJECTIVES The objective of this study was to evaluate the effectiveness of PP3M in relapse prevention among patients with schizophrenia. METHODS This is a multicentre retrospective study conducted in four outpatients' clinics across Canada. All consecutive patients with a main diagnosis of schizophrenia who initiated PP3M between June 2016 and March 2020 were included. The primary outcome was psychotic relapse, defined using broad and clinically relevant criteria. RESULTS Among 178 consecutive patients who were switched to PP3M, the 12-month relapse rate was 18.5% and the relapse-free survival probability was 0.788 (95% confidence interval [CI] = 0.725-0.856). Comorbid diagnoses of personality disorders and substance use disorders were associated with hazard rates (HRs) of 3.6 (95% CI = 1.8-7.3, p < 0.001) and 3.1 (95% CI = 1.6-6.2), respectively. Increased psychopathology severity was associated with an increased likelihood of relapse, while having a job or being in school was protective. CONCLUSION These findings reinforce the necessity of conducting research in patients with comorbid psychiatric disorders who are typically underrepresented in RCTs, yet overrepresented in real-life settings, in order to better inform and guide clinical practice.
Collapse
Affiliation(s)
- Olivier Corbeil
- Faculty of Pharmacy, Université Laval, 1050 Av. de la Médecine, Quebec City, QC G1V 0A6, Canada.,Quebec Mental Health University Institute, Quebec City, QC, Canada.,CERVO Brain Research Centre, Quebec City, QC, Canada
| | - Anne-Marie Essiambre
- CERVO Brain Research Centre, Quebec City, QC, Canada.,School of Psychology, Université Laval, Quebec City, QC, Canada
| | - Laurent Béchard
- Faculty of Pharmacy, Université Laval, Quebec City, QC, Canada.,Quebec Mental Health University Institute, Quebec City, QC, Canada.,CERVO Brain Research Centre, Quebec City, QC, Canada
| | - Audrey-Anne Roy
- Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Maxime Huot-Lavoie
- CERVO Brain Research Centre, Quebec City, QC, Canada.,Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Sébastien Brodeur
- Quebec Mental Health University Institute, Quebec City, QC, Canada.,CERVO Brain Research Centre, Quebec City, QC, Canada.,Department of Psychiatry, Université Laval, Quebec City, QC, Canada
| | | | | | - Candice Crocker
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | | | - Phil Tibbo
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Marie-France Demers
- Faculty of Pharmacy, Université Laval, Quebec City, QC, Canada.,Quebec Mental Health University Institute, Quebec City, QC, Canada.,CERVO Brain Research Centre, Quebec City, QC, Canada
| | - Marc-André Roy
- Quebec Mental Health University Institute, Quebec City, QC, Canada.,CERVO Brain Research Centre, Quebec City, QC, Canada.,Department of Psychiatry, Université Laval, Quebec City, QC, Canada
| |
Collapse
|
10
|
Comorbidity combinations in schizophrenia inpatients and their associations with service utilization: A medical record-based analysis using association rule mining. Asian J Psychiatr 2022; 67:102927. [PMID: 34847493 DOI: 10.1016/j.ajp.2021.102927] [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: 09/06/2021] [Revised: 10/29/2021] [Accepted: 11/16/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Comorbidities are common among patients with schizophrenia yet the prevalence of comorbidity combinations and their associations with inpatient service utilization and readmission have been scarcely explored. METHODS Data were extracted from discharge summaries of patients whose primary diagnosis was schizophrenia spectrum disorders (ICD-10: F20-F29). We identified 30 most frequent comorbidities in patients' secondary diagnoses and then used the association rule mining (ARM) method to derive comorbidity combinations associated with length of stay (LOS), daily expense and one-year readmission. RESULTS The study included data from 8252 patients. The top five most common comorbidities were extrapyramidal syndrome (EPS, 44.58%), constipation (31.63%), common cold (21.80%), hyperlipidemia (20.99%) and tachycardia (19.13%). Most comorbidity combinations identified by ARM were significantly associated with longer LOS (≥70 days), few were associated with higher daily expenses, and fewer with readmission. The 3-way combination of common cold, hyperlipidemia and fatty liver had the strongest association with longer LOS (adjusted OR (aOR): 3.38, 95% CI: 2.12-5.38). The combination of EPS and mild cognitive disorder was associated with higher daily expense (≥700 RMB) (aOR: 1.67, 95% CI: 1.20-2.31). The combination of constipation, tachycardia and fatty liver were associated with higher 1-year readmission (aOR: 2.05, 95% CI: 1.03-4.09). CONCLUSION EPS, constipation, and tachycardia were among the most commonly reported comorbidities in schizophrenia patients in Beijing, China. Specific groups of comorbidities may contribute to higher inpatient psychiatric service utilization and readmission. The mechanism behind the associations and potential interventions to optimize service use warrant further investigation.
Collapse
|
11
|
Chen E, Bazargan-Hejazi S, Ani C, Hindman D, Pan D, Ebrahim G, Shirazi A, Banta JE. Schizophrenia hospitalization in the US 2005-2014: Examination of trends in demographics, length of stay, and cost. Medicine (Baltimore) 2021; 100:e25206. [PMID: 33847618 PMCID: PMC8052007 DOI: 10.1097/md.0000000000025206] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 02/25/2021] [Indexed: 01/04/2023] Open
Abstract
Primarily we aimed to examine the crude and standardized schizophrenia hospitalization trend from 2005 to 2014. We hypothesized that there will be a statistically significant linear trend in hospitalization rates for schizophrenia from 2005 to 2014. Secondarily we also examined trends in hospitalization by race/ethnicity, age, gender, as well as trends in hospitalization Length of Stay (LOS) and inflation adjusted cost.In this observational study, we used Nationwide Inpatient Sample data and International Classification of Diseases, Eleventh Revisions codes for Schizophrenia, which revealed 6,122,284 cases for this study. Outcomes included crude and standardized hospitalization rates, race/ethnicity, age, cost, and LOS. The analysis included descriptive statistics, indirect standardization, Rao-Scott Chi-Square test, t-test, and adjusted linear regression trend.Hospitalizations were most prevalent for individuals ages 45-64 (38.8%), African Americans were overrepresented (25.8% of hospitalizations), and the gender distribution was nearly equivalent. Mean LOS was 9.08 days (95% confidence interval 8.71-9.45). Medicare was the primary payer for most hospitalizations (55.4%), with most of the costs ranging from $10,000-$49,999 (57.1%). The crude hospitalization rates ranged from 790-1142/100,000 admissions, while the US 2010 census standardized rates were 380-552/100,000 from 2005-2014. Linear regression trend analysis showed no significant difference in trend for race/ethnicity, age, nor gender (P > .001). The hospitalizations' overall rates increased while LOS significantly decreased, while hospitalization costs and Charlson's co-morbidity index increased (P < .001).From 2005-2014, the overall US hospitalization rates significantly increased. Over this period, observed disparities in hospitalizations for middle-aged and African Americans were unchanged, and LOS has gone down while costs have gone up. Further studies addressing the important disparities in race/ethnicity and age and reducing costs of acute hospitalization are needed.
Collapse
Affiliation(s)
- Ethan Chen
- Charles Drew University of Medicine and Science and David Geffen School of Medicine at University of California at Los Angeles (UCLA)
| | - Shahrzad Bazargan-Hejazi
- Department of Psychiatry; Charles Drew University of Medicine and Science & David Geffen School of Medicine at University of California at Los Angeles (UCLA)
| | - Chizobam Ani
- Department of Internal Medicine, Charles Drew University of Medicine and. Science & University
| | - David Hindman
- Department of Psychiatry; Charles Drew University of Medicine and Science & David Geffen School of Medicine at University of California at Los Angeles (UCLA)
- Department of Psychiatry; Charles Drew University of Medicine and Science
| | - Deyu Pan
- Charles Drew University of Medicine and Science
| | - Gul Ebrahim
- Department of Psychiatry; Charles Drew University of Medicine and Science
| | - Anaheed Shirazi
- Department of Psychiatry, University of California at San Diego
| | - Jim E. Banta
- Health Policy and Leadership, School of Public Health, Loma Linda University, Los Angeles CA
| |
Collapse
|
12
|
Kim SY, Kim AR. Effectiveness of community-based interventions for patients with schizophrenia spectrum disorders: a study protocol for a systematic review. Syst Rev 2021; 10:106. [PMID: 33845902 PMCID: PMC8042964 DOI: 10.1186/s13643-021-01662-0] [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: 04/17/2020] [Accepted: 04/05/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Schizophrenia requires a community-based intervention approach combined with standard treatment to prevent relapses. A literature review is required to understand the effectiveness of community-based interventions and to enhance quality in countries where they have not been fully established. This is a protocol for a systematic review of the effectiveness of community-based interventions for patients with schizophrenia spectrum disorders. METHODS We will search (from inception to January 2021) PubMed/MEDLINE, EMBASE, PsycINFO, CENTRAL, CINAHL, and Research Information Sharing Service/Korean databases. Randomized controlled trials on community-based interventions for patients with schizophrenia spectrum disorders will be eligible. The comparison groups will include patients with schizophrenia spectrum disorders who are only receiving the usual care and those who also receive community-based interventions. The schizophrenia spectrum disorders referred to in this study are defined according to the DSM-5: delusional disorders, schizophrenic disorders, and schizoaffective disorder will be included. Relapse/re-hospitalization rates (primary outcome) and quality of life (secondary outcome) will be identified for each group. Two reviewers will independently screen study titles, abstract data, and full-text articles and perform the data extraction process. Potential conflicts will be resolved through discussion. The study risk of bias will be appraised using the Cochrane Risk of Bias 2.0 tool. Results will be descriptively synthesized and will be structured according to patients' characteristics, intervention type and exposure, and outcome type. If feasible and appropriate, outcome data will be used to perform random effects meta-analyses. Discrete variables will be calculated via odds ratio, and continuous variables will be calculated via standardized mean difference using RevMan 5.3 software. DISCUSSION We will provide a summary of the available evidence on the effectiveness of community-based interventions and specific guidelines to improve their outcomes. SYSTEMATIC REVIEW REGISTRATION PROSPERO ( CRD42019145660 ).
Collapse
Affiliation(s)
- Soo-Yeon Kim
- Department of Nursing, Daegu Haany University, Hanuidae-ro, Gyeongsan-si, Gyeongsangbuk-do, 38609, Republic of Korea.
| | - Ah Rim Kim
- Department of Nursing, Far East University, Chungchungbuk-do, South Korea
| |
Collapse
|
13
|
Abstract
Schizophrenia is a mental disorder characterized by long hospitalizations and frequent need for chronic/acute psychiatric care. Hospitalizations represent a valuable quality of care indicator in schizophrenia patients. The aim of this study was to describe a nationwide perspective of schizophrenia related hospitalizations. We performed a retrospective observational study using a nationwide hospitalization database containing all hospitalizations registered in Portuguese public hospitals from 2008 to 2015. Hospitalizations with a primary diagnosis of schizophrenia were selected based on the definition by CCS - Clinical Classification Software diagnostic single-level 659. Schizophrenia subtypes were identified based on International Classification of Diseases version 9, Clinical Modification (ICD-9-CM) codes of diagnosis 295.xx. A total of 25,385 hospitalizations were registered belonging to 14,279 patients. 68.0% of the hospitalizations occurred in male patients and the median length of stay was 18.0 days. In male patients' hospitalizations, the most frequent age group was 31-50 years followed by the age group of 18-30 years (55.9 and 24.0% respectively). For female patients, the most frequent age group was 31-50 years followed by 51-70 years (54.1 and 22.6%, respectively). There were 73 hospitalization with a deadly outcome (0.29%). Paranoid type was the most frequent subtype of schizophrenia (50.5%). The mean hospitalization charges were 3509.7€ per episode, with a total charge of 89.1 M€ in the 8-year period. This is a nationwide study using Big Data analysis giving a broad perspective of schizophrenia hospitalization panorama at a nationwide level. We found differences in hospitalization characteristics according to patients' gender, age and primary diagnosis.
Collapse
|
14
|
Mansourian M, Khademi S, Marateb HR. A Comprehensive Review of Computer-Aided Diagnosis of Major Mental and Neurological Disorders and Suicide: A Biostatistical Perspective on Data Mining. Diagnostics (Basel) 2021; 11:393. [PMID: 33669114 PMCID: PMC7996506 DOI: 10.3390/diagnostics11030393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 02/13/2021] [Accepted: 02/17/2021] [Indexed: 02/07/2023] Open
Abstract
The World Health Organization (WHO) suggests that mental disorders, neurological disorders, and suicide are growing causes of morbidity. Depressive disorders, schizophrenia, bipolar disorder, Alzheimer's disease, and other dementias account for 1.84%, 0.60%, 0.33%, and 1.00% of total Disability Adjusted Life Years (DALYs). Furthermore, suicide, the 15th leading cause of death worldwide, could be linked to mental disorders. More than 68 computer-aided diagnosis (CAD) methods published in peer-reviewed journals from 2016 to 2021 were analyzed, among which 75% were published in the year 2018 or later. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol was adopted to select the relevant studies. In addition to the gold standard, the sample size, neuroimaging techniques or biomarkers, validation frameworks, the classifiers, and the performance indices were analyzed. We further discussed how various performance indices are essential based on the biostatistical and data mining perspective. Moreover, critical information related to the Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD) guidelines was analyzed. We discussed how balancing the dataset and not using external validation could hinder the generalization of the CAD methods. We provided the list of the critical issues to consider in such studies.
Collapse
Affiliation(s)
- Mahsa Mansourian
- Department of Medical Physics, School of Medicine, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran;
| | - Sadaf Khademi
- Biomedical Engineering Department, Faculty of Engineering, University of Isfahan, Isfahan 8174-67344, Iran;
| | - Hamid Reza Marateb
- Biomedical Engineering Department, Faculty of Engineering, University of Isfahan, Isfahan 8174-67344, Iran;
| |
Collapse
|
15
|
Massaoudi Y, Anissi J, Lefter R, Lobiuc A, Sendide K, Ciobica A, Hassouni ME. Protective Effects of Two Halophilic Crude Extracts from Pseudomonas zhaodongensis and Bacillus stratosphericus against Memory Deficits and Anxiety- and Depression-Like Behaviors in Methionine-Induced Schizophrenia in Mice Focusing on Oxidative Stress Status. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2020; 2020:8852418. [PMID: 33299461 PMCID: PMC7707988 DOI: 10.1155/2020/8852418] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/03/2020] [Accepted: 11/13/2020] [Indexed: 12/04/2022]
Abstract
Recently, the implication of oxidative stress in behavioral-like disorders has received a lot of attention. Many studies were interested in searching for new natural compounds with protective effects on behavioral-like disorders by focusing on oxidative stress as the main causal factor. Here, we assess the potential effect of cell-free extracts from halophilic bacteria on memory, anxiety, and depression-related behaviors in mice, as well as on cognitive deficits, negative symptoms, and some oxidative stress biomarkers in methionine-induced mice models of schizophrenia. Firstly, crude extracts of bacteria isolated from the Dead Sea were screened for their effects on memory and anxiety- and depression-like behaviors through Y-maze, elevated plus maze, and forced swimming test, respectively, using two doses 60 mg/kg and 120 mg/kg. Then, 120 mg/kg of two bacterial crude extracts, from two strains designated SL22 and BM20 and identified as Bacillus stratosphericus and Pseudomonas zhaodongensis, respectively, with significant contents of phenolic and flavonoid-like compounds, were selected for the assessment of cognitive and negative symptom improvement, as well as for their effects on oxidative stress status in methionine-induced mice models of schizophrenia using six groups (controls, methionine, crude extracts solely, and combinations of crude extracts and methionine). Results showed that the administration of the crude extracts caused a significant increase in the spontaneous alternations in the Y-maze task, the time spent in open arms of the elevated plus maze, and a decrease in immobility time in the forced swimming test in comparison with the control group. Furthermore, the administration of bacterial extracts seemed to diminish disorders related to cognitive and negative symptoms of schizophrenia and to improve the oxidative state in the temporal lobes, in comparison with the methionine group. Our findings suggest substantial antioxidant and anti-neuropsychiatric effects of the crude extracts prepared from Pseudomonas zhaodongensis strain BM20 and Bacillus stratosphericus strain SL22 and that further studies are needed to purify and to determine the active fraction from the extracts.
Collapse
Affiliation(s)
- Yousra Massaoudi
- Biotechnology, Environment, Agri-Food and Health Laboratory, Sidi Mohamed Ben Abdellah University, Faculty of Sciences Dhar El Mahraz, BP: 1796, Atlas, Fez, Morocco
| | - Jaouad Anissi
- Biotechnology, Environment, Agri-Food and Health Laboratory, Sidi Mohamed Ben Abdellah University, Faculty of Sciences Dhar El Mahraz, BP: 1796, Atlas, Fez, Morocco
- School of Engineering BIOMEDTECH, Euro-Mediterranean University of Fez, Rond-point Bensouda, Route de Meknès BP 51, Fez, Morocco
| | - Radu Lefter
- Romanian Academy, Iasi Branch, Center of Biomedical Research, B dul Carol I, 8, 700506 Iasi, Romania
| | - Andrei Lobiuc
- CERNESIM Research Centre, L2, Alexandru Ioan Cuza University, 700505 Carol I Bd., Iasi, Romania
- Human Health and Development Department, Stefan Cel Mare University, 720229 Universitatii Str., Suceava, Romania
| | - Khalid Sendide
- Laboratory of Biotechnology, School of Science and Engineering, Al Akhawayn University in Ifrane, P.O. Box 104, Ifrane, Morocco
| | - Alin Ciobica
- Department of Research, Alexandru Ioan Cuza University of Iasi, Faculty of Biology, Bd. Carol I, 20A, 700505 Iasi, Romania
| | - Mohammed El Hassouni
- Biotechnology, Environment, Agri-Food and Health Laboratory, Sidi Mohamed Ben Abdellah University, Faculty of Sciences Dhar El Mahraz, BP: 1796, Atlas, Fez, Morocco
| |
Collapse
|
16
|
Li W, Yang Y, An FR, Zhang L, Ungvari GS, Jackson T, Yuan Z, Xiang YT. Prevalence of comorbid depression in schizophrenia: A meta-analysis of observational studies. J Affect Disord 2020; 273:524-531. [PMID: 32560949 DOI: 10.1016/j.jad.2020.04.056] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 03/10/2020] [Accepted: 04/27/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Comorbid depressive symptoms (depression thereafter) often occur in schizophrenia and are associated with negative outcomes. This meta-analysis estimated the prevalence of comorbid depression and its associated factors in schizophrenia. METHODS Both international (PubMed, EMBASE, PsycINFO, and Web of Science) and Chinese (WANFANG and CNKI) databases were systematically searched. Studies with data on the prevalence of comorbid depression in schizophrenia measured with the Calgary Depression Scale for Schizophrenia (CDSS) were included. Random-effects models were used in all analyses. RESULTS Fifty-three studies covering 9,879 patients were included. The pooled prevalence of comorbid depression was 28.6% (95%CI: 25.3%-32.2%). Subgroup analyses revealed that studies examining inpatients, being published in Chinese language, or those with lower CDSS cut-od values reported higher depression rates. Meta-regression analyses indicated that the rate of depression was positively associated with publication year, proportion of males, mean age, and severity of psychotic symptoms, and negatively associated with illness duration and study quality. CONCLUSION Comorbid depression is common in schizophrenia. Due to its negative impact on patients' quality of life and prognosis, regular screening and effective treatment for comorbid depression should be implemented in patients with schizophrenia.
Collapse
Affiliation(s)
- Wen Li
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China; Center for Cognition and Brain Sciences, University of Macau, Macao SAR, China
| | - Yuan Yang
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China; Center for Cognition and Brain Sciences, University of Macau, Macao SAR, China; Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangdong, China
| | - Feng-Rong An
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Ling Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Gabor S Ungvari
- University of Notre Dame Australia, Fremantle, Australia; Division of Psychiatry, School of Medicine, University of Western Australia, Perth, Australia
| | - Todd Jackson
- Department of Psychology, Faculty of Social Sciences, University of Macau, Macau, SAR, China
| | - Zhen Yuan
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China; Center for Cognition and Brain Sciences, University of Macau, Macao SAR, China
| | - Yu-Tao Xiang
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China; Center for Cognition and Brain Sciences, University of Macau, Macao SAR, China.
| |
Collapse
|