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Assefa Fentahun B, Belete Mossie T, Damtew Hailu R, Bete T, Moges Demeke S. Adverse childhood experiences among people with schizophrenia at comprehensive specialized hospitals in Bahir Dar, Ethiopia: a comparative study. Front Psychiatry 2024; 15:1387833. [PMID: 38835545 PMCID: PMC11148370 DOI: 10.3389/fpsyt.2024.1387833] [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: 02/18/2024] [Accepted: 04/29/2024] [Indexed: 06/06/2024] Open
Abstract
Background People who have encountered adverse childhood experiences (ACEs) are predisposed to developing schizophrenia, experiencing exacerbated symptoms, and facing an elevated risk of disease relapse. It is imperative to evaluate the prevalence of ACEs to comprehend the specific attributes of this condition and enable the implementation of suitable interventions. Aims The aim of this study was to assess the prevalence of ACEs and its determinants among people with schizophrenia and the patient attendants in Bahir Dar, Ethiopia. Method A comparative cross-sectional study was carried out at the Comprehensive Specialized Hospitals in Bahir Dar, Ethiopia, from April 26 to June 10, 2023. A total of 291 individuals with schizophrenia and 293 individuals from the patient attendants were selected using a systematic random sampling method. A proportional odds model ordinal logistic regression analysis was used to identify the factors associated with ACEs. Results The occurrence of at least one ACE among individuals diagnosed with schizophrenia was 69.4%, while patient attendants had a 46.8%, as indicated by the Chi-square test, which showed a significant difference at p <0.05. The study findings indicated that individuals with schizophrenia who have encountered four or more ACEs are more inclined to have lower educational attainment (AOR: 4.69 [1.94 - 11.61]), low resilient coping mechanisms (AOR: 2.07 [1.11 - 3.90]), and poor social support (AOR: 3.93 [2.13 - 7.32]). Conversely, factors such as rural residency, illiteracy, and heightened attachment-related anxiety were found to be notably associated with the patient attendants. Conclusion In this study, the substantial prevalence of ACEs emphasized the necessity for ACE screening and the implementation of evidence-based interventions to address and alleviate the overall burden of ACEs.
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Affiliation(s)
- Birhanu Assefa Fentahun
- Department of Psychiatry, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tilahun Belete Mossie
- Department of Psychiatry, College Medical and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Rekik Damtew Hailu
- Department of Psychiatry, College Medical and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Tilahun Bete
- Department of Psychiatry, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Abdin E, Seet V, Jeyagurunathan A, Tan SC, Mohmad Khalid MIS, Mok YM, Verma S, Subramaniam M. Equipercentile linking of the Sheehan Disability Scale and the World Health Organization Assessment Schedule 2.0 scales in people with mental disorders. J Affect Disord 2024; 350:539-543. [PMID: 38218260 DOI: 10.1016/j.jad.2024.01.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 12/19/2023] [Accepted: 01/03/2024] [Indexed: 01/15/2024]
Abstract
BACKGROUND The Sheehan Disability Scale (SDS) and the World Health Organization Disability Assessment Scale (WHODAS 2.0) have been widely used to measure functional impairment and disability. To ensure that the scores from these two scales are practically exchangeable across diseases, therapies, and care programmes, the current study aimed to examine the linkage of the WHODAS 2.0 with the SDS and develop a simple and reliable conversion table for the two scales in people with mental disorders. METHODS A total of 798 patients (mean age = 36.1, SD = 12.7) were recruited from outpatient clinics of the Institute of Mental Health, and the Community Wellness Clinic in Singapore. Using a single-group design, an equipercentile equating method with log-linear smoothing was used to establish a conversion table from the SDS to the WHODAS 2.0 and vice versa. RESULTS The conversion table showed that the scores were consistent for the entire range of scores when the scores were converted either from the SDS to the WHODAS 2.0 or from the WHODAS 2.0 to the SDS. The agreement between the WHODAS 2.0's raw and converted scores and SDS's raw and converted scores were interpreted as good with intraclass correlation coefficient of 0.711 and 0.725, respectively. CONCLUSION This study presents a simple and reliable method for converting the SDS scores to the WHODAS 2.0 scores and vice versa, enabling interchangeable use of data across these two disability measures.
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Affiliation(s)
| | - Vanessa Seet
- Research Division, Institute of Mental Health, Singapore
| | | | - Sin Chik Tan
- Research Division, Institute of Mental Health, Singapore
| | | | - Yee Ming Mok
- Department of Mood and Anxiety, Institute of Mental Health, Singapore
| | - Swapna Verma
- Department of Psychosis, Institute of Mental Health, Singapore
| | - Mythily Subramaniam
- Research Division, Institute of Mental Health, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Long Y, Wu Q, Yang Y, Cai J, Xiao J, Liu Z, Xu Y, Chen Y, Huang M, Zhang R, Xu X, Hu J, Liu Z, Liu F, Zheng Y, Meng H, Wang Z, Tang Y, Song X, Chen Y, Wang X, Liu T, Wu X, Fang M, Wan C, Zhao J, Wu R. Early non-response as a predictor of later non-response to antipsychotics in schizophrenia: a randomized trial. BMC Med 2023; 21:263. [PMID: 37468932 DOI: 10.1186/s12916-023-02968-7] [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: 03/25/2023] [Accepted: 06/30/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND It remains a challenge to predict the long-term response to antipsychotics in patients with schizophrenia who do not respond at an early stage. This study aimed to investigate the optimal predictive cut-off value for early non-response that would better predict later non-response to antipsychotics in patients with schizophrenia. METHODS This multicenter, 8-week, open-label, randomized trial was conducted at 19 psychiatric centers throughout China. All enrolled participants were assigned to olanzapine, risperidone, amisulpride, or aripiprazole monotherapy for 8 weeks. The positive and negative syndrome scale (PANSS) was evaluated at baseline, week 2, week 4, and week 8. The main outcome was the prediction of nonresponse. Nonresponse is defined as a < 20% reduction in the total scores of PANSS from baseline to endpoint. Severity ratings of mild, moderate, and severe illness corresponded to baseline PANSS total scores of 58, 75, and 95, respectively. RESULTS At week 2, a reduction of < 5% in the PANSS total score showed the highest total accuracy in the severe and mild schizophrenia patients (total accuracy, 75.0% and 80.8%, respectively), and patients who were treated with the risperidone and amisulpride groups (total accuracy, 82.4%, and 78.2%, respectively). A 10% decrease exhibited the best overall accuracy in the moderate schizophrenia patients (total accuracy, 84.0%), olanzapine (total accuracy, 79.2%), and aripiprazole group (total accuracy, 77.4%). At week 4, the best predictive cut-off value was < 20%, regardless of the antipsychotic or severity of illness (total accuracy ranging from 89.8 to 92.1%). CONCLUSIONS Symptom reduction at week 2 has acceptable discrimination in predicting later non-response to antipsychotics in schizophrenia, and a more accurate predictive cut-off value should be determined according to the medication regimen and baseline illness severity. The response to treatment during the next 2 weeks after week 2 could be further assessed to determine whether there is a need to change antipsychotic medication during the first four weeks. TRIAL REGISTRATION This study was registered on Clinicaltrials.gov (NCT03451734).
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Affiliation(s)
- Yujun Long
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, 139# Renmin Middle RD, Changsha, 410011, Hunan, China
| | - Qiongqiong Wu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, 139# Renmin Middle RD, Changsha, 410011, Hunan, China
| | - Ye Yang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, 139# Renmin Middle RD, Changsha, 410011, Hunan, China
| | - Jingda Cai
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, 139# Renmin Middle RD, Changsha, 410011, Hunan, China
| | - Jingmei Xiao
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, 139# Renmin Middle RD, Changsha, 410011, Hunan, China
| | - Zhaoqian Liu
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yifeng Xu
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Chen
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Manli Huang
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Ruiguo Zhang
- Department of Psychiatry, Xijing Hospital, Air Force Military Medical University, Xi'an, Shaanxi, China
| | - Xijia Xu
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Brain Hospital, Nanjing, Jiangsu, China
| | - Jian Hu
- Department of Psychiatry, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Zhifen Liu
- Department of Psychiatry, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Fang Liu
- Department of Psychiatry, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Yingjun Zheng
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Huaqing Meng
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhimin Wang
- The National Clinical Research Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Yanqing Tang
- Department of Psychiatry, the First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xueqin Song
- Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yunchun Chen
- Department of Psychiatry, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Xueyi Wang
- Department of Psychiatry, First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Tiebang Liu
- Department of Psychiatry, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
| | - Xiaoli Wu
- Department of Psychiatry, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | | | - Chunling Wan
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders, Ministry of Education, Shanghai Jiao Tong University, Shanghai, China
| | - Jingping Zhao
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, 139# Renmin Middle RD, Changsha, 410011, Hunan, China
| | - Renrong Wu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, 139# Renmin Middle RD, Changsha, 410011, Hunan, China.
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Chang PY, Chen JH, Cheng HW, Wang YC. Effects of Psychiatric Disease Severity and Clinical Characteristics on Duration of High Violence Risk: A Perspective on Violence Prevention in the Psychiatric Ward. Neuropsychiatr Dis Treat 2023; 19:663-671. [PMID: 37007613 PMCID: PMC10065427 DOI: 10.2147/ndt.s403388] [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: 01/02/2023] [Accepted: 03/16/2023] [Indexed: 04/04/2023] Open
Abstract
Objective Prevention, de-escalation, and management of violence in the acute psychiatric ward is essential. Few studies have focused on differences in the duration of high-violence risk between different profiles of high-violence risk. This study aimed to analyze the data of high-violence patients and duration of high-violence risk to provide a new perspective on violence prevention, de-escalation and management. Methods This retrospective observational cohort study included 171 patients who were treated in the acute psychiatric ward of Keelung Chang Gung Memorial Hospital between January 2016 and June 2020, and who were assessed daily as having high violence risk. All patient data were collected from electronic hospital records (eg, age, gender, diagnosis, violence history, self-harm history, and admission condition (involuntary admission, discharged against medical advice). Between-group differences in disease severity, use of antipsychotics and benzodiazepine, and duration of high violence risk were analyzed using regression analysis. Results Only patients' age was significantly associated with duration of high-violence risk (P = 0.028), making it predictive of longer duration of high-violence risk. In patients with schizophrenia spectrum disorder or bipolar disorder, higher severity was significantly associated with longer duration of high-violence risk (P = 0.007, P = 0.001, respectively). Conclusion Only age is a predictor of longer duration of violence risk in psychiatric patients, although higher severity is associated with higher violence risk. Study results may help management and healthcare staff better understand how quickly or slowly violence risk will decrease and may improve efficient use of healthcare resources and individualized patient-centered care.
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Affiliation(s)
- Ping-Ying Chang
- Department of Psychiatry, Chang-Gung Medical Foundation Keelung Chang-Gung Memorial Hospital, Keelung, Taiwan, Republic of China
- School of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Jian-Hong Chen
- Department of Psychiatry, Chang-Gung Medical Foundation Keelung Chang-Gung Memorial Hospital, Keelung, Taiwan, Republic of China
- School of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
- Doctoral Program for Transnational Sport Management and Innovation, National Taiwan Sport University, Taoyuan, Taiwan, Republic of China
- Correspondence: Jian-Hong Chen, Email
| | - Hui-Wen Cheng
- Department of Psychiatry, Chang-Gung Medical Foundation Keelung Chang-Gung Memorial Hospital, Keelung, Taiwan, Republic of China
| | - Yen-Chin Wang
- Department of Psychiatry, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan, Republic of China
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Tang Y, Wu Y, Li X, Hao Q, Deng W, Yue W, Yan H, Zhang Y, Tan L, Chen Q, Yang G, Lu T, Wang L, Yang F, Zhang F, Yang J, Li K, Lv L, Tan Q, Zhang H, Ma X, Li L, Wang C, Ma X, Zhang D, Yu H, Zhao L, Ren H, Wang Y, Zhang G, Li C, Du X, Hu X, Li T, Wang Q. Early Efficacy of Antipsychotic Medications at Week 2 Predicts Subsequent Responses at Week 6 in a Large-scale Randomized Controlled Trial. Curr Neuropharmacol 2023; 21:424-436. [PMID: 36411567 PMCID: PMC10190139 DOI: 10.2174/1570159x21666221118164612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/25/2022] [Accepted: 10/18/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Since the early clinical efficacy of antipsychotics has not yet been well perceived, this study sought to decide whether the efficacy of antipsychotics at week 2 can predict subsequent responses at week 6 and identify how such predictive capacities vary among different antipsychotics and psychotic symptoms. METHODS A total of 3010 patients with schizophrenia enrolled in a randomized controlled trial (RCT) and received a 6-week treatment with one antipsychotic drug randomly chosen from five atypical antipsychotics (risperidone 2-6 mg/d, olanzapine 5-20 mg/d, quetiapine 400-750 mg/d, aripiprazole 10-30 mg/d, and ziprasidone 80-160 mg/d) and two typical antipsychotics (perphenazine 20-60 mg/d and haloperidol 6-20 mg/d). Early efficacy was defined as the reduction rate using the Positive and Negative Syndrome Scale (PANSS) total score at week 2. With cut-offs at 50% reduction, logistic regression, receiver operating characteristic (ROC) and random forests were adopted. RESULTS The reduction rate of PANSS total score and improvement of psychotic symptoms at week 2 enabled subsequent responses to 7 antipsychotics to be predicted, in which improvements in delusions, lack of judgment and insight, unusual thought content, and suspiciousness/ persecution were endowed with the greatest weight. CONCLUSION It is robust enough to clinically predict treatment responses to antipsychotics at week 6 using the reduction rate of PANSS total score and symptom relief at week 2. Psychiatric clinicians had better determine whether to switch the treatment plan by the first 2 weeks.
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Affiliation(s)
- Yiguo Tang
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China
| | - Yulu Wu
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China
| | - Xiaojing Li
- Department of Neurobiology, Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - QinJian Hao
- The Center of Gerontology and Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Wei Deng
- Department of Neurobiology, Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Weihua Yue
- Peking University Sixth Hospital, Institute of Mental Health, Beijing, China
- National Clinical Research Center for Mental Disorders and Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Hao Yan
- Peking University Sixth Hospital, Institute of Mental Health, Beijing, China
- National Clinical Research Center for Mental Disorders and Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Yamin Zhang
- Department of Neurobiology, Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Liwen Tan
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qi Chen
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Guigang Yang
- Beijing Anding Hospital, Institute for Brain Disorders, Capital Medical University, Beijing, China
| | - Tianlan Lu
- Peking University Sixth Hospital, Institute of Mental Health, Beijing, China
- National Clinical Research Center for Mental Disorders and Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Lifang Wang
- Peking University Sixth Hospital, Institute of Mental Health, Beijing, China
- National Clinical Research Center for Mental Disorders and Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Fude Yang
- Beijing HuiLongGuan Hospital, Beijing, China
| | - Fuquan Zhang
- Wuxi Mental Health Center, Nanjing Medical University, Wuxi, China
| | - Jianli Yang
- Institute of Mental Health, Tianjin Anding Hospital, Tianjin, China
- Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, China
| | - Keqing Li
- Hebei Mental Health Center, Baoding, Hebei, China
| | - Luxian Lv
- Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China
| | - Qingrong Tan
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, Shanxi, China
| | - Hongyan Zhang
- Wuxi Mental Health Center, Nanjing Medical University, Wuxi, China
| | - Xin Ma
- Beijing Anding Hospital, Institute for Brain Disorders, Capital Medical University, Beijing, China
| | - Lingjiang Li
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Chuanyue Wang
- Beijing Anding Hospital, Institute for Brain Disorders, Capital Medical University, Beijing, China
| | - Xiaohong Ma
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China
| | - Dai Zhang
- Peking University Sixth Hospital, Institute of Mental Health, Beijing, China
- National Clinical Research Center for Mental Disorders and Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Hao Yu
- Department of Psychiatry, Jining Medical University, Jining, China
| | - Liansheng Zhao
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China
| | - Hongyan Ren
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China
| | - Yingcheng Wang
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China
| | - Guangya Zhang
- Department of Psychiatry, Suzhou Psychiatric Hospital, Suzhou, China
- The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Chuanwei Li
- Department of Psychiatry, Suzhou Psychiatric Hospital, Suzhou, China
- The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xiangdong Du
- Department of Psychiatry, Suzhou Psychiatric Hospital, Suzhou, China
- The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xun Hu
- The Clinical Research Center and the Department of Pathology, Affiliated Second Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Tao Li
- Department of Neurobiology, Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Qiang Wang
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China
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Leichsenring F, Jaeger U, Masuhr O, Dally A, Dümpelmann M, Fricke-Neef C, Spitzer C, Steinert C. To Be or Not to Be Improved: Patients' Perception of Symptom Improvement - Linking the SCL-90-R to Patient-Rated Global Improvement in a Large Real-World Treatment Sample. PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 89:357-362. [PMID: 32731248 DOI: 10.1159/000509213] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 05/27/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION From both a clinical and research perspective, it is important to determine what constitutes a perceivable change in commonly used outcome measures. OBJECTIVE We aimed to do so for the Symptom Checklist-90-Revised (SCL-90-R). METHODS Patients from a large real-world sample treated with inpatient psychotherapy (n = 4,791) rated improvements in symptoms on a global 5-point Likert scale at discharge. These ratings were related to pre-post changes in the Global Severity Index (GSI) of the SCL-90-R by use of equipercentile linking. RESULTS A patient rating of 5 ("clearly improved") was found to be equivalent to an absolute pre-post difference in the GSI of 0.67 or to a percentage improvement of 54%, with the latter corresponding to the common definition of response as a 50% reduction in symptoms. A rating of 1 ("clearly worse") was equivalent to an increase in the GSI >0.50 and to a percentage worsening >55%. "Slightly improved" or "slightly worse" (ratings of 4 or 2) corresponded to pre-post changes in the GSI of 0.07 and 0.50. For severely disordered patients, larger changes were required for ratings of improvement, and for less severely disordered patients, larger changes were required for ratings of worsening. Results for depressive, anxiety, and personality disorders were widely consistent with those of the total sample. CONCLUSIONS This study is the first to link patient ratings of improvement or worsening to changes in the SCL-90-R. Results are relevant to both the interpretation of changes in individual patients and of effect sizes in outcome research. Results require replication.
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Affiliation(s)
- Falk Leichsenring
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany, .,Department of Psychosomatics and Psychotherapeutic Medicine, University of Rostock, Rostock, Germany,
| | | | | | | | | | | | - Carsten Spitzer
- Asklepios Clinic Tiefenbrunn, Tiefenbrunn, Germany.,Department of Psychosomatics and Psychotherapeutic Medicine, University of Rostock, Rostock, Germany
| | - Christiane Steinert
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany.,International Psychoanalytic University, Berlin, Germany
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Paris G, Bighelli I, Deste G, Siafis S, Schneider-Thoma J, Zhu Y, Davis JM, Vita A, Leucht S. Short-acting intramuscular second-generation antipsychotic drugs for acutely agitated patients with schizophrenia spectrum disorders. A systematic review and network meta-analysis. Schizophr Res 2021; 229:3-11. [PMID: 33607608 DOI: 10.1016/j.schres.2021.01.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 01/20/2021] [Accepted: 01/24/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Psychomotor agitation is a common condition in patients with psychotic disorders. One treatment possibility is intramuscular (IM) second-generation antipsychotics. Yet their efficacy in this formulation and for this aim is unclear. This network meta-analysis aims to evaluate the efficacy of short-acting IM second-generation antipsychotic drugs, haloperidol and placebo in patients with diagnosis of schizophrenia and schizophrenia-like disorders that present acute agitation. METHODS We searched the Cochrane Schizophrenia Group Controlled Trials Register, MEDLINE, EMBASE, PsycINFO, Cochrane Library, PubMed, BIOSIS, ClinicalTrials.gov and WHO ICTRP up to November 2018 and PubMed until March 2020. Study selection and outcome extraction were performed independently by two reviewers. Pairwise and network meta-analyses were conducted to compare the different IM second-generation antipsychotics among themselves and with IM haloperidol and placebo. The primary outcome was the number of responders at 2 h after the first injection. Responders at 24 h were also analysed. RESULTS 10 studies with 1964 patients were included in the meta-analysis. Ziprasidone, olanzapine, aripiprazole and haloperidol were more efficacious than placebo in calming patients at 2 h after administration. Furthermore, olanzapine was superior to aripiprazole. The results at 24 h confirmed the superiority of aripiprazole, olanzapine and haloperidol over placebo, while for ziprasidone no data were available. CONCLUSIONS All second-generation antipsychotics available as intramuscular medications were effective in reducing agitation in people with schizophrenia. Olanzapine was somewhat more efficacious than aripiprazole.
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Affiliation(s)
- Giulia Paris
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
| | - Irene Bighelli
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
| | - Giacomo Deste
- Department of Mental Health and Addiction Services, Spedali Civili Hospital, Brescia, Italy.
| | - Spyridon Siafis
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
| | - Johannes Schneider-Thoma
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
| | - Yikang Zhu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - John M Davis
- Department of Psychiatry, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States of America.
| | - Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Department of Mental Health and Addiction Services, Spedali Civili Hospital, Brescia, Italy.
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
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8
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Chestnykh DA, Amato D, Kornhuber J, Müller CP. Pharmacotherapy of schizophrenia: Mechanisms of antipsychotic accumulation, therapeutic action and failure. Behav Brain Res 2021; 403:113144. [PMID: 33515642 DOI: 10.1016/j.bbr.2021.113144] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 12/13/2022]
Abstract
Schizophrenia is a multi-dimensional disorder with a complex and mostly unknown etiology, leading to a severe decline in life quality. Antipsychotic drugs (APDs) remain beneficial interventions in the treatment of the disorder, but vary significantly in binding profile, clinical effects and adverse reactions. The present review summarizes the main principles of APD mechanisms of action with a particular focus on recent findings in APD accumulation and its role in the therapeutic efficacy and treatment failure. High and low doses of APDs were shown to be effective in different dimensions of antipsychotic-like behaviour in rodent models. Efficacy of the APDs correlates with high dopamine D2 receptor occupancy, which occurs quickly after drug administration. However, onset and peak of action are delayed up to several days or weeks. APD accumulation via acidic trapping in synaptic vesicles is considered to underlie the time course of APD action. Use-dependent exocytosis, co-release with dopamine and serotonin and inhibition of ion channels impact on the neuronal transmission and determine effects of APDs. Disruption in accumulating properties leads to diminished APD effects. In addition, long-term APD administration at therapeutic doses leads to treatment failure both in animal models and in humans. APD failure was associated with treatment induced neuroadaptations, including a decline in extracellular dopamine levels, dopamine transporter upregulation, and altered neuronal firing. However, enhanced synaptic vesicle release has also been reported. APD loss of efficacy may be reversed through inhibition of the dopamine transporter or switching the administration regimen from continuous to intermittent. Thus, manipulating the accumulation properties of APDs, changes in the administration regimen and doses, or co-administration with dopamine transporter inhibitors may be considered to yield benefits in the development of new effective strategies in the treatment of schizophrenia.
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Affiliation(s)
- Daria A Chestnykh
- Department of Psychiatry and Psychotherapy, University Clinic, Friedrich-Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Davide Amato
- Department of Psychiatry and Psychotherapy, University Clinic, Friedrich-Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany; Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, University Clinic, Friedrich-Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Christian P Müller
- Department of Psychiatry and Psychotherapy, University Clinic, Friedrich-Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany.
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9
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Siafis S, Deste G, Ceraso A, Mussoni C, Vita A, Hasanagic S, Schneider-Thoma J, Papazisis G, Davis JM, Leucht S. Antipsychotic drugs v. barbiturates or benzodiazepines used as active placebos for schizophrenia: a systematic review and meta-analysis. Psychol Med 2020; 50:2622-2633. [PMID: 31625485 DOI: 10.1017/s003329171900285x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Comparisons of antipsychotics with placebo can be biased by unblinding due to side effects. Therefore, this meta-analysis compared the efficacy of antipsychotics for acute schizophrenia in trials using barbiturates or benzodiazepines as active placebos. METHODS Randomized controlled trials (RCTs) in acute schizophrenia with at least 3 weeks duration and comparing any antipsychotic with barbiturates or benzodiazepines were eligible. ClinicalTrials.gov, CENTRAL, EMBASE, MEDLINE, PsycINFO, PubMed, WHO-ICTRP as well as previous reviews were searched up to 9 January 2018. Two separate meta-analyses, one for barbiturates and one for benzodiazepines, were conducted using random-effects models. The primary outcome was response to treatment, and mean values of schizophrenia rating scales and dropouts were analyzed as secondary outcomes. This study is registered with PROSPERO (CRD42018086263). RESULTS Seven barbiturate-RCTs (number of participants n = 1736), and two benzodiazepine-RCTs (n = 76) were included in the analysis. The studies were published between 1960 and 1968 and involved mainly chronically ill patients. More patients on antipsychotics in comparison to barbiturates achieved a 'good' response (36.2% v. 16.8%; RR 2.15; 95% CI 1.36-3.41; I2 = 48.9) and 'any' response (57.4% v. 27.8%; RR 2.07; 95% CI 1.35-3.18; I2 = 68.2). In a single small trial (n = 60), there was no difference between antipsychotics and benzodiazepines on 'any' response (74.7% v. 65%; RR 1.15; 95% CI 0.82-1.62). CONCLUSIONS Antipsychotic drugs were more efficacious than barbiturates, based on a large sample size. Response ratios were similar to those observed in placebo-controlled trials. The results on benzodiazepines were inconclusive due to the small number of studies and participants.
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Affiliation(s)
- Spyridon Siafis
- Department of Psychiatry and Psychotherapy, School of Medicine, Technische Universität München, München, Germany
| | - Giacomo Deste
- Department of Psychiatry, Spedali Civili Hospital, Brescia, Italy
| | - Anna Ceraso
- Department of Psychiatry, Spedali Civili Hospital, Brescia, Italy
| | | | - Antonio Vita
- Department of Psychiatry, Spedali Civili Hospital, Brescia, Italy
| | - Senad Hasanagic
- Medical Center of the University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Johannes Schneider-Thoma
- Department of Psychiatry and Psychotherapy, School of Medicine, Technische Universität München, München, Germany
| | - Georgios Papazisis
- Department of Clinical Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - John M Davis
- Department of Psychiatry, University of Illinois at Chicago, Chicago, USA
- Illinois and Maryland Psychiatric Research Center, Baltimore, Maryland, USA
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, School of Medicine, Technische Universität München, München, Germany
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10
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Meng Y, Li Y, Cao H, Xu Y, Wang B. Development of two psychological experience questionnaires for screening violence-related mental health disorders of non-psychiatric inpatients. Health Qual Life Outcomes 2020; 18:151. [PMID: 32450852 PMCID: PMC7249322 DOI: 10.1186/s12955-020-01399-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 05/07/2020] [Indexed: 11/10/2022] Open
Abstract
Background Increased violent events happen in the general hospitals in China and yet non-psychiatric departments do not have tools for violence-tendency screening. Methods The current study developed and evaluated two Inpatient Psychological Experience Questionnaires (IPEQs) for the screening of violence-related six mental health disorders: (Inpatient Psychological Experience Questionnaire-1 (IPEQ-1): anxiety, depression and suicidality; Inpatient Psychological Experience Questionnaire-2 (IPEQ-2): paranoid personality disorder, emotionally unstable personality disorder and histrionic personality disorder). Two initial IPEQs (IPEQ-1: 37 items and IPEQ-2: 30 items) were developed and assessed by domain experts. Then 1210 inpatients were recruited and divided into three groups (160, 450 and 600 samples, respectively) for IPEQs item selection and evaluation. During the two-stage item selection, three statistical methods including Pearson’s correlation coefficient, exploratory factor analysis and item response theory were applied. For the item evaluation, Cronbach’s alpha coefficient, test-retest reliability, criterion-related validity and construct validity of the final questionnaires were measured. Results Twelve items were selected for each IPEQs. Cronbach’s alpha coefficients were 0.91 and 0.78 for IPEQ-1 and IPEQ-2, respectively. Test-retest replication ratios were 0.95 and 0.87 for IPEQ-1 and IPEQ-2, respectively. Correlation coefficients between different disorders and their related-tools scores were [0.51, 0.44] and [0.40, 0.44] for IPEQ-1 and IPEQ-2, respectively and were significant (P < 0.01). Confirmatory factor analysis supported the validity of the final IPEQs (P < 0.05), and the model fit index met the criterion generally. Conclusion The IPEQs developed in this study could be effective and easy-to-use tools for screening inpatients with violence-intendancy in non-psychosomatic departments.
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Affiliation(s)
- Yanjun Meng
- Nursing College, Shanxi Medical University, 56 Xinjian South Road, Taiyuan, Shanxi, 030001, People's Republic of China.,Nursing College, Shanxi University of Chinese Medicine, Taiyuan, Shanxi, People's Republic of China
| | - Yuling Li
- Nursing College, Shanxi Medical University, 56 Xinjian South Road, Taiyuan, Shanxi, 030001, People's Republic of China
| | - Hongbao Cao
- School of Systems Biology, George Mason University (GMU), Fairfax, VA, USA
| | - Yong Xu
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, People's Republic of China.
| | - Binquan Wang
- Nursing College, Shanxi Medical University, 56 Xinjian South Road, Taiyuan, Shanxi, 030001, People's Republic of China. .,Department of Otolaryngology, Head and Neck Surgery, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, People's Republic of China.
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11
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The Relationship Between Medication Attitudes and Medication Adherence Behavior in Adults With Bipolar Disorder. J Nerv Ment Dis 2020; 208:87-93. [PMID: 31929465 PMCID: PMC7316161 DOI: 10.1097/nmd.0000000000001083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The relationship between medication attitudes and adherence as well as reliable measures of medication attitudes need further study. This study examined the psychometric properties of the Attitudes Toward Mood Stabilizers Questionnaire (AMSQ) in bipolar participants and the relationship between medication attitudes and adherence, measured by the self-reported Tablets Routine Questionnaire (TRQ). Inclusion criteria included mood stabilizer treatment and 20% or more medication nonadherence. Measures were given pretreatment and posttreatment. Average age was 47 years; majority were female (69%), African American (67%), and unmarried (53%). AMSQ's test-retest reliability was ρ = 0.73 (p < 0.001). AMSQ correlated with TRQ (rs = 0.20, p < 0.01) at baseline. Factor analysis identified three factors: positive/favorable attitudes, negative/critical attitudes, and unintentional nonadherence. Change in AMSQ across time correlated with change in TRQ. The AMSQ is valid psychometrically and is sensitive to change. Medication attitudes are related to adherence behavior. Interventions should include targeting specific domains of medication attitudes, such as illness knowledge.
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Park SC, Jang EY, Kim K, Lee H, Choi J, Dan A, Hussain A, Tanra AJ, Kato TA, Chee KY, Lin SK, Tan CH, Javed A, Sartorius N, Shinfuku N, Park YC. Establishing the cut-off scores for the severity ranges of schizophrenia on the BPRS-6 scale: findings from the REAP-AP. PSYCHIAT CLIN PSYCH 2019. [DOI: 10.1080/24750573.2019.1695994] [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] [Indexed: 10/25/2022] Open
Affiliation(s)
- Seon-Cheol Park
- Department of Psychiatry, Inje University Haeundae Paik Hospital, Busan, Republic of Korea
| | - Eun Young Jang
- Department of Counselling Psychology, Honam University College of Humanities and Social Sciences, Gwangju, Republic of Korea
| | - Kiwon Kim
- Department of Psychiatry, Veteran Health Service Medical Center, Seoul, Republic of Korea
| | - Hoseon Lee
- Department of Psychiatry, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Joonho Choi
- Department of Psychiatry, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Amitava Dan
- Department of Psychiatry, Burdwan Medical College, Bardhaman (E), India
| | - Arshad Hussain
- Institute of Mental Health and Neurosciences, Government Medical College, Srinagar, India
| | | | - Takahiro A. Kato
- Department of Neuropsychiatry, Graduate School of Medicine, Kyushu University, Fukuoka, Japan
| | - Kok Yoon Chee
- Tunku Abdul Rahman Institute of Neuroscience, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | - Sih-Ku Lin
- Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Chay Hoon Tan
- Department of Pharmacology, National University Hospital, Singapore, Singapore
| | - Afzal Javed
- Pakistan Psychiatric Research Centre, Lahore, Pakistan
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes, Geneva, Switzerland
| | - Naotaka Shinfuku
- Department of Social Welfare, School of Human Sciences, Seinan Gakuin University, Fukuoka, Japan
| | - Yong Chon Park
- Department of Psychiatry, Hanyang University Guri Hospital, Guri, Republic of Korea
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Egger ST, Weniger G, Müller M, Bobes J, Seifritz E, Vetter S. Assessing the severity of functional impairment of psychiatric disorders: equipercentile linking the mini-ICF-APP and CGI. Health Qual Life Outcomes 2019; 17:174. [PMID: 31744498 PMCID: PMC6862821 DOI: 10.1186/s12955-019-1235-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 10/18/2019] [Indexed: 12/02/2022] Open
Abstract
Background The assessment of functioning and impairment due to psychiatric illness has been acknowledged to be crucial for research and practice. This led to the development of the mini-ICF-APP, which provides a reliable and time-efficient measure of functioning and impairment. Although its use is increasing, it remains unclear how it reflects severity and how change might be interpreted from a clinical perspective. Methods In a clinical sample of 3067 individuals hospitalized for mental health treatment, we used an equipercentile approach to link the mini-ICF-APP with the Clinical Global Impression scale (CGI) at admission and discharge. We linked the mini-ICF-APP sum score to the CGI-S scale and the mini-ICF-APP proportional change between admission and discharge to the CGI-I scale. Results The mini-ICF-APP and CGI scales showed a Spearman correlation of 0.50 (p < .000). CGI-S: “borderline-ill” corresponded to a mini-ICF-APP score 1–2; “mildly-ill” to 3–7; “moderately-ill” to 8–15; “markedly-ill” to 16–24; “severely-ill” to 25–37; and “extremely-ill” to a score ≥ 38. The Spearman correlation between the percentage change of mini-ICF-APP sum score and the CGI-I was 0.32 (p > .000); “no-change” in the CGI-I corresponded to an increase or decrease of 2%; “minimally-improved” to a mini-ICF-APP reduction of 3–30%; “much-improved” to a reduction of 31–63%; “very-much-improved” to a reduction of ≥64% “minimally-worse” to an increase of 3–34% “much-worse” to an increase of 35–67%; and finally “very-much-worse” with an increase of ≥68%. Conclusions Our findings improve understanding of the clinical meaning of the mini-ICF-APP sum score and percentage change in patients hospitalized for treatment.
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Affiliation(s)
- Stephan T Egger
- Centre for Integrative Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland. .,Department of Psychiatry, Faculty of Medicine, University of Oviedo, CIBERSAM, Oviedo, Spain.
| | - Godehard Weniger
- Centre for Integrative Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland
| | - Mario Müller
- Centre for Integrative Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland
| | - Julio Bobes
- Department of Psychiatry, Faculty of Medicine, University of Oviedo, CIBERSAM, Oviedo, Spain
| | - Erich Seifritz
- Centre for Integrative Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland
| | - Stefan Vetter
- Centre for Integrative Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland
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14
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Haddad PM, Correll CU. The acute efficacy of antipsychotics in schizophrenia: a review of recent meta-analyses. Ther Adv Psychopharmacol 2018; 8:303-318. [PMID: 30344997 PMCID: PMC6180374 DOI: 10.1177/2045125318781475] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 04/04/2018] [Indexed: 12/19/2022] Open
Abstract
Schizophrenia is the eighth leading cause of disability worldwide in people aged 15-44 years. Before antidopaminergic antipsychotics were introduced in the 1950s, no effective medications existed for the treatment of schizophrenia. This review summarizes key meta-analytic findings regarding antipsychotic efficacy in the acute treatment of schizophrenia, including clozapine in treatment-resistant patients. In the most comprehensive meta-analysis of randomized controlled trials conducted in multi-episode schizophrenia, antipsychotics outperformed placebo regarding total symptoms, positive symptoms, negative symptoms, depressive symptoms, quality of life and social functioning. Amongst these outcomes, the standardized mean difference for overall symptoms was largest, that is, 0.47 (95% credible interval = 0.42-0.51), approaching a medium effect size, being reduced to 0.38 when publication bias and small-trial effects were accounted for. A comparison of two meta-analyses indicated that first-episode patients, compared with multi-episode patients, were more likely to have at least minimal treatment response [⩾20% Positive and Negative Syndrome Scale (PANSS)/Brief Psychiatric Rating Scale (BPRS) score reduction: 81% versus 51%] and good response (⩾50% PANSS/BPRS score reduction: 52% versus 23%). In multi-episode schizophrenia, no response or worsening after 2 weeks of a therapeutic antipsychotic dose was highly predictive of not achieving a good response at endpoint (median treatment = 6 weeks: specificity = 86%; positive predictive value = 90%), suggesting a change in treatment should be considered in such cases. In first-episode psychosis, adequately dosed antipsychotic treatment trials for more than 2 weeks are recommended before using no response or worsening as a decision point for aborting a given antipsychotic. In clearly defined treatment-resistant schizophrenia, clozapine generally outperformed other antipsychotics, especially when dosed appropriately (target = 3-6 months' duration; trough clozapine level ⩾350-400 μg/L) with a response rate (⩾20% PANSS/BPRS) of 33% by 3 months of treatment. High antipsychotic doses and psychotropic combinations are unlikely to be superior to standard doses of antipsychotic monotherapy. Acute antipsychotic efficacy in schizophrenia depends on the targeted symptom domain (greater efficacy: total and positive symptoms, lesser efficacy: negative symptoms, depressive symptoms, social functioning and quality of life). Greater antipsychotic efficacy is associated with higher total baseline symptom severity, treatment-naïveté/first-episode status, shorter illness duration, and trials that are nonindustry sponsored and that have a lower placebo effect. The heterogeneity of antipsychotic response across individuals and key symptom domains, the considerable degree of nonresponse/treatment resistance in multi-episode patients, and the adverse effect potential of antipsychotics are major limitations, underscoring the need to develop new medications for the treatment of schizophrenia. Drug development should include matching patient subgroups, which are identified by means of clinical and biomarker variables, to mechanisms of action of novel medications, targeting specific symptom domains, and investigating mechanisms of action other than dopaminergic blockade.
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Affiliation(s)
- Peter M Haddad
- Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar. Neuroscience and Psychiatry Unit, University of Manchester, Stopford Building, Oxford Road, Manchester, UK
| | - Christoph U Correll
- The Zucker Hillside Hospital, Psychiatry Research, Glen Oaks, NY, USA Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, NY, USA Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
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15
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Eguchi R, Onozuka D, Ikeda K, Kuroda K, Ieiri I, Hagihara A. The relationship between fine particulate matter (PM 2.5) and schizophrenia severity. Int Arch Occup Environ Health 2018; 91:613-622. [PMID: 29682692 DOI: 10.1007/s00420-018-1311-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 04/18/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE Although particulate matter (PM) is reported to affect the rate of emergency admissions for schizophrenia, no study has examined the relationship between particulate matter less than 2.5 μm in diameter (PM2.5) and the severity of schizophrenia. METHODS We obtained data on patients with schizophrenia at a psychiatric hospital, and on air pollution in Sakai, Japan between Feb 1, 2013 and April 30, 2016. Multivariate logistic regression analyses were used to estimate the relationship between PM2.5 concentrations and scores on the Brief Psychiatric Rating Scale (BPRS) of schizophrenia patients at admission, with a lag of up to 7 days. RESULTS During the study period, there were 1193 schizophrenia cases. The odds ratio (OR) for a BPRS score ≥ 50 at admission was 1.05 [95% confidence interval 1.00-1.10] and the effect of PM2.5 concentration was significant for lag period of 2 days. The ORs associated with PM2.5 concentration increased substantially for patients over 65 years of age. CONCLUSIONS Ambient PM2.5 concentration was associated with exacerbation of schizophrenia. Our results suggest that protection for several days should be considered for controlling PM2.5-related schizophrenia, especially among elderly patients.
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Affiliation(s)
- Rika Eguchi
- Department of Health Services Management and Policy, Kyushu University Graduate School of Medicine, Higashi-ku, Fukuoka, 812-8582, Japan.,Department of Clinical Pharmacokinetics, Kyushu University Graduate School of Pharmaceutical Science, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Daisuke Onozuka
- Department of Health Services Management and Policy, Kyushu University Graduate School of Medicine, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Kouji Ikeda
- Hannan Hospital, 277 Handaminamino-cho, Naka-ku, Sakai, Osaka, 599-8263, Japan
| | - Kenji Kuroda
- Hannan Hospital, 277 Handaminamino-cho, Naka-ku, Sakai, Osaka, 599-8263, Japan
| | - Ichiro Ieiri
- Department of Clinical Pharmacokinetics, Kyushu University Graduate School of Pharmaceutical Science, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Akihito Hagihara
- Department of Health Services Management and Policy, Kyushu University Graduate School of Medicine, Higashi-ku, Fukuoka, 812-8582, Japan.
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16
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Positive symptoms are associated with clinicians' global impression in treatment-resistant schizophrenia. J Clin Psychopharmacol 2015; 35:237-41. [PMID: 25839337 DOI: 10.1097/jcp.0000000000000310] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Previous investigations on the relationship between global rating measures and symptoms have not considered the additional role of functioning. In this naturalistic study, we examined the relationship between symptom domains and functioning on Clinical Global Impression scales for severity (CGI-S) and improvement (CGI-I) in a sample of patients with schizophrenia assessed to be treatment resistant. Participants were patients with a diagnosis of schizophrenia or schizoaffective disorder who failed 2 prior antipsychotic trials and were considered candidates for clozapine. They were assessed on the 18-item Brief Psychiatric rating Scale (BPRS), Social Occupational Functioning Assessment Scale (SOFAS), and CGI-S at baseline. A subset of patients was followed up at 6 weeks after initiation of clozapine and assessed on the CGI-I. The independent effects of symptom domains and functioning on the CGI scales were examined via multivariate regression models. Brief Psychiatric rating Scale positive factor (P < 0.001) and SOFAS (P < 0.001) scores were significant determinants of CGI-S at baseline. Multivariate models suggested that relative change measures had a better fit for the CGI-I compared to absolute change measures (R = 0.72 vs R = 0.61, respectively). Improvements in BPRS positive (P < 0.001) and affect (P = 0.002) factors and SOFAS (P = 0.030) scores were significant determinants of CGI-I. Ratings of 1 and 2 on the CGI-I corresponded to a mean relative change in the BPRS total of 65% and 41%, respectively. Positive symptoms were a key determinant of clinicians' impression of severity and improvement in this study. Although psychosocial functioning played a large part in determining severity, it was not as significant in the assessment of improvement.
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Trajectories of medication attitudes and adherence behavior change in non-adherent bipolar patients. Compr Psychiatry 2015; 58:29-36. [PMID: 25617964 PMCID: PMC4369431 DOI: 10.1016/j.comppsych.2014.11.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 11/26/2014] [Accepted: 11/27/2014] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES While medication treatment is necessary for the successful management of bipolar disorder (BD), non-adherence rates are up to 60%. Although medication attitudes are believed to be relevant to adherence behavior, few studies have investigated the trajectories of adherence change. This study evaluated attitudinal correlates of adherence conversion in 86 poorly adherent individuals with BD. METHODS This secondary analysis pooled data from two uncontrolled prospective trials of customized adherence enhancement (CAE), a psychosocial intervention delivered over 4-6 weeks. Poor adherence was defined as missing at least 20% of prescribed BD medication based on the self-reported Tablets Routine Questionnaire (TRQ). The sample was dichotomized into converters who achieved good adherence (N=44) and non-converters who remained poorly adherent (N=21). Converters vs. non-converters were compared on adherence, attitudes, and symptoms at baseline, 6 weeks and 3 months. RESULTS At baseline, converters and non-converters were similar demographically and clinically, but converters were less non-adherent (32% doses missed) than non-converters (59% missed). At 6 weeks, converters had better attitudes than non-converters. At 3 months, converters maintained improvements, but group differences were less pronounced due to some improvement in non-converters. Converters had better adherence at 3 months and trajectories differed for the groups on attitudes. Symptoms gradually improved for both converters and non-converters. CONCLUSIONS Over two-thirds of poorly adherent BD patients who received CAE converted to good adherence. Improved medication attitudes may be a driver of improved adherence behavior and ultimately reduce BD symptoms.
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Relationship between symptomatic improvement and overall illness severity in patients with schizophrenia. J Clin Psychopharmacol 2015; 35:128-33. [PMID: 25679125 DOI: 10.1097/jcp.0000000000000286] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Whether improvement on ratings of global illness severity is differentially associated with improvement in specific symptom domains in patients with schizophrenia is not well understood. The present study examined the independent relationships between improvement in specific symptom clusters and change in global impressions of illness severity. METHODS This study included 589 patients with chronic schizophrenia who were assessed at baseline and after 6 months of antipsychotic treatment. Both clinicians and patients completed the Clinical Global Impressions-Severity of Illness Scale (CGI-S). Symptom severity was assessed using factor scores derived from the Positive and Negative Syndrome Scale. RESULTS Change in illness severity ratings made by the clinician and those made by the patient demonstrated moderate overlap. Nearly half of the patients were evaluated as clinically improved during the 6-month period, as rated by the clinician, with less than a third of patients experiencing a reduction in illness severity as determined by both the clinician and themselves. Improvements in clinician-rated CGI-S scores were most strongly associated with reduction in positive symptom severity. In contrast, change in patient-rated CGI-S scores was not linked to reduction in positive symptoms but rather to improvement in depressive and anxiety symptoms. This latter finding remained in a subsample of patients with relatively preserved insight into illness, suggesting that lack of insight cannot account for these findings. Finally, reduction in positive symptoms beyond 2 to 3 points was found to be clinically meaningful. CONCLUSIONS In conclusion, change in overall illness severity, as determined by clinicians, is not necessarily interchangeable with patients' view of improvement of their own clinical status. Moreover, changes in the 2 evaluations of illness severity are associated with changes in different symptom domains.
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Samara MT, Engel RR, Millier A, Kandenwein J, Toumi M, Leucht S. Equipercentile linking of scales measuring functioning and symptoms: examining the GAF, SOFAS, CGI-S, and PANSS. Eur Neuropsychopharmacol 2014; 24:1767-72. [PMID: 25219937 DOI: 10.1016/j.euroneuro.2014.08.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 08/11/2014] [Accepted: 08/13/2014] [Indexed: 10/24/2022]
Abstract
The Global Assessment of Functioning (GAF) and the Social and Occupational Functioning Assessment Scale (SOFAS) are rating scales commonly used to assess the level of functioning in patients with schizophrenia. To understand the correspondence of scores between GAF and SOFAS, and what they mean from a clinical point of view, we examined the linkage of (a) GAF with SOFAS total scores, (b) GAF with Clinical Global Impressions Scale (CGI) and Positive and Negative Syndrome Scale (PANSS), and (c) SOFAS with CGI and PANSS. We used the equipercentile linking method to identify corresponding scores of simultaneous GAF, SOFAS, PANSS and CGI ratings in 1208 patients from a naturalistic European cohort study. Data were collected at baseline and at months 6, 12, 18 and 24. GAF and SOFAS total scores were found to be practically exchangeable. Both scales had strong negative correlations with CGI and PANSS; the linkage also suggested the presence of slight impairment in functioning even when patients are free from symptoms. These findings are important for the comparison of scores when different rating scales are used. We present a detailed conversion table in an online supplement.
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Affiliation(s)
- Myrto T Samara
- Department of Psychiatry and Psychotherapy, Technische Universität München, Klinikum rechts der Isar, Ismaningerstr. 22, 81675 Munich, Germany
| | - Rolf R Engel
- Psychiatrische Klinik der Ludwig-Maximilian-Universität München, Nussbaumstrasse 7, 80336 Munich, Germany
| | - Aurelie Millier
- Creativ-Ceutical, 215 rue du Faubourg St-Honoré, 75008 Paris, France
| | - Julia Kandenwein
- Medical Therapeutic Area Lead Neuroscience and Rheumatology, Roche Pharma AG, Medical Management Specialty Care, Emil-Barell-Str.1, 79639 Grenzach-Wyhlen, Bau 200, 3-N.10, Germany
| | - Mondher Toumi
- Aix Marseille University, Faculté de Médecine, Laboratoire de Santé Publique, 27 bd Jean Moulin, 13385 Marseille Cedex 05, France
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, Technische Universität München, Klinikum rechts der Isar, Ismaningerstr. 22, 81675 Munich, Germany.
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Lepping P, Schönfeldt-Lecuona C, Sambhi RS, Lanka SVN, Lane S, Whittington R, Leucht S, Poole R. A systematic review of the clinical relevance of repetitive transcranial magnetic stimulation. Acta Psychiatr Scand 2014; 130:326-41. [PMID: 24724996 DOI: 10.1111/acps.12276] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/20/2014] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Repetitive transcranial magnetic stimulation (rTMS) is an approved treatment for depression. The clinical relevance of its efficacy is unclear. The clinical relevance of findings in the rTMS literature was assessed by translating Hamilton Depression Rating Scale (HAMD) data into Clinical Global Impression-Improvement scale (CGI-I) scores. METHOD We performed electronic searches of MEDLINE, Embase, PsycINFO, PubMed and Cochrane Central Register of Controlled Trials for RCTs and non-RCT trials on rTMS using Hamilton Depression Rating Scale (HAMD). Articles were included if published in English before January 2014. We translated HAMD scores into nominal CGI-I scores for rTMS for depression and for treatment-resistant depression (TRD). RESULTS About 960 abstracts were retrieved. Sixty-three studies were included, yielding 130 study arms. For depression, the mean percentage change in HAMD scores in all sham-controlled rTMS treatment arms was 35.63 (SD 16.35) and for sham-rTMS 23.33 (SD 16.51). For TRD, active rTMS in sham-controlled studies showed a mean HAMD percentage reduction of 45.21 (SD 10.94) versus 25.04 (SD 17.55) for sham-rTMS. When aggregated scores were translated into notional CGI-I scores, for the treatment of depression, the notional CGI-I score difference between rTMS and sham-rTMS was 0.5 in favour of rTMS; for TRD, it was 0.75 in favour of rTMS. Differences between rTMS and sham-rTMS were bigger when all study arms were combined. CONCLUSION Whilst rTMS appears to be efficacious for both non-refractory and treatment-resistant depression, the clinical relevance of its efficacy is doubtful.
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Affiliation(s)
- P Lepping
- Department of Psychiatry, Betsi Cadwaladr University Health Board, North Wales, UK; Centre for Mental Health and Society, Bangor University, Wrexham, Wales, UK
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Samara MT, Cao H, Helfer B, Davis JM, Leucht S. Chlorpromazine versus every other antipsychotic for schizophrenia: a systematic review and meta-analysis challenging the dogma of equal efficacy of antipsychotic drugs. Eur Neuropsychopharmacol 2014; 24:1046-55. [PMID: 24766970 DOI: 10.1016/j.euroneuro.2014.03.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 03/27/2014] [Accepted: 03/30/2014] [Indexed: 10/25/2022]
Abstract
It is one of the major psychiatric dogmas that the efficacy of all antipsychotic drugs is same. This statement originated from old, narrative reviews on first-generation antipsychotics, but this old literature has never been meta-analysed. We therefore conducted a meta-analysis of randomised controlled trials on the efficacy of chlorpromazine versus any other antipsychotic in the treatment of schizophrenia. If the benchmark drug chlorpromazine were significantly more or less effective than other antipsychotics, the notion of equal efficacy would have to be rejected. We searched the Cochrane Schizophrenia Group׳s specialized register, MEDLINE, EMBASE, PsychInfo and reference lists of relevant articles. The primary outcome was response to treatment. We also analyzed mean values of schizophrenia rating scales at endpoint and drop-out rates. 128, mostly small, RCTs with 10667 participants were included. Chlorpromazine was compared with 43 other antipsychotics and was more efficacious than four (butaperazine, mepazine, oxypertine and reserpine) and less efficacious than other four antipsychotics (clomacran, clozapine, olanzapine and zotepine) in the primary outcome. There were no statistically significant efficacy differences between chlorpromazine and the remaining 28 antipsychotics. The most important finding was that, due to low numbers of participants (median 50, range 8-692), most comparisons were underpowered. Thus we infer that the old antipsychotic drug literature was inconclusive and the claim for equal efficacy of antipsychotics was never evidence-based. Recent meta-analyses on second-generation antipsychotics were in a better position to address this question and small, but consistent differences between drugs were found.
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Affiliation(s)
- Myrto T Samara
- Department of Psychiatry and Psychotherapy, Technische Universität München, Klinikum Rechts der Isar, Ismaningerstr. 22, 81675 Munich, Germany
| | - Haoyin Cao
- Department of Psychology, Neuro-Cognitive Psychology, Ludwig-Maximilians-Universität München, Germany; Klinik und Poliklinik für Psychiatrie und Psychotherapie der Technischen Universität München, Klinikum rechts der Isar, München, Germany
| | - Bartosz Helfer
- Department of Psychology, Neuro-Cognitive Psychology, Ludwig-Maximilians-Universität München, Germany; Klinik und Poliklinik für Psychiatrie und Psychotherapie der Technischen Universität München, Klinikum rechts der Isar, München, Germany
| | - John M Davis
- Psychiatric Institute, University of Illinois at Chicago, 1601 W. Taylor St., Chicago, IL 60612, USA; Maryland Psychiatric Research Center, Baltimore, MD, USA
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, Technische Universität München, Klinikum Rechts der Isar, Ismaningerstr. 22, 81675 Munich, Germany.
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Zahreddine N, Hady RT, Chammai R, Kazour F, Hachem D, Richa S. Psychiatric morbidity, phenomenology and management in hospitalized female foreign domestic workers in Lebanon. Community Ment Health J 2014; 50:619-28. [PMID: 24370752 DOI: 10.1007/s10597-013-9682-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 12/03/2013] [Indexed: 11/26/2022]
Abstract
40 million female domestic workers worldwide experience the inhumane conditions associated with this unregulated occupation, a situation that induces psychiatric morbidities in many. The case in Lebanon is not any better where it is estimated that one foreign domestic worker (FDW) commits suicide weekly. 33 female FDW and 14 female Lebanese (control group, CG) were enrolled. Brief Psychotic Rating Scale (BPRS) and Clinical Global Impression (CGI) scales were administered on admission and discharge and socio-demographic, living conditions, mental health care data and phenomenological observations were collected. Sexual, physical, and verbal abuses were detected in FDW (12.5, 37.5, and 50.0 %. respectively). 66.7 % of them were diagnosed with brief psychotic episode. The mean duration of hospital stay (13.1 days) was significantly lower in the FDW group. The mean cumulative antipsychotic dose of the FDW was 337.1 mg of chlorpromazine equivalent and the mean BPRS total pre-score of FDW was 66.4 with a much improved state on the CGI global improvement scale, all of which were nonsignificantly different from the CG. Striking phenomenological findings among FDW were acute anorexia (39.4 %), nudity (30.3 %), catatonic features (21.2 %), and delusion of pregnancy (12.1 %). Inpatient FDW are more diagnosed with psychotic than affective disorders and receive approximately similar treatment as controls in spite of the trend to rapidly discharge and deport the worker to limit the costs. Both groups presented with similar severity, although the FDW had peculiar phenomenological observations.
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Affiliation(s)
- Nada Zahreddine
- Department of Psychiatry, Saint-Joseph University, Beirut, Lebanon,
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Identifying clinically meaningful symptom response cut-off values on the SANS in predominant negative symptoms. Schizophr Res 2013; 145:125-7. [PMID: 23394742 DOI: 10.1016/j.schres.2012.12.032] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 12/19/2012] [Accepted: 12/26/2012] [Indexed: 11/20/2022]
Abstract
BACKGROUND The treatment and measurement of negative symptoms are currently at issue in schizophrenia, but the clinical meaning of symptom severity and change is unclear. AIM To offer a clinically meaningful interpretation of severity and change scores on the Scale for the Assessment of Negative Symptoms (SANS). METHOD Patients were intention-to-treat participants (n=383) in two double-blind randomized placebo-controlled clinical trials that compared amisulpride with placebo for the treatment of predominant negative symptoms. Equipercentile linking was used to examine extrapolation from (a) CGI-S to SANS severity ratings, and (b) CGI-I to SANS percentage change (n=383). Linking was conducted at baseline, 8-14 days, 28-30 days, and 56-60 days of the trials. RESULTS Across visits, CGI-S ratings of 'not ill' linked to SANS scores of 0-13, and ranged to 'extreme' ratings that linked to SANS scores of 102-105. The relationship between the CGI-S and the SANS severity scores assumed a linear trend (1=0-13, 2=15-56, 3=37-61, 4=49-66, 5=63-75, 6=79-89, 7=102-105). Similarly the relationship between CGI-I ratings and SANS percentage change followed a linear trend. For instance, CGI-I ratings of 'very much improved' were linked to SANS percent changes of -90 to -67, 'much improved' to -50 to -42, and 'minimally improved' to -21 to -13. CONCLUSIONS The current results uniquely contribute to the debate surrounding negative symptoms by providing clinical meaning to SANS severity and change scores and so offer direction regarding clinically meaningful response cut-off scores to guide treatment targets of predominant negative symptoms.
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