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Khosravani V, Sharifibastan F, Aghaeimazraji M, Berk M, Samimi Ardestani SM. The contribution of alexithymia, childhood maltreatment, impulsivity, C-reactive protein, lipid profile, and thyroid hormones to aggression and psychological distress (depression and anxiety) in schizophrenia. Psychoneuroendocrinology 2024; 167:107087. [PMID: 38820716 DOI: 10.1016/j.psyneuen.2024.107087] [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: 03/03/2024] [Revised: 05/22/2024] [Accepted: 05/23/2024] [Indexed: 06/02/2024]
Abstract
There are individual effects of alexithymia, childhood maltreatment, impulsivity, and some biological markers on aggression and psychological distress in schizophrenia. However, the combined effects of these psychological and biological markers have not yet been fully studied. This study therefore aimed to investigate the influence of these psychological and biological markers on aggression and psychological distress (e.g., depression and anxiety) in inpatients with schizophrenia (n = 355). Participants completed self-report and clinician-rated scales, and blood samples were collected. There were no significant differences between patients with and without alexithymia regarding biological markers. Patients with childhood maltreatment exhibited higher levels of free triiodothyronine (FT3) and C-reactive protein (CRP), as well as lower total cholesterol (TC) levels, compared to non-traumatized individuals. Aggression was positively predicted by psychological distress, alexithymia, childhood maltreatment, impulsivity, CRP, and FT3, and negatively by TC and low-density lipoprotein cholesterol. Negative symptoms, childhood maltreatment, alexithymia, aggression, and CRP positively, and high-density lipoprotein cholesterol negatively emerged as predictors of psychological distress. The study highlights the connections between childhood maltreatment, alexithymia, impulsivity, and potentially related biological dysregulation in explaining aggression and negative mood states as a bio-psychological model of aggression and mood in schizophrenia.
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Affiliation(s)
- Vahid Khosravani
- Behavioral Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Farangis Sharifibastan
- Behavioral Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Psychosocial Science, University of Bergen, Norway
| | - Morteza Aghaeimazraji
- Department of Clinical Psychology, Faculty of Psychology and Educational Sciences, Semnan University, Semnan, Iran
| | - Michael Berk
- Deakin University, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Victoria, Australia; University of Melbourne, Florey Institute for Neuroscience and Mental Health, Melbourne, Victoria, Australia; University of Melbourne, Department of Psychiatry, Royal Melbourne Hospital, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia; Orygen, Parkville, Victoria, Australia
| | - Seyed Mehdi Samimi Ardestani
- Department of Psychiatry, Behavioral Sciences Research Center, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Davidson M, Carpenter WT. Targeted Treatment of Schizophrenia Symptoms as They Manifest, or Continuous Treatment to Reduce the Risk of Psychosis Recurrence. Schizophr Bull 2024; 50:14-21. [PMID: 37929893 PMCID: PMC10754173 DOI: 10.1093/schbul/sbad145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Current pharmacological treatment of schizophrenia employs drugs that interfere with dopamine neurotransmission, aiming to suppress acute exacerbation of psychosis and maintenance treatment to reduce the risk of psychosis recurrence. According to this treatment scheme, available psychotropic drugs intended to treat negative symptoms, cognitive impairment, or anxiety are administered as add-ons to treatment with antipsychotics. However, an alternative treatment scheme proposes a targeted or intermittent treatment approach, by which antipsychotic drugs are administered upon psychosis exacerbation and discontinued upon remission or stabilization, while negative symptoms, cognitive impairment, or anxiety are treated with specific psychotropics as monotherapy. Along these lines, antipsychotics are renewed only in the event of recurrence of psychotic symptoms. This 50-year-old debate between targeted and continuous treatment schemes arises from disagreements about interpreting scientific evidence and discordant views regarding benefit/risk assessment. Among the debate's questions are: (1) what is the percentage of individuals who can maintain stability without antipsychotic maintenance treatment, and what is the percentage of those who exacerbate despite antipsychotic treatment? (2) how to interpret results of placebo-controlled 9- to 18-month-long maintenance trials in a life-long chronic disorder, and how to interpret results of the targeted trials, some of which are open label or not randomized; (3) how to weigh the decreased risk for psychotic recurrence vs the almost certainty of adverse effects on patient's quality of life. Patients' profiles, preferences, and circumstances of the care provision should be considered as the targeted vs continuous treatment options are considered.
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Affiliation(s)
- Michael Davidson
- Department of Basic and Clinical Sciences, Psychiatry, University of Nicosia Medical School, 2414, Nicosia, Cyprus and Minerva Neurosciences, 1500 District Avenue, Burlington, MA 01803, USA
| | - William T Carpenter
- University of Maryland School of Medicine, Department of Psychiatry, Maryland Psychiatric Research Center, Baltimore, MD, USA
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3
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Misdrahi D, Dupuy M, Dansou Y, Boyer L, Berna F, Capdevielle D, Chereau I, Coulon N, D'Amato T, Dubertret C, Leignier S, Llorca PM, Lançon C, Mallet J, Passerieux C, Pignon B, Rey R, Schürhoff F, Swendsen J, Urbach M, Szöke A, Godin O, Fond G. Predictors of medication adherence in a large 1-year prospective cohort of individuals with schizophrenia: insights from the multicentric FACE-SZ dataset. Transl Psychiatry 2023; 13:341. [PMID: 37935695 PMCID: PMC10630458 DOI: 10.1038/s41398-023-02640-x] [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: 03/28/2023] [Revised: 10/19/2023] [Accepted: 10/26/2023] [Indexed: 11/09/2023] Open
Abstract
Schizophrenia is characterized by the most salient medication adherence problems among severe mental disorders, but limited prospective data are available to predict and improve adherence in this population. This investigation aims to identify predictors of medication adherence over a 1-year period in a large national cohort using clustering analysis. Outpatients were recruited from ten Schizophrenia Expert Centers and were evaluated with a day-long standardized battery including clinician and patient-rated medication adherence measures. A two-step cluster analysis and multivariate logistic regression were conducted to identify medication adherence profiles based on the Medication Adherence rating Scale (MARS) and baseline predictors. A total of 485 participants were included in the study and medication adherence was significantly improved at the 1-year follow-up. Higher depressive scores, lower insight, history of suicide attempt, younger age and alcohol use disorder were all associated with poorer adherence at 1 year. Among the 203 patients with initially poor adherence, 86 (42%) switched to good adherence at the 1-year follow-up, whereas 117 patients (58%) remained poorly adherent. Targeting younger patients with low insight, history of suicide, alcohol use disorder and depressive disorders should be prioritized through literacy and educational therapy programs. Adherence is a construct that can vary considerably from year to year in schizophrenia, and therefore may be amenable to interventions for its improvement. However, caution is also warranted as nearly one in five patients with initially good adherence experienced worsened adherence 1 year later.
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Affiliation(s)
- David Misdrahi
- Fondation FondaMental, F-94010, Créteil, France.
- University of Bordeaux, Aquitaine Institute for Cognitive and Integrative Neuroscience (CNRS UMR 5287-INCIA), Bordeaux, France.
- Department of Adult Psychiatry, Charles Perrens Hospital, Bordeaux, France.
| | - Maud Dupuy
- Fondation FondaMental, F-94010, Créteil, France
- University of Bordeaux, Aquitaine Institute for Cognitive and Integrative Neuroscience (CNRS UMR 5287-INCIA), Bordeaux, France
| | - Yecodji Dansou
- Fondation FondaMental, F-94010, Créteil, France
- Université Paris-Est-Créteil (UPEC), AP-HP, Hôpitaux Universitaires "H. Mondor", DMU IMPACT, INSERM, IMRB, Translational Neuropsychiatry, Bordeaux, France
| | - Laurent Boyer
- Fondation FondaMental, F-94010, Créteil, France
- AP-HM, Aix-Marseille Univ, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, 27 Boulevard Jean Moulin, 13005, Marseille, France
| | - Fabrice Berna
- Fondation FondaMental, F-94010, Créteil, France
- Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - Delphine Capdevielle
- Fondation FondaMental, F-94010, Créteil, France
- Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, CHRU Montpellier, Université Montpellier 1, Inserm 1061, Montpellier, France
| | - Isabelle Chereau
- Fondation FondaMental, F-94010, Créteil, France
- University of Clermont Auvergne, CMP-B CHU, CNRS, Clermont Auvergne INP, Institut Pascal, F-63000, Clermont-Ferrand, France
| | - Nathalie Coulon
- Fondation FondaMental, F-94010, Créteil, France
- Centre Référent de Réhabilitation Psychosociale et de Remédiation Cognitive (C3R), CH Alpes Isère, Bordeaux, France
| | - Thierry D'Amato
- Fondation FondaMental, F-94010, Créteil, France
- INSERM U1028, CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon, Université Claude Bernard Lyon 1, Equipe PSYR2, Centre Hospitalier Le Vinatier, Pole Est, 95 bd Pinel, BP 30039, 69678, Bron Cedex, France
| | - Caroline Dubertret
- Fondation FondaMental, F-94010, Créteil, France
- AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France
- Université Paris Cité, INSERM UMR1266, Institute of Psychiatry and Neuroscience of Paris, Paris, France
| | - Sylvain Leignier
- Fondation FondaMental, F-94010, Créteil, France
- Centre Référent de Réhabilitation Psychosociale et de Remédiation Cognitive (C3R), CH Alpes Isère, Bordeaux, France
| | - Pierre Michel Llorca
- Fondation FondaMental, F-94010, Créteil, France
- University of Clermont Auvergne, CMP-B CHU, CNRS, Clermont Auvergne INP, Institut Pascal, F-63000, Clermont-Ferrand, France
| | - Christophe Lançon
- Fondation FondaMental, F-94010, Créteil, France
- AP-HM, Aix-Marseille Univ, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, 27 Boulevard Jean Moulin, 13005, Marseille, France
| | - Jasmina Mallet
- Fondation FondaMental, F-94010, Créteil, France
- AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France
- Université Paris Cité, INSERM UMR1266, Institute of Psychiatry and Neuroscience of Paris, Paris, France
| | - Christine Passerieux
- Fondation FondaMental, F-94010, Créteil, France
- Versailles Hospital, Department of Adult Psychiatry and Addictology, Centre Hospitalier de Versailles, 177 rue de Versailles, 78157, Le Chesnay, France
- DisAP-DevPsy-CESP, INSERM UMR1018, University of Paris-Saclay, University of Versailles Saint-Quentin-En-Yvelines, 94807, Villejuif, France
| | - Baptiste Pignon
- Fondation FondaMental, F-94010, Créteil, France
- Université Paris-Est-Créteil (UPEC), AP-HP, Hôpitaux Universitaires "H. Mondor", DMU IMPACT, INSERM, IMRB, Translational Neuropsychiatry, Bordeaux, France
| | - Romain Rey
- Fondation FondaMental, F-94010, Créteil, France
- INSERM U1028, CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon, Université Claude Bernard Lyon 1, Equipe PSYR2, Centre Hospitalier Le Vinatier, Pole Est, 95 bd Pinel, BP 30039, 69678, Bron Cedex, France
| | - Franck Schürhoff
- Fondation FondaMental, F-94010, Créteil, France
- Université Paris-Est-Créteil (UPEC), AP-HP, Hôpitaux Universitaires "H. Mondor", DMU IMPACT, INSERM, IMRB, Translational Neuropsychiatry, Bordeaux, France
| | - Joel Swendsen
- Fondation FondaMental, F-94010, Créteil, France
- University of Bordeaux, Aquitaine Institute for Cognitive and Integrative Neuroscience (CNRS UMR 5287-INCIA), Bordeaux, France
| | - Mathieu Urbach
- Fondation FondaMental, F-94010, Créteil, France
- Versailles Hospital, Department of Adult Psychiatry and Addictology, Centre Hospitalier de Versailles, 177 rue de Versailles, 78157, Le Chesnay, France
- DisAP-DevPsy-CESP, INSERM UMR1018, University of Paris-Saclay, University of Versailles Saint-Quentin-En-Yvelines, 94807, Villejuif, France
| | - Andrei Szöke
- Fondation FondaMental, F-94010, Créteil, France
- Université Paris-Est-Créteil (UPEC), AP-HP, Hôpitaux Universitaires "H. Mondor", DMU IMPACT, INSERM, IMRB, Translational Neuropsychiatry, Bordeaux, France
| | - Ophélia Godin
- Fondation FondaMental, F-94010, Créteil, France
- Université Paris-Est-Créteil (UPEC), AP-HP, Hôpitaux Universitaires "H. Mondor", DMU IMPACT, INSERM, IMRB, Translational Neuropsychiatry, Bordeaux, France
| | - Guillaume Fond
- Fondation FondaMental, F-94010, Créteil, France
- AP-HM, Aix-Marseille Univ, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, 27 Boulevard Jean Moulin, 13005, Marseille, France
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4
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Stabell L, Johnsen E, Kroken RA, Løberg E, Blindheim A, Joa I, Reitan S, Rettenbacher M, Munk-Jørgensen P, Gjestad R. Clinical insight among persons with schizophrenia spectrum disorders treated with amisulpride, aripiprazole or olanzapine: a semi-randomised trial. BMC Psychiatry 2023; 23:482. [PMID: 37386462 PMCID: PMC10311854 DOI: 10.1186/s12888-023-04981-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 06/22/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Antipsychotic treatment may improve clinical insight. However, previous studies have reported inconclusive findings on whether antipsychotics improve insight over and above the reduction in symptoms of psychosis. These studies assessed homogeneous samples in terms of stage of illness. Randomised studies investigating a mixed population of first- and multiepisode schizophrenia spectrum disorders might clarify this disagreement. METHODS Our data were derived from a pragmatic, rater-blinded, semi-randomised trial that compared the effectiveness of amisulpride, aripiprazole and olanzapine. A sample of 144 patients with first- or multiepisode schizophrenia spectrum disorders underwent eight assessments during a 1-year follow-up. Clinical insight was assessed by item General 12 from the Positive and Negative Syndrome Scale (PANSS). We analysed latent growth curve models to test if the medications had a direct effect on insight that was over and above the reduction in total psychosis symptoms. Furthermore, we investigated whether there were differences between the study drugs in terms of insight. RESULTS Based on allocation analysis, all three drugs were associated with a reduction in total psychosis symptoms in the initial phase (weeks 0-6). Amisulpride and olanzapine were associated with improved insight over and above what was related to the reduction in total psychosis symptoms in the long-term phase (weeks 6-52). However, these differential effects were lost when only including the participants that chose the first drug in the randomisation sequence. We found no differential effect on insight among those who were antipsychotic-naïve and those who were previously medicated with antipsychotics. CONCLUSIONS Our results suggest that antipsychotic treatment improves insight, but whether the effect on insight surpasses the effect of reduced total psychosis symptoms is more uncertain. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01446328, 05.10.2011.
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Affiliation(s)
- L.A Stabell
- Division of Psychiatry and NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Research Department, Sandviken sykehus, Haukeland University Hospital, P. Box 1400, Bergen, 5021 Norway
| | - E. Johnsen
- Division of Psychiatry and NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - R. A Kroken
- Division of Psychiatry and NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - E.M. Løberg
- Division of Psychiatry and NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway
- Faculty of Psychology, Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - A. Blindheim
- Division of Psychiatry and NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway
| | - I. Joa
- Network for Clinical Research in psychosis, TIPS, Stavanger University Hospital, Stavanger, Norway
- Faculty of Health, Network for Medical Sciences, University of Stavanger, Stavanger, Norway
| | - S.K. Reitan
- Department of Mental Health, St. Olav University Hospital, Trondheim, Norway
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - M. Rettenbacher
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innrain 52, Innsbruck, Austria
| | - P. Munk-Jørgensen
- Department of Psychiatry, University of Southern Denmark, Odense, Denmark
| | - R. Gjestad
- Division of Psychiatry and NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway
- Centre for Research and Education in Forensic psychiatry, Haukeland University Hospital, Bergen, Norway
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5
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Kim J, Song J, Kambari Y, Plitman E, Shah P, Iwata Y, Caravaggio F, Brown EE, Nakajima S, Chakravarty MM, De Luca V, Remington G, Graff-Guerrero A, Gerretsen P. Cortical thinning in relation to impaired insight into illness in patients with treatment resistant schizophrenia. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:27. [PMID: 37120642 PMCID: PMC10148890 DOI: 10.1038/s41537-023-00347-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 03/12/2023] [Indexed: 05/01/2023]
Abstract
Impaired insight into illness is a common element of schizophrenia that contributes to treatment nonadherence and negative clinical outcomes. Previous studies suggest that impaired insight may arise from brain abnormalities. However, interpretations of these findings are limited due to small sample sizes and inclusion of patients with a narrow range of illness severity and insight deficits. In a large sample of patients with schizophrenia, the majority of which were designated as treatment-resistant, we investigated the associations between impaired insight and cortical thickness and subcortical volumes. A total of 94 adult participants with a schizophrenia spectrum disorder were included. Fifty-six patients (60%) had treatment-resistant schizophrenia. The core domains of insight were assessed with the VAGUS insight into psychosis scale. We obtained 3T MRI T1-weighted images, which were analysed using CIVET and MAGeT-Brain. Whole-brain vertex-wise analyses revealed impaired insight, as measured by VAGUS average scores, was related to cortical thinning in left frontotemporoparietal regions. The same analysis in treatment-resistant patients showed thinning in the same regions, even after controlling for age, sex, illness severity, and chlorpromazine antipsychotic dose equivalents. No association was found in non-treatment-resistant patients. Region-of-interest analyses revealed impaired general illness awareness was associated with cortical thinning in the left supramarginal gyrus when controlling for covariates. Reduced right and left thalamic volumes were associated with VAGUS symptom attribution and awareness of negative consequences subscale scores, respectively, but not after correction for multiple testing. Our results suggest impaired insight into illness is related to cortical thinning in left frontotemporoparietal regions in patients with schizophrenia, particularly those with treatment resistance where insight deficits may be more chronic.
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Affiliation(s)
- Julia Kim
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Jianmeng Song
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Yasaman Kambari
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Eric Plitman
- Cerebral Imaging Centre, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Parita Shah
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Yusuke Iwata
- University of Yamanashi, Faculty of Medicine, Department of Neuropsychiatry, Yamanashi, Japan
| | - Fernando Caravaggio
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Eric E Brown
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, CAMH, Toronto, ON, Canada
- Geriatric Mental Health Division, CAMH, Toronto, ON, Canada
| | - Shinichiro Nakajima
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - M Mallar Chakravarty
- Cerebral Imaging Centre, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Department of Biomedical Engineering, McGill University, Montreal, QC, Canada
| | - Vincenzo De Luca
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Biomedical Engineering, McGill University, Montreal, QC, Canada
| | - Gary Remington
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, CAMH, Toronto, ON, Canada
- Schizophrenia Division, CAMH, Toronto, ON, Canada
| | - Ariel Graff-Guerrero
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Geriatric Mental Health Division, CAMH, Toronto, ON, Canada
- Schizophrenia Division, CAMH, Toronto, ON, Canada
| | - Philip Gerretsen
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
- Geriatric Mental Health Division, CAMH, Toronto, ON, Canada.
- Schizophrenia Division, CAMH, Toronto, ON, Canada.
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6
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Roux P, Faivre N, Urbach M, Aouizerate B, Brunel L, Capdevielle D, Chereau I, Dubertret C, Dubreucq J, Fond G, Lançon C, Leignier S, Mallet J, Misdrahi D, Pires S, Schneider P, Schurhoff F, Yazbek H, Zinetti-Bertschy A, Passerieux C, Brunet-Gouet E. Relationships between neuropsychological performance, insight, medication adherence, and social metacognition in schizophrenia. Schizophr Res 2023; 252:48-55. [PMID: 36623435 DOI: 10.1016/j.schres.2022.12.037] [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: 09/29/2021] [Revised: 08/24/2022] [Accepted: 12/28/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Social metacognition is still poorly understood in schizophrenia, particularly its neuropsychological basis and its impact on insight and medication adherence. We therefore quantified social metacognition as the agreement between objective and subjective mentalization and assessed its correlates in a sample of individuals with schizophrenia spectrum disorders. METHODS Participants consisted of 143 patients with schizophrenia or schizoaffective disorders who underwent a metacognitive version of a mentalization task, an extensive neuropsychological battery, and a clinical evaluation to assess their insight into illness and medication adherence. We studied potential interactions between confidence judgments and several neuropsychological and clinical variables on mentalization accuracy with mixed-effects multiple logistic regressions. RESULTS Confidence judgments were closely associated with mentalization accuracy, indicative of good social metacognition in this task. Working memory, visual memory, and reasoning and problem-solving were the three neuropsychological dimensions positively associated with metacognition. By contrast, the two measures of medication adherence were associated with poorer metacognition, whereas no association was found between metacognition and clinical insight. The multiple regression model showed a significant positive impact of better working memory, older age at onset, longer duration of hospitalization, and worse medication adherence on social metacognition. CONCLUSIONS We discuss possible mechanisms underlying the apparent association between social metacognition and working memory. Adherence should be monitored when remediating social metacognition, and psychoeducation should be given to patients with a high level of awareness of their capacity to mentalize.
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Affiliation(s)
- Paul Roux
- Fondation Fondamental, Créteil, France; Centre Hospitalier de Versailles, Service Hospitalo-Universitaire de Psychiatrie d'Adultes et d'Addictologie, Le Chesnay, France; Université Paris-Saclay, Université Versailles Saint-Quentin-En-Yvelines, DisAP-DevPsy-CESP, INSERM UMR1018, 94807 Villejuif, France.
| | - Nathan Faivre
- Univ. Grenoble Alpes, Univ. Savoie Mont Blanc, CNRS, LPNC, 38000 Grenoble, France
| | - Mathieu Urbach
- Fondation Fondamental, Créteil, France; Centre Hospitalier de Versailles, Service Hospitalo-Universitaire de Psychiatrie d'Adultes et d'Addictologie, Le Chesnay, France; Université Paris-Saclay, Université Versailles Saint-Quentin-En-Yvelines, DisAP-DevPsy-CESP, INSERM UMR1018, 94807 Villejuif, France
| | - Bruno Aouizerate
- Fondation Fondamental, Créteil, France; Department of Adult Psychiatry, Charles Perrens Hospital, F-33076 Bordeaux, France; Laboratory of Nutrition and Integrative Neurobiology (UMR INRA 1286), University of Bordeaux, France
| | - Lore Brunel
- Fondation Fondamental, Créteil, France; INSERM U955, Translational Psychiatry Team, AP-HP Mondor University Hospital, DHU Pe-PSY, Schizophrenia Expert Center, 40 rue de Mesly, 94000 Creteil, France
| | - Delphine Capdevielle
- Fondation Fondamental, Créteil, France; University Department of Adult Psychiatry, Hospital La Colombière, CHU Montpellier, France; INSERM, Univ Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France; University of Montpellier, Montpellier, France
| | - Isabelle Chereau
- Fondation Fondamental, Créteil, France; CHU Clermont-Ferrand, Service de Psychiatrie B, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Caroline Dubertret
- Fondation Fondamental, Créteil, France; AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France; Inserm UMR1266, Institute of Psychiatry and Neuroscience of Paris, Paris Descartes University, France; Université Paris Diderot, Sorbonne Paris Cité, Faculté de Médecine, France
| | - Julien Dubreucq
- Fondation Fondamental, Créteil, France; Psychosocial Rehabilitation Reference Centre, Alpes Isère Hospital, Grenoble, France
| | - Guillaume Fond
- Fondation Fondamental, Créteil, France; La Conception Hospital, AP-HM, Aix-Marseille Univ, School of Medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, 27 Boulevard Jean Moulin, 13005 Marseille, France
| | - Christophe Lançon
- Fondation Fondamental, Créteil, France; Ste Marguerite Hospital, AP-HM, Aix-Marseille Univ, School of Medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, 27 Boulevard Jean Moulin, 13005 Marseille, France
| | - Sylvain Leignier
- Fondation Fondamental, Créteil, France; Psychosocial Rehabilitation Reference Centre, Alpes Isère Hospital, Grenoble, France
| | - Jasmina Mallet
- Fondation Fondamental, Créteil, France; University Department of Adult Psychiatry, Hospital La Colombière, CHU Montpellier, France
| | - David Misdrahi
- Fondation Fondamental, Créteil, France; Department of Adult Psychiatry, Charles Perrens Hospital, F-33076 Bordeaux, France; University of Bordeaux, CNRS UMR 5287-INCIA, Bordeaux, France
| | - Sylvie Pires
- Fondation Fondamental, Créteil, France; CHU Clermont-Ferrand, Service de Psychiatrie B, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Priscille Schneider
- Fondation Fondamental, Créteil, France; University Hospital of Strasbourg, Department of Psychiatry, University of Strasbourg, Strasbourg, France; Inserm U1114, Strasbourg, France
| | - Franck Schurhoff
- Fondation Fondamental, Créteil, France; INSERM U955, Translational Psychiatry Team, AP-HP Mondor University Hospital, DHU Pe-PSY, Schizophrenia Expert Center, 40 rue de Mesly, 94000 Creteil, France
| | - Hanan Yazbek
- Fondation Fondamental, Créteil, France; University Department of Adult Psychiatry, Hospital La Colombière, CHU Montpellier, France; INSERM, Univ Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France; University of Montpellier, Montpellier, France
| | - Anna Zinetti-Bertschy
- Fondation Fondamental, Créteil, France; University Hospital of Strasbourg, Department of Psychiatry, University of Strasbourg, Strasbourg, France; Inserm U1114, Strasbourg, France
| | - Christine Passerieux
- Fondation Fondamental, Créteil, France; Centre Hospitalier de Versailles, Service Hospitalo-Universitaire de Psychiatrie d'Adultes et d'Addictologie, Le Chesnay, France; Université Paris-Saclay, Université Versailles Saint-Quentin-En-Yvelines, DisAP-DevPsy-CESP, INSERM UMR1018, 94807 Villejuif, France
| | - Eric Brunet-Gouet
- Fondation Fondamental, Créteil, France; Centre Hospitalier de Versailles, Service Hospitalo-Universitaire de Psychiatrie d'Adultes et d'Addictologie, Le Chesnay, France; Université Paris-Saclay, Université Versailles Saint-Quentin-En-Yvelines, DisAP-DevPsy-CESP, INSERM UMR1018, 94807 Villejuif, France
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7
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Gil-Berrozpe GJ, Peralta V, Sánchez-Torres AM, Moreno-Izco L, García de Jalón E, Peralta D, Janda L, Cuesta MJ. Psychopathological networks in psychosis: Changes over time and clinical relevance. A long-term cohort study of first-episode psychosis. Schizophr Res 2023; 252:23-32. [PMID: 36621323 DOI: 10.1016/j.schres.2022.12.046] [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: 01/24/2022] [Revised: 03/22/2022] [Accepted: 12/29/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND First-episode psychosis is a critical period for early interventions to reduce the risk of poor outcomes and relapse as much as possible. However, uncertainties about the long-term outcomes of symptomatology remain to be ascertained. METHODS The aim of the present study was to use network analysis to investigate first-episode and long-term stages of psychosis at three levels of analysis: micro, meso and macro. The sample was a cohort of 510 patients with first-episode psychoses from the SEGPEP study, who were reassessed at the long-term follow-up (n = 243). We used the Comprehensive Assessment of Symptoms and History for their assessments and lifetime outcome variables of clinical relevance. RESULTS Our results showed a similar pattern of clustering between first episodes and long-term follow-up in seven psychopathological dimensions at the micro level, 3 and 4 dimensions at the meso level, and one at the macro level. They also revealed significant differences between first-episode and long-term network structure and centrality measures at the three levels, showing that disorganization symptoms have more influence in long-term stabilized patients. CONCLUSIONS Our findings suggest a relative clustering invariance at all levels, with the presence of two domains of disorganization as the most notorious difference over time at micro level. The severity of disorganization at the follow-up was associated with a more severe course of the psychosis. Moreover, a relative stability in global strength of the interconnections was found, even though the network structure varied significantly in the long-term follow-up. The macro level was helpful in the integration of all dimensions into a common psychopathology factor, and in unveiling the strong relationships of psychopathological dimensions with lifetime outcomes, such as negative with poor functioning, disorganization with high antipsychotic dose-years, and delusions with poor adherence to treatment. These results add evidence to the hierarchical, dimensional and longitudinal structure of psychopathological symptoms and their clinical relevance in first-episode psychoses.
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Affiliation(s)
- Gustavo J Gil-Berrozpe
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Victor Peralta
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain; Mental Health Department, Servicio Navarro de Salud - Osasunbidea, Pamplona, Spain
| | - Ana M Sánchez-Torres
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Lucía Moreno-Izco
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Elena García de Jalón
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain; Mental Health Department, Servicio Navarro de Salud - Osasunbidea, Pamplona, Spain
| | - David Peralta
- Mental Health Department, Servicio Navarro de Salud - Osasunbidea, Pamplona, Spain
| | - Lucía Janda
- Mental Health Department, Servicio Navarro de Salud - Osasunbidea, Pamplona, Spain
| | - Manuel J Cuesta
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.
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8
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Kimhy D, Jones N, Dixon L. Investing in a Research Workforce With Personal Experience of Serious Mental Illness. JAMA Psychiatry 2022; 79:841-842. [PMID: 35921083 DOI: 10.1001/jamapsychiatry.2022.2026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- David Kimhy
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.,NY MIRECC, The James J. Peters VA Medical Center, Bronx, New York
| | - Nev Jones
- School of Social Work, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lisa Dixon
- Department of Psychiatry, Columbia University, New York, New York.,Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York
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9
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Arango C, Buitelaar JK, Correll CU, Díaz-Caneja CM, Figueira ML, Fleischhacker WW, Marcotulli D, Parellada M, Vitiello B. The transition from adolescence to adulthood in patients with schizophrenia: Challenges, opportunities and recommendations. Eur Neuropsychopharmacol 2022; 59:45-55. [PMID: 35550205 DOI: 10.1016/j.euroneuro.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/03/2022] [Accepted: 04/07/2022] [Indexed: 11/04/2022]
Abstract
Schizophrenia is a severely debilitating neurodevelopmental disorder that requires continuous multidisciplinary treatment. Early onset schizophrenia (EOS, onset before 18) is associated with poorer outcomes than the adult-onset type. The transition from adolescent to adult mental healthcare services (AMHS) poses various challenges for maintaining continuity of care. The heterogeneous availability of specialized mental health services and resources for people with schizophrenia across Europe and the inadequacy of training programs in creating a shared culture and knowledge base between child and adult mental health professionals are major challenges at the policy level. More flexible and individualized transition timing is also needed. While changes in the relationship between patients, caregivers and mental health professionals at a time when young people should acquire full responsibility for their own care are challenges common to all mental health disorders, these are particularly relevant to the care of schizophrenia because of the severe associated disability. This Expert Opinion Paper examines the main aspects of transitioning of care in schizophrenia with the aim of identifying the challenges and the potential approaches that could enhance continuity of care.
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Affiliation(s)
- Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid 28009, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid 28029, Spain.
| | - Jan K Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboudumc, Nijmegen, the Netherlands
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany; Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Covadonga M Díaz-Caneja
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid 28009, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid 28029, Spain
| | | | | | - Daniele Marcotulli
- Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, Italy
| | - Mara Parellada
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid 28009, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid 28029, Spain
| | - Benedetto Vitiello
- Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, Italy
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10
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Kam TK, Lui TT, Lau FC, Chan KW, Lee HM, Hui LM, Suen YN, Lui SY, Chen E, Chang WC. Clinical and psychological correlates of insight dimensions in patients with early psychosis. Early Interv Psychiatry 2022; 16:527-532. [PMID: 34309188 DOI: 10.1111/eip.13191] [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: 02/19/2021] [Revised: 04/23/2021] [Accepted: 07/04/2021] [Indexed: 11/29/2022]
Abstract
AIM To investigate correlates of insight dimensions in Chinese adult patients with early psychosis. METHODS Insight dimensions including awareness of mental disorder (AMD), illness consequences (AIC) and medication effect (AME) were measured. A wide array of variables encompassing demographics, premorbid adjustment, onset profiles, symptomatology, treatment characteristics and psychological factors were comprehensively assessed. RESULTS Of 130 participants, 53.1%, 47.7% and 56.2% were categorized with good AMD, AIC and AME, respectively. Good AMD was associated with female gender, fewer positive and disorganization symptoms, more severe depression and greater self-stigma. Good AIC was related to female gender, more severe depression and greater self-stigma. Younger age of onset, fewer positive symptoms and greater service satisfaction associated with good AME. CONCLUSIONS Poor insight is prevalent in early psychosis. Differential relationships of insight dimensions with other illness variables underscore the importance of multidimensional approach in insight evaluation, and suggest potential treatment target for insight enhancement.
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Affiliation(s)
- Tze Kwan Kam
- Department of Psychiatry, Queen Mary Hospital, Hospital Authority, Pokfulam, Hong Kong
| | - Tsz Ting Lui
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Fu Chun Lau
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Kit Wa Chan
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong.,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong
| | - Ho Ming Lee
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Lai Ming Hui
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Yi Nam Suen
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Sai Yu Lui
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Eric Chen
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong.,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong
| | - Wing Chung Chang
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong.,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong
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11
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Mervis JE, Vohs JL, Lysaker PH. An Update on Clinical Insight, Cognitive Insight, and Introspective Accuracy in Schizophrenia-Spectrum Disorders: Symptoms, Cognition, and Treatment. Expert Rev Neurother 2022; 22:245-255. [PMID: 35244496 DOI: 10.1080/14737175.2022.2049757] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Poor insight, or unawareness of morbid changes in cognition, emotional states, or behavior, is commonly observed among people with schizophrenia. Poor insight represents a persistent barrier to wellness because it interferes with treatment and self-direction. Paradoxically, good insight may also be a barrier to health when awareness of these changes leads to depression or self-stigma. AREAS COVERED This paper builds upon this previous work by exploring these issues in schizophrenia separately as they have appeared in published research over the last three years in three different kinds of insight: clinical, cognition, and introspective accuracy. Specifically, studies are reviewed that address: the adverse effects of poor insight, the paradoxical effects of good insight, correlates with other forms of cognition, and emerging treatments. EXPERT OPINION The evidence continues to offer a nuanced picture of the complex effects of good insight in schizophrenia. Incremental improvements were also found in the development of novel integrative treatment approaches. This work also highlights the intricacy of the concept of insight, the need for further exploration of the effects of culture, and conceptual work that distinguishes the points of convergence and divergence of these forms of insight.
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Affiliation(s)
- Joshua E Mervis
- University of Minnesota, Department of Psychology, Minneapolis, Minnesota, USA.,Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA
| | - Jenifer L Vohs
- Indiana University School of Medicine, Department of Psychiatry, Indianapolis, Indiana, USA.,Eskenzai Health, Sandra Eskenazi Mental Health Center, Prevention and Recovery Center for Early PsychosisE, Indianapolis, Indiana, USA
| | - Paul H Lysaker
- Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA.,Indiana University School of Medicine, Department of Psychiatry, Indianapolis, Indiana, USA
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12
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Ishigooka J, Nakagome K, Ohmori T, Iwata N, Inada K, Iga JI, Kishi T, Fujita K, Kikuchi Y, Shichijo T, Tabuse H, Koretsune S, Terada H, Terada H, Kishimoto T, Tsutsumi Y, Kanda Y, Ohi K, Sekiyama K. Discontinuation and remission rates and social functioning in patients with schizophrenia receiving second-generation antipsychotics: 52-week evaluation of JUMPs, a randomized, open-label study. Psychiatry Clin Neurosci 2022; 76:22-31. [PMID: 34626144 PMCID: PMC9299006 DOI: 10.1111/pcn.13304] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/01/2021] [Accepted: 09/21/2021] [Indexed: 11/28/2022]
Abstract
AIM Globally, evidence from short-term studies is insufficient for the guidelines to uniformly recommend a particular antipsychotic(s) for the maintenance treatment of schizophrenia. Therefore, long-term comprehensive evaluation of antipsychotics is required from a social rehabilitation perspective, especially for drugs that have not yet been studied. The Japan Useful Medication Program for Schizophrenia (JUMPs) is a large-scale, long-term naturalistic study to present pivotal 52-week data on the continuity of second-generation antipsychotics (SGA: aripiprazole, blonanserin, and paliperidone). METHODS JUMPs was an open-label, three-arm, randomized, parallel-group, 52-week study. Enrolled patients had schizophrenia, were ≥20 years old, and required antipsychotic treatment or switched from previous therapy. The primary endpoint was treatment discontinuation rate over 52 weeks. Secondary outcomes included remission rate, social functioning, and quality-of-life scores [Personal and Social Performance Scale (PSP) and EuroQol-5 dimensions], and safety. RESULTS In total, 251 patients received aripiprazole (n = 82), blonanserin (n = 85), or paliperidone (n = 84). The discontinuation rate (P = 0.9771) and remission rates (P > 0.05) over 52 weeks did not differ significantly between the three treatment groups. The discontinuation rates were 68.3%, 68.2%, and 65.5% in the aripiprazole, blonanserin, and paliperidone groups, respectively. Significant improvements (all P < 0.05) from baseline in PSP scores were observed at start of monotherapy, week 26, and week 52 in the overall cohort and blonanserin group and at week 26 in the aripiprazole group. The adverse event profile favored blonanserin. CONCLUSION All three SGAs evaluated in this study showed similar treatment discontinuation rates in patients with chronic schizophrenia in Japan.
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Affiliation(s)
- Jun Ishigooka
- Department of Psychiatry, Tokyo Women's Medical University, School of Medicine, Tokyo, Japan
| | - Kazuyuki Nakagome
- Department of Psychiatry, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Tetsuro Ohmori
- Department of Psychiatry, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Nakao Iwata
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake-shi, Japan
| | - Ken Inada
- Department of Psychiatry, Tokyo Women's Medical University, School of Medicine, Tokyo, Japan
| | - Jun-Ichi Iga
- Department of Psychiatry, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Taro Kishi
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake-shi, Japan
| | - Kiyoshi Fujita
- Okehazama Hospital Fujita Kokoro Care Center, Toyoake-shi, Japan
| | - Yuka Kikuchi
- Department of Psychiatry, Akita University Hospital, Akita, Japan
| | | | - Hideaki Tabuse
- Department of Psychiatry, Holy Cross Hospital, Toki-shi, Japan
| | | | | | | | | | | | - Yoshiki Kanda
- Musashikoganei Minamiguchi Shinryou Clinic, Koganei-shi, Japan
| | - Kazutaka Ohi
- Department of Neuropsychiatry, Kokubu Hospital, Osaka, Japan
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13
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Aguglia A, Fusar-Poli L, Amerio A, Placenti V, Concerto C, Martinotti G, Carrà G, Bartoli F, D'Agostino A, Serafini G, Amore M, Aguglia E, Ostuzzi G, Barbui C. The Role of Attitudes Toward Medication and Treatment Adherence in the Clinical Response to LAIs: Findings From the STAR Network Depot Study. Front Psychiatry 2021; 12:784366. [PMID: 34975581 PMCID: PMC8716539 DOI: 10.3389/fpsyt.2021.784366] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/23/2021] [Indexed: 01/10/2023] Open
Abstract
Background: Long-acting injectable (LAI) antipsychotics are efficacious in managing psychotic symptoms in people affected by severe mental disorders, such as schizophrenia and bipolar disorder. The present study aimed to investigate whether attitude toward treatment and treatment adherence represent predictors of symptoms changes over time. Methods: The STAR Network "Depot Study" was a naturalistic, multicenter, observational, prospective study that enrolled people initiating a LAI without restrictions on diagnosis, clinical severity or setting. Participants from 32 Italian centers were assessed at three time points: baseline, 6-month, and 12-month follow-up. Psychopathological symptoms, attitude toward medication and treatment adherence were measured using the Brief Psychiatric Rating Scale (BPRS), the Drug Attitude Inventory (DAI-10) and the Kemp's 7-point scale, respectively. Linear mixed-effects models were used to evaluate whether attitude toward medication and treatment adherence independently predicted symptoms changes over time. Analyses were conducted on the overall sample and then stratified according to the baseline severity (BPRS < 41 or BPRS ≥ 41). Results: We included 461 participants of which 276 were males. The majority of participants had received a primary diagnosis of a schizophrenia spectrum disorder (71.80%) and initiated a treatment with a second-generation LAI (69.63%). BPRS, DAI-10, and Kemp's scale scores improved over time. Six linear regressions-conducted considering the outcome and predictors at baseline, 6-month, and 12-month follow-up independently-showed that both DAI-10 and Kemp's scale negatively associated with BPRS scores at the three considered time points. Linear mixed-effects models conducted on the overall sample did not show any significant association between attitude toward medication or treatment adherence and changes in psychiatric symptoms over time. However, after stratification according to baseline severity, we found that both DAI-10 and Kemp's scale negatively predicted changes in BPRS scores at 12-month follow-up regardless of baseline severity. The association at 6-month follow-up was confirmed only in the group with moderate or severe symptoms at baseline. Conclusion: Our findings corroborate the importance of improving the quality of relationship between clinicians and patients. Shared decision making and thorough discussions about benefits and side effects may improve the outcome in patients with severe mental disorders.
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Affiliation(s)
- Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genoa, Italy
| | - Laura Fusar-Poli
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Catania, Italy
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genoa, Italy
| | - Valeria Placenti
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genoa, Italy
| | - Carmen Concerto
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Catania, Italy
| | - Giovanni Martinotti
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d'Annunzio” University of Chieti, Chieti, Italy
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Division of Psychiatry, University College London, London, United Kingdom
| | - Francesco Bartoli
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Armando D'Agostino
- Department of Health Sciences, Ospedale San Paolo, University of Milan, Milan, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genoa, Italy
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genoa, Italy
| | - Eugenio Aguglia
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Catania, Italy
| | - Giovanni Ostuzzi
- World Health Organization (WHO) Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Corrado Barbui
- World Health Organization (WHO) Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
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14
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Mervis JE, Fischer J, Cooper SE, Deckert AC, Lysaker PH, MacDonald AW, Meyer-Kalos P. Introspective accuracy for substance use across a year of treatment for first episode psychosis. Schizophr Res Cogn 2021; 26:100200. [PMID: 34136362 PMCID: PMC8176356 DOI: 10.1016/j.scog.2021.100200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/17/2021] [Accepted: 05/20/2021] [Indexed: 11/28/2022]
Abstract
Substance use exacerbates psychosis, mania, depression, and poor functioning in people with first episodes of psychosis (FEP) and is associated with poor treatment outcomes, even when it does not reach the level of a formal disorder. Impaired insight and substance use are common issues that may interfere with treatment outcomes among people experiencing FEP, yet both are treatable. Improvements in these domains are associated with better outcomes. Low insight could increase risk for substance use by impairing the ability to self-appraise and assess consequences. Introspective accuracy (IA) is understudied in this area and is one way of considering self-appraisal. This study is an archival review using data collected from NAVIGATE, a coordinated specialty care program treating people with FEP. IA was operationalized as the difference between clinician and client ratings of substance use. We tested whether IA changed over one year of treatment and whether those changes occurred alongside changes in symptoms and illness self-management. No changes in IA were detected in relation to illness self-management. Changes in IA for substance use occurred midway through treatment-individuals with greater symptom remission had more overconfident IA. Prior research on insight has shown a paradox where greater insight accompanies more symptoms. However, past research has also shown a relationship between IA and functional outcomes, like illness self-management, and that overconfidence in one domain can positively bias clinician ratings in another. Our findings suggest either a positive bias for ratings associated with overconfident IA or an insight paradox type effect.
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Affiliation(s)
- Joshua E. Mervis
- University of Minnesota, Department of Psychology, United States of America
| | - Jamie Fischer
- University of Minnesota, School of Social Work, United States of America
- University of Minnesota Medical Center, Department of Psychiatry and Behavioral Sciences, United States of America
| | - Samuel E. Cooper
- University of Texas at Austin, Department of Psychiatry and Behavioral Sciences, United States of America
| | - Andrew C. Deckert
- University of Minnesota, Department of Psychology, United States of America
| | - Paul H. Lysaker
- Richard L. Roudebush VA Medical Center, United States of America
- Indiana University School of Medicine, Department of Psychiatry, United States of America
| | - Angus W. MacDonald
- University of Minnesota, Department of Psychology, United States of America
- University of Minnesota Medical Center, Department of Psychiatry and Behavioral Sciences, United States of America
| | - Piper Meyer-Kalos
- University of Minnesota Medical Center, Department of Psychiatry and Behavioral Sciences, United States of America
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15
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Kim JJ, Pae CU, Han C, Bahk WM, Lee SJ, Patkar AA, Masand PS. Exploring Hidden Issues in the Use of Antipsychotic Polypharmacy in the Treatment of Schizophrenia. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2021; 19:600-609. [PMID: 34690115 PMCID: PMC8553537 DOI: 10.9758/cpn.2021.19.4.600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/13/2021] [Accepted: 02/02/2021] [Indexed: 12/23/2022]
Abstract
The mainstay of schizophrenia treatment is pharmacological therapy using various antipsychotics including first- and second-generation antipsychotics which have different pharmacokinetic and pharmacodynamic property leading to differential presentation of adverse events (AEs) and treatment effects such as negative symptoms, cognitive symptoms and cormorbid symptoms. Major treatment guidelines suggest the use of antipsychotic monotherapy (APM) as a gold standard in the treatment of schizophrenia. However, the effects of APM is inadequate and less potent to achieve symptom remission as well as functional recovery in real practice which has been consistently reported in numerous controlled clinical trials, large practical trials, independent small studies and systematic reviews till today. Therefore anti-psychotic polypharmacy (APP) regardless of the class of antipsychotics has been also commonly utilized for many reasons in real world practice. However, APP has also crucial pitfalls including increase of total psychotics including antipsychotics, high-doses of antipsychotics used, poor compliance, drug-drug interaction and risks for developing AEs, all of which are paradoxically related to poor clinical outcomes, whereas APP has also substantial advantages in reduction of re-hospitalization, severe psychopathology and targeted control of concurrent symptoms. Given currently limited therapeutic options, it is also important to properly utilize APP in order to maximize its clinical utility and minimize its risk for better treatment outcomes for patients with schizophrenia, based on risk/benefit with full understanding of pharmacological and clinical issues on APP. The present paper intends to address intriguing and important issues in the use of APP in real world practice.
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Affiliation(s)
- Jung-Jin Kim
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chi-Un Pae
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Cell Death Disease Research Center, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Changsu Han
- Department of Psychiatry, Korea University College of Medicine, Seoul, Korea
| | - Won-Myong Bahk
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Soo-Jung Lee
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ashwin A Patkar
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
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16
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Brasso C, Cisotto M, Ghirardini C, Pennazio F, Villari V, Rocca P. Accuracy of self-reported adherence and therapeutic drug monitoring in a psychiatric emergency ward. Psychiatry Res 2021; 305:114214. [PMID: 34587569 DOI: 10.1016/j.psychres.2021.114214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/14/2021] [Accepted: 09/17/2021] [Indexed: 11/28/2022]
Abstract
The aims of the study were: (1) the evaluation of the agreement between therapeutic drug monitoring (TDM) and a self-assessment of adherence to psychopharmacological treatments; (2) the identification of predictors of TDM results.Adherence in patients admitted into a psychiatric emergency service (PES) for a relapse of a schizophrenia spectrum disorder (SSD) or a bipolar disorder (BD; DSM-5) was assessed both directly with TDM and indirectly with a self-reported measure (Medication Adherence Report Scale -MARS- 10 items). The agreement between TDM and MARS was evaluated. Fifty-seven patients with SSD and 76 people with BD participated in the study. TDM was in range in about 50% of the global sample. No evidence of an association between MARS total scores and TDM results was found. Sensitivity, specificity, positive and negative predictive values of almost all MARS total scores were near to 50%. Smoking was strongly associated with a reduction of TDM results within the reference range. In the BD group, female sex was a predictor of TDM in range. In this clinical setting, self-assessment of adherence is neither reliable nor predictive. Furthermore, smoking is a strong predictor of poor adherence to psychopharmacological therapy.
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Affiliation(s)
- Claudio Brasso
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, Turin 10126, Italy.
| | - Marta Cisotto
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, Turin 10126, Italy; Psychiatric Emergency Service, Department of Neuroscience and Mental Health, A.O.U. "Città della Salute e della Scienza", Turin, Italy
| | - Camilla Ghirardini
- Psychiatric Emergency Service, Department of Neuroscience and Mental Health, A.O.U. "Città della Salute e della Scienza", Turin, Italy
| | - Filippo Pennazio
- Psychiatric Emergency Service, Department of Neuroscience and Mental Health, A.O.U. "Città della Salute e della Scienza", Turin, Italy
| | - Vincenzo Villari
- Psychiatric Emergency Service, Department of Neuroscience and Mental Health, A.O.U. "Città della Salute e della Scienza", Turin, Italy.
| | - Paola Rocca
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, Turin 10126, Italy.
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17
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The Effect of Therapeutic Alliance on Attitudes Toward Psychiatric Medications in Schizophrenia. J Clin Psychopharmacol 2021; 41:551-560. [PMID: 34411007 DOI: 10.1097/jcp.0000000000001449] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE/BACKGROUND The differential influence of therapeutic alliance with different health care professionals on patients' medication adherence has never been examined. METHODS/PROCEDURES Ninety-five stable outpatients (91 patients with schizophrenia and 4 patients with schizoaffective disorder) were recruited. Individual, clinical, and medication factors were assessed, along with drug attitude (10-item Drug Attitude Inventory). Comparison on these factors was made between outpatients who identified psychiatrists as the health care professional most involved in their care, as compared with other health care professionals. FINDINGS/RESULTS Older age, longer duration of illness, presence of medical comorbidities, lower levels of internalized stigma, higher levels of insight, higher levels of functioning, lesser severity of depressive symptoms, and positive symptoms were found to be significantly associated with greater levels of drug attitude (small to moderate associations). Only therapeutic alliance had a large correlation with drug attitude (ρ = 0.503, P < 0.001). The therapeutic alliance scores between the 2 health care professionals groups are not significantly different. However, participants who have identified psychiatrists as the health care professional that contributed the most to their recovery reported a significantly more positive attitude (μ = 6.18, SD = 3.42) toward psychiatric medication as compared with the other health care professionals group (μ = 3.11, SD = 5.32, P = 0.004). Only 2 factors, the Revised Helping Alliance Questionnaire (β = 0.424, P < 0.001) and Personal and Social Performance scale (β = 0.272, P = 0.006), were statistically significant predictors of drug attitude. IMPLICATIONS/CONCLUSIONS Therapeutic alliance is found to be the lead factor associated with drug attitude in patients with schizophrenia. Identifying psychiatrists as the health care professional most involved in the patients' recovery can greatly increase patients' drug attitudes. Maintaining individuals' functioning also contributes to drug attitude.
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18
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Kverno K, Rozenberg I. Long-Acting Injectable Antipsychotics in the Treatment of Schizophrenia: Practical Considerations. J Psychosoc Nurs Ment Health Serv 2021; 59:7-12. [PMID: 34228570 DOI: 10.3928/02793695-20210611-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The positive symptoms of schizophrenia are usually treated with oral antipsychotics despite high rates of nonadherence leading to relapse and rehospitalization. Seven long-acting injectable (LAI) antipsychotics are currently approved by the U.S. Food and Drug Administration for maintenance treatment of schizophrenia. These medications reduce the risk for nonadherence and relapse, yet relatively few clinicians prescribe them. All LAI anti-psychotics are equally effective in treating the positive symptoms of schizophrenia. Dosing requirements, dosing frequencies, and what clinicians should consider in choosing a LAI antipsychotic for a specific patient are discussed. Communication strategies that help patients and families understand what they need to know about schizophrenia and its treatment to share in the decision-making process are also provided. [Journal of Psychosocial Nursing and Mental Health Services, 59(7), 7-12.].
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Daniell K, Kim J, Iwata Y, Caravaggio F, Brown E, Remington G, Agid O, Graff-Guerrero A, Gerretsen P. Exploring the relationship between impaired illness awareness and visuospatial inattention in patients with schizophrenia. J Psychiatr Res 2021; 136:468-473. [PMID: 33168197 DOI: 10.1016/j.jpsychires.2020.10.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/30/2020] [Accepted: 10/12/2020] [Indexed: 10/23/2022]
Abstract
Anosognosia, described as impairment in an individual's ability to perceive and understand their illness, and visuospatial inattention commonly co-occur as a result of structural brain lesions in the right posterior parietal area. Anosognosia or impaired illness awareness is a common feature of schizophrenia that contributes to medication nonadherence and poor clinical outcomes. A recent pilot study suggests patients with impaired illness awareness have a rightward visuospatial bias. We aimed to examine this relationship in a large sample of patients. This study consisted of 106 patients with schizophrenia spectrum disorder (henceforth, schizophrenia) and 20 healthy controls. Visuospatial attention was assessed using the line bisection test (LBT). Illness awareness was assessed using the VAGUS self-report version. A Welch's t-test was used to examine differences in LBT scores between patients with schizophrenia and healthy controls. Correlation analyses between LBT and VAGUS scores were performed in patients with schizophrenia. For exploratory purposes, intra-subject reliability of the LBT was also examined using a two-way mixed intra-class correlation coefficient (ICC). There were no differences in LBT scores between patients with schizophrenia and healthy controls. In patients, there were no associations between LBT and VAGUS scores. ICCs between two consecutively acquired LBTs were 0.92 (95% CI: 0.81-0.96) in patients with schizophrenia and 0.93 (95% CI: 0.81-0.97) in healthy controls. Our results, using a reliable measure, did not support our previous preliminary finding that suggested a relationship between impaired illness awareness and visuospatial bias in patients with schizophrenia. Future studies should consider more sensitive visuospatial attention tasks when testing this hypothesis.
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Affiliation(s)
- Kyle Daniell
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Julia Kim
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Yusuke Iwata
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Fernando Caravaggio
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Eric Brown
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Gary Remington
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Ofer Agid
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Ariel Graff-Guerrero
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, CAMH, Toronto, Ontario, Canada; Geriatric Mental Health Division, CAMH, Toronto, Ontario, Canada
| | - Philip Gerretsen
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, CAMH, Toronto, Ontario, Canada; Geriatric Mental Health Division, CAMH, Toronto, Ontario, Canada.
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20
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Curto M, Fazio F, Ulivieri M, Navari S, Lionetto L, Baldessarini RJ. Improving adherence to pharmacological treatment for schizophrenia: a systematic assessment. Expert Opin Pharmacother 2021; 22:1143-1155. [PMID: 33543659 DOI: 10.1080/14656566.2021.1882996] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Introduction: Poor adherence to pharmacological treatment is prevalent in schizophrenia, affecting more than half of patients at some time, with increased risks of clinical worsening, adverse outcomes, suicide, and increased resource utilization including hospitalization, with higher costs.Areas Covered: This review considers factors associated with treatment-nonadherence among schizophrenia patients, with a systematic evaluation of interventions aimed at improving adherence with an emphasis on evidence arising from their testing.Expert opinion: Several interventions have addressed factors empirically associated with treatment-nonadherence, including various drug-, patient - and clinical services-associated factors. They include long-acting injected (LAI) drug formulations, behavioral interventions, and technology-supported methods. Use of LAI antipsychotics and behavioral techniques aimed at incorporating medicine-taking into daily routines with electronic monitoring have been assessed relatively extensively. Mobile, digital applications including medication monitoring systems and artificial intelligence-based interactions are emerging but have been tested in few trials of limited quality with inconclusive results. Randomized, controlled, blinded trials based on clinically representative samples are needed to evaluate not only adherence, but also to test for clinically meaningful and sustained clinical benefits in schizophrenia patients, who are especially difficult to treat.
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Affiliation(s)
- Martina Curto
- Department of Mental Health, Rome, Italy.,International Consortium for Mood Psychotic & Mood Disorders Research, McLean Hospital, Belmont, MA, USA
| | - Francesco Fazio
- Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, New York, NY, USA
| | - Martina Ulivieri
- Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, New York, NY, USA
| | - Serena Navari
- Department of Mental Health, Colleferro (Rome), Italy
| | - Luana Lionetto
- Advanced Molecular Diagnostics Unit, Sant'Andrea Hospital, Rome, Italy
| | - Ross J Baldessarini
- International Consortium for Mood Psychotic & Mood Disorders Research, McLean Hospital, Belmont, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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21
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Stockbridge EL, Webb NJ, Dhakal E, Garg M, Loethen AD, Miller TL, Nandy K. Antipsychotic medication adherence and preventive diabetes screening in Medicaid enrollees with serious mental illness: an analysis of real-world administrative data. BMC Health Serv Res 2021; 21:69. [PMID: 33461561 PMCID: PMC7812734 DOI: 10.1186/s12913-020-06045-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 12/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is excess amenable mortality risk and evidence of healthcare quality deficits for persons with serious mental illness (SMI). We sought to identify sociodemographic and clinical characteristics associated with variations in two 2015 Healthcare Effectiveness Data and Information Set (HEDIS) measures, antipsychotic medication adherence and preventive diabetes screening, among Medicaid enrollees with serious mental illness (SMI). METHODS We retrospectively analyzed claims data from September 2014 to December 2015 from enrollees in a Medicaid specialty health plan in Florida. All plan enrollees had SMI; analyses included continuously enrolled adults with antipsychotic medication prescriptions and schizophrenia or bipolar disorder. Associations were identified using mixed effects logistic regression models. RESULTS Data for 5502 enrollees were analyzed. Substance use disorders, depression, and having both schizophrenia and bipolar disorder diagnoses were associated with both HEDIS measures but the direction of the associations differed; each was significantly associated with antipsychotic medication non-adherence (a marker of suboptimal care quality) but an increased likelihood of diabetes screening (a marker of quality care). Compared to whites, blacks and Hispanics had a significantly greater risk of medication non-adherence. Increasing age was significantly associated with increasing medication adherence, but the association between age and diabetes screening varied by sex. Other characteristics significantly associated with quality variations according to one or both measures were education (associated with antipsychotic medication adherence), urbanization (relative to urban locales, residing in suburban areas was associated with both adherence and diabetes screening), obesity (associated with both adherence and diabetes screening), language (non-English speakers had a greater likelihood of diabetes screening), and anxiety, asthma, and hypertension (each positively associated with diabetes screening). CONCLUSIONS The characteristics associated with variations in the quality of care provided to Medicaid enrollees with SMI as gauged by two HEDIS measures often differed, and at times associations were directionally opposite. The variations in the quality of healthcare received by persons with SMI that were identified in this study can guide quality improvement and delivery system reform efforts; however, given the sociodemographic and clinical characteristics' differing associations with different measures of care quality, multidimensional approaches are warranted.
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Affiliation(s)
- Erica L Stockbridge
- Department of Advanced Health Analytics and Solutions, Magellan Health, Inc, 4800 N Scottsdale Rd #4400, Scottsdale, AZ, 85251, USA.
| | - Nathaniel J Webb
- Department of Health Behavior & Health Systems, School of Public Health, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
| | - Eleena Dhakal
- Department of Biostatistics and Epidemiology, School of Public Health, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
| | - Manasa Garg
- Department of Health Behavior & Health Systems, School of Public Health, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
- Loopback Analytics, 14900 Landmark Blvd # 240, Dallas, TX, 75254, USA
| | - Abiah D Loethen
- Department of Advanced Health Analytics and Solutions, Magellan Health, Inc, 4800 N Scottsdale Rd #4400, Scottsdale, AZ, 85251, USA
| | - Thaddeus L Miller
- Department of Health Behavior & Health Systems, School of Public Health, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
| | - Karabi Nandy
- Department of Population and Data Sciences, UT Southwestern Medical Center, Room E1.401A, South Campus, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
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22
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Leijala J, Kampman O, Suvisaari J, Eskelinen S. Daily functioning and symptom factors contributing to attitudes toward antipsychotic treatment and treatment adherence in outpatients with schizophrenia spectrum disorders. BMC Psychiatry 2021; 21:37. [PMID: 33441112 PMCID: PMC7805157 DOI: 10.1186/s12888-021-03037-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 01/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Poor adherence and negative attitudes to treatment are common clinical problems when treating psychotic disorders. This study investigated how schizophrenia core symptoms and daily functioning affect treatment adherence and attitudes toward antipsychotic medication and to compare patients using clozapine or other antipsychotics. METHOD A cross-sectional study with data from 275 patients diagnosed with schizophrenia spectrum disorder. Patients adherence, attitudes, insight and side-effects were evaluated using the Attitudes toward Neuroleptic Treatment scale. Overall symptomology was measured using the Brief Psychiatric Rating Scale (BPRS), the Health of the Nation Outcome Scale (HoNOS). The functioning was assessed using activities of daily living scale, instrumental activities of daily living scale and social functioning of daily living scale. RESULTS Self-reported treatment adherence was high. Of the patients, 83% reported using at least 75% of the prescribed medication. Having more symptoms was related with more negative attitude towards treatment. There was a modest association with functioning and treatment adherence and attitude toward antipsychotic treatment. Attitudes affected on adherence in non-clozapine but not in clozapine groups. CONCLUSION Early detection of non-adherence is difficult. Systematic evaluation of attitudes toward the treatment could be one way to assess this problem, along with optimized medication, prompt evaluation of side effects and flexible use of psychosocial treatments.
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Affiliation(s)
- J. Leijala
- Department of Psychiatry, South Ostrobothnia Hospital District, Huhtalantie 53, 60220 Seinäjoki, Finland
| | - O. Kampman
- grid.502801.e0000 0001 2314 6254Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland ,grid.415018.90000 0004 0472 1956Department of Psychiatry, Pirkanmaa Hospital District, Tampere, Finland
| | - J. Suvisaari
- grid.14758.3f0000 0001 1013 0499Finnish Institute for Health and Welfare, Mental Health Unit, Helsinki, Finland
| | - S. Eskelinen
- grid.7737.40000 0004 0410 2071Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland ,grid.14758.3f0000 0001 1013 0499Department of Public Health Solutions, Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland
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Specific Anti-hostility Effects of Atypical Antipsychotics in Persons with Schizophrenia: From Clozapine to Cariprazine. Harv Rev Psychiatry 2021; 29:20-34. [PMID: 33417374 DOI: 10.1097/hrp.0000000000000275] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
LEARNING OBJECTIVE After participating in this activity, learners should be better able to:• Evaluate the anti-hostility effects of available atypical antipsychotic agents. ABSTRACT In addition to hallucinations and delusions, persons with schizophrenia may exhibit hostility. In clinical trials of antipsychotics, hostility is routinely measured as part of rating scales such as the Brief Psychiatric Rating Scale or Positive and Negative Syndrome Scale. The availability of the atypical antipsychotic clozapine in 1989 led to the observation that it is possible to have a treatment effect on hostility that is independent of the treatment effect on hallucinations or delusions, and independent of general sedative effects. The data supporting this notion of a specific anti-hostility effect are the most robust for clozapine as the data include specifically designed randomized, controlled clinical trials. A specific anti-hostility effect is also observable to various degrees with most of the other atypical antipsychotics, as evidenced in post hoc analyses of clinical trials originally conducted for regulatory purposes, supplemented by post hoc analyses of large effectiveness trials. The generalizability of these studies, however, may be limited. Participants in these trials were not selected for aggressive and hostile behavior. Some of the studies also excluded patients with substance use disorders. The latter is particularly important because alcohol and substance use are well known to increase risk for hostility and aggression. Nevertheless, the repeated demonstrations of the specificity of an anti-hostility effect (in terms of statistical independence of effects on other positive symptoms and of sedation) are of potential clinical importance.
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Alisauskiene R, Johnsen E, Gjestad R, Kroken RA, Jørgensen HA, Løberg EM. The Influence of Substance Use on Side Effects of Olanzapine, Quetiapine, Risperidone, and Ziprasidone in Psychosis. Subst Use Misuse 2021; 56:1880-1891. [PMID: 34369263 DOI: 10.1080/10826084.2021.1958858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Side effects restrict the optimal use of antipsychotics. Little is known about the influence of substance use on side effects. The aim of this study was to compare antipsychotic side effects in patients with psychosis with and without substance use, while also taking medication history and diagnosis into consideration. METHODS All patients (n = 226, mean age 34, females 33%) diagnosed with schizophrenia spectrum disorders (SSD; F20-F29) or other psychosis (F30-F32; F10-F19), were treated with olanzapine, quetiapine, risperidone or ziprasidone, and were assessed at baseline, 4-weeks, 14-weeks, and 27-weeks. The UKU-Side Effects Self-Rating Scale version was used to evaluate the side effect profiles, and the information on substance use was based on the Clinician Drug Use Scale. RESULTS At baseline, 30% of the patients used substances, 54% were diagnosed with SSD, and 47% were antipsychotic naïve. The occurrence of side effects in total was not different in patients with substance use compared to without after 4-weeks of treatment, nor in the follow-up period. At 4-weeks there were some group differences in relation to substance use, diagnosis, and medication history for single side effects. Patients with substance use showed more increased dream activity, less reduced salivation, and more gynecomastia. Patients with SSD showed less neurological side effects, orgasm dysfunction, and tension/inner unrest. The medication naïve patients showed increased hypokinesia/akinesia. CONCLUSION Substance use alone does not influence the general magnitude of side effects of antipsychotic medication and does not indicate a different prescription practice in patients with psychosis and substance use.
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Affiliation(s)
- Renata Alisauskiene
- Department of Psychiatry, Haukeland University Hospital, Bergen, Norway.,NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway
| | - Erik Johnsen
- Department of Psychiatry, Haukeland University Hospital, Bergen, Norway.,NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Rolf Gjestad
- Department of Psychiatry, Haukeland University Hospital, Bergen, Norway.,NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway.,Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Rune A Kroken
- Department of Psychiatry, Haukeland University Hospital, Bergen, Norway.,NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Hugo A Jørgensen
- Department of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Else-Marie Løberg
- Department of Psychiatry, Haukeland University Hospital, Bergen, Norway.,NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway.,Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Psychology, University of Bergen, Bergen, Norway
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25
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Martin S, Graziani P, Del-Monte J. Insight's level in borderline personality disorder, questioning consciousness. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2020.100045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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26
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Smithnaraseth A, Seeherunwong A, Panitrat R, Tipayamongkholgul M. Hospital and patient factors influencing the health status among patients with schizophrenia, thirty days after hospital discharge: multi-level analysis. BMC Psychiatry 2020; 20:592. [PMID: 33317490 PMCID: PMC7737347 DOI: 10.1186/s12888-020-03001-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 12/03/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The time between discharge from hospital and transition to community and home is a critical period for health status among patients with a mental illness, including patients with schizophrenia. This study aimed to investigate crucial patient factors (patient-level) and hospital factors (hospital-level) affecting health status and see whether patient factor effects on health status vary with hospital factors, 30 days after hospital discharge. METHODS This is a prospective study of 1255 patients with schizophrenia and their primary caregivers from 13 public mental hospitals across Thailand. Logistic regression and multi-level logistic regression was used to investigate the effects of patient and hospital factors simultaneously on health status, 30 days after hospital discharge. RESULTS The intraclass correlation coefficient indicated that 14% of the change in health status was explained by the differences between hospital. Poor health status was identified in 14.26% of patients, 30 days after hospital discharge. The majority of participant patients were male (69.8%), single (71.87%), and the average age was 38.09 (SD = 9.74). The finding also showed that the patient factors; being female (ORadj .53, 95%CI .31,.92), perceived moderate and high levels of positive aspect of caregiving (ORadj .24, 95%CI .14,.42 and ORadj .05, 95%CI .02,.09), perceived readiness for hospital discharge (ORadj .21, 95%CI .13,.33), partial and full adherence to treatment (ORadj .24, 95%CI .14,.42 and ORadj .31, 95%CI .20,.47) showed a reduced likelihood of developing poor health status except substance use (ORadj 1.55, 95%CI .98, 2.44). Hospital factors; discharge planning process and nurse-patient ratio (ORadj 1.64, 95%CI 1.17, 2.30 and ORadj 1.16, 95%CI 1.09, 1.22) showed an increased likelihood of developing poor health status, 30 days after hospital discharge. CONCLUSIONS Findings provide relevant information on how both patient and hospital factors determine health status. These results might lead to better targeting of mental health service policy and enable more precise information gathering and allocation of resources. However, future research should be more focused and continue investigating the pathways through which hospital factors influence health status post-discharge.
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Affiliation(s)
| | - Acharaporn Seeherunwong
- Department of Mental Health and Psychiatric Nursing, Faculty of Nursing, Mahidol University, 999 Phuttamonthon 4 Road, Salaya, Nakhon Pathom, 73170, Thailand.
| | - Rungnapa Panitrat
- Faculty of Nursing HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
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Tang CT, Chua EC, Chew QH, He YL, Si TM, Chiu HFK, Xiang YT, Kato TA, Kanba S, Shinfuku N, Lee MS, Park SC, Park YC, Chong MY, Lin SK, Yang SY, Tripathi A, Avasthi A, Grover S, Kallivayalil RA, Udomratn P, Chee KY, Tanra AJ, Rabbani MG, Javed A, Kathiarachchi S, Waas D, Myint WA, Sartorius N, Tran VC, Nguyen KV, Tan CH, Baldessarini RJ, Sim K. Patterns of long acting injectable antipsychotic use and associated clinical factors in schizophrenia among 15 Asian countries and region. Asia Pac Psychiatry 2020; 12:e12393. [PMID: 32468725 DOI: 10.1111/appy.12393] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 04/24/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Patterns of clinical use of long-acting injectable (LAI) antipsychotic drugs in many countries, especially in Asia, for treatment of patients diagnosed with chronic psychotic disorders including schizophrenia are not well established. METHODS Within an extensive research consortium, we evaluated prescription rates for first- (FGA) and second-generation antipsychotic (SGA) LAI drugs and their clinical correlates among 3557 subjects diagnosed with schizophrenia across 15 Asian countries and region. RESULTS Overall, an average of 17.9% (638/3557; range: 0.0%-44.9%) of treated subjects were prescribed LAI antipsychotics. Those given LAI vs orally administered agents were significantly older, had multiple hospitalizations, received multiple antipsychotics more often, at 32.4% higher doses, were more likely to manifest disorganized behavior or aggression, had somewhat superior psychosocial functioning and less negative symptoms, but were more likely to be hospitalized, with higher BMI, and more tremor. Being prescribed an FGA vs SGA LAI agent was associated with male sex, aggression, disorganization, hospitalization, multiple antipsychotics, higher doses, with similar risks of adverse neurological or metabolic effects. Rates of use of LAI antipsychotic drugs to treat patients diagnosed with schizophrenia varied by more than 40-fold among Asian countries and given to an average of 17.9% of treated schizophrenia patients. We identified the differences in the clinical profiles and treatment characteristics of patients who were receiving FGA-LAI and SGA-LAI medications. DISCUSSION These findings behoove clinicians to be mindful when evaluating patients' need to be on LAI antipsychotics amidst multifaceted considerations, especially downstream adverse events such as metabolic and extrapyramidal side effects.
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Affiliation(s)
- Chao Tian Tang
- Institute of Mental Health, Buangkok Green Medical Park, Singapore, Singapore
| | - Ee Cheong Chua
- Institute of Mental Health, Buangkok Green Medical Park, Singapore, Singapore
| | - Qian Hui Chew
- Institute of Mental Health, Buangkok Green Medical Park, Singapore, Singapore
| | - Yan-Ling He
- Department of Psychiatric Epidemiology, Shanghai Mental Health Center, Shanghai, China
| | - Tian-Mei Si
- Institute of Mental Health, Peking University, Beijing, China
| | - Helen F-K Chiu
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yu-Tao Xiang
- Centre for Cognition and Brain Sciences, University of Macau, Macao SAR, China
| | - Takahiro A Kato
- Department of Neuropsychiatry, Graduate School of Medicine, Kyushu University, Fukuoka, Japan
| | - Shigenobu Kanba
- Department of Neuropsychiatry, Graduate School of Medicine, Kyushu University, Fukuoka, Japan
| | | | - Min-Soo Lee
- Department of Psychiatry, College of Medicine, Korea University, Seoul, South Korea
| | - Seon-Cheol Park
- Department of Psychiatry, Inje University Haeundae Paik Hospital, Busan, South Korea
| | - Yong-Chon Park
- Department of Neuropsychiatry, Hanyang University Guri Hospital, Guri, South Korea
| | - Mian-Yoon Chong
- Department of Psychiatry, Kaoshiung Chang Gung Memorial Hospital and Chang Gung University School of Medicine, Kaohsiung, Taiwan
| | - Shih-Ku Lin
- Department of Pharmacy, Taipei City Hospital and Fu Jen University, Taipei, Taiwan
| | - Shu-Yu Yang
- Department of Pharmacy, Taipei City Hospital and Fu Jen University, Taipei, Taiwan
| | - Adarsh Tripathi
- Department of Psychiatry, King George's Medical University, Lucknow, India
| | - Ajit Avasthi
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Roy A Kallivayalil
- Department of Psychiatry, Pushpagiri Institute of Medical Sciences, Tiruvalla, India
| | - Pichet Udomratn
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Kok Yoon Chee
- Department of Psychiatry & Mental Health, Tunku Abdul Rahman Institute of Neurosciences, Kuala Lumpur, Malaysia
| | - Andi J Tanra
- Department of Psychiatry, Hasanuddin University Faculty of Medicine, Makassar, Indonesia
| | | | - Afzal Javed
- Pakistan Psychiatric Research Center, Fountain House, Lahore, Pakistan
| | | | - Dulshika Waas
- Department of Psychiatry, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Wing Aung Myint
- Mental Health Society, Myanmar Medical Association, Yangon, Myanmar
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes, Geneva, Switzerland
| | - Van Cuong Tran
- Vietnam Psychiatric Association (VPA), Thuong Tin, Hanoi, Vietnam
| | - Kim Viet Nguyen
- Vietnam Psychiatric Association (VPA), Thuong Tin, Hanoi, Vietnam
| | - Chay-Hoon Tan
- Department of Pharmacology, National University Hospital, Singapore, Singapore
| | - Ross J Baldessarini
- International Consortium for Mood & Psychotic Disorder Research, McLean Hospital, Belmont, Massachusetts, USA
| | - Kang Sim
- Institute of Mental Health, Buangkok Green Medical Park, Singapore, Singapore
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Li W, Zhang HH, Wang Y, Zhang L, Ungvari GS, Cheung T, Xiang YT. Poor Insight in Schizophrenia Patients in China: a Meta-Analysis of Observational Studies. Psychiatr Q 2020; 91:1017-1031. [PMID: 32529379 DOI: 10.1007/s11126-020-09786-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Poor insight exists in all phases of schizophrenia and is associated with poor clinical prognosis and adverse psychosocial functioning. This is a meta-analysis examining the prevalence of poor insight and its correlates in Chinese patients with schizophrenia. Both major international (PubMed, EMBASE, PsycINFO, and Web of Science) and Chinese (WANFANG and CNKI) databases were systematically searched. The pooled prevalence of poor insight was calculated using the random-effects model. A total of 19 studies with 3112 schizophrenia patients were included. The prevalence of poor insight was 43.4% (95%CI: 36.0%-51.2%). Subgroup and meta-regression analyses revealed that the higher prevalence of poor insight was significantly associated with single-site design, smaller sample size, inpatient status, acute illness phase, higher male proportion, younger age, shorter duration of illness, lower study quality, and earlier publication year. Poor insight is common in Chinese schizophrenia patients. Considering the negative outcomes of poor insight, regular screening and effective psychosocial interventions should be delivered for this vulnerable population.
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Affiliation(s)
- Wen Li
- Center for Cognition and Brain Sciences, University of Macau, Macao SAR, China
| | - Hong-He Zhang
- Department of Psychiatry, Xiamen Xianyue Hospital, Xiamen, China
| | - Yu Wang
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital, 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
- Division of Psychiatry, School of Medicine, University of Western Australia, Perth, Australia.,University of Notre Dame Australia, Fremantle, Australia
| | - Teris Cheung
- School of Nursing, Hong Kong Polytechnic University, Hong Kong, SAR, China
| | - Yu-Tao Xiang
- Center for Cognition and Brain Sciences, University of Macau, Macao SAR, China.
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García-Pérez L, Linertová R, Serrano-Pérez P, Trujillo-Martín M, Rodríguez-Rodríguez L, Valcárcel-Nazco C, Del Pino-Sedeño T. Interventions to improve medication adherence in mental health: the update of a systematic review of cost-effectiveness. Int J Psychiatry Clin Pract 2020; 24:416-427. [PMID: 32609024 DOI: 10.1080/13651501.2020.1782434] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Medication non-adherence in mental health problems has social and economic costs. The objective of the study was to review the cost-effectiveness of interventions to enhance medication adherence in patients with mental health problems. METHODS The update of a previous systematic review was performed. Databases were searched in June 2019: MEDLINE, PSYCINFO, EMBASE, CINAHL, CRD, WOS. Cost-effectiveness studies comparing an intervention to improve the medication adherence with other interventions/usual care in adults with mental health problems were included. Data were extracted, methodological quality of the studies was assessed and a narrative synthesis was performed. RESULTS Nine studies were included in the review. The interventions that showed medication adherence increase were: a financial incentive when depot injection was taken by patients with psychotic disorders, a value-based benefit design policy including copayment and counselling in a company setting, and a medication treatment decision supported by a pharmacogenetic test. The other studies (coaching by pharmacists; a psychological and educational intervention at health care centres) did not find differences between groups. No study found cost differences between alternatives. CONCLUSIONS Interventions to improve medication adherence in adults with mental health problems could be cost-effective, especially those based on financial incentives, although more research is needed. KEYPOINTS There are several types of interventions designed to enhance medication adherence in patients with mental health problems. Few of them have demonstrated cost-effectiveness. Two studies found that a financial incentive per depot injection in patients with psychotic disorders improved the medication adherence. Two other studies found improvement in adherence due to two specific interventions: a value-based benefit design policy in a company setting and a pharmacogenetic test supporting the medication treatment decision. No study found differences in costs between the intervention and the comparator. More research is needed to implement cost-effective interventions.
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Affiliation(s)
- Lidia García-Pérez
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), El Rosario, Spain.,Servicio de Evaluación del Servicio Canario de la Salud (SESCS), El Rosario, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Galdakao, Spain.,Centro de Investigaciones Biomédicas de Canarias (CIBICAN), La Laguna, Spain.,Instituto Universitario de Desarrollo Regional (IUDR), Universidad de La Laguna, Spain
| | - Renata Linertová
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), El Rosario, Spain.,Servicio de Evaluación del Servicio Canario de la Salud (SESCS), El Rosario, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Galdakao, Spain.,Centro de Investigaciones Biomédicas de Canarias (CIBICAN), La Laguna, Spain
| | - Pedro Serrano-Pérez
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mar Trujillo-Martín
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), El Rosario, Spain.,Servicio de Evaluación del Servicio Canario de la Salud (SESCS), El Rosario, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Galdakao, Spain.,Centro de Investigaciones Biomédicas de Canarias (CIBICAN), La Laguna, Spain
| | - Leticia Rodríguez-Rodríguez
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), El Rosario, Spain.,Servicio de Evaluación del Servicio Canario de la Salud (SESCS), El Rosario, Spain
| | - Cristina Valcárcel-Nazco
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), El Rosario, Spain.,Servicio de Evaluación del Servicio Canario de la Salud (SESCS), El Rosario, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Galdakao, Spain.,Centro de Investigaciones Biomédicas de Canarias (CIBICAN), La Laguna, Spain
| | - Tasmania Del Pino-Sedeño
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), El Rosario, Spain.,Servicio de Evaluación del Servicio Canario de la Salud (SESCS), El Rosario, Spain
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30
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Progress in Schizophrenia Research and Treatment. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2020; 18:440-442. [PMID: 33343257 PMCID: PMC7725148 DOI: 10.1176/appi.focus.18310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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31
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Smith RL, Tveito M, Kyllesø L, Jukic MM, Ingelman-Sundberg M, Andreassen OA, Molden E. Impact of antipsychotic polypharmacy on nonadherence of oral antipsychotic drugs - A study based on blood sample analyses from 24,239 patients. Eur Neuropsychopharmacol 2020; 37:64-69. [PMID: 32595082 DOI: 10.1016/j.euroneuro.2020.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 05/27/2020] [Accepted: 06/05/2020] [Indexed: 12/23/2022]
Abstract
Nonadherence to oral antipsychotic drugs is a major issue in clinical psychiatry giving rise to treatment failure. Further, polypharmacy is common in the treatment of psychotic disorders due to insufficient treatment effect during monotherapy. As a potential circuit problem, we hypothesized that antipsychotic polypharmacy is associated with increased risk of nonadherence. To investigate this, in terms of 'complete' nonadherence, the rates of undetectable serum drug concentrations during prescribing of doses used in psychotic disorders were compared during antipsychotic 'monotherapy' vs 'polypharmacy' treatment using therapeutic drug monitoring (TDM) data of 24,239 patients. A complete nonadherence patient was objectively defined as the detection of at least one event of undetectable serum concentration of a prescribed antipsychotic drug. The rate of complete nonadherence patients was compared between antipsychotic monotherapy and polypharmacy by multivariate logistic regression analyses. The overall rate of complete nonadherence in the population was 6.8% (n = 1,644; 95%CI: 6.5-7.1). Compared to monotherapy patients, the rate of nonadherence increased significantly with the number of co-prescribed antipsychotic drugs. After adjusting for sex (p = 0.091) and age (p < 0.001) as covariates, the rates of nonadherence vs monotherapy were 1.69-fold (95% CI: 1.48-1.92; p < 0.001) for two, 2.60-fold (95% CI: 1.88-3.59; p < 0.001) for three, and 3.54-fold (95% CI: 1.46-8.58; p = 0.005) for four or more co-prescribed antipsychotics, respectively. The present naturalistic study shows that antipsychotic polypharmacy significantly increases the rate of complete nonadherence, which is positively correlated with increasing number of concurrently used antipsychotic drugs. Thus, the intended clinical benefit of combining oral antipsychotic drugs may probably be reduced by increased nonadherence.
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Affiliation(s)
- Robert L Smith
- Center for Psychopharmacology, Diakonhjemmet Hospital, PO Box 85 Vinderen, Oslo 0319, Norway.
| | - Marit Tveito
- Center for Psychopharmacology, Diakonhjemmet Hospital, PO Box 85 Vinderen, Oslo 0319, Norway; Norwegian National Advisory Unit on Aging and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Lennart Kyllesø
- Center for Psychopharmacology, Diakonhjemmet Hospital, PO Box 85 Vinderen, Oslo 0319, Norway
| | - Marin M Jukic
- Section of Pharmacogenetics, Department of Physiology and Pharmacology, Biomedicum 5B, Karolinska Institutet, Stockholm, Sweden; Department of Physiology, Faculty of Pharmacy, University of Belgrade, Serbia
| | - Magnus Ingelman-Sundberg
- Section of Pharmacogenetics, Department of Physiology and Pharmacology, Biomedicum 5B, Karolinska Institutet, Stockholm, Sweden
| | - Ole A Andreassen
- NORMENT center, Institute of Clinical Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Espen Molden
- Center for Psychopharmacology, Diakonhjemmet Hospital, PO Box 85 Vinderen, Oslo 0319, Norway; Department of Pharmaceutical Biosciences, School of Pharmacy, University of Oslo, Oslo, Norway
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32
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Güney E, Alnıak İ, Erkıran M. Predicting factors for non-suicidal self-injury in patients with schizophrenia spectrum disorders and the role of substance use. Asian J Psychiatr 2020; 52:102068. [PMID: 32371364 DOI: 10.1016/j.ajp.2020.102068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 11/19/2022]
Abstract
Non-suicidal self-injury (NSSI) has been shown as a characteristic feature in many clinical populations in recent years and schizophrenia is one of the most common psychiatric disorders which is associated with NSSI. In this study, we aimed to investigate predictors of NSSI in patients with schizophrenia spectrum disorders (SSD) and the role of lifetime substance use disorder (SUD). A sample of 165 patients with a diagnosis of SSD who were in remission participated in the study. Lifetime NSSI was assessed using the Inventory of Statements About Self-injury (ISAS). Lifetime SUD were evaluated. Logistic regression analysis was conducted to predict NSSI. SUD was found to be related to NSSI in patients with SSD, and it was associated with an approximately fourfold increase in the risk of NSSI. The rates of lifetime SUD in our sample and in the NSSI (+) group were 38.2 % and 55.6 %, respectively. The most commonly abused substances among patients with NSSI were cannabis and synthetic cannabinoids. The prevalence of NSSI was 43.6 % in our sample. 'Self-cutting' was the most common type and 'affect regulation' was the most common function of NSSI. One of the most significant risk factors for NSSI was a previous history of suicide attempts. SUD appears to be a significant predictor of NSSI in patients with SSD. Further investigation of treatable risk factors such as SUD which are related to NSSI is needed. It is also essential to screen SSD patients for NSSI due to the probable relation to high risk of suicide.
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Affiliation(s)
- Erengül Güney
- Bakırköy Prof. Mazhar Osman Training and Research Hospital for Psychiatry and Neurology, Bakırköy, İstanbul, 34280, Turkey.
| | - İzgi Alnıak
- Bakırköy Prof. Mazhar Osman Training and Research Hospital for Psychiatry and Neurology, Bakırköy, İstanbul, 34280, Turkey
| | - Murat Erkıran
- Bakırköy Prof. Mazhar Osman Training and Research Hospital for Psychiatry and Neurology, Bakırköy, İstanbul, 34280, Turkey
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33
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A qualitative study of medication adherence amongst people with schizophrenia. Arch Psychiatr Nurs 2020; 34:194-199. [PMID: 32828348 DOI: 10.1016/j.apnu.2020.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 05/20/2020] [Accepted: 06/02/2020] [Indexed: 12/14/2022]
Abstract
Non-adherence to antipsychotic medication is common among people with schizophrenia, and is associated with an increased risk of relapse. It is important to develop strategies to enhance medication adherence. Few qualitative studies have been undertaken to understand the consumer's perspective. The voice of people who are prescribed these medications is therefore missing from the research literature. Reasons for non-adherence were investigated by directly engaging with consumers and exploring their attitudes, beliefs and experiences concerning antipsychotic medications. Qualitative, semi- structured, one-to-one interviews were conducted with 25 community-dwelling people with schizophrenia from metropolitan Adelaide, Australia. Interviews were audio-recorded, transcribed and analysed, guided by a grounded theory approach. Codes identified in open coding were grouped into categories, reflective of the different aspects of consumers' attitudes and experiences with medication. Interviews continued until there was saturation of themes. Consumer-related factors, medication-related factors and service-related factors were reported to influence adherence behavior. These included poor insight, unpleasant medication side effects, inadequate efficacy and poor therapeutic alliance. Lessons gained during periods of non-adherence were the motivator for future adherence; such as worsening of symptoms if medication was not taken. Potential implications of future adherence described by Interviewees include greater involvement of peer workers, as they were considered to work more effectively with consumers to encourage adherence. Peer workers had more credibility than other service providers due to their lived experience. Multiple factors were identified that impact on antipsychotic medication adherence, providing opportunities for interventions and improvements in services that would enhance adherence.
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Alipour A, Gabrielson S, Patel PB. Ingestible Sensors and Medication Adherence: Focus on Use in Serious Mental Illness. PHARMACY 2020; 8:pharmacy8020103. [PMID: 32560178 PMCID: PMC7355811 DOI: 10.3390/pharmacy8020103] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/09/2020] [Accepted: 06/11/2020] [Indexed: 12/16/2022] Open
Abstract
Background: Poor medication adherence is a major public health concern. Patients living with a serious mental illness (SMI) commonly present with non-adherence to their medication regimen, which can lead to relapse and hospitalizations. The high rates of antipsychotic non-adherence continue to persist despite several interventions and medication advances. This review evaluates the possible role of the ingestible sensor technology for medication adherence in different conditions, with a focus on use in the SMI schizophrenia. Methods: Literature searches were conducted in July 2019 in the PubMed database. Results: In small studies of ingestible sensor use, the average adherence ranged from 73.9% to 88.6% for SMI and ≥ 80% for cardiac and transplant (99.4%) patients. In SMI studies, patients were clinically stable, and the majority had a clinical global impression severity of “mild disease”. Patients generally experienced relatively minor dermatological adverse effects related to wearable sensor use. Conclusions: A medication with an ingestible sensor may help provide real-time objective medication-taking adherence information for clinicians. However, further studies are needed to understand the impact of use on adherence and improvement on treatment outcomes with the ingestible sensor technology.
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Affiliation(s)
- Azita Alipour
- College of Pharmacy, Marshall B. Ketchum University, Fullerton, CA 92831, USA;
| | - Stephen Gabrielson
- Health Sciences Library System, University of Pittsburgh, Pittsburgh, PA 15261, USA;
| | - Puja Baldev Patel
- College of Pharmacy, Marshall B. Ketchum University, Fullerton, CA 92831, USA;
- Correspondence:
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Abstract
De-institutionalization of mental health patients has evolved, over nearly 3 generations now, to a status quo of mental health patients experiencing myriad contacts with first-responders, primarily police, in lieu of care. The current institutions in which these patients rotate through are psychiatric emergency units, emergency rooms, jails, and prisons. Although more police are now specially trained to respond to calls that involve mental health patients, the criminalization of persons with mental illness has been steadily increasing over the past several decades. There have also been deaths. The Crisis Intervention Team (CIT) model fosters mental health acumen among first responders, and facilitates collaboration among first responders, mental health professionals, and mental health patients and their families. Here, we review some modern, large city configurations of CIT, the co-responder model, the mitigating effects of critically situated community-based programs, as well as barriers to the success of joint efforts to better address this pressing problem.
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36
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De las Cuevas C, de Leon J. Self-Report for Measuring and Predicting Medication Adherence: Experts' Experience in Predicting Adherence in Stable Psychiatric Outpatients and in Pharmacokinetics. Patient Prefer Adherence 2020; 14:1823-1842. [PMID: 33116427 PMCID: PMC7555336 DOI: 10.2147/ppa.s242693] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 09/25/2020] [Indexed: 12/18/2022] Open
Abstract
THE PROBLEM Poor adherence to appropriately prescribed medication is a global challenge for psychiatrists. PRIOR STUDIES Measuring adherence is complicated. In our recent three-country naturalistic study including more than 1000 patients and their adherence to multiple medication prescriptions at the same time, patients' self-report of adherence to each specific drug was the only practical option for measuring adherence. Systematic literature reviews provide inconsistent results for sociodemographic, clinical and medication variables as predictors of adherence to psychiatric drugs. Our studies over the last 10 years in relatively stable psychiatric outpatients have shown that some self-reported health beliefs had consistent, strong effects and a better predictive role. Three dimensions of these health beliefs are characteristics of the individual: 1) attitudes toward psychiatric medication such as pharmacophobia (fear of taking drugs or medicines), 2) health locus of control (the belief patients have about who or what agent determines the state of their health), 3) psychological reactance (an emotional reaction in direct contradiction to rules or regulations that threaten or suppress certain freedoms in behavior). They can be measured by the Patient Health Beliefs Questionnaire on Psychiatric Treatment. The attitude toward each specific medication can be measured by the necessity-concern framework and summarized as the presence or absence of skepticism about that drug. After 25 years conducting pharmacokinetic studies in psychiatric drugs, particularly antipsychotics, we have limited understanding of how to use blood levels to predict the effects of non-adherence or to establish it. EXPERT OPINION ON FUTURE STUDIES Future studies to predict adherence should include the inpatient setting and explore insight. Studying the pharmacokinetics associated with non-adherence in each psychiatric drug is a major challenge. Medication adherence is a complex and dynamic process changing over time in the same patient. Personalizing adherence using psychological or pharmacological variables are in their initial stages.
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Affiliation(s)
- Carlos De las Cuevas
- Department of Internal Medicine, Dermatology and Psychiatry, University of La Laguna, San Cristóbal de La Laguna, Canary Islands, Spain
- Instituto Universitario de Neurociencia (IUNE), Universidad de La Laguna, San Cristóbal de La Laguna, Spain
- Correspondence: Carlos De las CuevasDepartment of Internal Medicine, Dermatology and Psychiatry, Universidad de La Laguna,, Campus de Ofra s/n, San Cristóbal de La Laguna, Canary Islands, SpainTel +34-922-316502Fax +34-922-319353 Email
| | - Jose de Leon
- Mental Health Research Center at Eastern State Hospital, Lexington, KY, USA
- Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, University of Granada, Granada, Spain
- Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Apóstol Hospital, University of the Basque Country, Vitoria, Spain
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Barnes TR, Drake R, Paton C, Cooper SJ, Deakin B, Ferrier IN, Gregory CJ, Haddad PM, Howes OD, Jones I, Joyce EM, Lewis S, Lingford-Hughes A, MacCabe JH, Owens DC, Patel MX, Sinclair JM, Stone JM, Talbot PS, Upthegrove R, Wieck A, Yung AR. Evidence-based guidelines for the pharmacological treatment of schizophrenia: Updated recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2020; 34:3-78. [PMID: 31829775 DOI: 10.1177/0269881119889296] [Citation(s) in RCA: 142] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
These updated guidelines from the British Association for Psychopharmacology replace the original version published in 2011. They address the scope and targets of pharmacological treatment for schizophrenia. A consensus meeting was held in 2017, involving experts in schizophrenia and its treatment. They were asked to review key areas and consider the strength of the evidence on the risk-benefit balance of pharmacological interventions and the clinical implications, with an emphasis on meta-analyses, systematic reviews and randomised controlled trials where available, plus updates on current clinical practice. The guidelines cover the pharmacological management and treatment of schizophrenia across the various stages of the illness, including first-episode, relapse prevention, and illness that has proved refractory to standard treatment. It is hoped that the practice recommendations presented will support clinical decision making for practitioners, serve as a source of information for patients and carers, and inform quality improvement.
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Affiliation(s)
- Thomas Re Barnes
- Emeritus Professor of Clinical Psychiatry, Division of Psychiatry, Imperial College London, and Joint-head of the Prescribing Observatory for Mental Health, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Richard Drake
- Clinical Lead for Mental Health in Working Age Adults, Health Innovation Manchester, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Carol Paton
- Joint-head of the Prescribing Observatory for Mental Health, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Stephen J Cooper
- Emeritus Professor of Psychiatry, School of Medicine, Queen's University Belfast, Belfast, UK
| | - Bill Deakin
- Professor of Psychiatry, Neuroscience & Psychiatry Unit, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - I Nicol Ferrier
- Emeritus Professor of Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Catherine J Gregory
- Honorary Clinical Research Fellow, University of Manchester and Higher Trainee in Child and Adolescent Psychiatry, Manchester University NHS Foundation Trust, Manchester, UK
| | - Peter M Haddad
- Honorary Professor of Psychiatry, Division of Psychology and Mental Health, University of Manchester, UK and Senior Consultant Psychiatrist, Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | - Oliver D Howes
- Professor of Molecular Psychiatry, Imperial College London and Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ian Jones
- Professor of Psychiatry and Director, National Centre of Mental Health, Cardiff University, Cardiff, UK
| | - Eileen M Joyce
- Professor of Neuropsychiatry, UCL Queen Square Institute of Neurology, London, UK
| | - Shôn Lewis
- Professor of Adult Psychiatry, Faculty of Biology, Medicine and Health, The University of Manchester, UK, and Mental Health Academic Lead, Health Innovation Manchester, Manchester, UK
| | - Anne Lingford-Hughes
- Professor of Addiction Biology and Honorary Consultant Psychiatrist, Imperial College London and Central North West London NHS Foundation Trust, London, UK
| | - James H MacCabe
- Professor of Epidemiology and Therapeutics, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and Honorary Consultant Psychiatrist, National Psychosis Service, South London and Maudsley NHS Foundation Trust, Beckenham, UK
| | - David Cunningham Owens
- Professor of Clinical Psychiatry, University of Edinburgh. Honorary Consultant Psychiatrist, Royal Edinburgh Hospital, Edinburgh, UK
| | - Maxine X Patel
- Honorary Clinical Senior Lecturer, King's College London, Institute of Psychiatry, Psychology and Neuroscience and Consultant Psychiatrist, Oxleas NHS Foundation Trust, London, UK
| | - Julia Ma Sinclair
- Professor of Addiction Psychiatry, Faculty of Medicine, University of Southampton, Southampton, UK
| | - James M Stone
- Clinical Senior Lecturer and Honorary Consultant Psychiatrist, King's College London, Institute of Psychiatry, Psychology and Neuroscience and South London and Maudsley NHS Trust, London, UK
| | - Peter S Talbot
- Senior Lecturer and Honorary Consultant Psychiatrist, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Rachel Upthegrove
- Professor of Psychiatry and Youth Mental Health, University of Birmingham and Consultant Psychiatrist, Birmingham Early Intervention Service, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Angelika Wieck
- Honorary Consultant in Perinatal Psychiatry, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Alison R Yung
- Professor of Psychiatry, University of Manchester, School of Health Sciences, Manchester, UK and Centre for Youth Mental Health, University of Melbourne, Australia, and Honorary Consultant Psychiatrist, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Ould Brahim L, Hanganu C, Gros CP. Understanding Helpful Nursing Care From the Perspective of Mental Health Inpatients With a Dual Diagnosis: A Qualitative Descriptive Study. J Am Psychiatr Nurses Assoc 2020; 26:250-261. [PMID: 31587601 DOI: 10.1177/1078390319878773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND: An estimated 30% to 50% of people with a mental illness also have a substance use problem. Referred to as having a dual diagnosis, these patients experience high levels of unmet needs, poor health outcomes, and require specialized care during psychiatric hospitalization. Research on nursing inpatients with a dual diagnosis is limited and patient perceptions of helpful care during hospitalization are unknown. AIMS: What nursing interventions, attitudes, actions, and/or behaviors are perceived as helpful by patients with a dual diagnosis during psychiatric hospitalization? METHODS: A qualitative-descriptive design was used. Twelve adult inpatients with a dual diagnosis were recruited using purposive sampling. Individual, semistructured interviews were conducted, and interview data were analyzed using content analysis. RESULTS: Helpful nursing occurred across three themes: (1) promoting health in everyday living, (2) managing substance use in tandem with mental illness, and (3) building therapeutic relationships. CONCLUSIONS: Specific examples of helpful interventions and their reported outcomes reinforce the critical role that nurses play in the health and recovery of inpatients with a dual diagnosis. The importance of collaborative, strengths-based approaches is highlighted, and expanding the nurse's role to include evidence-based responses to substance use is recommended.
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Affiliation(s)
- Lydia Ould Brahim
- Lydia Ould Brahim, MSc, RN, Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
| | - Cezara Hanganu
- Cezara Hanganu, MSc, RN, Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
| | - Catherine Pugnaire Gros
- Catherine Pugnaire Gros, MSc, RN, McGill University, Montreal, Quebec, Canada; Centre Intégré Universitaire de Santé et de Services Sociaux de l'Ouest-de-l'Île-de-Montréal; Douglas Mental Health University Institute, Verdun, Quebec, Canada
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Abstract
Clozapine is established as the gold standard for antipsychotic treatment of patients suffering from treatment-resistant schizophrenia. Over virtually 3 decades, the level of inadequate response to clozapine was found to range from 40% to 60%. A heightened interest developed in the augmentation of clozapine to try to achieve response or maximize partial response. A large variety of drug groups have been investigated. This article focuses on the meta-analyses of these trials to discover reasonable evidence-based approaches to the management of patients not responding to clozapine.
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40
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Kim J, Plitman E, Nakajima S, Alshehri Y, Iwata Y, Chung JK, Caravaggio F, Menon M, Blumberger DM, Pollock BG, Remington G, De Luca V, Graff-Guerrero A, Gerretsen P. Modulation of brain activity with transcranial direct current stimulation: Targeting regions implicated in impaired illness awareness in schizophrenia. Eur Psychiatry 2019; 61:63-71. [DOI: 10.1016/j.eurpsy.2019.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/15/2019] [Accepted: 06/21/2019] [Indexed: 01/29/2023] Open
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Olagunju AT, Clark SR, Baune BT. Long-acting atypical antipsychotics in schizophrenia: A systematic review and meta-analyses of effects on functional outcome. Aust N Z J Psychiatry 2019; 53:509-527. [PMID: 30957510 DOI: 10.1177/0004867419837358] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Impairment in psychosocial function is common in schizophrenia. Long-acting injectable atypical antipsychotics are thought to enhance psychosocial function by boosting adherence. However, no systematic review has examined the effects of long-acting injectable atypical antipsychotics on psychosocial function in clinical trials. METHODS We searched major databases including Medline/PubMed, PsychINFO, EMBASE, CINAHL, Scopus, Web of Science, Cochrane Central Register of Controlled Trials and Clinical Trial Registries for randomised controlled trials that compared long-acting injectable atypical antipsychotics to placebo, oral antipsychotic medications or long-acting injectable atypical antipsychotics for all years till 2018, with no language limits. We performed a systematic review of findings on change in psychosocial function and its predictors in the included reports. Data on change in psychosocial functioning were meta-analysed using a random-effects model. RESULTS A total of 26 studies were included in systematic review, and 19 studies with 8616 adults, 68.1% males were meta-analysed. Long-acting injectable atypical antipsychotics were superior to placebo (standardised mean difference = 0.39; 95% confidence interval = [0.32, 0.47]; p < 0.001; I2 = 0%; 9 studies) and oral antipsychotic medications (standardised mean difference = 0.16; 95% confidence interval = [0.01, 0.31]; p = 0.04; I2 = 77%; 10 studies) for improved psychosocial function and superiority was maintained in short- and long trials. Poor psychosocial function was predicted by longer treatment duration, severe symptoms, poor cognition and poor insight. Functioning was assessed by either a single or a combination of measures, but was not the primary outcome in most studies. Other sources of bias include poor blinding and reporting of randomisation. CONCLUSION Long-acting injectable atypical antipsychotics are beneficial for recovery of psychosocial function in comparison with placebo, but the magnitude of superiority over oral antipsychotic treatment was small. Severe psychopathology at baseline predicted poor psychosocial function. Future effectiveness trials in which post-randomisation involvement is kept to a minimum, and psychosocial function is included as primary outcome a priori, are needed to capture the real-world impact of long-acting injectable atypical antipsychotics and to address methodological biases.
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Affiliation(s)
- Andrew T Olagunju
- 1 Discipline of Psychiatry, School of Medicine, The University of Adelaide, Adelaide, SA, Australia.,2 Department of Psychiatry, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Scott R Clark
- 1 Discipline of Psychiatry, School of Medicine, The University of Adelaide, Adelaide, SA, Australia
| | - Bernhard T Baune
- 1 Discipline of Psychiatry, School of Medicine, The University of Adelaide, Adelaide, SA, Australia.,3 Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Parkville, VIC, Australia.,4 The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia.,5 University Hospital for Psychiatry and Psychotherapy, University of Münster, Münster, Germany
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Kim J, Ozzoude M, Nakajima S, Shah P, Caravaggio F, Iwata Y, De Luca V, Graff-Guerrero A, Gerretsen P. Insight and medication adherence in schizophrenia: An analysis of the CATIE trial. Neuropharmacology 2019; 168:107634. [PMID: 31077729 DOI: 10.1016/j.neuropharm.2019.05.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/30/2019] [Accepted: 05/07/2019] [Indexed: 01/11/2023]
Abstract
Adherence to antipsychotic medication is critical for the treatment of patients with schizophrenia. Impaired insight into illness is one of the principal drivers of medication nonadherence, which contributes to negative clinical outcomes. The aims of this study were to examine the relationships between impaired insight and (1) rates of antipsychotic medication nonadherence, and (2) time to medication nonadherence using data from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study. Insight was assessed using the Positive and Negative Syndrome Scale (PANSS) item G12 (lack of judgment and insight). Patients were divided into 3 groups based on their degree of insight impairment, i.e. no impairment (PANSS G12 = 1), minimal impairment (PANSS G12 = 2-3), and moderate-to-severe insight impairment (PANSS G12 ≥ 4). Medication nonadherence was defined as taking less than 80% of monthly pill counts. Kaplan-Meier survival and Cox regression analyses were performed to examine differences in time to medication nonadherence between insight groups. There were significant differences between insight groups in the percentage of nonadherent patients at 6 months (χ2(2) = 8.80, p = 0.012) and 18 months (χ2(2) = 10.04, p = 0.007) after study initiation. Moderate-to-severe insight impairment was associated with earlier nonadherence compared to minimal (χ2 = 4.70, p = 0.030) or no impairment (χ2 = 11.92, p = 0.001). The association remained significant after adjustment for illness severity, substance use, attitudes toward medication, cognition, level of hostility, and depression. The results of this study indicate a strong link between impaired insight and antipsychotic medication nonadherence. Interventions to enhance insight early during treatment may help improve medication adherence, and in turn, long-term clinical and functional outcomes in patients with schizophrenia. This article is part of the issue entitled 'Special Issue on Antipsychotics'.
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Affiliation(s)
- Julia Kim
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Miracle Ozzoude
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Shinichiro Nakajima
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Department of Neuropsychiatry, Keio University, Tokyo, Japan
| | - Parita Shah
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Fernando Caravaggio
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Yusuke Iwata
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Vincenzo De Luca
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Geriatric Mental Health Division, CAMH, University of Toronto, Toronto, Ontario, Canada; Schizophrenia Division, CAMH, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, CAMH, Toronto, Ontario, Canada
| | - Ariel Graff-Guerrero
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Geriatric Mental Health Division, CAMH, University of Toronto, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, CAMH, Toronto, Ontario, Canada
| | - Philip Gerretsen
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Geriatric Mental Health Division, CAMH, University of Toronto, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, CAMH, Toronto, Ontario, Canada.
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43
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Davidson M. The debate regarding maintenance treatment with antipsychotic drugs in schizophrenia. DIALOGUES IN CLINICAL NEUROSCIENCE 2019. [PMID: 30581291 PMCID: PMC6296388 DOI: 10.31887/dcns.2018.20.3/mdavidson] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Several large meta-analyses of maintenance trials have confirmed that patients who suffer from chronic schizophrenia, randomized to placebo, are likely to experience earlier symptomatic worsening than patients randomized to a dopamine (DA)-blocking drug. These findings led expert groups to issue treatment guidelines, which recommend treatment with DA-blocking drugs for periods ranging from several years to indefinitely. The recommendations were accepted by the majority of, but not all, the experts, some of whom proposed a targeted or intermittent therapy approach by which DA-blocking drugs are discontinued upon symptomatic remission, to be renewed in case of symptom re-emergence. The debate between continued and targeted treatment approaches arises from disagreements regarding scientific and ethical questions. Scientifically, the discussion focuses on the quality and interpretation of the supporting or detracting evidence regarding each treatment option. For example, what is the percentage of individuals who can maintain stability off drugs? What is the rate of individuals who exacerbate despite maintenance treatment? What is the percentage of individuals who experience drug-related adverse effects? How can we interpret results of open-label, nonrandomized targeted trials? Regarding ethical questions, the debating sides disagree on how to weigh the impact of the decreased risk for exacerbation versus the certainty of adverse effects on the patients quality of life, and how to reach a patient-therapist shared decision within the constraints of mental illness.
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Affiliation(s)
- Michael Davidson
- UniSackler School of Medicine, Tel Aviv, Israel; Nicosia Medical School, Nicosia, Cyprus
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44
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Schandrin A, Norton J, Raffard S, Aouizerate B, Berna F, Brunel L, Chereau-Boudet I, D'Amato T, Denizot H, Dubertret C, Dubreucq J, Faget C, Fond G, Gabayet F, Llorca PM, Mallet J, Misdrahi D, Passerieux C, Rey R, Schurhoff F, Urbach M, Bonnet S, Capdevielle D. A multi-dimensional approach to the relationship between insight and aggressiveness in schizophrenia: Findings from the FACE-SZ cohort. Schizophr Res 2019; 204:38-45. [PMID: 30082179 DOI: 10.1016/j.schres.2018.07.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 06/25/2018] [Accepted: 07/15/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Aggressiveness is a stigma frequently associated with schizophrenia. The role of insight as a risk factor of aggressiveness remains contradictory; mainly because single measures of these states mask their complexity and heterogeneity. METHODS This study was conducted on 666 patients aged 15 and above with a DSM-IV-TR diagnosis of schizophrenia spectrum disorder, drawn from the French national network of schizophrenia expert center database. Collected data comprised socio-demographics and standardized psychiatric assessments. Aggressiveness was evaluated using the Buss-Perry Aggression Questionnaire and insight using the Scale to assess Unawareness of Mental Disorder (SUMD) and Birchwood Insight Scale (BIS). RESULTS Hostility was the aggressiveness dimension the most strongly associated with SUMD insight dimensions. Patients aware of their illness were nearly twice as likely to show hostility than those seriously unaware (OR = 1.95, 95% CI.: 1.08-3.5), but not when further adjusting for depression. Similarly, those aware of the consequences of their illness and of their symptoms were more hostile. Patients moderately aware of illness consequences had a higher risk of both anger and physical aggressiveness than those unaware (OR = 2.63, 95% CI.: 1.42-4.86, OR = 2.47, 95% CI.: 1.33-4.60, respectively), even when adjusting for depression for anger. CONCLUSION Our study confirms that a multi-dimensional approach to insight and aggressiveness is essential to understand the types of links between these clinical states. Insight may trigger the expression of an underlying hostile tendency, maybe via depression and self-stigmatisation. This should be taken into account in therapeutic approaches to improve insight.
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Affiliation(s)
- A Schandrin
- Fondation FondaMental, Créteil, France; Department of Adult Psychiatry, University Hospital of Nimes, Nimes, France.
| | - J Norton
- Inserm 1061, Montpellier, France
| | - S Raffard
- Inserm 1061, Montpellier, France; University Department of Adult Psychiatry, La Colombiere Hospital, CHRU Montpellier, University of Montpellier 1, Montpellier, France
| | - B Aouizerate
- Fondation FondaMental, Créteil, France; Department of Adult Psychiatry, Charles Perrens Hospital, F-33076 Bordeaux, France; University of Bordeaux, Inserm, Magendie Neurocenter - Pathophysiology of neural plasticity, U862, F-33000 Bordeaux, France
| | - F Berna
- Fondation FondaMental, Créteil, France; Strasbourg University Hospital, University of Strasbourg, INSERM U1114, Federation of Translational Psychiatry, Strasbourg, France
| | - L Brunel
- Fondation FondaMental, Créteil, France; INSERM U955, Translational Psychiatry Team, DHU Pe-PSY, Centre Expert Schizophrénie, Pôle de Psychiatrie et d'Addictologie des Hôpitaux Universitaires Henri Mondor, Paris Est University, 40 rue de Mesly, 94000 Créteil, France
| | - I Chereau-Boudet
- Fondation FondaMental, Créteil, France; Clermont-Ferrand University Hospital, EA 7280 Auvergne University, BP 69 63003 Clermont-Ferrand Cedex 1, France
| | - T D'Amato
- Fondation FondaMental, Créteil, France; University Claude Bernard Lyon 1, Le Vinatier Hospital, Pole Est BP 300 39 - 95 bd Pinel, 69678 BRON Cedex, France
| | - H Denizot
- Fondation FondaMental, Créteil, France; Clermont-Ferrand University Hospital, EA 7280 Auvergne University, BP 69 63003 Clermont-Ferrand Cedex 1, France
| | - C Dubertret
- Fondation FondaMental, Créteil, France; AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, Inserm U894 Université Paris Diderot, Sorbonne Paris Cité, Faculté de médecine, France
| | - J Dubreucq
- Fondation FondaMental, Créteil, France; Psychosocial Rehabilitation Reference Center, Alpes Isère Hospital, Grenoble, France
| | - C Faget
- Fondation FondaMental, Créteil, France; Department of Psychiatry (AP-HM), Sainte-Marguerite University Hospital, Marseille, France
| | - G Fond
- Fondation FondaMental, Créteil, France
| | - F Gabayet
- Fondation FondaMental, Créteil, France; Psychosocial Rehabilitation Reference Center, Alpes Isère Hospital, Grenoble, France
| | - P M Llorca
- Fondation FondaMental, Créteil, France; Clermont-Ferrand University Hospital, EA 7280 Auvergne University, BP 69 63003 Clermont-Ferrand Cedex 1, France
| | - J Mallet
- Fondation FondaMental, Créteil, France; AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, Inserm U894 Université Paris Diderot, Sorbonne Paris Cité, Faculté de médecine, France
| | - D Misdrahi
- Fondation FondaMental, Créteil, France; Department of Adult Psychiatry, Charles Perrens Hospital, F-33076 Bordeaux, France; University of Bordeaux, Inserm, Magendie Neurocenter - Pathophysiology of neural plasticity, U862, F-33000 Bordeaux, France
| | - C Passerieux
- Fondation FondaMental, Créteil, France; Department of Adult Psychiatry, Versailles Hospital, Le Chesnay, France; HandiRESP Laboratory, EA4047, UFR Health Sciences Simone Veil, Université de Versailles Saint-Quentin-En-Yvelines, Montigny-le-Bretonneux, France
| | - R Rey
- Fondation FondaMental, Créteil, France; University Claude Bernard Lyon 1, Le Vinatier Hospital, Pole Est BP 300 39 - 95 bd Pinel, 69678 BRON Cedex, France
| | - F Schurhoff
- Fondation FondaMental, Créteil, France; INSERM U955, Translational Psychiatry Team, DHU Pe-PSY, Centre Expert Schizophrénie, Pôle de Psychiatrie et d'Addictologie des Hôpitaux Universitaires Henri Mondor, Paris Est University, 40 rue de Mesly, 94000 Créteil, France
| | - M Urbach
- Fondation FondaMental, Créteil, France; Department of Adult Psychiatry, Versailles Hospital, Le Chesnay, France; HandiRESP Laboratory, EA4047, UFR Health Sciences Simone Veil, Université de Versailles Saint-Quentin-En-Yvelines, Montigny-le-Bretonneux, France
| | - S Bonnet
- University Department of Adult Psychiatry, La Colombiere Hospital, CHRU Montpellier, University of Montpellier 1, Montpellier, France
| | - D Capdevielle
- Fondation FondaMental, Créteil, France; Inserm 1061, Montpellier, France; University Department of Adult Psychiatry, La Colombiere Hospital, CHRU Montpellier, University of Montpellier 1, Montpellier, France
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García-Cabeza I, Díaz-Caneja CM, Ovejero M, de Portugal E. Adherence, insight and disability in paranoid schizophrenia. Psychiatry Res 2018; 270:274-280. [PMID: 30278408 DOI: 10.1016/j.psychres.2018.09.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 08/19/2018] [Accepted: 09/12/2018] [Indexed: 12/31/2022]
Abstract
Insight has long been linked to both prognosis and functioning in patients with schizophrenia; likewise, it is key to treatment adherence. This study seeks to assess the association between insight, adherence to pharmacological treatment, and disability in schizophrenia, and to study the potential mediating role of adherence between insight and disability. Insight (SUMD), adherence (CRS), and disability (WHO-DAS) were measured in 80 clinically stable patients with DSM-IV TR paranoid schizophrenia. Psychopathology was assessed with the Positive and Negative Syndrome Scale (PANSS). In a first step, predictors of disability were identified using linear regression to identify variables related to disability and further a mediation analysis was carried out. Negative symptoms, insight, and adherence account for 54.2% of the variance in disability. Negative symptoms act directly on disability, while the effect of insight on disability is partially mediated by adherence. Insight is key in disability in schizophrenia and should be leveraged in treatment programs.
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Affiliation(s)
- I García-Cabeza
- Department of Psychiatry, Gregorio Marañón University Hospital, Complutense University of Madrid, Ibiza, 43, 28009 Madrid, Spain.
| | - C M Díaz-Caneja
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense de Madrid, Spain
| | - M Ovejero
- SERMES CRO, Calle de Rufino González, 14, 28037 Madrid, Spain
| | - E de Portugal
- Department of Psychiatry, Gregorio Marañón University Hospital, Complutense University of Madrid, Ibiza, 43, 28009 Madrid, Spain; Ciber del área de Salud Mental (CIBERSAM), Madrid, Spain
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46
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Faden J, Citrome L. Resistance is not futile: treatment-refractory schizophrenia - overview, evaluation and treatment. Expert Opin Pharmacother 2018; 20:11-24. [PMID: 30407873 DOI: 10.1080/14656566.2018.1543409] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Schizophrenia is a debilitating condition with three main symptom domains: positive, negative, and cognitive. Approximately one-third of persons with schizophrenia will fail to respond to treatment. Growing evidence suggests that treatment-resistant (refractory) schizophrenia (TRS) may be a distinct condition from treatment-respondent schizophrenia. There is limited evidence on effective treatments for TRS, and a lack of standardized diagnostic criteria for TRS has hampered research. Areas covered: A literature search was conducted using Pubmed.gov and the EMBASE literature database. The authors discuss the pragmatic definitions of TRS and review treatments consisting of antipsychotic monotherapy and augmentation strategies. Expert opinion: Currently available first-line antipsychotic medications are generally effective at treating the positive symptoms of schizophrenia, leaving residual negative and cognitive symptoms. Before diagnosing TRS, rule out any pharmacodynamic or pharmacokinetic failures. Most evidence supports clozapine as having the most efficacy for TRS. If clozapine is used, it should be optimized, and serum levels should be at least 350-420 ng/ml. If clozapine is unable to be tolerated, some evidence suggests olanzapine at dosages up to 40mg/day can be useful. Augmentation strategies have weak evidence. Tailoring treatment to the specific domain is the preferred approach, and the use of a structured assessment/outcome measure is encouraged.
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Affiliation(s)
- Justin Faden
- a Psychiatry , Lewis Katz School of Medicine at Temple University , Philadelphia , PA , USA
| | - Leslie Citrome
- b Psychiatry & Behavioral Sciences , New York Medical College , Valhalla , NY , USA
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Carbon M, Kane JM, Leucht S, Correll CU. Tardive dyskinesia risk with first- and second-generation antipsychotics in comparative randomized controlled trials: a meta-analysis. World Psychiatry 2018; 17:330-340. [PMID: 30192088 PMCID: PMC6127753 DOI: 10.1002/wps.20579] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Tardive dyskinesia (TD) risk with D2/serotonin receptor antagonists or D2 receptor partial agonists (second-generation antipsychotics, SGAs) is considered significantly lower than with D2 antagonists (first-generation antipsychotics, FGAs). As some reports questioned this notion, we meta-analyzed randomized controlled studies (RCTs) to estimate the risk ratio (RR) and annualized rate ratio (RaR) of TD comparing SGAs vs. FGAs and SGAs vs. SGAs. Additionally, we calculated raw and annualized pooled TD rates for each antipsychotic. Data from 57 head-to-head RCTs, including 32 FGA and 86 SGA arms, were meta-analyzed, yielding 32 FGA-SGA pairs and 35 SGA-SGA pairs. The annualized TD incidence across FGA arms was 6.5% (95% CI: 5.3-7.8%) vs. 2.6% (95% CI: 2.0-3.1%) across SGA arms. TD risk and annualized rates were lower with SGAs vs. FGAs (RR=0.47, 95% CI: 0.39-0.57, p<0.0001, k=28; RaR=0.35, 95% CI: 0.28-0.45, p<0.0001, number-needed-to-treat, NNT=20). Meta-regression showed no FGA dose effect on FGA-SGA comparisons (Z=-1.03, p=0.30). FGA-SGA TD RaRs differed by SGA comparator (Q=21.8, df=7, p=0.003), with a significant advantage of olanzapine and aripiprazole over other non-clozapine SGAs in exploratory pairwise comparisons. SGA-SGA comparisons confirmed the olanzapine advantage vs. non-clozapine SGAs (RaR=0.66, 95% CI: 0.49-0.88, p=0.006, k=17, NNT=100). This meta-analysis confirms a clinically meaningfully lower TD risk with SGAs vs. FGAs, which is not driven by high dose FGA comparators, and documents significant differences with respect to this risk between individual SGAs.
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Affiliation(s)
- Maren Carbon
- Department of PsychiatryZucker Hillside HospitalGlen OaksNYUSA
| | - John M. Kane
- Department of PsychiatryZucker Hillside HospitalGlen OaksNYUSA,Department of Psychiatry and Molecular MedicineHofstra Northwell School of MedicineHempsteadNYUSA,Center for Psychiatric NeuroscienceFeinstein Institute for Medical ResearchManhassetNYUSA,Department of Psychiatry and PsychotherapyKlinikum rechts der Isar der Technischen Universität MünchenMunichGermany
| | - Stefan Leucht
- Department of Psychiatry and PsychotherapyKlinikum rechts der Isar der Technischen Universität MünchenMunichGermany
| | - Christoph U. Correll
- Department of PsychiatryZucker Hillside HospitalGlen OaksNYUSA,Department of Psychiatry and Molecular MedicineHofstra Northwell School of MedicineHempsteadNYUSA,Center for Psychiatric NeuroscienceFeinstein Institute for Medical ResearchManhassetNYUSA,Campus Virchow‐Klinikum, Charité‐Universitätsmedizin Berlin, and Department of Child and Adolescent PsychiatryBerlin Institute of HealthBerlinGermany
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Karpov B, Joffe G, Aaltonen K, Oksanen J, Suominen K, Melartin T, Baryshnikov I, Koivisto M, Heikkinen M, Isometsä ET. Self-reported treatment adherence among psychiatric in- and outpatients. Nord J Psychiatry 2018; 72:526-533. [PMID: 30444157 DOI: 10.1080/08039488.2018.1538387] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Poor adherence to psychiatric treatment is a common clinical problem, leading to unfavourable treatment outcome and increased healthcare costs. AIM The aim of this study was to investigate the self-reported adherence and attitudes to outpatient visits and pharmacotherapy in specialized care psychiatric patients. METHODS Within the Helsinki University Psychiatric Consortium (HUPC) pilot study, in- and outpatients with schizophrenia or schizoaffective disorder (SSA, n = 113), bipolar disorder (BD, n = 99), or depressive disorder (DD, n = 188) were surveyed about their adherence and attitudes towards outpatient visits and pharmacotherapy. Correlates of self-reported adherence to outpatient and drug treatment were investigated using regression analysis. RESULTS The majority (78.5%) of patients reported having attended outpatient visits regularly or only partly irregularly. Most patients (79.2%) also reported regular use of pharmacotherapy. Self-reported non-adherence to preceding outpatient visits was consistently and significantly more common among inpatients than outpatients across all diagnostic groups (p < .001). Across all groups, hospital setting was the strongest independent correlate of poor adherence to outpatient visits (SSA β = -2.418, BD β = -3.417, DD β = -2.766; p < .001 in all). Another independent correlate of non-adherence was substance use disorder (SSA β = -1.555, p = .001; BD β = -1.535, p = .006; DD β = -2.258, p < .000). No other socio-demographic or clinical factor was significantly associated with poor adherence in multivariate regression models. CONCLUSIONS Irrespective of diagnosis, self-reported adherence to outpatient care among patients with schizophrenia or schizoaffective disorder, bipolar disorder, and depression is associated strongly with two factors: hospital setting and substance use disorders. Thus, detection of adherence problems among former inpatients and recognition and treatment of substance misuse are important to ensure proper outpatient care.
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Affiliation(s)
- Boris Karpov
- a Department of Psychiatry , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Grigori Joffe
- a Department of Psychiatry , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Kari Aaltonen
- a Department of Psychiatry , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Jorma Oksanen
- a Department of Psychiatry , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Kirsi Suominen
- b Department of Mental Health and Substance Abuse , Social Services and Health Care , Helsinki , Finland
| | - Tarja Melartin
- c Department of Psychiatry , Helsinki University Central Hospital , Helsinki , Finland
| | - Ilya Baryshnikov
- a Department of Psychiatry , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Maaria Koivisto
- a Department of Psychiatry , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Martti Heikkinen
- a Department of Psychiatry , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Erkki T Isometsä
- d Department of Psychiatry , Institute of Clinical Medicine , Helsinki , Finland
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Tielman ML, Neerincx MA, van Meggelen M, Franken I, Brinkman WP. How should a virtual agent present psychoeducation? Influence of verbal and textual presentation on adherence. Technol Health Care 2018; 25:1081-1096. [PMID: 28800346 PMCID: PMC5814660 DOI: 10.3233/thc-170899] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE With the rise of autonomous e-mental health applications, virtual agents can play a major role in improving trustworthiness, therapy outcome and adherence. In these applications, it is important that patients adhere in the sense that they perform the tasks, but also that they adhere to the specific recommendations on how to do them well. One important construct in improving adherence is psychoeducation, information on the why and how of therapeutic interventions. In an e-mental health context, this can be delivered in two different ways: verbally by a (virtual) embodied conversational agent or just via text on the screen. The aim of this research is to study which presentation mode is preferable for improving adherence. METHODS This study takes the approach of evaluating a specific part of a therapy, namely psychoeducation. This was done in a non-clinical sample, to first test the general constructs of the human-computer interaction. We performed an experimental study on the effect of presentation mode of psychoeducation on adherence. In this study, we took into account the moderating effects of attitude towards the virtual agent and recollection of the information. Within the paradigm of expressive writing, we asked participants (n= 46) to pick one of their worst memories to describe in a digital diary after receiving verbal or textual psychoeducation. RESULTS AND CONCLUSION We found that both the attitude towards the virtual agent and how well the psychoeducation was recollected were positively related to adherence in the form of task execution. Moreover, after controlling for the attitude to the agent and recollection, presentation of psychoeducation via text resulted in higher adherence than verbal presentation by the virtual agent did.
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Affiliation(s)
| | - Mark A Neerincx
- Delft University of Technology, Delft, The Netherlands.,TNO Perceptual and Cognitive Systems, Soesterberg, The Netherlands
| | | | - Ingmar Franken
- Erasmus University Rotterdam, Rotterdam, The Netherlands
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Calhoun S. The clinician-patient working alliance: Is it a significant predictor of psychiatric medication adherence in a sample of recently released parolees? THE JOURNAL OF FORENSIC PSYCHIATRY & PSYCHOLOGY 2018; 29:782-793. [PMID: 30524208 PMCID: PMC6277031 DOI: 10.1080/14789949.2018.1477976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Persistent psychiatric symptoms can serve as a major barrier to the successful reintegration of parolees with mental illness. Thus, it is important to identify factors that might impact their mental health recovery, such as low adherence to their treatment regimen. Although many studies have examined the issue of psychiatric medication nonadherence, very few studies have focused specifically on justice-involved individuals. The strength of the clinician/patient working alliance has been found to be significantly associated with psychiatric medication adherence in prior research, but this relationship has not been assessed in a parolee population. Logistic regression analysis was used to determine if patient-rated working alliance was a significant predictor of low psychiatric medication adherence while taking into account alcohol/illegal drug use, age, and ethnicity in a sample of recently released parolees with mental illness (N=49). Patient-rated working alliance, age, and ethnicity were not significant predictors of low adherence. Alcohol/illegal drug use during the follow-up period was associated with a significantly increased likelihood of meeting the criteria for low medication adherence (OR=8.36; 95% CI=1.60, 43.66). The findings from this study highlight the importance of addressing alcohol and illegal drug use issues as part of the psychiatric treatment plan for returning prisoners with mental illness.
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Affiliation(s)
- Stacy Calhoun
- UCLA Integrated Substance Abuse Programs, 11075 Santa Monica Blvd., Suite 200, Los Angeles, CA 90025
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