1
|
Starzer M, Hansen HG, Hjorthøj C, Albert N, Glenthøj LB, Nordentoft M. Long-term quality of life and social disconnection 20 years after a first episode psychosis, results from the 20-year follow-up of the OPUS trial. Schizophr Res 2024; 274:33-45. [PMID: 39245592 DOI: 10.1016/j.schres.2024.08.021] [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: 03/01/2024] [Revised: 08/26/2024] [Accepted: 08/28/2024] [Indexed: 09/10/2024]
Abstract
OBJECTIVE Schizophrenia disorders severely impact social and occupational function and reduce quality of life, furthermore patients often suffer from social withdrawal and isolation. The aim of this study was to investigate long-term quality of life and social disconnection and determine 10-year changes in quality of life and social disconnection later in life in association with changes in symptom severity, cognition, and global function. METHODS We used assessments of quality of life and assessor rated social disconnection from the 10- and 20-year follow-up of the OPUS trial to examined 10-year changes in self-rated quality of life and social disconnection in the later stage of illness following a first episode psychosis. Self-rated social disconnection was only assessed in the 174 participants of the 20-year follow-up. RESULTS Twenty years after a first episode psychosis only half of the participants reported having face-to-face contact with someone in their network more than once a week, while 90 % reported often or always being able to get emotional support when needed. Quality of life ratings were lower in our study population compared to the general population. On average physical and environmental quality of life worsened from the 10- to the 20-year follow-up while psychological and social quality of life remained stable. All quality-of-life domains were associated with negative symptoms (physical QoL: b = -6.6, p < 0.001, psychological QoL: b = -8, p < 0.001, social QoL: b = -5.7, p < 0.001 and environmental QoL: b = -6.5, p < 0.001) and global function (physical QoL: b = -0. 47, p < 0.001, psychological QoL: b = 0.52, p < 0.001, social QoL: b = 0.31, p < 0.001 and environmental QoL: b = 0.49, p < 0.001). CONCLUSION Social disconnection seems to persist over time. Social disconnection and quality of life were associated with negative symptoms and poor functioning, therefore interventions aimed at improving global and social function might likely also improve quality of life.
Collapse
Affiliation(s)
- Marie Starzer
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen, Mental Health Services in the Capital Region, Denmark; University of Copenhagen, Department of Clinical Medicine, Copenhagen, Denmark.
| | - Helene Gjervig Hansen
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen, Mental Health Services in the Capital Region, Denmark; University of Copenhagen, Department of Clinical Medicine, Copenhagen, Denmark
| | - Carsten Hjorthøj
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen, Mental Health Services in the Capital Region, Denmark; University of Copenhagen, Department of Public Health, Section of Epidemiology, Copenhagen, Denmark
| | - Nikolai Albert
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen, Mental Health Services in the Capital Region, Denmark; Mental Health Center Amager, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Louise Birkedal Glenthøj
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen, Mental Health Services in the Capital Region, Denmark; Department of Psychology, University of Copenhagen, Denmark
| | - Merete Nordentoft
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen, Mental Health Services in the Capital Region, Denmark; University of Copenhagen, Department of Clinical Medicine, Copenhagen, Denmark
| |
Collapse
|
2
|
Mélissa B, Sabrina G, Charles-Edouard G, Hind Z, Consortium S, Kingsada P, Stéphane P, Alexandre D. Clinical characteristics associated with functioning trajectories following admission to a psychiatric institution: A prospective cohort study of individuals with psychosis. Psychiatry Res 2024; 339:116062. [PMID: 38968920 DOI: 10.1016/j.psychres.2024.116062] [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: 02/23/2024] [Revised: 05/26/2024] [Accepted: 06/25/2024] [Indexed: 07/07/2024]
Abstract
Psychotic disorders can be severely enabling, and functional recovery is often difficult to achieve. Admission to a psychiatric unit represents a key opportunity to implement strategies that will improve functional outcomes. In the current literature, there is a lack of consensus on which factors influence functional recovery. Therefore, the present longitudinal cohort study aimed to identify factors associated with functional trajectories following hospital admission for acute psychosis. A sample of 453 individuals with acute psychosis was extracted from the Signature Biobank database. Participants were followed for up to a year following admission. Various clinical indicators were documented over time. Functional trajectories were calculated based on the World Health Organization Disability Assessment Schedule 2.0. Three groups were identified: "improving", "stable", and "worsening" function. Individuals with a more severe symptomatic presentation at baseline were found to have better functional improve more over time. Over time, individuals in the "improving" and "stable" groups had significant improvements in their psychiatric symptoms. Finally, individuals following a "worsening" functional trajectory initially improved in terms of psychotic symptoms, but it did not persist over time. These results highlight the importance of studying function as a key component of recovery rather than solely focusing on relapse prevention.
Collapse
Affiliation(s)
- Beaudoin Mélissa
- Department of Psychiatry and Addictology, Faculty of Medicine, University of Montreal. Montreal, QC, Canada; Faculty of Medicine, McGill University. Montreal, QC, Canada; Research center of the Institut universitaire en santé mentale de Montréal. Montreal, QC, Canada.
| | - Giguère Sabrina
- Department of Psychiatry and Addictology, Faculty of Medicine, University of Montreal. Montreal, QC, Canada; Research center of the Institut universitaire en santé mentale de Montréal. Montreal, QC, Canada
| | - Giguère Charles-Edouard
- Research center of the Institut universitaire en santé mentale de Montréal. Montreal, QC, Canada
| | - Ziady Hind
- Department of Psychiatry and Addictology, Faculty of Medicine, University of Montreal. Montreal, QC, Canada; Research center of the Institut universitaire en santé mentale de Montréal. Montreal, QC, Canada
| | - Signature Consortium
- Research center of the Institut universitaire en santé mentale de Montréal. Montreal, QC, Canada
| | - Phraxayavong Kingsada
- Research center of the Institut universitaire en santé mentale de Montréal. Montreal, QC, Canada; Services et recherche psychiatrique AD. Montreal, QC, Canada
| | - Potvin Stéphane
- Department of Psychiatry and Addictology, Faculty of Medicine, University of Montreal. Montreal, QC, Canada; Research center of the Institut universitaire en santé mentale de Montréal. Montreal, QC, Canada
| | - Dumais Alexandre
- Department of Psychiatry and Addictology, Faculty of Medicine, University of Montreal. Montreal, QC, Canada; Research center of the Institut universitaire en santé mentale de Montréal. Montreal, QC, Canada; Services et recherche psychiatrique AD. Montreal, QC, Canada; Institut national de psychiatrie légale Philippe-Pinel. Montreal, QC, Canada.
| |
Collapse
|
3
|
Espinosa V, Bagaeva A, López-Carrilero R, Barajas A, Barrigón ML, Birulés I, Frígola-Capell E, Díaz-Cutraro L, González-Higueras F, Grasa E, Gutiérrez-Zotes A, Lorente-Rovira E, Pélaez T, Pousa E, Ruiz-Delgado I, Verdaguer-Rodríguez M, Ochoa S. Neuropsychological profiles in first-episodes psychosis and their relationship with clinical, metacognition and social cognition variables. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-024-01813-z. [PMID: 38806850 DOI: 10.1007/s00406-024-01813-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 04/19/2024] [Indexed: 05/30/2024]
Abstract
An increasing interest in the assessment of neuropsychological performance variability in people with first-episode psychosis (FEP) has emerged. However, its association with clinical and functional outcomes requires further study. Furthermore, FEP neuropsychological subgroups have not been characterized by clinical insight or metacognition and social cognition domains. The aim of this exploratory study was to identify specific groups of patients with FEP based on neuropsychological variables and to compare their sociodemographic, clinical, metacognition and social cognition profiles. A sample of 149 FEP was recruited from adult mental health services. Neuropsychological performance was assessed by a neuropsychological battery (WAIS-III; TMT; WSCT; Stroop Test; TAVEC). The assessment also included sociodemographic characteristics, clinical, functional, metacognition and social cognition variables. Two distinct neuropsychological profiles emerged: one neuropsychological impaired cluster (N = 56) and one relatively intact cluster (N = 93). Significant differences were found between both profiles in terms of sociodemographic characteristics (age and level of education) (p = 0.001), clinical symptoms (negative, positive, disorganized, excitement and anxiety) (p = 0.041-0.001), clinical insight (p = 0.038-0.017), global functioning (p = 0.014), as well as in social cognition domains (emotional processing and theory of mind) (p = 0.001; p = 0.002). No significant differences were found in metacognitive variables (cognitive insight and 'jumping to conclusions' bias). Relationship between neurocognitive impairment, social cognition and metacognition deficits are discussed. Early identifying of neuropsychological profiles in FEP, characterized by significant differences in clinical and social cognition variables, could provide insight into the prognosis and guide the implementation of tailored early-intervention.
Collapse
Affiliation(s)
- Victoria Espinosa
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain.
- Fundació Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain.
- Etiopatogènia I Tractament Dels Trastorns Mentals Greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain.
| | - Alana Bagaeva
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Fundació Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Etiopatogènia I Tractament Dels Trastorns Mentals Greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Raquel López-Carrilero
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
- Fundació Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Etiopatogènia I Tractament Dels Trastorns Mentals Greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Ana Barajas
- Departament de Psicologia, Facultat de Psicologia Clínica I de la Salut. Serra Húnter Programme, Universitat Autònoma de Barcelona, Barcelona, Spain
- Departament of Research, Centre d'Higiene Mental Les Corts, Barcelona, Spain
| | - María Luisa Barrigón
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
- Departament of Psychiatry, University Hospital Virgen del Rocio, Sevilla, Spain
- Psychiatry Service, Area de Gestión Sanitaria Sur Granada, Motril, Granada, Spain
| | - Irene Birulés
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Facultat de Psicologia Departament de Cognició, Desenvolupament i Psicologia de l'Educació, Universitat de Barcelona, Barcelona, Spain
- Etiopatogènia I Tractament Dels Trastorns Mentals Greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Eva Frígola-Capell
- Mental Health and Addiction Research Group, Fundació Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta (IDIBGI), Girona, Spain
- Institut d'Assistencia Sanitària, Girona, Spain
| | - Luciana Díaz-Cutraro
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
- Fundació Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Etiopatogènia I Tractament Dels Trastorns Mentals Greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Psychology Department, FPCEE Blanquerna, Universitat Ramon Llull, Barcelona, Spain
| | | | - Eva Grasa
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
- Department of Psychiatry, Hospital de La Santa Creu I Sant Pau, Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - Alfonso Gutiérrez-Zotes
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
- Hospital Universitari Institut Pere Mata, Institut d'Investigació Sanitària Pere Virgili-CERCA, Universitat Rovira I Virgili, Reus, Spain
| | - Ester Lorente-Rovira
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
- Psychiatry Service, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Trinidad Pélaez
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
- Etiopatogènia I Tractament Dels Trastorns Mentals Greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Esther Pousa
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
- Department of Psychiatry, Hospital de La Santa Creu I Sant Pau, Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | | | - Marina Verdaguer-Rodríguez
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Fundació Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Etiopatogènia I Tractament Dels Trastorns Mentals Greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, 08193, Barcelona, Spain
| | - Susana Ochoa
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
- Etiopatogènia I Tractament Dels Trastorns Mentals Greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| |
Collapse
|
4
|
Johansson M, Hjärthag F, Helldin L. Exploring cross-sectional and longitudinal symptomatic remission and subjective quality of life in schizophrenia. Psychiatry Res 2023; 328:115421. [PMID: 37659163 DOI: 10.1016/j.psychres.2023.115421] [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: 04/27/2022] [Revised: 07/24/2023] [Accepted: 08/14/2023] [Indexed: 09/04/2023]
Abstract
Achieving symptomatic remission, as defined by the Remission in Schizophrenia Working Group, is intended to be a meaningful outcome for individuals with schizophrenia, resulting in enhanced well-being. Cross-sectional studies have reported an association between symptomatic remission and subjective quality of life (QoL). Longitudinal studies aimed at examining this association have showed mixed results. The aim of this study was to explore the relationship between symptomatic remission and subjective QoL, both cross-sectionally and longitudinally. The study comprised data from what were at most 386 patients with schizophrenia, of whom 122-140 were followed over a period of four years. Based on cross-sectional remission status and longitudinal remission pattern, differences in subjective QoL were explored. Remission status was assessed using the Positive and Negative Syndrome Scale (PANSS), and subjective QoL using the Short Form-36 Health Survey (SF-36). Both the cross-sectional and the longitudinal approach showed that patients in symptomatic remission had significantly higher subjective QoL. Patients who were in non-remission at baseline, but who achieved remission at follow-up, also had significantly higher subjective QoL at follow-up compared with baseline. The results from the study show a clear association between symptomatic remission and subjective QoL. However, achieving symptomatic remission does not appear to be a guarantee of sustained subjective QoL, and only continued stable remission appears to result in such an outcome.
Collapse
Affiliation(s)
- Madeleine Johansson
- Region Västra Götaland, Department of Psychiatry, NU Health Care Hospital, Trollhättan, Sweden; Department of Psychology, Karlstad University, Karlstad, Sweden.
| | | | - Lars Helldin
- Region Västra Götaland, Department of Psychiatry, NU Health Care Hospital, Trollhättan, Sweden; Department of Psychology, Karlstad University, Karlstad, Sweden
| |
Collapse
|
5
|
Veddum L, Gregersen M, Andreassen AK, Knudsen CB, Brandt JM, Krantz MF, Søndergaard A, Burton BK, Jepsen JRM, Hemager N, Thorup AAE, Nordentoft M, Mors O, Bliksted V, Greve AN. Social responsiveness in families with parental schizophrenia or bipolar disorder-The Danish High Risk and Resilience Study. Psychiatry Res 2023; 323:115140. [PMID: 36898170 DOI: 10.1016/j.psychres.2023.115140] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/17/2023] [Accepted: 02/28/2023] [Indexed: 03/12/2023]
Abstract
Schizophrenia and bipolar disorder are highly heritable severe mental disorders associated with social impairments. Moreover, partners to individuals with one of these disorders display poorer functioning and more psychopathology, but their social skills and the transgenerational transmission remains uninvestigated. Therefore, we aimed to examine social responsiveness in families with parental schizophrenia or bipolar disorder. The cohort consists of 11-year-old children with at least one parent with schizophrenia (n = 179) or bipolar disorder (n = 105) and population-based controls (PBC, n = 181). Children and parents were assessed with The Social Responsiveness Scale, Second Edition. Duration of time each parent and child have lived together was ascertained through interviews. Parents with schizophrenia and parents with bipolar disorder exhibited poorer social responsiveness compared with PBC parents. Parents with schizophrenia displayed poorer social responsiveness compared with parents with bipolar disorder. Schizophrenia co-parents exhibited poorer social responsiveness compared with bipolar co-parents and PBC co-parents. We found significant positive associations between parents' and children's social responsiveness, with no interaction effect of duration of time living together. Considering that social impairments are suggested as a vulnerability marker, this knowledge calls for increased attention towards vulnerable families, particularly those where both parents have social impairments.
Collapse
Affiliation(s)
- Lotte Veddum
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark; The Psychosis Research Unit, Aarhus University Hospital Skejby - Psychiatry, Aarhus, Denmark; iPSYCH -The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Asrhus, Denmark.
| | - Maja Gregersen
- iPSYCH -The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Asrhus, Denmark; CORE - Copenhagen Research Center for Mental Health, Mental Health Center, Copenhagen University Hospital, Hellerup, Denmark
| | - Anna Krogh Andreassen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark; The Psychosis Research Unit, Aarhus University Hospital Skejby - Psychiatry, Aarhus, Denmark; iPSYCH -The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Asrhus, Denmark
| | - Christina Bruun Knudsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark; The Psychosis Research Unit, Aarhus University Hospital Skejby - Psychiatry, Aarhus, Denmark; iPSYCH -The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Asrhus, Denmark
| | - Julie Marie Brandt
- iPSYCH -The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Asrhus, Denmark; CORE - Copenhagen Research Center for Mental Health, Mental Health Center, Copenhagen University Hospital, Hellerup, Denmark; Faculty of Health and Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mette Falkenberg Krantz
- iPSYCH -The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Asrhus, Denmark; CORE - Copenhagen Research Center for Mental Health, Mental Health Center, Copenhagen University Hospital, Hellerup, Denmark; Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services Copenhagen, Copenhagen, Denmark
| | - Anne Søndergaard
- iPSYCH -The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Asrhus, Denmark; CORE - Copenhagen Research Center for Mental Health, Mental Health Center, Copenhagen University Hospital, Hellerup, Denmark; Faculty of Health and Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Birgitte Klee Burton
- Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services Copenhagen, Copenhagen, Denmark; Faculty of Health and Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Child and Adolescent Psychiatry, Copenhagen University Hospital, Psychiatry Region Zealand, Roskilde, Denmark
| | - Jens Richardt Møllegaard Jepsen
- iPSYCH -The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Asrhus, Denmark; CORE - Copenhagen Research Center for Mental Health, Mental Health Center, Copenhagen University Hospital, Hellerup, Denmark; Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services Copenhagen, Copenhagen, Denmark; Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Mental Health Center, Copenhagen University Hospital, Mental Health Services Copenhagen, Glostrup, Denmark
| | - Nicoline Hemager
- iPSYCH -The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Asrhus, Denmark; CORE - Copenhagen Research Center for Mental Health, Mental Health Center, Copenhagen University Hospital, Hellerup, Denmark; Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services Copenhagen, Copenhagen, Denmark
| | - Anne Amalie Elgaard Thorup
- iPSYCH -The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Asrhus, Denmark; Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services Copenhagen, Copenhagen, Denmark; Faculty of Health and Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Merete Nordentoft
- iPSYCH -The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Asrhus, Denmark; CORE - Copenhagen Research Center for Mental Health, Mental Health Center, Copenhagen University Hospital, Hellerup, Denmark; Faculty of Health and Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ole Mors
- The Psychosis Research Unit, Aarhus University Hospital Skejby - Psychiatry, Aarhus, Denmark; iPSYCH -The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Asrhus, Denmark
| | - Vibeke Bliksted
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark; The Psychosis Research Unit, Aarhus University Hospital Skejby - Psychiatry, Aarhus, Denmark; iPSYCH -The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Asrhus, Denmark
| | - Aja Neergaard Greve
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark; The Psychosis Research Unit, Aarhus University Hospital Skejby - Psychiatry, Aarhus, Denmark; iPSYCH -The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Asrhus, Denmark
| |
Collapse
|
6
|
Clarke EL, Allott K, Anderson JFI, Gao CX, Filia KM, Killackey E, Cotton SM. Heterogeneity of quality of life in the later stages of first-episode psychosis recovery. Qual Life Res 2023; 32:769-780. [PMID: 36378390 PMCID: PMC9992035 DOI: 10.1007/s11136-022-03277-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE First-episode psychosis (FEP) is characterised by wide heterogeneity in terms of symptom presentation and illness course. However, the heterogeneity of quality of life (QoL) in FEP is not well understood. We investigated whether subgroups can be identified using participants' responses on four QoL domains (physical health, psychological, social relationships, and environmental) 18-months into the recovery phase of FEP. We then examined the discriminant validity of these subgroups with respect to clinical, cognitive, and functioning features of FEP. METHOD Demographic and clinical characteristics, QoL, cognition, and functioning were assessed in 100 people with FEP at the 18-month follow-up of a randomised controlled trial of Individual Placement Support, which aims to facilitate vocational recovery. QoL was measured using the World Health Organisation's QoL-BRIEF. A two-stage clustering approach using Ward's method and Squared Euclidean Distance with a k-means confirmation was conducted. Multinomial logistic regressions were used to establish external validity. RESULTS Three QoL subgroups emerged: a 'good' subgroup with relatively high QoL across all domains (31%), an 'intermediate' subgroup with relatively low psychological QoL (48%) and a 'poor' subgroup with markedly low social relationship QoL (21%). Negative symptoms, depressive symptoms, social/occupational functioning, and social inclusion at follow-up predicted subgroup membership. Sensitivity analysis found similar results. CONCLUSION Although some individuals with FEP have QoL comparable to individuals without mental ill health, QoL can remain concerningly low despite treatment efforts. Future research on interventions that target factors associated with poor QoL, such as low social inclusion, is required to counteract prolonged poor QoL in FEP.
Collapse
Affiliation(s)
- E L Clarke
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, 3010, Australia.
| | - K Allott
- , Orygen, Parkville, Melbourne, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, VIC, Australia
| | - J F I Anderson
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, 3010, Australia
| | - C X Gao
- , Orygen, Parkville, Melbourne, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, VIC, Australia.,School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - K M Filia
- , Orygen, Parkville, Melbourne, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, VIC, Australia
| | - E Killackey
- , Orygen, Parkville, Melbourne, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, VIC, Australia
| | - S M Cotton
- , Orygen, Parkville, Melbourne, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, VIC, Australia
| |
Collapse
|
7
|
Jauhar S, Fusar-Poli P, Foreman D. Off the RADAR; questions regarding the trial protocol of a randomised controlled trial of antipsychotic reduction and discontinuation. J Psychopharmacol 2023; 37:378-380. [PMID: 36633292 PMCID: PMC10101177 DOI: 10.1177/02698811221144633] [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: 01/13/2023]
Abstract
The randomised controlled trial of antipsychotic reduction and discontinuation addresses essential questions with regard to continued use of antipsychotics in schizophrenia, pertaining to social functioning and continued antipsychotic use. However, significant methodological issues stated in the trial protocol have the potential to confound interpretation of any findings. These include use of a non-blinded outcome measure, treatment as usual comparator and possible sample size issues.
Collapse
Affiliation(s)
- Sameer Jauhar
- Department of Psychological Medicine, IoPPN, King's College, London, UK
| | - Paolo Fusar-Poli
- Department of Psyhcosis Studies, IoPPN, King's College, London, UK
| | - David Foreman
- Department Child and Adolescent Psychiatry, King's College, London, UK
| |
Collapse
|
8
|
Joo SW, Kim H, Jo YT, Ahn S, Choi YJ, Choi W, Park S, Lee J. Risk of treatment discontinuation and psychiatric hospitalization associated with early dose reduction of antipsychotic treatment in first-episode schizophrenia: A nationwide, health insurance data-based study. Psychiatry Clin Neurosci 2022; 76:195-200. [PMID: 35233892 DOI: 10.1111/pcn.13341] [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: 12/03/2021] [Revised: 02/15/2022] [Accepted: 02/20/2022] [Indexed: 01/10/2023]
Abstract
AIM We investigated the impact of early dose reduction of antipsychotic treatment on the risk of treatment discontinuation and psychiatric hospitalization in patients with first-episode schizophrenia (FES). METHODS The Health Insurance Review Agency database in South Korea was used to include 16 153 patients with FES. At 6 months from their diagnosis, the patients were categorized by the magnitude of dose reduction (no reduction, 0%-50%, and >50%). With a reference of no reduction, the risk of treatment discontinuation and psychiatric hospitalization associated with dose reduction in the 1-year follow-up period after the first 6 months was examined with a Cox proportional hazard ratio model stratified by the mean daily olanzapine-equivalent dose in the first 3 months (<10, 10 to 20, >20 mg/day). RESULTS A >50% dose reduction was associated with an increased risk of treatment discontinuation in all subgroups (<10 mg/day: hazard ratio [HR] =1.44, 95% confidence interval [CI] =1.24-1.67 [P <0.01]; 10-20 mg/day: HR =1.60, 95% CI =1.37-1.86 [P <0.01]; and >20 mg/day: HR =1.62, 95% CI =1.37-1.91 [P <0.01]). In the subgroup taking <10 mg/day, an association of 0%-50% dose reduction with an increased risk of treatment discontinuation was observed (HR =1.20, 95% CI =1.09-1.31; P <0.01). A > 50% dose reduction was associated with increased risk of psychiatric hospitalization only in the subgroup taking <10 mg/day (HR =1.48, 95% CI =1.21-1.80; P <0.01). CONCLUSIONS Our results suggest that an above certain dose of antipsychotic drugs is required to prevent psychiatric hospitalization, and extensive dose reduction of antipsychotic drugs could result in a higher risk of treatment discontinuation.
Collapse
Affiliation(s)
- Sung Woo Joo
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Harin Kim
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young Tak Jo
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Soojin Ahn
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young Jae Choi
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Woohyeok Choi
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Soyeon Park
- Department of Psychiatry, Medical Foundation Yongin Mental Hospital, Yongin, Republic of Korea
| | - Jungsun Lee
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
9
|
El Ghamry R, Saad A, Elbatrawy AN, Hassan GAM, Rabie ES, Mohamed MY. Symptom remission and functional outcome in an Egyptian sample of patients with schizophrenia. MIDDLE EAST CURRENT PSYCHIATRY 2021. [DOI: 10.1186/s43045-021-00156-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The ultimate treatment goal of schizophrenia is regaining patients’ pre-morbid function.
Results
Ninety-three outpatients with schizophrenia, diagnosed according to the criteria of Diagnostic and Statistical Manual of Mental Disorders—fourth edition (DSM-IV), were recruited, of whom 35 patients (37.6%) had achieved the remission severity criteria, whereas 58 patients (62.4%) failed to fulfill the criteria for remission. The functional aspects were examined by the Global Assessment of Functioning scale (GAF) and the Social Functioning Questionnaire (SFQ). Predictors of outcome were examined by applying binary logistic regression analysis. Patients who fulfilled those specific criteria for remission showed a favorable outcome in the assessed areas, regarding GAF and social functioning in society. Lack of judgment or insight item of PANSS showed significantly good functional outcomes.
Conclusion
The results suggest that the remission concept has important implications for the treatment of schizophrenia. Remission seems to be associated with better functional capabilities. However, this does not necessarily mean that remitted patients have “adequate” functioning, especially regarding the social skills domain.
Collapse
|
10
|
Liao Z, Allott K, Anderson JFI, Killackey E, Cotton SM. Quality of life in first episode psychosis: a cluster analytic approach. Qual Life Res 2021; 31:1807-1817. [PMID: 34661805 DOI: 10.1007/s11136-021-03014-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE Quality of life is increasingly recognised as an important outcome for young people with first episode psychosis (FEP). The first aim was to determine whether distinct homogenous subgroups of young people with FEP could be delineated based on profiles on quality of life domains (Physical Health, Psychological, Social relationships and Environmental). The second aim was to examine the discriminant validity of these subgroups with respect to demographic, functioning and clinical features of FEP. METHOD Quality of life, demographic characteristics, clinical characteristics, cognition and functioning were assessed in 145 people with FEP. Cluster analysis using Ward's methods and Squared Euclidean Distance with a k-means verification were employed to identify subgroups with homogenous quality of life profiles. The clusters were externally validated using multinomial logistic regressions. RESULTS Three distinct quality of life profiles were identified: one with good quality of life across all domains (30%), one with poor quality of life particularly in Psychological and Social relationships domains (28%), and one 'intermediate' group with comparatively low Psychological quality of life (42%). Depression, semantic verbal fluency, social inclusion and social/occupational functioning showed associations with group membership. CONCLUSION Our results suggest the potential of maintaining relatively good quality of life despite the experience of FEP. Future research on interventions to improve quality of life may consider the potential of addressing depression, social inclusion and social/occupational functioning.
Collapse
Affiliation(s)
- Z Liao
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, 3010, Australia
| | - K Allott
- Orygen, Parkville, Melbourne, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Locked Bag 10 (35 Poplar Road), Parkville, Melbourne, VIC, 3052, Australia
| | - J F I Anderson
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, 3010, Australia
| | - E Killackey
- Orygen, Parkville, Melbourne, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Locked Bag 10 (35 Poplar Road), Parkville, Melbourne, VIC, 3052, Australia
| | - S M Cotton
- Orygen, Parkville, Melbourne, VIC, 3052, Australia. .,Centre for Youth Mental Health, The University of Melbourne, Locked Bag 10 (35 Poplar Road), Parkville, Melbourne, VIC, 3052, Australia.
| |
Collapse
|
11
|
Huxley P, Krayer A, Poole R, Prendergast L, Aryal S, Warner R. Schizophrenia outcomes in the 21st century: A systematic review. Brain Behav 2021; 11:e02172. [PMID: 33991072 PMCID: PMC8213926 DOI: 10.1002/brb3.2172] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/16/2021] [Accepted: 04/23/2021] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE We report a review of outcomes in schizophrenia in the twenty-first century, replicating and extending work undertaken by the late Richard Warner in his seminal book, "Recovery from Schizophrenia: Psychiatry and Political Economy" (1985;2004). METHOD Warner's methods were followed as closely as possible. Only observational/naturalistic studies were included. Six scientific databases were searched from 2000 to 2020. 6,640 records were retrieved. 47 met inclusion criteria. RESULTS Overall, complete recovery is higher in this study than in Warner's (37.75% cf 20.4%), especially for first episode psychosis (FEP) (57.1% cf 20.7%). Clinical recovery, annualized remission rate (ARR), and employment outcomes were significantly superior for first episode psychosis compared with multiple episode psychosis (MEP). ARR shows a trend toward reduction over time, from 2.2 before the financial crash of 2008 to 1.6 after (t = 1.85 df 40 p = .07). The decline is statistically significant for the MEP group (t = 2.32 df18 p = .03). There were no differences in outcome by region, sample characteristics, outcome measures used, or quality of studies. Heterogeneity of clinical outcome measures across the literature makes evidence synthesis difficult. Weak and inconsistent reporting of functional and employment outcomes mean that findings lack meaning with respect to lived experience. CONCLUSION Future research strategies should aim to reduce heterogeneity in clinical outcome measures and to increase the emphasis on capture and reporting of more sophisticated measures of social and functional outcome. Outcome domains should be disaggregated rather than conflated into unitary recovery constructs.
Collapse
Affiliation(s)
- Peter Huxley
- Centre for Mental Health and Society, School of Health Sciences, Bangor University, Bangor, UK
| | - Anne Krayer
- Centre for Mental Health and Society, School of Health Sciences, Bangor University, Bangor, UK
| | - Rob Poole
- Centre for Mental Health and Society, School of Health Sciences, Bangor University, Bangor, UK
| | - Louise Prendergast
- Centre for Mental Health and Society, School of Health Sciences, Bangor University, Bangor, UK
| | - Sanjaya Aryal
- Department of Sociology, University of Essex, Colchester, UK
| | - Richard Warner
- Clinical Professor of Psychiatry and Adjunct Professor of Anthropology, University of Colorado, Denver, CO, USA
| |
Collapse
|
12
|
Ajnakina O, Stubbs B, Francis E, Gaughran F, David AS, Murray RM, Lally J. Employment and relationship outcomes in first-episode psychosis: A systematic review and meta-analysis of longitudinal studies. Schizophr Res 2021; 231:122-133. [PMID: 33839370 DOI: 10.1016/j.schres.2021.03.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/20/2021] [Accepted: 03/28/2021] [Indexed: 10/21/2022]
Abstract
As employment and relationship status are important long-term outcomes in individuals with a diagnosis of first episode psychosis (FEP) disorders, there is a need to elucidate more accurately the extent of these social deficits in people with FEP. This in turn can aid treatment planning and policy development ultimately ensuring more complete and sustainable recoveries. We carried out a systematic review and meta-analysis of longitudinal studies in FEP reporting on employment and relationship status during the illness course. Random effects meta-analyses and meta-regression analyses were employed. Seventy-four studies were included with a sample totalling 15,272 (range = 20-1724) FEP cases with an average follow-up duration of 8.3 years (SD = 7.2). 32.5% (95%CI = 28.5-36.9) of people with a diagnosis of FEP disorders were employed and 21.3% (95%CI = 16.5-27.1) were in a relationship at the end of follow-up. Studies from high-income countries and Europe had a higher proportion of people in employment at the end of follow-up compared to middle-income nations and non-European countries. The inverse was found for relationship status. The proportion of people with a diagnosis of FEP in employment decreased significantly with longer follow-up. Living with family, being in a relationship at first contact and Black and White ethnicities were identified as significant moderators of these outcomes. These findings highlight marked functional recovery deficits for people with FEP, although cultural factors need to be considered. They support the need for interventions to improve employment opportunities, and social functioning, both in early psychosis and during the longitudinal illness course.
Collapse
Affiliation(s)
- Olesya Ajnakina
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, University of London, London, United Kingdom; Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, United Kingdom.
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Emma Francis
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, United Kingdom
| | - Fiona Gaughran
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Anthony S David
- Institute of Mental Health, University College London, London, United Kingdom
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Department of Psychiatry, Experimental Biomedicine and Clinical Neuroscience (BIONEC), University of Palermo, Italy
| | - John Lally
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Psychiatry, St Vincent's Hospital Fairview, Dublin, Ireland
| |
Collapse
|
13
|
The Association of Social Support and Symptomatic Remission among Community-Dwelling Schizophrenia Patients: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18083977. [PMID: 33918873 PMCID: PMC8070210 DOI: 10.3390/ijerph18083977] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 11/17/2022]
Abstract
Schizophrenia is a mental disease that often leads to chronicity. Social support could reduce the severity of psychotic symptoms; therefore, its influence on remission should be examined. This study investigated the remission rates in community-dwelling schizophrenia patients and examined the association between social support and remission status. A cross-sectional study was conducted in 129 schizophrenia patients in Taiwan. Remission rates were evaluated, and the level of social support, clinical characteristics, sociodemographic variables, and healthy lifestyle status were compared between the remission and nonremission groups. The association between social support and remission was analyzed after adjusting for confounding factors. The mean illness duration is 12.9 years. More than 95% of the participants lived with their families, 63% were unemployed, and 43% achieved remission. Higher social support was observed in the remission group, and a significant correlation was observed between family domain of social support and remission status. Family support was a protective factor of symptomatic remission in community-dwelling schizophrenia patients in Taiwan. The results reflect the effects of a family-centered culture on patients during illness. Consequently, reinforcing family relationships and the capacity of families to manage the symptoms of patients and providing support to families are recommended.
Collapse
|
14
|
Xenaki LA, Kollias CT, Stefanatou P, Ralli I, Soldatos RF, Dimitrakopoulos S, Hatzimanolis A, Triantafyllou TF, Kosteletos I, Vlachos II, Selakovic M, Foteli S, Mantonakis L, Ermiliou V, Voulgaraki M, Psarra E, Gülöksüz S, van Os J, Stefanis NC. Organization framework and preliminary findings from the Athens First-Episode Psychosis Research Study. Early Interv Psychiatry 2020; 14:343-355. [PMID: 31402581 DOI: 10.1111/eip.12865] [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: 12/28/2018] [Revised: 06/18/2019] [Accepted: 07/14/2019] [Indexed: 12/12/2022]
Abstract
AIMS Athens First-Episode Psychosis (FEP) Research study, aims to explore the potential associations between multiple genetic, environmental and neurometabolic risk factors of psychotic disorders, through the clinical management of FEP patients with minimal exposure (<2 weeks) to antipsychotic treatment at entry. The goal of this paper is to introduce the background, rationale and design of the study and present its preliminary findings. METHODS We developed a longitudinal cohort study of FEP patients 16-45 years old, presenting at the emergency units of five psychiatric hospitals across Athens, Greece. Research timeline includes baseline, 1-month and 1-year follow-up. Clinical, genetic, environmental, cognitive and biochemical parameters are measured, using psychometric tools, clinical interviews and laboratory tests. A descriptive analysis of baseline and 1-month assessments was performed including demographic characteristics, family history, medication, clinical picture, traumatic experiences, drug use and cognitive functioning. RESULTS During the last 3 years, 130 subjects have been enrolled in the study. Data so far reveal that, despite the severity of baseline presentation, at 1-month the majority (57.4%) met the Andreasen symptom severity criteria for remission, without the time criterion and showed mild functional improvement. Several environmental adversities and poor cognitive performance were identified, which need to be further elaborated. CONCLUSIONS Athens FEP Research study is the first gene-environment interaction study in Greece. In this article we introduce the organization and methodological framework of the project, along with its basic initial findings. Future analysis will allow the validation of tractable predictors and risk factors implicated in the development and outcome of psychosis.
Collapse
Affiliation(s)
- Lida-Alkisti Xenaki
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens, Greece
| | - Costas T Kollias
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens, Greece
| | - Pentagiotissa Stefanatou
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens, Greece
| | - Irene Ralli
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens, Greece
| | - Rigas-Filippos Soldatos
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens, Greece
| | - Stefanos Dimitrakopoulos
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens, Greece.,Psychiatric Clinic, 414 Military Hospital of Athens, Penteli, Greece
| | - Alex Hatzimanolis
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens, Greece.,Neurobiology Research Institute, Theodor-Theohari Cozzika Foundation, Athens, Greece
| | | | - Ioannis Kosteletos
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens, Greece
| | - Ilias I Vlachos
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens, Greece
| | - Mirjana Selakovic
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens, Greece
| | - Stefania Foteli
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens, Greece
| | - Leonidas Mantonakis
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens, Greece
| | - Vassiliki Ermiliou
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens, Greece
| | - Marina Voulgaraki
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens, Greece
| | - Evagelia Psarra
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens, Greece
| | - Sinan Gülöksüz
- Department Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Jim van Os
- Department Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Nikos C Stefanis
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens, Greece
| |
Collapse
|
15
|
McGinty J, Upthegrove R. Depressive symptoms during first episode psychosis and functional outcome: A systematic review and meta-analysis. Schizophr Res 2020; 218:14-27. [PMID: 31964558 DOI: 10.1016/j.schres.2019.12.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 12/17/2019] [Accepted: 12/17/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVES First episode psychosis (FEP) is associated with functional decline. Existing evidence was synthesised to explore the influence of depressive symptoms during FEP on future social, occupational and global functioning. METHODS Medline, Embase, PsychINFO, Cochrane Library, Open Grey, NICE Evidence and Web of Science were searched from inception to May 2018. Longitudinal studies of FEP patients were included. Study quality was assessed using the Downs and Black instrument. Two meta-analyses were performed using random effect models. The first meta-analysis correlates depressive symptoms during FEP with follow-up Global Assessment of Functioning (GAF) scores. The second meta-analysis shows the odds of long-term functional remission if depressive symptoms are present during FEP. RESULTS 4751 unique abstracts were found. 36 articles were included. The first meta-analysis included 7 studies (932 participants) and showed depressive symptoms during FEP were negatively correlated with follow-up GAF scores (r = -0.16, 95% CI: -0.24 to -0.09, p < 0.001). The second meta-analysis of 9 studies (2265 participants) showed weak evidence of an association between the presence of depressive symptoms in FEP and reduction in functional remission (OR = 0.87, 95% CI: 0.68 to 1.13, p = 0.294). CONCLUSION Depressive symptoms during FEP are associated with poorer long-term global functioning and may be associated with a reduced chance of achieving functional remission. Clinical trials are needed to identify efficacious management of depressive symptoms in early psychosis.
Collapse
Affiliation(s)
- Jessica McGinty
- University of Birmingham, College of Medical and Dental Sciences, Birmingham, United Kingdom
| | - Rachel Upthegrove
- University of Birmingham, College of Medical and Dental Sciences, Birmingham, United Kingdom; University of Birmingham, Institute for Mental Health, Birmingham, United Kingdom; Early Intervention Service, Birmingham Womens and Childrens NHS Trust, Birmingham, United Kingdom.
| |
Collapse
|
16
|
Sofronov A, Dobrovolskaya A, Trusova A, Getmanenko I, Gvozdetskiy A. The relationship of psychosocial well-being of patients with schizophrenia with clinical, socio-demographic and neurocognitive characteristics. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:105-112. [DOI: 10.17116/jnevro2020120062105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
17
|
Mallet J, Lancrenon S, Llorca PM, Lançon C, Baylé FJ, Gorwood P. Validation of a four items version of the Functional Remission of General Schizophrenia scale (the mini-FROGS) to capture the functional benefits of clinical remission. Eur Psychiatry 2020; 47:35-41. [DOI: 10.1016/j.eurpsy.2017.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 08/31/2017] [Accepted: 09/05/2017] [Indexed: 10/18/2022] Open
Abstract
AbstractObjectivesWe previously developed the Functional Remission Of General Schizophrenia (FROGS) scale demonstrating first, reliable assessment in a cross-sectional study and second, good time-stability. The purpose of the present analysis was to propose a shorter version (mini-FROGS), more compatible with the limited time available in a psychiatric visit, focusing on the functional domains that have higher likelihood of being improved with higher and/or longer symptomatic remission in different cultural backgrounds.MethodsWe used multiple regressions to find the most informative items explaining increased length of symptomatic remission, using prospective data from a national observational multicenter survey. Then, the mini-FROGS was used in different European countries to test its between-center reliability, compared to other scales.ResultsFour domains were retained as capturing the maximum of symptomatic remission, namely (1) travel and communication, (2) management of illness and treatment, (3) self-esteem and sense of independence and (4) respect of biological rhythms. First, the mini-FROG was evaluated in 443 French patients with clinical remission and 22 without, and 12/18 months later in 140 patients still in clinical remission and 23 in relapse. In Europe, 295 schizophrenia patients were assessed with the mini-FROGS and other scales devoted to functional remission, allowing comparisons. The mini-FROGS showed good correlations with other scales in different countries and demonstrated good psychometric properties.ConclusionThese results give evidence that a 4 items-only version of the FROGS scale may be useful to assess important aspects of functional remission, tightly linked to the length of clinical remission.
Collapse
|
18
|
Moncrieff J, Lewis G, Freemantle N, Johnson S, Barnes TRE, Morant N, Pinfold V, Hunter R, Kent LJ, Smith R, Darton K, Horne R, Crellin NE, Cooper RE, Marston L, Priebe S. Randomised controlled trial of gradual antipsychotic reduction and discontinuation in people with schizophrenia and related disorders: the RADAR trial (Research into Antipsychotic Discontinuation and Reduction). BMJ Open 2019; 9:e030912. [PMID: 31780589 PMCID: PMC6887002 DOI: 10.1136/bmjopen-2019-030912] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Antipsychotic medication is effective in reducing acute symptoms of psychosis, but it has a range of potentially serious and debilitating adverse effects and is often disliked by patients. It is therefore essential it is only used when benefits outweigh harms. Although multiple trials conducted with people with schizophrenia indicate an increased risk of relapse in the short-term following abrupt antipsychotic discontinuation, there is little evidence about the long-term outcome of a gradual process of reduction and discontinuation on social functioning, relapse and other outcomes. METHODS AND ANALYSIS This is a multicentre, randomised controlled trial involving people with schizophrenia and related disorders who have had more than one episode. Participants are randomised to have a clinically-supervised, gradual reduction of antipsychotic medication, leading to discontinuation when possible, or to continue with maintenance treatment. Blinded follow-up assessments are conducted at 6, 12 and 24 months and the primary outcome is social functioning, measured by the Social Functioning Scale at 24 months. A minimum of 134 evaluable participants provides 90% power to detect a five-point difference, and 206 to detect a four-point difference. Secondary outcomes include severe relapse (admission to hospital) and the study is also intended to detect a minimum 10% difference in severe relapse, which requires 402 participants, assuming a 15% loss to follow-up. Other secondary outcomes include all relapses, as identified by an independent and blinded endpoint committee, symptoms measured by the Positive and Negative Syndrome Scale, quality of life, adverse effects, self-rated recovery and neuropsychological measures. Enrolment started in 2016. The trial is scheduled to finish in June 2022. ETHICS AND DISSEMINATION Ethical approval was initially obtained on 27 October 2016 (UK Research Ethics Committee reference 16/LO/1507). Results will be published in peer-reviewed journals and disseminated to the public. TRIAL REGISTRATION NUMBER ISRCTN90298520. EudraCT: 2016-000709-36. Pre-results.
Collapse
Affiliation(s)
- Joanna Moncrieff
- Division of Psychiatry, University College London and North East London NHS Foundation Trust, London, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, UK
| | - Nick Freemantle
- Institute for Clinical Trials and Methodology, University College London, London, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK
| | | | - Nicola Morant
- Division of Psychiatry, University College London, London, UK
| | | | - Rachael Hunter
- Research Department of Primary Care and Population Health, University College London, London, UK
| | | | | | | | - Robert Horne
- School of Pharmacy, University College London, London, UK
| | - Nadia E Crellin
- Division of Psychiatry, University College London, London, UK
| | - Ruth E Cooper
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
| | | | - Stefan Priebe
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
| |
Collapse
|
19
|
Sollychin M, Jack BN, Polari A, Ando A, Amminger GP, Markulev C, McGorry PD, Nelson B, Whitford TJ, Yuen HP, Lavoie S. Frontal slow wave resting EEG power is higher in individuals at Ultra High Risk for psychosis than in healthy controls but is not associated with negative symptoms or functioning. Schizophr Res 2019; 208:293-299. [PMID: 30738699 DOI: 10.1016/j.schres.2019.01.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 01/23/2019] [Accepted: 01/27/2019] [Indexed: 12/23/2022]
Abstract
Decreased brain activity in the frontal region, as indicated by increased slow wave EEG power measured by electrodes place on the skull over this area, in association with negative symptoms has previously been shown to distinguish ultra-high risk (UHR) individuals who later transitioned to psychosis (UHR-P) from those who did not transition (UHR-NP). The aims of the current study were to: 1) replicate these results and 2) investigate whether similar association between increased frontal slow wave activity and functioning shows any value in the prediction of transition to psychosis in UHR individuals. The brain activity, recorded using EEG, of 44 UHR individuals and 38 healthy controls was included in the analyses. Symptom severity was assessed in UHR participants and functioning was measured in both groups. The power in the theta frequency band in the frontal region of UHR individuals was higher than in controls. However, there was no difference between the UHR-P and the UHR-NP groups, and no change in slow frequency power following transition to psychosis. The correlation between delta frequency power and negative symptoms previously observed was not present in our UHR cohort, and there was no association between frontal delta or theta and functioning in either group. Increased delta power was rather correlated with depressive symptoms in the UHR group. Future research will be needed to better understand when, in the course of the illness, does the slow wave activity in the frontal area becomes impaired.
Collapse
Affiliation(s)
- Miranda Sollychin
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | | | - Andrea Polari
- Orygen Youth Health and Melbourne Health, Parkville, Australia
| | - Ayaka Ando
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - G Paul Amminger
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Connie Markulev
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Patrick D McGorry
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Barnaby Nelson
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | | | - Hok Pan Yuen
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Suzie Lavoie
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.
| |
Collapse
|
20
|
Kebede D, Fekadu A, Kelkile TS, Medhin G, Hanlon C, Mayston R, Alem A. The 10-year functional outcome of schizophrenia in Butajira, Ethiopia. Heliyon 2019; 5:e01272. [PMID: 30923757 PMCID: PMC6423701 DOI: 10.1016/j.heliyon.2019.e01272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 12/11/2018] [Accepted: 02/20/2019] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Long-term functional schizophrenia outcomes are not well characterized in low-income environments because of the rarity of prospective studies. OBJECTIVES To assess and describe long-term schizophrenia's functional outcomes and potential outcome predictors. METHODS Following a baseline assessment, 316 people with schizophrenia were studied for 10 years, on average. Of the total, 79 were incident cases: cases with onset of the illness occurring two years or less from entry into the study. SF-36 scores of physical and social functioning were used to assess functional outcomes. Linear mixed models were employed to evaluate the association of functioning with potential predictors. RESULTS Social and physical functioning scores regarding the cohort were lower than the population's norm for most of the follow-up period. Incident cases had better function than prevalent cases. Fifteen percent of incident and 30% of prevalent cases had reduced social functioning for at least six years. Declining symptom severity during the follow-up period was significantly associated with improvement in social functioning. When baseline functioning was controlled for, the long-term trend in functionality was not associated with demographic or illness characteristics (age and speed of onset, duration of illness and neuroleptic use at entry, substance use, and medication adherence). CONCLUSION Long-term physical and social functioning of the population with schizophrenia were significantly lower than the population norm. A significant proportion of the cohort had lower functioning for the long-term. Functioning was not associated with demographic or illness characteristics of the study population.
Collapse
Affiliation(s)
- Derege Kebede
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abebaw Fekadu
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Global Health & Infection, Brighton and Sussex Medical School, Brighton, UK
| | | | - Girmay Medhin
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Charlotte Hanlon
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Global Mental Health, Health Service, and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Rosie Mayston
- Centre for Global Mental Health, Health Service, and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Atalay Alem
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| |
Collapse
|
21
|
D'Angelo EJ, Morelli N, Lincoln SH, Graber K, Tembulkar S, Gaudet A, Gonzalez-Heydrich J. Social impairment and social language deficits in children and adolescents with and at risk for psychosis. Schizophr Res 2019; 204:304-310. [PMID: 30077431 DOI: 10.1016/j.schres.2018.07.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 07/12/2018] [Accepted: 07/14/2018] [Indexed: 10/28/2022]
Abstract
INTRO One of the more debilitating functional outcomes of schizophrenia-spectrum disorders is social impairment. Previous studies have identified impaired social functioning both in the prodromal phase of psychosis and after acute symptoms abate, suggesting that social impairment represents a core deficit in psychosis not directly linked to psychotic episodes or symptom severity. To date, research in this area has focused primarily on adult populations rather than children, and has not directly assessed social language in individuals across the psychosis continuum. METHODS 81 youth ages 7-18 (N = 24 Typically Developing [TD], N = 36 Clinical High Risk [CHR], N = 21 Psychotic Disorder [PD]) were recruited. Youth participants were administered the Social Language Development Test (SLDT), and parent(s)/guardian(s) completed the Social Responsiveness Scale-II (SRS-II). RESULTS Social language ability was not associated with social impairment. PD participants performed significantly worse on the SLDT than TD participants. CHR and PD participants were both rated as having experienced significantly greater social impairment than TD participants on every subscale of the SRS-II. DISCUSSION Deficits in social language ability and social functioning are strong candidates for phenotypic markers of psychosis, and may be evident earlier in development than previous work has demonstrated. Additionally, the severity of social impairment did not differ between CHR and PD participants, further supporting that social cognitive deficits and social impairment, while related to symptom severity, are discrete deficits in individuals with and at risk for psychosis. These results highlight the importance of addressing social skills for individuals presenting in clinical settings with psychotic symptoms, including children.
Collapse
Affiliation(s)
- Eugene J D'Angelo
- Boston Children's Hospital, Department of Psychiatry, 300 Longwood Avenue, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
| | - Nicholas Morelli
- Boston Children's Hospital, Department of Psychiatry, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Sarah Hope Lincoln
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; McLean Hospital, Department of Psychiatry, 115 Mill Street, Belmont, MA 02478, USA.
| | - Kelsey Graber
- Boston Children's Hospital, Department of Psychiatry, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Sahil Tembulkar
- Boston Children's Hospital, Department of Psychiatry, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Alyssa Gaudet
- Boston Children's Hospital, Department of Psychiatry, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Joseph Gonzalez-Heydrich
- Boston Children's Hospital, Department of Psychiatry, 300 Longwood Avenue, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
| |
Collapse
|
22
|
Watson P, Zhang JP, Rizvi A, Tamaiev J, Birnbaum ML, Kane J. A meta-analysis of factors associated with quality of life in first episode psychosis. Schizophr Res 2018; 202:26-36. [PMID: 30005933 DOI: 10.1016/j.schres.2018.07.013] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 06/12/2018] [Accepted: 07/02/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Improving quality of life for people with first episode psychosis is an important aspect of recovery. Our objective was to review the associative factors on quality of life in first episode psychosis. A meta-analysis was conducted on the associations between quality of life, symptom severity, and duration of untreated psychosis. METHOD Fifty-one articles were identified (published through 08/29/2016) that provided data on the relationship between quality of life and at least one other outcome measure of interest in first episode psychosis. Of those studies, 21 were included in a meta-analysis (n = 3992) of the relationship between quality of life, severity of psychosis, and duration of untreated psychosis. RESULTS Meta-analysis identified significant negative correlations between quality of life and severity of symptoms (total symptom scores: r = -0.32, p < 0.001) and quality of life and duration of untreated psychosis (r = -0.21, p < 0.001). Heinrich's quality of life scale emerged as being more sensitive to the presence of psychotic symptoms than other measures of quality of life. CONCLUSIONS Associations were found between certain disease specific variables and quality of life in first episode psychosis, highlighting the relationship between symptom presentation and quality of life and the need for early intervention. Proper assessment of quality of life is important to promote improved quality of life in patients with first episode psychosis. Future research is needed to examine the interacting effects of symptom presentation, duration of untreated psychosis, and other variables, such as neurocognition, on quality of life.
Collapse
Affiliation(s)
- Philip Watson
- Zucker Hillside Hospital, 75-59 263rd Street, Glen Oaks, NY 11004, USA.
| | - Jian-Ping Zhang
- Zucker Hillside Hospital, 75-59 263rd Street, Glen Oaks, NY 11004, USA; Feinstein Institute for Medical Research, 350 Community Drive, Manhasset, NY 11030, USA; Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Boulevard, Hempstead, NY 11549, USA
| | - Asra Rizvi
- Zucker Hillside Hospital, 75-59 263rd Street, Glen Oaks, NY 11004, USA; Feinstein Institute for Medical Research, 350 Community Drive, Manhasset, NY 11030, USA
| | - Jonathan Tamaiev
- Zucker Hillside Hospital, 75-59 263rd Street, Glen Oaks, NY 11004, USA
| | - Michael L Birnbaum
- Zucker Hillside Hospital, 75-59 263rd Street, Glen Oaks, NY 11004, USA; Feinstein Institute for Medical Research, 350 Community Drive, Manhasset, NY 11030, USA; Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Boulevard, Hempstead, NY 11549, USA
| | - John Kane
- Zucker Hillside Hospital, 75-59 263rd Street, Glen Oaks, NY 11004, USA; Feinstein Institute for Medical Research, 350 Community Drive, Manhasset, NY 11030, USA; Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Boulevard, Hempstead, NY 11549, USA
| |
Collapse
|
23
|
Abstract
AIM Treatment gap refers to the percentage of individuals who require treatment in a country or a defined community but do not receive it due to various reasons. There is widespread acceptance of 'treatment gap' as a measure of unmet needs in mental health. However, the term 'treatment' carries a medical connotation and implies biomedical treatment (or lack of it) of mental illness and is often interpreted by policymakers, planners and researchers, as well as by non-professional stakeholders as exclusively referring to curative clinical psychiatric interventions. This common interpretation results in the exclusion of a range of effective psychosocial interventions available today. Treatment gap also does not include physical health services for persons with mental illness, a major concern due to the relative frequent yet highly unattended physical comorbidity and early mortality of persons with severe mental illness. METHODS & RESULTS We, therefore, propose a more comprehensive measure of unmet needs.
Collapse
|
24
|
Volavka J, Vevera J. Very long-term outcome of schizophrenia. Int J Clin Pract 2018; 72:e13094. [PMID: 29691957 DOI: 10.1111/ijcp.13094] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 03/28/2018] [Indexed: 01/01/2023] Open
Abstract
PURPOSE The principal aim is to review recent data concerning the very long-term outcome of schizophrenia and schizophrenia spectrum disorders. We examine factors that influence outcome, including therapeutic interventions. METHOD PubMed and Scopus databases were searched for papers published between 2008 and 2017 reporting on prospective studies of schizophrenia or schizophrenia spectrum with a follow-up period ≥5 years with adequate outcome information. Additional publications were found in reference lists and authors' reference libraries. RESULTS The average proportion of patients with symptomatic remission at follow-up ranged between 16.4% in never-treated patients to 37.5% in patients who were systematically treated with antipsychotics. Good outcomes at follow-up were observed in schizophrenia and schizophrenia spectrum patients on low doses of antipsychotics and in patients with no pharmacological treatment at that time. Early detection and intensive treatment of the first episode as well as the availability of continued psychosocial treatment and support over subsequent years appeared associated with better outcomes. CONCLUSION The long-term outcome of schizophrenia is highly variable, depending on access to mental healthcare, early detection of psychosis and pharmacological treatment. Recent data support the effectiveness of low-dose antipsychotic treatment for long-term maintenance in some patients. A proportion of first-episode schizophrenia patients, perhaps 20%, do not need long-term maintenance antipsychotic treatment. That proportion may be higher in schizophrenia spectrum patients. The reasons why these patients do not need the long-term treatment are not well understood. Methods to predict the membership in this subgroup are not yet good enough for clinical use in individual patients.
Collapse
Affiliation(s)
- Jan Volavka
- Department of Psychiatry, Faculty of Medicine and University Hospital in Pilsen, Charles University, Pilsen, Czech Republic
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - Jan Vevera
- Department of Psychiatry, Faculty of Medicine and University Hospital in Pilsen, Charles University, Pilsen, Czech Republic
- Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| |
Collapse
|
25
|
Gardsjord ES, Romm KL, Røssberg JI, Friis S, Barder HE, Evensen J, Haahr U, Ten Velden Hegelstad W, Joa I, Johannessen JO, Langeveld J, Larsen TK, Opjordsmoen S, Rund BR, Simonsen E, Vaglum P, McGlashan T, Melle I. Is going into stable symptomatic remission associated with a more positive development of life satisfaction? A 10-year follow-up study of first episode psychosis. Schizophr Res 2018; 193:364-369. [PMID: 28701275 DOI: 10.1016/j.schres.2017.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 06/16/2017] [Accepted: 07/03/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Quality of life is an important outcome measure for patients with psychosis. We investigated whether going into stable symptomatic remission is associated with a more positive development of subjective quality of life (S-QoL) and if different patient characteristics are associated with S-QoL depending on remission status. METHODS Three hundred and one patients with a first-episode psychosis were included at baseline. At 10-year follow-up 186 were reassessed. QoL was assessed by Lehman's Quality of Life Interview. Remission was defined according to criteria proposed by the Remission in Schizophrenia Working Group. One-way ANOVA, mixed model analysis, bivariate correlations and multiple regression analyses were performed. RESULTS Patients going into stable symptomatic remission showed a more positive S-QoL-development over the follow-up period and reported higher life satisfaction at 10-year follow-up compared to non-remission. At 10-year follow-up, depressive symptoms and alcohol abuse or dependence explained a significant amount of variance in S-QoL among patients in remission. Among patients in non-remission, PANSS excitative component explained a significant amount of variance in S-QoL. All significant effects were negative. CONCLUSIONS Stable symptomatic remission is associated with a more positive development of overall life satisfaction. Furthermore, different symptoms influence life satisfaction depending on status of remission. This has important clinical implications. While patients in remission might need treatment for depressive symptoms to increase S-QoL, in non-remission measures aiming to decrease hostility and uncooperativeness should be part of the treatment approach. Alcohol problems should be treated regardless of remission status.
Collapse
Affiliation(s)
- Erlend Strand Gardsjord
- Institute of Clinical Medicine, KG Jebsen Centre for Psychosis Research, NORMENT: Norwegian Centre for Mental Disorders Research, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway.
| | - Kristin Lie Romm
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway
| | - Jan Ivar Røssberg
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway
| | - Svein Friis
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway
| | | | - Julie Evensen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway; Adult Psychiatric Department Vinderen, Diakonhjemmet Hospital, 0319 Oslo, Norway
| | - Ulrik Haahr
- Psychiatric Research Unit, Region Zealand, 4000 Roskilde, Denmark
| | - Wenche Ten Velden Hegelstad
- Psychiatric Division, Network of Clinical Psychosis Research, Stavanger University Hospital, 4068 Stavanger, Norway
| | - Inge Joa
- Psychiatric Division, Network of Clinical Psychosis Research, Stavanger University Hospital, 4068 Stavanger, Norway; Faculty of Social Sciences, University of Stavanger, 4036 Stavanger, Norway
| | - Jan Olav Johannessen
- Psychiatric Division, Network of Clinical Psychosis Research, Stavanger University Hospital, 4068 Stavanger, Norway; Faculty of Social Sciences, University of Stavanger, 4036 Stavanger, Norway
| | - Johannes Langeveld
- Psychiatric Division, Network of Clinical Psychosis Research, Stavanger University Hospital, 4068 Stavanger, Norway
| | - Tor Ketil Larsen
- Psychiatric Division, Network of Clinical Psychosis Research, Stavanger University Hospital, 4068 Stavanger, Norway; Department of Clinical Medicine, Section Psychiatry, University of Bergen, 5021 Bergen, Norway
| | - Stein Opjordsmoen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway
| | - Bjørn Rishovd Rund
- Department of Psychology, University of Oslo, P.O. 1094 Blindern, 0317 Oslo, Norway; Vestre Viken Hospital Trust, 3004 Drammen, Norway
| | - Erik Simonsen
- Psychiatric Research Unit, Region Zealand, 4000 Roskilde, Denmark; Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen N, Denmark
| | - Per Vaglum
- Department of Behavioural Sciences in Medicine, University of Oslo, 0318 Oslo, Norway
| | - Thomas McGlashan
- Department of Social and Behavioural Health, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Ingrid Melle
- Institute of Clinical Medicine, KG Jebsen Centre for Psychosis Research, NORMENT: Norwegian Centre for Mental Disorders Research, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway
| |
Collapse
|
26
|
Untreated illness and recovery in clients of an early psychosis intervention program: a 10-year prospective cohort study. Soc Psychiatry Psychiatr Epidemiol 2018; 53:171-182. [PMID: 29188310 DOI: 10.1007/s00127-017-1464-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 11/22/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate whether duration of untreated psychosis (DUP) and duration of untreated illness (DUI) are associated with measures of both subjective and objective recovery 10 years after a first episode of psychosis. METHODS A cohort of 65 clients from an early psychosis intervention program completed a battery of outcome measures 10 years following initial treatment for first-episode psychosis (FEP). The outcomes of interest were self-perceived recovery scores (Maryland Assessment of Recovery in People with Serious Mental Illness Scale) and occupational activity, defined as engagement in work and/or school on a full/part-time basis. Multiple linear and logistic regression analyses were used to estimate the associations between DUP and DUI with each measure of recovery, adjusting for potential confounding factors. RESULTS We did not find a statistically significant association between DUP and either occupational activity (OR = 1.26, 95% CI 0.81-1.95) or self-perceived recovery score (β = - 0.73, 95% CI - 2.42 to 0.97). However, we found a significant negative association between DUI and self-perceived recovery score (β = - 0.52, 95% CI - 0.87 to - 0.16). CONCLUSIONS Our findings suggest that DUI may have a stronger influence than DUP on recovery from FEP at 10-year follow-up. This suggests the potential value in targeted interventions for people with a long DUI to increase the likelihood of achieving recovery after the first episode of psychosis.
Collapse
|
27
|
El Gharbi I, Chhoumi M, Mechri A. [Symptomatic remission and its relationship to social functioning in Tunisian out-patients with schizophrenia]. Encephale 2017; 45:15-21. [PMID: 29195805 DOI: 10.1016/j.encep.2017.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 09/09/2017] [Accepted: 09/15/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The concept of symptomatic and functional remission represents an important challenge in the care of the mentally ill, particularly in patients with schizophrenia. Operational criteria for symptomatic remission in schizophrenia have been proposed by Andreasen et al. (2005). Over the last decade, these criteria have been widely validated; however few studies have been conducted outside developed countries. Moreover, the association of symptomatic remission with functional outcome has not yet been established in developing countries including Tunisia, as there may be variability in the social and familial environment. OBJECTIVES To determine the frequency and associated factors of symptomatic remission in a sample of Tunisian out-patients with schizophrenia and to explore the relationship between symptomatic remission and some indicators of social functioning. METHODS A cross-sectional study was carried-out on 115 out-patients with schizophrenia (87 males, 28 females, mean age=37.56±10.2 years) in the psychiatry department of the university hospital in Monastir (Tunisia). Nearly all of the patients (98.26%) had been hospitalized at least once in a psychiatric unit. The last hospitalization dated back to 39 months on average (range=6 months to 16 years). Symptomatic remission was assessed by the eight core items of the positive and negative syndrome scale (PANSS). These are the items P1 "Delusions"; P3 "Hallucinatory behavior" and G9 "Unusual thought content" for the positive dimension, the items P2 "Conceptual disorganization" and G5 "Mannerism and disorders of posture" for the disorganization dimension and the items N1 "Blunted affect", N4 "Social withdrawal" and N6 "Lack of spontaneity and flow of conversation" for the negative dimension. A score of mild or less on all eight-core symptoms constitutes symptomatic remission. This symptom level should have been maintained for six months. The social functioning was assessed by the Social and Occupational Functioning Assessment Scale (SOFAS) and the Social Autonomy Scale (SAS) exploring personal care, management of daily life, resource management, the relationship with the outside and the emotional life and relationships social. A multivariate analysis using a binary logistic regression was conducted with as a dependent variable "symptomatic remission" and as explanatory variables the associated variables with symptomatic remission in bivariate analysis with age and gender. RESULTS The symptomatic remission was observed in 50.4% of patients. The items corresponding to positive dimension (P1, P3 and G9) and the item P2 "conceptual disorganization" had a better predictive value of symptomatic remission. After multivariate analysis, the associated factors of symptomatic remission were the acute of onset (P=0.026), the low score of negative symptoms during the last hospitalization (P=0.017) and the episodic course (P<0.0001). However, age or gender of the patients, educational or socioeconomic level, psychiatric family history, age of onset, duration of untreated psychosis, number and duration of previous hospitalizations, antipsychotic treatment dosage were not associated with symptomatic remission in our sample. The mean score of the SOFAS was 48.47±14.44, and the mean score of the SAS was 56.6±16.84. A significant association was shown between the SOFAS score and the symptomatic remission (P<0.0001) and between the SAS score and the symptomatic remission (P<0.0001). Moreover, a significant association was found between symptomatic remission and occupational activity (P=0.03). CONCLUSION The frequency of symptomatic remission according the PANSS criteria in our sample is above the average of the reported rates in literature (30 to 60%). This can be explained by the frequency of symptomatic remission in outpatient versus inpatients, or in relation to the notion of a more favorable course of schizophrenia in developing countries, although this notion is controversial. Remitter patients had significantly an acute onset of disorders, a low score of negative symptoms during the last hospitalization and an episodic course. They also showed a significant trend for better social functioning. In fact, a significant association was shown in our sample between symptomatic remission and social functioning. These results suggest that the concept of remission has important implications for the treatment of patients with schizophrenia.
Collapse
Affiliation(s)
- I El Gharbi
- Service de psychiatrie, hôpital universitaire de Monastir, 5000 Monastir, Tunisie
| | - M Chhoumi
- Service de psychiatrie, hôpital universitaire de Monastir, 5000 Monastir, Tunisie
| | - A Mechri
- Service de psychiatrie, hôpital universitaire de Monastir, 5000 Monastir, Tunisie; Faculté de médecine de Monastir, université de Monastir, 5000 Monastir, Tunisie.
| |
Collapse
|
28
|
Hofer A, Mizuno Y, Wartelsteiner F, Wolfgang Fleischhacker W, Frajo-Apor B, Kemmler G, Mimura M, Pardeller S, Sondermann C, Suzuki T, Welte A, Uchida H. Quality of life in schizophrenia and bipolar disorder: The impact of symptomatic remission and resilience. Eur Psychiatry 2017; 46:42-47. [PMID: 28992535 DOI: 10.1016/j.eurpsy.2017.08.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 08/18/2017] [Accepted: 08/20/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Health-related quality of life (HRQOL) is significantly affected in individuals with schizophrenia or bipolar I disorder (BD-I). The current study investigated whether symptomatic remission and resilience might differently impact HRQOL in these patients. METHODS Fifty-two patients with schizophrenia and 60 patients suffering from BD-I from outpatient mental health services as well as 77 healthy control subjects from the general community were included into a cross-sectional study. HRQOL and resilience were assessed using the WHOQOL-BREF and the Resilience Scale. In patients, psychopathology was quantified by the Positive and Negative Syndrome Scale or the Montgomery Asberg Depression Rating Scale and the Young Mania Rating Scale, respectively. RESULTS Notably, both patient groups showed lower HRQOL and resilience compared to control subjects, non-remitted patients indicated lower HRQOL than remitted ones. The effect of remission on HRQOL was significantly larger in patients with BD-I than in those with schizophrenia but did not explain the difference in HRQOL between groups. Resilience predicted HRQOL in all three groups. When accounting for the effect of resilience among remitted patients, only the difference in HRQOL between schizophrenia patients and control subjects was significant. CONCLUSION These findings demonstrate the impact of symptomatic remission and resilience on HRQOL of both patients suffering from schizophrenia and BD-I and indicate that these factors are especially relevant for HRQOL of patients with BD-I.
Collapse
Affiliation(s)
- A Hofer
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Anichstr. 35, 6020 Innsbruck, Austria.
| | - Y Mizuno
- Keio University School of Medicine, Department of Neuropsychiatry, Tokyo, Japan; Institute of Psychiatry, Psychology and Neuroscience, King's College London, Department of Psychosis Studies, London, UK
| | - F Wartelsteiner
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Anichstr. 35, 6020 Innsbruck, Austria
| | - W Wolfgang Fleischhacker
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Anichstr. 35, 6020 Innsbruck, Austria
| | - B Frajo-Apor
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Anichstr. 35, 6020 Innsbruck, Austria
| | - G Kemmler
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Anichstr. 35, 6020 Innsbruck, Austria
| | - M Mimura
- Keio University School of Medicine, Department of Neuropsychiatry, Tokyo, Japan
| | - S Pardeller
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Anichstr. 35, 6020 Innsbruck, Austria
| | - C Sondermann
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Anichstr. 35, 6020 Innsbruck, Austria
| | - T Suzuki
- Keio University School of Medicine, Department of Neuropsychiatry, Tokyo, Japan
| | - A Welte
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Anichstr. 35, 6020 Innsbruck, Austria
| | - H Uchida
- Keio University School of Medicine, Department of Neuropsychiatry, Tokyo, Japan
| |
Collapse
|
29
|
Napa W, Tungpunkom P, Pothimas N. Effectiveness of family interventions on psychological distress and expressed emotion in family members of individuals diagnosed with first-episode psychosis: a systematic review. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2017; 15:1057-1079. [PMID: 28398985 DOI: 10.11124/jbisrir-2017-003361] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND A critical period for persons with first-episode psychosis is the first two years after diagnosis, when they are at high risk of suicide attempts, violent behaviors and substance abuse. This period also has a great impact on the psychological distress of family members, particularly caregivers who either provide care or live with ill family members. In addition, the families also report feelings of being overwhelmed when accessing service facilities at this critical point. These consequences impact on the affective tone/atmosphere in the family, also referred to as so-called expressed emotion. In addition, expressed emotion research has indicated that the family atmosphere contributes to recurrent psychosis and lengthy hospital stays for patients in the initial phase. Therefore, family interventions aimed at reducing psychological distress and improving expressed emotion in families during this critical time are very important. Modern research has yielded international evidence addressing these outcomes, but little is known about which interventions are the most effective. Therefore, this review aimed to evaluate the effectiveness of these interventions. OBJECTIVES The objective of this review was to examine the effectiveness of family interventions on psychological distress and expressed emotion in family members of persons with first-episode psychosis (FEP). INCLUSION CRITERIA TYPES OF PARTICIPANTS Family members of persons with FEP and who had received treatment after being diagnosed within two years. TYPES OF INTERVENTION(S) Studies that examined interventions among family members of persons with FEP. Family interventions referred to any education, psychoeducation, communication, coping and problem-solving skills training and cognitive behavioral therapy that was provided to family members of persons with FEP. OUTCOMES Psychological distress and expressed emotions of those family members. TYPES OF STUDIES Randomized controlled trials, quasi-experimental studies, cohort studies and case-control studies. SEARCH STRATEGY The preliminary search was conducted in MEDLINE and CINAHL with keywords containing the title, abstract and subject description analysis as the first identification of related studies. An extensive search was conducted in other databases including ProQuest Dissertations and Theses, ScienceDirect, Scopus, PsychINFO, ThaiLIS and Thai National research databases. In addition, searches of reference lists and other manual searches were undertaken. METHODOLOGICAL QUALITY Studies were critically appraised by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute. DATA EXTRACTION Data were extracted using the standardized data extraction tools from the Joanna Briggs Institute. The mean score and standard deviation (SD) were extracted for targets outcomes relating to psychological distress and expressed emotion. DATA SYNTHESIS Quantitative data could not be pooled due to the heterogeneity of the included studies. Data were synthesized based on the individual results from the three included studies and have been presented in a narrative format accompanied with tabulated data. RESULTS Data synthesis of the three individual studies indicated that there were no statistically significant interventions that address psychological distress and expressed emotion in family members who live with and care for persons with FEP. There is insufficient evidence available to evaluate the effect sizes for pooled outcomes. CONCLUSION Based on the results of this review, there is insufficient evidence to validate the effectiveness of family interventions on psychological distress and expressed emotion in family members who live with and care for persons with FEP. In addition, based on the individual primary studies, the implications for practice should be carefully considered.
Collapse
Affiliation(s)
- Wilai Napa
- 1Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi, Mahidol University, Bangkok, Salaya, Thailand 2Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand 3Faculty of Nursing, Chiang Mai University, Thailand Centre for Evidence Based Health Care: a Joanna Briggs Institute Centre of Excellence, Chiang Mai, Thailand 4Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand
| | | | | |
Collapse
|