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Mason A, Irving J, Pritchard M, Sanyal J, Colling C, Chandran D, Stewart R. Association between depressive symptoms and cognitive-behavioural therapy receipt within a psychosis sample: a cross-sectional study. BMJ Open 2022; 12:e051873. [PMID: 35537795 PMCID: PMC9092128 DOI: 10.1136/bmjopen-2021-051873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 04/25/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To examine whether depressive symptoms predict receipt of cognitive-behavioural therapy for psychosis (CBTp) in individuals with psychosis. DESIGN Retrospective cross-sectional analysis of electronic health records (EHRs) of a clinical cohort. SETTING A secondary National Health Service mental healthcare service serving four boroughs of south London, UK. PARTICIPANTS 20 078 patients diagnosed with an International Classification of Diseases, version 10 (ICD-10) code between F20 and 29 extracted from an EHR database. PRIMARY AND SECONDARY OUTCOME MEASURES Primary: Whether recorded depressive symptoms predicted CBTp session receipt, defined as at least one session of CBTp identified from structured EHR fields supplemented by a natural language processing algorithm. Secondary: Whether age, gender, ethnicity, symptom profiles (positive, negative, manic and disorganisation symptoms), a comorbid diagnosis of depression, anxiety or bipolar disorder, general CBT receipt prior to the primary psychosis diagnosis date or type of psychosis diagnosis predicted CBTp receipt. RESULTS Of patients with a psychotic disorder, only 8.2% received CBTp. Individuals with at least one depressive symptom recorded, depression symptom severity and 12 out of 15 of the individual depressive symptoms independently predicted CBTp receipt. Female gender, White ethnicity and presence of a comorbid affective disorder or primary schizoaffective diagnosis were independently positively associated with CBTp receipt within the whole sample and the top 25% of mentioned depressive symptoms. CONCLUSIONS Individuals with a psychotic disorder who had recorded depressive symptoms were significantly more likely to receive CBTp sessions, aligning with CBTp guidelines of managing depressive symptoms related to a psychotic experience. However, overall receipt of CBTp is low and more common in certain demographic groups, and needs to be increased.
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Affiliation(s)
- Ava Mason
- Division of Psychiatry, University College London, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jessica Irving
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Megan Pritchard
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley Mental Health NHS Trust, London, UK
| | - Jyoti Sanyal
- South London and Maudsley Mental Health NHS Trust, London, UK
| | - Craig Colling
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley Mental Health NHS Trust, London, UK
| | - David Chandran
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Robert Stewart
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley Mental Health NHS Trust, London, UK
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Affective lability and social functioning in severe mental disorders. Eur Arch Psychiatry Clin Neurosci 2022; 272:873-885. [PMID: 35084540 PMCID: PMC9279216 DOI: 10.1007/s00406-022-01380-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 01/09/2022] [Indexed: 12/19/2022]
Abstract
Social functioning is impaired in severe mental disorders despite clinical remission, illustrating the need to identify other mechanisms that hinder psychosocial recovery. Affective lability is elevated and associated with an increased clinical burden in psychosis spectrum disorders. We aimed to investigate putative associations between affective lability and social functioning in 293 participants with severe mental disorders (schizophrenia- and bipolar spectrum), and if such an association was independent of well-established predictors of social impairments. The Affective Lability Scale (ALS-SF) was used to measure affective lability covering the dimensions of anxiety-depression, depression-elation and anger. The interpersonal domain of the Social Functioning Scale (SFS) was used to measure social functioning. Correlation analyses were conducted to investigate associations between affective lability and social functioning, followed by a hierarchical multiple regression and follow-up analyses in diagnostic subgroups. Features related to premorbid and clinical characteristics were entered as independent variables together with the ALS-SF scores. We found that higher scores on all ALS-SF subdimensions were significantly associated with lower social functioning (p < 0.005) in the total sample. For the anxiety-depression dimension of the ALS-SF, this association persisted after controlling for potential confounders such as premorbid social functioning, duration of untreated illness and current symptoms (p = 0.019). Our results indicate that elevated affective lability may have a negative impact on social functioning in severe mental disorders, which warrants further investigation. Clinically, it might be fruitful to target affective lability in severe mental disorders to improve psychosocial outcomes.
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Golubović B, Gajić Z, Ivetić O, Milatović J, Vuleković P, Đilvesi Đ, Golubović S, Vrban F, Subašić A, Rasulić L. FACTORS ASSOCIATED WITH DEPRESSION IN PATIENTS WITH SCHIZOPHRENIA. Acta Clin Croat 2020; 59:605-614. [PMID: 34285431 PMCID: PMC8253071 DOI: 10.20471/acc.2020.59.04.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 12/05/2019] [Indexed: 11/24/2022] Open
Abstract
The aim of this study was to analyze risk factors present in schizophrenic patients with depressive symptomatology. The sample comprised of 76 respondents diagnosed with schizophrenia. In the study, we used the Positive and Negative Syndrome Scale (PANSS) and Calgary Depression Scale for Schizophrenia. The prevalence of depression was estimated to be 30%. The mean scores on the negative subscale of the PANSS were significantly higher in patients with schizophrenia and depression compared to control group (U=3.64, p=0.00), and so were those on the General Psychopathology Scale (U=4.91, p=0.00). Socio-demographic factors were identified as important factors (p<0.05). Personal and environmental factors such as loneliness, immediate social environment, social support and isolation were statistically significantly different between the groups (p<0.05). There was a correlation of poor compliance with psycho-pharmacotherapy, increased number of hospitalizations and shorter remission period with the severity of clinical presentation (p<0.05). Since the presence of these factors is associated with depression in schizophrenia, their early detection in clinical practice is vital to ensure timely prevention of the development of depressive symptomatology.
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Affiliation(s)
| | - Zoran Gajić
- 1University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; 2Department of Psychiatry, Clinical Centre of Vojvodina, Novi Sad, Serbia; 3Department of Neurosurgery, Clinical Centre of Vojvodina, Novi Sad, Serbia; 4Clinical Centre of Vojvodina, Novi Sad, Serbia; 5Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6University of Health Applied Sciencies, Zagreb, Croatia; 7University of Belgrade, Faculty of Medicine, Belgrade, Serbia; 8Division of Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Department of Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Olga Ivetić
- 1University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; 2Department of Psychiatry, Clinical Centre of Vojvodina, Novi Sad, Serbia; 3Department of Neurosurgery, Clinical Centre of Vojvodina, Novi Sad, Serbia; 4Clinical Centre of Vojvodina, Novi Sad, Serbia; 5Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6University of Health Applied Sciencies, Zagreb, Croatia; 7University of Belgrade, Faculty of Medicine, Belgrade, Serbia; 8Division of Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Department of Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Jovan Milatović
- 1University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; 2Department of Psychiatry, Clinical Centre of Vojvodina, Novi Sad, Serbia; 3Department of Neurosurgery, Clinical Centre of Vojvodina, Novi Sad, Serbia; 4Clinical Centre of Vojvodina, Novi Sad, Serbia; 5Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6University of Health Applied Sciencies, Zagreb, Croatia; 7University of Belgrade, Faculty of Medicine, Belgrade, Serbia; 8Division of Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Department of Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Petar Vuleković
- 1University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; 2Department of Psychiatry, Clinical Centre of Vojvodina, Novi Sad, Serbia; 3Department of Neurosurgery, Clinical Centre of Vojvodina, Novi Sad, Serbia; 4Clinical Centre of Vojvodina, Novi Sad, Serbia; 5Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6University of Health Applied Sciencies, Zagreb, Croatia; 7University of Belgrade, Faculty of Medicine, Belgrade, Serbia; 8Division of Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Department of Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Đula Đilvesi
- 1University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; 2Department of Psychiatry, Clinical Centre of Vojvodina, Novi Sad, Serbia; 3Department of Neurosurgery, Clinical Centre of Vojvodina, Novi Sad, Serbia; 4Clinical Centre of Vojvodina, Novi Sad, Serbia; 5Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6University of Health Applied Sciencies, Zagreb, Croatia; 7University of Belgrade, Faculty of Medicine, Belgrade, Serbia; 8Division of Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Department of Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Sonja Golubović
- 1University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; 2Department of Psychiatry, Clinical Centre of Vojvodina, Novi Sad, Serbia; 3Department of Neurosurgery, Clinical Centre of Vojvodina, Novi Sad, Serbia; 4Clinical Centre of Vojvodina, Novi Sad, Serbia; 5Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6University of Health Applied Sciencies, Zagreb, Croatia; 7University of Belgrade, Faculty of Medicine, Belgrade, Serbia; 8Division of Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Department of Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Filip Vrban
- 1University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; 2Department of Psychiatry, Clinical Centre of Vojvodina, Novi Sad, Serbia; 3Department of Neurosurgery, Clinical Centre of Vojvodina, Novi Sad, Serbia; 4Clinical Centre of Vojvodina, Novi Sad, Serbia; 5Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6University of Health Applied Sciencies, Zagreb, Croatia; 7University of Belgrade, Faculty of Medicine, Belgrade, Serbia; 8Division of Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Department of Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Ante Subašić
- 1University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; 2Department of Psychiatry, Clinical Centre of Vojvodina, Novi Sad, Serbia; 3Department of Neurosurgery, Clinical Centre of Vojvodina, Novi Sad, Serbia; 4Clinical Centre of Vojvodina, Novi Sad, Serbia; 5Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6University of Health Applied Sciencies, Zagreb, Croatia; 7University of Belgrade, Faculty of Medicine, Belgrade, Serbia; 8Division of Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Department of Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Lukas Rasulić
- 1University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; 2Department of Psychiatry, Clinical Centre of Vojvodina, Novi Sad, Serbia; 3Department of Neurosurgery, Clinical Centre of Vojvodina, Novi Sad, Serbia; 4Clinical Centre of Vojvodina, Novi Sad, Serbia; 5Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6University of Health Applied Sciencies, Zagreb, Croatia; 7University of Belgrade, Faculty of Medicine, Belgrade, Serbia; 8Division of Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Department of Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia
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Li W. Association of APOE E2 and low-density lipoprotein with depressive symptoms in Chinese senile schizophrenia inpatients: A cross-sectional study. SCHIZOPHRENIA RESEARCH-COGNITION 2020; 23:100193. [PMID: 33294393 PMCID: PMC7689319 DOI: 10.1016/j.scog.2020.100193] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 11/15/2020] [Indexed: 11/23/2022]
Abstract
Background Schizophrenia is considered to occur due to both environmental and genetic factors. Depressive symptoms and apolipoprotein E (APOE) gene polymorphisms are involved in the pathogenesis of schizophrenia. However, the effect of APOE gene polymorphism on depressive symptoms has never been investigated among Chinese elderly schizophrenia patients. Objective This cross-sectional study aimed to determine the effect of APOE gene polymorphism on blood lipid metabolism and depressive symptoms among elderly schizophrenia patients. Method A total of 301 elderly schizophrenia patients (161 males, age ranges from 60 to 92 years, with an average age of 67.31 ± 6.667) were included in the study. Depressive symptoms were assessed using the Geriatric Depression Scale (GDS). APOE gene polymorphisms were determined by polymerase chain reaction (PCR). Correlations between GDS and serum low-density lipoprotein (LDL) levels with APOE genotypes were assessed. Results The concentration of LDL in the APOE E2 group was significantly lower than those in the APOE E3 and APOE E4 groups, and the GDS scores in the APOE E2 and APOE E3 groups were higher than those in the APOE E4 group. Using partial correlation analysis and controlling the duration of disease and hyperlipidemia, we found that GDS scores were significantly correlated with LDL (r = −0.179, p = 0.025). Conclusions The APOE E2 genotype is associated with more depressive symptoms and lower serum LDL in elderly Chinese schizophrenia patients, and there is a negative correlation between depressive symptoms and LDL.
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Affiliation(s)
- Wei Li
- Department of Geriatric Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Alzheimer's Disease and Related Disorders Center, Shanghai Jiao Tong University, Shanghai, China
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Henson P, Wisniewski H, Stromeyer Iv C, Torous J. Digital Health Around Clinical High Risk and First-Episode Psychosis. Curr Psychiatry Rep 2020; 22:58. [PMID: 32880764 DOI: 10.1007/s11920-020-01184-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW This review aims to examine relapse definitions and risk factors in psychosis as well as the role of technology in relapse predictions and risk modeling. RECENT FINDINGS There is currently no standard definition for relapse. Therefore, there is a need for data models that can account for the variety of factors involved in defining relapse. Smartphones have the ability to capture real-time, moment-to-moment assessment symptomology and behaviors via their variety of sensors and have high potential to be used to create prediction and risk modeling. While there is still a need for further research on how technology can predict and model relapse, there are simple ways to begin incorporating technology for relapse prediction in clinical care.
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Affiliation(s)
- Philip Henson
- Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Hannah Wisniewski
- Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Charles Stromeyer Iv
- Consumer Advisory Board, Massachusetts Mental Health Center, Boston, MA, 02115, USA
| | - John Torous
- Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA.
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Eisner E, Bucci S, Berry N, Emsley R, Barrowclough C, Drake RJ. Feasibility of using a smartphone app to assess early signs, basic symptoms and psychotic symptoms over six months: A preliminary report. Schizophr Res 2019; 208:105-113. [PMID: 30979665 PMCID: PMC6551369 DOI: 10.1016/j.schres.2019.04.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 03/06/2019] [Accepted: 04/02/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Psychosis relapses are common, have profound adverse consequences for patients, and are costly to health services. 'Early signs' have been used to predict relapse, in the hope of prevention or mitigation, with moderate sensitivity and specificity. We investigated the feasibility and validity of adding 'basic symptoms' to conventional early signs and monitoring these using a smartphone app. METHODS Individuals (n = 18) experiencing a relapse within the past year were asked to use a smartphone app ('ExPRESS') weekly for six months to report early signs, basic symptoms and psychotic symptoms. Above-threshold increases in app-reported psychotic symptoms prompted a telephone interview (PANSS positive items) to assess relapse. RESULTS Participants completed 65% app assessments and 58% telephone interviews. App items showed high concurrent validity with researcher-rated psychotic symptoms and basic symptoms over six months. There was excellent agreement between telephone call and face-to-face assessed psychotic symptoms. The primary relapse definition, based on telephone assessment and casenotes, compared well with a casenote-only definition but had better specificity. Mixed-effects models provided preliminary evidence of concurrent and predictive validity: early signs and basic symptoms were associated with most app-assessed psychotic symptom variables the same week and with a number of psychotic symptoms variables three weeks later; adding basic symptoms to early signs improved model fit in most of these cases. CONCLUSIONS This is the first study to test a smartphone app for monitoring early signs and basic symptoms as putative relapse predictors. It demonstrates that weekly app-based monitoring is feasible, valid and acceptable over six months.
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Affiliation(s)
- Emily Eisner
- University of Manchester, Division of Psychology and Mental Health, Zochonis Buildi ng (2(nd) Floor), Brunswick Street, Manchester M13 9L, United Kingdom.
| | - Sandra Bucci
- University of Manchester, Division of Psychology and Mental Health, Zochonis Buildi ng (2(nd) Floor), Brunswick Street, Manchester M13 9L, United Kingdom; Greater Manchester Mental Health NHS Foundation Trust, Bury New Road, Prestwich, Manchester, Greater Manchester M25 3BL, United Kingdom.
| | - Natalie Berry
- University of Manchester, Division of Psychology and Mental Health, Zochonis Buildi ng (2(nd) Floor), Brunswick Street, Manchester M13 9L, United Kingdom.
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, King's College London, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF, United Kingdom.
| | - Christine Barrowclough
- University of Manchester, Division of Psychology and Mental Health, Zochonis Buildi ng (2(nd) Floor), Brunswick Street, Manchester M13 9L, United Kingdom.
| | - Richard James Drake
- Greater Manchester Mental Health NHS Foundation Trust, Bury New Road, Prestwich, Manchester, Greater Manchester M25 3BL, United Kingdom; University of Manchester, Division of Psychology and Mental Health, Jean McFarlane Building (3(rd) Floor), Manchester M13 9L, United Kingdom.
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Moffa AH, Brunoni AR, Nikolin S, Loo CK. Transcranial Direct Current Stimulation in Psychiatric Disorders: A Comprehensive Review. Psychiatr Clin North Am 2018; 41:447-463. [PMID: 30098657 DOI: 10.1016/j.psc.2018.05.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that has been gaining favor as a viable tool in Psychiatry. The purpose of this review is to summarize the evidence of tDCS as a treatment of disorders such as depression, schizophrenia, and obsessive-compulsive disorder (OCD). Current findings indicate that tDCS is probably effective in non-treatment-resistant depressive patients. Regarding schizophrenia and OCD, present evidence is not robust enough, although preliminary results indicate that tDCS is a promising technique. Therefore, more trials are needed before using tDCS in a clinical setting.
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Affiliation(s)
- Adriano H Moffa
- School of Psychiatry, University of New South Wales, Black Dog Institute, Prince of Wales Hospital, Hospital Road, Randwick, Sydney, New South Wales 2031, Australia.
| | - Andre R Brunoni
- Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27) and National Institute of Biomarkers in Psychiatry (INBioN), Department and Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos 785, Sao Paulo, Sao Paulo 01060-970, Brazil; Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Leopoldstr. 13, Munich 80802, Germany
| | - Stevan Nikolin
- School of Psychiatry, University of New South Wales, Black Dog Institute, Prince of Wales Hospital, Hospital Road, Randwick, Sydney, New South Wales 2031, Australia
| | - Colleen K Loo
- School of Psychiatry, University of New South Wales, Black Dog Institute, Prince of Wales Hospital, Hospital Road, Randwick, Sydney, New South Wales 2031, Australia
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8
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Xu YM, Li F, Liu XB, Zhong BL. Depressive symptoms in Chinese male inpatients with schizophrenia: Prevalence and clinical correlates. Psychiatry Res 2018; 264:380-384. [PMID: 29677621 DOI: 10.1016/j.psychres.2018.04.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 04/03/2018] [Accepted: 04/04/2018] [Indexed: 11/17/2022]
Abstract
Depression is common in patients with schizophrenia and associated with serious consequences. However, previous studies have mixed findings on characteristics of depression in schizophrenia, partly because of the use of depressive symptom scales that are not specific to schizophrenia. This study examined the prevalence and correlates of depressive symptoms in Chinese patients with schizophrenia. A consecutive sample of 349 male inpatients with schizophrenia was recruited from the largest psychiatric specialty hospital in south-central China. Depressive symptoms and psychopathology of patients were assessed with the Calgary Depression Scale for Schizophrenia and the Positive and Negative Symptom Scale, respectively. Extrapyramidal side effects (EPSs) were assessed with the Simpson Angus Scale, the Barnes Akathisia Rating Scale, and the Abnormal Involuntary Movement Scale. Demographic and other clinical data were also collected. Depressive symptoms were present in 41.8% of male schizophrenia inpatients. Multiple logistic regression analysis revealed that early age at onset (OR [95%CI] = 1.12 [1.01,1.27], p = 0.049), more severe negative symptoms (OR [95%CI] = 1.05 [1.01,1.09], p = 0.034), more severe general psychopathological symptoms (OR [95%CI] = 1.06 [1.01,1.12], p = 0.041), akathisia (OR [95%CI] = 2.87 [1.45,5.69], p = 0.003), and dyskinesia (OR [95%CI] = 3.93 [1.36,11.33], p = 0.011) were significantly associated with depression. Appropriate antipsychotic medication treatment and reducing EPSs of antipsychotics may help prevent or relieve depression of patients with schizophrenia.
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Affiliation(s)
- Yan-Min Xu
- Affiliated Wuhan Mental Health Center (The Ninth Clinical School), Tongji Medical College of Huazhong University of Science & Technology, Wuhan, Hubei Province, China
| | - Fu Li
- Affiliated Wuhan Mental Health Center (The Ninth Clinical School), Tongji Medical College of Huazhong University of Science & Technology, Wuhan, Hubei Province, China
| | - Xiao-Bo Liu
- Affiliated Wuhan Mental Health Center (The Ninth Clinical School), Tongji Medical College of Huazhong University of Science & Technology, Wuhan, Hubei Province, China
| | - Bao-Liang Zhong
- Affiliated Wuhan Mental Health Center (The Ninth Clinical School), Tongji Medical College of Huazhong University of Science & Technology, Wuhan, Hubei Province, China.
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9
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A parallel group randomised open blinded evaluation of Acceptance and Commitment Therapy for depression after psychosis: Pilot trial outcomes (ADAPT). Schizophr Res 2017; 183:143-150. [PMID: 27894822 DOI: 10.1016/j.schres.2016.11.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 11/18/2016] [Accepted: 11/18/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Depression is one of the major contributors to poorer quality of life amongst individuals with psychosis and schizophrenia. The study was designed as a Pilot Trial to determine the parameters of a larger, definitive pragmatic multi-centre randomised controlled trial of Acceptance and Commitment Therapy for depression after psychosis (ACTdp) for individuals with a diagnosis of schizophrenia who also meet diagnostic criteria for major depression. METHODS Participants were required to meet criteria for schizophrenia and major depression. Blinded follow-ups were undertaken at 5-months (end of treatment) and at 10-months (5-months posttreatment). Primary outcomes were depression as measured by the Calgary Depression Scale for Schizophrenia (CDSS) and the Beck Depression Inventory (BDI). RESULTS A total of 29 participants were randomised to ACTdp + Standard Care (SC) (n=15) or SC alone (n=14). We did not observe significant differences between groups on the CDSS total score at 5-months (Coeff=-1.43, 95%CI -5.17, 2.32, p=0.45) or at 10-months (Coeff=1.8, 95%CI -2.10, 5.69, p=0.36). In terms of BDI, we noted a statistically significant effect in favour of ACTdp+SC at 5-months (Coeff=-8.38, 95%CI -15.49, -1.27, p=0.02) but not at 10-months (Coeff=-4.85, 95%CI -12.10, 2.39, p=0.18). We also observed significant effects on psychological flexibility at 5-months (Coeff=-8.83, 95%CI -14.94, -2.71, p<0.01) but not 10-months (Coeff=-4.92, 95%CI -11.09, 1.25, p=0.11). IMPLICATIONS In this first RCT of a psychological therapy with depression as the primary outcome, ACT is a promising intervention for depression in the context of psychosis. A further large-scale definitive randomised controlled trial is required to determine effectiveness. TRIAL REGISTRATION ISRCTN: 33306437.
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Hou CL, Ma XR, Cai MY, Li Y, Zang Y, Jia FJ, Lin YQ, Chiu HFK, Ungvari GS, Hall BJ, Zhong BL, Cao XL, Xiang YT. Comorbid Moderate-Severe Depressive Symptoms and their Association with Quality of Life in Chinese Patients with Schizophrenia Treated in Primary Care. Community Ment Health J 2016; 52:921-926. [PMID: 27306990 DOI: 10.1007/s10597-016-0023-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 05/27/2016] [Indexed: 11/26/2022]
Abstract
This study described the prevalence and correlates of comorbid moderate-severe depressive symptoms (comorbid depression thereafter) and their association with quality of life (QOL) in schizophrenia patients treated in primary care. 623 schizophrenia patients were enrolled. Patients' socio-demographic and clinical characteristics including comorbid depression [defined as a total score of 18 or above on the Montgomery-Asberg Depression Rating Scale (MADRS)] were recorded. Depressive symptoms (defined as a total score of 9 or above on the MADRS) were present in 54.1 % of patients, while 17.7 % had comorbid depression. Analysis of covariance revealed that comorbid depression was significantly associated with lower mental QOL. Multiple logistic regression analysis revealed that more severe positive and negative symptoms, anxiety symptoms, use of first-generation antipsychotics and antidepressants, were independently associated with comorbid depression. Given the negative association between comorbid depression and QOL, attempts to address comorbid depression in schizophrenia patients treated in primary care should be made.
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Affiliation(s)
- Cai-Lan Hou
- Guangdong Mental Health Center, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Xin-Rong Ma
- Ningxia Mental Health Center, Ningxia Ning-An Hospital, Yinchuan, Ningxia, China
| | - Mei-Ying Cai
- Guangzhou Yuexiu Center for Disease Control and Prevention, Guangzhou, Guangdong, China
| | - Yan Li
- Mood Disorders Centre, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Yu Zang
- Shenzhen Key Laboratory for Psychological Healthcare, Shenzhen Institute of Mental Health, Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, China
| | - Fu-Jun Jia
- Guangdong Mental Health Center, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China.
| | - Yong-Qiang Lin
- Guangdong Mental Health Center, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Helen F K Chiu
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Gabor S Ungvari
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia
- Marian Centre, The University of Notre Dame Australia, Perth, Australia
| | - Brian J Hall
- Department of Psychology, University of Macau, Macao SAR, China
| | - Bao-Liang Zhong
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xiao-Lan Cao
- Shenzhen Key Laboratory for Psychological Healthcare, Shenzhen Institute of Mental Health, Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, China
| | - Yu-Tao Xiang
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Avenida da Universidade, 3/F, Building E12, Macau SAR, Taipa, China.
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11
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Lako IM, Taxis K, van den Heuvel ER, Leenaars CHC, Burger H, Wiersma D, Slooff CJ, Knegtering H, Bruggeman R. Altered emotional experiences attributed to antipsychotic medications - A potential link with estimated dopamine D2 receptor occupancy. Psychiatry Res 2016; 236:9-14. [PMID: 26791397 DOI: 10.1016/j.psychres.2016.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 10/09/2015] [Accepted: 01/05/2016] [Indexed: 12/31/2022]
Abstract
Altered emotional experiences in response to antipsychotics may increase the burden of disease in patients with schizophrenia. In a large cross-sectional study, patients with schizophrenia completed the Subjects Reaction to Antipsychotics questionnaire (SRA) to assess whether they attributed altered emotional experiences (flattened affect or depressive symptoms) to their antipsychotics. Association with antipsychotic D2 receptor affinity and occupancy was examined using logistic regression. We compared antipsychotic-attributed emotional experiences between patients using antipsychotic monotherapy and combination therapy. Of the 1298 included patients, 23% attributed flattened affect to their antipsychotics and 16% attributed depressive symptoms to their antipsychotics, based on the SRA. No differences were observed between antipsychotics in patients on monotherapy. We discuss that within these patients' relatively low dose range, altered emotional experiences did not appear to relate to the level of D2 receptor affinity of antipsychotic monotherapy. Patients using antipsychotic combination therapy (22%) were more likely to attribute depressive symptoms to their antipsychotics than patients using antipsychotic monotherapy (OR [95%CI]=1.443 [1.033-2.015]); possibly due to higher D2 receptor occupancies as estimated by dose equivalents.
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Affiliation(s)
- Irene M Lako
- Pharmacotherapy and Pharmaceutical Care, University of Groningen, Groningen, The Netherlands
| | - Katja Taxis
- Pharmacotherapy and Pharmaceutical Care, University of Groningen, Groningen, The Netherlands.
| | - Edwin R van den Heuvel
- Department of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Cathalijn H C Leenaars
- Pharmacotherapy and Pharmaceutical Care, University of Groningen, Groningen, The Netherlands; Central Animal laboratory, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Huibert Burger
- Department of General Practice, University Medical Center Groningen, Groningen, The Netherlands
| | - Durk Wiersma
- Rob Giel Research center, University Medical Center Groningen, Groningen, The Netherlands
| | - Cees J Slooff
- Department of Psychotic Disorders, Mental Health Organization Drenthe, The Netherlands
| | - Henderikus Knegtering
- Rob Giel Research center, University Medical Center Groningen, Groningen, The Netherlands; Lentis Research, Center for Mental Health Groningen, Groningen, The Netherlands
| | - Richard Bruggeman
- Pharmacotherapy and Pharmaceutical Care, University of Groningen, Groningen, The Netherlands; Rob Giel Research center, University Medical Center Groningen, Groningen, The Netherlands
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12
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Trends in the access to and the use of antipsychotic medications and psychotropic co-treatments in Asian patients with schizophrenia. Epidemiol Psychiatr Sci 2016; 25:9-17. [PMID: 26289066 PMCID: PMC6998674 DOI: 10.1017/s2045796015000694] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
To date, antipsychotics remain the mainstay of treatment for schizophrenia and related disorders although other psychotropic medications and non-pharmaceutical interventions have been used adjunctively in some patients and settings. Regular surveys on access to and prescription patterns of psychotropic medications in clinical practice are an important and efficient way of examining the use and time trends of treatments in a given population and region. Unlike developed Western countries, Asian countries have not fully undergone deinstitutionalisation of the severely and chronically mentally ill, and community-based mental health services are still under-developed. As a result, a large number of psychiatric patients still receive treatments in psychiatric hospitals. Moreover, there have been very limited studies examining access to and prescription patterns of psychotropic medications for schizophrenia patients in Asian countries. In this paper, we focus on the only international project on the use of psychotropic medications in schizophrenia patients in selected East and Southeast Asian countries/territories summarising its major findings. Most of the first- and second-generation antipsychotics (FGAs and SGAs) are available in Asian countries, but the access to psychotropic medications is largely affected by socio-cultural and historical contexts, health insurance schemes, health care policy, medication cost and consumers' preference across different countries/territories. Overall, the proportional use of FGAs, high dose antipsychotic treatment and antipsychotic polypharmacy have decreased, while the use of SGAs and antidepressants have increased and the utilisation of benzodiazepines and mood stabilisers has remained relatively stable over time. However, within these general trends, there is great inter-country variation regarding the psychotropic prescribing patterns and trends in Asian schizophrenia patients that also seems to differ from data in many Western countries.
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13
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Gumley A, White R, Briggs A, Ford I, Barry S, Stewart C, Beedie S, Clarke C, MacLeod R, Lidstone E, Nam J, McLeod H. A parallel group randomised open blinded evaluation of Acceptance and Commitment Therapy for Depression After Psychosis: A Pilot Trial Protocol (ADAPT). PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES 2015. [DOI: 10.1080/17522439.2015.1100669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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14
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Olivares JM, Sermon J, Hemels M, Schreiner A. Definitions and drivers of relapse in patients with schizophrenia: a systematic literature review. Ann Gen Psychiatry 2013; 12:32. [PMID: 24148707 PMCID: PMC4015712 DOI: 10.1186/1744-859x-12-32] [Citation(s) in RCA: 164] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 10/07/2013] [Indexed: 11/11/2022] Open
Abstract
Relapse in patients with schizophrenia has devastating repercussions, including worsening symptoms, impaired functioning, cognitive deterioration and reduced quality of life. This progressive decline exacerbates the burden of illness on patients and their families. Relapse prevention is identified as a key therapeutic aim; however, the absence of widely accepted relapse definition criteria considerably hampers achieving this goal. We conducted a literature review in order to investigate the reporting of relapses and the validity of hospitalization as a proxy for relapse in patients with schizophrenia. The primary aim was to assess the range and validity of methods used to define relapse in observational or naturalistic settings. The secondary aim was to capture information on factors that predicted or influenced the risk of relapse. A structured search of the PubMed database identified articles that discussed relapse, and hospitalization as a proxy of relapse, in patients with schizophrenia. National and international guidelines were also reviewed. Of the 150 publications and guidelines identified, 87 defined relapse and 62% of these discussed hospitalization. Where hospitalization was discussed, this was as a proxy for, or a component of, relapse in the majority of cases. However, hospitalization duration and type varied and were not always well defined. Scales were used to define relapse in 53 instances; 10 different scales were used and multiple scales often appeared within the same definition. There were 95 references to factors that may drive relapse, including non-adherence to antipsychotic medication (21/95), stress/depression (11/95) and substance abuse (9/95). Twenty-five publications discussed the potential of antipsychotic therapy to reduce relapse rates-continuous antipsychotic therapy was associated with reduced frequency and duration of hospitalization. Non-pharmacological interventions, such as psychoeducation and cognitive behavioural therapy, were also commonly reported as factors that may reduce relapse. In conclusion, this review identified numerous factors used to define relapse. Hospitalization was the factor most frequently used and represents a useful proxy for relapse when reporting in a naturalistic setting. Several factors were reported to increase the risk of relapse, and observation of these may aid the identification of at-risk patients.
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Affiliation(s)
- José M Olivares
- Department of Psychiatry, Hospital Meixoeiro, Complejo Hospitalario Universitario de Vigo, Vigo 36200, Spain
| | - Jan Sermon
- Janssen-Cilag NV/SA, Antwerpseweg 15-17, Beerse 2340, Belgium
| | - Michiel Hemels
- Janssen Health Economics Market Access and Reimbursement, Europe, Middle East and Africa, Hammerbakken 19, Birkerød 3460, Denmark
| | - Andreas Schreiner
- Medical and Scientific Affairs, Janssen-Cilag Europe, Middle East and Africa, Johnson & Johnson Platz 5a, Neuss 41470, Germany
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Cortese L, Bressan RA, Castle DJ, Mosolov SN. Management of schizophrenia: clinical experience with asenapine. J Psychopharmacol 2013; 27:14-22. [PMID: 23535351 DOI: 10.1177/1359786813482533] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Schizophrenia is a chronic brain disorder comprising a range of clinical features, including positive and negative symptoms, cognitive dysfunction and mood symptoms (particularly depression and anxiety). The management of schizophrenia requires effective short- and long-term treatment with antipsychotic medication that is effective across these symptom domains, while being well tolerated over the long term. Asenapine is the first tetracyclic atypical antipsychotic to be licensed in the USA and several other countries outside Europe for the acute and maintenance treatment of schizophrenia in adults. It has a unique receptor-binding profile and a broad range of therapeutic effects. Since clinical trials are conducted under strict conditions in tightly defined patient populations, evidence of an agent's efficacy and tolerability under 'real-world' clinical practice conditions is also required. As in clinical trials, real-life case reports demonstrate that asenapine is effective in treating the positive symptoms of schizophrenia, both in the acute setting and for relapse prevention. It is also effective in treating negative symptoms and shows promise in the treatment of depressive symptoms associated with schizophrenia. Asenapine has a favourable tolerability profile, having a minimal impact on weight and metabolic parameters. As such, asenapine is valuable option for the treatment of schizophrenia in adults.
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Affiliation(s)
- Leonardo Cortese
- Faculty of Medicine, Windsor Regional Hospital, University of Western Ontario, Windsor, Canada.
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Mausbach BT, Moore RC, Davine T, Cardenas V, Bowie CR, Ho J, Jeste DV, Patterson TL. The use of the theory of planned behavior to predict engagement in functional behaviors in schizophrenia. Psychiatry Res 2013; 205:36-42. [PMID: 23031803 PMCID: PMC3538109 DOI: 10.1016/j.psychres.2012.09.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 09/06/2012] [Accepted: 09/12/2012] [Indexed: 12/31/2022]
Abstract
In schizophrenia, low motivation may play a role in the initiation and frequency of functional behaviors. Several reviews support the efficacy of the Theory of Planned Behavior (TPB) to predict engagement in various behaviors, but little research has utilized the TPB to explain functional behavior in schizophrenia. This study tested the TPB for predicting prospective engagement in functional behaviors in a sample of 64 individuals with schizophrenia. Participants completed questionnaires assessing their attitudes toward, social norms regarding, perceived behavioral control over, and intention to engage in various functional behaviors during the upcoming week. Follow-up questionnaires assessed engagement in functional behaviors. Zero-order correlations indicated that positive attitudes, social norms, and perceived behavioral control were positively correlated with intentions to engage in functional behaviors. In turn, intentions were positively correlated with engagement in functional behaviors. Using path analysis, social norms and control were significantly related to intentions, which in turn predicted greater engagement in functional behaviors. Results suggest that patients with schizophrenia make reasoned decisions for or against engaging in functional behaviors. Skills training interventions that also target components of the TPB may be effective for increasing motivation to engage in learned behaviors.
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Affiliation(s)
- Brent T Mausbach
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0993, USA.
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Atypical antipsychotics in the treatment of depressive and psychotic symptoms in patients with chronic schizophrenia: a naturalistic study. SCHIZOPHRENIA RESEARCH AND TREATMENT 2013; 2013:423205. [PMID: 23401771 PMCID: PMC3563169 DOI: 10.1155/2013/423205] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 12/25/2012] [Accepted: 01/08/2013] [Indexed: 11/18/2022]
Abstract
Objectives. The aim of this naturalistic study was to investigate whether treatment with clozapine and other atypical antipsychotics for at least 2 years was associated with a reduction in psychotic and depressive symptoms and an improvement in chronic schizophrenia patients' awareness of their illness. Methods. Twenty-three adult outpatients (15 men and 8 women) treated with clozapine and 23 patients (16 men and 7 women) treated with other atypical antipsychotics were included in the study. Psychotic symptoms were evaluated using the Positive and Negative Syndrome Scale (PANSS), depressive symptoms were assessed with the Calgary Depression Scale for Schizophrenia (CDSS), and insight was assessed with the Scale to Assess Unawareness of Mental Disorder (SUMD). Results. The sample as a whole had a significant reduction in positive, negative, and general symptoms, whereas the reduction in depression was significant only for patients with CDSS scores of 5 and higher at the baseline. At the follow-up, patients treated with other atypical antipsychotics reported a greater reduction in depression than patients treated with clozapine, but not when limiting the analyses to those with clinically relevant depression. Conclusions. Atypical antipsychotics may be effective in reducing psychotic and depressive symptoms and in improving insight in patients with chronic schizophrenia, with no differences in the profiles of efficacy between compounds.
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Braehler C, Schwannauer M. Recovering an emerging self: exploring reflective function in recovery from adolescent-onset psychosis. Psychol Psychother 2012; 85:48-67. [PMID: 22903893 DOI: 10.1111/j.2044-8341.2011.02018.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES This paper investigates (1) the processes involved in how young people with adolescent-onset psychosis adapt to psychosis and (2) how processes of reflective function (RF) influence the adaptation process. DESIGN This study used a qualitative design to inductively construct hypotheses about processes of adaptation and to deductively explore the influence of RF on adaptation. METHODS Eight young people (aged 18-21) who had experienced clinically significant psychosis and attended a Child and Adolescent Mental Health Services (CAMHS) first-episode psychosis service participated in two interviews: (1) grounded theory open interview; (2) Adult Attachment Interview (AAI). Grounded theory methodology was used to investigate young people's experiences of adaptation to psychosis. Fonagy's manual of RF was used to identify passages with different levels of RF in the adaptation narratives and to assign an overall rating of RF with regard to attachment states of mind to AAI transcripts. Links between adaptation themes and RF were examined qualitatively across participants. RESULTS Two main themes relating to adaptation and adolescent individuation emerged. Moderate RF was linked to primarily positive adjustment and successful individuation following psychosis. Impaired RF was associated with unresolved adaptation and blocked individuation post-psychosis. CONCLUSION Level of RF appeared to moderate adaptation and individuation processes post-psychosis and should be considered in the delivery of psychological therapies.
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Schennach R, Obermeier M, Seemüller F, Jäger M, Schmauss M, Laux G, Pfeiffer H, Naber D, Schmidt LG, Gaebel W, Klosterkötter J, Heuser I, Maier W, Lemke MR, Rüther E, Klingberg S, Gastpar M, Riedel M, Möller HJ. Evaluating depressive symptoms in schizophrenia: a psychometric comparison of the Calgary Depression Scale for Schizophrenia and the Hamilton Depression Rating Scale. Psychopathology 2012; 45:276-85. [PMID: 22796716 DOI: 10.1159/000336729] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Accepted: 01/15/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND The aim of this study was to compare two measures of depression in patients with schizophrenia and schizophrenia spectrum disorder, including patients with delusional and schizoaffective disorder, to conclude implications for their application. SAMPLING AND METHODS A total of 278 patients were assessed using the Calgary Depression Scale for Schizophrenia (CDSS) and the Hamilton Depression Rating Scale (HAMD-17). The Positive and Negative Syndrome Scale (PANSS) was also applied. At admission and discharge, a principal component analysis was performed with each depression scale. The two depression rating scales were furthermore compared using correlation and regression analyses. RESULTS Three factors were revealed for the CDSS and HAMD-17 factor component analysis. A very similar item loading was found for the CDSS at admission and discharge, whereas results of the loadings of the HAMD-17 items were less stable. The first two factors of the CDSS revealed correlations with positive, negative and general psychopathology. In contrast, multiple significant correlations were found for the HAMD-17 factors and the PANSS subscores. Multiple regression analyses demonstrated that the HAMD-17 accounted more for the positive and negative symptom domains than the CDSS. CONCLUSIONS The present results suggest that compared to the HAMD-17, the CDSS is a more specific instrument to measure depressive symptoms in schizophrenia and schizophrenia spectrum disorder, especially in acutely ill patients.
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Affiliation(s)
- Rebecca Schennach
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany.
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