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Jacobshagen L, Machetanz L, Kirchebner J. Differences between criminal offender versus non-offender female patients with schizophrenia spectrum disorder: a retrospective cohort study. Arch Womens Ment Health 2024:10.1007/s00737-024-01477-7. [PMID: 38809321 DOI: 10.1007/s00737-024-01477-7] [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: 10/04/2023] [Accepted: 05/21/2024] [Indexed: 05/30/2024]
Abstract
The purpose of this study was to investigate the difference between offender female patients (OFS) and non-offender female patients (NOFS) with schizophrenia spectrum disorder (SSD).The patients in this study were admitted to the university psychiatry in Zurich Switzerland between 1982 and 2016. Demography, psychopathology, comorbidity, and treatment differences were analyzed using binary statistics to compare 31 OFS and 29 matching NOFS with SSD. The Fisher's exact test was used for categorical data variables in small size samples and the Mann-Whitney-U-Test for nonparametric test variables, adjusted with the Benjamini and Hochberg method.The results indicate that the NOFS were cognitively more impaired, they were more likely to have had antipsychotic drugs prescribed (NOFS; 100%, OFS: 71%, OR 1.41, 95% CI 1.13-1.77, p=0.022) and their medication compliance was higher (NOFS: 84.6%, OFS: 4.5%, OR 0.09, 95% CI 0.00-0.08, p=0.000). In contrast, the OFS had completed compulsory school less often and the were observed to be more often homeless and socially isolated (OFS: 72.4%, NOFS: 34.6%, OR 4.96, 95% CI 1.58-15.6, p=0.026), self-disorders (OFS: 51.6%, NOFS: 11.1%, OR 8.53, 95% CI 2.12-34.32, p=0.011), delusions (OFS: 96.8%, NOFS: 63%, OR 17.65, 95% CI 2.08-149.99, p=0.014) and substance use disorder (51.6%, OR 0.27, 95% CI 0.09-0.85, p=0.039). Clinicians treating female offender patients with SSD should focus more on the treatment for substance use disorder, medication and early recognition of the illness for preventative purposes.
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Affiliation(s)
| | - Lena Machetanz
- Department of Forensic Psychiatry, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Johannes Kirchebner
- Department of Forensic Psychiatry, University Hospital of Psychiatry Zurich, Zurich, Switzerland
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DeLisi LE. A lifetime of mental health treatments for people with schizophrenia: update and narrative review. Curr Opin Psychiatry 2024; 37:140-146. [PMID: 38512852 DOI: 10.1097/yco.0000000000000926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
PURPOSE OF REVIEW To provide a summary of the most up-to-date thoughts about treatment for schizophrenia at different stages of illness. RECENT FINDINGS The use of Coordinated Specialty Care clinics has arisen as the standard for early on in the treatment of psychosis, providing the notion that recovery is possible. New medications that do not depend on postsynaptic dopamine receptor blockade are soon becoming available. SUMMARY A focus should be made by clinicians to personalize treatment plans for each patient who has the possibility of being diagnosed with a primary psychosis and the plan should be to predict outcomes based on biological markers that include genetic vulnerability, early psychosocial combined with pharmacological treatments as needed and then a plan to determine or maintain treatments going forward into the future. It is important to individualize treatment by stage of illness, as well as characteristics of the individual patient. Research is ongoing to advance knowledge for interventions at each stage from the premorbid period through to chronicity.
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Affiliation(s)
- Lynn E DeLisi
- Department of Psychiatry, Cambridge Health Alliance, Department of Psychiatry, Harvard Medical School, Cambridge, Massachusetts, USA
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Evans M, Cuddeback GS, Golin C, Muessig K, Bellamy C, Costa M, O'Connell M, Fisher EB. Diverse elements comprising studies of peer support complicate evidence synthesis. J Ment Health 2024:1-15. [PMID: 38556804 DOI: 10.1080/09638237.2024.2332798] [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: 02/24/2023] [Accepted: 01/20/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Innovative approaches to care, such as peer support, are needed to address the substantial and frequently unmet needs of people with serious mental illnesses such as schizophrenia. Although peer support services continue to expand in mental healthcare, findings of effectiveness from systematic reviews are mixed. However, the studies evaluated in these reviews consisted of diverse elements which the review methods neglected to consider. AIMS This review aims to demonstrate the substantial diversity in intervention components and measured outcomes among studies of peer support and lay the groundwork for more focused reviews of individual intervention components. METHODS As part of a realist review of the literature, here we synthesize evidence in a way that examines the substantial diversity in intervention components and measured outcomes comprising studies of peer support. RESULTS Seven categories of outcomes were represented, including recovery, symptoms and functioning, and care utilization. Importantly, seven distinct intervention components were represented in 26 studies: "being there," assistance in self-management, linkage to clinical care and community resources, social and emotional support, ongoing support, explicit utilization of shared lived experience or peer support values, and systems advocacy. Reflecting diversity in approaches, no study reported all intervention components, and no component was found among all studies. IMPLICATIONS Peer support services constitute a category of intervention approaches far too varied to evaluate as a single entity. Results suggest intervention components deserving more focused research, including assistance in self-management, "being there," and explicit utilization of shared lived experience or peer support values. PRISMA/PROSPERO As this article reports results from a realist review of the literature, we did not follow the PRISMA guidance which is suitable for systematic reviews. We did follow the Realist and Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) guidelines.This review was not registered on PROSPERO as it is not a systematic review.
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Affiliation(s)
- Megan Evans
- Program for Recovery and Community Health, Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Gary S Cuddeback
- School of Social Work, Virginia Commonwealth University, Richmond, VA, USA
| | - Carol Golin
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Kathryn Muessig
- College of Nursing, Florida State University, Tallahassee, FL, USA
| | - Chyrell Bellamy
- Program for Recovery and Community Health, Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Mark Costa
- Program for Recovery and Community Health, Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Maria O'Connell
- Program for Recovery and Community Health, Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Edwin B Fisher
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
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Ma CC, Lin YY, Chung YA, Park SY, Huang CCY, Chang WC, Chang HA. The two-back task leads to activity in the left dorsolateral prefrontal cortex in schizophrenia patients with predominant negative symptoms: a fNIRS study and its implication for tDCS. Exp Brain Res 2024; 242:585-597. [PMID: 38227007 DOI: 10.1007/s00221-023-06769-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/16/2023] [Indexed: 01/17/2024]
Abstract
Transcranial direct current stimulation (tDCS) over left dorsolateral prefrontal cortex (DLPFC) has shown some potential as an adjunctive intervention for ameliorating negative symptoms of schizophrenia, but its efficacy requires optimization. Recently, 'functional targeting' of stimulation holds promise for advancing tDCS efficacy by coupling tDCS with a cognitive task where the target brain regions are activated by that task and further specifically polarized by tDCS.The study used 48-channel functional near infra-red spectroscopy (fNIRS) aiming to determine a cognitive task that can effectively induce a cortical activation of the left DLPFC in schizophrenia patients with predominant negative symptoms before running a tDCS trial. Sixty schizophrenia patients with predominant negative symptoms completed measures of clinical and psychosocial functioning characteristics and assessments across cognitive domains. Hemodynamic changes during n-back working memory tasks with different cognitive loads (1-back and 2-back) and verbal fluency test (VFT) were measured using fNIRS. For n-back tasks, greater signal changes were found when the task required elevated cognitive load. One sample t-test revealed that only 2-back task elicited significant activation in left DLPFC (t = 4.23, FDR-corrected p = 0.0007). During VFT, patients failed to show significant task-related activity in left DLPFC (one sample t-test, t = -0.25, FDR-corrected p > 0.05). Our study implies that 2-back task can effectively activate left DLPFC in schizophrenia patients with predominant negative symptoms. This neurophysiologically-validated task is considered highly potential to be executed in conjunction with high-definition tDCS for "functional targeting" of the left DLPFC to treat negative symptoms in a double-blind randomized sham-control trial, registered on ClinicalTrials.gov Registry (ID: NCT05582980).
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Affiliation(s)
- Chin-Chao Ma
- Department of Psychiatry, Tri-Service General Hospital, Beitou Branch, National Defense Medical Center, No. 325, Cheng-Kung Road, Sec. 2, Nei-Hu District, Taipei, Taiwan
| | - Yen-Yue Lin
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Department of Emergency Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
- Department of Life Sciences, National Central University, Taoyuan, Taiwan
| | - Yong-An Chung
- Department of Nuclear Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sonya Youngju Park
- Department of Nuclear Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | | | - Wei-Chou Chang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hsin-An Chang
- Department of Psychiatry, Tri-Service General Hospital, Beitou Branch, National Defense Medical Center, No. 325, Cheng-Kung Road, Sec. 2, Nei-Hu District, Taipei, Taiwan.
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Nau CL, Braciszewski JM, Rossom RC, Penfold RB, Coleman KJ, Simon GE, Hong B, Padilla A, Butler RK, Chen A, Waters HC. Assessment of Disruptive Life Events for Individuals Diagnosed With Schizophrenia or Bipolar I Disorder Using Data From a Consumer Credit Reporting Agency. JAMA Psychiatry 2023:2804639. [PMID: 37163288 PMCID: PMC10173103 DOI: 10.1001/jamapsychiatry.2023.1179] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Importance There is a dearth of population-level data on major disruptive life events (defined here as arrests by a legal authority, address changes, bankruptcy, lien, and judgment filings) for patients with bipolar I disorder (BPI) or schizophrenia, which has limited studies on mental health and treatment outcomes. Objective To conduct a population-level study on disruptive life events by using publicly available data on disruptive life events, aggregated by a consumer credit reporting agency in conjunction with electronic health record (EHR) data. Design, Setting, and Participants This study used EHR data from 2 large, integrated health care systems, Kaiser Permanente Southern California and Henry Ford Health. Cohorts of patients diagnosed from 2007 to 2019 with BPI or schizophrenia were matched 1:1 by age at analysis, age at diagnosis (if applicable), sex, race and ethnicity, and Medicaid status to (1) an active comparison group with diagnoses of major depressive disorder (MDD) and (2) a general health (GH) cohort without diagnoses of BPI, schizophrenia, or MDD. Patients with diagnoses of BPI or schizophrenia and their respective comparison cohorts were matched to public records data aggregated by a consumer credit reporting agency (98% match rate). Analysis took place between November 2020 and December 2022. Main Outcomes and Measures The differences in the occurrence of disruptive life events among patients with BPI or schizophrenia and their comparison groups. Results Of 46 167 patients, 30 008 (65%) had BPI (mean [SD] age, 42.6 [14.2] years) and 16 159 (35%) had schizophrenia (mean [SD], 41.4 [15.1] years). The majoriy of patients were White (30 167 [65%]). In addition, 18 500 patients with BPI (62%) and 6552 patients with schizophrenia (41%) were female. Patients with BPI were more likely to change addresses than patients in either comparison cohort (with the incidence ratio being as high as 1.25 [95% CI, 1.23-1.28]) when compared with GH cohort. Patients with BPI were also more likely to experience any of the financial disruptive life events with odds ratio ranging from 1.15 [95% CI, 1.07-1.24] to 1.50 [95% CI, 1.42-1.58]). The largest differences in disruptive life events were seen in arrests of patients with either BPI or schizophrenia compared with GH peers (3.27 [95% CI, 2.84-3.78] and 3.04 [95% CI, 2.57-3.59], respectively). Patients with schizophrenia had fewer address changes and were less likely to experience a financial event than their matched comparison cohorts. Conclusions and Relevance This study demonstrated that data aggregated by a consumer credit reporting agency can support population-level studies on disruptive life events among patients with BPI or schizophrenia.
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Affiliation(s)
- Claudia L Nau
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | | | | | - Robert B Penfold
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Karen J Coleman
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Gregory E Simon
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Benjamin Hong
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Ariadna Padilla
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Rebecca K Butler
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Aiyu Chen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Heidi C Waters
- Global Value & Real World Evidence, Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, New Jersey
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Abstract
BACKGROUND Our goal was to identify the demographic profile of the people living homeless with mental illness in Lisboa, Portugal, and their relationship with the national healthcare system. We also tried to understand which factors contribute to the number and duration of psychiatric admissions among these homeless people. METHODS We used a cross-sectional design, collecting data for 4 years among homeless people, in Lisboa, Portugal, that were referred as possible psychiatric patients to Centro Hospitalar Psiquiátrico de Lisboa (CHPL). In total, we collected data from 500 homeless people, then cross-checked these people in our CHPL hospital electronic database and obtained 467 patient matches. RESULTS The most common psychiatric diagnosis in our sample was drug abuse (34%), followed by alcohol abuse (33%), personality disorder (24%), and acute stress reaction (23%). Sixty-two percent of our patients had multiple diagnoses, a subgroup with longer follow-ups, more psychiatric hospitalizations, and longer psychiatric hospitalizations. The prevalence of psychotic disorders was high: organic psychosis (17%), schizophrenia (15%), psychosis not otherwise specified (14%), and schizoaffective disorder (11%), that combined altogether were present in more than half (57%) of our homeless patients. CONCLUSION The people living homeless with multiple diagnoses have higher mental health needs and worse determinants of general health. An ongoing effort is needed to identify and address this subgroup of homeless people with mental illness to improve their treatment and outcomes.
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Wormley K, Dickson D, Alter H, Njoku N, Imani P, Anderson E. Association of Social Needs and Housing Status Among Urban Emergency Department Patients. West J Emerg Med 2022; 23:802-810. [PMID: 36409947 PMCID: PMC9683759 DOI: 10.5811/westjem.2022.8.55705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 08/08/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction People experiencing homelessness have high rates of social needs when presenting for emergency department (ED) services, but less is known about patients with housing instability who do not meet the established definitions of homelessness. Methods We surveyed patients in an urban, safety-net ED from June–August 2018. Patients completed two social needs screening tools and responded to additional questions on housing. Housing status was determined using validated questions about housing stability. Results Of the 1,263 eligible patients, 758 (60.0%) completed the survey. Among respondents, 40% identified as Latinx, 39% Black, 15% White, 5% Asian, and 8% other race/ethnicities. The median age was 42 years (interquartile range [IQR]: 29–57). and 54% were male. Of the 758 patients who completed the survey, 281 (37.1%) were housed, 213 (28.1%) were unstably housed, and 264 (34.8%) were homeless. A disproportionate number of patients experiencing homelessness were male (63.3%) and Black (54.2%), P <0.001, and a disproportionate number of unstably housed patients were Latinx (56.8%) or were primarily Spanish speaking (49.3%), P <0.001. Social needs increased across the spectrum of housing from housed to unstably housed and homeless, even when controlling for demographic characteristics. Conclusion Over one in three ED patients experience homelessness, and nearly one in three are unstably housed. Notable disparities exist by housing status, and there is a clear increase of social needs across the housing spectrum. Emergency departments should consider integrating social screening tools for patients with unstable housing.
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Affiliation(s)
- Kadia Wormley
- Department of Emergency Medicine, Alameda Health System, Oakland, California
| | - Drusia Dickson
- Department of Emergency Medicine, Alameda Health System, Oakland, California
| | - Harrison Alter
- Department of Emergency Medicine, Alameda Health System, Oakland, California; Andrew Levitt Center for Social Emergency Medicine, Berkeley, California
| | - Ndidi Njoku
- Howard University College of Medicine, Washington, DC
| | - Partow Imani
- University of California Berkeley, School of Public Health, Berkeley, California
| | - Erik Anderson
- Department of Emergency Medicine, Alameda Health System, Oakland, California; Substance Use Disorder Treatment Program, Alameda Health System, Oakland, California
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Lio G, Ghazzai M, Haesebaert F, Dubreucq J, Verdoux H, Quiles C, Jaafari N, Chéreau-Boudet I, Legros-Lafarge E, Guillard-Bouhet N, Massoubre C, Gouache B, Plasse J, Barbalat G, Franck N, Demily C. Actionable Predictive Factors of Homelessness in a Psychiatric Population: Results from the REHABase Cohort Using a Machine Learning Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12268. [PMID: 36231571 PMCID: PMC9565981 DOI: 10.3390/ijerph191912268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND There is a lack of knowledge regarding the actionable key predictive factors of homelessness in psychiatric populations. Therefore, we used a machine learning model to explore the REHABase database (for rehabilitation database-n = 3416), which is a cohort of users referred to French psychosocial rehabilitation centers in France. METHODS First, we analyzed whether the different risk factors previously associated with homelessness in mental health were also significant risk factors in the REHABase. In the second step, we used unbiased classification and regression trees to determine the key predictors of homelessness. Post hoc analyses were performed to examine the importance of the predictors and to explore the impact of cognitive factors among the participants. RESULTS First, risk factors that were previously found to be associated with homelessness were also significant risk factors in the REHABase. Among all the variables studied with a machine learning approach, the most robust variable in terms of predictive value was the nature of the psychotropic medication (sex/sex relative mean predictor importance: 22.8, σ = 3.4). Post hoc analyses revealed that first-generation antipsychotics (15.61%; p < 0.05 FDR corrected), loxapine (16.57%; p < 0.05 FWER corrected) and hypnotics (17.56%; p < 0.05 FWER corrected) were significantly associated with homelessness. Antidepressant medication was associated with a protective effect against housing deprivation (9.21%; p < 0.05 FWER corrected). CONCLUSIONS Psychotropic medication was found to be an important predictor of homelessness in our REHABase cohort, particularly loxapine and hypnotics. On the other hand, the putative protective effect of antidepressants confirms the need for systematic screening of depression and anxiety in the homeless population.
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Affiliation(s)
- Guillaume Lio
- Centre d’Excellence Autisme iMIND, pôle HU-ADIS, Hôpital le Vinatier, 69678 Bron, France
- Equipe «Disorders of the Brain», Institut Marc Jeannerod, UMR 5229, CNRS & Université Lyon 1, 69100 Villeurbanne, France
| | - Malek Ghazzai
- Centre d’Excellence Autisme iMIND, pôle HU-ADIS, Hôpital le Vinatier, 69678 Bron, France
| | | | - Julien Dubreucq
- Centre Hospitalier Universitaire de Saint-Etienne, 42270 Saint-Priest-en-Jarez, France
| | - Hélène Verdoux
- Hôpital Charles Perrens, Université de Bordeaux, 33405 Talence, France
| | - Clélia Quiles
- Hôpital Charles Perrens, Université de Bordeaux, 33405 Talence, France
| | - Nemat Jaafari
- CREATIV & URC Pierre Deniker, Centre Hospitalier Laborit, Université de Poitiers, 86000 Poitiers, France
| | - Isabelle Chéreau-Boudet
- Centre Référent Conjoint de Réhabilitation (CRCR), Centre Hospitalier Universitaire de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Emilie Legros-Lafarge
- Centre Référent de Réhabilitation Psychosociale de Limoges (C2RL), 87000 Limoges, France
| | | | - Catherine Massoubre
- Centre Hospitalier Universitaire de Saint-Etienne, 42270 Saint-Priest-en-Jarez, France
- Faculté de Médecine, Université de Saint-Etienne, 42023 Saint-Etienne, France
| | | | - Julien Plasse
- Pôle Centre Rive Gauche, Hôpital Le Vinatier, 69678 Bron, France
- Centre Ressource de Réhabilitation Psychosociale et de Remédiation Cognitive (CRR), CH le Vinatier et Institut Marc Jeannerod, UMR 5229 & Université Lyon 1, 69100 Bron, France
| | - Guillaume Barbalat
- Pôle Centre Rive Gauche, Hôpital Le Vinatier, 69678 Bron, France
- Centre Ressource de Réhabilitation Psychosociale et de Remédiation Cognitive (CRR), CH le Vinatier et Institut Marc Jeannerod, UMR 5229 & Université Lyon 1, 69100 Bron, France
| | - Nicolas Franck
- Pôle Centre Rive Gauche, Hôpital Le Vinatier, 69678 Bron, France
- Centre Ressource de Réhabilitation Psychosociale et de Remédiation Cognitive (CRR), CH le Vinatier et Institut Marc Jeannerod, UMR 5229 & Université Lyon 1, 69100 Bron, France
| | - Caroline Demily
- Centre d’Excellence Autisme iMIND, pôle HU-ADIS, Hôpital le Vinatier, 69678 Bron, France
- Equipe «Disorders of the Brain», Institut Marc Jeannerod, UMR 5229, CNRS & Université Lyon 1, 69100 Villeurbanne, France
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Tidmore LM, Keast SL, Waters HC, Pareja KL, Cothran T, Skrepnek GH. Readmissions, costs, and duration to subsequent outpatient visit after hospital discharge among Medicaid beneficiaries utilizing oral versus long-acting injectable antipsychotics in bipolar disorder or schizophrenia. Curr Med Res Opin 2022; 38:1621-1630. [PMID: 35833696 DOI: 10.1080/03007995.2022.2101819] [Citation(s) in RCA: 2] [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] [Indexed: 12/27/2022]
Abstract
BACKGROUND Long-acting injectable antipsychotics (LAIs) may reduce hospitalizations versus oral formulations (OAP) in bipolar disorder (BP) and schizophrenia/schizoaffective disorder (SCZ), but the impact on time to outpatient follow-up is less understood. OBJECTIVES To assess hospital readmissions and medical costs among Medicaid beneficiaries with BP or SCZ utilizing OAP or LAI SGAs. METHODS Cross-sectional and longitudinal analyses utilized comprehensive administrative claims of Oklahoma Medicaid beneficiaries (≥18 years) with BP or SCZ between 1 January 2013 and 31 December 2017. Readmissions, total direct medical costs, and psychiatry-related outpatient visits were assessed via generalized linear models and generalized estimating equations, controlling for demographic and clinical covariates. RESULTS Among 2523 included members, LAI utilization was associated with 1.50 and 1.73 times higher odds of any hospitalization and any readmission, respectively (p < .05). Cases involving both BP and SCZ were associated with a 2.40 times higher odds of any readmission, 2.26 times higher number of readmissions, and 24.5% higher costs (p < .001). Of the 468 members with a subsequent psychiatry-related outpatient visit, LAIs were associated with a 23.9% shorter duration to outpatient visit and 16.4% lower costs (p < .05). CONCLUSION In contrast to prior studies, this real-world investigation noted higher hospitalizations and readmissions among LAIs relative to OAP medications, but among members with a hospitalization or ED visit, LAIs were associated with shorter durations to outpatient visits and lower costs. Those with diagnoses of both BP with SCZ had higher odds of any readmission, number of readmissions, and costs relative to those with bipolar disorder alone and may be a key target for interventions.
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Affiliation(s)
- Laura M Tidmore
- Department of Clinical and Administrative Sciences, University of Oklahoma College of Pharmacy, Oklahoma City, OK, USA
| | - Shellie L Keast
- Government Human Services Consulting, Mercer LLC, Phoenix, AZ, USA
| | - Heidi C Waters
- Health Outcomes, Otsuka Pharmaceutical Development and Commercialization, Inc., Princeton, NJ, USA
| | - Kristin L Pareja
- Health Outcomes, Otsuka Pharmaceutical Development and Commercialization, Inc., Princeton, NJ, USA
| | - Terry Cothran
- Department of Pharmacy, Oklahoma Health Care Authority, Oklahoma City, OK, USA
| | - Grant H Skrepnek
- Department of Clinical and Administrative Sciences, University of Oklahoma College of Pharmacy, Oklahoma City, OK, USA
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Gabrielian S, Koosis ER, Cohenmehr J, Hellemann G, Tuepker A, Green MF, Vazzano JK, Young AS. Factors associated with recovery from homelessness among veterans in permanent supportive housing. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:2144-2162. [PMID: 34862803 DOI: 10.1002/jcop.22760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 09/13/2021] [Accepted: 11/15/2021] [Indexed: 06/13/2023]
Abstract
AIMS We sought to identify person- and program-level factors distinguishing permanent supportive housing (PSH) residents with higher versus lower social integration; and higher versus lower instrumental functioning. METHODS Among 60 PSH residents at Los Angeles' VA, surveys and medical records captured person-level factors. Using a median split, we dichotomized participants with higher versus lower social integration; and higher versus lower instrumental functioning. Recursive partitioning (RP) identified variables that best-differentiated these subgroups. Interviews with 26 participants captured their perceptions on social integration and instrumental functioning. RESULTS Using RP, health-related quality of life, psychiatric symptoms and case management frequency best-differentiated the social integration subgroups. Few perceived that PSH affected social integration. RP did not yield a stable model to differentiate the instrumental functioning subgroups; participants perceived that PSH addressed most functional deficits. CONCLUSIONS Services that enhance social integration may benefit PSH residents with poor health; existing services may adequately address instrumental functioning.
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Affiliation(s)
- Sonya Gabrielian
- Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles, Los Angeles, California, USA
- Department of Psychiatry, VA Greater Los Angeles, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Ella R Koosis
- Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles, Los Angeles, California, USA
| | - Jennifer Cohenmehr
- Department of Psychiatry, VA Greater Los Angeles, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Gerhard Hellemann
- Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Anaïs Tuepker
- VA HSR&D Center to Improve Veteran Involvement in Care, VA Portland Health Care, Portland, Oregon, USA
- Division of General Internal Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Michael F Green
- Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Jesse K Vazzano
- Care Management and Social Work, VA Western Colorado Health Care System, Grand Junction, Colorado, USA
| | - Alexander S Young
- Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles, Los Angeles, California, USA
- Department of Psychiatry, VA Greater Los Angeles, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
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11
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Mårtensson S, Johansen KS, Krarup J, Düring SW. REDD-PAC Cohort Description: Researching Dual Diagnosis - Prognosis and Characteristics. J Dual Diagn 2022; 18:111-122. [PMID: 35363594 DOI: 10.1080/15504263.2022.2055250] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Evidence from real-world integrated dual diagnosis treatment programs is limited. In 2017 we decided to establish the REDD-PAC cohort with the aim to provide more in-depth information regarding the effect of integrated treatment. METHODS The REDD-PAC cohort includes more than 2,500 patients with dual diagnosis that have been treated at an in-patient department specializing in the integrated treatment of both psychiatric illness and substance use disorder in Denmark in the period from 2002 to 2017. The collected data included information on diagnosis as well as patient-completed questionnaires regarding anxiety, depression, self-worth, and use of substances. Data regarding medications prescribed and administered, weight, height, and blood pressure were also included. RESULTS The primary diagnosis was psychosis spectrum disorder (37.0%), followed by affective disorders (18.8%). More than two-thirds of the patients were male, and most patients had a weak connection to the labor market and basic schooling. Patients were generally very motivated for treatment. CONCLUSIONS Further linking the data to Danish national register data makes it possible to follow individual trajectories pre- and post-admission as well as to access complete follow-up data regarding long-term outcomes, e.g., use of health services, mortality, morbidity, crime, and social circumstances. This article describes both the overarching aims of the REDD-PAC cohort and the basic diagnostic and sociodemographic characteristics of the cohort.
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Affiliation(s)
- Solvej Mårtensson
- Competency center for Dual diagnosis, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Katrine S Johansen
- Competency center for Dual diagnosis, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Jakob Krarup
- Department M, Mental Health Center Sct. Hans, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Signe W Düring
- Competency center for Dual diagnosis, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark.,Department M, Mental Health Center Sct. Hans, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark.,Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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12
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Chen J, Song H, Li S, Teng Z, Su Y, Chen J, Huang J. Social support and quality of life among chronically homeless patients with schizophrenia. Front Psychiatry 2022; 13:928960. [PMID: 35966475 PMCID: PMC9363777 DOI: 10.3389/fpsyt.2022.928960] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
This study aimed to describe the sociodemographic characteristics, social support received, and quality of life of chronically homeless patients with schizophrenia in China. A self-prepared sociodemographic questionnaire, the Social Support Rating Scale (SSRS), European Five-dimensional Health Scale (EQ-5D), and Eysenck Personality were administrated to 3,967 chronically homeless and 3,724 non-homeless patients from the Department of Xiangtan Fifth People's Hospital, Hunan, China, between April 2011 and October 2016. Results indicated that the homeless patients were more likely to live outside the city and be ethnic minorities compared with non-homeless patients. Although the married proportion was higher among homeless patients, they had a higher rate of being divorced or widowed. Notably, the homeless patients had higher employment rates before illness, despite significantly lower education (P < 0.001). Chronically homeless patients with schizophrenia showed a lower score in the SSRS (30.29 ± 7.34 vs. 26.16 ± 10.04, p < 0.001); they had significantly lower objective support, subject support, social support, and EQ-Visual Analog Scale, Eysenck Personality Questionnaire-Psychoticism, and Eysenck Personality-Neuroticism scores (p < 0.001). Homeless patients may be worse off, and could be assisted by providing accommodation, family intervention, medical services (such as pain medication), and other comprehensive measures.
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Affiliation(s)
- Jinliang Chen
- Department of Psychiatry, Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, Shenzhen, China
| | - Hongli Song
- Department of Psychiatry, Fifth Ren Min Hospital of Xiangtan, Xiangtan, China
| | - Shuchun Li
- Department of Psychiatry, Fifth Ren Min Hospital of Xiangtan, Xiangtan, China
| | - Ziwei Teng
- National Clinical Research Center for Mental Diseases and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yuhan Su
- National Clinical Research Center for Mental Diseases and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jindong Chen
- National Clinical Research Center for Mental Diseases and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,China National Technology Institute on Mental Disorders, Changsha, China
| | - Jing Huang
- National Clinical Research Center for Mental Diseases and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,China National Technology Institute on Mental Disorders, Changsha, China
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13
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Jahan S, Wraith D, Dunne MP, Naish S. Assessing evidence for seasonality of hospital admissions for schizophrenia in Queensland, Australia: a time series observational study. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2021; 65:2025-2035. [PMID: 34110485 DOI: 10.1007/s00484-021-02160-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 05/06/2021] [Accepted: 06/01/2021] [Indexed: 06/12/2023]
Abstract
Most evidence on seasonal admission patterns for schizophrenia derives from the Northern Hemisphere with results from the Southern Hemisphere less documented. This study examines seasonal patterns in hospital admissions due to schizophrenia in Queensland, Australia, a large area that has a range of different climatic features. Daily hospital admissions data for people with the primary diagnosis of schizophrenia were collected from Queensland Health Department for the period from January 1996 to December 2015. A generalised linear regression model with Quasi-Poisson distribution was used to assess seasonal admission patterns across different climatic regions. The evidence for seasonality was also explored in subgroups that had different socio-demographic characteristics or history of prior hospitalisation for psychiatric disorders. Overall, a significant winter pattern (RR 1.05, 95%CI 1.01-1.13) was found with a peak in August (RR 1.08, 95%CI 1.03-1.17) in temperate Southeast Queensland. However, the hot humid North and Far North Queensland showed a peak in October (RR 1.10, 95%CI 1.02-1.22). Males (RR 1.11, 95%CI 1.07-1.14), people aged 40-59 years old (RR 1.10, 95%CI 1.05-1.15) and those who had never married (RR 1.09, 95%CI 1.06-1.12), were Australian by birth (RR 1.07, 95%CI 1.04-1.10) or were unemployed (RR 1.13, 95%CI 1.09-1.18) had significantly higher risk for hospital admissions, particularly during the winter months. The seasonal admission pattern for schizophrenia did not change significantly according to admission status and history of outpatient or community psychiatric treatment. The study found some evidence for seasonality of hospital admissions for schizophrenia that differed from northern tropical to southern temperate regions of Queensland.
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Affiliation(s)
- Shafkat Jahan
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, Queensland, 4059, Australia.
| | - Darren Wraith
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, Queensland, 4059, Australia
| | - Michael P Dunne
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, Queensland, 4059, Australia
- Institute for Community Health Research, Hue University, Hue, Vietnam
| | - Suchithra Naish
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, Queensland, 4059, Australia
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14
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Evans M, Barker H, Peddireddy S, Zhang A, Luu S, Qian Y, Tang PY, Fisher EB. Peer-delivered services and peer support reaching people with schizophrenia: A scoping review. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2021. [DOI: 10.1080/00207411.2021.1975441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Megan Evans
- Peers for Progress and Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hannah Barker
- Peers for Progress and Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Snigdha Peddireddy
- Peers for Progress and Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Angela Zhang
- Peers for Progress and Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Samantha Luu
- Peers for Progress and Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Yiqing Qian
- Peers for Progress and Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Patrick Y. Tang
- Peers for Progress and Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Edwin B. Fisher
- Peers for Progress and Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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15
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Bonfils KA, Novick DM. Application of Interpersonal and Social Rhythm Therapy (IPSRT) for Depression Associated With Schizophrenia Spectrum Disorders. Am J Psychother 2021; 74:127-134. [PMID: 33445959 DOI: 10.1176/appi.psychotherapy.20200024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
People with schizophrenia spectrum disorders frequently experience depression, yet depressive symptoms are often unaddressed. The authors propose that interpersonal and social rhythm therapy (IPSRT) may be effective for individuals with these disorders who experience depression. IPSRT is a manualized, evidence-based treatment for bipolar disorders. It combines the core elements of interpersonal psychotherapy for unipolar depression with social rhythm therapy to target disrupted social rhythms. The authors highlight evidence for the potential utility of IPSRT to treat patients with schizophrenia spectrum disorders and present a case example. IPSRT is one promising therapy that could fill a treatment gap for people with schizophrenia spectrum disorders by addressing depressive symptoms. Future work should build on this rationale and case example to design and implement a randomized controlled trial of IPSRT for treatment of schizophrenia spectrum disorders and evaluate needed modifications.
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Affiliation(s)
- Kelsey A Bonfils
- School of Psychology, University of Southern Mississippi, Hattiesburg (Bonfils); U.S. Department of Veterans Affairs (VA) Pittsburgh Healthcare System, Pittsburgh (Novick)
| | - Danielle M Novick
- School of Psychology, University of Southern Mississippi, Hattiesburg (Bonfils); U.S. Department of Veterans Affairs (VA) Pittsburgh Healthcare System, Pittsburgh (Novick)
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16
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Kulkarni KR, Shyam RPS, Bagewadi VI, Gowda GS, Manjunatha BR, Shashidhara HN, Basavaraju V, Manjunatha N, Moirangthem S, Kumar CN, Math SB. A study of collaborative telepsychiatric consultations for a rehabilitation centre managed by a primary healthcare centre. Indian J Med Res 2021; 152:417-422. [PMID: 33380707 PMCID: PMC8061593 DOI: 10.4103/ijmr.ijmr_676_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background & objectives: Telepsychiatric methods can be used for the purpose of providing clinical care comparable to in-person treatment in various settings including rehabilitation. Previous evidence has shown that clinical outcomes for both are comparable. In view of challenges posed in the implementation of traditional psychiatric care in India, telepsychiatry offers an avenue to provide feasible, affordable and clinically useful psychiatric services. This study was conducted to examine the utility, feasibility and clinical effectiveness of providing collaborative telepsychiatric services with a primary care doctor for inpatients in a rehabilitation centre through a telepsychiatrist of estabilished psychiatry department in a tertiary care centre in south India in a collaborative care model with a primary care doctor. Methods: Patients at the rehabilitation centre attached to an urban primary healthcare centre received collaborative care using telepsychiatry for a period from January 2013 to December 2016. A retrospective review of their charts was performed and sociodemographic, clinical and treatment details were collected and analyzed. Results: The sample population (n=132) consisted of 75 per cent males, with a mean age of 43.8 ± 12.1 yr. Each patient received an average of 7.8 ± 4.9 live video-consultations. Initially, an antipsychotic was prescribed for 84.1 per cent (n=111) of patients. Fifty four patients (40.9%) had a partial response and 26 (19.7%) patients showed a good response. Interpretation & conclusions: The study sample represented the population of homeless persons with mental illness who are often brought to the rehabilitation centre. This study results demonstrated the successful implementation of inpatients collaborative telepsychiatry care model for assessment, follow up, investigation and treatment of patients through teleconsultation.
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Affiliation(s)
- Karishma R Kulkarni
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - R P S Shyam
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Guru S Gowda
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - B R Manjunatha
- Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Harihara N Shashidhara
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Vinay Basavaraju
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Narayana Manjunatha
- Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sydney Moirangthem
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Suresh Bada Math
- Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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17
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Simmons MB, Brushe M, Elmes A, Polari A, Nelson B, Montague A. Shared Decision Making With Young People at Ultra High Risk of Psychotic Disorder. Front Psychiatry 2021; 12:683775. [PMID: 34603094 PMCID: PMC8481955 DOI: 10.3389/fpsyt.2021.683775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/31/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction: While the majority of young people who meet the criteria for being considered at increased risk of psychosis do not go on to develop a psychotic disorder, young people are currently being identified and treated in early intervention services. Ethical concerns have been raised concerning the decision about whether or not to provide treatment, and if so, what type of treatment. This study sought to support young people themselves to make these decisions with support from their clinician through a shared decision-making approach, facilitated by an online decision aid. Methods: This project used the International Patient Decision Aid Standards (IPDAS) to guide the development and piloting of an online decision aid across two phases: (1) qualitative, semi-structured focus groups with young people who were past clients and clinicians from an early psychosis service; and (2) pilot testing of the decision aid with clinicians and young people who were current clients to finalize the development. Results: Issues discussed by clinicians in the focus group were grouped into three main areas: (1) engagement phase; (2) assessment and priorities for treatment; and (3) initial and ongoing decision making. Clients focused on the context in which the decisions were made, including as they experienced initial feelings of resistance, and then acceptance of efforts made to describe and treat their mental health challenges. Clients highlighted the need for collaboration between themselves and their clinician, and the need to be equipped with the knowledge and tools to take care of themselves. These focus group data were used to refine the online decision aid. Pilot testing revealed that while it was overall useful and relevant, important limitations were noted by both clients and clinicians. Discussion: The use of a decision aid to facilitate shared decision making (SDM) in this area is feasible and has utility for both clients and clinicians. Use of such a tool can help to address the need to uphold the rights of young people as decision makers about their own care. Future efforts should embed decision aids within complex SDM interventions, and research to understand issues relating to implementation of these interventions.
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Affiliation(s)
- Magenta Bender Simmons
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Mary Brushe
- Telethon Kids Institute, University of Western Australia, Adelaide, SA, Australia.,School of Public Health, University of Adelaide, Adelaide, SA, Australia
| | - Aurora Elmes
- Centre for Social Impact, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Andrea Polari
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Barnaby Nelson
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Alice Montague
- North East London Foundation NHS Trust, London, United Kingdom.,Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
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18
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Abstract
Special emphasis populations in the current context can be defined as groups experiencing health disparities resulting in elevated risk to health, safety, and well-being from drinking alcohol. Individuals from marginalized minority populations often encounter barriers to accessing and receiving effective alcohol treatment due to social inequities and disadvantaged life contexts, which also may adversely affect recovery from alcohol use disorder (AUD). Recovery from AUD often involves the adoption of a stable non-drinking lifestyle (sobriety), increased health and well-being, and increased social connection. Although there has been considerable work on AUD epidemiology among special emphasis populations, little research exists directly examining recovery among racial/ethnic minority populations and/or sexual and gender minority populations. The current narrative review hopes to spark scholarly interest in this critically neglected area. This article opens with a review of special emphasis populations and their alcohol-related risks. Next, definitions of recovery, Alcoholics Anonymous, and culturally adapted recovery models for racial/ethnic minority populations are explored. This is followed by a discussion of factors that may particularly influence recovery among marginalized minority populations. This narrative review concludes with a discussion of research priorities for promoting health equity through studies focused on understanding and supporting recovery from AUD among marginalized minority populations.
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Affiliation(s)
- Eric F Wagner
- Robert Stempel College of Public Health & Social Work, Community-Based Research Institute, and National Institute on Minority Health and Health Disparities (NIMHD) Research Center in a Minority Institution (RCMI), Florida International University, Miami, Florida
| | - Julie A Baldwin
- Center for Health Equity Research and NIMHD RCMI Southwest Health Equity Research Collaborative, Northern Arizona University, Flagstaff, Arizona
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19
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Lipidomics of the brain, retina, and biofluids: from the biological landscape to potential clinical application in schizophrenia. Transl Psychiatry 2020; 10:391. [PMID: 33168817 PMCID: PMC7653030 DOI: 10.1038/s41398-020-01080-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 01/10/2023] Open
Abstract
Schizophrenia is a serious neuropsychiatric disorder, yet a clear pathophysiology has not been identified. To date, neither the objective biomarkers for diagnosis nor specific medications for the treatment of schizophrenia are clinically satisfactory. It is well accepted that lipids are essential to maintain the normal structure and function of neurons in the brain and that abnormalities in neuronal lipids are associated with abnormal neurodevelopment in schizophrenia. However, lipids and lipid-like molecules have been largely unexplored in contrast to proteins and their genes in schizophrenia. Compared with the gene- and protein-centric approaches, lipidomics is a recently emerged and rapidly evolving research field with particular importance for the study of neuropsychiatric disorders such as schizophrenia, in which even subtle aberrant alterations in the lipid composition and concentration of the neurons may disrupt brain functioning. In this review, we aimed to highlight the lipidomics of the brain, retina, and biofluids in both human and animal studies, discuss aberrant lipid alterations in correlation with schizophrenia, and propose future directions from the biological landscape towards potential clinical applications in schizophrenia. Recent studies are in support of the concept that aberrations in some lipid species [e.g. phospholipids, polyunsaturated fatty acids (PUFAs)] lead to structural alterations and, in turn, impairments in the biological function of membrane-bound proteins, the disruption of cell signaling molecule accessibility, and the dysfunction of neurotransmitter systems. In addition, abnormal lipidome alterations in biofluids are linked to schizophrenia, and thus they hold promise in the discovery of biomarkers for the diagnosis of schizophrenia.
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20
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Higgins-Chen AT, Boks MP, Vinkers CH, Kahn RS, Levine ME. Schizophrenia and Epigenetic Aging Biomarkers: Increased Mortality, Reduced Cancer Risk, and Unique Clozapine Effects. Biol Psychiatry 2020; 88:224-235. [PMID: 32199607 PMCID: PMC7368835 DOI: 10.1016/j.biopsych.2020.01.025] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/28/2020] [Accepted: 01/31/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Schizophrenia (SZ) is associated with increased all-cause mortality, smoking, and age-associated proteins, yet multiple previous studies found no association between SZ and biological age using Horvath's epigenetic clock, a well-established aging biomarker based on DNA methylation. However, numerous epigenetic clocks that may capture distinct aspects of aging have been developed. This study tested the hypothesis that altered aging in SZ manifests in these other clocks. METHODS We performed a comprehensive analysis of 14 epigenetic clocks categorized according to what they were trained to predict: chronological age, mortality, mitotic divisions, or telomere length. To understand the etiology of biological age differences, we also examined DNA methylation predictors of smoking, alcohol, body mass index, serum proteins, and cell proportions. We independently analyzed 3 publicly available multiethnic DNA methylation data sets from whole blood, a total of 567 SZ cases and 594 nonpsychiatric controls. RESULTS All data sets showed accelerations in SZ for the 3 mortality clocks up to 5 years, driven by smoking and elevated levels of 6 age-associated proteins. The 2 mitotic clocks were decelerated in SZ related to antitumor natural killer and CD8T cells, which may help explain conflicting reports about low cancer rates in epidemiological studies of SZ. One cohort with available medication data showed that clozapine is associated with male-specific decelerations up to 7 years in multiple chronological age clocks. CONCLUSIONS Our study demonstrates the utility of studying the various epigenetic clocks in tandem and highlights potential mechanisms by which mental illness influences long-term outcomes, including cancer and early mortality.
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Affiliation(s)
- Albert T Higgins-Chen
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.
| | - Marco P Boks
- Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht, The Netherlands
| | - Christiaan H Vinkers
- Department of Psychiatry, Amsterdam University Medical Center, Amsterdam, The Netherlands; Department of Anatomy and Neurosciences, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - René S Kahn
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht, The Netherlands
| | - Morgan E Levine
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
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21
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Affiliation(s)
- Dermot J. Hurley
- School of Social Work, King’s University College, Western University, Canada
| | - Martin Agrest
- Department of Research, Proyecto Suma, Buenos Aires, Argentina
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22
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Steiner BD, Wahrenberger JT, Raney L. Providing Effective Primary Care for Patients with Serious Mental Illness: Additional Components to Enhance Practice. Community Ment Health J 2020; 56:592-596. [PMID: 31832818 DOI: 10.1007/s10597-019-00517-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 12/06/2019] [Indexed: 11/25/2022]
Abstract
Despite pronounced disparities in mortality and physical health outcomes, no well accepted models exist for integrating primary care with behavioral health for patients with serious mental illness (SMI). This article describes a case study of an enhanced approach to primary care that builds on the patient centered medical home (PCMH) model and adds three additional components: (1) longer and more frequent visits to establish trust and increase adherence, (2) a primary care team that has both the skills to provide effective primary care and the heart to take care of patients with SMI and (3) planned and proactive communication between the behavioral health team and the primary care team.
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Affiliation(s)
| | | | - Lori Raney
- University of Colorado School of Medicine, Aurora, USA
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23
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Lévesque IS, Abdel-Baki A. Homeless youth with first-episode psychosis: A 2-year outcome study. Schizophr Res 2020; 216:460-469. [PMID: 31899096 DOI: 10.1016/j.schres.2019.10.031] [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: 10/11/2018] [Revised: 08/23/2019] [Accepted: 10/12/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Psychosis augments the risk of homelessness, the latter is associated with increased morbidity and mortality. Young adults experiencing first-episode psychosis (FEP) are increasingly recognized as being vulnerable to homelessness. However, data on homeless in youth with FEP are sparse. OBJECTIVES To compare symptomatic and functional outcomes in homeless v. never homeless FEP, at admission and two years after admission to an Early Psychosis Intervention Service (EIS). METHOD From October 2005 to April 2011, 167 FEP consecutive admissions (aged 18-30 years old), were recruited in a 2-year prospective longitudinal study in an inner city EIS in Montreal, Canada. Socio-demographic characteristics, symptomatic and functional outcomes, as well as treatments and service use data were collected at admission and annually. RESULT 26% of FEP were homeless, prior or during the follow-up. Attrition rate was similar among the two groups. At baseline, the homeless group were more likely to have childhood abuse, forensic history, non-affective psychosis, negative symptoms, substance use disorder and cluster B personality. Despite the intensive care of EIS, the similarity of illness severity at baseline and medication adherence rate, homeless FEP had poorer 2-year symptomatic and functional outcomes, although having more long-acting injectable antipsychotics (LAI) (vs oral antipsychotics), community treatment order and hospitalizations. CONCLUSION Homelessness is a serious and prevalent phenomenon among FEP youth associated with worse symptomatic and functional outcomes. More studies on interventions focusing on potentially modifiable factors (e.g. substance use disorders, social support) are warranted.
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Affiliation(s)
- Isabelle Sarah Lévesque
- Jean-Talon Hospital, 1385 rue Jean-Talon Est, Montreal, QC, H2E 1S6, Canada; Centre Recherche du Centre hospitalier de l'Université de Montreal (CRCHUM), 900 rue St-Denis, Montréal, QC, H2X0A9, Canada
| | - Amal Abdel-Baki
- Centre Recherche du Centre hospitalier de l'Université de Montreal (CRCHUM), 900 rue St-Denis, Montréal, QC, H2X0A9, Canada; Department of psychiatry, Université de Montréal; Centre de recherche du Centre hospitalier de l'Université de Montreal, 1000 rue St-Denis, Montréal, QC, H2X 0C1, Canada; Université de Montréal, Department of psychiatry, Canada.
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24
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Goldsmith DR, Rapaport MH. Inflammation and Negative Symptoms of Schizophrenia: Implications for Reward Processing and Motivational Deficits. Front Psychiatry 2020; 11:46. [PMID: 32153436 PMCID: PMC7044128 DOI: 10.3389/fpsyt.2020.00046] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/20/2020] [Indexed: 01/08/2023] Open
Abstract
Negative symptoms of schizophrenia are debilitating and chronic in nature, are difficult to treat, and contribute to poor functional outcomes. Motivational deficits are a core negative symptom and may involve alterations in reward processing, which involve subcortical regions such as the basal ganglia. More specifically, dopamine-rich regions like the ventral striatum, have been implicated in these reward-processing deficits. Inflammation is one mechanism that may underlie negative symptoms, and specifically motivational deficits, via the effects of inflammatory cytokines on the basal ganglia. Previous work has demonstrated that inflammatory stimuli decrease neural activity in the ventral striatum and decrease connectivity in reward-relevant neural circuitry. The immune system has been shown to be involved in the pathophysiology of schizophrenia, and inflammatory cytokines have been shown to be altered in patients with the disorder. This paper reviews the literature on associations between inflammatory markers and negative symptoms of schizophrenia as well as the role of anti-inflammatory drugs to target negative symptoms. We also review the literature on the role of inflammation and reward processing deficits in both healthy controls and individuals with depression. We use the literature on inflammation and depression as a basis for a model that explores potential mechanisms responsible for inflammation modulating certain aspects of negative symptoms in patients with schizophrenia. This approach may offer novel targets to treat these symptoms of the disorder that are significant barriers to functional recovery and do not respond well to available antipsychotic medications.
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Affiliation(s)
- David R Goldsmith
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Mark Hyman Rapaport
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
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Jacques MC, St-Cyr Tribble D, Bonin JP. Filters in the coping process of people with schizophrenia: A constructivist grounded theory study. J Psychiatr Ment Health Nurs 2019; 26:142-152. [PMID: 30825402 DOI: 10.1111/jpm.12515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 02/06/2019] [Accepted: 02/27/2019] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: In the nursing perspective of Roy's adaptation model, to be adapted means to have positive interactions with one's environment. The ability to use effective coping strategies is an essential ingredient of mental health recovery. However, coping difficulties are often a problem for people with a diagnosis of schizophrenia spectrum disorder, especially those who have inadequate social support. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: "Filters in the coping process" is a grounded theory of coping in people with a diagnosis of schizophrenia spectrum disorder. A filter effect impairs their ability and limits their opportunities to use effective coping strategies. These filters are as follows: to have been helped, to understand in one's own way, to act despite limited freedom and to modulate the process of self-disclosure. "Surface coping" is the product of the effect of these filters on coping attempts and possibilities. It does not reflect the person's real potential. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: By offering an alternative, holistic nursing perspective, the filter model provides the nurse with factors to consider when assessing clients with a diagnosis of schizophrenia spectrum disorder, so as to plan interventions towards improving their coping capacity. By allowing for the presence of surface coping, the nurse will have less tendency to form negative judgments about clients with a diagnosis of schizophrenia spectrum disorder. ABSTRACT: Introduction Numerous studies confirm the coping difficulties of people diagnosed with schizophrenia spectrum disorder, especially those with limited social support. Further, the coping process is itself poorly understood. Aim Starting from a conceptualization of the adaptation of Roy's model, the aim of this study was to describe the coping process of people with schizophrenia spectrum disorder in the context of an inadequate social support. Method A constructivist grounded theorization was performed with a sample of 30 persons with schizophrenia spectrum disorder. Results The results are a model named: "Filters in the coping process of people with a diagnosis of schizophrenia spectrum disorder who have inadequate social support." The type of coping strategies used evolves over time and in accordance with the filters. The consequence of the process is "surface coping." Discussion The coping potential of people with schizophrenia spectrum disorder is affected by environmental factors as well as factors inherent to the disorder itself. The filter model provides a holistic perspective, as opposed to merely focusing on behaviours. Implication for practice The findings of this study could improve nursing interventions through a better understanding of impediments to coping: what they are, how they arise and the nature of their effects.
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Affiliation(s)
- Marie-Claude Jacques
- School of Nursing, Faculty of Medicine and Health Sciences, Université of Montreal, Montreal, Québec, Canada.,Institut universitaire de première ligne en santé et services sociaux, Sherbrooke, Québec, Canada
| | - Denise St-Cyr Tribble
- École des sciences infirmières, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Jean-Pierre Bonin
- Faculté des sciences infirmières, Université de Montréal, Montréal, Québec, Canada
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26
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Stock EM, Stamey JD, Zeber JE, Thompson AW, Copeland LA. A Bayesian Approach to Modeling Risk of Hospital Admissions Associated With Schizophrenia Accounting for Underdiagnosis of the Disorder in Administrative Records. COMPUTATIONAL PSYCHIATRY 2018; 2:1-10. [PMID: 30090859 PMCID: PMC6067824 DOI: 10.1162/cpsy_a_00010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 06/26/2017] [Indexed: 11/09/2022]
Abstract
Schizophrenia is a debilitating serious mental illness characterized by a complex array of symptoms with varying severity and duration. Patients may seek treatment only intermittently, contributing to challenges diagnosing the disorder. A misdiagnosis may potentially bias and reduce study validity. Thus we developed a statistical model to assess the risk of 1-year hospitalization for patients diagnosed with schizophrenia, accounting for when schizophrenia is underreported in administrative databases. A retrospective study design identified patients seeking care during 2010 within an integrated health care system from the Health Maintenance Organization Research Network located in the southwestern United States. Bayesian analysis addressed the problem of underdiagnosed schizophrenia with a statistical measurement error model assuming varying rates of underreporting. Results were then compared to classical multivariable logistic regression. Assuming no underreporting, there was an 87% greater relative odds of hospitalization associated with schizophrenia, OR = 1.87, CI [1.08, 3.23]. Effect sizes and interval estimates representing the association between hospitalization and schizophrenia were reduced with the Bayesian approach accounting for underdiagnosis, suggesting that less severe patients may be underrepresented in studies of schizophrenia. The analytical approach has useful applications in other contexts where the identification of patients with a given condition may be underreported in administrative records.
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Affiliation(s)
- Eileen M Stock
- Cooperative Studies Program Coordinating Center, VA Maryland Health Care System, Departmentof Veterans Affairs, Perry Point, Maryland, USA.,Center for Applied Health Research, Central Texas Veterans Health Care System/Baylor Scottand White Health, Temple, Texas, USA.,Texas A&M Health Science Center, Bryan, Texas, USA
| | - James D Stamey
- Department of Statistical Science, Baylor University, Waco, Texas, USA
| | - John E Zeber
- Center for Applied Health Research, Central Texas Veterans Health Care System/Baylor Scottand White Health, Temple, Texas, USA.,Texas A&M Health Science Center, Bryan, Texas, USA
| | - Alexander W Thompson
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Laurel A Copeland
- Center for Applied Health Research, Central Texas Veterans Health Care System/Baylor Scottand White Health, Temple, Texas, USA.,Texas A&M Health Science Center, Bryan, Texas, USA
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Llerena K, Gabrielian S, Green MF. Clinical and cognitive correlates of unsheltered status in homeless persons with psychotic disorders. Schizophr Res 2018; 197:421-427. [PMID: 29486957 DOI: 10.1016/j.schres.2018.02.023] [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: 10/12/2017] [Revised: 12/22/2017] [Accepted: 02/16/2018] [Indexed: 12/18/2022]
Abstract
Homeless persons with psychosis are particularly susceptible to unsheltered homelessness, which includes living on the streets, in cars, and other places not meant for human habitation. Homeless persons with psychosis have distinct barriers to accessing care and comprise a high-need and hard-to-serve homeless subpopulation. Therefore, this study sought to understand unsheltered homelessness in persons with psychosis and its relationship to cognitive impairment, clinical symptoms, and community functioning, examined both categorically and dimensionally. This study included 76 homeless participants with a history of a psychotic diagnosis who were enrolled in a supported housing program but had not yet received housing. This study used two different housing stability thresholds (literally homeless at any point vs. literally homeless >20% of days) for comparing homeless Veterans with psychosis living in sheltered versus unsheltered situations on cognition, clinical symptoms, and community integration. Dimensional analyses also examined the relationship between percentage of days spent in unsheltered locations and cognition, clinical symptoms, and community integration. Sheltered and unsheltered Veterans with psychosis did not differ on clinical symptoms or community integration, but there was an inconsistent group difference on cognition depending on the threshold used for determining housing stability. In the unsheltered group, cognitive deficits in overall cognition, visual learning, and social cognition were related to more days spent in unsheltered locations. Rehabilitation efforts targeting specific cognitive deficits may be useful to facilitate greater access to care and successful interventions in this population.
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Affiliation(s)
- Katiah Llerena
- Department of Veterans Affairs VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, United States; UCLA Semel Institute for Neuroscience & Human Behavior, David Geffen School of Medicine, United States; Department of Veterans Affairs VISN 21 Mental Illness Research, Education, and Clinical Center, San Francisco, CA, United States.
| | - Sonya Gabrielian
- Department of Veterans Affairs VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, United States; UCLA Semel Institute for Neuroscience & Human Behavior, David Geffen School of Medicine, United States
| | - Michael F Green
- Department of Veterans Affairs VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, United States; UCLA Semel Institute for Neuroscience & Human Behavior, David Geffen School of Medicine, United States
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Palacios-Ceña D, Martín-Tejedor EA, Elías-Elispuru A, Garate-Samaniego A, Pérez-Corrales J, García-García E. The impact of a short-term cohousing initiative among schizophrenia patients, high school students, and their social context: A qualitative case study. PLoS One 2018; 13:e0190895. [PMID: 29324773 PMCID: PMC5764336 DOI: 10.1371/journal.pone.0190895] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 12/21/2017] [Indexed: 11/19/2022] Open
Abstract
Background A number of programs have been developed to promote the contact between adolescents and mentally-ill patients, in order to break the stigma, improve understanding, promote mental health and prevent substance abuse. The aim of this study was to describe the experience of patients with schizophrenia, high school students, and their social context, participating in a short-term cohousing initiative. Methods A qualitative case-study approach was implemented. Patients with schizophrenia from the San Juan de Dios Psychiatric Hospital, female students from Almen High School, and participants from their social context (parents, hospital staff, and teachers) were included, using purposeful sampling. Data were collected from 51 participants (15 patients, nine students, 11 hospital staff, six teachers, 10 parents) via non-participant observation, focus groups, informal interviews, researchers’ field notes and patients’ personal diaries and letters. A thematic analysis was performed. Results The themes identified included a) learning to live together: students and patients participate and learn together; b) the perception of the illness and the mentally-ill: the barrier between health and disease is very slim, and society tends to avoid contact with those who are ill; c) change: a transformation takes place in students, in their self-perception, based on the real and intense nature of the experience; d) a trial and an opportunity: patients test their ability to live outside the hospital; e) discharge and readmission: discharge is experienced as both a liberation and a difficulty, whereas relapse and readmission are experienced as failures. Conclusions Our findings can help us to better understand schizophrenia and encourage a more positive approach towards both the illness and those who suffer from it. These results may be used for the development of cohousing programs in controlled environments.
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Affiliation(s)
- Domingo Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Alcorcón, Madrid, Spain
- * E-mail:
| | | | - Ana Elías-Elispuru
- Hospital Psiquiátrico San Juan de Dios Arrasate-Mondragón, Hermanos de San Juan de Dios, Arrasate, Spain
| | - Amaia Garate-Samaniego
- Hospital Psiquiátrico San Juan de Dios Arrasate-Mondragón, Hermanos de San Juan de Dios, Arrasate, Spain
| | - Jorge Pérez-Corrales
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Alcorcón, Madrid, Spain
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Sullivan K, Pantazopoulos H, Liebson E, Woo TUW, Baldessarini RJ, Hedreen J, Berretta S. What can we learn about brain donors? Use of clinical information in human postmortem brain research. HANDBOOK OF CLINICAL NEUROLOGY 2018; 150:181-196. [PMID: 29496141 DOI: 10.1016/b978-0-444-63639-3.00014-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Postmortem studies on the human brain reside at the core of investigations on neurologic and psychiatric disorders. Ground-breaking advances continue to be made on the pathologic basis of many of these disorders, at molecular, cellular, and neural connectivity levels. In parallel, there is increasing emphasis on improving methods to extract relevant demographic and clinical information about brain donors and, importantly, translate it into measures that can reliably and effectively be incorporated in the design and data analysis of postmortem human investigations. Here, we review the main source of information typically available to brain banks and provide examples on how this information can be processed. In particular, we discuss approaches to establish primary and secondary diagnoses, estimate exposure to therapeutic treatment and substance abuse, assess agonal status, and use time of death as a proxy in investigations on circadian rhythms. Although far from exhaustive, these considerations are intended as a contribution to ongoing efforts from tissue banks and investigators aimed at establishing robust, well-validated methods for collecting and standardizing information about brain donors, further strengthening the scientific rigor of human postmortem studies.
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Affiliation(s)
- Kathleen Sullivan
- Harvard Brain Tissue Resource Center, McLean Hospital, Belmont, MA, United States
| | - Harry Pantazopoulos
- Traslational Neuroscience Laboratory, McLean Hospital, Belmont, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Elizabeth Liebson
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States; Psychotic Disorders Division, McLean Hospital, Belmont, MA, United States
| | - T-U W Woo
- Harvard Brain Tissue Resource Center, McLean Hospital, Belmont, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States; Laboratory of Cellular Neuropathology, McLean Hospital, Belmont, MA, United States; Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Ross J Baldessarini
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States; International Consortium for Psychotic and Bipolar Disorders Research, McLean Hospital, Belmont, MA, United States
| | - John Hedreen
- Harvard Brain Tissue Resource Center, McLean Hospital, Belmont, MA, United States
| | - Sabina Berretta
- Harvard Brain Tissue Resource Center, McLean Hospital, Belmont, MA, United States; Traslational Neuroscience Laboratory, McLean Hospital, Belmont, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States; Program in Neuroscience, Harvard Medical School, Boston, MA, United States.
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30
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Maremmani AGI, Bacciardi S, Somers JM, Nikoo M, Schütz C, Jang KL, Krausz M. Substance Dependence Among Bipolar, Unipolar Depression and Psychotic Homeless: A Canadian National Study. Front Psychiatry 2018; 9:701. [PMID: 30618874 PMCID: PMC6305348 DOI: 10.3389/fpsyt.2018.00701] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 12/03/2018] [Indexed: 12/30/2022] Open
Abstract
Introduction: Homeless individuals are often mischaracterized as members of a homogeneous population that suffers from a wide mental health and addiction issues, with little consideration of potentially important differences within or between samples. The aim of the present study was to investigate the comorbidy of alcohol and/or substance dependence (ASD) and major psychiatric diagnoses (bipolar disorder, unipolar depression, and psychotic disorder) in a large Canadian sample of homeless individuals, and to examine potential sources of variability including location and ethnicity. Materials and Methods: A sample of 1,585 homeless individuals were assessed for alcohol and/or substance dependence and bipolar disorder, unipolar depression and psychotic disorder with the Mini-International Neuropsychiatric Interview (version 6.0). Regional and ethnic differences in major psychiatric diagnoses between homeless with and without ASD were examined using univariate (i.e., chi-square) and multivariate (i.e., logistic regression) statistics. Results: Members of the sample with ASD were found to be younger, Aboriginal, less well-educated, and born in the Americas. They were more significantly more prevalent in Western Canada and less prevalent in Central and Eastern Canada. The odds of having ASD were higher among people affected by bipolar disorder and (to a less extent) unipolar depression. Limitations: Data collected were self-reported and no urinalyses were performed. We considered diagnosis of ASD according to the previous 12 months only. Conclusions: Homeless people with major mental illness are at high risk for concurrent ASD, however the prevalence of ASD varies significantly between cities, and based on ethnicity and specific psychiatric diagnosis (with greater prevalence in individuals affected by bipolar disorder and, to a less extent, unipolar depression). Clinicians, administrators and policy makers should develop and deliver services based on careful assessment of the local population.
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Affiliation(s)
- Angelo G I Maremmani
- Association for the Application of Neuroscientific Knowledge to Social Aims (AU-CNS), Pietrasanta, Lucca, Italy.,Local Health Unit (Versilia Zone), Department of Psychiatry, North-Western Tuscany Region, Viareggio, Italy
| | - Silvia Bacciardi
- "Vincent P. Dole" Dual Diagnosis Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Julian M Somers
- Somers Research Group, Faculty of Health Science, Simon Fraser University, Barnaby, BC, Canada
| | - Mohammadali Nikoo
- Department of Psychiatry, Institute of Mental Health, University of British Columbia, Vancouver, BC, Canada
| | - Christian Schütz
- Department of Psychiatry, Institute of Mental Health, University of British Columbia, Vancouver, BC, Canada
| | - Kerry L Jang
- Department of Psychiatry, Institute of Mental Health, University of British Columbia, Vancouver, BC, Canada
| | - Michael Krausz
- Department of Psychiatry, Institute of Mental Health, University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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Gonzalez DM, Gregory J, Brennand KJ. The Importance of Non-neuronal Cell Types in hiPSC-Based Disease Modeling and Drug Screening. Front Cell Dev Biol 2017; 5:117. [PMID: 29312938 PMCID: PMC5742170 DOI: 10.3389/fcell.2017.00117] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 12/08/2017] [Indexed: 12/13/2022] Open
Abstract
Current applications of human induced pluripotent stem cell (hiPSC) technologies in patient-specific models of neurodegenerative and neuropsychiatric disorders tend to focus on neuronal phenotypes. Here, we review recent efforts toward advancing hiPSCs toward non-neuronal cell types of the central nervous system (CNS) and highlight their potential use for the development of more complex in vitro models of neurodevelopment and disease. We present evidence from previous works in both rodents and humans of the importance of these cell types (oligodendrocytes, microglia, astrocytes) in neurological disease and highlight new hiPSC-based models that have sought to explore these relationships in vitro. Lastly, we summarize efforts toward conducting high-throughput screening experiments with hiPSCs and propose methods by which new screening platforms could be designed to better capture complex relationships between neural cell populations in health and disease.
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Affiliation(s)
- David M Gonzalez
- Medical Scientist Training Program, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Department of Developmental and Stem Cell Biology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Black Family Stem Cell Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jill Gregory
- Instructional Technology Group, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Kristen J Brennand
- Black Family Stem Cell Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Department of Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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A 6-Month Prospective Trial of a Personalized Behavioral Intervention + Long-Acting Injectable Antipsychotic in Individuals With Schizophrenia at Risk of Treatment Nonadherence and Homelessness. J Clin Psychopharmacol 2017; 37:702-707. [PMID: 28930768 PMCID: PMC5678972 DOI: 10.1097/jcp.0000000000000778] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Long-acting injectable antipsychotics (LAI) can optimize adherence for high-risk serious mental illness (SMI). This customized adherence-enhancement approach delivered by social worker interventionists was combined with LAI (CAE-L) of paliperidone palmitate for homeless, poorly adherent individuals with SMI. METHODS This 6-month prospective, uncontrolled trial of CAE-L in 30 recently homeless individuals with SMI assessed adherence using the Tablets Routine Questionnaire, injection frequency, and SMI symptoms measured by the Positive and Negative Syndrome Scale, Brief Psychiatric Rating Scale, and Clinical Global Impressions. The Social and Occupational Functioning Assessment Scale measured social function. Standardized scales assessed extrapyramidal effects. FINDINGS Patients' mean age was 43.6 (SD, 9.53) years, and they were mainly minorities (86.7% African American) and single/never married (72.4%). Rate of substance abuse within the past year was 40.0%, and rate of incarceration within the past 6 months was 32.1%. Four participants (13.3%) terminated the study prematurely. Customized adherence enhancement + LAI was associated with good adherence to LAI (92.9%) and improved adherence with oral drug as measured by Tablets Routine Questionnaire (P = 0.02). There were significant improvements in Positive and Negative Syndrome Scale (P < 0.01), Brief Psychiatric Rating Scale (P < 0.001), Clinical Global Impressions (P = 0.003), and Social and Occupational Functioning Assessment Scale (P = 0.005). There were no significant extrapyramidal effects. IMPLICATIONS While findings must be tempered by the methodological limitations, CAE-L seems associated with multiple domains of improvement in homeless/recently homeless individuals with SMI. Adverse effects limit tolerability in some individuals, and not all will remain engaged. However, LAI combined with a patient-centered behavioral approach can improve outcomes for some high-risk individuals with SMI.
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Zhuo C, Hou W, Lin C, Hu L, Li J. Potential Value of Genomic Copy Number Variations in Schizophrenia. Front Mol Neurosci 2017; 10:204. [PMID: 28680393 PMCID: PMC5478687 DOI: 10.3389/fnmol.2017.00204] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 06/09/2017] [Indexed: 11/13/2022] Open
Abstract
Schizophrenia is a devastating neuropsychiatric disorder affecting approximately 1% of the global population, and the disease has imposed a considerable burden on families and society. Although, the exact cause of schizophrenia remains unknown, several lines of scientific evidence have revealed that genetic variants are strongly correlated with the development and early onset of the disease. In fact, the heritability among patients suffering from schizophrenia is as high as 80%. Genomic copy number variations (CNVs) are one of the main forms of genomic variations, ubiquitously occurring in the human genome. An increasing number of studies have shown that CNVs account for population diversity and genetically related diseases, including schizophrenia. The last decade has witnessed rapid advances in the development of novel genomic technologies, which have led to the identification of schizophrenia-associated CNVs, insight into the roles of the affected genes in their intervals in schizophrenia, and successful manipulation of the target CNVs. In this review, we focus on the recent discoveries of important CNVs that are associated with schizophrenia and outline the potential values that the study of CNVs will bring to the areas of schizophrenia research, diagnosis, and therapy. Furthermore, with the help of the novel genetic tool known as the Clustered Regularly Interspaced Short Palindromic Repeats-associated nuclease 9 (CRISPR/Cas9) system, the pathogenic CNVs as genomic defects could be corrected. In conclusion, the recent novel findings of schizophrenia-associated CNVs offer an exciting opportunity for schizophrenia research to decipher the pathological mechanisms underlying the onset and development of schizophrenia as well as to provide potential clinical applications in genetic counseling, diagnosis, and therapy for this complex mental disease.
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Affiliation(s)
- Chuanjun Zhuo
- Department of Psychological Medicine, Wenzhou Seventh People's HospitalWenzhou, China.,Department of Psychological Medicine, Tianjin Anding HospitalTianjin, China
| | - Weihong Hou
- Department of Biology, University of North Carolina at CharlotteCharlotte, NC, United States.,Department of Biochemistry and Molecular Biology, Zhengzhou UniversityZhengzhou, China
| | - Chongguang Lin
- Department of Psychological Medicine, Wenzhou Seventh People's HospitalWenzhou, China
| | - Lirong Hu
- Department of Psychological Medicine, Wenzhou Seventh People's HospitalWenzhou, China
| | - Jie Li
- Department of Psychological Medicine, Tianjin Anding HospitalTianjin, China
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Gouveia L, Massanganhe H, Mandlate F, Mabunda D, Fumo W, Mocumbi AO, de Jesus Mari J. Family reintegration of homeless in Maputo and Matola: a descriptive study. Int J Ment Health Syst 2017; 11:25. [PMID: 28413439 PMCID: PMC5387388 DOI: 10.1186/s13033-017-0133-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 04/01/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Homelessness is a global and local social problem with underestimated prevalence. It has been shown to increase the risk of mental illness, raising concerns from mental health providers about the need for effective interventions targeting this population. OBJECTIVES The aim of this paper is to describe the mental health status of the homeless people in two urban setting in a low-income country, through using standardised clinical and socio-demographic assessments as well assessing potential predictors of family integration versus non-family integration among a group of homeless individuals receiving psychiatric and psychosocial treatment. METHODS A descriptive study was performed in Maputo and Matola cities between 2008 and 2010. Homeless people with apparent mental illness were mapped and recruited. The participants were referred from community to hospital, using a multidisciplinary treatment model, according to their clinical condition and later entered a family reintegration process. RESULTS Seventy-one homeless people were recruited (93.0% male; 80.3% unemployed). The most common diagnosis was schizophrenia and other psychosis (46; 64.8%), followed by mental and behaviour disorder related to substance misuse (21; 29.6%), and intellectual disability (4; 5.6%). Family reintegration was achieved for 53.5% (38 patients). Patients with intellectual disability were less reintegrated and those with disorders related to substance use had better reinsertion in their families (Chi square (2) = 6.1; p = 0.047). CONCLUSIONS Family reintegration was achieved in more than half of participants after hospitalization. Integration was higher in cases of substance misuse, with those with associated intellectual disability being more difficult to reintegrate. Trial registration Trial Registration Number: NCT02936141, date of registration: 14/10/2016, retrospectively registered.
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Affiliation(s)
- Lídia Gouveia
- Department of Mental Health, Ministry of Health-Mozambique, Av. Eduardo Mondlane/Av. Salvador Allende, P.O.Box 1613, Maputo, Mozambique
- Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Honório Massanganhe
- Department of Mental Health, Ministry of Health-Mozambique, Av. Eduardo Mondlane/Av. Salvador Allende, P.O.Box 1613, Maputo, Mozambique
| | - Flávio Mandlate
- Department of Mental Health, Ministry of Health-Mozambique, Av. Eduardo Mondlane/Av. Salvador Allende, P.O.Box 1613, Maputo, Mozambique
- Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique
| | - Dirceu Mabunda
- Department of Mental Health, Ministry of Health-Mozambique, Av. Eduardo Mondlane/Av. Salvador Allende, P.O.Box 1613, Maputo, Mozambique
- Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique
| | - Wilza Fumo
- Department of Mental Health, Ministry of Health-Mozambique, Av. Eduardo Mondlane/Av. Salvador Allende, P.O.Box 1613, Maputo, Mozambique
- Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique
| | - Ana Olga Mocumbi
- Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique
- National Health Institute, Ministry of Health-Mozambique, Maputo, Mozambique
| | - Jair de Jesus Mari
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
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Abstract
Mental illness and substance use are overrepresented within urban homeless populations. This paper compared substance use patterns between homeless individuals diagnosed with schizophrenia spectrum (SS) and bipolar disorders (BD) using the Mini-International Neuropsychiatric Interview. From a sample of 497 subjects drawn from Vancouver, Canada who participated in the At Home/Chez Soi study, 146 and 94 homeless individuals were identified as BD and SS, respectively. In the previous 12 months, a greater proportion of BD homeless reported greater use of cocaine (χ = 20.0, p = 0.000), amphetamines (χ = 13,8, p = 0.000), opiates (χ = 24.6, p = 0.000), hallucinogens (χ = 11.7, p = 0.000), cannabinoids (χ = 5.05, p = 0.034), and tranquilizers (χ = 7.95, p = 0.004) compared to SS. Cocaine and opiates were significantly associated with BD homeless (χ = 39.06, df = 2, p < 0.000). The present study illustrates the relationship between substance use and BD in a vulnerable urban population of homeless, affected by adverse psychosocial factors and severe psychiatric conditions.
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Rahman T, Lauriello J. Schizophrenia: An Overview. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2016; 14:300-307. [PMID: 31975810 DOI: 10.1176/appi.focus.20160006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Few changes were made to the diagnostic criteria for schizophrenia in DSM-5. Schizophrenia is a chronic mental illness with positive symptoms (delusions, hallucinations, disorganized speech and behavior), negative symptoms, and cognitive impairment. Discoveries in genetics, neuroimaging, and immune function continue to advance understanding of the etiologies for this elusive disease. The authors reviewed the current literature to give an overview. The topics include historical foundations, epidemiology, suicide risk, genomewide association studies, twin studies, neuroimaging, ventricular size, complement component 4 mediated synapse elimination, major histocompatibility complex markers, and associations seen in obstetrical complications, nutritional issues, prodromal and attenuated states, cannabis use, childhood trauma, immigration, and traumatic brain injury. Also reviewed are expressed emotions of caregivers and recidivism, conditions comorbid with obsessive-compulsive disorder, mood disorders, substance use, and finally some legal and ethical issues. These important developments in elucidating the disease mechanism will likely allow for the development of future novel treatment strategies.
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Affiliation(s)
- Tahir Rahman
- Dr. Rahman is assistant professor of Clinical Psychiatry, University of Missouri-Columbia. Dr. Lauriello is professor and chairman of the Department of Psychiatry and a Robert J. Douglas, M.D., and Betty Douglas Distinguished Faculty Scholar in Psychiatry, University of Missouri-Columbia
| | - John Lauriello
- Dr. Rahman is assistant professor of Clinical Psychiatry, University of Missouri-Columbia. Dr. Lauriello is professor and chairman of the Department of Psychiatry and a Robert J. Douglas, M.D., and Betty Douglas Distinguished Faculty Scholar in Psychiatry, University of Missouri-Columbia
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Bohórquez Peñaranda A, Gómez Restrepo C, Oviedo Lugo GF, de la Hoz Bradford AM, Castro Díaz SM, García Valencia J, Jaramillo González LE, Ávila-Guerra M. [Types of Care for Adult Patients Diagnosed With Acute and Maintenance Phase Schizophrenia]. REVISTA COLOMBIANA DE PSIQUIATRIA 2015; 44 Suppl 1:101-109. [PMID: 26576466 DOI: 10.1016/j.rcp.2015.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 12/04/2014] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To assist the clinician in making decisions about the types of care available for adults with schizophrenia. To determine which are the modalities of treatment associated with better outcomes in adults with schizophrenia. METHODS A clinical practice guideline was elaborated under the parameters of the Methodological Guide of the Ministerio de Salud y Protección Social to identify, synthesize and evaluate the evidence and make recommendations about the treatment and follow-up of adult patients with schizophrenia. The evidence of NICE guide 82 was adopted and updated. The evidence was presented to the Guideline Developing Group and recommendations, employing the GRADE system, were produced. RESULTS Patients who were in Assertive community treatment had a lower risk of new hospitalizations. For the intensive case management, the results favored this intervention in the outcomes: medium term readmissions, social functioning and satisfaction with services. The crisis resolution teams was associated with better outcomes on outcomes of readmissions, social functioning and service satisfaction in comparison with standard care. CONCLUSION The use of different modalities of care leads to the need of a comprehensive approach to patients to reduce the overall disability associated with the disease. Evidence shows overall benefit for most outcomes studied without encountering hazards for health of patients. This evaluation is recommended to use the professional ways of providing health services that are community-based and have a multidisciplinary group. It is not recommended the modality "day hospital" during the acute phase of schizophrenia in adults.
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Affiliation(s)
- Adriana Bohórquez Peñaranda
- Médica psiquiatra, magístra en Epidemiología Clínica. Profesora asistente del departamento de Psiquiatría y Salud Mental. Pontificia Universidad Javeriana, Bogotá, Colombia.
| | - Carlos Gómez Restrepo
- Médico psiquiatra, psicoanalista, psiquiatra de enlace, magíster en Epidemiología Clínica. Profesor titular y Director del Departamento de Epidemiología Clínica y Bioestadística. Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Gabriel Fernando Oviedo Lugo
- Médico psiquiatra, psiquiatra de enlace, Profesor departamento de Psiquiatría y Salud Mental, Pontificia Universidad Javeriana. Delegado Asociación Colombiana de Psiquiatría, Bogotá, Colombia
| | - Ana María de la Hoz Bradford
- Médica, magístra en Epidemiología Clínica. Profesora instructora del Departamento de Epidemiología Clínica y Bioestadística. Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | - Jenny García Valencia
- Médica psiquiatra, Doctora en Epidemiología Clínica. Profesora asociada del Departamento de Psiquiatría, Universidad de Antioquia, Medellín, Antioquia, Colombia
| | | | - Mauricio Ávila-Guerra
- Médico Servicio Social Obligatorio. Pontificia Universidad Javeriana, Bogotá, Colombia
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The impact of mood symptomatology on pattern of substance use among homeless. J Affect Disord 2015; 176:164-70. [PMID: 25723559 DOI: 10.1016/j.jad.2015.01.059] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 01/28/2015] [Accepted: 01/29/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Homeless individuals are an extremely vulnerable and underserved population characterized by overlapping problems of mental illness and substance use. Given the fact that mood disorders are frequently associated with substance use disorders, we wanted to further highlight the role of excitement in substance abuse. Patterns of substance abuse among homeless suffering from unipolar and bipolar depression were compared. The "self-medication hypothesis" which would predict no-differences in substance preference by unipolar (UP) and bipolar (BP) depressed homeless was tested. METHODS Homeless individuals from the Vancouver At Home/Chez Soi study were selected for lifetime UP and lifetime BP depression and patterns of substances abused in the previous 12 months were identified with the Mini-International Neuropsychiatric Interview. Differences in substance use between BP-depressed homeless and UP-depressed homeless were tested using Chi-square and logistic regression techniques. RESULTS No significant differences were observed between UP and BP homeless demographics. The bipolar depressed homeless (BDH) group displayed a higher percentage of Central Nervous System (CNS) Stimulants (χ 8.66, p=0.004) and Opiates (χ 6.41, p=0.013) as compared to the unipolar depressed homeless (UDH) group. CSN Stimulant was the only predictor within the BDH Group (χ(2) 8.74 df 1 p<0.003). LIMITATIONS Data collected are self-reported and no urinalyses were performed. CONCLUSIONS The results support the hypothesis that beyond the self-medication hypothesis, bipolarity is strictly correlated to substance use; this correlation is also verified in a homeless population.
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A cross sectional study of prevalence and correlates of current and past risks in schizophrenia. Asian J Psychiatr 2015; 14:36-41. [PMID: 25703039 PMCID: PMC4450129 DOI: 10.1016/j.ajp.2015.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 12/22/2014] [Accepted: 01/27/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND The growing burden of chronic often untreated mental illness has increased the importance of risk assessment in people suffering from major mental disorders. AIMS The present study was undertaken to obtain prevalence of various risks and predictive factors for self-harm, violence and various other risks among randomly recruited schizophrenia subjects (N=270) on the basis of past history of their disorder. METHOD Using a rigorous translation, back translation and acceptability process, a specially constructed semi-structured assessment interview, based on a prior NHS Trust risk assessment interview along with the Diagnostic Interview for Genetic Studies (DIGS), detailed information was obtained for various risks. RESULTS Risk of violence (historical) was reported among 65.55%, and risk of self-neglect among 53.33%, risk to others (47.41%), risk of coming to harm (24.07%), self-harm (22.59%), risk from others (11.85%), fire risk (2.96%). Risk of violence (historical) and risk to others was related to 'ever' having emotions related to harm and self-harm, 'current' emotions related to violence and poor compliance to treatment. CONCLUSION Regular risk assessment is essential to assess emotions related to violence and non-adherence to treatment. Assessment of risk helps clinicians predict the risks involved in management and in timely intervention.
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Sajatovic M, Levin J, Ramirez LF, Hahn DY, Tatsuoka C, Bialko CS, Cassidy KA, Fuentes-Casiano E, Williams TD. Prospective trial of customized adherence enhancement plus long-acting injectable antipsychotic medication in homeless or recently homeless individuals with schizophrenia or schizoaffective disorder. J Clin Psychiatry 2013; 74:1249-55. [PMID: 24434094 PMCID: PMC4129952 DOI: 10.4088/jcp.12m08331] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 03/14/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Treatment nonadherence in people with schizophrenia is associated with relapse and homelessness. Building on the usefulness of long-acting medication and our work in psychosocial interventions to enhance adherence, we conducted a prospective uncontrolled trial of customized adherence enhancement (CAE) plus long-acting injectable antipsychotic (LAI) using haloperidol decanoate in 30 homeless or recently homeless individuals with DSM-IV-defined schizophrenia or schizoaffective disorder. METHOD Participants received monthly CAE and LAI (CAE-L) for 6 months. Primary outcomes were adherence, as measured by the Tablets Routine Questionnaire, and housing status. Secondary outcomes included psychiatric symptoms, functioning, side effects, and hospitalizations. The study was conducted from July 2010 to December 2012. RESULTS The mean age of participants was 41.8 years (SD = 8.6); they were mainly minorities (90%, n = 27 African-American) and mainly single/never married (70%, n = 21). Most (97%, n = 29) had past or current substance abuse and had been incarcerated (97%, n = 29). Ten individuals (33%) terminated the study prematurely. CAE-L was associated with good adherence to LAI (at 6 months, 76%) and dramatic improvement in oral medication adherence, which changed from missing 46% of medication at study enrollment to missing only 10% at study end (P = .03). There were significant improvements in psychiatric symptoms (P < .001) and functioning (P < .001). Akathisia was a major side effect with LAI. CONCLUSIONS While interpretation of findings must be tempered by the methodological limitations, CAE-L appears to be associated with improved adherence, symptoms, and functioning in homeless or recently homeless individuals with schizophrenia or schizoaffective disorder. Additional research is needed on effective and practical approaches to improving health outcomes for homeless people with serious mental illness. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01152697.
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Affiliation(s)
- Martha Sajatovic
- Departments of Psychiatry and Neurology, University Hospitals of Cleveland, 11100 Euclid Ave, Cleveland, OH
| | - Jennifer Levin
- Department of Psychiatry, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center
| | - Luis F. Ramirez
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center
| | - David Y. Hahn
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center
| | - Curtis Tatsuoka
- Department of Neurology, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center
| | - Christopher S. Bialko
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center
| | - Kristin A. Cassidy
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center
| | - Edna Fuentes-Casiano
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center
| | - Tiffany D. Williams
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center
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