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Hou MR, Wang J, Xue JH, Pei JQ, Shi Y, Li XW. Gender differences among long-stay inpatients with schizophrenia in China: A cross-sectional study. Heliyon 2023; 9:e15719. [PMID: 37159715 PMCID: PMC10163644 DOI: 10.1016/j.heliyon.2023.e15719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 04/03/2023] [Accepted: 04/19/2023] [Indexed: 05/11/2023] Open
Abstract
Objective We sought to examine the independent correlates of long-term hospitalization in a sample of Chinese inpatients with schizophrenia (SCZ) from a gender-based perspective. Methods This was a cross-sectional study that was carried out in a tertiary psychiatric hospital. All adult inpatients in this hospital were screened from January to March 2020, 251 of whom were identified as long-stay inpatients with SCZ (LSIS) and 224 as short-stay inpatients with SCZ (SSIS). Demographic and clinical information of the two groups was collected through medical records, scale assessments and interviews. Gender differences were analyzed, and independent correlates of long-stay between genders were explored by logistic regression analyses. Results Compared to SSIS, greater proportions of LSIS patients were male (64.1%), single (82.1%), unemployed (81.7%) and had no family caregivers (54.2%). For LSIS per se, proportionally more males were single (88.8%), had no family caregiver (65.8%), had concomitant physical disease (65.2%) and had a history of hazardous behavior (27.3%) than their female counterparts. For females, the top independent risk factors for a long stay included poor functioning (OR = 5.9, 95% CI: 2.9-12.0), older age (OR = 4.3, 95% CI: 2.1-9.1) and being single (OR = 3.9, 95% CI: 1.8-8.4). Similar to women, both older age (OR = 5.3, 95% CI: 2.5-11.2) and poor functioning (OR = 4.0, 95% CI: 2.1-7.9) were also independent factors for long-term hospitalization of male patients; however, having no family caregiver (OR = 10.2, 95% CI: 4.6-22.6) was the primary risk factor for men. Conclusions Both clinical and nonclinical factors play important roles in long-term hospitalization in Chinese patients with schizophrenia. There are overlaps and distinctions across genders with respect to the independent factors of long stays. These findings provide clues for developing better service strategies for this population, and highlight the importance of paying attention to gender differences in further research in this field.
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Affiliation(s)
- Ming-ru Hou
- Department of General Psychiatry, The Affiliated Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, 156 Qianrong Road, Wuxi, Jiangsu 214151, China
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu 211166, China
| | - Jun Wang
- Department of Clinical Psychology, The Affiliated Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, 156 Qianrong Road, Wuxi, Jiangsu 214151, China
- Corresponding author. Department of Clinical Psychology, The Affiliated Mental Health Center of Jiangnan University, 156 Qianrong Road, Wuxi, Jiangsu 214151, China.
| | - Jian-hua Xue
- Tongji University School of Medicine, Shanghai 200092, China
| | - Jian-qin Pei
- Department of General Psychiatry, The Affiliated Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, 156 Qianrong Road, Wuxi, Jiangsu 214151, China
| | - Yan Shi
- Nursing Department, Shanghai Tenth People's Hospital Affiliated to Tongji University, 301 Yanchang Road, Shanghai 200072, China
| | - Xian-wen Li
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu 211166, China
- Corresponding author. School of Nursing, Nanjing Medical University, Nanjing, Jiangsu 211166, China.
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Harvey PD, Bigdeli TB, Fanous AH, Li Y, Rajeevan N, Sayward F, Radhakrishnan K, Huang G, Aslan M. Cooperative Studies Program (CSP) #572: A Study of Serious Mental Illness in Veterans as a Pathway to personalized medicine in Schizophrenia and Bipolar Illness. PERSONALIZED MEDICINE IN PSYCHIATRY 2021; 27-28:10.1016/j.pmip.2021.100078. [PMID: 34222732 PMCID: PMC8247126 DOI: 10.1016/j.pmip.2021.100078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Personalization of psychiatric treatment includes treatment of symptoms, cognition and functional deficits, suicide, and medical co-morbidities. VA Collaborative Study 572 examined a large sample of male and female veterans with schizophrenia (n=3,942) and with bipolar disorder (n=5,414) with phenotyping and genomic analyses. We present the results to date and future directions. METHODS All veterans received a structured diagnostic interview and assessments of suicidal ideation and behavior, PTSD, and health. Veterans with schizophrenia were assessed for negative symptoms and lifetime depression. All were assessed with a cognitive and functional capacity assessment. Data for genome wide association studies were collected. Controls came from the VA Million Veteran Program. RESULTS Suicidal ideation or behavior was present in 66%. Cognitive and functional deficits were consistent with previous studies. 40% of the veterans with schizophrenia had a lifetime major depressive episode and PTSD was present in over 30%. Polygenic risk score (PRS) analyses indicated that cognitive and functional deficits overlapped with PRS for cognition, education, and intelligence in the general population and PRS for suicidal ideation and behavior correlated with previous PRS for depression and suicidal ideation and behavior, as did the PRS for PTSD. DISCUSSION Results to date provide directions for personalization of treatment in SMI, veterans with SMI, and veterans in general. The results of the genomic analyses suggest that cognitive deficits in SMI may be associated with general population features. Upcoming genomic analyses will reexamine the issues above, as well as genomic factors associated with smoking, substance abuse, negative symptoms, and treatment response.
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Affiliation(s)
- Philip D. Harvey
- Bruce W. Carter Miami Veterans Affairs (VA) Medical Center, Miami, FL
- University of Miami School of Medicine, Miami, FL
| | - Tim B. Bigdeli
- VA New York Harbor Healthcare System, Brooklyn, NY
- Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, NY
| | - Ayman H. Fanous
- VA New York Harbor Healthcare System, Brooklyn, NY
- Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, NY
| | - Yuli Li
- Clinical Epidemiology Research Center (CERC), VA Connecticut Healthcare System, West Haven, CT
- Yale University School of Medicine, New Haven, CT
| | - Nallakkandi Rajeevan
- Clinical Epidemiology Research Center (CERC), VA Connecticut Healthcare System, West Haven, CT
- Yale University School of Medicine, New Haven, CT
| | - Frederick Sayward
- Clinical Epidemiology Research Center (CERC), VA Connecticut Healthcare System, West Haven, CT
- Yale University School of Medicine, New Haven, CT
| | - Krishnan Radhakrishnan
- Clinical Epidemiology Research Center (CERC), VA Connecticut Healthcare System, West Haven, CT
- Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration
- University of Kentucky School of Medicine, Lexington, KY
| | - Grant Huang
- Office of Research and Development, Veterans Health Administration, Washington, DC
| | - Mihaela Aslan
- VA New York Harbor Healthcare System, Brooklyn, NY
- Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, NY
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Apolipoprotein E-ε4 allele predicts escalation of psychotic symptoms in late adulthood. Schizophr Res 2019; 206:82-88. [PMID: 30584027 PMCID: PMC6525644 DOI: 10.1016/j.schres.2018.12.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/14/2018] [Accepted: 12/07/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Research on a putative link between apolipoprotein-ε4 allele (APOE-ε4) and schizophrenia has been inconclusive. However, prior studies have not investigated the association between APOE-ε4 and symptom trajectories, nor has the existing literature taken into account the potentially moderating effect of age in genetic association studies. METHODS The association between APOE-ε4 and four symptom dimensions was investigated in a longitudinal study of 116 individuals with schizophrenia initially assessed during their first admission for psychosis and evaluated five times over the following 20years. A meta-analysis identified 29 case-control studies of APOE-ε4 allele frequency in schizophrenia, which were analyzed using random-effects meta-regression to test the potentially moderating effect of age. RESULTS Longitudinal models identified a specific association between APOE-ε4 and symptom trajectories, showing that APOE-ε4 portends worsening severity of hallucinations and delusions in late adulthood among people with schizophrenia, at a rate of a 0.46 standard deviation increase per decade. Meta-analysis showed a significant effect of age: the association between APOE-ε4 and schizophrenia was not detectable in younger people but became pronounced with age, such that APOE-ε4 increased the odds of diagnosis by 10% per decade. CONCLUSIONS Taken together, the meta-analysis and longitudinal analysis implicate APOE-ε4 as an age-related risk factor for worsening hallucinations and delusions, and suggest APOE-ε4 may play an age-mediated pathophysiological role in schizophrenia. The presence of an APOE-ε4 allele may also identify a subgroup of patients who require intensive monitoring and additional targeted interventions, especially in mid-to late-life.
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Minor KS, Willits JA, Marggraf MP, Jones MN, Lysaker PH. Measuring disorganized speech in schizophrenia: automated analysis explains variance in cognitive deficits beyond clinician-rated scales. Psychol Med 2019; 49:440-448. [PMID: 29692287 DOI: 10.1017/s0033291718001046] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Conveying information cohesively is an essential element of communication that is disrupted in schizophrenia. These disruptions are typically expressed through disorganized symptoms, which have been linked to neurocognitive, social cognitive, and metacognitive deficits. Automated analysis can objectively assess disorganization within sentences, between sentences, and across paragraphs by comparing explicit communication to a large text corpus. METHOD Little work in schizophrenia has tested: (1) links between disorganized symptoms measured via automated analysis and neurocognition, social cognition, or metacognition; and (2) if automated analysis explains incremental variance in cognitive processes beyond clinician-rated scales. Disorganization was measured in schizophrenia (n = 81) with Coh-Metrix 3.0, an automated program that calculates basic and complex language indices. Trained staff also assessed neurocognition, social cognition, metacognition, and clinician-rated disorganization. RESULTS Findings showed that all three cognitive processes were significantly associated with at least one automated index of disorganization. When automated analysis was compared with a clinician-rated scale, it accounted for significant variance in neurocognition and metacognition beyond the clinician-rated measure. When combined, these two methods explained 28-31% of the variance in neurocognition, social cognition, and metacognition. CONCLUSIONS This study illustrated how automated analysis can highlight the specific role of disorganization in neurocognition, social cognition, and metacognition. Generally, those with poor cognition also displayed more disorganization in their speech-making it difficult for listeners to process essential information needed to tie the speaker's ideas together. Our findings showcase how implementing a mixed-methods approach in schizophrenia can explain substantial variance in cognitive processes.
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Affiliation(s)
- K S Minor
- Department of Psychology,Indiana University- Purdue University Indianapolis,Indianapolis, IN,USA
| | - J A Willits
- Department of Psychology,University of California-Riverside,Riverside, CA,USA
| | - M P Marggraf
- Department of Psychology,Indiana University- Purdue University Indianapolis,Indianapolis, IN,USA
| | - M N Jones
- Department of Psychology,Indiana University,Bloomington, IN,USA
| | - P H Lysaker
- Roudebush VA Medical Center,Indianapolis, IN,USA
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Firmin RL, Luther L, Lysaker PH, Salyers MP. Veteran identity as a protective factor: A grounded theory comparison of perceptions of self, illness, and treatment among veterans and non-veterans with schizophrenia. AMERICAN JOURNAL OF PSYCHIATRIC REHABILITATION 2016. [DOI: 10.1080/15487768.2016.1231642] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Ruth L. Firmin
- Department of Psychology, Indiana University–Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Lauren Luther
- Department of Psychology, Indiana University–Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Paul H. Lysaker
- Roudebush VA Medical Center, Indianapolis, Indiana, USA
- Department of Psychology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Michelle P. Salyers
- Department of Psychology, Indiana University–Purdue University Indianapolis, Indianapolis, Indiana, USA
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Haselden M, Piscitelli S, Drapalski A, Medoff D, Glynn SM, Cohen AN, Dixon LB. Relationship between symptoms and family relationships in Veterans with serious mental illness. ACTA ACUST UNITED AC 2016. [DOI: 10.1682/jrrd.2015.08.0158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | | | - Amy Drapalski
- Department of Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network [VISN] 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore, MD
| | - Deborah Medoff
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Shirley M. Glynn
- VA Desert Pacific Healthcare Network (VISN 22) MIRECC, Los Angeles, CA
| | - Amy N. Cohen
- VA Desert Pacific Healthcare Network (VISN 22) MIRECC, Los Angeles, CA
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McGuire AB, Oles SK, White DA, Salyers MP. Perceptions of Treatment Plan Goals of People in Psychiatric Rehabilitation. J Behav Health Serv Res 2015; 43:494-503. [PMID: 26067132 DOI: 10.1007/s11414-015-9463-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Alan B McGuire
- Department of Psychology, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA.
- Health Services Research and Development, Richard L Roudebush VAMC, Indianapolis, IN, USA.
| | | | - Dominique A White
- Department of Psychology, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA
| | - Michelle P Salyers
- Department of Psychology, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA
- Regenstrief Institute, Indianapolis, IN, USA
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Harvey PD, Heaton RK, Carpenter WT, Green MF, Gold JM, Schoenbaum M. Functional impairment in people with schizophrenia: focus on employability and eligibility for disability compensation. Schizophr Res 2012; 140:1-8. [PMID: 22503642 PMCID: PMC3399960 DOI: 10.1016/j.schres.2012.03.025] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 03/16/2012] [Accepted: 03/21/2012] [Indexed: 12/23/2022]
Abstract
BACKGROUND The Social Security Administration (SSA) is considering whether schizophrenia may warrant inclusion in their new "Compassionate Allowances" process, which aims to identify diseases and other medical conditions that invariably quality for Social Security disability benefits and require no more than minimal objective medical information. This paper summarizes evidence on the empirical association between schizophrenia and vocational disability. A companion paper examines the reliability and validity of schizophrenia diagnosis which is critically relevant for granting a long-term disability on the basis of current diagnosis. METHODS This is a selective literature review and synthesis, based on a work plan developed in a meeting of experts convened by the National Institute of Mental Health and the SSA. This review of the prevalence of disability is focused on the criteria for receipt of disability compensation for psychotic disorders currently employed by the SSA. RESULTS Disability in multiple functional domains is detected in nearly every person with schizophrenia. Clinical remission is much more common than functional recovery, but most patients experience occasional relapses even with treatment adherence, and remissions do not predict functional recovery. Under SSA's current disability determination process, approximately 80% of SSDI/SSI applications in SSA's diagnostic category of "Schizophrenia/Paranoid Functional Disorders" are allowed, compared to around half of SSDI/SSI applications overall. Moreover, the allowance rate is even higher among applicants with schizophrenia. Many unsuccessful applicants are not denied, but rather simply are unable to manage the process of appeal after initial denials. DISCUSSION Research evidence suggests that disability applicants with a valid diagnosis of schizophrenia have significant impairment across multiple dimensions of functioning, and will typically remain impaired for the duration of normal working ages or until new interventions are developed.
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Affiliation(s)
- Philip D. Harvey
- CORRESPONDENCE: Please address correspondence to Dr. Philip Harvey, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 1450, Miami, FL 33136, +1 305-243-4094 (Voice), +1 305-243-1619 (Fax),
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Thorp SR, Sones HM, Glorioso D, Thompson W, Light GA, Golshan S, Jeste DV. Older patients with schizophrenia: does military veteran status matter? Am J Geriatr Psychiatry 2012; 20:248-56. [PMID: 22354115 PMCID: PMC3286234 DOI: 10.1097/jgp.0b013e3182096ae5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE : The objective of this study was to examine the influence of military veteran status within a data set of older patients with schizophrenia or schizoaffective disorder. METHODS : The data set was examined to determine whether veteran status influenced psychopathology, quality of life, cognitive performance, and everyday functioning among 746 male participants. RESULTS : There were no significant differences between the groups on measures of premorbid functioning or psychopathology. Veterans in the sample were older, had a higher likelihood of being married (or previously married), had a lower likelihood of living in a board-and-care facility, and had a later age of onset of schizophrenia compared with nonveterans. Though veterans reported worse physical health, they also had better everyday functioning and better performance on some cognitive tasks than nonveterans. Fewer veterans endorsed current use of substances than nonveterans. CONCLUSIONS : There were several differences based on veteran status, including everyday functioning, health-related quality of life, cognitive performance, and current substance use.
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Abstract
In spite of significant advances in treatment of patients with schizophrenia and continued efforts towards their deinstitutionalization, a considerable group of patients remain chronically hospitalized or otherwise dependent on others for basic necessities of life. It has been proposed that these patients belong to a distinct etiopathological subgroup, termed Kraepelinian, whose course of illness may be progressive and resistant to treatment. Indeed, longitudinal studies appear to show that elderly Kraepelinian patients follow a course of rapid cognitive and functional deterioration, commensurate with a dementing process, and that their poor functional status is closely correlated with the cognitive deterioration. Recent neuroimaging studies described a pattern of posteriorization of grey and white matter deficits with poor outcome in schizophrenia, and produced a constellation of findings implicating primary processing of visual and auditory information as central to the impaired functional status in this patient group. These studies are summarized in detail in this review and future directions for neuroimaging assessment of very poor outcome patients with schizophrenia are suggested.
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Affiliation(s)
- Serge A Mitelman
- Medical Center, Department of Psychiatry, Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029, USA.
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McChargue DE, Gulliver SB, Hitsman B. Would smokers with schizophrenia benefit from a more flexible approach to smoking treatment? Addiction 2002; 97:785-93; discussion 795-800. [PMID: 12133113 DOI: 10.1046/j.1360-0443.2002.00064.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We evaluated literature that addresses the notion that flexible smoking treatment approaches are warranted for smokers with a diagnosis of schizophrenia. Understanding the biological and psychological mechanisms that increase the likelihood of smoking and decrease the motivation to quit for these individuals is addressed within the framework of a neurobiological model. We provide a brief overview of the limited smoking cessation treatment literature for patients with schizophrenia and compare abstinence-focused versus reduction-focused treatment modalities. The potential utility of the reduction-focused approach to tobacco treatment for these smokers is evaluated. Suggestions for future research to address the utility and efficacy of reduction-focused interventions for smokers with schizophrenia are put forth. We conclude with a consideration of the implications for the current understanding of smoking treatment among patients with co-morbid psychiatric diagnoses.
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