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Shen C, Tong X, Ran J, Sun S, Yang Q, Shen H, Yao XI. Associations between residential environments and late-onset schizophrenia in UK Biobank: Interaction with genetic risk factor. Schizophr Res 2024; 270:85-93. [PMID: 38885569 DOI: 10.1016/j.schres.2024.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 05/04/2024] [Accepted: 06/08/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Environment and genes both contribute to schizophrenia. However, the impact of different natural environments surrounding residential addresses on schizophrenia in urban settings remains unknown. This study aimed to investigate the association of urbanisation, measured by residential environments, with late-onset schizophrenia and explore whether genetic risk for schizophrenia modified the associations. METHODS We examined the associations between residential environments and late-onset schizophrenia and its interaction with genetic risk factors in UK Biobank, followed from 2006 to 2010 (baseline) to Dec 2021. Residential environments, including greenspace, domestic garden, blue space, and total natural environment, were evaluated using land use coverage percentage. The polygenic risk score (PRS) of schizophrenia was derived using a Bayesian approach and adjusted it against ancestry. Cox proportional hazard regression model was used to assess the associations between per interquartile (IQR) increase of each type of residential environments and late-onset schizophrenia. Interactive effects of PRS and residential environments on late-onset schizophrenia were assessed on both additive and multiplicative scales. RESULTS A total of 393,680 participants were included in the analysis, with 844 cases of late-onset schizophrenia being observed after 12.8 years of follow-up. Within 300 m buffer surrounding the residential addresses, per interquartile increase in greenspace (31.5 %) and total natural environment (34.4 %) were both associated with an 11 % (HR = 0.89, 95 % CI 0.80, 0.99) lower risk of late-onset schizophrenia. Domestic garden and blue space did not show significant protective effects on late-onset schizophrenia. A strong dose-response relationship between schizophrenia PRS and schizophrenia was found, while no additive or multiplicative interaction effects were present between residential environments and PRS on late-onset schizophrenia. CONCLUSION Residential greenspace and total natural environment may protect against late-onset schizophrenia in older people regardless of genetic risk. These findings shed light on the prevention of schizophrenia and urban planning to optimise ecosystem benefits linked to schizophrenia.
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Affiliation(s)
- Chen Shen
- MRC Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, UK; National Institute for Health Research Health Protection Research Unit in Chemical and Radiation Threats and Hazards, Imperial College London, UK
| | - Xinning Tong
- Department of Orthopaedics, The Eighth Affiliated Hospital, Sun Yat-Sen University, China
| | - Jinjun Ran
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shengzhi Sun
- School of Public Health, Capital Medical University, Beijing 100069, China
| | - Qian Yang
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Huiyong Shen
- Department of Orthopaedics, The Eighth Affiliated Hospital, Sun Yat-Sen University, China; Department of Clinical Research, The Eighth Affiliated Hospital, Sun Yat-sen University, China
| | - Xiaoxin I Yao
- Department of Orthopaedics, The Eighth Affiliated Hospital, Sun Yat-Sen University, China; Department of Clinical Research, The Eighth Affiliated Hospital, Sun Yat-sen University, China.
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Chan YLE, Lin WS, Lai HC, Hung CY, Huang MH. Changes in cognitive function after a 12-week POWER rehabilitation in older adults with schizophrenia and frailty. Asia Pac Psychiatry 2024; 16:e12556. [PMID: 38727090 DOI: 10.1111/appy.12556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 02/19/2024] [Accepted: 04/21/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND The effectiveness of isolated resistance training (RT) on cognitive function among older adults with schizophrenia is insufficiently investigated. This study investigated the effectiveness of 12-weeks POWER rehabilitation, a novel RT regimen, on cognitive function among older patients with schizophrenia and frailty. METHODS Thirty-two older adults with schizophrenia and frailty were enrolled and randomized to receive either a 12-week, twice weekly POWER rehabilitation, or without add-on training. Cognitive functioning was assessed using mini-mental state examination (MMSE), digit symbol substitution test, color trail task (CTT), and digit span task (DST). Physical performance was assessed by walking speed and hand grip strength. The generalized estimating equations was used to compare pre- and post-training outcome measure between groups. RESULTS Between-group analysis revealed significant improvement in CTT1 and hand grip strength in the intervention group compared to the controls. Subgroup analyses showed CTT1 performance significantly improved after 12 weeks of POWER rehabilitation in the intervention group (time, p < .001), independent of age, educational level, global cognition, depressive symptoms, and psychotropic medication use. Increased hand grip strength was significantly associated with improved performance in MMSE, CTT1, and DST forward at study endpoint. CONCLUSION A 12-week POWER rehabilitation for older patients with schizophrenia and frailty is safe and feasible, and may benefit physical and some domains of cognitive functioning.
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Affiliation(s)
- Yee-Lam E Chan
- Department of Psychiatry, General Cheng Hsin Hospital, Taipei, Taiwan
| | - Wang-Sheng Lin
- Department of Physical Medicine and Rehabilitation, Yuanshan and Suao Branches of Taipei Veterans General Hospital, Ilan, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hui-Chen Lai
- Department of Psychiatry, Yuanshan and Suao Branches of Taipei Veterans General Hospital, Ilan, Taiwan
| | - Chih-Yuan Hung
- Department of Psychiatry, Yuanshan and Suao Branches of Taipei Veterans General Hospital, Ilan, Taiwan
| | - Mao-Hsuan Huang
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Psychiatry, Yuanshan and Suao Branches of Taipei Veterans General Hospital, Ilan, Taiwan
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Chidambaram SB, Anand N, Varma SR, Ramamurthy S, Vichitra C, Sharma A, Mahalakshmi AM, Essa MM. Superoxide dismutase and neurological disorders. IBRO Neurosci Rep 2024; 16:373-394. [PMID: 39007083 PMCID: PMC11240301 DOI: 10.1016/j.ibneur.2023.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 11/21/2023] [Indexed: 07/16/2024] Open
Abstract
Superoxide dismutase (SOD) is a common antioxidant enzyme found majorly in living cells. The main physiological role of SOD is detoxification and maintain the redox balance, acts as a first line of defence against Reactive nitrogen species (RNS), Reactive oxygen species (ROS), and other such potentially hazardous molecules. SOD catalyses the conversion of superoxide anion free radicals (O 2 -.) into molecular oxygen (O 2) and hydrogen peroxide (H 2O 2) in the cells. Superoxide dismutases (SODs) are expressed in neurons and glial cells throughout the CNS both intracellularly and extracellularly. Endogenous oxidative stress (OS) linked with enlarged production of reactive oxygen metabolites (ROMs), inflammation, deregulation of redox balance, mitochondrial dysfunction and bioenergetic crisis are found to be prerequisite for neuronal loss in neurological diseases. Clinical and genetic studies indicate a direct correlation between mutations in SOD gene and neurodegenerative diseases, like Amyotrophic Lateral Sclerosis (ALS), Huntington's disease (HD), Parkinson's Disease (PD) and Alzheimer's Disease (AD). Therefore, inhibitors of OS are considered as an optimistic approach to prevent neuronal loss. SOD mimetics like Metalloporphyrin Mn (II)-cyclic polyamines, Nitroxides and Mn (III)- Salen complexes are designed and used as therapeutic extensively in the treatment of neurological disorders. SODs and SOD mimetics are promising future therapeutics in the field of various diseases with OS-mediated pathology.
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Affiliation(s)
- Saravana Babu Chidambaram
- Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysuru 570015, Karnataka, India
- Centre for Experimental Pharmacology and Toxicology, Central Animal Facility, JSS Academy of Higher Education & Research, Mysuru 570015, Karnataka, India
| | - Nikhilesh Anand
- Department of Pharmacology, American University of Antigua College of Medicine, University Park, Jabberwock Beach Road, Antigua, Antigua and Barbuda
| | - Sudhir Rama Varma
- Department of Clinical Sciences, College of Dentistry, Ajman University, 346 Ajman, the United Arab Emirates
- Center of Medical and Bio-allied Health Sciences Research, Ajman University, 346 Ajman, the United Arab Emirates
| | - Srinivasan Ramamurthy
- College of Pharmacy & Health Sciences, University of Science and Technology of Fujairah, 2202 Fujairah, the United Arab Emirates
| | - Chandrasekaran Vichitra
- Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysuru 570015, Karnataka, India
- Centre for Experimental Pharmacology and Toxicology, Central Animal Facility, JSS Academy of Higher Education & Research, Mysuru 570015, Karnataka, India
| | - Ambika Sharma
- Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysuru 570015, Karnataka, India
- Centre for Experimental Pharmacology and Toxicology, Central Animal Facility, JSS Academy of Higher Education & Research, Mysuru 570015, Karnataka, India
| | - Arehally M Mahalakshmi
- Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysuru 570015, Karnataka, India
- Centre for Experimental Pharmacology and Toxicology, Central Animal Facility, JSS Academy of Higher Education & Research, Mysuru 570015, Karnataka, India
| | - Musthafa Mohamed Essa
- Department of Food Science and Nutrition, CAMS, Sultan Qaboos University, Muscat, Oman
- Ageing and Dementia Research Group, Sultan Qaboos University, Muscat, Oman
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Barak Y, Sajjadi SF, Hobbs L, Patterson T. Functional recovery in older adults with schizophrenia: A national interRAI study. Int J Soc Psychiatry 2024; 70:792-800. [PMID: 38366918 DOI: 10.1177/00207640241230837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2024]
Abstract
BACKGROUND The concept of recovery for people with schizophrenia (PwS) is still a matter of debate. Growing numbers of PwS living to older age calls for examination of their disease trajectories with a focus on recovery. AIM To compare two groups of PwS (good wellbeing; poor wellbeing) on several psychosocial variables associated with social wellbeing to identify interventions that support functional recovery. METHOD Data was drawn from participants from across New Zealand (NZ), who had received a formal diagnosis of Schizophrenia; were living independently in the community, and who had undergone their first International Resident Assessment Instrument (interRAI) assessment from 2012 to 2022. We compared two groups of PwS (good social wellbeing; poor social wellbeing) examining associations with demographic and psychosocial variables. RESULTS We compared interRAI assessments for: 'poor psychosocial wellbeing' (n = 1,378; 67%; 56% female; 70.5% 65 years and over; 36.1% never married); and 'good psychosocial wellbeing' (n = 693; 33%; 61.1% female; 78.1% 65 years and over; 29.8% never married; n = 549 did not have sufficient social wellbeing data to be included). We found significant associations between social wellbeing and depression, disruptive behaviour, decision making, self-expression, understanding verbal information, activity level, self-reported health and medication adherence. Logistical regression showed depression (β = .84, p < .001, Wald = 51.01, Exp(B) = 2.31) and mild disruptive behaviour (β = .63, p = .002, Wald = 9.26, Exp(B) = 0.53) were the only predictors of poor social wellbeing. Those who reported some degree of depressive symptoms were 2.31 (CI [1.84, 2.91]) more likely to be in the poor social wellbeing group. CONCLUSIONS A significant minority (33.5%) of older PwS enjoy positive social wellbeing. Several psychosocial variables are associated with wellbeing. By addressing the comorbidity of depressive symptoms, we may be able to improve wellbeing for older PwS.
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Affiliation(s)
- Yoram Barak
- Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, New Zealand
| | - S Fatemeh Sajjadi
- Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, New Zealand
| | - Linda Hobbs
- Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, New Zealand
| | - Tess Patterson
- Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, New Zealand
- Optentia Research Focus Area, North-West University, Potchefstroom, South Africa
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Li S, Liu W, Huang Z, Lin H, Ning Y, Li Z. Sex-specific associations between sex hormones and clinical symptoms in late-life schizophrenia. Schizophr Res 2024; 267:1-7. [PMID: 38492529 DOI: 10.1016/j.schres.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 02/14/2024] [Accepted: 03/08/2024] [Indexed: 03/18/2024]
Abstract
The prevalence of late-life schizophrenia is increasing with high burden. It is well-documented that schizophrenia affects men and women differently in terms of symptoms. Sex hormones, which play a role in the pathology and symptoms of schizophrenia, are greatly affected by aging. To the best of our knowledge, this is a study to examine the sex differences in psychiatric symptoms and their correlation with sex hormones in participants with late-life schizophrenia. Positive and Negative Syndrome Scale (PANSS) factors were evaluated. Testosterone, follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, progesterone, and prolactin were measured. Male participants with late-life schizophrenia had more severe negative symptoms than female participants (z = -2.56, P = 0.010), while female participants had more severe anxiety/depression compared to male participants (z = 2.64, P = 0.008). Testosterone levels in male participants were positively associated with negative symptoms (β = 0.23, t = 2.27, P = 0.025), while there was no significant association between sex hormones and symptoms in female participants. In conclusion, higher testosterone levels were associated with more severe negative symptoms in male participants with late-life schizophrenia, suggesting that attention should be paid to the sex differences in late-life schizophrenia in clinical practice.
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Affiliation(s)
- Shuyun Li
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province, Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Weijian Liu
- Peking University Sixth Hospital, Peking University, Beijing, China
| | - Zebin Huang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Hong Lin
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuping Ning
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province, Ministry of Education of China, Guangzhou Medical University, Guangzhou, China.
| | - Zezhi Li
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province, Ministry of Education of China, Guangzhou Medical University, Guangzhou, China.
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Abstract
OBJECTIVES The number of older adults suffering from schizophrenia is increasing. Despite this, less than 1% of published studies about schizophrenia focus on those older than 65 years. Research indicates these individuals may age differently from the general population due to lifestyle, medication factors, and effects of the disease itself. We aimed to analyze whether schizophrenia was associated with a younger age at first assessment for social care as a proxy measure for accelerated aging. DESIGN We analyzed the effect of schizophrenia diagnosis, demographics, mood, comorbidities, falls, cognition, and substance use on age at first assessment for social care using linear regression. PARTICIPANTS We used data from 168,780 interRAI Home Care and Long-Term Care Facility (HC; LTCF) assessments completed from July 2013 to June 2020. RESULTS When corrected for confounding factors, schizophrenia contributed to age at first assessment being 5.5 years younger (p = 0.0001 Cohen's D = 1.0) than in people free from schizophrenia. Its effect on age at first assessment was second only to smoking. People suffering from schizophrenia also required a higher level of care (long-term care facility rather than home care). People suffering from schizophrenia had significantly higher rates of diabetes mellitus and chronic obstructive pulmonary disease but otherwise had lower rates of comorbidity than people free from schizophrenia who required care. CONCLUSIONS Aging with schizophrenia is associated with needing increased social care at a younger age. This has implications for social spending and developing policies to decrease frailty in this population.
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Affiliation(s)
- Clare Taube
- Dunedin School of Medicine, University of Otago, New Zealand
| | | | - Paul Glue
- Dunedin School of Medicine, University of Otago, New Zealand
| | - Yoram Barak
- Dunedin School of Medicine, University of Otago, New Zealand
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Arafuka S, Fujishiro H, Torii Y, Sekiguchi H, Habuchi C, Miwa A, Yoshida M, Iritani S, Iwasaki Y, Ikeda M, Ozaki N. Neuropathological substrate of incident dementia in older patients with schizophrenia: A clinicopathological study. Psychiatry Clin Neurosci 2024; 78:29-40. [PMID: 37706608 DOI: 10.1111/pcn.13597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 08/08/2023] [Accepted: 09/08/2023] [Indexed: 09/15/2023]
Abstract
AIM Clinical studies reported that patients with schizophrenia are at a higher risk of developing dementia than people without schizophrenia. However, early neuropathological studies have shown that the incidence of Alzheimer's disease (AD) in schizophrenia patients does not differ from that in controls. These inconsistent results may be attributable to the inclusion of non-AD dementia, but there have been few clinicopathological studies in older patients with schizophrenia based on the current neuropathological classification. This study aimed to investigate the neuropathological basis of incident dementia in older patients with schizophrenia. METHODS We systematically examined 32 brains of old patients with schizophrenia using standardized pathological methods. The severity of dementia-related neuropathologies was analyzed using standardized semiquantitative assessments. After excluding patients who fulfilled the neuropathological criteria, clinicopathological variables were compared between patients with and without incident dementia to identify potential differences. RESULTS Seven patients fulfilled the pathological criteria for AD (n = 3), argyrophilic grain disease (AGD) (n = 2), dementia with Lewy bodies (n = 1), and AGD/progressive supranuclear palsy (n = 1). Among 25 patients for whom a neuropathological diagnosis was not obtained, 10 had dementia, but the clinicopathological findings did not differ from the remaining 15 patients without dementia. CONCLUSION Two types of older schizophrenia patient present dementia: patients with co-existing neurodegenerative disease and patients who do not meet pathological criteria based on the current classification. To understand the neurobiological aspects of incident dementia in older patients with schizophrenia, further clinicopathological studies are needed that do not simply analyze incident dementia as a comorbidity of conventional dementia-related neuropathologies.
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Affiliation(s)
- Shusei Arafuka
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan
- Moriyama General Mental Hospital, Nagoya, Japan
| | - Hiroshige Fujishiro
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Moriyama General Mental Hospital, Nagoya, Japan
| | - Youta Torii
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Moriyama General Mental Hospital, Nagoya, Japan
| | - Hirotaka Sekiguchi
- Department of Psychiatry, Okehazama Hospital Fujita Mental Care Center, Toyoake, Japan
| | | | - Ayako Miwa
- Moriyama General Mental Hospital, Nagoya, Japan
| | - Mari Yoshida
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan
| | - Shuji Iritani
- Moriyama General Mental Hospital, Nagoya, Japan
- Department of Psychiatry, Okehazama Hospital Fujita Mental Care Center, Toyoake, Japan
- Aichi Psychiatric Medical Center, Nagoya, Japan
| | - Yasushi Iwasaki
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan
| | - Masashi Ikeda
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Norio Ozaki
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Pathophysiology of Mental Disorders, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Institute for Glyco-core Research (iGCORE), Nagoya University, Nagoya, Japan
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Schofield E, Taylor N, Drake MJ. The association of lower urinary tract symptoms with schizophrenia and its treatments: A narrative review. Neurourol Urodyn 2024; 43:114-125. [PMID: 37916430 DOI: 10.1002/nau.25320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/14/2023] [Accepted: 10/22/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND A higher incidence of lower urinary tract symptoms (LUTS) in people with schizophrenia compared to the general population is often suggested. However, it is not clear whether this is a genuine association, and whether it is a direct result of schizophrenia itself, or a side-effect of certain antipsychotics. METHODS We undertook a narrative review evaluating how the published literature reports the relationship between LUTS and schizophrenia and its treatments. We searched Embase, Ovid Emcare, and Ovid MEDLINE(R) ALL to August 2022, limited to the English language. We selected the following search terms: schizophrenia, schizophrenic, LUTS, overactive bladder, urinary urgency, urinary incontinence, overactive bladder, enuresis, nocturnal enuresis, and voiding dysregulation. We identified seven domains for assessment in advance of commencing the review. These were the categorization, description, and treatment status of schizophrenia; evaluation of LUTS; categorization of LUTS confounders; recapturing of the disease states of both schizophrenia and LUTS after therapies; assessment of the association between LUTS and schizophrenia and/or antipsychotics. RESULTS The association between LUTS and schizophrenia was poorly described. The evidence was low quality and focused predominantly on urinary incontinence as an antipsychotic side effect, neglecting other LUTS. The status of schizophrenia was often incompletely characterized, and no papers made use of a bladder diary or LUTS-specific questionnaires to assess symptoms. No papers collected information about LUTS in patients not on antipsychotics, nor did any thoroughly evaluate the influence of confounding variables. Despite the tendency of symptoms and severity of both conditions to fluctuate over time, no studies fully assessed the status of both schizophrenia and LUTS at baseline, therapy initiation, and follow-up. CONCLUSIONS It is not possible to state whether there is an association between LUTS and schizophrenia or its treatments. This review highlights the need to improve research and clinical management of the urinary tract in schizophrenia, with meticulously designed longitudinal studies.
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Affiliation(s)
| | | | - Marcus J Drake
- Department of Surgery and Cancer, Imperial College, London, UK
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Yeh LL, Lee WC, Kuo KH, Pan YJ. Antipsychotics and Mortality in Adult and Geriatric Patients with Schizophrenia. Pharmaceuticals (Basel) 2023; 17:61. [PMID: 38256894 PMCID: PMC10819180 DOI: 10.3390/ph17010061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/20/2023] [Accepted: 12/27/2023] [Indexed: 01/24/2024] Open
Abstract
Patients with schizophrenia have a high mortality risk, and the role of antipsychotic medications remains inconclusive. In an aging society, older patients with schizophrenia warrant increased attention. This study investigated the association of antipsychotic medication dosages with mortality in patients with schizophrenia by using data from Taiwan's National Health Insurance Research Database from 2010 to 2014. This study included 102,964 patients with schizophrenia and a subgroup of 6433 older patients in addition to an age- and sex-matched control group. The findings revealed that among patients with schizophrenia, the no antipsychotic exposure group had the highest mortality risk (3.61- and 3.37-fold higher risk for overall and cardiovascular mortality, respectively) in the age- and sex-adjusted model, followed by the high, low, and moderate exposure groups. A similar pattern was observed in the older patients with schizophrenia. High exposure to antipsychotics was associated with the highest risks of overall and cardiovascular mortality (3.01- and 2.95-fold higher risk, respectively). In conclusion, the use of antipsychotics can be beneficial for patients with schizophrenia with recommended exposure levels being low to moderate. In older patients, high antipsychotic exposure was associated with the highest mortality risk, indicating that clinicians should be cautious when administering antipsychotic medications to such patients.
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Affiliation(s)
- Ling-Ling Yeh
- Graduate School of Humanities and Social Sciences, Dharma Drum Institute of Liberal Arts, New Taipei City 208, Taiwan;
| | - Wei-Chen Lee
- Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan;
| | - Kuei-Hong Kuo
- Division of Medical Imaging, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Yi-Ju Pan
- Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan;
- Department of Chemical Engineering and Materials Science, Yuan Ze University, Taoyuan City 320, Taiwan
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Santos Martins F, Feldens T, Guerra C, Santos JV. Long-term mental health care in Portugal: A portrait of the first years of activity. Int J Soc Psychiatry 2023; 69:1605-1616. [PMID: 37092774 DOI: 10.1177/00207640231168026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
INTRODUCTION In Portugal, a reform to implement Long-term mental health care (LTMHC) started in 2017 allowing patients with severe mental illness receiving psychosocial rehabilitation to regain their autonomy and be reintegrated into their communities. AIM To describe the first steps of the Portuguese LTMHC implementation and to assess the relationship between the LTMHC's demand (referrals) and supply (vacancies and occupancy). METHODS We conducted a national retrospective observational study to analyse the LTMHC referrals, vacancies and occupancy between mid-2017 (LTMHC establishment) and December 2022. We described and analysed the associated indicators through time and geography, as well as performed a simultaneous regression model to evaluate the relationship between supply and demand. RESULTS There were 1,192 referrals to the LTMHC, of which 99 (8.3%) were made for childhood and adolescence structures. The maximum support residence (RAMa, 'Residência de apoio máximo'), designed for patients with higher disabilities, had the highest number of referrals. Additionally, since the opening of vacancies in different institutions, residential structures became quickly saturated. On the other hand, domiciliary services were those with the lowest occupancy. Our estimates support that the vacancies (supply) are induced by the referrals (demand), and referrals are also related to the location of LTMHC facilities. CONCLUSION LTMHC is still in the initial stage of development in Portugal, and it is expected to receive financial support through the Recovery and Resilience Programme. According to the occupancy rates and referrals made, residential structures seem to be a priority, being also important to explore the partial use of domiciliary services. The geographical distribution of vacancies can also be a concern, considering the important proximity to the community in LTMHC.
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Affiliation(s)
- Filipa Santos Martins
- Psychiatry and Mental Health Department, Centro Hospitalar Universitário de São João (CHUSJ), Porto, Portugal
- CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal
| | - Tallys Feldens
- CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal
- Federal University of Paraná, Paraná, Brazil
| | - Cátia Guerra
- Psychiatry and Mental Health Department, Centro Hospitalar Universitário de São João (CHUSJ), Porto, Portugal
- Clinical Neurosciences and Mental Health Department, Faculty of Medicine, University of Porto (FMUP), Porto, Portugal
| | - João Vasco Santos
- CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- Public Health Unit, ACES Grande Porto V - Porto Ocidental, Porto, Portugal
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11
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Yu YH, Lu Q. Prevalence, risk factors and multiple outcomes of treatment delay in Chinese patients with schizophrenia. BMC Psychiatry 2023; 23:748. [PMID: 37833690 PMCID: PMC10576347 DOI: 10.1186/s12888-023-05247-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/02/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND People with schizophrenia often delay treatment. This issue is not fully understood, particularly in low-and middle-income countries. This study aimed to elucidate the prevalence, risk factors and multiple outcomes of treatment delay in schizophrenia in a Chinese metropolis. METHODS A two-stage whole cluster sampling survey was conducted in Beijing, China in 2020. A total of 1,619 patients with schizophrenia were included. Heterogeneity between groups and the changing trend of treatment delay were presented. Regression modelling methods were used to examine both the risk factors for treatment delay and related outcomes at individual and family levels. RESULTS The median treatment delay for schizophrenia was 89 days (about 13 weeks). 49.35% surveyed patients delayed treatment for more than three months. Early age of onset, low level of education, living in well developed districts were important risk factors. Treatment delay in schizophrenia was significantly associated with patients' poor medication adherence, comorbidity status and poor social functioning. It also increased the negative impact of the illness on families. CONCLUSIONS This study accumulated evidence of treatment delay in schizophrenia in China. It occurs even in the metropolis where mental health resources are relatively adequate. Further targeted interventions to raise public awareness should be crucial to reduce treatment delay.
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Affiliation(s)
- Yue-Hui Yu
- School of Public Administration and Policy, Renmin University of China, Beijing, 100872, China
| | - Quan Lu
- School of Labor and Human Resources, Renmin University of China, Beijing, 100872, China.
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12
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Mentzel C, Taube C, Glue P, Barak Y. Older adults with schizophrenia and dementia: Analysis of a national dataset. Australas J Ageing 2023; 42:609-612. [PMID: 36869573 DOI: 10.1111/ajag.13187] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 01/18/2023] [Accepted: 02/09/2023] [Indexed: 03/05/2023]
Abstract
OBJECTIVES Individuals with schizophrenia develop dementia in late life at higher rates than the general population. This is arguably explained by high rates of chronic medical conditions and exposure to antipsychotic medications. This risk has implications for public health. We aimed to test this in a large New Zealand database. METHODS Participants in this study were New Zealanders aged 65 years or older who had an interRAI assessment completed during the study period (July 2013-June 2020). This cohort study analysed data from 168,780 individuals. The majority were European (87%), and mostly assessment was for home care (86%). RESULTS There were 2103 individuals with schizophrenia, 1.25% of the total sample, mean age of 75 years (±1.9) and 61% female. A minority of individuals with schizophrenia, 23%, also had a dementia diagnosis. At 82 years of age (±1.7) and 60% female, 25% of individuals without schizophrenia had a dementia diagnosis; the difference from rate of dementia in individuals with schizophrenia was not statistically significant. CONCLUSIONS These findings suggest that further study is needed about the processes that lead to dementia diagnoses in older individuals with schizophrenia.
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Affiliation(s)
- Charlotte Mentzel
- Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Clare Taube
- Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Paul Glue
- Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Yoram Barak
- Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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13
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Meesters PD. New horizons in schizophrenia in older people. Age Ageing 2023; 52:afad161. [PMID: 37725971 DOI: 10.1093/ageing/afad161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Indexed: 09/21/2023] Open
Abstract
People aged 65 years and older will soon constitute more than a quarter of the total population with schizophrenia, challenging the existing systems of care. For a long time, research into schizophrenia in later life was very limited. However, recent years have seen an encouraging surge in novel and high-quality studies related to this stage of life. Older people with schizophrenia consist of those who had an early onset and aged with the disorder, and of a smaller but sizeable group with a late onset or a very late onset. With ageing, physical needs gain importance relative to psychiatric needs. Medical comorbidity contributes to a markedly higher mortality compared to the general population. In many persons, symptoms and functioning fluctuate with time, leading to deterioration in some but improvement in others. Of note, a substantial number of older people may experience subjective well-being in spite of ongoing symptoms and social impairments. The majority of individuals with schizophrenia reside in the community, but when institutionalization is required many are placed in residential or nursing homes where staff is often ill-equipped to address their complex needs. There is a clear need for implementation of new models of care in which mental health and general health systems cooperate. This review provides a state-of-the-art overview of current knowledge in late life schizophrenia and related disorders, with a focus on themes with clinical relevance.
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Affiliation(s)
- Paul D Meesters
- Department of Research and Education, Friesland Mental Health Services, Leeuwarden, The Netherlands
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14
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Malviya A, Bhuyan R. The recent advancements in circRNA research: From biogenesis to therapeutic interventions. Pathol Res Pract 2023; 248:154697. [PMID: 37506629 DOI: 10.1016/j.prp.2023.154697] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/14/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023]
Abstract
Circular RNAs (circRNAs) belong to the genre of long non-coding RNAs that are formed by special back-splicing events and are currently the molecule of interest for studies globally due their involvement in various ailments like diabetes, neurodegenerative disorders, cardio-vascular diseases and cancers. These class of highly stable RNAs participate in diverse cellular functionalities including microRNA (miRNA) sponging, ceRNA (competing endogenous RNA) activity or via exhibiting RNA binding protein (RBP) interactions. They are also known to regulate cancer progression both positively and negatively through various biological pathways such as, modulating the cell cycle and apoptotic pathways, epigenetic regulation, and translational and/or transcriptional regulations etc. Given its significance, a variety of computational tools and dedicated databases have been created for the identification, quantification, and differential expression of such RNAs in combination with sequencing approaches. In this review, we provide a comprehensive analysis of the numerous computational tools, pipelines, and online resources developed in recent years for the detection and annotation of circRNAs. We also summarise the most recent findings regarding the characteristics, functions, biological processes, and involvement of circRNAs in diseases. The review emphasises the significance of circRNAs as potential disease biomarkers and new treatment targets.
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Affiliation(s)
- Ayushi Malviya
- Department of Bioscience and Biotechnology, Banasthali Vidyapith, Banasthali, Tonk, Rajasthan 304022, India
| | - Rajabrata Bhuyan
- Department of Bioscience and Biotechnology, Banasthali Vidyapith, Banasthali, Tonk, Rajasthan 304022, India.
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15
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Wu C, Ye J, Li S, Wu J, Wang C, Yuan L, Wang H, Pan Y, Huang X, Zhong X, Huang M, Guo J, Ning Y, Xiao A. Predictors of everyday functional impairment in older patients with schizophrenia: A cross-sectional study. Front Psychiatry 2023; 13:1081620. [PMID: 36741560 PMCID: PMC9889971 DOI: 10.3389/fpsyt.2022.1081620] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/29/2022] [Indexed: 01/19/2023] Open
Abstract
Objective This study investigates the prevalence of everyday functional impairment among older adults with schizophrenia and builds a predictive model of functional decline. Methods A total of 113 hospitalized older patients enrolled in this study. Functional impairment is defined according to the Functional Activities Questionnaire (FAQ). Patients who scored <9 could function independently daily, while those who scored ≥9 had problems in everyday functional activities. Data collected include sociodemographic characteristics, depressive symptoms, social support, and physical comorbidities, which were classified according to the eight anatomical systems of the human body. Results The sample comprised 75% female participants with a mean age of 63.74 ± 7.42 years old. A total of 33.6% had a functional impairment, while cognitive impairment was present in 63.7%. Independent participants had better urinary system and respiratory system health (P < 0.05). After adjusting for the potential confounders of age, disease course, physical comorbidities, psychiatric symptoms, the ability to independently carry out daily activities, and cognitive function, we found that impaired everyday function is associated with poor cognition, depressive symptoms, first admission, psychiatric symptoms (especially positive symptoms), ADL, and respiratory and urinary system diseases. Conclusion Everyday functional capacity is predicted by disease course, admission time, cognition, depressive symptoms, severity of psychosis, ability to carry out daily activities, and respiratory and urinary system health status. Urinary system diseases contribute significantly to the prediction of impaired function. Future studies should focus on health status, drug use, and everyday functional recovery in older patients with schizophrenia.
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Affiliation(s)
- Chenxin Wu
- Department of Geriatric Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Junrong Ye
- Department of Geriatric Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Shaohua Li
- Department of Geriatric Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Jialan Wu
- Department of Geriatric Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
- Department of Nursing, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Chen Wang
- Department of Geriatric Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Lexin Yuan
- Department of Nursing, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Haoyun Wang
- Department of Geriatric Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
- School of Nursing, Guangzhou Medical University, Guangzhou, China
| | - Yuanxin Pan
- Department of Geriatric Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
- School of Nursing, Guangzhou Medical University, Guangzhou, China
| | - Xingxiao Huang
- Department of Geriatric Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Xiaomei Zhong
- Department of Geriatric Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Meilian Huang
- Department of Nursing, The Third People’s Hospital of North Guangdong, Guangdong, China
| | - Jianxiong Guo
- Department of Chronic Diseases, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Yuping Ning
- Department of Geriatric Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
- Department of Office, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Aixiang Xiao
- Department of Geriatric Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
- Department of Nursing, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
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16
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Dobbins S, Hubbard E, Leutwyler H. Education Mediates Racial Disparities in Cognitive Impairment Among Older Adults With Schizophrenia. Clin Gerontol 2023; 46:66-79. [PMID: 33579181 PMCID: PMC8610378 DOI: 10.1080/07317115.2021.1882021] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES In the general population, the construct of race is associated with disparities in cognitive aging. There are notable racial group disparities and inequities among people living with schizophrenia (PLWSz). Despite the salience of the construct of race in schizophrenia, there remains a knowledge gap about racial disparities in cognitive impairment among older adults in this vulnerable population. Our study uses mediation analysis to examine racial disparities in cognitive impairment among older adults with schizophrenia. METHODS We assess global cognition in PLWSz over age 55 with the Measurement and Treatment Research to Improve Cognition in Schizophrenia cognitive test battery in our "all-comer" sample (N = 64). The primary exposure is self-reported racial group. We examine mediation of cognitive impairment through educational attainment, adjusting for psychiatric illness severity, history of substance use, and vascular risk factors. RESULTS There was a Black/non-Black group racial disparity in global cognitive score (-2.8, 95% CI: -4.4, -1.3) after adjusting for confounding and interaction. This disparity was significantly mediated by years of education. CONCLUSIONS There are notable racial disparities in cognitive impairment among older adults with schizophrenia; however, differences in cognitive scores between racial groups are mediated by level of education. CLINICAL IMPLICATIONS Social determinants of health, particularly educational attainment, are important risk factors for cognitive impairment in PLWSz and should be considered by clinicians. Early screening and assessment of cognitive symptoms is essential to addressing health disparities/inequalities among older adults living with schizophrenia. ABBREVIATIONS CDE Controlled Direct EffectsHIV: Human Immunodeficiency VirusMATRICS: Measurement and Treatment Research to Improve Cognition in SchizophreniaMCCB: MATRICS Consensus Cognitive BatteryMTE: Marginal Total EffectsNDE: Natural Direct EffectsPANSS: Positive and Negative Symptom ScalePLWSz: People with schizophrenia.
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Affiliation(s)
- Sarah Dobbins
- University of California, San Francisco School of Nursing, 2 Koret Way, San Francisco, CA 94143, USA
| | - Erin Hubbard
- University of California, San Francisco School of Nursing, 2 Koret Way, San Francisco, CA 94143, USA
| | - Heather Leutwyler
- University of California, San Francisco School of Nursing, 2 Koret Way, San Francisco, CA 94143, USA
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17
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UÇAR Z, YILDIRIM B, TATLI SZ, ÖZEL KIZIL ET. Comparison of psychotropic drug preferences and side effects in old and young patients with schizophrenia and schizoaffective disorder. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1139145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose: The current study investigates the preferred psychotropic drug treatments and their tolerability in elderly patients (EP) with a diagnosis of schizophrenia or schizoaffective disorder compared to younger patients (YP).
Materials and Methods: The study included 154 EP and 195 YP with schizophrenia/schizoaffective disorder admitted to the outpatient unit at a university hospital in the last decade. The medical records of the patients were reviewed. The types and doses of antipsychotic drugs used by each patient, use of other psychotropic drugs, ongoing complaints, drug-related side effects and compliance with treatment were also examined.
Results: Second generation antipsychotic use was higher in YP (88% in YP, 80% in EP). Antipsychotic equivalent doses were found 266.63 mg in EP, 522.21 mg in YP, that also higher in the YP group. The use of clozapine (7% in EP, 37% in YP) and mood stabilizers (4.5% in EP, 18% in YP) were higher in YP. There was a higher rate of dose reduction of antipsychotic drugs in EP (21.5% in YP, 52% in EP). When the groups were compared in terms of the reasons of antipsychotic dose reduction, it was more frequent in EP due to side effects (21.4% in YP, 40% in EP), while the dose reduction due to remission was more common in YP (78.6% in YP, 60% in EP) .
Conclusion: Lower doses of antipsychotics in EP suggests milder symptoms or lower tolerability. The higher clozapine and mood stabilizer use in YP can be explained by avoiding side effects like extrapyramidal, cardiovascular and metabolic side effects that are more frequent in EP.
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Affiliation(s)
- Zehra UÇAR
- Ankara University School of Medicine, Department of Psychiatry
| | - Betül YILDIRIM
- Ankara University School of Medicine, Department of Psychiatry
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18
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Choi NG, DiNitto DM, Marti CN. Public mental health service use among U.S. adults age 50+ compared to younger age groups. SOCIAL WORK IN HEALTH CARE 2022; 61:499-515. [PMID: 36484172 DOI: 10.1080/00981389.2022.2154886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 10/29/2022] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
Despite increasing numbers of older-adult mental health service users, few studies have examined their use of public mental health services. Using the 2018 and 2019 Mental Health-Client Level data for clients age 18+ (N = 4,291,737 in 2018 and N = 4,513,946 in 2019), we examined whether those age 50+ who received outpatient-only, both outpatient and inpatient, or inpatient-only services had greater odds of certain types of mental disorders, especially schizophrenia, than younger adults. Of all users, 25.3% were age 50-64 and 6.7% were age 65 + . Multivariable logistic regression results, controlling for gender, race/ethnicity, census region, and alcohol/substance use disorder, showed that compared to the 30-49 age group, the 50-64 and 65+ age groups had higher odds of having depressive disorder in outpatient-only settings; however, they had consistently higher odds of a diagnosis of schizophrenia or other psychotic disorder in all three service settings. Along with advocating for increased funding for publicly-financed mental health services, social workers in public mental health service systems should ensure that they utilize effective intervention skills for older adults with serious mental illness.
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Affiliation(s)
- Namkee G Choi
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas, USA
| | - Diana M DiNitto
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas, USA
| | - C Nathan Marti
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas, USA
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19
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A systematic review of clozapine's effectiveness for primary psychotic and bipolar disorders in older adults. Int Psychogeriatr 2022; 34:875-887. [PMID: 33612141 DOI: 10.1017/s1041610220004172] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The primary aim was to systematically review the literature regarding the effectiveness of clozapine in reducing symptoms of primary psychotic and bipolar disorders in older adults. The secondary aim was to describe other reported patient and caregiver outcomes of clozapine treatment in older adults. DESIGN MEDLINE, Embase, PsychINFO, ProQuest, and PubMed databases were searched according to PRISMA guidelines for original empirical research examining the effectiveness of clozapine in adults aged 65 years or more with primary psychotic and bipolar disorders. Identified studies were assessed for methodological quality using the QualSyst tool. RESULTS 1121 records were screened, of which 7 studies met the inclusion criteria. In total, 128 subjects participated in the included studies (111 of whom were from a single study), with an age range of 65-86 years, and diagnoses including schizophrenia, schizoaffective disorder, bipolar disorder, and delusional disorder. Indications for clozapine use included treatment resistance and inability to tolerate other treatments. While six out of seven studies reported some improvement on the primary measure of psychopathology after treatment with clozapine, the group effects were modest and based on low-level evidence. Additional reported outcomes included discharge destination, death, and relapse. Most of the included studies were only of adequate methodological quality, with significant risks of bias identified. CONCLUSIONS Clozapine may have positive effects for primary psychotic and bipolar illnesses in some older adults, but the group effects reported were modest and based on low-level evidence studies with methodological limitations. Based on these findings, clinical decision-making about whether or not to trial clozapine should involve an individualized analysis of potential benefits and risks in collaboration with patients and their families and caregivers.
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20
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Leutwyler H, Hubbard E, Cooper B. A Group Videogame-Based Physical Activity Program Improves Walking Speed in Older Adults Living With a Serious Mental Illness. Innov Aging 2022; 6:igac049. [DOI: 10.1093/geroni/igac049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Indexed: 11/27/2022] Open
Abstract
Abstract
Background and Objectives
One of the most overlooked populations in our society and in health care are middle-aged and older adults living with a serious mental illness (SMI) despite the growing numbers of this population. Health care communities, including both inpatient and outpatient mental health programs, have a responsibility to provide care that nurtures clients’ mental as well as physical health needs. Providing accessible and engaging physical activity programs is an excellent way to provide this type of holistic care. The purpose of this article is to describe the impact of a pilot videogame-based physical activity program on walking speed in older adults with SMI.
Research Design and Methods
A one-group pretest post-test pilot study was conducted with a sample of 52 older adults with SMI recruited from community-based mental health programs. Participants played an active videogame (using the Kinect for Xbox 360 game system; Microsoft, Redmond, WA) for 50-minute group sessions 3 times a week for 10 weeks. Walking speed was assessed with the timed 3-m walk from the Short Physical Performance Battery at enrollment, 5 weeks, and 10 weeks.
Results
Participants achieved statistically significant improvement in walking speed (0.10 m/s, bias-corrected confidence interval Lower Limit (LL) 0.04, Upper Limit (UL) 0.15) over a 10-week period. This change represents a clinically and statistically (p ≤ .05) significant improvement in walking speed. Best estimates for clinically meaningful changes in walking speed are 0.05 m/s for a small change and 0.10 m/s for a substantial change.
Discussion and Implications
Results suggest that engagement in a group videogame-based physical activity program has the potential to improve walking speed in older adults with SMI. In turn, walking speed is an important indicator of premature mortality and cardiorespiratory fitness.
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Affiliation(s)
- Heather Leutwyler
- Department of Physiological Nursing, University of California , San Francisco, San Francisco, California , USA
| | - Erin Hubbard
- Department of Physiological Nursing, University of California , San Francisco, San Francisco, California , USA
| | - Bruce Cooper
- Department of Physiological Nursing, University of California , San Francisco, San Francisco, California , USA
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Chene M, Sánchez-Rico M, Blanco C, De Raykeer RP, Hanon C, Vandel P, Limosin F, Hoertel N. Psychiatric symptoms and mortality in older adults with major psychiatric disorders: results from a multicenter study. Eur Arch Psychiatry Clin Neurosci 2022; 273:627-638. [PMID: 35723739 DOI: 10.1007/s00406-022-01426-4] [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] [Received: 10/04/2021] [Accepted: 05/02/2022] [Indexed: 12/01/2022]
Abstract
Prior research suggests that certain psychiatric symptoms could be associated with increased risk of death. However, it remains unclear whether this association could rely on all or specific symptoms. In this report, we used data from a multicenter 5-year prospective study (N = 641) of older adults with an ICD-10 diagnosis of schizophrenia, bipolar disorder or major depressive disorder, recruited from French community psychiatric departments. We used a latent variable approach to disentangle the effects shared by all psychiatric symptoms (i.e., general psychopathology factor) and those specific to individual psychiatric symptoms, while adjusting for sociodemographic and clinical factors. Psychiatric symptoms were assessed face-to-face by psychiatrists trained to semi-structured interviews using the Brief Psychiatric Rating Scale (BPRS). Among older adults with major psychiatric disorders, we found that all psychiatric symptoms were associated with increased mortality, and that their effect on the 5-year mortality were exerted mostly through a general psychopathology dimension (β = 0.13, SE = 0.05, p < 0.05). No BPRS item or lower order factor had a significant effect on mortality beyond and above the effect of the general psychopathology factor. Greater number of medical conditions, older age, male sex, and being hospitalized or institutionalized at baseline were significantly associated with this risk beyond the effect of the general psychopathology factor. Since psychiatric symptoms may affect mortality mainly through a general psychopathology dimension, biological and psychological mechanisms underlying this dimension should be considered as promising targets for interventions to decrease excess mortality of older individuals with psychiatric disorders.
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Affiliation(s)
- Margaux Chene
- Department of Psychiatry, AP-HP, Western Paris University Hospitals, 92130, Issy-les-Moulineaux, France. .,Department of Psychiatry, Corentin Celton Hospital, Paris Descartes University, 4 parvis Corentin Celton, 92130, Issy-les-Moulineaux, France.
| | - Marina Sánchez-Rico
- Department of Psychiatry, AP-HP, Western Paris University Hospitals, 92130, Issy-les-Moulineaux, France.,Department of Psychobiology and Behavioural Sciences Methods, Faculty of Psychology, Universidad Complutense de Madrid, Campus de Somosaguas, Madrid, Spain
| | - Carlos Blanco
- Division of Epidemiology, Services, and Prevention Research, National Institute On Drug Abuse, Bethesda, MD, USA
| | - Rachel Pascal De Raykeer
- Department of Psychiatry, AP-HP, Western Paris University Hospitals, 92130, Issy-les-Moulineaux, France
| | - Cécile Hanon
- Department of Psychiatry, AP-HP, Western Paris University Hospitals, 92130, Issy-les-Moulineaux, France.,Department of Psychiatry, Corentin Celton Hospital, Paris Descartes University, 4 parvis Corentin Celton, 92130, Issy-les-Moulineaux, France
| | - Pierre Vandel
- Department of Adult Psychiatry, Laboratory of Neurosciences, University Hospital of Besançon, UBFC, EA-481, Besançon, France
| | - Frédéric Limosin
- Department of Psychiatry, AP-HP, Western Paris University Hospitals, 92130, Issy-les-Moulineaux, France.,INSERM UMR 894, Psychiatry and Neurosciences Center, Paris, France.,Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Department of Psychiatry, Corentin Celton Hospital, Paris Descartes University, 4 parvis Corentin Celton, 92130, Issy-les-Moulineaux, France
| | - Nicolas Hoertel
- Department of Psychiatry, AP-HP, Western Paris University Hospitals, 92130, Issy-les-Moulineaux, France.,INSERM UMR 894, Psychiatry and Neurosciences Center, Paris, France.,Paris Descartes University, Sorbonne Paris Cité, Paris, France
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22
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Zolk O, Greiner T, Schneider M, Heinze M, Dahling V, Ramin T, Grohmann R, Bleich S, Zindler T, Toto S, Seifert J. Antipsychotic drug treatment of schizophrenia in later life: Results from the European cross-sectional AMSP study. World J Biol Psychiatry 2022; 23:374-386. [PMID: 34907857 DOI: 10.1080/15622975.2021.2011403] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To investigate the relationship between patient age and the selection and dosage of antipsychotic drugs (APDs) for treatment of schizophrenia. We describe age effects for multiple individual APDs, thus allowing comparisons between drugs. METHODS Prescription data of 32,062 inpatients with schizophrenia from 2000 to 2017 were obtained from the Drug Safety Program in Psychiatry (AMSP) database. APD selection and dosage were related to patient age with sex as an influencing variable. Moreover, a systematic search of current guideline recommendations on APD treatment in patients with schizophrenia aged ≥65 years was performed. RESULTS Eighty percentof elderly patients (≥65 years) received a second-generation APD, most commonly risperidone. The dosage of APDs increased with age until about age 40 years, then decreased slowly at first and more steeply beyond age 55 years. The influence of age as well as sex on dosage partly differed between the individual drugs. Only one of eight schizophrenia guidelines systematically addressed specific aspects of pharmacotherapy in older adults. CONCLUSIONS In clinical routine, age has a significant impact on selection and dosing of APDs. Information on optimising pharmacotherapy in older adults with schizophrenia from clinical trials is needed. Guidelines should be improved regarding APD therapy specifically for older adults.
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Affiliation(s)
- Oliver Zolk
- Institute of Clinical Pharmacology of the Brandenburg Medical School, Immanuel Klinik Rüdersdorf, Rüdersdorf, Germany
| | - Timo Greiner
- Institute of Clinical Pharmacology of the Brandenburg Medical School, Immanuel Klinik Rüdersdorf, Rüdersdorf, Germany
| | - Michael Schneider
- University Clinic for Psychiatry and Psychotherapy of the Brandenburg Medical School, Immanuel Klinik Rüdersdorf, Rüdersdorf, Germany
| | - Martin Heinze
- University Clinic for Psychiatry and Psychotherapy of the Brandenburg Medical School, Immanuel Klinik Rüdersdorf, Rüdersdorf, Germany
| | - Volker Dahling
- University Clinic for Psychiatry and Psychotherapy of the Brandenburg Medical School, Immanuel Klinik Rüdersdorf, Rüdersdorf, Germany
| | - Tabea Ramin
- Institute of Clinical Pharmacology of the Brandenburg Medical School, Immanuel Klinik Rüdersdorf, Rüdersdorf, Germany
| | - Renate Grohmann
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover, Germany
| | - Tristan Zindler
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover, Germany
| | - Sermin Toto
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover, Germany
| | - Johanna Seifert
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover, Germany
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23
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Chen CR, Hung CF, Lee YW, Tseng WT, Chen ML, Chen TT. Functional Outcomes in a Randomized Controlled Trial of Animal-Assisted Therapy on Middle-Aged and Older Adults with Schizophrenia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106270. [PMID: 35627807 PMCID: PMC9141906 DOI: 10.3390/ijerph19106270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 12/10/2022]
Abstract
Deficits in cognition, physical, and social functions in adults with schizophrenia may become salient with aging. While animal-assisted therapy (AAT) can benefit physical function in older adults and improve symptoms of psychotic disorders, the effect of AAT on middle-aged patients with schizophrenia is unclear. The current randomized controlled trial aimed to explore the efficacy of AAT for middle-aged patients with schizophrenia. Forty participants were randomly assigned to either the AAT or control group. The AAT group participated in one-hour sessions with dog-assisted group activities once a week for 12 weeks. The controls participated in dose-matched, non-animal-related recreational activities. Both groups remained on their usual psychotropic medication during the trial. Evaluations included the Chair Stand Test (CST), Timed Up-and-Go (TUG) test, Montreal Cognitive Assessment (MoCA), 5-Meter walk test (5MWT), and Assessment of Communication and Interaction Skills (ACIS). The increases in CST repetitions and ACIS scores were larger in the AAT group than in the controls. The two groups did not differ significantly in MoCA scores, TUG performance, or the 5MWT. The AAT group showed a greater increase in lower extremity strength and social skills, but no improvement in cognitive function, agility, or mobility. Further research with more sensitive evaluations and longer follow-up is needed.
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Affiliation(s)
- Chyi-Rong Chen
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833401, Taiwan; (C.-R.C.); (C.-F.H.); (W.-T.T.)
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei 100025, Taiwan
- Department of Occupational Therapy, Shu-Zen Junior College of Medicine and Management, Kaohsiung 821004, Taiwan
| | - Chi-Fa Hung
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833401, Taiwan; (C.-R.C.); (C.-F.H.); (W.-T.T.)
- Department of Post-Baccalaureate Medicine, National Sun Yat-Sen University, Kaohsiung 804201, Taiwan
- College of Humanities and Social Sciences, National Pintung University of Science and Technology, Pingtung 912301, Taiwan
| | - Yi-Wen Lee
- Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833401, Taiwan;
| | - Wei-Ting Tseng
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833401, Taiwan; (C.-R.C.); (C.-F.H.); (W.-T.T.)
| | - Mei-Li Chen
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 112303, Taiwan;
- Professional Animal-Assisted Therapy Association of Taiwan, Taipei 112303, Taiwan
| | - Tzu-Ting Chen
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833401, Taiwan; (C.-R.C.); (C.-F.H.); (W.-T.T.)
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei 100025, Taiwan
- Professional Animal-Assisted Therapy Association of Taiwan, Taipei 112303, Taiwan
- Correspondence: or
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24
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Rodrigues JE, Martinho A, Santa C, Madeira N, Coroa M, Santos V, Martins MJ, Pato CN, Macedo A, Manadas B. Systematic Review and Meta-Analysis of Mass Spectrometry Proteomics Applied to Human Peripheral Fluids to Assess Potential Biomarkers of Schizophrenia. Int J Mol Sci 2022; 23:ijms23094917. [PMID: 35563307 PMCID: PMC9105255 DOI: 10.3390/ijms23094917] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/24/2022] [Accepted: 04/26/2022] [Indexed: 01/27/2023] Open
Abstract
Mass spectrometry (MS)-based techniques can be a powerful tool to identify neuropsychiatric disorder biomarkers, improving prediction and diagnosis ability. Here, we evaluate the efficacy of MS proteomics applied to human peripheral fluids of schizophrenia (SCZ) patients to identify disease biomarkers and relevant networks of biological pathways. Following PRISMA guidelines, a search was performed for studies that used MS proteomics approaches to identify proteomic differences between SCZ patients and healthy control groups (PROSPERO database: CRD42021274183). Nineteen articles fulfilled the inclusion criteria, allowing the identification of 217 differentially expressed proteins. Gene ontology analysis identified lipid metabolism, complement and coagulation cascades, and immune response as the main enriched biological pathways. Meta-analysis results suggest the upregulation of FCN3 and downregulation of APO1, APOA2, APOC1, and APOC3 in SCZ patients. Despite the proven ability of MS proteomics to characterize SCZ, several confounding factors contribute to the heterogeneity of the findings. In the future, we encourage the scientific community to perform studies with more extensive sampling and validation cohorts, integrating omics with bioinformatics tools to provide additional comprehension of differentially expressed proteins. The produced information could harbor potential proteomic biomarkers of SCZ, contributing to individualized prognosis and stratification strategies, besides aiding in the differential diagnosis.
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Affiliation(s)
- João E. Rodrigues
- CNC—Center for Neuroscience and Cell Biology, University of Coimbra, 3004-504 Coimbra, Portugal; (J.E.R.); (A.M.); (C.S.); (M.J.M.)
- CIBB—Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, 3004-504 Coimbra, Portugal; (M.C.); (V.S.)
| | - Ana Martinho
- CNC—Center for Neuroscience and Cell Biology, University of Coimbra, 3004-504 Coimbra, Portugal; (J.E.R.); (A.M.); (C.S.); (M.J.M.)
- CIBB—Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, 3004-504 Coimbra, Portugal; (M.C.); (V.S.)
| | - Catia Santa
- CNC—Center for Neuroscience and Cell Biology, University of Coimbra, 3004-504 Coimbra, Portugal; (J.E.R.); (A.M.); (C.S.); (M.J.M.)
- CIBB—Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, 3004-504 Coimbra, Portugal; (M.C.); (V.S.)
| | - Nuno Madeira
- Faculty of Medicine, University of Coimbra, 3004-504 Coimbra, Portugal;
- Psychiatry Department, Centro Hospitalar e Universitário de Coimbra, 3004-561 Coimbra, Portugal
- CIBIT—Coimbra Institute for Biomedical Imaging and Translational Research, University of Coimbra, 3000-548 Coimbra, Portugal
| | - Manuel Coroa
- CIBB—Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, 3004-504 Coimbra, Portugal; (M.C.); (V.S.)
- Faculty of Medicine, University of Coimbra, 3004-504 Coimbra, Portugal;
- Psychiatry Department, Centro Hospitalar e Universitário de Coimbra, 3004-561 Coimbra, Portugal
| | - Vítor Santos
- CIBB—Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, 3004-504 Coimbra, Portugal; (M.C.); (V.S.)
- Faculty of Medicine, University of Coimbra, 3004-504 Coimbra, Portugal;
- Psychiatry Department, Centro Hospitalar e Universitário de Coimbra, 3004-561 Coimbra, Portugal
| | - Maria J. Martins
- CNC—Center for Neuroscience and Cell Biology, University of Coimbra, 3004-504 Coimbra, Portugal; (J.E.R.); (A.M.); (C.S.); (M.J.M.)
- CIBB—Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, 3004-504 Coimbra, Portugal; (M.C.); (V.S.)
- Medical Services, University of Coimbra, 3004-517 Coimbra, Portugal
| | - Carlos N. Pato
- Department of Psychiatry and Behavioral Sciences, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA;
| | - Antonio Macedo
- Faculty of Medicine, University of Coimbra, 3004-504 Coimbra, Portugal;
- Psychiatry Department, Centro Hospitalar e Universitário de Coimbra, 3004-561 Coimbra, Portugal
- CIBIT—Coimbra Institute for Biomedical Imaging and Translational Research, University of Coimbra, 3000-548 Coimbra, Portugal
- Correspondence: (A.M.); (B.M.)
| | - Bruno Manadas
- CNC—Center for Neuroscience and Cell Biology, University of Coimbra, 3004-504 Coimbra, Portugal; (J.E.R.); (A.M.); (C.S.); (M.J.M.)
- CIBB—Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, 3004-504 Coimbra, Portugal; (M.C.); (V.S.)
- III Institute for Interdisciplinary Research, University of Coimbra (IIIUC), 3030-789 Coimbra, Portugal
- Correspondence: (A.M.); (B.M.)
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25
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Monji A, Mizoguchi Y. Neuroinflammation in Late-Onset Schizophrenia: Viewing from the Standpoint of the Microglia Hypothesis. Neuropsychobiology 2022; 81:98-103. [PMID: 34515181 DOI: 10.1159/000517861] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 06/14/2021] [Indexed: 11/19/2022]
Abstract
Schizophrenia develops mainly in adolescence, but late-onset schizophrenia (LOS) is not uncommon. According to the international consensus, schizophrenia which develops over 40 years old is called LOS and psychosis which develops over 60 years old is called very late-onset schizophrenia-like psychosis (VLOS). Compared to early-onset schizophrenia (EOS) that develops before the age of 40 years, LOS and VLOS are reported to be more common in women, and there are clinically clear differences such as less involvement of genetic factors than EOS. This review outlines the abnormalities of the neuroimmune system in the pathophysiology of LOS, especially focusing on the role of microglia.
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Affiliation(s)
- Akira Monji
- Department of Psychiatry, Faculty of Medicine, Saga University, Saga, Japan
| | - Yoshito Mizoguchi
- Department of Psychiatry, Faculty of Medicine, Saga University, Saga, Japan
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26
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Abo El-Enin HA, Ahmed MF, Naguib IA, El-Far SW, Ghoneim MM, Alsalahat I, Abdel-Bar HM. Utilization of Polymeric Micelles as a Lucrative Platform for Efficient Brain Deposition of Olanzapine as an Antischizophrenic Drug via Intranasal Delivery. Pharmaceuticals (Basel) 2022; 15:ph15020249. [PMID: 35215361 PMCID: PMC8877317 DOI: 10.3390/ph15020249] [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: 01/20/2022] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 12/10/2022] Open
Abstract
Schizophrenia is a mental disorder characterized by alterations in cognition, behavior and emotions. Oral olanzapine (OZ) administration is extensively metabolized (~up to 40% of the administrated dose). In addition, OZ is a P-glycoproteins substrate that impairs the blood–brain barrier (BBB) permeability. To direct OZ to the brain and to minimize its systemic side effects, the nasal pathway is recommended. OZ-loaded polymeric micelles nano-carriers were developed using suitable biodegradable excipients. The developed micelles were physicochemically investigated to assess their appropriateness for intranasal delivery and the potential of these carriers for OZ brain targeting. The selected formula will be examined in vivo for improving the anti-schizophrenic effects on a schizophrenia rat model. The binary mixture of P123/P407 has a low CMC (0.001326% w/v), which helps in maintaining the formed micelles’ stability upon dilution. The combination effect of P123, P407 and TPGS led to a decrease in micelle size, ranging between 37.5–47.55 nm and an increase in the EE% (ranging between 68.22–86.84%). The selected OZ–PM shows great stability expressed by a suitable negative charge zeta potential value (−15.11 ± 1.35 mV) and scattered non-aggregated spherical particles with a particle size range of 30–40 nm. OZ–PM maintains sustained drug release at the application site with no nasal cytotoxicity. In vivo administration of the selected OZ–PM formula reveals improved CNS targeting and anti-schizophrenia-related deficits after OZ nasal administration. Therefore, OZ–PM provided safe direct nose-to-brain transport of OZ after nasal administration with an efficient anti-schizophrenic effect.
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Affiliation(s)
- Hadel A. Abo El-Enin
- Department of Pharmaceutics and Industrial Pharmacy, College of Pharmacy, Taif University, Taif 21944, Saudi Arabia
- Correspondence:
| | - Marwa F. Ahmed
- Department of Pharmaceutical Chemistry, College of Pharmacy, Taif University, Taif 21944, Saudi Arabia; (M.F.A.); (I.A.N.)
| | - Ibrahim A. Naguib
- Department of Pharmaceutical Chemistry, College of Pharmacy, Taif University, Taif 21944, Saudi Arabia; (M.F.A.); (I.A.N.)
| | - Shaymaa W. El-Far
- Division of Pharmaceutical Microbiology, Department of Pharmaceutics and Industrial Pharmacy, College of Pharmacy, Taif University, Taif 21944, Saudi Arabia;
| | - Mohammed M. Ghoneim
- Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Riyadh 13713, Saudi Arabia;
| | - Izzeddin Alsalahat
- UK Dementia Research Institute Cardiff, School of Medicine, Cardiff University, Cardiff CF24 1TP, UK;
| | - Hend Mohamed Abdel-Bar
- Department of Pharmaceutics, Faculty of Pharmacy, University of Sadat City, Sadat City 32897, Egypt;
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27
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Lavaud P, McMahon K, Sánchez Rico M, Hanon C, Alvarado JM, de Raykeer RP, Limosin F, Hoertel N. Long-term care utilization within older adults with schizophrenia: Associated factors in a multicenter study. Psychiatry Res 2022; 308:114339. [PMID: 34963089 DOI: 10.1016/j.psychres.2021.114339] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Data are scarce regarding the clinical factors associated with utilization of long-term care facilities among older adults with schizophrenia. In this multicenter study, we sought to examine potential clinical differences between older adults with schizophrenia who are living in a long-term care facility and their community-dwelling counterparts. METHOD We used data from the French Cohort of individuals with Schizophrenia Aged 55-years or more (CSA) study, a large multicenter sample of older adults with schizophrenia (N = 353). RESULTS The prevalence of long-term care utilization was 35.1% of older patients with schizophrenia. Living in a long term care facility was significantly and independently associated with higher level of depression (Adjusted odds ratio (AOR) [95%CI]=1.97 [1.06-3.64]), lower cognitive (AOR [95%CI]=0.94 [0.88-0.99]) and global functioning (AOR [95%CI]=0.97 [0.95-0.99]), greater lifetime number of hospitalizations in a psychiatric department (AOR [95%CI]=2.30 [1.18-4.50]), not having consulted a general practitioner in the past year (AOR [95%CI]=0.28 [0.0.14-0.56]), urbanicity (AOR [95%CI]=2.81 [1.37-5.80]), and older age (AOR [95%CI]=1.08 [1.03-1.13]). DISCUSSION Older patients with schizophrenia who live in long-term care facilities appear to belong to a distinct group, marked by a more severe course of illness with higher level of depression and more severe cognitive deficits than older patients with schizophrenia living in other settings. Our study highlights the need of early assessment and management of depression and cognitive deficits in this population and the importance of monitoring closely this vulnerable population.
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Affiliation(s)
- Pierre Lavaud
- AP-HP Center, University of Paris, Department of Psychiatry, Regional Resource Center of old age psychiatry, Issy-les-Moulineaux 92130, France.
| | - Kibby McMahon
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2213 Elba Street, Durham, NC, 27710, United States
| | - Marina Sánchez Rico
- AP-HP Center, University of Paris, Department of Psychiatry, Regional Resource Center of old age psychiatry, Issy-les-Moulineaux 92130, France
| | - Cécile Hanon
- AP-HP Center, University of Paris, Department of Psychiatry, Regional Resource Center of old age psychiatry, Issy-les-Moulineaux 92130, France
| | - Jesús M Alvarado
- Department of Psychobiology & Behavioral Sciences Methods, Faculty of Psychology, Universidad Complutense de Madrid, Campus de Somosaguas S/N, 28223 Pozuelo de Alarcon, Spain
| | - Rachel Pascal de Raykeer
- AP-HP Center, University of Paris, Department of Psychiatry, Regional Resource Center of old age psychiatry, Issy-les-Moulineaux 92130, France; Paris University, Paris, France
| | - Frédéric Limosin
- AP-HP Center, University of Paris, Department of Psychiatry, Regional Resource Center of old age psychiatry, Issy-les-Moulineaux 92130, France; INSERM 1266, Psychiatry and Neurosciences Center, Paris, France; Paris University, Paris, France
| | - Nicolas Hoertel
- AP-HP Center, University of Paris, Department of Psychiatry, Regional Resource Center of old age psychiatry, Issy-les-Moulineaux 92130, France; INSERM 1266, Psychiatry and Neurosciences Center, Paris, France; Paris University, Paris, France
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28
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Lange SMM, Meesters PD, Stek ML, Penninx BW, Rhebergen D. The 5-year outcome of subjective quality of life in older schizophrenia patients. Qual Life Res 2022; 31:2471-2479. [DOI: 10.1007/s11136-021-03062-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2021] [Indexed: 10/19/2022]
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29
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Lin G, Wu Z, Chen B, Zhang M, Wang Q, Liu M, Zhang S, Yang M, Ning Y, Zhong X. Altered Microstate Dynamics and Spatial Complexity in Late-Life Schizophrenia. Front Psychiatry 2022; 13:907802. [PMID: 35832599 PMCID: PMC9271628 DOI: 10.3389/fpsyt.2022.907802] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/03/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Resting-state EEG microstate and omega complexity analyses have been widely used to explore deviant brain function in various neuropsychiatric disorders. This study aimed to investigate the features of microstate dynamics and spatial complexity in patients with late-life schizophrenia (LLS). METHOD Microstate and omega complexity analyses were performed on resting-state EEG data from 39 in patients with LLS and compared with 40 elderly normal controls (NCs). RESULT The duration of microstate classes A and D were significantly higher in patients with LLS compared with NCs. The occurrence of microstate classes A, B, and C was significantly lower in patients with LLS compared with NCs. LLS patients have a lower time coverage of microstate class A and a higher time coverage of class D than NCs. Transition probabilities from microstate class A to B and from class A to C were significantly lower in patients with LLS compared with NCs. Transition probabilities between microstate class B and D were significantly higher in patients with LLS compared with NCs. Global omega complexity and anterior omega complexity were significantly higher in patients with LLS compared with NCs. CONCLUSION This study revealed an altered pattern of microstate dynamics and omega complexity in patients with LLS. This may reflect the disturbed neural basis underlying LLS and enhance the understanding of the pathophysiology of LLS.
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Affiliation(s)
- Gaohong Lin
- Center for Geriatric Neuroscience, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhangying Wu
- Center for Geriatric Neuroscience, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ben Chen
- Center for Geriatric Neuroscience, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Min Zhang
- Center for Geriatric Neuroscience, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qiang Wang
- Center for Geriatric Neuroscience, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Meiling Liu
- Center for Geriatric Neuroscience, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Si Zhang
- Center for Geriatric Neuroscience, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Mingfeng Yang
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yuping Ning
- Center for Geriatric Neuroscience, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.,The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Xiaomei Zhong
- Center for Geriatric Neuroscience, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
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Abstract
OBJECTIVE While there is considerable current emphasis on youth and early psychosis, relatively little is known about the lives of people who live with psychotic disorders into middle age and beyond. We investigated social functioning, physical health status, substance use and psychiatric symptom profile in people with psychotic disorders aged between 50 and 65 years. METHODS Data were collected as part of the Survey of High Impact Psychosis, a population-based survey of Australians aged 18-65 years with a psychotic disorder. We compared those aged 50-65 years (N = 347) with those aged 18-49 years (N = 1478) across a range of measures. RESULTS The older group contained more women and more people with affective psychoses compared to the younger group. They were also more likely to have had a later onset and a chronic course of illness. The older group were more likely to have negative symptoms but less likely to exhibit positive symptoms; they also had lower current cognition, compared to the younger group. Compared to the younger group, the older group were more likely to be divorced/separated, to be living alone and to be unemployed. They had substantially lower lifetime use of alcohol and illicit substances, but rates of obesity, metabolic syndrome and diabetes mellitus were higher. CONCLUSION Our findings suggest that the characteristics of people with psychosis change significantly as they progress into the middle age and beyond. A better understanding of these differences is important in informing targeted treatment strategies for older people living with psychosis.
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Affiliation(s)
- Cherrie Galletly
- Interim Dean and Discipline of Psychiatry, Department of Medical Specialties, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
- Northern Adelaide Local Health Network (NALHN), Lyell McEwin Hospital, Adelaide, SA, Australia
- Ramsay Health Care (SA) Mental Health Services, The Adelaide Clinic, Gilberton, Australia
| | - Shuichi Suetani
- Physical and Mental Health Stream, Queensland Centre for Mental Health Research, Brisbane, QLD, Australia
- Queensland Brain Institute, The University of Queensland, St Lucia, QLD, Australia
- Metro South Addiction and Mental Health Services, Woolloongabba, QLD, Australia
- Department of Medicine, Griffith University, Nathan, QLD, Australia
| | - Lisa Hahn
- Ramsay Health Care (SA) Mental Health Services, The Adelaide Clinic, Gilberton, Australia
| | - Duncan McKellar
- Northern Adelaide Local Health Network (NALHN), Lyell McEwin Hospital, Adelaide, SA, Australia
- Office of the Chief Psychiatrist, SA Department of Health and Wellbeing, Adelaide, SA, Australia
| | - David Castle
- The University of Melbourne, Department of Psychiatry Melbourne, VIC, Australia
- St Vincent's Health Australia, Melbourne, VIC, Australia
- Scientific Director, Centre for Complex Interventions, Centre for Addictions and Mental Health; and Professor, Department of Psychiatry, University of Toronto, Toronto, Canada
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31
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Huo L, Lu X, Wu F, Chang C, Ning Y, Zhang XY. Elevated activity of superoxide dismutase in male late-life schizophrenia and its correlation with clinical symptoms and cognitive deficits. BMC Psychiatry 2021; 21:606. [PMID: 34863137 PMCID: PMC8642951 DOI: 10.1186/s12888-021-03604-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 11/15/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Despite inconsistent findings, accumulative evidence has shown abnormalities of the key antioxidant enzyme, superoxide dismutase (SOD), in patients with schizophrenia. However, few studies explored SOD in late-life schizophrenia (LLS). Our work aimed to investigate changes in SOD activity and the relationship between SOD activity and psychotic symptoms or cognitive deficits in LLS. METHODS 32 geriatric male patients with schizophrenia (age ≥ 60) and 28 age-matched male normal controls were recruited in the study. We assessed cognitive functions with the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), evaluated the severity of clinical symptoms with the Positive and Negative Syndrome Scale (PANSS), and measured the plasma levels of SOD. RESULTS Patients with LLS presented with higher total levels of SOD compared to the controls (81.70 vs. 65.26 U/ml, p < .001). Except for the visuospatial index, the cognitive performance was significantly worse on RBANS total and other domain scores in the schizophrenia group than the control group. In the schizophrenia group, SOD levels were positively correlated with subscores of general psychopathology and negative symptoms and total scores of the PANSS (all p < .05), and inversely associated with performance in immediate memory, language, and RBANS total scores (all p < .05). CONCLUSIONS Our findings suggest that patients with LLS display disturbances in the antioxidant system, which may underlie the pathological process of cognitive impairments and negative symptoms in the late stage of schizophrenia. Supplementing with antioxidants could be a potential treatment.
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Affiliation(s)
- Lijuan Huo
- grid.410737.60000 0000 8653 1072Department of Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, 510000 China ,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, 510000 China
| | - Xiaobing Lu
- grid.410737.60000 0000 8653 1072Department of Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, 510000 China ,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, 510000 China
| | - Fengchun Wu
- grid.410737.60000 0000 8653 1072Department of Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, 510000 China ,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, 510000 China
| | - Catherine Chang
- grid.267308.80000 0000 9206 2401Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX USA
| | - Yuping Ning
- grid.410737.60000 0000 8653 1072Department of Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, 510000 China ,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, 510000 China ,grid.284723.80000 0000 8877 7471The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xiang Yang Zhang
- Department of Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, 510000, China. .,CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing, 100101, China.
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32
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Five-year outcome of clinical recovery and subjective well-being in older Dutch patients with schizophrenia. Int Psychogeriatr 2021; 33:1099-1103. [PMID: 34399866 DOI: 10.1017/s1041610221000855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Outcome of schizophrenia in later life can be evaluated from different perspectives. The recovery concept has moved forward this evaluation, discerning clinical-based and patient-based definitions. Longitudinal data on measures of recovery in older individuals with schizophrenia are scant. This study evaluated the five-year outcome of clinical recovery and subjective well-being in a sample of 73 older Dutch schizophrenia patients (mean age 65.9 years; SD 5.4), employing a catchment-area based design that included both community living and institutionalized patients regardless of the age of onset of their disorder. At baseline (T1), 5.5% of participants qualified for clinical recovery, while at five-year follow-up (T2), this rate was 12.3% (p = 0.18; exact McNemar's test). Subjective well-being was reported by 20.5% of participants at T1 and by 27.4% at T2 (p = 0.27; exact McNemar's test). Concurrence of clinical recovery and subjective well-being was exceptional, being present in only one participant (1.4%) at T1 and in two participants (2.7%) at T2. Clinical recovery and subjective well-being were not correlated neither at T1 (p = 0.82; phi = 0.027) nor at T2 (p = 0.71; phi = -0.044). There was no significant correlation over time between clinical recovery at T1 and subjective well-being at T2 (p = 0.30; phi = 0.122) nor between subjective well-being at T1 and clinical recovery at T2 (p = 0.45; phi = -0.088). These results indicate that while reaching clinical recovery is relatively rare in older individuals with schizophrenia, it is not a prerequisite to experience subjective well-being.
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Abou Kassm S, Limosin F, Naja W, Vandel P, Sánchez-Rico M, Alvarado JM, von Gunten A, Hoertel N. Late-onset and nonlate-onset schizophrenia: A comparison of clinical characteristics in a multicenter study. Int J Geriatr Psychiatry 2021; 36:1204-1215. [PMID: 33580724 DOI: 10.1002/gps.5512] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 01/31/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Data are scarce regarding the potential clinical differences between non-late onset schizophrenia (NLOS, i.e., disorder occurring before 40 years of age), late-onset schizophrenia (LOS, occurring between ages 40 and 60 years) and very-late-onset schizophrenia-like psychosis (VLOSLP, occurring after 60 years of age). Furthermore, previous research compared LOS patients with non-age matched NLOS patients. In this study, we sought to examine potential clinical differences between patients of similar age with LOS and NLOS. METHODS/DESIGN This is a cross-sectional multicentre study that recruited in- and outpatients older adults (aged ≥55 years) with an ICD-10 diagnosis of schizophrenia or schizoaffective disorder with NLOS and LOS. Sociodemographic and clinical characteristics, comorbidity, psychotropic medications, quality of life, functioning, and mental health care utilization were drawn for comparison. RESULTS Two hundred seventy-two participants (79.8%) had NLOS, 61 (17.9%) LOS, and 8 (2.3%) VLOSLP. LOS was significantly and independently associated with greater severity of emotional withdrawal and lower severity of depression (all p < 0.05). However, the magnitude of these associations was modest, with significant adjusted odds ratios ranging from 0.71 to 1.24, and there were no significant between-group differences in other characteristics. CONCLUSION In an age-matched multicenter sample of elderly patients with schizophrenia, older adults with LOS were largely similar to older adults with NLOS in terms of clinical characteristics. The few differences observed may be at least partially related to symptom fluctuation with time. Implications of these findings for pharmacological and nonpharmacological management is yet to be determined.
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Affiliation(s)
- Sandra Abou Kassm
- Department of Psychiatry, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Frédéric Limosin
- Département de Psychiatrie, Institut de Psychiatrie et Neurosciences de Paris (IPNP), Université de Paris, AP-HP, Hôpital Corentin-Celton, DMU Psychiatrie et Addictologie, INSERM, Issy-les-Moulineaux, France
| | - Wadih Naja
- Department of Psychiatry, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Pierre Vandel
- Centre d'investigation Clinique-Innovation Technologique CIC-IT 1431, Inserm, CHRU Besançon, Besançon, France.,Neurosciences intégratives et cliniques EA 481, Univ. Franche-Comté, Univ. Bourgogne Franche-Comté, Besançon, France.,Service de psychiatrie de l'adulte, Centre Mémoire de Ressource et de Recherche de Franche-Comté, CHRU Besançon, Besançon, France
| | - Marina Sánchez-Rico
- Département de Psychiatrie, Institut de Psychiatrie et Neurosciences de Paris (IPNP), Université de Paris, AP-HP, Hôpital Corentin-Celton, DMU Psychiatrie et Addictologie, INSERM, Issy-les-Moulineaux, France.,Department of Psychobiology & Behavioral Sciences Methods, Faculty of Psychology, Universidad Complutense de Madrid, Campus de Somosaguas S/N, Pozuelo de Alarcon, Spain
| | - Jesús M Alvarado
- Department of Psychobiology & Behavioral Sciences Methods, Faculty of Psychology, Universidad Complutense de Madrid, Campus de Somosaguas S/N, Pozuelo de Alarcon, Spain
| | - Armin von Gunten
- Department of Psychiatry, Service of Old Age Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | - Nicolas Hoertel
- Département de Psychiatrie, Institut de Psychiatrie et Neurosciences de Paris (IPNP), Université de Paris, AP-HP, Hôpital Corentin-Celton, DMU Psychiatrie et Addictologie, INSERM, Issy-les-Moulineaux, France
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Hoertel N, Rotenberg L, Blanco C, Camus V, Dubertret C, Charlot V, Schürhoff F, Vandel P, Limosin F. A comprehensive model of predictors of quality of life in older adults with schizophrenia: results from the CSA study. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1411-1425. [PMID: 32415431 DOI: 10.1007/s00127-020-01880-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 05/02/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Numerous factors are known to influence quality of life of adults with schizophrenia. However, little is known regarding the potential predictors of quality of life in the increasing population of older adults with schizophrenia. The main objective of the present study was to propose a comprehensive model of quality of life in this specific population. METHODS Data were derived from the Cohort of individuals with Schizophrenia Aged 55 years or more (CSA) study, a large (N = 353) multicenter sample of older adults with schizophrenia or schizoaffective disorder recruited from French community mental-health teams. We used structural equation modeling to simultaneously examine the effects of six broad groups of clinical factors previously identified as potential predictors of quality of life in this population, including (1) severity of general psychopathology, (2) severity of depression, (3) severity of cognitive impairment, (4) psychotropic medications, (5) general medical conditions and (6) sociodemographic characteristics. RESULTS General psychopathology symptoms, and in particular negative and depressive symptoms, cognitive impairment, reduced overall functioning and low education were significantly and independently associated with diminished quality of life (all p < 0.05). Greater number of medical conditions and greater number of antipsychotics were also independently and negatively associated with quality of life, although these associations did not reach statistical significance in sensitivity analyses, possibly due to limited statistical power. CONCLUSION Several domains are implicated in quality of life among older adults with schizophrenia. Interventions targeting these factors may help improve importantly quality of life of this vulnerable population.
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Affiliation(s)
- Nicolas Hoertel
- DMU Psychiatrie et Addictologie, Service de Psychiatrie et d'Addictologie de l'Adulte et du Sujet Âgé, Centre Ressource Régional de Psychiatrie du Sujet Agé (CRRPSA), Hôpital Corentin Celton, AP-HP.Centre, Université de Paris, Paris, France. .,Inserm U1266, Institut de Psychiatrie et Neurosciences de Paris, Paris, France. .,Faculté de Médecine Paris Descartes, Université de Paris, Paris, France.
| | - Léa Rotenberg
- DMU Psychiatrie et Addictologie, Service de Psychiatrie et d'Addictologie de l'Adulte et du Sujet Âgé, Centre Ressource Régional de Psychiatrie du Sujet Agé (CRRPSA), Hôpital Corentin Celton, AP-HP.Centre, Université de Paris, Paris, France
| | - Carlos Blanco
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Bethesda, MD, USA
| | | | - Caroline Dubertret
- Inserm U1266, Institut de Psychiatrie et Neurosciences de Paris, Paris, France.,Department of Psychiatry, AP-HP, Louis Mourier Hospital, Colombes, France.,Faculté de médecine Paris Diderot, Université de Paris, Paris, France
| | - Véronique Charlot
- Department of Psychiatry, AP-HP, Louis Mourier Hospital, Colombes, France.,Faculté de médecine Paris Diderot, Université de Paris, Paris, France
| | - Franck Schürhoff
- AP-HP, DHU PePSY, Hôpitaux Universitaires Henri-Mondor, Pôle de Psychiatrie, 94000, Créteil, France.,Inserm, U955, Team 15, 94000, Créteil, France.,Fondation FondaMental, 94000, Créteil, France.,Faculté de médecine, UPEC, Université Paris-Est, 94000, Créteil, France
| | - Pierre Vandel
- Centre d'investigation Clinique-Innovation Technologique CIC-IT 1431, Inserm, CHRU Besançon, 25000, Besançon, France.,Neurosciences Intégratives et Cliniques EA 481, Université Franche-Comté, Université Bourgogne Franche-Comté, 25000, Besançon, France.,Service de Psychiatrie de l'adulte, CHRU Besançon, 25000, Besançon, France.,Centre Mémoire de Ressource et de Recherche de Franche-Comté, CHRU Besançon, 25000, Besançon, France
| | - Frédéric Limosin
- DMU Psychiatrie et Addictologie, Service de Psychiatrie et d'Addictologie de l'Adulte et du Sujet Âgé, Centre Ressource Régional de Psychiatrie du Sujet Agé (CRRPSA), Hôpital Corentin Celton, AP-HP.Centre, Université de Paris, Paris, France.,Inserm U1266, Institut de Psychiatrie et Neurosciences de Paris, Paris, France.,Faculté de Médecine Paris Descartes, Université de Paris, Paris, France
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Hsu MC, Lee SC, Ouyang WC. Use of Charlson Comorbidity Index and Nomogram to Predict Mortality in Elderly Patients with Late-Life Schizophrenia. Healthcare (Basel) 2021; 9:healthcare9070783. [PMID: 34206232 PMCID: PMC8304975 DOI: 10.3390/healthcare9070783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 12/29/2022] Open
Abstract
Objectives: Comorbid illness burden signifies a poor prognosis in schizophrenia. The aims of this study were to estimate the severity of comorbidities in elderly patients with schizophrenia, determine risk factors associated with mortality, and establish a reliable nomogram for predicting 1-, 3- and 5-year mortality and survival. Methods: This population-based study rigorously selected schizophrenia patients (≥65 years) having their first admission due to schizophrenia during the study period (2000–2013). Comorbidity was scored using the updated Charlson Comorbidity Index (CCI). Results: This study comprised 3827 subjects. The mean stay of first admission due to schizophrenia was 26 days. Mean numbers of schizophrenia and non-schizophrenia-related hospitalization (not including the first admission) were 1.80 and 3.58, respectively. Mean ages at death were 73.50, 82.14 and 89.32 years old, and the mean times from first admission to death were 4.24, 3.33, and 1.87 years in three different age groups, respectively. Nearly 30% were diagnosed with ≥3 comorbidities. The most frequent comorbidities were dementia, chronic pulmonary disease and diabetes. The estimated 1-, 3- and 5-year survival rates were 90%, 70%, and 64%, respectively. Schizophrenia patients with comorbid diseases are at increased risk of hospitalization and mortality (p < 0.05). Conclusion: The nomogram, composed of age, sex, the severity of comorbidity burden, and working type could be applied to predict mortality risk in the extremely fragile patients.
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Affiliation(s)
- Mei-Chi Hsu
- Department of Nursing, I-Shou University, Kaohsiung 82445, Taiwan;
| | - Shang-Chi Lee
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan;
| | - Wen-Chen Ouyang
- Department of Geriatric Psychiatry, Jianan Psychiatric Center, Ministry of Health and Welfare, Tainan 71742, Taiwan
- Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung 82144, Taiwan
- Department of Psychiatry, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Correspondence: ; Tel.: +886-6-2795019
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Walker VG, Walker EK. Older Adults Diagnosed With Schizophrenia in Long-term Care Facilities: Life Course Theory for Holistic Nursing Research and Practice. J Holist Nurs 2021; 40:181-192. [PMID: 34106020 DOI: 10.1177/08980101211025372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Older adults diagnosed with schizophrenia (OADWS) often enter long-term care facilities with unique challenges related to trauma and stress experienced throughout their life course. Health care workers often report that when they work with this population, they feel unprepared due to limited training. In this article, life course theory is presented as a lens for holistic nursing research and as a way for nurses to adapt interventions already used with cognitively impaired older adults (e.g., those diagnosed with Alzheimer's disease) for OADWS in long-term care. It is hoped that these ideas will facilitate discussion of ways to inform training for holistic long-term care of OADWS. Holistic principles of nursing addressed with life course theory as a lens include the following: (a) accounting for strengths and challenges; (b) honoring experiences, values, and health beliefs; (c) viewing interrelationships with the environment; and (d) nurturing of peace, wholeness, and healing.
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"Moving forward despite adversity": The lives of Korean older adults with schizophrenia. Arch Psychiatr Nurs 2021; 35:243-249. [PMID: 33966787 DOI: 10.1016/j.apnu.2021.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 02/13/2021] [Accepted: 02/20/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Older adults with schizophrenia experience aging-related challenges and chronic psychiatric difficulties. However, their uniqueness is understudied. Aim This study explored three life stories to illuminate schizophrenia's trajectory. METHOD A narrative inquiry method was used to elicit rich narratives in chronic patients' lives. Two men and one woman suffering from chronic schizophrenia for more than 20 years were engaged in conversation three times. RESULTS The analysis revealed one main theme expressing their fundamental perspective on their lives: "moving forward despite adversity." Three subthemes emerged: living with the mental disorder, giving and receiving support, and adaptation to old age. They reflected on their interpersonal relationships, failures, and successes in the context of the challenges of schizophrenia. They indicated adapting to schizophrenia, exchanging social support with loved ones, and meeting aging-related challenges with confidence. They were hopeful about brighter personal futures than their pasts. DISCUSSION Family and community supports were very important; self-acceptance positively influenced their successful community living. IMPLICATIONS FOR PRACTICE For effective long-term treatment of older adults with schizophrenia, mental health policies should focus on meeting the social needs of patients and families and reorient programs away from the medical model limited to symptom reduction.
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Abstract
PURPOSE OF REVIEW The aim of this review was to summarize the recent literature on the clinical symptoms, functioning, outcomes and treatments for older adults with chronic schizophrenia. RECENT FINDINGS The number and proportion of older adults with schizophrenia is rapidly increasing. Schizophrenia is a heterogeneous disorder and older adults with schizophrenia display significant variability in symptom severity, quality of life and overall outcomes. Many achieve stable disease remission, some display persistent nonremission and others experience fluctuating symptoms. Depression is commonly reported, and although rates of suicide are higher when compared with age-matched peers, the excess mortality seen in this population is mainly attributed to natural causes of death. Cognitive decline and reduced illness awareness have important implications for functional status and quality of life. Antipsychotics remain essential in the treatment regimen, although elderly patients with chronic disease may be good candidates for gradual dose reduction. Interdisciplinary treatment approaches as well as nonpharmacologic psychosocial interventions play a critical adjunctive role in the treatment of older adults with schizophrenia. SUMMARY Research focusing on schizophrenia in late life is sparse. Too often, older patients are eliminated from research studies or averaged in with all age groups. Thus, there continues to be gaps in our understanding of modifiable predictors of remission and recovery, and the most efficacious and safest treatment approaches for this age group.
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Chen PH, Tsai SY, Pan CH, Chang HM, Chen YL, Su SS, Chen CC, Kuo CJ. Age Effect on Incidence, Physical, and Psychiatric Comorbidity for Sudden Cardiac Death in Schizophrenia: Effet de l'âge sur l'incidence, la comorbidité physique et psychiatrique de la mort cardiaque subite dans la schizophrénie. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:367-375. [PMID: 32799653 PMCID: PMC8172351 DOI: 10.1177/0706743720948429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The pathogenesis of sudden cardiac death may differ between younger and older adults in schizophrenia, but evidence remains scant. This study investigated the age effect on the incidence and risk of the physical and psychiatric comorbidity for sudden cardiac death. METHODS Using 2000 to 2016 data from the Taiwan National Health Insurance Research Database and Department of Health Death Certification System, we identified a national cohort of 170,322 patients with schizophrenia, 1,836 of whom had a sudden cardiac death. Standardized mortality ratios (SMRs) were estimated. Hazard ratios and population attributable fractions of distinctive comorbidities for sudden cardiac death were assessed. RESULTS The SMRs of sudden cardiac death were all >1.00 across each age group for both sexes, with the highest SMR in male patients aged <35 years (30.88, 95% CI: 26.18-36.18). The fractions of sudden cardiac death attributable to hypertension and congestive heart failure noticeably increased with age. By contrast, the fraction attributable to drug-induced mental disorder decreased with age. Additionally, chronic hepatic disease and sleep disorder increased the risk of sudden cardiac death in patients aged <35 years. Dementia and organic mental disorder elevated the risk in patients aged between 35-54 years. Ischemic heart disease raised the risk in patients aged ≥55 years. CONCLUSIONS The risk is increased across the lifespan in schizophrenia, particularly for younger male patients. Furthermore, physical and psychiatric comorbidities have age-dependent risks. The findings suggest that prevention strategies targeted toward sudden cardiac death in patients with schizophrenia must consider the age effect.
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Affiliation(s)
- Pao-Huan Chen
- Department of Psychiatry, 63474Taipei Medical University Hospital, Taipei.,Psychiatric Research Center, 63474Taipei Medical University Hospital, Taipei.,Department of Psychiatry, School of Medicine, College of Medicine, 63474Taipei Medical University, Taipei
| | - Shang-Ying Tsai
- Department of Psychiatry, 63474Taipei Medical University Hospital, Taipei.,Psychiatric Research Center, 63474Taipei Medical University Hospital, Taipei.,Department of Psychiatry, School of Medicine, College of Medicine, 63474Taipei Medical University, Taipei
| | - Chun-Hung Pan
- Taipei City Psychiatric Center, 433112Taipei City Hospital, Taipei.,Department of Psychology, National Chengchi University, Taipei
| | - Hu-Ming Chang
- Taipei City Psychiatric Center, 433112Taipei City Hospital, Taipei
| | - Yi-Lung Chen
- Taipei City Psychiatric Center, 433112Taipei City Hospital, Taipei
| | - Sheng-Siang Su
- Taipei City Psychiatric Center, 433112Taipei City Hospital, Taipei
| | - Chiao-Chicy Chen
- Department of Psychiatry, School of Medicine, College of Medicine, 63474Taipei Medical University, Taipei.,Department of Psychiatry, 36897Mackay Memorial Hospital, Taipei.,Department of Psychiatry, Mackay Medical College, Taipei
| | - Chian-Jue Kuo
- Psychiatric Research Center, 63474Taipei Medical University Hospital, Taipei.,Department of Psychiatry, School of Medicine, College of Medicine, 63474Taipei Medical University, Taipei.,Taipei City Psychiatric Center, 433112Taipei City Hospital, Taipei
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40
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Huq R, Mithani F, Cullum S, Chacko R. An atypical progression of schizophrenia in an elderly woman. Proc (Bayl Univ Med Cent) 2021; 34:321-322. [DOI: 10.1080/08998280.2020.1834906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Rukan Huq
- College of Medicine, Texas A&M Health Science Center, Bryan, Texas
- Department of Psychiatry, Houston Methodist Hospital, Houston, Texas
| | - Farhan Mithani
- College of Medicine, Texas A&M Health Science Center, Bryan, Texas
- Department of Psychiatry, Houston Methodist Hospital, Houston, Texas
| | - Stav Cullum
- College of Medicine, Texas A&M Health Science Center, Bryan, Texas
- Department of Psychiatry, Houston Methodist Hospital, Houston, Texas
| | - Ranjit Chacko
- Department of Psychiatry, Houston Methodist Hospital, Houston, Texas
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Impact of age and gender on paliperidone exposure in patients after administration of long-acting injectable formulations-an observational study using blood samples from 1223 patients. Eur J Clin Pharmacol 2021; 77:1201-1208. [PMID: 33616704 DOI: 10.1007/s00228-021-03114-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/13/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Paliperidone palmitate is an antipsychotic medication available as long-acting injectable (LAI) formulations. The aim of this study was to investigate the effect of age and gender on paliperidone exposure after administration of LAI formulations. METHODS Data on serum concentrations of paliperidone from patients using LAI during were included retrospectively from a therapeutic drug monitoring (TDM) service. Information about dose was obtained from the requisition forms. As a measure of exposure, daily dose-adjusted serum concentration (C/D ratio) was used. Based on initial analysis of C/D ratios versus age, a breaking point close to 50 years was observed, thus deciding the grouping of patients as older (≥50 years) or younger (15-49 years). Linear mixed model analyses, allowing multiple measurements per patients, were used. RESULTS In total, 1223 patients were included, whereof 1158 patients used paliperidone LAI in once-monthly intervals. In these patients (27.9% older), older patients had significantly higher paliperidone C/D ratio than younger patients (+20%, p<0.001). Compared to males, females had higher C/D ratio (+14%; p<0.001). Subsequently, older female users of once-monthly LAI intervals had 41% higher paliperidone C/D ratios compared to younger males (15.0 vs. 21.2 nM/mg; p<0.001). Compared to females aged 21-30 years, females with high age (≥70 years) had at least 105% higher paliperidone C/D ratio (p<0.001). CONCLUSION The present study shows that older age and female gender are associated with higher paliperidone exposure than younger age and males, respectively. Particularly, older female patients (>50 years) are likely exposed to high concentration and cautious dosing in this subgroup is required.
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Khan WU, Ghazala Z, Brooks HJ, Subramaniam P, Mulsant BH, Kumar S, Voineskos AN, Blumberger DM, Kern RS, Rajji TK. The Impact of Anticholinergic Burden on Functional Capacity in Persons With Schizophrenia Across the Adult Life Span. Schizophr Bull 2021; 47:249-257. [PMID: 32619225 PMCID: PMC7825090 DOI: 10.1093/schbul/sbaa093] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Anticholinergic burden (ACB) from medications impairs cognition in schizophrenia. Cognition is a predictor of functional capacity; however, little is known about ACB effect on functional capacity in this population. This study assesses the relationship between ACB and functional capacity across the life span in individuals with schizophrenia after controlling for ACB effect on cognition. A cross-sectional analysis was performed with data collected from 6 academic tertiary health centers. Two hundred and twenty-three community-dwelling participants with schizophrenia or schizoaffective disorder were included in this study. Main variables were ACB, antipsychotic olanzapine equivalents, functional capacity, cognition, and negative symptoms. Simultaneous linear regression analyses were performed to assess the association between ACB, functional capacity, and cognition and then between ACB and cognition. A mediation analysis was then performed to examine whether cognition mediated ACB effect on functional capacity if there was an association between ACB and cognition. Mean age of participants was 49.0 years (SD = 13.1, range 19-79), and 63.7% of participants had severe ACB, ie, a total score of 3 or above. Regression analyses revealed that ACB, age, education, and cognition independently predicted functional capacity and that ACB predicted cognition among those aged 55 years and older. Mediation analysis showed that cognition did partially mediate the effect of ACB on functional capacity in this older cohort. In conclusion, people with schizophrenia are exposed to severe ACB that can have a direct negative impact on functional capacity after controlling for its impact on cognition. Reducing ACB could improve functional capacity and potentially real-world function in schizophrenia.
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Affiliation(s)
- Waqas Ullah Khan
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Zaid Ghazala
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Ponnusamy Subramaniam
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Benoit H Mulsant
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sanjeev Kumar
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Aristotle N Voineskos
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Daniel M Blumberger
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Robert S Kern
- Department of Psychiatry, University of California–Los Angeles, Los Angeles, CA
- Department of Veterans Affairs, VISN 22 Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Tarek K Rajji
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Howard EP, Martin L, Heckman GA, Morris JN. Does the Person-Centered Care Model Support the Needs of Long-Term Care Residents With Serious Mental Illness and Intellectual and Developmental Disabilities? Front Psychiatry 2021; 12:704764. [PMID: 34867509 PMCID: PMC8632811 DOI: 10.3389/fpsyt.2021.704764] [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: 05/03/2021] [Accepted: 10/07/2021] [Indexed: 11/13/2022] Open
Abstract
Person-centered care approaches continue to evolve in long-term care (LTC). At the same time, these settings have faced increased challenges due to a more diverse and complex population, including persons with intellectual and developmental disabilities (IDD) and serious mental illness (SMI). This study examined the mental, social, and physical wellbeing of residents with different diagnoses, within a person-centered care model. It was hypothesized that individual wellbeing would be comparable among all residents, regardless of primary diagnosis. The study cohort was drawn from all admissions to long-term care facilities in the USA from 2011 to 2013. Data are based on admission, 3 and 6 month follow-up Minimum Data Set (MDS) 3.0 assessments. The groups examined included: schizophrenia, other psychotic disorders, IDD, dementia, and all others (i.e., none of the above diagnoses). The wellbeing outcomes were depression (mental), pain (physical), and behaviors (social). All residents experienced improvements in pain and depression, though the group without the examined diagnoses experienced the greatest gains. Behaviors were most prevalent among those with psychotic disorders; though marked improvements were noted over time. Improvement also was noted among persons with dementia. Behavior worsened over time for the three other groups. In particular, those with IDD experienced the highest level of worsening at 3-month follow-up, and continued to worsen. The results suggest person-centered care in US nursing homes provides the necessary foundation to promote mental and physical wellbeing in persons with complex needs, but less so for social wellbeing.
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Affiliation(s)
- Elizabeth P Howard
- Connell School of Nursing, Boston College, Newton, MA, United States.,Hebrew SeniorLife, The Hinda and Arthur Marcus Institute for Aging Research, Boston, MA, United States
| | - Lynn Martin
- Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada.,Centre for Education and Research on Aging and Health, Thunder Bay, ON, Canada
| | - George A Heckman
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.,Schlegel-University of Waterloo Research Institute for Aging, Waterloo, ON, Canada
| | - John N Morris
- Hebrew SeniorLife, The Hinda and Arthur Marcus Institute for Aging Research, Boston, MA, United States
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Huo L, Zheng Z, Lu X, Wu F, Ning Y, Zhang XY. Decreased Peripheral BDNF Levels and Cognitive Impairment in Late-Life Schizophrenia. Front Psychiatry 2021; 12:641278. [PMID: 34239458 PMCID: PMC8257950 DOI: 10.3389/fpsyt.2021.641278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 05/14/2021] [Indexed: 02/04/2023] Open
Abstract
Objectives: There are relatively few studies on mechanisms of cognitive deficits in late-life schizophrenia (LLS). Brain-derived neurotrophic factor (BDNF), as an important neuroplastic molecule, has been reported to be involved in neurocognitive impairment in schizophrenia. This study aimed to examine whether peripheral BDNF levels were associated with cognitive deficits in LLS, which has not been explored yet. Methods: Forty-eight LLS patients and 45 age-matched elderly controls were recruited. We measured all participants on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) for cognition and serum BDNF levels. Psychopathological symptoms in patients were assessed by the Positive and Negative Syndrome Scale (PANSS). Results: The levels of BDNF in LLS patients were significantly lower than those in healthy controls (8.80 ± 2.30 vs. 12.63 ± 5.08 ng/ml, p < 0.001). The cognitive performance of LLS patients was worse than that of the controls on RBANS total score and scores of immediate memory, attention, language, and delayed memory (all p ≤ 0.005). BDNF was positively associated with attention in LLS patients (r = 0.338, p = 0.019). Conclusion: Our findings suggest that older patients with schizophrenia exhibit lower BDNF levels and more cognitive deficits than older controls, supporting the accelerated aging hypothesis of schizophrenia. Moreover, decreased BDNF is related to attention deficits, indicating that BDNF might be a candidate biomarker of cognitive impairments in LLS patients.
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Affiliation(s)
- Lijuan Huo
- Department of Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Zhiwei Zheng
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Xiaobing Lu
- Department of Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Fengchun Wu
- Department of Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Yuping Ning
- Department of Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China.,The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xiang Yang Zhang
- Department of Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
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Huang Y, Wu K, Jiang R, Zeng X, Zhou S, Guo W, Feng Y, Zou C, Li H, Li T, Ning Y, Yang M, Wu F. Suicide Attempts, Neurocognitive Dysfunctions and Clinical Correlates in Middle-Aged and Elderly Chinese Schizophrenia Patients. Front Psychiatry 2021; 12:684653. [PMID: 34122196 PMCID: PMC8192965 DOI: 10.3389/fpsyt.2021.684653] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/03/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Suicide is a common and complex symptom of schizophrenia that may be related to clinical variables and neurocognitive function. This study aimed to investigate the associated correlates of suicide attempts in Chinese middle-aged and elderly inpatients with schizophrenia, including demographic and clinical characteristics and cognitive level, which has not yet been reported. Methods: A total of 426 schizophrenia inpatients were recruited for this study. Clinical symptoms were evaluated using the Positive and Negative Syndrome Scale (PANSS). Neurocognitive function was measured by the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Results: The prevalence of suicide attempts in middle-aged and elderly Chinese schizophrenia patients was 13.3%. Female patients had a higher suicide rate than male patients. Patients with suicide attempts had significantly higher PANSS-positive subscores, depressive subscores, and RBANS-story recall than non-attempter patients (all p < 0.05). Multiple logistic regression showed that gender, positive subscore, depressive subscore and RBANS-story recall (OR = 1.10-2.19, p < 0.05) were independently associated with suicide attempts in middle-aged and elderly schizophrenia patients. Conclusions: Our study showed that the rate of suicide attempts in Chinese middle-aged and elderly schizophrenia patients is high. Compared to non-attempters, there are less cognitive impairments, more clinical symptoms, and more female patients in the suicide attempters.
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Affiliation(s)
- Yuanyuan Huang
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Kai Wu
- Department of Biomedical Engineering, School of Materials Science and Engineering, South China University of Technology (SCUT), Guangzhou, China
| | - Rui Jiang
- Qingdao Mental Health Center, Qingdao University, Qingdao, China
| | - Xiaoying Zeng
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.,New Growth of Guangzhou, Guangzhou, China
| | - Sumiao Zhou
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Weijian Guo
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yangdong Feng
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Caimei Zou
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Hehua Li
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ting Li
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuping Ning
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.,The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Mingzhe Yang
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Fengchun Wu
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.,The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
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Diabetes in late-life schizophrenia: Prevalence, factors, and association with clinical symptoms. J Psychiatr Res 2021; 132:44-49. [PMID: 33038565 DOI: 10.1016/j.jpsychires.2020.09.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 08/25/2020] [Accepted: 09/26/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The prevalence of diabetes mellitus has been found to be higher in patients with schizophrenia. Older patients are the fastest-growing segment of the schizophrenia population. However, few studies have explored diabetes in older patients with schizophrenia. Therefore, this study aimed to determine the prevalence and characteristics of factors associated with diabetes in Chinese patients with late-life schizophrenia (LLS), which has not been reported in previous studies. METHODS A total of 289 inpatients aged 60 or above who met the DSM-IV criteria for schizophrenia were recruited. The severity of psychopathology was assessed by the Positive and Negative Syndrome Scale (PANSS). Diabetes was diagnosed by fasting blood glucose tests, or oral glucose tolerance tests. RESULTS The overall prevalence of diabetes in LLS patients was 25.3%. The prevalence of diabetes in female patients was significantly higher than that in male patients (35% vs. 21.53%). Other factors associated with diabetes included higher BMI, greater waistline (only for males), higher levels of triglyceride, and more severe positive symptoms. CONCLUSION These results indicate that the prevalence of diabetes in LLS patients is similar to that in the age-matched general population. Female gender, excess weight and abdominal obesity, dyslipidemia, and clinical symptoms can be potential risk factors of diabetes in the LLS patient group.
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"Looking Forward": a qualitative evaluation of a physical activity program for middle-aged and older adults with serious mental illness. Int Psychogeriatr 2020; 32:1449-1456. [PMID: 31455434 PMCID: PMC7047554 DOI: 10.1017/s1041610218002004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Older adults with serious mental illness (SMI) often have poor physical health in addition to serious mental health issues. Sustained engagement in a group physical activity program may provide necessary physical and mental health benefits. The purpose of this report is to describe participants' feedback about a video game-based group physical activity program using the Kinect for Xbox 360 game system (Microsoft, Redmond, WA). In particular, we wanted to understand what worked about the program, what was not ideal, and how it impacted their lives. DESIGN Semi-structured interviews were collected and analyzed with grounded theory methodology. SETTING Mental health facility. PARTICIPANTS Sixteen older adults with SMI. MEASUREMENTS Participants played an active video game for 50-minute sessions, three times a week for 10 weeks. Qualitative interviews were conducted with 16 participants upon completion of the program. RESULTS Participants expressed enthusiasm for the physical activity program, indicating it was an activity that they looked forward to doing. The results of the study provide insight into how the program may be implemented into practice at mental health facilities. Three implementation to practice categories were identified: (1) programmatic considerations, such as when to hold the groups and where; (2) the critical importance of staff involvement; and (3) harnessing patients' interest in the program. CONCLUSION Our results suggest that engagement in an intense video game-based group physical activity program has a positive impact on participants' overall health. The group atmosphere, staff involvement, availability of the program at a mental health facility, and health benefits were critical.
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Brink M, Andersen K. Subjective health-related quality of life in community-dwelling middle-aged and older adults with early-onset schizophrenia. Nord J Psychiatry 2020; 74:585-593. [PMID: 32513037 DOI: 10.1080/08039488.2020.1769186] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Long-term outcome in schizophrenia remains unsatisfactory due to continued premature deaths and insufficient health treatment. Subjective quality of life (SQoL) measurements hold important information and have meaningful implications regarding ways of improving general health status. This study investigated the physical and mental SQoL and associated clinical and sociodemographic outcomes among community-dwelling middle-aged and older people with early-onset schizophrenia.Materials and methods: A cross-sectional interview study where participants residing in the Region of Southern Denmark were identified through The Danish Psychiatric Central Register. Of a total of 278 eligible individuals, 59 people aged 55-82 years old participated. The SQoL measure Medical Outcomes Short Form 36 version 2 (SF36) was used. Scores were compared by age groups with normative data for the Danish population. Associated outcomes were measured using Positive And Negative Symptom Scale Remission and others.Results: Increased mental SQoL was associated with schizophrenia in remission (adjusted B 9.43, p = .001), increased Mental Health Recovery Measure score (adjusted B 0.55, p < .001) and increased GAF score (adjusted B 0.32, p < .001). Comparing with Danish Normative data, mental SQoL was reduced (p = .001) among 55-64-year olds, but presented levels similar to the general population at ages over 65 years. Physical quality of life was similar to the general population.Conclusion: Over 65-year olds with schizophrenia seemed to have SQoL similar to their age peers in the general population. Aiming treatment at achieving state of remission or recovery would be an amenable measure toward increasing mental SQoL among middle-aged people with schizophrenia.
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Affiliation(s)
- Maria Brink
- Research Unit of Psychiatry, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Kjeld Andersen
- Research Unit of Psychiatry, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
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Kennedy M, Koehl J, Shenvi CL, Greenberg A, Zurek O, LaMantia M, Lo AX. The agitated older adult in the emergency department: a narrative review of common causes and management strategies. J Am Coll Emerg Physicians Open 2020; 1:812-823. [PMID: 33145525 PMCID: PMC7593470 DOI: 10.1002/emp2.12110] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/30/2020] [Accepted: 05/01/2020] [Indexed: 12/12/2022] Open
Abstract
Agitation and aggression are common in older emergency department (ED) patients, can impede the expedient diagnosis of potentially life-threatening conditions, and can adversely impact ED functioning and efficiency. Agitation and aggression in older adults may be due to multiple causes, but chief among them are primary psychiatric disorders, substance use, hyperactive delirium, and symptoms of dementia. Understanding the etiology of agitation in an older adult is critical to proper management. Effective non-pharmacologic modalities are available for the management of mild to moderate agitation and aggression in patients with dementia. Pharmacologic management is indicated for agitation related to a psychiatric condition, severe agitation where a patient is at risk to harm self or others, and to facilitate time-sensitive diagnostic imaging, procedures, and treatment. Emergency physicians have several pharmacologic agents at their disposal, including opioid and non-opioid analgesics, antipsychotics, benzodiazepines, ketamine, and combination agents. Emergency physicians should be familiar with geriatric-specific dosing, contraindications, and common adverse effects of these agents. This review article discusses the common causes and non-pharmacologic and pharmacologic management of agitation in older adults, with a specific focus on dementia, delirium, and pain.
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Affiliation(s)
- Maura Kennedy
- Department of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
- Department of Emergency MedicineHarvard Medical SchoolBostonMassachusettsUSA
| | - Jennifer Koehl
- Department of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
- Department of PharmacyMassachusetts General HospitalBostonMassachusettsUSA
| | - Christina L. Shenvi
- Department of Emergency MedicineUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Allyson Greenberg
- Department of PharmacyNorthwestern Memorial HospitalChicagoIllinoisUSA
- Department of Emergency MedicineNorthwestern Memorial HospitalChicagoIllinoisUSA
| | - Olivia Zurek
- Department of PsychiatryMassachusetts General HospitalBostonMassachusettsUSA
- Department of PsychiatryHarvard Medical SchoolBostonMassachusettsUSA
| | - Michael LaMantia
- Division of Geriatric MedicineUniversity of VermontBurlingtonVermontUSA
| | - Alexander X. Lo
- Department of Emergency MedicineNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
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Tveito M, Smith RL, Molden E, Høiseth G. Impact of age and CYP2D6 genotype on exposure of zuclopenthixol in patients using long-acting injectable versus oral formulation-an observational study including 2044 patients. Eur J Clin Pharmacol 2020; 77:215-221. [PMID: 33000414 DOI: 10.1007/s00228-020-03002-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/16/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Zuclopenthixol is an antipsychotic available as oral and long-acting injectable (LAI) formulations. The aim of this study was to investigate the effect of age on zuclopenthixol exposure during oral and LAI administrations without and with adjustment for CYP2D6 genotype. METHODS Data on serum concentrations of zuclopenthixol and CYP2D6 genotype (available for 28.2% of the population) from patients using oral or LAI zuclopenthixol were included retrospectively from a therapeutic drug monitoring service during the period 2005-2019. As a measure of exposure, dose-adjusted serum concentration (C/D ratio) was used. Based on age, patients were grouped to older (≥ 65 years) or younger (18-64 years). Linear mixed model analyses without and with adjustment for CYP2D6 genotype were used. RESULTS Serum concentrations of zuclopenthixol from 1145 (14.1% older) and 899 patients (24.6% older) in the LAI and oral groups were included, respectively. Compared with younger patients, older patients had a higher C/D ratio of zuclopenthixol for LAI (+ 25-33%, p < 0.001) and oral formulation (+ 25-29%, p ≤ 0.003) without and with adjustment for CYP2D6 genotype. The doses were lower in older versus younger patients (oral: - 30%; LAI: - 20%; p < 0.001). Compared with the younger LAI users without reduced CYP2D6 function, a higher C/D ratio was observed in the older LAI users with reduced CYP2D6 function (+ 104%, p < 0.001). CONCLUSION The present study showed that zuclopenthixol exposure increases in older patients and that the older LAI users with reduced CYP2D6 function are exposed to high serum concentrations. Also, the present study showed that similar dose reductions are required for oral and LAI users.
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Affiliation(s)
- Marit Tveito
- Center for Psychopharmacology, Diakonhjemmet Hospital, PO Box 85, Vinderen, 0319, Oslo, Norway. .,Norwegian National Advisory Unit on Aging and Health, Vestfold Hospital Trust, Tønsberg, Norway.
| | - Robert Løvsletten Smith
- Center for Psychopharmacology, Diakonhjemmet Hospital, PO Box 85, Vinderen, 0319, Oslo, Norway
| | - Espen Molden
- Center for Psychopharmacology, Diakonhjemmet Hospital, PO Box 85, Vinderen, 0319, Oslo, Norway.,Department of Pharmaceutical Biosciences, School of Pharmacy, University of Oslo, Oslo, Norway
| | - Gudrun Høiseth
- Center for Psychopharmacology, Diakonhjemmet Hospital, PO Box 85, Vinderen, 0319, Oslo, Norway.,Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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