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Chhagan U, Ntlantsana V, Karim E, Thela L, Tomita A, Chiliza B, Paruk S. Clinical presentation of first episode psychosis in people with and without HIV in KwaZulu-Natal, South Africa. Early Interv Psychiatry 2024. [PMID: 38803138 DOI: 10.1111/eip.13561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 12/06/2023] [Accepted: 05/09/2024] [Indexed: 05/29/2024]
Abstract
AIM Mental disorders and HIV are the main contributors to the increase in years lived with disability rates per person in sub-Saharan Africa. A complex inter-relationship exists between HIV and mental illness, especially in a region with a high HIV prevalence. We examined the duration of untreated psychosis (DUP), and the nature of psychotic and cognitive symptoms in people with first episode psychosis (FEP) living with and without HIV. METHODS Adults aged between 18 and 45 years were assessed using a clinical interview, physical examination and several psychiatric tools. These included the Mini International Neuro-psychiatric Interview to confirm psychosis, Positive and Negative Syndrome Scale, International HIV Dementia Scale and other scales to measure symptom variables. HIV ELISA was used for HIV serology testing, with measures being carried out within 6 weeks of the first presentation. RESULTS Of the 172 people presenting with FEP, 36 (21%) had comorbid HIV, those with both being older and more likely to be female (p < .001). Clinically, participants with FEP and HIV scored lower on the positive subscale (p = .008). There were no statistically significant differences for DUP or cognitive screening. Of those living with HIV and FEP (n = 36) comorbidity, nine were newly diagnosed with HIV at the time of the study. CONCLUSION Individuals presenting with FEP and comorbid HIV were older, female and reported more mood symptoms. The identification of nine new HIV infections also reflects the ongoing need to test for HIV in people presenting with severe mental illness.
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Affiliation(s)
- Usha Chhagan
- Department of Psychiatry, College of Health Sciences, Nelson R Mandela School of Medicine, University of Kwazulu-Natal, Durban, South Africa
| | - Vuyokazi Ntlantsana
- Department of Psychiatry, College of Health Sciences, Nelson R Mandela School of Medicine, University of Kwazulu-Natal, Durban, South Africa
| | - Enver Karim
- Department of Psychiatry, College of Health Sciences, Nelson R Mandela School of Medicine, University of Kwazulu-Natal, Durban, South Africa
| | - Lindokuhle Thela
- Department of Psychiatry, College of Health Sciences, Nelson R Mandela School of Medicine, University of Kwazulu-Natal, Durban, South Africa
| | - Andrew Tomita
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Centre for Rural Health, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Bonginkosi Chiliza
- Department of Psychiatry, College of Health Sciences, Nelson R Mandela School of Medicine, University of Kwazulu-Natal, Durban, South Africa
| | - Saeeda Paruk
- Department of Psychiatry, College of Health Sciences, Nelson R Mandela School of Medicine, University of Kwazulu-Natal, Durban, South Africa
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Moccia L, Kotzalidis GD, Bartolucci G, Ruggiero S, Monti L, Biscosi M, Terenzi B, Ferrara OM, Mazza M, Di Nicola M, Janiri D, Simonetti A, Caroppo E, Janiri L, Sani G. COVID-19 and New-Onset Psychosis: A Comprehensive Review. J Pers Med 2023; 13:jpm13010104. [PMID: 36675765 PMCID: PMC9865730 DOI: 10.3390/jpm13010104] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/23/2022] [Accepted: 12/30/2022] [Indexed: 01/03/2023] Open
Abstract
Psychosis is a multifactorial condition that typically involves delusions, hallucinations, and disorganized thought, speech or behavior. The observation of an association between infectious epidemics and acute psychosis dates back to the last century. Recently, concerns have been expressed regarding COVID-19 and the risk for the development of new-onset psychosis. This article reviewed the current evidence of a possible link between SARS-CoV-2 and risk of psychosis as an acute or post-infectious manifestation of COVID-19. We here discuss potential neurobiological and environmental factors as well as a number of challenges in ascribing a causal pathogenic relationship between SARS-CoV-2 infection and new-onset psychosis.
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Affiliation(s)
- Lorenzo Moccia
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168 Rome, Italy
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Correspondence: or ; Tel.: +39-0630154122
| | - Georgios D. Kotzalidis
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168 Rome, Italy
- Department of Neurosciences, Mental Health, and Sensory Organs (NESMOS), Sapienza University of Rome, Sant’Andrea Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy
| | - Giovanni Bartolucci
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Sara Ruggiero
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Laura Monti
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168 Rome, Italy
| | - Marco Biscosi
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Beatrice Terenzi
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Ottavia M. Ferrara
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Marianna Mazza
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168 Rome, Italy
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Marco Di Nicola
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168 Rome, Italy
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Delfina Janiri
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168 Rome, Italy
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Alessio Simonetti
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168 Rome, Italy
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Emanuele Caroppo
- Department of Mental Health, Local Health Authority ROMA 2, 00159 Rome, Italy
| | - Luigi Janiri
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168 Rome, Italy
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Gabriele Sani
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168 Rome, Italy
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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A 20-year population-based study of all-cause and cause-specific mortality among people with concurrent HIV and psychotic disorders. AIDS 2022; 36:1851-1860. [PMID: 35876651 DOI: 10.1097/qad.0000000000003341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We aimed to characterize mortality among people with HIV (PWH) and psychotic disorders (PWH/psychosis+) vs. PWH alone (PWH/psychosis-). METHOD A population-based analysis of mortality in PWH (age ≥19) in British Columbia (BC) from April 1996 to March 2017 was conducted using data from the Seek and Treat for Optimal Prevention of HIV/AIDS (STOP HIV/AIDS) study. Deaths were identified from the Vital Statistics Data (classified as HIV vs. non-HIV causes). Mortality trends across all fiscal years were examined. Cox models assessed the hazard of psychotic disorders on mortality; possible differences between schizophrenia and nonschizophrenia types of psychotic disorders were also evaluated. RESULTS Among 13 410 PWH included in the analysis, 1572 (11.7%) met the case definition for at least one psychotic disorder. Over the study period, 3274 deaths (PWH/psychosis-: n = 2785, PWH/psychosis+: n = 489) occurred. A decline over time in all-cause mortality and HIV-related mortality was observed in both PWH/psychosis+ and PWH/psychosis- ( P value <0.0001). A decline in non-HIV mortality was observed among PWH/psychosis- ( P value = 0.003), but not PWH/psychosis+ ( P value = 0.3). Nonschizophrenia psychotic disorders were associated with increased risk of mortality; adjusted hazard ratios with (95% confidence intervals): all-cause 1.75 (1.46-2.09), HIV-related 2.08 (1.60-2.69), non-HIV-related 1.45 (1.11-1.90). Similar associations between schizophrenia and mortality were not observed. CONCLUSION People with co-occurring HIV and nonschizophrenia psychotic disorders experienced a significantly higher risk of mortality vs. PWH without any psychotic disorder. Implementing care according to syndemic models considering interactions between HIV and particularly episodic psychotic disorders could help manage mortality risk more effectively among PWH/psychosis+.
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Mallik I, Pasvol T, Frize G, Ayres S, Barrera A, Fidler S, Foster C. Psychotic disorders in young adults with perinatally acquired HIV: a UK case series. Psychol Med 2022; 52:2263-2269. [PMID: 33183361 DOI: 10.1017/s0033291720004134] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Increasing numbers of children with perinatally acquired HIV (PaHIV) are transitioning into adult care. People living with behaviourally acquired HIV are known to be at more risk of psychosis than uninfected peers. Young adults living with PaHIV face numerous risk factors; biological: lifelong exposure to a neurotrophic virus, antiretroviral medication and immune dysfunction during brain development, and environmental; social deprivation, ethnicity-related discrimination, and migration-related issues. To date, there is little published data on the prevalence of psychotic illness in young people growing up with PaHIV. METHODS We conducted a retrospective case note review of all individuals with PaHIV aged over 18 years registered for follow up at a dedicated clinic in the UK (n = 184). RESULTS In total, 12/184 (6.5%), median age 23 years (interquartile range 21-26), had experienced at least one psychotic episode. The presentation and course of the psychotic episodes experienced by our cohort varied from short-lived symptoms to long term illness and nine (75%) appear to have developed a severe and enduring mental illness requiring long term care. CONCLUSION The prevalence of psychosis in our cohort was clearly above the lifetime prevalence of psychosis in UK individuals aged 16-34 years, which has been reported to be 0.5-1.0%. This highlights the importance of clinical vigilance regarding the mental health of young people growing up with PaHIV and the need to integrate direct access to mental health services within the HIV centres providing medical care.
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Affiliation(s)
- I Mallik
- Buckinghamshire Healthcare NHS Trust, Aylesbury, UK
- Department of Medicine, Imperial College London, London, UK, and Imperial College NIHR BRC, London, UK
| | - T Pasvol
- 900 Clinic, Imperial College Healthcare NHS Trust, London, UK
| | - G Frize
- 900 Clinic, Imperial College Healthcare NHS Trust, London, UK
| | - S Ayres
- 900 Clinic, Imperial College Healthcare NHS Trust, London, UK
| | - A Barrera
- Oxford Health NHS Trust, Oxford, UK and Oxford University Department of Psychiatry, Oxford, UK
| | - S Fidler
- Department of Medicine, Imperial College London, London, UK, and Imperial College NIHR BRC, London, UK
- 900 Clinic, Imperial College Healthcare NHS Trust, London, UK
| | - C Foster
- 900 Clinic, Imperial College Healthcare NHS Trust, London, UK
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MANGURIAN C, DAHIYA P, GOLDMAN ML, CORBEIL T, WALL MM, ESSOCK SM, DIXON LB, TANG F, FRIMPONG E, MASCAYANO F, RADIGAN M, WANG R, OLFSON M, SMITH TE. Underdetection of pre-existing HIV/AIDS during psychiatric hospitalizations. AIDS 2022; 36:1031-1037. [PMID: 35142705 PMCID: PMC9167207 DOI: 10.1097/qad.0000000000003190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES People with severe mental illness are 10 times more likely to have HIV/ AIDS than the general population, yet little is known about the characteristics and frequency of recognition of pre-existing HIV/AIDS diagnoses among inpatients with severe mental illness. This study examines documentation rates of pre-existing HIV/ AIDS among inpatients within psychiatric hospitals in New York State. DESIGN Retrospective cohort study to examine recognition of pre-existing HIV/AIDS among psychiatric inpatients. METHODS Patient-level Medicaid claims records were linked with hospital and regional data for people admitted to psychiatric inpatient units in New York State. Presence of HIV/AIDS diagnoses prior to psychiatric hospitalization was coded for each inpatient (n = 14 602). Adjusted odds ratios of undocumented HIV/AIDS diagnoses at the time of discharge were calculated using logistic regression analyses. RESULTS About 5.1% (741/14 602) of unique psychiatric inpatients had pre-existing HIV/AIDS diagnoses. Of these inpatients, 58.3% (432/741) were not coded as having HIV/AIDS upon discharge. Higher rates of missed detection were associated with younger age, non-Hispanic white race/ethnicity, shorter length of stay, more distal coding of an HIV/AIDS diagnosis, and fewer HIV/AIDS-related Medicaid claims in the past year. Hospitals with higher readmission rates also had higher rates of undetected HIV/AIDS diagnoses. CONCLUSION Over half of inpatients previously diagnosed with HIV/AIDS did not have their HIV-positive status noted upon discharge from psychiatric hospitalization. This finding underscores how frequently clinically significant medical comorbidities fail to be incorporated into psychiatric treatment and treatment planning. Inpatient clinicians are missing important opportunities to optimize HIV/AIDS treatment and reduce morbidity and mortality.
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Affiliation(s)
- Christina MANGURIAN
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco
- Department of Epidemiology & Biostatistics, University of California San Francisco
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital
| | - Priya DAHIYA
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco
| | - Matthew L. GOLDMAN
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco
| | | | - Melanie M. WALL
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons
| | - Susan M. ESSOCK
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons
| | - Lisa B. DIXON
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons
| | - Fei TANG
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health
| | - Eric FRIMPONG
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health
| | | | - Marleen RADIGAN
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health
| | - Rui WANG
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health
| | - Mark OLFSON
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons
| | - Thomas E. SMITH
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons
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6
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Gooden TE, Gardner M, Wang J, Chandan JS, Beane A, Haniffa R, Taylor S, Greenfield S, Manaseki-Holland S, Thomas GN, Nirantharakumar K. The risk of mental illness in people living with HIV in the UK: a propensity score-matched cohort study. Lancet HIV 2022; 9:e172-e181. [PMID: 35123667 DOI: 10.1016/s2352-3018(21)00319-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/27/2021] [Accepted: 11/30/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Prevalence of mental illness is higher in people living with HIV than in the general population, but the incidence of composite mental illness and its components is unclear. We aimed to identify the risk of incident mental illness along with individual conditions of depression, anxiety, and severe mental illness in people living with HIV in the UK. METHODS Data for this population-based cohort were extracted from the IQVIA Medical Research Database, a nationally representative UK-based database of primary care electronic health records. We included adults (aged ≥18 years) living with HIV, matched with adults without HIV using propensity score matching (1:1 ratio). The primary outcome was composite mental illness comprising a diagnosis of depression, anxiety, or severe mental illness. Secondary outcomes were individual mental health conditions. Cox proportional hazard regression models were used to compare the risk of each outcome between people with and without HIV. Each model excluded those with the outcome at baseline. Individuals were followed up prospectively. The study period was from Jan 1, 2000, to Jan 1, 2020. FINDINGS Of 7167 people living with HIV without mental illness at baseline, 586 developed a mental illness (incidence rate 19·6 per 1000 person-years) compared with 418 of 7167 people without HIV (incidence rate 12·1 per 1000 person-years), resulting in an adjusted hazard ratio (HR) of 1·63 (95% CI 1·44-1·85). People living with HIV had higher incidence rates for depression (15·4 per 1000 person-years), anxiety (7·2 per 1000 person-years), and severe mental illness (1·6 per 1000 person-years) compared with people without HIV (7·9, 5·0, and 0·6 per 1000 person-years, respectively), with adjusted HRs of 1·94 (95% CI 1·68-2·24) for depression, 1·38 (1·15-1·66) for anxiety, and 2·18 (1·41-3·39) for severe mental illness. INTERPRETATION People living with HIV have an increased risk for developing composite mental illness, depression, anxiety, and severe mental illness compared with people without HIV. People living with HIV should be regularly screened for mental illness; however, there is a strong need to improve prevention of mental illness in people living with HIV and for more outreach programmes to ensure that no groups of people living with HIV are being underdiagnosed. FUNDING None.
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Affiliation(s)
- Tiffany E Gooden
- Institute for Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Mike Gardner
- Institute for Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Jingya Wang
- Institute for Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Joht S Chandan
- Institute for Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Abi Beane
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand; Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Rashan Haniffa
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand; Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Stephen Taylor
- Institute for Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; Department of Infection and Immunology, University Hospitals Birmingham, Birmingham, UK
| | - Sheila Greenfield
- Institute for Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Semira Manaseki-Holland
- Institute for Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - G Neil Thomas
- Institute for Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
| | - Krishnarajah Nirantharakumar
- Institute for Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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HIV Infection and Related Mental Disorders. Brain Sci 2021; 11:brainsci11020248. [PMID: 33671125 PMCID: PMC7922767 DOI: 10.3390/brainsci11020248] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 01/13/2023] Open
Abstract
Over the more than thirty-year period of the human immunodeficiency virus type 1 (HIV-1) epidemic, many data have been accumulated indicating that HIV infection predisposes one to the development of mental pathologies. It has been proven that cognitive disorders in HIV-positive individuals are the result of the direct exposure of the virus to central nervous system (CNS) cells. The use of antiretroviral therapy has significantly reduced the number of cases of mental disorders among people infected with HIV. However, the incidence of moderate to mild cognitive impairment at all stages of HIV infection is still quite high. This review describes the most common forms of mental pathology that occur in people living with HIV and presents the current concepts on the possible pathogenetic mechanisms of the influence of human immunodeficiency virus (HIV-1) and its viral proteins on the cells of the CNS and the CNS’s functions. This review also provides the current state of knowledge on the impact of the antiretroviral therapy on the development of mental pathologies in people living with HIV, as well as current knowledge on the interactions between antiretroviral and psychotropic drugs that occur under their simultaneous administration.
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8
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Burygina LA, Orlov VA, Zhilenkova AV, Makaryan DE, Khannanova AN, Orlova AS, Akarachkova ES. [Social, demographic and clinical characteristics of female patients with schizophrenia and HIV]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:31-37. [PMID: 33580758 DOI: 10.17116/jnevro202112101131] [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] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate social, demographic and clinical characteristics of women with schizophrenia and HIV. MATERIAL AND METHODS Medical histories of patients who were in inpatient treatment during 2017 were retrospectively studied. A total of 174 medical histories were analyzed, but the final analysis included 40 HIV-infected patients (main groups) and 48 patients without HIV infection (comparison group). These groups included patients with a diagnosis of schizophrenia or acute polymorphic psychotic disorder. All patients with HIV infection were examined by a specialist and an immunological analysis was performed. Correlation analysis was performed between quantitative clinical indicators (duration of illness, number of hospitalizations, the number and duration of remissions, etc.) and immunological parameters. RESULTS AND CONCLUSION Patients with schizophrenia and HIV infection are more often hospitalized and stay in the hospital longer than patients with schizophrenia without HIV infection, which may in part be determined by the social problems of this cohort of patients. There is a relationship between individual indicators of the immune status of the patients, the duration and some features of the course of mental illness. Regular treatment of HIV infection correlates with a lower frequency of hospitalizations in a psychiatric hospital due to an exacerbation of the mental state.
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Affiliation(s)
- L A Burygina
- Gannushkin Psychiatric Clinical Hospital No. 4, Moscow, Russia
| | - V A Orlov
- Gannushkin Psychiatric Clinical Hospital No. 4, Moscow, Russia
| | - A V Zhilenkova
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - D E Makaryan
- Gannushkin Psychiatric Clinical Hospital No. 4, Moscow, Russia
| | - A N Khannanova
- Gilyarovsky Psychiatric Hospital - branch of Gannushkin Psychiatric Clinical Hospital No. 4, Moscow, Russia
| | - A S Orlova
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - E S Akarachkova
- International Society of Stress «Stress under control», Moscow, Russia
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9
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Nanditha NGA, Paiero A, Tafessu HM, St-Jean M, McLinden T, Justice AC, Kopec J, Montaner JSG, Hogg RS, Lima VD. Excess burden of age-associated comorbidities among people living with HIV in British Columbia, Canada: a population-based cohort study. BMJ Open 2021; 11:e041734. [PMID: 33419911 PMCID: PMC7799128 DOI: 10.1136/bmjopen-2020-041734] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES As people living with HIV (PLWH) live longer, morbidity and mortality from non-AIDS comorbidities have emerged as major concerns. Our objective was to compare prevalence trends and age at diagnosis of nine chronic age-associated comorbidities between individuals living with and without HIV. DESIGN AND SETTING This population-based cohort study used longitudinal cohort data from all diagnosed antiretroviral-treated PLWH and 1:4 age-sex-matched HIV-negative individuals in British Columbia, Canada. PARTICIPANTS The study included 8031 antiretroviral-treated PLWH and 32 124 HIV-negative controls (median age 40 years, 82% men). Eligible participants were ≥19 years old and followed for ≥1 year during 2000 to 2012. PRIMARY AND SECONDARY OUTCOME MEASURES The presence of non-AIDS-defining cancers, diabetes, osteoarthritis, hypertension, Alzheimer's and/or non-HIV-related dementia, cardiovascular, kidney, liver and lung diseases were identified from provincial administrative databases. Beta regression assessed annual age-sex-standardised prevalence trends and Kruskal-Wallis tests compared the age at diagnosis of comorbidities stratified by rate of healthcare encounters. RESULTS Across study period, the prevalence of all chronic age-associated comorbidities, except hypertension, were higher among PLWH compared with their community-based HIV-negative counterparts; as much as 10 times higher for liver diseases (25.3% vs 2.1%, p value<0.0001). On stratification by healthcare encounter rates, PLWH experienced most chronic age-associated significantly earlier than HIV-negative controls, as early as 21 years earlier for Alzheimer's and/or dementia. CONCLUSIONS PLWH experienced higher prevalence and earlier age at diagnosis of non-AIDS comorbidities than their HIV-negative controls. These results stress the need for optimised screening for comorbidities at earlier ages among PLWH, and a comprehensive HIV care model that integrates prevention and treatment of chronic age-associated conditions. Additionally, the robust methodology developed in this study, which addresses concerns on the use of administrative health data to measure prevalence and incidence, is reproducible to other settings.
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Affiliation(s)
- Ni Gusti Ayu Nanditha
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Adrianna Paiero
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Hiwot M Tafessu
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Martin St-Jean
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Taylor McLinden
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Amy C Justice
- VA Connecticut Health System, West Haven, Connecticut, USA
- Yale School of Medicine, New Haven, Connecticut, USA
| | - Jacek Kopec
- Arthritis Research Centre Of Canada, Richmond, British Columbia, Canada
- The University of British Columbia School of Population and Public Health, Vancouver, British Columbia, Canada
| | - Julio S G Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Robert S Hogg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Simon Fraser University Faculty of Health Sciences, Burnaby, British Columbia, Canada
| | - Viviane D Lima
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
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Liu N, Tan JS, Liu L, Wang Y, Hua L, Qian Q. Genetic Predisposition Between COVID-19 and Four Mental Illnesses: A Bidirectional, Two-Sample Mendelian Randomization Study. Front Psychiatry 2021; 12:746276. [PMID: 34744839 PMCID: PMC8564104 DOI: 10.3389/fpsyt.2021.746276] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/15/2021] [Indexed: 01/04/2023] Open
Abstract
Background: The outbreak of 2019 coronavirus disease (COVID-19) has become a global pandemic. Although it has long been suspected that COVID-19 could contribute to the development of mental illness, and individuals with a pre-existing mental illness may have a higher risk of and poorer outcomes from COVID-19 infection, no evidence has established a causal association between them thus far. Methods: To investigate associations in support of a causal association between the severity of COVID-19 and mental illnesses, we leveraged large-scale genetic summary data from genome-wide association study (GWAS) summary datasets, including attention-deficit/hyperactivity disorder (ADHD) (n = 55,374), schizophrenia (n = 77,096), bipolar disorder (n = 51,710), and depression (n = 173,005), based on a previous observational study. The random-effects inverse-variance weighted method was conducted for the main analyses, with a complementary analysis of the weighted median and MR-Egger approaches and multiple sensitivity analyses assessing horizontal pleiotropy and removing outliers in two different COVID-19 databases. Results: The Mendelian randomization (MR) analysis indicated that ADHD [odds ratio (OR) = 1.297; 95% confidence interval (CI), 1.029-1.634; p = 0.028] increased the risk of hospitalization due to COVID-19. A similar association was obtained in MR sensitivity analyses of the weighted median. In addition, genetically predicted COVID-19 was significantly associated with schizophrenia (OR = 1.043; 95% CI, 1.005-1.082; p = 0.027). Conclusions: Although many studies have reported a causal relationship between COVID-19 and mental illness, our study shows that this increased risk is modest. However, considering the characteristics of ADHD that might further increase the individuals' vulnerability to being infected by COVID-19, the ongoing massive worldwide exposure to COVID-19, and the high burden of schizophrenia, we believe that it is necessary to offer preventative measures to these populations and to provide more evidence in understanding the neurological impact of COVID-19.
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Affiliation(s)
- Ningning Liu
- Peking University Sixth Hospital/Institute of Mental Health, Beijing, China.,NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Jiang-Shan Tan
- Thrombosis Center, Key Laboratory of Pulmonary Vascular Medicine, National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lu Liu
- Peking University Sixth Hospital/Institute of Mental Health, Beijing, China.,NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Yufeng Wang
- Peking University Sixth Hospital/Institute of Mental Health, Beijing, China.,NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Lu Hua
- Thrombosis Center, Key Laboratory of Pulmonary Vascular Medicine, National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qiujin Qian
- Peking University Sixth Hospital/Institute of Mental Health, Beijing, China.,NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
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11
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Byrd KK, Hardnett F, Hou JG, Clay PG, Suzuki S, Camp NM, Shankle MD, Weidle PJ, Taitel MS. Improvements in Retention in Care and HIV Viral Suppression Among Persons with HIV and Comorbid Mental Health Conditions: Patient-Centered HIV Care Model. AIDS Behav 2020; 24:3522-3532. [PMID: 32415615 DOI: 10.1007/s10461-020-02913-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The Patient-centered HIV Care Model (PCHCM) integrated community-based pharmacists with medical providers and required sharing of patient clinical information and collaborative therapy-related action planning. We determined the proportions of participants with HIV and mental health conditions who were retained in care and the proportion virally suppressed, pre- and post-implementation. Overall, we found a relative 13% improvement in both retention [60% to 68% (p = 0.009)] and viral suppression [79% to 90% (p < 0.001)]. Notable improvements were seen among persons triply diagnosed with HIV, mental illness and substance use [+ 36% (50% to 68%, p = 0.036) and + 32% (66% to 86%, p = 0.001) in retention and viral suppression, respectively]. There were no differences in the proportions of persons adherent to psychiatric medications, pre- to post-implementation, nor were there differences in the proportions of persons retained in care or virally suppressed by psychiatric medication adherence, post-implementation. PCHCM demonstrated that collaborations between community-based pharmacists and medical providers can improve HIV care continuum outcomes among persons with mental health conditions.
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Affiliation(s)
- Kathy K Byrd
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, MS US8-4, Atlanta, GA, 30329, USA.
| | - Felicia Hardnett
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, MS US8-4, Atlanta, GA, 30329, USA
| | - John G Hou
- Health Analytics, Research, and Reporting Department, Walgreen Co., Deerfield, IL, USA
| | - Patrick G Clay
- Department of Pharmacotherapy, University of North Texas Health Science Center System College of Pharmacy, Fort Worth, TX, USA
| | - Sumihiro Suzuki
- Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Nasima M Camp
- Department of Health, Research, Informatics, and Technology, ICF, Atlanta, GA, USA
| | | | - Paul J Weidle
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, MS US8-4, Atlanta, GA, 30329, USA
| | - Michael S Taitel
- Health Analytics, Research, and Reporting Department, Walgreen Co., Deerfield, IL, USA
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12
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Watson CJ, Thomas RH, Solomon T, Michael BD, Nicholson TR, Pollak TA. COVID-19 and psychosis risk: Real or delusional concern? Neurosci Lett 2020; 741:135491. [PMID: 33220366 DOI: 10.1016/j.neulet.2020.135491] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 11/03/2020] [Indexed: 02/07/2023]
Abstract
Historical epidemiological perspectives from past pandemics and recent neurobiological evidence link infections and psychoses, leading to concerns that COVID-19 will present a significant risk for the development of psychosis. But are these concerns justified, or mere sensationalism? In this article we review the historical associations between viral infection and the immune system more broadly in the development of psychosis, before critically evaluating the current evidence pertaining to SARS-CoV-2 and risk of psychosis as an acute or post-infectious manifestation of COVID-19. We review the 42 cases of psychosis reported in infected patients to date, and discuss the potential implications of in utero infection on subsequent neurodevelopment and psychiatric risk. Finally, in the context of the wider neurological and psychiatric manifestations of COVID-19 and our current understanding of the aetiology of psychotic disorders, we evaluate possible neurobiological and psychosocial mechanisms as well as the numerous challenges in ascribing a causal pathogenic role to the infection.
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Affiliation(s)
- Cameron J Watson
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University London, UK.
| | - Rhys H Thomas
- Translational and Clinical Research Institute, University of Newcastle, UK; Royal Victoria Infirmary, Newcastle, UK
| | - Tom Solomon
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK; National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infection, University of Liverpool, UK; Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary, and Zoological Science, University of Liverpool, UK
| | - Benedict Daniel Michael
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK; National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infection, University of Liverpool, UK; Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary, and Zoological Science, University of Liverpool, UK
| | - Timothy R Nicholson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Thomas A Pollak
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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13
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Excess mortality associated with mental illness in people living with HIV in Cape Town, South Africa: a cohort study using linked electronic health records. LANCET GLOBAL HEALTH 2020; 8:e1326-e1334. [PMID: 32971055 PMCID: PMC7582785 DOI: 10.1016/s2214-109x(20)30279-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 06/03/2020] [Accepted: 06/12/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Mental disorders can adversely affect HIV treatment outcomes and survival. Data are scarce on premature deaths in people with mental disorders in HIV-positive populations, particularly in low-income and middle-income countries. In this study, we quantified excess mortality associated with mental disorders in HIV-positive people in South Africa, adjusting for HIV treatment outcomes. METHODS For this cohort study, we analysed routinely collected data on HIV-positive adults receiving antiretroviral therapy (ART) in Cape Town, South Africa between Jan 1, 2004, to Dec 31, 2017. Data from three ART programmes were linked with routine medical records on mental health treatment from Jan 1, 2010, to Dec 31, 2017, and mortality surveillance data from the South African National Population Register up to Dec 31, 2017. People living with HIV aged 15 years or older who initiated ART at a programme site were eligible for analysis. We followed up patients from ART initiation or Jan 1, 2010, whichever occurred later, to transfer, death, or Dec 31, 2017. Patients were considered as having a history of mental illness if they had ever received psychiatric medication or been hospitalised for a mental disorder. We calculated adjusted hazard ratios (aHRs) with 95% CIs for associations between history of mental illness, mortality, and HIV treatment outcomes (retention in care with viral load suppression [VLS; viral load <1000 copies per mL], retention in care with non-suppressed viral load [NVL; viral load ≥1000 copies per mL], and loss to follow-up [LTFU; >180 days late for a clinic visit at closure of the database]) using Cox proportional hazard regression and multistate models. RESULTS 58 664 patients were followed up for a median of 4·3 years (IQR 2·1-6·4), 2927 (5·0%) of whom had a history of mental illness. After adjustment for age, sex, treatment programme, and year of ART initiation, history of mental illness was associated with increased risk of mortality from all causes (aHR 2·98 [95% CI 2·69-3·30]), natural causes (3·00 [2·69-3·36]), and unnatural causes (2·10 [1·27-3·49]), compared with no history of mental illness. Risk of all-cause mortality in people with a history of mental illness remained increased in multivariable analysis adjusted for age, sex, treatment programme, year of ART initiation, CD4 count and WHO clinical stage at ART initiation, retention in HIV care with or without VLS, and LTFU (2·73 [2·46-3·02]). In our multistate model, adjusted for age, sex, year of ART initiation, cumulative time with NVL, and WHO clinical stage and CD4 cell count at ART initiation, rates of excess all-cause mortality in people with history of mental illness were greatest in patients retained in care with VLS (aHR 3·43 [95% CI 2·83-4·15]), followed by patients retained in care with NVL (2·74 [2·32-3·24]), and smallest in those LTFU (2·12 [1·78-2·53]). History of mental illness was also associated with increased risk of HIV viral rebound (transitioning from VLS to NVL; 1·50 [1·32-1·69]) and LTFU in people with VLS (1·19 [1·06-1·34]). INTERPRETATION Mental illness was associated with substantial excess mortality in HIV-positive adults in Cape Town. Excess mortality among people with a history of mental illness occurred independently of HIV treatment success. Interventions to reduce excess mortality should address the complex physical and mental health-care needs of people living with HIV and mental illness. FUNDING National Institutes of Health, Swiss National Science Foundation, South African Medical Research Council.
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14
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Momenzadeh A, Shumway M, Dong BJ, Dilley J, Nye J, Mangurian C. Patterns of Prescribing Antiretroviral Therapy Upon Discharge to Psychiatry Inpatients With HIV/AIDS at a Large Urban Hospital. Ann Pharmacother 2020; 55:452-458. [PMID: 32885983 DOI: 10.1177/1060028020954924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND HIV infection is more prevalent among people with severe mental illness (SMI) than in the general population. People with SMI may lack access to recommended antiretroviral therapy (ART), and inpatient psychiatric admissions may be opportunities to ensure that individuals receive recommended treatment. OBJECTIVE To evaluate ART prescription patterns on an inpatient psychiatry service. METHODS In this retrospective, observational study, patient and admission characteristics and ART prescriptions were obtained for 248 HIV-positive inpatients between 2006 and 2012. Receipt of any ART, any recommended ART regimen, and ART with potentially harmful adverse events and drug interactions were examined. General estimating equation models were used to evaluate prescription patterns in relation to patient and admission characteristics. RESULTS ART was prescribed at 39% of discharges and increased by 51% during the study. Prescription was more common in admissions with an AIDS diagnosis and age greater than 29 years and less common in admissions associated with a psychotic diagnosis and shorter inpatient stays. When ART was prescribed, regimens were consistent with guideline recommendations 91% of the time. Prescription of potentially harmful regimens was limited. CONCLUSION AND RELEVANCE In an acute inpatient psychiatry setting in an urban HIV/AIDS epicenter, where psychotic disorders and brief and involuntary admissions were the norm, guideline-recommended ART regimens were prescribed at almost 60% of discharges by the end of the study. Future studies should explore interventions to increase ART for high-risk subpopulations with SMI, including younger individuals or those with brief inpatient psychiatry hospitalizations.
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Affiliation(s)
- Amanda Momenzadeh
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.,University of California, San Francisco, CA, USA
| | - Martha Shumway
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.,University of California, San Francisco, CA, USA
| | - Betty J Dong
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.,University of California, San Francisco, CA, USA
| | - James Dilley
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.,University of California, San Francisco, CA, USA
| | - Jonathan Nye
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.,University of California, San Francisco, CA, USA
| | - Christina Mangurian
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.,University of California, San Francisco, CA, USA
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15
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Liang CS, Bai YM, Hsu JW, Huang KL, Ko NY, Chu HT, Yeh TC, Tsai SJ, Chen TJ, Chen MH. The Risk of Sexually Transmitted Infections Following First-Episode Schizophrenia Among Adolescents and Young Adults: A Cohort Study of 220 545 Subjects. Schizophr Bull 2020; 46:795-803. [PMID: 32060532 PMCID: PMC7344918 DOI: 10.1093/schbul/sbz126] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Young people are disproportionately affected by sexually transmitted infections (STIs). The risk of STIs in young people following first-episode schizophrenia is unknown. This study using Taiwan's National Health Insurance Research Database enrolled 44 109 adolescents and young adults with first-episode schizophrenia and 176 436 age- and sex-matched controls without schizophrenia from 2001 through 2009 and followed to the end of 2011. New-onset STIs were identified. Survival analysis was performed. Cox regression analysis was used to examine the effects of comorbid substance use disorder (SUD), schizophrenia medications, and schizophrenia severity. The E value for causality of evidence was calculated. We found that young people had a higher risk of STIs following first-episode schizophrenia compared with controls without schizophrenia (hazard ratio [HR] = 2.35, 95% CI = 2.08-2.64); these STIs included human immunodeficiency virus (HIV) (3.70, 2.60-5.28) and syphilis (5.35, 3.96-7.23). They also showed a disproportionate distribution of STIs, with an increased proportion of syphilis (20.4% vs 8.2%) and HIV (9.1% vs 6.0%). When presenting with SUD, the risks of HIV (11.00, 7.02-17.25) and syphilis (9.11, 6.16-13.47) were further increased. The severe schizophrenia group had an extremely high risk of syphilis (41.26, 27.69-61.47) and HIV (7.50, 3.85-14.62). Schizophrenia medications may provide beneficial effects against contracting STIs (0.77, 0.68-0.89). We concluded that following first-episode schizophrenia, young patients are at higher risk of STIs, particularly HIV and syphilis. The risk further increased when subjects presented with SUD or severe schizophrenia. Importantly, antipsychotic treatment may lower the risk of STIs.
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Affiliation(s)
- Chih-Sung Liang
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, Taipei, Taiwan,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Ya-Mei Bai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan,Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ju-Wei Hsu
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan,Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Kai-Lin Huang
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan,Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Nai-Ying Ko
- Department of Nursing, College of Medicine, National Cheng Kung University and Hospital, Tainan, Taiwan
| | - Hsuan-Te Chu
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, Taipei, Taiwan
| | - Ta-Chuan Yeh
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan,Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan,Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan,Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan,To whom correspondence should be addressed; Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Sec. 2, 11217 Taipei, Taiwan; tel: 886-2-28344012, fax: 886-2-28344012, e-mail:
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16
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Block J. High risk genotypes for schizophrenia may have been adaptive in the context of smallpox. Med Hypotheses 2020; 137:109556. [DOI: 10.1016/j.mehy.2020.109556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 01/05/2020] [Indexed: 10/25/2022]
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17
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Barker LC, Vigod SN. Sexual health of women with schizophrenia: A review. Front Neuroendocrinol 2020; 57:100840. [PMID: 32298687 DOI: 10.1016/j.yfrne.2020.100840] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/02/2020] [Accepted: 04/10/2020] [Indexed: 02/07/2023]
Abstract
Women with schizophrenia experience low rates of sexual satisfaction and high rates of sexual dysfunction. They are at high risk for adverse sexual health outcomes including unplanned pregnancies, induced abortions, and human immunodeficiency virus (HIV), and face higher rates of sexual violence and various forms of intimate partner violence. This review explores the complex and intersecting biopsychosocial risk factors that explain these outcomes among women with schizophrenia, including factors related to the illness itself, antipsychotic medications, medical and psychiatric comorbidities, stigma, childhood trauma, and social determinants of health including poverty and housing instability. Sexual health interventions designed to help women with schizophrenia achieve pleasurable and safe sexual experiences, free of coercion, discrimination and violence are few and far between, suggesting opportunities for future development in this area.
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Affiliation(s)
- Lucy C Barker
- Women's College Hospital and Research Institute, 76 Grenville St, Toronto, Ontario M5S 1B2, Canada; Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, Ontario M5T 1R8, Canada
| | - Simone N Vigod
- Women's College Hospital and Research Institute, 76 Grenville St, Toronto, Ontario M5S 1B2, Canada; Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, Ontario M5T 1R8, Canada.
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18
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Skikic M, Arriola JA. First Episode Psychosis Medical Workup: Evidence-Informed Recommendations and Introduction to a Clinically Guided Approach. Child Adolesc Psychiatr Clin N Am 2020; 29:15-28. [PMID: 31708044 DOI: 10.1016/j.chc.2019.08.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Evaluating the patient with first episode psychosis (FEP) requires a careful assessment that includes a thorough history, examination, and workup. This begins with a thoughtful consideration of the differential diagnoses and is followed and supported by laboratory, encephalographic, and imaging studies where appropriate. This article presents some of the diagnostic considerations for a patient presenting with psychosis with an emphasis on the secondary causes and proposes a tiered approach to the workup of FEP that is clinically guided.
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Affiliation(s)
- Maja Skikic
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, 1601 23rd Avenue South, Nashville, TN 37212, USA.
| | - Jose Alberto Arriola
- Department of Psychiatry and Behavioral Sciences, Consult-Liaison Psychiatry, Vanderbilt University Medical Center, 1601 23rd Avenue South, Nashville, TN 37212, USA
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19
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Discovering genetic interactions bridging pathways in genome-wide association studies. Nat Commun 2019; 10:4274. [PMID: 31537791 PMCID: PMC6753138 DOI: 10.1038/s41467-019-12131-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 08/20/2019] [Indexed: 12/20/2022] Open
Abstract
Genetic interactions have been reported to underlie phenotypes in a variety of systems, but the extent to which they contribute to complex disease in humans remains unclear. In principle, genome-wide association studies (GWAS) provide a platform for detecting genetic interactions, but existing methods for identifying them from GWAS data tend to focus on testing individual locus pairs, which undermines statistical power. Importantly, a global genetic network mapped for a model eukaryotic organism revealed that genetic interactions often connect genes between compensatory functional modules in a highly coherent manner. Taking advantage of this expected structure, we developed a computational approach called BridGE that identifies pathways connected by genetic interactions from GWAS data. Applying BridGE broadly, we discover significant interactions in Parkinson's disease, schizophrenia, hypertension, prostate cancer, breast cancer, and type 2 diabetes. Our novel approach provides a general framework for mapping complex genetic networks underlying human disease from genome-wide genotype data.
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20
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HIV, schizophrenia, and all-cause mortality: A population-based cohort study of individuals accessing universal medical care from 1998 to 2012 in British Columbia, Canada. Schizophr Res 2019; 209:198-205. [PMID: 31255392 DOI: 10.1016/j.schres.2019.04.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 02/01/2019] [Accepted: 04/26/2019] [Indexed: 11/20/2022]
Abstract
Schizophrenia is a severe mental illness with important implications for morbidity and mortality. This population-based cohort study examined the impact of schizophrenia diagnoses on all-cause mortality among a sample of people living with HIV (PLHIV) and a 10% random sample of individuals living without HIV (HIV-) in British Columbia (BC), through a data linkage between the BC Centre for Excellence in HIV/AIDS and Population Data BC's data holdings. Schizophrenia diagnoses were identified via International Classification of Diseases version 9 and version 10 codes. Age- and sex-adjusted all-cause mortality rates from January 1st, 1998 to December 31st, 2012 were calculated. Multivariable logistic models assessed (1) HIV status and mortality among individuals diagnosed with schizophrenia, (2) schizophrenia diagnosis and mortality among PLHIV, and (3) correlates of mortality among PLHIV concurrently diagnosed with schizophrenia (HIV+/SZO+). From 1998 to 2012, 6.3% of those with HIV had a schizophrenia diagnosis, compared to 1.1% of those without HIV. While significant declines in mortality rates were observed throughout the study period, mortality rates were highest among HIV+/SZO+. After adjustment for substance use disorder and age at baseline, HIV+/SZO+ had a 2.64 times greater odds of mortality (95% confidence interval [CI] = 2.14-3.25) compared to HIV-/SZO+. For PLHIV, a schizophrenia diagnosis was not associated with mortality after controlling for potential confounders (adjusted odds ratio [aOR] = 0.90, 95%CI = 0.74-1.09). Among HIV+/SZO+, age, history of injection drug use, ever having an AIDS-defining illness, and never being on anti-psychotic medication or accessing psychiatric services were associated with mortality. Efforts should be made to identify and link to care individuals disproportionately affected by schizophrenia and excess mortality, including those living with HIV.
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21
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Onyeka IN, Collier Høegh M, Nåheim Eien EM, Nwaru BI, Melle I. Comorbidity of Physical Disorders Among Patients With Severe Mental Illness With and Without Substance Use Disorders: A Systematic Review and Meta-Analysis. J Dual Diagn 2019; 15:192-206. [PMID: 31164045 DOI: 10.1080/15504263.2019.1619007] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: Physical disorders in patients with severe mental illness (SMI) are common and they tend to be underdiagnosed by clinicians, which might lead to negative treatment outcomes. The presence of substance use disorders could further aggravate the situation. There are existing systematic reviews on physical disorders among individuals with SMI in general but none of these previous reviews stratified their findings by substance use disorder status. This study aimed to synthesize the evidence on the frequency of comorbid physical disorders among patients with SMI with or without substance use disorders. Methods: We searched for studies published in English between 1988 and 2017 in MEDLINE, Embase, CINAHL, PsycINFO, Global Health, Web of Science, Scopus, WHO Global Health Library (Global Index Medicus), Google Scholar, OpenGrey, the Grey Literature Report, Cochrane Library, International Standardized Randomized Controlled Trial Number Registry, WHO International Clinical Trials Registry Platform, ClinicalTrials.gov, Australian and New Zealand Clinical Trials Registry, and PROSPERO. There was no geographical restriction and the target population was adults (≥18 years) with diagnosed SMI including schizophrenia, bipolar disorder, and other psychotic illnesses. The outcome of interest was physical disorder. Results: A total of 6,994 records were retrieved. Only 30 papers (representing 24 studies) met our inclusion criteria and 13 studies were included in the meta-analysis. The prevalence of most of the reported physical disorders was higher in SMI patients with substance use disorders than in those without substance use disorders. When ranked according to pooled prevalence level, hypertension (35.6%), tardive dyskinesia (35.4%), and hepatitis C (26.9%) were the most prevalent physical disorders among SMI patients with substance use disorders. For SMI patients without substance use disorders, hypertension (32.5%), tardive dyskinesia (25.1%), and endocrine disease (19.0%) were more common. Estimates for diabetes (7.5% vs. 7.5%) and cardiovascular diseases (11.8% vs. 11.3%) were similar across groups. Conclusions: Physical disorders among SMI patients vary by substance use disorder status. Clinicians managing SMI in patients should screen for physical disorders and substance use disorders and provide treatment or referral. Registration: International Prospective Register of Systematic Reviews (PROSPERO) registration number CRD42017072286.
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Affiliation(s)
- Ifeoma N Onyeka
- NORMENT K.G. Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo and Oslo University Hospital , Oslo , Norway.,UKCRC Centre of Excellence for Public Health (Northern Ireland), Centre for Public Health, Queen's University Belfast, Royal Victoria Hospital , Belfast , UK
| | - Margrethe Collier Høegh
- NORMENT K.G. Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo and Oslo University Hospital , Oslo , Norway
| | | | - Bright I Nwaru
- Krefting Research Centre, Institute of Medicine, University of Gothenburg , Gothenburg , Sweden.,Wallenberg Centre for Molecular and Translational Medicine, Institute of Medicine, University of Gothenburg , Gothenburg , Sweden
| | - Ingrid Melle
- NORMENT K.G. Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo and Oslo University Hospital , Oslo , Norway
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Drug-drug interactions and clinical considerations with co-administration of antiretrovirals and psychotropic drugs. CNS Spectr 2019; 24:287-312. [PMID: 30295215 DOI: 10.1017/s109285291800113x] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Psychotropic medications are frequently co-prescribed with antiretroviral therapy (ART), owing to a high prevalence of psychiatric illness within the population living with HIV, as well as a 7-fold increased risk of HIV infection among patients with psychiatric illness. While ART has been notoriously associated with a multitude of pharmacokinetic drug interactions involving the cytochrome P450 enzyme system, the magnitude and clinical impact of these interactions with psychotropics may range from negligible effects on plasma concentrations to life-threatening torsades de pointes or respiratory depression. This comprehensive review summarizes the currently available information regarding drug-drug interactions between antiretrovirals and pharmacologic agents utilized in the treatment of psychiatric disorders-antidepressants, stimulants, antipsychotics, anxiolytics, mood stabilizers, and treatments for opioid use disorder and alcohol use disorder-and provides recommendations for their management. Additionally, overlapping toxicities between antiretrovirals and the psychotropic classes are highlighted. Knowledge of the interaction and adverse effect potential of specific antiretrovirals and psychotropics will allow clinicians to make informed prescribing decisions to better promote the health and wellness of this high-risk population.
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Condomless Sex and Psychiatric Comorbidity in the Context of Constrained Survival Choices: A Longitudinal Study Among Homeless and Unstably Housed Women. AIDS Behav 2019; 23:802-812. [PMID: 30267368 DOI: 10.1007/s10461-018-2280-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
We sought to identify the prevalence and independent correlates of condomless sex within a cohort of community-recruited homeless and unstably housed cisgender adult women who were followed biannually for 3 years (N = 143 HIV+ , N = 139 HIV-). Nearly half (44%) of participants reported condomless sex in the 6 months before baseline, which increased to 65% throughout the study period. After adjusting for having a primary partner, longitudinal odds of condomless sex among women with HIV were significantly higher among those reporting < daily use of alcohol or cannabis (AOR = 2.09, p =.002, and 1.88, p =.005, respectively) and PTSD (AOR = 1.66, p =.034). Among women without HIV, adjusted longitudinal odds of condomless sex were significantly higher for those reporting < daily methamphetamine use (AOR = 2.02, p =.012), panic attack (AOR = 1.74, p =.029), and homelessness (AOR = 1.67, p = .006). Associations were slightly attenuated when adjusting for sex exchange. Targeted HIV/STI programs for unstably housed women should address anxiety and trauma disorders, infrequent substance use, and housing challenges.
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Chen SF, Chiang JH, Hsu CY, Shen YC. Schizophrenia is associated with an increased risk of sexually transmitted infections: A nationwide population-based cohort study in Taiwan. Schizophr Res 2018; 202:316-321. [PMID: 29954703 DOI: 10.1016/j.schres.2018.06.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/19/2018] [Accepted: 06/19/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVES In Taiwan, there has been a growing emphasis on physical health screening, health education and improving access to treatment in patients with schizophrenia (SCZ). However, sexual health needs, including screening and prevention of sexually transmitted infections (STI), are neglected in this population. The study aimed to investigate the association between SCZ and the subsequent incident STI and to examine potential risk factors. METHODS Using the National Health Insurance Research Database of Taiwan, 58,948 SCZ patients and 235,784 controls matched by gender and age were enrolled between 2000 and 2010 and followed until the end of 2011. Participants who developed any STI (HIV, syphilis, genital warts, gonorrhea, chlamydial infection, and trichomoniasis) during the follow-up period were identified. Cox regression analysis was performed to examine the risk of STI between SCZ patients and controls. RESULTS SCZ patients were predisposed to developing STI (hazard ratio (HR): 1.11, 95% confidence interval (95% CI): 1.01-1.21) that could be caused by syphilis (HR: 2.58, 95% CI: 2.14-3.10) or possibly HIV (Crude HR: 1.39, 95% CI: 1.04-1.86; adjusted HR: 1.11, 95% CI: 0.81-1.52). Additionally, this study found that female, young adults, low-income, living in less urbanized areas, and comorbid substance abuse were potential risk factors for developing STI. CONCLUSION This study shows that SCZ is associated with an increased risk of developing STI, which has direct implications for the development of targeted prevention interventions or regular sexual health screening in mental health clinics to reduce the disproportionate burden of HIV and other STI in SCZ patients.
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Affiliation(s)
- Shih-Fen Chen
- Center of Medical Genetics, Tzu Chi General Hospital, Hualien, Taiwan
| | - Jen-Huai Chiang
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan
| | - Chung-Y Hsu
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | - Yu-Chih Shen
- Department of Psychiatry, Tzu Chi General Hospital at Hualien, Hualien, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan.
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Ebuenyi I, Taylor C, O'Flynn D, Matthew Prina A, Passchier R, Mayston R. The Impact of co-morbid severe mental illness and HIV upon mental and physical health and social outcomes: a systematic review. AIDS Care 2018; 30:1586-1594. [PMID: 30114950 DOI: 10.1080/09540121.2018.1510110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Our aim was to review the evidence related to the impact of co-morbid severe mental illness SMI (schizophrenia, schizoaffective and bipolar disorder) and HIV upon mental health, physical health and social outcomes. We carried out a systematic review of scientific evidence, searching online databases (MEDLINE, PsychInfo, EMBASE, Global Health and Scopus) for studies between 1983 and 2017 using search terms for SMI and HIV. Studies were included if they compared health or social outcomes between people living with co-morbid SMI and HIV and people living with either: a) HIV only; or b) SMI only. Outcomes of interest were: mortality, health service use, HIV/SMI-related, co-morbidities, and social outcomes. We identified 20 studies which met our inclusion criteria. Although studies were generally high quality, there was heterogeneity in both selection of outcomes and choice of measure. It was therefore difficult to draw strong conclusions regarding the impact of co-morbid SMI and HIV across any outcome. We found little evidence that co-morbid SMI and HIV were associated with lower levels of treatment, care or poorer clinical outcomes compared to people living with SMI or HIV alone. However, mortality appeared to be higher among the co-morbid group in three out of four analyses identified. Physical and mental co-morbidities and social outcomes were rarely measured. Limited data mean that the impact of co-morbid SMI and HIV is uncertain. In order to develop evidence-based guidelines, there is an urgent need for further research. This may be realized by exploring opportunities for using data from existing cohort studies, routinely collected data and data linkage to investigate important questions relating to this neglected but potentially important area.
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Affiliation(s)
- Ikenna Ebuenyi
- a Athena Institute for Research on Innovation and Communication in Health and Life Sciences , Vrije Universiteit Amsterdam , Netherlands
| | - Chris Taylor
- b Department of Sexual Health and HIV , King's College Hospital London UK
| | - David O'Flynn
- c South London and Maudsley Trust , King's Health Partners
| | - A Matthew Prina
- d Centre for Global Mental Health, Health Service and Population Research , King's College London , London
| | - Ruth Passchier
- e Institute of Infectious Disease and Molecular Medicine , University of Cape Town
| | - Rosie Mayston
- d Centre for Global Mental Health, Health Service and Population Research , King's College London , London
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Mere SM, Paruk S. A chart review of human immunodeficiency virus status in patients admitted with psychosis in Durban, South Africa. S Afr J Psychiatr 2018; 24:1129. [PMID: 30263214 PMCID: PMC6138071 DOI: 10.4102/sajpsychiatry.v24i0.1129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 02/05/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Comorbid human immunodeficiency virus (HIV) infection among patients with psychotic disorders is associated with a poorer outcome. Understanding the association of HIV infection with demographic and clinical variables may provide clues to modify risk factors and outcomes. AIM To describe and compare the socio-demographic and clinical profile of patients admitted with psychotic disorders with and without HIV infection. METHOD A retrospective chart review of 100 adult patients consecutively admitted with psychosis and HIV infection and compared to 101 patients with psychosis without HIV infection. RESULTS HIV-infected patients with psychotic disorders were more likely to be females (74.0%), younger than 50 years (94.0%) and less likely to have secondary education than HIV- negative patients with psychotic disorders (56.0% vs. 72.0%). HIV-infected patients were also less likely to be diagnosed as having schizophrenia (33.0%), had higher rates of medical (73.0%) and psychiatric (21.0%) comorbid disorders and were less likely to report lifetime nicotine and cannabis use (p = 0.047 and p = 0.011). HIV-negative patients with psychotic disorders were more likely to be readmitted to the unit in the next 12 months (p < 0.05). HIV-infected patients with psychotic disorders had increased abnormal haematological results (33.0%). CONCLUSION Patients with psychotic disorders and HIV infection had several negative prognostic factors such as younger age, increased rates of medical and psychiatric comorbidity, abnormal haematological results and longer length of admission periods. This suggests the need to target HIV prevention programmes at young females with mental illness and provide an integrated healthcare service with medical and psychiatric assessment and care for patients with HIV and psychosis.
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Affiliation(s)
- Sellwane M Mere
- Department of Psychiatry, University of KwaZulu-Natal, South Africa
| | - Saeeda Paruk
- Department of Psychiatry, University of KwaZulu-Natal, South Africa
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27
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Shumway M, Mangurian C, Carraher N, Momenzadeh A, Leary M, Lee EK, Dilley JW. Increasing HIV Testing in Inpatient Psychiatry. PSYCHOSOMATICS 2018; 59:186-192. [PMID: 29153630 PMCID: PMC5857211 DOI: 10.1016/j.psym.2017.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 10/17/2017] [Accepted: 10/18/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND People with serious mental illness (SMI) are at elevated risk of HIV infection, but do not receive HIV tests regularly. Inpatient psychiatric admissions provide opportunities for HIV testing. OBJECTIVE This study retrospectively examined the impact of three sequential interventions designed to increase HIV testing on an acute inpatient psychiatry service: (1) advocacy by an administrative champion, (2) an on-site HIV counselor, and (3) a clinician championing HIV testing. METHOD Demographic and HIV testing data were extracted from hospital data systems for 11,360 admissions of HIV-negative patients to an inpatient psychiatry service between 2006 and 2012. Relationships among interventions, length of stay, patient demographics, and receipt of an HIV test were examined using general estimating equation methods. RESULTS In the year prior to the intervention, 7.2% of psychiatric inpatients received HIV tests. After 1 year of administrative advocacy, 11.2% received tests. Following the HIV counseling intervention, 25.1% of patients were tested. After the counseling intervention ended, continued administrative and clinical advocacy was associated with further increases in testing. In the final year studied, 30.3% of patients received HIV tests. Patients with shorter inpatient stays and those of Black or Asian race/ethnicity were less likely to be tested. Further, 1.6% of HIV tests were positive. CONCLUSION Three interventions of varying intensity were associated with a 5-fold increase in HIV testing on an acute inpatient psychiatry service. Nonetheless, 70% of inpatients were not tested. Continued efforts are needed to increase HIV testing in inpatient psychiatric settings.
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Affiliation(s)
- Martha Shumway
- Department of Psychiatry, University of California, San Francisco Weill Institute for Neurosciences and Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA.
| | - Christina Mangurian
- Department of Psychiatry, University of California, San Francisco Weill Institute for Neurosciences and Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA
| | - Noah Carraher
- San Francisco Department of Public Health, San Francisco, CA
| | - Amanda Momenzadeh
- Department of Clinical Pharmacy, University of California San Francisco Medical Center, San Francisco, CA
| | - Mark Leary
- Department of Psychiatry, University of California, San Francisco Weill Institute for Neurosciences and Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA
| | - Emily K Lee
- Department of Psychiatry, University of California, San Francisco Weill Institute for Neurosciences and Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA
| | - James W Dilley
- Department of Psychiatry, University of California, San Francisco Weill Institute for Neurosciences and Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA
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Dalseth N, Reed RS, Hennessy M, Eisenberg MM, Blank MB. Does Diagnosis Make a Difference? Estimating the Impact of an HIV Medication Adherence Intervention for Persons with Serious Mental Illness. AIDS Behav 2018; 22:265-275. [PMID: 28536741 PMCID: PMC6281165 DOI: 10.1007/s10461-017-1795-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The heightened risk of persons with serious mental illness to contract and transmit human immunodeficiency virus (HIV) is a public health problem. Here we evaluate the interaction between psychiatric diagnosis and response to a community based-intervention targeted at treatment adherence in 236 HIV+ persons with co-occurring mental illness. To examine differential effectiveness of the intervention for categories of patient diagnosis, we reanalyzed the data after stratifying participants into two diagnostic groups: (1) participants with depressive disorders without psychosis and (2) participants with a psychotic or bipolar disorder. Outcomes included viral load and mental health quality of life (SF-12 Mental Health). We found that HIV+ persons with non-psychotic depressive disorders demonstrated a larger decrease in HIV viral load and more improvement in measures of mental health quality of life when compared to HIV+ persons with psychotic and bipolar disorders. We suggest that successful adherence interventions should be informed by psychiatric symptomatology. TRIAL REGISTRATION clinicaltrials.gov 29 identifier NCT00264823.
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Affiliation(s)
- Natasha Dalseth
- Department of Psychiatry and Behavioral Science, Lewis Katz School of Medicine, Temple University, Episcopal Campus, 100 E Lehigh Ave MAB 305, Philadelphia, PA, 19125, USA.
| | - Regina Szucs Reed
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Marlene M Eisenberg
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael B Blank
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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29
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Efavirenz precipitating hallucinations in a patient with an undetected psychotic prodrome: a call for better screening at the point of care. AIDS 2017; 31:2561-2562. [PMID: 29120904 DOI: 10.1097/qad.0000000000001657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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30
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Honer WG, Cervantes-Larios A, Jones AA, Vila-Rodriguez F, Montaner JS, Tran H, Nham J, Panenka WJ, Lang DJ, Thornton AE, Vertinsky T, Barr AM, Procyshyn RM, Smith GN, Buchanan T, Krajden M, Krausz M, MacEwan GW, Gicas KM, Leonova O, Langheimer V, Rauscher A, Schultz K. The Hotel Study-Clinical and Health Service Effectiveness in a Cohort of Homeless or Marginally Housed Persons. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:482-492. [PMID: 28199798 PMCID: PMC5528984 DOI: 10.1177/0706743717693781] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The Hotel Study was initiated in Vancouver's Downtown East Side (DTES) neighborhood to investigate multimorbidity in homeless or marginally housed people. We evaluated the clinical effectiveness of existing, illness-specific treatment strategies and assessed the effectiveness of health care delivery for multimorbid illnesses. METHOD For context, we mapped the housing locations of patients presenting for 552,062 visits to the catchment hospital emergency department (2005-2013). Aggregate data on 22,519 apprehensions of mentally ill people were provided by the Vancouver Police Department (2009-2015). The primary strategy was a longitudinal cohort study of 375 people living in the DTES (2008-2015). We analysed mortality and evaluated the clinical and health service delivery effectiveness for infection with human immunodeficiency virus or hepatitis C virus, opioid dependence, and psychosis. RESULTS Mapping confirmed the association between poverty and greater number of emergency visits related to substance use and mental illness. The annual change in police apprehensions did not differ between the DTES and other policing districts. During 1581 person-years of cohort observation, the standardized mortality ratio was 8.43 (95% confidence interval, 6.19 to 11.50). Physician visits were common (84.3% of participants over 6 months). Clinical treatment effectiveness was highest for HIV/AIDS, intermediate for opioid dependence, and lowest for psychosis. Health service delivery mechanisms provided examples of poor access, poor treatment adherence, and little effect on multimorbid illnesses. CONCLUSIONS Clinical effectiveness was variable, and illness-specific service delivery appeared to have little effect on multimorbidity. New models of care may need to be implemented.
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Affiliation(s)
- William G Honer
- 1 Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | | | - Andrea A Jones
- 1 Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Fidel Vila-Rodriguez
- 1 Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Julio S Montaner
- 1 Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Howard Tran
- 3 Youth Services Section and Mental Health Portfolio, Vancouver Police Department, Vancouver, British Columbia
| | - Jimmy Nham
- 3 Youth Services Section and Mental Health Portfolio, Vancouver Police Department, Vancouver, British Columbia
| | - William J Panenka
- 1 Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Donna J Lang
- 4 Department of Radiology, University of British Columbia, Vancouver, British Columbia
| | - Allen E Thornton
- 5 Department of Psychology, Simon Fraser University, Burnaby, British Columbia
| | - Talia Vertinsky
- 4 Department of Radiology, University of British Columbia, Vancouver, British Columbia
| | - Alasdair M Barr
- 6 Department of Anesthesia, Pharmacology & Therapeutics, University of British Columbia, Vancouver, British Columbia
| | - Ric M Procyshyn
- 1 Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Geoffrey N Smith
- 1 Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Tari Buchanan
- 1 Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Mel Krajden
- 7 Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia
| | - Michael Krausz
- 1 Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - G William MacEwan
- 1 Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Kristina M Gicas
- 5 Department of Psychology, Simon Fraser University, Burnaby, British Columbia
| | - Olga Leonova
- 1 Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Verena Langheimer
- 1 Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Alexander Rauscher
- 1 Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Krista Schultz
- 1 Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
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Walter F, Carr MJ, Mok PL, Astrup A, Antonsen S, Pedersen CB, Shaw J, Webb RT. Premature Mortality Among Patients Recently Discharged From Their First Inpatient Psychiatric Treatment. JAMA Psychiatry 2017; 74:485-492. [PMID: 28296989 PMCID: PMC5417353 DOI: 10.1001/jamapsychiatry.2017.0071] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Nationwide cohorts provide sufficient statistical power for examining premature, cause-specific mortality in patients recently discharged from inpatient psychiatric services. OBJECTIVE To investigate premature mortality in a nationwide cohort of patients recently discharged from inpatient psychiatric treatment at ages 15 to 44 years. DESIGN, SETTING, AND PARTICIPANTS This single-cohort design included all persons born in Denmark (N = 1 683 385) between January 1, 1967, and December 31, 1996. Exactly 48 599 of these Danish residents were discharged from an inpatient psychiatric unit or ward on or after their 15th birthday, which took place during this study's observation period from January 1, 1982, through December 31, 2011. This group of patients was followed up beginning on their 15th birthday until their death, emigration, or December 31, 2011, whichever came first. Individuals discharged from inpatient psychiatric care at least once before their 15th birthday (n = 5882) were excluded from the study. All data were obtained from the Danish Civil Registration System, Psychiatric Central Research Register, and Register of Causes of Death. Data analysis took place between February 1, 2016, and December 10, 2016. MAIN OUTCOMES AND MEASURES Incidence rates and incidence rate ratios (IRRs) for all-cause mortality and for an array of unnatural and natural causes of death among patients recently discharged from an inpatient psychiatric unit vs persons not admitted to a psychiatric facility. Primary analysis considered risk within the year of first discharge. RESULTS Of the 48 599 discharged patients who were included in the study, 25 006 (51.4%) were female, 35 660 (73.4%) were aged 15 to 29 years, and 33 995 (70.0%) had a length of stay of 30 days or less. Compared with persons not admitted, patients discharged had an elevated risk for all-cause mortality within 1 year (IRR, 16.2; 95% CI, 14.5-18.0). The relative risk for unnatural death (IRR, 25.0; 95% CI, 22.0-28.4) was much higher than for natural death (IRR, 8.6; 95% CI, 7.0-10.7). The highest IRR found was for suicide at 66.9 (95% CI, 56.4-79.4), followed by alcohol-related death at 42.0 (95% CI, 26.6-66.1). Among the psychiatric diagnostic categories assessed, psychoactive substance abuse conferred the highest risk for all-cause mortality (IRR, 24.8; 95% CI, 21.0-29.4). Across the array of cause-specific outcomes examined, risk of premature death during the first year after discharge was markedly higher than the risk of death beyond the first year of discharge. CONCLUSIONS AND RELEVANCE Clinicians may help protect patients after discharge by serving as a liaison between primary and secondary health services to ensure they are receiving holistic care. Early intervention programs for drug and alcohol misuse could substantially decrease the greatly elevated mortality risk among these patients.
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Affiliation(s)
- Florian Walter
- Centre for Mental Health and Safety, University of Manchester, UK
| | - Matthew J. Carr
- Centre for Mental Health and Safety, University of Manchester, UK
| | - Pearl L.H. Mok
- Centre for Mental Health and Safety, University of Manchester, UK
| | - Aske Astrup
- Centre for Integrated Register-based Research, CIRRAU, Aarhus University, Aarhus, Denmark,National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - Sussie Antonsen
- Centre for Integrated Register-based Research, CIRRAU, Aarhus University, Aarhus, Denmark,National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - Carsten B. Pedersen
- Centre for Integrated Register-based Research, CIRRAU, Aarhus University, Aarhus, Denmark,National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - Jenny Shaw
- Centre for Mental Health and Safety, University of Manchester, UK
| | - Roger T. Webb
- Centre for Mental Health and Safety, University of Manchester, UK
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Cooccurrences of Putative Endogenous Retrovirus-Associated Diseases. BIOMED RESEARCH INTERNATIONAL 2017; 2017:7973165. [PMID: 28326328 PMCID: PMC5343228 DOI: 10.1155/2017/7973165] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Revised: 01/21/2017] [Accepted: 02/06/2017] [Indexed: 12/11/2022]
Abstract
At least 8% of the human genome is composed of endogenous retrovirus (ERV) sequences. ERVs play a role in placental morphogenesis and can sometimes protect the host against exogenous viruses. On the other hand, ERV reactivation has been found to be associated with different diseases, for example, multiple sclerosis (MS), schizophrenia, type 1 diabetes mellitus (T1D), or amyotrophic lateral sclerosis (ALS). Little is known about the cooccurrence of these diseases. If all these diseases are caused by ERV, antiretroviral therapy should perhaps also show some effects in the other diseases. Here, we summarize literature demonstrating that some ERV-associated diseases seem to appear together more often than expected, for example, MS and ALS, MS and T1D, MS and schizophrenia, or ALS and T1D. In contrast, some ERV-associated diseases seem to appear together less frequently than expected, for example, schizophrenia and T1D. Besides, some reports demonstrate amelioration of MS, ALS, or schizophrenia under antiretroviral therapy in human immunodeficiency virus-infected patients. If such results could be confirmed in larger studies, alternative therapy strategies for ERV-associated diseases like MS and schizophrenia might be possible.
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Wang Q, Polimanti R, Kranzler HR, Farrer LA, Zhao H, Gelernter J. Genetic factor common to schizophrenia and HIV infection is associated with risky sexual behavior: antagonistic vs. synergistic pleiotropic SNPs enriched for distinctly different biological functions. Hum Genet 2016; 136:75-83. [PMID: 27752767 DOI: 10.1007/s00439-016-1737-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 10/01/2016] [Indexed: 12/29/2022]
Abstract
Schizophrenia (SZ) and HIV infection are serious disorders with a complex phenotypic relationship. Observational studies have described their comorbidity; their genetic correlation is not well studied. We performed extensive analysis in search of common genetic factors for SZ and HIV, and their relationship with risky sexual behavior (RSB). Summary statistics from genome-wide association studies of HIV infection and schizophrenia were obtained and 2379 European Americans were genotyped and assessed for RSB score. Genetic relationships between traits were analyzed in three ways: linkage disequilibrium (LD) score regression to estimate genetic correlation; GPA (Genetic analysis incorporating Pleiotropy and Annotation) to test pleiotropy and identify pleiotropic loci; polygenic risk scores (PRS) of SZ and HIV to predict RSB using linear regression. We found significant pleiotropy (p = 5.31E - 28) and a positive genetic correlation (cor = 0.17, p = 0.002) for SZ and HIV infection. Pleiotropic SNPs with opposite effect directions (antagonistic) and SNPs with the same effect direction (synergistic) were enriched for distinctly different biological functions. SZ PRS computed with antagonistically pleiotropic SNPs consistently predicted RSB score with nominal significance, but SZ PRS based on either synergistically pleiotropic SNPs or all SNPs did not predict RSB. The epidemiologic correlation between schizophrenia and HIV can partly be explained by overlapping genetic risk factors, which are related to risky sexual behavior.
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Affiliation(s)
- Qian Wang
- Program in Computational Biology and Bioinformatics, Yale University, New Haven, CT, USA.,Department of Psychiatry, Yale University School of Medicine, 116A2, 950 Campbell Avenue, West Haven, CT, 06516, USA.,VA CT Healthcare Center, New Haven, CT, USA
| | - Renato Polimanti
- Department of Psychiatry, Yale University School of Medicine, 116A2, 950 Campbell Avenue, West Haven, CT, 06516, USA.,VA CT Healthcare Center, New Haven, CT, USA
| | - Henry R Kranzler
- Department of Psychiatry, Perelman School of Medicine of the University of Pennsylvania and VISN 4 MIRECC, Crescenz VAMC, Philadelphia, PA, USA
| | - Lindsay A Farrer
- Department of Medicine (Biomedical Genetics), Boston University School of Medicine, Boston, MA, USA.,Department of Neurology, Boston University School of Medicine, Boston, MA, USA.,Department of Ophthalmology, Boston University School of Medicine, Boston, MA, USA.,Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.,Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Hongyu Zhao
- Program in Computational Biology and Bioinformatics, Yale University, New Haven, CT, USA.,Department of Biostatistics, Yale University School of Public Health, New Haven, CT, USA.,Department of Genetics, Yale University School of Medicine, New Haven, CT, USA.,VA Cooperative Studies Program Coordinating Center, New Haven, CT, USA
| | - Joel Gelernter
- Department of Psychiatry, Yale University School of Medicine, 116A2, 950 Campbell Avenue, West Haven, CT, 06516, USA. .,VA CT Healthcare Center, New Haven, CT, USA. .,Department of Genetics, Yale University School of Medicine, New Haven, CT, USA. .,Department of Neuroscience, Yale University School of Medicine, New Haven, CT, USA.
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Blank MB, Eisenberg MM. Registries and syndemics: untapped potential for global health. Lancet HIV 2015; 2:e314-5. [PMID: 26423370 DOI: 10.1016/s2352-3018(15)00110-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 05/27/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Michael B Blank
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - Marlene M Eisenberg
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA
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