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Sleurs D, Speranza M, Etain B, Aouizerate B, Aubin V, Bellivier F, Belzeaux R, Carminati M, Courtet P, Dubertret C, Fredembach B, Haffen E, Groppi F, Laurent P, Leboyer M, Llorca PM, Olié E, Polosan M, Schwan R, Weill D, Passerieux C, Roux P. Functioning and neurocognition in very early and early-life onset bipolar disorders: the moderating role of bipolar disorder type. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02372-3. [PMID: 38702455 DOI: 10.1007/s00787-024-02372-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 01/08/2024] [Indexed: 05/06/2024]
Abstract
Defining homogeneous subgroups of bipolar disorder (BD) is a major goal in personalized psychiatry and research. According to the neurodevelopmental theory, age at onset may be a key variable. As potential trait markers of neurodevelopment, cognitive and functional impairment should be greater in the early form of the disease, particularly type 1 BD (BD I). The age at onset was assessed in a multicenter, observational sample of 4190 outpatients with BD. We used a battery of neuropsychological tests to assess six domains of cognition. Functioning was measured using the Functioning Assessment Short Test (FAST). We studied the potential moderation of the type of BD on the associations between the age at onset and cognitive and functioning in a subsample of 2072 euthymic participants, controlling for potential clinical and socio-demographic covariates. Multivariable analyses showed cognition to not be impaired in individuals with early (21-30 years) and very early-life (before 14 years) onset of BD. Functioning was equivalent between individuals with early and midlife-onset of BD II and NOS but better for individuals with early onset of BD I. In contrast, functioning was not worse in individuals with very early-onset BD I but worse in those with very early-onset BD II and NOS. Early-life onset BDs were not characterized by poorer cognition and functioning. Our results do not support the neurodevelopmental view that a worse cognitive prognosis characterizes early-life onset BD. This study suggests that functional remediation may be prioritized for individuals with midlife-onset BD I and very early life onset BD 2 and NOS.
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Affiliation(s)
- D Sleurs
- Fondation FondaMental, Créteil, France.
- AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, DMU ESPRIT, Service de Psychiatrie Et Addictologie, Hopital Louis Mourier, 178 Rue Des Renouillers, 92700, Colombes, France.
- Inserm U1266, Faculté de Médecine, Université Paris Cité, Paris, France.
| | - M Speranza
- Fondation FondaMental, Créteil, France
- Centre Hospitalier de Versailles, Service Universitaire de Psychiatrie de L'Enfant Et de L'Adolescent, Le Chesnay, France
- Université Paris-Saclay, Paris, France
- Université de Versailles Saint-Quentin-En-Yvelines, Versailles, France
- DisAP-DevPsy-CESP, INSERM UMR1018, Villejuif, France
| | - B Etain
- Fondation FondaMental, Créteil, France
- AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, DMU Neurosciences, Département de Psychiatrie Et de Médecine Addictologique, Hôpital Fernand Widal, Paris, France
- INSERM UMR-S 1144, Optimisation Thérapeutique en Neuropsychopharmacologie OTeN, Université Paris Cité, Paris, France
| | - B Aouizerate
- Fondation FondaMental, Créteil, France
- Laboratoire NutriNeuro (UMR INRA 1286), Centre Hospitalier Charles Perrens, Université de Bordeaux, Bordeaux, France
| | - V Aubin
- Fondation FondaMental, Créteil, France
- Pôle de Psychiatrie, Centre Hospitalier Princesse Grace, Monaco, France
| | - F Bellivier
- Fondation FondaMental, Créteil, France
- AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, DMU Neurosciences, Département de Psychiatrie Et de Médecine Addictologique, Hôpital Fernand Widal, Paris, France
- INSERM UMR-S 1144, Optimisation Thérapeutique en Neuropsychopharmacologie OTeN, Université Paris Cité, Paris, France
| | - R Belzeaux
- Fondation FondaMental, Créteil, France
- Pôle de Psychiatrie, Assistance Publique Hôpitaux de Marseille, Marseille, France
- INT-UMR7289, CNRS Aix-Marseille Université, Marseille, France
| | - M Carminati
- Fondation FondaMental, Créteil, France
- AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, DMU Neurosciences, Département de Psychiatrie Et de Médecine Addictologique, Hôpital Fernand Widal, Paris, France
- INSERM UMR-S 1144, Optimisation Thérapeutique en Neuropsychopharmacologie OTeN, Université Paris Cité, Paris, France
| | - P Courtet
- Fondation FondaMental, Créteil, France
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, Montpellier, France
- IGF, Université de Montpellier, CNRS, INSERM, Montpellier, France
| | - C Dubertret
- Fondation FondaMental, Créteil, France
- AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, DMU ESPRIT, Service de Psychiatrie Et Addictologie, Hopital Louis Mourier, 178 Rue Des Renouillers, 92700, Colombes, France
- Inserm U1266, Faculté de Médecine, Université Paris Cité, Paris, France
| | - B Fredembach
- Fondation FondaMental, Créteil, France
- Grenoble Institut Des Neurosciences (GIN), Université Grenoble Alpes, CHU de Grenoble Et Des Alpes, Inserm U 1216, Grenoble, France
| | - E Haffen
- Fondation FondaMental, Créteil, France
- Département de Psychiatrie Clinique, CIC-1431 INSERM, CHU de Besançon, Besançon, France
- EA481 Neurosciences, Université Bourgogne Franche-Comté, Besançon, France
| | - F Groppi
- Fondation FondaMental, Créteil, France
- Pôle de Psychiatrie, Assistance Publique Hôpitaux de Marseille, Marseille, France
- INT-UMR7289, CNRS Aix-Marseille Université, Marseille, France
| | - P Laurent
- Fondation FondaMental, Créteil, France
- AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, DMU ESPRIT, Service de Psychiatrie Et Addictologie, Hopital Louis Mourier, 178 Rue Des Renouillers, 92700, Colombes, France
- Inserm U1266, Faculté de Médecine, Université Paris Cité, Paris, France
| | - M Leboyer
- Fondation FondaMental, Créteil, France
- Translational NeuroPsychiatry Laboratory, Univ Paris Est Créteil, INSERM U955, IMRB, Créteil, France
- AP-HP, Hôpitaux Universitaires Henri Mondor, Département Médico-Universitaire de Psychiatrie Et d'Addictologie (DMU IMPACT), Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Créteil, France
| | - P M Llorca
- Fondation FondaMental, Créteil, France
- Département de Psychiatrie, Centre Hospitalier Et Universitaire, Clermont-Ferrand, France
- Université d'Auvergne, EA 7280, 63000, Clermont-Ferrand, France
| | - E Olié
- Fondation FondaMental, Créteil, France
- Grenoble Institut Des Neurosciences (GIN), Université Grenoble Alpes, CHU de Grenoble Et Des Alpes, Inserm U 1216, Grenoble, France
| | - M Polosan
- Fondation FondaMental, Créteil, France
- Centre Psychothérapique de Nancy, Université de Lorraine , Inserm U1254, Nancy, France
| | - R Schwan
- Fondation FondaMental, Créteil, France
- Centre Psychothérapique de Nancy, Université de Lorraine , Inserm U1254, Nancy, France
| | - D Weill
- Fondation FondaMental, Créteil, France
- Translational NeuroPsychiatry Laboratory, Univ Paris Est Créteil, INSERM U955, IMRB, Créteil, France
- AP-HP, Hôpitaux Universitaires Henri Mondor, Département Médico-Universitaire de Psychiatrie Et d'Addictologie (DMU IMPACT), Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Créteil, France
| | - C Passerieux
- Fondation FondaMental, Créteil, France
- Université Paris-Saclay, Paris, France
- Université de Versailles Saint-Quentin-En-Yvelines, Versailles, France
- DisAP-DevPsy-CESP, INSERM UMR1018, Villejuif, France
- Centre Hospitalier de Versailles, Service Universitaire de Psychiatrie d'Adultes Et d'Addictologie, Le Chesnay, France
| | - P Roux
- Fondation FondaMental, Créteil, France
- Université Paris-Saclay, Paris, France
- Université de Versailles Saint-Quentin-En-Yvelines, Versailles, France
- DisAP-DevPsy-CESP, INSERM UMR1018, Villejuif, France
- Centre Hospitalier de Versailles, Service Universitaire de Psychiatrie d'Adultes Et d'Addictologie, Le Chesnay, France
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Li Q, Li X, Ye C, Jia M, Si T. Characteristics of patients with schizophrenia switching from oral antipsychotics to once-monthly paliperidone palmitate (PP1M): a systematic review. BMC Psychiatry 2024; 24:57. [PMID: 38243208 PMCID: PMC10799459 DOI: 10.1186/s12888-024-05508-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 01/09/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND The utilization of once-monthly paliperidone palmitate (PP1M) in schizophrenia treatment has increased due to its enhanced adherence and convenience. However, there is limited evidence on patient characteristics that may influence treatment outcomes when switching from oral antipsychotics (OAPs) to PP1M therapy. This systematic review aims to identify such patient characteristics and explore potential beneficial factors to aid healthcare professionals in clinical practice. METHODS A systematic literature search was conducted in the PubMed, Embase, and Cochrane Library databases up to July 19, 2022. Studies related to patients with schizophrenia who had been previously treated with OAPs and switched to PP1M were identified and included. Outcomes included the Positive and Negative Syndrome Scale (PANSS) total score, the clinical Global Impressions - Severity (CGI-S) score, the Personal and Social Performance (PSP) total score, and hospitalisation rate. Data were independently extracted and analysed. The results were presented through a narrative synthesis. RESULTS Eleven studies with a total of 4150 patients were included, identifying nine potential characteristics. The most commonly reported characteristics was patient's prior treatment with OAPs, followed by the stage of disease, duration of illness (DI), ethnicity, reason for switching to PP1M, history of hospitalisation, time of start injection of PP1M, the PANSS and PSP total score at baseline. Patients in the acute stage, with a shorter DI, a less than 1-week time interval to PP1M injection, and a lower PANSS total score at baseline may have a trend on providing better improvements on PANSS total score. Acute stage and shorter DI also showed potential trends in reducing CGI-S score. Early initiation of PP1M, switching for reasons other than lack of efficacy, and a higher PSP score at baseline exhibited potential trends towards better PSP total score improvements. CONCLUSION Our findings may suggest that patients in acute stage, with a shorter duration of illness, with early initiation of PP1M injection, and lower PANSS or PSP scores may trend towards better clinical results when transitioning to PP1M from OAPs. Further research is necessary to validate these potential associations and identify any unexplored characteristics. Such investigations are crucial for providing comprehensive clinical recommendations and informing treatment strategies in this context.
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Affiliation(s)
- Qian Li
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Centre for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Xin Li
- Xi'an Janssen Pharmaceutical Ltd, Chaoyang District, Beijing, China
| | - Chong Ye
- Xi'an Janssen Pharmaceutical Ltd, Chaoyang District, Beijing, China
| | - Miaomiao Jia
- Xi'an Janssen Pharmaceutical Ltd, Chaoyang District, Beijing, China
| | - Tianmei Si
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Centre for Mental Disorders (Peking University Sixth Hospital), Beijing, China.
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Nixon N, Guo B, Kaylor-Hughes C, Simpson S, Garland A, Dalgleish T, Morriss R. Specialist treatment for persistent depression in secondary care: Sustained effects from a multicentre UK study at 24 and 36 months. J Affect Disord 2024; 345:70-77. [PMID: 37863366 DOI: 10.1016/j.jad.2023.10.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/21/2023] [Accepted: 10/15/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Despite the known health costs of persistent depression, there is no established service framework for the treatment of this disorder and a lack of long-term outcome data to inform commissioning. To address this gap, we report the long-term clinical effectiveness of a randomised controlled trial (RCT) testing a specialist, collaborative model of care for people with persistent moderate to severe unipolar depression. METHODS A multicentre, pragmatic, single-blind, parallel-group randomised controlled trial comparing outcomes from a Specialist Depression Service (SDS) offering collaborative treatment with cognitive behavioural therapy (CBT) and pharmacotherapy for 12 months with treatment as usual (TAU) for persistent, moderate-severe depression in UK secondary care. Participants were initially assessed at baseline, 3, 6, 9, 12, and 18 months, with primary endpoints (17-item Hamilton Depression Rating Scale [HDRS17], and a Global Assessment of Functioning [GAF]) reported elsewhere (Morriss et al., 2016). Additional long-term, post-treatment, follow-up was made at 24 and 36 months with outcomes presented here. CLINICALTRIALS gov (NCT01047124) and ISRCTN registration (ISRCTN 10963342). RESULTS At 24 months there remained a statistically significant between-group difference in HDRS17-2.69 (-5.14, -0.23) and a non-significant improvement in GAF 2.85 (-1.23, 6.94), both favouring the SDS. Simple statistics are presented at 36 months, due to attrition, showing higher continued response and remission vs TAU across all measures. LIMITATIONS Potential bias through loss to follow-up, particularly beyond 24 months. CONCLUSIONS Compared with standard secondary care, SDS management of persistent moderate-severe depression, produced long-term clinical benefits, sustained following treatment completion, suggesting a model for future specialist care.
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Affiliation(s)
- Neil Nixon
- Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK; Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK.
| | - Boliang Guo
- Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Catherine Kaylor-Hughes
- Primary Care Mental Health Program and ALIVE National Centre, Department of General Practice and Primary Care, The University of Melbourne, Melbourne, Australia
| | - Sandra Simpson
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Anne Garland
- Oxford Cognitive Therapy Centre, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Tim Dalgleish
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Richard Morriss
- Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK; Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
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Siafis S, Brandt L, McCutcheon RA, Gutwinski S, Schneider-Thoma J, Bighelli I, Kane JM, Arango C, Kahn RS, Fleischhacker WW, McGorry P, Carpenter WT, Falkai P, Hasan A, Marder SR, Schooler N, Engel RR, Honer WG, Buchanan RW, Davidson M, Weiser M, Priller J, Davis JM, Howes OD, Correll CU, Leucht S. Relapse in clinically stable adult patients with schizophrenia or schizoaffective disorder: evidence-based criteria derived by equipercentile linking and diagnostic test accuracy meta-analysis. Lancet Psychiatry 2024; 11:36-46. [PMID: 38043562 DOI: 10.1016/s2215-0366(23)00364-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 09/30/2023] [Accepted: 10/19/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND There is no consensus on defining relapse in schizophrenia, and scale-derived criteria with unclear clinical relevance are widely used. We aimed to develop an evidence-based scale-derived set of criteria to define relapse in patients with schizophrenia or schizoaffective disorder. METHODS We searched the Yale University Open Data Access (YODA) for randomised controlled trials (RCTs) in clinically stable adults with schizophrenia or schizoaffective disorder, and obtained individual participant data on Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression Severity (CGI-S), Personal and Social Performance (PSP), and Social and Occupational Functioning Assessment Scale (SOFAS). Our main outcomes were PANSS-derived criteria based on worsening in PANSS total score. We examined their relevance using equipercentile linking with CGI-S and functioning scales, and their test-performance in defining relapse with diagnostic test accuracy meta-analysis against CGI-S worsening (≥1-point increase together with a score ≥4 points) and psychiatric hospitalisation. FINDINGS Based on data from seven RCTs (2354 participants; 1348 men [57·3%] and 1006 women [42·7%], mean age of 39·5 years [SD 12·0, range 17-89]; 303 Asian [12.9%], 255 Black [10.8%], 1665 White [70.7%], and other or unspecified 131 [5.6%]), an increase of 12 points or more in PANSS total (range 30-210 points) corresponded to clinically important deterioration in global severity of illness (≥1 point increase in CGI-S, range 1-7) and functioning (≥10 points decline in PSP or SOFAS, range 1-100). The interpretation of percentage changes varied importantly across different baseline scores. An increase of 12 points or more in PANSS total had good sensitivity and specificity using CGI-S as reference standard (sensitivity 82·1% [95% CI 77·1-86·4], specificity 86·9% [82·9-90·3]), as well as good sensitivity but lower specificity compared to hospitalisation (sensitivity 81·7% [74·1-87·7], specificity 69·2% [60·5-76·9]). Requiring either an increase in PANSS total or in specific items for positive and disorganization symptoms further improved test-performance. Cutoffs for situations where high sensitivity or specificity is needed are presented. INTERPRETATION An increase of either 12 points or more in the PANSS total score, or worsening of specific positive and disorganisation symptom items could be a reasonable evidence-based definition of relapse in schizophrenia, potentially linking symptoms used to define remission and relapse. Percentage changes should not be used to define relapse because their interpretation depends on baseline scores. FUNDING German Research Foundation (grant number: 428509362).
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Affiliation(s)
- Spyridon Siafis
- Department of Psychiatry and Psychotherapy, School of Medicine and Health, Technical University of Munich, 81675 Munich, Germany; German Center for Mental Health (DZPG), Germany.
| | - Lasse Brandt
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Charité Campus Mitte, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Robert A McCutcheon
- Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK; Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - Stefan Gutwinski
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Charité Campus Mitte, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Johannes Schneider-Thoma
- Department of Psychiatry and Psychotherapy, School of Medicine and Health, Technical University of Munich, 81675 Munich, Germany; German Center for Mental Health (DZPG), Germany
| | - Irene Bighelli
- Department of Psychiatry and Psychotherapy, School of Medicine and Health, Technical University of Munich, 81675 Munich, Germany; German Center for Mental Health (DZPG), Germany
| | - John M Kane
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks NY, USA; The Donald and Barbara Zucker School of Medicine, Department of Psychiatry and Molecular Medicine, Hempstead NY, USA
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - René S Kahn
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York NY, USA
| | | | - Patrick McGorry
- Orygen, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - William T Carpenter
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore MD, USA
| | - Peter Falkai
- German Center for Mental Health (DZPG), Germany; Department of Psychiatry and Psychotherapy, School of Medicine, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Alkomiet Hasan
- German Center for Mental Health (DZPG), Germany; Department of Psychiatry, Psychotherapy and Psychosomatics, University of Augsburg, Medical Faculty, Bezirkskrankenhaus Augsburg, Augsburg, Germany
| | - Stephen R Marder
- Semel Institute for Neuroscience at UCLA, VA Desert Pacific Mental Illness Research, Education and Clinical Center, Los Angeles CA, USA
| | - Nina Schooler
- Department of Psychiatry and Behavioral Sciences, State University of New York Downstate Medical Center, Brooklyn NY, USA
| | - Rolf R Engel
- Department of Psychiatry and Psychotherapy, School of Medicine, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - William G Honer
- University of British Columbia, Department of Psychiatry, Faculty of Medicine, Vancouver BC, Canada; BC Mental Health and Substance Use Services Research Institute, Vancouver BC, Canada
| | - Robert W Buchanan
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore MD, USA
| | - Michael Davidson
- Minerva Neurosciences, Waltham MA, USA; Department of Basic and Clinical Sciences, Psychiatry, University of Nicosia Medical School, Nicosia, Cyprus
| | - Mark Weiser
- Department of Psychiatry, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Josef Priller
- Department of Psychiatry and Psychotherapy, School of Medicine and Health, Technical University of Munich, 81675 Munich, Germany; German Center for Mental Health (DZPG), Germany; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Neuropsychiatry, Charité-Universitätsmedizin Berlin and DZNE, Berlin, Germany; University of Edinburgh and UK DRI, Edinburgh, UK
| | - John M Davis
- Psychiatric Institute, University of Illinois, Chicago IL, USA
| | - Oliver D Howes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Institute of Medical Sciences, Medical Research Council London, London, UK; Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Christoph U Correll
- German Center for Mental Health (DZPG), Germany; Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks NY, USA; The Donald and Barbara Zucker School of Medicine, Department of Psychiatry and Molecular Medicine, Hempstead NY, USA; Department of Child and Adolescent Psychiatry, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, School of Medicine and Health, Technical University of Munich, 81675 Munich, Germany; German Center for Mental Health (DZPG), Germany
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Li Q, Li X, Ye C, Jia M, Si T. Effectiveness and Safety of Switching from Oral Antipsychotics to Once-Monthly Paliperidone Palmitate (PP1M) in the Management of Schizophrenia: A Systematic Review and Meta-Analysis. CNS Drugs 2023; 37:695-713. [PMID: 37490267 PMCID: PMC10439041 DOI: 10.1007/s40263-023-01028-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Considering the improvement in adherence and convenience, once-monthly paliperidone palmitate (PP1M) has been increasingly used in the treatment of schizophrenia. However, the outcomes for patients who switch from oral antipsychotics (OAPs) to PP1M have not been reliably assessed. The objective of this systematic review and meta-analysis was to investigate the efficacy and safety of PP1M in the management of patients with schizophrenia with a prior history of OAP use. METHODS We conducted a systematic search in PubMed, EMBASE, and the Cochrane Library on 19 July 2022 to identify eligible studies. All studies that examined the effectiveness and safety of switching from OAPs to PP1M in patients with schizophrenia were included. The primary outcomes were relapse rate, hospitalisation rate, and the change from baseline in the Positive and Negative Syndrome Scale (PANSS) total score. The secondary outcomes included the changed number of inpatient visits, changed length of stay hospitalisation, change from baseline in the Clinical Global Impressions-Severity (CGI-S) score and the personal and social performance (PSP) total score, response rate, proportion of treatment discontinuation, and adverse events. We included randomised-controlled trials (RCTs), single-arm studies, and observational studies. Case reports, case series, and reviews were excluded. The quality assessment of included studies was performed using the Revised Cochrane risk-of-bias tool for randomised trials (RoB2), the 9-point Newcastle-Ottawa Scale (NOS) instrument for non-randomised studies and cohort studies, and the 12-item National Institutes of Health (NIH) quality assessment tool for before-after (Pre-Post) study without control group. Follow-up times were reported as short- (≤ 13 weeks), medium- (14-26 weeks), and long term (≥ 27 weeks). Data were pooled using meta-analysis. RESULTS Fifteen studies with a total of 4740 patients were included. The long-term relapse rates and hospitalisation rates were 12% (95% CI 0.07-0.18) and 18% (95% CI 0.15-0.20), respectively. The short-, medium-, and long-term change in PANSS total score was - 21.69 (95% CI - 30.02 to -13.36), - 14.98 (95% CI - 21.45 to - 8.51) and - 17.88 (95% CI - 31.94 to -3.82), respectively. Approximately 50% of patients reported at least a 30% reduction in the PANSS score at the short-term follow-up. Improvements in CGI-S and PSP score were observed during various periods. There was a reduction in the length of stay hospitalisation and the number of inpatient visits at the medium- and long-term follow-ups. Low discontinuation and adverse event rates were reported. CONCLUSION Based on our findings, this study may support the efficacy and safety of switching from OAPs to PP1M for the treatment of patients with schizophrenia. Future large-scale studies are warranted to confirm our findings.
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Affiliation(s)
- Qian Li
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Centre for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Xin Li
- Xi'an Janssen Pharmaceutical Ltd., Chaoyang District, Beijing, China
| | - Chong Ye
- Xi'an Janssen Pharmaceutical Ltd., Chaoyang District, Beijing, China
| | - Miaomiao Jia
- Xi'an Janssen Pharmaceutical Ltd., Chaoyang District, Beijing, China
| | - Tianmei Si
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Centre for Mental Disorders (Peking University Sixth Hospital), Beijing, China.
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Buyle M, Jung Y, Pavlou M, Gonzalez SC, Bamiou DE. The role of motivation factors in exergame interventions for fall prevention in older adults: A systematic review and meta-analysis. Front Neurol 2022; 13:903673. [PMID: 35989930 PMCID: PMC9388774 DOI: 10.3389/fneur.2022.903673] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/11/2022] [Indexed: 11/27/2022] Open
Abstract
Balance disorders and falls are common in the elderly population. Regular balance exercises are an evidence-based physical intervention to prevent falls in older adults, while patient motivation and adherence are important factors for intervention outcome. Exergames are a relatively new, alternative intervention for physical rehabilitation as they improve balance and strength in older adults. The aims of this systematic review and meta-analysis were to assess the (1) effect of motivation factors as per the Capability, Opportunity and Motivation model of Behavior change (COM-B) on the effectiveness of exergame interventions in healthy older adults, (2) effectiveness of exergames to improve balance in older healthy adults and, (3) impact of exergames on cognitive outcomes. Results show that motivation and capability components influence the general outcome of the exergame training. Motivational factors should thus be considered when setting-up an exergame intervention. Furthermore, exergame intervention appears to be a promising training method in comparison to traditional exercise training. However, exergame training in itself might not be sufficient to improve fall risk and cognitive performance.
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Affiliation(s)
- Margot Buyle
- Psychological Sciences Research Institute and Institute of NeuroScience, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
- *Correspondence: Margot Buyle
| | - Yujin Jung
- Audiology Department, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Marousa Pavlou
- Faculty of Life Sciences and Medicine, Centre for Human and Applied Physiological Sciences, King's College London, London, United Kingdom
| | - Sergi Costafreda Gonzalez
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Doris-Eva Bamiou
- University College London Ear Institute, Faculty of Brain Sciences, University College London, London, United Kingdom
- Biomedical Research Centre, National Institute for Health Research, London, United Kingdom
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Exploring Clinical Correlates of Metacognition in Bipolar Disorders Using Moderation Analyses: The Role of Antipsychotics. J Clin Med 2021; 10:jcm10194349. [PMID: 34640367 PMCID: PMC8509459 DOI: 10.3390/jcm10194349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/18/2021] [Accepted: 09/21/2021] [Indexed: 11/17/2022] Open
Abstract
The determinants of metacognition are still poorly understood in bipolar disorders (BD). We aimed to examine the clinical determinants of metacognition, defined as the agreement between objective and subjective cognition in individuals with BD. The participants consisted of 281 patients with BD who underwent an extensive neuropsychological battery and clinical evaluation. To assess subjective cognition, participants provided a general rating of their estimated cognitive difficulties. Clinical characteristics of BD were also recorded, along with medication. We studied the potential moderation of the association between cognitive complaints and global objective cognitive performance by several clinical variables with ordinal logistic regressions. Depression and impulsivity were associated with greater cognitive complaints. The only variable that moderated the relationship between objective and subjective cognition in the global model was the prescription of antipsychotics. Patients taking antipsychotics had a poorer association between cognitive complaints and objective neuropsychological performance. This result suggests a role for dopamine in the modulation of metacognitive performance, and calls for the systematic control of antipsychotic medication in future studies documenting metacognitive deficits in severe and persistent mental disorders. Depression and impulsivity should be investigated as potential therapeutic targets for individuals with BD and cognitive complaints, before proposing an extensive neuropsychological evaluation.
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Lee WJ, Shin YW, Chang H, Shin HR, Kim WW, Jung SW, Kim M, Nah SY. Safety and efficacy of dietary supplement (gintonin-enriched fraction from ginseng) in subjective memory impairment: A randomized placebo-controlled trial. Integr Med Res 2021; 11:100773. [PMID: 34504764 PMCID: PMC8416956 DOI: 10.1016/j.imr.2021.100773] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 08/11/2021] [Accepted: 08/17/2021] [Indexed: 11/28/2022] Open
Abstract
Background Gintonin inhibits β-amyloid production, increases acetylcholine level in the brain, and promotes neurogenesis. We evaluated the efficacy of gintonin-enriched fraction (GEF) in improving the cognitive performance in subjective memory impairment. Methods In this 8-week, randomized, assessor and participant blinded, placebo–controlled study, participants with subjective memory impairment but preserved cognitive function (Korean Mini-Mental State Examination [K-MMSE] score ≥23) were assigned to GEF 300mg/day or placebo. K-MMSE, Korean versions of the Alzheimer's disease assessment scale, color-word stroop test (K-CWST), clinical dementia rating, and Beck depression inventory-II were evaluated along with the safety profiles. The primary outcome was set as the change in the K-MMSE. Results Seventy-six participants complete the study protocol. After 8 weeks, there was no inter-group difference in the primary or secondary outcome score changes. However, GEF group showed an improvement in the K-MMSE scores (P= 0.026), and in the number of correct answers in both word reading (P= 0.008) and color reading (P= 0.005) of K-CWST, although only the improvement in the K-CWST scores were higher than the minimum clinically important difference. The frequency of adverse events was comparable between the groups and all were of mild severity. Conclusion GEF is safe but might not be effective in treating subjective memory impairment within the current study setting. However, GEF showed a trend of improving the global cognition and the frontal executive function. Further large-sized studies with longer follow-up period are warranted. Clinical trial registration This clinical trial was registered at Clinical Research Information Service of Korea Centers for Disease Control and Prevention: KCT0004636.
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Affiliation(s)
- Woo-Jin Lee
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yong-Won Shin
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyeyeon Chang
- Department of Neurology, Konyang University Hospital, Daejeon, Republic of Korea
| | - Hye-Rim Shin
- Department of Neurology, Dankook University Hospital, Cheonan, Republic of Korea
| | - Won-Woo Kim
- Gintonin KU Biotech Co.,LTD., Republic of Korea
| | | | - Manho Kim
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea.,Protein metabolism and dementia neuroscience research center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung-Yeol Nah
- Department of Physiology, College of Veterinary Medicine, Konkuk University, Seoul, Republic of Korea
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9
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Yellowlees PM, Parish MB, Gonzalez AD, Chan SR, Hilty DM, Yoo BK, Leigh JP, McCarron RM, Scher LM, Sciolla AF, Shore J, Xiong G, Soltero KM, Fisher A, Fine JR, Bannister J, Iosif AM. Clinical Outcomes of Asynchronous Versus Synchronous Telepsychiatry in Primary Care: Randomized Controlled Trial. J Med Internet Res 2021; 23:e24047. [PMID: 33993104 PMCID: PMC8335606 DOI: 10.2196/24047] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 03/26/2021] [Accepted: 05/16/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Asynchronous telepsychiatry (ATP; delayed-time) consultations are a novel form of psychiatric consultation in primary care settings. Longitudinal studies comparing clinical outcomes for ATP with synchronous telepsychiatry (STP) are lacking. OBJECTIVE This study aims to determine the effectiveness of ATP in improving clinical outcomes in English- and Spanish-speaking primary care patients compared with STP, the telepsychiatry usual care method. METHODS Overall, 36 primary care physicians from 3 primary care clinics referred a heterogeneous sample of 401 treatment-seeking adult patients with nonurgent psychiatric disorders. A total of 184 (94 ATP and 90 STP) English- and Spanish-speaking participants (36/184, 19.6% Hispanic) were enrolled and randomized, and 160 (80 ATP and 80 STP) of them completed baseline evaluations. Patients were treated by their primary care physicians using a collaborative care model in consultation with the University of California Davis Health telepsychiatrists, who consulted with patients every 6 months for up to 2 years using ATP or STP. Primary outcomes (the clinician-rated Clinical Global Impressions [CGI] scale and the Global Assessment of Functioning [GAF]) and secondary outcomes (patients' self-reported physical and mental health and depression) outcomes were assessed every 6 months. RESULTS For clinician-rated primary outcomes, ATP did not promote greater improvement than STP at 6-month follow-up (ATP vs STP, adjusted difference in follow-up at 6 months vs baseline differences for CGI: 0.2, 95% CI -0.2 to 0.6; P=.28; and GAF: -0.6, 95% CI -3.1 to 1.9; P=.66) or 12-month follow-up (ATP vs STP, adjusted difference in follow-up at 12 months vs baseline differences for CGI: 0.4, 95% CI -0.04 to 0.8; P=.07; and GAF: -0.5, 95% CI -3.3 to 2.2; P=.70), but patients in both arms had statistically and clinically significant improvements in both outcomes. There were no significant differences in improvement from baseline between ATP and STP on any patient self-reported ratings at any follow-up (all P values were between .17 and .96). Dropout rates were higher than predicted but similar between the 2 arms. Of those with baseline visits, 46.8% (75/160) did not have a follow-up at 1 year, and 72.7% (107/147) did not have a follow-up at 2 years. No serious adverse events were associated with the intervention. CONCLUSIONS This is the first longitudinal study to demonstrate that ATP can improve clinical outcomes in English- and Spanish-speaking primary care patients. Although we did not find evidence that ATP is superior to STP in improving clinical outcomes, it is potentially a key part of stepped mental health interventions available in primary care. ATP presents a possible solution to the workforce shortage of psychiatrists and a strategy for improving existing systems of care. TRIAL REGISTRATION ClinicalTrials.gov NCT02084979; https://clinicaltrials.gov/ct2/show/NCT02084979.
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Affiliation(s)
- Peter M Yellowlees
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, United States
| | - Michelle Burke Parish
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, United States
| | - Alvaro D Gonzalez
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, United States
| | - Steven R Chan
- Stanford University School of Medicine, Stanford, CA, United States
- Veterans Administration Palo Alto Healthcare System, Palo Alto, CA, United States
| | - Donald M Hilty
- Northern California Veterans Administration, Mather, CA, United States
| | - Byung-Kwang Yoo
- Department of Public Health Sciences, University of California Davis, Davis, CA, United States
| | - J Paul Leigh
- Department of Public Health Sciences, University of California Davis, Davis, CA, United States
| | | | - Lorin M Scher
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, United States
| | - Andres F Sciolla
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, United States
| | - Jay Shore
- University of Colorado Anschutz Medical Campus, Denver, CO, United States
| | - Glen Xiong
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, United States
| | | | - Alice Fisher
- Department of Public Health Sciences, University of California Davis, Davis, CA, United States
| | - Jeffrey R Fine
- Department of Public Health Sciences, University of California Davis, Davis, CA, United States
| | - Jennifer Bannister
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, United States
| | - Ana-Maria Iosif
- Department of Public Health Sciences, University of California Davis, Davis, CA, United States
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