Gender differences in psychotic disorders with concurrent substance use

Contingency Management for Dually Diagnosed Inpatients with Psychosis

Contingency management (CM) is an evidence-based treatment method in substance abuse treatment. However, little is known about its efficacy in dually diagnosed patients with psychosis and in inpatient settings. Therefore, the aim of this study is to investigate the efficacy of CM for dually diagnosed patients with psychosis in an inpatient setting. Furthermore, we investigate the effect of the nature of the reward used (cash vs. prize) on the efficacy of CM. We made use of an 8-week fish-bowl CM intervention by means of a within-subject reversal design with three treatment phases (baseline-intervention-follow-up). Sixty-seven patients were included in this study, of whom thirty-four completed the protocol. The results show no effect of CM on abstinence nor an interaction with clinical or demographic variables. Cash money is as effective as prizes. Future research should further investigate the effect of psychosis and treatment setting on the efficacy of CM, with special attention for Patient Report Experience and Outcome Measures (PREM/PROM).

The influence of childhood aspirations on the risk of developing psychotic disorders, substance use disorders, and dual diagnosis in adulthood based on the Metropolit 1953 Danish Male Birth Cohort

The study aims to investigate the association of aspiration for future occupation, socioeconomic position, and intellectual abilities with risk of dual diagnosis, psychosis, substance use disorder (SUD) in later life, and to explore if social and intellectual disadvantage modify any effect of childhood aspirations on outcomes. The study included 7177 Danish boys born in 1953. We investigated childhood aspirations (preference regarding future occupation), socioeconomic position (paternal social group), and intellectual abilities (Härnquist intelligence score) on outcomes with dual diagnosis, psychotic disorder, or SUD in Danish registers. Combinations of variables were used for a two-way and three-way analysis (high and low levels of exposure variables). Cox regression with age as the underlying time scale was used for analysis. The separate analysis showed no associations between childhood aspirations and outcomes. Boys with low intelligence scores had an increased risk of developing psychotic disorders (aHR 1.5, 95% CI 1.1-2.1) and SUD (aHR 1.8, 95% CI 1.5-2.1) compared to high intelligence scores. The interaction analyses showed that individuals with a combination of low intelligence score, high aspirations, and/or high paternal social group might have an increased risk of developing dual diagnosis, psychotic disorders, or SUD in later life. This result should be interpreted with caution as interaction variables were not overall significant with the outcome of dual diagnosis or psychotic disorder. The findings suggest that childhood abilities and social position could be associated with the development of psychotic disorders and SUD in later life, however, further studies are needed to address the temporality of the association to gain an understanding of the underlying mechanism of the association.

Diagnostic stability in substance-induced psychosis

INTRODUCTION

Substance-induced psychosis (SIP) is the name given to a psychosis that starts in the context of substance abuse but persists for days and weeks with no substance use. There is as yet little knowledge about the longitudinal course of this psychosis, which suggests that significant numbers go on to be diagnosed with a severe mental disorder (SMD). The objective of this study was to analyse the progression of SIP to SMD in our environment and the possible factors that may be involved in that conversion.

MATERIAL AND METHODS

We used a retrospective cohort follow-up design. We reviewed all diagnoses of patients discharged from the psychiatric hospitalisation unit of the University Hospital of Basurto from January 2002 to December 2015 inclusively. In addition to sociodemographic and clinical data, information was collected on the consumption of cannabinoids, opioids, amphetamines, cocaine and alcohol. The data were analysed using descriptive analysis, Kaplan-Meier survival curves and Cox regression.

RESULTS

Of the 116 patients, 78.4% were male, had an average age of 33.0 (SD = 8.9) years and 44.0% were single; 31.0% had a psychiatric family history; the most commonly used substance was cannabis (60.3%), followed by cocaine (40.5%). The cumulative risk of diagnostic conversion to an SMD in 16 years was 41.6% (95%CI: 32.2-52.2) over a mean 36.43 months.

CONCLUSIONS

In interventions in episodes of SIP we must bear in mind that a significant proportion will progress to an SMD in the first three years.

Sex and gender differences in symptoms of early psychosis: a systematic review and meta-analysis

First-episode psychosis (FEP) can be quite variable in clinical presentation, and both sex and gender may account for some of this variability. Prior literature on sex or gender differences in symptoms of psychosis have been inconclusive, and a comprehensive summary of evidence on the early course of illness is lacking. The objective of this study was to conduct a systematic review and meta-analysis of the literature to summarize prior evidence on the sex and gender differences in the symptoms of early psychosis. We conducted an electronic database search (MEDLINE, Scopus, PsycINFO, and CINAHL) from 1990 to present to identify quantitative studies focused on sex or gender differences in the symptoms of early psychosis. We used random effects models to compute pooled standardized mean differences (SMD) and risk ratios (RR), with 95% confidence intervals (CI), for a range of symptoms. Thirty-five studies met the inclusion criteria for the systematic review, and 30 studies were included in the meta-analysis. All studies examined sex differences. Men experienced more severe negative symptoms (SMD =  - 0.15, 95%CI =  - 0.21, - 0.09), whereas women experienced more severe depressive symptoms (SMD = 0.21, 95%CI = 0.14, 0.27) and had higher functioning (SMD = 0.16, 95%CI = 0.10, 0.23). Women also had a lower prevalence of substance use issues (RR = 0.65, 95%CI = 0.61, 0.69). Symptoms of early psychosis varied between men and women; however, we were limited in our ability to differentiate between biological sex and gender factors. These findings may help to inform early detection and intervention efforts to better account for sex and gender differences in early psychosis presentation.

A comparative study of complete blood count inflammatory markers in substance-free acute psychotic disorder and substance-induced psychosis

AIM

Recent studies showed a compare complete blood count (CBC) with its related measurements, including neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), and platelet to lymphocyte ratio, are a simple and affordable test for inflammatory markers. The aim of this controlled study is to compare CBC inflammatory markers in substance-induced psychosis (SIP) and substance-free acute psychotic disorder (SF-APD) and to evaluate whether these CBC inflammation values can be used in diagnosis.

METHODS

This retrospective study was conducted with the data of 76 SF-APD patients (including 60 cases of first-episode psychosis [FEP]), 98 SIP patients (including 48 cases of FEP), and 32 controls.

RESULTS

Patients with SF-APD and SIP had higher white blood cell counts, neutrophil and monocyte counts, and MLR than controls. An increased NLR was more distinct in SF-APD, while an increased MLR was observed in APD (both SF and SI) and FEP groups more than in the controls. A receiver operating characteristic analysis showed that the NLR could contribute to the identification of SF-APD (52.6% sensitivity and 12.5% specificity, area under curve [AUC] = 0.704, 2.47 cutoff value) while an MLR could contribute to the identification of APD (70.1% sensitivity and 12.5% specificity, AUC = 0.842) as well as FEP (71.3% sensitivity and 12.5% specificity AUC = 0.831) with 0.26 cutoff value.

CONCLUSIONS

An NLR and MLR might be of interest for inflammatory processes involved in acute and first-episode psychotic events, regardless of substance involvement.

The association between internalizing and externalizing severity with current use of cigarettes, e-cigarettes, and alcohol in adults: Wave 1 of the Population Assessment of Tobacco and Health (PATH) study

INTRODUCTION

Concurrent tobacco/alcohol use is common in adults, and associated with the severity of symptoms experienced by those with mental health disorders. However, few studies have explored this relationship across different combinations of tobacco products [i.e., conventional cigarette (CC) and electronic cigarette (EC)] and alcohol.

METHODS

Data from the Wave 1 (2013-2014) Population Assessment of Tobacco and Health study were used. A total of 15,947 adults aged 18 years or older with complete study information were included. Multinomial logistic regression analyses were performed to determine the relationship between lifetime internalizing/externalizing severity and past 30-day use of tobacco and alcohol, adjusting for nicotine dependence (ND), sex, age, race, education, and income.

RESULTS

Internalizing severity was more strongly associated with CC and alcohol use (moderate AOR = 1.47, 95% CI = 1.22-1.77; high AOR = 1.29, 95% CI = 1.03-1.61) as well as alcohol-exclusive use (moderate AOR = 1.58, 95% CI = 1.27-1.96; high AOR = 1.31, 95% CI = 1.05-1.64) while externalizing severity was more strongly associated with EC and alcohol use (high AOR = 2.97, 95% CI = 1.84-4.81, moderate AOR = 2.29, 95% CI = 1.53-3.43) when accounting for ND compared to none. The relationship between externalizing severity with EC use was dependent on alcohol being used with EC.

CONCLUSIONS

The associations between psychopathology (internalizing vs. externalizing severity) varies by different combinations of alcohol, CC, and EC. Further, these relationships may be mediated through ND. Future investigations into the comorbidity between mental disorder symptoms with tobacco and alcohol use should consider use of specific substances as well as their combination.

Diagnostic stability in substance-induced psychosis

INTRODUCTION

Substance-induced psychosis (SIP) is the name given to a psychosis that starts in the context of substance abuse but persists for days and weeks with no substance use. There is as yet little knowledge about the longitudinal course of this psychosis, which suggests that significant numbers go on to be diagnosed with a severe mental disorder (SMD). The objective of this study was to analyse the progression of SIP to SMD in our environment and the possible factors that may be involved in that conversion.

MATERIAL AND METHODS

We used a retrospective cohort follow-up design. We reviewed all diagnoses of patients discharged from the psychiatric hospitalisation unit of the University Hospital of Basurto from January 2002 to December 2015 inclusively. In addition to sociodemographic and clinical data, information was collected on the consumption of cannabinoids, opioids, amphetamines, cocaine and alcohol. The data were analysed using descriptive analysis, Kaplan-Meier survival curves and Cox regression.

RESULTS

Of the 116 patients, 78.4% were male, had an average age of 33.0 (SD: 8.9) years and 44.0% were single; 31.0% had a psychiatric family history; the most commonly used substance was cannabis (60.3%), followed by cocaine (40.5%). The cumulative risk of diagnostic conversion to an SMD in 16years was 41.6% (95%CI: 32.2-52.2) over a mean 36.43months.

CONCLUSIONS

In interventions in episodes of SIP we must bear in mind that a significant proportion will progress to an SMD in the first three years.

Treatment barriers among individuals with co-occurring substance use and mental health problems: Examining gender differences

BACKGROUND

Despite the narrowing gender gap in the prevalence of substance use disorders, women continue to be vastly underrepresented in substance use services. Relational factors, family responsibilities, mental health, and stigma may present unique barriers encountered by women.

AIMS

The aims of this study were to examine: (1) gender differences in substance use treatment barriers, (2) gender differences in perceptions of stigmatization for seeking substance use treatment, and symptoms of depression, anxiety, and trauma-related stress, and (3) whether perceived stigmatization and mental health symptoms are associated with greater barriers among women.

METHODS

One hundred adults (50% self-identified women) from a substance use and concurrent disorders program in Ontario, Canada, completed a questionnaire package containing measures of sociodemographic information, substance use, mental health, perceived stigma, and substance use treatment barriers.

RESULTS

Women reported more barriers related to family responsibilities, relational factors, and mental health (p < .01), and higher levels of perceived stigma (p < .01) compared to men.

CONCLUSIONS

Findings from this study contribute to our understanding of treatment barriers and perceived stigmatization among women. This knowledge may be used to aid in the development and delivery of accessible, gender-responsive services that address these barriers and challenge the stigma attached to substance use among women.

Aripiprazole Long-Acting Injection During First Episode Schizophrenia-An Exploratory Analysis

Background: Long-acting injectable (LAI) aripiprazole was found to be efficacious in schizophrenia. In common clinical practice, the use of LAIs is often restricted to chronic patients with frequent relapses and poor adherence. Recently, some investigators advanced the idea of early LAI use also in young people with schizophrenia at their first psychotic episode (FEP). Objective: Our study aimed to assess the effect of LAI aripiprazole once monthly (AOM) in the treatment of FEP in patients aged 18-26 years. Methods: We included 50 patients with DSM-5 schizophrenia as assessed with SCID, and used the Clinical Global Impressions Scale-Severity of Illness (CGI-S) and the Positive and Negative Syndrome Scale (PANSS) to assess symptom severity and the World Health Organization Quality of Life (WHOQOL), the Short Form Health Survey (SF-36) and the Personal and Social Performance Scale (PSP) to assess quality of life (QoL) and global health perception at baseline and 3, 6, 9, and 12 months after the first AOM injection. Results: AOM was associated with a progressive improvement, compared to baseline, of both positive (p < 0.001) and negative (p < 0.001) symptoms and in general psychopathology (p < 0.001) and decrease in global severity (p < 0.001). We also observed progressive improvement in QoL and social and personal functioning. Treatment adherence was 78% at study endpoint. Our results support that AOM may improve psychotic symptoms, QoL and social functioning in young FEP patients. Further studies should compare AOM to its oral formulation in the treatment of young patients with schizophrenia at the outset of their illness.

Women who suffer from schizophrenia: Critical issues

Many brain diseases, including schizophrenia, affect men and women unequally - either more or less frequently, or at different times in the life cycle, or to varied degrees of severity. With updates from recent findings, this paper reviews the work of my research group over the last 40 years and underscores issues that remain critical to the optimal care of women with schizophrenia, issues that overlap with, but are not identical to, the cares and concerns of men with the same diagnosis. Clinicians need to be alert not only to the overarching needs of diagnostic groups, but also to the often unique needs of women and men.

Trajectories of depressive symptoms in the acute phase of psychosis: Implications for treatment

Depression is common in schizophrenia and associated with negative outcomes. Previous studies have identified heterogeneity in treatment response in schizophrenia. We aimed to investigate different trajectories of depression in patients suffering from psychosis and predictors of change in depressive symptoms during antipsychotic treatment. Two hundred and twenty-six patients >18 years acutely admitted due to psychosis were consecutively included and the follow-up was 27 weeks. The Calgary Depression Scale for Schizophrenia (CDSS) sum score was the primary outcome. Latent growth curve (LGCM) and Growth Mixture Models (GMM) were conducted. Predictors were the Positive sum score of the Positive and Negative Syndrome Scale for Schizophrenia (PANSS), Schizophrenia spectrum/non-spectrum psychoses, gender and being antipsychotic naive at inclusion. We found support for three depression-trajectories, including a high- (14.7%), a low depression-level (69.6%) class and a third depressed class quickly decreasing to a low level (15.7%). Change in CDSS was associated with change in PANSS positive score in all time intervals (4 weeks: b = 0.18, p < 0.001, 3 months: 0.21, p < 0.023, 6 months: 0.43, p < 0.001) and with a diagnosis within schizophrenia spectrum but not with antipsychotic naivety or gender. The schizophrenia-spectrum patients had less depressive symptoms at inclusion (-2.63, p < 0.001). In conclusion, an early responding and a treatment refractory group were identified. The treatment-refractory patients are candidates for enhanced anti-depressive treatment, for which current evidence is limited. The post-psychotic depression group was characterized by depressive symptoms in the acute phase as well. We could not identify differentiating characteristics of the depression trajectories.

Career Decision-Making Processes of Young Adults With First-Episode Psychosis

The first episode of psychosis often emerges during young adulthood, when individuals are pursuing important educational and career goals that can become derailed because of the development of major impairments. Past research has neglected the developmental nature of employment and education decisions that young adults with first-episode psychosis make within the context of their lives. The purpose of this grounded theory study was to advance a model of the career decision-making processes of young adults with first-episode psychosis, and the influences that affect their career decision-making. The career decision-making of young adults with first-episode psychosis emerged as a multistaged, iterative process that unfolded over three phases of illness, and was affected by several internal and environmental influences. These findings suggest the phase of illness and career decision-making stage should be considered in future vocational programming for young adults with first-episode psychosis.

Cannabis use in male and female first episode of non-affective psychosis patients: Long-term clinical, neuropsychological and functional differences

BACKGROUND

Numerous studies show the existence of a high prevalence of cannabis use among patients with psychosis. However, the differences between men and women who debut with a first episode of psychosis (FEP) regarding cannabis use have not been largely explored. The aim of this study was to identify the specific sex factors and differences in clinical evolution associated with cannabis use.

METHOD

Sociodemographic characteristics at baseline were considered in our sample of FEP patients to find differences depending on sex and the use of cannabis. Clinical, functional and neurocognitive variables at baseline, 1-year, and 3-years follow-up were also explored.

RESULTS

A total of 549 patients, of whom 43% (N = 236) were cannabis users, 79% (N = 186) male and 21% (N = 50) female, were included in the study. There was a clear relationship between being male and being a user of cannabis (OR = 5.6). Cannabis users were younger at illness onset. Longitudinal analysis showed that women significantly improved in all three dimensions of psychotic symptoms, both in the subgroup of cannabis users and in the non-users subgroup. Conversely, subgroups of men did not show improvement in the negative dimension. In cognitive function, only men presented a significant time by group interaction in processing speed, showing a greater improvement in the subgroup of cannabis users.

CONCLUSION

Despite knowing that there is a relationship between cannabis use and psychosis, due to the high prevalence of cannabis use among male FEP patients, the results showed that there were very few differences in clinical and neurocognitive outcomes between men and women who used cannabis at the start of treatment compared to those who did not.

Substance abuse and gender differences in first episode psychosis: Impact on hospital readmissions

INTRODUCTION

There have been controversial results in the study of gender differences in first episode psychosis (FEP). Substance abuse is the main existing comorbidity in FEP, and has been associated with worse prognosis and greater symptom severity.

OBJECTIVES

To explore gender differences in FEP in relation to drug abuse, and their relationship with hospital readmissions.

METHODOLOGY

Descriptive and prospective study (18 months).

RESULTS

We included 141 patients (31.2% women), aged 26.1 years on average, mostly diagnosed with schizophreniform disorder (32.6%). A percentage of 58.9 had problematic use of drugs. Gender significant differences were found in age of onset, age at entry to the programme, marital status and cohabitation, and percentage differences were revealed in current drug abuse and frequency of consumption. Gender, duration of untreated psychosis, psychiatric history, age of onset and previous drug use were not predictors of re-entry. Hospital readmission rate was 24.8%, with no gender differences. The most common reasons for admission were abandonment of treatment (66.7%) and drug abuse (44.4%). Drug abuse was higher in the men than in the women as a reason for re-admission.

CONCLUSIONS

There are gender differences in FEP. Men have an earlier onset of symptoms and have worse functional outcomes. Drug abuse in men is higher and represents a major cause of hospital readmission. Therapeutic interventions to prevent the effects of drug abuse are necessary from the early stages of the illness.

Women and schizophrenia: planning for the future

The aim of this narrative review is to provide readers with a summary of the recent literature on women and schizophrenia and to address commonly asked questions about the role of gender in this illness. Important gender distinctions were found in the knowledge base around schizophrenia, particularly in the areas of symptom onset, hormonal and immune effects, and antipsychotic drug kinetics and their consequences. We also discuss and address commonly asked questions about gender and schizophrenia. This review concludes that gender differences influence the effectiveness of various treatments and need to be taken into account when planning comprehensive care services for individuals with schizophrenia.

World Health Organization disability assessment schedule 2.0: An international systematic review

PURPOSE

This systematic review examines research and practical applications of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) as a basis for establishing specific criteria for evaluating relevant international scientific literature. The aims were to establish the extent of international dissemination and use of WHODAS 2.0 and analyze psychometric research on its various translations and adaptations. In particular, we wanted to highlight which psychometric features have been investigated, focusing on the factor structure, reliability, and validity of this instrument.

METHOD

Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) methodology, we conducted a search for publications focused on "whodas" using the ProQuest, PubMed, and Google Scholar electronic databases.

RESULTS

We identified 810 studies from 94 countries published between 1999 and 2015. WHODAS 2.0 has been translated into 47 languages and dialects and used in 27 areas of research (40% in psychiatry).

CONCLUSIONS

The growing number of studies indicates increasing interest in the WHODAS 2.0 for assessing individual functioning and disability in different settings and individual health conditions. The WHODAS 2.0 shows strong correlations with several other measures of activity limitations; probably due to the fact that it shares the same disability latent variable with them. Implications for Rehabilitation WHODAS 2.0 seems to be a valid, reliable self-report instrument for the assessment of disability. The increasing interest in use of the WHODAS 2.0 extends to rehabilitation and life sciences rather than being limited to psychiatry. WHODAS 2.0 is suitable for assessing health status and disability in a variety of settings and populations. A critical issue for rehabilitation is that a single "minimal clinically important .difference" score for the WHODAS 2.0 has not yet been established.

Current advances in biosampling for therapeutic drug monitoring of psychiatric CNS drugs

Many CNS drugs are effective for the treatment of psychiatric disorders. Psychotropic drugs work differently, thus clinical outcomes for many patients may be insufficient. For this reason it could be useful the measurement of drug levels for clinical decision-making. Analytical goals in therapeutic drug monitoring (TDM) should be established by selecting the appropriate biological matrix. The aim of this review is to highlight the usefulness of TDM for antiepileptics, antidepressants and antipsychotics, with a focus on current advances in biosampling. The literature on TDM was reviewed up to March 2015. An overview on the use of alternative biological matrices is provided to address the current issues and advances in the field of biosampling for psychiatric CNS drug TDM.