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Matuszewska A, Kowalski K, Jawień P, Tomkalski T, Gaweł-Dąbrowska D, Merwid-Ląd A, Szeląg E, Błaszczak K, Wiatrak B, Danielewski M, Piasny J, Szeląg A. The Hypothalamic-Pituitary-Gonadal Axis in Men with Schizophrenia. Int J Mol Sci 2023; 24:ijms24076492. [PMID: 37047464 PMCID: PMC10094807 DOI: 10.3390/ijms24076492] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/18/2023] [Accepted: 03/26/2023] [Indexed: 04/03/2023] Open
Abstract
Schizophrenia is a severe mental disorder with a chronic, progressive course. The etiology of this condition is linked to the interactions of multiple genes and environmental factors. The earlier age of onset of schizophrenia, the higher frequency of negative symptoms in the clinical presentation, and the poorer response to antipsychotic treatment in men compared to women suggests the involvement of sex hormones in these processes. This article aims to draw attention to the possible relationship between testosterone and some clinical features in male schizophrenic patients and discuss the complex nature of these phenomena based on data from the literature. PubMed, Web of Science, and Google Scholar databases were searched to select the papers without limiting the time of the publications. Hormone levels in the body are regulated by many organs and systems, and take place through the neuroendocrine, hormonal, neural, and metabolic pathways. Sex hormones play an important role in the development and function of the organism. Besides their impact on secondary sex characteristics, they influence brain development and function, mood, and cognition. In men with schizophrenia, altered testosterone levels were noted. In many cases, evidence from available single studies gave contradictory results. However, it seems that the testosterone level in men affected by schizophrenia may differ depending on the phase of the disease, types of clinical symptoms, and administered therapy. The etiology of testosterone level disturbances may be very complex. Besides the impact of the illness (schizophrenia), stress, and antipsychotic drug-induced hyperprolactinemia, testosterone levels may be influenced by, i.a., obesity, substances of abuse (e.g., ethanol), or liver damage.
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Fischer CE, Namasivayam A, Crawford-Holland L, Hakobyan N, Schweizer TA, Munoz DG, Pollock BG. Psychotic Disorders in the Elderly: Diagnosis, Epidemiology, and Treatment. Psychiatr Clin North Am 2022; 45:691-705. [PMID: 36396273 DOI: 10.1016/j.psc.2022.07.001] [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] [Indexed: 11/07/2022]
Abstract
This review covers the latest advances in our understanding of psychosis in the elderly population with respect to diagnosis, epidemiology, and treatment. Major topics of discussion include late life psychiatric disorders such as schizophrenia, schizoaffective disorder, and delusional disorder as well as dementia-related psychosis. Clinical differences between early-onset and late-onset disorders are reviewed in terms of prevalence, symptomatology, and approach to treatment. Newly revised research and clinical criteria for dementia-related psychosis are referenced. The evidence base for emerging therapies including citalopram and pimavanserin in relation to conventional therapies such as atypical antipsychotics are discussed..
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Affiliation(s)
- Corinne E Fischer
- Keenan Research Centre for Biomedical Science, Room 17044 cc wing, St. Michaels Hospital, #30 Bond St., Toronto, Ontario, M5B1W8, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada.
| | - Andrew Namasivayam
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Lucas Crawford-Holland
- Keenan Research Centre for Biomedical Science, Room 17044 cc wing, St. Michaels Hospital, #30 Bond St., Toronto, Ontario, M5B1W8, Canada
| | - Narek Hakobyan
- Keenan Research Centre for Biomedical Science, Room 17044 cc wing, St. Michaels Hospital, #30 Bond St., Toronto, Ontario, M5B1W8, Canada
| | - Tom A Schweizer
- Keenan Research Centre for Biomedical Science, Room 17044 cc wing, St. Michaels Hospital, #30 Bond St., Toronto, Ontario, M5B1W8, Canada; St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada; Department of Neurosurgery, University of Toronto, Toronto, Canada
| | - David G Munoz
- Keenan Research Centre for Biomedical Science, Room 17044 cc wing, St. Michaels Hospital, #30 Bond St., Toronto, Ontario, M5B1W8, Canada; St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Bruce G Pollock
- Division of Geriatric Psychiatry, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario, M5T 1R8, Canada; Toronto Dementia Research Alliance, University of Toronto, Toronto, Ontario, Canada
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Selvendra A, Toh WL, Neill E, Tan EJ, Rossell SL, Morgan VA, Castle DJ. Age of onset by sex in schizophrenia: Proximal and distal characteristics. J Psychiatr Res 2022; 151:454-460. [PMID: 35605342 DOI: 10.1016/j.jpsychires.2022.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 04/14/2022] [Accepted: 05/09/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Earlier schizophrenia onset in men relative to women has been a consistent finding in the literature, but a nuanced understanding of underlying reasons remains elusive. Further consideration should be given to factors associated with sex differences in age of onset. METHOD Participants with schizophrenia were derived from the 2010 Australian Survey of High Impact Psychosis (n = 857). The SHIP survey constituted a representative, population-based study of almost 1.5 million Australian adults seen at various mental health services, and assessed personal health information, psychiatric comorbidities as well as psychosis illness and treatment. Hierarchical clustering was employed to identify age of onset by sex. Within-sex comparisons on distal and proximal factors affecting age of onset were conducted. RESULTS Using modal age, two and three clusters were respectively found in men (early versus late onset) and women (early versus mid versus late onset). Early onset groups in both sexes had an increased family history of psychosis compared to older onset, but other risk factors were not consistent across the sexes. Less premorbid impairment was noted in females with middle to later onset schizophrenia. CONCLUSION These findings further inform our understanding of the pathogenesis of schizophrenia. Added explorations of trends in older onset schizophrenia cohorts is especially important.
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Affiliation(s)
- Ajit Selvendra
- Department of Psychiatry, St. Vincent's Hospital, Melbourne, VIC, Australia; Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia.
| | - Wei Lin Toh
- Centre for Mental Health (CMH), Swinburne University of Technology, Melbourne, VIC, Australia
| | - Erica Neill
- Department of Psychiatry, St. Vincent's Hospital, Melbourne, VIC, Australia; Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia; Centre for Mental Health (CMH), Swinburne University of Technology, Melbourne, VIC, Australia
| | - Eric J Tan
- Department of Psychiatry, St. Vincent's Hospital, Melbourne, VIC, Australia; Centre for Mental Health (CMH), Swinburne University of Technology, Melbourne, VIC, Australia
| | - Susan L Rossell
- Department of Psychiatry, St. Vincent's Hospital, Melbourne, VIC, Australia; Centre for Mental Health (CMH), Swinburne University of Technology, Melbourne, VIC, Australia
| | - Vera A Morgan
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, University of Western Australia, Perth, WA, Australia; Centre for Clinical Research in Neuropsychiatry, Medical School, University of Western Australia, Perth, WA, Australia
| | - David J Castle
- Department of Psychiatry, St. Vincent's Hospital, Melbourne, VIC, Australia; Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
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Gaillard A, Tan EJ, Carruthers SP, Gurvich C, Hughes ME, Neill E, Sumner PJ, Van Rheenen TE, Rossell SL. No influence of sex on the relationship between schizotypy factors and executive control across the schizophrenia spectrum. J Psychiatr Res 2022; 148:325-331. [PMID: 35193036 DOI: 10.1016/j.jpsychires.2022.02.015] [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: 09/03/2021] [Revised: 01/24/2022] [Accepted: 02/14/2022] [Indexed: 11/28/2022]
Abstract
Sex differences in symptoms and executive control across schizophrenia spectrum disorders (SSD) are consistently reported. Similarly, these findings of sex differences are also observed in schizotypy, that is, schizophrenia-like features occurring in healthy individuals in the absence of a clinical diagnosis. This study aimed to examine the relationships between performance on three major domains of executive control: performance monitoring, response inhibition, and cognitive set-shifting, and schizotypy factor scores in both SSD patients and healthy controls (HCs), and whether sex moderated any relationships observed. A total of 111 (67 males and 44 females) patients with SSD and 258 (129 males and 129 females) HCs were included in this study. Schizotypal personality traits (in both SSD and HC) was assessed using the Oxford-Liverpool Inventory of Feelings and Experiences (O-LIFE). Executive control performance was assessed using seven tasks. Stepwise linear regressions revealed that performance on cognitive set-shifting tasks was significantly associated with the introvertive anhedonia, cognitive disorganisation, and unusual experiences subscales of the O-LIFE. When sex was examined as a moderator, it was not a significant moderator of any of the relationships between cognitive set-shifting tasks and schizotypy factors. The results suggest that independent of sex, cognitive set-shifting ability is associated to an increased vulnerability to schizotypal personality traits, although performance monitoring and response inhibition did not.
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Affiliation(s)
- Alexandra Gaillard
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia; Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia.
| | - Eric J Tan
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia; Department of Mental Health, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Sean P Carruthers
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Caroline Gurvich
- Monash Alfred Psychiatry Research Centre, Central Clinical School, Monash University and the Alfred Hospital, Melbourne, VIC, Australia
| | - Matthew E Hughes
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Erica Neill
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia; Monash Alfred Psychiatry Research Centre, Central Clinical School, Monash University and the Alfred Hospital, Melbourne, VIC, Australia; Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Philip J Sumner
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Tamsyn E Van Rheenen
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia; Melbourne Neuropsychiatry Centre, The University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry St, Carlton, Victory, 3053, Australia
| | - Susan L Rossell
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia; Monash Alfred Psychiatry Research Centre, Central Clinical School, Monash University and the Alfred Hospital, Melbourne, VIC, Australia
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Ferrari M, Iyer S, LeBlanc A, Roy MA, Abdel-Baki A. A Rapid Learning Health System to Support Implementation of Early Intervention Services for Psychosis in Quebec, Canada: Study Protocol. (Preprint). JMIR Res Protoc 2022; 11:e37346. [PMID: 35852849 PMCID: PMC9346564 DOI: 10.2196/37346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 12/04/2022] Open
Abstract
Background Given the strong evidence of their effectiveness, early intervention services (EIS) for psychosis are being widely implemented. However, heterogeneity in the implementation of essential components remains an ongoing challenge. Rapid-learning health systems (RLHSs) that embed data collection in clinical settings for real-time learning and continuous quality improvement can address this challenge. Therefore, we implemented an RLHS in 11 EIS in Quebec, Canada. Objective This project aims to determine the feasibility and acceptability of implementing an RLHS in EIS and assess its impact on compliance with standards for essential EIS components. Methods Funding for this project was secured in July 2019, and ethics approval was received in December 2019. The implementation of this RLHS involves 6 iterative phases: external and internal scan, design, implementation, evaluation, adjustment, and dissemination. Multiple stakeholder groups (service users, families, clinicians, researchers, decision makers, and provincial EIS associations) are involved in all phases. Meaningful EIS quality indicators (eg, satisfaction and timeliness of response to referrals) were selected based on a literature review, provincial guidelines, and stakeholder consensus on prioritization of indicators. A digital infrastructure was designed and deployed comprising a user-friendly interface for routinely collecting data from programs; a digital terminal and mobile app to collect feedback from service users and families regarding care received, health, and quality of life; and data analytic, visualization, and reporting functionalities to provide participating programs with real-time feedback on their ongoing performance in relation to standards and to other programs, including tailored recommendations. Our community of practice conducts activities, leveraging insights from data to build program capacity while continuously aligning their practices with standards and best practices. Guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework, we are collecting quantitative and qualitative data on the reach, effectiveness, adoption, implementation, and maintenance of our RLHS for evaluating its impacts. Results Phase 1 (identifying RLHS indicators for EIS based on a literature synthesis, a survey, and consensus meetings with all stakeholder groups) and phase 2 (developing and implementing the RLHS digital infrastructure) are completed (September 2019 to May 2020). Phases 3 to 5 have been ongoing (June 2020 to June 2022). Continuous data collection through the RLHS data capture platforms and real-time feedback to all stakeholders are deployed. Phase 6 will be implemented in 2022 to assess the impact of the RLHS using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework with quantitative and qualitative data. Conclusions This project will yield valuable insights into the implementation of RLHS in EIS, offering preliminary evidence of its acceptability, feasibility, and impacts on program-level outcomes. The findings will refine our RLHS further and advance approaches that use data, stakeholder voices, and collaborative learning to improve outcomes and quality in services for psychosis. International Registered Report Identifier (IRRID) DERR1-10.2196/37346
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Affiliation(s)
- Manuela Ferrari
- Douglas Research Centre, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Srividya Iyer
- Douglas Research Centre, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Annie LeBlanc
- Department of Family Medicine, Laval University, Quebec, QC, Canada
- Vitam - Centre de recherche en santé durable, Laval University, Quebec, QC, Canada
| | - Marc-André Roy
- Department of Psychiatry and Neurosciences, Laval University, Quebec, QC, Canada
- Cervo Brain Research Centre, Quebec, QC, Canada
| | - Amal Abdel-Baki
- Centre de Recherche du Centre Hospitalier de l'Université de Montreal (CHUM), Montreal, QC, Canada
- Department of Psychiatry, Université de Montréal, Montreal, QC, Canada
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Abstract
OBJECTIVE While there is considerable current emphasis on youth and early psychosis, relatively little is known about the lives of people who live with psychotic disorders into middle age and beyond. We investigated social functioning, physical health status, substance use and psychiatric symptom profile in people with psychotic disorders aged between 50 and 65 years. METHODS Data were collected as part of the Survey of High Impact Psychosis, a population-based survey of Australians aged 18-65 years with a psychotic disorder. We compared those aged 50-65 years (N = 347) with those aged 18-49 years (N = 1478) across a range of measures. RESULTS The older group contained more women and more people with affective psychoses compared to the younger group. They were also more likely to have had a later onset and a chronic course of illness. The older group were more likely to have negative symptoms but less likely to exhibit positive symptoms; they also had lower current cognition, compared to the younger group. Compared to the younger group, the older group were more likely to be divorced/separated, to be living alone and to be unemployed. They had substantially lower lifetime use of alcohol and illicit substances, but rates of obesity, metabolic syndrome and diabetes mellitus were higher. CONCLUSION Our findings suggest that the characteristics of people with psychosis change significantly as they progress into the middle age and beyond. A better understanding of these differences is important in informing targeted treatment strategies for older people living with psychosis.
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Affiliation(s)
- Cherrie Galletly
- Interim Dean and Discipline of Psychiatry, Department of Medical Specialties, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
- Northern Adelaide Local Health Network (NALHN), Lyell McEwin Hospital, Adelaide, SA, Australia
- Ramsay Health Care (SA) Mental Health Services, The Adelaide Clinic, Gilberton, Australia
| | - Shuichi Suetani
- Physical and Mental Health Stream, Queensland Centre for Mental Health Research, Brisbane, QLD, Australia
- Queensland Brain Institute, The University of Queensland, St Lucia, QLD, Australia
- Metro South Addiction and Mental Health Services, Woolloongabba, QLD, Australia
- Department of Medicine, Griffith University, Nathan, QLD, Australia
| | - Lisa Hahn
- Ramsay Health Care (SA) Mental Health Services, The Adelaide Clinic, Gilberton, Australia
| | - Duncan McKellar
- Northern Adelaide Local Health Network (NALHN), Lyell McEwin Hospital, Adelaide, SA, Australia
- Office of the Chief Psychiatrist, SA Department of Health and Wellbeing, Adelaide, SA, Australia
| | - David Castle
- The University of Melbourne, Department of Psychiatry Melbourne, VIC, Australia
- St Vincent's Health Australia, Melbourne, VIC, Australia
- Scientific Director, Centre for Complex Interventions, Centre for Addictions and Mental Health; and Professor, Department of Psychiatry, University of Toronto, Toronto, Canada
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Qiu X, Lu S, Zhou M, Yan W, Du J, Zhang A, Xie S, Zhang R. The Relationship Between Abnormal Resting-State Functional Connectivity of the Left Superior Frontal Gyrus and Cognitive Impairments in Youth-Onset Drug-Naïve Schizophrenia. Front Psychiatry 2021; 12:679642. [PMID: 34721094 PMCID: PMC8548582 DOI: 10.3389/fpsyt.2021.679642] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 09/02/2021] [Indexed: 11/25/2022] Open
Abstract
Objective: Age of onset is one of the heterogeneous factors in schizophrenia, and an earlier onset of the disease indicated a worse prognosis. The left superior frontal gyrus (SFG) is involved in numerous cognitive and motor control tasks. Hence, we explored the relationship between abnormal changes in SFG resting-state functional connectivity (rsFC) and cognitive function in the peak age of incidence to understand better the pathophysiological mechanism in youth-onset drug-naïve schizophrenia to search for reliable biomarkers. Methods: About 66 youth-onset drug-naïve schizophrenia patients and 59 healthy controls (HCs) were included in this study. Abnormal connectivity changes in the left SFG and whole brain were measured using the region of interest (ROI) rsFC analysis method. The cognitive function was assessed using the MATRICS Consensus Cognitive Battery (MCCB), and the severity of the clinical symptoms was evaluated by positive and negative syndrome scale (PANSS). Furthermore, we analyzed the relationships among abnormal FC values, cognition scores, and clinical symptoms. Results: We found decreased FC between left SFG and bilateral precuneus (PCUN), right hippocampus, right parahippocampal gyrus, left thalamus, left caudate, insula, and right superior parietal lobule (SPL), whereas increased FC was seen between the left SFG and right middle frontal gyrus (MFG) in the youth-onset drug-naïve schizophrenia group, compared with HCs. Meanwhile, the T-scores were lower in each cognitive domain than HCs. Moreover, in the youth-onset drug-naive schizophrenia group, the insula was negatively correlated with processing speed. No significant correlations were found between the FC-value and PANSS score. Conclusions: Our findings suggest widespread FC network abnormalities in the left SFG and widespread cognitive impairments in the early stages of schizophrenia. The dysfunctional connectivity of the left SFG may be a potential pathophysiological mechanism in youth-onset drug-naïve schizophrenia.
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Affiliation(s)
- Xiaolei Qiu
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Shuiping Lu
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Min Zhou
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Wei Yan
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Jinglun Du
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Aoshuang Zhang
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Shiping Xie
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Rongrong Zhang
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
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Amoo G, Ogundele AT, Olajide AO, Ighoroje MG, Oluwaranti AO, Onunka GC, Ladeinde AA, Folaji OG. Prevalence and Pattern of Psychiatric Morbidity Among Community-Dwelling Elderly Populations in Abeokuta, Nigeria. J Geriatr Psychiatry Neurol 2020; 33:353-362. [PMID: 31916885 DOI: 10.1177/0891988719892327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Many elderly persons in Nigeria are having mental health challenges and there is a lack of commensurate increase in services to attend to such. AIM To assess the prevalence, pattern and correlates of psychiatric morbidity among community dwelling elderly persons (≥ 60 years) in Abeokuta, Nigeria. METHODS 532 respondents were selected using a multistage, stratified cluster sampling method from the elderly population in Abeokuta. First, participants were administered the socio-demographic questionnaire, General Health Questionnaire-12 (GHQ-12), and the Mini-Mental State Examination (MMSE). Those with a score of ≥ 3 in GHQ-12 were assessed with the Mini International Neuropsychiatric Interview (MINI PLUS), while those with ≤ 16 in MMSE were assessed with the Diagnostic Statistical Manual (DSM) IV criteria for Dementia and the Petersen's criteria for Mild Cognitive Impairment (MCI). RESULTS 36.3% of the respondents had a probable psychological disorder, while 25.4% had a probable cognitive impairment. 9.8% had a current definitive psychiatric disorder. The commonest disorders were major depressive disorder and dementia. The female gender, the oldest old (≥ 80 years), having a chronic medical illness and bereavement in the last 1 year were most significantly associated with having mental health problems. CONCLUSION A significant number of the elderly population in the studied community suffers from a psychiatric illness. It is hoped that studies as these will inform stakeholders on the need to pay closer attention to the mental health needs of the elderly, as their overall wellbeing plays a role in determining the overall health of the community.
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Affiliation(s)
- Gbolagade Amoo
- Psychogeriatric Unit, 151983Neuropsychiatric Hospital, Aro, Abeokuta, Ogun state, Nigeria
| | | | | | - Maroh Great Ighoroje
- Psychogeriatric Unit, 151983Neuropsychiatric Hospital, Aro, Abeokuta, Ogun state, Nigeria
| | | | | | - Agnes Abosede Ladeinde
- Psychogeriatric Unit, 151983Neuropsychiatric Hospital, Aro, Abeokuta, Ogun state, Nigeria
| | - Olubukola Grace Folaji
- Psychogeriatric Unit, 151983Neuropsychiatric Hospital, Aro, Abeokuta, Ogun state, Nigeria
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Utsumi K, Fukatsu R, Yamada R, Takamaru Y, Hara Y, Yasumura S. Characteristics of initial symptoms and symptoms at diagnosis in probable dementia with Lewy body disease: incidence of symptoms and gender differences. Psychogeriatrics 2020; 20:737-745. [PMID: 32743894 DOI: 10.1111/psyg.12586] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/23/2020] [Accepted: 05/31/2020] [Indexed: 12/15/2022]
Abstract
AIM Although dementia with Lewy bodies (DLB) is characterized by a variety of initial symptoms, there are almost no reports of the initial symptoms of DLB assessed in a large number of cases. We retrospectively evaluated the initial symptoms of 234 participants with DLB and DLB-related symptoms at diagnosis and characterized any gender differences in the symptom profiles. METHODS This study consisted of 234 participants with probable DLB who met the diagnostic criteria outlined in the Fourth Consensus Report of the DLB Consortium (2017). DLB was confirmed based on several characteristic biomarkers for dopamine transporter imaging with 123 I-N-omega-fluoropropyl-2-beta-carbomethoxy-3-beta (4-iodophenyl) nortropane single-photon emission computed tomography, 123 I-metaiodobenzylguanidine myocardial scintigraphy, and brain perfusion measured with single photon emission computed tomography. In addition, core and supportive clinical features were considered in the diagnosis. RESULTS Initial symptoms included cognitive impairment (41.9%) and psychiatric symptoms (i.e. visual and auditory hallucinations, delusions, and depression) (42.3%). Almost half of the women initially presented with psychiatric symptoms, with significantly more women than men presenting with auditory hallucinations. In contrast, men had a significantly higher rate of rapid eye movement sleep behaviour disorder (RBD) than women did. At diagnosis, DLB-related symptoms differed between men and women, with male patients exhibiting significantly more RBD, parkinsonism, hyposmia, and syncope than female patients. Moreover women presented significantly more often with auditory hallucinations than did men. CONCLUSIONS Our results indicate that there are gender differences in the initial symptoms of DLB, as well as in the presentation of subsequent symptoms observed at diagnosis. There was a higher incidence of RBD in men, whereas women had a higher incidence of psychotic symptoms.
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Affiliation(s)
- Kumiko Utsumi
- Department of Psychiatry, Sunagawa City Medical Center, Sunagawa, Japan
| | - Ryo Fukatsu
- Department of Psychiatry, Nishi Kumagaya Hospital, Kumagaya, Japan
| | - Ritsuko Yamada
- School of Nursing and Social Services, Health Sciences University of Hokkaido, Tobetsu, Japan
| | - Yuji Takamaru
- Department of Psychiatry, Otaru General Hospital, Otaru, Japan
| | - Yuko Hara
- Department of Psychiatry, Nishi Kumagaya Hospital, Kumagaya, Japan
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Kokkosis AG, Tsirka SE. Neuroimmune Mechanisms and Sex/Gender-Dependent Effects in the Pathophysiology of Mental Disorders. J Pharmacol Exp Ther 2020; 375:175-192. [PMID: 32661057 DOI: 10.1124/jpet.120.266163] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 07/09/2020] [Indexed: 12/12/2022] Open
Abstract
Innate and adaptive immune mechanisms have emerged as critical regulators of CNS homeostasis and mental health. A plethora of immunologic factors have been reported to interact with emotion- and behavior-related neuronal circuits, modulating susceptibility and resilience to mental disorders. However, it remains unclear whether immune dysregulation is a cardinal causal factor or an outcome of the pathologies associated with mental disorders. Emerging variations in immune regulatory pathways based on sex differences provide an additional framework for discussion in these psychiatric disorders. In this review, we present the current literature pertaining to the effects that disrupted immune pathways have in mental disorder pathophysiology, including immune dysregulation in CNS and periphery, microglial activation, and disturbances of the blood-brain barrier. In addition, we present the suggested origins of such immune dysregulation and discuss the gender and sex influence of the neuroimmune substrates that contribute to mental disorders. The findings challenge the conventional view of these disorders and open the window to a diverse spectrum of innovative therapeutic targets that focus on the immune-specific pathophenotypes in neuronal circuits and behavior. SIGNIFICANCE STATEMENT: The involvement of gender-dependent inflammatory mechanisms on the development of mental pathologies is gaining momentum. This review addresses these novel factors and presents the accumulating evidence introducing microglia and proinflammatory elements as critical components and potential targets for the treatment of mental disorders.
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Affiliation(s)
- Alexandros G Kokkosis
- Department of Pharmacological Sciences, Stony Brook University, Stony Brook, New York
| | - Stella E Tsirka
- Department of Pharmacological Sciences, Stony Brook University, Stony Brook, New York
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11
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Lindström E, Widerlöv B, von Knorring L. The ICD-10 and DSM-IV diagnostic criteria and the prevalence of schizophrenia. Eur Psychiatry 2020. [DOI: 10.1016/s0924-9338(97)83295-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
SummaryIn the present study, all patients who met the diagnostic criteria for a long-term functional psychosis (LFP) were identified within a defined uptake area in the northern part of the county of Uppsala, Sweden. LFP includes patients 1) with productive psychotic symptomatology, not caused by organic disease, for 1 week or more, at least once during the course of the illness; 2) having been affected by a psychosis for a continuous period of at least 6 months on the same occasion; 3) having shown psychotic features or residual symptoms during the index year; and 4) older than 18 years of age. Primarily, all diagnoses were made according to the Diagnostic and Statistical Manual of Mental Disorders (DSM)-III-R. The prevalence of schizophrenia was 4.2 per 1,000 inhabitants. The prevalence of schizoaffective disorder was 0.7 per 1,000 inhabitants and for delusional disorder, 0.1 per 1,000 inhabitants. When the patients were rediagnosed according to DSM-III, DSM-IV and International Statistical Classification of Disease (ICD)-10, it was found that the prevalence of schizophrenia, schizoaffective disorder and delusional disorder was somewhat lower according to the DSM-III criteria, while the same number of patients fulfilled the criteria according to DSM-IV. If ICD-10 was used, it resulted in a broader concept of schizophrenia and a somewhat more narrow concept of schizoaffective disorder. Thus, the introduction of the new parallel diagnostic systems, ICD-10 and DSM-IV, will result in different, but comparable, prevalence estimates concerning schizophrenia, schizoaffective disorder and delusional disorder.
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Abstract
As the life expectancy of the general population increases, the population of elderly people with schizophrenia is also expected to increase. Consideration of the particular needs of these patients and the challenges associated with their management is therefore important [45].
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Abstract
SUMMARYThis is an overview of epidemiology relevant to mental health problems in old age. We start by reviewing some basic terminology: the definitions of prevalence and incidence; the difference between descriptive and analytical epidemiology; the differences between study designs, including cross-sectional, case–control and cohort studies. We then cover the main epidemiological features of the major psychiatric diseases that affect older people (dementia and its different types, depression, late-onset schizophrenia, bipolar affective disorder, delirium, anxiety-related disorders, eating disorders, alcohol and substance misuse, personality disorders) and suicide.We end with some descriptive statistics regarding quality of life in older people.
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Stafford J, Howard R, Dalman C, Kirkbride JB. The Incidence of Nonaffective, Nonorganic Psychotic Disorders in Older People: A Population-based Cohort Study of 3 Million People in Sweden. Schizophr Bull 2019; 45:1152-1160. [PMID: 30339239 PMCID: PMC6737541 DOI: 10.1093/schbul/sby147] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND There are limited data on the epidemiology of very late-onset schizophrenia-like psychosis (VLOSLP) and how this relates to potential risk factors including migration, sensory impairment, traumatic life events, and social isolation. METHODS We followed up a cohort of 3 007 378 people living in Sweden, born 1920-1949, from their 60th birthday (earliest: January 15, 1980) until December 30 2011, emigration, death, or first recorded diagnosis of nonaffective psychosis. We examined VLOSLP incidence by age, sex, region of origin, income, partner or child death, birth period, and sensory impairments. RESULTS We identified 14 977 cases and an overall incidence of 37.7 per 100 000 person-years at-risk (95% CI = 37.1-38.3), with evidence that rates increased more sharply with age for women (likelihood ratio test: χ2(6) = 31.56, P < .001). After adjustment for confounders, rates of VLOSLP were higher among migrants from Africa (hazard ratio [HR] = 2.0, 95% CI = 1.4-2.7), North America (HR = 1.4, 95% CI = 1.0-1.9, P = .04), Europe (HR = 1.3, 95% CI = 1.2-1.4), Russian-Baltic regions (HR = 1.6, 95% CI = 1.4-1.9), and Finland (HR = 1.6, 95% CI = 1.5-1.7). VLOSLP risk was highest for those in the lowest income quartile (HR = 3.1, 95% CI = 2.9-3.3). Rates were raised in those whose partner died 2 years before cohort exit (HR = 1.1, 95% CI = 1.0-1.3, P = .02) or whose child died in infancy (HR = 1.2, 95% CI = 1.0-1.4, P = .05), those without a partner (HR = 1.9, 95% CI = 1.8-1.9) or children (HR = 2.4, 95% CI = 2.3-2.5), and those whose child had a psychotic disorder (HR = 2.4, 95% CI = 2.2-2.6). INTERPRETATION We identified a substantial burden of psychosis incidence in old age, with a higher preponderance in women and most migrant groups. Life course exposure to environmental factors including markers of deprivation, isolation, and adversity were associated with VLOSLP risk.
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Affiliation(s)
- Jean Stafford
- Division of Psychiatry, University College London, London, UK
| | - Robert Howard
- Division of Psychiatry, University College London, London, UK
| | - Christina Dalman
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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Prodromes and Preclinical Detection of Brain Diseases: Surveying the Ethical Landscape of Predicting Brain Health. eNeuro 2019; 6:ENEURO.0439-18.2019. [PMID: 31221862 PMCID: PMC6658915 DOI: 10.1523/eneuro.0439-18.2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 05/16/2019] [Accepted: 06/02/2019] [Indexed: 02/08/2023] Open
Abstract
The future of medicine lies not primarily in cures but in disease modification and prevention. While the science of preclinical detection is young, it is moving rapidly. Preclinical interventions offer hope to decrease the severity of a disease or delay the development of a disorder. With such promise, the research and practice of detecting brain disorders at a preclinical stage present unique ethical challenges that must be addressed to ensure the benefit of these technologies. Direct brain interventions have the potential to impact not just what a patient has but who they are and who they could become. Further, receiving an assessment for a preclinical or prodromal state has potential to impact perceptions about capacity, autonomy and personhood and could become entangled with stigma and discrimination. Exploring ethical issues alongside and integrated into the experimental design and research of these technologies is critical. This review will highlight ethical issues attendant to the current and near future states of preclinical detection across the life span, specifically as it relates to autism spectrum disorder (ASD), schizophrenia, and Alzheimer’s disease.
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Microglia along sex lines: From brain colonization, maturation and function, to implication in neurodevelopmental disorders. Semin Cell Dev Biol 2019; 94:152-163. [PMID: 31201858 DOI: 10.1016/j.semcdb.2019.06.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 06/10/2019] [Accepted: 06/11/2019] [Indexed: 12/30/2022]
Abstract
In addition to their traditional role as immune sentinels, recent discoveries over the last decade have shown that microglial functions now include regulation of neuronal/glial cell migration, differentiation and maturation, as well as neuronal network formation. It was thus proposed that disruption of these microglial roles, during critical periods of brain development, could lead to the pathological onset of several neurodevelopmental disorders, including autism spectrum disorder, attention deficit hyperactivity disorder, epilepsy, schizophrenia, and major depressive disorder. The prevalence of these disorders exhibits a clear distinction along sex lines with very little known about the mechanisms underlying this difference. One of the fundamental discoveries that arose from recent research into the physiological roles of microglia in neurodevelopment is their sexual dimorphism, raising the intriguing possibility that sex differences in microglial colonization, maturation and/or function in the developing brain could underlie the emergence of various neurodevelopmental disorders. This review discusses the physiological roles of microglia across neurodevelopment, these roles in the two sexes, and the recent evidence that microglial sexually dimorphic nature may contribute, at least partially, to neurodevelopmental disorders.
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Tampi RR, Young J, Hoq R, Resnick K, Tampi DJ. Psychotic disorders in late life: a narrative review. Ther Adv Psychopharmacol 2019; 9:2045125319882798. [PMID: 31662846 PMCID: PMC6796200 DOI: 10.1177/2045125319882798] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 09/25/2019] [Indexed: 11/25/2022] Open
Abstract
Psychotic disorders are not uncommon in late life. These disorders often have varied etiologies, different clinical presentations, and are associated with significant morbidity and mortality among the older adult population. Psychotic disorders in late life develop due to the complex interaction between various biological, psychological, social, and environmental factors. Given the significant morbidity and mortality associated with psychotic disorders in late life, a comprehensive work-up should be conducted when they are encountered. The assessment should not only identify the potential etiologies for the psychotic disorders, but also recognize factors that predicts possible outcomes for these disorders. Treatment approaches for psychotic disorders in late life should include a combination of nonpharmacological management strategies with the judicious use of psychotropic medications. When antipsychotic medications are necessary, they should be used cautiously with the goal of optimizing outcomes with regular monitoring of their efficacy and adverse effects.
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Affiliation(s)
- Rajesh R Tampi
- Department of Psychiatry and Behavioral Sciences, Cleveland Clinic Akron General, Akron, OH 44307, USA
| | - Juan Young
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Rakin Hoq
- NeoMed/Summa Psychiatry Residency Program, Akron, OH, USA
| | - Kyle Resnick
- NeoMed/Summa Psychiatry Residency Program, Akron, OH, USA
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Stafford J, Howard R, Kirkbride JB. The incidence of very late-onset psychotic disorders: a systematic review and meta-analysis, 1960-2016. Psychol Med 2018; 48:1775-1786. [PMID: 29198197 DOI: 10.1017/s0033291717003452] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A substantial subset of people with psychotic disorders are first diagnosed in old age, yet little is known about the epidemiology of very late-onset schizophrenia-like psychosis. We investigated the incidence of affective and non-affective psychotic disorders in those aged 65 and above, and examined variation related to potential risk factors via systematic literature review. We searched PubMed, PsychInfo, Web of Science and bibliographies and directly contacted authors to obtain citations published between 1960 and 2016 containing (derivable) incidence data. Cases were those diagnosed with non-organic psychotic disorders after age 65. Findings were presented narratively, and random-effects meta-analyses were used to obtain pooled incidence rates. From 5687 citations, 41 met inclusion criteria. The pooled incidence of: affective psychoses was 30.9 per 100 000 person-years at risk (100 kpy) [95% confidence interval (CI) 11.5-83.4; I2 = 0.99], and schizophrenia was 7.5 per 100 kpy (95% CI 6.2-9.1; I2 = 0.99), with some evidence of higher schizophrenia rates in women [odds ratio (OR) = 1.6; 95% CI 1.0-2.5, p = 0.05]. We found narrative evidence of increasing incidence rates of non-affective psychoses with age, and higher rates amongst migrants than baseline populations, but no evidence that incidence varied by study quality or case ascertainment period (quality OR = 1.04; 95% CI 0.74-1.48; time period OR = 1.00; 95% CI 0.95-1.05). Substantial heterogeneity in the incidence of very late-onset schizophrenia-like psychoses was observed. No identified studies examined possible risk factors which may account for such variation, including socio-economic status, sensory impairment, traumatic life events, or social isolation.
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Affiliation(s)
- Jean Stafford
- Division of Psychiatry, University College London, London, UK
| | - Robert Howard
- Division of Psychiatry, University College London, London, UK
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Greenfield P, Joshi S, Christian S, Lekkos P, Gregorowicz A, Fisher HL, Johnson S. First episode psychosis in the over 35 s: is there a role for early intervention? Early Interv Psychiatry 2018; 12:348-354. [PMID: 27018640 PMCID: PMC6001544 DOI: 10.1111/eip.12322] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 01/05/2016] [Accepted: 01/15/2016] [Indexed: 11/28/2022]
Abstract
AIM The early intervention (EI) model appears to improve outcomes of psychosis for younger people, and there is now interest in implementing it in older groups. In the UK, the National Institute of Clinical Excellence advised that EI should be accessible to all individuals with first episode psychosis (FEP). We aimed to explore the likely impact on EI workloads and clinical populations of extending age range. METHODS Data were collected on all patients aged 36-65 years who were referred to an inner London EI service from 2011-2014 using the MiData 2 tool at entry and at 1-year follow up. RESULTS People aged between 36 and 65 represented 30% of all referrals to the service. There were high levels of recorded past trauma in the sample (62.5%), half had dependent children (58.3%) and just under half physical comorbidity (48.6%). Duration of untreated psychosis was less than a year for the majority. At 1-year follow up, inpatient admission rates were lower than in previously studied younger EI populations, but only 15% experienced a single episode with full remission. CONCLUSIONS These findings indicate that admitting over 35-year-olds to EI results in a substantial increase in workload. A large proportion had become unwell relatively recently, indicating that the concept of EI may not be redundant in this age range. Evidence is needed on EI effectiveness in this group.
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Affiliation(s)
- Philippa Greenfield
- Camden & Islington Early Intervention Service, Camden and Islington NHS Foundation Trust, London, UK
| | - Snehita Joshi
- Camden & Islington Early Intervention Service, Camden and Islington NHS Foundation Trust, London, UK
| | - Suneel Christian
- Camden & Islington Early Intervention Service, Camden and Islington NHS Foundation Trust, London, UK
| | - Petros Lekkos
- Camden & Islington Early Intervention Service, Camden and Islington NHS Foundation Trust, London, UK
| | - Anna Gregorowicz
- Camden & Islington Early Intervention Service, Camden and Islington NHS Foundation Trust, London, UK
| | - Helen L Fisher
- MRC Social Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sonia Johnson
- Camden & Islington Early Intervention Service, Camden and Islington NHS Foundation Trust, London, UK.,Division of Psychiatry, University College London, London, UK
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Abstract
BACKGROUND Progression of dementia is often associated with the emergence of neuropsychiatric symptoms (NPS), though there is recent evidence that NPS may occur in prodromal dementia (PrD) and impact clinical course. Mood and anxiety symptoms are the NPS that tend to occur most frequently in PrD and thus have been most extensively studied. Comparatively, there has been little focus on psychotic symptoms in PrD. METHODS The authors review the existing literature on psychosis in PrD, including the functional psychosis of early and late onset, with a focus on epidemiology, phenomenology, and clinical course and treatment considerations. RESULTS Patients with psychotic disorders at baseline such as schizophrenia may be more at risk for developing dementia over time, although this is not completely clear. Psychotic symptoms are likely more common in PrD than previously understood based on factor analysis studies, although they are much more common in established dementia. Variability in findings may reflect the heterogeneous nature of PrD studies to date and the lack of inclusion of patients with late onset psychosis in most clinical studies. The presence of psychosis in patients with PrD may be associated with a worse prognosis in terms of mortality and conversion to dementia. CONCLUSIONS Research to date suggests that psychosis in PrD may be more common than previously thought and impact clinical course negatively. Future studies incorporating patients with late onset psychotic disorders, and focusing on the impact of early recognition and treatment, are required to more fully understand the role of psychosis in PrD.
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Early Intervention in Psychosis: Health of the Nation Outcome Scales (HoNOS) Outcomes From a Five-Year Prospective Study. Arch Psychiatr Nurs 2017; 31:553-560. [PMID: 29179820 DOI: 10.1016/j.apnu.2017.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 06/09/2017] [Accepted: 07/15/2017] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Over the last two decades, mental health services internationally have shifted towards intervening early in psychosis. The critical period for intervention is estimated to be five-years and many specialised programs target early psychosis. AIM/QUESTION This prospective cohort study aimed to evaluate five-year outcomes from an early psychosis program (EPP) that adopted an integrated model, providing nursing and multidisciplinary community mental healthcare to clients aged 16-65years, beyond the typical age range of 16-25years. METHOD We examined one routine outcome measure, the Health of the Nation Outcome Scales (HoNOS) across episodes of care for clients receiving EPP over a 5year period (n=239), comparing these results with HoNOS outcomes in an Australian national dataset for all public mental health clients. RESULTS HoNOS improvements were highly significant from intake to discharge and from review to discharge for EPP clients, and these compared well with national outcome performance. CONCLUSION There is potential for mental health nurses and other clinicians to significantly improve client symptoms and functioning, in a model of early psychosis treatment beyond a youth focus.
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Ramasamy S, Bharath S. Clinical characteristics of patients with non-affective, non-organic, late onset psychosis. Asian J Psychiatr 2017; 25:74-78. [PMID: 28262177 DOI: 10.1016/j.ajp.2016.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 10/17/2016] [Accepted: 10/23/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Schizophrenia and related psychotic disorders are predominantly studied in young population. However some individuals do develop psychotic disorder for the first time during their old age. The aim of this study is to look at the clinical characteristics of non-affective, non-organic, late onset psychosis. PARTICIPANTS AND METHODS Retrospective chart review study, medical records of all patients registered between 1st of January 2006 and 31st May 2011 at geriatric clinic in NIMHANS, Bangalore was screened, 83 files with a diagnosis of late onset psychosis and meeting the study criteria were systematically analyzed. RESULTS The mean age at onset of illness was 67±10years; 98.8% were married, females formed 67.5% of the sample, commonest phenomenon was delusions followed by hallucinations, 80.5% of the subjects had delusion of persecution, 38.5% had referential delusion, 51.8% had accusative and derogatory auditory hallucinations, negative symptoms was seen only in 2.4% of subjects, none had formal thought disorder. 3.6% had co-morbid Axis II diagnosis. CONCLUSION Despite its rarity non affective, non organic, late onset psychosis forms a distinct group with unique manifestation. Further systematic research is needed for better understanding of this condition.
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Affiliation(s)
- Sureshkumar Ramasamy
- Department of Psychiatry, PSG Institute of Medical Sciences and Research, Coimbatore, 641004, Tamilnadu, India.
| | - Srikala Bharath
- Department of Psychiatry, National Institute of Mental Health AND Neurosciences (NIMHANS), Bangalore, Karnataka, India
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Abstract
OBJECTIVE Recognizing that needs differ between men and women with schizophrenia and that they vary over time, this review attempts to categorize the needs that are relevant to younger and to older women. METHOD This is a selective literature review focusing on topic areas the two authors determined to be most germane to women with schizophrenia. Articles were selected on the basis of currency, comprehensiveness, and study design. Particular attention was paid to the voices of the women themselves. RESULTS There is considerable overlap between the needs of younger and older women with schizophrenia, but as a general rule, younger women require preventive strategies to stop the escalation of illness while older women require recovery interventions to regain lost hopes and abilities. CONCLUSIONS There is clinical utility in cataloguing the needs of younger and older women with schizophrenia and conceptualizing interventions according to gender and age rather than viewing needed services along purely diagnostic lines.
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Affiliation(s)
- Mary V Seeman
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Rina Gupta
- North East London Foundation Trust, Goodmayes Hospital, Ilford, Essex, UK
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Abstract
Women's mental health is closely linked to their status in society. This paper outlines the clinical features of women with schizophrenia and highlights the interpersonal and social ramifications on their lives. There is no significant gender difference in the incidence and prevalence of schizophrenia. There is no clear trend in mortality, although suicides seem to be more in women with schizophrenia. In India, women face a lot of problems, especially in relation to marriage, pregnancy, childbirth, and menopause. Most studies have shown better premorbid functioning, and social adjustment for women compared with men. There is a great need to plan for gender-sensitive mental health services targeting the special needs of these women. Women caregivers also deserve due attention.
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Affiliation(s)
- R. Thara
- Schizophrenia Research Foundation, Chennai, Tamil Nadu, India
| | - Shantha Kamath
- Schizophrenia Research Foundation, Chennai, Tamil Nadu, India
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Integration of neural networks activated by amphetamine in females with different estrogen levels: a functional imaging study in awake rats. Psychoneuroendocrinology 2015; 56:200-12. [PMID: 25827963 DOI: 10.1016/j.psyneuen.2015.02.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 02/10/2015] [Accepted: 02/24/2015] [Indexed: 01/15/2023]
Abstract
Previous studies demonstrate that schizophrenia symptomatology in women is dependent upon estrogen levels. Estrogen has beneficial properties when administered in conjunction with antipsychotics, and estrogen also alters, in rats, dopamine neurotransmission, which is a common target of all antipsychotic medications, suggesting a possible interaction between the two. The aim of the current study was to investigate this possible interaction using functional magnetic resonance imaging in awake, female rats. Amphetamine-sensitized, ovariectomized rats receiving no, chronic low, or phasic high levels of estradiol replacement were used, and changes in blood-oxygen-level-dependent (BOLD) signal were recorded over time in response to an acute amphetamine injection. Increasing levels of estradiol enhanced BOLD activation in pathways previously known to be implicated in schizophrenia symptomatology, such as the mesocorticolimbic, habenular and olfactory pathways, as well as more widespread areas. We propose here the first comprehensive "amphetamine activation map" integrating brain regions where amphetamine-related BOLD activity is influenced by estrogen levels in sensitized female rats.
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Abstract
Psychosis is one of the most common conditions in later life with a lifetime risk of 23 %. Despite its high prevalence, late-onset psychosis remains a diagnostic and treatment dilemma. There are no reliable pathognomonic signs to distinguish primary or secondary psychosis. Primary psychosis is a diagnosis of exclusion and the clinician must rule out secondary causes. Approximately 60 % of older patients with newly incident psychosis have a secondary psychosis. In this article, we review current, evidence-based diagnostic and treatment approaches for this heterogeneous condition, emphasizing a thorough evaluation for the "six d's" of late-life psychosis (delirium, disease, drugs dementia, depression, delusions). Treatment is geared towards the specific cause of psychosis and tailored based on comorbid conditions. Frequently, environmental and psychosocial interventions are first-line treatments with the judicious use of pharmacotherapy as needed. There is an enormous gap between the prevalence of psychotic disorders in older adults and the availability of evidence-based treatment. The dramatic growth in the elderly population over the first half of this century creates a compelling need to address this gap.
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Abstract
After over 100 years of research without clarifying the aetiology of schizophrenia, a look at the current state of knowledge in epidemiology, genetics, precursors, psychopathology, and outcome seems worthwhile. The disease concept, created by Kraepelin and modified by Bleuler, has a varied history. Today, schizophrenia is considered a polygenic disorder with onset in early adulthood, characterized by irregular psychotic episodes and functional impairment, but incident cases occur at all ages with marked differences in symptoms and social outcome. Men’s and women’s lifetime risk is nearly the same. At young age, women fall ill a few years later and less severely than men, men more rarely and less severely later in life. The underlying protective effect of oestrogen is antagonized by genetic load. The illness course is heterogeneous and depressive mood the most frequent symptom. Depression and schizophrenia are functionally associated, and affective and nonaffective psychoses do not split neatly. Most social consequences occur at the prodromal stage. Neither schizophrenia as such nor its main symptom dimensions regularly show pronounced deterioration over time. Schizophrenia is neither a residual state of a neurodevelopmental disorder nor a progressing neurodegenerative process. It reflects multifactorial CNS instability, which leads to cognitive deficits and symptom exacerbations.
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Selvendra A, Baetens D, Trauer T, Petrakis M, Castle D. First episode psychosis in an adult area mental health service-a closer look at early and late-onset first episode psychosis. Australas Psychiatry 2014; 22:235-241. [PMID: 24811714 DOI: 10.1177/1039856214532558] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To review the characteristics of all patients presenting with a first episode of psychosis between the ages of 16 and 65 years to an adult area mental health service. METHODS The early psychosis programme at St Vincent's Hospital Melbourne treats all patients presenting in the early stages of psychosis between the ages of 16 and 65 years. A database was developed to capture the demographic and diagnostic characteristics of the group. The characteristics of those with an onset under 26 years were compared with those with a later onset. RESULTS A large proportion (55%) of those presenting with first episode psychosis presented after the age of 25 years. There were a higher number of cases of depression with psychotic features in the older onset patients (notably so for those over 40) and a trend towards greater metabolic morbidity. DISCUSSION Older patients presenting with a first episode of psychosis are relatively understudied but appear to have certain distinguishing qualities. Understanding the needs of these patients is important in tailoring optimal treatment packages and service responses.
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Affiliation(s)
- Ajit Selvendra
- Consultant Psychiatrist, Mental Health Service, St Vincent's Hospital, Fitzroy, VIC and; Honorary Fellow, University of Melbourne, Melbourne, VIC, Australia
| | - Dominiek Baetens
- Consultant Psychiatrist and Deputy Director of Clinical Services, Mental Health Service, St Vincent's Hospital, Melbourne, Fitzroy, VIC, Australia
| | - Tom Trauer
- Honorary Professorial Fellow, University of Melbourne, Melbourne, VIC, Australia
| | - Melissa Petrakis
- Senior Research Fellow, Mental Health Service, St Vincent's Hospital, Fitzroy, VIC and; Lecturer, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - David Castle
- Chair of Psychiatry, Mental Health Service, St Vincent's Hospital, Fitzroy, VIC and; University of Melbourne, Melbourne, VIC, Australia
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Yasuda M, Kobayashi T, Kato S, Kishi K. Clinical features of late-onset schizophrenia in Japan: comparison with early-onset cases. Psychogeriatrics 2013; 13:244-9. [PMID: 24289465 DOI: 10.1111/psyg.12032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Revised: 09/07/2013] [Accepted: 10/04/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders abandoned the use of the specifier 'late-onset', a considerable number of studies have reported clinical characteristics of late-onset schizophrenia. Still, only limited research has been conducted on late-onset schizophrenia, especially in Asian countries. In this epidemiological study, the clinical characteristics of late-onset schizophrenia were examined in comparison with early-onset schizophrenia. METHODS All patients with schizophrenia admitted to the psychiatric ward of Jichi Medical University Hospital between 1 April 1993 and 31 March 2006 were divided into two groups according to age at first onset: ≥40 years (late-onset group) and <40 years (early-onset group). The sex ratio, presence or absence of depression, schizophrenia subtype, premorbid character, marital history, and employment history at first onset were compared between the two groups. RESULTS Of the 316 patients with schizophrenia identified, 38 patients were assigned to the late-onset group and 278 patients to the early-onset group. Mean age at onset was 23.9 ± 8.2 years for all men and 28.0 ± 13.5 years for all women. The late-onset group was characterized by more women, more paranoid type, more depressive symptoms, less introverted premorbid character, better premorbid adaptation and less neuroleptics. CONCLUSION The characteristics of late-onset schizophrenia in Japan are in line those reported previously.
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Affiliation(s)
- Manabu Yasuda
- Department of Psychiatry, Jichi Medical University, Shimotsuke, Japan
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Ramsey JM, Schwarz E, Guest PC, van Beveren NJM, Leweke FM, Rothermundt M, Bogerts B, Steiner J, Bahn S. Distinct molecular phenotypes in male and female schizophrenia patients. PLoS One 2013; 8:e78729. [PMID: 24244349 PMCID: PMC3823995 DOI: 10.1371/journal.pone.0078729] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 09/22/2013] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND In schizophrenia, sex specific dimorphisms related to age of onset, course of illness and response to antipsychotic treatment may be mirrored by sex-related differences in the underlying molecular pathways. METHODOLOGY/PRINCIPAL FINDINGS Here, we have carried out multiplex immunoassay profiling of sera from 4 independent cohorts of first episode antipsychotic naive schizophrenia patients (n = 133) and controls (n = 133) to identify such sex-specific illness processes in the periphery. The concentrations of 16 molecules associated with hormonal, inflammation and growth factor pathways showed significant sex differences in schizophrenia patients compared with controls. In female patients, the inflammation-related analytes alpha-1-antitrypsin, B lymphocyte chemoattractant BLC and interleukin-15 showed negative associations with positive and negative syndrome scale (PANSS) scores. In male patients, the hormones prolactin and testosterone were negatively associated with PANSS ratings. In addition, we investigated molecular changes in a subset of 33 patients before and after 6 weeks of treatment with antipsychotics and found that treatment induced sex-specific changes in the levels of testosterone, serum glutamic oxaloacetic transaminase, follicle stimulating hormone, interleukin-13 and macrophage-derived chemokine. Finally, we evaluated overlapping and distinct biomarkers in the sex-specific molecular signatures in schizophrenia, major depressive disorder and bipolar disorder. CONCLUSIONS/SIGNIFICANCE We propose that future studies should investigate the common and sex-specific aetiologies of schizophrenia, as the current findings suggest that different therapeutic strategies may be required for male and female patients.
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Affiliation(s)
- Jordan M. Ramsey
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom
| | - Emanuel Schwarz
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom
| | - Paul C. Guest
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom
| | - Nico J. M. van Beveren
- Department of Psychiatry, Erasmus University, Medical Center, Rotterdam, The Netherlands
| | - F. Markus Leweke
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | | | - Bernhard Bogerts
- Department of Psychiatry, University of Magdeburg, Magdeburg, Germany
| | - Johann Steiner
- Department of Psychiatry, University of Magdeburg, Magdeburg, Germany
| | - Sabine Bahn
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom
- Department of Neuroscience, Erasmus University Medical Centre, Rotterdam, The Netherlands
- * E-mail:
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Abstract
There are sex differences in the prevalence and presentation of many psychiatric disorders. Various trends in symptomatology have emerged that are thought to be linked to periods of hormonal fluctuations such as with menses, pregnancy or menopause. With data from animal and human studies, it has become clear that there is an important interplay between the serotonergic system and gonadal hormones. The majority of the research to date has focused on the influence that estrogen has within the CNS and, in particular, how it leads to an overall increase in serotonin synthesis and availability. In reviewing this female-specific topic we hope to raise awareness to sex/gender differences in psychopathology, help identify at-risk populations and consider development of new treatment options. Future research will also need to consider the influence that progesterone and oxytocin may have on sex-specific psychopathology as well as incorporate neuroimaging and consider the influence of hormones on the serotonergic system at a genetic level.
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Affiliation(s)
- Elise Hall
- Department of Psychiatry & Behavioural Neurosciences, Centre for Mountain Health Services, McMaster University, 100 West 5th, Box 585, Hamilton, ON, Canada
| | - Meir Steiner
- Women's Health Concerns Clinic, St Joseph's Healthcare, Hamilton, ON, Canada
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Fukuta H, Ito I, Tateno A, Nogami T, Taiji Y, Arakawa R, Suhara T, Asai K, Okubo Y. Effects of menopause on brain structural changes in schizophrenia. Psychiatry Clin Neurosci 2013; 67:3-11. [PMID: 23331283 DOI: 10.1111/pcn.12003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2011] [Revised: 06/13/2012] [Accepted: 06/15/2012] [Indexed: 01/08/2023]
Abstract
AIM The aim of this study was to investigate the influences of menopause on brain morphological changes in schizophrenia using magnetic resonance imaging (MRI). METHODS Forty female schizophrenia patients, 20 premenopausal and 20 postmenopausal, and 50 female controls underwent cerebral MRI. Optimized voxel-based morphometry was performed with Statistical Parametric Mapping version 5. RESULTS Compared with controls, regional gray matter reductions in schizophrenia patients were observed in the insula, superior temporal gyrus, anterior cingulate, parahippocampal gyrus, and thalamus. Direct comparison between the patient groups showed that the gray matter of postmenopausal patients was significantly smaller when compared with premenopausal patients in the left middle frontal gyrus, and no region had significantly lower gray matter volume in premenopausal patients relative to postmenopausal patients. Significant negative correlation between gray matter volume and the interval after menopause was found in the right superior frontal gyrus in the postmenopause patient group. CONCLUSION Differential morphological alterations between postmenopausal and premenopausal schizophrenia patients were observed, suggesting that the female hormone plays a protective role against schizophrenia.
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Affiliation(s)
- Hajime Fukuta
- Department of Neuropsychiatry, Nippon Medical School, Tokyo, Japan
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Manes F. Psychiatric conditions that can mimic early behavioral variant frontotemporal dementia: the importance of the new diagnostic criteria. Curr Psychiatry Rep 2012; 14:450-2. [PMID: 22700066 DOI: 10.1007/s11920-012-0294-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Facundo Manes
- Institute of Cognitive Neurology, Institute of Neuroscience, Favaloro University, Pacheco de Melo 1854/60, C1126AAB, Buenos Aires, Argentina.
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Bramon E, Murray RM. A plausible model of schizophrenia must incorporate psychological and social, as well as neuro developmental, risk factors. DIALOGUES IN CLINICAL NEUROSCIENCE 2012. [PMID: 22033679 PMCID: PMC3181665 DOI: 10.31887/dcns.2001.3.4/ebramon] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Subtle alterations in brain development caused by genes or early environmental hazards, such as obstetric complications, play a role in projecting some individuals on a trajectory toward schizophrenia. High-risk and cohort studies demonstrate that children destined to develop schizophrenia tend to have delayed milestones and subtle neuromotor and cognitive impairments (particularly in coordination and language). These neurocognitive problems lead to difficulties in interpersonal relations, and their progressive alienation makes these at-risk children more likely to harbor odd or paranoid ideas. This cascade of increasingly deviant development may then be compounded by brain maturational changes during adolescence with a resultant lability of the dopaminergic response to stress. As a result, the individual is more susceptible to the effects of the abuse of dopamine-releasing drugs, and to other risk factors such as migration or stressful life events; social isolation may be a common pathway underlying several of the social risk factors.
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Affiliation(s)
- E Bramon
- Division of Psychological Medicine, Institute of Psychiatry, London, UK
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Edad de inicio de los síntomas y sexo en pacientes con trastorno del espectro esquizofrénico. BIOMÉDICA 2012. [DOI: 10.7705/biomedica.v32i2.423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Somatic diseases in child survivors of the Holocaust with posttraumatic stress disorder: a comparative study. J Nerv Ment Dis 2012; 200:423-8. [PMID: 22551796 DOI: 10.1097/nmd.0b013e318253229e] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The incidence of mental and somatic sequelae has been shown to be very high in people who survived the Holocaust. In the current study, 80 Holocaust survivors with posttraumatic stress disorder were examined based on evaluation of their complete record (medical reports, clinical history, medical statements, and handwritten declarations of patients under oath). These survivors were compared with subjects with posttraumatic stress disorder caused by traumata other than the Holocaust. The data were analyzed for the presence of cardiovascular, gastrointestinal, and orthopedic diseases that developed in the time between the earliest medical report (expert opinion) and the latest expert opinion. Analysis revealed an increase in myocardial infarction, chronic degenerative diseases, and cancerous changes in the second expert opinion. No differences between the groups were seen with regard to sex, age at traumatization, or age at examination. Several implications of the data are discussed, including the implication that the survivors examined in this study may comprise a highly resilient group, inasmuch as they had reached an advanced age.
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Scherr M, Hamann M, Schwerthöffer D, Froböse T, Vukovich R, Pitschel-Walz G, Bäuml J. Environmental risk factors and their impact on the age of onset of schizophrenia: Comparing familial to non-familial schizophrenia. Nord J Psychiatry 2012; 66:107-14. [PMID: 21879797 DOI: 10.3109/08039488.2011.605171] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND AIMS Several risk factors for schizophrenia have yet been identified. The aim of our study was to investigate how certain childhood and adolescent risk factors predict the age of onset of psychosis in patients with and without a familial component (i.e. a relative with schizophrenia or schizoaffective disorder). METHODS Aside from the age of onset of psychosis, we examined the risk factors for schizophrenia including obstetric complications, birth during winter or spring, behavioral deviances or delayed motor and speech development, exposure to adverse life events and exposure to substance use within a group of 100 patients (45 female, 55 male) with a mean age (± standard deviation) of 35.15 ± 13.21. RESULTS Birth complications and cannabis abuse are predictors for an earlier onset of schizophrenia in patients with non-familial schizophrenia. No environmental risk factors for an earlier age of onset in familial schizophrenia have been identified. CONCLUSIONS Certain environmental risk factors for schizophrenia seem to have an impact on the age of onset of psychosis in non-familial schizophrenia, they do not seem to have an impact on familial schizophrenia.
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Affiliation(s)
- Martin Scherr
- Department of Psychiatry und Psychotherapy , Klinikum rechts der Isar der Technischen Universität München, Ismaningerstraße 22, Munich, Germany
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Vanasse A, Courteau J, Fleury MJ, Grégoire JP, Lesage A, Moisan J. Treatment prevalence and incidence of schizophrenia in Quebec using a population health services perspective: different algorithms, different estimates. Soc Psychiatry Psychiatr Epidemiol 2012; 47:533-43. [PMID: 21445625 DOI: 10.1007/s00127-011-0371-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Accepted: 03/10/2011] [Indexed: 11/28/2022]
Abstract
PURPOSE Using a population health services perspective, this article defines and assesses an efficient criteria-based algorithm to identify treatment prevalent and incident cases of schizophrenia. We refer here "treatment" prevalence and incidence since its evaluation depends on a patient receiving a health care service with a diagnosis of schizophrenia. METHODS A population-based cohort study was conducted among all adults having a hospital discharge or a physician claim for schizophrenia in the public health plan databases between January 1996 and December 2006. Four algorithms to characterize patients with schizophrenia were defined. To identify treatment incident cases in 2006, we removed from the treatment prevalent pool patients with a previous record of schizophrenia between 1996 and 2006 (10-year clearance period). Using this 10-year period as reference, Kappa coefficients (KC) and positive predictive values (PPV) were calculated to determine the "optimal" length of clearance period to identify incident cases. RESULTS The lifetime treatment prevalence and incidence of schizophrenia varied from 0.59 to 1.46% and from 42 to 94 per 100,000, respectively. When compared to the 10-year clearance period, the KC is excellent in a clearance period of 6-7 years. To achieve a PPV of 90%, a clearance period of 7-8 years would be necessary. CONCLUSIONS With an appropriate algorithm, treatment prevalence and incidence of schizophrenia can be conveniently estimated using administrative data. These estimates are a vital step toward appropriate planning of services for schizophrenia.
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Affiliation(s)
- Alain Vanasse
- Department of Family Medicine, Faculty of Medicine, Université de Sherbrooke, 3001 12th Avenue North, Sherbrooke, QC J1H 5N4, Canada.
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Kirkbride JB, Errazuriz A, Croudace TJ, Morgan C, Jackson D, Boydell J, Murray RM, Jones PB. Incidence of schizophrenia and other psychoses in England, 1950-2009: a systematic review and meta-analyses. PLoS One 2012; 7:e31660. [PMID: 22457710 PMCID: PMC3310436 DOI: 10.1371/journal.pone.0031660] [Citation(s) in RCA: 330] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Accepted: 01/17/2012] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND We conducted a systematic review of incidence rates in England over a sixty-year period to determine the extent to which rates varied along accepted (age, sex) and less-accepted epidemiological gradients (ethnicity, migration and place of birth and upbringing, time). OBJECTIVES To determine variation in incidence of several psychotic disorders as above. DATA SOURCES Published and grey literature searches (MEDLINE, PSycINFO, EMBASE, CINAHL, ASSIA, HMIC), and identification of unpublished data through bibliographic searches and author communication. STUDY ELIGIBILITY CRITERIA Published 1950-2009; conducted wholly or partially in England; original data on incidence of non-organic adult-onset psychosis or one or more factor(s) pertaining to incidence. PARTICIPANTS People, 16-64 years, with first -onset psychosis, including non-affective psychoses, schizophrenia, bipolar disorder, psychotic depression and substance-induced psychosis. STUDY APPRAISAL AND SYNTHESIS METHODS Title, abstract and full-text review by two independent raters to identify suitable citations. Data were extracted to a standardized extraction form. Descriptive appraisals of variation in rates, including tables and forest plots, and where suitable, random-effects meta-analyses and meta-regressions to test specific hypotheses; rate heterogeneity was assessed by the I²-statistic. RESULTS 83 citations met inclusion. Pooled incidence of all psychoses (N = 9) was 31.7 per 100,000 person-years (95%CI: 24.6-40.9), 23.2 (95%CI: 18.3-29.5) for non-affective psychoses (N = 8), 15.2 (95%CI: 11.9-19.5) for schizophrenia (N = 15) and 12.4 (95%CI: 9.0-17.1) for affective psychoses (N = 7). This masked rate heterogeneity (I²: 0.54-0.97), possibly explained by socio-environmental factors; our review confirmed (via meta-regression) the typical age-sex interaction in psychosis risk, including secondary peak onset in women after 45 years. Rates of most disorders were elevated in several ethnic minority groups compared with the white (British) population. For example, for schizophrenia: black Caribbean (pooled RR: 5.6; 95%CI: 3.4-9.2; N = 5), black African (pooled RR: 4.7; 95%CI: 3.3-6.8; N = 5) and South Asian groups in England (pooled RR: 2.4; 95%CI: 1.3-4.5; N = 3). We found no evidence to support an overall change in the incidence of psychotic disorder over time, though diagnostic shifts (away from schizophrenia) were reported. LIMITATIONS Incidence studies were predominantly cross-sectional, limiting causal inference. Heterogeneity, while evidencing important variation, suggested pooled estimates require interpretation alongside our descriptive systematic results. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS Incidence of psychotic disorders varied markedly by age, sex, place and migration status/ethnicity. Stable incidence over time, together with a robust socio-environmental epidemiology, provides a platform for developing prediction models for health service planning.
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Affiliation(s)
- James B Kirkbride
- Department of Psychiatry, Herchel Smith Building for Brain and Mind Sciences, University of Cambridge, Cambridge, United Kingdom.
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Brunelle S, Cole MG, Elie M. Risk factors for the late-onset psychoses: a systematic review of cohort studies. Int J Geriatr Psychiatry 2012; 27:240-52. [PMID: 21472779 DOI: 10.1002/gps.2702] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Accepted: 02/07/2011] [Indexed: 11/07/2022]
Abstract
BACKGROUND Psychoses with onset in late adulthood are challenging. Identifying those older patients at risk would be clinically important and would have research implications. METHODS A computer search was performed to identify all cohort studies of risk factor(s) for psychotic symptoms or disorders with onset at 40 years or older. Experts were contacted and bibliographies were screened for additional references. Validity of located studies was assessed according to evidence-based medicine criteria for risk factors studies. Data were extracted and tabulated for qualitative and quantitative analyses. RESULTS Twelve articles were retrieved, corresponding to 11 studies of 32 potential risk factors. In the qualitative analysis, only the history of psychotic symptoms, cognitive problems, poor health status, visual impairment, and negative life events appeared to be significant risk factors of late-onset psychosis. Older age, female gender, and hearing impairment were not associated with psychosis in older patients. Quantitative analysis was feasible with only one item, female gender, and confirmed the lack of associated risk with late-onset psychosis. CONCLUSIONS Despite the methodological limitations of the studies included in this review, there is some evidence from cohort studies that history of psychotic symptoms, cognitive problems, poor physical health, visual impairment, and negative life events are risk factors for late-onset psychosis. More long-term follow-up studies are needed to confirm these findings.
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Abstract
BACKGROUND Schizophrenia is usually considered an illness of young adulthood. However, onset after the age of 40 years is reported in 23% of patients hospitalised with schizophrenia. At least 0.1% of the world's elderly population have a diagnosis of late-onset schizophrenia which seems to differ from earlier onset schizophrenia on a variety of counts including response to antipsychotic drugs. OBJECTIVES To assess the effects of antipsychotic drugs for elderly people with late-onset schizophrenia. SEARCH METHODS We searched the Cochrane Schizophrenia Group Trials Register (January 2010) which is based on regular searches of CINAHL, EMBASE, MEDLINE and PsycINFO. We inspected references of all identified studies for further trials. We contacted relevant authors of trials for additional information. SELECTION CRITERIA All relevant randomised controlled trials that compared antipsychotic drugs with other treatments for elderly people (at least 80% older than 65 years) with a recent (within five years) diagnosis of schizophrenia or schizophrenia like illnesses. DATA COLLECTION AND ANALYSIS For the 2010 search, two new review authors (AE, AG) inspected all citations to ensure reliable selection. We assessed methodological quality of trials using the criteria recommended in the Cochrane Handbook for Systematic Reviews of Interventions. AE and AG also independently extracted data. For homogenous dichotomous data, we planned to calculate the relative risk (RR) and 95% confidence interval (CI). MAIN RESULTS There were no included studies in the original version of this review (2002 search). The 2010 search for the current update produced 211 references, among which we identified 88 studies. Only one study met the inclusion criteria and was of acceptable quality. This was an eight-week randomised trial of risperidone and olanzapine in 44 inpatients with late-onset schizophrenia. All participants completed the eight-week trial, indicating that both drugs were well tolerated. Unfortunately, this study provided little usable data. We excluded a total of 81 studies, 77 studies because they either studied interventions other than antipsychotic medication or because they involved elderly people with chronic - not late-onset - schizophrenia. We excluded a further four trials of antipsychotics in late-onset schizophrenia because of flawed design. Five studies are still awaiting classification, and one is on-going. AUTHORS' CONCLUSIONS There is no trial-based evidence upon which to base guidelines for the treatment of late-onset schizophrenia. There is a need for good quality-controlled clinical trials into the effects of antipsychotics for this group. Such trials are possible. Until they are undertaken, people with late-onset schizophrenia will be treated by doctors using clinical judgement and habit to guide prescribing.
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Affiliation(s)
- Adib Essali
- Psychiatry Centre, Teshreen Hospital, Damascus, Syrian Arab Republic.
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Schizophrenia spectrum disorders in later life: prevalence and distribution of age at onset and sex in a dutch catchment area. Am J Geriatr Psychiatry 2012; 20:18-28. [PMID: 22183010 DOI: 10.1097/jgp.0b013e3182011b7f] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The prevalence of schizophrenia in later life is affected by both outflow of early onset patients, due to recovery and excess mortality, and inflow of patients with a later age at onset, making it likely that characteristics of older patients differ markedly from younger patients. We assessed the prevalence of schizophrenia and spectrum disorders and their distribution according to age at onset and sex in an elderly population. DESIGN Case register study. SETTING AND PARTICIPANTS All patients age 60 years and older, in contact with the Mental Health Organization in a psychiatric catchment area in Amsterdam (the Netherlands), diagnosed with schizophrenia, schizoaffective disorder, or delusional disorder. MEASUREMENTS One-year prevalence estimates, including rates according to age group, age at onset, and sex. In addition, we determined the effect of using different criteria for age at onset. RESULTS The one-year prevalence of all disorders was 0.71%, subdivided in 0.55% for schizophrenia, 0.14% for schizoaffective disorder, and 0.03% for delusional disorder. The one-year prevalence of early-onset schizophrenia was 0.35%, of late-onset schizophrenia 0.14%, and of very-late-onset schizophrenia-like psychosis 0.05%. Variation of onset criterion affected the proportion of early-onset versus late-onset schizophrenia patients stronger in women than in men. Women outnumbered men markedly in the prevalence estimates for most diagnostic subgroups, including early-onset schizophrenia. CONCLUSIONS We found the prevalence of schizophrenia among older persons to be well within the range reported for younger populations. The considerable proportion with a later age at onset and the strong female preponderance are distinguishing characteristics of older patients with clinical implications.
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Cowan DN, Weber NS, Fisher JA, Bedno SA, Niebuhr DW. Incidence of adult onset schizophrenic disorders in the US military: patterns by sex, race and age. Schizophr Res 2011; 127:235-40. [PMID: 21227655 DOI: 10.1016/j.schres.2010.12.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Revised: 12/03/2010] [Accepted: 12/06/2010] [Indexed: 11/17/2022]
Abstract
BACKGROUND There are limited data describing the epidemiology of adult-onset schizophrenic disorders in the United States. Although the military is not proportionately comparable in all demographic characteristics to the civilian population, it is drawn from all racial/ethnic subgroups, and members range in age from 17 to >60 years. We describe the incidence of hospitalization for new onset schizophrenic disorders among military members by sex, race, and age. METHODS Using military inpatient data, we evaluated patterns of initial hospitalizations for schizophrenic disorders among military personnel for 2000-2009, focusing on sex, race, and age. No individual-level data were available. RESULTS From 2000-2009, 1976 military personnel had a first schizophrenic disorder hospitalization, with an overall incidence rate of 0.14/1000 person-years. There were no consistent changes in rates over time. While overall incidence rates were similar for men and women (incidence rate ratio (IRR)=1.10), rates were higher among men than women below age 25; after 25-30 rates were higher among women. Incidence was higher among blacks and other racial groups, with IRR=2.0 and 1.3, respectively. CONCLUSION Medical screening of military applicants prevents persons with overt or a reported history of psychosis, and most with serious behavior problems, from enlisting; therefore, first hospitalization is likely to reflect new illness. No pre-military socioeconomic data were available, however, essentially all study subjects were high school graduates; unmeasured differences in socioeconomic status were unlikely to explain the observed results. This report may provide lower bound estimates of the schizophrenic disorder incidence in the United States.
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Affiliation(s)
- David N Cowan
- Walter Reed Army Institute of Research, Department of Epidemiology, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA.
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Stefanopoulou E, Lafuente AR, Fonseca AS, Keegan S, Vishnick C, Huxley A. Global assessment of psychosocial functioning and predictors of outcome in schizophrenia. Int J Psychiatry Clin Pract 2011; 15:62-8. [PMID: 22122691 DOI: 10.3109/13651501.2010.519035] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study identified predictors of psychosocial outcome in schizophrenia. METHOD A mixed group of patients diagnosed with schizophrenia were assessed as part of a routine clinical evaluation. A linear regression analysis was conducted in order to examine the effect of duration of untreated illness, number of previous hospitalisations, history of psychotic episodes and age at illness onset on patients' functioning, as assessed with the Global Assessment of Functioning (GAF) scale. RESULTS Number of previous psychotic episodes as well as duration of untreated illness were the strongest predictors of patients' levels of functioning amongst all main outcome measures. Older age at illness onset also predicted poorer functioning. Limitations. A principal limitation of our study is that our sample included predominantly Caucasian males; therefore, any extrapolation to other groups may remain speculative. CONCLUSIONS Our preliminary results suggest that psychosocial outcome in schizophrenia may be affected by different factors. Longer history of psychotic episodes emerged as the most significant determinant of poorer outcome while longer duration of untreated illness and older age at illness onset were also associated with detrimental effects. Our findings may reflect the combined influences of neurodevelopmental abnormalities, exposure to psychotropic medication and psychosocial interventions as well as the vicissitudes of natural aging processes embedded in a chronic mental illness.
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Chang WC, Tang JYM, Hui CLM, Chiu CPY, Lam MML, Wong GHY, Chung DWS, Law CW, Tso S, Chan KPM, Hung SF, Chen EYH. Gender differences in patients presenting with first-episode psychosis in Hong Kong: a three-year follow up study. Aust N Z J Psychiatry 2011; 45:199-205. [PMID: 21261552 DOI: 10.3109/00048674.2010.547841] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of the current study was to investigate gender differences with respect to pre-treatment characteristics, clinical presentation, service utilization and functional outcome in patients presenting with first-episode psychosis. METHODS A total of 700 participants (men, n = 360; women, n = 340) aged 15 to 25 years consecutively enrolled in a territory-wide first-episode psychosis treatment programme in Hong Kong from July 2001 to August 2003 were studied. Baseline and three-year follow up variables were collected via systematic medical file review. RESULTS At service entry, men had significantly lower educational attainment (p < 0.01), longer median duration of untreated psychosis (p < 0.001), fewer past suicidal attempts (p < 0.01), more severe negative symptoms (p < 0.05) and fewer affective symptoms (p < 0.01) than women. There was no significant gender difference in age of onset. In three-year follow up, men had more prominent negative symptoms (p < 0.001), fewer affective symptoms (p < 0.01), more violent behaviour and forensic records (p < 0.01), and higher rate of substance abuse (p < 0.01). Women achieved higher levels of functioning than men (Social Occupational Functioning Assessment Scale (SOFAS), p < 0.001) and a significantly higher proportion of women than men engaged in full-time employment or study for at least 12 consecutive months (p < 0.001) in the initial three years after psychiatric treatment. CONCLUSION Notable gender differences in clinical profiles, illness trajectory and functional outcome were demonstrated in Chinese young people suffering from first-episode psychosis. Differential needs between men and women and hence gender-specific therapeutic strategies should be considered in early intervention service.
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Onwuameze OE, Schultz SK, Paradiso S. An initial study of modifiable and non-modifiable factors for late-life psychosis. Int J Psychiatry Med 2011; 42:437-51. [PMID: 22530403 PMCID: PMC3626263 DOI: 10.2190/pm.42.4.g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To determine rates of psychotic symptoms and associated modifiable and non-modifiable factors among elderly long term nursing home residents without prior history of psychiatric illness. METHOD A cross-sectional design using the Scale for the Assessment of Positive Symptoms (SAPS) to measure psychotic symptoms, the Folstein's Mini-Mental State Exam (MMSE), and Mattis Dementia Rating Scale (DRS) to evaluate cognitive impairment. Frequency and rates of global psychotic symptoms and hallucinations, delusions, formal thought disorder, and bizarre behavior were calculated. Logistic regression was used to examine modifiable (e.g., medication use) and non-modifiable clinical characteristics (e.g., older age) associated with late-life psychosis. RESULTS There were 15.9% of subjects reporting delusions and 7.3% reporting hallucinations. History of stroke, poorer cognition, and receiving multiple medications showed significant association with late-life psychosis. Only stroke (OR = 9.12; 95% CI: 1.58-52.74) and receiving different classes of medications (benzodiazepines, neuroleptics, and antidepressants) (OR = 13.17; 95% CI: 2.10-85.82) remained significantly associated with psychosis after adjusting for Mattis DRS total score. Further analyses excluding subjects with MMSE scores of 24 or lower (n = 24) showed essentially the same results but subjects with better cognitive function suffered a less severe form of psychosis, essentially constituted by one symptom type (i.e., visual hallucinations). CONCLUSIONS Rates of late-life psychosis in this sample of nursing home residents without previous psychiatric history were high. Simultaneous use of medications including antidepressants, sedatives, and stimulants may be a clinically relevant modifiable factor to be targeted in prevention studies. Severity and type of psychosis is dependent on the severity of cognitive impairment.
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Affiliation(s)
- Obiora E Onwuameze
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, Iowa 52242, USA
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Müller H, Seifert F, Asemann R, Schütz P, Maler JM, Sperling W. Persecution-induced reduction in earning capacity of Holocaust victims: influence of psychiatric and somatic aspects. Psychopathology 2011; 44:225-9. [PMID: 21502774 DOI: 10.1159/000322813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Accepted: 11/12/2010] [Indexed: 11/19/2022]
Abstract
The incidence of mental and somatic sequelae is very high in the group of persons damaged by the Holocaust. Based on the sociomedical criteria prevailing in Germany, the assessment of persecution-induced reduction in earning capacity of Holocaust victims (vMdE) is mainly orientated towards direct Holocaust-induced somatic and mental sequelae but must also take into account the interaction of direct Holocaust-induced damage with subsequently acquired physical, mental, and psychosocial factors. The current medical evaluation is focused on the question whether persecution-induced symptoms are exacerbated by endogenous factors like mental or somatic diseases and/or exogenous factors like life events. In that case the grade of vMdE could be increased. Based on the synopsis of 56 Holocaust victims, we ascertained in this study that newly acquired somatic diseases and psychic morbidities contribute to an increase in persecution-induced mental complaints.
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Affiliation(s)
- Helge Müller
- Department of Psychiatry and Psychotherapy, University of Erlangen-Nuremberg, Erlangen, Germany.
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Kohen I, Lester PE, Lam S. Antipsychotic treatments for the elderly: efficacy and safety of aripiprazole. Neuropsychiatr Dis Treat 2010; 6:47-58. [PMID: 20361061 PMCID: PMC2846120 DOI: 10.2147/ndt.s6411] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Indexed: 12/21/2022] Open
Abstract
Delusions, hallucinations and other psychotic symptoms can accompany a number of conditions in late life. As such, elderly patients are commonly prescribed antipsychotic medications for the treatment of psychosis in both acute and chronic conditions. Those conditions include schizophrenia, bipolar disorder, depression and dementia. Elderly patients are at an increased risk of adverse events from antipsychotic medications because of age-related pharmacodynamic and pharmacokinetic changes as well as polypharmacy. Drug selection should be individualized to the patient's previous history of antipsychotic use, current medical conditions, potential drug interactions, and potential side effects of the antipsychotic. Specifically, metabolic side effects should be closely monitored in this population. This paper provides a review of aripiprazole, a newer second generation antipsychotic agent, for its use in a variety of psychiatric disorders in the elderly including schizophrenia, bipolar disorder, dementia, Parkinson's disease and depression. We will review the pharmacokinetics and pharmacodynamics of aripiprazole as well as dosing, diagnostic indications, efficacy studies, and tolerability including its metabolic profile. We will also detail patient focused perspectives including quality of life, patient satisfaction and adherence.
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Affiliation(s)
- Izchak Kohen
- Division of Geriatric Psychiatry, Ambulatory Care Pavilion, Zucker-Hillside Hospital, Glen Oaks, NY, USA.
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