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Hyatt AS, William Flores M, Lê Cook B. Disproportionate increase in cannabis use among people with serious psychological distress and associations with psychiatric service use in the United States, 2009-2019. Addict Behav 2024; 157:108095. [PMID: 38905902 PMCID: PMC11283347 DOI: 10.1016/j.addbeh.2024.108095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 06/05/2024] [Accepted: 06/17/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND Cannabis use is on the rise, but it is unclear how use is changing among individuals with serious psychological distress (SPD) compared to the general population as well as what associations this may have with mental health service use. METHODS Retrospective cohort study using the National Survey on Drug Use and Health (NSDUH) 2009-19 public use files of 447,228 adults aged ≥ 18 years. Multivariable logistic regression and predictive margin methods were used to estimate linear time trends in any and greater-than-weekly levels of cannabis use by year and SPD status and rates of psychiatric hospitalization and outpatient mental health care. FINDINGS Rates of any and weekly-plus cannabis use increased similarly among individuals with SPD compared to those without from 200 to 2014 but more rapidly in SPD every year from 2015 to 2019 (p < 0.001). Among individuals with SPD, no use was associated with a 4.2 % probability of psychiatric hospitalization, significantly less than less-than-weekly (5.0 %, p = 0.037) and weekly-plus cannabis use (5.1 %, p = 0.028). For outpatient mental health care, no use was associated with a 27.4 % probability (95 % CI 26.7-28.1 %) of any outpatient care, significantly less than less than weekly use (32.6 % probability, p < 0.001) and weekly-plus use (29.9 % probability, p = 0.01). CONCLUSIONS Cannabis use is increasing more rapidly among individuals with SPD than the general population, and is associated with increased rates of psychiatric hospitalization and outpatient service use. These findings can inform policy makers looking to tailor regulations on advertising for cannabis and develop public health messaging on cannabis use by people with mental illness.
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Affiliation(s)
- Andrew S Hyatt
- Health Equity Research Lab, Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA 02139, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
| | - Michael William Flores
- Health Equity Research Lab, Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA 02139, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Benjamin Lê Cook
- Health Equity Research Lab, Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA 02139, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
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2
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Thomas EC, Hefron N, Zagorac S, Hewlett A, Wenzel RM, Kramer I, Walker L, Read H. Novel Occupational Therapy Program (Step Up) to Facilitate the Transition from Early Intervention in Psychosis Services. Community Ment Health J 2024:10.1007/s10597-024-01324-0. [PMID: 39052105 DOI: 10.1007/s10597-024-01324-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 07/12/2024] [Indexed: 07/27/2024]
Abstract
The purpose of this program evaluation was to examine preliminary outcomes associated with a novel stepdown program for clients of early intervention in psychosis services ("Step Up") that featured occupational therapy (OT) as a critical treatment component. Clients participated in Step Up for at least 6 months and were administered pre-post assessments of clinician-rated performance of daily living activities and self-perceived performance and satisfaction with daily occupational functioning. Paired samples Wilcoxon tests were used to compare outcomes across the two time points. Data from 23 participants of Step Up were analyzed. Clinician-rated performance of daily living (especially in the areas of money and time management and leisure engagement) and client-rated performance and satisfaction with daily occupational functioning improved significantly over time. Results demonstrate the promise of programs such as Step Up that capitalize on OT and promote functional outcomes during the transition from early intervention.
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Affiliation(s)
- Elizabeth C Thomas
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1700 N Broad St., Philadelphia, PA, 19121, USA.
| | | | - Sarah Zagorac
- Horizon House, Inc. PEACE Program, Philadelphia, PA, USA
| | - Ashley Hewlett
- Horizon House, Inc. PEACE Program, Philadelphia, PA, USA
| | | | - Ilyse Kramer
- Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Halley Read
- Western Oregon University, Monmouth, OR, USA
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Correll CU, Arango C, Fagerlund B, Galderisi S, Kas MJ, Leucht S. Identification and treatment of individuals with childhood-onset and early-onset schizophrenia. Eur Neuropsychopharmacol 2024; 82:57-71. [PMID: 38492329 DOI: 10.1016/j.euroneuro.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 01/31/2024] [Accepted: 02/07/2024] [Indexed: 03/18/2024]
Abstract
Approximately 8 % of patients with schizophrenia are diagnosed before age 18, and 18 % experience their first symptoms before age 18. This narrative review explores the management of patients with early-onset schizophrenia (EOS) and childhood-onset schizophrenia (COS) from diagnosis to their transition to adult care settings. Early diagnosis of schizophrenia in children and adolescents is essential for improving outcomes, but delays are common due to overlapping of symptoms with developmental phenomena and other psychiatric conditions, including substance use, and lack of clinicians' awareness. Once diagnosed, antipsychotic treatment is key, with specific second-generation agents generally being preferred due to better tolerability and their broader efficacy evidence-base in youth. Dosing should be carefully individualized, considering age-related differences in drug metabolism and side effect liability. Clinicians must be vigilant in detecting early non-response and consider switching or dose escalation when appropriate. Since early age of illness onset is a consistent risk factor for treatment-resistant schizophrenia (TRS), clinicians need to be competent in diagnosing TRS and using clozapine. Since COS and EOS are associated with cognitive deficits and impaired functioning, psychosocial interventions should be considered to improve overall functioning and quality of life. Good long-term outcomes depend on continuous treatment engagement, and successful transitioning from pediatric to adult care requires careful planning, early preparation, and collaboration between pediatric and adult clinicians. Targeting functional outcomes and quality of life in addition to symptom remission can improve overall patient well-being. Comprehensive evaluations, age-specific assessments, and targeted interventions are needed to address the unique challenges of EOS and COS.
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Affiliation(s)
- Christoph U Correll
- Department of Child and Adolescent Psychiatry, Charité - Universitätsmedizin Berlin, Berlin, Germany; Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Department of Psychiatry, Zucker Hillside Hospital, Northwell Health System, Glen Oaks, NY, USA.
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Birgitte Fagerlund
- Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark; Department of Psychology, Faculty of Social Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Silvana Galderisi
- Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Martien J Kas
- Groningen Institute for Evolutionary Life Sciences (GELIFES), Neurobiology, University of Groningen, the Netherlands
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Germany; Department of Psychiatry, Department of Psychosis Studies, and Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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4
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DeLisi LE. A lifetime of mental health treatments for people with schizophrenia: update and narrative review. Curr Opin Psychiatry 2024; 37:140-146. [PMID: 38512852 DOI: 10.1097/yco.0000000000000926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
PURPOSE OF REVIEW To provide a summary of the most up-to-date thoughts about treatment for schizophrenia at different stages of illness. RECENT FINDINGS The use of Coordinated Specialty Care clinics has arisen as the standard for early on in the treatment of psychosis, providing the notion that recovery is possible. New medications that do not depend on postsynaptic dopamine receptor blockade are soon becoming available. SUMMARY A focus should be made by clinicians to personalize treatment plans for each patient who has the possibility of being diagnosed with a primary psychosis and the plan should be to predict outcomes based on biological markers that include genetic vulnerability, early psychosocial combined with pharmacological treatments as needed and then a plan to determine or maintain treatments going forward into the future. It is important to individualize treatment by stage of illness, as well as characteristics of the individual patient. Research is ongoing to advance knowledge for interventions at each stage from the premorbid period through to chronicity.
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Affiliation(s)
- Lynn E DeLisi
- Department of Psychiatry, Cambridge Health Alliance, Department of Psychiatry, Harvard Medical School, Cambridge, Massachusetts, USA
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Hyatt A, Mullin B, Hasler V, Madore D, Progovac AM, Cook BL, DeLisi LE. Predictors of relapse and engagement in care one year after ending services in an urban safety net coordinated specialty care program for first episode psychosis. Schizophr Res 2024; 264:140-146. [PMID: 38128345 PMCID: PMC10983670 DOI: 10.1016/j.schres.2023.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 11/08/2023] [Accepted: 12/17/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE This study aimed to identify risk factors for relapse (psychiatric emergency department visits or hospitalization) and lack of follow-up with outpatient psychiatric care in the 12 months after ending services in an urban safety net coordinated specialty care (CSC) program for first episode psychosis (FEP). METHODS The study population (n = 143) were individuals with FEP who had any CSC care between 2014 and 2021. To identify risk factors for relapse and follow up after exit, multivariable logistic regression was performed using data from electronic health records and linked insurance claims data. RESULTS Individuals with any emergency department visit or hospitalization 12 months prior to ending CSC (aOR = 4.69, 95 % CI 1.78-12.34) and those who were using cannabis at last CSC contact (aOR = 4.06, 95 % CI 1.56-10.56) had a higher risk of relapse after ending CSC services. Cannabis use at last contact was also associated with lower rates of outpatient psychiatric follow-up (aOR = 0.32, 95 % CI 0.12-0.94), while CSC duration in months had a small positive association with post-CSC psychiatric follow-up. There were no differences in relapse or follow-up by race or ethnicity, primary diagnosis, or medication usage. CONCLUSIONS Prior relapse during CSC predicted relapse in the 12 months after ending CSC services, but not outpatient follow up. Cannabis use predicted both a higher rate of relapse and a lower rate of follow up after ending services. There were no differences by race or ethnicity in our sample, suggesting that once individuals engaged in FEP care there were no evident disparities in the observed outcomes.
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Affiliation(s)
- Andrew Hyatt
- Cambridge Health Alliance, Department of Psychiatry, 1493 Cambridge Street, Cambridge 02139, MA, United States; Harvard Medical School, Department of Psychiatry, 25 Shattuck Street, Boston 02115, MA, United States.
| | - Brian Mullin
- Cambridge Health Alliance, Department of Psychiatry, 1493 Cambridge Street, Cambridge 02139, MA, United States
| | - Victoria Hasler
- Cambridge Health Alliance, Department of Psychiatry, 1493 Cambridge Street, Cambridge 02139, MA, United States; Harvard Medical School, Department of Psychiatry, 25 Shattuck Street, Boston 02115, MA, United States
| | - Drew Madore
- Cambridge Health Alliance, Department of Psychiatry, 1493 Cambridge Street, Cambridge 02139, MA, United States; Harvard Medical School, Department of Psychiatry, 25 Shattuck Street, Boston 02115, MA, United States
| | - Ana M Progovac
- Cambridge Health Alliance, Department of Psychiatry, 1493 Cambridge Street, Cambridge 02139, MA, United States; Harvard Medical School, Department of Psychiatry, 25 Shattuck Street, Boston 02115, MA, United States
| | - Benjamin Lê Cook
- Cambridge Health Alliance, Department of Psychiatry, 1493 Cambridge Street, Cambridge 02139, MA, United States; Harvard Medical School, Department of Psychiatry, 25 Shattuck Street, Boston 02115, MA, United States
| | - Lynn E DeLisi
- Cambridge Health Alliance, Department of Psychiatry, 1493 Cambridge Street, Cambridge 02139, MA, United States; Harvard Medical School, Department of Psychiatry, 25 Shattuck Street, Boston 02115, MA, United States
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Zhang T, Wei Y, Cui H, Tang X, Xu L, Hu Y, Tang Y, Liu H, Chen T, Li C, Wang J. Associations between age and neurocognition in individuals at clinical high risk and first-episode psychosis. Psychiatry Res 2023; 327:115385. [PMID: 37567111 DOI: 10.1016/j.psychres.2023.115385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023]
Abstract
Neurocognitive deficits differ with age during the early stages of psychosis. This study aimed to explore age-related differences (9-35 years old) in the neurocognitive performance of a large clinical population. In total, 1059 individuals with first-episode psychosis (FEP), 794 individuals with a clinical high risk of psychosis (CHR), and 774 well-matched healthy controls (HC) were recruited between 2016 and 2021. Neurocognitive assessments were performed using the Chinese version of the Measurement and Treatment Research to Improve Cognition in Schizophrenia Battery(MCCB). The MCCB subtest scores differed significantly among the groups across the age span. The mean scores of subtests in CHR individuals were approximately one standard deviation(SD) lower than that of HC, while that of FEP patients was approximately two SDs. The adolescents performed better than the adults in the HC, CHR, and FEP groups. In the HC group, a stronger correlation was found between age and cognitive function, and more neurocognitive domains were affected by age than in the CHR and FEP groups. These results emphasize that neurocognitive deficits in psychosis are present at the pre-onset stage and deteriorate at the first-episode stage across the age span, implicating the development of specific strategies that could monitor the cognitive trajectory in early psychosis.
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Affiliation(s)
- TianHong Zhang
- Shanghai Mental Health Center, Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center (20DZ2253800), Shanghai Key Laboratory of Psychotic Disorders, Shanghai Jiaotong University School of Medicine, 600 Wanping Nan Road, Shanghai 200030, China
| | - YanYan Wei
- Shanghai Mental Health Center, Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center (20DZ2253800), Shanghai Key Laboratory of Psychotic Disorders, Shanghai Jiaotong University School of Medicine, 600 Wanping Nan Road, Shanghai 200030, China
| | - HuiRu Cui
- Shanghai Mental Health Center, Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center (20DZ2253800), Shanghai Key Laboratory of Psychotic Disorders, Shanghai Jiaotong University School of Medicine, 600 Wanping Nan Road, Shanghai 200030, China
| | - XiaoChen Tang
- Shanghai Mental Health Center, Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center (20DZ2253800), Shanghai Key Laboratory of Psychotic Disorders, Shanghai Jiaotong University School of Medicine, 600 Wanping Nan Road, Shanghai 200030, China
| | - LiHua Xu
- Shanghai Mental Health Center, Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center (20DZ2253800), Shanghai Key Laboratory of Psychotic Disorders, Shanghai Jiaotong University School of Medicine, 600 Wanping Nan Road, Shanghai 200030, China
| | - YeGang Hu
- Shanghai Mental Health Center, Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center (20DZ2253800), Shanghai Key Laboratory of Psychotic Disorders, Shanghai Jiaotong University School of Medicine, 600 Wanping Nan Road, Shanghai 200030, China
| | - YingYing Tang
- Shanghai Mental Health Center, Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center (20DZ2253800), Shanghai Key Laboratory of Psychotic Disorders, Shanghai Jiaotong University School of Medicine, 600 Wanping Nan Road, Shanghai 200030, China
| | - HaiChun Liu
- Department of Automation, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Tao Chen
- Big Data Research Lab, University of Waterloo, Ontario, Canada; Senior Research Fellow, Labor and Worklife Program, Harvard University, Cambridge, MA, United States
| | - ChunBo Li
- Shanghai Mental Health Center, Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center (20DZ2253800), Shanghai Key Laboratory of Psychotic Disorders, Shanghai Jiaotong University School of Medicine, 600 Wanping Nan Road, Shanghai 200030, China
| | - JiJun Wang
- Shanghai Mental Health Center, Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center (20DZ2253800), Shanghai Key Laboratory of Psychotic Disorders, Shanghai Jiaotong University School of Medicine, 600 Wanping Nan Road, Shanghai 200030, China; Chinese Academy of Science, Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Shanghai, China; Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, China.
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Tandon R, Nasrallah H, Keshavan M. Advancing the understanding of the early stages of the schizophrenia syndrome: New opportunities to make a difference. Asian J Psychiatr 2023; 81:103519. [PMID: 36806399 DOI: 10.1016/j.ajp.2023.103519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- Rajiv Tandon
- Department of Psychiatry, WMU Homer Stryker School of Medicine, Kalamazoo, MI, United States of America.
| | - Henry Nasrallah
- Department of Psychiatry, University of Cincinnati Medical School, Cincinnati, OH, United States of America
| | - Matcheri Keshavan
- Department of Psychiatry, BIDMC, Harvard Medical School, Boston, MA, United States of America
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