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Correll CU, Arango C, Fagiolini A, Giordano GM, Leucht S, Salazar de Pablo G. Finding the Right Setting for the Right Treatment During the Acute Treatment of Individuals with Schizophrenia: A Narrative Review and Clinical Practice Guideline. Neuropsychiatr Dis Treat 2024; 20:1293-1307. [PMID: 38911102 PMCID: PMC11194005 DOI: 10.2147/ndt.s459450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 05/22/2024] [Indexed: 06/25/2024] Open
Abstract
Background Schizophrenia is most times a chronic and often debilitating illness associated with poor mental health outcomes. Early and effective treatment of schizophrenia in the most appropriate setting can make a significant difference in the long-term recovery. The aim of this narrative review was to provide suggestions and recommendations for effectively managing patients with schizophrenia during acute exacerbations and to enhance awareness and skills related to personalized medicine. Methods A panel of academics and clinicians with experience in the field of psychosis met virtually on July 13th 2023 to narratively review and discuss the research evidence and their clinical experience about the most appropriate acute treatments for patients with schizophrenia. This manuscript represents a synthesis of the panel analysis and discussion. Results First contact is very important for service users, as is finding the most adequate treatment setting. If patients present to the emergency department, which may be a traumatic setting for service users, a dedicated environment with adequate space and specialized mental health support, including personnel trained in de-escalation techniques, is recommended. A well-connected continuum of care is strongly recommended, possibly with seamless links between inpatient units, day hospital services, outpatient facilities and rehabilitation services. Ideally, this should be structured as part of a coordinated step-down service line. Treatment challenges include suboptimal response, side effects, and nonadherence, which is reduced by the use of long-acting injectable antipsychotics. Conclusion Individual circumstances, including age, gender, and presence of hostility/aggression or self-harm, cognitive impairment and negative symptoms, comorbidities (depression, substance use disorders) or associated symptoms (anxiety, insomnia), should be considered when selecting the most appropriate treatment for the acute phase of schizophrenia. Efficacy and feasibility, as well as acceptability and tolerability of treatments, require joint consideration from the early stages of schizophrenia, thereby enhancing the possibility of improved short- and long-term outcomes.
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Affiliation(s)
- Christoph U Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/ Northwell, Hempstead, NY, USA
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
- German Center for Mental Health (DZPG), Partner Site Berlin, Berlin, Germany
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - Andrea Fagiolini
- Department of Molecular Medicine, School of Medicine, University of Siena, Siena, Italy
| | | | - Stefan Leucht
- German Center for Mental Health (DZPG), Partner Site Berlin, Berlin, Germany
- Technical University of Munich, TUM School of Medicine and Health, Department of Psychiatry and Psychotherapy, Munich, Germany
| | - Gonzalo Salazar de Pablo
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
- Child and Adolescent Mental Health Services (CAMHS) South London and Maudsley NHS Foundation Trust London, London, UK
- Department of Child and Adolescent Psychiatry Institute of Psychiatry, Psychology & Neuroscience King’s College London, London, UK
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Mamtani H, Pathak H, Sakhardande K, Gowda GS, Muliyala KP, Philip M, Moirangthem S, Reddi VSK, Varambally S. Suicide attempts in schizophrenia - A large retrospective cohort study from a tertiary care psychiatry centre in India. Asian J Psychiatr 2024; 96:104053. [PMID: 38678797 DOI: 10.1016/j.ajp.2024.104053] [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: 10/11/2023] [Revised: 02/26/2024] [Accepted: 04/14/2024] [Indexed: 05/01/2024]
Abstract
The extent of variability in identified risk factors for suicide attempts (SA) in schizophrenia limits their generalization. This study aimed to identify the rates and associated correlates of SA in schizophrenia by reviewing a large cohort (n=500). Nearly one-fourth had a history of SA, which was independently associated with a family history of SA, more inpatient admissions, and better long-term treatment response. These findings highlight the complex interaction between biological factors influencing SA and illness determinants in schizophrenia. Furthermore, they reinforce the need for future research to unravel the association between suicide vulnerability and the pathophysiology of schizophrenia to attenuate morbidity and mortality associated with the same.
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Affiliation(s)
- Harkishan Mamtani
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, India
| | - Harsh Pathak
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, India
| | - Kasturi Sakhardande
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, India
| | - Guru S Gowda
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, India
| | - Krishna Prasad Muliyala
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, India
| | - Mariamma Philip
- Department of Biostatistics, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, India
| | - Sydney Moirangthem
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, India
| | | | - Shivarama Varambally
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, India
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Fekih-Romdhane F, Al Mouzakzak F, Abilmona G, Dahdouh O, Hallit S. Validation and optimal cut-off score of the World Health Organization Well-being Index (WHO-5) as a screening tool for depression among patients with schizophrenia. BMC Psychiatry 2024; 24:391. [PMID: 38783217 PMCID: PMC11112932 DOI: 10.1186/s12888-024-05814-z] [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: 03/03/2024] [Accepted: 05/05/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND The utility of the World Health Organization Wellbeing Index (WHO-5) as rapid screening tool for depression has not yet been researched in the context of schizophrenia. The goals of this study were twofold: (1) to test the psychometric properties of the WHO-5 in a sample of Arabic-speaking patients with schizophrenia from Lebanon, with particular emphasis on validating the WHO-5 as a screening tool for wellbeing and depression in patients with schizophrenia; and (2) to determine the optimal cut-off point to identify schizophrenia patients with depression. METHODS Chronic, remitted patients with schizophrenia took part in this cross-sectional study between August and October 2023 (n = 117; mean age of 57.86 ± 10.88 years and 63.3% males). The Calgary Depression Scale for Schizophrenia (CDSS) was included as index of validity. For the validation of the WHO-5 scale, we performed a confirmatory factor analysis (CFA) using the original structure of the scale. To assess the discriminatory validity of the Arabic version of the WHO-5 as a screening tool for depression, we conducted a Receiver operating characteristic (ROC) curve analysis, taking the WHO-5 reversed score against the dichotomized CDSS score at a cut off value of 6. RESULTS The results of CFA supported the originally proposed unidimensional structure of the measure, with good internal consistency reliability (α = 0.80), concurrent validity, and cross-sex measurement invariance. The WHO-5 showed a sensitivity of 0.8 and a specificity of 0.7 in the detection of depression with a cut-off point of 9.5. The validity of the WHO-5 as a screening tool for depression was supported by the excellent discrimination AUC value of 0.838. Based on this WHO-5 cut-off value, 42.6% of the patients were screened as having a depression. CONCLUSION The study contributes to the field by showing that the WHO-5 is a concise and convenient self-report measure for quickly screening and monitoring depressive symptoms in patients with schizophrenia. It is therefore highly recommended to apply this cut-off point for screening and follow-up assessments. The current findings will hopefully encourage clinicians and researchers working in Arab settings, who are often confronted with significant time and resource constraints, to start using the WHO-5 to aid their efforts in mitigating depression in this vulnerable population and fostering research in this under-researched area.
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Affiliation(s)
- Feten Fekih-Romdhane
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.
- The Tunisian Center of Early Intervention in Psychosis, Department of psychiatry "Ibn Omrane", Razi hospital, Manouba, 2010, Tunisia.
| | | | | | - Oussama Dahdouh
- Faculty of Science, Lebanese University, Fanar, Lebanon
- Research Department, Psychiatric Hospital of the Cross, P.O. Box 60096, Jal Eddib, Lebanon
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon.
- Department of Psychology, College of Humanities, Effat University, 21478 Jeddah, Saudi Arabia.
- Applied Science Research Center, Applied Science Private University, Amman, Jordan.
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Dongxia L, Li M, Yingying F. Can neurocognition, brain neurotrophic factor, triglyceride, and total cholesterol predict suicidal ideation in first-episode Han Chinese patients with schizophrenia? Brain Behav 2024; 14:e3499. [PMID: 38680078 PMCID: PMC11056701 DOI: 10.1002/brb3.3499] [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: 10/29/2023] [Revised: 03/10/2024] [Accepted: 04/03/2024] [Indexed: 05/01/2024] Open
Abstract
OBJECTIVE Previous studies have suggested that the suicide rate of patients with schizophrenia is high. This study investigates factors influencing suicidal ideation in first-episode schizophrenia patients, focusing on cognitive function, brain-derived neurotrophic factor (BDNF), triglyceride (TG), and total cholesterol (TC) in patients with first-episode schizophrenia. METHODS A total of 123 patients with first-episode schizophrenia and 38 healthy controls were included in the study. The patients were divided into suicidal and nonsuicidal ideation groups based on the Beck Scale for Suicidal Ideation, and they were assessed with Positive and Negative Syndrome Scale (PANSS). Cognitive function was assessed using the Chinese version of the MATRICS consensus cognitive battery (MCCB) and the serum BDNF, TG, and TC were detected. The main statistical methods include t-test, χ2 test, multivariate logistic regression analysis, receiver operating characteristic (ROC) curve analysis, and the DeLong test. RESULTS 26.02% of patients exhibited suicidal ideation. Higher PANSS and TC levels were risk factors, while higher MCCB scores and BDNF levels were protective factors. ROC analysis indicated AUCs of 0.630, 0.724, and 0.762 for serum BDNF, PANSS, and MCCB, respectively, with a combined AUC of 0.870. CONCLUSION Serum BDNF level, PANSS score, and MCCB score can be used as auxiliary predictors of suicidal ideation in schizophrenic patients. Combining these three indicators can effectively predict suicidal ideation in schizophrenic patients.
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Affiliation(s)
- Li Dongxia
- Wuhan Mental Health CenterWuhan Psychological HospitalWuhan CityChina
| | - Ma Li
- Wuhan Mental Health CenterWuhan Psychological HospitalWuhan CityChina
| | - Feng Yingying
- Wuhan Mental Health CenterWuhan Psychological HospitalWuhan CityChina
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Chalker SA, Sicotte R, Bornheimer LA, Parrish EM, Wastler H, Ehret B, DeVylder J, Depp CA. A call to action: informing research and practice in suicide prevention among individuals with psychosis. Front Psychiatry 2024; 15:1378600. [PMID: 38711871 PMCID: PMC11073495 DOI: 10.3389/fpsyt.2024.1378600] [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: 01/29/2024] [Accepted: 03/22/2024] [Indexed: 05/08/2024] Open
Abstract
Although it is well established that individuals living with psychosis are at increased risk for suicidal ideation, attempts, and death by suicide, several gaps in the literature need to be addressed to advance research and improve clinical practice. This Call-to-Action highlights three major gaps in our understanding of the intersection of psychosis and suicide as determined by expert consensus. The three gaps include research methods, suicide risk screening and assessment tools used with persons with psychosis, and psychosocial interventions and therapies. Specific action steps to address these gaps are outlined to inform research and practice, and thus, improve care and prognoses among persons with psychosis at risk for suicide.
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Affiliation(s)
- Samantha A. Chalker
- Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, CA, United States
| | - Roxanne Sicotte
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Research Center of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Lindsay A. Bornheimer
- University of Michigan, School of Social Work, Ann Arbor, MI, United States
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Emma M. Parrish
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, United States
| | - Heather Wastler
- Department of Psychiatry & Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | | | - Jordan DeVylder
- Silver School of Social Work, New York University, New York, NY, United States
| | - Colin A. Depp
- Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, CA, United States
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Zuo C, Yang X, Wu X, Fan R, Liu J, Xiang H, Li Y, Zhao X, Liu X, Liu Y. Medication non-adherence and self-inflicted violence behaviors among 185,800 patients with schizophrenia in the community: a 12-year cohort study. BMC Med 2024; 22:136. [PMID: 38523268 PMCID: PMC10962179 DOI: 10.1186/s12916-024-03354-7] [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: 11/28/2023] [Accepted: 03/13/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Despite the importance of medication adherence in treatment effectiveness, little is known about the association between medication non-adherence and self-inflicted violence behaviors. We aimed to assess whether medication non-adherence increased the risk of self-inflicted violence behaviors among schizophrenics in communities (hypothesis 1) and whether the dose-response relationship existed (hypothesis 2). METHODS This 12-year cohort study in western China recruited 292,667 community-dwelling schizophrenics. The proportion of regular medication (PRM) was calculated by dividing the time of "regular adherence" by the total time of antipsychotic treatment during follow-up period as an indicator of medication adherence. For hypothesis 1, medication adherence was designated as a binary variable with a threshold of 0.8 (PRM); for hypothesis 2, medication adherence was specified as five-category and continuous variables, respectively. Inverse probability weighting and mixed effects Cox proportional hazards models were conducted for confounders control and survival analyses. RESULTS One hundred eighty-five thousand eight hundred participants were eligible for the final analyses, with a mean age of 47.49 years (SD 14.55 years), of whom 53.6% were female. For hypothesis 1, the medication non-adherence group (PRM < 0.8) had a lower risk of suicide (HR, 0.527, 95% CI, 0.447-0.620), an increased risk of NSSI (HR, 1.229, 95% CI, 1.088-1.388), and non-significant risk of attempted suicide compared with adherence group (PRM ≥ 0.8). For hypothesis 2, the lowest medication adherence (PRM < 0.2) was associated with increased risks of suicide attempt (HR, 1.614, 95% CI, 1.412-1.845), NSSI (HR, 1.873, 95% CI, 1.649-2.126), and a decreased risk of suicide (HR, 0.593, 95% CI, 0.490-0.719). The other non-adherence groups had lower risks for all three self-inflicted violence behaviors. The associations between medication adherence in continuous-variable and three outcomes were consistent with the categorical medication adherence results. CONCLUSIONS Almost no medication taken as prescribed was associated with an increased risk of suicide attempt and NSSI. However, medication adherence did not appear to prevent completed suicide. Besides, patients with moderate adherence had a lower incidence of suicide attempt and NSSI. These findings highlight the need for a more detailed portrayal of medication adherence and the need to be vigilant for suicide intent in schizophrenics with good medication adherence who may be overlooked previously.
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Affiliation(s)
- Chuanlong Zuo
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, No.17, Section 3, Renmin South Road, Chengdu, Sichuan, 610041, China
| | - Xianmei Yang
- Sichuan Mental Health Center, The Third Hospital of Mianyang, No. 190, Jiannan East Road, Mianyang, Sichuan, 621000, China
| | - Xiangrui Wu
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, No.17, Section 3, Renmin South Road, Chengdu, Sichuan, 610041, China
| | - Ruoxin Fan
- Sichuan Mental Health Center, The Third Hospital of Mianyang, No. 190, Jiannan East Road, Mianyang, Sichuan, 621000, China
| | - Jun Liu
- Sichuan Mental Health Center, The Third Hospital of Mianyang, No. 190, Jiannan East Road, Mianyang, Sichuan, 621000, China
| | - Hu Xiang
- Sichuan Mental Health Center, The Third Hospital of Mianyang, No. 190, Jiannan East Road, Mianyang, Sichuan, 621000, China
| | - Yang Li
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, No.17, Section 3, Renmin South Road, Chengdu, Sichuan, 610041, China
| | - Xing Zhao
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, No.17, Section 3, Renmin South Road, Chengdu, Sichuan, 610041, China
| | - Xiang Liu
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, No.17, Section 3, Renmin South Road, Chengdu, Sichuan, 610041, China.
| | - Yuanyuan Liu
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, No.17, Section 3, Renmin South Road, Chengdu, Sichuan, 610041, China.
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Yüksel A, Yilmaz EB, Dikmen SNT. Suicide Probability Among Patients With Schizophrenia and Bipolar Disorder. J Psychosoc Nurs Ment Health Serv 2024:1-9. [PMID: 38451120 DOI: 10.3928/02793695-20240227-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
PURPOSE To evaluate the possibility of suicide and related factors among individuals with schizophrenia and bipolar disorder (BD). METHOD Data were collected for 270 individuals registered in a community mental health center using the Suicide Probability Scale (SPS). Subsequently, t test and multiple linear regression analyses were conducted on independent samples. RESULTS There was no statistically significant difference found between mean SPS scores of participants with schizophrenia and BD. However, hostility subscale mean scores of participants with schizophrenia were higher than those of participants with BD, and the difference was statistically significant. Sex, family history of mental illness, need for help with medication, suicidal ideation in the past 10 days, and number of suicide attempts were important predictors of suicide probability. CONCLUSION Individuals with schizophrenia and BD and in remission should be evaluated periodically for the possibility of suicide. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].
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Fekih-Romdhane F, Malaeb D, Farah N, Stambouli M, Cheour M, Obeid S, Hallit S. The relationship between cyberbullying perpetration/victimization and suicidal ideation in healthy young adults: the indirect effects of positive and negative psychotic experiences. BMC Psychiatry 2024; 24:121. [PMID: 38355556 PMCID: PMC10865539 DOI: 10.1186/s12888-024-05552-2] [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: 06/11/2023] [Accepted: 01/23/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Even though not all cyber bullies or victims think of (or consider) suicide, they clearly appear to be at an increased risk. One possible strategy to reduce suicide risk is to decrease cyberbullying occurrence; but this approach has its limitations, as it is certainly an illusion to believe that cyberbullying could be controlled or eliminated in a digitalized world. Another alternative and interesting strategy is to consider mediating factors that may indirectly affect suicidality. To this end, our purpose was to test the hypothesis that positive and negative psychotic experiences (PEs) mediate the relationship from cyberbullying perpetration/victimization to suicidal ideation (SI). METHOD The study followed a cross-sectional design, and was conducted during the period from June to September 2022. A total of 3103 healthy community participants from Lebanon were included (mean age 21.73 ± 3.80 years, 63.6% females). RESULTS After adjusting over potential confounders, mediation analysis models showed that both positive and negative PEs partially mediated the associations between cyberbullying victimization/perpetration and SI. Higher cyberbullying perpetration and victimization were significantly associated with greater positive and negative PEs; more severe positive and negative PEs were significantly associated with higher levels of SI. Higher cyberbullying victimization and perpetration were significantly and directly associated with higher levels of SI. CONCLUSION In light of our preliminary findings, there appears to be an urgent need for a new focus on carefully assessing and addressing attenuated psychotic symptoms in healthy individuals engaged in cyberbullying either as victims or bullies and who present with SI. It is important that school counselors and decision-makers consider a holistic approach taking into account both external/environmental (bullying) and internal/individual (PEs) factors in their suicide prevention programs. Future longitudinal research in larger samples are still required to confirm our findings and further elucidate the mechanisms underlying the relationship between cyberbullying and suicide.
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Affiliation(s)
- Feten Fekih-Romdhane
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry "Ibn Omrane", Razi hospital, 2010, Manouba, Tunisia.
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.
| | - Diana Malaeb
- College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates
| | - Nour Farah
- Faculty of Science, Lebanese University, Fanar, Lebanon
| | - Manel Stambouli
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry "Ibn Omrane", Razi hospital, 2010, Manouba, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Majda Cheour
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry "Ibn Omrane", Razi hospital, 2010, Manouba, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Sahar Obeid
- School of Arts and Sciences, Social and Education Sciences Department, Lebanese American University, Jbeil, Lebanon
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, P.O. Box 446, Lebanon.
- Psychology Department, College of Humanities, Effat University, 21478, Jeddah, Saudi Arabia.
- Applied Science Research Center, Applied Science Private University, Amman, Jordan.
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Ma Z, Zhou HX, Chen DC, Wang DM, Zhang XY. Association between suicidal behavior and impaired glucose metabolism in first-episode drug-naïve patients with schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2024; 129:110900. [PMID: 38007210 DOI: 10.1016/j.pnpbp.2023.110900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 11/09/2023] [Accepted: 11/19/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND Schizophrenia (SZ) patients have been reported to have comorbid suicidal behavior (SB) and impaired glucose metabolism in early psychosis, but it is unclear whether impaired glucose metabolism plays a role in the occurrence of SB in patients with first-episode drug-naïve (FEDN) SZ. Therefore, our main aim was to examine the relationship between SB and glucose metabolism in FEDN SZ patients. METHODS We recruited 319 FEDN SZ patients and collected information on their sociodemographic characteristics, clinical data, and glucose metabolism parameters. Participants' psychotic and depressive symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS) and the Hamilton Depression Rating Scale (HAMD), respectively. Fasting plasma glucose and insulin levels were also measured. RESULTS The percentage of FEDN SZ patients with SB was 45.5% (145/319). Compared to SZ patients without SB, SZ patients with SB exhibited higher scores on HAMD, PANSS positive subscale, as well as higher levels of fasting plasma glucose, fasting plasma insulin, and homeostasis model assessment of insulin resistance index (all p<0.05). Logistic regression analysis indicated that increased levels of insulin resistance (adjusted OR = 1.920), body mass index (adjusted OR = 0.931), and PANSS general psychopathology (adjusted OR = 1.041) were independently associated with SB. The Receiver Operating Characteristic Curve showed an Area Under Curve value of 0.732 for the combination of three factors in regression model to distinguish between SB and non-SB. CONCLUSIONS Our results indicate that fasting glucose, fasting insulin, and insulin resistance are strongly associated with SB in FEDN SZ patients, suggesting that glucose metabolism abnormalities may be potential biomarkers of SB in SZ patients. Regular monitoring of glucose metabolism variables is essential for suicide prevention.
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Affiliation(s)
- Zheng Ma
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Hui-Xia Zhou
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Da-Chun Chen
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Dong-Mei Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
| | - Xiang-Yang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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Tandon R, Nasrallah H, Akbarian S, Carpenter WT, DeLisi LE, Gaebel W, Green MF, Gur RE, Heckers S, Kane JM, Malaspina D, Meyer-Lindenberg A, Murray R, Owen M, Smoller JW, Yassin W, Keshavan M. The schizophrenia syndrome, circa 2024: What we know and how that informs its nature. Schizophr Res 2024; 264:1-28. [PMID: 38086109 DOI: 10.1016/j.schres.2023.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 11/23/2023] [Accepted: 11/29/2023] [Indexed: 03/01/2024]
Abstract
With new data about different aspects of schizophrenia being continually generated, it becomes necessary to periodically revisit exactly what we know. Along with a need to review what we currently know about schizophrenia, there is an equal imperative to evaluate the construct itself. With these objectives, we undertook an iterative, multi-phase process involving fifty international experts in the field, with each step building on learnings from the prior one. This review assembles currently established findings about schizophrenia (construct, etiology, pathophysiology, clinical expression, treatment) and posits what they reveal about its nature. Schizophrenia is a heritable, complex, multi-dimensional syndrome with varying degrees of psychotic, negative, cognitive, mood, and motor manifestations. The illness exhibits a remitting and relapsing course, with varying degrees of recovery among affected individuals with most experiencing significant social and functional impairment. Genetic risk factors likely include thousands of common genetic variants that each have a small impact on an individual's risk and a plethora of rare gene variants that have a larger individual impact on risk. Their biological effects are concentrated in the brain and many of the same variants also increase the risk of other psychiatric disorders such as bipolar disorder, autism, and other neurodevelopmental conditions. Environmental risk factors include but are not limited to urban residence in childhood, migration, older paternal age at birth, cannabis use, childhood trauma, antenatal maternal infection, and perinatal hypoxia. Structural, functional, and neurochemical brain alterations implicate multiple regions and functional circuits. Dopamine D-2 receptor antagonists and partial agonists improve psychotic symptoms and reduce risk of relapse. Certain psychological and psychosocial interventions are beneficial. Early intervention can reduce treatment delay and improve outcomes. Schizophrenia is increasingly considered to be a heterogeneous syndrome and not a singular disease entity. There is no necessary or sufficient etiology, pathology, set of clinical features, or treatment that fully circumscribes this syndrome. A single, common pathophysiological pathway appears unlikely. The boundaries of schizophrenia remain fuzzy, suggesting the absence of a categorical fit and need to reconceptualize it as a broader, multi-dimensional and/or spectrum construct.
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Affiliation(s)
- Rajiv Tandon
- Department of Psychiatry, WMU Homer Stryker School of Medicine, Kalamazoo, MI 49008, United States of America.
| | - Henry Nasrallah
- Department of Psychiatry, University of Cincinnati College of Medicine Cincinnati, OH 45267, United States of America
| | - Schahram Akbarian
- Department of Psychiatry, Icahn School of Medicine at Mt. Sinai, New York, NY 10029, United States of America
| | - William T Carpenter
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, United States of America
| | - Lynn E DeLisi
- Department of Psychiatry, Cambridge Health Alliance and Harvard Medical School, Cambridge, MA 02139, United States of America
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, LVR-Klinikum Dusseldorf, Heinrich-Heine University, Dusseldorf, Germany
| | - Michael F Green
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute of Neuroscience and Human Behavior, UCLA, Los Angeles, CA 90024, United States of America; Greater Los Angeles Veterans' Administration Healthcare System, United States of America
| | - Raquel E Gur
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, United States of America
| | - Stephan Heckers
- Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN 37232, United States of America
| | - John M Kane
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Glen Oaks, NY 11004, United States of America
| | - Dolores Malaspina
- Department of Psychiatry, Neuroscience, Genetics, and Genomics, Icahn School of Medicine at Mt. Sinai, New York, NY 10029, United States of America
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannhein/Heidelberg University, Mannheim, Germany
| | - Robin Murray
- Institute of Psychiatry, Psychology, and Neuroscience, Kings College, London, UK
| | - Michael Owen
- Centre for Neuropsychiatric Genetics and Genomics, and Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Jordan W Smoller
- Center for Precision Psychiatry, Department of Psychiatry, Psychiatric and Neurodevelopmental Unit, Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States of America
| | - Walid Yassin
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, United States of America
| | - Matcheri Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, United States of America
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Bolhuis K, Ghirardi L, Kuja-Halkola R, Lång U, Cederlöf M, Metsala J, Corcoran P, O'Connor K, Dodd P, Larsson H, Kelleher I. Risk of Psychosis Among Individuals Who Have Presented to Hospital With Self-harm: A Prospective Nationwide Register Study in Sweden. Schizophr Bull 2024:sbae002. [PMID: 38243843 DOI: 10.1093/schbul/sbae002] [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] [Indexed: 01/22/2024]
Abstract
BACKGROUND AND HYPOTHESIS Recent research showed that young people who presented to hospital with self-harm in Finland had a significantly elevated risk of later psychosis. We investigated the prospective relationship between hospital presentation for self-harm and risk of psychosis in an unprecedentedly large national Swedish cohort. STUDY DESIGN We used inpatient and outpatient healthcare registers to identify all individuals born between 1981 and 1993 who were alive and living in Sweden on their 12th birthday and who presented to hospital one or more times with self-harm. We compared them with a matched cohort, followed up for up to 20 years, and compared the cumulative incidence of psychotic disorders. Furthermore, we examined whether the strength of the relationship between hospital presentation for self-harm and later psychosis changed over time by examining for cohort effects. STUDY RESULTS In total, 28 908 (2.0%) individuals presented to hospital with self-harm without prior psychosis diagnosis during the follow-up. For individuals who presented to hospital with self-harm, the cumulative incidence of diagnosed psychosis was 20.7% at 20 years follow-up (hazard radio = 13.9, 95% CI 13.3-14.6, P-value <5 × 10-308). There was no evidence of a dilution of the effect over time: while the incidence of hospital self-harm presentation increased, this did not result in an attenuation over time of the strength of the relationship between hospital self-harm presentation and subsequent psychosis. CONCLUSIONS Individuals who present to hospital with self-harm in their teens and 20s represent an important risk group for psychosis prediction and prevention.
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Affiliation(s)
- Koen Bolhuis
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Laura Ghirardi
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- MediNeos Observational Research-IQVIA, Data Management & Statistics, Modena, Italy
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ulla Lång
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Finnish Institute for Health and Welfare, Helsinki, Finland
- University of Oulu, School of Medicine, Oulu, Finland
| | - Martin Cederlöf
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Johanna Metsala
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Paul Corcoran
- National Suicide Research Foundation, University College Cork, Cork, Ireland
- School of Public Health, University College Cork, Cork, Ireland
| | - Karen O'Connor
- Rise, South Lee Mental Health Services, Cork & Department of Psychiatry, University College Cork, Cork, Ireland
- National Clinical Programme for Early Intervention in Psychosis, Health Service Executive Dublin, Dublin, Ireland
| | - Philip Dodd
- National Office for Suicide Prevention, Health Service Executive Dublin, Dublin, Ireland
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Ian Kelleher
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- University of Oulu, School of Medicine, Oulu, Finland
- University College Dublin, School of Medicine, Dublin, Ireland
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12
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Mulligan LD, Varese F, Harris K, Haddock G. Alcohol use and suicide-related outcomes in people with a diagnosis of schizophrenia: a comprehensive systematic review and meta-analysis. Psychol Med 2024; 54:1-12. [PMID: 37818642 DOI: 10.1017/s0033291723002738] [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] [Indexed: 10/12/2023]
Abstract
Suicide is the leading cause of unnatural death among people with a diagnosis of schizophrenia. Alcohol use is a prevalent comorbid feature of schizophrenia and a modifiable risk factor for suicide. We conducted a prospectively registered (PROSPERO, CRD42022358214) systematic review and meta-analysis to quantify the relationship between alcohol use and suicide-related outcomes in schizophrenia.We searched Medline, Embase, and PsycINFO for cross-sectional, case-control and longitudinal studies using exhaustive terms from database inception to December 2022 inclusive. Computation of odds ratios (ORs) and hazard ratios (HRs) were performed using a random-effects model with DerSimonian-Laird estimation. We also evaluated publication bias, study quality, and performed subgroup analysis and meta-regression. Fifty studies, comprising 65 samples, met eligibility criteria. Overall, alcohol use was associated with suicide (OR 1.38, 95% CI 1.21-1.58; HR = 1.32, 95% CI 1.00-1.74), attempted suicide (OR 1.69, 95% CI 1.45-1.98), and suicidal ideation (OR 1.69, 95% CI 1.22-2.34). While there was no evidence of publication bias, between-sample heterogeneity was moderate in analyses of attempted suicide (I2 = 39.6%, p = 0.01) and suicidal ideation (I2 = 56.0%, p = 0.01). Summary effects were significant in all subgroups except for longitudinal studies of attempted suicide (OR 1.60, 95% CI 0.86-3.00) and studies of suicidal ideation using gender combined samples (OR 1.63, 95% CI 0.99-2.67). Alcohol use is significantly associated with suicide-related outcomes in schizophrenia. Clinicians should routinely inquire about alcohol use in mental health services to focus preventative treatment efforts.
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Affiliation(s)
- Lee D Mulligan
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Filippo Varese
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust (GMMH), Manchester Academic Health Science Centre, Manchester, UK
- Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust (GMMH), Manchester, UK
| | - Kamelia Harris
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Gillian Haddock
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust (GMMH), Manchester Academic Health Science Centre, Manchester, UK
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13
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Parrish EM, Chalker S, Cano M, Harvey PD, Taylor CT, Pinkham A, Moore RC, Ackerman RA, Depp CA. Ecological Momentary Assessment of Social Approach and Avoidance Motivations in Serious Mental Illness: Connections to Suicidal Ideation and Symptoms. Arch Suicide Res 2024; 28:123-140. [PMID: 36377277 PMCID: PMC10183051 DOI: 10.1080/13811118.2022.2137445] [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] [Indexed: 11/17/2022]
Abstract
AIM People with serious mental illness (SMI) are at an increased risk for suicide. Social approach and avoidance motivations are linked to social functioning, and social isolation is a risk factor for suicide. This study uses ecological momentary assessment (EMA) to understand social approach and avoidance motivations in relation to symptoms and suicidal ideation (SI). METHODS Participants (N = 128) diagnosed with schizophrenia, schizoaffective disorder, or a mood disorder with psychotic features completed assessments of SI and symptoms at baseline. They completed EMA surveys 3×/day for 10 days. EMA surveys included questions about approach and avoidance motivations and psychotic symptoms. Participants were split into four groups based on the median scores of approach and avoidance. RESULTS Participants with SI at baseline had higher mean social avoidance motivation, t(126) = 2.84, p = .003, and lower mean social approach motivation, t(126) = -2.44, p = .008, than participants without baseline SI. Greater baseline positive symptoms were related to greater mean avoidance, r = .231, p = .009, but not approach motivation. The low approach/high avoidance group had significantly higher current SI than those with high approach/low avoidance (p < .001). Overall, the low approach/high avoidance group reported more EMA-measured voices than the low approach/low avoidance group (p < .001) and the high approach/low avoidance group (p < .001). Similarly, the low approach/high avoidance group reported more EMA-measured suspiciousness than the low approach/low avoidance (p < .001) and the high approach/low avoidance groups (p < .001). CONCLUSION The results of this study point to the role of social approach and avoidance motivations in relation to SI and psychotic symptoms. Clinically, exposure therapies and cognitive behavioral therapies may help to address these social approach and avoidance processes linked to SI.
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Affiliation(s)
- Emma M. Parrish
- San Diego State University / University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California
| | - Samantha Chalker
- University of California San Diego Department of Psychiatry, San Diego, California
- Veterans Affairs San Diego Healthcare System, San Diego, California
| | - Mayra Cano
- University of California San Diego Department of Psychiatry, San Diego, California
- University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania
| | - Philip D. Harvey
- University of Miami Miller School of Medicine, Miami, Florida, Research Service Miami VA Medical Center, Miami, FL
| | - Charles T. Taylor
- University of California San Diego Department of Psychiatry, San Diego, California
| | - Amy Pinkham
- The University of Texas at Dallas, Richardson, TX
| | - Raeanne C. Moore
- University of California San Diego Department of Psychiatry, San Diego, California
| | | | - Colin A. Depp
- University of California San Diego Department of Psychiatry, San Diego, California
- Veterans Affairs San Diego Healthcare System, San Diego, California
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14
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Horvitz-Lennon M, Leckman-Westin E, Finnerty M, Jeong J, Tsuei J, Zelevinsky K, Chen Q, Normand SLT. Healthcare Access for a Diverse Population with Schizophrenia Following the Onset of the COVID-19 Pandemic. Community Ment Health J 2024; 60:72-80. [PMID: 37199854 PMCID: PMC10193305 DOI: 10.1007/s10597-023-01105-1] [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: 11/30/2022] [Accepted: 02/20/2023] [Indexed: 05/19/2023]
Abstract
COVID-19 has had a disproportionate impact on the most disadvantaged members of society, including minorities and those with disabling chronic illnesses such as schizophrenia. We examined the pandemic's impacts among New York State's Medicaid beneficiaries with schizophrenia in the immediate post-pandemic surge period, with a focus on equity of access to critical healthcare. We compared changes in utilization of key behavioral health outpatient services and inpatient services for life-threatening conditions between the pre-pandemic and surge periods for White and non-White beneficiaries. We found racial and ethnic differences across all outcomes, with most differences stable over time. The exception was pneumonia admissions-while no differences existed in the pre-pandemic period, Black and Latinx beneficiaries were less likely than Whites to be hospitalized in the surge period despite minorities' heavier COVID-19 disease burden. The emergence of racial and ethnic differences in access to scarce life-preserving healthcare may hold lessons for future crises.
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Affiliation(s)
- Marcela Horvitz-Lennon
- RAND Corporation, 20 Park Plaza, Suite 920, Boston, MA, 02116, USA.
- Department of Psychiatry, Cambridge Health Alliance and Harvard Medical School, 1493 Cambridge Street, Cambridge, MA, 02139, USA.
| | - Emily Leckman-Westin
- Office of Mental Health, New York State Department of Health, 44 Holland Avenue, Albany, NY, 12229, USA
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, 1 University Pl, Rensselaer, NY, 12144, USA
| | - Molly Finnerty
- Office of Mental Health, New York State Department of Health, 44 Holland Avenue, Albany, NY, 12229, USA
| | - Junghye Jeong
- Office of Mental Health, New York State Department of Health, 44 Holland Avenue, Albany, NY, 12229, USA
| | - Jeannette Tsuei
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
| | - Katya Zelevinsky
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115, USA
| | - Qingxian Chen
- Office of Mental Health, New York State Department of Health, 44 Holland Avenue, Albany, NY, 12229, USA
| | - Sharon-Lise T Normand
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115, USA
- Department of Biostatistics, Harvard School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
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15
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Gregersen M, Møllegaard Jepsen JR, Marie Brandt J, Søndergaard A, Birkehøj Rohd S, Veddum L, Bruun Knudsen C, Krogh Andreassen A, Klee Burton B, Hjorthøj C, Falkenberg Krantz M, Neergaard Greve A, Bliksted V, Mors O, Nordentoft M, Elgaard Thorup AA, Hemager N. Suicidal Ideation and Non-Suicidal Self-Injury Following Early Childhood Psychotic Experiences in Preadolescent Children at Familial High Risk of Schizophrenia or Bipolar Disorder-The Danish High Risk and Resilience Study, VIA 11. Schizophr Bull 2023; 49:1602-1613. [PMID: 37171862 PMCID: PMC10686355 DOI: 10.1093/schbul/sbad052] [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] [Indexed: 05/13/2023]
Abstract
BACKGROUND AND HYPOTHESIS Suicide is a leading cause of death in youth and is often preceded by suicidal ideation (SI) and non-suicidal self-injury (NSSI). Identifying early markers of risk for SI and NSSI could improve timely identification of at-risk individuals. STUDY DESIGN Children (mean age 11.9, SD 0.2) at familial high risk of schizophrenia (N = 171), or bipolar disorder (N = 104), and controls (N = 174) were assessed for psychotic experiences (PE), SI, NSSI, and Axis I mental disorders in face-to-face interviews in early and middle childhood (age 7 and 11). STUDY RESULTS Having 2 types of early childhood PE predicted middle childhood SI after accounting for previous SI, NSSI, and mental disorders (OR 2.8, 95% CI 1.1-6.9; P = .03). Two PE predicted NSSI (OR 3.0, 95% CI 1.2-7.7; P = .02) in excess of previous SI, NSSI, mental disorders, and familial risk. Persistent and incident PE predicted SI (OR 3.2, 95% CI, 1.1-8.8; P = .03; OR 3.8, 95% CI, 1.3-11.5; P = .02) in the fully adjusted model. Nineteen percent of children with persistent PE reported middle childhood SI vs 3.8% of those who never reported PE. In children with early childhood mental disorders, those who reported 2 PE had 4.4-fold increased odds of later SI (95% CI, 1.2-16.7; P = .03) after adjustments. PE were nondifferentially associated with outcomes across familial risk groups. CONCLUSIONS Early childhood PE index elevated risk for subsequent SI and NSSI beyond what can be attributed to presence of mental disorders. Mental health screenings and clinical assessments should include early childhood PE.
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Affiliation(s)
- Maja Gregersen
- CORE – Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
| | - Jens Richardt Møllegaard Jepsen
- CORE – Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
- Child and Adolescent Mental Health Center, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
- Center for Neuropsychiatric Schizophrenia Research and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
| | - Julie Marie Brandt
- CORE – Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne Søndergaard
- CORE – Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sinnika Birkehøj Rohd
- CORE – Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
| | - Lotte Veddum
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark
- Psychosis Research Unit, Aarhus University Hospital Psychiatry, Skejby, Denmark
| | - Christina Bruun Knudsen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark
- Psychosis Research Unit, Aarhus University Hospital Psychiatry, Skejby, Denmark
| | - Anna Krogh Andreassen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark
- Psychosis Research Unit, Aarhus University Hospital Psychiatry, Skejby, Denmark
| | - Birgitte Klee Burton
- Child and Adolescent Mental Health Center, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Child and Adolescent Psychiatry, Copenhagen University Hospital, Psychiatry Region Zealand, Roskilde, Denmark
| | - Carsten Hjorthøj
- CORE – Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
- Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - Mette Falkenberg Krantz
- Child and Adolescent Mental Health Center, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
| | - Aja Neergaard Greve
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark
- Psychosis Research Unit, Aarhus University Hospital Psychiatry, Skejby, Denmark
| | - Vibeke Bliksted
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark
- Psychosis Research Unit, Aarhus University Hospital Psychiatry, Skejby, Denmark
| | - Ole Mors
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark
- Psychosis Research Unit, Aarhus University Hospital Psychiatry, Skejby, Denmark
| | - Merete Nordentoft
- CORE – Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne Amalie Elgaard Thorup
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
- Child and Adolescent Mental Health Center, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Nicoline Hemager
- CORE – Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
- Child and Adolescent Mental Health Center, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
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魏 泸, 杨 先, 范 箬, 王 丹, 刘 军, 何 昌, 李 杨, 左 传, 周 涵, 刘 祥, 刘 元. [Association Between Medication Compliance and Various Risky Behaviors in Patients With Schizophrenia]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2023; 54:1201-1207. [PMID: 38162067 PMCID: PMC10752770 DOI: 10.12182/20231360303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Indexed: 01/03/2024]
Abstract
Objective To investigate the status of medication adherence and various types of risky behaviors of schizophrenia patients in a certain area of western China and to explore accordingly the correlation between the two. Methods A total of 292 667 patients with schizophrenia were enrolled in a follow-up survey between 2006 and 2018. In addition, based on the outcome-wide analysis strategy, a multivariate Cox proportional risk regression model was used to estimate and compare the impact of medication adherence on different types of risky behaviors in schizophrenia patients. Results In this 13-year prospective cohort, 65 175 patients (31.4%) showed good medication adherence, while 142 394 patients (68.6%) showed poor medication adherence. The incidence rates of various risky behaviors during the follow-up period were as follows, minor nuisances, 12.25%, violation of the Law of the People's Republic of China on Penalties for Administration of Public Security (APS law), 3.82%, violation of criminal law, 0.94%, suicide completed, 0.28%, self-harm, 1.42%, and attempted suicide, 0.82%. Schizophrenia patients who had poor medication adherence had higher risks of committing violence against others and self-inflicted injury compared to patients with good medication adherence did, with the associated effects being minor nuisances (hazard ratio [HR]=1.31, 95% confidence interval [CI]: 1.27-1.35), violation of APS law (HR=1.47, 95% CI: 1.38-1.56), violation of criminal law (HR=1.17, 95% CI: 1.05-1.31), and self-harm (HR=1.43, 95% CI: 1.32-1.56), respectively, while the risk of suicide completed is lower in schizophrenia patients with poor medication adherence than that in patients with good medication adherence (HR=0.56, 95% CI: 0.47-0.66). There was no statistically significant association between attempted suicide and medication adherence. Conclusion There are variations in the direction and strength of the association between medication adherence and different types of risky behaviors and further research is needed to elucidate the mechanisms of the association.
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Affiliation(s)
- 泸懿 魏
- 四川大学华西公共卫生学院/四川大学华西第四医院 流行病与卫生统计学系 (成都 610041)Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 先梅 杨
- 四川大学华西公共卫生学院/四川大学华西第四医院 流行病与卫生统计学系 (成都 610041)Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 箬馨 范
- 四川大学华西公共卫生学院/四川大学华西第四医院 流行病与卫生统计学系 (成都 610041)Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 丹 王
- 四川大学华西公共卫生学院/四川大学华西第四医院 流行病与卫生统计学系 (成都 610041)Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 军 刘
- 四川大学华西公共卫生学院/四川大学华西第四医院 流行病与卫生统计学系 (成都 610041)Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 昌九 何
- 四川大学华西公共卫生学院/四川大学华西第四医院 流行病与卫生统计学系 (成都 610041)Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 杨 李
- 四川大学华西公共卫生学院/四川大学华西第四医院 流行病与卫生统计学系 (成都 610041)Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 传隆 左
- 四川大学华西公共卫生学院/四川大学华西第四医院 流行病与卫生统计学系 (成都 610041)Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 涵闻 周
- 四川大学华西公共卫生学院/四川大学华西第四医院 流行病与卫生统计学系 (成都 610041)Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 祥 刘
- 四川大学华西公共卫生学院/四川大学华西第四医院 流行病与卫生统计学系 (成都 610041)Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 元元 刘
- 四川大学华西公共卫生学院/四川大学华西第四医院 流行病与卫生统计学系 (成都 610041)Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
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Misdrahi D, Dupuy M, Dansou Y, Boyer L, Berna F, Capdevielle D, Chereau I, Coulon N, D'Amato T, Dubertret C, Leignier S, Llorca PM, Lançon C, Mallet J, Passerieux C, Pignon B, Rey R, Schürhoff F, Swendsen J, Urbach M, Szöke A, Godin O, Fond G. Predictors of medication adherence in a large 1-year prospective cohort of individuals with schizophrenia: insights from the multicentric FACE-SZ dataset. Transl Psychiatry 2023; 13:341. [PMID: 37935695 PMCID: PMC10630458 DOI: 10.1038/s41398-023-02640-x] [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: 03/28/2023] [Revised: 10/19/2023] [Accepted: 10/26/2023] [Indexed: 11/09/2023] Open
Abstract
Schizophrenia is characterized by the most salient medication adherence problems among severe mental disorders, but limited prospective data are available to predict and improve adherence in this population. This investigation aims to identify predictors of medication adherence over a 1-year period in a large national cohort using clustering analysis. Outpatients were recruited from ten Schizophrenia Expert Centers and were evaluated with a day-long standardized battery including clinician and patient-rated medication adherence measures. A two-step cluster analysis and multivariate logistic regression were conducted to identify medication adherence profiles based on the Medication Adherence rating Scale (MARS) and baseline predictors. A total of 485 participants were included in the study and medication adherence was significantly improved at the 1-year follow-up. Higher depressive scores, lower insight, history of suicide attempt, younger age and alcohol use disorder were all associated with poorer adherence at 1 year. Among the 203 patients with initially poor adherence, 86 (42%) switched to good adherence at the 1-year follow-up, whereas 117 patients (58%) remained poorly adherent. Targeting younger patients with low insight, history of suicide, alcohol use disorder and depressive disorders should be prioritized through literacy and educational therapy programs. Adherence is a construct that can vary considerably from year to year in schizophrenia, and therefore may be amenable to interventions for its improvement. However, caution is also warranted as nearly one in five patients with initially good adherence experienced worsened adherence 1 year later.
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Affiliation(s)
- David Misdrahi
- Fondation FondaMental, F-94010, Créteil, France.
- University of Bordeaux, Aquitaine Institute for Cognitive and Integrative Neuroscience (CNRS UMR 5287-INCIA), Bordeaux, France.
- Department of Adult Psychiatry, Charles Perrens Hospital, Bordeaux, France.
| | - Maud Dupuy
- Fondation FondaMental, F-94010, Créteil, France
- University of Bordeaux, Aquitaine Institute for Cognitive and Integrative Neuroscience (CNRS UMR 5287-INCIA), Bordeaux, France
| | - Yecodji Dansou
- Fondation FondaMental, F-94010, Créteil, France
- Université Paris-Est-Créteil (UPEC), AP-HP, Hôpitaux Universitaires "H. Mondor", DMU IMPACT, INSERM, IMRB, Translational Neuropsychiatry, Bordeaux, France
| | - Laurent Boyer
- Fondation FondaMental, F-94010, Créteil, France
- AP-HM, Aix-Marseille Univ, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, 27 Boulevard Jean Moulin, 13005, Marseille, France
| | - Fabrice Berna
- Fondation FondaMental, F-94010, Créteil, France
- Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - Delphine Capdevielle
- Fondation FondaMental, F-94010, Créteil, France
- Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, CHRU Montpellier, Université Montpellier 1, Inserm 1061, Montpellier, France
| | - Isabelle Chereau
- Fondation FondaMental, F-94010, Créteil, France
- University of Clermont Auvergne, CMP-B CHU, CNRS, Clermont Auvergne INP, Institut Pascal, F-63000, Clermont-Ferrand, France
| | - Nathalie Coulon
- Fondation FondaMental, F-94010, Créteil, France
- Centre Référent de Réhabilitation Psychosociale et de Remédiation Cognitive (C3R), CH Alpes Isère, Bordeaux, France
| | - Thierry D'Amato
- Fondation FondaMental, F-94010, Créteil, France
- INSERM U1028, CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon, Université Claude Bernard Lyon 1, Equipe PSYR2, Centre Hospitalier Le Vinatier, Pole Est, 95 bd Pinel, BP 30039, 69678, Bron Cedex, France
| | - Caroline Dubertret
- Fondation FondaMental, F-94010, Créteil, France
- AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France
- Université Paris Cité, INSERM UMR1266, Institute of Psychiatry and Neuroscience of Paris, Paris, France
| | - Sylvain Leignier
- Fondation FondaMental, F-94010, Créteil, France
- Centre Référent de Réhabilitation Psychosociale et de Remédiation Cognitive (C3R), CH Alpes Isère, Bordeaux, France
| | - Pierre Michel Llorca
- Fondation FondaMental, F-94010, Créteil, France
- University of Clermont Auvergne, CMP-B CHU, CNRS, Clermont Auvergne INP, Institut Pascal, F-63000, Clermont-Ferrand, France
| | - Christophe Lançon
- Fondation FondaMental, F-94010, Créteil, France
- AP-HM, Aix-Marseille Univ, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, 27 Boulevard Jean Moulin, 13005, Marseille, France
| | - Jasmina Mallet
- Fondation FondaMental, F-94010, Créteil, France
- AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France
- Université Paris Cité, INSERM UMR1266, Institute of Psychiatry and Neuroscience of Paris, Paris, France
| | - Christine Passerieux
- Fondation FondaMental, F-94010, Créteil, France
- Versailles Hospital, Department of Adult Psychiatry and Addictology, Centre Hospitalier de Versailles, 177 rue de Versailles, 78157, Le Chesnay, France
- DisAP-DevPsy-CESP, INSERM UMR1018, University of Paris-Saclay, University of Versailles Saint-Quentin-En-Yvelines, 94807, Villejuif, France
| | - Baptiste Pignon
- Fondation FondaMental, F-94010, Créteil, France
- Université Paris-Est-Créteil (UPEC), AP-HP, Hôpitaux Universitaires "H. Mondor", DMU IMPACT, INSERM, IMRB, Translational Neuropsychiatry, Bordeaux, France
| | - Romain Rey
- Fondation FondaMental, F-94010, Créteil, France
- INSERM U1028, CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon, Université Claude Bernard Lyon 1, Equipe PSYR2, Centre Hospitalier Le Vinatier, Pole Est, 95 bd Pinel, BP 30039, 69678, Bron Cedex, France
| | - Franck Schürhoff
- Fondation FondaMental, F-94010, Créteil, France
- Université Paris-Est-Créteil (UPEC), AP-HP, Hôpitaux Universitaires "H. Mondor", DMU IMPACT, INSERM, IMRB, Translational Neuropsychiatry, Bordeaux, France
| | - Joel Swendsen
- Fondation FondaMental, F-94010, Créteil, France
- University of Bordeaux, Aquitaine Institute for Cognitive and Integrative Neuroscience (CNRS UMR 5287-INCIA), Bordeaux, France
| | - Mathieu Urbach
- Fondation FondaMental, F-94010, Créteil, France
- Versailles Hospital, Department of Adult Psychiatry and Addictology, Centre Hospitalier de Versailles, 177 rue de Versailles, 78157, Le Chesnay, France
- DisAP-DevPsy-CESP, INSERM UMR1018, University of Paris-Saclay, University of Versailles Saint-Quentin-En-Yvelines, 94807, Villejuif, France
| | - Andrei Szöke
- Fondation FondaMental, F-94010, Créteil, France
- Université Paris-Est-Créteil (UPEC), AP-HP, Hôpitaux Universitaires "H. Mondor", DMU IMPACT, INSERM, IMRB, Translational Neuropsychiatry, Bordeaux, France
| | - Ophélia Godin
- Fondation FondaMental, F-94010, Créteil, France
- Université Paris-Est-Créteil (UPEC), AP-HP, Hôpitaux Universitaires "H. Mondor", DMU IMPACT, INSERM, IMRB, Translational Neuropsychiatry, Bordeaux, France
| | - Guillaume Fond
- Fondation FondaMental, F-94010, Créteil, France
- AP-HM, Aix-Marseille Univ, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, 27 Boulevard Jean Moulin, 13005, Marseille, France
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Tsai M, Klonsky ED. Warning signs for suicide attempts in psychiatric inpatients: Patient and informant perspectives. Gen Hosp Psychiatry 2023; 85:207-212. [PMID: 37979471 DOI: 10.1016/j.genhosppsych.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/03/2023] [Accepted: 11/05/2023] [Indexed: 11/20/2023]
Abstract
OBJECTIVE Warning signs can help prevent suicide attempts and death. It is important to develop an evidence base for warning signs that considers both self-perspectives (i.e., those at risk for suicide) and informant-perspectives (i.e., those who observe individuals at risk for suicide). METHODS A questionnaire assessing a diverse set of 80 potential warning signs ("present in the minutes, hours, or days before the suicide attempts") was developed based on literature searches, lived experience consultations, and the American Association of Suicidology (AAS) expert consensus list. This questionnaire was administered to two samples: psychiatric inpatients who had attempted suicide (n = 476), and informants identified as friends, family, or caretakers of patients (n = 120). RESULTS Hopelessness, anxiousness, and unbearable pain were each endorsed as warning signs by >80% of inpatients and informants. Warning signs were similar across patient and informant perspectives, and across sociodemographic and clinical characteristics. Some AAS warning signs were endorsed by few patients and informants (risky behaviors, alcohol or drug use, seeking revenge) and may warrant re-evaluation. CONCLUSIONS Findings are consistent with models of suicide risk emphasizing pain, hopelessness, and anxiousness. Existing lists of warning signs may benefit from revision as the evidence base continues to develop.
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Affiliation(s)
- Michelle Tsai
- Vancouver Coastal Health, Gordon and Leslie Diamond Health Care Centre, 2775 Laurel Street, Vancouver, BC V5Z 1M, Canada
| | - E David Klonsky
- University of British Columbia, Department of Psychology, 2136 West Mall, Vancouver, BC V6T 1Z4, Canada.
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Parrish EM, Quynh A, Scott V, Chalker SA, Chang C, Kamarsu S, Twamley EW, Depp CA. Suicide Safety Plan Self-knowledge in Serious Mental Illness: Psychiatric Symptom Correlates and Effects of Brief Intervention. Community Ment Health J 2023; 59:1639-1646. [PMID: 37340170 DOI: 10.1007/s10597-023-01155-5] [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: 02/23/2023] [Accepted: 06/05/2023] [Indexed: 06/22/2023]
Abstract
Psychiatric symptoms experienced by people with serious mental illness (SMI; schizophrenia, bipolar and other psychotic disorders) may impact suicide safety planning. This study examined safety plan self-knowledge, or an individual's own knowledge and awareness of their safety plan, in a sample of people with SMI. Participants (N = 53) with SMI at elevated risk of suicide completed a 4-session intervention that included safety plans, with one intervention group that included mobile augmentation. Self-knowledge was assessed from previous safety plans at 4-, 12- and 24-weeks. Fewer warning signs generated was correlated with greater psychiatric symptoms (r = - .306, p = .026) and suicidal ideation (r = - .298, p = .030). Fewer coping strategies generated was correlated with greater suicidal ideation (r = .- 323, p = .018). Preliminarily, there was greater self-knowledge of warning signs over time among participants in the mobile intervention. These preliminary findings highlight the relationship of safety plan self-knowledge to symptoms and suggest that mobile augmentation of safety planning may be beneficial. Trial Registration: NCT03198364.
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Affiliation(s)
- Emma M Parrish
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University, University of California, San Diego, CA, USA
| | - Avery Quynh
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Vanessa Scott
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Samantha A Chalker
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Cindy Chang
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Snigdha Kamarsu
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Elizabeth W Twamley
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Colin A Depp
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA.
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA.
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Rogers E, Gresswell M, Durrant S. The relationship between sleep and suicidality in schizophrenia spectrum and other psychotic disorders: A systematic review. Schizophr Res 2023; 261:291-303. [PMID: 37879227 DOI: 10.1016/j.schres.2023.10.010] [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: 02/02/2023] [Revised: 09/06/2023] [Accepted: 10/14/2023] [Indexed: 10/27/2023]
Abstract
Individuals with Schizophrenia Spectrum Disorders (SSDs) have significantly higher rates of suicidal thoughts, attempts, and death by suicide in comparison to the general population. Sleep disturbances (reduced duration, timing and quality of sleep) are risk factors for suicidality in the general population, with research indicating the relationship is both immediate and accumulative. Sleep disturbances are also considered to be implicated in the onset and exacerbation of psychotic symptoms in SSDs. Reducing the risk of suicidality in SSDs remains an important public health priority, thus exploration of contributing risk factors is warranted. Sleep monitoring may also offer an adjunct risk monitoring method to suicidality assessments in SSDs, and a potential treatment target for psychotic symptoms. This review aimed to explore proximal and longitudinal relationships between self-reported and objectively measured sleep and suicidality in SSDs and other psychotic disorders. A comprehensive search of four databases was conducted. Eleven studies met the inclusion criteria (10 cross sectional and 1 longitudinal). Narrative synthesis indicated that self-reported sleep disturbances and sleep disorders (e.g. insomnia) were associated with increased risk of suicidal ideation and attempt. However, one study employing polysomnography did not find sleep to be associated with suicidality. Methodological limitations of the evidence base include: i) little experimental or longitudinal evidence, (ii) self-report and/or single item assessment of sleep disturbance, (iii) limited use of validated measures of suicidality, (iv) considerable research in long-term schizophrenia but sparse evidence in early psychosis. Future research should explore (i) cross-sectional and longitudinal relationships between specific aspects of suicidality and objective sleep parameters, (ii) use qualitative or mixed-methods designs to disentangle the nuances and bidirectionality in the sleep-suicide relationship, (iii) explore the psychological processes underpinning or mediating the sleep-suicide relationship in SSDs.
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Affiliation(s)
- Eva Rogers
- Xu Yafen Building, Jubilee Campus, University of Nottingham, NG8 1BB, United Kingdom; Nottinghamshire Healthcare NHS Foundation Trust, Duncan Macmillan House, Porchester Road, Nottingham, NG3 6AA, United Kingdom.
| | - Mark Gresswell
- Department of Clinical Psychology, Sarah Swift Building Brayford Wharf East, University of Lincoln, United Kingdom
| | - Simon Durrant
- School of Psychology, Sarah Swift Building Brayford Wharf East, University of Lincoln, United Kingdom
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Kim JS, Baek SH, Kim H, Kim JW, Kang HJ, Ryu S, Lee JY, Kim JM, Kim SW. Association between suicidal ideation and cognitive function in young patients with schizophrenia spectrum disorder. Front Psychiatry 2023; 14:1276511. [PMID: 37965366 PMCID: PMC10641781 DOI: 10.3389/fpsyt.2023.1276511] [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: 08/12/2023] [Accepted: 10/09/2023] [Indexed: 11/16/2023] Open
Abstract
Introduction Suicide is a major concern for patients with recent-onset schizophrenia. We hypothesized that preserved cognitive function might be associated with a higher level of suicidality in patients with schizophrenia. We investigated the associations between cognitive function and suicidal ideation (SI) in young patients recently diagnosed with a psychotic disorder. Methods This study analyzed data from a naturalistic clinical cohort study that comprised 402 patients with schizophrenia spectrum disorder. Patients with a treatment duration of ≤5 years and an age range of 15-39 years were enrolled. Participants were categorized into two groups based on SI as assessed by the Columbia Suicidal Severity Rating Scale. We collected demographic and clinical data and administered psychiatric, neurocognitive, and social cognitive measures. Results Among participants, 52% reported experiencing SI. Patients with SI were significantly younger and had a longer duration of untreated psychosis (DUP) than those without it. The Positive and Negative Syndrome Scale-general psychopathology score was significantly higher in the SI group. Scores on the Calgary Depression Scale for Schizophrenia, Perceived Stress Scale, Beck Depression Inventory (BDI), and Beck Hopelessness Scale were significantly higher among patients with SI, while scores on the Subjective Well-being Under Neuroleptics-Short Form and Brief Resilience Scale were significantly lower compared to those without it. Patients with SI demonstrated significantly higher scores on the verbal and visual learning test, false belief task, picture stories task, and Controlled Oral Word Association Test. They also completed the Trail Making Test (TMT) parts A and B in significantly less time than those without it. After adjusting for age, DUP, and scores on the BDI, group differences in scores on the verbal and visual learning tests, TMT (parts A and B), and the false belief task, and the picture story task remained significant. Discussion Our results suggest that along with traditional risk factors, better cognitive function may also be a major risk factor for suicidality in patients with schizophrenia. Providing psychological support and cognitive interventions is essential for young patients with recent-onset schizophrenia spectrum disorders, particularly those with high levels of depression, hopelessness, perceived stress, low resilience, and good cognitive function.
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Affiliation(s)
- Ji-Su Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Seon-Hwa Baek
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
- Mindlink, Gwangju Bukgu Mental Health Center, Gwangju, Republic of Korea
| | - Honey Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
- Mindlink, Gwangju Bukgu Mental Health Center, Gwangju, Republic of Korea
| | - Ju-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
- Mindlink, Gwangju Bukgu Mental Health Center, Gwangju, Republic of Korea
| | - Hee-Ju Kang
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Seunghyong Ryu
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Ju-Yeon Lee
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
- Mindlink, Gwangju Bukgu Mental Health Center, Gwangju, Republic of Korea
| | - Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
- Mindlink, Gwangju Bukgu Mental Health Center, Gwangju, Republic of Korea
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Wang Q, Tang W, Zhang J, Wang Y, Wang Q, Ma Y, Mao JK, Ye C, Yu X. Visuospatial ability and attention as risk factors for suicidal ideation in middle-aged and elderly schizophrenia patients: a cross-sectional study. BMC Psychiatry 2023; 23:765. [PMID: 37853396 PMCID: PMC10585849 DOI: 10.1186/s12888-023-05272-z] [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: 05/30/2023] [Accepted: 10/11/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Schizophrenia patients have a high risk of suicide, and their cognition function is impaired with increasing age. The association between neurocognitive and suicidality in schizophrenia patients are heterogeneous. We aimed to explore the relationship between neurocognitive function and suicidal ideation in schizophrenia patients across age groups. METHODS A total of 587 patients with schizophrenia were enrolled in this study. The schizophrenia patients were divided into young group (aged 18-44) and middle-aged and elderly group (aged 45-70). The schizophrenia patients were divided into suicidal ideation group and non-suicidal ideation group according to the evaluation results of the Beck Scale for Suicide Ideation. Insomnia symptoms were measured by the Insomnia Severity Index (ISI). Psychotic symptoms were measured by the Positive and Negative Syndrome Scale (PANSS), and cognitive function was measured by the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). RESULTS There was a negative correlation between the age and attention scores of RBANS (P = 0.018). The young schizophrenia patients had higher risk of suicidality than middle-aged and elderly schizophrenia patients (P = 0.001). In the logistic regression analysis, the scores of ISI and positive symptoms scores of PANSS were associated with suicidal ideation among young schizophrenia patients (All P < 0.05). Age, BMI, the scores of ISI, general symptoms scores of PANSS, visuospatial scores of RBANS and attention scores of RBANS were associated with suicidal ideation in middle-aged and elderly schizophrenia patients (All P < 0.05). CONCLUSIONS High visuospatial scores of RBANS and attention scores of RBANS were risk factors for suicidal ideation in middle-aged and elderly schizophrenia patients.
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Affiliation(s)
- Qiongzhang Wang
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Wei Tang
- The Affiliated Kangning Hospital of Wenzhou Medical University Zhejiang Provincial Clinical Research Center for Mental Disorder, Wenzhou, China.
| | - Junjie Zhang
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Yiwei Wang
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Qing Wang
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Yimin Ma
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Jian Kai Mao
- Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Chengyu Ye
- Wenzhou Central Hospital, The Dingli Clinical Institute of Wenzhou Medical University, Wenzhou, China.
| | - Xin Yu
- School of Mental Health, Wenzhou Medical University, Wenzhou, China.
- Peking University Institute of Mental Health (Sixth Hospital, Beijing, China.
- National Clinical Research Center for Mental Disorders and Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing, China.
- Beijing Municipal Key Laboratory for Translational Research on Diagnosis and Treatment of Dementia, Beijing, China.
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23
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van Dee V, Kia SM, Winter-van Rossum I, Kahn RS, Cahn W, Schnack HG. Revealing the impact of psychiatric comorbidities on treatment outcome in early psychosis using counterfactual model explanation. Front Psychiatry 2023; 14:1237490. [PMID: 37900290 PMCID: PMC10602778 DOI: 10.3389/fpsyt.2023.1237490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/29/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction Psychiatric comorbidities have a significant impact on the course of illness in patients with schizophrenia spectrum disorders. To accurately predict outcomes for individual patients using computerized prognostic models, it is essential to consider these comorbidities and their influence. Methods In our study, we utilized a multi-modal deep learning architecture to forecast symptomatic remission, focusing on a multicenter sample of patients with first-episode psychosis from the OPTiMiSE study. Additionally, we introduced a counterfactual model explanation technique to examine how scores on the Mini International Neuropsychiatric Interview (MINI) affected the likelihood of remission, both at the group level and for individual patients. Results Our findings at the group level revealed that most comorbidities had a negative association with remission. Among them, current and recurrent depressive disorders consistently exerted the greatest negative impact on the probability of remission across patients. However, we made an interesting observation: current suicidality within the past month and substance abuse within the past 12 months were associated with an increased chance of remission in patients. We found a high degree of variability among patients at the individual level. Through hierarchical clustering analysis, we identified two subgroups: one in which comorbidities had a relatively limited effect on remission (approximately 45% of patients), and another in which comorbidities more strongly influenced remission. By incorporating comorbidities into individualized prognostic prediction models, we determined which specific comorbidities had the greatest impact on remission at both the group level and for individual patients. Discussion These results highlight the importance of identifying and including relevant comorbidities in prediction models, providing valuable insights for improving the treatment and prognosis of patients with psychotic disorders. Furthermore, they open avenues for further research into the efficacy of treating these comorbidities to enhance overall patient outcomes.
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Affiliation(s)
- Violet van Dee
- Department of Psychiatry, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Seyed Mostafa Kia
- Department of Psychiatry, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
- Department of Cognitive Science and Artificial Intelligence, Tilburg University, Tilburg, Netherlands
| | - Inge Winter-van Rossum
- Department of Psychiatry, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Icahn School of Medicine at Mount Sinai, New York City, NY, United States
| | - René S. Kahn
- Icahn School of Medicine at Mount Sinai, New York City, NY, United States
| | - Wiepke Cahn
- Department of Psychiatry, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Altrecht Science, Altrecht Mental Health Institute, Utrecht, Netherlands
| | - Hugo G. Schnack
- Department of Psychiatry, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
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Wastler HM, Llamocca E, Moe AM, Steelsmith DL, Brock G, Bridge JA, Campo JV, Fontanella CA. Impact of Treatment Initiation and Engagement on Deliberate Self-Harm Among Individuals With First-Episode Psychosis. Psychiatr Serv 2023; 74:921-928. [PMID: 36852553 PMCID: PMC11170932 DOI: 10.1176/appi.ps.20220372] [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] [Indexed: 03/01/2023]
Abstract
OBJECTIVE Individuals with psychosis are at increased risk for suicide, with the greatest risk being present during the first few months after diagnosis. The authors aimed to examine whether treatment initiation within 14 days of diagnosis and treatment engagement within 90 days of initiation reduce the risk for deliberate self-harm (DSH) among individuals with first-episode psychosis (FEP). METHODS A retrospective longitudinal cohort design was adopted by using Ohio Medicaid claims for 6,349 adolescents and young adults ages 15-24 years with FEP. Logistic regression was used to examine factors associated with treatment initiation and engagement. Cox proportional hazard models were used to estimate the impact of treatment initiation and engagement on DSH. Propensity score weighting was used to control for sociodemographic and clinical covariates. RESULTS Approximately 70% of the sample initiated treatment, 55% of whom engaged in treatment. Treatment initiation and engagement were associated with both demographic and clinical variables. Treatment initiation significantly reduced the hazard of DSH (average treatment effect in the entire population: hazard ratio [HR]=0.62, 95% CI=0.47-0.81; average treatment effect among those treated: HR=0.64, 95% CI=0.52-0.80). In contrast, treatment engagement was not significantly associated with DSH. CONCLUSIONS These results suggest that the initial treatment contact is essential for reducing DSH among adolescents and young adults with FEP. Additionally, the finding that treatment engagement did not reduce DSH suggests that standard clinical care may not be sufficient for reducing DSH in this population. These findings highlight the need for suicide-specific interventions for individuals with FEP.
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Affiliation(s)
- Heather M Wastler
- Departments of Psychiatry and Behavioral Health (Wastler, Llamocca, Moe, Fontanella), Psychology (Moe), Biomedical Informatics (Brock), and Pediatrics (Bridge), Ohio State University, Columbus; Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Llamocca); Center for Suicide Prevention and Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio (Steelsmith, Bridge, Fontanella); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Campo)
| | - Elyse Llamocca
- Departments of Psychiatry and Behavioral Health (Wastler, Llamocca, Moe, Fontanella), Psychology (Moe), Biomedical Informatics (Brock), and Pediatrics (Bridge), Ohio State University, Columbus; Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Llamocca); Center for Suicide Prevention and Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio (Steelsmith, Bridge, Fontanella); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Campo)
| | - Aubrey M Moe
- Departments of Psychiatry and Behavioral Health (Wastler, Llamocca, Moe, Fontanella), Psychology (Moe), Biomedical Informatics (Brock), and Pediatrics (Bridge), Ohio State University, Columbus; Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Llamocca); Center for Suicide Prevention and Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio (Steelsmith, Bridge, Fontanella); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Campo)
| | - Danielle L Steelsmith
- Departments of Psychiatry and Behavioral Health (Wastler, Llamocca, Moe, Fontanella), Psychology (Moe), Biomedical Informatics (Brock), and Pediatrics (Bridge), Ohio State University, Columbus; Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Llamocca); Center for Suicide Prevention and Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio (Steelsmith, Bridge, Fontanella); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Campo)
| | - Guy Brock
- Departments of Psychiatry and Behavioral Health (Wastler, Llamocca, Moe, Fontanella), Psychology (Moe), Biomedical Informatics (Brock), and Pediatrics (Bridge), Ohio State University, Columbus; Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Llamocca); Center for Suicide Prevention and Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio (Steelsmith, Bridge, Fontanella); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Campo)
| | - Jeffrey A Bridge
- Departments of Psychiatry and Behavioral Health (Wastler, Llamocca, Moe, Fontanella), Psychology (Moe), Biomedical Informatics (Brock), and Pediatrics (Bridge), Ohio State University, Columbus; Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Llamocca); Center for Suicide Prevention and Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio (Steelsmith, Bridge, Fontanella); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Campo)
| | - John V Campo
- Departments of Psychiatry and Behavioral Health (Wastler, Llamocca, Moe, Fontanella), Psychology (Moe), Biomedical Informatics (Brock), and Pediatrics (Bridge), Ohio State University, Columbus; Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Llamocca); Center for Suicide Prevention and Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio (Steelsmith, Bridge, Fontanella); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Campo)
| | - Cynthia A Fontanella
- Departments of Psychiatry and Behavioral Health (Wastler, Llamocca, Moe, Fontanella), Psychology (Moe), Biomedical Informatics (Brock), and Pediatrics (Bridge), Ohio State University, Columbus; Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Llamocca); Center for Suicide Prevention and Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio (Steelsmith, Bridge, Fontanella); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Campo)
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Lv M, Wang X, Wang Z, Li X, Wang L, Tan Y, Zhang XY. Alcohol drinking in male patients with chronic schizophrenia: prevalence and its relationship to clinical symptoms. Front Psychiatry 2023; 14:1164968. [PMID: 37520222 PMCID: PMC10372417 DOI: 10.3389/fpsyt.2023.1164968] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/19/2023] [Indexed: 08/01/2023] Open
Abstract
Background It is common practice to associate schizophrenia (SCZ) patients with substance use. The most commonly used substances in China are tobacco and alcohol. However, few studies have focused on alcohol consumption itself in patients with SCZ. Thus the purpose of this study was to detect the prevalence of alcohol use and associated clinical factors in Chinese patients with SCZ. Methods A total of 616 male inpatients who met the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for SCZ participated in this study. A detailed questionnaire, including data on alcohol consumption was used to collect demographic and clinical information on all patients. The five-factor model of the positive and negative syndrome scale (PANSS) was adopted to assess psychiatric symptoms. Results In this study, 31.49% of SCZ inpatients had a history of alcohol use, and 82.9% of these patients abstained from alcohol use after the onset of SCZ. Compared to nondrinkers, patients who drank were more likely to smoke (p = 0.004), more likely to have suicide attempts (p = 0.002) and suicidal ideation (p = 0.001), more severe positive (p < 0.001) and depressive symptoms (p = 0.034), but less severe negative symptoms (p = 0.04). Conclusion These findings suggest that alcohol use is common during the lifetime of SCZ patients and that alcohol use may be associated with clinical symptoms in SCZ patients.
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Affiliation(s)
- Menghan Lv
- Beijing Huilongguan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Xuan Wang
- Beijing Huilongguan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Zhiren Wang
- Beijing Huilongguan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Xiaohong Li
- Beijing Huilongguan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Li Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Yunlong Tan
- Beijing Huilongguan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Xiang Yang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
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Kruckow L, Basit S, Nordentoft M, Banner J, Boyd HA. The influence of comorbid disease on premature death due to natural and unnatural causes in persons with schizophrenia. Schizophr Res 2023; 257:27-33. [PMID: 37244167 DOI: 10.1016/j.schres.2023.04.006] [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: 04/06/2022] [Revised: 02/24/2023] [Accepted: 04/17/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Comorbid disease may increase mortality in persons with schizophrenia, but how specific diseases are associated with natural and unnatural death in different age groups is unclear. AIMS To investigate the association between eight major comorbid diseases and death from natural and unnatural causes in different age groups in persons with schizophrenia. METHOD Retrospective register-based cohort study in 77,794 persons with schizophrenia in Denmark, 1977-2015. Using Cox regression in matched cohorts, we estimated hazard ratios for natural and unnatural death in three age groups (<55 years, 55-64 years, ≥65 years). RESULTS Hypertensive disease, atrial fibrillation, coronary heart disease, cerebrovascular disease, heart failure, type 2 diabetes, liver disease and chronic kidney disease were all strongly associated with natural death, with the strongest associations observed in persons <55 years (hazard ratio [HR] range 1.98-7.19). The strongest associations were observed for heart failure (HR 7.19, 95 % confidence interval [CI] 5.57-9.28; HR 4.56, CI 3.85-5.40; HR 2.83, CI 2.53-3.17), liver disease (HR 4.66, CI 3.59-6.05; HR 4.70, CI 3.55-6.22; HR 2.57, CI 1.98-3.34) and chronic kidney disease (HR 6.59, CI 1.66-26.1; HR 7.37, CI 3.03-17.9; HR 2.86, CI 1.84-4.46) for persons <55 years, 55-64 years and ≥65 years, respectively. Liver disease was strongly associated with unnatural death in persons <55 years (HR 5.42, CI 3.01-9.75); associations with the remaining comorbidities were weaker. CONCLUSIONS Comorbid disease was strongly associated with natural death, with the strength of the associations decreasing with age. Comorbid disease was also modestly associated with unnatural death, regardless of age.
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Affiliation(s)
- Line Kruckow
- Department of Forensic Medicine, University of Copenhagen, Frederik V's Vej 11, 2100 Copenhagen, Denmark.
| | - Saima Basit
- Department of Epidemiology Research, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen, Denmark.
| | - Merete Nordentoft
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Mental Health Services, Capital Region of Denmark, Copenhagen, Gentofte Hospitalsvej 15, 4th floor, DK-2900 Hellerup, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Fuglesangs Allé 26, DK-8210 Aarhus, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, DK-2200 Copenhagen N, Denmark.
| | - Jytte Banner
- Department of Forensic Medicine, University of Copenhagen, Frederik V's Vej 11, 2100 Copenhagen, Denmark.
| | - Heather Allison Boyd
- Department of Epidemiology Research, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen, Denmark.
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Abaatyo J, Favina A, Bulega SE, Kaggwa MM. Suicidal behavior among inpatients with severe mental conditions in a public mental health hospital in Uganda. BMC Psychiatry 2023; 23:346. [PMID: 37208631 DOI: 10.1186/s12888-023-04858-x] [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: 02/15/2023] [Accepted: 05/10/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Suicidal behaviors are prevalent among inpatients with severe mental conditions and may result in many dying by suicide. Few studies have focused on the burden of suicidal behaviors among these inpatients in low-income settings, despite suicide being consistently higher in lower-income countries such as Uganda. This study, therefore, provides the prevalence and associated factors of suicidal behaviors and suicide attempts among inpatients with severe mental conditions in Uganda. METHOD This was a retrospective chart review of all individuals admitted with severe mental conditions to a large psychiatry inpatient unit in Uganda for four years (2018-2021). Two separate logistic regressions were conducted to determine the factors associated with suicidal behaviors or suicidal attempts among the admitted individuals. RESULTS The prevalence of suicidal behavior and suicidal attempts among 3104 (mean age = 33, Standard deviation [SD] = 14.0; 56% were males) were 6.12% and 3.45%, respectively. Having a diagnosis of depression increased the likelihood of both suicidal behaviors (adjusted odds ratio [aOR]: 5.36; 95% confidence interval [CI]: 2.14-13.37; p =0.001) and attempts (aOR: 10.73; 95% CI: 3.44-33.50; p < 0.001). However, a diagnosis of substance-related disorder increased the likelihood of having attempted suicide (aOR: 4.14; 95% CI: 1.21-14.15; p = 0.023). The likelihood of having suicidal behavior decreased as one increased in age (aOR: 0.97; 95% CI: 0.94-0.99; p = 0.006) and increased among individuals reporting stress from financial constraints (aOR: 2.26; 95% CI: 1.05-4.86; p = 0.036). CONCLUSION Suicidal behaviors are common among inpatients managed for severe mental health conditions in Uganda, especially those with substance use and depressive disorders. In addition, financial stressors are a main predictor in this low-income country. Therefore, regular screening for suicide behaviors is warranted, especially among individuals with depression, and substance use, among those who are young, and among those reporting financial constraints/stress.
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Affiliation(s)
- Joan Abaatyo
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Alain Favina
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Steven Elijah Bulega
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Mark Mohan Kaggwa
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, McMaster, Canada.
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Liu J, Zhao K, Zhou S, Hong L, Xu Y, Sun S, Tong S, Huang L, Liu J, Wang J, Li N, Lou M, Tang W, Cai Z. Suicidal ideation in Chinese adults with schizophrenia: associations with neurocognitive function and empathy. BMC Psychiatry 2023; 23:311. [PMID: 37138258 PMCID: PMC10155378 DOI: 10.1186/s12888-023-04739-3] [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: 12/26/2022] [Accepted: 03/31/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Suicidal ideation is common among people diagnosed with schizophrenia spectrum disorders and may be related to neurocognitive, social cognitive, and clinical variables. This study aimed to investigate the relationships between suicidal ideation and both neurocognitive function and empathy. METHODS The sample for this cross-sectional study comprised 301 schizophrenic patients aged 18-44 years. All participants were administered the Beck Scale for Suicide Ideation-Chinese Version (BSI-CV), the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), the Interpersonal Reactivity Index (IRI), and the Positive and Negative Syndrome Scale (PANSS). The demographic and clinical data of the patients were also collected. RESULTS In total, 82 patients reported suicidal ideation. Compared to patients without suicidal ideation, patients with suicidal ideation showed significant differences in the IRI-Personal Distress subscale, PANSS-General Psychopathology symptom scores, and suicide attempts. Moreover, there were moderating effects of neurocognitive function and empathy on the relationship between suicide attempts and suicidal ideation. CONCLUSIONS These results indicate that the personal distress component of empathy, general psychopathology symptoms and suicide attempts are independent risk factors for suicidal ideation in Chinese adults with schizophrenia. Moreover, neurocognitive function may also be related to suicidal ideation through a moderating relationship. In order to reduce suicidal ideation among patients with schizophrenia, early screening of empathy and neurocognitive function is essential.
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Affiliation(s)
- Jie Liu
- School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Ke Zhao
- Lishui Second People's Hospital Affiliated to Wenzhou Medical University, Lishui, China
| | - Siyao Zhou
- School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Lan Hong
- School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yao Xu
- School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Shiyu Sun
- School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Siyu Tong
- School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Liandan Huang
- The Affiliated Kangning Hospital of Wenzhou Medical University Zhejiang Provincial Clinical Research Center for Mental Disorder, 325000, Wenzhou, China
| | - Jiahong Liu
- The Affiliated Kangning Hospital of Wenzhou Medical University Zhejiang Provincial Clinical Research Center for Mental Disorder, 325000, Wenzhou, China
| | - Jieqiong Wang
- The Affiliated Kangning Hospital of Wenzhou Medical University Zhejiang Provincial Clinical Research Center for Mental Disorder, 325000, Wenzhou, China
| | - Na Li
- School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Mengbei Lou
- School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Wei Tang
- School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang, China.
- The Affiliated Kangning Hospital of Wenzhou Medical University Zhejiang Provincial Clinical Research Center for Mental Disorder, 325000, Wenzhou, China.
| | - Zhengmao Cai
- The Affiliated Kangning Hospital of Wenzhou Medical University Zhejiang Provincial Clinical Research Center for Mental Disorder, 325000, Wenzhou, China.
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Farah N, Obeid S, Malaeb D, Haddad C, Fekih-Romdhane F, Hallit S. Mediation effect of insomnia symptoms between positive psychotic like experiences and suicidal ideation among Lebanese young adults. BMC Psychiatry 2023; 23:272. [PMID: 37081441 PMCID: PMC10116113 DOI: 10.1186/s12888-023-04778-w] [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: 11/11/2022] [Accepted: 04/12/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Psychotic symptoms reported by healthy individuals in the general population are referred to as psychotic-like experiences (PLEs) and have been proven to increase the risk of suicidal ideation (SI) in these individuals. As it is well established that PLEs and insomnia share a bidirectional association and also that insomnia is linked to SI, we hypothesized that insomnia may represent a mediator underlying the relationship between PLEs and SI. Our aim was to validate this hypothesis among Lebanese young adults. METHODS A total of 3103 young adults (mean age 21.73 ± 3.80 years; 63.6% females) recruited from all Lebanese governorates completed a self-administered online questionnaire. PLEs were assessed using the CAPE-42 scale, SI using the Columbia Suicide Rating Scale, and insomnia using the Insomnia Severity Index). We conducted a mediation analysis using SPSS PROCESS v3.4 model 4 with three pathways. Variables that showed a p < 0.25 in the bivariate analysis were entered in the path analysis. RESULTS A total of 1378 participants (44.4%) had insomnia; 18.8% had SI; 42.5% reported at least one positive PE 'nearly always', and 30.5% reported at least one negative PE with this frequency. The results of the mediation analysis showed that insomnia severity partially mediated the association between positive dimension and SI; higher positive dimension was significantly associated with more insomnia severity, which was, in turn, significantly associated with more SI. Finally, more positive dimension was significantly and directly associated with more SI. CONCLUSION These preliminary findings might encourage the implementation of new preventive measures to reduce SI among PLEs patients. Treating symptoms of insomnia might help reduce the risk of suicide.
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Affiliation(s)
- Nour Farah
- Faculty of Science, Lebanese University, Fanar, Lebanon
| | - Sahar Obeid
- School of Arts and Sciences, Social and Education Sciences Department, Lebanese American University, Jbeil, Lebanon
| | - Diana Malaeb
- College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates
| | - Chadia Haddad
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
- School of Health Sciences, Modern University for Business and Science, Beirut, Lebanon
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique Et de Toxicologie-Liban), Beirut, Lebanon
| | - Feten Fekih-Romdhane
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry "Ibn Omrane", Razi Hospital, 2010, Manouba, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Souheil Hallit
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon.
- Applied Science Research Center, Applied Science Private University, Amman, Jordan.
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Yin Y, Tong J, Huang J, Tian B, Chen S, Tan S, Wang Z, Yang F, Tong Y, Fan F, Kochunov P, Tan Y, Hong LE. Auditory Hallucinations, Depressive Symptoms, and Current Suicidal Ideation or Behavior Among Patients with Acute-episode Schizophrenia. Arch Suicide Res 2023; 27:323-338. [PMID: 34689715 PMCID: PMC9682271 DOI: 10.1080/13811118.2021.1993399] [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] [Indexed: 10/20/2022]
Abstract
Suicide risk and auditory hallucinations are common in schizophrenia, but less is known about its associations. This cross-sectional study aimed to determine whether the presence and severity of auditory hallucinations were associated with current suicidal ideation or behavior (CSIB) among patients with schizophrenia. We interviewed 299 individuals with schizophrenia and acute symptoms and reviewed their medical records. Measurement included the Psychotic Symptom Rating Scale (PSYRATS-AH), the Calgary Depression Scale for Schizophrenia (CDSS), and the Positive and Negative Syndrome Scale. Logistic regression and path analysis were used. The CSIB prevalence was higher among patients with current auditory hallucination than those without (19.5% vs. 8.6%, crude odds ratio = 2.58, p = .009). Lifetime auditory hallucination experience (adjusted odds ratio [AOR] = 3.81; 95% CI: 1.45-10.05) or current auditory hallucination experience (AOR = 3.22; 95% CI: 1.25-8.28) can elevate the likelihood of CSIB while controlling for depressive symptoms and lifetime suicide-attempt history. Among those with auditory hallucinations, the emotional score of the PSYRATS-AH was positively associated with the CDSS score and there was a small indirect effect of the CDSS score on the association between the emotional domain score and CSIB (bias-corrected 95% CI, 0.02-0.20). In conclusion, the presence of auditory hallucinations was strongly associated with CSIB, independent of depressive symptoms and lifetime suicide attempts. Suicide risk assessment should consider auditory hallucination experience and patients' appraisal of its emotional characteristics. Future cohort studies are necessary to provide more conclusive evidence for the mediating pathways between auditory hallucinations and CSIB.HIGHLIGHTSThe presence of auditory hallucinations was associated with current suicidality.Auditory hallucinations' emotional severity was related to depressive symptoms.The severity of auditory hallucination was not directly associated with suicidality.
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Affiliation(s)
- Yi Yin
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, P. R. China
| | - Jinghui Tong
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, P. R. China
| | - Junchao Huang
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, P. R. China
| | - Baopeng Tian
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, P. R. China
| | - Song Chen
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, P. R. China
| | - Shuping Tan
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, P. R. China
| | - Zhiren Wang
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, P. R. China
| | - Fude Yang
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, P. R. China
| | - Yongsheng Tong
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, P. R. China
- Beijing Suicide Research and Prevention Center, WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, P. R. China
| | - Fengmei Fan
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, P. R. China
| | - Peter Kochunov
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, USA
| | - Yunlong Tan
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, P. R. China
| | - L. Elliot Hong
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, USA
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Martinho FP, Magalhães D, Felício R, Ferreira TF, Jorge S. Obsessive-compulsive symptoms in first episode psychosis and risk states: Systematic review with meta-analysis. Schizophr Res 2023; 255:41-51. [PMID: 36958269 DOI: 10.1016/j.schres.2023.03.024] [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: 09/30/2022] [Revised: 03/09/2023] [Accepted: 03/11/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND AND HYPOTHESIS Recent studies have reported high prevalences of obsessive-compulsive symptoms and obsessive-compulsive disorder in at risk and first-episode psychosis patients. This sparked an interest in the effect of these symptoms in the clinical characteristics and outcomes of patients. However these studies have never been formally meta-analyzed. STUDY DESIGN Systematic review and meta-analysis of prevalence of obsessive-compulsive symptoms and obsessive-compulsive disorder in at risk and first-episode psychosis patients and comparison of clinical characteristics and outcomes in patients with and without obsessive-compulsive symptoms. STUDY RESULTS Obsessive-compulsive disorder was present in 7.9 % (5.9 to 10.0 %) and 10.5 % (8.3 to 12.8 %) and obsessive-compulsive symptoms in 21.4 % (8.3 to 38.2 %) and 34.0 % (26.3 to 42.1 %) of at risk and first episode psychosis patients respectively. The prevalences of obsessive-compulsive symptoms had high heterogeneity due in part to different measurement methods and cut-off values. Similar ages of onset for OCS and psychosis symptoms were found (mean difference - 0.49 years, 95 % CI -1.74 to 0.77). Patients with obsessive-compulsive symptoms had statistically insignificant higher Positive and Negative Syndrome Scale (positive subscale) scores and marginally higher depression scores. There were no differences between both groups in age of onset, Positive and Negative Syndrome Scale (negative subscale) score, risk of conversion to psychosis, anxiety score, suicide rate, and functionality score. CONCLUSIONS Obsessive-compulsive disorder and obsessive-compulsive symptoms are very prevalent in at risk and first-episode psychosis patients.
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Affiliation(s)
| | - Daniela Magalhães
- Hospital Prof. Doutor Fernando Fonseca, IC19, 2720-276 Amadora, Portugal.
| | - Rita Felício
- Hospital Prof. Doutor Fernando Fonseca, IC19, 2720-276 Amadora, Portugal.
| | | | - Susana Jorge
- Hospital Prof. Doutor Fernando Fonseca, IC19, 2720-276 Amadora, Portugal.
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Huang YC, Kao LT, Liao TH, Chiu CC, Wen HC. Risk factors of involuntary referral by police to ER psychiatric services for patients with a severe mental illness: A GEE analysis. Schizophr Res 2023; 254:68-75. [PMID: 36801516 DOI: 10.1016/j.schres.2023.02.002] [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: 03/30/2022] [Revised: 02/03/2023] [Accepted: 02/04/2023] [Indexed: 02/17/2023]
Abstract
This study aimed to identify risk factors for involuntary referral by police to emergency room (ER) psychiatric services for community-based patients with a mental illness via a generalized estimating equation (GEE) analysis. The analysis was based on data from the Management Information System of Psychiatric Care (MISPC) system for patients with a severe mental illness in Taipei, Taiwan and registered referral records of the police. Data on 6378 patients aged ≥20 years were used in this study, including 164 patients who were involuntarily referred to the ER by the police and 6214 patients who were not during the period of January 1, 2018 to December 31, 2020. GEEs were utilized to explore possible risk factors of repeated involuntary referral to ER psychiatric services for patients with a severe mental illness. The logistic regressions indicated that patients defined as "severe" according to the Mental Health Act of Taiwan (crude odds ratio (OR): 3.840, 95 % confidence interval (CI): 2.407-6.126), with a disability (crude OR: 3.567, 95 % CI: 1.339-9.501), with two or more family members with a psychiatric disorder (crude OR: 1.598, 95 % CI: 1.002-2.548), with a history of a suicide attempt (crude OR: 25.582, 95 % CI: 17.608-37.167), and with a history of domestic violence (crude OR: 16.141, 95 % CI: 11.539-22.579) were positively associated with involuntary referral to ER psychiatric services. However, age (crude OR: 0.971, 95 % CI: 0.960-0.983) and the MISPC score (crude OR: 0.834, 95 % CI: 0.800-0.869) were inversely associated with involuntary referral to ER psychiatric services. After adjusting for demographics and potential confounders, we found that patients defined as "severe" (Exp (β): 3.236), with a disability (Exp (β): 3.715), with a history of a suicide attempt (Exp (β): 8.706), and with a history of domestic violence (Exp (β): 8.826), as well as age (Exp (β): 0.986) and the MISPC score (Exp (β): 0.902) remained significantly associated with repeated involuntary referral to ER psychiatric services. In conclusion, community-based mentally ill patients with a history of a suicide attempt, with a history of domestic violence, with a severe illness, and with a profound level of disability were highly associated with involuntary referral to ER psychiatric services. We suggest that community mental health case managers identify significant factors associated with involuntary referral to ER psychiatric services to accordingly arrange case management plans.
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Affiliation(s)
- Y C Huang
- Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan
| | - L T Kao
- Department of Pharmacy Practice, Tri-Service General Hospital, Taipei, Taiwan; School of Pharmacy, National Defense Medical Center, Taipei, Taiwan; Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan; School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - T H Liao
- Department of Health, Taipei City Government, Taiwan
| | - C C Chiu
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - H C Wen
- School of Healthcare Administration, College of Management, Taipei Medical University, Taiwan.
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Chalker SA, Pozun CT, Ehret BC. Functional impairment, internalized stigma, and well-being: Considerations for recovery-oriented suicide prevention for U.S. Veterans with serious mental illness. PRACTICE INNOVATIONS (WASHINGTON, D.C.) 2023; 2023. [PMID: 37900980 PMCID: PMC10601383 DOI: 10.1037/pri0000213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
Veterans Health Administration's (VHA) Psychosocial Rehabilitation and Recovery Centers (PRRCs) provide recovery-oriented care to Veterans with serious mental illness (SMI). As part of program evaluation, PRRC providers regularly assess recovery-oriented outcomes. Given the high rates of suicidal thoughts and behaviors among Veterans with SMI, understanding such outcomes in relation to suicide risk is crucial. Among Veterans entering a PRRC (N=4,731), the present study aimed to a) report suicidal ideation frequency in the past two weeks across demographics and psychiatric diagnoses, b) explore rates of current functional impairment, internalized stigma, and well-being, and c) examine differences in suicidal ideation frequency and functional impairment, internalized stigma, and well-being. Measurements before treatment were utilized. Younger (ρ=-.08, p<.001), married (z=-5.23, p<.001) Veterans, those not identifying as Black or African American (z=-4.80, p<.001), not diagnosed with schizophrenia (z=-6.97, <.001), diagnosed with depressive disorders (z=-8.79, <.001), anxiety disorders (z=-5.01, <.001), posttraumatic stress disorder (z=-7.69, <.001), or personality disorders (z=-7.12, <.001) were significantly more likely to endorse suicidal ideation. Veterans in this cohort had higher than average functional impairment (M=18.05, SD=9.85), mild internalized stigma (M=2.36, SD=0.51), and lower than average well-being (M=18.96, SD=3.93). The more often a Veteran reported thinking about suicide in the past two weeks, the more likely the Veteran viewed themselves to be more functionally impaired (p<.001), reported higher levels of internalized stigma (p<.001), and reported lower levels of well-being (p<.001). Findings and limitations, particularly the suicidal ideation frequency measurement, are discussed to contextualize suggestions to integrate recovery-oriented practices and suicide prevention care.
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Affiliation(s)
- Samantha A Chalker
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- University of California, San Diego, Department of Psychiatry, San Diego, California, USA
| | - Cara T Pozun
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Blaire C Ehret
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- University of California, San Diego, Department of Psychiatry, San Diego, California, USA
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李 硕, 杨 先, 王 丹, 范 箬, 田 绍, 王 荣, 向 虎, 张 强, 刘 元, 刘 祥. [Factors Influencing Suicide Deaths in Patients With Schizophrenia Based on Cohort Data: An Empirical Study of a Sample of 170006 Patients in Sichuan Province]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2023; 54:142-147. [PMID: 36647657 PMCID: PMC10409051 DOI: 10.12182/20230160302] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Indexed: 01/18/2023]
Abstract
Objective To prospectively explore the risk factors of suicide in patients with schizophrenia. Methods Data on schizophrenia patients in Sichuan Province between 2006 and 2018 were obtained from the National Severe Mental Disorders Information System, and the Cox proportional hazards regression model was used to explore for risk factors for suicide in schizophrenia patients. Result A total of 170006 patients with schizophrenia were included in the study. At the end of the follow-up period, 160570 patients were alive and 9436 died from various causes, 929 of which being suicide deaths, resulting in a suicide rate of 223.61/100, 000 person-years. The Cox proportional hazards regression model suggested that risk factors for suicide in patients with schizophrenia included poverty ( HR=1.20, 95% CI: 1.02-1.41), higher education level (primary school [ HR=1.32, 95% CI: 1.09-1.60], middle school [ HR=1.40, 95% CI: 1.14-1.73], high school and above [ HR=1.93, 95% CI: 1.49-2.52]) in comparison with illiteracy and semi-literacy, suicide attempts ( HR=2.70, 95% CI: 1.70-4.29), strict medication compliance ( HR=1.91, 95% CI: 1.66-2.20), history of antipsychotic drug therapy ( HR=1.42, 95% CI: 1.06-1.90), younger age group of patients of 46-60 ( HR=1.95, 95% CI: 1.60-2.39), 31-45 ( HR=3.61, 95% CI: 2.92-4.47), and 15-30 ( HR=12.37, 95% CI: 9.69-15.78) compared with the 61-90 age group, and doing agriculture jobs ( HR=1.36, 95% CI: 1.13-1.65). Conclusion Young and middle-aged schizophrenia patients with higher education levels, especially those with a history of suicide attempts, are at high risk for suicide. Focused interventions should be directed at high-risk groups to reduce suicide deaths in patients with schizophrenia.
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Affiliation(s)
- 硕 李
- 四川大学华西公共卫生学院/四川大学华西第四医院 (成都 610041)West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 先梅 杨
- 四川大学华西公共卫生学院/四川大学华西第四医院 (成都 610041)West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 丹 王
- 四川大学华西公共卫生学院/四川大学华西第四医院 (成都 610041)West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 箬馨 范
- 四川大学华西公共卫生学院/四川大学华西第四医院 (成都 610041)West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 绍丽 田
- 四川大学华西公共卫生学院/四川大学华西第四医院 (成都 610041)West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 荣科 王
- 四川大学华西公共卫生学院/四川大学华西第四医院 (成都 610041)West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 虎 向
- 四川大学华西公共卫生学院/四川大学华西第四医院 (成都 610041)West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 强 张
- 四川大学华西公共卫生学院/四川大学华西第四医院 (成都 610041)West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 元元 刘
- 四川大学华西公共卫生学院/四川大学华西第四医院 (成都 610041)West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 祥 刘
- 四川大学华西公共卫生学院/四川大学华西第四医院 (成都 610041)West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
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Botchway S, Tsiachristas A, Pollard J, Fazel S. Cost-effectiveness of implementing a suicide prediction tool (OxMIS) in severe mental illness: Economic modeling study. Eur Psychiatry 2022; 66:e6. [PMID: 36529858 PMCID: PMC9879904 DOI: 10.1192/j.eurpsy.2022.2354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 12/10/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Cost-effectiveness analysis needs to be considered when introducing new tools and treatments to clinical services. The number of new assessment tools in mental health has rapidly expanded, including suicide risk assessment. Such suicide-based assessments, when linked to preventative interventions, are integral to high-quality mental health care for people with severe mental illness (SMI). We examined the cost implications of implementing Oxford Mental Illness and Suicide (OxMIS), an evidence-based, scalable suicide risk assessment tool that provides probabilistic estimates of suicide risk over 12 months for people with SMI in England. METHODS We developed a decision analytic model using secondary data to estimate the potential cost-effectiveness of incorporating OxMIS into clinical decision-making in secondary care as compared to usual care. Cost-effectiveness was measured in terms of costs per quality-adjusted life years (QALYs) gained. Uncertainty was addressed with deterministic and probabilistic sensitivity analysis. RESULTS Conducting suicide risk assessment with OxMIS was potentially cheaper than clinical risk assessment alone by £250 (95% confidence interval, -786;31) to £599 (-1,321;-156) (in 2020-2021 prices) per person with SMI and associated with a small increase in quality of life (0.01 [-0.03;0.05] to 0.01 QALY, [-0.04;0.07]). The estimated incremental cost-effectiveness ratio of implementing OxMIS was cost saving. Using probabilistic sensitivity analysis, 99.96% of 10,000 simulations remained cost saving. CONCLUSION Cost-effectiveness analysis can be conducted on risk prediction models. Implementing one such model that focuses on suicide risk in a high-risk population can lead to cost savings and improved health outcomes, especially if explicitly linked to preventative treatments.
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Affiliation(s)
- Stella Botchway
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Apostolos Tsiachristas
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Jack Pollard
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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Wastler HM, Núñez D. Psychotic experiences, emotion regulation, and suicidal ideation among Chilean adolescents in the general population. Front Psychiatry 2022; 13:983250. [PMID: 36465305 PMCID: PMC9710630 DOI: 10.3389/fpsyt.2022.983250] [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: 06/30/2022] [Accepted: 10/24/2022] [Indexed: 11/18/2022] Open
Abstract
Psychotic experiences are associated with increased risk for suicide. Despite this well-established finding, very little is known about factors that contribute to this relationship. The current study investigated the relationship between psychotic experiences, emotion regulation, and suicidal ideation among 1,590 Chilean adolescents in the general population. Participants completed self-report measures of psychotic experiences (Community Assessment of Psychic Experiences), emotion regulation (Emotion Regulation Questionnaire), depression (Patient Health Questionnaire-9), and suicidal ideation (Columbia Suicide Severity Rating Scale). Statistical analyses included Mann-Whitney U tests, point-biserial correlations, logistic regression, and moderation analyses. Results suggest that paranoid ideation, bizarre experiences, and perceptual abnormalities were moderately associated with suicidal ideation. Additionally, greater expressive suppression and cognitive reappraisal were associated with suicidal ideation. Results from the logistic regression indicate that paranoid ideation, perceptual abnormalities, and expressive suppression have the strongest relationship with suicidal ideation, even when controlling for depression and relevant demographic variables. Additionally, paranoid ideation interacted with expressive suppression to predict suicidal ideation, with expressive suppression having the strongest relationship with suicidal ideation when paranoid ideation was low to moderate. Taken together, these findings support the broader literature suggesting that emotion regulation might be a transdiagnostic risk factor for suicidal ideation. Additional longitudinal research is needed to examine whether expressive suppression and other maladaptive emotion regulation strategies serve as a mechanism for suicidal ideation both in the general population and among individuals with psychotic experiences.
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Affiliation(s)
- Heather M. Wastler
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, United States
| | - Daniel Núñez
- Faculty of Psychology, Universidad de Talca, Talca, Chile
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago, Chile
- Programa de Investigación Asociativa, Faculty of Psychology, Centro de Investigación en Ciencias Cognitivas, Universidad de Talca, Talca, Chile
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Álvarez A, Guàrdia A, González-Rodríguez A, Betriu M, Palao D, Monreal JA, Soria V, Labad J. A systematic review and meta-analysis of suicidality in psychotic disorders: stratified analyses by psychotic subtypes, clinical setting and geographical region. Neurosci Biobehav Rev 2022; 143:104964. [DOI: 10.1016/j.neubiorev.2022.104964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 10/02/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022]
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Grover LE, Jones R, Bass NJ, McQuillin A. The differential associations of positive and negative symptoms with suicidality. Schizophr Res 2022; 248:42-49. [PMID: 35933743 DOI: 10.1016/j.schres.2022.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 06/27/2022] [Accepted: 07/24/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND Suicide is one of the leading causes of death in people with schizophrenia. Identifying risk factors for suicide in schizophrenia is therefore an important clinical and research priority. METHOD A cross-sectional secondary analysis was conducted on the DNA Polymorphisms in Mental Illness Study (DPIM) data. Suicidality data was extracted, and the number of positive and negative symptoms were established for a total of 1494 participants. Logistic and negative binomial regression analyses were conducted to assess for associations between positive or negative symptoms and suicidal ideation, attempt, or number of attempts, whilst adjusting for potential confounders. RESULTS Negative symptoms were associated with a reduction in the risk of suicidal ideation (odds ratio [OR]: 0.83; 95 % CI: 0.75-0.91) and suicide attempt (OR: 0.79; 95 % CI: 0.71-0.88) after adjusting for age and sex. Positive symptoms were associated with an increased risk of suicidal ideation (OR: 1.06; 95 % CI: 1.03-1.09), suicide attempt (OR: 1.04; 95 % CI: 1.00-1.07) and number of suicide attempts (incidence rate ratio [IRR]: 1.05; 95 % CI: 1.01-1.08). Further adjusting for depressive symptoms slightly increased the magnitude of associations with negative symptoms but attenuated associations between positive symptoms and suicidality to the null. CONCLUSIONS Negative symptoms are associated with a reduced risk of suicidality, whilst positive symptoms are associated with an increased risk of suicidality. Depressive symptoms may confound or mediate these associations.
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Affiliation(s)
- Laura E Grover
- Molecular Psychiatry Laboratory, Division of Psychiatry, University College London, Rockefeller Building, 21 University Street, London WC1E 6DE, UK.
| | - Rebecca Jones
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7BN, UK
| | - Nicholas J Bass
- Molecular Psychiatry Laboratory, Division of Psychiatry, University College London, Rockefeller Building, 21 University Street, London WC1E 6DE, UK.
| | - Andrew McQuillin
- Molecular Psychiatry Laboratory, Division of Psychiatry, University College London, Rockefeller Building, 21 University Street, London WC1E 6DE, UK.
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Demographics, clinical characteristics and cognitive symptoms of heavy smokers and non-heavy smokers in Chinese male patients with chronic schizophrenia. Eur Arch Psychiatry Clin Neurosci 2022; 272:1325-1333. [PMID: 35474549 DOI: 10.1007/s00406-022-01410-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 04/05/2022] [Indexed: 11/03/2022]
Abstract
Many studies have shown a high smoking rate and cognitive impairment in patients with schizophrenia. The effects of smoking and nicotine intake on cognitive function in schizophrenia are still controversial. In this study, we divided patients into heavy smoking and non-heavy smoking groups and compared the clinical characteristics and cognitive symptoms between the two groups in Chinese male patients with schizophrenia. A total of 154 heavy smoking patients and 372 non-heavy smoking patients were recruited. They completed a detailed questionnaire including general and socio-demographic data. Positive and Negative Syndrome Scale (PANSS) was rated for psychopathology. The Fagerstrom Test for Nicotine Dependence (FTND) was used to assess the degree of nicotine dependence. Heavy smokers were younger, started smoking earlier and had a higher FTND total score than non-heavy smoking patients. Moreover, we found that heavy smokers had significantly lower negative symptom scores and cognitive factor scores than non-heavy smokers. Logistic regression analysis showed that cognitive factor score and age of initial smoking were significantly associated with heavy smoking. Linear regression analysis showed that cognitive factor score, age of initial smoking and dose of antipsychotics were significant predictors of the amount of smoking. Our findings suggest that there are significant differences in some demographic and clinical variables between heavy and non-heavy smokers in Chinese male patients with chronic schizophrenia. Moreover, heavy smokers have less cognitive symptoms, suggesting that heavy smoking may be beneficial for cognition of patients with schizophrenia.
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Carruthers SP, Lee SJ, Sankaranarayanan A, Sumner PJ, Toh WL, Tan EJ, Neill E, Van Rheenen TE, Gurvich C, Rossell SL. Psychosis and Hopelessness Mediate the Relationship Between Reduced Sleep and Suicidal Ideation in Schizophrenia Spectrum Disorders. Arch Suicide Res 2022; 26:1862-1879. [PMID: 34225564 DOI: 10.1080/13811118.2021.1944412] [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: 10/20/2022]
Abstract
OBJECTIVE Suicide is a major cause of death amongst individuals with schizophrenia spectrum disorders (SSD). Despite numerous risk factors being identified, accurate prediction of suicidality and provision of tailored and effective treatment is difficult. One factor that may warrant particular attention as a contributor to increased psychopathology and suicidality in SSD is disturbed sleep. Sleep disturbances have been reliably linked to greater levels of suicidal ideation and are highly prevalent amongst individuals with SSD. This study aimed to examine if reduced sleep duration and psychopathology are associated with increased suicidal ideation. METHOD One-hundred and eighteen adults with chronic SSD living within the community participated in this cross-sectional study. Psychosis symptoms were assessed using the Positive and Negative Syndrome Scale. Items 4 and 10 from the Montgomery-Asperg Depression Rating Scale and Item 2 from the Calgary Depression Scale for Schizophrenia were used to assess reduced sleep duration, current suicidal ideation, and hopelessness, respectively. All measures were rated concurrently. RESULTS A hierarchical logistic regression revealed that greater acute sleep disturbances were associated with increased suicidal ideation and this relationship was found to be uniquely mediated by both positive symptom severity and hopelessness. CONCLUSION These results suggest that individuals with SSD who exhibited disrupted or disordered sleep, positive symptoms and/or hopelessness should be routinely screened for suicidal thinking. Furthermore, interventions that effectively target sleep disruptions may provide much-needed action against suicidal ideation.HIGHLIGHTSReduced sleep found to be associated with increased suicidal ideationThis was uniquely mediated by both hopelessness and positive symptomsMore regular screening of sleep problems in schizophrenia is needed.
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Dai Q, Zhou Y, Liu R, Wei S, Zhou H, Tian Y, Xia L, Cervenka GM, Wu HE, Wang L, Zhang X. Alcohol use history increases the likelihood of suicide behavior among male chronic patients with schizophrenia in a Chinese population. Suicide Life Threat Behav 2022; 52:716-724. [PMID: 35318712 DOI: 10.1111/sltb.12855] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 06/13/2021] [Accepted: 10/25/2021] [Indexed: 11/28/2022]
Abstract
AIMS This study was designed to detect the association between the history of alcohol drinking and suicidality in schizophrenia (SCZ) inpatients in a Chinese population. METHODS We recruited 616 male SCZ inpatients and collected demographic and clinical data. Five-factor model of the Positive and Negative Syndrome Scale (PANSS) was used to assess their psychopathological symptoms. RESULTS Our results showed that 31.33% of SCZ patients had a history of alcohol drinking. They had higher rates of lifetime suicide attempt and suicidal ideation than those without a history of alcohol drinking. Moreover, patients with a history of drinking were more likely to attempt suicide (14.51% vs. 7.09%; χ2 = 7.70, df = 1, p = 0.006), with an odds ratio (OR) of 2.22 and have suicidal ideation (29.02% vs. 17.49%; χ2 = 9.89, df = 1, p = 0.002), with an OR of 1.93. In addition, patients who used to drink alcohol were more likely to be smokers and had more severe positive and depressive symptoms (all p < 0.05). CONCLUSIONS Our study indicates that history of alcohol drinking may increase the prevalence of lifetime suicide attempt and suicidal ideation in male patients with chronic SCZ. Moreover, the history of alcohol drinking may be associated with some demographic data and clinical symptoms.
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Affiliation(s)
- Qilong Dai
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yongjie Zhou
- Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
| | - Ran Liu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Shuochi Wei
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Huixia Zhou
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yang Tian
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Luyao Xia
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Gregory M Cervenka
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Hanjing E Wu
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Li Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
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Suicidality in clinically stable bipolar disorder and schizophrenia patients during the COVID-19 pandemic. Transl Psychiatry 2022; 12:303. [PMID: 35906234 PMCID: PMC9335454 DOI: 10.1038/s41398-022-02045-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 06/26/2022] [Accepted: 06/29/2022] [Indexed: 11/14/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has a disproportionate impact on vulnerable subpopulations, including those with severe mental illness (SMI). This study examined the one-year prevalence of suicidal ideation (SI), suicide plans (SP), and suicide attempts (SA) in bipolar disorder (BD) and schizophrenia (SCZ) patients during the pandemic. Prevalence rates were compared between the two disorders and associated factors were examined. A survey was conducted in six tertiary psychiatric hospitals and psychiatric units. People with a diagnosis of BD or SCZ were invited to participate. SI, SP, and SA (suicidality for short) were assessed and associated factors were examined using binary logistical regression. The 1-year prevalence of SI, SP and SA in BD patients were 58.3%, (95% CI: 54.1-62.6%), 38.4% (95% CI: 34.3-42.6%) and 38.6% (95% CI: 34.5-42.8%), respectively, which were higher than the corresponding figures in SCZ patients (SI: 33.2%, 95% CI: 28.6-37.8%; SP: 16.8%, 95% CI: 13.2-20.5%; SA: 19.4%, 95% CI: 15.5-23.3%). Patients with younger age, experience of cyberbullying, a history of SA among family or friends, a higher fatigue and physical pain score, inpatient status, and severe depressive symptoms were more likely to have suicidality. The COVID-19 pandemic was associated with increased risk of suicidality, particularly in BD patients. It is of importance to regularly screen suicidality in BD and SCZ patients during the pandemic even if they are clinically stable.
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Chen L, Tan W, Lin X, Lin H, Xi J, Zhang Y, Jia F, Hao Y. Influencing factors of multiple adverse outcomes among schizophrenia patients using count regression models: a cross-sectional study. BMC Psychiatry 2022; 22:472. [PMID: 35840915 PMCID: PMC9284775 DOI: 10.1186/s12888-022-04070-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 06/17/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Schizophrenia patients have increased risks of adverse outcomes, including violent crime, aggressiveness, and suicide. However, studies of different adverse outcomes in schizophrenia patients are limited and the influencing factors for these outcomes need clarification by appropriate models. This study aimed to identify influencing factors of these adverse outcomes by examining and comparing different count regression models. METHODS This study included schizophrenia patients who had at least one follow-up record in the Guangdong Mental Health Center Network Medical System during 2020. Three types of adverse outcomes were included: a) aggressiveness with police dispatch or violent crime, b) aggressiveness without police dispatch, and c) self-harm or suicide attempts. The incidence density of these adverse outcomes was investigated using the Poisson, negative binomial (NB), zero-inflated Poisson (ZIP), and zero-inflated negative binomial (ZINB) models, accordingly. The best model was chosen based on goodness-of-fit tests. We further analyzed associations between the number of occurrences of adverse outcomes and sociodemographic, clinical factors with the best model. RESULTS A total of 130,474 schizophrenia patients were enrolled. Adverse outcomes rates were reported to be less than 1% for schizophrenia patients in 2020, in Guangdong. The NB model performed the best in terms of goodness-of-fit and interpretation when fitting for the number of occurrences of aggressiveness without police dispatch, whereas the ZINB models performed better for the other two outcomes. Age, sex, and history of adverse outcomes were influencing factors shared across these adverse outcomes. Higher education and employment were protective factors for aggressive and violent behaviors. Disease onset aged ≥ 18 years served as a significant risk factor for aggressiveness without police dispatch, and self-harm or suicide attempts. Family history of mental diseases was a risk factor for self-harm or suicide attempts individually. CONCLUSIONS NB and ZINB models were selected for fitting the number of occurrences of adverse outcomes among schizophrenia patients in our studies. Influencing factors for the incidence density of adverse outcomes included both those shared across different types and those individual to specific types. Therefore, comprehensive and customized tools in risk assessment and intervention might be necessary.
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Affiliation(s)
- Lichang Chen
- grid.12981.330000 0001 2360 039XDepartment of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080 Guangdong China
| | - Wenyan Tan
- Guangdong Mental Health Center, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080 Guangdong China
| | - Xiao Lin
- grid.12981.330000 0001 2360 039XDepartment of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080 Guangdong China
| | - Haicheng Lin
- Guangdong Mental Health Center, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080 Guangdong China
| | - Junyan Xi
- grid.12981.330000 0001 2360 039XDepartment of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080 Guangdong China
| | - Yuqin Zhang
- grid.12981.330000 0001 2360 039XDepartment of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080 Guangdong China
| | - Fujun Jia
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong, China.
| | - Yuantao Hao
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China. .,Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China. .,Center for Public Health and Epidemic Preparedness & Response, Peking University, Beijing, 100191, China.
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Telomere Length as a Marker of Suicidal Risk in Schizophrenia. CONSORTIUM PSYCHIATRICUM 2022. [DOI: 10.17816/cp171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND: Schizophrenia and suicidal behavior are associated with shortening in the length of telomeres. The aim of the study was to compare the content (pg/mcg) of telomeric repeat in DNA isolated from peripheral blood cells in three groups of subjects: patients with schizophrenia and a history of suicide attempts, patients with schizophrenia without suicidal tendencies, and healthy control volunteers.
METHODS: Relapses according to gender and age were examined in 47 patients with schizophrenia with suicidal behavior, 47 patients without self-destructive conditions, and 47 volunteers with healthy control and maintenance for the content of telomeric and the number of copies of mitochondrial DNA (mtDNA) in peripheral blood leukocytes.
RESULTS: Analysis of determining the content of telomeric repeat (TR) in the DNA of massive weight gain in the series: patients with schizophrenia and suicidal attempts patients with schizophrenia without suicidal observations healthy controls (22528.4 (227 [190; 250]) vs. 24321 (245 [228; 260]) vs. 25517.9 (255 [242; 266]), p 0.005. The same trend is observed for the number of mtDNA copies (257101.5 (250 [194; 297])) vs. 262.359.3 (254 [217; 312]) vs. 27279.9 (274 [213; 304]); p=0.012), but no significant differences were recorded.
CONCLUSIONS: For the first time, the phenomenon of telomere shortening was discovered in schizophrenics with suicidal risk. The length of the telomere corresponds to the parameter of a biological marker an objectively measured indicator of normal or pathological processes, but gaining an idea of its reliability is still necessary for verification with an assessment of its sensitivity, specificity, and positive and negative predictive value. The telomere may be considered a putative predictive indicator of suicidal risk.
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Childhood Trauma Associations With the Interpersonal Psychological Theory of Suicide and Social Cognitive Biases in Psychotic Disorders. J Nerv Ment Dis 2022; 210:432-438. [PMID: 34966112 PMCID: PMC9156551 DOI: 10.1097/nmd.0000000000001462] [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] [Indexed: 11/26/2022]
Abstract
Childhood trauma (CT) is associated with suicidal ideation and behaviors (SI/SB) in people with psychosis. The interpersonal psychological theory of suicide (IPTS) suggests that there are four factors that increase suicide risk: thwarted belongingness, perceived burdensomeness, acquired capacity for suicide, and hopelessness. The IPTS constructs and social cognitive biases are associated with SI/SB in psychotic disorders. However, the role of CT in IPTS constructs and social cognitive biases has not been examined in psychosis. In an outpatient community sample of persons with psychotic disorders (N = 96) assessed with the Childhood Trauma Questionnaire, the aims of this study were to a) evaluate rates of CT in this sample, b) determine the relationship between CT types and lifetime SI/SB, and c) explore the relationship between CT types, IPTS constructs, and social cognitive biases. All participants reported experiencing CT. Emotional abuse was associated with greater SI severity and higher rates of lifetime suicide attempts, as well as with greater perceived burdensomeness and more severe negative social cognitive biases. Other CT types were minimally associated with SI/SB or IPST constructs; hopelessness was not associated. Overall, negative interpersonal beliefs and social cognitive biases may explain how CT increases suicide risk in psychosis.
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Mamtani H, Pathak H, Sakhardande KA, Gowda GS, Muliyala KP, Moirangthem S, Reddi VSK, Varambally S. Can peripheral brain-derived neurotrophic factor (BDNF) be a potential biomarker of suicide risk in schizophrenia? Schizophr Res 2022; 243:203-205. [PMID: 35398726 DOI: 10.1016/j.schres.2022.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/14/2022] [Accepted: 03/21/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Harkishan Mamtani
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Harsh Pathak
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Kasturi Atmaram Sakhardande
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Guru S Gowda
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Krishna Prasad Muliyala
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Sydney Moirangthem
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Venkata Senthil Kumar Reddi
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India.
| | - Shivarama Varambally
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
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Pelizza L, Pellegrini C, Quattrone E, Azzali S, Landi G, Pellegrini P, Leuci E. Suicidal Thinking and Behavior in First Episode Schizophrenia: Findings from the 24-Month Follow-Up of the "Parma Early Psychosis" Program. Arch Suicide Res 2022; 26:656-676. [PMID: 32970972 DOI: 10.1080/13811118.2020.1820411] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Although suicide risk is relevant in First Episode Schizophrenia (FES), little data are reported on suicidal ideation and its longitudinal stability. Aim of this study was: (1) to evaluate incidence rates of suicide attempts, completed suicide and suicidal thinking in FES patients at baseline and along a 24-month follow-up period, (2) to investigate any relevant association of baseline suicidal ideation with psychopathology, and (3) to longitudinally monitor suicidal thinking during the 2-years of follow-up. Participants (n = 149; age = 12-35 years) were assessed with the Brief Psychiatric Rating Scale (BPRS) and the Positive and Negative Syndrome Scale. FES participants showed a 40.8% percentage of baseline suicidal ideation (i.e., BPRS item 4 cutoff score of ≥3) and a 2-year cumulative incidence rate of attempted suicide of 6.1%. One completed suicide (0.7%) was also found during the follow-up. Baseline suicidal ideation was positively correlated with depression and negatively correlated with younger age. These results support a routine monitoring of suicide risk in this young population at the point of entry into early intervention services.
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Vold JH, Løberg EM, Aas CF, Steier JA, Johansson KA, Fadnes LT. Prevalence and correlates of suicide attempts in high-risk populations: a cross-sectional study among patients receiving opioid agonist therapy in Norway. BMC Psychiatry 2022; 22:181. [PMID: 35291968 PMCID: PMC8922793 DOI: 10.1186/s12888-022-03829-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 03/03/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Death by suicide in patients enrolled in opioid agonist therapy (OAT) is a major clinical concern. However, little knowledge exists regarding suicide attempts in this patient group. This study presents the lifetime prevalence of suicide attempts and the associations between suicide attempts and clinical and sociodemographic variables such as education, sex, early onset of substance use (< 13 years of age), substance use patterns, and injecting substance use among patients receiving OAT. METHODS We used data from a cohort of OAT patients in Norway obtained from a health assessment of self-reported suicide attempts and sociodemographic and clinical factors. A total of 595 patients receiving OAT were assessed from 2016 to 2020. A binary logistic regression analysis was performed and reported with an unadjusted odds ratio and 95% confidence intervals (OR). The purpose of this assessment was to analyze associations between suicide attempts and substance use patterns as well as the injection of substances during the 30 days leading up to the health assessment. A negative binomial regression analysis with an incidence rate ratio and 95% confidence intervals (IRR) was performed to investigate sex, education, early onset of substance use, and the number of suicide attempts. RESULTS Forty-one percent of the OAT patients had attempted to die by suicide at least once during their lifetime. An early onset of substance use was strongly associated with the suicide attempts (IRR: 1.7, 1.3-2.2). No significant association was found between suicide attempts and sex (IRR: 1.2, 0.9-1.6) or education (IRR: 0.6, 0.2-2.1). Likewise, no association was identified between suicide attempts and injecting substance use (OR: 0.9, 0.6-1.3), nor using alcohol (OR: 0.9, 0.7-1.3), amphetamines (OR: 1.0, 0.7-1.3), benzodiazepines (OR: 1.0, 0.7-1.4), cannabis (OR: 1.2, 0.9-1.7), cocaine (OR: 1.3, 0.6-3.0), or opioids (OR: 1.4, 0.9-2.0). CONCLUSION The lifetime prevalence of suicide attempts was alarmingly high in the OAT population. An early onset of substance use seemed to be an important risk factor for suicide attempts. There was a non-significant association to more current use of opioids among OAT patients with previous suicide attempts.
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Affiliation(s)
- Jørn Henrik Vold
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway. .,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway. .,Department of Psychiatry, Haukeland University Hospital, Bergen, Norway.
| | - Else-Marie Løberg
- grid.412008.f0000 0000 9753 1393Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway ,grid.412008.f0000 0000 9753 1393Department of Psychiatry, Haukeland University Hospital, Bergen, Norway ,grid.7914.b0000 0004 1936 7443Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Christer F. Aas
- grid.412008.f0000 0000 9753 1393Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway ,grid.7914.b0000 0004 1936 7443Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway ,grid.412008.f0000 0000 9753 1393Department of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Jan Alexander Steier
- grid.412008.f0000 0000 9753 1393Department of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Kjell Arne Johansson
- grid.412008.f0000 0000 9753 1393Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway ,grid.7914.b0000 0004 1936 7443Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Lars Thore Fadnes
- grid.412008.f0000 0000 9753 1393Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway ,grid.7914.b0000 0004 1936 7443Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Kowalski K, Bogudzińska B, Stańczykiewicz B, Piotrowski P, Bielawski T, Samochowiec J, Szczygieł K, Plichta P, Misiak B. The Deficit Schizophrenia Subtype Is Associated with Low Adherence to the Mediterranean Diet: Findings from a Case–Control Study. J Clin Med 2022; 11:jcm11030568. [PMID: 35160019 PMCID: PMC8836983 DOI: 10.3390/jcm11030568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/17/2022] [Accepted: 01/20/2022] [Indexed: 11/16/2022] Open
Abstract
Accumulating evidence indicates that individuals with schizophrenia show poor dietary habits that might account for increased susceptibility to cardiovascular diseases in this population. However, it remains unknown whether this observation can be generalized over the whole population of individuals with schizophrenia. Therefore, in this study we aimed to investigate dietary habits, in terms of adherence to the Mediterranean diet (MD) in subjects with the deficit subtype of schizophrenia (SCZ-D), those with non-deficit subtype (SCZ-ND), and healthy controls (HCs). We recruited 45 individuals with SCZ-ND, 40 individuals with SCZ-D, and 60 HCs. Dietary habits were assessed using the Food Frequency Questionnaire-6 with a 12-month recall. Adherence to MD was decreased only in subjects with SCZ-D compared with HCs. Lower adherence to MD was associated with significantly higher levels of clinician-rated and self-reported negative symptoms (including alogia, avolition, and anhedonia). No significant correlations of adherence to MD with depressive symptoms were found. Lower adherence to MD was related to significantly higher body mass index in subjects with schizophrenia, but not in HCs. Our results indicate that poor adherence to MD is associated with a diagnosis of SCZ-D, higher severity of negative symptoms, and greater risk of developing overweight or obesity.
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Affiliation(s)
- Krzysztof Kowalski
- Department of Psychiatry, Division of Consultation Psychiatry and Neuroscience, Wroclaw Medical University, 50-367 Wroclaw, Poland; (K.K.); (B.B.); (B.S.); (P.P.)
| | - Bogna Bogudzińska
- Department of Psychiatry, Division of Consultation Psychiatry and Neuroscience, Wroclaw Medical University, 50-367 Wroclaw, Poland; (K.K.); (B.B.); (B.S.); (P.P.)
| | - Bartłomiej Stańczykiewicz
- Department of Psychiatry, Division of Consultation Psychiatry and Neuroscience, Wroclaw Medical University, 50-367 Wroclaw, Poland; (K.K.); (B.B.); (B.S.); (P.P.)
| | - Patryk Piotrowski
- Department of Psychiatry, Division of Consultation Psychiatry and Neuroscience, Wroclaw Medical University, 50-367 Wroclaw, Poland; (K.K.); (B.B.); (B.S.); (P.P.)
| | - Tomasz Bielawski
- Department and Clinic of Psychiatry, Wroclaw Medical University, 50-367 Wroclaw, Poland;
| | - Jerzy Samochowiec
- Department and Clinic of Psychiatry, Pomeranian Medical University, 71-457 Szczecin, Poland; (J.S.); (K.S.); (P.P.)
| | - Krzysztof Szczygieł
- Department and Clinic of Psychiatry, Pomeranian Medical University, 71-457 Szczecin, Poland; (J.S.); (K.S.); (P.P.)
| | - Piotr Plichta
- Department and Clinic of Psychiatry, Pomeranian Medical University, 71-457 Szczecin, Poland; (J.S.); (K.S.); (P.P.)
| | - Błażej Misiak
- Department of Psychiatry, Division of Consultation Psychiatry and Neuroscience, Wroclaw Medical University, 50-367 Wroclaw, Poland; (K.K.); (B.B.); (B.S.); (P.P.)
- Correspondence:
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Ongeri L, Kariuki SM, Nyawira M, Schubart C, Tijdink JK, Newton CRJC, Penninx BWJH. Suicidal attempts and ideations in Kenyan adults with psychotic disorders: An observational study of frequency and associated risk factors. Front Psychiatry 2022; 13:1085201. [PMID: 36741571 PMCID: PMC9892760 DOI: 10.3389/fpsyt.2022.1085201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/28/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Psychotic disorders increase the risk for premature mortality with up to 40% of this mortality attributable to suicide. Although suicidal ideation (SI) and suicidal behavior (SB) are high in persons with psychotic disorders in sub-Saharan Africa, there is limited data on the risk of suicide and associated factors among persons with psychotic disorders. METHODS We assessed SI and SB in persons with psychotic disorders, drawn from a large case-control study examining the genetics of psychotic disorders in a Kenyan population. Participants with psychotic disorders were identified using a clinical review of records, and the diagnosis was confirmed with the Mini-International Neuropsychiatric Interview (MINI). We conducted bivariate and multivariate logistic (for binary suicide outcomes) or linear regression (for suicide risk score) analysis for each of the suicide variables, with demographic and clinical variables as determinants. RESULTS Out of 619 participants, any current SI or lifetime suicidal attempts was reported by 203 (32.8%) with psychotic disorders, of which 181 (29.2%) had a lifetime suicidal attempt, 60 (9.7%) had SI in the past month, and 38 (20.9%) had both. Family history of suicidality was significantly associated with an increased risk of suicidality across all the following four outcomes: SI [OR = 2.56 (95% CI: 1.34-4.88)], suicidal attempts [OR = 2.01 (95% CI: 1.31-3.06)], SI and SB [OR = 2.00 (95% CI: 1.31-3.04)], and suicide risk score [beta coefficient = 7.04 (2.72; 11.36), p = 0.001]. Compared to persons aged <25 years, there were reduced odds for SI for persons aged ≥ 25 years [OR = 0.30 (95% CI: 0.14-0.62)] and ≥ 45 years [OR = 0.32 (95% CI: 0.12-0.89)]. The number of negative life events experienced increased the risk of SI and SB [OR = 2.91 (95% CI: 1.43-5.94)] for 4 or more life events. Higher negative symptoms were associated with more suicidal attempts [OR = 2.02 (95%CI: 1.15-3.54)]. Unemployment was also associated with an increased risk for suicidal attempts [OR = 1.58 (95%CI: 1.08-2.33)] and SI and SB [OR = 1.68 (95% CI: 1.15-2.46)]. CONCLUSION Suicidal ideation and SB are common in persons with psychotic disorders in this African setting and are associated with sociodemographic factors, such as young age and unemployment, and clinical factors, such as family history of suicidality. Interventions targeted at the community (e.g., economic empowerment) or at increasing access to care and treatment for persons with psychotic disorders may reduce the risk of suicide in this vulnerable population group.
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Affiliation(s)
- Linnet Ongeri
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Symon M Kariuki
- Department of Public Health, Pwani University, Kilifi, Kenya.,Neuroscience Unit, Kenya Medical Research Institute-Wellcome Trust Research Program, Kilifi, Kenya.,Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Miriam Nyawira
- Neuroscience Unit, Kenya Medical Research Institute-Wellcome Trust Research Program, Kilifi, Kenya
| | | | - Joeri K Tijdink
- Department of Ethics, Law and Humanities, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Philosophy, Faculty of Humanities, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Charles R J C Newton
- Department of Public Health, Pwani University, Kilifi, Kenya.,Neuroscience Unit, Kenya Medical Research Institute-Wellcome Trust Research Program, Kilifi, Kenya.,Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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