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Chaturvedi J, Stewart R, Ashworth M, Roberts A. Distributions of recorded pain in mental health records: a natural language processing based study. BMJ Open 2024; 14:e079923. [PMID: 38642997 PMCID: PMC11033644 DOI: 10.1136/bmjopen-2023-079923] [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: 09/18/2023] [Accepted: 02/28/2024] [Indexed: 04/22/2024] Open
Abstract
OBJECTIVE The objective of this study is to determine demographic and diagnostic distributions of physical pain recorded in clinical notes of a mental health electronic health records database by using natural language processing and examine the overlap in recorded physical pain between primary and secondary care. DESIGN, SETTING AND PARTICIPANTS The data were extracted from an anonymised version of the electronic health records of a large secondary mental healthcare provider serving a catchment of 1.3 million residents in south London. These included patients under active referral, aged 18+ at the index date of 1 July 2018 and having at least one clinical document (≥30 characters) between 1 July 2017 and 1 July 2019. This cohort was compared with linked primary care records from one of the four local government areas. OUTCOME The primary outcome of interest was the presence of recorded physical pain within the clinical notes of the patients, not including psychological or metaphorical pain. RESULTS A total of 27 211 patients were retrieved. Of these, 52% (14,202) had narrative text containing relevant mentions of physical pain. Older patients (OR 1.17, 95% CI 1.15 to 1.19), females (OR 1.42, 95% CI 1.35 to 1.49), Asians (OR 1.30, 95% CI 1.16 to 1.45) or black (OR 1.49, 95% CI 1.40 to 1.59) ethnicities, living in deprived neighbourhoods (OR 1.64, 95% CI 1.55 to 1.73) showed higher odds of recorded pain. Patients with severe mental illnesses were found to be less likely to report pain (OR 0.43, 95% CI 0.41 to 0.46, p<0.001). 17% of the cohort from secondary care also had records from primary care. CONCLUSION The findings of this study show sociodemographic and diagnostic differences in recorded pain. Specifically, lower documentation across certain groups indicates the need for better screening protocols and training on recognising varied pain presentations. Additionally, targeting improved detection of pain for minority and disadvantaged groups by care providers can promote health equity.
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Affiliation(s)
- Jaya Chaturvedi
- Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - Robert Stewart
- Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Mark Ashworth
- School of Population Health & Environmental Sciences, King's College, London, UK
| | - Angus Roberts
- Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
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Fujita K, Mori Y, Kakumae Y, Takeuchi N, Kanemoto K, Nishihara M. Pre-emptive ice pack cryotherapy for reducing pain caused by long-acting deltoid injectable antipsychotic treatment: A single-center open-label study. Schizophr Res 2024; 266:19-23. [PMID: 38364729 DOI: 10.1016/j.schres.2024.02.009] [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: 07/01/2023] [Revised: 01/29/2024] [Accepted: 02/10/2024] [Indexed: 02/18/2024]
Abstract
PURPOSE This empirical study aims to investigate the efficacy of pre-emptive cryotherapy in reducing pain that is caused by the deltoid intramuscular (IM) injection of long-acting injectable (LAI) antipsychotics in clinical settings. PATIENTS AND METHODS This study included 29 outpatients receiving LAI antipsychotic treatment. The evaluations of pain during (1) the usual procedure (control), (2) pre-emptive use of ice pack cryotherapy (pre-cooling), and (3) pre-emptive use of a room-temperature ice pack (pre-touching) were conducted using a numerical rating scale (NRS) for comparison. All patients were administered with LAI antipsychotics via deltoid IM. Furthermore, the results of the Positive and Negative Symptom Scale (PANSS), clinical global impressions (CGI) scale, and Global Assessment of Functioning (GAF) scale that were administered during the control procedure were evaluated. RESULTS The median NRS pain scores during the IM injection of LAI antipsychotics were 4.0 (3.0-5.0), 2.0 (1.0-3.0), and 3.0 (2.5-6.0) for the control, pre-cooling, and pre-touching conditions, indicating a significant difference (p = 6.0 × 10-6). The NRS pain scores for the pre-cooling condition were significantly lower than those for the control and pre-touching conditions (p = 2.5 × 10-5 and 6.7 × 10-5, respectively). No significant correlation was observed between the NRS pain scores for the control condition and the PANSS, CGI scale, or GAF scale scores. Furthermore, no adverse events were recorded during the study period. CONCLUSION Pain during the deltoid IM injection of LAI antipsychotics was found to be reduced by pre-emptive skin cooling. To date, this is the first study to confirm the effectiveness of pre-emptive cryotherapy for relieving such pain in clinical situations.
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Affiliation(s)
- Kohei Fujita
- Neuropsychiatric Department, Aichi Medical University, Nagakute 480-1195, Japan.
| | - Yasuhiro Mori
- Neuropsychiatric Department, Aichi Medical University, Nagakute 480-1195, Japan
| | - Yu Kakumae
- Department of Psychiatry, Takarakai Sippou Hospital, Ama 497-0012, Japan
| | - Nobuyuki Takeuchi
- Department of Psychiatry, Okazaki City Hospital, Okazaki 444-8585, Japan
| | - Kousuke Kanemoto
- Neuropsychiatric Department, Aichi Medical University, Nagakute 480-1195, Japan
| | - Makoto Nishihara
- Neuropsychiatric Department, Aichi Medical University, Nagakute 480-1195, Japan; Department of Psychiatry, Kamibayashi memorial Hospital, Ichinomiya 491-0201, Japan; Multidisciplinary Pain Center, Aichi Medical University, Nagakute 480-1195, Japan
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Schaible SF, Hamann C, Grunt S, Aregger FC, Deml MC. Case report: C1/2 rotational instability progressing to extreme subaxial hyperkyphosis in an adolescent with severe catatonia. BRAIN & SPINE 2024; 4:102747. [PMID: 38510616 PMCID: PMC10951775 DOI: 10.1016/j.bas.2024.102747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 01/05/2024] [Indexed: 03/22/2024]
Abstract
Introduction Autism spectrum disorder (ASD) is characterized by deficits in social communication, repetitive behaviors, and can be accompanied by a spectrum of psychiatric symptoms, such as schizophrenia and catatonia. Rarely, these symptoms, if left untreated, can result in spinal deformities. Research question and case description This case report details the treatment of a 16-year-old male ASD patient with catatonic schizophrenia and mutism, presenting with neck pain, left-rotated torticollis, and fever. MRI revealed atlantoaxial rotational instability and spinal cord compression from a dislocated dens axis. After inconclusive biopsies, empirical antibiotics, hard collar and halo fixation treatment, persistent instability necessitated C1/2 fusion. The ongoing catatonia was addressed with electroconvulsive therapy. Concurrently, he developed severe subaxial hyperkyphosis. The report examines the decision-making between conservative and surgical management for an adolescent with significant psychiatric comorbidity and progressive spinal symptoms against a backdrop of uncertain etiology. Materials and methods A case report and review of the literature. Results Posterior C1-C7 stabilization was successfully executed, effectively restoring cervical sagittal alignment, which was maintained throughout a two-year follow-up. Concurrently, the catatonia resolved. Discussion and conclusion To our knowledge, this is the third reported case of severe cervical deformity associated with fixed posture in a psychiatric patient. This case report emphasizes the critical importance of multidisciplinary collaboration in managing the interplay between neuropsychiatric disorders and severe spinal deformities. It showcases the practicality and efficacy of surgical intervention for persistent cervical deformity in pediatric schizophrenia patients, highlighting the necessity for a comprehensive risk-benefit analysis.
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Affiliation(s)
- Samuel F Schaible
- Department of Orthopaedic Surgery and Traumatology, University Hospital Bern, Inselspital, University of Bern, CH-3010 Bern, Switzerland
| | - Christoph Hamann
- Division of Child and Adolescent Psychiatry and Psychosomatic Medicine, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland
| | - Sebastian Grunt
- Division of Neuropaediatrics, Development and Rehabilitation, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland
| | - Fabian C Aregger
- Department of Orthopaedic Surgery and Traumatology, University Hospital Bern, Inselspital, University of Bern, CH-3010 Bern, Switzerland
| | - Moritz C Deml
- Department of Orthopaedic Surgery and Traumatology, University Hospital Bern, Inselspital, University of Bern, CH-3010 Bern, Switzerland
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Kishikawa Y, Kawahara Y, Ohnishi YN, Sotogaku N, Koeda T, Kawahara H, Nishi A. Dysregulation of dopamine neurotransmission in the nucleus accumbens in immobilization-induced hypersensitivity. Front Pharmacol 2022; 13:988178. [PMID: 36160381 PMCID: PMC9493457 DOI: 10.3389/fphar.2022.988178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 08/26/2022] [Indexed: 12/03/2022] Open
Abstract
Cast immobilization causes sensory hypersensitivity, which is also a symptom of neuropathic pain and chronic pain. However, the mechanisms underlying immobilization-induced hypersensitivity remain unclear. The present study investigated the role of dopamine neurotransmission in the nucleus accumbens shell (NAcSh) of rats with cast immobilization-induced mechanical hypersensitivity using in vivo microdialysis. Cast immobilization of the hind limb decreased the paw withdrawal threshold (PWT). Mechanical stimulation of the cast-immobilized hind limb induced a decrease in dopamine in the NAcSh, and this decrease was associated with the upregulation of presynaptic D2-like receptors. A D2-like receptor antagonist infused into the NAcSh reversed the decrease in PWT in rats with cast immobilization, whereas a D2-like receptor agonist infused into the NAcSh induced a decrease in PWT in control rats. In addition, the expression of the D2 receptor (Drd2) mRNA in the NAcSh was increased by cast immobilization. Importantly, systemic administration of the D2-like receptor antagonist reversed the decrease in PWT in rats with cast immobilization. As dopamine levels regulated by presynaptic D2-like receptors did not correlate with the PWT, it is presumed that the D2-like receptor antagonist or agonist acts on postsynaptic D2-like receptors. These results suggest that immobilization-induced mechanical hypersensitivity is attributable to the upregulation of postsynaptic D2-like receptors in the NAc. Blockade of D2-like receptors in the NAcSh is a potential therapeutic strategy for immobilization-induced hypersensitivity.
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Affiliation(s)
- Yuki Kishikawa
- Department of Rehabilitation Sciences, Faculty of Rehabilitation Sciences, Nishikyushu University, Kanzaki, Japan
- Department of Pharmacology, Kurume University School of Medicine, Kurume, Japan
| | - Yukie Kawahara
- Department of Pharmacology, Kurume University School of Medicine, Kurume, Japan
- *Correspondence: Yukie Kawahara, ; Akinori Nishi,
| | | | - Naoki Sotogaku
- Department of Pharmacology, Kurume University School of Medicine, Kurume, Japan
| | - Tomoko Koeda
- Department of Physical Therapy, Faculty of Rehabilitation Sciences, Nagoya Gakuin University, Nagoya, Japan
| | - Hiroshi Kawahara
- Department of Dental Anesthesiology, Tsurumi University School of Dental Medicine, Yokohama, Japan
| | - Akinori Nishi
- Department of Pharmacology, Kurume University School of Medicine, Kurume, Japan
- *Correspondence: Yukie Kawahara, ; Akinori Nishi,
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Baklouti E, Karoui M, Kammoun R, Ellouze F. Case report: Schizophrenia and hypertrophic osteoarthropathy, a rare syndrome hiding a life-threatening condition. Clin Case Rep 2022; 10:e05247. [PMID: 35059198 PMCID: PMC8755596 DOI: 10.1002/ccr3.5247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/26/2021] [Accepted: 12/05/2021] [Indexed: 11/10/2022] Open
Abstract
Schizophrenia is associated to somatic disorders especially cardio-vascular and auto-immune. Through this case report, we describe an association with hypertrophic osteoarthropathy (HPO). For this patient, it was a paraneoplastic syndrome secondary to lung cancer. This syndrome is rare but important to recognize since it could hide a life-threatening condition.
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Affiliation(s)
- Emna Baklouti
- Psychiatry DepartmentRazi Psychiatric HospitalManoubaTunisia
| | - Mehdi Karoui
- Psychiatry DepartmentRazi Psychiatric HospitalManoubaTunisia
| | - Rania Kammoun
- Psychiatry DepartmentRazi Psychiatric HospitalManoubaTunisia
| | - Faten Ellouze
- Psychiatry DepartmentRazi Psychiatric HospitalManoubaTunisia
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6
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Evaluation of acute and chronic nociception in subchronically administered MK-801-induced rat model of schizophrenia. Behav Pharmacol 2021; 32:571-580. [PMID: 34494988 DOI: 10.1097/fbp.0000000000000651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Patients diagnosed with schizophrenia have been reported to exhibit atypically low pain sensitivity and to vary in their experience of chronic pain. To the best of our knowledge, there has yet to be an animal study that provides information concerning the relationship between models of schizophrenia and pain. In the present study, we investigated several distinct nociceptive behaviors in a translational rat model of schizophrenia (0. 5 mg/kg MK-801, twice a day for 7 days followed by a 7-day washout period). The presence of the expected cognitive deficit was confirmed with novel object recognition (NOR) paradigm prior to nociception testing. MK-801-treated rats with lack of novelty interest in NOR testing showed: hyposensitivity to thermal and mechanical stimuli; short-term hypoalgesia followed by augmented hyperalgesia in response to formalin-induced spontaneous nociception and increased thermal and mechanical hyperalgesia in the complete Freund's adjuvant (CFA) induced chronic pain model. In conclusion, MK-801 induced antinociception effects for thermal stimuli in rats that were consistent with the decreased pain sensitivity observed in schizophrenia patients. Additionally, the amplified biphasic response exhibited by the MK-801 group in the formalin-induced spontaneous nociception test affirms the suitability of the test as a model of acute to delayed pain transition.
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Denis F, Rouached I, Siu-Paredes F, Delpierre A, Amador G, El-Hage W, Rude N. Psychometric Properties of the Schizophrenia Oral Health Profile: Preliminary Results. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179090. [PMID: 34501679 PMCID: PMC8430897 DOI: 10.3390/ijerph18179090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 12/20/2022]
Abstract
The Schizophrenia Oral Health Profile questionnaire was developed to assess the oral health-related quality of life among individuals with schizophrenia based on their perceptions rather than from caregivers. A 5-point Likert scale was used to self-report on 42 items. In the present study, different analyses were conducted to determine the dimensional structure of the final scale: (1) inter-item correlation analysis and Cronbach’s α coefficient, (2) Rasch model analysis, (3) exploratory factor analysis and (4) confirmatory factor analysis. The final version of the Schizophrenia Oral Health Profile questionnaire consisted of 20 items and an internal structure composed of three dimensions: (1) emotions related to oral health, (2) oral pain and discomfort and (3) self-image, others’ views and the need for care. We showed that the difficulty and discrimination indices of each of the 20 selected items were acceptable according to the Rasch model, as well as their inter-item and inter-score correlations (α = 0.875). The psychometric study of the Schizophrenia Oral Health Profile questionnaire is still in progress to investigate reproducibility, sensitivity to change and external structure.
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Affiliation(s)
- Frédéric Denis
- Faculty of Dentistry, Nantes University, 44000 Nantes, France;
- Department of Odontology, Tours University Hospital, 37000 Tours, France;
- EA 75-05 Education, Ethique, Santé, Faculté de Médecine, Université de Tours, 37000 Tours, France
- Correspondence:
| | - Ines Rouached
- EA 481 Integrative and Clinical Neurosciences, University of Besançon, 25000 Besançon, France; (I.R.); (F.S.-P.); (N.R.)
| | - Francesca Siu-Paredes
- EA 481 Integrative and Clinical Neurosciences, University of Besançon, 25000 Besançon, France; (I.R.); (F.S.-P.); (N.R.)
- Faculté d’Odontologie de Reims, Université Champagne Ardenne, 51100 Reims, France
| | - Alexis Delpierre
- Department of Odontology, Tours University Hospital, 37000 Tours, France;
| | - Gilles Amador
- Faculty of Dentistry, Nantes University, 44000 Nantes, France;
| | - Wissam El-Hage
- U1253, iBrain, CIC1415, Inserm, CHRU de Tours (Regional University Hospital Centre), Université de Tours, 37000 Tours, France;
| | - Nathalie Rude
- EA 481 Integrative and Clinical Neurosciences, University of Besançon, 25000 Besançon, France; (I.R.); (F.S.-P.); (N.R.)
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O'Connell F, Osiyemi N, Saliba Z, Mortimer N, Pourmand A. Reduced pain perception in patients with schizophrenia; A missed case of hand fracture. Am J Emerg Med 2021; 49:440.e1-440.e3. [PMID: 33965278 DOI: 10.1016/j.ajem.2021.04.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 04/25/2021] [Indexed: 10/21/2022] Open
Abstract
Altered pain perception among patients with schizophrenia is often underrecognized in the medical community. The cause is not known, and medical professionals are not sure whether these patients experience less pain or are simply unable to express it. There are documented cases of patients with schizophrenia presenting to hospital settings with serious injuries without obvious (expected) pain. Research into the underlying cause(s) is underway; meanwhile, ensuring awareness of this issue among medical providers is of upmost importance. We report a case of a patient with schizophrenia who presented voluntarily to the emergency department (ED) with a hand fracture that went unrecognized in the ED and further discuss the implications of reduced pain perception. Additionally, we summarize existing hypotheses regarding the source of this reduced pain perception in this population.
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Affiliation(s)
- Francis O'Connell
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States.
| | - Naiya Osiyemi
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Zeina Saliba
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States; Department of Psychiatry & Behavioral Sciences, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Nakita Mortimer
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Ali Pourmand
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
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Denis F, Siu-Paredes F, Maitre Y, Amador G, Rude N. A qualitative study on experiences of persons with schizophrenia in oral-health-related quality of life. Braz Oral Res 2021; 35:e050. [PMID: 33759972 DOI: 10.1590/1807-3107bor-2021.vol35.0050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 10/30/2020] [Indexed: 11/21/2022] Open
Abstract
Our study aimed to explore the views and experiences in oral health and oral-health-related quality of life (OHRQoL) of persons with schizophrenia (PWS) in order to expand the understanding of the factors that either limit or facilitate their healthcare pathway, which can ultimately optimize their oral health and/or OHRQoL. A qualitative study was conducted in France in the Côte d'Or department (530 000 in habitants) centered on PWS's perceived meanings regarding oral health or OHRQoL, and semi-structured individual interviews were used. A conventional content analysis approach was chosen in order to highlight unrevealed themes. A sample of 20 PWS (12 males; 8 females) with a median age was 45.8 (± 9.5) were recruited to assess views and experiences regarding OHRQoL, which were focused on three dimensions: an individual dimension related to experience of "oral symptoms", a second dimension related to experience of "stress and its management", and a third related to "Autonomy dimension in oral health". We showed that PWS clearly expressed their mental representations of oral health and OHRQoL. This study supports that PWS were able to define their needs and had the ability to discuss their oral health and OHRQoL. These finding could be used to support specific interventions for this population to better manage the negative impact of antipsychotics and help them to consult dentists on a regular basis.
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Affiliation(s)
- Frédéric Denis
- Université François-Rabelais, Faculté de Médecine, Santé, Tours, France
| | | | | | - Gilles Amador
- Université de Nantes, Faculté d'Odontologie, Nantes, France
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Pain Sensitivity in Schizophrenia Spectrum Disorders: A Narrative Review of Recent Work. PSYCHIATRY INTERNATIONAL 2021. [DOI: 10.3390/psychiatryint2010004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Many patients with schizophrenia seem relatively immune to physical pain while others complain of constant pain. This may result from disturbances or alterations of the sensory threshold for pain in populations with psychosis, a possibility for which there is some preliminary evidence. The inconsistency in pain perception may, in part, be explained by the treatments patients receive, but treatment-naïve patients also exhibit differences in response to pain. This suggests that decreased pain sensitivity may represent a specific psychosis endophenotype. Thus far, few experimental studies have investigated sensory thresholds, pain modalities, or other factors contributing to the perception or expression of physical pain in psychosis. A digital search for information on this topic was conducted in PubMed and Google Scholar. The result is a non-systematic, narrative review focusing on recent clinical and experimental findings of pain sensitivity in patients with psychosis. Importantly, physical and mental pain are closely connected constructs that may be difficult to differentiate. Our hope is that the review provides some clarity to the field in the specific context of schizophrenia.
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Taylor MT, Horton DB, Juliano T, Olfson M, Gerhard T. Outpatient prescribing of opioids to adults diagnosed with mental disorders in the United States. Drug Alcohol Depend 2021; 219:108414. [PMID: 33307300 PMCID: PMC8140618 DOI: 10.1016/j.drugalcdep.2020.108414] [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: 01/21/2020] [Revised: 11/06/2020] [Accepted: 11/12/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Adults with mood and anxiety disorders have an increased likelihood of being prescribed opioids. The influence of other mental disorders, such as psychotic and attention disorders, on opioid prescribing patterns is less known. METHODS We studied a population-representative sample of 166,927 outpatient visits for adults with painful conditions from the 2002-2016 National Ambulatory Medical Care Survey and the 2002-2011 National Hospital Ambulatory Medical Care Survey. Logistic regression analyses examined the likelihood of opioid prescription among visits with specific mental disorder diagnoses (anxiety, attention, mood, psychotic, post-traumatic stress disorder (PTSD), opioid use, and non-opioid substance use), adjusted for covariates and weighted for the complex survey design. Secondary analyses stratified results by whether opioids were newly initiated or continued. RESULTS Opioids were prescribed at 16.8 % of visits. Mood, anxiety, and non-opioid substance use disorders were associated with higher likelihoods of opioid prescriptions, particularly for continued rather than first-time prescriptions. Psychotic disorders were strongly negatively associated with opioid prescriptions (adjusted odds ratio 0.44, 95 % CI 0.22-0.86). Diagnoses of PTSD and attention disorders were not associated with opioid prescribing. CONCLUSIONS Outpatient physicians are more likely to prescribe and refill opioids for adults with pain who present with mood, anxiety, and non-opioid substance use disorders, but not for those who present with PTSD or attention disorders. Patients with psychotic disorders and pain are markedly less likely to be prescribed opioids.
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Affiliation(s)
- Matthew T. Taylor
- Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut St., Philadelphia, Pennsylvania, 19107,Rutgers Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, 112 Paterson St., New Brunswick, New Jersey, 08901
| | - Daniel B. Horton
- Rutgers Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, 112 Paterson St., New Brunswick, New Jersey, 08901,Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, 89 French St., New Brunswick, New Jersey, 08901
| | - Theresa Juliano
- National Opinion Research Center at The University of Chicago, 55 East Monroe Street, 30th Floor, Chicago, Illinois 60603
| | - Mark Olfson
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, 1051 Riverside Drive, New York, New York, 10032
| | - Tobias Gerhard
- Rutgers Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, 112 Paterson St., New Brunswick, NJ, 08901, USA; Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, 160 Frelinghuysen Road, Piscataway, NJ, 08854, USA.
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The Opioid Interactions of the Antipsychotic Medications Risperidone and Amisulpride in Mice and Their Potential Use in the Treatment of Other Non-Psychotic Medical Conditions. Cell Mol Neurobiol 2020; 41:1077-1084. [PMID: 33184770 DOI: 10.1007/s10571-020-01001-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 11/06/2020] [Indexed: 12/20/2022]
Abstract
Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. The opioid epidemic in the USA has highlighted the need for alternative treatments for pain. Following reports on the opioid interactions of various antipsychotic medications, we speculated that the involvement of the opioid system in some of the antipsychotics' mechanism of action may suggest their potential use in the treatment of pain. Risperidone is a neuroleptic with a potent dopamine D2 and serotonin 5-HT2 receptor-blocking activity as well as a high affinity for adrenergic and histamine H1 receptors. Amisulpride is a neuroleptic which selectively blocks dopamine D2 and D3 receptors. Both had a potent antinociceptive effect on ICR mice tested with a tail flick assay. That effect on both medications was antagonized by naloxone, indicating that at least some of the antinociceptive effects were mediated by an opioid mechanism of action. Further investigation found that β-Funaltrexamine hydrochloride (β-FNA), naloxonazine, and nor-Binaltorphimine dihydrochloride (nor-BNI) reversed the antinociceptive effect of both risperidone and amisulpride. Naltrindole at a dose that blocked [D-Pen2,D-Pen5]enkephalin (DPDPE, δ analgesia) blocked notably amisplride effect and only partially reversed that of risperidone. Risperidone induced an antinociceptive effect, implying involvement of μ and κ-opioid and δ-opioid mechanisms. Amisulpride-induced antinociception was mediated through selective involvement of all three opioid receptor subtypes. These findings emphasize the need for clinical trials to assess the possibility of extending the spectrum of medications available for the treatment of pain.
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An Obsessive-Compulsive Symptom-Related Headache in a Patient with Schizophrenia. Case Rep Psychiatry 2020; 2020:8824204. [PMID: 33101750 PMCID: PMC7576360 DOI: 10.1155/2020/8824204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 08/25/2020] [Accepted: 10/05/2020] [Indexed: 11/30/2022] Open
Abstract
Obsessive-compulsive symptoms are prevalent, manifold, and sometimes insidious in patients with schizophrenia. In this case study, we reported an intractable headache that bears a close relationship with obsessive-compulsive symptoms in a schizophrenia patient. In a series of treatments, the headache was miraculously susceptible to haloperidol treatment.
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Hindmarsh J, Huggin A, Belfonte A, Lee M, Pickard J. Subcutaneous Olanzapine at the End of Life in a Patient with Schizophrenia and Dysphagia. Palliat Med Rep 2020; 1:72-75. [PMID: 34223460 PMCID: PMC8241334 DOI: 10.1089/pmr.2020.0039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2020] [Indexed: 11/13/2022] Open
Abstract
Currently, there is a paucity of evidence to guide the management of antipsychotic therapy at the end of life for patients with schizophrenia. A 51-year-old female with a diagnosis of palliative squamous cell carcinoma of the tonsils was admitted to her local hospice for end-of-life care. She had a history of treatment-resistant schizophrenia, which was ordinarily managed with oral clozapine and aripiprazole. Owing to a deteriorating swallow and the inappropriateness of other enteral administration routes for this patient however, it became necessary to consider alternative means by which to give essential antipsychotic medicine. A subcutaneous infusion of olanzapine was chosen as the most viable solution. During the course of the admission, her schizophrenia began to relapse with the onset of positive psychotic symptoms (paranoia and hallucinations). This was posited as likely due to interruption of her regular oral antipsychotic medication combined with insufficient olanzapine dosing. The olanzapine dose was thus subsequently titrated over the course of a week with close monitoring, and her psychotic symptoms abated. Owing to a protracted dying phase, the patient remained on subcutaneous olanzapine for a total of 56 days, which allowed for accurate assessment of her psychiatric symptoms and evaluation of therapeutic response. The findings of this case report suggest that subcutaneous olanzapine may be an appropriate alternative for patients who are unable to take their complex oral antipsychotic regimens through enteral routes at the end of life.
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Affiliation(s)
- Jonathan Hindmarsh
- Specialist Centre for Palliative Care, St. Benedict's Hospice, Sunderland, United Kingdom
| | - Amy Huggin
- Specialist Centre for Palliative Care, St. Benedict's Hospice, Sunderland, United Kingdom
| | - Anya Belfonte
- Specialist Centre for Palliative Care, St. Benedict's Hospice, Sunderland, United Kingdom
| | - Mark Lee
- Specialist Centre for Palliative Care, St. Benedict's Hospice, Sunderland, United Kingdom
| | - Jonathan Pickard
- Specialist Centre for Palliative Care, St. Benedict's Hospice, Sunderland, United Kingdom
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15
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Lin HY, Hsieh JG, Hsieh CJ, Wang YW. Differences in the Opioid Consumption of Terminally Ill Schizophrenic and Nonschizophrenic Cancer Patients: Analysis of Secondary National Population Data. J Pain Symptom Manage 2020; 59:1232-1238. [PMID: 31884115 DOI: 10.1016/j.jpainsymman.2019.12.360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 12/15/2019] [Accepted: 12/16/2019] [Indexed: 01/14/2023]
Abstract
CONTEXT It is uncertain whether terminally ill schizophrenic cancer patients are hypoalgesic or have disparities in pain management. OBJECTIVES The objective of this study was to analyze the dosage of opioids used in terminally ill cancer patients with and without schizophrenia. METHODS This is a population-based retrospective cohort study based on data derived from the Taiwan National Health Insurance Research Database. Patients aged >20 years and newly diagnosed between 2000 and 2012 with at least one of the six most common cancers were included. After 1:4 matching, 1001 schizophrenic cancer patients comprised the schizophrenia cohort, while 4004 cancer patients without schizophrenia comprised the nonschizophrenia cohort. The percentage of opioid use, accumulated dose, and average daily dose near the end of life were analyzed for each cohort using multiple logistic and linear regression models. RESULTS The percentage of opioid use was lower in the schizophrenic cohort than the nonschizophrenic cohort during the last month before death (69.6% vs. 84.8%, odds ratio = 0.40, 95% CI = 0.34-0.48). The accumulated dose of opioid consumption was also lower in the schizophrenic cohort (2407 mg vs. 3694 mg, P value < 0.05). CONCLUSION Near the end of life, cancer patients with schizophrenia use less opioid than their nonschizophrenic counterparts. Cognitive impairment may be a cause in the disparity in end-of-life care for terminally ill schizophrenic cancer patients. Thus, we should formulate a more accurate pain scale system and pay attention to their need for pain treatment.
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Affiliation(s)
- Hao-Ying Lin
- Department of Family Medicine, E-Da Hospital, Kaohsiung, Taiwan, Republic of China
| | - Jyh-Gang Hsieh
- Department of Family Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan, Republic of China; School of Medicine, Tzu Chi University, Hualien, Taiwan, Republic of China
| | - Chia-Jung Hsieh
- Department of Public Health, Tzu Chi University, Hualien, Taiwan, Republic of China
| | - Ying-Wei Wang
- Department of Family Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan, Republic of China; School of Medicine, Tzu Chi University, Hualien, Taiwan, Republic of China.
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16
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Brennan PL, SooHoo S. Effects of Mental Health Disorders on Nursing Home Residents' Nine-Month Pain Trajectories. PAIN MEDICINE 2020; 21:488-500. [PMID: 31407787 DOI: 10.1093/pm/pnz177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine the key classes of nursing home residents' nine-month pain trajectories, the influence of residents' mental health disorders on membership in these classes, and nine-month health-related outcomes associated with pain trajectory class membership. METHODS Four times over a nine-month period, the MDS 3.0 resident assessment instrument was used to record the demographic characteristics, mental health disorder diagnoses, pain characteristics, and health and functioning outcomes of 2,539 Department of Veterans Affairs Community Living Center (VA CLC) residents. Growth mixture modeling was used to estimate the key classes of residents' nine-month pain trajectories, the influence of residents' mental health disorders on their pain trajectory class membership, and the associations of class membership with residents' health and functioning outcomes at nine-month follow-up. RESULTS Four-class solutions best described nursing home residents' nine-month trajectories of pain frequency, severity, and interference. Residents with dementia and severe mental illness diagnoses were less likely, and those with depressive disorder, PTSD, and substance use disorder diagnoses more likely, to belong to adverse nine-month pain trajectory classes. Membership in adverse pain frequency and pain severity trajectory classes, and in trajectory classes characterized by initially high but steeply declining pain interference, portended more depressive symptoms but better cognitive and physical functioning at nine-month follow-up. CONCLUSIONS Nursing home residents' mental health disorder diagnoses help predict their subsequent pain frequency, severity, and interference trajectories. This may be clinically useful information for improving pain assessment and treatment approaches for nursing home residents.
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Affiliation(s)
- Penny L Brennan
- Institute for Health & Aging, University of California, San Francisco, San Francisco, California, USA
| | - Sonya SooHoo
- Institute for Health & Aging, University of California, San Francisco, San Francisco, California, USA
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17
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Reyad AA, Girgis E, Ayoub A, Mishriky R. Bruxism and psychotropic medications. PROGRESS IN NEUROLOGY AND PSYCHIATRY 2020. [DOI: 10.1002/pnp.560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ayman Antoun Reyad
- Dr Antoun Reyad is a Senior Lecturer in Pharmacology, School of PharmacyUniversity of Wolverhampton
| | - Eriny Girgis
- Dr Girgis is a Dental Officer, Community Dental Service, City of Coventry Health Centre, Coventry and Warwickshire Partnership NHS Trust
| | - Amin Ayoub
- Dr Ayoub is an Associate Professor of DentistryNew York University New York
| | - Raafat Mishriky
- Dr Mishriky is Consultant Psychiatrist, Birmingham and Solihull Mental Health NHS Foundation Trust
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Abstract
We tested endogenous pain modulation mechanisms in adults with autism spectrum disorders (ASD). Nineteen ASD adults without intellectual disabilities were included, matched with 19 healthy volunteers on the basis of sex and chronological age. An experimental pain model was used to measure excitatory and inhibitory pain mechanisms in a single session. Statistical analyses indicated that endogenous pain modulation mechanisms in ASD group did not differ significantly from those of healthy adults. The pain scores were very disparate in ASD group with a greater range of extreme scores than in control group. Unlike schizophrenic patients, there was no systematic dysfunction of endogenous excitatory pain modulation mechanisms, but the high variability requires to be wise to interpret the results and formulate conclusion.
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19
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Owen-Smith A, Stewart C, Sesay MM, Strasser SM, Yarborough BJ, Ahmedani B, Miller-Matero LR, Waring SC, Haller IV, Waitzfelder BE, Sterling SA, Campbell CI, Hechter RC, Zeber JE, Copeland LA, Scherrer JF, Rossom R, Simon G. Chronic pain diagnoses and opioid dispensings among insured individuals with serious mental illness. BMC Psychiatry 2020; 20:40. [PMID: 32005200 PMCID: PMC6995196 DOI: 10.1186/s12888-020-2456-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 01/22/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Individuals with major depressive disorder (MDD) and bipolar disorder (BD) have particularly high rates of chronic non-cancer pain (CNCP) and are also more likely to receive prescription opioids for their pain. However, there have been no known studies published to date that have examined opioid treatment patterns among individuals with schizophrenia. METHODS Using electronic medical record data across 13 Mental Health Research Network sites, individuals with diagnoses of MDD (N = 65,750), BD (N = 38,117) or schizophrenia or schizoaffective disorder (N = 12,916) were identified and matched on age, sex and Medicare status to controls with no documented mental illness. CNCP diagnoses and prescription opioid medication dispensings were extracted for the matched samples. Multivariate analyses were conducted to evaluate (1) the odds of receiving a pain-related diagnosis and (2) the odds of receiving opioids, by separate mental illness diagnosis category compared with matched controls, controlling for age, sex, Medicare status, race/ethnicity, income, medical comorbidities, healthcare utilization and chronic pain diagnoses. RESULTS Multivariable models indicated that having a MDD (OR = 1.90; 95% CI = 1.85-1.95) or BD (OR = 1.71; 95% CI = 1.66-1.77) diagnosis was associated with increased odds of a CNCP diagnosis after controlling for age, sex, race, income, medical comorbidities and healthcare utilization. By contrast, having a schizophrenia diagnosis was associated with decreased odds of receiving a chronic pain diagnosis (OR = 0.86; 95% CI = 0.82-0.90). Having a MDD (OR = 2.59; 95% CI = 2.44-2.75) or BD (OR = 2.12; 95% CI = 1.97-2.28) diagnosis was associated with increased odds of receiving chronic opioid medications, even after controlling for age, sex, race, income, medical comorbidities, healthcare utilization and chronic pain diagnosis; having a schizophrenia diagnosis was not associated with receiving chronic opioid medications. CONCLUSIONS Individuals with serious mental illness, who are most at risk for developing opioid-related problems, continue to be prescribed opioids more often than their peers without mental illness. Mental health clinicians may be particularly well-suited to lead pain assessment and management efforts for these patients. Future research is needed to evaluate the effectiveness of involving mental health clinicians in these efforts.
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Affiliation(s)
- Ashli Owen-Smith
- Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Urban Life Building, 140 Decatur Street, Suite 434, Atlanta, GA, 30303, USA. .,Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, USA.
| | - Christine Stewart
- 0000 0004 0615 7519grid.488833.cHealth Research Institute, Kaiser Permanente Washington, Seattle, USA
| | - Musu M. Sesay
- 0000 0000 9957 7758grid.280062.eCenter for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, USA
| | - Sheryl M. Strasser
- 0000 0004 1936 7400grid.256304.6Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Urban Life Building, 140 Decatur Street, Suite 434, Atlanta, GA 30303 USA
| | - Bobbi Jo Yarborough
- 0000 0000 9957 7758grid.280062.eCenter for Health Research, Kaiser Permanente Northwest, Portland, USA
| | - Brian Ahmedani
- 0000 0000 8523 7701grid.239864.2Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, USA ,0000 0000 8523 7701grid.239864.2Depart Behavioral Health Services, Henry Ford Health System, Detroit, USA
| | - Lisa R. Miller-Matero
- 0000 0000 8523 7701grid.239864.2Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, USA ,0000 0000 8523 7701grid.239864.2Depart Behavioral Health Services, Henry Ford Health System, Detroit, USA
| | - Stephen C. Waring
- 0000 0004 0449 6525grid.428919.fEssentia Institute of Rural Health, Duluth, USA
| | - Irina V. Haller
- 0000 0004 0449 6525grid.428919.fEssentia Institute of Rural Health, Duluth, USA
| | - Beth E. Waitzfelder
- 0000 0000 9957 7758grid.280062.eCenter for Health Research, Kaiser Permanente Hawaii, Honolulu, USA
| | - Stacy A. Sterling
- 0000 0000 9957 7758grid.280062.eDivision of Research, Kaiser Permanente Northern California, Oakland, USA
| | - Cynthia I. Campbell
- 0000 0000 9957 7758grid.280062.eDepartment of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, USA
| | - Rulin C. Hechter
- 0000 0000 9957 7758grid.280062.eDepartment of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, USA
| | - John E. Zeber
- 0000 0001 2184 9220grid.266683.fSchool of Public Health & Health Sciences, University of Massachusetts Amherst, Amherst, USA
| | | | - Jeffrey F. Scherrer
- 0000 0004 1936 9342grid.262962.bDepartment of Family and Community Medicine, Saint Louis University School of Medicine, Saint Louis, USA
| | - Rebecca Rossom
- 0000 0004 0461 4886grid.280625.bHealth Partners Institute, Minneapolis, USA
| | - Greg Simon
- 0000 0004 0615 7519grid.488833.cHealth Research Institute, Kaiser Permanente Washington, Seattle, USA
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20
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Lin HR, Wang HC, Wang JH, Lu HH. Increased risk of perforated appendicitis in patients with schizophrenia and dementia: A population-based case-control study. Medicine (Baltimore) 2020; 99:e18919. [PMID: 32000401 PMCID: PMC7004784 DOI: 10.1097/md.0000000000018919] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Previous studies have suggested that patients with psychotic or mental disorders are relatively pain insensitive, resulting in difficulties in the diagnosis of acute intra-abdominal diseases requiring emergency surgeries. We aimed to evaluate whether central nervous system (CNS) or mental disorders are associated with perforated appendicitis in patients with acute appendicitis.We conducted a population-based case-control study using Taiwan's National Health Insurance Research database. Patients aged >18 years who had been hospitalized with a diagnosis of acute appendicitis between 2000 and 2013 were identified. After 1:1 matching for age and sex, 2792 patients with perforated appendicitis (case group) and 2792 patients with nonperforated appendicitis (control group) were included. CNS disorders, mental disorders, pain control medication, and several comorbidities were analyzed for the odds of appendiceal perforation with 95% confidence interval (CI) using the multivariable logistic regression model.Schizophrenia and dementia were associated with a high risk of appendiceal rupture in patients with acute appendicitis, with an adjusted odds ratio of 2.01 for dementia (95% CI: 1.19-3.39, P = .009) and 4.8 for schizophrenia (95% CI: 1.62-14.19, P = .005). Other factors, such as other CNS disorders, comorbidities, and pain control medication, were not associated with the risk of perforated appendicitis.Dementia and schizophrenia are associated with perforated appendicitis in patients with acute appendicitis. This might be owing to altered pain perception, difficult symptom expression, and delayed hospitalization. Further studies are still needed to determine the underlying mechanism and confirm the causality.
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Affiliation(s)
- Huang Ren Lin
- Department of Family medicine, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan
| | - Hsiang Chi Wang
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung
| | - Jen Hung Wang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation
| | - Hsin Han Lu
- Department of Family Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
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21
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Zhou L, Bi Y, Liang M, Kong Y, Tu Y, Zhang X, Song Y, Du X, Tan S, Hu L. A modality-specific dysfunction of pain processing in schizophrenia. Hum Brain Mapp 2019; 41:1738-1753. [PMID: 31868305 PMCID: PMC7267942 DOI: 10.1002/hbm.24906] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 12/06/2019] [Accepted: 12/11/2019] [Indexed: 12/21/2022] Open
Abstract
Clinical observations showed that schizophrenia (SCZ) patients reported little or no pain under various conditions that are commonly associated with intense painful sensations, leading to a higher risk of morbidity and mortality. However, this phenomenon has received little attention and its underlying neural mechanisms remain unclear. Here, we conducted two experiments combining psychophysics, electroencephalography (EEG), and functional magnetic resonance imaging (fMRI) techniques to investigate neural mechanisms of pain insensitivity in SCZ patients. Specifically, we adopted a stimulus–response paradigm with brief stimuli of different sensory modalities (i.e., nociceptive, non‐nociceptive somatosensory, and auditory) to test whether pain insensitivity in SCZ patients is supra‐modal or modality‐specific, and used EEG and fMRI techniques to clarify its neural mechanisms. We observed that perceived intensities to nociceptive stimuli were significantly smaller in SCZ patients than healthy controls, whereas perceived intensities to non‐nociceptive somatosensory and auditory stimuli were not significantly different. The behavioral results were confirmed by stimulus‐evoked brain responses sampled by EEG and fMRI techniques, thus verifying the modality‐specific nature of the modulation of nociceptive information processing in SCZ patients. Additionally, significant group differences were observed in the spectral power of alpha oscillations in prestimulus EEG and the seed‐based functional connectivity in resting‐state fMRI (seeds: the thalamus and periaqueductal gray that are key nodes in ascending and descending pain pathways respectively), suggesting a possible contribution of cortical–subcortical dysfunction to the phenomenon. Overall, our study provides insight into the neural mechanisms of pain insensitivity in SCZ and highlights a need for systematic assessments of their pain‐related diseases.
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Affiliation(s)
- Lili 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
| | - Yanzhi Bi
- 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
| | - Meng Liang
- School of Medical Imaging and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University, Tianjin, China
| | - Yazhuo Kong
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.,CAS Key Laboratory of Behavioural Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Yiheng Tu
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts
| | - 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
| | - Yanying Song
- Psychiatry Research Centre, Beijing Huilonguan Hospital, Beijing, China
| | - Xia Du
- Psychiatry Research Centre, Beijing Huilonguan Hospital, Beijing, China
| | - Shuping Tan
- Psychiatry Research Centre, Beijing Huilonguan Hospital, Beijing, China
| | - Li Hu
- 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.,Department of Pain Management, The State Key Clinical Specialty in Pain Medicine, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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22
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Brennan PL, Greenbaum MA, Lemke S, Schutte KK. Mental health disorder, pain, and pain treatment among long-term care residents: Evidence from the Minimum Data Set 3.0. Aging Ment Health 2019; 23:1146-1155. [PMID: 30404536 DOI: 10.1080/13607863.2018.1481922] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: This study evaluated: (a) associations between long-term care residents' mental health disorder diagnoses and their pain self-reports and pain treatments, and (b) the extent to which communication, cognitive, and physical functioning problems help explain disparities in the pain and pain treatments of long-term care residents with and without mental health disorders. Method: Minimum Data Set 3.0 records of 8,300 residents of Department of Veterans Affairs Community Living Centers were used to determine statistically unadjusted and adjusted cross-sectional associations between residents' mental health diagnoses and their pain and pain treatments. Results: Residents diagnosed with dementia and serious mental illness (SMI) were less likely, and those diagnosed with depressive disorder, post-traumatic stress disorder (PTSD), and substance use disorder (SUD) were more likely, to report recent, severe, and debilitating pain. Among residents affirming recent pain, those with dementia or SMI diagnoses were twice as likely to obtain no treatment for their pain and significantly less likely to receive as-needed pain medication and non-pharmacological pain treatments than were other residents. Those with either depressive disorder or PTSD were more likely, and those with SUD less likely, to obtain scheduled pain medication. In general, these associations remained even after statistically adjusting for residents' demographic characteristics, other mental health disorder diagnoses, and functioning. Conclusion: Long-term care residents with mental health disorders experience disparities in pain and pain treatment that are not well-explained by their functioning deficits. They may benefit from more frequent, thorough pain assessments and from more varied and closely tailored pain treatment approaches.
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Affiliation(s)
- Penny L Brennan
- a Institute for Health & Aging, University of California , San Francisco, San Francisco , CA
| | - Mark A Greenbaum
- b Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System , Palo Alto , CA.,c National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System , Menlo Park , CA
| | - Sonne Lemke
- d Program Evaluation and Resource Center, VA Palo Alto Health Care System , Menlo Park , CA
| | - Kathleen K Schutte
- e Center for Innovation to Implementation, VA Palo Alto Health Care System , Menlo Park , CA
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23
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24
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Neugebauer K, Hammans C, Wensing T, Kumar V, Grodd W, Mevissen L, Sternkopf MA, Novakovic A, Abel T, Habel U, Nickl-Jockschat T. Nerve Growth Factor Serum Levels Are Associated With Regional Gray Matter Volume Differences in Schizophrenia Patients. Front Psychiatry 2019; 10:275. [PMID: 31105606 PMCID: PMC6498747 DOI: 10.3389/fpsyt.2019.00275] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 04/10/2019] [Indexed: 12/24/2022] Open
Abstract
Numerous neuroimaging studies have revealed structural brain abnormalities in schizophrenia patients. There is emerging evidence that dysfunctional nerve growth factor (NGF) signaling may contribute to structural brain alterations found in these patients. In this pilot study, we investigated whether there was a correlation between NGF serum levels and gray matter volume (GMV) in schizophrenia patients. Further, we investigated whether there was an overlap between the correlative findings and cross-sectional GMV differences between schizophrenia patients (n = 18) and healthy controls (n = 19). Serum NGF was significantly correlated to GMV in the left prefrontal lobe, the left midcingulate cortex, and the brainstem in schizophrenia patients. However, we did not find any correlations of NGF serum levels with GMV in healthy controls. Schizophrenia patients showed smaller GMV than healthy controls in brain regions located in the bilateral limbic system, bilateral parietal lobe, bilateral insula, bilateral primary auditory cortex, left frontal lobe, and bilateral occipital regions. In a conjunction analysis, GMV in the left midcingulate cortex (MCC) appears negatively correlated to NGF serum levels in the group of schizophrenia patients and also to be reduced compared to healthy controls. These results suggest an increased vulnerability of schizophrenia patients to changes in NGF levels compared to healthy controls and support a role for NGF signaling in the pathophysiology of schizophrenia. As our pilot study is exploratory in nature, further studies enrolling larger sample sizes will be needed to further corroborate our findings and to investigate the influence of additional covariates.
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Affiliation(s)
- Kristina Neugebauer
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Aachen, Germany.,Jülich-Aachen Research Alliance, Jülich, Germany
| | - Christine Hammans
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Aachen, Germany.,Jülich-Aachen Research Alliance, Jülich, Germany
| | - Tobias Wensing
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Vinod Kumar
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Aachen, Germany.,Jülich-Aachen Research Alliance, Jülich, Germany.,Max-Planck-Institute for Biological Cybernetics, Tübingen, Germany
| | - Wolfgang Grodd
- Max-Planck-Institute for Biological Cybernetics, Tübingen, Germany
| | - Lea Mevissen
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Aachen, Germany.,Jülich-Aachen Research Alliance, Jülich, Germany
| | - Melanie A Sternkopf
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Aachen, Germany.,Jülich-Aachen Research Alliance, Jülich, Germany
| | - Ana Novakovic
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Aachen, Germany.,Jülich-Aachen Research Alliance, Jülich, Germany
| | - Ted Abel
- Iowa Neuroscience Institute, University of Iowa, Iowa City, IA, United States
| | - Ute Habel
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Aachen, Germany.,Jülich-Aachen Research Alliance, Jülich, Germany
| | - Thomas Nickl-Jockschat
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Aachen, Germany.,Jülich-Aachen Research Alliance, Jülich, Germany.,Iowa Neuroscience Institute, University of Iowa, Iowa City, IA, United States.,Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
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25
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Zilg B. A Case of Fatal Dehydration During Police Custody. J Forensic Sci 2018; 64:917-919. [DOI: 10.1111/1556-4029.13932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 09/27/2018] [Accepted: 10/02/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Brita Zilg
- Swedish National Board of Forensic Medicine Retzius väg 5 171 65 Solna Sweden
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26
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Brooks JM, Umucu E, Huck GE, Fortuna K, Sánchez J, Chiu CY, Bartels SJ. Sociodemographic characteristics, health conditions, and functional impairment among older adults with serious mental illness reporting moderate-to-severe pain. Psychiatr Rehabil J 2018; 41:224-233. [PMID: 30160508 PMCID: PMC6123826 DOI: 10.1037/prj0000316] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To compare adults aged ≥50 years with serious mental illness reporting moderate-to-severe pain to older adults with serious mental illness without pain with respect to sociodemographic characteristics, health conditions, and functional impairment. METHOD Secondary data analyses were conducted using baseline assessments of 183 participants recruited for the Helping Older People Experience Success (HOPES) study from three community mental health centers. The primary outcome was self-reported, nonexperimentally induced, moderate-to-severe pain (referent = no-to-mild pain). Predictor variables consisted of sociodemographic characteristics, health conditions, and functional impairment. We conducted univariable and multivariable logistic regression analyses to examine the associations between these variables. RESULTS Sixty-one participants (33.3%) from our sample reported pain. Pain was associated with all of the sociodemographic and health-related factors in univariable analyses. In the multivariable model, only older age, pain-related activity interference, and physical and emotional health-related social limitations were significantly associated with pain. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE The presence of moderate-to-severe pain in older adults with serious mental illness is associated with pain-attributable impairment of activities and social problems above and beyond the substantial functional limitations routinely experienced by this high-risk, high-need group. Given the high rates of preexisting conditions and persistent social impairment among these older adults, our findings suggest that pain may contribute to worse overall functional outcomes. Future research and clinical interventions focused on improving outcomes should include an evaluation of pain as a contributor to decreased functioning and assess the need for early intervention, nonpharmacological pain management, or other health promotion services in psychiatric rehabilitation. (PsycINFO Database Record
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Affiliation(s)
- Jessica M. Brooks
- Department of Psychiatry, Geisel School of Medicine and Centers for Health and Aging, Dartmouth College, Lebanon, NH
- University of North Texas, Denton, TX
| | - Emre Umucu
- Department of Rehabilitation Sciences, The University of Texas at El Paso, El Paso, Texas
| | - Garrett E. Huck
- Department of Rehabilitation and Human Services, Pennsylvania State University- Penn State Hazleton, Hazleton, PA
| | - Karen Fortuna
- Department of Psychiatry, Geisel School of Medicine and Centers for Health and Aging, Dartmouth College, Lebanon, NH
| | - Jennifer Sánchez
- Department of Rehabilitation and Counselor Education, The University of Iowa, Iowa City, IA
| | - Chung-Yi Chiu
- Department of Kinesiology and Community Health, University of Illinois at Urbana Champaign, Urbana, IL
| | - Stephen J. Bartels
- Department of Psychiatry, Geisel School of Medicine and Centers for Health and Aging, Dartmouth College, Lebanon, NH
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH
- Centers for Health and Aging, Lebanon, NH
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McNamara B, Same A, Rosenwax L, Kelly B. Palliative care for people with schizophrenia: a qualitative study of an under-serviced group in need. BMC Palliat Care 2018; 17:53. [PMID: 29580230 PMCID: PMC5870335 DOI: 10.1186/s12904-018-0309-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 03/15/2018] [Indexed: 11/10/2022] Open
Abstract
Background People with schizophrenia are at risk of receiving poorer end of life care than other patients. They are often undertreated, avoid treatment and are about half as likely to access palliative care. There are limited options for end of life care for this under-serviced group in need. This study aims to address the paucity of research by documenting possible need, experiences of health care service use and factors affecting palliative care use for people with schizophrenia who have advanced life limiting illness. Methods Semi-structured interviews were undertaken with 16 experienced health professionals caring for people with schizophrenia in Western Australia. The interviews focussed on their perceptions and experiences of end of life care, their patients’ unmet needs, palliative care options, and suggested services to support this vulnerable group and improve health care provision. The research used a qualitative design and thematic analyses. Results The participants all advocated strongly for their patients and recognised their extreme vulnerability. They identified a range of challenges and unmet needs experienced by people with schizophrenia at the end of life including: illness factors such as the impact of schizophrenia on information processing and communication; social factors such as stigma, isolation and the absence of a carer; and health care factors such as late diagnosis, delayed access to care, and mismanagement in care. Four themes were organised into two domains with the first exploring the individual and social circumstances of people with schizophrenia, including the challenges they experience in the health care system. The second domain covers themes that discuss barriers and facilitators to people with schizophrenia receiving palliative care and key features in palliative care provision, including recognising declining health, communication and planning, and collaboration and capacity building in the broader health, mental health and palliative care sectors. Conclusions To ensure people with schizophrenia are well supported at the end of life a model of palliative care is required that offers both specialised services and capacity building within the pre-existing health workforce. Resources are needed to address the stigma and lack of services faced by this vulnerable group.
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Affiliation(s)
- Beverley McNamara
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Kent Street, Bentley, WA, Australia.
| | - Anne Same
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Kent Street, Bentley, WA, Australia
| | - Lorna Rosenwax
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Kent Street, Bentley, WA, Australia
| | - Brian Kelly
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, Australia
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Dixon M. Using a systematic approach to assess an acutely unwell patient with catatonia: a case study. Nurs Stand 2018; 32:44-52. [PMID: 29488728 DOI: 10.7748/ns.2018.e10870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2018] [Indexed: 06/08/2023]
Abstract
Patients in acute settings may present with a variety of signs and symptoms; however, the principles of assessment are applicable to all acutely unwell patients. This article details a case study of a patient who presented to the author's medical ward in a catatonic state, and was assessed using the ABCDE (airway, breathing, circulation, disability, exposure) approach. Catatonia is a disturbed mental state in which a patient exhibits abnormal behaviour, such as the inability to speak and non-responsiveness to stimuli, alongside immobility. Although catatonia is a rare condition, it is important that nurses can identify its signs and symptoms, because it can be fatal if not treated appropriately and rapidly. Thus, it is crucial for nurses to be able to systematically assess acutely unwell patients, including those with catatonia, using the ABCDE approach.
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Bourvis N, Aouidad A, Cabelguen C, Cohen D, Xavier J. How Do Stress Exposure and Stress Regulation Relate to Borderline Personality Disorder? Front Psychol 2017; 8:2054. [PMID: 29250007 PMCID: PMC5714931 DOI: 10.3389/fpsyg.2017.02054] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 11/13/2017] [Indexed: 12/26/2022] Open
Abstract
Borderline personality disorder (BPD) is a severe and frequent disorder characterized by a pervasive pattern of instability affecting impulse control, emotional regulation, cognitive processing, self-image and interpersonal relationships. Patients’ personal histories are often marked by stressful or traumatic experiences, either unique or repeated. Moreover, while clinical signs of the disorder include both chronic and acute features, acute features are mostly triggered by acute stressful situations. Such features include transient cognitive distortion, intense anger, uncontrollable impulsivity, and self-harm behavior – including suicide – and contribute to the burden of the disease. In this paper, we review the various aspects (epidemiological, clinical, and physiological) contributing to the relationship between BDP and stress. In particular, we explore the statistical association between stress exposure and the emergence of BPD while taking into account other psychopathologies, such as post-traumatic stress disorder. Then, the different aspects of stress responses (namely, the phenomenological, behavioral, hormonal, neuro-vegetative and neural responses) are reviewed in BPD patients. Pathophysiological hypotheses are formulated to explain the differences in responses between BPD patients and healthy subjects and their relation to BPD symptoms. Although the pathogenesis remains uncertain, our conclusions seem to reflect a specific biological and neural pattern of altered stress perception and regulation in BPD.
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Affiliation(s)
- Nadège Bourvis
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique Hopitaux de Paris, Paris, France.,UMR 7222, Institut des Systèmes Intelligents et Robotiques, Université Paris-Sorbonne, Paris, France.,Pôle de Psychiatrie Infanto-Juvénile, Centre Hospitalier Intercommunal Toulon - La Seyne, Toulon, France
| | - Aveline Aouidad
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique Hopitaux de Paris, Paris, France
| | - Clémence Cabelguen
- Department de Psychiatrie Infanto Juvénile, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - David Cohen
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique Hopitaux de Paris, Paris, France.,UMR 7222, Institut des Systèmes Intelligents et Robotiques, Université Paris-Sorbonne, Paris, France
| | - Jean Xavier
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique Hopitaux de Paris, Paris, France.,UMR 7222, Institut des Systèmes Intelligents et Robotiques, Université Paris-Sorbonne, Paris, France
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30
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Giersch A, Mishara AL. Is Schizophrenia a Disorder of Consciousness? Experimental and Phenomenological Support for Anomalous Unconscious Processing. Front Psychol 2017; 8:1659. [PMID: 29033868 PMCID: PMC5625017 DOI: 10.3389/fpsyg.2017.01659] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 09/08/2017] [Indexed: 12/27/2022] Open
Abstract
Decades ago, several authors have proposed that disorders in automatic processing lead to intrusive symptoms or abnormal contents in the consciousness of people with schizophrenia. However, since then, studies have mainly highlighted difficulties in patients' conscious experiencing and processing but rarely explored how unconscious and conscious mechanisms may interact in producing this experience. We report three lines of research, focusing on the processing of spatial frequencies, unpleasant information, and time-event structure that suggest that impairments occur at both the unconscious and conscious level. We argue that focusing on unconscious, physiological and automatic processing of information in patients, while contrasting that processing with conscious processing, is a first required step before understanding how distortions or other impairments emerge at the conscious level. We then indicate that the phenomenological tradition of psychiatry supports a similar claim and provides a theoretical framework helping to understand the relationship between the impairments and clinical symptoms. We base our argument on the presence of disorders in the minimal self in patients with schizophrenia. The minimal self is tacit and non-verbal and refers to the sense of bodily presence. We argue this sense is shaped by unconscious processes, whose alteration may thus affect the feeling of being a unique individual. This justifies a focus on unconscious mechanisms and a distinction from those associated with consciousness.
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Affiliation(s)
- Anne Giersch
- INSERM U1114, Pôle de Psychiatrie, Fédération de Médecine Translationnelle de Strasbourg, Centre Hospitalier Régional Universitaire of Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Aaron L. Mishara
- Department of Clinical Psychology, The Chicago School of Professional Psychology, Los Angeles, CA, United States
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31
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Connaughton J, Wand B. Prevalence, characteristics and management of headache experienced by people with schizophrenia and schizoaffective disorder: a cross sectional cohort study. Australas Psychiatry 2017; 25:381-384. [PMID: 28747114 DOI: 10.1177/1039856217695703] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Headache is the most common type of pain reported by people with schizophrenia. This study aimed to establish prevalence, characteristics and management of these headaches. METHODS One hundred participants with schizophrenia/schizoaffective disorder completed a reliable and valid headache questionnaire. Two clinicians independently classified each headache as migraine, tension-type, cervicogenic or other. RESULTS The 12-month prevalence of headache (57%) was higher than the general population (46%) with no evidence of a relationship between psychiatric clinical characteristics and presence of headache. Prevalence of cervicogenic (5%) and migraine (18%) was comparable to the general population. Tension-type (16%) had a lower prevalence and 19% of participants experienced other headache. No one with migraine was prescribed migraine specific medication; no one with cervicogenic and tension-type received best-practice treatment. CONCLUSIONS Headache is a common complaint in people with schizophrenia/schizoaffective disorder with most fitting recognised diagnostic criteria for which effective interventions are available. No one in this sample was receiving best-practice care for their headache.
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Affiliation(s)
- Joanne Connaughton
- Associate Professor, Acting Dean, School of Physiotherapy, The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Benedict Wand
- Professor, The University of Notre Dame Australia, Fremantle, WA, Australia
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32
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Ruggiero RN, Rossignoli MT, De Ross JB, Hallak JEC, Leite JP, Bueno-Junior LS. Cannabinoids and Vanilloids in Schizophrenia: Neurophysiological Evidence and Directions for Basic Research. Front Pharmacol 2017; 8:399. [PMID: 28680405 PMCID: PMC5478733 DOI: 10.3389/fphar.2017.00399] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 06/06/2017] [Indexed: 01/14/2023] Open
Abstract
Much of our knowledge of the endocannabinoid system in schizophrenia comes from behavioral measures in rodents, like prepulse inhibition of the acoustic startle and open-field locomotion, which are commonly used along with neurochemical approaches or drug challenge designs. Such methods continue to map fundamental mechanisms of sensorimotor gating, hyperlocomotion, social interaction, and underlying monoaminergic, glutamatergic, and GABAergic disturbances. These strategies will require, however, a greater use of neurophysiological tools to better inform clinical research. In this sense, electrophysiology and viral vector-based circuit dissection, like optogenetics, can further elucidate how exogenous cannabinoids worsen (e.g., tetrahydrocannabinol, THC) or ameliorate (e.g., cannabidiol, CBD) schizophrenia symptoms, like hallucinations, delusions, and cognitive deficits. Also, recent studies point to a complex endocannabinoid-endovanilloid interplay, including the influence of anandamide (endogenous CB1 and TRPV1 agonist) on cognitive variables, such as aversive memory extinction. In fact, growing interest has been devoted to TRPV1 receptors as promising therapeutic targets. Here, these issues are reviewed with an emphasis on the neurophysiological evidence. First, we contextualize imaging and electrographic findings in humans. Then, we present a comprehensive review on rodent electrophysiology. Finally, we discuss how basic research will benefit from further combining psychopharmacological and neurophysiological tools.
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Affiliation(s)
- Rafael N Ruggiero
- Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São PauloRibeirão Preto, Brazil
| | - Matheus T Rossignoli
- Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São PauloRibeirão Preto, Brazil
| | - Jana B De Ross
- Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São PauloRibeirão Preto, Brazil
| | - Jaime E C Hallak
- Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São PauloRibeirão Preto, Brazil.,National Institute for Science and Technology-Translational Medicine, National Council for Scientific and Technological Development (CNPq)Ribeirão Preto, Brazil
| | - Joao P Leite
- Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São PauloRibeirão Preto, Brazil
| | - Lezio S Bueno-Junior
- Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São PauloRibeirão Preto, Brazil
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33
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Increased spinal pain sensitization in major depressive disorder: A pilot study. Psychiatry Res 2016; 246:756-761. [PMID: 27817904 DOI: 10.1016/j.psychres.2016.10.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 09/19/2016] [Accepted: 10/25/2016] [Indexed: 11/23/2022]
Abstract
Although patients suffering from major depressive disorder (MDD) often complain from painful symptoms, the relationship between experimental pain processes and depression has yet to be clearly characterized. Only recently have studies employing temporal summation (TS) paradigms offered preliminary insight into the co-occurrence of pain and depression. This study sets out to evaluate the contribution of spinal and supraspinal processes in pain sensitization in MDD using a TS paradigm. Thirteen volunteers with no psychiatric disorders (controls) and fourteen MDD subjects were included in the analysis. Low-(0.14Hz) and high-(1Hz) frequency intermittent stimulations of the sural nerve were used to induce TS. Spinal pain sensitization was quantified by measuring the change in the amplitude of the nociceptive-specific flexion reflex (NFR) response, and supraspinal pain sensitization was obtained by measuring change in subjective pain rating, from the low- to high-frequency stimulation condition. We found an increased sensitization in the NFR response (p<0.05) in MDD subjects in the high-frequency condition, which did not translate into an increase of their subjective responses. However, we found a positive association between spinal sensitization and painful somatic symptoms in MDD subjects. Together, these results suggest increased spinal pain sensitization in MDD, which might explain the high prevalence of painful somatic symptoms in these patients.
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Sakson-Obada O, Chudzikiewicz P, Pankowski D, Jarema M. Body Image and Body Experience Disturbances in Schizophrenia: an Attempt to Introduce the Concept of Body Self as a Conceptual Framework. CURRENT PSYCHOLOGY 2016; 37:390-400. [PMID: 29563762 PMCID: PMC5845076 DOI: 10.1007/s12144-016-9526-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Disturbances in body experience are described as key schizophrenia symptoms and early disease predictors. In case studies, different disorders relating to body experience are presented, but only a few empirical studies have aimed to distinguish the characteristics of body experience in schizophrenia, and these have been selected arbitrarily and without reference to cohesive theoretical model. To integrate this fragmentary approach, we propose a body self (BS) model, composed of: functions; representations (e.g., body image); and sense of body identity. The aim of the study was to determine whether the BS differentiates schizophrenic patients from healthy controls, and to investigate the relations between aspects of BS and a history of illness and clinical characteristics. The Body Self Questionnaire and the Positive and Negative Syndrome Scale were administered to 63 schizophrenic patients and 63 healthy subjects. The difference was found in the functions of the body-self (perceiving, interpreting, and regulating body experience), in the sense of body identity, and in one of three aspects of body image explored (e.g., acceptance of biological sex). Disturbances in BS were related to positive symptoms and to the number of hospitalizations for other diseases. Together, the results demonstrate that schizophrenia is more body experience than body image disorder, since the negative emotional attitude towards the body and acceptance of fitness were not distinctive for schizophrenia. The link between the disturbances in BS and the number of nonpsychiatric hospitalizations suggests that misinterpretation of body experiences in schizophrenia can promote a search for medical attention.
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Affiliation(s)
- Olga Sakson-Obada
- Institute of Psychology, Adam Mickiewicz University, 89 Szamarzewskiego Street, 60-568 Poznan, PL Poland
| | - Paulina Chudzikiewicz
- III Psychiatric Clinic, Institute of Psychiatry and Neurology, Sobieskiego 9 Street, 02-957 Warsaw, PL Poland
| | - Daniel Pankowski
- Faculty of Psychology, University of Warsaw, Stawki 5/7 Street, 00-183 Warsaw, PL Poland
| | - Marek Jarema
- III Psychiatric Clinic, Institute of Psychiatry and Neurology, Sobieskiego 9 Street, 02-957 Warsaw, PL Poland
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35
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Minichino A, Delle Chiaie R, Cruccu G, Piroso S, Di Stefano G, Francesconi M, Bersani FS, Biondi M, Truini A. Pain-processing abnormalities in bipolar I disorder, bipolar II disorder, and schizophrenia: A novel trait marker for psychosis proneness and functional outcome? Bipolar Disord 2016; 18:591-601. [PMID: 27782355 DOI: 10.1111/bdi.12439] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 09/02/2016] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Overlapping neural system dysfunctions, mainly involving the secondary somatosensory cortex (S2), the anterior cingulate cortex (ACC) and the anterior insular cortex (AIC), seem to be related to both pain-perception abnormalities and psychotic symptoms in schizophrenia (SCZ) and bipolar disorder (BD). Laser-evoked potentials (LEPs) were used to investigate pain-perception and central pain-processing abnormalities in SCZ, bipolar I disorder (BD-I), and bipolar II disorder (BD-II), and to evaluate their relationship with history of psychosis, and social-cognitive and functional impairments. METHODS Twenty patients with SCZ, 17 patients with BD-I, and 21 patients with BD-II who were all under similar pharmacological treatment underwent clinical, functional, and neuro-psychological assessment. LEPs were analyzed in patients and 19 healthy subjects (HS). LEPs elicit responses reflecting the activity of the S2 (N1 wave) and the ACC/AIC cortices (N2/P2 complex). A four-group ANOVA was conducted between patients and HS to compare pain-perceptive thresholds (PThs), N1, and N2/P2-LEP components. RESULTS Compared to HS: (i) patients with SCZ showed pain-processing and pain-perception abnormalities, as revealed by significantly higher PTh (P<.01), and lower N1 (P<.01) and N2/P2 (P<.01) amplitudes, (ii) patients with BD-I showed only pain-processing abnormalities, as revealed by significantly lower N1 (P<.05) and N2 (P<.01) amplitudes; and patients with BD-II did not differ for any of the LEP variables investigated. N1 and N2 amplitudes negatively correlated to history of psychosis (P<.01), social-cognition (P<.05), and real-world functioning (P<.01) measures in the whole group of patients. CONCLUSIONS To the best of our knowledge, this is the first study comparing central pain processing in patients with SCZ, BD-I, and BD-II. Our results suggest that pain-processing abnormalities may represent a novel locus of interest for research investigating trait markers of the psychosis spectrum.
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Affiliation(s)
- Amedeo Minichino
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy.,Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Roberto Delle Chiaie
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Giorgio Cruccu
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Serena Piroso
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Giulia Di Stefano
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Marta Francesconi
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy.,Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | | | - Massimo Biondi
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Andrea Truini
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
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Markedly Reduced Thermal Pain Perception in a Schizoaffective Patient with Tardive Dyskinesia. Case Rep Psychiatry 2016; 2016:8702483. [PMID: 27144045 PMCID: PMC4842046 DOI: 10.1155/2016/8702483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 03/31/2016] [Indexed: 11/25/2022] Open
Abstract
Several case reports have described stories of schizophrenia patients reporting no discomfort in response to several medical conditions which normally elicit pain. Comparatively, experimental studies performed on pain perception in schizophrenia have not documented hypoalgesic responses that are as frank as those reported in these clinical cases. Here, we report the case of a female patient with schizoaffective disorder, who displayed markedly reduced pain perception during an experimental heat pain paradigm. Compared to a large group of healthy volunteers that we tested in 3 previous studies using the same psychophysical procedure, the experimental temperature required to induce moderate pain was radically increased in this patient (z-score = 3.6). The patient had mild psychiatric symptoms and had insight into her symptoms. She had drug-induced dyskinetic symptoms. This case report illustrates that it is possible to observe marked reductions in pain perception in schizophrenia patients tested in experimental settings but that the phenomenon is relatively rare. Regardless of the exact nature of pain indifference in schizophrenia, it can delay diagnosis and treatment of medical problems in these patients. Future studies in the field will need to pay attention to drug-induced extrapyramidal symptoms.
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Duval CZ, Goumon Y, Kemmel V, Kornmeier J, Dufour A, Andlauer O, Vidailhet P, Poisbeau P, Salvat E, Muller A, Mensah-Nyagan AG, Schmidt-Mutter C, Giersch A. Neurophysiological responses to unpleasant stimuli (acute electrical stimulations and emotional pictures) are increased in patients with schizophrenia. Sci Rep 2016; 6:22542. [PMID: 26935652 PMCID: PMC4776095 DOI: 10.1038/srep22542] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 02/15/2016] [Indexed: 01/14/2023] Open
Abstract
Patients with schizophrenia have often been described as insensitive to nociceptive signals, but objective evidence is sparse. We address this question by combining subjective behavioral and objective neurochemical and neurophysiological measures. The present study involved 21 stabilized and mildly symptomatic patients with schizophrenia and 21 control subjects. We applied electrical stimulations below the pain threshold and assessed sensations of pain and unpleasantness with rating scales, and Somatosensory Evoked Potentials (SEPs/EEG). We also measured attention, two neurochemical stress indices (ACTH/cortisol), and subjective VEPs/EEG responses to visual emotional stimuli. Our results revealed that, subjectively, patients’ evaluations do not differ from controls. However, the amplitude of EEG evoked potentials was greater in patients than controls as early as 50 ms after electrical stimulations and beyond one second after visual processing of emotional pictures. Such responses could not be linked to the stress induced by the stimulations, since stress hormone levels were stable. Nor was there a difference between patients and controls in respect of attention performance and tactile sensitivity. Taken together, all indices measured in patients in our study were either heightened or equivalent relative to healthy volunteers.
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Affiliation(s)
- Céline Z Duval
- INSERM U-1114, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Département de Psychiatrie, Hôpitaux Universitaires de Strasbourg; 1, place de l'Hôpital, 67000 Strasbourg, France.,Fondation FondaMental, Créteil, France.,Fondation APICIL, 21, place Bellecour, 69002 Lyon, France
| | - Yannick Goumon
- Institut des Neurosciences Cellulaires et Intégratives, CNRS UPR 3212, 5, rue Blaise Pascal, 67084 Strasbourg, France
| | - Véronique Kemmel
- INSERM U-1119 Biopathologie de la Myéline, Neuroprotection et Stratégies Thérapeutiques, Université de Strasbourg, Bâtiment 3 de la Faculté de Médecine, 11 rue Humann, 67000 Strasbourg, France.,Laboratoire de Biochimie et Biologie Moléculaire, Hôpitaux Universitaire de Strasbourg, 67098 Strasbourg, France
| | - Jürgen Kornmeier
- Institute for Frontier Areas of Psychology and Mental Health, 79098 Freiburg, Germany.,University Eye-Hospital, Killianstraße 5, 79106 Freiburg, Germany
| | - André Dufour
- Laboratoire de Neurosciences Cognitives et Adaptatives, UMR 7364, Université de Strasbourg, CNRS, Strasbourg, France
| | - Olivier Andlauer
- EA 481 Laboratoire de Neurosciences, Université de Franche-Comte, 1 place du maréchal Leclerc, 25030 Besançon Cedex, France
| | - Pierre Vidailhet
- INSERM U-1114, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Département de Psychiatrie, Hôpitaux Universitaires de Strasbourg; 1, place de l'Hôpital, 67000 Strasbourg, France
| | - Pierrick Poisbeau
- Institut des Neurosciences Cellulaires et Intégratives, CNRS UPR 3212, 5, rue Blaise Pascal, 67084 Strasbourg, France
| | - Eric Salvat
- Institut des Neurosciences Cellulaires et Intégratives, CNRS UPR 3212, 5, rue Blaise Pascal, 67084 Strasbourg, France.,Centre 'Evaluation et de Traitement de la Douleur (CETD) du CHRU, Hôpital de Hautepierre, 1 av Moliere, 67078 Strasbourg, France
| | - André Muller
- Institut des Neurosciences Cellulaires et Intégratives, CNRS UPR 3212, 5, rue Blaise Pascal, 67084 Strasbourg, France.,Centre 'Evaluation et de Traitement de la Douleur (CETD) du CHRU, Hôpital de Hautepierre, 1 av Moliere, 67078 Strasbourg, France
| | - Ayikoé G Mensah-Nyagan
- INSERM U-1119 Biopathologie de la Myéline, Neuroprotection et Stratégies Thérapeutiques, Université de Strasbourg, Bâtiment 3 de la Faculté de Médecine, 11 rue Humann, 67000 Strasbourg, France
| | | | - Anne Giersch
- INSERM U-1114, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Département de Psychiatrie, Hôpitaux Universitaires de Strasbourg; 1, place de l'Hôpital, 67000 Strasbourg, France
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Szűcs E, Büki A, Kékesi G, Horváth G, Benyhe S. Mu-Opioid (MOP) receptor mediated G-protein signaling is impaired in specific brain regions in a rat model of schizophrenia. Neurosci Lett 2016; 619:29-33. [PMID: 26946106 DOI: 10.1016/j.neulet.2016.02.060] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 02/16/2016] [Accepted: 02/29/2016] [Indexed: 12/20/2022]
Abstract
Schizophrenia is a complex mental health disorder. Clinical reports suggest that many patients with schizophrenia are less sensitive to pain than other individuals. Animal models do not interpret schizophrenia completely, but they can model a number of symptoms of the disease, including decreased pain sensitivities and increased pain thresholds of various modalities. Opioid receptors and endogenous opioid peptides have a substantial role in analgesia. In this biochemical study we investigated changes in the signaling properties of the mu-opioid (MOP) receptor in different brain regions, which are involved in the pain transmission, i.e., thalamus, olfactory bulb, prefrontal cortex and hippocampus. Our goal was to compare the transmembrane signaling mediated by MOP receptors in control rats and in a recently developed rat model of schizophrenia. Regulatory G-protein activation via MOP receptors were measured in [(35)S]GTPγS binding assays in the presence of a highly selective MOP receptor peptide agonist, DAMGO. It was found that the MOP receptor mediated activation of G-proteins was substantially lower in membranes prepared from the 'schizophrenic' model rats than in control animals. The potency of DAMGO to activate MOP receptor was also decreased in all brain regions studied. Taken together in our rat model of schizophrenia, MOP receptor mediated G-proteins have a reduced stimulatory activity compared to membrane preparations taken from control animals. The observed distinct changes of opioid receptor functions in different areas of the brain do not explain the augmented nociceptive threshold described in these animals.
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Affiliation(s)
- Edina Szűcs
- Institute of Biochemistry, Biological Research Center, Hungarian Academy of Sciences, H-6726 Szeged, Temesvári krt. 62., Hungary
| | - Alexandra Büki
- Department of Physiology, Faculty of Medicine, University of Szeged, H-6720 Szeged, Dóm tér 10., Hungary
| | - Gabriella Kékesi
- Department of Physiology, Faculty of Medicine, University of Szeged, H-6720 Szeged, Dóm tér 10., Hungary
| | - Gyöngyi Horváth
- Department of Physiology, Faculty of Medicine, University of Szeged, H-6720 Szeged, Dóm tér 10., Hungary
| | - Sándor Benyhe
- Institute of Biochemistry, Biological Research Center, Hungarian Academy of Sciences, H-6726 Szeged, Temesvári krt. 62., Hungary.
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Stubbs B, Gardner-Sood P, Smith S, Ismail K, Greenwood K, Patel A, Farmer R, Gaughran F. Pain is independently associated with reduced health related quality of life in people with psychosis. Psychiatry Res 2015; 230:585-91. [PMID: 26471828 DOI: 10.1016/j.psychres.2015.10.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 08/25/2015] [Accepted: 10/05/2015] [Indexed: 01/08/2023]
Abstract
The objective was to investigate the relationship between pain and health related quality of life (HRQOL) in people with psychosis. The study utilised a cross-sectional design including individuals with established psychosis from five Mental Health Trusts across England. Participants were classified as having pain or not and HRQOL was determined with the EQ-5D-3L. Covariates considered include the Positive and Negative Syndrome Scale (PANSS), the Montgomery Asberg Depression Rating Scale (MADRS) and Global Assessment of Functioning (GAF). Hierarchical multiple linear regression analyses were conducted. The final sample included 438 individuals with psychosis (47.5 years, SD 10.1, 193 females (42.9%)). 160 participants reported pain (36.5%) and compared to the non-pain group (N=278) they had significantly higher depressive symptoms (MADRS 14.91 vs 8.68), total (51.8 vs 47.9) and general PANSS scores (26.8 vs. 23.5) and lower overall HRQOL (54.7 vs 68.3). The final regression analysis (n=387) demonstrated that lower levels of pain were a predictor of better HRQOL (β=.173) after adjusting for the PANSS, MADRS and GAF. Depressive symptoms were the largest predictor of HRQOL (β=-.486). Only 1-2% of the sample were in receipt of analgesic medication suggesting pain is greatly overlooked despite its wider deleterious impact on HRQOL.
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Affiliation(s)
- Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, United Kingdom.
| | - Poonam Gardner-Sood
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Shubulade Smith
- Institute of Psychiatry, Psychology and Neuroscience, King's College London and Consultant Psychiatrist, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Khalida Ismail
- Institute of Psychiatry, Psychology and Neuroscience, King's College London and Consultant Liaison Psychiatrist at King's College Hospital NHS Foundation Trust, United Kingdom
| | - Kathryn Greenwood
- School of Psychology, University of Sussex, Brighton and Early Intervention in Psychosis Service, Sussex Partnership NHS Foundation Trust, West Sussex, United Kingdom
| | - Anita Patel
- Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Ross Farmer
- Physiotherapy Department, South London and Maudsley NHS Foundatio n Trust, Denmark Hill, London, United Kingdom; School of Health and Social Work, University of Hertfordshire, College Lane, HATFIELD AL10 9AB, United Kingdom
| | - Fiona Gaughran
- Physiotherapy Department, South London and Maudsley NHS Foundatio n Trust, Denmark Hill, London, United Kingdom; National Psychosis Service, South London and Maudsley NHS Foundation Trust, Senior Lecturer, Institute of Psychiatry, Psychology and Neuroscience and the Biomedical Research Centre, BRC Nucleus, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, United Kingdom
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Koyanagi A, Stickley A. The association between psychosis and severe pain in community-dwelling adults: Findings from 44 low- and middle-income countries. J Psychiatr Res 2015; 69:19-26. [PMID: 26343590 DOI: 10.1016/j.jpsychires.2015.07.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 07/12/2015] [Accepted: 07/17/2015] [Indexed: 12/19/2022]
Abstract
Previous studies examining the association between schizophrenia and pain have produced mixed results and data on sub-threshold psychosis or psychotic symptoms and pain are scarce. This study assessed the association between psychosis and severe pain among community-dwelling adults in 44 low- and middle-income countries (LMICs) where no data exists. Data on 235,370 adults aged ≥18 years from the World Health Survey (WHS) 2002-2004 were analyzed. The presence of past 12-month psychotic symptoms was established using four questions from the Composite International Diagnostic Interview. Participants were categorized into four mutually exclusive groups based on whether they had at least one psychotic symptom and/or a lifetime psychosis or schizophrenia diagnosis. Multivariable logistic regression was used to estimate the association between psychosis and past 30-day severe pain. The prevalence of severe pain among those with 0, 1, 2, ≥3 psychotic symptoms was 8.7%, 16.7%, 21.8%, 30.5% respectively. Compared to those with no psychotic symptoms or diagnosis, the ORs (95% CIs) were: at least one symptom without diagnosis [2.17 (1.99-2.38)]; no symptom with diagnosis [2.33 (1.71-3.17)]; at least one symptom and diagnosis [4.27 (3.20-5.71)]. Associations were partly mediated by chronic physical conditions, anxiety, and depression. Despite some limitations such as the use of a single-item question to assess pain, the results of this study suggest that individuals with psychotic symptoms or a psychosis diagnosis should be systematically assessed for pain, and if necessary, receive treatment for pain and its underlying conditions. Future research on the effect of pain management on psychosis outcome is warranted.
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Affiliation(s)
- Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain; The Stockholm Centre for Health and Social Change (SCOHOST), Södertörn University, Huddinge, Sweden; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.
| | - Andrew Stickley
- The Stockholm Centre for Health and Social Change (SCOHOST), Södertörn University, Huddinge, Sweden; Department of Human Ecology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Child and Adolescent Mental Health, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
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Oke V, Schmidt F, Bhattarai B, Basunia M, Agu C, Kaur A, Enriquez D, Quist J, Salhan D, Gayam V, Mungikar P. Unrecognized clozapine-related constipation leading to fatal intra-abdominal sepsis - a case report. Int Med Case Rep J 2015; 8:189-92. [PMID: 26392790 PMCID: PMC4573205 DOI: 10.2147/imcrj.s86716] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Clozapine is the preferred antipsychotic used for the treatment of resistant schizophrenia with suicidal ideation. The drug is started at a low dose and gradually increased to a target dose of 300–450 mg/day. It is well known to cause agranulocytosis and neutropenia. Several cases of fatal sepsis have been reported in neutropenic patients and emphasis is placed on monitoring for agranulocytosis; however, clozapine also causes intestinal hypomotility and constipation, which if unrecognized can lead to intestinal obstruction, bowel necrosis, and intra-abdominal sepsis. Reduced behavioral pain reactivity in schizophrenics may alter the ability to express pain, potentially leading to a delay in the presentation for medical attention. We report a case of fatal intra-abdominal sepsis secondary to an unrecognized case of clozapine-related constipation.
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Affiliation(s)
- Vikram Oke
- Department of Pulmonary Medicine, Interfaith Medical Center, NY, USA
| | - Frances Schmidt
- Department of Pulmonary Medicine, Interfaith Medical Center, NY, USA
| | - Bikash Bhattarai
- Department of Pulmonary Medicine, Interfaith Medical Center, NY, USA
| | - Md Basunia
- Department of Pulmonary Medicine, Interfaith Medical Center, NY, USA
| | - Chidozie Agu
- Department of Pulmonary Medicine, Interfaith Medical Center, NY, USA
| | - Amrit Kaur
- Department of Pulmonary Medicine, Interfaith Medical Center, NY, USA
| | - Danilo Enriquez
- Department of Pulmonary Medicine, Interfaith Medical Center, NY, USA
| | - Joseph Quist
- Department of Pulmonary Medicine, Interfaith Medical Center, NY, USA
| | - Divya Salhan
- Department of Pulmonary Medicine, Interfaith Medical Center, NY, USA
| | - Vijay Gayam
- Department of Pulmonary Medicine, Interfaith Medical Center, NY, USA
| | - Prajakta Mungikar
- Department of Pulmonary Medicine, Interfaith Medical Center, NY, USA
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Waltz JA, Brown JK, Gold JM, Ross TJ, Salmeron BJ, Stein EA. Probing the Dynamic Updating of Value in Schizophrenia Using a Sensory-Specific Satiety Paradigm. Schizophr Bull 2015; 41:1115-22. [PMID: 25834028 PMCID: PMC4535640 DOI: 10.1093/schbul/sbv034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
It has been proposed that both positive and negative symptoms in schizophrenia (SZ) may derive, at least in part, from a disrupted ability to accurately and flexibly represent the value of stimuli and actions. To assess relationships between dimensions of psychopathology in SZ, and the tendency to devalue food stimuli, on which subjects were fed to satiety, we administered a sensory-specific satiety (SSS) paradigm to 42 SZ patients and 44 controls. In each of 2 sessions, subjects received 16 0.7-ml squirts of each of 2 rewarding foods and 32 squirts of a control solution, using syringes. In between the 2 sessions, each subject was instructed to drink one of the foods until he/she felt "full, but not uncomfortable." At 10 regular intervals, interspersed throughout the 2 sessions, subjects rated each liquid for pleasantness, using a Likert-type scale. Mann-Whitney U-tests revealed group differences in SSS effects. Within-group tests revealed that, while controls showed an effect of satiety that was sensory specific, patients showed an effect of satiety that was not, devaluing the sated and unsated foods similarly. In SZ patients, we observed correlations between the magnitude of SSS effects and measures of both positive and negative symptoms. We argue that the ability to flexibly and rapidly update representations of the value of stimuli and actions figures critically in the ability of patients with psychotic illness to process salient events and adaptively engage in goal-directed behavior.
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Affiliation(s)
- James A. Waltz
- Department of Psychiatry, University of Maryland School of Medicine, Maryland Psychiatric Research Center, Baltimore, MD;,*To whom correspondence should be addressed; Department of Psychiatry, University of Maryland School of Medicine, Maryland Psychiatric Research Center, PO Box 21247, Baltimore, MD 21228, US; tel: +1-410-402-6044, fax: +1-410-402-7198, e-mail:
| | - Jaime K. Brown
- Department of Psychiatry, University of Maryland School of Medicine, Maryland Psychiatric Research Center, Baltimore, MD
| | - James M. Gold
- Department of Psychiatry, University of Maryland School of Medicine, Maryland Psychiatric Research Center, Baltimore, MD
| | - Thomas J. Ross
- Neuroimaging Research Branch, National Institute on Drug Abuse - Intramural Research Program, Baltimore, MD
| | - Betty J. Salmeron
- Neuroimaging Research Branch, National Institute on Drug Abuse - Intramural Research Program, Baltimore, MD
| | - Elliot A. Stein
- Neuroimaging Research Branch, National Institute on Drug Abuse - Intramural Research Program, Baltimore, MD
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Ulstrup A, Ugleholdt R, Rasmussen JV. Fulminant crural compartment syndrome preceded by psychogenic polydipsia. BMJ Case Rep 2015; 2015:bcr-2014-208603. [PMID: 25976194 DOI: 10.1136/bcr-2014-208603] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a case of bilateral anterolateral crural compartment syndrome elicited by hyponatraemia and psychogenic polydipsia. The unusual constellation of clinical findings and diminished pain expression made initial diagnostic procedures challenging. The possible pathogenesis and treatment options are discussed. Impairment of lower extremity function at follow-up was serious and permanent.
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Affiliation(s)
- Anton Ulstrup
- Department of Orthopaedic Surgery, Herlev University Hospital, Copenhagen, Denmark
| | - Randi Ugleholdt
- Department of Medicine, Herlev University Hospital, Copenhagen, Denmark
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Abstract
OBJECTIVE Schizophrenia is associated with a reduction of the lifespan by 20 years, with type II diabetes and cardiovascular disease contributing the most to the increased mortality. Unrecognised or silent myocardial infarction (MI) occurs in ~30% of the population, but the rates of unrecognised MI in patients with schizophrenia have only been sparsely investigated. METHOD Electrocardiograms (ECG) from three psychiatric hospitals in Denmark were manually interpreted for signs of previous MI. Subsequently, ECGs were linked to the National Patient Registry in order to determine whether patients had a diagnosis consistent with previous MI. RESULTS A total of 937 ECGs were interpreted, 538 men (57.4%) and 399 women (42.6%). Mean age at the time of ECG acquisition was 40.6 years (95% CI: 39.7-41.5, range: 15.9-94.6). We identified 32 patients with positive ECG signs of MIs. Only two of these patients had a diagnosis of MI in the National Patient Registry. An additional number of eight patients had a diagnosis of MI in the Danish National Patient Registry, but with no ECG signs of previous MI. This means that 30 out of 40 (75%) MIs were unrecognised. Only increasing age was associated with unrecognised MI in a stepwise multiple logistic regression model compared with patients with no history of MI, OR: 1.03 per year of age, 95% CI: 1.00-1.06, p=0.021. CONCLUSION Unrecognised MI is common among patients with schizophrenia and may contribute to the increased mortality found in this patient group.
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Tzeng NS, Hsu YH, Ho SY, Kuo YC, Lee HC, Yin YJ, Chen HA, Chen WL, Chu WCC, Huang HL. Is schizophrenia associated with an increased risk of chronic kidney disease? A nationwide matched-cohort study. BMJ Open 2015; 5:e006777. [PMID: 25628048 PMCID: PMC4316552 DOI: 10.1136/bmjopen-2014-006777] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The impact of schizophrenia on vital diseases, such as chronic kidney disease (CKD), has not as yet been verified. This study aims to establish whether there is an association between schizophrenia and CKD. DESIGN A nationwide matched cohort study. SETTING Taiwan's National Health Insurance Research Database. PARTICIPANTS A total of 2338 patients with schizophrenia, and 7014 controls without schizophrenia (1:3), matched cohort for sex, age group, geography, urbanisation and monthly income, between 1 January 2003 and 31 December 2007, based on the International Classifications of Disease Ninth Edition (ICD-9), Clinical Modification codes. PRIMARY AND SECONDARY OUTCOME MEASURES After making adjustments for confounding risk factors, a Cox proportional hazards model was used to compare the risk of developing CKD during a 3-year follow-up period from the index date. RESULTS Of the 2338-subject case cohort, 163 (6.97%) developed a CKD, as did 365 (5.20%) of the 7014 control participants. Cox proportional hazards regression analysis revealed that patients with schizophrenia were more likely to develop CKD (HR=1.36, 95% CI 1.13 to 1.63; p<0.001). After adjusting for gender, age group, hypertension, diabetes mellitus, hyperlipidaemia, heart disease and non-steroid anti-inflammatory drugs (NSAIDs) usage, the HR for patients with schizophrenia was 1.25 (95% CI 1.04 to 1.50; p<0.05). Neither typical nor atypical antipsychotics was associated an increased risk of CKD in patients with schizophrenia. CONCLUSIONS The findings from this population-based retrospective cohort study suggest that schizophrenia is associated with a 25% increase in the risk of developing CKD within only a 3-year follow-up period.
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Affiliation(s)
- Nian-Sheng Tzeng
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Student Counseling Center, National Defense Medical Center, Taipei, Taiwan
| | - Yung-Ho Hsu
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Shinn-Ying Ho
- Institute of Bioinformatics and Systems Biology, National Chiao Tung University, Hsinchu, Taiwan
- Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan
| | - Yu-Ching Kuo
- Institute of Bioinformatics and Systems Biology, National Chiao Tung University, Hsinchu, Taiwan
| | - Hua-Chin Lee
- Institute of Bioinformatics and Systems Biology, National Chiao Tung University, Hsinchu, Taiwan
| | - Yun-Ju Yin
- Institute of Bioinformatics and Systems Biology, National Chiao Tung University, Hsinchu, Taiwan
| | - Hong-An Chen
- Institute of Bioinformatics and Systems Biology, National Chiao Tung University, Hsinchu, Taiwan
| | - Wen-Liang Chen
- Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan
| | | | - Hui-Ling Huang
- Institute of Bioinformatics and Systems Biology, National Chiao Tung University, Hsinchu, Taiwan
- Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan
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Stubbs B, Mitchell AJ, De Hert M, Correll CU, Soundy A, Stroobants M, Vancampfort D. The prevalence and moderators of clinical pain in people with schizophrenia: a systematic review and large scale meta-analysis. Schizophr Res 2014; 160:1-8. [PMID: 25458569 DOI: 10.1016/j.schres.2014.10.017] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 09/17/2014] [Accepted: 10/09/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND People with schizophrenia frequently have physical comorbidities that can cause pain. Experimental studies report reduced pain sensitivity among schizophrenia patients, but it remains unclear if clinically relevant pain is less prevalent in schizophrenia. METHOD We systematically searched major electronic databases from inception till 03/2014. Articles were included that reported the prevalence of clinical pain in people with schizophrenia. Two independent authors conducted searches, completed methodological quality assessment and extracted data. A random effects relative risks (RR) meta-analysis was conducted to determine the prevalence of all-cause and specific pain in schizophrenia, and the relative prevalence compared to the general population, and to assess moderators. RESULTS Altogether, 14 studies were included encompassing 242,703 individuals with schizophrenia (30.2-55.8 years) and 4,259,221 controls. Different types of pain were considered. The overall pooled prevalence of clinical pain in people with schizophrenia was 34.7% (95% CI=23.6-46.6). In the comparative analysis involving 7 studies with controls, the RR was 0.99 (95% CI=0.83-1.19). The pooled prevalence of headache among 94,043 individuals with schizophrenia was 29.9% (95% CI=3-69%) and the RR compared to 4,248,284 controls was 1.32 (95% CI=0.85-2.07). In moderator analyses, neither age, sex, study quality or pain assessment method influenced pain prevalence. CONCLUSION Clinical pain affects a third of people with schizophrenia and levels are similar with age- and sex-comparable controls. Future research is needed to determine if similar clinical pain prevalences in schizophrenia occur despite having more painful conditions, resulting from under-reporting, higher pain thresholds or lower help seeking behaviours.
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Affiliation(s)
- Brendon Stubbs
- Faculty of Education and Health, University of Greenwich, Southwood Site, Avery Hill Road, Eltham, London SE9 2UG, UK.
| | - Alex J Mitchell
- Department of Psycho-oncology, University of Leicester, Leicester LE1 5WW, UK.
| | - Marc De Hert
- University Psychiatric Centre, KU Leuven, KU Leuven Departement of Neurosciences, Leuvensesteenweg 517, B-3070 Kortenberg, Belgium.
| | - Christoph U Correll
- Zucker Hillside Hospital, Long Island Jewish Medical Center, Glen Oaks, NY 11004, USA.
| | - Andy Soundy
- Department of Physiotherapy, University of Birmingham, Birmingham B15 2TT, UK.
| | - Marc Stroobants
- University Psychiatric Centre, KU Leuven, KU Leuven Departement of Neurosciences, Leuvensesteenweg 517, B-3070 Kortenberg, Belgium.
| | - Davy Vancampfort
- University Psychiatric Centre, KU Leuven, KU Leuven Departement of Neurosciences, Leuvensesteenweg 517, B-3070 Kortenberg, Belgium; KU Leuven Department of Rehabilitation Sciences, Tervuursevest 101, B-3001 Leuven, Belgium.
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Boucekine M, Boyer L, Baumstarck K, Millier A, Ghattas B, Auquier P, Toumi M. Exploring the Response Shift Effect on the Quality of Life of Patients with Schizophrenia. Med Decis Making 2014; 35:388-97. [DOI: 10.1177/0272989x14559273] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background. Interpretation of quality of life (QoL) scores over time can be difficult because of possible changes in internal standards, values, and conceptualization of QoL by individuals. This effect is called a response shift (RS). The purpose of this study was to examine whether an RS effect occurred over a 24-mo period in patients who were suffering from schizophrenia. Methods. The random forest method was applied to detect any RS reprioritization in a multicenter cohort study. QoL was recorded using a generic questionnaire (SF36) at baseline (T0), 12 mo (T12), and 24 mo (T24). Patients were categorized into 3 groups based on psychotic symptoms and relapse (stable, improved, and worsened groups) from their clinical profiles. The random forest method was performed to predict the General Health score of the SF36 from the other QoL domain scores of the SF36. We estimated the average variable importance of the QoL domain for each of the 3 groups. Results. A total of 124 (53.2%) patients were defined as stable, 59 (25.3%) as improved, and 50 (21.5%) as worsened. Among the stable group, the Social Functioning domain became more important over time. Of those classified as improved, the Mental Health domain became more important over time, while the Vitality domain became less important. Among those in the group who worsened, the Mental Health domain became less important while the Vitality and Bodily Pain domains became more important. Conclusions. Our study identified differential RS reprioritization among patients with different clinical profiles. Further work is needed to determine whether RS should be interpreted as a measurement bias or as an effect integrated in a true change.
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Affiliation(s)
- Mohamed Boucekine
- Aix-Marseille University, Marseille, France (MB, LB, KB, BG, PA)
- Creativ-Ceutical France, Paris, France (AM, MT)
- UCBL 1, Chair of Market Access University, Claude Bernard Lyon I, Decision Sciences & Health Policy, Villeurbanne, France (MT)
| | - Laurent Boyer
- Aix-Marseille University, Marseille, France (MB, LB, KB, BG, PA)
- Creativ-Ceutical France, Paris, France (AM, MT)
- UCBL 1, Chair of Market Access University, Claude Bernard Lyon I, Decision Sciences & Health Policy, Villeurbanne, France (MT)
| | - Karine Baumstarck
- Aix-Marseille University, Marseille, France (MB, LB, KB, BG, PA)
- Creativ-Ceutical France, Paris, France (AM, MT)
- UCBL 1, Chair of Market Access University, Claude Bernard Lyon I, Decision Sciences & Health Policy, Villeurbanne, France (MT)
| | - Aurelie Millier
- Aix-Marseille University, Marseille, France (MB, LB, KB, BG, PA)
- Creativ-Ceutical France, Paris, France (AM, MT)
- UCBL 1, Chair of Market Access University, Claude Bernard Lyon I, Decision Sciences & Health Policy, Villeurbanne, France (MT)
| | - Badih Ghattas
- Aix-Marseille University, Marseille, France (MB, LB, KB, BG, PA)
- Creativ-Ceutical France, Paris, France (AM, MT)
- UCBL 1, Chair of Market Access University, Claude Bernard Lyon I, Decision Sciences & Health Policy, Villeurbanne, France (MT)
| | - Pascal Auquier
- Aix-Marseille University, Marseille, France (MB, LB, KB, BG, PA)
- Creativ-Ceutical France, Paris, France (AM, MT)
- UCBL 1, Chair of Market Access University, Claude Bernard Lyon I, Decision Sciences & Health Policy, Villeurbanne, France (MT)
| | - Mondher Toumi
- Aix-Marseille University, Marseille, France (MB, LB, KB, BG, PA)
- Creativ-Ceutical France, Paris, France (AM, MT)
- UCBL 1, Chair of Market Access University, Claude Bernard Lyon I, Decision Sciences & Health Policy, Villeurbanne, France (MT)
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Terpstra TL, Williamson S, Terpstra T. Palliative care for terminally ill individuals with schizophrenia. J Psychosoc Nurs Ment Health Serv 2014; 52:32-8. [PMID: 24893353 DOI: 10.3928/02793695-20140522-01] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 05/08/2014] [Indexed: 11/20/2022]
Abstract
Individuals with schizophrenia are often medically undertreated and experience symptoms that interfere with communication and the capacity to make medical decisions. These issues complicate quality end-of-life care for this population and are of particular concern for hospice and palliative care nurses and health care providers. This article presents a case study of a terminally ill patient with schizophrenia. It is divided into a series of vignettes; each vignette presents a common clinical issue encountered by the palliative care team. Interventions suggested in the literature and those used by team members when working with the patient are discussed.
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de Araújo AN, do Nascimento MA, de Sena EP, Baptista AF. Temporomandibular disorders in patients with schizophrenia using antipsychotic agents: a discussion paper. Drug Healthc Patient Saf 2014; 6:21-7. [PMID: 24648768 PMCID: PMC3956479 DOI: 10.2147/dhps.s57172] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Patients with psychiatric problems show a tendency to develop temporomandibular disorders (TMD). Particularly, patients with schizophrenia are quite likely to have signs and symptoms of TMD due to the impairment of their oral health, the use of antipsychotic drugs, and other general health problems. In nonschizophrenic populations, TMD have been considered as the main cause of nondental pain in the orofacial region, involving mechanisms associated with changes in masticatory activity at the cortical and neuromuscular levels. Individuals with schizophrenia do not usually complain of pain, and TMD is misdiagnosed in this population. In this paper, we aimed to review the clinical aspects of TMD in people with schizophrenia on antipsychotic drug therapy.
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Affiliation(s)
- Arão Nogueira de Araújo
- Postgraduate Program in Interactive Processes of Organs and Systems, Federal University of Bahia, Salvador, Brazil
| | - Marion Alves do Nascimento
- Postgraduate Program in Interactive Processes of Organs and Systems, Federal University of Bahia, Salvador, Brazil
| | - Eduardo Pondé de Sena
- Postgraduate Program in Interactive Processes of Organs and Systems, Federal University of Bahia, Salvador, Brazil ; Department of Pharmacology, Institute of Health Sciences, Federal University of Bahia, Salvador, Brazil
| | - Abrahão Fontes Baptista
- Department of Biomorphology, Institute of Health Sciences, Federal University of Bahia, Salvador, Brazil ; Postgraduate Program in Medicine and Health, Federal University of Bahia, Salvador, Brazil
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