1
|
Abstract
BACKGROUND Lung cancer risk factors, like tobacco smoking, are highly prevalent in patients with schizophrenia. Whether these patients have a higher risk of lung cancer remains unknown. AIMS We aimed to investigate whether patients with schizophrenia have a higher incidence of lung cancer compared with general population, in a meta-analysis. METHOD Eligible studies were searched from PubMed and EMBASE databases to identify cases of lung cancer in patients with schizophrenia and the general population. This meta-analysis utilised the random-effects model and prediction interval was used to calculate the heterogeneity of these eligible studies. We assessed the quality of evidence with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS There were 12 studies, totalling 496 265 patients, included in this meta-analysis. The data showed that the baseline schizophrenia diagnosis was not associated with any changes in lung cancer incidence in the overall population, with a standardised incidence ratio of 1.11 (95% CI 0.90-1.37; P = 0.31), although there was a significant heterogeneity among these studies (I2 = 94%). Moreover, there was also a substantial between-study variance with wide prediction interval values (0.47-2.64). The data were consistent for both males and females. CONCLUSIONS Up-to-date evidence from epidemiological studies indicates the lack of certainty about the association between schizophrenia diagnosis and lung cancer incidence.
Collapse
Affiliation(s)
- Chuanjun Zhuo
- Professor, Department of Psychiatric-Neuroimaging-Genetics Laboratory, Tianjin Anding Hospital; Department of Psychiatry and Comorbidity, Mental Health Teaching Hospital, Tianjin Medical University; Department of Psychiatry, Jinning Medical University; and Department of Psychiatry, Wenzhou Seventh People's Hospital, China,Correspondence: Chuanjun Zhuo, Department of Psychiatry and Comorbidity, Mental Health Teaching Hospital, Tianjin Medical University, 13 Liulin Road, Hexi District, Tianjin 300300, China.
| | - Hongqing Zhuang
- Professor, Department of Radiation Oncology, Peking University Third Hospital, China
| | - Xiangyang Gao
- Professor, Health Management Institute, Big Data Analysis Center, Chinese PLA General Hospital, China
| | - Patrick Todd Triplett
- Assistant Professor, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, USA
| |
Collapse
|
2
|
Shah A, Hoffman EM, Mauermann ML, Loprinzi CL, Windebank AJ, Klein CJ, Staff NP. Incidence and disease burden of chemotherapy-induced peripheral neuropathy in a population-based cohort. J Neurol Neurosurg Psychiatry 2018; 89:636-641. [PMID: 29439162 PMCID: PMC5970026 DOI: 10.1136/jnnp-2017-317215] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 01/04/2018] [Accepted: 01/24/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To assess disease burden of chemotherapy-induced peripheral neuropathy (CIPN), which is a common dose-limiting side effect of neurotoxic chemotherapy. Late effects of CIPN may increase with improved cancer survival. METHODS Olmsted County, Minnesota residents receiving neurotoxic chemotherapy were identified and CIPN was ascertained via text searches of polyneuropathy symptoms in the medical record. Clinical records were queried to collect data on baseline characteristics, risk factors, signs and symptoms of CIPN, medications, impairments and International Classification of Diseases, Ninth Revision (ICD-9) diagnostic codes for all subjects. RESULTS A total of 509 individuals with incident exposure to an inclusive list of neurotoxic chemotherapy agents between 2006 and 2008 were identified. 268 (52.7%) of these individuals were determined to have CIPN. The median time from incident exposure to first documented symptoms was 71 days. Patients with CIPN received a neuropathy ICD-9 diagnosis in only 37 instances (13.8%). Pain symptoms and use of pain medications were observed more often in patients with CIPN. Five-year survival was greater in those with CIPN (55.2%) versus those without (36.1%). Those with CIPN surviving greater than 5 years (n=145) continued to have substantial impairments and were more likely to be prescribed opioids than those without CIPN (OR 2.0, 1.06-3.69). CONCLUSIONS Results from our population-based study are consistent with previous reports of high incidence of CIPN in the first 2 years following incident exposure to neurotoxic chemotherapeutic agents, and its association with significant pain symptomatology and accompanied long-term opioid use. Increased survival following exposure to neurotoxic chemotherapy and its long-term disease burden necessitates further study among survivors.
Collapse
Affiliation(s)
- Arya Shah
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | | | | | | | - Nathan P Staff
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
3
|
Brixner DI, Said Q, Corey-Lisle PK, Tuomari AV, L'italien GJ, Stockdale W, Oderda GM. Naturalistic Impact of Second-Generation Antipsychotics on Weight Gain. Ann Pharmacother 2016; 40:626-32. [PMID: 16569802 DOI: 10.1345/aph.1g564] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: While second-generation antipsychotics (SGAs) have had benefits over earlier antipsychotic treatments, their use has been associated with reports of weight gain. Body mass index (BMI) has been studied in clinical trials with limited comparison between drugs. Objective: To investigate the impact of each SGA on the risk of weight increase in an adult population. Methods: Using a national electronic medical records database, a naturalistic impact of SGAs on BMI was evaluated. Patients (aged ≥ 18 y) receiving a prescription for an antipsychotic drug between January 1995 and March 2004 were identified. An adverse event was defined as at least a 7% increase in BMI from baseline within one year of antipsychotic prescription and a post-increase BMI of at least 25 kg/m2. Results: A total of 9394 patients were identified, with 1514 cases of increased BMI after initial prescription. Risperidone (OR 1.39; 95% CI 1.16 to 1.66), quetiapine (OR 1.36; 95% CI 1.13 to 1.64), and olanzapine (OR 1.76; 95% CI 1.50 to 2.07)were significantly more likely to cause BMI increase compared with first-generation antipsychotics (FGAs). Aripiprazole (OR 0.72; 95% CI 0.36 to 1.46), ziprasidone (OR 0.68; 95% CI 0.39 to 1.18), and clozapine (OR 1.01; 95% CI 0.56 to 1.81) were less likely to induce weight gain compared with FGAs. Conclusions: This study provides a foundation for understanding how SGAs impact weight gain in a naturalistic, as opposed to a clinical trial, setting and provides evidence that there are differential risks of weight gain between SGAs. Because of negative long-term health effects of weight gain, physicians need to take all factors into consideration when recommending pharmaceutical therapy for patients with severe mental illness.
Collapse
Affiliation(s)
- Diana I Brixner
- Executive Pharmacotherapy Outcomes Research Center, University of Utah, Salt Lake City, UT 84108, USA.
| | | | | | | | | | | | | |
Collapse
|
4
|
Davis KAS, Sudlow CLM, Hotopf M. Can mental health diagnoses in administrative data be used for research? A systematic review of the accuracy of routinely collected diagnoses. BMC Psychiatry 2016; 16:263. [PMID: 27455845 PMCID: PMC4960739 DOI: 10.1186/s12888-016-0963-x] [Citation(s) in RCA: 160] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 07/05/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND There is increasing availability of data derived from diagnoses made routinely in mental health care, and interest in using these for research. Such data will be subject to both diagnostic (clinical) error and administrative error, and so it is necessary to evaluate its accuracy against a reference-standard. Our aim was to review studies where this had been done to guide the use of other available data. METHODS We searched PubMed and EMBASE for studies comparing routinely collected mental health diagnosis data to a reference standard. We produced diagnostic category-specific positive predictive values (PPV) and Cohen's kappa for each study. RESULTS We found 39 eligible studies. Studies were heterogeneous in design, with a wide range of outcomes. Administrative error was small compared to diagnostic error. PPV was related to base rate of the respective condition, with overall median of 76 %. Kappa results on average showed a moderate agreement between source data and reference standard for most diagnostic categories (median kappa = 0.45-0.55); anxiety disorders and schizoaffective disorder showed poorer agreement. There was no significant benefit in accuracy for diagnoses made in inpatients. CONCLUSIONS The current evidence partly answered our questions. There was wide variation in the quality of source data, with a risk of publication bias. For some diagnoses, especially psychotic categories, administrative data were generally predictive of true diagnosis. For others, such as anxiety disorders, the data were less satisfactory. We discuss the implications of our findings, and the need for researchers to validate routine diagnostic data.
Collapse
Affiliation(s)
- Katrina A. S. Davis
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, Kings College London, London, UK
| | - Cathie L. M. Sudlow
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, SE5 8AZ UK
| | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, Kings College London, London, UK. .,Department of Psychological Medicine and SLaM/IoPPN BRC, Kings College London, PO62, Weston Education Centre, Cutcombe Road, London, SE5 9RJ, UK.
| |
Collapse
|
5
|
Gråwe R, Levander S, Krüger M. Incidence, clinical characteristics, and short-term outcome of first-episode schizophrenia. ACTA ACUST UNITED AC 2009. [DOI: 10.3109/08039489109101990] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
6
|
Rezvyy G, Parniakov A, Fedulova E, Olstad R. Correcting biases in psychiatric diagnostic practice in Northwest Russia: comparing the impact of a general educational program and a specific diagnostic training program. BMC MEDICAL EDUCATION 2008; 8:15. [PMID: 18394150 PMCID: PMC2346459 DOI: 10.1186/1472-6920-8-15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2007] [Accepted: 04/04/2008] [Indexed: 05/26/2023]
Abstract
BACKGROUND A general education in psychiatry does not necessary lead to good diagnostic skills. Specific training programs in diagnostic coding are established to facilitate implementation of ICD-10 coding practices. However, studies comparing the impact of these two different educational approaches on diagnostic skills are lacking. The aim of the current study was to find out if a specific training program in diagnostic coding improves the diagnostic skills better than a general education program, and if a national bias in diagnostic patterns can be minimised by a specific training in diagnostic coding. METHODS A pre post design study with two groups was carried in the county of Archangelsk, Russia. The control group (39 psychiatrists) took the required course (general educational program), while the intervention group (45 psychiatrists) were given a specific training in diagnostic coding. Their diagnostic skills before and after education were assessed using 12 written case-vignettes selected from the entire spectrum of psychiatric disorders. RESULTS There was a significant improvement in diagnostic skills in both the intervention group and the control group. However, the intervention group improved significantly more than did the control group. The national bias was partly corrected in the intervention group but not to the same degree in the control group. When analyzing both groups together, among the background factors only the current working place impacted the outcome of the intervention. CONCLUSION Establishing an internationally accepted diagnosis seems to be a special skill that requires specific training and needs to be an explicit part of the professional educational activities of psychiatrists. It does not appear that that skill is honed without specific training. The issue of national diagnostic biases should be taken into account in comparative cross-cultural studies of almost any character. The mechanisms of such biases are complex and need further consideration in future research. Future research should also address the question as to whether the observed improvement in diagnostic skills after specific training actually leads to changes in routine diagnostic practice.
Collapse
Affiliation(s)
- Grigory Rezvyy
- Nordland Hospital, Psychiatric Department, N-8092, Bodø, Norway
| | - Alexander Parniakov
- Northern State Medical University, 51 Troitsky avenue, 163061, Archangelsk, Russia
| | - Elena Fedulova
- Archangelsk County Psychiatric Dispensary, 262 Lomonosova avenue, 163061, Archangelsk, Russia
| | - Reidun Olstad
- University Hospital in Northern Norway, Åsgård, 9291, Tromsø, Norway
- University of Tromsø, Faculty of medicine, Institute of clinical psychiatry, Åsgård, 9291, Tromsø, Norway
| |
Collapse
|
7
|
Rezvyy G, Oiesvold T, Parniakov A, Olstad R. A comparative study of diagnostic practice in psychiatry in Northern Norway and Northwest Russia. Soc Psychiatry Psychiatr Epidemiol 2005; 40:316-23. [PMID: 15834783 DOI: 10.1007/s00127-005-0894-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2004] [Indexed: 10/25/2022]
Abstract
BACKGROUND The co-operation between psychiatrists in Norway and Russia is increasing. The object of this study was to find out whether there were differences in diagnostic practice of psychiatrists in both countries, to look at the nature of the differences and to examine whether these differences affected diagnostic quality. METHOD Thirty medical doctors working at psychiatric hospitals in both countries diagnosed 12 clinical case vignettes selected from a wide spectre of psychiatric disorders. RESULTS The Russian clinicians used a larger range of diagnoses than the Norwegians. The Russians tended to diagnose schizophrenia and schizophrenia-like disorders in cases that presented psychotic syndromes, and somatoform disorders in cases that presented agoraphobia. The Norwegians tended to evaluate affective aspects in preference to psychotic symptoms in the case of schizoaffective disorder and overestimate the degree of depression. In general, the Russians had lower total score of correct answers than the Norwegians. CONCLUSION In spite of the limitations due to minor differences in the data collection phase in the two countries, the study clearly demonstrates differences in diagnostic practice between the countries.
Collapse
Affiliation(s)
- Grigory Rezvyy
- Nordland Hospital, Kløveråsveien 1, 8002, Bodø, Norway, and Northern State Medical University, Archangelsk, Russia.
| | | | | | | |
Collapse
|
8
|
Malt UF, Huyse FJ, Herzog T, Lobo A, Rijssenbeek AJ. The ECLW Collaborative Study: III. Training and reliability of ICD-10 psychiatric diagnoses in the general hospital setting--an investigation of 220 consultants from 14 European countries. European Consultation Liaison Workgroup. J Psychosom Res 1996; 41:451-63. [PMID: 9032709 DOI: 10.1016/s0022-3999(96)00213-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A comprehensive training program for reliable use of the ICD/10 in Consultation-Liaison (C-L) psychiatry was conducted with 220 psychiatrists and psychologists from 14 European countries. The training included rating of written test cases and development of a coding manual to avoid diagnostic pitfalls not addressed in the ICD-10 manual. Following this training, all consultants rated 13 written case histories. One hundred sixty-seven consultants (76%) had a kappa (kappa) of at least 0.70. Only 13 (6%) had a kappa 0.40. The percentage of high reliability raters was evenly distributed among the different countries. Consultants had some problems in the differentiation between adjustment disorders and depressive disorders, and in the classification of disorders where ICD-10 differs from the DSM-III-R system. National biases in diagnostic practice were found with regard to the "case" concept and the role of alcohol in confusional states. Finnish consultants coded "no psychiatric disorder" significantly more often, whereas German and Italian consultants attributed delirious state more often to alcohol than consultants from other European countries. The study demonstrates that it is possible to achieve acceptable interrater reliability in applying the ICD-10 guidelines, through training programs designed for C-L psychiatrists and psychologists. Nevertheless, this first cross-national study shows the importance of addressing differences in national diagnostic practice.
Collapse
Affiliation(s)
- U F Malt
- Department of Psychosomatic and Behavioral Medicine University of Oslo, National Hospital, Norway
| | | | | | | | | |
Collapse
|