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Dark F, Galloway G, Gray M, Cella M, De Monte V, Gore-Jones V, Ritchie G. Reward Learning as a Potential Mechanism for Improvement in Schizophrenia Spectrum Disorders Following Cognitive Remediation: Protocol for a Clinical, Nonrandomized, Pre-Post Pilot Study. JMIR Res Protoc 2024; 13:e52505. [PMID: 38252470 PMCID: PMC10845020 DOI: 10.2196/52505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/23/2023] [Accepted: 12/04/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Cognitive impairment is common with schizophrenia spectrum disorders. Cognitive remediation (CR) is effective in improving global cognition, but not all individuals benefit from this type of intervention. A better understanding of the potential mechanism of action of CR is needed. One proposed mechanism is reward learning (RL), the cognitive processes responsible for adapting behavior following positive or negative feedback. It is proposed that the structure of CR enhances RL and motivation to engage in increasingly challenging tasks, and this is a potential mechanism by which CR improves cognitive functioning in schizophrenia. OBJECTIVE Our primary objective is to examine reward processing in individuals with schizophrenia before and after completing CR and to compare this with a group of matched clinical controls. We will assess whether RL mediates the relationship between CR and improved cognitive function and reduced negative symptoms. Potential differences in social RL and nonsocial RL in individuals with schizophrenia will also be investigated and compared with a healthy matched control group. METHODS We propose a clinical, nonrandomized, pre-post pilot study comparing the impact of CR on RL and neurocognitive outcomes. The study will use a combination of objective and subjective measures to assess neurocognitive, psychiatric symptoms, and neurophysiological domains. A total of 40 individuals with schizophrenia spectrum disorders (aged 18-35 years) will receive 12 weeks of CR therapy (n=20) or treatment as usual (n=20). Reward processing will be evaluated using a reinforcement learning task with 2 conditions (social reward vs nonsocial reward) at baseline and the 12-week follow-up. Functional magnetic resonance imaging responses will be measured during this task. To validate the reinforcement learning task, RL will also be assessed in 20 healthy controls, matched for age, sex, and premorbid functioning. Mixed-factorial ANOVAs will be conducted to evaluate treatment group differences. For the functional magnetic resonance imaging analysis, computational modeling will allow the estimation of learning parameters at each point in time, during each task condition, for each participant. We will use a variational Bayesian framework to measure how learning occurred during the experimental task and the subprocesses that underlie this learning. Second-level group analyses will examine how learning in patients differs from that observed in control participants and how CR alters learning efficiency and the underlying neural activity. RESULTS As of September 2023, this study has enrolled 15 participants in the CR group, 1 participant in the treatment-as-usual group, and 11 participants in the healthy control group. Recruitment is expected to be completed by September 2024. Data analysis is expected to be completed and published in early 2025. CONCLUSIONS The results of this study will contribute to the knowledge of CR and RL processes in severe mental illness and the understanding of the systems that impact negative symptoms and cognitive impairments within this population. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52505.
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Affiliation(s)
- Frances Dark
- Metro South Addiction and Mental Health Services, Woolloongabba, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Graham Galloway
- Translational Research Institute, Woolloongabba, Australia
- Herston Imaging Research Facility, The University of Queensland, Brisbane, Australia
| | - Marcus Gray
- Translational Research Institute, Woolloongabba, Australia
| | | | - Veronica De Monte
- Metro South Addiction and Mental Health Services, Woolloongabba, Australia
| | | | - Gabrielle Ritchie
- Metro South Addiction and Mental Health Services, Woolloongabba, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
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Shin D, Lee J, Kim Y, Park J, Shin D, Song Y, Joo EJ, Roh S, Lee KY, Oh S, Ahn YM, Rhee SJ, Kim Y. Evaluation of a Nondepleted Plasma Multiprotein-Based Model for Discriminating Psychiatric Disorders Using Multiple Reaction Monitoring-Mass Spectrometry: Proof-of-Concept Study. J Proteome Res 2024; 23:329-343. [PMID: 38063806 DOI: 10.1021/acs.jproteome.3c00580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
Psychiatric evaluation relies on subjective symptoms and behavioral observation, which sometimes leads to misdiagnosis. Despite previous efforts to utilize plasma proteins as objective markers, the depletion method is time-consuming. Therefore, this study aimed to enhance previous quantification methods and construct objective discriminative models for major psychiatric disorders using nondepleted plasma. Multiple reaction monitoring-mass spectrometry (MRM-MS) assays for quantifying 453 peptides in nondepleted plasma from 132 individuals [35 major depressive disorder (MDD), 47 bipolar disorder (BD), 23 schizophrenia (SCZ) patients, and 27 healthy controls (HC)] were developed. Pairwise discriminative models for MDD, BD, and SCZ, and a discriminative model between patients and HC were constructed by machine learning approaches. In addition, the proteins from nondepleted plasma-based discriminative models were compared with previously developed depleted plasma-based discriminative models. Discriminative models for MDD versus BD, BD versus SCZ, MDD versus SCZ, and patients versus HC were constructed with 11 to 13 proteins and showed reasonable performances (AUROC = 0.890-0.955). Most of the shared proteins between nondepleted and depleted plasma models had consistent directions of expression levels and were associated with neural signaling, inflammatory, and lipid metabolism pathways. These results suggest that multiprotein markers from nondepleted plasma have a potential role in psychiatric evaluation.
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Affiliation(s)
- Dongyoon Shin
- Proteomics Research Team, CHA Institute of Future Medicine, Seongnam 13520, Republic of Korea
| | - Jihyeon Lee
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Yeongshin Kim
- Department of Life Science, General Graduate School, CHA University, Seongnam 13488, Republic of Korea
| | - Junho Park
- Proteomics Research Team, CHA Institute of Future Medicine, Seongnam 13520, Republic of Korea
- Department of Life Science, General Graduate School, CHA University, Seongnam 13488, Republic of Korea
| | - Daun Shin
- Department of Psychiatry, Korea University Anam Hospital, Seoul 02841, Republic of Korea
| | - Yoojin Song
- Department of Psychiatry, Kangwon National University Hospital, Chuncheon 24289, Republic of Korea
| | - Eun-Jeong Joo
- Department of Neuropsychiatry, School of Medicine, Eulji University, Daejeon 34824, Republic of Korea
- Department of Psychiatry, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu 11759, Republic of Korea
| | - Sungwon Roh
- Department of Psychiatry, Hanyang University Hospital and Hanyang University College of Medicine, Seoul 04763, Republic of Korea
| | - Kyu Young Lee
- Department of Neuropsychiatry, School of Medicine, Eulji University, Daejeon 34824, Republic of Korea
- Department of Psychiatry, Nowon Eulji University Hospital, Seoul 01830, Republic of Korea
| | - Sanghoon Oh
- Department of Neuropsychiatry, School of Medicine, Eulji University, Daejeon 34824, Republic of Korea
- Department of Psychiatry, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu 11759, Republic of Korea
| | - Yong Min Ahn
- Department of Psychiatry, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul 03080, Republic of Korea
- Institute of Human Behavioral Medicine, Seoul National University Medical Research Center, Seoul 03080, Republic of Korea
| | - Sang Jin Rhee
- Biomedical Research Institute, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Youngsoo Kim
- Proteomics Research Team, CHA Institute of Future Medicine, Seongnam 13520, Republic of Korea
- Department of Life Science, General Graduate School, CHA University, Seongnam 13488, Republic of Korea
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Wu H, Xu L, Zheng X, Zhou X, Zhang Y, Sun Y. Neuropsychiatric disorders associated with recreational nitrous oxide use. Clin Toxicol (Phila) 2023; 61:961-967. [PMID: 37999959 DOI: 10.1080/15563650.2023.2279936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 11/01/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Recreational nitrous oxide use has grown in popularity among young people and has become a serious public health problem. Chronic use of nitrous oxide can lead to a functional vitamin B12 deficiency and neuropsychiatric complications. PURPOSE This study aimed to investigate the characteristics of neuropsychiatric complications associated with nitrous oxide use and to enhance clinicians' awareness of this public health problem. METHODS We retrospectively reviewed 16 patients with neuropsychiatric disorders related to nitrous oxide use who were treated in our hospital from June 2021 to October 2022. Their demographics, clinical features, investigations, treatments and outcomes were analyzed. RESULTS There were ten males and six females between the ages of 17 and 25 with a mean age of 20.5 ± 2.6 years. Thirteen patients sought medical help from the neurology clinic. Two patients presented to the psychiatric department and one patient presented to the emergency department with acute cognitive impairment. All 16 patients presented with neurological symptoms, such as paresthesia in four limbs or the lower limbs, unsteady gait and weakness. Twelve patients developed psychiatric symptoms, such as hallucinations, agitation, depression, emotional indifference and personality changes. Twelve patients had vitamin B12 deficiency. All 16 patients had hyperhomocysteinemia. Fourteen patients showed abnormal high signal on T2-weighted imaging and an inverted "V" sign in axial view, mainly involving the cervical cord. Neuropsychiatric symptoms improved with vitamin B12 treatment and cessation of nitrous oxide use in all cases. CONCLUSION Young adults are predominately involved in recreational use of nitrous oxide, which can cause neuropsychiatric complications. The clinical response to vitamin B12 supplementation and cessation of nitrous oxide use is generally good. Clinicians should recognize nitrous oxide use as a public health problem and a cause of a wide range of neuropsychiatric symptoms, particularly in younger patients.
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Affiliation(s)
- Huijuan Wu
- Jinzhou Medical University, Jinzhou, China
| | - Liaoyang Xu
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Xingyongpei Zheng
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Xinyu Zhou
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
- Department of Neurology, The First Affiliated Hospital of Kangda College of Nanjing Medical University, Lianyungang, China
| | - Yongjin Zhang
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
- Department of Neurology, The First Affiliated Hospital of Kangda College of Nanjing Medical University, Lianyungang, China
| | - Yong Sun
- Department of Neurosurgery, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
- Department of Neurosurgery, The First Affiliated Hospital of Kangda College of Nanjing Medical University, Lianyungang, China
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4
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Rhee SJ, Shin D, Shin D, Song Y, Joo EJ, Jung HY, Roh S, Lee SH, Kim H, Bang M, Lee KY, Lee J, Kim J, Kim Y, Kim Y, Ahn YM. Network analysis of plasma proteomes in affective disorders. Transl Psychiatry 2023; 13:195. [PMID: 37296094 DOI: 10.1038/s41398-023-02485-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 05/13/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
The conventional differentiation of affective disorders into major depressive disorder (MDD) and bipolar disorder (BD) has insufficient biological evidence. Utilizing multiple proteins quantified in plasma may provide critical insight into these limitations. In this study, the plasma proteomes of 299 patients with MDD or BD (aged 19-65 years old) were quantified using multiple reaction monitoring. Based on 420 protein expression levels, a weighted correlation network analysis was performed. Significant clinical traits with protein modules were determined using correlation analysis. Top hub proteins were determined using intermodular connectivity, and significant functional pathways were identified. Weighted correlation network analysis revealed six protein modules. The eigenprotein of a protein module with 68 proteins, including complement components as hub proteins, was associated with the total Childhood Trauma Questionnaire score (r = -0.15, p = 0.009). Another eigenprotein of a protein module of 100 proteins, including apolipoproteins as hub proteins, was associated with the overeating item of the Symptom Checklist-90-Revised (r = 0.16, p = 0.006). Functional analysis revealed immune responses and lipid metabolism as significant pathways for each module, respectively. No significant protein module was associated with the differentiation between MDD and BD. In conclusion, childhood trauma and overeating symptoms were significantly associated with plasma protein networks and should be considered important endophenotypes in affective disorders.
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Affiliation(s)
- Sang Jin Rhee
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dongyoon Shin
- Department of Biomedical Science, School of Medicine, CHA University, Seongnam, Republic of Korea
| | - Daun Shin
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yoojin Song
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eun-Jeong Joo
- Department of Neuropsychiatry, School of Medicine, Eulji University, Daejeon, Republic of Korea
- Department of Psychiatry, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu, Republic of Korea
| | - Hee Yeon Jung
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Psychiatry, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
- Institute of Human Behavioral Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Sungwon Roh
- Department of Psychiatry, Hanyang University Hospital and Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Sang-Hyuk Lee
- Department of Psychiatry, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Hyeyoung Kim
- Department of Psychiatry, Inha University Hospital, Incheon, Republic of Korea
| | - Minji Bang
- Department of Psychiatry, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Kyu Young Lee
- Department of Neuropsychiatry, School of Medicine, Eulji University, Daejeon, Republic of Korea
- Department of Psychiatry, Nowon Eulji University Hospital, Seoul, Republic of Korea
| | - Jihyeon Lee
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jaenyeon Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yeongshin Kim
- Department of Biomedical Science, School of Medicine, CHA University, Seongnam, Republic of Korea
| | - Youngsoo Kim
- Department of Biomedical Science, School of Medicine, CHA University, Seongnam, Republic of Korea.
| | - Yong Min Ahn
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea.
- Institute of Human Behavioral Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.
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5
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Latent class analysis of psychotic-affective disorders with data-driven plasma proteomics. Transl Psychiatry 2023; 13:44. [PMID: 36746927 PMCID: PMC9902608 DOI: 10.1038/s41398-023-02321-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 01/09/2023] [Accepted: 01/13/2023] [Indexed: 02/08/2023] Open
Abstract
Data-driven approaches to subtype transdiagnostic samples are important for understanding heterogeneity within disorders and overlap between disorders. Thus, this study was conducted to determine whether plasma proteomics-based clustering could subtype patients with transdiagnostic psychotic-affective disorder diagnoses. The study population included 504 patients with schizophrenia, bipolar disorder, and major depressive disorder and 160 healthy controls, aged 19 to 65 years. Multiple reaction monitoring was performed using plasma samples from each individual. Pathologic peptides were determined by linear regression between patients and healthy controls. Latent class analysis was conducted in patients after peptide values were stratified by sex and divided into tertile values. Significant demographic and clinical characteristics were determined for the latent clusters. The latent class analysis was repeated when healthy controls were included. Twelve peptides were significantly different between the patients and healthy controls after controlling for significant covariates. Latent class analysis based on these peptides after stratification by sex revealed two distinct classes of patients. The negative symptom factor of the Brief Psychiatric Rating Scale was significantly different between the classes (t = -2.070, p = 0.039). When healthy controls were included, two latent classes were identified, and the negative symptom factor of the Brief Psychiatric Rating Scale was still significant (t = -2.372, p = 0.018). In conclusion, negative symptoms should be considered a significant biological aspect for understanding the heterogeneity and overlap of psychotic-affective disorders.
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Li X, Gao Y, Wang Y, Wang Y, Wu Q. Prevalence and Influence Factors for Non-Alcoholic Fatty Liver Disease in Long-Term Hospitalized Patients with Schizophrenia: A Cross-Sectional Retrospective Study. Neuropsychiatr Dis Treat 2023; 19:379-389. [PMID: 36846597 PMCID: PMC9946011 DOI: 10.2147/ndt.s398385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 01/27/2023] [Indexed: 02/19/2023] Open
Abstract
PURPOSE Long-term hospitalized patients with schizophrenia (SCZ) are vulnerable to physical illness, leading to impaired life expectancy and treatment outcomes. There are few studies on the influence of non-alcoholic fatty liver disease (NAFLD) in long-term hospitalized patients. This study aimed to investigate the prevalence of and influence factors for NAFLD in hospitalized patients with SCZ. PATIENTS AND METHODS This cross-sectional retrospective study included 310 patients who had experienced long-term hospitalization for SCZ. NAFLD was diagnosed based on the results of abdominal ultrasonography. The T-test, Mann-Whitney U-test, correlation analysis, and logistic regression analysis were used to determine the influence factors for NAFLD. RESULTS Among the 310 patients who had experienced long-term hospitalization for SCZ, the prevalence of NAFLD was 54.84%. Antipsychotic polypharmacy (APP), body mass index (BMI), hypertension, diabetes, total cholesterol (TC), apolipoprotein B (ApoB), aspartate aminotransferase (AST), alanine aminotransferase (ALT), triglycerides (TG), uric acid, blood glucose, gamma-glutamyl transpeptidase (GGT), high-density lipoprotein, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio significantly differed between the NAFLD and non-NAFLD groups (all P<0.05). Hypertension, diabetes, APP, BMI, TG, TC, AST, ApoB, ALT, and GGT were positively correlated with NAFLD (all P<0.05). The results of the logistic regression analysis indicated that APP, diabetes, BMI, ALT, and ApoB were the influence factors for NAFLD in patients with SCZ. CONCLUSION Our results suggest a high prevalence of NAFLD among patients hospitalized long-term due to severe SCZ symptoms. Moreover, a history of diabetes, APP, overweight/obese status, and increased levels of ALT and ApoB were identified as negative factors for NAFLD in these patients. These findings may provide a theoretical basis for the prevention and treatment of NAFLD in patients with SCZ and contribute to the development of novel targeted treatments.
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Affiliation(s)
- Xuelong Li
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, People's Republic of China.,Department of Psychiatry, Affiliated Psychological Hospital of Anhui Medical University, Hefei, People's Republic of China.,Anhui Mental Health Center, Hefei, People's Republic of China
| | - Yakun Gao
- Affiliated Hospital of Weifang Medical College, Weifang, People's Republic of China
| | - Yongmei Wang
- Department of Psychiatry, Affiliated Psychological Hospital of Anhui Medical University, Hefei, People's Republic of China.,Anhui Mental Health Center, Hefei, People's Republic of China.,Hefei Fourth People's Hospital, Hefei, People's Republic of China
| | - Ying Wang
- Department of Psychiatry, Affiliated Psychological Hospital of Anhui Medical University, Hefei, People's Republic of China.,Anhui Mental Health Center, Hefei, People's Republic of China.,Hefei Fourth People's Hospital, Hefei, People's Republic of China
| | - Qing Wu
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, People's Republic of China.,Department of Psychiatry, Affiliated Psychological Hospital of Anhui Medical University, Hefei, People's Republic of China.,Anhui Mental Health Center, Hefei, People's Republic of China.,Hefei Fourth People's Hospital, Hefei, People's Republic of China
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7
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Hofmann AB, Schmid HM, Jabat M, Brackmann N, Noboa V, Bobes J, Garcia-Portilla MP, Seifritz E, Vetter S, Egger ST. Utility and validity of the Brief Psychiatric Rating Scale (BPRS) as a transdiagnostic scale. Psychiatry Res 2022; 314:114659. [PMID: 35709637 DOI: 10.1016/j.psychres.2022.114659] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 05/15/2022] [Accepted: 05/30/2022] [Indexed: 10/18/2022]
Abstract
The Brief Psychiatric Rating Scale (BPRS) was originally conceived to assess psychopathology in several psychiatric disorders, making it an appropriate candidate to be used as a transdiagnostic instrument. We analyzed the utility and validity of the BPRS in a diagnostically heterogeneous sample of 600 psychiatric inpatients. As a comparator, we chose the mini-ICF-APP, a scale used to measure functioning and impairment across the diagnostic spectrum. Both scales had good internal consistency. The BPRS and the mini-ICF-APP showed a moderate correlation, with good levels of agreement. We were able to identify general symptoms present across the diagnostic spectrum, influencing severity and a cluster of symptoms specific for each diagnosis. Our results show the utility and validity of the BPRS as a transdiagnostic assessment tool that could easily be introduced in routine clinical work.
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Affiliation(s)
- Andreas B Hofmann
- University of Zurich, Faculty of Medicine, Psychiatric University Hospital of Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich, Switzerland
| | - Hanna M Schmid
- University of Zurich, Faculty of Medicine, Psychiatric University Hospital of Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich, Switzerland
| | - Mounira Jabat
- University of Zurich, Faculty of Medicine, Psychiatric University Hospital of Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich, Switzerland
| | - Nathalie Brackmann
- University of Zurich, Faculty of Medicine, Psychiatric University Hospital of Zurich, Department of Forensic Psychiatry, Zurich, Switzerland
| | - Vanessa Noboa
- University of Zurich, Faculty of Medicine, Psychiatric University Hospital of Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich, Switzerland; University San Francisco de Quito, Faculty of Medicine, Quito, Ecuador
| | - Julio Bobes
- University of Oviedo, Faculty of Medicine, Department of Psychiatry, ISPA, INEUROPA, CIBERSAM, Oviedo, Spain
| | - Maria Paz Garcia-Portilla
- University of Oviedo, Faculty of Medicine, Department of Psychiatry, ISPA, INEUROPA, CIBERSAM, Oviedo, Spain
| | - Erich Seifritz
- University of Zurich, Faculty of Medicine, Psychiatric University Hospital of Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich, Switzerland
| | - Stefan Vetter
- University of Zurich, Faculty of Medicine, Psychiatric University Hospital of Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich, Switzerland
| | - Stephan T Egger
- University of Zurich, Faculty of Medicine, Psychiatric University Hospital of Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich, Switzerland; University of Oviedo, Faculty of Medicine, Department of Psychiatry, ISPA, INEUROPA, CIBERSAM, Oviedo, Spain.
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Shin D, Rhee SJ, Shin D, Joo EJ, Jung HY, Roh S, Lee SH, Kim H, Bang M, Lee KY, Kim SH, Lee J, Kim Y, Yeo I, Kim Y, Kim J, Kwon JS, Ha K, Ahn YM, Kim Y. Integrating proteomic and clinical data to discriminate major psychiatric disorders: Applications for major depressive disorder, bipolar disorder, and schizophrenia. Clin Transl Med 2022; 12:e929. [PMID: 35758551 PMCID: PMC9235346 DOI: 10.1002/ctm2.929] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/19/2022] [Accepted: 05/23/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Dongyoon Shin
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sang Jin Rhee
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Daun Shin
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eun-Jeong Joo
- Department of Neuropsychiatry, School of Medicine, Eulji University, Daejeon, Republic of Korea.,Department of Psychiatry, Uijeongbu Eulji Medical Center, Eulji University, Seoul, Republic of Korea
| | - Hee Yeon Jung
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Psychiatry, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea.,Institute of Human Behavioral Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Sungwon Roh
- Department of Psychiatry, Hanyang University Hospital and Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Sang-Hyuk Lee
- Department of Psychiatry, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Hyeyoung Kim
- Department of Psychiatry, Inha University Hospital, Incheon, Republic of Korea
| | - Minji Bang
- Department of Psychiatry, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Kyu Young Lee
- Department of Neuropsychiatry, School of Medicine, Eulji University, Daejeon, Republic of Korea.,Department of Psychiatry, Nowon Eulji University Hospital, Seoul, Republic of Korea
| | - Se Hyun Kim
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jihyeon Lee
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yoseop Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Injoon Yeo
- Institute of Medical and Biological Engineering Medical Research Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yeongshin Kim
- Interdisciplinary Program of Bioengineering, Seoul National University College of Engineering, Seoul, Republic of Korea
| | - Jaenyeon Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jun Soo Kwon
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea.,Institute of Human Behavioral Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Kyooseob Ha
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea.,Institute of Human Behavioral Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Yong Min Ahn
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea.,Institute of Human Behavioral Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Youngsoo Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea.,Institute of Medical and Biological Engineering Medical Research Center, Seoul National University College of Medicine, Seoul, Republic of Korea
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9
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He Y, Gu Y, Wang S, Li Y, Li G, Hu Z. Migration, Schizophrenia, and Crime: A Study From a Forensic Psychiatric Sample. Front Psychiatry 2022; 13:869978. [PMID: 35599762 PMCID: PMC9120637 DOI: 10.3389/fpsyt.2022.869978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 04/13/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The association between mental health problems and crime in immigrants has attracted recent academic interest, with results suggesting that there were possible interactions between immigration, schizophrenia, and criminal behavior. However, very few studies have examined these interactions, especially in developing countries that have mass internal immigration. Therefore, this study sought to identify the associations between the sociodemographic, clinical, and criminal factors in migrants and non-migrants with schizophrenia who had been involved in criminal activities in China. METHODS Forensic archives of suspects who had been referred for criminal responsibility assessments in the Sichuan West China Forensic Center from January 2015 to December 2019 were reviewed. The sociodemographic, and criminal activity information of the suspects were extracted, while the clinical and social function were measured by the Brief Psychiatric Rating Scale (BPRS) and Social Disability Screening Schedule (SDSS) based on the archives. A Chi-squared test, a T-test, a Mann-Whitney U test, and Multinomial logistic regression were employed for the statistical analysis. RESULTS A total of 552 patients were reviewed and evaluated, 17.2% (n = 95) of which were migrants. The migrant patient group was younger than the non-migrant patient group. The BPRS and SDSS scores for the migrant patient group were lower than for the non-migrant patient group. The migrant patient group had more work experience and more had been employed at the time of the crime than the non-migrant patient group. The unemployed migrant patients were more likely to commit a property-related crime. CONCLUSIONS Compared to the non-migrant schizophrenia patient group, the migrant patient group had less severe psychiatric symptoms and less social function impairments. Employment was an important factor in preventing criminality in patients with schizophrenia, especially for migrant patients. Vocational rehabilitation focuses on developing appropriate employment that can significantly assist in schizophrenia patient recovery, which in turn could reduce their chances of committing crime. Besides, reducing other obstacles to stigma, housing and health insurance would also be beneficial to crime reduction.
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Affiliation(s)
- Yong He
- Department of Forensic Psychiatry, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Sichuan, China
| | - Yan Gu
- Department of Forensic Psychiatry, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Sichuan, China
| | - Shujian Wang
- Shanghai Key Laboratory of Forensic Medicine, Key Lab of Forensic Science, Ministry of Justice, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai, China
| | - Yan Li
- Department of Forensic Psychiatry, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Sichuan, China
| | - Gangqin Li
- Department of Forensic Psychiatry, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Sichuan, China
| | - Zeqing Hu
- Department of Forensic Psychiatry, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Sichuan, China
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10
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He X, Zhang D, Zhang L, Zheng X, Zhang G, Pan K, Yu H, Zhang L, Hu X. Neurological and psychiatric presentations associated with COVID-19. Eur Arch Psychiatry Clin Neurosci 2022; 272:41-52. [PMID: 33710424 PMCID: PMC7953372 DOI: 10.1007/s00406-021-01244-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 02/24/2021] [Indexed: 12/13/2022]
Abstract
The objective is to investigate coronavirus disease 2019 (COVID-19)-associated neurological and psychiatric effects and explore possible pathogenic mechanisms. This study included 77 patients with laboratory-confirmed COVID-19 in Wuhan, China. Neurological manifestations were evaluated by well-trained neurologists, psychologists, psychiatric presentations and biochemical changes were evaluated using the Generalized Anxiety Disorder 7-item scale, Patient Health Questionnaire-9, Brief Psychiatric Rating Scale, and electronic medical records. Eighteen (23.4%) patients presented with neurological symptoms. Patients with neurological presentations had higher urea nitrogen, cystatin C, and high-sensitivity C-reactive protein levels and lower basophil counts. Among them, patients with muscle involvement had higher urea nitrogen and cystatin C levels but lower basophil counts. In addition, patients with psychiatric presentations were older and had higher interleukin (IL)-6 and IL-10 levels and higher alkaline phosphatase, R-glutamate transferase, and urea nitrogen levels. Moreover, patients with anxiety had higher IL-6 and IL-10 levels than those without, and patients with moderate depression had higher CD8 + T cell counts and lower CD4 + /CD8 + ratios than other patients. This study indicates that the central nervous system may be influenced in patients with COVID-19, and the pathological mechanisms may be related to direct virus invasion of the central nervous system, infection-mediated overreaction of the immune system, and aberrant serum pro-inflammatory factors. In addition, basophils and cystatin C may also play important roles during these pathological processes. Our findings suggest that neurological and psychiatric presentations should be evaluated and managed in patients with COVID-19. Further studies are needed to investigate the underlying mechanisms.
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Affiliation(s)
- Xudong He
- Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Dan Zhang
- Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lei Zhang
- Department of Psychiatry, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xu Zheng
- Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ge Zhang
- Department of Critical Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Konghan Pan
- Department of Critical Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hong Yu
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lisan Zhang
- Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xingyue Hu
- Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
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11
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Shin D, Rhee SJ, Lee J, Yeo I, Do M, Joo EJ, Jung HY, Roh S, Lee SH, Kim H, Bang M, Lee KY, Kwon JS, Ha K, Ahn YM, Kim Y. Quantitative Proteomic Approach for Discriminating Major Depressive Disorder and Bipolar Disorder by Multiple Reaction Monitoring-Mass Spectrometry. J Proteome Res 2021; 20:3188-3203. [PMID: 33960196 DOI: 10.1021/acs.jproteome.1c00058] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Because major depressive disorder (MDD) and bipolar disorder (BD) manifest with similar symptoms, misdiagnosis is a persistent issue, necessitating their differentiation through objective methods. This study was aimed to differentiate between these disorders using a targeted proteomic approach. Multiple reaction monitoring-mass spectrometry (MRM-MS) analysis was performed to quantify protein targets regarding the two disorders in plasma samples of 270 individuals (90 MDD, 90 BD, and 90 healthy controls (HCs)). In the training set (72 MDD and 72 BD), a generalizable model comprising nine proteins was developed. The model was evaluated in the test set (18 MDD and 18 BD). The model demonstrated a good performance (area under the curve (AUC) >0.8) in discriminating MDD from BD in the training (AUC = 0.84) and test sets (AUC = 0.81) and in distinguishing MDD from BD without current hypomanic/manic/mixed symptoms (90 MDD and 75 BD) (AUC = 0.83). Subsequently, the model demonstrated excellent performance for drug-free MDD versus BD (11 MDD and 10 BD) (AUC = 0.96) and good performance for MDD versus HC (AUC = 0.87) and BD versus HC (AUC = 0.86). Furthermore, the nine proteins were associated with neuro, oxidative/nitrosative stress, and immunity/inflammation-related biological functions. This proof-of-concept study introduces a potential model for distinguishing between the two disorders.
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Affiliation(s)
| | - Sang Jin Rhee
- Department of Psychiatry, Seoul National University College of Medicine, Seoul 03080, Republic of Korea.,Department of Neuropsychiatry, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | | | | | | | - Eun-Jeong Joo
- Department of Neuropsychiatry, School of Medicine, Eulji University, Daejeon 34824, Republic of Korea.,Department of Psychiatry, Nowon Eulji Medical Center, Eulji University, Seoul 01830, Republic of Korea
| | - Hee Yeon Jung
- Department of Psychiatry, Seoul National University College of Medicine, Seoul 03080, Republic of Korea.,Department of Psychiatry, SMG-SNU Boramae Medical Center, Seoul 07061, Republic of Korea.,Institute of Human Behavioral Medicine, Seoul National University Medical Research Center, 101 Daehakro, Seoul 30380, Republic of Korea
| | - Sungwon Roh
- Department of Psychiatry, Hanyang University Hospital, Seoul 04763, Republic of Korea.,Department of Psychiatry, Hanyang University College of Medicine, Seoul 04763, Republic of Korea
| | - Sang-Hyuk Lee
- Department of Psychiatry, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam 13496, Republic of Korea
| | - Hyeyoung Kim
- Department of Psychiatry, Inha University Hospital, Incheon 22332, Republic of Korea
| | - Minji Bang
- Department of Psychiatry, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam 13496, Republic of Korea
| | - Kyu Young Lee
- Department of Neuropsychiatry, School of Medicine, Eulji University, Daejeon 34824, Republic of Korea.,Department of Psychiatry, Nowon Eulji Medical Center, Eulji University, Seoul 01830, Republic of Korea
| | - Jun Soo Kwon
- Department of Psychiatry, Seoul National University College of Medicine, Seoul 03080, Republic of Korea.,Department of Neuropsychiatry, Seoul National University Hospital, Seoul 03080, Republic of Korea.,Institute of Human Behavioral Medicine, Seoul National University Medical Research Center, 101 Daehakro, Seoul 30380, Republic of Korea
| | - Kyooseob Ha
- Department of Psychiatry, Seoul National University College of Medicine, Seoul 03080, Republic of Korea.,Department of Neuropsychiatry, Seoul National University Hospital, Seoul 03080, Republic of Korea.,Institute of Human Behavioral Medicine, Seoul National University Medical Research Center, 101 Daehakro, Seoul 30380, Republic of Korea
| | - Yong Min Ahn
- Department of Psychiatry, Seoul National University College of Medicine, Seoul 03080, Republic of Korea.,Department of Neuropsychiatry, Seoul National University Hospital, Seoul 03080, Republic of Korea.,Institute of Human Behavioral Medicine, Seoul National University Medical Research Center, 101 Daehakro, Seoul 30380, Republic of Korea
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12
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Barakat A, Blankers M, Cornelis JE, van der Post L, Lommerse NM, Beekman ATF, Dekker JJM. Police Encounters, Agitation, Diagnosis, and Employment Predict Psychiatric Hospitalisation of Intensive Home Treatment Patients During a Psychiatric Crisis. Front Psychiatry 2021; 12:602912. [PMID: 33633607 PMCID: PMC7901988 DOI: 10.3389/fpsyt.2021.602912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 01/13/2021] [Indexed: 11/30/2022] Open
Abstract
Objective: This study aims to determine factors associated with psychiatric hospitalisation of patients treated for an acute psychiatric crisis who had access to intensive home treatment (IHT). Methods: This study was performed using data from a randomised controlled trial. Interviews, digital health records and eight internationally validated questionnaires were used to collect data from patients on the verge of an acute psychiatric crisis enrolled from two mental health organisations. Thirty-eight factors were assigned to seven risk domains. The seven domains are "sociodemographic", "social engagement", "diagnosis and psychopathology", "aggression", "substance use", "mental health services" and "quality of life". Multiple logistic regression analysis (MLRA) was conducted to assess how much pseudo variance in hospitalisation these seven domains explained. Forward MLRA was used to identify individual risk factors associated with hospitalisation. Risks were expressed in terms of relative risk (RR) and absolute risk difference (ARD). Results: Data from 183 participants were used. The mean age of the participants was 40.03 (SD 12.71), 57.4% was female, 78.9% was born in the Netherlands and 51.4% was employed. The range of explained variance for the domains related to "psychopathology and care" was between 0.34 and 0.08. The "aggression" domain explained the highest proportion (R 2 = 0.34) of the variance in hospitalisation. "Quality of life" had the lowest explained proportion of variance (R 2 = 0.05). The forward MLRA identified four predictive factors for hospitalisation: previous contact with the police or judiciary (OR = 7.55, 95% CI = 1.10-51.63; ARD = 0.24; RR = 1.47), agitation (OR = 2.80, 95% CI = 1.02-7.72; ARD = 0.22; RR = 1.36), schizophrenia spectrum and other psychotic disorders (OR = 22.22, 95% CI = 1.74-284.54; ARD = 0.31; RR = 1.50) and employment status (OR = 0.10, 95% CI = 0.01-0.63; ARD = -0.28; RR = 0.66). Conclusion: IHT teams should be aware of patients who have histories of encounters with the police/judiciary or were agitated at outset of treatment. As those patients benefit less from IHT due to the higher risk of hospitalisation. Moreover, type of diagnoses and employment status play an important role in predicting hospitalisation.
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Affiliation(s)
- Ansam Barakat
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, Netherlands.,Department of Psychiatry, Amsterdam University Medical Centres (UMC), Location VUmc, Amsterdam Public Health Research Institute Amsterdam UMC, Amsterdam, Netherlands
| | - Matthijs Blankers
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, Netherlands.,Trimbos-Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands.,Department of Psychiatry, Amsterdam University Medical Centres (UMC), Location AMC, Amsterdam Public Health Research Institute Amsterdam UMC, Amsterdam, Netherlands
| | - Jurgen E Cornelis
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, Netherlands.,Department of Emergency Psychiatry, Arkin Institute for Mental Health Care, Amsterdam, Netherlands
| | - Louk van der Post
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, Netherlands
| | - Nick M Lommerse
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry, Amsterdam University Medical Centres (UMC), Location VUmc, Amsterdam Public Health Research Institute Amsterdam UMC, Amsterdam, Netherlands.,Department of Research and Innovation, GGZ InGeest Specialized Mental Health Care, Amsterdam, Netherlands
| | - Jack J M Dekker
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, Netherlands.,Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute Amsterdam UMC, Amsterdam, Netherlands
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13
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Chuang SP, Wu JYW, Wang CS. Metacognitive Beliefs, Cognitive Functioning, Psychiatric Symptoms and Empathy in People with Schizophrenia. Neuropsychiatr Dis Treat 2021; 17:2209-2217. [PMID: 34262281 PMCID: PMC8274239 DOI: 10.2147/ndt.s313932] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/17/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND People with schizophrenia often exhibit deficits in empathy, which plays a major role in social cognition and interpersonal relationship. However, little work has investigated potential factors that influence empathy in schizophrenia. The study aimed to investigate the relationship among metacognition, psychiatric symptoms, cognitive functioning and empathy in patients diagnosed with schizophrenia. METHODS Forty-eight people with schizophrenia were enrolled in the study group. All subjects participated in the metacognitions questionnaire-30 (MCQ-30), brief psychiatric rating scale (BPRS), neurocognitive functioning, interpersonal reactivity index (IRI), and the pictorial empathy test (PET). RESULTS Stepwise regression analysis revealed that cognitive self-consciousness (domain of metacognitions questionnaire-30) accounted for 37% of the variance in perspective taking scores (domain of interpersonal reactivity index). Resistance (subscale of brief psychiatric rating scale) and positive beliefs about worry (domain of metacognitions questionnaire-30) accounted for 34% of the variance in fantasy (domain of interpersonal reactivity index). Activation (subscale of brief psychiatric rating scale) was a significant predictor for empathic concern (domain of interpersonal reactivity index). Resistance, cognitive confidence (domain of metacognitions questionnaire-30), intellectual processes and inhibitory control (go-no-go task) accounted for 38% of the variance in personal distress. Negative symptoms (subscale of brief psychiatric rating scale) and cognitive self-consciousness were significant predictors for the pictorial empathy test. CONCLUSION The study was aimed to examine self-perception of metacognitive beliefs and empathy. More research is needed to explore the association between metacognitive beliefs, cognitive functioning and psychiatric symptoms on empathy in people with schizophrenia.
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Affiliation(s)
- Shu Ping Chuang
- Department of Psychiatry, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | | | - Chien Shu Wang
- Department of Psychiatry, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
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14
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Cornelis J, Barakat A, Dekker J, Schut T, Berk S, Nusselder H, Ruhl N, Zoeteman J, Van R, Beekman A, Blankers M. Intensive home treatment for patients in acute psychiatric crisis situations: a multicentre randomized controlled trial. BMC Psychiatry 2018; 18:55. [PMID: 29486741 PMCID: PMC6389203 DOI: 10.1186/s12888-018-1632-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 02/12/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Hospitalization is a common method to intensify care for patients experiencing a psychiatric crisis. A short-term, specialised, out-patient crisis intervention by a Crisis Resolution Team (CRT) in the Netherlands, called Intensive Home Treatment (IHT), is a viable intervention which may help reduce hospital admission days. However, research on the (cost-)effectiveness of alternatives to hospitalisation such as IHT are scarce. In the study presented in this protocol, IHT will be compared to care-as-usual (CAU) in a randomized controlled trial (RCT). CAU comprises low-intensity outpatient care and hospitalisation if necessary. In this RCT it is hypothesized that IHT will reduce inpatient days by 33% compared to CAU while safety and clinical outcomes will be non-inferior. Secondary hypotheses are that treatment satisfaction of patients and their relatives are expected to be higher in the IHT condition compared to CAU. METHODS A 2-centre, 2-arm Zelen double consent RCT will be employed. Participants will be recruited in the Amsterdam area, the Netherlands. Clinical assessments will be carried out at baseline and at 6, 26 and 52 weeks post treatment allocation. The primary outcome measure is the number of admission days. Secondary outcomes include psychological well-being, safety and patients' and their relatives' treatment satisfaction. Alongside this RCT an economic evaluation will be carried out to assess the cost-effectiveness and cost-utility of IHT compared to CAU. DISCUSSION RCTs on the effectiveness of crisis treatment in psychiatry are scarce and including patients in studies performed in acute psychiatric crisis care is a challenge due to the ethical and practical hurdles. The Zelen design may offer a feasible opportunity to carry out such an RCT. If our study finds that IHT is a safe and cost-effective alternative for CAU it may help support a further decrease of in-patient bed days and may foster the widespread implementation of IHT by mental health care organisations internationally. TRIAL REGISTRATION The trial is registered in the Netherlands Trial Register as # NTR-6151 . Registered 23 November 2016.
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Affiliation(s)
- Jurgen Cornelis
- Department of Research, Arkin Mental Health Care, Klaprozenweg 111, 1033, NN, Amsterdam, The Netherlands. .,Department of Emergency Psychiatry, Arkin Mental Health Care, Amsterdam, The Netherlands.
| | - Ansam Barakat
- Department of Research, Arkin Mental Health Care, Klaprozenweg 111, 1033 NN Amsterdam, The Netherlands
| | - Jack Dekker
- Department of Research, Arkin Mental Health Care, Klaprozenweg 111, 1033 NN Amsterdam, The Netherlands ,0000 0004 1754 9227grid.12380.38Department Clinical Psychology, VU University, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
| | - Tessy Schut
- Department of Emergency Psychiatry, Arkin Mental Health Care, Amsterdam, The Netherlands
| | - Sandra Berk
- 0000 0004 0546 0540grid.420193.dDepartment of Emergency Psychiatry, GGZ inGeest Mental Health Care, Amsterdam, The Netherlands
| | - Hans Nusselder
- Department of Emergency Psychiatry, Arkin Mental Health Care, Amsterdam, The Netherlands
| | - Nikander Ruhl
- 0000 0004 0546 0540grid.420193.dDepartment of Emergency Psychiatry, GGZ inGeest Mental Health Care, Amsterdam, The Netherlands
| | - Jeroen Zoeteman
- Department of Emergency Psychiatry, Arkin Mental Health Care, Amsterdam, The Netherlands
| | - Rien Van
- Department of Research, Arkin Mental Health Care, Klaprozenweg 111, 1033 NN Amsterdam, The Netherlands
| | - Aartjan Beekman
- 0000 0004 0435 165Xgrid.16872.3aGGZ inGeest and Department of Psychiatry, Amsterdam Public Health research institute, VU University Medical Center, A.J. Ernststraat 1187, 1081 HL Amsterdam, The Netherlands
| | - Matthijs Blankers
- Department of Research, Arkin Mental Health Care, Klaprozenweg 111, 1033 NN Amsterdam, The Netherlands ,0000000084992262grid.7177.6Academic Medical Center, Department of Psychiatry, University of Amsterdam, Amsterdam, The Netherlands ,0000 0001 0835 8259grid.416017.5Trimbos Institute – The Netherlands Institute of Mental Health and Addiction, Da Costakade 45, 3521 VS Utrecht, The Netherlands
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15
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McKinnon I, Srivastava S, Kaler G, Grubin D. Screening for psychiatric morbidity in police custody: results
from the HELP-PC project. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/pb.bp.112.041608] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and methodTo ascertain the efficacy of custody health screening for mental
disorders. We assessed a sample of detainees for the presence of mental
disorders and the need for an appropriate adult. The assessments were
carried out using pragmatic interviews and examinations supported by
structured tools. Where possible, we attributed a probable clinical
diagnosis based on the information available to us. The need for an
appropriate adult was judged based on this information and capacity
assessments.ResultsExisting screening procedures missed a quarter of cases of severe mental
illness and moderate depression; they also failed to detect about a half
of those at risk of alcohol withdrawal and 70% of those at risk of
withdrawal from crack cocaine. The need for an appropriate adult was not
recognised in more than half of cases.Clinical implicationsConsideration should be given to modifying police screening procedures
for mental and associated disorders so that detainees receive the
appropriate attention.
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16
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Şentürk Cankorur V, Demirel H, Atbaşoğlu C. Cognitive Functioning in Euthymic Bipolar Patients on Monotherapy with Novel Antipsychotics or Mood Stabilizers. ACTA ACUST UNITED AC 2017; 54:244-250. [PMID: 29033637 DOI: 10.5152/npa.2017.15883] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 05/11/2016] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Bipolar disorder is associated with cognitive dysfunction in several domains. Medication effect is a potential confounder that can only be statistically controlled in many studies. The cognitive profile in bipolar disorder during remission on maintenance antipsychotics or mood stabilizers medication has not been compared before. METHODS We compared the cognitive profile of bipolar disorder patients euthymic for 2 month or more on monotherapy with novel antipsychotics (AP) (n=16), lithium carbonate (Li) (n=25) or valproic acid (VPA; n=26). Forty-two individuals were assessed as controls. The cognitive battery included Wechsler Adult Intelligence Scale-Revised (WAIS-R) subtests, the Wechsler Memory Scale (WMS), and Wisconsin Card Sorting Test (WCST). RESULTS All three patient groups compared to controls performed poorly on the working memory and verbal memory tasks (F=3.59, df=3, p=0.02 for WAIS-R Arithmetic and F=123.64, df=3, p<0.01 for WMS Logical Memory). The differences remained significant after controlling for age. Across patients, the only significant difference was between the Li and AP groups in terms of working memory. The Li group performed better (F=3.59, df=2, p=0.02) and the difference survived correction for age and clinical features. CONCLUSIONS The findings of this study suggest that working memory impairment in bipolar patients on monotherapy with atypical AP, whereas verbal memory impairment might be related to bipolar disorder itself. Working memory might be a state marker, whereas verbal memory could be a trait marker of bipolar disorder. Atypical AP might have an adverse effect on cognition in bipolar disorder. These findings cannot be generalized to all bipolar patients, particularly the poor responders to monotherapy.
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Affiliation(s)
| | | | - Cem Atbaşoğlu
- Department of Psychiatry, Ankara University School of Medicine, Ankara, Turkey
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17
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Anticevic A, Tang Y, Cho YT, Repovs G, Cole MW, Savic A, Wang F, Krystal JH, Xu K. Amygdala connectivity differs among chronic, early course, and individuals at risk for developing schizophrenia. Schizophr Bull 2014; 40:1105-16. [PMID: 24366718 PMCID: PMC4133672 DOI: 10.1093/schbul/sbt165] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Alterations in circuits involving the amygdala have been repeatedly implicated in schizophrenia neuropathology, given their role in stress, affective salience processing, and psychosis onset. Disturbances in amygdala whole-brain functional connectivity associated with schizophrenia have yet to be fully characterized despite their importance in psychosis. Moreover, it remains unknown if there are functional alterations in amygdala circuits across illness phases. To evaluate this possibility, we compared whole-brain amygdala connectivity in healthy comparison subjects (HCS), individuals at high risk (HR) for schizophrenia, individuals in the early course of schizophrenia (EC-SCZ), and patients with chronic schizophrenia (C-SCZ). We computed whole-brain resting-state connectivity using functional magnetic resonance imaging at 3T via anatomically defined individual-specific amygdala seeds. We identified significant alterations in amygdala connectivity with orbitofrontal cortex (OFC), driven by reductions in EC-SCZ and C-SCZ (effect sizes of 1.0 and 0.97, respectively), but not in HR for schizophrenia, relative to HCS. Reduced amygdala-OFC coupling was associated with schizophrenia symptom severity (r = .32, P < .015). Conversely, we identified a robust increase in amygdala connectivity with a brainstem region around noradrenergic arousal nuclei, particularly for HR individuals relative to HCS (effect size = 1.54), but not as prominently for other clinical groups. These results suggest that deficits in amygdala-OFC coupling could emerge during the initial episode of schizophrenia (EC-SCZ) and may present as an enduring feature of the illness (C-SCZ) in association with symptom severity but are not present in individuals with elevated risk for developing schizophrenia. Instead, in HR individuals, there appears to be increased connectivity in a circuit implicated in stress response.
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Affiliation(s)
| | - Yanqing Tang
- Department of Psychiatry, The First Affiliated Hospital, China Medical University, Shenyang , Liaoning, PR China
| | - Youngsun T Cho
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Grega Repovs
- Department of Psychology, University of Ljubljana, Ljubljana, Slovenia
| | - Michael W Cole
- Department of Psychology, Washington University in St Louis, St Louis, MO
| | - Aleksandar Savic
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT; University Psychiatric Hospital Vrapce, University of Zagreb, Zagreb, Croatia
| | - Fei Wang
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT; Department of Radiology, The First Affiliated Hospital, China Medical University, Shenyang , Liaoning, PR China
| | | | - Ke Xu
- Department of Radiology, The First Affiliated Hospital, China Medical University, Shenyang , Liaoning, PR China
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18
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Farrelly S, Clement S, Gabbidon J, Jeffery D, Dockery L, Lassman F, Brohan E, Henderson RC, Williams P, Howard LM, Thornicroft G. Anticipated and experienced discrimination amongst people with schizophrenia, bipolar disorder and major depressive disorder: a cross sectional study. BMC Psychiatry 2014; 14:157. [PMID: 24885144 PMCID: PMC4045950 DOI: 10.1186/1471-244x-14-157] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 05/15/2014] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The unfair treatment of individuals with severe mental illness has been linked to poorer physical and mental health outcomes. Additionally, anticipation of discrimination may lead some individuals to avoid participation in particular life areas, leading to greater isolation and social marginalisation. This study aimed to establish the levels and clinical and socio-demographic associations of anticipated and experienced discrimination amongst those diagnosed with a schizophrenia and comparator severe mental illnesses (bipolar and major depressive disorders). METHODS This study was a cross-sectional analysis of anticipated and experienced discrimination from 202 individuals in South London (47% with schizophrenia, 32% with depression and 20% with bipolar disorder). RESULTS 93% of the sample anticipated discrimination and 87% of participants had experienced discrimination in at least one area of life in the previous year. There was a significant association between the anticipation and the experience of discrimination. Higher levels of experienced discrimination were reported by those of a mixed ethnicity, and those with higher levels of education. Women anticipated more discrimination than men. Neither diagnosis nor levels of functioning were associated with the extent of discrimination. Clinical symptoms of anxiety, depression and suspiciousness were associated with more experienced and anticipated discrimination respectively. CONCLUSIONS The unfair treatment of individuals with severe mental illnesses remains unacceptably common. Population level interventions are needed to reduce levels of discrimination and to safeguard individuals. Interventions are also required to assist those with severe mental illness to reduce internalised stigma and social avoidance.
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Affiliation(s)
- Simone Farrelly
- Section of Community Mental Health, Health Service and Population Research Department, King's College London, Institute of Psychiatry, De Crespigney Park, Box PO29, SE5 8AF London, UK.
| | - Sarah Clement
- Section of Community Mental Health, Health Service and Population Research Department, King’s College London, Institute of Psychiatry, De Crespigney Park, Box PO29, SE5 8AF London, UK
| | - Jheanell Gabbidon
- Section of Community Mental Health, Health Service and Population Research Department, King’s College London, Institute of Psychiatry, De Crespigney Park, Box PO29, SE5 8AF London, UK
| | - Debra Jeffery
- Section of Community Mental Health, Health Service and Population Research Department, King’s College London, Institute of Psychiatry, De Crespigney Park, Box PO29, SE5 8AF London, UK
| | - Lisa Dockery
- Section of Community Mental Health, Health Service and Population Research Department, King’s College London, Institute of Psychiatry, De Crespigney Park, Box PO29, SE5 8AF London, UK
| | - Francesca Lassman
- Section of Community Mental Health, Health Service and Population Research Department, King’s College London, Institute of Psychiatry, De Crespigney Park, Box PO29, SE5 8AF London, UK
| | - Elaine Brohan
- Section of Community Mental Health, Health Service and Population Research Department, King’s College London, Institute of Psychiatry, De Crespigney Park, Box PO29, SE5 8AF London, UK,Adelphi Values, Adelphi Mill, Grimshaw Lane, SK10 5JB Bollington, Cheshire, UK
| | - R Claire Henderson
- Section of Community Mental Health, Health Service and Population Research Department, King’s College London, Institute of Psychiatry, De Crespigney Park, Box PO29, SE5 8AF London, UK
| | - Paul Williams
- Section of Community Mental Health, Health Service and Population Research Department, King’s College London, Institute of Psychiatry, De Crespigney Park, Box PO29, SE5 8AF London, UK
| | - Louise M Howard
- Section of Community Mental Health, Health Service and Population Research Department, King’s College London, Institute of Psychiatry, De Crespigney Park, Box PO29, SE5 8AF London, UK
| | - Graham Thornicroft
- Section of Community Mental Health, Health Service and Population Research Department, King’s College London, Institute of Psychiatry, De Crespigney Park, Box PO29, SE5 8AF London, UK
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Psychosis assessment in early-stage Parkinson's disease: comparing Parkinson's psychosis questionnaire with the brief psychiatric rating scale in a portuguese sample. PARKINSONS DISEASE 2012; 2012:469126. [PMID: 22690350 PMCID: PMC3368525 DOI: 10.1155/2012/469126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 03/31/2012] [Indexed: 11/18/2022]
Abstract
Psychotic symptoms in Parkinson's disease (PD) are frequent, disabling, and an important prognostic factor. Thus, screening instruments for detecting psychosis in PD are needed. For this purpose, we applied the Parkinson's Psychosis Questionnaire (PPQ), a short structured questionnaire, which requires no specific training, along with the Brief Psychiatric Rating Scale, expanded version (BPRS-E), for rating general psychopathology, including psychotic symptoms.
We evaluated, in a cross-sectional study, a Portuguese sample of 36 early-stage PD patients (mean age of 73 years; mean duration of illness of 3.2 years). The PPQ total score correlated with the BPRS-E total score (0.359; P = 0.032) and with the BPRS-E-positive symptoms score (0.469; P = 0.004). The prevalence of psychosis (41.7%) was higher than expected. Sampling bias and detection of minor psychotic phenomena may have contributed to this result.
These findings suggest that the PPQ should be further evaluated as a feasible assessment for psychotic symptoms in PD.
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McKinnon IG, Grubin D. Health screening of people in police custody--evaluation of current police screening procedures in London, UK. Eur J Public Health 2012; 23:399-405. [PMID: 22539630 DOI: 10.1093/eurpub/cks027] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Previous research has highlighted excess health morbidity in offender populations. A small number of studies have described health problems within police custody settings. The efficacy of police screening procedures has not been evaluated. METHODS Prospective clinical interviews with custody detainees in London were conducted. Clinical findings were compared with those recorded in police health screening documentation. RESULTS High levels of health morbidity were observed. The sensitivity and specificity of the current screen with respect to its ability to trigger a call for a health-care professional (HCP), regardless of the reason, was 70 and 66%, respectively. Fifty-one percent of the detainees with asthma, 36% with diabetes mellitus and 40% with epilepsy were not picked up by the screen. Fewer than one-half of the detainees at risk of alcohol withdrawal syndrome had 'alcohol' documented on their screen, although 81% saw the HCP. The police screen missed heroin use in 28% and crack cocaine use in 68% of users. A HCP was called in 84 and 64% of the cases, respectively, for any reason. Two of the 12 detainees (17%) who described a head injury with serious-associated symptoms were detected; 9 had a HCP called for any reason. Whereas mental disturbance was detected in 79% of the detainees with serious mental illness, one-third of the detainees with a risk history of suicide and one-half of the detainees with suicidal ideation were not documented as such on the police screen. CONCLUSION Given the amounts of morbidity and the need for reliable triage, improvement in the health screening procedures used by the police is needed.
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Affiliation(s)
- Iain G McKinnon
- Institute of Neuroscience, Newcastle University, Academic Psychiatry, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, UK.
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Barbato A, Parabiaghi A, Panicali F, Battino N, D'Avanzo B, de Girolamo G, Rucci P, Santone G. Do patients improve after short psychiatric admission?: a cohort study in Italy. Nord J Psychiatry 2011; 65:251-8. [PMID: 21062122 DOI: 10.3109/08039488.2010.533387] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Information on outcomes of acute inpatient care in routine psychiatric practice is scant. In particular, it is uncertain to what extent short hospitalization can produce clinically meaningful changes. AIM Our aim was to estimate the symptomatic outcome in a representative sample of patients admitted for short treatment to general hospital psychiatric units in Italy. METHODS Patients were assessed at admission and discharge using 24-item Brief Psychiatric Rating Scale (BPRS). Reliable change index was calculated to estimate the proportion of change attributable to measurement error and a cut-off score of 38 was adopted to identify the patients who showed clinically significant change. RESULTS Average length of stay was 5.7 days. Mean BPRS score dropped from 53.2 on admission to 41.5 at discharge, showing statistically significant improvement with an effect size of 0.80. However, reliable change was achieved by 24.7% of patients and clinically meaningful change by 13.6%. CONCLUSIONS Reliance on statistical significance and effect size overestimates treatment effects, whereas reliable and clinically significant change index provides a conservative way to assess outcome. Few patients showed relevant improvement after a brief admission.
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Affiliation(s)
- Angelo Barbato
- Epidemiology and Social Psychiatry Unit, Mario Negri Institute for Pharmacological Research, Milan, Italy.
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Program evaluation of a community crisis stabilization program. Arch Psychiatr Nurs 2010; 24:387-96. [PMID: 21111293 DOI: 10.1016/j.apnu.2010.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2009] [Revised: 03/08/2010] [Accepted: 03/25/2010] [Indexed: 11/23/2022]
Abstract
The purpose of this program evaluation was to evaluate the outcomes of treatment for participants in a community crisis stabilization (CCS) program. This CCS incorporated a patient-centered and wellness model of treatment. A descriptive study was conducted to assess change in psychological symptoms and quality of life of participants from admission to discharge. The sample (n = 42) was evaluated on admission and at discharge with four measurements: the Brief Symptoms Inventory (BSI), the Revised 24-Item Behavior and Symptom Identification Scale (BASIS-24), the Brief Psychiatric Rating Scale (BPRS), and the World Health Organization Quality of Life Scale-Brief Measure (WHOQOL-BREF). Changes in total scores on the BSI (t = 6.263, P < .001), the BASIS-24 (t = 6.964, P < .001), the BPRS (t = 4.638, P < .001), and the WHOQOL-BREF (t = 6.574, P < .001) demonstrated improvement at discharge.
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Validation de la version française de l’échelle abrégée d’appréciation psychiatrique étendue avec ancrage, BPRS-E(A). Encephale 2010; 36:294-301. [DOI: 10.1016/j.encep.2009.04.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2008] [Accepted: 04/28/2009] [Indexed: 10/20/2022]
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Depressive dimension, clinical outcome, and duration of hospitalization in acute schizophrenia. Asian J Psychiatr 2010; 3:121-5. [PMID: 23051568 DOI: 10.1016/j.ajp.2010.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Revised: 07/30/2010] [Accepted: 08/08/2010] [Indexed: 11/23/2022]
Abstract
In the present study we extract clusters of symptoms in acute hospitalized patients affected by Schizophrenia, using factor analysis of BPRS-E. We aim to explore the relationship between symptom dimensions, duration of hospitalization, and clinical outcome, in order to test if the depressive dimension might contribute significantly to predict the outcome. The data were drawn from a prospective, naturalistic, observational study of schizophrenic patients consecutively admitted to a psychiatric ward (SPDC, Ospedale Maggiore Policlinico of Milan), during a re-exacerbation phase. General symptomatology was measured through BPRS-E at baseline (T0) and at discharge (T1). We found symptoms of acute schizophrenia to cluster together in four distinct domains, labelled "Depression", "Excitement", "Positive symptoms", and "Negative symptoms". The "Depression" cluster is significantly associated to a good clinical outcome, as measured by percentage of improvement in BPRS score, but not to duration of hospitalization.
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Colasanti A, Paletta S, Moliterno D, Mazzocchi A, Mauri MC, Altamura AC. Symptom dimensions as predictors of clinical outcome, duration of hospitalization, and aggressive behaviours in acutely hospitalized patients with psychotic exacerbation. Clin Pract Epidemiol Ment Health 2010; 6:72-8. [PMID: 21283648 PMCID: PMC3026339 DOI: 10.2174/1745017901006010072] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Revised: 05/31/2010] [Accepted: 06/06/2010] [Indexed: 12/04/2022]
Abstract
In the present study we extract clusters of symptoms in acute hospitalized psychotic patients during a re-exacerbation phase, using factor analysis of BPRS-E. We aim to investigate the relative contribution of each symptom dimension in predicting the severity of symptoms at discharge, the length of acute hospitalization, and the occurrence of aggressive behaviours during acute hospitalization. The data are drawn from a prospective, naturalistic, observational study of 183 patients with Psychotic Disorders consecutively admitted to a psychiatric ward, during a re-exacerbation phase. General symptomatology has been measured through BPRS-E at admission and at discharge. Statistical analyses include principal component analysis and multiple linear regression. We found symptoms of acute psychosis disorder to cluster together in four distinct domains, labelled "Excitement/Activation", "Positive symptoms", and "Negative symptoms", and "Depression/Anxiety". Excitement/activation was the dimension most associated with occurrence of aggressive behaviours and severity of psychopathological symptoms at discharge. The negative symptoms dimension, also, predicted the severity of symptoms at discharge. Positive and negative symptoms dimensions were both predictors of duration of hospitalization. The depressive dimension was significantly associated only to self-aggression. These data indicate that during acute hospitalization due to re-exacerbation of psychosis each symptom dimension has a specific impact on distinct measures of outcome.
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Affiliation(s)
- Alessandro Colasanti
- Clinical Psychiatry, Clinical Neuropsychopharmacology Unit, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F.Sforza 35, 20122 Milan, Italy
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Abstract
OBJECTIVE To consider applied psychometrics in psychiatry as a discipline focusing on pharmacopsychology rather than psychopharmacology as illustrated by the pharmacopsychometric triangle. METHOD The pharmacopsychological dimensions of clinically valid effects of drugs (antianxiety, antidepressive, antimanic, and antipsychotic), of clinically unwanted effects of these drugs, and the patients' own subjective perception of the balance between wanted and unwanted effects are analysed using rating scales assessed by modern psychometric tests (item response theory models) RESULTS Symptom rating scales fulfilling the item response theory models have been shown to be psychometrically valid outcome scales as their total scores are sufficient statistics for demonstrating dose-response relationship within the various classes of antianxiety, antidepressive, antimanic or antipsychotic drugs. The total scores of side-effect rating scales are, however, not sufficient statistics, implying that each symptom has to be analysed individually. Self-rating scales with very few items appear to be sufficient statistics when measuring the patients' own perception of quality of life. CONCLUSION Applied psychometrics in psychiatry have been found to cover a pharmacopsychometric triangle illustrating the measurements of wanted and unwanted effects of pharmacotherapeutic drugs as well as health-related quality of life.
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Affiliation(s)
- P Bech
- Psychiatric Research Unit, Frederiksborg General Hospital, University of Copenhagen, Hillerød, Denmark.
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Graham HL, Copello A, Birchwood M, Orford J, McGovern D, Mueser KT, Clutterbuck R, Godfrey E, Maslin J, Day E, Tobin D. A preliminary evaluation of integrated treatment for co-existing substance use and severe mental health problems: Impact on teams and service users. J Ment Health 2009. [DOI: 10.1080/09638230600902633] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Youngmann R, Zilber N, Workneh F, Giel R. Adapting the SRQ for Ethiopian populations: a culturally-sensitive psychiatric screening instrument. Transcult Psychiatry 2008; 45:566-89. [PMID: 19091726 DOI: 10.1177/1363461508100783] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective of the study was to develop a culturally sensitive psychiatric screening instrument valid for Ethiopians in Ethiopia and Israel. The study sample was composed of 356 Amharic-speaking Ethiopians from Ethiopia and Israel, aged 18-55, divided into three groups: i) general population; ii) people in non-psychiatric treatment; iii) people in psychiatric treatment. They were interviewed with the Self-Reporting Questionnaire (SRQ), modified to include 10 culturally specific items, and the Brief Psychiatric Research Scale (BPRS) as a criterion of psychopathology. Physicians also completed an encounter form about the presence of mental health symptoms in participants. To make the questions more culturespecific, the translation of 12 items on the SRQ was changed. The content, construct, and criterion validity of each question were also examined, leading to the deletion of five items. The validity of the revised instrument (SRQ-F) was superior to that of the original instrument (SRQ). This study demonstrates the need for psychiatric screening instruments to be adapted to different cultures by incorporating meaningful translations and adding culturally specific items.
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Affiliation(s)
- Rafael Youngmann
- The Falk Institute for Mental Health Studies, Kfar Shaul Hospital, Givat Shaul, Jerusalem, Israel.
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29
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Cooper VG, Zapf PA. Psychiatric patients' comprehension of Miranda rights. LAW AND HUMAN BEHAVIOR 2008; 32:390-405. [PMID: 17674169 DOI: 10.1007/s10979-007-9099-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2006] [Accepted: 05/29/2007] [Indexed: 05/16/2023]
Abstract
Seventy-five psychiatric inpatients were evaluated with respect to their Miranda-related abilities using Grisso's (1998, Instruments for assessing understanding and appreciation of Miranda rights. Sarasota, FL: Professional Resource Press) instruments and Goldstein's (2002, Revised instruments for assessing understanding and appreciation of Miranda rights) revision to determine: whether different versions of Miranda warnings translate into differences in understanding; the influence of psychiatric symptoms, diagnostic categories, and IQ upon Miranda comprehension; and the relative performance of persons with psychiatric impairment on Miranda-relevant abilities. Results indicated that although the Miranda language used in Goldstein's revision generally showed lower grade reading levels and higher reading ease scores than Grisso's original instruments, this did not translate into improved understanding. In addition, psychiatric symptoms were negatively correlated with Miranda comprehension, even after controlling for IQ. Finally, results revealed that psychiatric patients' understanding and appreciation was substantially impaired compared to Grisso's adult validation samples, and was roughly comparable to Grisso's juvenile validation sample. Implications of these results for policy reform are discussed.
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Senturk V, Goker C, Bilgic A, Olmez S, Tugcu H, Oncu B, Atbasoglu EC. Impaired verbal memory and otherwise spared cognition in remitted bipolar patients on monotherapy with lithium or valproate. Bipolar Disord 2007; 9 Suppl 1:136-44. [PMID: 17543032 DOI: 10.1111/j.1399-5618.2007.00481.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Patients with bipolar disorder have been reported to have neurocognitive deficits; however, it is not known whether the cognitive dysfunctions are state-dependent or a stable trait. Lithium and valproate, 2 of the most widely used mood stabilizers in the treatment of bipolar disorder, have also been associated with cognitive impairment. However, the degree and pattern of neurocognitive impairment in euthymic bipolar patients on either monotherapy with lithium or valproate have not been compared before in depth. METHODS We compared 17 euthymic outpatients with bipolar disorder (BD) on lithium monotherapy to 11 euthymic outpatients with BD on valproate monotherapy and 29 comparison subjects using tests measuring immediate verbal memory and executive functions in addition to 3 subtests of the Wechsler Adult Intelligence Scale Revised. The groups were similar in terms of level of education, duration and severity of illness, and gender distribution. Patients on lithium monotherapy were older than patients on valproate and healthy controls. Mood symptoms as assessed by standardized scales were mild to non-existent in both patient groups. RESULTS Immediate verbal memory was impaired in both patient groups compared to controls, where the main effect of age was not significant. No significant differences could be found on the other cognitive measures. CONCLUSIONS Both lithium and valproate may be associated with immediate verbal memory impairment, sparing other cognitive functions. Presence of a similar verbal memory deficit in the lithium and valproate groups suggests that this deficit might be intrinsic to BD or that the 2 medications influence immediate verbal memory similarly. Larger samples of remitted bipolar patients on monotherapy should be studied for more precise conclusions.
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Affiliation(s)
- Vesile Senturk
- Department of Psychiatry, Ankara University School of Medicine, Ankara, Turkey.
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Whetten K, Reif S, Ostermann J, Pence BW, Swartz M, Whetten R, Conover C, Bouis S, Thielman N, Eron J. Improving health outcomes among individuals with HIV, mental illness, and substance use disorders in the Southeast. AIDS Care 2007; 18 Suppl 1:S18-26. [PMID: 16938671 DOI: 10.1080/09540120600839330] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Providing behavioral treatment for mental health and substance use disorders among HIV-infected individuals is critical because these disorders have been associated with negative outcomes such as poorer medication adherence. This study examines the effectiveness of an integrated treatment model for HIV-infected individuals who have both substance use and mental disorders. Study participants (n = 141) were recruited through routine mental health and substance abuse screening at tertiary Infectious Disease clinics in North Carolina. The study participants received integrated mental health and substance abuse treatment for one year and were interviewed at three-month intervals. Using linear regression analyses, we detected statistically significant decreases in participants' psychiatric symptomatology, illicit substance use, alcohol use, and inpatient hospital days. Participants also reported fewer emergency room visits and were more likely to be receiving antiretroviral medications and adequate psychotropic medication regimens at follow-up. No changes in sexual risk, physical health, or medical adherence were detected after treatment participation. This integrated treatment model offers an option for treating HIV-infected individuals with mental health and substance use disorders that can be adapted for use in a variety of psychiatric and medical treatment settings.
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Affiliation(s)
- K Whetten
- Center for Health Policy, Law, and Management, Department of Public Policy, Duke University, Durham, NC 27708, USA.
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Hanssen M, Krabbendam L, Vollema M, Delespaul P, Van Os J. Evidence for instrument and family-specific variation of subclinical psychosis dimensions in the general population. JOURNAL OF ABNORMAL PSYCHOLOGY 2006; 115:5-14. [PMID: 16492091 DOI: 10.1037/0021-843x.115.1.5] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
It is unknown to what degree dimensions of schizotypy (subclinical psychosis) show independent, family-specific variation in the general population. Psychologists administered the Community Assessment of Psychic Experiences, the Structured Interview for Schizotypy-Revised (SIS-R), and the Brief Psychiatric Rating Scale to 257 subjects pertaining to 82 general population families. All 3 instruments showed family-specific variation for positive and negative subclinical psychosis dimensions with between-families proportions of total variance between 10% and 40%. However, only the SIS-R showed family-specific variation of the negative dimension independent of its correlation with the positive dimension. The positive dimension of subclinical psychosis shows familial-specific variation in samples unselected for psychiatric disorder, suggesting dimensional liability in the population. The SIS-R additionally captures family-specific variation in the negative domain.
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Affiliation(s)
- M Hanssen
- Department of Psychiatry and Neuropsychology, EURON, Maastricht University, Maastricht, The Netherlands
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Waldheter EJ, Jones NT, Johnson ER, Penn DL. Utility of social cognition and insight in the prediction of inpatient violence among individuals with a severe mental illness. J Nerv Ment Dis 2005; 193:609-18. [PMID: 16131944 DOI: 10.1097/01.nmd.0000177788.25357.de] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The purpose of this study was to assess the utility of social cognition and insight in the prediction of violence in a psychiatric inpatient sample. Violence history, demographic information, symptomatology, neuropsychological functioning, social cognition (i.e., attributional style), and insight were assessed in 29 inpatients with severe mental illness. Greater posttest violence was associated with greater pretest violence, less education, greater psychiatric distress, neuropsychological impairment, and hostile attributional and personalizing biases. Hierarchical multiple regression analyses showed that history of violence contributed the most variance to posttest violence. Hostile attributional and personalizing biases were also uniquely associated with posttest violence. Overall, this study supported the modest utility of attributional style measures in the prediction of inpatient violence. The predictive value of insight in this context appears limited.
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Affiliation(s)
- Evan J Waldheter
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-3270, USA
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Hafkenscheid A. The Impact Message Inventory (IMI-C): generalizability of patients' command and relationship messages across psychiatric nurses. J Psychiatr Ment Health Nurs 2005; 12:325-32. [PMID: 15876240 DOI: 10.1111/j.1365-2850.2005.00843.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This paper tests the hypothesis that patients' stereotypical dysfunctional interpersonal communication styles would be validly measurable by the command or relationship messages experienced by psychiatric nurses while interacting with the patient in the relatively unstructured every day context of the psychiatric ward. The generalizability of interpersonal pressures exerted by patients was tested by having different psychiatric nurses independently appraise patients' command or relationship messages with the Impact Message Inventory, circumplex version (IMI-C). Generalizability of interpersonal pressures strongly depended on the specific combination of psychiatric nurses. Out of eight classes of command or relationships three turned out to be generalizable across nurses: Dominance, Hostile-Submissive and Friendly Dominance.
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Affiliation(s)
- A Hafkenscheid
- Sinai Centre, Jewish Mental Health Services, Amersfoort, The Netherlands.
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Ruggeri M, Koeter M, Schene A, Bonetto C, Vàzquez-Barquero JL, Becker T, Knapp M, Knudsen HC, Tansella M, Thornicroft G. Factor solution of the BPRS-expanded version in schizophrenic outpatients living in five European countries. Schizophr Res 2005; 75:107-17. [PMID: 15820329 DOI: 10.1016/j.schres.2004.05.017] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2004] [Accepted: 05/28/2004] [Indexed: 11/15/2022]
Abstract
RATIONALE The expanded version of the Brief Psychiatric Rating Scale (BPRS-E) has improved the instrument's coverage and interrater reliability, but there is little knowledge on its subsyndromes. OBJECTIVES To assess: (1) whether there are common underlying BPRS-E subscales in patients living in different countries and (2) if this is the case, whether these subscales behave the same in all populations and, if not, what are the differences over these populations. METHODS Data are part of the EPSILON study, a collaborative project carried out in Denmark, England, Holland, Italy and Spain. A random representative sample of 404 adult patients with a ICD-10 diagnosis of schizophrenia who have been in contact with mental health services of a defined catchment area in each site were assessed. Simultaneous component analysis (SCA) was used to find component weights that optimally explain the variance of the variables in different populations simultaneously. RESULTS Symptom severity differed significantly among the five EPSILON sites in 12 out of 24 BPRS-E items, but a common component solution could be found. It explained 48.8% of the variance and gave four well-interpretable components: manic excitement/disorganization, depression/anxiety, negative and positive symptoms. Each component's internal consistency and intercomponent correlation matrix differed significantly among sites. The four components mean score differed significantly among sites for negative symptoms and depression/anxiety. CONCLUSIONS In spite of the heterogeneity of symptom's severity in the various countries, the way symptoms cluster in schizophrenia is rather stable cross-culturally. Data demonstrate that to explore schizophrenia a third component, including mania/disorganization items, is necessary beside the positive-negative symptom dimensions. The subscales derived from these analyses can be readily used in clinical trials and epidemiological studies.
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Affiliation(s)
- Mirella Ruggeri
- Dipartimento di Medicina e Sanità Pubblica, Sezione di Psichiatria, e Psicologie Clinice, Università di Verona, Ospedale Policlinico, Piazzale Scuro, 10, 37134 Verona, Italy.
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Margari F, Matarazzo R, Casacchia M, Roncone R, Dieci M, Safran S, Fiori G, Simoni L. Italian validation of MOAS and NOSIE: a useful package for psychiatric assessment and monitoring of aggressive behaviours. Int J Methods Psychiatr Res 2005; 14:109-18. [PMID: 16175880 PMCID: PMC6878297 DOI: 10.1002/mpr.22] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
A validation of two rating scales is presented. We first translated the Modified Overt Aggression Scale (MOAS) and the Nurses' Observation Scale for In-patient Evaluation (NOSIE), which cover different aspects of psychopathology, into Italian. We then tested their validity and reliability in terms of inter-rater and internal consistency. For validity, both cases and controls were included: for the MOAS we compared patients who were aggressive (cases) to those who were presumably non-aggressive (controls). For the NOSIE, cases were acute inpatients and controls were subjects with expected stable behaviour. The Brief Psychiatric Rating Scale (BPRS) was also administered to cases in order to test convergent validity. Either the NOSIE and/or MOAS scales were administered to 358 psychiatric inpatients. A subset of these patients (131 for the MOAS and 226 for the NOSIE) was also used to test the inter-rater reliability. Both scales showed good psychometric properties. The correlation coefficients between raters were much higher than 0.75 (for the NOSIE) or 0.90 (for the MOAS), while the discriminant power between cases and controls was confirmed for both scales and good concordance with BPRS was observed. The NOSIE showed good internal consistency for all domains except neatness. In general the MOAS showed better results than the NOSIE for all psychometric properties, although both scales are suitable for monitoring the behaviour and aggression of acute ward inpatients.
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Affiliation(s)
- Francesco Margari
- Department of Neurological and Psychiatric Sciences, University of Bari, Italy
| | - Rosanna Matarazzo
- Department of Neurological and Psychiatric Sciences, University of Bari, Italy
| | | | - Rita Roncone
- Department of Experimental Medicine, University of L'Aquila, Italy
| | - Massimiliano Dieci
- Department of Psychiatry, Hospital S. Maria delle Stelle, Melzo, Italy 4 MediData SRL Studies and Research, Modena, Italy
| | - Simona Safran
- Department of Psychiatry, Hospital S. Maria delle Stelle, Melzo, Italy 4 MediData SRL Studies and Research, Modena, Italy
| | | | - Lucia Simoni
- MediData SRL Studies and Research, Modena, Italy
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Hafkenscheid A. Objective countertransference: do patients' interpersonal impacts generalize across therapists? Clin Psychol Psychother 2003. [DOI: 10.1002/cpp.349] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Schützwohl M, Jarosz-Nowak J, Briscoe J, Szajowski K, Kallert T. Inter-rater reliability of the Brief Psychiatric Rating Scale and the Groningen Social Disabilities Schedule in a European multi-site randomized controlled trial on the effectiveness of acute psychiatric day hospitals. Int J Methods Psychiatr Res 2003; 12:197-207. [PMID: 14657976 PMCID: PMC6878593 DOI: 10.1002/mpr.157] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The objectives of this study were to report the inter-rater reliability of the Brief Psychiatric Rating Scale (BPRS 4.0) and the Groningen Social Disabilities Schedule (GSDS-II) as assessed in a randomized controlled trial on the effectiveness of psychiatric day hospitals spanning five sites in countries of Central and Western Europe. Following brief training sessions, videotaped BPRS-interviews and written GSDS-vignettes were rated by clinically experienced researchers from all participating sites. Inter-rater reliability often proved to be poor for items assessing the severity of both psychopathology and social dysfunction, but findings suggest that both instruments allow for the assessment of the presence or absence of specific psychopathological symptoms or social disabilities. Inter-rater reliability at subscale level proved to be good for both instruments. Results indicate that, with a brief training session and proper use of the instruments, psychopathology and social disabilities can be reliably assessed within cross-national research studies. The results are of particular interest given that the need to conduct cross-national multi-site studies including countries with different cultural backgrounds increases.
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Affiliation(s)
- Matthias Schützwohl
- Department of Psychiatry at Dresden University of Technology, Dresden, Germany.
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Lachar D, Bailley SE, Rhoades HM, Espadas A, Aponte M, Cowan KA, Gummattira P, Kopecky CR, Wassef A. New subscales for an anchored version of the Brief Psychiatric Rating Scale: construction, reliability, and validity in acute psychiatric admissions. Psychol Assess 2001; 13:384-95. [PMID: 11556275 DOI: 10.1037/1040-3590.13.3.384] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Attending psychiatrists completed an anchored version of the 18-item Brief Psychiatric Rating Scale (BPRS-A) based on admission and evaluation information on a total of 2,921 adult patients treated at 1 public sector acute psychiatric teaching hospital. Exploratory factor analysis was applied to a 6-month sample to construct 4 nonoverlapping subscales: Resistance, Positive Symptoms, Negative Symptoms, and Psychological Discomfort. Confirmatory factor analysis compared these new subscales to 3 other published subscale models using a second 6-month sample. Internal consistency, rater influence, and interrater agreement were estimated in separate studies. Discriminant validity was explored by comparison of diagnosis-based samples. Application of the BPRS-A as a debriefing instrument in the study of symptomatic change and the multiple challenges inherent in psychometric study of such a rating scale in realistic hospital practice are discussed.
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Affiliation(s)
- D Lachar
- Department of Psychiatry and Behavioral Sciences, University of Texas-Houston Medical School, Harris County Psychiatric Center, University of Texas-Houston Health Science Center, Houston, Texas, USA.
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40
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Crippa JA, Sanches RF, Hallak JE, Loureiro SR, Zuardi AW. A structured interview guide increases Brief Psychiatric Rating Scale reliability in raters with low clinical experience. Acta Psychiatr Scand 2001; 103:465-70. [PMID: 11401662 DOI: 10.1034/j.1600-0447.2001.00185.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess the beneficial impact of a structured interview on the reliability of BPRS ratings in raters with low clinical experience. METHOD Each patient was rated once a week in two separate interviews, conducted on the same day. The first interview was conducted by a rater with low clinical experience (recruited from a group of five residents in psychiatry and one clinical psychologist in training). All second interviews were conducted by the same highly experienced psychiatrist. RESULTS The number of items with full agreement between observers increased with the use of SIG. The value of intraclass correlation coefficients for individual items and the total score also increased, approaching reported studies with experienced raters. CONCLUSION These results suggest that the use of SIG reduces variability of information gathering in reliability testing of BPRS with less experienced raters.
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Affiliation(s)
- J A Crippa
- Department of Neuropsychiatry and Medical Psychology, Faculty of Medicine, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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Zaudig M. A risk-benefit assessment of risperidone for the treatment of behavioural and psychological symptoms in dementia. Drug Saf 2000; 23:183-95. [PMID: 11005702 DOI: 10.2165/00002018-200023030-00002] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The importance of behavioural and psychological symptoms in dementia (BPSD) is increasingly being recognised. Symptoms such as verbal and physical aggression, agitation, sleep disturbances and wandering are common, cause great distress to caregivers and are likely to lead to institutionalisation of patients. At present, these symptoms are also more amenable to treatment compared with the progressive intellectual decline caused by dementing illnesses. The care of individuals with BPSD involves a broad range of psychosocial treatments for the patient and his or her family. If pharmacotherapy is deemed necessary to manage BPSD, a careful balance must be struck between the benefits of symptom control and the inherent risks associated with most psychotropic agents in the elderly. Elderly patients in general, and patients with dementia in particular, are more sensitive to medication adverse effects, including anticholinergic effects, orthostatic hypotension, sedation, parkinsonism, tardive dyskinesia and cognitive impairment than younger patients with dementia or individuals without dementia. To date, treatment of symptoms of aggression and psychosis has relied on the empirical use of antidepressants, anxiolytics, typical antipsychotics (neuroleptics) and other agents. Treatment-limiting adverse effects are frequently reported with all of these agents. However, it is the typical antipsychotics and the atypical antipsychotic clozapine that are associated with the greatest risk of adverse effects in the elderly. The present review highlights the issues that limit the use of older psychotropic agents in the elderly, and presents an assessment of the available evidence concerning the efficacy, safety and tolerability of the atypical antipsychotic risperidone, in the treatment of BPSD in elderly patients with dementia. The extensive clinical development programme for risperidone has shown the drug to be effective and well tolerated in many fragile patients. As a result of its efficacy and safety profile, risperidone can be used for the treatment of behavioural and psychological symptoms in patients with dementia. Risperidone therefore represents a significant addition to the armamentarium for BPSD. While efforts continue in the development of treatment for the cognitive decline associated with dementia, treatment is now available for the noncognitive symptoms. By treating the latter, risperidone has the potential to be of substantial benefit to patients with dementia, their carers and the costs of healthcare.
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Affiliation(s)
- M Zaudig
- Windach Institute and Hospital of Neurobehavioural Research and Therapy (WINTR), Psychosomatic Hospital, Germany.
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Roncone R, Ventura J, Impallomeni M, Falloon IR, Morosini PL, Chiaravalle E, Casacchia M. Reliability of an Italian standardized and expanded Brief Psychiatric Rating Scale (BPRS 4.0) in raters with high vs. low clinical experience. Acta Psychiatr Scand 1999; 100:229-36. [PMID: 10493090 DOI: 10.1111/j.1600-0447.1999.tb10850.x] [Citation(s) in RCA: 103] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aims of this study were (i) to assess the inter-rater reliability of the latest Italian expanded 24-item version of the Brief Psychiatric Rating Scale, BPRS version 4.0 and (ii) to assess the feasibility of obtaining reliable BPRS 4.0 ratings by reliability training of clinically less experienced trainees (medical and rehabilitation students). METHOD A videotape-training procedure was used, and the inter-rater agreement scores of three different groups of raters, namely psychiatrists and psychologists (n=28), psychosocial rehabilitation students (n=27) and medical students (n=54) were calculated and compared. RESULTS The results indicated that both experienced raters (psychiatrists and psychologists) and inexperienced raters (medical and psychosocial rehabilitation students) were able to achieve high levels of inter-rater reliability. CONCLUSION Our results are of particular interest in view of the increasing need to draw upon professionals, other than psychiatrists and psychologists, for cost-effective and standardized evaluation of rehabilitation interventions.
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Affiliation(s)
- R Roncone
- Psychiatric Department, University of LAquila, Italy
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Martinsen EW, Ruud T, Borge L, Watne O, Friis S. The fate of chronic in-patients after closure of psychiatric nursing homes in Norway: a personal follow-up 6 years later. Acta Psychiatr Scand 1998; 98:360-5. [PMID: 9845173 DOI: 10.1111/j.1600-0447.1998.tb10099.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We evaluated all 107 chronic in-patients in a catchment area before and 6 years after a planned reduction in the number of psychiatric institution beds was implemented. At follow-up, 32 of the patients had died. One had probably committed suicide, while the others were elderly people who had died of natural causes. In the remaining patients the level of functioning was low, and below that which could be deduced from their level of symptoms, which was also low. The majority of the patients still lived in institutions, mostly in general nursing homes. Among those who had moved out, there were non-significant trends towards a reduction in symptoms and an increase in functioning. In general, the patients were satisfied with their new accommodation. Most of them needed extensive help and support to establish an acceptable standard of living in the community.
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Affiliation(s)
- E W Martinsen
- Department of Psychiatry, Central Hospital of Sogn and Fjordane, Førde, Norway
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Ruud T, Martinsen EW, Friis S. Chronic patients in psychiatric institutions: psychopathology, level of functioning and need for care. Acta Psychiatr Scand 1998; 97:55-61. [PMID: 9504704 DOI: 10.1111/j.1600-0447.1998.tb09963.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A total of 107 chronic in-patients in a catchment area of 106,000 inhabitants were rated for psychopathology on the Brief Psychiatric Rating Scale expanded version (BPRS-E), for level of functioning on the Rehabilitation Evaluation Hall And Baker (REHAB), and for geriatric problems on the Geriatric Rating Scale (GRS). The results showed low levels of severe psychopathology and low to moderate levels of functioning, indicating that the main obstacle to community placement was the lack of functioning. Global assessment by ward nurses with regard to the future level of care needed divided the patients into three categories: 40 patients in need of a psychiatric nursing home, 30 patients in need of a general nursing home, and 37 patients who could potentially be discharged to apartments with community support. This study indicates that the REHAB may help to identify patients who are potential candidates for community placement, while the BPRS-E may help to identify patients who are still in need of care in a psychiatric institution.
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Affiliation(s)
- T Ruud
- Nordfjordeid Psychiatric Center, Norway
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45
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Cascardi M, Poythress NG. Correlates of perceived coercion during psychiatric hospital admission. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 1997; 20:445-458. [PMID: 9436054 DOI: 10.1016/s0160-2527(97)00014-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Affiliation(s)
- M Cascardi
- Dating Violence Prevention Project, Bala Cynwyd, PA 19004, USA
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46
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Dingemans PM, Linszen DH, Lenior ME, Smeets RM. Component structure of the expanded Brief Psychiatric Rating Scale (BPRS-E). Psychopharmacology (Berl) 1995; 122:263-7. [PMID: 8748395 DOI: 10.1007/bf02246547] [Citation(s) in RCA: 107] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The component structure of the expanded Brief Psychiatric Rating Scale (BPRS-E) was analyzed in a sample (n = 150) of consecutively admitted general psychiatric inpatients and compared with a group (n = 97) of adolescent patients with schizophrenia spectrum diagnoses. A stable five-component solution, of which four were interpretable, was found across groups. The component scales of the 24-item version of the BPRS had good internal consistency, allowed better coverage of schizophrenia and affective symptoms than the 18-item version but did not distinguish the schizophrenia diagnostic subgroups. The implications of the findings are discussed.
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Affiliation(s)
- P M Dingemans
- Psychiatric Center of the Academic Medical Center, University of Amsterdam, The Netherlands
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47
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Abstract
This study aimed to determine the replicability of the interrater reliability coefficients obtained with a standardized and expanded Brief Psychiatric Rating Scale (BPRS-E) in a 1991 psychometric evaluation. Furthermore, intrarater reliability was assessed. At item level, interrater concordance turned out to be satisfactory for most of the BPRS-E items. However, only a few of the items reached acceptable chance-corrected coefficients. In contrast to the previous study, the anxiety-depression subscale met the standard of acceptable interrater reliability in the present study. As in the 1991 study, the 10-item psychotic disintegration scale as well as BPRS-18 global scores met (or closely approximated) this standard. The 6 additional items of BPRS-E did not contribute to the scale's reliability. Joining the samples of the 1991 and replication studies (to cover the range of symptoms' severity and heterogeneity more fully) did not improve interrater reliability. Intrarater reliability coefficients were globally comparable to interrater reliability coefficients. In all, the results of this replication study suggest that only the anxiety-depression subscale, the 10-item psychotic disintegration scale and the BPRS-18 global scale can be used reliably in unselected groups of psychiatric inpatients in acute distress.
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Affiliation(s)
- A Hafkenscheid
- Sinai-Centre, Jewish Mental Health Services, Amersfoort, The Netherlands
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