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Rucci P, Caporusso E, Sanmarchi F, Giordano GM, Mucci A, Giuliani L, Pezzella P, Perrottelli A, Bucci P, Rocca P, Rossi A, Bertolino A, Galderisi S, Maj M. The structure stability of negative symptoms: longitudinal network analysis of the Brief Negative Symptom Scale in people with schizophrenia. BJPsych Open 2023; 9:e168. [PMID: 37674282 PMCID: PMC10594087 DOI: 10.1192/bjo.2023.541] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/23/2023] [Accepted: 07/06/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND The structure of negative symptoms of schizophrenia is still a matter of controversy. Although a two-dimensional model (comprising the expressive deficit dimension and the motivation and pleasure dimension) has gained a large consensus, it has been questioned by recent investigations. AIMS To investigate the latent structure of negative symptoms and its stability over time in people with schizophrenia using network analysis. METHOD Negative symptoms were assessed in 612 people with schizophrenia using the Brief Negative Symptom Scale (BNSS) at baseline and at 4-year follow-up. A network invariance analysis was conducted to investigate changes in the network structure and strength of connections between the two time points. RESULTS The network analysis carried out at baseline and follow-up, supported by community detection analysis, indicated that the BNSS's items aggregate to form four or five distinct domains (avolition/asociality, anhedonia, blunted affect and alogia). The network invariance test indicated that the network structure remained unchanged over time (network invariance test score 0.13; P = 0.169), although its overall strength decreased (6.28 at baseline, 5.79 at follow-up; global strength invariance test score 0.48; P = 0.016). CONCLUSIONS The results lend support to a four- or five-factor model of negative symptoms and indicate overall stability over time. These data have implications for the study of pathophysiological mechanisms and the development of targeted treatments for negative symptoms.
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Affiliation(s)
- Paola Rucci
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Edoardo Caporusso
- Department of Psychiatry, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Francesco Sanmarchi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giulia M. Giordano
- Department of Psychiatry, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Armida Mucci
- Department of Psychiatry, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Luigi Giuliani
- Department of Psychiatry, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Pasquale Pezzella
- Department of Psychiatry, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Andrea Perrottelli
- Department of Psychiatry, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Paola Bucci
- Department of Psychiatry, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Paola Rocca
- Department of Neuroscience, Section of Psychiatry, University of Turin, Turin, Italy
| | - Alessandro Rossi
- Department of Biotechnological and Applied Clinical Sciences, Section of Psychiatry, University of L'Aquila, L'Aquila, Italy
| | - Alessandro Bertolino
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari ‘Aldo Moro’, Bari, Italy
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Mario Maj
- Department of Psychiatry, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
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2
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Khare C, Mueser KT, McGurk SR. The relationship between cognitive functioning, age and employment in people with severe mental illnesses in an urban area in India: A longitudinal study. Schizophr Res Cogn 2022; 29:100255. [PMID: 35542828 PMCID: PMC9079721 DOI: 10.1016/j.scog.2022.100255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/25/2022] [Accepted: 04/25/2022] [Indexed: 11/16/2022]
Abstract
Although there is substantial evidence of the association between cognitive impairment and work in people with severe mental illnesses (SMI) in developed countries, less is known about this relationship in developing countries such as India. Studies showing higher rates of employment in people with SMI in developing countries than developed ones raise the question of whether cognitive functioning is related to work status and characteristics of work (e.g., wages earned). We conducted a one-year follow-up study to investigate the relationship between employment and cognitive functioning, assessed with the Montreal Cognitive Assessment (MoCA), in 150 participants with SMI (92% schizophrenia) living in an urban area and receiving psychiatric outpatient treatment at a public hospital in India. The MoCA had good internal reliability and test-retest reliability over the one-year period. Better cognitive functioning was associated with younger age, shorter duration of illness, higher education, and male gender. Both younger and older participants with higher cognitive functioning at baseline were more likely to be employed at baseline and one year later. Work status at baseline and one year follow-up was consistently related to executive functions among younger participants, and to attention among older participants, suggesting changes over the course of illness in the importance of specific cognitive domains for achieving satisfactory work performance. The findings suggest that cognitive functioning is associated with employment in people with SMI in India. Attention to impaired cognitive functioning may be critical to improving employment outcomes in this population.
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Affiliation(s)
- Chitra Khare
- College of Health and Rehabilitation Sciences, Sargent College, Boston University, 635 Commonwealth Ave., Boston, MA 02215, USA
- Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Ave. West, Boston, MA 02215, USA
| | - Kim T. Mueser
- Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Ave. West, Boston, MA 02215, USA
- Department of Occupational Therapy, Boston University, Boston, MA 02215, USA
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Susan R. McGurk
- Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Ave. West, Boston, MA 02215, USA
- Department of Occupational Therapy, Boston University, Boston, MA 02215, USA
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
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3
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Dijkxhoorn MA, Padmakar A, Bunders JFG, Regeer BJ. Stigma, lost opportunities, and growth: Understanding experiences of caregivers of persons with mental illness in Tamil Nadu, India. Transcult Psychiatry 2022; 60:255-271. [PMID: 35171067 PMCID: PMC10149884 DOI: 10.1177/13634615211059692] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aimed to address gaps in understanding of the lived experiences of caregivers of persons with mental illness in low-income countries. It was conducted among caregivers of persons with mental illness making use of a free non-governmental clinic in and around Chennai, India. The study adopted a qualitative methodology, with semi-structured interviews and life history exercises (n = 29) and six focus group discussions with caregivers (n = 21) and mental health professionals and community-based workers (n = 39). The experiences of caregivers were analyzed in the framework of "The Banyan model of caregiving," which identifies six phases. Major themes in caregivers' experience were: embarrassment and losing honor; fear; awareness; stigma and social exclusion; and reduced social interaction and loneliness. Posttraumatic growth considered as the result of caregiver experiences was found to consist mainly of personal growth and focusing on positive life experiences. Lost opportunities particular to the context of Tamil Nadu were described as the inability to get married, obtaining less education than desired, and loss of employment. Siblings faced lower levels of burden, while elderly mothers experienced especially high levels of burden and lack of happiness in life. Caregiver gains were identified as greater compassion for other people with disabilities, resulting in a desire to help others, as well as increased personal strength and confidence. Understanding the nuances of the caregiving experiences over time can provide a framework to devise more fine-tuned support structures that aim to prevent reductions in social interaction and lost opportunities, and improve a sense of meaning, in order to assist caregivers to continue providing care for their relatives with mental illness in a context with scarce mental health resources.
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Affiliation(s)
- Mirjam A Dijkxhoorn
- The Banyan Academy of Leadership in Mental Health, Vrije Universiteit Amsterdam
| | - Archana Padmakar
- The Banyan Academy of Leadership in Mental Health, Vrije Universiteit Amsterdam
| | - Joske F G Bunders
- The Banyan Academy of Leadership in Mental Health, Vrije Universiteit Amsterdam
| | - Barbara J Regeer
- The Banyan Academy of Leadership in Mental Health, Vrije Universiteit Amsterdam
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Ghosh S, Samanta A. A study on socioeconomic correlates of family caregiver burden: Comparison between geriatric patients with dementia and with schizophrenia in a tertiary care center in Kolkata. JOURNAL OF GERIATRIC MENTAL HEALTH 2022. [DOI: 10.4103/jgmh.jgmh_7_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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5
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Salunkhe G, Böge K, Wilker T, Zieger A, Jena S, Mungee A, Ta TMT, Bajbouj M, Schomerus G, Hahn E. Perceived Course of Illness on the Desire for Social Distance From People Suffering From Symptoms of Schizophrenia in India. Front Psychiatry 2022; 13:891409. [PMID: 35722581 PMCID: PMC9204028 DOI: 10.3389/fpsyt.2022.891409] [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: 03/07/2022] [Accepted: 05/03/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Stigmatization of people with schizophrenia remains a highly relevant topic worldwide, particularly in low- and middle-income countries like India. It is crucial to identify the determinants of the desire for social distance as a proxy for discriminatory behavior in a socio-cultural context to indicate ways to reduce stigma. This study aims to explore whether the public perception of the perceived course of an illness concerning people with symptoms of schizophrenia has an impact on the desire for social distance. SUBJECTS AND METHODS Data collection took place in five cities in India. The sample (N = 447) was stratified for gender, age, and religion. Desire for social distance was sampled based on a self-reported questionnaire using unlabelled vignettes for schizophrenia. First, factor analysis was conducted to identify the main factors underlying the perception of the perceived course of the illness. Subsequently, a regression analysis was conducted to examine the impact of the perception of those prognostic factors on the desire for social distance. RESULTS Factor analysis revealed two independent factors of the perceived course of an illness: (1) life-long dependency on others and loss of social integration and functioning and (2) positive expectations toward treatment outcome. This second factor was significantly associated with a less desire for social distance toward persons with schizophrenia. CONCLUSION The desire for social distance toward people with schizophrenia reduces with the expectation of positive treatment outcomes which underlines the need to raise public mental health awareness and provide psychoeducation for affected people and their family members in India. Help-seeking behaviors can be promoted by directing those needing treatment toward locally available, affordable and credible community-based services rather than facility-based care. Strikingly, lifelong dependency and the inability to socially integrate do not increase the desire for social distance, reflecting the Indian nation's socio-relational values and insufficiency of public mental health services. This indicates the suitability of systemic therapy approaches in public mental healthcare services to support the family's involvement and family-based interventions in caregiving for mentally ill people across the lifespan.
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Affiliation(s)
- Gayatri Salunkhe
- Centre of Medicine and Society, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Kerem Böge
- Department of Psychiatry and Neurosciences, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Tanja Wilker
- Department of Psychiatry and Neurosciences, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Aron Zieger
- Department of Psychiatry and Neurosciences, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Sunita Jena
- Public Health Department, Asian Institute of Public Health, Utkal University, Bhubhaneshwar, India
| | - Aditya Mungee
- Department of Psychiatry and Neurosciences, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Thi Minh Tam Ta
- Department of Psychiatry and Neurosciences, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Malek Bajbouj
- Department of Psychiatry and Neurosciences, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Georg Schomerus
- Department of Psychiatry, Universitätsklinikum Leipzig, University of Leipzig, Leipzig, Germany
| | - Eric Hahn
- Department of Psychiatry and Neurosciences, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
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6
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Mamah D, Mutiso VN, Ndetei DM. Neurocognition in Kenyan youth at clinical high risk for psychosis. SCHIZOPHRENIA RESEARCH-COGNITION 2021; 25:100198. [PMID: 34094888 PMCID: PMC8167199 DOI: 10.1016/j.scog.2021.100198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/09/2021] [Accepted: 04/10/2021] [Indexed: 11/27/2022]
Abstract
Introduction Cognitive deficits are typically seen in schizophrenia and in the prodrome, and are a major predictor of functional outcomes in patients. In Africa, few studies have investigated neurocognition in psychosis, which presents a gap in our understanding of the heterogeneity of the illness. In this study, we assessed neurocognition among the largest sample of psychosis-risk participants recruited in the continent to date. Methods The study was conducted in Kenya, and involved 295 psychiatric medication-naïve participants at clinical high-risk (CHR) for psychosis and healthy controls, aged 15–25 yrs. Psychosis-risk status was determined separately using the Structured Interview of Psychosis-Risk Syndromes (i.e. CHR) and by self-report with the Washington Early Recognition Center Affectivity and Psychosis Screen. Eleven tests were administered using the University of Pennsylvania Computerized Neurocognitive Battery. Test performance across groups were investigated, as well as demographic and clinical effects. Results Fewer participants were designated as being at psychosis-risk with structured interview (n = 47; CHR) than with self-report (n = 155). A MANOVA of cognitive test performance was significant only when groups were ascertained based on self-report (p = 0.03), with decreased performance in the risk group on verbal intelligence (p = 0.003; d = 0.39), emotion recognition (p = 0.003; d = 0.36), sensorimotor processing (p = 0.01; d = 0.31) and verbal memory (p = 0.035; d = 0.21). Only verbal intelligence was significantly worse in the CHR group compared to controls (p = 0.036; d = 0.45). There were no significant age and gender relationships. Conclusion Deficits across multiple cognitive domains are present in Kenyan psychosis-risk youth, most significantly in verbal intelligence. The pattern of cognitive deficits and an absence of gender effects may represent ethnicity-specific phenotypes of the psychosis-risk state. Longitudinal studies of neurocognition in Kenyan patients who convert to psychosis may enhance risk prediction in this population, and facilitate targeted interventions.
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Affiliation(s)
- Daniel Mamah
- Department of Psychiatry, Washington University Medical School, St. Louis, MO, United States of America
| | - Victoria N Mutiso
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - David M Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya.,Department of Psychiatry, University of Nairobi, Kenya
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Dazzan P, Lappin JM, Heslin M, Donoghue K, Lomas B, Reininghaus U, Onyejiaka A, Croudace T, Jones PB, Murray RM, Fearon P, Doody GA, Morgan C. Symptom remission at 12-weeks strongly predicts long-term recovery from the first episode of psychosis. Psychol Med 2020; 50:1452-1462. [PMID: 31364523 PMCID: PMC7385193 DOI: 10.1017/s0033291719001399] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 04/18/2019] [Accepted: 05/28/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND To determine the baseline individual characteristics that predicted symptom recovery and functional recovery at 10-years following the first episode of psychosis. METHODS AESOP-10 is a 10-year follow up of an epidemiological, naturalistic population-based cohort of individuals recruited at the time of their first episode of psychosis in two areas in the UK (South East London and Nottingham). Detailed information on demographic, clinical, and social factors was examined to identify which factors predicted symptom and functional remission and recovery over 10-year follow-up. The study included 557 individuals with a first episode psychosis. The main study outcomes were symptom recovery and functional recovery at 10-year follow-up. RESULTS At 10 years, 46.2% (n = 140 of 303) of patients achieved symptom recovery and 40.9% (n = 117) achieved functional recovery. The strongest predictor of symptom recovery at 10 years was symptom remission at 12 weeks (adj OR 4.47; CI 2.60-7.67); followed by a diagnosis of depression with psychotic symptoms (adj OR 2.68; CI 1.02-7.05). Symptom remission at 12 weeks was also a strong predictor of functional recovery at 10 years (adj OR 2.75; CI 1.23-6.11), together with being from Nottingham study centre (adj OR 3.23; CI 1.25-8.30) and having a diagnosis of mania (adj OR 8.17; CI 1.61-41.42). CONCLUSIONS Symptom remission at 12 weeks is an important predictor of both symptom and functional recovery at 10 years, with implications for illness management. The concepts of clinical and functional recovery overlap but should be considered separately.
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Affiliation(s)
- Paola Dazzan
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- National Institute for Health Research Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Julia M. Lappin
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Margaret Heslin
- National Institute for Health Research Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
- Department of Health Service & Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Kim Donoghue
- Department of Addictions, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ben Lomas
- Department of Psychiatry, University of Nottingham, Nottingham, UK
| | - Uli Reininghaus
- Department of Health Service & Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University
| | - Adanna Onyejiaka
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Tim Croudace
- School of Nursing & Health Sciences, University of Dundee, Dundee, UK
| | - Peter B. Jones
- University of Cambridge, and Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Robin M. Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- National Institute for Health Research Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Paul Fearon
- Discipline of Psychiatry, School of Medicine, Trinity College, Dublin, Ireland
| | - Gillian A. Doody
- Department of Psychiatry, University of Nottingham, Nottingham, UK
| | - Craig Morgan
- National Institute for Health Research Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
- Department of Health Service & Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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8
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Invited commentary from a LAMIC country: Thirty-five years of schizophrenia - the Madras Longitudinal study. Schizophr Res 2020; 220:27-28. [PMID: 32216993 DOI: 10.1016/j.schres.2020.03.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 03/16/2020] [Accepted: 03/16/2020] [Indexed: 11/23/2022]
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9
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Correll CU, Schooler NR. Negative Symptoms in Schizophrenia: A Review and Clinical Guide for Recognition, Assessment, and Treatment. Neuropsychiatr Dis Treat 2020; 16:519-534. [PMID: 32110026 PMCID: PMC7041437 DOI: 10.2147/ndt.s225643] [Citation(s) in RCA: 295] [Impact Index Per Article: 73.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 01/29/2020] [Indexed: 12/11/2022] Open
Abstract
Schizophrenia is frequently a chronic and disabling disorder, characterized by heterogeneous positive and negative symptom constellations. The objective of this review was to provide information that may be useful for clinicians treating patients with negative symptoms of schizophrenia. Negative symptoms are a core component of schizophrenia that account for a large part of the long-term disability and poor functional outcomes in patients with the disorder. The term negative symptoms describes a lessening or absence of normal behaviors and functions related to motivation and interest, or verbal/emotional expression. The negative symptom domain consists of five key constructs: blunted affect, alogia (reduction in quantity of words spoken), avolition (reduced goal-directed activity due to decreased motivation), asociality, and anhedonia (reduced experience of pleasure). Negative symptoms are common in schizophrenia; up to 60% of patients may have prominent clinically relevant negative symptoms that require treatment. Negative symptoms can occur at any point in the course of illness, although they are reported as the most common first symptom of schizophrenia. Negative symptoms can be primary symptoms, which are intrinsic to the underlying pathophysiology of schizophrenia, or secondary symptoms that are related to psychiatric or medical comorbidities, adverse effects of treatment, or environmental factors. While secondary negative symptoms can improve as a consequence of treatment to improve symptoms in other domains (ie, positive symptoms, depressive symptoms or extrapyramidal symptoms), primary negative symptoms generally do not respond well to currently available antipsychotic treatment with dopamine D2 antagonists or partial D2 agonists. Since some patients may lack insight about the presence of negative symptoms, these are generally not the reason that patients seek clinical care, and clinicians should be especially vigilant for their presence. Negative symptoms clearly constitute an unmet medical need in schizophrenia, and new and effective treatments are urgently needed.
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Affiliation(s)
- Christoph U Correll
- The Zucker Hillside Hospital, Division of Psychiatry Research, Northwell Health, Glen Oaks, NY, USA.,The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, New York, NY, USA.,Charité Universitätsmedizin, Department of Child and Adolescent Psychiatry, Berlin, Germany
| | - Nina R Schooler
- State University of New York, Downstate Medical Center, Brooklyn, NY, USA
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Lieberman JA, Small SA, Girgis RR. Early Detection and Preventive Intervention in Schizophrenia: From Fantasy to Reality. Am J Psychiatry 2019; 176:794-810. [PMID: 31569988 DOI: 10.1176/appi.ajp.2019.19080865] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Scientific progress in understanding human disease can be measured by the effectiveness of its treatment. Antipsychotic drugs have been proven to alleviate acute psychotic symptoms and prevent their recurrence in schizophrenia, but the outcomes of most patients historically have been suboptimal. However, a series of findings in studies of first-episode schizophrenia patients transformed the psychiatric field's thinking about the pathophysiology, course, and potential for disease-modifying effects of treatment. These include the relationship between the duration of untreated psychotic symptoms and outcome; the superior responses of first-episode patients to antipsychotics compared with patients with chronic illness, and the reduction in brain gray matter volume over the course of the illness. Studies of the effectiveness of early detection and intervention models of care have provided encouraging but inconclusive results in limiting the morbidity and modifying the course of illness. Nevertheless, first-episode psychosis studies have established an evidentiary basis for considering a team-based, coordinated specialty approach as the standard of care for treating early psychosis, which has led to their global proliferation. In contrast, while clinical high-risk research has developed an evidence-based care model for decreasing the burden of attenuated symptoms, no treatment has been shown to reduce risk or prevent the transition to syndromal psychosis. Moreover, the current diagnostic criteria for clinical high risk lack adequate specificity for clinical application. What limits our ability to realize the potential of early detection and intervention models of care are the lack of sensitive and specific diagnostic criteria for pre-syndromal schizophrenia, validated biomarkers, and proven therapeutic strategies. Future research requires methodologically rigorous studies in large patient samples, across multiple sites, that ideally are guided by scientifically credible pathophysiological theories for which there is compelling evidence. These caveats notwithstanding, we can reasonably expect future studies to build on the research of the past four decades to advance our knowledge and enable this game-changing model of care to become a reality.
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Affiliation(s)
- Jeffrey A Lieberman
- Department of Psychiatry (Lieberman, Small, Girgis) and Department of Neurology (Small), College of Physicians and Surgeons, Columbia University, New York; New York State Psychiatric Institute, New York (Lieberman, Small, Girgis)
| | - Scott A Small
- Department of Psychiatry (Lieberman, Small, Girgis) and Department of Neurology (Small), College of Physicians and Surgeons, Columbia University, New York; New York State Psychiatric Institute, New York (Lieberman, Small, Girgis)
| | - Ragy R Girgis
- Department of Psychiatry (Lieberman, Small, Girgis) and Department of Neurology (Small), College of Physicians and Surgeons, Columbia University, New York; New York State Psychiatric Institute, New York (Lieberman, Small, Girgis)
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Pavitra KS, Kalmane S, Kumar A, Gowda M. Family matters! - The caregivers' perspective of Mental Healthcare Act 2017. Indian J Psychiatry 2019; 61:S832-S837. [PMID: 31040483 PMCID: PMC6482692 DOI: 10.4103/psychiatry.indianjpsychiatry_141_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Mental health continues to fight for acceptance in health care all over the world. The need for a separate act for mental illnesses proves this fact even more. The very nature of the mental illness has necessitated legislation to aid the service providers and service users. The Mental Healthcare Act 2017 has taken great initiatives in terms of protection of human rights for people with mental illness such as the inclusion of mental illness in health insurance, stress on informed consent, decriminalization of suicide, and introduction of advance directives (ADs) and punishment to those who violate the law. However, in a country like India where the family as a unit has more significance than personal autonomy, the new act emphasizes the patient's rights and, in doing so, may make the doctors more defensive and fearful in making clinical decisions, thus shifting the burden to the shoulders of the family members. There is a need for suitable amendments to include the family's concerns as well; otherwise, the present act would stand as an alien Western law enforced on Indian cohesive family dynamics. Qualitative studies are required from the family's perspective to illustrate the hindrances that the patients' families are facing. In the context of Indian family structure and dynamics and working in the Indian community, we feel that without suitable amendments to include the family's concerns, the present act would stand as an alien Western law enforced on Indian cohesive family dynamics.
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Affiliation(s)
- K S Pavitra
- Consultant Psychiatrist, Department of Psychiatry, Sridhar Neuropsychiatric Centre, Shimoga, Karnataka, India
| | - Shubrata Kalmane
- Associate Professor of Psychiatry, Subbaiah Institute of Medical Sciences, Karnataka, India.,Managing Trustee, Shimoga, Karnataka, India
| | - Akilesh Kumar
- Caregiver of a Patient and Clinical Research Coordinator, Kshema Trust, NGO for Mental Health, Shimoga, Karnataka, India
| | - Mahesh Gowda
- Director, Spandana Health Care, Bengaluru, Karnataka, India
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12
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Kebede D, Fekadu A, Kelkile TS, Medhin G, Hanlon C, Mayston R, Alem A. The 10-year functional outcome of schizophrenia in Butajira, Ethiopia. Heliyon 2019; 5:e01272. [PMID: 30923757 PMCID: PMC6423701 DOI: 10.1016/j.heliyon.2019.e01272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 12/11/2018] [Accepted: 02/20/2019] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Long-term functional schizophrenia outcomes are not well characterized in low-income environments because of the rarity of prospective studies. OBJECTIVES To assess and describe long-term schizophrenia's functional outcomes and potential outcome predictors. METHODS Following a baseline assessment, 316 people with schizophrenia were studied for 10 years, on average. Of the total, 79 were incident cases: cases with onset of the illness occurring two years or less from entry into the study. SF-36 scores of physical and social functioning were used to assess functional outcomes. Linear mixed models were employed to evaluate the association of functioning with potential predictors. RESULTS Social and physical functioning scores regarding the cohort were lower than the population's norm for most of the follow-up period. Incident cases had better function than prevalent cases. Fifteen percent of incident and 30% of prevalent cases had reduced social functioning for at least six years. Declining symptom severity during the follow-up period was significantly associated with improvement in social functioning. When baseline functioning was controlled for, the long-term trend in functionality was not associated with demographic or illness characteristics (age and speed of onset, duration of illness and neuroleptic use at entry, substance use, and medication adherence). CONCLUSION Long-term physical and social functioning of the population with schizophrenia were significantly lower than the population norm. A significant proportion of the cohort had lower functioning for the long-term. Functioning was not associated with demographic or illness characteristics of the study population.
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Affiliation(s)
- Derege Kebede
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abebaw Fekadu
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Global Health & Infection, Brighton and Sussex Medical School, Brighton, UK
| | | | - Girmay Medhin
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Charlotte Hanlon
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Global Mental Health, Health Service, and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Rosie Mayston
- Centre for Global Mental Health, Health Service, and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Atalay Alem
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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13
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Dijkxhoorn MA, Padmakar A, Jude N, Bunders J, Regeer B. Understanding caregiver burden from a long-term perspective: The Banyan model of caregiver experiences. Perspect Psychiatr Care 2019; 55:61-71. [PMID: 29862525 DOI: 10.1111/ppc.12299] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 04/26/2018] [Accepted: 05/13/2018] [Indexed: 01/14/2023] Open
Abstract
PURPOSE A multiphase model for experiences of family members of persons with mental illness that considers both positive and negative aspects is proposed. DESIGN AND METHODS Mixed methods (semistructured interviews, life history timelines, focus group discussions, and the Experience of Caregiving Inventory) were used with caregivers accessing outpatient services of a nongovernmental organization in urban and rural locations around Chennai, India. FINDINGS Based on our results, we constructed a multiphase model, which we named The Banyan model of caregiver experiences. The phases are (1) manifestation of symptoms, (2) seeking help, (3) helplessness and attribution, (4) relative control and insight, (5) loss and worries, and (6) finding new meaning. PRACTICAL IMPLICATIONS Our multiphase model allows us to identify in more detail the needs of caregivers at various stages.
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Affiliation(s)
- Mirjam Anne Dijkxhoorn
- The Banyan Academy of Leadership in Mental Health, Chennai, Tamil Nadu, India.,Athena Institute, VU University, Amsterdam, North-Holland, The Netherlands
| | - Archana Padmakar
- The Banyan Academy of Leadership in Mental Health, Chennai, Tamil Nadu, India.,The Banyan, Chennai, Tamil Nadu, India.,Athena Institute, VU University, Amsterdam, North-Holland, The Netherlands
| | | | - Joske Bunders
- Athena Institute, VU University, Amsterdam, North-Holland, The Netherlands
| | - Barbara Regeer
- Athena Institute, VU University, Amsterdam, North-Holland, The Netherlands
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14
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Lyne J, O'Donoghue B, Roche E, Renwick L, Cannon M, Clarke M. Negative symptoms of psychosis: A life course approach and implications for prevention and treatment. Early Interv Psychiatry 2018; 12:561-571. [PMID: 29076240 DOI: 10.1111/eip.12501] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 07/29/2017] [Accepted: 08/20/2017] [Indexed: 01/09/2023]
Abstract
AIM Negative symptoms are a cause of enduring disability in serious mental illness. In spite of this, the development of effective treatments for negative symptoms has remained slow. The challenge of improving negative symptom outcomes is compounded by our limited understanding of their aetiology and longitudinal development. METHODS A literature search was conducted for life course approach of negative symptoms using PubMed. Further articles were included following manual checking of reference lists and other search strategies. The paper contains a theoretical synthesis of the literature, summarized using conceptual models. RESULTS Negative symptom definitions are compared and considered within a context of the life course. Previous studies suggest that several illness phases may contribute to negative symptoms, highlighting our uncertainty in relation to the origin of negative symptoms. CONCLUSIONS Similar to other aspects of schizophrenia, negative symptoms likely involve a complex interplay of several risk and protective factors at different life phases. Concepts suggested in this article, such as "negative symptom reserve" theory, require further research, which may inform future prevention and treatment strategies.
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Affiliation(s)
- John Lyne
- Royal College of Surgeons in Ireland, North Dublin Mental Health Service, Ashlin Centre, Dublin, Ireland.,Dublin and East Treatment and Early Care Team (DETECT), Dublin, Ireland
| | - Brian O'Donoghue
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre of Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Eric Roche
- Dublin and East Treatment and Early Care Team (DETECT), Dublin, Ireland
| | - Laoise Renwick
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Mary Cannon
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mary Clarke
- Dublin and East Treatment and Early Care Team (DETECT), Dublin, Ireland.,School of Medicine and Medical Science, University College Dublin, Dublin, Ireland.,Saint John of God Community Services Ltd, Blackrock, Co., Dublin, Ireland
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15
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Abstract
BackgroundOutcome of schizophrenia has been described as favourable in low-and middle-income countries. Recently, researchers have questioned these findingsAimsTo examine the outcome studies carried out in different countries specifically looking atthose from low-and middle-income countriesMethodsLong-term course and outcome studies in schizophrenia were reviewedResultsA wide variety of outcome measures are used. The most frequent are clinical symptoms, hospitalisation and mortality (direct indicators), and social/ occupational functioning, marriage, social support and burden of care (indirect indicators). Areas such as cognitive function, duration of untreated psychosis, quality of life and effect of medication have not been widely studied in low-and middle-income countriesConclusionsThe outcome of schizophrenia appears to be better in low-and middle-income countries. A host of sociocultural factors have been cited as contributing to this but future research should aim to understand this better outcome. There is a need for more culture-specific instruments to measure outcomes
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16
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Breitborde NJK, Moe AM, Ered A, Ellman LM, Bell EK. Optimizing psychosocial interventions in first-episode psychosis: current perspectives and future directions. Psychol Res Behav Manag 2017; 10:119-128. [PMID: 28490910 PMCID: PMC5414722 DOI: 10.2147/prbm.s111593] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Psychotic-spectrum disorders such as schizophrenia, schizoaffective disorder, and bipolar disorder with psychotic features are devastating illnesses accompanied by high levels of morbidity and mortality. Growing evidence suggests that outcomes for individuals with psychotic-spectrum disorders can be meaningfully improved by increasing the quality of mental health care provided to these individuals and reducing the delay between the first onset of psychotic symptoms and the receipt of adequate psychiatric care. More specifically, multicomponent treatment packages that 1) simultaneously target multiple symptomatic and functional needs and 2) are provided as soon as possible following the initial onset of psychotic symptoms appear to have disproportionately positive effects on the course of psychotic-spectrum disorders. Yet, despite the benefit of multicomponent care for first-episode psychosis, clinical and functional outcomes among individuals with first-episode psychosis participating in such services are still suboptimal. Thus, the goal of this review is to highlight putative strategies to improve care for individuals with first-episode psychosis with specific attention to optimizing psychosocial interventions. To address this goal, we highlight four burgeoning areas of research with regard to optimization of psychosocial interventions for first-episode psychosis: 1) reducing the delay in receipt of evidence-based psychosocial treatments; 2) synergistic pairing of psychosocial interventions; 3) personalized delivery of psychosocial interventions; and 4) technological enhancement of psychosocial interventions. Future research on these topics has the potential to optimize the treatment response to evidence-based psychosocial interventions and to enhance the improved (but still suboptimal) treatment outcomes commonly experienced by individuals with first-episode psychosis.
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Affiliation(s)
- Nicholas JK Breitborde
- Department of Psychiatry and Behavioral Health
- Department of Psychology, The Ohio State University, Columbus, OH
| | | | - Arielle Ered
- Department of Psychology, Temple University, Philadelphia, PA
| | - Lauren M Ellman
- Department of Psychology, Temple University, Philadelphia, PA
| | - Emily K Bell
- Department of Psychiatry, University of Arizona, Tucson, AZ, USA
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17
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Rathod S, Pinninti N, Irfan M, Gorczynski P, Rathod P, Gega L, Naeem F. Mental Health Service Provision in Low- and Middle-Income Countries. Health Serv Insights 2017; 10:1178632917694350. [PMID: 28469456 PMCID: PMC5398308 DOI: 10.1177/1178632917694350] [Citation(s) in RCA: 264] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 01/27/2017] [Indexed: 11/16/2022] Open
Abstract
This article discusses the provision of mental health services in low- and middle-income countries (LMICs) with a view to understanding the cultural dynamics-how the challenges they pose can be addressed and the opportunities harnessed in specific cultural contexts. The article highlights the need for prioritisation of mental health services by incorporating local population and cultural needs. This can be achieved only through political will and strengthened legislation, improved resource allocation and strategic organisation, integrated packages of care underpinned by professional communication and training, and involvement of patients, informal carers, and the wider community in a therapeutic capacity.
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Affiliation(s)
- Shanaya Rathod
- Clinical Trials Facility, Southern Health NHS Foundation Trust, Southampton, UK
| | - Narsimha Pinninti
- School of Osteopathic Medicine, Rowan University and Oaks Integrated Care, Stratford, NJ, USA
| | - Muhammed Irfan
- Department of Mental Health, Psychiatry & Behavioral Sciences, Peshawar Medical College, Peshawar, Pakistan
| | - Paul Gorczynski
- Department of Sport and Exercise Science, University of Portsmouth, Portsmouth, UK
| | - Pranay Rathod
- Department of Economics, The London School of Economics and Political Science, London, UK
| | - Lina Gega
- Department of Health Sciences and Hull York Medical School, University of York, York, UK
| | - Farooq Naeem
- Department of Psychiatry, Queen’s University, Kingston, ON, Canada
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18
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Chandra RM, Arora L, Mehta UM, Asnaani A, Radhakrishnan R. Asian Indians in America: The influence of values and culture on mental health. Asian J Psychiatr 2016; 22:202-9. [PMID: 26442987 DOI: 10.1016/j.ajp.2015.09.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 09/18/2015] [Accepted: 09/19/2015] [Indexed: 11/30/2022]
Abstract
Asian Indians represent a significant portion of the largest growing race of Asians in the past decade in the United States. This selective review examines major cultural themes related to first- and second-generation Asian Indians living in the United States as they impact psychological and psychiatric dysfunction in this population. Specifically, we review the impact of Asian Indian culture on mental health, discuss the impact of acculturation and ethnic identity development on the mental health of Indian-Americans, and focus on typical mental health problems of Asian Indian adolescents, women and elderly in America. Finally, we provide a brief overview of empirically-supported treatment approaches and cultural considerations for additional treatments relevant to this population. This review is intended to provide an important foundation for more systematic empirically-driven investigation into better understanding how Asian Indian cultural themes impact mental health for Indian-Americans, and how to develop effective treatments for these issues in this cultural group.
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Affiliation(s)
| | - Lily Arora
- Rutgers University - New Jersey Medical School, Newark, NJ, United States
| | - Urvakhsh M Mehta
- Beth Israel Deaconess Medical Center, Boston, MA, United States; National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Anu Asnaani
- Department of Psychiatry, Center for the Treatment and Study of Anxiety, University of Pennsylvania, 3535 Market St, Suite 600 North, Philadelphia, PA 19104, United States.
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19
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Prognostic Value of Affective Symptoms in First-Admission Psychotic Patients. Int J Mol Sci 2016; 17:ijms17071039. [PMID: 27376266 PMCID: PMC4964415 DOI: 10.3390/ijms17071039] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 06/22/2016] [Accepted: 06/24/2016] [Indexed: 01/09/2023] Open
Abstract
Background: Very little research has been conducted in patients with first-episode psychosis using a dimensional approach. Affective dimensional representations might be useful to predict the clinical course and treatment needs in such patients. Methods: Weincluded 112 patients with first-episode psychosis in a longitudinal-prospective study with a five-year follow-up (N = 82). Logistic analyses were performed to determine the predictive factors associated with depressive, manic, activation, and dysphoric dimensions. Results: High scores on the depressive dimension were associated with the best prognosis. On the other hand, high scores on the activation dimension and the manic dimension were associated with a poorer prognosis in terms of relapses. Only the dysphoric dimension was not associated with syndromic or functional prognosis. Conclusion: Ourresults suggest that the pattern of baseline affective symptoms helps to predict the course of psychotic illness. Therefore, the systematic assessment of affective symptoms would enable us to draw important conclusions regarding patients’ prognosis. Interventions for patients with high scores on manic or activation dimensions could be beneficial in decreasing relapses in first-episode psychosis.
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20
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Amaresha AC, Joseph B, Agarwal SM, Narayanaswamy JC, Venkatasubramanian G, Muralidhar D, Subbakrishna DK. Assessing the needs of siblings of persons with schizophrenia: A qualitative study from India. Asian J Psychiatr 2015; 17:16-23. [PMID: 26272276 DOI: 10.1016/j.ajp.2015.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 06/23/2015] [Accepted: 07/18/2015] [Indexed: 01/16/2023]
Abstract
There is a lack of studies on siblings of persons with schizophrenia (SOPS) in Asia. This study aims to explore the needs of SOPS in India. 15 SOPS participated in this qualitative explorative study. All the interviews were audio recorded and later transcribed. Data analysis was carried out using General Inductive Approach. Five themes emerged from the data: managing illness or socio-occupational functioning; follow up services; informational needs; personal needs; and miscellaneous needs. SOPS in India have some distinctive needs. Identifying these needs might help in developing and designing specific psychosocial interventions for better management.
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Affiliation(s)
- Anekal C Amaresha
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India.
| | - Boban Joseph
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Sri Mahavir Agarwal
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Janardhanan C Narayanaswamy
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Ganesan Venkatasubramanian
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Daliboina Muralidhar
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Doddaballapura K Subbakrishna
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India
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21
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Revier CJ, Reininghaus U, Dutta R, Fearon P, Murray RM, Doody GA, Croudace T, Dazzan P, Heslin M, Onyejiaka A, Kravariti E, Lappin J, Lomas B, Kirkbride JB, Donoghue K, Morgan C, Jones PB. Ten-Year Outcomes of First-Episode Psychoses in the MRC ÆSOP-10 Study. J Nerv Ment Dis 2015; 203:379-86. [PMID: 25900547 PMCID: PMC4414339 DOI: 10.1097/nmd.0000000000000295] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
It has long been held that schizophrenia and other psychotic disorders have a predominately poor course and outcome. We have synthesized information on mortality, clinical and social outcomes from the ÆSOP-10 multicenter study, a 10-year follow-up of a large epidemiologically characterized cohort of 557 people with first-episode psychosis. Symptomatic remission and recovery were more common than previously believed. Distinguishing between symptom and social recovery is important given the disparity between these; even when symptomatic recovery occurs social inclusion may remain elusive. Multiple factors were associated with an increased risk of mortality, but unnatural death was reduced by 90% when there was full family involvement at first contact compared with those without family involvement. These results suggest that researchers, clinicians and those affected by psychosis should countenance a much more optimistic view of symptomatic outcome than was assumed when these conditions were first described.
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Affiliation(s)
- Camice J. Revier
- *Department of Psychiatry, University of Cambridge, National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre and NIHR Collaboration for Leadership in Applied Health Research & Care, Cambridge, UK; †Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, UK; ‡Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands; §Department of Psychological Medicine, Institute of Psychiatry, King’s College, London, UK; ∥Department of Psychiatry, Trinity College, Dublin, Ireland; ¶NIHR Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College, London, UK; #Psychosis Studies Department, Institute of Psychiatry, King’s College, London, UK; **Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK; ††Department of Nursing and Midwifery, University of Dundee, Dundee, UK; ‡‡Centre for Economics of Mental and Physical Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, UK; §§Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience at King's College, London, UK; ∥∥Institute of Psychiatry, Psychology & Neuroscience at King's College, London, UK; ¶¶Department of Psychiatry, University of New South Wales, Sydney, NSW, Australia; ##Division of Psychiatry, University College London, London, UK; and ***Addictions Department, Institute of Psychiatry, King’s College, London, UK
| | - Ulrich Reininghaus
- *Department of Psychiatry, University of Cambridge, National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre and NIHR Collaboration for Leadership in Applied Health Research & Care, Cambridge, UK; †Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, UK; ‡Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands; §Department of Psychological Medicine, Institute of Psychiatry, King’s College, London, UK; ∥Department of Psychiatry, Trinity College, Dublin, Ireland; ¶NIHR Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College, London, UK; #Psychosis Studies Department, Institute of Psychiatry, King’s College, London, UK; **Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK; ††Department of Nursing and Midwifery, University of Dundee, Dundee, UK; ‡‡Centre for Economics of Mental and Physical Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, UK; §§Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience at King's College, London, UK; ∥∥Institute of Psychiatry, Psychology & Neuroscience at King's College, London, UK; ¶¶Department of Psychiatry, University of New South Wales, Sydney, NSW, Australia; ##Division of Psychiatry, University College London, London, UK; and ***Addictions Department, Institute of Psychiatry, King’s College, London, UK
| | - Rina Dutta
- *Department of Psychiatry, University of Cambridge, National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre and NIHR Collaboration for Leadership in Applied Health Research & Care, Cambridge, UK; †Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, UK; ‡Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands; §Department of Psychological Medicine, Institute of Psychiatry, King’s College, London, UK; ∥Department of Psychiatry, Trinity College, Dublin, Ireland; ¶NIHR Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College, London, UK; #Psychosis Studies Department, Institute of Psychiatry, King’s College, London, UK; **Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK; ††Department of Nursing and Midwifery, University of Dundee, Dundee, UK; ‡‡Centre for Economics of Mental and Physical Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, UK; §§Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience at King's College, London, UK; ∥∥Institute of Psychiatry, Psychology & Neuroscience at King's College, London, UK; ¶¶Department of Psychiatry, University of New South Wales, Sydney, NSW, Australia; ##Division of Psychiatry, University College London, London, UK; and ***Addictions Department, Institute of Psychiatry, King’s College, London, UK
| | - Paul Fearon
- *Department of Psychiatry, University of Cambridge, National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre and NIHR Collaboration for Leadership in Applied Health Research & Care, Cambridge, UK; †Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, UK; ‡Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands; §Department of Psychological Medicine, Institute of Psychiatry, King’s College, London, UK; ∥Department of Psychiatry, Trinity College, Dublin, Ireland; ¶NIHR Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College, London, UK; #Psychosis Studies Department, Institute of Psychiatry, King’s College, London, UK; **Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK; ††Department of Nursing and Midwifery, University of Dundee, Dundee, UK; ‡‡Centre for Economics of Mental and Physical Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, UK; §§Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience at King's College, London, UK; ∥∥Institute of Psychiatry, Psychology & Neuroscience at King's College, London, UK; ¶¶Department of Psychiatry, University of New South Wales, Sydney, NSW, Australia; ##Division of Psychiatry, University College London, London, UK; and ***Addictions Department, Institute of Psychiatry, King’s College, London, UK
| | - Robin M. Murray
- *Department of Psychiatry, University of Cambridge, National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre and NIHR Collaboration for Leadership in Applied Health Research & Care, Cambridge, UK; †Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, UK; ‡Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands; §Department of Psychological Medicine, Institute of Psychiatry, King’s College, London, UK; ∥Department of Psychiatry, Trinity College, Dublin, Ireland; ¶NIHR Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College, London, UK; #Psychosis Studies Department, Institute of Psychiatry, King’s College, London, UK; **Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK; ††Department of Nursing and Midwifery, University of Dundee, Dundee, UK; ‡‡Centre for Economics of Mental and Physical Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, UK; §§Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience at King's College, London, UK; ∥∥Institute of Psychiatry, Psychology & Neuroscience at King's College, London, UK; ¶¶Department of Psychiatry, University of New South Wales, Sydney, NSW, Australia; ##Division of Psychiatry, University College London, London, UK; and ***Addictions Department, Institute of Psychiatry, King’s College, London, UK
| | - Gillian A. Doody
- *Department of Psychiatry, University of Cambridge, National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre and NIHR Collaboration for Leadership in Applied Health Research & Care, Cambridge, UK; †Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, UK; ‡Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands; §Department of Psychological Medicine, Institute of Psychiatry, King’s College, London, UK; ∥Department of Psychiatry, Trinity College, Dublin, Ireland; ¶NIHR Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College, London, UK; #Psychosis Studies Department, Institute of Psychiatry, King’s College, London, UK; **Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK; ††Department of Nursing and Midwifery, University of Dundee, Dundee, UK; ‡‡Centre for Economics of Mental and Physical Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, UK; §§Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience at King's College, London, UK; ∥∥Institute of Psychiatry, Psychology & Neuroscience at King's College, London, UK; ¶¶Department of Psychiatry, University of New South Wales, Sydney, NSW, Australia; ##Division of Psychiatry, University College London, London, UK; and ***Addictions Department, Institute of Psychiatry, King’s College, London, UK
| | - Tim Croudace
- *Department of Psychiatry, University of Cambridge, National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre and NIHR Collaboration for Leadership in Applied Health Research & Care, Cambridge, UK; †Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, UK; ‡Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands; §Department of Psychological Medicine, Institute of Psychiatry, King’s College, London, UK; ∥Department of Psychiatry, Trinity College, Dublin, Ireland; ¶NIHR Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College, London, UK; #Psychosis Studies Department, Institute of Psychiatry, King’s College, London, UK; **Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK; ††Department of Nursing and Midwifery, University of Dundee, Dundee, UK; ‡‡Centre for Economics of Mental and Physical Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, UK; §§Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience at King's College, London, UK; ∥∥Institute of Psychiatry, Psychology & Neuroscience at King's College, London, UK; ¶¶Department of Psychiatry, University of New South Wales, Sydney, NSW, Australia; ##Division of Psychiatry, University College London, London, UK; and ***Addictions Department, Institute of Psychiatry, King’s College, London, UK
| | - Paola Dazzan
- *Department of Psychiatry, University of Cambridge, National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre and NIHR Collaboration for Leadership in Applied Health Research & Care, Cambridge, UK; †Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, UK; ‡Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands; §Department of Psychological Medicine, Institute of Psychiatry, King’s College, London, UK; ∥Department of Psychiatry, Trinity College, Dublin, Ireland; ¶NIHR Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College, London, UK; #Psychosis Studies Department, Institute of Psychiatry, King’s College, London, UK; **Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK; ††Department of Nursing and Midwifery, University of Dundee, Dundee, UK; ‡‡Centre for Economics of Mental and Physical Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, UK; §§Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience at King's College, London, UK; ∥∥Institute of Psychiatry, Psychology & Neuroscience at King's College, London, UK; ¶¶Department of Psychiatry, University of New South Wales, Sydney, NSW, Australia; ##Division of Psychiatry, University College London, London, UK; and ***Addictions Department, Institute of Psychiatry, King’s College, London, UK
| | - Margaret Heslin
- *Department of Psychiatry, University of Cambridge, National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre and NIHR Collaboration for Leadership in Applied Health Research & Care, Cambridge, UK; †Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, UK; ‡Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands; §Department of Psychological Medicine, Institute of Psychiatry, King’s College, London, UK; ∥Department of Psychiatry, Trinity College, Dublin, Ireland; ¶NIHR Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College, London, UK; #Psychosis Studies Department, Institute of Psychiatry, King’s College, London, UK; **Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK; ††Department of Nursing and Midwifery, University of Dundee, Dundee, UK; ‡‡Centre for Economics of Mental and Physical Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, UK; §§Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience at King's College, London, UK; ∥∥Institute of Psychiatry, Psychology & Neuroscience at King's College, London, UK; ¶¶Department of Psychiatry, University of New South Wales, Sydney, NSW, Australia; ##Division of Psychiatry, University College London, London, UK; and ***Addictions Department, Institute of Psychiatry, King’s College, London, UK
| | - Adanna Onyejiaka
- *Department of Psychiatry, University of Cambridge, National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre and NIHR Collaboration for Leadership in Applied Health Research & Care, Cambridge, UK; †Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, UK; ‡Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands; §Department of Psychological Medicine, Institute of Psychiatry, King’s College, London, UK; ∥Department of Psychiatry, Trinity College, Dublin, Ireland; ¶NIHR Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College, London, UK; #Psychosis Studies Department, Institute of Psychiatry, King’s College, London, UK; **Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK; ††Department of Nursing and Midwifery, University of Dundee, Dundee, UK; ‡‡Centre for Economics of Mental and Physical Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, UK; §§Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience at King's College, London, UK; ∥∥Institute of Psychiatry, Psychology & Neuroscience at King's College, London, UK; ¶¶Department of Psychiatry, University of New South Wales, Sydney, NSW, Australia; ##Division of Psychiatry, University College London, London, UK; and ***Addictions Department, Institute of Psychiatry, King’s College, London, UK
| | - Eugenia Kravariti
- *Department of Psychiatry, University of Cambridge, National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre and NIHR Collaboration for Leadership in Applied Health Research & Care, Cambridge, UK; †Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, UK; ‡Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands; §Department of Psychological Medicine, Institute of Psychiatry, King’s College, London, UK; ∥Department of Psychiatry, Trinity College, Dublin, Ireland; ¶NIHR Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College, London, UK; #Psychosis Studies Department, Institute of Psychiatry, King’s College, London, UK; **Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK; ††Department of Nursing and Midwifery, University of Dundee, Dundee, UK; ‡‡Centre for Economics of Mental and Physical Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, UK; §§Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience at King's College, London, UK; ∥∥Institute of Psychiatry, Psychology & Neuroscience at King's College, London, UK; ¶¶Department of Psychiatry, University of New South Wales, Sydney, NSW, Australia; ##Division of Psychiatry, University College London, London, UK; and ***Addictions Department, Institute of Psychiatry, King’s College, London, UK
| | - Julia Lappin
- *Department of Psychiatry, University of Cambridge, National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre and NIHR Collaboration for Leadership in Applied Health Research & Care, Cambridge, UK; †Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, UK; ‡Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands; §Department of Psychological Medicine, Institute of Psychiatry, King’s College, London, UK; ∥Department of Psychiatry, Trinity College, Dublin, Ireland; ¶NIHR Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College, London, UK; #Psychosis Studies Department, Institute of Psychiatry, King’s College, London, UK; **Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK; ††Department of Nursing and Midwifery, University of Dundee, Dundee, UK; ‡‡Centre for Economics of Mental and Physical Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, UK; §§Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience at King's College, London, UK; ∥∥Institute of Psychiatry, Psychology & Neuroscience at King's College, London, UK; ¶¶Department of Psychiatry, University of New South Wales, Sydney, NSW, Australia; ##Division of Psychiatry, University College London, London, UK; and ***Addictions Department, Institute of Psychiatry, King’s College, London, UK
| | - Ben Lomas
- *Department of Psychiatry, University of Cambridge, National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre and NIHR Collaboration for Leadership in Applied Health Research & Care, Cambridge, UK; †Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, UK; ‡Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands; §Department of Psychological Medicine, Institute of Psychiatry, King’s College, London, UK; ∥Department of Psychiatry, Trinity College, Dublin, Ireland; ¶NIHR Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College, London, UK; #Psychosis Studies Department, Institute of Psychiatry, King’s College, London, UK; **Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK; ††Department of Nursing and Midwifery, University of Dundee, Dundee, UK; ‡‡Centre for Economics of Mental and Physical Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, UK; §§Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience at King's College, London, UK; ∥∥Institute of Psychiatry, Psychology & Neuroscience at King's College, London, UK; ¶¶Department of Psychiatry, University of New South Wales, Sydney, NSW, Australia; ##Division of Psychiatry, University College London, London, UK; and ***Addictions Department, Institute of Psychiatry, King’s College, London, UK
| | - James B. Kirkbride
- *Department of Psychiatry, University of Cambridge, National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre and NIHR Collaboration for Leadership in Applied Health Research & Care, Cambridge, UK; †Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, UK; ‡Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands; §Department of Psychological Medicine, Institute of Psychiatry, King’s College, London, UK; ∥Department of Psychiatry, Trinity College, Dublin, Ireland; ¶NIHR Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College, London, UK; #Psychosis Studies Department, Institute of Psychiatry, King’s College, London, UK; **Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK; ††Department of Nursing and Midwifery, University of Dundee, Dundee, UK; ‡‡Centre for Economics of Mental and Physical Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, UK; §§Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience at King's College, London, UK; ∥∥Institute of Psychiatry, Psychology & Neuroscience at King's College, London, UK; ¶¶Department of Psychiatry, University of New South Wales, Sydney, NSW, Australia; ##Division of Psychiatry, University College London, London, UK; and ***Addictions Department, Institute of Psychiatry, King’s College, London, UK
| | - Kim Donoghue
- *Department of Psychiatry, University of Cambridge, National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre and NIHR Collaboration for Leadership in Applied Health Research & Care, Cambridge, UK; †Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, UK; ‡Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands; §Department of Psychological Medicine, Institute of Psychiatry, King’s College, London, UK; ∥Department of Psychiatry, Trinity College, Dublin, Ireland; ¶NIHR Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College, London, UK; #Psychosis Studies Department, Institute of Psychiatry, King’s College, London, UK; **Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK; ††Department of Nursing and Midwifery, University of Dundee, Dundee, UK; ‡‡Centre for Economics of Mental and Physical Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, UK; §§Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience at King's College, London, UK; ∥∥Institute of Psychiatry, Psychology & Neuroscience at King's College, London, UK; ¶¶Department of Psychiatry, University of New South Wales, Sydney, NSW, Australia; ##Division of Psychiatry, University College London, London, UK; and ***Addictions Department, Institute of Psychiatry, King’s College, London, UK
| | - Craig Morgan
- *Department of Psychiatry, University of Cambridge, National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre and NIHR Collaboration for Leadership in Applied Health Research & Care, Cambridge, UK; †Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, UK; ‡Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands; §Department of Psychological Medicine, Institute of Psychiatry, King’s College, London, UK; ∥Department of Psychiatry, Trinity College, Dublin, Ireland; ¶NIHR Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College, London, UK; #Psychosis Studies Department, Institute of Psychiatry, King’s College, London, UK; **Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK; ††Department of Nursing and Midwifery, University of Dundee, Dundee, UK; ‡‡Centre for Economics of Mental and Physical Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, UK; §§Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience at King's College, London, UK; ∥∥Institute of Psychiatry, Psychology & Neuroscience at King's College, London, UK; ¶¶Department of Psychiatry, University of New South Wales, Sydney, NSW, Australia; ##Division of Psychiatry, University College London, London, UK; and ***Addictions Department, Institute of Psychiatry, King’s College, London, UK
| | - Peter B. Jones
- *Department of Psychiatry, University of Cambridge, National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre and NIHR Collaboration for Leadership in Applied Health Research & Care, Cambridge, UK; †Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, UK; ‡Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands; §Department of Psychological Medicine, Institute of Psychiatry, King’s College, London, UK; ∥Department of Psychiatry, Trinity College, Dublin, Ireland; ¶NIHR Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College, London, UK; #Psychosis Studies Department, Institute of Psychiatry, King’s College, London, UK; **Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK; ††Department of Nursing and Midwifery, University of Dundee, Dundee, UK; ‡‡Centre for Economics of Mental and Physical Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, UK; §§Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience at King's College, London, UK; ∥∥Institute of Psychiatry, Psychology & Neuroscience at King's College, London, UK; ¶¶Department of Psychiatry, University of New South Wales, Sydney, NSW, Australia; ##Division of Psychiatry, University College London, London, UK; and ***Addictions Department, Institute of Psychiatry, King’s College, London, UK
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22
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Shibre T, Medhin G, Alem A, Kebede D, Teferra S, Jacobsson L, Kullgren G, Hanlon C, Fekadu A. Long-term clinical course and outcome of schizophrenia in rural Ethiopia: 10-year follow-up of a population-based cohort. Schizophr Res 2015; 161:414-20. [PMID: 25468171 DOI: 10.1016/j.schres.2014.10.053] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 10/27/2014] [Accepted: 10/27/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Although the few available studies from LMICs report favorable outcome, the course of schizophrenia is more complex than has been indicated so far. METHODS A sample of 361 people with a standardized clinical diagnosis of schizophrenia were recruited from a predominantly rural community in Ethiopia and followed up regularly for an average of 10years. Psychiatrists used the Longitudinal Interval Follow-up Evaluation chart to carry out assessment of illness course. Duration of time in clinical remission was the primary outcome. RESULT About 61.0% of the patients remained under active follow-up, while 18.1% (n=65) were deceased. The mean percentage of follow-up time in complete remission was 28.4% (SD=33.0). Female patients were significantly more likely to have episodic illness course with no inter-episode residual or negative symptoms (χ(2)=6.28, P=0.012). Nearly 14.0% had continuous psychotic symptoms for over 75% of their follow-up time. Only 18.1% achieved complete remission for over 75% of their follow-up time. Later onset of illness was the only significant predictor of achieving full remission for over 50% of follow-up time in a fully adjusted model. Conventional antipsychotic medications were fairly well tolerated in 80% of the patients and 4.2% (n=15) experienced tardive dyskinesia. CONCLUSION This population-based study is one of the very few long-term outcome studies of schizophrenia in LMICs. The study demonstrated clearly a differential and more favorable course and outcome for female patients but overall course and outcome of schizophrenia appeared less favorable in this setting than has been reported from other LMICs.
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Affiliation(s)
- Teshome Shibre
- Addis Ababa University, Ethiopia; University of Toronto, Ontario Shores Centre for Mental Health Sciences, Canada.
| | - Girmay Medhin
- Addis Ababa University, Aklilu-Lemma Institute of Pathobiology, Ethiopia
| | | | - Derege Kebede
- Addis Ababa University, School of Public Health, Addis Ababa, Ethiopia; WHO Regional Office for Africa, Brazzaville, Congo
| | | | | | | | - Charlotte Hanlon
- Addis Ababa University, Ethiopia; King's College London, Institute of Psychiatry, Health Services and Population Research Department, Centre for Global Mental Health, London, UK
| | - Abebaw Fekadu
- Addis Ababa University, Ethiopia; King's College London, Institute of Psychiatry, Department of Psychological Medicine, London, UK
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23
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Morgan C, Hibben M, Esan O, John S, Patel V, Weiss HA, Murray RM, Hutchinson G, Gureje O, Thara R, Cohen A. Searching for psychosis: INTREPID (1): systems for detecting untreated and first-episode cases of psychosis in diverse settings. Soc Psychiatry Psychiatr Epidemiol 2015; 50:879-93. [PMID: 25631693 PMCID: PMC4441747 DOI: 10.1007/s00127-015-1013-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 01/14/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE Our understanding of psychotic disorders is largely based on studies conducted in North America, Europe and Australasia. Few methodologically robust and comparable studies have been carried out in other settings. INTREPID is a programme of research on psychoses in India, Nigeria, and Trinidad. As a platform for INTREPID, we sought to establish comprehensive systems for detecting representative samples of cases of psychosis by mapping and seeking to engage all professional and folk (traditional) providers and potential key informants in defined catchment areas. METHOD We used a combination of official sources, local knowledge of principal investigators, and snowballing techniques. RESULTS The structure of the mental health systems in each catchment area was similar, but the content (i.e., type, extent, and nature) differed. Tunapuna-Piarco (Trinidad), for example, has the most comprehensive and accessible professional services. By contrast, Ibadan (Nigeria) has the most extensive folk (traditional) sector. We identified and engaged in our detection system-(a) all professional mental health services in each site (in- and outpatient services-Chengalpet, 6; Ibadan, 3; Trinidad, 5); (b) a wide range of folk providers (Chengalpet, 3 major healing sites; Ibadan, 19 healers; Trinidad: 12 healers); and c) a number of key informants, depending on need (Chengalpet, 361; Ibadan, 54; Trinidad, 1). CONCLUSIONS Marked differences in mental health systems in each catchment area illustrate the necessity of developing tailored systems for the detection of representative samples of cases with untreated and first-episode psychosis as a basis for robust, comparative epidemiological studies.
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Affiliation(s)
- Craig Morgan
- Health Service and Population Research Department, Centre for Epidemiology and Public Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK,
| | - Maia Hibben
- Department of Psychiatry, University of the West Indies, Saint Augustine, Trinidad
| | - Oluyomi Esan
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
| | - Sujit John
- Schizophrenia Research Foundation, Chennai, India
| | - Vikram Patel
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Helen A. Weiss
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Robin M. Murray
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, King’s College London, London, UK ,Psychosis Studies Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Gerard Hutchinson
- Department of Psychiatry, University of the West Indies, Saint Augustine, Trinidad
| | - Oye Gureje
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
| | | | - Alex Cohen
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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24
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Affiliation(s)
- Geoff Waghorn
- Policy and Economics Group, Queensland Centre for Mental Health Research (QCMHR), School of Population Health, University of Queensland, Australia
| | - Chris Lloyd
- Division of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Queensland, Australia
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25
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Morgan C, Lappin J, Heslin M, Donoghue K, Lomas B, Reininghaus U, Onyejiaka A, Croudace T, Jones PB, Murray RM, Fearon P, Doody GA, Dazzan P. Reappraising the long-term course and outcome of psychotic disorders: the AESOP-10 study. Psychol Med 2014; 44:2713-2726. [PMID: 25066181 PMCID: PMC4134320 DOI: 10.1017/s0033291714000282] [Citation(s) in RCA: 162] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Studies of the long-term course and outcome of psychoses tend to focus on cohorts of prevalent cases. Such studies bias samples towards those with poor outcomes, which may distort our understanding of prognosis. Long-term follow-up studies of epidemiologically robust first-episode samples are rare. METHOD AESOP-10 is a 10-year follow-up study of 557 individuals with a first episode of psychosis initially identified in two areas in the UK (South East London and Nottingham). Detailed information was collated on course and outcome in three domains (clinical, social and service use) from case records, informants and follow-up interviews. RESULTS At follow-up, of 532 incident cases identified, at baseline 37 (7%) had died, 29 (6%) had emigrated and eight (2%) were excluded. Of the remaining 458, 412 (90%) were traced and some information on follow-up was collated for 387 (85%). Most cases (265, 77%) experienced at least one period of sustained remission; at follow-up, 141 (46%) had been symptom free for at least 2 years. A majority (208, 72%) of cases had been employed for less than 25% of the follow-up period. The median number of hospital admissions, including at first presentation, was 2 [interquartile range (IQR) 1-4]; a majority (299, 88%) were admitted a least once and a minority (21, 6%) had 10 or more admissions. Overall, outcomes were worse for those with a non-affective diagnosis, for men and for those from South East London. CONCLUSIONS Sustained periods of symptom remission are usual following first presentation to mental health services for psychosis, including for those with a non-affective disorder; almost half recover.
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Affiliation(s)
- Craig Morgan
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, UK
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London
| | - Julia Lappin
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London
- Psychosis Studies Department, Institute of Psychiatry, King’s College, London, UK
| | - Margaret Heslin
- Centre for Economics of Mental and Physical Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, UK
| | - Kim Donoghue
- Addictions Department, Institute of Psychiatry, King’s College, London, UK
| | - Ben Lomas
- Division of Psychiatry, University of Nottingham, Nottingham, UK
| | - Ulrich Reininghaus
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, UK
| | - Adanna Onyejiaka
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, UK
| | - Tim Croudace
- Department of Health Sciences, University of York, York, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Robin M Murray
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London
- Psychosis Studies Department, Institute of Psychiatry, King’s College, London, UK
| | - Paul Fearon
- Department of Psychiatry, Trinity College, Dublin, Ireland
| | - Gillian A Doody
- Division of Psychiatry, University of Nottingham, Nottingham, UK
| | - Paola Dazzan
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London
- Psychosis Studies Department, Institute of Psychiatry, King’s College, London, UK
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26
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Affiliation(s)
- Rakesh K. Chadda
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
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27
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Hagi N, Takamura M, Yokoyama K. Factors affecting early psychiatric intervention for patients with first-episode psychosis in Japan. Early Interv Psychiatry 2013; 7:255-60. [PMID: 22816433 DOI: 10.1111/j.1751-7893.2012.00385.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2011] [Accepted: 05/20/2012] [Indexed: 11/28/2022]
Abstract
AIM The present study aimed to clarify the factors affecting early psychiatric intervention for patients with first-episode psychosis in Japan. METHODS A postal questionnaire survey was conducted in 346 members of the Association of Family of Psychosis Patients, in Mie, Japan. RESULTS The questionnaire was completed by 138 respondents. The mean interval between a suspected first episode of psychosis and the first visit to a medical institution was 18.4 months (SD: 40.0, range: 0-336 months). Forty-five respondents consulted a family member first and required a mean duration of 9.8 months (SD: 11.2) before their first visit; this was significantly shorter than those who did not. Eighteen respondents consulted their class teacher at school first and required a mean duration of 40.2 months (SD: 63.0) before their first visit; this was significantly longer (P < 0.05) than those who did not. When loss of sleep or appetite was present, the mean duration before their first visit was 9.3 months (SD: 12.1), which was significantly shorter (P < 0.05) than the time required by those who did not. Logistic regression analysis using the first episode-first visit interval as an independent variable, and independent variables such as age, gender of the patient and family member, and loss of sleep, revealed that variables relating to the respondent's notion about the psychosis were mitigating factors (e.g. 'prejudice-causing' and 'nothing to do with me'). CONCLUSION Prejudice towards psychosis and poor awareness about mental illnesses are two factors that may affect early psychiatric intervention.
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Affiliation(s)
- Noriko Hagi
- Department of Epidemiology and Environmental Health, Juntendo University Faculty of Medicine, Tokyo, Japan
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Abstract
BACKGROUND Most studies reporting the gender difference in age at onset of schizophrenia show an earlier onset in males, but vary considerably in their estimates of the difference. This may be due to variations in study design, setting and diagnostic criteria. In particular, several studies conducted in developing countries have found no difference or a reversed effect whereby females have an earlier onset. The aim of the study was to investigate gender differences in age of onset, and the impact of study design and setting on estimates thereof. METHOD Study methods were a systematic literature search, meta-analysis and meta-regression. RESULTS A total of 46 studies with 29,218 males and 19,402 females fulfilled the inclusion criteria and were entered into a meta-analysis. A random-effects model gave a pooled estimate of the gender difference of 1.07 years (95% confidence interval 0.21-1.93) for age at first admission of schizophrenia, with males having earlier onset. The gender difference in age at onset was not significantly different between developed and developing countries. Studies using diagnostic and statistical manual of mental disorders (DSM) criteria showed a significantly greater gender difference in age at onset than studies using International Classification Of Diseases (ICD) criteria, the latter showing no difference. CONCLUSIONS The gender difference in age of onset in schizophrenia is smaller than previously thought, and appears absent in studies using ICD. There is no evidence that the gender difference differs between developed and developing countries.
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Affiliation(s)
- S V Eranti
- Newham Early Intervention Service, East London Foundation Trust, Stratford Office Village, London, UK.
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Abstract
For Hindus, marriage is a sacrosanct union. It is also an important social institution. Marriages in India are between two families, rather two individuals, arranged marriages and dowry are customary. The society as well as the Indian legislation attempt to protect marriage. Indian society is predominantly patriarchal. There are stringent gender roles, with women having a passive role and husband an active dominating role. Marriage and motherhood are the primary status roles for women. When afflicted mental illness married women are discriminated against married men. In the setting of mental illness many of the social values take their ugly forms in the form of domestic violence, dowry harassment, abuse of dowry law, dowry death, separation, and divorce. Societal norms are powerful and often override the legislative provisions in real life situations.
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Affiliation(s)
- Indira Sharma
- Department of Psychiatry, Institute of Medical Sciences, Banras Hindu University, Varanasi, India
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Chandra PS, Kommu JVS, Rudhran V. Schizophrenia in women and children: a selective review of literature from developing countries. Int Rev Psychiatry 2012; 24:467-82. [PMID: 23057983 DOI: 10.3109/09540261.2012.707118] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Women and children with psychotic disorders in developing countries may be vulnerable and have considerable social disadvantages. Gender disadvantage has implications for all health outcomes including mental illnesses. In the more relevant gender-related context we discuss several important issues which affect women with schizophrenia, namely stigma, caregiver burden, functional outcome, marriage, victimization and help-seeking. The findings indicate that there are variations in clinical and functional outcomes and age of onset of illness between different regions. Drug side effects, such as metabolic syndrome appear to be quite common, adding to disease burden in women from developing countries. Victimization and coercion may contribute to poor quality of life and health concerns such as STIs and HIV. Stigma among women with schizophrenia appears to play a major role in help-seeking, caregiver burden and issues such as marriage and parenting. Gender-sensitive care and practices are few and not well documented. Research in the area of psychoses in children and adolescents from LAMI countries is sparse and is mainly restricted to a few clinic-based studies. More research is needed on organic and medical factors contributing to childhood psychoses, pathways to care, help-seeking, and impact of early detection and community care.
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Affiliation(s)
- Prabha S Chandra
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India.
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Viswanath B, Chaturvedi SK. Cultural aspects of major mental disorders: a critical review from an Indian perspective. Indian J Psychol Med 2012; 34:306-12. [PMID: 23723536 PMCID: PMC3662125 DOI: 10.4103/0253-7176.108193] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Major mental disorders such as schizophrenia and affective disorders are highly disabling illnesses. The cultural factors that influence the diagnosis and treatment of these disorders are of paramount clinical significance. We attempted to critically review the cultural factors in relation to the epidemiology, phenomenology, treatment, and outcome of major mental disorders from an Indian perspective, and tried to compare these with the cultural factors identified in major international studies. The clinical expression of major mental disorders was noted to vary across cultures in the review. In addition, the outcome of major mental disorders is reported to be better in developing nations than in the developed countries. Transcultural variations are also noted to exist in pharmacokinetics, pharmacodynamics, traditional healing practices, and psychotherapeutic approaches. The role of cultural factors in severe mental illnesses needs adequate attention from mental health professionals. Continued research on the cultural aspects is required to understand the interplay of all social, cultural, and biological factors. It is important to consider other cultural, traditional, and folk methods for understanding and management of mental illnesses.
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Affiliation(s)
- Biju Viswanath
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
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Erickson M, Lysaker P. Self-Esteem and Insight as Predictors of Symptom Change in Schizophrenia: A Longitudinal Study. ACTA ACUST UNITED AC 2012; 6:69-75. [DOI: 10.3371/csrp.6.2.4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
AIM To determine the 25 year follow-up of subjects originally enrolled in the Study of factors associated with course and outcome of schizophrenia (SOFACOS) at Chennai. MATERIALS AND METHODS All subjects who were followed up were administered the same research tools which were done at inclusion, namely the PSE & PPHS. RESULTS At the end of 25 years, 47 of the original ninety subjects were assessed completely. Twenty five (26%) had died and 18 (20%) were lost to follow-up during the 25 year period. 32 of the 47 followed up were in partial or total remission. Outcome was good in 27.7%, intermediate in 52% and poor in 19%. More men were single and more women were either married or separated. Gender differences were not marked. CONCLUSIONS This is one of the few prospective, long term follow up studies from India. Although outcome was good in those followed up, the numbers who died and could not be followed up causes concern.
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Affiliation(s)
- Thara Rangaswamy
- Director of Schizophrenia Research Foundation, Chennai, Tamil Nadu, India
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Wong GHY, Hui CLM, Tang JYM, Chang WC, Chan SKW, Xu JQ, Lin JJX, Lai DC, Tam W, Kok J, Chung D, Hung SF, Chen EYH. Early intervention for psychotic disorders: Real-life implementation in Hong Kong. Asian J Psychiatr 2012; 5:68-72. [PMID: 26878952 DOI: 10.1016/j.ajp.2012.01.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Accepted: 01/11/2012] [Indexed: 11/16/2022]
Abstract
Hong Kong is among the first few cities in Asia to have implemented early intervention for psychosis in 2001. Substantial changes in psychosis service have since taken place. We reviewed available outcome data in Hong Kong, with reference to the philosophy of early intervention in psychosis, discussing experience and lessons learned from the implementation process, and future opportunities and challenges. Data accumulated in the past decade provided evidence for the benefits and significance of early intervention programmes: patients under the care of early intervention service showed improved functioning, milder symptoms, and fewer hospitalizations and suicides. Early intervention is more cost-effective compared with standard care. Stigma and misconception remains an issue, and public awareness campaigns are underway. In recent years, a critical mass is being formed, and Hong Kong has witnessed the unfolding of public service extension, new projects and organizations, and increasing interest from the community. Several major platforms are in place for coherent efforts, including the public Early Assessment Service for Young people with psychosis (EASY) programme, the Psychosis Studies and Intervention (PSI) research unit, the independent Hong Kong Early Psychosis Intervention Society (EPISO), the Jockey Club Early Psychosis (JCEP) project, and the postgraduate Psychological Medicine (Psychosis Studies) programme. The first decade of early intervention work has been promising; consolidation and further development is needed on many fronts of research, service and education.
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Affiliation(s)
- Gloria H Y Wong
- Department of Psychiatry, The University of Hong Kong, Hong Kong; Hong Kong Early Psychosis Intervention Society, Hong Kong
| | - Christy L M Hui
- Department of Psychiatry, The University of Hong Kong, Hong Kong; Hong Kong Early Psychosis Intervention Society, Hong Kong
| | - Jennifer Y M Tang
- Department of Psychiatry, The University of Hong Kong, Hong Kong; Hong Kong Early Psychosis Intervention Society, Hong Kong
| | - Wing-Chung Chang
- Department of Psychiatry, The University of Hong Kong, Hong Kong; Hong Kong Early Psychosis Intervention Society, Hong Kong
| | - Sherry K W Chan
- Department of Psychiatry, The University of Hong Kong, Hong Kong; Hong Kong Early Psychosis Intervention Society, Hong Kong
| | - Jia-Qi Xu
- Department of Psychiatry, The University of Hong Kong, Hong Kong; Hong Kong Early Psychosis Intervention Society, Hong Kong
| | - Jessie J X Lin
- Department of Psychiatry, The University of Hong Kong, Hong Kong
| | - Dik-Chee Lai
- Department of Psychiatry, The University of Hong Kong, Hong Kong
| | - Wendy Tam
- Department of Psychiatry, The University of Hong Kong, Hong Kong
| | - Joy Kok
- Hong Kong Early Psychosis Intervention Society, Hong Kong
| | - Dicky Chung
- Hong Kong Early Psychosis Intervention Society, Hong Kong; Department of Psychiatry, Tai Po Hospital, Hong Kong
| | - S F Hung
- Hong Kong Early Psychosis Intervention Society, Hong Kong; Department of Psychiatry, Kwai Chung Hospital, Hong Kong
| | - Eric Y H Chen
- Department of Psychiatry, The University of Hong Kong, Hong Kong; Hong Kong Early Psychosis Intervention Society, Hong Kong
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Balaji M, Chatterjee S, Koschorke M, Rangaswamy T, Chavan A, Dabholkar H, Dakshin L, Kumar P, John S, Thornicroft G, Patel V. The development of a lay health worker delivered collaborative community based intervention for people with schizophrenia in India. BMC Health Serv Res 2012; 12:42. [PMID: 22340662 PMCID: PMC3312863 DOI: 10.1186/1472-6963-12-42] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Accepted: 02/16/2012] [Indexed: 11/07/2022] Open
Abstract
Background Care for schizophrenia in low and middle income countries is predominantly facility based and led by specialists, with limited use of non-pharmacological treatments. Although community based psychosocial interventions are emphasised, there is little evidence about their acceptability and feasibility. Furthermore, the shortage of skilled manpower is a major barrier to improving access to these interventions. Our study aimed to develop a lay health worker delivered community based intervention in three sites in India. This paper describes how the intervention was developed systematically, following the MRC framework for the development of complex interventions. Methods We reviewed the lierature on the burden of schizophrenia and the treatment gap in low and middle income countries and the evidence for community based treatments, and identified intervention components. We then evaluated the acceptability and feasibility of this package of care through formative case studies with individuals with schizophrenia and their primary caregivers and piloted its delivery with 30 families. Results Based on the reviews, our intervention comprised five components (psycho-education; adherence management; rehabilitation; referral to community agencies; and health promotion) to be delivered by trained lay health workers supervised by specialists. The intervention underwent a number of changes as a result of formative and pilot work. While all the components were acceptable and most were feasible, experiences of stigma and discrimination were inadequately addressed; some participants feared that delivery of care at home would lead to illness disclosure; some participants and providers did not understand how the intervention related to usual care; some families were unwilling to participate; and there were delivery problems, for example, in meeting the targeted number of sessions. Participants found delivery by health workers acceptable, and expected them to have knowledge about the subject matter. Some had expectations regarding their demographic and personal characteristics, for example, preferring only females or those who are understanding/friendly. New components to address stigma were then added to the intervention, the collaborative nature of service provision was strengthened, a multi-level supervision system was developed, and delivery of components was made more flexible. Criteria were evolved for the selection and training of the health workers based on participants' expectations. Conclusions A multi-component community based intervention, targeting multiple outcomes, and delivered by trained lay health workers, supervised by mental health specialists, is an acceptable and feasible intervention for treating schizophrenia in India.
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Teferra S, Shibre T, Fekadu A, Medhin G, Wakwoya A, Alem A, Kullgren G, Jacobsson L. Five-year mortality in a cohort of people with schizophrenia in Ethiopia. BMC Psychiatry 2011; 11:165. [PMID: 21985179 PMCID: PMC3207944 DOI: 10.1186/1471-244x-11-165] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Accepted: 10/10/2011] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Schizophrenia is associated with a two to three fold excess mortality. Both natural and unnatural causes were reported. However, there is dearth of evidence from low and middle income (LAMIC) countries, particularly in Africa. To our knowledge this is the first community based report from Africa. METHODS We followed a cohort of 307 (82.1% males) patients with schizophrenia for five years in Butajira, rural Ethiopia. Mortality was recorded using broad rating schedule as well as verbal autopsy. Standardized Mortality Ratio (SMR) was calculated using the mortality in the demographic and surveillance site as a reference. RESULT Thirty eight (12.4%) patients, 34 men (11.1%) and 4 women (1.3%), died during the five-year follow up period. The mean age (SD) of the deceased for both sexes was 35 (7.35). The difference was not statistically significant (p = 0.69). It was 35.3 (7.4) for men and 32.3 (6.8) for women. The most common cause of death was infection, 18/38 (47.4%) followed by severe malnutrition, 5/38 (13.2%) and suicide 4/38 (10.5%). The overall SMR was 5.98 (95% CI = 4.09 to 7.87). Rural residents had lower mortality with adjusted hazard ratio (HR) of 0.30 (95% CI = 0.12-0.69) but insidious onset and antipsychotic treatment for less than 50% of the follow up period were associated with higher mortality, adjusted HR 2.37 (95% CI = 1.04-5. 41) and 2.66(1.054-6.72) respectively. CONCLUSION The alarmingly high mortality observed in this patient population is of major concern. Most patients died from potentially treatable conditions. Improving medical and psychiatric care as well as provision of basic needs is recommended.
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Affiliation(s)
- Solomon Teferra
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Teshome Shibre
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abebaw Fekadu
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia,Department of Psychological Medicine, Section of Neurobiology of Mood Disorders, Institute of Psychiatry, King's College London, UK
| | - Girmay Medhin
- Aklilu Lemma Institute of Pathobiology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Asfaw Wakwoya
- Amanauel Specialized Mental Hospital, Addis Ababa, Ethiopia
| | - Atalay Alem
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gunnar Kullgren
- Division of Psychiatry, Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | - Lars Jacobsson
- Division of Psychiatry, Department of Clinical Sciences, Umeå University, Umeå, Sweden
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Ngoma M, Vansteelandt K, Delespaul P, Krabbendam L, Miezi SMM, Peuskens J. Cognitive deficits in nonaffective functional psychoses: a study in the Democratic Republic of Congo. Psychiatry Res 2010; 180:86-92. [PMID: 20494461 DOI: 10.1016/j.psychres.2009.10.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2009] [Revised: 10/13/2009] [Accepted: 10/19/2009] [Indexed: 10/19/2022]
Abstract
Cognition has been studied extensively in schizophrenia in Western countries. Far less research is devoted, however, to cognitive functioning in brief psychotic disorder and schizophreniform disorder. Moreover, few studies have been performed in third world countries. In this study, we want to fill this gap by comparing the cognitive functioning of three groups of ambulant, first-episode patients with a non-affective psychosis in the Democratic Republic of Congo. To test if cognitive dysfunction is a core symptom of psychosis in an African population, 153 healthy control subjects are compared with a sample of 68 patients with brief psychotic disorder, 50 patients with schizophreniform disorder, and 70 patients with schizophrenia in a cross-sectional study on several distinctive cognitive domains including verbal, visual, and working memory, attention, visuomotor control, motor speed, verbal fluency, and executive functions. In addition, these three groups of patients are compared among themselves on these cognitive domains. Results indicate that patients perform significantly worse than healthy controls on all cognitive domains with cognitive deficits being most pronounced in verbal and working memory, attention, motor speed, and executive functions. No major differences were found, however, between the three patient groups.
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Affiliation(s)
- Malanda Ngoma
- Department of Psychiatry, University of Kinshasa, Kinshasa, Democratic Republic of Congo
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Skalli L, Nicole L. [Specialised first-episode psychosis services: a systematic review of the literature]. Encephale 2010; 37 Suppl 1:S66-76. [PMID: 21600336 DOI: 10.1016/j.encep.2010.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Accepted: 05/19/2010] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Schizophrenia and its related disorders are prevalent, disabling and costly. Recent longitudinal studies found that the first two to five years of schizophrenia-spectrum disorders are characterised by symptomatic and functional deterioration. This led to the hypothesis of the existence of a critical period in the treatment of individuals suffering from psychosis: an assertive intervention during the first two to five years of psychosis could improve long term outcomes and prevent the emergence of psychosocial deficits. OBJECTIVES The objectives of this review are to describe different specialised first-episode psychosis services (FEP) and report their results at different times of follow-up in order to determine what specific approaches they should include, the optimal duration of treatment, and the characteristics of the patients who benefit the most from such programs. METHOD We systematically reviewed psycINFO and MEDLINE in search of studies dealing with efficacy or efficiency of specialized FEP programs. We only included research that had at least one comparison group and excluded those dealing with primary prevention of psychosis or prodromal interventions. RESULTS Five, all Scandinavian, programs and their results at different follow-up times are presented. The Parachute project started in 1994 in Sweden with the objectives to use low dosages of antipsychotics (AP), to minimize hospitalisations, to offer specialized individual and familial psychotherapy, and to assure continuity of care during a five-year period. It compared the Parachute study group with a prospective and a historical group. At three years, the Parachute group had spent less days hospitalised (but more days in a crisis home), was associated with a lower percentage of patients receiving disability allowances and had a trend toward better efficiency than the control groups. The Danish National schizophrenia project started in 1997 and included 16 centers that offered a two-year specialised FEP treatment. Patients were randomly assigned to treatment as usual (TU), treatment as usual enriched with support psychodynamic psychotherapy (SPP) and integrated treatment (IT). At the end of the two-year treatment period, patients receiving IT had significantly less positive symptoms, less negative symptoms and better scores in the global assessment scale (GAS) than TU. The Opus project started in 1998 in Denmark. It is a randomised, controlled study comparing a two-year FEP integrated treatment (IT) with standard treatment (ST). After the two-year period, patients were transferred to ST and were assessed at five years (three years after the end of the IT). At the end of the active phase of treatment, patients in IT group had better positive, negative and GAS scores, used lower dosages of AP and used less illicit drugs. At five-years, the only difference between IT and ST groups was that the IT group was associated with more patients living independently. The Open Dialogue project started in 1994 in Finland. It compared conventional treatment (CT) with acute psychosis integrated treatment (API) and Open dialogue approach in acute psychosis treatment (ODAP). At the two-year assessment, API and ODAP groups had less relapses, spent less days hospitalised, used less AP and had better GAS scores than CT. The ODAP group had better scores on the brief psychiatric rating scale than the API group and was associated with fewer patients receiving disability allowances than the CT group. At five-years, there was no difference in the outcomes between API and ODAP, but the authors suggest that the ODAP group was more efficient, because it had similar results as the API group while using less resources. The Soteria Nacka project started in 1990 in Sweden. It compared patients receiving only outpatient specialised FEP treatment (CE) with those receiving outpatient and crisis home specialised FEP treatment (CC). At the five-year assessment, the CC group had better GAS scores than the CE group, but only for patients suffering from a psychosis in the schizophrenia-spectrum. Also, less patients in the CC group used AP and when they did, they had lower dosages. The CC group was also associated with more patients working or studying at the end of the five-year follow-up and with significantly more patients in remission compared to the CE group. Finally, the Opus project, Parachute project and Soteria Nacka found that patients suffering from a psychosis in the schizophrenia-spectrum are those who benefit the most from the specialized, comprehensive, FEP-programs. CONCLUSION The programs specialised in the treatment of FEP show encouraging results mainly during their active phase. This review suggests that a two-year treatment period is not long enough to enable patients to maintain the improvements obtained during the active phase of an integrated treatment. Future studies should aim to determine--the characteristics of the patients that most benefit from--the specific interventions that should be included in and--the ideal duration of treatment of the comprehensive FEP programs.
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Affiliation(s)
- L Skalli
- Direction de l'enseignement, hôpital Louis-H.-Lafontaine, 7401 Hochelaga, H1N 3M5, Montréal, Québec, Canada.
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Shrivastava A, Shah N, Johnston M, Stitt L, Thakar M. Predictors of long-term outcome of first-episode schizophrenia: A ten-year follow-up study. Indian J Psychiatry 2010; 52:320-6. [PMID: 21267365 PMCID: PMC3025157 DOI: 10.4103/0019-5545.74306] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Schizophrenia is a severe mental disorder for which final outcomes continue to be unfavorable. The main objectives of this research were to examine and determine the baseline predictors of outcome status of first-episode schizophrenia in a long-term follow-up of ten years and of recovery ten years later. MATERIALS AND METHODS The study was carried out in a non-governmental, psychiatric hospital and participants consisted of patients available for assessment ten years following their initial diagnosis. Outcome was assessed on clinical and social parameters. Clinical measures of outcome included psychopathology, hospitalization, and suicidality. Social parameters included quality of life functioning, employability, interpersonal functioning, and the ability to live independently. RESULTS In our sample, mean positive symptoms' score were reduced by more than 65% between baseline and endpoint. The percentage of reduction in scores of negative symptoms is much less than reduction in positive symptoms. It was observed that only 23-25% patients showed social recovery on two or three different parameters. Additionally, fewer negative symptoms, lower depression scores, and low levels of aggression at baseline predicted good outcome. A higher level of positive symptoms at baseline also predicted recovery. The two social variables that predicted later outcomes were initially high levels of work performance and the ability to live independently at baseline. CONCLUSIONS Clinical information is not sufficient to make an accurate prediction of outcome status; rather, outcome depends upon multiple factors (including social parameters). A major implication of this research is the argument for moving toward a comprehensive assessment of outcome and to plan management accordingly. Bringing social outcome measures to the forefront and into the communities will allow for a more patient-centric approach. It also opens newer vistas for addressing the complex interaction of clinical and social parameters.
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Affiliation(s)
- Amresh Shrivastava
- Regional Mental Health Care, 467 Sunset Drive, St. Thomas, Ontario, Canada N5H 3V
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Möller HJ, Jäger M, Riedel M, Obermeier M, Strauss A, Bottlender R. The Munich 15-year follow-up study (MUFUSSAD) on first-hospitalized patients with schizophrenic or affective disorders: comparison of psychopathological and psychosocial course and outcome and prediction of chronicity. Eur Arch Psychiatry Clin Neurosci 2010; 260:367-84. [PMID: 20495979 DOI: 10.1007/s00406-010-0117-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2010] [Accepted: 04/27/2010] [Indexed: 01/15/2023]
Abstract
Given the limited explanatory power of the available neurobiological findings, results of long-term follow-up studies should still be considered as one criterion among others in the development of psychiatric classification systems regarding schizophrenia and affective disorders. A total of 323 first hospitalized inpatients of the Psychiatric Department of the University Munich were recruited at index time and followed up after 15 years. The full follow-up evaluation including several standardized assessment procedures (AMDP, PANSS, SANS, DAS, GAS) could be performed in 197 patients. The patients originally diagnosed according to ICD-9 were re-diagnosed according to ICD-10 and DSM-IV, using SCID among others. Schizophrenic patients had a much poorer outcome than affective or schizoaffective patients in terms of negative syndrome, deficit syndrome, psychosocial impairments and GAS results, and a higher prevalence of a chronic course. The logistic regression analyses performed to find optimized predictor combinations for the prognosis of a chronic course found, for example, the total Strauss-Carpenter Scale score, male gender and several other psychopathological syndromes to be relevant predictors. The findings reflect some long-term related validity for the differentiation between schizophrenia and affective disorders. The Strauss-Carpenter Scale, male gender as well as several psychopathological syndromes are the most relevant predictors for chronicity.
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Affiliation(s)
- Hans-Jürgen Möller
- Department of Psychiatry, University of Munich, Nussbaumstrasse 7, 80336, Munich, Germany.
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Saravanan B, Jacob KS, Johnson S, Prince M, Bhugra D, David AS. Outcome of first-episode schizophrenia in India: longitudinal study of effect of insight and psychopathology. Br J Psychiatry 2010; 196:454-9. [PMID: 20513855 PMCID: PMC2878819 DOI: 10.1192/bjp.bp.109.068577] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2009] [Revised: 12/03/2009] [Accepted: 02/08/2010] [Indexed: 11/23/2022]
Abstract
BACKGROUND Transcultural studies have found lack of insight to be an almost invariable feature of acute and chronic schizophrenia, but its influence on prognosis is unclear. AIMS To investigate the relationship between insight, psychopathology and outcome of first-episode schizophrenia in Vellore, India. METHOD Patients with a DSM-IV diagnosis of schizophrenia (n = 131) were assessed prospectively at baseline and at 6-month and 12-month follow-up. Demographic and clinical measures included insight, psychopathology, duration of untreated psychosis (DUP) and social functioning. Linear and logistic regression was used to measure predictors of outcome. RESULTS Follow-up data were available for 115 patients at 1 year. All achieved remission, half of them with and half without residual symptoms. Changes in psychopathology and insight during the first 6 months and DUP strongly predicted outcome (relapse or functional impairment), controlling for baseline measures. CONCLUSIONS Outcome of schizophrenia in this setting is driven by early symptomatic improvement and is relatively favourable, in line with other studies from low- and middle-income countries. Early improvement in insight might be a useful clinical guide to future outcome. Reduction of DUP should be a target for intervention.
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Affiliation(s)
- Balasubramanian Saravanan
- Section of Cognitive Neuropsychiatry, PO Box 68, Institute of Psychiatry, King's College London, Denmark Hill, London SE58AF, UK
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Affiliation(s)
- Ajit Avasthi
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
Schizophrenia is still one of the most mysterious and costliest mental disorders in terms of human suffering and societal expenditure. Here, we focus on the key developments in biology, epidemiology, and pharmacology of schizophrenia and provide a syndromal framework in which these aspects can be understood together. Symptoms typically emerge in adolescence and early adulthood. The incidence of the disorder varies greatly across places and migrant groups, as do symptoms, course, and treatment response across individuals. Genetic vulnerability is shared in part with bipolar disorder and recent molecular genetic findings also indicate an overlap with developmental disorders such as autism. The diagnosis of schizophrenia is associated with demonstrable alterations in brain structure and changes in dopamine neurotransmission, the latter being directly related to hallucinations and delusions. Pharmacological treatments, which block the dopamine system, are effective for delusions and hallucinations but less so for disabling cognitive and motivational impairments. Specific vocational and psychological interventions, in combination with antipsychotic medication in a context of community-case management, can improve functional outcome but are not widely available. 100 years after being so named, research is beginning to understand the biological mechanisms underlying the symptoms of schizophrenia and the psychosocial factors that moderate their expression. Although current treatments provide control rather than cure, long-term hospitalisation is not required and prognosis is better than traditionally assumed.
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Affiliation(s)
- Jim van Os
- Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University Medical Centre, Maastricht, Netherlands.
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Kulhara P, Shah R, Grover S. Is the course and outcome of schizophrenia better in the 'developing' world? Asian J Psychiatr 2009; 2:55-62. [PMID: 23051029 DOI: 10.1016/j.ajp.2009.04.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2008] [Revised: 03/11/2009] [Accepted: 04/10/2009] [Indexed: 11/16/2022]
Abstract
Historically, poor outcome has often been considered to be an integral part of the concept of schizophrenia, though in recent times this has been challenged by many cross-cultural studies. In this article, we review various studies pertaining to course and outcome of schizophrenia to have an understanding about variations in course and outcome of schizophrenia across cultures and nations. For better appraisal, the research studies have been divided into studies prior to cross-cultural World Health Organization (WHO) sponsored studies (Pre-WHO studies), WHO sponsored cross-cultural studies, and studies on course and outcome of schizophrenia not sponsored by WHO. We believe that the evidence arising from various studies across the globe largely supports the 'favorable outcome hypothesis in developing countries', i.e. developing countries have a larger proportion of patients with a good outcome and lesser percentage with a worst outcome as compared to developed countries, albeit amidst the controversies discussed by us. We suggest that in course and outcome studies, culture should not be used as a synonym for unexplained variance and research designs focusing at other potential factors impacting course and outcome of schizophrenia are much needed.
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Affiliation(s)
- Parmanand Kulhara
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
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VENKATESH BASAPPAK, THIRTHALLI JAGADISHA, NAVEEN MAGADIN, KISHOREKUMAR KENGERIV, ARUNACHALA UDUPI, VENKATASUBRAMANIAN GANESAN, SUBBAKRISHNA DODDABALLAPURAK, GANGADHAR BANGALOREN. Sex difference in age of onset of schizophrenia: findings from a community-based study in India. World Psychiatry 2008; 7:173-6. [PMID: 18836543 PMCID: PMC2559927 DOI: 10.1002/j.2051-5545.2008.tb00191.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
This study examined the sex difference in age of onset of schizophrenia in a community sample. Community-level health workers identified patients with symptoms of schizophrenia living in the community in a defined geographical area in South India. Two hundred and nine of them were diagnosed as hav-ing schizophrenia according to ICD-10 criteria by a team of psychiatrists. The age of onset of schizophrenia was assessed using the Interview for Retro-spective Assessment of Onset of Schizophrenia (IRAOS). The mean age of onset of schizophrenia did not significantly differ between males (29.2+/-8.8 years) and females (30.8+/-11.4 years) (t = 1.12; p = 0.27). Among those with an age of onset </=33 years, females had a significantly earlier onset; among those with an age of onset >33 years, females had a significantly later onset. The results from this community-based study confirm the previous findings in hospital-based patients in Asia. There is a need to revise the description of schizophrenia in the classificatory systems, keeping in view the regional varia-tions in the age of onset of the disorder.
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Affiliation(s)
- BASAPPA K. VENKATESH
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore 560029, India
| | - JAGADISHA THIRTHALLI
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore 560029, India
| | - MAGADI N. NAVEEN
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore 560029, India
| | - KENGERI V. KISHOREKUMAR
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore 560029, India
| | | | - GANESAN VENKATASUBRAMANIAN
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore 560029, India
| | | | - BANGALORE N. GANGADHAR
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore 560029, India
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Abstract
INTRODUCTION That schizophrenia has a better course and outcome in developing countries has become an axiom in international psychiatry. This is based primarily on a series of cross-national studies by the World Health Organization (WHO). However, increasing evidence from other research indicates a far more complex picture. METHODS Literature review and tabulation of data from 23 longitudinal studies of schizophrenia outcomes in 11 low- and middle-income countries. RESULTS We reviewed the evidence about the following domains: clinical outcomes and patterns of course, disability and social outcomes (marital and occupational status, in particular), and untreated samples and duration of untreated psychosis. Outcomes varied across the studies and the evidence suggests a need to reexamine the conclusions of the WHO studies. Additionally, assessments of outcomes should take excess mortality and suicide into account. CONCLUSIONS It is time to reexamine presumed wisdom about schizophrenia outcomes in low- and middle-income countries.
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Affiliation(s)
- Alex Cohen
- Department of Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115, USA.
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Yamazawa R, Nemoto T, Kobayashi H, Chino B, Kashima H, Mizuno M. Association between duration of untreated psychosis, premorbid functioning, and cognitive performance and the outcome of first-episode schizophrenia in Japanese patients: prospective study. Aust N Z J Psychiatry 2008; 42:159-65. [PMID: 18197512 DOI: 10.1080/00048670701787537] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of the present study was to identify the relationship between duration of untreated psychosis (DUP), premorbid functioning, and cognitive dysfunction and the outcome of first-episode schizophrenia. METHOD Thirty-four neuroleptic-naïve patients who consulted hospitals in Tokyo and who were treated by psychiatrists for the first time were evaluated with regard to DUP, premorbid functioning, psychiatric symptoms, and global functioning. The neuropsychological test battery consisted of the Letter Cancellation Test, Trail-Making Test, Digit Span and Verbal Fluency Test. One year later, 24 of the subjects were reassessed for psychiatric symptoms, global functioning, and social functioning, and the relationships between DUP, premorbid functioning, and cognitive performance and the outcome was investigated. RESULTS Short DUP, good premorbid functioning, and good Letter Cancellation Test, Digit Span and Verbal Fluency Test scores were significantly associated with good outcome. CONCLUSIONS The present results in a Japanese sample are consistent with previous international evidence that delay of initial treatment, premorbid functioning, and cognitive deficits are associated with outcome. A major limitation of the present study was the small size of the subject group. But because the subjects were relatively homogeneous and not influenced by psychoactive substances, the results reflect the essence of the disorder.
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Affiliation(s)
- Ryoko Yamazawa
- Department of Neuropsychiatry, School of Medicine, Keio University, Shinjuku-ku, Tokyo, Japan
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Chabungbam G, Avasthi A, Sharan P. Sociodemographic and clinical factors associated with relapse in schizophrenia. Psychiatry Clin Neurosci 2007; 61:587-93. [PMID: 18081617 DOI: 10.1111/j.1440-1819.2007.01722.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The aim of the present study was to examine sociodemographic and clinical factors associated with relapse in schizophrenia. The study group consisted of a convenience sample of 40 schizophrenia patients (20 patients each in relapse and remission). Relapse and remission were defined based on clinical criteria (ICD-10 criteria, course since last episode, and duration of remission) and psychometric criteria (scores on Socio-Occupational Functioning Assessment Scale [SOFAS] and Positive and Negative Syndrome Scale for Schizophrenia [PANSS]). The index group was evaluated after the occurrence of current relapse but within 6 months of its onset. Sociodemographic, current psychopathology (PANSS) and functioning (SOFAS), and other (mainly retrospective) variables were assessed with a specifically designed clinical profile sheet, Schedule for Affective Disorders and Schizophrenia Lifetime version, Presumptive Stressful life Events Scale, and World Health Organization Life Chart Schedule for Assessment of Course and Outcome of Schizophrenia. Patients who had relapsed were more symptomatic and exhibited greater dysfunction in comparison to remitted patients. Relapse in schizophrenia was significantly associated with unemployment, number of psychotic episodes, side-effects of medication, and life events score. The present findings suggest that a severe illness (no. psychotic episodes, unemployment), psychological stress and inappropriate treatment (side-effects of medicines) may be causally related to relapse in schizophrenia. However, the possibility that these variables may be caused by relapse or may be explained by a common underlying variable needs to be assessed prospectively.
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Affiliation(s)
- Gobind Chabungbam
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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