1
|
Davis GE, Davis MJ, Lowell WE. The effect of ultraviolet radiation on the incidence and severity of major mental illness using birth month, birth year, and sunspot data. Heliyon 2022; 8:e09197. [PMID: 35368522 PMCID: PMC8969152 DOI: 10.1016/j.heliyon.2022.e09197] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 08/06/2021] [Accepted: 03/22/2022] [Indexed: 11/16/2022] Open
Abstract
Background and objectives The evaluation of the severity of patients afflicted with major mental illness (MMI) has been problematic because of confounding variables and genetic variability. There have been multiple studies that suggest several human diseases, especially schizophrenia, are predisposed to be born in certain months or seasons. This observation implied an epigenetic effect of sunlight, likely ultraviolet radiation (UVR), which is damaging to DNA, especially in an embryo. This paper outlines a method to evaluate the severity of schizophrenia (SZ), bipolar disorder (BPD), and schizoaffective disorder (SZ-AFF) using the month/year of birth of those affected compared to the month/year of birth of the general population (GP). Relevance Our previous research found that more intense UVR (equal to or greater than 90 sunspot number (SSN)) had a negative effect on the average human lifespan. Also, human birth rates vary in frequency by month of birth reflecting variables like availability of food, sunlight, and other unknown epigenetic factors. We wanted to see if the patient month of birth varied from the average birth months of the general population and if UVR has an epigenetic effect promoting these diseases. Methods We obtained the month and year of birth of 1,233 patients admitted over a 15-year period to Maine's largest state psychiatric hospital and counted the months of birth for each diagnosis of SZ, BPD, and SZ-AFF, and compared these results to the general population's birth months of 4,265,555 persons from U. S. Census Year 2006. The number of patients in each month was normalized to August and compared with the normalized birth months of the general population (GP). Plots of the normalized months were considered rates of change (e.g., derivatives) and their respective integrals gave domains of each mental illness relative to the GP. Normalizing the GP to unity was then related to the factor 1.28, e.g., 28% more entropy, deduced from the Sun's fractal dimension imprinted on biological organisms. Results The percent of patients meeting our criterion for severity: SZ = 27%; BPD = 26%; SZ-AFF = 100%. Conclusions High UVR intensity or a rapid increase in UVR in early gestation are likely epigenetic triggers of major mental illness. BPD is more epigenetically affected than SZ or SZ-AFF disorders. We found that 52% of 1,233 patients comprised the core function of a tertiary-care psychiatric hospital. Also, mental illness exacerbated when the median SSN doubled. This work also validates the Kraeplinian dichotomy. What is new in this research This paper offers a new paradigm for evaluating the severity of MMI and supports significant epigenetic effects from UVR.
Collapse
Affiliation(s)
- George E Davis
- Riverview Psychiatric Center, 250 Arsenal Street, State House Station #11, Augusta, Maine, 04333-0011, USA
| | - Matthew J Davis
- Riverview Psychiatric Center, 250 Arsenal Street, State House Station #11, Augusta, Maine, 04333-0011, USA
| | - Walter E Lowell
- Riverview Psychiatric Center, 250 Arsenal Street, State House Station #11, Augusta, Maine, 04333-0011, USA
| |
Collapse
|
2
|
Wyatt S, Ostbye T, De Silva V, Long Q. Antenatal depression in Sri Lanka: a qualitative study of public health midwives' views and practices. Reprod Health 2022; 19:23. [PMID: 35090509 PMCID: PMC8796187 DOI: 10.1186/s12978-022-01330-z] [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: 10/03/2021] [Accepted: 01/08/2022] [Indexed: 11/25/2022] Open
Abstract
Background Almost all pregnant people in Sri Lanka receive antenatal care by public health midwives. While there is strong infrastructure in Sri Lanka for postpartum mental health care, the current practices within antenatal mental health care have not been externally evaluated. The purpose of this study is to investigate the current clinical guidelines and experiences of how public health midwives diagnose and treat antenatal depression. Methods We conducted in-depth interviews with 12 public health midwives from four antenatal clinics in the Bope Poddala division in Galle, Sri Lanka and reviewed and extracted information on antenatal depression from clinical guidelines. Data was collected in Sinhala and translated into English. We used applied thematic analysis and worked closely with our local team to ensure data trustworthiness. Results Midwives (n = 12) reported varying degrees of knowledge on antenatal depression and did not have standardized diagnosis patterns. However, they were very consistent in their clinical practices, following guidelines for referral and follow-up of case management, building strong rapport. In their practice, midwives continue to face challenges of lack of human resources and high stigma around mental illness. They suggested that that care could be improved with use of a standardized diagnostic tool, and easier access to specialist care. We found the clinical guideline on the diagnosis and treatment of antenatal depression is lacking key details on symptoms for appropriate diagnosis, but it clearly guides on how to navigate treatment. Conclusions Public health midwives are following the clinical guideline to refer pregnant women who need intervention for antenatal depression and follow-up for case management. However, there is a need for more specific and context-relevant guidelines, especially for diagnosis of antenatal depression. Formative research is needed to explore intervention strategies to improve antenatal depression management in Sri Lanka. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-022-01330-z. We interviewed 12 midwives at pregnancy clinics in southern Sri Lanka about what happens if a pregnant woman gets depressed. Some midwives knew a lot about depression, while others did not know very much. They all had different ideas of what the signs of depression were, and what percentage of pregnant women are usually depressed. They have a rule book about how to be a midwife, but it is not clear about how they should find out if a pregnant woman has depression. However, all midwives agreed on what they should do if they meet a depressed woman during an antenatal appointment in their clinic, following the rule book closely. They said they need to tell their supervisor, who will tell a psychiatrist who can treat the depression. However, sometimes there are problems. Midwives said that they, their supervisor and the psychiatrist are all very busy and don’t have enough time to spend with pregnant women. Also, a lot of the women in their clinics don’t want to get treated because they feel embarrassed about having depression, and don’t want other people to know. Midwives told us they could do their jobs better if they could give a quick test for depression to every woman visiting their clinic. This would be an easy solution, because they already use a test like this for after women give birth.
Collapse
Affiliation(s)
- Sage Wyatt
- Global Health Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, 215316, Jiangsu, China.,University of Bergen, Bergen, Vestland, Norway
| | - Truls Ostbye
- Duke Global Health Institute, Duke University, Durham, NC, USA.,University of Bergen, Bergen, Vestland, Norway
| | - Vijitha De Silva
- Duke Global Health Institute, Duke University, Durham, NC, USA.,Faculty of Medicine, University of Ruhuna, Matara, Southern Province, Sri Lanka
| | - Qian Long
- Global Health Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, 215316, Jiangsu, China.
| |
Collapse
|
3
|
Holt DJ, DeTore NR. Prevention of Psychiatric Illness in the Community: Seeds of Change. Psychiatr Ann 2021. [DOI: 10.3928/00485713-20210511-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
4
|
Castriotta L, Giangreco M, Cogliati-Dezza MG, Spanò M, Atrigna E, Ehrenfreund C, Rosolen V, Paoletti F, Barbone F. Measuring the impact of a social programme on healthcare: a 10-year retrospective cohort study in Trieste, Italy. BMJ Open 2020; 10:e036857. [PMID: 32709652 PMCID: PMC7413194 DOI: 10.1136/bmjopen-2020-036857] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Poor social conditions are strong determinants of poor health but positive health and healthcare changes caused by social interventions are difficult to demonstrate. In 2006, in Trieste (Italy), a social intervention known as 'Habitat Microaree' (HM) project was implemented in eight deprived neighbourhoods. In 2016, an observational study was launched to assess the impact of the HM project on healthcare. DESIGN Retrospective cohort study. SETTING The eight geographically defined neighbourhoods of Trieste involved in the 2006 HM project, accounting for a total of 11 380 residents. PARTICIPANTS Participants were all residents in the intervention areas. By means of a propensity score based on deprivation index, age, sex, Charlson index and drug utilisation, a non-participating, comparison group was defined. INTERVENTION The community-based intervention consisted of facilitating access to social services and outpatient healthcare facilities, coordinating intersectoral public services and specifically planning hospital discharge. These services were not provided in other areas of the city. OUTCOME MEASURES Hospital admissions and emergency department access. RESULTS We followed 16 256 subjects between 2008 and 2015. Living in microareas was associated with an HR for first hospital admission, for all causes, of 0.95 (95% CI 0.91 to 0.99); while the HR for urgent admissions in females was 0.92 (95% CI 0.85 to 1.00). The HR for psychiatric disorders, in females, was 0.39 (95%CI 0.18 to 0.82); in particular, the HR for psychosis was 0.15 (95% CI 0.05 to 0.51). The HR for acute respiratory diseases in females was 0.44 (95% CI 0.21 to 0.95). In males, the HR for genitourinary diseases and heart diseases were 0.65 (95% CI 0.42 to 1.01) and 0.72 (95% CI 0.54 to 0.97), respectively. Concerning urgent multiple admissions, the OR for fractures in females was 0.75 (95% CI 0.58 to 0.97). CONCLUSION In the study period, the effects on healthcare appear evident, especially in females.
Collapse
Affiliation(s)
- Luigi Castriotta
- Istituto di Igiene ed Epidemiologia Clinica, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Manuela Giangreco
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo" - Trieste, Trieste, Italy
| | | | - Marco Spanò
- Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Enrico Atrigna
- Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | | | - Valentina Rosolen
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo" - Trieste, Trieste, Italy
| | - Flavio Paoletti
- Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Fabio Barbone
- Department Medical Area - DAME, Università degli Studi di Udine, Udine, Italy
| |
Collapse
|
5
|
Parham LD, Roush S, Downing DT, Michael PG, McFarlane WR. Sensory characteristics of youth at clinical high risk for psychosis. Early Interv Psychiatry 2019; 13:264-271. [PMID: 28840977 DOI: 10.1111/eip.12475] [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] [Received: 12/19/2016] [Revised: 06/20/2017] [Accepted: 07/11/2017] [Indexed: 11/28/2022]
Abstract
AIM To identify and compare the sensory characteristics of young people at clinical high risk (CHR) for psychosis to those of peers at clinical low risk (CLR), and to national normative data. CHR and CLR participants were recruited from 6 US regions. METHOD A descriptive cohort design was used to analyse baseline data collected as part of the Early Detection and Intervention for the Prevention of Psychosis Program (EDIPPP). Raw scores on the Adolescent/Adult Sensory Profile (AASP) were analysed for 205 young people with CHR and 87 with CLR in 2 age groups: 12 to 17 years (N = 203) and 18 to 25 years (N = 89). ANOVA procedures were used to determine whether differences in AASP scores existed across CLR, CHR, and normative groups by age group. RESULTS CHR participants differed significantly from the normative group for all 4 AASP quadrant scores (Low Registration, Sensory Seeking, Sensory Sensitivity and Sensory Avoiding) in both age groups. CLR participants were similar to norms, except for Sensory Seeking scores that were significantly lower than norms in both age ranges. CONCLUSION Young people with CHR demonstrate active avoidance, heightened sensitivity, reduced seeking, and reduced registration of sensations in everyday life compared to typical peers. This pattern of differences may be a valuable marker for identifying individuals who are at high risk for developing a psychotic illness, and may also inform interventions designed to prevent or minimize the illness process and accompanying dysfunction.
Collapse
Affiliation(s)
- L Diane Parham
- Occupational Therapy Graduate Program, University of New Mexico, Albuquerque, New Mexico
| | - Sean Roush
- School of Occupational Therapy, Pacific University, Hillsboro, Oregon
| | - Donna T Downing
- Pier Training Institute, Maine Medical Center, Portland, Maine
| | - Paul G Michael
- School of Graduate Psychology, Pacific University, Hillsboro, Oregon
| | - William R McFarlane
- Maine Medical Center Research Institute, Tufts University School of Medicine, Boston, Massachusetts
| |
Collapse
|
6
|
McClellan J. Psychosis in Children and Adolescents. J Am Acad Child Adolesc Psychiatry 2018; 57:308-312. [PMID: 29706159 DOI: 10.1016/j.jaac.2018.01.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 01/26/2018] [Accepted: 03/07/2018] [Indexed: 12/12/2022]
Abstract
Psychosis is characterized by overt disruptions in thought, perceptions, and behavior. Complex syndromes presenting with psychosis, including schizophrenia spectrum disorders, mood disorders, and medical illnesses, are differentiated by characteristic patterns of symptom presentation and course of illness. Accurate diagnosis is important to guide treatment and to avoid inaccurate labeling, because most youth reporting psychotic-like experiences do not have a true psychotic disorder.
Collapse
Affiliation(s)
- Jon McClellan
- University of Washington Child Study and Treatment Center, Lakewood.
| |
Collapse
|
7
|
McFarlane WR. Family Interventions for Schizophrenia and the Psychoses: A Review. FAMILY PROCESS 2016; 55:460-82. [PMID: 27411376 DOI: 10.1111/famp.12235] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Family psychoeducation as a treatment for schizophrenia was developed 40 years ago almost simultaneously and independently by investigators who at the time were not family therapists. Although the original goal was to decrease high expressed emotion as a means of preventing relapse, later variations have gone beyond to focus on social and role functioning and family well-being. Explicitly disavowing the earlier assumptions that family pathology caused relapse and deterioration, family psychoeducation seeks to engage family members as more sophisticated partners, complementing interventions by clinicians with specialized interactions and coping skills that counter the neurologic deficits inherent to the disorder. It has proved to be one of the most consistently effective treatments available. Reports on outcome studies now number more than 100, while meta-analyses put relapse rate reduction at 50-60% over treatment as usual. The most recent application in first episode and prodromal psychosis, combined with other evidence-based interventions, is yielding perhaps the most promising results yet achieved-substantial return of functioning and avoidance of psychosis altogether. Reviewed here are its scientific, theoretical, and clinical sources, a description of the most commonly applied version-the multifamily group format, selected clinical trials spanning those four decades, international and ethnic adaptations, and studies on mechanisms of efficacy.
Collapse
Affiliation(s)
- William R McFarlane
- Tufts University School of Medicine, Maine Medical Center Research Institute, Portland, ME.
| |
Collapse
|
8
|
Changing trends in hospitalization rates associated with psychosis: Spain, 1980-2009. Soc Psychiatry Psychiatr Epidemiol 2015; 50:1843-55. [PMID: 26415493 DOI: 10.1007/s00127-015-1128-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 09/22/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To analyze the prevalence of hospitalization attributable to psychosis in Spain over the last three decades. METHODS Longitudinal analysis (1980-2009) of age-adjusted hospital discharges rates associated with psychosis (ICD9 290-8) in all Spanish hospitals. DATA SOURCE Spanish Hospital Morbidity Survey. RESULTS The hospitalization rate associated with psychotic episodes had been gradually increasing since 1980 until 2004; an abrupt turnaround observed in 2004 marks the beginning of a steady decline in the rate. The turning point described is not observed for each of the psychotic diagnoses separately analyzed. However, it is clearly seen when data are grouped in diagnosis-related groups (organic-psychosis, functional psychosis and substance-induced psychosis) since the time course of the diseases within the major diagnostic groups are interrelated as evidenced by shared turning points which collectively display a common time course pattern. Main hospital indicators and antipsychotic drug prescriptions were analyzed for any possible turning point in mid-2000s. Psychiatric hospital beds and length of stays remained stable by 2004; the hospitalizations associated with non-psychotic psychiatric pathologies show no turning point in 2004. However, an abrupt change on antipsychotic drug prescriptions is precisely observed in 2004. CONCLUSIONS After decades of linear growth, hospitalizations for psychotic patients begin to decline in 2004, coinciding with the start of last generation atypical antipsychotic drug consumption in Spain. Some of the psychotic diagnostic rates evolve in an interrelated manner which calls into question the diagnosis and nosological boundaries between some of these pathologies.
Collapse
|
9
|
A focus on adolescence to reduce neurological, mental health and substance-use disability. Nature 2015; 527:S161-6. [DOI: 10.1038/nature16030] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
10
|
Nieman DH, McGorry PD. Detection and treatment of at-risk mental state for developing a first psychosis: making up the balance. Lancet Psychiatry 2015; 2:825-34. [PMID: 26360901 DOI: 10.1016/s2215-0366(15)00221-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 04/02/2015] [Accepted: 05/01/2015] [Indexed: 12/26/2022]
Abstract
The at-risk mental state (ARMS) has been substantially researched and used as the basis for new clinical settings and strategies over the past two decades. However, it has also caused controversy and intense debate. In this Review, we assess available evidence and propose future directions. Accumulating research suggests that a blend of clinical staging and profiling, which naturally incorporates ARMS, might be a better guide for treatment of patients in different stages of psychiatric illness than the categorical DSM and ICD systems. Furthermore, clinical staging, with its emphasis on balancing risks and benefits, could help to prevent premature treatment or overtreatment with psychotropic drugs. Meta-analyses and reviews show that treatment of ARMS leads to a significant reduction in transition rate to a first psychosis. The debate about stigma associated with ARMS is based on scarce published work. The few studies that have been done suggest that stigma (including self-stigma) arises largely from negative societal views on psychiatric disorders and, depending on the setting and approach, not from engagement in treatment for ARMS per se. The evidence base suggests that definition of ARMS is an important step in implementation of clinical staging and profiling in psychiatry. However, more research across traditional diagnostic boundaries is needed to refine these clinical phenotypes and link them to biomarkers with the goal of personalised stepwise care. Health-system reform is overdue and a parallel process to support this approach is needed, which is similar to how physical forms of non-communicable disease are treated.
Collapse
Affiliation(s)
- Dorien H Nieman
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
| | - Patrick D McGorry
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| |
Collapse
|