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Montes JM, Agüera-Ortiz L, Mané A, Martinez-Raga J, Gutiérrez-Rojas L. Clinical decision-making before discharge in hospitalized persons with schizophrenia: a Spanish Delphi expert consensus. Front Psychiatry 2024; 15:1412637. [PMID: 38915849 PMCID: PMC11194714 DOI: 10.3389/fpsyt.2024.1412637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 05/22/2024] [Indexed: 06/26/2024] Open
Abstract
Introduction The care of people with schizophrenia (PWS) is usually provided in an outpatient setting by community mental health teams. However, PWS frequently require inpatient treatment because of a wide array of clinical, personal and/or social situations. Unfortunately, to our knowledge, there are no guidelines available to help psychiatrists in the decision-making process on hospital discharge for PWS. The aim of this project was to develop an expert consensus on discharge criteria for PWS after their stay in an acute inpatient psychiatric unit. Methods Using a modified Delphi method a group of 42 psychiatrists throughout Spain evaluated four areas of interest regarding this issue: clinical symptomatology, treatment-related factors, follow-up health care units after discharge, and physical health and monitoring. Results After two rounds, among the 64 statements, a consensus was reached for 59 (92.2%) statements. In three (17.7%) of the 17 statements on 'clinical symptomatology' and 2 (13.3%) of the 15 statements on 'follow-up health care units after discharge', a consensus was not reached; in contrast, a consensus was reached for all statements concerning 'treatment-related factors' and those concerning 'physical health and monitoring'. The consensus results highlight the importance for discharge of the control of symptoms rather than their suppression during admission and of tolerability in the selection of anantipsychotic. Discussion Although there is a lack of relevant data for guiding the discharge of PWS after hospitalization in an acute inpatient psychiatric unit, we expect that this consensus based on expert opinion may help clinicians to take appropriate decisions.
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Affiliation(s)
- José Manuel Montes
- Psychiatry Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain
- Centro de Investigación en Red de Salud Mental, CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain
| | - Luis Agüera-Ortiz
- Centro de Investigación en Red de Salud Mental, CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain
- Department of Psychiatry, Instituto de Investigación Sanitaria (imas12), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Anna Mané
- Centro de Investigación en Red de Salud Mental, CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain
- Psychiatry Department, Parc de Salut Mar, Barcelona, Spain; Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Jose Martinez-Raga
- Psychiatry Department, Hospital Universitario Doctor Peset & Universitat de Valencia, Valencia, Spain
| | - Luis Gutiérrez-Rojas
- Department of Psychiatry, University of Granada, Granada, Spain
- Psychiatry Department, Hospital Clínico San Cecilio, Granada, Spain
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Lisoni J, Nibbio G, Baldacci G, Zucchetti A, Cicale A, Zardini D, Miotto P, Deste G, Barlati S, Vita A. Improving depressive symptoms in patients with schizophrenia using bilateral bipolar-nonbalanced prefrontal tDCS: Results from a double-blind sham-controlled trial. J Affect Disord 2024; 349:165-175. [PMID: 38199388 DOI: 10.1016/j.jad.2024.01.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 01/02/2024] [Accepted: 01/03/2024] [Indexed: 01/12/2024]
Abstract
BACKGROUND Treating depressive symptoms in patients with schizophrenia is challenging. While transcranical Dicrect Current Stimulation (tDCS) improved other core symptoms of schizophrenia, conflicting results have been obtained on depressive symptoms. Thus, we aimed to expand current evidence on tDCS efficacy to improve depressive symptoms in patients with schizophrenia. METHODS A double-blind RCT was performed with patients randomized to 2 mA active-tDCS or sham-tDCS (15 daily sessions) with a bilateral bipolar-nonbalanced prefrontal placement (anode: left Dorsolateral prefrontal cortex; cathode: right orbitofrontal region). Clinical outcomes included variations of Calgary Depression Scale for Schizophrenia total score (CDSS) and of Depression-hopelessness and Guilty idea of reference-pathological guilt factors. Analysis of covariance was performed evaluating between-group changes over time. The presence/absence of probable clinically significant depression was determined when CDSS > 6. RESULTS As 50 outpatients were included (both groups, n = 25), significant improvements following active-tDCS were observed for CDSS total score (p = 0.001), Depression-hopelessness (p = 0.001) and Guilty idea of reference-pathological guilt (p = 0.03). Considering patients with CDSS>6 (n = 23), compared to sham, active-tDCS significantly improved CDSS total score (p < 0.001), Depression-hopelessness (p = 0.001) but Guilty idea of reference-pathological guilt only marginally improved (p = 0.051). Considering response rates of clinically significant depression, important reductions of CDSS score were observed (78 % of the sample scored ≤6; active-tDCS, n = 23; sham-tDCS, n = 16; p = 0.017). Early wakening item did not significantly change in any group. LIMITATIONS The study lacks a follow-up period and evaluation of tDCS effects on psychosocial functioning. CONCLUSIONS Bilateral bipolar-nonbalanced prefrontal tDCS is a successful protocol for the treatment of depressive symptoms in patients with schizophrenia.
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Affiliation(s)
- Jacopo Lisoni
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy.
| | - Gabriele Nibbio
- Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123 Brescia, Italy
| | - Giulia Baldacci
- Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123 Brescia, Italy
| | - Andrea Zucchetti
- Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123 Brescia, Italy
| | - Andrea Cicale
- Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123 Brescia, Italy
| | - Daniela Zardini
- Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123 Brescia, Italy
| | - Paola Miotto
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy
| | - Giacomo Deste
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123 Brescia, Italy
| | - Stefano Barlati
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123 Brescia, Italy
| | - Antonio Vita
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123 Brescia, Italy
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Chen WY, Pan CH, Su SS, Yang TW, Chen CC, Kuo CJ. Incidence and Risk Profiles for Suicide Mortality in Patients With Schizophrenia Receiving Homecare Case Management in Taiwan. Schizophr Bull 2024; 50:295-303. [PMID: 37163678 PMCID: PMC10919775 DOI: 10.1093/schbul/sbad067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Case management (CM)-based community therapy for patients with schizophrenia had little effect on reducing suicide mortality. We investigate the long-term suicide mortality outcome and associated risk factors in patients with schizophrenia receiving homecare (CM) in Taiwan. We enrolled a nationwide cohort of patients with schizophrenia who newly received homecare CM intervention (n = 13 317) between January 1, 2001, and December 31, 2015; their data were derived from Taiwan's National Health Insurance Research Database. We calculated the incidence rate of suicide methods. We examined the demographic and medical utilization profile for suicide and then performed a nested case-control study and multivariate regression to identify independent risk factors for suicide mortality. Among the 13 317 patients who received homecare CM intervention, 1766 died during the study period, of whom 213 died by suicide, which is the leading cause of unnatural death. Jumping from a high place, self-poisoning, and hanging were the top 3 suicide methods. Increased medical utilization was noted for both psychiatric and non-psychiatric services within 3 months of suicide mortality. Comorbidities of depressive disorder, nonspecific heart diseases, pneumonia, and gastrointestinal ulcers were identified as independent risk factors for suicide mortality. Suicide was the leading cause of unnatural mortality in patients with schizophrenia receiving homecare CM intervention in Taiwan. We noted the preferred suicide methods, high medical utilization, and comorbidities before suicide. Thus, we suggest that the CM team should assess lethal methods for suicide and ensure that patients adhere to psychiatry treatment for improving the current care model for this specified population.
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Affiliation(s)
- Wen-Yin Chen
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Chun-Hung Pan
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Department of Psychology, National Chengchi University, Taipei, Taiwan
| | - Sheng-Shiang Su
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Tien-Wei Yang
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chiao-Chicy Chen
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan
| | - Chian-Jue Kuo
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Yu H, Sun Y, Ren J, Qin M, Su H, Zhou Y, Hou D, Zhang W. Factors related to suicidal ideation of schizophrenia patients in China: a study based on decision tree and logistic regression model. PSYCHOL HEALTH MED 2024:1-15. [PMID: 38166506 DOI: 10.1080/13548506.2023.2301225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 12/26/2023] [Indexed: 01/04/2024]
Abstract
This study aimed to investigate the factors associated with suicidal ideation in schizophrenia patients in China using decision tree and logistic regression models. From October 2020 to March 2022, patients with schizophrenia were chosen from Chifeng Anding Hospital and Daqing Third Hospital in Heilongjiang Province. A total of 300 patients with schizophrenia who met the inclusion criteria were investigated by questionnaire. The questionnaire covered general data, suicidal ideation, childhood trauma, social support, depressive symptoms and psychological resilience. Logistic regression analysis revealed that childhood trauma and depressive symptoms were risk factors for suicidal ideation in schizophrenia (OR = 2.330, 95%CI: 1.177 ~ 4.614; OR = 10.619, 95%CI: 5.199 ~ 21.688), while psychological resilience was a protective factor for suicidal ideation in schizophrenia (OR = 0.173, 95%CI: 0.073 ~ 0.409). The results of the decision tree model analysis demonstrated that depressive symptoms, psychological resilience and childhood trauma were influential factors for suicidal ideation in patients with schizophrenia (p < 0.05). The area under the ROC for the logistic regression model and the decision tree model were 0.868 (95% CI: 0.821 ~ 0.916) and 0.863 (95% CI: 0.814 ~ 0.912) respectively, indicating excellent accuracy of the models. Meanwhile, the logistic regression model had a sensitivity of 0.834 and a specificity of 0.743 when the Youden index was at its maximum. The decision tree model had a sensitivity of 0.768 and a specificity of 0.8. Decision trees in combination with logistic regression models are of high value in the study of factors influencing suicidal ideation in schizophrenia patients.
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Affiliation(s)
- Hong Yu
- Department of Nursing, Harbin Medical University Daqing Campus, Daqing, China
- The Third People's Hospital of Daqing, Daqing, China
| | - Yujing Sun
- Department of Nursing, Harbin Medical University Daqing Campus, Daqing, China
| | - Jiaxin Ren
- Department of Nursing, Harbin Medical University Daqing Campus, Daqing, China
| | - Mengnan Qin
- Department of Nursing, Harbin Medical University Daqing Campus, Daqing, China
| | - Hong Su
- Department of Nursing, Harbin Medical University Daqing Campus, Daqing, China
| | - Yuqiu Zhou
- Department of Nursing, Harbin Medical University Daqing Campus, Daqing, China
| | - Dongyu Hou
- Department of Nursing, Harbin Medical University Daqing Campus, Daqing, China
| | - Weimiao Zhang
- The second Clinical Medical College, Shanxi Medical University, Taiyuan, China
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Inada K, Saito Y, Baba K, Fukui D, Masuda Y, Inoue S, Masuda T. Factors associated with death, hospitalization, resignation, and sick leave from work among patients with schizophrenia in Japan: a nested case-control study using a large claims database. BMC Psychiatry 2024; 24:22. [PMID: 38172827 PMCID: PMC10765934 DOI: 10.1186/s12888-023-05474-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Premature mortality, frequent relapse that easily leads to hospitalization, and discontinuous employment are key challenges for the treatment of schizophrenia. We evaluated risk factors for important clinical outcomes (death, hospitalization, resignation, and sick leave from work) in patients with schizophrenia in Japan. METHODS A nested case-control study was conducted for patients with schizophrenia identified in a Japanese claims database. For each outcome, the case was matched with up to four controls of the same age, sex, index year, and enrollment status (employee or dependent family). Potential risk factors were defined by prescriptions or diagnoses within 3 months prior to or in the month of the event. The association among potential risk factors and each outcome was evaluated using multivariable conditional logistic regression analysis with stepwise variable selection. RESULTS The number of cases and eligible patients for each outcome were 144 and 38,451 (death), 1,520 and 35,225 (hospitalization), 811 and 18,770 (resignation), and 4,590 and 18,770 (sick leave), respectively. Depression was a risk factor for death (odds ratio [OR]: 1.92; 95% confidence interval [CI]: 1.12, 3.29), hospitalization (OR: 1.22; 95% CI: 1.05, 1.42), and sick leave from work (OR: 1.46; 95% CI: 1.36, 1.57). Other risk factors for death were hospitalization history, Charlson Comorbidity Index (CCI) score, and prescription for laxatives. Prescriptions for hypnotics, laxatives, and anticholinergics were risk factors for hospitalization. Prescriptions for hypnotics and anticholinergics were risk factors for resignation. CCI score, prescription for hypnotics, laxatives, and antidiabetics were risk factors for sick leave from work. CONCLUSIONS Our findings suggest that depression and some physical symptoms, such as constipation and extrapyramidal symptoms, are risk factors for important clinical outcomes in patients with schizophrenia. Attention should be paid to both depression and physical symptoms for the treatment of schizophrenia.
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Affiliation(s)
- Ken Inada
- Department of Psychiatry, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0374, Japan.
| | - Yoshitaka Saito
- Department of Psychiatry, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Kenji Baba
- Medical Science, Sumitomo Pharma Co., Ltd., Osaka, Japan
| | - Daisuke Fukui
- Global Data Design Office, Sumitomo Pharma Co., Ltd., Tokyo, Japan
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Kline CL, Suzuki T, Simmonite M, Taylor SF. Catatonia is associated with higher rates of negative affect amongst patients with schizophrenia and schizoaffective disorder. Schizophr Res 2024; 263:208-213. [PMID: 36114099 DOI: 10.1016/j.schres.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 11/19/2022]
Abstract
Catatonia is a complex syndrome encompassing motor, behavioral, and affective symptoms seen in a significant proportion of patients with schizophrenia. There is growing evidence to suggest affective dysregulation is a salient feature of both catatonia and schizophrenia. To test the hypothesis of a linkage between affective dysregulation and catatonia in schizophrenia, we searched electronic medical records from 36,839 patients with schizophrenia, using anxiety and depression diagnoses as proxies for affective dysregulation. Catatonia was found in 4.7 % of the cohort. Analyses indicated that catatonia was significantly associated with both anxiety and depression co-morbidities: schizophrenia patients with catatonia were 1.71 times more likely to have anxiety and 1.80 times more likely to have depression than those without catatonia. Benzodiazepine usage was also 7.73 times more common in schizophrenia patients with a catatonia diagnosis than without that diagnosis. Taken together, the findings could be related to GABAergic dysfunction underlying schizophrenia, catatonia, and affective dysregulation.
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Affiliation(s)
- Christopher L Kline
- Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA
| | - Takakuni Suzuki
- Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA
| | - Molly Simmonite
- Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA
| | - Stephan F Taylor
- Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA.
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Kim JS, Baek SH, Kim H, Kim JW, Kang HJ, Ryu S, Lee JY, Kim JM, Kim SW. Association between suicidal ideation and cognitive function in young patients with schizophrenia spectrum disorder. Front Psychiatry 2023; 14:1276511. [PMID: 37965366 PMCID: PMC10641781 DOI: 10.3389/fpsyt.2023.1276511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 10/09/2023] [Indexed: 11/16/2023] Open
Abstract
Introduction Suicide is a major concern for patients with recent-onset schizophrenia. We hypothesized that preserved cognitive function might be associated with a higher level of suicidality in patients with schizophrenia. We investigated the associations between cognitive function and suicidal ideation (SI) in young patients recently diagnosed with a psychotic disorder. Methods This study analyzed data from a naturalistic clinical cohort study that comprised 402 patients with schizophrenia spectrum disorder. Patients with a treatment duration of ≤5 years and an age range of 15-39 years were enrolled. Participants were categorized into two groups based on SI as assessed by the Columbia Suicidal Severity Rating Scale. We collected demographic and clinical data and administered psychiatric, neurocognitive, and social cognitive measures. Results Among participants, 52% reported experiencing SI. Patients with SI were significantly younger and had a longer duration of untreated psychosis (DUP) than those without it. The Positive and Negative Syndrome Scale-general psychopathology score was significantly higher in the SI group. Scores on the Calgary Depression Scale for Schizophrenia, Perceived Stress Scale, Beck Depression Inventory (BDI), and Beck Hopelessness Scale were significantly higher among patients with SI, while scores on the Subjective Well-being Under Neuroleptics-Short Form and Brief Resilience Scale were significantly lower compared to those without it. Patients with SI demonstrated significantly higher scores on the verbal and visual learning test, false belief task, picture stories task, and Controlled Oral Word Association Test. They also completed the Trail Making Test (TMT) parts A and B in significantly less time than those without it. After adjusting for age, DUP, and scores on the BDI, group differences in scores on the verbal and visual learning tests, TMT (parts A and B), and the false belief task, and the picture story task remained significant. Discussion Our results suggest that along with traditional risk factors, better cognitive function may also be a major risk factor for suicidality in patients with schizophrenia. Providing psychological support and cognitive interventions is essential for young patients with recent-onset schizophrenia spectrum disorders, particularly those with high levels of depression, hopelessness, perceived stress, low resilience, and good cognitive function.
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Affiliation(s)
- Ji-Su Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Seon-Hwa Baek
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
- Mindlink, Gwangju Bukgu Mental Health Center, Gwangju, Republic of Korea
| | - Honey Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
- Mindlink, Gwangju Bukgu Mental Health Center, Gwangju, Republic of Korea
| | - Ju-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
- Mindlink, Gwangju Bukgu Mental Health Center, Gwangju, Republic of Korea
| | - Hee-Ju Kang
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Seunghyong Ryu
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Ju-Yeon Lee
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
- Mindlink, Gwangju Bukgu Mental Health Center, Gwangju, Republic of Korea
| | - Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
- Mindlink, Gwangju Bukgu Mental Health Center, Gwangju, Republic of Korea
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Wang R, Zheng S, Ouyang X, Zhang S, Ge M, Yang M, Sheng X, Yang K, Xia L, Zhou X. Suicidality and Its Association with Stigma in Clinically Stable Patients with Schizophrenia in Rural China. Psychol Res Behav Manag 2023; 16:1947-1956. [PMID: 37275277 PMCID: PMC10237198 DOI: 10.2147/prbm.s413070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 05/18/2023] [Indexed: 06/07/2023] Open
Abstract
Purpose Patients with schizophrenia not only experience more stigma than those with other mental illnesses, but they also have a higher risk of committing suicide. There are, however, few research on the connection between rural individuals with clinically stable schizophrenia and suicidality when they feel stigmatized. Therefore, the purpose of this study was to look at the suicidality in clinically stable patients with schizophrenia in rural China, including the prevalence, clinical correlates, and its relationships with stigma. Patients and Methods From September 2022 to October 2022, we conducted a multicenter, cross-sectional study in rural Chaohu, Anhui Province, China, and A total of 821 patients with schizophrenia completed the assessment. Three standardized questions were used to assess suicidality (including suicidal ideation, suicide plan, and suicide attempt), Patient Health Questionnaire with 9 items (PHQ-9) for determining depressive state, the first two items of the World Health Organization Quality of Life Questionnaire-Brief Version (QOL), which measures quality of life, the Social Impact Scale (SIS) to assess stigma, and some other important variables (eg employment, psychiatric medication, etc.) were measured using a homemade scale. Results Of the 821 participants who completed the questionnaire, 19.2% of the patients were found to have suicidality, of which 19.2% (158/821) were suicidal ideation, 5.6% (46/821) were suicide plans and 4.5% (37/821) were suicide attempts. Binary logistic regression analysis showed that job status (OR=0.520, p=0.047), psychiatric medication (OR=2.353, p=0.020), number of hospitalizations (OR=1.047, p=0.042), quality of life (OR=0.829, p=0.027), PHQ-9 (OR=0.209, p<0.001) stigma (OR=1.060, p<0.001) and social isolation in stigma (OR=1.134, p=0.001) were associated independently with suicidality. Conclusion Among clinically stable schizophrenia patients in rural China, suicidality is frequent and associated with stigma. Since stigma and some risk factors have a negative impact on suicidality, we should conduct routine screening and take suicide prevention measures to clinically stable schizophrenia patients in rural areas of China.
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Affiliation(s)
- Ruoqi Wang
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei City, People’s Republic of China
- Chaohu Hospital of Anhui Medical University, Hefei City, People’s Republic of China
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei City, People’s Republic of China
| | - Siyuan Zheng
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei City, People’s Republic of China
- Chaohu Hospital of Anhui Medical University, Hefei City, People’s Republic of China
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei City, People’s Republic of China
| | - Xu Ouyang
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei City, People’s Republic of China
- Chaohu Hospital of Anhui Medical University, Hefei City, People’s Republic of China
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei City, People’s Republic of China
| | - Shaofei Zhang
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei City, People’s Republic of China
- Chaohu Hospital of Anhui Medical University, Hefei City, People’s Republic of China
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei City, People’s Republic of China
| | - Menglin Ge
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei City, People’s Republic of China
- Chaohu Hospital of Anhui Medical University, Hefei City, People’s Republic of China
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei City, People’s Republic of China
| | - Meng Yang
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei City, People’s Republic of China
- Chaohu Hospital of Anhui Medical University, Hefei City, People’s Republic of China
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei City, People’s Republic of China
| | - Xuanlian Sheng
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei City, People’s Republic of China
- Chaohu Hospital of Anhui Medical University, Hefei City, People’s Republic of China
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei City, People’s Republic of China
| | - Kefei Yang
- Chaohu Hospital of Anhui Medical University, Hefei City, People’s Republic of China
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei City, People’s Republic of China
| | - Lei Xia
- Chaohu Hospital of Anhui Medical University, Hefei City, People’s Republic of China
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei City, People’s Republic of China
| | - Xiaoqin Zhou
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei City, People’s Republic of China
- Chaohu Hospital of Anhui Medical University, Hefei City, People’s Republic of China
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei City, People’s Republic of China
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Qubad M, Bittner RA. Second to none: rationale, timing, and clinical management of clozapine use in schizophrenia. Ther Adv Psychopharmacol 2023; 13:20451253231158152. [PMID: 36994117 PMCID: PMC10041648 DOI: 10.1177/20451253231158152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/24/2023] [Indexed: 03/31/2023] Open
Abstract
Despite its enduring relevance as the single most effective and important evidence-based treatment for schizophrenia, underutilization of clozapine remains considerable. To a substantial degree, this is attributable to a reluctance of psychiatrists to offer clozapine due to its relatively large side-effect burden and the complexity of its use. This underscores the necessity for continued education regarding both the vital nature and the intricacies of clozapine treatment. This narrative review summarizes all clinically relevant areas of evidence, which support clozapine's wide-ranging superior efficacy - for treatment-resistant schizophrenia (TRS) and beyond - and make its safe use eminently feasible. Converging evidence indicates that TRS constitutes a distinct albeit heterogeneous subgroup of schizophrenias primarily responsive to clozapine. Most importantly, the predominantly early onset of treatment resistance and the considerable decline in response rates associated with its delayed initiation make clozapine an essential treatment option throughout the course of illness, beginning with the first psychotic episode. To maximize patients' benefits, systematic early recognition efforts based on stringent use of TRS criteria, a timely offer of clozapine, thorough side-effect screening and management as well as consistent use of therapeutic drug monitoring and established augmentation strategies for suboptimal responders are crucial. To minimize permanent all-cause discontinuation, re-challenges after neutropenia or myocarditis should be considered. Owing to clozapine's unique efficacy, comorbid conditions including substance use and most somatic disorders should not dissuade but rather encourage clinicians to consider clozapine. Moreover, treatment decisions need to be informed by the late onset of clozapine's full effects, which for reduced suicidality and mortality rates may not even be readily apparent. Overall, the singular extent of its efficacy combined with the high level of patient satisfaction continues to distinguish clozapine from all other available antipsychotics.
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Affiliation(s)
- Mishal Qubad
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
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10
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Thematic analysis of the raters' experiences administering scales to assess depression and suicide in Arab schizophrenia patients. BMC Psychiatry 2022; 22:652. [PMID: 36271342 PMCID: PMC9587575 DOI: 10.1186/s12888-022-04313-3] [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: 01/15/2021] [Accepted: 10/16/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND This study aimed to enhance the cultural adaptation and training on administering the Arabic versions of the Calgary Depression Scale in Schizophrenia (CDSS) and The International Scale for Suicidal Thinking (ISST) to Arab schizophrenia patients in Doha, Qatar. METHODS We applied the qualitative thematic analysis of the focus group discussions with clinical research coordinators (CRCs). Five CRCs met with the principal investigator for two sessions; we transcribed the conversations and analyzed the content. RESULTS This study revealed one set of themes related to the scales themselves, like the role of the clinician-patient relationship during administration, the semantic variations in Arabic dialects, and the design of scales to assess suicide and differentiate between negative symptoms and depression. The other set of themes is relevant to the sociocultural domains of Muslim Arabs, covering religion, families' roles, and stigma. It also covered the approaches to culturally sensitive issues like suicide, taboos in Islam, and the gender roles in Arab countries and their impact on the patients' reports of their symptoms. CONCLUSIONS Our results highlight several cultural and religious aspects to tackle when approaching schizophrenia patients through in-depth discussions and training to improve the validity of the assessment tools and treatment services.
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11
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The clinical and psychosocial correlates of self-stigma among people with schizophrenia spectrum disorders across cultures: A systematic review and meta-analysis. Schizophr Res 2022; 248:64-78. [PMID: 35963056 DOI: 10.1016/j.schres.2022.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/29/2022] [Accepted: 08/01/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Individuals with schizophrenia spectrum disorders (SSD) are at heightened risk of experiencing self-stigma, and some cultures are more stigmatizing towards SSD than others. The first purpose of this review is to provide an estimate of the relationship between self-stigma and clinical and psychosocial outcomes. The second purpose is to examine how these relationships vary across cultures. METHOD Studies reporting correlations between self-stigma and outcome variable(s) were identified through electronic database searches from June 1, 2021, to January 2, 2022. Mean effect sizes were calculated using Fisher's r-to-Z-transformation. RESULTS Sixty-three articles (N = 8925, 22 countries) were included in the systematic review and fifty-three articles (N = 7756) were included in the meta-analysis. For the most studied clinical correlates, self-stigma had a moderate, positive correlation with depressive symptoms (r = 0.49, p < .001), a moderate, negative correlation with functioning (r = -0.39, p < .001), and a positive, small correlation with severity of psychotic symptoms (r = 0.29, p < .001), negative symptoms (r = 0.18, p < .001) and positive symptoms (r = 0.13, p = .01). For the most studied psychosocial correlates, self-stigma had a strong, negative correlation with quality of life (r = -0.52, p < .001) and self-esteem (r = -0.55, p < .001). The correlates of self-stigma were similar across cultures. DISCUSSION Self-stigma shows strong to small correlations with clinical and psychosocial variables similarly across cultures. More research is needed to examine underlying mechanisms to develop effective interventions.
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Analysis of color vision and cognitive function in first-episode schizophrenia before and after antipsychotic treatment. J Psychiatr Res 2022; 152:278-288. [PMID: 35759980 DOI: 10.1016/j.jpsychires.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/31/2022] [Accepted: 06/07/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND A large body of recent research has demonstrated that patients with schizophrenia exhibit significant changes in visual function and ocular tissue structure in the early stages of onset. It is therefore possible to explore a novel scientific breakthrough in the etiology of schizophrenia by transforming the traditional study of brain structure and function with a view to examining the potential field of eye tissue and function. However, few studies have investigated the correlation between iris characteristics and schizophrenia, and evidence is lacking in this regard. Thus, further exploration is needed. PURPOSE This study was designed to analyze the characteristics of iris structure, color vision function and cognitive function, as well as the changes therein in patients with the first-episode drug-free schizophrenia before and after antipsychotic treatment. It aimed to preliminarily identify easily-measurable biomarkers for early clinical screening and diagnosis of schizophrenia. METHODS This study recruited 61 patients (22 males) with first-episode schizophrenia. Prior to the commencement of treatment with antipsychotic drugs, the Montreal Cognitive Assessment (MoCA) and Farnsworth-Munsell Dichotomous (D-15 Hue Test) were used as assessment tools to evaluate cognitive function and color vision function, respectively. Over a 6-week period, patients received a second-generation antipsychotic treatment (all converted to olanzapine equivalent dose) as prescribed by the doctor, and the Positive and Negative Syndrome Scale (PANSS) was applied to evaluate the clinical treatment effects before treatment (baseline), as well as at the 2nd, 4th, and 6th weeks after drug treatment. On the basis of iris characteristics, the patients were divided into groups. The observed differences in drug treatment effects between the groups were then compared and analyzed to further clarify the relationship between treatment efficacy and iris characteristics. Finally, changes in the cognitive function and color vision function of patients at baseline and at the 6th week after drug treatment were compared, and the effects of antipsychotic drug treatment on the above-mentioned functions were analyzed. RESULTS On the basis of structural iris characteristics, 61 patients were classified as follows: 28 patients without iris crypts and 33 with iris crypts; 35 without iris pigment dots and 26 with iris pigment dots; 42 without iris wrinkles and 19 with iris wrinkles. No significant difference was observed in the PANSS scores of all of the patients at baseline; however, significant differences were found in patients with iris crypts and iris pigment dots at each follow-up timepoint (i.e., at the 2nd, 4th, and 6th week). Moreover, it is noteworthy that, compared with other patients, the PANSS scores of patients without specific iris structure characteristics (iris crypts and pigment dots) decreased significantly (P<0.05), which indicated that the drug therapy was highly effective. Excluding the interference of drug factors, a significant correlation was found between the results of the D-15 (color vision function) and MoCA (cognitive function) in first-episode untreated patients (r = -0.401, P < 0.05). In addition, the MoCA scores (mean difference = 2.36, t = 10.05, P ˂ 0.01) were significantly higher after 6 weeks of antipsychotic drug treatment compared to conditions at baseline. CONCLUSIONS The findings of this study demonstrated that color vision function of patients with schizophrenia improved with the improvement of cognitive function. The structural characteristics of the iris with crypts and pigment dots could have a significant impact on the drug treatment effect of schizophrenia and could be considered as a potential biomarker for detecting and recognizing schizophrenia.
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Crișan RM, Băcilă CI, Morar S. The role of psychological autopsy in investigating a case of atypical suicide in schizophrenia: a case report with a brief review of literature. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2022; 12:30. [PMID: 35815293 PMCID: PMC9257119 DOI: 10.1186/s41935-022-00291-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/26/2022] [Indexed: 02/08/2023] Open
Abstract
Background Self-harm typically is without lethal intent. Death can occur rarely, with suicide taking on an atypical form that raises the suspicion of hetero-aggression. Our study aimed to identify the link between self-harm and suicide intent and also to outline the positive diagnosis of an atypical suicide case which has raised the suspicion of hetero-aggression. For this purpose, the psychological autopsy method should be used regularly in suicide investigation because it not only allows a positive diagnosis of suicide but can also provide a detailed picture of mental degradation and associated suicide risk factors. Case presentation The case of a 26-year-old man from a rural area, found dead in the basement, at home, naked, barricaded inside, is described. Methods The on-site investigation and a complete forensic autopsy were performed. In addition, we apply the psychological autopsy method which gathered enough information to outline the positive diagnosis of suicide. We also made a brief literature review on the suicide risk factors and the behavioral changes that occurred during the COVID-19 pandemic in schizophrenic patients. Results The forensic autopsy revealed that he presented a complex craniofacial trauma as the cause of death (with scalp lacerations, frontal fracture, subarachnoid hemorrhage, and frontal cerebral contusions) associated with torso trauma (with self-inflicted stabbed wounds) with bruises and abrasions on the limbs. The injuries that caused death were self-inflicted and ensued repeatedly hitting his head against blunt objects. Using the psychological autopsy method, we found out that he presented multiple psychiatric hospitalizations for schizophrenia for almost 10 years, recently with reduced compliance to treatment. We also documented two previous suicide attempts and a gradual deterioration of his mental health. Conclusions We highlighted the role of the psychological autopsy (in addition to the judicial investigation and the forensic autopsy) for the diagnosis of committed suicide, for making a rigorous differential diagnosis between accident, hetero-aggression, and suicide, and also in pin-pointing the suicide risk factors. Supplementary Information The online version contains supplementary material available at 10.1186/s41935-022-00291-5.
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Telomere Length as a Marker of Suicidal Risk in Schizophrenia. CONSORTIUM PSYCHIATRICUM 2022. [DOI: 10.17816/cp171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND: Schizophrenia and suicidal behavior are associated with shortening in the length of telomeres. The aim of the study was to compare the content (pg/mcg) of telomeric repeat in DNA isolated from peripheral blood cells in three groups of subjects: patients with schizophrenia and a history of suicide attempts, patients with schizophrenia without suicidal tendencies, and healthy control volunteers.
METHODS: Relapses according to gender and age were examined in 47 patients with schizophrenia with suicidal behavior, 47 patients without self-destructive conditions, and 47 volunteers with healthy control and maintenance for the content of telomeric and the number of copies of mitochondrial DNA (mtDNA) in peripheral blood leukocytes.
RESULTS: Analysis of determining the content of telomeric repeat (TR) in the DNA of massive weight gain in the series: patients with schizophrenia and suicidal attempts patients with schizophrenia without suicidal observations healthy controls (22528.4 (227 [190; 250]) vs. 24321 (245 [228; 260]) vs. 25517.9 (255 [242; 266]), p 0.005. The same trend is observed for the number of mtDNA copies (257101.5 (250 [194; 297])) vs. 262.359.3 (254 [217; 312]) vs. 27279.9 (274 [213; 304]); p=0.012), but no significant differences were recorded.
CONCLUSIONS: For the first time, the phenomenon of telomere shortening was discovered in schizophrenics with suicidal risk. The length of the telomere corresponds to the parameter of a biological marker an objectively measured indicator of normal or pathological processes, but gaining an idea of its reliability is still necessary for verification with an assessment of its sensitivity, specificity, and positive and negative predictive value. The telomere may be considered a putative predictive indicator of suicidal risk.
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Styles of Coping with Stress among Healthy People and People with Diagnosis of Schizophrenia and Selected Personality Dimensions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095129. [PMID: 35564523 PMCID: PMC9104465 DOI: 10.3390/ijerph19095129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 04/21/2022] [Indexed: 11/23/2022]
Abstract
Background: Schizophrenia is considered a chronic and disabling mental disorder that affects approximately one percent of the world’s population. It is characterized by a variable course and its various symptoms may predominate depending on the characteristics of the person. Aim: Recognition of the personality traits and styles of stress-coping applied by healthy people and people diagnosed with schizophrenia. Methods: The study examined 60 people in total: 30 healthy people between 19 and 58 years old and29 people diagnosed with schizophrenia and 1 person with schizophrenia spectrum disorder between 25 and 72 years old. In the present study we used Personality inventory NEO-FFI by Paul Costa and Robert McCreae, designed to diagnose personality traits described in the five-factor model called “The Big Five” and CISS: Coping Inventory for Stressful Situations by N.S. Endler, J.D.A. Parker, designed to diagnose stress-coping styles.
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16
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Karnick AT, Boska RL, Caulfield NM, Winchell R, Capron DW. Suicide and self-injury outcomes for patients with comorbid psychiatric and physical health conditions. Psychiatry Res 2022; 308:114345. [PMID: 34954501 DOI: 10.1016/j.psychres.2021.114345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 12/08/2021] [Accepted: 12/12/2021] [Indexed: 11/29/2022]
Abstract
Suicide is a transdiagnostic public health issue that affects nearly all psychiatric disorders, individuals without a mental health diagnosis, and individuals with physical health issues. We assessed the relationship between these variables and suicide outcomes using a novel epidemiological research paradigm. Data were collected from the National Trauma Data Bank. Participants included patients admitted to trauma units for suicide and self-injury (n = 13,422). Patients were classified to one of four comorbid condition groups: no comorbidity, comorbid physical condition, comorbid major psychiatric condition, or multimorbidity (comorbid physical and psychiatric conditions). Multivariable logistic regression measured associations between comorbid condition and mortality and multivariable linear regression measured associations between comorbidity and injury severity. Mortality in patients with physical health comorbidity was not significant, but patients with psychiatric comorbidity or multimorbidity had significantly lower mortality than patients without either. No association between injury severity and comorbidity was detected. There were no differences in suicide mortality for individuals with a physical health comorbidity, but mortality was lower for individuals with a comorbid major psychiatric illness or multimorbidity. Since physical health conditions and psychiatric illness are associated with eventual suicide mortality, prevention strategies could target these populations at trauma units for suicide and self-injury admissions.
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Affiliation(s)
- Aleksandr T Karnick
- Department of Psychology, The University of Southern Mississippi, 118 College Drive, #5025, Hattiesburg, MS, USA.
| | - Rachel L Boska
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, 400 Fort hill Avenue, Canandaigua, NY, 14424; Department of Psychiatry, University of Rochester School of Medicine & Dentistry, 300 Crittenden Blvd., Rochester, NY, 14642
| | - Nicole M Caulfield
- Department of Psychology, The University of Southern Mississippi, 118 College Drive, #5025, Hattiesburg, MS, USA
| | - Robert Winchell
- Department of Surgery, Weill Cornell Medicine, 525 E. 68th Street, New York, NY, USA
| | - Daniel W Capron
- Department of Psychology, The University of Southern Mississippi, 118 College Drive, #5025, Hattiesburg, MS, USA
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Petrova N, Grigorieva E. Second-generation long-acting injectable antipsychotics in clinical practice. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:115-123. [DOI: 10.17116/jnevro2022122021115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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18
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Price GD, Heinz MV, Nemesure MD, McFadden J, Jacobson NC. Predicting symptom response and engagement in a digital intervention among individuals with schizophrenia and related psychoses. Front Psychiatry 2022; 13:807116. [PMID: 36032242 PMCID: PMC9403124 DOI: 10.3389/fpsyt.2022.807116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 07/27/2022] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Despite existing work examining the effectiveness of smartphone digital interventions for schizophrenia at the group level, response to digital treatments is highly variable and requires more research to determine which persons are most likely to benefit from a digital intervention. MATERIALS AND METHODS The current work utilized data from an open trial of patients with psychosis (N = 38), primarily schizophrenia spectrum disorders, who were treated with a psychosocial intervention using a smartphone app over a one-month period. Using an ensemble of machine learning models, pre-intervention data, app use data, and semi-structured interview data were utilized to predict response to change in symptom scores, engagement patterns, and qualitative impressions of the app. RESULTS Machine learning models were capable of moderately (r = 0.32-0.39, R2 = 0.10-0.16, MAE norm = 0.13-0.29) predicting interaction and experience with the app, as well as changes in psychosis-related psychopathology. CONCLUSION The results suggest that individual smartphone digital intervention engagement is heterogeneous, and symptom-specific baseline data may be predictive of increased engagement and positive qualitative impressions of digital intervention in patients with psychosis. Taken together, interrogating individual response to and engagement with digital-based intervention with machine learning provides increased insight to otherwise ignored nuances of treatment response.
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Affiliation(s)
- George D Price
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States.,Quantitative Biomedical Sciences Program, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Michael V Heinz
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States.,Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Matthew D Nemesure
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States.,Quantitative Biomedical Sciences Program, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | | | - Nicholas C Jacobson
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States.,Quantitative Biomedical Sciences Program, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States.,Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States.,Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
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Ongeri L, Kariuki SM, Nyawira M, Schubart C, Tijdink JK, Newton CRJC, Penninx BWJH. Suicidal attempts and ideations in Kenyan adults with psychotic disorders: An observational study of frequency and associated risk factors. Front Psychiatry 2022; 13:1085201. [PMID: 36741571 PMCID: PMC9892760 DOI: 10.3389/fpsyt.2022.1085201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/28/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Psychotic disorders increase the risk for premature mortality with up to 40% of this mortality attributable to suicide. Although suicidal ideation (SI) and suicidal behavior (SB) are high in persons with psychotic disorders in sub-Saharan Africa, there is limited data on the risk of suicide and associated factors among persons with psychotic disorders. METHODS We assessed SI and SB in persons with psychotic disorders, drawn from a large case-control study examining the genetics of psychotic disorders in a Kenyan population. Participants with psychotic disorders were identified using a clinical review of records, and the diagnosis was confirmed with the Mini-International Neuropsychiatric Interview (MINI). We conducted bivariate and multivariate logistic (for binary suicide outcomes) or linear regression (for suicide risk score) analysis for each of the suicide variables, with demographic and clinical variables as determinants. RESULTS Out of 619 participants, any current SI or lifetime suicidal attempts was reported by 203 (32.8%) with psychotic disorders, of which 181 (29.2%) had a lifetime suicidal attempt, 60 (9.7%) had SI in the past month, and 38 (20.9%) had both. Family history of suicidality was significantly associated with an increased risk of suicidality across all the following four outcomes: SI [OR = 2.56 (95% CI: 1.34-4.88)], suicidal attempts [OR = 2.01 (95% CI: 1.31-3.06)], SI and SB [OR = 2.00 (95% CI: 1.31-3.04)], and suicide risk score [beta coefficient = 7.04 (2.72; 11.36), p = 0.001]. Compared to persons aged <25 years, there were reduced odds for SI for persons aged ≥ 25 years [OR = 0.30 (95% CI: 0.14-0.62)] and ≥ 45 years [OR = 0.32 (95% CI: 0.12-0.89)]. The number of negative life events experienced increased the risk of SI and SB [OR = 2.91 (95% CI: 1.43-5.94)] for 4 or more life events. Higher negative symptoms were associated with more suicidal attempts [OR = 2.02 (95%CI: 1.15-3.54)]. Unemployment was also associated with an increased risk for suicidal attempts [OR = 1.58 (95%CI: 1.08-2.33)] and SI and SB [OR = 1.68 (95% CI: 1.15-2.46)]. CONCLUSION Suicidal ideation and SB are common in persons with psychotic disorders in this African setting and are associated with sociodemographic factors, such as young age and unemployment, and clinical factors, such as family history of suicidality. Interventions targeted at the community (e.g., economic empowerment) or at increasing access to care and treatment for persons with psychotic disorders may reduce the risk of suicide in this vulnerable population group.
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Affiliation(s)
- Linnet Ongeri
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Symon M Kariuki
- Department of Public Health, Pwani University, Kilifi, Kenya.,Neuroscience Unit, Kenya Medical Research Institute-Wellcome Trust Research Program, Kilifi, Kenya.,Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Miriam Nyawira
- Neuroscience Unit, Kenya Medical Research Institute-Wellcome Trust Research Program, Kilifi, Kenya
| | | | - Joeri K Tijdink
- Department of Ethics, Law and Humanities, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Philosophy, Faculty of Humanities, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Charles R J C Newton
- Department of Public Health, Pwani University, Kilifi, Kenya.,Neuroscience Unit, Kenya Medical Research Institute-Wellcome Trust Research Program, Kilifi, Kenya.,Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Penadés R, Forte F, Mezquida G, Rodríguez AG, García-Rizo C, Catalán R, Bernardo M. Effectiveness of Cognitive Behavioural Therapy for Suicide in Schizophrenia: A Systematic Review. CURRENT PSYCHIATRY RESEARCH AND REVIEWS 2021. [DOI: 10.2174/2666082218666211220164527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Suicide is probably one of the worst potential complications for people with schizophrenia. Even though the use of antipsychotic medication is essential in reducing suicidal behaviour, the use of psychological treatments seems to be in the same way necessary. Cognitive Behavioural Therapy (CBT) is an evidence-based form of psychotherapy that is constantly trying to synchronise with the latest recommendations from the research. The goal of the present work is to systematically review the scientific evidence from published studies testing the effectiveness of CBT designed to deal with suicide in patients with schizophrenia.
Methods:
We searched using multiple terms related to suicide prevention based on CBT in schizophrenia. Two databases (Medline and SCOPUS) were scrutinised for the electronic search and different reference lists from previous reviews were also hand checked.
Results:
We identified 5 randomised and controlled trials of CBT that included suicide-related cognitions or behaviours as a primary outcome measure. CBT focusing on suicidal cognitions and behaviours was found to be effective in reducing suicidal ideation. As the number of studies fulfilling the inclusion criteria is small and the assessment of outcomes is heterogeneous, we did not perform a meta-analysis and we present results in a narrative way.
Conclusion:
Research on CBT focused on suicide prevention in patients with schizophrenia is promising but current evidence is notoriously insufficient. Although those therapies seemed to be efficacious in the prevention of suicide, scarcity of randomised clinical trials specifically focusing on suicide is probably the most important issue to be faced. Given the current evidence, clinicians should be familiar with CBT techniques focusing on suicidal cognitions. However, suicide prevention and treatment in those with schizophrenia is complex, and many other factors such as possible earlier use of clozapine, optimizing adherence to medication, and other psychosocial aspects should be addressed. Combination of different strategies appears to be mandatory.
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Affiliation(s)
- Rafael Penadés
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic, Barcelona, Spain
| | - Florencia Forte
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic, Barcelona, Spain
| | - Gisela Mezquida
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic, Barcelona, Spain
| | | | | | - Rosa Catalán
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic, Barcelona, Spain
| | - Miguel Bernardo
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic, Barcelona, Spain
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Lieberman A, Rogers ML, Graham A, Joiner TE. Examining Correlates of Suicidal Ideation between those with and without Psychosis in a Psychiatric Inpatient Sample. J Affect Disord 2021; 294:254-260. [PMID: 34303305 DOI: 10.1016/j.jad.2021.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 07/11/2021] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The present study explored group differences in suicide-related variables between those with and without psychosis within the context of a psychiatric inpatient sample that included a range of affective disorder diagnoses. METHODS 54 individuals with psychosis and 103 individuals without psychosis (but experiencing other severe and acute mental health issues) were compared, and analyses of indirect effects were conducted to test specificity of thwarted belongingness, perceived burdensomeness, capability for suicide, agitation, and insomnia as accounting for group differences in suicidal ideation. RESULTS Patients without psychosis experienced higher levels of suicidal ideation, perceived burdensomeness, thwarted belongingness, agitation, and insomnia than patients with psychosis. Additionally, perceived burdensomeness and agitation emerged as robust explanatory factors for the relationship between psychosis status and suicidal ideation. LIMITATIONS Future work should include longitudinal analyses to understand temporal relationships between study variables. Additionally, stability of patients' psychotic symptoms was required and therefore may not reflect those at greatest acuity. CONCLUSIONS Although several studies have investigated suicide-related variables among those with psychosis as compared to the general population, the present study is novel in that the severity of these symptoms in those with psychosis is compared to that of those in other acutely ill populations (e.g., major depression, substance use).
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Affiliation(s)
- Amy Lieberman
- Department of Psychology, Florida State University, United States.
| | | | - Adam Graham
- Mental Health Cooperative, Nashville, TN, United States
| | - Thomas E Joiner
- Department of Psychology, Florida State University, United States
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Guo H, Zhong S, Yue Y, Gou N, Sun Q, Liang X, Wang F, Lu J, Li Q, Zhou J, Wang X. Self-Harm History, Anxiety-Depression, Severity of Disease, and Insight Are Significantly Associated With Suicide Risk in Forensic Psychiatric Inpatients of China. Front Psychiatry 2021; 12:706416. [PMID: 34630175 PMCID: PMC8497710 DOI: 10.3389/fpsyt.2021.706416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/27/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Forensic psychiatric patients have higher suicide risk than the general population. This study aimed to evaluate the extent of suicide risk and to explore the associated factors in forensic psychiatric inpatients in China. Methods: We conducted a cross-sectional study from 1st November, 2018 to 30th January, 2019 in the Forensic Psychiatric Hospital of Hunan Province, China. Patient's information on socio-demographic, clinical, and criminological characteristics was collected. The suicidality subscale of the MINI-International Neuropsychiatric Interview (M.I.N.I.), the Brief Psychiatric Rating Scale (BPRS), and the Severity of Illness of Clinical Global Impressions Scale (CGI-SI) were used to measure present suicide risks, psychiatric symptoms, and the severity of the patient's disease, respectively. Binary logistic regression models were used to examine factors associated with suicide risk. Results: Twenty-one percent (84/408) of the forensic psychiatric inpatients reported suicide risk. Logistic regression analysis suggested that self-harm history (OR:3.47, 95% confidence interval CI: 1.45-8.33), symptoms of anxiety-depression (OR:1.15, 95% CI:1.04-1.27), and more severe mental disorder (OR:1.42, 95% CI:1.08-1.87) were associated with elevated suicide risk, while insight disorder (OR:0.81, 95% CI:0.65-0.99) was related to decreasing suicide risk. Conclusion: The study supplied useful clinical information to recognize high suicide risk in forensic psychiatric inpatients and may aid the development of valuable strategies for preventing and reducing suicide events.
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Affiliation(s)
- Huijuan Guo
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Shaoling Zhong
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yuchen Yue
- Department of Psychiatry at the Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Ningzhi Gou
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Qiaoling Sun
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xiaoxi Liang
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Fanglan Wang
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Juntao Lu
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Qiguang Li
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jiansong Zhou
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xiaoping Wang
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
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Girgis RR, Basavaraju R, France J, Wall MM, Brucato G, Lieberman JA, Provenzano FA. An exploratory magnetic resonance imaging study of suicidal ideation in individuals at clinical high-risk for psychosis. Psychiatry Res Neuroimaging 2021; 312:111287. [PMID: 33848727 PMCID: PMC8137659 DOI: 10.1016/j.pscychresns.2021.111287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 11/18/2020] [Accepted: 04/06/2021] [Indexed: 11/28/2022]
Abstract
Suicide is a major cause of death in psychosis and associated with significant morbidity. Suicidal ideation (SI) is very common in those at clinical high-risk for psychosis (CHR) and predicts later suicide. Despite substantial work on the pathobiology of suicide in schizophrenia, little is known of its neurobiological underpinnings in the CHR or putatively prodromal state. Therefore, in this pilot study, we examined the neurobiology of SI in CHR individuals using structural MRI. Subjects were aged 14-30 and met criteria for the Attenuated Positive Symptom Psychosis-Risk Syndrome (APSS) delineated in the Structured Interview for Psychosis-Risk Syndromes (SIPS). Suicidality was assessed using the Columbia Suicide Severity Rating Scale (C-SSRS). Volumetric MRI scans were obtained on a 3T Phillips scanner. MRI data were available for 69 individuals (19 CHR without SI, 31 CHR with SI and 19 healthy control subjects). CHR individuals with SI had thicker middle temporal and right insular cortices than CHR individuals without SI and healthy control subjects. The location of these findings is consistent with neurobiological findings regarding suicide in syndromal psychosis. These findings underscore the potential for the use of brain imaging biomarkers of suicide risk in CHR individuals.
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Affiliation(s)
- Ragy R Girgis
- The New York State Psychiatric Institute/Columbia University Irving Medical Center, New York, N.Y., U.S.A.
| | - Rakshathi Basavaraju
- The New York State Psychiatric Institute/Columbia University Irving Medical Center, New York, N.Y., U.S.A
| | - Jeanelle France
- The New York State Psychiatric Institute/Columbia University Irving Medical Center, New York, N.Y., U.S.A
| | - Melanie M Wall
- The New York State Psychiatric Institute/Columbia University Irving Medical Center, New York, N.Y., U.S.A
| | - Gary Brucato
- The New York State Psychiatric Institute/Columbia University Irving Medical Center, New York, N.Y., U.S.A
| | - Jeffrey A Lieberman
- The New York State Psychiatric Institute/Columbia University Irving Medical Center, New York, N.Y., U.S.A
| | - Frank A Provenzano
- The New York State Psychiatric Institute/Columbia University Irving Medical Center, New York, N.Y., U.S.A
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Bornheimer LA, Tarrier N, Brinen AP, Li J, Dwyer M, Himle JA. Longitudinal predictors of stigma in first-episode psychosis: Mediating effects of depression. Early Interv Psychiatry 2021; 15:263-270. [PMID: 32052566 PMCID: PMC10731984 DOI: 10.1111/eip.12935] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 12/16/2019] [Accepted: 01/27/2020] [Indexed: 12/27/2022]
Abstract
AIM Stigma is commonly experienced among individuals with schizophrenia spectrum disorders and has been shown to be a barrier to help-seeking and behavioural service utilization. Given the established relationships between stigma, barriers to treatment, and poorer psychiatric outcomes including depression and psychotic symptoms, we examined the relationships between symptoms of depression, positive and negative symptoms, and the emergence of stigma longitudinally among a sample of first-episode of psychosis (FEP) participants in the United States. METHODS Data were obtained from the Recovery After an Initial Schizophrenia Episode project of National Institute of Mental Health's Early Treatment Program. Participants (n = 404) included adults between ages 15 and 40 with schizophrenia or other psychotic disorders based on the DSM-IV. Data were analysed using structural equation modelling (SEM). RESULTS Findings indicated that increased positive and negative symptoms independently related to greater symptoms of depression at baseline. Furthermore, increased positive symptoms and symptoms of depression at baseline independently related to the emergence of greater stigma being experienced over time. CONCLUSIONS Considering the role that symptoms of depression played as a factor explaining the relationships between positive and negative symptoms and emergence of stigma over time among individuals in FEP, and symptoms of depression is important predictor of stigma and may furthermore present as a viable and less stigmatizing initial treatment target in the early course of a psychotic disorder.
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Affiliation(s)
- Lindsay A Bornheimer
- School of Social Work, University of Michigan, 1080 S. University Ave., School of Social Work, Ann Arbor, Michigan
| | - Nicholas Tarrier
- School of Psychological Sciences, University of Manchester, United Kingdom
| | - Aaron P Brinen
- College of Medicine, Drexel University, Philadelphia, Pennsylvania
| | - Juliann Li
- School of Social Work, University of Michigan, 1080 S. University Ave., School of Social Work, Ann Arbor, Michigan
| | - Meredith Dwyer
- Silver School of Social Work, New York University, New York, New York
| | - Joseph A Himle
- School of Social Work and Department of Psychiatry, University of Michigan, 1080 S. University Ave., School of Social Work, Ann Arbor, Michigan
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Suicidal ideation in first-episode psychosis: Considerations for depression, positive symptoms, clinical insight, and cognition. Schizophr Res 2021; 228:298-304. [PMID: 33493778 PMCID: PMC7987901 DOI: 10.1016/j.schres.2020.12.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 10/05/2020] [Accepted: 12/31/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Suicide is a leading cause of death for individuals with psychosis. Although factors influencing suicide risk have been studied in schizophrenia, far less is known about factors that protect against or trigger increased risk during early-stage and first episode of psychosis. This study examined whether depression, psychotic symptoms, clinical insight, and cognition were associated with suicide ideation among individuals with first-episode psychosis. METHODS Data were obtained from the Recovery After an Initial Schizophrenia Episode (RAISE) project. Participants (n = 404) included adults between ages 15 and 40 in a first episode of psychosis. Measurement included the Positive and Negative Syndrome Scale, Brief Assessment of Cognition in Schizophrenia, and Calgary Depression Scale for Schizophrenia. A logistic regression model evaluated clinical and cognitive variables as predictors of suicidal ideation. RESULTS Greater positive symptoms (OR = 1.085, p < .01) and depression (OR = 1.258, p < .001) were associated with increased likelihood of experiencing suicidal ideation during the RAISE project. Meanwhile, stronger working memory (OR = 0.922, p < .05) and impaired clinical insight (OR = 0.734, p < .05) were associated with a decreased likelihood of experiencing suicidal ideation. CONCLUSION The likelihood of experiencing suicidal ideation was significantly increased when positive and depressive symptoms were present, and significantly decreased when clinical insight was poorer and working memory stronger. These findings have important implications for the role of cognition and insight in risk for suicide ideation in early-stage psychosis, which may aid in improving the prediction of suicide behaviors and inform clinical decision-making over the course of the illness.
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Kalniunas A, Chakrabarti I, Mandalia R, Munjiza J, Pappa S. The Relationship Between Antipsychotic-Induced Akathisia and Suicidal Behaviour: A Systematic Review. Neuropsychiatr Dis Treat 2021; 17:3489-3497. [PMID: 34887662 PMCID: PMC8651045 DOI: 10.2147/ndt.s337785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 11/10/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE We aim to systematically review evidence for a relationship between antipsychotic-induced akathisia and suicidal behaviour, in order to guide further clinical decision making in this area. METHODS Several electronic databases (Embase, Medline, Cochrane and PsychINFO) were systemically searched for articles published up to February 2021, using search terms related to akathisia, antipsychotics and suicidal behaviour. Two reviewers independently evaluated all the relevant studies using predetermined criteria and assessed the risk of bias for each included study. The systematic review was conducted in line with PRISMA methodology and reporting. RESULTS Following de-duplication, screening and application of exclusion criteria, four eligible studies were identified. All of the available studies were in English and included adult patients. Nevertheless, there was significant variability regarding methodology and overall quality was deemed low due to small sample sizes. There was insufficient data to perform statistical analyses of the results. Of the four studies, two found a weak correlation between antipsychotic-related akathisia and suicidal behaviour, a finding that was not supported by the remaining two studies. CONCLUSION The search yielded very few studies for inclusion. On the basis of the existing evidence, akathisia cannot be reliably linked to the presence of suicidal behaviour in patients treated with antipsychotic medication. However, proactive screening for emerging suicidal behaviour in this vulnerable patient group is advisable. Our findings highlight the pressing need for further research in this area.
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Affiliation(s)
| | | | | | - Jasna Munjiza
- Division of Psychiatry, Imperial College London, London, UK.,Central and North West London NHS Foundation Trust, London, UK
| | - Sofia Pappa
- West London NHS Trust, London, UK.,Division of Psychiatry, Imperial College London, London, UK
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Suicide Behavior and Its Predictors in Patients with Schizophrenia in Ethiopia. SCHIZOPHRENIA RESEARCH AND TREATMENT 2021; 2021:6662765. [PMID: 33868728 PMCID: PMC8032509 DOI: 10.1155/2021/6662765] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/12/2021] [Accepted: 03/27/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND People with schizophrenia (PWS) are at greater risk of suicide. However, suicide behaviors that occur in PWS are often overlooked, inadequately characterized, and not consistently integrated into treatment. Despite this burden and consequences in Ethiopia, there is a dearth of studies concerning suicide behavior in PWS. Therefore, this study is aimed at assessing the magnitude of suicide behavior and its predictors among PWS in Ethiopia. METHODS An institution based cross-sectional study was employed. Data were collected using the structured interviewer-administered questionnaire from a sample of 300 PWS at Amanuel Mental Specialized Hospital (AMSH). The revised version of Suicide Behavior Questionnaire (SBQ-R) was used to assess suicide behavior in PWS. The data was collected from March 1 to 30, 2019. Binary logistic regression was performed to identify independent predictors of suicidal behavior at 95% confidence level. Statistical significance was declared at p value <0.05. RESULT A total of 300 patients with schizophrenia participated in the study. More than two-thirds of 203 (67.7%) of the participants were males, and 116 (38.7%) participants were between the ages of 28 and 37 years. We found that the prevalence of suicide behavior among PWS was 30.3%. Being unemployed (AOR = 3.65, CI = 1.32, 10.05), family history of suicide (AOR = 3.16, CI = 1.38, 7.23), substance use (AOR = 2.51, CI = 1.13, 5.59), current positive psychotic symptoms (hallucination (AOR = 6.39, CI = 2.86, 14.29), and delusion (AOR = 4.15, CI = 1.95, 14.29) and presence of comorbid depression (AOR = 4.81, CI = 1.98, 11.68) were independent significant predictors with suicidal behavior in PWS. CONCLUSION The prevalence of suicidal behavior among PWS was found to be high. Hence, designing strategies for early screening and intervention is the most critical prevention strategy of suicide in PWS.
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Abstract
Depression is the third most common illness among patients with schizophrenia which negatively affects the course of the disease and significantly contributes to the mortality rate, due to increased suicide. Depression, along with negative symptoms and cognitive deficits, is one of the main factors that significantly decreases the quality of life and the disease prognosis in patients with schizophrenia. In addition, depression increases the frequency of exacerbations and readmissions, decreases the quality and duration of remissions and is associated with more frequent substance abuse and an increased economic burden. Data on the prevalence of depression among patients with schizophrenia are contradictory and are associated with a low detection rate of depression in such patients, a lack of clear diagnostic criteria and difficulties in differentiation between extrapyramidal and negative symptoms. The average prevalence of depression that meets the diagnostic criteria of major depressive episodes in patients with schizophrenia is 25% at a specific point, and 60% over the course of a lifetime; the frequency of subsyndromal depression is much higher. It is essential to distinguish between primary (axial syndrome) and secondary depressive symptoms (extrapyramidal symptoms, psychogenic or nosogenic reactions, social factors, etc.) to determine treatment strategies.
The published data relating to randomized clinical trials for the development of evidence-based guidelines are limited. Current recommendations are based mainly on the results of small-scale trials and reviews. Certain atypical antipsychotics (quetiapine, lurasidone, amisulpride, aripiprazole, olanzapine, clozapine) are superior to typical antipsychotics in the reduction of depressive symptoms. Clozapine is effective in the management of patients at risk from suicide. The additional prescription of antidepressants, transcranial magnetic stimulation and electroconvulsive therapy are not always effective and are only possible following the management of acute psychosis in cases when antipsychotic monotherapy proved to be ineffective.
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Golubović B, Gajić Z, Ivetić O, Milatović J, Vuleković P, Đilvesi Đ, Golubović S, Vrban F, Subašić A, Rasulić L. FACTORS ASSOCIATED WITH DEPRESSION IN PATIENTS WITH SCHIZOPHRENIA. Acta Clin Croat 2020; 59:605-614. [PMID: 34285431 PMCID: PMC8253071 DOI: 10.20471/acc.2020.59.04.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 12/05/2019] [Indexed: 11/24/2022] Open
Abstract
The aim of this study was to analyze risk factors present in schizophrenic patients with depressive symptomatology. The sample comprised of 76 respondents diagnosed with schizophrenia. In the study, we used the Positive and Negative Syndrome Scale (PANSS) and Calgary Depression Scale for Schizophrenia. The prevalence of depression was estimated to be 30%. The mean scores on the negative subscale of the PANSS were significantly higher in patients with schizophrenia and depression compared to control group (U=3.64, p=0.00), and so were those on the General Psychopathology Scale (U=4.91, p=0.00). Socio-demographic factors were identified as important factors (p<0.05). Personal and environmental factors such as loneliness, immediate social environment, social support and isolation were statistically significantly different between the groups (p<0.05). There was a correlation of poor compliance with psycho-pharmacotherapy, increased number of hospitalizations and shorter remission period with the severity of clinical presentation (p<0.05). Since the presence of these factors is associated with depression in schizophrenia, their early detection in clinical practice is vital to ensure timely prevention of the development of depressive symptomatology.
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Affiliation(s)
| | - Zoran Gajić
- 1University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; 2Department of Psychiatry, Clinical Centre of Vojvodina, Novi Sad, Serbia; 3Department of Neurosurgery, Clinical Centre of Vojvodina, Novi Sad, Serbia; 4Clinical Centre of Vojvodina, Novi Sad, Serbia; 5Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6University of Health Applied Sciencies, Zagreb, Croatia; 7University of Belgrade, Faculty of Medicine, Belgrade, Serbia; 8Division of Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Department of Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Olga Ivetić
- 1University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; 2Department of Psychiatry, Clinical Centre of Vojvodina, Novi Sad, Serbia; 3Department of Neurosurgery, Clinical Centre of Vojvodina, Novi Sad, Serbia; 4Clinical Centre of Vojvodina, Novi Sad, Serbia; 5Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6University of Health Applied Sciencies, Zagreb, Croatia; 7University of Belgrade, Faculty of Medicine, Belgrade, Serbia; 8Division of Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Department of Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Jovan Milatović
- 1University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; 2Department of Psychiatry, Clinical Centre of Vojvodina, Novi Sad, Serbia; 3Department of Neurosurgery, Clinical Centre of Vojvodina, Novi Sad, Serbia; 4Clinical Centre of Vojvodina, Novi Sad, Serbia; 5Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6University of Health Applied Sciencies, Zagreb, Croatia; 7University of Belgrade, Faculty of Medicine, Belgrade, Serbia; 8Division of Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Department of Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Petar Vuleković
- 1University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; 2Department of Psychiatry, Clinical Centre of Vojvodina, Novi Sad, Serbia; 3Department of Neurosurgery, Clinical Centre of Vojvodina, Novi Sad, Serbia; 4Clinical Centre of Vojvodina, Novi Sad, Serbia; 5Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6University of Health Applied Sciencies, Zagreb, Croatia; 7University of Belgrade, Faculty of Medicine, Belgrade, Serbia; 8Division of Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Department of Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Đula Đilvesi
- 1University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; 2Department of Psychiatry, Clinical Centre of Vojvodina, Novi Sad, Serbia; 3Department of Neurosurgery, Clinical Centre of Vojvodina, Novi Sad, Serbia; 4Clinical Centre of Vojvodina, Novi Sad, Serbia; 5Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6University of Health Applied Sciencies, Zagreb, Croatia; 7University of Belgrade, Faculty of Medicine, Belgrade, Serbia; 8Division of Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Department of Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Sonja Golubović
- 1University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; 2Department of Psychiatry, Clinical Centre of Vojvodina, Novi Sad, Serbia; 3Department of Neurosurgery, Clinical Centre of Vojvodina, Novi Sad, Serbia; 4Clinical Centre of Vojvodina, Novi Sad, Serbia; 5Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6University of Health Applied Sciencies, Zagreb, Croatia; 7University of Belgrade, Faculty of Medicine, Belgrade, Serbia; 8Division of Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Department of Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Filip Vrban
- 1University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; 2Department of Psychiatry, Clinical Centre of Vojvodina, Novi Sad, Serbia; 3Department of Neurosurgery, Clinical Centre of Vojvodina, Novi Sad, Serbia; 4Clinical Centre of Vojvodina, Novi Sad, Serbia; 5Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6University of Health Applied Sciencies, Zagreb, Croatia; 7University of Belgrade, Faculty of Medicine, Belgrade, Serbia; 8Division of Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Department of Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Ante Subašić
- 1University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; 2Department of Psychiatry, Clinical Centre of Vojvodina, Novi Sad, Serbia; 3Department of Neurosurgery, Clinical Centre of Vojvodina, Novi Sad, Serbia; 4Clinical Centre of Vojvodina, Novi Sad, Serbia; 5Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6University of Health Applied Sciencies, Zagreb, Croatia; 7University of Belgrade, Faculty of Medicine, Belgrade, Serbia; 8Division of Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Department of Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Lukas Rasulić
- 1University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; 2Department of Psychiatry, Clinical Centre of Vojvodina, Novi Sad, Serbia; 3Department of Neurosurgery, Clinical Centre of Vojvodina, Novi Sad, Serbia; 4Clinical Centre of Vojvodina, Novi Sad, Serbia; 5Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6University of Health Applied Sciencies, Zagreb, Croatia; 7University of Belgrade, Faculty of Medicine, Belgrade, Serbia; 8Division of Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Department of Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia
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Chong BTW, Wahab S, Muthukrishnan A, Tan KL, Ch'ng ML, Yoong MT. Prevalence and Factors Associated with Suicidal Ideation in Institutionalized Patients with Schizophrenia. Psychol Res Behav Manag 2020; 13:949-962. [PMID: 33204188 PMCID: PMC7667143 DOI: 10.2147/prbm.s266976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/21/2020] [Indexed: 01/08/2023] Open
Abstract
Purpose The shorter life expectancy and increased risk of suicide in patients with schizophrenia have been well documented. However, study outcomes on suicidality in this special population have been few to date. This study investigated the prevalence and factors associated with suicidal ideation in a population of institutionalized patients with schizophrenia. Methods Two hundred fifty-six patients with schizophrenia between the age of 18 and 65 years were randomly recruited. This cross-sectional study utilised the Calgary Depression Scale for Schizophrenia (CDSS), the Positive and Negative Syndrome Scale (PANSS) and the Psychotic Symptom Rating Scale (PSYRATS-AH). Univariate analysis was performed using an independent t-test or chi-square test, followed by binary logistic regression to determine the factors associated with increased suicidal risks. Results The socio-demographic factors associated with suicidal ideation included level of education (p=0.039); secondary-level education (OR=5.76, 95% CI:1.49, 22.34, p=0.011) and tertiary-level education (OR=9.30, 95% CI: 1.80, 48.12, p=0.008) posed a greater risk. A history of attempted suicide (OR=2.09, 95% CI: 1.01, 4.36, p=0.049) and the presence of co-morbid physical illnesses (OR=2.07, 95% CI: 1.02, 4.21, p=0.044) were also found to be associated with a suicidal ideation. Other significant factors associated with suicidal thoughts were concurrent depression (OR=9.68, 95% CI: 3.74, 25.05, p<0.001) and a higher PSYRATS score in emotional characteristics of auditory hallucinations (OR=1.13, 95% CI: 1.06, 1.21, p<0.001). Conclusion Suicide in schizophrenia appears to be more closely associated with certain socio-demographic factors and affective symptoms. Appropriate screening and treatment addressing these challenges must be emphasized if suicidal thoughts and actions are to be reduced.
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Affiliation(s)
- Benedict Tak Wai Chong
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Wilayah Persekutuan 56000, Malaysia
| | - Suzaily Wahab
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Wilayah Persekutuan 56000, Malaysia
| | - Arunakiri Muthukrishnan
- Department of Psychiatry, Hospital Bahagia Ulu Kinta, Tanjung Rambutan, Perak Darul Ridzwan 31250, Malaysia
| | - Kok Leong Tan
- Department of Community Medicine, School of Medicine, International Medical University (IMU), Kuala Lumpur, Wilayah Persekutuan 57000, Malaysia
| | - May Lee Ch'ng
- Department of Community Medicine, School of Medicine, International Medical University (IMU), Kuala Lumpur, Wilayah Persekutuan 57000, Malaysia
| | - Mei Theng Yoong
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Wilayah Persekutuan 56000, Malaysia
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Knorr R, Hoffmann K. [Suicidality in schizophrenic psychosis: a current overview]. DER NERVENARZT 2020; 92:1186-1195. [PMID: 33165624 DOI: 10.1007/s00115-020-01028-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/13/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Suicidality in schizophrenic psychosis is an important topic but stands in clinical everyday work behind the perception of suicide especially in affective disorders. Schizophrenic psychosis is recognized as an independent risk factor for suicide attempts and suicides, whereas it poses particular challenges to the clinical professional due to the frequent unpredictability, abruptness and brutality of the methods used. For this reason, the suicide of a psychotic patient often leaves the professional and non-professional environment disturbed. AIMS An overview of the existing relevant literature on suicide in psychosis is given. Explanations on the psychodynamics, indications on pharmacotherapy and psychotherapy and considerations on prevention round off this article and provide an up to date overview of this topic for clinicians. MATERIAL AND METHODS A search was carried out in PubMed and Google scholar using the terms "suicide", "suicidality", "schizophrenia", "suicide AND schizophrenia", "suicide AND psychosis", "suicidality AND schizophrenia", "suicidality AND psychosis", "suicidality AND psychosis AND prevention", "suicide AND psychosis AND prevention", "suicidality AND schizophrenia AND prevention", "suicide AND schizophrenia AND prevention". CONCLUSION Clinicians must have knowledge of the specific risk factors for suicide in psychotic patients, the characteristics of suicide in terms of design and temporal connection with treatment. The exploration and assessment of suicidality is often more difficult in psychotic patients than in affective or personality disorder patients, as there are often impulsive suicide attempts that can be explained by (suddenly occurring) psychotic symptoms and are therefore difficult or even impossible to foresee.
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Affiliation(s)
- Roman Knorr
- Klinik für Sozialpsychiatrie, ZfP Reichenau, Feursteinstr. 55, 78479, Reichenau, Deutschland.
| | - Klaus Hoffmann
- Klinik für Forensische Psychiatrie und Psychotherapie, ZfP Reichenau, Feursteinstr. 55, 78479, Reichenau, Deutschland
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Beck-Felts K, Goodman M, Ospina LH, Wall M, McEvoy J, Jarskog LF, Ballon JS, Bartels MN, Buchsbaum R, Sloan RP, Stroup TS, Kimhy D. Suicide Reduction in Schizophrenia via Exercise (SUnRISE): study protocol for a multi-site, single-blind, randomized clinical trial of aerobic exercise for suicide risk reduction in individuals with schizophrenia. Trials 2020; 21:871. [PMID: 33087170 PMCID: PMC7579916 DOI: 10.1186/s13063-020-04788-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 10/05/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Suicide risk among individuals with schizophrenia (SZ) is intractably high, with over 40% of individuals attempting to take their own lives during their lifetime and an estimated 5-10% completing suicide. At present, available pharmacological and psychotherapeutic treatments offer limited risk reduction benefits, and thus, there remains an urgent need to explore novel interventions that will ameliorate this risk. Aerobic exercise (AE) has been shown to improve a number of predictors of suicide risk (e.g., depressed mood, sleeping difficulties). As individuals with SZ display a highly sedentary lifestyle, AE may reduce suicide risk. METHODS Employing a multi-site, single-blind, randomized clinical trial design, we will examine the impact of AE on risk for suicide and related variables in individuals with SZ. Participants will be randomized to one of two 12-week exercise interventions: AE or a stretching and toning (ST) control intervention. Primary outcome measures will include suicide risk (Columbia Suicide Severity Rating Scale, C-SSRS) and aerobic fitness (VO2max), along with additional measures of suicide risk, mood, emotion regulation, sleep, cognition, and physical activity, with assessments completed at baseline and after 6 and 12 weeks of interventions. DISCUSSION It is hypothesized that AE will reduce suicide risk among individuals with SZ. This study may offer support for a more efficacious treatment method for this population in addition to the pre-existing pharmacological and psychotherapeutic treatment regimens. TRIAL REGISTRATION Clinicaltrials.gov, NCT03270098 . Registered on September 1, 2017.
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Affiliation(s)
- Katie Beck-Felts
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1230, New York, NY, 10029, USA
| | | | - Luz H Ospina
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1230, New York, NY, 10029, USA
| | - Melanie Wall
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Joseph McEvoy
- Department of Psychiatry and Health Behavior, Georgia Regents University, Augusta, GA, USA
| | - Lars F Jarskog
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Jacob S Ballon
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Matthew N Bartels
- Department of Rehabilitation Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | | | - Richard P Sloan
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - T Scott Stroup
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - David Kimhy
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1230, New York, NY, 10029, USA.
- MIRECC, James J. Peters VA Medical Center, Bronx, NY, USA.
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Edinoff A, Wu N, deBoisblanc C, Feltner CO, Norder M, Tzoneva V, Kaye AM, Cornett EM, Kaye AD, Viswanath O, Urits I. Lumateperone for the Treatment of Schizophrenia. PSYCHOPHARMACOLOGY BULLETIN 2020; 50:32-59. [PMID: 33012872 PMCID: PMC7511146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Introduction Schizophrenia is a severe psychotic disorder that is diagnosed by the presence of hallucinations or delusions along with disorganized speech, disorganized thought, or negative symptoms that are present for at least six months. Roughly 1 in 10,000 people a year are diagnosed with this psychiatric disorder. It is a chronic disorder requiring a lifetime of treatment of which antipsychotics have been the mainstay of this treatment. First-generation antipsychotics have dystonia, parkinsonism, and development of Tardive Dyskinesia as major side effects, and they are also nonspecific in terms of their actions. Second Generation antipsychotics target more specific dopamine and sometimes serotonin receptors with less dystonic side effects; however, there are additional concerns for the development of metabolic syndrome. This review aims to look at new medication on the market, lumateperone, for the treatment of Schizophrenia. Recent studies In one four week study with 60mg and 120mg of Lumateperone compared, 4mg of Risperdal, and a placebo found that Lumateperone significantly decreased the total Positive and Negative Syndrome Scale (PANSS) from baseline. Safety analysis of this study also found that Lumateperone was not associated with EPS or significant weight gain. Another study found that 42mg of Lumateperone significantly decreased PANSS score over placebo and 28mg of Lumateperone with associated TEAEs of somnolence, sedation, fatigue, and constipation. In an open-label safety, patients were switched from their current antipsychotic to Lumateperone and then switched back to their previous treatment after six weeks. PATIENTS were found to have statistically significant improvements in metabolic parameters, weight, and endocrine parameters, which were all lost when they were switched back to their previous treatment and their schizophrenic symptoms at pre-trial levels or improved them while on Lumateperone. In a continuation of the previous study over 12 months, 4 TEAEs occurred in 5% or more of the participants: diarrhea, dry mouth, weight decrease, and headache. Prolactin, metabolic labs, BMI, and weight all decreased as compared to the standard of care. Pooled studies revealed EPS related TEAEs were less frequent in patients receiving 42 mg lumateperone over Risperdal. Another pooled study looked at the safety profile; they found patients treated with lumateperone, two TEAEs occurred at twice the placebo rate and at a rate of 5% or more: dry mouth (5% vs. 2.2%) and sedation (24.1% vs. 10.0%) though TEAE discontinuation rates were lower than with Risperdal. Summary Taken together, data from these trials suggest that lumateperone can effectively treat positive symptoms, negative symptoms, and cognitive dysfunction in schizophrenia. Lumateperone entrance to the market introduces an innovative way to treat schizophrenia featuring both a novel mechanism of action and a markedly reduced side effect profile. Further research is needed to determine the efficacy of Lumateperone in treating bipolar disorder in addition to schizophrenia.
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Affiliation(s)
- Amber Edinoff
- Edinoff, Wu, Tzoneva, Louisiana State University Health Science Center Shreveport, Department of Psychiatry, and Behavioral Medicine. deBoisblanc, Feltner, Norder, Louisiana State University Shreveport School of Medicine. Kaye, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Cornett, Kaye, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
| | - Natalie Wu
- Edinoff, Wu, Tzoneva, Louisiana State University Health Science Center Shreveport, Department of Psychiatry, and Behavioral Medicine. deBoisblanc, Feltner, Norder, Louisiana State University Shreveport School of Medicine. Kaye, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Cornett, Kaye, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
| | - Charles deBoisblanc
- Edinoff, Wu, Tzoneva, Louisiana State University Health Science Center Shreveport, Department of Psychiatry, and Behavioral Medicine. deBoisblanc, Feltner, Norder, Louisiana State University Shreveport School of Medicine. Kaye, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Cornett, Kaye, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
| | - Catherine Olivia Feltner
- Edinoff, Wu, Tzoneva, Louisiana State University Health Science Center Shreveport, Department of Psychiatry, and Behavioral Medicine. deBoisblanc, Feltner, Norder, Louisiana State University Shreveport School of Medicine. Kaye, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Cornett, Kaye, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
| | - Mariah Norder
- Edinoff, Wu, Tzoneva, Louisiana State University Health Science Center Shreveport, Department of Psychiatry, and Behavioral Medicine. deBoisblanc, Feltner, Norder, Louisiana State University Shreveport School of Medicine. Kaye, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Cornett, Kaye, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
| | - Vesela Tzoneva
- Edinoff, Wu, Tzoneva, Louisiana State University Health Science Center Shreveport, Department of Psychiatry, and Behavioral Medicine. deBoisblanc, Feltner, Norder, Louisiana State University Shreveport School of Medicine. Kaye, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Cornett, Kaye, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
| | - Adam M Kaye
- Edinoff, Wu, Tzoneva, Louisiana State University Health Science Center Shreveport, Department of Psychiatry, and Behavioral Medicine. deBoisblanc, Feltner, Norder, Louisiana State University Shreveport School of Medicine. Kaye, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Cornett, Kaye, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
| | - Elyse M Cornett
- Edinoff, Wu, Tzoneva, Louisiana State University Health Science Center Shreveport, Department of Psychiatry, and Behavioral Medicine. deBoisblanc, Feltner, Norder, Louisiana State University Shreveport School of Medicine. Kaye, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Cornett, Kaye, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
| | - Alan D Kaye
- Edinoff, Wu, Tzoneva, Louisiana State University Health Science Center Shreveport, Department of Psychiatry, and Behavioral Medicine. deBoisblanc, Feltner, Norder, Louisiana State University Shreveport School of Medicine. Kaye, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Cornett, Kaye, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
| | - Omar Viswanath
- Edinoff, Wu, Tzoneva, Louisiana State University Health Science Center Shreveport, Department of Psychiatry, and Behavioral Medicine. deBoisblanc, Feltner, Norder, Louisiana State University Shreveport School of Medicine. Kaye, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Cornett, Kaye, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
| | - Ivan Urits
- Edinoff, Wu, Tzoneva, Louisiana State University Health Science Center Shreveport, Department of Psychiatry, and Behavioral Medicine. deBoisblanc, Feltner, Norder, Louisiana State University Shreveport School of Medicine. Kaye, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Cornett, Kaye, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
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Abstract
The lifetime risk of dying by suicide in schizophrenia and related psychoses has been estimated to be approximately between 5% and 7%, though some have estimated that the number is closer to 10%. The highest risk for suicide occurs within the first year after presentation, when patients have a 12 times greater risk of dying by suicide than the general population, or a 60% higher risk compared with patients in other phases of psychosis, although the risk continues for many years. Some 31% of all deaths in first and early episode samples are due to suicide. Studies in individuals at clinical high-risk for psychosis (CHR) or with attenuated positive symptoms also demonstrate that suicidality is common and problematic in these individuals. Therefore, suicide in psychosis is a particularly severe problem. In order to develop interventions aimed at reducing the risk of suicide in psychotic individuals, it will be critical to understand the neurobiology of suicide in psychosis. In this paper, I report on the results of a systematic review of the work done to date on the neurobiology of suicide in psychosis and on suicidality in the CHR period. I will also identify gaps in knowledge and discuss future strategies for studying the neurobiology of suicidality in psychosis that may help to disentangle the links between suicide and psychosis and, by doing so, allow us to gain a greater understanding of the relationship between suicide and psychosis, which is critical for developing interventions aimed at reducing the risk of suicide in psychotic individuals.
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Affiliation(s)
- Ragy R Girgis
- The New York State Psychiatric Institute/Columbia University Irving Medical Center, New York, NY, USA
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Hasan A, Falkai P, Lehmann I, Gaebel W. Schizophrenia. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 117:412-419. [PMID: 32865492 PMCID: PMC7477695 DOI: 10.3238/arztebl.2020.0412] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 05/03/2019] [Accepted: 03/04/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The lifetime prevalence of schizophrenia is 1%. Schizophrenia is among the most severe mental illnesses and gives rise to the highest treatment costs per patient of any disease. It is characterized by frequent relapses, marked impairment of quality of life, and reduced social and work participation. METHODS The group entrusted with the creation of the German clinical practice guideline was chosen to be representative and pluralistic in its composition. It carried out a systematic review of the relevant literature up to March 2018 and identified a total of 13 389 publications, five source guidelines, three other relevant German clinical practice guidelines, and four reference guidelines. RESULTS As the available antipsychotic drugs do not differ to any great extent in efficacy, it is recommended that acute antipsychotic drug therapy should be sideeffect- driven, with a number needed to treat (NNT) of 5 to 8. The choice of treatment should take motor, metabolic, sexual, cardiac, and hematopoietic considerations into account. Ongoing antipsychotic treatment is recommended to prevent relapses (NNT: 3) and should be re-evaluated on a regular basis in every case. It is also recommended, with recommendation grades ranging from strong to intermediate, that disorder- and manifestation-driven forms of psychotherapy and psychosocial therapy, such as cognitive behavioral therapy for positive or negative manifestations (effect sizes ranging from d = 0.372 to d = 0.437) or psycho-education to prevent relapses (NNT: 9), should be used in combination with antipsychotic drug treatment. Further aspects include rehabilitation, the management of special treatment situations, care coordination, and quality management. A large body of evidence is available to provide a basis for guideline recommendations, particularly in the areas of pharmacotherapy and cognitive behavioral therapy. CONCLUSION The evidence-based diagnosis and treatment of persons with schizophrenia should be carried out in a multiprofessional process, with close involvement of the affected persons and the people closest to them.
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Affiliation(s)
- Alkomiet Hasan
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Faculty of Medicine, University of Augsburg, District Hospital Augsburg, Augsburg
- Department of Psychiatry and Psychotherapy, LMU Medical Center, Munich
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, LMU Medical Center, Munich
| | | | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, LVR Hospital Düsseldorf, Faculty of Medicine, University of Düsseldorf
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Loebel A, Cucchiaro J, Silva R, Mao Y, Xu J, Pikalov A, Marder S. Efficacy of lurasidone across five symptom dimensions of schizophrenia: Pooled analysis of short-term, placebo-controlled studies. Eur Psychiatry 2020; 30:26-31. [DOI: 10.1016/j.eurpsy.2014.08.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 07/31/2014] [Accepted: 08/04/2014] [Indexed: 10/24/2022] Open
Abstract
AbstractObjective:To evaluate the efficacy of lurasidone for schizophrenia using an established five-factor model of the Positive and Negative Syndrome Scale (PANSS).Methods:Patient-level data were pooled from five randomized, double-blind, placebo-controlled, 6-week studies of lurasidone (fixed doses, 40–160 mg/d) for patients with an acute exacerbation of schizophrenia. Changes in five established PANSS factors were assessed using mixed-model repeated measures analysis.Results:Compared with placebo (n = 496), lurasidone (n = 1029, dose groups pooled) significantly improved the PANSS total score at Week 6 (−22.6 vs. −12.8; P < 0.001; effect size, 0.45), as well as all factor scores (P < 0.001 for each): positive symptoms (−8.4 vs. −6.0; effect size, 0.43), negative symptoms (−5.2 vs. −3.3; effect size, 0.33), disorganized thought (−4.9 vs. −2.8; effect size, 0.42), hostility/excitement (−2.7 vs. −1.6; effect size, 0.31), and depression/anxiety (−3.2 vs. −2.3; effect size, 0.31). Separation from placebo occurred at Week 1 for the positive symptoms, disorganized thought, and hostility/excitement factors and at Week 2 for the other factors.Conclusions:In this pooled analysis of short-term studies in patients with acute schizophrenia, lurasidone demonstrated significant improvement for each of the five PANSS factor scores, indicating effectiveness across the spectrum of schizophrenia symptoms.
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Mosolov SN, Malyutin AV, Pikalov AA. [Effect of Lurasidone on symptoms of schizophrenia in five-factor dimensional model: pooled analysis of two short-term, randomized, double-blind, placebo-controlled studies in patients from Russia and Ukraine]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 119:29-37. [PMID: 31994511 DOI: 10.17116/jnevro201911912129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM Evaluation of a new five-factor dimensional model of schizophrenia in recent revisions of classifications of mental disorders (DSM-5 and ICD-11) dictates the need to use this approach in conducting a comprehensive assessment of the effectiveness of new antipsychotic agents, including ethnically homogeneous populations of patients. MATERIAL AND METHODS Post-hoc analysis of pooled data from two randomized, double-blind, placebo-controlled, 6-week clinical studies (RCTs) of lurasidone (fixed doses, 40, 80, 120 or 160 mg/d) in patients experiencing an acute exacerbation of schizophrenia. Changes in PANSS total score, CGI-S score and five established PANSS factors were assessed using mixed-model repeated measures analysis. RESULTS Lurasidone (n=162, dose groups pooled) compared with placebo (n=68), significantly improved the PANSS total score at Week 6 (-23.0 vs. -10.5; p<0.001; effect size 0.82) as well as all PANSS factor scores: positive symptoms (-8.5 vs. -4.2; p<0.001; effect size 0.88), negative symptoms (-4.4 vs. -2.8; p=0.011, effect size 0.44), disorganized thoughts (-4.4 vs. -2.1; p<0.001; effect size 0.70), hostility/excitement (-2.7 vs. -0.7; p<0.001; effect size 0.66), and depression/anxiety (-3.5 vs. -2.2; p=0.002; effect size 0.53). CONCLUSION Lurasidone demonstrated significant improvement for both PANSS total score and each of the five PANSS factor scores, indicating effectiveness across the broad spectrum of schizophrenia symptoms. Effect size for both PANSS total score and each of the five PANSS factor scores for the local population was higher than for the wider population, which included patients from various countries.
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Affiliation(s)
- S N Mosolov
- Moscow Research Institute of Psychiatry, the Branch of National Medical Research Center for Psychiatry and Addictology named after V.P. Serbsky of the Ministry of Health of Russia, Moscow, Russia
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Ceskova E. Pharmacological strategies for the management of comorbid depression and schizophrenia. Expert Opin Pharmacother 2020; 21:459-465. [DOI: 10.1080/14656566.2020.1717466] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Eva Ceskova
- Central European Institute of Technology (CEITEC), Masaryk University, Brno, Czech Republic
- Department of Psychiatry, University Hospital Brno, Brno, Czech Republic
- Department of Psychiatry, University Hospital Ostrava, Ostrava, Czech Republic
- Department of Neurology and Psychiatry, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
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Grigoriou M, Upthegrove R, Bortolotti L. Instrumental rationality and suicide in schizophrenia: a case for rational suicide? JOURNAL OF MEDICAL ETHICS 2019; 45:802-805. [PMID: 31395694 DOI: 10.1136/medethics-2019-105454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 07/17/2019] [Accepted: 07/18/2019] [Indexed: 06/10/2023]
Abstract
It is estimated that up to 7500 people develop schizophrenia each year in the UK. Schizophrenia has significant consequences, with 28% of the excess mortality in schizophrenia being attributed to suicide. Previous research suggests that suicide in schizophrenia may be more related to affective factors such as depression and hopelessness, rather than psychotic symptoms themselves. Considering suicide in schizophrenia within this framework enables us to develop a novel philosophical approach, in which suicide may not be related to loss of self-consciousness, thought processing dysfunctions or perception disturbances. The action of suicide may be due neither to persistent hallucinations nor other psychotic symptoms, such as delusional beliefs, but to other underexamined, perhaps rational reasons, such as extreme social isolation, severe depression or emotional withdrawal. This paper does not examine the moral character of suicide. Instead, it argues that we should conceive the action of suicide in schizophrenia as an act that is not necessarily irrational. People with schizophrenia might end their life based on reasons if suicide is the best means to achieve their ends. However, the paper does not support assisted suicide. It aims to provide a better understanding of the reasons why people take their own lives and suggests that understanding can inform effective interventions to reduce high rates of suicide.
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Affiliation(s)
- Markella Grigoriou
- Psychiatry Department, Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - Rachel Upthegrove
- Psychiatry Department, Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - Lisa Bortolotti
- Psychiatry Department, Institute for Mental Health, University of Birmingham, Birmingham, UK
- Philosophy Department, University of Birmingham, Birmingham, UK
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Abstract
BACKGROUND Psychotic disorders, as well as psychotic symptoms, are associated with a greater lifetime risk of suicidal behavior (SB). It is not known, however, whether psychotic symptoms are independent predictors for short-term SB. METHODS Data were collected from 201 psychiatric inpatients at Mount Sinai Beth Israel Hospital. Self-reported psychotic symptoms were assessed using the Brief Symptom Inventory (BSI). Postdischarge SB defined as an aborted, interrupted, or actual suicide attempt was assessed using the Columbia-Suicide Severity Rating Scale (C-SSRS), during the 4 to 8 weeks following discharge from an inpatient psychiatric unit (n=127, 63% retention). Logistic regressions were performed to assess the relationships between psychotic symptoms and SB, controlling for primary psychiatric disorders. RESULTS Self-reported psychotic symptoms were associated with subsequent postdischarge SB. There was no significant difference between the SB versus no SB groups on the basis of primary psychiatric disorder. Self-reported psychotic symptoms remained an independent and significant predictor of postdischarge SB when the analysis controlled for primary psychiatric disorder. CONCLUSIONS These results suggest that psychotic symptoms are a dimensional predictor of near-term postdischarge SB and are a necessary component of suicide risk assessment during inpatient hospitalization, independent of psychiatric diagnosis.
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Suicide in Schizophrenia: An Educational Overview. ACTA ACUST UNITED AC 2019; 55:medicina55070361. [PMID: 31295938 PMCID: PMC6681260 DOI: 10.3390/medicina55070361] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 06/30/2019] [Accepted: 07/07/2019] [Indexed: 12/15/2022]
Abstract
Suicide is an important public health problem. The most frequent psychiatric illnesses associated with suicide or severe suicide attempt are mood and psychotic disorders. The purpose of this paper is to provide an educational overview of suicidal behavior in individuals with schizophrenia. A lifetime suicide rate in individuals with schizophrenia is approximately 10%. Suicide is the largest contributor to the decreased life expectancy in individuals with schizophrenia. Demographic and psychosocial factors that increase a risk of suicide in individuals with schizophrenia include younger age, being male, being unmarried, living alone, being unemployed, being intelligent, being well-educated, good premorbid adjustment or functioning, having high personal expectations and hopes, having an understanding that life’s expectations and hopes are not likely to be met, having had recent (i.e., within past 3 months) life events, having poor work functioning, and having access to lethal means, such as firearms. Throughout the first decade of their disorder, patients with schizophrenia are at substantially elevated suicide risk, although they continue to be at elevated suicide risk during their lives with times of worsening or improvement. Having awareness of symptoms, especially, awareness of delusions, anhedonia, asociality, and blunted affect, having a negative feeling about, or non-adherence with, treatment are associated with greater suicide risk in patients with schizophrenia. Comorbid depression and a history of suicidal behavior are important contributors to suicide risk in patients with schizophrenia. The only reliable protective factor for suicide in patients with schizophrenia is provision of and compliance with comprehensive treatment. Prevention of suicidal behavior in schizophrenia should include recognizing patients at risk, delivering the best possible therapy for psychotic symptoms, and managing comorbid depression and substance misuse.
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Bang M, Park JY, Kim KR, Lee SY, Song YY, Kang JI, Lee E, An SK. Suicidal ideation in individuals at ultra-high risk for psychosis and its association with suspiciousness independent of depression. Early Interv Psychiatry 2019; 13:539-545. [PMID: 29164799 DOI: 10.1111/eip.12517] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 08/22/2017] [Accepted: 09/30/2017] [Indexed: 12/28/2022]
Abstract
AIM Psychotic experiences, including delusions and hallucinations, and their attenuated forms have been recently suggested as a significant but under-recognized marker of suicide risk. However, the relationship between attenuated positive symptoms and suicide has not yet been clearly demonstrated in individuals at ultra-high risk (UHR) for psychosis. Here, we investigated the effect of attenuated positive symptoms on suicidal ideation in UHR individuals. METHODS Fifty-three healthy controls (HCs) and 74 UHR individuals participated in the present study. All participants were assessed for the intensity of suicidal ideation and depressive symptoms at baseline. The effect of attenuated positive symptoms on suicidal ideation in the UHR group was examined using a multiple linear regression analysis after adjustment for concurrent depressive symptoms. RESULTS UHR participants were found to have significantly greater suicidal ideation and more severe depressive symptoms compared to those of HCs. The regression model demonstrated that suspiciousness significantly increased suicidal ideation in UHR participants, independent of the severity of depressive symptoms. CONCLUSION The findings of the present study suggest that suspiciousness may serve as a risk indicator for suicide in clinical practice for UHR individuals. It is crucial to focus on the risk of suicide in the UHR population, as they require sufficient clinical attention and proper management for crises related to their unusual and confusing experiences.
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Affiliation(s)
- Minji Bang
- Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea.,Section of Self, Affect, and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Young Park
- Section of Self, Affect, and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Psychiatry, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea
| | - Kyung Ran Kim
- Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea.,Section of Self, Affect, and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Su Young Lee
- Section of Self, Affect, and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Psychiatry, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Republic of Korea
| | - Yun Young Song
- Section of Self, Affect, and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jee In Kang
- Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea.,Section of Self, Affect, and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Lee
- Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea.,Section of Self, Affect, and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Suk Kyoon An
- Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea.,Section of Self, Affect, and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.,Graduate Program in Cognitive Science, Yonsei University, Seoul, Republic of Korea
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Kim J, Ozzoude M, Nakajima S, Shah P, Caravaggio F, Iwata Y, De Luca V, Graff-Guerrero A, Gerretsen P. Insight and medication adherence in schizophrenia: An analysis of the CATIE trial. Neuropharmacology 2019; 168:107634. [PMID: 31077729 DOI: 10.1016/j.neuropharm.2019.05.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/30/2019] [Accepted: 05/07/2019] [Indexed: 01/11/2023]
Abstract
Adherence to antipsychotic medication is critical for the treatment of patients with schizophrenia. Impaired insight into illness is one of the principal drivers of medication nonadherence, which contributes to negative clinical outcomes. The aims of this study were to examine the relationships between impaired insight and (1) rates of antipsychotic medication nonadherence, and (2) time to medication nonadherence using data from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study. Insight was assessed using the Positive and Negative Syndrome Scale (PANSS) item G12 (lack of judgment and insight). Patients were divided into 3 groups based on their degree of insight impairment, i.e. no impairment (PANSS G12 = 1), minimal impairment (PANSS G12 = 2-3), and moderate-to-severe insight impairment (PANSS G12 ≥ 4). Medication nonadherence was defined as taking less than 80% of monthly pill counts. Kaplan-Meier survival and Cox regression analyses were performed to examine differences in time to medication nonadherence between insight groups. There were significant differences between insight groups in the percentage of nonadherent patients at 6 months (χ2(2) = 8.80, p = 0.012) and 18 months (χ2(2) = 10.04, p = 0.007) after study initiation. Moderate-to-severe insight impairment was associated with earlier nonadherence compared to minimal (χ2 = 4.70, p = 0.030) or no impairment (χ2 = 11.92, p = 0.001). The association remained significant after adjustment for illness severity, substance use, attitudes toward medication, cognition, level of hostility, and depression. The results of this study indicate a strong link between impaired insight and antipsychotic medication nonadherence. Interventions to enhance insight early during treatment may help improve medication adherence, and in turn, long-term clinical and functional outcomes in patients with schizophrenia. This article is part of the issue entitled 'Special Issue on Antipsychotics'.
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Affiliation(s)
- Julia Kim
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Miracle Ozzoude
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Shinichiro Nakajima
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Department of Neuropsychiatry, Keio University, Tokyo, Japan
| | - Parita Shah
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Fernando Caravaggio
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Yusuke Iwata
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Vincenzo De Luca
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Geriatric Mental Health Division, CAMH, University of Toronto, Toronto, Ontario, Canada; Schizophrenia Division, CAMH, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, CAMH, Toronto, Ontario, Canada
| | - Ariel Graff-Guerrero
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Geriatric Mental Health Division, CAMH, University of Toronto, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, CAMH, Toronto, Ontario, Canada
| | - Philip Gerretsen
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Geriatric Mental Health Division, CAMH, University of Toronto, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, CAMH, Toronto, Ontario, Canada.
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44
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Sher L, Kahn RS. Family interventions and prevention of suicide in first-episode schizophrenia. Acta Psychiatr Scand 2019; 139:484. [PMID: 30839096 DOI: 10.1111/acps.13018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Suicide is one of the leading causes of premature death among individuals with schizophrenia and psychotic spectrum disorders (1). Suicide and suicide attempts occur at a significantly greater rate in schizophrenia than in the general population. Common estimates are that 10% of people with schizophrenia will eventually have a completed suicide, and that attempts are made at two to five times that rate. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- L Sher
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA.,Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - R S Kahn
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA.,Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Xu J, Jiao Y, Xing M, Lin Y, Su Y, Ding W, Zhu C, Peng Y, Qi D, Cui D. Increased plasma leptin as a novel predictor for psychopathological depressive symptoms in chronic schizophrenia. Gen Psychiatr 2018; 31:e100018. [PMID: 30815631 PMCID: PMC6371651 DOI: 10.1136/gpsych-2018-100018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 11/16/2018] [Accepted: 11/18/2018] [Indexed: 12/14/2022] Open
Abstract
Background Depressive symptoms are often seen in schizophrenia. The overlap in presentation makes it difficult to distinguish depressive symptoms from the negative symptoms of schizophrenia. The adipokine leptin was found to be altered in both depression and schizophrenia. There are few studies focusing on the prediction of leptin in diagnosis and evaluation of depressive symptoms in schizophrenia. ObjectiveAims To assess the plasma leptin level in patients with schizophrenia and its relationships with depressive symptoms. Methods Cross-sectional studies were applied to (1) compare the levels of plasma leptin between schizophrenia (n=74) and healthy controls (n=50); and (2) investigate the relationship between plasma leptin levels and depressive subscores. Results (1) Plasma leptin levels were significantly higher in patients with schizophrenia than in healthy controls. (2) Correlation analysis revealed a significant negative association between leptin levels and the depressed factor scores on the Positive and Negative Syndrome Scale (PANSS). (3) Stepwise multiple regression analyses identified leptin as an influencing factor for depressed factor score on PANSS. Conclusion Leptin may serve as a predictor for the depressive symptoms of chronic schizophrenia.
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Affiliation(s)
- Jinjie Xu
- Shanghai Mental Health Center, Shanghai Jiao Tong University, School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China.,Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Yumei Jiao
- Shanghai Mental Health Center, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Mengjuan Xing
- Shanghai Mental Health Center, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Yezhe Lin
- Shanghai Mental Health Center, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Yousong Su
- Shanghai Mental Health Center, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Wenhua Ding
- Shanghai Mental Health Center, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Cuizhen Zhu
- Shanghai Mental Health Center, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Yanmin Peng
- Shanghai Mental Health Center, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Dake Qi
- Shanghai Mental Health Center, Shanghai Jiao Tong University, School of Medicine, Shanghai, China.,Division of Biomedical Sciences, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Donghong Cui
- Shanghai Mental Health Center, Shanghai Jiao Tong University, School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China.,Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China
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SanSegundo MS, Ferrer-Cascales R, Bellido JH, Bravo MP, Oltra-Cucarella J, Kennedy HG. Prediction of Violence, Suicide Behaviors and Suicide Ideation in a Sample of Institutionalized Offenders With Schizophrenia and Other Psychosis. Front Psychol 2018; 9:1385. [PMID: 30131743 PMCID: PMC6091276 DOI: 10.3389/fpsyg.2018.01385] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 07/17/2018] [Indexed: 11/13/2022] Open
Abstract
This study examined the predictive validity of the Spanish version of the Suicide Risk Assessment Manual (S-RAMM) and the Historical-Clinical-Risk Management-20 (HCR-20) in a sample of violent offenders with schizophrenia and other psychosis, who had committed violent crimes and had been sentenced to compulsory psychiatric treatment by the criminal justice system. Patients were prospectively monitored within the institution for 18 months. During the follow-up period, 25% of offenders were involved in any suicidal behavior including acts of self-harm, suicidal ideation and suicide attempts and 34% were physically or verbally violent. The S-RAMM and HCR-20 risk assessment tools were strongly correlated and were able to predict suicidal behavior and violence with a moderate-large effect size (AUCs = 0.81-0.85; AUCs = 0.78-0.80 respectively). Patients scoring above the mean on the S-RAMM (>20-point cut-off) had a five times increased risk of suicide related events (OR = 5.05, 95% CI = 2.6-9.7) and sevenfold risk of violence in the HCR-20 (>21-point cut-off) (OR = 7.13, 95% CI = 2.0-21.2) than those scoring below the mean. Offenders at high risk for suicide and violence had significantly more suicide attempts (p < 0.001) and more prior sentences for violent crimes (p < 0.001). These results support the use of the S-RAMM and HCR-20 for clinical practice by providing evidence of the utility of these measures for predicting risk for suicidal and violent behavior in mentally disordered offenders.
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Affiliation(s)
| | | | - Jesús H. Bellido
- Department of Psychology, Alicante Forensic Psychiatric Hospital, Alicante, Spain
| | - Mar P. Bravo
- Department of Psychiatry, Institute of Legal Medicine, Alicante, Spain
| | | | - Harry G. Kennedy
- Department of Psychiatry, Trinity College, University of Dublin, Dundrum, Ireland
- Central Mental Hospital, Dublin, Ireland
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Abstract
After the identification of the influence of serotonergic receptors in ameliorating the negative symptoms associated with schizophrenia, atypical antipsychotics were developed by incorporating dopamine and serotonin antagonism. Risperidone, sold under the trade name Risperdal, was the second atypical antipsychotic developed following clozapine but quickly became a first-line treatment for acute and chronic schizophrenia because of its preferential side effect profile. Despite initial Food and Drug Administration approval 25 years ago, risperidone continues to be a fundamental treatment for schizophrenia, bipolar I disorder, and autism-related irritability. It is on the World Health Organization's List of Essential Medicines for its balance of efficacy, safety, tolerability, and cost-effectiveness. In this review, we highlight the history and importance of risperidone as an atypical antipsychotic, in addition to its chemical synthesis, manufacturing, drug metabolism and pharmacokinetics, pharmacology, structure-activity relationship, indications, and adverse effects.
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Affiliation(s)
- Trevor C. Chopko
- Vanderbilt Center for Neuroscience Drug Discovery, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, United States
| | - Craig W. Lindsley
- Vanderbilt Center for Neuroscience Drug Discovery, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, United States
- Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, United States
- Department of Chemistry, Vanderbilt Institute of Chemical Biology, Vanderbilt University, Nashville, Tennessee 37232, United States
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Lamster F, Kiener J, Wagner K, Rief W, Görge SC, Iwaniuk S, Leube D, Falkenberg I, Kluge I, Kircher T, Mehl S. Ist Wahn indirekt veränderbar? Ein stimmungsverbesserndes Konzept der kognitive Verhaltenstherapie für die stationäre Standardversorgung von Patienten mit schizophrenen Störungen. VERHALTENSTHERAPIE 2018. [DOI: 10.1159/000486966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Kim EJ, Kim YK. 196G/A of the Brain-Derived Neurotrophic Factor Gene Polymorphisms Predicts Suicidal Behavior in Schizophrenia Patients. Psychiatry Investig 2018; 15:733-738. [PMID: 29898578 PMCID: PMC6056694 DOI: 10.30773/pi.2018.02.27] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 02/27/2018] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Brain-derived neurotrophic factor (BDNF) has possible neurobiologic impact on etiology of schizophrenia. We hypothesized that the specific allele or the genotype such as two single nucleotide polymorphisms (SNPs) , 196G/A (rs6265), 11757G/C(rs16917204) is associated with schizophrenia or its clinical features. METHODS 241 normal controls and 157 schizophrenia patients are included. The differences in allele or genotype distribution for the patients and normal controls were analyzed. We also analyzed clinical variables among patients. RESULTS We found no significant difference in genotype or allele distributions of two studied SNPs between the patient group and the control group. However, history of suicide attempt was relatively higher in patients with genotype with A allele, compared to patients with genotype G/G for 196G/A (p-value=0.045). CONCLUSION Our results suggest that it is possible to use BDNF gene allele and genotype as a predictor for suicide attempt in schizophrenia patients. It can help manage the schizophrenia patients regarding suicidal behavior and furthermore, mortality.
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Affiliation(s)
- Eun-Jeong Kim
- Department of Psychiatry, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Yong-Ku Kim
- Department of Psychiatry, Korea University Ansan Hospital, Ansan, Republic of Korea
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50
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Cassidy RM, Yang F, Kapczinski F, Passos IC. Risk Factors for Suicidality in Patients With Schizophrenia: A Systematic Review, Meta-analysis, and Meta-regression of 96 Studies. Schizophr Bull 2018; 44:787-797. [PMID: 29036388 PMCID: PMC6007264 DOI: 10.1093/schbul/sbx131] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The lifetime risk of suicide and suicide attempt in patients with schizophrenia are 5% and 25%-50%, respectively. The current meta-analysis aims to determine risk factors associated with suicidality in subjects with schizophrenia. We searched Pubmed, Web of Science, EMBASE, and the reference lists of included studies. Inclusion criteria were met if an article reported a dichotomous sample of patients with schizophrenia with suicidal ideation, attempted suicide, or suicide compared to patients without. We also performed a cohort study meta-analysis as a supplemental analysis. A total of 96 studies with 80488 participants were included in our analysis. Depressive symptoms (P < .0001), Positive and Negative Symptom Scale (PANSS) general score (P < .0001) and number of psychiatric hospitalizations (P < .0001) were higher in patients with suicide ideation. History of alcohol use (P = .0001), family history of psychiatric illness (P < .0001), physical comorbidity (P < .0001), history of depression (P < .0001), family history of suicide (P < .0001), history of drug use (P = .0024), history of tobacco use (P = .0034), being white (P = .0022), and depressive symptoms (P < .0001) were the most consistent variables associated with suicide attempts. The first two were also significant in the cohort meta-analysis. Being male (P = .0005), history of attempted suicide (P < .0001), younger age (P = .0266), higher intelligence quotient (P < .0001), poor adherence to treatment (P < .0001), and hopelessness (P < .0001) were the most consistently associated with suicide. The first three were also significant in the cohort meta-analysis. Our findings may help with future development of preventive strategies to combat suicide. Future studies may combine the above-mentioned variables by using multivariate predictive analysis techniques to objectively stratify suicidality in schizophrenia.
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Affiliation(s)
- Ryan Michael Cassidy
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX
| | - Fang Yang
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX
| | - Flávio Kapczinski
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Ives Cavalcante Passos
- Bipolar Disorder Program and Laboratory of Molecular Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- Graduation Program in Psychiatry and Department of Psychiatry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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