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Yan Y, Zhou D, Chen J. Navigating Nutritional Inequality in Schizophrenia: A Comprehensive Exploration of Diet, Genetics, and Holistic Management Across the Life Cycle. Nutrients 2024; 16:3738. [PMID: 39519571 PMCID: PMC11547656 DOI: 10.3390/nu16213738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Revised: 10/27/2024] [Accepted: 10/31/2024] [Indexed: 11/16/2024] Open
Abstract
This review explores the understudied topic of nutritional inequality among individuals with schizophrenia, highlighting the complex interplay between diet, genetics, and mental health. Unhealthy dietary patterns, socioeconomic factors, and disordered eating behaviors contribute to malnutrition, increasing the risk of physical health issues and premature mortality. Socioeconomic factors exacerbate nutritional disparities, necessitating targeted interventions. Genetic influences on nutrient metabolism remain under-researched, although nutritional genomics shows potential for personalized interventions. Current research reveals methodological gaps, urging larger sample sizes and standardized approaches. The integration of nutrigenomics, encompassing various omics disciplines, emerges as a transformative tool. The holistic life-cycle approach to schizophrenia management underscores the vital role of nutrition, calling for personalized interventions to enhance mental health outcomes.
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Affiliation(s)
- Yiming Yan
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China;
- Shanghai Clinical Research Center for Mental Health, Shanghai Key Laboratory of Psychotic Disorders, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Disheng Zhou
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China;
| | - Jianhua Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China;
- Shanghai Clinical Research Center for Mental Health, Shanghai Key Laboratory of Psychotic Disorders, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
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2
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Seo S, Healey BE, McLin R, Sacks NC, Benson CJ, Citrome L. Impact of Demographics and Insurance Coverage on Schizophrenia Treatment and Healthcare Resource Utilization Within an Integrated Healthcare System. Neuropsychiatr Dis Treat 2024; 20:1837-1848. [PMID: 39351585 PMCID: PMC11441306 DOI: 10.2147/ndt.s473492] [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: 04/12/2024] [Accepted: 09/13/2024] [Indexed: 10/04/2024] Open
Abstract
Purpose Little is known about the impact of health disparities on antipsychotic treatment and healthcare resource utilization (HRU) among patients with schizophrenia. The objective of this analysis is to examine treatment patterns and HRU by age, race/ethnicity, and insurance coverage among patients with schizophrenia in an integrated delivery network (IDN). Patients and Methods This cross-sectional study used electronic health record data from MedStar Health, an IDN in the Baltimore-Washington, DC, area. Patients were aged ≥18 years and had ≥2 outpatient encounters or ≥1 hospitalization with a diagnosis of schizophrenia between January 1, 2017 and March 31, 2021. Outcomes assessed included oral antipsychotic prescriptions, long-acting injectable antipsychotic (LAI) utilization, hospitalizations, emergency department (ED) visits, and outpatient visits. Analyses compared subgroups based on age, race/ethnicity (non-Hispanic Black, non-Hispanic White, and other), and type of insurance coverage at index (Medicare, Medicaid, and other) during 12 months of follow-up. Results A total of 78.1% of patients had ≥1 prescription for an antipsychotic and 69.1% received ≥1 second-generation antipsychotic. Second-generation long-acting injectables (SGA LAI) were utilized by 9.0% of patients, with the elderly and Medicaid beneficiaries having the lowest SGA LAI utilization. Overall, 61.7% of patients had ≥1 hospitalization, 56.4% had ≥1 outpatient visit, and 50.5% had ≥1 ED visit. Hospitalizations and ED visits were most common in those 18 to 24 years of age and in Medicaid beneficiaries, whereas outpatient visits were more common for the elderly and Medicare beneficiaries. Conclusion At the population level, the results indicate widespread underprescription/underutilization of antipsychotics that have been shown to improve clinical and economic outcomes in patients with schizophrenia, particularly SGA LAI. Within specific subpopulations, disparities in treatment selection and HRU were observed, suggesting the need for increased attention to at-risk groups to ensure consistent quality of care regardless of age, race/ethnicity, or insurance coverage.
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Affiliation(s)
- Sanghyuk Seo
- Medical Affairs Neuroscience, Janssen Scientific Affairs, LLC, a Johnson & Johnson company, Titusville, NJ, USA
| | | | | | | | - Carmela J Benson
- Medical Affairs Neuroscience, Janssen Scientific Affairs, LLC, a Johnson & Johnson company, Titusville, NJ, USA
| | - Leslie Citrome
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, NY, USA
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3
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Gillespie B, Dunn A, Sundram S, Hill RA. Investigating 7,8-Dihydroxyflavone to combat maternal immune activation effects on offspring gene expression and behaviour. Prog Neuropsychopharmacol Biol Psychiatry 2024; 134:111078. [PMID: 38950841 DOI: 10.1016/j.pnpbp.2024.111078] [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: 03/13/2024] [Revised: 06/25/2024] [Accepted: 06/26/2024] [Indexed: 07/03/2024]
Abstract
Infection during pregnancy is a substantial risk factor for the unborn child to develop autism or schizophrenia later in life, and is thought to be driven by maternal immune activation (MIA). MIA can be modelled by exposing pregnant mice to Polyinosinic: polycytidylic acid (Poly-I:C), a viral mimetic that induces an immune response and recapitulates in the offspring many neurochemical features of ASD and schizophrenia, including altered BDNF-TrkB signalling and disruptions to excitatory/inhibitory balance. Therefore, we hypothesised that a BDNF mimetic, 7,8-Dihydroxyflavone (7,8-DHF), administered prophylactically to the dam may prevent the neurobehavioural sequelae of disruptions induced by MIA. Dams were treated with 7,8-DHF in the drinking water (0.08 mg/ML) from gestational day (GD) 9-20 and were exposed to Poly-I:C at GD17 (20 mg/kg, i.p.). Foetal brains were collected 6 h post Poly-I:C exposure for RT-qPCR analysis of BDNF, cytokine, GABAergic and glutamatergic gene targets. A second adult cohort were tested in a battery of behavioural tests relevant to schizophrenia and the prefrontal cortex and ventral hippocampus dissected for RT-qPCR analysis. Foetal brains exposed to Poly-I:C showed increased IL-6, but reduced expression of Ntrk2 and multiple GABAergic and glutamatergic markers. Anxiety-like behaviour was observed in adult offspring prenatally exposed to poly-I:C, which was accompanied by altered expression of Gria2 in the prefrontal cortex and Gria4 in the ventral hippocampus. While 7-8 DHF normalised the expression of some glutamatergic (Grm5) and GABAergic (Gabra1) genes in Poly-I:C exposed offspring, it also led to substantial alterations in offspring not exposed to Poly-I:C. Furthermore, mice exposed to 7,8-DHF prenatally showed increased pre-pulse inhibition and reduced working memory in adulthood. These data advance understanding of how 7,8-DHF and MIA prenatal exposure impacts genes critical to excitatory/inhibitory pathways and related behaviour.
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Affiliation(s)
- Brendan Gillespie
- Department of Psychiatry, Monash University, Clayton, VIC 3168, Australia
| | - Ariel Dunn
- Department of Psychiatry, Monash University, Clayton, VIC 3168, Australia
| | - Suresh Sundram
- Department of Psychiatry, Monash University, Clayton, VIC 3168, Australia
| | - Rachel A Hill
- Department of Psychiatry, Monash University, Clayton, VIC 3168, Australia.
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Andersen SH, Richmond-Rakerd LS, Moffitt TE, Caspi A. The causal effect of mental health on labor market outcomes: The case of stress-related mental disorders following a human-made disaster. Proc Natl Acad Sci U S A 2024; 121:e2316423121. [PMID: 38923986 PMCID: PMC11228458 DOI: 10.1073/pnas.2316423121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 03/30/2024] [Indexed: 06/28/2024] Open
Abstract
As disasters increase due to climate change, population density, epidemics, and technology, information is needed about postdisaster consequences for people's mental health and how stress-related mental disorders affect multiple spheres of life, including labor-market attachment. We tested the causal hypothesis that individuals who developed stress-related mental disorders as a consequence of their disaster exposure experienced subsequent weak labor-market attachment and poor work-related outcomes. We leveraged a natural experiment in an instrumental variables model, studying a 2004 fireworks factory explosion disaster that precipitated the onset of stress-related disorders (posttraumatic stress disorder, anxiety, and depression) among individuals in the local community (N = 86,726). We measured labor-market outcomes using longitudinal population-level administrative data: sick leave, unemployment benefits, early retirement pension, and income from wages from 2007 to 2010. We found that individuals who developed a stress-related disorder after the disaster were likely to go on sickness benefit, both in the short- and long-term, were likely to use unemployment benefits and to lose wage income in the long term. Stress-related disorders did not increase the likelihood of early retirement. The natural experiment design minimized the possibility that omitted confounders biased these effects of mental health on work outcomes. Addressing the mental health and employment needs of survivors after a traumatic experience may improve their labor-market outcomes and their nations' economic outputs.
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Affiliation(s)
| | | | - Terrie E Moffitt
- Department of Psychology & Neuroscience, Duke University, Durham, NC 27708
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC 27708
- Institute of Psychiatry, Psychology, & Neuroscience, King's College London, London SE5 8AF, United Kingdom
- Promenta Center, Department of Psychology, University of Oslo, Oslo 0316, Norway
| | - Avshalom Caspi
- Department of Psychology & Neuroscience, Duke University, Durham, NC 27708
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC 27708
- Institute of Psychiatry, Psychology, & Neuroscience, King's College London, London SE5 8AF, United Kingdom
- Promenta Center, Department of Psychology, University of Oslo, Oslo 0316, Norway
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Burrer A, Egger ST, Spiller TR, Kirschner M, Homan P, Seifritz E, Vetter S. Examining the impact of substance use on hospital length of stay in schizophrenia spectrum disorder: a retrospective analysis. BMC Med 2024; 22:233. [PMID: 38853281 PMCID: PMC11163832 DOI: 10.1186/s12916-024-03447-3] [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: 09/01/2023] [Accepted: 05/28/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND Among patients diagnosed with schizophrenia, the presence of substance use poses an aggravating comorbidity, exerting a negative impact on the course of the disease, adherence to therapeutic regimens, treatment outcomes, duration of hospital stays, and the frequency of hospitalizations. The primary objective of the present study is to investigate the relationship between comorbid substance use disorders, antipsychotic treatment, and the length of stay in individuals hospitalized for treatment of schizophrenia. METHODS We conducted a retrospective analysis of electronic health records spanning a 12-month period, specifically focusing on adult patients diagnosed with schizophrenia who were discharged from the University Hospital of Psychiatry Zurich between January and December 2019. We documented the number and types of diagnosed substance use disorder, the antipsychotic treatment, the length of stay, and the number of previous hospitalizations for each patient. RESULTS Over a third (n = 328; 37.1%) of patients with schizophrenia had comorbid substance use with cannabis being the most frequent consumed substance. Patients with substance use (either single or multiple) were more frequently hospitalized; those with multiple substance use more frequently than those with a single substance use (F(2, 882) = 69.06; p < 0.001). There were no differences regarding the rate of compulsory admission. Patients with no substance use had a lower HoNOS score at discharge (F(2, 882) = 4.06). Patients with multiple substance use had a shorter length of stay (F(2, 882) = 9.22; p < 0.001), even after adjusting for duration of illness, previous hospitalizations, diagnosis, and antipsychotic treatment. CONCLUSIONS In patients with schizophrenia, comorbid single or multiple substance use has a relevant negative impact on treatment and thus on the course of disease. Substance use in patients with schizophrenia should therefore receive special attention in order to reduce re-hospitalization rates and improve the clinical outcome.
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Affiliation(s)
- Achim Burrer
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.
| | - Stephan T Egger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Tobias R Spiller
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Matthias Kirschner
- Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Philipp Homan
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich, Zurich, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Stefan Vetter
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
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Fadeeva A, Tomietto M, Tiwari A, Mann E, Serra G, Kiernan MD. Validation of a complex needs indicator for veterans in the UK using a composite indicators' method. PUBLIC HEALTH IN PRACTICE 2024; 7:100464. [PMID: 38283755 PMCID: PMC10821619 DOI: 10.1016/j.puhip.2024.100464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 12/18/2023] [Accepted: 12/21/2023] [Indexed: 01/30/2024] Open
Abstract
Objective To construct an indicator for assessing the complexity of UK veterans' needs. Study design Cross-sectional, secondary analysis. Methods The study applied principal component (PCA) analysis as the method to determine the weights of different needs based on their interactions with each other, the effectiveness of the model was evaluated using bootstrapping. The dataset on UK veterans' support provided by the "Soldiers, Sailors, Airmen and Families Associations" (SSAFA) (N = 35,208) was considered. The grant applications for different categories of support were used as indicators of different needs. The dimensions of breadth (number of different needs) and depth (number of grant applications to address the need) were incorporated in the assessment of complexity. Results The complex needs indicator for the current sample was validated. The majority of cases had a complexity score of 1 or less. Conclusions The research suggested and tested an assessment method for the complexity of veterans' needs, that may be positively associated with higher risk of adverse health outcomes. This indicator can be used by decision-makers for risk stratification of the veteran population, thus supporting the allocation of resources in a more effective way.
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Affiliation(s)
- Anastasia Fadeeva
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
- Violence and Society Centre, City, University of London, London, United Kingdom
| | - Marco Tomietto
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Ajay Tiwari
- Centrum Wiskunde & Informatica, Amsterdam, Netherlands
| | - Emily Mann
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Giuseppe Serra
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
- Department of Medicine (DIME), University of Udine, Udine, Italy
| | - Matthew D. Kiernan
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
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Sprong ME, Blankenberger B, Pierce SM, Hollender H. The COVID-19 pandemic’s influence on employment outcomes of veterans enrolled in VA healthcare vocational rehabilitation. JOURNAL OF VOCATIONAL REHABILITATION 2024; 60:379-388. [DOI: 10.3233/jvr-230065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2024]
Abstract
BACKGROUND: Employment has been shown to be the fourth most commonly reported need for veterans and their families, and unemployment rates have ranged from 1–69% dependent on the mental health diagnosis. Complications from the COVID-19 pandemic have had a significant impact on psychological functioning, and social isolation has led to increased psychiatric symptoms. Vocational rehabilitation is an intervention provided to Veterans in an attempt to remove barriers to employment while also increasing involvement in gainful work activity. OBJECTIVE: The purpose of the current study was to examine the impact that COVID-19 has had on employment rates at discharge for veterans with mental health disorders participating in a VHA vocational rehabilitation program. METHODS: An outcome-based, summative program evaluation design was used to assess the quality of Veterans served (2016-2021) at a vocational rehabilitation program served at a medical center located in VISN 12 of the U.S. Department of Veteran Affairs. RESULTS: Findings showed that veterans with Bipolar and Psychosis were less likely to discharge with employment (not considering COVID-19). CONCLUSION: No significant meaningful differences existed in employment rates when comparing pre/post March 2020 (official start of COVID-19 pandemic) for veterans with psychiatric diagnoses.
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Affiliation(s)
- Matthew E. Sprong
- School of Public Management and Policy, University of Illinois Springfield, Springfield, IL, USA
- Edward Hines Jr. VA Medical Center, U.S. Department of Veteran Affairs, Hines, IL, USA
| | - Bob Blankenberger
- School of Public Management and Policy, University of Illinois Springfield, Springfield, IL, USA
| | - Sami M. Pierce
- School of Public Management and Policy, University of Illinois Springfield, Springfield, IL, USA
| | - Heaven Hollender
- School of Health and Human Sciences, Indiana University, Indianapolis, IN, USA
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8
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O'Reardon AB, Litenski MN, Hernandez M, Niyazov Y, Acosta J, Cruz J. Markedly Delayed Presentation of a Psychotic Disorder 10 Years After the First Onset of Symptoms. Cureus 2024; 16:e57191. [PMID: 38681378 PMCID: PMC11056097 DOI: 10.7759/cureus.57191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/28/2024] [Indexed: 05/01/2024] Open
Abstract
Schizophrenia affects 1% of the population, causing chronic debilitating symptoms with largely unknown causes. Structural brain changes and neurochemical alterations are believed to contribute to its etiology. Delayed treatment initiation is a major concern. This case involves a male patient with a decade-long history of psychosis, experiencing isolation, agoraphobia, and paranoid delusions. His situation deteriorated to the point where he lived in a self-imposed physically constraining environment for a year, leading to muscle atrophy and deteriorating health. Delayed help-seeking was driven by insurance concerns, despite prior academic success. Following extensive evaluation, he received the diagnosis of schizophrenia (first episode, severe), requiring multidisciplinary treatment, including medication adjustments and therapy. This case serves as a poignant illustration of a missed opportunity for early intervention, with treatment initiated only after symptoms became severe. Research indicates that early intervention in schizophrenia is crucial, typically leading to improved outcomes, emphasizing its critical importance.
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Affiliation(s)
- Aoife B O'Reardon
- Department of Psychiatry and Behavioral Health, Herbert Wertheim College of Medicine, Miami, USA
| | - Melissa N Litenski
- Department of Psychiatry and Behavioral Health, Herbert Wertheim College of Medicine, Miami, USA
| | | | - Yakov Niyazov
- Psychiatry, Mount Sinai Medical Center, Miami Beach, USA
| | - Jadiyer Acosta
- Psychiatry, Mount Sinai Medical Center, Miami Beach, USA
| | - Jose Cruz
- Psychiatry, Mount Sinai Medical Center, Miami Beach, USA
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Le TP, Green MF, Wynn JK, Iglesias JE, Franco RL, Kopelowicz A, Kern RS. Effort-based decision-making as a determinant of supported employment outcomes in psychotic disorders. Schizophr Res 2023; 262:149-155. [PMID: 37979418 PMCID: PMC10923523 DOI: 10.1016/j.schres.2023.11.003] [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: 06/28/2023] [Revised: 09/29/2023] [Accepted: 11/04/2023] [Indexed: 11/20/2023]
Abstract
Schizophrenia is associated with a heavy economic burden in the United States that is partly due to the high rates of chronic unemployment. Individual Placement and Support (IPS) is an evidenced-based type of supported employment that can improve job obtainment and work outcomes in psychotic disorders. Outcomes vary widely and a persistent challenge for IPS is low levels of engagement in the initial job search phase. Past studies have focused on interview-based motivation deficits as a key determinant of poor treatment engagement and work outcomes in schizophrenia. New validated performance-based measures of motivation, including effort-based decision-making (EBDM) tasks, may explain supported employment outcomes and provide insights into individual differences in IPS outcomes. This study investigated the degree to which IPS engagement (i.e., number of sessions attended during the first four months of service delivery) was related to baseline interview-based motivation deficits and performance on three EBDM tasks - two tasks of physical effort and one of cognitive effort (i.e., Balloon Task, Effort Expenditure for Rewards Task, Deck Choice Effort Task) - in a sample (N = 47) of people with a psychotic disorder. Results indicated that the level of EBDM performance, specifically on the Balloon Task, predicted IPS engagement, accounting for an additional 17 % of the variance above and beyond interview-based motivation deficits (total R2 = 24 %). Overall, these findings suggest that addressing motivational deficits in effort-based decision-making may be beneficial to IPS engagement, which in turn may improve the trajectory of work outcomes.
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Affiliation(s)
- Thanh P Le
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States of America; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America; Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States of America.
| | - Michael F Green
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America; Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States of America
| | - Jonathan K Wynn
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America; Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States of America
| | - Julio E Iglesias
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States of America
| | - Richard L Franco
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Alex Kopelowicz
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Robert S Kern
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America; Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States of America
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Murphy KA, Daumit GL. Establishing a Care Continuum for Cardiometabolic Conditions for Patients with Serious Mental Illness. Curr Cardiol Rep 2023; 25:193-202. [PMID: 36847991 PMCID: PMC10042919 DOI: 10.1007/s11886-023-01848-z] [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] [Accepted: 02/03/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE OF REVIEW Addressing cardiometabolic risk factors in persons with serious mental illness requires early screening and proactive medical management in both medical and mental health settings. RECENT FINDINGS Cardiovascular disease remains the leading cause of death for persons with serious mental illness (SMI), such as schizophrenia or bipolar disorder, much of which is driven by a high prevalence of metabolic syndrome, diabetes, and tobacco use. We summarize barriers and recent approaches to screening and treatment for metabolic cardiovascular risk factors within physical health and specialty mental health settings. Incorporating system-based and provider-level support within physical health and psychiatric clinical settings should contribute to improvement for screening, diagnosis, and treatment for cardiometabolic conditions for patients with SMI. Targeted education for clinicians and leveraging multi-disciplinary teams are important first steps to recognize and treat populations with SMI at risk of CVD.
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Affiliation(s)
- Karly A. Murphy
- Division of General Internal Medicine, University of California San Francisco School of Medicine, 1701 Divisidero Street, Suite 500, 94117 San Francisco, CA USA
| | - Gail L. Daumit
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD USA
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11
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Matsunaga M, Li Y, He Y, Kishi T, Tanihara S, Iwata N, Tabuchi T, Ota A. Physical, Psychiatric, and Social Comorbidities of Individuals with Schizophrenia Living in the Community in Japan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4336. [PMID: 36901345 PMCID: PMC10001945 DOI: 10.3390/ijerph20054336] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/25/2023] [Accepted: 02/27/2023] [Indexed: 06/18/2023]
Abstract
The physical, psychiatric, and social comorbidities interfere with the everyday activities of community-dwelling individuals with schizophrenia and increase the risk of their readmission. However, these comorbidities have not been investigated comprehensively in Japan. We conducted a self-reported internet survey in February 2022 to identify individuals aged 20-75 years with and without schizophrenia using a prevalence case-control study. The survey compared physical comorbidities such as being overweight, hypertension, and diabetes; psychiatric comorbidities such as depressive symptoms and sleep disturbances; social comorbidities such as employment status, household income, and social support between participants with and without schizophrenia. A total of 223 participants with schizophrenia and 1776 participants without schizophrenia were identified. Participants with schizophrenia were more likely to be overweight and had a higher prevalence of hypertension, diabetes, and dyslipidemia than participants without schizophrenia. Additionally, depressive symptoms, unemployment, and non-regular employment were more prevalent in participants with schizophrenia than those without schizophrenia. These results highlight the necessity of comprehensive support and interventions addressing physical, psychiatric, and social comorbidities in individuals with schizophrenia in the community. In conclusion, effective interventions for managing comorbidities in individuals with schizophrenia are necessary to enable them to continue to live in the community.
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Affiliation(s)
- Masaaki Matsunaga
- Department of Public Health, Fujita Health University School of Medicine, Toyoake 470-1192, Japan
| | - Yuanying Li
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya 466-8550, Japan
| | - Yupeng He
- Department of Public Health, Fujita Health University School of Medicine, Toyoake 470-1192, Japan
| | - Taro Kishi
- Department of Psychiatry, School of Medicine, Fujita Health University, Toyoake 470-1192, Japan
| | - Shinichi Tanihara
- Department of Public Health, School of Medicine, Kurume University, Kurume 830-0011, Japan
| | - Nakao Iwata
- Department of Psychiatry, School of Medicine, Fujita Health University, Toyoake 470-1192, Japan
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka 541-8567, Japan
| | - Atsuhiko Ota
- Department of Public Health, Fujita Health University School of Medicine, Toyoake 470-1192, Japan
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12
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Gouse BM, Kline ER. Clinical insights: Preventing psychosis treatment disengagement. Schizophr Res 2023; 252:64-66. [PMID: 36628870 PMCID: PMC10593115 DOI: 10.1016/j.schres.2022.12.027] [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: 08/19/2022] [Revised: 12/07/2022] [Accepted: 12/23/2022] [Indexed: 01/10/2023]
Abstract
Many patients with schizophrenia spectrum disorders disengage from treatment, with negative impacts on prognosis and recovery. This commentary provides an overview of common reasons underlying treatment dropout and strategies for overcoming obstacles and enhancing patient engagement. Basic clinical skills such as open-ended questions and reflective listening can be powerful tools in unmasking structural and attitudinal barriers to psychosis care.
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Affiliation(s)
- Brittany M Gouse
- Boston University School of Medicine, Department of Psychiatry, 801 Massachusetts Avenue, 4th Floor, Boston, MA 02118, United States of America; Boston Medical Center, Department of Psychiatry, 801 Massachusetts Avenue, 4th Floor, Boston, MA 02118, United States of America
| | - Emily R Kline
- Boston University School of Medicine, Department of Psychiatry, 801 Massachusetts Avenue, 4th Floor, Boston, MA 02118, United States of America; Boston Medical Center, Department of Psychiatry, 801 Massachusetts Avenue, 4th Floor, Boston, MA 02118, United States of America.
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