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Partanen JJ, Häppölä P, Kämpe A, Ahola-Olli A, Hellsten A, Rask SM, Haaki W, Hietala J, Kampman O, Tiihonen J, Tanskanen AJ, Daly MJ, Ripatti S, Palotie A, Taipale H, Lähteenvuo M, Koskela JT. High Burden of Ileus and Pneumonia in Clozapine-Treated Individuals With Schizophrenia: A Finnish 25-Year Follow-Up Register Study. Am J Psychiatry 2024:appiajp20230744. [PMID: 39262212 DOI: 10.1176/appi.ajp.20230744] [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] [Indexed: 09/13/2024]
Abstract
OBJECTIVE The authors used longitudinal biobank data with up to 25 years of follow-up on over 2,600 clozapine users to derive reliable estimates of the real-world burden of clozapine adverse drug events (ADEs). METHODS A total of 2,659 participants in the FinnGen biobank project had a schizophrenia diagnosis and clozapine purchases with longitudinal electronic health record follow-up for up to 25 years after clozapine initiation. Diseases and health-related events enriched during clozapine use were identified, adjusting for disease severity. The incidence and recurrence of ADEs over years of clozapine use, their effect on clozapine discontinuation and deaths, and their pharmacogenetics were studied. RESULTS Median follow-up time after clozapine initiation was 12.7 years. Across 2,157 diseases and health-related events, 27 were enriched during clozapine use, falling into five disease categories: gastrointestinal hypomotility, seizures, pneumonia, other acute respiratory tract infections, and tachycardia, along with a heterogeneous group including neutropenia and type 2 diabetes, among others. Cumulative incidence estimates for ileus (severe gastrointestinal hypomotility) and pneumonia were 5.3% and 29.5%, respectively, 20 years after clozapine initiation. Both events were significantly associated with increased mortality among clozapine users (ileus: odds ratio=4.5; pneumonia: odds ratio=2.8). Decreased genotype-predicted CYP2C19 and CYP1A2 activities were associated with higher pneumonia risk. CONCLUSIONS Clozapine-induced ileus and pneumonia were notably more frequent than has previously been reported and were associated with increased mortality. Two CYP genes influenced pneumonia risk. Pneumonia and ileus call for improved utilization of available preventive measures.
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Affiliation(s)
- Juulia J Partanen
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (Partanen, Häppölä, Kämpe, Daly, Ripatti, Palotie, Koskela), and Faculty of Medicine (Ripatti), University of Helsinki, Helsinki; Department of Molecular Medicine and Surgery (Kämpe) and Department of Clinical Neuroscience (Tiihonen, Tanskanen, Taipale), Karolinska Institutet, Stockholm; Department of Internal Medicine (Ahola-Olli) and Department of Psychiatry (Haaki, Hietala), Turku University Hospital, Turku, Finland; Aurora Hospital, City of Helsinki, Helsinki (Hellsten); Department of Psychiatry, Faculty of Medicine and Health Technology (Rask), and Faculty of Medicine and Health Technology (Kampman), Tampere University, Tampere, Finland; Department of Psychiatry, Tampere University Hospital, Tampere, Finland (Rask); Department of Psychiatry, University of Turku, Turku, Finland (Haaki, Hietala); Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden (Kampman); Department of Clinical Medicine, Psychiatry, Faculty of Medicine, University of Turku, Turku, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Ostrobothnia, Vaasa, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Pirkanmaa, Tampere, Finland (Kampman); Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tiihonen, Tanskanen, Taipale, Lähteenvuo); Center for Psychiatry Research, Stockholm City Council, Stockholm (Tiihonen); Stanley Center for Psychiatric Research (Daly, Palotie) and Program in Medical and Population Genetics (Daly, Ripatti, Palotie), Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston (Daly, Ripatti, Palotie)
| | - Paavo Häppölä
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (Partanen, Häppölä, Kämpe, Daly, Ripatti, Palotie, Koskela), and Faculty of Medicine (Ripatti), University of Helsinki, Helsinki; Department of Molecular Medicine and Surgery (Kämpe) and Department of Clinical Neuroscience (Tiihonen, Tanskanen, Taipale), Karolinska Institutet, Stockholm; Department of Internal Medicine (Ahola-Olli) and Department of Psychiatry (Haaki, Hietala), Turku University Hospital, Turku, Finland; Aurora Hospital, City of Helsinki, Helsinki (Hellsten); Department of Psychiatry, Faculty of Medicine and Health Technology (Rask), and Faculty of Medicine and Health Technology (Kampman), Tampere University, Tampere, Finland; Department of Psychiatry, Tampere University Hospital, Tampere, Finland (Rask); Department of Psychiatry, University of Turku, Turku, Finland (Haaki, Hietala); Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden (Kampman); Department of Clinical Medicine, Psychiatry, Faculty of Medicine, University of Turku, Turku, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Ostrobothnia, Vaasa, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Pirkanmaa, Tampere, Finland (Kampman); Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tiihonen, Tanskanen, Taipale, Lähteenvuo); Center for Psychiatry Research, Stockholm City Council, Stockholm (Tiihonen); Stanley Center for Psychiatric Research (Daly, Palotie) and Program in Medical and Population Genetics (Daly, Ripatti, Palotie), Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston (Daly, Ripatti, Palotie)
| | - Anders Kämpe
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (Partanen, Häppölä, Kämpe, Daly, Ripatti, Palotie, Koskela), and Faculty of Medicine (Ripatti), University of Helsinki, Helsinki; Department of Molecular Medicine and Surgery (Kämpe) and Department of Clinical Neuroscience (Tiihonen, Tanskanen, Taipale), Karolinska Institutet, Stockholm; Department of Internal Medicine (Ahola-Olli) and Department of Psychiatry (Haaki, Hietala), Turku University Hospital, Turku, Finland; Aurora Hospital, City of Helsinki, Helsinki (Hellsten); Department of Psychiatry, Faculty of Medicine and Health Technology (Rask), and Faculty of Medicine and Health Technology (Kampman), Tampere University, Tampere, Finland; Department of Psychiatry, Tampere University Hospital, Tampere, Finland (Rask); Department of Psychiatry, University of Turku, Turku, Finland (Haaki, Hietala); Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden (Kampman); Department of Clinical Medicine, Psychiatry, Faculty of Medicine, University of Turku, Turku, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Ostrobothnia, Vaasa, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Pirkanmaa, Tampere, Finland (Kampman); Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tiihonen, Tanskanen, Taipale, Lähteenvuo); Center for Psychiatry Research, Stockholm City Council, Stockholm (Tiihonen); Stanley Center for Psychiatric Research (Daly, Palotie) and Program in Medical and Population Genetics (Daly, Ripatti, Palotie), Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston (Daly, Ripatti, Palotie)
| | - Ari Ahola-Olli
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (Partanen, Häppölä, Kämpe, Daly, Ripatti, Palotie, Koskela), and Faculty of Medicine (Ripatti), University of Helsinki, Helsinki; Department of Molecular Medicine and Surgery (Kämpe) and Department of Clinical Neuroscience (Tiihonen, Tanskanen, Taipale), Karolinska Institutet, Stockholm; Department of Internal Medicine (Ahola-Olli) and Department of Psychiatry (Haaki, Hietala), Turku University Hospital, Turku, Finland; Aurora Hospital, City of Helsinki, Helsinki (Hellsten); Department of Psychiatry, Faculty of Medicine and Health Technology (Rask), and Faculty of Medicine and Health Technology (Kampman), Tampere University, Tampere, Finland; Department of Psychiatry, Tampere University Hospital, Tampere, Finland (Rask); Department of Psychiatry, University of Turku, Turku, Finland (Haaki, Hietala); Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden (Kampman); Department of Clinical Medicine, Psychiatry, Faculty of Medicine, University of Turku, Turku, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Ostrobothnia, Vaasa, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Pirkanmaa, Tampere, Finland (Kampman); Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tiihonen, Tanskanen, Taipale, Lähteenvuo); Center for Psychiatry Research, Stockholm City Council, Stockholm (Tiihonen); Stanley Center for Psychiatric Research (Daly, Palotie) and Program in Medical and Population Genetics (Daly, Ripatti, Palotie), Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston (Daly, Ripatti, Palotie)
| | - Anni Hellsten
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (Partanen, Häppölä, Kämpe, Daly, Ripatti, Palotie, Koskela), and Faculty of Medicine (Ripatti), University of Helsinki, Helsinki; Department of Molecular Medicine and Surgery (Kämpe) and Department of Clinical Neuroscience (Tiihonen, Tanskanen, Taipale), Karolinska Institutet, Stockholm; Department of Internal Medicine (Ahola-Olli) and Department of Psychiatry (Haaki, Hietala), Turku University Hospital, Turku, Finland; Aurora Hospital, City of Helsinki, Helsinki (Hellsten); Department of Psychiatry, Faculty of Medicine and Health Technology (Rask), and Faculty of Medicine and Health Technology (Kampman), Tampere University, Tampere, Finland; Department of Psychiatry, Tampere University Hospital, Tampere, Finland (Rask); Department of Psychiatry, University of Turku, Turku, Finland (Haaki, Hietala); Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden (Kampman); Department of Clinical Medicine, Psychiatry, Faculty of Medicine, University of Turku, Turku, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Ostrobothnia, Vaasa, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Pirkanmaa, Tampere, Finland (Kampman); Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tiihonen, Tanskanen, Taipale, Lähteenvuo); Center for Psychiatry Research, Stockholm City Council, Stockholm (Tiihonen); Stanley Center for Psychiatric Research (Daly, Palotie) and Program in Medical and Population Genetics (Daly, Ripatti, Palotie), Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston (Daly, Ripatti, Palotie)
| | - Susanna M Rask
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (Partanen, Häppölä, Kämpe, Daly, Ripatti, Palotie, Koskela), and Faculty of Medicine (Ripatti), University of Helsinki, Helsinki; Department of Molecular Medicine and Surgery (Kämpe) and Department of Clinical Neuroscience (Tiihonen, Tanskanen, Taipale), Karolinska Institutet, Stockholm; Department of Internal Medicine (Ahola-Olli) and Department of Psychiatry (Haaki, Hietala), Turku University Hospital, Turku, Finland; Aurora Hospital, City of Helsinki, Helsinki (Hellsten); Department of Psychiatry, Faculty of Medicine and Health Technology (Rask), and Faculty of Medicine and Health Technology (Kampman), Tampere University, Tampere, Finland; Department of Psychiatry, Tampere University Hospital, Tampere, Finland (Rask); Department of Psychiatry, University of Turku, Turku, Finland (Haaki, Hietala); Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden (Kampman); Department of Clinical Medicine, Psychiatry, Faculty of Medicine, University of Turku, Turku, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Ostrobothnia, Vaasa, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Pirkanmaa, Tampere, Finland (Kampman); Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tiihonen, Tanskanen, Taipale, Lähteenvuo); Center for Psychiatry Research, Stockholm City Council, Stockholm (Tiihonen); Stanley Center for Psychiatric Research (Daly, Palotie) and Program in Medical and Population Genetics (Daly, Ripatti, Palotie), Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston (Daly, Ripatti, Palotie)
| | - Willehard Haaki
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (Partanen, Häppölä, Kämpe, Daly, Ripatti, Palotie, Koskela), and Faculty of Medicine (Ripatti), University of Helsinki, Helsinki; Department of Molecular Medicine and Surgery (Kämpe) and Department of Clinical Neuroscience (Tiihonen, Tanskanen, Taipale), Karolinska Institutet, Stockholm; Department of Internal Medicine (Ahola-Olli) and Department of Psychiatry (Haaki, Hietala), Turku University Hospital, Turku, Finland; Aurora Hospital, City of Helsinki, Helsinki (Hellsten); Department of Psychiatry, Faculty of Medicine and Health Technology (Rask), and Faculty of Medicine and Health Technology (Kampman), Tampere University, Tampere, Finland; Department of Psychiatry, Tampere University Hospital, Tampere, Finland (Rask); Department of Psychiatry, University of Turku, Turku, Finland (Haaki, Hietala); Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden (Kampman); Department of Clinical Medicine, Psychiatry, Faculty of Medicine, University of Turku, Turku, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Ostrobothnia, Vaasa, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Pirkanmaa, Tampere, Finland (Kampman); Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tiihonen, Tanskanen, Taipale, Lähteenvuo); Center for Psychiatry Research, Stockholm City Council, Stockholm (Tiihonen); Stanley Center for Psychiatric Research (Daly, Palotie) and Program in Medical and Population Genetics (Daly, Ripatti, Palotie), Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston (Daly, Ripatti, Palotie)
| | - Jarmo Hietala
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (Partanen, Häppölä, Kämpe, Daly, Ripatti, Palotie, Koskela), and Faculty of Medicine (Ripatti), University of Helsinki, Helsinki; Department of Molecular Medicine and Surgery (Kämpe) and Department of Clinical Neuroscience (Tiihonen, Tanskanen, Taipale), Karolinska Institutet, Stockholm; Department of Internal Medicine (Ahola-Olli) and Department of Psychiatry (Haaki, Hietala), Turku University Hospital, Turku, Finland; Aurora Hospital, City of Helsinki, Helsinki (Hellsten); Department of Psychiatry, Faculty of Medicine and Health Technology (Rask), and Faculty of Medicine and Health Technology (Kampman), Tampere University, Tampere, Finland; Department of Psychiatry, Tampere University Hospital, Tampere, Finland (Rask); Department of Psychiatry, University of Turku, Turku, Finland (Haaki, Hietala); Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden (Kampman); Department of Clinical Medicine, Psychiatry, Faculty of Medicine, University of Turku, Turku, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Ostrobothnia, Vaasa, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Pirkanmaa, Tampere, Finland (Kampman); Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tiihonen, Tanskanen, Taipale, Lähteenvuo); Center for Psychiatry Research, Stockholm City Council, Stockholm (Tiihonen); Stanley Center for Psychiatric Research (Daly, Palotie) and Program in Medical and Population Genetics (Daly, Ripatti, Palotie), Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston (Daly, Ripatti, Palotie)
| | - Olli Kampman
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (Partanen, Häppölä, Kämpe, Daly, Ripatti, Palotie, Koskela), and Faculty of Medicine (Ripatti), University of Helsinki, Helsinki; Department of Molecular Medicine and Surgery (Kämpe) and Department of Clinical Neuroscience (Tiihonen, Tanskanen, Taipale), Karolinska Institutet, Stockholm; Department of Internal Medicine (Ahola-Olli) and Department of Psychiatry (Haaki, Hietala), Turku University Hospital, Turku, Finland; Aurora Hospital, City of Helsinki, Helsinki (Hellsten); Department of Psychiatry, Faculty of Medicine and Health Technology (Rask), and Faculty of Medicine and Health Technology (Kampman), Tampere University, Tampere, Finland; Department of Psychiatry, Tampere University Hospital, Tampere, Finland (Rask); Department of Psychiatry, University of Turku, Turku, Finland (Haaki, Hietala); Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden (Kampman); Department of Clinical Medicine, Psychiatry, Faculty of Medicine, University of Turku, Turku, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Ostrobothnia, Vaasa, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Pirkanmaa, Tampere, Finland (Kampman); Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tiihonen, Tanskanen, Taipale, Lähteenvuo); Center for Psychiatry Research, Stockholm City Council, Stockholm (Tiihonen); Stanley Center for Psychiatric Research (Daly, Palotie) and Program in Medical and Population Genetics (Daly, Ripatti, Palotie), Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston (Daly, Ripatti, Palotie)
| | - Jari Tiihonen
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (Partanen, Häppölä, Kämpe, Daly, Ripatti, Palotie, Koskela), and Faculty of Medicine (Ripatti), University of Helsinki, Helsinki; Department of Molecular Medicine and Surgery (Kämpe) and Department of Clinical Neuroscience (Tiihonen, Tanskanen, Taipale), Karolinska Institutet, Stockholm; Department of Internal Medicine (Ahola-Olli) and Department of Psychiatry (Haaki, Hietala), Turku University Hospital, Turku, Finland; Aurora Hospital, City of Helsinki, Helsinki (Hellsten); Department of Psychiatry, Faculty of Medicine and Health Technology (Rask), and Faculty of Medicine and Health Technology (Kampman), Tampere University, Tampere, Finland; Department of Psychiatry, Tampere University Hospital, Tampere, Finland (Rask); Department of Psychiatry, University of Turku, Turku, Finland (Haaki, Hietala); Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden (Kampman); Department of Clinical Medicine, Psychiatry, Faculty of Medicine, University of Turku, Turku, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Ostrobothnia, Vaasa, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Pirkanmaa, Tampere, Finland (Kampman); Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tiihonen, Tanskanen, Taipale, Lähteenvuo); Center for Psychiatry Research, Stockholm City Council, Stockholm (Tiihonen); Stanley Center for Psychiatric Research (Daly, Palotie) and Program in Medical and Population Genetics (Daly, Ripatti, Palotie), Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston (Daly, Ripatti, Palotie)
| | - Antti J Tanskanen
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (Partanen, Häppölä, Kämpe, Daly, Ripatti, Palotie, Koskela), and Faculty of Medicine (Ripatti), University of Helsinki, Helsinki; Department of Molecular Medicine and Surgery (Kämpe) and Department of Clinical Neuroscience (Tiihonen, Tanskanen, Taipale), Karolinska Institutet, Stockholm; Department of Internal Medicine (Ahola-Olli) and Department of Psychiatry (Haaki, Hietala), Turku University Hospital, Turku, Finland; Aurora Hospital, City of Helsinki, Helsinki (Hellsten); Department of Psychiatry, Faculty of Medicine and Health Technology (Rask), and Faculty of Medicine and Health Technology (Kampman), Tampere University, Tampere, Finland; Department of Psychiatry, Tampere University Hospital, Tampere, Finland (Rask); Department of Psychiatry, University of Turku, Turku, Finland (Haaki, Hietala); Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden (Kampman); Department of Clinical Medicine, Psychiatry, Faculty of Medicine, University of Turku, Turku, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Ostrobothnia, Vaasa, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Pirkanmaa, Tampere, Finland (Kampman); Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tiihonen, Tanskanen, Taipale, Lähteenvuo); Center for Psychiatry Research, Stockholm City Council, Stockholm (Tiihonen); Stanley Center for Psychiatric Research (Daly, Palotie) and Program in Medical and Population Genetics (Daly, Ripatti, Palotie), Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston (Daly, Ripatti, Palotie)
| | - Mark J Daly
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (Partanen, Häppölä, Kämpe, Daly, Ripatti, Palotie, Koskela), and Faculty of Medicine (Ripatti), University of Helsinki, Helsinki; Department of Molecular Medicine and Surgery (Kämpe) and Department of Clinical Neuroscience (Tiihonen, Tanskanen, Taipale), Karolinska Institutet, Stockholm; Department of Internal Medicine (Ahola-Olli) and Department of Psychiatry (Haaki, Hietala), Turku University Hospital, Turku, Finland; Aurora Hospital, City of Helsinki, Helsinki (Hellsten); Department of Psychiatry, Faculty of Medicine and Health Technology (Rask), and Faculty of Medicine and Health Technology (Kampman), Tampere University, Tampere, Finland; Department of Psychiatry, Tampere University Hospital, Tampere, Finland (Rask); Department of Psychiatry, University of Turku, Turku, Finland (Haaki, Hietala); Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden (Kampman); Department of Clinical Medicine, Psychiatry, Faculty of Medicine, University of Turku, Turku, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Ostrobothnia, Vaasa, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Pirkanmaa, Tampere, Finland (Kampman); Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tiihonen, Tanskanen, Taipale, Lähteenvuo); Center for Psychiatry Research, Stockholm City Council, Stockholm (Tiihonen); Stanley Center for Psychiatric Research (Daly, Palotie) and Program in Medical and Population Genetics (Daly, Ripatti, Palotie), Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston (Daly, Ripatti, Palotie)
| | - Samuli Ripatti
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (Partanen, Häppölä, Kämpe, Daly, Ripatti, Palotie, Koskela), and Faculty of Medicine (Ripatti), University of Helsinki, Helsinki; Department of Molecular Medicine and Surgery (Kämpe) and Department of Clinical Neuroscience (Tiihonen, Tanskanen, Taipale), Karolinska Institutet, Stockholm; Department of Internal Medicine (Ahola-Olli) and Department of Psychiatry (Haaki, Hietala), Turku University Hospital, Turku, Finland; Aurora Hospital, City of Helsinki, Helsinki (Hellsten); Department of Psychiatry, Faculty of Medicine and Health Technology (Rask), and Faculty of Medicine and Health Technology (Kampman), Tampere University, Tampere, Finland; Department of Psychiatry, Tampere University Hospital, Tampere, Finland (Rask); Department of Psychiatry, University of Turku, Turku, Finland (Haaki, Hietala); Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden (Kampman); Department of Clinical Medicine, Psychiatry, Faculty of Medicine, University of Turku, Turku, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Ostrobothnia, Vaasa, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Pirkanmaa, Tampere, Finland (Kampman); Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tiihonen, Tanskanen, Taipale, Lähteenvuo); Center for Psychiatry Research, Stockholm City Council, Stockholm (Tiihonen); Stanley Center for Psychiatric Research (Daly, Palotie) and Program in Medical and Population Genetics (Daly, Ripatti, Palotie), Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston (Daly, Ripatti, Palotie)
| | - Aarno Palotie
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (Partanen, Häppölä, Kämpe, Daly, Ripatti, Palotie, Koskela), and Faculty of Medicine (Ripatti), University of Helsinki, Helsinki; Department of Molecular Medicine and Surgery (Kämpe) and Department of Clinical Neuroscience (Tiihonen, Tanskanen, Taipale), Karolinska Institutet, Stockholm; Department of Internal Medicine (Ahola-Olli) and Department of Psychiatry (Haaki, Hietala), Turku University Hospital, Turku, Finland; Aurora Hospital, City of Helsinki, Helsinki (Hellsten); Department of Psychiatry, Faculty of Medicine and Health Technology (Rask), and Faculty of Medicine and Health Technology (Kampman), Tampere University, Tampere, Finland; Department of Psychiatry, Tampere University Hospital, Tampere, Finland (Rask); Department of Psychiatry, University of Turku, Turku, Finland (Haaki, Hietala); Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden (Kampman); Department of Clinical Medicine, Psychiatry, Faculty of Medicine, University of Turku, Turku, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Ostrobothnia, Vaasa, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Pirkanmaa, Tampere, Finland (Kampman); Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tiihonen, Tanskanen, Taipale, Lähteenvuo); Center for Psychiatry Research, Stockholm City Council, Stockholm (Tiihonen); Stanley Center for Psychiatric Research (Daly, Palotie) and Program in Medical and Population Genetics (Daly, Ripatti, Palotie), Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston (Daly, Ripatti, Palotie)
| | - Heidi Taipale
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (Partanen, Häppölä, Kämpe, Daly, Ripatti, Palotie, Koskela), and Faculty of Medicine (Ripatti), University of Helsinki, Helsinki; Department of Molecular Medicine and Surgery (Kämpe) and Department of Clinical Neuroscience (Tiihonen, Tanskanen, Taipale), Karolinska Institutet, Stockholm; Department of Internal Medicine (Ahola-Olli) and Department of Psychiatry (Haaki, Hietala), Turku University Hospital, Turku, Finland; Aurora Hospital, City of Helsinki, Helsinki (Hellsten); Department of Psychiatry, Faculty of Medicine and Health Technology (Rask), and Faculty of Medicine and Health Technology (Kampman), Tampere University, Tampere, Finland; Department of Psychiatry, Tampere University Hospital, Tampere, Finland (Rask); Department of Psychiatry, University of Turku, Turku, Finland (Haaki, Hietala); Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden (Kampman); Department of Clinical Medicine, Psychiatry, Faculty of Medicine, University of Turku, Turku, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Ostrobothnia, Vaasa, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Pirkanmaa, Tampere, Finland (Kampman); Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tiihonen, Tanskanen, Taipale, Lähteenvuo); Center for Psychiatry Research, Stockholm City Council, Stockholm (Tiihonen); Stanley Center for Psychiatric Research (Daly, Palotie) and Program in Medical and Population Genetics (Daly, Ripatti, Palotie), Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston (Daly, Ripatti, Palotie)
| | - Markku Lähteenvuo
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (Partanen, Häppölä, Kämpe, Daly, Ripatti, Palotie, Koskela), and Faculty of Medicine (Ripatti), University of Helsinki, Helsinki; Department of Molecular Medicine and Surgery (Kämpe) and Department of Clinical Neuroscience (Tiihonen, Tanskanen, Taipale), Karolinska Institutet, Stockholm; Department of Internal Medicine (Ahola-Olli) and Department of Psychiatry (Haaki, Hietala), Turku University Hospital, Turku, Finland; Aurora Hospital, City of Helsinki, Helsinki (Hellsten); Department of Psychiatry, Faculty of Medicine and Health Technology (Rask), and Faculty of Medicine and Health Technology (Kampman), Tampere University, Tampere, Finland; Department of Psychiatry, Tampere University Hospital, Tampere, Finland (Rask); Department of Psychiatry, University of Turku, Turku, Finland (Haaki, Hietala); Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden (Kampman); Department of Clinical Medicine, Psychiatry, Faculty of Medicine, University of Turku, Turku, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Ostrobothnia, Vaasa, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Pirkanmaa, Tampere, Finland (Kampman); Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tiihonen, Tanskanen, Taipale, Lähteenvuo); Center for Psychiatry Research, Stockholm City Council, Stockholm (Tiihonen); Stanley Center for Psychiatric Research (Daly, Palotie) and Program in Medical and Population Genetics (Daly, Ripatti, Palotie), Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston (Daly, Ripatti, Palotie)
| | - Jukka T Koskela
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (Partanen, Häppölä, Kämpe, Daly, Ripatti, Palotie, Koskela), and Faculty of Medicine (Ripatti), University of Helsinki, Helsinki; Department of Molecular Medicine and Surgery (Kämpe) and Department of Clinical Neuroscience (Tiihonen, Tanskanen, Taipale), Karolinska Institutet, Stockholm; Department of Internal Medicine (Ahola-Olli) and Department of Psychiatry (Haaki, Hietala), Turku University Hospital, Turku, Finland; Aurora Hospital, City of Helsinki, Helsinki (Hellsten); Department of Psychiatry, Faculty of Medicine and Health Technology (Rask), and Faculty of Medicine and Health Technology (Kampman), Tampere University, Tampere, Finland; Department of Psychiatry, Tampere University Hospital, Tampere, Finland (Rask); Department of Psychiatry, University of Turku, Turku, Finland (Haaki, Hietala); Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden (Kampman); Department of Clinical Medicine, Psychiatry, Faculty of Medicine, University of Turku, Turku, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Ostrobothnia, Vaasa, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Pirkanmaa, Tampere, Finland (Kampman); Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tiihonen, Tanskanen, Taipale, Lähteenvuo); Center for Psychiatry Research, Stockholm City Council, Stockholm (Tiihonen); Stanley Center for Psychiatric Research (Daly, Palotie) and Program in Medical and Population Genetics (Daly, Ripatti, Palotie), Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston (Daly, Ripatti, Palotie)
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Greydanus DE, Nazeer A, Qayyum Z, Patel DR, Rausch R, Hoang LN, Miller C, Chahin S, Apple RW, Saha G, Prasad Rao G, Javed A. Pediatric suicide: Review of a preventable tragedy. Dis Mon 2024; 70:101725. [PMID: 38480023 DOI: 10.1016/j.disamonth.2024.101725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2024]
Abstract
Concepts of suicide are explored in this issue with a focus on suicide in children and adolescents. The epidemiology of pediatric suicide in the United States is reviewed; also, risk and protective factors, as well as prevention strategies, are discussed. Suicide in the pediatric athlete and the potential protective effect of exercise are examined. In addition, this analysis addresses the beneficial role of psychological management as well as current research on pharmacologic treatment and brain stimulation procedures as part of comprehensive pediatric suicide prevention. Though death by suicide in pediatric persons has been and remains a tragic phenomenon, there is much that clinicians, other healthcare professionals, and society itself can accomplish in the prevention of pediatric suicide as well as the management of suicidality in our children and adolescents.
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Affiliation(s)
- Donald E Greydanus
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States.
| | - Ahsan Nazeer
- Division of Child and Adolescent Psychiatry, Sidra Medicine/Weill Cornell Medicine, Doha, Qatar
| | - Zheala Qayyum
- Harvard Medical School, Boston, Massachusetts, United States
| | - Dilip R Patel
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Rebecca Rausch
- Division of Pediatric Psychology, Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Linh-Nhu Hoang
- Western Michigan University, Kalamazoo, MI, United States
| | - Caroline Miller
- Fielding Graduate University, Santa Barbara, CA, United States
| | - Summer Chahin
- Mott Children's Hospital, University of Michigan, Ann Arbor, MI, United States
| | - Roger W Apple
- Division of Pediatric Psychology, Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Gautam Saha
- Immediate Past President of the SAARC (South Asian Association for Regional Cooperation) Psychiatric Federation (SPF), India
| | - G Prasad Rao
- President, Asian Federation of Psychiatric Association (AFPA), India
| | - Afzal Javed
- Chairman Pakistan Psychiatric Research Centre, Immediate Past President of the World Psychiatric Association (WPA), Pakistan
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Ayers N, McCall WV, Miller BJ. Sleep Problems, Suicidal Ideation, and Psychopathology in First-Episode Psychosis. Schizophr Bull 2024; 50:286-294. [PMID: 37086485 PMCID: PMC10919767 DOI: 10.1093/schbul/sbad045] [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: 04/24/2023]
Abstract
BACKGROUND AND HYPOTHESIS Insomnia occurs frequently in the clinical course of schizophrenia. A growing literature has found associations between insomnia, suicidal ideation and behavior, and psychopathology in schizophrenia. We explored associations between sleep problems, suicidal ideation, and psychopathology in a cohort of patients with first-episode psychosis. STUDY DESIGN We performed a secondary analysis of data for n = 403 subjects with data from the Recovery After an Initial Schizophrenia Episode study using regression models. STUDY RESULTS The prevalence of sleep problems and suicidal ideation at baseline was 57% and 15%, respectively. After controlling for potential confounders, in the study baseline sleep problems were associated with increased odds of suicidal ideation with evidence of a dose-dependent relationship (OR = 2.25, 95% CI 1.15-4.41, P = .018). Over 24 months, sleep problems at any time point were associated with an over 3-fold increased odds of concurrent suicidal ideation (OR = 3.21, 95% CI 1.45-7.14, P = .004). Subjects with persistent sleep problems were almost 14 times more likely to endorse suicidal ideation at least once over the study than those without sleep problems (OR = 13.8, 95% CI 6.5-53.4, P < .001). Sleep problems were also a predictor of higher Positive and Negative Syndrome Scale total (β = 0.13-0.22), positive (β = 0.14-0.25), and general (β = 0.16-0.27) subscale scores at baseline and multiple follow-up visits (P < .01 for each). CONCLUSIONS Sleep problems are highly prevalent and associated with suicidal ideation and greater psychopathology in first-episode psychosis. Formal assessment and treatment of insomnia appear relevant to the clinical care of patients with psychosis as a predictor of suicidal ideation and symptom severity.
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Affiliation(s)
- Nolan Ayers
- Medical College of Georgia, Augusta University, Augusta, GA, USA
| | | | - Brian J Miller
- Department of Psychiatry, Augusta University, Augusta, GA, USA
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Krupnik V, Danilova N. To be or not to be: The active inference of suicide. Neurosci Biobehav Rev 2024; 157:105531. [PMID: 38176631 DOI: 10.1016/j.neubiorev.2023.105531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/27/2023] [Accepted: 12/29/2023] [Indexed: 01/06/2024]
Abstract
Suicide presents an apparent paradox as a behavior whose motivation is not obvious since its outcome is non-existence and cannot be experienced. To address this paradox, we propose to frame suicide in the integrated theory of stress and active inference. We present an active inference-based cognitive model of suicide as a type of stress response hanging in cognitive balance between predicting self-preservation and self-destruction. In it, self-efficacy emerges as a meta-cognitive regulator that can bias the model toward either survival or suicide. The model suggests conditions under which cognitive homeostasis can override physiological homeostasis in motivating self-destruction. We also present a model proto-suicidal behavior, programmed cell death (apoptosis), in active inference terms to illustrate how an active inference model of self-destruction can be embodied in molecular mechanisms and to offer a hypothesis on another puzzle of suicide: why only humans among brain-endowed animals are known to practice it.
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Affiliation(s)
- Valery Krupnik
- Department of Mental Health, Naval Hospital Camp Pendleton, Camp Pendleton, CA, USA.
| | - Nadia Danilova
- Department of Cell Biology, UCLA (retired), Los Angeles, CA, USA
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Hudon A, Beaudoin M, Phraxayavong K, Potvin S, Dumais A. Enhancing Predictive Power: Integrating a Linear Support Vector Classifier with Logistic Regression for Patient Outcome Prognosis in Virtual Reality Therapy for Treatment-Resistant Schizophrenia. J Pers Med 2023; 13:1660. [PMID: 38138887 PMCID: PMC10744538 DOI: 10.3390/jpm13121660] [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: 10/14/2023] [Revised: 11/11/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023] Open
Abstract
(1) Background: Approximately 30% of schizophrenia patients are known to be treatment-resistant. For these cases, more personalized approaches must be developed. Virtual reality therapeutic approaches such as avatar therapy (AT) are currently undergoing investigations to address these patients' needs. To further tailor the therapeutic trajectory of patients presenting with this complex presentation of schizophrenia, quantitative insight about the therapeutic process is warranted. The aim of the study is to combine a classification model with a regression model with the aim of predicting the therapeutic outcomes of patients based on the interactions taking place during their first immersive session of virtual reality therapy. (2) Methods: A combination of a Linear Support Vector Classifier and logistic regression was conducted over a dataset comprising 162 verbatims of the immersive sessions of 18 patients who previously underwent AT. As a testing dataset, 17 participants, unknown to the dataset, had their first immersive session presented to the combinatory model to predict their clinical outcome. (3) Results: The model accurately predicted the clinical outcome for 15 out of the 17 participants. Classification of the therapeutic interactions achieved an accuracy of 63%. (4) Conclusion: To our knowledge, this is the first attempt to predict the outcome of psychotherapy patients based on the content of their interactions with their therapist. These results are important as they open the door to personalization of psychotherapy based on quantitative information about the interactions taking place during AT.
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Affiliation(s)
- Alexandre Hudon
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montreal, QC H1N 3V2, Canada; (A.H.); (M.B.); (S.P.)
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Mélissa Beaudoin
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montreal, QC H1N 3V2, Canada; (A.H.); (M.B.); (S.P.)
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | | | - Stéphane Potvin
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montreal, QC H1N 3V2, Canada; (A.H.); (M.B.); (S.P.)
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Alexandre Dumais
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montreal, QC H1N 3V2, Canada; (A.H.); (M.B.); (S.P.)
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada
- Services et Recherches Psychiatriques AD, Montreal, QC H1N 3V2, Canada;
- Institut National de Psychiatrie Légale Philippe-Pinel, Montreal, QC H1C 1H1, Canada
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Abstract
PURPOSE OF REVIEW Insomnia is common in schizophrenia. Insomnia has been associated with suicidal ideation and behavior, as well as greater severity of psychopathology, in schizophrenia. This review performs a meta-analysis of associations between insomnia, suicide, and psychopathology in patients with schizophrenia. RECENT FINDINGS We searched major electronic databases from inception until November 2022 for studies of insomnia, suicide, and psychopathology in patients with schizophrenia. Random effects meta-analysis calculating odds ratios (ORs, for suicide) and effect sizes (ESs, for psychopathology) and 95% confidence intervals (CIs) were performed. Ten studies met the inclusion criteria, comprising 3428 patients with schizophrenia. Insomnia was associated with a significant increased odds of suicidal ideation (OR = 1.84, 95% CI 1.28-2.65, P < 0.01) and suicide attempt or death (OR = 5.83, 95% CI 1.61-2.96, P < 0.01). Insomnia was also associated with total (ES = 0.16, 95% CI 0.09-0.23, P < 0.01), positive (ES = 0.14, 95% CI 0.08-0.20, P = 0.02), and general (ES = 0.17, 95% CI 0.08-0.27, P < 0.01) psychopathology. In meta-regression analyses, BMI was negatively associated with suicidal ideation. Otherwise, age, sex, and study year were all unrelated to the associations. SUMMARY Insomnia is associated with suicide and psychopathology in schizophrenia. Formal assessment and treatment of insomnia appears relevant to the clinical care of schizophrenia.
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Affiliation(s)
| | - William V McCall
- Medical College of Georgia, Augusta University
- Department of Psychiatry and Health Behavior, Augusta University, Augusta, Georgia, USA
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Miller BJ, McEvoy JP, McCall WV. Meta-analysis of clozapine and insomnia in schizophrenia. Schizophr Res 2023; 252:208-215. [PMID: 36669344 DOI: 10.1016/j.schres.2023.01.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 11/21/2022] [Accepted: 01/09/2023] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Insomnia commonly occurs in schizophrenia, and insomnia is associated with suicide risk. Clozapine has anti-suicidal properties and beneficial effects on sleep. We performed a meta-analysis of insomnia in randomized controlled trials (RCTs) of patients with schizophrenia treated with clozapine. We hypothesized that compared to clozapine there is an increased odds of insomnia in patients treated with other antipsychotics. METHODS We systematically searched PubMed, PsycINFO, and Web of Science databases. We included RCTs, in English, with data on insomnia in patients with schizophrenia treated with clozapine versus other antipsychotics. Data were pooled using a random effects model. RESULTS Eight RCTs (1952 patients: 922 on clozapine and 1030 on other antipsychotics) met inclusion criteria. Patients treated with other antipsychotics versus clozapine had a significant increased odds of insomnia (22.3 % versus 12.4 %, OR = 2.20, 95 % CI = 1.64-2.94, p < 0.01). Olanzapine, quetiapine, risperidone, and ziprasidone were each associated with significant increased odds of insomnia compared to clozapine. In meta-regression analyses, clozapine dose, publication year, sex, trial duration, and study quality score were unrelated to the association; however, there was a significant association with age. The observed ORs for insomnia from RCTs were almost perfectly correlated with reported ORs from pharmacovigilance data. CONCLUSION Clozapine is associated with significantly less insomnia compared to other antipsychotics. Findings provide additional evidence for improvement in sleep as a potential pathway underlying clozapine's anti-suicidal properties. A greater mechanistic understanding of this association is needed.
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Affiliation(s)
- Brian J Miller
- Department of Psychiatry and Health Behavior, Augusta University, Augusta, GA, United States.
| | - Joseph P McEvoy
- Department of Psychiatry and Health Behavior, Augusta University, Augusta, GA, United States
| | - William V McCall
- Department of Psychiatry and Health Behavior, Augusta University, Augusta, GA, United States
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Masdrakis VG, Baldwin DS. Prevention of suicide by clozapine in mental disorders: systematic review. Eur Neuropsychopharmacol 2023; 69:4-23. [PMID: 36640481 DOI: 10.1016/j.euroneuro.2022.12.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/21/2022] [Accepted: 12/27/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Previous research has investigated the efficacy of clozapine in reducing suicidality in patients with schizophrenia and schizoaffective disorder. We aimed to systematically review published evidence, including studies concerning clozapine administration to treat: (a) refractory suicidality in other mental disorders, including bipolar disorder and borderline and other personality disorders; and (b) refractory cases of non-suicidal self-injury. METHOD We performed a PUBMED-search (last day: July 17, 2022) of English-language studies, combining the keywords "clozapine", "suicidality", and "suicide" with various psychopathological terms (e.g. "schizophrenia"). All duplications were eliminated. RESULTS Fifty-one studies were eligible for inclusion in the review. Most studies suggest a superior anti-suicide effect of clozapine in schizophrenia/schizoaffective disorder, compared to other antipsychotics, or no antipsychotic therapy, which is not due to the close monitoring of patients for blood dyscrasias. No consensus exists as to whether other antipsychotic drugs share this effect. Discontinuation of clozapine is associated with increases in suicidality. Reductions in refractory suicidality/NSSI are observed in clozapine-treated patients with bipolar disorder or borderline personality disorder, but the evidence is limited. Potential biological underpinnings of the anti-suicide effect of clozapine include its unique profile of modulation of brain neurotransmitters; its non-selectivity for neurotransmitter receptors; specific genetic and hormonal factors; effects on neuroinflammation; and ability to elicit epileptiform activity. CONCLUSION The superior anti-suicide effect of clozapine in schizophrenia/schizoaffective disorder patients is well established. It may have a role in severe and refractory cases of suicidality and non-suicidal self-injury in patients with bipolar disorder or borderline personality disorder, but the level and quality of supporting evidence is limited.
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Affiliation(s)
- Vasilios G Masdrakis
- National and Kapodistrian University of Athens, School of Medicine, First Department of Psychiatry, Eginition Hospital, 74 Vas. Sofias Avenue, 11528 Athens, Greece
| | - David S Baldwin
- University Department of Psychiatry, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, United Kingdom; University Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
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Understanding the Association Between Mental Health Knowledge and Mental Health Service Utilization Among Black Adults. Community Ment Health J 2023; 59:57-67. [PMID: 35794413 PMCID: PMC10371774 DOI: 10.1007/s10597-022-00988-w] [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: 10/11/2021] [Accepted: 05/16/2022] [Indexed: 01/07/2023]
Abstract
Mental health knowledge limitations may contribute to the treatment gap among Black adults. We conducted an online cross-sectional study of Black adults in the United States (n = 262, aged 18-65 years) from diverse ethnic backgrounds (African-Americans, African immigrants, Afro-Caribbean immigrants). Gamma regression using generalized linear models was used to estimate the associations between mental health knowledge and willingness to seek help from mental health professionals. After adjusting for age, education and ethnicity, participants with higher specific knowledge about mental health (such as recognition of schizophrenia as a mental illness) were 26% more likely to report willingness to seek help from a mental health professional for personal and emotional problems (RR = 1.26, CI 1.12-1.41, p < 0.001). Knowledge building interventions (such as psychoeducation) that seek to increase specific knowledge (rather than general knowledge) may correlate more strongly with utilization of mental health services among Black adults.
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Bornheimer LA, Li Verdugo J, Thompson S. Depression Mediates the Relationships between Hallucinations, Delusions, and Social Isolation in First-Episode Psychosis. SOCIAL WORK RESEARCH 2022; 46:332-341. [PMID: 36420428 PMCID: PMC9673164 DOI: 10.1093/swr/svac025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/12/2021] [Accepted: 08/12/2022] [Indexed: 06/16/2023]
Abstract
Social isolation is common among individuals with schizophrenia spectrum and other psychotic disorders. Research indicates that social isolation relates to poorer mental health outcomes, depression, and negative symptoms, with less known about its relationship with positive symptoms. This study examined depression as a mediator in the relationships between positive symptoms (i.e., hallucinations and delusions) and social isolation among an early treatment phase sample in the United States. Data were obtained from the Recovery After an Initial Schizophrenia Episode project of the National Institute of Mental Health's Early Treatment Program. Participants (N = 404) included adults between ages 15 and 40 in a first episode of psychosis. Data were analyzed using structural equation modeling in Mplus (Version 8). The study showed that delusions (b = .095, SE = 0.04, p < .05) and hallucinations (b = .076, SE = 0.03, p < .01) were directly related to depression, and that both delusions (b = .129, SE = 0.06, p < .05) and depression (b = .254, SE = 0.09, p < .05) were directly related to social isolation. Findings of this study determined that depression functioned as a mediator in the relationships between positive symptoms and social isolation. Targeting psychosis symptomatology and depression in treatment, improving social skills and social support networks, and considering the role of stigma in social isolation are of great importance in the prevention of poorer mental health outcomes.
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Affiliation(s)
- Lindsay A Bornheimer
- PhD, is an assistant professor, School of Social Work, University of Michigan, 1080 S. University Avenue, Ann Arbor, MI 48109-1106, USA
| | - Juliann Li Verdugo
- MSW, is a project coordinator, is a research assistant, School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | - Sara Thompson
- MSW, is a research assistant, School of Social Work, University of Michigan, Ann Arbor, MI, USA
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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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Zakharova N, Bravve L, Mamedova G, Kaydan M, Ershova E, Martynov A, Veiko N, Kostyuk S. Telomere Length as a Marker of Suicidal Risk in Schizophrenia. CONSORTIUM PSYCHIATRICUM 2022; 3:37-47. [PMID: 39045115 PMCID: PMC11262099 DOI: 10.17816/cp171] [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: 03/29/2022] [Accepted: 05/30/2022] [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 (225±28.4 (227 [190; 250]) vs. 243±21 (245 [228; 260]) vs. 255±17.9 (255 [242; 266]), p <0.005. The same trend is observed for the number of mtDNA copies (257±101.5 (250 [194; 297])) vs. 262.3±59.3 (254 [217; 312]) vs. 272±79.9 (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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13
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Miller BJ, McCall WV. Insomnia and suicide as reported adverse effects of second-generation antipsychotics and mood stabilizers. J Clin Sleep Med 2022; 18:517-522. [PMID: 34543183 PMCID: PMC8804988 DOI: 10.5664/jcsm.9646] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
STUDY OBJECTIVES Insomnia and suicide ideation/behavior/death (SIB) are common in psychiatric disorders. There is evidence that clozapine and lithium have antisuicidal properties and beneficial effects on sleep. We investigated the reported odds of spontaneously reported psychiatric adverse drug reactions of insomnia and SIB in adults for second-generation antipsychotics (SGAs) and mood stabilizers compared to clozapine and lithium, respectively. METHODS We searched the U.S. Food & Drug Administration Adverse Event Reporting System from inception through February 2021 for which an SGA or mood stabilizer was the suspected agent of a psychiatric adverse drug reaction. RESULTS We investigated 10 SGAs and 5 mood stabilizers. Compared to clozapine, other SGAs were associated with a significantly increased reported odds of insomnia (reported odds ratio [rOR] = 2.41-9.70) and SIB (rOR = 1.18-2.72). Compared to lithium, there was a significantly increased reported odds of SIB (rOR = 1.17-1.70) for other mood stabilizers and odds of insomnia (rOR = 1.66) for lamotrigine. The insomnia and SIB rORs for SGAs and mood stabilizers were positively correlated. CONCLUSIONS Our results are consistent with evidence for antisuicidal properties of clozapine and lithium. Findings also raise the possibility of beneficial effects on sleep as one potential pathway underlying the antisuicidal properties for these agents. Future studies are needed to identify underlying biological mechanisms that contribute to these associations. CITATION Miller BJ, McCall WV. Insomnia and suicide as reported adverse effects of second-generation antipsychotics and mood stabilizers. J Clin Sleep Med. 2022;18(2):517-522.
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Affiliation(s)
| | - William V. McCall
- Address correspondence to: William V. McCall, MD, MS, Department of Psychiatry and Health Behavior, Augusta University, 997 Saint Sebastian Way, Augusta, GA 30912; Tel: (706) 721-6719; Fax: (706) 721-1793;
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14
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Te T. You lack the season of all natures, sleep. J Clin Sleep Med 2022; 18:343-344. [PMID: 34857085 PMCID: PMC8805017 DOI: 10.5664/jcsm.9826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Tue Te
- Division of Sleep Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;,Division of Sleep Medicine, Penn Medicine—Hospital of the University of Pennsylvania, Penn Sleep Center Market Street, Philadelphia, Pennsylvania,Address correspondence to: Tue Te, MD, Division of Sleep Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Translational Research Laboratories, Suite 2100, 125 South 31st Street, Philadelphia, PA 19104;
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15
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Which are the best evidence-based therapeutic options for clozapine and ECT resistant schizophrenia? A case-report. Psychiatry Res 2021; 305:114248. [PMID: 34739952 DOI: 10.1016/j.psychres.2021.114248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 11/20/2022]
Abstract
This is a case description of a patient with clozapine and ECT resistance schizophrenia with several suicide attempts. We discussed evidence-based clinical decisions to deal with such conditions.
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16
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Forte A, Pompili M, Imbastaro B, De Luca GP, Mastrangelo M, Montalbani B, Baldessarini RJ. Effects on suicidal risk: Comparison of clozapine to other newer medicines indicated to treat schizophrenia or bipolar disorder. J Psychopharmacol 2021; 35:1074-1080. [PMID: 34291676 DOI: 10.1177/02698811211029738] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Clozapine is the only treatment with regulatory-recognition of lowering suicidal risk, at least in schizophrenia patients. It remains uncertain whether such effects extend to other drugs for psychosis. METHODS We searched for reports on rates of suicidal behavior during treatment with clozapine and other modern drugs for psychosis (aripiprazole, olanzapine, risperidone, quetiapine, and ziprasidone) versus comparison or control treatments and analyzed the contrasts by random-effect meta-analysis to obtain pooled odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS We identified 35 paired comparisons of modern drugs for psychosis versus comparison or control treatments in 18 reports. There was moderate overall superiority of all agents tested over alternatives (OR = 0.522, p = 0.004). With clozapine, this effect was large (OR = 0.229, p < 0.0001) and consistent (7/7 trials), but significant antisuicidal effects were not found with other drugs for psychosis in 28 other trials (OR = 0.941, p = 0.497). Apparent efficacy of specific agents ranked: risperidone ⩾ olanzapine ⩾ aripiprazole ⩾ ziprasidone ⩾ mixed drugs for psychosis ⩾ quetiapine, but none of these differences was significant. CONCLUSIONS An ability of clozapine to reduce risk of suicides and attempts in schizophrenia patients appears to be a unique effect not shared with other modern medicines indicated for schizophrenia or bipolar disorder.
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Affiliation(s)
- Alberto Forte
- Psychiatry Residency Program, Faculty of Medicine and Psychology Sapienza University of Rome, Italy.,Department of Mental Health and Substance Abuse, ASL Roma 5, Rome, Italy.,International Consortium for Mood and Psychotic Disorder Research, Mailman Research Center, McLean Hospital, Belmont, MA, USA
| | - Maurizio Pompili
- International Consortium for Mood and Psychotic Disorder Research, Mailman Research Center, McLean Hospital, Belmont, MA, USA.,Department of Neurosciences, Mental Health, and Sensory Organs, Suicide Prevention Centre, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Benedetta Imbastaro
- Psychiatry Residency Program, Faculty of Medicine and Psychology Sapienza University of Rome, Italy
| | | | - Martina Mastrangelo
- Psychiatry Residency Program, Faculty of Medicine and Psychology Sapienza University of Rome, Italy
| | - Benedetta Montalbani
- Psychiatry Residency Program, Faculty of Medicine and Psychology Sapienza University of Rome, Italy
| | - Ross J Baldessarini
- International Consortium for Mood and Psychotic Disorder Research, Mailman Research Center, McLean Hospital, Belmont, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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17
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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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18
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Athanassiou M, Dumais A, Iammatteo V, De Benedictis L, Dubreucq JL, Potvin S. The processing of angry faces in schizophrenia patients with a history of suicide: An fMRI study examining brain activity and connectivity. Prog Neuropsychopharmacol Biol Psychiatry 2021; 107:110253. [PMID: 33485961 DOI: 10.1016/j.pnpbp.2021.110253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/05/2021] [Accepted: 01/14/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND The high rate of suicidal behaviours (SBs) in psychiatric populations remain an important preoccupation to address. The literature reveals emotional instability as an important risk factor for SBs. However, the neural mechanisms underpinning this risk factor have never been investigated in schizophrenia patients with SBs. The following study implemented a task-based emotional processing functional magnetic resonance imaging (fMRI) paradigm to evaluate the activation and connectivity differences exhibited by schizophrenia patients with a history of suicide attempt (SA). METHOD A sample of 62 schizophrenia patients with and without SA and 22 controls completed an fMRI emotional processing task, which included the visualization of dynamic angry facial expressions. Task-based connectivity was assessed using generalized psychophysical interaction analyses. RESULTS During the processing of angry faces, suicidal schizophrenia patients displayed increased activation of the left median cingulate gyrus, left middle frontal gyrus, and left precuneus when compared to nonsuicidal schizophrenia patients and healthy controls. Whole-brain connectivity analyses yielded an increased coupling of the right amygdala and right superior frontal gyrus, as well as between the left precuneus and median cingulate gyrus, in suicidal schizophrenia patients. Schizophrenia patients' hostility scores on the Positive and Negative Symptom Scale (PANSS) were significantly and positively correlated with the activity of the left median cingulate gyrus. CONCLUSION When exposed to angry faces, suicidal schizophrenia patients demonstrate elevated activation of brain regions associated to executive functioning and self-processing, as well as aberrant fronto-limbic connectivity involved in emotion regulation. Our results highlight the neglected role of anger when investigating the neural alterations underpinning SBs in schizophrenia.
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Affiliation(s)
- Maria Athanassiou
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada; Department of Psychiatry and Addiction, Faculty of Medicine, University of Montreal, Montreal, Canada
| | - Alexandre Dumais
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada; Department of Psychiatry and Addiction, Faculty of Medicine, University of Montreal, Montreal, Canada; Philippe-Pinel National Institute of Legal Psychiatry, Montreal, Canada
| | - Veronica Iammatteo
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada; Department of Psychiatry and Addiction, Faculty of Medicine, University of Montreal, Montreal, Canada
| | - Luigi De Benedictis
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada; Department of Psychiatry and Addiction, Faculty of Medicine, University of Montreal, Montreal, Canada
| | - Jean-Luc Dubreucq
- Philippe-Pinel National Institute of Legal Psychiatry, Montreal, Canada
| | - Stéphane Potvin
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada; Department of Psychiatry and Addiction, Faculty of Medicine, University of Montreal, Montreal, Canada.
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19
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Hoseinipalangi Z, Golmohammadi Z, Rafiei S, Pashazadeh Kan F, Hosseinifard H, Rezaei S, Ahmadi S, Ahmadi N, Raoofi S, Aghajani F, Dehnad A, Shabaninejad H, Aghalou S, Shabani H, Ghashghaee A. Global health-related quality of life in schizophrenia: systematic review and meta-analysis. BMJ Support Palliat Care 2021; 12:123-131. [PMID: 33837111 DOI: 10.1136/bmjspcare-2021-002936] [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: 01/25/2021] [Revised: 03/13/2021] [Accepted: 03/27/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND AIM Signs and symptoms of schizophrenia may have serious impacts on patients' quality of life leading to concern about different aspects of their lives. This study presents a systematic review and meta-analysis of the studies examining the quality of life among patients with schizophrenia and its relationship with patients' characteristics. MATERIALS AND METHODS A total of 40 studies were extracted from searching of relevant databases published between 2000 and 2020. Descriptive data and correlation coefficients between patient's characteristics and quality of life were extracted and the results were reported according to Preferred Reporting Items for Systematic Reviews and Meta-analyses standards and meta-analysis of pooled studies. RESULTS In total, 8363 patients with schizophrenia participated in 40 studies which used Schizophrenia Quality of Life Scale revision 4. The total score of quality of life (QOL) in the study subjects was reported to be 40.66. Weighted effect size analyses revealed a significant relationship between QOL and variables including patients' age and duration of the disease. Furthermore, the highest (the worst) score of QOL in schizophrenia patients was observed in Europe 47.04 (95% CI 41.26 to 52.82) and the Euro region 47.05 (95% CI 41.18 to 52.92). CONCLUSION Overall, the QOL among patients with schizophrenia was in a good status, which could be improved through considering different life aspects of people living in various contexts. In fact, clarifying the determinants of QOL would be a key step in the provision of future treatment efforts.
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Affiliation(s)
- Zahra Hoseinipalangi
- Student Research Committee, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Zahra Golmohammadi
- Student Research Committee, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Sima Rafiei
- Social determinants of health research center, Qazvin University of Medical Sciences, Qazvin, Iran (the Islamic Republic of)
| | - Fatemeh Pashazadeh Kan
- Student Research Committee, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Hossein Hosseinifard
- Research center for evidence based medicine, Tabriz University of Medical Sciences, Tabriz, Iran (the Islamic Republic of)
| | - Sepideh Rezaei
- Student Research Committee, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Saba Ahmadi
- Student Research Committee, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Niloofar Ahmadi
- Student Research Committee, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Samira Raoofi
- Student Research Committee, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Farnaz Aghajani
- Student Research Committee, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Afsaneh Dehnad
- Department of English Language, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Hosein Shabaninejad
- Population Health Sciences Institute (PHSI), Newcastle University, Newcastle, UK
| | - Sepideh Aghalou
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Hamide Shabani
- Student Research Committee, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Ahmad Ghashghaee
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran .,School of Public Health, Qazvin University of Medical Sciences, Qazvin, Iran
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20
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Hassan A, De Luca V, Dai N, Asmundo A, Di Nunno N, Monda M, Villano I. Effectiveness of Antipsychotics in Reducing Suicidal Ideation: Possible Physiologic Mechanisms. Healthcare (Basel) 2021; 9:healthcare9040389. [PMID: 33915767 PMCID: PMC8066782 DOI: 10.3390/healthcare9040389] [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] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/16/2021] [Accepted: 03/16/2021] [Indexed: 11/16/2022] Open
Abstract
Background: The aim of this study is to evaluate whether any specific antipsychotic regimen or dosage is effective in managing suicidal ideation in schizophrenia. Four comparisons were conducted between: (1) clozapine and other antipsychotics; (2) long-acting injectable and oral antipsychotics; (3) atypical and typical antipsychotics; (4) antipsychotics augmented with antidepressants and antipsychotic treatment without antidepressant augmentation. Methods: We recruited 103 participants diagnosed with schizophrenia spectrum disorders. Participants were followed for at least six months. The Beck Scale for Suicidal Ideation (BSS) was used to assess the severity of suicidal ideation at each visit. We performed a multiple linear regression model controlling for BSS score at study entry and other confounding variables to predict the change in the BSS scores between two visits. Results: Overall, there were 28 subjects treated with clozapine (27.2%), and 21 subjects with depot antipsychotics (20.4%). In our sample, 30 subjects experienced some suicidal ideation at study entry. When considering the entire sample, there was a statistically significant decrease in suicidal ideation severity in the follow-up visit compared to the study entry visit (p = 0.043). Conclusions: To conclude, our preliminary analysis implies that antipsychotics are effective in controlling suicidal ideation in schizophrenia patients, but no difference was found among alternative antipsychotics’ classes or dosages.
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Affiliation(s)
- Ahmed Hassan
- Group for Suicide Studies, CAMH, Department of Psychiatry, University of Toronto, Toronto, ON M5T1R8, Canada; (A.H.); (N.D.)
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON M5T1R8, Canada
| | - Vincenzo De Luca
- Group for Suicide Studies, CAMH, Department of Psychiatry, University of Toronto, Toronto, ON M5T1R8, Canada; (A.H.); (N.D.)
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON M5T1R8, Canada
- Correspondence: ; Tel.: +1-416-535-8501 (ext. 34421); Fax: +1-416-979-4666
| | - Nasia Dai
- Group for Suicide Studies, CAMH, Department of Psychiatry, University of Toronto, Toronto, ON M5T1R8, Canada; (A.H.); (N.D.)
| | - Alessio Asmundo
- Department of Biomedical and Dental Sciences, and of Morphological and Functional Images, Section of Legal Medicine, University of Messina, 98122 Messina, Italy;
| | - Nunzio Di Nunno
- Department of History, Society and Studies on Humanity, University of Salento, 73100 Lecce, Italy;
| | - Marcellino Monda
- Department of Experimental Medicine, Universita’ della Campania ‘Luigi Vanvitelli’, Via Santa Maria a Costantinopoli 16, I-80138 Naples, Italy; (M.M.); (I.V.)
| | - Ines Villano
- Department of Experimental Medicine, Universita’ della Campania ‘Luigi Vanvitelli’, Via Santa Maria a Costantinopoli 16, I-80138 Naples, Italy; (M.M.); (I.V.)
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21
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Briana DD, Malamitsi-Puchner A. Chorioamnionitis in utero, schizophrenia in adulthood: limited current evidence-future research focus? J Matern Fetal Neonatal Med 2021; 35:4782-4787. [PMID: 33435777 DOI: 10.1080/14767058.2020.1863370] [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: 01/18/2023]
Abstract
Background: Developmental adaptive processes during gestation that are known to be involved in permanent changes in physiology and metabolism or "early life programming" can adversely affect fetal brain development, impacting both brain structure and function.Data: Emerging evidence strongly supports the developmental origin of schizophrenia, which may potentially be a result of prenatal exposure to a diversity of factors, especially infections, in genetically predisposed subjects. Structural and functional brain changes during development of schizophrenia are determined by genetic components, altered expression of schizophrenia risk genes and epigenetic dysregulation. However, the precise mechanisms underlying these relationships remain unclear. Findings from human and animal studies suggest that inflammatory-immune responses and activation of oxidative stress pathways are crucial in mediating intrauterine infection-induced neurodevelopmental and neuropsychiatric diseases.Aim: Considering the high prevalence of intrauterine inflammation in the context of chorioamnionitis during human pregnancy and the paucity of knowledge on fetal programming of schizophrenia, this mini review aims to exclusively consolidate the current evidence supporting a potential association between chorioamnionitis and schizophrenia.
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Affiliation(s)
- Despina D Briana
- NICU, 3rd Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ariadne Malamitsi-Puchner
- NICU, 3rd Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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22
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Berardelli I, Rogante E, Sarubbi S, Erbuto D, Lester D, Pompili M. The Importance of Suicide Risk Formulation in Schizophrenia. Front Psychiatry 2021; 12:779684. [PMID: 34975579 PMCID: PMC8716825 DOI: 10.3389/fpsyt.2021.779684] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 11/02/2021] [Indexed: 12/31/2022] Open
Abstract
Suicide is a cause of early mortality in nearly 5% of patients with schizophrenia, and 25-50% of patients with schizophrenia attempt suicide in their lifetime. Evidence points to numerous individual, clinical, social, and psychological risk factors for suicide in patients with schizophrenia. Although recognizing suicidal risk factors in schizophrenia is extremely important in suicidal risk assessment, we have recently witnessed a change in suicide risk management that shifts the focus from suicide risk assessment to suicide risk formulation. Suicide risk formulation is dependent on the data gathered in the suicide risk assessment and assigns a level of suicide risk that is indispensable for the choice of treatment and the management of patients with a high suicidal risk. In this article, we extend the suicide risk formulation model to patients with schizophrenia. Suicide risk formulation results from four different areas that help clinicians collect as much information as possible for the management of suicidal risk. The four distinct judgments comprise risk status (the risk relating to the specific group to which the patient belongs), risk state (the risk for the person compared with his baseline or another reference point in the course of his life), available resources (on whom the person can count during a crisis) and foreseeable events (which can exacerbate the crisis). In schizophrenia, the suicide risk formulation model allows the clinician to evaluate in depth the clinical context of the patient, the patient's own history and patient-specific opportunities for better choosing and applying suicide prevention strategies.
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Affiliation(s)
- Isabella Berardelli
- Department of Neurosciences, Mental Health, and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Centre, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Elena Rogante
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Salvatore Sarubbi
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Denise Erbuto
- Department of Neurosciences, Mental Health, and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Centre, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - David Lester
- Psychology Program, Stockton University, Galloway, NJ, United States
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health, and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Centre, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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23
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Song Y, Rhee SJ, Lee H, Kim MJ, Shin D, Ahn YM. Comparison of Suicide Risk by Mental Illness: a Retrospective Review of 14-Year Electronic Medical Records. J Korean Med Sci 2020; 35:e402. [PMID: 33289369 PMCID: PMC7721561 DOI: 10.3346/jkms.2020.35.e402] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 09/16/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Korea is one of the countries with the highest rate of suicide, while suicidality is known to be closely related to mental illnesses. The study aimed to evaluate the suicide rates in psychiatric patients, to compare it to that of the general population, and to investigate the differences among psychiatric diagnoses and comorbidities. METHODS Medical records and mortality statistics of psychiatric patients at Seoul National University Hospital from 2003 to 2017 were reviewed. The standardized mortality ratio (SMR) for suicide was calculated to compare the psychiatric patients with the general population. The diagnosis-specific standardized mortality rate and hazard ratio (HR) were adjusted by age, sex, and psychiatric comorbidity (i.e., personality disorder and/or pain disorder). RESULTS A total of 40,692 survivors or non-suicidal deaths and 597 suicidal death were included. The suicide rate among psychiatric patients was 5.13-fold higher than that of the general population. Psychotic disorder had the highest SMR (13.03; 95% confidence interval [CI], 11.23-15.03), followed by bipolar disorder (10.26; 95% CI, 7.97-13.00) and substance-related disorder (6.78; 95% CI, 4.14-10.47). In survival analysis, psychotic disorder had the highest HR (4.16; 95% CI, 2.86-6.05), which was further increased with younger age, male sex, and comorbidity of personality disorder. CONCLUSION All psychiatric patients are at a higher risk of suicide compared to the general population, and the risk is highest for those diagnosed with psychotic disorder.
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Affiliation(s)
- Yoojin Song
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Jin Rhee
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
| | - Hyunju Lee
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
| | - Min Ji Kim
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
| | - Daun Shin
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
| | - Yong Min Ahn
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
- Institute of Human Behavioral Medicine, Seoul National University Medical Research Center, Seoul, Korea.
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24
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Harris K, Haddock G, Peters S, Gooding P. Psychological resilience to suicidal thoughts and behaviours in people with schizophrenia diagnoses : A systematic literature review. Psychol Psychother 2020; 93:777-809. [PMID: 31625283 DOI: 10.1111/papt.12255] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 09/13/2019] [Indexed: 12/01/2022]
Abstract
PURPOSE Suicide deaths are a major concern in people with schizophrenia diagnoses. However, many people with such diagnoses do not attempt suicide, nor die by suicide, suggesting that some individuals are resilient to the impact of suicide triggers. This systematic literature review aimed to (1) appraise the evidence for psychological factors which confer resilience to suicidal thoughts and behaviours, and (2) categorize these psychological factors into broader psychological constructs which characterize resilience. METHODS The review was conducted in accordance with the PRISMA guidelines for the reporting of systematic reviews. A literature search of four electronic databases (Web of Science, PubMed, PsycINFO, and MEDLINE) was conducted. A quality evaluation of the included studies was carried out by two independent researchers using a quality assessment tool. RESULTS Psychological factors from 27 studies were categorized into four constructs: (1) perceived social support, (2) holding religious and spiritual beliefs, (3) identifying reasons for living, and (4) perceived positive personal skills and attributes. CONCLUSIONS The limited literature showed that resilience is important in understanding suicidal thoughts and behaviours in people with schizophrenia diagnoses. There is a need for prospective research that investigates moderating effects of psychological resilience in the pathways to suicidal thoughts and behaviours in people with schizophrenia diagnoses. PRACTITIONER POINTS Novel evidence for four psychological constructs which may confer resilience to suicidal thoughts and behaviours in people with schizophrenia diagnoses. Strong evidence for the impact of perceived social support and appraisals of personal skills and attributes on the severity of suicidal experiences in people with schizophrenia diagnoses. There was equivocal evidence for the effect of holding religious and spiritual beliefs on suicide attempts. Clinical practice would benefit from assessing perceived personal attributes and levels of social support from significant others and health professionals.
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Affiliation(s)
- Kamelia Harris
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK.,Manchester Academic Health Science Centre (MAHSC), UK
| | - Gillian Haddock
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK.,Manchester Academic Health Science Centre (MAHSC), UK.,Greater Manchester Mental Health NHS Foundation Trust, UK
| | - Sarah Peters
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK.,Manchester Academic Health Science Centre (MAHSC), UK.,Manchester Centre for Health Psychology, University of Manchester, UK
| | - Patricia Gooding
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK.,Manchester Academic Health Science Centre (MAHSC), UK
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25
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Abstract
In the past 15 years, researchers utilizing prescription databases to assess medication usage have concluded that antipsychotics reduce mortality in patients diagnosed with schizophrenia and other psychotic disorders. These findings stand in contrast to studies in non-psychiatric patients that have found that antipsychotics, because of their adverse effects on physical health, increase the risk of early death. A critical review of the evidence reveals that the worry remains. There is reason to conclude that antipsychotics contribute to the 'mortality gap' between the seriously mentally ill and the general population and that the database studies are plagued with methodological and reporting issues. Most importantly, the database studies tell of mortality rates within a drug-centered paradigm of care, which confounds any comparison of mortality risks when patients are on or off antipsychotics.
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Dragoi AM, Radulescu I, Năsui BA, Pop AL, Varlas VN, Trifu S. Clozapine: An Updated Overview of Pharmacogenetic Biomarkers, Risks, and Safety-Particularities in the Context of COVID-19. Brain Sci 2020; 10:E840. [PMID: 33187329 PMCID: PMC7697202 DOI: 10.3390/brainsci10110840] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/06/2020] [Accepted: 11/08/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND clozapine (CLZ) use is precarious due to its neurological, cardiovascular, and hematological side effects; however, it is the gold standard in therapy-resistant schizophrenia (TRS) in adults and is underused. OBJECTIVE to examine the most recent CLZ data on (a) side effects concerning (b) recent pharmacological mechanisms, (c) therapy benefits, and (d) the particularities of the COVID-19 pandemic. DATA SOURCES a search was performed in two databases (PubMed and Web of Science) using the specific keywords "clozapine" and "schizophrenia", "side effects", "agranulocytosis", "TRS", or "bipolar affective disorder (BAF)" for the last ten years. STUDY ELIGIBILITY CRITERIA clinical trials on adults with acute symptoms of schizophrenia or related disorders. RESULTS we selected 37 studies, randomized controlled trials (RCTs), and clinical case series (CCS), centered on six main topics in the search area: (a) CLZ in schizophrenia, (b) CLZ in bipolar disorder, (c) side effects during the clozapine therapy, (d) CLZ in pregnancy, (e) CLZ in early-onset schizophrenia, and (f) CLZ therapy and COVID-19 infection. LIMITATIONS we considered RCTs and CCS from two databases, limited to the search topics. Conclusions and implications of key findings: (a) clozapine doses should be personalized for each patient based on pharmacogenetics testing when available; the genetic vulnerability postulates predictors of adverse reactions' severity; patients with a lower genetic risk could have less frequent hematological monitoring; (b) a CLZ-associated risk of pulmonary embolism imposes prophylactic measures for venous thromboembolism; (c) convulsive episodes are not an indication for stopping treatment; the plasma concentration of clozapine is a better side effect predictor than the dosage; (d) COVID-19 infection may enhance clozapine toxicity, generating an increased risk of pneumonia. Therapy must be continued with the proper monitoring of the white blood count, and the clozapine dose decreased by half until three days after the fever breaks; psychiatrists and healthcare providers must act together.
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Affiliation(s)
- Ana Miruna Dragoi
- Department of Psychiatry, “Alexandru Obregia” Clinical Hospital for Psychiatry, 10 Berceni St., 041914 Bucharest, Romania;
| | - Ioana Radulescu
- Department of General Medicine, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu St., 020021 Bucharest, Romania; (I.R.); (V.N.V.)
| | - Bogdana Adriana Năsui
- Department of Community Health, “Iuliu Hațieganu” University of Medicine and Pharmacy, 6 Louis Pasteur St., 400349 Cluj-Napoca, Romania; or
| | - Anca Lucia Pop
- Department of Clinical Laboratory, Food Safety, “Carol Davila” University of Medicine and Pharmacy, 6 Traian Vuia St., 020945 Bucharest, Romania
| | - Valentin Nicolae Varlas
- Department of General Medicine, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu St., 020021 Bucharest, Romania; (I.R.); (V.N.V.)
| | - Simona Trifu
- Department of Clinical Neurosciences, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu St., 020021 Bucharest, Romania;
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27
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Hui L, Hu WM, Zhu ZH, Gao ST, Han M, Fan Y, Tian Q, Yin XY, Yuan Y, Jiang CX, Yin GZ, Jia QF, Zhang XY. Association between dopamine beta-hydroxylase polymorphism and attention function in suicide attempters with chronic schizophrenia. Hum Psychopharmacol 2020; 35:1-8. [PMID: 32896003 DOI: 10.1002/hup.2755] [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: 11/13/2019] [Revised: 07/13/2020] [Accepted: 08/03/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND Patients with schizophrenia are at a higher risk for suicide compared with the general population. Dopamine beta-hydroxylase (DβH) plays a key role in the conversion of dopamine to norepinephrine, which is related to suicidal behavior and cognitive regulation. OBJECTIVE To examine whether there is the effect of DβH 5'-insertion/deletion (Ins/Del) polymorphism on cognitive performance in suicide attempters with chronic schizophrenia. METHODS This polymorphism was detected in 114 suicide attempters and 617 non-suicide attempters with chronic schizophrenia. Cognitive performance was assessed by the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). RESULTS The allelic and genotypic frequencies of this polymorphism between two groups did not differ after controlling for covariates (both, p > .05). There were no differences in RBANS scores between two groups after adjusting for covariates (all, p > .05). However, based on the genotype grouping in suicide attempters and non-attempters, the attention score significantly differed after adjusting for covariates (both, p < .05). Further analysis indicated that this polymorphism was associated with attention score in suicide attempters (p < .05), but not in non-suicide attempters (p > .05). CONCLUSIONS DβH 5'-Ins/Del polymorphism was not a risk locus of suicide attempters, but it was implicated in attention regulation in suicide attempters with chronic schizophrenia.
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Affiliation(s)
- Li Hui
- Research Center of Biological Psychiatry, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Wei Ming Hu
- Mental Health Center of Yanqing District, Beijing, China
| | - Zhen Hua Zhu
- Research Center of Biological Psychiatry, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | | | - Mei Han
- School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Yu Fan
- Research Center of Biological Psychiatry, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Qing Tian
- Research Center of Biological Psychiatry, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xu Yuan Yin
- Research Center of Biological Psychiatry, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Ying Yuan
- Research Center of Biological Psychiatry, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Cai Xia Jiang
- Research Center of Biological Psychiatry, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Guang Zhong Yin
- Research Center of Biological Psychiatry, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Qiu Fang Jia
- Research Center of Biological Psychiatry, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xiang Yang Zhang
- Research Center of Biological Psychiatry, The Affiliated Guangji Hospital of Soochow University, Suzhou, China.,Institute of Psychology, Chinese Academy of Sciences, Beijing, China
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28
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Taipale H, Lähteenvuo M, Tanskanen A, Mittendorfer-Rutz E, Tiihonen J. Comparative Effectiveness of Antipsychotics for Risk of Attempted or Completed Suicide Among Persons With Schizophrenia. Schizophr Bull 2020; 47:23-30. [PMID: 33428766 PMCID: PMC7824993 DOI: 10.1093/schbul/sbaa111] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The objective of our study was to investigate the comparative effectiveness of antipsychotics for the risk of attempted or completed suicide among all patients with schizophrenia in Finland and Sweden. METHODS Two nationwide register-based cohort studies were conducted, including all individuals with schizophrenia in Finland (n = 61 889) and Sweden (n=29 823). The main exposure was 10 most commonly used antipsychotic monotherapies; also, adjunctive pharmacotherapies were investigated. The main outcome measure was attempted or completed suicide, which was analyzed with within-individual models by comparing use and nonuse periods in the same individual to minimize selection bias. Sensitivity analyses included attempted suicide (hospitalization only) as an outcome. RESULTS Compared with no use of antipsychotics, clozapine use was the only antipsychotic consistently associated with a decreased risk of suicidal outcomes. Hazard ratios (HRs) and 95% CIs for attempted or completed suicide were 0.64 (0.49-0.84) in the Finnish cohort and 0.66 (0.43-0.99) in the Swedish cohort. No other antipsychotic was associated with a reduced risk of attempted and/or completed suicide. Benzodiazepines and Z-drugs were associated with an increased risk of attempted or completed suicide (HRs: 1.29-1.30 for benzodiazepines and 1.33-1.62 for Z-drugs). CONCLUSION Clozapine was the only antipsychotic associated with decreased risk of attempted or completed suicide among patients with schizophrenia, and it should be considered as first-line treatment for high-risk patients.
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Affiliation(s)
- Heidi Taipale
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,School of Pharmacy, University of Eastern Finland, Kuopio, Finland,To whom correspondence should be addressed; tel: 358 50 3418363, fax: 358 17 368 2419, e-mail:
| | - Markku Lähteenvuo
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
| | - Antti Tanskanen
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | - Jari Tiihonen
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden
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29
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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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30
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Günther MP, Kirchebner J, Kling S, Lau S. Antipsychotic Overdosing and Polypharmacy in Schizophrenic Delinquents Explored. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2020; 64:938-952. [PMID: 31884869 DOI: 10.1177/0306624x19895903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A logistic regression model for 289 cases of schizophrenic offenders in a Swiss forensic hospital between 1995 and 2016 revealed the following factors for above average levels of antipsychotic overdosing and polypharmacy: Odds for overdosing increased in absence of a personality disorder (237%), for each point increase in emotional withdrawal (63.5%) and motor retardation (71.7%), and decreased for poor rapport (42.3%) recorded at admission. Odds for polypharmacy increased with complaints about physicians (157%), for each point increase in IQ (3.6%; range = 65-131, M = 92, SD = 14), reduction of the security level of the ward (36.8%; four levels), and for each point increase in poor attention (27.6%) at admission. It decreased with each previous conviction (10.9%; range = 1-21, M = 3, SD = 2), breaking of rules (46.4%) and the administration of compulsory measures (55.7%) on the ward, a poor legal prognosis (29.4%, four levels), and each point increase in grandiosity (40.3%), passive social withdrawal (42.3%), and depressive symptoms (38.7%) at admission.
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Affiliation(s)
- M P Günther
- University Hospital of Psychiatry Zurich, Switzerland
| | - J Kirchebner
- University Hospital of Psychiatry Zurich, Switzerland
| | - S Kling
- Swiss Federal Institute of Technology (ETH) Zurich, Switzerland
| | - S Lau
- University Hospital of Psychiatry Zurich, Switzerland
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31
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Díaz-Fernández S, Frías-Ortiz DF, Fernández-Miranda JJ. Suicide attempts in people with schizophrenia before and after participating in an intensive case managed community program: A 20-year follow-up. Psychiatry Res 2020; 287:112479. [PMID: 31377009 DOI: 10.1016/j.psychres.2019.112479] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 07/09/2019] [Accepted: 07/09/2019] [Indexed: 01/22/2023]
Abstract
Lack of treatment compliance in patients with schizophrenia is a risk factor that leads to illness-relapse, hospitalization and potentially strengthens suicidal behavior. The purpose of this investigation was to assess treatment adherence, reasons for treatment discharge, suicidal behaviour and impact of route of antipsychotics administration in a group of patients with schizophrenia treated in a comprehensive, community-based, intensive case managed program for people with severe mental illness. And to compare it to previous standard treatment received in mental health units (MHU). An observational, longitudinal, mirror-image study of patients with severe schizophrenia (N = 344) was carried out: ten years of follow-up (Program) and ten years retrospective (MHU). Reasons for treatment discharge, suicide attempts and antipsychotic (AP) medication were recorded. Treatment adherence during the Program was higher than in MHU (abandonment of treatment: 12.2% vs. 84.3% of patients). Forty patients died during follow-up, five of them due to suicide. Suicidal attempts significantly decreased during Program treatment compared to the standard one (7.6% vs. 38.9% of patients). Long-acting injectable (LAI) AP medication was significantly related to this outcome. A combination of intensive case-managed and LAIAP treatment helped to improve compliance and to reduce suicidal behavior compared to standard treatment in patients with severe schizophrenia.
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Affiliation(s)
- Sylvia Díaz-Fernández
- Centro de Tratamiento Integral-AGC SM-HUCAB-SESPAsturian Mental Health Service, Gijón, Spain; Health Sciences Dt. Camilo J Cela University, Madrid, Spain
| | - Danny F Frías-Ortiz
- Centro de Tratamiento Integral-AGC SM-HUCAB-SESPAsturian Mental Health Service, Gijón, Spain; Health Sciences Dt. Camilo J Cela University, Madrid, Spain
| | - Juan J Fernández-Miranda
- Centro de Tratamiento Integral-AGC SM-HUCAB-SESPAsturian Mental Health Service, Gijón, Spain; Health Sciences Dt. Camilo J Cela University, Madrid, Spain.
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32
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Wang W, Zhou Y, Wang J, Xu H, Wei S, Wang D, Wang L, Zhang XY. Prevalence, clinical correlates of suicide attempt and its relationship with empathy in patients with schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2020; 99:109863. [PMID: 31931089 DOI: 10.1016/j.pnpbp.2020.109863] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/06/2020] [Accepted: 01/09/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Previous studies have shown that cognitive impairment plays a key role in suicide, an important factor leading to premature death in schizophrenia (SCZ) patients. Empathy has received extensive attention recently; however, the relationship of empathy with suicide in schizophrenia is still unknown. The main aim of this study was to investigate the prevalence of suicide attempts and its association with empathy and other characteristics in Chinese chronic SCZ patients. METHODS The suicide attempt data, together with demographic characteristics and clinical variables were collected from 627 chronic inpatients with schizophrenia. We utilized the Positive and Negative Syndrome Scale (PANSS) for the psychopathological symptoms, and the Interpersonal Reactivity Index (IRI) for affective and cognitive empathy in this study. RESULTS We found a suicide attempt rate of 11.3% in chronic SCZ patients. Compared to non-attempters, suicide attempters were more likely to be women, had younger age and higher education levels, as well as higher positive symptoms and depressive factor score, but lower negative symptoms of PANSS (all p < .05). Moreover, after controlling the confounding factors, suicide attempters scored higher in Personal Distress subscale of IRI (F1, 455 = 5.446, p = .020) than non-attempters. CONCLUSIONS The prevalence of suicide attempt is high in chronic SCZ patients. Its risk factors include some demographic and clinical variables. Moreover, suicide attempters experienced stronger personal distress, suggesting that stronger empathy may be a risk factor of suicide.
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Affiliation(s)
- Wenjia Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yongjie Zhou
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China; Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China
| | - Jiesi Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Hang Xu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Shuochi Wei
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Dongmei Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Li Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Xiang Yang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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Woottiluk P, Maneeton B, Jaiyen N, Khemawichanurat W, Kawilapat S, Maneeton N. Prevalence and associated factors of suicide among hospitalized schizophrenic patients. World J Clin Cases 2020; 8:757-770. [PMID: 32149059 PMCID: PMC7052544 DOI: 10.12998/wjcc.v8.i4.757] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/15/2019] [Accepted: 01/14/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Previous studies found several factors associated with suicide in schizophrenic patients, such as age, sex, education level, history of suicide attempts, psychotic symptoms, social factors, and substance abuse. However, there might be some additional factors that were not considered in previous studies but may be correlated with a greater likelihood of suicide attempts, such as medication and treatment.
AIM To investigate the prevalence of suicide attempts and identify the risk of suicidality in hospitalized schizophrenia patients.
METHODS This is a cross-sectional study of schizophrenic patients admitted to a psychiatric hospital who were 18 years of age or more. The outcomes and possible suicide risk factors in these patients were collated. The current suicide risk was evaluated using the mini-international neuropsychiatric interview module for suicidality and categorized as none (0 points), mild (1-8 points), moderate (9-16 points), or severe (17 or more points). This study used ordinal logistic regression to assess the association of potential risk factors with the current suicide risk in schizophrenic patients.
RESULTS Of 228 hospitalized schizophrenia patients, 214 (93.9%) were included in this study. The majority (79.0%) of patients were males. Females appeared to have a slightly higher suicidality risk than males, with borderline significance. With regard to the current suicide risk assessed with the mini-international neuropsychiatric interview, 172 (80.4%) schizophrenic patients scored zero, 20 (9.4%) had a mild risk, 8 (3.7%) had a moderate risk, and 14 (6.5%) had a severe risk. The total prevalence of current suicide risk in these schizophrenic patients was 19.6%. Based on multivariable ordinal logistic regression analysis with backward elimination, it was found that younger age, a current major depressive episode, receiving fluoxetine or lithium carbonate in the previous month, or a relatively higher Charlson comorbidity index score were all significantly and independently associated with a higher level of suicide risk.
CONCLUSION The prevalence rate of suicide attempts in schizophrenia is high. Considering risk factors in routine clinical assessments, environmental manipulations and adequate treatment might prevent or decrease suicide in these patients.
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Affiliation(s)
- Pakapan Woottiluk
- Psychiatric Nursing Division, Faculty of Nursing, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Benchalak Maneeton
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Natthanan Jaiyen
- Graduate School, Chiang Mai University, Chiang Mai 50200, Thailand
| | | | - Suttipong Kawilapat
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Narong Maneeton
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
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34
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Jameel HT, Panatik SA, Nabeel T, Sarwar F, Yaseen M, Jokerst T, Faiz Z. Observed Social Support and Willingness for the Treatment of Patients with Schizophrenia. Psychol Res Behav Manag 2020; 13:193-201. [PMID: 32158288 PMCID: PMC7049275 DOI: 10.2147/prbm.s243722] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 02/05/2020] [Indexed: 11/23/2022] Open
Abstract
Background Schizophrenia is a mental disorder that causes the social breakdown of relationships with others. Patients with schizophrenia interpret reality and verbal communication in an abnormal way. They experience great difficulty in building and maintaining of social relationships within society. They also experience barriers in communication and motivation that hinder their readiness for treatment. The willingness of patients with schizophrenia to be treated improves mental illness, social support and other health-related issues. The main purpose of this study was to explore the relationship between social support and willingness for treatment in patients with Schizophrenia. Methods The qualitative research approach was used to solicit and capture more in-depth information from participants. The research design was phenomenological in nature. A cross-sectional survey method was employed. The sample consisted of twenty female patients diagnosed with schizophrenia, seven psychiatrists, and seven psychologists. A semi-structured interview guide was developed to collect the data. The interview guide covered three themes. The first theme included four questions for patients with schizophrenia. The second theme consisted of six questions for the psychiatrists and the third theme included two questions for the psychologists. Interview data were analysed through frame workanalysis. Results The results of the study showed that social support plays an essential role in the improvement of patients with schizophrenia. Psychiatrists with the help of medication and therapies reduce the negativity and anxiety level of patients and motivate patients to accept treatment. Through counseling, psychologists help patients with schizophrenia build social skills such as the ability to engage in eye contact. Conclusion It is revealed that the social support is closely related to the willingness for treatment in patients with schizophrenia. Therefore, social support is recommended in the course of treatment of patients with schizophrenia.
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Affiliation(s)
- Hafiz Tahir Jameel
- Department of Special Education, Allama Iqbal Open University, Islamabad, Pakistan
| | - Siti Aisyah Panatik
- School of Human Resource Development and Psychology, Faculty of Social Sciences and Humanities, Universiti Teknologi Malaysia, Johor Bahru, Johor, Malaysia
| | - Tanzila Nabeel
- Department of Special Education, Allama Iqbal Open University, Islamabad, Pakistan
| | - Farhan Sarwar
- Department of Business Administration and Economics, University of Education, Township Campus, Lahore, Pakistan
| | - Muhammad Yaseen
- Department of Mathematics and Statistics, University of Agriculture, Faisalabad, Pakistan
| | - Tricia Jokerst
- Special Education, Huston-Tillotson University, Austin, TX, USA
| | - Zikra Faiz
- School of Social Sciences and Humanities, University of Management and Technology, Lahore, Pakistan
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Kamil Gharab KM, Onmaz DE, Abusoglu S, Aydin M, Sivrikaya A, Tok O, Abusoglu G, Unlu A. The relationship between serum clozapine concentrations and hematological parameters by a validated mass spectrometric method. J Pharm Biomed Anal 2020; 180:113056. [PMID: 31887669 DOI: 10.1016/j.jpba.2019.113056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/10/2019] [Accepted: 12/18/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Clozapine is one of the most effective drugs for resistant schizophrenia, but its severe metabolic and hematological side effects limit the use of clozapine. It has been reported that clozapine blood concentrations should be maintained between 350-600 ng/mL. Our aim was to develop a determination method for clozapine and its main metabolites norclozapine and clozapine-N-oxide, to perform validation studies and to investigate the change of various biochemical parameters in patients using clozapine. METHODS A liquid chromatography-tandem mass spectrometry (LC-MS/MS) method was developed and validated for clozapine measurement. Thus, blood samples were collected from 38 patients with schizophrenia and 32 healthy volunteers. Biochemical and hematological parameters were measured by Beckman-Coulter AU 5800 (Beckman Coulter, Brea, USA) and Beckman Coulter LH 780 analyzer (Beckman Coulter, Miami, FL, USA), respectively. Hormone levels were analyzed using Cobas 6000 analyzer (Roche Diagnostics, Germany). RESULTS The LCMS/MS method was linear between 1.22-2500 ng/mL (r2 = 0.9971) for clozapine. The retention times of clozapine, norclozapine and clozapine-N-oxide were 0.92, 0.89 and 0.95, respectively. Blood glucose (GLU) (p = 0.025), low density lipoprotein (LDL-cholesterol) (p = 0.015), triglyseride (TG) (p = 0.042) and total cholesterol (TC) (p = 0.024) levels were higher; hemoglobin (HGB) (0.015), mean corpuscular hemoglobin (MCH) (0.036), red blood cell count (RBC) (0.020), neutrophil (NEU) (0.034), and platelet (PLT) (P = 0.005) levels were lower in the clozapine group. CONCLUSIONS This LC-MS/MS method was rapid, simple, cost-effective and suitable for the routine clozapine monitoring. Furthermore, norclozapine and clozapine-N-oxide were also determined. Monitoring of metabolic and hematological parameters with clozapine levels is very important. However, the limitations of the study were that the method was not validated for norclozapine and clozapine-N-oxide, so the validation parameters were not evaluated for these two metabolites.
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Affiliation(s)
| | - Duygu Eryavuz Onmaz
- Department of Biochemistry, Selcuk University, Faculty of Medicine, Konya, Turkey.
| | - Sedat Abusoglu
- Department of Biochemistry, Selcuk University, Faculty of Medicine, Konya, Turkey
| | - Memduha Aydin
- Department of Psychiatry, Selcuk University, Faculty of Medicine, Konya, Turkey
| | - Abdullah Sivrikaya
- Department of Biochemistry, Selcuk University, Faculty of Medicine, Konya, Turkey
| | - Oguzhan Tok
- Department of Biochemistry, Selcuk University, Faculty of Medicine, Konya, Turkey
| | - Gulsum Abusoglu
- Department of Medical Laboratory Techniques, Selcuk University, Vocational School of Health, Konya, Turkey
| | - Ali Unlu
- Department of Biochemistry, Selcuk University, Faculty of Medicine, Konya, Turkey
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Chiappini S, Schifano F, Corkery JM, Guirguis A. Focus on Clozapine Withdrawal- and Misuse-Related Cases as Reported to the European Medicines Agency (EMA) Pharmacovigilance Database. Brain Sci 2020; 10:E105. [PMID: 32079135 PMCID: PMC7071448 DOI: 10.3390/brainsci10020105] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/11/2020] [Accepted: 02/14/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Clozapine is of high clinical relevance for the management of both treatment-resistant schizophrenia and psychotic disturbances with concurrent drug misuse. Although the molecule presents with a range of well-known side-effects, its discontinuation/withdrawal syndrome has been only anecdotally described. AIMS the 2005-2018 European Medicines Agency (EMA) dataset of Adverse Drug Reactions (ADRs) was analyzed to identify and describe possible clozapine withdrawal- and misuse-/abuse-/dependence-related issues. METHOD A descriptive analysis of clozapine-related ADRs was performed when available, data on ADRs' outcome, dosage, and possible concomitant drug(s) were considered. RESULTS Out of 11,847 clozapine-related ADRs, some 599 (5.05%) were related to misuse/abuse/dependence/withdrawal issues, including 258 withdrawal-related (43.1%); 241 abuse-related (40.2%); and 80 intentional product misuse-related (13.3%) ADRs. A small number of overdose- and suicide-related ADRs were reported as well. Clozapine was typically (69.2%) identified alone, and most (84.7%) fatalities/high-dosage intake instances were reported in association with a history of substance abuse. CONCLUSIONS Previous suggestions about the possibility of a clozapine discontinuation/withdrawal occurrence are here supported, but further studies are needed. However, the misuse/abuse cases here identified might be difficult to interpret, given the lack of studies highlighting the possible recreational use of clozapine. The high-dosage intake, fatal outcomes and clozapine/polydrug abuse issues reported here may, however, be a reason for concern.
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Affiliation(s)
- Stefania Chiappini
- Psychopharmacology, Drug Misuse, and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Hertfordshire AL10 9AB, UK; (S.C.); (J.M.C.)
| | - Fabrizio Schifano
- Psychopharmacology, Drug Misuse, and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Hertfordshire AL10 9AB, UK; (S.C.); (J.M.C.)
| | - John Martin Corkery
- Psychopharmacology, Drug Misuse, and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Hertfordshire AL10 9AB, UK; (S.C.); (J.M.C.)
| | - Amira Guirguis
- Swansea University Medical School, Institute of Life Sciences 2, Swansea University, Singleton Park, Swansea SA2 8PP, UK;
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Tor PC, Bin Abdin E, Hadzi-Pavlovic D, Loo C. Relief of expressed suicidality in schizophrenia after electroconvulsive therapy: A naturalistic cohort study. Psychiatry Res 2020; 284:112759. [PMID: 31927303 DOI: 10.1016/j.psychres.2020.112759] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 12/10/2019] [Accepted: 01/03/2020] [Indexed: 11/18/2022]
Abstract
Suicide risk in schizophrenia is a significant treatment challenge but there are few approved treatments. Electroconvulsive therapy (ECT) is a highly effective treatment for suicidality in depression but its effect on suicidality in schizophrenia is unclear. We conducted a retrospective naturalistic study of the real-world effect of ECT on expressed suicidality as assessed by item 4 of the 24-item Brief Psychiatric Rating Scale in 113 patients with treatment resistant schizophrenia receiving ECT. 19.5% of patients expressed suicidal ideation pre-ECT of which 86.4% experienced an improvement in expressed suicidality after an average of 10.2 (SD 2.7) sessions of ECT. Changes in suicide scores before and after ECT was examined using a generalized estimating equation (GEE) model which showed that the effect of ECT on suicide was significantly mediated by depression and explained 72.2% of the decreased in expressed suicidality. ECT is effective in decreasing depression and expressed suicidality in patients with schizophrenia and should be considered as a treatment option for managing suicidality and psychosis in patients with treatment resistant schizophrenia.
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Affiliation(s)
- Phern-Chern Tor
- Department of Mood and Anxiety, Institute of Mental Health, , 10 Buangkok View, Buangkok Green Medical Park, Hougang 539747, Singapore.
| | | | | | - Colleen Loo
- School of Psychiatry, University of New South Wales, Sydney, Australia; The Black Dog Institute, Sydney, Australia; St George Hospital, Sydney, Australia
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Zhong Y, Xia L, Zhao TT, Zhang YL, Zhang YL, Li WZ, Hu YQ, Yao XH, Ungvari GS, Balbuena L, Liu HZ, Xiang YT. The Prevalence of Suicide Attempts and Independent Demographic and Clinical Correlates among Chronic Schizophrenia Patients in Agricultural Areas of China. Psychiatr Q 2019; 90:683-691. [PMID: 31102121 DOI: 10.1007/s11126-019-09644-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This study investigated the lifetime prevalence of suicide attempts (SA) and independent demographic and clinical correlates in stabilized schizophrenia inpatients. A cross-sectional study was conducted in three psychiatric hospitals in Anhui province, an agricultural province located in east China. Psychopathology and depressive symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS) and Hamilton Depression Rating Scale (HAMD), respectively. A total of 315 stable schizophrenia inpatients were interviewed prior to discharge. The lifetime prevalence of SA was 22.2%. Multiple logistic regression analysis revealed that female gender (P < 0.001, OR = 3.4, 95%CI: 1.9-6.0), being married (P = 0.02, OR = 2.2, 95%CI: 1.1-4.4) and having more severe depressive symptoms (P = 0.014, OR = 1.2, 95%CI: 1.01-1.3) were independently and significantly associated with higher risk of SA. Lifetime SA is common among hospitalized schizophrenia patients living in agricultural areas of China. For suicide prevention, regular assessments, appropriate interventions and clinical management should be integrated into a community-based psychiatric service model for this population.
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Affiliation(s)
- Yi Zhong
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 Chaohu North Road, Hefei, Anhui Province, China.,Anhui Psychiatric Center, Anhui Medical University, Anhui Province, China
| | - Lei Xia
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 Chaohu North Road, Hefei, Anhui Province, China.,Anhui Psychiatric Center, Anhui Medical University, Anhui Province, China
| | - Tong-Tong Zhao
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 Chaohu North Road, Hefei, Anhui Province, China.,Anhui Psychiatric Center, Anhui Medical University, Anhui Province, China
| | - Yu-Long Zhang
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 Chaohu North Road, Hefei, Anhui Province, China.,Anhui Psychiatric Center, Anhui Medical University, Anhui Province, China
| | - Ye-Lei Zhang
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 Chaohu North Road, Hefei, Anhui Province, China.,Anhui Psychiatric Center, Anhui Medical University, Anhui Province, China
| | - Wen-Zheng Li
- Anhui Psychiatric Center, Anhui Medical University, Anhui Province, China.,Hefei Fourth People's Hospital, Anhui Province, China
| | - Yan-Qiong Hu
- Hefei Fourth People's Hospital, Anhui Province, China
| | - Xian-Hu Yao
- MaAnshan Fourth People's Hospital, Anhui Province, China
| | - Gabor S Ungvari
- The University of Notre Dame Australia / Graylands Hospital, Perth, Australia.,Division of Psychiatry, Medical School, University of Western Australia, Perth, Australia
| | - Lloyd Balbuena
- Department of Psychiatry, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Huan-Zhong Liu
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 Chaohu North Road, Hefei, Anhui Province, China. .,Anhui Psychiatric Center, Anhui Medical University, Anhui Province, China.
| | - Yu-Tao Xiang
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, 3/F, Building E12, Avenida da Universidade, Taipa, Macau, SAR, China.
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Alli S, Tasmim S, Adanty C, Graff A, Strauss J, Zai C, Gerretsen P, Borlido C, De Luca V. Childhood trauma predicts multiple, high lethality suicide attempts in patients with schizophrenia. Psychiatry Res 2019; 281:112567. [PMID: 31586840 DOI: 10.1016/j.psychres.2019.112567] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 09/12/2019] [Accepted: 09/12/2019] [Indexed: 11/17/2022]
Abstract
Childhood trauma has been shown to increase the risk of suicide attempts in individuals with schizophrenia. However, previous literature has been limited by considerable heterogeneity within the category of suicide attempters. Here we tested the predictive effect of childhood maltreatment on lifetime suicide attempt in a homogeneous sample of 650 patients with schizophrenia spectrum disorders. Childhood trauma was assessed using the Childhood Trauma Questionnaire-Short Form and suicide history was measured using subjective and objective validated scales as well as medical chart reviews. We refined our sample into two homogenous groups: 1) suicide attempters: patients who had attempted suicide multiple times, with highly lethal results (medical hospitalization required) (n = 24); and 2) non-ideators: patients who had no personal history of suicide attempt or ideation, or family history of attempt (n = 25). Binary logistic regression models revealed that total childhood trauma (β = 0.002; OR: 1.07; 95% CI: 1.00-1.14) and emotional abuse (β = 0.04; OR: 1.38; 95% CI: 1.08-1.77), but not other trauma subtypes, significantly predicted lifetime multiple, high lethality suicide attempts after adjusting for demographic and clinical covariates. Thus, childhood trauma is a weak, independent risk factor for extreme suicide attempts in patients with schizophrenia spectrum disorders.
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Affiliation(s)
- Sauliha Alli
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Samia Tasmim
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | - Ariel Graff
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - John Strauss
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Clement Zai
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Philip Gerretsen
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Carol Borlido
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Vincenzo De Luca
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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Navin K, Kuppili PP, Menon V, Kattimani S. Suicide Prevention Strategies for General Hospital and Psychiatric Inpatients: A Narrative Review. Indian J Psychol Med 2019; 41:403-412. [PMID: 31548762 PMCID: PMC6753714 DOI: 10.4103/ijpsym.ijpsym_169_19] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 06/18/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND In-patient (IP) suicides contribute a small but significant proportion of overall suicides. Despite this, suicide prevention strategies focusing on the general hospital IP population remain relatively underresearched. This paper is intended to provide an overview of various proposed suicide prevention approaches in the general hospital, including psychiatric IP, settings, and their evidence base. METHODOLOGY Electronic searches of MEDLINE through PubMed, ScienceDirect, and Google Scholar databases were performed to identify potentially relevant articles from inception till January 2019. The generated abstracts were systematically screened for their eligibility to be included in the review. Included articles were grouped under five broad themes: environmental modification, staff education, pharmacotherapy, psychotherapy, and brain stimulation. Data extraction was done using a structured proforma. RESULTS Environmental modifications and educating the health care professionals appear to be the most promising strategies to reduce suicide-related mortality among IPs. Among pharmacological methods, ketamine has shown initial promise in reducing suicidal ideations. Follow-up data are lacking for most of the described methods. Limited but positive evidence exists for cognitive therapies focusing on the immediate postadmission period and brain stimulation techniques, and it warrants further replication. CONCLUSION There is a striking paucity of original research on IP suicide prevention. Given the ethical and methodological issues in carrying out studies with IP suicide as the primary outcome, there is a need to focus on intermediate suicide outcome measures, such as knowledge, attitude, and skills among staff handlers of suicidal patients.
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Affiliation(s)
- Karthick Navin
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Pooja Patnaik Kuppili
- Department of Psychiatry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Vikas Menon
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Shivanand Kattimani
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Gohar SM, Dieset I, Steen NE, Mørch RH, Vedal TSJ, Reponen EJ, Steen VM, Andreassen OA, Melle I. Association between leptin levels and severity of suicidal behaviour in schizophrenia spectrum disorders. Acta Psychiatr Scand 2019; 139:464-471. [PMID: 30848483 PMCID: PMC6593433 DOI: 10.1111/acps.13019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/04/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Associations between suicidality and lipid dysregulation are documented in mental illness, but the potential role of leptin remains unclear. We examined the association between leptin and suicidal behaviour in schizophrenia, together with the influence of other clinical and biological indices. METHOD We recruited a sample of 270 participants with schizophrenia spectrum diagnoses. Blood samples were analysed for leptin, while symptom severity was assessed by Positive and Negative Syndrome Scale (PANSS) and Inventory of Depressive Symptomatology (IDS-C). Patients' history of suicidal behaviour was categorized into three subgroups based on IDS-C suicide subscale: No suicidal behaviour, mild/moderate suicidal behaviour and severe suicidal behaviour with/without attempts. RESULTS Mild/moderate suicidal behaviour was present in 17.4% and severe suicidal behaviour in 34.8%. Both groups were significantly associated with female gender (OR = 6.0, P = 0.004; OR = 5.9, P = 0.001), lower leptin levels (OR = 0.4, P = 0.008; OR = 0.5, P = 0.008) and more severe depression (OR = 1.2, P < 0.001; OR = 1.1, P < 0.001) respectively. Smoking (OR = 2.6, P = 0.004), younger age of onset (OR = 0.9, P = 0.003) and less use of leptin-increasing medications (OR = 0.5, P = 0.031) were associated with severe/attempts group, while higher C-reactive protein CRP (OR = 1.3, P = 0.008) was associated with mild/moderate group. CONCLUSION Lower leptin levels were associated with higher severity of suicidal behaviour in schizophrenia.
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Affiliation(s)
- S. M. Gohar
- NORMENT, K.G. Jebsen Centre for Psychosis ResearchInstitute of Clinical MedicineUniversity of OsloOsloNorway,Division of Mental Health and AddictionOslo University HospitalOsloNorway,Department of PsychiatryFaculty of MedicineCairo UniversityCairoEgypt
| | - I. Dieset
- NORMENT, K.G. Jebsen Centre for Psychosis ResearchInstitute of Clinical MedicineUniversity of OsloOsloNorway,Division of Mental Health and AddictionOslo University HospitalOsloNorway
| | - N. E. Steen
- NORMENT, K.G. Jebsen Centre for Psychosis ResearchInstitute of Clinical MedicineUniversity of OsloOsloNorway,Division of Mental Health and AddictionOslo University HospitalOsloNorway
| | - R. H. Mørch
- NORMENT, K.G. Jebsen Centre for Psychosis ResearchInstitute of Clinical MedicineUniversity of OsloOsloNorway,Division of Mental Health and AddictionOslo University HospitalOsloNorway
| | - T. S. J. Vedal
- NORMENT, K.G. Jebsen Centre for Psychosis ResearchInstitute of Clinical MedicineUniversity of OsloOsloNorway,Division of Mental Health and AddictionOslo University HospitalOsloNorway
| | - E. J. Reponen
- NORMENT, K.G. Jebsen Centre for Psychosis ResearchInstitute of Clinical MedicineUniversity of OsloOsloNorway,Division of Mental Health and AddictionOslo University HospitalOsloNorway
| | - V. M. Steen
- Department of Clinical ScienceNORMENT, K.G. Jebsen Center for Psychosis ResearchUniversity of BergenBergenNorway,Department of Medical GeneticsDr. Einar Martens Research Group for Biological PsychiatryHaukeland University HospitalBergenNorway
| | - O. A. Andreassen
- NORMENT, K.G. Jebsen Centre for Psychosis ResearchInstitute of Clinical MedicineUniversity of OsloOsloNorway,Division of Mental Health and AddictionOslo University HospitalOsloNorway
| | - I. Melle
- NORMENT, K.G. Jebsen Centre for Psychosis ResearchInstitute of Clinical MedicineUniversity of OsloOsloNorway,Division of Mental Health and AddictionOslo University HospitalOsloNorway
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Si T, Zhuo J, Feng Y, Lu H, Hong D, Zhang L. Long-term efficacy and safety of paliperidone palmitate once-monthly in Chinese patients with recent-onset schizophrenia. Neuropsychiatr Dis Treat 2019; 15:1685-1694. [PMID: 31303756 PMCID: PMC6603286 DOI: 10.2147/ndt.s191803] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 04/02/2019] [Indexed: 11/23/2022] Open
Abstract
Background: The subgroup analysis of a primary study (NCT01051531) evaluated the effect of long-term paliperidone palmitate once-monthly (PP1M) therapy in Chinese patients with recent-onset schizophrenia responding unsatisfactorily to previous oral antipsychotics. Patients and methods: This 18-month, open-label study consisted of 3 phases - screening (7 days), treatment (18 months) and end-of-study/withdrawal visit. All enrolled patients (18-50 years) received PP1M: 150 mg eq. (day 1), 100 mg eq. (day 8) followed by a once-monthly flexible dose (50, 75, 100 or 150 mg eq.). Efficacy and safety were assessed. Results: Among the 118 enrolled Chinese patients, 68 completed the treatment (mean age: 25.6 years; male: 54.7%). A clinically meaningful change from baseline to day 548 was observed in Positive and Negative Syndrome scale (primary endpoint, mean [SD]: -15.3 [20.76]), Personal and Social Performance scale (15.9 [19.65]), Clinician Global Impression-schizophrenia score (-1.2 [1.54]) and Medication Satisfaction Questionnaire score (0.9 [1.73]). Commonly reported treatment-emergent adverse events (TEAEs) included insomnia (13.9%), injection-site pain (13.9%), upper respiratory tract infection (13.0%), restlessness (13.0%) and akathisia (13.0%). Serious TEAEs were reported in 9.3% patients with schizophrenia being most common (6.5%) and one death (suicide) was observed. Conclusion: Efficacy of PP1M corroborate findings from earlier studies and no new safety concerns emerged in this Chinese subgroup of patients with schizophrenia.
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Affiliation(s)
- Tianmei Si
- National Clinical Research Center for Mental Disorders & The Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, People's Republic of China.,Peking University Institute of Mental Health/The Sixth Hospital, Beijing, People's Republic of China
| | - Jianmin Zhuo
- Janssen (China) Research & Development Center, Johnson & Johnson (China) Investment Ltd., Shanghai, People's Republic of China
| | - Yu Feng
- Department of Neuroscience, Janssen Pharmaceutical Companies of Johnson and Johnson, Singapore
| | - Huafei Lu
- Medical Affairs, Xi'an Janssen Pharmaceuticals, Beijing, People's Republic of China
| | - Di Hong
- Medical Affairs, Xi'an Janssen Pharmaceuticals, Beijing, People's Republic of China
| | - Lili Zhang
- Medical Affairs, Xi'an Janssen Pharmaceuticals, Beijing, People's Republic of China
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Hswen Y, Naslund JA, Brownstein JS, Hawkins JB. Monitoring Online Discussions About Suicide Among Twitter Users With Schizophrenia: Exploratory Study. JMIR Ment Health 2018; 5:e11483. [PMID: 30545811 PMCID: PMC6315229 DOI: 10.2196/11483] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 09/13/2018] [Accepted: 09/14/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND People with schizophrenia experience elevated risk of suicide. Mental health symptoms, including depression and anxiety, contribute to increased risk of suicide. Digital technology could support efforts to detect suicide risk and inform suicide prevention efforts. OBJECTIVE This exploratory study examined the feasibility of monitoring online discussions about suicide among Twitter users who self-identify as having schizophrenia. METHODS Posts containing the terms suicide or suicidal were collected from a sample of Twitter users who self-identify as having schizophrenia (N=203) and a random sample of control users (N=173) over a 200-day period. Frequency and timing of posts about suicide were compared between groups. The associations between posting about suicide and common mental health symptoms were examined. RESULTS Twitter users who self-identify as having schizophrenia posted more tweets about suicide (mean 7.10, SD 15.98) compared to control users (mean 1.89, SD 4.79; t374=-4.13, P<.001). Twitter users who self-identify as having schizophrenia showed greater odds of tweeting about suicide compared to control users (odds ratio 2.15, 95% CI 1.42-3.28). Among all users, tweets about suicide were associated with tweets about depression (r=0.62, P<.001) and anxiety (r=0.45, P<.001). CONCLUSIONS Twitter users who self-identify as having schizophrenia appear to commonly discuss suicide on social media, which is associated with greater discussion about other mental health symptoms. These findings should be interpreted cautiously, as it is not possible to determine whether online discussions about suicide correlate with suicide risk. However, these patterns of online discussion may be indicative of elevated risk of suicide observed in this patient group. There may be opportunities to leverage social media for supporting suicide prevention among individuals with schizophrenia.
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Affiliation(s)
- Yulin Hswen
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, United States.,Informatics Program, Boston Children's Hospital, Boston, MA, United States
| | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
| | - John S Brownstein
- Informatics Program, Boston Children's Hospital, Boston, MA, United States.,Department of Pediatrics, Harvard Medical School, Boston, MA, United States.,Department of Biomedical Informatics, Harvard Medical School, Boston, MA, United States
| | - Jared B Hawkins
- Informatics Program, Boston Children's Hospital, Boston, MA, United States.,Department of Pediatrics, Harvard Medical School, Boston, MA, United States.,Department of Biomedical Informatics, Harvard Medical School, Boston, MA, United States
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O’Connor RC, Portzky G. Looking to the Future: A Synthesis of New Developments and Challenges in Suicide Research and Prevention. Front Psychol 2018; 9:2139. [PMID: 30538647 PMCID: PMC6277491 DOI: 10.3389/fpsyg.2018.02139] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 10/17/2018] [Indexed: 12/13/2022] Open
Abstract
Suicide and attempted suicide are major public health concerns. In recent decades, there have been many welcome developments in understanding and preventing suicide, as well as good progress in intervening with those who have attempted suicide. Despite these developments, though, considerable challenges remain. In this article, we explore both the recent developments and the challenges ahead for the field of suicide research and prevention. To do so, we consulted 32 experts from 12 countries spanning four continents who had contributed to the International Handbook of Suicide Prevention (2nd edition). All contributors nominated, in their view, (i) the top 3 most exciting new developments in suicide research and prevention in recent years, and (ii) the top 3 challenges. We have synthesized their suggestions into new developments and challenges in research and practice, giving due attention to implications for psychosocial interventions. This Perspective article is not a review of the literature, although we did draw from the suicide research literature to obtain evidence to elucidate the responses from the contributors. Key new developments and challenges include: employing novel techniques to improve the prediction of suicidal behavior; testing and applying theoretical models of suicidal behavior; harnessing new technologies to monitor and intervene in suicide risk; expanding suicide prevention activities to low and middle-income countries; moving toward a more refined understanding of sub-groups of people at risk and developing tailored interventions. We also discuss the importance of multidisciplinary working and the challenges of implementing interventions in practice.
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Affiliation(s)
- Rory C. O’Connor
- Suicidal Behaviour Research Laboratory, Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Gwendolyn Portzky
- Unit for Suicide Research, Flemish Centre of Expertise in Suicide Prevention, Ghent University, Ghent, Belgium
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Ko J. Help-seeking Pathway among Working-Age Adults with Suicidal Ideation: Testing the Integrated Model of Suicide Help-seeking. SOCIAL WORK IN PUBLIC HEALTH 2018; 33:467-482. [PMID: 30451101 DOI: 10.1080/19371918.2018.1546251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Despite a high suicide rate among working-age adults, there is a significant lack of empirical evidence on their help-seeking behavior. This study tested the integrated model of suicide help-seeking to examine help-seeking behavior as a continuous decision-making process. Data were drawn from the 2011 and 2012 National Survey on Drug Use and Health (N = 1,414). Results from structural equational modeling analyses demonstrated that the integrated model fit reasonably well among the sample. Suicide help-seeking behavior is characterized by an inequitable access, where enabling factors affect throughout the help-seeking pathway. The results provide a foundation for future help-seeking interventions.
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Affiliation(s)
- Jungyai Ko
- a School of Social Welfare , Hallym University , Chuncheon , Gangwon-do , Korea
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Villa J, Pinkham AE, Kaufmann CN, Granholm E, Harvey PD, Depp CA. Interpersonal beliefs related to suicide and facial emotion processing in psychotic disorders. J Psychiatr Res 2018; 100. [PMID: 29514121 PMCID: PMC5962269 DOI: 10.1016/j.jpsychires.2018.02.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Deficits in social cognition are present in psychotic disorders; moreover, maladaptive interpersonal beliefs have been posited to underlie risk of suicidal ideation and behavior. However, the association between social cognition and negative appraisals as potential risk factors for suicidal ideation and behavior in psychotic disorders has not been assessed. In a pilot study, we assessed accuracy and error biases in facial emotion recognition (Penn ER-40), maladaptive interpersonal beliefs as measured by the Interpersonal Needs Questionnaire (INQ), and current suicide ideation and history of past attempts in a sample of 101 outpatients with psychotic disorders (75 schizophrenia/schizoaffective; 26 bipolar disorder). INQ scores were positively associated with history of suicide attempts and current ideation. INQ scores were inversely related with emotion recognition accuracy yet positively correlated with bias toward perceiving anger in neutral expressions. The association between biases pertaining to anger and INQ scores persisted after adjusting for global cognitive ability and were more evident in schizophrenia than in bipolar disorder. The present findings suggest that maladaptive beliefs are associated with a tendency to misperceive neutral stimuli as threatening and are associated with suicidal ideation and behavior. Although better cognitive ability is associated with higher rates of suicide attempts in psychotic disorders, biases in misinterpreting anger in others may be a specific deficit related to formation of maladaptive beliefs about others, which, in turn, are associated with history of suicide attempts.
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Affiliation(s)
- Jennifer Villa
- Department of Psychology, San Diego State University, San Diego, CA, United States
| | - Amy E Pinkham
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, United States
| | | | - Eric Granholm
- Department of Psychiatry, UC San Diego, La Jolla, CA, United States
| | - Philip D Harvey
- Research Service, Bruce W. Carter Veterans Affairs (VA) Medical Center, Miami, FL, United States; Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Colin A Depp
- Department of Psychiatry, UC San Diego, La Jolla, CA, United States; VA San Diego Healthcare System, San Diego, CA, United States.
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Kulkarni K, Arasappa R, Prasad M K, Zutshi A, Chand PK, Muralidharan K, Murthy P. The impact of depressive symptoms on the clinical presentation of Persistent Delusional Disorder. Asian J Psychiatr 2018; 32:123-125. [PMID: 29248867 DOI: 10.1016/j.ajp.2017.12.002] [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: 11/05/2017] [Revised: 11/15/2017] [Accepted: 12/03/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Our aim was to investigate the influence of depressive symptoms on the clinical presentation of Persistent Delusional Disorder (PDD). METHODS We have previously conducted a retrospective review of patients diagnosed with PDD (n = 455). We divided this sample into two groups according to the presence or absence of co-morbid depressive symptoms - a subsample of PDD with depressive co-morbidity (PDD + D; n = 187) and a subsample of PDD without depressive co-morbidity (PDD only; n = 268). RESULTS PDD + D group had a significantly younger age at onset of PDD. The PDD + D group received significantly more antidepressants but had similar response and adherence rates. CONCLUSIONS The presence of depressive symptoms in 41% of the study population did not appear to influence the clinical presentation or response to treatment.
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Affiliation(s)
- Karishma Kulkarni
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (INI), Bangalore, 560029, Karnataka, India.
| | - Rashmi Arasappa
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (INI), Bangalore, 560029, Karnataka, India
| | - Krishna Prasad M
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (INI), Bangalore, 560029, Karnataka, India
| | - Amit Zutshi
- Epworth Hospital, Camberwell, Victoria, 3124, Australia; Department of Psychiatry, Faculty of Medicine, Dentistry, and Health Sciences, The University of Melbourne, Australia
| | - Prabhat K Chand
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (INI), Bangalore, 560029, Karnataka, India
| | - Kesavan Muralidharan
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (INI), Bangalore, 560029, Karnataka, India
| | - Pratima Murthy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (INI), Bangalore, 560029, Karnataka, India
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Associations of suicidality with cognitive ability and cognitive insight in outpatients with Schizophrenia. Schizophr Res 2018; 192:340-344. [PMID: 28655480 PMCID: PMC5742308 DOI: 10.1016/j.schres.2017.06.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 06/09/2017] [Accepted: 06/10/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Previous literature suggests that better cognitive ability and insight are associated with greater lifetime risk of suicide attempts in schizophrenia, counter to the direction of association in the general population. However, the conjoint association between distinct cognitive domains, insight, and suicidality has not been assessed. METHOD In a cross-sectional study, 162 adults with schizophrenia or schizoaffective disorder completed cognitive testing via the MATRICS battery, symptom and cognitive insight assessments, along with the Columbia Suicide Severity Rating Scale. We then contrasted participants based on history of suicidality by cognitive domains and insight measures and conducted multivariate analyses. RESULTS Although a history of any passive ideation was not associated with cognitive ability or insight, verbal learning was positively associated with a greater history of suicidal attempt and prior ideation with a plan and intent. Higher cognitive insight, and the self-reflectiveness subscale insight, was also associated with history of passive or active suicidal ideation. Cognitive insight and cognitive ability were independent from each other, and there were no moderating influences of insight on the effect of cognitive ability on suicide related history. Exploratory analyses revealed that history of planned attempts were associated with greater verbal learning, whereas histories of aborted attempts were associated with poorer reasoning and problem-solving. IMPLICATIONS Although cross-sectional and retrospective, this study provides support that greater cognitive ability, specifically verbal learning, along with self-reflectiveness, may confer elevated risk for more severe suicidal ideation and behavior in an independent fashion. Interestingly, poorer problem-solving was associated with aborted suicide attempts.
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Abstract
Schizophrenia is a complex disorder lacking an effective treatment option for the pervasive and debilitating cognitive impairments experienced by patients. Working memory is a core cognitive function impaired in schizophrenia that depends upon activation of distributed neural network, including the circuitry of the dorsolateral prefrontal cortex (DLPFC). Accordingly, individuals diagnosed with schizophrenia show reduced DLPFC activation while performing working-memory tasks. This lower DLPFC activation appears to be an integral part of the disease pathophysiology, and not simply a reflection of poor performance. Thus, the cellular and circuitry alterations that underlie lower DLPFC neuronal activity in schizophrenia must be determined in order to identify appropriate therapeutic targets. Studies using human postmortem brain tissue provide a robust way to investigate and characterize these cellular and circuitry alterations at multiple levels of resolution, and such studies provide essential information that cannot be obtained either through in vivo studies in humans or through experimental animal models. Studies examining neuronal morphology, protein expression and localization, and transcript levels indicate that a microcircuit composed of excitatory pyramidal cells and inhibitory interneurons containing the calcium-binding protein parvalbumin is altered in the DLPFC of subjects with schizophrenia and likely contributes to DLPFC dysfunction.
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Affiliation(s)
- Jill R Glausier
- Translational Neuroscience Program, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - David A Lewis
- Translational Neuroscience Program, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States.
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Abstract
Earlier findings suggest that forensic schizophrenia patients are treated with higher doses of antipsychotics. This practice-based specificity is insufficiently studied, and clinicians' motives regarding this practice remain poorly understood. In this editorial, the authors provide their data on treatment of forensic schizophrenia patients and identify characteristics of psychopathology and previous types of behaviors, including suicidal attempts, as potential reasons for the practice. They also emphasize that "these previous acts" often took place years ago, and suggest that current or recent aggression is unlikely the main reason for dosing, but rather the clinicians' intention to maintain "must remain unaggressive" condition. Therefore, the authors suggest new ideas that may contribute to a better understanding of the specific prescribing patterns in the forensic population and hope that these ideas would be implemented in further well-designed prospective studies.
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