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Zhou DN, Yang X, Wang W, Jin WQ, Tang YL, Zheng Z, Ren Y. Exploring the interplay of psychiatric symptoms, antipsychotic medications, side effects, employment status, and quality of life in Chronic Schizophrenia. BMC Psychiatry 2024; 24:484. [PMID: 38956530 PMCID: PMC11220993 DOI: 10.1186/s12888-024-05929-3] [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: 03/12/2024] [Accepted: 06/24/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Many factors contribute to quality of life (QoL) in patients with schizophrenia, yet limited research examined these factors in patients in China. This cross-sectional study explores subjective QoL and its associated factors in patients. METHODS The QoL was assessed using the Schizophrenia Quality of Life Scale (SQLS). Clinical symptoms were evaluated using the Brief Psychiatric Rating Scale (BPRS) and seven factors were extracted. Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder Scale (GAD-7) were used to assess depression and anxiety. Cognitive impairment was assessed using the Ascertain Dementia 8 (AD8). The Treatment Emergent Symptom Scale (TESS) and Rating Scale for Extrapyramidal Side Effects (RSESE) were used to evaluate the side effects of medications. RESULTS We recruited 270 patients (male:142,52.6%, mean age:41.9 ± 9.4 years). Positive correlations were observed between SQLS and its subdomains with the total score of BPRS, PHQ-9, GAD-7, AD8, TESS, and RSESE (all P < 0.005). Patients who were taking activating second-generation antipsychotics (SGAs) had lower scores on total SQLS, Motivation/ Energy domain of SQLS (SQLS-ME) as well as Symptoms/ Side effects domain of SQLS (SQLS-SS) compared to those taking non-activating SGAs (all P < 0.005). Multiple regression analysis showed that depressive/ anxiety symptoms and cognitive impairment had significant negative effects on QoL (P ≤ 0.001), while activating SGAs had a positive effect (P < 0.005). Blunted affect and unemployment were inversely associated with the motivation/energy domain (P < 0.001). CONCLUSION Our findings emphasize the important role of depression/anxiety symptoms and cognitive impairment in the QoL of patients with chronic schizophrenia. Activating SGAs and employment may improve the QoL of these individuals. TRIAL REGISTRATION This protocol was registered at chictr.org.cn (Identifier: ChiCTR2100043537).
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Affiliation(s)
- Dan-Na Zhou
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Xue Yang
- The First Psychiatric Hospital of Harbin, Harbin, Heilongjiang Province, China
| | - Wen Wang
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Wen-Qing Jin
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yi-Lang Tang
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, 30329, USA
- Mental Health Service Line, Atlanta VA Medical Center, Decatur, GA, 30033, USA
| | - Zhi Zheng
- Huai'an No. 3 People's Hospital, Huaian, Jiangsu Province, China.
| | - Yanping Ren
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Capital Medical University, Beijing, China.
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
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Balogun MM, Coker OA. Ocular toxicity of psychotropic medications in a tertiary hospital in Lagos, Nigeria. Rom J Ophthalmol 2024; 68:99-107. [PMID: 39006334 PMCID: PMC11238872 DOI: 10.22336/rjo.2024.20] [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] [Accepted: 04/20/2024] [Indexed: 07/16/2024] Open
Abstract
Objective: This study aimed to determine the ocular toxicity of the psychotropic drugs used by patients and to proffer suggestions on how to prevent visual impairment or blindness in patients on antipsychotics. Methodology: This was a prospective, hospital-based cross-sectional study. Participants were adult patients between 18 and 70 years, diagnosed with psychosis, and who had been on antipsychotic medications for at least one year. All the recruited participants had an examination of the anterior and posterior segments of the eyes done. Schirmer's test, Tear film Break-up time (TBUT), Central Corneal thickness (CCT), Colour vision test, and Contrast sensitivity test were done. The collected data was analyzed using IBM SPSS 28.0. Results: The study enrolled patients who were mainly females (55.1%). The highest age group of the cases was 29-38 years (29.7%). The examination of the eyes and investigations revealed that 10.2% of the respondents on antipsychotics had color vision deficiency and 25.4% - loss of contrast sensitivity. Lid pigmentation was observed in 20.3% and cataract in 32.2%. Degeneration of the peripheral retina was observed in 4.2% of patients on antipsychotic medication. Schirmer's test showed mild, moderate, and severe dry eyes in 11%,17.8%, and 20.3% of the participants respectively. The test for Central Corneal Thickness (CCT) showed 50.0% of the respondents had a thin cornea and 24.6% had a thick cornea. 17.8% of the surveyed respondents manifested high eye pressure. Discussion: Psychotropics are the gold standard for the treatment of psychotic episodes and disorders. The choice of drug, dosing, and mode of administration depends on the severity of the psychotic disorder. Higher doses of psychotropics were reported to cause toxicity in different organs in the body including the eyes, especially on long-term use and high dosage and this can affect the quality of life of the individual negatively. Conclusion: The earliest and most prominent side effect seen in patients on psychotic medication was dry eyes. There were a few cases of blinding eye diseases like glaucoma, and cataract. For these reasons, ophthalmic assessments should be included as part of the management of psychiatric patients early at the start of antipsychotic treatment. Abbreviations: FGA = First Generation Antipsychotics, SGA = Second Generation Antipsychotics, TCAs = Tricyclic Antidepressants, CCT = Central Corneal Thickness, IOP = Intraocular Pressure, TBUT =Tear film Break-up Time, BIO = Binocular Indirect Ophthalmoscope.
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Affiliation(s)
- Modupe Medina Balogun
- Department of Surgery, Ophthalmology Unit, Lagos State University College of Medicine, Lagos State, Nigeria
- Lagos State University Teaching Hospital, Lagos State, Nigeria
| | - Olurotimi Ayodele Coker
- Department of Behavioural Medicine, Lagos State University College of Medicine, Lagos State, Nigeria
- Lagos State University Teaching Hospital, Lagos State, Nigeria
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Sun Y, Yu H, Wang Z, Zhang J, Zhou Y, Cui W, Jiang W. Relationship between medication burden and medication experience in stable patients with schizophrenia: the mediating effect of medication belief. BMC Nurs 2024; 23:197. [PMID: 38519927 PMCID: PMC10958954 DOI: 10.1186/s12912-024-01882-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/19/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Individuals with schizophrenia require prolonged antipsychotic medication treatment. But more than 50% of individuals with schizophrenia experience adverse medication experiences during their antipsychotic treatments. Such individuals often adjust or discontinue medication, leading to disease relapse and impaired social functioning. Psychiatric nurses should pay close attention to the medication experiences of individuals with schizophrenia. This research explore the relationship between medication burden and medication experience, as well as the mediating effect of medication belief in stable patients with schizophrenia. METHODS A convenience sample of hospitalized stable patients with schizophrenia were selected from Daqing Third Hospital and Baiyupao Hospital from September 2023 to December 2023. A survey was conducted with them using a questionnaire consisting of general information questionnaire, The Subjective Well-being Under Neuroleptic Treatment Scale(SWN), The Living with Medicines Questionnaire(LMQ), Beliefs about Medicines Questionnaire-Specific (BMQ-Specific). Pearson correlation analysis was used to explore the correlation between LMQ, BMQ-Specific and SWN scores, and multiple linear regression analysis was used to explore the influencing factors of medication experience in patients with schizophrenia. AMOS 24.0 was used to construct the structural equation modeling(SEM), and the mediation effect of the SEM was tested using Bootstrap method. RESULTS According to the sample size calculation requirements of structural equation model, a total of 300 samples were required in this study, and 400 effective questionnaires were actually collected in this study, which met the sample size requirements for constructing structural equation models. Bootstrap test showed that the mediation effect was significant. The total effect of medication burden on medication experience was significant (Z=-12.146, 95%CI (-0.577, -0.417), P < 0.001). The indirect effect of medication burden on medication experience, that is, the mediating effect of medication belief was significant (Z=-4.839, 95%CI (-0.217, -0.096), P < 0.001). The direct effect of medication burden on medication experience was significant (Z=-7.565, 95%CI (-0.437, -0.257), P < 0.001). This model belongs to partial mediation model. CONCLUSIONS Psychiatric nurses can enhance the patients' medication experience by reducing medication burden and strengthening medication beliefs. Therefore, the results also provide theoretical references and decision-making foundations for psychiatric nursing professionals to develop appropriate management strategies for individuals with schizophrenia.
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Affiliation(s)
- Yujing Sun
- Department of Nursing, Harbin Medical University Daqing Campus, Daqing, China
- The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hong Yu
- Department of Nursing, Harbin Medical University Daqing Campus, Daqing, China
| | - Zhengjun Wang
- Department of Nursing, Harbin Medical University Daqing Campus, Daqing, China
| | - Jing Zhang
- The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China.
| | - Yuqiu Zhou
- Department of Nursing, Harbin Medical University Daqing Campus, Daqing, China
| | - Wenming Cui
- The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
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Allott K, Chopra S, Rogers J, Dauvermann MR, Clark SR. Advancing understanding of the mechanisms of antipsychotic-associated cognitive impairment to minimise harm: a call to action. Mol Psychiatry 2024:10.1038/s41380-024-02503-x. [PMID: 38454078 DOI: 10.1038/s41380-024-02503-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 02/21/2024] [Accepted: 02/27/2024] [Indexed: 03/09/2024]
Affiliation(s)
- Kelly Allott
- Orygen, Parkville, VIC, Australia.
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.
| | - Sidhant Chopra
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Jack Rogers
- Institute for Mental Health, University of Birmingham, Birmingham, UK
| | | | - Scott Richard Clark
- University of Adelaide, Discipline of Psychiatry, Adelaide, SA, Australia
- Basil Hetzel Institute, Woodville South, SA, Australia
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Qadir ZS, Kar N, Ball PA, Morrissey H. Antipsychotic Use: Cross-Sectional Opinion Survey of Psychiatrists in India and United Kingdom. PHARMACY 2023; 11:162. [PMID: 37888507 PMCID: PMC10609856 DOI: 10.3390/pharmacy11050162] [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: 09/10/2023] [Revised: 09/26/2023] [Accepted: 09/30/2023] [Indexed: 10/28/2023] Open
Abstract
The aim of this survey of psychiatrists from the UK and India was to compare their opinions on antipsychotic medication choice and their experiences of such medications' effectiveness and tolerability in patients who were newly diagnosed with acute schizophrenia. Following ethical approval, a cross-sectional online survey of psychiatrists from the UK and India was conducted. Ninety-five responses were received from each country. The most selected first-line APDs in both countries were olanzapine (47.5%), risperidone (42.8%) and aripiprazole (25.3%). A total of 60% of psychiatrists from India (60%) and 48% from the UK (48%) selected 'medication efficacy' as the main factor in their choice. Reassessment and consideration to switch most often took place within 4-6 weeks (53.7%) and 3-6 months (11.6%). The major reasons for switching antipsychotic medications were poor clinical efficacy (69%) and lack of tolerability (45%). Nonadherence was the most common reason for relapse (90% of UK psychiatrists and 70% of Indian psychiatrists), followed by illicit drug use (27.6%). The most commonly reported side effects that led to nonadherence were weight gain (10.8%), drowsiness (10.4%), erectile dysfunction and movement disorders (equally 8.7%). It was concluded that olanzapine, risperidone and aripiprazole are the most commonly selected as the initial treatment choice by psychiatrists from India and the UK. They are perceived as widely effective and well tolerated.
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Affiliation(s)
- Zina Sherzad Qadir
- Research Institute in Health Sciences, University of Wolverhampton, Wolverhampton WV1 1LY, UK; (Z.S.Q.); (N.K.); (P.A.B.)
| | - Nilamadhab Kar
- Research Institute in Health Sciences, University of Wolverhampton, Wolverhampton WV1 1LY, UK; (Z.S.Q.); (N.K.); (P.A.B.)
- Black Country Healthcare NHS Foundation Trust, Wolverhampton B71 4NH, UK
| | - Patrick Anthony Ball
- Research Institute in Health Sciences, University of Wolverhampton, Wolverhampton WV1 1LY, UK; (Z.S.Q.); (N.K.); (P.A.B.)
- School of Dentistry & Medical Sciences, Charles Sturt University, Wagga Wagga, NSW 2678, Australia
| | - Hana Morrissey
- Research Institute in Health Sciences, University of Wolverhampton, Wolverhampton WV1 1LY, UK; (Z.S.Q.); (N.K.); (P.A.B.)
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Panda SP, Singh V. The Dysregulated MAD in Mad: A Neuro-theranostic Approach Through the Induction of Autophagic Biomarkers LC3B-II and ATG. Mol Neurobiol 2023; 60:5214-5236. [PMID: 37273153 DOI: 10.1007/s12035-023-03402-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/24/2023] [Indexed: 06/06/2023]
Abstract
The word mad has historically been associated with the psyche, emotions, and abnormal behavior. Dementia is a common symptom among psychiatric disorders or mad (schizophrenia, depression, bipolar disorder) patients. Autophagy/mitophagy is a protective mechanism used by cells to get rid of dysfunctional cellular organelles or mitochondria. Autophagosome/mitophagosome abundance in autophagy depends on microtubule-associated protein light chain 3B (LC3B-II) and autophagy-triggering gene (ATG) which functions as an autophagic biomarker for phagophore production and quick mRNA disintegration. Defects in either LC3B-II or the ATG lead to dysregulated mitophagy-and-autophagy-linked dementia (MAD). The impaired MAD is closely associated with schizophrenia, depression, and bipolar disorder. The pathomechanism of psychosis is not entirely known, which is the severe limitation of today's antipsychotic drugs. However, the reviewed circuit identifies new insights that may be especially helpful in targeting biomarkers of dementia. Neuro-theranostics can also be achieved by manufacturing either bioengineered bacterial and mammalian cells or nanocarriers (liposomes, polymers, and nanogels) loaded with both imaging and therapeutic materials. The nanocarriers must cross the BBB and should release both diagnostic agents and therapeutic agents in a controlled manner to prove their effectiveness against psychiatric disorders. In this review, we highlighted the potential of microRNAs (miRs) as neuro-theranostics in the treatment of dementia by targeting autophagic biomarkers LC3B-II and ATG. Focus was also placed on the potential for neuro-theranostic nanocells/nanocarriers to traverse the BBB and induce action against psychiatric disorders. The neuro-theranostic approach can provide targeted treatment for mental disorders by creating theranostic nanocarriers.
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Affiliation(s)
- Siva Prasad Panda
- Institute of Pharmaceutical Research, GLA University, Uttar Pradesh, Mathura, India.
| | - Vikrant Singh
- Research Scholar, Institute of Pharmaceutical Research, GLA University, Uttar Pradesh, Mathura, India
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Valencia Carlo YE, Saracco-Alvarez RA, Valencia Carlo VA, Vázquez Vega D, Natera Rey G, Escamilla Orozco RI. Adverse effects of antipsychotics on sleep in patients with schizophrenia. Systematic review and meta-analysis. Front Psychiatry 2023; 14:1189768. [PMID: 37441144 PMCID: PMC10333591 DOI: 10.3389/fpsyt.2023.1189768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/31/2023] [Indexed: 07/15/2023] Open
Abstract
Introduction Our objective was to conduct a systematic review and meta-analysis of adverse effects on sleep in patients with schizophrenia receiving antipsychotic treatment. Methods A systematic search was performed in PubMed, Cochrane Central, Embase, Toxline, Ebsco, Virtual Health Library, Web of Science, SpringerLink, and in Database of abstracts of Reviews of Effects of Randomized Clinical Trials to identify eligible studies published from January 1990 to October 2021. The methodological quality of the studies was evaluated using the CONSORT list, and the Cochrane bias tool. Network meta-analysis was performed using the Bayesian random-effects model, with multivariate meta-regression to assess the association of interest. Results 87 randomized clinical trials were identified that met the inclusion criteria, and 70 articles were included in the network meta-analysis. Regarding the methodological quality of the studies, 47 had a low or moderate bias risk. The most common adverse effects on sleep reported in the studies were insomnia, somnolence, and sedation. The results of the network meta-analysis showed that ziprasidone was associated with an increased risk of insomnia (OR, 1.56; 95% credible interval CrI, 1.18-2.06). Several of the included antipsychotics were associated with a significantly increased risk of somnolence; haloperidol (OR, 1.90; 95% CrI, 1.12-3.22), lurasidone (OR, 2.25; 95% CrI, 1.28-3.97) and ziprasidone (OR, 1.79; 95% CrI, 1.06-3.02) had the narrowest confidence intervals. In addition, perphenazine (OR, 5.33; 95% CrI, 1.92-14.83), haloperidol (OR, 2.61; 95% CrI, 1.14-5.99), and risperidone (OR, 2.41; 95% CrI, 1.21-4.80) were associated with an increased risk of sedation compared with placebo, and other antipsychotics did not differ. According to the SUCRAs for insomnia, chlorpromazine was ranked as the lowest risk of insomnia (57%), followed by clozapine (20%), while flupentixol (26 %) and perospirone (22.5%) were associated with a lower risk of somnolence. On the other hand, amisulpride (89.9%) was the safest option to reduce the risk of sedation. Discussion Insomnia, sedation, and somnolence were the most frequent adverse effects on sleep among the different antipsychotics administered. The evidence shows that chlorpromazine, clozapine, flupentixol, perospirone, and amisulpride had favorable safety profiles. In contrast, ziprasidone, perphenazine, haloperidol, and risperidone were the least safe for sleep. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42017078052, identifier: PROSPERO 2017 CRD42017078052.
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Affiliation(s)
| | | | | | - Daniela Vázquez Vega
- Health Sciences Program, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico
| | - Guillermina Natera Rey
- Department of Epidemiological and Psychosocial Research, National Institute of Psychiatry Ramon de la Fuente Muñiz, Mexico City, Mexico
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Allott K, Yuen HP, Baldwin L, O'Donoghue B, Fornito A, Chopra S, Nelson B, Graham J, Kerr MJ, Proffitt TM, Ratheesh A, Alvarez-Jimenez M, Harrigan S, Brown E, Thompson AD, Pantelis C, Berk M, McGorry PD, Francey SM, Wood SJ. Effects of risperidone/paliperidone versus placebo on cognitive functioning over the first 6 months of treatment for psychotic disorder: secondary analysis of a triple-blind randomised clinical trial. Transl Psychiatry 2023; 13:199. [PMID: 37301832 DOI: 10.1038/s41398-023-02501-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 05/17/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
The drivers of cognitive change following first-episode psychosis remain poorly understood. Evidence regarding the role of antipsychotic medication is primarily based on naturalistic studies or clinical trials without a placebo arm, making it difficult to disentangle illness from medication effects. A secondary analysis of a randomised, triple-blind, placebo-controlled trial, where antipsychotic-naive patients with first-episode psychotic disorder were allocated to receive risperidone/paliperidone or matched placebo plus intensive psychosocial therapy for 6 months was conducted. A healthy control group was also recruited. A cognitive battery was administered at baseline and 6 months. Intention-to-treat analysis involved 76 patients (antipsychotic medication group: 37; 18.6Mage [2.9] years; 21 women; placebo group: 39; 18.3Mage [2.7]; 22 women); and 42 healthy controls (19.2Mage [3.0] years; 28 women). Cognitive performance predominantly remained stable (working memory, verbal fluency) or improved (attention, processing speed, cognitive control), with no group-by-time interaction evident. However, a significant group-by-time interaction was observed for immediate recall (p = 0.023), verbal learning (p = 0.024) and delayed recall (p = 0.005). The medication group declined whereas the placebo group improved on each measure (immediate recall: p = 0.024; ηp2 = 0.062; verbal learning: p = 0.015; ηp2 = 0.072 both medium effects; delayed recall: p = 0.001; ηp2 = 0.123 large effect). The rate of change for the placebo and healthy control groups was similar. Per protocol analysis (placebo n = 16, medication n = 11) produced similar findings. Risperidone/paliperidone may worsen verbal learning and memory in the early months of psychosis treatment. Replication of this finding and examination of various antipsychotic agents are needed in confirmatory trials. Antipsychotic effects should be considered in longitudinal studies of cognition in psychosis.Trial registration: Australian New Zealand Clinical Trials Registry ( http://www.anzctr.org.au/ ; ACTRN12607000608460).
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Affiliation(s)
- Kelly Allott
- Orygen, Parkville, VIC, Australia.
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.
| | - Hok Pan Yuen
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Lara Baldwin
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Brian O'Donoghue
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Department of Psychiatry, University College Dublin, Belfield, Ireland
| | - Alex Fornito
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
- Monash Biomedical Imaging, Monash University, Clayton, VIC, Australia
| | - Sidhant Chopra
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Barnaby Nelson
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | | | - Melissa J Kerr
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | | | - Aswin Ratheesh
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Mario Alvarez-Jimenez
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Susy Harrigan
- Department of Social Work, School of Primary and Allied Health Care, Monash University, Melbourne, VIC, Australia
- Centre for Mental Health, Melbourne School of Global and Population Health, The University of Melbourne, Parkville, VIC, Australia
| | - Ellie Brown
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Andrew D Thompson
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Warwick, UK
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
- NorthWestern Mental Health, Western Hospital Sunshine, St Albans, VIC, Australia
| | - Michael Berk
- Orygen, Parkville, VIC, Australia
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, VIC, Australia
| | - Patrick D McGorry
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Shona M Francey
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Stephen J Wood
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- School of Psychology, University of Birmingham, Edgbaston, UK
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Bogers JPAM, Hambarian G, Walburgh Schmidt N, Vermeulen JM, de Haan L. Risk Factors for Psychotic Relapse After Dose Reduction or Discontinuation of Antipsychotics in Patients With Chronic Schizophrenia. A Meta-Analysis of Randomized Controlled Trials. Schizophr Bull 2023; 49:11-23. [PMID: 36200866 PMCID: PMC9810020 DOI: 10.1093/schbul/sbac138] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND HYPOTHESIS Although maintenance treatment with antipsychotics protects against psychotic relapse, high doses may hamper recovery. Therefore, dose reduction or discontinuation may be considered in patients with chronic schizophrenia. Here, we identified risk factors for psychotic relapse when doses are reduced. STUDY DESIGN We systematically searched MEDLINE, EMBASE, and PsycINFO from January 1950 through January 2021 and reviewed randomized controlled trials (RCTs) that reported relapse rates after antipsychotic dose reduction or discontinuation in patients with chronic schizophrenia. We calculated relative risks (RRs) with 95% confidence intervals (CIs) per person-year and sought to identify potential risk factors for relapse. The study is registered with PROSPERO (CRD42017058296). STUDY RESULTS Forty-seven RCTs (54 patient cohorts, 1746 person-years) were included. The RR for psychotic relapse with dose reduction/discontinuation versus maintenance treatment was 2.3 per person-year (95% CI: 1.9 to 2.8). The RR was higher with antipsychotic discontinuation, dose reduction to less than 3-5 mg haloperidol equivalent (HE), or relatively rapid dose reduction (<10 weeks). The RR was lower with long-acting injectable agents versus oral antipsychotic dose reduction. Other factors that increased the risk of psychotic relapse were younger age and short follow-up time. CONCLUSIONS Clinicians should take several risk factors for psychotic relapse into account when considering dose reduction in patients with chronic schizophrenia. Studies of a relatively fast reduction in antipsychotic dose support a minimum dose of 3-5 mg HE. However, if the dose is tapered more gradually, relapses related to medication withdrawal might be avoided, possibly enabling lower-end doses to be achieved.
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Affiliation(s)
- Jan P A M Bogers
- High Care Clinics and Rivierduinen Academy, Mental Health Services Rivierduinen, Leiden, The Netherlands
| | | | | | - Jentien M Vermeulen
- Department of Psychiatry, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry, Amsterdam University Medical Center, Amsterdam, The Netherlands
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Adherence to Typical Antipsychotics among Patients with Schizophrenia in Uganda: A Cross-Sectional Study. SCHIZOPHRENIA RESEARCH AND TREATMENT 2023; 2023:7035893. [PMID: 36778520 PMCID: PMC9918368 DOI: 10.1155/2023/7035893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 01/26/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND There has been a recent transition from typical to atypical antipsychotics in managing schizophrenia. This has been attributed to the acute side effects experienced by patients on typical antipsychotics that lead to nonadherence. However, the treatment cost with typical antipsychotics is cheaper (preferred in low-income settings), and there is no difference in the effectiveness, efficacy, discontinuation rate, or side effect symptom burden with atypical antipsychotics. This study is aimed at determining the prevalence of nonadherence and the associated factors to typical antipsychotics among patients with schizophrenia attending a psychiatric outpatient clinic at a rural tertiary facility in Uganda. METHOD A cross-sectional study among 135 patients with schizophrenia for at least six months on typical antipsychotics (mean age of 39.7 (±11.9) and 55.6% were female) from a rural tertiary facility in Uganda. Data were collected regarding sociodemographics, adherence, insight for psychosis, attitude towards typical antipsychotics, side effects, satisfaction with medications, and explanations from health workers about medications and side effects. Logistic regression was used to determine the factors associated with nonadherence. RESULTS The prevalence of nonadherence was 16.3%, and the likelihood of being nonadherent was more among the poor (monthly earning below the poverty line). However, having reduced energy was associated with reducing the likelihood of having nonadherence. CONCLUSION The prevalence of nonadherence was lower than many previously obtained prevalence and was comparable to nonadherence for atypical antipsychotics. However, to reduce nonadherence, we need all stakeholders (such as the government, insurance companies, and caregivers) to assist patients living in poverty with access to medication.
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Uso de psicofármacos en personas con discapacidad intelectual en Extremadura, España. ACTA COLOMBIANA DE PSICOLOGIA 2022. [DOI: 10.14718/acp.2023.26.1.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
El uso de psicofármacos es frecuente en adultos con discapacidad intelectual, a menudo por conductas desafiantes en ausencia de diagnóstico de trastorno mental. Investigaciones previas cuestionan la eficacia de estos tratamientos a falta de una enfermedad psiquiátrica, y destacan sus efectos secundarios. El objetivo de esta investigación es analizar el uso de psicofármacos en función del diagnóstico de enfermedad mental y conducta desafiante, así como la distribución de la población según el uso de psicofármacos en 569 adultos con discapacidad intelectual que presentan enfermedad mental o conductas desafiantes. Los datos acerca de la elevada prescripción de psicofármacos y, especialmente, de antipsicóticos alertan sobre la necesidad de una profunda revisión de la práctica clínica que permita reducir el uso de esta medicación en el tratamiento de la conducta y los trastornos mentales en esta población, para garantizar una atención de calidad y el respeto de los derechos de estas personas.
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12
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Prevalence and correlates of dissociative symptoms among people with depression. J Psychiatr Res 2022; 154:132-138. [PMID: 35933857 DOI: 10.1016/j.jpsychires.2022.07.054] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 07/11/2022] [Accepted: 07/21/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND To improve the outcomes of depression treatment, personalized treatments that take individual needs into account are recommended. Recent research suggests that a subgroup of depressed people who suffer from co-occurring dissociation may be more likely to have encountered traumatic or stressful experiences and they may also have more psychosocial intervention needs. METHODS This study examined the prevalence and correlates of dissociative symptoms in an online convenience sample of people (N = 410) from 18 different countries/regions who reported clinically significant levels of depressive symptoms (indicated by Patient Health Questionnaire-9 score ≥10). RESULTS Over 60% of participants exhibited clinically significant levels of dissociative symptoms (indicated by a Multiscale Dissociation Inventory total score >66). Compared with those with low levels of dissociative symptoms, participants with high levels of dissociative symptoms reported more traumas, interpersonal stress, depression and trauma-related symptoms. Emotional constriction in particular had a weak but significant negative correlation with the level of perceived medication benefits. LIMITATIONS The use of an online convenience sample could limit the generalizability of our findings. Our cross-sectional data could not demonstrate causal relationships between the study variables. CONCLUSIONS The findings highlight a need for complex health interventions for depressed people with co-occurring dissociative symptoms, focusing not only on depressive symptoms but also addressing trauma and dissociation-related symptoms.
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Read J. How important are informed consent, informed choice, and patient-doctor relationships, when prescribing antipsychotic medication? J Ment Health 2022:1-9. [PMID: 35536145 DOI: 10.1080/09638237.2022.2069708] [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: 06/25/2021] [Revised: 02/25/2022] [Accepted: 03/05/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Antipsychotic medications (APs) are used for people with psychosis diagnoses and, increasingly for other problems and groups. AIMS This study examines how APs are prescribed, from the perspective of recipients. METHODS 757 people, from 30 countries, responded to questions about their experiences with APs, in an online survey. RESULTS Most (70%) were told nothing about adverse effects. Fewer than 2% recalled being told about the risks of diabetes, suicidality, sexual dysfunction, or reduced life span. None recalled being told about reduced brain volume or withdrawal effects. Only 28% recalled being offered other treatments; with only 14% offered talking therapies. 46% were not told how long to take the APs; and, of those who were told something, 48% were told to take them forever. Most respondents (76%) were not told how APs work. Only 19% were satisfied with the prescribing process, and only 25% reported a good, or very good, relationship with the prescriber. Information, satisfaction with the process, and the prescriber relationship were all positively related to three self-reported outcomes: reduction of problems the drugs were prescribed for, general helpfulness, and quality of life. CONCLUSIONS Steps need to be taken to ensure people prescribed antipsychotics are fully informed, especially about adverse effects and alternatives.
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Affiliation(s)
- John Read
- School of Psychology, University of East London, London, UK
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14
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Read J. The experiences of 585 people when they tried to withdraw from antipsychotic drugs. Addict Behav Rep 2022; 15:100421. [PMID: 35434245 PMCID: PMC9006667 DOI: 10.1016/j.abrep.2022.100421] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/28/2022] [Accepted: 03/12/2022] [Indexed: 12/14/2022] Open
Abstract
72% of an international sample of 585 antipsychotics users report withdrawal effects when they try to stop taking them. none recall being told anything about withdrawal effects, dependence, rebound psychosis, the need to reduce gradually, by the prescriber. 26% report positive effects of withdrawing, such as feeling more alive and more like themselves.
Introduction Many recipients of antipsychotic drugs try to stop taking them, primarily because of distressing adverse effects. Little research has been undertaken into the withdrawal symptoms that ensue. Methods In an online survey 585 antipsychotic users, from 29 countries, who had tried to stop taking the drugs, were asked specific questions about the process and the open question: ‘What were the effects of withdrawing from the medication?’ 44% had a diagnosis in the ‘schizophrenia’ spectrum. Results Responding to specific questions, 72% reported classical withdrawal effects of the kind associated with other central nervous system medications, including nausea, tremors, anxiety, agitation and headaches. 52% of these categorized those effects as ‘severe’. 26% had tried four or more times to discontinue, and 23% took at least one year to successfully withdraw completely. In response to the open question, 73% reported one or more withdrawal effects, most frequently, insomnia, nervousness and extreme feelings; 26% reported one or more positive outcomes, most frequently more energy/alive and clearer thinking; and 18% reported psychosis. Conclusion These findings are consistent with a small but growing body of literature on this topic. Prescribers need to inform themselves about the nature, frequency and intensity of withdrawal effects from APs, and about withdrawal psychosis. National guidelines, professional bodies’ statements, and drug company information urgently need to be updated to prevent the suffering that can occur when withdrawal is minimised, misunderstood or unsupported.
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Ngamratanapaiboon S, Yambangyang P. Quantification of antipsychotic biotransformation in brain microvascular endothelial cells by using untargeted metabolomics. Drug Discov Ther 2022; 15:317-324. [PMID: 35034925 DOI: 10.5582/ddt.2021.01101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Most studies of antipsychotic-therapies have highlighted the discrepancy between plasma and brain pharmacokinetics of antipsychotics, but how the drug changes through the blood brain barrier (BBB) has not been investigated. Cell-based metabolomics using liquid chromatography-mass spectrometry (LC-MS) combined with multivariate data analysis were applied for screening of antipsychotic metabolites in the BBB. We applied this approach to analyze the antipsychotic biotransformation in brain microvascular endothelia cells (BMVECs), the main component of the BBB. From this study, five, four, three, and one metabolite of chlorpromazine, clozapine, haloperidol and risperidone, respectively, were locally metabolized on the BMVECs. These results confirm that there is a drug biotransformation process within the BBB and show that drug metabolite screening employed cell-based metabolomics using LC-MS, combined with multivariate analysis in the study of BMVECs exposed to antipsychotics can provide a way to screen drug metabolites in the BBB.
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Affiliation(s)
- Surachai Ngamratanapaiboon
- Division of Pharmacology, Department of Basic Medical Science, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Pracha Yambangyang
- Department of Biomedical Engineering, Faculty of Engineering, Mahidol University, Nakhon Pathom, Thailand
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Horowitz MA, Moncrieff J, de Haan L, Bogers JPAM, Gangadin SS, Kikkert M, Veling W, Sommer IEC. Tapering antipsychotic medication: practical considerations. Psychol Med 2022; 52:32-35. [PMID: 34542027 DOI: 10.1017/s0033291721003299] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Mark A Horowitz
- Department of Psychiatry, University College London, London, UK
- Goodmayes Hospital, North East London NHS Foundation Trust, London, UK
| | - Joanna Moncrieff
- Department of Psychiatry, University College London, London, UK
- Goodmayes Hospital, North East London NHS Foundation Trust, London, UK
| | - Lieuwe de Haan
- Amsterdam UMC, location AMC/Arkin, Amsterdam, Netherlands
| | - Jan P A M Bogers
- Mental Health Organisation Rivierduinen, High Care Clinics, Leiden, The Netherlands
| | - Shiral S Gangadin
- Department of Biomedical Sciences of Cells and Systems, Rijksuniversiteit Groningen, University Medical Center Groningen, Groningen, Netherlands
| | | | - Wim Veling
- Department of Psychiatry, Rijksuniversiteit Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Iris E C Sommer
- Department of Biomedical Sciences of Cells and Systems, Rijksuniversiteit Groningen, University Medical Center Groningen, Groningen, Netherlands
- Department of Psychiatry, Rijksuniversiteit Groningen, University Medical Center Groningen, Groningen, Netherlands
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Ballesteros A, Sánchez Torres AM, López-Ilundáin J, Mezquida G, Lobo A, González-Pinto A, Pina-Camacho L, Corripio I, Vieta E, de la Serna E, Mané A, Bioque M, Moreno-Izco L, Espliego A, Lorente-Omeñaca R, Amoretti S, Bernardo M, Cuesta MJ. The longitudinal effect of antipsychotic burden on psychosocial functioning in first-episode psychosis patients: the role of verbal memory. Psychol Med 2021; 51:2044-2053. [PMID: 32326991 DOI: 10.1017/s003329172000080x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Previous literature supports antipsychotics' (AP) efficacy in acute first-episode psychosis (FEP) in terms of symptomatology and functioning but also a cognitive detrimental effect. However, regarding functional recovery in stabilised patients, these effects are not clear. Therefore, the main aim of this study is to investigate dopaminergic/anticholinergic burden of (AP) on psychosocial functioning in FEP. We also examined whether cognitive impairment may mediate these effects on functioning. METHODS A total of 157 FEP participants were assessed at study entry, and at 2 months and 2 years after remission of the acute episode. The primary outcomes were social functioning as measured by the functioning assessment short test (FAST). Cognitive domains were assessed as potential mediators. Dopaminergic and anticholinergic AP burden on 2-year psychosocial functioning [measured with chlorpromazine (CPZ) and drug burden index] were independent variables. Secondary outcomes were clinical and socio-demographic variables. RESULTS Mediation analysis found a statistical but not meaningful contribution of dopaminergic receptor blockade burden to worse functioning mediated by cognition (for every 600 CPZ equivalent points, 2-year FAST score increased 1.38 points). Regarding verbal memory and attention, there was an indirect effect of CPZ burden on FAST (b = 0.0045, 95% CI 0.0011-0.0091) and (b = 0.0026, 95% CI 0.0001-0.0006) respectively. However, only verbal memory post hoc analyses showed a significant indirect effect (b = 0.009, 95% CI 0.033-0.0151) adding premorbid IQ as covariate. We did not find significant results for anticholinergic burden. CONCLUSION CPZ dose effect over functioning is mediated by verbal memory but this association appears barely relevant.
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Affiliation(s)
- Alejandro Ballesteros
- Red de Salud Mental de Navarra, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNa), Pamplona, Spain
| | - Ana M Sánchez Torres
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNa), Pamplona, Spain
| | - Jose López-Ilundáin
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNa), Pamplona, Spain
| | - Gisela Mezquida
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), August Pi I Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Antonio Lobo
- Department of Medicine and Psychiatry, Zaragoza University, Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Ana González-Pinto
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- BIOARABA Health Research Institute, OSI Araba, University Hospital, University of the Basque Country, Vitoria, Spain
| | - Laura Pina-Camacho
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IISGM, CIBERSAM, Madrid, Spain
| | - Iluminada Corripio
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Psychiatry Department, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Eduard Vieta
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Unidad de Trastornos bipolares y depresivos, Hospital Clínic, Universidad de Barcelona, IDIBAPS, Barcelona, Spain
| | - Elena de la Serna
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Department of Child and Adolescent Psychiatry and Psychology, Clínic Institute of Neurosciences, Hospital Clínic de Barcelona, 2017SGR881, Spain
| | - Anna Mané
- Hospital del Mar Medical Research Institute (IMIM), CIBERSAM, Autonomous University of Barcelona, Barcelona, Spain
| | - Miquel Bioque
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), August Pi I Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Lucía Moreno-Izco
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNa), Pamplona, Spain
| | - Ana Espliego
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IISGM, CIBERSAM, Madrid, Spain
| | - Ruth Lorente-Omeñaca
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNa), Pamplona, Spain
| | - Silvia Amoretti
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), August Pi I Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Miguel Bernardo
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), August Pi I Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Manuel J Cuesta
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNa), Pamplona, Spain
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Larsen-Barr M, Seymour F. Service-user efforts to maintain their wellbeing during and after successful withdrawal from antipsychotic medication. Ther Adv Psychopharmacol 2021; 11:2045125321989133. [PMID: 33796264 PMCID: PMC7970681 DOI: 10.1177/2045125321989133] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 12/28/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND It is well-known that attempting antipsychotic withdrawal can be a fraught process, with a high risk of relapse that often leads people to resume the medication. Nonetheless, there is a group of people who appear to be able to discontinue successfully. Relatively little is known about how people do this. METHODS A convenience sample of adults who had stopped taking antipsychotic medication for more than a year were recruited to participate in semi-structured interviews through an anonymous online survey that investigated antipsychotic medication experiences in New Zealand. Thematic analysis explored participant descriptions of their efforts to maintain their wellbeing during and after the withdrawal process. RESULTS Of the seven women who volunteered to participate, six reported bipolar disorder diagnoses and one reported diagnoses of obsessive compulsive disorder and depression. The women reported successfully discontinuing antipsychotics for 1.25-25 years; six followed a gradual withdrawal method and had support to prepare for and manage this. Participants defined wellbeing in terms of their ability to manage the impact of any difficulties faced rather than their ability to prevent them entirely, and saw this as something that evolved over time. They described managing the process and maintaining their wellbeing afterwards by 'understanding myself and my needs', 'finding what works for me' and 'connecting with support'. Sub-themes expand on the way in which they did this. For example, 'finding what works for me' included using a tool-box of strategies to flexibly meet their needs, practicing acceptance, drawing on persistence and curiosity and creating positive life experiences. CONCLUSION This is a small, qualitative study and results should be interpreted with caution. This sample shows it is possible for people who experience mania and psychosis to successfully discontinue antipsychotics and safely manage the impact of any symptoms that emerge as a result of the withdrawal process or other life stressors that arise afterwards. Findings suggest internal resources and systemic factors play a role in the outcomes observed among people who attempt to stop taking antipsychotics and a preoccupation with avoiding relapse may be counterproductive to these efforts. Professionals can play a valuable role in facilitating change.
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Affiliation(s)
| | - Fred Seymour
- School of Psychology, The University of Auckland, Auckland, New Zealand
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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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Magliano L, Citarelli G, Read J. The beliefs of non-psychiatric doctors about the causes, treatments, and prognosis of schizophrenia. Psychol Psychother 2020; 93:674-689. [PMID: 31502403 DOI: 10.1111/papt.12252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/23/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To examine the causal beliefs about schizophrenia of non-psychiatric doctors and whether differential belief in biogenetic vs. psychosocial causes influences doctors' views about treatments and prognosis. DESIGN AND METHODS Three hundred and five non-psychiatric doctors working in outpatient community centres completed the 'Opinions on mental disorders Questionnaire' after reading a clinical description of people with schizophrenia. RESULTS The factors most frequently reported as causes of schizophrenia were heredity (65.2%) and use of street drugs (54.1%). Seventy-five per cent of participants endorsed both one or more biological causal factors and one or more psychosocial causal factors. Of the 264 participants who expressed their opinion about the most important cause of schizophrenia, 53.8% indicated a biogenetic cause. Fifty-two per cent of respondents thought it 'completely true' that drugs are useful in schizophrenia, and 33.9% thought it 'completely true' that people with schizophrenia must take drugs all their life. Participants stating that the most important cause was biogenetic more frequently recommended a psychiatrist and less frequently a psychologist. Compared to doctors who indicated a psychosocial cause as the most important one, those who indicated a biogenetic cause were more sceptical about recovery, more confident in the usefulness of drugs, and more convinced of the need of lifelong pharmacological treatments in schizophrenia. CONCLUSIONS These findings suggest the need to provide some doctors with training on the multiple, interacting causes of schizophrenia and the efficacy of the broad range of available treatments. The education of health professionals regarding stigma and its effects on clinical practice is also needed. PRACTITIONER POINTS Viewing schizophrenia as mainly due to a biological cause is associated with greater confidence in the usefulness of drugs, higher belief in the need for lifelong pharmacological treatments, and greater prognostic pessimism. Belief in a biologically oriented model of schizophrenia may lead doctors to underestimate the value of psychologists. Prognostic pessimism among doctors may negatively influence clinical decisions, the information doctors provide to their clients, and clients' own beliefs about their chances of recovery. Belief in the need for lifelong pharmacological treatments in schizophrenia may lead doctors to resist drug withdrawal in case of severe side effects.
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Affiliation(s)
- Lorenza Magliano
- Department of Psychology, University of Campania 'Luigi Vanvitelli', Caserta, Italy
| | - Giulia Citarelli
- Department of Psychology, University of Campania 'Luigi Vanvitelli', Caserta, Italy
| | - John Read
- School of Psychology, University of East London, UK
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Abstract
Studies of antipsychotic medication, which are increasingly prescribed for a broad range of problems and circumstances, rarely ask the people who take them to describe their experiences with the drugs. In this study, 650 people, from 29 countries, responded, in an online survey, to "Overall in my life antipsychotic medications have been _____?" and "Is there anything else you would like to say, or emphasise, about your experiences with antipsychotic drugs?" Of the total participants, 14.3% were categorized as reporting purely positive experiences, 27.9% had mixed experiences, and 57.7% reported only negative ones. Negative experiences were positively correlated with age. Thematic analysis identified 749 negative, 180 positive, and 53 mixed statements. The 2 positive themes were "symptom reduction" (14) and "sleep" (14), with the majority (153) unspecified. The 4 negative themes (besides "unspecified"-191) were: "adverse effects" (316), "interactions with prescriber" (169), "withdrawal/difficult to get off them" (62), and "ineffective" (11). The adverse effects included: weight gain, emotional numbing, cognitive dysfunction, sedation, akathisia, effects on relationships, and suicidality. "Interactions with prescriber" included lack of information about withdrawal effects, support, or discussion of alternatives. The only mixed theme was "short-term good, long-term bad" (28). Open questions can add to findings from methodologies focused on symptom reduction. Clinicians should pay more attention to the need for respectful and collaborative patient-prescriber relationships. At the point of prescription, this must include providing the full range of information about antipsychotics, including potential benefits and harms, difficulties withdrawing, and information on alternatives treatments such as psychological therapies.
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Affiliation(s)
- John Read
- Department of Psychology, University of East London – Stratford Campus, London, UK,To whom correspondence should be addressed; University of East London – Stratford Campus, Water Lane, London E15 4LZ; tel: +44 (0)208 223 4943, e-mail:
| | - Ann Sacia
- Department of Psychology, University of East London – Stratford Campus, London, UK
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Read J, Harper DJ. The Power Threat Meaning Framework: Addressing Adversity, Challenging Prejudice and Stigma, and Transforming Services. JOURNAL OF CONSTRUCTIVIST PSYCHOLOGY 2020. [DOI: 10.1080/10720537.2020.1773356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- John Read
- School of Psychology, University of East London, London, UK
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Daya I, Hamilton B, Roper C. Authentic engagement: A conceptual model for welcoming diverse and challenging consumer and survivor views in mental health research, policy, and practice. Int J Ment Health Nurs 2020; 29:299-311. [PMID: 31538723 PMCID: PMC7328715 DOI: 10.1111/inm.12653] [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] [Received: 06/13/2019] [Revised: 08/08/2019] [Accepted: 08/11/2019] [Indexed: 12/18/2022]
Abstract
As involvement of consumers/survivors in planning, delivery, and evaluation of services has increased, expectations of authentic and effective engagement, versus tokenism, have also risen. Different factors contribute to, or detract from, authentic engagement. Writing from mental health consumer/survivor and nursing positioning, respectively, we aim to redress the common problem of including only a narrow range of views and voices. This paper introduces a conceptual model that supports leaders in research, clinical, service, and policy roles to understand the necessity of engaging with a broader spectrum of consumer/survivor views and voices. The model draws on published consumer/survivor materials, making explicit diverse experiences of treatment and care and identifying the subsequent rich consumer/survivor advocacy agendas. We propose that strong co-production is made possible by recognizing and welcoming consumer/survivor activist, facilitator, transformer, and humanizer contributions. The conceptual model forms the basis for a proposed qualitative validation project.
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Affiliation(s)
- Indigo Daya
- Melbourne Social Equity Institute, University of Melbourne, Melbourne, Victoria, Australia.,Victorian Mental Illness Awareness Council (VMIAC), East Brunswick, Victoria, Australia.,Centre for Psychiatric Nursing, School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Bridget Hamilton
- Centre for Psychiatric Nursing, School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Cath Roper
- Centre for Psychiatric Nursing, School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
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Cooper RE, Grünwald LM, Horowitz M. The case for including antipsychotics in the UK NICE guideline: “Medicines associated with dependence or withdrawal symptoms: safe prescribing and withdrawal management for adults”. PSYCHOSIS 2020. [DOI: 10.1080/17522439.2020.1722734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- R. E. Cooper
- Newham Centre for Mental Health, Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
- Newham Centre for Mental Health, East London NHS Foundation Trust, London, UK
| | - L. M. Grünwald
- Research & Development Department, Goodmayes Hospital, North East London NHS Foundation Trust, Essex, UK
- Division of Psychiatry, University College London, London, UK
| | - M. Horowitz
- Research & Development Department, Goodmayes Hospital, North East London NHS Foundation Trust, Essex, UK
- Division of Psychiatry, University College London, London, UK
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Read J. Bad things happen and can drive you crazy: The causal beliefs of 701 people taking antipsychotics. Psychiatry Res 2020; 285:112754. [PMID: 32086059 DOI: 10.1016/j.psychres.2020.112754] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/28/2019] [Accepted: 01/01/2020] [Indexed: 01/22/2023]
Abstract
In almost all countries the public prefers psycho-social explanations of 'schizophrenia' to bio-genetic ones. The causal explanations of people who experience psychosis have been under-researched, and, if they diverge from the dominant bio-genetic paradigm, can be dismissed as 'lack of insight'. 701 people, from 30 countries, who completed an online survey about their experiences on antipsychotics, answered an open question about what had caused the problems for which they had been prescribed the drugs. On a 'Bio-Social' likert scale, from 1 = 'Purely Biological' to 5 = 'Purely Social', the mean score was 4.24. Thematic analysis of 1,063 causal statements produced seven themes: Social (49.9%), Psychological (12.1%), Bio-genetic (11.6%), Iatrogenic (11.3%), Drug and Alcohol (6.7%), Medical Condition (4.5%) and Insomnia (4.0%). Respondents were 13 times more likely to report predominantly or exclusively Social causes as to report predominantly or exclusively Bio-genetic causes. Those with a psychosis diagnosis were even more likely than others to report a Social cause. The causal beliefs of this sample are consistent with previous studies of people diagnosed with 'schizophrenia' and the beliefs of the public. They are also aligned with recent research into the social causes of psychosis. It is argued that rather than dismiss the beliefs as 'lack of insight' it is more respectful and productive to listen carefully and adjust our understandings and services accordingly.
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Affiliation(s)
- John Read
- School of Psychology, University of East London, London E15 4LZ, UK.
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