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Ivanov SV. [Melatonergic antidepressant agomelatine: augmentation of antipsychotic drugs in treatment of post-schizophrenic depression]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:5-12. [PMID: 39269291 DOI: 10.17116/jnevro20241240815] [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: 09/15/2024]
Abstract
The article presents an analytical review of the data on the effectiveness of agomelatine as an augmentation of antipsychotics in the treatment of post-schizophrenic depression (PSD). The results of 5 published studies with a total sample size of 137 patients, the duration of therapy from 28 to 180 days with the appointment of agomelatin in combination with antipsychotics, including cases of additional use of drugs of other classes (normotimics, antidepressants, anxiolytics, anticholinergic correctors) were used. As a result, a pronounced effect was established in the indicators of respondents and patients in remission, combined with a favorable tolerability and safety profile, determining the prospects for the use of agomelatin in the therapy of PSD. Certain limitations in the methodology, including open and uncontrolled research design and small sample sizes, determine the relevance of systematic controlled trials to confirm the results obtained.
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Affiliation(s)
- S V Ivanov
- Mental Health Research Center, Moscow, Russia
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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Kim H, Baek SH, Kim JW, Ryu S, Lee JY, Kim JM, Chung YC, Kim SW. Inflammatory markers of symptomatic remission at 6 months in patients with first-episode schizophrenia. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:68. [PMID: 37794014 PMCID: PMC10550944 DOI: 10.1038/s41537-023-00398-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 09/21/2023] [Indexed: 10/06/2023]
Abstract
Neuroinflammation contributes to the pathophysiology of various mental illnesses including schizophrenia. We investigated peripheral inflammatory cytokines as a biomarker for predicting symptomatic remission in patients with first-episode schizophrenia. The study included 224 patients aged 15-60 years who fulfilled the criteria for schizophrenia spectrum disorder with a treatment duration ≤6 months. Serum levels of tumor necrosis factor (TNF) -α, interferon-γ, interleukin (IL)-1α, IL-1β, IL-6, IL-8, IL-10, and IL-12 were measured. Psychotic symptoms, depressive symptoms, and general functioning were assessed using the Positive and Negative Syndrome Scale, Beck Depression Inventory (BDI), Calgary Depression Scale for Schizophrenia, and Personal and Social Performance scale, respectively. Duration of untreated psychosis (DUP) was also recorded. We investigated the factors associated with remission for each sex in logistic regression analysis. In total, 174 patients achieved remission at the 6-month follow-up (females, 83.5%; males, 70.9%). Remission was associated with older age and lower BDI scores in male patients and with lower TNF-α levels and shorter DUP in female patients. Our findings suggest that peripheral inflammatory cytokines may impede early symptomatic remission in female patients with schizophrenia. In addition, depressive symptoms in males and long DUP in females may be poor prognostic factors for early remission in patients with first-episode psychosis.
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Affiliation(s)
- Honey Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea
- Mindlink, Gwangju Bukgu Community Mental Health and Welfare Center, Gwangju, Korea
| | - Seon-Hwa Baek
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea
- Mindlink, Gwangju Bukgu Community Mental Health and Welfare Center, Gwangju, Korea
| | - Ju-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea
- Mindlink, Gwangju Bukgu Community Mental Health and Welfare Center, Gwangju, Korea
| | - Seunghyong Ryu
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea
| | - Ju-Yeon Lee
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea
- Mindlink, Gwangju Bukgu Community Mental Health and Welfare Center, Gwangju, Korea
| | - Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea
| | - Young-Chul Chung
- Department of Psychiatry, Chonbuk National University Medical School, Jeonju, Korea
| | - Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea.
- Mindlink, Gwangju Bukgu Community Mental Health and Welfare Center, Gwangju, Korea.
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Camprodon-Boadas P, De la Serna E, Plana MT, Flamarique I, Lázaro L, Borràs R, Baeza I, Tasa-Vinyals E, Sugranyes G, Ortiz AE, Castro-Fornieles J. Delusional beliefs in adolescents with anorexia nervosa, obsessive-compulsive disorder, or first-episode psychosis: A comparative study. Psychiatry Res 2023; 328:115490. [PMID: 37748237 DOI: 10.1016/j.psychres.2023.115490] [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: 05/25/2023] [Revised: 09/13/2023] [Accepted: 09/21/2023] [Indexed: 09/27/2023]
Abstract
Delusional thinking is a key symptom of first-episode psychosis (FEP), but it has also been studied in obsessive-compulsive disorder (OCD) and anorexia nervosa (AN). This study aimed to analyze the psychometric properties of the Brown Assessment of Beliefs Scale (BABS) in a sample of adolescents diagnosed with a FEP, AN, or OCD, and to compare delusional thinking among the three samples. The sample comprised 60 patients in three groups of 20 diagnosed with OCD, AN, or FEP. Participants underwent assessment by diagnostic interview, the BABS scale, and a measure of depressive symptomatology. Specific instruments were also used to assess the main symptomatology of each disorder. The BABS had good internal consistency, and high validity and reliability. The OCD group scored significantly lower than the other two groups in all scale items except for items 4 (fixation of ideas), 6 (insight), and 7 (delusions of reference). A significant difference only existed between the AN and FEP groups for item 7 (delusions of reference). The BABS scale is a valid and reliable tool for assessing delusionality in adolescents diagnosed with OCD, AN, or FEP, with evidence of marked differences between the disorders. Assessing these symptoms could influence management, helping to improve treatment adherence and prognosis.
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Affiliation(s)
- Patricia Camprodon-Boadas
- Department of Child and Adolescent Psychiatry and Psychology, 2021SGR01319, Institut Clinic de Neurociències, Hospital Clínic de Barcelona, Barcelona, Spain; Fundació de Recerca Clínic Barcelona-Institut d´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM - ISCIII, Spain
| | - Elena De la Serna
- Department of Child and Adolescent Psychiatry and Psychology, 2021SGR01319, Institut Clinic de Neurociències, Hospital Clínic de Barcelona, Barcelona, Spain; Fundació de Recerca Clínic Barcelona-Institut d´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM - ISCIII, Spain.
| | - Maria Teresa Plana
- Department of Child and Adolescent Psychiatry and Psychology, 2021SGR01319, Institut Clinic de Neurociències, Hospital Clínic de Barcelona, Barcelona, Spain; Fundació de Recerca Clínic Barcelona-Institut d´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Itziar Flamarique
- Department of Child and Adolescent Psychiatry and Psychology, 2021SGR01319, Institut Clinic de Neurociències, Hospital Clínic de Barcelona, Barcelona, Spain; Fundació de Recerca Clínic Barcelona-Institut d´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM - ISCIII, Spain
| | - Luisa Lázaro
- Department of Child and Adolescent Psychiatry and Psychology, 2021SGR01319, Institut Clinic de Neurociències, Hospital Clínic de Barcelona, Barcelona, Spain; Fundació de Recerca Clínic Barcelona-Institut d´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM - ISCIII, Spain; Department of Medicine, Institute of Neuroscience, University of Barcelona, Spain
| | - Roger Borràs
- Department of Child and Adolescent Psychiatry and Psychology, 2021SGR01319, Institut Clinic de Neurociències, Hospital Clínic de Barcelona, Barcelona, Spain; Fundació de Recerca Clínic Barcelona-Institut d´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM - ISCIII, Spain
| | - Inmaculada Baeza
- Department of Child and Adolescent Psychiatry and Psychology, 2021SGR01319, Institut Clinic de Neurociències, Hospital Clínic de Barcelona, Barcelona, Spain; Fundació de Recerca Clínic Barcelona-Institut d´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM - ISCIII, Spain; Department of Medicine, Institute of Neuroscience, University of Barcelona, Spain
| | - Elisabet Tasa-Vinyals
- Department of Child and Adolescent Psychiatry and Psychology, 2021SGR01319, Institut Clinic de Neurociències, Hospital Clínic de Barcelona, Barcelona, Spain; Fundació de Recerca Clínic Barcelona-Institut d´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Department of Medicine, Institute of Neuroscience, University of Barcelona, Spain
| | - Gisela Sugranyes
- Department of Child and Adolescent Psychiatry and Psychology, 2021SGR01319, Institut Clinic de Neurociències, Hospital Clínic de Barcelona, Barcelona, Spain; Fundació de Recerca Clínic Barcelona-Institut d´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM - ISCIII, Spain
| | - Ana Encarnación Ortiz
- Department of Child and Adolescent Psychiatry and Psychology, 2021SGR01319, Institut Clinic de Neurociències, Hospital Clínic de Barcelona, Barcelona, Spain; Fundació de Recerca Clínic Barcelona-Institut d´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Josefina Castro-Fornieles
- Department of Child and Adolescent Psychiatry and Psychology, 2021SGR01319, Institut Clinic de Neurociències, Hospital Clínic de Barcelona, Barcelona, Spain; Fundació de Recerca Clínic Barcelona-Institut d´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM - ISCIII, Spain; Department of Medicine, Institute of Neuroscience, University of Barcelona, Spain
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Bodoano Sánchez I, Mata Agudo A, Guerrero-Jiménez M, Girela Serrano B, Álvarez Gil P, Carrillo de Albornoz Calahorro CM, Gutiérrez-Rojas L. Treatment of post-psychotic depression in first-episode psychosis. A systematic review. Nord J Psychiatry 2023; 77:109-117. [PMID: 35507756 DOI: 10.1080/08039488.2022.2067225] [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: 10/18/2022]
Abstract
BACKGROUND Post-psychotic depression (PPD) after a FEP (first-episode psychosis) differs from other depressive symptoms in chronic schizophrenia in its aetiology, symptomatology, and prognostic implications. The objective was to search if any pharmacological or non-pharmacological interventions have proven to be effective on depressive symptoms after a FEP. METHODS for this systematic review we systematically searched and screened PubMed for articles published from August 1975 to October 15, 2020, with the terms: treatment AND first-episode psychosis OR post-psychotic OR post-schizophrenic AND depression. RESULTS we identified 139 articles of which 20 met the inclusion criteria. These interventions were then categorized into four subgroups (antipsychotics, antidepressants, psychological and miscellaneous). LIMITATIONS this review has several limitations. The reviewed studies were heterogeneous as to assessments, interventions, and samples; furthermore, only one study had PPD in FEP as its primary outcome. CONCLUSIONS to our knowledge, this is the first review of PPD in a FEP's treatment. PPD continues to be a diagnostic and therapeutic challenge. The available evidence for the use of treatment whether pharmacological or non-pharmacological is limited. However, certain approaches such as online therapy and treatment with n-3 polyunsaturated fatty acids (PUFA) show promising results. It could be of interest for future studies to focus not only on the treatment of PPD but also on the diagnostic heterogeneity of the sample and the adaptation of the content of the intervention to the individual.
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Affiliation(s)
| | - Alba Mata Agudo
- Psychiatry Service, Virgen de las Nieves University Hospital, Granada, Spain
| | | | | | - Paula Álvarez Gil
- Psychiatry Service, Virgen de las Nieves University Hospital, Granada, Spain
| | | | - Luis Gutiérrez-Rojas
- Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, University of Granada, Granada, Spain.,Psychiatry Service, San Cecilio University Hospital, Granada, Spain.,Psychiatry Department, University of Granada, Granada, Spain
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Association between depression in chronic phase and future clinical outcome of patients with schizophrenia. Psychopharmacology (Berl) 2022; 239:965-975. [PMID: 35190858 DOI: 10.1007/s00213-022-06099-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/16/2022] [Indexed: 10/19/2022]
Abstract
RATIONALE Depression in schizophrenia is an important symptom. We investigated whether depression and suicidal symptoms in the chronic phase are related to remote future clinical outcomes in patients with schizophrenia and whether psychotropics improved clinical outcomes. OBJECTIVES The subjects included 462 outpatients of working age (15 to 64 years old) with schizophrenia treated at Okayama University Hospital from January 2010 to December 2011. We investigated the relationship between the Clinical Global Impression-Severity score at the last visit (average 19.2 years) and the existence of previous depression, suicidal ideas, and suicide attempts. We adjusted by several possible confounders including medical history using multiple regression analysis or logistic regression analysis. RESULTS Of 462 patients, 168 (36.4%) presented with depression 2 years after schizophrenia onset. A history of suicidal ideas and attempts was related to worse clinical outcome. In males, a history of depression was related to worse clinical outcome, but not in females. Lithium carbonate was related to better clinical outcome in all schizophrenia patients with depression, especially in males. Treatment with antidepressants was related to better clinical outcome only in males. CONCLUSIONS A history of depression or suicidal symptoms in the chronic phase predicted the future worse clinical outcome in patients with schizophrenia. The administration of lithium carbonate or antidepressants might be recommended, especially to male schizophrenia patients with depression.
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Coentre R, Fonseca A, Mendes T, Rebelo A, Fernandes E, Levy P, Góis C, Figueira ML. Suicidal behaviour after first-episode psychosis: results from a 1-year longitudinal study in Portugal. Ann Gen Psychiatry 2021; 20:35. [PMID: 34229687 PMCID: PMC8262034 DOI: 10.1186/s12991-021-00356-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/30/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Suicide is one of the main causes of excess of premature death in psychotic patients. Published studies found that suicide risk begins in ultra-high risk of psychosis and continues in early years of the disease. Previous studies identifying predictive and risk factors associated with suicidality in first-episode psychosis (FEP) are highly inconsistent. Also, there are relatively few longitudinal studies on suicidal behaviour in FEP. The aim of this study was to examine prevalence, evolution and predictors of suicidal behaviour at baseline and the 12-month follow-up in patients presenting with FEP. METHODS One hundred and eighteen patients presenting with FEP were recruited from two early psychosis units in Portugal. A comprehensive assessment examining socio-demographic and clinical characteristics was administered at baseline and the 12-month follow-up. Odds ratio were calculated using logistic regression analyses. McNemar test was used to evaluate the evolution of suicidal behaviour and depression prevalence from baseline to 12 months of follow-up. RESULTS Follow-up data were available for 60 participants from the 118 recruited. Approximately 25.4% of the patients had suicidal behaviour at the baseline evaluation, with a significant reduction during the follow-up period to 13.3% (p = 0.035). A multivariate binary logistic regression showed that a history of suicidal behaviour and depression at baseline independently predicted suicidal behaviour at baseline, and a history of suicidal behaviour and low levels of total cholesterol predicted suicidal behaviour at the 12-month follow-up. A significant proportion of patients also had depression at the baseline evaluation (43.3%), with the last month of suicidal behaviour at baseline independently predicting depression at this time. CONCLUSIONS The findings of our study indicate that suicidal behaviour was prevalent on the year after FEP. Patients with a history of suicidal behaviour, depression at baseline and low levels of cholesterol should undergo close evaluation, monitoring and possible intervention in order to reduce suicide risk in the early phases of psychosis.
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Affiliation(s)
- Ricardo Coentre
- Department of Psychiatry, Centro Hospitalar Universitário Lisboa Norte, Av Prof. Egas Moniz, 1649-035, Lisboa, Portugal.
- Psychiatric University Clinic, Faculdade de Medicina, Universidade de Lisboa, 1649-028, Lisboa, Portugal.
| | - Alexandra Fonseca
- Department of Psychiatry, Centro Hospitalar Universitário Lisboa Norte, Av Prof. Egas Moniz, 1649-035, Lisboa, Portugal
| | - Tiago Mendes
- Department of Psychiatry, Centro Hospitalar Universitário Lisboa Norte, Av Prof. Egas Moniz, 1649-035, Lisboa, Portugal
- Psychiatric University Clinic, Faculdade de Medicina, Universidade de Lisboa, 1649-028, Lisboa, Portugal
| | - Ana Rebelo
- Department of Psychiatry, Centro Hospitalar Universitário Lisboa Norte, Av Prof. Egas Moniz, 1649-035, Lisboa, Portugal
| | - Elisabete Fernandes
- Biomathematics Laboratory, Faculdade de Medicina, Universidade de Lisboa, 1649-028, Lisboa, Portugal
| | - Pedro Levy
- Department of Psychiatry, Centro Hospitalar Universitário Lisboa Norte, Av Prof. Egas Moniz, 1649-035, Lisboa, Portugal
| | - Carlos Góis
- Department of Psychiatry, Centro Hospitalar Universitário Lisboa Norte, Av Prof. Egas Moniz, 1649-035, Lisboa, Portugal
- Psychiatric University Clinic, Faculdade de Medicina, Universidade de Lisboa, 1649-028, Lisboa, Portugal
| | - Maria Luísa Figueira
- Psychiatric University Clinic, Faculdade de Medicina, Universidade de Lisboa, 1649-028, Lisboa, Portugal
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Abstract
Depression is the third most common illness among patients with schizophrenia which negatively affects the course of the disease and significantly contributes to the mortality rate, due to increased suicide. Depression, along with negative symptoms and cognitive deficits, is one of the main factors that significantly decreases the quality of life and the disease prognosis in patients with schizophrenia. In addition, depression increases the frequency of exacerbations and readmissions, decreases the quality and duration of remissions and is associated with more frequent substance abuse and an increased economic burden. Data on the prevalence of depression among patients with schizophrenia are contradictory and are associated with a low detection rate of depression in such patients, a lack of clear diagnostic criteria and difficulties in differentiation between extrapyramidal and negative symptoms. The average prevalence of depression that meets the diagnostic criteria of major depressive episodes in patients with schizophrenia is 25% at a specific point, and 60% over the course of a lifetime; the frequency of subsyndromal depression is much higher. It is essential to distinguish between primary (axial syndrome) and secondary depressive symptoms (extrapyramidal symptoms, psychogenic or nosogenic reactions, social factors, etc.) to determine treatment strategies. The published data relating to randomized clinical trials for the development of evidence-based guidelines are limited. Current recommendations are based mainly on the results of small-scale trials and reviews. Certain atypical antipsychotics (quetiapine, lurasidone, amisulpride, aripiprazole, olanzapine, clozapine) are superior to typical antipsychotics in the reduction of depressive symptoms. Clozapine is effective in the management of patients at risk from suicide. The additional prescription of antidepressants, transcranial magnetic stimulation and electroconvulsive therapy are not always effective and are only possible following the management of acute psychosis in cases when antipsychotic monotherapy proved to be ineffective.
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Affiliation(s)
- Sergey N Mosolov
- Moscow Research Institute of Psychiatry - a branch of the V. Serbsky Federal Medical Research Centre of Psychiatry and Narcology of the Ministry of Health of the Russian Federation
- Russian Medical Academy of Continuous Professional Education of the Ministry of Public Health of Russian Federation
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Sönmez N, Romm KL, Østefjells T, Grande M, Jensen LH, Hummelen B, Tesli M, Melle I, Røssberg JI. Cognitive behavior therapy in early psychosis with a focus on depression and low self-esteem: A randomized controlled trial. Compr Psychiatry 2020; 97:152157. [PMID: 31935529 DOI: 10.1016/j.comppsych.2019.152157] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/11/2019] [Accepted: 12/21/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients in early phases of psychosis often struggle with depressive symptoms and low self-esteem. The main aims of the present study were to examine whether cognitive behavior therapy (CBT) compared to treatment as usual (TAU) would reduce depressive symptoms (primary outcome) and increase self-esteem (secondary outcome). Furthermore, we wanted to examine whether CBT reduces symptoms measured with the PANSS (positive, negative, cognitive, or excited symptoms) or increases general functioning compared to TAU. METHODS A total of 63 early psychosis patients were included and randomly assigned to receive either CBT (maximum 26 sessions) or TAU for a period of up to six months. A linear mixed model was used for longitudinal analysis, with a focus on whether patients in the CBT group or the TAU group changed differently to one another between the baseline and 15-month follow-up. RESULTS There were no differences between the CBT group and TAU group regarding improvements in depressive symptoms measured with the Calgary Depression Scale for Schizophrenia (P = 0.188) or self-esteem measured with the Rosenberg Self-Esteem Scale (P = 0.580). However, patients in the CBT group improved significantly more on negative symptoms (P = 0.002) and social functioning (P = 0.001). CONCLUSIONS We did not find CBT to be more effective than TAU in reducing depressive symptoms or increasing self-esteem in patients with early psychosis. However, CBT seems to improve negative symptoms and functioning. These results still need to be replicated in further studies as the present one was merely an exploratory analysis. ClinicalTrials.gov Identifier: NCT01511406.
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Affiliation(s)
- Nasrettin Sönmez
- Diakonhjemmet Hospital, Forskningsveien 7, 0373 Oslo, Norway; Department of Research and Education, Clinic of Mental Health and Addiction, Oslo University Hospital, Norway
| | - Kristin Lie Romm
- Department of Research and Education, Clinic of Mental Health and Addiction, Oslo University Hospital, Norway; NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, 0424 Oslo, Norway
| | - Tiril Østefjells
- NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, 0424 Oslo, Norway; Department for Specialised Inpatient Treatment, Akershus University Hospital, Sykehusveien 25, 1478 Lørenskog, Norway
| | - Marit Grande
- Grande, Sandviksveien 157, 1337 Sandvika, Norway
| | - Lene Hunnicke Jensen
- Early Intervention in Psychosis Unit, Vestre Viken Hospital Trust, Drammen, Norway
| | - Benjamin Hummelen
- Department of Research and Education, Clinic of Mental Health and Addiction, Oslo University Hospital, Norway
| | - Martin Tesli
- NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, 0424 Oslo, Norway; Department of Mental Disorders, Norwegian Institute of Public Health, P.O. Box 4404, Nydalen, 0403 Oslo, Norway
| | - Ingrid Melle
- Department of Research and Education, Clinic of Mental Health and Addiction, Oslo University Hospital, Norway; NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, 0424 Oslo, Norway
| | - Jan Ivar Røssberg
- Department of Research and Education, Clinic of Mental Health and Addiction, Oslo University Hospital, Norway; NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, 0424 Oslo, Norway.
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9
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Ceskova E. Pharmacological strategies for the management of comorbid depression and schizophrenia. Expert Opin Pharmacother 2020; 21:459-465. [DOI: 10.1080/14656566.2020.1717466] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Eva Ceskova
- Central European Institute of Technology (CEITEC), Masaryk University, Brno, Czech Republic
- Department of Psychiatry, University Hospital Brno, Brno, Czech Republic
- Department of Psychiatry, University Hospital Ostrava, Ostrava, Czech Republic
- Department of Neurology and Psychiatry, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
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Herniman SE, Allott K, Phillips LJ, Wood SJ, Uren J, Mallawaarachchi SR, Cotton SM. Depressive psychopathology in first-episode schizophrenia spectrum disorders: a systematic review, meta-analysis and meta-regression. Psychol Med 2019; 49:2463-2474. [PMID: 31524121 DOI: 10.1017/s0033291719002344] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Despite knowing for many decades that depressive psychopathology is common in first-episode schizophrenia spectrum disorders (FES), there is limited knowledge regarding the extent and nature of such psychopathology (degree of comorbidity, caseness, severity) and its demographic, clinical, functional and treatment correlates. This study aimed to determine the pooled prevalence of depressive disorder and caseness, and the pooled mean severity of depressive symptoms, as well as the demographic, illness, functional and treatment correlates of depressive psychopathology in FES. METHODS This systematic review, meta-analysis and meta-regression was prospectively registered (CRD42018084856) and conducted in accordance with PRISMA and MOOSE guidelines. RESULTS Forty studies comprising 4041 participants were included. The pooled prevalence of depressive disorder and caseness was 26.0% (seven samples, N = 855, 95% CI 22.1-30.3) and 43.9% (11 samples, N = 1312, 95% CI 30.3-58.4), respectively. The pooled mean percentage of maximum depressive symptom severity was 25.1 (38 samples, N = 3180, 95% CI 21.49-28.68). Correlates of depressive psychopathology were also found. CONCLUSIONS At least one-quarter of individuals with FES will experience, and therefore require treatment for, a full-threshold depressive disorder. Nearly half will experience levels of depressive symptoms that are severe enough to warrant diagnostic investigation and therefore clinical intervention - regardless of whether they actually fulfil diagnostic criteria for a depressive disorder. Depressive psychopathology is prominent in FES, manifesting not only as superimposed comorbidity, but also as an inextricable symptom domain.
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Affiliation(s)
- Sarah E Herniman
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre of Youth Mental Health, University of Melbourne, Melbourne, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Kelly Allott
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre of Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Lisa J Phillips
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Stephen J Wood
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre of Youth Mental Health, University of Melbourne, Melbourne, Australia
- School of Psychology, University of Birmingham, Birmingham, UK
| | - Jacqueline Uren
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre of Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Sumudu R Mallawaarachchi
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre of Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Sue M Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre of Youth Mental Health, University of Melbourne, Melbourne, Australia
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Fang X, Chen L, Wang D, Yu L, Wang Y, Chen Y, Ren J, Tang W, Zhang C. Metabolic profiling identifies TC and LDL as potential serum biomarkers for depressive symptoms in schizophrenia. Psychiatry Res 2019; 281:112522. [PMID: 31521045 DOI: 10.1016/j.psychres.2019.112522] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/15/2019] [Accepted: 08/16/2019] [Indexed: 01/25/2023]
Abstract
This study aimed to explore the relationship between serum levels of cardiometabolic biomarkers and depressive symptoms in schizophrenia patients treated with atypical antipsychotics. A total of 210 patients with schizophrenia and 70 healthy controls were recruited in our present study. All patients were rated on the 17-item Hamilton Depression Rating Scale (HAMD-17) to measure depressive symptoms and the Positive and Negative Syndrome Scale (PANSS) for psychopathology. Serum cardiometabolic biomarkers (HDL, LDL, TC, TG, GLU) in all participants were measured. Our results showed that schizophrenia patients had higher levels of serum GLU, TG, TC, LDL and BMI, but lower levels of HDL than controls (all P < 0.05). Compared to patients without depressive symptoms, those with depressive symptoms showed higher PANSS total, general psychopathology, positive and negative symptom scores (all p < 0.05), as well as higher serum levels of LDL (p < 0.001) and TC (p = 0.011). In addition, our correlation analysis showed that serum LDL (P < 0.001) and TC (P = 0.045) levels were positively associated with HAMD total scores in schizophrenia patients after age, sex and education levels were controlled. Our results suggest the appearance of depression in schizophrenia patients may be associated with high levels of metabolic parameters, especially TC and LDL.
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Affiliation(s)
- Xinyu Fang
- Schizophrenia Program, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Lixian Chen
- The Second People's Hospital of Yuhuan, Zhejiang, China
| | - Dandan Wang
- Schizophrenia Program, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Lingfang Yu
- Schizophrenia Program, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Yewei Wang
- Schizophrenia Program, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Yan Chen
- Schizophrenia Program, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Juanjuan Ren
- Schizophrenia Program, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Wei Tang
- Wenzhou Kangning Hospital, Wenzhou Medical University, Zhejiang, China
| | - Chen Zhang
- Schizophrenia Program, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.
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12
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The association of clinical insight and depression with quality of life in schizophrenia. Psychiatry Res 2019; 279:350-352. [PMID: 30902352 DOI: 10.1016/j.psychres.2019.02.069] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 02/27/2019] [Accepted: 02/27/2019] [Indexed: 11/21/2022]
Abstract
This study assesses how insight influences depression and Quality of Life (QOL) in schizophrenia-spectrum outpatients and whether depression modifies the relationship between insight and QOL. 141 patients with schizophrenia or schizoaffective disorders with stable disease completed the EUROQOL-5D-5L and SQLS-R4, SAI-E and Calgary scales. Univariate and multivariate linear regression models were fitted to assess whether insight was related to QOL and/or depression. Higher levels of insight were (inversely) only related to EuroQOL-health but showed no relationship with depression. Depression showed an inversely strong relationship with EuroQOL-health. The relationship between clinical insight and QOL does not seem to be associated with depression.
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13
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Stabell LA, Gjestad R, Kroken RA, Løberg EM, Jørgensen HA, Johnsen E. Predictors of treatment satisfaction in antipsychotic-naïve and previously medicated patients with acute-phase psychosis. Nord J Psychiatry 2019; 73:349-356. [PMID: 31271338 DOI: 10.1080/08039488.2019.1636134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Treatment satisfaction predicts treatment adherence and long-term outcome for patients with psychosis. It is therefore important to understand the underpinnings of patient satisfaction in psychosis treatment for optimal treatment delivery. Aims: To examine the associations between satisfaction and level and change in positive symptoms, insight, depression and side effects of antipsychotics in previously medicated and antipsychotic-naïve patients. Method: Data derive from a randomised trial, with 226 respondents at baseline and 104 at follow-up. The measures were the positive subscale and insight item from the Positive and Negative Syndrome Scale, Calgary Depression Scale, the UKU Consumer Satisfaction Rating Scale, and the UKU side effects scale. Structural equation modelling was used to test the model. The full information maximum likelihood estimator used all available data. Results: In the sample of 226 patients, 67.3% were male and 44.2% were antipsychotic-naïve. The mean age was 34.1 years. For previously medicated patients, satisfaction was predicted by level of insight (b = -2.21, β = -0.42) and reduction in positive symptoms (b = -0.56, β = -0.39). For antipsychotic-naïve patients, satisfaction was predicted by level and change of insight (b = -2.21, β = -0.46), change in depression (b = -0.37, β = -0.26) and side effects (b = -0.15, β = -0.30). All predictors were significant at the 0.05 level. Conclusion: Reducing positive symptoms and side effects are important to enhance patient satisfaction. However, improving insight and reducing depression are more important in antipsychotic-naïve patients.
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Affiliation(s)
- Lena Antonsen Stabell
- a Division of Psychiatry and Centre of Excellence NORMENT, Haukeland University Hospital , Bergen , Norway
| | - Rolf Gjestad
- a Division of Psychiatry and Centre of Excellence NORMENT, Haukeland University Hospital , Bergen , Norway.,b Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital , Bergen , Norway
| | - Rune A Kroken
- a Division of Psychiatry and Centre of Excellence NORMENT, Haukeland University Hospital , Bergen , Norway.,c Department of Clinical Medicine, University of Bergen , Bergen , Norway
| | - Else-Marie Løberg
- a Division of Psychiatry and Centre of Excellence NORMENT, Haukeland University Hospital , Bergen , Norway.,d Department of Addiction Medicine, Haukeland University Hospital , Bergen , Norway.,e Department of Clinical Psychology, University of Bergen , Bergen , Norway
| | - Hugo A Jørgensen
- c Department of Clinical Medicine, University of Bergen , Bergen , Norway
| | - Erik Johnsen
- a Division of Psychiatry and Centre of Excellence NORMENT, Haukeland University Hospital , Bergen , Norway.,c Department of Clinical Medicine, University of Bergen , Bergen , Norway
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14
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Yoshimura B, Sakamoto S, Sato K, Takaki M, Yamada N. Predictors of remission during acute treatment of first-episode schizophrenia patients involuntarily hospitalized and treated with algorithm-based pharmacotherapy: Secondary analysis of an observational study. Early Interv Psychiatry 2019; 13:589-597. [PMID: 29498481 DOI: 10.1111/eip.12531] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 10/13/2017] [Accepted: 11/08/2017] [Indexed: 12/24/2022]
Abstract
AIM Early clinical response predicts symptomatic remission and recovery in the maintenance treatment phase of first-episode schizophrenia (FES). However, little is known about predictors of symptomatic remission during acute treatment of severely ill patients with FES. Here, we conducted a secondary analysis of our retrospective observational study, which examined response, remission and treatment-resistance rates in seriously ill patients with FES spectrum disorders involuntarily hospitalized and treated with algorithm-based pharmacotherapy. METHODS We performed a retrospective chart review of 131 involuntarily admitted patients with schizophrenia or schizoaffective disorder. Our algorithm aimed to delay olanzapine treatment, standardize medications and suggest initiation of clozapine after failure of third-line antipsychotic treatment. The duration of each adequate antipsychotic treatment at an optimal dosage was 4 weeks or more. Remission was defined using the symptom-severity component of consensus remission criteria. A logistic regression model was applied to identify significant predictors of remission at discharge. RESULTS Overall, 74 patients (56%) were in remission at discharge. Non-remitters were hampered from becoming remitters mainly by the presence of negative symptoms. There were no differences in first-line antipsychotics, dosage of antipsychotics at time of response and adherence rates to algorithm-based pharmacotherapy between remitters and non-remitters. Shorter duration of untreated psychosis, favourable early response and less negative symptoms at baseline were identified as independent predictors of remission at discharge. CONCLUSIONS The importance of early intervention and specific and adequate treatments of negative symptoms is highlighted.
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Affiliation(s)
- Bunta Yoshimura
- Department of Psychiatry, Okayama Psychiatric Medical Center, Okayama, Japan.,Department of Psychiatry, Okinawa Miyako Hospital, Miyakojima, Japan.,Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Shinji Sakamoto
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kojiro Sato
- Department of Psychiatry, Okayama Psychiatric Medical Center, Okayama, Japan
| | - Manabu Takaki
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Norihito Yamada
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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15
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Essali A, Turkmani K, Aboudamaah S, AbouDamaah A, Diaa Aldeen MR, Marwa ME, AlMounayer N. Haloperidol discontinuation for people with schizophrenia. Cochrane Database Syst Rev 2019; 4:CD011408. [PMID: 31006114 PMCID: PMC6475523 DOI: 10.1002/14651858.cd011408.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Schizophrenia is a disabling serious mental illness that can be chronic. Haloperidol, one of the first generation of antipsychotic drugs, is effective in the treatment of schizophrenia but can have adverse side effects. The effects of stopping haloperidol in people with schizophrenia who are stable on their prescription are not well researched in the context of systematic reviews. OBJECTIVES To review the effects of haloperidol discontinuation in people with schizophrenia who are stable on haloperidol. SEARCH METHODS On 20 February 2015, 24 May 2017, and 12 January 2019, we searched the Cochrane Schizophrenia Group's Study-Based Register of Trials including trial registers. SELECTION CRITERIA We included clinical trials randomising adults with schizophrenia or related disorders who were receiving haloperidol, and were stable. We included trials that randomised such participants to either continue their current treatment with haloperidol or discontinue their haloperidol treatment. We included trials that met our selection criteria and reported usable data. DATA COLLECTION AND ANALYSIS We independently checked all records retrieved from the search and obtained full reports of relevant records for closer inspection. We extracted data from included studies independently. All usable data were dichotomous, and we calculated relative risks (RR) and their 95% confidence intervals (95% CI) using a fixed-effect model. We assessed risk of bias within the included studies and used GRADE to create a 'Summary of findings' table. MAIN RESULTS We included five randomised controlled trials (RCTs) with 232 participants comparing haloperidol discontinuation with haloperidol continuation. Discontinuation was achieved in all five studies by replacing haloperidol with placebo. The trials' size ranged between 23 and 87 participants. The methods of randomisation, allocation concealment and blinding were poorly reported.Participants allocated to discontinuing haloperidol treatment were more likely to show no improvement in global state compared with those in the haloperidol continuation group (n = 49; 1 RCT; RR 2.06, 95% CI 1.33 to 3.20; very low quality evidence: our confidence in the effect estimate is limited due to relevant methodological shortcomings of included trials). Those who continued haloperidol treatment were less likely to experience a relapse compared to people who discontinued taking haloperidol (n = 165; 4 RCTs; RR 1.80, 95% CI 1.18 to 2.74; very low quality evidence). Satisfaction with treatment (measured as numbers leaving the study early) was similar between groups (n = 43; 1 RCT; RR 0.13, 95% CI 0.01 to 2.28; very low quality evidence).No usable mental state, general functioning, general behaviour or adverse effect data were reported by any of the trials. AUTHORS' CONCLUSIONS This review provides limited evidence derived from small, short-term studies. The longest study was for one year, making it difficult to generalise the results to a life-long disorder. Very low quality evidence shows that discontinuation of haloperidol is associated with an increased risk of relapse and a reduction in the risk of 'global state improvement'. However, participant satisfaction with haloperidol treatment was not different from participant satisfaction with haloperidol discontinuation as measured by leaving the studies early. Due to the very low quality of these results, firm conclusions cannot be made. In addition, the available studies did not report usable data regarding the adverse effects of haloperidol treatment.Considering that haloperidol is one of the most widely used antipsychotic drugs, it was surprising that only a small number of studies into the benefit and harm of haloperidol discontinuation were available. Moreover, the available studies did not report on outcomes that are important to clinicians and to people with schizophrenia, particularly adverse effects and social outcomes. Better designed trials are warranted.
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Affiliation(s)
- Adib Essali
- Counties Manukau HealthCommunity Mental HealthBuilding 6, 17 Lambie Drive,ManukauAucklandNew Zealand2241
| | - Khaled Turkmani
- Damascus UniversityFaculty of MedicineDamascusSyrian Arab Republic
| | | | - Alaa AbouDamaah
- Damascus UniversityDamascus Health UnitDamascusSyrian Arab Republic
| | | | | | - Nawar AlMounayer
- Damascus UniversityFaculty of MedicineDamascusSyrian Arab Republic
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16
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Rasmussen SA, Rosebush PI, Anglin RE, Mazurek MF. The predictive value of early treatment response in antipsychotic-naive patients with first-episode psychosis: Haloperidol versus olanzapine. Psychiatry Res 2016; 241:72-7. [PMID: 27156027 DOI: 10.1016/j.psychres.2016.04.097] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 02/26/2016] [Accepted: 04/26/2016] [Indexed: 11/30/2022]
Abstract
Early antipsychotic response predicts outcomes for psychotic patients, but recent evidence suggests that this may not be true for patients treated with olanzapine. In this study, we assessed the predictive value of early response to olanzapine or haloperidol in 75 antipsychotic-naive, first-episode psychosis inpatients. Patients were assessed weekly using the Brief Psychiatric Rating Scale (BPRS), Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), and Young Mania Rating Scale (YMRS). Regression analyses were used to determine whether improvement at week 2 or week 3 predicted improvement at hospital discharge. The majority of patients in both groups experienced a decrease in symptom severity of ≥50% at week 2. In the haloperidol group, week 2 improvement predicted improvement at discharge for all measures except the HAM-A. In the olanzapine group, week 2 improvement only predicted improvement at discharge for HAM-D scores. However, week 3 improvement in the olanzapine group predicted improvement at discharge for all measures except the HAM-A. Olanzapine non-responders at week 3 (but not week 2) benefited from having olanzapine switched to another antipsychotic. These results suggest that a 2 week trial of haloperidol is sufficient to predict treatment outcomes, while a 3 week trial is required for olanzapine.
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Affiliation(s)
- Sean A Rasmussen
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
| | - Patricia I Rosebush
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Rebecca E Anglin
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada; Department of Medicine (Gastroenterology), McMaster University, Hamilton, Ontario, Canada
| | - Michael F Mazurek
- Department of Medicine (Neurology), McMaster University, Hamilton, Ontario, Canada
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17
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Sönmez N, Røssberg JI, Evensen J, Barder HE, Haahr U, Ten Velden Hegelstad W, Joa I, Johannessen JO, Langeveld H, Larsen TK, Melle I, Opjordsmoen S, Rund BR, Simonsen E, Vaglum P, McGlashan T, Friis S. Depressive symptoms in first-episode psychosis: a 10-year follow-up study. Early Interv Psychiatry 2016; 10:227-33. [PMID: 24956976 DOI: 10.1111/eip.12163] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 04/29/2014] [Indexed: 11/27/2022]
Abstract
AIMS The present study examined if any patient characteristics at baseline predicted depressive symptoms at 10 years and whether patients prone to depressive symptoms in the first year of treatment had a different prognosis in the following years. METHOD A total of 299 first-episode psychosis (FEP) patients with schizophrenia spectrum disorders were assessed for depressive symptoms with PANSS depression item (g6) at baseline, and 1, 2, 5 and 10 years of follow up. At 10 years, depressive symptoms were also assessed with Calgary Depression Scale for Schizophrenia (CDSS). A PANSS g6 ≥ 4 and CDSS score ≥ 6 were used as a cut-off score for depression. RESULTS A total of 122 (41%) patients were scored as depressed at baseline, 75 (28%) at 1 year, 50 (20%) at 2 years, 33 (16%) at 5 years, and 35 (19%) at 10 years of follow up. Poor childhood social functioning and alcohol use at baseline predicted depression at 10 years of follow up. Thirty-eight patients were depressed at both baseline and 1 year follow up. This group had poorer symptomatic and functional outcome in the follow-up period compared to a group of patients with no depression in the first year of treatment. CONCLUSION Depressive symptoms are frequent among FEP patients at baseline but decrease after treatment because their general symptoms have been initiated. Patients with poor social functioning in childhood and alcohol use at baseline are more prone to have depressive symptoms at 10 years of follow up. Patients struggling with depressive symptoms in the first year of treatment should be identified as having poorer long-term prognosis.
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Affiliation(s)
- Nasrettin Sönmez
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jan Ivar Røssberg
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Julie Evensen
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Helene Eidsmo Barder
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Departments of Psychology, University of Oslo, Oslo, Norway
| | - Ulrik Haahr
- Early Psychosis Intervention Center, Psychiatry Roskilde, Region Zealand, Roskilde, Denmark
| | - Wenche Ten Velden Hegelstad
- Regional Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway
| | - Inge Joa
- Regional Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway.,Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Jan Olav Johannessen
- Regional Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway.,Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Hans Langeveld
- Regional Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway
| | - Tor Ketil Larsen
- Regional Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway.,Institute of Psychiatry, University of Bergen, Bergen, Norway
| | - Ingrid Melle
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Stein Opjordsmoen
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bjørn Rishovd Rund
- Departments of Psychology, University of Oslo, Oslo, Norway.,Vestre Viken Hospital Trust, Drammen, Norway
| | - Erik Simonsen
- Psychiatric Research Unit, Zealand Region, Psychiatry Roskilde, Roskilde University and University of Copenhagen, Roskilde, Denmark
| | - Per Vaglum
- Department of Behavioral Sciences in Medicine, University of Oslo, Oslo, Norway
| | - Thomas McGlashan
- Department of Psychiatry, Yale University School of Medicine, Yale Psychiatric Research at Congress Place, New Haven, Connecticut, USA
| | - Svein Friis
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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18
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Chang WC, Cheung R, Hui CLM, Lin J, Chan SKW, Lee EHM, Chen EYH. Rate and risk factors of depressive symptoms in Chinese patients presenting with first-episode non-affective psychosis in Hong Kong. Schizophr Res 2015; 168:99-105. [PMID: 26235752 DOI: 10.1016/j.schres.2015.07.040] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 07/14/2015] [Accepted: 07/23/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Depressive symptoms are a distinct symptom dimension in psychotic disorders and are associated with elevated suicide risk, and poorer clinical and functional outcomes. Previous research on depressive symptoms mainly focused on chronic patients and few studies were conducted to investigate factors associated with depression in the early illness course. We aimed to examine the prevalence and risk factors of depressive symptoms, and their impacts on functioning, subjective quality of life (QoL) and self-efficacy in first-episode non-affective psychosis. METHOD Three hundred fifty-one Hong Kong Chinese aged 26-55years presenting with first-episode non-affective psychosis to early intervention service were recruited. Assessments encompassing sociodemographics, premorbid adjustment, clinical and treatment profiles, functioning, QoL and perceived self-efficacy were conducted. Patients who had Calgary Depression Scale for Schizophrenia (CDSS) total score ≥6 were classified as having depressive symptoms. RESULTS Fifty-three (15.1%) patients exhibited depressive symptoms at entry. Depressed patients had worse functioning, poorer QoL and lower level of self-efficacy than non-depressed counterparts. Multivariate regression analysis showed that previous exposure to stressful life events, unemployment, being married, more severe positive symptoms, higher level of antipsychotic-induced Parkinsonism and negative attitude towards medication treatment were independently associated with depression status. CONCLUSIONS Depressive symptoms were frequently observed in adult patients with first-episode nonaffective psychosis, and were linked to poor functioning and QoL. Our findings indicated that, aside from social and clinical risk factors, presence of drug-induced Parkinsonism and negative treatment attitude may render patients more vulnerable to developing depression in the early stage of psychotic illness.
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Affiliation(s)
- Wing Chung Chang
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong.
| | - Rowan Cheung
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Christy Lai Ming Hui
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Jingxia Lin
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Sherry Kit Wa Chan
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | - Edwin Ho Ming Lee
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Eric Yu Hai Chen
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
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19
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González-Ortega I, Alberich S, Echeburúa E, Aizpuru F, Millán E, Vieta E, Matute C, González-Pinto A. Subclinical depressive symptoms and continued cannabis use: predictors of negative outcomes in first episode psychosis. PLoS One 2015; 10:e0123707. [PMID: 25875862 PMCID: PMC4398379 DOI: 10.1371/journal.pone.0123707] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 03/06/2015] [Indexed: 01/21/2023] Open
Abstract
Background Although depressive symptoms in first episode psychosis have been associated with cannabis abuse, their influence on the long-term functional course of FEP patients who abuse cannabis is unknown. The aims of the study were to examine the influence of subclinical depressive symptoms on the long-term outcome in first episode-psychosis patients who were cannabis users and to assess the influence of these subclinical depressive symptoms on the ability to quit cannabis use. Methods 64 FEP patients who were cannabis users at baseline were followed-up for 5 years. Two groups were defined: (a) patients with subclinical depressive symptoms at least once during follow-up (DPG), and (b) patients without subclinical depressive symptoms during follow-up (NDPG). Psychotic symptoms were measured using the Positive and Negative Syndrome Scale (PANSS), depressive symptoms using the Hamilton Depression Rating Scale (HDRS)-17, and psychosocial functioning was assessed using the Global Assessment of Functioning (GAF). A linear mixed-effects model was used to analyze the combined influence of cannabis use and subclinical depressive symptomatology on the clinical outcome. Results Subclinical depressive symptoms were associated with continued abuse of cannabis during follow-up (β= 4.45; 95% confidence interval [CI]: 1.78 to 11.17; P = .001) and with worse functioning (β = -5.50; 95% CI: -9.02 to -0.33; P = .009). Conclusions Subclinical depressive symptoms and continued cannabis abuse during follow-up could be predictors of negative outcomes in FEP patients.
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Affiliation(s)
- Itxaso González-Ortega
- Department of Psychiatry, University Hospital of Alava-Santiago, University of the Basque Country, CIBERSAM, Vitoria, Spain
- * E-mail:
| | - Susana Alberich
- Department of Psychiatry, University Hospital of Alava-Santiago, University of the Basque Country, CIBERSAM, Vitoria, Spain
| | - Enrique Echeburúa
- Department of Psychiatry, University Hospital of Alava-Santiago, University of the Basque Country, CIBERSAM, Vitoria, Spain
| | | | - Eduardo Millán
- Dirección de Asistencia Sanitaria, Osakidetza, Vitoria, Spain
| | - Eduard Vieta
- Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Carlos Matute
- Achucarro Basque Center for Neuroscience, University of the Basque Country, CIBERNED, Leioa, Spain
| | - Ana González-Pinto
- Department of Psychiatry, University Hospital of Alava-Santiago, University of the Basque Country, CIBERSAM, Vitoria, Spain
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20
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Hasan A, Falkai P, Wobrock T, Lieberman J, Glenthøj B, Gattaz WF, Thibaut F, Möller HJ. World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Schizophrenia. Part 3: Update 2015 Management of special circumstances: Depression, Suicidality, substance use disorders and pregnancy and lactation. World J Biol Psychiatry 2015; 16:142-70. [PMID: 25822804 DOI: 10.3109/15622975.2015.1009163] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
These updated guidelines are based on the first edition of the World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of schizophrenia published in the years 2005 and 2006. For this 2015 revision, all available publications pertaining to the biological treatment of schizophrenia were reviewed systematically to allow for an evidence-based update. These guidelines provide evidence-based practice recommendations which are clinically and scientifically relevant. They are intended to be used by all physicians diagnosing and treating patients with schizophrenia. Based on the first version of these guidelines a systematic review, as well as a data extraction from national guidelines have been performed for this update. The identified literature was evaluated with respect to the strength of evidence for its efficacy and subsequently categorised into six levels of evidence (A-F) and five levels of recommendation (1-5). This third part of the updated guidelines covers the management of the following specific treatment circumstances: comorbid depression, suicidality, various comorbid substance use disorders (legal and illegal drugs), and pregnancy and lactation. These guidelines are primarily concerned with the biological treatment (including antipsychotic medication and other pharmacological treatment options) of patients with schizophrenia.
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Affiliation(s)
- Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University , Munich , Germany
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Belvederi Murri M, Respino M, Innamorati M, Cervetti A, Calcagno P, Pompili M, Lamis DA, Ghio L, Amore M. Is good insight associated with depression among patients with schizophrenia? Systematic review and meta-analysis. Schizophr Res 2015; 162:234-47. [PMID: 25631453 DOI: 10.1016/j.schres.2015.01.003] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 12/23/2014] [Accepted: 01/02/2015] [Indexed: 12/22/2022]
Abstract
Among patients with schizophrenia, better insight may be associated with depression, but the findings on this issue are mixed. We examined the association between insight and depression in schizophrenia by conducting a systematic review and meta-analysis. The meta-analysis was based on 59 correlational studies and showed that global clinical insight was associated weakly, but significantly with depression (effect size r=0.14), as were the insight into the mental disorder (r=0.14), insight into symptoms (r=0.14), and symptoms' attributions (r=0.17). Conversely, neither insight into the social consequences of the disorder nor into the need for treatment was associated with symptoms of depression. Better cognitive insight was significantly associated with higher levels of depression. The exploratory meta-regression showed that methodological factors (e.g. the instrument used to assess depression and the phase of the illness) can significantly influence the magnitude of the association between insight and depression. Moreover, results from longitudinal studies suggest that the relation between insight and depression might be stronger than what is observed at the cross-sectional level. Finally, internalized stigma, illness perception, recovery attitudes, ruminative style, and premorbid adjustment seem to be relevant moderators and/or mediators of the association between insight and depression. In conclusion, literature indicates that among patients with schizophrenia, better insight is associated with higher levels of depressive symptoms. Thus, interventions aimed at promoting patients' insight should take into account the clinical implications of these findings.
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Affiliation(s)
- Martino Belvederi Murri
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy; Institute of Psychiatry, Department of Psychological Medicine, King's College London, London, UK.
| | - Matteo Respino
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy
| | - Marco Innamorati
- Department of Human Sciences, European University of Rome, Italy
| | - Alice Cervetti
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy
| | - Pietro Calcagno
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Italy
| | - Dorian A Lamis
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Lucio Ghio
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy
| | - Mario Amore
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy
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Sönmez N, Romm KL, Andreasssen OA, Melle I, Røssberg JI. Depressive symptoms in first episode psychosis: a one-year follow-up study. BMC Psychiatry 2013; 13:106. [PMID: 23560591 PMCID: PMC3635985 DOI: 10.1186/1471-244x-13-106] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 03/16/2013] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Depressive symptoms are common in patients with first episode psychosis (FEP) and have serious consequences for them. The main aims of this study were to examine the course of depression in FEP patients and explore whether any patient characteristics at baseline predicts depressive symptoms after one year. METHOD A total of 198 FEP patients with schizophrenia spectrum disorders were assessed for depressive symptoms with Calgary Depression Scale for Schizophrenia (CDSS) at baseline and 127 were followed for one year. A CDSS score [greater than or equal to] 6 was used as a cut-off score for depression. RESULTS Approximately 50% of the patients were depressed (CDSS[greater than or equal to]6) at baseline. At follow-up approximately 35% had depression. The course of depressive symptoms varied, 26% was depressed at both baseline and follow-up, 9% became depressed during the follow-up, 22% remitted from depression during the 12 months and 43% was neither depressed at baseline nor at follow-up. Poor childhood social functioning, long duration of untreated psychosis (DUP) and depressive symptoms at baseline predicted depression at 12 months follow-up. CONCLUSION Depressive symptoms are frequent in the first year after onset of psychosis. Patients with poor social functioning in childhood, long DUP and depressive symptoms at baseline are more prone to have depressive symptoms after one year. These patients should be identified and proper treatment provided.
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Affiliation(s)
- Nasrettin Sönmez
- Oslo University Hospital, (TIPS Sor Ost) Centre of Competence for Early Intervention in Psychosis, Fridtjof Nansens vei 12, Oslo, 0369, Norway,KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction and Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Pb 85, Oslo, 0319, Norway
| | - Kristin Lie Romm
- Oslo University Hospital, (TIPS Sor Ost) Centre of Competence for Early Intervention in Psychosis, Fridtjof Nansens vei 12, Oslo, 0369, Norway
| | - Ole A Andreasssen
- KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction and Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Pb 85, Oslo, 0319, Norway
| | - Ingrid Melle
- KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction and Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Pb 85, Oslo, 0319, Norway
| | - Jan Ivar Røssberg
- Oslo University Hospital, (TIPS Sor Ost) Centre of Competence for Early Intervention in Psychosis, Fridtjof Nansens vei 12, Oslo, 0369, Norway,KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction and Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Pb 85, Oslo, 0319, Norway
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