Schizophrenia and periodontal disease: An oro-neural connection? A cross-sectional epidemiological study

An Update Review to Cast Light on the Possible Role of Altered Oropharyngeal Microbiota in Differentiating True Psychosis from Malingered Psychosis in a Forensic Psychiatric Setting

Over the past few years, malingered psychosis has had a progressive occurrence since a great deal of attention has been directed to the closures of long-stay psychiatric institutions and care in the community. Therefore, malingered psychosis needs to be identified to conduct precise forensic assessments and prevent miscarriages of justice and misuse of restricted healthcare resources. Although, over the past decades, researchers have introduced a number of workable psychometric strategies and tools for diagnosing true psychosis, it is still sometimes challenging to differentiate between true and malingered psychosis. Hence, identifying reliable and innovative diagnostic alternatives seems crucial. Accordingly, a summary of gathered evidence is provided by the present review for enhancing future evaluation of oropharyngeal microbiome composition as a practical indicator for diagnosing true psychosis in a forensic psychiatric setting. As per the systematic search terms (namely, “diagnostic marker,” “oropharyngeal microbiome,” “forensic psychiatric setting,” “psychosis,” and “oropharyngeal microbiota”), relevant English publications were searched from January 1, 1980, to September 15, 2023, in Scopus, the Web of Science, Embase, Cochrane Library, PubMed, and Google Scholar databases. Finally, eight articles were included in the present review. Also, we adopted the narrative technique so that the material synthesis leads to a cohesive and compelling story. The results revealed that the periodontal disease and saliva microbiome were possibly associated with true psychosis. Thus, since oropharyngeal microbial compositions are highly different among healthy controls and patients with true psychosis, future research can take advantage of saliva to differentiate between fake and true fake psychosis throughout the initial stages of forensic psychiatric assessment. As a substrate of interest, saliva could also be used for characterizing the various stages of psychosis under a forensic psychiatric setting.

Predictors of antipsychotics switching among ambulatory patients with schizophrenia in Ethiopia: a multicenter hospital-based cross-sectional study

INTRODUCTION

A change of therapy from one to another antipsychotic medication is currently the main challenge of therapy. This study aimed to assess the prevalence of antipsychotic medication switches and determinants among patients with schizophrenia in Northwest Ethiopia.

METHODS

Multi-center hospital-based cross-sectional study was conducted at five Comprehensive Specialized Hospitals found in Northwest Ethiopia from April 30, 2021, to August 30, 2021. Data were extracted from both patients' medical charts and interviews. Data were entered into Epi-data software version 3.5.1 and exported to SPSS version 25.0 for analysis. A multivariable logistic regression model was fitted to identify factors associated with medication regimen switch. The level of significance of the study was kept at a p-value of 0.05 with a 95% confidence interval.

RESULT

A total of 414 patients are involved in the study, and 188 (45.5%) of patients switched antipsychotics within one year. The unavailability of the medication is the commonest reason for switching. Being male [AOR = 2.581, 95% CI (1.463, 4.552)], having relapse [AOR = 2.341,95% CI (1.169,4.687)], history of hospitalization in the past year [AOR = 3.00,95% CI (1.478,5.715)] and taking typical antipsychotics [AOR = 3.340, CI (1.76, 6.00)] had a significant association with antipsychotics switching.

CONCLUSIONS AND RECOMMENDATIONS

There is a high prevalence of antipsychotic switches among schizophrenia patients. Prescribers need to be careful while dosing, selecting, and switching antipsychotics, hence may help reduce discontinuation and unnecessary switch and thus achieve optimal clinical management.

The effect of antipsychotic medication and the associated hyperprolactinemia as a risk factor for periodontal diseases in schizophrenic patients: a cohort retrospective study

BACKGROUND

Periodontal disease is a major health problem that results in tooth loss and thus affects oral health, which affects quality of life. In particular, schizophrenic patients are at higher risk for periodontal disease due to several factors, including the effect of antipsychotic medications received by those patients. Accordingly, the aim of the present cohort retrospective study is to explore the effect of antipsychotics on periodontal health and the possible effect of antipsychotic-induced hyperprolactinemia as a risk factor for periodontal disease progression in schizophrenic patients.

METHODS AND OUTCOMES

The study population consisted of three groups: Group A (n = 21): schizophrenic patients that have been taking "prolactin-inducing" antipsychotics for at least 1 year; Group B (n = 21): schizophrenic patients who have been taking "prolactin-sparing" antipsychotics for at least 1 year; and Group C (n = 22): newly diagnosed schizophrenic patients and/or patients who did not receive any psychiatric treatment for at least 1 year. The study groups underwent assessment of periodontal conditions in terms of pocket depth (PD), clinical attachment loss (CAL), gingival recession, tooth mobility, and bleeding on probing (BOP). Also, bone mineral density was evaluated using DEXA scans, and the serum prolactin level was measured by automated immunoassay.

RESULTS

Results revealed a statistically significant difference in PD, CAL, and serum prolactin levels (P ≤ 0.001, P = 0.001, and P ≤ 0.001, respectively) among the 3 study groups. For both PD and CAL measurements, group A has shown significantly higher values than both groups B and C, whereas there was no statistically significant difference between the values of groups C and B. Concerning serum prolactin levels, group A had significantly higher values than groups B and C (P ≤ 0.001 and P ≤ 0.001 respectively). There was a statistically significant difference (P ≤ 0.001) between the 3 study groups in terms of bone mineral density. Moreover, there was a statistically significant direct relation between serum prolactin level and other parameters including clinical attachment loss, pocket depth measurements and bone mineral density.

CONCLUSION

According to our results, it could be concluded that all antipsychotics contribute to the progression of periodontal disease, with a higher risk for prolactin-inducing antipsychotics. However, further long term, large sampled, interventional and controlled studies are required to reach definitive guidelines to allow clinicians properly manage this group of patients.

Oropharyngeal microbiome composition as a possible diagnostic marker for true psychosis in a forensic psychiatric setting: A narrative literature review and an opinion

The malingered psychosis has increasingly occurred over the past few years due to the tendency towards care in the community and the closures of long-stay psychiatric institutions. Thus, it is required to identify malingered psychosis to reach accurate forensic assessments and inhibit misuse of restricted healthcare resources and miscarriages of justice. Despite the fact that some practical psychometric tools and strategies have been proposed for diagnosing true psychosis over the past decades, the differentiation between true psychosis and malingered psychosis is still sometimes challenging. Accordingly, it seems crucial to identify innovative and reliable diagnostic alternatives. Hence, the present article summarizes a collection of evidence that can be used by researchers to improve future assessment of oropharyngeal microbiome composition as a feasible diagnostic marker for true psychosis in a forensic psychiatric setting.

Is There a Link between Oropharyngeal Microbiome and Schizophrenia? A Narrative Review

The study aimed to examine the impact of the oropharyngeal microbiome in the pathophysiology of schizophrenia and to clarify whether there might be a bidirectional link between the oral microbiota and the brain in a context of dysbiosis-related neuroinflammation. We selected nine articles including three systemic reviews with several articles from the same research team. Different themes emerged, which we grouped into 5 distinct parts concerning the oropharyngeal phageome, the oropharyngeal microbiome, the salivary microbiome and periodontal disease potentially associated with schizophrenia, and the impact of drugs on the microbiome and schizophrenia. We pointed out the presence of phageoma in patients suffering from schizophrenia and that periodontal disease reinforces the role of inflammation in the pathophysiology of schizophrenia. Moreover, saliva could be an interesting substrate to characterize the different stages of schizophrenia. However, the few studies we have on the subject are limited in scope, and some of them are the work of a single team. At this stage of knowledge, it is difficult to conclude on the existence of a bidirectional link between the brain and the oral microbiome. Future studies on the subject will clarify these questions that for the moment remain unresolved.

Association between schizophrenia and periodontal disease in relation to cortisol levels: an ELISA-based descriptive analysis

Background

Schizophrenia is a chronic psychosis marked by multiple bioenvironmental and immunological dysregulation with its intricate role in etiopathogenesis of periodontal disease remaining unclear. Hence, the aim of this study is to determine the association between periodontal disease and schizophrenia in relation with cortisol levels.

Methods

The study is in descriptive design comprised of 40 subjects randomly selected (20 schizophrenic patients as Group A and 20 healthy volunteers as group B). All the study participants underwent complete periodontal examination including scoring of gingival index (GI), plaque index (PI), Probing depths (PD) and clinical attachment loss (CAL). Salivary cortisol levels are estimated using ELISA. Link between schizophrenia and periodontal disease is described in relation to cortisol levels with elimination of other shared risk factors, such as tobacco smoking and xerostomia.

Results

Significant higher values of periodontal parameters are observed in Group A with schizophrenic patients (GI 2.467 ± 0.528; PI 2.402 ± 0.526; PD 2.854 ± 0.865; CAL 1.726 ± 3.096) than Group B with healthy subjects (GI 0.355 ± 0.561; PI 0.475 ± 0.678; PD 1.493 ± 0.744; CAL 0.108 ± 0.254). However, cortisol levels are lower in schizophrenic group (0.190 ± 0.059) than non-schizophrenic group (0.590 ± 0.228) ruling out the possible role of cortisol in periodontal disease severity associated with schizophrenic patients.

Conclusion

Findings of this study, provides ground evidence for consideration of schizophrenia as a risk factor for periodontitis and demands greater emphasis on management of schizophrenic patients in dental setting similar to other comorbid disorders such as diabetes mellitus and also incorporating periodontal care measures in the clinical guidelines for schizophrenia management.

Schizophrenia and Dental Health: A Systematic Review

ABSTRACT

Schizophrenia is characterized not only by psychopathological symptoms but also by medical comorbidities. Among the latter, there are limited data on dental health. We conducted a systematic review with the primary aim of clarifying the extent of the relationship between dental diseases and schizophrenia. The second aim was to delineate an intervention program based on illness-related factors that influence dental health. The preferred reporting items for systematic reviews and meta-analyses statement for reporting systematic reviews was used. Only articles published in English language peer-reviewed journals were considered; we excluded case reports, meta-analyses, and systematic reviews, as well as studies that did not clearly report statistical analysis, diagnostic criteria, or the number of patients included. Twenty-one studies comprising 13,110 patients with schizophrenia and 9025 healthy controls were included. Negative symptomatology, long duration of illness, smoking habit, drug-induced xerostomia, and neuroinflammation are the most critical areas. We suggest an intervention program for prevention and treatment of dental diseases in schizophrenia.

Periodontal Pathogens and Neuropsychiatric Health

Increasing evidence incriminates low-grade inflammation in cardiovascular, metabolic diseases, and neuropsychiatric clinical conditions, all important causes of morbidity and mortality. One of the upstream and modifiable precipitants and perpetrators of inflammation is chronic periodontitis, a polymicrobial infection with Porphyromonas gingivalis (P. gingivalis) playing a central role in the disease pathogenesis. We review the association between P. gingivalis and cardiovascular, metabolic, and neuropsychiatric illness, and the molecular mechanisms potentially implicated in immune upregulation as well as downregulation induced by the pathogen. In addition to inflammation, translocation of the pathogens to the coronary and peripheral arteries, including brain vasculature, and gut and liver vasculature has important pathophysiological consequences. Distant effects via translocation rely on virulence factors of P. gingivalis such as gingipains, on its synergistic interactions with other pathogens, and on its capability to manipulate the immune system via several mechanisms, including its capacity to induce production of immune-downregulating micro-RNAs. Possible targets for intervention and drug development to manage distal consequences of infection with P. gingivalis are also reviewed.

From conifers to cognition: Microbes, brain and behavior

A diversity of bacteria, protozoans and viruses ("endozoites") were recently uncovered within healthy tissues including the human brain. By contrast, it was already recognized a century ago that healthy plants tissues contain abundant endogenous microbes ("endophytes"). Taking endophytes as an informative precedent, we overview the nature, prevalence, and role of endozoites in mammalian tissues, centrally focusing on the brain, concluding that endozoites are ubiquitous in diverse tissues. These passengers often remain subclinical, but they are not silent. We address their routes of entry, mechanisms of persistence, tissue specificity, and potential to cause long-term behavioral changes and/or immunosuppression in mammals, where rabies virus is the exemplar. We extend the discussion to Herpesviridae, Coronaviridae, and Toxoplasma, as well as to diverse bacteria and yeasts, and debate the advantages and disadvantages that endozoite infection might afford to the host and to the ecosystem. We provide a clinical perspective in which endozoites are implicated in neurodegenerative disease, anxiety/depression, and schizophrenia. We conclude that endozoites are instrumental in the delicate balance between health and disease, including age-related brain disease, and that endozoites have played an important role in the evolution of brain function and human behavior.

Periodontal disease and effects of antipsychotic medications in patients newly diagnosed with schizophrenia: a population-based retrospective cohort

AIM

Compared with the general population, individuals with schizophrenia have a higher risk of periodontal disease, which can potentially reduce their life expectancy. However, evidence for the early development of periodontal disease in schizophrenia is scant. The current study investigated risk factors for periodontal disease in patients newly diagnosed with schizophrenia.

METHODS

We identified a population-based cohort of patients in Taiwan with newly diagnosed schizophrenia who developed periodontal disease within 1 year of their schizophrenia diagnosis. Treatment with antipsychotics and other medications was categorised according to medication type and duration, and the association between medication use and the treated periodontal disease was assessed through logistic regression.

RESULTS

Among 3610 patients with newly diagnosed schizophrenia, 2373 (65.7%) had an incidence of treated periodontal disease during the 1-year follow-up. Female sex (adjusted odds ratios [OR] 1.40; 95% confidence interval [CI] 1.20-1.63); young age (adjusted OR 0.99; 95% CI 0.98-0.99); a 2-year history of periodontal disease (adjusted OR 2.45; 95% CI 1.84-3.26); high income level (adjusted OR 2.24; 95% CI 1.64-3.06) and exposure to first-generation (adjusted OR 1.89; 95% CI 1.54-2.32) and secondary-generation (adjusted OR 1.33; 95% CI 1.11-1.58) antipsychotics, anticholinergics (adjusted OR 1.24; 95% CI 1.03-1.50) and antihypertensives (adjusted OR 1.91; 95% CI 1.64-2.23) were independent risk factors for periodontal disease. Hyposalivation - an adverse effect of first-generation antipsychotics (FGAs) (adjusted OR 2.00; 95% CI 1.63-2.45), anticholinergics (adjusted OR 1.27; 95% CI 1.05-1.53) and antihypertensives (adjusted OR 1.90; 95% CI 1.63-2.22) - was associated with increased risk of periodontal disease. Therefore, hypersalivation due to FGA use (adjusted OR 0.72; 95% CI 0.59-0.88) was considered a protective factor.

CONCLUSIONS

The current study highlights that early prevention of periodontal disease in individuals with schizophrenia is crucial. Along with paying more attention to the development of periodontal disease, assessing oral health regularly, helping with oral hygiene, and lowering consumption of sugary drinks and tobacco, emphasis should also be given by physicians to reduce the prescription of antipsychotics to the extent possible under efficacious pharmacotherapy for schizophrenia.

Necessity of oral health intervention in schizophrenic patients - A review

Individuals with mental illness often cannot perform day to day activities due to a psychiatric or emotional disorder. Schizophrenia is one such psychiatric disorder characterized by worsening self-care ability with progressing mental illness. This disease may potentially deteriorate oral health by affecting the subject's ability to perform oral hygiene measures. Literature on oral disease manifestations in schizophrenia is limited. Lack of desire for oral health care as well as generally poor awareness of oral health issues in these patients, compounded further by side effects of medications, may complicate dental management in schizophrenic patients. The present review explores clinical features and possible factors associated with oral health status among those with Schizophrenia.

Barriers and enablers for oral health care for people affected by mental health disorders

BACKGROUND

People with mental health disorders are reported to have poorer access to dental services and poorer oral health outcomes. The aim of this paper is to analyze current published work regarding barriers and enablers for oral health outcomes and access to dental care for adults with mental health disorders which will be addressed from individual, organizational and systemic perspectives METHODS: A narrative review based on a search of the relevant published work regarding oral health for people with mental health disorders was undertaken using Medline, Web of Science, ERIC and Psychlit. Any relevant systematic reviews were highlighted in this process along with primary studies.

RESULTS

The published work repeatedly verified poorer oral health and inadequate access to dental services in people with mental health disorders. The published work identified barriers at individual, organizational and systemic levels. Much of the published work focused on barriers with less focus on enablers and interventions.

CONCLUSIONS

Considerable investigation of barriers had not elucidated options to improve care or outcomes.

Periodontal Systemic Connections-Novel Associations-A Review of the Evidence with Implications for Medical Practitioners

Periodontal diseases, considered as inflammatory diseases have proved to have a spectrum of systemic implications. Earliest research has associated periodontal disease with common systemic aliments such as hypertension, diabetes, osteoporosis, rheumatoid arthritis to name a few. The evolution of advanced diagnostic aids let researchers make vast inroads in linking periodontal diseases to systemic diseases like Alzheimer's disease (AD) and even Schizophrenia. Our aim was to review and critically evaluate comprehensive literature and provide knowledge to medical practitioners on these associations so as to pave way for closer interactions between medical and dental practitioners in implementing better health care. Electronic databases such as PubMed, Google Scholar and Cochrane databases were used as source of the data for relevant studies published from 2005 up to 2015 with the following keywords, "'Periodontal disease", "systemic conditions", "periodontal disease and Alzheimer's", "Periodontal disease and Schizophrenia", "Periodontal disease and Psoriasis" and "Periodontal disease and erectile dysfunction". The evidence presented ascertains that a reasonable and modest association does exist between Periodontal disease and Alzheimer's, Schizophrenia, Erectile dysfunction, as well as Psoriasis and thus establishes periodontal disease as a potential risk factor.