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Hansen HG, Speyer H, Starzer M, Albert N, Hjorthøj C, Eplov LF, Nordentoft M. Clinical Recovery Among Individuals With a First-Episode Schizophrenia an Updated Systematic Review and Meta-Analysis. Schizophr Bull 2023; 49:297-308. [PMID: 36029094 PMCID: PMC10016416 DOI: 10.1093/schbul/sbac103] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND HYPOTHESIS Through decades the clinical recovery outcomes among individuals diagnosed with schizophrenia have been highly inconsistent ranging from 13.5% to 57%. The primary objective of this updated examination was to report the pooled estimate and explore various moderators to improve the understanding of the course of schizophrenia. STUDY DESIGN A systematic literature search was set up on PubMed, PsycInfo, and EMBASE until January 13th, 2022. Both observational and interventional studies among cohorts of individuals with the first episode of schizophrenia reporting on clinical recovery were included. The PRISMA 2020 statement was used and data was extracted for a random-effects meta-analysis, meta-regression, and sensitivity analyses. Risk of bias was assessed using The Newcastle-Ottawa Scale. STUDY RESULTS A 20.8% (95% CI = 17.3 to 24.8) recovery rate was found among 26 unique study samples (mean trial duration, 9.5 years) including 3877 individuals (mean age, 26.4 years). In meta-regression none of the following study characteristics could uncover the diverse reported recovery rates; age at inclusion (P = .84), year of inclusion (P = .93), follow-up time (P = .99), drop-out rate (P = .07), or strictness of the recovery criteria (P = .35). Furthermore, no differences in recovery were found between early intervention services (EIS; 19.5%; 95% CI = 15.0 to 24.8) compared to other interventions (21%; 95% CI = 16.9 to 25.8), P = .65. CONCLUSIONS A clinical recovery rate of approximately 21% was found with minimum impact from various moderators. The rate was not different comparing EIS with other interventions implying that new initiatives are needed to improve the rate of recovery.
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Affiliation(s)
- Helene Gjervig Hansen
- Copenhagen Research Centre for Mental Health – CORE, Mental Health Centre Copenhagen, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Helene Speyer
- Copenhagen Research Centre for Mental Health – CORE, Mental Health Centre Copenhagen, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Marie Starzer
- Copenhagen Research Centre for Mental Health – CORE, Mental Health Centre Copenhagen, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Nikolai Albert
- Copenhagen Research Centre for Mental Health – CORE, Mental Health Centre Copenhagen, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
- Center of Psychiatry Amager, Copenhagen, Denmark
| | - Carsten Hjorthøj
- Copenhagen Research Centre for Mental Health – CORE, Mental Health Centre Copenhagen, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Lene Falgaard Eplov
- Copenhagen Research Centre for Mental Health – CORE, Mental Health Centre Copenhagen, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Merete Nordentoft
- Copenhagen Research Centre for Mental Health – CORE, Mental Health Centre Copenhagen, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
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Pradier MF, McCoy Jr TH, Hughes M, Perlis RH, Doshi-Velez F. Predicting treatment dropout after antidepressant initiation. Transl Psychiatry 2020; 10:60. [PMID: 32066733 PMCID: PMC7026064 DOI: 10.1038/s41398-020-0716-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 06/20/2019] [Indexed: 11/16/2022] Open
Abstract
Antidepressants exhibit similar efficacy, but varying tolerability, in randomized controlled trials. Predicting tolerability in real-world clinical populations may facilitate personalization of treatment and maximize adherence. This retrospective longitudinal cohort study aimed to determine the extent to which incorporating patient history from electronic health records improved prediction of unplanned treatment discontinuation at index antidepressant prescription. Clinical data were analyzed from individuals from health networks affiliated with two large academic medical centers between March 1, 2008 and December 31, 2014. In total, the study cohorts included 51,683 patients with at least one International Classification of Diseases diagnostic code for major depressive disorder or depressive disorder not otherwise specified who initiated antidepressant treatment. Among 70,121 total medication changes, 16,665 (23.77%) of them were followed by failure to return; maximum risk was observed with paroxetine (27.71% discontinuation), and minimum with venlafaxine (20.78% discontinuation); Mantel-Haenzel χ2 (8 df) = 126.44, p = 1.54e-23 <1e-6. Models incorporating diagnostic and procedure codes and medication prescriptions improved per-medication Areas Under the Curve (AUCs) to a mean of 0.69 [0.64-0.73] (ranging from 0.62 for paroxetine to 0.80 for escitalopram), with similar performance in the second, replication health system. Machine learning applied to coded electronic health records facilitates identification of individuals at high-risk for treatment dropout following change in antidepressant medication. Such methods may assist primary care physicians and psychiatrists in the clinic to personalize antidepressant treatment on the basis not solely of efficacy, but of tolerability.
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Affiliation(s)
- Melanie F. Pradier
- grid.38142.3c000000041936754XHarvard John A. Paulson School of Engineering and Applied Sciences, 29 Oxford Street, Cambridge, MA 02138 USA
| | - Thomas H. McCoy Jr
- grid.32224.350000 0004 0386 9924Center for Quantitative Health, Massachusetts General Hospital, 185 Cambridge Street, Boston, MA 02114 USA ,grid.38142.3c000000041936754XHarvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
| | - Michael Hughes
- grid.38142.3c000000041936754XHarvard John A. Paulson School of Engineering and Applied Sciences, 29 Oxford Street, Cambridge, MA 02138 USA ,grid.429997.80000 0004 1936 7531Tufts University, 419 Boston Avenue, Medford, MA 02155 USA
| | - Roy H. Perlis
- grid.32224.350000 0004 0386 9924Center for Quantitative Health, Massachusetts General Hospital, 185 Cambridge Street, Boston, MA 02114 USA ,grid.38142.3c000000041936754XHarvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
| | - Finale Doshi-Velez
- Harvard John A. Paulson School of Engineering and Applied Sciences, 29 Oxford Street, Cambridge, MA, 02138, USA.
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Cheng Z, Yuan Y, Han X, Yang L, Zeng X, Yang F, Lu Z, Wang C, Deng H, Zhao J, Xiang YT, Correll CU, Yu X. Rates and predictors of one-year antipsychotic treatment discontinuation in first-episode schizophrenia: Results from an open-label, randomized, "real world" clinical trial. Psychiatry Res 2019; 273:631-640. [PMID: 30735922 DOI: 10.1016/j.psychres.2019.01.068] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 01/16/2019] [Accepted: 01/23/2019] [Indexed: 02/05/2023]
Abstract
Antipsychotic treatment discontinuation is a major challenge in the treatment of first-episode schizophrenia (FES) patients. However, the rate and predictors remain unclear. Five hundred and sixty-nine FES patients were randomized to risperidone (n = 190), olanzapine (n = 185) or aripiprazole (n = 194) in a six-site study in China with 1-year follow-up. Patients failing the initially assigned antipsychotic were switched to one of the other 2 antipsychotics. By 52 weeks, 47.1% of FES patients discontinued all antipsychotics. In the 8-week acute phase, an antipsychotic switch was protective against antipsychotic discontinuation, whereas higher positive symptoms at the endpoint predicted discontinuation. In the maintenance phase, discontinuation was predicted by male gender and higher CGI-S score at the endpoint. The findings indicate that in China nearly half of patients with FES discontinued antipsychotic treatment during one year treatment. Clinicians should employ strategies other than medication choice to keep them from discontinuing.
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Affiliation(s)
- Zhang Cheng
- Institute of Mental Health, Peking University, Huayuanbei 51, Haidian District, Beijing, 100191, China.
| | - Yanbo Yuan
- Institute of Mental Health, Peking University, Huayuanbei 51, Haidian District, Beijing, 100191, China.
| | - Xue Han
- Institute of Mental Health, Peking University, Huayuanbei 51, Haidian District, Beijing, 100191, China.
| | - Lei Yang
- Institute of Mental Health, Peking University, Huayuanbei 51, Haidian District, Beijing, 100191, China.
| | - Xin Zeng
- Peking University Clinical Research Institute, Beijing, China.
| | - Fude Yang
- Beijing Hui-Long-Guan Hospital, Beijing, China.
| | - Zheng Lu
- Tongji Hospital of Tongji University, Shanghai, China.
| | - Chuanyue Wang
- Beijing Anding Hospital, Capital Medical University, Beijing, China.
| | - Hong Deng
- West China Hospital, Sichuan University, Chengdu, China.
| | - Jingping Zhao
- Mental Health Institute, Second Xiangya Hospital, Central South University, Changsha, China.
| | - Yu-Tao Xiang
- Unit of Psychiatry, Faculty of Health Science, University of Macau, Macao SAR, China.
| | - Christoph U Correll
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, NY, USA; Hofstra Northwell School of Medicine, Hempstead, NY, USA; The Feinstein Institute for Medical Research, Manhasset, NY, USA.
| | - Xin Yu
- Institute of Mental Health, Peking University, Huayuanbei 51, Haidian District, Beijing, 100191, China.
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Rami H, Hussien H, Rabie M, Sabry W, Missiry ME, Ghamry RE. Evaluating the effectiveness of a culturally adapted behavioral family psycho-educational program for Egyptian patients with schizophrenia. Transcult Psychiatry 2018; 55:601-622. [PMID: 29966499 DOI: 10.1177/1363461518782520] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although a growing body of evidence supports the effectiveness of behavioral family therapies for patients with schizophrenia, few studies have been carried out on the effectiveness of such programs for Egyptian patients. The current study translated and culturally adapted the Behavioral Family Psycho-Education Program (BFPEP) and conducted a preliminary efficacy evaluation for outpatients suffering from schizophrenia. Thirty patients received 14 sessions of culturally adapted Program (CA-BFPEP) and 30 received treatment as usual; all were followed up for 6 months. Pre- and post-intervention assessment included primary outcome measures that assessed the clinical, social, quality of life and attitude towards medications. The CA-BFPEP group demonstrated significant treatment effects as they had greater reductions in psychotic symptoms (PANSS), improvement of social function (SFQ), quality of life (QoL), and attitude towards medications (DAI), compared to patients in the control group. These results demonstrate the feasibility of implementing family therapy interventions in different cultural settings with relatively minor modifications. These promising findings invite further efforts to maximize the benefits of family therapy interventions internationally and to encourage mental health policy makers to integrate this mode of therapy in routine care management plans for patients with schizophrenia.
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Abdullah-Koolmees H, Gardarsdottir H, Minnema LA, Elmi K, Stoker LJ, Vuyk J, Goedhard LE, Egberts TCG, Heerdink ER. Predicting rehospitalization in patients treated with antipsychotics: a prospective observational study. Ther Adv Psychopharmacol 2018; 8:213-229. [PMID: 30065813 PMCID: PMC6058452 DOI: 10.1177/2045125318762373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 01/22/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Prediction of rehospitalization in patients treated with antipsychotics is important for identifying patients in need of additional support to prevent hospitalization. Our aim was to identify factors that predict rehospitalization in patients treated with antipsychotics at discharge from a psychiatric hospital. METHODS Adult patients suffering from schizophrenia, psychotic or bipolar I disorders who had been hospitalized in a psychiatric hospital for ⩾7 days and were treated with oral antipsychotics at discharge were included. The main outcome was rehospitalization within 6 months after discharge. A prediction model for rehospitalization was constructed including: patient/disease and medication characteristics, patients' beliefs about medicines, and healthcare-professional-rated assessment for all patients. The patients were stratified by diagnosis (schizophrenia and nonschizophrenia). Area under the receiver operating characteristic curve (AUCROC) was also assessed. RESULTS A total of 87 patients were included and 33.3% of them were rehospitalized within 6 months after discharge. The variables that predicted rehospitalization were duration of hospitalization, patients' attitude towards medicine use, and healthcare-professional-rated assessment with an AUCROC of 0.82. Rehospitalization for patients with schizophrenia could be predicted (AUCROC = 0.71) by the Global Assessment of Functioning score, age, and harm score. Rehospitalization was predicted (AUCROC = 0.73) for nonschizophrenia patients with, for example rehospitalization predicted by the nurse. CONCLUSIONS Rehospitalization was predicted by a combination of variables from the patient/disease and medication characteristics, patients' attitude towards medicine use, and healthcare-professional-rated assessment. These variables can be assessed relatively easily at discharge to predict rehospitalization within 6 months.
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Affiliation(s)
- Heshu Abdullah-Koolmees
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, The Netherlands
| | - Helga Gardarsdottir
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, The Netherlands
| | - Lotte A Minnema
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, The Netherlands
| | - Kamjar Elmi
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, The Netherlands
| | - Lennart J Stoker
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, The Netherlands
| | - Judith Vuyk
- Altrecht Mental Health Care, Utrecht, The Netherlands
| | | | - Toine C G Egberts
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, The Netherlands
| | - Eibert R Heerdink
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, The Netherlands
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Comparison of the long-term treatment outcomes of women and men diagnosed with schizophrenia over a period of 20 years. A prospective study. Compr Psychiatry 2018; 84:62-67. [PMID: 29694934 DOI: 10.1016/j.comppsych.2018.03.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 03/02/2018] [Accepted: 03/31/2018] [Indexed: 11/23/2022] Open
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Fasmer EE, Fasmer OB, Berle JØ, Oedegaard KJ, Hauge ER. Graph theory applied to the analysis of motor activity in patients with schizophrenia and depression. PLoS One 2018; 13:e0194791. [PMID: 29668743 PMCID: PMC5905887 DOI: 10.1371/journal.pone.0194791] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 03/10/2018] [Indexed: 12/11/2022] Open
Abstract
Depression and schizophrenia are defined only by their clinical features, and diagnostic separation between them can be difficult. Disturbances in motor activity pattern are central features of both types of disorders. We introduce a new method to analyze time series, called the similarity graph algorithm. Time series of motor activity, obtained from actigraph registrations over 12 days in depressed and schizophrenic patients, were mapped into a graph and we then applied techniques from graph theory to characterize these time series, primarily looking for changes in complexity. The most marked finding was that depressed patients were found to be significantly different from both controls and schizophrenic patients, with evidence of less regularity of the time series, when analyzing the recordings with one hour intervals. These findings support the contention that there are important differences in control systems regulating motor behavior in patients with depression and schizophrenia. The similarity graph algorithm we have described can easily be applied to the study of other types of time series.
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Affiliation(s)
| | - Ole Bernt Fasmer
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, Section for Psychiatry, University of Bergen, Bergen, Norway
- K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, Bergen, Norway
- * E-mail:
| | - Jan Øystein Berle
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, Section for Psychiatry, University of Bergen, Bergen, Norway
| | - Ketil J. Oedegaard
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, Section for Psychiatry, University of Bergen, Bergen, Norway
- K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, Bergen, Norway
| | - Erik R. Hauge
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
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Fasmer OB, Hauge E, Berle JØ, Dilsaver S, Oedegaard KJ. Distribution of Active and Resting Periods in the Motor Activity of Patients with Depression and Schizophrenia. Psychiatry Investig 2016; 13:112-20. [PMID: 26766953 PMCID: PMC4701674 DOI: 10.4306/pi.2016.13.1.112] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 02/16/2015] [Accepted: 03/28/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Alterations of activity are prominent features of the major functional psychiatric disorders. Motor activity patterns are characterized by bursts of activity separated by periods with inactivity. The purpose of the present study has been to analyze such active and inactive periods in patients with depression and schizophrenia. METHODS Actigraph registrations for 12 days from 24 patients with schizophrenia, 23 with depression and 29 healthy controls. RESULTS Patients with schizophrenia and depression have distinctly different profiles with regard to the characterization and distribution of active and inactive periods. The mean duration of active periods is lowest in the depressed patients, and the duration of inactive periods is highest in the patients with schizophrenia. For active periods the cumulative probability distribution, using lengths from 1 to 35 min, follows a straight line on a log-log plot, suggestive of a power law function, and a similar relationship is found for inactive periods, using lengths from 1 to 20 min. For both active and inactive periods the scaling exponent is higher in the depressed compared to the schizophrenic patients. CONCLUSION The present findings add to previously published results, with other mathematical methods, suggesting there are important differences in control systems regulating motor behavior in these two major groups of psychiatric disorders.
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Affiliation(s)
- Ole Bernt Fasmer
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, Section for Psychiatry, University of Bergen, Bergen, Norway
- K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, Bergen, Norway
| | - Erik Hauge
- Olaviken Psychiatric Hospital, Bergen, Norway
| | - Jan Øystein Berle
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | | | - Ketil J. Oedegaard
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, Section for Psychiatry, University of Bergen, Bergen, Norway
- K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, Bergen, Norway
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Lee SY, Kim KH, Kim T, Kim SM, Kim JW, Han C, Song JY, Paik JW. Outpatient Follow-Up Visit after Hospital Discharge Lowers Risk of Rehospitalization in Patients with Schizophrenia: A Nationwide Population-Based Study. Psychiatry Investig 2015; 12:425-33. [PMID: 26508952 PMCID: PMC4620298 DOI: 10.4306/pi.2015.12.4.425] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 01/17/2015] [Accepted: 02/03/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Non-adherence to medication is a recognized problem in psychiatric patients and may be one of the most challenging aspects of treatment for patients with schizophrenia. Failure of follow-up care after discharge greatly increases non-adherence to prescribed medications, relapse and rehospitalization. However, it is still unknown whether and how much outpatient follow-up visits can mitigate the risk of rehospitalization. Therefore we sought to investigate the continuity and effectiveness of outpatient care after inpatient discharge and its effect on rehospitalization of patients with schizophrenia. METHODS Data were extracted from National Health Insurance Claim Database covering the period from 2007 through 2010. We identified 10,246 patients aged 18 years or older who were admitted in psychiatric facilities with the diagnosis of schizophrenia between January 1 and December 31 in 2007. The number of outpatient visits within 60 days after discharge from index admission was defined as the indicator for the continuous care and rehospitalization was inspected during the following 36-month period. Cox's proportional hazard model was used to examine the factors affecting the risk of rehospitalization including the number of outpatient visits, age, sex, comorbidities, antipsychotics, and characteristics of medical institution. RESULTS We found that 12.7% (n=1,327) of the patients visited psychiatric outpatient department once within 60 days after hospital discharge, 34.8% (n=3,626) twice, and 27.8% (n=2,900) more than three times. Patients taking atypical antipsychotics showed higher proportion in 2 or more outpatient visits, whereas patients taking typical antipsychotics showed higher proportion in one or no outpatient visits. Cox hazard ratios of rehospitalization for the factor of 3 or more outpatient visits referenced to that of no follow-up visit were 0.567 (0.428-0.750, 95% confidence interval) within 90 days, 0.673 (0.574-0.789) within 180 days, 0.800 (0.713-0.898) within a year, 0.906 (0.824-0.997) within 2 years, and 0.993 (0.910-1.084) within 3 years. CONCLUSION Although continuous outpatient treatment is important for relapse prevention, patients with schizophrenia showed a low rate of outpatient visit as 62.6% of total patients in 2 or more visits within 60 days after discharge. Lack of follow-up treatment might lead to increase psychotic symptoms and raised risk of relapse and rehospitalization. Our data suggest that the number of outpatient visits within 60 days after discharge in patients with schizophrenia is an important indicator of rehospitalization within a year. Therefore, further efforts to examine factors affecting failure of outpatient follow-up after discharge are warranted.
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Affiliation(s)
- Seung Yup Lee
- Department of Neuropsychiatry, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Kyoung Hoon Kim
- Health Insurance Review & Assessment Service, Seoul, Republic of Korea
| | - Tae Kim
- Department of Neuropsychiatry, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Sun Min Kim
- Health Insurance Review & Assessment Service, Seoul, Republic of Korea
| | - Jong-Woo Kim
- Department of Neuropsychiatry, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Changsu Han
- Department of Psychiatry, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Ji Young Song
- Department of Neuropsychiatry, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jong-Woo Paik
- Department of Neuropsychiatry, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
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Lang FU, Kösters M, Lang S, Becker T, Jäger M. Psychopathological long-term outcome of schizophrenia -- a review. Acta Psychiatr Scand 2013; 127:173-82. [PMID: 23136879 DOI: 10.1111/acps.12030] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/20/2012] [Indexed: 01/17/2023]
Abstract
OBJECTIVE In the past, the comparability of empirical studies that examined the course and outcome of schizophrenia was limited by their use of different diagnostic systems. Focussing on the psychopathological long-term outcome, the present article aims to review follow-up studies that used modern operationalized diagnostic criteria for schizophrenia (DSM-III, DSM-III-R, DSM-IV and ICD-10). METHOD We searched MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE, PsycINFO and PSYNDEX for relevant studies up to the year 2011. Twenty-one studies were included in the final analysis. RESULTS The long-term outcome of schizophrenia was heterogeneous and included full remissions as well as severe chronic states. Schizophrenia, however, showed a considerably more unfavourable outcome than other diagnostic groups such as schizoaffective or affective disorders. Psychopathological symptoms remained relatively stable in the course of illness. Several predictors for a poor outcome were identified, such as male gender or pronounced negative symptoms. CONCLUSION Recent studies using modern diagnostic systems largely confirm the results of earlier studies. Current diagnostic criteria for schizophrenia identify a heterogeneous sample of patients. The influence of therapeutic interventions on long-term outcome remains unclear.
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Affiliation(s)
- F U Lang
- Department of Psychiatry II, Ulm University, Ulm, Germany.
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Ye W, Ascher-Svanum H, Tanji Y, Flynn JA, Takahashi M. Predictors of continuation with olanzapine during the 1-year naturalistic treatment of patients with schizophrenia in Japan. Patient Prefer Adherence 2011; 5:611-7. [PMID: 22259238 PMCID: PMC3259076 DOI: 10.2147/ppa.s26002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Treatment continuation is considered an important measure of antipsychotic effectiveness in schizophrenia, reflecting the medication's efficacy, safety, and tolerability from both patients' and clinicians' perspectives. This study identified characteristics of patients with schizophrenia who continue olanzapine therapy for a 1-year period in Japan. METHODS In a large (N = 1850), prospective, observational study, Japanese patients with schizophrenia who initiated treatment with olanzapine were followed for 1 year. Baseline characteristics were compared using t-tests and chi-square tests. Stepwise logistic regression was used to identify independent baseline predictors of treatment continuation. RESULTS Most patients (68.2%) continued with olanzapine therapy for the full 1-year study period, with an average duration of 265.5 ± 119.4 days. At baseline, patients who continued were significantly more likely to be male, older, and inpatients; have longer illness duration, higher negative and cognitive symptoms, better health-related quality of life, and prior anticholinergic use. Continuers were significantly less likely to engage in social activities, live independently, work for pay, or have prior antidepressant use. Continuers showed significantly greater early (3-month) improvement in global symptom severity. Logistic regression found that continuation was significantly predicted by longer illness duration, lower positive symptoms, higher negative symptoms, and better health-related quality of life. CONCLUSIONS In this large naturalistic study in Japan, most patients with schizophrenia stayed on olanzapine therapy for the full 1-year study period. Treatment completion with olanzapine was independently predicted by longer illness duration, lower positive symptoms, higher negative symptoms, and better health-related quality of life.
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Affiliation(s)
- Wenyu Ye
- Lilly Suzhou Pharmaceutical Co, Shanghai, People’s Republic of China
| | | | - Yuka Tanji
- Lilly Research Laboratories Japan, Eli Lilly Japan KK, Kobe
| | | | - Michihiro Takahashi
- Lilly Research Laboratories Japan, Eli Lilly Japan KK, Kobe
- Terauchi-Takahashi Psychiatric Clinic, Ashiya, Japan
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