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Winter-van Rossum I, Weiser M, Galderisi S, Leucht S, Bitter I, Glenthøj B, Hasan A, Luykx J, Kupchik M, Psota G, Rocca P, Stefanis N, Teitelbaum A, Bar Haim M, Leucht C, Kemmler G, Schurr T, Davidson M, Kahn RS, Fleischhacker WW. Efficacy of oral versus long-acting antipsychotic treatment in patients with early-phase schizophrenia in Europe and Israel: a large-scale, open-label, randomised trial (EULAST). Lancet Psychiatry 2023; 10:197-208. [PMID: 36716759 DOI: 10.1016/s2215-0366(23)00005-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 01/29/2023]
Abstract
BACKGROUND Schizophrenia is a severe psychiatric disorder with periods of remission and relapse. As discontinuation of antipsychotic medication is the most important reason for relapse, long-term maintenance treatment is key. Whether intramuscular long-acting (depot) antipsychotics are more efficacious than oral medication in preventing medication discontinuation is still unresolved. We aimed to compare time to all-cause discontinuation in patients randomly allocated to long-acting injectable (LAI) versus oral medication. METHODS EULAST was a pragmatic, randomised, open-label trial conducted at 50 general hospitals and psychiatric specialty clinics in 15 European countries and Israel. Patients aged 18 years and older, with DSM-IV schizophrenia (as confirmed by the Mini International Neuropsychiatric Interview 5 plus) and having experienced their first psychotic episode from 6 months to 7 years before screening, were randomly allocated (1:1:1:1) using block randomisation to LAI paliperidone, LAI aripiprazole, or the respective oral formulations of these antipsychotics. Randomisation was stratified by country and duration of illness (6 months up to 3 years vs 4 to 7 years). Patients were followed up for up to 19 months. The primary endpoint was discontinuation, regardless of the reason, during 19 months of treatment. We used survival analysis to assess the time until all-cause discontinuation in the intention-to-treat (ITT) group, and per protocol analyses were also done. This trial is registered with ClinicalTrials.gov, NCT02146547, and is complete. FINDINGS Between Feb 24, 2015, and Dec 15, 2018, 533 individuals were recruited and assessed for eligibility. The ITT population included 511 participants, with 171 (33%) women and 340 (67%) men, and a mean age of 30·5 (SD 9·6) years. 410 (80%) of 511 participants were White, 35 (7%) were Black, 20 (4%) were Asian, and 46 (9%) were other ethnicity. In the combined oral antipsychotics treatment group of 247 patients, 72 (29%) patients completed the study and 175 (71%) met all-cause discontinuation criteria. In the combined LAI treatment arm of 264 patients, 95 (36%) completed the study and 169 (64%) met the all-cause discontinuation criteria. Cox regression analyses showed that treatment discontinuation for any cause did not differ between the two combined treatment groups (hazard ration [HR] 1·16, 95% CI 0·94-1·43, p=0·18). No significant difference was found in the time to all-cause discontinuation between the combined oral and combined LAI treatment groups (log rank test χ2=1·87 [df 1]; p=0·17). During the study, 121 psychiatric hospitalisations occurred in 103 patients, and one patient from each of the LAI groups died; the death of the patient assigned to paliperidone was assessed to be unrelated to the medication, but the cause of other patient's death was not shared with the study team. 86 (25%) of 350 participants with available data met akathisia criteria and 70 (20%) met parkinsonism criteria at some point during the study. INTERPRETATION We found no substantial advantage for LAI antipsychotic treatment over oral treatment regarding time to discontinuation in patients with early-phase schizophrenia, indicating that there is no reason to prescribe LAIs instead of oral antipsychotics if the goal is to prevent discontinuation of antipsychotic medication in daily clinical practice. FUNDING Lundbeck and Otsuka.
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Affiliation(s)
- Inge Winter-van Rossum
- Department of Psychiatry, UMC Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mark Weiser
- Department of Psychiatry, Sheba Medical Center, Tel Hashomer, Israel
| | | | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Istvan Bitter
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Birte Glenthøj
- Center for Neuropsychiatric Schizophrenia Research, CNSR, and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Mental Health Center Glostrup, University of Copenhagen, Glostrup, Denmark; University of Copenhagen, Faculty of Health and Medical Sciences, Department of Clinical Medicine, Copenhagen, Denmark
| | - Alkomiet Hasan
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University of Augsburg, Bezirkskrankenhaus, Augsburg, Germany
| | - Jurjen Luykx
- Department of Psychiatry, UMC Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands; Department of Translational Neuroscience, UMC Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Marina Kupchik
- Beer Yakov, Ness Ziona MHC, Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Georg Psota
- Psychosocial Services in Vienna, Vienna, Austria
| | - Paola Rocca
- Department of Neuroscience, University of Turin, Turin, Italy
| | - Nikos Stefanis
- A' Department of Psychiatry, National and Kapodistrian University of Athens School of Medicine, Eginition Hospital, Athens, Greece
| | - Alexander Teitelbaum
- Jerusalem MHC, Kfar Shaul Psychiatric Hospital, Affiliated with The Hebrew University-Hadassah School of Medicine, Jerusalem, Israel
| | - Mor Bar Haim
- Department of Psychiatry, Sheba Medical Center, Tel Hashomer, Israel
| | - Claudia Leucht
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Georg Kemmler
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria
| | - Timo Schurr
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - René S Kahn
- Department of Psychiatry, UMC Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - W Wolfgang Fleischhacker
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria.
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Pirkis J, Gunnell D, Shin S, Del Pozo-Banos M, Arya V, Aguilar PA, Appleby L, Arafat SMY, Arensman E, Ayuso-Mateos JL, Balhara YPS, Bantjes J, Baran A, Behera C, Bertolote J, Borges G, Bray M, Brečić P, Caine E, Calati R, Carli V, Castelpietra G, Chan LF, Chang SS, Colchester D, Coss-Guzmán M, Crompton D, Ćurković M, Dandona R, De Jaegere E, De Leo D, Deisenhammer EA, Dwyer J, Erlangsen A, Faust JS, Fornaro M, Fortune S, Garrett A, Gentile G, Gerstner R, Gilissen R, Gould M, Gupta SK, Hawton K, Holz F, Kamenshchikov I, Kapur N, Kasal A, Khan M, Kirtley OJ, Knipe D, Kõlves K, Kölzer SC, Krivda H, Leske S, Madeddu F, Marshall A, Memon A, Mittendorfer-Rutz E, Nestadt P, Neznanov N, Niederkrotenthaler T, Nielsen E, Nordentoft M, Oberlerchner H, O'Connor RC, Papsdorf R, Partonen T, Phillips MR, Platt S, Portzky G, Psota G, Qin P, Radeloff D, Reif A, Reif-Leonhard C, Rezaeian M, Román-Vázquez N, Roskar S, Rozanov V, Sara G, Scavacini K, Schneider B, Semenova N, Sinyor M, Tambuzzi S, Townsend E, Ueda M, Wasserman D, Webb RT, Winkler P, Yip PS, Zalsman G, Zoja R, John A, Spittal MJ. Suicide numbers during the first 9-15 months of the COVID-19 pandemic compared with pre-existing trends: An interrupted time series analysis in 33 countries. EClinicalMedicine 2022; 51:101573. [PMID: 35935344 PMCID: PMC9344880 DOI: 10.1016/j.eclinm.2022.101573] [Citation(s) in RCA: 77] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/24/2022] [Accepted: 06/30/2022] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Predicted increases in suicide were not generally observed in the early months of the COVID-19 pandemic. However, the picture may be changing and patterns might vary across demographic groups. We aimed to provide a timely, granular picture of the pandemic's impact on suicides globally. METHODS We identified suicide data from official public-sector sources for countries/areas-within-countries, searching websites and academic literature and contacting data custodians and authors as necessary. We sent our first data request on 22nd June 2021 and stopped collecting data on 31st October 2021. We used interrupted time series (ITS) analyses to model the association between the pandemic's emergence and total suicides and suicides by sex-, age- and sex-by-age in each country/area-within-country. We compared the observed and expected numbers of suicides in the pandemic's first nine and first 10-15 months and used meta-regression to explore sources of variation. FINDINGS We sourced data from 33 countries (24 high-income, six upper-middle-income, three lower-middle-income; 25 with whole-country data, 12 with data for area(s)-within-the-country, four with both). There was no evidence of greater-than-expected numbers of suicides in the majority of countries/areas-within-countries in any analysis; more commonly, there was evidence of lower-than-expected numbers. Certain sex, age and sex-by-age groups stood out as potentially concerning, but these were not consistent across countries/areas-within-countries. In the meta-regression, different patterns were not explained by countries' COVID-19 mortality rate, stringency of public health response, economic support level, or presence of a national suicide prevention strategy. Nor were they explained by countries' income level, although the meta-regression only included data from high-income and upper-middle-income countries, and there were suggestions from the ITS analyses that lower-middle-income countries fared less well. INTERPRETATION Although there are some countries/areas-within-countries where overall suicide numbers and numbers for certain sex- and age-based groups are greater-than-expected, these countries/areas-within-countries are in the minority. Any upward movement in suicide numbers in any place or group is concerning, and we need to remain alert to and respond to changes as the pandemic and its mental health and economic consequences continue. FUNDING None.
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Affiliation(s)
- Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Corresponding author at: Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Victoria, 3010, Australia.
| | - David Gunnell
- National Institute of Health and care Research Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, United Kingdom
| | - Sangsoo Shin
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | | | - Vikas Arya
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | | | - Louis Appleby
- National Confidential Inquiry into Suicide and Safety in Mental Health, University of Manchester, Manchester, United Kingdom
| | - S. M. Yasir Arafat
- Department of Psychiatry, Enam Medical College and Hospital, Dhaka, Bangladesh
| | - Ella Arensman
- School of Public Health, National Suicide Research Foundation, University College Cork, Cork, Ireland
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Jose Luis Ayuso-Mateos
- Department of Psychiatry, Universidad Autonoma de Madrid, Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
| | - Yatan Pal Singh Balhara
- National Drug Dependence Treatment Center and Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Jason Bantjes
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Anna Baran
- Working Group on Prevention of Suicide and Depression at Public Health Council, Ministry of Health, Warsaw, Poland
- Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
- Department of Psychiatry, Blekinge Hospital, Karlshamn, Sweden
| | - Chittaranjan Behera
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, New Delhi, India
| | - Jose Bertolote
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu, Brazil
| | - Guilherme Borges
- Department of Global Mental Health, Instituto Nacional de Psiquiatría Ramon de la Fuente Muñiz, Mexico City, Mexico
| | - Michael Bray
- Department of Psychiatry and Behavioural Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Petrana Brečić
- Department for Psychiatry, University Psychiatric Hospital Vrapče; School of Medicine University of Zagreb, Zagreb, Croatia
| | - Eric Caine
- University of Rochester Medical Center, Rochester, NY, United States
| | - Raffaella Calati
- Department of Psychology, University of Milan-Bicocca, Milan, Italy
- Department of Psychiatry, Nimes University Hospital, Nimes, France
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm, Sweden
| | - Giulio Castelpietra
- Region Friuli Venezia Giulia, Central Health Directorate, Outpatient and Inpatient Care Service, Trieste, Italy
| | - Lai Fong Chan
- Department of Psychiatry, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Shu-Sen Chang
- Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
| | | | - Maria Coss-Guzmán
- Puerto Rico Department of Health's Commission on Suicide Prevention, San Juan, Puerto Rico
| | - David Crompton
- School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Marko Ćurković
- Department for Medical Ethics, University Psychiatric Hospital Vrapče; School of Medicine University of Zagreb, Zagreb, Croatia
| | - Rakhi Dandona
- Public Health Foundation of India, Gurugram, India
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, United States
| | - Eva De Jaegere
- Flemish Centre of Expertise in Suicide Prevention, Department of Head and Skin, Ghent University, Ghent, Belgium
| | | | - Eberhard A. Deisenhammer
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology; University Hospital for Psychiatry 2, Medical University of Innsbruck, Innsbruck, Austria
| | - Jeremy Dwyer
- Coroners Court of Victoria, Melbourne, Australia
| | - Annette Erlangsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Copenhagen Research Centre for Mental Health, Copenhagen, Denmark
- Centre for Mental Health Research, Australian National University, Canberra, Australia
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jeremy S. Faust
- Brigham and Women's Hospital Department of Emergency Medicine, Harvard Medical School, Boston, United States
| | - Michele Fornaro
- Department of Psychiatry, Neuroscience Institute, Federico II University of Naples, Naples, Italy
| | - Sarah Fortune
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Andrew Garrett
- Coronial Division, Tasmanian Magistrates Court, Hobart, Australia
| | - Guendalina Gentile
- Institute of Forensic Medicine, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Rebekka Gerstner
- Undersecretary of Health Services, Ministry of Public Health, Quito, Ecuador
- Monitoring and Evaluation, German Institute for Medical Mission, Tübingen, Germany
| | - Renske Gilissen
- 113 Suicide Prevention, Research Department, Amsterdam, the Netherlands
| | - Madelyn Gould
- Departments of Psychiatry and Epidemiology, Columbia University Medical Center/New York State Psychiatric Institute, New York, NY, United States
| | - Sudhir Kumar Gupta
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, New Delhi, India
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Franziska Holz
- Institute of Legal Medicine, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Iurii Kamenshchikov
- Udmurtia Republican Clinical Psychiatric Hospital, Izhevsk, Russian Federation
| | - Navneet Kapur
- Centre for Mental Health and Safety and National Institute for Health Research (NIHR) Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Alexandr Kasal
- National Institute of Mental Health, Klecany, Czechia
- Faculty of Social Sciences, Charles University, Prague, Czechia
| | - Murad Khan
- Department of Psychiatry, Aga Khan University, Karachi, Pakistan
| | | | - Duleeka Knipe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Kairi Kõlves
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Sarah C. Kölzer
- Institute of Legal Medicine, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Hryhorii Krivda
- Department of Forensic Medicine, Odessa National Medical University, Odessa, Ukraine
| | - Stuart Leske
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Fabio Madeddu
- Department of Psychology, University of Milan-Bicocca, Milan, Italy
| | - Andrew Marshall
- Brigham and Women's Hospital, Harvard Medical School, MA, United States
| | - Anjum Memon
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Ellenor Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Paul Nestadt
- Department of Psychiatry and Behavioural Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Nikolay Neznanov
- Bekhterev National Medical Research Center of Psychiatry and Neurology, Saint Petersburg, Russian Federation
- Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russian Federation
| | - Thomas Niederkrotenthaler
- Unit Suicide Research and Mental Health Promotion, Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Emma Nielsen
- School of Psychology, University of Nottingham, Nottingham, United Kingdom
| | - Merete Nordentoft
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark
| | - Herwig Oberlerchner
- Department of Psychiatry and Psychotherapy; Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria
| | - Rory C. O'Connor
- Suicidal Behaviour Research Lab, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Rainer Papsdorf
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital Leipzig, Leipzig, Germany
| | - Timo Partonen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Michael R. Phillips
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Departments of Psychiatry and Epidemiology, Columbia University, New York, United States
| | - Steve Platt
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Gwendolyn Portzky
- Flemish Centre of Expertise in Suicide Prevention, Department of Head and Skin, Ghent University, Ghent, Belgium
| | - Georg Psota
- Psychosocial Services in Vienna, Vienna, Austria
| | - Ping Qin
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Daniel Radeloff
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital Leipzig, Leipzig, Germany
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt - Goethe University, Frankfurt am Main, Germany
| | - Christine Reif-Leonhard
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt - Goethe University, Frankfurt am Main, Germany
| | - Mohsen Rezaeian
- Department of Epidemiology and Biostatistics, Occupational Environment Research Center, Medical School, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Nayda Román-Vázquez
- Puerto Rico Department of Health's Commission on Suicide Prevention, San Juan, Puerto Rico
| | - Saska Roskar
- National Institute of Public Health, Ljubljana, Slovenia
| | - Vsevolod Rozanov
- Bekhterev National Medical Research Center of Psychiatry and Neurology, Saint Petersburg, Russian Federation
- Saint Petersburg State University, Saint Petersburg, Russian Federation
| | - Grant Sara
- System Information and Analytics Branch, NSW Ministry of Health, Sydney, Australia
| | | | - Barbara Schneider
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt - Goethe University, Frankfurt am Main, Germany
- LVR Klinik Köln, Department of Addictive Disorders, Psychiatry and Psychotherapy, Cologne, Germany
| | - Natalia Semenova
- Organizational-Scientific Department, Bekhterev National Medical Research Center of Psychiatry and Neurology, Saint Petersburg, Russian Federation
| | - Mark Sinyor
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Stefano Tambuzzi
- Institute of Forensic Medicine, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Ellen Townsend
- School of Psychology, University of Nottingham, Nottingham, United Kingdom
| | - Michiko Ueda
- Waseda University, Faculty of Political Science and Economics, Tokyo, Japan
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm, Sweden
| | - Roger T. Webb
- Centre for Mental Health and Safety and National Institute for Health Research (NIHR) Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom
| | - Petr Winkler
- National Institute of Mental Health, Klecany, Czechia
| | - Paul S.F. Yip
- Hong Kong Jockey Club Centre for Suicide Research and Prevention, Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
| | - Gil Zalsman
- Geha Mental Health Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Riccardo Zoja
- Institute of Forensic Medicine, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Ann John
- Swansea University Medical School, Swansea, United Kingdom
| | - Matthew J. Spittal
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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Psota G, Schuett S, Vyssoki B. “Protect, test, vaccinate”: dealing with Covid-19 in outpatient psychiatric care. Eur Psychiatry 2022. [PMCID: PMC9566139 DOI: 10.1192/j.eurpsy.2022.1284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Curbing the spread of the coronavirus and stabilizing the overall psychosocial situation requires compliance with preventive measures: “Protect, test, vaccinate”. Objectives Population groups with psychosocial problems which are difficult to reach and have a high risk of infection, morbidity and mortality as well as unfavorable help-seeking behavior and generally lower vaccination rates need support. Methods In the outpatient psychiatric facilities of the Psychosocial Services in Vienna (PSD-Wien), specific concepts to support “protect, test, vaccinate” were implemented to protect patients and employees. Information about the benefits and risks of vaccination, relieving fears and support in registering and attending vaccination appointments were of special significance. Results Analyzes of selected data from 1,319 patients at PSD-Wien show (period: 1st half of 2021) that these measures made it possible to achieve a significantly higher vaccination willingness in people with severe mental illnesses (84 %) than in the general Austrian population (based on the date of examination, currently approximately 60 %). The same applies to vaccination rates: at least 47 % have received a partial vaccination, of which about half have already received both partial vaccinations. Conclusions High vaccination willingness and rates as well as the necessary protection (wearing masks, keeping distance, complying with hygiene rules) and regular testing must not be a phenomenon of privileged population groups. Psychosocial support is needed so that the trilogy “Protect, test, vaccinate” becomes possible for everyone, including people with severe mental illnesses. Social psychiatry is not just about mental health, but also about physical health care and prevention. Disclosure No significant relationships.
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Pirkis J, John A, Shin S, DelPozo-Banos M, Arya V, Analuisa-Aguilar P, Appleby L, Arensman E, Bantjes J, Baran A, Bertolote JM, Borges G, Brečić P, Caine E, Castelpietra G, Chang SS, Colchester D, Crompton D, Curkovic M, Deisenhammer EA, Du C, Dwyer J, Erlangsen A, Faust JS, Fortune S, Garrett A, George D, Gerstner R, Gilissen R, Gould M, Hawton K, Kanter J, Kapur N, Khan M, Kirtley OJ, Knipe D, Kolves K, Leske S, Marahatta K, Mittendorfer-Rutz E, Neznanov N, Niederkrotenthaler T, Nielsen E, Nordentoft M, Oberlerchner H, O'Connor RC, Pearson M, Phillips MR, Platt S, Plener PL, Psota G, Qin P, Radeloff D, Rados C, Reif A, Reif-Leonhard C, Rozanov V, Schlang C, Schneider B, Semenova N, Sinyor M, Townsend E, Ueda M, Vijayakumar L, Webb RT, Weerasinghe M, Zalsman G, Gunnell D, Spittal MJ. Suicide trends in the early months of the COVID-19 pandemic: an interrupted time-series analysis of preliminary data from 21 countries. Lancet Psychiatry 2021; 8:579-588. [PMID: 33862016 PMCID: PMC9188435 DOI: 10.1016/s2215-0366(21)00091-2] [Citation(s) in RCA: 358] [Impact Index Per Article: 119.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/12/2021] [Accepted: 02/24/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND The COVID-19 pandemic is having profound mental health consequences for many people. Concerns have been expressed that, at their most extreme, these consequences could manifest as increased suicide rates. We aimed to assess the early effect of the COVID-19 pandemic on suicide rates around the world. METHODS We sourced real-time suicide data from countries or areas within countries through a systematic internet search and recourse to our networks and the published literature. Between Sept 1 and Nov 1, 2020, we searched the official websites of these countries' ministries of health, police agencies, and government-run statistics agencies or equivalents, using the translated search terms "suicide" and "cause of death", before broadening the search in an attempt to identify data through other public sources. Data were included from a given country or area if they came from an official government source and were available at a monthly level from at least Jan 1, 2019, to July 31, 2020. Our internet searches were restricted to countries with more than 3 million residents for pragmatic reasons, but we relaxed this rule for countries identified through the literature and our networks. Areas within countries could also be included with populations of less than 3 million. We used an interrupted time-series analysis to model the trend in monthly suicides before COVID-19 (from at least Jan 1, 2019, to March 31, 2020) in each country or area within a country, comparing the expected number of suicides derived from the model with the observed number of suicides in the early months of the pandemic (from April 1 to July 31, 2020, in the primary analysis). FINDINGS We sourced data from 21 countries (16 high-income and five upper-middle-income countries), including whole-country data in ten countries and data for various areas in 11 countries). Rate ratios (RRs) and 95% CIs based on the observed versus expected numbers of suicides showed no evidence of a significant increase in risk of suicide since the pandemic began in any country or area. There was statistical evidence of a decrease in suicide compared with the expected number in 12 countries or areas: New South Wales, Australia (RR 0·81 [95% CI 0·72-0·91]); Alberta, Canada (0·80 [0·68-0·93]); British Columbia, Canada (0·76 [0·66-0·87]); Chile (0·85 [0·78-0·94]); Leipzig, Germany (0·49 [0·32-0·74]); Japan (0·94 [0·91-0·96]); New Zealand (0·79 [0·68-0·91]); South Korea (0·94 [0·92-0·97]); California, USA (0·90 [0·85-0·95]); Illinois (Cook County), USA (0·79 [0·67-0·93]); Texas (four counties), USA (0·82 [0·68-0·98]); and Ecuador (0·74 [0·67-0·82]). INTERPRETATION This is the first study to examine suicides occurring in the context of the COVID-19 pandemic in multiple countries. In high-income and upper-middle-income countries, suicide numbers have remained largely unchanged or declined in the early months of the pandemic compared with the expected levels based on the pre-pandemic period. We need to remain vigilant and be poised to respond if the situation changes as the longer-term mental health and economic effects of the pandemic unfold. FUNDING None.
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Affiliation(s)
- Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
| | - Ann John
- Swansea University Medical School, Swansea, UK
| | - Sangsoo Shin
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | | | - Vikas Arya
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, Australia
| | | | - Louis Appleby
- National Confidential Inquiry into Suicide and Safety in Mental Health, University of Manchester, Manchester, UK
| | - Ella Arensman
- School of Public Health, National Suicide Research Foundation, University College Cork, Cork, Ireland; Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, QLD, Australia
| | - Jason Bantjes
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Anna Baran
- Working Group on Prevention of Suicide and Depression at Public Health Council, Warsaw, Poland; Department of Psychiatry, Blekinge Hospital, Karlshamn, Sweden
| | - Jose M Bertolote
- Botucatu Medical School, Universidade Estadual Paulista, São Paulo, Brazil
| | - Guilherme Borges
- Instituto Nacional de Psiquiatría Ramon de la Fuente Muñiz, Mexico City, Mexico
| | - Petrana Brečić
- Department for Medical Ethics, University Psychiatric Hospital Vrapče, School of Medicine, University of Zagreb, Zagreb, Croatia; Department for Psychiatry, University Psychiatric Hospital Vrapče, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Eric Caine
- University of Rochester Medical Center, Rochester, NY, USA
| | - Giulio Castelpietra
- Region Friuli Venezia Giulia, Central Health Directorate, Outpatient and Inpatient Care Service, Trieste, Italy; Department of Medicine, University of Udine, Trieste, Italy
| | - Shu-Sen Chang
- Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
| | | | - David Crompton
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, QLD, Australia
| | - Marko Curkovic
- Department for Medical Ethics, University Psychiatric Hospital Vrapče, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Eberhard A Deisenhammer
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Chengan Du
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, CT, USA
| | - Jeremy Dwyer
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; Coroners Court of Victoria, Melbourne, VIC, Australia
| | - Annette Erlangsen
- Danish Research Institute for Suicide Prevention, Copenhagen, Denmark; Department of Mental Health, Johns Hopkins School of Public Health, Baltimore, MD, USA; Centre for Mental Health Research, Australian National University, Canberra, ACT, Australia
| | - Jeremy S Faust
- Brigham and Women's Hospital Department of Emergency Medicine, Boston, MA, USA
| | - Sarah Fortune
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Andrew Garrett
- Magistrates Court of Tasmania (Coronial Division), Hobart, TAS, Australia
| | - Devin George
- Bureau of Vital Records and Statistics, Louisiana Office of Public Health, Baton Rouge, LA, USA
| | - Rebekka Gerstner
- Ministry of Public Health, Undersecretary of Health Services, Quito, Ecuador
| | - Renske Gilissen
- Research Department, 113 Suicide Prevention, Amsterdam, Netherlands
| | - Madelyn Gould
- Departments of Psychiatry and Epidemiology, Columbia University Medical Center/New York State Psychiatric Institute, New York, NY, USA
| | - Keith Hawton
- Centre for Suicide Research, University of Oxford, Oxford, UK
| | - Joseph Kanter
- Louisiana Department of Health, Baton Rouge, LA, USA
| | - Navneet Kapur
- Centre for Mental Health and Safety and National Institute for Health Research Patient Safety Translational Research Centre, University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Murad Khan
- Department of Psychiatry, Aga Khan University, Karachi, Pakistan
| | | | - Duleeka Knipe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Kairi Kolves
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, QLD, Australia
| | - Stuart Leske
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, QLD, Australia
| | - Kedar Marahatta
- World Health Organization, Country Office for Nepal, Kathmandu, Nepal
| | | | - Nikolay Neznanov
- Bekhterev National Medical Research Center of Psychiatry and Neurology, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia
| | - Thomas Niederkrotenthaler
- Unit Suicide Research and Mental Health Promotion, Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Emma Nielsen
- School of Psychology, University of Nottingham, Nottingham, UK
| | | | - Herwig Oberlerchner
- Department of Psychiatry and Psychotherapy, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria
| | - Rory C O'Connor
- Suicidal Behaviour Research Lab, University of Glasgow, Glasgow, UK
| | - Melissa Pearson
- Preventing Deaths from Poisoning Research Group, University of Edinburgh, Edinburgh, UK
| | - Michael R Phillips
- Suicide Research and Prevention Center, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Departments of Psychiatry and Epidemiology, Columbia University, New York, NY, USA
| | - Steve Platt
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Paul L Plener
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria; Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | - Georg Psota
- Psychosocial Services in Vienna, Vienna, Austria
| | - Ping Qin
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Daniel Radeloff
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital Leipzig, Leipzig, Germany
| | - Christa Rados
- Department of Psychiatry and Psychotherapeutic Medicine, Landeskrankenhaus Villach, Villach, Austria
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Christine Reif-Leonhard
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Vsevolod Rozanov
- Department of Borderline Disorders and Psychotherapy, Bekhterev National Medical Research Center of Psychiatry and Neurology, Saint Petersburg State University, Saint Petersburg, Russia
| | - Christiane Schlang
- Department of Psychiatry, Health Authority Frankfurt am Main, Frankfurt, Germany
| | - Barbara Schneider
- Department of Addictive Disorders, Psychiatry and Psychotherapy, LVR-Klinik Köln, Cologne, Germany; Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe-University, Frankfurt am Main, Germany
| | - Natalia Semenova
- Organizational-Scientific Department, Bekhterev National Medical Research Center of Psychiatry and Neurology, Saint Petersburg, Russia
| | - Mark Sinyor
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Ellen Townsend
- Self-Harm Research Group, School of Psychology, University of Nottingham, Nottingham, UK
| | - Michiko Ueda
- Waseda University, Faculty of Political Science and Economics, Tokyo, Japan
| | | | - Roger T Webb
- Centre for Mental Health and Safety and National Institute for Health Research Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | - Manjula Weerasinghe
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Gil Zalsman
- Department of Psychiatry, Sackler School of Medicine, Tel Aviv University and Geha Mental Health Center, Tel Aviv, Israel; Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York, USA
| | - David Gunnell
- National Institute of Health Research Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Matthew J Spittal
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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Affiliation(s)
- Georg Psota
- Kuratorium für Psychosoziale Dienste in Wien, Modecenterstraße 14/A/2. OG, 1030, Wien, Österreich.
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Hinterhuber H, Meißel T, Psota G, Schanda H. [Not Available]. Neuropsychiatr 2020; 34:91-93. [PMID: 32166630 DOI: 10.1007/s40211-020-00342-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Hartmann Hinterhuber
- Department für Psychiatrie, Psychotherapie und Psychosomatik, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich.
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Psota G. [Not Available]. Neuropsychiatr 2018; 32:119-120. [PMID: 30178223 DOI: 10.1007/s40211-018-0281-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Georg Psota
- Psychosoziale Dienste Wien, Modecenterstraße 14/A/2.OG, 1030, Wien, Österreich.
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Psota G. Aufgaben des Psychosozialen Dienstes in Wien/Chancen und Herausforderungen. Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1602085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- G Psota
- Psychosoziale Dienste in Wien, Wien
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Fleischhacker WW, Hofer A, Jagsch C, Pirker W, Psota G, Rittmannsberger H, Seppi K. [Antipsychotic-induced tardive syndromes]. Neuropsychiatr 2016; 30:123-130. [PMID: 27580887 DOI: 10.1007/s40211-016-0189-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 06/14/2016] [Indexed: 06/06/2023]
Abstract
Tardive dyskinesia (TD) remains a relevant clinical problem despite the increasing use of new-generation antipsychotics. Antipsychotic-induced tardive syndromes are difficult to treat and have a low tendency of remission. Therefore, prophylaxis is of utmost importance, with the responsible use of antipsychotics as a prime desideratum. With respect to managing tardive dyskinesia, discontinuing the antipsychotic, if possible, albeit not backed up by unequivocal evidence, is still the main recommendation. If this is not possible, the switch to an antipsychotic with a lower TD risk is the next-preferred option. Other symptomatic treatments have been explored, but clinical trials have provided inhomogeneous results and only very few compounds are approved for the treatment of tardive dyskinesia. This manuscript summarizes the current evidence with respect to the phenomenology, course, prevention and treatment of tardive syndromes.
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Affiliation(s)
- W Wolfgang Fleischhacker
- Universitätsklinik für Psychiatrie I, Department für Psychiatrie, Psychotherapie und Psychosomatik, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich.
| | - Alex Hofer
- Universitätsklinik für Psychiatrie I, Department für Psychiatrie, Psychotherapie und Psychosomatik, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
| | - Christian Jagsch
- Abteilung für Alterspsychiatrie und Alterspsychotherapie, LKH Graz Süd-West, Graz, Österreich
| | | | | | - Hans Rittmannsberger
- Psychiatrische Abteilung 1, Landes-Nervenklinik Wagner-Jauregg, Linz, Österreich
| | - Klaus Seppi
- Universitätsklinik für Neurologie, Medizinische Universität Innsbruck, Innsbruck, Österreich
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10
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Psota G. Social Psychiatric Aspects of Dementia. Psychiatr Danub 2015; 27:432-438. [PMID: 26609660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The future of a dementia-appropriate care rests on early diagnosis and treatment (also in terms of a timely information, counselling and assistance), developing mobile medical healthcare, integrating and coordinating all dementia care partners and stakeholders, appropriate assessments of the stages of care allowance, providing new forms of housing, addressing the migration issue, and reducing unnecessary administrative bureaucracy - as well as, last but not least, the fight against prejudice. People affected by dementia suffer not only from symptoms of their illness but also from society's reaction towards this illness. Stigmatisation of dementia prevents an early diagnosis and treatment which could improve the course of the illness and create a "better everyday life", a more of inclusion for the affected people and their environment. But Albert Einstein already knew: "It's harder to crack prejudice than an atom." Nevertheless, it is paramount to work towards it - for dementia can affect each and every one of us. Dementia matters, for all of us.
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Affiliation(s)
- Georg Psota
- Obmann pro mente Wien, Grüngasse 1A, 1040 Wien, Austria,
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Herz R, Czelecz A, Gadinger-Häupl C, Psota G. Early Rehabilitation in Young People with First-episode Psychosis: experience From the Day Centre for Psychiatric Early Rehabilitation (Taf, Psd Vienna). Eur Psychiatry 2015. [DOI: 10.1016/s0924-9338(15)30548-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Psota G. [Viewpoints]. Neuropsychiatr 2015; 29:105. [PMID: 26788566 DOI: 10.1007/s40211-015-0163-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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13
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Psota G. [Not Available]. Neuropsychiatr 2013; 27:61-62. [PMID: 23653437 DOI: 10.1007/s40211-013-0064-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Psota G, Maier W. [Not Available]. Neuropsychiatr 2013; 27:169-171. [PMID: 24272948 DOI: 10.1007/s40211-013-0087-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Psota G, Schmidl F, Berghofer G, Lang A. P-759 - Six years of psychiatric liaison services for institutions sheltering the homeless. Eur Psychiatry 2012. [DOI: 10.1016/s0924-9338(12)74926-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Berghofer G, Schmidl F, Psota G. P-584 - Patient satisfaction of people with chronic mental illnesses as routine outcome measurement in outpatient mental health care. Eur Psychiatry 2012. [DOI: 10.1016/s0924-9338(12)74751-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Vyssoki B, Willeit M, Blüml V, Höfer P, Erfurth A, Psota G, Lesch OM, Kapusta ND. Inpatient treatment of major depression in Austria between 1989 and 2009: impact of downsizing of psychiatric hospitals on admissions, suicide rates and outpatient psychiatric services. J Affect Disord 2011; 133:93-6. [PMID: 21497914 DOI: 10.1016/j.jad.2011.03.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 10/29/2010] [Accepted: 03/18/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND During the last 20 years Austrian psychiatric services underwent fundamental changes, as a focus was set on downsizing psychiatric hospitals. Little is known about how restructuring of mental health services affected patients with major depression and suicide rates. METHODS Monthly hospital discharges from all hospitals in Austria with the diagnosis of unipolar major depression as primary reason for inpatient treatment were obtained for the time period between 1989 and 2008. These data were correlated with relevant parameters from the general health system, such as number of hospital beds, suicide rate, density of psychotherapists and sales of antidepressants. RESULTS While the number of psychiatric beds was reduced by almost 30%, the total annual numbers of inpatient treatment episodes for depression increased by 360%. This increase was stronger for men than for women. Further on this development was accompanied by a decrease in the suicide rate and an improvement in the availability of professional outpatient mental health service providers. LIMITATIONS Only aggregated patient data and no single case histories were available for this study. The validity of the correct diagnosis of unipolar major depression must be doubted, as most likely not all patients were seen by a clinical expert. CONCLUSIONS Our data show that although inpatient treatment for unipolar major depression dramatically increased, reduction of psychiatric beds did not lead to an increase of suicide rates.
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Affiliation(s)
- B Vyssoki
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
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Schmidt R, Marksteiner M, Dal-Bianco P, Ransmayr G, Bancher C, Benke T, Wancata J, Fischer P, Leblhuber CF, Psota G, Ackerl M, Alf C, Berek K, Croy A, Delazer M, Fasching P, Frühwald T, Fruhwürth G, Fuchs-Nieder B, Gatterer G, Grossmann J, Hinterhuber H, Iglseder B, Imarhiagbe D, Jagsch C, Jellinger K, Kalousek M, Kapeller P, Ladurner G, Lampl C, Lechner A, Lingg A, Nakajima T, Rainer M, Reisecker F, Spatt J, Walch T, Uranüs M, Walter A. [Consensus statement "Dementia 2010" of the Austrian Alzheimer Society]. Neuropsychiatr 2010; 24:67-87. [PMID: 20605003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The Austrian Alzheimer Society developed evidence-based guidelines based on a systematic literature search and criteria-guided assessment with subsequent transparent determination of grades of clinical recommendation. The authors evaluated currently available therapeutic approaches for the most common forms of dementia and focused on diagnosis and pharmacological intervention, taking into consideration the situation in Austria. The purpose of these guidelines is the rational and cost-effective use of diagnostic and therapeutic measures in dementing illnesses. Users are physicians and all other providers of care for patients with dementia in Austria.
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Affiliation(s)
- Reinhold Schmidt
- Universitätsklinik für Neurologie, Medizinische Universität Graz,
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Kamenski G, Dorner T, Lawrence K, Psota G, Rieder A, Schwarz F, Sepandj A, Spiegel W, Strotzka S. Detection of dementia in primary care: comparison of the original and a modified Mini-Cog Assessment with the Mini-Mental State Examination. Ment Health Fam Med 2009; 6:209-217. [PMID: 22477912 PMCID: PMC2873877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Background Dementia is considered widely under-detected in primary care, and general practitioners (GPs) frequently ask for easy to use tools to assist in its early detection.Aim To determine the degree of correlation between the Mini-Cog Assessment (Mini-Cog) as performed by GPs and the Mini-Mental State Examination (MMSE).Design of study This was a prospective study (2005, 2006) comparing two cognitive screening instruments.Setting Ten general practices in Austria, with patients with a hitherto undiagnosed suspicion of dementia seen consecutively.Method Sensitivity, specificity and positive and negative predictive values (PPVs and NPVs) of the Mini-Cog (applying both a colour-coded and the original rating method) were assessed for degree of correlation with the MMSE. In phase one GPs examined patients suspected of having dementia using the Mini-Cog; in phase two a neurologist retested them applying the MMSE, a clock-drawing test (CDT) and a routine clinical examination. A questionnaire on the practicability of the Mini-Cog was answered by GPs.Results Of the 107 patients who participated 86 completed the whole study protocol. The Mini-Cog, as performed by the ten GPs, displayed a sensitivity of 0.85 (95% CI: 0.71, 0.98), a specificity of 0.58 (95% CI: 0.46, 0.71), a PPV of 0.47 (95% CI: 0.33, 0.61) and an NPV of 0.90 (95% CI: 0.80, 0.99) as against the MMSE carried out by neurologists. The GPs judged the Mini-Cog useful and time saving.Conclusion The Mini-Cog has a high sensitivity and acceptable specificity in the general practice setting and has proved to be a practicable tool for the diagnosis of dementia in primary care.
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Affiliation(s)
- Gustav Kamenski
- Department of General Practice, Centre for Public Health, Medical University, Vienna, Austria
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