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Healy D, Bahrick A, Bak M, Barbato A, Calabrò RS, Chubak BM, Cosci F, Csoka AB, D'Avanzo B, Diviccaro S, Giatti S, Goldstein I, Graf H, Hellstrom WJG, Irwig MS, Jannini EA, Janssen PKC, Khera M, Kumar MT, Le Noury J, Lew-Starowicz M, Linden DEJ, Lüning C, Mangin D, Melcangi RC, Rodríguez OWMAAS, Panicker JN, Patacchini A, Pearlman AM, Pukall CF, Raj S, Reisman Y, Rubin RS, Schreiber R, Shipko S, Vašečková B, Waraich A. Diagnostic criteria for enduring sexual dysfunction after treatment with antidepressants, finasteride and isotretinoin. Int J Risk Saf Med 2021; 33:65-76. [PMID: 34719438 PMCID: PMC8925105 DOI: 10.3233/jrs-210023] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND: A set of enduring conditions have been reported in the literature involving persistent sexual dysfunction after discontinuation of serotonin reuptake inhibiting antidepressants, 5 alpha-reductase inhibitors and isotretinoin. OBJECTIVE: To develop diagnostic criteria for post-SSRI sexual dysfunction (PSSD), persistent genital arousal disorder (PGAD) following serotonin reuptake inhibitors, post-finasteride syndrome (PFS) and post-retinoid sexual dysfunction (PRSD). METHODS: The original draft was designed using data from two published case series (Hogan et al., 2014 and Healy et al., 2018), which represent the largest public collections of data on these enduring conditions. It was further developed with the involvement of a multidisciplinary panel of experts. RESULTS: A set of criteria were agreed upon for each of the above conditions. Features of PSSD, PFS and PRSD commonly include decreased genital and orgasmic sensation, decreased sexual desire and erectile dysfunction. Ancillary non-sexual symptoms vary depending on the specific condition but can include emotional blunting and cognitive impairment. PGAD presents with an almost mirror image of unwanted sensations of genital arousal or irritability in the absence of sexual desire. A new term, post-SSRI asexuality, is introduced to describe a dampening of sexual interest and pleasure resulting from a pre-natal or pre-teen exposure to a serotonin reuptake inhibitor. CONCLUSIONS: These criteria will help in both clinical and research settings. As with all criteria, they will likely need modification in the light of developments.
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Affiliation(s)
- David Healy
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Audrey Bahrick
- University Counseling Service, University of Iowa, Iowa City, IA, USA
| | - Maarten Bak
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands.,FACT, Mondriaan Mental Health, Maastricht/Heerlen, The Netherlands
| | - Angelo Barbato
- Unit for Quality of Care and Rights Promotion in Mental Health, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | | | - Barbara M Chubak
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Fiammetta Cosci
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands.,Department of Health Sciences, University of Florence, Florence, Italy.,Clinical Pharmacopsychology Laboratory, University of Florence, Florence, Italy
| | - Antonei B Csoka
- Department of Anatomy, Howard University College of Medicine, Washington, DC, USA
| | - Barbara D'Avanzo
- Unit for Quality of Care and Rights Promotion in Mental Health, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Silvia Diviccaro
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Silvia Giatti
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Irwin Goldstein
- Alvarado Hospital, San Diego, CA, USA.,San Diego Sexual Medicine, San Diego, CA, USA
| | - Heiko Graf
- Department of Psychiatry and Psychotherapy, Ulm University, Ulm, Germany
| | - Wayne J G Hellstrom
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Michael S Irwig
- Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | - Paddy K C Janssen
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Hospital Pharmacy, VieCuri Medical Center, Venlo, The Netherlands
| | - Mohit Khera
- Department of Urology, Baylor School of Medicine, Houston, TX, USA
| | | | - Joanna Le Noury
- North Wales Department of Psychological Medicine, Bangor, Wales, UK
| | - Michał Lew-Starowicz
- Department of Psychiatry, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - David E J Linden
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Celine Lüning
- Department of Psychology and Psychotherapy, Witten/Herdecke University, Germany
| | - Dee Mangin
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | | | | | - Jalesh N Panicker
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.,Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | | | - Amy M Pearlman
- Carver College of Medicine, University of Iowa Health Care, Iowa City, IA, USA
| | | | - Sanjana Raj
- Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands
| | | | - Rachel S Rubin
- Department of Urology, Georgetown University School of Medicine, Washington, DC, USA
| | - Rudy Schreiber
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | | | - Barbora Vašečková
- Psychiatric Clinic, Slovak Medical University and University Hospital, Bratislava, Slovakia
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Abstract
OBJECTIVE A petition to the European Medicines Agency provided an opportunity to collect reports of a specific adverse event from patients and healthcare professionals, along with details of clinicians' attitudes when asked to endorse patient reports. METHODS We approached a cohort of patients reporting post-SSRI sexual dysfunction (PSSD) to an adverse event reporting website, RxISK.org. The responses of patients on their interactions with healthcare professionals were subject to a qualitative analysis. RESULTS A total of 62 participants from 23 countries provided details of their experiences. While some had received support and validation of their condition, many described a number of difficulties including a lack of awareness or knowledge about PSSD, not being listened to, receiving unsympathetic or inappropriate responses, and a refusal to engage with the published medical literature. CONCLUSIONS Healthcare professionals are nervous about or reluctant to engage with novel problems on a treatment. This is not widely appreciated and the reasons for this concern are not understood.
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Affiliation(s)
- David Healy
- North Wales Department of Psychological Medicine, Bangor, Wales, UK
| | - Joanna Le Noury
- North Wales Department of Psychological Medicine, Bangor, Wales, UK
| | - Dee Mangin
- David Braley and Nancy Gordon Chair of Family Medicine, Department of Family Medicine, McMaster University, Hamilton, ON, Canada
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Healy D, Le Noury J, Mangin D. Enduring sexual dysfunction after treatment with antidepressants, 5α-reductase inhibitors and isotretinoin: 300 cases. Int J Risk Saf Med 2018; 29:125-134. [PMID: 29733030 PMCID: PMC6004900 DOI: 10.3233/jrs-180744] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE: To investigate clinical reports of post-SSRI sexual dysfunction (PSSD), post-finasteride syndrome (PFS) and enduring sexual dysfunction following isotretinoin. METHODS: Data from RxISK.org, a global adverse event reporting website, have been used to establish the clinical features, demographic details and clinical trajectories of syndromes of persistent sexual difficulties following three superficially different treatment modalities. RESULTS We report on 300 cases of enduring sexual dysfunction from 37 countries following 14 different drugs comprised of serotonin reuptake inhibiting antidepressants, 5α-reductase inhibitors and isotretinoin. While reports of certain issues were unique to the antidepressants, such as the onset of premature ejaculation and persistent genital arousal disorder (PGAD), there was also a significant overlap in symptom profile between the drug groups, with common features including genital anaesthesia, pleasureless or weak orgasm, loss of libido and impotence. Secondary consequences included relationship breakdown and impaired quality of life. CONCLUSIONS These data point to a legacy syndrome or syndromes comprising a range of disturbances to sexual function. More detailed studies will require developments in coding systems that recognise the condition(s). Further exploration of these tardive sexual syndromes may yield greater understanding of tardive syndromes in general.
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Affiliation(s)
- David Healy
- North Wales Department of Psychological Medicine, Bangor, Wales, UK
| | - Joanna Le Noury
- North Wales Department of Psychological Medicine, Bangor, Wales, UK
| | - Derelie Mangin
- David Braley and Nancy Gordon Chair of Family Medicine, Department of Family Medicine, McMaster University, ON, Canada
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Abstract
The data supporting the use of "antidepressants" in children and adolescents is largely unavailable. Academic publications give a different picture as regards benefits and harms to publications from regulatory other sources. Despite disagreements about the data driving use of these medicines, in practice "antidepressants" may now be the most commonly used drugs by adolescent girls, and children's mental health services are attracting increasing attention.This paper reviews the difficulties surrounding the data. It outlines a case for benefits (as well as risks) that would require physicians to exert a greater degree of professional autonomy than service managers might wish.
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Affiliation(s)
- David Healy
- Department of Psychiatry, Hergest Unit, Bangor, Wales, UK
| | | | - Jon Jureidini
- Robinson Research Institute, University of Adelaide, SA, Australia
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Le Noury J, Nardo JM, Healy D, Jureidini J, Raven M, Tufanaru C, Abi-Jaoude E. Study 329 continuation phase: Safety and efficacy of paroxetine and imipramine in extended treatment of adolescent major depression. Int J Risk Saf Med 2016; 28:143-61. [PMID: 27662279 PMCID: PMC5044781 DOI: 10.3233/jrs-160728] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 07/13/2016] [Indexed: 01/27/2023]
Abstract
OBJECTIVE This is an analysis of the unpublished continuation phase of Study 329, the primary objective of which was to compare the efficacy and safety of paroxetine and imipramine with placebo in the treatment of adolescents with unipolar major depression. The objectives of the continuation phase were to assess safety and relapse rates in the longer term. The objective of this publication, under the Restoring Invisible and Abandoned Trials (RIAT) initiative, was to see whether access to and analysis of the previously unpublished dataset from the continuation phase of this randomized controlled trial would have clinically relevant implications for evidence-based medicine. METHODS The study was an eight-week double-blind randomized placebo-controlled trial with a six month continuation phase. The setting was 12 North American academic psychiatry centres, from 20 April 1994 to 15 February 1998. 275 adolescents with major depression were originally enrolled in Study 329, with 190 completing the eight-week acute phase. Of these, 119 patients (43%) entered the six-month continuation phase (paroxetine n = 49; imipramine n = 39; placebo n = 31), in which participants were continued on their current treatment, blinded. As per the protocol, we have looked at rates of relapse (based on Hamilton Depression Scale scores) across both acute and continuation phases, and generated a safety profile for paroxetine and imipramine compared with placebo for up to six months.ANOVA testing (generalized linear model) using a model including effects of site, treatment and site x treatment interaction was applied. Otherwise we used only descriptive statistics. RESULTS Of patients entering the continuation phase, 15 of 49 for paroxetine (31%), 12 of 39 for imipramine (31%) and 12 of 31 for placebo (39%) completed as responders. Across the study, 25 patients on paroxetine relapsed (41% of those showing an initial response), 15 on imipramine (26%), and 10 on placebo (21%). In the continuation and taper phases combined there were 211 adverse events in the paroxetine group, 147 on imipramine and 100 on placebo. The taper phase had a higher proportion of severe adverse events per week of exposure than the acute phase, with the continuation phase having the fewest events. CONCLUSIONS The continuation phase did not offer support for longer-term efficacy of either paroxetine or imipramine. Relapse and adverse events on both active drugs open up the risks of a prescribing cascade. The previously largely unrecognised hazards of the taper phase have implications for prescribing practice and need further exploration.
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Affiliation(s)
| | - John M. Nardo
- Department of Psychiatry, Emory University, Atlanta, GA, USA
| | - David Healy
- School of Medical Sciences, Bangor University, Wales, UK
| | - Jon Jureidini
- Critical and Ethical Mental Health Research Group, Robinson Research Institute, University of Adelaide, North Adelaide, SA, Australia
| | - Melissa Raven
- Critical and Ethical Mental Health Research Group, Robinson Research Institute, University of Adelaide, North Adelaide, SA, Australia
| | - Catalin Tufanaru
- Critical and Ethical Mental Health Research Group, Robinson Research Institute, University of Adelaide, North Adelaide, SA, Australia
| | - Elia Abi-Jaoude
- Department of Psychiatry, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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Abstract
We compared admission rates and outcomes for bipolar disorder patients using the medical records of patients with a first hospital admission in 1875-1924 retrospectively diagnosed based on International Classification of Diseases (ICD)-10 criteria, and patients with a first admission in 1994-2007. The incidences of first admissions in the historical and contemporary periods are comparable: 1.2 and 1.3 per hundred thousand per year, respectively. Manic episodes constituted a greater proportion of admissions historically, while depressive episodes made up more in the contemporary sample. There is no evidence for a reduction in the mean inter-admission intervals with duration of illness. This study suggests that modern treatments may have decreased lengths of stay in hospital, but at a cost of contributing to more admissions. It also points to a shift in the threshold for admissions.
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Affiliation(s)
- Onome V Atigari
- North Wales Department of Psychological Medicine, Hergest Unit, Bangor, Wales
| | - Margaret Harris
- North Wales Department of Psychological Medicine, Hergest Unit, Bangor, Wales
| | - Joanna Le Noury
- North Wales Department of Psychological Medicine, Hergest Unit, Bangor, Wales
| | - David Healy
- North Wales Department of Psychological Medicine, Hergest Unit, Bangor, Wales
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Le Noury J, Nardo JM, Healy D, Jureidini J, Raven M, Tufanaru C, Abi-Jaoude E. Authors' reply to Sasich and Linden. BMJ 2015; 351:h5412. [PMID: 26467813 DOI: 10.1136/bmj.h5412] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Joanna Le Noury
- School of Medical Sciences, Bangor University, Bangor, Wales, UK
| | | | - David Healy
- School of Medical Sciences, Bangor University, Bangor, Wales, UK
| | - Jon Jureidini
- Critical and Ethical Mental Health Research Group, Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - Melissa Raven
- Critical and Ethical Mental Health Research Group, Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - Catalin Tufanaru
- Joanna Briggs Institute, Faculty of Health Sciences, University of Adelaide
| | - Elia Abi-Jaoude
- Department of Psychiatry, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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Le Noury J, Nardo JM, Healy D, Jureidini J, Raven M, Tufanaru C, Abi-Jaoude E. Restoring Study 329: efficacy and harms of paroxetine and imipramine in treatment of major depression in adolescence. BMJ 2015; 351:h4320. [PMID: 26376805 PMCID: PMC4572084 DOI: 10.1136/bmj.h4320] [Citation(s) in RCA: 154] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVES To reanalyse SmithKline Beecham's Study 329 (published by Keller and colleagues in 2001), the primary objective of which was to compare the efficacy and safety of paroxetine and imipramine with placebo in the treatment of adolescents with unipolar major depression. The reanalysis under the restoring invisible and abandoned trials (RIAT) initiative was done to see whether access to and reanalysis of a full dataset from a randomised controlled trial would have clinically relevant implications for evidence based medicine. DESIGN Double blind randomised placebo controlled trial. SETTING 12 North American academic psychiatry centres, from 20 April 1994 to 15 February 1998. PARTICIPANTS 275 adolescents with major depression of at least eight weeks in duration. Exclusion criteria included a range of comorbid psychiatric and medical disorders and suicidality. INTERVENTIONS Participants were randomised to eight weeks double blind treatment with paroxetine (20-40 mg), imipramine (200-300 mg), or placebo. MAIN OUTCOME MEASURES The prespecified primary efficacy variables were change from baseline to the end of the eight week acute treatment phase in total Hamilton depression scale (HAM-D) score and the proportion of responders (HAM-D score ≤8 or ≥50% reduction in baseline HAM-D) at acute endpoint. Prespecified secondary outcomes were changes from baseline to endpoint in depression items in K-SADS-L, clinical global impression, autonomous functioning checklist, self-perception profile, and sickness impact scale; predictors of response; and number of patients who relapse during the maintenance phase. Adverse experiences were to be compared primarily by using descriptive statistics. No coding dictionary was prespecified. RESULTS The efficacy of paroxetine and imipramine was not statistically or clinically significantly different from placebo for any prespecified primary or secondary efficacy outcome. HAM-D scores decreased by 10.7 (least squares mean) (95% confidence interval 9.1 to 12.3), 9.0 (7.4 to 10.5), and 9.1 (7.5 to 10.7) points, respectively, for the paroxetine, imipramine and placebo groups (P=0.20). There were clinically significant increases in harms, including suicidal ideation and behaviour and other serious adverse events in the paroxetine group and cardiovascular problems in the imipramine group. CONCLUSIONS Neither paroxetine nor high dose imipramine showed efficacy for major depression in adolescents, and there was an increase in harms with both drugs. Access to primary data from trials has important implications for both clinical practice and research, including that published conclusions about efficacy and safety should not be read as authoritative. The reanalysis of Study 329 illustrates the necessity of making primary trial data and protocols available to increase the rigour of the evidence base.
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Affiliation(s)
- Joanna Le Noury
- School of Medical Sciences, Bangor University, Bangor, Wales, UK
| | | | - David Healy
- School of Medical Sciences, Bangor University, Bangor, Wales, UK
| | - Jon Jureidini
- Critical and Ethical Mental Health Research Group, Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Melissa Raven
- Critical and Ethical Mental Health Research Group, Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Catalin Tufanaru
- Joanna Briggs Institute, Faculty of Health Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Elia Abi-Jaoude
- Department of Psychiatry, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Abstract
Adverse effects of treatment on cardiac QT intervals were first reported 50 years ago. A clear link to sudden death was established, but the problem remained relatively unknown. The issue of treatment related effects on the heart, and the contribution this might make to sudden cardiac deaths in general, came more clearly into focus 20 years ago, linked to regulatory actions. In an era of polypharmacy, and mixing of prescribed and non-prescribed pharmacologically active agents it is now becoming increasingly clear that unanticipated cardiac effects may be common and a significant cause of mortality. There is likely underreporting and also underdiagnosis, as recognition requires a timely ECG. This paper proposes two methods to handle the problem.
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Affiliation(s)
- David Healy
- North Wales Department of Psychological Medicine, Bangor, Wales, UK
| | - Gareth Howe
- North Wales Department of Psychological Medicine, Bangor, Wales, UK
| | - Derelie Mangin
- David Braley & Nancy Gordon Chair of Family Medicine, Department of Family Medicine, McMaster University, Hamilton, Canada
| | - Joanna Le Noury
- North Wales Department of Psychological Medicine, Bangor, Wales, UK
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Basa FB, Harris M, Syed MA, Le Noury J, Healy D. Mental health admissions in paediatric populations in North Wales: two cohorts compared 1875-1924 and 1994-2008. BMJ Open 2014; 4:e004331. [PMID: 24682574 PMCID: PMC3975741 DOI: 10.1136/bmjopen-2013-004331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 03/06/2014] [Accepted: 03/07/2014] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To investigate frequency of under-18s admitted to mental health services (MHS) in North West Wales (NWW) between 1875 and 2008. There are claims that 1 in 10 children have a mental illness, but there are little data on their inpatient MHS utilisation. SETTING Looking at admissions at the secondary care level, three data samples were included; the first comprises historical asylum admissions, the second comprises contemporary admissions to acute psychiatric beds, and the third comprises admissions to district general hospital (DGH) beds that resulted in a mental health coding. PARTICIPANTS All were under 18. There were 65 historical patients, 41 contemporary mental illness admissions and 943 DGH admissions. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measures were diagnoses based on case notes of the historical cohort between 1875 and 1924, as well as details of paediatric admissions to MHS from 1994 to 2008 and paediatric admissions with a mental health component to the DGH in NWW. RESULTS The incidence of admission to a mental health bed was 1.55 per year in the historical cohort compared with 2.9 in the contemporary. The overall incidence of admission to any bed in the contemporary cohort was 129 patients per year. There has been a twofold increase in the incidence of admissions for schizophrenia and related psychosis, but this most likely stems from an earlier age of admission rather than a true increase. CONCLUSIONS There is a greater frequency of hospital admissions for youth under the age of 18 in NWW for mental health today than previously. The rates reported in the DGH sample are consistent with data from community surveys of patients meeting criteria for mental disorders and complement such data when it comes to planning for paediatric MHS. However, they also raise questions about the boundaries between disease and distress.
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Affiliation(s)
- Fouad B Basa
- Hergest Unit, Betsi Cadwaladr University Health Board, Bangor, Gwynedd, UK
| | - Margret Harris
- North Wales Department of Psychological Medicine, Hergest Unit, Penrhosgarnedd, Bangor, Gwynedd, UK
| | - Mujahid Ali Syed
- Hergest Unit, Betsi Cadwaladr University Health Board, Bangor, Gwynedd, UK
| | - Joanna Le Noury
- North Wales Department of Psychological Medicine, Hergest Unit, Penrhosgarnedd, Bangor, Gwynedd, UK
| | - David Healy
- North Wales Department of Psychological Medicine, Hergest Unit, Penrhosgarnedd, Bangor, Gwynedd, UK
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Hogan C, Le Noury J, Healy D, Mangin D. One hundred and twenty cases of enduring sexual dysfunction following treatment. International Journal of Risk & Safety in Medicine 2014; 26:109-16. [DOI: 10.3233/jrs-140617] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Carys Hogan
- North Wales Department of Psychological Medicine, Bangor, Wales, UK
| | - Joanna Le Noury
- North Wales Department of Psychological Medicine, Bangor, Wales, UK
| | - David Healy
- North Wales Department of Psychological Medicine, Bangor, Wales, UK
| | - Derelie Mangin
- David Braley & Nancy Gordon Chair of Family Medicine, Department of Family Medicine, McMaster University, ON, Canada
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12
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Healy D, Le Noury J, Harris M, Butt M, Linden S, Whitaker C, Zou L, Roberts AP. Mortality in schizophrenia and related psychoses: data from two cohorts, 1875-1924 and 1994-2010. BMJ Open 2012; 2:e001810. [PMID: 23048063 PMCID: PMC3488735 DOI: 10.1136/bmjopen-2012-001810] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 09/06/2012] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To investigate death rates in schizophrenia and related psychoses. DESIGN Data from two epidemiologically complete cohorts of patients presenting for the first time to mental health services in North Wales for whom there are at least 1, and up to 10-year follow-up data have been used to calculate survival rates and standardised death rates for schizophrenia and related psychoses. SETTING The North Wales Asylum Denbigh (archived patient case notes) and the North West Wales District General Hospital psychiatric unit. POPULATION Cohort 1: The North Wales Asylum Denbigh (archived patient case notes). Of 3168 patients admitted to the North Wales Asylum Denbigh 1875-1924, 1074 had a schizophrenic or related psychosis. Cohort 2: Patients admitted between 1994 and 2010 to the North West Wales District General Hospital psychiatric unit, of whom 355 had first admissions for schizophrenia or related psychoses. RESULTS We found a 10-year survival probability of 75% in the historical cohort and a 90% survival probability in the contemporary cohort with a fourfold increase in standardised death rates in schizophrenia and related psychoses in both historical and contemporary periods. Suicide is the commonest cause of death in schizophrenia in the contemporary period (SMR 35), while tuberculosis was the commonest cause historically (SMR 9). In the contemporary data, deaths from cardiovascular causes arise in the elderly and deaths from suicide in the young. CONCLUSIONS Contemporary death rates in schizophrenia and related psychoses are high but there are particular hazards and windows of risk that enable interventions. The data point to possible interventions in the incident year of treatment that could give patients with schizophrenia a normal life expectancy.
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Affiliation(s)
- David Healy
- North Wales Department of Psychological Medicine, Hergest Unit, Bangor, Wales, UK
| | - Joanna Le Noury
- North Wales Department of Psychological Medicine, Hergest Unit, Bangor, Wales, UK
| | - Margaret Harris
- North Wales Department of Psychological Medicine, Hergest Unit, Bangor, Wales, UK
| | - Mohammed Butt
- North Wales Department of Psychological Medicine, Hergest Unit, Bangor, Wales, UK
| | | | | | - Lu Zou
- NWORTH, Bangor University, Bangor, UK
| | - Anthony P Roberts
- North Wales Department of Psychological Medicine, Hergest Unit, Bangor, Wales, UK
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Healy D, Le Noury J, Linden SC, Harris M, Whitaker C, Linden D, Baker D, Roberts AP. The incidence of admissions for schizophrenia and related psychoses in two cohorts: 1875-1924 and 1994-2010. BMJ Open 2012; 2:e000447. [PMID: 22267688 PMCID: PMC3263437 DOI: 10.1136/bmjopen-2011-000447] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective To investigate changes in incidence of admissions for schizophrenia and related non-affective psychoses in North Wales. Design Data from two epidemiologically complete cohorts of patients presenting for the first time to mental health services in North Wales between 1875-1924 and 1994-2010 are used in this study to map the incidence of hospital admissions for schizophrenia and non-affective psychoses. Setting The North Wales Asylum Denbigh (archived patient case notes) and the North West Wales District General Hospital psychiatric unit. Population 3168 patients admitted to the North Wales Asylum Denbigh between 1875 and 1924 and 355 patients admitted to the District General Hospital psychiatric unit between 1994 and 2010. Results There was an increasing admission incidence for schizophrenia between 1875 and 1900, a higher admission rate in the 1990s for men, followed by a drop in rates of admission for both genders since 2006. Admission incidences switch from parity between the sexes in the historical period to a doubling of the admission rates for men compared with women in the modern period. This admission pattern differs from the admission patterns for affective psychoses or organic disorders. Conclusion There have been changes in the incidence of admissions for schizophrenia in North Wales.
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Affiliation(s)
- David Healy
- North Wales Department of Psychological Medicine, Hergest Unit, Bangor, Wales, UK
| | - Joanna Le Noury
- North Wales Department of Psychological Medicine, Hergest Unit, Bangor, Wales, UK
| | - Stefanie Caroline Linden
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK
| | - Margaret Harris
- North Wales Department of Psychological Medicine, Hergest Unit, Bangor, Wales, UK
| | | | - David Linden
- Department of Psychological Medicine and Neurology Cardiff University, Cardiff, UK
| | | | - Anthony P Roberts
- North Wales Department of Psychological Medicine, Hergest Unit, Bangor, Wales, UK
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Harris M, Farquhar F, Healy D, Le Noury J, Baker D, Whitaker C, Linden S, Green P, Roberts AP. The incidence and prevalence of admissions for melancholia in two cohorts (1875-1924 and 1995-2005). J Affect Disord 2011; 134:45-51. [PMID: 21733576 DOI: 10.1016/j.jad.2011.06.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [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: 12/13/2010] [Revised: 06/06/2011] [Accepted: 06/14/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND METHOD There have been recent proposals to have melancholia reinstated in classification systems as a disorder distinct from major depressive disorder. Data from two epidemiologically complete cohorts of patients presenting to mental health services in North Wales between 1875-1924 and 1995-2005 have been used to map the features of melancholia. RESULTS The data point to a decline in the contemporary incidence of hospital admissions for depressive psychosis, and greater heterogeneity among hospitalized severe non-psychotic depressions today. They indicate that historically untreated episodes of "melancholia" had a sudden onset, an average duration of less than 6 months and a lesser likelihood of relapse than severe depressive disorders have today. LIMITATIONS This is a study of the hospitalized illness rather than the natural illness and the relationship between illness and being hospitalized remains at present poorly understood. CONCLUSIONS These are the first data on the comparative incidence and natural history of melancholia in historical and contemporary samples. They point to the distinctiveness of the condition and support arguments for its separation from other mood disorders.
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Affiliation(s)
- Margaret Harris
- North Wales Department of Psychological Medicine, Hergest Unit, Bangor, Wales, UK
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15
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Noury JL, Tatineni RK, Healy D. Perceptions of Adult ADHD. International Journal of Risk & Safety in Medicine 2010. [DOI: 10.3233/jrs-2010-0492] [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: 11/15/2022]
Affiliation(s)
- Joanna Le Noury
- Department of Psychological Medicine, Hergest Unit, Bangor District General Hospital, Bangor, North Wales, UK
| | - Ranjit Kumar Tatineni
- Department of Psychological Medicine, Hergest Unit, Bangor District General Hospital, Bangor, North Wales, UK
| | - David Healy
- Cardiff University, Department of Psychological Medicine, Hergest Unit, Bangor District General Hospital, Bangor, North Wales, UK
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Le Noury J, Khan A, Harris M, Wong W, Williams D, Roberts T, Tranter R, Healy D. The incidence and prevalence of diabetes in patients with serious mental illness in North West Wales: two cohorts, 1875-1924 & 1994-2006 compared. BMC Psychiatry 2008; 8:67. [PMID: 18687107 PMCID: PMC2518146 DOI: 10.1186/1471-244x-8-67] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Accepted: 08/07/2008] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Against a background of interest in rates of diabetes in schizophrenia and related psychoses and claims that data from historical periods demonstrate a link that antedates modern antipsychotics, we sought to establish the rate of diabetes in first onset psychosis and subsequent prevalence in historical and contemporary cohorts. METHODS Analysis of two epidemiologically complete databases of individuals admitted for mental illness. 3170 individuals admitted to the North Wales Asylum between 1875-1924 and tracked over 18,486 patient years and 394 North West Wales first admissions for schizophrenia and related psychoses between 1994 and 2006 and tracked after treatment. RESULTS The prevalence of Type 2 diabetes among patients with psychoses at time of first admission in both historical and contemporary samples was 0%. The incidence of diabetes remained 0% in the historical sample throughout 15 years of follow-up but rose in the contemporary sample after 3, 5 and 6 years of treatment with an incidence rate double the expected population rate so that the 15 year prevalence is likely to be over 8%. CONCLUSION No association was found between diabetes and serious mental illness, but there may be an association between diabetes and treatment.
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Affiliation(s)
- Joanna Le Noury
- Department of Psychiatry, North West Wales NHS Trust, Bangor, Wales, LL57 2PW, UK
| | - Afshan Khan
- Department of Psychiatry, North West Wales NHS Trust, Bangor, Wales, LL57 2PW, UK
| | - Margaret Harris
- Department of Psychiatry, North West Wales NHS Trust, Bangor, Wales, LL57 2PW, UK
| | - Winnie Wong
- Department of Psychiatry, North West Wales NHS Trust, Bangor, Wales, LL57 2PW, UK
| | - Dawn Williams
- Department of Psychiatry, North West Wales NHS Trust, Bangor, Wales, LL57 2PW, UK
| | - Tony Roberts
- Department of Psychiatry, North West Wales NHS Trust, Bangor, Wales, LL57 2PW, UK
| | - Richard Tranter
- Department of Psychiatry, North West Wales NHS Trust, Bangor, Wales, LL57 2PW, UK
| | - David Healy
- Department of Psychological Medicine, Cardiff University, Bangor, Wales, LL57 2PW, UK
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Abstract
This paper reviews the importance Emil Kraepelin put on disease course as a classificatory principle. It then outlines the academic reception of Kraepelin's disease entities outside Germany, charts the uptake of his diagnostic concepts within clinical practice in Britain, and compares data on admissions for bipolar disorders, involutional melancholia and postpartum psychoses to the North Wales asylum during the period Kraepelin was working to data on contemporary admissions in an effort to shed further light on the validity of his diagnostic concepts.
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Affiliation(s)
- David Healy
- Department of Psychological Medicine, Cardiff University, Hergest Unit, Ysbyly Gwynedd, Bangor Gwynedd, LL57 2PW, UK.
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Reseland S, Le Noury J, Aldred G, Healy D. National suicide rates 1961-2003: further analysis of nordic data for suicide, autopsies and ill-defined death rates. Psychother Psychosom 2008; 77:78-82. [PMID: 18230940 DOI: 10.1159/000112884] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Concerns about the risk-benefit ratio of treatment with antidepressants in the light of recent evidence pointing to a risk of suicide induction during the course of treatment with antidepressants. These concerns have led to a series of recent studies exploring national rates of suicide and correlating these with data on antidepressant consumption. METHODS We have compared suicide rates in the Nordic countries with autopsy and ill-defined death rates, and antidepressant sales, during the period 1961 through to 2003. RESULTS There is a close correlation between suicide rates and both autopsy and ill-defined death rates. CONCLUSIONS The role of autopsies and other factors in the registration of a death as a suicide appear to need further clarification.
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Affiliation(s)
- Svein Reseland
- North Wales Department of Psychological Medicine, Cardiff University, Hergest Unit, Bangor, Wales, UK
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