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Ryland H, Cook J, Fitzpatrick R, Fazel S. Examination of the psychometric properties of the FORensic oUtcome Measure (FORUM): a new outcome measure for forensic mental health services. Eur Psychiatry 2022. [PMCID: PMC9566908 DOI: 10.1192/j.eurpsy.2022.1541] [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 Forensic mental health services provide care to people in secure psychiatric hospitals and specialised community teams. Measuring outcomes is important to ensure such services perform optimally, however existing measures are not sufficiently comprehensive and are rarely patient reported. Objectives To examine a novel instrument for measuring outcomes in forensic mental health services, the FORensic oUtsome Measure (FORUM), which consists of a complementary patient reported questionnaire (FORUM-P) and clinician reported questionnaire (FORUM-C). Methods Inpatients at a forensic psychiatric service based in a regional healthcare organization in the UK completed the FORUM-P, while members of their clinical teams completed the FORUM-C. Patients and clinicians also provided feedback on the questionnaires. Results Sixty-two patients participated with a mean age of 41.0 years (standard deviation 11.3). For internal consistency, Cronbach’s alpha for the FORUM-P was 0.87 (95% confidence interval (CI) 0.80-0.93) and for the FORUM-C was 0.93 (95% CI 0.91-0.96). For test-retest reliability the weighted kappa for the FORUM-P was 0.44 (95% CI 0.24-0.63) and for the FORUM-C was 0.78 (95% CI 0.73-0.85). For interrater reliability of the FORUM-C the Spearman correlation coefficient was 0.47 (95% CI 0.18-0.69). The FORUM-P received an average rating of 4.0 out of 5 for comprehensiveness, 4.6 for ease of use and 3.9 for relevance, while the FORUM-C received 4.1 for comprehensiveness, 4.5 for ease of use and 4.3 for relevance. Conclusions Outcome measures in forensic mental health can be developed with good measures of reliability and validity, and can be introduced into services to monitor patient progress. Disclosure No significant relationships.
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Jimenez T, Barrios A, Tucker A, Collazo J, Arias N, Fazel S, Baker M, Halim M, Huynh T, Singh R, Pervin S. DUSP9-mediated reduction of pERK1/2 supports cancer stem cell-like traits and promotes triple negative breast cancer. Am J Cancer Res 2020; 10:3487-3506. [PMID: 33163285 PMCID: PMC7642669] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 09/13/2020] [Indexed: 06/11/2023] Open
Abstract
Breast cancer remains a complex disease resulting in high mortality in women. A subset of cancer stem cell (CSC)-like cells expressing aldehyde dehydrogenase 1 (ALDH1) and SOX2/OCT4 are implicated in aggressive biology of specific subtypes of breast cancer. Targeting these populations in breast tumors remain challenging. We examined xenografts from three poorly studied triple negative (TN) breast cancer cells (MDA-MB-468, HCC70 and HCC1806) as well as HMLEHRASV12 for stem cell (SC)-specific proteins, proliferation pathways and dual-specific phosphatases (DUSPs) by quantitative real-time PCR (qRT-PCR), immunoblot analysis and immunohistochemistry. We found that pERK1/2 remained suppressed in TN xenografts examined at various stages of growth, while the levels of pp38 MAPK and pAKT was upregulated. We found that DUSP was involved in the suppression of pERK1/2, which was MEK1/2 independent. Our in vitro assays, using HMLEHRASV12 xenografts as a positive control, confirmed increased phosphatase activity that specifically influenced pERK1/2 but not pp38MAPK or pJNK levels. Family members of DUSPs examined, showed increase in DUSP9 expression in TN xenografts. Increased DUSP9 expression in xenografts was consistently associated with upregulation of SC-specific proteins, ALDH1 and SOX2/OCT4. HRAS driven HMLEHRASV12 xenografts as well as mammospheres from TN breast cancer cells showed inverse relationship between pERK1/2 and increased expression of DUSP9 and CSC traits. In addition, treatment in vitro, with MEK1/2 inhibitor, PD 98059, reduced pERK1/2 levels and increased DUSP9 and SC-specific proteins. Depletion of subsets of SOX2/OCT4 by fluorescence-activated cell sorting (FACS), as well as pharmacological and genetic reduction of DUSP9 levels influenced ALDH1 and SOX2/OCT4 expression and reduced mammosphere growth in vitro as well as tumor growth in vivo. Collectively our data support the possibility that DUSP9 contributed to stem cell-like cells that could influence TN breast tumor growth. Conclusion: Our study shows that subsets of TN breast cancers with MEK1/2 independent reduced pERK1/2 levels will respond less to MEK1/2 inhibitors, thereby questioning their therapeutic efficacy. Our study also demonstrates context-dependent DUSP9-mediated reduced pERK1/2 levels could influence stem cell-like traits in TN breast tumors. Therefore, targeting DUSP9 could be an attractive target for improved clinical outcome in a subset of basal-like breast cancers.
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Affiliation(s)
- Thalia Jimenez
- Division of Endocrinology and Metabolism, Charles R. Drew University of Medicine and Science1748 118 Street, Los Angeles, CA 90059, USA
| | - Albert Barrios
- Department of Biology, California State University Dominguez HillsLos Angeles, CA 90747, USA
| | - Alexandria Tucker
- Division of Endocrinology and Metabolism, Charles R. Drew University of Medicine and Science1748 118 Street, Los Angeles, CA 90059, USA
| | - Javier Collazo
- Division of Endocrinology and Metabolism, Charles R. Drew University of Medicine and Science1748 118 Street, Los Angeles, CA 90059, USA
| | - Nataly Arias
- Department of Biology, California State University Dominguez HillsLos Angeles, CA 90747, USA
| | - Sayeda Fazel
- Division of Endocrinology and Metabolism, Charles R. Drew University of Medicine and Science1748 118 Street, Los Angeles, CA 90059, USA
| | - Melanie Baker
- Division of Endocrinology and Metabolism, Charles R. Drew University of Medicine and Science1748 118 Street, Los Angeles, CA 90059, USA
| | - Mariza Halim
- Division of Endocrinology and Metabolism, Charles R. Drew University of Medicine and Science1748 118 Street, Los Angeles, CA 90059, USA
| | - Travis Huynh
- Division of Endocrinology and Metabolism, Charles R. Drew University of Medicine and Science1748 118 Street, Los Angeles, CA 90059, USA
| | - Rajan Singh
- Division of Endocrinology and Metabolism, Charles R. Drew University of Medicine and Science1748 118 Street, Los Angeles, CA 90059, USA
- Department of Obstetrics and Gynecology, Jonsson Comprehensive Cancer Center, David Geffen School of Medicine at UCLALos Angeles, CA 90095, USA
| | - Shehla Pervin
- Division of Endocrinology and Metabolism, Charles R. Drew University of Medicine and Science1748 118 Street, Los Angeles, CA 90059, USA
- Department of Obstetrics and Gynecology, Jonsson Comprehensive Cancer Center, David Geffen School of Medicine at UCLALos Angeles, CA 90095, USA
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Borschmann R, Tibble H, Spittal MJ, Preen D, Pirkis J, Larney S, Rosen DL, Young JT, Love AD, Altice FL, Binswanger IA, Bukten A, Butler T, Chang Z, Chen CY, Clausen T, Christensen PB, Culbert GJ, Degenhardt L, Dirkzwager AJE, Dolan K, Fazel S, Fischbacher C, Giles M, Graham L, Harding D, Huang YF, Huber F, Karaminia A, Keen C, Kouyoumdjian FG, Lim S, Møller L, Moniruzzaman A, Morenoff J, O’Moore E, Pizzicato LN, Pratt D, Proescholdbell SK, Ranapurwala SI, Shanahan ME, Shaw J, Slaunwhite A, Somers JM, Spaulding AC, Stern MF, Viner KM, Wang N, Willoughby M, Zhao B, Kinner SA. The Mortality After Release from Incarceration Consortium (MARIC): Protocol for a multi-national, individual participant data meta-analysis. Int J Popul Data Sci 2020; 5:1145. [PMID: 32935053 PMCID: PMC7473255 DOI: 10.23889/ijpds.v5i1.1145] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION More than 30 million adults are released from incarceration globally each year. Many experience complex physical and mental health problems, and are at markedly increased risk of preventable mortality. Despite this, evidence regarding the global epidemiology of mortality following release from incarceration is insufficient to inform the development of targeted, evidence-based responses. Many previous studies have suffered from inadequate power and poor precision, and even large studies have limited capacity to disaggregate data by specific causes of death, sub-populations or time since release to answer questions of clinical and public health relevance. OBJECTIVES To comprehensively document the incidence, timing, causes and risk factors for mortality in adults released from prison. METHODS We created the Mortality After Release from Incarceration Consortium (MARIC), a multi-disciplinary collaboration representing 29 cohorts of adults who have experienced incarceration from 11 countries. Findings across cohorts will be analysed using a two-step, individual participant data meta-analysis methodology. RESULTS The combined sample includes 1,337,993 individuals (89% male), with 75,795 deaths recorded over 9,191,393 person-years of follow-up. CONCLUSIONS The consortium represents an important advancement in the field, bringing international attention to this problem. It will provide internationally relevant evidence to guide policymakers and clinicians in reducing preventable deaths in this marginalized population. KEY WORDS Mortality; incarceration; prison; release; individual participant data meta-analysis; consortium; cohort.
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Affiliation(s)
- R Borschmann
- Justice Health Unit, Centre for Health Equity, The University of Melbourne, 207 Bouverie street, Carlton 3010, Melbourne, Victoria, AUSTRALIA
| | - H Tibble
- Usher Institute of Population Health Sciences and Informatics, Centre for Medical Informatics, University of Edinburgh, Edinburgh, UK
| | - MJ Spittal
- University of Melbourne, Melbourne School of Population and Global Health, Melbourne, AUSTRALIA
| | - D Preen
- The University of Western Australia, School of Population and Global Health, Nedlands, AUSTRALIA
| | - J Pirkis
- University of Melbourne, Melbourne School of Population and Global Health, Melbourne, AUSTRALIA
| | - S Larney
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, AUSTRALIA
| | - DL Rosen
- University of North Carolina at Chapel Hill, North Carolina, USA
| | - JT Young
- University of Melbourne, Melbourne School of Population and Global Health, Melbourne, AUSTRALIA
| | - AD Love
- University of Melbourne, Melbourne School of Population Health, Melbourne, AUSTRALIA
| | - FL Altice
- Yale University School of Medicine and Public Health, New Haven, Connecticut, USA
| | - IA Binswanger
- Kaiser Permanente Colorado, Colorado Permanente Medical Group, USA
| | - A Bukten
- Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, Norway
| | - T Butler
- University of New South Wales, Kirby Institute, Sydney, AUSTRALIA
| | - Z Chang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, SWEDEN
| | - C-Y Chen
- National Yang-Ming University, Institute of Public Health, TAIWAN
| | - T Clausen
- Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, Norway
| | - PB Christensen
- Department of Infectious Diseases, Odense University Hospital and Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, DENMARK
| | - GJ Culbert
- Department of Health Systems Science, University of Illinois at Chicago, Chicago, USA
| | - L Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, AUSTRALIA
| | - AJE Dirkzwager
- Netherlands Institute for the Study of Crime and Law Enforcement (NSCR), Amsterdam, NETHERLANDS
| | - K Dolan
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, AUSTRALIA
| | - S Fazel
- University of Oxford, Department of Psychiatry, Medical Sciences Division, Oxford, ENGLAND
| | - C Fischbacher
- NHS National Services, Information Services Division, Edinburgh, SCOTLAND
| | - M Giles
- Edith Cowan University, School of Arts and Humanities, Joondalup, AUSTRALIA
| | - L Graham
- NHS National Services, Information Services Division, Edinburgh, SCOTLAND
| | - D Harding
- University of California Berkeley, USA
| | - Y-F Huang
- Taiwan Centers for Disease Control, Taipei, TAIWAN
| | - F Huber
- Cayenne General Hospital, COREVIH Guyane, and Reseau Kikiwi, Cayenne, French Guiana, FRANCE
| | - A Karaminia
- University of New South Wales, Sydney, AUSTRALIA
| | - C Keen
- University of Melbourne, Melbourne School of Population and Global Health, Melbourne, AUSTRALIA
| | - FG Kouyoumdjian
- McMaster University, Department of Family Medicine, Hamilton, Ontario, CANADA
| | - S Lim
- New York City Department of Health and Mental Hygiene, Bureau of Epidemiology Services, Division of Epidemiology, New York, USA
| | - L Møller
- World Health Organization, Division of Noncommunicable Diseases and Promoting Health through the Life-course, Marmorvej, DENMARK
| | - A Moniruzzaman
- Somers Research Group, Simon Fraser University, Burnaby, British Columbia, CANADA
| | - J Morenoff
- University of Michigan, Department of Sociology, USA
| | - E O’Moore
- Public Health England, London, ENGLAND
| | - LN Pizzicato
- Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - D Pratt
- University of Manchester, Division of Psychology and Mental Health, School of Health Sciences, Manchester, ENGLAND
| | - SK Proescholdbell
- North Carolina Department of Health and Human Services, North Carolina, USA
| | - SI Ranapurwala
- Department of Epidemiology, University of North Carolina at Chapel Hill, USA
| | - ME Shanahan
- Department of Maternal and Child Health, University of North Carolina at Chapel Hill, USA
| | - J Shaw
- Centre for Mental Health and Safety, Division of Psychology and Mental Health, University of Manchester, Manchester, ENGLAND
| | - A Slaunwhite
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, British Columbia, CANADA
| | - JM Somers
- Somers Research Group, Simon Fraser University, Burnaby, British Columbia, CANADA
| | - AC Spaulding
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - MF Stern
- Department of Health Services, University of Washington, Seattle, Washington, USA
| | - KM Viner
- Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - N Wang
- Institute of Public Health, National Yang-Ming University, TAIWAN
| | - M Willoughby
- University of Melbourne, Melbourne School of Population and Global Health, Melbourne, AUSTRALIA
| | - B Zhao
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, British Columbia, CANADA
| | - SA Kinner
- Murdoch Children’s Research Institute, Centre for Adolescent Health, Melbourne, Victoria, AUSTRALIA
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Wolf A, Fanshawe TR, Sariaslan A, Cornish R, Larsson H, Fazel S. Prediction of violent crime on discharge from secure psychiatric hospitals: A clinical prediction rule (FoVOx). Eur Psychiatry 2018; 47:88-93. [PMID: 29161680 PMCID: PMC5797975 DOI: 10.1016/j.eurpsy.2017.07.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 07/19/2017] [Accepted: 07/21/2017] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Current approaches to assess violence risk in secure hospitals are resource intensive, limited by accuracy and authorship bias and may have reached a performance ceiling. This study seeks to develop scalable predictive models for violent offending following discharge from secure psychiatric hospitals. METHODS We identified all patients discharged from secure hospitals in Sweden between January 1, 1992 and December 31, 2013. Using multiple Cox regression, pre-specified criminal, sociodemographic, and clinical risk factors were included in a model that was tested for discrimination and calibration in the prediction of violent crime at 12 and 24 months post-discharge. Risk cut-offs were pre-specified at 5% (low vs. medium) and 20% (medium vs. high). RESULTS We identified 2248 patients with 2933 discharges into community settings. We developed a 12-item model with good measures of calibration and discrimination (area under the curve=0.77 at 12 and 24 months). At 24 months post-discharge, using the 5% cut-off, sensitivity was 96% and specificity was 21%. Positive and negative predictive values were 19% and 97%, respectively. Using the 20% cut-off, sensitivity was 55%, specificity 83% and the positive and negative predictive values were 37% and 91%, respectively. The model was used to develop a free online tool (FoVOx). INTERPRETATION We have developed a prediction score in a Swedish cohort of patients discharged from secure hospitals that can assist in clinical decision-making. Scalable predictive models for violence risk are possible in specific patient groups and can free up clinical time for treatment and management. Further evaluation in other countries is needed. FUNDING Wellcome Trust (202836/Z/16/Z) and the Swedish Research Council. The funding sources had no involvement in writing of the manuscript or decision to submit or in data collection, analysis or interpretation or any aspect pertinent to the study.
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Affiliation(s)
- A Wolf
- Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, OX3 7JX Oxford, UK
| | - T R Fanshawe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG Oxford, UK
| | - A Sariaslan
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - R Cornish
- Oxford Health NHS Foundation Trust, OX3 7JX Oxford, UK
| | - H Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden; School of Medical Sciences, Örebro University, 701 82 Örebro, Sweden
| | - S Fazel
- Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, OX3 7JX Oxford, UK.
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Douglas T, Pugh J, Singh I, Savulescu J, Fazel S. Risk assessment tools in criminal justice and forensic psychiatry: The need for better data. Eur Psychiatry 2017; 42:134-137. [PMID: 28371726 PMCID: PMC5408162 DOI: 10.1016/j.eurpsy.2016.12.009] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 12/04/2016] [Accepted: 12/11/2016] [Indexed: 11/20/2022] Open
Abstract
Violence risk assessment tools are increasingly used within criminal justice and forensic psychiatry, however there is little relevant, reliable and unbiased data regarding their predictive accuracy. We argue that such data are needed to (i) prevent excessive reliance on risk assessment scores, (ii) allow matching of different risk assessment tools to different contexts of application, (iii) protect against problematic forms of discrimination and stigmatisation, and (iv) ensure that contentious demographic variables are not prematurely removed from risk assessment tools.
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Affiliation(s)
- T Douglas
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Suite 8, Littlegate House, St Ebbes Street, Oxford OX1 1PT, United Kingdom
| | - J Pugh
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Suite 8, Littlegate House, St Ebbes Street, Oxford OX1 1PT, United Kingdom
| | - I Singh
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Suite 8, Littlegate House, St Ebbes Street, Oxford OX1 1PT, United Kingdom; Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, United Kingdom
| | - J Savulescu
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Suite 8, Littlegate House, St Ebbes Street, Oxford OX1 1PT, United Kingdom
| | - S Fazel
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, United Kingdom; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford OX3 7JX, United Kingdom.
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Babchishin KM, Seto MC, Sariaslan A, Lichtenstein P, Fazel S, Långström N. Parental and perinatal risk factors for sexual offending in men: a nationwide case-control study. Psychol Med 2017; 47:305-315. [PMID: 27733213 PMCID: PMC5217130 DOI: 10.1017/s003329171600249x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 08/23/2016] [Accepted: 08/25/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Prior studies suggest parental and perinatal risk factors are associated with later offending. It remains uncertain, however, if such risk factors are similarly related to sexual offending. METHOD We linked socio-demographic, family relations, and perinatal (obtained at birth) data from the nationwide Swedish registers from 1973 to 2009 with information on criminal convictions of cases and control subjects. Male sex offenders (n = 13 773) were matched 1:5 on birth year and county of birth in Sweden to male controls without sexual or non-sexual violent convictions. To examine risk-factor specificity for sexual offending, we also compared male violent, non-sexual offenders (n = 135 953) to controls without sexual or non-sexual violent convictions. Predictors included parental (young maternal or paternal age at son's birth, educational attainment, violent crime, psychiatric disorder, substance misuse, suicide attempt) and perinatal (number of older brothers, low Apgar score, low birth weight, being small for gestational age, congenital malformations, small head size) variables. RESULTS Conditional logistic regression models found consistent patterns of statistically significant, small to moderate independent associations of parental risk factors with sons' sexual offending and non-sexual violent offending. For perinatal risk factors, patterns varied more; small for gestational age and small head size exhibited similar risk effects for both offence types whereas a higher number of older biological brothers and any congenital malformation were small, independent risk factors only for non-sexual violence. CONCLUSIONS This nationwide study suggests substantial commonalities in parental and perinatal risk factors for the onset of sexual and non-sexual violent offending.
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Affiliation(s)
- K. M. Babchishin
- Royal's Institute of Mental Health
Research, University of Ottawa,
Ottawa, Canada
- Department of Medical Epidemiology and
Biostatistics, Karolinska Institutet,
Stockholm, Sweden
| | - M. C. Seto
- Royal's Institute of Mental Health
Research, University of Ottawa,
Ottawa, Canada
| | - A. Sariaslan
- Department of Psychiatry,
University of Oxford, Oxford,
UK
| | - P. Lichtenstein
- Department of Medical Epidemiology and
Biostatistics, Karolinska Institutet,
Stockholm, Sweden
| | - S. Fazel
- Department of Psychiatry,
University of Oxford, Oxford,
UK
| | - N. Långström
- Department of Medical Epidemiology and
Biostatistics, Karolinska Institutet,
Stockholm, Sweden
- Department of Neuroscience,
Uppsala University, Sweden
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Rezansoff SN, Moniruzzaman A, Fazel S, Procyshyn R, Somers JM. Adherence to antipsychotic medication among homeless adults in Vancouver, Canada: a 15-year retrospective cohort study. Soc Psychiatry Psychiatr Epidemiol 2016; 51:1623-1632. [PMID: 27338740 PMCID: PMC5091737 DOI: 10.1007/s00127-016-1259-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 06/15/2016] [Indexed: 12/22/2022]
Abstract
PURPOSE The purpose of this study was to investigate the level of adherence to antipsychotic prescription medication in a well-defined homeless cohort over a 15-year period. We hypothesized that adherence would be well below the recommended threshold for clinical effectiveness (80 %), and that it would be strongly associated with modifiable risk factors in the social environment in which homeless people live. METHOD Linked baseline data (including comprehensive population-level administrative prescription records) were examined in a subpopulation of participants from two pragmatic-randomized trials that investigated Housing First for homeless and mentally ill adults. Adherence to antipsychotic medication was operationalized using the medication possession ratio. Multivariable logistic regression was used to estimate effect sizes between socio-demographic, homelessness-related and illness factors, and medication possession ratio. RESULTS Among the 290 participants who met inclusion criteria for the current analysis, adherence to antipsychotic prescription was significantly associated with: history of psychiatric hospitalization; receipt of primary medical services; long-acting injectable antipsychotic formulations; and duration of homelessness. Mean medication possession ratio in the pre-randomization period was 0.41. Socio-demographic characteristics previously correlated with antipsychotic non-adherence were not significantly related to medication possession ratio. CONCLUSIONS This is the first study to quantify the very low level of adherence to antipsychotic medication among homeless people over an extended observation period of 15 years. Each of the four factors found to be significantly associated with adherence presents opportunities for intervention. Strategies to end homelessness for this population may represent the greatest opportunity to improve adherence to antipsychotic medication.
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Affiliation(s)
- Stefanie N Rezansoff
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
| | - A Moniruzzaman
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - S Fazel
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, 0X3 7JX, UK
| | - R Procyshyn
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, V6T 2A1, Canada
| | - J M Somers
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
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Goodwin GM, Haddad PM, Ferrier IN, Aronson JK, Barnes T, Cipriani A, Coghill DR, Fazel S, Geddes JR, Grunze H, Holmes EA, Howes O, Hudson S, Hunt N, Jones I, Macmillan IC, McAllister-Williams H, Miklowitz DR, Morriss R, Munafò M, Paton C, Saharkian BJ, Saunders K, Sinclair J, Taylor D, Vieta E, Young AH. Evidence-based guidelines for treating bipolar disorder: Revised third edition recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2016; 30:495-553. [PMID: 26979387 PMCID: PMC4922419 DOI: 10.1177/0269881116636545] [Citation(s) in RCA: 443] [Impact Index Per Article: 55.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The British Association for Psychopharmacology guidelines specify the scope and targets of treatment for bipolar disorder. The third version is based explicitly on the available evidence and presented, like previous Clinical Practice Guidelines, as recommendations to aid clinical decision making for practitioners: it may also serve as a source of information for patients and carers, and assist audit. The recommendations are presented together with a more detailed review of the corresponding evidence. A consensus meeting, involving experts in bipolar disorder and its treatment, reviewed key areas and considered the strength of evidence and clinical implications. The guidelines were drawn up after extensive feedback from these participants. The best evidence from randomized controlled trials and, where available, observational studies employing quasi-experimental designs was used to evaluate treatment options. The strength of recommendations has been described using the GRADE approach. The guidelines cover the diagnosis of bipolar disorder, clinical management, and strategies for the use of medicines in short-term treatment of episodes, relapse prevention and stopping treatment. The use of medication is integrated with a coherent approach to psychoeducation and behaviour change.
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Affiliation(s)
- G M Goodwin
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - P M Haddad
- Greater Manchester West Mental Health NHS Foundation Trust, Eccles, Manchester, UK
| | - I N Ferrier
- Institute of Neuroscience, Newcastle University, UK and Northumberland Tyne and Wear NHS Foundation Trust, Newcastle, UK
| | - J K Aronson
- Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Oxford, UK
| | - Trh Barnes
- The Centre for Mental Health, Imperial College London, Du Cane Road, London, UK
| | - A Cipriani
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - D R Coghill
- MACHS 2, Ninewells' Hospital and Medical School, Dundee, UK; now Departments of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, VIC, Australia
| | - S Fazel
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - J R Geddes
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - H Grunze
- Univ. Klinik f. Psychiatrie u. Psychotherapie, Christian Doppler Klinik, Universitätsklinik der Paracelsus Medizinischen Privatuniversität (PMU), Salzburg, Christian Doppler Klinik Salzburg, Austria
| | - E A Holmes
- MRC Cognition & Brain Sciences Unit, Cambridge, UK
| | - O Howes
- Institute of Psychiatry (Box 67), London, UK
| | | | - N Hunt
- Fulbourn Hospital, Cambridge, UK
| | - I Jones
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff, UK
| | - I C Macmillan
- Northumberland, Tyne and Wear NHS Foundation Trust, Queen Elizabeth Hospital, Gateshead, Tyne and Wear, UK
| | - H McAllister-Williams
- Institute of Neuroscience, Newcastle University, UK and Northumberland Tyne and Wear NHS Foundation Trust, Newcastle, UK
| | - D R Miklowitz
- UCLA Semel Institute for Neuroscience and Human Behavior, Division of Child and Adolescent Psychiatry, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - R Morriss
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Nottingham, UK
| | - M Munafò
- MRC Integrative Epidemiology Unit, UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, Bristol, UK
| | - C Paton
- Oxleas NHS Foundation Trust, Dartford, UK
| | - B J Saharkian
- Department of Psychiatry (Box 189), University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Cambridge, UK
| | - Kea Saunders
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - Jma Sinclair
- University Department of Psychiatry, Southampton, UK
| | - D Taylor
- South London and Maudsley NHS Foundation Trust, Pharmacy Department, Maudsley Hospital, London, UK
| | - E Vieta
- Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - A H Young
- Centre for Affective Disorders, King's College London, London, UK
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Zlodre J, Yiend J, Burns T, Fazel S. Coercion, competence, and consent in offenders with personality disorder. Psychol Crime Law 2015; 22:315-330. [PMID: 27284235 PMCID: PMC4896379 DOI: 10.1080/1068316x.2015.1109086] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Competence to consent to treatment has not previously been examined in a personality disorder cohort without comorbid mental disorder. We examined competence and coercion in 174 individuals diagnosed with severe personality disorder using two validated tools (the MacArthur Competence Assessment Tool for Treatment and the MacArthur Coercion Assessment Scale - Short Form). Competence was not categorically impaired, but there were variations within the sample on dimensional competence measures. Further, there were significant negative correlations between experienced coercion and competence. Higher coercion scores were associated with two components of competence: lower understanding and reasoning. Patients who consented to treatment had higher scores on competence measures and experienced less coercion. These findings suggest that therapeutic approaches that decrease experienced coercion and increase competence may increase the engagement of individuals diagnosed with severe personality disorders in treatment.
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Affiliation(s)
- J Zlodre
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - J Yiend
- Institute of Psychiatry, King's College London, London, UK
| | - T Burns
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - S Fazel
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
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Singh R, Parveen M, Basgen JM, Fazel S, Meshesha MF, Thames EC, Moore B, Martinez L, Howard CB, Vergnes L, Reue K, Pervin S. Increased Expression of Beige/Brown Adipose Markers from Host and Breast Cancer Cells Influence Xenograft Formation in Mice. Mol Cancer Res 2015; 14:78-92. [PMID: 26464213 DOI: 10.1158/1541-7786.mcr-15-0151] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 09/30/2015] [Indexed: 12/28/2022]
Abstract
UNLABELLED The initiation and progression of breast cancer is a complex process that is influenced by heterogeneous cell populations within the tumor microenvironment. Although adipocytes have been shown to promote breast cancer development, adipocyte characteristics involved in this process remain poorly understood. In this study, we demonstrate enrichment of beige/brown adipose markers, contributed from the host as well as tumor cells, in the xenografts from breast cancer cell lines. In addition to uncoupling protein-1 (UCP1) that is exclusively expressed in beige/brown adipocytes, gene expression for classical brown (MYF5, EVA1, and OPLAH) as well as beige (CD137/TNFRSF9 and TBX1) adipocyte markers was also elevated in the xenografts. Enrichment of beige/brown characteristics in the xenografts was independent of the site of implantation of the breast tumor cells. Early stages of xenografts showed an expansion of a subset of mammary cancer stem cells that expressed PRDM16, a master regulator of brown adipocyte differentiation. Depletion of UCP1(+) or Myf5(+) cells significantly reduced tumor development. There was increased COX2 (MT-CO2) expression, which is known to stimulate formation of beige adipocytes in early xenografts and treatment with a COX2 inhibitor (SC236) reduced tumor growth. In contrast, treatment with factors that induce brown adipocyte differentiation in vitro led to larger tumors in vivo. A panel of xenografts derived from established breast tumor cells as well as patient tumor tissues were generated that expressed key brown adipose tissue-related markers and contained cells that morphologically resembled brown adipocytes. IMPLICATIONS This is the first report demonstrating that beige/brown adipocyte characteristics could play an important role in breast tumor development and suggest a potential target for therapeutic drug design.
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Affiliation(s)
- Rajan Singh
- Charles R. Drew University of Medicine and Science, Los Angeles, California. Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California. Jonsson Comprehensive Cancer Center at UCLA, Los Angeles, California
| | - Meher Parveen
- Charles R. Drew University of Medicine and Science, Los Angeles, California
| | - John M Basgen
- Charles R. Drew University of Medicine and Science, Los Angeles, California
| | - Sayeda Fazel
- Charles R. Drew University of Medicine and Science, Los Angeles, California
| | - Meron F Meshesha
- Charles R. Drew University of Medicine and Science, Los Angeles, California
| | | | - Brandis Moore
- Charles R. Drew University of Medicine and Science, Los Angeles, California
| | - Luis Martinez
- Charles R. Drew University of Medicine and Science, Los Angeles, California
| | | | - Laurent Vergnes
- Department of Human Genetics, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Karen Reue
- Department of Human Genetics, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Shehla Pervin
- Charles R. Drew University of Medicine and Science, Los Angeles, California. Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California. Jonsson Comprehensive Cancer Center at UCLA, Los Angeles, California.
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11
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Fazel S. Schizophrenia and Violence: an Overview of Research On Associations, Risk Factors, and Trends over Time. Eur Psychiatry 2015. [DOI: 10.1016/s0924-9338(15)31822-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Senior J, Forsyth K, Walsh E, O'Hara K, Stevenson C, Hayes A, Short V, Webb R, Challis D, Fazel S, Burns A, Shaw J. Health and social care services for older male adults in prison: the identification of current service provision and piloting of an assessment and care planning model. Health Services and Delivery Research 2013. [DOI: 10.3310/hsdr01050] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
AbstractBackgroundOlder prisoners are the fastest growing subgroup in the English and Welsh prison estate. Existing research highlights that older prisoners have high health and social care needs and that, currently, these needs routinely remain unmet.Objectives(1) To explore the needs of men entering and leaving prison; (2) to describe current provision of services, including integration between health and social care services; and (3) to develop and pilot an intervention for identifying health and social care needs on reception into prison, ensuring that these are systematically addressed during custody.MethodsThe research programme was a mixed-methods study comprising four parts: (1) a study of all prisons in England and Wales housing older adult men, establishing current availability and degree of integration between health and social care services through a national survey and qualitative interviews; (2) establishing the health and social care needs of older men entering prison, including experiences of reception into custody, through structured (n = 100) and semistructured (n = 27) interviews; (3) the development and implementation of an intervention to identify and manage the health, social care and custodial needs of older men entering prison; and (4) exploration of the health and social care needs of older men released from prison into the community through qualitative interviews with older prisoners prior to and following discharge from prison. Descriptive statistics were produced for all quantitative data, and qualitative data were analysed using the constant comparison method.ResultsThe number of older prisoner leads has increased in recent years but they do not all appear always to be active in their roles, nor in receipt of specialist training. Nearly half (44%) of establishments do not have an older prisoner policy. There is a lack of integration between health and social care services because of ambiguity regarding responsibility for older prisoners' social care. The responsible social service may be located a considerable distance from where the prisoner is held; in such instances, local social services do not co-ordinate their care. The most frequent unmet need on prison entry was the provision of information about care and treatment. Release planning for older prisoners was frequently non-existent.LimitationsThe study used a cut-off age of 60 years as the lower limit for the definition of an older prisoner; evidence has emerged that supports a redefinition of that cut-off to 50 years. Our study examined the care provided for men and this should be considered if contemplating using the Older prisoner Health and Social Care Assessment and Plan (OHSCAP) with older women in prison.ConclusionThe OHSCAP, developed as part of this study, provided a feasible and acceptable means of identifying and systematically addressing older prisoners' health and social care needs. Future work will include the conduct of a randomised controlled trial to examine the impact of the OHSCAP in terms of improving a range of outcomes, including economic impact.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- J Senior
- Institute of Brain Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - K Forsyth
- Institute of Brain Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - E Walsh
- School of Health Care, University of Leeds, Leeds, UK
| | - K O'Hara
- Institute of Brain Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - C Stevenson
- Institute of Brain Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - A Hayes
- Institute of Brain Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - V Short
- Institute of Brain Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - R Webb
- Institute of Brain Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - D Challis
- Personal Social Services Research Unit, University of Manchester, Manchester, UK
| | - S Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - A Burns
- Institute of Brain Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - J Shaw
- Institute of Brain Behaviour and Mental Health, University of Manchester, Manchester, UK
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Cheng L, Qureshi A, Fazel S, Lankathilake P, Turner B, Ali E, Qureshi R, Ezsias A, Hutchison I, Bridle C, Jones J. Medical treatment of bisphosphonate-related osteonecrosis of the jaws (BRONJ) and fast track referral system. Br J Oral Maxillofac Surg 2011. [DOI: 10.1016/j.bjoms.2011.03.051] [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] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Fitzpatrick R, Chambers J, Burns T, Doll H, Fazel S, Jenkinson C, Kaur A, Knapp M, Sutton L, Yiend J. A systematic review of outcome measures used in forensic mental health research with consensus panel opinion. Health Technol Assess 2010; 14:1-94. [DOI: 10.3310/hta14180] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- R Fitzpatrick
- Department of Public Health, University of Oxford, Oxford, UK
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Fazel S, Angoulvant D, Butany J, Weisel R, Li RK. D011 Mesenchymal stem cells engineered to overexpress stem cell factor improve cardiac function but have malignant potential. Arch Cardiovasc Dis 2009. [DOI: 10.1016/s1875-2136(09)72221-1] [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: 11/16/2022]
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Fazel S, Langstrom, N. Increased risk of sexual offending in men with psychotic disorders. Evidence-Based Mental Health 2008; 11:95. [DOI: 10.1136/ebmh.11.3.95] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
As the number of elderly prisoners increases in the UK and other Western countries, there will be individuals who develop dementia whilst in custody. We present two case vignettes of men with dementia in English prisons, and explore some of the ethical implications that their continuing detention raises. We find little to support their detention in the various purposes of prison put forward by legal philosophers and penologists, and conclude by raising some of the possible implications of The Human Rights Act 1998.
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Affiliation(s)
- S Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK.
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Abstract
BACKGROUND Psychiatric disorders are purported to play a role in the aetiology of violent crime, but evidence for their role in sexual offending is less clear. The authors investigated the prevalence of psychiatric morbidity and personality disorders in elderly incarcerated sex offenders compared with elderly non-sex offenders. METHOD One hundred and one sex offenders and 102 non-sex offenders aged over 59 years wereinterviewed using standardized semi-structured interviews for psychiatric illness (the Geriatric Mental State) and the personality disorder (Structured Clinical Interview for DSM-IV personality disorders). Data on demographic, offence and victim characteristics were collected. RESULTS Six per cent of the elderly sex offenders had a psychotic illness, 7% a DSM-IV major depressive episode and 33% a personality disorder; and 1% had dementia. These prevalence figures were not different from the elderly non-sex offenders interviewed in this study. Differences emerged at the level of personality traits with sex offenders having more schizoid, obsessive-compulsive, and avoidant traits, and fewer antisocial traits compared with non-sex offenders. CONCLUSIONS Elderly sex offenders and non-sex-offenders have similar prevalence rates of mental illness. However, elderly sex offenders have increased schizoid, obsessive-compulsive, and avoidant personality traits, supporting the view that sex offending in the elderly is associated more with personality factors than mental illness or organic brain disease.
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Affiliation(s)
- S Fazel
- University of Oxford Department of Psychiatry, Warneford Hospital
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Abstract
BACKGROUND The number of elderly prisoners has increased significantly in Western countries over the past decade. Little is known about the psychiatric morbidity of this population. AIMS To determine the prevalence of psychiatric morbidity in elderly sentenced prisoners. METHOD A stratified sample of 203 male sentenced prisoners aged over 59 years, from 15 prisons in England and Wales, representing one in five men in this age group, was interviewed using semistructured standardised instruments for psychiatric illness and personality disorder. RESULTS More than half of the elderly prisoners had a psychiatric diagnosis. The most common diagnoses were personality disorder and depressive illness. CONCLUSIONS The prevalence of depressive illness was five times greater than that found in other studies of younger adult prisoners and elderly people in the community. Underdetected, undertreated depressive illness in elderly prisoners is an increasing public health problem.
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Affiliation(s)
- S Fazel
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
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Fazel S, Hope T, O'Donnell I, Piper M, Jacoby R. Health of elderly male prisoners: worse than the general population, worse than younger prisoners. Age Ageing 2001; 30:403-7. [PMID: 11709379 DOI: 10.1093/ageing/30.5.403] [Citation(s) in RCA: 122] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Assessment of the health of men aged 60 and over in English and Welsh prisons. METHODS 203 men were interviewed from 15 prisons, comprising one-fifth of all sentenced men in this age group in England and Wales. Assessment included semi-structured interviews covering chronic and acute health problems, and recording of major illnesses from the medical notes and prison reception health screen. RESULTS 85% of the elderly prisoners had one or more major illnesses reported in their medical records, and 83% reported at least one chronic illness on interview. The most common illnesses were psychiatric, cardiovascular, musculoskeletal and respiratory. CONCLUSION The rates of illness in elderly prisoners are higher than those reported in other studies of younger prisoners and surveys of the general population of a similar age. The increasing number of elderly people in prison poses specific health challenges for prison health-care services.
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Affiliation(s)
- S Fazel
- University of Oxford Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, UK.
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Abstract
BACKGROUND Several studies have reported the incidence, morbidity, and mortality of general surgical conditions (GSCs) in orthotopic heart transplant (OHT) patients. The following is the largest reported series of such patients and the first study with sufficient patient numbers to formally evaluate peritransplant variables as risk factors for GSC development. STUDY DESIGN A GSC was defined as a condition for which a general surgeon had been consulted or as a general surgical condition recognized at the time of autopsy. The records of 453 consecutive patients who underwent OHT between 1981 and 1999 were reviewed to identify patients who developed a GSC. Kaplan-Meier actuarial analysis on this cohort, and univariate and multivariate logistic regression models applied to a subpopulation of 324 consecutive OHT patients between 1987 and 1997 were used to determine factors associated with and predictive of GSC after OHT. RESULTS Of 453 OHT patients, 371 (81.9%) were men, and the average age was 44.5 +/- 15 (standard deviation) years. Median followup was 2,086 days (range 1 to 6,642 days). Ninety-three patients (20.5%) developed 111 GSCs. Of these, 78 were men, and the average age was 49.9+/-10.2 years. There were 83 general surgical interventions. Actuarial analyses revealed that age greater than 50 years, pretransplant diagnosis of ischemic (PTDxI) versus nonischemic heart disease, and previous general surgical history were factors associated (p < 0.05) with a higher GSC incidence. Gender, more urgent transplant priority status, cardiopulmonary bypass time, total graft ischemic time, and intensive care unit length of stay were not associated with GSC. Factors associated with GSC on univariate analysis, with odds ratios (ORs) and 95% confidence intervals (CIs) included: age analyzed as a continuous variable (OR 1.04 per year; CI 1.01, 1.06 per year; p = 0.0021), PTDxI (OR 2.40; CI 1.39, 4.15; p = 0.0016), and pretransplant general surgical history (OR 3.35; CI 1.65, 6.82; p = 0.0008). Multivariate analysis revealed that only pretransplant general surgical history (OR 3.27; CI 1.58, 6.76; p = 0.0004) and PTDxI (OR 2.37; CI 1.35, 4.16; p = 0.0023) were associated with subsequent development of GSC. CONCLUSIONS A pretransplant diagnosis of ischemic heart disease and previous history of a general surgical procedure are two independent risk factors that predispose OHT patients to development of GSC. Because GSC may arise insidiously in immunosuppressed patients, identification of OHT patients at higher risk for GSC will permit timely intervention decisions, decreasing morbidity and mortality in this challenging group of patients.
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Affiliation(s)
- S Fazel
- London Health Sciences Centre, Ontario, Canada
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22
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Fazel S, McMillan J. Commentary: a climate of secrecy undermines public trust. BMJ 2001; 322:1239-40. [PMID: 11398785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Affiliation(s)
- S Fazel
- Section of Old Age Psychiatry, University of Oxford, Warneford Hospital, Oxford.
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Phillips-Quagliata JM, Patel S, Han JK, Arakelov S, Rao TD, Shulman MJ, Fazel S, Corley RB, Everett M, Klein MH, Underdown BJ, Corthésy B. The IgA/IgM receptor expressed on a murine B cell lymphoma is poly-Ig receptor. J Immunol 2000; 165:2544-55. [PMID: 10946281 DOI: 10.4049/jimmunol.165.5.2544] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
T560, a mouse B lymphoma that originated in gut-associated lymphoid tissue, expresses receptors that bind dimeric IgA and IgM in a mutually inhibitory manner but have little affinity for monomeric IgA. Evidence presented in this paper indicates that the receptor is poly-Ig receptor (pIgR) known in humans and domestic cattle to bind both IgA and IgM. The evidence includes the demonstration that binding of IgM is J chain dependent, and that pIg-precipitated receptor has an appropriate Mr of 116-120 kDa and can be detected on immunoblots with specific rabbit anti-mouse pIgR. Overlapping RT-PCR performed using template mRNA from T560 cells and oligonucleotide primer pairs designed from the published sequence of mouse liver pIgR indicate that T560 cells express mRNA virtually identical with that of the epithelial cell pIgR throughout its external, transmembrane, and intracytoplasmic coding regions. Studies using mutant IgAs suggest that the Calpha2 domain of dimeric IgA is not involved in high-affinity binding to the T560 pIgR. Inasmuch as this mouse B cell pIgR binds IgM better than IgA, it is similar to human pIgR and differs from rat, mouse, and rabbit epithelial cell pIgRs that bind IgA but not IgM. Possible explanations for this difference are discussed. All clones of T560 contain some cells that spontaneously secrete both IgG2a and IgA, but all of the IgA recoverable from the medium and from cell lysates is monomeric; it cannot be converted to secretory IgA by T560 cells.
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MESH Headings
- Amino Acid Sequence
- Animals
- Base Sequence
- Binding Sites, Antibody
- Binding, Competitive/immunology
- Carbohydrate Metabolism
- Carbohydrates/immunology
- Chemical Precipitation
- Cross Reactions
- Enzyme Activation/immunology
- Epitopes, B-Lymphocyte/metabolism
- Epitopes, T-Lymphocyte/metabolism
- Humans
- Immunoblotting
- Immunoglobulin A/metabolism
- Immunoglobulin A, Secretory/metabolism
- Immunoglobulin J-Chains/physiology
- Immunoglobulin M/metabolism
- Lymphoma, B-Cell/immunology
- Lymphoma, B-Cell/metabolism
- Mice
- Mice, Inbred BALB C
- Molecular Sequence Data
- Molecular Weight
- Phosphatidylinositol Diacylglycerol-Lyase
- Protein Kinase C/metabolism
- RNA, Messenger/biosynthesis
- Rats
- Receptors, Fc/biosynthesis
- Receptors, Fc/isolation & purification
- Receptors, Polymeric Immunoglobulin/biosynthesis
- Receptors, Polymeric Immunoglobulin/genetics
- Receptors, Polymeric Immunoglobulin/isolation & purification
- Tumor Cells, Cultured
- Type C Phospholipases/metabolism
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Affiliation(s)
- J M Phillips-Quagliata
- Department of Pathology, New York University School of Medicine and Kaplan Cancer Center, New York, NY 10016, USA.
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Abstract
OBJECTIVE This study examines the influence of cognitive impairment, premorbid intelligence, and decision-making capacity to complete advance directives on the treatment preferences for life-sustaining medical therapy in the elderly. METHOD One hundred elderly individuals were recruited. Fifty were first referrals to specialist services with a DSM-IV diagnosis of dementia, and 50 were volunteers. Each person was asked about treatment preferences in three clinical vignettes. RESULTS Elderly individuals who had cognitive impairment and were incapable of completing advance directives were significantly more likely to opt for life-sustaining interventions. There was no association between premorbid intelligence and treatment preferences. CONCLUSIONS Cognitive impairment appears to influence treatment preferences for life-sustaining medical therapy. With increasing cognitive impairment, elderly individuals tend to opt for treatment interventions.
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Affiliation(s)
- S Fazel
- Section of Old Age Psychiatry, Department of Psychiatry, University of Oxford, Warneford Hospital, UK.
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Fazel S, Harwood D. CAMCOG detected dementia and cognitive impairment in Parkinson's disease. Evidence-Based Mental Health 1999. [DOI: 10.1136/ebmh.2.3.90] [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: 11/04/2022]
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Abstract
At referral, a fifth of patients with dementia were competent to complete advance directives. Competence was significantly related to higher premorbid IQ estimated by the National Adult Reading Test.
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Abstract
OBJECTIVE To develop a patient centred approach for the assessment of competence to complete advance directives ("living wills") of elderly people with cognitive impairment. DESIGN Semistructured interviews. SETTING Oxfordshire. SUBJECTS 50 elderly volunteers living in the community, and 50 patients with dementia on first referral from primary care. MAIN OUTCOME MEASURES Psychometric properties of competence assessment. RESULTS This patient centred approach for assessing competence to complete advance directives can discriminate between elderly persons living in the community and elderly patients with dementia. The procedure has good interrater (r=0.95) and test-retest (r=0.97) reliability. Validity was examined by relating this approach with a global assessment of competence to complete an advance directive made by two of us (both specialising in old age psychiatry). The data were also used to determine the best threshold score for discriminating between those competent and those incompetent to complete an advance directive. CONCLUSION A patient centred approach to assess competence to complete advance directives can be reliably and validly used in routine clinical practice.
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Affiliation(s)
- S Fazel
- Section of Old Age Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX.
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30
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Wiersma EJ, Collins C, Fazel S, Shulman MJ. Structural and functional analysis of J chain-deficient IgM. J Immunol 1998; 160:5979-89. [PMID: 9637512] [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: 02/07/2023]
Abstract
Previous studies have discerned two forms of polymeric mouse IgM: moderately cytolytic (complement-activating) pentamer, which contains J chain, and highly cytolytic hexamer, which lacks J chain. To investigate the relationships among polymeric structure, J chain content, and cytolytic activity, we produced IgM in J chain-deficient and J chain-proficient mouse hybridoma cell lines. Both hexamer and pentamer were produced in the absence as well as the presence of J chain. Hexameric IgM activated (guinea pig) complement approximately 100-fold more efficiently than did J chain-deficient pentamer, which, in turn, was more active than J chain-containing pentamer. These results are consistent with the hypothesis that J chain-containing pentamer cannot activate complement. We also analyzed the structure of IgM-S337, in which the mu-chain bears the C337S substitution. Like normal IgM, IgM-S337 was formed as a hexamer and as both J chain deficient- and J chain-containing pentamers. Unlike normal IgM, IgM-S337 dissociated in SDS into various subunits. For IgM-S337 pentamer, the predominant subunits migrated as mu2kappa2 and mu4kappa4, and the subunit distribution was unaltered by J chain. However, J chain was found only in the mu2kappa2 species, suggesting that some arrangement of inter-mu bonds directs incorporation of J chain. IgM-S337 hexamer also dissociated to mu2kappa2 and mu4kappa4, but also yielded several species migrating much more slowly in SDS-PAGE than wild-type mu12kappa12. To account for these forms, we propose that each mu-chain can interact with three other mu-chains and that some hexameric molecules contain two catenated mu6kappa6 circles.
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Affiliation(s)
- E J Wiersma
- Department of Immunology, University of Toronto, Ontario, Canada
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Fazel S, Hope T, Jacoby R. Ways of assessing capacity to complete an advance directive should be developed. West J Med 1998. [DOI: 10.1136/bmj.316.7140.1321] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Fazel S, Hope T, Jacoby R. Ways of assessing capacity to complete an advance directive should be developed. BMJ 1998; 316:1321-2. [PMID: 9554916 PMCID: PMC1113047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Fazel S, Elphick M. Affective incontinence in a young adult. Postgrad Med J 1998; 74:243-4. [PMID: 9683983 PMCID: PMC2360859 DOI: 10.1136/pgmj.74.870.243] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- S Fazel
- Oxfordshire Mental Healthcare NHS Trust, Banbury, UK
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Abstract
Normal mouse IgM is synthesized as hexamers in the absence of J chain and as pentamers in its presence. Previous work has suggested that polymer size is also closely related to formation of the inter-mu chain disulfide bond mediated by cysteine 414, one of three cysteines involved in inter-mu chain bonding. This correlation in turn suggested that formation of C414-C414 might be required for J chain to influence how IgM assembles and that formation of C414-C414 might affect the J chain/IgM stoichiometry. To test such hypotheses we have used cell lines which either expressed or did not express J chain to produce IgM in which serine was substituted for C414. In contrast to the case of IgM assembled from normal mu chains, IgM-S414 was secreted mostly as pentamers and tetramers but not as hexamers, irrespective of J chain synthesis. These results indicate that the role of J chain as modulator of IgM structure and function requires C414. Moreover, a more detailed analysis of the structure of J-plus and J-minus IgM-S414 revealed that J chain, in fact, influenced the nature of secreted IgM-S414: In the absence of J chain, some IgM-S414 was secreted as dimers and trimers, while in the presence of J chain, some IgM was secreted as non-covalently assembled pentamers. These results imply that disulfide bonding can occur differently from the pattern depicted in conventional models of IgM structure.
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Affiliation(s)
- S Fazel
- Department of Immunology, University of Toronto, Ontario, Canada
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