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Bai W, Liu ZH, Jiang YY, Zhang QE, Rao WW, Cheung T, Hall BJ, Xiang YT. Worldwide prevalence of suicidal ideation and suicide plan among people with schizophrenia: a meta-analysis and systematic review of epidemiological surveys. Transl Psychiatry 2021; 11:552. [PMID: 34716297 PMCID: PMC8556328 DOI: 10.1038/s41398-021-01671-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [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: 02/08/2021] [Revised: 09/19/2021] [Accepted: 09/30/2021] [Indexed: 12/18/2022] Open
Abstract
Schizophrenia is a severe psychiatric disorder with high premature mortality rates. This is a meta-analysis and systematic review of the prevalence of suicidal ideation (SI) and suicide plan (SP) among people with schizophrenia. PubMed, Web of Science, Embase, and PsycINFO were systematically searched from their respective inception to October 10, 2020. Data on prevalence of SI and/or SP were synthesized using the random effects model. Twenty-six studies covering 5079 people with schizophrenia were included for meta-analysis. The lifetime and point prevalence of SI were 34.5% (95% CI: 28.2-40.9%), and 29.9% (95% CI: 24.2-35.6%), respectively. The lifetime prevalence of SP was 44.3% and the point prevalence of SP ranged between 6.4 and 13%. Subgroup and meta-regression analyses revealed that source of patients, survey countries, and sample size were significantly associated with the point prevalence of SI, while male proportion and quality assessment scores were significantly associated with the lifetime and point prevalence of SI. Survey time and mean age were significantly associated with lifetime prevalence of SI. Both SI and SP are common in people living with schizophrenia, especially in males and inpatients. Routine screening and effective interventions for SI and SP should be implemented in this population.
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Affiliation(s)
- W Bai
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China
- Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China
- Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao SAR, China
| | - Z H Liu
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China
- Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China
- Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao SAR, China
| | - Y Y Jiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China
- Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China
- Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao SAR, China
| | - Q E Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
| | - W W Rao
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China
- Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China
- Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao SAR, China
| | - T Cheung
- School of Nursing, Hong Kong Polytechnic University, Hong Kong SAR, China
| | - B J Hall
- New York University (Shanghai), Shanghai, China
- Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Y T Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China
- Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China
- Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao SAR, China
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Wang F, Wang S, Zong QQ, Zhang Q, Ng CH, Ungvari GS, Xiang YT. Prevalence of comorbid major depressive disorder in Type 2 diabetes: a meta-analysis of comparative and epidemiological studies. Diabet Med 2019; 36:961-969. [PMID: 31127631 DOI: 10.1111/dme.14042] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2019] [Indexed: 01/14/2023]
Abstract
AIMS To examine the average point prevalence of major depressive disorder in people with Type 2 diabetes and its associated factors in a comprehensive meta-analysis. METHODS Two researchers independently conducted a systematic literature search of PubMed, EMBASE, PsycINFO and Cochrane databases. Studies reporting the prevalence of major depressive disorder in people with Type 2 diabetes were identified and analysed using a random-effects model. RESULTS A total of 26 studies meeting the inclusion criteria were included in the study. The point prevalence of major depressive disorder was 14.5% (95% CI 7.9-25.3; I²=99.65). People with Type 2 diabetes were more likely to have major depressive disorder compared with the general population (odds ratio 1.73, 95% CI 1.38-2.16). Subgroup and meta-regression analyses showed that study site, study type, diagnostic criteria and age significantly moderated the prevalence of major depressive disorder. CONCLUSIONS In this meta-analysis, the average point prevalence of major depressive disorder in people with Type 2 diabetes was high. Routine screening and more effective interventions should be implemented for this population.
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Affiliation(s)
- F Wang
- Guangdong Provincial People's Hospital, Guangdong Province
| | - S Wang
- Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Q-Q Zong
- School of Nursing, Capital Medical University, Beijing
- National Clinical Research Centre for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital and Advanced Innovation Centre for Human Brain Protection, Capital Medical University, Beijing
| | - Q Zhang
- National Clinical Research Centre for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital and Advanced Innovation Centre for Human Brain Protection, Capital Medical University, Beijing
| | - C H Ng
- Department of Psychiatry, University of Melbourne, Melbourne, VIC
| | - G S Ungvari
- University of Notre Dame Australia, Fremantle, WA
- Division of Psychiatry, School of Medicine, University of Western Australia, Perth, WA, Australia
| | - Y-T Xiang
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China
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Zheng W, Zhang QE, Cai DB, Yang XH, Qiu Y, Ungvari GS, Ng CH, Berk M, Ning YP, Xiang YT. N-acetylcysteine for major mental disorders: a systematic review and meta-analysis of randomized controlled trials. Acta Psychiatr Scand 2018; 137:391-400. [PMID: 29457216 DOI: 10.1111/acps.12862] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/25/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE This systematic review and meta-analysis of randomized controlled trials (RCTs) examined the efficacy and safety of adjunctive N-acetylcysteine (NAC), an antioxidant drug, in treating major depressive disorder (MDD), bipolar disorder, and schizophrenia. METHODS The PubMed, Cochrane Library, PsycINFO, CNKI, CBM, and WanFang databases were independently searched and screened by two researchers. Standardized mean differences (SMDs), risk ratios, and their 95% confidence intervals (CIs) were computed. RESULTS Six RCTs (n = 701) of NAC for schizophrenia (three RCTs, n = 307), bipolar disorder (two RCTs, n = 125), and MDD (one RCT, n = 269) were identified and analyzed as separate groups. Adjunctive NAC significantly improved total psychopathology (SMD = -0.74, 95% CI: -1.43, -0.06; I2 = 84%, P = 0.03) in schizophrenia, but it had no significant effect on depressive and manic symptoms as assessed by the Young Mania Rating Scale in bipolar disorder and only a small effect on major depressive symptoms. Adverse drug reactions to NAC and discontinuation rates between the NAC and control groups were similar across the three disorders. CONCLUSIONS Adjunctive NAC appears to be a safe treatment that has efficacy for schizophrenia, but not for bipolar disorder or MDD. Further higher quality RCTs are warranted to determine the role of adjunctive NAC in the treatment of major psychiatric disorders.
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Affiliation(s)
- W Zheng
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Q-E Zhang
- The National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - D-B Cai
- Clinics of Chinese Medicine, the First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - X-H Yang
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Y Qiu
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - G S Ungvari
- The University of Notre Dame Australia/Graylands Hospital, Perth, WA, Australia
| | - C H Ng
- Department of Psychiatry, University of Melbourne, Melbourne, Vic., Australia
| | - M Berk
- School of Medicine, IMPACT Strategic Research Centre, Barwon Health, Deakin University, Geelong, Vic., Australia.,Orygen, The Centre of Excellence in Youth Mental Health, Department of Psychiatry and the Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Vic., Australia
| | - Y-P Ning
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Y-T Xiang
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
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Zheng W, Li XH, Yang XH, Cai DB, Ungvari GS, Ng CH, Wang SB, Wang YY, Ning YP, Xiang YT. Adjunctive memantine for schizophrenia: a meta-analysis of randomized, double-blind, placebo-controlled trials. Psychol Med 2018; 48:72-81. [PMID: 28528597 DOI: 10.1017/s0033291717001271] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Dysfunction of N-methyl-D-aspartate receptor (NMDAR) is involved in the pathophysiology of schizophrenia. A meta-analysis of randomized controlled trials (RCTs) was conducted to examine the efficacy and safety of memantine, a non-competitive NMDAR antagonist, in the treatment of schizophrenia. METHODS Standardized/weighted mean differences (SMDs/WMDs), risk ratio (RR), and their 95% confidence intervals (CIs) were calculated and analyzed. RESULTS Included in the meta-analysis were eight RCTs (n = 452) of 11.5 ± 2.6 weeks duration, with 229 patients on memantine (20 mg/day) and 223 patients on placebo. Adjunctive memantine outperformed placebo in the measures of Positive and Negative Syndrome Scale and Brief Psychiatric Rating Scale negative symptoms [SMD: -0.63 (95% CI -1.10 to -0.16), p = 0.009, I 2 = 77%], but not in the total, positive and general symptoms [SMD: -0.46 to -0.08 (95% CI -0.93 to 0.22), p = 0.06-0.60, I 2 = 0-74%] or the Clinical Global Impression Severity Scale [WMD: 0.04 (95% CI -0.24 to 0.32), p = 0.78]. The negative symptoms remained significant after excluding one outlying RCT [SMD: -0.41 (95% CI -0.72 to -0.11), p = 0.008, I 2 = 47%]. Compared with the placebo group, adjunctive memantine was associated with significant improvement in neurocognitive function using the Mini-Mental State Examination (MMSE) [WMD: 3.09, (95% CI 1.77-4.42), p < 0.00001, I 2 = 22%]. There was no significant difference in the discontinuation rate [RR: 1.34 (95% CI 0.76-2.37), p = 0.31, I 2 = 0%] and adverse drug reactions between the two groups. CONCLUSIONS This meta-analysis showed that adjunctive memantine appears to be an efficacious and safe treatment for improving negative symptoms and neurocognitive performance in schizophrenia. Higher quality RCTs with larger samples are warranted to confirm these findings.
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Affiliation(s)
- W Zheng
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital),Guangzhou,China
| | - X-H Li
- The National Clinical Research Center for Mental Disorders,China
| | - X-H Yang
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital),Guangzhou,China
| | - D-B Cai
- Clinics of Chinese Medicine,the First Clinical Medical College of Guangzhou University of Chinese Medicine,Guangzhou,China
| | - G S Ungvari
- The University of Notre Dame Australia/Marian Centre,Perth,Australia
| | - C H Ng
- Department of Psychiatry,University of Melbourne,Melbourne,Victoria,Australia
| | - S-B Wang
- Faculty of Health Sciences,Unit of Psychiatry,University of Macau,Macao SAR,China
| | - Y-Y Wang
- Faculty of Health Sciences,Unit of Psychiatry,University of Macau,Macao SAR,China
| | - Y-P Ning
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital),Guangzhou,China
| | - Y-T Xiang
- Faculty of Health Sciences,Unit of Psychiatry,University of Macau,Macao SAR,China
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Zheng W, Xiang YT, Xiang YQ, Li XB, Ungvari GS, Chiu HFK, Correll CU. Efficacy and safety of adjunctive topiramate for schizophrenia: a meta-analysis of randomized controlled trials. Acta Psychiatr Scand 2016; 134:385-398. [PMID: 27585549 DOI: 10.1111/acps.12631] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/28/2016] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To systematically examine the randomized controlled trial (RCT) evidence regarding efficacy and tolerability of topiramate cotreatment with antipsychotics in schizophrenia-spectrum disorders. METHODS Random-effects meta-analysis of RCTs of topiramate cotreatment with antipsychotics vs. placebo/ongoing antipsychotic treatment in schizophrenia-spectrum disorders. Standardized or weighted mean difference (SMD/WMD), risk ratio (RR) ±95% confidence intervals (CIs), and number needed to harm (NNH) were calculated. RESULTS Across 16 RCTs (n = 934, duration = 11.8 ± 5.6 weeks), topiramate outperformed the comparator regarding change/endpoint of total (SMD: -0.58, 95% CI: -0.82, -0.35, P < 0.00001), positive (SMD: -0.37, 95% CI: -0.61, -0.14, P = 0.002), negative (SMD: -0.58, 95% CI: -0.87, -0.29, P < 0.0001), and general symptoms (SMD: -0.68, 95% CI: -0.95, -0.40, P < 0.00001). Furthermore, topiramate was superior regarding body weight (WMD: -2.75 kg, 95% CI: -4.03, -1.47, P < 0.0001), body mass index (BMI) (WMD: -1.77, 95% CI: -2.38, -1.15, P < 0.00001), triglycerides (P = 0.006), and insulin levels (P < 0.00001). Superiority regarding psychopathology and body weight/BMI was consistent across Chinese/Asian and Western RCTs, double-blind and open designs, clozapine and non-clozapine cotreatment, augmentation and co-initiation RCTs, and higher and lower quality RCTs. In meta-regression analyses, topiramate's efficacy for total symptoms was moderated by shorter illness duration (P = 0.047), while weight loss was greater in prevention/co-initiation vs. intervention/augmentation RCTs (-4.11 kg, 95% CI: -6.70, -1.52 vs. -1.41 kg, 95% CI: -2.23, -0.59, P < 0.001). All-cause discontinuation was similar between topiramate and comparators (RR: 1.28, 95% CI: 0.91, 1.81, P = 0.16). While topiramate led to more concentration/attention difficulties (P = 0.03, NNH = 8, 95% CI=4-25), psychomotor slowing (P = 0.02, NNH = 7, 95% CI = 4-25), and paresthesia (P = 0.05, NNH = 2, 95% CI = 4-33), it led to less ≥7% weight gain (P = 0.0001, NNH = 2, 95% CI = 2-3) and constipation (P = 0.04, NNH = 9, 95% CI = 5-100) than the comparator. CONCLUSIONS These results indicate that adjunctive topiramate to antipsychotics is an effective and safe treatment choice for symptomatic improvement and weight reduction in patients with schizophrenia-spectrum disorders.
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Affiliation(s)
- W Zheng
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.
| | - Y-T Xiang
- The National Clinical Research Center for Mental Disorders, China & Beijing Anding Hospital, Capital Medical University, Beijing, China. .,Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao, China.
| | - Y-Q Xiang
- Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - X-B Li
- Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - G S Ungvari
- The University of Notre Dame Australia/Marian Centre, Perth, WA, Australia.,School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth, WA, Australia
| | - H F K Chiu
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China
| | - C U Correll
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA.,Hofstra Northwell School of Medicine, Hempstead, NY, USA
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Zheng W, Zhang YF, Zhong HQ, Mai SM, Yang XH, Xiang YT. Wuling Capsule for Major Depressive Disorder: A Meta-analysis of Randomised Controlled Trials. East Asian Arch Psychiatry 2016; 26:87-97. [PMID: 27703096] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION In China, Wuling capsule, a traditional Chinese medicine consisting of Wuling mycelia of Xylaria nigripes (Kl.) Sacc (a rare type of fungus), is used to treat major depressive disorders. A meta-analysis of randomised controlled trials was performed to compare the efficacy and safety of Wuling capsule alone with Wuling capsule-antidepressant combination in the treatment of major depressive disorders. METHODS Two assessors independently selected studies, extracted data, and conducted quality assessment and data synthesis. Standard mean difference, risk ratio (RR) ± 95% confidence interval (CI), the number needed to treat, and the number needed to harm were analysed. RESULTS A total of 12 randomised controlled trials (880 patients; mean age ± standard deviation, 39.7 ± 12.5 years; male patients, 41%) were identified, including 4 trials with Wuling capsule alone (n = 340) and 8 with Wuling capsule-antidepressant (sertraline, mianserin, mirtazapine, and paroxetine) combination (n = 540). The mean length of trial was 5.7 ± 1.3 weeks. Meta-analysis of symptomatic improvement at last-observation endpoint and study-defined response and remission revealed no significant differences between the Wuling capsule alone and antidepressant monotherapy. The Wuling capsule-antidepressant cotreatment was superior to antidepressant monotherapy in symptomatic improvement at last-observation endpoint (standard mean difference: -0.46, p = 0.001) as well as study-defined response (68.4% vs. 56.0%, RR = 1.23; p = 0.03) and remission (46.5% vs. 34.5%, RR = 1.35; p = 0.05). Wuling capsule was associated with fewer adverse drug reactions than antidepressant monotherapy. CONCLUSIONS Adjunctive Wuling capsule may augment the effects of antidepressants and may be associated with fewer adverse drug reactions. More large-scale and rigorously designed randomised controlled trials with large sample size are warranted to clarify the effectiveness of Wuling capsule for major depressive disorders.
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Affiliation(s)
- W Zheng
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, PR China
| | - Y F Zhang
- The National Clinical Research Center for Mental Disorders, Beijing, China & Center of Depression, Beijing Institute for Brain Disorders, PR China; Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, PR China
| | - H Q Zhong
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, PR China
| | - S M Mai
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, PR China
| | - X H Yang
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, PR China
| | - Y T Xiang
- Unit of Psychiatry, Faculty of Health Sciences, University of Macao, Macao SAR, PR China
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Zheng W, Xiang YQ, Ng CH, Ungvari GS, Chiu HFK, Xiang YT. Extract of Ginkgo biloba for Tardive Dyskinesia: Meta-analysis of Randomized Controlled Trials. Pharmacopsychiatry 2016; 49:107-11. [PMID: 26979525 DOI: 10.1055/s-0042-102884] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Free radicals may be involved in the pathogenesis of tardive dyskinesia (TD). We conducted this meta-analysis to systematically examine the efficacy of extract of Ginkgo biloba (EGb), a potent antioxidant possessing free radical-scavenging properties, as a treatment for TD in schizophrenia using randomized controlled trial (RCT) data. METHOD Drawn from English and Chinese databases, 3 RCTs of EGb augmentation of antipsychotics (APs) vs. AP plus placebo or AP monotherapy were identified. 2 evaluators extracted data. The primary outcome measure was the severity of TD symptoms assessed by the Abnormal Involuntary Movement Scale (AIMS). Weighted mean difference (WMD) and risk ratio (RR) ±95% confidence intervals (CI) were calculated. Statistical analyses were performed using Review Manager (version 5.1.7.0) and STATA (version 12.0). RESULTS The 3 RCTs (n=299) from China, of 12 weeks duration, involved schizophrenia patients with TD of 55.9±13.4 years old. EGb (240 mg/day) outperformed the control group in reducing the severity of TD and clinical symptoms as measured by the AIMS (trials=3, n=299, WMD: -2.30 (95%CI: - 3.04, -1.55), P<0.00001) and the adverse drug reactions as assessed by the Treatment Emergent Symptom Scale (TESS) (trials=2, n=142, WMD: -2.38 (95%CI: -4.01, -0.74), P=0.004). Both the Positive and Negative Syndrome Scale (PANSS) total score (trials=2, n=239, P=0.87) and all-cause discontinuation (trials=3, n=299, P=0.21) were similar between the EGb and control group. CONCLUSION This meta-analysis suggests that adjunctive EGb appeared to be an effective and safe option for improving TD in the treatment of schizophrenia patients. However, better RCTs are needed to demonstrate its efficacy and safety especially on cognitive function in TD. TRIAL REGISTRATION PROSPERO CRD42015024930.
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Affiliation(s)
- W Zheng
- Guangzhou Brain Hospital (Guangzhou Huiai Hospital), Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Y-Q Xiang
- National Clinical Research Center for Mental Disorders, Beijing, China & Center of Depression, Beijing Institute for Brain Disorders, China
| | - C H Ng
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - G S Ungvari
- School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth, Australia
| | - H F K Chiu
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Y-T Xiang
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macau SAR, China
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Chee KY, Tripathi A, Avasthi A, Chong MY, Xiang YT, Sim K, Kanba S, He YL, Lee MS, Chiu HFK, Yang SY, Kuga H, Udomratn P, Tanra AJ, Maramis MM, Grover S, Mahendran R, Kallivayalil RA, Shen WW, Shinfuku N, Tan CH, Sartorius N. Prescribing Pattern of Antidepressants in Children and Adolescents: Findings from the Research on Asia Psychotropic Prescription Pattern. East Asian Arch Psychiatry 2016; 26:10-17. [PMID: 27086755] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Pharmacotherapy of depression in children and adolescents is complex. In the absence of research into the efficacy and safety of antidepressants in this group of patients, their off-label prescription is common. This paper aimed to illustrate the prescription pattern of antidepressants in children and adolescents from major psychiatric centres in Asia. METHODS The Research on Asia Psychotropic Prescription Pattern on Antidepressants worked collaboratively in 2013 to study the prescription pattern of antidepressants in Asia using a unified research protocol and questionnaire. Forty psychiatric centres from 10 Asian countries / regions participated and 2321 antidepressant prescriptions were analysed. RESULTS A total of 4.7% antidepressant prescriptions were for children and adolescents. Fluoxetine, sertraline, and escitalopram were the most common antidepressants prescribed for children and adolescents. Almost one-third (30.3%) of prescriptions were for diagnoses other than depressive and anxiety disorders. There was less antidepressant polypharmacy and concomitant use of benzodiazepine, but more concomitant use of antipsychotics in children and adolescents compared with adults. CONCLUSION Off-label use of antidepressants in children and adolescents was reported by 40 Asian psychiatric institutions that participated in the study. In-service education and regulatory mechanisms should be reinforced to ensure efficacy and safety of antidepressants in children and adolescents.
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Affiliation(s)
- K Y Chee
- Department of Psychiatry & Mental Health, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | - A Tripathi
- Department of Psychiatry, King George's Medical University, Chowk, Lucknow, India
| | - A Avasthi
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - M Y Chong
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital-Kaohsiung Medical Center and School of Medicine, Chang Gung University, Taiwan
| | - Y T Xiang
- Faculty of Health Sciences, University of Macao, Macao SAR, PR China
| | - K Sim
- Institute of Mental Health, Buangkok View, Buangkok Green Medical Park, Singapore
| | - S Kanba
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Y L He
- Department of Psychiatric Epidemiology, Shanghai Mental Health Center, Shanghai, PR China
| | - M S Lee
- Department of Psychiatry, College of Medicine, Korea University, Seoul, South Korea
| | - H F K Chiu
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, PR China
| | - S Y Yang
- Department of Pharmacy, Taipei City Hospital, Taipei, Taiwan
| | - H Kuga
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - P Udomratn
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - A J Tanra
- Department of Psychiatry, Faculty of Medicine, Hasanuddin University, Makassar, South Sulawesi, Indonesia
| | - M M Maramis
- Dr Soetomo Hospital-Faculty of Medicine, Airlangga University, Jawa Timur, Indonesia
| | - S Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - R Mahendran
- Department of Psychological Medicine, National University Hospital, Singapore
| | - R A Kallivayalil
- Department of Psychiatry, Pushpagiri Medical College, Thiruvalla, India
| | - W W Shen
- Department of Psychiatry, TMU-Wan Fang Medical Center and School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - N Shinfuku
- Department of Psychiatry, Kobe University, Kobe, Japan
| | - C H Tan
- Department of Pharmacology, National University of Singapore, Singapore
| | - N Sartorius
- Association for the Improvement of Mental Health Programmes, Geneva, Switzerland
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Hu YD, Xiang YT, Fang JX, Zu S, Sha S, Shi H, Ungvari GS, Correll CU, Chiu HFK, Xue Y, Tian TF, Wu AS, Ma X, Wang G. Single i.v. ketamine augmentation of newly initiated escitalopram for major depression: results from a randomized, placebo-controlled 4-week study. Psychol Med 2016; 46:623-635. [PMID: 26478208 DOI: 10.1017/s0033291715002159] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND While oral antidepressants reach efficacy after weeks, single-dose intravenous (i.v.) ketamine has rapid, yet time-limited antidepressant effects. We aimed to determine the efficacy and safety of single-dose i.v. ketamine augmentation of escitalopram in major depressive disorder (MDD). METHOD Thirty outpatients with severe MDD (17-item Hamilton Rating Scale for Depression total score ⩾ 24) were randomized to 4 weeks double-blind treatment with escitalopram 10 mg/day+single-dose i.v. ketamine (0.5 mg/kg over 40 min) or escitalopram 10 mg/day + placebo (0.9% i.v. saline). Depressive symptoms were measured using the Montgomery-Asberg Depression Rating Scale (MADRS) and the Quick Inventory of Depressive Symptomatology - Self-Report (QIDS-SR). Suicidal ideation was evaluated with the QIDS-SR item 12. Adverse psychopathological effects were measured with the Brief Psychiatric Rating Scale (BPRS)-positive symptoms, Young Mania Rating Scale (YMRS) and Clinician Administered Dissociative States Scale (CADSS). Patients were assessed at baseline, 1, 2, 4, 24 and 72 h and 7, 14, 21 and 28 days. Time to response (⩾ 50% MADRS score reduction) was the primary outcome. RESULTS By 4 weeks, more escitalopram + ketamine-treated than escitalopram + placebo-treated patients responded (92.3% v. 57.1%, p = 0.04) and remitted (76.9% v. 14.3%, p = 0.001), with significantly shorter time to response [hazard ratio (HR) 0.04, 95% confidence interval (CI) 0.01-0.22, p < 0.001] and remission (HR 0.11, 95% CI 0.02-0.63, p = 0.01). Compared to escitalopram + placebo, escitalopram + ketamine was associated with significantly lower MADRS scores from 2 h to 2 weeks [(peak = 3 days-2 weeks; effect size (ES) = 1.08-1.18)], QIDS-SR scores from 2 h to 2 weeks (maximum ES = 1.27), and QIDS-SR suicidality from 2 to 72 h (maximum ES = 2.24). Only YMRS scores increased significantly with ketamine augmentation (1 and 2 h), without significant BPRS or CADSS elevation. CONCLUSIONS Single-dose i.v. ketamine augmentation of escitalopram was safe and effective in severe MDD, holding promise for speeding up early oral antidepressant efficacy.
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Affiliation(s)
- Y-D Hu
- China & Beijing Key Laboratory of Mental Disorders,The National Clinical Research Center for Mental Disorders,Beijing Anding Hospital,Capital Medical University,Beijing,China
| | - Y-T Xiang
- Unit of Psychiatry,Faculty of Health Sciences,University of Macau,Macao SAR,China
| | - J-X Fang
- Unit of Psychological Medicine,Beijing Chao-Yang Hospital,Capital Medical University,Beijing,China
| | - S Zu
- Unit of Psychological Medicine,Beijing Chao-Yang Hospital,Capital Medical University,Beijing,China
| | - S Sha
- China & Beijing Key Laboratory of Mental Disorders,The National Clinical Research Center for Mental Disorders,Beijing Anding Hospital,Capital Medical University,Beijing,China
| | - H Shi
- China & Beijing Key Laboratory of Mental Disorders,The National Clinical Research Center for Mental Disorders,Beijing Anding Hospital,Capital Medical University,Beijing,China
| | - G S Ungvari
- The University of Notre Dame Australia/Marian Centre,Perth,Australia
| | - C U Correll
- Division of Psychiatry Research,The Zucker Hillside Hospital,North Shore-Long Island Jewish Health System,Glen Oaks,NY,USA
| | - H F K Chiu
- Department of Psychiatry,Chinese University of Hong Kong,Hong Kong SAR,China
| | - Y Xue
- China & Beijing Key Laboratory of Mental Disorders,The National Clinical Research Center for Mental Disorders,Beijing Anding Hospital,Capital Medical University,Beijing,China
| | - T-F Tian
- China & Beijing Key Laboratory of Mental Disorders,The National Clinical Research Center for Mental Disorders,Beijing Anding Hospital,Capital Medical University,Beijing,China
| | - A-S Wu
- Unit of Psychological Medicine,Beijing Chao-Yang Hospital,Capital Medical University,Beijing,China
| | - X Ma
- China & Beijing Key Laboratory of Mental Disorders,The National Clinical Research Center for Mental Disorders,Beijing Anding Hospital,Capital Medical University,Beijing,China
| | - G Wang
- China & Beijing Key Laboratory of Mental Disorders,The National Clinical Research Center for Mental Disorders,Beijing Anding Hospital,Capital Medical University,Beijing,China
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10
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Zheng W, Tang LR, Correll CU, Ungvari GS, Chiu HFK, Xiang YQ, Xiang YT. Frequency and Correlates of Distant Visual Impairment in Patients with Schizophrenia, Bipolar Disorder, and Major Depressive Disorder. East Asian Arch Psychiatry 2015; 25:115-121. [PMID: 26429838] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Distant visual impairment in the severely mentally ill is under-researched. This study aimed to assess the frequency and correlates of distant visual impairment in a cohort of Chinese psychiatric patients, including its effect on their quality of life. METHODS Adult psychiatric inpatients with schizophrenia, bipolar disorder, and major depressive disorder consecutively admitted to a psychiatric hospital in Beijing, China underwent assessments of psychopathology (Brief Psychiatric Rating Scale, 16-item Quick Inventory of Depressive Symptomatology [Self-Report]), quality of life (12-item Short-Form Medical Outcomes Study [SF-12], 25-item National Eye Institute Visual Function Questionnaire [NEI-VFQ25]), adverse effects (Udvalg for Kliniske Undersøgelser Side Effect Rating Scale), and presenting (as opposed to uncorrected) distant visual acuity (Logarithm of the Minimum Angle of Resolution [LogMAR] chart with patients wearing spectacles, if they owned them). Distant visual impairment was defined as binocular distant visual acuity of a LogMAR score of ≥ 0.5 (< 6/18 Snellen acuity). RESULTS Among 356 patients who met the study criteria, the frequency of distant visual impairment was 12.6% (15.2% with schizophrenia, 11.9% with bipolar disorder, 8.8% with major depressive disorder). In multiple logistic regression analysis, distant visual impairment was significantly associated with ocular disease only (p = 0.002, odds ratio = 3.2, 95% confidence interval = 1.5-6.7). Controlling for the confounding effect of ocular disease, patients with distant visual impairment had a lower quality of life in the general vision domain of the NEI-VFQ25 (F[2, 353] = 9.5, p = 0.002) compared with those without. No differences in the physical and mental domains of the SF-12 and in other domains of the NEI-VFQ25 were noted in these 2 groups. CONCLUSION One-eighth of middle-aged severely mentally ill patients had distant visual impairment. Considering the impact of distant visual impairment on daily functioning, severely mentally ill patients need to be screened for impaired eyesight as part of their comprehensive health assessment.
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Affiliation(s)
- W Zheng
- Guangzhou Brain Hospital (Guangzhou Huiai Hospital), Affiliated Hospital of Guangzhou Medical University, Guangzhou, PR China & Beijing Anding Hospital, Capital Medical University, PR China
| | - L R Tang
- Beijing Anding Hospital, Capital Medical University, PR China
| | - C U Correll
- Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, New York, United States
| | - G S Ungvari
- University of Notre Dame Australia / Marian Centre and School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth, Australia
| | - H F K Chiu
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, PR China
| | - Y Q Xiang
- Beijing Anding Hospital, Capital Medical University, PR China
| | - Y T Xiang
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, PR China
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11
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Grover S, Avasthi A, Tripathi A, Tanra AJ, Chee KY, He YL, Chiu HF, Kuga H, Lee MS, Chong MY, Udormatn P, Kanba S, Yang SY, Si TM, Sim K, Tan CH, Shen WW, Xiang YT, Sartorius N, Shinfuku N. Antidepressant Prescription Pattern in the Presence of Medical Co-morbidity: REAP-AD 2013 Study. East Asian Arch Psychiatry 2015; 25:99-107. [PMID: 26429836] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To evaluate the prescription pattern of antidepressants in patients with medical co-morbidity from major psychiatric centres in Asia. METHODS The Research on Asian Psychotropic Prescription Pattern for Antidepressants (REAP-AD 2013) collected data from 42 psychiatric centres in 10 Asian countries and regions. Antidepressant prescriptions of 2320 patients with various psychiatric disorders were evaluated. Of these, 370 patients who had specified medical co-morbidities formed the study cohort. RESULTS Escitalopram (20%) and mirtazapine (20%) were the most commonly prescribed antidepressants in patients with medical co-morbidity followed by sertraline (16%), trazodone (15%), and paroxetine (12%). Overall, more than half (52%; 247/476) of prescriptions comprised selective serotonin reuptake inhibitors. Slightly less than two-thirds (63%; n = 233) of patients received at least 1 selective serotonin reuptake inhibitor. In addition, 79% of patients were prescribed only 1 antidepressant. The mean number of antidepressants used per patient was 1.25 (standard deviation, 0.56). There were subtle differences in the most preferred antidepressant across medical illnesses such as diabetes mellitus, liver dysfunction, acid peptic disease, and cerebrovascular disease. Differences were also seen in prescription patterns across different countries. CONCLUSION Although selective serotonin reuptake inhibitors formed the bulk of antidepressant prescriptions in the presence of medical co-morbidity, mirtazapine was also commonly used in the presence of medical co-morbidities. Specified medical morbidities do influence the selection of antidepressants.
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Affiliation(s)
- S Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - A Avasthi
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - A Tripathi
- Department of Psychiatry, King George's Medical University, Chowk, Lucknow, India
| | - A J Tanra
- Department of Psychiatry, Hasanuddin University Faculty of Medicine, Makassar, Sulawesi Selatan, Indonesia
| | - K Y Chee
- Department of Psychiatry and Mental Health, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | - Y L He
- Department of Psychiatric Epidemiology, Shanghai Mental Health Center, Shanghai, PR China
| | - H Fk Chiu
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, PR China
| | - H Kuga
- Department of Neuropsychiatry, Kyushu University, Fukuoka, Japan
| | - M S Lee
- Department of Psychiatry, College of Medicine, Korea University, Seoul, Korea
| | - M Y Chong
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital-Kaohsiung Medical Center and School of Medicine, Chang Gung University, Taiwan
| | - P Udormatn
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - S Kanba
- Department of Neuropsychiatry, Kyushu University, Fukuoka, Japan
| | - S Y Yang
- Department of Pharmacy, Taipei City Hospital, Taipei, Taiwan
| | - T M Si
- Department of Psychiatry, Peking University Institute of Mental Health, Beijing, PR China
| | - K Sim
- Institute of Mental Health, Buangkok View, Buangkok Green Medical Park Singapore, Taipei, Taiwan
| | - C H Tan
- Department of Pharmacology, National University of Singapore, Singapore
| | - W W Shen
- Department of Psychiatry, TMU-Wan Fang Medical Center, Taipei Medical University, Taipei, Taiwan
| | - Y T Xiang
- Faculty of Health Sciences, University of Macau, Macao SAR, PR China
| | - N Sartorius
- Association for the Improvement of Mental Health Programmes, Geneva, Switzerland
| | - N Shinfuku
- Department of Psychiatry, Kobe University, Kobe, Japan
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12
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Hou CL, Cai MY, Ma XR, Zang Y, Jia FJ, Lin YQ, Chiu HFK, Ungvari GS, Ng CH, Zhong BL, Cao XL, Li Y, Shinfuku N, Xiang YT. Clozapine prescription and quality of life in Chinese patients with schizophrenia treated in primary care. Pharmacopsychiatry 2015; 48:200-4. [PMID: 26244858 DOI: 10.1055/s-0035-1555939] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Clozapine is frequently used to treat schizophrenia in China. Maintenance treatment for clinically stable patients with schizophrenia is usually provided by Chinese primary care physicians, but no study has investigated the frequency of its use prescribed by primary care physicians. This study described the frequency, demographic and clinical characteristics of clozapine treatment and its impact on insight and quality of life (QOL) of patients with schizophrenia treated in primary care in China. METHOD A total of 623 patients with schizophrenia treated in 22 primary care services in Guangzhou, China in 2013 formed the study sample. Patients' socio-demographic and clinical characteristics including psychopathology, medication side effects and QOL were recorded using a standardized protocol and data collection. RESULTS The frequency of clozapine prescription was 35.6% with a mean daily dose of 127.7±88.2 mg. There were no significant differences between the patients with and without clozapine in either of the QOL domains after controlling the confounding factors. Multiple logistic regression analyses revealed that patients on clozapine had younger age of onset, more hospitalizations, more severe extrapyramidal side effects, but better insight and fewer prescriptions of first generation antipsychotics. CONCLUSIONS Clozapine use was found to be common and associated with better insight in patients with schizophrenia treated in primary care in China. Further examination of the rationale and appropriateness of clozapine in primary care in China is warranted.
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Affiliation(s)
- C-L Hou
- Guangdong Mental Health Center, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangdong Province, China
| | - M-Y Cai
- Guangzhou Yuexiu Center for Disease Control and Prevention, Guangdong Province, China
| | - X-R Ma
- Ningxia Mental Health Center, Ningxia Ning-An Hospital, Ningxia Province, China
| | - Y Zang
- Shenzhen Key Laboratory for Psychological Healthcare & Shenzhen Institute of Mental Health, Shenzhen Kangning Hospital & Shenzhen Mental Health Center, Shenzhen, China
| | - F-J Jia
- Guangdong Mental Health Center, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangdong Province, China
| | - Y-Q Lin
- Guangdong Mental Health Center, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangdong Province, China
| | - H F K Chiu
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China
| | - G S Ungvari
- The University of Notre Dame Australia/Marian Centre, Perth, Australia
| | - C H Ng
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - B-L Zhong
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China
| | - X-L Cao
- Shenzhen Key Laboratory for Psychological Healthcare & Shenzhen Institute of Mental Health, Shenzhen Kangning Hospital & Shenzhen Mental Health Center, Shenzhen, China
| | - Y Li
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China
| | - N Shinfuku
- International Center for Medical Research, School of Medicine, Kobe University, Kobe, Japan
| | - Y-T Xiang
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
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13
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Han X, Yuan YB, Yu X, Zhao JP, Wang CY, Lu Z, Yang FD, Dong H, Wu YF, Ungvari GS, Xiang YT, Chiu HFK. The Chinese First-Episode Schizophrenia Trial: background and study design. East Asian Arch Psychiatry 2014; 24:169-173. [PMID: 25482837] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Schizophrenia is a complex illness with unknown aetiology and pathogenesis. Currently, a considerable number of patients with schizophrenia do not receive standardised and systematic treatment in China. In the past years, many controlled trials have been conducted in chronic schizophrenia. In contrast, research on first-episode schizophrenia is lacking. This paper describes the background and design of the Chinese First-Episode Schizophrenia Trial project--a multicentre, randomised, open-label clinical trial. A total of 600 first-episode schizophrenia patients were randomly divided into 3 groups and treated with risperidone, aripiprazole, and olanzapine for 1 year. During the study period, only 1 medication change of the 3 antipsychotic medications was allowed.
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Affiliation(s)
- X Han
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Y B Yuan
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - X Yu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - J P Zhao
- Mental Health Institute, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - C Y Wang
- Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Z Lu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - F D Yang
- Center for Biological Psychiatry, Beijing Hui-Long-Guan Hospital, Beijing, China
| | - H Dong
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan province, China
| | - Y F Wu
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - G S Ungvari
- The University of Notre Dame Australia / Marian Centre, Perth, Australia
| | - Y T Xiang
- Faculty of Health Sciences, University of Macau, Macao, China
| | - H F K Chiu
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China
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14
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Xiang YT, Yu X, Ungvari GS, Correll CU, Chiu HF. Outcomes of SARS survivors in China: not only physical and psychiatric co-morbidities. East Asian Arch Psychiatry 2014; 24:37-38. [PMID: 24676486] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The year 2013 marks the 10th anniversary of the outbreak of the severe acute respiratory syndrome (SARS). We present a comprehensive introduction to the current situation of surviving SARS victims in China where the disease originated and spread across the world 10 years ago.
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Affiliation(s)
- Y T Xiang
- Beijing Anding Hospital, Capital Medical University, Beijing, China / Department of Psychiatry, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - X Yu
- President of Chinese Society of Psychiatry and the Director of National Mental Health Program Office / Peking University Institute of Mental Health, Beijing, China
| | - G S Ungvari
- School of Psychiatry and Clinical Neurosciences, University of Western Australia / The University of Notre Dame Australia / Marian Centre, Perth, Australia
| | - C U Correll
- Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, New York, United States
| | - H Fk Chiu
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China
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15
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Chen FZ, Xiang YT, Lu Z, Wang G, Hu C, Kilbourne AM, Ungvari GS, Fang YR, Si TM, Yang HC, Lai KY, Hu J, Chen ZY, Huang Y, Sun J, Wang XP, Li HC, Zhang JB, Zhang XY, Chiu HFK. Characteristics of unrecognised bipolar disorder in patients treated for major depressive disorder in China: general versus psychiatric hospitals. East Asian Arch Psychiatry 2013; 23:139-143. [PMID: 24374485] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Bipolar disorder is often misdiagnosed as major depressive disorder. Such misdiagnosis partly depends on the type of treatment setting. This study compared general hospital psychiatric units with psychiatric hospitals in China with respect to basic demographic and clinical characteristics of patients with unrecognised bipolar disorder who are treated for major depressive disorder. METHODS Patients treated for major depressive disorder were consecutively examined in 13 health centres (6 general hospital psychiatric units and 7 psychiatric hospitals) in China. Their socio-demographic and clinical features were recorded using a standardised protocol and data collection procedure. The DSM-IV diagnoses were established using the Mini-International Neuropsychiatric Interview. RESULTS Of the 1487 patients included in the study, 309 (20.8%) were diagnosed with bipolar disorder. There was no significant difference between general hospital psychiatric units and psychiatric hospitals in the ratio of all types of unrecognised bipolar disorders (χ2 = 0.008, degrees of freedom = 1, p = 0.9) and bipolar II disorders (χ2 = 3.1, degrees of freedom = 1, p = 0.08). The proportions of unrecognised bipolar I disorders (χ2 = 4.1, degrees of freedom = 1, p = 0.04) differed significantly between the 2 types of study site. Multivariate analyses showed that patients with bipolar I disorders with more seasonal depressive episodes were more likely to receive treatment in general hospital psychiatric units (odds ratio = 3.3, 95% confidence interval = 1.1-9.8). CONCLUSION Patients with bipolar I disorders receiving treatment in general hospital psychiatric units had different clinical characteristics compared to their counterparts treated in psychiatric hospitals in China.
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Affiliation(s)
- F Z Chen
- Department of Psychiatry, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
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16
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Xiang YT, Dickerson F, Kreyenbuhl J, Ungvari GS, Wang CY, Si TM, Lee EHM, He YL, Chiu HFK, Yang SY, Chong MY, Tan CH, Kua EH, Fujii S, Sim K, Yong MKH, Trivedi JK, Chung EK, Udomratn P, Chee KY, Sartorius N, Shinfuku N. Adjunctive mood stabilizer and benzodiazepine use in older Asian patients with schizophrenia, 2001-2009. Pharmacopsychiatry 2012; 45:217-22. [PMID: 22290203 DOI: 10.1055/s-0031-1301292] [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] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVE This study surveyed the use of adjunctive mood stabilizers (MS) and benzodiazepines (BZD) in older Asian schizophrenia patients and examined their demographic and clinical correlates. METHOD Information on hospitalized schizophrenia patients aged 55 years or more were extracted from the database of the Research on Asian Psychotropic Prescription Patterns (REAP) study. A total of 1,452 patients from 9 Asian countries and territories was included in the study. The patients' sociodemographic and clinical characteristics and the prescriptions of antipsychotics, MS and BZD were recorded using a standardized protocol and data collection procedure. RESULTS The frequency of MS prescription was 26.7% in the pooled sample, with 25.5% in 2001, 26.9% in 2004 and 27.7% in 2009. The corresponding figures for BZD were 20.7%, 20.2%, 18.4% and 23.1%, respectively. Multiple logistic regression analysis of the whole sample revealed that patients on MS were younger and more likely to be men and to have extrapyramidal side effects (EPS) and a longer duration of illness. Compared to patients in China, those in Japan were more likely to receive MS, while Korean patents were prescribed less MS. In contrast, there were no significant sociodemographic or clinical correlates of BZD use. Compared to patients in China, their Korean and Singaporean counterparts were more likely to be on BZD. CONCLUSIONS The use of MS and BZD is not uncommon in older Asian patients with schizophrenia. Given the paucity of empirical data on the efficacy of these agents in individuals with schizophrenia of any age and concerns about added side effects in older patients in particular, the rationale for the prescription of these agents in this population warrants further examination.
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Affiliation(s)
- Y-T Xiang
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR
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17
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Wang Y, Xiang YT, Wang CY, Chiu HFK, Zhao JP, Chen Q, Chan SSM, Lee EHM, Tang WK, Ungvari GS. Insight in Chinese schizophrenia patients: a 12-month follow-up. J Psychiatr Ment Health Nurs 2011; 18:751-7. [PMID: 21985677 DOI: 10.1111/j.1365-2850.2010.01677.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [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] [Indexed: 11/28/2022]
Abstract
This study aimed to assess insight in Chinese schizophrenia patients and to identify its relationship with socio-demographic and clinical factors, executive functions and quality of life (QOL). A cohort of 139 clinically stable schizophrenia patients was selected by consecutively screening patients diagnosed with schizophrenia who were attending the outpatient department of a university-affiliated psychiatric hospital in China. Participants' socio-demographic and clinical characteristics, including psychotic symptoms, depression and insight, as well as QOL and executive functions, were periodically assessed with standardized rating instruments. Patients received standard psychiatric care and were followed up for 1 year. Impaired insight was found to be common in stable Chinese schizophrenia patients (76.3%), with merely 5% showing improvement over the 1-year follow-up. Insight was inversely correlated with positive and negative symptoms at all but the 12-month assessment and with both the physical and mental components of QOL at baseline and the 12-month assessment. Insight was not associated with depressive symptoms or executive functions. Standard psychiatric care does not improve the level of insight in clinically stable Chinese schizophrenia outpatients, which warrants the introduction of specific therapeutic interventions that enhance insight.
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Affiliation(s)
- Y Wang
- Beijing Anding Hospital, Capital Medical University, Beijing, China
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18
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Xiang YT, Wang CY, Si TM, Lee EHM, He YL, Ungvari GS, Chiu HFK, Yang SY, Chong MY, Tan CH, Kua EH, Fujii S, Sim K, Yong KH, Trivedi JK, Chung EK, Udomratn P, Chee KY, Sartorius N, Shinfuku N. Antipsychotic polypharmacy in inpatients with schizophrenia in Asia (2001-2009). Pharmacopsychiatry 2011; 45:7-12. [PMID: 21989602 DOI: 10.1055/s-0031-1286345] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
OBJECTIVE This study aimed to identify trends in the use of antipsychotic polypharmacy (APP) and their demographic and clinical correlates in the treatment of schizophrenia in Asia between 2001 and 2009. METHOD A total of 6,761 schizophrenia inpatients in 9 Asian countries and territories were examined; 2,399 in 2001, 2,136 in 2004, and 2,226 in 2009. Patients’ socio-demographic and clinical characteristics and prescriptions of psychotropic drugs were recorded using a standardized protocol and data collection procedure. RESULTS The proportion of APP prescription decreased from 46.8 % in 2001, to 38.3 % in 2004, and increased to 43.4 % in 2009, with wide intercountry variations at each survey. Multiple logistic regression analysis of the whole sample revealed that patients on APP were younger, had a higher dose of antipsychotics in chlorpromazine equivalents, and more severe positive and negative symptoms. They were also more likely to receive depot and fi rst-generation antipsychotic drugs. CONCLUSIONS The frequency of APP prescription varied between countries and territories, suggesting that a host of clinical and socio-cultural factors played a role in determining APP use in Asia. To resolve the discrepancy between treatment recommendation and clinical practice, regular reviews of prescription patterns are needed.
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Affiliation(s)
- Y-T Xiang
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, P. R. China.
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19
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Xiang YT, Wang CY, Ungvari GS, Kreyenbuhl JA, Chiu HFK, Lai KYC, Lee EHM, Bo QJ, Dixon LB. Weight changes and their associations with demographic and clinical characteristics in risperidone maintenance treatment for schizophrenia. Pharmacopsychiatry 2011; 44:135-41. [PMID: 21710403 DOI: 10.1055/s-0031-1277178] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study aimed to characterize weight changes in schizophrenia patients taking risperidone as part of a randomized, controlled, open-label clinical trial. METHODS A total of 374 patients with schizophrenia who had been clinically stabilized following an acute episode were randomly assigned to a 'no-dose-reduction' group (initial optimal therapeutic doses continued throughout the study), a '4-week group' (initial optimal therapeutic doses continued for 4 weeks followed by a half dose reduction that was maintained until the end of the study) or a '26-week group' (initial optimal therapeutic doses continued for 26 weeks followed by a half dose reduction until the end of the study). Participants were assessed monthly using standardized assessment instruments during the first 6 months, and then every 2 months until the last recruited patient completed the 1-year follow-up. Weight gain was defined as gaining at least 7% of initial body weight, weight loss as losing at least 7% of initial body weight. A BMI <18.5 kg m⁻² was defined as underweight, 18.5-24.9 kg m⁻² as normal range, and ≥ 25 kg m⁻² as overweight or obese. RESULTS At the end of follow-up, of the patients who started within the underweight range (n=22), 77.3% gained weight, whereas 4.5% lost weight. The corresponding figures were 39.6% and 4.8% in patients who started at normal weight (n=273), respectively, and 17.7% and 17.7% in patients who started at overweight (n=79), respectively. At the same time, 59.1% of the patients who started at underweight range went into the normal weight and 13.6% into the overweight/obese range, respectively, while 24.5% of those who started at normal weight went into the overweight/obese range, and 1.1% into underweight range, respectively; 20.3% of those who started at overweight range went into normal weight at the end of the follow-up. Multiple logistic regression analyses revealed that being underweight or normal weight at study entry predicted weight gain compared to being overweight, whereas being overweight at entry was associated with a higher likelihood of weight loss compared to being normal weight. No correlation was found between weight change and dose reduction. CONCLUSIONS Weight change is a common, long-term, but heterogeneous side effect in risperidone maintenance treatment for stable schizophrenia patients. Special attention should be paid to fluctuations in weight that may occur throughout the course of treatment with risperidone.
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Affiliation(s)
- Y-T Xiang
- Beijing Anding Hospital, Capital Medical University, Beijing, People's Republic of China
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Lee E, Lum CM, Xiang YT, Ungvari GS, Tang WK. Psychosocial condition of family caregivers of patients with chronic obstructive pulmonary disease in Hong Kong. East Asian Arch Psychiatry 2010; 20:180-185. [PMID: 22348927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES. Chronic obstructive pulmonary disease is associated with physical and psychological burdens. Although there is research about health-related quality of life (HRQOL) of such patients, less is known about the psychosocial condition of their family caregivers. The objectives of this study were to examine the HRQOL and the burden of chronic obstructive pulmonary disease patient caregivers, and to identify associated relevant factors. METHODS. A total of 81 eligible caregivers completed a caregiver survey on HRQOL (Short Form-36 Questionnaire), caregiving burden (Cumulative Illness Rating Scale, CIRS) and other biopsychosocial factors. Descriptive statistics, correlations, and multiple linear regression models were used to analyse data. RESULTS. The caregiver's Mental Component Summary measure of the Short Form-36 was associated with each caregiver's total CIRS scores, the anxiety subscale of the Hospital Anxiety and Depression Scale, and the Lubben Social Network Scale. The caregiver's Physical Component Summary measure was associated with the patient's disability allowance, the caregiver's total CIRS score, and the Barthel Index score. Caregivers' Caregiving Burden Scale scores were associated with their Geriatric Depression Scale total score and the need to take care of other family members. CONCLUSIONS. This study demonstrates that depressive and anxiety symptoms are associated with caregivers' burden and HRQOL. Further studies on evaluating interventions on caregivers' HRQOL and burden should take mood symptoms into consideration.
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Affiliation(s)
- E Lee
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China
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Abstract
OBJECTIVE The clinical significance of microbleeds (MBs) in the development of psychiatric conditions following a stroke is unknown. Lesions located in various cortical and subcortical areas are thought to be involved in the pathophysiology of post-stroke emotional lability (PSEL). This study examined the association between PSEL and MBs. METHODS A total of 519 Chinese patients with acute ischaemic stroke consecutively admitted to the acute stroke unit of a university affiliated regional hospital in Hong Kong were screened for PSEL 3 months after their index stroke. The number and location of MBs were evaluated with MRI. RESULTS According to Kim's criteria, 74 (14.3%) patients had PSEL. In comparison with the non-PSEL group, patients in the PSEL group were more likely to have MBs in the thalamus as a whole (16.2% vs 6.5%; p = 0.004), its anterior (6.9% vs 2.0%, p = 0.02) and paramedian territories (8.1% vs 3.1%; p = 0.04), and a higher number of MBs in the entire brain (1.7+3.4 vs 1.3+5.0; p = 0.031). MBs in the thalamus remained an independent predictor of PSEL in the multivariate analysis, with an odds ratio of 4.7 (p = 0.002). CONCLUSION Our results suggest that MBs in the thalamus may play a role in the development of PSEL. The importance of MBs in PSEL and other psychiatric conditions in stroke survivors warrants further investigation.
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Affiliation(s)
- W K Tang
- Department of Psychiatry, Shatin Hospital, Shatin, NT, Hong Kong SAR, China.
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Ma X, Xiang YT, Li SR, Xiang YQ, Guo HL, Hou YZ, Cai ZJ, Li ZB, Li ZJ, Tao YF, Dang WM, Wu XM, Deng J, Ungvari GS, Chiu HFK. Prevalence and sociodemographic correlates of depression in an elderly population living with family members in Beijing, China. Psychol Med 2008; 38:1723-1730. [PMID: 18366820 DOI: 10.1017/s0033291708003164] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND To date, there has been no large-scale survey of geriatric depression (GD) involving both rural and urban areas in China using standardized assessment tools and diagnostic criteria. This study aimed to determine the 12-month and lifetime prevalence rates of GD and sociodemographic correlates in urban and rural regions of Beijing, China.MethodA total of 1601 elderly patients (aged 60 years) were randomly selected and interviewed in Beijing using the Composite International Diagnostic Interview (CIDI 1.0). Basic sociodemographic and clinical data were also collected during the interviews. RESULTS The overall 12-month prevalence of GD was 4.33%, and the 12-month prevalence rates for men and women were 2.65% and 5.83% respectively. The overall lifetime prevalence of GD was 7.83%, and lifetime prevalence rates for men and women were 4.65% and 10.66% respectively. Female sex, lower educational level, monthly income, rural abode, and the presence of one or more major medical conditions were associated with increased risk of GD. Of the GD subjects interviewed, 25.2% were receiving some type of treatment, with only 4.7% preferring to seek treatment from mental health professionals. CONCLUSIONS Although still relatively low by international standards, there is an increasing trend in the prevalence of GD in China. The low percentage of subjects treated for GD is a major public health concern that should be addressed urgently.
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Affiliation(s)
- X Ma
- Beijing An Ding Hospital, Capital Medical University, Beijing, China
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Xiang YT, Weng YZ, Leung CM, Tang WK, Ungvari GS. Clinical and social determinants of long-term use of benzodiazepines and its impact on quality of life of Chinese schizophrenia patients. Pharmacopsychiatry 2008; 40:269-74. [PMID: 18030651 DOI: 10.1055/s-2007-992143] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIMS To date there have been no studies investigating prescription patterns of benzodiazepine agents (BZDs) in Chinese outpatients with schizophrenia. This study examined the frequency and socio-demographic and clinical correlates of BZD prescription in Hong Kong (HK) and Beijing (BJ), China. METHODS Five hundred and five clinically stable outpatients with schizophrenia were randomly selected and interviewed in HK and BJ using standardized assessment instruments. Basic socio-demographic and clinical data and psychotropic drug prescriptions were collected at the time of a diagnostic interview. RESULTS One-hundred and fifty one (29.9%) patients were prescribed BZDs in the whole sample; 25.1% and 34.8% of the HK and BJ samples, respectively. Use of BZDs was associated with sex, employment status, history of suicide, less use of clozapine, more frequent use of typical antipsychotics (APs), higher doses of APs, severity of positive symptoms, extrapyramidal side effects (EPS) and insomnia. In multiple logistic regression analysis, severity of depressive symptoms, study site, sex, employment status, less use of clozapine and history of suicide remained significantly associated with BZDs. CONCLUSION Although the ethnic and clinical characteristics of the two samples were nearly identical, there was a wide variation in the frequency of BZD prescriptions between HK and BJ suggesting that socio-cultural and economic factors as well as traditions of psychiatric training and practice all played a role in determining the use of BZDs. Prescription of BZDs in either site was not in line with current recommendation.
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Affiliation(s)
- Y-T Xiang
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, PR China.
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Xiang YT, Weng YZ, Leung CM, Tang WK, Ungvari GS. Clinical and social determinants of antipsychotic polypharmacy for Chinese patients with schizophrenia. Pharmacopsychiatry 2007; 40:47-52. [PMID: 17447172 DOI: 10.1055/s-2007-970062] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Most prescription pattern surveys have found a high rate of antipsychotic polypharmacy. To date few studies have investigated antipsychotic polypharmacy in Chinese patients with schizophrenia in general and outpatients in particular. This study examined the frequency and sociodemographic and clinical correlates of antipsychotic polypharmacy in Hong Kong (HK) and Beijing (BJ), China. Three hundred and ninety-eight clinically stable outpatients with schizophrenia were randomly selected and interviewed in HK and BJ using standardized assessment instruments. Antipsychotic polypharmacy was found in 17.6% ( N=70) of the whole sample and in 28% and 7.1% of the HK and BJ samples, respectively. Polypharmacy was associated with monthly income, severity of negative symptoms and extrapyramidal side effects (EPS), use of depot antipsychotic and anticholinergic drugs, doses of antipsychotics, and the number of hospitalizations. In multiple logistic regression analysis, younger age, number of hospitalizations, site (HK vs. BJ), and the use of depot antipsychotics were all significantly associated with antipsychotic polypharmacy. Although the ethnic and clinical characteristics of the two cohorts were nearly identical, there was a wide variation in the prescription frequency of antipsychotic polypharmacy between HK and BJ, suggesting that sociocultural and economical factors and traditions of psychiatric practice all played a role in determining antipsychotic polypharmacy. Clinicians should bear in mind that, at least for clinically stable patients, no scientifically sound therapeutic principles for antipsychotic polypharmacy exist.
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Affiliation(s)
- Y-T Xiang
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China.
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