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OBJECTIVE: A history of adverse childhood experiences (ACE) is common among people with severe mental illness (SMI), and they are also associated with physical health problems, including metabolic syndrome (MetS) in general adult populations. We aimed to evaluate and synthesise the evidence relating to the association between ACE and MetS and/or its components in patients with SMI. METHODS: We systematically searched multiple databases (MEDLINE, PubMed, PsycINFO, EMBASE, Emcare, Cochrane Library, Health Technology Assessments, Joanna Briggs Institute, and Maternity and Infant Care database) and reviewed studies that described an association between ACE and MetS or its components in SMI adult patients. RESULTS: Twenty studies were reviewed. Most studies described a significant association between ACE and at least one to three components of MetS, with obesity being the most studied and, therefore, showing a more consistent association compared to the other MetS components. ACE and the components of MetS did not remain significant, in most of the studies, after adjusting for confounders. None of the studies showed an association with MetS as a whole entity. CONCLUSION: Adults with SMI with a history of ACE are more likely to demonstrate health problems such as MetS and cardiovascular disease-related risk factors.
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Experiências Adversas da Infância , Transtornos Mentais , Pessoas Mentalmente Doentes , Síndrome Metabólica , Adulto , Humanos , Feminino , Gravidez , Síndrome Metabólica/epidemiologia , Transtornos Mentais/epidemiologia , Transtornos Mentais/complicações , Obesidade/complicaçõesRESUMO
OBJECTIVE: A systematic review of literature was conducted to determine the association between serum lipids and suicidality in people with schizophrenia spectrum disorders. METHODS: We undertook a systematic search of multiple databases for studies that ascertained an association between serum lipids and suicidality in adult patients with schizophrenia spectrum disorders (18-65 years) from database inception to 2 September 2020. Qualitative analysis was done using National Institute of Health (NIH) scales. The standard mean difference (SMD) and 95% confidence intervals (CI) were calculated for each study and standardized relative to the study. Adjusted p-value, Z-test, and heterogeneity were calculated, as well as testing for publication bias. RESULTS: Of 1262 records identified, 17 studies (n = 3113) were included in our systematic review, while 11 studies were included in the meta-analysis. The majority of studies (11) rated fair on qualitative analysis. Data from seven studies (n = 1597) revealed a medium effect size for an association between low total cholesterol and suicide attempts (SMD -0.560; 95% CI: 0.949-0.170; p = 0.005). People with history of suicide attempt had a mean cholesterol value 0.56 SD lower than the mean in those without suicide attempts. There were differences in how a suicide attempt was defined and there was high heterogeneity (I2 = 83.3%). No significant association was found between any of the serum lipid parameters and suicide ideation. Funnel-plot analysis suggested small study effects with publication bias. CONCLUSIONS: Suicide attempts in people with schizophrenia spectrum disorders are associated with low mean total cholesterol levels.
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Esquizofrenia , Ideação Suicida , Colesterol , Humanos , Esquizofrenia/epidemiologia , Tentativa de SuicídioRESUMO
OBJECTIVES: Community mental health services are often required to manage people experiencing repeated crises. Personality disorders are not uncommon, accounting for up to one-third of such presentations. These patients are often difficult to treat, leading to a revolving-door phenomenon. This study evaluated the effectiveness of a pilot intervention in reducing psychological symptoms and distress, and examined the impact of the intervention on mental health service utilization. METHODS: A pre- versus post-treatment evaluation was conducted of the effectiveness of a 10-week group psychological intervention based on Dialectical Behaviour Therapy skills, conducted in a regional Australian community mental health service with patients diagnosed with either Cluster B personality disorder or a mood disorder. RESULTS: Of those who completed the program ( N = 38 patients), 84% were female, with an average age of 35.13 years. Participants were active clients of the service for an average of 58.3 weeks prior to the program. They demonstrated significant improvements in quality of life and self-control, and a reduction in hopelessness, cognitive instability and dependence on mental health services. CONCLUSIONS: Limiting the Dialectical Behaviour Therapy program to a short-term skills-based group component was successful with the targeted patient group; however, more research is required to establish the generalizability of these results.
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Serviços Comunitários de Saúde Mental/métodos , Terapia do Comportamento Dialético/métodos , Transtornos do Humor/terapia , Avaliação de Resultados em Cuidados de Saúde , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Transtornos da Personalidade/terapia , Psicoterapia de Grupo/métodos , Adulto , Serviços Comunitários de Saúde Mental/estatística & dados numéricos , Feminino , Humanos , Masculino , Projetos PilotoRESUMO
OBJECTIVE: We aim to describe the burden associated with smoking as a risk factor for suicidal behaviors among patients with psychosis. METHOD: We calculated the Population Attributable Risk (PAR) associated with smoking and other known modifiable risk factors for suicidal behaviors for participants (N=1812) who took part in the Australian Survey of High Impact Psychosis (SHIP). A combined PAR for the seven identified modifiable risk factors was calculated. RESULTS: Smoking contributed to 21% of the suicidal behaviors in this sample; together, the seven factors contributed to 86% of all attempted suicide in this cohort. CONCLUSIONS: Smoking may exert a role either directly or indirectly. Evidence indicates that smoking is associated with psychological, biochemical and neurobiological changes that are in turn implicated in smoking. Suicidal behaviors are nevertheless complex behaviors needing multi-faceted approach.
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Transtornos Psicóticos/psicologia , Fumar/efeitos adversos , Fumar/epidemiologia , Tentativa de Suicídio/estatística & dados numéricos , Adolescente , Adulto , Austrália/epidemiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Adulto JovemRESUMO
Disorders of gambling are more common among the mentally ill, including in people with psychotic disorders. The aim of this study was to conduct a systematic review of the literature regarding the prevalence and correlates of gambling disorders in people with psychotic disorders. We systematically reviewed English-language literature through searches of six bibliographic databases, all run on 11 November 2022: Medline ALL, Embase, Emcare, APA PsycINFO, CINAHL and the Cochrane Library. Observational studies that reported the prevalence of gambling in psychotic disorders or psychosis among gamblers were included. Studies were critically appraised using the Joanna Briggs Institute Critical Appraisal Tools. Sixteen studies, including 1,116,103 participants, from across a range of settings, were included. Most studies were done on males and recruited participants with a mean age of 40 years. Most of the studies (n = 12) were cross-sectional, and the remaining were case control in design. Most of the studies rated fair in quality. The prevalence of gambling among psychotic population ranged from 0.32 to 19.3%, with the majority of the studies reporting rates between 6.4 and 17%. The rates were 5-25 times higher than in the general population. While there were no consistent associations found with socio-demographic indices, several studies reported an association between gambling behaviours and substance use disorder among those with psychotic illnesses. Our research suggests that clinicians should assess for comorbid gambling among those with psychotic illness, particularly in those with mood symptoms, impulsivity, and substance use disorders. Gambling can negatively impact on their financial and social situations. Future research should study specific strategies or therapies among those with comorbid gambling and psychotic disorders.
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Background: Persons with schizophrenia (PwS) are vulnerable to developing disordered eating behaviors. However, standardized tools to assess disordered eating patterns are unavailable in the regional language, Tamil. Different versions of the Three-Factor Eating Questionnaire (TFEQ) have been used to measure disordered eating patterns among PwS worldwide. This study aimed to assess the factor structure and reliability of the Tamil version of TFEQ-R18V2 among Tamil-speaking PwS. Methods: Over three months, 135 PwS, aged 18-65 years, who attended the outpatient department of a tertiary mental health service provider in Chennai, completed the Tamil version of TFEQ-R18V2. Thirty PwS completed the tool after two weeks to assess its test-retest reliability. The factor structure of the tool was explored using principal component analysis. Results: The sample included 75 (55.6%) males and 60 (44.4%) females with a mean (±SD) age of 40.1 (±9.8) years and a mean duration of illness of 11.99 (± 8.72) years. Internal consistency and test-retest reliability of the Tamil version were 0.84 and 0.532, respectively. A five-factor structure emerged from the factor analysis, with 65.67% of the variance. Conclusion: The Tamil version of TFEQ-R18V2 emerged as a reliable tool to assess disordered eating patterns among Tamil-speaking PwS.
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OBJECTIVE: The present study was undertaken to evaluate the effect of cognitive training in improving trained and untrained cognitive processes in schizophrenia. METHODS: A simple pre- and post experimental study with a three month follow-up was conducted to determine the efficacy of cognitive training in speed of processing and executive functions improving cognition in 22 schizophrenia patients. RESULTS: Significant improvement was found in those cognitive domains specifically targeted in the training protocol, but also to a limited extent on verbal memory and social cognition. There was also evidence of improvements in symptoms and social functioning. The training effects failed to transfer to community functioning skills however. Except for social cognition, these improvements were maintained at 3month follow-up. CONCLUSION: The study highlights the importance of understanding the mechanisms that contribute to the transfer of skills as well as the maintenance of cognitive changes in individuals with schizophrenia.
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Cognição , Terapia Cognitivo-Comportamental/métodos , Função Executiva , Esquizofrenia/reabilitação , Psicologia do Esquizofrênico , Atividades Cotidianas , Adulto , Austrália , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Ajustamento Social , Comportamento Social , Percepção Social , Resultado do TratamentoRESUMO
BACKGROUND: Many antipsychotic drugs have been associated with QTc prolongation, which is a risk factor for sudden death. We studied the prevalence and predictors of QTc prolongation in treatment-resistant schizophrenia patients who were receiving clozapine in a real-world setting. METHODS: Data were extracted from the records of all schizophrenia patients aged 18-65 years, enrolled in a clozapine clinic in metropolitan Australia during October 2020 to April 2022, for whom ECG data were available. RESULTS: There were 104 eligible patients. The mean age of the sample was 42 years. The sample was 56 % male. About a third of patients were receiving antipsychotic and antidepressant drugs in addition to clozapine. The mean (standard deviation) QTc was 437.0 (24.8) ms in men and 445.8 (28.5) ms in women. QTc prolongation was present in 36.5 % of the sample. In univariate analysis, higher heart rate and higher clozapine levels were significantly associated with QTc prolongation; in multivariable logistic regression analysis, nonsignificant statistical trends were observed for male sex, higher heart rate, and higher serum clozapine level. CONCLUSIONS: QTc prolongation may be common in schizophrenia patients who receive clozapine in real world settings; this is a matter of much concern. Potential predictors of QTc prolongation need to be identified and these predictors and their interactions require to be explored in studies with greater statistical power.
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Background: Disordered eating behaviors (DEBs) among persons with schizophrenia (PwS) have been reported widely in the literature, with very few studies in India. Robust tools to assess DEB are needed in the vernacular language to capture symptoms of disordered eating accurately. No such tools are available in the Tamil language. Globally, the Eating Attitudes Test (EAT-26) is widely used to assess DEB among PwS. Aim: This study aimed to translate and study the factor structure and reliability of EAT-26 among Tamil-speaking PwS. Materials and Methods: EAT-26 was translated into Tamil following the Oxford linguistic validation process. Experts evaluated its face validity and content validity. One hundred and fifty PwS, aged between 18 and 65 years, who attended the outpatient department of a psychiatric facility, and consented to participate, completed the Tamil version of EAT-26. Test-retest reliability of EAT-26 was assessed by readministering the tool to 30 PwS after two weeks. Data were analyzed using Stata 16.1. Internal consistency and test-retest reliability were computed using Cronbach's alpha and intraclass coefficients, respectively. The factor structure of EAT-26 was explored using principal component analysis (PCA). Spearman's rho was calculated to understand the correlation between the factors. Results: EAT-26 had an internal consistency of 0.71 and test-retest reliability of 0.896. Factor analysis revealed nine latent factors consisting of 21 of the original 26 items on EAT-26. These 21 items could explain a variance of 63.63%. Conclusions: The Tamil version of the EAT-26 is a reliable tool to assess DEB among Tamil-speaking PwS. It can be used to screen PwS for eating disorder risk.
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OBJECTIVE: Suicide is a major cause of death amongst individuals with schizophrenia spectrum disorders (SSD). Despite numerous risk factors being identified, accurate prediction of suicidality and provision of tailored and effective treatment is difficult. One factor that may warrant particular attention as a contributor to increased psychopathology and suicidality in SSD is disturbed sleep. Sleep disturbances have been reliably linked to greater levels of suicidal ideation and are highly prevalent amongst individuals with SSD. This study aimed to examine if reduced sleep duration and psychopathology are associated with increased suicidal ideation. METHOD: One-hundred and eighteen adults with chronic SSD living within the community participated in this cross-sectional study. Psychosis symptoms were assessed using the Positive and Negative Syndrome Scale. Items 4 and 10 from the Montgomery-Asperg Depression Rating Scale and Item 2 from the Calgary Depression Scale for Schizophrenia were used to assess reduced sleep duration, current suicidal ideation, and hopelessness, respectively. All measures were rated concurrently. RESULTS: A hierarchical logistic regression revealed that greater acute sleep disturbances were associated with increased suicidal ideation and this relationship was found to be uniquely mediated by both positive symptom severity and hopelessness. CONCLUSION: These results suggest that individuals with SSD who exhibited disrupted or disordered sleep, positive symptoms and/or hopelessness should be routinely screened for suicidal thinking. Furthermore, interventions that effectively target sleep disruptions may provide much-needed action against suicidal ideation.HIGHLIGHTSReduced sleep found to be associated with increased suicidal ideationThis was uniquely mediated by both hopelessness and positive symptomsMore regular screening of sleep problems in schizophrenia is needed.
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Transtornos Psicóticos , Esquizofrenia , Adulto , Humanos , Ideação Suicida , Esquizofrenia/epidemiologia , Esquizofrenia/diagnóstico , Estudos Transversais , Transtornos Psicóticos/epidemiologia , Fatores de Risco , SonoRESUMO
Disordered eating, or abnormal eating behaviours that do not meet the criteria for an independent eating disorder, have been reported among people with schizophrenia. We aimed to systemati-cally review literature on disordered eating among people with schizophrenia spectrum disorder (SSD). Seven databases were systematically searched for studies that described the prevalence and correlates of disordered eating among patients with SSD from January 1984 to 15 February 2021. Qualitative analysis was performed using the National Institutes of Health scales. Of 5504 records identified, 31 studies involving 471,159 subjects were included in the systematic review. The ma-jority of studies (17) rated fair on qualitative analysis and included more men, and participants in their 30s and 40s, on antipsychotics. The commonest limitations include lack of sample size or power calculations, poor sample description, not using valid tools, or not adjusting for con-founders. The reported rates were 4.4% to 45% for binge eating, 16.1% to 64%, for food craving, 27% to 60.6% for food addiction, and 4% to 30% for night eating. Positive associations were re-ported for binge eating with antipsychotic use and female gender, between food craving and weight gain, between food addiction and increased dietary intake, and between disordered eating and female gender, mood and psychotic symptoms. Reported rates for disordered eating among people with SSD are higher than those in the general population. We will discuss the clinical, treatment and research implications of our findings.
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Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Esquizofrenia/complicações , Psicologia do Esquizofrênico , Adulto , Antipsicóticos/uso terapêutico , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Feminino , Humanos , Masculino , Prevalência , Esquizofrenia/tratamento farmacológicoRESUMO
OBJECTIVES: The aim of this project was to assess the effect of community treatment orders (CTOs) on local hospital utilization rates. METHODS: We undertook a pre-post comparison of the number of admissions and the total length of hospital stay for all 28 patients of the Hunter Valley Mental Health Service who were on a CTO at the audit date (31 July 2008). At that time, there were 611 active patients being managed by the service. RESULTS: Twice the number of admissions per annum (2.54 versus 1.14 admissions, p < 0.001) and length of stay (41.58 versus 20.23 days, p < 0.01) were observed during the pre-CTO year compared to the CTO period. However, there were no significant differences when the index admission was excluded from these analyses (1.54 versus 1.14 admissions, 20.00 versus 20.23 days in hospital). CONCLUSION: CTOs have doubtful value in reducing hospital utilization, which may not be an appropriate outcome measure to study CTO effectiveness.
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Internação Compulsória de Doente Mental/estatística & dados numéricos , Serviços Comunitários de Saúde Mental/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Projetos PilotoRESUMO
This paper reports the findings of a local pilot that was aimed to assess if making a local psychiatrist available would improve GP satisfaction with regard to responsiveness and access to specialist mental health services. A psychiatrist was made available via a telephone advice line for 1 h every day. Pre- and post-survey of all GPs was conducted to elicit GP satisfaction and suggestions. The pilot was conducted from Maitland, the base of Hunter Valley Mental Health Service. A total of 202 GPs in the area were contacted and surveyed; 17% responded to the pre-survey and 27% to the post-survey. Only 8% of the GPs used the telephone advice service. Despite low use, most responding GPs indicated that they would like to see the services continue. Most of the responding GPs (both users and non-users of this service) were not aware of or had not used the Royal Australian College of General Practitioners' GP Psych Support initiative. Results from this pilot indicate that making a local psychiatrist available improves GP satisfaction with regard to responsiveness and access, despite low use. Further research is needed to establish if such a service can be made available at an area level and whether this would be cost effective.
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Atitude do Pessoal de Saúde , Medicina Geral/métodos , Acessibilidade aos Serviços de Saúde , Transtornos Mentais/terapia , Serviços de Saúde Mental/provisão & distribuição , Psiquiatria , Austrália , Medicina Geral/estatística & dados numéricos , Humanos , Projetos Piloto , Consulta Remota/estatística & dados numéricos , TelefoneRESUMO
Background: There are few research studies from Arab countries on suicide since many cultural and religious factors influence reporting. Aims: The purpose of this study was to explore the correlates of near-fatal deliberate self-harm in Qatar. Method: The study comprised a retrospective review of documented data of all patients with a suicide attempt admitted to the only Psychiatry Hospital in Qatar over a 12-month period. Logistic regression analysis was used to evaluate the contributors to near-fatal deliberate self-harm. Results: Out of 165 admissions with self-harm, 47 fulfilled criteria for near-fatal deliberate self-harm. The commonest methods were hanging followed by jumping from a height. Limitations: The retrospective nature of the study meant a lot of valuable data was missing. Also, lethality scales were not used and thus could not be measured. Conclusion: Men over the age of 25 years, widowed or divorced, and/or with psychotic disorder were more likely to engage in near-fatal deliberate self-harm.
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Estado Civil/estatística & dados numéricos , Transtornos Psicóticos/epidemiologia , Tentativa de Suicídio/estatística & dados numéricos , Adulto , Fatores Etários , Emigrantes e Imigrantes/psicologia , Emigrantes e Imigrantes/estatística & dados numéricos , Emprego/estatística & dados numéricos , Feminino , Esperança , Hospitalização , Humanos , Comportamento Impulsivo , Masculino , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Transtornos do Humor/epidemiologia , Transtornos do Humor/psicologia , Transtornos Psicóticos/psicologia , Catar , Religião , Características de Residência/estatística & dados numéricos , Fatores Sexuais , Sono , Tentativa de Suicídio/psicologia , Adulto JovemRESUMO
This article explores predictors of job satisfaction and stress among clinicians and administrative staff at the public health sector in the State of Qatar. This is a rapidly growing sector, aiming for excellence in service, education and research. The vast majority of the staff are expatriates with different cultural backgrounds, and varying qualifications. After obtaining ethical approvals to conduct the study, the target population were asked to complete an anonymous online survey, that included sociodemographic data followed by the National Institute for Occupational Safety and Health (NIOSH) generic Job Stress questionnaire. Total number included in the analysis is 1260, female, married with children. Role ambiguity, conflict, skill underutilization and workload were associated with job dissatisfaction. Role and job future ambiguity were significantly associated with depression.
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Esgotamento Profissional/epidemiologia , Pessoal de Saúde/estatística & dados numéricos , Satisfação no Emprego , Adulto , Esgotamento Profissional/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Catar/epidemiologia , Fatores de Risco , Adulto JovemRESUMO
BACKGROUND: Visual rating of medial temporal lobe atrophy (MTA) is an accepted structural neuroimaging marker of Alzheimer's disease. Corneal confocal microscopy (CCM) is a non-invasive ophthalmic technique that detects neuronal loss in peripheral and central neurodegenerative disorders. OBJECTIVE: To determine the diagnostic accuracy of CCM for mild cognitive impairment (MCI) and dementia compared to medial temporal lobe atrophy (MTA) rating on MRI. METHODS: Subjects aged 60-85 with no cognitive impairment (NCI), MCI, and dementia based on the ICD-10 criteria were recruited. Subjects underwent cognitive screening, CCM, and MTA rating on MRI. RESULTS: 182 subjects with NCI (nâ=â36), MCI (nâ=â80), and dementia (nâ=â66), including AD (nâ=â19, 28.8%), VaD (nâ=â13, 19.7%), and mixed AD (nâ=â34, 51.5%) were studied. CCM showed a progressive reduction in corneal nerve fiber density (CNFD, fibers/mm2) (32.0±7.5 versus 24.5±9.6 and 20.8±9.3, pâ<â0.0001), branch density (CNBD, branches/mm2) (90.9±46.5 versus 59.3±35.7 and 53.9±38.7, pâ<â0.0001), and fiber length (CNFL, mm/mm2) (22.9±6.1 versus 17.2±6.5 and 15.8±7.4, pâ<â0.0001) in subjects with MCI and dementia compared to NCI. The area under the ROC curve (95% CI) for the diagnostic accuracy of CNFD, CNBD, CNFL compared to MTA-right and MTA-left for MCI was 78% (67-90%), 82% (72-92%), 86% (77-95%) versus 53% (36-69%) and 40% (25-55%), respectively, and for dementia it was 85% (76-94%), 84% (75-93%), 85% (76-94%) versus 86% (76-96%) and 82% (72-92%), respectively. CONCLUSION: The diagnostic accuracy of CCM, a non-invasive ophthalmic biomarker of neurodegeneration, was high and comparable with MTA rating for dementia but was superior to MTA rating for MCI.
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Encéfalo/diagnóstico por imagem , Disfunção Cognitiva/diagnóstico por imagem , Córnea/diagnóstico por imagem , Córnea/inervação , Demência/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/psicologia , Demência/psicologia , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Microscopia Confocal/métodos , Pessoa de Meia-Idade , Nervo Oftálmico/diagnóstico por imagemRESUMO
OBJECTIVES: Corneal confocal microscopy (CCM) is a noninvasive ophthalmic technique that identifies corneal nerve degeneration in a range of peripheral neuropathies and in patients with multiple sclerosis, Parkinson's disease, and amyotrophic lateral sclerosis. We sought to determine whether there is any association of corneal nerve fiber measures with cognitive function and functional independence in patients with MCI and dementia. METHODS: In this study, 76 nondiabetic participants with MCI (n = 30), dementia (n = 26), and healthy age-matched controls (n = 20) underwent assessment of cognitive and physical function and CCM. RESULTS: There was a progressive reduction in corneal nerve fiber density (CNFD), branch density (CNBD), and fiber length (CNFL) (P < 0.0001) in patients with MCI and dementia compared to healthy controls. Adjusted for confounders, all three corneal nerve fiber measures were significantly associated with cognitive function (P < 0.05) and functional independence (P < 0.01) in MCI and dementia. The area under the ROC curve to distinguish MCI with CNFD, CNBD, and CNFL was 69.1%, 73.2%, and 73.0% and for dementia it was 84.8%, 84.2%, and 86.2%, respectively. INTERPRETATION: CCM demonstrates corneal nerve fiber loss, which is associated with a decline in cognitive function and functional independence in patients with MCI and dementia.
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Cognição/fisiologia , Córnea/inervação , Demência/patologia , Fibras Nervosas/patologia , Idoso , Demência/etiologia , Neuropatias Diabéticas/patologia , Neuropatias Diabéticas/fisiopatologia , Feminino , Humanos , Masculino , Microscopia Confocal/métodos , Pessoa de Meia-Idade , Doença de Parkinson/patologiaAssuntos
Antineoplásicos/uso terapêutico , Antipsicóticos/efeitos adversos , Clozapina/efeitos adversos , Neoplasias/tratamento farmacológico , Neutropenia/induzido quimicamente , Esquizofrenia/tratamento farmacológico , Adulto , Antineoplásicos/sangue , Antipsicóticos/sangue , Bleomicina/sangue , Bleomicina/uso terapêutico , Neoplasias da Mama/sangue , Neoplasias da Mama/complicações , Neoplasias da Mama/tratamento farmacológico , Carcinoma/sangue , Carcinoma/complicações , Carcinoma/tratamento farmacológico , Cisplatino/sangue , Cisplatino/uso terapêutico , Clozapina/sangue , Etoposídeo/sangue , Etoposídeo/uso terapêutico , Feminino , Humanos , Neoplasias Intestinais/sangue , Neoplasias Intestinais/complicações , Neoplasias Intestinais/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Neoplasias/sangue , Neoplasias/complicações , Esquizofrenia/sangue , Esquizofrenia/complicações , Seminoma/sangue , Seminoma/complicações , Seminoma/tratamento farmacológico , Neoplasias Testiculares/sangue , Neoplasias Testiculares/complicações , Neoplasias Testiculares/tratamento farmacológicoRESUMO
This study sought to explore the impact of smoking reduction on suicidality (suicide ideation and behaviour) among people with a psychotic disorder (n=235) who participated in a randomized trial of a healthy lifestyle intervention trial. Suicidality, measured by item -4 of the Brief Psychiatric Rating Scale (BPRS) was the main variable of interest. Measures were collected by research assistants blind to treatment allocation at baseline, at 15 weeks (mid-intervention) and 12 months after baseline. Mediation analysis, adjusted for confounders, was used to determine the relationship between smoking reduction and suicidality and to explore whether this was mediated through depression. At 12 months, smoking reduction was found to be significantly associated with suicidality change; an association was also seen between smoking reduction and depression and depression and suicidality. After adjusting for depression, the association between smoking reduction and suicidality was attenuated but remained statistically significant; the proportion of the total effect that was mediated through depression was 30%. There was no significant association between suicidality and treatment group (vs. controls) over time. Our study suggests that smoking interventions may have benefits over and above those for improved physical health, by reducing suicidal ideation in people with psychosis.