Assessment of the Readability and Quality of Online Information for Patients and Their Families Regarding Schizophrenia.

ABSTRACT: To our knowledge, this is the first study that specifically aims to assess the readability and quality of online information about schizophrenia. The analysis is performed on 93 of 195 websites that appeared in an advanced Google search of the term "schizophrenia" performed on a single day. The websites were categorized as commercial, nonprofit, professional, and government. The websites were evaluated using the Health on the Net Foundation (HON) code certificate, DISCERN tool, and Journal of the American Medical Association ( JAMA ) benchmark criteria for quality and the Flesch Reading Ease Formula, Flesch-Kincaid Grade Level (FKGL) Formula, Simple Measure of Gobbledygook, and Gunning Fog indices for readability. A total of 21.5% of all websites had a HON code certificate, 50.5% were accepted as high quality ( JAMA score ≥3), and 25.8% reached the recommended readability level (FKGL ≤8). Only three websites scored at a fifth- to sixth-grade reading level. Commercial and government websites had significantly lower DISCERN scores. Commercial websites had significantly lower Flesch Reading Ease Score and FKGL score than nonprofit websites. In conclusion, the current findings indicate that the quality of online information on schizophrenia is generally acceptable, but the readability is insufficient. Website creators, physicians, and health authorities should be more sensitive to the readability of online information about schizophrenia, considering the poor cognitive capacity of the patients and the unique nature of the disease.

What Our Patients and Their Families Are Reading: Quality and Readability of Internet Information About Electroconvulsive Therapy.

OBJECTIVES: The Internet is now more widely used than before by psychiatric patients and their families to search for medical conditions and treatments. To our knowledge, no study has addressed the quality and readability of online information about electroconvulsive therapy (ECT). We aimed to examine the quality and readability of English-language Internet information related to ECT. METHODS: An advanced search of Internet Web sites containing information about ECT was conducted by using the search term "ECT or electroconvulsive therapy." The resulting Web sites were categorized into 1 of 3 categories (commercial, nonprofit, or professional organizations). Their quality was evaluated using Health on the Net code certification, the Journal of the American Medical Association (JAMA) benchmark criteria, and the DISCERN tool. The readability of the Web sites was assessed using the Flesch Reading Ease, Flesch-Kincaid Grade Level Formula, Simple Measure of Gobbledygook, and Gunning Fog indexes. RESULTS: A total of 86 Web sites were included in the analysis. Of all these Web sites, 18 (20.9%) had a Health on the Net code certificate, and 16 (18.6%) were accepted as high quality (JAMA total score ≥3). The commercial Web sites had significantly lower DISCERN and JAMA benchmark scores compared with the other Web sites. A total of 30.23% of all the Web sites reached the recommended readability level (Flesch-Kincaid Grade Level Formula ≤ 8). Moreover, only 4 scored at the grade 5 to 6 reading level, which is considered ideal for patient educational materials. CONCLUSIONS: Our study indicates that both the quality and readability of online information about ECT are not at the desired level. Physicians, patients, and their families should consider this failure in relation to online information about ECT. In addition, Web site creators and health authorities should be aware of their responsibilities for providing quality and readable health information to the public.

Demographic and Clinical Factors Related to Severe COVID-19 Infection and Mortality in Patients With Schizophrenia.

ABSTRACT: We aimed to explore the prevalence and determinants of severe COVID-19 disease and mortality in patients with schizophrenia in this study. We conducted a retrospective observational study of 1620 patients with schizophrenia. Of the 1620 patients, 52 (3.2%) tested positive for SARS-CoV-19. Among SARS-CoV-2-positive patients, 40 patients were hospitalized, and 17 patients required intensive care unit admission due to COVID-19 (76.9% and 32.7%, respectively). Severe COVID-19 disease was noted in 17 patients (32.7%) requiring intubation. In the logistic regression analysis, antipsychotic dose, and comorbidity score were independently associated with a greater risk of severe COVID-19 disease in patients with schizophrenia. Our study suggests that factors such as age, sex, comorbidities, and a daily antipsychotic dose may have effects on the poor outcome of SARS-CoV-2 disease in schizophrenia patients. In addition, the current findings propose that mortality may be associated with an older age, comorbidity score, and a longer duration of psychiatric disease among the SARS-CoV-2-positive patients with schizophrenia. However, the findings of our study should be verified in prospective and larger sample studies.

Neurological Soft Signs and Clinical Features of Tic-Related Obsessive-Compulsive Disorder Indicate a Unique Subtype.

Tic-related obsessive-compulsive disorder (OCD) may be a unique OCD subtype. This study examined whether neurological soft signs (NSSs) of patients with tic-related and tic-free OCD enable discrimination of these subgroups. We used the Neurological Evaluation Scale to assess 32 patients with tic-related and 94 with tic-free OCD, as well as 84 controls. Most patients with tic-related OCD were male, with earlier illness onset and poorer insight scores than those of patients with tic-free OCD. Patients with tic-related OCD had poorer motor coordination, sensory integration, and motor sequencing than did tic-free patients. Logistic regression using NSS subscale scores predicted tic-related OCD. Patients with tic-related OCD displayed greater neurodevelopmental abnormalities than did tic-free patients. NSSs of the former group suggest the need to separate this subgroup. Our results also support the newly introduced tic-related specifier in the fifth edition of the Diagnostic and statistical manual of mental disorders.

Early diagnosis of acute coronary syndrome.

The diagnostic evaluation of acute chest pain has been augmented in recent years by advances in the sensitivity and precision of cardiac troponin assays, new biomarkers, improvements in imaging modalities, and release of new clinical decision algorithms. This progress has enabled physicians to diagnose or rule-out acute myocardial infarction earlier after the initial patient presentation, usually in emergency department settings, which may facilitate prompt initiation of evidence-based treatments, investigation of alternative diagnoses for chest pain, or discharge, and permit better utilization of healthcare resources. A non-trivial proportion of patients fall in an indeterminate category according to rule-out algorithms, and minimal evidence-based guidance exists for the optimal evaluation, monitoring, and treatment of these patients. The Cardiovascular Round Table of the ESC proposes approaches for the optimal application of early strategies in clinical practice to improve patient care following the review of recent advances in the early diagnosis of acute coronary syndrome. The following specific 'indeterminate' patient categories were considered: (i) patients with symptoms and high-sensitivity cardiac troponin <99th percentile; (ii) patients with symptoms and high-sensitivity troponin <99th percentile but above the limit of detection; (iii) patients with symptoms and high-sensitivity troponin >99th percentile but without dynamic change; and (iv) patients with symptoms and high-sensitivity troponin >99th percentile and dynamic change but without coronary plaque rupture/erosion/dissection. Definitive evidence is currently lacking to manage these patients whose early diagnosis is 'indeterminate' and these areas of uncertainty should be assigned a high priority for research.

The connections among suicidal behavior, lipid profile and low-grade inflammation in patients with major depressive disorder: a specific relationship with the neutrophil-to-lymphocyte ratio.

OBJECTIVES: The role of inflammation and lipid metabolism in the pathophysiology of suicidal behavior has received particular attention in recent years. The neutrophil-to-lymphocyte ratio (NLR) has been suggested as a new and more reliable indicator of low-grade inflammation. NLR has been found to be altered in major depressive disorder (MDD) and has been related to various factors, including chronic stress and impulsivity that were previously reported to be related to suicidal behavior. We aimed to explore the roles of NLR, C-reactive protein (CRP) and serum lipid levels on suicidal behavior in patients with MDD. METHODS: The study group consisted of 139 inpatients diagnosed with MDD [37 suicide attempters (SA); 102 suicide non-attempters (NSA)], 50 healthy controls and matched according to age, gender and education. NLR, PLR, CRP and lipid values were obtained from digital inpatient records. RESULTS: CRP levels and NLR were substantially higher in patients with SA than in subjects with NSA and healthy comparison subjects after adjusting the confounding factors. The logistic regression included two predictive variables for suicide status in patients with depressive disorder (A) previous suicidal history; (B) NLR. CONCLUSIONS: This is the first study suggesting that NLR may be a trait marker for suicidal vulnerability via a relationship between NLR and a recent suicide attempt in depressed inpatients. Future prospective studies are needed to determine the exact roles of NLR, and other inflammatory markers on suicidality in MDD.

The relationship between clinical characteristics, metacognitive appraisals, and cognitive insight in patients with obsessive-compulsive disorder.

BACKGROUND: Cognitive insight, a recently developed insight measure, refers to metacognitive processes of the re-evaluation and correction of distorted beliefs and misinterpretations. However, to the best of the authors' knowledge, no study has specifically examined cognitive insight, demographics, psychopathological variables, and distorted beliefs in OCD. AIM: The aim of this research was to examine links between cognitive insight and demographics, clinical factors, and distorted beliefs among patients with OCD. METHOD: Eighty-four consecutive outpatients with a diagnosis of OCD underwent a detailed clinical assessment for OCD, including the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Beck Cognitive Insight Scale (BCIS), Thought-Action Fusion Scale (TAFS), White Bear Thought Suppression Inventory, Metacognition Questioniarre-30 (MCQ-30), and a sociodemographic questionnaire. In addition, 82 control subjects matched for age, education, and gender were tested. RESULTS: BCIS-self-certainty scores were all substantially higher in subjects with remitted and unremitted OCD than in healthy comparison subjects, while BCIS-composite scores were significantly lower in both patient groups than controls. Obsession and compulsion severity had significant effects on BCIS scores. In addition, it was found that the specific symptoms were linked to self-certainty scores. Self-reflectiveness and composite scores had positive correlations with the sub-scale scores of the MCQ-30, while the TAF-morality score was positively correlated with self-certainty scores. CONCLUSION: The results demonstrated poor cognitive insight among remitted and unremitted OCD patients. In addition, the present study suggested significant associations between sociodemographic and clinical features and dysfunctional appraisals. Cognitive-behavioural techniques aimed at enhancing cognitive insight may be beneficial for patients with OCD, particularly patients who have prominent dysfunctional beliefs.

Association between insight, cognitive insight, positive symptoms and violence in patients with schizophrenia.

BACKGROUND: Violence is a significant clinical and public concern and is a frequent occurrence in patients with schizophrenia. The relationship between insight and violence remains controversial. In addition, there is a lack of research on insight, cognitive insight, demographic and psychopathologic variables in violent versus nonviolent schizophrenia patients. AIM: We aimed to compare insight, cognitive insight, psychopathological and demographic variables in violent and nonviolent subjects suffering from schizophrenia. In addition, we aimed to determine the demographic and clinical predictors of violent behaviour in patients with schizophrenia. METHOD: We recruited 133 schizophrenic patients without concomitant substance abuse or axis II disorder. Diagnoses were based on the SCID-I and SCID-II. Violent behaviours were assessed using the Overt Aggression Scale. Insight and cognitive insight were assessed with the Scale to Assess Unawareness of Mental Disorder and the Beck Cognitive Insight Scale, respectively. RESULTS: We compared 47 patients with violent schizophrenia with 86 nonviolent patients. Non-violent patients had more severe depression, lower scores on positive symptoms, better clinical insight, more self-reflectivity and higher R-C index scores than did violent patients. In addition, history of violence, lower self-reflectiveness, worse clinical insight and delusion severity were significant predictors of violence in schizophrenia. CONCLUSION: The present study suggests that the inclusion of insight and cognitive insight may increase the prediction of violence in this population. In addition, clinicians should consider using non-pharmacological techniques that are based on cognitive behaviour therapy and enhance insight, particularly cognitive insight, among patients with schizophrenia who exhibit violent behaviour.

Temperament and character personality profile in relation to suicide attempts in patients with schizophrenia.

INTRODUCTION: Schizophrenia is associated with a significant risk of suicide, and suicide still remains one of the main causes of death in schizophrenic patients. Beside classic risk factors for suicidality, temperament and character traits have been researched and considered as risk factors for suicidal behavior in recent years. METHOD: Subjects were 94 patients with schizophrenia who were under treatment. All patients were in a stable phase of the illness. Patients with lifetime suicide attempt (n = 46) and without suicidal attempt (n = 48) were compared with each other in terms of temperament and character traits by using the Temperament and Character Inventory. RESULTS: Harm avoidance and persistence scores were higher in suicidal schizophrenic patients compared with nonsuicidal schizophrenic patients. The scores of self-directedness and cooperativeness were lower in suicidal schizophrenic patients compared with nonsuicidal schizophrenic patients. These 4 variables remained significant predictors of lifetime suicidal attempts in a logistic regression model. CONCLUSION: To the best of our knowledge, the present study is the first that specifically compares schizophrenic patients with and without suicidal behavior by the Cloninger temperament and character model. Our data indicate that schizophrenic patients will show a greater risk for suicide according to certain personality configurations. However, to establish causal relationships between personality and suicidality in schizophrenia, longitudinal studies are warranted within a multifactorial interactive framework of biologic and clinical variables.

The relationship between cognitive insight, clinical insight, and depression in patients with schizophrenia.

Despite comorbid depression being relatively common even in subjects with schizophrenia, to the best of our knowledge, there is, to date, no report in the literature specifically and detailed examining the cognitive and clinical insight in subjects with schizophrenia and a comorbid depressive syndrome. Hence, in this study, we sought to compare the cognitive and clinical insight in our subjects with schizophrenia with and without a comorbid depressive syndrome. We found that participants in the depressive group scored significantly higher on self-reflectiveness and the reflectiveness-certainty (R-C) index scores than those in the nondepressive group. There was no significant difference among groups on the Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms, and clinical insight scores assessed by the Scale to Assess Unawareness of Mental Disorder. In addition, self-reflectiveness scores significantly correlated with depression, observed depression, hopelessness, and suicidality subscores of the Calgary Depression Scale for Schizophrenia. A better understanding of the cognitive component of insight in schizophrenia with comorbid depression may contribute to develop more efficient cognitive strategies, thus improving patient outcome. However, clinicians should be aware of the possibility of exacerbating a sense of hopelessness and suicide risk during the interventions that improve cognitive insight.

Cognitive insight and its relationship with symptoms in deficit and nondeficit schizophrenia.

Patients with deficit schizophrenia have worse cognition and poorer social functioning compared with those with nondeficit schizophrenia. Insight is another domain in which these two groups might differ. However, there is no literature data specifically on cognitive insight impairment in deficit versus nondeficit schizophrenia. We compared 40 patients with deficit schizophrenia with 81 nondeficit patients and found that schizophrenic patients with deficit syndrome were more self-reflective and have higher self-reflectiveness-self-certainty index scores than did those without deficit syndrome. These differences remained significant when analysis was controlled for sex, age, education, and depression severity. On the other hand, there was no significant difference in self-certainty scores between two groups. In addition, we found significant relationships between cognitive insight and specific psychotic symptoms. A better understanding of the cognitive component of insight in schizophrenia with deficit syndrome may help us to understand the true relationship between insight and negative symptoms and contribute to the development of more efficient cognitive strategies, thus improving patients' outcome in a severely disabled psychiatric patient group.

Short-term, but not long-term, beneficial effects of concomitant benzodiazepine use on clinical course in patients with schizophrenia.

This study aims to examine possible differences in the effect on the course characteristics of the disease in cases of no use, short-term use and long-term use of benzodiazepines in patients with schizophrenia. In this retrospective observational study, the sample comprised patients with schizophrenia who were admitted to our psychiatric clinics from January 2015 to January 2019. Patients were also retrospectively tracked from the date of the first admission during the specified time until the end of the observation period (24 months) for clinical course characteristics. Data for 1710 patients with schizophrenia were included in the analyses. Patients with short-term benzodiazepines use had fewer psychiatric hospitalizations and shorter lengths of stay at psychiatric services than patients with no use or long-term use. Rates of antipsychotic drug discontinuation and suicidal behavior were also significantly lower among short-term benzodiazepines users than among those with no use or long-term use. In conclusion, our study indicates that short-term benzodiazepines use is associated with a better clinical course in patients with schizophrenia. Future studies should evaluate the effects of different benzodiazepines use patterns on disease prognosis with longer-term follow-up and prospective methodology and should concomitantly examine psychopathological variables.

Development and validation of ACTE-MTB: A tool to systematically assess the maturity of molecular tumor boards.

Molecular tumor boards (MTBs) require specialized activities to leverage genomic data for therapeutic decision-making. Currently, there are no defined standards for implementing, executing, and tracking the impact of MTBs. This study describes the development and validation of ACTE-MTB, a tool to evaluate the maturity of an organization's MTB to identify specific areas that would benefit from process improvements and standardization. The ACTE-MTB maturity assessment tool is composed of 3 elements: 1) The ACTE-MTB maturity model; 2) a 59-question survey on MTB processes and challenges; and 3) a 5-level MTB maturity scoring algorithm. This tool was developed to measure MTB maturity in the categories of Access, Consultation, Technology, and Evidence (ACTE) and was tested on 20 MTBs spanning the United States, Europe, and Asia-Pacific regions. Validity testing revealed that the average maturity score was 3.3 out of 5 (+/- 0.1; range 2.0-4.3) with MTBs in academic institutions showing significantly higher overall maturity levels than in non-academic institutions (3.7 +/- 0.2 vs. 3.1 +/- 0.2; P = .018). While maturity scores for academic institutions were higher for Consultation, Technology, and Evidence domains, the maturity score for the Access domain did not significantly differ between the two groups, highlighting a disconnect between MTB operations and the downstream impact on ability to access testing and/or therapies. To our knowledge, ACTE-MTB is the first tool of its kind to enable structured, maturity assessment of MTBs in a universally-applicable manner. In the process of establishing construct validity of this tool, opportunities for further investigation and improvements were identified that address the key functional areas of MTBs that would likely benefit from standardization and best practice recommendations. We believe a unified approach to assessment of MTB maturity will help to identify areas for improvement at both the organizational and system level.

Evaluation of a clinical decision support tool for matching cancer patients to clinical trials using simulation-based research.

There is a growing need for alternative methodologies to evaluate digital health solutions in a short timeframe and at relatively low cost. Simulation-based research (SBR) methods have been proposed as an alternative methodology for evaluating digital health solutions; however, few studies have described the applicability of SBR methods to evaluate such solutions. This study used SBR to evaluate the feasibility and user experience of a clinical decision support (CDS) tool used for matching cancer patients to clinical trials. Twenty-five clinicians and research staff were recruited to match 10 synthetic patient cases to clinical trials using both the CDS tool and publicly available online trial databases. Participants were significantly more likely to report having sufficient time (p = 0.020) and to require less mental effort (p = 0.001) to complete trial matching with the CDS tool. Participants required less time for trial matching using the CDS tool, but the difference was not significant (p = 0.093). Most participants reported that they had sufficient guidance to participate in the simulations (96%). This study demonstrates the use of SBR methods is a feasible approach to evaluate digital health solutions and to collect valuable user feedback without the need for implementation in clinical practice. Further research is required to demonstrate the feasibility of using SBR to conduct remote evaluations of digital health solutions.

Relationship of trait impulsivity with clinical presentation in euthymic bipolar disorder patients.

The purpose of this study was to examine trait impulsivity in patients with bipolar disorder and explore the possible connections between impulsivity and clinical presentation of the illness. Diagnoses were based on the Structured Clinical Interview for DSM-IV. The sociodemographic and clinical properties of 71 patients with bipolar disorder, who were euthymic according to Young Mania Rating Scale and Hamilton Depression Scale scores, were recorded. Their trait impulsivity was evaluated by using the Barratt Impulsiveness Scale (BIS) and impulsivity subscale of the Temperament and Character Inventory, and the results were compared with 50 age- and sex-matched healthy controls and among patients with different clinical properties. All BIS-11 subscale scores were higher in bipolar than in comparison subjects. There were no effects of education and age. Elevated BIS-11 scores were associated with predominant depressive polarity, longer duration of illness and a history of psychotic mood episodes and suicide attempts. These relationships persisted when age, gender, and education were taken into account. These results show that after accounting for common confounding factors, trait-like impulsivity was substantially higher in subjects with bipolar disorder than in nonbipolar comparison subjects and may vary according to different clinical presentations.

Impulsivity in euthymic patients with major depressive disorder: the relation to sociodemographic and clinical properties.

The purpose of this study was to examine the trait impulsivity of patients with a major depressive disorder and to explore the possible connections between impulsivity and clinical and sociodemographic variables. The sociodemographic and clinical properties of 60 patients with major depression, who were euthymic according to Hamilton Depression Scale scores, were recorded. Their trait impulsivity was evaluated using the Barratt Impulsiveness Scale (BIS-11) and the impulsivity subscale of the Temperament and Character Inventory, and the results were compared with those of 50 age- and sex-matched healthy controls. We used general linear model analysis to evaluate the manner in which the variables contributed to BIS-11 scores. Some impulsivity scores were higher in those with a major depressive disorder than in comparison subjects. There were significant effects of education and sex in these differences. Elevated BIS-11 scores were associated with a history of psychotic mood episode and suicide attempts. These relationships persisted when age, sex, and education were taken into account. These results show that, after accounting for common confounding factors, trait-like impulsivity was substantially higher in subjects with major depressive disorder than in comparison subjects and may be associated with sociodemographic and clinical properties.

A novel way of standardized and automized retrieval of timing information along clinical pathways.

Improving the effectiveness and efficiency of acute healthcare is very important nowadays. Optimization of clinical pathways regarding quality, time and costs is one of the key management strategies of critical diseases such as heart attack and stroke. To identify workflow bottlenecks requires a thorough understanding about both the hospital environment (e.g. IT-systems) and processes (e.g. clinical pathways). Having in mind the interoperability issues in hospitals, the standardized division- and system-crossing time measurement is still a challenge. Therefore this paper presents a novel way of structured and standardized retrieval of timing information along the clinical pathway of time-critical diseases in the context of hospital IT-systems, which represents a promising opportunity to identify workflow bottlenecks over several departmental and system borders.

Benefits of switching women schizophrenic patients to aripiprazole: a case study and brief review of the literature.

Hyperprolactinemia, an adverse side-effect of the use of typical and some atypical antipsychotics, has both acute and chronic clinical consequences. When observed in schizophrenic patients, it may be treated by switching the patient to an antipsychotic agent with a lower liability for the induction of hyperprolactinemia. The effects of substituting aripiprazole for other antipsychotic agents on schizophrenic patients with antipsychotic-induced hyperprolactinemia have been previously reported in several studies. Many studies have also noted that aripiprazole can sometimes lead to increases in psychotic symptoms, especially in the period immediately following the switch or when aripiprazole is combined with a dopamine antagonist. Here, we report observations on five female patients who were experiencing symptomatic hyperprolactinemia and psychotic exacerbation while on antipsychotic treatment, yet improved in both conditions after being switched to aripiprazole monotherapy. We also provide a brief review of the existing studies that report the results of switching patients from other antipsychotics to aripiprazole.

Atrial septal defects type II: noninvasive evaluation of patients before implantation of an Amplatzer Septal Occluder and on follow-up by magnetic resonance imaging compared with TEE and invasive measurement.

The purpose of this study was to evaluate morphological and functional MRI of atrial septal defects (ASD) before and after interventional occlusion by the Amplatzer Septal Occluder (AOC) in comparison to trans-oesophageal echocardiography (TEE), invasive balloon measurement (IVBM) and cardiac catheterisation (QCC). Sixty patients with an ASD type II were enrolled. They underwent TEE, IVBM, QCC and MRI at 1.5T. Cine gradient echo, steady-state free precession sequences and a gradient echo phase contrast sequence were used. In MRI, pulmonary-to-systemic flow ratio (Qp/Qs) was calculated and compared with the QCC Qp/Qs ratio. Qp/Qs ratio in baseline MRI examination was 1.56 +/- 0.29 (range: 1.05-2.2) and in QCC 1.71 +/- 0.30 (range: 1.2-2.4) with a significant correlation (R = 0.65, P < 0.01). Defect size on MRI was 15.3 +/- 7.4 mm (range: 3-30 mm), in TEE 14.3 +/- 4.9 mm (range: 4-24 mm), and the balloon stretched diameter in IVBM was 23.4 +/- 4.2 mm (range: 14-32 mm). Correlation between defect size in MRI vs. TEE was R = 0.67 (P < 0.01) and MRI vs. IVBM was R = 0.77 (P < 0.01). Right ventricular volumes decreased after intervention. MRI is an accurate noninvasive test for diagnosis, planning and follow-up after interventional ASD occlusion using an AOC.