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1.
J Clin Psychopharmacol ; 44(2): 117-123, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38230861

RESUMO

BACKGROUND: As clinical practices with lithium salts for patients diagnosed with bipolar disorder (BD) are poorly documented in Asia, we studied the prevalence and clinical correlates of lithium use there to support international comparisons. METHODS: We conducted a cross-sectional study of use and dosing of lithium salts for BD patients across 13 Asian sites and evaluated bivariate relationships of lithium treatment with clinical correlates followed by multivariate logistic regression modeling. RESULTS: In a total of 2139 BD participants (52.3% women) of mean age 42.4 years, lithium salts were prescribed in 27.3% of cases overall, varying among regions from 3.20% to 59.5%. Associated with lithium treatment were male sex, presence of euthymia or mild depression, and a history of seasonal mood change. Other mood stabilizers usually were given with lithium, often at relatively high doses. Lithium use was associated with newly emerging and dose-dependent risk of tremors as well as risk of hypothyroidism. We found no significant differences in rates of clinical remission or of suicidal behavior if treatment included lithium or not. CONCLUSIONS: Study findings clarify current prevalence, dosing, and clinical correlates of lithium treatment for BD in Asia. This information should support clinical decision-making regarding treatment of BD patients and international comparisons of therapeutic practices.


Assuntos
Transtorno Bipolar , Humanos , Masculino , Feminino , Adulto , Transtorno Bipolar/tratamento farmacológico , Transtorno Bipolar/epidemiologia , Transtorno Bipolar/induzido quimicamente , Lítio/uso terapêutico , Estudos Transversais , Farmacoepidemiologia , Sais/uso terapêutico , Antimaníacos/uso terapêutico , Compostos de Lítio/uso terapêutico
2.
J Clin Psychopharmacol ; 43(3): 278-282, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37068038

RESUMO

BACKGROUND: Pharmacoepidemiological studies of clozapine use to treat bipolar disorder (BD), especially in Asia, are rare, although they can provide insights into associated clinical characteristics and support international comparisons of indications and drug dosing. METHODS: We examined the prevalence and clinical correlates of clozapine treatment for BD in 13 Asian countries and regions (China, Hong Kong SAR, India, Indonesia, Japan, Korea, Malaysia, Myanmar, Pakistan, Singapore, Sri Lanka, Taiwan, and Thailand) within an Asian Prescription Patterns Research Consortium. We compared BD patients treated with clozapine or not in initial bivariate comparisons followed by multivariable logistic regression modeling. RESULTS: Clozapine was given to 2.13% of BD patients overall, at a mean daily dose of 275 (confidence interval, 267-282) chlorpromazine-equivalent mg/day. Patients receiving clozapine were older, more likely males, hospitalized, currently manic, and given greater numbers of mood-stabilizing and antipsychotic drugs in addition to clozapine. Logistic regression revealed that older age, male sex, current mania, and greater number of other antipsychotics remained significantly associated with clozapine treatment. Clozapine use was not associated with depressed mood, remission of illness, suicidal risk, or electroconvulsive treatment within the previous 12 months. CONCLUSIONS: The identified associations of clozapine use with particular clinical features call for vigilance in personalized clinical monitoring so as to optimize clinical outcomes of BD patients and to limit risks of adverse effects of polytherapy.


Assuntos
Antipsicóticos , Transtorno Bipolar , Clozapina , Humanos , Masculino , Clozapina/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Antipsicóticos/efeitos adversos , Psicotrópicos/uso terapêutico , Prescrições
3.
J Nerv Ment Dis ; 211(11): 876-880, 2023 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-37890027

RESUMO

ABSTRACT: In this study, we examined the cerebellar dysfunction in schizophrenia by evaluating the clinical, cognitive, resilience, and coping correlates of cerebellar signs (CSs) in 162 subjects (63 patients with schizophrenia and 99 healthy controls). The presence of CS was evaluated based on six clinical tests. Measures to assess the severity of psychopathology, cognitive functioning, resilience, and frequency of coping strategies used were included. Patients had more CS than controls. Patients with more CS were older, had more severe psychopathology, had poorer performance on Brief Assessment of Cognition for Schizophrenia token motor task, and used less self-distraction as a coping strategy than those with fewer CS. Patients without CS used less self-blame coping at higher level of resilience. The association of less self-distraction with more CS may be related to cognitive inflexibility as a result of cerebellar dysfunction. Greater attentiveness to the presence of CS in schizophrenia patients may aid in better management of their psychotic condition.


Assuntos
Doenças Cerebelares , Transtornos Cognitivos , Disfunção Cognitiva , Esquizofrenia , Humanos , Esquizofrenia/diagnóstico , Testes Neuropsicológicos , Transtornos Cognitivos/psicologia , Cognição , Adaptação Psicológica , Doenças Cerebelares/complicações , Disfunção Cognitiva/complicações
4.
J Clin Psychopharmacol ; 42(3): 293-297, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35384905

RESUMO

BACKGROUND: Because use and dosing of mood stabilizers (MSs) to treat bipolar disorder (BD) patients in Asia are not well documented, we examined prevalence and clinical correlates of treatment of Asian BD patients with relatively high doses of MSs. METHODS: We conducted a pharmacoepidemiological survey across 13 Asian countries and territory in the Research on Asian Psychotropic Prescription Patterns Consortium. Mood stabilizer doses were converted to lithium carbonate equivalents (Li-eq milligrams per day). We compared relatively high (>900 Li-eq mg/day) versus lower MS doses by bivariate comparisons, followed by multivariable linear regression to identify factors associated with higher MS doses. RESULTS: Among 1647 participants, MS dose averaged 584 (confidence interval, 565-603 Li-eq mg/d). Preliminarily, the 13.1% of the subjects given greater than 900 mg/d versus those given lower doses were younger, male, currently hospitalized, not currently depressed, and reported lifetime suicidal ideation; they also received relatively high doses of antipsychotics, received electroconvulsive treatment within the previous 12 months, and had greater ratings of tremors and sedation. By linear regression modeling, the mean proportion given high doses of MS was associated significantly and independently with higher doses of antipsychotics, younger age, male sex, hospitalized, more years of illness, country, higher body mass index, recent electroconvulsive treatment, and being in illness remission. CONCLUSIONS: Relatively high doses of MSs for BD are prevalent, but vary markedly among Asian countries, and are particularly likely among young males, ill for many years, and given high doses of antipsychotics or ECT. These characteristics allow better identification of patient profiles that can guide treatment of BD patients.


Assuntos
Antipsicóticos , Transtorno Bipolar , Anticonvulsivantes/uso terapêutico , Antimaníacos , Transtorno Bipolar/tratamento farmacológico , Humanos , Lítio/uso terapêutico , Masculino , Padrões de Prática Médica , Prescrições , Psicotrópicos/uso terapêutico
5.
Artigo em Inglês | MEDLINE | ID: mdl-35173792

RESUMO

OBJECTIVE: In light of the substantial clinical and societal burden of social phobia (SP) and impact on the sense of well-being of affected individuals, we sought to summarise extant data related to quality of life and relevant correlates in adults with SP to distill clinical profiles for earlier identification and appropriate management. METHODS: A scoping review was carried out on studies examining quality of life in adults with SP and clinical correlates within different settings. PubMed/Medline and Web of Science databases were searched for relevant articles beginning from database inception until May 2021. RESULTS: A total of 25 papers were included. Most of the studies (92%) were cross sectional in nature (80%), conducted in the West (92%), and within clinic or community settings (88%). Patients with comorbid psychiatric conditions, and undergraduate students reported higher rates of SP compared with community population. Significant correlates of SP included demographic (such as females, younger age, living alone, fewer years of education, unemployment) and clinical factors (such as family history of anxiety disorders, suicidal ideas, avoidant personality features). SP was widely associated with decreased QoL involving several domains and especially related to complexity, greater number of feared or trigger situations, and comorbid medical and psychiatric conditions. CONCLUSION: SP is not uncommon within clinical, and undergraduate populations, and has a significantly negative impact on quality of life. Awareness of its associated clinical profiles allows better identification and overall management of this condition including improvement in QoL.

6.
J Neural Transm (Vienna) ; 127(7): 1073-1079, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32435900

RESUMO

The considerable clinical heterogeneity in schizophrenia makes elucidation of its neurobiology challenging. Subtyping the disorder is one way to reduce this heterogeneity and deficit status is one such categorization based on the prominence of negative symptoms. We aimed to utilize diffusion tensor imaging (DTI) to identify unique white matter cerebral changes in deficit schizophrenia (DS) compared with non-deficit schizophrenia (NDS) and healthy controls (HC) in an Asian sample. A total of 289 subjects (111 HC, 133 NDS and 45 DS) underwent DTI and completed rating scales which assessed the severity of psychopathology, psychosocial functioning and premorbid intelligence.We found that DS patients had fractional anisotropy (FA) reductions in the Body of the Corpus Callosum (BCC) and right Posterior Thalamic Radiation (PTR) regions relative to HCs, and FA reductions in the right PTR relative to NDS patients. NDS patients had FA reductions of the BCC and right PTR relative to HCs. Binomial logistic regression analyses revealed that FA reductions of the right PTR FA was an independent predictor of deficit status. The identified brain white matter changes especially in the PTR relate to deficits of cognitive control and emotional awareness, which may underlie psychopathology associated with deficit status like inattention and affective blunting. These potential biomarkers of DS warrant further examination to determine their utility for monitoring illness progression and intervention response in schizophrenia.


Assuntos
Esquizofrenia , Substância Branca , Anisotropia , Encéfalo/diagnóstico por imagem , Imagem de Tensor de Difusão , Humanos , Esquizofrenia/diagnóstico por imagem , Substância Branca/diagnóstico por imagem
7.
Hum Psychopharmacol ; 35(6): 1-7, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32738085

RESUMO

OBJECTIVE: Studies examining coprescription and dosages of mood stabilizers (MSs) with antipsychotics for psychotic disorders are infrequent. Based on sparse extant data and clinical experience, we hypothesized that adjunctive MS use would be associated with certain demographic (e.g., younger age), clinical factors (e.g., longer illness duration), and characteristics of antipsychotic treatment (e.g., multiple or high antipsychotic doses). METHODS: Within an Asian research consortium focusing on pharmaco-epidemiological factors in schizophrenia, we evaluated rates of MS coprescription, including high doses (>1000 mg/day lithium-equivalents) and clinical correlates. RESULTS: Among 3557 subjects diagnosed with schizophrenia in 14 Asian countries, MSs were coprescribed with antipsychotics in 13.6% (n = 485) of the sample, with 10.9% (n = 53) on a high dose. Adjunctive MS treatment was associated (all p < 0.005) with demographic (female sex and younger age), setting (country and hospitalization), illness (longer duration, more hospitalizations, non-remission of illness, behavioral disorganization, aggression, affective symptoms, and social-occupational dysfunction), and treatment-related factors (higher antipsychotic dose, multiple antipsychotics, higher body mass index, and greater sedation). Patients given high doses of MSs had a less favorable illness course, more behavioral disorganization, poorer functioning, and higher antipsychotic doses. CONCLUSIONS: Schizophrenia patients receiving adjunctive MS treatment in Asian psychiatric centers are more severely ill and less responsive to simpler treatment regimens.


Assuntos
Antimaníacos/administração & dosagem , Antipsicóticos/administração & dosagem , Padrões de Prática Médica/estatística & dados numéricos , Esquizofrenia/tratamento farmacológico , Adulto , Ásia , Relação Dose-Resposta a Droga , Quimioterapia Combinada , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Esquizofrenia/fisiopatologia , Índice de Gravidade de Doença , Adulto Jovem
8.
J Neural Transm (Vienna) ; 126(5): 531-558, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30888511

RESUMO

Actigraphy is a non-invasive method of monitoring circadian rhythms and motor activity. We systematically reviewed extant evidence until September 2018 pertaining to actigraphy use in schizophrenia, its clinical/biological correlates and posit future research directions. Within 38 included studies involving 2700 subjects, patients with schizophrenia generally have lower motor activity levels, poorer sleep quality and efficiency, increased sleep fragmentation and duration compared with healthy controls. Lowered motor activity and longer sleep duration in patients were associated with greater severity of negative symptoms. Less structured motor activity and decreased sleep quality were associated with greater severity of positive symptoms, worse cognitive functioning involving attention and processing speed, illness chronicity, higher antipsychotic dose, and poorer quality of life. Correlations of actigraphic measures with biological factors are sparse with inconclusive results. Future studies with larger sample sets may adopt a multimodal, longitudinal approach which examines both motor and sleep activity, triangulates clinical, actigraphic and biological measures to clarify their inter-relationships and inform risk prediction of illness onset, course, and treatment response over time.


Assuntos
Actigrafia/métodos , Esquizofrenia , Humanos
9.
Curr Opin Psychiatry ; 37(3): 212-224, 2024 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-38415716

RESUMO

PURPOSE OF REVIEW: This review aims to provide an update on the association between urbanization and psychotic spectrum disorders, focusing on specific aspects of the urban environment that could be a bane or boon for the risk of psychosis. RECENT FINDINGS: Majority of the included studies support previous evidence suggesting that urbanization is linked to a higher risk of psychotic experiences and psychotic spectrum disorders. A small minority, however, have also found specific factors in the urban environment that could give rise to positive outcomes, such as better social functioning and lower mortality rates in psychotic spectrum disorders, or mitigate the risks associated with urbanization. The perception of the urban environment was also an important factor that increased or mitigated stress levels in patients with psychosis, which in turn affected their susceptibility to psychotic symptoms. SUMMARY: Specific aspects of the urban environment such as the availability and density of greenspaces are crucial for mitigating the effect of urbanization on risk of psychotic spectrum disorders, and should be incorporated into urban planning. At the same time, there is a need to further explore how modifiable risk factors of the urban environment such as air and noise pollution can be minimized to allow for more liveable cities in the context of psychotic spectrum conditions.


Assuntos
Transtornos Psicóticos , Humanos , Transtornos Psicóticos/etiologia , Urbanização , Cidades , Fatores de Risco
10.
Perspect Med Educ ; 13(1): 108-118, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38406650

RESUMO

Introduction: This scoping review aimed to examine 1) types of inter-professional (IPE) interventions using Strosahl's typology framework, 2) practice outcomes related to healthcare setting and patients using Kirkpatrick's model of training evaluation, and 3) enablers and challenges related to the effectiveness of IPE interventions specific to the mental healthcare setting in order to guide the development of such future programs. Methods: This scoping review was conducted in accordance with the methodology of the Joanna Briggs Institute for scoping reviews. Several databases were searched for relevant studies from database inception until December 2023. Articles were included if it 1) involved IPE interventions within mental healthcare, 2) reported practice outcomes related to healthcare setting and patients, and 3) was published in English. Variables of interest included the mode of IPE intervention using Strosahl's typology, enablers, and challenges related to IPE interventions. Results: Overall, 16 studies were included. IPE intervention outcomes within healthcare setting related to shifts in practice culture, engagement with family members, and increased collaborations with other inter-professional groups. Reported patient outcomes included clinical improvements (e.g., reduced depression and anxiety, psychotropic drug use, better psychosocial functioning), patient empowerment, satisfaction, and confidence in treatment. The enablers and challenges included resource limitations, inter-professional group and individual participation, and pedagogy. Discussion: Future efforts in IPE mental healthcare practice can focus on garnering sustained institutional support, identifying and investing in committed faculty, encouraging greater learner participation, and making iterative changes to the IPE program structure to facilitate involvement of inter-professional disciplines for better patient care.


Assuntos
Educação Profissionalizante , Serviços de Saúde Mental , Humanos , Equipe de Assistência ao Paciente , Atenção à Saúde
11.
Brain Sci ; 14(1)2024 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-38275522

RESUMO

Lithium remains an effective option in the treatment of bipolar disorder (BD). Thus, we aim to characterize the pharmaco-epidemiological patterns of lithium use internationally over time and elucidate clinical correlates associated with BD using a scoping review, which was conducted using the methodological framework by Arksey and O'Malley (2005). We searched several databases for studies that examined the prescriptions for lithium and clinical associations in BD from inception until December 2023. This review included 55 articles from 1967 to 2023, which collected data from North America (n = 24, 43.6%), Europe (n = 20, 36.4%), and Asia (n = 11, 20.0%). The overall prescription rates ranged from 3.3% to 84% (33.4% before and 30.6% after the median year cutoffs). Over time, there was a decline in lithium use in North America (27.7% before 2010 to 17.1% after 2010) and Europe (36.7% before 2003 to 35.7% after 2003), and a mild increase in Asia (25.0% before 2003 to 26.2% after 2003). Lithium use was associated with specific demographic (e.g., age, male gender) and clinical factors (e.g., lower suicide risk). Overall, we found a trend of declining lithium use internationally, particularly in the West. Specific clinical correlates can support clinical decision-making for continued lithium use.

12.
J Clin Psychiatry ; 84(2)2023 02 22.
Artigo em Inglês | MEDLINE | ID: mdl-36811518

RESUMO

Objective: A systematic review was conducted to examine resilience in bipolar disorder (BD) and its relationship to demographic, psychopathology, illness features, and psychosocial functioning.Data Sources: A literature search was conducted from database inception to August 2022 using PubMed, Web of Science, EMBASE, and PsycINFO. Reference lists were also manually searched for relevant articles.Study Selection: Studies were included if they involved patients with a primary diagnosis of BD, were published in English, and measured resilience using a clearly defined rating scale. Studies were excluded if they were case reports, systematic reviews, or conference articles. Of the initial 100 records screened after duplicates were removed, 29 articles were finally included in the systematic review.Data Extraction: Information extracted included the number and type of subjects, socio-demographic characteristics, resilience scale(s) used, and relevant clinical correlates.Results: Higher resilience in BD was associated with specific psychopathology (lower severity of depressive and psychotic symptoms; less rumination, hopelessness, impulsivity, and aggression; fewer depressive episodes and suicide attempts), clinical features (self-directed temperament, less childhood trauma, and positive attitudes toward pharmacologic treatment), social factors (better social support and family organization), and psychosocial functioning (better quality of life, social functioning, personal recovery, and spiritual well-being). Resilience also mediated pathways between childhood trauma, depression, and quality of life.Conclusions: Based on resilience models, BD patients can be helped to better manage challenges and stressors and bolster internal compensatory factors and external protective factors during the course of their illness.


Assuntos
Transtorno Bipolar , Transtornos Psicóticos , Humanos , Transtorno Bipolar/psicologia , Qualidade de Vida , Funcionamento Psicossocial , Transtornos Psicóticos/psicologia , Comportamento Impulsivo
13.
Postgrad Med ; 135(7): 646-668, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-37776227

RESUMO

OBJECTIVES: We sought to examine the contributory factors as well as consequences of moral injury amongst healthcare workers within mental healthcare settings. METHODS: Several databases were searched for relevant studies from database inception until May 2023. Keywords and concepts included moral injury and distress in mental healthcare and psychiatry. We identified 961 studies, of which 48 were assessed for eligibility. Eventually, 35 studies were included in the review. Papers were selected for inclusion if 1) they included mental healthcare professionals (MHP) regardless of practice setting, 2) moral injury as experienced by MHP was one of their main variables of interest, 3) were written in English. Year of publication, location of study, participant characteristics, study design, settings in which injury occur (context), factors contributing to moral injury (contributors), and its effects on MHP (consequences) were extracted from the studies. RESULTS: The majority of studies were conducted in the West (n = 26, 74.3%). Contributors to moral injury were found at the individual (e.g. poor competence), practice setting (e.g. lack of resources), and organizational levels (e.g. inconsistent policies). Moral injury had negative repercussions for the individual (e.g. psychological and physical symptoms), healthcare teams (e.g. lack of trust and empathy), and healthcare system (e.g. staff attrition). CONCLUSIONS: Seen through the moral habitability framework, interventions must include an acknowledgment of the influence of various factors on the ability of MHP to enact their moral agency, and seek to establish safe moral communities within a supportive moral climate.

14.
J Med Educ Curric Dev ; 10: 23821205231214393, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-38025022

RESUMO

OBJECTIVES: Previous studies have found that the inclusion of medical humanities in medical education was associated with improvements in learner reflectivity and empathy. There is less data, however, on the impact of medical humanities on perceived patient care and mediators of learner outcomes. Our study aimed to determine the impact of medical humanities on perceived learner well-being and patient care, and the mediators of these outcomes in medical undergraduates undergoing psychiatric training. METHODS: This cross-sectional study was conducted from August 2021 to December 2022 within undergraduate medical students undergoing psychiatry rotations and who attended sessions entitled "Humanities in Psychiatry." Both quantitative and qualitative data were obtained through anonymized online feedback forms. Path analysis was performed to examine the relationship between learners' perception of the medical humanities writing activity and its potential to improve their well-being, patient care, as well as mediators of these outcomes. RESULTS: Overall, 97 medical undergraduates (response rate 67.4%) participated in the study and more than four-fifths reported improvements in listening, reflection, empathy, personal well-being, and perceived patient care. Males showed more interest in additional medical humanities sessions (mean rank 57.9 vs 42.5, P = .005) and greater improvements in personal well-being (mean rank 55.1 vs 44.5, P = .044). Path analysis showed that reflective capacity of learners mediated the relationship between reflective writing and perceived improvements in learner well-being (ß = 0.596, 95% CI = 0.409-0.737) and patient care (ß = 0.557, 95% CI = 0.379-0.702). CONCLUSIONS: Our study found that the majority of learners responded positively to the medical humanities sessions, which suggests that its use could be beneficial in fostering empathy, reflection, learner well-being, and improved patient care. Using the PRISM model, we present practical implications for educators to consider when using medical humanities in relation to psychiatry training.

15.
Brain Sci ; 14(1)2023 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-38275511

RESUMO

It is important to examine the psychotropic prescription practices in schizophrenia, as it can inform regarding changing treatment choices and related patient profiles. No recent reviews have evaluated the global neuropsychopharmacological prescription patterns in adults with schizophrenia. A systematic search of the literature published from 2002 to 2023 found 88 empirical papers pertinent to the utilization of psychotropic agents. Globally, there were wide inter-country and inter-regional variations in the prescription of psychotropic agents. Overall, over time there was an absolute increase in the prescription rate of second-generation antipsychotics (up to 50%), mood stabilizers (up to 15%), and antidepressants (up to 17%), with an observed absolute decrease in the rate of antipsychotic polypharmacy (up to 15%), use of high dose antipsychotic (up to 12% in Asia), clozapine (up to 9%) and antipsychotic long-acting injectables (up to 10%). Prescription patterns were mainly associated with specific socio-demographic (such as age), illness (such as illness duration), and treatment factors (such as adherence). Further work, including more evidence in adjunctive neuropsychopharmacological treatments, pharmaco-economic considerations, and examination of cohorts in prospective studies, can proffer insights into changing prescription trends relevant to different treatment settings and predictors of such trends for enhancement of clinical management in schizophrenia.

16.
Genes (Basel) ; 14(3)2023 03 10.
Artigo em Inglês | MEDLINE | ID: mdl-36980961

RESUMO

Treatment-resistant schizophrenia (TRS) is often associated with severe burden of disease, poor quality of life and functional impairment. Clozapine is the gold standard for the treatment of TRS, although it is also known to cause significant side effects in some patients. In view of the burgeoning interest in the role of genetic factors in precision psychiatry, we conducted a scoping review to narratively summarize the current genetic factors associated with TRS, clozapine resistance and side effects to clozapine treatment. We searched PubMed from inception to December 2022 and included 104 relevant studies in this review. Extant evidence comprised associations between TRS and clozapine resistance with genetic factors related to mainly dopaminergic and serotoninergic neurotransmitter systems, specifically, TRS and rs4680, rs4818 within COMT, and rs1799978 within DRD2; clozapine resistance and DRD3 polymorphisms, CYP1A2 polymorphisms; weight gain with LEP and SNAP-25 genes; and agranulocytosis risk with HLA-related polymorphisms. Future studies, including replication in larger multi-site samples, are still needed to elucidate putative risk genes and the interactions between different genes and their correlations with relevant clinical factors such as psychopathology, psychosocial functioning, cognition and progressive changes with treatment over time in TRS and clozapine resistance.


Assuntos
Antipsicóticos , Clozapina , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Psiquiatria , Esquizofrenia , Humanos , Clozapina/efeitos adversos , Esquizofrenia/tratamento farmacológico , Esquizofrenia/genética , Antipsicóticos/efeitos adversos , Esquizofrenia Resistente ao Tratamento , Qualidade de Vida
17.
Sci Rep ; 13(1): 21047, 2023 11 29.
Artigo em Inglês | MEDLINE | ID: mdl-38030699

RESUMO

Schizophrenia is a highly heterogeneous disorder and salient functional connectivity (FC) features have been observed to vary across study sites, warranting the need for methods that can differentiate between site-invariant FC biomarkers and site-specific salient FC features. We propose a technique named Semi-supervised learning with data HaRmonisation via Encoder-Decoder-classifier (SHRED) to examine these features from resting state functional magnetic resonance imaging scans gathered from four sites. Our approach involves an encoder-decoder-classifier architecture that simultaneously performs data harmonisation and semi-supervised learning (SSL) to deal with site differences and labelling inconsistencies across sites respectively. The minimisation of reconstruction loss from SSL was shown to improve model performance even within small datasets whilst data harmonisation often led to lower model generalisability, which was unaffected using the SHRED technique. We show that our proposed model produces site-invariant biomarkers, most notably the connection between transverse temporal gyrus and paracentral lobule. Site-specific salient FC features were also elucidated, especially implicating the paracentral lobule for our local dataset. Our examination of these salient FC features demonstrates how site-specific features and site-invariant biomarkers can be differentiated, which can deepen our understanding of the neurobiology of schizophrenia.


Assuntos
Esquizofrenia , Humanos , Encéfalo/patologia , Imageamento por Ressonância Magnética/métodos , Lobo Frontal , Redes Neurais de Computação , Mapeamento Encefálico/métodos
18.
Asia Pac Psychiatry ; 14(2): e12486, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34431616

RESUMO

BACKGROUND: Schizophrenia is a major psychiatric disorder which poses substantial illness burden on affected individuals. In view of the need to better understand the growing literature on resilience (adaptation in the face of adversity) and its clinical correlates to inform and optimize clinical management in schizophrenia, we sought to summarize the extant literature which examined the inter-relationships between resilience and demographic features, phenomenology, illness course, psychosocial functioning, and its mediational role among relevant factors. METHODS: A systematic review was conducted on published empirical studies examining the topic of resilience and clinical correlates within schizophrenia spectrum conditions up until December 2020. RESULTS: Higher level of resilience was associated with lower severity of specific symptomatology including positive, negative, depressive symptoms, suicidal ideation, cognitive deficits, and better insight. Moreover, higher resilience was significantly associated with different aspects of illness course (such as shorter duration of untreated psychosis, longer duration of illness, improved symptom remission and recovery), internal factors (such as lower stigma, better self-esteem), and psychosocial functioning (better overall, real-life, social and interpersonal functioning, better quality of life). Resilience also acts as a mediator in pathways leading to depression, functioning, and quality of life within schizophrenia spectrum conditions. DISCUSSION: Viewed within the context of various resiliency models (compensatory, challenge, protective factor models), suggestions were made to enhance resilience and balance risk versus protective factors in order to improve disease management. Future research should seek to better elucidate associated biomarkers, inter-relationships with carer resilience, and evaluate the efficacy of suitable resilience-targeted interventions in schizophrenia.


Assuntos
Transtornos Psicóticos , Esquizofrenia , Humanos , Funcionamento Psicossocial , Transtornos Psicóticos/terapia , Qualidade de Vida/psicologia , Esquizofrenia/diagnóstico , Psicologia do Esquizofrênico
19.
Singapore Med J ; 63(5): 229-235, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-36043286

RESUMO

The rapid spread of COVID-19 has a potentially significant impact on not only physical health but also psychological well-being. To the best of our knowledge, no review thus far has consolidated the psychological impact of COVID-19 across different subpopulations. A systematic search of the literature until 15 June 2020 found 150 empirical papers pertinent to the mental health consequences of the pandemic. The majority (87.3%) were from China (45.3%), the rest of Asia (22.0%) and Europe (20.0%), and mostly examined the general population (37.3%), healthcare workers (31.3%) and those with pre-existing mental and physical illnesses (14.7%). The most common psychological responses across these subpopulations were anxiety (overall range 24.8%-49.5%), depression (overall range 18.6%-42.6%) and traumatic stress symptoms (overall range 12.7%-31.6%). Healthcare workers and those with pre-existing physical and mental illnesses were more severely affected. Future studies are needed on underexamined subgroups such as the elderly and patients who recovered from COVID-19.


Assuntos
COVID-19 , Idoso , Ansiedade/epidemiologia , COVID-19/epidemiologia , Depressão/epidemiologia , Pessoal de Saúde/psicologia , Humanos , Pandemias , SARS-CoV-2 , Estresse Psicológico/epidemiologia
20.
BMJ Open ; 12(9): e060148, 2022 09 19.
Artigo em Inglês | MEDLINE | ID: mdl-36123086

RESUMO

OBJECTIVES: Recent research suggests that burn-out is high and appears to be rooted in system-level factors including the local learning environment (LE). While most studies on this topic have been cross-sectional, our aim was to explore the relationship between burn-out and the LE over time within psychiatry residents. We hypothesised that burn-out is a significant predictor of learner perception of overall and all subdomains of LE within residents. DESIGN: This was a repeated measures questionnaire study. SETTING: We surveyed psychiatry residents in Singapore between January 2016 and December 2019. PRIMARY AND SECONDARY OUTCOME MEASURES: The Oldenburg Burnout Inventory and the Postgraduate Hospital Education Environment Measure (PHEEM) were used to assess burn-out and resident perception of the LE, respectively. Linear mixed modelling was used to examine changes in PHEEM scores over time while taking into account burn-out status. PARTICIPANTS: Overall, 93 residents (response rate 89.4%) took part. RESULTS: The average difference between initial PHEEM total scores for residents with and without burn-out was significant (p<0.001). Burn-out status was a significant predictor of lower overall and all subdomain PHEEM scores at baseline (all p<0.001). PHEEM Teaching scores showed a significant increase over time for all residents regardless of burn-out status (p<0.05). However, PHEEM Total, Role Autonomy, Social Support scores did not change significantly over time or change significantly between residents with or without burn-out. CONCLUSIONS: Perceptions of LE among psychiatry residents at baseline are inversely associated with burn-out status. That only the Teaching subdomain score increased over time could be accounted for by the fact that it is a more tangible and visible aspect of the LE compared with perceived role autonomy or social support subdomains. Our findings underscore the importance of attending to the well-being and improving the LE of our residents so as to optimise learning during training.


Assuntos
Esgotamento Profissional , Internato e Residência , Psiquiatria , Esgotamento Profissional/epidemiologia , Estudos Transversais , Educação de Pós-Graduação em Medicina , Hospitais de Ensino , Humanos , Estudos Longitudinais , Psiquiatria/educação
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