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1.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 172-175, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33017957

RESUMO

In this paper, the classification problem of schizophrenia patients from healthy controls is considered, whose goal is to explore the relationship between DNA characteristics and schizophrenia. However, the DNA methylation data has the properties of small samples in high dimension and non-Gaussian distribution which makes it hard to do classification with DNA methylation data. Hence a classification method based on deep learning is designed. We propose a feature selection method based on attention mechanism which embeds a weight gated layer in the network structure to get a task-related sparse representation of the DNA methylation data. The performance of proposed method outperforms existing feature selection methods. On a real-world data set, the classification with proposed method achieves a high accuracy.


Assuntos
Metilação de DNA , Esquizofrenia , Atenção , Aprendizado Profundo , Humanos , Esquizofrenia/genética
2.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 549-552, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018048

RESUMO

Quantification of directed (nonlinear) brain-heart interactions has turned to be an emerging topic of research and is important for the better understanding of central autonomic processing during specific diseases such as schizophrenia. Convergent Cross Mapping (CCM) was able to provide directed, frequency-selective and topographic views on existent interaction pattern of those patients. Investigations of the influence of individual heart rate (HR) on CCM estimations may further contribute to this topic. Relationship of mean HR and CCM was analyzed in a group of schizophrenic patients (N=17) and healthy controls (N=21). Influence of individual HR values was most pronounced for patients, for interactions from brain to heart and for the subgroup of patients with highest mean HR values.


Assuntos
Encéfalo , Esquizofrenia , Sistema Nervoso Autônomo , Coração , Frequência Cardíaca , Humanos
3.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 1742-1745, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018334

RESUMO

Convolutional Neural Network (CNN) has been successfully applied on classification of both natural images and medical images but limited studies applied it to differentiate patients with schizophrenia from healthy controls. Given the subtle, mixed, and sparsely distributed brain atrophy patterns of schizophrenia, the capability of automatic feature learning makes CNN a powerful tool for classifying schizophrenia from controls as it removes the subjectivity in selecting relevant spatial features. To examine the feasibility of applying CNN to classification of schizophrenia and controls based on structural Magnetic Resonance Imaging (MRI), we built 3D CNN models with different architectures and compared their performance with a handcrafted feature-based machine learning approach. Support vector machine (SVM) was used as classifier and Voxel-based Morphometry (VBM) was used as feature for handcrafted feature-based machine learning. 3D CNN models with sequential architecture, inception module and residual module were trained from scratch. CNN models achieved higher cross-validation accuracy than handcrafted feature-based machine learning. Moreover, testing on an independent dataset, 3D CNN models greatly outperformed handcrafted feature-based machine learning. This study underscored the potential of CNN for identifying patients with schizophrenia using 3D brain MR images and paved the way for imaging-based individual-level diagnosis and prognosis in psychiatric disorders.


Assuntos
Imagem por Ressonância Magnética , Esquizofrenia , Encéfalo/diagnóstico por imagem , Humanos , Redes Neurais de Computação , Esquizofrenia/diagnóstico por imagem , Máquina de Vetores de Suporte
4.
Artigo em Russo | MEDLINE | ID: mdl-33081452

RESUMO

OBJECTIVE: To assess the dynamics of cognitive functions in patients with schizophrenia during intake of various forms of folate as an add-on to antipsychotic therapy. MATERIAL AND METHODS: Using a battery of cognitive tests, the authors evaluated the dynamics of cognitive functions in 3 groups of patients with schizophrenia who received folic acid (n=25), metafolin (n=25) during 4 weeks and in the control group (n=25). Genetic variants of the polymorphism of the folate metabolism enzyme methylenetetrahydrofolate reductase (MTHFR) 677C>T were determined using real-time PCR. Only the carriers of the minor T allele were included in the study. RESULTS AND CONCLUSION: The improvement of certain cognitive functions was noted after folate administration, it was more pronounced and statistically significant in the metapholin group. The results hold promises for further studies of prolonged use of folate in prophylactic doses for schizophrenia.


Assuntos
Ácido Fólico , Esquizofrenia , Cognição , Humanos , Metilenotetra-Hidrofolato Redutase (NADPH2)/genética , Polimorfismo Genético , Esquizofrenia/tratamento farmacológico , Esquizofrenia/genética
5.
Zhonghua Yi Xue Za Zhi ; 100(36): 2841-2845, 2020 Sep 29.
Artigo em Chinês | MEDLINE | ID: mdl-32988144

RESUMO

Objective: To investigate the effect of antipsychotic medicine risperidone on prepulse inhibition of the startle reflex (PPI) and P50 deficit in patients with first-episode and chronic. Methods: Thirty-eight patients with first-episode schizophrenia and 36 patients with chronic schizophrenia, both in acute stage, were enrolled in the study. All patients were treated with risperidone of different doses (2 to 6mg/d). All patients fulfilled the evaluation of PPI and P50 before treatment and 8 weeks after treatment. The psychotic symptoms were assessed with Positive and Negative Syndrome Scale (PANSS), and the therapeutic effects were evaluated with PANSS reduction rate. Results: (1) There was no significant difference in PPI and P50 parameters between the two groups before treatment (PPI ratio: first group 43%±29%, chronic group 42%±27%, P>0.05; P50 S2/S1 ratio: first group 83%±33%, chronic group 82%±24%, P>0.05). (2) There was no significant correlation between PPI and P50 inhibition parameters and disease course, psychotic episodes and psychiatric symptoms (PANSS total score, positive symptoms score, negative symptoms score and general psychopathology symptoms score) of schizophrenia (P>0.05). (3) Except the group main effect for S2 amplitude (F=5.75, P=0.019), there was no significant change for main effect and interaction of the other P50 and PPI inhibition ratio parameters after treatment (P50 S2/S1 ratio: first group before treatment 83%±33%, after treatment 85%±49%, P>0.05; chronic group before treatment 82%±44%, after treatment 84%±35%, P>0.05. PPI ratio: first group before treatment 43%±29%, after treatment 42%±27%; chronic group before treatment 42%±27%, after treatment 41%±28%,P>0.05). The effect of risperidone on P50 and PPI parameters was not related to the therapeutic effect. Conclusion: Deficit in sensory gating inhibition exists in both first-episode schizophrenia and chronic schizophrenia, and risperidone is not effective in treating the deficit in sensory gating (PPI and P50) inhibition of schizophrenia.


Assuntos
Inibição Pré-Pulso , Esquizofrenia/tratamento farmacológico , Humanos , Reflexo de Sobressalto , Risperidona , Filtro Sensorial
6.
Psychiatr Danub ; 32(Suppl 1): 70-74, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32890366

RESUMO

BACKGROUND: The present retrospective study is aimed at exploring the impact of gender differences in a sample of inpatients with dual diagnosis. SUBJECTS AND METHODS: The study was carried out at the Psychiatric Service of the General Hospital/University of Perugia (Italy). Patients were recruited from January 2015 until December 2018. The sample consists of patients with dual diagnosis, divided into two subgroups based on gender; descriptive and bivariate statistics were performed (p<0.05). Male and females were compared according to socio-demographic, clinical and psychopathological features, measured by Clinical Global Impressions (CGI) and factor models of the Positive and Negative Syndrome Scale (PANSS) and the Brief Psychiatric Rating Scale (BPRS). RESULTS: In our sample (n=157), no significant differences in socio-demographic features were found between male (n=108, 68.8%) and female subjects (n=49, 31.2%). Women displayed a higher frequency of involuntary hospitalizations (53.1% vs 32.4%, p=0.022) and a higher score on the general psychopathology scale of the Positive and Negative Syndrome Scale (PANSS) (41.86±8.96 vs 36.54±10.38, p=0.041). CONCLUSIONS: Our study confirms the prevalence of dual diagnosis in the male gender. Female sex appears more frequently connected to some indices of clinical severity. We expect to enlarge our sample to confirm these results and further clarify the knowledge on the subject.


Assuntos
Diagnóstico Duplo (Psiquiatria) , Esquizofrenia , Escalas de Graduação Psiquiátrica Breve , Feminino , Humanos , Itália , Masculino , Escalas de Graduação Psiquiátrica , Estudos Retrospectivos , Esquizofrenia/diagnóstico
7.
Psychiatr Danub ; 32(Suppl 1): 88-92, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32890370

RESUMO

BACKGROUND: The present study reports preliminary results from the multicentre project on the approbation of the Russian language version of the "The Communication Checklist-Self Report" (RL-CC-SR) and its first use in schizophrenia (SZ), aiming to evaluate the contribution of language disturbances in the pathogenesis of this heterogeneous disorder. SUBJECTS AND METHODS: The study evaluated patients' clinical state with the Diagnostic Interview for Psychoses (DIP), and assessed language and communication disturbances (LCD) with the RL-CC-SR in all participants (213 healthy controls (HC), 83 SZ patients, 31 SZ first-degree relatives). Data from the current sample of SZ (n=50), and HC (n=213) was analysed to calculate the relationships between LCD, social and clinical variables using descriptive statistics methods, T-test and Pearson's correlations (SPSS-26, 2019). RESULTS: The quotient scores (<6) and raw scores on all three CC-SR subscales demonstrated prominent LCD in SZ: (i) language structure (LS) (SZ:11.92±8.01, HC:7.54±5.91; p<0.001), (ii) pragmatic skills (PS) (SZ:11.30±10.07, HC:8.71±7.39; p=0.040), (iii) social engagement (SE) (SZ:31.94±11.76, HC:19.42±10.35; p<0.001). In SZ, Pearson correlations of LS scores were significant for the DIP-items Odd Speech (p=0.033), and Social Engagement - Blunted Affect (p=0.042). PS was related to early disease onset (p=0.027), poor premorbid work adjustment (p=0.003), along with LS (p=0.005), and was also linked to poor premorbid social adjustment (p=0.005). CONCLUSIONS: SZ patients are aware of their LCD at all levels of language structure, pragmatics, and nonverbal communication, but are unable to compensate. Disturbances of LS and PS in SZ patients relate to their poor social adjustment and functioning, and may prove to be associated with the primary negative symptoms domain of the disorder and its generally poor outcome.


Assuntos
Lista de Checagem , Transtornos do Desenvolvimento da Linguagem , Esquizofrenia , Autorrelato , Humanos , Transtornos do Desenvolvimento da Linguagem/etiologia , Esquizofrenia/complicações , Esquizofrenia/diagnóstico , Ajustamento Social
8.
Croat Med J ; 61(4): 354-365, 2020 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-32881434

RESUMO

AIM: To analyze axon morphology on rapid Golgi impregnated pyramidal neurons in the dorsolateral prefrontal cortex in schizophrenia. METHODS: Postmortem brain tissue from five subjects diagnosed with schizophrenia and five control subjects without neuropathological findings was processed with the rapid Golgi method. Layer III and layer V pyramidal neurons from Brodmann area 9 were chosen in each brain for reconstruction with Neurolucida software. The axons and cell bodies of 136 neurons from subjects with schizophrenia and of 165 neurons from control subjects were traced. The data obtained by quantitative analysis were compared between the schizophrenia and control group with the t test. RESULTS: Axon impregnation length was consistently greater in the schizophrenia group. The axon main trunk length was significantly greater in the schizophrenia than in the control group (93.7 ± 36.6 µm vs 49.8 ± 9.9 µm, P = 0.032). Furthermore, in the schizophrenia group more axons had visibly stained collaterals (14.7% vs 5.5%). CONCLUSION: Axon rapid Golgi impregnation stops at the beginning of the myelin sheath. The increased axonal staining in the schizophrenia group could, therefore, be explained by reduced axon myelination. Such a decrease in axon myelination is in line with both the disconnection hypothesis and the two-hit model of schizophrenia as a neurodevelopmental disease. Our results support that the cortical circuitry disorganization in schizophrenia might be caused by functional alterations of two major classes of principal neurons due to altered oligodendrocyte development.


Assuntos
Axônios/patologia , Córtex Pré-Frontal/patologia , Células Piramidais/patologia , Esquizofrenia/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Complexo de Golgi/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Coloração e Rotulagem/métodos
9.
Value Health ; 23(9): 1256-1267, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32940244

RESUMO

OBJECTIVES: Patient preferences are increasingly important in informing clinical and policy decisions. Health-state utility values (HSUVs) are quantitative measures of people's preferences over different health states. In schizophrenia, there is no clarity about HSUVs across the symptoms' severity spectrum. This meta-analysis aims to synthesize the literature on HSUVs in people with schizophrenia. METHODS: We searched Medline, PsycInfo, Embase, EconLit, The Cochrane Library, and specialized databases. The studies reporting HSUVs in people with schizophrenia were selected and pooled in a random-effects meta-analysis. The primary outcome was the mean HSUV obtained from participants. RESULTS: A total of 54 studies involving 87 335 participants were included. The pooled estimate using direct elicitation was a mean HSUV of 0.79 (95% CI: 0.70-0.88) for mild symptomatic states, 0.69 (95% CI: 0.54-0.85) in moderate states, and 0.34 (95% CI: 0.13-0.56) in severe states. Studies using indirect techniques resulted in a pooled mean HSUV of 0.73 (95% CI: 0.67-0.78) applying the EuroQol 5-dimension, 0.66 (95% CI: 0.62-0.71) in the Short-Form 6-dimension, and 0.59 (95% CI: 0.57-0.61) using the Quality of Well-Being scale. All the estimates resulted in considerable heterogeneity, partially reduced by meta-regression. CONCLUSION: Our findings suggest that the severity of psychotic symptoms has an important effect on HSUVs in schizophrenia, with values mirroring patients with disabling physical conditions such as cancer and stroke. Decision makers should be aware of these results when including people's preferences in trials, models, and policy decisions.


Assuntos
Indicadores Básicos de Saúde , Preferência do Paciente , Qualidade de Vida , Esquizofrenia , Humanos , Anos de Vida Ajustados por Qualidade de Vida
10.
Dtsch Arztebl Int ; 117(24): 412-419, 2020 06 12.
Artigo em Inglês | MEDLINE | ID: mdl-32865492

RESUMO

BACKGROUND: The lifetime prevalence of schizophrenia is 1%. Schizophrenia is among the most severe mental illnesses and gives rise to the highest treatment costs per patient of any disease. It is characterized by frequent relapses, marked impairment of quality of life, and reduced social and work participation. METHODS: The group entrusted with the creation of the German clinical practice guideline was chosen to be representative and pluralistic in its composition. It carried out a systematic review of the relevant literature up to March 2018 and identified a total of 13 389 publications, five source guidelines, three other relevant German clinical practice guidelines, and four reference guidelines. RESULTS: As the available antipsychotic drugs do not differ to any great extent in efficacy, it is recommended that acute antipsychotic drug therapy should be sideeffect- driven, with a number needed to treat (NNT) of 5 to 8. The choice of treatment should take motor, metabolic, sexual, cardiac, and hematopoietic considerations into account. Ongoing antipsychotic treatment is recommended to prevent relapses (NNT: 3) and should be re-evaluated on a regular basis in every case. It is also recommended, with recommendation grades ranging from strong to intermediate, that disorder- and manifestation-driven forms of psychotherapy and psychosocial therapy, such as cognitive behavioral therapy for positive or negative manifestations (effect sizes ranging from d = 0.372 to d = 0.437) or psycho-education to prevent relapses (NNT: 9), should be used in combination with antipsychotic drug treatment. Further aspects include rehabilitation, the management of special treatment situations, care coordination, and quality management. A large body of evidence is available to provide a basis for guideline recommendations, particularly in the areas of pharmacotherapy and cognitive behavioral therapy. CONCLUSION: The evidence-based diagnosis and treatment of persons with schizophrenia should be carried out in a multiprofessional process, with close involvement of the affected persons and the people closest to them.


Assuntos
Antipsicóticos , Terapia Cognitivo-Comportamental , Psicoterapia , Esquizofrenia , Antipsicóticos/uso terapêutico , Humanos , Qualidade de Vida , Esquizofrenia/terapia
11.
Medicine (Baltimore) ; 99(36): e21918, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899025

RESUMO

Schizophrenia (SCZ) is a chronic disability disorder related to oxidative stress. Glutathione S-transferase (GST) is a group enzyme that protects cells and tissues from oxidative stress damage. Among GSTs, GSTT1 and GSTM1 have well defined genetic polymorphisms. The purpose of our research was to explore the correlation between GSTT1 and GSTM1 polymorphism and SCZ risk in Chinese Han population.A total of 650 subjects (386 SCZ patients and 264 healthy individuals) were included in this case-control designed study. The GSTT1 and GSTM1 polymorphisms were analyzed by multiplex polymerase chain reaction (PCR). We explored the relationship between these 2 polymorphisms and the risk of SCZ.We found that the GSTT1 null genotype had a protective effect on the development of SCZ [odds ratio (OR) = 0.601, 95% confidence interval (95% CI) = 0.412-0.986, P = .031]. We also found that the combination of null genotypes of the GSTT1 and GSTM1 genes was made at a lower risk of SCZ (OR = 0.452, 95% CI = 0.238-0.845, P = .028). However, we found no correction between Positive and Negative Syndrome Scale score (PANSS) and GSTM1, GSST1 genotypes in SCZ patients.Our finding revealed that GSTT1 null polymorphisms may be related to the reduced risk of SCZ in Chinese Han population, and this risk was further reduced with the combination of GSTT1 null polymorphisms and GSTM1 null polymorphisms.


Assuntos
Glutationa Transferase/genética , Esquizofrenia/genética , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polimorfismo Genético , Fatores de Risco
12.
Wei Sheng Yan Jiu ; 49(4): 640-644, 2020 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-32928362

RESUMO

OBJECTIVE: To investigate the expression of 22 q11 deletion syndrome in children and adolescents with schizophrenia and its effect on mental symptoms and cognitive function. METHODS: Case-control method was used. 134 cases of children and adolescents diagnosed with schizophrenia in hospital from April 2016 to December 2018 were selected as the case group, and the patients in the case group were divided into the two groups including 22 q11 deletion group and the non-deletion group. The control group included 418 healthy children with no history of mental illness or family history. In situ hybridization was used to diagnose 22 q11 microdeletion syndrome, and positive and negative symptom scales and Chinese version of schizophrenia cognitive function battery test were used to score the patients in the case group. RESULTS: The expression of 22 q11 microdeletion was more significant in children and adolescents with schizophrenia(χ~2=33. 52, P<0. 0001). The negative symptoms(P=0. 034), general condition(P=0. 005) and total score(P=0. 001) were significantly increased in the 22 q11 deletion group. The five indicators of attachment test, verbal memory, spatial span, emotional management, continuous operation and total score in the 22 q11 deletion group were significantly lower than those in the non-deletion group(P<0. 05). Among children and adolescents with schizophrenia, there was a significant decrease in the FA value in the 22 q11 deletion group compared with the non-deletion group, mainly distributed in the corpus callosum, the knee and the cingulate tract(P<0. 05), and no increase in the FA value was observed in other brain areas. FA value of corpus callosum somatic white matter in the absence group was positively correlated with visual memory and language fluency. FA value of the knee in corpus callosum was positively correlated with language fluency. FA value of the buckle was positively correlated with spatial width(all P values were less than 0. 05). CONCLUSION: 22 q11 microdeletion is more common in children and adolescents with schizophrenia, which may affect visual memory, language fluency and spatial span by reducing FA values in corpus callosum, knee and cingulate tract.


Assuntos
Esquizofrenia , Adolescente , Encéfalo , Criança , Cognição , Humanos
13.
Artigo em Russo | MEDLINE | ID: mdl-32929919

RESUMO

OBJECTIVE: To test the general hypothesis about executive deficits in language production in schizophrenia as well as more specific hypothesis that this deficit would be more pronounced in the case of higher demand on executive functions. MATERIAL AND METHODS: Twenty-five patients with schizophrenia and twenty-seven healthy controls were asked to tell a story based on a series of pictures and then to give an oral composition on the given topic. RESULTS AND CONCLUSION: Schizophrenia patients, compared to controls, demonstrated poorer programming as well as shorter text and phrase length in both tasks. Oral composition on the given topic in patients was characterized by the presence of agrammatism, need for leading questions due to the difficulties of story plot generation as well as higher variance in syntactic complexity and text length. Therefore, the authors revealed executive deficit in language production, more pronounced in the task with less numerous external cues for planning and sequential text explication, in schizophrenia patients.


Assuntos
Função Executiva , Esquizofrenia , Humanos , Idioma , Testes Neuropsicológicos , Escalas de Graduação Psiquiátrica
14.
Artigo em Russo | MEDLINE | ID: mdl-32929925

RESUMO

BACKGROUND: A search for accurate linear discriminant function (LDF) allowing the diagnosis of schizophrenia and estimation of treatment effectiveness according to EEG is an urgent problem. OBJECTIVE: To develop a methodology for discriminant EEG analysis for minimizing the overlearning effect, selection of optimal LDF model and evaluation of its generalizing ability. MATERIAL AND METHODS: Two hundred and twenty patients with schizophrenia and 1400 people without psychiatric diseases, who were comparable in basic characteristics, were enrolled. EEG was recorded using 16 leads, 10-20 system and aural reference electrodes. EEG was processed by spectral and coherent analysis. RESULTS: After linear discriminant analysis, LDF was obtained to differentiate people with schizophrenia from healthy subjects and a formula was selected from LDF that included 8 predictors (spectral and coherent parameters of standard EEG ranges theta, alpha and beta) with 90% sensitivity and 80% specificity, significance level for Wilks' lambda p<3.9E-28 and the Mahalanobis distance between training set centroids 4,6. CONCLUSION: A method for obtaining optimal LDF models and selection the best one with further LDF generalizing ability assessment is suggested.


Assuntos
Esquizofrenia , Diagnóstico Diferencial , Análise Discriminante , Eletroencefalografia , Humanos , Sensibilidade e Especificidade
15.
Artigo em Russo | MEDLINE | ID: mdl-32929943

RESUMO

The article presents current literature data on genetic studies of neurocognitive deficit in schizophrenia, including the genes of neurotransmitter systems (dopaminergic, glutamatergic, and serotonergic); genes analyzed in genome-wide association studies (GWAS), as well as other genetic factors related to the pathophysiological mechanisms underlying schizophrenia and neurocognitive disorders.


Assuntos
Estudo de Associação Genômica Ampla , Esquizofrenia , Humanos , Transtornos Neurocognitivos , Neurotransmissores
16.
Artigo em Português | LILACS, Coleciona SUS, CONASS, SES-GO | ID: biblio-1121615

RESUMO

Tecnologia: Aripiprazol, medicamento antipsicótico de segunda geração. Indicação: tratamento da esquizofrenia. Objetivos: Apresentar evidências de análise econômicas em saúde, no cenário do SUS e contextos internacionais, do tratamento com Aripiprazol para esquizofrenia, comparado a outros antipsicóticos de uso oral de primeira e segunda geração utilizados no SUS. Realizar uma análise de impacto orçamentário para o contexto do SUS em Goiás e estimar uma projeção de gastos diretos com aquisição de Aripiprazol pela Secretaria de Saúde de Goiás, em cenário de incorporação do Aripiprazol para tratamento de esquizofrenia, no período de 2021 a 2025. Materiais e Métodos: Levantamentos bibliográficos nas bases de dados PUBMED e Biblioteca Virtual em Saúde, no mês de junho de 2020. Realizada avaliação da qualidade metodológica das revisões sistemáticas e dos estudos econômicos com as ferramentas Assessing the Methodological Quality of Systematic Reviews (AMSTAR), e Quality of Health Economic Studies (QHES) checklist, respectivamente. Foi calculado o impacto orçamentário, seguindo diretrizes do Ministério da Saúde, e projeção de gastos para a Secretaria de Saúde de Goiás. Resultados: Foram selecionadas e incluídas 1 revisão sistemática e 1 estudo econômico brasileiro no estudo de revisão rápida de evidências. Conclusão: No contexto brasileiro, o Aripiprazol é custo-efetivo, quando comparado a Clorpromazina, Haloperidol, Quetiapina e Ziprasidona. Porém, é menos custo-efetivo que Risperidona e Olanzapina. Caso seja padronizado pela Secretaria de Saúde de Goiás, promoverá economia anual para o SUS de R$ 250.042,05 a R$ 407.418,41, em sua máxima difusão. A projeção de gastos diretos é estimada em R$1.582.115,24 a R$27.960.108,08


Technology: Aripiprazole, second generation antipsychotic medication. Indication: treatment of schizophrenia. Objectives: To show evidence of health economic analysis in the scenario of Brazilian Public Health System (BPHS) and international contexts, for schizophrenia treatment with Aripiprazole, compared to other oral antipsychotics used in BPHS. To make a budget impact analysis for the Goias Public Health System perspective and estimate direct expenditures for the acquisition of Aripiprazole by State Department of Health of Goias, in a scenario of technology incorporation of Aripiprazole for the treatment of schizophrenia, in the period from 2021 to 2025. Materials and Methods: Bibliographical searches were done in the PUBMED and Virtual Health Library databases, in 2020 June. An evaluation of the methodological quality of systematic reviews and economic studies was done using the tools AMSTAR (Assessing the Methodological Quality of Systematic Reviews), and QHES (Quality of Health Economic Studies) checklist, respectively. Calculation of budget impact, following guidelines of the Brazilian Health Ministry, and projection of expenditures for the State Department of Health of Goias. Results: 1 systematic review and 1 Brazilian economic study were selected and included in the study of rapid evidence review. Conclusion: In the Brazilian context, Aripiprazole is cost-effective when compared to Chlorpromazine, Haloperidol, Quetiapine and Ziprasidone. However, it is less cost-effective than Risperidone and Olanzapine. If it is standardized by State Department of Health of Goias, it will promote anual savings for BPHS from R$ 250,042.05 to R$ 407,418.41, in its maximum dissemination. The direct expenses are estimated at R$ 1,582,115.24 to R $ 27,960,108.08


Assuntos
Humanos , Esquizofrenia/tratamento farmacológico , Antipsicóticos , Aripiprazol/uso terapêutico , Análise de Impacto Orçamentário , Sistema Único de Saúde/economia , Aripiprazol/economia , Revisão Sistemática
19.
Nat Commun ; 11(1): 4637, 2020 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-32934226

RESUMO

An association between schizophrenia and subsequent breast cancer has been suggested; however the risk of schizophrenia following a breast cancer is unknown. Moreover, the driving forces of the link are largely unclear. Here, we report the phenotypic and genetic positive associations of schizophrenia with breast cancer and vice versa, based on a Swedish population-based cohort and GWAS data from international consortia. We observe a genetic correlation of 0.14 (95% CI 0.09-0.19) and identify a shared locus at 19p13 (GATAD2A) associated with risks of breast cancer and schizophrenia. The epidemiological bidirectional association between breast cancer and schizophrenia may partly be explained by the genetic overlap between the two phenotypes and, hence, shared biological mechanisms.


Assuntos
Neoplasias da Mama/genética , Fatores de Transcrição GATA/genética , Esquizofrenia/genética , Idoso , Cromossomos Humanos Par 19/genética , Estudos de Coortes , Feminino , Estudo de Associação Genômica Ampla , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Fenótipo , Polimorfismo de Nucleotídeo Único , Suécia
20.
Epidemiol Psychiatr Sci ; 29: e169, 2020 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-32996442

RESUMO

AIMS: Many people who are homeless with severe mental illnesses are high users of healthcare services and social services, without reducing widen health inequalities in this vulnerable population. This study aimed to determine whether independent housing with mental health support teams with a recovery-oriented approach (Housing First (HF) program) for people who are homeless with severe mental disorders improves hospital and emergency department use. METHODS: We did a randomised controlled trial in four French cities: Lille, Marseille, Paris and Toulouse. Participants were eligible if they were 18 years or older, being absolutely homeless or precariously housed, with a diagnosis of schizophrenia (SCZ) or bipolar disorder (BD) and were required to have a high level of needs (moderate-to-severe disability and past hospitalisations over the last 5 years or comorbid alcohol or substance use disorder). Participants were randomly assigned (1:1) to immediate access to independent housing and support from the Assertive Community Treatment team (social worker, nurse, doctor, psychiatrist and peer worker) (HF group) or treatment as usual (TAU group) namely pre-existing dedicated homeless-targeted programs and services. Participants and interviewers were unmasked to assignment. The primary outcomes were the number of emergency department (ED) visits, hospitalisation admissions and inpatient days at 24 months. Secondary outcomes were recovery (Recovery Assessment Scale), quality of life (SQOL and SF36), mental health symptoms, addiction issues, stably housed days and cost savings from a societal perspective. Intention-to-treat analysis was performed. RESULTS: Eligible patients were randomly assigned to the HF group (n = 353) or TAU group (n = 350). No differences were found in the number of hospital admissions (relative risk (95% CI), 0.96 (0.76-1.21)) or ED visits (0.89 (0.66-1.21)). Significantly less inpatient days were found for HF v. TAU (0.62 (0.48-0.80)). The HF group exhibited higher housing stability (difference in slope, 116 (103-128)) and higher scores for sub-dimensions of S-QOL scale (psychological well-being and autonomy). No differences were found for physical composite score SF36, mental health symptoms and rates of alcohol or substance dependence. Mean difference in costs was €-217 per patient over 24 months in favour of the HF group. HF was associated with cost savings in healthcare costs (RR 0.62(0.48-0.78)) and residential costs (0.07 (0.05-0.11)). CONCLUSION: An immediate access to independent housing and support from a mental health team resulted in decreased inpatient days, higher housing stability and cost savings in homeless persons with SCZ or BP disorders.


Assuntos
Serviços Comunitários de Saúde Mental/métodos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Pessoas em Situação de Rua/psicologia , Habitação/estatística & dados numéricos , Adulto , Alcoolismo/complicações , Alcoolismo/epidemiologia , Transtorno Bipolar/complicações , Transtorno Bipolar/epidemiologia , Comorbidade , Feminino , França/epidemiologia , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Avaliação de Programas e Projetos de Saúde/métodos , Qualidade de Vida , Esquizofrenia/complicações , Esquizofrenia/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
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