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1.
Nord J Psychiatry ; 75(1): 54-62, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32720838

RESUMO

AIM: We investigated the stability of diagnoses during admission over an 11-year period in patients admitted to a highly specialized integrated dual diagnosis treatment facility in Denmark using diagnosis coded in patient charts. MATERIALS AND METHODS: Admission and discharge diagnoses from patient files were examined for stability of primary diagnosis and association with year of admission, age, sex, and duration of admission, in 1570 patients from 2007 to 2017. RESULTS: A vast proportion (69.6%) of the patients retained their diagnosis during a 3-month admission. Stability was highest for schizophrenia spectrum diagnoses and lowest for unspecified diagnosis. Type of primary diagnosis, age, and length of admission was associated with lower likelihood of a stable primary diagnosis. CONCLUSIONS: Long-term admission for psychiatric patients with substance use disorder (SUD) was significantly associated with stability of diagnosis. The finding calls for longer observation of dual diagnosis patients to ensure that relevant diagnosis is given, and consequently that the appropriate clinical treatment such as psychopharmacological as well as non-pharmacological intervention can be applied.


Assuntos
Transtornos Mentais , Esquizofrenia , Transtornos Relacionados ao Uso de Substâncias , Diagnóstico Duplo (Psiquiatria) , Hospitalização , Humanos , Tempo de Internação , Transtornos Mentais/diagnóstico , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Admissão do Paciente , Esquizofrenia/diagnóstico , Esquizofrenia/epidemiologia , Esquizofrenia/terapia , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/terapia
2.
Nord J Psychiatry ; 75(1): 73-78, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32886012

RESUMO

BACKGROUND: Schizophrenia patients (SPP) have an increased risk of metabolic syndrome (MetS) and are twice more likely to experience diabetes mellitus and obesity than the general population. AIMS: The main purpose of this study was to assess the prevalence of MetS and its components in first-episode psychosis patients (FEPP) and SPP. METHODS: This study consisted a total of 38 untreated FEPP, 40 SPP and 41 randomly selected healthy volunteers admitted to the psychiatric outpatient clinic. The diagnosis of MetS was made based on Adult Treatment Panel III (ATP III), ATP III-A and International Diabetes Federation (IDF) criteria. RESULTS: The prevalence of MetS was 26.3, 28.9 and 31.5% according to ATP III, ATP III-A and IDF criteria in the FEPP, respectively. The prevalence of MetS was 37.5, 40 and 42.5% according to ATP III, ATP III-A and IDF criteria in the SPP, respectively. The prevalence of MetS was 9.7, 9.7 and 12.2% according to ATP III, ATP III-A and IDF criteria in the control group, respectively. The prevalence of MetS was higher in female patients than male patients based on all three diagnostic criteria. The MetS patients had a higher mean of age, a longer duration of disease, and treatment compared to patients without MetS. CONCLUSION: The current study found that FEPP and SPP had an increased prevalence of MetS. Especially, clinicians should pay attention to MetS in SPP due to the presence of risk factors, such as advanced age, being female, and long duration of disease and treatment.


Assuntos
Síndrome Metabólica , Transtornos Psicóticos , Esquizofrenia , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Síndrome Metabólica/epidemiologia , Prevalência , Transtornos Psicóticos/epidemiologia , Fatores de Risco , Esquizofrenia/epidemiologia , Turquia/epidemiologia
3.
Artigo em Inglês | MEDLINE | ID: mdl-33166098

RESUMO

Objective: To report the clinical characteristics and transmission rate of coronavirus disease 2019 (COVID-19) in a community inpatient long-term care psychiatric rehabilitation facility designed for persons with serious mental illness to provide insight into transmission and symptom patterns and emerging testing protocols, as well as medical complications and prognosis. Methods: This study examined a cohort of 54 residents of a long-term care psychiatric rehabilitation program from March to April 2020. Baseline demographics, clinical diagnoses, and vital signs were examined to look for statistical differences between positive versus negative severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) groups. During the early phase of the pandemic, the facility closely followed the local shelter-in-place order (starting March 19, 2020) and symptom-based testing. Results: Of the residents, the primary psychiatric diagnoses were schizoaffective disorder: 28 (51.9%), schizophrenia: 21 (38.9%), bipolar I disorder: 3 (5.5%), and unspecified psychotic disorder: 2 (3.7%). Forty (74%) of 54 residents tested positive for SARS-COV-2, with a doubling time of 3.9 days. There were no statistical differences between the positive SARS-COV-2 versus negative groups for age or race/ethnicity. Psychiatric and medical conditions were not significantly associated with contracting SARS-COV-2, with the exception of obesity (n = 17 [43%] positive vs n = 12 [86%] negative, P = .01). Medical monitoring of vital signs and symptoms did not lead to earlier detection. All of the residents completely recovered, with the last resident no longer showing any symptoms 24 days from the index case. Conclusion: Research is needed to determine optimal strategies for long-term care mental health settings that incorporate frequent testing and personal protective equipment use to prevent rapid transmission of SARS-COV-2.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Transtornos Psicóticos/reabilitação , Centros de Reabilitação , Esquizofrenia/reabilitação , Adulto , Afro-Americanos , Americanos Asiáticos , Betacoronavirus , Transtorno Bipolar/epidemiologia , Transtorno Bipolar/reabilitação , California/epidemiologia , Técnicas de Laboratório Clínico , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/transmissão , Diabetes Mellitus/epidemiologia , Grupo com Ancestrais do Continente Europeu , Refluxo Gastroesofágico/epidemiologia , Hispano-Americanos , Humanos , Hiperlipidemias/epidemiologia , Hipertensão/epidemiologia , Hipotireoidismo/epidemiologia , Controle de Infecções , Assistência de Longa Duração , Programas de Rastreamento , Pessoa de Meia-Idade , Obesidade/epidemiologia , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Pneumonia Viral/transmissão , Reabilitação Psiquiátrica , Psicoterapia de Grupo , Transtornos Psicóticos/epidemiologia , Recreação , Reabilitação Vocacional , Esquizofrenia/epidemiologia , Fumar/epidemiologia , Visitas a Pacientes
4.
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
5.
Open Heart ; 7(2)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32994353

RESUMO

BACKGROUND: Patients with schizophrenia are a high-risk population due to higher prevalences of cardiovascular risk factors and comorbidities that contribute to shorter life expectancy. PURPOSE: To investigate patients with and without schizophrenia experiencing an acute myocardial infarction (AMI) in relation to guideline recommended in-hospital management, discharge medications and 5-year major adverse cardiac events (MACE: composite of all-cause mortality, rehospitalisation for reinfarction, stroke or heart failure). METHODS: All patients with schizophrenia who experienced AMI during 2000-2018 were identified (n=1008) from the nationwide Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies registry and compared with AMI patients without schizophrenia (n=2 85 325). Kaplan-Meier survival curves and multivariable Cox regression models were used to compare the populations. RESULTS: Patients with schizophrenia presented with AMI approximately 10 years earlier (median age 64 vs 73 years), and had higher prevalences of diabetes, heart failure and chronic obstructive pulmonary disease. They were less likely to be invasively investigated or discharged with aspirin, P2Y12 inhibitors, ACE inhibitors/angiotensin II receptor blockers, beta-blockers and statins (all p<0.005). AMI patients with schizophrenia had higher adjusted risk of MACE (aHR=2.05, 95% CI 1.63 to 2.58), mortality (aHR=2.38, 95% CI 1.84 to 3.09) and hospitalisation for heart failure (aHR=1.39, 95% CI 1.04 to 1.86) compared with AMI patients without schizophrenia. CONCLUSION: Patients with schizophrenia experienced an AMI almost 10 years earlier than patients without schizophrenia. They less often underwent invasive procedures and were less likely to be treated with guideline recommended medications at discharge, and had more than doubled risk of MACE and all-cause mortality. Improved primary and secondary preventive measures, including adherence to guideline recommendations, are warranted and may improve outcome.


Assuntos
Infarto do Miocárdio sem Supradesnível do Segmento ST/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Esquizofrenia/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Disparidades em Assistência à Saúde , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio sem Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio sem Supradesnível do Segmento ST/mortalidade , Infarto do Miocárdio sem Supradesnível do Segmento ST/terapia , Readmissão do Paciente , Prevalência , Recidiva , Sistema de Registros , Medição de Risco , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Esquizofrenia/diagnóstico , Esquizofrenia/mortalidade , Esquizofrenia/terapia , Prevenção Secundária , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/terapia , Suécia/epidemiologia , Fatores de Tempo , Resultado do Tratamento
6.
Psychiatry Res ; 291: 113278, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32763540

RESUMO

Tobacco smoking is highly prevalent in patients with schizophrenia and alcohol dependence. The underlying neurobiology of nicotine addiction is complex. Rewarding effects of nicotine from cigarettes are associated, among others, with mu-opioid receptors encoded by the OPRM1 gene. The aim of the study was to evaluate the association between two OPRM1 gene polymorphisms, rs1799971 and rs510769, and tobacco smoking in Caucasian patients with schizophrenia, alcohol dependence, and healthy control subjects. The study included 1058 Caucasians (277 patients with schizophrenia, 359 patients with alcohol dependence, and 422 healthy control subjects), subdivided according to the nicotine dependence into smokers (i.e. current smokers) and non-smokers. A significant association was found between the GC haplotype (OPRM1 rs1799971 and rs510769) and smoking in healthy controls, but not in patients with schizophrenia and alcohol dependence. A nominal association was detected in all cases/controls, but this significance did not survive the correction for the multiple testing. This is the first study to reveal that nicotine dependence is associated with the GC haplotype of the OPRM1 rs1799971 and rs510769 in all subjects or specifically in healthy controls. These results did not confirm the strong connection between OPRM1 polymorphisms and nicotine dependence in schizophrenia or alcohol dependence.


Assuntos
Alcoolismo/genética , Estudos de Associação Genética/métodos , Haplótipos/genética , Receptores Opioides mu/genética , Esquizofrenia/genética , Adulto , Alcoolismo/diagnóstico , Alcoolismo/epidemiologia , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polimorfismo Genético/genética , Esquizofrenia/diagnóstico , Esquizofrenia/epidemiologia
7.
Psychiatry Res ; 291: 113281, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32763543

RESUMO

Individuals with schizophrenia are over three times more likely to have problem and pathological gambling (PPG) than the general population (Cunningham-Williams et al., 1998; Desai and Potenza, 2009), but little is known about this co-occurrence and how PPG relates to specific symptom dimensions of psychotic disorders. Although cognitive distortions in PPG have been linked to gambling motivations (e.g., distorted thoughts about odds of winning), how psychotic symptoms in schizophrenia or related disorders relate to gambling motivations have not been examined systematically to date. Individuals with schizophrenia or schizoaffective disorder (n = 170) completed structured face-to-face interviews regarding problem-gambling severity, gambling motivations, and five symptom factors of psychosis (Positive, Negative, Disorganized/Concrete, Depressed, and Excited). Different symptom dimensions of psychosis showed distinct patterns of relationships with motivations to gamble and gambling onset. PPG in schizophrenia was associated with elevated scores on the Depressed factor. Psychotic symptom severity was associated with increased motivation to gamble for financial reasons and decreased motivations to gamble for service, and possibly social or interpersonal, reasons. Age of gambling onset was inversely associated with psychotic symptom severity, particularly positive features. Our findings suggest that motivations for gambling may differ in the context of schizophrenia and relate to specific symptom clusters.


Assuntos
Jogo de Azar/diagnóstico , Jogo de Azar/psicologia , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/psicologia , Esquizofrenia/diagnóstico , Psicologia do Esquizofrênico , Adulto , Feminino , Jogo de Azar/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Motivação/fisiologia , Transtornos Psicóticos/epidemiologia , Esquizofrenia/epidemiologia , Índice de Gravidade de Doença
8.
Psychiatry Res ; 291: 113285, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32763546

RESUMO

Cognitive impairments are core features of schizophrenia and the best predictor of functional outcome. Cholinergic system and alpha-7 nicotinic acetylcholine (α7nACh) receptors are strongly implicated in the pathophysiologic mechanisms associated with cognitive impairments in schizophrenia. Galantamine is not only a reversible, competitive inhibitor of acetylcholinesterase but also a type I positive allosteric modulator of α7nACh receptors. The objective of this meta-analysis was to examine the efficacy of galantamine for cognitive symptoms of schizophrenia. In the meta-analysis that included six randomized controlled trials (RCTs, N=226), cognitive impairments significantly improved with galantamine compared to placebo, with a small Hedges' g effect size of 0.233. This finding is consistent with other RCTs in schizophrenia with medications with a similar mechanism of action. On the basis of the results from all the failed (although some efficacy has been shown) RCTs to date in schizophrenia, targeting only one pathophysiologic mechanism may be insufficient to detect a clinically meaningful signal. Nicotinergic medications, like any other add-on medications, are unlikely to be effective as stand-alone medications. Hence, these medications may have to be combined with other medications with complementary mechanisms such as glutamatergic/N-methyl-D-aspartate systems to detect a meaningful effect size for the three domains of psychopathology.


Assuntos
Disfunção Cognitiva/tratamento farmacológico , Galantamina/administração & dosagem , Nootrópicos/administração & dosagem , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Esquizofrenia/tratamento farmacológico , Cognição/efeitos dos fármacos , Cognição/fisiologia , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/psicologia , Quimioterapia Combinada , Humanos , Esquizofrenia/epidemiologia , Psicologia do Esquizofrênico
9.
Psychiatry Res ; 291: 113293, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32763550

RESUMO

Toxoplasmosis has been previously associated with an increased risk of having schizophrenia in several epidemiological studies. The aim of this prospective study was to examine for the first time a possible association between positive serology to Toxoplasma gondii (T. gondii) and schizophrenia in the Algerian population. Seventy patients affected by schizophrenia according to DSM-5 criteria and seventy healthy controls were enrolled in the study. We found a significant association between schizophrenia and the infection status with a seroprevalence of 70% in patients with schizophrenia compared to 52.9% in controls and a calculated odds ratio of 2.081. In addition, while T. gondii seroprevalence increases significantly with age in controls, this association was not observed in patients with schizophrenia, which display a high percentage of seropositive subjects under 38 years of age, suggesting that T. gondii infection may promote the onset of schizophrenia. Moreover, our analysis also revealed that patients with schizophrenia had significantly lower levels of serum immunoglobulins G (IgG) to T. gondii compared to controls. Thus, this study adds to previous research questioning the asymptomatic aspect of chronic toxoplasmosis and the etiology of schizophrenia.


Assuntos
Esquizofrenia/sangue , Esquizofrenia/epidemiologia , Toxoplasma/isolamento & purificação , Toxoplasmose/sangue , Toxoplasmose/epidemiologia , Adulto , Argélia/epidemiologia , Anticorpos Antiprotozoários/sangue , Feminino , Humanos , Imunoglobulina G/sangue , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Esquizofrenia/diagnóstico , Estudos Soroepidemiológicos , Toxoplasmose/diagnóstico , Adulto Jovem
10.
BMC Health Serv Res ; 20(1): 771, 2020 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-32819374

RESUMO

BACKGROUND: People with schizophrenia have a higher premature mortality risk compared with the general population mainly due to cardiovascular disease (CVD). Despite this, people with schizophrenia are less likely to access physical health services or have their physical health investigated and monitored. AIMS: To examine the beliefs and actions of mental health professionals regarding the physical health of people with schizophrenia. METHOD: Two hundred and fifty-five healthcare professionals who support people with schizophrenia within Greater Manchester Mental Health NHS Foundation Trust (GMMH), United Kingdom and Pennine Care NHS Foundation Trust (PCFT), United Kingdom took part. Beliefs and actions were assessed using a self-administered questionnaire, which was constructed around two primary domains (1) CVD risk factors; and (2) physical health interventions. Descriptive statistics were reported and responses between different healthcare professional groups were compared. RESULTS: The overwhelming majority of participants were aware of established CVD risk factors with 98% identifying family history of CVD, 98% for smoking and 96% for high blood pressure. Most participants believed nearly all healthcare professionals were responsible for monitoring the physical health of people with schizophrenia, regardless of job speciality. There were 67% of participants who reported delivering an intervention to improve sedentary behaviour for people with schizophrenia. However, awareness of government and NHS recommended lifestyle interventions were low. CONCLUSIONS: This study found good knowledge regarding many established CVD risk factors but little clarity regarding who is responsible for monitoring the physical health of people with schizophrenia and how often brief lifestyle interventions are being implemented.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/psicologia , Serviços de Saúde Mental , Esquizofrenia/terapia , Adolescente , Adulto , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Hipertensão/epidemiologia , Hipertensão/prevenção & controle , Estilo de Vida , Masculino , Fatores de Risco , Esquizofrenia/epidemiologia , Reino Unido/epidemiologia , Adulto Jovem
11.
Artigo em Inglês | MEDLINE | ID: mdl-32756418

RESUMO

Women with schizophrenia show sex-specific health needs that differ according to stage of life. The aim of this narrative review is to resolve important questions concerning the treatment of women with schizophrenia at different periods of their life-paying special attention to reproductive and post-reproductive stages. Review results suggest that menstrual cycle-dependent treatments may be a useful option for many women and that recommendations re contraceptive options need always to be part of care provision. The pregnancy and the postpartum periods-while constituting vulnerable time periods for the mother-require special attention to antipsychotic effects on the fetus and neonate. Menopause and aging are further vulnerable times, with extra challenges posed by associated health risks. Pregnancy complications, neurodevelopmental difficulties of offspring, cancer risk and cognitive defects are indirect results of the interplay of hormones and antipsychotic treatment of women over the course of the lifespan. The literature recommends that health promotion strategies need to be directed at lifestyle modifications, prevention of medical comorbidities and increased psychosocial support. Careful monitoring of pharmacological treatment has been shown to be critical during periods of hormonal transition. Not only does treatment of women with schizophrenia often need to be different than that of their male peers, but it also needs to vary over the course of life.


Assuntos
Antipsicóticos , Promoção da Saúde , Esquizofrenia , Adulto , Idoso , Antipsicóticos/uso terapêutico , Feminino , Humanos , Longevidade , Pessoa de Meia-Idade , Gravidez , Esquizofrenia/tratamento farmacológico , Esquizofrenia/epidemiologia , Resultado do Tratamento
12.
Psychiatry Res ; 291: 113177, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32615314

RESUMO

Research has suggested that negative symptoms in psychotic disorders may be in part fueled by deficits in metacognition or the ability to form integrated ideas about oneself and others. One limitation of this work is that it has largely come from North America and Western Europe. To further the literature, we assessed symptoms using the Positive and Negative Syndrome Scale and Metacognition using the Metacognitive Assessment Scale - Abbreviated in a sample of outpatients with prolonged schizophrenia (n = 41), early episode psychosis (n = 37) and major depression (n = 30) gathered in Moscow, Russia. Verbal memory was assessed for use as a potential covariate. ANOVA revealed the two groups with psychosis had significantly poorer metacognitive function in terms of self-reflectivity and awareness of the other, than the group with depression. In both psychosis groups negative symptoms were more robustly related to metacognition than other forms of symptoms after controlling for neurocognition. Results support the possibility that metacognitive deficits are a psychological factor which cross culturally contributes to negative symptoms and point to metacognition as a potentially important target for intervention.


Assuntos
Transtorno Depressivo Maior/diagnóstico , Entrevista Psicológica , Metacognição/fisiologia , Transtornos Psicóticos/diagnóstico , Esquizofrenia/diagnóstico , Adulto , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/psicologia , Feminino , Humanos , Entrevista Psicológica/métodos , Masculino , Memória/fisiologia , Pessoa de Meia-Idade , Transtornos Psicóticos/epidemiologia , Transtornos Psicóticos/psicologia , Federação Russa/epidemiologia , Esquizofrenia/epidemiologia , Psicologia do Esquizofrênico , Adulto Jovem
13.
Psychiatry Res ; 291: 113168, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32619823

RESUMO

While evidence suggests that adults with serious mental illness have an elevated rate of 30-day readmissions after medical hospitalizations, most studies are of patients who are privately insured or Medicare beneficiaries, and little is known about the differential experiences of people with schizophrenia, bipolar disorder, and major depression. We used the Truven Health Analytics MarketScan® Medicaid Multi-State Database to study 43,817 Medicaid enrollees from 11 states, age 18-64, who were discharged from medical hospitalizations in 2011. Our outcome was unplanned all-cause readmissions within 30 days of discharge. In a multivariable analysis, compared to those with no SMI, people with schizophrenia had the highest odds of 30-day readmission (aOR: 1.46, 95% CI: 1.33-1.59), followed by those with bipolar disorder (aOR: 1.25, 95% CI: 1.14-1.38), and those with major depressive disorder (aOR: 1.18, 95% CI: 1.06-1.30). Readmissions also were more likely among those with substance use disorders, males, those with Medicaid eligibility due to disability, patients with longer index hospitalizations, and those with 2 or more medical co-morbidities. This is the first large-scale study to demonstrate the elevated risk of hospital readmission among low-income, working-age adults with schizophrenia. Given their greater psychological, social, and economic vulnerability, our findings can be used to design transition interventions and service delivery systems that address their complex needs.


Assuntos
Transtorno Bipolar/epidemiologia , Transtorno Depressivo Maior/epidemiologia , Medicaid/tendências , Readmissão do Paciente/tendências , Esquizofrenia/epidemiologia , Adulto , Idoso , Transtorno Bipolar/economia , Transtorno Bipolar/terapia , Comorbidade , Bases de Dados Factuais/tendências , Transtorno Depressivo Maior/economia , Transtorno Depressivo Maior/terapia , Feminino , Hospitalização/tendências , Humanos , Masculino , Medicaid/economia , Pessoa de Meia-Idade , Esquizofrenia/economia , Esquizofrenia/terapia , Transtornos Relacionados ao Uso de Substâncias/economia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/terapia , Estados Unidos/epidemiologia
15.
PLoS One ; 15(7): e0235955, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32663229

RESUMO

OBJECTIVES: At any point in time, a person's lifetime health is the number of healthy life years they are expected to experience during their lifetime. In this article we propose an equity-relevant health metric, Health Adjusted Age at Death (HAAD), that facilitates comparison of lifetime health for individuals at the onset of different medical conditions, and allows for the assessment of which patient groups are worse off. A method for estimating HAAD is presented, and we use this method to rank four conditions in six countries according to several criteria of "worse off" as a proof of concept. METHODS: For individuals with specific conditions HAAD consists of two components: past health (before disease onset) and future expected health (after disease onset). Four conditions (acute myeloid leukemia (AML), acute lymphoid leukemia (ALL), schizophrenia, and epilepsy) are analysed in six countries (Ethiopia, Haiti, China, Mexico, United States and Japan). Data from 2017 for all countries and for all diseases were obtained from the Global Burden of Disease Study database. In order to assess who are the worse off, we focus on four measures: the proportion of affected individuals who are expected to have HAAD<20 (T20), the 25th and 75th percentiles of HAAD for affected individuals (Q1 and Q3, respectively), and the average HAAD (aHAAD) across all affected individuals. RESULTS: Even in settings where aHAAD is similar for two conditions, other measures may vary. One example is AML (aHAAD = 59.3, T20 = 2.0%, Q3-Q1 = 14.8) and ALL (58.4, T20 = 4.6%, Q3-Q1 = 21.8) in the US. Many illnesses, such as epilepsy, are associated with more lifetime health in high-income settings (Q1 in Japan = 59.2) than in low-income settings (Q1 in Ethiopia = 26.3). CONCLUSION: Using HAAD we may estimate the distribution of lifetime health of all individuals in a population, and this distribution can be incorporated as an equity consideration in setting priorities for health interventions.


Assuntos
Epilepsia/mortalidade , Nível de Saúde , Leucemia Mieloide Aguda/mortalidade , Mortalidade/tendências , Leucemia-Linfoma Linfoblástico de Células Precursoras/mortalidade , Anos de Vida Ajustados por Qualidade de Vida , Esquizofrenia/mortalidade , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Epilepsia/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Leucemia Mieloide Aguda/epidemiologia , Masculino , Pessoa de Meia-Idade , Leucemia-Linfoma Linfoblástico de Células Precursoras/epidemiologia , Esquizofrenia/epidemiologia , Estados Unidos/epidemiologia , Adulto Jovem
16.
PLoS One ; 15(7): e0236241, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32716957

RESUMO

BACKGROUND: Early-Onset Schizophrenia (EOS) is rare but severe mental health disorder in children and adolescents. Diagnosis of schizophrenia before the age of 18 years remains complex and challenging, especially in young children. In France, there are no recent reliable epidemiological data about the prevalence of EOS. The present study evaluates the EOS rate in a target clinical population of children and adolescents in psychiatric and medico-social care centres in the South-East of France. METHODS: Psychiatric and medico-social centres for children and adolescent in the geographical area have been contacted, and after receiving their agreement to participate in the study, eligible patients corresponding to inclusion criteria were selected based on patients' medical records. Main inclusion criteria were age 7 to 17 years and intelligence quotient > 35. EOS categorical diagnosis was assessed by Kiddie-SADS Present and Lifetime psychosis section. RESULTS: 37 centres participated and 302 subjects have been included in the study. The main result was the categorical diagnosis of EOS in 27 subjects, corresponding to a rate of 8.9% in the study population. Half of the patients presented mild to moderate intellectual deficiency. Interestingly, only 2.3% had a diagnosis of schizophrenia spectrum disorder noted in their medical records before standardized assessment. CONCLUSIONS: The results of the study highlight the importance of using a standardized diagnostic tool for the diagnosis of schizophrenia in the paediatric population. In fact, EOS might be underdiagnosed in children and adolescents with neurodevelopmental disorders and subnormal cognitive functioning. TRIAL REGISTRATION: NCT01512641. Registered 19 January 2012; https://clinicaltrials.gov/ct2/show/NCT01512641.


Assuntos
Assistência à Saúde , Esquizofrenia/epidemiologia , Psicologia do Esquizofrênico , Idade de Início , Criança , Cognição , Estudos Transversais , Escolaridade , Feminino , França/epidemiologia , Geografia , Humanos , Recém-Nascido , Testes de Inteligência , Classificação Internacional de Doenças , Masculino , Gravidez , Esquizofrenia/tratamento farmacológico , Esquizofrenia/reabilitação , Fatores Socioeconômicos
17.
Psychiatry Res ; 291: 113249, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32603929

RESUMO

This study aims to assess the differences in adverse event profiles of long-acting injectable antipsychotics (LAIs) and oral antipsychotics (OAPs) using real-world data in the Japanese Adverse Drug Event Report database. Reporting odds ratios were determined using disproportionality analysis to estimate the risk of adverse events for LAIs and OAPs. Differences in adverse event profiles between formulations were determined after propensity score matching. Time-to-onset of adverse events was compared between LAIs and OAPs using the Weibull shape parameter. Signals were detected for approximately 50% of the adverse events (12 of 22) with LAIs and for the majority of adverse events (19 of 22) with OAPs. LAIs was associated with significantly lower reporting rate than OAPs for extrapyramidal symptom, neuroleptic malignant syndrome, and dystonia. For QT prolongation, convulsions, and hyperglycemia associated with LAIs, the 95% Confidence Interval of ß included 1 in time-to-onset analysis. Real-world data suggest that LAIs tend to reduce the occurrence of extrapyramidal symptom and neuroleptic malignant syndrome, but a number of other adverse events have potential risks as well as OAPs. In addition, onset of adverse events with LAIs have been shown to be slightly delayed, requiring more careful long-term monitoring.


Assuntos
Sistemas de Notificação de Reações Adversas a Medicamentos/tendências , Antipsicóticos/administração & dosagem , Antipsicóticos/efeitos adversos , Esquizofrenia/tratamento farmacológico , Esquizofrenia/epidemiologia , Administração Oral , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Bases de Dados Factuais , Preparações de Ação Retardada/administração & dosagem , Preparações de Ação Retardada/efeitos adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Feminino , Seguimentos , Humanos , Injeções , Japão/epidemiologia , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
18.
PLoS One ; 15(7): e0235409, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32726314

RESUMO

OBJECTIVES: To identify inequalities in cancer survival rates for patients with a history of severe psychiatric illness (SPI) compared to those with no history of mental illness and explore differences in the provision of recommended cancer treatment as a potential explanation. DESIGN: Population-based retrospective cohort study using linked cancer registry and administrative data at ICES. SETTING: The universal healthcare system in Ontario, Canada. PARTICIPANTS: Colorectal cancer (CRC) patients diagnosed between April 1st, 2007 and December 31st, 2012. SPI history (schizophrenia, schizoaffective disorders, other psychotic disorders, bipolar disorders or major depressive disorders) was determined using hospitalization, emergency department, and psychiatrist visit data and categorized as 'no history of mental illness, 'outpatient SPI history', and 'inpatient SPI history'. MAIN OUTCOME MEASURES: Cancer-specific survival, non-receipt of surgical resection, and non-receipt of adjuvant chemotherapy or radiation. RESULTS: 24,507 CRC patients were included; 482 (2.0%) had an outpatient SPI history and 258 (1.0%) had an inpatient SPI history. Individuals with an SPI history had significantly lower survival rates and were significantly less likely to receive guideline recommended treatment than CRC patients with no history of mental illness. The adjusted HR for cancer-specific death was 1.69 times higher for individuals with an inpatient SPI (95% CI 1.36-2.09) and 1.24 times higher for individuals with an outpatient SPI history (95% CI 1.04-1.48). Stage II and III CRC patients with an inpatient SPI history were 2.15 times less likely (95% CI 1.07-4.33) to receive potentially curative surgical resection and 2.07 times less likely (95% CI 1.72-2.50) to receive adjuvant radiation or chemotherapy. These findings were consistent across multiple sensitivity analyses. CONCLUSIONS: Individuals with an SPI history experience inequalities in colorectal cancer care and survival within a universal healthcare system. Increasing advocacy and the availability of resources to support individuals with an SPI within the cancer system are warranted to reduce the potential for unnecessary harm.


Assuntos
Transtorno Bipolar/terapia , Neoplasias Colorretais/terapia , Transtorno Depressivo Maior/terapia , Esquizofrenia/terapia , Adulto , Transtorno Bipolar/complicações , Transtorno Bipolar/epidemiologia , Transtorno Bipolar/patologia , Sobreviventes de Câncer/psicologia , Quimioterapia Adjuvante , Estudos de Coortes , Neoplasias Colorretais/complicações , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/patologia , Transtorno Depressivo Maior/complicações , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/patologia , Serviço Hospitalar de Emergência , Feminino , Hospitalização , Humanos , Pacientes Internados/psicologia , Masculino , Pessoa de Meia-Idade , Ontário/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Esquizofrenia/complicações , Esquizofrenia/epidemiologia , Esquizofrenia/patologia
19.
PLoS One ; 15(7): e0235365, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32614868

RESUMO

OBJECTIVE: To determine the magnitude and factors associated with psychotropic drug-induced parkinsonism and akathisia among mentally ill patients. METHODS: A hospital-based cross-sectional study was conducted with a total of 410 participants attending a follow-up treatment service at Jimma Medical Center, a psychiatry clinic from April to June 2019. Participants were recruited using a systematic random sampling method. Drug-induced parkinsonism and akathisia were assessed using the Extra-pyramidal Symptom Rating Scale. Substance use was assessed using the World Health Organization Alcohol, Smoking, and Substance Involvement Screening Test. Data entry was done using EpiData version 3.1, and analysis done by the Statistical Package for Social Sciences version 22. Statistically, the significant association was declared by adjusted odds ratio, 95% confidence interval, and p-value less than or equal to 0.05. RESULTS: The mean age of the respondents was 33.3 years (SD ± 8.55). Most of the participants 223 (54.4%) had a diagnosis of schizophrenia. The prevalence of drug-induced parkinsonism was 14.4% (95% CI: 11.0 to 18.0) and it was 12.4% (95% CI: 9.3 to 15.4) for drug-induced akathisia. The result of the final model found out drug-induced parkinsonism was significantly associated with female sex, age, type of antipsychotics, physical illness, and anti-cholinergic medication use. Similarly, female sex, chlorpromazine equivalent doses of 200 to 600 mg, combined treatment of sodium valproate with antipsychotic, and severe khat/Catha edulis use risk level was significantly associated with akathisia. CONCLUSION: One of seven patients developed drug-induced parkinsonism and akathisia. Careful patient assessment for drug-induced movement disorders, selection of drugs with minimal side effects, screening patients for physical illness, and psycho-education on substance use should be given top priority.


Assuntos
Acatisia Induzida por Medicamentos/epidemiologia , Antipsicóticos/efeitos adversos , Doença de Parkinson Secundária , Esquizofrenia/tratamento farmacológico , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Adulto , Assistência ao Convalescente , Instituições de Assistência Ambulatorial , Antipsicóticos/uso terapêutico , Estudos Transversais , Etiópia/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson Secundária/induzido quimicamente , Doença de Parkinson Secundária/epidemiologia , Prevalência , Psiquiatria , Esquizofrenia/epidemiologia , Adulto Jovem
20.
Soc Psychiatry Psychiatr Epidemiol ; 55(12): 1563-1569, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32691081

RESUMO

OBJECTIVE: Schizophrenia is a public concern in metropolises. Increases in city size may strengthen the correlation between prevalence of schizophrenia and indices of socioeconomic status, such as education. This study used population-based data of adults to investigate the association between education and schizophrenia in Chinese metropolises and its differences between inner city areas and outer suburbs. METHODS: Data was obtained from the Second China National Sample Survey on Disability in 2006, and analysis was restricted to 189,143 participants aged 18 years or older in all counties (districts) of Beijing, Shanghai, and Tianjin. Schizophrenia diagnoses were ascertained according to the International Statistical Classification of Diseases, 10th Revision. Logistic regression models were fitted to examine the association between education and schizophrenia. RESULTS: An inverse U-shaped pattern between education and schizophrenia was found in inner city areas of Chinese metropolises. Compared with the primary school or below group, the odds ratios of junior high school group and senior high school or above group was 2.79 (95% CI 1.96, 3.96) and 1.45(95% CI 0.99, 2.13), respectively. In outer suburbs, junior high school (OR = 0.87, 95% CI 0.63, 1.19) and senior high school or above groups (0.58, 95% CI 0.38, 0.87) were less likely to develop schizophrenia than the primary school or below group. CONCLUSIONS: This study showed an association between education and schizophrenia in Chinese metropolises. In inner city areas, the association was an inverse U-shaped pattern between education and schizophrenia, whereas in suburban areas, the association was a negative linear pattern. Our findings can help identify high-risk populations of schizophrenia in Chinese metropolises. Programs for prevention and early intervention of schizophrenia will need to consider the socioeconomic disparities between inner city and outer suburban areas. Public policies can help improve mental health by developing social security for migrants in inner city areas and promoting regional equality.


Assuntos
Esquizofrenia , Adolescente , Adulto , Grupo com Ancestrais do Continente Asiático , Pequim , China/epidemiologia , Humanos , Esquizofrenia/epidemiologia , Classe Social
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