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1.
J Ment Health Policy Econ ; 22(3): 95-108, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31811753

RESUMO

BACKGROUND: Psychosis onset commonly occurs at ages 16-30 when individuals are typically developing their education, employment and career trajectories. Coordinated specialty care (CSC) programs provide access to team-based early invention services for psychosis, including supported education and employment (SEE) services. AIMS OF STUDY: We examine factors associated with the use of SEE services and whether use of SEE services (for supported education, supported employment, or both) is associated with education and employment participation within New York's CSC program, OnTrackNY. METHODS: Participants (n=779) enrolled in OnTrackNY from October 2013-September 2017. Assessments were collected by clinical staff at admission, quarterly, and at discharge. Logistic regression models were specified to identify factors associated with the probability of use of SEE specialist services during the first year of program participation, using generalized estimating equations with an autoregressive covariance structure to account for within-subject correlations over time. Logistic models were also used to predict whether use of SEE services in the prior quarter predict the probability of work and school participation in the subsequent quarter, respectively; these were analyzed cross-sectionally for each time period. Models controlled for other factors associated with work/school outcomes for young people with early psychosis. RESULTS: Participants who were younger, and who had lower rates of work/school participation had greater odds of SEE service use. Use of SEE services for education support in the first quarter among clients under age 23 is significantly associated with school enrollment in the second quarter and this continued through the first year. Use of SEE services for employment support in the first quarter is significantly associated with employment in the second quarter, but significant associations for employment were not found at later periods of participation. Use of SEE services for both education and employment support was inconsistently associated with subsequent school enrollment or employment in the subsequent quarter. Results were upheld when limiting the sample to those not receiving other SEE services. DISCUSSION: Rates of school and work participation increased over the duration of OnTrackNY participation. Clients with lower work/school participation were more likely to use SEE services. Supported education services are associated with greater school participation during the first year for clients under age 23. However, this association is only significant in the first quarter for supported employment services, and is inconsistent when examining those who used both simultaneously. It is possible that we may find significant associations for employment as the program continues. It is also possible that clients may end supported employment services after obtaining employment, while those in school may require ongoing services (e.g. to renew educational accommodations). Additionally, it is possible that OnTrackNY's supported education model, designed to adhere to Individual Placenment and Support (IPS) principles, may be helping clients stay in school. However, as this is an observational study with no control condition, we cannot say that OnTrackNY, or SEE services participation, caused the observed outcomes. IMPLICATIONS FOR FURTHER RESEARCH: Future research should continue to develop the evidence base for supported education services.


Assuntos
Pessoas com Deficiência/psicologia , Intervenção Médica Precoce/métodos , Educação Especial/métodos , Readaptação ao Emprego/métodos , Transtornos Psicóticos/reabilitação , Adolescente , Adulto , Serviços Comunitários de Saúde Mental , Readaptação ao Emprego/estatística & dados numéricos , Hospitalização , Humanos , New York , Desenvolvimento de Programas , Transtornos Psicóticos/complicações , Transtornos Psicóticos/psicologia , Transtornos Psicóticos/terapia , Adulto Jovem
2.
Zh Nevrol Psikhiatr Im S S Korsakova ; 119(11): 103-108, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31851180

RESUMO

Platelets are an easily accessible model for the study of biochemical mechanisms of mental diseases, including schizophrenia and depression. This literature review addresses a role of platelet activation in the pathogenesis of mental diseases. Platelet activation observed in patients with schizophrenia, depression and other mental illnesses is associated with the development of cardiovascular disease and an increased risk of thrombotic complications, which can be the main cause of morbidity and mortality in patients with mental disorders. A deeper understanding of the biochemical mechanisms of mental disorders will help in the study of clinical consequences of these disorders and in choosing the right therapeutic strategy for patients.


Assuntos
Transtornos Mentais , Ativação Plaquetária , Trombose , Plaquetas , Fibrinólise , Hemostasia , Humanos , Transtornos Mentais/complicações , Transtornos Psicóticos/complicações , Trombose/complicações
4.
Psychiatr Danub ; 31(3): 355-357, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31596829

RESUMO

We aimed to compare processing speed (PS) and its subcomponents in schizophrenia (SC) and schizoaffective disorder (SA). Thirty-five patients were divided into two groups (SC=18; SA=17). PS tasks from the MATRICS Consensus Cognitive Battery Central/South America version were used. Additional PS subcomponents were analyzed (i.e., behavioral execution, response processing, and accuracy). SA obtained significant higher scores than SC in response processing, verbal fluency and the PS general domain. Our results indicate that PS is a potential cognitive marker to differentiate between SC and SA. Further research with larger samples must be conducted.


Assuntos
Transtornos Cognitivos/fisiopatologia , Transtornos Cognitivos/psicologia , Transtornos Psicóticos/fisiopatologia , Transtornos Psicóticos/psicologia , Esquizofrenia/fisiopatologia , Psicologia do Esquizofrênico , Transtornos Cognitivos/complicações , Humanos , Testes Neuropsicológicos , Projetos Piloto , Transtornos Psicóticos/complicações , Esquizofrenia/complicações
5.
Psychiatr Danub ; 31(Suppl 3): 608-612, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488799

RESUMO

Schizophrenic patients have traditionally suffered from high rates of cardiovascular disease and early mortality. NICE guidelines suggest that several physical health measures be monitored regularly in these patients, and particularly those on antipsychotic medication, which has a wide side-effect profile that may potentiate the risk of cardiovascular disease and other comorbidities. This general practice audit aimed to determine the rates of physical health monitoring in primary care in patients on antipsychotic medication for over a year for psychotic symptoms or schizophrenia. The search was conducted in three different general practices in March 2019, yielding 19, 8 and 30 patients respectively, with a total of 57 patients. This audit aims to record and analyse rates of monitoring of a range of physical health measures recommended by NICE guidelines over the past year. The results demonstrated that physical health monitoring was poor amongst all the practices audited, especially that of prolactin and waist circumference. We recommend that these rates of monitoring be improved, through implementing templates or the delivery of targeted education to general practitioners and nurses.


Assuntos
Antipsicóticos/efeitos adversos , Medicina Geral , Atenção Primária à Saúde , Transtornos Psicóticos/complicações , Transtornos Psicóticos/tratamento farmacológico , Esquizofrenia/complicações , Esquizofrenia/tratamento farmacológico , Antipsicóticos/administração & dosagem , Auditoria Clínica , Humanos , Transtornos Psicóticos/fisiopatologia , Esquizofrenia/fisiopatologia
6.
Psychiatr Danub ; 31(2): 162-171, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31291220

RESUMO

In this project, we recruited a sample of 150 patients with first episode of psychosis with schizophrenia features (FEP) and 100 healthy controls. We assessed the differences between these two groups, as well as the changes between the acute phase of illness and subsequent remission among patients over 18-month longitudinal follow-up. The assessments were divided into four work packages (WP): WP1- psychopathological status, neurocognitive functioning and emotional recognition; WP2- stress response measured by saliva cortisol during a stress paradigm; cerebral blood perfusion in the resting state (with single photon emission computed tomography (SPECT) and during activation paradigm (with Transcranial Ultrasonography Doppler (TCD); WP3-post mortem analysis in histologically prepared human cortical tissue of post mortem samples of subjects with schizophrenia in the region that synaptic alteration was suggested by WP1 and WP2; WP4- pharmacogenetic analysis (single gene polymorphisms and genome wide association study (GWAS). We expect that the analysis of these data will identify a set of markers that differentiate healthy controls from patients with FEP, and serve as an additional diagnostic tool in the first episode of psychosis, and prediction tool which can be then used to help tailoring individualized treatment options. In this paper, we describe the project protocol including aims and methods and provide a brief description of planned post mortem studies and pharmacogenetic analysis.


Assuntos
Biomarcadores/análise , Transtornos Psicóticos/genética , Feminino , Seguimentos , Estudo de Associação Genômica Ampla , Humanos , Hidrocortisona/análise , Masculino , Farmacogenética , Estudos Prospectivos , Transtornos Psicóticos/complicações , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/tratamento farmacológico , Saliva/química , Esquizofrenia/complicações
7.
Rev Med Suisse ; 15(654): 1169-1172, 2019 Jun 05.
Artigo em Francês | MEDLINE | ID: mdl-31166666

RESUMO

Substance abuse among adolescents and young adults is common. For 5 to 7 % of young people, substance use become problematic, take a function in the psychic equilibrium of the subject and will stop the adolescent process. For some, continuing substances use will be associated with the development of a primary or secondary psychiatric disorder. People with a first psychotic episode (FEP) with cannabis use will stop their use for 50 % of them, with early management of the disorder, without targeted addictive intervention. For the other half, persistent substance uses deteriorate the evolution of psychotic disorders. The treatment aims to avoid such evolution.


Assuntos
Abuso de Maconha , Transtornos Psicóticos , Transtornos Relacionados ao Uso de Substâncias , Adolescente , Humanos , Transtornos Psicóticos/complicações , Transtornos Psicóticos/terapia , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/terapia , Adulto Jovem
8.
Nervenarzt ; 90(7): 745-761, 2019 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-31197396

RESUMO

In the context of secondary, possibly organic schizophreniform psychoses, autoantibody(AB)-associated autoimmune encephalitis (AE) plays an increasingly important role. If this is suspected, clinical investigations, including laboratory, magnetic resonance imaging, electroencephalography and cerebrospinal fluid (CSF) analyses are recommended. The AB screening should include the most frequent ABs against neuronal cell surface antigens (NMDA receptor [R], CASPR2, LGI1, AMPA-R, GABAB-R), intracellular antigens (Hu, Ri, Yo, CV2/CRMP5, Ma2[Ta], amphiphysin, GAD65), thyroid tissue (TG, TPO, TRAK), and antinuclear antigens (ANAs). The ABs against cell surface antigens and GAD65 should be examined directly in serum and CSF. Less frequent ABs can be looked for in a second step. Furthermore, immunofluorescence tests on brain slices of rodents may identify previously unknown ABs. The detection of ABs in combination with further findings can lead to the diagnosis of AE which implies new therapeutic opportunities with immunomodulators.


Assuntos
Autoanticorpos , Encefalite , Transtornos Psicóticos , Autoanticorpos/sangue , Encéfalo/patologia , Encefalite/complicações , Humanos , Fatores Imunológicos/uso terapêutico , Transtornos Psicóticos/sangue , Transtornos Psicóticos/complicações , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/terapia
9.
BMC Med ; 17(1): 112, 2019 06 19.
Artigo em Inglês | MEDLINE | ID: mdl-31215494

RESUMO

BACKGROUND: Atypical antipsychotics, also known as second-generation antipsychotics, are commonly prescribed as treatment for psychotic disorders in adults, as well as in children and adolescents with behavioral problems. However, in many cases, second-generation antipsychotics have unwanted side effects, such as weight gain, potentially further increasing risk for morbidities including obesity, diabetes, and cardiovascular disease. While various mechanisms for this weight gain have been proposed, including effects on metabolic hormone signaling, recent evidence points to the importance of the gut microbiome in this process. The microbial communities residing within the gut are affected by second-generation antipsychotics and can confer weight gain. MAIN TEXT: This review summarizes recent findings and presents data linking second-generation antipsychotics, gut microbiota alterations and weight gain. The review focuses on children and adolescent populations, which have not previously received much attention, but are of great interest because they may be most vulnerable to gut microbiome changes and may carry long-term metabolic effects into adulthood. CONCLUSIONS: We present correlations between second-generation antipsychotics, gut microbiota alterations and weight gain, and suggest some mechanisms that may link them. A better understanding of the underlying mechanisms may lead to the design of improved treatments for psychotic disorders with fewer harmful side effects.


Assuntos
Antipsicóticos/efeitos adversos , Microbiota/efeitos dos fármacos , Obesidade/etiologia , Transtornos Psicóticos/tratamento farmacológico , Ganho de Peso/efeitos dos fármacos , Antipsicóticos/farmacologia , Antipsicóticos/uso terapêutico , Criança , Feminino , Humanos , Masculino , Obesidade/patologia , Transtornos Psicóticos/complicações
10.
J Coll Physicians Surg Pak ; 29(6): S56-S58, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31142424

RESUMO

Erotomania is a delusional phenomenon in which patient believes that some celebrity is in love with her. It is associated with various psychiatric illnesses. We herein present a report of a young woman with erotomanic delusion diagnosed with recurrent depression, current episode being severe with psychotic features. A 22-year woman, previously treated for a depressive episode three years ago, was brought by the mother for evaluation. The woman presented with symptoms of depression for the past six months along with the delusion that famous singer SY is in love with her for the past two months. This has resulted in a gross decline in social and academic functioning. Psychometrics revealed Beck's depression inventory (BDI) score of 36 and brief psychiatric rating scale (BPRS) score of 41. A diagnosis of recurrent depression with current severe episode with psychotic features, was made at our psychiatric facility. This case report highlights that psychotic depression can present with a rare mood incongruent delusion of erotomanic content and accurate diagnosis and management require adequate knowledge about this phenomenon.


Assuntos
Transtorno Bipolar/complicações , Delusões/diagnóstico , Depressão/diagnóstico , Transtorno Depressivo/diagnóstico , Transtornos Psicóticos/complicações , Delusões/etiologia , Delusões/psicologia , Depressão/tratamento farmacológico , Depressão/psicologia , Transtorno Depressivo/tratamento farmacológico , Transtorno Depressivo/psicologia , Emoções , Feminino , Fluoxetina/administração & dosagem , Fluoxetina/uso terapêutico , Humanos , Amor , Olanzapina/administração & dosagem , Olanzapina/uso terapêutico , Transtornos Psicóticos/psicologia , Adulto Jovem
12.
Psychiatry Res ; 276: 218-222, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31112855

RESUMO

Recent studies have found hyperprolactinemia in first episode psychotic patients that had not previously received antipsychotic treatment (drug-naïve). Our goal was to learn whether there were differences in baseline prolactin concentrations between drug-naïve psychotic patients and healthy controls, as well as to study possible gender differences in the prolactin elevation. A cross-sectional study was conducted that included 61 drug-naïve psychosis patients and 45 healthy controls (aged between 14-55 years old). A blood sample was extracted between 8 and 10 a.m. Prolactin levels and TSH were determined. The Perceived Stress Scale (PSS) was conducted across the sample. This study showed significantly higher levels of prolactin in drug-naïve patients compared to healthy controls. These results were maintained after controlling prolactin levels for sex, age, THC consumption, baseline TSH, and PSS. A significant correlation between prolactin and PSS was not observed. Significant differences in prolactin levels between men and women were not observed. These results are clinically important because if elevated baseline prolactin levels are detected in these patients, it will be necessary to initiate neuroleptics that do not increase this hormone. There was no evidence that stress was related to an increase in prolactin at the onset of psychosis.


Assuntos
Hiperprolactinemia/psicologia , Prolactina/sangue , Transtornos Psicóticos/sangue , Fatores Sexuais , Adolescente , Adulto , Antipsicóticos/uso terapêutico , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Hiperprolactinemia/sangue , Masculino , Pessoa de Meia-Idade , Transtornos Psicóticos/complicações , Adulto Jovem
13.
Fortschr Neurol Psychiatr ; 87(7): 375-379, 2019 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-30991422

RESUMO

INTRODUCTION: Epilepsy and psychosis are not only closely related by clinical phenomena but presumably by causal factors, too. There is evidence that long-standing epileptic seizures can induce chronic psychosis. Whether chronic psychosis can cause epilepsy remains to be further investigated. CASE REPORT: We report a case of a 28-year-old man with chronic psychosis since early childhood who developed epilepsy many years after the onset of the psychosis. Medical treatment resulted in complete remission of psychosis and seizures. CONCLUSION: 1.) This case could be a further example for the bidirectional causality of psychosis and epilepsy. 2.) A conditioning psychosis could be understood as a variety of interictal psychosis and complement current classifications.


Assuntos
Epilepsia/etiologia , Transtornos Psicóticos/complicações , Adulto , Epilepsia/complicações , Humanos , Masculino , Transtornos Psicóticos/etiologia , Convulsões/complicações , Convulsões/etiologia , Fatores de Tempo
14.
Zh Nevrol Psikhiatr Im S S Korsakova ; 119(1. Vyp. 2): 50-54, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31006792

RESUMO

AIM: To study the influence of depression on the quality of remission in patients with schizoaffective disorder (SAD) and develop recommendations for anti-relapse therapy. MATERIAL AND METHODS: Eighty-nine outpatients with the diagnosis of SAD were examined, in whom 348 remission cases were studied. In accordance with the characteristics of the episodes, the patients were divided into 2 main groups: patients with only depressive manifestations (group 1) and patients with affective disorders of both poles (group 2). Clinical-psychopathological, clinical-anamnestic, clinical-follow-up and statistical methods were used. RESULTS AND CONCLUSION: The type of SAD did not have a significant effect on the duration of remission and the duration of subsequent hospitalization. Patients of group 2 had residual symptoms in remission almost 2 times less often and the level of affective-delusional disorders in this group was higher compared to group 1. In both groups, affective symptoms are represented by subdepression. Patients without residual symptoms had a longer remission compared to patients with subdepression. Subdepressive disorders are associated with lower treatment adherence. Prescribing anti-relapse treatment of SAD, one should consider not only the current state and features of the last episode, but also the features of previous episodes. Patients with depressive episodes are characterized by subdepressive residual symptoms in remission. For patients with different variants of affective disorders in SAD, emotional disorders in remission are as specific as elements of affective-delusional disorders. Anti-relapse therapy should include neuroleptics and normothymics. In case of residual depressive symptoms, the authors recommend the addition of antidepressants.


Assuntos
Antipsicóticos , Depressão , Transtorno Depressivo Maior , Transtornos Psicóticos , Antidepressivos/uso terapêutico , Depressão/complicações , Depressão/tratamento farmacológico , Transtorno Depressivo Maior/complicações , Transtorno Depressivo Maior/tratamento farmacológico , Humanos , Transtornos Psicóticos/complicações
15.
Medicine (Baltimore) ; 98(16): e15292, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31008977

RESUMO

RATIONALE: Brain atrophy coupled with impaired cognition may be a sign of dementia. However, growing evidence indicates that schizoaffective disorder (SAD) and type 2 diabetes mellitus (T2DM) play roles in the processes of frontotemporal atrophy and cognitive decline. Few cases of frontotemporal atrophy and impaired cognition have been reported in young adult patients with SAD and T2DM. PATIENT CONCERNS: A 34-year-old man was admitted for his 19th rehospitalization due to auditory verbal hallucinations (AVHs), delusions of persecution, mania, and fluctuating blood sugar levels. After admission, a brain computed tomography (CT) scan revealed that the patient's frontotemporal atrophy, which was first found in 2014, had gradually degenerated over time. The Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) revealed cognitive impairments. Based on the clinical assessment, his cognition and social function impairments were determined to mainly result from SAD and T2DM because the clinical characteristics and course of the disease did not coincide with the features of progressive aggravation of dementia. DIAGNOSES: Diagnoses include the following: SAD-mania and T2DM. INTERVENTIONS: Paliperidone and sodium valproate coupled with quetiapine add-on treatment were prescribed for the patient. OUTCOMES: The therapeutic strategy had a limited effect on the patient. LESSONS: Early onset of SAD and T2DM, as well as irregular treatment, resulting in brain atrophy coupled with cognitive impairments, may be the main causes of the patient's treatment resistance and poor outcome. The risks and benefits of treatment strategies should be individually assessed. Further neuroimaging, pertinent biomarkers, and genetic tests along with long-term follow-up are needed for precise evaluation of the patient's condition.


Assuntos
Transtornos Cognitivos/complicações , Disfunção Cognitiva/etiologia , Diabetes Mellitus Tipo 2/complicações , Degeneração Lobar Frontotemporal/etiologia , Transtornos Psicóticos/complicações , Adulto , Disfunção Cognitiva/diagnóstico por imagem , Degeneração Lobar Frontotemporal/diagnóstico por imagem , Degeneração Lobar Frontotemporal/patologia , Humanos , Masculino , Neuroimagem , Tomografia Computadorizada por Raios X
17.
Gene ; 704: 68-73, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-30986448

RESUMO

AIM: The purpose of the present study is to evaluate and understand the association of global and MTHFR gene specific methylation in preeclampsia and recurrent miscarriages in light of MTHFR C677T polymorphism. METHODS: The subjects comprised of recurrent miscarriage cases, their gestation matched controls, preeclampsia cases and matched controls. A set of women at full term were also recruited. Fasting blood sample (~5 ml) was drawn from all the participants followed by DNA extraction, global DNA methylation and MTHFR gene specific methylation. MTHFR C677T polymorphism was analysed by PCR followed by RFLP. RESULTS HIGHER: Global DNA methylation at maternal front (p = 0.04) and hypomethylation of MTHFR gene at fetal front (p = 0.001) might be a characteristic of preeclampsia. Recurrent miscarriage cases were having significantly (p = 0.002) hyper MTHFR gene specific methylation as compared to controls. Women carrying CT genotype were found to be having significantly (p = 0.001) higher global DNA methylation in PE cases and MTHFR gene specific methylation (p = 0.005) in RM cases. Intergenerational analysis revealed similar patterns of global DNA methylation and MTHFR gene specific methylation among both PE and RM cases at maternal and fetal fronts. CONCLUSION: The study highlights the importance of global DNA methylation in Preeclampsia and MTHFR gene specific methylation in recurrent miscarriages. MTHFR C677T gene polymorphism in association with global and gene specific methylation seem to play a pivotal role in PE and RM respectively.


Assuntos
Aborto Habitual/genética , Metilação de DNA , Metilenotetra-Hidrofolato Redutase (NADPH2)/genética , Pré-Eclâmpsia/genética , Adulto , Estudos de Casos e Controles , Feminino , Estudos de Associação Genética , Predisposição Genética para Doença , Homocistinúria/complicações , Homocistinúria/genética , Humanos , Índia , Metilenotetra-Hidrofolato Redutase (NADPH2)/deficiência , Espasticidade Muscular/complicações , Espasticidade Muscular/genética , Polimorfismo de Fragmento de Restrição , Polimorfismo de Nucleotídeo Único , Pré-Eclâmpsia/diagnóstico , Gravidez , Segundo Trimestre da Gravidez/genética , Terceiro Trimestre da Gravidez/genética , Transtornos Psicóticos/complicações , Transtornos Psicóticos/genética
19.
Neurosci Biobehav Rev ; 101: 68-77, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30940436

RESUMO

Psychosis-a cardinal symptom of schizophrenia-has been associated with a failure to appropriately create or use stored regularities about past states of the world to guide the interpretation of incoming information, which leads to abnormal perceptions and beliefs. The visual system provides a test bed for investigating the role of prior experience and prediction, as accumulated knowledge of the world informs our current perception. More specifically, the strength of visual aftereffects, illusory percepts that arise after prolonged viewing of a visual stimulus, can serve as a valuable measure of the influence of prior experience on current visual processing. In this paper, we review findings from a largely older body of work on visual aftereffects in schizophrenia, attempt to reconcile discrepant findings, highlight the role of antipsychotic medication, consider mechanistic interpretations for behavioral effects, and propose directions for future research.


Assuntos
Transtornos Psicóticos/fisiopatologia , Transtornos Psicóticos/psicologia , Esquizofrenia/fisiopatologia , Psicologia do Esquizofrênico , Percepção Visual , Adaptação Fisiológica , Encéfalo/fisiopatologia , Humanos , Neurônios/fisiologia , Estimulação Luminosa , Transtornos Psicóticos/complicações , Esquizofrenia/complicações
20.
JMIR Mhealth Uhealth ; 7(3): e11568, 2019 03 29.
Artigo em Inglês | MEDLINE | ID: mdl-30924789

RESUMO

BACKGROUND: Schizophrenia relapses are common, have profound, adverse consequences for patients and are costly to health services. Early signs interventions aim to use warning signs of deterioration to prevent full relapse. Such interventions show promise but could be further developed. This study addresses 2 developments: adding basic symptoms to checklists of conventional early signs and using a mobile phone app ExPRESS to aid early signs monitoring. OBJECTIVE: This study aimed to (1) design a pool of self-report items assessing basic symptoms (Basic Symptoms Checklist, BSC); (2) develop and beta test a mobile phone app (ExPRESS) for monitoring early signs, basic symptoms, and psychotic symptoms; and (3) evaluate the long-term acceptability of ExPRESS via qualitative feedback from participants in a 6-month feasibility study. METHODS: The BSC items and ExPRESS were developed and then adjusted following feedback from beta testers (n=5) with a schizophrenia diagnosis. Individuals (n=18) experiencing a relapse of schizophrenia within the past year were asked to use ExPRESS for 6 months to answer weekly questions about experiences of early signs, basic symptoms, and psychotic symptoms. At the end of follow-up, face-to-face qualitative interviews (n=16; 2 were uncontactable) explored experiences of using ExPRESS. The topic guide sought participants' views on the following a priori themes regarding app acceptability: item content, layout, and wording; app appearance; length and frequency of assessments; worries about app use; how app use fitted with participants' routines; and the app's extra features. Interview transcripts were analyzed using the framework method, which allows examination of both a priori and a posteriori themes, enabling unanticipated aspects of app use experiences to be explored. RESULTS: Participants' mean age was 38 years (range 22-57 years). Responses to a priori topics indicated that long-term use of ExPRESS was acceptable; small changes for future versions of ExPRESS were suggested. A posteriori themes gave further insight into individuals' experiences of using ExPRESS. Some reported finding it more accessible than visits from a clinician, as assessments were more frequent, more anonymous, and did not require the individual to explain their feelings in their own words. Nevertheless, barriers to app use (eg, unfamiliarity with smartphones) were also reported. Despite ExPRESS containing no overtly therapeutic components, some participants found that answering the weekly questions prompted self-reflection, which had therapeutic value for them. CONCLUSIONS: This study suggests that apps are acceptable for long-term symptom monitoring by individuals with a schizophrenia diagnosis across a wide age range. If the potential benefits are understood, patients are generally willing and motivated to use a weekly symptom-monitoring app; most participants in this study were prepared to do so for more than 6 months. TRIAL REGISTRATION: ClinicalTrials.gov NCT03558529; https://clinicaltrials.gov/ct2/show/NCT03558529 (Archived by WebCite at http://www.webcitation.org/70qvtRmZY).


Assuntos
Aplicativos Móveis/normas , Transtornos Psicóticos/diagnóstico , Prevenção Secundária/instrumentação , Síndrome , Fatores de Tempo , Adulto , Estudos de Viabilidade , Feminino , Humanos , Entrevistas como Assunto/métodos , Masculino , Pessoa de Meia-Idade , Aplicativos Móveis/estatística & dados numéricos , Desenvolvimento de Programas/métodos , Transtornos Psicóticos/complicações , Pesquisa Qualitativa , Prevenção Secundária/métodos , Prevenção Secundária/normas , Autorrelato/estatística & dados numéricos , Smartphone/instrumentação
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