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1.
Rev. Rol enferm ; 46(3,supl): 11-15, mar. 2023.
Artigo em Português | IBECS | ID: ibc-216892

RESUMO

Introdução: Associado à iliteracia do que fazer para prevenir, retardar e quando procurar ajuda, perante a esquizofrenia, requer-se ao enfermeiro especialista em saúde mental um agir ético, alicerçado no conhecimento empírico, técnico-científico, envolvendo os deveres profissionais: dignidade, individualidade e autonomia. Objetivo: Promover a literacia em saúde mental, através da análise do adoecer de uma pessoa com esquizofrenia e das questões éticas associadas ao cuidar em enfermagem de saúde mental. Metodologia: Estudo de caso – filme “Uma Mente Brilhante”, de natureza qualitativa, exploratória-descritiva. Resultados e Discussão: A esquizofrenia transforma a forma de pensar, de sentir e de relação com as pessoas, conduzindo à estigmatização associada a mitos conectivos entre a doença mental e a violência, contribuindo para a dificuldade/exclusão no emprego, apoio social e procura de ajuda. Conclusão: Salienta-se a promoção da literacia do agir perante uma pessoa com esquizofrenia, e do cuidado ético em enfermagem inerente. (AU)


Introduction: Associated with the illiteracy of what to do to prevent, delay, and when to seek help, in the face of schizophrenia, the nurse specialist in mental health is required to act ethically, based on empirical, technical-scientific knowledge, involving professional duties: dignity, individuality and autonomy. Objective: To promote mental health literacy by analysing the illness of a person with schizophrenia and the ethical issues associated with mental health nursing care. Methodology: Case study – film “A Brilliant Mind”, of a qualitative, exploratory-descriptive nature. Results and Discussion: Schizophrenia transforms the way of thinking, feeling, and relating to people, leading to stigmatisation associated with connecting myths between mental illness and violence, contributing to difficulty/exclusion in employment, social support and seeking help. Conclusion: The promotion of literacy on how to act towards a person with schizophrenia, and the inherent ethical care in nursing, are highlighted. (AU)


Assuntos
Humanos , Masculino , Esquizofrenia/tratamento farmacológico , Esquizofrenia/reabilitação , Psicologia do Esquizofrênico , Medicina na Literatura , Filmes Cinematográficos , Medicina nas Artes
2.
CMAJ ; 195(9): E322-E329, 2023 03 06.
Artigo em Inglês | MEDLINE | ID: mdl-36878538

RESUMO

BACKGROUND: Schizophrenia is associated with increased risk of experiencing interpersonal violence. Little is known about risk specifically around the time of pregnancy. METHODS: This population-based cohort study included all individuals (aged 15-49 yr) listed as female on their health cards who had a singleton birth in Ontario, Canada, between 2004 and 2018. We compared those with and without schizophrenia on their risk of an emergency department (ED) visit for interpersonal violence in pregnancy or within 1 year postpartum. We adjusted relative risks (RRs) for demographics, prepregnancy history of substance use disorder and history of interpersonal violence. In a subcohort analysis, we used linked clinical registry data to evaluate interpersonal violence screening and self-reported interpersonal violence during pregnancy. RESULTS: We included 1 802 645 pregnant people, 4470 of whom had a diagnosis of schizophrenia. Overall, 137 (3.1%) of those with schizophrenia had a perinatal ED visit for interpersonal violence, compared with 7598 (0.4%) of those without schizophrenia, for an RR of 6.88 (95% confidence interval [CI] 5.66-8.37) and an adjusted RR of 3.44 (95% CI 2.86-4.15). Results were similar when calculated separately for the pregnancy (adjusted RR 3.47, 95% CI 2.68-4.51) period and the first year postpartum (adjusted RR 3.45, 95% CI 2.75-4.33). Pregnant people with schizophrenia were equally likely to be screened for interpersonal violence (74.3% v. 73.8%; adjusted RR 0.99, 95% CI 0.95-1.04), but more likely to self-report it (10.2% v. 2.4%; adjusted RR 3.38, 95% CI 2.61-4.38), compared with those without schizophrenia. Among patients who did not self-report interpersonal violence, schizophrenia was associated with an increased risk for a perinatal ED visit for interpersonal violence (4.0% v. 0.4%; adjusted RR 6.28, 95% CI 3.94-10.00). INTERPRETATION: Pregnancy and postpartum are periods of higher risk for interpersonal violence among people with schizophrenia compared with those without schizophrenia. Pregnancy is a key period for implementing violence prevention strategies in this population.


Assuntos
Esquizofrenia , Violência , Feminino , Humanos , Gravidez , Estudos de Coortes , Ontário/epidemiologia , Parto , Pesquisa , Esquizofrenia/epidemiologia , Complicações na Gravidez/psicologia
3.
Sci Rep ; 13(1): 3890, 2023 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-36890161

RESUMO

Cortical and subcortical structural alteration has been extensively reported in schizophrenia, including the unusual expansion of gray matter volumes (GMVs) of basal ganglia (BG), especially putamen. Previous genome-wide association studies pinpointed kinectin 1 gene (KTN1) as the most significant gene regulating the GMV of putamen. In this study, the role of KTN1 variants in risk and pathogenesis of schizophrenia was explored. A dense set of SNPs (n = 849) covering entire KTN1 was analyzed in three independent European- or African-American samples (n = 6704) and one mixed European and Asian Psychiatric Genomics Consortium sample (n = 56,418 cases vs. 78,818 controls), to identify replicable SNP-schizophrenia associations. The regulatory effects of schizophrenia-associated variants on the KTN1 mRNA expression in 16 cortical or subcortical regions in two European cohorts (n = 138 and 210, respectively), the total intracranial volume (ICV) in 46 European cohorts (n = 18,713), the GMVs of seven subcortical structures in 50 European cohorts (n = 38,258), and the surface areas (SA) and thickness (TH) of whole cortex and 34 cortical regions in 50 European cohorts (n = 33,992) and eight non-European cohorts (n = 2944) were carefully explored. We found that across entire KTN1, only 26 SNPs within the same block (r2 > 0.85) were associated with schizophrenia across ≥ 2 independent samples (7.5 × 10-5 ≤ p ≤ 0.048). The schizophrenia-risk alleles, which increased significantly risk for schizophrenia in Europeans (q < 0.05), were all minor alleles (f < 0.5), consistently increased (1) the KTN1 mRNA expression in 12 brain regions significantly (5.9 × 10-12 ≤ p ≤ 0.050; q < 0.05), (2) the ICV significantly (6.1 × 10-4 ≤ p ≤ 0.008; q < 0.05), (3) the SA of whole (9.6 × 10-3 ≤ p ≤ 0.047) and two regional cortices potentially (2.5 × 10-3 ≤ p ≤ 0.042; q > 0.05), and (4) the TH of eight regional cortices potentially (0.006 ≤ p ≤ 0.050; q > 0.05), and consistently decreased (1) the BG GMVs significantly (1.8 × 10-19 ≤ p ≤ 0.050; q < 0.05), especially putamen GMV (1.8 × 10-19 ≤ p ≤ 1.0 × 10-4; q < 0.05, (2) the SA of four regional cortices potentially (0.010 ≤ p ≤ 0.048), and (3) the TH of four regional cortices potentially (0.015 ≤ p ≤ 0.049) in Europeans. We concluded that we identified a significant, functional, and robust risk variant block covering entire KTN1 that might play a critical role in the risk and pathogenesis of schizophrenia.


Assuntos
Esquizofrenia , Humanos , Esquizofrenia/genética , Esquizofrenia/patologia , Estudo de Associação Genômica Ampla , Imageamento por Ressonância Magnética , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Polimorfismo de Nucleotídeo Único , RNA Mensageiro , Proteínas de Membrana/genética
4.
J Clin Psychiatry ; 84(2)2023 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-36883881

RESUMO

Objective: To describe lumateperone for the treatment of schizophrenia in adults using number needed to treat (NNT), number needed to harm (NNH), and likelihood to be helped or harmed (LHH).Methods: Data were obtained from the 3 phase 2/3 lumateperone trials, conducted between 2011 and 2016, in patients with schizophrenia diagnosed using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, or Fifth Edition. Efficacy was assessed using various response criteria; tolerability was principally assessed using rates of adverse events (AEs).Results: Pooled data of the 2 informative studies showed statistically significant estimates of NNT versus placebo for lumateperone 42 mg/d for the responder thresholds of ≥ 20% and ≥ 30% improvement on Positive and Negative Syndrome Scale (PANSS) total scores, with NNT for response versus placebo at 4 weeks and endpoint of 9 (95% confidence interval [CI], 5-36) and 8 (95% CI, 5-21), respectively. Pooling all studies, discontinuation because of AEs was uncommon, and the NNH versus placebo was 389 (not statistically significant from placebo [NS]). Rates of individual AEs resulted in NNH versus placebo > 10 except for somnolence/sedation (NNH of 8; 95% CI, 6-12). The occurrence of weight gain ≥ 7% from baseline yielded a NNH estimate of 122 (NS). Rates of akathisia were lower for patients receiving lumateperone compared with placebo. LHH for response versus somnolence/sedation was ~ 1 for lumateperone (similar to the risperidone active control group); otherwise, lumateperone exhibited LHH ratios that were much greater than 1 for all other AEs and that ranged from 13.6 to 48.6 for these other benefit-risk calculations.Conclusions: In 3 phase 2/3 trials, the benefit-risk assessment of lumateperone was favorable as measured by NNT, NNH, and LHH.Trial Registration: ClinicalTrials.gov identifiers: NCT01499563, NCT02282761, NCT02469155.


Assuntos
Antipsicóticos , Esquizofrenia , Adulto , Humanos , Antipsicóticos/efeitos adversos , Compostos Heterocíclicos de 4 ou mais Anéis/uso terapêutico , Risperidona/uso terapêutico , Esquizofrenia/tratamento farmacológico , Esquizofrenia/induzido quimicamente , Sonolência
5.
Ugeskr Laeger ; 185(7)2023 Feb 13.
Artigo em Dinamarquês | MEDLINE | ID: mdl-36892229

RESUMO

Patients with late-onset schizophrenia form a subgroup of schizophrenia that to some extent differs from the typical Gestalt of schizophrenia. Therefore, some of these patients may be overlooked in the clinic. This review describes the characteristics of the late-onset subgroup: Overweight of women, higher education, has been or is still married, and with more children than patients with early onset schizophrenia. The symptomatology of the subgroup is characterised by persecutory delusions and auditory hallucination. Knowledge of this subgroup of patients may lead to attention in the clinic and hopefully have therapeutic value in the recovery process for the patients.


Assuntos
Esquizofrenia , Criança , Humanos , Feminino , Esquizofrenia/diagnóstico , Esquizofrenia/terapia , Delusões , Alucinações/etiologia , Psicologia do Esquizofrênico , Instituições de Assistência Ambulatorial
6.
Behav Brain Res ; 444: 114365, 2023 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-36858318

RESUMO

Schizophrenia is a devastating psychiatric disorder with complex symptoms and neurobiology. Serotonergic dysregulation is known to contribute to the pathogenesis of schizophrenia although dopaminergic and glutamatergic systems are thought to have central roles in neurobiology. No significant success can be achieved in the treatment of negative and cognitive symptoms while positive symptoms can be significantly reduced with current pharmacotherapy. Vortioxetine is a new multimodal antidepressant with 5-HT1A agonism, 5-HT1B partial agonism, 5-HT3, 5-HT7, and 5-HT1D antagonism, and serotonin reuptake inhibition. A limited number of studies suggest its therapeutic effect on the negative and cognitive symptoms of schizophrenia. Therefore, we investigated the potential beneficial effects of vortioxetine on behavioral and molecular deficits in the MK-801 model of schizophrenia in rats. Female Wistar albino rats (10-12 weeks) were grouped as saline, MK-801 (0.2 mg/kg), MK-801 + vortioxetine (2.5 mg/kg), MK-801 + vortioxetine (5 mg/kg), MK-801 + vortioxetine (10 mg/kg), MK-801 + risperidone (0.3 mg/kg), MK-801 + haloperidol (1 mg/kg) (n = 8 in each group). MK-801 has been daily administered (i.p.) for 14 days. Vortioxetine and antipsychotic treatments were injected for 21 days after a washout period of MK-801 and locomotor activity (LA), social interaction (SI), novel object recognition (NOR), Y-maze and prepulse inhibition (PPI) tests were performed at the 16-20th days of treatments, respectively. ELISA test was conducted to evaluate molecular analyses. MK-801 decreased PPI (%), social behaviors, and discrimination index in NOR and alternation (%) in the Y-maze test. In NOR and Y-maze tests, especially vortioxetine 5 and 10 mg/kg increased discrimination index and alternation (%) compared to MK-801. In addition, vortioxetine administration increased social behaviors. Moreover, MK-801 decreased GAD67 and parvalbumin levels while vortioxetine increased these protein levels compared to MK-801. Herein, we first suggested a potential therapeutic effect of vortioxetine, a new multimodal antidepressant, on negative and cognitive symptoms and neurobiological deficits including GAD67 and parvalbumin low expression in the MK-801 model in rats. It would be beneficial to confirm our results in different rodent models and to shed light on the possible mechanisms underlying these effects.


Assuntos
Maleato de Dizocilpina , Esquizofrenia , Animais , Ratos , Feminino , Vortioxetina/farmacologia , Esquizofrenia/tratamento farmacológico , Parvalbuminas , Piperazinas/farmacologia , Ratos Wistar , Antidepressivos/farmacologia , Agonistas do Receptor 5-HT1 de Serotonina , Cognição
7.
Psychiatry Res ; 322: 115134, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-36871410

RESUMO

Schizophrenia is a chronic disorder with a heterogenous course and different ways in which recovery is measured or perceived. Recovery in schizophrenia is a complex process that it can be defined either from a clinical perspective focused on sustained symptom and functional remission, or from a patient-focused one, as a self-broadening process aimed at living a meaningful life beyond mental illness. Until now, studies analysed these domains separately, without examining their mutual relations and changes over time. Therefore, this meta-analysis aimed to examine the relationship of global measures of subjective recovery with each of the components of clinical recovery such as symptom severity and functioning, in patients with schizophrenia spectrum disorders. The results showed that the association between different indicators of personal recovery and remission are weak and inverse (dIG+ = -0.18, z = -2.71, p < 0.01), however, this finding is not substantial according to the sensitivity indicators. With respect to functionality and personal recovery, there was a moderate relationship (dIG+ = 0.26, z = 7.894, p < 0.01) with adequate sensitivity indices. In addition, a low consensus exists between subjective measures that are more related to the patient's perspective and clinical measures based on experts and clinician's viewpoint.


Assuntos
Esquizofrenia , Humanos , Esquizofrenia/diagnóstico , Avaliação de Resultados em Cuidados de Saúde
8.
Psychiatry Res ; 322: 115138, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-36871411

RESUMO

Hyperprolactinemia and metabolic disturbance are common side effects of antipsychotics that cause intolerance. Despite its potential influence on relapse, there are no established guidelines for antipsychotic switching. This naturalistic study explored the association between antipsychotic switching, baseline clinical status, metabolic changes, and relapse in patients with schizophrenia. In total, 177 patients with amisulpride-induced hyperprolactinemia and 274 with olanzapine-induced metabolic disturbance were enrolled. Relapse was determined by assessing changes in Positive and Negative Syndrome Scale (PANSS) total scores from baseline to 6 months (increased over 20% or 10% reaching 70). Metabolic indices were measured at baseline and 3 months. Patients with baseline PANSS >60 were more likely to relapse. Further, patients switching to aripiprazole had a higher risk of relapse regardless of their original medication. Participants who originally used amisulpride had reduced prolactin levels following medication change, while switching to olanzapine caused increased weight and blood glucose levels. In patients originally using olanzapine, only switching to aripiprazole reduced insulin resistance. Adverse effects on weight and lipid metabolism were observed in patients who switched to risperidone, while amisulpride improved lipid profiles. Changing schizophrenia treatment requires careful consideration of multiple variables, particularly the choice of substituted drug and the patient's baseline symptoms.


Assuntos
Antipsicóticos , Hiperprolactinemia , Quinolonas , Esquizofrenia , Humanos , Antipsicóticos/uso terapêutico , Olanzapina/uso terapêutico , Esquizofrenia/tratamento farmacológico , Amissulprida/uso terapêutico , Aripiprazol/uso terapêutico , Benzodiazepinas/uso terapêutico , Piperazinas/efeitos adversos , Quinolonas/efeitos adversos , Doença Crônica , Recidiva
9.
Transl Psychiatry ; 13(1): 82, 2023 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-36882419

RESUMO

Although many studies on brain-age prediction in patients with schizophrenia have been reported recently, none has predicted brain age based on different neuroimaging modalities and different brain regions in these patients. Here, we constructed brain-age prediction models with multimodal MRI and examined the deviations of aging trajectories in different brain regions of participants with schizophrenia recruited from multiple centers. The data of 230 healthy controls (HCs) were used for model training. Next, we investigated the differences in brain age gaps between participants with schizophrenia and HCs from two independent cohorts. A Gaussian process regression algorithm with fivefold cross-validation was used to train 90, 90, and 48 models for gray matter (GM), functional connectivity (FC), and fractional anisotropy (FA) maps in the training dataset, respectively. The brain age gaps in different brain regions for all participants were calculated, and the differences in brain age gaps between the two groups were examined. Our results showed that most GM regions in participants with schizophrenia in both cohorts exhibited accelerated aging, particularly in the frontal lobe, temporal lobe, and insula. The parts of the white matter tracts, including the cerebrum and cerebellum, indicated deviations in aging trajectories in participants with schizophrenia. However, no accelerated brain aging was noted in the FC maps. The accelerated aging in 22 GM regions and 10 white matter tracts in schizophrenia potentially exacerbates with disease progression. In individuals with schizophrenia, different brain regions demonstrate dynamic deviations of brain aging trajectories. Our findings provided more insights into schizophrenia neuropathology.


Assuntos
Esquizofrenia , Substância Branca , Humanos , Esquizofrenia/diagnóstico por imagem , Imageamento por Ressonância Magnética , Encéfalo/diagnóstico por imagem , Substância Cinzenta/diagnóstico por imagem , Substância Branca/diagnóstico por imagem
10.
J Clin Psychiatry ; 84(2)2023 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-36856526

RESUMO

Objective: To compare well-baby visit and vaccination schedule adherence up to age 24 months in children of mothers with versus without schizophrenia.Methods: Using administrative health data on births in Ontario, Canada (2012-2016), children of mothers with schizophrenia (ICD-9: 295; ICD-10: F20/F25; DSM-IV schizophrenia or schizoaffective disorder) (n = 1,275) were compared to children without maternal schizophrenia (n = 520,831) on (1) well-baby visit attendance, including an enhanced well-baby visit at age 18 months, and (2) vaccine schedule adherence for diphtheria, tetanus, pertussis, polio, Haemophilus influenzae type B (DTaP-IPV-Hib), and measles, mumps, rubella (MMR). Cox proportional hazard regression models were adjusted for each of maternal sociodemographics, maternal health, and child health characteristics in blocks and all together in a fully adjusted model.Results: About 50.3% of children with maternal schizophrenia had an enhanced 18-month well-baby visit versus 58.6% of those without, corresponding to 29.0 versus 33.9 visits/100 person-years (PY), a hazard ratio (HR) of 0.82 (95% CI, 0.76-0.89). The association was dampened after adjustment for maternal sociodemographics, maternal health, and child health factors in blocks and overall, with a fully adjusted HR of 0.91 (95% CI, 0.84-0.98). Full vaccine schedule adherence occurred in 40.0% of children with maternal schizophrenia versus 46.0% of those without (22.6 vs 25.9/100 PY), yielding a HR of 0.86 (95% CI, 0.78-0.94). The association was dampened when adjusted for maternal sociodemographics and child health characteristics and became nonsignificant when adjusted for maternal health characteristics. The fully adjusted HR was 0.95 (95% CI, 0.87-1.04).Conclusions: Increased efforts to ensure that children with maternal schizophrenia receive key early preventive health care services are warranted.


Assuntos
Transtornos Psicóticos , Esquizofrenia , Lactente , Humanos , Criança , Feminino , Pré-Escolar , Estudos de Coortes , Manual Diagnóstico e Estatístico de Transtornos Mentais , Mães
11.
Philos Trans R Soc Lond B Biol Sci ; 378(1875): 20210480, 2023 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-36871591

RESUMO

People with a diagnosis of schizophrenia (PSz) have difficulty engaging in social interaction, but little research has focused on dialogues involving PSz interacting with partners who are unaware of their diagnosis. Using quantitative and qualitative methods on a unique corpus of triadic dialogues of PSz first social encounters, we show that turn-taking is disrupted in dialogues involving a PSz. Specifically, there are on average longer gaps between turns in groups which contain a PSz compared to those which do not, particularly when the speaker switch occurs from one control (C) participant to the other. Furthermore, the expected link between gesture and repair is not present in dialogues with a PSz, particularly for C participants interacting with a PSz. As well as offering some insights into how the presence of a PSz affects an interaction, our results also demonstrate the flexibility of our mechanisms for interaction. This article is part of a discussion meeting issue 'Face2face: advancing the science of social interaction'.


Assuntos
Esquizofrenia , Humanos , Gestos , Resolução de Problemas , Grupo Social , Interação Social
13.
Psychopharmacol Bull ; 53(1): 55-57, 2023 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-36873922

RESUMO

No single neurotransmitter aberration could explain the heterogeneity of schizophrenia syndrome and thus, treatment strategies capitalizing solely on a single neurotransmitter system (e.g., DA blockade) is less likely to be fully successful on clinical grounds. Hence, there is a pressing need to develop newer antipsychotics above and beyond DA antagonism. In this regard, authors brief on five agents that sound pretty promising and might usher in a new sparkle in the psychopharmacotherapy of schizophrenia. This paper is a sequel for authors' previous article on future of schizophrenia psychopharmacotherapy.


Assuntos
Antipsicóticos , Esquizofrenia , Humanos
14.
Nutrients ; 15(5)2023 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-36904193

RESUMO

Polyunsaturated fatty acids (PUFAs), especially long-chain PUFAs (LCPUFAs), are crucial for both the structural and functional integrity of cells. PUFAs have been reported to be insufficient in schizophrenia, and the resulting cell membrane impairments have been hypothesized as an etiological mechanism. However, the impact of PUFA deficiencies on the onset of schizophrenia remain uncertain. We investigated the associations between PUFAs consumption and schizophrenia incidence rates through correlational analyses and conducted Mendelian randomization analyses to reveal the causal effects. Using dietary PUFA consumption and national schizophrenia incidence rates in 24 countries, we found that incidence rates of schizophrenia were inversely correlated with arachidonic acid (AA) and ω-6 LCPUFA consumption (rAA = -0.577, p < 0.01; rω-6 LCPUFA = -0.626, p < 0.001). Moreover, Mendelian randomization analyses revealed that genetically predicted AA and gamma-linolenic acid (GLA) were protective factors against schizophrenia (ORAA = 0.986, ORGLA = 0.148). In addition, no significant relationships were observed between schizophrenia and docosahexaenoic acid (DHA) or other ω-3 PUFAs. These findings show that the deficiencies of ω-6 LCPUFAs, especially AA, are associated with schizophrenia risk, which sheds novel insight into the etiology of schizophrenia and a promising diet supplementation for the prevention and treatment of schizophrenia.


Assuntos
Ácidos Graxos Ômega-3 , Esquizofrenia , Humanos , Ácido Araquidônico , Análise da Randomização Mendeliana , Ácidos Graxos Insaturados/metabolismo
15.
BMC Cardiovasc Disord ; 23(1): 126, 2023 03 08.
Artigo em Inglês | MEDLINE | ID: mdl-36890440

RESUMO

BACKGROUND: Patients with schizophrenia have an increased prevalence of risk factors for peripheral artery disease (PAD) and is expected to have an increased prevalence of PAD. PAD can be detected utilizing toe-brachial index (TBI) which screens for vascular pathology proximal to the toes. METHODS: Using a cross-sectional design, we defined the subpopulations: (1) Patients diagnosed with schizophrenia less than 2 years before inclusion (SCZ < 2), (2) Psychiatric healthy controls matched to subpopulation 1 on sex, age, and smoking status, and (3) Patients diagnosed with schizophrenia 10 or more years before inclusion (SCZ ≥ 10). TBI was calculated by dividing toe pressures by systolic brachial blood pressure, and PAD was defined by TBI < 0.70. Logistic regression analysis with PAD as outcome and sex, age, smoking status, BMI, skin temperature, diagnosis of schizophrenia, and comorbidities as explanatory variables was conducted. RESULTS: PAD was present in 26.2% of patients diagnosed with SCZ < 2 (17 of 65) and in 18.5% of psychiatric healthy controls (12 of 65) with no statistically significant difference in prevalence rates (p = 0.29). PAD was present in 22.0% of patients diagnosed with SCZ ≥ 10 (31 of 141). In logistic regression, patients diagnosed with SCZ < 2 had an increased odds of PAD with psychiatric healthy controls as reference (Odds ratio = 2.80, 95% confidence interval 1.09-7.23, p = 0.03). The analysis was adjusted for age, sex, smoking status, BMI and comorbidities such as hypertension, diabetes and heart disease. CONCLUSIONS: This study did not find statistically significant increased prevalence rates of PAD in patients with schizophrenia even though patients with SCZ were compared to psychiatric healthy controls using TBI. Utilizing logistic regression PAD was associated with schizophrenia diagnosis within the last 2 years, age and skin temperature. As PAD is initially asymptomatic, screening could be relevant in patients with schizophrenia if other risk factors are prevalent. Further large-scale multicenter studies are warranted to investigate schizophrenia as a potential risk factor for PAD. TRIAL REGISTRATION: Clinicaltrials.gov identifier NCT02885792.


Assuntos
Doença Arterial Periférica , Esquizofrenia , Humanos , Estudos Transversais , Esquizofrenia/diagnóstico , Esquizofrenia/epidemiologia , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/epidemiologia , Pressão Sanguínea/fisiologia , Índice Tornozelo-Braço , Fatores de Risco , Prevalência
16.
Tijdschr Psychiatr ; 65(2): 87-94, 2023.
Artigo em Holandês | MEDLINE | ID: mdl-36912053

RESUMO

BACKGROUND: It has long been thought that women with a schizophrenia spectrum disorder have a more favorable course than men. However, this is not the case, even though they become ill later in life and are less likely to have comorbid drug abuse. Guidelines for prescribing antipsychotics are based on research with mostly male participants, and by following these guidelines we are doing our female patients a disservice. Gender and sex differences lead to differences in preferences, pharmacokinetics and pharmacodynamics. AIM: Providing an overview of antipsychotics for women with a schizophrenia spectrum disorder and discuss the consequences for practice. METHOD: A clinically oriented study of the literature. RESULTS: Women reach higher plasma levels than men when they receive the same dose of antipsychotic drugs (except for lurasidone and quetiapine). The effect of antipsychotics is also greater in women, because estrogens increase the brain’s dopamine sensitivity. This leads to higher risks of side effects. Clinical guidelines differ for women at different stages of life because estrogens greatly contribute to the sex differences seen in the efficacy and tolerability of antipsychotics. CONCLUSION: Clinicians should be aware that women should be treated differently with antipsychotics than men.


Assuntos
Antipsicóticos , Esquizofrenia , Feminino , Humanos , Masculino , Antipsicóticos/uso terapêutico , Esquizofrenia/tratamento farmacológico , Fumarato de Quetiapina/uso terapêutico
17.
Actas Esp Psiquiatr ; 51(1): 29-40, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36912392

RESUMO

BACKGROUND: Alterations in pain perception have been observed in people diagnosed with schizophrenia. Some research suggests the existence of a possible hyposensitivity, while others describe a hypersensitivity to pain in people with schizophrenia. In summary, the studies present contradictory results.


Assuntos
Esquizofrenia , Humanos , Dor
18.
Sci Prog ; 106(1): 368504231160415, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36919454

RESUMO

Individuals with severe mental illnesses (SMI) often have difficulty performing daily activities that require intact executive functions, such as grocery shopping. Performance-based evaluations are valuable but lack the subjects' viewpoints during task performance. This study aims to combine performance-based observation and cognitive science methods to provide insights regarding real-life behavior and problem-solving in populations with SMI. In this correlational-research study, 42 participants (10 in the SMI group and 32 in the control group) performed the Test of Grocery Shopping Skills (TOGSS) while wearing an eye-tracking device. We hypothesized that patterns in task planning, task-time use, and attention allocation to written information relevant to the task would differ between the groups during the task. The results showed between-group differences in both TOGSS efficiency outcomes (time and redundancy), duration, and number of fixations. An eye-tracking pattern analysis determined between-group differences in scanning patterns of the grocery list but similarities in task planning. The selection process was found to be significantly more accurate and efficient for the control group than for the SMI group. Our findings suggest that a combination of perspectives allows us to better understand the behavior of SMI individuals in a regular daily task.


Assuntos
Transtornos Mentais , Esquizofrenia , Humanos , Supermercados , Atividades Cotidianas/psicologia , Análise e Desempenho de Tarefas
19.
Medicine (Baltimore) ; 102(10): e32912, 2023 Mar 10.
Artigo em Inglês | MEDLINE | ID: mdl-36897697

RESUMO

To analyze the relationship between olanzapine blood concentration and clinical efficacy in schizophrenia patients, which has been expected to provide a scientific reference basis for improving the treatment effect of olanzapine in schizophrenia patients. Four hundred eighty-six psychiatric inpatients were randomly selected from October 31, 2019, to October 31, 2020, and all enrolled patients were given olanzapine treatment, and the treatment effect of schizophrenia patients was assessed according to the Positive and Negative Symptom Scale subtraction rate, and divided into treatment effective and ineffective groups at 1, 2, and 3 weeks of treatment, respectively. The olanzapine blood concentration in the body was monitored at 1, 2, and 3 weeks of treatment, and the relationship between olanzapine blood concentration and treatment effect at different time points was analyzed. Patients in the ineffective group had lower olanzapine blood concentrations than the effective group in treatment 1, 2, and 3 weeks and lower Positive and Negative Symptom Scale score reduction rates than the effective group (P < .05); the differences in other baseline information between the groups were not statistically significant (P > .05). Logistic regression analysis showed that olanzapine blood concentration at different times of treatment was related to the treatment effect (odds ratio > 1, P < .05); the results of the bivariate Spearman linear correlation test showed that olanzapine blood concentration at different times of treatment was positively related to the treatment effect of schizophrenia patients (R > 0, P < .05). In schizophrenia patients treated with olanzapine, the higher the olanzapine blood concentration in patients, the better the clinical treatment effect. Accordingly, the clinical can develop individualized medication regimens based on the results of blood concentration testing in the body under the premise of ensuring safety, aiming to ensure maximum efficacy.


Assuntos
Antipsicóticos , Esquizofrenia , Humanos , Olanzapina/uso terapêutico , Esquizofrenia/tratamento farmacológico , Antipsicóticos/uso terapêutico , Benzodiazepinas/efeitos adversos , Resultado do Tratamento , Método Duplo-Cego
20.
Artigo em Inglês | MEDLINE | ID: mdl-36898036

RESUMO

Objective: To leverage electronic health record (EHR) data to explore the relationship between weight gain and antipsychotic adherence among patients with schizophrenia and bipolar disorder (BD).Methods: EHR data were used to identify individuals with at least 60 days of continuous antipsychotic use between 2005 and 2019. Patients were diagnosed with schizophrenia, schizoaffective disorder, BD, or neither diagnosis (psychiatric controls). We examined the association of weight gain in the first 90 days with the proportion of days covered (PDC) with an antipsychotic and with the frequency of medication switching or stopping.Results: We identified 590 adults with schizophrenia or schizoaffective disorder, 819 adults with BD, and 642 psychiatric controls. In the first 90 days, the percentages of patients with a PDC ≥ 0.80 were 76.8% (schizophrenia), 77.1% (BD), and 70.7% (controls). Logistic regression models revealed that weight gain of ≥ 7% trended toward being significantly associated with greater adherence in the first 90 days (odds ratio = 1.29, P = .077) and was significantly associated with an increased likelihood of a medication switch in the first 180 days (odds ratio = 1.60, P = .003).Discussion: Patients whose weight increased by 7% or more in the first 90 days were more adherent but were also more likely to switch medications during the first 180 days.


Assuntos
Antipsicóticos , Esquizofrenia , Adulto , Humanos , Antipsicóticos/efeitos adversos , Registros Eletrônicos de Saúde , Adesão à Medicação/psicologia , Esquizofrenia/tratamento farmacológico , Cooperação e Adesão ao Tratamento
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