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Clinical guidelines provide evidence-based recommendations to regulate pharmacological treatment of psychotic disorders. However, the quality of evidence, country of origin, and publication dates of such guidelines vary, which leads to discrepancies between recommendations. This systematic review aimed to examine consensus and disparities between clinical recommendations on the choice, dose, and duration of antipsychotic treatment for first- and multi-episode schizophrenia patients. A literature search through The Cochrane Library, Embase, Medline, PsycINFO, PubMed, Scopus, Web of Sciences, and relevant bibliographies revealed 24 guidelines that met the inclusion criteria. The guidelines indicated mostly consistent recommendations regarding the optimal dose range of antipsychotics, while guidance with regards to the choice and duration of treatment remains somewhat controversial. Current trends in guidelines emphasize that there is simply no 'one-size-fits-all' method to manage schizophrenia patients. Further research is needed not only to address discrepancies between guidelines, but also to justify the gap between theory and practice.
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Antipsicóticos/administração & dosagem , Guias de Prática Clínica como Assunto , Esquizofrenia/tratamento farmacológico , Antipsicóticos/uso terapêutico , Humanos , Apoio Social , Fatores de Tempo , Resultado do TratamentoRESUMO
Psychotic disorders have long been known to be a condition that peaks during adolescence and early adulthood. A considerable proportion of patients have their first onset at or after the age of 40, but little is known about this population. The current systematic review examined the clinical presentation of late-onset psychosis (LOP) and very-late-onset-schizophrenia-like psychosis (VLOSLP) with focus on their psychopathological, neuropsychological, neurobiological, psychosocial and psychological correlates. A systematic search of studies published from 2000 to 2019 from Cochrane Library, Pubmed, Medline, Embase, PsycINFO, and Scopus yielded 27 original studies that were included in this review. Results revealed there is a dearth of empirical research on the conditions in the current literature and inconsistencies in the findings reported may be associated with the lack of uniformity in the definitions for LOP and VLOSLP. Future research on the topic shall (i) specify the onset age criteria for LOP and VLOSLP; (ii) study the conditions independently; (iii) involve a larger sample size, and iv) account for potential confounding variables. A comprehensive evaluation of the risks and benefits of pharmacological treatment may also be needed.
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Antipsicóticos/uso terapêutico , Testes Neuropsicológicos , Transtornos Psicóticos/terapia , Humanos , Neurobiologia , Esquizofrenia/terapiaRESUMO
Despite the importance of the role of caregivers of people with psychosis being widely recognized, comprehensive understanding of their experience is limited. A thorough understanding of the experience of caregivers over the journey of the illness, particularly during its early stages, is crucial. Qualitative studies published between 1 January 1949 and 31 January 2018 were obtained from seven databases based on PICo search strategy. Meta-aggregation methodology of the Joanna Briggs Institute (JBI) was adopted to aggregate existing qualitative findings about caregivers' experiences. Twenty-eight qualitative studies on 635 caregivers and family members were included in the review. Six inter-related categories-'stigma', 'help-seeking', 'service encounter', 'emotional challenges', 'on becoming a caregiver' and 'making sense of experience'-were aggregated from 129 themes from the sub-acute stage, the acute stage and the recovery or residual stage. Three statements about caregivers' experiences of their relative's first episode of psychosis were synthesized from the findings. Results highlighted the need of incorporating caregiver intervention into the existing services to support the emotional challenges, uncertainty, and stigma-related burden along the caregiving journey.
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Cuidadores/psicologia , Transtornos Psicóticos/enfermagem , Pesquisa Qualitativa , Humanos , Estigma SocialRESUMO
Despite convincing evidence of short-term symptom control and functional recovery of patients with psychosis after receiving early intervention (EI) services, little is known about the long-term outcomes of EI for these patients. This review aims to evaluate the effectiveness of EI services in improving long-term outcomes of patients with psychosis. A systematic literature search was conducted on PubMed, PsycINFO, Scopus, Medline, CINAHL, BIOSIS, and EMBASE electronic databases to identify studies that evaluated long-term outcomes of patients with psychosis measured 5 years or beyond after entering the EI service. Of 13,005 articles returned from the search, 14 eligible articles reporting study cohorts from nine EI services in seven countries and regions were identified. Data on study design, patient characteristics, intervention components, and outcomes were extracted and reviewed. Only a few studies reported better longitudinal outcomes for negative symptoms, mortality, employment, and hospitalization in patients received EI services. However, results from cross-sectional measurements provided little evidence for long-term impacts of EI services on clinical and functional outcomes. A dilution effect of benefits over time was also demonstrated in several studies. This review highlights the gap in current EI service provision and suggests possible future directions for service improvement and further research.
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Diagnóstico Precoce , Transtornos Psicóticos , Resultado do Tratamento , Humanos , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/terapia , Esquizofrenia/diagnóstico , Esquizofrenia/terapiaRESUMO
BACKGROUND: There is growing concern regarding teratogenic effect of antipsychotics. Previous research assessing association between antipsychotics and congenital malformations (CMs) yielded mixed results and were all derived from Western countries. We aimed to examine risk of major and organ/system-specific CMs associated with prenatal antipsychotic exposure in Hong Kong. METHODS: This population-based study identified women aged 15-50 years who delivered their first/singleton child between 2003-2018 from public healthcare service database. Propensity score (PS)-weighted logistic-regression analyses were performed to examine risk of CMs following first-trimester exposure to antipsychotic classes (second- and first-generation antipsychotic; SGA and FGA) and six most frequently-prescribed individual antipsychotics. RESULTS: Of 465,069 women, 419 and 420 redeemed ≥1 prescription of SGA and FGA during first-trimester, respectively. Prevalence of any CMs was 4.9% (95%CI:4.9-5.0%) in unexposed-infants, 9.1% (6.7-12.3%) in SGA-exposed infants, and 6.2% (4.3-9.0%) in FGA-exposed infants. SGA exposure (adjusted-odds-ratio: 2.11 [95%CI:1.19-3.86]) was associated with increased risk of CMs. This finding was consistent with sensitivity analyses addressing exposure misclassification and confounding by treatment indication, but not with PS-matched sensitivity analysis. Elevated risk of CMs was observed in infants exposed to high-dose olanzapine (7.50 [1.65-36.13]) and high-dose quetiapine (15.03 [4.86-56.72]), but with wide-CIs. Organ/system-specific malformations were not associated with SGA, FGA or individual antipsychotics. CONCLUSION: We observed a small increased risk of major malformations associated with SGA, but was not consistently affirmed in sensitivity analyses, precluding firm conclusions. Research with large sample size clarifying comparative safety of individual antipsychotics on specific malformations is warranted.
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Anormalidades Induzidas por Medicamentos , Antipsicóticos , Primeiro Trimestre da Gravidez , Pontuação de Propensão , Humanos , Feminino , Antipsicóticos/efeitos adversos , Gravidez , Adulto , Anormalidades Induzidas por Medicamentos/epidemiologia , Anormalidades Induzidas por Medicamentos/etiologia , Adolescente , Hong Kong/epidemiologia , Adulto Jovem , Pessoa de Meia-Idade , Estudos de Coortes , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente , Recém-Nascido , Complicações na Gravidez/tratamento farmacológico , Complicações na Gravidez/epidemiologiaRESUMO
CONTEXT: Despite recent advances in antidepressants in treating major depression (MDD), their usage is marred by adverse effects and social stigmas. Probiotics may be an efficacious adjunct or standalone treatment, potentially circumventing the aforementioned issues with antidepressants. However, there is a lack of head-to-head clinical trials between these 2 interventions. OBJECTIVE: A systematic review and network meta-analysis was conducted to compare the efficacy and acceptability of these 2 interventions in treating MDD. DATA SOURCES: Six databases and registry platforms for the clinical trial were systematically searched to identify the eligible double-blinded, randomized controlled trials published between 2015 and 2022. DATA EXACTION: Two authors selected independently the placebo-controlled trials of antidepressants and microbiota-targeted interventions (prebiotics, probiotics, and synbiotics) used for the treatment of MDD in adults (≥18 years old). Standardized mean differences (SMDs) of depressive symptom scores from individual trials were pooled for network meta-analysis (PROSPERO no. CRD42020222305). RESULTS: Forty-two eligible trials covering 22 interventions were identified, of which 16 were found to be effective in MDD treatment and the certainty of evidence was moderate to very low. When all trials were considered, compared with placebo, SMDs of interventions ranged from -0.16 (95% credible interval: -0.30, -0.04) for venlafaxine to -0.81 (-1.06, -0.52) for escitalopram. Probiotics were superior to brexpiprazole (SMD [95% credible interval]: -0.42 [-0.68, -0.17]), cariprazine (-0.44 [-0.69, -0.24]), citalopram (-0.37 [-0.66, -0.07]), duloxetine (-0.26, [-0.51, -0.04]), desvenlafaxine (-0.38 [-0.63, -0.14]), ketamine (-0.32 [-0.66, -0.01]), venlafaxine (-0.47 [-0.73, -0.23]), vilazodone (-0.37 [-0.61, -0.12]), vortioxetine (-0.39 [-0.63, -0.15]), and placebo (-0.62 [-0.86, -0.42]), and were noninferior to other antidepressants. In addition, probiotics ranked the second highest in the treatment hierarchy after escitalopram. Long-term treatment (≥8 weeks) using probiotics showed the same tolerability as antidepressants. CONCLUSION: Probiotics, compared with antidepressants and placebo, may be efficacious as an adjunct or standalone therapy for treating MDD. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration no. CRD42020222305.
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OBJECTIVE: Direct contact interventions are known to reduce stigma. Effects of both filmed and direct social contact were found similar in reducing stigma. This study aims to understand the effect of video intervention, especially the effects between patient-sharing video and expert information video, among the medical students. METHODS: Seventy-two medical students were recruited from two consecutive clinical study periods. Students from one period were in the patient-sharing group, watching a 7-minute patient-sharing video. The others were in expert information group watching a 5-minute psychosis video. Subject's desire of social distance (Reported and Intended Behaviour Scale) knowledge (the Social Contact Intended Learning Outcome) attitude towards mental illness (Clinicians Attitudes Scales version 4) and emotional reactions (the Emotional Reactions to Mental illness Scales) were measured. Assessments were done at baseline, immediately after video watching and at 1 to 2 weeks follow-up. Within-group ANOVA was used to assess the difference between time points. Group by time effect was explored. RESULTS: Significant improvement in knowledge level was found with a significant group by time effect (F = 6.261, P = .004) for PS group and was maintained at follow-up. Post-intervention attitude was significantly improved in PS group but not maintained. Only social distance was improved significantly in EX group (F = 8.093, P = 0.003). Both groups had a significant reduction in fear sub-score. CONCLUSION: This study provided evidence on the effect of patient-sharing video in improving the attitude and knowledge of medical students. Expert information video about psychosis can improve social proximity. Combining these approaches may improve stigma and knowledge among medical students.
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Transtornos Mentais , Transtornos Psicóticos , Estudantes de Medicina , Atitude , Humanos , Conhecimento , Transtornos Psicóticos/diagnóstico , Estigma SocialRESUMO
AIM: Psychiatric comorbidity frequently occurs with at-risk mental state (ARMS) for psychosis. Its relationships with psychopathology, cognition and functioning, however, remain to be further clarified. We aimed to examine prevalence and correlates of psychiatric comorbidity, and its associations with psychosocial functioning and subjective quality-of-life (QoL) in a representative sample of Chinese ARMS individuals. METHODS: One hundred ten help-seeking participants aged 15 to 40 years with ARMS were recruited from a specialized early psychosis service in Hong Kong. ARMS status was verified by comprehensive assessment of at-risk mental state (CAARMS). Comorbid Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition non-psychotic psychiatric disorders at baseline were ascertained using diagnostic interview and medical record review. Assessments encompassing symptom profiles, psychosocial functioning, subjective QoL and a brief cognitive battery were conducted. RESULTS: Forty-nine (44.5%) ARMS participants were diagnosed as having comorbid non-psychotic psychiatric disorders at baseline, primarily depressive and anxiety disorders. Binary multiple logistic regression analysis revealed that female gender, more severe depressive symptoms, higher suicidality and poorer global cognitive functioning were independently associated with comorbid diagnosis status. ARMS participants with psychiatric comorbidity displayed significantly more limited extended social networks and poorer subjective QoL than those without psychiatric comorbidity. CONCLUSION: Comorbid disorders were frequently observed in Chinese ARMS individuals, and were linked to poorer cognition and higher suicide risk. Our findings underscore a potential critical role of psychiatric comorbidity in determining social functioning and subjective QoL in at-risk individuals. Further longitudinal research is required to clarify trajectories of comorbid disorder status and its prospective impact on clinical and functional outcomes in ARMS populations.
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Transtornos Psicóticos , Qualidade de Vida , Cognição , Comorbidade , Feminino , Humanos , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Funcionamento Psicossocial , Transtornos Psicóticos/epidemiologiaRESUMO
AIM: The current study explored the effect of an early intervention (EI) service for psychosis in Hong Kong (EASY) on the reduction of the duration of untreated psychosis (DUP) at 10 years, in adolescent and adult patients. METHOD: Data from three first-episode psychosis (FEP) studies conducted over 10 years using the same DUP assessment was analysed. FEP study 1 year before the EI service (2000) was used as a control, with those aged <25 comprising the youth psychosis control group and those aged over 25 comprising the adult psychosis control group. Data from the EASY service collected in 2010 constituted the youth psychosis EI group and data from an adult EI service collected from 2009 to 2011 constituted the adult psychosis EI group. DUP of EI and control groups was compared. The effect of the mode of onset and family history of psychosis on DUP was studied. RESULTS: DUP in the adult group was significantly reduced from median of 180 days to 93 days after 10 years (U = 12 906.50, P = 0.01), particularly in those with gradual onset and without family history. However, no significant change of DUP was found in the youth psychosis group. CONCLUSIONS: Results of the current study provide evidence that EI programmes with public awareness campaign can significantly reduce DUP of adult patients but not in youth group. The effect is more specific in those with long DUP. Further research should explore the specific factors contributed to the long DUP of patients of different age groups so as to establish targeted intervention strategies.
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Intervenção Médica Precoce , Transtornos Psicóticos/terapia , Tempo para o Tratamento/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Feminino , Hong Kong/epidemiologia , Humanos , Masculino , Transtornos Psicóticos/epidemiologia , Fatores de Tempo , Adulto JovemRESUMO
AIM: In Hong Kong, 'si-jue-shi-tiao' () was officially adopted as the Chinese translation of psychosis in 2001. The new term covered a broader aspect of psychosis, compared with the original term, 'jing-shen-fen-lie' (), which gave a negative stereotype as a 'mental split-mind disorder'. The current study compared the usage of the two terms, and added evidence to the name changing as anti-stigma strategy. METHODS: The usage and themes of the new Chinese name of psychosis 'si-jue-shi-tiao' was examined in 1217 local newspaper articles in comparison with the traditional Chinese name of schizophrenia 'jing-shen-fen-lie'. RESULTS: Results show that an increase use of 'si-jue-shi-tiao' was found equally across themes, whereas 'jing-shen-fen-lie' was decreasingly used in positive/neutral themes over time. The association of 'jing-shen-fen-lie' with dangerous wordings increased over time, but no change was found with the new name. CONCLUSIONS: Our finding adds to literature on effects of changing new name on public stigma.
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Jornais como Assunto/tendências , Transtornos Psicóticos , Estigma Social , Terminologia como Assunto , Hong Kong , HumanosRESUMO
Caregivers of patients with first-episode psychosis are often with little knowledge about the illness and experience more burden of care. Psychoeducation to caregivers has shown to be effective in improving outcomes of patients and possibly reduce stress of the caregivers. This has been recommended as one of the key psychosocial interventions for specific early intervention for psychosis service. However, the accessibility of the service, high case load of the health care professionals and self-stigma of caregivers are often the barriers of implementation of these programs in the real world. Incorporating the convenience of information access via internet and the concept of self-management approach, an interactive internet-based self-help psychoeducation program (iPEP) (www.ipep.hk) for the caregivers of patients with psychosis was established targeting the caregivers of patients with psychosis at early stage in Hong Kong. It provides a comprehensive online resource center in both written and video format on knowledge about psychosis, skills of care, and information of local resources. It also has a forum facilitate information exchange between healthcare professionals and the caregivers, allowing for self-management. Over 800 caregivers have joined the program as members. The evaluation of the subset of the members/users of the iPEP suggested that the iPEP program has been well received and appreciated by the caregivers of patients with first episode psychosis locally. It can potentially serve as a platform for future development of specific manual-based psychoeducation program for caregivers targeting at the needs of different groups.
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AIM: Psychotic disorders incur substantial long-term burdens to patients and society. Early intervention (EI) during the initial years of psychotic disorders can improve long-term outcome. In Hong Kong, a pilot EI programme (EASY, Early Assessment Service for Young people with psychosis) had been set up since 2001 to serve clients under 25 years of age. Although EASY has been effective in improving outcome, consolidation of early psychosis work requires further development. METHODS: The present paper describes a new EI development which targets adult patients with psychosis in Hong Kong. The Jockey Club Early Psychosis (JCEP) project was launched in 2009. Expanding the service to patients above 25 years old, JCEP aims to deliver a territory-wide specialized EI service to adult-onset psychosis patients, to promote public awareness on early psychosis, and to research on the optimal intervention model and duration for early psychosis in a 4-year randomized controlled trial (RCT). Participants were randomly assigned to receive either 4 years of EI service, 2 years of EI service, or 4 years of standard care. Their symptoms, neurocognitive functions, psychosocial well-being and health economics were regularly assessed. RESULTS: To date, 360 patients were recruited into the RCT, and 740 patients were recruited in a 2-year naturalistic study. Prospective, longitudinal follow-up assessments of these patients are still underway. CONCLUSIONS: JCEP is the first EI project to provide adult early psychosis service in Chinese population. Future data would help to address the optimal duration of EI and its cost-effectiveness. This would also assist regional and international mental health development.