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Schizophrenia Research Jun 2021We used proton magnetic resonance spectroscopy (H MRS) to quantify N-acetylaspartate (NAA) concentrations and apparent spin-spin (T2) relaxation times, which also...
We used proton magnetic resonance spectroscopy (H MRS) to quantify N-acetylaspartate (NAA) concentrations and apparent spin-spin (T2) relaxation times, which also include diffusion attenuations, in first episode and chronic psychosis patients compared to matched healthy controls. 104 patients diagnosed with psychotic disorders and 50 matched controls were scanned at 4 Tesla. H MRS data were collected at four echo times (TE = 30, 90, 150 and 200 ms) using PRESS. NAA concentrations referenced to water and apparent T2 relaxation times of NAA and water were calculated. At TE = 30 ms, NAA concentration without T2 correction was significantly lower in chronic psychosis patients compared to age-matched healthy controls (p = 0.013, N = 61 and 26, respectively) but normal in first episode patients compared to matched controls (N = 43 and 24, respectively). After T2 correction, no significant differences remained between the groups. While diffusion attenuation was not independently accounted for, these findings indicate that T2 relaxation makes a major impact on NAA concentration measures in psychotic disorders. Thus, it may be neuronal microenvironment indexed by NAA and water T2 relaxation times and not neuronal integrity indexed by NAA concentration that underlies the widely reported NAA concentration reductions in psychotic disorders.
Topics: Aspartic Acid; Choline; Creatine; Humans; Magnetic Resonance Spectroscopy; Neurons; Psychotic Disorders
PubMed: 34015554
DOI: 10.1016/j.schres.2021.04.012 -
Journal of Mental Health (Abingdon,... Apr 2023Mental illness prevalence is increasing globally and has caused a significant economic burden. However, information from developing countries regarding this issue is...
BACKGROUND
Mental illness prevalence is increasing globally and has caused a significant economic burden. However, information from developing countries regarding this issue is still limited.
AIMS
To estimate the cost of treating psychotic disorders in outpatient and inpatient wards in a provincial referral mental health hospital in West Java province, Indonesia.
METHODS
We collected data on the direct cost of treating psychotic disorders within 2014-2015. Billing data from 1565 patients were used to calculate inpatient cost, while micro-costing was used to estimate outpatient cost. One hundred and five patients visiting the hospital were interviewed to estimate indirect costs, for example, patients' and caretakers' travel, meal, and opportunity costs.
RESULTS
For inpatient care, the average direct and indirect cost/patient/episode are USD328.84 and USD213.22, respectively. For outpatient care, the direct and indirect costs are USD148,484.83/year (USD25.38/visit) and USD88,503.70/year (USD15.13/visit), respectively. The total societal cost of treating patients in the hospital is USD1,085,310.21/year (39% is an indirect cost, dominated by productivity loss).
CONCLUSION
The societal cost of treating psychotic disorders is large and potentially catastrophic to the patients. Early treatment for mental illness may avoid the high costs and lead to better productivity. Potential access barriers such as financial factors and stigma should be addressed.
Topics: Humans; Indonesia; Health Care Costs; Cost of Illness; Psychotic Disorders; Hospitals
PubMed: 34983298
DOI: 10.1080/09638237.2021.2022609 -
PloS One 2020Even though all guidelines recommend generally against antipsychotic polypharmacy, antipsychotic polypharmacy appears to be a very common practice across the globe. This...
OBJECTIVE
Even though all guidelines recommend generally against antipsychotic polypharmacy, antipsychotic polypharmacy appears to be a very common practice across the globe. This study aimed to examine the prescription patterns of antipsychotics in Qatar, in comparison with the international guidelines, and to scrutinize the sociodemographic and clinical features associated with antipsychotic polypharmacy.
METHODS
All the medical records of all the inpatients and outpatients treated by antipsychotics at the Department of Psychiatry-Hamad Medical Corporation (HMC) in Doha, Qatar (between October 2012 and April 2014) were retrospectively analyzed. We retrieved the available sociodemographic data, psychiatric features, and details on the medication history.
RESULTS
Our sample consisted of 537 individuals on antipsychotics (2/3 were male; mean age 33.8±10.2 years), prescribed for a psychotic disorder in 57%, a mood disorder in 9.3%, and various other diagnoses in 33.7%. About 55.9% received one antipsychotic, 29.6% received two antipsychotics, and 14.5% received more than two antipsychotics. Polypharmacy was associated with younger age (p = 0.025), being single (p<0.001), the diagnosis of a psychotic disorder (p<0.001), and previous admissions to psychiatry (p<0.001).
CONCLUSIONS
Antipsychotic polypharmacy appears to be quite common in Qatar, as it is the case in many other countries, in contrast with most international recommendations. Studies are needed to explore the reasons behind this disparity.
Topics: Adult; Antipsychotic Agents; Drug Prescriptions; Female; Humans; Male; Polypharmacy; Psychotic Disorders; Qatar; Retrospective Studies; Young Adult
PubMed: 33166337
DOI: 10.1371/journal.pone.0241986 -
Neuropsychopharmacology Reports Sep 2023Patients with autism spectrum disorder (ASD) are prone to develop overt psychosis and share symptom presentations with those with schizophrenia (SZ). This study aimed to...
AIM
Patients with autism spectrum disorder (ASD) are prone to develop overt psychosis and share symptom presentations with those with schizophrenia (SZ). This study aimed to explore differences in the distributions of psychotic symptoms among first-visit patients with ASD, SZ, or a nonpsychiatric diagnosis (N-PD).
METHODS
Data from first-visit patients were retrospectively collected from medical records from the Department of Psychiatry, Dokkyo Medical University Hospital between June 2019 and May 2021. A total of 254 patients with data on the PRIME Screen-Revised (PS-R) assessments were included in our analysis. In the hospital, all psychiatric diagnoses were based on the DSM-5 diagnostic criteria.
RESULTS
In the ASD, SZ, and N-PD groups, endorsements of perplexity and delusional mood were 15.6% (7/45), 41.5% (44/106), and 1.1% (1/88), and those of perceptual abnormalities were 11.1% (5/45), 40.6% (43/106), and 2.3% (2/88), respectively. Trend analysis clarified that the endorsement of these psychotic symptoms increased from N-PD to ASD and SZ. In the multivariate-adjusted multinomial logistic regression analysis, the ASD and N-PD groups were compared with the SZ group. Higher age and the presence of perceptual abnormalities were associated with lack of an ASD diagnosis, whereas male sex, lack of perplexity and delusional mood, and lack of perceptual abnormalities were associated with N-PD.
CONCLUSION
Our results are preliminary; however, a detailed assessment of positive symptoms might facilitate differentiation between ASD and SZ.
Topics: Humans; Male; Schizophrenia; Self Report; Autism Spectrum Disorder; Retrospective Studies; Psychotic Disorders
PubMed: 37605491
DOI: 10.1002/npr2.12374 -
Molecular Psychiatry Aug 2022In psychotic and mood disorders, immune alterations are hypothesized to underlie cognitive symptoms, as they have been associated with elevated blood levels of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
In psychotic and mood disorders, immune alterations are hypothesized to underlie cognitive symptoms, as they have been associated with elevated blood levels of inflammatory cytokines, kynurenine metabolites, and markers of microglial activation. The current meta-analysis synthesizes all available clinical evidence on the associations between immunomarkers (IMs) and cognition in these psychiatric illnesses.
METHODS
Pubmed, Web of Science, and Psycinfo were searched for peer-reviewed studies on schizophrenia spectrum disorder (SZ), bipolar disorder (BD), or major depressive disorder (MDD) including an association analysis between at least one baseline neuropsychological outcome measure (NP) and one IM (PROSPERO ID:CRD42021278371). Quality assessment was performed using BIOCROSS. Correlation meta-analyses, and random effect models, were conducted in Comprehensive Meta-Analysis version 3 investigating the association between eight cognitive domains and pro-inflammatory and anti-inflammatory indices (PII and AII) as well as individual IM.
RESULTS
Seventy-five studies (n = 29,104) revealed global cognitive performance (GCP) to be very weakly associated to PII (r = -0.076; p = 0.003; I = 77.4) or AII (r = 0.067; p = 0.334; I = 38.0) in the combined patient sample. Very weak associations between blood-based immune markers and global or domain-specific GCP were found, either combined or stratified by diagnostic subgroup (GCP x PII: SZ: r = -0.036, p = 0.370, I = 70.4; BD: r = -0.095, p = 0.013, I = 44.0; MDD: r = -0.133, p = 0.040, I = 83.5). We found evidence of publication bias.
DISCUSSION
There is evidence of only a weak association between blood-based immune markers and cognition in mood and psychotic disorders. Significant publication and reporting biases were observed and most likely underlie the inflation of such associations in individual studies.
Topics: Humans; Depressive Disorder, Major; Psychotic Disorders; Bipolar Disorder; Cognitive Dysfunction; Biomarkers
PubMed: 35484245
DOI: 10.1038/s41380-022-01582-y -
Psychological Medicine Dec 2023The stressful minority position of transgender persons may result in a high risk of psychosis. Conflicting data suggest that the observed risk depends on setting of...
BACKGROUND
The stressful minority position of transgender persons may result in a high risk of psychosis. Conflicting data suggest that the observed risk depends on setting of recruitment. We assessed the relative risk of non-affective psychotic disorder (NAPD) in a large, representative cohort of transgender persons.
METHODS
This cohort was composed using: data on legal sex change from the Dutch population registry and data on dispensing of cross-sex hormones (route 1), and a registry of insurance claims from mental health care including persons with a diagnosis of gender identity disorder (DSM-IV) or gender dysphoria (DSM-5) (route 2). They were matched by sex at birth, calendar year and country of birth to controls from the general population. Transgender persons ( = 5564) and controls ( = 27 820), aged 16-60 years at 1 January 2011, were followed until the first insurance claim for NAPD in 2011-2019.
RESULTS
The incidence rate ratio (IRR) of NAPD for transgender persons selected exclusively through route 1 ( = 3859, IRR = 2.00, 95%-CI 1.52-2.63) was increased, but significantly lower than the IRRs for those selected exclusively through route 2 ( = 694, IRR = 22.15, 95%-CI 13.91-35.28) and for those found by both routes ( = 1011, IRR = 5.17, 95%-CI 3.57-7.49; value for differences in IRR < 0.001).
CONCLUSIONS
This study supports the social defeat-hypothesis of NAPD. The results also show the presence of a substantial number of transgender persons with severe psychiatric problems who have not (yet) taken steps to gender-affirmative care.
Topics: Infant, Newborn; Humans; Transgender Persons; Cohort Studies; Gender Dysphoria; Psychotic Disorders; Affective Disorders, Psychotic
PubMed: 37539460
DOI: 10.1017/S0033291723002088 -
Schizophrenia Research Nov 2021Vitamin D deficiency is prevalent among people with psychosis and may play a role in the aetiology of psychotic disorders. However, its impact on clinical symptom... (Review)
Review
BACKGROUND
Vitamin D deficiency is prevalent among people with psychosis and may play a role in the aetiology of psychotic disorders. However, its impact on clinical symptom severity has not been independently reviewed.
METHODS
We conducted a systematic search of randomized trials and observational studies that assessed the relationship between vitamin D and symptom domains (positive and negative psychotic symptoms, total and general psychopathology, cognitive and depressive) in people with a psychotic disorder.
RESULTS
1040 articles were identified, of which 29 were eligible for inclusion: 26 observational studies and 3 randomized trials. Five studies included people with First-Episode Psychosis (FEP) and 24 included people with enduring psychosis. Most observational studies found that vitamin D was inversely associated with negative symptoms (57%; 13/23), positively associated with cognitive performance (63%; 5/8), and bore no association with positive symptoms (68%; 15/22), total psychopathology (64%; 7/11), general psychopathology (57%; 4/7) or depressive symptoms (64%; 9/14). Randomized controlled trials indicated that vitamin D supplementation improved cognitive performance (100%; 1/1) and, in some cases, reduced total psychopathology (50%; 1/2), general psychopathology (50%; 1/2) and negative symptoms (30%; 1/3), but had no effect on positive (100%; 3/3) or depressive (100%; 3/3) symptoms. Some positive associations were attenuated when controlled for potential confounders.
CONCLUSION
Low vitamin D was found to be inversely associated with more severe clinical symptoms in some, but not all symptom domains in people with psychosis. These preliminary findings warrant further exploration, particularly in regard to cognitive performance and negative symptoms.
Topics: Humans; Psychopathology; Psychotic Disorders; Vitamin D; Vitamin D Deficiency
PubMed: 34509104
DOI: 10.1016/j.schres.2021.08.001 -
Psychiatric Services (Washington, D.C.) Aug 2023This study examined time trends and patient characteristics related to guideline-recommended cardiometabolic risk factor monitoring among youths treated with... (Observational Study)
Observational Study
OBJECTIVE
This study examined time trends and patient characteristics related to guideline-recommended cardiometabolic risk factor monitoring among youths treated with antipsychotic medications.
METHODS
This observational study assessed participant sociodemographic and clinical characteristics and year of antipsychotic medication initiation, with receipt of glycemic and lipid testing within 2 years of initiation as the primary outcome. Electronic health records and pharmacy data from Kaiser Permanente Northern California for 4,568 youths (ages 10-21 years) who began antipsychotic medication treatment during 2013-2017 were included.
RESULTS
Mean±SD age of the sample was 17.0±3.0 years, 52% were male, and 50% were Asian American, Native Hawaiian, or Pacific Islander; Black; Latino; or another or unknown race-ethnicity. Overall, 54% of the sample completed glycemic and lipid monitoring within 2 years of medication initiation (41% within 1 year). With each study year, monitoring rates increased by 5% in this cohort, after the analyses were adjusted for participant factors (p=0.001). In the fully adjusted analysis, youths with a psychotic disorder were 23% more likely to receive cardiometabolic monitoring than those without a psychotic disorder or bipolar disorder (p<0.001). Monitoring was also more common among younger versus older adolescents and among those with risperidone (vs. quetiapine) medication, obesity, or more frequent use of outpatient health care. Youths with (vs. without) substance use disorder were 19% less likely to complete monitoring (p<0.001).
CONCLUSIONS
Cardiometabolic monitoring increased modestly over time, but close to half of the studied youths did not receive glycemic or lipid testing. Additional clinical strategies may be needed to increase monitoring overall and among harder-to-reach youth subgroups.
Topics: Humans; Adolescent; Male; Young Adult; Adult; Female; Antipsychotic Agents; Risperidone; Psychotic Disorders; Cardiovascular Diseases; Lipids
PubMed: 37016828
DOI: 10.1176/appi.ps.20220151 -
The Journal of Adolescent Health :... Sep 2021Psychotic disorders develop during mid-adolescence through early adulthood, with the initial few months a "critical period" offering the greatest promise for recovery....
PURPOSE
Psychotic disorders develop during mid-adolescence through early adulthood, with the initial few months a "critical period" offering the greatest promise for recovery. However, the duration of untreated psychosis is typically over a year. This study aimed to identify aspects of care episodes contributing to delays in diagnosis of a first psychotic episode.
METHODS
Study subjects included 161 adolescents and young adults referred to a first episode psychosis treatment program. We captured the various ways that people who experience a severe mental illness engage in treatment using standardized interviews with patients and informants (e.g., family member) and medical record review.
RESULTS
A psychotic disorder diagnosis was not given for 38% of subjects at their initial episode of care. Time to first care episode was virtually the same for subjects that did and did not receive a psychosis diagnosis; 50% within 1 month and 84% within 6 months. Compared to initial care episodes with a psychosis diagnosis, those without a psychosis diagnosis less often involved emergency services (80% vs. 38%, respectively; p value = 1 × 10) and more often outpatient primary care (6% vs. 18%; p value = .032) and mental health (32% vs. 49%; p value = .045) services. However, dangerousness indicators were similar (29% vs. 28%; p value = 1). Dangerousness indicators increased to 54% (p value = .002) by the time of eventual diagnosis for those requiring multiple care episodes.
CONCLUSIONS
Clinicians were important contributors to delays in diagnosis and treatment of psychosis. Interventions targeting outpatient health care providers may be fruitful in reducing the duration of untreated psychosis.
Topics: Adolescent; Adult; Ambulatory Care; Family; Humans; Psychotic Disorders; Referral and Consultation; Young Adult
PubMed: 33846053
DOI: 10.1016/j.jadohealth.2020.12.138 -
Revista Brasileira de Psiquiatria (Sao... Apr 2020Presence of psychotic symptoms seems to be a commonplace in early-onset bipolar disorder (BD). However, few studies have examined their occurrence in adolescent-onset... (Observational Study)
Observational Study
OBJECTIVE
Presence of psychotic symptoms seems to be a commonplace in early-onset bipolar disorder (BD). However, few studies have examined their occurrence in adolescent-onset BD. We sought to investigate the frequency of affective and psychotic symptoms observed during the first manic episode in adolescents.
METHODS
Forty-nine adolescents with bipolar I disorder (DSM-IV criteria) were admitted to a psychiatric hospital during their first acute manic episode. Assessment for current psychiatric diagnosis was performed by direct clinical interview and the DSM-IV version of the Diagnostic Interview for Children and Adolescents (DICA).
RESULTS
Teenage inpatients with BD consistently exhibited typical manic features, such as euphoria, grandiosity, and psychomotor agitation. In addition, disorganization and psychotic symptoms were present in 82 and 55% of the total sample, respectively. There was no significant difference in symptoms between early- and late-adolescent subgroups. Remarkably, most patients (76%) reported previous depressive episode(s); of these, 47% had prominent psychotic features in the prior depressive period.
CONCLUSION
These findings suggest that disorganization and psychotic symptoms during the first manic episode are salient features in adolescent-onset BD, and that psychotic depression frequently may precede psychotic mania. Nevertheless, differential diagnosis with schizophrenia should be routinely ruled out in cases of early-onset first psychotic episode.
Topics: Adolescent; Affective Symptoms; Bipolar Disorder; Child; Female; Humans; Male; Psychotic Disorders
PubMed: 31576937
DOI: 10.1590/1516-4446-2019-0455