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Acta Psychiatrica Scandinavica May 2020To conduct a systematic review and meta-analysis of the existing evidence on the association between age at migration and the risk of psychotic disorders. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To conduct a systematic review and meta-analysis of the existing evidence on the association between age at migration and the risk of psychotic disorders.
METHODS
Observational studies were eligible for inclusion if they presented data on the association between age at migration and the risk of psychotic disorders among first-generation migrant groups. We used two random effects meta-analyses to pool effect estimates for each stratum of age at migration relative to (i) a native-born reference category and (ii) the youngest age stratum (0 to 2 years).
RESULTS
Ten studies met inclusion criteria, and five were included in the meta-analysis. The risk of psychotic disorder among people who migrate prior to age 18 is nearly twice as high as the native-born population, with no evidence of effect modification by age strata. People who migrate during early adulthood (19 to 29 years) have a similar risk of psychotic disorder as the native-born population (IRR = 0.93, 95% CI = 0.60, 1.44) and a lower risk relative to those who migrate during infancy (0 to 2 years) (IRR = 0.58, 95% CI = 0.33, 1.04).
CONCLUSIONS
Migrant status is one of few well-established risk factors for psychotic disorder, yet we have limited understanding of the underlying etiology. The findings of this review advance our understanding of this association and identify high-risk groups to target for intervention.
Topics: Adolescent; Adult; Age Factors; Child; Child, Preschool; Emigrants and Immigrants; Emigration and Immigration; Female; Humans; Infant; Infant, Newborn; Male; Observational Studies as Topic; Psychotic Disorders; Refugees; Risk Factors; Socioeconomic Factors; Young Adult
PubMed: 31903545
DOI: 10.1111/acps.13147 -
CNS Drugs Nov 2016Cariprazine is a novel antipsychotic agent recently approved for treating schizophrenia and bipolar mania in the USA. The sample sizes of published randomized controlled... (Meta-Analysis)
Meta-Analysis Review
Tolerability and Safety Profile of Cariprazine in Treating Psychotic Disorders, Bipolar Disorder and Major Depressive Disorder: A Systematic Review with Meta-Analysis of Randomized Controlled Trials.
BACKGROUND
Cariprazine is a novel antipsychotic agent recently approved for treating schizophrenia and bipolar mania in the USA. The sample sizes of published randomized controlled trials (RCTs) of the drug are small; previous meta-analyses included few RCTs and did not specifically investigate the tolerability/safety profile of cariprazine.
OBJECTIVE
Our objective was to conduct a meta-analysis of published RCTs to systematically review the tolerability and safety of cariprazine versus placebo.
METHODS
We searched the clinical trial registers (the metaRegister of controlled trials, ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform) and electronic databases (PubMed, Embase, PsycINFO and Cochrane library) up to June 2016 to identify phase II/III RCTs of cariprazine in patients with schizophrenia, bipolar disorder or major depressive disorder. We conducted a meta-analysis to investigate outcomes, including risks of discontinuation due to adverse events (AEs), extrapyramidal side effects (EPS) or related events, metabolic syndrome and cardiovascular-related events.
RESULTS
We included nine RCTs, with a total of 4324 subjects. The risk of discontinuation due to AEs for cariprazine was similar to that for placebo (risk ratio [RR] 1.13, 95 % confidence interval [CI] 0.77-1.66). Cariprazine was associated with higher risks of EPS-related events than was placebo, including risk of akathisia (RR 3.92, 95 % CI 2.83-5.43), tremor (RR 2.41, 95 % CI 1.53-3.79) and restlessness (RR 2.17, 95 % CI 1.38-3.40). The cariprazine treatment group was more likely to have clinically significant weight gain (RR 1.68, 95 % CI 1.12-2.52). No statistically significant differences in results were found in other metabolic parameters or cardiovascular-related events.
CONCLUSION
There was a statistically significant higher risk of EPS-related AEs and a slight increase in mean body weight with cariprazine. There were no statistically significant effects on prolactin level or cardiovascular parameters. EPSs were the main short-term adverse reactions reported in the limited number of patients studied. Further clinical and post-marketing pharmacovigilance studies are needed to investigate the long-term safety of cariprazine.
Topics: Antipsychotic Agents; Bipolar Disorder; Clinical Trials, Phase II as Topic; Clinical Trials, Phase III as Topic; Depressive Disorder, Major; Humans; Piperazines; Psychotic Disorders; Schizophrenia
PubMed: 27550371
DOI: 10.1007/s40263-016-0382-z -
Schizophrenia Research Jun 2022For people with a psychotic disorder lack of insight can be detrimental on their condition and recovery. For this reason, insight has been considered as a target for... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
For people with a psychotic disorder lack of insight can be detrimental on their condition and recovery. For this reason, insight has been considered as a target for therapy. We conducted a systematic review of the literature on pharmacological, psychological and other treatments to test the hypothesis that these interventions could improve insight.
METHODS
We performed a literature search (1970-2020) across the following databases: PubMed, EMBASE, PsychINFO, Medline and Web of Science. Within each database the following search terms and the associated Boolean operatives were used: "Insight AND (treatment OR therapy) AND (psychosis OR schizophrenia) AND (awareness or denial)". Further filters were applied to identify peer reviewed controlled trials on adults. Following assessment for bias and inclusion criteria, we calculated the effect size (Cohen's d) for each study and overall, using a random effects model with 95% confidence intervals.
RESULTS
Of 94 articles found in the initial literature search, 30 studies that examined the treatment of insight in psychosis met the initial selection criteria and were assessed for bias. A total of 21 studies were included in the final meta-analysis. The overall calculated mean effect size for all interventions was 0.441 (95% CI, 0.23-0.66), representing a medium effect size. The effect of psychoeducation studies alone was medium (0.613, 95% CI, -0.35-2.06), but not significant. The effect of CBT studies was small (0.235, 95% CI, 0.01-0.46), and significant. The effect of combined antipsychotic medication and psychosocial intervention was of medium size and significant (0.683, 95% CI = 0.54-0.83). Finally, tDCS over the left fronto-temporal cortex, produced a very large and significant improvement of insight 1.153 (95% CI = 0.61-1.70), which was present for at least a month after the intervention.
CONCLUSIONS
Despite the variation and small number and size of trials into possible interventions, the hypothesis that insight could be improved was confirmed. Whilst most research focuses on psychotherapies, there is scope and potential for pharmacological, as well as other interventions (e.g. physical exercise, self-video observation, Direct Current Stimulation) to improve insight over and above treatment as usual. Given the association of insight with illness severity and treatment adherence, it is important to direct efforts in therapies that target insight improvement in psychosis.
Topics: Adult; Antipsychotic Agents; Humans; Psychotherapy; Psychotic Disorders; Schizophrenia
PubMed: 35661550
DOI: 10.1016/j.schres.2022.05.023 -
Progress in Neuro-psychopharmacology &... Jul 2022Neuroimaging findings in people at either genetic risk or at clinical high-risk for psychosis (CHR-P) or bipolar disorder (CHR-B) remain unclear. A meta-analytic review... (Meta-Analysis)
Meta-Analysis Review
A systematic review and meta-analysis of structural and functional brain alterations in individuals with genetic and clinical high-risk for psychosis and bipolar disorder.
Neuroimaging findings in people at either genetic risk or at clinical high-risk for psychosis (CHR-P) or bipolar disorder (CHR-B) remain unclear. A meta-analytic review of whole-brain voxel-based morphometry (VBM) and functional magnetic resonance imaging (fMRI) studies in individuals with genetic risk or CHR-P or CHR-B and controls identified 94 datasets (N = 7942). Notwithstanding no significant findings were observed following adjustment for multiple comparisons, several findings were noted at a more liberal threshold. Subjects at genetic risk for schizophrenia or bipolar disorder or at CHR-P exhibited lower gray matter (GM) volumes in the gyrus rectus (Hedges' g = -0.19). Genetic risk for psychosis was associated with GM reductions in the right cerebellum and left amygdala. CHR-P was associated with decreased GM volumes in the frontal superior gyrus and hypoactivation in the right precuneus, the superior frontal gyrus and the right inferior frontal gyrus. Genetic and CHR-P were associated with small structural and functional alterations involving regions implicated in psychosis. Further neuroimaging studies in individuals with genetic or CHR-B are warranted.
Topics: Bipolar Disorder; Brain; Gray Matter; Humans; Magnetic Resonance Imaging; Neuroimaging; Psychotic Disorders
PubMed: 35240226
DOI: 10.1016/j.pnpbp.2022.110540 -
Psychological Bulletin Jan 2009A systematic review (58 studies, 5,009 individuals) is presented of associations between psychopathological dimensions of psychosis and measures of neurocognitive... (Review)
Review
A systematic review (58 studies, 5,009 individuals) is presented of associations between psychopathological dimensions of psychosis and measures of neurocognitive impairment in subjects with a lifetime history of nonaffective psychosis. Results showed that negative and disorganized dimensions were significantly but modestly associated with cognitive deficits (correlations from -.29 to -.12). In contrast, positive and depressive dimensions of psychopathology were not associated with neurocognitive measures. The patterns of association for the 4 psychosis dimensions were stable across neurocognitive domains and were independent of age, gender, and chronicity of illness. In addition, significantly higher correlations were found for the negative dimension in relation to verbal fluency (p = .005) and for the disorganized dimension in relation to reasoning and problem solving (p = .004) and to attention/vigilance (p = .03). Psychotic psychopathology and neurocognition are not entirely orthogonal, as heterogeneity in nonaffective psychosis is weakly but meaningfully associated with measures of neurocognition. This association suggests that differential latent cerebral mechanisms underlie the cluster of disorganized and negative symptoms versus that of positive and affective symptoms.
Topics: Adult; Chronic Disease; Cognition Disorders; Female; Humans; Male; Neuropsychological Tests; Psychiatric Status Rating Scales; Psychometrics; Psychopathology; Psychotic Disorders; Schizophrenia; Schizophrenic Psychology
PubMed: 19210058
DOI: 10.1037/a0014415 -
Psychiatric Services (Washington, D.C.) Nov 2017Ecological momentary assessment (EMA) and ecological momentary intervention (EMI) are technologies used to track fluctuations in experiences and prompt behavioral... (Review)
Review
OBJECTIVE
Ecological momentary assessment (EMA) and ecological momentary intervention (EMI) are technologies used to track fluctuations in experiences and prompt behavioral responses within the context of a person's daily life. Most commonly delivered via smartphone, EMA and EMI have potential to provide simple, cost-effective, and user-led treatment for psychotic disorders. This systematic review aimed to synthesize current research exploring the feasibility, acceptability, and clinical outcomes of EMA and EMI in the treatment of psychotic disorders.
METHODS
A systematic search was conducted identifying studies published between 1980 and July 7, 2016, by searching PubMed, PsycINFO, PsycARTICLES, and the Cochrane Central Register of Controlled Trials with combinations of search terms related to mobile devices, EMA and EMI, and psychotic disorders.
RESULTS
Of 1,623 studies identified, nine met inclusion criteria for the review. These studies found satisfactory feasibility and acceptability and preliminary evidence of improved clinical outcomes. The interventions, which had a broad array of features, targeted remote monitoring of illness and symptoms, and they also targeted illness self-management by using momentary reminders or instructions for behaviors, including medication adherence, management of symptoms and psychosocial impairments, daily living skills, and goal achievement.
CONCLUSIONS
The findings of this review provide preliminary support for the clinical utility of EMA and EMI in the treatment of psychotic disorders. Future research should explore further applications of these technologies with larger sample sizes and controlled designs.
Topics: Ecological Momentary Assessment; Humans; Monitoring, Ambulatory; Outcome and Process Assessment, Health Care; Psychotic Disorders; Self-Management
PubMed: 28669284
DOI: 10.1176/appi.ps.201600523 -
Schizophrenia Bulletin Jan 2019Psychotic disorders often have been linked with violence. However, studies have shown that people with a psychotic disorder are more often victim than perpetrator of... (Meta-Analysis)
Meta-Analysis
Psychotic disorders often have been linked with violence. However, studies have shown that people with a psychotic disorder are more often victim than perpetrator of violence. The objective of this meta-analysis was to review prevalence rates for different types of victimization and to identify risk factors associated with victimization. Based on a search in MEDLINE, PsycINFO, and Web of Science, 27 studies were found with samples consisting of adults with a psychotic disorder and possible victimization occurring during adulthood and data on "violent victimization," "sexual victimization," "non-violent victimization," and/or "victimization not otherwise specified." The median prevalence rate for violent victimization was 20%, for sexual victimization 20%, nonviolent victimization 19%, and for victimization not otherwise specified 19%. Victimization rates were approximately 4-6 times higher than in the general community. Meta-analyses showed the following significant risk factors: delusion (OR = 1.69), hallucinations (OR = 1.70), manic symptoms (OR = 1.66), drugs (OR = 1.90) or alcohol abuse (OR = 2.05), perpetration of a crime (OR = 4.33), unemployment (OR = 1.31), and homelessness (OR = 2.49). Other risk factors like previous victimization, impaired social functioning, personality disorder, and living in a disadvantaged neighborhood were found only in 1 or 2 studies. Based on the results, we conclude that, depending on the examined time period, 1 in 5 (assessment period ≤3 y) or 1 in 3 (assessment period entire adulthood) people with a psychotic disorder was victim of a crime. Clinical, behavioral, and sociodemographic factors were significantly associated with victimization, as well as previous victimization. Prospective research into risk factors is needed to capture causal trajectories of victimization.
Topics: Adult; Crime Victims; Humans; Prevalence; Psychotic Disorders; Risk Factors; Schizophrenia
PubMed: 29547958
DOI: 10.1093/schbul/sby020 -
Psychological Medicine Sep 2012Psychotic symptoms occur more frequently in the general population than psychotic disorder and index risk for psychopathology. Multiple studies have reported on the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Psychotic symptoms occur more frequently in the general population than psychotic disorder and index risk for psychopathology. Multiple studies have reported on the prevalence of these symptoms using self-report questionnaires or clinical interviews but there is a lack of consensus about the prevalence of psychotic symptoms among children and adolescents.
METHOD
We conducted a systematic review of all published literature on psychotic symptom prevalence in two age groups, children aged 9-12 years and adolescents aged 13-18 years, searching through electronic databases PubMed, Ovid Medline, PsycINFO and EMBASE up to June 2011, and extracted prevalence rates.
RESULTS
We identified 19 population studies that reported on psychotic symptom prevalence among children and adolescents. The median prevalence of psychotic symptoms was 17% among children aged 9-12 years and 7.5% among adolescents aged 13-18 years.
CONCLUSIONS
Psychotic symptoms are relatively common in young people, especially in childhood. Prevalence is higher in younger (9-12 years) compared to older (13-18 years) children.
Topics: Adolescent; Child; Delusions; Hallucinations; Humans; Prevalence; Psychotic Disorders
PubMed: 22225730
DOI: 10.1017/S0033291711002960 -
Journal of the American Academy of... May 2022Psychosis is one of the most extreme and feared forms of psychopathology. Because early intervention leads to better outcomes for psychotic disorders, our field is...
Psychosis is one of the most extreme and feared forms of psychopathology. Because early intervention leads to better outcomes for psychotic disorders, our field is highly motivated to identify this problem in its earliest stages. Ideally, early intervention during childhood and adolescence would be optimal to help restore healthy brain development and prevent the onset of a psychotic disorder. Structural clinical interviews have been developed to identify youth who are at high risk for psychosis, based largely on the presence of attenuated and/or transient psychotic symptoms. However, these evaluations are challenging because of vast developmental differences among children, adolescents, and adults in how these experiences are understood and expressed. In the wake of a growing body of literature examining the utility of assessments for At Risk Mental States (ARMS) for predicting later transition to a psychotic disorder, the time is ripe for a systematic review to assess the state of this emerging field.
Topics: Adolescent; Adult; Child; Humans; Psychopathology; Psychotic Disorders
PubMed: 34678426
DOI: 10.1016/j.jaac.2021.10.007 -
The Lancet. Public Health May 2019The last comprehensive systematic review of the incidence of psychotic disorders was published in 2004. New epidemiological data from different settings now permit a... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The last comprehensive systematic review of the incidence of psychotic disorders was published in 2004. New epidemiological data from different settings now permit a broader understanding of global variation. We examined the variation in psychosis by demographic characteristics and study method.
METHODS
For this systematic review and meta-analysis, we searched PubMed, Embase, Web of Science, PsycINFO, and bibliographies, and directly contacted first authors. We sought to obtain citations of original research published between Jan 1, 2002, and Dec 31, 2017, on incidence of non-organic adult-onset psychotic disorder. We included papers that were published or in grey literature and had no language restrictions. Data were extracted from published reports, where possible, by sex, age, and ethnic group. Quality of yield was assessed. Data were assessed using univariable random-effects meta-analysis and meta-regression. We registered our systematic review on PROSPERO, number CRD42018086800.
FINDINGS
From 56 721 records identified, 177 met inclusion criteria. The pooled incidence of all psychotic disorders was 26·6 per 100 000 person-years (95% CI 22·0-31·7). Heterogeneity was high (I≥98·5%). Men were at higher risk of all psychotic disorders (incidence rate ratio 1·44 [1·27-1·62]) and non-affective disorders (1·60 [1·44-1·77]) than women, but not affective psychotic disorders (0·87 [0·75-1·00]). Ethnic minorities were also at excess risk of all psychotic disorders (1·75 [1·53-2·00]), including non-affective disorders (1·71 [1·40-2·09]). Meta-regression revealed that population registers reported higher rates of non-affective disorders (9·64 [2·72-31·82]), schizophrenia (2·51 [1·24-5·21]), and bipolar disorder (4·53 [2·41-8·51]) than first contact study designs.
INTERPRETATION
We found marked variation in incidence of psychotic disorders by personal characteristics and place. Some geographical variation could be partially explained by differences in case ascertainment methods.
FUNDING
None.
Topics: Global Health; Humans; Incidence; Psychotic Disorders
PubMed: 31054641
DOI: 10.1016/S2468-2667(19)30056-8