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Importance: Schizophrenia is associated with premature mortality from mostly natural causes. Decreased cognitive functioning has been identified as a determinant of mortality in the general population. However, there have been few prospective studies of this issue in persons with schizophrenia. Objective: To examine whether lower cognitive functioning is a risk factor for natural cause mortality in schizophrenia. Design, Setting, and Participants: This prospective cohort study included persons with schizophrenia or schizoaffective disorder enrolled between February 1, 1999, and December 31, 2022, at a nonprofit psychiatric system in Baltimore, Maryland. Participants were evaluated using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and other clinical measures. Exposure: Natural cause mortality. Main Outcomes and Measures: Associations of cognitive function, obesity, tobacco smoking, and medical conditions with natural cause mortality were evaluated using Cox proportional hazards regression models. Results: Of the 844 participants enrolled (mean [SD] age, 39.6 [12.1] years; 533 male [63.2%]), 158 (18.7%) died of natural causes during a median follow-up of 14.4 years (range, 7.0 days to 23.9 years). The most significant factor associated with mortality was lower cognitive functioning as measured by the RBANS (Cox coefficient, -0.04; 95% CI, -0.05 to -0.03; z = -5.72; adjusted P < .001). Additional factors independently associated with mortality included the diagnosis of an autoimmune disorder (hazard ratio [HR], 2.86; 95% CI, 1.83-4.47; z = 4.62; adjusted P < .001), tobacco smoking (HR, 2.26; 95% CI, 1.55-3.30; z = 4.23; adjusted P < .001), diagnosis of chronic obstructive pulmonary disease (HR, 3.31; 95% CI, 1.69-6.49; z = 3.48; adjusted P = .006), body mass index as a continuous variable (HR, 1.06; 95% CI, 1.02-1.09; z = 3.30; adjusted P = .01), diagnosis of a cardiac rhythm disorder (HR, 2.56; 95% CI, 1.40-4.69; z = 3.06; adjusted P = .02), and being divorced or separated (HR, 1.80; 95% CI, 1.22-2.65; z = 2.97; adjusted P = .02). An RBANS score below the 50th percentile displayed a joint association with being a smoker, having an elevated body mass index, and having a diagnosis of an autoimmune or a cardiac rhythm disorder. Conclusions and Relevance: In this prospective cohort study, lower cognitive functioning was a risk factor for natural cause mortality in schizophrenia. Efforts should be directed at methods to improve cognitive functioning, particularly among individuals with additional risk factors.

Asunto(s)

Esquizofrenia , Humanos , Esquizofrenia/mortalidad , Esquizofrenia/complicaciones , Esquizofrenia/epidemiología , Masculino , Femenino , Adulto , Factores de Riesgo , Estudios Prospectivos , Persona de Mediana Edad , Causas de Muerte , Baltimore/epidemiología , Modelos de Riesgos Proporcionales , Pruebas Neuropsicológicas/estadística & datos numéricos , Trastornos Psicóticos/mortalidad , Trastornos Psicóticos/complicaciones , Trastornos Psicóticos/epidemiología , Disfunción Cognitiva/epidemiología , Disfunción Cognitiva/mortalidad

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INTRODUCTION: Many articles suggest that clozapine was strongly associated with a higher incidence of new-onset diabetes mellitus, and the issue has remained unsettled. Many articles have compared clozapine with FGAs, but few have compared clozapine with SGAs. We aimed to compare the risk of new-onset diabetes mellitus in adults with schizophrenia treated with clozapine and other SGAs. METHODS: We conducted a comprehensive search of databases from their inception up until August 26, 2023. The specific databases include PubMed, Embase and others. We included non-randomized controlled trials involving the use of SGAs such as clozapine, olanzapine, risperidone, quetiapine, amisulpride, and zotepine, with a focus on new-onset diabetes mellitus as an outcome. We utilized odds ratio with 95 % credible intervals (95 % CI) as our effect size measures. The study protocol is registered with PROSPERO, number CRD42024511280. RESULTS: We included 7 studies with sufficient data to include in the meta-analysis. A total of eight studies with 641,48 participants met the eligibility criteria. The OR of the incidence rates of new-onset diabetes between clozapine and olanzapine was 0.95 (95 % CI:[0.82-1.09]), between clozapine and risperidone was 1.25 (95 % CI: [1.09-1.44]), between clozapine and quetiapine was 1.44 (95 % CI: [0.92-2.25]). CONCLUSION: In patients with schizophrenia, clozapine has been found to have a higher rate of new-onset diabetes mellitus compared to risperidone. However, there was no significant difference in incidence rate between clozapine versus olanzapine and quetiapine. These findings can assist clinicians in balancing the risks and benefits of those drugs.

Asunto(s)

Antipsicóticos , Clozapina , Diabetes Mellitus , Olanzapina , Fumarato de Quetiapina , Risperidona , Esquizofrenia , Humanos , Esquizofrenia/tratamiento farmacológico , Esquizofrenia/epidemiología , Antipsicóticos/efectos adversos , Fumarato de Quetiapina/efectos adversos , Fumarato de Quetiapina/uso terapéutico , Olanzapina/efectos adversos , Olanzapina/uso terapéutico , Clozapina/efectos adversos , Clozapina/uso terapéutico , Diabetes Mellitus/epidemiología , Diabetes Mellitus/inducido químicamente , Risperidona/efectos adversos , Adulto

Asunto(s)

Servicio de Urgencia en Hospital , Esquizofrenia , Humanos , Esquizofrenia/epidemiología , Texas/epidemiología , Servicio de Urgencia en Hospital/estadística & datos numéricos , Adulto , Femenino , Masculino , Persona de Mediana Edad , Disparidades en Atención de Salud/estadística & datos numéricos , Adulto Joven , Adolescente , Visitas a la Sala de Emergencias

RESUMEN

BACKGROUND: Nutrition is largely affected in bipolar disorder (BD), however, there is a lack of understanding on the relationship between dietary categories, BD, and the prevalence of metabolic syndrome. The objective of this study is to examine dietary trends in BD and it is hypothesized that diets with increased consumption of seafood and high-fiber carbohydrates will be correlated to improved patient outcomes, and a lower frequency of metabolic syndrome. METHODS: This retrospective cohort study includes two French cohorts. The primary cohort, FACE-BD, includes 268 stable BD patients. The second cohort, I-GIVE, includes healthy controls, both stable and acute BD and schizophrenia patients. Four dietary categories were assessed: meat, seafood, low-fiber and high-fiber carbohydrates. Dietary data from two food frequency questionnaires were normalized using min-max scaling and assessed using various statistical analyses. RESULTS: In our primary cohort, the increased high-fiber carbohydrate consumption was correlated to lower prevalence of metabolic syndrome and improved mood. Low-fiber carbohydrate consumption is associated with higher BMI, while higher seafood consumption was correlated to improved mood and delayed age of onset. Results were not replicated in our secondary cohort. LIMITATIONS: Our populations were small and two different dietary questionnaires were used; thus, results were used to examine similarities in trends. CONCLUSIONS: Overall, various dietary trends were associated with metabolic syndrome, BMI, lactate, mood and age of onset. Improving our understanding of nutrition in BD can provide mechanistic insight, clinically relevant nutritional guidelines for precision medicine and ultimately improve the quality of lives for those with BD.

Asunto(s)

Trastorno Bipolar , Ácido Láctico , Síndrome Metabólico , Humanos , Trastorno Bipolar/epidemiología , Femenino , Masculino , Síndrome Metabólico/epidemiología , Adulto , Estudios Retrospectivos , Persona de Mediana Edad , Ácido Láctico/sangre , Dieta , Esquizofrenia/epidemiología , Alimentos Marinos , Francia/epidemiología , Fibras de la Dieta , Índice de Masa Corporal , Carne , Afecto

RESUMEN

ABSTRACT: Schizophrenia is a debilitating mental health disorder that imposes profound economic, societal, and personal burdens. The negative symptoms of schizophrenia ( i.e. , blunted affect, alogia, anhedonia, asociality, and avolition) are highly prevalent and pervasive in the psychotic disorder and pose significant resistance to available treatment options. Traumatic childhood experiences are strongly linked with the risk of developing schizophrenia. Most prior studies have primarily focused on positive symptoms of schizophrenia ( e.g. , hallucinations and delusions), whereas less attention has been given to negative symptoms. The current study investigated the relationship between childhood trauma ( i.e. , physical abuse, sexual abuse, and emotional abuse and neglect) and negative symptoms in a sample of schizophrenia outpatients and healthy controls ( n = 159 participants, including 99 patients with schizophrenia). The observations from the current study revealed that schizophrenia patients experienced a significantly greater degree of childhood trauma and negative symptoms than the control individuals. The results of the current study also indicated that more severe experiences of total childhood trauma ( i.e. , summation of all trauma types), physical abuse, and emotional neglect may increase the risk of schizophrenia patients reporting negative symptoms. However, childhood sexual and emotional abuse was found to have no impact on the degree of negative symptoms experienced by schizophrenia patients. Implications and limitations of the current study are discussed. In conclusion, we found that the severity of overall childhood trauma, physical abuse, and emotional neglect may play an important role in increasing the likelihood of schizophrenia patients reporting negative symptoms.

Asunto(s)

Experiencias Adversas de la Infancia , Esquizofrenia , Humanos , Masculino , Femenino , Esquizofrenia/epidemiología , Adulto , Experiencias Adversas de la Infancia/estadística & datos numéricos , Persona de Mediana Edad , Adultos Sobrevivientes del Maltrato a los Niños/psicología , Psicología del Esquizofrénico , Maltrato a los Niños/psicología , Niño

RESUMEN

Importance: Evidence on the association of early intervention services (EISs) with self-harm and suicide among patients with first-episode schizophrenia (FES) at older than 25 years is lacking. Objective: To examine changes in self-harm and suicide rates among patients with FES before and after the implementation of an EIS program. Design, Setting, and Participants: This population-based cohort study conducted among 37 040 patients aged 15 to 64 years with FES between January 1, 2001, and March 31, 2020, used electronic medical records from the Hong Kong Clinical Data Analysis and Reporting System. All patients were followed up from the first diagnosis of schizophrenia (the index date) until the date of their death or the end of the study period (March 31, 2021), whichever came first. Statistical analysis was performed from July to November 2023. Exposure: The EIS extended the Early Assessment Service for Young People With Early Psychosis (EASY) program from patients aged 15 to 25 years to those aged 15 to 64 years (EASY Plus). The exposure was the implementation of the EASY Plus program in April 2011. The exposure period was defined as between April 2012 and March 2021 for the 1-year-time-lag analysis. Main Outcomes and Measures: The outcomes were monthly rates of self-harm and suicide among patients with FES before and after the implementation of the EASY Plus program. Interrupted time series analysis was used for the main analysis. Results: This study included 37 040 patients with FES (mean [SD] age at onset, 39 [12] years; 82.6% older than 25 years; 53.0% female patients). The 1-year-time-lag analysis found an immediate decrease in self-harm rates among patients aged 26 to 44 years (rate ratio [RR], 0.77 [95% CI, 0.59-1.00]) and 45 to 64 years (RR, 0.70 [95% CI, 0.49-1.00]) and among male patients (RR, 0.71 [95% CI, 0.56-0.91]). A significant long-term decrease in self-harm rates was found for all patients with FES (patients aged 15-25 years: RR, 0.98 [95% CI, 0.97-1.00]; patients aged 26-44 years: RR, 0.98 [95% CI, 0.97-0.99]; patients aged 45-64 years: RR, 0.97 [95% CI, 0.96-0.98]). Suicide rates decreased immediately after the implementation of the EASY Plus program among patients aged 15 to 25 years (RR, 0.33 [95% CI, 0.14-0.77]) and 26 to 44 years (RR, 0.38 [95% CI, 0.20-0.73]). Compared with the counterfactual scenario, the EASY Plus program might have led to 6302 fewer self-harm episodes among patients aged 26 to 44 years. Conclusions and Relevance: This cohort study of the EASY Plus program suggests that the extended EIS was associated with reduced self-harm and suicide rates among all patients with FES, including those older than 25 years. These findings emphasize the importance of developing tailored interventions for patients across all age ranges to maximize the benefits of EISs.

Asunto(s)

Esquizofrenia , Conducta Autodestructiva , Suicidio , Humanos , Masculino , Esquizofrenia/epidemiología , Esquizofrenia/terapia , Femenino , Adulto , Conducta Autodestructiva/epidemiología , Conducta Autodestructiva/psicología , Adolescente , Hong Kong/epidemiología , Adulto Joven , Persona de Mediana Edad , Suicidio/estadística & datos numéricos , Suicidio/psicología , Estudios de Cohortes , Intervención Médica Temprana/métodos

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Toxoplasma gondii (T.gondii) can influence the host's neurotransmission, central immune responses, and brain structure, potentially impacting the onset and development of various psychiatric disorders such as schizophrenia. We employed Electrochemiluminescence Immunoassay (ECLIA) to measure anti-Toxoplasma antibodies in 451 schizophrenic patients and 478 individuals from the general population in Hunan, China. The incidence rate of T.gondii infection in schizophrenic patients (8.87 %) was higher than that in the general population (3.77 %). A significant difference was observed among females, but not in males. Age-stratified analysis revealed significant differences in the 21-40 and 41-60 age groups. The two populations had no significant difference in the antibody titer for T. gondii infection. Additionally, the profile of circulating metabolites in the serum of schizophrenic patients with or without T. gondii infection was examined using non-targeted metabolomics assay. A total of 68 metabolites were differentially expressed between Toxoplasma-positive and Toxoplasma-negative groups, potentially mediating the connection between T. gondii infection and schizophrenia. Our research suggests that schizophrenic patients are susceptible to T. gondii infection with distinct metabolic program.

Asunto(s)

Anticuerpos Antiprotozoarios , Metabolómica , Esquizofrenia , Toxoplasma , Toxoplasmosis , Humanos , Esquizofrenia/sangre , Esquizofrenia/epidemiología , China/epidemiología , Toxoplasmosis/epidemiología , Toxoplasmosis/sangre , Femenino , Masculino , Adulto , Toxoplasma/inmunología , Persona de Mediana Edad , Anticuerpos Antiprotozoarios/sangre , Adulto Joven , Estudios Seroepidemiológicos , Incidencia

RESUMEN

PURPOSE: During the COVID-19 pandemic, public health measures were implemented, yet it is unknown whether these measures affected medication access in those with schizophrenia (SCZ). This study aimed to assess whether the antipsychotic utilization in SCZ changed during the pandemic. METHODS: We used dispensed prescription drug data from the Canadian province of Manitoba in individuals with SCZ using linked administrative data from the Manitoba Population Research Data Repository. The quarterly incident and prevalent dispensation of antipsychotics at two periods were compared with the expected trend (April 1, 2015 to April 1, 2020 and 2021) using linear autoregression. We stratified the primary results by age and sex and examined multiple subgroups. RESULTS: There were 9045 individuals with SCZ in the first fiscal quarter of 2020. The prevalent use of the most common antipsychotics were: olanzapine (206.7/1000), risperidone (190.8/1000), quetiapine (174.4/1000), and clozapine (100.9/1000). The overall prevalent use of antipsychotics remained stable during the pandemic compared with the expected trend. A significant decrease in the incident use in April-June 2020 (estimate: -1.3, 95%CI:-2.2,-0.3) was noted compared with the expected. A significantly higher incidence of atypical antipsychotics (estimate: 1.4, 95%CI: 0.2,2.5) and risperidone separately (estimate: 1.8, 95%CI: 0.2,3.3) was noted in 2021 compared with expected. CONCLUSION: This study found a decline in the receipt of antipsychotics for people with SCZ during the initial implementation of COVID-19 public health measures, particularly on the overall incidence. Future work on investigating the impact of these trends on SCZ outcomes is needed to inform future pandemic-related policies.

Asunto(s)

Antipsicóticos , COVID-19 , Esquizofrenia , Humanos , Esquizofrenia/tratamiento farmacológico , Esquizofrenia/epidemiología , Femenino , Masculino , Antipsicóticos/uso terapéutico , Adulto , COVID-19/epidemiología , Manitoba/epidemiología , Persona de Mediana Edad , Adulto Joven , Anciano , Adolescente , Salud Pública , Utilización de Medicamentos/estadística & datos numéricos , Utilización de Medicamentos/tendencias

RESUMEN

Insomnia and suicidal ideation (SI) are common in schizophrenia, including in individuals at clinical high-risk for psychosis (CHR-P). Previous studies have found associations between sleep disturbance, SI, and psychopathology in schizophrenia. We explored these associations in a CHR-P cohort. We leveraged data from CHR-P individuals in the North American Prodrome Longitudinal Studies (NAPLS-3) (n = 688) cohort. We investigated relationships between sleep disturbance (Scale of Prodromal Symptoms [SOPS]; Calgary Depression Scale for Schizophrenia [CDSS], and the Pittsburgh Sleep Quality Index [PSQI]), suicidal ideation (CDSS), and psychosis-risk symptoms. The prevalence of terminal insomnia, sleep disturbance, and SI in NAPLS3 was 25 %, 69 %, and 29 %, respectively. After controlling for potential confounders, multiple indices of sleep disturbance (SOPS, PSQI: OR = 1.05-1.40) were significant indicators of concurrent SI. Terminal insomnia was not associated with conversion to psychosis. Multiple indices of sleep problems were associated with higher total and subscale psychosis-risk symptom scores (ß = 0.09-0.39). Sleep problems are prevalent and associated with SI and more severe psychosis-risk symptoms in CHR-P individuals. These findings underscore the importance of designing longitudinal intervention studies to investigate whether the treatment of sleep disturbances may reduce suicidality and symptoms in this population.

Asunto(s)

Síntomas Prodrómicos , Trastornos Psicóticos , Trastornos del Sueño-Vigilia , Ideación Suicida , Humanos , Trastornos Psicóticos/epidemiología , Trastornos Psicóticos/psicología , Masculino , Femenino , Adulto Joven , Adulto , Estudios Longitudinales , Adolescente , Trastornos del Sueño-Vigilia/epidemiología , Trastornos del Inicio y del Mantenimiento del Sueño/epidemiología , Trastornos del Inicio y del Mantenimiento del Sueño/psicología , Esquizofrenia/epidemiología , Esquizofrenia/complicaciones

RESUMEN

Abstract.Objective: To conduct a targeted literature review to examine the impact of cognitive impairment and negative symptoms among patients with schizophrenia treated in the United States across a range of outcomes pertinent to the US health care system decision-makers, such as payers and policy-makers.Data Sources: The authors searched EMBASE and PubMed from January 2012 to January 2024. Search terms included schizophrenia, cognitive impairment and negative symptoms, and direct medical and nonmedical, indirect, and societal outcomes.Study Selection: Considered for inclusion were US-based studies reporting on the relationship between cognitive impairment or negative symptoms and direct medical and nonmedical, indirect, and societal outcomes in patients with schizophrenia. A total of 4,212 articles were initially identified for screening.Data Extraction: One reviewer extracted data and another reviewer ensured studies met Population, Intervention, Comparison, Outcomes, Study Design-Time Period (PICOS-T) criteria for inclusion and exclusion.Results: Eight studies (n = 262,683) were included that reported specifically on associations between cognitive impairment or negative symptoms and targeted outcomes. Patients with schizophrenia and moderate/severe cognitive impairment had a 100% increase in relapse-related hospitalizations (0.6 vs 0.3, adjusted incidence rate ratio = 1.85, P < .05) and ER visits (0.4 vs 0.2, adjusted odds ratio = 1.77, P < .05) vs patients with no/mild cognitive impairment. Additionally, there was an almost 50% increase in outpatient visits (8.4 vs 5.5, P < .001) and inpatient admissions (6.8 vs 4.5, P < .001) over the study period (2014 Q1-2017 Q4) for patients with negative symptoms vs without negative symptoms. Direct nonmedical, indirect, and societal outcomes are described.Conclusions: This review highlights the economic burden of cognitive impairment and negative symptoms by focusing on outcomes relevant to health care decision-makers in the United States.

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Disfunción Cognitiva , Esquizofrenia , Humanos , Disfunción Cognitiva/epidemiología , Disfunción Cognitiva/economía , Esquizofrenia/epidemiología , Esquizofrenia/economía , Esquizofrenia/terapia , Estados Unidos/epidemiología , Costo de Enfermedad

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This review delves into the intricate interplay between caffeine consumption and schizophrenia, examining evidence from epidemiological and clinical studies. While epidemiological research offers conflicting findings regarding the association between coffee intake and schizophrenia risk, clinical studies reveal diverse impacts of caffeine on symptomatology and cognition in individuals with schizophrenia. Some epidemiological studies suggest a potential protective effect of coffee consumption against schizophrenia, whereas others fail to establish a significant correlation. Clinical investigations highlight the complexity of caffeine's influence, with varied effects on symptom severity and cognitive function observed among schizophrenia patients. Notably, caffeine may exacerbate positive symptoms while alleviating negative symptoms and cognitive deficits in this population. However, limitations such as small sample sizes and reliance on self-reported data hinder the generalizability of these findings. Furthermore, genetic factors, prenatal exposure, and substance abuse contribute to the complexity of the relationship between caffeine and schizophrenia. Studies indicate that individuals with a genetic predisposition to schizophrenia may be more vulnerable to the effects of caffeine, while prenatal exposure to caffeine may elevate the risk of schizophrenia in offspring. Additionally, substance abuse, including high caffeine and nicotine consumption, is prevalent among individuals with schizophrenia, exacerbating symptom severity. Future research directions include addressing methodological limitations, such as small sample sizes and reliance on self-reported data, and exploring the effects of caffeine on schizophrenia using larger, more diverse cohorts and controlled methodologies. A deeper understanding of caffeine's impact on schizophrenia is crucial for informing clinical practice and developing personalized interventions for patients. Ultimately, this review underscores the need for further investigation into the complex relationship between caffeine consumption and schizophrenia to improve patient outcomes and inform evidence-based interventions.

Asunto(s)

Cafeína , Esquizofrenia , Humanos , Cafeína/administración & dosificación , Cafeína/efectos adversos , Esquizofrenia/epidemiología , Café , Estimulantes del Sistema Nervioso Central/efectos adversos , Estimulantes del Sistema Nervioso Central/administración & dosificación , Embarazo

RESUMEN

The risk that COVID-19 poses for mortality risk in individuals with schizophrenia in low- and middle-income countries has only been the subject of a few studies. In this retrospective study, we examined the standardized mortality ratio (SMR), by age group and sex, in a cohort of patients diagnosed with schizophrenia (n = 20,417), with second-generation antipsychotics, in a South Brazilian State database (Paraná-Brazil). We performed a linkage with the Brazilian Mortality Information System database between 2020 and 2021. We also assessed in a logistic regression how clozapine could affect COVID-19 mortality controlling by sex, age, and presence of obesity. A secondary analysis was to compare mortality with SMR due to COVID-19 in individuals with and without obesity. Compared to the State population (8,850,682 individuals), those with schizophrenia had more than two times greater risk of dying from COVID-19 (SMR = 2.21, 95 % CI: 1.90-2.55). Between the ages of 16 and 29, their risk is more than ten times higher than the state population (SMR = 10.18, 95 % CI: 4.73-19.33). Obesity showed an almost twofold risk of dying from COVID-19 in the patient's group (OR = 1.89, 95 % CI: 1.39-2.57). Clozapine was not found as a protector or a risk factor for COVID-19 mortality. In Brazil, a middle-income nation, people with schizophrenia are more likely to die prematurely from COVID-19. The burden of schizophrenia is higher in younger and in patients with obesity.

Asunto(s)

Antipsicóticos , COVID-19 , Obesidad , Esquizofrenia , Humanos , Esquizofrenia/mortalidad , Esquizofrenia/tratamiento farmacológico , Esquizofrenia/epidemiología , COVID-19/mortalidad , COVID-19/complicaciones , Brasil/epidemiología , Masculino , Femenino , Adulto , Estudios Retrospectivos , Persona de Mediana Edad , Adulto Joven , Adolescente , Antipsicóticos/uso terapéutico , Antipsicóticos/efectos adversos , Obesidad/epidemiología , Obesidad/mortalidad , Clozapina/uso terapéutico , Anciano , Factores de Riesgo

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Undertreated medical illnesses can compound the disabling cognitive deficits of schizophrenia. Obstructive sleep apnea (OSA) impairs cognitive domains also affected by schizophrenia, is common, and is treatable. The effects of sleep apnea on cognition in schizophrenia, however, are not well understood. We estimated the prevalence of OSA in a previously characterized sample of 3942 Veterans with schizophrenia by self-report and with a predictive model to identify individuals at high risk for OSA. We then compared neuropsychological and functional capacity assessment results between those who reported OSA versus those who did not, and between those predicted to have OSA versus predicted to not have OSA. We expected that many Veterans not reporting sleep apnea would be predicted to have it, and that both reported and predicted sleep apnea would be associated with lower cognitive and functional performance. The reported prevalence of OSA in the sample was 14%, whereas 72% were predicted to be at high risk of OSA. Interestingly, participants who reported having OSA had better cognitive and functional capacity performance (p's < 0.001) compared to those who did not report OSA, particularly on speed of processing assessments (p < 0.001). Predicted OSA, by contrast, was associated with lower speed of processing, verbal learning and working memory test scores (p's < 0.001). One possible interpretation of these results is that people with higher cognitive capacity may be more likely to seek medical care, while those with cognitive impairments are at greater risk for having untreated co-occurring medical conditions that further compromise cognition.

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Pruebas Neuropsicológicas , Esquizofrenia , Humanos , Esquizofrenia/epidemiología , Masculino , Femenino , Persona de Mediana Edad , Prevalencia , Adulto , Apnea Obstructiva del Sueño/epidemiología , Veteranos/estadística & datos numéricos , Trastornos del Conocimiento/epidemiología , Comorbilidad , Psicología del Esquizofrénico , Anciano

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BACKGROUND: Depressive and anxiety symptoms commonly manifested throughout the progression of schizophrenia. However, the prevalence of these symptoms, alongside their co-occurrence, remains uncertain, and clinical correlates remain elusive. OBJECTIVES: This study seeks to investigate the prevalence of such symptoms and their demographic and clinical associations among patients diagnosed with schizophrenia. METHODS: The study included 19,623 patients diagnosed with schizophrenia based on the ICD-10 criteria. Participants were recruited from community-dwelling patients registered in the local health system in Hangzhou of China between August 1 and October 30, 2022. RESULTS: The prevalence rates of depressive and anxiety symptoms, as well as their co-occurrence, were determined to be 19 % (95%CI = 18.5-19.6 %), 37.4 % (95%CI = 36.8-38.0 %), and 17.7 % (95%CI = 17.2-18.2 %), respectively. Patients prescribed quetiapine, olanzapine, and risperidone exhibited significantly lower prevalence rates of these symptoms (P < 0.01). Spearman's correlation analysis revealed a significant correlation between depressive symptoms and anxiety symptoms (r = 0.60, P = 0.006). Additionally, age, social relationships, and sleep status were significantly associated with depressive and anxiety symptoms, and their co-occurrence, in both univariate and multivariate analyses. CONCLUSION: Given the pervasive nature and detrimental consequences of these symptoms among individuals diagnosed with schizophrenia, comprehensive evaluation and implementation of efficacious interventions are highly recommended.

Asunto(s)

Antipsicóticos , Ansiedad , Depresión , Esquizofrenia , Humanos , Esquizofrenia/epidemiología , Masculino , Femenino , Adulto , Depresión/epidemiología , Persona de Mediana Edad , Ansiedad/epidemiología , China/epidemiología , Prevalencia , Antipsicóticos/uso terapéutico , Comorbilidad , Psicología del Esquizofrénico , Adulto Joven , Olanzapina/uso terapéutico , Risperidona/uso terapéutico , Fumarato de Quetiapina/uso terapéutico

RESUMEN

BACKGROUND: The mental health of child and adolescent intensive care unit (ICU) survivors is increasingly being researched. However, the literature on how various types of critical illness influence specific psychiatric disorders remains limited. METHODS: This study analyzed the data of 8704 child and adolescent ICU survivors and 87,040 age-, sex-, family income-, and residence-matched controls who were followed from enrollment to the end of 2013; the data covered the period from 1996 to 2013 and were extracted from a nationwide data set. The primary outcomes were the risks of five major psychiatric disorders (MPDs), namely schizophrenia, bipolar disorder (BD), major depressive disorder (MDD), obsessive compulsive disorder (OCD), and posttraumatic stress disorder (PTSD). RESULTS: Relative to the controls, the child and adolescent ICU survivors (mean age = 10.33 years) exhibited higher risks of developing five MPDs. The associated hazard ratios (HRs) and confidence intervals (CIs) are as follows: PTSD, HR = 4.67, 95 % CI = 2.42-9.01; schizophrenia, HR = 3.19, 95 % CI = 2.27-4.47; BD, HR = 2.02, 95 % CI = 1.33-3.05; OCD, HR = 1.96, 95 % CI = 1.21-3.16; and MDD, HR = 1.68, 95 % CI = 1.44-1.95. The risks of developing MPDs varied across multiple types of critical illness related to ICU admission. CONCLUSIONS: The risks of MPDs were significantly higher among the child and adolescent ICU survivors than among the controls. The development of appropriate MPD prevention strategies should be emphasized for this vulnerable population.

Asunto(s)

Trastorno Bipolar , Trastorno Depresivo Mayor , Trastorno Obsesivo Compulsivo , Esquizofrenia , Trastornos por Estrés Postraumático , Sobrevivientes , Humanos , Femenino , Masculino , Adolescente , Sobrevivientes/psicología , Sobrevivientes/estadística & datos numéricos , Niño , Trastornos por Estrés Postraumático/epidemiología , Trastornos por Estrés Postraumático/psicología , Trastorno Depresivo Mayor/epidemiología , Trastorno Depresivo Mayor/psicología , Trastorno Obsesivo Compulsivo/epidemiología , Esquizofrenia/epidemiología , Trastorno Bipolar/epidemiología , Trastorno Bipolar/psicología , Enfermedad Crítica/psicología , Trastornos Mentales/epidemiología , Trastornos Mentales/psicología , Factores de Riesgo , Unidades de Cuidados Intensivos/estadística & datos numéricos , Estudios de Casos y Controles

RESUMEN

The risk of violence is higher in schizophrenia spectrum disorders (SSD) compared to the general population and it is a pressing and understudied issue. Several dispositional and environmental factors have been previously correlated with violence, however, there has been little success in assessing their ability to predict violence patterns across the life span. This study aims to assess violence prediction based on personality traits, psychological resilience, and life-course adversities in a non-forensic population of SSD patients. In a sample of 231 patients with SSD, we assessed violence using the Brown-Goodwin History of Lifetime Aggression Scale and conducted cross-sectional assessments of possible predictors such as childhood trauma, personality traits and resilience scores. We then utilized a logistic regression classification algorithm to predict different violence trajectories based on the proposed risk factors. Our model significantly predicted individuals with violence in both childhood and adulthood, as well as childhood-only violence (p < 0.001). However, the model did not show significance for adult-only violence (p = 0.604). In all given trajectories, female sex appeared to be protective against violence, while stressful life events appeared to contribute to it. These results suggest that distinct factors can better inform risk assessment of lifespan violence patterns for personalized interventions in SSD.

Asunto(s)

Personalidad , Resiliencia Psicológica , Esquizofrenia , Violencia , Humanos , Masculino , Femenino , Adulto , Esquizofrenia/epidemiología , Personalidad/fisiología , Violencia/psicología , Violencia/estadística & datos numéricos , Persona de Mediana Edad , Experiencias Adversas de la Infancia/estadística & datos numéricos , Estudios Transversales , Factores de Riesgo , Adulto Joven , Psicología del Esquizofrénico

RESUMEN

BACKGROUND: During the COVID-19 pandemic, social-distancing and confinement measures were implemented. These may affect the mental health of patients with mental disorders such as schizophrenia. This study examined the clinical course of patients with schizophrenia at a public hospital in Morocco during the COVID-19 pandemic. METHODS: This longitudinal observational study was conducted across three periods in 15 months: 1 April 2020 (start of strict home confinement) to 30 June 2020 (T1), 1 July 2020 to 31 January 2021 (corresponding to the Delta wave) [T2], and 1 February 2021 to 30 June 2021 (corresponding to the Omicron wave) [T3]. Patients aged 18 to 65 years with a diagnosis of schizophrenia or schizoaffective disorder (based on DSM 5) made before the pandemic who presented to the Faculty of Medicine and Pharmacy of Rabat were invited to participate. Psychotic symptomatology was evaluated using the Positive and Negative Syndrome Scale (PANSS). Severity and improvement of mental disorder were evaluated using the Clinical Global Impression (CGI)-Severity and -Improvement subscales. Depressive symptoms were assessed using the Calgary Depression Scale (CDS). Adherence to treatments was assessed using the Medication Adherence Rating Scale (MARS). All assessments were made by psychiatrists or residents face-to-face (for T1) or via telephone (for T2 and T3). RESULTS: Of 146 patients recruited, 83 men and 19 women (mean age, 39 years) completed all three assessments. The CGI-Severity score was higher at T2 than T1 and T3 (3.24 vs 3.04 vs 3.08, p = 0.041), and the MARS score was higher at T1 and T2 than T3 (6.80 vs 6.83 vs 6.35, p = 0.033). Patient age was negatively correlated with CDS scores for depressive symptoms at T1 (Spearman's rho = -0.239, p = 0.016) and at T2 (Spearman's rho = -0.231, p = 0.019). The MARS score for adherence was higher in female than male patients at T1 (p = 0.809), T2 (p = 0.353), and T3 (p = 0.004). Daily tobacco consumption was associated with the PANSS total score at T3 (p = 0.005), the CGI-Severity score at T3 (p = 0.021), and the MARS score at T3 (p = 0.002). Patients with a history of attempted suicide had higher CDS scores than those without such a history at T1 (p = 0.015) and T3 (p = 0.018) but not at T2 (p = 0.346). CONCLUSION: Home confinement during the COVID-19 pandemic had limited negative impact on the mental health of patients with schizophrenia in Morocco.

Asunto(s)

COVID-19 , Esquizofrenia , Humanos , COVID-19/epidemiología , COVID-19/psicología , Marruecos , Masculino , Femenino , Adulto , Estudios Longitudinales , Persona de Mediana Edad , Esquizofrenia/epidemiología , Adulto Joven , Adolescente , Trastornos Psicóticos/epidemiología , Trastornos Psicóticos/psicología , Antipsicóticos/uso terapéutico , Anciano , Cumplimiento de la Medicación/estadística & datos numéricos , Cumplimiento de la Medicación/psicología , Escalas de Valoración Psiquiátrica , Depresión/epidemiología , Depresión/psicología , SARS-CoV-2

RESUMEN

Negative symptoms are a source of disability in schizophrenia, but criteria for identifying patients for clinical trials are in flux. Minimum severity for negative symptoms is paired with a definition of minimal psychosis to identify predominant negative symptoms. Two previous successful negative symptoms treatment studies used very different severity and selection criteria. We compared the prevalence of participants meeting those two criteria in a large outpatient sample of participants with schizophrenia. Data from 867 outpatients with schizophrenia who participated in one of four NIMH-funded studies were analyzed. Common data elements included diagnoses, the PANSS, and an assessment of everyday functioning. We compared previous criterion for premoninant negative symptoms based on low levels of agitation and psychosis and different cut-offs for negative symptoms severity. 57 % of the participants met the agitation-based criteria for low scores and 33 % met the psychosis-based criteria. 18 % met total PANSS score ≥ 20 and 8 % met ≥24 prominent negative symptoms criteria. 14 % met low agitation and PANSS≥20 and 2 % met the low psychosis and negative symptoms ≥24 criteria. Participants who met all predominant criteria had more impairments in social functioning (all p < .001, all d > 0.37). Criteria for predominant negative symptoms from previous clinical trials identify widely different numbers of cases, with criteria for negative symptom severity and low symptoms both impacting. All criteria yield the expected profile of relatively specific social deficits. Even in unselected populations who participated in complex research protocols, 14 % meet low- agitation based criteria for predominant negative symptoms and many more participants would be expected to meet criteria with enrichment for the presence of negative symptoms.

Asunto(s)

Escalas de Valoración Psiquiátrica , Esquizofrenia , Psicología del Esquizofrénico , Índice de Severidad de la Enfermedad , Humanos , Esquizofrenia/diagnóstico , Esquizofrenia/fisiopatología , Esquizofrenia/epidemiología , Masculino , Femenino , Adulto , Prevalencia , Escalas de Valoración Psiquiátrica/normas , Persona de Mediana Edad , Trastornos Psicóticos/diagnóstico , Trastornos Psicóticos/epidemiología , Trastornos Psicóticos/fisiopatología , Agitación Psicomotora/diagnóstico , Agitación Psicomotora/fisiopatología , Agitación Psicomotora/epidemiología , Adulto Joven

RESUMEN

OBJECTIVE: Human endogenous retroviruses (HERV) are the remnants of infections that occurred million years ago. They gradually integrated into the human genome, comprising 8 % of it. There are growing reports suggesting their potential role in various diseases, including schizophrenia. Schizophrenia, a serious psychiatric disorder, is caused by the interaction of genetic and environmental factors. In the present paper, we investigated studies focusing on the association between schizophrenia and HERV-W. METHODS: We registered this study at PROSPERO (registration number: CRD42022301122). The entire steps of this study were based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. We searched PubMed, Scopus, Web of Science, and Google Scholar up to 1 August 2022. Heterogeneity was estimated through I2 statistics, and the association was measured using the first estimate and penalization methods. RESULTS: Finally, 13 eligible studies were analyzed, including 698 cases and 728 controls. The overall odds ratio indicated a significant association in both the first estimate (OR = 9.34, 95 % CI = 4.92-17.75; P = 0.002) and penalization (OR = 7.38, 95 % CI = 4.15-13.10; P = 0.003) methods. In the subgroup analysis, among HERV-W fragments, the HERV-W envelope protein or RNA (OR = 11.41, 95 % CI: 5.67-22.97; P = 0.03) showed the strongest association with schizophrenia. CONCLUSION: Our meta-analysis showed that HERV-W is significantly associated with schizophrenia. More studies are required to determine the pathophysiological mechanism and the diagnostic, prognostic, and therapeutic value of HERV-W in schizophrenia.

Asunto(s)

Retrovirus Endógenos , Esquizofrenia , Esquizofrenia/virología , Esquizofrenia/epidemiología , Humanos , Retrovirus Endógenos/genética , Activación Viral

RESUMEN

BACKGROUND: Visual impairment (VI) is associated with dementia and other neuropsychiatric outcomes, but previous studies have not considered genetic sources of confounding or effect modification. METHODS: We analysed data from the Health and Retirement Study, an ongoing nationally representative survey of older US adults, a subset of whom underwent genetic testing from 2006 to 2012 (n = 13 465). Using discrete time proportional hazards models and generalised estimating equations, we measured the association between VI and dementia, depression and hallucinations adjusting for demographics and comorbidities, ancestry-specific principal components and polygenic risk scores (PRS) for Alzheimer's disease, major depressive disorder or schizophrenia. Effect modification was assessed using VI-PRS interaction terms and stratified analyses. RESULTS: VI was associated with dementia, depression and hallucinations after adjusting polygenic risk and other confounders. There was no VI-PRS interaction for dementia or depression. However, the association between VI and hallucinations varied by genetic risk of schizophrenia. Within the bottom four quintiles of schizophrenia PRS, VI was not associated with hallucinations among White (OR 1.16, 95% CI: 0.87-1.55) or Black participants (OR 0.96, 95% CI: 0.49-1.89). In contrast, VI was strongly associated with hallucinations among White (OR 2.08, 95% CI: 1.17-3.71) and Black (OR 10.63, 95% CI: 1.74-65.03) participants in the top quintile of schizophrenia PRS. CONCLUSIONS: The association between VI and neuropsychiatric outcomes is not explained by shared genetic risk factors, and there is a significant interaction between VI and polygenic risk of hallucinations in older adults.

Asunto(s)

Demencia , Predisposición Genética a la Enfermedad , Alucinaciones , Trastornos Psicóticos , Trastornos de la Visión , Humanos , Masculino , Femenino , Anciano , Demencia/genética , Demencia/epidemiología , Demencia/psicología , Demencia/diagnóstico , Factores de Riesgo , Estados Unidos/epidemiología , Trastornos de la Visión/genética , Trastornos de la Visión/epidemiología , Trastornos de la Visión/psicología , Alucinaciones/genética , Alucinaciones/epidemiología , Alucinaciones/psicología , Alucinaciones/diagnóstico , Trastornos Psicóticos/genética , Trastornos Psicóticos/epidemiología , Trastornos Psicóticos/psicología , Herencia Multifactorial , Medición de Riesgo , Factores de Edad , Persona de Mediana Edad , Anciano de 80 o más Años , Esquizofrenia/genética , Esquizofrenia/epidemiología