Jenny Bergqvist, Stina Hedskog, Christel Hedman, Torbjörn Schultz, Peter Strang
Background
Schizophrenia and advanced cancer are complex conditions that impact life expectancy. This study aimed to examine the receipt of specialized palliative care (SPC) in patients with metastatic cancer and a coexisting diagnosis of psychosis compared to patients with cancer only. Secondary objectives included analyzing differences in emergency visits and place of death in relation to receipt of SPC.
Patients and Methods
This retrospective, observational registry study utilized health care consumption data from the Stockholm Regional Council. We included 23,056 patients aged >18 years who died between 2015 and 2021 with a diagnosis of metastatic cancer, hematologic malignancy, or malignant brain tumor in the Stockholm Gotland region. Among them, 320 patients had a concomitant diagnosis of psychosis.
Results
Patients with cancer and psychosis were less likely to receive SPC compared to patients with cancer only (61% vs. 74%, p < 0.001). Additionally, they were, on average, four and a half years younger at the time of death (68.5 years vs. 73.1 years, p < 0.0001), more likely to reside in nursing homes (25% vs. 11%, p < 0.0001), and had a higher prevalence of low area-based socioeconomic status (46% vs. 32%, p < 0.0001). Receipt of SPC was associated with reduced frequency of emergency visits and a higher probability of place of death to be at home or in a care facility outside the acute hospital.
Conclusions
Patients with a coexisting diagnosis of psychosis and metastatic cancer have a lower probability of receiving SPC. Receipt of specialized palliative care was associated with reduced number of unplanned emergency visits and a lower risk for death at an acute hospital. Efforts are needed to ensure equitable provision of SPC for patients with cancer and psychosis.
{"title":"Patients with both cancer and psychosis—to what extent do they receive specialized palliative care","authors":"Jenny Bergqvist, Stina Hedskog, Christel Hedman, Torbjörn Schultz, Peter Strang","doi":"10.1111/acps.13666","DOIUrl":"10.1111/acps.13666","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Schizophrenia and advanced cancer are complex conditions that impact life expectancy. This study aimed to examine the receipt of specialized palliative care (SPC) in patients with metastatic cancer and a coexisting diagnosis of psychosis compared to patients with cancer only. Secondary objectives included analyzing differences in emergency visits and place of death in relation to receipt of SPC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>This retrospective, observational registry study utilized health care consumption data from the Stockholm Regional Council. We included 23,056 patients aged >18 years who died between 2015 and 2021 with a diagnosis of metastatic cancer, hematologic malignancy, or malignant brain tumor in the Stockholm Gotland region. Among them, 320 patients had a concomitant diagnosis of psychosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Patients with cancer and psychosis were less likely to receive SPC compared to patients with cancer only (61% vs. 74%, <i>p</i> < 0.001). Additionally, they were, on average, four and a half years younger at the time of death (68.5 years vs. 73.1 years, <i>p</i> < 0.0001), more likely to reside in nursing homes (25% vs. 11%, <i>p</i> < 0.0001), and had a higher prevalence of low area-based socioeconomic status (46% vs. 32%, <i>p</i> < 0.0001). Receipt of SPC was associated with reduced frequency of emergency visits and a higher probability of place of death to be at home or in a care facility outside the acute hospital.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Patients with a coexisting diagnosis of psychosis and metastatic cancer have a lower probability of receiving SPC. Receipt of specialized palliative care was associated with reduced number of unplanned emergency visits and a lower risk for death at an acute hospital. Efforts are needed to ensure equitable provision of SPC for patients with cancer and psychosis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"149 4","pages":"313-322"},"PeriodicalIF":6.7,"publicationDate":"2024-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13666","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139898914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Masaru Tsukahara, Ryuhei So, Yusaku Yoshimura, Shinichiro Nakajima, Hiroyoshi Takeuchi
{"title":"Response to the letter to the Editor from Araujo and colleagues on the research article entitled, “Effect of smoking habits and concomitant valproic acid use on relapse in patients with treatment-resistant schizophrenia receiving clozapine: A 1-year retrospective cohort study”","authors":"Masaru Tsukahara, Ryuhei So, Yusaku Yoshimura, Shinichiro Nakajima, Hiroyoshi Takeuchi","doi":"10.1111/acps.13674","DOIUrl":"10.1111/acps.13674","url":null,"abstract":"","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"149 5","pages":"436-438"},"PeriodicalIF":6.7,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139739899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Raquel Costa, Ana Mesquita, Emma Motrico, Sara Domínguez-Salas, Pelin Dikmen-Yildiz, Sandra Saldivia, Eleni Vousoura, Ana Osorio, Claire A. Wilson, Rena Bina, Drorit Levy, Andri Christoforou, Maria Fernanda González, Camelia Hancheva, Ethel Felice, Tiago Miguel Pinto
<div> <section> <h3> Objective/Background</h3> <p>Unmet needs in perinatal mental healthcare are an important public health issue particularly in the context of a stressful life event such as the COVID-19 pandemic but data on the extent of this problem are needed.</p> </section> <section> <h3> Aim</h3> <p>The aim of this study is to determine the (1) proportion of women with clinically significant symptoms of perinatal depression, anxiety or comorbid symptoms of depression and anxiety, receiving mental healthcare overall and by country and (2) factors associated with receiving mental healthcare.</p> </section> <section> <h3> Method</h3> <p>Women in the perinatal period (pregnancy or up to 6 months postpartum) participating in the Riseup-PPD-COVID-19 cross-sectional study, reported on sociodemographic, social support health-related factors, and COVID-19 related factors, and on symptoms of depression (Edinburgh Postnatal Depression Scale [EPDS]) and anxiety (Generalised Anxiety Disorder [GAD-7]) using self-report questionnaires. Clinically significant symptoms were defined as EPDS ≥ 13 for depression and GAD-7 ≥ 10 for anxiety. Mental healthcare was defined as self-reported current mental health treatment.</p> </section> <section> <h3> Results</h3> <p>Of the 11 809 participants from 12 countries included in the analysis, 4 379 (37.1%) reported clinically significant symptoms of depression (n = 1 228; 10.4%; EPDS ≥ 13 and GAD-7 ⟨ 10), anxiety (n = 848; 7.2%; GAD-7 ≥ 10 and EPDS ⟨ 13) or comorbid symptoms of depression and anxiety (n = 2 303; 19.5%; EPDS ≥ 13 and GAD-7 ≥ 10). Most women with clinically significant symptoms of depression, anxiety, or comorbid symptoms of depression and anxiety were not receiving mental healthcare (89.0%). Variation in the proportion of women with clinically significant symptoms of depression and/or anxiety reporting mental healthcare was high (4.7% in Turkey to 21.6% in Brazil). Women in the postpartum (vs. pregnancy) were less likely (OR 0.72; 95% CI 0.59-0.88), whereas women with previous mental health problems (vs. no previous mental health problems) (OR 5.56; 95% CI 4.41-7.01), were more likely to receive mental healthcare.</p> </section> <section> <h3> Conclusion</h3> <p>There are high unmet needs in mental healthcare for women with clinically significant symptoms of perinatal depression and/or anxiety across countries during the COVID-19 pandemic. Studies beyond the COVID-19 pandemic and covering the whole range o
{"title":"Unmet needs in mental healthcare for women with clinically significant symptoms of perinatal depression and/or anxiety during the COVID-19 pandemic","authors":"Raquel Costa, Ana Mesquita, Emma Motrico, Sara Domínguez-Salas, Pelin Dikmen-Yildiz, Sandra Saldivia, Eleni Vousoura, Ana Osorio, Claire A. Wilson, Rena Bina, Drorit Levy, Andri Christoforou, Maria Fernanda González, Camelia Hancheva, Ethel Felice, Tiago Miguel Pinto","doi":"10.1111/acps.13664","DOIUrl":"10.1111/acps.13664","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective/Background</h3>\u0000 \u0000 <p>Unmet needs in perinatal mental healthcare are an important public health issue particularly in the context of a stressful life event such as the COVID-19 pandemic but data on the extent of this problem are needed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The aim of this study is to determine the (1) proportion of women with clinically significant symptoms of perinatal depression, anxiety or comorbid symptoms of depression and anxiety, receiving mental healthcare overall and by country and (2) factors associated with receiving mental healthcare.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>Women in the perinatal period (pregnancy or up to 6 months postpartum) participating in the Riseup-PPD-COVID-19 cross-sectional study, reported on sociodemographic, social support health-related factors, and COVID-19 related factors, and on symptoms of depression (Edinburgh Postnatal Depression Scale [EPDS]) and anxiety (Generalised Anxiety Disorder [GAD-7]) using self-report questionnaires. Clinically significant symptoms were defined as EPDS ≥ 13 for depression and GAD-7 ≥ 10 for anxiety. Mental healthcare was defined as self-reported current mental health treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 11 809 participants from 12 countries included in the analysis, 4 379 (37.1%) reported clinically significant symptoms of depression (n = 1 228; 10.4%; EPDS ≥ 13 and GAD-7 ⟨ 10), anxiety (n = 848; 7.2%; GAD-7 ≥ 10 and EPDS ⟨ 13) or comorbid symptoms of depression and anxiety (n = 2 303; 19.5%; EPDS ≥ 13 and GAD-7 ≥ 10). Most women with clinically significant symptoms of depression, anxiety, or comorbid symptoms of depression and anxiety were not receiving mental healthcare (89.0%). Variation in the proportion of women with clinically significant symptoms of depression and/or anxiety reporting mental healthcare was high (4.7% in Turkey to 21.6% in Brazil). Women in the postpartum (vs. pregnancy) were less likely (OR 0.72; 95% CI 0.59-0.88), whereas women with previous mental health problems (vs. no previous mental health problems) (OR 5.56; 95% CI 4.41-7.01), were more likely to receive mental healthcare.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>There are high unmet needs in mental healthcare for women with clinically significant symptoms of perinatal depression and/or anxiety across countries during the COVID-19 pandemic. Studies beyond the COVID-19 pandemic and covering the whole range o","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"150 5","pages":"474-491"},"PeriodicalIF":5.3,"publicationDate":"2024-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13664","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139717051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Isak Fredén Klenfeldt, Gunnar Skoog, Johan Skoog, Ingmar Skoog
Objective
Few long-term studies have examined the life-time prevalence of comorbid psychiatric conditions in patients with obsessive-compulsive disorder (OCD). We therefore studied the frequency of comorbid psychiatric disorders, and their relation to onset and prognosis, in patients with OCD who were followed for almost half a century.
Methods
During 1947–1953, 285 OCD patients were admitted as inpatients to a university hospital in Gothenburg, Sweden. Among those, 251 (88%) accepted a structured comprehensive psychiatric examination in 1954–1956. In 1989–1993, 176 survivors were eligible and 144 (response rate 82%) were re-examined. The same psychiatrist performed both examinations. OCD was diagnosed according to the Schneider criteria, and other mental disorders according to DSM-IV. Mean follow-up since onset was 47 years.
Results
The lifetime frequency of depressive disorders was 84.7% (major depression 43.8%), generalized anxiety disorder (GAD) 71.5%, panic anxiety disorder 47.9%, agoraphobia 52.1%, specific phobias 64.6%, social phobia 47.9%, paranoid conditions 40.3% (29.1% paranoid ideation), psychotic disorders 15.3%, alcohol abuse 13.2% (men 39%, women 3%) and substance abuse 17.4%. Specific phobia most often started before OCD, while depression had a varied onset in relation to OCD. Social phobia, agoraphobia, GAD, alcohol and substance abuse, psychotic disorders and paranoid conditions most often started after OCD. Presence of GAD, psychotic disorder and substance abuse worsened prognosis of OCD.
Conclusion
Comorbid psychiatric conditions are common in OCD patients, and have onset throughout the course. OCD signals vulnerability for other psychiatric conditions, which are important to detect in clinical practice as they negatively affect the outcome.
{"title":"The natural history of lifetime psychiatric disorders in patients with obsessive-compulsive disorder followed over half a century","authors":"Isak Fredén Klenfeldt, Gunnar Skoog, Johan Skoog, Ingmar Skoog","doi":"10.1111/acps.13665","DOIUrl":"10.1111/acps.13665","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Few long-term studies have examined the life-time prevalence of comorbid psychiatric conditions in patients with obsessive-compulsive disorder (OCD). We therefore studied the frequency of comorbid psychiatric disorders, and their relation to onset and prognosis, in patients with OCD who were followed for almost half a century.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>During 1947–1953, 285 OCD patients were admitted as inpatients to a university hospital in Gothenburg, Sweden. Among those, 251 (88%) accepted a structured comprehensive psychiatric examination in 1954–1956. In 1989–1993, 176 survivors were eligible and 144 (response rate 82%) were re-examined. The same psychiatrist performed both examinations. OCD was diagnosed according to the Schneider criteria, and other mental disorders according to DSM-IV. Mean follow-up since onset was 47 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The lifetime frequency of depressive disorders was 84.7% (major depression 43.8%), generalized anxiety disorder (GAD) 71.5%, panic anxiety disorder 47.9%, agoraphobia 52.1%, specific phobias 64.6%, social phobia 47.9%, paranoid conditions 40.3% (29.1% paranoid ideation), psychotic disorders 15.3%, alcohol abuse 13.2% (men 39%, women 3%) and substance abuse 17.4%. Specific phobia most often started before OCD, while depression had a varied onset in relation to OCD. Social phobia, agoraphobia, GAD, alcohol and substance abuse, psychotic disorders and paranoid conditions most often started after OCD. Presence of GAD, psychotic disorder and substance abuse worsened prognosis of OCD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Comorbid psychiatric conditions are common in OCD patients, and have onset throughout the course. OCD signals vulnerability for other psychiatric conditions, which are important to detect in clinical practice as they negatively affect the outcome.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"149 4","pages":"284-294"},"PeriodicalIF":6.7,"publicationDate":"2024-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13665","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139705443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>In their remarkable paper, Castellini et al<span><sup>1</sup></span> provide us with not so much a survey but a census of psychiatric trainees in Italy with a remarkable response rate of over 80% compared with a more quotidian comparison group of medical trainees at a similar point of their professional development. The comprehensiveness of their approach permits a tentative conclusion about the average mental state of psychiatric residents—it seems young doctors do not generally go into the mental health specialty to address their own psychological needs; trainee psychiatrists are, on average, less neurotic, notwithstanding above-average childhood adversity. The report also adds to the growing literature that trainees who feel supported and mentally well will perform better in the workplace in the long run,<span><sup>2</sup></span> at least in terms of symptoms of burnout.</p><p>The study, being cross-sectional and relying solely on self-report data, inherently restricts the extent to which we can confidently infer causality from the observed associations. However, with the authors' indication that future longitudinal data might be provided, it is worthwhile to cautiously consider the implications of the reported correlations. For this purpose, we shall make the generous assumption that these correlations represent authentic associations and are not skewed by factors like recall bias, social desirability bias or the impact of any unmeasured confounding variables. The correlations, albeit tentative, provide a starting point for deeper investigation into the factors contributing to burnout and the potential avenues for intervention, while fully recognising their limitations we can acknowledge the value they add to the ongoing discourse on mental health and resilience in medical training.</p><p>Work-related burnout syndrome, characterised by the triad of emotional exhaustion, cynicism and low sense of professional efficacy<span><sup>3</sup></span> has been associated with stress-related health problems,<span><sup>4</sup></span> broken personal relationships,<span><sup>5</sup></span> inadequate patient care<span><sup>6</sup></span> and reduced learning capacity.<span><sup>7</sup></span> Medical doctors experience higher rates of burnout syndrome than the general population<span><sup>5</sup></span> likely because a critical factor in the development of burnout is the sustained mismatch between job demands and resources available. Training years, more than any other stage in physicians' career, are characterised by this type of imbalance due to long and irregular work hours<span><sup>8</sup></span> and high levels of responsibility combined with lack of professional experience.<span><sup>9</sup></span> Psychiatry itself adds several very specific stressors such as perceived stigma of this profession, demanding therapeutic relationships, personal threats from violent patients and the risk of patient suicide.<span><sup>10</sup></span></p><p>The repor
{"title":"Mentalizing psychiatric training","authors":"Peter Fonagy","doi":"10.1111/acps.13662","DOIUrl":"https://doi.org/10.1111/acps.13662","url":null,"abstract":"<p>In their remarkable paper, Castellini et al<span><sup>1</sup></span> provide us with not so much a survey but a census of psychiatric trainees in Italy with a remarkable response rate of over 80% compared with a more quotidian comparison group of medical trainees at a similar point of their professional development. The comprehensiveness of their approach permits a tentative conclusion about the average mental state of psychiatric residents—it seems young doctors do not generally go into the mental health specialty to address their own psychological needs; trainee psychiatrists are, on average, less neurotic, notwithstanding above-average childhood adversity. The report also adds to the growing literature that trainees who feel supported and mentally well will perform better in the workplace in the long run,<span><sup>2</sup></span> at least in terms of symptoms of burnout.</p><p>The study, being cross-sectional and relying solely on self-report data, inherently restricts the extent to which we can confidently infer causality from the observed associations. However, with the authors' indication that future longitudinal data might be provided, it is worthwhile to cautiously consider the implications of the reported correlations. For this purpose, we shall make the generous assumption that these correlations represent authentic associations and are not skewed by factors like recall bias, social desirability bias or the impact of any unmeasured confounding variables. The correlations, albeit tentative, provide a starting point for deeper investigation into the factors contributing to burnout and the potential avenues for intervention, while fully recognising their limitations we can acknowledge the value they add to the ongoing discourse on mental health and resilience in medical training.</p><p>Work-related burnout syndrome, characterised by the triad of emotional exhaustion, cynicism and low sense of professional efficacy<span><sup>3</sup></span> has been associated with stress-related health problems,<span><sup>4</sup></span> broken personal relationships,<span><sup>5</sup></span> inadequate patient care<span><sup>6</sup></span> and reduced learning capacity.<span><sup>7</sup></span> Medical doctors experience higher rates of burnout syndrome than the general population<span><sup>5</sup></span> likely because a critical factor in the development of burnout is the sustained mismatch between job demands and resources available. Training years, more than any other stage in physicians' career, are characterised by this type of imbalance due to long and irregular work hours<span><sup>8</sup></span> and high levels of responsibility combined with lack of professional experience.<span><sup>9</sup></span> Psychiatry itself adds several very specific stressors such as perceived stigma of this profession, demanding therapeutic relationships, personal threats from violent patients and the risk of patient suicide.<span><sup>10</sup></span></p><p>The repor","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"149 3","pages":"173-176"},"PeriodicalIF":6.7,"publicationDate":"2024-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13662","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139700658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Giovanni A. Fava, Chiara Patierno, Nicoletta Sonino, Fiammetta Cosci
Objective
The aim of this review is to illustrate an innovative framework for assessing the psychosocial aspects of medical disorders within the biopsychosocial model. It is based on clinimetrics, the science of clinical measurements. It may overcome the limitations of DSM-5 in identifying highly individualized responses at the experiential, behavioral, and interpersonal levels.
Method
A critical review of the clinimetric formulations of the biopsychosocial model in the setting of medical disease was performed. References were identified through searches from PubMed for English articles on human subjects published from January 1982 to October 2023.
Results
Clinimetric methods of classification have been found to deserve special attention in four major areas: allostatic load (the cumulative cost of fluctuating and heightened neural or neuroendocrine responses to environmental stressors); health attitudes and behavior; persistent somatization; demoralization and irritable mood. This type of assessment, integrated with traditional psychiatric nosography, may disclose pathophysiological links and provide clinical characterizations that demarcate major prognostic and therapeutic differences among patients who otherwise seem deceptively similar because they have the same medical diagnosis. It may be of value in a number of medical situations, such as: high level of disability or compromised quality of life in relation to what is expected by disease status; delayed or partial recovery; insufficient participation in self-management and/or rehabilitation; failure to resume healthy role after convalescence; unhealthy lifestyle; high attendance of medical facilities disproportionate to detectable disease; lack of treatment adherence; illness denial.
Conclusions
The clinimetric approach to the assessment of key psychosocial variables may lead to unique individual profiles, that take into account both biology and biography. It may offer new opportunities for integrating psychosocial and medical perspectives.
{"title":"Key psychosocial issues in medical care","authors":"Giovanni A. Fava, Chiara Patierno, Nicoletta Sonino, Fiammetta Cosci","doi":"10.1111/acps.13667","DOIUrl":"10.1111/acps.13667","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The aim of this review is to illustrate an innovative framework for assessing the psychosocial aspects of medical disorders within the biopsychosocial model. It is based on clinimetrics, the science of clinical measurements. It may overcome the limitations of DSM-5 in identifying highly individualized responses at the experiential, behavioral, and interpersonal levels.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>A critical review of the clinimetric formulations of the biopsychosocial model in the setting of medical disease was performed. References were identified through searches from PubMed for English articles on human subjects published from January 1982 to October 2023.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Clinimetric methods of classification have been found to deserve special attention in four major areas: allostatic load (the cumulative cost of fluctuating and heightened neural or neuroendocrine responses to environmental stressors); health attitudes and behavior; persistent somatization; demoralization and irritable mood. This type of assessment, integrated with traditional psychiatric nosography, may disclose pathophysiological links and provide clinical characterizations that demarcate major prognostic and therapeutic differences among patients who otherwise seem deceptively similar because they have the same medical diagnosis. It may be of value in a number of medical situations, such as: high level of disability or compromised quality of life in relation to what is expected by disease status; delayed or partial recovery; insufficient participation in self-management and/or rehabilitation; failure to resume healthy role after convalescence; unhealthy lifestyle; high attendance of medical facilities disproportionate to detectable disease; lack of treatment adherence; illness denial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The clinimetric approach to the assessment of key psychosocial variables may lead to unique individual profiles, that take into account both biology and biography. It may offer new opportunities for integrating psychosocial and medical perspectives.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"149 5","pages":"368-377"},"PeriodicalIF":6.7,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139664085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sini-Tuulia Eronen, Terhi Kurko, Sirkka-Liisa Kivelä, Tiina Paunio, Marja Airaksinen, Tomi Rantamäki
Background
Sleep medicines should be prescribed cautiously, accompanied by instructions that ensure appropriate use and reduce risks. This is especially important for older adults, for whom many of these medicines are classified as potentially inappropriate medicines.
Methods
We investigated the use and appropriateness of dosing instructions for sleep medicines (described in the Finnish National Current Care Guideline for Insomnia) prescribed for older adults (≥75 years) and dispensed with instruction label in pharmacies. The retrospective reimbursement register data for year 2020 by the Social Insurance Institution of Finland was used as the data source (1,080,843 purchases by 143,886 individuals of which 565,228 purchases were pharmacy dispenses). The appropriateness of the pharmacy dosing instructions containing keyword(s) referring to insomnia treatment was examined according to the prescribed dose, time of intake, frequency of use, and warnings/remarks. A random sample of 1000 instructions was used to manually analyze the phrasing and appropriateness.
Outcomes
We focused our analysis on 58.1% (328,285 purchases by 87,396 individuals) of the pharmacy dispenses, which contained dosing instructions referring insomnia treatment. Of these, zopiclone and mirtazapine were the most prescribed drugs (134,631 and 112,463 purchases, respectively). Dose and time of intake were specified in most of the instructions (98.4% and 83.4%, respectively), whereas frequency of use was specified in 57.3%. A small percentage of the instructions included warnings/remarks (2.8%). Overall, only 2.1% of the instructions contained information about a single dose, time of intake, temporary use, and warnings/remarks and were thus defined as sufficient. Notably, 47.7% (n = 515,615) of all the purchases in our dataset were dispensed via automated multi-dose dispensing systems, which is aimed for long-term treatment.
Interpretation
It is common to prescribe sleep medicines for older adults without appropriate dosing instructions, particularly excluding warnings against long-term, regular use. Actions to change the current prescribing practices are warranted.
{"title":"Sleep medicines are often prescribed for older adults (≥75 years) without appropriate dosing instructions: A nationwide retrospective register study in Finland","authors":"Sini-Tuulia Eronen, Terhi Kurko, Sirkka-Liisa Kivelä, Tiina Paunio, Marja Airaksinen, Tomi Rantamäki","doi":"10.1111/acps.13661","DOIUrl":"10.1111/acps.13661","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Sleep medicines should be prescribed cautiously, accompanied by instructions that ensure appropriate use and reduce risks. This is especially important for older adults, for whom many of these medicines are classified as potentially inappropriate medicines.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We investigated the use and appropriateness of dosing instructions for sleep medicines (described in the Finnish National Current Care Guideline for Insomnia) prescribed for older adults (≥75 years) and dispensed with instruction label in pharmacies. The retrospective reimbursement register data for year 2020 by the Social Insurance Institution of Finland was used as the data source (1,080,843 purchases by 143,886 individuals of which 565,228 purchases were pharmacy dispenses). The appropriateness of the pharmacy dosing instructions containing keyword(s) referring to insomnia treatment was examined according to the prescribed dose, time of intake, frequency of use, and warnings/remarks. A random sample of 1000 instructions was used to manually analyze the phrasing and appropriateness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Outcomes</h3>\u0000 \u0000 <p>We focused our analysis on 58.1% (328,285 purchases by 87,396 individuals) of the pharmacy dispenses, which contained dosing instructions referring insomnia treatment. Of these, zopiclone and mirtazapine were the most prescribed drugs (134,631 and 112,463 purchases, respectively). Dose and time of intake were specified in most of the instructions (98.4% and 83.4%, respectively), whereas frequency of use was specified in 57.3%. A small percentage of the instructions included warnings/remarks (2.8%). Overall, only 2.1% of the instructions contained information about a single dose, time of intake, temporary use, and warnings/remarks and were thus defined as sufficient. Notably, 47.7% (<i>n</i> = 515,615) of all the purchases in our dataset were dispensed via automated multi-dose dispensing systems, which is aimed for long-term treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Interpretation</h3>\u0000 \u0000 <p>It is common to prescribe sleep medicines for older adults without appropriate dosing instructions, particularly excluding warnings against long-term, regular use. Actions to change the current prescribing practices are warranted.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"149 4","pages":"350-360"},"PeriodicalIF":6.7,"publicationDate":"2024-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13661","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139544994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
O. Godin, E. Olié, G. Fond, B. Aouizerate, V. Aubin, F. Bellivier, R. Belzeaux, P. Courtet, C. Dubertret, E. Haffen, A. Lefrere, P. M. Llorca, M. Polosan, P. Roux, L. Samalin, R. Schwan, the FondaMental Academic Centers of Expertise in Bipolar Disorders (FACE-BD) Collaborators, M. Leboyer, B. Etain
Introduction
Metabolic syndrome (MetS) is a cluster of components including abdominal obesity, hyperglycemia, hypertension, and dyslipidemia. MetS is highly prevalent in individuals with bipolar disorders (BD) with an estimated global rate of 32.6%. Longitudinal data on incident MetS in BD are scarce and based on small sample size. The objectives of this study were to estimate the incidence of MetS in a large longitudinal cohort of 1521 individuals with BD and to identify clinical and biological predictors of incident MetS.
Methods
Participants were recruited from the FondaMental Advanced Center of Expertise for Bipolar Disorder (FACE-BD) cohort and followed-up for 3 years. MetS was defined according to the International Diabetes Federation criteria. Individuals without MetS at baseline but with MetS during follow-up were considered as having incident MetS. A logistic regression model was performed to estimate the adjusted odds ratio and its corresponding 95% confidence interval (CI) for an association between each factor and incident MetS during follow-up. We applied inverse probability-of-censoring weighting method to minimize selection bias due to loss during follow-up.
Results
Among individuals without MetS at baseline (n = 1521), 19.3% developed MetS during follow-up. Multivariable analyses showed that incident MetS during follow-up was significantly associated with male sex (OR = 2.2, 95% CI = 1.7–3.0, p < 0.0001), older age (OR = 2.14, 95% CI = 1.40–3.25, p = 0.0004), presence of a mood recurrence during follow-up (OR = 1.91, 95% CI = 1.22–3.00, p = 0.0049), prolonged exposure to second-generation antipsychotics (OR = 1.56, 95% CI = 0.99, 2.45, p = 0.0534), smoking status at baseline (OR = 1.30, 95% CI = 1.00–1.68), lifetime alcohol use disorders (OR = 1.33, 95% CI = 0.98–1.79), and baseline sleep disturbances (OR = 1.04, 95% CI = 1.00–1.08), independently of the associations observed for baseline MetS components.
Conclusion
We observed a high incidence of MetS during a 3 years follow-up (19.3%) in individuals with BD. Identification of predictive factors should help the development of early interventions to prevent or treat early MetS.
{"title":"Incidence and predictors of metabolic syndrome onset in individuals with bipolar disorders: A longitudinal study from the FACE-BD cohort","authors":"O. Godin, E. Olié, G. Fond, B. Aouizerate, V. Aubin, F. Bellivier, R. Belzeaux, P. Courtet, C. Dubertret, E. Haffen, A. Lefrere, P. M. Llorca, M. Polosan, P. Roux, L. Samalin, R. Schwan, the FondaMental Academic Centers of Expertise in Bipolar Disorders (FACE-BD) Collaborators, M. Leboyer, B. Etain","doi":"10.1111/acps.13655","DOIUrl":"10.1111/acps.13655","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Metabolic syndrome (MetS) is a cluster of components including abdominal obesity, hyperglycemia, hypertension, and dyslipidemia. MetS is highly prevalent in individuals with bipolar disorders (BD) with an estimated global rate of 32.6%. Longitudinal data on incident MetS in BD are scarce and based on small sample size. The objectives of this study were to estimate the incidence of MetS in a large longitudinal cohort of 1521 individuals with BD and to identify clinical and biological predictors of incident MetS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Participants were recruited from the FondaMental Advanced Center of Expertise for Bipolar Disorder (FACE-BD) cohort and followed-up for 3 years. MetS was defined according to the International Diabetes Federation criteria. Individuals without MetS at baseline but with MetS during follow-up were considered as having incident MetS. A logistic regression model was performed to estimate the adjusted odds ratio and its corresponding 95% confidence interval (CI) for an association between each factor and incident MetS during follow-up. We applied inverse probability-of-censoring weighting method to minimize selection bias due to loss during follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among individuals without MetS at baseline (<i>n</i> = 1521), 19.3% developed MetS during follow-up. Multivariable analyses showed that incident MetS during follow-up was significantly associated with male sex (OR = 2.2, 95% CI = 1.7–3.0, <i>p</i> < 0.0001), older age (OR = 2.14, 95% CI = 1.40–3.25, <i>p</i> = 0.0004), presence of a mood recurrence during follow-up (OR = 1.91, 95% CI = 1.22–3.00, <i>p</i> = 0.0049), prolonged exposure to second-generation antipsychotics (OR = 1.56, 95% CI = 0.99, 2.45, <i>p</i> = 0.0534), smoking status at baseline (OR = 1.30, 95% CI = 1.00–1.68), lifetime alcohol use disorders (OR = 1.33, 95% CI = 0.98–1.79), and baseline sleep disturbances (OR = 1.04, 95% CI = 1.00–1.08), independently of the associations observed for baseline MetS components.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We observed a high incidence of MetS during a 3 years follow-up (19.3%) in individuals with BD. Identification of predictive factors should help the development of early interventions to prevent or treat early MetS.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"149 3","pages":"207-218"},"PeriodicalIF":6.7,"publicationDate":"2024-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139544969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Marisa Bezerra de Araujo, Guilherme Nobre Nogueira, Pedro Lucas Santana da Silveira, Sergio Andre de Souza Júnior, Fabio Gomes de Matos e Souza, Luisa Weber Bisol
{"title":"Insights and improvements: A critical analysis of methodological limitations in the investigation of smoking and valproic acid in treatment-resistant schizophrenia","authors":"Marisa Bezerra de Araujo, Guilherme Nobre Nogueira, Pedro Lucas Santana da Silveira, Sergio Andre de Souza Júnior, Fabio Gomes de Matos e Souza, Luisa Weber Bisol","doi":"10.1111/acps.13659","DOIUrl":"10.1111/acps.13659","url":null,"abstract":"","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"149 4","pages":"361-362"},"PeriodicalIF":6.7,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139540915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Juan Wang, Ziqian Wei, Luxia Jia, Jiaao Yu, Yuanyuan Wang, Yaxuan Meng, Yi Feng, Runsen Chen
Background
Digital self-harm (DiSH) is a recently identified self-harm distinct from physical self-harm (PSH, also known as non-suicidal self-injury, NSSI). Although prior research has shown that DiSH was associated with suicidal thoughts and behaviors (STBs), it was still unclear whether DiSH has a unique association with STBs after controlling for PSH.
Method
A cross-sectional survey was conducted on Chinese college students. The lifetime prevalence of DiSH and PSH, the functions of DiSH, recent suicide experiences (including suicide ideation, plans, and attempts), anxiety and depression were examined. A total of 5281 participants were analyzed.
Results
A total of 10.83% of participants had ever engaged in DiSH, and 1.59% of participants reported histories of both DiSH and PSH. Among participants with a history of PSH, 30.11% engaged in DiSH. Engagement in DiSH was significantly associated with suicide ideation (SI), suicide plans (SPs), and suicide attempts (SAs). More importantly, participants who engaged in both DiSH and PSH showed higher odds of SI and SPs compared to those who had only engaged in PSH. Regarding the functions of DiSH, using DiSH for self-punishment was associated with SI and SPs, and using DiSH for sensation seeking was associated with SPs and SAs. Similar results were found for the association between DiSH and anxiety and depression.
Conclusions
Our findings suggest that DiSH has a unique association with the risks of STBs beyond PSH. Early identification and intervention for DiSH are crucial, even for individuals who already engage in PSH.
{"title":"Can digital self-harm relate to suicidal thoughts and behaviors beyond physical self-harm?","authors":"Juan Wang, Ziqian Wei, Luxia Jia, Jiaao Yu, Yuanyuan Wang, Yaxuan Meng, Yi Feng, Runsen Chen","doi":"10.1111/acps.13658","DOIUrl":"10.1111/acps.13658","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Digital self-harm (DiSH) is a recently identified self-harm distinct from physical self-harm (PSH, also known as non-suicidal self-injury, NSSI). Although prior research has shown that DiSH was associated with suicidal thoughts and behaviors (STBs), it was still unclear whether DiSH has a unique association with STBs after controlling for PSH.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>A cross-sectional survey was conducted on Chinese college students. The lifetime prevalence of DiSH and PSH, the functions of DiSH, recent suicide experiences (including suicide ideation, plans, and attempts), anxiety and depression were examined. A total of 5281 participants were analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 10.83% of participants had ever engaged in DiSH, and 1.59% of participants reported histories of both DiSH and PSH. Among participants with a history of PSH, 30.11% engaged in DiSH. Engagement in DiSH was significantly associated with suicide ideation (SI), suicide plans (SPs), and suicide attempts (SAs). More importantly, participants who engaged in both DiSH and PSH showed higher odds of SI and SPs compared to those who had only engaged in PSH. Regarding the functions of DiSH, using DiSH for <i>self-punishment</i> was associated with SI and SPs, and using DiSH for <i>sensation seeking</i> was associated with SPs and SAs. Similar results were found for the association between DiSH and anxiety and depression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our findings suggest that DiSH has a unique association with the risks of STBs beyond PSH. Early identification and intervention for DiSH are crucial, even for individuals who already engage in PSH.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"149 3","pages":"256-266"},"PeriodicalIF":6.7,"publicationDate":"2024-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139519327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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