Riddhita De, Emily C. C. Smith, Janani Navagnanavel, Emily Au, Kateryna Maksyutynska, Maria Papoulias, Raghunath Singh, Kristoffer J. Panganiban, Bailey Humber, Grimur Høgnason Mohr, Mette Ødegaard Nielsen, Bjørn H. Ebdrup, Gary Remington, Sri Mahavir Agarwal, Margaret K. Hahn
BackgroundNonadherence/discontinuation of antipsychotic (AP) medications represents an important clinical issue in patients across psychiatric disorders, including schizophrenia spectrum disorders (SSDs). While antipsychotic‐induced weight gain (AIWG) is a reported contributor to nonadherence, a systematic review of the association between AIWG and medication nonadherence/discontinuation has not been explored previously.MethodA systematic search was conducted in MEDLINE, EMBASE, PsychINFO, CINAHL, and CENTRAL databases, among others, to help identify all studies which explored adherence, study dropouts, AP switching and/or discontinuations attributable to AIWG among individuals with severe mental illness. A meta‐analysis was also completed where applicable.ResultsWe identified two categories of studies for the meta‐analysis. Category 1 included three studies, which compared measures of AP adherence or discontinuation across BMI classes/degrees of self‐reported weight gain. When compared to normal weight individuals receiving APs or those who did not report AIWG, individuals who were either overweight or obese or reported weight gain in relation to AP use had an increased odds of AP nonadherence (OR 2.37; 95% CI 1.51–3.73; p = 0.0002). Category 2 had 14 studies which compared measures of discontinuation related to weight gain reported as an adverse effect across different APs. Olanzapine was associated with a 3.32 times (95% CI 2.32–4.74; p < 0.00001) increased likelihood of nonadherence or discontinuation when compared to other APs with lower weight gain liabilities. Similarly, APs with moderate weight gain liability (paliperidone, risperidone, and quetiapine) increased the odds of nonadherence or discontinuation by 2.25 (95% CI 1.31–3.87; p = 0.003) when compared to APs considered to have lower weight gain liability (i.e. haloperidol and aripiprazole). The qualitative summary also confirmed these findings.ConclusionThis review and meta‐analysis suggests that AIWG influences medication nonadherence/discontinuation, whereby APs with higher weight gain liability are associated with nonadherence/discontinuation. Additional studies are needed to confirm these findings.
背景抗精神病药物(AP)的不依从/停药是包括精神分裂症谱系障碍(SSD)在内的各种精神疾病患者的一个重要临床问题。方法 在MEDLINE、EMBASE、PsychINFO、CINAHL和CENTRAL等数据库中进行了系统检索,以帮助确定所有探讨严重精神疾病患者因AIWG而导致的依从性、研究辍学、抗精神病药物转换和/或停药的研究。在适用的情况下,我们还完成了一项荟萃分析。结果我们为荟萃分析确定了两类研究。第一类包括三项研究,这些研究比较了不同 BMI 等级/自我报告体重增加程度的 AP 依从性或停药情况。与接受 AP 或未报告 AIWG 的正常体重者相比,超重或肥胖或报告体重增加与 AP 使用有关的人不坚持 AP 的几率更高(OR 2.37;95% CI 1.51-3.73;P = 0.0002)。第 2 类共有 14 项研究,这些研究比较了与不同 APs 的不良反应体重增加有关的停药措施。与体重增加责任较低的其他 APs 相比,奥氮平导致不依从或停药的可能性增加了 3.32 倍 (95% CI 2.32-4.74; p < 0.00001)。同样,与被认为具有较低体重增加责任的 APs(即氟哌啶醇和阿立哌唑)相比,具有中等体重增加责任的 APs(帕潘利酮、利培酮和喹硫平)使不依从或停药的几率增加了 2.25 (95% CI 1.31-3.87; p = 0.003)。结论本综述和荟萃分析表明,AIWG 会影响药物的不依从性/停药,其中体重增加责任较高的 APs 与不依从性/停药相关。还需要更多的研究来证实这些发现。
{"title":"The impact of weight gain on antipsychotic nonadherence or discontinuation: A systematic review and meta‐analysis","authors":"Riddhita De, Emily C. C. Smith, Janani Navagnanavel, Emily Au, Kateryna Maksyutynska, Maria Papoulias, Raghunath Singh, Kristoffer J. Panganiban, Bailey Humber, Grimur Høgnason Mohr, Mette Ødegaard Nielsen, Bjørn H. Ebdrup, Gary Remington, Sri Mahavir Agarwal, Margaret K. Hahn","doi":"10.1111/acps.13758","DOIUrl":"https://doi.org/10.1111/acps.13758","url":null,"abstract":"BackgroundNonadherence/discontinuation of antipsychotic (AP) medications represents an important clinical issue in patients across psychiatric disorders, including schizophrenia spectrum disorders (SSDs). While antipsychotic‐induced weight gain (AIWG) is a reported contributor to nonadherence, a systematic review of the association between AIWG and medication nonadherence/discontinuation has not been explored previously.MethodA systematic search was conducted in MEDLINE, EMBASE, PsychINFO, CINAHL, and CENTRAL databases, among others, to help identify all studies which explored adherence, study dropouts, AP switching and/or discontinuations attributable to AIWG among individuals with severe mental illness. A meta‐analysis was also completed where applicable.ResultsWe identified two categories of studies for the meta‐analysis. Category 1 included three studies, which compared measures of AP adherence or discontinuation across BMI classes/degrees of self‐reported weight gain. When compared to normal weight individuals receiving APs or those who did not report AIWG, individuals who were either overweight or obese or reported weight gain in relation to AP use had an increased odds of AP nonadherence (OR 2.37; 95% CI 1.51–3.73; <jats:italic>p</jats:italic> = 0.0002). Category 2 had 14 studies which compared measures of discontinuation related to weight gain reported as an adverse effect across different APs. Olanzapine was associated with a 3.32 times (95% CI 2.32–4.74; <jats:italic>p</jats:italic> < 0.00001) increased likelihood of nonadherence or discontinuation when compared to other APs with lower weight gain liabilities. Similarly, APs with moderate weight gain liability (paliperidone, risperidone, and quetiapine) increased the odds of nonadherence or discontinuation by 2.25 (95% CI 1.31–3.87; <jats:italic>p</jats:italic> = 0.003) when compared to APs considered to have lower weight gain liability (i.e. haloperidol and aripiprazole). The qualitative summary also confirmed these findings.ConclusionThis review and meta‐analysis suggests that AIWG influences medication nonadherence/discontinuation, whereby APs with higher weight gain liability are associated with nonadherence/discontinuation. Additional studies are needed to confirm these findings.","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":null,"pages":null},"PeriodicalIF":6.7,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142256090","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}
M. Alvarez‐Jimenez, J. Nicholas, L. Valentine, P. Liu, S. Mangelsdorf, S. Baker, T. Gilbertson, G. O'Loughlin, C. McEnery, P. D. McGorry, J. F. Gleeson, S. P. Cross
BackgroundYouth mental health (YMH) services have been established internationally to provide timely, age‐appropriate, mental health treatment and improve long‐term outcomes. However, YMH services face challenges including long waiting times, limited continuity of care, and time‐bound support. To bridge this gap, MOST was developed as a scalable, blended, multi‐modal digital platform integrating real‐time and asynchronous clinician‐delivered counselling; interactive psychotherapeutic content; vocational support; peer support, and a youth‐focused online community. The implementation of MOST within Australian YMH services has been publicly funded.ObjectiveThe primary aim of this study was to evaluate the real‐world engagement, outcomes, and experience of MOST during the first 32 months of implementation.MethodYoung people from participating YMH services were referred into MOST. Engagement metrics were derived from platform usage. Symptom and satisfaction measures were collected at baseline, 6, and 12 (primary endpoint) weeks. Effect sizes were calculated for the primary outcomes of depression and anxiety and secondary outcomes of psychological distress and wellbeing.ResultsFive thousand seven hundred and two young people from 262 clinics signed up and used MOST at least once. Young people had an average of 19 login sessions totalling 129 min over the first 12 weeks of use, with 71.7% using MOST for at least 14 days, 40.1% for 12 weeks, and 18.8% for 24 weeks. There was a statistically significant, moderate improvement in depression and anxiety at 12 weeks as measured by the PHQ4 across all users irrespective of treatment stage (d = 0.41, 95% CI 0.35–0.46). Satisfaction levels were high, with 93% recommending MOST to a friend. One thousand one hundred and eighteen young people provided written feedback, of which 68% was positive and 31% suggested improvement.ConclusionsMOST is a highly promising blended digital intervention with potential to address the limitations and enhance the impact of YMH services.
{"title":"A national evaluation of a multi‐modal, blended, digital intervention integrated within Australian youth mental health services","authors":"M. Alvarez‐Jimenez, J. Nicholas, L. Valentine, P. Liu, S. Mangelsdorf, S. Baker, T. Gilbertson, G. O'Loughlin, C. McEnery, P. D. McGorry, J. F. Gleeson, S. P. Cross","doi":"10.1111/acps.13751","DOIUrl":"https://doi.org/10.1111/acps.13751","url":null,"abstract":"BackgroundYouth mental health (YMH) services have been established internationally to provide timely, age‐appropriate, mental health treatment and improve long‐term outcomes. However, YMH services face challenges including long waiting times, limited continuity of care, and time‐bound support. To bridge this gap, MOST was developed as a scalable, blended, multi‐modal digital platform integrating real‐time and asynchronous clinician‐delivered counselling; interactive psychotherapeutic content; vocational support; peer support, and a youth‐focused online community. The implementation of MOST within Australian YMH services has been publicly funded.ObjectiveThe primary aim of this study was to evaluate the real‐world engagement, outcomes, and experience of MOST during the first 32 months of implementation.MethodYoung people from participating YMH services were referred into MOST. Engagement metrics were derived from platform usage. Symptom and satisfaction measures were collected at baseline, 6, and 12 (primary endpoint) weeks. Effect sizes were calculated for the primary outcomes of depression and anxiety and secondary outcomes of psychological distress and wellbeing.ResultsFive thousand seven hundred and two young people from 262 clinics signed up and used MOST at least once. Young people had an average of 19 login sessions totalling 129 min over the first 12 weeks of use, with 71.7% using MOST for at least 14 days, 40.1% for 12 weeks, and 18.8% for 24 weeks. There was a statistically significant, moderate improvement in depression and anxiety at 12 weeks as measured by the PHQ4 across all users irrespective of treatment stage (<jats:italic>d</jats:italic> = 0.41, 95% CI 0.35–0.46). Satisfaction levels were high, with 93% recommending MOST to a friend. One thousand one hundred and eighteen young people provided written feedback, of which 68% was positive and 31% suggested improvement.ConclusionsMOST is a highly promising blended digital intervention with potential to address the limitations and enhance the impact of YMH services.","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":null,"pages":null},"PeriodicalIF":6.7,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142222105","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}
Robin Olfermann, Sabine Schlegel, Anna Vogelsang, Ulrich Ebner-Priemer, Almut Zeeck, Markus Reichert
Introduction: Many patients with eating disorders (EDs) engage in excessive and compulsive physical activity (pathological exercise, PE) to regulate negative mood or to "burn calories." PE can lead to negative health consequences. Non-exercise activity (NEA) bears the potential to serve as intervention target to counteract PE and problematic eating behaviors since it has been associated with positive mood effects. However, to date, there is no investigation on whether the positive link between NEA and mood seen in the healthy translates to patients with ED.
Material and methods: To study potential associations of NEA and mood in ED, we subjected 29 ED-patients and 35 healthy controls (HCs) to an ambulatory assessment study across 7 days. We measured NEA via accelerometers and repeatedly assessed mood on electronic smartphone diaries via a mixed sampling strategy based on events, activity and time. Within- and between-subject effects of NEA on mood, PE as moderator, and the temporal course of effects were analyzed via multilevel modeling.
Results: NEA increased valence (β = 2.12, p < 0.001) and energetic arousal (β = 4.02, p < 0.001) but showed no significant effect on calmness. The effects of NEA on energetic arousal where significantly stronger for HCs (βHC = 6.26, p < 0.001) than for EDs (βED = 4.02, p < 0.001; βinteraction = 2.24, p = 0.0135). Effects of NEA were robust across most timeframes of NEA and significantly moderated by PE, that is, Lower PE levels exhibited stronger NEA effects on energetic arousal.
Conclusion: Patients with ED and HC show an affective benefit from NEA, partly depending on the level of PE. If replicated in experimental daily life studies, this evidence may pave the way towards expedient NEA interventions to cope with negative mood. Interventions could be especially promising if delivered as Just-in-time adaptive interventions (JITAIs) and should be tailored according to the PE level.
导言:许多饮食失调症(EDs)患者为了调节负面情绪或 "燃烧卡路里",会进行过度和强迫性的体育锻炼(病理性锻炼,PE)。病理性运动会对健康造成负面影响。由于非运动性活动(NEA)与积极情绪效应相关,因此有可能成为抵制 PE 和问题饮食行为的干预目标。然而,迄今为止,尚无研究表明,健康人的 NEA 与情绪之间的积极联系是否也适用于 ED 患者:为了研究 NEA 与 ED 患者情绪之间的潜在联系,我们对 29 名 ED 患者和 35 名健康对照者(HCs)进行了为期 7 天的流动评估研究。我们通过加速度计测量NEA,并通过基于事件、活动和时间的混合采样策略,在电子智能手机日记上反复评估情绪。通过多层次建模分析了NEA对情绪的受试者内和受试者间效应、作为调节因素的PE以及效应的时间过程:NEA 增加了情绪(β = 2.12,p HC = 6.26,p ED = 4.02,p 交互作用 = 2.24,p = 0.0135)。NEA的效应在NEA的大多数时间范围内都是稳健的,并受到PE的显著调节,即较低的PE水平表现出较强的NEA对精力唤醒的效应:结论:ED和HC患者可从NEA中获得情感益处,部分取决于PE水平。如果在日常生活实验研究中得到证实,这一证据可能会为采取便捷的 NEA 干预措施来应对负面情绪铺平道路。如果以适时适应性干预(JITAIs)的方式进行干预,并根据 PE 水平量身定制干预方案,则会特别有前景。
{"title":"Relationship between nonexercise activity and mood in patients with eating disorders.","authors":"Robin Olfermann, Sabine Schlegel, Anna Vogelsang, Ulrich Ebner-Priemer, Almut Zeeck, Markus Reichert","doi":"10.1111/acps.13757","DOIUrl":"https://doi.org/10.1111/acps.13757","url":null,"abstract":"<p><strong>Introduction: </strong>Many patients with eating disorders (EDs) engage in excessive and compulsive physical activity (pathological exercise, PE) to regulate negative mood or to \"burn calories.\" PE can lead to negative health consequences. Non-exercise activity (NEA) bears the potential to serve as intervention target to counteract PE and problematic eating behaviors since it has been associated with positive mood effects. However, to date, there is no investigation on whether the positive link between NEA and mood seen in the healthy translates to patients with ED.</p><p><strong>Material and methods: </strong>To study potential associations of NEA and mood in ED, we subjected 29 ED-patients and 35 healthy controls (HCs) to an ambulatory assessment study across 7 days. We measured NEA via accelerometers and repeatedly assessed mood on electronic smartphone diaries via a mixed sampling strategy based on events, activity and time. Within- and between-subject effects of NEA on mood, PE as moderator, and the temporal course of effects were analyzed via multilevel modeling.</p><p><strong>Results: </strong>NEA increased valence (β = 2.12, p < 0.001) and energetic arousal (β = 4.02, p < 0.001) but showed no significant effect on calmness. The effects of NEA on energetic arousal where significantly stronger for HCs (β<sub>HC</sub> = 6.26, p < 0.001) than for EDs (β<sub>ED</sub> = 4.02, p < 0.001; β<sub>interaction</sub> = 2.24, p = 0.0135). Effects of NEA were robust across most timeframes of NEA and significantly moderated by PE, that is, Lower PE levels exhibited stronger NEA effects on energetic arousal.</p><p><strong>Conclusion: </strong>Patients with ED and HC show an affective benefit from NEA, partly depending on the level of PE. If replicated in experimental daily life studies, this evidence may pave the way towards expedient NEA interventions to cope with negative mood. Interventions could be especially promising if delivered as Just-in-time adaptive interventions (JITAIs) and should be tailored according to the PE level.</p>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":null,"pages":null},"PeriodicalIF":5.3,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142144552","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}
Maria Serra-Navarro, Derek Clougher, Brisa Solé, Jose Sánchez-Moreno, Ana González-Pinto, Esther Jiménez, Benedikt L. Amann, Vicent Balanzá-Martínez, Rafael Tabarés-Seisdedos, Celso Arango, Vivian Accardo, María Paz García-Portilla, Ángela Ibáñez, José Manuel Crespo, José Luis Ayuso-Mateos, Silvia Amoretti, Carla Torrent, Anabel Martínez-Aran, Eduard Vieta, CIBERSAM Functional Remediation Group