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It is unknown if the positive effects of intensive early intervention programmes are sustainable over time. Duration of untreated psychosis (DUP) is associated with outcome of schizophrenia, and it has been proved that DUP can be shortened. Randomized clinical trials have tested possibilities for interventions in high risk groups.
We conducted a single-blinded randomized controlled trial of two years of specialized assertive early intervention programme (OPUS) versus standard treatment. A total of 547 first-episode patients with first episode psychosis or schizotypal disorder were included in the trial and reinterviewed after one, two and five years. OPUS treatment consisted of ACT with family involvement and social skills training.
At five-year follow-up, the positive effect on psychotic and negative symptoms of the treatment seen after two years had disappeared. A significantly smaller percentage of patients from the experimental group were living in supported housing and were hospitalized fewer days during the five-year period. Among patients with schizotypal disorder, the proportion who had a transition to psychosis after one year was 8.1 vs. 28.0 percent for patients randomized to OPUS vs. standard treatment, respectively. At two-year follow-up the figures were 28.1 vs. 44.0. Duration of untreated psychosis (DUP) median was 48 weeks. Longer DUP was independently associated with more psychotic symptoms at entry and at one-year and two-year follow-up.
Due to previous findings, we have started a new trial in which we will randomize 400 patients to two years versus five years of specialized assertive treatment.
To determine long term effects of intensive early intervention programme (OPUS)for first episode psychotic patients.
RCT of two years of intensive early-intervention programme versus standard treatment. Follow-up was two and five years.
547 first-episode psychotic patients were included and interviewed after two years (N=369) and five years (N=301). Registerbased information was available for all patients.
The intensive early intervention programme OPUS consisted of ACT with family involvement and social skills training.
At five-year follow-up, the positive effect of the OPUS treatment seen after two years had equalized between treatment groups. A significantly smaller percentage of patients from the experimental group were living in supported housing (4% vs. 10%, OR 2.3, 95% CI 1.1 to 4.8, P =0.02) and were hospitalized fewer days (mean days 149 vs. 193, mean difference 44, 95% CI 0.15 to 88,12 P= 0.05) during the five-year period.
The OPUS treatment improved clinical outcome after two years, but the effects were not sustainable up to five years after. A difference on supported housing and use of bed days were found after five years in favour of the OPUS treatment.
To evaluate the effects of integrated treatment for first-episode psychotic patients.
In a randomised clinical trial of 547 first-episode patients with schizophrenia spectrum disorders, effects of integrated treatment and standard treatment was compared. The integrated treatment lasted for two years and consisted of assertive community treatment with programmes for family-involvement and social skills training. Standard treatment offered contact with a community mental health centre. Patients were assessed at entry and after one, two and five years by investigators that were not involved in treatment.
At the one-year and two-year follow-up psychotic and negative symptoms changed in favour of integrated treatment. Patients in integrated treatment had significantly less co-morbid substance abuse, better adherence to treatment, and more satisfaction with treatment. Use of bed days was 22 percent less in integrated treatment than in standard treatment. Results of five-year follow-up will be presented.
Integrated treatment improved clinical outcome and adherence to treatment. The improvement in clinical outcome was consistent in the one-year and two-year follow-ups.
Gender differences in psychosis have been investigated, and the results have contributed to a better understanding of the disease, but many questions are unanswered. In clinical terms, women and men with psychosis differ in terms of access to social support, tendency of substance abuse, level of functioning and symptom patterns. We aimed to investigate how gender differences at onset of psychosis develop during the first 5 years of treatment.
A total of 578 patients with a first-episode psychosis in the schizophrenia spectrum were included in the Danish OPUS trial – a randomized clinical trial comparing 2 years of intensive early-intervention programme with standard treatment. All patients were assessed with validated instruments at inclusion, and after 2 and 5 years. Data were analysed for significant gender differences.
Males have significantly higher levels of negative symptoms at all times, and are more likely to live alone and suffer from substance abuse. Females reach higher levels of social functioning at follow-up, and show a greater tendency to be employed or in education than males. Markedly more women than men live with children. More women than men reach a state of recovery and are more compliant with medication.
There are significant gender differences at 2- and 5-year follow-up in this large cohort of first-episode psychotic patients. Males and females show different symptomatology and different levels of social functioning.
It has been hypothesized that the first five years after first episode of psychosis constitutes a critical period in with opportunities for ameliorating the course of illness. Based on this rationale, specialized assertive early intervention services were developed. We wanted to investigate the evidence basis for such interventions.
The evidence for the effectiveness of specialized assertive early intervention services is mainly based on one large randomized clinical trial, the OPUS trial, but it is supported by the findings in smaller trials such as the Lambeth Early Onset (LEO) trial, the Croydon Outreach and Assertive Support Team COAST trial and the Norwegian site of Optimal Treatment (OTP) trial. There are positive effects on psychotic and negative symptoms, on substance abuse and user satisfaction, but the clinical effects are not sustainable when patients are transferred back to standard treatment. However the positive effects on service use and ability to live independently seem to be durable.
Implementation of specialized assertive early intervention services is recommended, but the evidence basis needs to be strengthened through replication in large high quality trials. Recommendation regarding the duration of treatment must await results of ongoing trials comparing two years of intervention with extended treatment periods.
This article examines the goals and practices of the Ministry of Foreign Affairs in Ukraine in the 1970s, a Soviet institution that functioned as an ideological organ fighting against Ukrainian nationalists domestically and abroad. The central figure of this article is Heorhii Shevel who governed the Ministry from 1970 to 1980 and whose tactics, strategies, and practices reveal the existence of a distinct phenomenon in the Soviet Union—the nationally conscious political elite with double loyalties who, by action or inaction, expanded the space of nationalism in Ukraine. This research illuminates a paradox of pervasive Soviet power, which produced an institution that supported and reinforced Soviet “anti-nationalist” ideology, simultaneously creating an environment where heterodox views or sentiments were stimulated and nurtured.
Irving I. Gottesman played an important role for psychiatric genetic research in Denmark through more than 40 years of collaboration with Danish scientists, resulting in important twin and family studies based upon the unique national registers available in Denmark.
This review assesses factors affecting fouling in conventional pens for slaughter pigs. Fouling of the pen happens when pigs change their excretory behaviour from occurring in the designated dunging area to the lying area. This can result in a lower hygiene, bad air quality, extra work for the farmer, disturbance of the pigs’ resting behaviour and an increase in agonistic interactions. A systematic search was conducted and results narrowed down to 21 articles. Four factors were found to affect fouling directly: insufficient space allowance, the flooring design of the pen, the thermal climate and pigs’ earlier experience. Further, these primary factors are affected by secondary factors such as the shape of the pen, the weight of the pigs and especially the heat balance of the pigs, which is affected by several tertiary factors including, for example, temperature, humidity and draught. Results indicate that the most important factor to control when trying to prevent fouling of a pen is the pen climate. An appropriate climate may be accomplished through floor cooling in the designated lying area, sprinklers above the designated dunging area and by ensuring a more optimal ambient temperature curve that also fits the weight of the pigs in different stages of the production. All in all, fouling of the pen in conventional slaughter pigs is a multifactorial problem, but it is important to focus on increasing the comfortability, and especially the climate, of the designated lying area.
Prenatal exposure to valproic acid (VPA) enhances the risk for later development of autism spectrum disorders (ASD). An altered gamma-aminobutyric acid (GABA) system may be a key factor in ASD. Here we investigated possible changes in the GABA system in rats exposed to a low dose of prenatal VPA.
We performed autoradiography with [3H]muscimol, (a GABAA receptor agonist), and [11C]Ro15-4513 (a partial agonist of the GABAA α1+5 receptor subtypes), in brain sections containing amygdala, thalamus and hippocampus of rats treated prenatally with 20 mg/kg VPA or saline from the 12th day of gestation.
Prenatal VPA significantly increased [11C]Ro15-4513 binding in the left amygdala compared with controls (p<0.05). This difference was not observed in the hippocampus, thalamus or right amygdala. No differences were observed in [3H]muscimol binding.
We observed an asymmetric increase in GABAA receptor binding. Disturbances in the GABAA receptor system have also been detected in human autism with [11C]Ro15-4513.
Numerous studies describe the occurrence of post-traumatic stress disorder following disasters, but less is known about the risk of major depression.
To review the risk of depressive disorder in people surviving disasters and in soldiers returning from military deployment.
A systematic literature search combined with reference screening identified 23 controlled epidemiological studies. We used random effects models to compute pooled odds ratios (ORs).
The average OR was significantly elevated following all types of exposures: natural disaster OR = 2.28 (95% CI 1.30–3.98), technological disaster OR = 1.44 (95% CI 1.21–1.70), terrorist acts OR = 1.80 (95% CI 1.38–2.34) and military combat OR = 1.60 (95% CI 1.09–2.35). In a subset of ten high-quality studies OR was 1.41 (95% CI 1.06–1.87).
Disasters and combat experience substantially increase the risk of depression. Whether psychological trauma per se or bereavement is on the causal path is unresolved.
The aim of the present study was to validate figural drawing scales depicting extremely lean to extremely obese subjects to obtain proxies for BMI and waist circumference in postal surveys.
Reported figural scales and anthropometric data from a large population-based postal survey were validated with measured anthropometric data from the same individuals by means of receiver-operating characteristic curves and a BMI prediction model.
Adult participants in a Scandinavian cohort study first recruited in 1990 and followed up twice since.
Individuals aged 38–66 years with complete data for BMI (n 1580) and waist circumference (n 1017).
Median BMI and waist circumference increased exponentially with increasing figural scales. Receiver-operating characteristic curve analyses showed a high predictive ability to identify individuals with BMI > 25·0 kg/m2 in both sexes. The optimal figural scales for identifying overweight or obese individuals with a correct detection rate were 4 and 5 in women, and 5 and 6 in men, respectively. The prediction model explained 74 % of the variance among women and 62 % among men. Predicted BMI differed only marginally from objectively measured BMI.
Figural drawing scales explained a large part of the anthropometric variance in this population and showed a high predictive ability for identifying overweight/obese subjects. These figural scales can be used with confidence as proxies of BMI and waist circumference in settings where objective measures are not feasible.
In 1929–1934 Galician intellectuals who emigrated to Soviet Ukraine from abroad were subject to mass repression. This article demonstrates how the party and the Soviet secret police discredited and eliminated this intelligentsia. Leading party officials perceived Galicians as possessing a strong sense of national identity and internal unity, and therefore an obstacle to plans for homogenizing Soviet Ukraine. The research draws on Ukrainian periodicals published in the early 1930s, on files relating to two major group criminal cases that were conducted in the early 1930s and that are now available to scholars in the Security Service archives of Ukraine (the former Soviet secret police archives), and on recent scholarship in the field. The archival evidence demonstrates that the cases were fabricated and the charges against Galicians were constructed as part of a planned “anti-nationalist” campaign.
Several studies indicate that cannabis use among patients with psychotic disorders is associated with worse outcome, but only a few studies have controlled for baseline condition and medication.
At 5-year follow-up, interviews were carried out with 314 first-episode psychosis patients included in the OPUS trial. The patients included were in the age range of 18 to 45 years old and 59% were male. Cannabis use was extracted from the Schedule for Clinical Assessment in Neuropsychiatry. At follow-up, the patients were divided into different groups according to the variable cannabis use: abstainers, stoppers, starters and continuers. Psychotic, negative and disorganized dimensions (ranging from zero to five) were calculated for each of the four groups based on the Schedule for the Assessment of Positive and Negative Symptoms in Schizophrenia.
Cannabis users were younger (24.6 years v. 27.4 years, p < 0.001) and had a lower level of education. At the 5-year follow-up, users of cannabis had higher scores on the psychotic dimension [difference 0.97, 95% confidence interval (CI) 0.41–1.53, p = 0.001] and lower levels of the Global Assessment of Functioning (difference 8.26, 95% CI 2.13–14.39, p = 0.01). Those who stopped using cannabis between entry and 5-year follow-up had a significantly lower level of psychotic symptoms at 5-year follow-up even after controlling for baseline level of psychotic symptoms and for insufficient antipsychotic medication (adjusted difference in psychotic dimension –1.04, 95% CI –1.77 to –0.31, p = 0.006).
Continuous cannabis use was associated with higher levels of psychotic symptoms after 5 years, and this association was only partly explained by insufficient antipsychotic medication.
Although transient psychotic disorders are currently classified as a category separate from schizophrenia (SZ) and affective disorders, their distinctive features remain uncertain. This study examines the family psychiatric morbidity of the ICD-10 category of ‘acute and transient psychotic disorders’ (ATPDs), pointing out differences from SZ and bipolar disorder (BD).
From a cohort of 2.5 million persons, we identified all patients enrolled in the Danish Psychiatric Register who were ever admitted with ATPDs (n=2537), SZ (n = 10639) and BD disorder (n=5292) between 1996 and 2008. The relative risk (RR) of ATPDs, SZ and BD associated with psychiatric morbidity in first-degree relatives (FDRs) was calculated as the incidence rate ratio using Poisson regression.
The RR of ATPDs [1.93, 95% confidence interval (CI) 1.76–2.11] was higher if patients with ATPDs had at least one FDR admitted with any mental disorder than patients without family psychiatric antecedents. An additional risk arose if they had FDRs admitted not only with ATPDs (RR 1.60, 95% CI 1.33–1.92) but also with SZ (RR 2.06, 95% CI 1.70–2.50) and/or BD (RR 1.55, 95% CI 1.23–1.96). Despite some overlap, the risk of SZ (RR 2.80, 95% CI 2.58–3.04) and BD (RR 3.68, 95% CI 3.29–4.12) was markedly higher if patients with SZ and BD had FDRs admitted with the same condition.
These findings suggest that family psychiatric predisposition has a relatively modest impact on ATPDs and argue against a sharp differentiation of ATPDs from SZ and BD.
Information about the cost-effectiveness of early intervention programmes for first-episode psychosis is limited.
To evaluate the cost-effectiveness of an intensive early-intervention programme (called OPUS) (trial registration NCT00157313) consisting of enriched assertive community treatment, psychoeducational family treatment and social skills training for individuals with first-episode psychosis compared with standard treatment.
An incremental cost-effectiveness analysis of a randomised controlled trial, adopting a public sector perspective was undertaken.
The mean total costs of OPUS over 5 years (€123683, s.e. = 8970) were not significantly different from that of standard treatment (€148751, s.e. = 13073). At 2-year follow-up the mean Global Assessment of Functioning (GAF) score in the OPUS group (55.16, s.d. = 15.15) was significantly higher than in standard treatment group (51.13, s.d. = 15.92). However, the mean GAF did not differ significantly between the groups at 5-year follow-up (55.35 (s.d. = 18.28) and 54.16 (s.d. = 18.41), respectively). Cost-effectiveness planes based on non-parametric bootstrapping showed that OPUS was less costly and more effective in 70% of the replications. For a willingness-to-pay up to €50000 the probability that OPUS was cost-effective was more than 80%.
The incremental cost-effectiveness analysis showed that there was a high probability of OPUS being cost-effective compared with standard treatment.