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Little is known about the trend and predictors of 21-year mortality and suicide patterns in persons with schizophrenia.
To explore the trend and predictors of 21-year mortality and suicide in persons with schizophrenia in rural China.
This longitudinal follow-up study included 510 persons with schizophrenia who were identified in a mental health survey of individuals (≥15 years old) in 1994 in six townships of Xinjin County, Chengdu, China, and followed up in three waves until 2015. Kaplan–Meier survival analysis and Cox hazard regressions were conducted.
Of the 510 participants, 196 died (38.4% mortality) between 1994 and 2015; 13.8% of the deaths (n = 27) were due to suicide. Life expectancy was lower for men than for women (50.6 v. 58.5 years). Males consistently showed higher rates of mortality and suicide than females. Older participants had higher mortality (hazard ratio HR = 1.03, 95% CI 1.01–1.05) but lower suicide rates (HR = 0.95, 95% CI 0.93–0.98) than their younger counterparts. Poor family attitudes were associated with all-cause mortality and death due to other causes; no previous hospital admission and a history of suicide attempts independently predicted death by suicide.
Our findings suggest there is a high mortality and suicide rate in persons with schizophrenia in rural China, with different predictive factors for mortality and suicide. It is important to develop culture-specific, demographically tailored and community-based mental healthcare and to strengthen family intervention to improve the long-term outcome of persons with schizophrenia.
We began this book with the premise that what ultimately distinguishes strong institutions from weak ones is that the former matter more than the latter. The same institution, in two different contexts or at two different times, is stronger if it makes more of a behavioral difference in one instance than in the other. As the chapters in this volume make clear, however, it is difficult to evaluate exactly how much an institution “matters.” It is relatively simple to say that an institution is strong because, on paper, it possesses features that should make it matter – for example, it commands great things. But it is an altogether different – and, we believe, far more interesting – thing to say that an institution is strong because it actually produces an outcome that is substantially different from what we might have observed in its absence, and that it continues to produce that outcome even in the face of pressures to change it or avoid it altogether.
The third wave of democratization transformed Latin America. Across the region, regime transitions triggered a plethora of institutional reforms aimed at enhancing the stability and quality of both the new and the few long-standing democracies. Most states adopted new constitutions. Many of them extended new rights to citizens, including unprecedented social rights, such as the right to health care, housing, and a clean environment (Klug 2000; Yashar 2005; Brinks and Blass 2018). Electoral systems were redesigned – at least once – in every Latin American country except Costa Rica; judicial and central bank reforms spread across the region (Jácome and Vásquez 2008); and governments launched far-reaching decentralization initiatives and experimented with new institutions of direct or participatory democracy (Falleti 2010; Cameron, Hershberg, and Sharpe 2012; Altman 2014; Mayka 2019).
Analysts and policymakers often decry the failure of institutions to accomplish their stated purpose. Bringing together leading scholars of Latin American politics, this volume helps us understand why. The volume offers a conceptual and theoretical framework for studying weak institutions. It introduces different dimensions of institutional weakness and explores the origins and consequences of that weakness. Drawing on recent research on constitutional and electoral reform, executive-legislative relations, property rights, environmental and labor regulation, indigenous rights, squatters and street vendors, and anti-domestic violence laws in Latin America, the volume's chapters show us that politicians often design institutions that they cannot or do not want to enforce or comply with. Challenging existing theories of institutional design, the volume helps us understand the logic that drives the creation of weak institutions, as well as the conditions under which they may be transformed into institutions that matter.
This Element introduces the concept of institutional weakness, arguing that weakness or strength is a function of the extent to which an institution actually matters to social, economic or political outcomes. It then presents a typology of three forms of institutional weakness: insignificance, in which rules are complied with but do not affect the way actors behave; non-compliance, in which state elites either choose not to enforce the rules or fail to gain societal cooperation with them; and instability, in which the rules are changed at an unusually high rate. The Element then examines the sources of institutional weakness.
Although prescription rates of antidepressants for children and adolescents have increased, concerns have been raised regarding effects on neurodevelopment and long-term outcome. Using a genetic animal model of depression, this study investigated the long-term effects of pre-pubertal administration of fluoxetine (FLX) on depressive-like behaviour in early adulthood, as well as on central monoaminergic response to an acute stressor. We postulated that pre-pubertal FLX will have lasting effects on animal behaviour and monoaminergic stress responses in early adulthood.
Flinders sensitive line (FSL) rats received 10 mg/kg/day FLX subcutaneously from postnatal day 21 (PnD21) to PnD34 (pre-pubertal). Thereafter, following normal housing, rats were either subjected to locomotor testing and the forced swim test (FST) on PnD60 (early adulthood), or underwent surgery for microdialysis, followed on PnD60 by exposure to acute swim stress and measurement of stressor-induced changes in plasma corticosterone and pre-frontal cortical monoamine concentrations.
Pre-pubertal FLX did not induce a late emergent effect on immobility in FSL rats on PnD60, whereas locomotor activity was significantly decreased. Acute swim stress on PnD60 significantly increased plasma corticosterone levels, and increased pre-frontal cortical norepinephrine (NE) and 5-hydroxyindole-3-acetic acid (5-HIAA) concentrations. Pre-pubertal FLX significantly blunted the pre-frontal cortical NE and 5-HIAA response following swim stress on PnD60. Baseline dopamine levels were significantly enhanced by pre-pubertal FLX, but no further changes were induced by swim stress.
Pre-pubertal FLX did not have lasting antidepressant-like behavioural effects in genetically susceptible, stress-sensitive FSL rats. However, such treatment reduced locomotor activity, abrogated noradrenergic and serotonergic stressor responses and elevated dopaminergic baseline levels in adulthood.
Dialectical behaviour therapy (DBT) is widely considered to be a promising treatment for borderline personality disorder (BPD). However, the evidence for its efficacy published thus far should be regarded as preliminary.
To compare the effectiveness of DBT with treatment as usual for patients with BPD and to examine the impact of baseline severity on effectiveness.
Fifty-eight women with BPD were randomly assigned to either 12 months of DBT or usual treatment in a randomised controlled study. Participants were recruited through clinical referrals from both addiction treatment and psychiatric services. Outcome measures included treatment retention and the course of suicidal, self-mutilating and self-damaging impulsive behaviours.
Dialectical behaviour therapy resulted in better retention rates and greater reductions of self-mutilating and self-damaging impulsive behaviours compared with usual treatment, especially among those with a history of frequent self-mutilation.
Dialectical behaviour therapy is superior to usual treatment in reducing high-risk behaviours in patients with BPD.
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