To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Antidepressants are frequently prescribed in patients with psychotic disorders, but little is known about their effects in routine clinical practice. The objective was to investigate the prescribing patterns of antidepressants in relation to the course of depressive symptoms in patients with psychotic disorders.
A cohort of 214 Dutch patients with psychotic disorders received two assessments of somatic and psychiatric health, including a clinician-rated screening for depressive symptoms, as part of annual routine outcome monitoring.
Depressive symptoms were prevalent among 43% (93) of the patients. Antidepressants were prescribed for 40% (86) of the patients and the majority 83% (71) continued this therapy after one year. Multivariable analysis showed that patients with more severe psychopathology had a higher risk to develop depressive symptoms the following year (OR [95% CI]=0.953 [0.912–0.995]). For patients with depressive symptoms at baseline, polypharmacy was a potential risk factor to keep having depressive symptoms (OR [95% CI]=1.593 [1.123–2.261]). Antidepressant use was not an independent predictor in both analyses.
Routine outcome monitoring in patients with psychotic disorders revealed a high prevalence of depressive symptoms. Antidepressants were frequently prescribed and continued in routine clinical practice.
Effective antipsychotic treatment of schizophrenia should, beyond symptom control, translate into meaningful functional improvements. This study explored functional outcomes in patients with schizophrenia switched from previous unsuccessful treatment with oral antipsychotics to flexible doses of paliperidone palmitate (PP).
Two groups of acute (N=212) and non-acute (N=593) patients from an international prospective open-label 6-month study. Outcomes were change in Positive and Negative Syndrome Scale (PANSS) total score, Personal and Psychosocial Performance scale (PSP) and Mini International Classification of Functionality, Disability and Health Rating for Activity and Participation Disorders in Psychological Illnesses (Mini-ICF-APP).
Both groups significantly improved from baseline to endpoint in mean PANSS total score from 98.5±20.1 to 67.4±24.0 (mean change -31.0±29.0) in acute and from 71.5±14.6 to 59.7±18.1 (mean change -11.7±15.9) in non-acute patients (all p<0.0001). Patient functioning in PSP total score increased from 43.9±15.0 at baseline to 62.9±17.1 at endpoint (mean change 19.0±18.7; 95% confidence interval [CI] 16.4;21.6) in the acute and from 58.1±13.4 at baseline to 66.1±15.7 at endpoint (mean change 8.0±14.0; 95%CI 6.8;9.1) in the non-acute group (both groups p<0.0001). Illness-related disabilities of activity and participation within groups improved significantly in Mini-ICF-APP global score decreasing from 26.8±8.5 to 18.5±9.8 (mean change -8.0±10.4; 95%CI -9.5;-6.5) in acute and from 19.8±7.9 to 15.9±8.8 (mean change: -4.0±7.5; 95%CI - 4.6;-3.3) from baseline to endpoint in non-acute patients (both groups p<0.0001).
Symptom reduction in acute and non-acute patients with schizophrenia treated with PP after previous unsuccessful treatment with oral antipsychotics was associated with clinically meaningful functional improvements.
Suicide remains the leading cause of premature death in patients with psychotic disorders. The lifetime suicide risk for schizophrenia is approximately 10%.
This study aims to compare the suicide risk over the past decade following recent onset psychosis to findings from the eighties and nineties in the same catchment area and to identify predictors of suicide in the context of the Psychosis Recent Onset Groningen – Survey (PROGR-S).
A medical file search was carried out to determine the current status of all patients admitted between 2000 and 2009. The suicide rate was compared with a study executed in 1973-1988 in the same catchment area. Predictors of suicide were investigated using Cox regression.
The status of 424 of the 614 patients was known in July 2014. Suicide occurred in 2.4% of the patients with psychotic disorders (n=10; mean follow-up 5.6 years); 6 out of 10 suicides took place within two years. Within two decades, the suicide rate dropped from 11% (follow-up 15 years, 8.5% after 5 years) to 2.4%. The Standardized Mortality Rate (SMR) of suicides compared with the general population was 41.6. A higher age was the only significant predictor for suicide. Neuroticism, living situation, disorganized and negative symptoms, and passive coping style showed a trend for significance. A significant reduction in the suicide rate was found for people with psychosis over the past decades.
A considerable drop in suicide rate was found. Given the high SMR, suicide research should have the highest priority.
In schizophrenia the life expectancy is significantly lower compared to the general population. To monitor their functioning over the course of the illness, a protocol for routine outcome monitoring (ROM) has been developed in the Netherlands.
This study investigated the effectiveness of Routine Outcome Monitoring (ROM) in clinical practice. More specifically, we investigated whether ROM outcomes resulted in treatment in accordance with guidelines for schizophrenia.
Out of the ROM database of 2010 (n=1040), a random sample of 100 patients diagnosed with a psychotic disorder was taken. Data from blood tests, a physical examination, interviews, and standardized questionnaires were used. The prevalence of cardiovascular risk factors, psychosocial problems and sexual dysfunctions was calculated. Offered treatment was investigated with the treatment plans of patients.
The sample consisted of 63 males and 37 females. The average age was 44 and the average duration of illness was 17.7 years. High prevalences of cardiovascular risk factors, psychosocial problems and sexual dysfunctions were found. Cardiovascular risk factors remained untreated in 61% of cases, psychosocial problems remained untreated in 85% of cases and sexual dysfunctions were not treated at all in our sample.
High rates of non-treatment were found for cardiovascular risk factors, psychosocial problems and sexual dysfunctions, despite high prevalences as identified with ROM. Thus, ROM outcomes do not result in treatment in accordance with guidelines for the majority of patients. Steps are necessary to bridge the gap between ROM and treatment to ensure this group of severely mentally ill patients receives the best possible treatment.
Despite important progress, the results of pharmacological treatment of schizophrenia are frequently unsatisfactory. Therefore some patients use natural medicines although it is unclear whether natural medicines are effective and safe. We assessed the evidence for natural medicines with and without antipsychotics in treating symptoms or reducing side effects of antipsychotics in schizophrenia.
A systematic review until April 2013. Only RCTs with a Jadad score of 3 or higher, were included.
105 RCTs were identified. Evidence was found for glycine, sarcosine, NAC, some Chinese and ayurvedic herbs, ginkgo biloba, estradiol and vitamin B6 for improving symptoms of schizophrenia when added to antipsychotics. Inconclusive or no evidence was found for omega-3, Dserine, D-alanine, D-cycloserine, B vitamins, vitamin C, dehydroepiandrosteron (DHEA), pregnenolone (PREG), inositol, gamma-hydroxybutyrate (GHB) and des-tyr-gamma-endorphin when added to antipsychotics. Omega-3 without antipsychotics might be beneficial in the prevention of schizophrenia. Only ayurvedic herbs (in one study), no other agents, seemed effective without antipsychotics. Ginkgo and vitamin B6 seemed to be effective in reducing side effects of antipsychotics. All natural agents produced only mild or no side-effects.
High quality research on natural medicines for schizophrenia is scarce. However, there is emerging evidence for improved outcome for glycine, sarcosine, NAC, some Chinese and ayurvedic herbs, ginkgo biloba, estradiol and vitamin B6, all with only mild or no side effects. Most study samples are small, the study periods are generally short, the studies only cover a modest part of the world's population and most results need replication.
Studying stigma in health care professionals may be helpful to address stigma in people with mental illness. The purpose of this study is to assess (stigmatising) attitudes of mental health care professionals (MHC), forensic psychiatric professionals (FP) and general practitioners (GP) in the Netherlands.
The Mental Illness Clinicians Attitude (MICA) questionnaire is used to assess stigmatising attitudes in three different groups of health care professionals. Scores range from 16 (minimum stigma) to 96 (maximum stigma). Additionally, background information was obtained including gender, age, work and personal experience.
All three groups of health care professionals had a positive attitude towards psychiatry and patients with a mental health problem. However, the total MICA score differed significantly between the three groups (p<0.001). GP's had the highest score (44) on stigmatising attitudes, followed by the FP's (39) and MH's (34). In our study population 25%-38% had personal experience with having a mental illness. Most stigmatising attitudes were found regarding protection of the public against patients with severe mental illness, telling colleagues about personal experience with mental illness and, appreciating psychiatry as less respectable compared to other medical disciplines.
General practitioners showed in comparison to mental health care professionals a significantly higher stigmatising attitude. The scores still represent a mild positive attitude towards psychiatry and psychiatric patients. Although all three groups have a relatively positive attitude, there is still room for improvement.
Few studies have investigated the efficacy of repetitive transcranial magnetic stimulation (rTMS) treatment for negative symptoms of schizophrenia, reporting inconsistent results. We aimed to investigate whether 10 Hz stimulation of the bilateral dorsolateral prefrontal cortex during 3 weeks enhances treatment effects.
A multicenter double-blind randomized controlled trial was performed in 32 patients with schizophrenia or schizo-affective disorder, and moderate to severe negative symptoms [Positive and Negative Syndrome Scale (PANSS) negative subscale ⩾15]. Patients were randomized to a 3-week course of active or sham rTMS. Primary outcome was severity of negative symptoms as measured with the Scale for the Assessment of Negative Symptoms (SANS) and the PANSS negative symptom score. Secondary outcome measures included cognition, insight, quality of life and mood. Subjects were followed up at 4 weeks and at 3 months. For analysis of the data a mixed-effects linear model was used.
A significant improvement of the SANS in the active group compared with sham up to 3 months follow-up (p = 0.03) was found. The PANSS negative symptom scores did not show a significant change (p = 0.19). Of the cognitive tests, only one showed a significant improvement after rTMS as compared with sham. Finally, a significant change of insight was found with better scores in the treatment group.
Bilateral 10 Hz prefrontal rTMS reduced negative symptoms, as measured with the SANS. More studies are needed to investigate optimal parameters for rTMS, the cognitive effects and the neural basis.
Email your librarian or administrator to recommend adding this to your organisation's collection.