Schizophrenia bulletin open最新文献

{"title":"Cost-Effectiveness of a Multidisciplinary Lifestyle-Enhancing Treatment for Inpatients With Severe Mental Illness: The MULTI Study V.","authors":"Jeroen Deenik, Chris van Lieshout, Harold F van Driel, Geert W J Frederix, Ingrid J M Hendriksen, Peter N van Harten, Diederik E Tenback","doi":"10.1093/schizbullopen/sgac022","DOIUrl":"10.1093/schizbullopen/sgac022","url":null,"abstract":"<p><p>Economic evaluations of lifestyle interventions for people with mental illness are needed to inform policymakers and managers about implementing such interventions and corresponding reforms in routine mental healthcare. We aimed to evaluate changes in healthcare costs 18 months after the implementation of a multidisciplinary lifestyle-enhancing treatment for inpatients with severe mental illness (MULTI) versus treatment as usual (TAU). In a cohort study (<i>n</i> = 114; 65 MULTI, 49 TAU), we retrospectively retrieved cost data in Euros on all patient sessions, ward stay, medication use, and hospital referrals in the quarter year at the start of MULTI (Q1 2014) and after its evaluation (Q3 2015). We used linear regression analyses correcting for baseline values and differences between groups, calculated deterministic incremental cost-effectiveness ratios for previously shown changes in physical activity, metabolic health, psychosocial functioning, and additionally quality of life, and performed probabilistic sensitivity analyses including cost-effectiveness planes. Adjusted regression showed reduced total costs per patient per quarter year in favor of MULTI (B = -736.30, 95%CI: -2145.2 to 672.6). Corresponding probabilistic sensitivity analyses accounting for uncertainty surrounding the parameters showed statistically non-significant cost savings against health improvements for all health-related outcomes in MULTI compared to TAU. It is concluded that MULTI did not increase healthcare costs while improving health outcomes. This indicates that starting lifestyle interventions does not need to be hampered by costs. Potential societal and economic value may justify investment to support implementation and maintenance. Further research is needed to study this hypothesis.</p>","PeriodicalId":94380,"journal":{"name":"Schizophrenia bulletin open","volume":"3 1","pages":"sgac022"},"PeriodicalIF":0.0,"publicationDate":"2022-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11206082/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141984265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Twelve-Month Cognitive Trajectories in Individuals at Ultra-High Risk for Psychosis: A Latent Class Analysis.","authors":"Kelly Allott, Stefanie J Schmidt, Hok Pan Yuen, Stephen J Wood, Barnaby Nelson, Connie Markulev, Suzie Lavoie, Warrick J Brewer, Miriam R Schäfer, Nilufar Mossaheb, Monika Schlögelhofer, Stefan Smesny, Ian B Hickie, Gregor Emanuel Berger, Eric Y H Chen, Lieuwe de Haan, Dorien H Nieman, Merete Nordentoft, Anita Riecher-Rössler, Swapna Verma, Andrew Thompson, Alison R Yung, Paul Amminger, Patrick D McGorry, Jessica Hartmann","doi":"10.1093/schizbullopen/sgac008","DOIUrl":"10.1093/schizbullopen/sgac008","url":null,"abstract":"<p><p>Understanding longitudinal cognitive performance in individuals at ultra-high risk for psychosis (UHR) is important for informing theoretical models and treatment. A vital step in this endeavor is to determine whether there are UHR subgroups that have similar patterns of cognitive change over time. The aims were to: i) identify latent class trajectories of cognitive performance over 12-months in UHR individuals, ii) identify baseline demographic and clinical predictors of the resulting classes, and iii) determine whether trajectory classes were associated with transition to psychosis or functional outcomes. Cognition was assessed using the Brief Assessment of Cognition in Schizophrenia (BACS) at baseline, 6- and 12-months (<i>N</i> = 288). Using Growth Mixture Modeling, a single unimpaired improving trajectory class was observed for motor function, speed of processing, verbal fluency, and BACS composite. A two-class solution was observed for executive function and working memory, showing one unimpaired and a second impaired class. A three-class solution was found for verbal learning and memory: unimpaired, mildly impaired, and initially extremely impaired, but improved (\"caught up\") to the level of the mildly impaired. IQ, omega-3 index, and premorbid adjustment were associated with class membership, whereas clinical variables (symptoms, substance use), including transition to psychosis, were not. Working memory and verbal learning and memory trajectory class membership was associated with functioning outcomes. These findings suggest there is no short-term progressive cognitive decline in help-seeking UHR individuals, including those who transition to psychosis. Screening of cognitive performance may be useful for identifying UHR individuals who may benefit from targeted cognitive interventions.</p>","PeriodicalId":94380,"journal":{"name":"Schizophrenia bulletin open","volume":"3 1","pages":"sgac008"},"PeriodicalIF":0.0,"publicationDate":"2022-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11205973/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141984272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Environmental Factors Causing My Relapses.","authors":"Rudy Tian","doi":"10.1093/schizbullopen/sgac007","DOIUrl":"https://doi.org/10.1093/schizbullopen/sgac007","url":null,"abstract":"","PeriodicalId":94380,"journal":{"name":"Schizophrenia bulletin open","volume":"3 1","pages":"sgac007"},"PeriodicalIF":0.0,"publicationDate":"2022-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11206018/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141984269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ENHANCE: Phase 3, Randomized, Double-Blind, Placebo-Controlled Study of Adjunctive Pimavanserin for Schizophrenia in Patients With an Inadequate Response to Antipsychotic Treatment.","authors":"Dragana Bugarski-Kirola, Istvan Bitter, I-Yuan Liu, Brandon Abbs, Srdjan Stankovic","doi":"10.1093/schizbullopen/sgac006","DOIUrl":"10.1093/schizbullopen/sgac006","url":null,"abstract":"<p><p>Inadequate response to antipsychotic treatment is common in patients with schizophrenia. This study evaluated pimavanserin, a 5-HT _<b>2A</b> receptor inverse agonist/antagonist, as adjunctive treatment in patients with inadequate response. This was a 6-week, randomized, double-blind, placebo-controlled, study conducted in North America and Europe. Adult outpatients with schizophrenia and inadequate response to current antipsychotic were enrolled. Inclusion criteria included Positive and Negative Syndrome Scale (PANSS) total score ≥65 and ≤110 and retrospective antipsychotic treatment stability of 8 weeks. Pimavanserin 20 mg/day or placebo added to ongoing antipsychotic was tested in a flexible-dose paradigm with dose adjustments allowed during the first 3 weeks. The primary efficacy endpoint, PANSS total score change from baseline to week 6, was not met, although improvement was greater with pimavanserin than placebo (LS mean difference: -2.1, [95% CI: -4.5, 0.4]; <i>P</i> = .094). As a hierarchical testing procedure was used, additional efficacy analyses were exploratory. Clear separation from placebo was observed with pimavanserin at week 6 for the PANSS Negative Symptoms subscale (LS mean difference: -0.7, [95% CI: -1.5, 0.0]) and Marder Negative Symptom Factor score (-0.9, [-1.7, -0.1]). Analysis of European sites (81.5% of patients) revealed a difference for pimavanserin versus placebo on PANSS total score (LS mean difference: -3.1, [95% CI: -5.8, -0.4]) and Clinical Global Impressions-Severity score (-0.2, [-0.4, -0.0]). Treatment-emergent adverse events occurred in 39.9% with pimavanserin and 36.4% with placebo. Although statistical significance for the primary endpoint was not met, a trend toward improvement in negative symptoms was observed with pimavanserin, warranting further study.</p>","PeriodicalId":94380,"journal":{"name":"Schizophrenia bulletin open","volume":"3 1","pages":"sgac006"},"PeriodicalIF":0.0,"publicationDate":"2022-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11205884/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141984266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the Potential Benefits of Cannabidiol for Patients With Schizophrenia: A Narrative Review.","authors":"Garrison J B Dyck, Zaid H Maayah, Dean T Eurich, Jason R B Dyck","doi":"10.1093/schizbullopen/sgab053","DOIUrl":"10.1093/schizbullopen/sgab053","url":null,"abstract":"<p><p>Research suggests that cannabis-derived delta-9-tetrahydrocannabinol can be linked to the worsening of psychosis and/or other symptoms of schizophrenia. However, studies have shown that another major cannabinoid found in cannabis, cannabidiol (CBD), may be a potential alternative or adjunctive treatment for psychosis and schizophrenia. As such, herein we review the relevant literature relating to the safety and efficacy of CBD treatment in patients with schizophrenia, including the effects of CBD in treating the positive, negative, and cognitive symptoms of the disorder, as well as the molecular mechanisms by which CBD can reduce schizophrenic symptoms. The potential utility of CBD for mitigating cannabis cravings and cannabis withdrawal in this patient population will also be reviewed. Lastly, the dosing, method of drug delivery, length of treatment, and adverse effects of CBD in patients with schizophrenia are discussed. Thus, the goal of this narrative review is to help clinicians and researchers better understand the risks and benefits of this potential therapy for this patient population.</p>","PeriodicalId":94380,"journal":{"name":"Schizophrenia bulletin open","volume":"3 1","pages":"sgab053"},"PeriodicalIF":0.0,"publicationDate":"2021-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11205871/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141984273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}