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Schizophrenia: Length of Stay, Recividism, Readmission

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48 papers 100 to 500 followers
By Edwin Kim Resident Physician, Aspiring Addiction Psychiatrist
Donald C Goff, Peter Falkai, W Wolfgang Fleischhacker, Ragy R Girgis, Rene M Kahn, Hiroyuki Uchida, Jingping Zhao, Jeffrey A Lieberman
Concerns have been raised that treatment with antipsychotic medication might adversely affect long-term outcomes for people with schizophrenia. The evidence cited for these concerns includes the association of antipsychotic treatment with brain volume reduction and with dopamine receptor sensitization, which might make patients vulnerable to relapse and illness progression. An international group of experts was convened to examine findings from clinical and basic research relevant to these concerns. Little evidence was found to support a negative long-term effect of initial or maintenance antipsychotic treatment on outcomes, compared with withholding treatment...
September 1, 2017: American Journal of Psychiatry
Wei Zheng, Yu-Tao Xiang, Xin-Hu Yang, Ying-Qiang Xiang, Jose de Leon
OBJECTIVE: To meta-analyze randomized controlled trials (RCTs) for the efficacy and safety of adjunctive antiepileptic drugs (AEDs) to augment clozapine therapy for treatment-resistant schizophrenia. DATA SOURCES: The search included databases in English (PubMed, PsycINFO, Embase, and Cochrane Library databases and the Cochrane Controlled Trials Register) and in Chinese (China Journal Net [CJN], WanFang, and China Biology Medicine [CBM]) and references from retrieved articles...
May 2017: Journal of Clinical Psychiatry
Lisa Anne Hahn, Andrew Mackinnon, Debra L Foley, Vera A Morgan, Anna Waterreus, Gerald F Watts, David J Castle, Dennis Liu, Cherrie A Galletly
OBJECTIVE: This study explored the prevalence and associations of eight WHO-defined CVD risk factors for death and disability in people with psychosis. METHOD: The study included 1156 people aged 18-64years, diagnosed with psychosis. The 2009 World Health Organisation (WHO) Global Health Risks Report was used as a framework to determine the prevalence and number of eight key risk factors for cardiovascular disease (CVD) in men and women with psychosis. Differences in the number and type of risk factors by age and gender were investigated...
April 2017: Schizophrenia Research
Taro Kishi, Kazuto Oya, Nakao Iwata
This meta-analysis of randomized controlled trials (RCTs) investigated the advantages of long-acting injectable antipsychotics (LAI-APs) over oral antipsychotics (OAPs) with regard to efficacy and safety for patients with recent-onset psychotic disorders. Effect sizes and 95% confidence intervals (95%CIs) were calculated. We identified five RCTs (1022 patients, mean study duration=18±7.59 months) that compared LAI-APs (paliperidone or risperidone) with OAPs. Pooled LAI-APs did not outperform OAPs in terms of the preventing of relapse (N=3, n=875)...
December 30, 2016: Psychiatry Research
Kim T Mueser, David L Penn, Jean Addington, Mary F Brunette, Susan Gingerich, Shirley M Glynn, David W Lynde, Jennifer D Gottlieb, Piper Meyer-Kalos, Susan R McGurk, Corinne Cather, Sylvia Saade, Delbert G Robinson, Nina R Schooler, Robert A Rosenheck, John M Kane
Comprehensive coordinated specialty care programs for first-episode psychosis have been widely implemented in other countries but not in the United States. The National Institute of Mental Health's Recovery After an Initial Schizophrenia Episode (RAISE) initiative focused on the development and evaluation of first-episode treatment programs designed for the U.S. health care system. This article describes the background, rationale, and nature of the intervention developed by the RAISE Early Treatment Program project-known as the NAVIGATE program-with a particular focus on its psychosocial components...
July 2015: Psychiatric Services: a Journal of the American Psychiatric Association
Eva Velthorst, Abraham Reichenberg, Ori Kapra, Shira Goldberg, Menachem Fromer, Eyal Fruchter, Karen Ginat, Lieuwe de Haan, Michael Davidson, Mark Weiser
IMPORTANCE: Community functioning is a core component of the functional deficits in schizophrenia, yet little systematic research on the origins of these functional deficits has been performed. OBJECTIVES: To examine 3 key domains of community functioning--social activity, independent behavior, and functioning in school or work--before first hospitalization for schizophrenia and to determine whether these domains are familial. DESIGN, SETTING, AND PARTICIPANTS: In this population-based, prospective study that included a sibling-control comparison, data from the Israeli National Draft Board Registry were linked with data from the Israeli Psychiatric Hospitalization Case Registry...
January 2016: JAMA Psychiatry
Delbert G Robinson, Nina R Schooler, Majnu John, Christoph U Correll, Patricia Marcy, Jean Addington, Mary F Brunette, Sue E Estroff, Kim T Mueser, David Penn, James Robinson, Robert A Rosenheck, Joanne Severe, Amy Goldstein, Susan Azrin, Robert Heinssen, John M Kane
OBJECTIVE: Treatment guidelines suggest distinctive medication strategies for first-episode and multiepisode patients with schizophrenia. To assess the extent to which community clinicians adjust their usual treatment regimens for first-episode patients, the authors examined prescription patterns and factors associated with prescription choice in a national cohort of early-phase patients. METHOD: Prescription data at study entry were obtained from 404 participants in the Recovery After an Initial Schizophrenia Episode Project's Early Treatment Program (RAISE-ETP), a nationwide multisite effectiveness study for patients with first-episode schizophrenia spectrum disorders...
March 1, 2015: American Journal of Psychiatry
John M Kane, Nina R Schooler, Patricia Marcy, Christoph U Correll, Mary F Brunette, Kim T Mueser, Robert A Rosenheck, Jean Addington, Sue E Estroff, James Robinson, David L Penn, Delbert G Robinson
OBJECTIVE: The premise of the National Institute of Mental Health Recovery After an Initial Schizophrenia Episode Early Treatment Program (RAISE-ETP) is to combine state-of-the-art pharmacologic and psychosocial treatments delivered by a well-trained, multidisciplinary team in order to significantly improve the functional outcome and quality of life for first-episode psychosis patients. The study is being conducted in non-academic (ie, real-world) treatment settings, using primarily extant reimbursement mechanisms...
March 2015: Journal of Clinical Psychiatry
T Scott Stroup, Tobias Gerhard, Stephen Crystal, Cecilia Huang, Mark Olfson
OBJECTIVE: The authors compared the effectiveness of initiating treatment with either clozapine or a standard antipsychotic among adults with evidence of treatment-resistant schizophrenia in routine clinical practice. METHOD: U.S. national Medicaid data from 2001 to 2009 were used to examine treatment outcomes in a cohort of patients with schizophrenia and evidence of treatment resistance that initiated clozapine (N=3,123) and in a propensity score-matched cohort that initiated a standard antipsychotic (N=3,123)...
February 1, 2016: American Journal of Psychiatry
Farnaz Rahmani, Fatemeh Ranjbar, Hossein Ebrahimi, Mina Hosseinzadeh
INTRODUCTION: Family members often play a vital role as caregivers in the lives of individuals with schizophrenia. RESULTS of the studies showed that family invironment is the most important determinint of patients outcomes like as quality of life, relapse, adherence. This study aimed to determine the effect of group psychoeducational programme on attitude towards mental illness in families of patients with schizophrenia. METHODS: In this quasi-experimental study, 74 families who have schizophrenic patients hospitalized in psychiatric wards during sampling were selected by convenience sampling method...
2015: Journal of Caring Sciences
Georgia L Stevens, Gail Dawson, Jacqueline Zummo
AIM: Results from clinical trials support the use of oral antipsychotics for treatment of early or first-episode psychosis in patients with schizophrenia. This paper will review literature on the advantages of early initiation of treatment for schizophrenia and the clinical benefits of early use of long-acting injectable antipsychotics (LAIs). METHOD: A comprehensive literature review was conducted to identify published literature on the use of LAIs early in the treatment of schizophrenia...
October 2016: Early Intervention in Psychiatry
Jan Wolff, Paul McCrone, Anita Patel, Klaus Kaier, Claus Normann
BACKGROUND: Length of stay is a straightforward measure of hospital costs and retrospective data are widely available. However, a prospective idea of a patient's length of stay would be required to predetermine hospital reimbursement per case based on patient classifications. The aim of this study was to analyse the predictive power of patient characteristics in terms of length of stay in a psychiatric hospital setting. A further aim was to use patient characteristics to predict episodes with extreme length of stay...
2015: BMC Psychiatry
Derek K Tracy, Dan W Joyce, S Neil Sarkar, Maria-Jesus Mateos Fernandez, Sukhwinder S Shergill
BACKGROUND: Clozapine is the treatment of choice for medication refractory psychosis, but it does not benefit half of those put on it. There are numerous studies of potential post-clozapine strategies, but little data to guide the order of such treatment in this common clinical challenge. We describe a naturalistic observational study in 153 patients treated by a specialist psychosis service to identify optimal pharmacotherapy practice, based on outcomes. METHODS: Medication and clinical data, based on the OPCRIT tool, were examined on admission and discharge from the national psychosis service...
July 25, 2015: BMC Psychiatry
Ariel Graff-Guerrero, Tarek K Rajji, Benoit H Mulsant, Shinichiro Nakajima, Fernando Caravaggio, Takefumi Suzuki, Hiroyuki Uchida, Philip Gerretsen, Wanna Mar, Bruce G Pollock, David C Mamo
IMPORTANCE: Patients with late-life schizophrenia (LLS) are highly susceptible to antipsychotic adverse effects. Treatment guidelines endorse lower antipsychotic doses. However, the optimal dose of antipsychotics and associated dopamine D2/3 receptor (D2/3R) occupancies remain largely unexplored in patients with LLS. OBJECTIVE: To evaluate effects of antipsychotic dose reduction on striatal dopamine D2/3R occupancies, clinical variables, and blood pharmacokinetic measures in patients with LLS...
September 2015: JAMA Psychiatry
Susan R McGurk, Kim T Mueser, Haiyi Xie, Jason Welsh, Susan Kaiser, Robert E Drake, Deborah R Becker, Edward Bailey, Ginnie Fraser, Rosemarie Wolfe, Gregory J McHugo
OBJECTIVE: Cognitive impairment presents a serious and common obstacle to competitive employment for people with severe mental illness, including those who receive supported employment. This study evaluated a cognitive enhancement program to improve cognition and competitive employment in people with mental illness who had not responded to supported employment. METHOD: In a randomized controlled trial, 107 people with severe mental illness (46% with schizophrenia or schizoaffective disorder) who had not obtained or kept competitive work despite receiving high-fidelity supported employment were assigned to receive either enhanced supported employment (with specialized cognitive training of employment specialists) or enhanced supported employment plus the Thinking Skills for Work program, a standardized cognitive enhancement program that includes practice of computer cognitive exercises, strategy coaching, and teaching of coping and compensatory strategies...
September 1, 2015: American Journal of Psychiatry
Peter J Weiden, Rebecca S Roma, Dawn I Velligan, Larry Alphs, Matthew DiChiara, Brad Davidson
OBJECTIVE: To characterize patterns of communication in the offer of long-acting injectable (LAI) antipsychotic medication made by psychiatrists to patients with schizophrenia by (1) examining the style and content of their interaction and (2) determining how these may have driven the ultimate response to recommendations for LAI therapy. METHOD: This was an observational study conducted at 10 community mental health centers in 3 waves from July 2010 to May 2011...
June 2015: Journal of Clinical Psychiatry
Satyajit Mohite, Ikenna Ngana, Olaoluwa O Okusaga
OBJECTIVES: Despite the high prevalence of cocaine use disorder in schizophrenia, the impact of cocaine on antipsychotic requirement has not been studied in this population. The aim of this study was to evaluate the effect of cocaine on doses of antipsychotic medication prescribed during periods of acute exacerbation of psychotic symptoms in individuals with schizophrenia. METHODS: We reviewed the medical records of individuals with schizophrenia discharged from hospitals between 2008 and 2012...
May 2015: Journal of Addiction Medicine
Deanne T Kashiwagi, M Caroline Burton, Fayaz A Hakim, Dennis M Manning, David L Klocke, Natalie A Caine, Kristin M Hembre, Prathibha Varkey
Factors intrinsic to local practice, but not captured by the medical record, contribute to readmissions. Frontline providers familiar with their practice systems can identify these. The objective was to decrease 30-day hospital readmissions. The intervention involved retrospective review by hospitalists of their own patients' readmissions, using reflective practice guided by a chart review tool. Subjects were patients discharged by hospitalists and readmitted to a tertiary care academic medical center. Hospitalists reviewed 193 readmissions of 170 patients...
May 2016: American Journal of Medical Quality: the Official Journal of the American College of Medical Quality
Maren Carbon, Christoph U Correll
The search for clinical outcome predictors for schizophrenia is as old as the field of psychiatry. However, despite a wealth of large, longitudinal studies into prognostic factors, only very few clinically useful outcome predictors have been identified. The goal of future treatment is to either affect modifiable risk factors, or use nonmodifiable factors to parse patients into therapeutically meaningful subgroups. Most clinical outcome predictors are nonspecific and/or nonmodifiable. Nonmodifiable predictors for poor odds of remission include male sex, younger age at disease onset, poor premorbid adjustment, and severe baseline psychopathology...
December 2014: Dialogues in Clinical Neuroscience
Wing Chung Chang, Gloria Hoi Kei Chan, Olivia Tsz Ting Jim, Emily Sin Kei Lau, Christy Lai Ming Hui, Sherry Kit Wa Chan, Edwin Ho Ming Lee, Eric Yu Hai Chen
BACKGROUND: Numerous early intervention services targeting young people with psychosis have been established, based on the premise that reducing treatment delay and providing intensive treatment in the initial phase of psychosis can improve long-term outcome. AIMS: To establish the effect of extending a specialised early intervention treatment for first-episode psychosis by 1 year. METHOD: A randomised, single-blind controlled trial (NCT01202357) compared a 1-year extension of specialised early intervention with step-down care in patients who had all received a 2-year intensive early intervention programme for first-episode psychosis...
June 2015: British Journal of Psychiatry: the Journal of Mental Science
2015-02-17 16:54:07
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