Diagnosis Of Schizophrenia Spectrum Disorder Research Articles

T216. VARIATION IN SIDE EFFECTS TO ANTIPSYCHOTIC TREATMENT ACROSS SCHIZOPHRENIA SPECTRUM DISORDERS

BackgroundAdverse effects of antipsychotic drugs play a key role in non-compliance and discontinuation of treatment in Schizophrenia Spectrum Disorders (SSD). Precision medicine aims to minimize such adverse effects by selecting the right treatment for the right patients. To determine the need for precision medicine we need to estimate the amount of variation in adverse effects between patients. While clinical experience suggests that such variation is considerable, analyzing how variation differs between treated and untreated patients can answer this question. Here, we hypothesized to find larger variation in treatment compared to control groups of patients treated with second generation antipsychotics.MethodsWe included double-blind, placebo-controlled, randomized trials of adults with a diagnosis of schizophrenia spectrum disorders and prescription for licensed antipsychotic drugs. Means and variances of the pretreatment and posttreatment outcome differences of weight gain, prolactine levels, and corrected QTC times were extracted. Data quality and validity were ensured by following the PRISMA guidelines. The outcome measure was the overall variability ratio of treatment to control across RCTs. Individual variability ratios were weighted by the inverse-variance method and entered into a random-effects model.ResultsWe included N = 13 282 patients for weight gain, N = 11 767 for prolactine levels, and N = 7 203 for QTC time. For all the measured adverse effects, variances were greater in treatment compared to control. Specifically, variance ratios were increased for weight gain (VR = 1.13, 95% CI: 1.06, 1.20), prolactine levels (VR = 1.38, 95% CI: 1.13, 1.68) and QTc time (VR = 1.06, 95% CI: 1.01, 1.12).DiscussionWe found increased variability in the major side effects that patients with SSD had under treatment with second generation antipsychotics. Indeed, some patients were more susceptible than others to weight gain, prolactine level increase, and QTC time increase, suggesting that precision medicine in antipsychotic treatment should be informed by individual differences in side effects rather than treatment effects. Future studies should aim at finding biological predictors of such individual differences in side effects.

T31. TIME TO TALK MENTAL HEALTH IN DUBAI: DESCRIBING A SAMPLE OF ADOLESCENT HELP-SEEKERS ACCESSING MENTAL HEALTH SERVICES

BackgroundMost mental health disorders begin to develop in adolescence and early adulthood. These disorders account for a significant portion of hospitalization and other societal costs. The United Arab Emirates (UAE) has a rapidly growing population, one-third of which is below 25 years of age. The UAE government has pointed at mental health as one of the areas requiring attention and has approved a strategic plan supporting mental health research, education and promotion with a specific focus on youth (Dubai Mental Health Strategy 2021). The current study represents the first investigation aimed at characterizing youth who access mental health services in the UAE (specifically Dubai).MethodsData was collected retrospectively from child psychiatry case records of inpatients who accessed the Mental Health Clinic at Rashid Hospital between 2011–2016. Patients who received a diagnosis of schizophrenia spectrum disorders, bipolar and related disorders, depressive disorders or anxiety disorders were included. From patients’ records, information collected included demographics, life stressors (related to family, friends, health, academic performance, or religion), duration of untreated illness (DUI), family history of mental illness, parents’ age and education, main diagnosis, presence/absence of psychotic features. Demographic information and family history had been acquired from patients and family members at the time of intake.ResultsThe final sample (N=99; Age 12–19) included 47.5% local (UAE national) and 52.5% non-local patients. The frequency of life stressors did not differ across ethnic groups except for relationships with friends, which were less likely to be reported as a source of stress among UAE nationals (χ2=4.35; p=0.04) compared to other nationalities. Suicidal thoughts were less common in patients with psychotic features compared to patients without psychotic features (χ2=4.64; p=0.03). A diagnosis of Depression was more common in females than males (χ2=3.93; p<.05) and was associated with more frequent suicidal thoughts (χ2=23.81; p<0.001) and self-harm behavior (χ2=16.20; p<0.001). Separate ANOVAs were conducted to explore the effect of different variables on DUI: results showed that presence of Psychotic features was associated with shorter DUI (F (1,55) =4.37; p<0.05) while Self-harm was associated with longer DUI (F (1,70) =5.82; p<0.05).DiscussionTo our knowledge, this is the first study attempting to describe youth who access mental health services in the urban multi-cultural context of Dubai. A number of interesting findings were highlighted. Relationships with friends were more likely to represent a source of stress for non-local than local patients, suggesting a possible role of adjustment and social stress in migrant/expatriate youth. Suicidal thoughts were more common in patients diagnosed with depressive disorders (somewhat expected) but less common in patients presenting psychotic features. Patients experiencing psychotic symptoms were accessing mental health services sooner (shorter DUI) compared to patients who did not experience psychotic symptoms, in line with previous literature. Interestingly, patients reporting self-harm behaviors had longer DUI. Several interpretations can be proposed, for example, it is possible that self-harm represented a copying strategy to temporarily “handle” mental illness and delay help seeking in our sample. Studies in support of this and alternative explanations will be discussed. Taken together, our study can be a useful start point to open prevention-focused mental health discussions in the UAE and lead to improved national policies to promote youth wellbeing in the region.

M107. EXPLORING REAL-TIME VARIABILITY IN PSYCHOLOGICAL, PSYCHOPHYSIOLOGICAL, AND BEHAVIOURAL RISK FACTORS FOR AGGRESSION: A NOVEL APPROACH COMBINING ACTIVE AND PASSIVE REMOTE MONITORING

BackgroundMost service users diagnosed with a schizophrenia-spectrum disorder are not aggressive, but this behaviour does occur in inpatient mental health services worldwide. Aggression is difficult to predict and is influenced by a combination of changeable psychological, psychophysiological, and behavioural factors. Current assessment methods are limited to observable behaviours, conducted relatively infrequently, and demonstrate poor predictive accuracy. Advances in active (experience sampling methodology) and passive (wearable psychophysiological sensors) remote monitoring enable monitoring of psychological, psychophysiological, and behavioural parameters in real-time. Monitoring real-time variability in these parameters could identify concerning changes earlier than is currently possible and enable support to be provided sooner. This study aimed to examine real-time variability psychological, psychophysiological, and behavioural factors among an inpatient sample, and relationship with behavioural incidents.MethodsService users (N=40) with a diagnosis of schizophrenia-spectrum disorder and/or antisocial personality disorder were recruited from a medium-secure inpatient forensic mental health service in the UK. Participants completed a blended active and passive remote monitoring study for seven consecutive days. Participants rated 20 psychological and behavioural items at random periods seven times per day, while wearing a passive remote monitoring device which simultaneously collected measurements of electrodermal activity, heart rate variability, and physical activity. Behavioural incidents occurring during the study were recorded from staff-completed behaviour rating scales, and participants’ electronic hospital records. Multi-level models were constructed to examine the role of psychophysiological, psychological, and behavioural factors in predicting behavioural incidents, controlling for covariates such as physical movement and medication.ResultsThe findings demonstrate the within- and between-participant variability in psychological, psychophysiological, and behavioural parameters occurring in real-time, with high ecological validity. Multi-level modelling enabled the predictive ability of these changes in relation to behavioural incidents to be examined, in addition to the timeframe over which this predictive relationship exists.DiscussionTo our knowledge this is the first study to examine real-time change in psychological, psychophysiological, and behavioural parameters in relation to behavioural incidents. This blended active and passive remote monitoring approach can offer a temporally precise method of assessing change in these parameters, which participants regarded as acceptable. This novel method could assist in identifying concerning change in these parameters earlier and delivering timely support for service users experiencing difficulties, which could be explored in future research.

Predicting factors for non-suicidal self-injury in patients with schizophrenia spectrum disorders and the role of substance use.

Non-suicidal self-injury (NSSI) has been shown as a characteristic feature in many clinical populations in recent years and schizophrenia is one of the most common psychiatric disorders which is associated with NSSI. In this study, we aimed to investigate predictors of NSSI in patients with schizophrenia spectrum disorders (SSD) and the role of lifetime substance use disorder (SUD). A sample of 165 patients with a diagnosis of SSD who were in remission participated in the study. Lifetime NSSI was assessed using the Inventory of Statements About Self-injury (ISAS). Lifetime SUD were evaluated. Logistic regression analysis was conducted to predict NSSI. SUD was found to be related to NSSI in patients with SSD, and it was associated with an approximately fourfold increase in the risk of NSSI. The rates of lifetime SUD in our sample and in the NSSI (+) group were 38.2 % and 55.6 %, respectively. The most commonly abused substances among patients with NSSI were cannabis and synthetic cannabinoids. The prevalence of NSSI was 43.6 % in our sample. 'Self-cutting' was the most common type and 'affect regulation' was the most common function of NSSI. One of the most significant risk factors for NSSI was a previous history of suicide attempts. SUD appears to be a significant predictor of NSSI in patients with SSD. Further investigation of treatable risk factors such as SUD which are related to NSSI is needed. It is also essential to screen SSD patients for NSSI due to the probable relation to high risk of suicide.

Improving the "real life" management of schizophrenia spectrum disorders by LAI antipsychotics: A one-year mirror-image retrospective study in community mental health services.

Schizophrenia poses a significant economic burden on the healthcare system as well as it has a significant impact on society at large. Reasons for such a high economic burden of schizophrenia include the frequent relapses and hospitalizations occurring in this disorder. We analyze the effectiveness of long-acting injectable antipsychotics (LAIs) compared to oral medications, in terms of "clinical process management" in a sample of patients with a diagnosis of schizophrenia spectrum disorder treated in community mental health centers. An observational, retrospective, mirror-image study was carried out to evaluate the effectiveness of LAIs compared to oral medications in terms of number of hospitalizations, emergency visits and planned visits on a 10-year period (from July 2007 to June 2017). Differences between first and second generation LAIs were also explored. Our findings show that hospitalization and emergency visits are significantly decreased with the use of LAIs, while planned visits are increased in patients treated with LAIs. Our results suggest that LAIs, in particular, second generation ones, reduce hospitalization rates and emergency visits, improving the economic burden of schizophrenia. Therefore, LAIs should be considered a cost-effective treatment in the management of schizophrenia under routine conditions.

Clinical evolution of patients treated with aripiprazole long-acting injectable: a preliminary, prospective, observational study

Objective: To evaluate the effectiveness of 6-month treatment with aripiprazole long-acting injectable (LAI) in improving psychotic symptoms, social functioning and side effects and reducing co-administered antipsychotic drugs.Methods: Multicentre, observational, prospective study that enrolled 53 patients with diagnosis of schizophrenia spectrum disorders who initiated or switched to aripiprazole LAI. The effectiveness of aripiprazole LAI was assessed through the Positive and Negative Syndrome Scale (PANSS), the Udvalg for Kliniske Undersogelser scale for side effects, the Global Assessment of Functioning and the Clinical Global Impression-Schizophrenia (CGI-SCH).Results: Upon treatment with aripiprazole LAI, patients significantly improved all the domains of PANSS (p < .05). Adverse event severity significantly improved after a 6-month aripiprazole LAI treatment (p < .05). Differences from baseline to month 6 in Global Assessment of Functioning score were significant (p = .0002). The proportion of severely ill patients decreased upon treatment with aripiprazole LAI (CGI-SCH scale). Prolactin levels were normalised after a 6-month treatment (from 43.0 to 14.7 ng/mL). Co-administered antipsychotic drugs significantly decreased after a 6-month treatment with aripiprazole LAI.Conclusion: A 6-month treatment with aripiprazole LAI improved the clinical status of our patients without modifying their metabolic profile, and allowed the reduction of co-administered antipsychotic drugs.Practice implicationsLong-acting injectable antipsychotics are effective treatment options for the maintenance of patients with schizophrenia and related disorders, and to ensure treatment adherence. This study describes the evolution of patients over six months of treatment with aripiprazole long-acting injectable. The results from this study support previous data on the efficacy and safety of this atypical antipsychotic. This study may be of wide interest to the community of psychiatrists and may help clinicians optimise treatment adherence in patients with schizophrenia spectrum disorders.Key pointsAripiprazole long-acting injectable is an atypical antipsychotic intended to improve treatment adherence and prevent relapses.This multicentre prospective study evaluated the effectiveness of aripiprazole long-acting injectable over six months of treatment on the control of a comprehensive set of clinical variables.Clinical rating scales showed that treatment with aripiprazole long-acting injectable improved clinical symptoms and social functioning, and reduced the severity of adverse events.Aripiprazole long-acting injectable contributed to the maintenance of adequate metabolic profiles and the normalisation of prolactin levels.Patients significantly decreased co-administered antipsychotic drugs after 6-month treatment with aripiprazole.

Substance Use Patterns and Schizophrenia Spectrum Disorders: A Retrospective Study of Inpatients at a Community Teaching Hospital.

BackgroundSchizophrenia is one of the chronic mental illnesses, characterized by delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and cognitive decline. It frequently leads to a lifetime of impairment and disability that span the entire lifespan of the patients. Several epidemiologic studies have shown that schizophrenia spectrum disorders (SSDs) contribute significantly to years lived with disability. Additionally, substance use disorders have been reported to co-occur commonly among patients with SSD (a comorbidity also known as dual diagnosis), attracting notable attention over the past few decades. This dual diagnosis often requires treatment modifications to ensure for best patient outcomes.MethodsThis study was a retrospective review of the electronic medical charts. The patients included in the study were discharged from the psychiatric unit of our hospital between July 1, 2017 and October 31, 2017. Patients were included in the study using three inclusion criteria: 1) age ≥18 years; 2) had a diagnosis of SSD at discharge; and 3) had urine drug screen performed. Sociodemographic and clinical variables were abstracted. Univariate analysis and summary statistics were performed. Bivariate and multivariate analyses were done via logistic regression models to determine the odds ratios (ORs) and corresponding P values (P).ResultsA total of 365 (52.2%) patients had a diagnosis of SSD at discharge. Of these, 349 met the inclusion criteria. The age ranged from 19 to 79 years, with a mean age of 42.2 years, and 76.8% of the patients used substances. Out of the 269 patients who used substances, 199 (74%) used two or more substances. Tobacco use was most prevalent (62.3%), followed by cannabis use (41.5%), alcohol use (40.2%), and cocaine use (27.4%). Patients who reported using tobacco, were more likely to have comorbid alcohol use (OR = 7.24; P = 0.000), cannabis use (OR = 2.80; P = 0.000), cocaine use (OR = 5.00; P = 0.000), and synthetic cannabis (K2) use (OR = 4.62; P = 0.048). Results of the multivariate analyses supported the other findings.ConclusionsOur study found a high association between schizophrenia spectrum disorders and substance use, with three out of four patients with SSD using a substance. This prevalence is higher than previously reported by other studies. Among those who use substances, about three in four use multiple substances. These point to some interaction between the substances and appear to be heavily influenced by significant social determinants of mental health that continue to plague the community. It is important to establish if a patient with schizophrenia has a comorbid substance use disorder, because addressing both generally leads to better patient outcomes.

Schizophrenia and other psychotic disorders in ICD-11 and DSM-5: evolution of the concepts and current status

The concepts of schizophrenia and other primary psychotic disorders have been changed a lot since their beginnings more than century ago due to many factors such as the dominance of a certain hypothesis during a particular period of time, the development of new clinical research and specific treatments as well as different understanding of the boundaries between mental disorders. It was appeared the diagnosis of schizophrenia spectrum disorders which still based only on clinical symptoms. Whether psychotic disorders can be better represented dimensionally or categorically remains a challenging question. Regarding schizophrenia and other primary psychotic disorders, there are some important changes in DSM-5 and ICD-11 concerning the use of quantitative assessment of psychopathological domains, course of psychosis and remission as well as giving more attention to cognitive issues. The main differences between these classifications are the structure of corresponding sections and different criteria of some disorders. Before the ICD-11 implementation in 2022 into clinical practice, it is highly recommended to conduct a set of trainings for clinicians along with the comments to Diagnostic guidelines for Schizophrenia and other primary psychotic disorders.

Rates and Predictors of Relapse in First-Episode Psychosis: An Australian Cohort Study

Abstract Background Clinical and functional recovery is usually achieved after treatment for a first episode of psychosis (FEP). Unfortunately, subsequent relapse remains common, occurring within a year for approximately 30% of individuals and up to 80% over 5 years. Factors that make relapse more likely in any given individual remain poorly understood. Methods This article presents a naturalistic cohort study of young people (15–24 years old) accessing an early intervention in psychosis service in Melbourne, Australia between January 1, 2011 and December 31, 2016. Demographic and clinical predictors of relapse were collected and analyzed using Cox regression analysis. Results A total of 1220 young people presented with an FEP during the study period; 37.7% (N = 460) experienced at least 1 relapse during their episode of care. Over half of all relapses resulted in an admission to hospital. Non-adherence to medication, substance use, and psychosocial stressors were commonly noted as clinical precipitants of relapse. Significant predictors of relapse (vs no relapse) were a diagnosis of schizophrenia spectrum disorder (adjusted hazard ratio [aHR] = 1.62) or affective psychotic disorder (aHR = 1.37), lifetime amphetamine use (aHR = 1.48), and any substance use during treatment (aHR = 1.63). Conclusion These findings suggest that relapse occurs frequently for young people who have experienced FEP. This is one of the first studies to report that amphetamine use (predominantly illicit methamphetamine) increases the risk of relapse. Clinical services, especially in Australasia, need to consider how best to manage this comorbidity in young people with FEP.

Relación entre funcionamiento cognitivo y el perfil sintomático con la calidad de vida de pacientes con trastornos del espectro de la esquizofrenia

Objective: To evaluate the association of psychopathological symptoms and cognitive functioning with the measures of subjective quality of life of a group of patients diag¬nosed with the schizophrenia spectrum. Methodology: The study included 102 outpatients who met the DSM-IV-TR criteria for the diagnosis of schizophrenia spectrum disorders. The data were obtained by means of the Seville Questionnaire of Quality of Life (CSCV), the scale for the positive and negative schizophrenia syndrome (PANSS), the Beck Depression Inventory (BDI) as well as the state-trait Anxiety Inventory (STAI). Results: The multiple regression analysis showed, on one hand, that favorable aspects of quality of life are affected by cognitive disorganization, positive, depressive and anxiety symptoms. On the other hand, the presence of emotional symptoms is strongly associated with unfavorable aspects, which suggests that this symptomatic dimension impairs the subjective perception of well-being of patients with schizophrenia spectrum disorders. Conclusions: Psychopathological symptoms and cognitive function affect the subjective quality of life in patients with schizophrenia. If the aim of the treatment is to improve the perceived quality of life, the strategies should consider seeking the improvement symptoms of an emotional nature, such as depression / anxiety and emotional distress.

Cannabis Use in Inpatients With Schizophrenia Spectrum Disorders at a Community Hospital.

BackgroundCannabis is the second most used recreational drug in the United States and one of the most used substances in patients with schizophrenia spectrum disorder (SSD). Unfortunately, the increased use is likely to continue as more states legalize recreational use of cannabis. Although the association between cannabis and schizophrenia has been studied extensively, the understanding of the relationship is still evolving. In this study, we sought to determine the prevalence and potential factors associated with cannabis use (CU) among inpatients with SSD at a community teaching hospital.MethodsWe performed a retrospective review of the electronic medical charts of patients discharged from the psychiatric unit of our hospital from July 1, 2017 through October 31, 2017. Patients were included in this study if: 1) They were ≥ 18 years old; 2) They had discharge diagnosis of SSD; and 3) They had urine drug testing performed. Pertinent sociodemographic and clinical variables, including substance use status and hospital length of stay (LOS), were abstracted. Univariate frequencies and summary statistics were performed. Odds ratios (ORs) were determined by logistic regression analysis of bivariate and multivariate analyses.ResultsThree hundred sixty-five (52.2%) patients had a discharge diagnosis of SSD, and only 322 had urine toxicology result for cannabinoids and were included in analysis. Of the 322 patients, 41.5% (n = 133) screened positive for cannabinoids. Of the 133 patients, 78% were African American, 15% were Hispanic and 5% were White; 77% were male and the median age was 36 years. Bivariate analyses showed tobacco use (OR: 2.8, 95% confidence interval (CI): 1.7 - 4.6), alcohol use (OR: 3.4, 95% CI: 2.9 - 7.0), younger age (OR: 2.8, 95% CI: 1.8 - 4.5), male gender (OR: 2.9, 95% CI: 2.2 - 3.2), unemployment (OR: 3.91, 95% CI: 3.49 - 7.35), homelessness (OR: 3.18, 95% CI: 2.76 - 3.84) and LOS (OR: 3.46, 95% CI: 2.93 - 4.31) were significantly associated with CU. Result of multivariate analysis was similar to that found in bivariate analysis.ConclusionsCU appears to be prevalent among patients with SSD. Clinicians and public health professionals are encouraged to understand the health implications of its use in patients with mental illness especially against the backdrop of current marijuana laws.

Basic self-disorders in adolescence predict schizophrenia spectrum disorders in young adulthood: A 7-year follow-up study among non-psychotic help-seeking adolescents

Background and goalsRecent studies indicate that basic self-disorder (SD) is a core clinical phenotype of schizophrenia and its spectrum. The goal of the present study was to test the degree to which SD characterizes the pre-onset phase of schizophrenia-spectrum disorders (SSD). A secondary goal was to replicate previous findings regarding the long-term stability of SD. MethodTo accomplish these goals, the long-term association of SD in adolescence with SSD seven years later was examined in a sample of 39 non-psychotic, help-seeking adolescents. SD was assessed with the Examination of Anomalous Self-Experience (EASE), and presence of schizophrenia-spectrum and other co-morbid illnesses in young adulthood was assessed with the Operational Criteria+ (OPCRIT+) checklist for psychotic and affective disorders. ResultsNine (23.1%) of the 39 participants were diagnosed as suffering from SSD (three Schizophrenia, three non-organic and non-affective psychotic disorder, and three schizotypal disorder) in young adulthood. A diagnosis of SSD in young adulthood was significantly predicted by SD, but not by prodromal symptoms in adolescence. The correlation between the EASE total score at adolescence and young adulthood was moderate and significant (r = 0.64, p < .001). ConclusionsThese results provide first long-term prospective support, in a sample not enriched for risk for psychosis, for the possibility that SD is a clinical marker of risk for SSD. Also, they provide additional support for the longitudinal persistence of SD over time.

Association of physical health multimorbidity with mortality in people with schizophrenia spectrum disorders: Using a novel semantic search system that captures physical diseases in electronic patient records

ObjectiveSingle physical comorbidities have been associated with the premature mortality in people with schizophrenia-spectrum disorders (SSD). We investigated the association of physical multimorbidity (≥two physical health conditions) with mortality in people with SSD. MethodsA retrospective cohort study between 2013 and 2017. All people with a diagnosis of SSD (ICD-10: F20–F29), who had contact with secondary mental healthcare within South London during 2011–2012 were included. A novel semantic search system captured conditions from electronic mental health records, and all-cause mortality were retrieved. Hazard ratios (HRs) and population attributable fractions (PAFs) were calculated for associations between physical multimorbidity and all-cause mortality. ResultsAmong the 9775 people with SSD (mean (SD) age, 45.9 (15.4); males, 59.3%), 6262 (64%) had physical multimorbidity, and 880 (9%) died during the 5-year follow-up. The top three physical multimorbidity combinations with highest mortality were cardiovascular-respiratory (HR: 2.23; 95% CI, 1.49–3.32), respiratory-skin (HR: 2.06; 95% CI, 1.31–3.24), and respiratory-digestive (HR: 1.88; 95% CI, 1.14–3.11), when adjusted for age, gender, and all other physical disease systems. Combinations of physical diseases with highest PAFs were cardiovascular-respiratory (PAF: 35.7%), neurologic-respiratory (PAF: 32.7%), as well as respiratory-skin (PAF: 29.8%). ConclusionsApproximately 2/3 of patients with SSD had physical multimorbidity and the risk of mortality in these patients was further increased compared to those with none or single physical conditions. These findings suggest that in order to reduce the physical health burden and subsequent mortality in people with SSD, proactive coordinated prevention and management efforts are required and should extend beyond the current focus on single physical comorbidities.

A Comprehensive Cohort Description and Statistical Grouping of Community-Based Residential Rehabilitation Service Users in Australia.

Background: Community Care Units (CCUs) are a model of community-based residential rehabilitation support available in Australia that assists people affected by severe and persistent mental illness to enhance their independent living skills and community involvement. These services have been subject to limited evaluation, and available descriptions of consumer cohorts lack relevance to the understanding of their rehabilitation needs. Method: A clinical assessment battery covering a broad range of relevant domains was completed with consumers commencing at three CCUs in Queensland, Australia, between December 2014 and December 2017 (N = 145). The cohort was described based on demographic, diagnostic, treatment-related variables, and the assessment battery. The comparability of included sites was assessed. This contemporary cohort was also compared to the pooled cohort of Australian community-based residential rehabilitation services emerging from a previous systematic review. Additionally, cluster analysis (CA) was completed in two stages based on the clinician-rated assessments: hierarchical CA (Wards method) to identify the optimal number of clusters, followed by K-means clustering. Results: Dominant features of the cohort were male sex and the primary diagnoses of schizophrenia spectrum disorders. The average consumer age was 31.4 years. Most consumers were referred from the community, had been living with family, and were not subject to involuntary treatment orders. No site-based differences were observed on demographic, diagnostic and treatment-related variables. However, some site-based variation in levels of symptoms and functional impairment emerged. Overall, the cohort was comparable with the Transitional Residential Rehabilitation (TRR) cohort defined in a previous systematic review. Through CA, a three-cluster solution emerged: Cluster 1 (15%) was characterised by higher levels of substance use comorbidity; Cluster 2 (39%) was characterised by higher levels of disability and symptoms; and Cluster 3 (46%) was distinguished by lower levels of general psychiatric symptoms. Conclusions: The cohort was generally comparable to the TRR cohort. Site-based variability in the characteristics of admitted consumers was minimal. The CA solution suggested that three different sub-groups of consumers are admitted to CCUs, which have implications for adapting the approach to rehabilitation. Recommendations include ensuring early availability of interventions to address co-morbidities and pacing rehabilitation expectations to consumers stage of recovery.

Investigation of a traumatic psychosis subgroup: a cluster analysis of an antipsychotic free cohort.

ABSTRACTChildhood trauma is linked to an increased risk of developing psychosis in adulthood. The extent and severity of trauma experienced is known to correlate with the intensity or presence of specific psychotic symptoms. The relative impact of types of abuse and neglect (sexual, physical, emotional) is unknown. Cluster analysis was used to create natural groupings of similarity based on Childhood Trauma Questionnaire Scores (CTQ) in a sub-sample of 51 anti-psychotic-free patients with diagnoses of Schizophrenia Spectrum Disorders from the ACTION trial. The derived clusters were compared on the Positive and Negative Syndrome Scale (PANSS) scores. Two clusters emerged: one characterized by abuse and the other by neglect. The abuse group was found to have significantly higher positive symptoms scores (p < 0.05). This is the first investigation of this concept in an un-medicated cohort that distinguished between trauma types using natural groupings in the data, and therefore, a more ecologically valid means of exploring the existence of a traumatic psychosis subgroup.

Evaluation of Differences in Individual Treatment Response in Schizophrenia Spectrum Disorders

An assumption among clinicians and researchers is that patients with schizophrenia vary considerably in their response to antipsychotic drugs in randomized clinical trials (RCTs). To evaluate the overall variation in individual treatment response from random variation by comparing the variability between treatment and control groups. Cochrane Schizophrenia, MEDLINE/PubMed, Embase, PsycINFO, Cochrane CENTRAL, BIOSIS Previews, ClinicalTrials.gov, and World Health Organization International Clinical Trials Registry Platform from January 1, 1955, to December 31, 2016. Double-blind, placebo-controlled, RCTs of adults with a diagnosis of schizophrenia spectrum disorders and prescription for licensed antipsychotic drugs. Means and SDs of the Positive and Negative Syndrome Scale pretreatment and posttreatment outcome difference scores were extracted. Data quality and validity were ensured by following the PRISMA guidelines. The outcome measure was the overall variability ratio of treatment to control in a meta-analysis across RCTs. Individual variability ratios were weighted by the inverse-variance method and entered into a random-effects model. A personal element of response was hypothesized to be reflected by a substantial overall increase in variability in the treatment group compared with the control group. An RCT was simulated, comprising 30 patients with schizophrenia randomized to either the treatment or the control group. The different components of variation in RCTs were illustrated with simulated data. In addition, we assessed the variability ratio in 52 RCTs involving 15 360 patients with a schizophrenia or schizoaffective diagnosis. The variability was slightly lower in the treatment compared with the control group (variability ratio = 0.97; 95% CI, 0.95-0.99; P = .01). In this study, no evidence was found in RCTs that antipsychotic drugs increased the outcome variance, suggesting no personal element of response to treatment but instead indicating that the variance was slightly lower in the treatment group than in the control group; although the study cannot rule out that subsets of patients respond differently to treatment, it suggests that the average treatment effect is a reasonable assumption for the individual patient.

Filters in the coping process of people with schizophrenia: A constructivist grounded theory study.

WHAT IS KNOWN ON THE SUBJECT?: In the nursing perspective of Roy's adaptation model, to be adapted means to have positive interactions with one's environment. The ability to use effective coping strategies is an essential ingredient of mental health recovery. However, coping difficulties are often a problem for people with a diagnosis of schizophrenia spectrum disorder, especially those who have inadequate social support. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: "Filters in the coping process" is a grounded theory of coping in people with a diagnosis of schizophrenia spectrum disorder. A filter effect impairs their ability and limits their opportunities to use effective coping strategies. These filters are as follows: to have been helped, to understand in one's own way, to act despite limited freedom and to modulate the process of self-disclosure. "Surface coping" is the product of the effect of these filters on coping attempts and possibilities. It does not reflect the person's real potential. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: By offering an alternative, holistic nursing perspective, the filter model provides the nurse with factors to consider when assessing clients with a diagnosis of schizophrenia spectrum disorder, so as to plan interventions towards improving their coping capacity. By allowing for the presence of surface coping, the nurse will have less tendency to form negative judgments about clients with a diagnosis of schizophrenia spectrum disorder. ABSTRACT: Introduction Numerous studies confirm the coping difficulties of people diagnosed with schizophrenia spectrum disorder, especially those with limited social support. Further, the coping process is itself poorly understood. Aim Starting from a conceptualization of the adaptation of Roy's model, the aim of this study was to describe the coping process of people with schizophrenia spectrum disorder in the context of an inadequate social support. Method A constructivist grounded theorization was performed with a sample of 30 persons with schizophrenia spectrum disorder. Results The results are a model named: "Filters in the coping process of people with a diagnosis of schizophrenia spectrum disorder who have inadequate social support." The type of coping strategies used evolves over time and in accordance with the filters. The consequence of the process is "surface coping." Discussion The coping potential of people with schizophrenia spectrum disorder is affected by environmental factors as well as factors inherent to the disorder itself. The filter model provides a holistic perspective, as opposed to merely focusing on behaviours. Implication for practice The findings of this study could improve nursing interventions through a better understanding of impediments to coping: what they are, how they arise and the nature of their effects.

Examining the independent and joint effects of molecular genetic liability and environmental exposures in schizophrenia: results from the EUGEI study.

Schizophrenia is a heritable complex phenotype associated with a background risk involving multiple common genetic variants of small effect and a multitude of environmental exposures. Early twin and family studies using proxy-genetic liability measures suggest gene-environment interaction in the etiology of schizophrenia spectrum disorders, but the molecular evidence is scarce. Here, by analyzing the main and joint associations of polygenic risk score for schizophrenia (PRS-SCZ) and environmental exposures in 1,699 patients with a diagnosis of schizophrenia spectrum disorders and 1,542 unrelated controls with no lifetime history of a diagnosis of those disorders, we provide further evidence for gene-environment interaction in schizophrenia. Evidence was found for additive interaction of molecular genetic risk state for schizophrenia (binary mode of PRS-SCZ above 75% of the control distribution) with the presence of lifetime regular cannabis use and exposure to early-life adversities (sexual abuse, emotional abuse, emotional neglect, and bullying), but not with the presence of hearing impairment, season of birth (winter birth), and exposure to physical abuse or physical neglect in childhood. The sensitivity analyses replacing the a priori PRS-SCZ at 75% with alternative cut-points (50% and 25%) confirmed the additive interaction. Our results suggest that the etiopathogenesis of schizophrenia involves genetic underpinnings that act by making individuals more sensitive to the effects of some environmental exposures.

A Sociodemographic Profile of Asian Americans Served in Community Mental Health Centers for a Diagnosis of Schizophrenia Spectrum Disorder.

Little is known about Asian Americans treated for serious psychiatric disorders in the public mental health system. We characterized 75 Asian Americans seen at community mental health centers for a diagnosis of schizophrenia spectrum disorder to anticipate likely clients and gain insights into their service needs. Participants completed in-person interviews and self-report questionnaires on their demographic and social characteristics. The ethnically diverse sample featured mostly foreign-born individuals with long-standing schizophrenia. Findings highlighted participants' differential experience of social adversities and stressful events, but also revealed salient cultural resources that shielded some from the social sequelae of schizophrenia. Recovery-oriented mental health programs staffed by culturally and linguistically compatible providers remain key to engaging this marginalized population in service. Findings also uphold a holistic management of schizophrenia spectrum disorder among racial and ethnic minorities, taking into account the complex social needs of afflicted individuals.

Metaphor framing and distress in lived-experience accounts of voice-hearing

ABSTRACTThis paper explores the potential role of metaphor as a signal and determinant of distress in first-person accounts of voice-hearing by people with schizophrenia diagnoses. The degree of distress experienced by voice-hearers depends, amongst other factors, on voice-hearers’ perceptions of the “power” of the voices, and on the extent to which the voices can control or be controlled by the person. Metaphors are well known to both reflect and reinforce particular ways of making sense of subjective and sensitive experiences, including in terms of attributions of agency, power and control.Metaphors were systematically identified and analysed in semi-structured interviews with 10 voice-hearers with diagnoses of schizophrenia-spectrum disorders. Divergent uses of metaphors framed the experience of voice-hearing in distinctive ways and were found to have different implications for perceptions of mutual power and control between voice-hearer and voices. Participants who used metaphors in which they are in disempowered positions tended to report higher level of distress, while participants who used metaphors in ways that constructed them as empowered tended to report lower levels of distress. It is argued that metaphor analysis can be usefully added to well-established approaches to both understanding and addressing distress in voice-hearers.