Glasgow Antipsychotic Side-effect Scale Research Articles

Treatment of schizophrenia evaluated via the pharmacopsychometric triangle—An integrative approach with emphasis on well-being and functioning

Quantification of treatment response is crucial to optimize outcomes for patients with schizophrenia. In this study, we evaluated the relationship between quantitative measures of clinician-rated symptom severity and self-rated side effects, well-being, and functioning among inpatients with schizophrenia using the six-item version of the Positive and Negative Syndrome Scale (PANSS-6), the Glasgow Antipsychotic Side-effect Scale (GASS), the WHO-Five Well-being Index (WHO-5), and the Sheehan Disability Scale (SDS). All measurements were conducted as close to admission and discharge as possible. Well-being and functioning were found to be most strongly associated with the additive effect of symptoms and side effects, while changes in side effects, well-being, and functioning appeared to be relatively independent from changes in symptom severity. The use of both symptom and side effect measures should inform clinical decision-making in the treatment of schizophrenia, as it has the potential to optimize functioning and well-being.

Exploring Personal Recovery in Schizophrenia: The Role of Mentalization.

Recovery is a broadly debated concept in the field of psychiatry research and in schizophrenia. Our study aims to understand the correlation between personal recovery from schizophrenia and factors such as mentalization, disability, quality of life, and antipsychotic side effects; Methods: Participants with schizophrenia (according to DSM-5 criteria) were consecutively recruited from the Psychiatry Unit of the University of Catania, Italy. Participants were assessed with the Recovery Assessment Scale (RAS), the Multidimensional Mentalizing Questionnaire (MMQ), the brief version of the WHO Disability Assessment Schedule (WHO-DAS), the EuroQoL-5 dimensions-5 levels, the Insight Orientation Scale (IOS) and the Glasgow Antipsychotic Side Effect Scale (GASS); Results: 81 patients were included. Our findings showed a positive correlation between RAS total scores and MMQ scores, especially in "good mentalizing" subdomains. IOS scores also had a positive association with RAS and MMQ scores. In contrast, poor mentalizing abilities negatively correlated with WHO-DAS 2.0 scores. While antipsychotic side effects influenced functioning, they did not impact perceived recovery. Conclusions: The study's results identified potential predictors of personal recovery from schizophrenia. These findings could contribute to creating tailored interventions to facilitate the recovery process.

Severity in schizophrenia patients receiving atypical antipsychotic medications.

Atypical antipsychotic drugs are nowadays the mainstay of treatment of schizophrenia due to their lesser extrapyramidal symptoms (EPS) as adverse effects. However, these drugs have different profiles of adverse drug reactions (ADRs). Here, the objective of this study was to analyze the probability, occurrences, and more significant involvement of various risk factors. A prospective observational study was carried out on a patient with schizophrenia who has prescribed atypical antipsychotic drugs for their treatment. The probability of the ADR was analyzed by using the Naranjo causality assessment scale. While Glasgow antipsychotic Side effect Scale (GASS) was used to estimate the severity of side effects. Statistical software for social science (SPSS) ver 25; was used for different descriptive statistics and chi-square analysis. A total of 140 patients were included in the study of which the majority (58.57 %) was male. However, atypical antipsychotic drugs were primarily prescribed to the patient as mono therapy (81.43 %). Interestingly, COVID-19 infections were reported as positive in 39.29 % of total patients. Probability assessment of ADRs revealed that most (55 %) were "Probable". Subsequently, the GASS score was evaluated for severity, the majority (55.71 %) were reported as "Mild". The statistically significant association between gender and severity of side effects & duration of illness and severity of side effects were found (P>0.5).The Present study aids in knowing the risk factors and improving the management practices of ADR, thereby improving the guidelines in terms of safe clinical approaches for psychiatric patients.

Validation of the Glasgow Antipsychotic Side-Effect Scale (GASS) in an Italian Sample of Patients with Stable Schizophrenia and Bipolar Spectrum Disorders.

Antipsychotics are a class of psychotropic drugs that improve psychotic symptoms and reduce relapse risk. However, they may cause side effects (SE) that impact patients’ quality of life and psychosocial functioning. Therefore, there is a need for practical tools to identify them and possibly intervene. The objective of the present study was to translate into Italian the Glasgow Antipsychotic Side Effect Scale (GASS), which is suggested as the questionnaire of choice to collect SE reported by patients treated with antipsychotics. We administered the GASS and the Udvalg for Kliniske Undersøgelser (UKU) SE scale—which is considered the gold standard—to 100 stable patients with schizophrenia and bipolar spectrum disorders. We measured the structural validity, internal consistency, concurrent criterion validity, construct validity, and clinical feasibility. GASS was characterized by modest structural validity and good internal consistency. The binary correlations concerning the presence of specific symptoms investigated with the GASS and the UKU were strong or relatively strong for only half of them. The GASS total scale score was inversely related to patients’ quality of life and psychosocial functioning. The GASS is useful to briefly assess the burden of antipsychotic SE (~5 min) but is not optimal in identifying them.

Clozapine Once-Daily Versus Divided Dosing Regimen: A Cross-sectional Study in Japan.

Clozapine is generally recommended to be prescribed in a divided dosing regimen based on its relatively short plasma half-life. However, there has been little evidence to support the superiority of divided dosing of clozapine over once-daily dosing. To our knowledge, there have been no studies examining differences in actual plasma concentrations or adverse effects between the 2 dosing strategies of clozapine. We aimed to compare actual plasma concentrations of clozapine between once-daily and divided dosing regimens, and to examine the relationships of these regimens with psychiatric symptoms and adverse effects of clozapine. We analyzed data from 108 participants of a previous study conducted in 2 hospitals in Japan. A population pharmacokinetic model was used to estimate the peak and trough plasma concentrations of clozapine based on actual plasma concentrations. We evaluated psychiatric symptoms with the Brief Evaluation of Psychosis Symptom Domains and adverse effects of clozapine with the Glasgow Antipsychotic Side-effects Scale for Clozapine. The estimated peak and trough plasma concentrations of clozapine did not differ significantly between once-daily and divided dosing regimens. There were no significant differences in psychiatric symptoms except for depression/anxiety or subjective adverse effects of clozapine between the 2 dosing strategies. Our findings tentatively support the feasibility and clinical utility of once-daily dosing of clozapine in clinical practice. Further studies are needed to replicate these findings and determine causality between dosing strategies and clinical outcomes.

Clozapine Management in Schizophrenia Inpatients: A 5-Year Prospective Observational Study of Its Safety and Tolerability Profile.

BackgroundClozapine is well known for its efficacy and clinical superiority compared to other antipsychotics in treatment-resistant schizophrenia (TRS). However, it is frequently underutilized worldwide because of its acute adverse events, as well as for its long-term cardiometabolic and hematological consequences.ObjectiveThe aim of the study was to evaluate 5-year safety in chronic TRS inpatients with continuous clozapine use.MethodsPatients with TRS and clozapine treatment were evaluated for 5 years. All participants were assessed using the Brief Psychiatric Rating Scale (BPRS), Glasgow Antipsychotic Side-effect Scale for Clozapine (GASS-C), Social Performance Scale (PSP) and Short Portable Mental Status Questionnaire (SPMSQ). Clinical, cardiometabolic and hematological data were collected periodically. General linear models (GLM) repeated measures controlling for CLZ dose were utilized to determine differences in variables across the time.ResultsOverall, 189 inpatients were screened for study participation. The final sample included twenty-one TRS patients (16 males, 76%) with an average age of 57.6 years, all with 5-year continuous use of clozapine (mean dose 266 mg/day). There was not a significant effect of time on BPRS (p=0.774), PSP (p=0.855) and SPMSQ (p=0.066); differences remained not significant after controlling for CLZ dose (p=0.585, p=0.467 and p=0.105, respectively). No changes were found in blood and clinical parameters except for red blood cell count, which decreased over time (p=0.024; η2= 0.952). Patients reported a significant BMI decrease (−8.98 kg, p=0.008) between baseline and 5 years last observation.ConclusionThe findings show how the application of a structured dietary, clinical and therapeutic monitoring program in psychiatric care facilities could allow the safe and effective long-term cardiometabolic and hematological management of clozapine. The unique role that clozapine plays in the current treatment of patients with TRS requires greater clinical awareness. Although its acute and chronic side effects are notorious, its safety management is feasible and broadens its potential practical application.

Monitoring side-effects of antipsychotics using the glasgow antipsychotic side-effect scale

AimsAntipsychotic drugs frequently produce side-effects which represent common reasons for noncompliance. National guidelines, published by the National Institute of Care and Health Excellence, the Royal College of Psychiatrists, and the Maudsley Prescribing Guidelines in Psychiatry, stipulate that patients prescribed antipsychotic drugs should be reviewed for side-effects on a weekly basis. This completed audit cycle, conducted on a mixed acute general adult psychiatric ward, examined whether patients were being assessed for side-effects of antipsychotic drugs using a standardised, self-reporting scale – the Glasgow Antipsychotic Side-effect Scale (GASS) – as per national guidelines. As identification of side-effects is important in tailoring treatment to improve compliance, auditing monitoring practice was important in realising these outcomes.MethodRetrospectively, 26 inpatients were identified over a two-month period who were prescribed antipsychotic drugs. Their notes were reviewed for documented weekly GASS scores for the duration of antipsychotic treatment. Initial data demonstrated 0% compliance with guidelines, as no patients completed a weekly GASS. The intervention to improve compliance was a training session for ward staff on implementing the GASS. Data were subsequently collected prospectively over three weeks for 15 patients.ResultSeven patients completed the GASS weekly over three weeks, representing 47% compliance. Two patients (13%) completed two forms, three (20%) completed one form, and three (20%) completed no forms. There was a positive correlation between being offered the GASS and completing it – only one patient declined to complete it and was not offered it during the third week. Of the remaining 14 patients, if the GASS was offered there was 100% rate of completion. Staff did not offer the GASS to every patient each week, which accounted for most cases of non-completion. Some patients with pre-existing symptoms of physical illnesses included these on the GASS, which complicated interpretation. Future interventions could include further staff education, and involving a ward pharmacist to review results during medication reviews to optimise treatment compliance, as no medication changes resulted directly from patients completing the GASS.ConclusionCompliance with completing the GASS weekly improved following staff education, identifying the main factor affecting compliance as staff not offering the GASS to patients. Patients generally engaged well with side-effect monitoring, as most completed the GASS when offered. Further staff education may produce even greater compliance with guidelines, and involving pharmacy staff to review GASS scores and inform medication choices may lead to use of the GASS resulting in more tolerable and effective treatment plans.

GASS-tly side effects: antipsychotic monitoring for inpatients across NHS Lanarkshire

AimsBest practice in the prescribing of antipsychotic therapy includes monitoring for medication side effects. National guideline SIGN 131 advises the use of a validated side effect scale, for example the Glasgow Antipsychotic Side-effect Scale (GASS). Local recommendation in NHS Lanarkshire advises that patients prescribed antipsychotic therapy should be offered GASS at each contact and after initiation or titration. We aimed to improve compliance with antipsychotic side effect monitoring for inpatients in general adult psychiatry across two hospital sites in NHS Lanarkshire.MethodWe conducted a full-cycle audit. In October 2020, we took a cross-sectional sample of inpatients in general adult psychiatry in University Hospital Hairmyres and University Hospital Wishaw who were prescribed antipsychotic therapy for a functional psychotic disorder. For these inpatients, if applicable, we identified whether GASS had been completed on admission (OA), whether GASS had been completed after initiation or titration of antipsychotic therapy (I/T), and whether GASS had been acknowledged and discussed at consultant-led multi-disciplinary team meeting (MDT). Thereafter, we implemented several targeted interventions in order to improve compliance. In January 2021, we completed the cycle by taking a new cross-sectional sample of inpatients fulfilling identical parameters.ResultFirst cycle in October 2020 (n = 27) showed compliance OA of 4.2%, I/T of 9.5%, and MDT of 3.7%. Our interventions included a presentation at trust-wide clinical governance meeting; a presentation at one of the weekly departmental teaching sessions in psychiatry; an email summarising the audit to consultants in general adult psychiatry; meetings with senior charge nurses for each ward; and inclusion of GASS as part of routine admission paperwork. Re-audit in January 2021 (n = 23) showed compliance OA of 11.1%, I/T of 40.0%, and MDT of 21.7%.ConclusionOur full-cycle audit led to modest improvement in documented monitoring for antipsychotic side effects. There was relatively greater improvement in prescriber-led outcomes I/T and MDT, suggesting increased prescriber awareness. However, rather than reliance on individual prescribers to ensure compliance, consideration of GASS alongside monitoring of other physical health parameters would likely result in greater and more sustained improvement. In NHS Lanarkshire there is ongoing work to this end, ultimately with the intention to set up a defined antipsychotic physical health monitoring schedule, integrated across inpatient and community care.

Improving baseline and follow-up physical health monitoring when commencing oral antipsychotics

AimsNICE guidelines suggest baseline physical health monitoring be performed prior to commencing antipsychotics, in addition to follow-up monitoring for adverse effects for at least 12 months. ‘Shared Care Guidelines’ were adapted from NICE guidance for local use in North East Lincolnshire. Nevertheless, a local audit published in 2018 reported low compliance with baseline monitoring in community mental health teams (CMHTs) compared to inpatient teams. The parameter most infrequently performed overall was the Glasgow Antipsychotic Side Effect Scale (GASS) questionnaire.This study aimed to assess whether compliance with baseline physical health monitoring had improved in line with the previous audit's recommendations. Additionally, it aimed to expand on previous findings by adding compliance data for follow-up physical health checks and produce further recommendations to optimise performance.MethodA retrospective re-audit was performed in NAViGO Health and Social Care to assess compliance with the guidelines for physical health monitoring when commencing antipsychotics in previously antipsychotic-naïve patients. Patient records were examined for which recommended physical health checks were performed at baseline, and at 1-, 3- and 6- months from commencing antipsychotics.Result15 eligible patients were identified to have been commenced on antipsychotics, 8 patients under a CMHT and 7 under an inpatient team. The average overall compliance at baseline for checking 16 parameters was 50%. For the CMHT, compliance was 60%, compared to 38% for the inpatient team. Across both teams, baseline compliance was highest for renal function tests, liver function tests, and blood pressure and pulse (80%). For 1-, 3-, and 6- month checks, overall compliance for checking recommended parameters were 33%, 29% and 29% respectively. GASS monitoring compliance was 7% at baseline, 0% at 1- and 3-months, 7% at 6-months.ConclusionThe CMHT performed better than the inpatient team at baseline monitoring. This may reflect action on the previous audit's recommendations to increase provision of community ‘Wellbeing Health Improvement Service’ (WHISe) clinics. However, performance of the GASS questionnaire at baseline was consistent with the previous audit, with similar performance at follow-up extending these findings.In response, the first recommendation is for Quality Improvement Activities to help improve compliance with the ‘Shared Care Guidelines’. This may include CQUINs and further provision of community clinics to improve compliance with both baseline and follow-up checks. Secondly, it is proposed that GASS questionnaires be sent to patients prior to appointments to be completed in advance to avoid further risk of GASS being incomplete.

Comprehensive assessment of exposure to clozapine in association with side effects among patients with treatment-resistant schizophrenia: a population pharmacokinetic study.

Background:There have been scarce data on the distribution of clozapine concentrations in comparison with the recommended range (350–600 ng/ml) or their relationship with side effects among patients with treatment-resistant schizophrenia. Furthermore, no studies have assessed the association between side effects and overall exposure to the drug by calculating the 24-h area-under-curve (AUC).Methods:In- and outpatients with schizophrenia or schizoaffective disorder (ICD-10) who were receiving a stable dose of clozapine for ⩾2 weeks were included. Side effects were assessed using the Glasgow antipsychotic side-effects scale for clozapine (GASS-C). Using two collected plasma samples, plasma clozapine and norclozapine concentrations at peak and trough and their 24-h AUC were estimated using population pharmacokinetic models.Results:A total of 108 patients completed the study (mean ± SD age, 43.0 ± 10.1 years; clozapine dose, 357.5 ± 136.9 mg/day); 33 patients (30.6%) showed estimated trough concentrations of clozapine within the recommended range (350–600 ng/ml) whereas the concentrations were higher and lower than this range among 37 (43.5%) and 28 (25.9%) patients (%), respectively. There were no significant correlations between estimated peak or trough concentrations or 24-h AUC of both clozapine or norclozapine, and GASS-C total or individual scores. No significant differences were found between GASS-C total or individual item scores between the patients with estimated trough concentrations of clozapine of >600 ng/ml and the other subjects.Conclusion:The results suggest that clozapine or norclozapine concentrations are not linked directly to the extent of side effects experienced in clozapine-treated patients with treatment-resistant schizophrenia while the cross-sectional study design limits the interpretation of any causal relationships. These findings indicate that side effects associated with clozapine may occur at any dose or concentration.

Identification of Antipsychotic Side Effects with Glassgow Antipsychotic Side-Effect Scale (GASS)

Schizophrenia is ranked 4th of the top 10 diseases that burden worldwide. If the population of Indonesia reaches 200 million, it estimates that around two million have Schizophrenia. Based on Data from the World Health Organization (WHO), it estimates that around 24 million people worldwide have schizophrenia.2  the American Psychiatric Association (APA) were reported the incidence of Schizophrenia in the United States is about 1% of the adult population with a total of more than 2 million people. Schizophrenic patients were treated by antipsychotic agents that act to inhibit dopamine receptors, especially D2, and also inhibit adrenergic acetylcholine receptors and serotonin 5-HT2A. It can manifest side effects like extrapyramidal syndrome, amenorrhea, drowsiness, and others. This research aims to the identification of antipsychotic side effects with Glasgow Antipsychotic Side-effect Scale (GASS). 100 schizophrenics in HB. Saanin Mental Hospital were participating in this descriptive study after fulfilling the criteria of inclusion and exclusion. This study used the GASS questionnaire to interview subjects who were signing informed consent and get an explanation about this study. In this study, 92% of subjects reported mild side effects. The frequent complaints were extrapyramidal effects, sedation and CNS effects, anticholinergic effects, and weight gain (93%,80%,70 0% and 70% respectively). We found women complained of the side effects more often (16.38 ± 5.275) than men (12.58 ± 5.484) significantly with the value P = 0.001. Gass instruments can use screening antipsychotic side effects. This study concludes the most side effects complaints being extrapyramidal and drowsiness, and women more commonly found side effects than men.

The impact on functioning of second-generation antipsychotic medication side effects for patients with schizophrenia: a worldwide, cross-sectional, web-based survey

BackgroundIt is well established that the different antipsychotics used for schizophrenia symptoms differ substantially in their side effects. However, relatively little is known about the impact of these side effects on functioning from the patient’s perspective. We aimed to understand how key side effects of second-generation antipsychotics impact the functioning and quality of life (QoL) of patients with schizophrenia.MethodsThis is a cross-sectional, web-based survey of patient-reported side effect burden of antipsychotic drugs in adults with schizophrenia. The survey was deployed in the United States, Canada, Australia, Spain, Italy, Norway, and Denmark. It included sociodemographic and clinical questions, the Quality of Life Enjoyment and Satisfaction Questionnaire Short Form (Q-LES-Q-SF), and the Glasgow Antipsychotic Side-Effect Scale (GASS). Eight pre-defined key side effects classified as activating (“Shaky hands or arms,” “Restlessness,” and “Difficulty sleeping”), sedating (“Sleepy during the day”, “Feeling drugged or like a zombie,” and “Feeling dizzy/Fainted”) or other side effects (“Problems enjoying sex” and “Gaining weight”), and additional questions related to impacts on function and quality of life were asked.ResultsIn total, 435 participants (mean age: 38 years, 53.8% female) were included. The total Q-LES-Q-SF score indicated overall medium satisfaction with their quality of life (score of 44.3; possible range 14–70). The most prevalent side effects were “Sleepy during the day” (83.2%), “Difficulty sleeping” (74.7%), “Dry mouth” (63.9%), “Problems enjoying sex” (53.4%) and “Gaining weight” (52.4%). Women reported the side effects of “Sleepy during the day”, “Problems enjoying sex” and “Gaining weight” more frequently than men. Key side effects impacted physical, social, occupational and psychological aspects of functioning. Patients with key side effects often felt frustrated by their experiences. Total Q-LES-Q-SF score showed a significant inverse correlation with the score of pre-defined groups of side effects indicating worse QoL in association with more severe key side effects in these patients.ConclusionStable patients with schizophrenia taking second-generation antipsychotics live with many side effects, including activating and sedating side effects, sexual side effects, and weight gain. Presence of these side effects is associated with substantial impacts across all aspects of daily functioning and lower quality of life and satisfaction.

Family Support is the Key to Compliance with the Treatment of Relapsing Schizophrenia Patients

Introduction: One problem in treating schizophrenia patients is relapse. The previous study results state that the biggest factor causing relapse is non-compliance with taking medication. This non-compliance with taking medication is influenced by several factors, including patient sociodemography, drug side effects, and family support. The purpose of this study was to determine the factors associated with medication adherence in Schizophrenia patients who were undergoing rehospitalization in an inpatient installation at RSJD in one city in Central Java, Indonesia.Methods: This study is a descriptive correlational analytic study with a cross-sectional approach. The population in this study were Schizophrenia patients who were undergoing re-hospital in the inpatient installation. Thirty-six samples were taken with the consecutive sampling method. The research instruments used were a socio-demographic questionnaire, family support questionnaire, Medication Adherence Rating Scale (MARS), and Glasgow Antipsychotic Side-effect Scale (GASS). Data analysis using descriptive analysis and chi-square test.Results: There is a relationship between family support for relapse in schizophrenia patients (p = 0.023).Conclusion: Researchers suggest that the hospital improves the treatment of family motivation to provide good support to patients to reduce the rate of re-hospitalization.

Reliability of the Glasgow Antipsychotic Side-effects Scale for Clozapine Japanese version (GASS-C-J).

The purpose of this study was to develop the Glasgow Antipsychotic Side effects Scale for Clozapine Japanese version (GASS-C-J) and examine its reliability to assess clozapine-related side effects. We developed the GASS-C-J using forward and backward translation. Semantic equivalence of the GASS-C-J to the GASS-C was confirmed by the original author. We then administered the GASS-C-J twice to 109 patients on clozapine treatment at two psychiatric hospitals in Japan. We assessed the internal consistency and test-retest reliability of the GASS-C-J using Cronbach’s alpha and weighted kappa coefficient, respectively. We also examined if discrepancies in each GASS-C-J item score between the first and second rating were correlated with items of the Brief Evaluation of Psychosis Symptom Domains (BE-PSD). The Cronbach’s alpha coefficient of the GASS-C-J at the first and second rating was 0.78 (95% CI: 0.72 to 0.84) and 0.82 (95% CI: 0.76 to 0.88), respectively. The weighted kappa coefficient of individual and total GASS-C-J item scores ranged from 0.45 to 0.88. Some symptom domains were correlated with discrepancies in specific items of the GASS-C-J: psychotic symptoms and nausea/vomiting (rs = 0.27), thirst (rs = 0.31), and appetite/weight gain (rs = 0.27); disorganized thinking and urinary incontinence (rs = 0.26); depression/anxiety and myoclonus (rs = 0.25), hypersalivation (rs = -0.27), and blurred vision (rs = -0.22). These findings demonstrate that the GASS-C-J can be used in clinical and research settings as a reliable scale to assess clozapine-related side effects.

Clinical validation of the self-reported Glasgow Antipsychotic Side-effect Scale using the clinician-rated UKU side-effect scale as gold standard reference.

Antipsychotics are key for the treatment of psychotic and several non-psychotic disorders. Unfortunately, antipsychotic medications are associated with side effects, which may reduce quality of life and treatment adherence. Therefore, regular screening of antipsychotic side effects is essential. The Glasgow Antipsychotic Side-effect Scale is a patient self-report scale developed for this purpose. However, the Glasgow Antipsychotic Side-effect Scale has only been validated against another self-report side effect measure, which is suboptimal. We aimed to validate the Glasgow Antipsychotic Side-effect Scale using the clinician-rated Udvalg for Kliniske Undersøgelser side-effect rating scale as the gold standard reference. 81 antipsychotic-treated outpatients with schizophrenia-spectrum disorders (age = 42±13 years; males = 43%, schizophrenia = 77%, illness duration: median = 11 years) completed the Glasgow Antipsychotic Side-effect Scale and were subsequently scored on the Udvalg for Kliniske Undersøgelser by trained raters. Sensitivity, specificity, positive predictive value and negative predictive value were calculated for paired Glasgow Antipsychotic Side-effect Scale and Udvalg for Kliniske Undersøgelser items. Sensitivity of Glasgow Antipsychotic Side-effect Scale items ranged from 33-96%, with 19 (86%) having >75% sensitivity. Lowest sensitivity emerged for "nocturnal enuresis" (33%), "galactorrhea" (50%) and "hyperkinesia" 14-99%, with 14 items (64%) having >75% specificity, being lowest for "asthenia" (14%), "polyuria/polydipsia" (35%), "sedation" (41%), "akathisia" (53%), "dystonia" (65%), "hyperkinesia" (68%), "hypokinesia" (70%) and "accommodation" (70%). Positive predictive value ranged from 7-85%, with six items (27%) having a positive predictive value >75%. Negative predictive value ranged from 40-98%, with 21 items (95%) having a negative predictive value >75%. The mean time to complete the Glasgow Antipsychotic Side-effect Scale was 4±2 minutes. The Glasgow Antipsychotic Side-effect Scale demonstrated satisfactory validity as a self-rated tool for antipsychotic side effects and may aid measurement-based care and decision-making.

T220. IMPACT OF SECOND-GENERATION ANTIPSYCHOTIC SIDE EFFECTS ON FUNCTIONING FROM A SCHIZOPHRENIA PATIENT PERSPECTIVE: GLOBAL PATIENT CENTERED SURVEY INCLUDING PATIENTS FROM ITALY

BackgroundSecond-generation antipsychotics (SGAs) used to treat patients with schizophrenia generally have lower risk of motor side effects (SEs) than first-generation antipsychotics, but they are associated with other well-known SEs. The goal of this study was to understand how specific SEs of SGAs impact daily functioning, emotional well-being, and overall quality of life of patients with schizophrenia from their own perspective.MethodsThis study was a cross-sectional, participant-reported web survey, conducted globally during 2017–2018. The survey captured participants’ socio-demographic information, and assessments using the Quality of Life Enjoyment and Satisfaction Questionnaire Short Form (Q-LES-Q-SF) instrument, and the Glasgow Antipsychotic Side-Effect Scale (GASS). Additionally, specific questions about functional and emotional impacts were developed for SEs recognized as being bothersome to patients,2 such as activating SEs (‘Feeling restless/unable to sit still’, ‘Shaky hands or arms’, and ‘Difficulty sleeping’) sedating SEs (‘Feeling sleepy during the day’, ‘Feeling drugged/like a zombie’) and metabolic or endocrine SEs (‘Weight gain’, ‘Problems enjoying sex’). Participants noted on a visual analog scale (VAS) the degree of impact on functioning, 0 indicating ‘no impact at all’ and 100 indicating the ‘largest degree of impact’. Participants with schizophrenia (≥18 years old) stable for at least one month, taking an SGA for 1–12 months, and self-reporting at least one SE were included.ResultsOf 6,556 respondents screened, 435 were included in the study – United States, n=180; Canada, n=99; Australia, n=28; and Europe, n=128 (Italy, n=90; Spain, n=22; Denmark, n=8; Norway, n=8). The majority of the participants were diagnosed within the last 5 years and nearly half were living with a spouse or partner. The employment rate (full time or part time) was 39.9% globally and 43.3% in Italy. Respondents in Italy were on ‘predominantly sedating’ (54.4%), and/or ‘similarly activating and sedating’ (43.3%) SGAs (as defined in Citrome, J Clin Psychopharmacol 2017). In Italy, Q-LES-Q-SF total score was (mean [standard deviation; SD]) 46.6 [9.1], out of a possible score range of 14–70 (globally, 44.3 [9.8]). Similar to other countries, participants from Italy showed lowest satisfaction scores for Q-LES-Q-SF items of ‘Sexual drive, interest and/or performance’, ‘Economic status’, and ‘Work’. In Italy, the most prevalent SEs reported on the GASS were ‘Feeling sleepy during the day’, ‘Difficulty sleeping’, and ‘Problems enjoying sex’, while globally patients reported ‘Feeling sleepy during the day’, ‘Difficulty sleeping’, and ‘Dry mouth’ as the most common SEs. More than half of the participants stated they had experienced gaining weight as an SE (52.4% globally and 62.2% in Italy). Globally, SEs perceived as bothersome by patients were reported to impact participants’ functioning and emotions. These SEs had at least a moderate to severe impact (defined by a VAS score ≥50) on all aspects of functioning (physical, psychological, social, and vocational). The most common emotions associated with SEs reported by participants were feeling ‘Frustrated’, ‘Dissatisfied’, and ‘Ashamed/embarrassed’. Generally, the results from the survey in Italy were comparable to those of the global survey.DiscussionFindings from this survey confirm that participants taking SGAs for the treatment of schizophrenia still have many SEs, including activating and sedating SEs, sexual SEs, and weight gain. These SEs have a considerable negative impact on participant’s daily functioning and quality of life satisfaction, including on work, and sexual drive, in addition to psychosocial effects.

M244. PENNSYLVANIA FIRST-EPISODE PROGRAM EVALUATION OF COORDINATED SPECIALTY CARE: SIX- AND 12-MONTH OUTCOMES

BackgroundInterest in early intervention for first-episode psychosis (FEP) has increased globally in recent decades in response to evidence that multi-component programs may reduce individual and societal burden of psychotic disorders. In 2016, the Pennsylvania (PA) Office of Mental Health and Substance Abuse Services (OMHSAS) provided funding to develop a statewide Program Evaluation (PE) initiative. PA-FEP-PE assesses benefits of nine PA coordinated specialty care (CSC) programs both individually and in aggregate. We previously (SIRS 2019) presented preliminary data from initial participants. We now present data from 598 participants enrolled across PA.MethodsOur CSC programs serve youth age 12–34 experiencing early psychosis onset between 12–24 months before admission. Services, including pharmacotherapy, CBT-based psychotherapy, case management, supported employment and education, peer support, and multi-family groups and psychoeducation, are offered for >=2 years. Participant characteristics at referral, admission, follow-up and discharge are collected via standardized computerized (REDCap) forms. The computerized clinical battery, administered at admission and at 6-month follow-up intervals, is composed of measures selected for domain coverage, clinical utility, reliability/validity (from the PhenX toolkit), practical utility, low burden, and high utility to multiple stakeholders. Domains include symptoms and diagnosis (Brief Psychiatric Rating Scale, Beck Depression Inventory-7, Hopelessness Scale, Self-Esteem-Scale-Revised, Loneliness Scale, Defeatist Beliefs Scale, Post-Traumatic Stress Disorder Symptom Scale), psychosocial functioning and recovery (Global Function Role and Social Scales, Psychosis Recovery Assessment Questionnaire, Quality of Life Functional Assessment, Systematic Clinical Outcome Routine Evaluation), medication side effect monitoring (Extrapyramidal Symptom Rating Scale, Glasgow Antipsychotic Side Effect Scale), and service quality and satisfaction (Youth Services Survey).ResultsBetween 1/1/17-7/1/19, 1,917 referrals were received, of whom 598 participants (mean age=21.1 SD=4.5; 35% female; 45% Caucasian, 41% African-American) were enrolled. Unspecified/other psychotic disorder was the most common diagnosis at admission (48%). Mean age at psychosis onset was 20.2 years (SD=4.6). An average 13.7 (SD=21.8) months lapsed between symptom onset and admission. The majority (78%) of participants had prior hospitalizations. At admission, participants showed moderate severity of psychiatric symptoms, serious impairment in global role and social functioning, and 72% reported experiencing >=1 traumatic events. At 6-month follow-up, participants (n=142) exhibited several significant improvements, including decreased hospitalizations and hospitalization days, suicidal ideation, substance use, overall psychopathology, and positive psychosis symptoms, and increased employment and school enrollment, global role and social function, self-rated quality of life, medication side effects, and satisfaction with mental health services. Individuals who engaged for 12 months (n=60) continued to maintain significant improvement in clinical features.DiscussionPA-FEP-PA is a comprehensive model yielding clinical and functional improvements after 6 and 12 months of CSC participation. Continued data collection will enable increased power to analyze population and site differences to illuminate mediators and moderators underlying individual variations and improve personalized prediction of salient outcomes. Further, the PA-FEP-PE model offers PA CSC programs a collaborative learning network for ongoing quality improvement.

Validity and Reliability of the Turkish Version of the Glasgow Antipsychotic Side Effect Scale

Validity and Reliability of the Turkish Version of the Glasgow Antipsychotic Side Effect Scale

Attitude towards Antipsychotic Medications in Patients Diagnosed with Schizophrenia: A Cross-Sectional Study at Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia.

Background Poor attitude towards antipsychotic drugs is high, and it is a factor for non-adherence to treatment. This increases the risk of relapse, associated healthcare utilization, and costs. This study aimed to assess attitude towards antipsychotic medication among patients with schizophrenia. Objectives The aim of this institution based cross-sectional study was to assess attitude towards antipsychotic medications and associated factors among patients with schizophrenia who attend the outpatient clinics at Amanuel Mental Specialized Hospital, 2018. Methods In a cross-sectional study, 393 schizophrenic patients from Amanuel Mental Specialized Hospital were recruited by a systematic random sampling technique. Drug Attitude Inventory (DAI-10) was used to assess attitude, experience, and belief about antipsychotics. Glasgow antipsychotic side effect scale modified version, positive and negative syndrome scale, and Birch wood's insight scale for psychosis were the instruments used to assess the associated factors. Simple and multiple linear regression analysis models were fitted, and the adjusted unstandardized beta (β) coefficient at 95% confidence interval was used. Results The mean score of attitude towards antipsychotic medications was 6.51 with standard deviation (SD) of 2.22. In multiple linear regression, positive symptoms (β= -0.07, 95% CI: (-0.09, -0.05)), negative symptoms (β= -0.04, 95% CI: (-0.06,-0.02)), shorter (≤5 years) duration of illness (β= -0.39, 95% CI: (-0.63, -0.15)), first generation antipsychotics (β = -0.35, 95% CI: (-0.55,-0.14)), having sedation (β= -0.28, 95% CI: (-0.52, -0.02)), and extra-pyramidal side effects (β= -0.34, 95% CI: (-0.59,-0.09)) were factors negatively associated with attitude towards antipsychotic medication treatment. Insight to illness (β= 0.24, 95% CI: (0.20, 0.27) was a factor positively associated with attitude towards antipsychotic medications. Conclusion The result suggests that the mean score of participants' attitude towards antipsychotic medications was good. Prevention of side effects particularly due to first generation antipsychotics is necessary.

Certifiable disability in schizophrenia and its correlates: A cross-sectional study

Background: Disability associated with schizophrenia has an impact on various domains of life. Patients with >40% disability are entitled for getting benefits from the government. The study aimed at assessing the certifiable disability, severity of the disability, and its correlates in patients with schizophrenia. Materials and Methods: Tertiary hospital-based cross-sectional study comprised of 63 patients with schizophrenia fulfilling the selection criteria. The data included sociodemographic and illness variables. Positive and Negative Syndrome Scale, Medication Adherence Rating Scale, and Glasgow Antipsychotic Side-effects Scale were used to assess the symptom severity, treatment adherence, and side effects, respectively. The Indian Disability Evaluation Assessment Scale (IDEAS) was used to evaluate the disability. Data were analyzed using the Statistical Package for Social Sciences software. Results: Majority of the patients (53.7%) had certifiable disability. About 46% of patients had mild level of disability, while 39.7% had moderate level of disability, 1.6% had severe level of disability, and 12.7% had profound disability. The disability was observed to be more in the work, social relationships, and communication domain of IDEAS. There was a strong positive correlation between symptom severity, antipsychotic side effects, and disability. The disability was greater in patients who had a poor medication adherence. Conclusion: Patients with schizophrenia have a significant certifiable disability in all domains of life. Symptomatology, antipsychotic side effects, and medication adherence are important predictors of disability. Preventive and rehabilitative measures should be taken for controlling these modifiable factors which would help in limiting disability. Suitable guidance should be given to avail the disability benefits.