Support management in schizophrenia: a systematic review of current literature

Maurizio Pompili,1 Franco Montebovi,1 Alberto Forte,1 Mario Palermo,1 Henry Stefani,1 Ludovica Telesforo,1 Sandra Campi,1 Gloria Giordano,1 Lucia Longo,1 Dorian A Lamis,2 Gianluca Serafini,1 Paolo Girardi11Department of Neurosciences, Mental Health and Sensory Functions, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy; 2Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USABackground: Schizophrenia is generally considered a chronic disorder characterized by psychotic symptoms and relatively stable neurocognitive and interpersonal deficits. Antipsychotic medication has proven beneficial in reducing psychotic symptoms, but is often not enough to treat cognitive or functional impairments. Residual cognitive impairments are barriers to a patient's full recovery from schizophrenia. Rehabilitation is an alternative and important approach which may be useful, and encompasses a variety of treatments including social skills training and psychoeducational and cognitive behavioral treatments.Objective: To investigate the efficacy of psychosocial treatments in schizophrenia, evaluating its effects in the short and long term, comparing psychosocial treatments with pharmacotherapy, and assessing the effects of treatment and the main indications for use in patients with schizophrenia.Methods: A careful MEDLINE®, Excerpta Medica, PsycLIT®, PsycINFO®, and Index Medicus search was performed to identify all papers and book chapters in English for the period 1970–2012.Results: Findings from the studies included in this qualitative analysis suggest that social skills therapy, cognitive behavioral therapy, family intervention therapy, cognitive remediation therapy, and other nonpharmacological therapeutic strategies may be beneficial for patients with significant functional and symptomatic impairments.Conclusion: Schizophrenic patients treated with nonpharmacological techniques have more rapid remission and relapse less frequently than patients treated only pharmacologically.Keywords: schizophrenia, support management, nonpharmacological treatment, cognitive behavioral therap

PRN OPINION PAPER: Application of precision medicine across pharmacy specialty areas

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149551/1/jac51107_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149551/2/jac51107.pd

Global Retinoblastoma Presentation and Analysis by National Income Level.

Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68]). Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs

Travel burden and clinical presentation of retinoblastoma: analysis of 1024 patients from 43 African countries and 518 patients from 40 European countries

BACKGROUND: The travel distance from home to a treatment centre, which may impact the stage at diagnosis, has not been investigated for retinoblastoma, the most common childhood eye cancer. We aimed to investigate the travel burden and its impact on clinical presentation in a large sample of patients with retinoblastoma from Africa and Europe. METHODS: A cross-sectional analysis including 518 treatment-naïve patients with retinoblastoma residing in 40 European countries and 1024 treatment-naïve patients with retinoblastoma residing in 43 African countries. RESULTS: Capture rate was 42.2% of expected patients from Africa and 108.8% from Europe. African patients were older (95% CI -12.4 to -5.4, p<0.001), had fewer cases of familial retinoblastoma (95% CI 2.0 to 5.3, p<0.001) and presented with more advanced disease (95% CI 6.0 to 9.8, p<0.001); 43.4% and 15.4% of Africans had extraocular retinoblastoma and distant metastasis at the time of diagnosis, respectively, compared to 2.9% and 1.0% of the Europeans. To reach a retinoblastoma centre, European patients travelled 421.8 km compared to Africans who travelled 185.7 km (p<0.001). On regression analysis, lower-national income level, African residence and older age (p<0.001), but not travel distance (p=0.19), were risk factors for advanced disease. CONCLUSIONS: Fewer than half the expected number of patients with retinoblastoma presented to African referral centres in 2017, suggesting poor awareness or other barriers to access. Despite the relatively shorter distance travelled by African patients, they presented with later-stage disease. Health education about retinoblastoma is needed for carers and health workers in Africa in order to increase capture rate and promote early referral

The global retinoblastoma outcome study : a prospective, cluster-based analysis of 4064 patients from 149 countries

DATA SHARING : The study data will become available online once all analyses are complete.BACKGROUND : Retinoblastoma is the most common intraocular cancer worldwide. There is some evidence to suggest that major differences exist in treatment outcomes for children with retinoblastoma from different regions, but these differences have not been assessed on a global scale. We aimed to report 3-year outcomes for children with retinoblastoma globally and to investigate factors associated with survival. METHODS : We did a prospective cluster-based analysis of treatment-naive patients with retinoblastoma who were diagnosed between Jan 1, 2017, and Dec 31, 2017, then treated and followed up for 3 years. Patients were recruited from 260 specialised treatment centres worldwide. Data were obtained from participating centres on primary and additional treatments, duration of follow-up, metastasis, eye globe salvage, and survival outcome. We analysed time to death and time to enucleation with Cox regression models. FINDINGS : The cohort included 4064 children from 149 countries. The median age at diagnosis was 23·2 months (IQR 11·0–36·5). Extraocular tumour spread (cT4 of the cTNMH classification) at diagnosis was reported in five (0·8%) of 636 children from high-income countries, 55 (5·4%) of 1027 children from upper-middle-income countries, 342 (19·7%) of 1738 children from lower-middle-income countries, and 196 (42·9%) of 457 children from low-income countries. Enucleation surgery was available for all children and intravenous chemotherapy was available for 4014 (98·8%) of 4064 children. The 3-year survival rate was 99·5% (95% CI 98·8–100·0) for children from high-income countries, 91·2% (89·5–93·0) for children from upper-middle-income countries, 80·3% (78·3–82·3) for children from lower-middle-income countries, and 57·3% (52·1-63·0) for children from low-income countries. On analysis, independent factors for worse survival were residence in low-income countries compared to high-income countries (hazard ratio 16·67; 95% CI 4·76–50·00), cT4 advanced tumour compared to cT1 (8·98; 4·44–18·18), and older age at diagnosis in children up to 3 years (1·38 per year; 1·23–1·56). For children aged 3–7 years, the mortality risk decreased slightly (p=0·0104 for the change in slope). INTERPRETATION : This study, estimated to include approximately half of all new retinoblastoma cases worldwide in 2017, shows profound inequity in survival of children depending on the national income level of their country of residence. In high-income countries, death from retinoblastoma is rare, whereas in low-income countries estimated 3-year survival is just over 50%. Although essential treatments are available in nearly all countries, early diagnosis and treatment in low-income countries are key to improving survival outcomes.The Queen Elizabeth Diamond Jubilee Trust and the Wellcome Trust.https://www.thelancet.com/journals/langlo/homeam2023Paediatrics and Child Healt

Childhood Physical Maltreatment and Borderline Personality Disorder Symptoms in Adolescents: Mediating and Moderating Effects of Attachment Styles and Gender

Childhood physical maltreatment may contribute to the onset of borderline personality disorder (BPD) features in adolescence; however, the mechanisms explaining this association warrant investigation. This study focused on insecure attachment styles as mediators in this relationship among a sample of adolescents. Analyses were also conducted to determine whether gender moderated the association between physical maltreatment and BPD features. The sample consisted of 529 Italian adoles- cents between 14 and 18 years (Mage = 16.48, SD = 1.37). Participants completed a survey including three self-report questionnaires: CTQ-SF, ASQ, and BPI. Physical abuse was related to BPD features through insecure-anxious and insecure- avoidant attachment styles, whereas physical neglect was asso- ciated with BPD features only through insecure-avoidant attach- ment. Gender moderated the pathway between physical maltreatment and BPD features so that boys who experienced childhood physical abuse and neglect reported more BPD fea- tures than girls. This study expanded our knowledge of the role of insecure attachment styles in the onset of BPD features among adolescents with early experiences of childhood physi- cal maltreatment. This study also advances our understanding of potential gender differences in the childhood maltreatment- BPD features link in adolescents

Suicide Risk among Immigrants and Ethnic Minorities: A Literature Overview

Recent studies have demonstrated that immigrants and ethnic minorities may be at higher risk of suicidal behaviour as compared to the general population. We conducted a literature search to identify studies in English from 1980 to 2017 related to suicide risk among immigrants and ethnic minorities. Six hundred and seventy-eight reports were screened, and 43 articles were included in the qualitative synthesis of the review. Some studies reported lower rates of suicide attempts, while other findings suggested higher rates of suicidal behaviour and deaths among immigrants as compared to the native population. Also, a positive correlation was found between suicidal behaviour and specific countries of origin. Non-European immigrant women were at the highest risk for suicide attempts, a group which included young women of South Asian and black African origin. Risk factors among migrants and ethnic minorities were found to be: language barriers, worrying about family back home, and separation from family. The lack of information on health care system, loss of status, loss of social network, and acculturation were identified as possible triggers for suicidal behaviour. Overall, results suggest that specific migrant populations and ethnic minorities present a higher risk of suicidal behaviour than native populations, as well as a higher risk of death by suicide

Adapting and evaluating a social cognitive remediation program for schizophrenia in Arabic

a b s t r a c t a r t i c l e i n f o Although growing evidence supports the efficacy of social cognitive training interventions for schizophrenia, nearly all studies to date have been conducted in Westernized countries. In the current study, we translated and adapted an existing social cognitive skills training (SCST) program into Arabic and conducted a preliminary efficacy evaluation in schizophrenia outpatients in Egypt. Twenty-two patients were randomized to 16 sessions of group-based SCST and 20 were randomized to a format-and time-matched illness management training control condition. Pre-and post-intervention assessments included a primary social cognition outcome measure that assessed four branches of emotional intelligence and a battery of neurocognitive tests. The SCST group demonstrated significant treatment effects on total emotional intelligence scores (F = 24.31, p b .001), as well as the sub-areas of Identifying Emotions (F = 11.77, p b .001) and Managing Emotions (F = 23.27, p b .001), compared with those in the control condition. There were no treatment benefits for neurocognition for either condition, and both interventions were well-tolerated by patients. These initial results demonstrate the feasibility of implementing social cognitive interventions in different cultural settings with relatively minor modifications. The findings are encouraging regarding further efforts to maximize the benefits of social cognitive interventions internationally

Differential clinical characteristics and possible predictors of bipolarity in a sample of unipolar and bipolar inpatients

Major affective conditions including both unipolar (UD) and bipolar disorders (BD) are associated with significant disability throughout the life course. We aimed to investigate the most relevant socio-demographic/clinical differences between UD and BD subjects. Our sample included 180 inpatients, of which 82 (45.5%) participants were diagnosed with UD and 98 (54.5%) with BD. Relative to UD patients, BD individuals were more likely to report prior psychoactive medications, lifetime psychotic symptoms, nicotine abuse, a reduced ability to provide to their needs, gambling behavior, and fewer nonsuicidal self-harm episodes. Moreover, BD patients were more likely to report severe side effects related to medications, a younger age at illness onset and first hospitalization, higher illness episodes, and longer illness duration in years than UD subjects. In a multivariate logistic analysis accounting for age, gender, and socio-demographic characteristics, a significant positive contribution to bipolarity was found only for higher lifetime psychotic symptoms (β = 1.178; p ≤.05) and number of illness episodes (β =.155; p ≤.05). The present findings suggest that specific clinical factors may be used in order to better distinguish between UD and BD subgroups. Further studies are required to replicate these findings in larger samples