Prevalence of diabetes and the metabolic syndrome in a sample of patients with bipolar disorder.

OBJECTIVES: The presence of metabolic abnormalities is an important risk factor for cardiovascular disease and diabetes. There are limited data on the prevalence of the metabolic abnormalities in disorders other than schizophrenia in which antipsychotic medication is part of routine treatment. METHODS: Sixty consecutive patients with bipolar disorder (BD) at our university psychiatric hospital and affiliate services were entered in an extensive prospective metabolic study including an oral glucose tolerance test. The prevalence of the metabolic syndrome was assessed based on the National Cholesterol Education Program Adult Treatment Protocol (ATP-III) criteria, the adapted ATP-III criteria using a fasting glucose threshold of 100 mg/dL, and the recently proposed criteria from the International Diabetes Federation (IDF). RESULTS: The analysis of 60 patients showed a prevalence of the metabolic syndrome of 16.7% (ATP-III), 18.3% (adapted ATP-III) and 30.0% (IDF), respectively. A total of 6.7% of the patients met criteria for diabetes and 23.3% for pre-diabetic abnormalities. CONCLUSIONS: The metabolic syndrome and glucose abnormalities are highly prevalent among patients with BD. They represent an important risk for cardiovascular and metabolic disorders. Assessment of the presence and monitoring of metabolic abnormalities and its associated risks should be part of the clinical management of patients with BD

Usability of the experience sampling method in specialized mental healthcare:A pilot study

Background:Although mental health problems occur in interaction with the natural environment, bringing this contextualized information into the therapy room is challenging. The experience sampling method (ESM) may facilitate this by assessing clients' thoughts, feelings, symptoms, and behavior as they are experienced in everyday life. However, ESM is still primarily used in research settings with little uptake in clinical practice. One aspect that may facilitate clinical implementation concerns the use of 'ESM protocols', which involves providing practitioners with ready-to-use ESM questionnaires, sampling schemes, visualizations, and training.Objective:This pilot study's objective was to evaluate the usability of an ESM protocol in clinical practice using a mixed-methods approach.Methods:In this pilot study, we created an ESM protocol and tested its usability in clinical practice. The ESM protocol was tailored to the m-Path software platform, consisting of a dashboard for practitioners and an app for clients. The dashboard was used to configure an ESM questionnaire template we designed. Additionally, the dashboard contained custom data visualizations that were made based on end-user feedback. The app was used for completing ESM assessments. A total of 8 practitioners and 17 clients used ESM in practice between December 2020 and July 2021. Usability was assessed using questionnaires, ESM compliance rates, and semi-structured interviews.Results:The usability was overall rated reasonable to good by practitioners (Mean scores to usability items ranging from 5.33 [SD = 0.91] to 6.06 [SD = 0.73] on a cale from 1 to 7]). However, practitioners expressed difficulty personalizing the template and reported insufficient guidelines on how to use ESM in clinical practice. On average, clients completed 55% (SD=25%) of the ESM questionnaires. They rated the usability as reasonable to good but slightly lower and more variable than the practitioners (mean scores to usability items ranging from 4.18 [SD = 1.7] to 5.94 [SD = 1.5] on a cale from 1 to 7). Clients also voiced several concerns over the piloted ESM template, with some indicating no interest in the continued use of ESM.Conclusions:The findings suggest that using an ESM protocol may facilitate the implementation of ESM as a mobile health assessment tool in psychiatry. However, further adaptions should be made prior to further implementation. Adaptions include training on personalizing questionnaires, adding additional sampling scheme formats, and creating a dynamic data visualization interface. Future studies should also identify factors determining the suitability of ESM for specific treatment goals among different client populations

Oral glucose tolerance tests in schizophrenic patients treated with antipsychotics

peer reviewedObjective. –A recent consensus conference has proposed guidelines for the monitoring for diabetes in patients with schizophrenia and also identifies the need of long-term prospective studies. Method. – A large scale prospective study on metabolic risks of antipsychotic medication is currently ongoing. At baseline, patients get a full laboratory screening, ECG and an oral glucose tolerance test (OGTT). Baseline data on 100 non-diabetic patients at study inclusion and stable on medication for at least 6 months are presented. Results. – Glucose abnormalities are found in 22% of patients at baseline.A monitoring protocol based only on fasting glucose would not have detected 63.6% of these patients with classifiable glucose abnormalities in our sample. Fasting insulin and measures for insulin resistance have a high predictive value for abnormalities late in the OGTT. Conclusion. – Already at baseline, metabolic problems are frequently present in patients with schizophrenia treated with antipsychotics. Adding assessment of fasting insulin in a monitoring protocol improves detection of glucose abnormalities late in an OGTT

Be(com)ing Social:Daily-Life Social Interactions and Parental Bonding

Parents are known to provide a lasting basis for their children's social development. Understanding parent-driven socialization is particularly relevant in adolescence, as an increasing social independence is developed. However, the relationship between key parenting styles of care and control and the microlevel expression of daily-life social interactions has been insufficiently studied. Adolescent and young adult twins and their nontwin siblings (N = 635; mean age = 16.6; age range = 14.2-21.9; 58.6% female; 79.5% in or having completed higher secondary/tertiary education; 2.8% speaking language other than Dutch at home) completed the Parental Bonding Instrument (PBI) on parental care and control. Participants also completed a 6-day experience sampling period (10 daily beeps, mean compliance = 68.0%) to assess daily-life social interactions. Higher overall parental bonding quality (of both parents) related to more positive social experiences in daily life (e.g., belonging in company), but not to more social behaviors (e.g., being with others). Factor analysis indicated a three-factor structure of the PBI, with care, denial of psychological autonomy, and encouragement of behavioral freedom. Paternal care was uniquely predictive of better social experiences. These findings demonstrate how parenting styles may be uniquely associated with how adolescents experience their social world, with a potentially important role for fathers in particular. This complements the long-held idea of socialization through parenting by bringing it into the context of daily life and implies how both conceptualizations of social functioning and interventions aimed at alleviating social dysfunction might benefit from a stronger consideration of day-to-day social experiences.</p

Prevalence and severity of antipsychotic related constipation in patients with schizophrenia: a retrospective descriptive study

<p>Abstract</p> <p>Background</p> <p>Antipsychotic are the cornerstone in the treatment of schizophrenia. They also have a number of side-effects. Constipation is thought to be common, and a potential serious side-effect, which has received little attention in recent literature.</p> <p>Method</p> <p>We performed a retrospective study in consecutively admitted patients, between 2007 and 2009 and treated with antipsychotic medication, linking different electronic patient data to evaluate the prevalence and severity of constipation in patients with schizophrenia under routine treatment conditions.</p> <p>Results</p> <p>Over a period of 22 months 36.3% of patients (99) received at least once a pharmacological treatment for constipation. On average medication for constipation was prescribed for 273 days. Severe cases (N = 50), non-responsive to initial treatment, got a plain x-ray of the abdomen. In 68.4% fecal impaction was found.</p> <p>Conclusion</p> <p>A high prevalence of constipation, often severe and needing medical interventions, was confirmed during the study period. Early detection, monitoring over treatment and early intervention of constipation could prevent serious consequences such as ileus.</p

Staging of Schizophrenia with the Use of PANSS: An International Multi-Center Study

Introduction: A specific clinically relevant staging model for schizophrenia has not yet been developed. The aim of the current study was to evaluate the factor structure of the PANSS and develop such a staging method.Methods: Twenty-nine centers from 25 countries contributed 2358 patients aged 37.21 ± 11.87 years with schizophrenia. Analysis of covariance, Exploratory Factor Analysis, Discriminant Function Analysis, and inspection of resultant plots were performed.Results: Exploratory Factor Analysis returned 5 factors explaining 59% of the variance (positive, negative, excitement/hostility, depression/anxiety, and neurocognition). The staging model included 4 main stages with substages that were predominantly characterized by a single domain of symptoms (stage 1: positive; stages 2a and 2b: excitement/hostility; stage 3a and 3b: depression/anxiety; stage 4a and 4b: neurocognition). There were no differences between sexes. The Discriminant Function Analysis developed an algorithm that correctly classified >85% of patients.Discussion: This study elaborates a 5-factor solution and a clinical staging method for patients with schizophrenia. It is the largest study to address these issues among patients who are more likely to remain affiliated with mental health services for prolonged periods of time.<br /

Juridische aspecten in België

status: publishe

Schizofrenie

edition: VIstatus: publishe