Do adverse perinatal events predict mortality in schizophrenia during midlife?

Background: We examined mortality in schizophrenia spectrum disorder (SSD) and non-schizophrenic psychosis (NSSD) compared to individuals without psychosis, and whether perinatal factors predict mortality. Methods: Within Northern Finland Birth Cohort 1966 (n = 10 933; 203 with SSD, 178 with NSSD), mortality was followed until end of 2011 by national register. Wantedness of pregnancy, mother's antenatal depression, smoking and age, parity, paternal socio-economic status (SES) and family type at birth were examined as predictors of mortality. Results: Mortality was higher in SSD (hazard ratio (HR) 3.60; 95% confidence interval (CI) 2.38-5.45) and NSSD (4.05; 2.65-6.17) compared to persons without psychoses after adjustment for gender. HR for natural death was 2.01 (0.82-4.91) in SSD and 4.63 (2.43-8.80) in NSSD after adjustment for gender. Corresponding figures for unnatural deaths were 4.71 (2.94-7.54) and 2.94 (1.56-5.55), respectively. Among non-psychotic persons, mother's depression, smoking and low SES predicted mortality after adjustment for gender and parental psychoses (and SES), whereas among psychosis those whose father was a farmer had lower risk of mortality compared to those with high SES. Conclusions: Individuals with SSD had a higher risk of unnatural death and individuals with NSSD of natural and unnatural deaths. Perinatal factors seem to be more important predictors of mortality in individuals without psychoses than with psychoses. According to population-based long follow-up data, it is important to pay attention to somatic morbidity behind natural causes of death in psychoses and to prevent suicides in order to prevent excess mortality. (C) 2016 Elsevier B.V. All rights reserved.Peer reviewe

Antipsychotics in late-life schizophrenia - a narrative review

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Pitkäaikaisen psykoosilääkityksen vaikutukset skitsofreniapotilaan aivojen rakenteeseen

English summaryPeer reviewe

Mielenterveyshäiriöiden riskitekijät ja taudinkulku Pohjois-Suomen vuoden 1966 syntymäkohortissa

Vertaisarvioitu.Kohortti- ja rekisteritutkimuksilla on merkittävä rooli mielenterveyshäiriöiden riskitekijöiden, ennusteen ja hoidon selvittämisessä. Pohjois-Suomen syntymäkohortissa 1966 (Kohortti 66) on tutkittu vuodesta 1990 alkaen mielenterveyshäiriöitä, erityisesti skitsofreniaa ja myös masennusta. Tulosten mukaan skitsofreniaa ennustavat useat varhaiset raskauteen, synnytykseen ja kehitykseen liittyvät tekijät. Skitsofreniaan liittyy muutoksia aivojen rakenteessa ja kognitiivisessa suorituskyvyssä sekä somaattisen terveyden ongelmia. Ennuste on usein epätyydyttävä. Masennuksen osalta on löydetty riskitekijöitä lapsuudesta aikuisuuteen sekä suurentunut somaattisen oheissairastavuuden riski. Kohortissa 66 on tutkittu myös muun muassa persoonallisuushäiriöitä, somatisaatio-oireita, alkoholinkäyttöä ja temperamenttipiirteitä. Tutkimustulokset ovat lisänneet tietoa psykiatristen häiriöiden riskitekijöistä, taudinkulusta ja hoidosta.Peer reviewe

Off-label prescribing of antipsychotics - a questionnaire survey of Finnish physicians

English abstract.Peer reviewe

Mielenterveyshäiriöiden riskitekijät ja taudinkulku Pohjois-Suomen vuoden 1966 syntymäkohortissa

Vertaisarvioitu.Kohortti- ja rekisteritutkimuksilla on merkittävä rooli mielenterveyshäiriöiden riskitekijöiden, ennusteen ja hoidon selvittämisessä. Pohjois-Suomen syntymäkohortissa 1966 (Kohortti 66) on tutkittu vuodesta 1990 alkaen mielenterveyshäiriöitä, erityisesti skitsofreniaa ja myös masennusta. Tulosten mukaan skitsofreniaa ennustavat useat varhaiset raskauteen, synnytykseen ja kehitykseen liittyvät tekijät. Skitsofreniaan liittyy muutoksia aivojen rakenteessa ja kognitiivisessa suorituskyvyssä sekä somaattisen terveyden ongelmia. Ennuste on usein epätyydyttävä. Masennuksen osalta on löydetty riskitekijöitä lapsuudesta aikuisuuteen sekä suurentunut somaattisen oheissairastavuuden riski. Kohortissa 66 on tutkittu myös muun muassa persoonallisuushäiriöitä, somatisaatio-oireita, alkoholinkäyttöä ja temperamenttipiirteitä. Tutkimustulokset ovat lisänneet tietoa psykiatristen häiriöiden riskitekijöistä, taudinkulusta ja hoidosta.Peer reviewe

m-RESIST, a Mobile Therapeutic Intervention for Treatment-Resistant Schizophrenia: Feasibility, Acceptability, and Usability Study

Mental disorder; Schizophrenia; Treatment-resistantTrastorno mental; Esquizofrenia; Resistentencia al tratamientoMalaltia mental; Esquizofrènia; Resistència al tractamentBackground: In the European Union, around 5 million people are affected by psychotic disorders, and approximately 30%-50% of people with schizophrenia have treatment-resistant schizophrenia (TRS). Mobile health (mHealth) interventions may be effective in preventing relapses, increasing treatment adherence, and managing some of the symptoms of schizophrenia. People with schizophrenia seem willing and able to use smartphones to monitor their symptoms and engage in therapeutic interventions. mHealth studies have been performed with other clinical populations but not in populations with TRS. Objective: The purpose of this study was to present the 3-month prospective results of the m-RESIST intervention. This study aims to assess the feasibility, acceptability, and usability of the m-RESIST intervention and the satisfaction among patients with TRS after using this intervention. Methods: A prospective multicenter feasibility study without a control group was undertaken with patients with TRS. This study was performed at 3 sites: Sant Pau Hospital (Barcelona, Spain), Semmelweis University (Budapest, Hungary), and Sheba Medical Center and Gertner Institute of Epidemiology and Health Policy Research (Ramat-Gan, Israel). The m-RESIST intervention consisted of a smartwatch, a mobile app, a web-based platform, and a tailored therapeutic program. The m-RESIST intervention was delivered to patients with TRS and assisted by mental health care providers (psychiatrists and psychologists). Feasibility, usability, acceptability, and user satisfaction were measured. Results: This study was performed with 39 patients with TRS. The dropout rate was 18% (7/39), the main reasons being as follows: loss to follow-up, clinical worsening, physical discomfort of the smartwatch, and social stigma. Patients' acceptance of m-RESIST ranged from moderate to high. The m-RESIST intervention could provide better control of the illness and appropriate care, together with offering user-friendly and easy-to-use technology. In terms of user experience, patients indicated that m-RESIST enabled easier and quicker communication with clinicians and made them feel more protected and safer. Patients' satisfaction was generally good: 78% (25/32) considered the quality of service as good or excellent, 84% (27/32) reported that they would use it again, and 94% (30/32) reported that they were mostly satisfied. Conclusions: The m-RESIST project has provided the basis for a new modular program based on novel technology: the m-RESIST intervention. This program was well-accepted by patients in terms of acceptability, usability, and satisfaction. Our results offer an encouraging starting point regarding mHealth technologies for patients with TRS.This work has been supported by the Horizon 2020 Framework Programme of the European Union (grant 643552) and partly funded by CERCA (Centres de Recerca de Catalunya) Programme/Generalitat de Catalunya

Hoitoresistentin skitsofrenian hoitomahdollisuudet

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Predictors of response to pharmacological treatments in treatment-resistant schizophrenia - A systematic review and meta-analysis

Background: As the burden of treatment-resistant schizophrenia (TRS) on patients and society is high it is important to identify predictors of response to medications in TRS. The aim was to analyse whether baseline patient and study characteristics predict treatment response in TRS in drug trials. Methods: A comprehensive search strategy completed in PubMed, Cochrane and Web of Science helped identify relevant studies. The studies had to meet the following criteria: English language clinical trial of pharmacological treatment of TRS, clear definition of TRS and response, percentage of response reported, at least one baseline characteristic presented, and total sample size of at least 15. Meta-regression techniques served to explore whether baseline characteristics predict response to medication in TRS. Results: 77 articles were included in the systematic review. The overall sample included 7546 patients, of which 41% achieved response. Higher positive symptom score at baseline predicted higher response percentage. None of the other baseline patient or study characteristics achieved statistical significance at predicting response. When analysed in groups divided by antipsychotic drugs, studies of clozapine and other atypical antipsychotics produced the highest response rate. Conclusions: This meta-analytic review identified surprisingly few baseline characteristics that predicted treatment response. However, higher positive symptoms and the use of atypical antipsychotics - particularly clozapine -was associated with the greatest likelihood of response. The difficulty involved in the prediction of medication response in TRS necessitates careful monitoring and personalised medication management. There is a need for more investigations of the predictors of treatment response in TRS.Peer reviewe