Medicine and Health Sciences Commons^™

Lai Antipsychotics Vs. Oral Antipsychotics: Treatment Adherence, Relapses, And Readmissions, Natalie N. Lewis Bsn, Rn, Mallory F. Johnson Bsn, Rn-Bc, Tyler N. Halle-Todd Bsn, Rn, Natalie N. Ragland Bsn, Rn, Sharon H. Little Dnp, Aprn, Fnp-Bc, Jacqueline Sharp Dnp, Aprn,Pmhnp-Bc

Doctor of Nursing Practice Projects

Purpose/Background

Schizophrenia is a lifelong illness with recurrent and often debilitating symptoms that may impair daily functioning, cognition, behaviors, socialization, emotions, and expression. It is recognized as a global mental health burden that affects the individual, their family, and society. Medication nonadherence and resulting relapse detrimentally affect the patient’s physical and mental health and quality of life. They are associated with increased hospitalization and emergency room visits, substance use, suicide, and homelessness. Current guidelines endorse second-generation antipsychotics such as Risperidone and Aripiprazole as the first-line treatment for most cases of psychosis. However, long-acting injectable (LAIs) atypical antipsychotics are a promising …

Neurotropic Manifestations As A Potential Risk Factor For Schizophrenia Following In Utero Exposure To Sars-Cov-2, Mir Ali R Talpur, Omar H. Elsayed, Rif S. El-Mallakh

The University of Louisville Journal of Respiratory Infections

Background: COVID-19 infection is associated with neurologic and psychiatric morbidity that suggests a direct effect of the virus or secondary effect of an inflammatory process. These neuropsychiatric consequences may increase the likelihood of schizophrenia in the offspring of women who become infected with COVID-19 during their pregnancy.

Methods: We performed a directed narrative review of the literature focusing on the proposed pathophysiological processes that lead to schizophrenia and known pathological consequences of COVID-19 infection.

Results: Schizophrenia in adult offspring has been associated with maternal infections during pregnancy by a wide range of respiratory and neurotropic pathogens. Spikes in the incidence …

Cancer Incidence And Stage At Diagnosis Among People With Psychotic Disorders: Systematic Review And Meta-Analysis., Jared C Wootten, Joshua C Wiener, Phillip S Blanchette, Kelly K. Anderson

Epidemiology and Biostatistics Publications

Research regarding the incidence of cancer among people with psychotic disorders relative to the general population is equivocal, although the evidence suggests that they have more advanced stage cancer at diagnosis. We conducted a systematic review and meta-analysis to examine the incidence and stage at diagnosis of cancer among people with, relative to those without, psychotic disorders. We searched the MEDLINE, EMBASE, PsycINFO, and CINAHL databases. Articles were included if they reported the incidence and/or stage at diagnosis of cancer in people with psychotic disorders. Random effects meta-analyses were used to determine risk of cancer and odds of advanced stage …

Cancer Incidence And Stage At Diagnosis Among People With Recent-Onset Psychotic Disorders: A Retrospective Cohort Study Using Health Administrative Data From Ontario, Canada., Jared C Wootten, Lucie Richard, Phillip S Blanchette, Joshua C. Wiener, Kelly K. Anderson

Epidemiology and Biostatistics Publications

OBJECTIVE: Prior evidence on the relative risk of cancer among people with psychotic disorders is equivocal. The objective of this study was to compare incidence and stage at diagnosis of cancer for people with psychotic disorders relative to the general population.

METHOD: We constructed a retrospective cohort of people with a first diagnosis of non-affective psychotic disorder and a comparison group from the general population using linked health administrative databases in Ontario, Canada. The cohort was followed for incident diagnoses of cancer over a 25-year period. We used Poisson and logistic regression models to compare cancer incidence and stage at …

Incidence Of Cancer And Stage At Diagnosis Among People With Recent-Onset Psychotic Disorders, Jared C. Wootten

Electronic Thesis and Dissertation Repository

Evidence on cancer incidence in people with psychotic disorders, compared to the general population, is equivocal, although those with psychotic disorders so have more advanced stage of cancer at the time of diagnosis. The objective of this thesis was to compare cancer incidence and stage at diagnosis for people with psychotic disorders, relative to the general population. Our systematic review did not observe a significant difference in overall cancer incidence among people diagnosed with psychotic disorders (RR = 1.08, 95% CI: 1.00 to 1.16), however people with psychotic disorders were more likely to be present with advanced stage cancer at …

Risk Stratification For Treatment Decisions In People At Ultra-High Risk For Psychosis: A Cost-Effectiveness Analysis, Olajumoke Marissa Ologundudu

Electronic Thesis and Dissertation Repository

People with psychotic disorders have long-term negative health outcomes and contribute large health system costs. Intervening among those at ultra-high risk (UHR) for psychosis may prevent or mitigate risk for psychotic disorder; however, it is unclear if we should treat all UHR individuals or only those above a certain risk threshold. The objectives were to systematically review the literature on the cost-effectiveness of UHR programs, and to conduct an economic evaluation of a risk stratification strategy, where treatment decisions are based on the probability of transitioning to psychotic disorder. Our systematic review found that UHR programs are potentially cost-effective. The …

Increased Dietary Inflammatory Index Is Associated With Schizophrenia: Results Of A Case–Control Study From Bahrain, Haitham Jahrami, Moez Al-Islam Faris, Hadeel Ghazzawi, Zahra Saif, Layla Habib, Nitin Shivappa, James R. Hébert

Faculty Publications

Background: Several studies have indicated that chronic low-grade inflammation is associated with the development of schizophrenia. Given the role of diet in modulating inflammatory markers, excessive caloric intake and increased consumption of pro-inflammatory components such as calorie-dense, nutrient-sparse foods may contribute toward increased rates of schizophrenia. This study aimed to examine the association between dietary inflammation, as measured by the dietary inflammatory index (DII^®), and schizophrenia. Methods: A total of 120 cases attending the out-patient department in the Psychiatric Hospital/Bahrain were recruited, along with 120 healthy controls matched on age and sex. The energy-adjusted DII (E-DII) was computed …

Increased Dietary Inflammatory Index Is Associated With Schizophrenia: Results Of A Case-Control Study From Bahrain, Haitham Jahrami, Mo'ez Al-Islam Faris, Hadeel Ali Ghazzawi, Zahra Saif, Layla Habib, Nitin Shivappa, James R. Hebert

Faculty Publications

Background: Several studies have indicated that chronic low-grade inflammation is associated with the development of schizophrenia. Given the role of diet in modulating inflammatory markers, excessive caloric intake and increased consumption of pro-inflammatory components such as calorie-dense, nutrient-sparse foods may contribute toward increased rates of schizophrenia. This study aimed to examine the association between dietary inflammation, as measured by the dietary inflammatory index (DII (R)), and schizophrenia. Methods: A total of 120 cases attending the out-patient department in the Psychiatric Hospital/Bahrain were recruited, along with 120 healthy controls matched on age and sex. The energy-adjusted DII (E-DII) was computed based …

The Suffering Of Schizophrenia: Stigma, Enigma And The Search For A Cure, Fatima Sheikh

MSJ Capstone Projects

Patients suffering from Schizophrenia, a severe mental illness, firmly believe in their delusions due to a loss of connection with reality and creation of an imaginary world. Generally, diagnosis and treatment of the mental disorder have been ignored due to cultural and social setup in Karachi. Schizophrenia cannot be cured but manageable with lifetime medicines and rehabilitation after each lapse. The purpose of my investigative piece is to highlight the stigma attached to Schizophrenia along with a search for its treatment.

Do Not Miss Your Shot: Improving Follow-Up In Patients Receiving Long-Acting Injectable Medications, Mary O'Hara

Doctor of Nursing Practice Final Manuscripts

Background: Serious mental illness including schizophrenia and bipolar disorder affects 1 in 24 adults in California. These chronic disorders are difficult to treat and often sabotaged by medication nonadherence. Long-acting injectable (LAI) medications are one strategy to combat medication nonadherence. Effectively providing treatment with LAI medications can be challenging at the clinic level.

Objectives: Reduce the number of days without medication by reducing the number of days between injection due date and injection administration for patients receiving LAI medications.

Design: Establish appointments for all injection visits. Standardize visit protocol for injection encounters to optimize provider time. Arrange immediate follow-up and …

Schizophrenia And Its Effects On An American Family: A Call To Action For The 21st Century, Cynthia Newton Captain

Senior Theses

Our country’s healthcare system is at a moral crossroads. The way we treat those whom we call “the homeless” is deplorable. The majority of the homeless are mentally ill and need treatment. Our country needs to treat those with the severe brain diseases of schizophrenia, schizo-affective disorder, and bi-polar disorder just as we would Alzheimer’s disease and Parkinson’s disease. Those with severe mental illness, who have no insight into their illness, should not be allowed to dictate their own treatment. If a homeless person is brought to San Francisco General Hospital and is found to be a schizophrenic in psychiatric …

Recruiting And Retaining Individuals With Serious Mental Illness And Diabetes In Clinical Research: Lessons Learned From A Randomized, Controlled Trial., Stephanie W. Kanuch M.Ed., Kristin A. Cassidy Ma, Neal Dawson Md, Melanie Athey Ms, Edna Fuentes-Casiano Mssw, Martha Sajatovic Md

Journal of Health Disparities Research and Practice

Abstract: Recruitment and retention of individuals with serious mental illness (SMI) and comorbid diabetes mellitus (DM) in research studies can be challenging with major impediments being difficulties reaching participants via telephone contact, logistic difficulties due to lack of transportation, ongoing psychiatric symptoms, and significant medical complications. Research staff directly involved in recruitment and retention processes of this study reviewed their experiences. The largest barriers at the macro, mediator, and micro levels identified in this study were inclement weather, transportation difficulties, and intermittent and inaccessible telephone contact. Barrier work-around practices included using the health system’s EHR to obtain current phone numbers, …

The Genetic And Environmental Etiology Of Schizophrenia In Palau, Elora James, William Byerley, Md, Christopher U. Kitalong, Phd

Journal of Health Disparities Research and Practice

Schizophrenia is a chronic, severe, and disabling brain disorder that has been affecting people throughout the world. There is an established worldwide 1% average prevalence of schizophrenia; however there are high degrees of variability between different regions. Palau, an oceanic nation located in Micronesia, has an abnormally high prevalence rate of schizophrenia at 1.99%. When separated by gender, women have abnormal prevalence rate of 1.24%, while the men have a high prevalence rate of 2.77%, which is over twice the average worldwide. There has been a plethora of research conducted over the years to determine the genetic and environmental etiology …

Neurologists Look At Causes Of Baffling Brain Condition, Maggie Freleng

Capstones

It can be hard getting help for someone with mental illness, but almost impossible when that person doesn't think they are sick. At at least half of people with schizophrenia, for example, insist that the voices they hear are real. People who do not know they are ill often refuse therapy and medication -- and their symptoms can spiral out of control. Doctors call this lack of awareness anosognosia. Neurologists are trying to discover what causes this baffling condition--and how to treat it.

Community Mental Health Services And The Prevalence Of Severe Mental Illness In Local Jails: Are They Related, William Fisher, Ira Packer, Lorna Simon, David Smith

Ira K Packer

The excessive prevalence of severe mental illness noted in correctional settings has sometimes been attributed to the inadequacy of community based mental health services. This study examines the prevalence of severe mental illness in two jails situated within catchment areas featuring markedly different levels of community mental health services. We use these settings to test the hypothesis that greater levels of services in a community are associated with lower prevalence of severe mental illness in the community's jail. An epidemiologic approach, using standardized field instruments, was used to estimate the prevalence of major mental illness in detainees arriving at the …

Fieldwork Summary Report-World Health Organization, Anna Cross

Master's Projects and Capstones

My fieldwork experience took place at the World Health Organization in Geneva, Switzerland, where I completed over 420 hours of practical experience. My fieldwork focused in the field of mental health, working on disorders management (psychosis, depression and suicide) and evidence-based research, but more specifically focusing on schizophrenia, premature death in severe mental disorders, and maternal mental health. Although my fieldwork focused within these areas, for the purpose of this final report, I have opted to focus on my contributions to the research around schizophrenia and premature death within severe mental disorders. Specifically, I contributed to multiple fact/information sheets for …

Analysis Of Schizophrenia Data Using A Nonlinear Threshold Index Logistic Model., Zhenyu Jiang, Chengan Du, Assen Jablensky, Hua Liang, Zudi Lu, Yang Ma, Kok Lay Teo

GW Biostatistics Center

Genetic information, such as single nucleotide polymorphism (SNP) data, has been widely recognized as useful in prediction of disease risk. However, how to model the genetic data that is often categorical in disease class prediction is complex and challenging. In this paper, we propose a novel class of nonlinear threshold index logistic models to deal with the complex, nonlinear effects of categorical/discrete SNP covariates for Schizophrenia class prediction. A maximum likelihood methodology is suggested to estimate the unknown parameters in the models. Simulation studies demonstrate that the proposed methodology works viably well for moderate-size samples. The suggested approach is therefore …

Pd_Ngsatlas: A Reference Database Combining Next-Generation Sequencing Epigenomic And Transcriptomic Data For Psychiatric Disorders, Zheng Zhao, Yongsheng Li, Hong Chen, Jianping Lu, Peter M. Thompson, Juan Cheng, Zishan Wang, Juan Xu, Chun Xu, Xia Li

Health & Biomedical Sciences Faculty Publications and Presentations

Background: Psychiatric disorders such as schizophrenia (SZ) and bipolar disorder (BP) are projected to lead the global disease burden within the next decade. Several lines of evidence suggest that epigenetic- or genetic-mediated dysfunction is frequently present in these disorders. To date, the inheritance patterns have been complicated by the problem of integrating epigenomic and transcriptomic factors that have yet to be elucidated. Therefore, there is a need to build a comprehensive database for storing epigenomic and transcriptomic data relating to psychiatric disorders.

Description: We have developed the PD_NGSAtlas, which focuses on the efficient storage of epigenomic and transcriptomic data based …

Re-Hospitalization Of Psychiatric Patients: The Patients, Or The Illness And Treatment?, Amresh Srivastava, Robbie Campbell, Megan Johnston, Ruth Mooser, Larry Stitt

Amresh Srivastava

Purpose: The goal of this project was to find out why psychiatric patients get hospitalised repeatedly. Studies have found that repeated hospitalization leads to economic drain, disability, poor outcome, stigma and discrimination. Hospitalization consumes more than 90% of mental health budgets. Identifying the potential risk factors for repeated hospitalization, interrelationships between risk factors, and vulnerability will help us take the appropriate measures to prevent hospitalization and promote care in the community. Logistically, there are three possible factors which may lead to repeated hospitalization: (1) Characteristics of the patient; (2) Nature of the illness; and (3) The management of the illness …

Pengetahuan Dan Ekspresi Emosi Keluarga Serta Frekuensi Kekambuhan Penderita Skizofrenia, Surya Mulya Fadli, Mitra Mitra

Kesmas

Skizofrenia merupakan gangguan psikotik yang bersifat kronis dan selalu mengalami kekambuhan. Tujuan penelitian adalah untuk mengetahui hubungan faktor keluarga dan kepatuhan minum obat dengan kekambuhan penderita skizofrenia di Rumah Sakit Jiwa Tampan Provinsi Riau tahun 2012. Desain penelitian ini adalah cross sectional study dengan ukuran sampel adalah 50 responden dari keluarga penderita skizofrenia yang berkunjung di poliklinik rawat jalan Rumah Sakit Jiwa Tampan. Analisis data dilakukan secara univariat, bivariat dengan korelasi, regresi linier sederhana, dan uji t independen, multivariat dengan uji regresi linier ganda. Variabel yang berhubungan dengan frekuensi kekambuhan penderita skizofrenia adalah pengetahuan keluarga dan ekspresi emosi keluarga. Pengetahuan …

Baseline Serum Prolactin In Drug-Naive, Firstepisode Schizophrenia And Outcome At Five Years: Is It A Predictive Factor?, Amresh Srivastava, Megan Johnston, Yves Bureau, Nilesh Shah

Amresh Srivastava

Objective: Serum prolactin is influenced by antipsychotic use but its relationships with psychopathology and general functioning are not clear. This study aimed to assess these relationships. Design: Serum prolactin levels were measured in patients with schizophrenia before being treated with antipsychotics and at various follow-up points. Setting: The study was conducted in a nongovernmental psychiatric treatment center in Mumbai, India. Participants: The participants included 30 male and 30 female drug-naïve patients with schizophrenia and 31 control participants. Measurements: The severity of psychopathology at baseline, three weeks, six weeks, and five years following treatment was assessed using a modified Brief Psychiatric …

Early Intervention Of Psychosis And Re! Ections For Programmes In India, Amresh Srivastava

Amresh Srivastava

Mental illness is perhaps the most common and most debilitating among non-communicable diseases. Schizophrenia, for example, normally occurs before the age of 25, affect the most productive years of life. The World Economic Forum graphically illustrates that mental illnesses will be a major contributor to the erosion of gross domestic product over the next 20 years. The developed world has established programs that have proven to be clinically and economically effective and sustainable.[1] Early intervention has played an important role in demonstrating that outcome can be improved if patients are treated in the early phase of illness. It is believed …

A Systematic Review Of Interventions To Increase Mental Health Service Use, Jennifer Greene

USF Tampa Graduate Theses and Dissertations

Relatively few pre-treatment interventions to increase out-patient mental health (MH) service use have been created and experimentally tested. Therefore, not only is there limited availability of these interventions, it is uncertain whether existing interventions are effective. Moreover, it is unclear which components of the interventions are effective. To address these gaps in knowledge, a systematic review of pre-treatment interventions was conducted, using the Cochrane Review methodology. Three primary outcomes were evaluated: attendance at any type of out-patient MH visit; number of appointments of any type of out-patient MH visit; and/or initiation and adherence to psychotropic medication. PubMed and PsycINFO databases …

Suicide From A Global Perspective, Amresh Srivastava

Amresh Srivastava

This book is in 5 volumes, Hard cover and e-book, with 110 Chapters and contributions from more than 30 Countries

Amresh Shrivastava (ed), Megan Kimbrell and David Lester Handbook of Suicide From Global Perspective

Preface by Professor N. Sartorius, MD, PhD

Suicide is the cause of death for nearly one million people a year. Death by suicide is often reported as being due to other causes to avoid stigmatization and other negative consequences of suicide for the family: it can therefore be assumed that the number of people who commit suicide is much higher than this number. Attempts of suicide …

Should ‘Risk Syndrome Of Psychosis’ Be Included In Dsm V As A Diagnosis? A Road Towards Preventive Psychiatry”, Amresh Srivastava

Amresh Srivastava

Psychiatric diagnosis has acquired a position of a quasi-legal document for mental health services and agencies working with mental health. Its utility has gone far beyond ‘clinical diagnosis for treatment’.

The concept of risk syndrome for schizophrenia has been thoroughly researched in last ten years or so. Significant advancement has been made in phenomenology, diagnostic criteria, classification, & neurobiology. The research of prodromal or at-risk or Ultra high-risk psychosis has significantly contributed to the body of knowledge of aetio-pathogenesis of schizophrenia.

The science of risk syndrome has apparently matured and its proponents are ready for its inclusion in DSM V …

Outcome, Early Intervention & Dup: The Matrix Of Research In Early Psychosis, Amresh Srivastava, Megan Johnston

Amresh Srivastava

There has been little investigation of the relationship of DUP to other long-term outcomes such as negative symptoms and cognitive functioning neither have the possible confounds of DUP been widely investigated or controlled. It is important that there should be more thorough investigations of DUP, its correlates, and the extent to which it does mediate any advantages of earlier intervention. Shorter duration of untreated psychosis was associated with greater response to antipsychotic treatment, as measured by severity of global psychopathology, positive symptoms, negative symptoms, and functional outcomes. At the time of treatment initiation, duration of initially untreated psychosis was associated …

Optimizing Outcome Measures For Schizophrenia: From Research To Clinics, Amresh Srivastava, Nina Schoolar, Alexander Miller, Jitenra Trivedi

Amresh Srivastava

Outcome measures in schizophrenia have evolved considerably to bring in more objectivity, uniformity and attempt to reflect ‘real-life’ situation. It has significantly moved away from measurement of symptom remission to assessment of level of functioning and quality of life parameters. Schizophrenia is a complex neurobehavioral disorder afflicting approximately 1% population, with onset in early adolescence, across the world. It cause immense burden of patients, families and caregivers. The economic cost of schizophrenia is enormous. It is therefore important that assessment of schizophrenia be reflective of ground reality, scientific, evidence-based and comprehensive. Several researchers have proposed multidimensional outcome parameters. The heterogeneity …

Neurobiological Markers Of Schizophrenia: Findings From Indian Studies Of Early Psychoses, Amresh Srivastava, Megan Johnston, John John, Harsha Halahalli, Shivarama Varambally Varambally

Amresh Srivastava

Neurobiological Markers of Schizophrenia: Findings from Indian Studies of Early Psychoses. Amresh Srivastava, Megan Johnston, John John, Harsha Halahalli,Shivarama Varambally 1The University of Western Ontario, London, Ontario, Canada/3NIMHANS, Banglore , Karnataka , India OVERALL PANEL PROPOSAL: Advancement in technology together with early intervention studies have revealed a great deal about changes in neurobiological profile of brain in schizophrenia. In last fifteen years , there has been a trend all over the world to study early psychosis from the perspective of not only risk factors and causes of psychosis but also about brain vulnerability to understand what exactly happens that emotional …

Effects Of Duration Of Untreated Psychosis On Long-Term Outcome Of People Hospitalized With First Episode Schizophrenia, Amresh Shrivastava, Nilesh Shah, Megan Johnston, Larry Stitt, Meghana Thakar, Gurusamy Chinnasamy

Amresh Srivastava

Duration of untreated psychosis (DUP) has emerged as a reliable predictor of outcome but continues to remain under scientific scrutiny. The present study examines the effect of differential periods of DUP on long-term outcome of first episode schizophrenia at Mumbai, India. This research was a prospective, 10-year follow-up naturalistic study. Hospitalized patients of first episode schizophrenia were selected and followed up. Results showed that the mean DUP was higher for a group which showed clinical recovery on Clinical Global Impression Scale [14.0 months (SD=8.0) in recovered and 10.8 months (SD=5.7) in non-recovered group (P=0.091)]. DUP was not found to be …

Integrating Social & Clinical Parameters In Outcome Measures Of Schizophrenia: Clinician’S Perspective., Amresh Srivastava, Nilesh Shah, Yves Bureau

Amresh Srivastava

Schizophrenia is a complex neurobehavioral disorder for which there are many promising new treatments. There is, however, a discrepancy in outcome measure reports when they are obtained from patients, relatives, caregivers, or professionals, thus making it difficult to determine the level of recovery. The reason for this lack of agreement may be due to the limitations of the measurement tools themselves, which are not comprehensive and may be measuring different aspects of outcome. Alternatively, it could be that the conceptual understanding of outcome and recovery require development. Unfortunately for one of the above reasons or both, patients assessed as “recovered” …