Medicine and Health Sciences Commons^™

Predictors Of Long-Term Outcome Of First-Episode Schizophrenia: A Ten-Year Follow-Up Study, Amresh Shrivastava, Nilesh Shah, Megan Johnston, Larry Stitt, Meghana Thakar

Amresh Srivastava

Objective: Schizophrenia is a severe mental disorder for which final outcomes continue to be unfavorable. The main objectives of this research were to examine and determine the baseline predictors of outcome status of first-episode schizophrenia in a long-term follow-up of ten years and of recovery ten years later.

Materials and Methods: The study was carried out in a non-governmental, psychiatric hospital and participants consisted of patients available for assessment ten years following their initial diagnosis. Outcome was assessed on clinical and social parameters. Clinical measures of outcome included psychopathology, hospitalization, and suicidality. Social parameters included quality of life functioning, employability, …

Should “Risk Syndrome For Psychosis” Be Included As A Diagnosis In Dsm-V?, Amresh Shrivastava

Amresh Srivastava

No abstract provided.

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 …

Serum Lipids And Suicidality In Early Psychosis: Is There A Connection? A Preliminary Study, Amresh Srivastava, Megan Johnston, Lenore Purde, Robbie Campbell

Amresh Srivastava

No abstract provided.

Psychoendocrinology (Thyroid Hormone) And Early Psychosis: Preliminary Findings, Amresh Srivastava, Megan Johnston, Lenore Purde, Robbie Campbell

Amresh Srivastava

No abstract provided.

Enhancing Risk Assessment Across Mental Health Services, Amresh Srivastava, Megan Johnston, Charles Nelson

Amresh Srivastava

No abstract provided.

Need For Risk Assessment Of Suicide Across Mental Health Services, Amresh Srivastava, Megan Johnstom

Amresh Srivastava

Clinical practice of psychiatry has acquired role and responsibility which goes far beyond traditional expectations .Incident of suicide, particularly, is considered a high liability for then professionals, organizations and the consumer. It also remains a clinical issue which examines can we prevent suicide which in the system of care. Studies have shown about 1 in 6 psychologists or psychiatrist are likely to loose a patient due to suicide in a mean duration of 18-20 years practice. Repeatedly it has demonstrated that clinical skill training for risk assessment is the necessary for all professionals not only in mental health but also …

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 …

To Be Or Not To Be: Education For Clinical Decisions In Risk Assessment Of Suicide Behavior, Amresh Srivastava, Megan Johnston

Amresh Srivastava

Clinical practice of psychiatry has acquired role and responsibility which goes far beyond traditional expectations .Incident of suicide, particularly, is considered a high liability for then professionals, organizations and the consumer. It also remains a clinical issue which examines can we prevent suicide which in the system of care. Studies have shown about 1 in 6 psychologist or psychiatrist are likely to loose a patient due to suicide in a mean duration of 18-20 years practice. Repeatedly it has demonstrated that clinical skill training for risk assessment is the necessary for all professionals not only in mental health but also …

Cognitive Factors In Long Term Outcome Of First Episode Psychosis, Amresh Srivastava, Megan Johnston, Nilesh Shah, Meghana Thakar, Larry Stitt

Amresh Srivastava

Cognitive factors in long term outcome of first episode psychosis

Amresh Shrivastava, Megan Johnston, Nilesh Shah , Meghana Thakar , and Larry Stitt

a Excecutive Director , Mental Health Foundation of India (PRERANA Charitable trust) and Silver Mind Hospital, 209 Shivkripa Complex, Gokhale Road, Thane, Mumbai, Maharashtra, India 400 602, Currently: Assistant Professor of Psychiatry, The University of western Ontario, & associate Scientist, Lawson Health Research Institute, London, Ontario,Canada, E Mail : amresh.edu@gmail.com b Professor of Psychiatry LTMG Hospital, University of Mumbai, Sion, Mumbai, Maharashtra, India 400 022 c Clinical psychologist, Silver Mind Hospital, Mumbai,India d Department of Epidemiology & …

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 …

Cognitive Neurosciences: A New Paradigm In Management And Outcome Of Schizophrenia, Amresh K. Shrivastava, Megan E. Johnston

Amresh Srivastava

No abstract provided.

Predictors And Characteristics Of Response And Nonresponse: A Ten Year Follow-Up Of First Episode Schizophrenia In Mumbai, Amresh Shrivastava, Nilesh Shah, Megan Johnston, Larry Stitt, Meghana Thakar, Gurusamy Chinnasamy

Amresh Srivastava

▪ It is not clearly known what predicts good long-term outcome in first episode schizophrenia and what the characteristics are that differentiate patients who do and do not show good response ▪ We attempted to find the characteristics and predictors of good out-come for patients who presented with severe psychopathology and were hospitalized in their first episode psychosis in a tertiary psychiatric hospital in the city of Mumbai ▪ 101 patients of first episode schizophrenia were assessed at hospitalization, and reassessed at ten years ▪ The data was analyzed on 13 outcome parameters for predictors and characteristics of good outcome, …

Predictors And Characteristics Of Response And Nonresponse: A Ten Year Follow-Up Of First Episode Schizophrenia In Mumbai, Amresh Shrivastava, Nilesh Shah, Megan Johnston, Larry Stitt, Meghana Thakar, Gurusamy Chinnasamy

Amresh Srivastava

▪ It is not clearly known what predicts good long-term outcome in first episode schizophrenia and what the characteristics are that differentiate patients who do and do not show good response ▪ We attempted to find the characteristics and predictors of good out-come for patients who presented with severe psychopathology and were hospitalized in their first episode psychosis in a tertiary psychiatric hospital in the city of Mumbai ▪ 101 patients of first episode schizophrenia were assessed at hospitalization, and reassessed at ten years ▪ The data was analyzed on 13 outcome parameters for predictors and characteristics of good outcome, …

Do Atypical Antipsychotics Differ In Determining Long-Term Outcome Of First Episode Schizophrenia? A Naturalistic Outcome Study In India, Amresh Srivastava, Nilesh Shah, Megan Johnston, Larry Stitt, Meghana Thakar, Gurusamy Chinnasamy, Anukant Mital

Amresh Srivastava

Antipsychotic medications form the mainstream of treatment in schizophrenia. These drugs have several short term as well long term advantage. It is not known if atypical antipsychotics have the long-term effect in improving outcome and meeting expectations (1,2,3). The present study examined usage and association of antipsychotics drugs with clinical outcome a long-term naturalistic study.

Predictors And Characteristics Of Response And Nonresponse: A Ten Year Follow-Up Of First Episode Schizophrenia In Mumbai, Amresh Shrivastava, Nilesh Shah, Megan Johnston, Larry Stitt, Meghana Thakar, Gurusamy Chinnasamy

Amresh Srivastava

▪ It is not clearly known what predicts good long-term outcome in first episode schizophrenia and what the characteristics are that differentiate patients who do and do not show good response ▪ We attempted to find the characteristics and predictors of good out-come for patients who presented with severe psychopathology and were hospitalized in their first episode psychosis in a tertiary psychiatric hospital in the city of Mumbai ▪ 101 patients of first episode schizophrenia were assessed at hospitalization, and reassessed at ten years ▪ The data was analyzed on 13 outcome parameters for predictors and characteristics of good outcome, …

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” …

Redefining Outcome Measures In Schizophrenia: Integrating Social And Clinical Parameters, Amresh Srivastava, Megan Johnston, Nilesh Shah, Yves Bureau

Amresh Srivastava

PURPOSE OF REVIEW: 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, making it difficult to determine the level of recovery. This lack of agreement may result from 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.

RECENT FINDINGS: For various reasons, patients assessed as 'recovered' remain excluded from mainstream society. We are …

Antipsychotics And Outcome In Schizophrenia, Amresh Srivastava, Anukant Mital

Amresh Srivastava

No abstract provided.

What Do We Know About People Who Kill Themselves: A Trajectory For Prevention In Developing Countries., Amresh Srivastava, Megan Johnston

Amresh Srivastava

Abstract: Lecture

Title: What do we know about people who kill themselves: A trajectory for prevention in Developing Countries. Amresh Shrivastava 1, Megan Johnston 2 Address: 1. Department of Psychiatry, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada); Mental Health Foundation of India (PRERANA Charitable Trust) 209 Shivkripa Complex, Gokhale Road, Thane, Mumbai, Maharashtra, India 400 602 (Present Address: Regional Mental Health Care, 467 Sunset Drive, St. Thomas, Ontario, Canada N5H 3V9; 2. Department of Psychology, University of Toronto. About one million people die due to suicide …

Weight Gain In Psychiatric Treatment: Risks, Implications, And Strategies For Prevention And Management, Amresh Srivastava, Megan Johnston

Amresh Srivastava

Weight gain in psychiatric populations is a common clinical challenge. Many patients suffering from mental disorders, when exposed to psychotropic medications, gain significant weight with or without other side effects. In addition to reducing the patients’ willingness to comply with treatment, this weight gain may create added psychological or physiological problems that need to be addressed. Thus, it is critical that clinicians take precautions to monitor and control weight gain and to take into account and treat all problems facing an individual. In this review, we examine some of the key issues surrounding weight gain in individuals suffering from mental …

Persistent Suicide Risk In Clinically Improved Schizophrenia Patients: Challenge Of The Suicidal Dimension, Amresh Shrivastava, Megan Johnston, Nilesh Shah, Marco Innamorati, Larry Stitt, Meghana Thakar, David Lester, Maurizio Pompili

Amresh Srivastava

BACKGROUND: Suicide is a major problem in schizophrenia, estimated to affect 9%-13% of patients. About 25% of schizophrenic patients make at least one suicide attempt in their lifetime. Current outcome measures do not address this problem, even though it affects quality of life and patient safety. The aim of this study was to assess suicidality in long-term clinically improved schizophrenia patients who were treated in a nongovernmental psychiatric treatment centre in Mumbai, India.

METHOD: Participants were 61 patients out of 200 consecutive hospitalized first-episode patients with schizophrenia diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders who were …

Improving Risk Assessment With Suicidal Patients: A Preliminary Evaluation Of The Clinical Utility Of The Scale For Impact Of Suicidality - Management, Assessment And Planning Of Care (Sis-Map), Charles Nelson, Megan Johnston, Amresh Srivastava

Amresh Srivastava

Although a number of suicide risk assessment tools are available to clinicians, the high levels of suicide still evident in society suggest a clear need for new strategies in order to facilitate the prevention of suicidal behaviors. The present study examined the utilization of a new structured clinical interview called the Scale for Impact of Suicidality Management, Assessment and Planning of Care (SIS-MAP). SIS-MAP ratings were obtained from a group of incoming psychiatric patients over a 6-month period at Regional Mental Health Care, St. Thomas, Ontario. A canonical discriminant function analysis resulted in a total 74.0% of original grouped cases …

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

Amresh Srivastava

AIM: Duration of untreated psychosis (DUP), which has emerged as a reliable predictor of outcome continues to remain under scientific scrutiny . The present study examines effect of differential periods of DUP on long-term outcome of first episode schizophrenia at Mumbai, India. Method: This is a prospective, ten year follow up naturalistic study. Hospitalized patients of first episode schizophrenia were selected and followed up Results: The mean DUP was higher for 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 …

Improved Schizophrenia Patient’S Ability To Work And Live Independently In The Community: A Ten-Year Long-Term Outcome Study From Mumbai, India, Amresh Srivastava, Larry Stitt, Meghana Thakar, Nilesh Shah, Gurusamy Chinnasamy

Amresh Srivastava

Background: The outcome of schizophrenia has several determinants. Socio-ecological factors, particularly living conditions, migration, community and culture, not only affect the level of risk but also the outcome. Mega cities around the world show a unique socio-ecological condition which has several challenges for mental health. The present study reports the long-term status of patients with schizophrenia in such a mega city - Mumbai, India. Aim: This study aims to reveal long-term outcome of patients suffering from schizophrenia with special reference to clinical symptoms and social functioning. Methods: The cohort for this study was drawn from a 10-year follow-up of first …

Early Intervention In Psychotic Disorders: Challenges And Relevance In The Indian Context, Matcheri Keshavan, Amresh Shrivastava, Bangalore Gangadhar

Amresh Srivastava

Over the last two decades, there has been an increasing interest in the concept of early intervention (EI) in psychotic disorders, notably schizophrenia. Several lines of research underlie this emerging paradigm shift: (a) an increasingly well-established association between the duration of prolonged untreated illness and poor outcome; (b) evidence of progressive neurobiological changes in the early course of schizophrenia both in the pre-psychotic and psychotic phases, as evidenced by brain imaging studies in schizophrenia; and (c) emerging data, albeit preliminary, suggesting the efficacy and effectiveness of EI programs in improving the outcome in these patients. Mental health service systems across …

Weight-Gain In Psychiatric Treatment: Risks, Implications, And Strategies For Prevention And Management, Amresh Srivastava, Megan Johnston

Amresh Srivastava

Weight-gain in psychiatric populations is a common clinical challenge. Many patients suffering from mental disorders, when exposed to psychotropic medications, gain significant weight with or without other side-effects. In addition to reducing the patients' willingness to comply with treatment, this weight-gain may create added psychological or physiological problems that need to be addressed. Thus, it is critical that clinicians take precautions to monitor and control weight-gain and take into account and treat all problems facing an individual. In this review, we examine some of the key issues surrounding weight-gain in individuals suffering from mental disorders for contemporary practitioners in community …

Lessons Learned From Research In Prodromal Phase Of Schizophrenia, Amresh Shrivastava, Megan Johnston

Amresh Srivastava

In the last ten years, a significant amount of research data has accumulated to identify and predict the vulnerability of individuals to develop psychosis. At a time when DSM-V academia is becoming active with field trials, researchers in prodromal psychosis research are arguing for inclusion of 'risk syndrome for psychosis,' which has generated an interesting debate. Studies indicate that approximately 80-85% of cases experience subsyndromal symptoms for a period lasting from several months to several years prior to the onset of the illness, including impaired perception, thought processes, subjective cognitive functions and mood. Also, much of the functional decline associated …