photo extracted from: www.give-us-strength.com

Continuity of care for patients with schizophrenia and other serious mental illnesses is often suboptimal, despite its recognized importance. A new retrospective outcomes study, “Continuity of Care in Patients with Schizophrenia and Schizoaffective Disorder,” presented this week at the Quality of Behavioral Healthcare Conference, reveals significant associations between specific interventions and improved rates of 30-day outpatient follow-up care for patients following hospitalization for schizophrenia or schizoaffective disorder. The study found that such interventions include: direct coordination of care plans by staff at inpatient facilities with staff at outpatient facilities, inpatient facility involvement with regional joint planning efforts, and social work support for patients during the transition from inpatient care to outpatient care. “The interventions shown to be associated with high rates of follow-up care are administrative coordination between the discharging and receiving mental health units that is modest in cost and within the means of most psychiatric units in community treatment systems,” said Jean-Pierre Lindenmayer, MD, study co-author and Director, Psychopharmacology Research Unit, Nathan Kline Institute for Psychiatric Research, Manhattan Psychiatric Center, New York, N.Y. The study authors used data from a retrospective record review of care provided to patients with schizophrenia or schizoaffective disorder, who had been hospitalized for psychiatric care in Missouri and New York state. The study described prevailing patterns of continuity of care for these patients by assessing the percentage of patients receiving outpatient follow-up care within 30 days of inpatient discharge. The authors studied patient factors and facility and system processes associated with receipt of follow-up care within 30 days. Results: Processes Associated with Improved Rates of Follow-Up Care Among the 240 patients included in this analysis, 73 percent had recovery plans in place at the time of discharge, 41 percent received social work support during the transition from inpatient to outpatient care, 29 percent received supportive housing resources and 11 percent participated in a peer-group support program. Three facility-level processes were observed to be significantly associated with improved rates of receiving follow-up care within 30 days of patients being discharged from inpatient settings: — Rates of 30-day follow up were significantly higher among patients who received social work support during the transition from inpatient to ambulatory care settings. Eighty percent of patients with social work support during this period of time had confirmed follow-up care within 30 days, compared to just 68 percent of patients without social work support (p < 0.05). — Of patients discharged from facilities with facility-level protocols for the transfer of care plans to outpatient providers, 83 percent received 30-day follow-up care, compared to 55 percent of patients discharged from other facilities (p < 0.01). — Patients discharged from inpatient facilities that participated in regional joint planning efforts were significantly more likely to receive follow-up care within 30 days than patients receiving care at institutions that did not participate in such efforts (100 percent versus 69 percent , p <0.01). The study authors have concluded that future research should examine specific components of these processes to identify best practices to bolster continuity of care for patients with schizophrenia and schizoaffective disorder. Study Description Data for this study were collected through retrospective medical record review and survey interviews with directors of participating inpatient mental health facilities. Medical records from a total of 240 consecutively discharged patients were reviewed to create the data set. They included 30 patient records from each of the eight inpatient facilities that participated in the analysis, four in Missouri and four in New York state. Participating facilities in each state included a state-operated inpatient facility as well as both urban and rural not-for-profit community hospitals with psychiatric units. Continuity of care processes between the inpatient and outpatient settings were studied. The primary continuity of care-related outcome assessed in this study was receipt of follow-up outpatient psychiatric care within 30 days of the inpatient discharge. This study was supported by Ortho-McNeil Janssen Scientific Affairs, L.L.C. Other organizations involved include Health Research Associates, Seattle, Wash.; Missouri Institute of Mental Health Research Associates, Jefferson City, Mo.; Manhattan Psychiatric Center, Nathan Kline Institute for Psychiatric Research, New York, N.Y.; National Association of County Behavioral Health and Developmental Disability Directors, Washington, D.C. Dr. Lindenmayer and all of these organizations are paid consultants for Ortho-McNeil Janssen Scientific Affairs, L.L.C. About Ortho-McNeil Janssen Scientific Affairs, L.L.C. Ortho-McNeil Janssen Scientific Affairs, L.L.C. is a member of the Johnson & Johnson family of companies. Johnson & Johnson is the world’s largest manufacturer of healthcare products serving the consumer, pharmaceutical and professional markets. Source: Ortho-McNeil Janssen

Extracted from www.newscientist.com 05 April 2010 by Emma Young Magazine issue 2754

“THERE is no great genius without a tincture of madness.” So wrote the Roman philosopher Seneca, nearly 2000 years ago.

Today it is routine for creative geniuses from history to get retrospective diagnoses of mental illness – some more believable than others. Schizophrenia and other forms of psychosis are the most common illnesses cited, with Newton and Einstein among the most famous subjects. Vincent van Gogh and Virginia Woolf have been linked with bipolar disorder.

Few would argue that full-blown psychosis is conducive to creative accomplishment, but perhaps a little bit helps. Psychiatrists view mental health as a spectrum, with serious illness at one end and “normality” at the other. Perhaps those in the middle have enhanced creative tendencies.

Some evidence comes from considering the relative dominance of the right and left hemispheres of the brain. There is much dubious pop psychology written about “right-brain people” and “left-brain people”, but it is accepted that the left side is mainly involved in language and logical analysis, while the right side is more involved in creative thought. Various techniques for studying dominance do seem to show that people with schizophrenia have more right-brain activity.

There is also genetic evidence relating to a protein called neuregulin 1, which is involved in brain development in the womb. Jeremy Hall of the University of Edinburgh, UK, found that a mutation in the gene that codes for the protein is linked to a higher risk of schizophrenia. And last year, Szabolcs Kéri at Semmelweis University in Hungary found that people with two copies of the mutation scored higher on a creativity test than people with one copy, who in turn scored higher than people with no copies (Psychological Science, vol 20, p 1070). Kéri says the mutation might dampen activity in the brain’s prefrontal cortex, easing its usual brake on mood and emotions. This might unleash creativity in some, and psychotic delusions in others – with intelligence perhaps influencing the outcome.

But more work is needed, says Hall. “The evidence for a link between creativity and mental disorders has long been speculated but rarely, if ever, proven.”

14 April 2010

MedWire News: Poor adherence to antipsychotic drugs in outpatients with schizophrenia can be predicted by current alcohol and substance abuse and a history of previous nonadherence, among other factors, researchers report.

Patients who reported poor medication adherence were at increased risk for relapse, hospitalization, and suicide attempts – a largely unexplored consequence of nonadherence.

“Greater understanding of the factors associated with medication nonadherence is needed so that any modifiable risk factors can be identified and managed using appropriate interventions,” say Diego Novick (Lilly Research Centre, Surrey, UK) and colleagues in the journal Psychiatry Research.

At present, it is unclear which factors predict long-term nonadherence to antipsychotic medication among patients with schizophrenia in routine clinical practice, and how the course of illness is influenced by medication nonadherence.

To investigate, the researchers reviewed data from the European Schizophrenia Outpatients Health Outcomes (SOHO) project, a 3-year, prospective, observational study in which outpatients starting or changing antipsychotics were assessed every 6 months.

A total of 6731 patients were included in the analysis. The mean age of the patients was 40.2 years and 57.4% were men.

At the baseline visit, 20.6% of the patients had not been prescribed an antipsychotic in the previous 4 weeks, 61.2% were considered to be adherent, and 18.2% were considered to be non-adherent to medication.

At the 3-year follow-up, 71.2% of the patients were considered to be adherent to antipsychotic medication during the study period, with 28.8% nonadherent.

The strongest predictor of adherence during the study period was adherence in the month before baseline assessment, yielding an odds ratio (OR) of 4.01.

Other predictors for adherence were first-time treatment for schizophrenia (OR=1.37), being socially active (OR=1.26), and higher body mass index (OR=1.02 per one-point BMI increment); while predictors for nonadherence were current alcohol dependence (OR=0.63), hospitalization in the previous 6 months (OR=0.78), and independent living (OR=0.80).

In terms of illness course, adherent patients were more likely to achieve remission (OR=1.46), while nonadherent patients were more likely to relapse (OR=0.58), be hospitalized (OR=0.61), or attempt suicide (OR=0.60).

Novick and colleagues say their findings may allow strategies to improve adherence to be targeted at a high-risk group.

“It is also possible that strategies that address modifiable risk factors associated with nonadherence may lead to improved adherence and also improved patient outcomes,” they comment.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

14 April 2010

MedWire News: Patients with schizophrenia have a higher body mass index (BMI), body surface area, and percentage body fat than healthy age-matched individuals, report researchers who found that the effect was more pronounced in female patients.

Although most patients were using antipsychotic medication, which has previously been linked to obesity, the emergence of a gender effect hints at some underlying propensity towards obesity, say the researchers.

“Over the past decade, research data indicated that the metabolic syndrome and some of its components are more prevalent in patients with schizophrenia than in the general population,” say Melina Siamouli (Asklepeios Mental Hospital, Veroia, Greece) and colleagues in the journal Psychiatry Research.

In the present study the researchers recruited 105 patients with schizophrenia aged an average of 36.3 years and 156 mentally healthy control subjects aged an average of 36.0 years.

Height, weight, waist circumference, and number of cigarettes smoked daily were recorded. Body surface area and BMI were calculated, as was percentage body fat, which is derived from the body’s electrical impedance.

 The researchers found that 31.2% of male patients and 38.6% of female patients were clinically obese (defined by a BMI of 30 kg/m2 or more) compared with 16.5% and 12.3% of male and female controls, respectively.

Similarly, mean percentage body fat was also higher in the patient group than the controls (male: 26.4%, female: 33.2% versus m: 25.0%, f: 30.2%) as was body surface area.

Analysis of variance showed that the apparent gender effect, whereby female patients were more prone than males to obesity, remained after multiple correction.

Discussing their findings the researchers note that percentage body fat correlated well with body weight, BMI, and waist circumference and could be a useful additional monitoring tool in patients suffering from schizophrenia.

“There is a need for close physical health monitoring and for the development of intervention programs in order to reduce risk and improve long-term health in schizophrenic patients,” Siamouli et al conclude.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

ScienceDaily (Apr. 5, 2010) — For many people, remembering to take a daily medication can be the difference between life and death. Yet, people forget all the time. Now a landmark study from North Carolina State University has found that changes in daily behavior have a significant effect on whether we remember to take our medication – and that these changes influence older and younger adults differently. That’s good news, because it means there’s something we can do about it.

“We’ve found that it is not just differences between people, but differences in what we do each day, that affect our ability to remember to take medication,” says Dr. Shevaun Neupert, an assistant professor of psychology at NC State and lead author of a paper describing the research. “This is the first time anyone has looked at the effect daily changes in how busy we are affects our ability to remember medications. We also learned that these changes in daily behavior affect different age groups in different ways. “For example, young people do the best job of remembering to take their medication on days when they are busier than usual,” Neupert says. “But older adults do a better job of remembering their medication on days when they are less busy.” The researchers evaluated study participants who were on prescribed daily medications. The participants were divided into two groups: younger adults (between the ages of 18 and 20) and older adults (between the ages of 60 and 89). For both age groups, the researchers found that participants were more likely to remember to take their medications on days when they performed better than usual on “cognition” tests – which evaluate memory and critical thinking. “We found that cognition is an important factor in remembering medications,” Neupert says, “but that how busy we are is also important.” This has very real applications for helping people remember to take medications that can be essential to their health and well-being. “We’ve found such a disparity between young and old adults, that it’s clear we need to tailor our messages to these two groups,” Neupert says. “For example, it is important for young people to stay busy and be active. That will help them remember to take their medications. However, we need to let older adults know that need to be particularly vigilant about remembering medication on days when they expect to be busier than usual.” The study, “Age Differences in Daily Predictors of Forgetting to Take Medication: The Importance of Context and Cognition,” will be published in a forthcoming issue of Experimental Aging Research. It was co-authored by Neupert, NC State graduate student Taryn Patterson, former NC State undergraduate Agnes Davis and Dr. Jason Allaire, an associate professor of psychology at NC State. The research was funded by a gift from Vasudha Gupta. NC State’s Department of Psychology is part of the university’s College of Humanities and Social Sciences.

A very enlightening, well referenced documentary by David Suzuki’s The Nature of Things. Something everyone should see. Follow this link to watch it now: http://www.cbc.ca/documentaries/natureofthings/2010/downsideofhigh/

A new study finds that young adults who have used cannabis or marijuana for a longer period of time appear more likely to have hallucinations or delusions or to meet criteria for psychosis.

ScienceDaily (Mar. 2, 2010) — Young adults who have used cannabis or marijuana for a longer period of time appear more likely to have hallucinations or delusions or to meet criteria for psychosis, according to a report posted online that will appear in the May print issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

Previous studies have identified an association between cannabis use and psychosis, according to background information in the article. However, concerns remain that this research has not adequately accounted for confounding variables.

John McGrath, M.D., Ph.D., F.R.A.N.Z.C.P., of the Queensland Brain Institute, University of Queensland, Australia, and colleagues studied 3,801 young adults born between 1981 and 1984. At a 21-year follow-up, when participants were an average age of 20.1, they were asked about cannabis use in recent years and assessed using several measures of psychotic outcomes (including a diagnostic interview, an inventory of delusions and items identifying the presence of hallucinations).

At the 21-year follow-up, 17.7 percent reported using cannabis for three or fewer years, 16.2 percent for four to five years and 14.3 percent for six or more years. Overall, 65 study participants received a diagnosis of “non-affective psychosis,” such as schizophrenia, and 233 had at least one positive item for hallucination on the diagnostic interview.

Among all the participants, a longer duration since the first time they used cannabis was associated with multiple psychosis-related outcomes. “Compared with those who had never used cannabis, young adults who had six or more years since first use of cannabis (i.e., who commenced use when around 15 years or younger) were twice as likely to develop a non-affective psychosis and were four times as likely to have high scores on the Peters et al Delusions Inventory [a measure of delusion],” the authors write. “There was a ‘dose-response’ relationship between the variables of interest: the longer the duration since first cannabis use, the higher the risk of psychosis-related outcomes.”

In addition, the researchers assessed the association between cannabis use and psychotic symptoms among a subgroup of 228 sibling pairs. The association persisted in this subgroup, “thus reducing the likelihood that the association was due to unmeasured shared genetic and/or environmental influences,” the authors continue.

“The nature of the relationship between psychosis and cannabis use is by no means simple,” they write. Individuals who had experienced hallucinations early in life were more likely to have used cannabis longer and to use it more frequently. “This demonstrates the complexity of the relationship: those individuals who were vulnerable to psychosis (i.e., those who had isolated psychotic symptoms) were more likely to commence cannabis use, which could then subsequently contribute to an increased risk of conversion to a non-affective psychotic disorder.”

The findings should encourage further research to elucidate the mechanisms underlying the relationship between psychosis and cannabis use, the authors conclude.

This work was funded by the National Health and Medical Research Council of Australia. Co-author Dr. Alati is funded by a National Health and Medical Research Council Career Development Award in Population Health.

For Immediate Release – March 1, 2010 – (TORONTO) – CrossCurrents: The Journal of Addiction and Mental Health has launched an interactive, online edition. At www.camhcrosscurrents.net, you can read about the latest developments in the mental health and addiction fields, and interact with other front-line professionals to enhance your knowledge. It’s the next step for CrossCurrents, which since 1998 has educated front-line and allied professionals about the emerging issues in addiction and mental health. It is published by the Centre for Addiction and Mental Health (CAMH) in Toronto, one of North America’s largest addiction and mental health clinical and research facilities. Each theme-based issue features professionally written stories, personal perspectives, research summaries and debates columns that challenge readers to reflect on their practice in innovative ways. Do you want to have your say in the debate about whether Internet addiction is a valid disorder requiring specialized treatment? Would you like to share your experience of how social networks are blurring the lines between private and professional boundaries in clinical care? Are you interested in learning how hospitals are changing seclusion and restraints practices that can retraumatize people with histories of trauma? With the addition of forums, blogs and other interactive online features, CrossCurrents online lets you exchange ideas, expertise and information about topics like these. “CrossCurrents is going online so busy practitioners can easily find the information they want, when they want it,” says executive editor, Dr. Kwame McKenzie. “People can also get involved and exchange ideas and experiences. It’s a chance to be part of a community of practitioners that spans across Canada and internationally.” Recent themes include advances in schizophrenia treatment and research, supported employment and clinical implications of the Internet. Upcoming themes include stigma by health care professionals, men’s mental health and addiction, chronic disease management and prescription medication. Join us at www.camhcrosscurrents.net as we evolve. Take advantage of the opportunity to share information, expertise and experience with other front-line professionals across Canada and around the world.