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- Björkenstam, C., et al.
(författare)
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Suicide in first episode psychosis : A nationwide cohort study
- 2014
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Ingår i: Schizophrenia Research. - : Elsevier BV. - 0920-9964 .- 1573-2509. ; 157:1-3, s. 1-7
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Tidskriftsartikel (refereegranskat)abstract
- Background: Relatively little is known about suicide in diagnostic subtypes of first episode psychosis (FEP). Our aim was to assess suicide rates and potential risk factors for suicide in FEP. Methods: This is a national register-based cohort study of patients born in 1973-1978 in Sweden and who were hospitalized with a FEP between ages 15 and 30 years (n = 2819). The patients were followed from date of discharge until death, emigration, or 31st of December 2008. The suicide rates for six diagnostic subtypes of FEP were calculated. Suicide incidence rate ratios (IRRs) were calculated to evaluate the association between suicide and psychiatric, familial, social, and demographic factors. Results: In total 121 patients died by suicide. The overall suicide rate was 4.3 (95% confidence interval [CI] 3.5-5.0) per 1000 person-years. The highest suicide rates were found in depressive disorder with psychotic symptoms and in delusional disorder. In an adjustedmodel, the strongest risk factors for suicide were self-harm (IRR 2.7, CI 1.7-4.4) or a conviction for violent crime (IRR 2.0, CI 1.3-3.2). Also having a first-degree relative with a schizophrenia/bipolar diagnosis (IRR 2.1, CI 1.2-3.6) or substance use disorder (IRR 2.0, CI 1.2-3.2) were significant risk factors for suicide. Conclusions: Impulsive behavior such as self-harm as well as having a family history of severe mental disorder or substance use are important risk factors for suicide in FEP.
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- Björkenstam, E., et al.
(författare)
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A five year diagnostic follow-up of 1840 patients after a first episode non-schizophrenia and non-affective psychosis
- 2013
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Ingår i: Schizophrenia Research. - : Elsevier BV. - 0920-9964 .- 1573-2509. ; 150:1, s. 205-210
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveIt is not clear which patients with a first psychotic episode will develop schizophrenia. We performed a diagnostic follow-up of patients treated for a first time non-affective, non-schizophrenia psychosis and explored potential predictors of a subsequent schizophrenia or schizoaffective diagnosis.MethodsThis register-based cohort study comprises individuals born between 1973 and 1978 in Sweden, with a first hospital-treated psychosis excluding schizophrenia, schizoaffective disorder, bipolar disorder and depressive disorder with psychotic symptoms (n = 1840). The patients were followed for five years regarding subsequent diagnoses. Psychiatric, social, family history of psychiatric illness, premorbid intellectual level, head injuries and obstetrical complications were investigated by logistic regression as predictors of schizophrenia or schizoaffective diagnosis.ResultsDuring the follow-up, 18% were diagnosed with schizophrenia or schizoaffective disorder, 5% were diagnosed with bipolar disorder, whereas 29% were not re-admitted to a psychiatric clinic. Patients with a first-degree relative hospitalized for schizophrenia and/or bipolar disorder had an increased risk of subsequent diagnosis for schizophrenia or schizoaffective disorder (odds ratio 1.9 and 95% confidence interval 1.1 to 3.0)), whereas previous severe criminality was associated with a decreased risk (odds ratio 0.5, 95% confidence interval 0.3–0.8).ConclusionDiagnostic outcome was diverse after a first non-schizophrenia and non-affective psychosis. Family history of severe mental illness and no previous conviction for severe criminality were the strongest risk factors for a future schizophrenia or schizoaffective diagnosis.
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- Boden, Robert, et al.
(författare)
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Early non-adherence to medication and other risk factors for rehospitalization in schizophrenia and schizoaffective disorder
- 2011
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Ingår i: Schizophrenia Research. - : Elsevier BV. - 0920-9964 .- 1573-2509. ; 133:1-3, s. 36-41
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Tidskriftsartikel (refereegranskat)abstract
- Non-adherence to antipsychotic medication and hospitalization in psychotic disorders are common and costly problems. Our aim was to identify risk factors for rehospitalization of patients with recent onset schizophrenia or schizoaffective disorder in a population-based cohort study. All patients with a first hospitalization for schizophrenia or schizoaffective disorder between 2006 and 2007 were included (n = 861). Patients were identified through and data retrieved from national Swedish health and population registers. We investigated how socio-demographic variables, duration of first hospitalization and prescription fills of antipsychotics were associated with rehospitalization in Cox regression models. A higher risk for rehospitalization within 28 days was observed in patients with a first hospitalization that was shorter than two weeks compared with patients who were hospitalized for more than four weeks: hazard ratio (HR) 2.30,95% confidence interval (CI) 1.42 to 3.74. Further, patients who did not fill a prescription of antipsychotics within the first week after discharge had a higher risk of early rehospitalization than patients who were given antipsychotics (HR 1.75, 95% CI 1.13 to 2.72). More than 12 years of education was associated with a lower risk of early rehospitalization (HR 0.44,95% CI 0.26 to 0.77). Sex, age, being born in Sweden, urban area residence and prescription fills of antipsychotics prior to first admission did not significantly affect the risk of early rehospitalization. In conclusion, we identified two potentially modifiable risk factors for rehospitalization: short duration of initial hospitalization and early non-adherence to medication.
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- Fatouros-Bergman, Helena, et al.
(författare)
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Meta-analysis of cognitive performance in drug-naive patients with schizophrenia
- 2014
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Ingår i: Schizophrenia Research. - : Elsevier BV. - 0920-9964 .- 1573-2509. ; 158:1-3, s. 156-162
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Tidskriftsartikel (refereegranskat)abstract
- Cognitive deficits represent a significant characteristic of schizophrenia. However, a majority of the clinical studies have been conducted in antipsychotic drug treated patients. Thus, it remains unclear if significant cognitive impairments exist in the absence of medication. This is the first meta-analysis of cognitive findings in drug-na ve patients with schizophrenia. Cognitive data from 23 studies encompassing 1106 patients and 1385 controls published from 1992 to 2013 were included. Tests were to a large extent ordered in cognitive domains according to the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) battery. Analysis was performed with STATA using the random-effects model and heterogeneity as well as Egger's publication bias was assessed. Overall the results show that patients performed worse than healthy controls in all cognitive domains with medium to large effect sizes. Verbal memory, speed of processing and working memory were three of the domains with the greatest impairments. The pattern of results is in line with previous meta-analytic findings in antipsychotic treated patients. The present meta-analysis confirms the existence of significant cognitive impairments at the early stage of the illness in the absence of antipsychotic medication.
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- Fazel, Seena, et al.
(författare)
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Homicide in discharged patients with schizophrenia and other psychoses : a national case-control study.
- 2010
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Ingår i: Schizophrenia Research. - : Elsevier BV. - 0920-9964 .- 1573-2509. ; 123:2-3, s. 263-9
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate factors associated with homicide after discharge from hospital in patients with schizophrenia and other psychoses.DESIGN: All homicides committed by patients with psychosis within 6 months of hospital discharge were identified in Sweden from 1988-2001 and compared with patients with psychoses discharged over the same time period who did not subsequently commit any violent offences. Medical records were then collected, and data extracted using a validated protocol. Interrater reliability tests were performed on a subsample, and variables with poor reliability excluded from subsequent analyses.RESULTS: We identified 47 cases who committed a homicide within 6 months of discharge, and 105 controls who did not commit any violent offence after discharge. On univariate analyses, clinical factors on admission associated with homicide included evidence of poor self-care, substance misuse, and being previously hospitalized for a violent episode. Inpatient characteristics included having a severe mental illness for one year prior to admission. After-care factors associated with homicide were evidence of medication non-compliance and substance misuse. The predictive validity of combining two or three of these factors was not high. Depression appeared to be inversely associated with homicide, and there was no relationship with the presence of delusions or hallucinations.CONCLUSIONS: There are a number of potentially treatable factors that are associated with homicide in schizophrenia and other psychoses. Associations with substance misuse and treatment compliance could be the focus of therapeutic interventions if validated in other samples. However, their clinical utility in violence risk assessment remains uncertain.
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