Substance use and the course of early psychosis: a 2-year follow-up of first-admitted subjects

2003 ◽  
Vol 18 (3) ◽  
pp. 133-136 ◽  
Author(s):  
F. Sorbara ◽  
F. Liraud ◽  
F. Assens ◽  
F. Abalan ◽  
H. Verdoux
Keyword(s):  
Substance Use ◽  
Substance Misuse ◽  
Alcohol Misuse ◽  
Psychotic Symptoms ◽  
Sources Of Information ◽  
Social Outcome ◽  
Course Of Illness ◽  
Increased Risk ◽  
The Impact

AbstractObjectiveTo examine the impact of alcohol and substance use on the early course of psychosis.Methods: First-admitted subjects with psychosis (n = 58) were assessed at 6-month intervals over a 2-year follow-up. Information on substance and alcohol misuse and clinical and social outcome was collected using multiple sources of information.ResultsAfter adjustment for potential confounding factors, subjects with persistent substance misuse over the follow-up were at increased risk of readmission (OR = 3.1; 95%CI = 1.0-9.4; P = 0.05), of presenting with psychotic symptoms (OR = 4.3; 95%CI = 1.0-18.1; P = 0.04), and with a non-continuous course of illness (OR = 11; 95%CI = 1-122; P = 0.05). No significant association was found between substance misuse and social outcome, or between alcohol misuse and clinical and social outcome.ConclusionsPersistent substance misuse after a first admission for psychosis has a deleterious impact on clinical outcome. Early identification and treatment of substance use is essential in the care of subjects with incipient psychosis.

Psychopathological predictors of suicide in patients with major depression during a 5-year follow-up

2001 ◽  
Vol 16 (5) ◽  
pp. 283-288 ◽  
Author(s):  
B. Schneider ◽  
M. Philipp ◽  
M.J. Müller
Keyword(s):  
Major Depression ◽  
Depressive Disorders ◽  
Suicide Attempts ◽  
Psychotic Symptoms ◽  
Mortality Data ◽  
Course Of Illness ◽  
Early Predictors ◽  
Increased Risk ◽  
A Prospective Study

SummaryObjective. It is widely known that the risk of suicide is higher in cases of major depressive disorders in comparison to the general population. The purpose of this study was to examine which psychopathologic symptoms during the index episode are predictors for an increased risk of suicide in the further course of major depression. Method. Mortality data were determined from a prospective study of 280 patients with major depression (DSM-III-R, single episode or recurrent) during a follow-up period of 5 years. The predictive power of different depressive symptoms including psychotic symptoms for suicide risk was investigated. Results. Patients who committed suicide (N = 16) during the follow-up period had reported significantly more often hypochondriacal preoccupations or delusions (but not delusions or preoccupations of impoverishment, guilt or sin), suicidal thoughts and suicide attempts as well as feelings of severe hopelessness during the index episode than still living patients or patients who had died from natural causes. Conclusion. These symptoms seem to be helpful early predictors for the risk of suicide during the further course of illness. This should be taken into account for suicide prevention in the course of major depression.

Improvement in psychological wellbeing among adolescents with a substance use disorder attending an outpatient treatment programme

2021 ◽  
pp. 1-8
Author(s):  
N.M. Gamage ◽  
C. Darker ◽  
B.P. Smyth
Keyword(s):  
Substance Use ◽  
Psychological Symptoms ◽  
Significant Proportion ◽  
Cannabis Use ◽  
Psychological Wellbeing ◽  
Substance Use Treatment ◽  
Disruptive Behaviour ◽  
Treatment Programme ◽  
The Impact

Objectives: Adolescents with substance use disorders (SUDs) exhibit high rates of comorbid psychological problems. This study aimed to examine the impact of an outpatient substance use treatment programme upon the psychological wellbeing of adolescents. Methods: A prospective study was carried out examining psychological symptoms in a group of adolescents attending the Youth Drug and Alcohol (YoDA) Addiction Service in Dublin. Participants were treated with evidenced based psychological models such as cognitive behavioural therapy, motivational interviewing and systemic family therapy. The Becks Youth Inventory was utilised to assess psychological symptoms at treatment entry and repeated three months later at follow up. Results: Among 36 adolescents who were included in this study, poly-substance misuse was the norm. Almost three-quarter had a cannabis use disorder (CUD). There were significant reductions in mean subscale scores of depression (56.0 to 50.8, p = 0.003), anger (55.2 to 49.5, p < 0.001) and disruptive behaviour (61.6 to 56.5, p = 0.002) at follow up. Although there wasn’t a statistically significant reduction in mean scores for anxiety, we observed a significant proportion of participants (p = 0.008) improving and moving out of a moderate to severe symptom range when examined by category. This was also the case for self-concept (p = 0.04). Furthermore this study revealed a positive correlation between the reduction in days of cannabis use and reduction in depressive scores (Pearson correlation 0.49, p = 0.01) among those with a CUD. Conclusion: The findings indicate that substance use treatment for adolescents is associated with important psychological and behavioural improvements.

scholarly journals Associations between left bundle branch block with different PR intervals, QRS durations, heart rates and the risk of heart failure: a register-based cohort study using ECG data from the primary care setting

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001425
Author(s):  
Marc Meller Søndergaard ◽  
Johannes Riis ◽  
Karoline Willum Bodker ◽  
Steen Møller Hansen ◽  
Jesper Nielsen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Heart Rate ◽  
Left Bundle Branch Block ◽  
Bundle Branch Block ◽  
Increased Risk ◽  
Pr Interval ◽  
Qrs Duration ◽  
The Impact

AimLeft bundle branch block (LBBB) is associated with an increased risk of heart failure (HF). We assessed the impact of common ECG parameters on this association using large-scale data.Methods and resultsUsing ECGs recorded in a large primary care population from 2001 to 2011, we identified HF-naive patients with a first-time LBBB ECG. We obtained information on sex, age, emigration, medication, diseases and death from Danish registries. We investigated the association between the PR interval, QRS duration, and heart rate and the risk of HF over a 2-year follow-up period using Cox regression analysis.Of 2471 included patients with LBBB, 464 (18.8%) developed HF during follow-up. A significant interaction was found between QRS duration and heart rate (p<0.01), and the analyses were stratified on these parameters. Using a QRS duration <150 ms and a heart rate <70 beats per minute (bpm) as the reference, all groups were statistically significantly associated with the development of HF. Patients with a QRS duration ≥150 ms and heart rate ≥70 bpm had the highest risk of developing HF (HR 3.17 (95% CI 2.41 to 4.18, p<0.001). There was no association between the PR interval and HF after adjustment.ConclusionProlonged QRS duration and higher heart rate were associated with increased risk of HF among primary care patients with LBBB, while no association was observed with PR interval. Patients with LBBB with both a prolonged QRS duration (≥150 ms) and higher heart rate (≥70 bpm) have the highest risk of developing HF.

Abstract MP25: Obesity, Heart Failure Risk & Cardiorespiratory Fitness

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Peter F Kokkinos ◽  
Puneet Narayan ◽  
Charles Faselis ◽  
Jonathan Myers ◽  
Carl Lavie ◽  
...  
Keyword(s):  
Heart Failure ◽  
Exercise Capacity ◽  
Cardiorespiratory Fitness ◽  
Reference Group ◽  
Normal Weight ◽  
Entire Cohort ◽  
Metabolic Equivalents ◽  
Increased Risk ◽  
The Impact

Introduction: Obesity, defined as body mass index (BMI) ≥30 kg/m 2 , is associated with increased incidence of heart failure (HF). Increased cardiorespiratory fitness (CRF), as indicated by increased exercise capacity, is associated with lower risk of cardiovascular disease and HF. However, the CRF-BMI-HF interaction has not been fully explored. Hypothesis: We assessed the hypothesis that the risk of HF associated with increased BMI is moderated by increased CRF. Methods: We identified 19,881 Veterans (mean age: 58.0±11.3 years) who completed an exercise tolerance test (ETT) to assess either CRF status or suspected ischemia at two VA Medical Centers (Washington DC and Palo Alto, CA). None had documented HF at baseline or evidence of ischemia during the ETT. We established four BMI categories: <25 kg/m 2 ; 25-29.9 kg/m 2 ; 30-34.9 kg/m 2 ; and ≥35 kg/m 2 . In addition, we established four CRF categories based on age-stratified quartiles of peak metabolic equivalents (METs) achieved (mean ± SD): Least-Fit (4.5±1.2 METs; n=4,743); Low-Fit (6.6±1.3; n=5,103); Moderate-Fit (8.0±1.3 METs; n=5,084); and High-Fit (11.1±2.4 METs; n=4,951). Multivariable Cox models were used to estimate hazard ratios (HR) and 95% confidence intervals [CI] for incidence of HF across BMI categories for the entire cohort, using BMI 25-29.9 kg/m 2 (lowest HF rate) as the reference group. We then stratified the cohort by the four BMI categories and assessed HF risk across CRF categories within each stratum, using the Least-fit category as the reference group. The models were adjusted for age, race, gender, cardiac risk factors, sleep apnea, alcohol dependence, medications. Results: During follow-up (median=11.8 years), 2,193 developed HF (10.5 per 1,000 person-years of follow-up). The HF risk for normal weight individuals (18.5-24.9 kg/m2) was 10% higher (p=0.93). For obese individuals, the HF risk was 22% higher in those with BMI 30-34.9 kg/m 2 (HR=1.22; 95% CI: 1.09-1.35) and 50% higher (HR=1.50, 95% CI: 1.32-1.72) for those with BMI ≥35 kg/m 2 . When CRF (peak METs achieved) was introduced in the model, the risk for those with BMI 30-34.9 was reduced from 22% to 16% (HR=1.16; 95% CI: 1.04-1.29) and from 50% to 29% (HR=1.29; 95% CI: 1.13-1.48) among those with ≥35 kg/m 2 . For every 1-MET increase in exercise capacity, HF risk was 15% lower (HR=0.85; 95% CI: 0.83-0.87). We then assessed the impact of CRF on the risk of HF within each of the four BMI categories. The HF risk declined progressively (range: 25% to 69%; p<0.01) with increasing fitness within all BMI categories. Conclusions: The obesity-associated increased risk of HF was attenuated by increased CRF. The HF risk was progressively decreased with increased CRF within all BMI categories.

Abstract 15775: The Impact of B-type Natriuretic Peptide Activation on the Association of Left Ventricular Longitudinal Strain With All-cause Mortality

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Zi Ye ◽  
Maurice Enriquez-Sarano ◽  
Joseph Malouf ◽  
Hector I Michelena ◽  
Allan S Jaffe ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Natriuretic Peptide ◽  
Longitudinal Strain ◽  
Left Ventricular ◽  
Aortic Valve Area ◽  
Increased Risk ◽  
Highly Correlated ◽  
The Impact ◽  
Normal Lvef

Introduction: Left ventricular longitudinal strain (LV-LS) 1) predicts mortality in patients with aortic stenosis (AS) and 2) is highly correlated to type-B natriuretic peptide (BNP) values. The BNP ratio (measured BNP/maximal expected BNP value specific for age and sex) is a powerful independent predictor of death in patients with AS. Hypothesis: we hypothesize that BNP activation (i.e. BNP ratio >1) affects the association between LV-LS and mortality in patients with asymptomatic AS and preserved LV ejection fraction (EF ≥50%). Methods: 315 patients (age 74±12 years, 56% men and mean aortic valve area = 1.02±0.15cm2) underwent simultaneous Doppler echocardiographic and BNP measurements. LV-LS was calculated as the average of 12 LV segments from apical 2- and 4-chamber views using Velocity Vector Imaging. Results: Mean LV-LS was -16.8±3.2%, LV EF 66±7%, median BNP level 121 (interquartile 48-320) pg/ml. 58% of patients had BNP activation. Better LV-LS was associated with lower log BNPratio (regression coefficient 0.10, p<0.001). After a median follow-up of 6.5 yrs (interquartile: 3.6-8.2), 119 deaths occurred. After adjustment for age, sex, Charlson score index, hemoglobin level, aortic valve replacement (as a time dependent variable), LV-LS and log BNPratio were separately associated with increased risk for death (all p<0.01). Further adjustment for predictors of mortality, LV-LS and log-BNP ratio remained associated with increased risk for death (hazard ratio HR [95%CI]: 1.09 [1.03-1.15]; p=0.003 and 1.82 [1.52-2.19]; p<0.0001 respectively). In patients without BNP activation (i.e. normal BNP), LV-LS was associated with mortality (HR: 1.22 [1.04-1.43]; p=0.01) while it was not in patients with BNP activation (p=0.22). Conclusions: In patients with asymptomatic AS, without clinically obvious myocardial impairment (i.e. normal LVEF), a notable proportion of patients present with myocardial alterations detected by an elevated BNPratio or reduced LV-LS. These signs of myocardial alterations were predictive of mortality after diagnosis. Thus both BNP and LV-LS should be assessed in the clinical setting to provide complementary information on prognosis in patients with asymptomatic AS and preserved LV EF.

Comparative data on left atrial appendage occlusion efficacy and clinical outcomes by age group in the Amplatzer™ Amulet™ Occluder Observational Study

EP Europace ◽  
2020 ◽  
Author(s):  
Xavier Freixa ◽  
Boris Schmidt ◽  
Patrizio Mazzone ◽  
Sergio Berti ◽  
Sven Fischer ◽  
...  
Keyword(s):  
Observational Study ◽  
Ischaemic Stroke ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Serious Adverse Events ◽  
Left Atrial Appendage Occlusion ◽  
Increased Risk ◽  
The Impact

Abstract Aims Left atrial appendage occlusion (LAAO) may be considered for patients with non-valvular atrial fibrillation (NVAF) and a relative/formal contraindication to anticoagulation. This study aimed to summarize the impact of aging on LAAO outcomes at short and long-term follow-up. Methods and results We compared subjects aged &lt;70, ≥70 and &lt;80, and ≥80 years old in the prospective, multicentre Amplatzer™ Amulet™ Occluder Observational Study (Abbott, Plymouth, MN, USA). Serious adverse events (SAEs) were reported from implant through a 2-year post-LAAO visit and adjudicated by an independent clinical events committee. Overall, 1088 subjects were prospectively enrolled. There were 265 subjects (24.4%) &lt;70 years old, 491 subjects (45.1%) ≥70 and &lt;80 years old, and 332 subjects (30.5%) ≥80 years old, with the majority (≥80%) being contraindicated to anticoagulation. As expected, CHA2DS2-VASc and HAS-BLED Scores increased with age. Implant success was high (≥98.5%) across all groups, and the proportion of subjects with a procedure- or device-related SAE was similar between groups. At follow-up, the observed ischaemic stroke rate was not significantly different between groups, and corresponding risk reductions were 62, 56, and 85% when compared with predicted rates for subjects &lt;70, ≥70 and &lt;80, and ≥80 years old, respectively. Major bleeding and mortality rates increased with age, while the incidence of device-related thrombus tended to increase with age. Conclusions Despite the increased risk for ischaemic stroke with increasing age in AF patients, LAAO reduced the risk for ischaemic stroke compared with the predicted rate across all age groups without differences in procedural SAEs.

Impact of illness course perception on desire for social distance towards people suffering from schizophrenia in Hanoi, Vietnam

2017 ◽  
Vol 41 (S1) ◽  
pp. S515-S515
Author(s):  
L.K. Martensen ◽  
E. Hahn ◽  
T.D. Cao ◽  
G. Schomerus ◽  
M. Dettling ◽  
...  
Keyword(s):  
Social Distance ◽  
Cultural Context ◽  
Public Perception ◽  
Social Acceptance ◽  
Social Role ◽  
Population Based ◽  
Psychotic Symptoms ◽  
Middle Income ◽  
Course Of Illness ◽  
The Impact

IntroductionIn Vietnam, as well as in other low and middle-income countries, stigmatization and discrimination of mentally ill patients is highly prevalent.ObjectivesIt is important to identify determinants of stigmatization in a socio-cultural context as they may reveal anchor points for anti-stigma efforts.AimsThis population based study conducted in urban and rural Hanoi aims to explore whether public perception of prognosis and course of illness concerning people with symptoms indicating schizophrenia have an impact on the desire for social distance, an important factor of stigmatization.MethodsBased on a population survey using unlabelled vignettes for schizophrenia carried out in the greater Hanoi area in 2013, a sum score of the Social Distance Scale was calculated. A regression analysis was carried out to examine the impact perception of prognostic factors on the desire for social distance. The stratification of the sample (n = 455) was representative in terms of gender, age, urbanity and household size to the Hanoi population according to the 2013 census.ResultsFactor analysis revealed three independent factors of prognosis perception:– 1. lifelong dependency on others;– 2. loss of social integration and functioning;– 3. positive expectations towards treatment outcome.Both negative prognostic ideas (1,2) were significantly correlated with more desire for social distance in schizophrenia.ConclusionStronger desire for social distance was observed among people with negative expectations about the prognosis of persons suffering from psychotic symptoms. Thus, our study indicates a link between social acceptance and ability to maintain a social role in the Vietnamese society.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals The Impact of a Long-Term Rivastigmine and Donepezil Treatment on All-Cause Mortality in Patients With Alzheimer’s Disease

2018 ◽  
Vol 33 (6) ◽  
pp. 385-393 ◽  
Author(s):  
Jakub Kazmierski ◽  
Chaido Messini-Zachou ◽  
Mara Gkioka ◽  
Magda Tsolaki
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Cox Regression ◽  
Symptomatic Treatment ◽  
Risk Of Death ◽  
Increased Risk ◽  
Functional Assessments ◽  
The Impact

Cholinesterase inhibitors (ChEIs) are the mainstays of symptomatic treatment of Alzheimer’s disease (AD); however, their efficacy is limited, and their use was associated with deaths in some groups of patients. The aim of the current study was to assess the impact of the long-term use of ChEIs on mortality in patients with AD. This observational, longitudinal study included 1171 adult patients with a diagnosis of AD treated with donepezil or rivastigmine. Each patient was observed for 24 months or until death. The cognitive and functional assessments, the use of ChEIs, memantine, antipsychotics, antidepressants, and anxiolytics were recorded. The total number of deaths at the end of the observational period was 99 (8.45%). The patients who had received rivastigmine treatment were at an increased risk of death in the follow-up period. The higher risk of death in the rivastigmine group remained significant in multivariate Cox regression models.

scholarly journals Physical Functioning Decline and Mortality in Older Adults With Multimorbidity: Joint Modeling of Longitudinal and Survival Data

2018 ◽  
Vol 74 (2) ◽  
pp. 226-232 ◽  
Author(s):  
Melissa Y Wei ◽  
Mohammed U Kabeto ◽  
Andrzej T Galecki ◽  
Kenneth M Langa
Keyword(s):  
Older Adults ◽  
Mortality Risk ◽  
Physical Functioning ◽  
Survival Data ◽  
Short Form ◽  
Joint Modeling ◽  
Full Spectrum ◽  
Increased Risk ◽  
The Impact

Abstract Background Multimorbidity is common among older adults and strongly associated with physical functioning decline and increased mortality. However, the full spectrum of direct and indirect effects of multimorbidity on physical functioning and survival has not been quantified. We aimed to determine the longitudinal relationship of multimorbidity on physical functioning and quantify the impact of multimorbidity and multimorbidity-attributed changes in physical functioning on mortality risk. Methods The Health and Retirement Study (HRS) is a nationally representative population-based prospective cohort of adults aged 51 or older. In 2000, participants were interviewed about physician-diagnosed chronic conditions, from which their multimorbidity-weighted index (MWI) was computed. Between 2000 and 2011, participants reported their current physical functioning using a modified Short Form-36. With MWI as a time-varying exposure, we jointly modeled its associations with physical functioning and survival. Results The final sample included 74,037 observations from 18,174 participants. At baseline, participants had a weighted mean MWI of 4.6 ± 4.2 (range 0–36.8). During follow-up, physical functioning declined: −1.72 (95% confidence interval [CI] −1.77, −1.67, p < .001) HRS physical functioning units per point MWI in adjusted models. Over follow-up, 6,362 (34%) participants died. Mortality risk increased 8% (hazard ratio 1.08, 95% CI 1.07–1.08, p < .001) per point MWI in adjusted models. Across all population subgroups, MWI was associated with greater physical functioning decline and mortality risk. Conclusions Multimorbidity and its associated decline in physical functioning were significantly associated with increased mortality. These associations can be predicted with an easily interpreted and applied multimorbidity index that can better identify and target adults at increased risk for disability and death.

scholarly journals Reorganisation of faecal microbiota transplant services during the COVID-19 pandemic

Gut ◽  
2020 ◽  
Vol 69 (9) ◽  
pp. 1555-1563 ◽  
Author(s):  
Gianluca Ianiro ◽  
Benjamin H Mullish ◽  
Colleen R Kelly ◽  
Zain Kassam ◽  
Ed J Kuijper ◽  
...  
Keyword(s):  
Healthcare Professionals ◽  
Faecal Microbiota ◽  
Clostridioides Difficile ◽  
Research Activities ◽  
Increased Risk ◽  
Recruitment And Selection ◽  
Spread Of Infection ◽  
The Impact

The COVID-19 pandemic has led to an exponential increase in SARS-CoV-2 infections and associated deaths, and represents a significant challenge to healthcare professionals and facilities. Individual countries have taken several prevention and containment actions to control the spread of infection, including measures to guarantee safety of both healthcare professionals and patients who are at increased risk of infection from COVID-19. Faecal microbiota transplantation (FMT) has a well-established role in the treatment of Clostridioides difficile infection. In the time of the pandemic, FMT centres and stool banks are required to adopt a workflow that continues to ensure reliable patient access to FMT while maintaining safety and quality of procedures. In this position paper, based on the best available evidence, worldwide FMT experts provide guidance on issues relating to the impact of COVID-19 on FMT, including patient selection, donor recruitment and selection, stool manufacturing, FMT procedures, patient follow-up and research activities.

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