Continuity of antipsychotic medication use among migrant and Finnish-born populations with a psychotic disorder: a register-based study

2021 ◽  
pp. 1-11
Author(s):  
Venla Lehti ◽  
Heidi Taipale ◽  
Mika Gissler ◽  
Antti Tanskanen ◽  
Martta Elonheimo ◽  
...  
Keyword(s):  
Psychotic Disorder ◽  
Psychotic Disorders ◽  
Cox Regression ◽  
Sub Saharan Africa ◽  
Antipsychotic Treatment ◽  
Involuntary Hospitalization ◽  
Cox Regression Analysis ◽  
Migrant Populations ◽  
Sub Saharan ◽  
New Treatment

Abstract Background Higher incidence of psychotic disorders and underuse of mental health services have been reported among many migrant populations. This study examines the initiation and continuity of antipsychotic treatment among migrants and non-migrants with a non-affective psychosis during a new treatment episode. Methods This study is based on a nationwide sample of migrants and Finnish-born controls. Participants who were diagnosed with a psychotic disorder in 2011–2014 were identified from the Care Register for Health Care (n = 1693). Information on purchases of antipsychotic drugs in 2011–2015 was collected from the National Prescription Register. The duration of antipsychotic treatment since diagnosis was estimated using the PRE2DUP model. Cox regression analysis was used to study factors that are associated with discontinuing the use of medication. Results There were fewer initiators of antipsychotic treatment after being diagnosed with psychosis among migrants (68.1%) than among Finnish-born patients (73.6%). After controlling for sociodemographic background and factors related to the type of disorder and treatment, migrants were more likely to discontinue medication (adjusted hazard ratio 1.28, 95% confidence interval 1.08–1.52). The risk of discontinuation was highest among migrants from North Africa and the Middle East and Sub-Saharan Africa and among recent migrants. Non-use of antipsychotic treatment before being diagnosed with psychosis, involuntary hospitalization and diagnosis other than schizophrenia were associated with earlier discontinuation both among migrants and non-migrants. Conclusions Migrants with a psychotic disorder are less likely to continue antipsychotic treatment than non-migrants. The needs of migrant patients have to be addressed to improve adherence.

scholarly journals Purchases of psychotropic drugs among the migrant population in Finland: a nationwide register-based cohort study

2020 ◽  
Vol 30 (6) ◽  
pp. 1152-1157
Author(s):  
Venla Lehti ◽  
Jaana Suvisaari ◽  
Mika Gissler ◽  
Niina Markkula
Keyword(s):  
Psychotropic Drugs ◽  
Service Use ◽  
Cox Regression ◽  
Sub Saharan Africa ◽  
Service Needs ◽  
Foreign Born ◽  
Cox Regression Analysis ◽  
Migrant Populations ◽  
Native Populations ◽  
Sub Saharan

Abstract Background Migrant populations may have different mental health service needs when compared with native populations. One indicator of service use is the use of psychotropic medication. The aim of this study was to compare the purchases of psychotropic drugs among different migrant populations with the native population in Finland. Methods Foreign-born participants (n = 184 805) and their Finnish-born controls (n = 185 183) were identified from the Finnish Central Population Register. Information on their purchases of psychotropic drugs in 2011–15 was collected from the National Prescription Register. A washout period of 2009–10 was used to define incident purchases. Cox regression analysis was the statistical method used. Results At least one incident purchase of a psychotropic drug was identified for 11.1% of migrant women, 11.4% of Finnish-born women, 8.7% of migrant men and 9.8% of Finnish-born men. When controlled for age, sex, marital status, socioeconomic status and social assistance, migrants were less likely to purchase psychotropic drugs (adjusted hazard ratio 0.96, 95% confidence interval 0.93–0.98), but there was variation between different drug categories. Recent migrants and migrants from Asia and Sub-Saharan Africa were least likely to purchase drugs. Migrants from Nordic countries and other Western countries most closely resembled the Finnish-born controls. Conclusions Recent migrants in Finland appear to use fewer psychotropic drugs than native Finns. It is important to analyze the reasons for this pattern, as they may indicate delays in access to care or benefits. The heterogeneity of migrant populations must also be considered when developing services to better address their needs.

scholarly journals The effect of non-adherence to antipsychotic treatment on rehospitalization in patients with psychotic disorders

2021 ◽  
Vol 11 ◽  
pp. 204512532110274
Author(s):  
H. Abdullah-Koolmees ◽  
S. Nawzad ◽  
T.C.G. Egberts ◽  
J. Vuyk ◽  
H. Gardarsdottir ◽  
...  
Keyword(s):  
Drug Use ◽  
Psychotic Disorders ◽  
Cox Regression ◽  
First Year ◽  
Antipsychotic Treatment ◽  
Early Discontinuation ◽  
Cox Regression Analysis ◽  
Follow Up Study ◽  
Increased Risk

Background and Aims: Many patients with psychotic disorders are non-adherent to antipsychotic (AP) medication(s), potentially contributing to rehospitalization. It is unknown whether non-adherence in different phases of AP use is associated with rehospitalization. The aim of this study was to assess the association between non-adherence to APs and rehospitalization in patients with psychotic disorders. Non-adherence was assessed specifically for the initiation, continued drug use and early discontinuation of AP use. Methods: A retrospective follow-up study was performed. Adult patients were included at discharge if they suffered from schizophrenia, psychotic, or bipolar I disorder; had been hospitalized in a psychiatric hospital for ⩾7 days; and were treated with oral APs. Patients discharged between January 2006 and December 2009 from Altrecht Mental Health Care were included. Non-adherence was studied in the three phases of medication use: initiation, continued drug use (implementation) and (early) discontinuation after discharge until the end of follow up or until patients were rehospitalized. Cox regression analysis was used to assess the strength of the association between non-adherence for the different phases of AP use and rehospitalization during follow up and expressed as relative risk (RR) with 95% confidence intervals (CI). Results: A total of 417 patients were included. Patients who did not initiate their APs compared with those who did in the first month (RR = 1.62, 95% CI: 1.19–2.19) and between the first and third month after discharge (RR = 1.70, 95% CI: 1.04–2.79) had the highest risk for rehospitalization during follow up. Overall, patients who did not initiate their AP medication within the first year after discharge had a RR of 2.70 (95% CI: 1.97–3.68) for rehospitalization during follow up compared with those that initiated their AP. Conclusion: Not initiating APs right after discharge was associated with an increased risk of rehospitalization. Interventions should aim to promote the initiation of APs soon after discharge to minimize the risk of rehospitalization.

scholarly journals Resting Heart Rate predicts all-cause mortality in sub-Saharan African Patients with Heart Failure: Insight from the Douala Heart failure registry (Do-HF)

2020 ◽  
Author(s):  
Anastase Dzudie ◽  
Blaise Barche ◽  
Sidick Mouliom ◽  
Ariane Nouko ◽  
Fogue Raissa ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Rate ◽  
Cox Regression ◽  
Sub Saharan Africa ◽  
Resting Heart Rate ◽  
Cox Regression Analysis ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Sub Saharan

AbstractBackgroundHigher resting heart rate (HR) is associated with mortality amongst Caucasians with heart failure (HF), but its significance has yet to be established in sub-Saharan Africans in whom HF differs in terms of characteristics and etiologies.ObjectivesWe assessed the association of HR with all-cause mortality in patients with HF in sub-Saharan Africa.MethodsThe Douala HF registry (Do–HF) is an ongoing prospective data collection on patients with HF receiving care at four cardiac referral services in Douala, Cameroon. Patients included in this report were followed-up for 12 months from their index admission, for all-cause mortality. We used Cox-regression analysis to study the association of HR with all-cause mortality during follow-up.ResultsOf 347 patients included, 343 (98.8%) completed follow-up. The mean age was 64±14 years, 176 (50.7%) were female, and median admission HR was 85 bpm. During a median follow-up of 12 months, 78 (22.7%) patients died. Mortality increased steadily with HR increase and ranged from 12.2% in the lower quartile of HR (≤69 bpm) to 34.1% in the upper quartile of HR (>100 bpm). Hazard ratio of 12-month death per 10 bpm higher heart rate was 1.16 (1.04–1.29), with consistent effects across most subgroups, but a higher effect in participants with hypertension vs those without (interaction p=0.044).ConclusionHeart rate was independently associated with increased risk of all-cause mortality in this study, particularly among participants with hypertension. The implication of this finding for risk prediction or reduction should be actively investigated.

scholarly journals Sauna Bathing and Risk of Psychotic Disorders: A Prospective Cohort Study

2018 ◽  
Vol 27 (6) ◽  
pp. 562-569 ◽  
Author(s):  
Tanjaniina Laukkanen ◽  
Jari A. Laukkanen ◽  
Setor K. Kunutsor
Keyword(s):  
Psychotic Disorders ◽  
Cox Regression ◽  
Well Being ◽  
Population Based ◽  
Hazard Ratio ◽  
Male Population ◽  
Cox Regression Analysis ◽  
Sauna Bathing ◽  
General Male Population ◽  
Independent Association

Objective: Sauna bathing has been suggested to promote mental well-being and relaxation, but the evidence is uncertain with respect to mental disorders. We aimed to assess the association of frequency of sauna bathing with risk of psychosis in the Kuopio Ischemic Heart Disease prospective population-based study. Subjects and Methods: Baseline sauna bathing habits were assessed in 2,138 men aged 42–61 years who had no history of psychotic disorders. Participants were classified into three groups based on the frequency of sauna bathing (once, 2–3, and 4–7 times per week). Results: During a median follow-up of 24.9 years, 203 psychotic disorders were recorded. A total of 537, 1,417, and 184 participants reported having a sauna bath once a week, 2–3 times, and 4–7 times per week, respectively. In Cox regression analysis adjusted for age, compared to men who had 1 sauna session per week, the hazard ratio (95% confidence intervals) of psychosis for 4–7 sauna sessions per week was 0.23 (0.09–0.58). In a multivariable model adjusted for several risk factors and other potential confounders, the corresponding hazard ratio was 0.21 (0.08–0.52). The association was similar after further adjustment for total energy intake, socioeconomic status, physical activity, and C-reactive protein (0.22 [0.09–0.54]) and was unchanged on additional adjustment for duration of a sauna session and temperature of the sauna bath (0.23 [0.09–0.57]). Conclusion: Our study suggests a strong inverse and independent association between frequent sauna bathing and the future risk of psychotic disorders in a general male population.

scholarly journals Predictors of three-month mortality among hospitalized older adults in Togo

2020 ◽  
Author(s):  
Fifonsi Adjidossi GBEASOR-KOMLANVI ◽  
Martin Kouame TCHANKONI ◽  
Akila Wimima BAKOUBAYI ◽  
Matthieu Yaovi LOKOSSOU ◽  
Arnold SADIO ◽  
...  
Keyword(s):  
Older Adults ◽  
Hospital Mortality ◽  
Cox Regression ◽  
Sub Saharan Africa ◽  
Mortality Data ◽  
Kaplan Meier ◽  
All Cause Mortality ◽  
Hospitalized Older Adults ◽  
Sub Saharan

Abstract Background: Assessing hospital mortality and its predictors is important as some of these can be prevented through appropriate interventions. Few studies have reported hospital mortality data among older adults in sub-Saharan Africa. The objective of this study was to assess the mortality and associated factors among hospitalized older adults in Togo.Methods: We conducted a prospective cohort study from February 2018 to September 2019 among patients ≥50 years admitted in medical and surgical services of six hospitals in Togo. Data were recorded during hospitalization and through telephone follow-up survey within 90 days after admission. The main outcome was all-cause mortality at 3 months. Survival curves were estimated using the Kaplan-Meier method and Cox regression analyses were performed to assess predictors of mortality.Results: The median age of the 650 older adults included in the study period was 61 years, IQR: [55-70] and at least one comorbidity was identified in 59.7% of them. The all-cause mortality rate of 17.2% (95%CI: 14.4-20.4) and the majority of death (93.7%) occurred in hospital. Overall survival rate was 85.5% and 82.8% after 30 and 90 days of follow-up, respectively. Factors associated with 3-month mortality were the hospital level in the health pyramid, hospitalization service, length of stay, functional impairment, depression and malignant diseases.Conclusion: Togolese health system needs to adjust its response to an aging population in order to provide the most effective care.

scholarly journals Diagnostic validity of ICD-10 acute and transient psychotic disorders and DSM-5 brief psychotic disorder

2017 ◽  
Vol 45 ◽  
pp. 104-113 ◽  
Author(s):  
A.C. Castagnini ◽  
P. Fusar-Poli
Keyword(s):  
Psychotic Disorder ◽  
Psychotic Disorders ◽  
Case Identification ◽  
Migrant Populations ◽  
Diagnostic Categories ◽  
Dsm 5 ◽  
Characteristic Family ◽  
Brief Psychotic Disorder ◽  
Icd 10

AbstractBackground:Short-lived psychotic disorders are currently classified under “acute and transient psychotic disorders” (ATPDs) in ICD-10, and “brief psychotic disorder” (BPD) in DSM-5. This study's aim is to review the literature and address the validity of ATPDs and BPD.Method:Papers published between January 1993 and December 2016 were identified through searches in Web of Science. Reference lists in the located papers provided further sources.Results:A total of 295 articles were found and 100 were included in the review. There were only a few studies about the epidemiology, vulnerability factors, neurobiological correlates and treatment of these disorders, particularly little interest seems to exist in BPD. The available evidence suggests that short-lived psychotic disorders are rare conditions and more often affect women in early to middle adulthood. They also are neither associated with premorbid dysfunctions nor characteristic family predisposition, while there seems to be greater evidence of environmental factors particularly in developing countries and migrant populations. Follow-up studies report a favourable clinical and functional outcome, but case identification has proved difficult owing to high rates of transition mainly either to schizophrenia and related disorders or, to a lesser extent, affective disorders over the short- and longer-terms.Conclusions:Although the lack of neurobiological findings and little predictive power argue against the validity of the above diagnostic categories, it is important that they are kept apart from longer-lasting psychotic disorders both for clinical practice and research. Close overlap between ATPDs and BPD could enhance the understanding of these conditions.

scholarly journals Community perceptions of barriers to management of chronic psychotic disorders and knowledge and attitudes about long-acting injectable antipsychotic medication: qualitative study in Dar es Salaam, Tanzania

BJPsych Open ◽  
2020 ◽  
Vol 6 (2) ◽  
Author(s):  
Carol Blixen ◽  
Isaac Lema ◽  
Jessie Mbwambo ◽  
Sylvia Kaaya ◽  
Jennifer B. Levin ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Focus Groups ◽  
Psychotic Disorders ◽  
Mental Healthcare ◽  
Community Context ◽  
Sub Saharan Africa ◽  
Behavioural Intervention ◽  
Cross Sectional ◽  
Sub Saharan ◽  
Long Acting

Background Low- and middle-income countries (LMICs) experience a disproportionate burden from chronic psychotic disorders (CPDs), which are the most disabling conditions among people aged 10–24 in Sub-Saharan Africa. Poor medication adherence is seen in approximately half of individuals with CPDs in Sub-Saharan Africa, and is a major driver of relapse. A CPD treatment approach that combines the use of long-acting injectable (LAI) antipsychotic medications with a brief and practical customised adherence-enhancement behavioural intervention (CAE-L) was recently developed and tested for use in the USA. Aims To use a qualitative cross-sectional analysis to gather information on potentially modifiable barriers to management of CPDs, and assess attitudes about LAIs from community participants in Tanzania. Findings were intended to refine the CAE-L curriculum for use in Tanzania. Method In-depth interviews and focus groups were conducted with 44 participants (patients with CPD, caregivers, mental healthcare providers). All interviews and focus groups were audiotaped, translated, transcribed and analysed using content analysis, with an emphasis on dominant themes. Results Findings indicated that promoting medication adherence and management of CPDs in the Tanzanian setting needs to consider the individual with CPD, the family, the healthcare setting and the broader community context. Conclusions Qualitative findings enabled the study team to better understand the real-time barriers to medication adherence, LAI use and management of CPDs more broadly. Refinement of the CAE-L is expected to pave the way for an intervention trial for individuals with CPDs that is culturally and linguistically appropriate to the Tanzanian setting.

scholarly journals Malaria and risk of lymphoid neoplasms and other cancer: a nationwide population-based cohort study

BMC Medicine ◽  
2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Katja Wyss ◽  
Fredrik Granath ◽  
Andreas Wångdahl ◽  
Therese Djärv ◽  
Michael Fored ◽  
...  
Keyword(s):  
Cox Regression ◽  
Health Agency ◽  
Malaria Diagnosis ◽  
B Cell Lymphoma ◽  
Population Based ◽  
Sub Saharan Africa ◽  
Lymphoid Neoplasms ◽  
Hazard Ratios ◽  
Increased Risk ◽  
Sub Saharan

Abstract Background Malaria is associated with Burkitt lymphoma among children in Sub-Saharan Africa. No longitudinal studies have assessed the long-term risk of other lymphoma or cancer overall. Here, we investigated the risk of lymphoid neoplasms and other cancer after malaria. Methods We included 4125 patients diagnosed with malaria in Sweden in 1987–2015, identified either through the National Surveillance Database at the Public Health Agency of Sweden, the National Inpatient and Outpatient Register, or by reports from microbiology departments. A comparator cohort (N = 66,997) matched on sex, age and birth region was retrieved from the general population and an additional cohort with all individuals born in Sub-Saharan Africa registered in the Total Population Register in 1987–2015 (N = 171,756). Incident lymphomas and other cancers were identified through linkage with the Swedish Cancer Register. Hazard ratios (HRs) were assessed using Cox regression with attained age as the timescale. Results A total of 20 lymphoid neoplasms and 202 non-haematological cancers were identified among malaria patients during a mean follow-up of 13.3 and 13.7 years, respectively. The overall risk of lymphoid neoplasms was not significantly increased (hazard ratio [HR] 1.24, 95% confidence interval [CI] 0.79–1.94), neither did we find any association with all-site non-haematological cancer (HR 0.89, 95% CI 0.77–1.02). However, in the Sub-Saharan Africa cohort, we observed an increased risk of lymphoid neoplasms after malaria diagnosis (HR 2.39, 95% CI 1.06–5.40), but no difference in the risk of other cancer (HR 1.01, 95% CI 0.70–1.45). The association could not be explained by co-infection with HIV or chronic hepatitis B or C, since the risk estimate was largely unchanged after excluding patients with these comorbidities (HR 2.63, 95% CI 1.08–6.42). The risk became more pronounced when restricting analyses to only including non-Hodgkin and Hodgkin lymphomas (HR 3.49, 95% CI 1.42–8.56). Conclusion Individuals born in malaria-endemic areas and diagnosed with malaria in Sweden had an increased risk of lymphoid neoplasms, especially B cell lymphoma. There was no association with cancer overall nor did single malaria episodes confer an increased risk in travellers.

scholarly journals Effectiveness of antipsychotics used in first-episode psychosis: a naturalistic cohort study

BJPsych Open ◽  
2016 ◽  
Vol 2 (5) ◽  
pp. 323-329 ◽  
Author(s):  
Richard Whale ◽  
Michael Harris ◽  
Gail Kavanagh ◽  
Vijitha Wickramasinghe ◽  
Christopher I. Jones ◽  
...  
Keyword(s):  
Cohort Study ◽  
Treatment Initiation ◽  
Cox Regression ◽  
First Episode ◽  
Antipsychotic Treatment ◽  
Cox Regression Analysis ◽  
Episode Psychosis ◽  
Case Files ◽  
One Year ◽  
Risk Of Treatment

BackgroundOne year of antipsychotic treatment from symptom remission is recommended following a first episode of psychosis (FEP).AimsTo investigate the effectiveness of commonly used antipsychotic medications in FEP.MethodA retrospective cohort study of naturalistic treatment of patients (N = 460) accepted by FEP services across seven UK sites. Treatment initiation to all-cause discontinuation determined from case files.ResultsRisk of treatment discontinuation is greatest within 3 months of treatment initiation. Risperidone had longest median survival time. No significant differences were observed in time to discontinuation between commonly used antipsychotics on multivariable Cox regression analysis. Poor adherence and efficacy failure were the most common reasons for discontinuation.ConclusionsEffectiveness differences appear not to be a current reason for antipsychotic choice in FEP. Adherence strategies and weighing up likely adverse effects should be the clinical focus.

scholarly journals Prognostic Factors of Time to First Abortion After Sexual Debut Among Fragile State Congolese Women: A Survival Analysis

2020 ◽  
Author(s):  
Michael Ekholuenetale ◽  
Charity Ehimwenma Ekholuenetale ◽  
Amadou Barrow
Keyword(s):  
Formal Education ◽  
Cox Regression ◽  
Sexual Debut ◽  
Statistical Significance ◽  
Unwanted Pregnancy ◽  
Total Sample ◽  
Sub Saharan Africa ◽  
High Prevalence ◽  
Sub Saharan ◽  
Adverse Pregnancy

Abstract Background: Despite the common restrictive abortion laws, abortion remains widespread in sub-Saharan Africa (SSA) countries. Women still utilize abortion services and put their lives and health at risk because abortion can only be procured illegally in private facilities such as mid-level or small patent medicine store that may be manned by unskilled providers or through a non-medicated approach. The objective of this study was to determine median years and factors of time to first abortion after sexual debut among Congolese women.Methods: We used data from the most recent Republic of Congo Demographic and Health Survey (DHS). A total sample of 3,622 women aged 15-49 years was analyzed. We estimated the overall prevalence of abortion and median years to first abortion. Furthermore, we examined the factors of time to first abortion after sexual debut using multivariable Cox regression and reported the estimates using adjusted Hazard Ratio (aHR) and 95% confidence intervals (CI). Statistical significance was determined at p<0.05.Results: The prevalence of abortion was 60.0% and median years of time to first abortion after sexual debut was 9.0. The prominent reasons for abortion were due to too short birth interval (23.8%), lack of money (21.0%) and that husband/partner did not need a child at that time (14.0%). Women’s age and region were notable factors in timing to first abortion. Furthermore, women from poorer, middle, richer and richest households had 34%, 67%, 86% and 94% higher risk of abortion respectively, when compared with women from poorest households. Women currently in union/living with a man and formerly in union had 41% and 29% reduction in the risk of abortion respectively, when compared with those never in union. In addition, women with primary and secondary+ education had 42% and 76% higher risk of abortion respectively, when compared with women with no formal education. Conclusion: There was high prevalence of abortion with short years at first abortion. Abortion was associated with women’s characteristics. There is need for unwanted pregnancy prevention intervention and the improvement in pregnancy care to reduce adverse pregnancy outcomes among women.

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