Clinical phenomenology of the prodrome for psychosis

2020 ◽  
pp. 105-112
Author(s):  
Albert R. Powers III ◽  
Thomas H. McGlashan ◽  
Scott W. Woods
Keyword(s):  
Cognitive Impairment ◽  
Clinical Epidemiology ◽  
High Reliability ◽  
Research Effort ◽  
Clinical High Risk ◽  
Increased Risk ◽  
Follow Up Studies ◽  
Clinical Phenomenology ◽  
Epidemiology Studies

More than 100 years of retrospective studies show that psychosis is usually preceded by a prodrome. Nonspecific symptoms such as anxiety and depression precede more specific negative and attenuated positive symptoms. Prospective diagnostic criteria have been developed based on the retrospective work. The prospective criteria have shown high reliability in the research context, and follow-up studies demonstrate that those assessed as at clinical high risk (CHR) are five to seven times more likely to progress to psychosis as those who are not. Functional and cognitive impairment and distress accompany the increased risk. CHR diagnosis rates in general epidemiology studies are low, supporting validity, but rates in clinical epidemiology studies are substantially higher, suggesting that CHR constitutes an important but often overlooked clinical entity. Despite this importance, several areas in need of additional research effort are identified.

scholarly journals Long-term glycemic variability and risk of stroke in patients with diabetes: a meta-analysis

2022 ◽  
Vol 14 (1) ◽  
Author(s):  
Xiaoli Ren ◽  
Zhiyun Wang ◽  
Congfang Guo
Keyword(s):  
Standard Deviation ◽  
Coefficient Of Variation ◽  
Meta Analysis ◽  
Glycemic Variability ◽  
Diabetic Patients ◽  
Increased Risk ◽  
Follow Up Studies ◽  
Patients With Diabetes

Abstract Objectives Long-term glycemic variability has been related to increased risk of vascular complication in patients with diabetes. However, the association between parameters of long-term glycemic variability and risk of stroke remains not fully determined. We performed a meta-analysis to systematically evaluate the above association. Methods Medline, Embase, and Web of Science databases were searched for longitudinal follow-up studies comparing the incidence of stroke in diabetic patients with higher or lower long-term glycemic variability. A random-effect model incorporating the potential heterogeneity among the included studies were used to pool the results. Results Seven follow-up studies with 725,784 diabetic patients were included, and 98% of them were with type 2 diabetes mellitus (T2DM). The mean follow-up duration was 7.7 years. Pooled results showed that compared to those with lowest category of glycemic variability, diabetic patients with the highest patients had significantly increased risk of stroke, as evidenced by glycemic variability analyzed by fasting plasma glucose coefficient of variation (FPG-CV: risk ratio [RR] = 1.24, 95% confidence interval [CI] 1.11 to 1.39, P < 0.001; I2 = 53%), standard deviation of FPG (FPG-SD: RR = 1.16, 95% CI 1.02 to 1.31, P = 0.02; I2 = 74%), HbA1c coefficient of variation (HbA1c-CV: RR = 1.88, 95% CI 1.61 to 2.19 P < 0.001; I2 = 0%), and standard deviation of HbA1c (HbA1c-SD: RR = 1.73, 95% CI 1.49 to 2.00, P < 0.001; I2 = 0%). Conclusions Long-term glycemic variability is associated with higher risk of stroke in T2DM patients.

scholarly journals Anxiety and clinical outcomes of patients with acute coronary syndrome: a meta-analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e034135 ◽  
Author(s):  
Jie Li ◽  
Feng Ji ◽  
Junxian Song ◽  
Xiangyang Gao ◽  
Deguo Jiang ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Clinical Outcomes ◽  
Mortality Risk ◽  
Meta Analysis ◽  
Secondary Outcome ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
Follow Up Studies ◽  
Poor Outcomes

ObjectivesAnxiety has been suggested to be associated with poor outcomes in patients with acute coronary syndrome (ACS). However, results of previous follow-up studies were inconsistent. The aim of this meta-analysis was to evaluate the association between anxiety and clinical outcomes in patients with ACS, and to investigate the potential role of depression underlying the above association.DesignA meta-analysis of prospective follow-up studies.SettingHospitals.ParticipantsPatients with ACS.InterventionsWe included related prospective follow-up studies up through 20 July 2019 that were identified by searching PubMed and Embase databases. A random-effect model was used for the meta-analysis. Anxiety was evaluated by validated instruments at baseline.Primary and secondary outcome measuresWe determined the association between anxiety and risks of mortality and adverse cardiovascular events (MACEs) in patients with ACS.ResultsOur analysis included 17 studies involving 39 038 patients wqith ACS. Anxiety was independently associated with increased mortality risk (adjusted risk ratio (RR) 1.21, 95% CI 1.07 to 1.37, p=0.002) and MACEs (adjusted RR 1.47, 95% CI 1.24 to 1.74, p<0.001) in patients with ACS. Subgroup analyses showed that depression may at least partly confound the association between anxiety and poor outcomes in patients with ACS. Adjustment of depression significantly attenuated the association between anxiety and MACEs (adjusted RR 1.25, 95% CI 1.04 to 1.52, p=0.02). Moreover, anxiety was not significantly associated with mortality risk after adjusting for depression (adjusted RR 0.88, 95% CI 0.66 to 1.17, p=0.37).ConclusionsAnxiety is associated with increased risk of mortality and MACEs in patients with ACS. However, at least part of the association may be confounded by concurrent depressive symptoms in these patients.

Mild Cognitive Impairment and Alzheimer Disease

2021 ◽  
pp. 662-671
Author(s):  
Philip W. Tipton ◽  
Nilüfer Ertekin-Taner
Keyword(s):  
Clinical Trials ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Alzheimer Disease ◽  
Activities Of Daily Living ◽  
Cognitive Decline ◽  
Increased Risk ◽  
Intervention Point ◽  
Risk Of Progression

Many patients who have Alzheimer disease (AD) present initially with mild cognitive impairment (MCI). This chapter reviews the clinical features of MCI and AD, the clinical evaluation of patients with these entities, and the approaches to management. MCI is defined by cognitive decline that is more than expected by aging alone but does not meet criteria for dementia because the person has the ability to perform activities of daily living. MCI is considered to be a prodrome to dementia, especially AD, given the increased risk of progression to dementia. MCI, which probably represents the earliest stages of dementia in many patients, requires clinical follow-up and is expected to become an important intervention point in future clinical trials of novel preventive therapies.

scholarly journals Designing Epidemiology Studies to Determine the Incidence and Prevalence of Encapsulating Peritoneal Sclerosis (EPS)

2015 ◽  
Vol 35 (7) ◽  
pp. 678-682 ◽  
Author(s):  
Dorothea Nitsch ◽  
Andrew Davenport
Keyword(s):  
Significant Risk ◽  
Significant Risk Factor ◽  
Epidemiological Studies ◽  
Length Of Treatment ◽  
Current Test ◽  
Number Of Patients ◽  
Increased Risk ◽  
Different Types ◽  
Epidemiology Studies

The reported incidence and prevalence of encapsulating peritoneal sclerosis (EPS) varies markedly between North America, Europe, Japan, and Australia. Although this could reflect differences in clinical practice patterns and access to transplantation as there is no current test for early detection, and some patients may present many years after discontinuation of peritoneal dialysis (PD), there are concerns about under-reporting, particularly for those with milder forms. Currently, only PD vintage has been identified as a significant risk factor for developing EPS, although some patients can develop EPS within months of starting PD. As such, there is a need for epidemiological studies to determine the incidence and prevalence of EPS to allow for patient education and counselling in terms of dialysis modality choice and length of treatment. In addition, carefully designed epidemiological studies could potentially allow for the identification of risk factors and bio-markers that could then be used to identify patients at increased risk of developing EPS in the future. Typically, studies to date have been underpowered with inadequate longitudinal follow-up. We review the different types of epidemiological studies and provide information as to the number of patients to be recruited and the duration of follow-up required to determine the incidence and prevalence of EPS.

Diabetes is associated with cognitive impairment no dementia in the aging, demographics, and memory study (ADAMS)

2012 ◽  
Vol 25 (1) ◽  
pp. 167-168 ◽  
Author(s):  
Christine E. Gould ◽  
Sherry A. Beaudreau ◽  
Huma Salman
Keyword(s):  
Diabetes Mellitus ◽  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Cognitive Decline ◽  
Vascular Dementia ◽  
Increased Risk ◽  
Cognitive Impairment No Dementia

Individuals with diabetes mellitus have a 1.39 times increased risk of Alzheimer's disease, a 2.38 times increased risk of vascular dementia, and a faster rate of cognitive decline compared to individuals without diabetes (Lu et al., 2009). In a study, over a 9-year follow-up diabetes was associated with accelerated progression from mild cognitive impairment (MCI) to dementia, but was not associated with progression from no impairment to MCI (Xu et al., 2010). Many previous studies on cognitive impairment and diabetes are limited by the use of cognitive screens to diagnose and assess cognitive impairment. A few studies diagnosing cognitive impairment with comprehensive neuropsychological batteries provide mixed results. For instance, Luchinger et al. (2007) found that diabetes was correlated with the presence of MCI, whereas diabetes was not associated with the presence of dementia versus no dementia in the Aging, Demographics, and Memory Study ADAMS; (Llewellyn et al., 2010).

scholarly journals Assessing short-term risk of ischemic stroke in relation to all prescribed medications

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Imre Janszky ◽  
Ioannis Vardaxis ◽  
Bo Henry Lindqvist ◽  
Jens Wilhelm Horn ◽  
Ben Michael Brumpton ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Odds Ratio ◽  
Crossover Design ◽  
Lasso Regression ◽  
Short Term ◽  
Case Crossover ◽  
Increased Risk ◽  
Follow Up Studies ◽  
Prescription Databases

AbstractWe examined the short-term risk of stroke associated with drugs prescribed in Norway or Sweden in a comprehensive, hypothesis-free manner using comprehensive nation-wide data. We identified 27,680 and 92,561 cases with a first ischemic stroke via the patient- and the cause-of-death registers in Norway (2004–2014) and Sweden (2005–2014), respectively, and linked these data to prescription databases. A case-crossover design was used that compares the drugs dispensed within 1 to 14 days before the date of ischemic stroke occurrence with those dispensed 29 to 42 days before the index event. A Bolasso approach, a version of the Lasso regression algorithm, was used to select drugs that acutely either increase or decrease the apparent risk of ischemic stroke. Application of the Bolasso regression algorithm selected 19 drugs which were associated with increased risk for ischemic stroke and 11 drugs with decreased risk in both countries. Morphine in combination with antispasmodics was associated with a particularly high risk of stroke (odds ratio 7.09, 95% confidence intervals 4.81–10.47). Several potentially intriguing associations, both within and across pharmacological classes, merit further investigation in focused, follow-up studies.

scholarly journals Predictors of Incident Mild Cognitive Impairment and Its Course in a Diverse Community-Based Population

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000013017
Author(s):  
Milou J Angevaare ◽  
Jet M.J. Vonk ◽  
Laiss Bertola ◽  
Laura Zahodne ◽  
Caitlin Wei-Ming Watson ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Leisure Activities ◽  
Community Based ◽  
Cognitively Normal ◽  
Clinical Criteria ◽  
Apoe Ε4 ◽  
Increased Risk ◽  
Antidepressant Use

Objective:To investigate socio-demographic and medical predictors of incident mild cognitive impairment (MCI) and subsequent course of MCI at follow-up, including sustained MCI diagnosis, classification as cognitively normal, and progression to dementia.Methods:Within a community-based cohort, diagnoses of MCI were made using a published algorithm. Diagnosis of dementia was based on clinical consensus. Cox regressions estimated hazard ratios of incident MCI associated with several predictors. Modified Poisson regressions estimated relative risks associated with predictors of diagnostic status at follow-up after incidence.Results:Among 2903 cognitively normal participants at baseline, 752 developed MCI over an average of 6.3 (SD=4.5) years (incidence rate: 56/1,000 person-years). Presence of APOE ε4 and higher medical burden increased risk of incident MCI, while more years of education, more leisure activities, and higher income decreased this risk. Of the incident MCI cases, after an average of 2.4 years follow-up, 12.9% progressed to dementia, 9.6% declined in functioning and did not meet the algorithmic criteria for MCI but did not meet the clinical criteria for dementia either, 29.6% continued to meet MCI criteria, and 47.9% no longer met MCI criteria. Multi-domain MCI, presence of APOE ε4, depressive symptoms and antidepressant use increased the risk of progression to dementia.Conclusions:This community-based study showed that almost half of the individuals with incident MCI diagnoses were classified as cognitively normal at follow-up. Predictors of incident MCI demonstrably differed from those of subsequent MCI course; these findings can refine expectations for cognitive and functional course of those presenting with MCI.

scholarly journals Bidirectional association between migraine and rheumatoid arthritis: two longitudinal follow-up studies with a national sample cohort

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e046283
Author(s):  
Yoo Hwan Kim ◽  
Jung Woo Lee ◽  
Yerim Kim ◽  
Jong Seok Bae ◽  
Yeo Jin Kim ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Migraine Without Aura ◽  
National Sample ◽  
Secondary Outcome ◽  
Increased Risk ◽  
Bidirectional Association ◽  
Follow Up Studies ◽  
Region Of Residence ◽  
National Cohort

ObjectiveTo investigate the bidirectional association between migraine and rheumatoid arthritis (RA).DesignTwo longitudinal follow-up studies.SettingData collected from a national cohort between 2002 and 2013 by the Korean National Health Insurance Service-Health Screening Cohort.ParticipantsIn cohort 1, matching resulted in the inclusion of 31 589 migraine patients and 126 356 control I participants. In cohort 2, matching resulted in the inclusion of 9287 RA patients and 37 148 control II participants.Primary and secondary outcome measuresThe HRs for RA in patients with migraine (cohort 1) and migraine in patients with RA (cohort 2) were analysed using stratified Cox proportional hazard models after adjusting for autoimmune disease, Charlson Comorbidity Index scores without rheumatoid diseases, obesity (body mass index), smoking and history of alcohol intake. Subgroup analyses stratified by age, sex, income and region of residence were also performed.ResultsThe incidence of RA in the migraine group (2.0% (640/31 589)) was higher than that in the control I group (1.4% (1709/126 356), p<0.001). The adjusted HR for RA in the migraine without aura group was 1.48 (95% CIs=1.34 to 1.63, p<0.001).The incidence of migraine in the RA group (6.4% (590/9287)) was higher than that in the control II group (4.6% (1721/37 148), p<0.001). The adjusted HR for migraine without aura in the RA group was 1.35 (95% CI=1.23 to 1.49, p<0.001).ConclusionMigraine increases the risk of RA, and RA is also associated with an increased risk of migraine.

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