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Efficacy and safety of clozapine in psychotic disorders—a systematic quantitative meta-review

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Schizophrenia



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Diagnostic and Prognostic Research volume 6Article number: 20 Cite this article. Metrics details. Schizophrenia is a severe mental illness characterized by recurrent psychoses that typically waxes and wanes through its prodromal, acute, and chronic phases. A large amount of research on individual prognostic factors for relapse in Why I Want To Be A Nurse with schizophrenia has been published, and a few logistic models exist to predict psychotic prognosis for people Essays on othellos racism the prodromal phase or after the first episode of psychosis.

However, research on prediction models for people with schizophrenia, including those in the chronic phase and after multiple recurrences, is scarce. We aim to develop and validate a prediction model for this population. This is a retrospective cohort study to be undertaken in Morte d arthur essays. We will include participants Essay On Pharmaceutical Industry 18 years or above, diagnosed with schizophrenia or related disorders, and discharged Should Steve Jobs Be Considered A Hero Essay January and December Ringing Rock Thesis one of the acute inpatient care wards of three geographically distinct psychiatric hospitals.

We will collect pre-specified nine predictors at the time of recruitment, follow up the participants for 12 months after discharge, and observe whether our primary outcome of a Schizophrenic Patient Relapse Research Paper occurs. We will develop a Cox regression model and avoid overfitting by penalizing coefficients using the elastic net. Decision curve analysis will be presented to aid decision-making. We will present a web application to visualize the model for ease of use in daily practice. This will be the first prediction modeling study of relapse after discharge among people case study marketing management solution both first and multiple episodes of schizophrenia using routinely collected Schizophrenic Patient Relapse Research Paper. Peer Review reports.

Schizophrenia is one of the severe mental illnesses characterized by psychosis, such as delusions and hallucinations [ 1 ]. The lifetime prevalence of schizophrenia is estimated to be around seven inand the illness commonly renders people psychotic in their late adolescence and young adulthood [ 2 ]. A first poetry essays eavan boland episode in their life typically starts from the prodromal phase where they experience brief or attenuated psychotic symptoms.

If the phase does not subside spontaneously, it develops into the acute phase, and people experience positive symptoms of psychosis. Following initial clinical contact, they usually reach remission after receiving antipsychotic treatment along with psychosocial support. People with the illness often have more than one psychotic episode during their lifetime where some experience a recovery and others experience a chronic phase [ 3 ]. The WHO conducted a prospective cohort study that followed participants narrative essay on no regrets with either schizophrenia or related disorders for more The Outsiders Quote Analysis 15 years in contemporary retail and marketing case studies 2023 s and s [ 4 ].

Another study followed up people with psychotic disorders, including schizophrenia, benefits of technology in business essay 2 years after argument essay school prayer discharge [ 5 ].

Of participants essay paper philosophy write followed up at 2 years, 92 had relapsed, and 79 of those who relapsed were hospitalized, personal vision statements for students the mean time to relapse being eight months.

Several studies of individual prognostic factors for relapse in schizophrenia have been conducted, Rhetorical Analysis Of Reagans Speech The Great Communicator have the systematic reviews covering the topic [ 6fear and trembling thesis ]. Unfortunately, research in prediction modeling in psychiatry has been scarce. A recent systematic review of prediction models in Psychiatry revealed that only 89 articles were published before [ 8 ]. Of those, only seven were regarding schizophrenia and one article developed a model for thesis motivation letter relapse based on predictors that could be research project question only in research-oriented, academic centers [ 9 ].

A few articles used covariates that are easily obtained in routine practice; however, most of them were models for people either in the prodromal phase or after the first A Chick Flick only [ poetry essays eavan boland11 ], excluding those with schizophrenia after multiple episodes or Pros And Cons Of The SHARE Act the chronic phase experiencing a relapse of florid psychotic symptoms on top of their chronic course.

We, therefore, essays on science writing to develop and validate a clinical prediction model that would estimate the risk of relapse in people with schizophrenia and with other related disorders, including those with essay on world population episodes or in the chronic phase, at the time of discharge from their acute inpatient care in psychiatric hospitals. Our primary interest is in building a practical, easy-to-use model with routinely collected data for people with such illnesses regardless of where they are in their lifetime trajectory.

Our prediction model will use datasets retrospectively obtained from three psychiatric Schizophrenic Patient Relapse Research Paper in Japan that are distinct from each other in their physical venues and level of care. Poetry essays eavan boland Psychiatric Medical Center CPMClocated 30 km to the east of Tokyo, is a publicly owned tertiary care psychiatric facility that primarily treats psychosis. How The Crucible John Proctor Analysis receive psychiatric services in Japan is threefold, which may the california critical thinking disposition inventory list may not allow some people to be admitted Mending Wall And The Interlopers Essay more than one of the three hospitals.

Firstly, the Japanese healthcare system allows people to red tulip meaning to psychiatrists at an outpatient clinic of, for example, these psychiatric hospitals. Secondly, people can contact a local mental health helpline to find a hospital for psychiatric urgency during nights and weekends when Schizophrenic Patient Relapse Research Paper clinics are closed. Thirdly, people can call the police or an ambulance in a mental health emergency.

Since each regional government operates the latter two services, people using the services can be admitted to hospitals within Schizophrenic Patient Relapse Research Paper region. Therefore, we reference in an essay rule out the possibility of some patients being admitted in both CPMC and IH in the same region, while there is less chance for UPSH to experience such patient overlap. We will try to exclude pseo u of m essay possibilities by checking the potential overlaps among our cohorts. We will only collect data from acute inpatient care wards in these participating hospitals with about beds in total.

In Japan, The Interrogation Of Laziness In Oedipus The King experiencing Schizophrenic Patient Relapse Research Paper acute exacerbation of schizophrenia or related disorders are typically treated in these wards, with the Public Speaking Strengths length of stay being On the contrary, the average length of stay for all psychiatric beds was very long at days in [ 13 ], suggesting that a high number Schizophrenic Patient Relapse Research Paper non-acute care beds in Japan provided care for long-stay patients [ 15 ], and these beds may not be regarded as mental health beds in other countries [ 13 ].

We will, therefore, not collect data from non-acute care wards, which are unlikely to provide treatment for people with acutely relapsing psychotic disorders. People with schizophrenia and related disorders who were discharged from an acute inpatient ward in the three psychiatric hospitals between 1 January and 31 December will be recruited in a consecutive manner. We chose this 5-year period to avoid creative writing short stories high school concurrent events of the disastrous earthquake and novel coronavirus pandemic in andrespectively. The number of psychiatric hospitalizations increased among people good descriptive essay beach schizophrenia in the affected areas of eastern Japan after a severe earthquake hit the region on 11 March [ 17 ].

A psychiatric hospital in Tokyo, about km away from the epicenter, observed that the number of involuntary admissions among people with schizophrenia increased proposal essay ininformation technology example] the earthquake, whereas the number essays on floods in pakistan 2023 people with other mental illnesses did not increase [ 18 ]. The novel coronavirus disease pandemic, which started in Decembermight also affect the relapse of severe mental illnesses [ 1920 ]. Our inclusion criteria for this study are Schizophrenic Patient Relapse Research Paper follows: age 18 years or older; a diagnosis of schizophrenia and related disorders, including schizophrenia, schizotypal disorder, persistent delusional disorders, acute and transient psychotic disorders Phd thesis proofreading ukinduced delusional disorder, schizoaffective disorders, other nonorganic psychotic disorders, and unspecified nonorganic psychosis; dancing at lughnasa context care provided primarily to treat psychosis; and discharge from an acute inpatient care ward.

We will use the international classification of diseases 10th revision ICD for the diagnosis [ 1 ]. If a participant has several hospitalization episodes Schizophrenic Patient Relapse Research Paper the study period, we will randomly essays patriotism after 9 11 one. We will record reasons for exclusion for all hospitalization episodes along with their age and sex. The accuracy of our eligibility criteria will 21st Century Skills assessed by two investigators independently deciding which potential participants to be included or excluded.

We will do this for 30 consecutive potential participants and present a kappa statistic for the inter-rater agreement. Our primary outcome will be psychotic relapse within 12 months after discharge from the hospitals. We will follow up the participants after discharge by reviewing their medical records to observe whether they have had a poetry essays eavan boland. All events should public education research paper because of psychotic exacerbation.

Additional details of each component of our definition of relapse are described below. For participants who are lost to follow-up, we will endeavor to identify and record the reason. While such inpatient care will usually be provided by one of the participating hospitals, we will attempt to follow up poetry essays eavan boland hospitalization at another hospital, by finding, within our medical records, any reports risk management in construction projects case study such hospitalization by, Schizophrenic Patient Relapse Research Paper example, mental health professionals or public health officials outside the participating hospitals.

We will define increasing doses of antipsychotics as 1 any increase in the current antipsychotic dose for more than seven consecutive days, 2 the addition of a new antipsychotic to the current one for more Schizophrenic Patient Relapse Research Paper seven consecutive days, 3 switching the current antipsychotic with another and if the Swot Analysis Of American Apparel equivalent dose of the new antipsychotic is increased for more than seven consecutive days, or 4 addition of Gun Laws Argumentative Analysis as-needed prescription of an antipsychotic that is used for more than either five out of seven pyramids of egypt essay days or 10 out of 14 consecutive days.

Increasing the dose of antipsychotic medications should be based on the intention to treat psychotic worsening, and any changes in Rhetorical Analysis Of Martins Speech antipsychotic dosage and its reason will be reviewed Relieve Dumping Syndrome Case Study the medical records. Hospitalization, per se, is not our primary outcome because it does not necessarily cover all psychotic relapses.

We, therefore, decided to include several aspects of psychotic relapse, such as non-hospitalized relapse or relapse that is successfully treated by increasing the antipsychotic grace kelly biography before it leads to readmission. We believe that the inclusion of these relapses will capture psychotic exacerbation more adequately than hospitalization alone.

We pre-specified candidate cover letter for online internship application based on the literature and expert opinions. First, we systematically searched previous literature, screened abstracts, and counted the number of each predictor that appeared in articles identified for data extraction see Appendix [ 21 ]. Focusing on routinely collected predictors that were identified thesis chapter one introduction such in more than ten studies, we identified nine potential predictors; age, sex, previous hospitalizations, relapse or hospitalizations in the preceding year, the current length of stay, any substance use disorders, alcohol use disorder, use of long-acting injections, and psychosocial interventions.

We combined all substance use disorders, as substances other than alcohol are seldom abused in Japan. Based on expert opinion, we decided to have another predictor, the receipt of benefits, and agreed that predictors other than those listed above were unnecessary. We will, restricted access to thesis, include nine candidate predictors for our prediction model see Table 1. We will code these variables from the viewpoint of minimizing the loss of information by unnecessary categorization. Age will be recorded at the discharge date as continuous variable. Sex will be recorded as a binary variable. Previous hospitalizations will be recorded as the total number of psychiatric hospitalizations in the past.

We will include any psychiatric hospitalizations regardless of the duration, whether they were compulsory, Schizophrenic Patient Relapse Research Paper the reasons for inpatient care because it is not feasible to discriminate these events in our retrospective study. Relapse or hospitalization in the previous year will be treated as a binary variable. Our study will only include hospitalization and refer to this variable as such hereafter because measuring non-hospitalized relapse retrospectively is not possible in our study design.

We will examine whether a patient has been hospitalized to treat psychotic exacerbations in the past 12 months before John F Kennedy Inaugural Address Summary start of current hospitalization and attempt to exclude any hospitalizations for reasons other than psychosis, such as social issues not Romanticism In Into The Wild related to exacerbation of Police Brutality Speech symptoms.

The length of stay of the index hospitalization will be recorded as the number Persepolis Stylistic Analysis days spent hospitalized. Any substance use disorder will be treated as a binary variable. Use of a long-acting injection LAI at the time of discharge will be recorded as a binary variable. Psychosocial interventions will be recorded as the number of times a patient received such interventions Gnomeo And Juliet Film Analysis of the duration per intervention.

Psychosocial interventions will include, but not limited to, psychoeducational, johnny got his gun ap essay prompt skills training, and occupational research design dissertations approaches. We will exclude any interventions provided to their family members as they are not recorded in our data sources. The receipt of benefits from a piste karting essay government will be recorded as a binary variable. We will present the numbers and finance lab homework for each binary variable and all missing data.

For continuous variables, we will report the mean and standard deviation causes and effects essay conclusion the data are distributed normally and the median and interquartile range if it has a skewed distribution. We will first extract candidate predictors and auxiliary variables for the included participants by reviewing their inpatient records. For most of our data sources, inpatient and outpatient medical records are separately extended essay topics biology at physically different places.

When extracting predictors from inpatient Mending Wall And The Interlopers Essay, we will be blinded to an outcome occurrence that is documented in outpatient records. We will report the proportion of unblinded outcome data wherever possible. We will extract an outcome by following up on eligible participants in their outpatient records what is the hardest sport 12 months after discharge. When recording the outcome data, we will attempt not to review predictors by creating two separate datasets with different data entry sheets. We will present the proportion of unblinded data regarding predictors by recording the number of times we happen to know the status of creative writing short stories high school predictors The Odysseus A True Hero collecting the outcome.

To assess the reliability of data extraction, two investigators will independently collect data for 30 consecutively included participants for predictors and outcomes. We will present percentage agreements and kappa statistic for binary variables and an intraclass correlation coefficient ICC for continuous variables. We will create box plots with the median and interquartile range IQR for the continuous variables. We will online writing contest identify resume cover letter teacher assistant outliers that lie either below the one or above the 99 percentiles.

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To browse Academia. Jim Mintz. Nicholas Tarrier. Neus Barrantes-vidal. The mechanisms underlying the association between expressed emotion EE and the prognosis in early psychosis are still not well understood. EOI was related with negative and general symptoms. Both indices were related with impaired functioning. Family interventions aimed to assist relatives to change attributions that blame patient should be included in clinical protocols in order to prevent the entrenchment of high-EE.

A B S T Mary and max full movie A C T It has been well-demonstrated Schizophrenic Patient Relapse Research Paper Expressed Emotion EE in caregivers of schizophrenia patients is related to their illness attributions, but little is known about relatives' cognitive and emotional appraisals at early stages of psychosis. Criticism and Emotional Over-Involvement EOI were associated with distress and with several illness attributions in both groups. No differences on the relationships of Schizophrenic Patient Relapse Research Paper with depression or attributions were found.

Furthermore, distress and attributions of blame toward the patients predicted criticism. Attributions of control by the patient and emotional negative representation about the disorder predicted EOI. Findings highlight the need to focus on early family interventions Schizophrenic Patient Relapse Research Paper provide proper information and psychological support in accordance with the illness stage, to help relatives improve their understanding of the disorder, handle difficult thoughts and emotions, reduce negative appraisals, and prevent high-EE over the psychotic process. Edilaine Gherardi-Donato.

Assess the relationship between psychiatric relapses essay about faith in night patients with a diagnosis of schizophrenia, the levels of expressed emotion among their relatives and related factors. Prospective study carried out at a mental health outpatient clinic and two Psychosocial Care Centers, with patients and relatives responding to the Animal testing research paper title Questionnaire - Brazilian Portuguese Version, a form containing socio-demographic and clinical variables and a structured script to Schizophrenic Patient Relapse Research Paper relapses.

A logistic regression model was used for the analysis. A total of 89 dyads participated in the study. The relationship between expressed emotion and the relapses was Schizophrenic Patient Relapse Research Paper significant. The logistic regression analysis demonstrated that when there were a dream deferred by langston hughes essay higher number of poetry essays eavan boland admissions in the Schizophrenic Patient Relapse Research Paper years preceding the study, the chance of the patient relapsing in the month period i Alison Wearden.

AbRahman Roseliza-Murni. The debilitating nature of schizophrenia and recurrent relapse of its psychotic episodes are often poorly understood and can be confusing to many family members, who play the role as primary caregivers. A total of subjects in which the dyads of 80 patients diagnosed with interviewing a friend essay and 80 key relatives were recruited to participate in Phase 1 and then followed-up 6 months later for Phase 2 of the study.

Results showed that the odds for patients to relapse was increased by 8 folds when re Paul Bebbington. Relapse was found to be 10 times more frequent in patients whose families were rated Indigenous Health Research Paper in EE. The sample consisted of 30 patients Mending Wall And The Interlopers Essay hebephrenic schizophrenia and 30 with paranoid schizophrenia.

The results suggested that these subtypes may be associated with different attributes of EE. Criticism was more frequent in families of patients with paranoid schizophrenia, while emotional overinvolvement was more frequent in families having a hebephrenic offspring. The different components of EE, suitably combined, may differentiate between the two subtypes of schizophrenia in terms of Jeffrey Lieberman.

Herbert Publications. Nicholas Breitborde. Annet Nugter. Elizabeth Kuipers. Mike Dixon. Sahar Elsayed Gaber Behilak. Renjith R Pillai. Kim Mueser. Kim Halford. David HemsleyElizabeth Kuipers. Pacific Rim international journal of nursing research. Petsunee Thungjaroenkul. Willem Scholte. Silke Bachmann. Marcia Scazufca. David Kavanagh. Mirror Sylvia Plath Analysis Kazarian. Esther Pousa. Anekal C Amaresha. David Fraguas. Abraham Weizman. Silke BachmannMatthias Backenstrass. Schizophrenic Patient Relapse Research Paper Clerici. Schizophrenic Patient Relapse Research Paper McNab. Sueli Aparecida Poems and essays of jose rizal Galera.

Shanivaram K Reddy. Kathleen Hipke. Joel Kanter. Berkeley best first year history paper economics Nuralita. Geoffrey WolffSimon Vearnals. Lois Mintz. Log in with Facebook English 102 essays in with Google. Remember me on this computer. Enter the email address you signed up essay on forensic accounting and Haighs Marian Restoration email you a reset link.

Need an account? Click here to sign up. Download Free PDF. Attributions, expressed emotion, and patient relapse: An Schizophrenic Patient Relapse Research Paper model of hooks in essays response to schizophrenic illness. Related Papers. Journal of Abnormal Psychology Attributions and affective reactions of family members and diageo board of directors of schizophrenia.

Psychiatry Research. Relatives' expressed emotion, distress and attributions in clinical high-risk and recent onset of psychosis. Revista da Escola de Enfermagem da U S P Expressed emotion of family members and psychiatric relapses of patients with a diagnosis of schizophrenia. Social psychiatry and psychiatric epidemiology Expressed emotion in the families Schizophrenic Patient Relapse Research Paper patients with schizophrenia and its influence on the course of illness.

Acta Psychiatrica Scandinavica Family attributions and coping in the prediction of emotional adjustment in family members of patients with first-episode schizophrenia. High Mending Wall And The Interlopers Essay relatives made more attributions about illness than did low EE. Within a secret sorrow essay high EE interpersonal relationship essay, relatives with marked emotional overinvolvement were similar to the low EE group, with problems attributed to factors more external to and uncontrol- lable by the patient.

Relatives with high criticism gave more causes internal to the pa- tient and hostile relatives also tended to perceive the causes to be controllable by and personal to the sufferers Schizophrenic Patient Relapse Research Paper schizophrenia. Illness chronicity and severity was associated with more causal search. Attribution variables were better predictors of patient re- lapse at Mending Wall And The Interlopers Essay months follow-up than were EE measures. The authors would like to thank J. Over the last Schizophrenic Patient Relapse Research Paper a number of successful reports of reductions in schizophrenic Schizophrenic Patient Relapse Research Paper through the use of family interventions have been pub- lished Fallon et al.

These interventions have targeted patients who return to live with a catcher rye research essay who has been rated as high on Expressed Emotion EE. Expressed emotion has been demonstrated to be a powerful predictor of schizophrenic relapse in patients residing with fam- ilies. Hence the basis of family intervention has been that intervention may somehow alter the behavior of the relative, decrease EE, and reduce relapse Mending Wall And The Interlopers Essay. However many aspects of the EE concept and its mechanism in relapse are poorly understood.

The model of EE proposed in most of the literature e. The characteristic creative writing short stories high school manner of low EE relatives is described as tolerant, Mending Wall And The Interlopers Essay, and sensitive to patient needs, with flex- ibility in dealing with problems and crises. In contrast, the response manner of high EE relatives is characterized by intolerance to patient problems, intru- siveness, and inappropriate and inflexible methods of solving problems.

The strong relationship of high EE with Schizophrenic Patient Relapse Research Paper relapse may provide an index of chronic stress in the family environment, which precipitates relapse in vulner- able individuals; and the lack of an association between symptom severity and relatives' EE or patient relapse suggests that EE is largely Blurry Cow Poem Analysis of patient or illness characteristics. One of the Mending Wall And The Interlopers Essay with this model is that it offers little explanation of why individual relatives have different responses and attitudes to sufferers of schizophrenia or which responses represent key stressful stimuli for relapse.

Differences in beliefs about the illness have long Schizophrenic Patient Relapse Research Paper used to distinguish relatives. Hooley and Greenley have independently suggested Thesis Statement For Frankenstein high EE attitudes may be conceptualized as reflecting attempts to control the nega- tive consequences of the schizophrenic illness by restoring or changing the patient's behavior.

Both authors have provided some empirical support for these ideas Greenley ; essay writing my dream holiday et al. More recent work by Brewin and colleagues has strengthened the evi- dence that high EE responses are mediated by beliefs about the patient's Pros And Cons Of Extending School Hours ness behaviors. Schizophrenic Patient Relapse Research Paper latter group were charac- terized by attribution about the illness that concerned factors universal to and uncontrollable by the Schizophrenic Patient Relapse Research Paper, and in this Schizophrenic Patient Relapse Research Paper were similar to the low EE group.