Treatment resistance affects up to one in four individuals with psychosis in the first few years of illness. However, there is limited information about the brain changes associated with treatment resistance, restricting our ability to develop effective prognostic biomarkers or new treatments. Using resting-state functional MRI, we examined striatocortical connectivity in 87 patients who presented a non-affective first-episode of psychosis and 118 healthy controls, with follow-up imaging on more than half of the participants in the next 6 years, totaling 361 images.
View Article and Find Full Text PDFBackground: Research on cognitive functions in treatment-resistant schizophrenia (TRS) has focused on chronic patients, complicating the distinction between disease-related deficits from those influenced by chronicity or antipsychotic exposure. Identifying early cognitive differences could offer insights into the nature of TRS cognitive performance and serve as potential markers of treatment resistance.
Methods: Cohort study of 81 first-episode schizophrenia patients from Chile.
Introduction: Qualitative data provides deep insights into an individual's behaviors and beliefs, and the contextual factors that may shape these. Big qualitative data analysis is an emerging field that aims to identify trends and patterns in large qualitative datasets. The purpose of this review was to identify the methods used to analyse large bodies of qualitative data, their cited strengths and limitations and comparisons between manual and digital analysis approaches.
View Article and Find Full Text PDFObjectives: This study aims to synthesize health state utility values (HSUVs) of type 2 diabetes mellitus (T2DM) and its related complications published in the literature, conducting a meta-analysis of the data when possible.
Methods: We conducted a systematic search in MEDLINE and School of Health and Related Research Health Utilities Database repository. Studies focused on T2DM and its complications reporting utility values elicited using direct and indirect methods were selected.
Background: Educational attainment is associated with wellbeing and health, but patients with schizophrenia achieve lower levels of education than people without. Several effective interventions can ameliorate this situation. However, the magnitude of the education gap in schizophrenia and its change over time are unclear.
View Article and Find Full Text PDFPrevious studies have suggested that subjects participating in schizophrenia research are not representative of the demographics of the global population of people with schizophrenia, particularly in terms of gender and geographical location. We here explored if this has evolved throughout the decades, examining changes in geographical location, gender and age of participants in studies of schizophrenia published in the last 50 years. We examined this using a meta-analytical approach on an existing database including over 3,000 studies collated for another project.
View Article and Find Full Text PDFObjective: The aim of this study was to review and appraise how quality improvement (QI) skills are taught to surgeons and surgical residents.
Background: There is a global drive to deliver capacity in undertaking QI within surgical services. However, there are currently no specifications regarding optimal QI content or delivery.
The objective of this research was to systematically review and synthesize quantitative studies that assessed the association between socioeconomic inequalities and primary health care (PHC) utilization among older people living in low- and middle- income countries (LMICs). Six databases were searched, including Embase, Medline, Psych Info, Global Health, Latin American and Caribbean Health Sciences Literature (LILACS), and China National Knowledge Infrastructure, CNKI, to identify eligible studies. A narrative synthesis approach was used for evidence synthesis.
View Article and Find Full Text PDFPharmacoeconomics
July 2021
The availability and use of tools to guide the choice of modelling technique are not well understood. Our study aims to review existing tools and explore the use of those tools in health economic models. Two reviews and one case study were conducted.
View Article and Find Full Text PDFBackground: Substantial evidence has highlighted the importance of considering the mental health of healthcare workers during the COVID-19 pandemic, and several organisations have issued guidelines with recommendations. However, the definition of well-being and the evidence base behind such guidelines remain unclear.
Aims: The aims of the study are to assess the applicability of well-being guidelines in practice, identify unaddressed healthcare workers' needs and provide recommendations for supporting front-line staff during the current and future pandemics.
Early Interv Psychiatry
October 2021
Aim: The evidence of the effectiveness and cost-effectiveness of early intervention for psychosis (EIP) services has motivated their implementation worldwide. However, complex interventions of such EIP services require local adaptations to successfully match population needs and cultural differences. Latin America is a heterogenous region where EIP services are progressively being adopted.
View Article and Find Full Text PDFValue Health
September 2020
Objectives: Patient preferences are increasingly important in informing clinical and policy decisions. Health-state utility values (HSUVs) are quantitative measures of people's preferences over different health states. In schizophrenia, there is no clarity about HSUVs across the symptoms' severity spectrum.
View Article and Find Full Text PDFBackground: Evidence suggests the incidence of non-affective psychotic disorders (NAPDs) varies across persons and places, but data from the Global South is scarce. We aimed to estimate the treated incidence of NAPD in Chile, and variance by person, place and time.
Methods: We used national register data from Chile including all people, 10-65 years, with the first episode of NAPD (International Classification of Diseases, Tenth Revision: F20-F29) between 1 January 2005 and 29 August 2018.
Background: Numerous economic models have assessed the cost-effectiveness of antipsychotic medications in schizophrenia. It is important to understand what key impacts of antipsychotic medications were considered in the existing models and limitations of existing models in order to inform the development of future models.
Objectives: This systematic review aims to identify which clinical benefits, clinical harms, costs and cost savings of antipsychotic medication have been considered by existing models, to assess quality of existing models and to suggest good practice recommendations for future economic models of antipsychotic medications.
Pharmacoeconomics
June 2020
Background: Schizophrenia is associated with a high economic burden. Economic models can help to inform resource allocation decisions to maximise benefits to patients.
Objectives: This systematic review aims to assess the availability, quality and consistency of conclusions of health economic models evaluating the cost effectiveness of interventions for schizophrenia.
Evid Based Ment Health
November 2019
Art therapy is used as a complementary treatment to antipsychotics in schizophrenia. However, its effectiveness is not clear. To answer this question, we searched in Epistemonikos database, which is maintained by screening multiple databases.
View Article and Find Full Text PDFClozapine constitutes the treatment of choice in patients with schizophrenia with persisting symptoms despite antipsychotics at adequate dose and treatment duration. However, an important proportion does not respond to optimal doses of clozapine, so the addition of a second antipsychotic might increase clinical response. Searching in Epistemonikos database, which is maintained by screening multiple databases, we identified 17 systematic reviews comprising 62 studies addressing the question of this article, including 26 randomized trials.
View Article and Find Full Text PDFClozapine is considered to be the most effective antipsychotic drug for patients with treatment resistant schizophrenia, but up to a third of the patients do not respond to this treatment. Various strategies have been tried to augment the effect of clozapine in non-responders, one of these strategies being electroconvulsive therapy. However, its efficacy and safety are not yet clear.
View Article and Find Full Text PDFDepot antipsychotics have been generally used in patients with chronic schizophrenia with adherence problems to oral therapy. However, it has been suggested they can be a good alternative in earlier stages too. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified three systematic reviews including two pertinent randomized trials.
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