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  • 1
    Online Resource
    Online Resource
    Schizophrenia around the time of pregnancy: leveraging population-based health data and electronic health record data to fill knowledge gaps
    Royal College of Psychiatrists ; 2020
    In:  BJPsych Open Vol. 6, No. 5 ( 2020-09)
    Details
    In: BJPsych Open, Royal College of Psychiatrists, Vol. 6, No. 5 ( 2020-09)
    Abstract: Research in schizophrenia and pregnancy has traditionally been conducted in small samples. More recently, secondary analysis of routine healthcare data has facilitated access to data on large numbers of women with schizophrenia. Aims To discuss four scientific advances using data from Canada, Denmark and the UK from population-level health registers and clinical data sources. Method Narrative review of research from these three countries to illustrate key advances in the area of schizophrenia and pregnancy. Results Health administrative and clinical data from electronic medical records have been used to identify population-level and clinical cohorts of women with schizophrenia, and follow them longitudinally along with their children. These data have demonstrated that fertility rates in women with schizophrenia have increased over time and have enabled documentation of the course of illness in relation with pregnancy, showing the early postpartum as the time of highest risk. As a result of large sample sizes, we have been able to understand the prevalence of and risk factors for rare outcomes that would be difficult to study in clinical research. Advanced pharmaco-epidemiological methods have been used to address confounding in studies of antipsychotic medications in pregnancy, to provide data about the benefits and risks of treatment for women and their care providers. Conclusions Use of these data has advanced the field of research in schizophrenia and pregnancy. Future developments in use of electronic health records include access to richer data sources and use of modern technical advances such as machine learning and supporting team science.
    Type of Medium: Online Resource
    ISSN: 2056-4724
    URL: Article
    DOI: 10.1192/bjo.2020.78
    Language: English
    Publisher: Royal College of Psychiatrists
    Publication Date: 2020
    detail.hit.zdb_id: 2829557-2
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  • 2
    Online Resource
    Online Resource
    Morbidity and mortality of women and men with intellectual and developmental disabilities newly initiating antipsychotic drugs
    Royal College of Psychiatrists ; 2016
    In:  BJPsych Open Vol. 2, No. 2 ( 2016-03), p. 188-194
    Details
    In: BJPsych Open, Royal College of Psychiatrists, Vol. 2, No. 2 ( 2016-03), p. 188-194
    Abstract: While up to 45% of individuals with intellectual and developmental disabilities (IDD) have a comorbid psychiatric disorder, and antipsychotics are commonly prescribed, gender differences in the safety of antipsychotics have rarely been studied in this population. Aims To compare men and women with IDD on medical outcomes after antipsychotic initiation. Method Our population-based study in Ontario, Canada, compared 1457 women and 1951 men with IDD newly initiating antipsychotic medication on risk for diabetes mellitus, hypertension, venous thromboembolism, myocardial infarction, stroke and death, with up to 4 years of follow-up. Results Women were older and more medically complex at baseline. Women had higher risks for venous thromboembolism (HR 1.72, 95% CI 1.15–2.59) and death (HR 1.46, 95% CI 1.02–2.10) in crude analyses; but only thromboembolism risk was greater for women after covariate adjustment (aHR 1.58, 95% CI 1.05–2.38). Conclusions Gender should be considered in decision-making around antipsychotic medications for individuals with IDD.
    Type of Medium: Online Resource
    ISSN: 2056-4724
    URL: Article
    DOI: 10.1192/bjpo.bp.116.002691
    Language: English
    Publisher: Royal College of Psychiatrists
    Publication Date: 2016
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  • 3
    Online Resource
    Online Resource
    Clinical index to quantify the 1-year risk for common postpartum mental disorders at the time of delivery (PMH CAREPLAN): development and internal validation
    Royal College of Psychiatrists ; 2023
    In:  The British Journal of Psychiatry Vol. 223, No. 3 ( 2023-09), p. 422-429
    Details
    In: The British Journal of Psychiatry, Royal College of Psychiatrists, Vol. 223, No. 3 ( 2023-09), p. 422-429
    Abstract: Common postpartum mental health (PMH) disorders such as depression and anxiety are preventable, but determining individual-level risk is difficult. Aims To create and internally validate a clinical risk index for common PMH disorders. Method Using population-based health administrative data in Ontario, Canada, comprising sociodemographic, clinical and health service variables easily collectible from hospital birth records, we developed and internally validated a predictive model for common PMH disorders and converted the final model into a risk index. We developed the model in 75% of the cohort ( n = 152 362), validating it in the remaining 25% ( n = 75 772). Results The 1-year prevalence of common PMH disorders was 6.0%. Independently associated variables (forming the mnemonic PMH CAREPLAN) that made up the risk index were: (P) prenatal care provider; (M) mental health diagnosis history and medications during pregnancy; (H) psychiatric hospital admissions or emergency department visits; (C) conception type and complications; (A) apprehension of newborn by child services (newborn taken into care); (R) region of maternal origin; (E) extremes of gestational age at birth; (P) primary maternal language; (L) lactation intention; (A) maternal age; (N) number of prenatal visits. In the index (scored 0–39), 1-year common PMH disorder risk ranged from 1.5 to 40.5%. Discrimination (C-statistic) was 0.69 in development and validation samples; the 95% confidence interval of expected risk encompassed observed risk for all scores in development and validation samples, indicating adequate risk index calibration. Conclusions Individual-level risk of developing a common postpartum mental health disorder can be estimated with data feasibly collectable from birth records. Next steps are external validation and evaluation of various cut-off scores for their utility in guiding postpartum individuals to interventions that reduce their risk of illness.
    Type of Medium: Online Resource
    ISSN: 0007-1250 , 1472-1465
    URL: Article
    DOI: 10.1192/bjp.2023.74
    RVK:
    XA 10000
    Language: English
    Publisher: Royal College of Psychiatrists
    Publication Date: 2023
    detail.hit.zdb_id: 2021500-9
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  • 4
    Online Resource
    Online Resource
    Sexual health experiences of women and non-binary people with early psychosis: qualitative study
    Royal College of Psychiatrists ; 2023
    In:  BJPsych Open Vol. 9, No. 5 ( 2023-09)
    Details
    In: BJPsych Open, Royal College of Psychiatrists, Vol. 9, No. 5 ( 2023-09)
    Abstract: Women and gender-diverse people with early psychosis are at risk for suboptimal sexual health outcomes, yet little research has explored their sexual health experiences. Aims This study explored sexual health experiences and related priorities among women and gender-diverse people with early psychosis, to identify opportunities for improvements in sexual health and well-being. Method Semi-structured individual qualitative interviews explored how patient participants ( n = 19, aged 18–31 years, cisgender and transgender women and non-binary individuals) receiving clinical care from early psychosis programmes in Ontario, Canada, experienced their sexual health, including sexual function and behaviour. Thematic analysis was conducted, with triangulation from interviews/focus groups with clinicians ( n = 36) who provide sexual and mental healthcare for this population. Results Three key themes were identified based on patient interviews: theme 1 was the impact of psychotic illness and its treatments on sexual function and activity, including variable changes in sex drive, attitudes and behaviours during acute psychosis, vulnerability to trauma and medications; theme 2 related to intimacy and sexual relationships in the context of psychosis, with bidirectional effects between relationships and mental health; and theme 3 comprised autonomy, identity and intersectional considerations, including gender, sexuality, culture and religion, which interplay with psychosis and sexual health. Clinicians raised each of these priority areas, but emphasised risk prevention relative to patients’ more holistic view of their sexual health and well-being. Conclusions Women and non-binary people with early psychosis have wide-ranging sexual health priorities, affecting many facets of their lives. Clinical care should incorporate this knowledge to optimise sexual health and well-being in this population.
    Type of Medium: Online Resource
    ISSN: 2056-4724
    URL: Article
    DOI: 10.1192/bjo.2023.518
    Language: English
    Publisher: Royal College of Psychiatrists
    Publication Date: 2023
    detail.hit.zdb_id: 2829557-2
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  • 5
    Online Resource
    Online Resource
    Transitional interventions to reduce early psychiatric readmissions in adults: systematic review
    Royal College of Psychiatrists ; 2013
    In:  British Journal of Psychiatry Vol. 202, No. 3 ( 2013-03), p. 187-194
    Details
    In: British Journal of Psychiatry, Royal College of Psychiatrists, Vol. 202, No. 3 ( 2013-03), p. 187-194
    Abstract: Up to 13% of psychiatric patients are readmitted shortly after discharge. Interventions that ensure successful transitions to community care may play a key role in preventing early readmission. Aims To describe and evaluate interventions applied during the transition from in-patient to out-patient care in preventing early psychiatric readmission. Method Systematic review of transitional interventions among adults admitted to hospital with mental illness where the study outcome was psychiatric readmission. Results The review included 15 studies with 15 non-overlapping intervention components. Absolute risk reductions of 13.6 to 37.0% were observed in statistically significant studies. Effective intervention components were: pre- and post-discharge patient psychoeducation, structured needs assessments, medication reconciliation/education, transition managers and in-patient/out-patient provider communication. Key limitations were small sample size and risk of bias. Conclusions Many effective transitional intervention components are feasible and likely to be cost-effective. Future research can provide direction about the specific components necessary and/or sufficient for preventing early psychiatric readmission.
    Type of Medium: Online Resource
    ISSN: 0007-1250 , 1472-1465
    URL: Article
    DOI: 10.1192/bjp.bp.112.115030
    RVK:
    XA 10000
    Language: English
    Publisher: Royal College of Psychiatrists
    Publication Date: 2013
    detail.hit.zdb_id: 2021500-9
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  • 6
    Online Resource
    Online Resource
    A population-based study of the frequency and predictors of induced abortion among women with schizophrenia
    Royal College of Psychiatrists ; 2019
    In:  British Journal of Psychiatry Vol. 215, No. 6 ( 2019-12), p. 736-743
    Details
    In: British Journal of Psychiatry, Royal College of Psychiatrists, Vol. 215, No. 6 ( 2019-12), p. 736-743
    Abstract: Induced abortion is an indicator of access to, and quality of reproductive healthcare, but rates are relatively unknown in women with schizophrenia. Aims We examined whether women with schizophrenia experience increased induced abortion compared with those without schizophrenia, and identified factors associated with induced abortion risk. Method In a population-based, repeated cross-sectional study (2011–2013), we compared women with and without schizophrenia in Ontario, Canada on rates of induced abortions per 1000 women and per 1000 live births. We then followed a longitudinal cohort of women with schizophrenia aged 15–44 years ( n = 11 149) from 2011, using modified Poisson regression to identify risk factors for induced abortion. Results Women with schizophrenia had higher abortion rates than those without schizophrenia in all years (15.5–17.5 v. 12.8–13.6 per 1000 women; largest rate ratio, 1.33; 95% CI 1.16–1.54). They also had higher abortion ratios (592–736 v. 321–341 per 1000 live births; largest rate ratio, 2.25; 95% CI 1.96–2.59). Younger age ( 〈 25 years; adjusted relative risk (aRR), 1.84; 95% CI 1.39–2.44), multiparity (aRR 2.17, 95% CI 1.66–2.83), comorbid non-psychotic mental illness (aRR 2.15, 95% CI 1.34–3.46) and substance misuse disorders (aRR 1.85, 95% CI 1.47–2.34) were associated with increased abortion risk. Conclusions These results demonstrate vulnerability related to reproductive healthcare for women with schizophrenia. Evidence-based interventions to support optimal sexual health, particularly in young women, those with psychiatric and addiction comorbidity, and women who have already had a child, are warranted.
    Type of Medium: Online Resource
    ISSN: 0007-1250 , 1472-1465
    URL: Article
    DOI: 10.1192/bjp.2018.262
    RVK:
    XA 10000
    Language: English
    Publisher: Royal College of Psychiatrists
    Publication Date: 2019
    detail.hit.zdb_id: 2021500-9
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  • 7
    Online Resource
    Online Resource
    Using a simulation centre to evaluate preliminary acceptability and impact of an artificial intelligence-powered clinical decision support system for depression treatment on the physician–patient interaction
    Royal College of Psychiatrists ; 2021
    In:  BJPsych Open Vol. 7, No. 1 ( 2021-01)
    Details
    In: BJPsych Open, Royal College of Psychiatrists, Vol. 7, No. 1 ( 2021-01)
    Abstract: Recently, artificial intelligence-powered devices have been put forward as potentially powerful tools for the improvement of mental healthcare. An important question is how these devices impact the physician-patient interaction. Aims Aifred is an artificial intelligence-powered clinical decision support system (CDSS) for the treatment of major depression. Here, we explore the use of a simulation centre environment in evaluating the usability of Aifred, particularly its impact on the physician–patient interaction. Method Twenty psychiatry and family medicine attending staff and residents were recruited to complete a 2.5-h study at a clinical interaction simulation centre with standardised patients. Each physician had the option of using the CDSS to inform their treatment choice in three 10-min clinical scenarios with standardised patients portraying mild, moderate and severe episodes of major depression. Feasibility and acceptability data were collected through self-report questionnaires, scenario observations, interviews and standardised patient feedback. Results All 20 participants completed the study. Initial results indicate that the tool was acceptable to clinicians and feasible for use during clinical encounters. Clinicians indicated a willingness to use the tool in real clinical practice, a significant degree of trust in the system's predictions to assist with treatment selection, and reported that the tool helped increase patient understanding of and trust in treatment. The simulation environment allowed for the evaluation of the tool's impact on the physician–patient interaction. Conclusions The simulation centre allowed for direct observations of clinician use and impact of the tool on the clinician–patient interaction before clinical studies. It may therefore offer a useful and important environment in the early testing of new technological tools. The present results will inform further tool development and clinician training materials.
    Type of Medium: Online Resource
    ISSN: 2056-4724
    URL: Article
    DOI: 10.1192/bjo.2020.127
    Language: English
    Publisher: Royal College of Psychiatrists
    Publication Date: 2021
    detail.hit.zdb_id: 2829557-2
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