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  • 1
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    T6. ASSOCIATION BETWEEN THE USE OF AN ANTIPSYCHOTIC DRUG AND CHANGES IN LIPID PROFILE: A META-ANALYSIS
    Oxford University Press (OUP) ; 2020
    In:  Schizophrenia Bulletin Vol. 46, No. Supplement_1 ( 2020-05-18), p. S232-S233
    Details
    In: Schizophrenia Bulletin, Oxford University Press (OUP), Vol. 46, No. Supplement_1 ( 2020-05-18), p. S232-S233
    Abstract: Despite their efficacy, antipsychotic drugs appear to be associated with metabolic side effects such as impaired lipid metabolism and an increased risk for developing metabolic syndrome. The association between individual antipsychotics with a stratification for different durations of exposure and mean changes in the complete lipid profile has not yet been the focus of a meta-analysis. Aim of this meta-analysis was to examine the association between changes in lipid parameters in adults using an antipsychotic drug, irrespective of diagnostic indication. Methods This meta-analysis follows the PRISMA guidelines and a protocol has been published in PROSPERO. A systematic search was performed using the databases PubMed, EMBASE, Cochrane, and PsycINFO. Eligible RCTs were identified and no restriction was made regarding diagnosis or publication date. Statistical analysis was based on a random effects model from which forest plots were generated. Effect sizes were reported as the standardized mean difference (SMD) with 95% confidence intervals (CI). Results were presented stratified by four exposure categories, namely & lt; 6 weeks, 6–16 weeks, 16–38 weeks, and ≥ 38 weeks. Outcome measures include mean change from baseline in total cholesterol, high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL) and triglyceride levels. Results The search strategy identified 1144 citations. Of these, 746 abstracts were excluded as being off-topic. A total of 398 full-text articles were assessed for eligibility and 135 RCT’s fulfilled the inclusion criteria. Preliminary results show an overall significant association between olanzapine and mildly elevated triglyceride levels (SMD 0.40, 95% CI 0.02–0.77), risperidone and elevated LDL levels (SMD 0.07, 95% CI 0.01–0.13) and clozapine with elevated total cholesterol and triglyceride levels (SMD 0.59 95% CI 0.26-0.02 and SMD 0.44 95% CI 0.35–0.53, respectively). Final results stratified by exposure category will be presented at the SIRS congress. Discussion The preliminary findings of this meta-analysis build upon previous literature and do confirm an association between the use of an antipsychotic drug and changes in lipid parameters. However, changes in the different lipid parameters do not seem to be consistent for each antipsychotic. Tentatively, we may suggest that the duration of exposure to an antipsychotic drug is correlated to the extent of lipid abnormalities. It should be noted that the majority of included studies had a short study duration ( & lt; 6 weeks). Monitoring over short periods might give misleading results. Furthermore, literature suggests that the role of lipids should not be seen independently, and interplay exists between lipid metabolism and changes in weight. For example, previous studies suggest that there is a positive association between increases in triglyceride levels and increases in weight, and that once weight has stabilised, triglyceride levels decrease. Further analysis should focus on including longer-term studies in which changes in body weight in relation to changes in lipids should be taken into account. We expect the findings of this study to be of clinical relevance in the management and monitoring of antipsychotic treatment. The knowledge of whether duration of exposure is associated with different lipid changes could provide interesting results benefiting individualised choices, appropriate prevention and early management.
    Type of Medium: Online Resource
    ISSN: 0586-7614 , 1745-1701
    URL: Article
    DOI: 10.1093/schbul/sbaa029.566
    RVK:
    XA 10000
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
    detail.hit.zdb_id: 2180196-4
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  • 2
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    The pharmacological management of agitated and aggressive behaviour: A systematic review and meta-analysis
    Cambridge University Press (CUP) ; 2019
    In:  European Psychiatry Vol. 57 ( 2019-04), p. 78-100
    Details
    In: European Psychiatry, Cambridge University Press (CUP), Vol. 57 ( 2019-04), p. 78-100
    Abstract: Non-pharmacological interventions preferably precede pharmacological interventions in acute agitation. Reviews of pharmacological interventions remain descriptive or compare only one compound with several other compounds. The goal of this study is to compute a systematic review and meta-analysis of the effect on restoring calmness after a pharmacological intervention, so a more precise recommendation is possible. Method: A search in Pubmed and Embase was done to isolate RCT’s considering pharmacological interventions in acute agitation. The outcome is reaching calmness within maximum of 2 h, assessed by the psychometric scales of PANSS-EC, CGI or ACES. Also the percentages of adverse effects was assessed. Results: Fifty-three papers were included for a systematic review and meta-analysis. Most frequent studied drug is olanzapine. Changes on PANNS-EC and ACES at 2 h showed the strongest changes for haloperidol plus promethazine, risperidon, olanzapine, droperidol and aripiprazole. However, incomplete data showed that the effect of risperidon is overestimated. Adverse effects are most prominent for haloperidol and haloperidol plus lorazepam. Conclusion: Olanzapine, haloperidol plus promethazine or droperidol are most effective and safe for use as rapid tranquilisation. Midazolam sedates most quickly. But due to increased saturation problems, midazolam is restricted to use within an emergency department of a general hospital.
    Type of Medium: Online Resource
    ISSN: 0924-9338 , 1778-3585
    URL: Article
    DOI: 10.1016/j.eurpsy.2019.01.014
    RVK:
    XA 10000
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2019
    detail.hit.zdb_id: 2005377-0
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  • 3
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    Interaction between environmental and familial affective risk impacts psychosis admixture in states of affective dysregulation
    Cambridge University Press (CUP) ; 2019
    In:  Psychological Medicine Vol. 49, No. 11 ( 2019-08), p. 1879-1889
    Details
    In: Psychological Medicine, Cambridge University Press (CUP), Vol. 49, No. 11 ( 2019-08), p. 1879-1889
    Abstract: Evidence suggests that cannabis use, childhood adversity, and urbanicity, in interaction with proxy measures of genetic risk, may facilitate onset of psychosis in the sense of early affective dysregulation becoming ‘complicated’ by, first, attenuated psychosis and, eventually, full-blown psychotic symptoms. Methods Data were derived from three waves of the second Netherlands Mental Health Survey and Incidence Study (NEMESIS-2). The impact of environmental risk factors (cannabis use, childhood adversity, and urbanicity) was analyzed across severity levels of psychopathology defined by the degree to which affective dysregulation was ‘complicated’ by low-grade psychotic experiences (‘attenuated psychosis’ – moderately severe) and, overt psychotic symptoms leading to help-seeking (‘clinical psychosis’ – most severe). Familial and non-familial strata were defined based on family history of (mostly) affective disorder and used as a proxy for genetic risk in models of family history × environmental risk interaction. Results In proxy gene–environment interaction analysis, childhood adversity and cannabis use, and to a lesser extent urbanicity, displayed greater-than-additive risk if there was also evidence of familial affective liability. In addition, the interaction contrast ratio grew progressively greater across severity levels of psychosis admixture (none, attenuated psychosis, clinical psychosis) complicating affective dysregulation. Conclusion Known environmental risks interact with familial evidence of affective liability in driving the level of psychosis admixture in states of early affective dysregulation in the general population, constituting an affective pathway to psychosis. There is interest in decomposing family history of affective liability into the environmental and genetic components that underlie the interactions as shown here.
    Type of Medium: Online Resource
    ISSN: 0033-2917 , 1469-8978
    URL: Article
    DOI: 10.1017/S0033291718002635
    RVK:
    XA 10000
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2019
    detail.hit.zdb_id: 1470300-2
    SSG: 5,2
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  • 4
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    Context v. algorithm: evidence that a transdiagnostic framework of contextual clinical characterization is of more clinical value than categorical diagnosis
    Cambridge University Press (CUP) ; 2023
    In:  Psychological Medicine Vol. 53, No. 5 ( 2023-04), p. 1825-1833
    Details
    In: Psychological Medicine, Cambridge University Press (CUP), Vol. 53, No. 5 ( 2023-04), p. 1825-1833
    Abstract: A transdiagnostic and contextual framework of ‘clinical characterization’, combining clinical, psychopathological, sociodemographic, etiological, and other personal contextual data, may add clinical value over and above categorical algorithm-based diagnosis. Methods Prediction of need for care and health care outcomes was examined prospectively as a function of the contextual clinical characterization diagnostic framework in a prospective general population cohort ( n = 6646 at baseline), interviewed four times between 2007 and 2018 (NEMESIS-2). Measures of need, service use, and use of medication were predicted as a function of any of 13 DSM-IV diagnoses, both separately and in combination with clinical characterization across multiple domains: social circumstances/demographics, symptom dimensions, physical health, clinical/etiological factors, staging, and polygenic risk scores (PRS). Effect sizes were expressed as population attributable fractions. Results Any prediction of DSM-diagnosis in relation to need and outcome in separate models was entirely reducible to components of contextual clinical characterization in joint models, particularly the component of transdiagnostic symptom dimensions (a simple score of the number of anxiety, depression, mania, and psychosis symptoms) and staging (subthreshold, incidence, persistence), and to a lesser degree clinical factors (early adversity, family history, suicidality, slowness at interview, neuroticism, and extraversion), and sociodemographic factors. Clinical characterization components in combination predicted more than any component in isolation. PRS did not meaningfully contribute to any clinical characterization model. Conclusion A transdiagnostic framework of contextual clinical characterization is of more value to patients than a categorical system of algorithmic ordering of psychopathology.
    Type of Medium: Online Resource
    ISSN: 0033-2917 , 1469-8978
    URL: Article
    DOI: 10.1017/S0033291721003445
    RVK:
    XA 10000
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2023
    detail.hit.zdb_id: 1470300-2
    SSG: 5,2
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  • 5
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    Evidence, and replication thereof, that molecular-genetic and environmental risks for psychosis impact through an affective pathway
    Cambridge University Press (CUP) ; 2022
    In:  Psychological Medicine Vol. 52, No. 10 ( 2022-07), p. 1910-1922
    Details
    In: Psychological Medicine, Cambridge University Press (CUP), Vol. 52, No. 10 ( 2022-07), p. 1910-1922
    Abstract: There is evidence that environmental and genetic risk factors for schizophrenia spectrum disorders are transdiagnostic and mediated in part through a generic pathway of affective dysregulation. Methods We analysed to what degree the impact of schizophrenia polygenic risk (PRS-SZ) and childhood adversity (CA) on psychosis outcomes was contingent on co-presence of affective dysregulation, defined as significant depressive symptoms, in (i) NEMESIS-2 ( n = 6646), a representative general population sample, interviewed four times over nine years and (ii) EUGEI ( n = 4068) a sample of patients with schizophrenia spectrum disorder, the siblings of these patients and controls. Results The impact of PRS-SZ on psychosis showed significant dependence on co-presence of affective dysregulation in NEMESIS-2 [relative excess risk due to interaction (RERI): 1.01, p = 0.037] and in EUGEI (RERI = 3.39, p = 0.048). This was particularly evident for delusional ideation (NEMESIS-2: RERI = 1.74, p = 0.003; EUGEI: RERI = 4.16, p = 0.019) and not for hallucinatory experiences (NEMESIS-2: RERI = 0.65, p = 0.284; EUGEI: −0.37, p = 0.547). A similar and stronger pattern of results was evident for CA (RERI delusions and hallucinations: NEMESIS-2: 3.02, p 〈 0.001; EUGEI: 6.44, p 〈 0.001; RERI delusional ideation: NEMESIS-2: 3.79, p 〈 0.001; EUGEI: 5.43, p = 0.001; RERI hallucinatory experiences: NEMESIS-2: 2.46, p 〈 0.001; EUGEI: 0.54, p = 0.465). Conclusions The results, and internal replication, suggest that the effects of known genetic and non-genetic risk factors for psychosis are mediated in part through an affective pathway, from which early states of delusional meaning may arise.
    Type of Medium: Online Resource
    ISSN: 0033-2917 , 1469-8978
    URL: Article
    DOI: 10.1017/S0033291720003748
    RVK:
    XA 10000
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2022
    detail.hit.zdb_id: 1470300-2
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  • 6
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    Evidence for an interrelated cluster of Hallucinatory experiences in the general population: an incidence study
    Cambridge University Press (CUP) ; 2021
    In:  Psychological Medicine Vol. 51, No. 12 ( 2021-09), p. 2034-2043
    Details
    In: Psychological Medicine, Cambridge University Press (CUP), Vol. 51, No. 12 ( 2021-09), p. 2034-2043
    Abstract: Although hallucinations have been studied in terms of prevalence and its associations with psychopathology and functional impairment, very little is known about sensory modalities other than auditory (i.e. haptic, visual and olfactory), as well the incidence of hallucinations, factors predicting incidence and subsequent course. Methods We examined the incidence, course and risk factors of hallucinatory experiences across different modalities in two unique prospective general population cohorts in the same country using similar methodology and with three interview waves, one over the period 1996–1999 (NEMESIS) and one over the period 2007–2015 (NEMESIS-2). Results In NEMESIS-2, the yearly incidence of self-reported visual hallucinations was highest (0.33%), followed by haptic hallucinations (0.31%), auditory hallucinations (0.26%) and olfactory hallucinations (0.23%). Rates in NEMESIS-1 were similar (respectively: 0.35%, 0.26%, 0.23%, 0.22%). The incidence of clinician-confirmed hallucinations was approximately 60% of the self-reported rate. The persistence rate of incident hallucinations was around 20–30%, increasing to 40–50% for prevalent hallucinations. Incident hallucinations in one modality were very strongly associated with occurrence in another modality (median OR = 59) and all modalities were strongly associated with delusional ideation (median OR = 21). Modalities were approximately equally strongly associated with the presence of any mental disorder (median OR = 4), functioning, indicators of help-seeking and established environmental risk factors for psychotic disorder. Conclusions Hallucinations across different modalities are a clinically relevant feature of non-psychotic disorders and need to be studied in relation to each other and in relation to delusional ideation, as all appear to have a common underlying mechanism.
    Type of Medium: Online Resource
    ISSN: 0033-2917 , 1469-8978
    URL: Article
    DOI: 10.1017/S0033291720000793
    RVK:
    XA 10000
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2021
    detail.hit.zdb_id: 1470300-2
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  • 7
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    Prevalence, incidence, and persistence of psychotic experiences in the general population: results of a 9-year follow-up study – CORRIGENDUM
    Cambridge University Press (CUP) ; 2023
    In:  Psychological Medicine Vol. 53, No. 8 ( 2023-06), p. 3762-3762
    Details
    In: Psychological Medicine, Cambridge University Press (CUP), Vol. 53, No. 8 ( 2023-06), p. 3762-3762
    Type of Medium: Online Resource
    ISSN: 0033-2917 , 1469-8978
    URL: Article
    DOI: 10.1017/S0033291723000119
    RVK:
    XA 10000
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2023
    detail.hit.zdb_id: 1470300-2
    SSG: 5,2
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  • 8
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    Study protocol of a randomized, double-blind, placebo-controlled, multi-center trial to treat antipsychotic-induced weight gain: the Metformin-Lifestyle in antipsychotic users (MELIA) trial
    Springer Science and Business Media LLC ; 2021
    In:  BMC Psychiatry Vol. 21, No. 1 ( 2021-12)
    Details
    In: BMC Psychiatry, Springer Science and Business Media LLC, Vol. 21, No. 1 ( 2021-12)
    Abstract: Antipsychotic-induced Weight Gain (AiWG) is a debilitating and common adverse effect of antipsychotics. AiWG negatively impacts life expectancy, quality of life, treatment adherence, likelihood of developing type-2 diabetes and readmission. Treatment of AiWG is currently challenging, and there is no consensus on the optimal management strategy. In this study, we aim to evaluate the use of metformin for the treatment of AiWG by comparing metformin with placebo in those receiving treatment as usual, which includes a lifestyle intervention. Methods In this randomized, double-blind, multicenter, placebo-controlled, pragmatic trial with a follow-up of 52 weeks, we aim to include 256 overweight participants (Body Mass Index (BMI) 〉  25 kg/m 2 ) of at least 16 years of age. Patients are eligible if they have been diagnosed with schizophrenia spectrum disorder and if they have been using an antipsychotic for at least three months. Participants will be randomized with a 1:1 allocation to placebo or metformin, and will be treated for a total of 26 weeks. Metformin will be started at 500 mg b.i.d. and escalated to 1000 mg b.i.d. 2 weeks thereafter (up to a maximum of 2000 mg daily). In addition, all participants will undergo a lifestyle intervention as part of the usual treatment consisting of a combination of an exercise program and dietary consultations. The primary outcome measure is difference in body weight as a continuous trait between the two arms from treatment inception until 26 weeks of treatment, compared to baseline. Secondary outcome measures include: 1) Any element of metabolic syndrome (MetS); 2) Response, defined as ≥5% body weight loss at 26 weeks relative to treatment inception; 3) Quality of life; 4) General mental and physical health; and 5) Cost-effectiveness. Finally, we aim to assess whether genetic liability to BMI and MetS may help estimate the amount of weight reduction following initiation of metformin treatment. Discussion The pragmatic design of the current trial allows for a comparison of the efficacy and safety of metformin in combination with a lifestyle intervention in the treatment of AiWG, facilitating the development of guidelines on the interventions for this major health problem. Trial registration This trial was registered in the Netherlands Trial Register (NTR) at  https://www.trialregister.nl/trial/8440 as NTR NL8840 on March 8, 2020.
    Type of Medium: Online Resource
    ISSN: 1471-244X
    URL: Article
    DOI: 10.1186/s12888-020-02992-4
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 2050438-X
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  • 9
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    Development of depressed mood predicts onset of psychotic disorder in individuals who report hallucinatory experiences
    Wiley ; 2005
    In:  British Journal of Clinical Psychology Vol. 44, No. 1 ( 2005-03), p. 113-125
    Details
    In: British Journal of Clinical Psychology, Wiley, Vol. 44, No. 1 ( 2005-03), p. 113-125
    Type of Medium: Online Resource
    ISSN: 0144-6657
    URL: Article
    DOI: 10.1348/014466504X19767
    RVK:
    CL 1000
    Language: English
    Publisher: Wiley
    Publication Date: 2005
    detail.hit.zdb_id: 1491701-4
    SSG: 5,2
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  • 10
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    Capturing coping with symptoms in people with a diagnosis of schizophrenia: introducing the MACS‐24
    Wiley ; 2009
    In:  International Journal of Methods in Psychiatric Research Vol. 18, No. 1 ( 2009-03), p. 4-12
    Details
    In: International Journal of Methods in Psychiatric Research, Wiley, Vol. 18, No. 1 ( 2009-03), p. 4-12
    Abstract: In order to assess coping with psychotic symptoms, the Maastricht Assessment of Coping Strategies (MACS), 24 symptom version, was developed as a refinement of the previous MACS‐13. Associations between type of coping and the experienced level of control over psychotic symptoms were examined using MACS‐24. MACS‐24 was administered to 32 individuals with a diagnosis of schizophrenia. For each of 24 symptoms, experience of distress, type of coping and the resulting degree of perceived control were assessed. Coping types were reduced to two contrasting coping factors: symptomatic coping and non‐symptomatic coping (combining active problem solving, passive illness behaviour, active problem avoiding, and passive problem avoiding). Mean level of distress and perceived control (range: 1–7) were, respectively, 4.2 [standard deviation (SD) = 1.9] and 4.2 (SD = 1.9). The association between distress and perceived control was negative [β = −0.28; 95% confidence interval (95%CI) = −0.41 to −0.15] . Type of coping interacted with perceived control (p = 0.005), in that symptomatic coping was negatively associated with perceived control [odds ratio (OR) over seven levels = 0.82, 95%CI = 0.71–0.94], whereas for non‐symptomatic coping a positive association was apparent (OR over seven levels = 1.10, 95% CI = 1.03–1.19). Previous contrasts between symptomatic and non‐symptomatic coping were replicated using MACS‐24, suggesting clinical validity and utility. Copyright © 2009 John Wiley & Sons, Ltd.
    Type of Medium: Online Resource
    ISSN: 1049-8931 , 1557-0657
    URL: Issue
    URL: Article
    DOI: 10.1002/mpr.v18:1
    DOI: 10.1002/mpr.272
    Language: English
    Publisher: Wiley
    Publication Date: 2009
    detail.hit.zdb_id: 2135760-2
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