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Data are scarce regarding the clinical factors associated with utilization of long-term care facilities among older adults with schizophrenia.
Objectives
In this multicenter study, we sought to examine potential clinical differences between older adults with schizophrenia who are living in a long-term care facility and their community-dwelling counterparts.
Methods
We used data from the French Cohort of individuals with Schizophrenia Aged 55-years or more (CSA) study, a large multicenter sample of older adults with schizophrenia (N = 353).
We used data from the French Cohort of individuals with Schizophrenia Aged 55-years or more (CSA)study, a large multicenter sample of older adults with schizophrenia (N = 353).
Results
Results from the multivariable binary logistic regression analysis including all variables that had a significant association in univariate analyses (i.e., p < 0.05) revealed that older age (Adjusted odds ratio (AOR) [95%CI]=1.08 [1.03–1.13]), depression (AOR [95%CI]=1.97 [1.06–3.64]), lower MMSE (AOR [95%CI]=0.94 [0.88–0.99]) and GAF scores (AOR [95%CI]=0.97 [0.95–0.99]), living in an area comprising more than 1000 inhabitants per km2 (AOR [95%CI]=2.81 [1.37–5.80]), having consulted a general practitioner in the past year (AOR [95%CI]=0.28 [0.0.14–0.56]), and a greater lifetime number of hospitalizations in a psychiatric department (AOR [95%CI]=2.30 [1.18–4.50]) were significantly and independently associated with long-term care utilization among older adults with schizophrenia . In the multivariable logistic regression model, the variance inflation factor (VIF) and tolerance values of each predictor variable were respectively lower than 2.5 and higher than 0.2, supporting that multicollinearity was not a concern in our analysis.
Conclusions
In a multicenter sample of 353 older adults with schizophrenia, we found that ong-term care utilization was significantly and independently associated with depression, lower cognitive and global functioning, greater lifetime number of hospitalizations in a psychiatric department, not having consulted a general practitioner in the past year, urbanicity and older age. Patients living in a long-term care facility appear to belong to a distinct group, marked by a more severe course of illness with higher level of depression and more severe cognitive deficits.
Despite its limitations, this study contributes to gain more specific knowledge about this specific understudied population. Our study highlights the need of early assessment and management of depression and cognitive deficits in this population and the importance of monitoring closely this vulnerable population.
The coronavirus disease 2019 (COVID-19) pandemic continues to cause significant morbidity and mortality worldwide. Since a large portion of the world’s population is currently unvaccinated or incompletely vaccinated and has limited access to approved treatments against COVID-19, there is an urgent need to continue research on treatment options, especially those at low cost and which are immediately available to patients, particularly in low- and middle-income countries. Prior in vitro and observational studies have shown that fluoxetine, possibly through its inhibitory effect on the acid sphingomyelinase/ceramide system, could be a promising antiviral and anti-inflammatory treatment against COVID-19.
Objectives
The aim of this sudy was to test the potential antiviral and anti-inflammatory activities of fluoxetine against SARS-CoV-2 in a K18-hACE2 mouse model of infection, and against several variants of concern in vitro, and test the hypothesis of the implication of ceramides and/or their derivatives hexosylceramides.
Methods
We evaluated the potential antiviral and anti-inflammatory activities of fluoxetine in a K18-hACE2 mouse model of SARS-CoV-2 infection, and against variants of concern in vitro, i.e., SARS-CoV-2 ancestral strain, Alpha B.1.1.7, Gamma P1, Delta B1.617 and Omicron BA.5.
Results
Fluoxetine, administrated after SARS-CoV-2 infection, significantly reduced lung tissue viral titres (Figure 1) and expression of several inflammatory markers (i.e., IL-6, TNFα, CCL2 and CXCL10) (Figure 2). It also inhibited the replication of all variants of concern in vitro. A modulation of the ceramide system in the lung tissues, as reflected by the increase in the ratio HexCer 16:0/Cer 16:0 in fluoxetine-treated mice, may contribute to explain these effects (Figure 3).
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Conclusions
Our findings demonstrate the antiviral and anti-inflammatory properties of fluoxetine in a K18-hACE2 mouse model of SARS-CoV-2 infection, and its in vitro antiviral activity against variants of concern, establishing fluoxetine as a very promising candidate for the prevention and treatment of SARS-CoV-2 infection and disease pathogenesis.
To reduce Coronavirus Disease 2019 (COVID-19)-related mortality and morbidity, widely available oral COVID-19 treatments are urgently needed. Certain antidepressants, such as fluvoxamine or fluoxetine, may be beneficial against COVID-19.
Objectives
The main objective was two-fold: (i) to test the hypothesis that the prevalence of antidepressant use in patients hospitalized with COVID-19 would be lower than in patients with similar characteristics hospitalized without COVID-19, and (ii) to examine, among patients hospitalized with COVID-19, whether antidepressant use is associated with reduced 28-day mortality. Our secondary aim was to examine whether this potential association could only concern specific antidepressant classes or molecules, is dose-dependent, and/or only observed beyond a certain dose threshold.
Methods
We included 388,945 adult inpatients who tested positive for SARS-CoV-2 at 36 AP–HP (Assistance Publique–Hôpitaux de Paris) hospitals from 2 May 2020 to 2 November 2021. We compared the prevalence of antidepressant use at admission in a 1:1 ratio matched analytic sample with and without COVID-19 (N = 82,586), and assessed its association with 28-day all-cause mortality in a 1:1 ratio matched analytic sample of COVID-19 inpatients with and without antidepressant use at admission (N = 1482) (Figure 1).
Results
Antidepressant use was significantly less prevalent in inpatients with COVID-19 than in a matched control group of inpatients without COVID-19 (1.9% versus 4.8%; Odds Ratio (OR) = 0.38; 95%CI = 0.35–0.41, p < 0.001) (Figure 2). Antidepressant use was significantly associated with reduced 28-day mortality among COVID-19 inpatients (12.8% versus 21.2%; OR = 0.55; 95%CI = 0.41–0.72, p < 0.001), particularly at daily doses of at least 40 mg fluoxetine equivalents (Figure 3). Antidepressants with high FIASMA (Functional Inhibitors of Acid Sphingomyelinase) activity seem to drive both associations.
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Conclusions
Antidepressant use is associated with a reduced likelihood of hospitalization in patients infected with SARS-CoV-2 and with a reduced risk of death in patients hospitalized with COVID-19. These associations were stronger for molecules with high FIASMA activity. These findings posit that prospective interventional studies of antidepressants with the highest FIASMA activity may be appropriate to help identify variant-agnostic, affordable, and scalable interventions for outpatient and inpatient therapy of COVID-19.
Studies in adult psychiatric patients consistently call attention to premature mortality and its association with metabolic syndrome. However, the utility of the metabolic syndrome construct is controversial in older adults in the general population, since literature shows that some components, such as obesity, can be protective against mortality. In older adults with mental illness, only one study explored the relation between metabolic syndrome and mortality and found no association.
Objectives
To examine whether metabolic syndrome or any of its components predicted mortality in a cohort of older adults with psychiatric disorders, and to determine if this association differs across diagnostic groups.
Methods
We used a multicentric prospective design to follow, over 5 years, a cohort that included 634 in– and outpatients with schizophrenia, bipolar or major depressive disorder (MDD). Metabolic syndrome was assessed at baseline following NCEP-ATPIII criteria. Cause of death was categorized as cardiovascular disorder (CVD) mortality, non-CVD disease-related mortality, suicide and accident.
Results
We found no significant association between metabolic syndrome or any of its components with all-cause, CVD and non-CVD mortality. However, an association with increased all-cause and disease-related mortality was found in the subpopulation of older adults with MDD, even after adjustment for age, sex and smoking status (p=0.032 and p=0.036, respectively). A significant interaction was found between metabolic syndrome and psychiatric diagnoses indicating that in participants with MDD, metabolic syndrome had a significantly greater effect on all-cause mortality (p=0.025) and on disease-related mortality (p=0.008) than in participants with either bipolar disorder or schizophrenia.
Conclusions
In older adults with psychiatric illness, our findings do not support an association between metabolic syndrome and increased mortality, in contrast with the literature findings on their younger counterparts. We discuss several possible explanations, including a survival bias, a lack of sensitivity of the used cut-offs and a ceiling effect of metabolic syndrome on mortality in this very high-risk population. The lack of a ceiling effect in the depressive subgroup, because of a less marked premature mortality, could explain the positive association, in contrast with bipolar disorder or schizophrenia subgroups.
The European Psychiatric Association (EPA) Summer School allows psychiatric trainees and early career psychiatrists (ECPs) from all over Europe to meet, network, and learn together. After the 2020 edition being cancelled due to COVID-19, the 10th edition in 2021 focused for the first time on research and was conducted remotely.
Objectives
To provide an overview and feedback about the first Virtual EPA Research Summer School as a new way to encourage international networking during COVID-19.
Methods
The School was organized by the EPA Secretary for Education, and 4 Faculty members. It started with a “breaking the ice session” one week before and then a two-days meeting on 23-24 September 2021 using an online video-platform. This was preceded by all the 21 participants (from 18 different countries) recording a short 4-minute video presentation, which was uploaded and shared with other participants and Faculty.
Results
Participants were divided on a voluntary basis into three working groups: 1) “Drug repurposing: overcoming challenges in pharmacoepidemiology” 2) “Psychopathological research in psychiatry”; 3) “How to conduct a cross-sectional survey?”. The Summer School program was composed of plenary sessions with lectures by the Faculty members, discussion sessions, and working groups time. At the end, each group presented a summary of the work done to the rest of the participants.
Conclusions
Although the remote format limits social interactions during the Summer School, overall participants’ high satisfaction and productivity indicate that not only online formats, but also the topic of research might be covered in future editions.
To examine the association between benzodiazepine receptor agonist (BZRA) use and mortality in patients hospitalised for coronavirus disease 2019 (COVID-19).
Methods
A multicentre observational study was performed at Greater Paris University hospitals. The sample involved 14 381 patients hospitalised for COVID-19. A total of 686 (4.8%) inpatients received a BZRA at hospital admission at a mean daily diazepam-equivalent dose of 19.7 mg (standard deviation (s.d.) = 25.4). The study baseline was the date of admission, and the primary endpoint was death. We compared this endpoint between patients who received BZRAs and those who did not in time-to-event analyses adjusted for sociodemographic characteristics, medical comorbidities and other medications. The primary analysis was a Cox regression model with inverse probability weighting (IPW).
Results
Over a mean follow-up of 14.5 days (s.d. = 18.1), the primary endpoint occurred in 186 patients (27.1%) who received BZRAs and in 1134 patients (8.3%) who did not. There was a significant association between BZRA use and increased mortality both in the crude analysis (hazard ratio (HR) = 3.20; 95% confidence interval (CI) = 2.74–3.74; p < 0.01) and in the IPW analysis (HR = 1.61; 95% CI = 1.31–1.98, p < 0.01), with a significant dose-dependent relationship (HR = 1.55; 95% CI = 1.08–2.22; p = 0.02). This association remained significant in sensitivity analyses. Exploratory analyses indicate that most BZRAs may be associated with an increased mortality among patients hospitalised for COVID-19, except for diazepam, which may be associated with a reduced mortality compared with any other BZRA treatment.
Conclusions
BZRA use may be associated with an increased mortality among patients hospitalised for COVID-19, suggesting the potential benefit of decreasing dose or tapering off gradually these medications when possible.
Depression in later life is a major public heath issue. Few studies to date examined the psychiatric correlates of depression in elderly surveys in the general population.
Objective
To provide nationally representative data on the prevalence, sociodemographic correlates and comorbidity of current major depressive disorder in late life.
Methods
This study is based on a nationally representative survey, the National Epidemiologic Survey on Alcohol and Related Conditions, of the noninstitutionalized household population (8,205 respondents aged 65 and above). The past 12-months prevalence of major depressive disorder was estimated, and logistic regression analyses were used to examine the relationship between 12-months major depressive disorder and sociodemographic characteristics, general medical condition and psychiatric disorder. Diagnoses were made according to the of DSM-IV criteria.
Results
Among the respondents, 3.2% individuals with a past 12-months diagnosis of major depressive disorder were identified. Women and individuals living in urban areas were more likely to be diagnosed with a major depressive disorder. Significant associations between major depressive disorder and cardiovascular, gastrointestinal diseases, arthritis were found. Several psychiatric disorder were associated with past 12-months major depressive disorder, including dysthymia, bipolar disorder, panic disorder, specific phobia, generalized anxiety disorder, nicotine and alcohol dependence, and histrionic personality disorder.
Conclusion
Recent Major depressive disorder in the elderly was associated with a large number of psychiatric disorders. This study highlights the need to develop effective and targeted intervention initiatives to detect major depressive disorder in elderly.
Research on the impact of the continuity of care (COC) on health outcomes in patients with mental illness is limited. This observational study examined whether the longitudinal COC is associated with a decreased likelihood of death among patients with mental disorders in the French general population.
Method
Data were derived from the French National Health Insurance (NHI) reimbursement database. Patients with any mental disorder who visited a psychiatrist at least twice within 6 months were included. The primary endpoint was death by all causes. We measured longitudinal COC with a psychiatrist twice a year between 2007 and 2010, using the COC index developed by Bice and Boxerman. The COC index was analysed as a time-dependent variable in a survival analysis after adjustments for age, gender and stratifying on comorbidities and social status.
Results
Among 14,515 patients visiting a psychiatrist at least twice in 6 months and tracked over 3 years, likelihood of death was significantly lower in patients with higher continuity of care (hazard ratio for an increase in 0.1 of continuity, adjusted for age, sex, and stratified on comorbidities and social status: 0.83 [0.83–0.83]), particularly in those with bipolar disorder, major depressive disorder and schizophrenia.
Conclusion
Improving longitudinal continuity of care in mental health care may contribute to substantially decrease mortality.
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