Eirik Kjelby

Suicidality in schizophrenia spectrum disorders: The relationship to hallucinations and persecutory delusions

BACKGROUND Assessment of suicide risk is crucial in schizophrenia and results concerning risk contributed by hallucinations and persecutory delusions are inconsistent. We aimed to determine factors associated with suicidal ideation and plans at the time of acute admission in patients suffering from schizophrenia spectrum disorders. METHODS One hundred and twenty-four patients older than 18 years admitted to an acute psychiatric ward due to psychosis were consecutively included. Predictors of suicidal ideation and suicide plans at the time of admission were examined with multinominal logistic regression and structural equation modelling (SEM). The study design was pragmatic, thus entailing a clinically relevant representation. RESULTS Depression Odds Ratio (OR) 12.9, Drug use OR 4.07, Hallucinations OR 2.55 and Negative symptoms OR 0.88 significantly predicted Suicidal ideation. Suspiciousness/ Persecution did not. Only Depression and Hallucinations significantly predicted Suicide plans. In the SEM-model Anxiety, Depression and Hopelessness connected Suspiciousness/Persecution, Hallucinations and Lack of insight with Suicidal ideation and Suicide plans. CONCLUSIONS The study contributes to an increasing evidence base supporting an association between hallucinations and suicide risk. We want to emphasise the importance of treating depression and hallucinations in psychotic disorders, reducing hopelessness while working with insight and reducing drug abuse in order to lower suicide risk. TRIAL REGISTRATION ClinicalTrials.gov ID; URL: http://www.clinicaltrials.gov/NCT00932529.

Anti-depressive effectiveness of olanzapine, quetiapine, risperidone and ziprasidone: a pragmatic, randomized trial

BackgroundEfficacy studies indicate anti-depressive effects of at least some second generation antipsychotics (SGAs). The Bergen Psychosis Project (BPP) is a 24-month, pragmatic, industry-independent, randomized, head-to-head comparison of olanzapine, quetiapine, risperidone and ziprasidone in patients acutely admitted with psychosis. The aim of the study is to investigate whether differential anti-depressive effectiveness exists among SGAs in a clinically relevant sample of patients acutely admitted with psychosis.MethodsAdult patients acutely admitted to an emergency ward for psychosis were randomized to olanzapine, quetiapine, risperidone or ziprasidone and followed for up to 2 years. Participants were assessed repeatedly using the Positive and Negative Syndrome Scale - Depression factor (PANSS-D) and the Calgary Depression Scale for Schizophrenia (CDSS).ResultsA total of 226 patients were included. A significant time-effect showing a steady decline in depressive symptoms in all medication groups was demonstrated. There were no substantial differences among the SGAs in reducing the PANSS-D score or the CDSS sum score. Separate analyses of groups with CDSS sum scores > 6 or ≤6, respectively, reflecting degree of depressive morbidity, revealed essentially identical results to the primary analyses. There was a high correlation between the PANSS-D and the CDSS sum score (r = 0.77; p < 0.01).ConclusionsThere was no substantial difference in anti-depressive effectiveness among olanzapine, quetiapine, risperidone or ziprasidone in this clinically relevant sample of patients acutely admitted to hospital for symptoms of psychosis. Based on our findings we can make no recommendations concerning choice of any particular SGA for targeting symptoms of depression in a patient acutely admitted with psychosis.Trial RegistrationClinicalTrials.gov ID; URL: http://www.clinicaltrials.gov/: NCT00932529

Sexual dysfunction and hyperprolactinemia in male psychotic inpatients: a cross-sectional study.

Introduction. Sexual dysfunction (SD) and hyperprolactinemia are frequently reported in patients with psychotic disorders and have the potential for severe complications but investigations in males are particularly scarce. The primary aims were to determine the prevalence of SD and hyperprolactinemia in male patients and to investigate whether associations exist between SD and prolactin levels. Methods. Cross-sectional data were obtained at discharge from the hospital or 6 weeks after admittance for patients acutely admitted for psychosis and treated with a second-generation antipsychotic drug. Results. Half the patients reported diminished sexual desire and more than a third reported erectile and ejaculatory dysfunctions with no differences among the drugs. More than half the sample was hyperprolactinemic. No association was found between prolactin levels and SD. Conclusion. High rates of SD and hyperprolactinemia were found in male patients and should be a treatment target. SD and hyperprolactinemia were not correlated.

Time to discontinuation of antipsychotic drugs in a schizophrenia cohort: influence of current treatment strategies.

Background Rates of discontinuation of antipsychotic treatment for patients with schizophrenia are high and evidence is limited by selective inclusion and high attrition in randomized controlled trials. Aims To study time to discontinuation of antipsychotic treatment for patients with schizophrenia. Method All patients with schizophrenia (n = 396) discharged between 2005 and 2011 were followed until discontinuation (clinician or patient decided) of antipsychotic treatment or other endpoints. Univariate and multivariate survival analyses (with time on antipsychotic treatment as the dependent variable) using time-dependent variables were performed. Results Clozapine displayed lower risk for all-cause (p < 0.001), clinician-decided (p = 0.012) and patient-decided (p = 0.039) discontinuation versus olanzapine oral treatment in the multivariate Cox regression. Second-generation long-acting injection antipsychotics (LAI) (p = 0.015) and first-generation long-acting injection antipsychotics (p = 0.013) showed significantly lower risks for patient-decided discontinuation than olanzapine oral. Conclusion Higher effectiveness of clozapine and LAI treatment versus oral olanzapine were identified in a clinical cohort of patients with schizophrenia.

F108. PSYCHOTIC EXPERIENCES IN A NORWEGIAN SAMPLE - TENTATIVE RESULTS OF A QUESTIONNAIRE VALIDATION

Abstract Background Auditory verbal hallucinations are a major symptom in schizophrenia but also affect patients with other diagnoses and healthy people without any pathology. This applies also to delusions and hallucinations of other sensory modalities. Since most questionnaires that assess hallucinations focus on one particular disorder, the Questionnaire for Psychotic Experiences (QPE) was created to provide an instrument that is applicable independently of clinical status. The QPE is a semi-structured interview consisting of 50 items that are categorized into four subscales (visual, auditory, other hallucinations and delusions). Each subscale starts with a screening question to indicate if a symptom is present, followed by questions regarding specific characteristics. We translated the QPE into Norwegian (bokmål) and distributed the screening questions online with the aims (1) to validate the Norwegian version of the screener QPE and (2) to assess the prevalence of hallucinations and delusions in the Norwegian population independently of the clinical status. Methods We conducted an online survey using a test/re-test design, which comprised the 13 screening questions of the QPE as well as demographic and clinical questions. Seven days after initial completion of the QPE participants received a link for the second round. For test/re-test reliability, we calculated concordance rates (i.e., percentage rates of how many participants gave the same response at the first and second measurement). Internal consistency is indicated with Cronbach’s alpha. Finally, we calculated a principal component analysis (PCA) for the QPE items to identify the QPE’s item structure. The study was approved by the regional ethics committee. Results Until now, 407 individuals (304 females, 103 males) with an age range of 18 to 78 (mean = 32.7) participated in the first part of the online survey, of whom 185 also took part in the re-test. Twenty-eight % of all participants had at least one psychiatric diagnosis. Among the healthy participants alone, 35% reported auditory hallucinations, 26% visual hallucinations, 40% tactile hallucinations and 28% olfactory hallucinations. Around 68% of all healthy participants reported at least one delusional experience. Cronbach’s alpha across all 13 items for the entire sample was 0.772 in the first round and 0.765 in the second round. Test/re-test reliability was between 79% and 99%. The PCA, also based on the entire sample, revealed one dimension, with high loadings especially on delusion-related questions (range: 0.488–0.697). Discussion The distribution of different modalities of hallucinations and delusions in the healthy sample suggests that psychotic experiences are not necessarily connected to diagnoses. This finding is in accordance with other studies and supports the hypothesis that psychotic experiences are independent of the clinical status. The Cronbach’s alpha suggests a good internal consistency at both time points, which stays stable over time and the test/re-test reliability shows a high accordance between the answers of round one and two. The PCA implies that the QPE screener is best characterized with a unidimensional structure, indicating that there is substantial overlap between hallucinations and delusions, even though factor loadings are particularly high for delusions. We conclude that the Norwegian version of the screener QPE is a viable tool for assessing psychotic experiences across both psychiatric and healthy populations.

Trajectories of depressive symptoms in the acute phase of psychosis: Implications for treatment

Depression is common in schizophrenia and associated with negative outcomes. Previous studies have identified heterogeneity in treatment response in schizophrenia. We aimed to investigate different trajectories of depression in patients suffering from psychosis and predictors of change in depressive symptoms during antipsychotic treatment. Two hundred and twenty-six patients >18 years acutely admitted due to psychosis were consecutively included and the follow-up was 27 weeks. The Calgary Depression Scale for Schizophrenia (CDSS) sum score was the primary outcome. Latent growth curve (LGCM) and Growth Mixture Models (GMM) were conducted. Predictors were the Positive sum score of the Positive and Negative Syndrome Scale for Schizophrenia (PANSS), Schizophrenia spectrum/non-spectrum psychoses, gender and being antipsychotic naive at inclusion. We found support for three depression-trajectories, including a high- (14.7%), a low depression-level (69.6%) class and a third depressed class quickly decreasing to a low level (15.7%). Change in CDSS was associated with change in PANSS positive score in all time intervals (4 weeks: b = 0.18, p < 0.001, 3 months: 0.21, p < 0.023, 6 months: 0.43, p < 0.001) and with a diagnosis within schizophrenia spectrum but not with antipsychotic naivety or gender. The schizophrenia-spectrum patients had less depressive symptoms at inclusion (-2.63, p < 0.001). In conclusion, an early responding and a treatment refractory group were identified. The treatment-refractory patients are candidates for enhanced anti-depressive treatment, for which current evidence is limited. The post-psychotic depression group was characterized by depressive symptoms in the acute phase as well. We could not identify differentiating characteristics of the depression trajectories.