Dear Editor,Schizophrenia is a chronic and debilitating brain disorder,which has a strong genetic component with heritability ranging from 66%to 85%[1,2].Currently,antipsychotic drugs remain the most effective treatme...Dear Editor,Schizophrenia is a chronic and debilitating brain disorder,which has a strong genetic component with heritability ranging from 66%to 85%[1,2].Currently,antipsychotic drugs remain the most effective treatment for the psychotic symptoms of schizophrenia[3].Because of the severe sideeffects of first-generation antipsychotics(FGAs),secondgeneration antipsychotics(SGAs)have become more widely used in the treatment of schizophrenia.展开更多
Background:While emotional distress,encompassing anxiety and depression,has been associated with negative clinical outcomes,its impact across various clinical departments and general hospitals has been less explored.P...Background:While emotional distress,encompassing anxiety and depression,has been associated with negative clinical outcomes,its impact across various clinical departments and general hospitals has been less explored.Previous studies with limited sample sizes have examined the effectiveness of specific treatments(e.g.,antidepressants)rather than a systemic management strategy for outcome improvement in non-psychiatric inpatients.To enhance the understanding of the importance of addressing mental health care needs among non-psychiatric patients in general hospitals,this study retrospectively investigated the impacts of emotional distress and the effects of early detection and management of depression and anxiety on hospital length of stay(LOS)and rate of long LOS(LLOS,i.e.,LOS>30 days)in a large sample of non-psychiatric inpatients.Methods:This retrospective cohort study included 487,871 inpatients from 20 non-psychiatric departments of a general hospital.They were divided,according to whether they underwent a novel strategy to manage emotional distress which deployed the Huaxi Emotional Distress Index(HEI)for brief screening with grading psychological services(BS-GPS),into BS-GPS(n=178,883)and non-BS-GPS(n=308,988)cohorts.The LOS and rate of LLOS between the BS-GPS and non-BS-GPS cohorts and between subcohorts with and without clinically significant anxiety and/or depression(CSAD,i.e.,HEI score≥11 on admission to the hospital)in the BS-GPS cohort were compared using univariable analyses,multilevel analyses,and/or propensity score-matched analyses,respectively.Results:The detection rate of CSAD in the BS-GPS cohort varied from 2.64%(95%confidence interval[CI]:2.49%-2.81%)to 20.50%(95%CI:19.43%-21.62%)across the 20 departments,with a average rate of 5.36%.Significant differences were observed in both the LOS and LLOS rates between the subcohorts with CSAD(12.7 days,535/9590)and without CSAD(9.5 days,3800/169,293)and between the BS-GPS(9.6 days,4335/178,883)and non-BS-GPS(10.8 days,11,483/308,988)cohorts.These differences remained significant after controlling for confounders using propensity score-matched comparisons.A multilevel analysis indicated that BS-GPS was negatively associated with both LOS and LLOS after controlling for sociodemographics and the departments of patient discharge and remained negatively associated with LLOS after controlling additionally for the year of patient discharge.Conclusion:Emotional distress significantly prolonged the LOS and increased the LLOS of non-psychiatric inpatients across most departments and general hospitals.These impacts were moderated by the implementation of BS-GPS.Thus,BS-GPS has the potential as an effective,resource-saving strategy for enhancing mental health care and optimizing medical resources in general hospitals.展开更多
Antipsychotic-induced metabolic disturbance(AIMD) is a common adverse effect of antipsychotics with genetics partly underpinning variation in susceptibility among schizophrenia patients. Melanocortin4 receptor(MC4 R) ...Antipsychotic-induced metabolic disturbance(AIMD) is a common adverse effect of antipsychotics with genetics partly underpinning variation in susceptibility among schizophrenia patients. Melanocortin4 receptor(MC4 R) gene, one of the candidate genes for AIMD, has been under-studied in the Chinese patients. We conducted a pharmacogenetic study in a large cohort of Chinese patients with schizophrenia. In this study, we investigated the genetic variation of MC4 R in Chinese population by genotyping two SNPs(rs489693 and rs17782313) in 1,991 Chinese patients and examined association of these variants with the metabolic effects that were often observed to be related to AIMD. Metabolic measures, including body mass index(BMI), waist circumference(WC), glucose, triglyceride, high-density lipoprotein(HDL), and low-density lipoprotein(LDL) levels were assessed at baseline and after 6-week antipsychotic treatment. We found that interaction of SNP×medication status(drug-na?ve/medicated) was significantly associated with BMI, WC, and HDL change %, respectively. Both SNPs were significantly associated with baseline BMI and WC in the medicated group. Moderate association of rs489693 with WC, Triglyceride, and HDL change % were observed in the whole sample. In the drug-na?ve group, we found recessive effects of rs489693 on BMI gain more than 7%, WC and Triglyceride change %, with AA incurring more metabolic adverse effects. In conclusion, the association between rs489693 and the metabolic measures is ubiquitous but moderate. Rs17782313 is less involved in AIMD. Two SNPs confer risk of AIMD to patients treated with different antipsychotics in a similar way.展开更多
基金supported by the National Basic Research Development Program (2016YFC0904300)the National Natural Science Foundation of China (81630030 and 81461168029)the 1.3.5 Project for Disciplines of Excellence of West China Hospital, Sichuan University (ZY2016103 and ZY2016203), China
文摘Dear Editor,Schizophrenia is a chronic and debilitating brain disorder,which has a strong genetic component with heritability ranging from 66%to 85%[1,2].Currently,antipsychotic drugs remain the most effective treatment for the psychotic symptoms of schizophrenia[3].Because of the severe sideeffects of first-generation antipsychotics(FGAs),secondgeneration antipsychotics(SGAs)have become more widely used in the treatment of schizophrenia.
基金funded by the National Natural Science Foundation of China Key Project(Nos.81630030 and 81920108018)the Special Foundation for Brain Research from Science and Technology Program of Guangdong(Nos.2018B030334001)+1 种基金the National Key Research&Development Program,Ministry of Science and Technology,China(Nos.2016YFC0904300)1.3.5 Project for Disciplines of Excellence,West China Hospital of Sichuan University(Nos.ZY2016103,ZY2016203,and ZYGD20004).
文摘Background:While emotional distress,encompassing anxiety and depression,has been associated with negative clinical outcomes,its impact across various clinical departments and general hospitals has been less explored.Previous studies with limited sample sizes have examined the effectiveness of specific treatments(e.g.,antidepressants)rather than a systemic management strategy for outcome improvement in non-psychiatric inpatients.To enhance the understanding of the importance of addressing mental health care needs among non-psychiatric patients in general hospitals,this study retrospectively investigated the impacts of emotional distress and the effects of early detection and management of depression and anxiety on hospital length of stay(LOS)and rate of long LOS(LLOS,i.e.,LOS>30 days)in a large sample of non-psychiatric inpatients.Methods:This retrospective cohort study included 487,871 inpatients from 20 non-psychiatric departments of a general hospital.They were divided,according to whether they underwent a novel strategy to manage emotional distress which deployed the Huaxi Emotional Distress Index(HEI)for brief screening with grading psychological services(BS-GPS),into BS-GPS(n=178,883)and non-BS-GPS(n=308,988)cohorts.The LOS and rate of LLOS between the BS-GPS and non-BS-GPS cohorts and between subcohorts with and without clinically significant anxiety and/or depression(CSAD,i.e.,HEI score≥11 on admission to the hospital)in the BS-GPS cohort were compared using univariable analyses,multilevel analyses,and/or propensity score-matched analyses,respectively.Results:The detection rate of CSAD in the BS-GPS cohort varied from 2.64%(95%confidence interval[CI]:2.49%-2.81%)to 20.50%(95%CI:19.43%-21.62%)across the 20 departments,with a average rate of 5.36%.Significant differences were observed in both the LOS and LLOS rates between the subcohorts with CSAD(12.7 days,535/9590)and without CSAD(9.5 days,3800/169,293)and between the BS-GPS(9.6 days,4335/178,883)and non-BS-GPS(10.8 days,11,483/308,988)cohorts.These differences remained significant after controlling for confounders using propensity score-matched comparisons.A multilevel analysis indicated that BS-GPS was negatively associated with both LOS and LLOS after controlling for sociodemographics and the departments of patient discharge and remained negatively associated with LLOS after controlling additionally for the year of patient discharge.Conclusion:Emotional distress significantly prolonged the LOS and increased the LLOS of non-psychiatric inpatients across most departments and general hospitals.These impacts were moderated by the implementation of BS-GPS.Thus,BS-GPS has the potential as an effective,resource-saving strategy for enhancing mental health care and optimizing medical resources in general hospitals.
基金supported by the National Natural Science Foundation of China Key Project(91332205,81130024,81630030to T.L.)National Natural Science Foundation of China(8157051859 to W.D.et al.)+3 种基金National Key Technology R&D Program of the Ministry of Science and Technology of China(2016YFC0904300 to T.L.)National Natural Science Foundation of China/Research Grants Council of Hong Kong Joint Research Scheme(8141101084 to T.L.)Sichuan Science&Technology Department(2015JY0173 to Q.W.)1.3.5 Project for disciplines of excellence,West China Hospital of Sichuan University(ZY2016103,ZY2016203 to T.L.)
文摘Antipsychotic-induced metabolic disturbance(AIMD) is a common adverse effect of antipsychotics with genetics partly underpinning variation in susceptibility among schizophrenia patients. Melanocortin4 receptor(MC4 R) gene, one of the candidate genes for AIMD, has been under-studied in the Chinese patients. We conducted a pharmacogenetic study in a large cohort of Chinese patients with schizophrenia. In this study, we investigated the genetic variation of MC4 R in Chinese population by genotyping two SNPs(rs489693 and rs17782313) in 1,991 Chinese patients and examined association of these variants with the metabolic effects that were often observed to be related to AIMD. Metabolic measures, including body mass index(BMI), waist circumference(WC), glucose, triglyceride, high-density lipoprotein(HDL), and low-density lipoprotein(LDL) levels were assessed at baseline and after 6-week antipsychotic treatment. We found that interaction of SNP×medication status(drug-na?ve/medicated) was significantly associated with BMI, WC, and HDL change %, respectively. Both SNPs were significantly associated with baseline BMI and WC in the medicated group. Moderate association of rs489693 with WC, Triglyceride, and HDL change % were observed in the whole sample. In the drug-na?ve group, we found recessive effects of rs489693 on BMI gain more than 7%, WC and Triglyceride change %, with AA incurring more metabolic adverse effects. In conclusion, the association between rs489693 and the metabolic measures is ubiquitous but moderate. Rs17782313 is less involved in AIMD. Two SNPs confer risk of AIMD to patients treated with different antipsychotics in a similar way.
