Search

Objective: To examine variations in rates of inpatient suicide and clinical risk factors for this phenomenon., Method: The National Israeli Psychiatric Hospitalization Case Registry was used to study inpatient suicide. Clinical risk factors for inpatient suicide were examined in a nested case control design., Results: Between 1990 and 2013 there were 326 inpatient suicides, at an average of one inpatient suicide per 1614 admissions. A significant decline in rates of suicide per admission over time (p<0.001) was associated with a reduced number of beds (p<0.001) and a decline in nationwide suicide rates (p=0.001). Clinical risk factors for inpatient suicide were: affective disorders (OR=5.95), schizoaffective disorder (OR=5.27), schizophrenia (OR=3.82), previous suicide attempts (OR=2.59), involuntary hospitalization (OR=1.67), and more previous hospitalizations (OR=1.16,). A multivariate model with sensitivity of 27.3% and specificity of 95.3% for inpatient suicide, showed a positive predictive value of 0.4%., Conclusions: The absolute number and rates of inpatient suicide per admission have decreased over time, probably due to the decreased number of beds lowering total time at risk. Patients with affective and psychotic disorders and with previous suicide attempts have the greatest risk of inpatient suicide. However, clinical characteristics do not enable identification of patients who are at risk for suicide., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Suicide is a major cause of death in schizophrenia. Identifying factors which increase the risk of suicide among schizophrenia patients might help focus prevention efforts. This study examined risk of suicide in male schizophrenia patients using population-based data, examining the timing of suicide in relation to the last hospital discharge, and the effect of premorbid IQ on risk of suicide. Data on 930,000 male adolescents from the Israeli military draft board were linked with data from the Israeli Psychiatric Hospitalization Case Registry and vital statistics from the Israeli Ministry of Health. The relationship between premorbid IQ and risk for suicide was examined among 2881 males hospitalized with schizophrenia and compared to a control group of 566,726 males from the same cohort, who were not hospitalized for a psychiatric disorder, using survival analysis methods. Over a mean follow-up period of 9.9 years (SD=5.8, range: 0-22 years), 77/3806 males with schizophrenia died by suicide (a suicide rate of 204.4 per 100,000 person-years). Approximately 48% of the suicides occurred within a year of discharge from the last hospital admission for schizophrenia. Risk of suicide was higher in male schizophrenia patients with high premorbid IQ (HR=4.45, 95% CI=1.37-14.43) compared to those with normal premorbid IQ. These data indicate that male schizophrenia patients with high premorbid IQ are at particularly high risk of suicide, and the time of peak risk is during the first year after the last hospitalization discharge., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Background: Negative symptoms are an important target for intervention in schizophrenia. There is lack of clarity in defining appropriate patients for negative symptom trials. While regulators, drug developers and academics have expressed positions in this regard, the implications of these definitions are not yet tested in large-scale trials and there is no consensus., Objectives: We examined the extent to which various operational criteria for inclusion in negative symptoms in schizophrenia clinical trials can impact patient selection and examined the effectiveness of second generation antipsychotics (SGAs) in patients with various degrees of negative symptoms., Method: Using anonymized patient data from AstraZeneca, Janssen Pharmaceuticals, Eli Lilly, Lundbeck, and Pfizer from 20 placebo-controlled trials of SGAs in schizophrenia from the NewMeds repository, we applied different criteria for negative symptoms: prominent, predominant, and EMA criteria, which require predominant and core negative symptoms to be present and examined the impact of these on inclusion and outcome., Results: Operational criteria for negative symptoms in trials vary greatly in their inclusion of patients from "typical" trial samples. Of the patients in our studies, 8.1% and 62.3% met criteria for prominent negative symptoms, 10.2% to 50.2% met criteria for predominant negative symptoms and 7.6% to 40.0% met EMA criteria at baseline. After 6weeks of active treatment, 8% and 33.1% of patients met criteria for prominent residual negative symptoms and 14.9% to 65% met criteria for prominent and 12.2% to 45.5% met EMA criteria. Patients with predominant or prominent negative symptoms showed marked improvement on second generation antipsychotics., Conclusions: Applying various operational criteria for selecting patients for negative symptoms trials provides a great variability in percentage of suitable patients calling into question the extent to which some definitions may be overly narrow., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Background: Psychiatric hospitalization registries are utilized to investigate the incidence and prevalence of schizophrenia for both research and administrative purposes. The assumption behind this is that most individuals with schizophrenia will be hospitalized at least once in their life-time., Method: In an epidemiological survey conducted in the 1980s, a population-based sample (n = 4914) of Israel-born individuals then aged 25-34 were screened in the community, and 29 (0.6%) were subsequently diagnosed by psychiatrists using SADS/RDC criteria. Twenty four years later we linked data from the epidemiological survey with the Israeli National Psychiatric Hospitalization Registry., Results: Twenty seven of the 29 individuals (93%) diagnosed with schizophrenia in the survey were identified in the hospitalization registry with the same diagnosis. Fifty-two (1.0%) participants not diagnosed during the survey with schizophrenia were identified in the psychiatric hospitalization registry 24 years later with schizophrenia. The majority of them were diagnosed with other psychiatric disorders in the survey. If all diagnoses of schizophrenia are accepted at face value, the lifetime prevalence rate would be 1.8% for this cohort., Conclusion: The overwhelming majority of individuals diagnosed with schizophrenia at ages 25-34 in an epidemiological survey were present in the Psychiatric Hospitalization Registry. However, the assessment of life-time rates of schizophrenia at these ages is problematic because some future cases are asymptomatic, others have premorbid non-psychotic disorders, while in others it is difficult to differentiate between affective disorders and schizophrenia. Availability of psychiatric services and hospitalization policy must be considered when generalizing these findings to other countries., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Objective: The Scale for the Assessment of Negative Symptoms (SANS) is the most widely used instrument for measuring negative symptoms in schizophrenia. The validity of its factor structure has not been established. Congruence of the SANS and its subscales to the negative subscale of the Positive and Negative Symptom Scale (PANSS-N) and the Calgary Depression Scale for Schizophrenia (CDSS) were never explored. The current study revised SANS's structure and examined its correlations with the PANSS and the CDSS., Method: Two-hundred and forty patients with schizophrenia with predominantly negative symptoms were analyzed. A principal component analysis was conducted for SANS. Spearman's correlations were conducted for SANS and PANSS-N, and for SANS and CDSS., Results: Principal Component Analyses (PCA) of SANS revealed four factors, corresponding to the original SANS subscales with two exceptions: Item #13 (grooming and hygiene) loaded on the alogia factor rather than on its original affective flattening factor, and Item #4 (poor eye contact) did not load onto any factor. The total PANSS-N score showed a moderate correlation with the SANS and all of its subscales. The total CDSS score showed a low negative correlation with the total SANS score and with its avolition subscale., Conclusions: Our results supported the validity of SANS's structure except for "poor eye contact" and "grooming end hygiene". The moderate correlation between SANS and PANSS-N suggests that although they are not identical, they measure similar constructs. The low negative correlation between SANS and CDSS suggests that they measure different constructs., (Copyright © 2010 Elsevier B.V. All rights reserved.)

Objective: The hypothesized role of CNS infection during childhood in increasing later risk of brain malfunction manifested as schizophrenia has been supported by some but not other studies. We sought to contribute to this debate by linking data on persons who had been hospitalized for meningitis as children, with a National Psychiatric Hospitalization Registry., Method: Data were gathered on 3599 persons who had been hospitalized for a CNS infection before the age of 16, and 6371 controls who had been hospitalized as children for gastroenteritis. Both groups were followed for later hospitalization for schizophrenia between 1970 and 2007 using the Israeli National Psychiatric Hospitalization Case Registry. Data were analyzed using Cox regression analyses., Results: The mean age of the subjects at hospitalization for a CNS infection was 3.4 ± 3.6 years, mean age of the subjects at follow up was 29.3 ± 6.0 years. Compared to controls, hospitalization for any CNS infection during childhood was not associated with an increased risk of later hospitalization for schizophrenia, adjusted HR = 0.81, 95% CI: 0.5-1.32., Conclusions: Overall there was no significant association between childhood CNS infection and schizophrenia. These data do not support the presence of an infectious etiology of schizophrenia., (Copyright © 2010 Elsevier B.V. All rights reserved.)