Shorter Time Between Antipsychotic Initiation and CSC Referral Improves Outcomes

Individuals with first-episode psychosis who experience a shorter period between first use of an antipsychotic and enrollment in a coordinated specialty care (CSC) program show improved functioning and quality of life at six months, according to a report in Schizophrenia Bulletin.

Hadar Hazan, M.D., of Yale University School of Medicine, and colleagues wrote that shorter duration of untreated psychosis (DUP) has been repeatedly shown to improve patient outcomes. Their study examined both parts of the treatment pathway: the time between the onset of symptoms and first use of antipsychotic medication (termed DUP-Demand) and the time between antipsychotic initiation and CSC enrollment (DUP-Supply). “Much can occur between the first effort to treat psychosis in an emergency room or psychiatric hospital and eventual entry into a local CSC, including multiple help-seeking events that can involve many community stakeholders,” they wrote.

The researchers examined outcomes for 147 first-episode psychosis patients enrolled from 2014 to 2019 in Specialized Treatment in Early Psychosis (STEP), a CSC in New Haven, Connecticut, that ran a dedicated four-year early detection campaign focused on raising public awareness of psychosis, training health professionals to identify symptoms, and streamlining the CSC referral process. STEP patients were compared with 75 patients enrolled in a CSC in Boston with standard early detection protocols.

Average total DUP for patients enrolled in STEP was 5.9 months shorter than those in the CSC with standard detection protocols. This included a 1.3-month reduction in DUP-Demand and a 4.6-month reduction in DUP-Supply.

This time reduction translated into improvements in functional outcomes: At six months, STEP participants showed significantly greater improvements on their Global Assessment of Function and Quality of Life scales than individuals at the comparison CSC. Further analysis showed that shorter DUP-Supply was the primary driver of these improvements, particularly for quality of life; shorter DUP-Demand time was not significantly associated with either improved functioning or improved quality of life.

The authors said these results demonstrate the value of early detection in CSC. “While reducing DUP may not be easy or cheap, the costs of early detection can be offset by reduced hospitalization and may interact with other health-economic benefits of CSC, including reduced criminal justice involvement,” they wrote.

For related information, see the Psychiatric News article, “New Network Collects Real-Time Data to Improve Treatment of Early Psychosis.”

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Physiotherapy Added to CBT May Boost Quality of Life in Patients With Functional Movement Disorders

Adding physiotherapy to mental health support such as cognitive-behavioral therapy (CBT) may improve the quality of life for people with functional movement disorders, a study in JAMA Neurology has found. Functional movement disorders are a subset of functional neurologic disorder (conversion disorder) and include unusual, involuntary movements or body positions caused by a problem with the way signals are sent throughout the brain.

Daniel Macías-García, M.D., Ph.D., of the University of Seville, and colleagues analyzed data from 38 patients with functional movement disorders who were randomized to receive either physiotherapy plus CBT (the treatment group) or psychological support only (the control group). The treatment group participated in four successive, weekly, one-hour group sessions of CBT and 12 one-hour individualized physiotherapy sessions delivered three times a week. The control group participated in four weekly one-hour group sessions of supportive psychotherapy that included discussion about life stressors.

The researchers measured the patients’ perceived mental and physical quality of life using various surveys at baseline, three months, and five months. At five months, patients in the treatment group reported significantly greater improvements in physical measures of quality of life such as severity of motor symptoms, pain, and perception of overall health compared with the control group.

Also at the fifth month, 47% of patients in the treatment group reported improvement in at least one aspect of quality of life and no worsening in others compared with 16% of patients in the control group.

“[The] effect [of multidisciplinary care] on the physical aspects of quality of life is superior to a comprehensive diagnosis followed by psychoeducation and psychological support, and it seems to be driven by improvements in mobility and pain,” the researchers wrote. “Multidisciplinary treatment may also improve social functioning and may be cost effective regarding return to work; however, further studies with larger cohorts and longer follow-up periods must clarify these aspects.”

For related information, see the Journal of Neuropsychiatry and Clinical Neurosciences article “A Review and Expert Opinion on the Neuropsychiatric Assessment of Motor Functional Neurological Disorders.”

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Behavioral Activation, Medication Equally Effective for Depression in Patients With Heart Failure

Behavioral activation psychotherapy may be just as effective as antidepressants at reducing symptoms of depression in patients with heart failure, a study in JAMA Network Open has found. Behavioral activation psychotherapy, a form of cognitive-behavioral therapy, encourages patients to engage in activities that they enjoyed before developing depression so as to improve their mood.

“Approximately 50% of people with [heart failure] experience depressive symptoms,” wrote Waguih William IsHak, M.D., of Cedars-Sinai Medical Center in Los Angeles and colleagues. Previous studies show that the greater the severity of depression in people with heart failure, the greater the risk for functional decline or death at six months.

The study included 416 adults (mean age, 61 years) who had been diagnosed with heart failure and depression. The patients were randomized to receive either behavioral activation psychotherapy or antidepressant medications. The patients were followed for up to one year.

Behavioral activation therapists and medication care managers facilitated a 50-minute introductory session with patients followed by 12 weekly sessions, then 3 monthly sessions, then contact as needed for an additional 6 months. Behavioral activation sessions lasted 50 minutes and medication management sessions (which did not include psychotherapy) lasted 15 minutes. All sessions were delivered using video or telephone because patients with heart failure may face challenges that make it harder for them to attend sessions in person. The primary outcome was depressive symptom severity at 6 months, measured using the Patient Health Questionnaire 9-Item (PHQ-9).

At baseline, the patients’ mean PHQ-9 scores were 14.54 in the behavioral activation group and 14.31 in the medication group. At the 6-month follow-up, researchers found that the severity of depressive symptoms decreased by nearly 50% for both groups of patients: The mean PHQ-9 scores were 7.53 in the behavioral activation group and 8.09 in the medication group. At 12 months, the mean PHQ-9 scores were 7.62 in the behavioral activation psychotherapy group and 7.98 in the medication group. Patients in the behavioral activation group also experienced small improvement in physical health–related quality of life at 6 months, had fewer emergency department visits, and spent fewer days in the hospital compared with those in the medication group.

“The improvement in physical health–related quality of life, lower likelihood of [emergency department] visits, and fewer hospitalization days observed in the [behavioral activation] group compared with the [medication] group suggest secondary advantages for [behavioral activation], especially that patients with [heart failure] and depression may be reluctant to add more medications to their already large pill burden,” IsHak and colleagues wrote.

“Our findings demonstrate that both interventions are comparably effective in reducing depression for patients with [heart failure], giving patients, caregivers, and health care practitioners the choice between [behavioral activation] and [medication], thus improving patient-centered depression care in [heart failure],” they concluded.

For related information, see the Psychiatric News article “Collaborative Care Improves Quality of Life in Patients With Heart Failure.”

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Living With Adults With Depressive Symptoms Linked to Lower Income, Quality of Life

Living with an adult with depressive symptoms is linked to substantially lower average yearly income and employment rates as well as reduced quality of life for adults who do not have depressive symptoms, a study in the Journal of Affective Disorders has found.

“These findings indicate that the impact of depressive symptoms may extend beyond the affected individuals, imposing a burden on other adults in their households,” wrote Paul Greenberg, M.S., M.A., of the Analysis Group, an economics consulting firm in Boston. “This further supports the value of adequate treatment to address depressive symptoms for adults and reduce the spillover effect to others in their households.”

Greenberg and colleagues analyzed data from The Medical Expenditure Panel Survey Household Component (MEPS-HC), which collects data on demographics, health conditions, health status, use of health care services, income, and employment for each person in a household. As part of MEPS-HC, adults also complete a self-administered questionnaire that contains the 2-item Patient Health Questionnaire. Data on quality of life were obtained from Short-Form 12 version 2 (SF-12v2), a survey which assesses mental and physical health. The researchers identified 1,699 adults without depressive symptoms living in a household with other adults who had depressive symptoms and 15,286 adults without depressive symptoms living in a household where no other adults had depressive symptoms between 2015 and 2019.

Adults without depressive symptoms who lived with adults with depressive symptoms earned $4,720 less in total annual income (representing 11.3% lower than the average income of $41,634 in MEPS), were less likely to be employed, and missed more workdays per year than their peers who lived with adults without depressive symptoms.

Adults without depressive symptoms who lived with adults with depressive symptoms also had a lower quality of life than their peers who lived with adults without depressive symptoms, as evidenced by mean scores that were 2.5 points lower on the mental component score and 2.1 points lower on the physical component score on the SF-12v2.

The “findings emphasize the need to ensure patients with depressive symptoms are identified and receive appropriate intervention, as improved management could address the increasing prevalence of depressive disorder and alleviate the burden associated with depressive symptoms on the individual themselves as well as on the members of their household,” the researchers wrote.

For related information, see the Psychiatric Services article “Incremental Health Care Burden of Treatment-Resistant Depression Among Commercial, Medicaid, and Medicare Payers.”

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Study Supports Use of Emotional Support, Service Dogs for Veterans With PTSD

Eighteen months after being paired with an emotional support or service dog, veterans with posttraumatic stress disorder (PTSD) continued to report improvements in overall functioning and quality of life, a report in Psychiatric Services in Advance has found.

While emotional support dogs can provide comfort to their handlers, service dogs for PTSD receive additional training in a variety of tasks specific to assisting individuals with PTSD (for example, turning on lights in a dark room and providing space between the individual and an approaching person), wrote Joan T. Richerson, M.S., D.V.M., of the VA Tennessee Valley Health Care System and colleagues. The researchers wanted to know whether veterans who were paired with service dogs for PTSD might experience greater therapeutic benefits than those paired with emotional support dogs.

Richerson and colleagues randomly assigned veterans who had been diagnosed with PTSD to receive either a service dog or emotional support dog. Emotional support dogs and service dogs were required to pass the American Kennel Club Canine Good Citizen and Assistance Dogs International Public Access tests. In addition, service dogs were taught to perform tasks specific to a handler’s PTSD (turn on lights in dark room; enter rooms and sweep the perimeter; bring objects; and stand in front or behind the handler, respectively, to provide space between the handler and a person approaching from front or back).

After an observation period during which the randomized participants were asked to complete a dog care course, 97 participants received a service dog, and 84 received an emotional support dog. Over 18 months, the researchers evaluated the study participants’ level of disability and health-related quality of life, using the World Health Organization Disability Assessment Scale II (WHODAS 2.0) and the Veterans RAND 12-Item Health Survey (VR-12 physical and mental scores). They also collected data on participants’ PTSD symptoms, health care use, and more.

Among the findings:

• WHODAS 2.0 scores fell in both groups from three months after pairing with the dogs to 18 months (indicating less disability).
• VR-12 mental scores in both groups increased from baseline to 18 months (indicating improvement in quality of life). There was no significant difference in VR-12 physical scores over time.
• PTSD Checklist for DSM-5 (PCL-5) scores in both groups fell over the course of the study (indicating improvement in PTSD symptoms).

“Some separation in [PCL-5] scores between the groups started to appear at 9 months, with scores for the service dog group decreasing more than those for the emotional support dog group,” the authors noted.

Receipt of a service dog compared with receipt of an emotional support dog did not significantly affect VA costs for any category of care or VA health care use, except for outpatient substance use disorder treatment, the authors continued.

“Future work should examine mechanisms by which a service or emotional support dog has an impact on patient functioning, such as by directly reducing PTSD symptoms (e.g., arousal or avoidance), indirectly reducing symptoms through improved treatment engagement (e.g., in psychotherapy) or adherence (e.g., to pharmacotherapy), or by enabling veterans to overcome challenging situations in the presence of such symptoms.”

For related information, see the Psychiatric Research & Clinical Practice article “A Qualitative Exploration of the Use of Service Dogs in Veterans with Post Traumatic Stress Disorder and Traumatic Brain Injury.”

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Biden to End Public Health Emergency Declaration in May

The COVID-19 public health emergency (PHE) will end on Thursday, May 11, the Biden Administration announced yesterday.

The administration’s decision to end the national emergency and PHE on May 11 will result in the end of multiple federal flexibilities affecting health care programs, including regulatory and statutory flexibilities provided by HHS and other Departments. This is a developing story; more information will be provided to APA members tomorrow.

Attachment Anxiety Following Mild TBI Associated With Poor Outcomes

Adults with attachment anxiety are more likely to have severe and persistent symptoms following a mild traumatic brain injury (mTBI), according to a report in The Journal of Neuropsychiatry and Clinical Neurosciences. The presence of attachment anxiety following mTBI was also associated with increased depression, increased anxiety, and decreased quality of life.

“Interpersonal attachment influences the development and course of disease,” wrote Noah D. Silverberg, Ph.D., of the University of British Columbia and colleagues. “Overall, our findings suggest that attachment strategies in current relationships may buffer or exacerbate stress after mTBI. Greater consideration of the attachment system may improve understanding and management of persistent symptoms after mTBI.”

Silverberg and colleagues recruited 91 adults from two outpatient mTBI clinics in British Columbia who were experiencing persistent mTBI symptoms such as headache, fatigue, memory, and/or sleep problems. The participants completed two sets of questionnaires on TBI symptoms, depression, anxiety, and health-related quality of life at intake (about 18 weeks after their injury) and about three to four months later. They also completed the Relationship Scales Questionnaire (includes questions about attachment) at the follow-up session. Eighty-three adults who completed both assessments were included in the final analysis.

The researchers found significant associations between higher attachment anxiety and persistent symptoms, greater depression and anxiety symptoms, and less improvement in depression and quality of life at follow-up. In contrast, there was no association between higher attachment avoidance (being more emotionally and affectionately distant) and any clinical measures.

Silverberg and colleagues wrote that the mechanisms that connect attachment anxiety with slower mTBI recovery are unclear.

“Future research is needed to disentangle the directionality of the relationship between attachment strategies and clinical outcomes after mTBI,” they concluded. “Longitudinal assessment of attachment strategies and analyses of individual trajectories might reveal unique patterns (attachment strategies contributing to persistent symptoms, persistent symptoms influencing attachment strategies, or both) for different patients.”

To read more on this topic, see the Psychiatric News article “Healing After Moderate to Severe TBI Takes Time.”

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Early Intervention for First-Episode Psychosis Produces Long-Term Benefits, Study Shows

Individuals with first-episode psychosis who participated in a comprehensive, team-based treatment program experienced fewer symptoms, better quality of life, and fewer inpatient hospital days over five years than those who received usual care in the community, according to a report in Schizophrenia Bulletin.

The results were from a five-year follow-up of patients enrolled in NIMH’s Recovery After Initial Schizophrenia Episode-Early Treatment Program (RAISE-ETP). The comprehensive treatment program tested in RAISE was called NAVIGATE, which includes four core interventions: personalized medication management, family psychoeducation, resilience-focused individual therapy, and supported employment and education.

Previous studies found that patients who participated in NAVIGATE showed greater symptom improvements and quality of life compared with those who received standard community care over the first two years of treatment. The new results demonstrate longer-term benefits of NAVIGATE compared with community care, wrote lead author Delbert G. Robinson, M.D., of The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and colleagues.

The researchers compared data on 223 patients at 17 community sites enrolled in NAVIGATE and 181 patients at 17 sites receiving usual care. The primary outcomes were quality of life, as measured by the Heinrichs-Carpenter Quality of Life Scale (QLS); positive and negative symptoms of psychosis, as measured by the Positive and Negative Syndrome Scale (PANSS); and hospital inpatient days.

Assessments occurred every six months; 61% of participants had assessments conducted for at least two years, and 31% had assessments conducted at five years. Overall, the most common causes of dropout recorded by sites were lost to follow-up (34%) followed by declined assessments (10%) and moving out of area (10%), Robinson and colleagues noted.

On average, NAVIGATE participants improved by 7.73 points more than standard care group on PANSS and 13.14 points more than the standard care group on the QLS over the five-year period. They also had 2.53 fewer hospitalization days over five years than those in usual care treatment. The difference in hospitalization days “may be small from an individual perspective but substantial from a policy perspective when considered across many individuals in large scale initiatives,” the researchers wrote.

“[T]he data support long-term benefit of NAVIGATE compared to community care. These benefits are important for making individual decisions about treatment and for policy decisions about program development, implementation, and support.”

For more information, see the Psychiatric News article “Early Psychosis Intervention Shows Robust Real-World Effectiveness.”

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Rheumatoid Arthritis, Depression Raise Risk of One Another, Meta-Analysis Finds

Rheumatoid arthritis and depression have a bidirectional association in which having one condition raises the risk of developing the other, a meta-analysis in the Journal of Affective Disorders has found.

Cyrus S.H. Ho, M.B.B.S., M.Sc., of the National University of Singapore and colleagues conducted a meta-analysis of 11 studies that included a total of 39,130 patients with rheumatoid arthritis, 550,782 patients with depression, and 7,802,230 patients who had neither condition when they enrolled (controls). The studies were conducted in six different countries and had a mean or median follow-up period ranging from 3.4 to 15.8 years.

Compared with controls, patients with rheumatoid arthritis had a 47% greater risk of developing depression.

“The mechanisms mediating the development of depression among [rheumatoid arthritis] patients are overlapping and multifactorial. Pain and functional disability form the hallmark features of [rheumatoid arthritis,] leading to impaired quality of life,” the researchers wrote. They added that fatigue is also highly prevalent in patients who have rheumatoid arthritis and that they often experience stress at the onset of disease.

Patients with depression had a 34% greater risk of developing rheumatoid arthritis compared with controls.

“There is a growing body of evidence supporting the molecular role of inflammation in the pathogenesis of depression,” the researchers wrote. They added that depression has also been associated with myriad autoimmune conditions such as systemic lupus erythematosus, psoriasis vulgaris, and Crohn's disease, all of which involve inflammation.

“Clinicians should systematically screen patients with [rheumatoid arthritis] for depression and be vigilant for the possibility of comorbid [rheumatoid arthritis] in persons, especially elderly, with depression,” the researchers wrote. “The use of anti-cytokine therapies in depression also represents a potential alternative for the treatment of depression that is not responsive to conventional therapy.”

For related information, see the Journal of Neuropsychiatry and Clinical Neurosciences article “Biomarkers of Autoimmunity in Acute Psychiatric Disorders.”

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Deadline for Mental Health Services Conference Abstracts Is Next Thursday

The Mental Health Services Conference will empower all mental health service providers with practical tools and innovations to shape the future of community collaboration. Held in person in Washington, D.C., at the Capital Hilton Hotel on October 13-14, the conference will provide up to 18 continuing education credits for physicians, psychologists, social workers, and nurses. The deadline for abstracts is Thursday, June 2, at 5 p.m. ET.

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Breast Cancer Patients Benefit From Tailored Approach to Depression Screening

Developing tailored strategies that encourage staff at oncology clinics to routinely screen patients with breast cancer for depression can help increase the number of patients connected with behavioral health services, suggests a report published today in JAMA.

Depression is known to be associated with worse outcomes in cancer patients, including decreased social and physical functioning and poor quality of life. The American College of Surgeons Commission on Cancer recommends that health professionals screen cancer patients for distress; however, patients with breast cancer are often underdiagnosed and undertreated for depression and depressive symptoms, wrote Erin E. Hahn, Ph.D., M.P.H., of Kaiser Permanente Southern California and colleagues.

Hahn and colleagues wanted to know whether a depression screening program tailored to individual oncology clinics might increase the proportion of patients receiving referrals to behavioral health services compared with an education-only strategy. They randomized six medical centers within Kaiser Permanente Southern California that were treating patients diagnosed with a new primary breast cancer to one of two interventions: three centers received a tailored intervention; the other three received general education about the program. All centers were encouraged to screen newly diagnosed patients with the nine-item Patient Health Questionnaire (PHQ-9) and, as indicated based on PHQ-9 scores, refer patients for additional behavioral health services.

The clinical teams at tailored intervention sites were educated about the PHQ-9 and the scoring-referral algorithm, engaged in regular check-ins with a nurse researcher, and received tailored audit and feedback reports of progress compared with those of the other intervention sites throughout the study. The teams at the education-only sites were provided with general information about the screening program, including the PHQ-9 questionnaire and scoring-referral algorithm.

The trial included 1,436 patients diagnosed with new primary breast cancer who had a consultation with medical oncology between October 1, 2017, through September 30, 2018; these patients were followed up to May 31, 2019, insurance disenrollment, or death. Regardless of PHQ-9 screening, a significantly greater number of patients in the tailored intervention group received a referral for any behavioral health service compared with patients treated at the education-only clinics during the study period: 135 patients (18%) vs. 74 (11%), the authors reported.

“Given the high burden of depression in patients with breast cancer, effective screening and referral programs are needed. In the current era of heightened health-related concerns due to SARS-CoV-2, which may disproportionately affect patients with cancer and survivors, systematic depression screening and referral for patients with cancer may be even more important,” Hahn and colleagues concluded.

For related information, see the Psychiatric Services article “Factors Influencing Receipt of Mental Health Services Among Medicaid Beneficiaries With Breast Cancer.”

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Integrative Oncology Care May Reduce Emotional Distress in Cancer Patients

Cancer patients undergoing chemotherapy who regularly attended a weekly integrative oncology program had lower levels of depression, anxiety, and sleep problems than patients who did not regularly attend the program, according to a report in Psycho-Oncology.

“Emotional distress is one of the leading challenges facing supportive and palliative oncology care,” wrote Eran Ben‐Arye, M.D., of Technion‐Israel Institute of Technology in Haifa, Israel, and colleagues. Several studies have suggested that integrative oncology care—which combines complementary therapies with conventional cancer treatments—may reduce some symptoms in patients with cancer. Ben-Arye and colleagues specifically focused on the impact of such programs on emotional distress in cancer patients.

They examined data from 439 adults who received personalized integrative oncology care while undergoing chemotherapy for localized cancer (stages 1-3). After an initial hour-long consultation, patients were invited to attend weekly 30- to 45-minute integrative oncology sessions tailored to their needs. These sessions included guidance on herbal supplements, acupuncture, reflexology, music therapy, and more.

The researchers evaluated patients’ depression, anxiety, and sleep quality using the Edmonton Symptom Assessment Scale (ESAS) and quality of life was assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC) at baseline and six weeks later. They compared outcomes in 260 patients who attended at least four integrative oncology sessions over a six-week period with 179 patients who attended fewer sessions.

After six weeks, the patients who attended four or more integrative oncology sessions showed significantly greater improvements in both ESAS and EORTC scores compared with patients who attended fewer sessions. The benefits of attending the integrative oncology sessions were most pronounced in patients with moderate or high anxiety levels (ESAS anxiety scores of 4 to 10) at baseline.

“Patients with baseline mild ESAS anxiety showed no improvement for any of the study outcomes, with some in the high- and low‐[adherence to integrative oncology] groups reporting worsening ESAS anxiety scores at six weeks,” the researchers noted. “The reduced beneficial effect of the [integrative oncology] program on emotional distress in patients with low baseline ESAS anxiety scores presents an opportunity to explore this unique subgroup of patients. It is possible that what appears to be a worsening of ESAS anxiety scores in this group at six weeks was not due to symptom progression but rather an increased willingness to open up with time to the [integrative physicians and integrative oncology] practitioners.”

To read more on this topic, see the Psychiatric News article “Understanding the Breadth and Depth of the Subspecialty: Psycho-Oncology.”

Monthly Buprenorphine May Improve OUD Patients’ Sense of Well-Being, Satisfaction With Treatment

A study in the Journal of Substance Abuse Treatment has shown that treating patients with opioid use disorder (OUD) with monthly injections of extended-release buprenorphine may result in measurable improvements in patients’ quality of life and sense of well-being. This represents a departure from standard research on OUD treatment, which largely focuses on how long patients remain in treatment and whether they abstain from illicit opioid use, according to the researchers.

“Outcomes that are easily measurable during office visits can help clinicians assess life changes reflective of a person’s recovery—a lifestyle characterized not only by abstinence but also health and return to normality,” wrote Walter Ling, M.D., of the University of California, Los Angeles, and colleagues.

In the 12-month study, 206 patients between 18 and 65 years old with moderate to severe OUD received monthly injections of extended-release buprenorphine. Researchers used standard assessment tools and questionnaires at various intervals throughout the study to measure how the patients felt about their own well-being. These tools included the following:

• The EQ-5D-5L to measure the patients’ sense of health such as mobility, self-care, daily activities, pain and discomfort, and anxiety and depression.
• The SF-36v2 to measure the patients’ sense of health-related quality of life and physical and mental health.
• The Treatment Effectiveness Assessment to assess the patients’ perception of treatment effectiveness.
• The Addiction Severity Index-Lite to assess challenging treatment areas, medical, family/social, or psychiatric issues, employment/support status, alcohol use, drug use, and legal issues.
• The Medication Satisfaction Questionnaire to assess the patients’ satisfaction with their treatment.

At the end of the study, the patients’ scores had remained stable on the EQ-5d-5L and the physical component of the SF-36v2. However, their scores rose in the mental health component of the SF-36v2, which suggests that they felt their mental health had improved. The patients’ scores also rose an average of 9 points on the Treatment Effectiveness Assessment, which suggests that they felt the treatment was working. Their scores on the Addiction Severity Index-Lite improved for every measure except alcohol use, and their employment rate increased 7%. At the end of the study, 89% of participants stated they were satisfied with treatment on the Medication Satisfaction Questionnaire.

The researchers noted one important caveat in their study: 412 patients had originally enrolled, but half had withdrawn before the study was over. However, the researchers added that this dropout rate was comparable to that of 11 other studies on buprenorphine treatment.

“Results from this long-term study show positive patient-centered outcomes and high treatment satisfaction for participants initiating and receiving up to 12 months of [extended-release buprenorphine] treatment during the open-label study, demonstrating that meaningful life changes are measurable during a person's recovery journey,” they concluded.

For related information, see the Psychiatric News article “Multidisciplinary Teams Knock Down Barriers to Medication Treatment for OUD.”

This work was funded by Indivior Inc., who manufactures Sublocade, the extended-release buprenorphine medication used in this trial.

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Cancer Patients at Increased Risk for Suicide Within a Year After Diagnosis

Patients with cancer are at an increased risk of suicide in the first year after diagnosis compared with the general population,according to a report in the journal Cancer. The risk differs by type of cancer, with pancreatic and lung cancer having the highest risk.

“After the diagnosis, it is important that health care providers be vigilant in screening for suicide and ensuring that patients have access to social and emotional support,” wrote Anas M. Saad, M.D., of Ain Shams University, Cairo, and colleagues.

Using data from the Surveillance, Epidemiology, and End Results (SEER) Program, the researchers calculated observed/expected (O/E) risk ratios for more than 4 million patients diagnosed with cancer between 2004 and 2014 in the United States. The O/E risk ratio represents the observed number of patients who died from suicide in the first year after diagnosis compared with a demographically similar population within the same period. Mortality data for the general population were collected by the National Center for Health Statistics.

A total of 1,005,825 cancer patients died within the first year after their diagnosis. Suicide was the cause of death for 1,585 of these patients (0.16%). The O/E risk ratio for cancer patients was 2.52, representing a more than two-and-a-half times greater risk of suicide than in the general population.

The patients with the highest increases in suicide rates were those who had been diagnosed with pancreatic cancer or lung cancer: their O/E ratios were 8.01 and 6.05, respectively.

“Social support for patients with cancer plays an integral role in suicide prevention,” Saad and colleagues wrote. “The most effective forms of support seem to be peer support, partner support, and one-to-one professional support. Discussing the quality of life after the diagnosis, the effectiveness of therapy, and the prognosis of the disease and maintaining a trusting relationship with health care professionals all decrease the likelihood of suicide immediately after a diagnosis of cancer.”

For related information, see the Psychiatric News article “Researcher Looks at Improving Well-Being of Families Affected by Cancer.”

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With Early Intervention, Patients With Schizophrenia Experience Greater Improvements in Health, Function

Patients with early-phase psychosis who received integrated, coordinated antipsychotic treatment and psychosocial care experienced greater improvements in health and function over a two-year period than those who did not participate in these programs, according to a comprehensive meta-analysis published today in JAMA Psychiatry. Such outcomes included a reduced risk of hospitalization and treatment discontinuation, shorter stays at the hospital, and better quality of life.

“These findings should provide further impetus for the widespread implementation and funding of EIS [early intervention services] in the United States and across the world, as has already begun,” wrote Christoph Correll, M.D., of the Zucker Hillside Hospital in Glen Oaks, N.Y., and colleagues.

Correll and colleagues searched the literature for randomized, controlled trials comparing outcomes in patients who received early intervention services (including several psychosocial and psychopharmacological interventions) with those who received nonspecialized treatment as usual. This search yielded 10 such studies, including 2,176 patients (mean age 27.5 years), followed for 9 to 24 months.

The meta-analysis revealed that EIS was associated with better outcomes than treatment as usual at the end of treatment for all the outcomes examined, including all-cause treatment discontinuation, at least one psychiatric hospitalization, involvement in school or work, total symptom severity, positive symptom severity, and negative symptom severity. Correll and colleagues noted that the superiority of EIS was evident at 6, 9 to 12, and 18 to 24 months of treatment, except for general symptom severity and depressive symptom severity at 18 to 24 months in several studies included in the analysis.

“Given that schizophrenia is one of the disorders most associated with personal distress and societal cost, sustaining gains achieved by EIS could be cost-effective,” they wrote. “Therefore, additional trials are needed that study different EIS extension vs. step-down procedures for patient subgroups that can move between these options based on identified needs.”

For related information, see the Psychiatric News article “Youth Later Diagnosed With Psychotic Disorders May Show Up in Acute Care Settings First” and the Psychiatric Services article “Implementing Coordinated Specialty Care for Early Psychosis: The RAISE Connection Program.”

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