RESUMO
BACKGROUND AND HYPOTHESIS: There is a substantial gap in life expectancy between patients with severe mental illness (SMI) and the general population and it is important to understand which factors contribute to this difference. Research suggests an association between tardive dyskinesia (TD) and mortality; however, results are inconclusive. In addition, studies investigating associations between parkinsonism or akathisia and mortality are rare. We hypothesized that TD would be a risk factor for mortality in patients with SMI. STUDY DESIGN: We studied a cohort of 157 patients diagnosed predominantly with schizophrenia on the former Netherlands Antilles. TD, parkinsonism, and akathisia were assessed with rating scales on eight occasions over a period of 18 years. Twenty-four years after baseline, survival status and if applicable date of death were determined. Associations between movement disorders and survival were analyzed using Cox regression. Sex, age, antipsychotics, antidepressants and benzodiazepines at each measurement occasion were tested as covariates. STUDY RESULTS: Parkinsonism was a significant risk factor with an HR of 1.02 per point on the motor subscale of the Unified Parkinson's Disease Rating Scale (range 0-56). TD and akathisia were not significantly associated with mortality. CONCLUSIONS: Parkinsonism may be an important risk factor for mortality in SMI patients. This finding calls for more follow-up and intervention studies to confirm this finding and to explore whether treatment or prevention of parkinsonism can reduce excess mortality.
Assuntos
Antipsicóticos , Doenças dos Gânglios da Base , Discinesia Induzida por Medicamentos , Pessoas Mentalmente Doentes , Transtornos Parkinsonianos , Discinesia Tardia , Antipsicóticos/efeitos adversos , Doenças dos Gânglios da Base/induzido quimicamente , Doenças dos Gânglios da Base/diagnóstico , Doenças dos Gânglios da Base/epidemiologia , Curaçao , Discinesia Induzida por Medicamentos/diagnóstico , Discinesia Induzida por Medicamentos/epidemiologia , Discinesia Induzida por Medicamentos/etiologia , Humanos , Agitação Psicomotora , Síndrome , Discinesia Tardia/induzido quimicamenteRESUMO
BACKGROUND: The aim was to assess incidence, prevalence and risk factors of medication-induced tremor in African-Caribbean patients with severe mental illness (SMI). METHOD: A prospective study of SMI patients receiving care from the only mental health service of the previous Dutch Antilles. Eight clinical assessments, over 18 years, focused on movement disorders, medication use, and resting tremor (RT) and (postural) action tremor (AT). Risk factors were modeled with logistic regression for both current (having) tremor and for tremor at the next time point (developing). The latter used a time-lagged design to assess medication changes prior to a change in tremor state. RESULTS: Yearly tremor incidence rate was 2.9% and mean tremor point prevalence was 18.4%. Over a third of patients displayed tremor during the study. Of the patients, 5.2% had AT with 25% of cases persisting to the next time point, while 17.1% of patients had RT of which 65.3% persisted. When tremor data were examined in individual patients, they often had periods of tremor interspersed with periods of no tremor. Having RT was associated with age (OR=1.07 per year; 95% confidence interval 1.03-1.11), sex (OR=0.17 for males; 0.05-0.78), cocaine use (OR=10.53; 2.22-49.94), dyskinesia (OR=0.90; 0.83-0.97), and bradykinesia (OR=1.16; 1.09-1.22). Developing RT was strongly associated with previous measurement RT (OR=9.86; 3.80-25.63), with previous RT severity (OR=1.22; 1.05-1.41), and higher anticholinergic load (OR= 1.24; 1.08-1.43). Having AT was associated with tremor-inducing medication (OR= 4.54; 1.90-10.86), cocaine use (OR=14.04; 2.38-82.96), and bradykinesia (OR=1.07; 1.01-1.15). Developing AT was associated with, previous AT severity (OR=2.62 per unit; 1.64-4.18) and tremor reducing medication (OR=0.08; 0.01-0.55). CONCLUSIONS: Long-stay SMI patients are prone to developing tremors, which show a relapsing-remitting course. Differentiation between RT and AT is important as risk factors differ and they require different prevention and treatment strategies.
RESUMO
OBJECTIVE: To test the efficacy of current treatment recommendations for parkinsonism and tardive dyskinesia (TD) severity in patients with severe mental illness (SMI). METHODS: We present an 18-year prospective study including all 223 patients with SMI (as defined by the 1987 US National Institute of Mental Health, which were based on DSM-III-R diagnostic criteria) receiving care from the only psychiatric hospital of the former Netherlands Antilles. Eight clinical assessments (1992-2009) focused on movement disorders and medication use. Tardive dyskinesia was measured by the Abnormal Involuntary Movement Scale and parkinsonism by the Unified Parkinson's Disease Rating Scale. Antipsychotics were classified into first-generation antipsychotic (FGA) versus second-generation antipsychotic (SGA) and high versus low dopamine 2 (D2) affinity categories. The effect that switching has within each category on subsequent movement scores was calculated separately by using time-lagged multilevel logistic regression models. RESULTS: There was a significant association between reduction in TD severity and starting/switching to an FGA (B = -3.54, P < .001) and starting/switching to a high D2 affinity antipsychotic (B = -2.49, P < .01). Adding an SGA to existing FGA treatment was associated with reduction in TD severity (B = -2.43, P < .01). For parkinsonism, stopping antipsychotics predicted symptom reduction (B = -7.76, P < .01 in FGA/SGA-switch model; B = -7.74, P < .01 in D2 affinity switch model), while starting a high D2 affinity antipsychotic predicted an increase in symptoms (B = 3.29, P < .05 in D2 affinity switch model). CONCLUSIONS: The results show that switching from an FGA to an SGA does not necessarily result in a reduction of TD or parkinsonism. Only stopping all antipsychotics reduces the severity of parkinsonism, and starting an FGA or a high D2 affinity antipsychotic may reduce the severity of TD.
Assuntos
Antipsicóticos/efeitos adversos , Antipsicóticos/uso terapêutico , Substituição de Medicamentos , Transtornos Mentais/tratamento farmacológico , Doença de Parkinson Secundária/induzido quimicamente , Doença de Parkinson Secundária/epidemiologia , Discinesia Tardia/epidemiologia , Adulto , Antipsicóticos/administração & dosagem , Estudos Transversais , Dopaminérgicos/efeitos adversos , Dopaminérgicos/uso terapêutico , Feminino , Fidelidade a Diretrizes , Humanos , Masculino , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Antilhas Holandesas , Exame Neurológico/efeitos dos fármacos , Resultado do TratamentoRESUMO
Brua is an Afro-Caribbean religion and healing tradition from the southern part of the former Netherlands Antilles. Like other Caribbean healing traditions, it plays a significant role in shaping how individuals experience and express disorders which Western health professionals consider to require psychiatric care. Because little has been published on Brua, and because patients from Aruba, Bonaire, and Curaçao are often reluctant to discuss their commitment to this tradition, they are often misdiagnosed and either over- or undertreated by biomedically trained health professionals. The present paper provides a review of the literature on Brua and its relation to psychiatry. A systematic search was carried out in PubMed, the Ovid database, Google Scholar, and the historical literature. Our search yielded 35 texts on Brua, including three peer-reviewed scientific papers and eight academic theses. From those texts Brua emerges as a holistic patchwork of creolized beliefs and practices which are considered to be both cause and remedy for a wide variety of ailments. Despite the fact that tension between the Brua discourse and Western-oriented psychiatric practice is significant, adherence to Brua does not seem to cause much patient delay in help-seeking. However, belief in Brua as a possible source of mental and physical complaints, as well as patients' frequent recourse to Brua practices, including the use of hallucinogens, may affect the diagnosis and treatment of mental disorders.
Assuntos
Etnopsicologia , Medicina Tradicional , Transtornos Mentais/diagnóstico , Transtornos Mentais/terapia , Religião e Medicina , Terapias Espirituais , Humanos , Transtornos Mentais/etnologia , Transtornos Mentais/etiologia , Antilhas Holandesas/epidemiologia , Superstições/psicologiaRESUMO
OBJECTIVE: The aim of this study was to examine paternal age in relation to risk of autism spectrum disorders (ASDs) in a setting other than the industrialized west. DESIGN: A case-control study of Aruban-born children (1990-2003). Cases (N = 95) were identified at the Child and Adolescent Psychiatry Clinic, the only such clinic in Aruba; gender and age matched controls (N = 347) were gathered from public health records. Parental age was defined categorically (≤ 29, 30-39, 40-49, ≥ 50 y). The analysis was made, using conditional logistic regression. RESULTS: Advanced paternal age was associated with increased risk of ASDs in offspring. In comparison to the youngest paternal age group (≤ 29 y), risk of autism increased 2.18 times for children born from fathers in their thirties, 2.71 times for fathers in their forties, and 3.22 thereafter. CONCLUSION: This study, part of the first epidemiologic study of autism in the Caribbean, contributes additional evidence, from a distinctive sociocultural setting, of the risk of ASD associated with increased paternal age.
Assuntos
Transtorno Autístico/epidemiologia , Idade Paterna , Medição de Risco/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Transtorno Autístico/etnologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Humanos , Indígenas Sul-Americanos , Modelos Logísticos , Masculino , Idade Materna , Pessoa de Meia-Idade , Países Baixos/etnologia , Medição de Risco/métodos , Fatores de Risco , Espanha/etnologia , Índias Ocidentais/epidemiologiaRESUMO
OBJECTIVE: Previously we found that the incidence of anorexia nervosa (AN) in the general population was much lower in the Netherlands Antilles than in the Netherlands. As a follow-up we compared the incidence of AN in the Netherlands in persons from the Netherlands Antilles to native Dutch. METHOD: A national register of psychiatric hospital admissions was screened for cases of AN. Incidence rates (IR) and incidence rate ratios (IRR) were computed. RESULTS: The IR of AN was 1.32 per 100 000 person years (95% confidence interval (CI): 0.53-2.71) for Netherlands Antilleans and 1.09 (95% CI: 1.04-1.15) for native Dutch. The age- and sex-adjusted IRR was 1.21 (95% CI: 0.58-2.54). CONCLUSION: Contrary to the Netherlands Antilles, in the Netherlands AN is as common among Netherlands Antilleans as among native Dutch. Exposure to the Western idealization of thinness is a risk factor for the development of AN, possibly in interaction with migration-related stress.
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Anorexia Nervosa/etnologia , Anorexia Nervosa/epidemiologia , Emigrantes e Imigrantes/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Adulto , Anorexia Nervosa/psicologia , Comparação Transcultural , Emigrantes e Imigrantes/psicologia , Feminino , Humanos , Incidência , Masculino , Países Baixos/epidemiologia , Antilhas Holandesas/etnologia , Fatores de Risco , Mudança SocialRESUMO
This article presents the results of a large efficacy study comparing different forms of therapy for major depressive disorder (MDD), including interpersonal psychotherapy (IPT) and pharmacotherapy. Patients were randomized to either IPT, IPT in combination with anti-depressant medication, IPT in combination with pill-placebo or medication only. The primary outcome measure was the Hamilton Rating Scale for Depression (HAMD). Patients were treated for 12 to 16 weeks. Ratings were performed at baseline, after 6 weeks of treatment and at the end of treatment. Ethnic minority patients (EMP) had higher scores on the HAMD than non-EMP for every rating period. However, the rate of improvement was the same for EMP and non-EMP. The higher mean scores of EMP on the HAMD could not be explained as solely due to higher scores on somatic items of the rating scales. The attrition rate in EMP (45.9%) was significantly higher than in non-EMP (24.4%), even in the structured treatment format studied. The results suggest that standard antidepressant therapy, be it medication, psychotherapy or both, may be effective for depressed minority patients but therapists should focus on enhancing adherence to treatment.
Assuntos
Antidepressivos de Segunda Geração/uso terapêutico , Comparação Transcultural , Transtorno Depressivo Maior/etnologia , Transtorno Depressivo Maior/terapia , Psicoterapia , Triazóis/uso terapêutico , Adulto , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Marrocos/etnologia , Países Baixos , Piperazinas , Suriname/etnologia , Turquia/etnologiaRESUMO
Recent studies demonstrate an association between antipsychotic-induced parkinsonism (AIP) and rs4606 SNP of RGS2 gene in Jewish and African-Americans. The current study investigates the association between rs4606 and AIP or its subsymptoms (rest tremor, rigidity, and bradykinesia) in 112 psychiatric inpatients of African-Caribbean origin. Presence of AIP, rigidity, bradykinesia, and tremor was measured by the UPDRS. We applied chi(2) (or Fisher Exact) and logistic regression analyses in several models including rs4606, age, gender, dose of antipsychotics, and anticholinergics, and two other putatively functional SNPs in DRD2 (-141CIns/Del) and HTR2C (Cys23Ser) genes. In contrast to recent literature, we find no evidence for an association between rs4606 and AIP or any of its subsymptoms. We hypothesize that the observed lack of association is due probably to differences in serotonin 2A-receptor affinities of the antipsychotics utilized (in contrast to the other published studies, the majority of our patients utilized typical antipsychotics).
Assuntos
Antipsicóticos/efeitos adversos , Transtornos Parkinsonianos/genética , Polimorfismo de Nucleotídeo Único , Proteínas RGS/genética , Adulto , Fatores Etários , Antipsicóticos/administração & dosagem , Antipsicóticos/farmacologia , População Negra , Relação Dose-Resposta a Droga , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Transtornos Parkinsonianos/induzido quimicamente , Escalas de Graduação Psiquiátrica , Receptor 5-HT2A de Serotonina/metabolismo , Fatores de Risco , Fatores Sexuais , Índias OcidentaisRESUMO
To study autism outside of a narrow range of settings previously studied, and in a particularly distinctive setting in the Caribbean. The aim of the Aruba Autism Project was to determine the prevalence of autism spectrum disorders (ASDs) in birth years 1990-1999 in Aruba. A record review study was conducted; cases were ascertained from children treated at the Child & Adolescent Psychiatry Clinic of Aruba, the first and only child psychiatry service on the island. In these 10 birth years we found a prevalence for autistic disorder (AD) of 1.9 per 1,000 (95% CI 1.2-2.8) and for autism spectrum disorders of 5.3 per 1,000 (95% CI 4.1-6.7). Comparison analysis with a cumulative incidence report from the UK, showed a similar cumulative incidence to age five in Aruba. Prevalence of ASDs in birth years 1990-1999 and cumulative incidence to age five in Aruba are similar to recent reports from the United Kingdom and the United States.
RESUMO
We studied the association between polymorphisms of genes coding for dopamine D(2) (DRD2), dopamine D(3) (DRD3), serotonin 2(a) (HTR2A), and serotonin 2(c) (HTR2C) receptors and Antipsychotic-Induced Parkinsonism (AIP), rigidity, bradykinesia, and rest-tremor in African-Caribbeans treated with antipsychotics. Polymorphisms of DRD2 (-141CIns/Del, TaqIA, 957C > T), DRD3 (Ser9Gly), HTR2A (-1438A > G, 102T > C, His452Tyr), and HTR2C (-759C > T, Cys23Ser) genes were determined according to standard protocols. The Unified Parkinson Disease Rating Scale was used for the measurement of AIP, rigidity, bradykinesia, and rest-tremor. Chi-squared or Fisher's exact tests were applied for the association analyses. The t-test was applied for continuous data. Ninety nine males and 27 females met the inclusion criteria (Schizophr Res 1996, 19:195). In males, but not in females, there were significant associations between -141CDel-allele carriership (DRD2) and rigidity (Fisher's Exact Test: P = 0.021) and between 23Ser-allele carriership (HTR2C) and bradykinesia (P = 0.026, chi(2) = 5.0) or AIP (P = 0.008, chi(2) = 7.1). Rest-tremor was not associated with any of the polymorphisms studied. Analyses of the age, chlorpromazine equivalents, benztropine equivalents, the number of patients using anticholinergic medication, and the utilization patterns of the antipsychotic medication did not show statistically significant differences between patients with and without AIP, rigidity, bradykinesia, rest-tremor. Conducting the analysis without gender stratification did not affect our findings considerably, except for the association between bradykinesia and 23Ser-allele which failed to reach statistical significance in the total sample (P = 0.0646, chi(2) = 3.41). Since AIPs subsymptoms (rigidity, bradykinesia, and rest-tremor) may differ pharmacogenetically, our data strongly support symptom-specific analysis of AIP. However, further research is warranted to confirm our findings.