Epidemiology of Psychosis

Transcription

1 Epidemiology of Psychosis Chris Gale Otago Registrar Training Group Feb 2011.

2 Methodologies used. Population surveys. General population. High risk populations. Screener and re-interview. Case records (raw or capture release). Comprehensive national records Insurance and prescribing Admission and outpatient Complications of psychosis.

3 Early intervention surveys: CAMEO study. (Cheng, in press) Urban and rural Cambridgeshire. Number of people referred to early psychosis. Early psychosi defined by Melbourne Criteria. 1 week psychotic symptoms Less than six months treatment. PANSS score & clinician consensus diagnosis. The rate seems to be dependant on age and gender. This may be an artifact of second criteria (no treatment)

4 CAMEO Results. Highly variable crude rates around England. However, when corrected for age and gender, prevalence of early psychosis around 5 per

5 Contact prevelance and capturerecapture

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7 Atypical Metabolic: 6 to 8 Weeks. The average weight gain after 6 to 8 weeks taking olanzapine was 5 to 6 kg,18, 26, which was significantly higher than the average weight gained while taking risperidone (4 kg) or haloperidol (3 kg). A significant increase in fasting and postprandial blood glucose levels and the incidence of diabetes The largest effects were seen for olanzapine, then risperidone and haloperidol. At 8 weeks, there was a significant increase in insulin level, insulin resistance, and glucose, cholesterol, triglyceride, and C peptide levels across clozapine, olanzapine, risperidone, and sulpiride combined but no significant difference between drugs. Foley, Arch Gen Psychiatry, in press.

8 Atypical Metabolic: By 3 to 4 Months. Increase in cholesterol and fasting insulin levels was found after 3 to 4 months taking olanzapine in 1 study but not another. No significant increase was found in fasting triglyceride, glucose,or leptin levels A significant increase in absolute fat mass; percentage of body fat and waist to hip ratio, suggesting central deposition of body fat; and C peptide level while taking olanzapine. Foley, Arch Gen Psychiatry, in press.

9 Atypical Metabolics by six months to one year. Gain in intra-abdominal fat was nonsignificantly higher with risperidone (27 cm2) than olanzapine (18 cm2). By 1 Year. There was no significant difference in weight gain across different antipsychotics. This ranking of antipsychotics was reflected in other weight-related changes, such as 4-kg or more weight increase,36 7% or more weight increase, increasing BMI, and the incidence of metabolic syndrome, but not for intra-abdominal fat. Orally disintegrating tablets of olanzapine were associated with significantly less weight gain than standard tablets, as was adjunctive reboxetine but not fluoxetine. A significant increase in insulin level, insulin resistance, and total and LDL cholesterol, triglyceride, leptin, and ghrelin levels. Weight gain was significantly correlated with insulin and leptin levels An elevation in fasting glucose level in 1 study but not in 2 others Foley, Arch Gen Psychiatry, in press. Range of average weight gain over 12 months Olanzapine kg Amisulpride 10 kg Quetiapine 10 kg Risperidone 8 9 kg Haloperidol 4 7 kg Chlorpromazine 6 kg Ziprasadone 5 kg Perphenazine 1 kg.

10 Prevalence of psychosis? Type Contact Early Psychosis Per Reference 5 CAMEO Study (Cheng, in press) Contact (non maori) 7.6 Wellington data, MOH (cited by Kake) Contact (capture recapture): non maori. 35 Wellington clinical data set (Kake, 2008). Latent class analysis fully structured interview (lifetime). 20 NZMHS, Gale, submitted. CIDI screen with clinician recoding, 150 USA NCS-R, Kessler month, clinician reinterview. 14 USA NCS-R. Kessler 2005 Lifetime, clinician reinterview 31 USA NCS-R. Kessler 2005

11 Fully structured interviews I: clinician reinterview

12 Symptom profile, Diagnosis psychosis, US NCR

13 Comorbidity 87.9% of respondents with lifetime NAP met criteria for at least one other lifetime disorder 74.2% of respondents with 12-month NAP met criteria for at least one other 12-month disorder. The highest lifetime odds-ratios are: bipolar disorder (11.4) OCD (26.0) The highest 12-month odds-ratios are: panic disorder (14.7) drug dependence (15.8) Variation in the ORs across disorders is not reliable due to the very wide confidence intervals. The ORs with having high comorbidity: three or more hierarchy-free diagnoses in addition to NAP 30.4 lifetime month larger than those associated with any individual disorder.

14 Disability Clinical Interview. Two to four times greater risk of impaired. Basic Functioning Cognition Days out of role Social function Work function.

15 Clinician reinterview... Estimated rate non affective psychosis 15/1000 from structured interview 3/1000 with structured clinical interview. Non significant correlation of clinician reassignment of screening question text with reinterview results. Delusions and Halluncinations most highly correlated with psychosis. BUT SCID modified to have first question same as screener in CIDI. Very expensive project, not replicated.

16 Fully structured interviews II: Latent Class analysis 'Psychotic' 'Hallucinatory' 'Normal' Probability Visions Voices Thought insertion Thought control Telepathy Persecution

17 Distribution of Patients, Deaths, and Suicides in the 3 Geographic Catchment Areas Dutta, R. et al. Arch Gen Psychiatry 2010;67: Copyright restrictions may apply.

18 Rate Ratios for Suicide According to Sex, Age of Onset, Calendar Period, and Geographic Center Dutta, R. et al. Arch Gen Psychiatry 2010;67: Copyright restrictions may apply.

19 References. Cheng F, Kirkbride JB, Lennox BR, et al. Administrative incidence of psychosis assessed in an early intervention service in England: first epidemiological evidence from a diverse, rural and urban setting. Psychol Med Dec 23:1-10. [Epub ahead of print] Foley DL, Morley KI. Systematic Review of Early Cardiometabolic Outcomes of the First Treated Episode of Psychosis. Arch Gen Psychiatry Feb 7. [Epub ahead of print Kake TR, Arnold R, Ellis P. Estimating the prevalence of schizophrenia among New Zealand Maori: a capture-recapture approach. Aust N Z J Psychiatry Nov;42(11):941-9]