bluuebunny/crossref_metadata_2025_split huggingface dataset:
T153. THE ECONOMIC BURDEN OF MENTAL DISORDERS: A SYSTEMATIC REVIEW
Authors: Christensen Maria , Lim Carmen , Saha Sukanta , Cannon Danielle , Presley Finley , Iburg Kim , McGrath John 
Published: May 2020

Abstract

Background
About a third of the world’s population will develop a mental disorder over their lifetime. Having a mental disorder is a huge burden in health loss and cost for the individual, but also for society because of treatment cost, production loss and caregivers’ cost. The objective of this study is to synthesize the international published literature on the economic burden of mental disorders.

Methods
Systematic literature searches were conducted in the databases PubMed, Embase, Web of Science, EconLit, NHS York Database and PsychInfo using key terms for cost and mental disorders. Searches were restricted to 1980 until May 2019. The inclusion criteria were: (1) cost-of-illness studies or cost-analyses; (2) diagnosis of at least one mental disorder (3) samples based on the general population; (4) outcome in monetary units.
13,640 publications were screened by their title/abstract and 439 articles were full-text screened by two independent reviewers. 113 articles were included from the systematic searches and 31 articles from snowball searching, giving a total of 144 included articles. Of these, 41 studies had estimates of the economic burden among people with schizophrenia.

Results
Information about diagnosis, diagnostic criteria, sample size, age, sex, data sources, study perspective, study period, costing approach, cost categories, discount rate and production loss method and cost unit was extracted. The preliminary results show a substantial variety in the used perspective, methodology, costs components and outcomes in the included studies.
An online tool is under development enabling the reader to explore the published information on costs by type of mental disorder, subgroups, country, methodology, and study quality.

Discussion
To the best of our knowledge, this is the first systematic review synthesizing the economic cost of mental disorders worldwide. The paper will provide an important and comprehensive overview over the economic burden of mental disorders, and the output from this review will inform policy-making.
T167. QUALITATIVE DIFFERENCES IN LONG ACTING INJECTABLE ANTIPSYCHOTIC MEDICATIONS AMONG SCHIZOPHRENIA PATIENTS
Authors: Karakasi Valeria , Pavlidis Pavlos , Vlachaki Aikaterini 
Published: May 2020

Abstract

Background
The purpose of this presentation is to investigate qualitative differences associated with treatment of Schizophrenia spectrum disorder patients with long acting injectable (LAI) antipsychotics, including adverse effects and efficacy.

Methods
Literature around LAI antipsychotics and their comparative data was reviewed and evaluated via all electronic databases up to December 2018.

Results
Metabolic, hepatic and cardiovascular complications in olanzapine treatment have been the major concern in most studies, despite the effectiveness of the medication, as coronary heart disease is strongly associated with a decrease in the life expectancy of schizophrenia patients (coupled with higher levels of smoking and malnutrition). Treatment with risperidone was associated with a worsening of depressive affect and suicidal ideation (except prolactin-related and extrapyramidal adverse effects), as well as sexual dysfunction. Hyperprolactinemia, extrapyramidal / neurological symptoms, and sexual dysfunction were the major problems with haloperidol treatment despite a good efficacy profile with respect to positive symptoms of schizophrenia. Sporadic effectiveness, agitation and, to a lesser extent, weight gain were some of the concerns in palimperidone treatment. Aripiprazole treatment was associated with a comparatively milder and in the long term more preferable adverse effect profile, while exhibiting similarly high levels of efficacy with olanzapine in controlling schizophrenia symptoms, but with a reported relatively higher rate in treatment discontinuation (drop-outs) in comparison to olanzapine and haloperidol in case of schizophrenia (in contrast to schizoaffective disorder in which high levels of both compliance and effectiveness are exhibited).

Discussion
The need for an individualized approach in psychiatric treatment highlighted so that the needs of each patient be taken into account by the therapist in choosing the optimal treatment within a given time frame.
T204. CLOZAPINE COMBINATION AND AUGMENTATION STRATEGIES IN PATIENTS WITH SCHIZOPHRENIA –RECOMMENDATIONS FROM AN INTERNATIONAL EXPERT SURVEY AMONG THE TREATMENT RESPONSE AND RESISTANCE IN PSYCHOSIS (TRRIP) WORKING GROUP
Authors: Wagner Elias , Kane John , Correll Christoph , Howes Oliver , Siskind Dan , Honer William G , Lee Jimmy , Falkai Peter , Schneider-Axmann Thomas , Hasan Alkomiet ,   TRRIP Network
Published: May 2020

Abstract

Background
Evidence for the management of inadequate clinical response to clozapine in treatment-resistant schizophrenia is sparse. Accordingly, an international initiative aimed to develop consensus recommendations for treatment strategies for clozapine-refractory patients with schizophrenia.

Methods
We conducted an online survey among members of the Treatment Response and Resistance in Psychosis (TRRIP) working group. An agreement threshold of ≥75% (responses “agree”+“strongly agree”) was set to define a first-round consensus. Questions achieving agreement or disagreement proportions of &gt;50% in the first round, were re-presented to develop second-round final consensus recommendations.

Results
From a total of 61 TRRIP members 44 (first round) and 49 (second round) participated in the consensus-process. Expert recommendations included raising clozapine plasma levels to ≥350 ng/mL for refractory positive, negative and mixed symptoms. In case of ineffective plasma level-guided dose escalation waiting for a delayed response was recommended for persistent positive symptoms. For ongoing clozapine-refractory positive symptoms, combination with a second antipsychotic, (amisulpride and oral aripiprazole) and augmentation with ECT achieved consensus. For clozapine-refractory negative symptoms, waiting for a delayed response was recommended, and as an intervention, clozapine augmentation with an antidepressant reached consensus. For clozapine-refractory suicidality, augmentation with antidepressants or mood-stabilisers, and ECT met consensus criteria. For aggression, augmentation with a mood-stabiliser or combination with antipsychotic medication achieved consensus. Generally, cognitive-behavioural therapy (CBT) and psychosocial interventions reached consensus.

Discussion
This consensus-based series of recommendations provides a framework for decision-making to manage the challenging clinical situation of CRS, where the evidence from randomised-controlled trials remains sparse.
T213. TREND OF LONG-ACTING INJECTABLE ANTIPSYCHOTICS USE IN ASIA: FINDINGS FROM REAP ANTIPSYCHOTIC STUDIES
Authors: Lin Shih-Ku , Chung An-Nie 
Published: May 2020

Abstract

Background
Research on Asian Prescription Pattern (REAP) is the largest and the longest lasting international collaborative research in psychiatry in Asia since 2001. At present, four studies on antipsychotics in schizophrenia, two antidepressants, one bipolar disorder and one mood disorder were completed. Previous studies have examined the use of Long-acting Injectable (LAI) antipsychotic in patients with schizophrenia and revealed major differences across countries. The aim of the study is to investigate the prescription trend of LAI antipsychotic use in four REAP schizophrenia surveys.

Methods
We analyzed the results from four times of REAP studies (AP1 to AP4, 2001, 2004, 2009 and 2016), to compare the trend of LAI prescriptions rates in China, Hong Kong, Japan, Korea, Singapore, and Taiwan, and also the rate of LAI use among 15 Asian countries in AP4.

Results
A total of 10505 patients were analyzed, with an average rate of 14.6% of patients received LAI antipsychotic treatment. For comparison of AP1 to AP4, there was a wide variation in the rate of LAI use among the six countries, with the highest prescription rate in Singapore (68.1%) and the lowest in Korea (1.6 %). Korean patients received no LAIs treatment in the first two surveys, and the rates in China and Japan were also very low. While in Hong Kong and Singapore, the rates were much higher. In AP4 survey, India, Malaysia, Thailand, Pakistan and Sri Lanka have a higher rate of LAI use, while in Indonesia, Myanmar, the rate is much lower. Vietnam does not use LAI at all. The prescription trend was also diverse, which increased in Korea and Japan and decreased in China, Hong Kong and Singapore. The overall prescription trend of LAI was in decrease. Besides, when analyzing cases with only using second generation antipsychotics, the usage of LAI was increased.

Discussion
Previous studies identified several factors associated with prescription of LAI, including demographic and clinical characteristics of patients, patients’ and physicians’ attitude towards LAI, availability of LAI, insurance coverage and related cultural factors. The prescription trend of first generation LAI was decreased in most of the six countries; on the other hand, second generation LAI usages maintain steady level and even slightly increased. In conclusion, LAI antipsychotic is still underuse in Asia, especially in some countries such as Korea, China, Japan, Indonesia and Myanmar. Various factors that influenced the prescription rate of LAI antipsychotic should be addressed further.
M94. NO EVIDENCE OF ASSOCIATIONS BETWEEN GENETIC LIABILITY FOR SCHIZOPHRENIA RISK OF CANNABIS USE DISORDER
Authors: Hjorthøj Carsten , Jamal Uddin Md , Wimberley Theresa , Dalsgaard Søren , Hougaard David , Børglum Anders , Werge Thomas , Nordentoft Merete 
Published: May 2020

Abstract

Background
Cannabis use and cannabis use disorder (CUD) is increased in patients with schizophrenia. It is important to establish if this is explained by non-causal factors, such as shared genetic vulnerability. We aimed to investigate whether the polygenic risk scores (PRS) for schizophrenia and other psychiatric disorders would predict CUD in controls, patients with schizophrenia, and patients with other psychiatric disorders.

Methods
We linked nationwide Danish registers and genetic information obtained from dried neonatal bloodspots in an observational analysis. We included people with schizophrenia, other psychiatric disorders, and controls. The exposures of interest were the polygenic risk scores for schizophrenia, ADHD autism spectrum disorder, and anorexia nervosa. The main outcome of interest was diagnosis of cannabis use disorder.

Results
The study included 88,637 individuals. PRS for schizophrenia did not predict CUD in controls (hazard ratio (HR)=1.16, 95% CI 0.95–1.43 per standard-deviation increase in PRS, or HR=1.47, 95% CI 0.72–3.00 comparing highest versus remaining decile), but PRS for ADHD did (HR=1.27, 95% CI 1.08–1.50 per standard-deviation increase, or HR=2.02, 95% CI 1.27–3.22 for the highest decile of PRS). . Among cases with schizophrenia, the PRS for schizophrenia was associated with CUD. While CUD was a strong predictor of schizophrenia (HR=4.91 (95% CI 4.36–5.53)), the inclusion of various PRS did not appreciably alter this association.

Discussion
The PRS for schizophrenia was not associated with CUD in controls or patients with other psychiatric disorders than schizophrenia. This speaks against the hypothesis that shared genetic vulnerability would explain the association between cannabis and schizophrenia.
M99. INVESTIGATING THE BEST PREDICTIVE CLINICAL FEATURES OF ANTI-N-METHYL-D-ASPARTATE RECEPTOR (NMDAR) ENCEPHALITIS IN THE 2010 AUSTRALIAN NATIONAL SURVEY OF HIGH IMPACT PSYCHOSIS (SHIP) COHORT
Authors: Rossell Susan , Meyer Denny , Shannon Weickert Cyndi , Phillipou Andrea , Galletly Cherrie , Morgan Vera , Harvey Carol , Tooney Paul , Castle David J 
Published: May 2020

Abstract

Background
Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis, a recently reported autoimmune disorder, can be mistakenly diagnosed as a psychotic disorder, especially schizophrenia, as patients can present with prominent psychotic symptoms, in particular persecutory ideation, hallucinations and disturbed speech. In this study we used machine learning of the clinical data in a large cohort of persons with a positive psychosis history to ascertain whether we could predict NMDAR-positive cases, and which variables most accurately distinguished between NMDAR-positive and -negative cases.

Methods
SHIP collected nationally representative data from 1825 individuals with a psychotic illness. Plasma samples were available for n=472. To investigate the prevalence of NMDAR autoantibodies a recombinant indirect immunofluorescence test was performed (EuroImmun AG, Lübeck, Germany), with NMDAR transfected human embryonic kidney (HEK) 293 cells quantified using NIS Elements software. NMDAR-positive cases were estimated. Gradient boosting machine learning (the data were randomly split: 60% for initial ascertainment and 40% for validation) was subsequently performed using the clinical data available: 120 variables in total across various domains of sociodemographic, medical history, psychiatric diagnosis and current psychiatric symptoms. Only the variables found to have significant (or near significant) association with being NMDAR-positive were used to develop rules for identifying cases.

Results
There were 38 NMDAR-positive cases. They were more likely to be associated with a schizophrenia /schizoaffective and a depressive psychosis diagnosis, and less likely to be associated with a bipolar diagnosis, than antibody-negative cases. They were also more likely to be associated with a single episode with good recovery, and with anxiety symptoms and dizziness in the prior 12 months (which included light headedness, feeling faint and unsteady). For the present state symptoms, restricted affect was more likely to be present whereas poverty of speech was rare. Initial insomnia and a medical history that included epilepsy were not present for any of the NMDAR-positive cases. The machine learning algorithm was able to successfully classify 94% of cases to the correct antibody group.

Discussion
In this significant Australian epidemiological cohort, we have identified key clinical features associated with anti-NMDAR encephalitis, including diagnosis, and symptoms and clinical course. The novel and insightful analyses afforded by using machine learning should be replicated in other samples to confirm the important clinical findings reported in the current work.
M146. NEUROCHEMICAL MODULATION OF AUDITORY CORTEX FUNCTIONAL CONNECTIVITY IN PATIENTS WITH AUDITORY VERBAL HALLUCINATIONS
Authors: Weber Sarah , Hjelmervik Helene , Craven Alexander R , Johnsen Erik , Kroken Rune , Løberg Else-Marie , Ersland Lars , Kompus Kristiina , Hugdahl Kenneth 
Published: May 2020

Abstract

Background
Auditory hallucinations have been linked to aberrant functioning of the left superior temporal gyrus (STG) and are associated with impaired cognitive control regulated by areas in the prefrontal cortex. However, the mechanisms behind these dysfunctions are still unclear.

Methods
The current study combined resting state connectivity fMRI with MR spectroscopy (MRS) in a sample of 81 psychosis patients to explore how neurochemical correlates of auditory hallucinations modulate left STG functioning. The analyses were focused on glutamate (Glu) and gamma-aminobutyric acid (GABA), two neurotransmitters with excitatory and inhibitory functions, respectively, since these have previously been implicated in psychosis.

Results
Glu and GABA showed differential relationships with left STG connectivity in patients with and without hallucinations. Specifically, Glu concentration in the anterior cingulate cortex (ACC) was positively related to functional connectivity between the left and right temporal lobe in hallucinating patients only. In contrast, GABA concentration in the ACC was negatively related to connectivity between the left and right temporal lobe in non-hallucinating patients only.

Discussion
These findings support a recently proposed model of interhemispheric temporal lobe miscommunication in auditory hallucinations and indicate prefrontal neurochemical modulation as a potential underlying mechanism. The results can further be integrated with previously suggested excitatory/inhibitory imbalances as neurochemical modulators in AVH.
M180. SUSCEPTIBILITY AND RESILIENCE IN A MOUSE MODEL OF MATERNAL IMMUNE ACTIVATION
Authors: Müller Flavia , Scarborough Joseph , Richetto Juliet , Schalbetter Sina , Weber-Stadlbauer Ulrike , Meyer Urs 
Published: May 2020

Abstract

Background
Epidemiological studies over the past decades have repeatedly implicated maternal immune activation (MIA) in the etiology of psychiatric illnesses, including schizophrenia and related psychotic disorders. Not all offspring exposed to MIA, however, develop overt pathologies, suggesting that some are susceptible while others are resilient to MIA. To elucidate susceptibility and resilience in MIA, we used a mouse model that is based on prenatal exposure to the viral mimic poly(I:C).

Methods
Poly(I:C)-based MIA was induced in C57BL6/N mice on gestation day 12. Control dams received vehicle solution only. Offspring of poly(I:C)- or vehicle-exposed dams were subjected to a comprehensive behavioral testing battery when they reached adulthood (12 weeks of age onwards). Next-generation mRNA sequencing and gene pathway analyses were conducted after behavioral testing to explore the molecular correlates of resilience and susceptibility to MIA.

Results
Behavioral characterization coupled with unbiased TwoStep cluster analysis of a large number offspring (N &gt;150) revealed that offspring exposed to MIA could be stratified into susceptible and resilient subgroups. While the former was characterized by deficits in social interaction, sensorimotor gating, and working memory, the behavioral profile of the latter was indistinguishable from control offspring. Susceptible and resilient MIA offspring were also dissociable by the presence of distinct molecular profiles in cortical and subcortical brain areas. In the medial prefrontal cortex, susceptible MIA offspring displayed a more profound deregulation of genes relevant for oxidative phosphorylation and mitochondrial functions than resilient MIA offspring. In the amygdala, the susceptible and resilient offspring differed in gene transcription pertinent to opioid signaling, DARPP-32 signaling, and G protein-coupled receptor signaling.

Discussion
Our data show that MIA can result in substantial phenotypic and transcriptomic variability even in the context of genetic homogeneity and under identical experimental conditions. If extended further, our model system may help to explain why only a subgroup of offspring exposed to MIA develops overt neurodevelopmental sequelae.
M185. THE EFFECTS OF GROUP ARTS THERAPY BASED ON EMOTION MANAGEMENT TRAINING ON THE EMOTIONAL EXPRESSION, ALEXITHYMIA, DEPRESSION AND QUALITY OF LIFE IN PATIENTS WITH SCHIZOPHRENIA
Authors: Lim Eunsung , Park Sung-Yong , Jang Seung-Ho , Bahk Won-Myong , Kwon Young-Joon , Yoon Bo-Hyun , Lee Kwanghun , Lee Sang-Yeol 
Published: May 2020

Abstract

Background
The objective of this study was to investigate the effects of group arts therapy based on emotion management training on emotional expression, positive emotion and negative emotion, alexithymia, depression and quality of life in patients with schizophrenia.

Methods
24 of 160 in-patients with schizophrenia, according to DSM-IV from H Mental Health Hospital, were randomly assigned to either an experimental or control group. Each group were consisting of 12 patients. Group arts therapy was conducted on the experimental group twice a week, 60 minutes per session, for a total of 16 sessions, while the control group was left untreated. The following scales were used for assessment: Berkeley Expressivity Questionnaire (BEQ), Positive Affective and Negative Affect Schedule (PANAS), Toronto Alexithymia Scale-Korean vesion (TAS-20K), Depression Scale for Schizophrenia (K-CDSS), Positive and Negative Syndrome Scale (PANSS), and Schizophrenia Quality of Life Scale (SQLS-R4K). Independent t-test was conducted to confirm the homogeneity, and to find the effects of group arts therapy, Repeated measures ANOVA was conducted to confirm the differences for scores of each scales regarding groups, measuring timing, and also the interaction between groups and measuring timing by pre, post and follow-up test.

Results
The result of this study are as follows.
First, total score, expressivity factors and impulse strength factors of emotional expressivity were significantly increased after group arts therapy compared to the control group.
Second, positive emotion was significantly increased and negative emotion was significantly decreased after group integrative therapy compared to the control group.
Third, total score, difficulty identifying feelings of Alexithymia were significantly decreased after group arts therapy compared to the control group.
Fourth, depression was significantly decreased after group integrative arts therapy compared to the control group.
Fifth, negative syndromes and general psychopathology were significantly decreased after group arts therapy compared to the control group.
Sixth, quality of life was significantly increased after group arts therapy compared to the control group.

Discussion
The group arts therapy have significantly improved the emotional expression, positive emotion, negative emotion and Alexithymia in patients with schizophrenia and also improved negative syndromes, general psychopathology, depression and quality of life. These result suggest that group arts therapy based on emotion management training could be a useful intervention for emotional disturbance treatment for in patients with schizophrenia.