OBJECTIVE To examine the psychological effects on clinicians of working to manage novel viral outbreaks, and successful measures to manage stress and psychological distress.
DESIGNRapid review and meta-analysis.
The presentation of anti-NMDA receptor encephalitis is variable. However, there are often psychiatric features which are atypical to a primary psychiatric illness, such as severe agitation, speech abnormalities, and catatonia, which may help early identification.
The clinical utility of EEG in cases of NMDA encephalitis is broad with many findings indicating not just epileptiform activity but also encephalopathy and potentially providing insights into pathophysiologic mechanisms of disease. We aimed to determine the frequency of different abnormalities described on EEG and their association with outcome in patients affected by NMDARE through a systematic review of all cases published. Method: A systematic literature review of PubMed and Embase of all published cases of anti-NMDA receptor encephalitis with EEG results, was performed from inception to January 2018. Results: A total of 446 cases of anti-NMDA receptor encephalitis with reported EEG findings were identified. 373 EEGs were abnormal, and this strongly correlated with ICU admission and time to recovery (p = 0.014 and 0.04 respectively). ICU admission and recovery were also correlated with delta range abnormalities including extreme delta brush (p = 0.007 and 0.03). Electrographic seizures correlated strongly with clinical seizures (p < 0.0001), however only 39 cases had EEG seizures captured, while there were 294 cases with clinical seizures. Conclusions: EEG is useful in the clinical management and prognostication of cases on NMDA encephalitis. This is particularly true of certain findings which portend a higher likelihood of ICU admission or poorer outcome and this may assist in the decision to pursue more aggressive treatment options.
Given the functional impairment, medical and psychiatric consequences and the difficulties of treatment, early identification of DDS should be a priority.
Background
Treatment-resistant schizophrenia (TRS) is associated with high levels of functional impairment, healthcare usage and societal costs. Cross-sectional studies may overestimate TRS rates because of selection bias.
Aims
We aimed to quantify TRS rates by using first-episode cohorts to improve resource allocation and clozapine access.
Method
We undertook a systematic review of TRS rates among people with first-episode psychosis and schizophrenia, with a minimum follow-up of 8 weeks. We searched PubMed, PsycINFO, EMBASE, CINAHL and the Cochrane Database of Systematic Reviews, and meta-analysed TRS rates from included studies.
Results
Twelve studies were included, totalling 11 958 participants; six studies were of high quality. The rate of TRS was 22.8% (95% CI 19.1–27.0%, P < 0.001) among all first-episode cohorts and 24.4% (95% CI 19.5–30.0%, P < 0.001) among first-episode schizophrenia cohorts. Subgroup sensitivity analyses by location of recruitment, TRS definition, study quality, time of data collection and retrospective versus prospective data collection did not lead to statistically significant differences in heterogeneity. In a meta-regression, duration of follow-up and percentage drop-out did not significantly affect the overall TRS rate. Men were 1.57 times more likely to develop TRS than women (95% CI 1.11–2.21, P = 0.010).
Conclusions
Almost a quarter of people with first-episode psychosis or schizophrenia will develop TRS in the early stages of treatment. When including people with schizophrenia who relapse despite initial response and continuous treatment, rates of TRS may be as high as a third. These high rates of TRS highlight the need for improved access to clozapine and psychosocial supports.
People with serious mental illness (SMI) are at increased risk of being infected by coronavirus disease 2019 (COVID-19) and have higher subsequent rates of hospitalization, morbidity, and mortality. 1,2 Factors that contribute to worse outcomes include concomitant medications, poorer premorbid general health, physical comorbidity, reduced access to medical care, and environmental and lifestyle factors such as lower socioeconomic status, overcrowding, smoking, or obesity. In light of these vulnerabilities, it is important that people with SMI are a priority group to receive a vaccination, should one be developed and deemed safe and effective. 3 De Hert and colleagues 3 noted that there is an ethical duty to prioritize vaccination for people with SMI given their increased risk of worse outcomes following COVID-19 infection and the structural barriers faced by people with SMI in accessing a vaccine. In addressing the Framework for Equitable Allocation of the COVID-19 Vaccine 4 principle mitigation of health inequities, people with SMI should be included with other priority groups, including Indigenous people, older adults, and people with physical health comorbidities.Over and above the ethical need to ensure vaccination allocation priority for people with SMI, evidence from existing vaccination programs suggests that there are challenges in achieving this aim at both an individual and public health level. People with SMI are less likely to receive preventive or guideline-appropriate health care for concerns such as cardiovascular disease and cancer. This reduced access to preventive care is reflected in the low uptake of immunizations recommended for adults among people with SMI. Of these, influenza may serve as a particularly useful model given the recommendation for an annual vaccination. In contrast with other vulnerable groups in the United States, influenza vaccination rates among people with SMI are as low as 25%. 5,6 Based on the experience with influenza vaccination programs, we have outlined key barriers and solutions to access any potential COVID-19 vaccine for people with SMI (Table ).
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.