epidemiology of psychosis

Epidemiology of Psychosis

Chris Gale

Otago Registrar Training Group

Feb 2011.

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.

Prevalence of psychosis?Type Per 10 000 Reference

Contact Early Psychosis 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 2005

12-month, clinician reinterview.

14 USA NCS-R. Kessler 2005

Lifetime, clinician reinterview 31 USA NCS-R. Kessler 2005

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)

CAMEO Results.

● Highly variable crude rates around England.

● However, when corrected for age and gender, prevalence of early psychosis around 5 per 10 000.

Contact prevelance and capture-recapture

Fully structured interviews I: clinician reinterview

Symptom profile, Diagnosis psychosis, US NCR

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.

Fully structured interviews II: Latent Class analysis

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

Visions Voices Thoughtinsertion

Thoughtcontrol

Telepathy Persecution

Pro

bab

ilit

y

'Psychotic''Hallucinatory''Normal'

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

– 17.2 12-month

● larger than those associated with any individual disorder.

Disability Clinical Interview.

● Two to four times greater risk of impaired.● Basic Functioning● Cognition● Days out of role● Social function● Work function.

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.

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.


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


Range of average weight gain over 12 months

Olanzapine 10 – 14 kg

Amisulpride 10 kg

Quetiapine 10 kg

Risperidone 8 – 9 kg

Haloperidol 4 – 7 kg

Chlorpromazine 6 kg

Ziprasadone 5 kg

Perphenazine 1 kg.

Copyright restrictions may apply.

Dutta, R. et al. Arch Gen Psychiatry 2010;67:1230-1237.

Distribution of Patients, Deaths, and Suicides in the 3 Geographic Catchment Areas



Suicide Rates (per 100000 Person-years) and Age- and Calendar Period-Adjusted SMRs by Time Since First Presentation With Psychosis



No Caption Found



Rate Ratios for Suicide According to Sex, Age of Onset, Calendar Period, and Geographic Center

Summary

● Male earlier than female.● Rate around 0.3/100 (30/1000

● Higher in men● Higher in ethnic minorities.● Higher in poor, urban

● Complications.● Disability● Comorbidity● Metabolic syndrome.● Suicide.

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. 2010 Dec 23:1-10. [Epub ahead of print]

● Dutta R, Murray RM, Hotopf M, Allardyce J, Jones PB, Boydell J. Reassessing the long-term risk of suicide after a first episode of psychosis. Arch Gen Psychiatry. 2010 Dec;67(12):1230-7.

● Foley DL, Morley KI. Systematic Review of Early Cardiometabolic Outcomes of the First Treated Episode of Psychosis. Arch Gen Psychiatry. 2011 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. 2008 Nov;42(11):941-9]

● Kessler RC, Birnbaum H, Demler O, Falloon IR, Gagnon E, Guyer M, Howes MJ, Kendler KS, Shi L, Walters E, Wu EQ. The prevalence and correlates of nonaffective psychosis in the National Comorbidity Survey Replication (NCS-R). Biol Psychiatry. 2005 Oct 15;58(8):668-76.

epidemiology of psychosis

Documents