{"id":58236,"date":"2015-07-04T18:06:21","date_gmt":"2015-07-04T22:06:21","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=58236"},"modified":"2015-07-04T21:01:50","modified_gmt":"2015-07-05T01:01:50","slug":"further-study","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2015\/07\/04\/further-study\/","title":{"rendered":"further study…"},"content":{"rendered":"
Here’s a study that’s likely to engender a brisk discussion: <\/div>\n
\n
Psychotic experiences and risk of death in the general population: 24-27 year follow-up of the Epidemiologic Catchment Area study<\/a>.<\/div>\n
by Sharifi V, Eaton WW, Wu LT, Roth KB, Burchett BM, and Mojtabai R.<\/div>\n
British Journal of Psychiatry<\/font><\/strong>. 2015 May 7 [Epub ahead of print].<\/div>\n
[full text on-line<\/a>]<\/div>\n
[First received 10 Dec 2013, final revision 24 Nov 2014, accepted 24 Nov 2014, Published online<\/span> 1 July 2015.]<\/div>\n

<\/p>\n

Background<\/font><\/strong><\/u>: Psychotic experiences are common in the general population and are associated with adverse psychiatric and social outcomes, even in the absence of a psychotic disorder.<\/div>\n
Aims<\/font><\/strong><\/u>: To examine the association between psychotic experiences and mortality over a 24-27 year period. <\/div>\n
Method<\/font><\/strong><\/u>: We used data on 15,049 adult participants from four sites of the Epidemiologic Catchment Area baseline survey in the USA in the early 1980s, linked to the National Death Index and other sources of vital status up until 2007. Psychotic experiences were assessed by the Diagnostic Interview Schedule. <\/div>\n
Results<\/font><\/strong><\/u>: Lifetime psychotic experiences at baseline [n = 855; weighted prevalence, 5.5%] were significantly associated with all-cause mortality at follow-up after adjustment for sociodemographic characteristics and psychiatric diagnoses, including schizophrenia spectrum disorders [P<0.05]. Baseline psychotic experiences were associated with over 5 years’ shorter median survival time. Among the underlying causes of death, suicide had a particularly high hazard ratio [9.16, 95% CI 3.19-26.29]. <\/div>\n
Conclusions<\/font><\/strong><\/u>: Future research needs to explore the association of psychotic experiences with physical health and lifestyle factors that may mediate the relationship of psychotic experiences with mortality.<\/div>\n
 <\/div>\n<\/blockquote>\n
[note that it was accepted November 24, 2014 and that the BPS final draft for Understanding Psychosis and Schizophrenia<\/font><\/em> is dated 19 November 2014<\/a> suggesting to me that they were generated independently from and blind to one another].<\/div>\n

Earlier this year when the British Psychological Society released their Understanding Psychosis and Schizophrenia<\/font><\/em><\/a>,<\/font><\/em> Dr. Jeffrey Lieberman unleashed an ad hominem<\/em> attack that a lot of us felt was way out of bounds [even for him] [see which side of the street?…<\/a>] similar to another a bit later against Robert Whitaker [just stop…<\/a>]. But calling out Dr. Lieberman for conduct unbecoming didn’t necessarily signal support for the BPS Report. It really was a hard report to even discuss because it was presented more as an emotional polemic than a scientific report. If you haven’t read it, please do. It isn’t something that can be easily summarized. But there are only two possible responses: Psychiatry pathologizes normality<\/font><\/em> or The BPS normalizes pathology<\/font><\/em>. Here were some of my reactions at the time it came out : <to be continued>…<\/a>, back to the drawing board…<\/a>, impossibility…<\/a>, jettison schizophrenia?…<\/a>, and jettison schizophrenia? no thanks…<\/a>. In this study, beside the loss of 6+ years from the lifespan [survival curve above], the other data of note in this paper is in Table 2 [abbreviated below]: <\/p>\n


[truncated for simplicity]<\/sup><\/font><\/p>\n

In both the Cox and the Generalized Gamma Models, the shortened lifespan was significant for the overall group reporting psychotic experiences [p<0.001]. And when the analysis was repeated with the covariates separated out [formal psychotic disorders like Schizophrenia, Bipolar Disorder, etc], the significance remained [p<0.05]. In the overall group with psychotic experiences, suicide was a particularly prominent cause of death [Cox Model 9.16(3.19–26.29) p<0.001], but not in the psychotic experience without psychotic disorder group [Cox Model 2.28 (0.36–14.41) p>0.05]. <\/p>\n

This was a population study with information limited to the recorded parameters without specific subject narratives. But the difference, over a six year shortening of lifespan, is impressive. The contrast between the pictures painted by the British Psychological Society’s Understanding Psychosis and Schizophrenia<\/em> and an article like this one is dramatic. The BPS Report would characterize the psychotic experience without psychotic disorder group as a benign variant of normal, not something that would be expected to be associated with morbidity or shortened life. <\/p>\n

I find the controversies that swirl around these differences difficult. In their recent book, Psychiatry Under the Influence<\/a>, Whitaker and Cosgrove make much of the guild interests that have driven a lot of the psychiatric literature in the recent decades, and they are justified – as am I when I make similar complaints. But I can’t read that BPS Report or many of the like-minded blog posts without seeing the guild interests of those authors front and center as an equally prominent force. I expect there will come a time when all of this is will be clear, but I’m not sure this is it. It feels like it’s a yes\/no argument that needs a large [non-binary] study that reframes the issue into one with many answers done by impartial people, and there aren’t many in sight. Guild wars appear to be the currency of the day. <\/p>\n

I know that as a clinician, the non-psychotic disorder people with reported psychotic experiences are much more common than I knew. I’ve seen patients who would go in either category, and plenty where I had no clue. Personally, I’ve come to see their reports as in need of exploring, but not de novo<\/em> evidence of problems. That determination is on other grounds – usually patient defined, based on something they say, not something I think. And at least in my experience, these patients aren’t particularly guarded in talking about their experiences, something of a surprise. While it’s a line in every paper these days, these findings are suggestive, but deserve further study<\/font><\/em> [as does that BPS Report!]… <\/div>\n","protected":false},"excerpt":{"rendered":"

Here’s a study that’s likely to engender a brisk discussion: Psychotic experiences and risk of death in the general population: 24-27 year follow-up of the Epidemiologic Catchment Area study. by Sharifi V, Eaton WW, Wu LT, Roth KB, Burchett BM, and Mojtabai R. British Journal of Psychiatry. 2015 May 7 [Epub ahead of print]. [full […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[5],"tags":[],"class_list":["post-58236","post","type-post","status-publish","format-standard","hentry","category-opinion"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/58236","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=58236"}],"version-history":[{"count":18,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/58236\/revisions"}],"predecessor-version":[{"id":58258,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/58236\/revisions\/58258"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=58236"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=58236"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=58236"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}