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McCutcheon RA, Cannon A, Parmer S, Howes OD. How to classify antipsychotics: time to ditch dichotomies? Br J Psychiatry 2024; 224:20-25. [PMID: 37960929 DOI: 10.1192/bjp.2023.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
The dichotomies of 'typical/atypical' or 'first/second generation' have been employed for several decades to classify antipsychotics, but justification for their use is not clear. In the current analysis we argue that this classification is flawed from both clinical and pharmacological perspectives. We then consider what approach should ideally be employed in both clinical and research settings.
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Affiliation(s)
- Robert A McCutcheon
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK; and Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Sita Parmer
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Oliver D Howes
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK; Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, London, UK; and H. Lundbeck A/S, Copenhagen, Denmark
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2
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Sabo A, Iaboni A, Taati B, Fasano A, Gorodetsky C. Evaluating the ability of a predictive vision-based machine learning model to measure changes in gait in response to medication and DBS within individuals with Parkinson's disease. Biomed Eng Online 2023; 22:120. [PMID: 38082277 PMCID: PMC10714555 DOI: 10.1186/s12938-023-01175-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 11/19/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Gait impairments in Parkinson's disease (PD) are treated with dopaminergic medication or deep-brain stimulation (DBS), although the magnitude of the response is variable between individuals. Computer vision-based approaches have previously been evaluated for measuring the severity of parkinsonian gait in videos, but have not been evaluated for their ability to identify changes within individuals in response to treatment. This pilot study examines whether a vision-based model, trained on videos of parkinsonism, is able to detect improvement in parkinsonian gait in people with PD in response to medication and DBS use. METHODS A spatial-temporal graph convolutional model was trained to predict MDS-UPDRS-gait scores in 362 videos from 14 older adults with drug-induced parkinsonism. This model was then used to predict MDS-UPDRS-gait scores on a different dataset of 42 paired videos from 13 individuals with PD, recorded while ON and OFF medication and DBS treatment during the same clinical visit. Statistical methods were used to assess whether the model was responsive to changes in gait in the ON and OFF states. RESULTS The MDS-UPDRS-gait scores predicted by the model were lower on average (representing improved gait; p = 0.017, Cohen's d = 0.495) during the ON medication and DBS treatment conditions. The magnitude of the differences between ON and OFF state was significantly correlated between model predictions and clinician annotations (p = 0.004). The predicted scores were significantly correlated with the clinician scores (Kendall's tau-b = 0.301, p = 0.010), but were distributed in a smaller range as compared to the clinician scores. CONCLUSION A vision-based model trained on parkinsonian gait did not accurately predict MDS-UPDRS-gait scores in a different PD cohort, but detected weak, but statistically significant proportional changes in response to medication and DBS use. Large, clinically validated datasets of videos captured in many different settings and treatment conditions are required to develop accurate vision-based models of parkinsonian gait.
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Affiliation(s)
- Andrea Sabo
- KITE, Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
| | - Andrea Iaboni
- KITE, Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, ON, M5T 1R8, Canada
- Centre for Mental Health, University Health Network, 33 Russell Street, Toronto, ON, M5S 2S1, Canada
| | - Babak Taati
- KITE, Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
- Department of Computer Science, University of Toronto, 10 King's College Road, Room 3302, Toronto, ON, M5S 3G4, Canada
- Institute of Biomedical Engineering, University of Toronto, 164 College Street. Room 407, Toronto, ON, M2S 3G9, Canada
- Vector Institute, 661 University Ave Suite 710, Toronto, ON, M5G 1M1, Canada
| | - Alfonso Fasano
- KITE, Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
- Division of Neurology, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, ON, Canada
- Krembil Brain Institute, Toronto, ON, Canada
- CenteR for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, Canada
| | - Carolina Gorodetsky
- Division of Neurology, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, ON, Canada.
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Kim E, Kim S, Suh HS. Use of gastrointestinal prokinetics and the risk of parkinsonism: A population-based case-crossover study. Pharmacoepidemiol Drug Saf 2023; 32:1378-1386. [PMID: 37491627 DOI: 10.1002/pds.5668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 05/03/2023] [Accepted: 07/10/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND The disease burden of parkinsonism is extremely costly in the United States. Unlike Parkinson's disease, drug-induced parkinsonism (DIP) is acute and reversible; exploring the causative drug is important to prevent DIP in patients at high-risk of parkinsonism. OBJECTIVE To examine whether the use of gastrointestinal (GI) prokinetics is associated with an increased risk of parkinsonism. METHODS We conducted a case-crossover study using nationally representative data. We included patients who were newly diagnosed with parkinsonism (ICD-10 G20, G21.1, G25.1) between January 1, 2007 and December 1, 2015. The first prescription date of G20, G21.1, or G25.1 diagnoses was defined as the index date (0 day). Patients with prior extrapyramidal and movement disorders or brain tumors were excluded. We assessed the exposure within the risk (0-29 days) and control periods (60-89 days), before or on the index date. Conditional logistic regression estimated the adjusted odds ratio (aOR) for parkinsonism. RESULTS Overall, 2268 and 1674 patients were exposed to GI prokinetics during the risk and control periods, respectively. The use of GI prokinetics significantly increased the occurrence of parkinsonism (aOR = 2.31; 95% Confidence Interval [CI], 2.06-2.59). The use of GI prokinetics was associated with a higher occurrence of parkinsonism in elderly patients (≥65 years old; aOR = 2.69; 95% CI, 2.30-3.14) than in younger patients (aOR = 1.90; 95% CI, 1.59-2.27). CONCLUSIONS The use of GI prokinetics was significantly associated with higher occurrences of parkinsonism, necessitating close consideration when using GI prokinetics.
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Affiliation(s)
- Eunji Kim
- Department of Pharmacy, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Siin Kim
- College of Pharmacy, Kyung Hee University, Seoul, Republic of Korea
- Institute of Regulatory Innovation through Science (IRIS), Kyung Hee University, Seoul, Republic of Korea
| | - Hae Sun Suh
- College of Pharmacy, Kyung Hee University, Seoul, Republic of Korea
- Institute of Regulatory Innovation through Science (IRIS), Kyung Hee University, Seoul, Republic of Korea
- Department of Regulatory Science, Graduate School, Kyung Hee University, Seoul, Republic of Korea
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Jeon SM, Lee YJ, Kwon JW. Prevalence and causative drugs of drug-induced Parkinsonism in pediatric patients. Eur Child Adolesc Psychiatry 2023; 32:1805-1814. [PMID: 37039890 DOI: 10.1007/s00787-023-02207-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 04/05/2023] [Indexed: 04/12/2023]
Abstract
Although several studies provided evidence on the epidemiology of drug-induced Parkinsonism (DIP) and its causative drugs, it is still limited in pediatrics. This study aimed to investigate the prevalence and risk of DIP in pediatrics. We used the Health Insurance Review and Assessment Service-Pediatric Patients Sample in Korea between 2010 and 2017 to estimate the annual prevalence of DIP and causative drug use using a cross-sectional design. The risk of DIP associated with causative drugs was evaluated using a case-crossover design. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) were calculated using a conditional logistic regression. A total of 2925 pediatric patients had diagnosed with DIP from 2010 to 2017. Most patients were aged between 12 and19 years old, and 99.8% had any diagnosis of mental health disorder (MHD). During the study period, the prevalence of DIP increased by 10.0-fold from 2010 to 2017. All causative drugs showed a corresponding increase in their use, with atypical antipsychotics being the most prominent (increase ratio, 2.07). For both in the prevalence of DIP and atypical antipsychotic use, the increment was much bigger in patients with non-psychotic MHD than that in patients with psychotic MHD. In the case-crossover study, antipsychotics showed the largest aOR with DIP. Risperidone among antipsychotics showed the highest risk for DIP (aOR = 7.09, 95% CI = 3.83-13.09), followed by aripiprazole (aOR = 5.03, 95% CI = 2.88-8.80). This study suggests that the increase in DIP prevalence in pediatric patients might be because of the increased use of atypical antipsychotics.
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Affiliation(s)
- Soo Min Jeon
- College of Pharmacy, Jeju National University, Jeju, South Korea
| | - Yu Jin Lee
- BK21 FOUR Community-Based Intelligent Novel Drug Discovery Education Unit, College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, 80 Daehak-Ro, Daegu, 41566, South Korea
| | - Jin-Won Kwon
- BK21 FOUR Community-Based Intelligent Novel Drug Discovery Education Unit, College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, 80 Daehak-Ro, Daegu, 41566, South Korea.
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Lühnen J, Richter T, Calo S, Meyer G, Köpke S, Möhler R. Psychosocial interventions for reducing antipsychotic medication in care home residents. Cochrane Database Syst Rev 2023; 8:CD008634. [PMID: 37650479 PMCID: PMC10471006 DOI: 10.1002/14651858.cd008634.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
BACKGROUND Antipsychotic medications are regularly prescribed in care home residents for the management of behavioural and psychological symptoms of dementia (BPSD) despite questionable efficacy, important adverse effects, and available non-pharmacological interventions. Prescription rates are related to organisational factors, staff training and job satisfaction, patient characteristics, and specific interventions. Psychosocial intervention programmes aimed at reducing the prescription of antipsychotic drugs are available. These programmes may target care home residents (e.g. improving communication and interpersonal relationships) or target staff (e.g. by providing skills for caring for people with BPSD). Therefore, this review aimed to assess the effectiveness of these interventions, updating our earlier review published in 2012. OBJECTIVES To evaluate the benefits and harms of psychosocial interventions to reduce antipsychotic medication use in care home residents compared to regular care, optimised regular care, or a different psychosocial intervention. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was 14 July 2022. SELECTION CRITERIA We included individual or cluster-randomised controlled trials comparing a psychosocial intervention aimed primarily at reducing the use of antipsychotic medication with regular care, optimised regular care, or a different psychosocial intervention. Psychosocial interventions were defined as non-pharmacological intervention with psychosocial components. We excluded medication withdrawal or substitution interventions, interventions without direct interpersonal contact and communication, and interventions solely addressing policy changes or structural interventions. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Critical appraisal of studies addressed risks of selection, performance, attrition and detection bias, as well as criteria related to cluster randomisation. We retrieved data on the complex interventions on the basis of the TIDieR (Template for Intervention Description and Replication) checklist. Our primary outcomes were 1. use of regularly prescribed antipsychotic medication and 2. ADVERSE EVENTS Our secondary outcomes were 3. mortality; 4. BPSD; 5. quality of life; 6. prescribing of regularly psychotropic medication; 7. regimen of regularly prescribed antipsychotic medication; 8. antipsychotic medication administered 'as needed'; 9. physical restraints; 10. cognitive status; 11. depression; 12. activities of daily living; and 13. COSTS We used GRADE to assess certainty of evidence. MAIN RESULTS We included five cluster-randomised controlled studies (120 clusters, 8342 participants). We found pronounced clinical heterogeneity and therefore decided to present study results narratively. All studies investigated complex interventions comprising, among other components, educational approaches. Because of the heterogeneity of the results, including the direction of effects, we are uncertain about the effects of psychosocial interventions on the prescription of antipsychotic medication. One study investigating an educational intervention for care home staff assessed the use of antipsychotic medication in days of use per 100 resident-days, and found this to be lower in the intervention group (mean difference 6.30 days, 95% confidence interval (CI) 6.05 to 6.66; 1152 participants). The other four studies reported the proportion of participants with a regular antipsychotic prescription. Of two studies implementing an intervention to promote person-centred care, one found a difference in favour of the intervention group (between-group difference 19.1%, 95% CI 0.5% to 37.7%; 338 participants), while the other found a difference in favour of the control group (between-group difference 11.4%, 95% CI 0.9% to 21.9%; 862 participants). One study investigating an educational programme described as "academic detailing" found no difference between groups (odds ratio 1.06, 95% CI 0.93 to 1.20; 5363 participants). The fifth study used a factorial design to compare different combinations of interventions to supplement person-centred care. Results showed a positive effect of medication review, and no clear effect of social interaction or exercise. We considered that, overall, the evidence about this outcome was of low certainty. We found high-certainty evidence that psychosocial interventions intended primarily to reduce antipsychotic use resulted in little to no difference in the number of falls, non-elective hospitalisations, or unplanned emergency department visits. Psychosocial interventions intended primarily to reduce antipsychotic use also resulted in little to no difference in quality of life (moderate-certainty evidence), and BPSD, regular prescribing of psychotropic medication, use of physical restraints, depression, or activities of daily living (all low-certainty evidence). We also found low-certainty evidence that, in the context of these interventions, social interaction and medication review may reduce mortality, but exercise does not. AUTHORS' CONCLUSIONS All included interventions were complex and the components of the interventions differed considerably between studies. Interventions and intervention components were mostly not described in sufficient detail. Two studies found evidence that the complex psychosocial interventions may reduce antipsychotic medication use. In addition, one study showed that medication review might have some impact on antipsychotic prescribing rates. There were no important adverse events. Overall, the available evidence does not allow for clear generalisable recommendations.
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Affiliation(s)
- Julia Lühnen
- Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Institute of Clinical Nursing Science, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Tanja Richter
- Unit of Health Sciences and Education, University of Hamburg, Hamburg, Germany
| | - Stella Calo
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Gabriele Meyer
- Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Sascha Köpke
- Unit of Health Sciences and Education, University of Hamburg, Hamburg, Germany
- Institute of Nursing Science, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ralph Möhler
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
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Lang X, Xue M, Zang X, Wu F, Xiu M, Zhang X. Efficacy of low-dose risperidone in combination with sertraline in first-episode drug-naïve patients with schizophrenia: a randomized controlled open-label study. J Transl Med 2023; 21:432. [PMID: 37403159 DOI: 10.1186/s12967-023-04272-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 06/13/2023] [Indexed: 07/06/2023] Open
Abstract
OBJECTIVE Despite advances in pharmacology, the treatment of schizophrenia (SZ) remains a challenge due to relapse after antipsychotic discontinuation and multiple adverse effects of antipsychotics. We hypothesized that a low dose of risperidone in combination with sertraline would reduce serious adverse effects without decreasing treatment response. This study aimed to examine the efficacy, safety, and tolerability of low-dose risperidone combined with sertraline to reduce risperidone dose and serious adverse effects in first-episode and medication-naive (FEMN) SZ patients. METHODS A total of 230 patients with FEMN SZ were randomly assigned to receive low-dose risperidone in combination with sertraline (RS group) or regular-dose risperidone (control group). The Positive and Negative Syndrome Scale (PANSS), Hamilton Depression Rating Scale (HAMD), and Personal and Social Performance Scale (PSP) were assessed at baseline and the end of the first, second, third, and sixth months. In addition, serum prolactin levels and extrapyramidal symptoms were measured at baseline and follow-up. RESULTS Repeated measures ANCOVA showed significant interaction effects of treatment by time on psychotic symptoms, as well as HAMD, PSP scores, prolactin levels, and extrapyramidal symptoms (all p < 0.05). Compared with the control group, the RS group had greater decreases in PANSS total score and its subscores and HAMD score (all p < 0.01) and a greater increase in PSP total score (p < 0.01). Notably, side effects were lower in the RS group relative to the control group. Improvements in HAMD and PANSS total scores, changes in prolactin levels and gender predicted improvements in PSP from baseline to month 6. CONCLUSIONS Our study suggests that low-dose risperidone in combination with sertraline was more effective for psychotic symptoms and psychosocial functioning, with significantly fewer adverse effects in patients with FEMN SZ. TRIAL REGISTRATION NUMBER ClinicalTrials.gov, NCT04076371.
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Affiliation(s)
- Xiaoe Lang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Mei Xue
- Qingdao Mental Health Center, Qingdao, China
| | | | - Fengchun Wu
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China.
| | - Meihong Xiu
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, China.
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China.
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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Feldman M, Marmol S, Margolesky J. Updated Perspectives on the Management of Drug-Induced Parkinsonism (DIP): Insights from the Clinic. Ther Clin Risk Manag 2022; 18:1129-1142. [PMID: 36573102 PMCID: PMC9789682 DOI: 10.2147/tcrm.s360268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 12/07/2022] [Indexed: 12/30/2022] Open
Abstract
Parkinsonism refers to the clinical combination of bradykinesia, rigidity, tremor, and postural instability. Parkinsonism is often neurodegenerative, but it can be secondary or iatrogenic, as in drug-induced parkinsonism (DIP), which is the topic of this review. We review the pathophysiology of DIP, differentiate DIP and idiopathic Parkinson's disease (PD), list culprit medications in the development of DIP, discuss the diagnosis of DIP as well as the motor and nonmotor signs and symptoms that can help with differentiation of DIP and PD, and detail the management of DIP.
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Affiliation(s)
- Matthew Feldman
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sarah Marmol
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jason Margolesky
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA,Correspondence: Jason Margolesky, Department of Neurology, University of Miami Miller School of Medicine, 1150 NW 14th St, Miami, FL, 33136, USA, Email
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Doherty AS, Shahid F, Moriarty F, Boland F, Clyne B, Dreischulte T, Fahey T, Kennelly SP, Wallace E. Prescribing cascades in community-dwelling adults: A systematic review. Pharmacol Res Perspect 2022; 10:e01008. [PMID: 36123967 PMCID: PMC9485823 DOI: 10.1002/prp2.1008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 12/15/2022] Open
Abstract
The misattribution of an adverse drug reaction (ADR) as a symptom or illness can lead to the prescribing of additional medication, referred to as a prescribing cascade. The aim of this systematic review is to identify published prescribing cascades in community-dwelling adults. A systematic review was reported in line with the PRISMA guidelines and pre-registered with PROSPERO. Electronic databases (Medline [Ovid], EMBASE, PsycINFO, CINAHL, Cochrane Library) and grey literature sources were searched. Inclusion criteria: community-dwelling adults; risk-prescription medication; outcomes-initiation of new medicine to "treat" or reduce ADR risk; study type-cohort, cross-sectional, case-control, and case-series studies. Title/abstract screening, full-text screening, data extraction, and methodological quality assessment were conducted independently in duplicate. A narrative synthesis was conducted. A total of 101 studies (reported in 103 publications) were included. Study sample sizes ranged from 126 to 11 593 989 participants and 15 studies examined older adults specifically (≥60 years). Seventy-eight of 101 studies reported a potential prescribing cascade including calcium channel blockers to loop diuretic (n = 5), amiodarone to levothyroxine (n = 5), inhaled corticosteroid to topical antifungal (n = 4), antipsychotic to anti-Parkinson drug (n = 4), and acetylcholinesterase inhibitor to urinary incontinence drugs (n = 4). Identified prescribing cascades occurred within three months to one year following initial medication. Methodological quality varied across included studies. Prescribing cascades occur for a broad range of medications. ADRs should be included in the differential diagnosis for patients presenting with new symptoms, particularly older adults and those who started a new medication in the preceding 12 months.
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Affiliation(s)
- Ann S. Doherty
- Department of General PracticeRCSI University of Medicine and Health SciencesDublin 2Ireland
| | - Faiza Shahid
- Institute of General Practice and Family MedicineUniversity Hospital of Ludwig‐Maximilians‐University MunichMunichGermany
| | - Frank Moriarty
- School of Pharmacy and Biomolecular SciencesRCSI University of Medicine and Health SciencesDublin 2Ireland
| | - Fiona Boland
- Department of General PracticeRCSI University of Medicine and Health SciencesDublin 2Ireland
- Data Science CentreRCSI University of Medicine and Health SciencesDublin 2Ireland
| | - Barbara Clyne
- Department of General PracticeRCSI University of Medicine and Health SciencesDublin 2Ireland
| | - Tobias Dreischulte
- Institute of General Practice and Family MedicineUniversity Hospital of Ludwig‐Maximilians‐University MunichMunichGermany
| | - Tom Fahey
- Department of General PracticeRCSI University of Medicine and Health SciencesDublin 2Ireland
| | - Seán P. Kennelly
- Department of Medical GerontologyTrinity College DublinDublin 2Ireland
- Department of Age‐related HealthcareTallaght University HospitalDublin 24Ireland
| | - Emma Wallace
- Department of General PracticeUniversity College CorkCorkIreland
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Quality Use of Medicines Indicators and Associated Factors in Residential Aged Care Facilities: Baseline Findings from the Pharmacists in RACF Study in Australia. J Clin Med 2022; 11:jcm11175189. [PMID: 36079117 PMCID: PMC9457045 DOI: 10.3390/jcm11175189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 12/02/2022] Open
Abstract
Prescribing potentially inappropriate medications (PIMs), including antipsychotics and benzodiazepines, has been used as an indicator of the quality use of medicines in residential aged care facilities (RACFs). PIMs are associated with an increased risk of falls and hospitalisations in the elderly. The purpose of this study is to assess the extent of prescribing of PIMs in RACFs at baseline in the Pharmacists in residential aged care facilities (PiRACF) study and examine the association of resident and system factors with the number of PIMs. A cross-sectional analysis of 1368 participants from 15 Australian RACFs was performed to detect PIMs using the American Geriatrics Society 2019 Beers® criteria. Most residents (68.1%) were taking at least one regular PIM; 16.9% were taking regular antipsychotics and 11.1% were taking regular benzodiazepines. Long-term proton pump inhibitors were the most frequent class of PIMs. History of falls and higher Charlson Comorbidity Index were associated with an increased number of prescribed PIMs, while dementia diagnosis and older age (85 years or more) were associated with decreased number of PIMs (p-value <0.05). Residents in facilities with lower nurse-to-resident ratios were more likely to have an increased number of PIMs (p value = 0.001). This study indicates that potentially inappropriate prescribing is common in RACFs and interventions to target residents at highest risk are needed.
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Jeon SM, Park HY, Park S, Chung US, Kwon JW. Association of Treatment With Antipsychotics, Antidepressants, or Both With Movement Disorders and Seizures Among Children and Adolescents With Depression in Korea. JAMA Netw Open 2022; 5:e227074. [PMID: 35426925 PMCID: PMC9012964 DOI: 10.1001/jamanetworkopen.2022.7074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Little evidence exists on neurological adverse events (movement disorders and seizures) that occur during adjuvant use of antipsychotics with antidepressants, especially in children and adolescents. OBJECTIVE To assess the association between neurological adverse events (movement disorders, including parkinsonism, dystonia, extrapyramidal symptoms, chorea, and tic, and seizures) and the adjuvant use of antipsychotics in children and adolescents with depression. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study using the Health Insurance Review and Assessment claims database in Korea between 2008 and 2018. The study population was children and adolescents aged 2 to 18 years with depression who began treatment with antidepressants between January 1, 2010, and December 31, 2018. Data were analyzed between December 9, 2020, and December 10, 2021. EXPOSURE Time-varying exposure to antidepressants, antipsychotics, and concomitant use of antidepressants and antipsychotics. Concomitant use was further subdivided according to the antipsychotic treatment status (dose and agent). MAIN OUTCOMES AND MEASURES The extended Cox proportional hazards regression model, with adjustment for sex, age, health insurance type, psychiatric comorbidities, psychiatric hospitalization, and comedication with other psychotropic drugs, was used to estimate adjusted hazard ratios (aHRs) and 95% CIs for the associations of movement disorders and seizures with use of antidepressants and antipsychotics. RESULTS A total of 9890 patients were included in the study: 9541 (mean [SD] age, 14.8 [2.8] years; 4956 [51.9%] female) and 7731 (mean [SD] age, 14.9 [2.7] years; 4150 [53.7%] female) met the inclusion criteria for movement disorders and seizures, respectively. For movement disorders, associations were found between concomitant use (aHR, 3.68; 95% CI, 3.06-4.44) and antipsychotic-only use (aHR, 3.84; 95% CI, 3.03-4.87) compared with antidepressant-only use, but their CIs overlapped. The associations with seizure were similar (concomitant use: aHR, 2.06; 95% CI, 1.66-2.55; antipsychotic-only use: aHR, 2.05; 95% CI, 1.53-2.75). With concomitant use, the aHRs gradually increased with increasing doses of antipsychotics. Haloperidol had the highest aHR, 7.15 (95% CI, 3.89-10.00) for movement disorders. The highest aHR for seizure was observed with quetiapine (aHR, 2.36; 95% CI, 1.55-3.59), followed by aripiprazole (aHR, 2.05; 95% CI, 1.52-2.77). CONCLUSIONS AND RELEVANCE In this cohort study, adjunctive antipsychotics with antidepressants were associated with movement disorders and seizures compared with antidepressant monotherapy in children and adolescents with depression. These results suggest that careful consideration of the risk-benefit profile of the antipsychotic use as adjuvant therapy in this population is needed.
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Affiliation(s)
- Soo Min Jeon
- BK21 FOUR Community-Based Intelligent Novel Drug Discovery Education Unit, College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu, South Korea
| | - Hae-Young Park
- BK21 FOUR Community-Based Intelligent Novel Drug Discovery Education Unit, College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu, South Korea
| | - Susan Park
- Red Cross College of Nursing, Chung-Ang University, Seoul, South Korea
| | - Un Sun Chung
- Department of Psychiatry, School of Medicine, Kyungpook National University, and Department of Psychiatry, Kyungpook National University Children's Hospital
| | - Jin-Won Kwon
- BK21 FOUR Community-Based Intelligent Novel Drug Discovery Education Unit, College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu, South Korea
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Sabo A, Mehdizadeh S, Iaboni A, Taati B. Prediction of Parkinsonian Gait in Older Adults with Dementia using Joint Trajectories and Gait Features from 2D Video . ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:5700-5703. [PMID: 34892415 DOI: 10.1109/embc46164.2021.9630563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Older adults with dementia have a high risk of developing drug-induced parkinsonism; however, formal clinical gait assessments are too infrequent to capture fluctuations in their gait. Camera-based human pose estimation and tracking provides a means to frequently monitor gait in nonclinical settings. In this study, 2160 walking bouts from 49 participants were recorded using a ceiling-mounted camera. Recorded color videos were processed using AlphaPose to obtain 2D joint trajectories of the participant as they were walking down a hallway of the unit. A subset of 324 walking bouts from 14 participants were annotated with clinical scores of parkinsonism on the Unified Parkinson's Disease Rating Scale (UPDRS)-gait scale. Linear, random forest, and ordinal logistic regression models were evaluated for regression to UPDRS-gait scores using engineered 2D gait features calculated from the AlphaPose joint trajectories. Additionally, spatial temporal graph convolutional networks (ST-GCNs) were trained to predict UPDRS-gait scores from joint trajectories and gait features using a two-stage training scheme (self-supervised pretraining stage on all walks followed by a finetuning stage on labelled walks). All models were trained using leave-one-subject-out cross-validation to simulate testing on previously unseen participants. The macro-averaged F1-score was 0.333 for the best model operating on only gait features and 0.372 for the top ST-GCN model that used both joint trajectories and gait features as input. When accepting predicted scores that were only off by at most 1 point on the UPDRS-gait scale, the accuracy of the model that only used gait features was 82.8%, while the model that also used joint trajectories had an accuracy of 94.2%.Clinical Relevance- The combination of gait features and joint trajectories capture parkinsonian qualities in gait better than either group of data individually.
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d'Errico A, Strippoli E, Vasta R, Ferrante G, Spila Alegiani S, Ricceri F. Use of antipsychotics and long-term risk of parkinsonism. Neurol Sci 2021; 43:2545-2553. [PMID: 34652577 PMCID: PMC8918175 DOI: 10.1007/s10072-021-05650-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/01/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Few epidemiological studies have assessed the risk of parkinsonisms after prolonged use of neuroleptics. We aimed to examine the long-term risk of degenerative parkinsonisms (DP) associated with previous use of neuroleptics. METHODS All residents in Piedmont, Northern-west Italy, older than 39 years (2,526,319 subjects), were retrospectively followed up from 2013 to 2017. Exposure to neuroleptics was assessed through the regional archive of drug prescriptions. The development of DP was assessed using the regional archives of both drug prescriptions and hospital admissions. We excluded prevalent DP cases at baseline as well as those occurred in the first 18 months (short-term risk). The risk of DP associated with previous use of neuroleptics was examined through Cox regression, using a matched cohort design. RESULTS The risk of DP was compared between 63,356 exposed and 316,779 unexposed subjects. A more than threefold higher risk of DP was observed among subjects exposed to antipsychotics, compared to those unexposed (HR = 3.27, 95% CI 3.00-3.57), and was higher for exposure to atypical than typical antipsychotics. The risk decreased after 2 years from therapy cessation but remained significantly elevated (HR = 2.38, 95% CI 1.76-3.21). CONCLUSIONS These results indicate a high risk of developing DP long time from the start of use and from the cessation for both typical and atypical neuroleptics, suggesting the need of monitoring treated patients even after long-term use and cessation.
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Affiliation(s)
- Angelo d'Errico
- Epidemiology Unit, Piedmont Region, ASL TO3, Grugliasco, Italy
| | - Elena Strippoli
- Epidemiology Unit, Piedmont Region, ASL TO3, Grugliasco, Italy
| | - Rosario Vasta
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Via Cherasco, 15, 10126, Turin, Italy.
| | - Gianluigi Ferrante
- National Centre for Drug Research and Evaluation, National Institute of Health (ISS), Rome, Italy.,Center for Oncology Prevention Piemonte, Città della Salute e della Scienza, Turin, Italy
| | - Stefania Spila Alegiani
- National Centre for Drug Research and Evaluation, National Institute of Health (ISS), Rome, Italy
| | - Fulvio Ricceri
- Epidemiology Unit, Piedmont Region, ASL TO3, Grugliasco, Italy.,Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
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Morris EJ, Hollmann J, Hofer AK, Bhagwandass H, Oueini R, Adkins LE, Hallas J, Vouri SM. Evaluating the use of prescription sequence symmetry analysis as a pharmacovigilance tool: A scoping review. Res Social Adm Pharm 2021; 18:3079-3093. [PMID: 34376366 DOI: 10.1016/j.sapharm.2021.08.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/25/2021] [Accepted: 08/03/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND The (prescription) sequence symmetry analysis (PSSA) design has been used to identify potential prescribing cascade signals by assessing the prescribing sequence of an index drug relative to a marker drug presumed to treat an adverse drug event provoked by the index drug. OBJECTIVES This review aimed to explore the use of the PSSA design as a pharmacovigilance tool with a particular focus on the breadth of identified signals and advances in PSSA methodology. METHODS We searched Embase, PubMed/Medline, Google Scholar, Web of Science and grey literature to identify studies that used the PSSA methodology. Two reviewers independently extracted relevant data for each included article. Study characteristics including signals identified, exposure time window, stratified analyses, and use of controls were extracted. RESULTS We identified 53 studies which reported original results obtained using PSSA methodology or quantified the validity of components of the PSSA design. Of those, nine studies provided validation metrics showing reasonable sensitivity and high specificity of PSSA to identify prescribing cascade signals. We identified 340 unique index drug - marker drug signals published in the PSSA literature, representing 281 unique index - marker pharmacological class dyads (i.e., unique fourth-level Anatomical Therapeutic Chemical [ATC] classification dyads). Commonly observed signals were identified for index drugs acting upon the nervous system (34%), cardiovascular system (21%), and blood and blood-forming organs (15%), and many marker drugs were related to the nervous system (25%), alimentary tract and metabolism (23%), cardiovascular system (17%), and genitourinary system and sex hormones (14%). Negative controls and positive controls were utilized in 21% and 13% of studies, respectively. CONCLUSIONS The PSSA methodology has been used in 53 studies worldwide to detect and evaluate over 300 unique prescribing cascades signals. Researchers should consider sensitivity analyses incorporating negative and/or positive controls and additional time windows to evaluate time-varying biases when designing PSSA studies.
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Affiliation(s)
- Earl J Morris
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Josef Hollmann
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Ann-Kathrin Hofer
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Hemita Bhagwandass
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Razanne Oueini
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Lauren E Adkins
- Health Science Center Libraries, University of Florida, Gainesville, FL, USA
| | - Jesper Hallas
- Clinical Pharmacology and Pharmacy, IST, University of Southern Denmark, Odense, Denmark; Department of Clinical Pharmacology and Biochemistry, Odense University Hospital, Odense, Denmark
| | - Scott M Vouri
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA; Center for Drug Evaluation and Safety, University of Florida, Gainesville, FL, USA.
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Orayj K. Cardiovascular Events Associated with Antipsychotics in Newly Diagnosed Parkinson's Disease Patients: A Propensity Score Matched Cohort Study. Int J Gen Med 2021; 14:2975-2987. [PMID: 34234527 PMCID: PMC8254603 DOI: 10.2147/ijgm.s319600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 06/08/2021] [Indexed: 12/31/2022] Open
Abstract
Purpose Observational studies have examined the association between antipsychotics and ischemic heart disease (IHD) in general populations, but results did not take into account other comorbid diseases, such as Parkinson's disease (PD). This study investigates the one-year risk of IHD, all cardiovascular events, and all-cause mortality among newly diagnosed PD patients who used antipsychotics compared to non-users. Materials and Methods This study included individuals aged 40 years or older with a first definitive PD diagnosis Read Code in the Secure Anonymised Information Linkage (SAIL) databank who had been initiated on any PD medication between 2000 and 2016. Antipsychotic users were matched 1:1 with non-users by a propensity score model to control the confounding effects of patients' demographics, social deprivation status, comorbidities, and medication history. Cox regression was performed to calculate the hazard ratios (HR) and 95% CIs for the association between antipsychotics and study outcomes. Results A total of 1837 participants were included in the analysis. Users of first-generation antipsychotics (FGA) were significantly more likely to develop IHD compared to non-users, with an HR of 2.60 (95% CI 1.103-6.167). Among the FGAs, haloperidol had the highest likelihood of IHD developing, with an HR of 3.01 (95% CI 1.038-8.729). Any use of antipsychotics, regardless of whether they were FGA or second-generation antipsychotics (SGA), was linked to all-cause mortality, with an HR of 4.201 (95% CI 3.272-5.394). When subdividing antipsychotics into FGAs and SGAs, mortality was more likely in FGA users, with an HR of 7.557 (95% CI 5.633-10.139). Mortality also occurred in SGA users, but with a lower HR of 3.278 (95% CI 2.509-4.282). Conclusion FGAs were associated with an increased risk of IHD and all-cause mortality in newly diagnosed PD patients with psychosis. This finding emphasizes the need to use antipsychotics with caution in PD patients with psychosis.
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Affiliation(s)
- Khalid Orayj
- School of Pharmacy, King Khalid University, Abha, Saudi Arabia
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15
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Orayj K. Trends and Contributing Factors for Prescribing Antipsychotics in Newly Diagnosed Parkinson's Disease Patients: A Population-Based Study. Risk Manag Healthc Policy 2021; 14:2443-2452. [PMID: 34113198 PMCID: PMC8187095 DOI: 10.2147/rmhp.s313212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 05/23/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose Psychosis is very common in later stages of Parkinson’s disease (PD) patients, but its prevalence in newly diagnosed patients is not rare. The use of antipsychotics in PD patients is complex given their association with worsening Parkinsonian motor symptoms and increased mortality rate. This study aims to examine factors that affect the use of antipsychotics in newly diagnosed PD patients and to identify changes in prescribing over time. Patients and Methods The Secure Anonymized Information Linkage (SAIL) databank was used to identify a cohort of newly diagnosed PD patients aged 40 years and older in Wales. The cohort was longitudinally examined over 17 years to determine the incidence of new antipsychotic use. Logistic regression models were used to analyze the data and were adjusted for several potential confounding variables. Results A total of 9142 PD patients were identified after applying inclusion and exclusion criteria, of whom 58.6% were male. During the first year of PD diagnosis, 12% of the patients developed psychosis and were prescribed antipsychotics. Quetiapine was the most commonly prescribed (49%), followed by risperidone (10.7%). The use of antipsychotics in newly diagnosed PD patients was significantly lower in the years 2009–2016 compared to 2000–2008 (OR 0.37, 95% CI 0.32–0.43). Other significant prescribing factors included patient’s age and history of dementia. Conclusion A dramatic decline in antipsychotic use was identified across years, showing adherence to warnings against use of antipsychotics for PD patients. Given that psychosis is prevalent in PD patients, the continuous assessment of the safety risks of antipsychotics is a matter of priority.
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Affiliation(s)
- Khalid Orayj
- Clinical Pharmacy Department, School of Pharmacy, King Khalid University, Abha, Saudi Arabia
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Wisidagama S, Selladurai A, Wu P, Isetta M, Serra-Mestres J. Recognition and Management of Antipsychotic-Induced Parkinsonism in Older Adults: A Narrative Review. MEDICINES 2021; 8:medicines8060024. [PMID: 34073269 PMCID: PMC8227528 DOI: 10.3390/medicines8060024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/19/2021] [Accepted: 05/23/2021] [Indexed: 12/30/2022]
Abstract
Background: Parkinsonism is a common side-effect of antipsychotic drugs especially in older adults, who also present with a higher frequency of neurodegenerative disorders like Idiopathic Parkinson’s disease (IPD). Distinguishing between antipsychotic-induced parkinsonism (AIP) and IPD is challenging due to clinical similarities. Up to 20% of older adults may suffer from persisting parkinsonism months after discontinuation of antipsychotics, suggesting underlying neurodegeneration. A review of the literature on AIP in older adults is presented, focusing on epidemiology, clinical aspects, and management. Methods: A literature search was undertaken on EMBASE, MEDLINE and PsycINFO, for articles on parkinsonism induced by antipsychotic drugs or other dopamine 2 receptor antagonists in subjects aged 65 or older. Results: AIP in older adults is the second most common cause of parkinsonism after IPD. Older age, female gender, exposure to high-potency first generation antipsychotics, and antipsychotic dosage are the main risk factors. The clinical presentation of AIP resembles that of IPD, but is more symmetrical, affects upper limbs more, and tends to have associated motor phenomena such as orofacial dyskinesias and akathisia. Presence of olfactory dysfunction in AIP suggests neurodegeneration. Imaging of striatal dopamine transporters is widely used in IPD diagnosis and could help to distinguish it from AIP. There is little evidence base for recommending pharmacological interventions for AIP, the best options being dose-reduction/withdrawal, or switching to a second-generation drug. Conclusions: AIP is a common occurrence in older adults and it is possible to differentiate it from IPD. Further research is needed into its pathophysiology and on its treatment.
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Affiliation(s)
- Sharadha Wisidagama
- Departments of Psychiatry, Central and North West London NHS Foundation Trust, London NW1 3AX, UK; (S.W.); (A.S.); (P.W.)
| | - Abiram Selladurai
- Departments of Psychiatry, Central and North West London NHS Foundation Trust, London NW1 3AX, UK; (S.W.); (A.S.); (P.W.)
| | - Peter Wu
- Departments of Psychiatry, Central and North West London NHS Foundation Trust, London NW1 3AX, UK; (S.W.); (A.S.); (P.W.)
| | - Marco Isetta
- Knowledge and Library Services, Central and North West London NHS Foundation Trust, London NW1 3AX, UK;
| | - Jordi Serra-Mestres
- Old Age Psychiatry, Central and North West London NHS Foundation Trust, Uxbridge UB8 3NN, UK
- Correspondence: ; Tel.: +44-0-1895-484911
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Singh S, Cocoros NM, Haynes K, Nair VP, Harkins TP, Rochon PA, Platt R, Dashevsky I, Reynolds J, Mazor KM, Bloomstone S, Anzuoni K, Crawford SL, Gurwitz JH. Antidopaminergic-Antiparkinsonian Medication Prescribing Cascade in Persons with Alzheimer's Disease. J Am Geriatr Soc 2021; 69:1328-1333. [PMID: 33432578 DOI: 10.1111/jgs.17013] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/08/2020] [Accepted: 12/11/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Persons living with Alzheimer's disease (AD) may be at increased risk for prescribing cascades due to greater multimorbidity, polypharmacy, and the need for more complex care. Our objective was to assess the proportion of the antidopaminergic-antiparkinsonian medication prescribing cascades among persons living with Alzheimer's disease. SETTING Two large administrative claims databases in the United States. PARTICIPANTS We identified patients aged ≥50 on January 1, 2017, who were dispensed a drug used to treat Alzheimer's disease for at least 1 day in the 365 days prior to or on cohort entry date and who had medical and pharmacy coverage in the 365 days prior to the cohort entry date. We excluded individuals with a recent institutional stay. We identified incident antidopaminergic (antipsychotic/metoclopramide) use in the 183 days following cohort entry and identified subsequent incident antiparkinsonian drug use within 8 to 365 days. RESULTS There were 121,538 patients with Alzheimer's disease eligible for inclusion. Approximately 62% were women with a mean age of 79.5 (SD ± 8.6). The mean number of drugs dispensed was 9.2 (SD ± 4.9). There were 36 incident antiparkinsonian users among 4,534 incident antipsychotic/metoclopramide users (0.8%). CONCLUSION We determined that the proportion of antidopaminergic-antiparkinsonian medication prescribing cascades, widely considered as high-priority, was low. Our approach can be used to assess the proportion of prescribing cascades in populations considered to be at high risk and to prioritize system-level interventional efforts to improve medication safety in these patients.
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Affiliation(s)
- Sonal Singh
- University of Massachusetts Medical School & Meyers Primary Care Institute, Worcester, Massachusetts, USA
| | - Noelle M Cocoros
- Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | | | - Vinit P Nair
- Humana Healthcare Research Inc., (Humana), Louisville, Kentucky, USA
| | | | - Paula A Rochon
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Richard Platt
- Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Inna Dashevsky
- Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Juliane Reynolds
- Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Kathleen M Mazor
- University of Massachusetts Medical School & Meyers Primary Care Institute, Worcester, Massachusetts, USA
| | - Sarah Bloomstone
- University of Massachusetts Medical School & Meyers Primary Care Institute, Worcester, Massachusetts, USA
| | - Kathryn Anzuoni
- University of Massachusetts Medical School & Meyers Primary Care Institute, Worcester, Massachusetts, USA
| | - Sybil L Crawford
- University of Massachusetts Medical School & Meyers Primary Care Institute, Worcester, Massachusetts, USA
| | - Jerry H Gurwitz
- University of Massachusetts Medical School & Meyers Primary Care Institute, Worcester, Massachusetts, USA
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Jeon SM, Park S, Kwon S, Kwon JW. Association Between Antipsychotic Treatment and Neurological Adverse Events in Pediatric Patients: A Population-Based Cohort Study in Korea. Front Psychiatry 2021; 12:668704. [PMID: 34122182 PMCID: PMC8187563 DOI: 10.3389/fpsyt.2021.668704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/27/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Potential adverse effects might be caused by increasing the number of antipsychotic prescriptions. However, the empirical evidence regarding pediatric psychiatric patients is insufficient. Therefore, we explored the antipsychotic-induced adverse effects focusing on the neurological system. Method: Using the medical information of pediatric patients retrieved from the claims data of Health Insurance Review and Assessment in Korea, we identified those psychiatric patients who were started on antipsychotic treatment at age 2-18 years between 2010 and 2018 (n = 10,969). In this study, movement disorders and seizures were considered as major neurological adverse events. The extended Cox model with time-varying covariates was applied to explore the association between antipsychotic medication and adverse events. Findings: Total 1,894 and 1,267 cases of movement disorders and seizures occurred in 32,046 and 33,280 person-years, respectively. The hazard risks of neurological adverse events were 3-8 times higher in the exposed to antipsychotics period than in the non-exposure period. Among the exposure periods, the most dangerous period was within 30 days of cumulative exposure. High doses or polypharmacy of antipsychotics was associated with increased risks of neurological adverse events. Among individual antipsychotics, haloperidol showed the highest risk of developing movement disorders among the examined agents. Quetiapine showed a lower risk of developing movement disorders but a higher risk of developing seizures than risperidone. Conclusion: These findings suggest that antipsychotics should be used with caution in pediatric patients, especially regarding initial exposure, high dose, and polypharmacy.
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Affiliation(s)
- Soo Min Jeon
- BK21 FOUR Community-Based Intelligent Novel Drug Discovery Education Unit, College of Pharmacy, Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu, South Korea
| | - Susan Park
- BK21 FOUR Community-Based Intelligent Novel Drug Discovery Education Unit, College of Pharmacy, Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu, South Korea
| | - Soonhak Kwon
- Department of Pediatric Neurology, Kyung-pook National University Children's Hospital, Kyungpook National University School of Medicine, Daegu, South Korea
| | - Jin-Won Kwon
- BK21 FOUR Community-Based Intelligent Novel Drug Discovery Education Unit, College of Pharmacy, Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu, South Korea
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Initiation of antipsychotics after moving to residential aged care facilities and mortality: a national cohort study. Aging Clin Exp Res 2021; 33:95-104. [PMID: 32162240 PMCID: PMC7897604 DOI: 10.1007/s40520-020-01518-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 02/15/2020] [Indexed: 12/29/2022]
Abstract
Background There is a high burden of antipsychotic use in residential aged care facilities (RACFs) and there is concern regarding potential inappropriate prescribing of antipsychotics in response to mild behavioural symptoms. Antipsychotic use has been associated with a higher risk of mortality in community-dwelling older adults with dementia, but few studies have examined associations upon RACF entry. Aims To examine associations between incident antipsychotic use and risk of mortality for people with and without diagnosed dementia in RACFs. Methods A retrospective cohort study, employing a new-user design (individuals did not receive an antipsychotic 6 months before enrolment) of 265,820 people who accessed RACFs in Australia between 1/4/2008 and 30/6/2015 was conducted. Cox regression models were used to examine adjusted associations between antipsychotic use in the first 100 days of RACF entry and mortality. Results In the 100 days after entering care, 29,455 residents (11.1%) were dispensed an antipsychotic. 180,956 (68.1%) residents died [38,249 (14.4%) were related to cerebrovascular causes] over a median 2.1 years (interquartile range 1.0–3.6) follow-up. Of the residents included, 119,665 (45.0%) had a diagnosis of dementia. Incident antipsychotic use was associated with higher risk of mortality in residents with dementia (adjusted hazard ratio 1.20, 95% confidence interval 1.18–1.22) and without dementia (1.28, 1.24–1.31). Conclusion Initiation of antipsychotics after moving to RACFs is associated with a higher risk of mortality. Careful consideration of the potential benefits and harms should be given when starting a new prescription for antipsychotics for people moving to RACFs. Electronic supplementary material The online version of this article (10.1007/s40520-020-01518-y) contains supplementary material, which is available to authorized users.
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Orayj K. Impact of Antidepressants on Cardiac Events and All-Cause Mortality in Parkinson's Disease: A National Data-Linkage Study. Neuropsychiatr Dis Treat 2021; 17:2499-2510. [PMID: 34354357 PMCID: PMC8331107 DOI: 10.2147/ndt.s325521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 07/27/2021] [Indexed: 12/03/2022] Open
Abstract
PURPOSE This study investigated the 1-year risk of ischemic heart disease (IHD), all cardiovascular events, and all-cause mortality among newly diagnosed Parkinson's disease (PD) patients who used antidepressants compared to those who did not. PATIENTS AND METHODS Patients with PD aged 40 years or older were identified using data from 2000 through 2016 held within the Welsh Secure Anonymized Information Linkage (SAIL) databank. Antidepressant users were propensity-score matched 1:1 with non-users, adjusting for patients' demographics, socioeconomic status, and multiple comorbidities. Cox proportional hazard regression analyses were performed to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between the antidepressants and the study outcomes. The follow-up period was 1 year after the initial prescription of antidepressants. RESULTS The study group comprised a total of 3364 participants, with numbers split equally between the antidepressant-user and non-user groups, based on the propensity score-matching process. Overall, the propensity score-adjusted model showed that antidepressant usage in PD patients was not significantly associated with the risk of IHD (HR = 1.05; 95% CI 0.63-1.75) or all cardiovascular events (HR = 1.01; 95% CI 0.71-1.45) compared to non-users. The propensity score-adjusted model also showed that the use of any antidepressant, regardless of its category, was not statistically significantly associated with all-cause mortality (HR = 0.81; 95% CI 0.65-1.02). However, this association reached statistical significance in the multivariate adjusted model (HR = 0.67; 95% CI 0.54-0.84). CONCLUSION There was no evidence that antidepressant use was associated with an increased risk of IHD or all cardiovascular events in newly diagnosed PD patients who suffered from depression. Furthermore, antidepressant use might reduce the mortality rate in PD patients during the first year after initiation.
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Affiliation(s)
- Khalid Orayj
- Clinical Pharmacy Department, School of Pharmacy, King Khalid University, Abha, Saudi Arabia
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21
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Abstract
A number of studies reported the possible differences between men and women in movement disorders. Evidence shows that estrogens may have a neuroprotective effect and may modulate the neurodevelopment of the different brain structures. Movement disorders including Parkinson's disease, dementia with Lewy body, Huntington's disease, Tourette's syndrome, and dystonia among others display significant clinical differences between sexes, with structural differences in the dopaminergic pathways between men and women. Here we summarize the most relevant clinical aspects of some of the most common movement disorders, highlighting the differences in disease onset, clinical presentation, therapy, and outcomes. Increased recognition of these differences may help physicians better understand the pathophysiology of these conditions and provide a tailored therapeutic approach.
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Affiliation(s)
- Pierpaolo Turcano
- Department of Neurology, Mayo Clinic, Jacksonville, FL, United States.
| | - Rodolfo Savica
- Department of Neurology and Health Science Research, Mayo Clinic, Rochester, MN, United States
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Kajero JA, Seedat S, Ohaeri J, Akindele A, Aina O. Investigation of the effects of cannabidiol on vacuous chewing movements, locomotion, oxidative stress and blood glucose in rats treated with oral haloperidol. World J Biol Psychiatry 2020; 21:612-626. [PMID: 32264772 DOI: 10.1080/15622975.2020.1752934] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objectives: Tardive dyskinesia (TD) unlike acute dystonia may be irreversible. This study investigated the effects of oral cannabidiol (CBD) on haloperidol-induced vacuous chewing movement (VCM) model of TD. Methods: There were six experimental groups with different combinations of oral cannabidiol with 5 mg/kg of haloperidol given orally. Behavioural assays and FBS were measured. VCMs were assessed after the last dose of medication. Blood for oxidative stress assays was collected on the 8th day after the administration of the last dose of medication. Results: This study found that CBD co-administration with haloperidol attenuated the VCMs and increased motor tone produced by haloperidol. CBD alone at 5 mg/kg appears to have anxiolytic properties but may not be as effective as haloperidol which exhibited a greater anxiolytic effect at 5 mg/kg. Treatment with CBD alone at 5 mg/kg also appeared to enhance brain DPPH scavenging activity. Conclusions: We confirmed that CBD can ameliorate motor impairments produced by haloperidol. Our data suggest that CBD can be combined with haloperidol to prevent the emergent of extrapyramidal side effects and long-term movement disorders, such as acute dystonic disorder and TD.
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Affiliation(s)
| | - Soraya Seedat
- Department of Psychiatry, University of Stellenbosch, Cape Town, South Africa
| | - Jude Ohaeri
- Department of Psychological Medicine, University of Nigeria, Enugu State, Nigeria
| | - Abidemi Akindele
- Faculty of Basic Medical Sciences, Department of Pharmacology, Therapeutics & Toxicology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Oluwagbemiga Aina
- Department of Biochemistry, Nigerian Institute of Medical Research Yaba Lagos, Lagos, Nigeria
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23
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McCleary N, Desveaux L, Reis C, Linklater S, Witteman HO, Taljaard M, Thavorn K, Grimshaw JM, Ivers NM, Presseau J. A multiple-behaviour investigation of goal prioritisation in physicians receiving audit and feedback to address high-risk prescribing in nursing homes. Implement Sci Commun 2020; 1:33. [PMID: 32885191 PMCID: PMC7427855 DOI: 10.1186/s43058-020-00019-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 02/05/2020] [Indexed: 12/14/2022] Open
Abstract
Background As part of their professional role, healthcare providers enact multiple competing goal-directed behaviours in time-constrained environments. Better understanding healthcare providers’ motivation to engage in the pursuit of particular goals may help inform the development of implementation interventions. We investigated healthcare providers’ pursuit of multiple goals as part of a trial evaluating the effectiveness of an audit and feedback intervention in supporting appropriate adjustment of high-risk medication prescribing by physicians working in nursing homes. Our objectives were to determine whether goal priority and constructs from Social Cognitive Theory (self-efficacy, outcome expectations, and descriptive norms) predicted intention to adjust prescribing of multiple high-risk medications and to investigate how physicians in nursing homes prioritise their goals related to high-risk medication prescribing. Methods Physicians in Ontario, Canada, who signed up for and accessed the audit and feedback report were invited to complete a questionnaire assessing goal priority, self-efficacy, outcome expectations, descriptive norms, and intention in relation to the three targeted behaviours (adjusting prescribing of antipsychotics, benzodiazepines, and antidepressants) and a control behaviour (adjusting statin prescribing). We conducted multiple linear regression analyses to identify predictors of intention. We also conducted semi-structured qualitative interviews to investigate how physicians in nursing homes prioritise their goals in relation to appropriately adjusting prescribing of the medications included in the report: analysis was informed by the framework analysis method. Results Thirty-three of 89 (37%) physicians completed the questionnaire. Goal priority was the only significant predictor of intention for each medication type; the greater a priority it was for physicians to appropriately adjust their prescribing, the stronger was their intention to do so. Across five interviews, physicians reported prioritising adjustment of antipsychotic prescribing specifically. This was influenced by negative media coverage of antipsychotic prescribing in nursing homes, the provincial government’s mandate to address antipsychotic prescribing, and by the deprescribing initiatives or best practice routines in place in their nursing homes. Conclusions Goal priority predicted nursing home physicians’ intention to adjust prescribing. Targeting goal priority through implementation interventions therefore has the potential to influence behaviour via increased motivation. Implementation intervention developers should consider the external factors that may drive physicians’ prioritization.
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Affiliation(s)
- Nicola McCleary
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Room L1202, Box 711, Ottawa, ON K1H 8L6 Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Laura Desveaux
- Women's College Research Institute, Women's College Hospital, Toronto, Canada.,Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Catherine Reis
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Canada
| | - Stefanie Linklater
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Room L1202, Box 711, Ottawa, ON K1H 8L6 Canada
| | - Holly O Witteman
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Room L1202, Box 711, Ottawa, ON K1H 8L6 Canada.,Department of Family and Emergency Medicine, and Office of Education and Continuing Professional Development, Laval University, Québec City, Canada.,Laval University Research Institute for Primary Care and Health Services, Laval University, Québec City, Canada
| | - Monica Taljaard
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Room L1202, Box 711, Ottawa, ON K1H 8L6 Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Kednapa Thavorn
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Room L1202, Box 711, Ottawa, ON K1H 8L6 Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Jeremy M Grimshaw
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Room L1202, Box 711, Ottawa, ON K1H 8L6 Canada.,Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Noah M Ivers
- Women's College Research Institute, Women's College Hospital, Toronto, Canada.,Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Canada.,ICES, Toronto, Canada
| | - Justin Presseau
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Room L1202, Box 711, Ottawa, ON K1H 8L6 Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.,School of Psychology, University of Ottawa, Ottawa, Canada
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Sabo A, Mehdizadeh S, Ng KD, Iaboni A, Taati B. Assessment of Parkinsonian gait in older adults with dementia via human pose tracking in video data. J Neuroeng Rehabil 2020; 17:97. [PMID: 32664973 PMCID: PMC7362631 DOI: 10.1186/s12984-020-00728-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 07/06/2020] [Indexed: 01/01/2023] Open
Abstract
Background Parkinsonism is common in people with dementia, and is associated with neurodegenerative and vascular changes in the brain, or with exposure to antipsychotic or other dopamine antagonist medications. The detection of parkinsonian changes to gait may provide an opportunity to intervene and address reversible causes. In this study, we investigate the use of a vision-based system as an unobtrusive means to assess severity of parkinsonism in gait. Methods Videos of walking bouts of natural gait were collected in a specialized dementia unit using a Microsoft Kinect sensor and onboard color camera, and were processed to extract sixteen 3D and eight 2D gait features. Univariate regression to gait quality, as rated on the Unified Parkinson’s Disease Rating Scale (UPDRS) and Simpson-Angus Scale (SAS), was used to identify gait features significantly correlated to these clinical scores for inclusion in multivariate models. Multivariate ordinal logistic regression was subsequently performed and the relative contribution of each gait feature for regression to UPDRS-gait and SAS-gait scores was assessed. Results Four hundred one walking bouts from 14 older adults with dementia were included in the analysis. Multivariate ordinal logistic regression models incorporating selected 2D or 3D gait features attained similar accuracies: the UPDRS-gait regression models achieved accuracies of 61.4 and 62.1% for 2D and 3D features, respectively. Similarly, the SAS-gait models achieved accuracies of 47.4 and 48.5% with 2D or 3D gait features, respectively. Conclusions Gait features extracted from both 2D and 3D videos are correlated to UPDRS-gait and SAS-gait scores of parkinsonism severity in gait. Vision-based systems have the potential to be used as tools for longitudinal monitoring of parkinsonism in residential settings.
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Affiliation(s)
- Andrea Sabo
- KITE, Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, 164 College Street. Room 407, Toronto, ON, M2S 3G9, Canada
| | - Sina Mehdizadeh
- KITE, Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
| | - Kimberley-Dale Ng
- KITE, Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, 164 College Street. Room 407, Toronto, ON, M2S 3G9, Canada
| | - Andrea Iaboni
- KITE, Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada.,Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, ON, M5T 1R8, Canada.,Centre for Mental Health, University Health Network, 33 Russell Street, Toronto, ON, M5S 2S1, Canada
| | - Babak Taati
- KITE, Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada. .,Institute of Biomaterials and Biomedical Engineering, University of Toronto, 164 College Street. Room 407, Toronto, ON, M2S 3G9, Canada. .,Department of Computer Science, University of Toronto, 10 King's College Road, Room 3302, Toronto, ON, M5S 3G4, Canada.
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Chyou TY, Nishtala R, Nishtala PS. Comparative risk of Parkinsonism associated with olanzapine, risperidone and quetiapine in older adults-a propensity score matched cohort study. Pharmacoepidemiol Drug Saf 2020; 29:692-700. [PMID: 32301237 DOI: 10.1002/pds.5007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/09/2020] [Accepted: 03/29/2020] [Indexed: 01/31/2023]
Abstract
PURPOSE The purpose of this study was to examine the incidence of Parkinsonism in new users of second-generation antipsychotics (SGAs) in older adults (≥65 years). In the secondary analyses, we examined the risk of Parkinsonism by type and dose of SGA and conducted age-sex interactions. METHOD This population-based study included older adults who had a new-onset diagnosis of Parkinsonism and who started taking olanzapine, risperidone or quetiapine between 1 January 2005, and 30 December 2016. The Cox proportional hazard (COXPH) model with inverse probability treatment weighted (IPTW) covariates was used to evaluate the risk of new-onset Parkinsonism associated with SGAs, using quetiapine as the reference. We used the Generalized Propensity Score method to evaluate the dose-response risk of Parkinsonism associated with SGAs. RESULTS After IPTW adjustment for covariates, the COXPH model showed that compared to quetiapine, the use of olanzapine and risperidone were associated with an increased risk of Parkinsonism. The IPTW-hazard ratios are 1.76 (95% confidence interval 1.57-1.97) and 1.31 (95%CI 1.16-1.49), respectively. The dose-response risk of Parkinsonism was highest for olanzapine with a hazard ratio of 1.69 (95%CI 1.40-2.05) and the least for quetiapine with a hazard ratio of 1.22 (95%CI 1.14-1.31). The risk of Parkinsonism in the 65 to 74-year age group was higher for both sexes with risperidone compared to olanzapine, but the risk increased with olanzapine for both sexes in the 85+ age group. CONCLUSION The study found that the risk of new-onset Parkinsonism in older adults is 31% and 76% higher with risperidone and olanzapine respectively compared to quetiapine.
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Affiliation(s)
- Te-Yuan Chyou
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
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26
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Severe parkinsonism under treatment with antipsychotic drugs. Eur Arch Psychiatry Clin Neurosci 2020; 270:35-47. [PMID: 31444566 DOI: 10.1007/s00406-019-01060-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 08/13/2019] [Indexed: 10/26/2022]
Abstract
The aim of the study was to assess rates of severe parkinsonism related to different antipsychotic drugs (APDs) using data from an observational pharmacovigilance programme in German-speaking countries-Arzneimittelsicherheit in der Psychiatrie (AMSP). Data on APD utilization and reports of severe APD-induced parkinsonism were collected in 99 psychiatric hospitals in Austria, Germany and Switzerland during the period 2001-2016. Of 340,099 patients under surveillance, 245,958 patients were treated with APDs for the main indications of schizophrenic disorders, depression, mania and organic mental disorders. A total of 200 events of severe APD-induced parkinsonism were identified (0.08%). First-generation low-potency APDs were significantly less often implicated (0.02%) than second-generation APDs (0.07%) and first-generation high-potency APDs (0.16%). Among the second-generation APDs, amisulpride and risperidone ranked highest. The phenothiazines were associated with significantly lower rates of severe parkinsonism (0.02%) than those of the butyrophenones (0.11%) and thioxanthenes (0.12%). In 71 cases (35.5%), more than 1 drug was considered responsible for the induction of severe parkinsonism. In 44 patients (22.0%), the symptoms were extremely severe, leading to complete immobility and/or massive complications such as pneumonia and severe injuries due to falls. Higher age (> 60 years) was associated with significantly higher rates of severe parkinsonism, as were the diagnoses of schizophrenic disorder or mania. The large number of patients included in the present survey allows for the comparison of severe parkinsonism rates related to different APD classes and single APDs. The first-generation low-potency APDs had significantly reduced risk of severe parkinsonism compared not only to high potency but also to second-generation APDs.
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Misgana T, Yigzaw N, Asfaw G. Drug-Induced Movement Disorders and Its Associated Factors Among Patients Attending Treatment at Public Hospitals in Eastern Ethiopia. Neuropsychiatr Dis Treat 2020; 16:1987-1995. [PMID: 32884274 PMCID: PMC7443022 DOI: 10.2147/ndt.s261272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/01/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Antipsychotic medications have both beneficial and undesired effects at a dose used for treatment purposes. Among undesired effects caused by antipsychotics, movement disorders are prevalent. However, there is no study done to determine the prevalence of movement disorders that occurred due to antipsychotics and their determinants in eastern Ethiopia. OBJECTIVE This study aimed to find out the prevalence of drug-induced movement disorders and its determinants among patients who had been on follow-up at public hospitals in eastern Ethiopia. METHODS A cross-sectional study was conducted from May to June 2018 at HFSUH and Jugal hospital. Extrapyramidal symptom rating scale (ESRS) was used to identify patients with drug-induced movement disorders in a sample of 411 outpatients. A systematic random sampling method was used to select the sample. Logistic regression was done to identify factors associated. RESULTS A drug-induced movement disorder was found in 44% of the participants: Of this, 27.3% had drug-induced pseudo-Parkinsonism, 21.2% had drug-induced akathisia, 9.5% had drug-induced tardive dyskinesia, and 3.4% had drug-induced tardive dystonia. Being female was associated with pseudo-Parkinsonism (AOR=3.6, 95% CI: 2.03, 6.35), akathisia (AOR=4.9, 95% CI: 2.73, 8.78), and tardive dyskinesia (AOR=2.51, 95% CI: 1.08, 5.86) and being male with tardive dystonia (AOR=4.6, 95% CI: 1.8, 18.5). Alcohol use was associated with tardive dyskinesia (AOR= 5.89, 95% CI: 2.20, 15.69). CONCLUSION Drug-induced movement disorder in this study was high and nearly half of patients on antipsychotic treatment were experiencing it. Age, sex, and doses of antipsychotics were factors associated with all of the types of drug-induced movement disorders.
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Affiliation(s)
- Tadesse Misgana
- Department of Psychiatry, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Niguse Yigzaw
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Getachew Asfaw
- Research and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
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Aprahamian I, Morley JE. Editorial: To Drug or Not to Drug: The Geriatrician Dilemma of Polypharmacy. J Nutr Health Aging 2020; 24:809-811. [PMID: 33009528 DOI: 10.1007/s12603-020-1451-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- I Aprahamian
- John E. Morley, MB, BCh, Division of Geriatric Medicine, Saint Louis University, SLUCare Academic Pavilion, Section 2500, 1008 S. Spring Ave., 2nd Floor, St. Louis, MO 63110, , Twitter: @drjohnmorley
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Han S, Kim S, Kim H, Shin HW, Na KS, Suh HS. Prevalence and incidence of Parkinson's disease and drug-induced parkinsonism in Korea. BMC Public Health 2019; 19:1328. [PMID: 31640652 PMCID: PMC6805681 DOI: 10.1186/s12889-019-7664-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 09/20/2019] [Indexed: 12/13/2022] Open
Abstract
Background Parkinson’s disease (PD) and drug-induced parkinsonism (DIP) are the major diseases of parkinsonism. To better understand parkinsonism, we aimed to assess the prevalence and incidence of PD and DIP in Korea from 2012 to 2015. Methods We used the Health Insurance Review and Assessment Service database, which covers the entire population in Korea. We used claims during 2011–2015 to assess epidemiology of PD and DIP during 2012–2015. Retrospective cross-sectional study design was employed to assess prevalence, whereas retrospective cohort study design was used to determine incidence. Patients with at least one claim with ICD-10 G20 and who received antiparkinsonian drugs for at least 60 days were classified as having PD. We excluded patients with antiparkinsonian drugs that can be used for indications other than PD. Patients with at least one claim with ICD-10 G211 or G251 during the prescription period of drugs that are frequently related with DIP were classified as having DIP. Incident cases had a disease-free period of 1 year before diagnosis. To evaluate the significance of changes in the prevalence or incidence over time, Poisson regression was used to determine p for trend. Results The prevalence of PD increased from 156.9 per 100,000 persons in 2012 to 181.3 per 100,000 persons in 2015 (p for trend< 0.0001). The incidence of PD decreased steadily from 35.4 per 100,000 person-years in 2012 to 33.3 per 100,000 person-years in 2015 (p for trend< 0.0001). The prevalence of DIP increased from 7.3 per 100,000 persons in 2012 to 15.4 per 100,000 persons in 2015 (p for trend< 0.0001) and the incidence of DIP increased from 7.1 per 100,000 person-years in 2012 to 13.9 per 100,000 person-years in 2015 (p for trend< 0.0001). Conclusions Our study suggests that the incidence of PD has gradually decreased whereas, the incidence of DIP increased from 2012 to 2015. Further studies are warranted to examine possible causes of increased DIP incidence in order to develop management strategy for parkinsonism.
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Affiliation(s)
- Sola Han
- College of Pharmacy, Pusan National University, Busan, South Korea
| | - Siin Kim
- College of Pharmacy, Pusan National University, Busan, South Korea
| | - Hyungtae Kim
- College of Pharmacy, Pusan National University, Busan, South Korea
| | - Hae-Won Shin
- Department of Neurology, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Kyoung-Sae Na
- Gachon University School of Medicine, Incheon, South Korea
| | - Hae Sun Suh
- College of Pharmacy, Pusan National University, Busan, South Korea. .,Pharmaceutical Economics, Outcomes Research & Policy, College of Pharmacy, Pusan National University, 2, Busandaehak-ro 63 beon-gil, Geumjeong-gu, Busan, 46241, South Korea.
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Weiss HD, Pontone GM. "Pseudo-syndromes" associated with Parkinson disease, dementia, apathy, anxiety, and depression. Neurol Clin Pract 2019; 9:354-359. [PMID: 31583191 PMCID: PMC6745743 DOI: 10.1212/cpj.0000000000000644] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 01/15/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Physicians treating patients with Parkinson disease must evaluate not only motor symptoms but also acquire expertise in assessing the complex behavioral features that often accompany the disease, such as dementia, apathy, anxiety, and depression. RECENT FINDINGS There is a risk of diagnostic confusion and error because many of the behavioral and motor symptoms accentuate, overlap, or mimic each other. SUMMARY Awareness of potential diagnostic pitfalls and "pseudo-syndromes" should lead to more accurate clinical assessment and better care for our patients.
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Affiliation(s)
- Howard D Weiss
- Sinai Hospital of Baltimore (HDW); Department of Neurology and Neurological Sciences, Johns Hopkins University (HDW); and Department of Psychiatry and Behavioral Sciences, Johns Hopkins University (GMP)
| | - Gregory M Pontone
- Sinai Hospital of Baltimore (HDW); Department of Neurology and Neurological Sciences, Johns Hopkins University (HDW); and Department of Psychiatry and Behavioral Sciences, Johns Hopkins University (GMP)
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Kim S, Cheon SM, Suh HS. Association Between Drug Exposure and Occurrence of Parkinsonism in Korea: A Population-Based Case-Control Study. Ann Pharmacother 2019; 53:1102-1110. [PMID: 31216861 DOI: 10.1177/1060028019859543] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Although drug-induced parkinsonism is reversible in most cases, some patients can suffer from persistent/recurrent symptoms. Therefore, prevention is the most efficient way to manage drug-induced parkinsonism. However, there is a paucity of studies exploring the relationship between parkinsonism and drug exposure. Objective: To examine the association between drug exposure and the risk of parkinsonism using Korean population-based data. Methods: We conducted a matched case-control study using the National Health Insurance Service-National Sample Cohort database. Cases and controls were defined as individuals with and without parkinsonism, respectively, between 2007 and 2013. Cases and controls were matched for sex, age group, income, type of insurance, and Charlson comorbidity index. Drug exposures, including propulsives, antipsychotics, and flunarizine, were identified at 1 year before the first date of parkinsonism and stratified by recency and cumulative dose. Conditional logistic regression was used to estimate odds ratios (ORs) and 95% CIs. Results: We identified 5496 cases and 5496 controls. ORs for current use group of propulsives, antipsychotics, and flunarizine compared with those of the never use group were 2.812 (95% CI = 2.466-3.206), 3.009 (95% CI = 1.667-5.431), and 4.950 (95% CI = 2.711-9.037), respectively. ORs were greater in those more recently exposed and those exposed to higher cumulative doses. Conclusion and Relevance: At the population level, use of propulsives, antipsychotics, and flunarizine had a significant association with the increased risk of parkinsonism, depending on recency and cumulative dose. Drugs associated with parkinsonism should be used with careful monitoring to prevent drug-induced parkinsonism.
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Affiliation(s)
- Siin Kim
- Pusan National University, Busan, South Korea
| | | | - Hae Sun Suh
- Pusan National University, Busan, South Korea
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Antipsychotic Treatment Associated With Increased Mortality Risk in Patients With Dementia. A Registry-Based Observational Cohort Study. J Am Med Dir Assoc 2019; 20:323-329.e2. [DOI: 10.1016/j.jamda.2018.12.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 12/18/2018] [Accepted: 12/20/2018] [Indexed: 11/19/2022]
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Hirano Y. Risk of Extrapyramidal Syndromes Associated With Psychotropic Polypharmacy. Ther Innov Regul Sci 2018. [DOI: 10.1177/2168479018808248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Yoko Hirano
- Department of Clinical Medicine (Pharmaceutical Medicine), Graduate School of Pharmaceutical Sciences, Kitasato University, Minato-ku, Tokyo, Japan
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Movement Disorders After Exposure to Antipsychotic Drugs in Patients With Depressive Disorders. Clin Neuropharmacol 2018; 41:177-180. [PMID: 30234617 DOI: 10.1097/wnf.0000000000000300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aims of the study were to explore the frequency of movement disorders (MDs) in depressive patients exposed to antipsychotic drugs (APDs) and to compare it with nonexposed depressive patients and APDs-treated schizophrenic patients. METHODS Four hundred fifty-two depressive patients not exposed to APDs (group A), 156 depressives exposed to APDs (group B), and 75 patients with schizophrenia on APDs (group C) were recruited. Presence of MDs was explored by the Simpson-Angus and UKU scales (Registration: NCT02409823). RESULTS Movement disorders were observed in 5%, 9%, and 13% of patients in groups A to C, respectively (P < 0.001, χ for linear trend). A logistic multivariate analysis revealed that male sex (odds ratio = 2.26, 95% confidence interval = 1.13-4.49, P < 0.01), exposure to first-generation (vs second-generation) APDs (odds ratio = 5.71, 95% confidence interval = 2.08-15.66, P < 0.01), and exposure to lithium (odds ratio = 3.99, 95% confidence interval = 1.74-9.14, P < 0.01) were independently and significantly associated with MDs. CONCLUSIONS Male sex, use first-generation APDs, and exposure to lithium were associated with MDs in depression. Therefore, caution is advised with the use of these drugs in depressive patients. Prospective studies are needed to confirm these results.
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Rochon PA, Gruneir A, Gill SS, Wu W, Zhu L, Herrmann N, Bell CM, Austin PC, Stall NM, McCarthy L, Giannakeas V, Alberga A, Seitz DP, Normand SL, Gurwitz JH, Bronskill SE. Initial Cholinesterase Inhibitor Therapy Dose and Serious Events in Older Women and Men. J Am Geriatr Soc 2018; 66:1692-1699. [DOI: 10.1111/jgs.15442] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 04/03/2018] [Accepted: 04/17/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Paula A. Rochon
- Women's College Research Institute; Women's College Hospital; Toronto Ontario Canada
- Department of Medicine; University of Toronto; Toronto Ontario Canada
- Institute of Health Policy, Management, and Evaluation; University of Toronto; Toronto Ontario Canada
| | - Andrea Gruneir
- Women's College Research Institute; Women's College Hospital; Toronto Ontario Canada
- Institute for Clinical Evaluative Sciences; Toronto Ontario Canada
- Department of Family Medicine; University of Alberta; Edmonton, Alberta, Canada
| | - Sudeep S. Gill
- Institute for Clinical Evaluative Sciences; Toronto Ontario Canada
- Department of Medicine; Queen's University; Kingston Ontario Canada
| | - Wei Wu
- Women's College Research Institute; Women's College Hospital; Toronto Ontario Canada
| | - Lynn Zhu
- Women's College Research Institute; Women's College Hospital; Toronto Ontario Canada
| | - Nathan Herrmann
- Department of Psychiatry; University of Toronto; Toronto Ontario Canada
| | - Chaim M. Bell
- Department of Medicine; University of Toronto; Toronto Ontario Canada
- Institute of Health Policy, Management, and Evaluation; University of Toronto; Toronto Ontario Canada
- Institute for Clinical Evaluative Sciences; Toronto Ontario Canada
- Sinai Health System; Toronto Ontario Canada
| | - Peter C. Austin
- Institute of Health Policy, Management, and Evaluation; University of Toronto; Toronto Ontario Canada
- Institute for Clinical Evaluative Sciences; Toronto Ontario Canada
| | - Nathan M. Stall
- Department of Medicine; University of Toronto; Toronto Ontario Canada
| | - Lisa McCarthy
- Women's College Research Institute; Women's College Hospital; Toronto Ontario Canada
- Leslie Dan Faculty of Pharmacy; University of Toronto; Toronto Ontario Canada
| | - Vasily Giannakeas
- Women's College Research Institute; Women's College Hospital; Toronto Ontario Canada
- Institute for Clinical Evaluative Sciences; Toronto Ontario Canada
| | - Amanda Alberga
- Institute for Clinical Evaluative Sciences; Toronto Ontario Canada
| | - Dallas P. Seitz
- Institute for Clinical Evaluative Sciences; Toronto Ontario Canada
- Division of Geriatric Psychiatry, Department of Psychiatry; Queen's University; Kingston Ontario Canada
| | - Sharon-Lise Normand
- Department of Health Care Policy, School of Medicine; Harvard University; Boston Massachusetts
- Department of Biostatistics, T.H. Chan School of Public Health; Harvard University; Boston Massachusetts
| | - Jerry H. Gurwitz
- Division of Geriatric Medicine, Department of Medicine; University of Massachusetts Medical School; Worcester Massachusetts
| | - Susan E. Bronskill
- Women's College Research Institute; Women's College Hospital; Toronto Ontario Canada
- Institute of Health Policy, Management, and Evaluation; University of Toronto; Toronto Ontario Canada
- Institute for Clinical Evaluative Sciences; Toronto Ontario Canada
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Huang ZH, Chen HC, Chou YC, Lin CL, Kao CH, Lo HY, Yang TY, Liu FC. Does nephrotic syndrome without chronic kidney disease increase the risk of Parkinson's disease and secondary parkinsonism? A nationwide population-based study in Taiwan. BMJ Open 2018; 8:e020821. [PMID: 29982207 PMCID: PMC6045768 DOI: 10.1136/bmjopen-2017-020821] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 04/27/2018] [Accepted: 06/08/2018] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Previous research has shown that patients with nephrotic syndrome (NS) have a higher risk of cognitive impairment, dementia or neurodegenerative disorder. The present study aimed to examine a relationship, if any exists between NS and Parkinson's disease (PD), a neurodegenerative disorder and secondary parkinsonism (sPS). METHODS A nationwide retrospective observational study conducted using data from the 2000-2010 Taiwan National Health Insurance Research Database. This study included 3663 patients with NS and 14 652 randomly selected, age-matched and sex-matched patients without NS. A Cox multivariable proportional hazards model was used to evaluate the risk of PD and sPS (PDsPS) in the NS cohort. RESULTS This study identified a positive association between NS and the risk of PDsPS in both men and women and in all age groups (adjusted HR 1.51; 95% CI 1.37 to 1.66). Compared with patients without NS and comorbidities, those with NS with two or more comorbidities exhibited an 8.23-fold higher risk of PDsPS (95% CI 6.22 to 10.9) and patients with NS and one comorbidity exhibited a 2.93-fold higher risk of PDsPS (95% CI 2.37 to 3.63). CONCLUSIONS Patients with NS have an increased risk of PDsPS. This increased risk may be related to brain vascular damage or blood-brain barrier impairment. Further research is necessary to explore the underlying relationship between NS and PDsPS.
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Affiliation(s)
- Zheng-Hao Huang
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Hsiang-Cheng Chen
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Ching Chou
- Department of Health Promotion and Health Education, National Defense Medical Center, Taipei, Taiwan
| | - Cheng-Li Lin
- School of Medicine, China Medical University, Taichung, Taiwan
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Chia-Hung Kao
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Hsin-Yi Lo
- Graduate Institute of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Tse-Yen Yang
- Molecular and Genomic Epidemiology Center, China Medical University Hospital, Taichung, Taiwan
| | - Feng-Cheng Liu
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Abstract
OBJECTIVE The aim of the study was to explore the current status of drug-induced parkinsonism and drugs possibly related to drug-induced parkinsonism in Korea. METHODS We conducted a cross-sectional study using the Korea Adverse Event Reporting System database between July 1, 2010, and June 30, 2015. We identified all adverse event reports associated with parkinsonism. RESULTS There were 1402 adverse event reports associated with parkinsonism. The number of adverse event reports has increased annually. Among the 1499 drugs associated with parkinsonism, the most common were metoclopramide (49.77%) and paliperidone (16.14%). The major therapeutic groups (the third level of the Anatomical Therapeutic Chemical code) were propulsives (53.87%) and antipsychotics (35.58%). The mean time of onset of parkinsonism was 34.9 days. However, the time of onset of parkinsonism varied by drug, for example, it was 4.6 days for metoclopramide and 37.2 days for paliperidone. CONCLUSIONS Metoclopramide and antipsychotics were reported in most adverse event reports associated with parkinsonism in Korea.
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Call to Caution with the Use of Atypical Antipsychotics for Treatment of Depression in Older Adults. Geriatrics (Basel) 2016; 1:geriatrics1040033. [PMID: 31022826 PMCID: PMC6371141 DOI: 10.3390/geriatrics1040033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 12/12/2016] [Accepted: 12/14/2016] [Indexed: 11/30/2022] Open
Abstract
Atypical antipsychotics are increasingly being used to manage depression in older adults where these symptoms can often be refractory to first-line treatment with selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs). Unfortunately, atypical antipsychotics can be associated with the development of extrapyramidal symptoms (EPS), with drug-induced parkinsonism (DIP) being the most common movement disorder induced by this class of medication. The management of treatment-resistant depression in older adults is of particular concern as depression is a common feature of idiopathic Parkinson’s disease (IPD) and can manifest prior to the development of motor symptoms. Herein, we discuss the use of atypical antipsychotics for the management of depression in older adults including the risk of DIP and propose that antipsychotics may potentially unmask IPD.
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Savica R, Grossardt BR, Bower JH, Ahlskog JE, Mielke MM, Rocca WA. Incidence and time trends of drug-induced parkinsonism: A 30-year population-based study. Mov Disord 2016; 32:227-234. [PMID: 27779780 PMCID: PMC5318251 DOI: 10.1002/mds.26839] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 09/07/2016] [Accepted: 09/19/2016] [Indexed: 12/22/2022] Open
Abstract
Background Epidemiological studies of drug‐induced parkinsonism remain limited. Objectives To investigate the incidence and time trends of drug‐induced parkinsonism over 30 years in a geographically defined American population. Methods We used the medical records‐linkage system of the Rochester Epidemiology Project to identify all persons in Olmsted County, Minnesota, who received a screening diagnostic code for parkinsonism from 1976 through 2005. A movement disorders specialist reviewed the complete medical records of each person to confirm the presence of drug‐induced parkinsonism associated with dopamine‐blocking or dopamine‐depleting medications. Results Among 906 incident cases of parkinsonism from 1976 to 2005, 108 persons had drug‐induced parkinsonism (11.9%). The average annual incidence rate of drug‐induced parkinsonism was 3.3 per 100,000 person‐years, was higher in women, and increased with older age. Drug‐induced parkinsonism was the fifth‐most common type of parkinsonism overall; however, it was the most common type among persons younger than age 40 years. Typical antipsychotic drugs were the most common class of drugs associated with parkinsonism, whereas atypical antipsychotic drugs were rarely involved. The incidence rate of drug‐induced parkinsonism decreased 32.0% per decade (relative risk = 0.68; 95% confidence interval: 0.49–0.94) and 68.6% over the 30 years of the study. The decrease was similar in men (65.2%) and women (69.4%); however, the trend was significant only in women. Conclusions The incidence of drug‐induced parkinsonism increased with older age and was higher in women at all ages. Typical antipsychotic drugs were the most common cause. The incidence of drug‐induced parkinsonism decreased over the 30 years of the study because of changes in drug use. © 2016 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Rodolfo Savica
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.,Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Brandon R Grossardt
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - James H Bower
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - J Eric Ahlskog
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Michelle M Mielke
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.,Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Walter A Rocca
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.,Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
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Abstract
INTRODUCTION Drug-induced movement disorders (DIMDs) can be elicited by several kinds of pharmaceutical agents. The major groups of offending drugs include antidepressants, antipsychotics, antiepileptics, antimicrobials, antiarrhythmics, mood stabilisers and gastrointestinal drugs among others. AREAS COVERED This paper reviews literature covering each movement disorder induced by commercially available pharmaceuticals. Considering the magnitude of the topic, only the most prominent examples of offending agents were reported in each paragraph paying a special attention to the brief description of the pathomechanism and therapeutic options if available. EXPERT OPINION As the treatment of some DIMDs is quite challenging, a preventive approach is preferable. Accordingly, the use of the offending agents should be strictly limited to appropriate indications and they should be applied in as low doses and as short duration as the patient's condition allows. As most of DIMDs are related to an unspecific adverse action of medications in the basal ganglia and the cerebellum, future research should focus on better characterisation of the neurochemical profile of the affected functional systems, in addition to the development of drugs with higher selectivity and better side-effect profile.
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Affiliation(s)
- Dénes Zádori
- University of Szeged, Albert Szent-Györgyi Clinical Center, Department of Neurology, Faculty of Medicine , Semmelweis u. 6, H-6725 Szeged , Hungary +36 62 545351 ; +36 62 545597 ;
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Koponen M, Tolppanen AM, Taipale H, Tanskanen A, Tiihonen J, Johnell K, Fastbom J, Ahonen R, Hartikainen S. Incidence of antipsychotic use in relation to diagnosis of Alzheimer's disease among community-dwelling persons. Br J Psychiatry 2015; 207:444-9. [PMID: 26450581 DOI: 10.1192/bjp.bp.114.162834] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 12/09/2015] [Indexed: 01/23/2023]
Abstract
BACKGROUND Behavioural and psychological symptoms of dementia are frequently treated with antipsychotics. AIMS To determine the incidence of antipsychotic use in relation to diagnosis of Alzheimer's disease. METHOD Cohort of all community-dwellers in Finland diagnosed with Alzheimer's disease in 2005 and matched controls. All antipsychotics dispensed between 1995 and 2009 were extracted from the Finnish National Prescription Register. RESULTS Altogether 1996/6087 (32.8%) persons with Alzheimer's disease initiated antipsychotic use. The incidence of antipsychotic use was fivefold among persons with Alzheimer's disease compared with controls, started to increase 2-3 years before diagnosis and was highest during the first 6 months after diagnosis. CONCLUSIONS A distinct increase in antipsychotic initiations occurs in the same time window as Alzheimer's disease diagnosis.
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Affiliation(s)
- Marjaana Koponen
- Marjaana Koponen, MSc, School of Pharmacy, University of Eastern Finland, Kuopio, Finland; Anna-Maija Tolppanen, PhD, Research Centre for Comparative Effectiveness and Patient Safety (RECEPS), University of Eastern Finland, Kuopio, Finland; Heidi Taipale, PhD, School of Pharmacy, University of Eastern Finland, Kuopio, Finland; Antti Tanskanen, Phil Lic, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden and National Institute for Health and Welfare, Helsinki, Finland; Jari Tiihonen, MD, PhD, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden, Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland and National Institute for Health and Welfare, Helsinki, Finland; Kristina Johnell, PhD, Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden and Stockholm Gerontology Research Center, Stockholm, Sweden; Johan Fastbom, MD, PhD, Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Riitta Ahonen, PhD, Sirpa Hartikainen, MD, PhD, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Anna-Maija Tolppanen
- Marjaana Koponen, MSc, School of Pharmacy, University of Eastern Finland, Kuopio, Finland; Anna-Maija Tolppanen, PhD, Research Centre for Comparative Effectiveness and Patient Safety (RECEPS), University of Eastern Finland, Kuopio, Finland; Heidi Taipale, PhD, School of Pharmacy, University of Eastern Finland, Kuopio, Finland; Antti Tanskanen, Phil Lic, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden and National Institute for Health and Welfare, Helsinki, Finland; Jari Tiihonen, MD, PhD, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden, Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland and National Institute for Health and Welfare, Helsinki, Finland; Kristina Johnell, PhD, Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden and Stockholm Gerontology Research Center, Stockholm, Sweden; Johan Fastbom, MD, PhD, Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Riitta Ahonen, PhD, Sirpa Hartikainen, MD, PhD, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Heidi Taipale
- Marjaana Koponen, MSc, School of Pharmacy, University of Eastern Finland, Kuopio, Finland; Anna-Maija Tolppanen, PhD, Research Centre for Comparative Effectiveness and Patient Safety (RECEPS), University of Eastern Finland, Kuopio, Finland; Heidi Taipale, PhD, School of Pharmacy, University of Eastern Finland, Kuopio, Finland; Antti Tanskanen, Phil Lic, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden and National Institute for Health and Welfare, Helsinki, Finland; Jari Tiihonen, MD, PhD, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden, Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland and National Institute for Health and Welfare, Helsinki, Finland; Kristina Johnell, PhD, Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden and Stockholm Gerontology Research Center, Stockholm, Sweden; Johan Fastbom, MD, PhD, Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Riitta Ahonen, PhD, Sirpa Hartikainen, MD, PhD, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Antti Tanskanen
- Marjaana Koponen, MSc, School of Pharmacy, University of Eastern Finland, Kuopio, Finland; Anna-Maija Tolppanen, PhD, Research Centre for Comparative Effectiveness and Patient Safety (RECEPS), University of Eastern Finland, Kuopio, Finland; Heidi Taipale, PhD, School of Pharmacy, University of Eastern Finland, Kuopio, Finland; Antti Tanskanen, Phil Lic, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden and National Institute for Health and Welfare, Helsinki, Finland; Jari Tiihonen, MD, PhD, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden, Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland and National Institute for Health and Welfare, Helsinki, Finland; Kristina Johnell, PhD, Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden and Stockholm Gerontology Research Center, Stockholm, Sweden; Johan Fastbom, MD, PhD, Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Riitta Ahonen, PhD, Sirpa Hartikainen, MD, PhD, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Jari Tiihonen
- Marjaana Koponen, MSc, School of Pharmacy, University of Eastern Finland, Kuopio, Finland; Anna-Maija Tolppanen, PhD, Research Centre for Comparative Effectiveness and Patient Safety (RECEPS), University of Eastern Finland, Kuopio, Finland; Heidi Taipale, PhD, School of Pharmacy, University of Eastern Finland, Kuopio, Finland; Antti Tanskanen, Phil Lic, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden and National Institute for Health and Welfare, Helsinki, Finland; Jari Tiihonen, MD, PhD, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden, Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland and National Institute for Health and Welfare, Helsinki, Finland; Kristina Johnell, PhD, Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden and Stockholm Gerontology Research Center, Stockholm, Sweden; Johan Fastbom, MD, PhD, Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Riitta Ahonen, PhD, Sirpa Hartikainen, MD, PhD, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Kristina Johnell
- Marjaana Koponen, MSc, School of Pharmacy, University of Eastern Finland, Kuopio, Finland; Anna-Maija Tolppanen, PhD, Research Centre for Comparative Effectiveness and Patient Safety (RECEPS), University of Eastern Finland, Kuopio, Finland; Heidi Taipale, PhD, School of Pharmacy, University of Eastern Finland, Kuopio, Finland; Antti Tanskanen, Phil Lic, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden and National Institute for Health and Welfare, Helsinki, Finland; Jari Tiihonen, MD, PhD, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden, Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland and National Institute for Health and Welfare, Helsinki, Finland; Kristina Johnell, PhD, Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden and Stockholm Gerontology Research Center, Stockholm, Sweden; Johan Fastbom, MD, PhD, Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Riitta Ahonen, PhD, Sirpa Hartikainen, MD, PhD, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Johan Fastbom
- Marjaana Koponen, MSc, School of Pharmacy, University of Eastern Finland, Kuopio, Finland; Anna-Maija Tolppanen, PhD, Research Centre for Comparative Effectiveness and Patient Safety (RECEPS), University of Eastern Finland, Kuopio, Finland; Heidi Taipale, PhD, School of Pharmacy, University of Eastern Finland, Kuopio, Finland; Antti Tanskanen, Phil Lic, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden and National Institute for Health and Welfare, Helsinki, Finland; Jari Tiihonen, MD, PhD, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden, Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland and National Institute for Health and Welfare, Helsinki, Finland; Kristina Johnell, PhD, Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden and Stockholm Gerontology Research Center, Stockholm, Sweden; Johan Fastbom, MD, PhD, Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Riitta Ahonen, PhD, Sirpa Hartikainen, MD, PhD, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Riitta Ahonen
- Marjaana Koponen, MSc, School of Pharmacy, University of Eastern Finland, Kuopio, Finland; Anna-Maija Tolppanen, PhD, Research Centre for Comparative Effectiveness and Patient Safety (RECEPS), University of Eastern Finland, Kuopio, Finland; Heidi Taipale, PhD, School of Pharmacy, University of Eastern Finland, Kuopio, Finland; Antti Tanskanen, Phil Lic, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden and National Institute for Health and Welfare, Helsinki, Finland; Jari Tiihonen, MD, PhD, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden, Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland and National Institute for Health and Welfare, Helsinki, Finland; Kristina Johnell, PhD, Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden and Stockholm Gerontology Research Center, Stockholm, Sweden; Johan Fastbom, MD, PhD, Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Riitta Ahonen, PhD, Sirpa Hartikainen, MD, PhD, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Sirpa Hartikainen
- Marjaana Koponen, MSc, School of Pharmacy, University of Eastern Finland, Kuopio, Finland; Anna-Maija Tolppanen, PhD, Research Centre for Comparative Effectiveness and Patient Safety (RECEPS), University of Eastern Finland, Kuopio, Finland; Heidi Taipale, PhD, School of Pharmacy, University of Eastern Finland, Kuopio, Finland; Antti Tanskanen, Phil Lic, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden and National Institute for Health and Welfare, Helsinki, Finland; Jari Tiihonen, MD, PhD, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden, Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland and National Institute for Health and Welfare, Helsinki, Finland; Kristina Johnell, PhD, Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden and Stockholm Gerontology Research Center, Stockholm, Sweden; Johan Fastbom, MD, PhD, Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Riitta Ahonen, PhD, Sirpa Hartikainen, MD, PhD, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
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Richter C, Berg A, Fleischer S, Köpke S, Balzer K, Fick EM, Sönnichsen A, Löscher S, Vollmar HC, Haastert B, Icks A, Dintsios CM, Mann E, Wolf U, Meyer G. Effect of person-centred care on antipsychotic drug use in nursing homes (EPCentCare): study protocol for a cluster-randomised controlled trial. Implement Sci 2015; 10:82. [PMID: 26037324 PMCID: PMC4464611 DOI: 10.1186/s13012-015-0268-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 05/15/2015] [Indexed: 12/02/2022] Open
Abstract
Background The majority of nursing home residents with dementia experience behavioural and psychological symptoms like apathy, agitation, and anxiety. According to analyses of prescription prevalence in Germany, antipsychotic drugs are regularly prescribed as first-line treatment of neuropsychiatric symptoms in persons with dementia, although guidelines clearly prioritise non-pharmacological interventions. Frequently, antipsychotic drugs are prescribed for inappropriate reasons and for too long without regular reviewing. The use of antipsychotics is associated with adverse events like increased risk of falling, stroke, and mortality. The aim of the study is to investigate whether a person-centred care approach, successfully evaluated in nursing homes in the United Kingdom, can be implemented in German nursing homes and, in comparison with a control group, can result in a clinically relevant reduction of the proportion of residents with antipsychotic prescriptions. Methods/design The study is a cluster-randomised controlled trial comparing an intervention group (two-day initial training on person-centred care and ongoing training and support programme) with a control group. Both study groups will receive, as optimised usual care, a medication review by an experienced psychiatrist/geriatrician providing feedback to the prescribing physician. Overall, 36 nursing homes in East, North, and West Germany will be randomised. The primary outcome is the proportion of residents receiving at least one antipsychotic prescription (long-term medication) after 12 months of follow-up. Secondary outcomes are residents’ quality of life, agitated behaviour, as well as safety parameters like falls and fall-related medical attention. A health economic evaluation and a process evaluation will be performed alongside the study. Discussion To improve care, a reduction of the current high prescription rate of antipsychotics in nursing homes by the intervention programme is expected. Trial registration ClinicalTrials.gov: NCT02295462 Electronic supplementary material The online version of this article (doi:10.1186/s13012-015-0268-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christin Richter
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
| | - Almuth Berg
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
| | - Steffen Fleischer
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
| | - Sascha Köpke
- Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany.
| | - Katrin Balzer
- Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany.
| | - Eva-Maria Fick
- Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany.
| | - Andreas Sönnichsen
- Institute of General Practice and Family Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany.
| | - Susanne Löscher
- Institute of General Practice and Family Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany.
| | - Horst Christian Vollmar
- Institute of General Practice and Family Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany. .,Institute of General Practice, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
| | | | - Andrea Icks
- Department of Public Health, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
| | - Charalabos-Markos Dintsios
- Department of Public Health, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
| | - Eva Mann
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria.
| | - Ursula Wolf
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany. .,University Hospital of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
| | - Gabriele Meyer
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
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Abstract
Dementia with Lewy bodies is an under-recognized disease; it is responsible for up to 20 % of all dementia cases. Accurate diagnosis is essential because the management of dementia with Lewy bodies is more complex than many neurodegenerative diseases. This is because alpha-synuclein, the pathological protein responsible for dementia with Lewy bodies (and Parkinson's disease), produces symptoms in multiple domains. By dividing the symptoms into cognitive, neuropsychiatric, movement, autonomic, and sleep categories, a comprehensive treatment strategy can be achieved. Management decisions are complex, since the treatment of one set of symptoms can cause complications in other symptom domains. Nevertheless, a comprehensive treatment program can greatly improve the patient's quality of life, but does not alter the progression of disease. Cholinesterase inhibitors are effective for cognitive and neuropsychiatric symptoms; rivastigmine has the widest evidence base. Special care needs to be taken to avoid potentially fatal idiopathic reactions to neuroleptic medications; these should be used for short periods only when absolutely necessary and when alternative treatments have failed. Pimavanserin, a selective serotonin 5-HT2A inverse agonist, holds promise as an alternative therapy for synuclein-associated psychosis. Levodopa/carbidopa treatment of parkinsonism is often limited by dopa-induced exacerbations of neuropsychiatric and cognitive symptoms. Autonomic symptoms are under-recognized complications of synucleinopathy. Constipation, urinary symptoms and postural hypotension respond to standard medications. Rapid eye movement sleep behavior disorder is highly specific (98 %) to the synucleinopathies. Nonpharmacological treatments, melatonin and clonazepam are all effective.
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Affiliation(s)
- Brendon P Boot
- Department of Neurology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA 02115 USA ; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
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Greenbaum L, Lerer B. Pharmacogenetics of antipsychotic-induced movement disorders as a resource for better understanding Parkinson's disease modifier genes. Front Neurol 2015; 6:27. [PMID: 25750634 PMCID: PMC4335175 DOI: 10.3389/fneur.2015.00027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 01/30/2015] [Indexed: 12/05/2022] Open
Abstract
Antipsychotic-induced movement disorders are major side effects of antipsychotic drugs among schizophrenia patients, and include antipsychotic-induced parkinsonism (AIP) and tardive dyskinesia (TD). Substantial pharmacogenetic work has been done in this field, and several susceptibility variants have been suggested. In this paper, the genetics of antipsychotic-induced movement disorders is considered in a broader context. We hypothesize that genetic variants that are risk factors for AIP and TD may provide insights into the pathophysiology of motor symptoms in Parkinson’s disease (PD). Since loss of dopaminergic stimulation (albeit pharmacological in AIP and degenerative in PD) is shared by the two clinical entities, genes associated with susceptibility to AIP may be modifier genes that influence clinical expression of PD motor sub-phenotypes, such as age at onset, disease severity, or rate of progression. This is due to their possible functional influence on compensatory mechanisms for striatal dopamine loss. Better compensatory potential might be beneficial at the early and later stages of the PD course. AIP vulnerability variants could also be related to latent impairment in the nigrostriatal pathway, affecting its functionality, and leading to subclinical dopaminergic deficits in the striatum. Susceptibility of PD patients to early development of l-DOPA induced dyskinesia (LID) is an additional relevant sub-phenotype. LID might share a common genetic background with TD, with which it shares clinical features. Genetic risk variants may predispose to both phenotypes, exerting a pleiotropic effect. According to this hypothesis, elucidating the genetics of antipsychotic-induced movement disorders may advance our understanding of multiple aspects of PD and it clinical course, rendering this a potentially rewarding field of study.
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Affiliation(s)
- Lior Greenbaum
- Department of Neurology, Sheba Medical Center at Tel Hashomer , Ramat Gan , Israel ; The Joseph Sagol Neuroscience Center, Sheba Medical Center at Tel Hashomer , Ramat Gan , Israel
| | - Bernard Lerer
- Biological Psychiatry Laboratory, Department of Psychiatry, Hadassah - Hebrew University Medical Center , Jerusalem , Israel
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Abstract
Use of antipsychotics for treatment of behavioral and psychological symptoms of dementia is frequent among persons with Alzheimer disease (AD). Doses used in long-term therapy have not been previously reported. We describe antipsychotic doses used among community-dwelling persons with AD and investigate factors associated with high-dose use. The MEDALZ-2005 (Medication use and Alzheimer disease) cohort is a nationwide sample including all persons with clinically diagnosed AD at the end of year 2005 in Finland (n = 28,093). Data including prescriptions, comorbidities, and hospital discharge diagnoses were collected from nationwide registers. Antipsychotic doses in monotherapy were investigated during 2006 to 2009. Among 8920 antipsychotic users, 4% (n = 336) used antipsychotics with high dose. Typical antipsychotics were more often used with high dose than atypical antipsychotics. High-dose use was associated with younger age (<80 years) (odds ratio [OR], 1.71; 95% confidence interval [CI], 1.36-2.15]), male sex (OR, 1.52; CI, 1.21-1.91), history of psychiatric disorder (OR, 3.25; CI, 2.54-4.15), and inversely associated with Charlson Comorbidity Index score (score 1: OR, 0.74; CI, 0.57-0.97; score ≥2: OR, 0.68; CI, 0.47-0.97). In conclusion, the majority of persons with AD used antipsychotics with low or medium dose. Typical antipsychotics were more often used with high dose than atypical antipsychotics, which indicates a need for precise dosing instructions in the treatment of behavioral and psychological symptoms of dementia. Clinicians should regularly assess dosing levels especially among men and those with history of psychiatric disorder.
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Marvanova M. Antipsychotic use in elderly patients with dementia: Efficacy and safety concerns. Ment Health Clin 2014. [DOI: 10.9740/mhc.n204371] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Behavioral and psychiatric symptoms of dementia (BPSD) refer to a heterogeneous group of symptoms that represent non-cognitive complications of Alzheimer's disease (AD) and other dementias. Currently, there are no FDA-approved antipsychotic medications for management of BPSD in the United States. Second generation antipsychotics (SGAs) should only be used for appropriate and justified BPSD targets including distressing and severe physical aggression and/or disturbing hallucinations or delusions that pose a risk of harm to self or others after non-pharmacologic interventions have failed. At best, SGAs provide only modest effects and are associated with increased risk for mortality and cerebrovascular complications in addition to other agent-specific side effects. Current evidence and recommendations support use of risperidone, aripiprazole or olanzapine for Alzheimer's disease (AD) and vascular dementia (VaD), and use of quetiapine or clozapine for Lewy body dementia (LBD) and Parkinson's disease dementia (PDD). Any SGA should be initiated at low dosages with slow titration; and the lowest effective dose should be used as a maintenance dose only for a short period of time. Patients should be monitored for clinical response and adverse effects and should be periodically evaluated for continued need for medication. Appropriate use of SGAs for management of BPSD is critical to increase safety for our growing elderly population with dementia.
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Affiliation(s)
- Marketa Marvanova
- 1 Associate Professor, Pharmacy Practice, Chicago State University College of Pharmacy, Adjunct Associate Professor of Neurology, Northwestern University Feinberg School of Medicine, Department of Neurology, Clinical Pharmacy Specialist, Neurology, Rush University Medical Center, Chicago, IL
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Second-generation antipsychotics and extrapyramidal adverse effects. BIOMED RESEARCH INTERNATIONAL 2014; 2014:656370. [PMID: 24995318 PMCID: PMC4065707 DOI: 10.1155/2014/656370] [Citation(s) in RCA: 164] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 05/06/2014] [Indexed: 12/19/2022]
Abstract
Antipsychotic-induced extrapyramidal adverse effects are well recognized in the context of first-generation antipsychotic drugs. However, the introduction of second-generation antipsychotics, with atypical mechanism of action, especially lower dopamine receptors affinity, was met with great expectations among clinicians regarding their potentially lower propensity to cause extrapyramidal syndrome. This review gives a brief summary of the recent literature relevant to second-generation antipsychotics and extrapyramidal syndrome. Numerous studies have examined the incidence and severity of extrapyramidal syndrome with first- and second-generation antipsychotics. The majority of these studies clearly indicate that extrapyramidal syndrome does occur with second-generation agents, though in lower rates in comparison with first generation. Risk factors are the choice of a particular second-generation agent (with clozapine carrying the lowest risk and risperidone the highest), high doses, history of previous extrapyramidal symptoms, and comorbidity. Also, in comparative studies, the choice of a first-generation comparator significantly influences the results. Extrapyramidal syndrome remains clinically important even in the era of second-generation antipsychotics. The incidence and severity of extrapyramidal syndrome differ amongst these antipsychotics, but the fact is that these drugs have not lived up to the expectation regarding their tolerability.
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Mattison MLP, Catic A, Davis RB, Olveczky D, Moran J, Yang J, Aronson M, Zeidel M, Lipsitz L, Marcantonio ER. A standardized, bundled approach to providing geriatric-focused acute care. J Am Geriatr Soc 2014; 62:936-42. [PMID: 24749723 DOI: 10.1111/jgs.12780] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To determine whether a bundled intervention can increase detection of delirium and facilitate safer use of high-risk medications. DESIGN Pre-post interventional trial. SETTING Large academic medical center. PARTICIPANTS Individuals aged 70 and older (n = 19,949) admitted between May 1, 2008, September 30, 2011. Individuals aged 80 and older admitted after April 26, 2010, received the intervention, those aged 80 and older admitted before were primary controls, and those aged 70 to 79 were concurrent controls. INTERVENTION The intervention uses a checklist promoting delirium prevention, recognition and management, and modifies the computerized provider order entry system to provide care focused on elderly adults. MEASUREMENTS Frequency of orders for activating the rapid response team for altered mental status, frequency of orders for haloperidol in excess of 0.5 mg or intravenous (IV) morphine in excess of 2 mg, and discharge disposition. RESULTS Participants receiving the intervention had a mean age of 86.1 ± 4.6; 58.2% were female. The number of orders to activate the rapid response team for altered mental status increased in participants receiving the bundle and in controls (odds ratio (OR) for the difference of differences = 1.23 (95% confidence interval (CI) = 0.68-2.24, P = .49)). Participants receiving the bundle were less likely to receive more than 0.5 mg of IV, intramuscular, or oral haloperidol (OR = 0.60, 95% CI = 0.39-0.91, P = .02) and more than 2 mg of IV morphine (OR = 0.52, 95% CI = 0.42-0.63, P < .001). Participants who received the bundle were more likely to be discharged home than to extended care facilities (OR = 1.18, 95% CI = 1.04-1.35, P = .01). CONCLUSION An intervention focused on delirium prevention and recognition by bedside staff combined with computerized decision support facilitates safer prescribing of high-risk medications and possibly results in less need for extended care.
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Affiliation(s)
- Melissa L P Mattison
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Management of neuropsychiatric symptoms in long-term care residents with Parkinson's disease: a retrospective cohort study. Drugs Aging 2014. [PMID: 23188751 DOI: 10.1007/s40266-012-0038-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND The management of neuropsychiatric symptoms, including psychosis, in Parkinson's Disease (PD) is complicated by the fact that treatment with antipsychotics can worsen the movement disorder, which may necessitate changes to antiparkinsonian medications. OBJECTIVES The objectives of this study were to determine what antipsychotics are prescribed to residents in long-term care with PD and document subsequent changes in levodopa dosage. METHODS A retrospective cohort study using administrative health database information from Ontario, Canada, was conducted. PD diagnostic codes were obtained from the Ontario Health Insurance Plan (physician diagnostic codes) and the Canadian Institute of Health Information (hospitalization discharge diagnoses). The Ontario Drug Benefit database provided information on the use of antiparkinsonian medications and antipsychotics. Residents diagnosed with PD in long-term care were included if they were treated with stable doses of levodopa monotherapy and received a new prescription for an antipsychotic. The type of antipsychotic and the changes in levodopa dosage were determined. RESULTS There were 479 residents who met inclusion criteria. The prescribed antipsychotics were quetiapine (n = 192; 40 %), risperidone (n = 185; 39 %) and olanzapine (n = 81; 17 %), and only 21 (4 %) received a prescription for a typical antipsychotic. The first levodopa dosage change was a dose reduction in 469 (98 %) patients, and a dose increase in ten (2 %) patients. CONCLUSIONS Many PD patients in long-term care are treated with potentially inappropriate antipsychotic medications. However, there is no evidence that this treatment results in a prescribing cascade that leads to inappropriate increases in levodopa dosage.
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Abstract
OPINION STATEMENT Dementia with Lewy bodies (DLB) is a multisystem disorder with diverse disease expression. A treatment regime restricted to the cognitive aspects of the disease does no favor to patients. Instead, patients should be educated to recognize the symptoms of this multisystem involvement. There are no treatments that slow the progression of disease, but symptomatic treatments can be effective. When thinking about treatment, we find it useful to divide the symptoms and signs into five categories: (a) cognitive features, (b) neuropsychiatric features, (c) motor dysfunction, (d) autonomic dysfunction, and (e) sleep dysfunction. Clinicians, funding bodies and industry are increasingly recognizing the importance of this common and debilitating disease.
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Affiliation(s)
- Brendon P Boot
- Department of Neurology, Brigham and Women's Hospital, 221 Longwood Ave, Boston, MA, 02115, USA,
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