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Sweileh WM. Neuroleptic malignant syndrome and serotonin syndrome: a comparative bibliometric analysis. Orphanet J Rare Dis 2024; 19:221. [PMID: 38825678 PMCID: PMC11145872 DOI: 10.1186/s13023-024-03227-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 05/27/2024] [Indexed: 06/04/2024] Open
Abstract
OBJECTIVE This study aimed to analyze and map scientific literature on Neuroleptic Malignant Syndrome (NMS) and Serotonin Syndrome (SS) from prestigious, internationally indexed journals. The objective was to identify key topics, impactful articles, prominent journals, research output, growth patterns, hotspots, and leading countries in the field, providing valuable insights for scholars, medical students, and international funding agencies. METHODS A systematic search strategy was implemented in the PubMed MeSH database using specific keywords for NMS and SS. The search was conducted in the Scopus database, renowned for its extensive coverage of scholarly publications. Inclusion criteria comprised articles published from 1950 to December 31st, 2022, restricted to journal research and review articles written in English. Data were analyzed using Microsoft Excel for descriptive analysis, and VOSviewer was employed for bibliometric mapping. RESULTS The search yielded 1150 articles on NMS and 587 on SS, with the majority being case reports. Growth patterns revealed a surge in NMS research between 1981 and 1991, while SS research increased notably between 1993 and 1997. Active countries and journals differed between NMS and SS, with psychiatry journals predominating for NMS and pharmacology/toxicology journals for SS. Authorship analysis indicated higher multi-authored articles for NMS. Top impactful articles focused on review articles and pathogenic mechanisms. Research hotspots included antipsychotics and catatonia for NMS, while SS highlighted drug interactions and specific medications like linezolid and tramadol. CONCLUSIONS NMS and SS represent rare but life-threatening conditions, requiring detailed clinical and scientific understanding. Differential diagnosis and management necessitate caution in prescribing medications affecting central serotonin or dopamine systems, with awareness of potential drug interactions. International diagnostic tools and genetic screening tests may aid in safe diagnosis and prevention. Reporting rare cases and utilizing bibliometric analysis enhance knowledge dissemination and research exploration in the field of rare drug-induced medical conditions.
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Affiliation(s)
- Waleed M Sweileh
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
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2
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Chan VKY, Chai Y, Chan SSM, Luo H, Jit M, Knapp M, Bishai DM, Ni MY, Wong ICK, Li X. Impact of COVID-19 pandemic on depression incidence and healthcare service use among patients with depression: an interrupted time-series analysis from a 9-year population-based study. BMC Med 2024; 22:169. [PMID: 38644506 PMCID: PMC11034087 DOI: 10.1186/s12916-024-03386-z] [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: 12/04/2023] [Accepted: 04/09/2024] [Indexed: 04/23/2024] Open
Abstract
BACKGROUND Most studies on the impact of the COVID-19 pandemic on depression burden focused on the earlier pandemic phase specific to lockdowns, but the longer-term impact of the pandemic is less well-studied. In this population-based cohort study, we examined the short-term and long-term impacts of COVID-19 on depression incidence and healthcare service use among patients with depression. METHODS Using the territory-wide electronic medical records in Hong Kong, we identified all patients aged ≥ 10 years with new diagnoses of depression from 2014 to 2022. We performed an interrupted time-series (ITS) analysis to examine changes in incidence of medically attended depression before and during the pandemic. We then divided all patients into nine cohorts based on year of depression incidence and studied their initial and ongoing service use patterns until the end of 2022. We applied generalized linear modeling to compare the rates of healthcare service use in the year of diagnosis between patients newly diagnosed before and during the pandemic. A separate ITS analysis explored the pandemic impact on the ongoing service use among prevalent patients with depression. RESULTS We found an immediate increase in depression incidence (RR = 1.21, 95% CI: 1.10-1.33, p < 0.001) in the population after the pandemic began with non-significant slope change, suggesting a sustained effect until the end of 2022. Subgroup analysis showed that the increases in incidence were significant among adults and the older population, but not adolescents. Depression patients newly diagnosed during the pandemic used 11% fewer resources than the pre-pandemic patients in the first diagnosis year. Pre-existing depression patients also had an immediate decrease of 16% in overall all-cause service use since the pandemic, with a positive slope change indicating a gradual rebound over a 3-year period. CONCLUSIONS During the pandemic, service provision for depression was suboptimal in the face of increased demand generated by the increasing depression incidence during the COVID-19 pandemic. Our findings indicate the need to improve mental health resource planning preparedness for future public health crises.
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Affiliation(s)
- Vivien Kin Yi Chan
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Yi Chai
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- The Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong SAR, China
| | - Sandra Sau Man Chan
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Hao Luo
- Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Martin Knapp
- Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong SAR, China
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - David Makram Bishai
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Michael Yuxuan Ni
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR, China
- Urban Systems Institute, The University of Hong Kong, Hong Kong SAR, China
| | - Ian Chi Kei Wong
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
- Laboratory of Data Discovery for Health (D24H), Hong Kong SAR, China.
- School of Pharmacy, Aston University, London, UK.
- Advanced Data Analytics for Medical Science (ADAMS) Limited, Hong Kong SAR, China.
| | - Xue Li
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
- Laboratory of Data Discovery for Health (D24H), Hong Kong SAR, China.
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
- Advanced Data Analytics for Medical Science (ADAMS) Limited, Hong Kong SAR, China.
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3
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Kheirbek RE, LaFon C. Use of antipsychotics in adults with dementia. BMJ 2024; 385:q819. [PMID: 38631727 DOI: 10.1136/bmj.q819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Affiliation(s)
- Raya Elfadel Kheirbek
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
- Geriatrics Research, Education and Clinical Center (GRECC), Veterans Affairs Medical Center, Baltimore, MD, USA
| | - Cristina LaFon
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
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4
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Mok PLH, Carr MJ, Guthrie B, Morales DR, Sheikh A, Elliott RA, Camacho EM, van Staa T, Avery AJ, Ashcroft DM. Multiple adverse outcomes associated with antipsychotic use in people with dementia: population based matched cohort study. BMJ 2024; 385:e076268. [PMID: 38631737 PMCID: PMC11022137 DOI: 10.1136/bmj-2023-076268] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVE To investigate risks of multiple adverse outcomes associated with use of antipsychotics in people with dementia. DESIGN Population based matched cohort study. SETTING Linked primary care, hospital and mortality data from Clinical Practice Research Datalink (CPRD), England. POPULATION Adults (≥50 years) with a diagnosis of dementia between 1 January 1998 and 31 May 2018 (n=173 910, 63.0% women). Each new antipsychotic user (n=35 339, 62.5% women) was matched with up to 15 non-users using incidence density sampling. MAIN OUTCOME MEASURES The main outcomes were stroke, venous thromboembolism, myocardial infarction, heart failure, ventricular arrhythmia, fracture, pneumonia, and acute kidney injury, stratified by periods of antipsychotic use, with absolute risks calculated using cumulative incidence in antipsychotic users versus matched comparators. An unrelated (negative control) outcome of appendicitis and cholecystitis combined was also investigated to detect potential unmeasured confounding. RESULTS Compared with non-use, any antipsychotic use was associated with increased risks of all outcomes, except ventricular arrhythmia. Current use (90 days after a prescription) was associated with elevated risks of pneumonia (hazard ratio 2.19, 95% confidence interval (CI) 2.10 to 2.28), acute kidney injury (1.72, 1.61 to 1.84), venous thromboembolism (1.62, 1.46 to 1.80), stroke (1.61, 1.52 to 1.71), fracture (1.43, 1.35 to 1.52), myocardial infarction (1.28, 1.15 to 1.42), and heart failure (1.27, 1.18 to 1.37). No increased risks were observed for the negative control outcome (appendicitis and cholecystitis). In the 90 days after drug initiation, the cumulative incidence of pneumonia among antipsychotic users was 4.48% (4.26% to 4.71%) versus 1.49% (1.45% to 1.53%) in the matched cohort of non-users (difference 2.99%, 95% CI 2.77% to 3.22%). CONCLUSIONS Antipsychotic use compared with non-use in adults with dementia was associated with increased risks of stroke, venous thromboembolism, myocardial infarction, heart failure, fracture, pneumonia, and acute kidney injury, but not ventricular arrhythmia. The range of adverse outcomes was wider than previously highlighted in regulatory alerts, with the highest risks soon after initiation of treatment.
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Affiliation(s)
- Pearl L H Mok
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, University of Manchester, Manchester, M13 9PT, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | - Matthew J Carr
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, University of Manchester, Manchester, M13 9PT, UK
- Manchester Academic Health Science Centre, Manchester, UK
- NIHR Greater Manchester Patient Safety Research Collaboration, University of Manchester, Manchester, UK
| | - Bruce Guthrie
- Advanced Care Research Centre, Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Daniel R Morales
- Population Health and Genomics, University of Dundee, Dundee, UK
| | - Aziz Sheikh
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Rachel A Elliott
- NIHR Greater Manchester Patient Safety Research Collaboration, University of Manchester, Manchester, UK
- Manchester Centre for Health Economics, Division of Population Health, Manchester, UK
| | - Elizabeth M Camacho
- Manchester Centre for Health Economics, Division of Population Health, Manchester, UK
| | - Tjeerd van Staa
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK
| | - Anthony J Avery
- NIHR Greater Manchester Patient Safety Research Collaboration, University of Manchester, Manchester, UK
- Centre for Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, University of Manchester, Manchester, M13 9PT, UK
- Manchester Academic Health Science Centre, Manchester, UK
- NIHR Greater Manchester Patient Safety Research Collaboration, University of Manchester, Manchester, UK
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5
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Chart-Pascual JP, Montero-Torres M, Ortega MA, Mar-Barrutia L, Zorrilla Martinez I, Alvarez-Mon M, Gonzalez-Pinto A, Alvarez-Mon MA. Areas of interest and sentiment analysis towards second generation antipsychotics, lithium and mood stabilizing anticonvulsants: Unsupervised analysis using Twitter. J Affect Disord 2024; 351:649-660. [PMID: 38290587 DOI: 10.1016/j.jad.2024.01.234] [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] [Received: 08/21/2023] [Revised: 01/23/2024] [Accepted: 01/26/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND Severe mental disorders like Schizophrenia and related psychotic disorders (SRD) or Bipolar Disorder (BD) require pharmacological treatment for relapse prevention and quality of life improvement. Yet, treatment adherence is a challenge, partly due to patients' attitudes and beliefs towards their medication. Social media listening offers insights into patient experiences and preferences, particularly in severe mental disorders. METHODS All tweets posted between 2008 and 2022 mentioning the names of the main drugs used in SRD and BD were analyzed using advanced artificial intelligence techniques such as machine learning, and deep learning, along with natural language processing. RESULTS In this 15-year study analyzing 893,289 tweets, second generation antipsychotics received more mentions in English tweets, whereas mood stabilizers received more tweets in Spanish. English tweets about economic and legal aspects displayed negative emotions, while Spanish tweets seeking advice showed surprise. Moreover, a recurring theme in Spanish tweets was the shortage of medications, evoking feelings of anger among users. LIMITATIONS This study's analysis of Twitter data, while insightful, may not fully capture the nuances of discussions due to the platform's brevity. Additionally, the wide therapeutic use of the studied drugs, complicates the isolation of disorder-specific discourse. Only English and Spanish tweets were examined, limiting the cultural breadth of the findings. CONCLUSION This study emphasizes the importance of social media research in understanding user perceptions of SRD and BD treatments. The results provide valuable insights for clinicians when considering how patients and the general public view and communicate about these treatments in the digital environment.
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Affiliation(s)
- Juan Pablo Chart-Pascual
- Psychiatry Department, Osakidetza Basque Health Service, Araba University Hospital, Vitoria-Gasteiz, Spain; University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain; Bioaraba Health Research Institute, Vitoria-Gasteiz, Spain; CIBERSAM.
| | - Maria Montero-Torres
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain; Department of Medicine and Medical Specialities, University of Alcala, 28801 Alcala de Henares, Madrid, Spain
| | - Miguel Angel Ortega
- Cancer Registry and Pathology Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain; Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain; Department of Medicine and Medical Specialities, University of Alcala, 28801 Alcala de Henares, Madrid, Spain
| | - Lorea Mar-Barrutia
- Psychiatry Department, Osakidetza Basque Health Service, Araba University Hospital, Vitoria-Gasteiz, Spain; Bioaraba Health Research Institute, Vitoria-Gasteiz, Spain; CIBERSAM
| | - Iñaki Zorrilla Martinez
- Psychiatry Department, Osakidetza Basque Health Service, Araba University Hospital, Vitoria-Gasteiz, Spain; University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain; Bioaraba Health Research Institute, Vitoria-Gasteiz, Spain; CIBERSAM
| | - Melchor Alvarez-Mon
- Immune System Diseases-Rheumatology and Internal Medicine Service, Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas, University Hospital Príncipe de Asturias, Alcala de Henares, Spain; Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain; Department of Medicine and Medical Specialities, University of Alcala, 28801 Alcala de Henares, Madrid, Spain
| | - Ana Gonzalez-Pinto
- Psychiatry Department, Osakidetza Basque Health Service, Araba University Hospital, Vitoria-Gasteiz, Spain; University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain; Bioaraba Health Research Institute, Vitoria-Gasteiz, Spain; CIBERSAM
| | - Miguel Angel Alvarez-Mon
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain; Department of Medicine and Medical Specialities, University of Alcala, 28801 Alcala de Henares, Madrid, Spain; Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, Madrid, Spain
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6
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Chai Y, Man KKC, Luo H, Torre CO, Wing YK, Hayes JF, Osborn DPJ, Chang WC, Lin X, Yin C, Chan EW, Lam ICH, Fortin S, Kern DM, Lee DY, Park RW, Jang JW, Li J, Seager S, Lau WCY, Wong ICK. Incidence of mental health diagnoses during the COVID-19 pandemic: a multinational network study. Epidemiol Psychiatr Sci 2024; 33:e9. [PMID: 38433286 PMCID: PMC10940053 DOI: 10.1017/s2045796024000088] [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] [Received: 10/08/2023] [Revised: 12/27/2023] [Accepted: 01/20/2024] [Indexed: 03/05/2024] Open
Abstract
AIMS Population-wide restrictions during the COVID-19 pandemic may create barriers to mental health diagnosis. This study aims to examine changes in the number of incident cases and the incidence rates of mental health diagnoses during the COVID-19 pandemic. METHODS By using electronic health records from France, Germany, Italy, South Korea and the UK and claims data from the US, this study conducted interrupted time-series analyses to compare the monthly incident cases and the incidence of depressive disorders, anxiety disorders, alcohol misuse or dependence, substance misuse or dependence, bipolar disorders, personality disorders and psychoses diagnoses before (January 2017 to February 2020) and after (April 2020 to the latest available date of each database [up to November 2021]) the introduction of COVID-related restrictions. RESULTS A total of 629,712,954 individuals were enrolled across nine databases. Following the introduction of restrictions, an immediate decline was observed in the number of incident cases of all mental health diagnoses in the US (rate ratios (RRs) ranged from 0.005 to 0.677) and in the incidence of all conditions in France, Germany, Italy and the US (RRs ranged from 0.002 to 0.422). In the UK, significant reductions were only observed in common mental illnesses. The number of incident cases and the incidence began to return to or exceed pre-pandemic levels in most countries from mid-2020 through 2021. CONCLUSIONS Healthcare providers should be prepared to deliver service adaptations to mitigate burdens directly or indirectly caused by delays in the diagnosis and treatment of mental health conditions.
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Affiliation(s)
- Yi Chai
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
- The Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong
| | - Kenneth K. C. Man
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
- Laboratory of Data Discovery for Health (D4H), Hong Kong Science Park, Hong Kong
| | - Hao Luo
- The Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong
| | - Carmen Olga Torre
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
- Real World Data Sciences, Roche, Welwyn Garden City, UK
- School of Science and Engineering, University of Groningen, Groningen, The Netherlands
| | - Yun Kwok Wing
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Joseph F. Hayes
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - David P. J. Osborn
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Wing Chung Chang
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | - Xiaoyu Lin
- Real-World Solutions, IQVIA, Durham, NC, USA
| | - Can Yin
- Real-World Solutions, IQVIA, Durham, NC, USA
| | - Esther W. Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
- Laboratory of Data Discovery for Health (D4H), Hong Kong Science Park, Hong Kong
- The University of Hong Kong Shenzhen Institute of Research and Innovation, Shenzhen, Guangdong, China
| | - Ivan C. H. Lam
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Stephen Fortin
- Observation Health Data Analytics, Janssen Research & Development, Titusville, NJ, USA
| | - David M. Kern
- Department of Epidemiology, Janssen Research & Development, Titusville, NJ, USA
| | - Dong Yun Lee
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, South Korea
| | - Rae Woong Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, South Korea
| | - Jae-Won Jang
- Department of Neurology, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Jing Li
- Real-World Solutions, IQVIA, Durham, NC, USA
| | | | - Wallis C. Y. Lau
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
- Laboratory of Data Discovery for Health (D4H), Hong Kong Science Park, Hong Kong
| | - Ian C. K. Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
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Du J, Burger H, Kupers T, Sulim K, Homburg MT, Muris JWM, Olde Hartman TC, Zuidema SU, Peters LL, Janus SIM. Patterns of psychotropic drug prescriptions and general practice consultations among community-dwelling older people with dementia during the first two years of the COVID-19 pandemic. BMC Geriatr 2024; 24:120. [PMID: 38297202 PMCID: PMC10832125 DOI: 10.1186/s12877-024-04708-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 01/14/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic and subsequent lockdown measures had serious implications for community-dwelling older people with dementia. While the short-term impacts of the pandemic on this population have been well studied, there is limited research on its long-term impacts. Quantifying the long-term impacts may provide insights into whether healthcare adaptations are needed after the acute phase of the pandemic to balance infection prevention measures with healthcare provision. This study aims to examine patterns of psychotropic drug prescriptions and general practice consultations in community-dwelling older people with dementia during the first two years of the pandemic. METHODS We utilised routine electronic health records from three Dutch academic general practice research networks located in the North, East, and South, between 2019 and 2021. We (1) compared the weekly prescription rates of five groups of psychotropic drugs and two groups of tracer drugs, and weekly general practice consultation rates per 1000 participants, between the first two years of the pandemic and the pre-pandemic phase, (2) calculated changes in these rates during three lockdowns and two relaxation phases relative to the corresponding weeks in 2019, and (3) employed interrupted time series analyses for the prescription rates. Analyses were performed for each region separately. RESULTS The study population sizes in the North, East, and South between 2019 and 2021 were 1726 to 1916, 93 to 117, and 904 to 960, respectively. Data from the East was excluded from the statistical analyses due to the limited sample size. During the first two years of the pandemic, the prescription rates of psychotropic drugs were either lower or similar to those in the pre-pandemic phase, with differences varying from -2.6‰ to -10.2‰. In contrast, consultation rates during the pandemic were higher than in the pre-pandemic phase, increasing by around 38‰. CONCLUSIONS This study demonstrates a decrease in psychotropic drug prescriptions, but an increase in general practice consultations among community-dwelling older people with dementia during the first two years of the pandemic. However, reasons for the decrease in psychotropic drug prescriptions are unclear due to limited information on the presence of neuropsychiatric symptoms and the appropriateness of prescribing.
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Affiliation(s)
- Jiamin Du
- Department of Primary and Long-Term Care, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Huibert Burger
- Department of Primary and Long-Term Care, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Thijmen Kupers
- Department of Primary and Long-Term Care, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Karina Sulim
- Department of Primary and Long-Term Care, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Maarten T Homburg
- Department of Primary and Long-Term Care, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Jean W M Muris
- Department of Family Medicine, Maastricht University Medical Centre, CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands
| | - Tim C Olde Hartman
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Sytse U Zuidema
- Department of Primary and Long-Term Care, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
- Alzheimer Centre Groningen, Groningen, the Netherlands
| | - Lilian L Peters
- Department of Primary and Long-Term Care, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
- Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Midwifery Science, AVAG, Amsterdam Public Health, Amsterdam, the Netherlands
| | - Sarah I M Janus
- Department of Primary and Long-Term Care, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands.
- Alzheimer Centre Groningen, Groningen, the Netherlands.
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8
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Maxwell CJ, Dampf H, Alkabbani W, Cotton CA, Gamble JM, Hogan DB, Gruneir A, McArthur E, Youngson E, Hsu Z, Hoben M. Psychotropic, Anticonvulsant, and Opioid Use in Assisted Living Residents Before and During the COVID-19 Pandemic. J Am Med Dir Assoc 2024; 25:121-129. [PMID: 37863111 DOI: 10.1016/j.jamda.2023.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/04/2023] [Accepted: 09/12/2023] [Indexed: 10/22/2023]
Abstract
OBJECTIVES To examine the associations between COVID-19 pandemic waves (1-4) and prevalent antipsychotic, antidepressant, benzodiazepine, anticonvulsant, and opioid use among assisted living (AL) residents, by setting (dementia care vs other). DESIGN Population-based, repeated cross-sectional study. SETTING AND PARTICIPANTS Linked clinical and health administrative databases for residents of all publicly subsidized AL homes (N = 256) in Alberta, Canada, examined from January 2018 to December 2021. Setting-specific quarterly cohorts of residents were derived for pandemic (starting March 1, 2020) and comparable historical (2018/2019 combined) periods. METHODS The quarterly proportion of residents dispensed an antipsychotic, antidepressant, benzodiazepine, anticonvulsant, or opioid was examined for each setting and period. Log-binomial generalized estimating equations models estimated prevalence ratios (PR) for period (pandemic vs historical quarterly periods), setting (dementia care vs other AL), and period-setting interactions. RESULTS On March 1, 2020, there were 2874 dementia care and 6611 other AL residents (mean age 82.4 vs 79.9 years, 68.2% vs 66.1% female, 93.5% vs 42.6% with dementia, respectively). Antipsychotic use increased during waves 2 to 4 for residents of both settings, but this increase was significantly greater for dementia care than other AL residents during waves 3 and 4 (eg, wave 3, PR 1.21, 95% CI 1.14-1.27 vs PR 1.12, 95% CI 1.07-1.17, interaction term P = .029). In both settings, there was a significant but modest increase in antidepressant use and a significant decrease in benzodiazepine use during several pandemic waves. For other AL residents only, there was a small statistically significant increase in anticonvulsant use during waves 2 to 4. No significant pandemic effect was observed for prevalent opioid use in either setting. CONCLUSIONS AND IMPLICATIONS The persistence of the pandemic-associated increase in antipsychotic, antidepressant, and anticonvulsant use in AL residents, and greater increase in antipsychotic use for dementia care settings, raises concerns about the attendant risks for residents, especially those with dementia.
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Affiliation(s)
- Colleen J Maxwell
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada; ICES, Toronto, Ontario, Canada.
| | - Hana Dampf
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Wajd Alkabbani
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | - Cecilia A Cotton
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada
| | | | - David B Hogan
- Division of Geriatric Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrea Gruneir
- ICES, Toronto, Ontario, Canada; Department of Family Medicine, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Eric McArthur
- London Health Sciences Centre, London, Ontario, Canada
| | - Erik Youngson
- Provincial Research Data Services, Alberta Health Services, Alberta, Edmonton, Canada; Data and Research Services, Alberta SPOR SUPPORT Unit, Alberta, Edmonton, Canada
| | - Zoe Hsu
- Provincial Research Data Services, Alberta Health Services, Alberta, Edmonton, Canada; Data and Research Services, Alberta SPOR SUPPORT Unit, Alberta, Edmonton, Canada
| | - Matthias Hoben
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada; School of Health Policy and Management, Faculty of Health, York University, Toronto, Ontario, Canada
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9
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Burghardt KJ, Kajy M, Ward KM, Burghardt PR. Metabolomics, Lipidomics, and Antipsychotics: A Systematic Review. Biomedicines 2023; 11:3295. [PMID: 38137517 PMCID: PMC10741000 DOI: 10.3390/biomedicines11123295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/06/2023] [Accepted: 12/09/2023] [Indexed: 12/24/2023] Open
Abstract
Antipsychotics are an important pharmacotherapy option for the treatment of many mental illnesses. Unfortunately, selecting antipsychotics is often a trial-and-error process due to a lack of understanding as to which medications an individual patient will find most effective and best tolerated. Metabolomics, or the study of small molecules in a biosample, is an increasingly used omics platform that has the potential to identify biomarkers for medication efficacy and toxicity. This systematic review was conducted to identify metabolites and metabolomic pathways associated with antipsychotic use in humans. Ultimately, 42 studies were identified for inclusion in this review, with all but three studies being performed in blood sources such as plasma or serum. A total of 14 metabolite classes and 12 lipid classes were assessed across studies. Although the studies were highly heterogeneous in approach and mixed in their findings, increases in phosphatidylcholines, decreases in carboxylic acids, and decreases in acylcarnitines were most consistently noted as perturbed in patients exposed to antipsychotics. Furthermore, for the targeted metabolomic and lipidomic studies, seven metabolites and three lipid species had findings that were replicated. The most consistent finding for targeted studies was an identification of a decrease in aspartate with antipsychotic treatment. Studies varied in depth of detail provided for their study participants and in study design. For example, in some cases, there was a lack of detail on specific antipsychotics used or concomitant medications, and the depth of detail on sample handling and analysis varied widely. The conclusions here demonstrate that there is a large foundation of metabolomic work with antipsychotics that requires more complete reporting so that an objective synthesis such as a meta-analysis can take place. This will then allow for validation and clinical application of the most robust findings to move the field forward. Future studies should be carefully controlled to take advantage of the sensitivity of metabolomics while limiting potential confounders that may result from participant heterogeneity and varied analysis approaches.
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Affiliation(s)
- Kyle J. Burghardt
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University Detroit, Detroit, MI 48201, USA;
| | - Megan Kajy
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University Detroit, Detroit, MI 48201, USA;
| | - Kristen M. Ward
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan Ann Arbor, Detroit, MI 48109, USA;
| | - Paul R. Burghardt
- Department of Nutrition and Food Science, Wayne State University Detroit, Detroit, MI 48201, USA;
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10
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Wang J, Shen JY, Conwell Y, Yu F, Nathan K, Heffner KL, Li Y, Caprio TV. Antipsychotic use among older patients with dementia receiving home health care services: Prevalence, predictors, and outcomes. J Am Geriatr Soc 2023; 71:3768-3779. [PMID: 37671461 PMCID: PMC10841208 DOI: 10.1111/jgs.18555] [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: 03/22/2023] [Revised: 07/07/2023] [Accepted: 07/26/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Antipsychotic use is a safety concern among older patients in home health care (HHC), particularly for those with Alzheimer's disease and related dementias (ADRD). The objective of this study was to examine the prevalence and predictors of antipsychotic use among older adults with and without ADRD who received HHC, and the association of antipsychotic use with outcomes among patients living with ADRD. METHODS In this secondary analysis of adults ≥65 years receiving care from an HHC agency in New York in 2019 (N = 6684), we used data from the Outcome and Assessment Information Set, Medicare HHC claims, and home medication review results in the electronic HHC records during a 60-day HHC episode. ADRD was identified by diagnostic codes. Functional outcome was the change in the composite activities of daily living (ADL) score from HHC admission to HHC discharge (measured in 5833 patients), where a positive score means improvement and a negative score means decline. Data were analyzed using logistic (predictors) and linear regression (association with outcome) analyses. RESULTS The point prevalence of antipsychotic use was 17.2% and 6.6% among patients with and without ADRD, respectively. Among patients living with ADRD, predictors of antipsychotic use included having greater ADL limitations (odds ratio [OR] = 1.30, p = 0.01), taking more medications (OR = 1.04, p = 0.02), having behavioral and psychological symptoms (OR = 5.26, p = 0.002), and living alone (OR = 0.52, p = 0.06). Among patients living with ADRD, antipsychotic use was associated with having less ADL improvement at HHC discharge (β = -0.70, p < 0.001). CONCLUSIONS HHC patients living with ADRD were more likely to use antipsychotics and to experience worse functional outcomes when using antipsychotics. Antipsychotics should be systematically reviewed and, if contraindicated or unnecessary, deprescribed. Efforts are needed to improve HHC patients' access to nonpharmacological interventions and to provide education for caregivers regarding behavioral approaches to manage symptoms in ADRD.
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Affiliation(s)
- Jinjiao Wang
- Elaine Hubbard Center for Nursing Research on Aging, University of Rochester, School of Nursing, Rochester, New York, USA
| | - Jenny Y Shen
- Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Fang Yu
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Kobi Nathan
- Division of Geriatrics & Aging, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
- Wegmans School of Pharmacy, St. John Fisher College, Rochester, New York, USA
| | - Kathi L Heffner
- Elaine Hubbard Center for Nursing Research on Aging, University of Rochester, School of Nursing, Rochester, New York, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
- Division of Geriatrics & Aging, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Yue Li
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York, USA
| | - Thomas V Caprio
- Division of Geriatrics & Aging, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
- University of Rochester Medical Home Care, Rochester, New York, USA
- Finger Lakes Geriatric Education Center, Rochester, New York, USA
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11
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Engineer M, Kot S, Dixon E. Investigating the Readability and Linguistic, Psychological, and Emotional Characteristics of Digital Dementia Information Written in the English Language: Multitrait-Multimethod Text Analysis. JMIR Form Res 2023; 7:e48143. [PMID: 37878351 PMCID: PMC10632922 DOI: 10.2196/48143] [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: 04/12/2023] [Revised: 08/10/2023] [Accepted: 08/15/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Past research in the Western context found that people with dementia search for digital dementia information in peer-reviewed medical research articles, dementia advocacy and medical organizations, and blogs written by other people with dementia. This past work also demonstrated that people with dementia do not perceive English digital dementia information as emotionally or cognitively accessible. OBJECTIVE In this study, we sought to investigate the readability; linguistic, psychological, and emotional characteristics; and target audiences of digital dementia information. We conducted a textual analysis of 3 different types of text-based digital dementia information written in English: 300 medical articles, 35 websites, and 50 blogs. METHODS We assessed the text's readability using the Flesch Reading Ease and Flesch-Kincaid Grade Level measurements, as well as tone, analytical thinking, clout, authenticity, and word frequencies using a natural language processing tool, Linguistic Inquiry and Word Count Generator. We also conducted a thematic analysis to categorize the target audiences for each information source and used these categorizations for further statistical analysis. RESULTS The median Flesch-Kincaid Grade Level readability score and Flesch Reading Ease score for all types of information (N=1139) were 12.1 and 38.6, respectively, revealing that the readability scores of all 3 information types were higher than the minimum requirement. We found that medical articles had significantly (P=.05) higher word count and analytical thinking scores as well as significantly lower clout, authenticity, and emotional tone scores than websites and blogs. Further, blogs had significantly (P=.48) higher word count and authenticity scores but lower analytical scores than websites. Using thematic analysis, we found that most of the blogs (156/227, 68.7%) and web pages (399/612, 65.2%) were targeted at people with dementia. Website information targeted at a general audience had significantly lower readability scores. In addition, website information targeted at people with dementia had higher word count and lower emotional tone ratings. The information on websites targeted at caregivers had significantly higher clout and lower authenticity scores. CONCLUSIONS Our findings indicate that there is an abundance of digital dementia information written in English that is targeted at people with dementia, but this information is not readable by a general audience. This is problematic considering that people with <12 years of education are at a higher risk of developing dementia. Further, our findings demonstrate that digital dementia information written in English has a negative tone, which may be a contributing factor to the mental health crisis many people with dementia face after receiving a diagnosis. Therefore, we call for content creators to lower readability scores to make the information more accessible to a general audience and to focus their efforts on providing information in a way that does not perpetuate overly negative narratives of dementia.
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Affiliation(s)
- Margi Engineer
- Computer Science Department, Clemson University, Clemson, SC, United States
| | - Sushant Kot
- Computer Science Department, Clemson University, Clemson, SC, United States
| | - Emma Dixon
- Human Centered Computing Department, Clemson University, Clemson, SC, United States
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12
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Ballard C, Corbett A. Antipsychotic drug presribing in dementia: changes from the pandemic. THE LANCET. HEALTHY LONGEVITY 2023; 4:e366-e367. [PMID: 37543045 DOI: 10.1016/s2666-7568(23)00131-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 08/07/2023] Open
Affiliation(s)
- Clive Ballard
- Clinical and Biomedical Sciences, University of Exeter, Exeter EX1 2LU, UK.
| | - Anne Corbett
- Health and Community Sciences, University of Exeter, Exeter EX1 2LU, UK
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13
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Schnier C, McCarthy A, Morales DR, Akbari A, Sofat R, Dale C, Takhar R, Mamas MA, Khunti K, Zaccardi F, Sudlow CL, Wilkinson T. Antipsychotic drug prescribing and mortality in people with dementia before and during the COVID-19 pandemic: a retrospective cohort study in Wales, UK. THE LANCET. HEALTHY LONGEVITY 2023; 4:e421-e430. [PMID: 37543047 DOI: 10.1016/s2666-7568(23)00105-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/03/2023] [Accepted: 06/05/2023] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND Concerns have been raised that antipsychotic drug prescribing, which has been associated with increased mortality in people with dementia, might have increased during the COVID-19 pandemic due to social restrictions imposed to limit the spread of SARS-CoV-2. We used multisource, routinely collected health-care data from Wales, UK to investigate prescribing and mortality variations in people with dementia before and during the COVID-19 pandemic. METHODS In this retrospective cohort study, we used individual-level, anonymised, population-scale linked health data to identify adults aged 60 years and older with a diagnosis of dementia in Wales, UK. We used the CVD-COVID-UK initiative to access Welsh routinely collected electronic health record data from the Secure Anonymised Information Linkage (SAIL) Databank. Patients who were alive and registered with a SAIL general practice on Jan 1, 2016, and who received a dementia diagnosis before the age of 60 years and before or during the study period were included. We explored antipsychotic drug prescribing rate changes over 67 months, between Jan 1, 2016, and Aug 1, 2021, overall and stratified by age and dementia subtype. We used time-series analyses to examine all-cause and myocardial infarction and stroke mortality over the study period and identified the leading causes of death in people with dementia between Jan 1, 2020, and Aug 1, 2021. FINDINGS Of 3 106 690 participants in SAIL between Jan 1, 2016 and Aug 1, 2021, 57 396 people (35 148 [61·2%] women and 22 248 [38·8%] men) met inclusion criteria for this study and contributed 101 428 person-years of follow-up. Of the 57 396 people with dementia, 11 929 (20·8%) were prescribed an antipsychotic drug at any point during follow-up. Accounting for seasonality, antipsychotic drug prescribing increased during the second half of 2019 and throughout 2020. However, the absolute difference in prescribing rates was small, ranging from 1253 prescriptions per 10 000 person-months in March, 2019, to 1305 per 10 000 person-months in September, 2020. All-cause mortality and stroke mortality increased throughout 2020, while myocardial infarction mortality declined. From Jan 1, 2020, to Aug 1, 2021, 1286 (17·1%) of 7508 participants who died had COVID-19 recorded as the underlying cause of death. INTERPRETATION During the COVID-19 pandemic, antipsychotic drug prescribing in people with dementia in the UK increased slightly; however, it is unlikely that this was solely related to the pandemic and this increase was unlikely to be a major factor in the substantial increase in mortality during 2020. The long-term increase in antipsychotic drug prescribing in younger people and in those with Alzheimer's disease warrants further investigation using resources with access to more granular clinical data. Although deprescribing antipsychotic medications remains an essential aspect of dementia care, the results of this study suggest that changes in prescribing and deprescribing practices as a result of the COVID-19 pandemic are not required. FUNDING British Heart Foundation (via the British Heart Foundation Data Science Centre led by Health Data Research UK), and the Scottish Neurological Research Fund.
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Affiliation(s)
- Christian Schnier
- The Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, UK
| | - Aoife McCarthy
- Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Daniel R Morales
- Division of Population Health and Genomics, University of Dundee, Dundee, UK; Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Ashley Akbari
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Reecha Sofat
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK; British Heart Foundation Data Science Centre, Health Data Research UK, London, UK
| | - Caroline Dale
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Rohan Takhar
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK
| | - Kamlesh Khunti
- Diabetes Research Centre and Real World Evidence Unit, University of Leicester, Leicester, UK
| | - Francesco Zaccardi
- Diabetes Research Centre and Real World Evidence Unit, University of Leicester, Leicester, UK
| | - Cathie Lm Sudlow
- Usher Institute, University of Edinburgh, Edinburgh, UK; Centre for Clinical Brain Sciences UK, University of Edinburgh, Edinburgh, UK; British Heart Foundation Data Science Centre, Health Data Research UK, London, UK
| | - Tim Wilkinson
- Centre for Clinical Brain Sciences UK, University of Edinburgh, Edinburgh, UK; Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.
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14
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Fick DM. AGS CoCare ®: HELP Reduces In-Hospital Delirium. J Gerontol Nurs 2023; 49:51-52. [PMID: 37523335 DOI: 10.3928/00989134-20230707-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
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