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Angotti ML, Burnett RA, Khalid S, Terhune EB, Della Valle CJ. Intra-articular corticosteroids associated with increased risk of total hip arthroplasty at 5 years. Hip Int 2023; 33:800-805. [PMID: 35722779 DOI: 10.1177/11207000221107225] [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: 02/04/2023]
Abstract
BACKGROUND Intra-articular corticosteroid injections are commonly administered for hip pain. However, guidelines are conflicting on their efficacy, particularly in patients without arthritis. This study assessed for an association of corticosteroid injections and the incidence of total hip arthroplasty at 5 years. METHODS Patients with a diagnosis of hip pain without femoroacetabular osteoarthritis who were administered an intra-articular corticosteroid injection of the hip within a 2-year period were identified from the Mariner PearlDiver database. Patient were matched to patients with a diagnosis of hip pain who did not receive an injection. 5-year incidence of total hip arthroplasty was compared between matched patients who received an intra-articular corticosteroid injection and those who did not. RESULTS 2,540,154 patients diagnosed with hip pain without femoroacetabular arthritis were identified. 25,073 (0.9%) patients received a corticosteroid injection and were matched to an equal number of control patients. The incidence of total hip arthroplasty (THA) at 5-year-follow up was significantly higher for the corticosteroid cohort compared to controls (1.1% vs. 0.5%; p < 0.001). The incidence and risk of THA increased along with number of injections (1 injection: 0.8%, OR 1.37; 95% CI, 1.34-1.42; p < 0.001, 2 injections: 1.1%; OR 1.45; CI, 1.40-1.50; p < 0.001, ⩾3 injections: 1.5%; OR 1.48; CI, 1.40-1.56; p < 0.001). CONCLUSIONS There may be a dose-dependent association of corticosteroid injections and a greater risk of total hip arthroplasty at 5 years. These results along with the conflicting guidelines on the efficacy of intra-articular steroids for hip pain should prompt physicians to consider osteoarthritis progression that may occur in the setting of corticosteroid injections in non-arthritic hips.
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Affiliation(s)
| | | | - Syed Khalid
- Midwest Orthopaedics at Rush LLC, Chicago, IL, USA
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Lopresti BJ, Royse SK, Mathis CA, Tollefson SA, Narendran R. Beyond monoamines: I. Novel targets and radiotracers for Positron emission tomography imaging in psychiatric disorders. J Neurochem 2023; 164:364-400. [PMID: 35536762 DOI: 10.1111/jnc.15615] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 10/18/2022]
Abstract
With the emergence of positron emission tomography (PET) in the late 1970s, psychiatry had access to a tool capable of non-invasive assessment of human brain function. Early applications in psychiatry focused on identifying characteristic brain blood flow and metabolic derangements using radiotracers such as [15 O]H2 O and [18 F]FDG. Despite the success of these techniques, it became apparent that more specific probes were needed to understand the neurochemical bases of psychiatric disorders. The first neurochemical PET imaging probes targeted sites of action of neuroleptic (dopamine D2 receptors) and psychoactive (serotonin receptors) drugs. Based on the centrality of monoamine dysfunction in psychiatric disorders and the measured success of monoamine-enhancing drugs in treating them, the next 30 years witnessed the development of an armamentarium of PET radiopharmaceuticals and imaging methodologies for studying monoamines. Continued development of monoamine-enhancing drugs over this time however was less successful, realizing only modest gains in efficacy and tolerability. As patent protection for many widely prescribed and profitable psychiatric drugs lapsed, drug development pipelines shifted away from monoamines in search of novel targets with the promises of improved efficacy, or abandoned altogether. Over this period, PET radiopharmaceutical development activities closely paralleled drug development priorities resulting in the development of new PET imaging agents for non-monoamine targets. Part one of this review will briefly survey novel PET imaging targets with relevance to the field of psychiatry, which include the metabotropic glutamate receptor type 5 (mGluR5), purinergic P2 X7 receptor, type 1 cannabinoid receptor (CB1 ), phosphodiesterase 10A (PDE10A), and describe radiotracers developed for these and other targets that have matured to human subject investigations. Current limitations of the targets and techniques will also be discussed.
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Affiliation(s)
- Brian J Lopresti
- Departments of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Sarah K Royse
- Departments of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Chester A Mathis
- Departments of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Savannah A Tollefson
- Departments of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Rajesh Narendran
- Departments of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,Departments of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Brooks JM, Umucu E, Fortuna KL, Reid MC, Tracy K, Poghosyan L. Prevalence of lifetime nonmedical opioid use among U.S. Health Center Patients aged 45 years and older with psychiatric disorders. Aging Ment Health 2022; 26:179-185. [PMID: 33291958 PMCID: PMC8187460 DOI: 10.1080/13607863.2020.1855105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 11/15/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Despite recent concerns over the increase in opioid misuse among aging adults, little is known about the prevalence of lifetime nonmedical opioid use in underserved, vulnerable middle-aged and older patients with psychiatric disorders. This study aims to determine the lifetime prevalence of nonmedical opioid use among underserved, vulnerable U.S. adults aged ≥45 years with psychiatric disorders. METHOD A nationally representative sample (n = 3,294) was obtained from the 2014 Health Center Patient Survey which collects data on psychiatric disorders, opioid use, and other health information from underserved, vulnerable U.S. primary care populations. Predictor variables included self-reported panic disorder, generalized anxiety disorder, schizophrenia, or bipolar disorder. The outcome variable was self-reported lifetime nonmedical opioid use. Frequencies, counts, and unadjusted and adjusted logistic regression models were conducted with the cross-sectional survey dataset. RESULTS Patients with bipolar disorder had the highest lifetime nonmedical opioid use rate (20.8%), followed by schizophrenia (19.3%), panic disorder (16.5%), and generalized anxiety disorder (14.5%). Nonmedical opioid use was significantly associated with bipolar disorder (OR 3.46, 95% CI [1.33, 8.99]) and generalized anxiety disorder (OR 2.03 95% CI [1.08, 3.83]). CONCLUSION Our findings demonstrate a high prevalence of lifetime nonmedical opioid use in underserved, vulnerable middle-aged and older health center patients with psychiatric disorders. Given the prevalence, health center professionals should monitor, prevent, and treat new or reoccurring signs and symptoms of nonmedical opioid use in this high-risk group of aging patients with psychiatric disorders.
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Affiliation(s)
- Jessica M. Brooks
- Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Emre Umucu
- Department of Rehabilitation Sciences, University of Texas at El Paso, El Paso, TX, USA
| | - Karen L. Fortuna
- Geisel School of Medicine, Dartmouth College, Concord, NH, USA
- CDC Health Promotion Research Center at Dartmouth, Lebanon, NH, USA
| | - M. Carrington Reid
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Kathlene Tracy
- Psychosocial Division, Addiction Institute within Icahn School of Medicine at Mount Sinai (AIMS), New York, NY, USA
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Greiner B, Checketts J, Fishbeck K, Hartwell M. Clinical characteristics and lifestyle behaviors among individuals with arthritis: an analysis of 2017 Behavioral Risk Factor Surveillance System data. J Osteopath Med 2021; 121:113-119. [PMID: 33512394 DOI: 10.1515/jom-2020-0123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Context The combination of osteoarthritis and rheumatoid arthritis affects nearly one-fourth of Americans. Many of the risk factors for arthritis are lifestyle related, such as obesity, physical activity, dietary behaviors, and alcohol and tobacco use. Objective To analyze lifestyle behaviors of patients with vs. those without arthritis. Methods A cross-sectional analysis of 2017 Behavioral Risk Factor Surveillance System (BRFSS) data was conducted on patients with and without a history of arthritis. Physical activity, smoking status, alcohol use, and dietary behaviors were extracted. Logistic regression models were constructed to calculate adjusted risk ratios (ARRs). All confidence intervals (CIs) were reported at 95%. Results The median response rate for the 2017 BRFSS survey was 45.1% (sample n=292,808; population N=118,751,156). The overall prevalence of arthritis was 44% (n=128,850). Respondents with arthritis were significantly more likely to be physically inactive than nonarthritic respondents, with a significant gender interaction (male absolute risk reduction [ARR], 1.2 [CI, 1.15-1.25]; female ARR, 1.29 [CI, 1.24-1.33]). Those with arthritis were also more likely to be current smokers (ARR 1.1; CI, 1.05-1.15) and less likely to have attempted to quit smoking in the last 12 months (ARR, 0.91; CI, 0.87-0.96). Finally, men with arthritis were more likely to drink alcohol heavily (ARR, 1.14; CI, 1.02-1.27]). Conclusion Patients with arthritis were more likely to be women, White, current smokers, and physically inactive, and to have poor mental health, lower education levels, and difficulty paying for healthcare and medications than those without arthritis. Further efforts should be made to address these findings through resource allocation in the care of patients with arthritis. Practitioners should also seek increased understanding of the psychological, social, and economic impacts of physical activity and smoking in patients with arthritis.
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Affiliation(s)
- Benjamin Greiner
- Department of Internal Medicine , University of Texas Medical Branch , Galveston, TX , USA
| | - Jake Checketts
- Department of Orthopedic Surgery , Oklahoma State University Medical Center , Tulsa, OK , USA
| | - Keith Fishbeck
- Department of Orthopedic Surgery , Oklahoma State University Medical Center , Tulsa, OK , USA
| | - Micah Hartwell
- Department of Psychiatry and Behavioral Sciences , Oklahoma State University Center for Health Sciences , Tulsa, OK , USA
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Hunter ML, Knuiman MW, Musk BAW, Hui J, Murray K, Beilby JP, Hillman DR, Hung J, Newton RU, Bucks RS, Straker L, Walsh JP, Zhu K, Bruce DG, Eikelboom RH, Davis TME, Mackey DA, James AL. Prevalence and patterns of multimorbidity in Australian baby boomers: the Busselton healthy ageing study. BMC Public Health 2021; 21:1539. [PMID: 34380465 PMCID: PMC8359115 DOI: 10.1186/s12889-021-11578-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 07/30/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Chronic medical conditions accumulate within individuals with age. However, knowledge concerning the trends, patterns and determinants of multimorbidity remains limited. This study assessed the prevalence and patterns of multimorbidity using extensive individual phenotyping in a general population of Australian middle-aged adults. METHODS Participants (n = 5029, 55% female), born between 1946 and 1964 and attending the cross-sectional phase of the Busselton Healthy Ageing Study (BHAS) between 2010 and 2015, were studied. Prevalence of 21 chronic conditions was estimated using clinical measurement, validated instrument scores and/or self-reported doctor-diagnosis. Non-random patterns of multimorbidity were explored using observed/expected (O/E) prevalence ratios and latent class analysis (LCA). Variables associated with numbers of conditions and class of multimorbidity were investigated. RESULTS The individual prevalence of 21 chronic conditions ranged from 2 to 54% and multimorbidity was common with 73% of the cohort having 2 or more chronic conditions. (mean ± SD 2.75 ± 1.84, median = 2.00, range 0-13). The prevalence of multimorbidity increased with age, obesity, physical inactivity, tobacco smoking and family history of asthma, diabetes, myocardial infarct or cancer. There were 13 pairs and 27 triplets of conditions identified with a prevalence > 1.5% and O/E > 1.5. Of the triplets, arthritis (> 50%), bowel disease (> 33%) and depression-anxiety (> 33%) were observed most commonly. LCA modelling identified 4 statistically and clinically distinct classes of multimorbidity labelled as: 1) "Healthy" (70%) with average of 1.95 conditions; 2) "Respiratory and Atopy" (11%, 3.65 conditions); 3) "Non-cardiometabolic" (14%, 4.77 conditions), and 4) "Cardiometabolic" (5%, 6.32 conditions). Predictors of multimorbidity class membership differed between classes and differed from predictors of number of co-occurring conditions. CONCLUSION Multimorbidity is common among middle-aged adults from a general population. Some conditions associated with ageing such as arthritis, bowel disease and depression-anxiety co-occur in clinically distinct patterns and at higher prevalence than expected by chance. These findings may inform further studies into shared biological and environmental causes of co-occurring conditions of ageing. Recognition of distinct patterns of multimorbidity may aid in a holistic approach to care management in individuals presenting with multiple chronic conditions, while also guiding health resource allocation in ageing populations.
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Affiliation(s)
- Michael L Hunter
- Busselton Population Medical Research Institute Inc, Nedlands, WA, 6009, Australia.
- School of Population and Global Health, The University of Western Australia, Crawley, WA, 6009, Australia.
- BPMRI Busselton Health Study Centre, PO Box 659, Busselton, Western Australia, 6280.
| | - Matthew W Knuiman
- School of Population and Global Health, The University of Western Australia, Crawley, WA, 6009, Australia
| | - Bill A W Musk
- Busselton Population Medical Research Institute Inc, Nedlands, WA, 6009, Australia
- School of Population and Global Health, The University of Western Australia, Crawley, WA, 6009, Australia
| | - Jennie Hui
- Busselton Population Medical Research Institute Inc, Nedlands, WA, 6009, Australia
- School of Population and Global Health, The University of Western Australia, Crawley, WA, 6009, Australia
- PathWest Laboratory Medicine of WA, QEII Medical Centre, Nedlands, WA, 6009, Australia
| | - Kevin Murray
- School of Population and Global Health, The University of Western Australia, Crawley, WA, 6009, Australia
| | - John P Beilby
- Busselton Population Medical Research Institute Inc, Nedlands, WA, 6009, Australia
- PathWest Laboratory Medicine of WA, QEII Medical Centre, Nedlands, WA, 6009, Australia
| | - David R Hillman
- Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, 6009, Australia
| | - Joseph Hung
- Busselton Population Medical Research Institute Inc, Nedlands, WA, 6009, Australia
- Faculty of Health and Medical Sciences, Medical School, University of Western Australia, Crawley, 6009, Australia
| | - Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, 6027, Australia
| | - Romola S Bucks
- School of Psychological Science, University of Western Australia, Perth, WA, 6083, Australia
| | - Leon Straker
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, WA, 6845, Australia
| | - John P Walsh
- Faculty of Health and Medical Sciences, Medical School, University of Western Australia, Crawley, 6009, Australia
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, 6009, Australia
| | - Kun Zhu
- Faculty of Health and Medical Sciences, Medical School, University of Western Australia, Crawley, 6009, Australia
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, 6009, Australia
| | - David G Bruce
- Faculty of Health and Medical Sciences, Medical School, University of Western Australia, Crawley, 6009, Australia
| | - Robert H Eikelboom
- Ear Science Institute Australia, Subiaco, WA, 6008, Australia
- Ear Sciences Centre, The University of Western Australia, Crawley, WA, Australia
- Department of Speech Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - Timothy M E Davis
- Medical School, University of Western Australia, Fremantle Hospital, Fremantle, WA, 6959, Australia
| | - David A Mackey
- Centre for Ophthalmology and Visual Science, University of Western Australia, Lions Eye Institute, Perth, Australia
| | - Alan L James
- Busselton Population Medical Research Institute Inc, Nedlands, WA, 6009, Australia
- Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, 6009, Australia
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Prados-Ojeda JL, Luque-Luque R, Gordillo-Urbano RM, Guler I, López-Medina C, Collantes-Estévez E, Escudero-Contreras A. Assessment of Subclinical Psychotic Symptoms in Patients with Rheumatoid Arthritis and Spondyloarthritis. J Clin Med 2021; 10:jcm10163461. [PMID: 34441756 PMCID: PMC8396915 DOI: 10.3390/jcm10163461] [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: 05/26/2021] [Revised: 07/31/2021] [Accepted: 08/01/2021] [Indexed: 11/17/2022] Open
Abstract
Inflammatory and autoimmune processes have been associated with the onset of depressive and psychotic symptoms. Rheumatoid arthritis (RA) and spondyloarthritis (SpA) are rheumatic diseases with an inflammatory etiology. A high prevalence of depressive and anxiety-related comorbidity has been reported for both diseases, with no evidence of a greater prevalence of psychosis. The objective of the present study was to evaluate for the first time subclinical psychotic symptoms in patients with RA and SpA. This is a cross-sectional, single-center study including RA and SpA patients, as well as healthy controls. Abnormal psychotic experiences (positive, negative, and depressive symptoms) were evaluated using the Community Assessment of Psychic Experiences (CAPE-42). Functional capacity was evaluated using the Short-Form Health Survey SF-12. We compared the CAPE and SF-12 scores between the three groups. We recruited 385 individuals: 218 with RA, 100 with SpA, and 67 healthy controls. According to the CAPE scale, the frequency of subclinical psychotic symptoms was greater in patients than in healthy controls (RA, 1.90 vs. 1.63, p < 0.001; SpA, 1.88 vs. 1.63, p = 0.001). Distress was also greater in patients than in controls owing to the presence of symptoms. No differences were observed between the three groups for the mental dimension scores in the SF-12 Health Survey (43.75 in RA, 45.54 in SpA, and 43.19 in healthy controls). Our findings point to a greater prevalence of subclinical psychotic symptoms in patients with RA and patients with SpA than in the general population. The results suggest an association between inflammation and depression/subclinical psychotic symptoms.
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Affiliation(s)
- Juan L. Prados-Ojeda
- Mental Health Department, Reina Sofia University Hospital, 14004 Cordoba, Spain; (J.L.P.-O.); (R.L.-L.); (R.M.G.-U.)
- Morphological and Socio-Sanitary Sciences, University of Cordoba, 14004 Cordoba, Spain
- Maimonides Institute of Biomedical Research of Córdoba (IMIBIC), 14004 Cordoba, Spain; (I.G.); (E.C.-E.); (A.E.-C.)
| | - Rogelio Luque-Luque
- Mental Health Department, Reina Sofia University Hospital, 14004 Cordoba, Spain; (J.L.P.-O.); (R.L.-L.); (R.M.G.-U.)
- Morphological and Socio-Sanitary Sciences, University of Cordoba, 14004 Cordoba, Spain
- Maimonides Institute of Biomedical Research of Córdoba (IMIBIC), 14004 Cordoba, Spain; (I.G.); (E.C.-E.); (A.E.-C.)
| | - Rafael M. Gordillo-Urbano
- Mental Health Department, Reina Sofia University Hospital, 14004 Cordoba, Spain; (J.L.P.-O.); (R.L.-L.); (R.M.G.-U.)
| | - Ipek Guler
- Maimonides Institute of Biomedical Research of Córdoba (IMIBIC), 14004 Cordoba, Spain; (I.G.); (E.C.-E.); (A.E.-C.)
| | - Clementina López-Medina
- Maimonides Institute of Biomedical Research of Córdoba (IMIBIC), 14004 Cordoba, Spain; (I.G.); (E.C.-E.); (A.E.-C.)
- Medical and Surgical Sciences Department, University of Cordoba, 14004 Cordoba, Spain
- Rheumatology Department, Reina Sofia University Hospital, 14004 Cordoba, Spain
- Correspondence:
| | - Eduardo Collantes-Estévez
- Maimonides Institute of Biomedical Research of Córdoba (IMIBIC), 14004 Cordoba, Spain; (I.G.); (E.C.-E.); (A.E.-C.)
- Medical and Surgical Sciences Department, University of Cordoba, 14004 Cordoba, Spain
- Rheumatology Department, Reina Sofia University Hospital, 14004 Cordoba, Spain
| | - Alejandro Escudero-Contreras
- Maimonides Institute of Biomedical Research of Córdoba (IMIBIC), 14004 Cordoba, Spain; (I.G.); (E.C.-E.); (A.E.-C.)
- Medical and Surgical Sciences Department, University of Cordoba, 14004 Cordoba, Spain
- Rheumatology Department, Reina Sofia University Hospital, 14004 Cordoba, Spain
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Self-Reported Pain Intensity and Depressive Symptoms Among Community-Dwelling Older Adults with Schizophrenia Spectrum Disorders. Community Ment Health J 2019; 55:1298-1304. [PMID: 31098766 PMCID: PMC7053180 DOI: 10.1007/s10597-019-00403-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 05/06/2019] [Indexed: 12/28/2022]
Abstract
Older adults with schizophrenia have some of the highest rates of both medical and psychiatric comorbidities. Despite this, little is known about comorbid pain and depressive symptoms in schizophrenia research. This study aimed to examine the associations between levels of pain intensity and depressive symptoms among community-dwelling adults aged 50 years and older with schizophrenia spectrum disorders. Recruited from U.S. community mental health centers, participants reported on pain and depressive symptoms at the onset of the Helping Older People Experience Success (HOPES) study. Unadjusted and adjusted regression analyses were conducted. Higher pain intensity was associated with elevated depressive symptoms in all analyses, which is consistent with other studies in the general population. Given the widespread efforts to manage pain and related mental health complications in older adults without serious mental illnesses, it is likewise important that community-based mental health professionals monitor and address intense pain and related depressive symptoms among older adults with schizophrenia.
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Brooks JM, Petersen C, Kelly SM, Reid MC. Likelihood of depressive symptoms in US older adults by prescribed opioid potency: National Health and Nutrition Examination Survey 2005-2013. Int J Geriatr Psychiatry 2019; 34:1481-1489. [PMID: 31134673 PMCID: PMC6742518 DOI: 10.1002/gps.5157] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 05/22/2019] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To investigate the relationships between depressive symptoms and opioid potency among adults aged 50 years and older reporting use of one or more prescription opioids in the past 30 days. MATERIALS/DESIGN Adjusted multiple linear regression models were conducted with 2005-2013 files from a secondary cross-sectional dataset, the National Health and Nutrition Examination Survey (NHANES). Respondents were community-dwelling, noninstitutionalized adults 50 years or older (n = 1036). Predictor variables included a positive screen for minor depression symptoms (Patient Health Questionnaire [PHQ-9] score greater than or equal to 5 and less than or equal to 9), moderate depression symptoms (PHQ-9 greater than or equal to 10 and less than or equal to 14), and severe depression symptoms (PHQ-9 greater than or equal to 15). Criterion variables included weaker-than-morphine analgesics (eg, codeine and tramadol) and morphine-equivalent opioids (eg, morphine and hydrocodone), which served as the reference category, as well as stronger-than-morphine opioid analgesics (eg, fentanyl and oxycodone). RESULTS Prevalence rates for symptoms of minor depression, moderate depression, and severe depression were n = 236 (22.8%), n = 135 (13.0%), and n = 122 (11.8%), respectively. Severe depression was significantly associated with high-potency opioid use (odds ratio [OR]: 2.27; confidence interval [CI], 1.16-4.46). In post hoc tests, severe depression remained significantly associated with high-potency opioid use only among respondents without arthritis (OR: 5.80; CI, 1.59-21.13). CONCLUSIONS Compared with older adults without depressive symptoms, older adults with severe depressive symptoms are more likely to be taking high-potency opioid medications. Future prescription opioid medication research should prioritize investigations among older adults with pain-related diagnoses, other than arthritis, reporting preexisting or new symptoms of severe depression.
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Affiliation(s)
- Jessica M. Brooks
- Geriatric Research, Education, and Clinical Center, James J. Peters VA, Medical Center, Bronx, NY
| | - Curtis Petersen
- Quantiative Biomedical Sciences, Geisel School of Medicine at Dartmouth College, Lebanon, NH
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH
| | - Stephanie M. Kelly
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH
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