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Mikulska J, Pietrzak D, Rękawek P, Siudaj K, Walczak-Nowicka ŁJ, Herbet M. Celiac disease and depressive disorders as nutritional implications related to common factors - A comprehensive review. Behav Brain Res 2024; 462:114886. [PMID: 38309373 DOI: 10.1016/j.bbr.2024.114886] [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: 12/14/2023] [Revised: 01/23/2024] [Accepted: 01/27/2024] [Indexed: 02/05/2024]
Abstract
Celiac disease (CD) is an immune-mediated disease affecting the small intestine. The only treatment strategy for CD is the gluten-free diet (GFD). One of the more common mental disorders in CD patients is major depressive disorder (MDD). The influence of GFD on the occurrence of MDD symptoms in patients with CD will be evaluated. This diet often reduces nutritional deficiencies in these patients and also helps to reduce depressive symptoms. Both disease entities are often dominated by the same deficiencies of nutrients such as iron, zinc, selenium, iodine, or B and D vitamins. Deficiencies of particular components in CD can favor MDD and vice versa. Gluten can adversely affect the mental state of patients without CD. Also, intestinal microbiota may play an important role in the described process. This work aims to comprehensively assess the common factors involved in the pathomechanisms of MDD and CD, with particular emphasis on nutrient imbalances. Given the complexity of both disease entities, and the many common links, more research related to improving mental health in these patients and the implementation of a GFD would need to be conducted, but it appears to be a viable pathway to improving the quality of life and health of people struggling with CD and MDD. Therefore, probiotics, micronutrients, macronutrients, and vitamin supplements are recommended to reduce the risk of MDD, given that they may alleviate the symptoms of both these disease entities. In turn, in patients with MDD, it is worth considering testing for CD.
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Affiliation(s)
- Joanna Mikulska
- Chair and Department of Toxicology, Faculty of Pharmacy, Medical University of Lublin, 8 Chodźki Street, 20-093 Lublin, Poland
| | - Diana Pietrzak
- Chair and Department of Toxicology, Faculty of Pharmacy, Medical University of Lublin, 8 Chodźki Street, 20-093 Lublin, Poland
| | - Paweł Rękawek
- Chair and Department of Toxicology, Faculty of Pharmacy, Medical University of Lublin, 8 Chodźki Street, 20-093 Lublin, Poland
| | - Krystian Siudaj
- Chair and Department of Toxicology, Faculty of Pharmacy, Medical University of Lublin, 8 Chodźki Street, 20-093 Lublin, Poland
| | - Łucja Justyna Walczak-Nowicka
- Chair and Department of Toxicology, Faculty of Pharmacy, Medical University of Lublin, 8 Chodźki Street, 20-093 Lublin, Poland.
| | - Mariola Herbet
- Chair and Department of Toxicology, Faculty of Pharmacy, Medical University of Lublin, 8 Chodźki Street, 20-093 Lublin, Poland
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Mohd Salleh Sahimi H, Midin M, Lim JTY, Anwar MWA, Abdul Samad FD, Mohamad Kamal NA. An elderly patient with depression and a suicide attempt during the COVID-19 pandemic: a case report. Front Psychiatry 2023; 14:1151482. [PMID: 37840789 PMCID: PMC10568006 DOI: 10.3389/fpsyt.2023.1151482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 09/04/2023] [Indexed: 10/17/2023] Open
Abstract
Objective Elderly individuals are among the age groups with the highest risk of suicide. The coronavirus (COVID-19) pandemic forced isolation and resulted in an increased risk of depression, hopelessness, and perceived burdensomeness among the elderly, thereby increasing the risk of suicide. Methods This is a case report of an elderly single retired school principal with obsessive-compulsive personality traits who developed depression with psychotic symptoms after being isolated following the movement control order (MCO) during the COVID-19 pandemic. The social isolation led to feelings of loneliness and hopelessness. The patient's depressive symptoms worsened after he developed physical illnesses, such as eye floaters, that affected his daily activities. This caused him to have suicidal ideation to the extent that he attempted suicide by ingesting 90 mL of pesticide. Two weeks prior to the attempt, he updated his will and asked his friend to keep it. After the suicide attempt, he vomited and had diarrhea and epigastric pain. He called his friend, who brought him to the hospital emergency room (ER). He was resuscitated and subsequently admitted to the intensive care unit (ICU). After being medically stabilized, he was transferred to the psychiatric ward, where further treatment was administered for his depression. His depressive symptoms and suicidal ideation improved after he was administered antidepressants and psychotherapy. Results The impact of the COVID pandemic has led to a surge in mental health issues such as anxiety and depression. The elderly are among the highest-risk groups of individuals to contract or die of COVID-19 infection, and they are also the most likely to develop mental health issues related to the pandemic. Furthermore, the risk of death by suicide is highest in this age group due to physical illness, social isolation, and the lack of a support system. This case also highlights the need for awareness of suicidal ideation screening among non-medical healthcare professionals and religious organizations to avoid the treatment gap. Conclusion It is essential to enhance suicide risk assessment and management among the elderly after the COVID-19 pandemic.
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Affiliation(s)
- Hajar Mohd Salleh Sahimi
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Malaysia
- Hospital Canselor Tuanku Muhriz, Bandar Tun Razak, Kuala Lumpur, Malaysia
| | - Marhani Midin
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Malaysia
- Hospital Canselor Tuanku Muhriz, Bandar Tun Razak, Kuala Lumpur, Malaysia
| | - Jane Tze Yn Lim
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Malaysia
- Hospital Canselor Tuanku Muhriz, Bandar Tun Razak, Kuala Lumpur, Malaysia
| | - Mohd Wafiy Ariffin Anwar
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Malaysia
- Hospital Canselor Tuanku Muhriz, Bandar Tun Razak, Kuala Lumpur, Malaysia
| | - Farah Deena Abdul Samad
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Malaysia
- Hospital Canselor Tuanku Muhriz, Bandar Tun Razak, Kuala Lumpur, Malaysia
| | - Nurul Ain Mohamad Kamal
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Malaysia
- Hospital Canselor Tuanku Muhriz, Bandar Tun Razak, Kuala Lumpur, Malaysia
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Schlosser RJ, Dubno JR, Eckert MA, Benitez AM, Gregoski M, Ramakrishnan V, Matthews L, Soler ZM. Unsupervised Clustering of Olfactory Phenotypes. Am J Rhinol Allergy 2022; 36:796-803. [PMID: 35837713 PMCID: PMC10031609 DOI: 10.1177/19458924221114255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Current clinical classifications of olfactory function are based primarily upon a percentage of correct answers in olfactory identification testing. This simple classification provides little insight into etiologies of olfactory loss, associated comorbidities, or impact on the quality of life (QOL). METHODS Community-based subjects underwent olfactory psychophysical testing using Sniffin Sticks to measure threshold (T), discrimination (D), and identification (I). The cognitive screening was performed using Mini-Mental Status Examination (MMSE). Unsupervised clustering was performed based upon T, D, I, and MMSE. Post hoc differences in demographics, comorbidities, and QOL measures were assessed. RESULTS Clustering of 219 subjects, mean age 51 years (range 20-93 years) resulted in 4 unique clusters. Cluster 1 was the largest and predominantly younger normosmics. Cluster 2 had the worst olfaction with impairment in nearly all aspects of olfaction and decreased MMSE scores. This cluster had higher rates of smoking, heart disease, and cancer and had the worst olfactory-specific QOL. Cluster 3 had normal MMSE with relative preservation of D and I, but severely impaired T. This cluster had higher rates of smoking and heart disease with moderately impaired QOL. Cluster 4 was notable for the worst MMSE scores, but general preservation of D and I with moderate loss of T. This cluster had higher rates of Black subjects, diabetes, and viral/traumatic olfactory loss. CONCLUSION Unsupervised clustering based upon detailed olfactory testing and cognitive testing results in clinical phenotypes with unique risk factors and QOL impacts. These clusters may provide additional information regarding etiologies and subsequent therapies to treat olfactory loss.
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Affiliation(s)
- Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, 2345Medical University of South Carolina, Charleston, South Carolina
| | - Judy R Dubno
- Department of Otolaryngology-Head and Neck Surgery, 2345Medical University of South Carolina, Charleston, South Carolina
| | - Mark A Eckert
- Department of Otolaryngology-Head and Neck Surgery, 2345Medical University of South Carolina, Charleston, South Carolina
| | - Andreana M Benitez
- Department of Neurology, 2345Medical University of South Carolina, Charleston, South Carolina
| | - Matthew Gregoski
- Department of Public Health Sciences, 2345Medical University of South Carolina, Charleston, South Carolina
| | - Viswanathan Ramakrishnan
- Department of Public Health Sciences, 2345Medical University of South Carolina, Charleston, South Carolina
| | - Lois Matthews
- Department of Otolaryngology-Head and Neck Surgery, 2345Medical University of South Carolina, Charleston, South Carolina
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, 2345Medical University of South Carolina, Charleston, South Carolina
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Casanova-Muñoz V, Hernández-Ruiz Á, Durantez-Fernández C, López-Mongil R, Niño-Martín V. Descripción y aplicación clínica de las escalas de valoración geriátrica integral: una revisión sistemática rápida de revisiones. Rev Clin Esp 2022. [DOI: 10.1016/j.rce.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Casanova-Muñoz V, Hernández-Ruiz Á, Durantez-Fernández C, López-Mongil R, Niño-Martín V. Description and clinical application of comprehensive geriatric assessment scales: A rapid systematic review of reviews. Rev Clin Esp 2022; 222:417-431. [PMID: 35504782 DOI: 10.1016/j.rceng.2022.01.002] [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: 12/22/2021] [Accepted: 01/26/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This work aims to describe the main scales used in comprehensive geriatric assessment through a narrative analysis detailing their clinical application in relation to their advantages and disadvantages in terms of their psychometric properties (mental assessment) and biases in their application. The scales selected were: Barthel Index, Katz Index, Lawton and Brody Scale, Mini-Mental State Examination, Clock Test, Geriatric Depression Scale, and the Social Resources Scale. METHODS We conducted a rapid systematic review of reviews in MEDLINE (PubMed) up to January 2021, reporting findings using PRISMA, 2020. MeSH language, keywords, and the Boolean operators AND and OR were used to construct the reproducible search strategy. RESULTS Thirty-one works were selected that met the eligibility criteria: 18 systematic reviews, 12 literature reviews, and one scoping review. Multiple versions were found for some of the scales and biases in their interpretation were observed. Short, easy-to-administer questionnaires are recommended and cut-off points should be defined by formal education. CONCLUSION Comprehensive geriatric assessment scales are inexpensive, effective, and useful instruments for identifying problems and potential problems in the elderly. They should be easy to apply, not extensive, valid for multiple cultures and different levels of formal education, and applicable to individuals with different degrees of disability. It is recommended that health professionals be instructed in their use to avoid biases in the interpretation of the results.
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Affiliation(s)
- V Casanova-Muñoz
- Departamento de Enfermería, Universidad de Valladolid, Valladolid, Spain; Unidad de Onco-Hematología, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Á Hernández-Ruiz
- Área de Desarrollo de proyectos científicos, Fundación Iberoamericana de Nutrición (FINUT), Granada, Spain.
| | - C Durantez-Fernández
- Facultad de Ciencias de la Salud, Universidad de Castilla-La Mancha, Talavera de la Reina, Toledo, Spain
| | | | - V Niño-Martín
- Departamento de Enfermería, Universidad de Valladolid, Valladolid, Spain; Grupo de investigación en Cuidados de Enfermería (GICE), Facultad de Enfermería, Universidad de Valladolid, Valladolid, Spain; Gerencia de Atención Primaria Valladolid Este (SACYL), Valladolid, Spain
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Brañez-Condorena A, Soriano-Moreno DR, Navarro-Flores A, Solis-Chimoy B, Diaz-Barrera ME, Taype-Rondan A. Accuracy of the Geriatric Depression Scale (GDS)-4 and GDS-5 for the screening of depression among older adults: A systematic review and meta-analysis. PLoS One 2021; 16:e0253899. [PMID: 34197527 PMCID: PMC8248624 DOI: 10.1371/journal.pone.0253899] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/16/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The Geriatric Depression Scale (GDS) is a widely used instrument to assess depression in older adults. The short GDS versions that have four (GDS-4) and five items (GDS-5) represent alternatives for depression screening in limited-resource settings. However, their accuracy remains uncertain. OBJECTIVE To assess the accuracy of the GDS-4 and GDS-5 versions for depression screening in older adults. METHODS Until May 2020, we systematically searched PubMed, PsycINFO, Scopus, and Google Scholar; for studies that have assessed the sensitivity and specificity of GDS-4 and GDS-5 for depression screening in older adults. We conducted meta-analyses of the sensitivity and specificity of those studies that used the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the International Classification of Diseases-10 (ICD-10) as reference standard. Study quality was assessed with the QUADAS-2 tool. We performed bivariate random-effects meta-analyses to calculate the pooled sensitivity and specificity with their 95% confidence intervals (95% CI) at each reported common cut-off. For the overall meta-analyses, we evaluated each GDS-4 version or GDS-5 version separately by each cut-off, and for investigations of heterogeneity, we assessed altogether across similar GDS versions by each cut-off. Also, we assessed the certainty of evidence using the GRADE methodology. RESULTS Twenty-three studies were included and meta-analyzed, assessing eleven different GDS versions. The number of participants included was 5048. When including all versions together, at a cut-off 2, GDS-4 had a pooled sensitivity of 0.77 (95% CI: 0.70-0.82) and a pooled specificity of 0.75 (0.68-0.81); while GDS-5 had a pooled sensitivity of 0.85 (0.80-0.90) and a pooled specificity of 0.75 (0.69-0.81). We found results for more than one GDS-4 version at cut-off points 1, 2, and 3; and for more than one GDS-5 version at cut-off points 1, 2, 3, and 4. Mostly, significant subgroup differences at different test thresholds across versions were found. The accuracy of the different GDS-4 and GDS-5 versions showed a high heterogeneity. There was high risk of bias in the index test domain. Also, the certainty of the evidence was low or very low for most of the GDS versions. CONCLUSIONS We found several GDS-4 and GDS-5 versions that showed great heterogeneity in estimates of sensitivity and specificity, mostly with a low or very low certainty of the evidence. Altogether, our results indicate the need for more well-designed studies that compare different GDS versions.
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Affiliation(s)
- Ana Brañez-Condorena
- Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Peru
- Asociación para el Desarrollo de la Investigación Estudiantil en Ciencias de la Salud (ADIECS), Lima, Peru
| | - David R. Soriano-Moreno
- Unidad de Investigación Clínica y Epidemiológica, Escuela de Medicina, Universidad Peruana Unión, Lima, Peru
| | | | - Blanca Solis-Chimoy
- Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Peru
- Asociación para el Desarrollo de la Investigación Estudiantil en Ciencias de la Salud (ADIECS), Lima, Peru
| | - Mario E. Diaz-Barrera
- Unidad de Investigación en Bibliometría, Universidad San Ignacio de Loyola, Lima, Peru
- Sociedad Científica de Estudiantes de Medicina de la Universidad Nacional de Trujillo, SOCEMUNT, Trujillo, Peru
| | - Alvaro Taype-Rondan
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
- * E-mail:
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Dong M, Zeng LN, Zhang Q, Ungvari GS, Ng CH, Chiu HFK, Si TM, Sim K, Avasthi A, Grover S, Chong MY, Chee KY, Kanba S, Lee MS, Yang SY, Udomratn P, Kallivayalil RA, Tanra AJ, Maramis MM, Shen WW, Sartorius N, Mahendran R, Tan CH, Shinfuku N, Xiang YT. Concurrent antipsychotic use in older adults treated with antidepressants in Asia. Psychogeriatrics 2019; 19:333-339. [PMID: 30734411 DOI: 10.1111/psyg.12416] [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: 07/22/2018] [Revised: 10/15/2018] [Accepted: 12/24/2018] [Indexed: 12/23/2022]
Abstract
AIM Depressive disorders are common in old age. Antipsychotics (APs) are often used as an adjunctive treatment with antidepressants (ADs) in this population but its patterns of use in Asia are not known. This study explored the rate of combination of APs and ADs in older adult psychiatric patients in Asia. METHODS This is a secondary analysis of the database of a multicentre study which recorded participants' basic demographical and clinical data in standardised format in 10 Asian countries and territories. The data were analysed using univariate and multivariate logistic regression analyses. RESULTS A total of 955 older adult psychiatric in- and outpatients were included in this study. The proportion of concurrent AP and AD use was 32.0%, ranging from 23.3% in Korea to 44.0% in Taiwan. Multivariate logistic regression analysis found that younger age, inpatient status and diagnosis of schizophrenia, anxiety and other mental disorders were significantly related to a higher proportion of concurrent use of APs and ADs. CONCLUSION Around a third of older adult psychiatric patients had concurrent AP and AD use in the Asian countries/regions surveyed. Considering the uncertain effectiveness and questionable safety of the AP and AD combination in this patient population, such should be cautiously used.
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Affiliation(s)
- Min Dong
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Liang-Nan Zeng
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Qinge Zhang
- The National Clinical Research Center for Mental Disorders, China & Center of Depression, Beijing Institute for Brain Disorders & Mood Disorders Center, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Gabor S Ungvari
- University of Notre Dame Australia, Fremantle, Australia.,Division of Psychiatry, School Medicine, University of Western Australia, Perth, Australia
| | - Chee H Ng
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - Helen F K Chiu
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China
| | - Tian-Mei Si
- Peking University Institute of Mental Health (the sixth Hospital) & National Clinical Research Center for Mental Disorders & the key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Kang Sim
- Institute of Mental Health, Singapore, Singapore
| | - Ajit Avasthi
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Mian-Yoon Chong
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi & Chang Gung University, Taoyuan, Taiwan
| | - Kok-Yoon Chee
- Department of Psychiatry & Mental Health, Tunku Abdul Rahman Institute of Neurosciences, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | - Shigenobu Kanba
- Department of Neuropsychiatry, Kyushu University, Fukuoka, Japan
| | - Min-Soo Lee
- Department of Psychiatry, College of Medicine, Korea University, Seoul, Korea
| | - Shu-Yu Yang
- Department of Pharmacy, Songde Branch, Taipei City Hospital, & College of Medicine, Fu Jen Catholic University, Taipei, Taiwan
| | - Pichet Udomratn
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Roy A Kallivayalil
- Department of Psychiatry, Pushpagiri Institute of Medical Sciences, Thiruvalla, India
| | - Andi J Tanra
- Department of Psychiatry, Hasanuddin University Faculty of Medicine, Makassar, Indonesia
| | - Margarita M Maramis
- Dr. Soetomo Hospital - Faculty of Medicine, Airlangga University, Surabaya, Jawa Timur, Indonesia
| | - Winston W Shen
- Departments of Psychiatry, TMU-Wan Fang Medical Center and School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes, Geneva, Switzerland
| | - Rathi Mahendran
- Department of Psychological Medicine, National University of Singapore, Singapore, Singapore
| | - Chay-Hoon Tan
- Department of Pharmacology, National University of Singapore, Singapore, Singapore
| | - Naotaka Shinfuku
- International Center for Medical Research, Kobe University School of Medicine, Kobe, Japan
| | - Yu-Tao Xiang
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
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Gilmer TP, Celli BR, Xu Z, Cho-Reyes S, Dembek C, Navaie M. Predictors of Nebulized Arformoterol Treatment: A Retrospective Analysis of Medicare Beneficiaries with Chronic Obstructive Pulmonary Disease*. COPD 2019; 16:140-151. [DOI: 10.1080/15412555.2019.1618256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Todd P. Gilmer
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - Bartolome R. Celli
- Harvard Medical School, Boston, MA, USA
- Chronic Obstructive Pulmonary Disease Center, Brigham and Women’s Hospital, Boston, MA, USA
| | - Zhun Xu
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | | | - Carole Dembek
- Global Health Economics and Outcomes Research, Sunovion Pharmaceuticals Inc., Marlborough, MA, USA
| | - Maryam Navaie
- Advance Health Solutions, LLC, New York, NY, USA
- School of Professional Studies, Columbia University, New York, NY, USA
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Celli BR, Navaie M, Xu Z, Cho-Reyes S, Dembek C, Gilmer TP. Medication management patterns among Medicare beneficiaries with chronic obstructive pulmonary disease who initiate nebulized arformoterol treatment. Int J Chron Obstruct Pulmon Dis 2019; 14:1019-1031. [PMID: 31190787 PMCID: PMC6526678 DOI: 10.2147/copd.s199251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 04/25/2019] [Indexed: 12/22/2022] Open
Abstract
Purpose: Global evidence-based treatment strategies for chronic obstructive pulmonary disease (COPD) recommend using long-acting bronchodilators (LABDs) as maintenance therapy. However, COPD patients are often undertreated. We examined COPD treatment patterns among Medicare beneficiaries who initiated arformoterol tartrate, a nebulized long-acting beta2 agonist (LABA), and identified the predictors of initiation. Methods: Using a 100% sample of Medicare administrative data, we identified beneficiaries with a COPD diagnosis (ICD-9 490-492.xx, 494.xx, 496.xx) between 2010 and 2014 who had ≥1 year of continuous enrollment in Parts A, B, and D, and ≥2 COPD-related outpatient visits within 30 days or ≥1 hospitalization(s). After applying inclusion/exclusion criteria, three cohorts were identified: (1) study group beneficiaries who received nebulized arformoterol (n=11,886), (2) a subset of the study group with no LABD use 90 days prior to initiating arformoterol (n=5,542), and (3) control group beneficiaries with no nebulized LABA use (n=220,429). Logistic regression was used to evaluate predictors of arformoterol initiation. Odds ratios (ORs), 95% confidence intervals (CIs), and p values were computed. Results: Among arformoterol users, 47% (n=5,542) had received no LABDs 90 days prior to initiating arformoterol. These beneficiaries were being treated with a nebulized (50%) or inhaled (37%) short-acting bronchodilator or a systemic corticosteroid (46%), and many received antibiotics (37%). Compared to controls, beneficiaries who initiated arformoterol were significantly more likely to have had an exacerbation, a COPD-related hospitalization, and a pulmonologist or respiratory therapist visit prior to initiation (all p<0.05). Beneficiaries with moderate/severe psychiatric comorbidity or dual-eligible status were significantly less likely to initiate arformoterol, as compared to controls (all p<0.05). Conclusion: Medicare beneficiaries who initiated nebulized arformoterol therapy had more exacerbations and hospitalizations than controls 90 days prior to initiation. Findings revealed inadequate use of maintenance medications, suggesting a lack of compliance with evidence-based treatment guidelines.
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Affiliation(s)
- Bartolome R Celli
- Chronic Obstructive Pulmonary Disease Center, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA, USA
| | - Maryam Navaie
- Global Strategy, Advance Health Solutions, LLC, New York, NY, USA
- School of Professional Studies, Columbia University, New York, NY, USA
| | - Zhun Xu
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - Soojin Cho-Reyes
- Global Strategy, Advance Health Solutions, LLC, New York, NY, USA
| | - Carole Dembek
- Global Health Economics and Outcomes Research, Sunovion Pharmaceuticals Inc, Marlborough, MA, USA
| | - Todd P Gilmer
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
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Brooks SE, Burruss SK, Mukherjee K. Suicide in the Elderly: A Multidisciplinary Approach to Prevention. Clin Geriatr Med 2018; 35:133-145. [PMID: 30390980 DOI: 10.1016/j.cger.2018.08.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Suicide in the elderly is a growing problem. The elderly population is increasing, and elderly patients have multiple issues that place them at higher risk of suicidality. These issues include physical illnesses, mental illness, loss of functional status, isolation, and family, financial, and social factors. Access to firearms is another significant risk factor, because elderly patients are more likely to use firearms in suicide attempts; interventions to reduce firearms mortality may save lives. Tackling the difficult problem of suicide in the elderly may require a multidisciplinary, community-based series of interventions.
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Affiliation(s)
- Steven E Brooks
- Division of Trauma and Surgical Critical Care, Texas Tech University Health Sciences Center, 3601 4th Street MS 8312, Lubbock, TX 79430, USA
| | - Sigrid K Burruss
- Division of Acute Care Surgery, Loma Linda University Medical Center, 11175 Campus Street, CP 21109, Loma Linda, CA 92350, USA
| | - Kaushik Mukherjee
- Division of Acute Care Surgery, Loma Linda University Medical Center, 11175 Campus Street, CP 21109, Loma Linda, CA 92350, USA.
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Bessey LJ, Radue RM, Chapman EN, Boyle LL, Shah MN. Behavioral Health Needs of Older Adults in the Emergency Department. Clin Geriatr Med 2018; 34:469-489. [PMID: 30031428 DOI: 10.1016/j.cger.2018.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Behavioral health disorders are common among older adults and, owing to limited access to resources for mental health care in the community, emergency department providers are often on the front lines of mental health crises. This article reviews the available literature regarding the care of behavioral health emergencies in older adults and provides a framework for navigating the evaluation and management of older adults presenting to the emergency department with behavioral health concerns.
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Affiliation(s)
- Laurel J Bessey
- Department of Psychiatry, University of Wisconsin Hospital and Clinics, 600 Highland Avenue, Madison, WI 53792, USA
| | - Rebecca M Radue
- Department of Psychiatry, University of Wisconsin Hospital and Clinics, 600 Highland Avenue, Madison, WI 53792, USA
| | - Elizabeth N Chapman
- Department of Medicine, Division of Geriatrics, William S. Middleton Memorial VA Hospital, Geriatrics Research Education and Clinical Center, University of Wisconsin School of Medicine and Public Health, 2500 Overlook Terrace, Madison, WI 53705, USA
| | - Lisa L Boyle
- Department of Psychiatry, William S. Middleton Memorial VA Hospital, University of Wisconsin School of Medicine and Public Health, 2500 Overlook Terrace, Box 116A, Madison, WI 53705, USA.
| | - Manish N Shah
- Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive, Suite 310, MC9123, Madison, WI 53705, USA
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Fulone I, Lopes LC. Potentially inappropriate prescriptions for elderly people taking antidepressant: comparative tools. BMC Geriatr 2017; 17:278. [PMID: 29197326 PMCID: PMC5712132 DOI: 10.1186/s12877-017-0674-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 11/23/2017] [Indexed: 12/28/2022] Open
Abstract
Background The use of psychotropic drugs by elderly people is widely spread around the world, given that prevalence of inappropriate medication is frequent. Strictly speaking, in Brazil, the vulnerable population of elderly people is more likely to use Potentially Inappropriate Psychotropic (PIP) due to the impact of social-economic characteristics, to the Brazilian Public Health System, and to the lack of patient monitoring. However, neither the use pattern nor the prevalence rate of PIP have been studied in Brazil so far. The objectives of this study were to determine the prevalence of PIP in elderly outpatients taking antidepressants, and to compare the performance of two different tools (Beers, STOPP). Methods This cross-sectional study involved all the aged outpatients (≥ 60 years of age) taking antidepressants attended by the public health system in a city of the State of São Paulo, Brazil. Data were obtained from a pharmacy database and medical records. All psychotropic drugs evaluated included: antidepressants, antipsychotics, anti-epileptics and benzodiazepines. STOPP and Beers criteria were applied to detect PIP. Results One thousand one hundred forty prescriptions from 174 outpatients were subjected to two different screening tools. The average patient age was 67 (interquartile range 63–74) and the median number of drugs used was 3.0 (interquartile 2–4) per patient. The overall prevalence of PIP was 121 (69.5%). The levels of PIP observed according to tools were 39.6% (STOPP) and 29.9% (Beers).The long-term use of benzodiazepines was the most common PIP recognized, and the one which contributed more significantly to higher levels of PIP than other medications. Conclusions The prevalence of PIP was high among the elderly. STOPP criteria identified more PIP than Beers criteria. Knowledge of PIP prevalence should gear efforts to reduce the level of inappropriate prescriptions and may provide the need for developing national criteria.
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Affiliation(s)
- Izabela Fulone
- Pharmaceutical Sciences Post graduate Course, University of Sorocaba, UNISO, Rodovia Raposo Tavares, KM 92,5, Sorocaba, São Paulo, ZIP Code 18023-000, Brazil
| | - Luciane Cruz Lopes
- Pharmaceutical Sciences Post graduate Course, University of Sorocaba, UNISO, Rodovia Raposo Tavares, KM 92,5, Sorocaba, São Paulo, ZIP Code 18023-000, Brazil.
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