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Lio G, Ghazzai M, Haesebaert F, Dubreucq J, Verdoux H, Quiles C, Jaafari N, Chéreau-Boudet I, Legros-Lafarge E, Guillard-Bouhet N, Massoubre C, Gouache B, Plasse J, Barbalat G, Franck N, Demily C. Actionable Predictive Factors of Homelessness in a Psychiatric Population: Results from the REHABase Cohort Using a Machine Learning Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12268. [PMID: 36231571 PMCID: PMC9565981 DOI: 10.3390/ijerph191912268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND There is a lack of knowledge regarding the actionable key predictive factors of homelessness in psychiatric populations. Therefore, we used a machine learning model to explore the REHABase database (for rehabilitation database-n = 3416), which is a cohort of users referred to French psychosocial rehabilitation centers in France. METHODS First, we analyzed whether the different risk factors previously associated with homelessness in mental health were also significant risk factors in the REHABase. In the second step, we used unbiased classification and regression trees to determine the key predictors of homelessness. Post hoc analyses were performed to examine the importance of the predictors and to explore the impact of cognitive factors among the participants. RESULTS First, risk factors that were previously found to be associated with homelessness were also significant risk factors in the REHABase. Among all the variables studied with a machine learning approach, the most robust variable in terms of predictive value was the nature of the psychotropic medication (sex/sex relative mean predictor importance: 22.8, σ = 3.4). Post hoc analyses revealed that first-generation antipsychotics (15.61%; p < 0.05 FDR corrected), loxapine (16.57%; p < 0.05 FWER corrected) and hypnotics (17.56%; p < 0.05 FWER corrected) were significantly associated with homelessness. Antidepressant medication was associated with a protective effect against housing deprivation (9.21%; p < 0.05 FWER corrected). CONCLUSIONS Psychotropic medication was found to be an important predictor of homelessness in our REHABase cohort, particularly loxapine and hypnotics. On the other hand, the putative protective effect of antidepressants confirms the need for systematic screening of depression and anxiety in the homeless population.
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Affiliation(s)
- Guillaume Lio
- Centre d’Excellence Autisme iMIND, pôle HU-ADIS, Hôpital le Vinatier, 69678 Bron, France
- Equipe «Disorders of the Brain», Institut Marc Jeannerod, UMR 5229, CNRS & Université Lyon 1, 69100 Villeurbanne, France
| | - Malek Ghazzai
- Centre d’Excellence Autisme iMIND, pôle HU-ADIS, Hôpital le Vinatier, 69678 Bron, France
| | | | - Julien Dubreucq
- Centre Hospitalier Universitaire de Saint-Etienne, 42270 Saint-Priest-en-Jarez, France
| | - Hélène Verdoux
- Hôpital Charles Perrens, Université de Bordeaux, 33405 Talence, France
| | - Clélia Quiles
- Hôpital Charles Perrens, Université de Bordeaux, 33405 Talence, France
| | - Nemat Jaafari
- CREATIV & URC Pierre Deniker, Centre Hospitalier Laborit, Université de Poitiers, 86000 Poitiers, France
| | - Isabelle Chéreau-Boudet
- Centre Référent Conjoint de Réhabilitation (CRCR), Centre Hospitalier Universitaire de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Emilie Legros-Lafarge
- Centre Référent de Réhabilitation Psychosociale de Limoges (C2RL), 87000 Limoges, France
| | | | - Catherine Massoubre
- Centre Hospitalier Universitaire de Saint-Etienne, 42270 Saint-Priest-en-Jarez, France
- Faculté de Médecine, Université de Saint-Etienne, 42023 Saint-Etienne, France
| | | | - Julien Plasse
- Pôle Centre Rive Gauche, Hôpital Le Vinatier, 69678 Bron, France
- Centre Ressource de Réhabilitation Psychosociale et de Remédiation Cognitive (CRR), CH le Vinatier et Institut Marc Jeannerod, UMR 5229 & Université Lyon 1, 69100 Bron, France
| | - Guillaume Barbalat
- Pôle Centre Rive Gauche, Hôpital Le Vinatier, 69678 Bron, France
- Centre Ressource de Réhabilitation Psychosociale et de Remédiation Cognitive (CRR), CH le Vinatier et Institut Marc Jeannerod, UMR 5229 & Université Lyon 1, 69100 Bron, France
| | - Nicolas Franck
- Pôle Centre Rive Gauche, Hôpital Le Vinatier, 69678 Bron, France
- Centre Ressource de Réhabilitation Psychosociale et de Remédiation Cognitive (CRR), CH le Vinatier et Institut Marc Jeannerod, UMR 5229 & Université Lyon 1, 69100 Bron, France
| | - Caroline Demily
- Centre d’Excellence Autisme iMIND, pôle HU-ADIS, Hôpital le Vinatier, 69678 Bron, France
- Equipe «Disorders of the Brain», Institut Marc Jeannerod, UMR 5229, CNRS & Université Lyon 1, 69100 Villeurbanne, France
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Ferrer M, Soto-Angona Ó, Soler-Artigas M, Ibáñez P, Fadeuilhe C, Palma-Álvarez RF, Lidai R, Vargas-Cáceres S, Ángeles Torrecilla M, López A, Ramos-Quiroga JA. Inhaled Loxapine as a Rapid Treatment for Agitation in Patients with Personality Disorder: A Prospective Study on the Effects of Time. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2022; 20:482-490. [PMID: 35879032 PMCID: PMC9329112 DOI: 10.9758/cpn.2022.20.3.482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/26/2021] [Accepted: 06/01/2021] [Indexed: 11/18/2022]
Abstract
Objective Agitation in patients diagnosed with personality disorders (PD) is one of the most frequent crises in emergency departments (ED). Although many medications have been tested, their effectiveness has been small or non-significant, and no specific drugs are supported by the available evidence. This study aimed to evaluate the efficacy of Inhaled loxapine (IL) as a therapeutic option for agitated patients with PD. Methods A naturalistic, unicentric, prospective study was carried out. Thirty subjects diagnosed with PD and attending the ED with episodes of agitation were recruited most of whom were women diagnosed with Borderline Personality Disorder. Subjects were treated with a single dose of IL (9.1 mg). Efficacy was assessed with the Clinical Global Impression scale, the Excited Component of the Positive and Negative Syndrome Scale (PANSS-EC) and the Agitation-Calmness Evaluation Scale (ACES). Patients were followed 60 minutes after administration to measure IL effect and its duration. Results IL exhibited an overall efficacy in managing mild to severe agitation, with a quick onset of effect and persistence. ‘Effect of time’, where IL efficacy is maintained over time, is more marked in higher-severity agitation. No additional treatments were needed to improve agitation during the follow-up time. Conclusion Results suggest that IL could be a safe and effective option to manage agitation in PD.
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Affiliation(s)
- Marc Ferrer
- Department of Psychiatry, Hospital Universitari Vall d’Hebron, Barcelona, Catalonia, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Catalonia, Spain
- Group of Psychiatry, Mental Health and Addiction, Vall d’Hebron Research Institute (VHIR), Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Óscar Soto-Angona
- Department of Psychiatry, Hospital Universitari Vall d’Hebron, Barcelona, Catalonia, Spain
| | - María Soler-Artigas
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Catalonia, Spain
- Group of Psychiatry, Mental Health and Addiction, Vall d’Hebron Research Institute (VHIR), Barcelona, Spain
- Department of Genetics, Microbiology and Statistics, Faculty of Biology, Universitat de Barcelona, Barcelona, Spain
| | - Pol Ibáñez
- Group of Psychiatry, Mental Health and Addiction, Vall d’Hebron Research Institute (VHIR), Barcelona, Spain
| | - Christian Fadeuilhe
- Department of Psychiatry, Hospital Universitari Vall d’Hebron, Barcelona, Catalonia, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Catalonia, Spain
- Group of Psychiatry, Mental Health and Addiction, Vall d’Hebron Research Institute (VHIR), Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Raúl Felipe Palma-Álvarez
- Department of Psychiatry, Hospital Universitari Vall d’Hebron, Barcelona, Catalonia, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Catalonia, Spain
- Group of Psychiatry, Mental Health and Addiction, Vall d’Hebron Research Institute (VHIR), Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Raquefet Lidai
- Department of Psychiatry, Hospital Universitari Vall d’Hebron, Barcelona, Catalonia, Spain
| | | | | | - Anna López
- Department of Psychiatry, Hospital Universitari Vall d’Hebron, Barcelona, Catalonia, Spain
| | - Josep Antoni Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d’Hebron, Barcelona, Catalonia, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Catalonia, Spain
- Group of Psychiatry, Mental Health and Addiction, Vall d’Hebron Research Institute (VHIR), Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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Épisodes d’agitation et d’hallucinations dans les suites d’une intoxication aux tricycliques : à partir de deux cas cliniques. Therapie 2020; 75:311-314. [DOI: 10.1016/j.therap.2019.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/08/2019] [Accepted: 03/15/2019] [Indexed: 11/21/2022]
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Pacciardi B, Calcedo A, Messer T. Inhaled Loxapine for the Management of Acute Agitation in Bipolar Disorder and Schizophrenia: Expert Review and Commentary in an Era of Change. Drugs R D 2019; 19:15-25. [PMID: 30721526 PMCID: PMC6380965 DOI: 10.1007/s40268-019-0262-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Agitation is a common and costly phenomenon associated with a number of psychiatric conditions including schizophrenia and bipolar disorder. Early identification and prompt intervention to relieve the symptoms of agitation are essential to avoid symptomatic escalation and emergence of aggressive behaviour. Recent consensus guidelines emphasise the need for non-coercive management strategies to protect the therapeutic alliance between patients and their healthcare providers—an alliance that is critical for the effective management of chronic psychiatric conditions. Rapid symptom relief and de-escalation of agitation are necessary to avoid the costly and traumatic use of coercive techniques of physical restraint and seclusion, which require admission and prolonged hospitalisation. Inhaled loxapine is approved for the treatment of acute agitation in patients with schizophrenia or bipolar disorder. Clinical studies have confirmed the efficacy, rapid onset of action, and safety and tolerability of this agent in the psychiatric emergency and hospital settings. Emerging data have indicated the potential for inhaled loxapine as a self-administered agent for use in the community setting without the direct supervision of a healthcare professional. We discuss the evolving treatment paradigm and the place of inhaled medications for acutely agitated patients both within and outside the emergency and hospital setting.
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Affiliation(s)
| | - Alfredo Calcedo
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Thomas Messer
- Danuvius Klinik GmbH, Pfaffenhofen an Der Ilm, Germany
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Patrizi B, Navarro-Haro MV, Gasol M. Inhaled loxapine for agitation in patients with personality disorder: an initial approach. Eur Neuropsychopharmacol 2019; 29:122-126. [PMID: 30497838 DOI: 10.1016/j.euroneuro.2018.10.009] [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: 05/15/2018] [Revised: 09/12/2018] [Accepted: 10/23/2018] [Indexed: 12/22/2022]
Abstract
Inhaled Loxapine (IL) has demonstrated efficacy in the treatment of agitation in schizophrenic and bipolar patients, although data in patients with Personality Disorder (PD) are scarce. To evaluate the effectiveness and safety of IL in the treatment of agitation in PD, data from 41 patients who presented at our unit with acute agitation and were treated with 9.1 mg of IL were collected retrospectively. The results showed that IL significantly decreased agitation within 10 minutes and its effect was greater at 20 minutes (Positive and Negative Syndrome Scale-excited component: from 22.78 ± 4.39 at baseline to 11.14 ± 4.17 at 20 minutes; p < 0.001; Agitation and Calmness Evaluation Scale: from 1.80 ± 0.49 at baseline to 4.53 ± 1.05 at 20 minutes; p < 0.01) without any severe adverse reactions registered. IL led to fast, safe and well-tolerated control of agitation in patients with PD.
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Affiliation(s)
- Barbara Patrizi
- Psychotherapy Center Barcelona (Mental Health Center Dreta de l'Eixample), Barcelona, Spain.
| | - María V Navarro-Haro
- Unit Of Borderline Disorder Personality Disorder, General Hospital Of Catalunya, Sant Cugat del Valles, Barcelona, Spain
| | - Miquel Gasol
- Unit Of Borderline Disorder Personality Disorder, General Hospital Of Catalunya, Sant Cugat del Valles, Barcelona, Spain
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Rolland B, Fovet T, Poissy J, Eichholtzer C, Lesage M, Thomas P, Jourdain M. Evaluation by undergraduate medical students of a role-playing training program on the management of acute states of agitation. Encephale 2017; 44:101-105. [PMID: 29275981 DOI: 10.1016/j.encep.2017.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 09/19/2017] [Accepted: 09/26/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Acute states of agitation (ASAs) are frequent in daily medical practice. However, training on real ASAs raises technical and ethical issues, whereas lecture-based teaching hardly addresses some educational objectives, e.g., improving relational skills and team-based coordination. Simulation-based medical education (SBME) is a promising medium to train students on managing ASAs. We have recently implemented a role-playing training module on ASAs. In this scenario, four to five students play the role of the staff, while a trained professional actor plays the agitated patient. A subsequent standardized debriefing is conducted by a senior psychiatrist. A first wave of 219 students participated in a one-session training of this ASA module in June 2015. They completed pre-session and post-session questionnaires aiming to collect "proof-of-concept" data. METHODS The pre-session questionnaire investigated: previous experience of ASA among students during their clinical training; previous participation in a role-playing SBME; and perceived knowledge of the good practice rules for managing ASAs. The post-session questionnaire investigated among the students if: they thought having been able to appropriately manage the simulated ASA; they found the SBME medium more fitted for training than real situations; they found that the SBME session faithfully reproduced a real ASA; and the session was found useful for transmitting the skills on correct management of ASA. The average level of stress induced by the training was assessed using a numerical rating scale (0-10). RESULTS Two hundred and six of the 219 students completed the pre-session questionnaire (63% females; response rate 96.7%). A hundred and thirty four students played the scenario and completed the post-session questionnaire (65.7% females; response rate 100%). 38.3% of the responders reported having previously experienced a situation of ASA in their practice, and 31.1% deemed to know the good practices rules for managing an ASA. In post-session, 29.9% of the participants considered that they appropriately managed the ASA, 79.9% deemed that the role-playing session faithfully reproduced a real ASA, and 97% deemed that this SBME was more fitted and useful than a real clinical situation to improve their medical skills. Bivariate analyses revealed that the post-session responses and level of stress were not influenced by previous experience on ASA, previous participation in a SBME role-playing session, or thinking to know the rules for managing ASAs. CONCLUSION SBME role-playing training appears a promising, realistic, and well-accepted method for teaching the management of ASA.
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Affiliation(s)
- B Rolland
- CHU Lille, pôle de psychiatrie, université de Lille, 59000 Lille, France; Centre de simulation PRESAGE, faculté de médecine de Lille, université de Lille, 59000 Lille, France
| | - T Fovet
- CHU Lille, pôle de psychiatrie, université de Lille, 59000 Lille, France; Centre de simulation PRESAGE, faculté de médecine de Lille, université de Lille, 59000 Lille, France
| | - J Poissy
- Centre de simulation PRESAGE, faculté de médecine de Lille, université de Lille, 59000 Lille, France; Service de réanimation médicale, université de Lille, CHU de Lille, 59000 Lille, France
| | - C Eichholtzer
- CHU Lille, pôle de psychiatrie, université de Lille, 59000 Lille, France; Centre de simulation PRESAGE, faculté de médecine de Lille, université de Lille, 59000 Lille, France
| | - M Lesage
- CHU Lille, pôle de psychiatrie, université de Lille, 59000 Lille, France; Centre de simulation PRESAGE, faculté de médecine de Lille, université de Lille, 59000 Lille, France
| | - P Thomas
- CHU Lille, pôle de psychiatrie, université de Lille, 59000 Lille, France
| | - M Jourdain
- Centre de simulation PRESAGE, faculté de médecine de Lille, université de Lille, 59000 Lille, France; Service de réanimation médicale, université de Lille, CHU de Lille, 59000 Lille, France.
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7
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Antipsychotiques : quand et comment les prescrire ? Rev Med Interne 2017; 38:328-336. [DOI: 10.1016/j.revmed.2016.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 12/17/2016] [Indexed: 11/23/2022]
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Jarzebowski W, Donatio C, Nouhaud C, Magny E, Lafuente-Lafuente C, Belmin J. [Drug treatment of agitation in emergency departments: The case of elderly persons. Letter to the article: "Drug management of agitation in emergency departments: Theoretical recommendations and studies of practices"]. Presse Med 2015; 44:1211-2. [PMID: 26482916 DOI: 10.1016/j.lpm.2015.05.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 05/27/2015] [Indexed: 10/22/2022] Open
Affiliation(s)
- Witold Jarzebowski
- Hôpital universitaire Charles-Foix, service de gériatrie à orientation cardiovasculaire et neuropsychogériatrique, 7, avenue de la République, 94200 Ivry-sur-Seine, France
| | - Cristiano Donatio
- Hôpital universitaire Charles-Foix, service de gériatrie à orientation cardiovasculaire et neuropsychogériatrique, 7, avenue de la République, 94200 Ivry-sur-Seine, France
| | - Charlotte Nouhaud
- Hôpital universitaire Charles-Foix, service de gériatrie à orientation cardiovasculaire et neuropsychogériatrique, 7, avenue de la République, 94200 Ivry-sur-Seine, France; Université Pierre-et-Marie-Curie, 4, place Jussieu, 75005 Paris, France
| | - Emmanuelle Magny
- Hôpital universitaire Charles-Foix, service de gériatrie à orientation cardiovasculaire et neuropsychogériatrique, 7, avenue de la République, 94200 Ivry-sur-Seine, France; Université Pierre-et-Marie-Curie, 4, place Jussieu, 75005 Paris, France
| | - Carmelo Lafuente-Lafuente
- Hôpital universitaire Charles-Foix, service de gériatrie à orientation cardiovasculaire et neuropsychogériatrique, 7, avenue de la République, 94200 Ivry-sur-Seine, France; Université Pierre-et-Marie-Curie, 4, place Jussieu, 75005 Paris, France
| | - Joël Belmin
- Hôpital universitaire Charles-Foix, service de gériatrie à orientation cardiovasculaire et neuropsychogériatrique, 7, avenue de la République, 94200 Ivry-sur-Seine, France; Université Pierre-et-Marie-Curie, 4, place Jussieu, 75005 Paris, France.
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Braillon A. [Nicotine replacement therapy for agitation in the emergency department. Letter on the article "Drug management of agitation in emergency departments: Theoretical recommendations and studies of practices"]. Presse Med 2015; 44:578-9. [PMID: 25753960 DOI: 10.1016/j.lpm.2015.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 02/04/2015] [Indexed: 11/25/2022] Open
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Horn M, Vaiva G, Dumais A. [Drug management of agitation in emergency departments: The need of new assessments. Author's response to the letter on the article]. Presse Med 2015; 44:579-80. [PMID: 25753959 DOI: 10.1016/j.lpm.2015.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Mathilde Horn
- Centre hospitalier universitaire de Lille, université Lille Nord-de-France, 59037 Lille, France; Université de Montréal, institut Philippe-Pinel de Montréal, institut universitaire en santé mentale de Montréal, Montréal, Canada.
| | - Guillaume Vaiva
- Centre hospitalier universitaire de Lille, université Lille Nord-de-France, 59037 Lille, France
| | - Alexandre Dumais
- Université de Montréal, institut Philippe-Pinel de Montréal, institut universitaire en santé mentale de Montréal, Montréal, Canada
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