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David MS, Jones J, Lauriello A, Nnake I, Plazas Montana M, Lasko K, Buri-Nagua C, Olagbaju Y, Williams E, Sears M, Salzberg B, Lanzkron SM, Carroll CP. Converting adults with sickle cell disease from full agonist opioids to buprenorphine: A reliable method with safety and early evidence of reduced acute care utilization. Am J Hematol 2022; 97:1435-1442. [PMID: 36053825 DOI: 10.1002/ajh.26699] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 07/21/2022] [Accepted: 08/13/2022] [Indexed: 01/28/2023]
Abstract
Buprenorphine, a novel opioid with complex pharmacology, is effective for treating pain and is qualitatively safer than high-dose full agonist opioid therapy; but transitioning to buprenorphine can be technically complex and carries some risk of precipitated withdrawal. We report our clinic's experience converting 36 patients with sickle cell disease (SCD) from full agonist opioids to buprenorphine using a method developed in the past 10 years. Thirty of these patients were induced using a standard outpatient protocol and six were induced during medical admissions. Typically, patients were on high-dose chronic opioid therapy (COT) with inadequate response, and often with very high acute care utilization. Unlike prior case series, the method of induction, dosing, and management of withdrawal are detailed, as are post-induction adverse events. There were seven adverse events in the first 3 days following standard induction, and two of which were judged to be definitely related to the induction but none with any lasting sequelae. At 6 months follow-up, five participants had discontinued buprenorphine (16.67%), and overall acute care visits dropped from a mean of 10.50 (SD 11.35) in the 6 months pre-induction to 2.89 (SD 3.40) in the 6 months post-induction. In an appropriately interdisciplinary care setting, buprenorphine shows promise as a safe alternative to COT with early evidence of benefit for high-utilizing patients with SCD.
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Affiliation(s)
- Mandy S David
- Department of Medicine, Division of Hematology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jennifer Jones
- Department of Medicine, Division of Hematology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ashley Lauriello
- Department of Medicine, Division of Hematology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ijeoma Nnake
- Department of Medicine, Division of Hematology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Manuela Plazas Montana
- Department of Medicine, Division of Hematology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kyra Lasko
- Department of Emergency Medicine, University of Maryland Medical System, Baltimore, Maryland, USA
| | | | - Yetunde Olagbaju
- Department of Medicine, Division of Hematology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Elizabeth Williams
- Department of Medicine, Division of Hematology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Matthew Sears
- Department of Medicine, Division of Hematology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Sophie M Lanzkron
- Department of Medicine, Division of Hematology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - C Patrick Carroll
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Karatas KS, Bahceci I, Telatar TG, Bahceci B, Hocaoglu C. Relationship between disease and disease severity and semaphorin 5A and hemogram level in obsessive-compulsive disorder. Nord J Psychiatry 2021; 75:509-515. [PMID: 33771090 DOI: 10.1080/08039488.2021.1896779] [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] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Semaphorin 5A (SEMA 5A) is a neuroprotein that regulates the formation of excitatory synapses between neurons, important in autoimmunity, inflammatory processes and behaviors. This study aimed to investigate the SEMA 5A levels in patients with obsessive-compulsive disorder (OCD) diagnosed for the first time and evaluate the relationship of disease and disease severity with the blood SEMA 5A level and hemogram. METHODS More than 41,465 patients who applied to the psychiatry clinic from January 2018 to December 2020 were evaluated according to the DSM-5 criteria; 57 patients diagnosed with OCD for the first time, who met the inclusion criteria, were included in the study. Disease severity was investigated administering the Yale Brown Obsessive Compulsion Scale. The peripheral blood SEMA 5A level and hemogram were measured and evaluated in relation to platelet (PLT) activity, neutrophil-lymphocyte ratio (NLR), PLT-lymphocyte ratio (PLR), monocyte-lymphocyte ratio (MLR), C-reactive protein (CRP), and compared with control group of 26 people. RESULTS The comparison of the groups revealed a significant difference in SEMA 5A and CRP level, neutrophil count and percentage, lymphocyte count, PLT activity. A significant correlation was found between disease and SEMA 5A level, NLR, PLR, and PLT parameters in diagnosis of OCD. As the severity of OCD increased, the SEMA 5A level and PLT count decreased, while the PDW and MLR values increased. CONCLUSION In patients with OCD, a relationship was found between plasma SEMA 5A, PLT activity, NLR, PLR, and MLR activity levels with disease and the disease severity.
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Affiliation(s)
- Kader Semra Karatas
- Psychiatry Department, Recep Tayyip Erdoğan University Medical School, Rize, Turkey
| | - Ilkay Bahceci
- Medical Microbiology and Clinical Microbiology Department, Recep Tayyip Erdoğan University Medical School, Rize, Turkey
| | - Tahsin Gokhan Telatar
- Public Health Department, Recep Tayyip Erdoğan University Medical School, Rize, Turkey
| | - Bulent Bahceci
- Psychiatry Department, Recep Tayyip Erdoğan University Medical School, Rize, Turkey
| | - Cicek Hocaoglu
- Psychiatry Department, Recep Tayyip Erdoğan University Medical School, Rize, Turkey
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McCoy B, Jaffe RJ, Coffey BJ. Regaining Control: Anxiety in Sickle Cell Disease. J Child Adolesc Psychopharmacol 2020; 30:572-575. [PMID: 33185469 DOI: 10.1089/cap.2020.29193.bjc] [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: 11/13/2022]
Affiliation(s)
- Brittany McCoy
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Robert J Jaffe
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Barbara J Coffey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
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Pope S, Artuch R, Heales S, Rahman S. Cerebral folate deficiency: Analytical tests and differential diagnosis. J Inherit Metab Dis 2019; 42:655-672. [PMID: 30916789 DOI: 10.1002/jimd.12092] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 03/19/2019] [Accepted: 03/25/2019] [Indexed: 11/07/2022]
Abstract
Cerebral folate deficiency is typically defined as a deficiency of the major folate species 5-methyltetrahydrofolate in the cerebrospinal fluid (CSF) in the presence of normal peripheral total folate levels. However, it should be noted that cerebral folate deficiency is also often used to describe conditions where CSF 5-MTHF is low, in the presence of low or undefined peripheral folate levels. Known defects of folate transport are deficiency of the proton coupled folate transporter, associated with systemic as well as cerebral folate deficiency, and deficiency of the folate receptor alpha, leading to an isolated cerebral folate deficiency associated with intractable seizures, developmental delay and/or regression, progressive ataxia and choreoathetoid movement disorders. Inborn errors of folate metabolism include deficiencies of the enzymes methylenetetrahydrofolate reductase, dihydrofolate reductase and 5,10-methenyltetrahydrofolate synthetase. Cerebral folate deficiency is potentially a treatable condition and so prompt recognition of these inborn errors and initiation of appropriate therapy is of paramount importance. Secondary cerebral folate deficiency may be observed in other inherited metabolic diseases, including disorders of the mitochondrial oxidative phosphorylation system, serine deficiency, and pyridoxine dependent epilepsy. Other secondary causes of cerebral folate deficiency include the effects of drugs, immune response activation, toxic insults and oxidative stress. This review describes the absorption, transport and metabolism of folate within the body; analytical methods to measure folate species in blood, plasma and CSF; inherited and acquired causes of cerebral folate deficiency; and possible treatment options in those patients found to have cerebral folate deficiency.
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Affiliation(s)
- Simon Pope
- Neurometabolic Unit, National Hospital for Neurology, London, UK
| | - Rafael Artuch
- Clinical Biochemistry Department, Institut de Recerca Sant Joan de Déu and CIBERER, ISCIII, Barcelona, Spain
| | - Simon Heales
- Neurometabolic Unit, National Hospital for Neurology, London, UK
- Department of Chemical Pathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Mitochondrial Research Group, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Shamima Rahman
- Mitochondrial Research Group, UCL Great Ormond Street Institute of Child Health, London, UK
- Department of Metabolic Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Anim MT, Osafo J, Yirdong F. Prevalence of psychological symptoms among adults with sickle cell disease in Korle-Bu Teaching Hospital, Ghana. BMC Psychol 2016; 4:53. [PMID: 27832817 PMCID: PMC5103464 DOI: 10.1186/s40359-016-0162-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 11/02/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous research revealed high prevalence of psychological symptoms among sickle cell disease (SCD) patients in the West and Europe. In some Black SCD populations such as Nigeria and Jamaica, anxiety and depression had low prevalence rates compared to Europe. With difficulty locating research data on the prevalence of psychological symptoms in Ghana, this study aimed at exploring psychological symptoms among adults with SCD in a Teaching Hospital in Accra, Ghana. METHODS Two hundred and one participants (males 102 and females 99) who were HbSS (n = 131) and HbSC (n = 70), aged 18 years and above were purposively recruited. Using the Brief Symptom Inventory (BSI) in a cross-sectional survey, the research answered questions about the prevalence of psychological symptoms. It also examined gender and genotype differences in psychological symptoms scores. RESULTS Results indicated that adults with SCD had non-distress psychological symptoms scores. Although paranoid ideation as a psychological symptom indicated "a little bit" score, its prevalence was only 1 %. The prevalence of psychological symptoms as indexed by the Positive Symptom Total (PST) was 10 %. Anxiety, hostility, and depression were psychological symptoms with low scores. Furthermore, except psychoticism scores, males did not differ significantly from females in other psychological symptoms. On the contrary, HbSS participants differed significantly, reporting more psychological symptoms than their HbSC counterparts. CONCLUSIONS The study concluded that there was low prevalence of psychological symptoms among adults with SCD in this Ghanaian study. Although psychological symptoms distress scores were not observed among study participants at this time, females differed significantly by experiencing more psychoticism symptoms than males. HbSS participants also differed significantly by experiencing more depression, phobic anxiety, paranoid ideation, psychoticism, and additional symptoms such as poor appetite, trouble falling asleep, thoughts of dying, and feeling guilty, than their HbSC counterparts. Implications for further study and clinical practice were discussed.
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Affiliation(s)
- Michael Tetteh Anim
- Department of Psychological Medicine and Mental Health, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
- Department of Psychological Medicine and Mental Health, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Joseph Osafo
- Department of Psychology, University of Ghana, Legon, Ghana
| | - Felix Yirdong
- Department of Psychological Medicine and Mental Health, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
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Tamayo Martínez N, Bohórquez Peñaranda AP, García Valencia J, Jaramillo González LE, Ávila MJ, Gómez-Restrepo C, Arenas González ML. [Hematological Evaluation and Monitoring in Adult Patients Diagnosed With Schizophrenia]. ACTA ACUST UNITED AC 2015; 44:131-6. [PMID: 26578412 DOI: 10.1016/j.rcp.2015.05.007] [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: 07/13/2014] [Accepted: 12/13/2014] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To guide the clinician in taking decisions on the best strategies for assessing and monitoring the risk of blood disorders in adults diagnosed with schizophrenia in pharmacological treatment. METHOD A clinical practice guideline was developed following the guidelines of the Methodological Guide of the Ministry of Social Protection to collect evidence and grade recommendations. De novoliterature researchwas performed. RESULTS With the use of antipsychotics there isriskofreducción in the leukocyte count and the risk of agranulocytosis,the later associated with the use of clozapine, although it is a rare event(0.8%) can be fatal; this effect occurs most frequently in the first twelve weeks of treatment and the risk is maintained aroundthe first year of it. CONCLUSION The recommendations were considered strongin all hematologic related monitoring.A blood count should be taken at the start of pharmacological treatment. If the patient is started on clozapine one shouldbe taken weekly during the first three months, monthly until completing one year and every six months thereafter. If there is a decrease in white blood cell count the patient should be monitored regularly, stopping if is a less than 3,500 cells/mm(3) and consider referral if is less than 2,000 cells/mm(3).
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Affiliation(s)
- Nathalie Tamayo Martínez
- Médica psiquiatra, candidata a magístra Epidemiología Clínica. Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Adriana Patricia Bohórquez Peñaranda
- Médica psiquiatra, magístra en Epidemiología Clínica. Profesora asistente del departamento de Psiquiatría y Salud Mental. Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Jenny García Valencia
- Médica psiquiatra, Doctora en Epidemiología Clínica. Profesora titular del Departamento de Psiquiatría, Facultad de Medicina. Universidad de Antioquia., Medellín, Antioquia, Colombia
| | | | - Mauricio J Ávila
- Médico Servicio Social Obligatorio. Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Carlos Gómez-Restrepo
- Médico psiquiatra, psicoanalista, psiquiatra de enlace, magíster en Epidemiología Clínica. Profesor titular y Director del Departamento de Epidemiología Clínica y Bioestadística. Pontificia Universidad Javeriana. Hospital Universitario San Ignacio., Bogotá, Colombia.
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[Metabolic Control, Evaluation and Follow-up Interventions in Patients With Schizophrenia]. ACTA ACUST UNITED AC 2015; 44:220-9. [PMID: 26578473 DOI: 10.1016/j.rcp.2015.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Accepted: 12/01/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To determine the laboratory tests, related to metabolic risk that should be practiced to adult patients diagnosed with schizophrenia. To assist the clinician decision-making process about complementary diagnostic evaluation strategies in adult diagnosed with schizophrenia. METHODS A clinical practice guideline was elaborated under the parameters of the Methodological Guide of the Ministerio de Salud y Protección Social to identify, synthesize and evaluate the evidence and make recommendations about the treatment and follow-up of adult patients with schizophrenia. The evidence of NICE guide 82 was adopted and updated. The evidence was presented to the Guideline Developing Group and recommendations, employing the GRADE system, were produced. RESULTS The risk of overall mortality in schizophrenia is higher than in the general population excluding suicide. Results related with mortality associated to antipsychotics showed contradictory results. Metabolic outcomes showed a higher incidence and association with schizophrenia and treatment with antipsychotics (AP). The diagnosis of dyslipidemia in men with schizophrenia appears to be lower in comparison with the general population. However, changes in weight, blood sugar levels, HDL cholesterol and triglycerides are influenced by the use of antipsychotics in general there is a higher risk of developing diabetes mellitus in adults with schizophrenia. CONCLUSION Based on the evidence found a plan was formulated for the evaluation of physiological and paraclinical variables during and before the management with AP in adult diagnosed with schizophrenia. The overall quality of evidence is low considering that most of the reports come from observational studies that have risk of bias and some designs have methodological limitations.
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Korkmaz S, Yıldız S, Korucu T, Gundogan B, Sunbul ZE, Korkmaz H, Atmaca M. Frequency of anemia in chronic psychiatry patients. Neuropsychiatr Dis Treat 2015; 11:2737-41. [PMID: 26543367 PMCID: PMC4622486 DOI: 10.2147/ndt.s91581] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Anemia could cause psychiatric symptoms such as cognitive function disorders and depression or could deteriorate an existing psychiatric condition when it is untreated. The objective of this study is to scrutinize the frequency of anemia in chronic psychiatric patients and the clinical and sociodemographic factors that could affect this frequency. METHODS All inpatients in our clinic who satisfied the study criteria and received treatment between April 2014 and April 2015 were included in this cross-sectional study. Sociodemographic data for 378 patients included in the study and hemoglobin (Hb) and hematocrit values observed during their admission to the hospital were recorded in the forms. Male patients with an Hb level of <13 g/dL and nonpregnant female patients with an Hb level of <12 g/dL were considered as anemic. FINDINGS Axis 1 diagnoses demonstrated that 172 patients had depressive disorder, 51 patients had bipolar disorder, 54 patients had psychotic disorder, 33 patients had conversion disorder, 19 patients had obsessive-compulsive disorder, 25 patients had generalized anxiety disorder, and 24 patients had other psychiatric conditions. It was also determined that 25.4% of the patients suffered from anemia. Thirty-five percent of females and 10% of males were considered as anemic. The frequency of anemia was the highest among psychotic disorder patients (35%), followed by generalized anxiety disorder patients (32%), and obsessive-compulsive disorder patients (26%). Anemia was diagnosed in 22% of depressive disorder patients, 25% of bipolar disorder patients, and 24% of conversion disorder patients. RESULTS The prevalence of anemia among chronic psychiatry patients is more frequent than the general population. Thus, the study concluded that it would be beneficial to consider the physical symptoms and to conduct the required examinations to determine anemia among this patient group.
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Affiliation(s)
- Sevda Korkmaz
- Department of Psychiatry, Faculty of Medicine, Fırat University, Elazıg, Turkey
| | - Sevler Yıldız
- Department of Psychiatry, Faculty of Medicine, Fırat University, Elazıg, Turkey
| | - Tuba Korucu
- Department of Psychiatry, Faculty of Medicine, Fırat University, Elazıg, Turkey
| | - Burcu Gundogan
- Department of Psychiatry, Faculty of Medicine, Fırat University, Elazıg, Turkey
| | - Zehra Emine Sunbul
- Department of Psychiatry, Faculty of Medicine, Fırat University, Elazıg, Turkey
| | - Hasan Korkmaz
- Department of Cardiology, Faculty of Medicine, Fırat University, Elazıg, Turkey
| | - Murad Atmaca
- Department of Psychiatry, Faculty of Medicine, Fırat University, Elazıg, Turkey
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Multiple antipsychotic induced neutropenia—a possible genetic association. Asian J Psychiatr 2014; 11:81. [PMID: 25453707 DOI: 10.1016/j.ajp.2014.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 06/12/2014] [Accepted: 06/14/2014] [Indexed: 11/20/2022]
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Lopez-Castroman J, Blasco-Fontecilla H, Paz-Yepes M, Montoya-Ferrer A, De Leon-Martinez V, Alvarez R, Baca-Garcia E. Cost-efficiency of laboratory testing among psychiatric inpatients. Int J Psychiatry Med 2013; 44:211-24. [PMID: 23586277 DOI: 10.2190/pm.44.3.c] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND A set of tests to rule out medical conditions among psychiatric inpatients is still to be defined. A first step in this direction is to determine the utility of lab tests commonly used by psychiatrists. METHODS Biochemical tests have been routinely performed on inpatients in a psychiatric hospitalization unit from 2006 to 2009. This study examines the prevalence of abnormal values in 1,278 laboratory tests performed on 894 patients. The number of subjects screened and the direct expenditure needed to find results outside the normal range were computed. Differences in clinical profiles were compared between diagnostic groups according to main diagnosis. RESULTS We found high rates of seropositive patients for human immunodeficiency virus (14.3%) and hepatitis B virus (15.7%). Most patients met at least one criteria of metabolic syndrome (67.6%). The detection of hepatic abnormalities was very efficient (65.71%), particularly for patients diagnosed with alcohol use disorders. CONCLUSIONS The cost-efficiency of lab tests in psychiatric units is greatly variable. Though results of this study may not be generalized due to the different prevalence of medical conditions, the methodology can be easily implemented across psychiatric services. Cost-effectiveness and costbenefit analyses are warranted.
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Affiliation(s)
- J Lopez-Castroman
- IIS-Fundacion Jimenez Diaz, Av. Reyes Catolicos 2, 28040 Madrid, Spain.
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Jerrell JM, Tripathi A, McIntyre RS. Prevalence and treatment of depression in children and adolescents with sickle cell disease: a retrospective cohort study. Prim Care Companion CNS Disord 2011; 13:PCC.10m01063. [PMID: 21977359 PMCID: PMC3184596 DOI: 10.4088/pcc.10m01063] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Accepted: 09/22/2010] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To describe the prevalence and treatment of comorbid depressive disorders in children and adolescents diagnosed with sickle cell disease. METHOD A retrospective cohort design evaluating South Carolina Medicaid medical and pharmacy claims between January 1, 1996, and December 31, 2006, was employed to identify 2,194 children and adolescents aged 17 years and younger diagnosed with sickle cell disease. Cohorts diagnosed with and without comorbid unipolar depressive disorders (using DSM-IV-TR criteria) were then compared. RESULTS Forty-six percent of the sickle cell disease cohort was diagnosed with a depressive disorder (n = 1,017), either dysthymia (90%) or major depressive disorder (10%). Dysthymia was diagnosed at approximately 9 years of age, whereas major depressive disorder was diagnosed at approximately 14 years of age. Compared with the controls, the sickle cell disease cohort with depression had more acute vaso-occlusive pain and acute chest syndrome visits per year, developed more complications with related organ damage, and incurred significantly higher outpatient, acute (emergency + inpatient), and total sickle cell disease care costs. The depression cohort was primarily treated with selective serotonin reuptake inhibitors (SSRIs; 12%) or serotonin-norepinephrine reuptake inhibitors (SNRIs; 10%) for approximately 9 months. Although alleviating the comorbid depression might positively affect their sickle cell disease pain, over 80% of the patients received no antidepressant medications, and many of the prescribed SSRIs and SNRIs have previously shown no impact on relieving chronic pain. CONCLUSIONS Comorbid depression in sickle cell disease is associated with adverse course and outcomes. These findings underscore the need for earlier and more aggressive treatment of comorbid depression by primary care or psychiatric providers in order to reduce the chronic, severe pain-depression burden on these patients.
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Affiliation(s)
- Jeanette M Jerrell
- Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, Columbia (Dr Jerrell); Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia (Dr Tripathi); and Departments of Psychiatry and Pharmacology, University of Toronto, Ontario, Canada (Dr McIntyre)
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Allen KN, Kachalsky E. Aging with hemophilia: implications for social work practice. SOCIAL WORK IN HEALTH CARE 2010; 49:327-344. [PMID: 20379903 DOI: 10.1080/00981380903520434] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Individuals with hemophilia and other congenital bleeding disorders are surviving beyond any life expectancy previously predicted and now face conditions associated with "normal" aging. Hemophilia along with co-morbid conditions of HIV and Hepatitis C complicate treatment for heart disease, cancer, kidney disease, and other age-related diseases. Lack of understanding of the condition, its treatment, and its costs hampers care, particularly when patients are treated outside of specialty clinics. This article provides an overview of bleeding disorders with a special focus on aging considerations. The role of social work in specialized hemophilia treatment centers is described and suggestions made to other social workers who may encounter this population in their practice. Finally, the need for policy and advocacy strategies is also addressed.
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Flórez S, León M, Torres M, Reyes F, Serpa JC, Ríos AM. Manejo farmacológico del dolor neuropático. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2009. [DOI: 10.1016/s0120-3347(09)74011-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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Abstract
Psychiatric medications are frequently an essential component of care for critically ill patients. Their use may lead to medical complications, however, as a result of (1) direct toxicity from psychotropic medications, (2) drug-drug interactions, or (3) intoxication or withdrawal states. These complications may be a nuisance (eg, dry mouth and nausea) or serious and life-threatening (eg, neuroleptic malignant syndrome and cardiac arrhythmias). This article addresses the most important medical complications (organized by organ systems) of psychiatric treatment.
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Affiliation(s)
- Felicia A Smith
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
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