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Parabiaghi A, Monzio Compagnoni M, D’Avanzo B, Caggiu G, Galbussera AA, Tettamanti M, Fortino I, Barbato A. Association of Antipsychotic Polypharmacy and Two-Year All-Cause Mortality: A Population-Based Cohort Study of 33,221 Italian Continuous Users. J Clin Med 2024; 13:2073. [PMID: 38610838 PMCID: PMC11012528 DOI: 10.3390/jcm13072073] [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: 02/27/2024] [Revised: 03/23/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Differences in survival between patients treated with antipsychotic monotherapy vs. polytherapy are debated. This study aimed to examine the association of antipsychotic polytherapy with 2-year all-cause mortality in a population-based cohort. Methods: Data were retrieved from healthcare databases of four local health units of Lombardy, Italy. Subjects aged 18-79 years who received continuous antipsychotic prescriptions in 2018 were identified. Overall survival among patients with antipsychotic monotherapy vs. polytherapy was compared. A multivariate Cox PH model was used to estimate the association between antipsychotic therapy, or antipsychotic use (continuous vs. non-continuous), and all-cause mortality. Adjustments were made for the presence of metabolic disturbances, total antipsychotic dosage amount (olanzapine equivalent doses), age, and sex. Results: A total of 49,875 subjects receiving at least one prescription of antipsychotics during 2018 were identified. Among the 33,221 patients receiving continuative antipsychotic prescriptions, 1958 (5.9%) experienced death from any cause at two years. Patients with continuous antipsychotic use had a 1.13-point increased mortality risk compared with non-continuous users. Patients treated with antipsychotic polytherapy showed an adjusted mortality risk increased by 17% (95% CI: 2%, 33%) compared to monotherapy. Conclusions: The study highlights the potential risks associated with antipsychotic polypharmacy, emphasizing the importance of optimizing drug prescriptions to improve patient safety and reduce mortality rates in individuals receiving antipsychotic therapy.
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Affiliation(s)
- Alberto Parabiaghi
- Unit for Quality of Care and Rights Promotion in Mental Health, Istituto di Ricerche Farmacologiche “Mario Negri”-IRCCS, 20156 Milan, Italy; (A.P.); (A.B.)
| | - Matteo Monzio Compagnoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy;
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy
| | - Barbara D’Avanzo
- Laboratory for Assessing Quality of Care and Services, Istituto di Ricerche Farmacologiche “Mario Negri”-IRCCS, 20156 Milan, Italy;
| | - Giulia Caggiu
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy;
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy
- Department of Mental Health and Addiction Services, ASST Lecco, 23900 Lecco, Italy
| | - Alessia A. Galbussera
- Laboratory of Geriatric Epidemiology, Istituto di Ricerche Farmacologiche “Mario Negri”-IRCCS, 20156 Milan, Italy; (A.A.G.); (M.T.)
| | - Mauro Tettamanti
- Laboratory of Geriatric Epidemiology, Istituto di Ricerche Farmacologiche “Mario Negri”-IRCCS, 20156 Milan, Italy; (A.A.G.); (M.T.)
| | - Ida Fortino
- Directorate General for Health, Lombardy Region, 00144 Milan, Italy
| | - Angelo Barbato
- Unit for Quality of Care and Rights Promotion in Mental Health, Istituto di Ricerche Farmacologiche “Mario Negri”-IRCCS, 20156 Milan, Italy; (A.P.); (A.B.)
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Wand T. We have to cancel psychiatric nursing and forge a new way forward. Int J Ment Health Nurs 2024; 33:215-219. [PMID: 38308416 DOI: 10.1111/inm.13301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 02/04/2024]
Affiliation(s)
- Timothy Wand
- Nursing and Midwifery Research Unit, Wollongong Hospital, Illawarra Shoalhaven Local Health District and University of Wollongong, Wollongong, New South Wales, Australia
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Bergström T, Gauffin T. The Association of Antipsychotic Postponement With 5-Year Outcomes of Adolescent First-Episode Psychosis. SCHIZOPHRENIA BULLETIN OPEN 2023; 4:sgad032. [PMID: 39145341 PMCID: PMC11207772 DOI: 10.1093/schizbullopen/sgad032] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
Background and Hypothesis Based on the need-adapted approach, delaying antipsychotics could help identify first-episode psychosis (FEP) adolescents who might not require them. However, some individuals might need antipsychotics, and postponing could harm their prognosis. This nationwide register-based follow-up aimed to test these two hypotheses. Study Design All adolescents aged 13-20 with a psychotic disorder (ICD-10 codes: F20-F29) in Finland between 2003 and 2013 were identified (n = 6354) from national registers. For each case, a fixed 1825-day follow-up period was established from the onset of psychosis or until death. The outcome was considered "good" if adolescents did not die and had not received psychiatric treatment and/or disability allowances during the final year of follow-up. Testing the first hypothesis involved all antipsychotic treatment-naïve adolescents with FEP (n = 3714). The second hypothesis was tested with a sub-sample of only those who had received antipsychotics during follow-up (n = 3258). To account for baseline confounders, hypotheses were tested via a stabilized inverse probability of treatment weighted generalized linear models with logit link function. Study Results Immediate antipsychotic treatment after the onset of psychosis was associated with poor 5-year outcome (adjusted odds ratio [aOR]: 1.8, 95% CI: 1.6-2.1). There was no statistically significant association between antipsychotic postponement and treatment outcome in those who eventually received antipsychotic treatment (aOR: 1.02, 95% CI: 0.7-1.2, P: .8), thus not providing support for second hypothesis. Conclusions There is a significant subgroup of adolescent with psychosis who do not require immediate antipsychotic treatment. A more robust design is needed to evaluate the causality of the observed association.
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Affiliation(s)
- Tomi Bergström
- Department of Psychiatry, The Wellbeing Services County of Lapland, Kemi, Finland
- Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
| | - Tapio Gauffin
- Department of Strategic Services, The Wellbeing Services County of Lapland, Rovaniemi, Finland
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Bergström T, Seikkula J, Köngäs-Saviaro P, Taskila JJ, Aaltonen J. Need adapted use of medication in the open dialogue approach for psychosis: a descriptive longitudinal cohort study. PSYCHOSIS 2022. [DOI: 10.1080/17522439.2022.2134444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Tomi Bergström
- Department of Psychology, University of Jyväskylä, Jyvaskyla, Finland
| | - Jaakko Seikkula
- Department of Psychology, University of Jyväskylä, Jyvaskyla, Finland
- Faculty of Health and Sport, University of Agder, Kristiansand, Norway
| | | | - Jyri J. Taskila
- Department of Psychiatry, Länsi-Pohja healthcare district, Kemi, Finland
| | - Jukka Aaltonen
- Department of Psychology, University of Jyväskylä, Jyvaskyla, Finland
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Katz IR, Szymanski BR, Marder SR, Shotwell A, Hein TC, McCarthy JF, Bowersox NW. Comparative risks of all-cause mortality for Veterans with schizophrenia with ongoing receipt of clozapine and other antipsychotic medications. Psychiatry Res 2022; 313:114590. [PMID: 35567853 DOI: 10.1016/j.psychres.2022.114590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/15/2022] [Accepted: 04/30/2022] [Indexed: 11/18/2022]
Abstract
To guide care for patients with schizophrenia, the Veterans Health Administration (VHA) evaluated the associations between current or recent use of clozapine and all-cause mortality and explored associations for other antipsychotic medications. Using a case-control design, patients with schizophrenia who died in fiscal years 2014-2018 were matched on age, sex, race, and VHA facility to up to 10 controls who were alive on the case's date of death (index date). Medication coverage during the 91 days before the index date was classified as none, partial (1-44 days), and consistent (45-91 days). Medication coverage patterns during the index period were compared to coverage patterns during the period of 92-182 days prior to index date with each medication coverage classified as no change, no coverage, increased, or decreased. Conditional logistic regression analyses controlling for patient characteristics identified no associations of consistent or increasing clozapine coverage with mortality; partial and decreasing coverage were associated with greater mortality and these effects did not differ from those of other the medications considered. Exploratory analyses considering non-clozapine antipsychotic agents suggest that consistent coverage by olanzapine may be associated with increased mortality, that mortality associated with olanzapine may be greater than aripiprazole, and that this effect can be attributed primarily to patients with diabetes. Further study of this topic is needed.
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Affiliation(s)
- Ira R Katz
- Department of Veterans Affairs, VA Office of Mental Health and Suicide Prevention, Washington, DC, USA
| | - Benjamin R Szymanski
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, North Campus Research Complex, 2800 Plymouth Rd, Building 16, Room 016-233W, Ann Arbor, MI 48109, USA
| | - Stephen R Marder
- Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, CA, USA; Veterans Affairs Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, USA
| | - Abigail Shotwell
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, North Campus Research Complex, 2800 Plymouth Rd, Building 16, Room 016-233W, Ann Arbor, MI 48109, USA
| | - Tyler C Hein
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, North Campus Research Complex, 2800 Plymouth Rd, Building 16, Room 016-233W, Ann Arbor, MI 48109, USA; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - John F McCarthy
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, North Campus Research Complex, 2800 Plymouth Rd, Building 16, Room 016-233W, Ann Arbor, MI 48109, USA; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Nicholas W Bowersox
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, North Campus Research Complex, 2800 Plymouth Rd, Building 16, Room 016-233W, Ann Arbor, MI 48109, USA; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA.
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Wand T, Glover S, Paul D. What should be the future focus of mental health nursing? Exploring the perspectives of mental health nurses, consumers, and allied health staff. Int J Ment Health Nurs 2022; 31:179-188. [PMID: 34679235 DOI: 10.1111/inm.12947] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/26/2021] [Accepted: 10/08/2021] [Indexed: 12/11/2022]
Abstract
The landscape of mental health care and service delivery is changing, as is our understanding of the underlying causes for mental distress. It is now apparent that biogenic explanations have been overstated and instead experiences of trauma and adversity constitute the main contributor to people's experiences of mental health challenges. The shortcomings of treatments traditionally used in mental health care are also evident, and with a contemporary focus on person-centred care, the utility of diagnostic labels has been called into question. Taking all this into consideration, this study sought to explore, what should be the future focus of mental health nursing? Three separate focus groups were conducted. One with a sample of senior clinical mental health nurses, one with a sample of consumer representatives and another with allied health professionals. The common theme across all three focus groups was the centrality of the therapeutic role of mental health nurses (MHNs). Consumers and allied health participants, in particular, advocated for a de-emphasis on medications, psychiatric diagnoses, and custodial practices. The MHNs role in health promotion, working collaboratively with consumers, being hopeful, understanding the individual perspective, and appreciating the social determinants of mental health were all highlighted in framing the future focus of MHN practice.
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Affiliation(s)
- Timothy Wand
- Emergency Department, Royal Prince Alfred Hospital, University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
| | - Suzanne Glover
- Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Diane Paul
- Northern Sydney Local Health District, Sydney, New South Wales, Australia
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Murray RM. Listening to our critics; the care of people with psychosis. Psychol Med 2020; 50:2641-2642. [PMID: 33280631 DOI: 10.1017/s0033291720004341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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