1
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Bell C, Tesli N, Gurholt TP, Rokicki J, Hjell G, Fischer-Vieler T, Melle I, Agartz I, Andreassen OA, Ringen PA, Rasmussen K, Dahl H, Friestad C, Haukvik UK. Psychopathy subdomains in violent offenders with and without a psychotic disorder. Nord J Psychiatry 2022; 77:393-402. [PMID: 36260740 DOI: 10.1080/08039488.2022.2128869] [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: 10/24/2022]
Abstract
BACKGROUND Violence in psychosis has been linked to antisocial behavior and psychopathy traits. Psychopathy comprises aspects of interpersonal, affective, lifestyle, and antisocial traits which may be differently involved in violent offending by persons with psychotic disorders. We explored psychopathy subdomains among violent offenders with and without a psychotic disorder. METHODS 46 males, with a history of severe violence, with (n = 26; age 35.85 ± 10.34 years) or without (n = 20; age 39.10 ± 11.63 years) a diagnosis of a psychotic disorder, were assessed with the Psychopathy Checklist-Revised (PCL-R). PCL-R was split into subdomains following the four-facet model. Group differences in total and subdomain scores were analyzed with a general linear model with covariates. RESULTS Total PCL-R scores did not differ between the groups (p = 0.61, Cohen's d = 0.17). The violent offenders without psychotic disorders had higher facet 2 scores than the patient group with psychotic disorders (p = 0.029, Cohen's d = 0.77). Facet 1, 3, or 4 scores did not differ between the groups. Controlling for age did not alter the results. CONCLUSION Patients with a psychotic disorder and a history of severe violence have lower affective psychopathy scores than violent offenders without psychotic disorders. This observation may point toward distinct underlying mechanisms for violence and may provide a target for focused treatment and prevention.
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Affiliation(s)
- Christina Bell
- Department of Psychiatry, Oslo University Hospital, Oslo, Norway.,Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Natalia Tesli
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Tiril P Gurholt
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Jaroslav Rokicki
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Centre of Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway
| | - Gabriela Hjell
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatry, Østfold Hospital Trust, Graalum, Norway
| | - Thomas Fischer-Vieler
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Vestre Viken Hospital Trust, Division of Mental health and Addiction, Drammen Hospital, Drammen, Norway
| | - Ingrid Melle
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Ingrid Agartz
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway.,Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden.,Stockholm Health Care Services, Stockholm Region, Stockholm, Sweden
| | - Ole A Andreassen
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Petter Andreas Ringen
- Department of Psychiatry, Oslo University Hospital, Oslo, Norway.,Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Adult Psychiatry, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kirsten Rasmussen
- St.Olavs Hospital, Centre for Research and Education in Forensic Psychiatry, Trondheim, Norway.,Department of Psychology and Department of Mental Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Hilde Dahl
- St.Olavs Hospital, Centre for Research and Education in Forensic Psychiatry, Trondheim, Norway.,Department of Psychology and Department of Mental Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Christine Friestad
- Centre of Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway.,University College of Norwegian Correctional Service, Oslo, Norway
| | - Unn K Haukvik
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Adult Psychiatry, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Centre of Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway
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2
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Mauri MC, Cirnigliaro G, Piccoli E, Vismara M, De Carlo V, Girone N, Dell’Osso B. Substance Abuse Associated with Aggressive/Violent Behaviors in Psychiatric Outpatients and Related Psychotropic Prescription. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00842-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
AbstractPsychiatric
disorders with substance abuse are considered the leading causes of most violent and aggressive behaviors in the general population. This study was aimed to assess the impact of substance abuse and the therapeutic approaches adopted by psychiatrists in aggressive vs non-aggressive outpatients (n = 400) attending community-based psychiatric services and recruited over a 3-year period. Clinical and therapeutic variables were collected from medical records and the Modified Overt Aggression Scale (MOAS) was used to assess any aggressive/violent behavior. Violent behaviors were significantly higher in alcohol and substance abusers compared to non-abusers (p < 0.01), except for heroin abusers. Mean weighted MOAS score was significantly higher in patients taking antipsychotics (p < 0.005). The administration of Haloperidol, Zuclopenthixol, and Clozapine was more frequent in aggressive than in non-aggressive patients. The most frequently administered drug in these patients was Haloperidol (23.91%), with a higher mean daily dosage in violent vs non-violent patients. Our results confirm the well-established relationship between substance abuse and violent behaviors in psychiatric inpatients also within outpatient community services. Observed rates of most frequently prescribed antipsychotics to aggressive patients did not show any preference for newer generation compounds, with clinicians operating in the community setting likely being in need for further evidence and specific training to support their treatment choice.
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3
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Grover D, Tom M, Maguire G, Stahl S. Polypharmacy- Purpose, Benefits and Limitations. Curr Med Chem 2022; 29:5606-5614. [PMID: 34994308 DOI: 10.2174/0929867329666220107153813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/24/2021] [Accepted: 12/01/2021] [Indexed: 11/22/2022]
Abstract
With what has become increasingly common among nearly all medical specialties, the number of patients who have various comorbid diseases both psychiatrically and mentally challenges the field of psychiatry. As a result, it is not uncommon physicians are imposed with treatment decisions regarding polypharmacy- the use of multiple medications to treat either different diseases, or even many times, the same illness. In recent years the concept of polypharmacy has been known to have a negative undertone, implying its use is inappropriate or causing more harm than potential benefit. Although the use of any medication should involve a risk versus benefit discussion, when used with good clinical judgment and pharmacologically sound knowledge this practice can be potentially life altering for patients.
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Affiliation(s)
- Douglas Grover
- Department of Psychiatry, University of California Riverside
| | - Michelle Tom
- Department of Psychiatry, University of California Riverside
| | - Gerald Maguire
- Department of Psychiatry, University of California Riverside
| | - Stephen Stahl
- Department of Psychiatry, University of California Riverside
- Department of Psychiatry, University of California San Diego
- Department of Psychiatry, University of Cambridge
- Neuroscience Education Institute
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4
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Gouveia FV, Germann J, Elias GJ, Hamani C, Fonoff ET, Martinez RCR. Case report: 5 Years follow-up on posterior hypothalamus deep brain stimulation for intractable aggressive behaviour associated with drug-resistant epilepsy. Brain Stimul 2021; 14:1201-1204. [PMID: 34371210 DOI: 10.1016/j.brs.2021.07.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/15/2021] [Accepted: 07/31/2021] [Indexed: 12/17/2022] Open
Affiliation(s)
- Flavia Venetucci Gouveia
- Biological Sciences Platform, Sunnybrook Research Institute, Toronto, Canada; Division of Neuroscience, Sírio-Libanês Hospital, São Paulo, Brazil.
| | - Jürgen Germann
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Gavin Jb Elias
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Clement Hamani
- Biological Sciences Platform, Sunnybrook Research Institute, Toronto, Canada; Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, Canada; Division of Neurosurgery, University of Toronto, Toronto, Canada
| | - Erich Talamoni Fonoff
- Department of Neurology, University of São Paulo School of Medicine and Integrated Clinic of Neuroscience, São Paulo, Brazil
| | - Raquel Chacon Ruiz Martinez
- Division of Neuroscience, Sírio-Libanês Hospital, São Paulo, Brazil; LIM 23, Institute of Psychiatry, University of Sao Paulo, School of Medicine, São Paulo, Brazil.
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5
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Mouaffak F, Ferreri F, Bourgin-Duchesnay J, Baloche E, Blin O, Vandel P, Garay RP, Vidailhet P, Corruble E, Llorca PM. Dosing antipsychotics in special populations of patients with schizophrenia: severe psychotic agitation, first psychotic episode and elderly patients. Expert Opin Pharmacother 2021; 22:2507-2519. [PMID: 34338130 DOI: 10.1080/14656566.2021.1958781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Antipsychotic (AP) dosing is well established in nonelderly patients with acute exacerbations of schizophrenia, but not in special populations.This review describes the AP dosing procedures that have been used in clinical studies for acute psychotic agitation, a first episode of psychosis (FEP), and elderly patients. AP dosing data was extracted from the databases of drug regulatory authorities, and from clinical studies available in the medical literature. In acute psychotic agitation, intramuscular and oral APs are frequently prescribed in higher doses than those that saturate D2 receptors. Supersaturating doses of APs should be avoided due to an increased risk of adverse effects. In FEP, many studies showed efficacy of low doses of APs. Studies with risperidone and haloperidol suggested a dose reduction of approximately one third. Titration with a lower starting dose is recommended in elderly patients, due to possible decreases in pharmacokinetic clearance, and due to the risk of concomitant diseases and drug interactions. Exposure to some APs has been associated with QTc prolongation and arrhythmias, and a small but significant increase in the risk of stroke and mortality with APs has been seen, particularly in older people with dementia-related psychosis.
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Affiliation(s)
- Fayçal Mouaffak
- Emergency Psychiatry Unit, Ville Evrard Psychiatric Hospital, Seine-Saint-Denis, France
| | - Florian Ferreri
- Sorbonne University. APHP. Department of Adult Psychiatry and Medical Psychology, ICRIN, Saint-Antoine Hospital, Paris, France
| | - Julie Bourgin-Duchesnay
- Department Head of the Department of Child and Adolescent Psychiatry, Orsay Hospital, University Paris Saclay, France
| | - Emmanuelle Baloche
- Department of Neurosciences, Medical Advisor Neurosciences, Eisai SAS, La Défense, France
| | - Olivier Blin
- Institute of Neurosciences, Aix-Marseille University, Marseille, France
| | - Pierre Vandel
- Department of Adult Psychiatry, University Hospital of Besançon, EA-481, Laboratory of Neurosciences, UBFC, Besançon, France
| | - Ricardo P Garay
- Department of Pharmacology and Therapeutics, Craven, France; CNRS, National Centre of Scientific Research, Paris, France
| | - Pierre Vidailhet
- Department of Psychiatry, Strasbourg University Hospital, Strasbourg, France
| | - Emmanuelle Corruble
- Head of the Department of Psychiatry, Bicetre Hospital, APHP, INSERM UMR-1018, MOODS Team, Saclay School of Medicine, University Paris Saclay, Paris, France
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6
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Gouveia FV, Germann J, Devenyi GA, Fonoff ET, Morais RMCB, Brentani H, Chakravarty MM, Martinez RCR. Bilateral Amygdala Radio-Frequency Ablation for Refractory Aggressive Behavior Alters Local Cortical Thickness to a Pattern Found in Non-refractory Patients. Front Hum Neurosci 2021; 15:653631. [PMID: 34177490 PMCID: PMC8219880 DOI: 10.3389/fnhum.2021.653631] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/03/2021] [Indexed: 12/02/2022] Open
Abstract
Aggressive behaviors comprise verbal and/or physical aggression directed toward oneself, others, or objects and are highly prevalent among psychiatric patients, especially patients diagnosed with autism spectrum disorder and severe intellectual disabilities. Some of these patients are considered refractory to treatment, and functional neurosurgery targeting the amygdala can result in widespread plastic brain changes that might reflect ceasing of some abnormal brain function, offering symptom alleviation. This study investigated cortical thickness changes in refractory aggressive behavior patients that were treated with bilateral amygdala ablation and compared to control patients presenting non-refractory aggressive behavior [three refractory and seven non-refractory patients, all males diagnosed with autism spectrum disorder (ASD) and intellectual disabilities]. The Overt Aggression Scale (OAS) was used to quantify behavior and magnetic resonance imaging was performed to investigate cortical thickness. Before surgery, both groups presented similar total OAS score, however refractory patients presented higher physical aggression against others. After surgery the refractory group showed 88% average reduction of aggressive behavior. Imaging analysis showed that while refractory patients present an overall reduction in cortical thickness compared to non-refractory patients across both timepoints, the local pattern of thickness difference found in areas of the neurocircuitry of aggressive behavior present before surgery is diminished and no longer detected after surgery. These results corroborate the hypotheses on induction of widespread neuronal plasticity following functional neurosurgical procedures resulting in modifications in brain morphology and improvement in behavior. Further studies are necessary to determine the underlying cause of these morphological changes and to better understand and improve treatment options.
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Affiliation(s)
- Flavia Venetucci Gouveia
- Biological Sciences Platform, Sunnybrook Research Institute, Toronto, ON, Canada.,Division of Neuroscience, Sirio-Libanês Hospital, São Paulo, Brazil
| | - Jürgen Germann
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada.,Cerebral Imaging Centre, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
| | - Gabriel A Devenyi
- Cerebral Imaging Centre, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Erich T Fonoff
- Department of Neurology, Division of Functional Neurosurgery of the Institute of Psychiatry, University of São Paulo, Medical School, São Paulo, Brazil
| | - Rosa M C B Morais
- Division of Neuroscience, Sirio-Libanês Hospital, São Paulo, Brazil.,LIM/23, Department of Psychiatry, University of São Paulo, Medical School, São Paulo, Brazil
| | - Helena Brentani
- LIM/23, Department of Psychiatry, University of São Paulo, Medical School, São Paulo, Brazil
| | - M Mallar Chakravarty
- Cerebral Imaging Centre, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada.,Department of Biological and Biomedical Engineering, McGill University, Montreal, QC, Canada
| | - Raquel C R Martinez
- Division of Neuroscience, Sirio-Libanês Hospital, São Paulo, Brazil.,LIM/23, Department of Psychiatry, University of São Paulo, Medical School, São Paulo, Brazil
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7
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Gouveia FV, Germann J, de Morais R, Fonoff ET, Hamani C, Alho EJ, Brentani H, Martins AP, Devenyi G, Patel R, Steele C, Gramer R, Chakravarty M, Martinez RCR. Longitudinal Changes After Amygdala Surgery for Intractable Aggressive Behavior: Clinical, Imaging Genetics, and Deformation-Based Morphometry Study-A Case Series. Neurosurgery 2021; 88:E158-E169. [PMID: 33026432 DOI: 10.1093/neuros/nyaa378] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 06/27/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Intractable aggressive behavior (iAB) is a devastating behavioral disorder that may affect psychiatric patients. These patients have reduced quality of life, are more challenging to treat as they impose a high caregiver burden and require specialized care. Neuromodulatory interventions targeting the amygdala, a key hub in the circuitry of aggressive behavior (AB), may provide symptom alleviation. OBJECTIVE To Report clinical and imaging findings from a case series of iAB patients treated with bilateral amygdala ablation. METHODS This series included 4 cases (3 males, 19-32 years old) who underwent bilateral amygdala radiofrequency ablation for iAB hallmarked by life-threatening self-injury and social aggression. Pre- and postassessments involved full clinical, psychiatric, and neurosurgical evaluations, including scales quantifying AB, general agitation, quality of life, and magnetic resonance imaging (MRI). RESULTS Postsurgery assessments revealed decreased aggression and agitation and improved quality of life. AB was correlated with testosterone levels and testosterone/cortisol ratio in males. No clinically significant side effects were observed. Imaging analyses showed preoperative amygdala volumes within normal populational range and confirmed lesion locations. The reductions in aggressive symptoms were accompanied by significant postsurgical volumetric reductions in brain areas classically associated with AB and increases in regions related to somatosensation. The local volumetric reductions are found in areas that in a normal brain show high expression levels of genes related to AB (eg, aminergic transmission) using gene expression data provided by the Allen brain atlas. CONCLUSION These findings provide new insight into the whole brain neurocircuitry of aggression and suggest a role of altered somatosensation and possible novel neuromodulation targets.
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Affiliation(s)
- Flavia Venetucci Gouveia
- Laboratory of Neuromodulation, Teaching and Research Institute, Hospital Sirio-Libanes, Sao Paulo, Brazil.,Sunnybrook Research Institute, Toronto, Canada
| | - Jürgen Germann
- CIC, Douglas Mental Health University Institute, McGill University, Montreal, Canada
| | - Rosa de Morais
- PROTEA, Department of Psychiatry, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Erich Talamoni Fonoff
- Department of Neurology, Division of Functional Neurosurgery, Institute of Psychiatry, Medical School, University of Sao Paulo, Sao Paulo, Brazil
| | - Clement Hamani
- Sunnybrook Research Institute, Toronto, Canada.,Department of Neurology, Division of Functional Neurosurgery, Institute of Psychiatry, Medical School, University of Sao Paulo, Sao Paulo, Brazil.,Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Eduardo Joaquim Alho
- Department of Neurology, Division of Functional Neurosurgery, Institute of Psychiatry, Medical School, University of Sao Paulo, Sao Paulo, Brazil
| | - Helena Brentani
- Department of Psychiatry, Medical School, University of Sao Paulo, Sao Paulo, Brazil.,National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, Sao Paulo, Brazil
| | - Ana Paula Martins
- PROTEA, Department of Psychiatry, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Gabriel Devenyi
- CIC, Douglas Mental Health University Institute, McGill University, Montreal, Canada
| | - Raihaan Patel
- CIC, Douglas Mental Health University Institute, McGill University, Montreal, Canada
| | - Christopher Steele
- CIC, Douglas Mental Health University Institute, McGill University, Montreal, Canada
| | - Robert Gramer
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - Mallar Chakravarty
- CIC, Douglas Mental Health University Institute, McGill University, Montreal, Canada
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8
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Moreno-Calvete MC, Ruiz-Ibañez I, Uriarte-Uriarte JJ. Scoping review protocol on non-pharmacological interventions for interpersonal and self-directed violence in adults with severe mental illness. BMJ Open 2020; 10:e037006. [PMID: 32928853 PMCID: PMC7488835 DOI: 10.1136/bmjopen-2020-037006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Violence committed by people with mental illness has implications for mental health policy and clinical practice. Several strategies to reduce the risk of aggressive and violent behaviour have been proposed, and these include non-pharmacological interventions. There is, however, a need to identify which of these interventions are effective, and as a first step, we will conduct a scoping review to identify non-pharmacological interventions for self-directed or interpersonal violence in adults with severe mental illness across different conditions and settings. METHODS AND ANALYSIS This is a scoping review protocol. The review will include any randomised controlled trials (RCTs) and cluster RCTs that assess the efficacy of interventions on self-directed or interpersonal violence with no restrictions on the control treatment in people with severe mental illness in any setting. No restrictions will be applied in terms of language or date of publication. To identify studies, a search will be performed in the following databases: Embase, MEDLINE (via PubMed), PsycINFO, CINAHL, LILACS, SciELO, Cochrane Library, Web of Science, Scopus, ProQuest, Epistemonikos and databases of clinical trials. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement will be followed for reporting the findings, including the use of a PRISMA flow diagram. A standardised form will be used to extract data from studies. The findings will be classified using conceptual categories that will be specified in detail and a descriptive summary of the main results will be created. Moreover, it will be assessed whether the studies identified have been included in systematic reviews or meta-analyses and the results will be used to generate a conceptual map. ETHICS AND DISSEMINATION No patients or other participants will be involved in this study. We will prepare a manuscript for publication in a peer-reviewed journal and the results will be presented at mental health conferences.
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Affiliation(s)
| | - Ivan Ruiz-Ibañez
- Basque Health Service, Bizkaia Mental Health Network, Assertive Community Treatment (ACT) Team, Buenavista Health Centre, Portugalete, Biscay, Spain
| | - Jose Juan Uriarte-Uriarte
- Biocruces Bizkaia Health Research Institute, Basque Health Service, Bizkaia Mental Health Network, Bilbao, Biscay, Spain
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9
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Gouveia FV, Germann J, Devenyi GA, Morais RMCB, Santos APM, Fonoff ET, Hamani C, Brentani H, Chakravarty MM, Martinez RCR. Refractoriness of aggressive behaviour to pharmacological treatment: cortical thickness analysis in autism spectrum disorder. BJPsych Open 2020; 6:e85. [PMID: 32762791 PMCID: PMC7453794 DOI: 10.1192/bjo.2020.71] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/23/2020] [Accepted: 07/12/2020] [Indexed: 01/22/2023] Open
Abstract
Aggressive behaviour is a highly prevalent and devastating condition in autism spectrum disorder resulting in impoverished quality of life. Gold-standard therapies are ineffective in about 30% of patients leading to greater suffering. We investigated cortical thickness in individuals with autism spectrum disorder with pharmacological-treatment-refractory aggressive behaviour compared with those with non-refractory aggressive behaviour and observed a brain-wide pattern of local increased thickness in key areas related to emotional control and overall decreased cortical thickness in those with refractory aggressive behaviour, suggesting refractoriness could be related to specific morphological patterns. Elucidating the neurobiology of refractory aggressive behaviour is crucial to provide insights and potential avenues for new interventions.
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Affiliation(s)
| | - Jürgen Germann
- University Health Network; and CIC, Douglas Mental Health University Institute, McGill University, Canada
| | - Gabriel A. Devenyi
- CIC, Douglas Mental Health University Institute, McGill University; and Department of Psychiatry, McGill University, Canada
| | - Rosa M. C. B. Morais
- Hospital Sirio-Libanes; and Department of Psychiatry, University of Sao Paulo, Medical School, Brazil
| | | | - Erich T. Fonoff
- Department of Neurology, Division of Functional Neurosurgery of the Institute of Psychiatry, University of Sao Paulo, Medical School, Brazil
| | - Clement Hamani
- Sunnybrook Research Institute; Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre; and Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | - Helena Brentani
- Department of Psychiatry, University of Sao Paulo, Medical School, Brazil
| | - M. Mallar Chakravarty
- CIC, Douglas Mental Health University Institute, McGill University, Canada; Department of Psychiatry, McGill University, Canada; and Department of Biological and Biomedical Engineering, McGill University, Canada
| | - Raquel C. R. Martinez
- Hospital Sirio-Libanes; and Department of Psychiatry, University of Sao Paulo, Medical School, Brazil
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10
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Abstract
Background: Concurrent prescription of more than one type of antipsychotic for the same patient - antipsychotic polypharmacy (APP) - is associated with increased incidence of side effects, uncertain therapeutic benefit and general guidelines advise against it. Nevertheless, APP is common and there is little evidence about possible interventions to improve practice.Aims: To investigate the prevalence and documentation quality of APP in specialized psychiatric care and assess the feasibility and effect of a simple intervention to improve clinical practice.Methods: We examined the prevalence and the quality of documentation of APP in medical records from a large inpatient treatment department before and 6 months after an intervention, which consisted of giving feedback to doctors on their prescription practices as well as teaching about current guidelines. Prescription and documentation before and after intervention were compared between intervention and control wards.Results: One hundred and twenty-one medical records were examined at baseline. 43% of these had APP, of these 27% was satisfactory documented. After the intervention, the proportion with APP was reduced from 42% to 29% in the intervention group. There was a statistically significant interaction effect of the intervention group and the after-intervention condition on this reduction. The percentage with satisfactory documentation of APP was increased after the intervention in both groups, but we found no corresponding interaction effect.Conclusion: APP is prevalent in inpatient treatment of patients with mainly psychotic disorders but documentation of this is insufficient. Simple education and feedback on prescription and records documentation practices may increase adherence to guidelines.
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Affiliation(s)
- Hanne Høilund
- Department for Inpatient Treatment, Adult Mental Health, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - David P Galea
- Department for Inpatient Treatment, Adult Mental Health, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Petter Andreas Ringen
- Department for Inpatient Treatment, Adult Mental Health, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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11
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Abstract
Chronic aggression and violence in schizophrenia are rare, but receive disproportionate negative media coverage. This contributes to the stigma of mental illness and reduces accessibility to mental health services. Substance Use Disorders (SUD), antisocial behavior, non-adherence and recidivism are known risk factors for violence. Treatment with antipsychotic medication can reduce violence. Aside from clozapine, long-acting injectable antipsychotics (LAI) appear to be superior to oral antipsychotics for preventing violence, addressing adherence and recidivism. LAI also facilitate the implementation of functional skills training. For the high-risk recidivist target population with schizophrenia, better life skills have the potential to also reduce the risk for contact with the legal system, including an improved ability to live independently in supported environments and interact appropriately with others. High-risk patients who are resistant to treatment with other antipsychotics should receive treatment with clozapine due to its direct positive effects on impulsive violence, along with a reduction in comorbid risk factors such as SUDs.
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12
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Meftah AM, Deckler E, Citrome L, Kantrowitz JT. New discoveries for an old drug: a review of recent olanzapine research. Postgrad Med 2020; 132:80-90. [DOI: 10.1080/00325481.2019.1701823] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Amir M Meftah
- Department of Psychiatry, Columbia University, New York, NY, USA
- Schizophrenia Research, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | - Elizabeth Deckler
- Department of Psychiatry, Columbia University, New York, NY, USA
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Leslie Citrome
- Department of Psychiatry, New York Medical College, Valhalla, NY, USA
| | - Joshua T Kantrowitz
- Department of Psychiatry, Columbia University, New York, NY, USA
- Schizophrenia Research, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, USA
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13
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Günther MP, Kirchebner J, Lau S. Identifying Direct Coercion in a High Risk Subgroup of Offender Patients With Schizophrenia via Machine Learning Algorithms. Front Psychiatry 2020; 11:415. [PMID: 32477188 PMCID: PMC7237713 DOI: 10.3389/fpsyt.2020.00415] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 04/23/2020] [Indexed: 11/13/2022] Open
Abstract
PURPOSE This study aims to explore risk factors for direct coercive measures (seclusion, restraint, involuntary medication) in a high risk subpopulation of offender patients with schizophrenia spectrum disorders. METHODS Five hundred sixty nine potential predictor variables were explored in terms of their predictive power for coercion/no coercion in a set of 131 (36.6%) offender patients who experienced coercion and 227 who did not, using machine learning analysis. The dataset was split (70/30%) applying variable filtering, machine learning model building, and selection embedded in nested resampling approach in one subset. The best model was then selected, and the most important variables extracted on the second data subset. RESULTS In the final model the following variables identified coercion with a balanced accuracy of 73.28% and a predictive power (area under the curve, AUC) of 0.8468: threat of violence, (actual) violence toward others, the application of direct coercive measures during past psychiatric inpatient treatments, the positive and negative syndrome scales (PANSS) poor impulse control, uncooperativeness, and hostility and the total PANSS-score at admission, prescription of haloperidol during inpatient treatment, the daily cumulative olanzapine equivalent antipsychotic dosage at discharge, and the legal prognosis estimated by a team of licensed forensic psychiatrists. CONCLUSIONS Results confirm prior findings, add detail on factors indicative for the use of direct coercion, and provide clarification on inconsistencies. Limitations, clinical relevance, and avenues for future research are discussed.
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Affiliation(s)
- Moritz Philipp Günther
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Johannes Kirchebner
- Department of Forensic Psychiatry, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Steffen Lau
- Department of Forensic Psychiatry, University Hospital of Psychiatry Zurich, Zurich, Switzerland
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Hirsch S, Steinert T. In Reply. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 116:691. [PMID: 31709977 PMCID: PMC6865191 DOI: 10.3238/arztebl.2019.0691b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Sophie Hirsch
- *ZfP Südwürttemberg Klinik für Psychiatrie und Psychotherapie I der Universität Ulm ;
| | - Tilman Steinert
- *ZfP Südwürttemberg Klinik für Psychiatrie und Psychotherapie I der Universität Ulm ;
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15
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Gouveia FV, Hamani C, Fonoff ET, Brentani H, Alho EJL, de Morais RMCB, de Souza AL, Rigonatti SP, Martinez RCR. Amygdala and Hypothalamus: Historical Overview With Focus on Aggression. Neurosurgery 2019; 85:11-30. [PMID: 30690521 PMCID: PMC6565484 DOI: 10.1093/neuros/nyy635] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 01/08/2019] [Indexed: 12/29/2022] Open
Abstract
Aggressiveness has a high prevalence in psychiatric patients and is a major health problem. Two brain areas involved in the neural network of aggressive behavior are the amygdala and the hypothalamus. While pharmacological treatments are effective in most patients, some do not properly respond to conventional therapies and are considered medically refractory. In this population, surgical procedures (ie, stereotactic lesions and deep brain stimulation) have been performed in an attempt to improve symptomatology and quality of life. Clinical results obtained after surgery are difficult to interpret, and the mechanisms responsible for postoperative reductions in aggressive behavior are unknown. We review the rationale and neurobiological characteristics that may help to explain why functional neurosurgery has been proposed to control aggressive behavior.
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Affiliation(s)
| | - Clement Hamani
- Department of Neurology, Division of Functional Neurosurgery of the Institute of Psychiatry, University of Sao Paulo School, Medicine School, Sao Paulo, Brazil
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Erich Talamoni Fonoff
- Department of Neurology, Division of Functional Neurosurgery of the Institute of Psychiatry, University of Sao Paulo School, Medicine School, Sao Paulo, Brazil
| | - Helena Brentani
- Department of Psychiatry, University of Sao Paulo, Medical School, Sao Paulo, Brazil
- National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, Sao Paulo, Brazil
| | - Eduardo Joaquim Lopes Alho
- Department of Neurology, Division of Functional Neurosurgery of the Institute of Psychiatry, University of Sao Paulo School, Medicine School, Sao Paulo, Brazil
| | | | - Aline Luz de Souza
- Department of Neurology, Division of Functional Neurosurgery of the Institute of Psychiatry, University of Sao Paulo School, Medicine School, Sao Paulo, Brazil
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McInnis P, Kasinathan J. Combination long-acting injectable (LAI) antipsychotic medication in adolescents with severe psychosis and aggression: a case series. Australas Psychiatry 2019; 27:160-164. [PMID: 30474388 DOI: 10.1177/1039856218815744] [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] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We examine the use of combination long-acting injectable (LAI) antipsychotic medication for adolescents with severe psychosis and aggression. We discuss benefits and risks with this approach, for a highly challenging small group of young people. METHODS A clinical summary is given of three adolescents admitted to a secure adolescent forensic inpatient unit, and the literature is reviewed. RESULTS In these adolescents with severe psychosis, aggression and violent offending, combination LAI antipsychotics effectively treated psychosis and enabled transfer to less restrictive settings. Brief Psychiatric Rating Scale (BPRS) scores decreased significantly with treatment, without any severe adverse effects. CONCLUSIONS Combination LAI antipsychotics may be an effective treatment for adolescents with severe psychosis and aggression where clozapine is not a realistic therapeutic option. Close monitoring for side-effects, clear documentation of clinical reasoning and appropriate safeguards are important.
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Affiliation(s)
- Peter McInnis
- Consultant Child and Adolescent Psychiatrist, Sydney Local Health District, Sydney, NSW, Australia
| | - John Kasinathan
- Consultant Forensic, Child and Adolescent Psychiatrist, Adolescent Unit, The Forensic Hospital, Matraville, NSW, and; Conjoint Senior Lecturer, School of Psychiatry, University of New South Wales, Sydney, NSW, Child and Adolescent Mental Health Service, ACT Health, Sydney, NSW, and; Visiting Fellow, Centre for Mental Health Research, Australian National University, Canberra, ACT, and; The Level 8 Practice, Sydney, NSW, Australia
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17
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Abstract
Earlier findings suggest that forensic schizophrenia patients are treated with higher doses of antipsychotics. This practice-based specificity is insufficiently studied, and clinicians' motives regarding this practice remain poorly understood. In this editorial, the authors provide their data on treatment of forensic schizophrenia patients and identify characteristics of psychopathology and previous types of behaviors, including suicidal attempts, as potential reasons for the practice. They also emphasize that "these previous acts" often took place years ago, and suggest that current or recent aggression is unlikely the main reason for dosing, but rather the clinicians' intention to maintain "must remain unaggressive" condition. Therefore, the authors suggest new ideas that may contribute to a better understanding of the specific prescribing patterns in the forensic population and hope that these ideas would be implemented in further well-designed prospective studies.
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18
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Moore BA, Morrissette DA, Meyer JM, Stahl SM. Drug information update. Unconventional treatment strategies for schizophrenia: polypharmacy and heroic dosing. BJPsych Bull 2017; 41:164-168. [PMID: 28584654 PMCID: PMC5451651 DOI: 10.1192/pb.bp.115.053223] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The majority of patients respond to antipsychotic monotherapy at standard doses, but a subset of patients will require more heroic measures that include antipsychotic polypharmacy and high-dose monotherapy. Indeed, research has shown that roughly 30% of patients with psychosis are prescribed multiple antipsychotic medications. We discuss the potential benefits and challenges of these approaches and provide a rationale for why and when they should be utilised.
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Affiliation(s)
- Bret A Moore
- U.S. Army Regional Health Command-Central, San Antonio, Texas, USA
| | | | - Jonathan M Meyer
- California Department of State Hospitals, Sacramento, California, USA
| | - Stephen M Stahl
- Neuroscience Education Institute, Carlsbad, California, USA.,Department of Psychiatry, University of Cambridge, Cambridge, UK
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19
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Abstract
Pharmacogenomic testing can be integrated into modern mental health practices to help select psychotropic drugs for individuals who have failed first-line evidence-based treatments. This can be done by the process of "equipoise"-namely, balancing the weight of all available evidence. That evidence now includes not only diagnosis-specific treatment guidelines and "personalized" patient information, such as an individual's specific symptom profile, past response to medications, side effects, family history, and patient preference, but also "precision medicine," which incorporates the ever-expanding base of pharmacogenomic evidence for how an individual's own biomarkers alter the odds for that individual's treatment response or treatment intolerance.
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20
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Meyer JM, Cummings MA, Proctor G, Stahl SM. Psychopharmacology of Persistent Violence and Aggression. Psychiatr Clin North Am 2016; 39:541-556. [PMID: 27836150 DOI: 10.1016/j.psc.2016.07.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Persistent violence not due to acute psychosis or mania can be managed only after appropriate characterization of the aggressive episodes (psychotic, impulsive, or predatory/planned/instrumental). The type of violence combined with the psychiatric diagnosis dictates the evidence-based pharmacologic approaches for psychotically motivated and impulsive aggression, whereas instrumental violence mandates forensic/behavioral strategies. For nonacute inpatients, schizophrenia spectrum disorders, traumatic brain injury, and dementia comprise the majority of individuals who are persistently aggressive, with impulsive actions the most common form of violence across all diagnoses. Neurobiological considerations combined with empirical data provide a comprehensive framework for systematic medication trials to manage persistently aggressive patients.
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Affiliation(s)
- Jonathan M Meyer
- California Department of State Hospitals (DSH), Psychopharmacology Resource Network, DSH-Patton, 3102 East Highland Avenue, Patton, CA 92369, USA; Department of Psychiatry, University of California, San Diego; 9500 Gilman Drive, MC 0603, La Jolla, CA 92093-0603, USA.
| | - Michael A Cummings
- California Department of State Hospitals (DSH), Psychopharmacology Resource Network, DSH-Patton, 3102 East Highland Avenue, Patton, CA 92369, USA
| | - George Proctor
- California Department of State Hospitals (DSH), Psychopharmacology Resource Network, DSH-Patton, 3102 East Highland Avenue, Patton, CA 92369, USA
| | - Stephen M Stahl
- Department of Psychiatry, University of California, San Diego; 9500 Gilman Drive, MC 0603, La Jolla, CA 92093-0603, USA; California Department of State Hospitals (DSH), Bateson Building, 1600 9th Street, Room 400, Sacramento, CA 95814, USA
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21
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Liu X, Kubilis P, Bussing R, Winterstein AG. Development of a refill pattern method to measure polypharmacy in administrative claims databases. Pharmacoepidemiol Drug Saf 2016; 25:1407-1413. [PMID: 27528378 DOI: 10.1002/pds.4082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 07/02/2016] [Accepted: 07/26/2016] [Indexed: 11/12/2022]
Abstract
PURPOSE The purposes of the study were to develop a refill pattern method to identify polypharmacy in pharmacy billing records and to compare the method with traditional days' supply overlap algorithms. METHODS This method is characterized by the assessment of prescription refill pattern. Concomitant therapy is assumed when two drugs are dispensed repeatedly during the active days' supply of each other. We tested the refill pattern method in a simplified scenario in which two drugs (methylphenidate/dexmethylphenidate and atomoxetine) for attention deficit/hyperactivity disorder (ADHD) were considered. Children who had at least one prescription of methylphenidate/dexmethylphenidate or atomoxetine in 2008 were included for the calculation of 2-year prevalence of ADHD treatment polypharmacy. Results were compared with traditional method that requires a minimum overlap of 30, 60 or 90 days of filled prescriptions. We compared polypharmacy prevalence estimated by the two methods and explored reasons for disagreement. RESULTS Among 131 385 children who had at least one prescription of methylphenidate/dexmethylphenidate or atomoxetine, the refill pattern method identified 4021 patients who had ADHD treatment polypharmacy (2-year prevalence = 3.1%). This prevalence estimate fell between those from a 30- to 60-day overlap method. The Cohen's kappa regarding determination of polypharmacy was 0.83, 0.92 and 0.80 considering 90-, 60- and 30-day overlap method, respectively. CONCLUSIONS The refill pattern method can be used as another way to measure polypharmacy in administrative claims databases and can be adapted to a wide variety of research questions, diseases and study populations. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Xinyue Liu
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Paul Kubilis
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Regina Bussing
- Department of Psychiatry, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Almut G Winterstein
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA.,Department of Epidemiology, College of Medicine and Public Health and Health Professions, University of Florida, Gainesville, FL, USA
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22
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Abstract
Impulsive violence may be the behavioral consequence of inefficient information processing within specific neuronal networks. Analogous to the hypothetical pathophysiology of addiction, maladaptations within reward pathways may shift goal-directed behaviors to impulsive reactions and then to compulsive habits, in order to create impulsive violence.
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Illustrative cases to support the Cal-VAT guidelines. CNS Spectr 2015; 20:311-8. [PMID: 25817927 DOI: 10.1017/s1092852915000127] [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: 11/07/2022]
Abstract
There is increasing interest in developing more nuanced methods for managing aggression and violence in long-term psychiatric inpatient settings. However, the dearth of controlled studies has, at times, hampered presentation of viable options. Following the publication of guidelines developed in the California State Hospital forensic system, the authors present a group of 7 cases illustrating different approaches to violence management, including pharmacological, psychotherapeutic, and environmental interventions.
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24
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Hyperglycemic adverse events following antipsychotic drug administration in spontaneous adverse event reports. J Pharm Health Care Sci 2015; 1:15. [PMID: 26819726 PMCID: PMC4728749 DOI: 10.1186/s40780-015-0015-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 03/23/2015] [Indexed: 12/18/2022] Open
Abstract
Background Antipsychotics are potent dopamine antagonists used to treat schizophrenia and bipolar disorder. The aim of this study was to evaluate the relationship between antipsychotic drugs and adverse hyperglycemic events using the FDA Adverse Event Reporting System (FAERS) database. In particular, we focused on adverse hyperglycemic events associated with atypical antipsychotic use, which are major concerns. Findings We analyzed reports of adverse hyperglycemic events associated with 26 antipsychotic drugs in the FAERS database from January 2004 to March 2013. The Standardized Medical Dictionary for Regulatory Activities Queries (SMQ) preferred terms (PTs) was used to identify adverse hyperglycemic events. The number of adverse hyperglycemic reports for the top eight antipsychotic drugs, quetiapine, olanzapine, risperidone, aripiprazole, haloperidol, clozapine, prochlorperazine, and chlorpromazine was 12,471 (28.9%), 8,423 (37.9%), 5,968 (27.0%), 4,045 (23.7%), 3,445 (31.5%), 2,614 (14.3%), 1,800 (19.8%), and 1,003 (35.7%), respectively. The reporting ratio increased with co-administration of multiple antipsychotic drugs. For example, adverse hyperglycemic events represented 21.6% of reports for quetiapine monotherapy, 39.9% for two-drug polypharmacy, and 66.3% for three-drug polypharmacy. Conclusion Antipsychotic drug polypharmacy may influence signal strength, and may be associated with hyperglycemia. After considering the causality restraints of the current analysis, further robust epidemiological studies are recommended.
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