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Karrento K, Zhang L, Conley W, Qazi Z, Venkatesan T, Simpson P, Li BU. Percutaneous electrical nerve field stimulation improves comorbidities in children with cyclic vomiting syndrome. FRONTIERS IN PAIN RESEARCH 2023; 4:1203541. [PMID: 37389229 PMCID: PMC10300638 DOI: 10.3389/fpain.2023.1203541] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 05/23/2023] [Indexed: 07/01/2023] Open
Abstract
Introduction Children with cyclic vomiting syndrome (CVS) frequently suffer from disabling abdominal pain and comorbidities that impair quality of life. A noninvasive, auricular percutaneous electrical nerve field stimulation (PENFS) device is shown to be effective for abdominal pain in children with disorders of gut-brain interaction. We aimed to determine the effects of PENFS on pain, common comorbidities, and quality of life in pediatric CVS. Methods Children aged 8-18 years with drug-refractory CVS were enrolled in a prospective, open-label study receiving 6 consecutive weeks of PENFS. Subjects completed the following surveys at baseline, during/after therapy (week 6), and at extended follow-up approximately 4-6 months later: Abdominal Pain Index (API), State-Trait Anxiety Inventory for Children (STAI-C), Pittsburgh Sleep Quality Index (PSQI), and Patient Reported Outcome Measurement Information System (PROMIS) Pediatric Profile-37. Results Thirty subjects were included. Median (interquartile range, IQR) age was 10.5 (8.5-15.5) years; 60% were female. Median API scores decreased from baseline to week 6 (p = 0.003) and to extended follow-up (p < 0.0001). State anxiety scores decreased from baseline to week 6 (p < 0.0001) and to extended follow-up (p < 0.0001). There were short-term improvements in sleep at 6 weeks (p = 0.031) but not at extended follow-up (p = 0.22). Quality of life measures of physical function, anxiety, fatigue, and pain interference improved short-term, while there were long-term benefits for anxiety. No serious side effects were reported. Conclusions This is the first study to demonstrate the efficacy of auricular neurostimulation using PENFS for pain and several disabling comorbidities in pediatric CVS. PENFS improves anxiety, sleep, and several aspects of quality of life with long-term benefits for anxiety.Clinical trial registration: ClinicalTrials.gov, identifier NCT03434652.
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Affiliation(s)
- Katja Karrento
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Liyun Zhang
- Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States
| | - William Conley
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Zeeshan Qazi
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Thangam Venkatesan
- Division of Gastroenterology, The Ohio State University, Columbus, OH, United States
| | - Pippa Simpson
- Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States
| | - B U.K. Li
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States
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Chang JC, Hai-Ti-Lin, Wang YC, Gau SSF. Treatment-resistant depression in children and adolescents. PROGRESS IN BRAIN RESEARCH 2023; 281:1-24. [PMID: 37806711 DOI: 10.1016/bs.pbr.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Major depressive disorder (MDD) in children and adolescents is a significant health problem, causing profound impairments in social, academic, and family functioning and substantial morbidity and mortality. Up to 15% of children and adolescents suffer from MDD, and a proportion, around 30 to 40% of them, failed to respond to initial selective serotonin reuptake inhibitor (SSRI) treatment. The only evidence-based recommendation is medication switching to another SSRI and augmentation with cognitive behavioral therapy. Newly developing treatment, including ketamine, transcranial magnetic stimulation, psychotherapy other than cognitive behavioral therapy, and combined pharmacotherapy with other interventions, requires further longitudinal controlled trials regarding efficacy and safety in this vulnerable population.
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Affiliation(s)
- Jung-Chi Chang
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hai-Ti-Lin
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yen-Ching Wang
- Department of Psychiatry, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Susan Shur-Fen Gau
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
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Xu F, Xie Q, Kuang W, Dong Z. Interactions Between Antidepressants and Intestinal Microbiota. Neurotherapeutics 2023; 20:359-371. [PMID: 36881351 PMCID: PMC10121977 DOI: 10.1007/s13311-023-01362-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 03/08/2023] Open
Abstract
The microbiota-gut-brain axis has been shown to influence human health and diseases, including depression. The interactions between drugs and intestinal microbiota are complex and highly relevant to treat diseases. Studies have shown an interaction between antidepressants and intestinal microbiota. Antidepressants may alter the abundance and composition of intestinal microbiota, which are closely related to the treatment outcomes of depression. Intestinal microbiota can influence the metabolism of antidepressants to change their availability (e.g., tryptophan can be metabolized to kynurenine by intestinal microbiota) and regulate their absorption by affecting intestinal permeability. In addition, the permeability of the blood-brain barrier can be altered by intestinal microbiota, influencing antidepressants to reach the central nervous system. Bioaccumulation is also a type of drug-microbiota interaction, which means bacteria accumulate drugs without biotransformation. These findings imply that it is important to consider intestinal microbiota when evaluating antidepressant therapy regimens and that intestinal microbiota can be a potential target for depression treatment.
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Affiliation(s)
- Feiyu Xu
- West China School of Medicine, Sichuan University, Chengdu, 610041, China
| | - Qinglian Xie
- Department of Outpatient, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Weihong Kuang
- Mental Health Center of West China Hospital, Sichuan University, Chengdu, 610041, China
- Department of Psychiatry and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Zaiquan Dong
- Mental Health Center of West China Hospital, Sichuan University, Chengdu, 610041, China.
- Department of Psychiatry and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, China.
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Hu J, McMillan SS, Theodoros T, Collins JC, El-Den S, O’Reilly CL, Wheeler AJ. Psychotropic medication use in people living with severe and persistent mental illness in the Australian community: a cross-sectional study. BMC Psychiatry 2022; 22:705. [PMID: 36380352 PMCID: PMC9667665 DOI: 10.1186/s12888-022-04324-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 10/19/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Psychotropic polypharmacy and high-dose prescribing may play a role in therapy, however, with associated risks. The aim of this study was to describe current prescribing practices and use of four psychotropic medication groups (antipsychotics, antidepressants, mood stabilisers and benzodiazepines), focusing on polypharmacy (across and within groups) and high-dose prescribing in adults experiencing severe and persistent mental illness (SPMI) in the Australian community. METHODS 318 people taking psychotropic medication for SPMI had a medication review undertaken by a community pharmacist. Participants were recruited as part of an RCT from three Australian states/territories between September 2020-July 2021. All psychotropic medication and daily doses were recorded and reviewed for alignment with current clinical guidelines. Univariate and multiple logistic regression models investigated factors associated with antipsychotic, antidepressant, and mood stabiliser polypharmacy, and antipsychotic and antidepressant high-dose therapy. Variables included age, gender, geographic location, self- reported mental illness(es), hospital admission(s) in previous 6-months and prescriber type. RESULTS 806 psychotropic medications were prescribed for the 318 participants. Mood stabiliser polypharmacy was recorded in 19.0% of participants prescribed mood stabilisers; antipsychotic polypharmacy in 18.4% of participants prescribed antipsychotics; antidepressant polypharmacy in 11.3% of those prescribed antidepressants; and three participants (5.1%) were prescribed two benzodiazepines concurrently. Almost 18.6% of the cohort was receiving high-dose treatment; 18 participants were prescribed high-dose antipsychotics and 39 high-dose antidepressants, with two participants prescribed both. Adjusted logistic regression for polypharmacy found male gender, psychiatrist as sole prescriber, or multiple prescribers, were associated with antipsychotic polypharmacy. The adjusted model for high-dose therapy found psychiatrist as sole prescriber was significantly associated with antipsychotic and antidepressant high-dose prescribing. CONCLUSION Psychotropic polypharmacy was common in this community cohort experiencing SPMI. Whilst polypharmacy is not always inappropriate, it is a complex construct with potential benefits alongside potential risks. Benefits and harms need to be balanced however this practice is not supported by clear guidance to assist health practitioners. This study highlights the important need for regular medication reviews and strengthened communication between consumers and all healthcare professionals involved in community mental health care, to support safe and effective use of psychotropic medications.
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Affiliation(s)
- Jie Hu
- grid.1022.10000 0004 0437 5432Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Sara S McMillan
- grid.1022.10000 0004 0437 5432Menzies Health Institute Queensland, Griffith University, Brisbane, Australia ,grid.1022.10000 0004 0437 5432School of Pharmacy and Medical Sciences, Griffith University, Brisbane, Australia ,grid.1022.10000 0004 0437 5432Centre for Mental Health, Griffith University, Nathan campus, 4111 Brisbane, Australia
| | - Theo Theodoros
- grid.1003.20000 0000 9320 7537University of Queensland Faculty of Medicine, Brisbane, Australia ,Metro South Mental Health Services, Brisbane, Australia
| | - Jack C Collins
- grid.1013.30000 0004 1936 834XFaculty of Medicine and Health, The University of Sydney School of Pharmacy, University of Sydney, Sydney, Australia
| | - Sarira El-Den
- grid.1013.30000 0004 1936 834XFaculty of Medicine and Health, The University of Sydney School of Pharmacy, University of Sydney, Sydney, Australia
| | - Claire L O’Reilly
- grid.1013.30000 0004 1936 834XFaculty of Medicine and Health, The University of Sydney School of Pharmacy, University of Sydney, Sydney, Australia
| | - Amanda J Wheeler
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia. .,Centre for Mental Health, Griffith University, Nathan campus, 4111, Brisbane, Australia. .,Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
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Egberts KM, Gerlach M, Correll CU, Plener PL, Malzahn U, Heuschmann P, Unterecker S, Scherf-Clavel M, Rock H, Antony G, Briegel W, Fleischhaker C, Häge A, Hellenschmidt T, Imgart H, Kaess M, Karwautz A, Kölch M, Reitzle K, Renner T, Reuter-Dang SY, Rexroth C, Schulte-Körne G, Theisen FM, Walitza S, Wewetzer C, Fekete S, Taurines R, Romanos M. Serious Adverse Drug Reactions in Children and Adolescents Treated On- and Off-Label with Antidepressants and Antipsychotics in Clinical Practice. PHARMACOPSYCHIATRY 2022; 55:255-265. [PMID: 35130562 PMCID: PMC9458344 DOI: 10.1055/a-1716-1856] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Despite the growing evidence base for psychotropic drug treatment in pediatric patients, knowledge about the benefit-risk ratio in clinical practice remains limited. The 'Therapeutic Drug Monitoring (TDM)-VIGIL' study aimed to evaluate serious adverse drug reactions (ADRs) in children and adolescents treated with antidepressants and/or antipsychotics in approved ('on-label'), and off-label use in clinical practice. METHODS Psychiatric pediatric patients aged 6-18 years treated with antidepressants and/or antipsychotics either on-label or off-label were prospectively followed between October 2014 and December 2018 within a multicenter trial. Follow-up included standardized assessments of response, serious ADRs and therapeutic drug monitoring. RESULTS 710 youth (age=14.6±2.2 years, female=66.6%) were observed for 5.5 months on average; 76.3% received antidepressants, 47.5% antipsychotics, and 25.2% both. Altogether, 55.2% of the treatment episodes with antidepressants and 80.7% with antipsychotics were off-label. Serious ADRs occurred in 8.3% (95%CI=6.4-10.6%) of patients, mainly being psychiatric adverse reactions (77.4%), predominantly suicidal ideation and behavior. The risk of serious ADRs was not significantly different between patients using psychotropics off-label and on-label (antidepressants: 8.1% vs. 11.3%, p=0.16; antipsychotics: 8.7% vs 7.5%, p=0.67). Serious ADRs occurred in 16.6% of patients who were suicidal at enrollment versus 5.6% of patients who were not suicidal (relative risk 3.0, 95%CI=1.9-4.9). CONCLUSION Off-label use of antidepressants and antipsychotics in youth was not a risk factor for the occurrence of serious ADRs in a closely monitored clinical setting. Results from large naturalistic trials like ours can contribute to bridging the gap between knowledge from randomized controlled trials and real-world clinical settings.
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Affiliation(s)
- Karin M Egberts
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Manfred Gerlach
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany.,The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA
| | - Paul L Plener
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital Ulm, Ulm, Germany.,Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria
| | - Uwe Malzahn
- Clinical Trial Center Wuerzburg, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Peter Heuschmann
- Clinical Trial Center Wuerzburg, University Hospital Wuerzburg, Wuerzburg, Germany.,Institute of Clinical Epidemiology and Biometry, University of Wuerzburg, Germany
| | - Stefan Unterecker
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Maike Scherf-Clavel
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Hans Rock
- Central Information Office, Department of Neurology, Philipps University of Marburg, Marburg, Germany
| | - Gisela Antony
- Central Information Office, Department of Neurology, Philipps University of Marburg, Marburg, Germany
| | - Wolfgang Briegel
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital Wuerzburg, Wuerzburg, Germany.,Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Leopoldina Hospital, Schweinfurt, Germany
| | - Christian Fleischhaker
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany
| | - Alexander Häge
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Tobias Hellenschmidt
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Clinic Berlin Neukölln, Berlin, Germany
| | - Harmut Imgart
- Parkland-Clinic, Clinic for Psychosomatics and Psychotherapy, Academic Teaching hospital for the University Gießen, Bad Wildungen, Germany
| | - Michael Kaess
- Clinic for Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany.,University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Andreas Karwautz
- Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria
| | - Michael Kölch
- Department of Child and Adolescent Psychiatry and Psychotherapy, Brandenburg Medical School Brandenburg, Neuruppin, Germany.,Department of Child and Adolescent Psychiatry, Neurology, Psychosomatics, and Psychotherapy, University Medical Center Rostock, Rostock, Germany
| | - Karl Reitzle
- Specialist practice and Medical Care Center for Child and Adolescent Psychiatry Munich, Munich, Germany
| | - Tobias Renner
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Psychiatry and Psychotherapy Tuebingen, Center of Mental Health Tuebingen, Germany
| | - Su-Yin Reuter-Dang
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital Wuerzburg, Wuerzburg, Germany.,Specialist practice and Medical Care Center for Child and Adolescent Psychiatry Munich, Munich, Germany
| | - Christian Rexroth
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy at the Regensburg District Hospital, Medbo KU, University Hospital, Regensburg, Germany
| | - Gerd Schulte-Körne
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Ludwig-Maximilians-University (LMU) Hospital, Munich, Germany
| | - Frank M Theisen
- Herz-Jesu-Krankenhaus gGmbH, Department of Child and Adolescent Psychiatry and Psychotherapy, Fulda, Germany
| | - Susanne Walitza
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, Switzerland
| | - Christoph Wewetzer
- Kliniken der Stadt Köln gGmbH, Clinic for Child and Adolescent Psychiatry Holweide, Children's Hospital Amsterdamer Straße, Cologne, Germany
| | - Stefanie Fekete
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Regina Taurines
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Marcel Romanos
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital Wuerzburg, Wuerzburg, Germany
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Spence O, Reeves G, dosReis S. Evaluating the association between antidepressant dose trajectories and treatment augmentation in pediatric depression. Pharmacoepidemiol Drug Saf 2021; 31:176-186. [PMID: 34529312 DOI: 10.1002/pds.5358] [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: 03/07/2021] [Revised: 09/08/2021] [Accepted: 09/13/2021] [Indexed: 11/08/2022]
Abstract
PURPOSE To identify antidepressant dose trajectories in the first 6-months of antidepressant initiation and to evaluate the association between antidepressant dose trajectories and augmentation with another psychotropic medication. METHODS Using the IQVIA PharMetrics® Plus database, we identified 5655 commercially insured youth (3-18 years) with depression who newly initiated an antidepressant anytime from January 2007 to June 2015. No antidepressant use within 1 year prior to the index prescription defined new use. Latent class growth analysis of antidepressant dosing in the 6 months after initiation defined the exposure groups. The outcome was any regimen change, that is, antidepressant augmentation with another psychotropic or discontinuation of the antidepressant, with and without switching to another psychotropic. Baseline covariates measured in the 6 months before antidepressant initiation included demographic factors, psychiatric comorbidities, and health service use. Multinomial logistic regression tested the association between antidepressant dose trajectories and the odds of an antidepressant regimen change. RESULTS Five dose trajectories were sharp decline (n = 897; 16%), slow decline (n = 1029; 18%), stable minimum dose (n = 1397; 25%), stable maximum dose (n = 1783; 32%), and increasing high dose (n = 549; 10%). Relative to the stable minimum dose group, the sharp and slow decline groups were more likely to discontinue the antidepressant, either switch to another psychotropic (OR [odds ratio]: 5.91; 95%CI: 3.23-10.80 and OR: 1.67; 95%CI: 1.04-2.68, respectively) or stop all psychotropic medication (OR: 6.64; 95%CI: 4.24-10.39 and OR: 1.62; 95%CI: 1.22-2.13, respectively). However, the stable maximum and increasing high-dose groups were less likely to discontinue, either switch (OR: 0.38; 95%CI: 0.24-0.61 and OR: 0.30; 95%CI: 0.16-0.59, respectively) or stop all psychotropic medications (OR: 0.15; 95%CI: 0.12-0.20 and OR: 0.02; 95%CI: 0.01-0.03 respectively) than augment with another psychotropic. CONCLUSIONS The findings from this cross-sectional study demonstrate an association between antidepressant dose trajectories within 6 months of initiating treatment and the odds of augmenting with another psychotropic.
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Affiliation(s)
- O'Mareen Spence
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Gloria Reeves
- Division of Child and Adolescent Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Susan dosReis
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
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Nind J, Smith A, Devananda M, Auvray B. A whole of population retrospective observational study on the rates of polypharmacy in New Zealand 2014 to 2018 Polypharmacy in New Zealand: What is the current status? Health Sci Rep 2021; 4:e263. [PMID: 33732897 PMCID: PMC7945953 DOI: 10.1002/hsr2.263] [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: 08/07/2020] [Revised: 01/29/2021] [Accepted: 02/07/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND AIMS Polypharmacy (≥5 medicines) and hyperpolypharmacy (≥10 medicines) can significantly impact people's health. The literature surrounding polypharmacy focuses on the elderly, particularly rest home populations, with few studies looking into younger age bands. Moreover, there have been no recent studies looking into the rates of polypharmacy in New Zealand. This study aimed to determine whether polypharmacy rates have increased over time in the New Zealand population. Specifically investigating polypharmacy rates across age and ethnicity, and identifying which medicines are most commonly prescribed in people with polypharmacy. METHODS A nationwide retrospective observational study was carried out between 2014 and 2018 on 4 697 274 New Zealanders (96% of the population) by linking dispensing data from the Pharmaceutical Collection to patient enrolment data using a National Health Identifier (NHI) to identify the rate of long-term medicine prescribing in New Zealand. RESULTS Our study found the rate of polypharmacy to be 9.93% and hyperpolypharmacy to be 1.92% nationwide in 2018, a percentage increase of 4.1% and 7.11% from 2014, respectively. During the same period, we observed the greatest percentage increase (30.37%) in the rate of polypharmacy in the 20 to 29 age band while the rates decreased in older populations. Variation was also noted between ethnicities. Medicines contributing to polypharmacy differed by age group. CONCLUSION Current methods for minimizing polypharmacy and optimizing medicines use are narrowly focused on the elderly. Despite an increase in education and awareness raising campaigns, rates continue to rise in New Zealand's population.
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Affiliation(s)
- James Nind
- School of Pharmacy, University of OtagoDunedinNew Zealand
| | - Alesha Smith
- School of Pharmacy, University of OtagoDunedinNew Zealand
- Airmed LtdDunedinNew Zealand
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Cao TXD, Fraga LFC, Fergusson E, Michaud J, Dell'Aniello S, Yin H, Rej S, Azoulay L, Renoux C. Prescribing Trends of Antidepressants and Psychotropic Coprescription for Youths in UK Primary Care, 2000-2018. J Affect Disord 2021; 287:19-25. [PMID: 33765538 DOI: 10.1016/j.jad.2021.03.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/03/2021] [Accepted: 03/05/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND There is lack of recent information on the prescribing trends of antidepressants and coprescription with other psychotropic medications in the United Kingdom (UK) pediatric population. METHODS Using the Clinical Practice Research Datalink, we estimated the annual rates of patients newly prescribed an antidepressant (selective serotonin reuptake inhibitors (SSRIs), other newer generation antidepressants, and tricyclic antidepressants (TCAs)) and the percentage of new users of antidepressants with a same-day coprescription for other psychotropic medications. We also estimated the prevalence of patients with antidepressant prescriptions and percentage of coprescription for other psychotropic medications. RESULTS After a 42% decline from 2000 to 2005, the rate of patients newly prescribed an antidepressant increased from 2006 onwards. From 2008 to 2018, the rate increased from 254.3 to 471.2 per 100,000 person-years (rate ratio 1.97, 95% confidence interval 1.96-1.99). The rate was higher in females and adolescents aged 15 to 17. SSRIs were most commonly prescribed (70% of all antidepressant prescriptions). Overall, 4.7% of patients newly prescribed an antidepressant had at least one same-day coprescription for another psychotropic medication. During the study period, coprescription rose from 2.6% to 6.4% and was more frequent in males. In 2018, most coprescriptions were anxiolytics and hypnotics (63%) and antipsychotics (26%). Trends in prevalent prescriptions corresponded to trends in new prescriptions. LIMITATIONS By using a primary care database, we did not have information on prescriptions from specialists or during hospitalizations. CONCLUSIONS During the last decade, antidepressant prescriptions and psychotropic coprescription in primary care increased in UK children and adolescents.
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Affiliation(s)
- Thi Xuan Dai Cao
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Québec, Canada; Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Québec, Canada
| | | | - Emma Fergusson
- Oxford Health NHS Trust, Department of Psychiatry, Oxford University, Oxford, United Kingdom
| | - Jonathan Michaud
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Québec, Canada
| | - Sophie Dell'Aniello
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Québec, Canada
| | - Hui Yin
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Québec, Canada
| | - Soham Rej
- Department of Psychiatry, McGill University, Montreal, Québec, Canada
| | - Laurent Azoulay
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Québec, Canada; Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Québec, Canada; Gerald Bronfman Department of Oncology, McGill University, Montreal, Québec, Canada
| | - Christel Renoux
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Québec, Canada; Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Québec, Canada; Department of Neurology and Neurosurgery, McGill University, Montreal, Québec, Canada.
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9
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Baker M, Huefner JC, Bellonci C, Hilt R, Carlson GA. Polypharmacy in the Management of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents: A Review and Update. J Child Adolesc Psychopharmacol 2021; 31:148-163. [PMID: 33600217 DOI: 10.1089/cap.2020.0162] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Objective: Prescription of multiple medications concurrently for children and adolescents has increased in recent years. Examination of this practice has been undervalued relative to its incidence. This article reviews studies investigating effectiveness of medication combinations for youth with attention-deficit/hyperactivity disorder (ADHD). Methods: A literature search identified studies that combined two or more prescribed medications for the treatment of ADHD. Included studies focused on youth; had study design of randomized controlled trial (RCT), nonrandomized trial, or case review (n > 10); and included an outcome measure of treatment effectiveness. Results: Thirty-nine pertinent studies were identified. All studies combined two medications, with the vast majority including a stimulant (n = 37). The largest group (n = 16) combined stimulant and alpha-agonist, finding greater efficacy than alpha-agonist alone but not stimulant alone in all cases. A few RCTs found benefit from the addition of risperidone or divalproex to stimulant for comorbid aggression. Four studies adding atomoxetine found mixed reports of benefit, including the only small RCT showing no benefit. RCTs with selective serotonin reuptake inhibitors found minimal evidence of benefit for mood or anxiety comorbidities. Conclusion: The best studied combination is stimulant and alpha-agonist; addition of alpha-agonist to stimulant seems effective for residual symptoms of ADHD. Stimulant plus risperidone has the most evidence of efficacy for comorbid aggression or disruptive behavior. Limited support exists for the effectiveness of other medication combinations, including no trials studying three or more medications concurrently. Combinations frequently yielded more side effects, leaving monotherapy preferable if a sufficient treatment response can be achieved.
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Affiliation(s)
- Megan Baker
- Momentum for Health, San Jose, California, USA
| | - Jonathan C Huefner
- Boys Town Child and Family Translational Research Center, Boys Town, Nebraska, USA
| | - Christopher Bellonci
- Judge Baker Children's Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert Hilt
- Seattle Children's Hospital, Seattle, Washington, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Gabrielle A Carlson
- Division of Child and Adolescent Psychiatry, Renaissance School of Medicine at Stony Brook, Stony Brook, New York, USA
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10
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Zito JM, Zhu Y, Safer DJ. Psychotropic Polypharmacy in the US Pediatric Population: A Methodologic Critique and Commentary. Front Psychiatry 2021; 12:644741. [PMID: 34194346 PMCID: PMC8236612 DOI: 10.3389/fpsyt.2021.644741] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/26/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Psychotropic concomitant medication use for the treatment of youth with emotional and behavioral disorders has grown significantly in the U.S. over the past 25 years. The use of pharmacy claims to analyze these trends requires the following: age of the selected population, overlapping days of use, and precision of the outcome itself. This review will also address the gaps in reporting of pediatric psychotropic polypharmacy. Methods: An electronic literature search was undertaken for the period 2000 through 2020 using keywords such as "pediatric," "concomitant," "polypharmacy," "multiple medications," and "concurrent psychotropic"; Relevant references in textbooks were also used. Only English language and U.S. studies were included, resulting in 35 inter-class studies. Results: Studies were organized into seven groups according to data sources and clinical topics: (1) population surveys; (2a) multi-state publicly insured populations; (2b) single/two state studies; (3) privately insured populations; (4) diagnosed populations; (5) foster care populations; (6) special settings. Across 20 years it is apparent that pediatric psychotropic polypharmacy affects substantially more children and adolescents today than had been the case. As many as 300,000 youth now receive 3 or more classes concomitantly. The duration of concomitant use is relatively long, e.g., 69-89% of annual medicated days. Finally, more adverse event reports were associated with 3-class compared with 2-class drug regimens. Discussion: Factors that contribute to the growth of pediatric psychotropic polypharmacy include: (1) predominance of the biological model in psychiatric practice; (2) invalid assumptions on efficacy of combinations, (3) limited professional awareness of metabolic and neurological adverse drug events, and (4) infrequent use of appropriate deprescribing. Conclusion: A review of publications documenting U.S. pediatric psychotropic polypharmacy written over the last 20 years supports the need to standardize the methodologies used. The design of population-based studies should maximize information on the number of youth receiving regimens of 3-, 4-, and 5 or more concomitant classes and the duration of such use. Next, far more post-marketing research is needed to address the effectiveness, safety and tolerability of complex drug regimens prescribed for youngsters.
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Affiliation(s)
- Julie M Zito
- Department of Pharmaceutical Health Services Research, School of Pharmacy, Baltimore, MD, United States.,Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, MD, United States
| | - Yue Zhu
- Department of Pharmaceutical Health Services Research, School of Pharmacy, Baltimore, MD, United States.,Department of Epidemiology, School of Public Health, George Washington University, Washington, DC, United States
| | - Daniel J Safer
- Department of Psychiatry, The Johns Hopkins Hospital, Johns Hopkins Medicine, Baltimore, MD, United States
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11
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Lopez Pineda A, Pourshafeie A, Ioannidis A, Leibold CM, Chan AL, Bustamante CD, Frankovich J, Wojcik GL. Discovering prescription patterns in pediatric acute-onset neuropsychiatric syndrome patients. J Biomed Inform 2020; 113:103664. [PMID: 33359113 DOI: 10.1016/j.jbi.2020.103664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 10/28/2020] [Accepted: 12/10/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Pediatric acute-onset neuropsychiatric syndrome (PANS) is a complex neuropsychiatric syndrome characterized by an abrupt onset of obsessive-compulsive symptoms and/or severe eating restrictions, along with at least two concomitant debilitating cognitive, behavioral, or neurological symptoms. A wide range of pharmacological interventions along with behavioral and environmental modifications, and psychotherapies have been adopted to treat symptoms and underlying etiologies. Our goal was to develop a data-driven approach to identify treatment patterns in this cohort. MATERIALS AND METHODS In this cohort study, we extracted medical prescription histories from electronic health records. We developed a modified dynamic programming approach to perform global alignment of those medication histories. Our approach is unique since it considers time gaps in prescription patterns as part of the similarity strategy. RESULTS This study included 43 consecutive new-onset pre-pubertal patients who had at least 3 clinic visits. Our algorithm identified six clusters with distinct medication usage history which may represent clinician's practice of treating PANS of different severities and etiologies i.e., two most severe groups requiring high dose intravenous steroids; two arthritic or inflammatory groups requiring prolonged nonsteroidal anti-inflammatory drug (NSAID); and two mild relapsing/remitting group treated with a short course of NSAID. The psychometric scores as outcomes in each cluster generally improved within the first two years. DISCUSSION AND CONCLUSION Our algorithm shows potential to improve our knowledge of treatment patterns in the PANS cohort, while helping clinicians understand how patients respond to a combination of drugs.
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Affiliation(s)
- Arturo Lopez Pineda
- Department of Biomedical Data Science, Stanford University, CA, USA; Department of Data Science, Amphora Health, Morelia, Mexico
| | - Armin Pourshafeie
- Department of Biomedical Data Science, Stanford University, CA, USA; Department of Physics, Stanford University, CA, USA
| | | | - Collin McCloskey Leibold
- Department of Pediatrics, Division of Allergy, Immunology, and Rheumatology, Stanford University, CA, USA; Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Avis L Chan
- Department of Pediatrics, Division of Allergy, Immunology, and Rheumatology, Stanford University, CA, USA
| | - Carlos D Bustamante
- Department of Biomedical Data Science, Stanford University, CA, USA; Department of Genetics, Stanford University, CA, USA; Chan Zuckerberg Biohub, San Francisco, CA, USA.
| | - Jennifer Frankovich
- Department of Pediatrics, Division of Allergy, Immunology, and Rheumatology, Stanford University, CA, USA.
| | - Genevieve L Wojcik
- Department of Biomedical Data Science, Stanford University, CA, USA; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
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12
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Brett J, Pearson SA, Daniels B, Wylie CE, Buckley NA. A cross sectional study of psychotropic medicine use in Australia in 2018: A focus on polypharmacy. Br J Clin Pharmacol 2020; 87:1369-1377. [PMID: 32881057 DOI: 10.1111/bcp.14527] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 07/23/2020] [Accepted: 07/28/2020] [Indexed: 12/29/2022] Open
Abstract
AIMS To examine prescribed psychotropic medicine use on a given day in Australia (25 September 2018; World Pharmacists Day), with a focus on psychotropic polypharmacy. METHODS We used a 10% sample of individual-level nationwide dispensing claims to examine psychotropic medicine use on a given day. We estimated the prevalence of psychotropic medicine use in all ages stratified by age and sex. We also calculated the observed vs expected (had medicines been randomly combined) prevalence of psychotropic combinations used. We focused on combinations of clinical significance as well combinations of psychotropics with medicines prescribed to manage cardiovascular risk and disease. RESULTS Serotonin reuptake inhibitors, serotonin-noradrenalin reuptake inhibitors/noradrenaline reuptake inhibitors, tricyclic antidepressants and gabapentinoids dominated psychotropic use. The use of any psychotropic as a proportion of people in the Australian population increased with age, peaking at the 85-89 year age group and declining thereafter. Combinations of medicines from the same subclass generally occurred at lower than expected frequencies. However, combinations including atypical antipsychotics occurred more frequently than expected; e.g. 7.4× with anticonvulsants and 2.2× with other atypical antipsychotics. This was also the case for combinations of sedatives, e.g. anxiolytic with hypnotic benzodiazepines (3.8×). Lipid-lowering drugs and antidiabetic medicines were combined with psychotropics at frequencies close to those expected had they been randomly combined. CONCLUSION Psychotropic use in older adults and certain psychotropic combinations that are not well supported with evidence remain prevalent and greater consideration of the drivers of this potentially inappropriate prescribing is required.
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Affiliation(s)
- Jonathan Brett
- Medicines Policy Research Unit, Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia.,Clinical Pharmacology and Toxicology Research Group, Discipline of Pharmacology, The University of Sydney, Sydney, NSW, Australia
| | - Sallie-Anne Pearson
- Medicines Policy Research Unit, Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Benjamin Daniels
- Medicines Policy Research Unit, Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Claire E Wylie
- Clinical Pharmacology and Toxicology Research Group, Discipline of Pharmacology, The University of Sydney, Sydney, NSW, Australia
| | - Nicholas A Buckley
- Clinical Pharmacology and Toxicology Research Group, Discipline of Pharmacology, The University of Sydney, Sydney, NSW, Australia
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13
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Lai LL, Alvarez G, Dang L, Vuong D, Ngo V, Jo Y, Koh L. Prevalence and trend of potential drug–drug interaction among children with depression in U.S. outpatient settings. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2019. [DOI: 10.1111/jphs.12320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- L. Leanne Lai
- Department of Sociobehavioral and Administrative Pharmacy College of Pharmacy Nova Southeastern University Ft. Lauderdale FL USA
| | - Goar Alvarez
- College of Pharmacy Nova Southeastern University Ft. Lauderdale FL USA
| | - Linh Dang
- College of Pharmacy Nova Southeastern University Ft. Lauderdale FL USA
| | - Dung Vuong
- College of Pharmacy Nova Southeastern University Ft. Lauderdale FL USA
| | - Vy Ngo
- College of Pharmacy Nova Southeastern University Ft. Lauderdale FL USA
| | - Yailin Jo
- College of Pharmacy Nova Southeastern University Ft. Lauderdale FL USA
| | - Leroy Koh
- Department of Pharmacy Houston Methodist Hospital Houston TX USA
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14
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Jeon SM, Park S, Rhie SJ, Kwon JW. Prescribing patterns of polypharmacy in Korean pediatric patients. PLoS One 2019; 14:e0222781. [PMID: 31574095 PMCID: PMC6773215 DOI: 10.1371/journal.pone.0222781] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 09/07/2019] [Indexed: 02/06/2023] Open
Abstract
Background Several studies have examined the risk and health outcomes related to polypharmacy among the elderly. However, information regarding polypharmacy among pediatric patients is lacking. Objective The aim of this study was to investigate the prevalence of polypharmacy and its related factors among the pediatric population of South Korea. Methods We used national claim data from the Health Insurance Review and Assessment Service—Pediatric Patients Sample (HIRA-PPS) in Korea originating from 2012 through 2016. Polypharmacy was defined as a daily average of two or more drugs used yearly. Complex chronic conditions (CCCs) were examined to evaluate concomitant chronic diseases in pediatric patients. Age-specific contraindications and potential drug-drug interactions were assessed according to criteria established by the Korea Institute of Drug Safety & Risk Management (KIDS). Descriptive statistics and logistic regression were conducted to analyze the status of polypharmacy and its associated risk factors in pediatric patients. Results The 5-year prevalence of pediatric polypharmacy in pediatric patients was 3.7%. The prevalence of polypharmacy was much higher in younger pediatric patients: 9.5% for patients between the ages of 1–7 years, 0.9% for ages 6–11 years, and 1.1% for ages 12–19 years. Pediatric patients with CCCs, Medical Aid benefits, or a hospital admission history had a significantly higher prevalence of polypharmacy when compared to their counterparts without those conditions. The most commonly prescribed drugs were respiratory agents (29%) followed by anti-allergic drugs (18.7%), central nervous system agents (15.9%), antibiotics (10.1%), and gastrointestinal drugs (7.7%). There was a positive correlation between the daily average number of inappropriate prescriptions and the degree of polypharmacy, especially in pediatric patients between the ages of 1–7 years. Contraindications and potential drug-drug interactions occurred in 11.0% and 10.1% of patients exposed to polypharmacy, respectively. Conclusions One in ten pediatric patients under the age of 7 years was prescribed two or more concurrent drugs on average per day. Furthermore, pediatric patients exposed to polypharmacy showed an increased risk of inappropriate drug use. The implementation of a medication review system that considers pediatric patient polypharmacy exposure would reduce inappropriate drug use and prevent unwanted adverse outcomes.
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Affiliation(s)
- Soo-Min Jeon
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu, Korea
| | - Susan Park
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu, Korea
| | - Sandy Jeong Rhie
- College of Pharmacy and Division of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul, Korea
| | - Jin-Won Kwon
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu, Korea
- * E-mail:
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15
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Blasco-Fontecilla H. Clinical utility of pharmacogenetic testing in children and adolescents with severe mental disorders. J Neural Transm (Vienna) 2018; 126:101-107. [PMID: 29626260 PMCID: PMC6373261 DOI: 10.1007/s00702-018-1882-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 04/02/2018] [Indexed: 12/03/2022]
Abstract
This is a retrospective cohort study of 20 children and adolescents to evaluate the clinical utility of a pharmacogenetic decision support tool. Twenty children and adolescents underwent pharmacogenetic testing between June 2014 and May 2017. All children and adolescents were evaluated at Puerta de Hierro University Hospital-Majadahonda (Madrid, Spain). We report the proportion of patients achieving clinical improvement, amelioration of side effects, and changes in number of drugs. Data normality was assessed with the Shapiro–Wilk test, and changes of pre- and post-pharmacogenetic testing were analyzed with the Wilcoxon test for paired samples. A two-sided p value threshold of 0.05 was considered for significance. Pharmacogenetic testing helped to improve the clinical outcome as measured by the Clinical Global Impressions (CGI) Scale in virtually all children (95%; 19 out of 20 children). The CGI improvement (CGI-I) was 2 (0.79) (range 1–4), 2.1 (0.56) (range 1–3), and 1.9 (0.99) (range 1–4) in foster and non-foster care children, respectively. Pharmacogenetic testing also helped to reduce the number of children using polypharmacy (from 65 to 45%), the mean number of drugs per children (from 3.3 to 2.4 drugs, p = 0.017), and self-reported relevant side effects (p = 0.006). Pharmacogenetic testing helped to improve the clinical outcome, and to reduce polypharmacy and the number of drugs used in children and adolescents with severe mental disorders. More evidence using robust (i.e., clinical trials) independent studies is required to properly determine the clinical utility and cost-effectiveness of pharmacogenetic testing tools in children and adolescents with mental disorders.
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Affiliation(s)
- Hilario Blasco-Fontecilla
- Department of Psychiatry, Segovia de Arana Health Research Institute (IDIPHISA)-Puerta de Hierro University Hospital, Avenida Manuel de Falla s/n, Majadahonda, Madrid, Spain.
- Autonoma University, Madrid, Spain.
- Biomedical Research Centre in Mental Health Net (CIBERSAM), Madrid, Spain.
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16
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Bushnell GA, Compton SN, Dusetzina SB, Gaynes BN, Brookhart MA, Walkup JT, Rynn MA, Stürmer T. Treating Pediatric Anxiety: Initial Use of SSRIs and Other Antianxiety Prescription Medications. J Clin Psychiatry 2018; 79:16m11415. [PMID: 29099547 PMCID: PMC6468981 DOI: 10.4088/jcp.16m11415] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 06/15/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Multiple pharmacotherapies for treating anxiety disorders exist, including selective serotonin reuptake inhibitors (SSRIs), the recommended first-line pharmacotherapy for pediatric anxiety. We sought to describe initial antianxiety medication use in children and estimate how long antianxiety medications were continued. METHODS In a large commercial claims database, we identified children (3-17 years) initiating prescription antianxiety medication from 2004 to 2014 with a recent anxiety diagnosis (ICD-9-CM = 293.84, 300.0x, 300.2x, 300.3x, 309.21, 309.81, 313.23). We estimated the proportion of children initiating each medication class across the study period and used multivariable regression to evaluate factors associated with initiation with an SSRI. We evaluated treatment length for each initial medication class. RESULTS Of 84,500 children initiating antianxiety medication, 70% initiated with an SSRI (63% [95% CI, 62%-63%] SSRI alone, 7% [95% CI, 7%-7%] SSRI + another antianxiety medication). Non-SSRI medications initiated included benzodiazepines (8%), non-SSRI antidepressants (7%), hydroxyzine (4%), and atypical antipsychotics (3%). Anxiety disorder, age, provider type, and comorbid diagnoses were associated with initial medication class. The proportion of children refilling their initial medication ranged from 19% (95% CI, 18%-20%) of hydroxyzine initiators and 25% (95% CI, 24%-26%) of benzodiazepine initiators to 81% (95% CI, 80%-81%) of SSRI initiators. Over half (55%, 95% CI, 55%-56%) of SSRI initiators continued SSRI treatment for 6 months. CONCLUSIONS SSRIs are the most commonly used first-line medication for pediatric anxiety disorders, with about half of SSRI initiators continuing treatment for 6 months. Still, a third began therapy on a non-SSRI medication, for which there is limited evidence of effectiveness for pediatric anxiety, and a notable proportion of children initiated with 2 antianxiety medication classes.
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Affiliation(s)
- Greta A. Bushnell
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Scott N. Compton
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Stacie B. Dusetzina
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill Eshelman School of Pharmacy and the Department of Health Policy and Management, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Bradley N. Gaynes
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - M. Alan Brookhart
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - John T. Walkup
- Division of Child and Adolescent Psychiatry, Weill Cornell Medical College, New York, New York
| | - Moira A. Rynn
- Division of Child and Adolescent Psychiatry, Department of Psychiatry at Columbia University/New York State Psychiatric Institute, New York, New York
| | - Til Stürmer
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina
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Olashore AA, Rukewe A. Polypharmacy among children and adolescents with psychiatric disorders in a mental referral hospital in Botswana. BMC Psychiatry 2017; 17:174. [PMID: 28486963 PMCID: PMC5424412 DOI: 10.1186/s12888-017-1347-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 05/03/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a dearth of data on polypharmacy in child and adolescent mental health in Africa, especially Botswana where children and adults are treated in the same facility by general adult psychiatrists. This study was therefore designed to assess the prevalence and the risk factors of psychiatric polypharmacy among children and adolescents treated at Sbrana Psychiatric Hospital, Lobatse, Botswana. METHODS Data involving socio-demographics, diagnosis (using ICD-10 classification) and pharmacological treatment were retrieved from the records of 120 children and adolescents aged below 18 years, between 1 January 2012 and 31 July 2016, who presented with psychiatric disorders. They were analysed with univariate and multivariate models. RESULTS The prevalence of psychiatric polypharmacy was 29.2%. Psychiatric co-morbidity (OR = 3.374, 95% CI: 1.177-9.9673) and psychotropic side effects (OR = 5.782, 95% CI: 1.636-20.430) were significantly associated with polypharmacy after regression analysis. CONCLUSION Psychiatric co-morbidity and psychotropic side effects were significant risk factors for polypharmacy in Botswana.
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Affiliation(s)
- Anthony A. Olashore
- 0000 0004 0635 5486grid.7621.2Department of Psychiatry, University of Botswana, Gaborone, Botswana
| | - Ambrose Rukewe
- 0000 0004 0635 5486grid.7621.2Department of Anesthesia and Critical Care, University of Botswana, Gaborone, Botswana
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Baumann P, Spies M, Möller HJ, Kasper S, Bitter I, Laux G. A proposal for a psychopharmacology-pharmacotherapy catalogue of learning objectives and a curriculum in Europe. World J Biol Psychiatry 2017; 18:29-38. [PMID: 26850137 DOI: 10.3109/15622975.2016.1149219] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objectives Post-graduate training for specialisation in psychiatry and psychotherapy is part of a 4-6-year programme. This paper aims to inform on the general situation of teaching and training of psychopharmacology-psychopharmacotherapy in Europe. It presents the need for a psychopharmacotherapy education in psychiatric training programmes. Arguments as well as a proposal for a catalogue of learning objectives and an outline of a psychopharmacology curriculum are presented. Methods Based on their experience and on an analysis of the literature, the authors, experts in psychopharmacology-pharmacotherapy teaching, critically analyse the present situation and propose the development of a curriculum at the European level. Results Teaching programmes vary widely between European countries and, generally, teaching of psychopharmacology and pharmacotherapy does not exceed two-dozen hours. This is insufficient if one considers the central importance of psychopharmacology. A psychopharmacology-psychopharmacotherapy curriculum for the professional training of specialists in psychiatry and psychotherapy is proposed. Conclusions As the number of hours of theoretical teaching and practical training is insufficient, a catalogue of learning objectives should be established, which would then be part of a comprehensive curriculum at the European level. It could be inspired partly by those few previously proposed by other groups of authors and organisations.
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Affiliation(s)
- Pierre Baumann
- a Department of Psychiatry (DP-CHUV) , University of Lausanne, Site de Cery , Prilly-Lausanne , Switzerland
| | - Marie Spies
- b Department of Psychiatry and Psychotherapy , Medical University of Vienna , Vienna , Austria
| | - Hans-Jürgen Möller
- c Department of Psychiatry and Psychotherapy , Ludwig-Maximilians-University , Munich , Germany
| | - Siegfried Kasper
- b Department of Psychiatry and Psychotherapy , Medical University of Vienna , Vienna , Austria
| | - Istvan Bitter
- d Department of Psychiatry and Psychotherapy , Semmelweis University , Budapest , Hungary
| | - Gerd Laux
- e Institute of Psychological Medicine (IPM), Haag i.OB, and Department of Psychiatry and Psychotherapy , Ludwig-Maximilians-University , Munich , Germany
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Present and future of developmental neuropsychopharmacology. Eur Neuropsychopharmacol 2015; 25:703-12. [PMID: 25432076 DOI: 10.1016/j.euroneuro.2014.11.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 10/08/2014] [Accepted: 11/04/2014] [Indexed: 11/24/2022]
Abstract
The field of child and adolescent psychiatry has always lagged behind adult psychiatry. With recent evidence that the vast majority of mental disorders, even when they emerge in adulthood, cause abnormal neurodevelopment and resultant emphasis on prevention and early intervention, there is a need to put child psychiatry at the top of the agenda in mental health research. This should also be the case for developmental neuropsychopharmacology. The target of drug discovery should shift toward a population younger than the one that is typically included in clinical trials. This is not only a matter of trying to replicate what has been found in individuals with mature brains; it is about searching for new strategies that address developing brains while the therapeutic window for their effect is still open. At present, major concerns in developmental psychopharmacology are over-prescription rates and use of psychotropic medications for conditions with a particularly underdeveloped evidence base, as well as adverse effects, especially potentially life-shortening cardiometabolic effects and suicidal ideation. The future of research in this area should focus on the use of drugs for primary and secondary prevention that would modify abnormal brain development.
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20
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Pottegård A, Zoëga H, Hallas J, Damkier P. Use of SSRIs among Danish children: a nationwide study. Eur Child Adolesc Psychiatry 2014; 23:1211-8. [PMID: 24493268 DOI: 10.1007/s00787-014-0523-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 01/20/2014] [Indexed: 01/05/2023]
Abstract
Our objective was to describe the use of selective serotonin reuptake inhibitors (SSRIs) in the entire Danish population of children and adolescents from 1995 to 2011. Data on filled SSRIs were obtained for all children in Denmark aged 5-17 during 1995-2011. The amount and type of SSRIs filled were calculated as well as incidence rates and prevalence proportions. Furthermore, we looked at concurrent use of other psychotropic drug treatment duration. A total of 23,547 children aged 5-17 used SSRIs during the study period, most commonly sertraline followed by citalopram. Overall, the incidence rate increased from 0.57 per 1,000 person years in 1997 to 3.30 in 2010 and fell to 2.55 in 2011, while the prevalence proportion rose from 0.1 per 1,000 children at the end of 1995 to 3.3 at the end of 2011. However, these findings were driven entirely by an increase among adolescents (12-17 years), where the prevalence proportion rose from 0.11 and 0.36 to 4.64 and 8.52 per 1,000 boys and girls, respectively. A significant proportion of SSRI users used other psychotropic drugs concurrently, most notably antipsychotics (12-28 %) and psychostimulants (10-33 %). About 50 % of adolescents and 40 % of children discontinued treatment within 12 months of initiation. We found a marked increase in the use of SSRI drugs among adolescents in Denmark between 1995 and 2011. Whether this increase reflects a true increase in disorder occurrence, an increase in diagnostic intensity or more aggressive treatment remains uncertain.
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Affiliation(s)
- Anton Pottegård
- Clinical Pharmacology, Institute of Public Health, University of Southern Denmark, JB Winsløwsvej 19, 2, 5000, Odense C, Denmark,
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