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Xu B, Forthman KL, Kuplicki R, Ahern J, Loughnan R, Naber F, Thompson WK, Nemeroff CB, Paulus MP, Fan CC. Genetic Correlates of Treatment-Resistant Depression: Insights from Polygenic Scores Across Cognitive, Temperamental, and Sleep Traits in the All of US cohort. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.07.03.24309914. [PMID: 39006419 PMCID: PMC11245070 DOI: 10.1101/2024.07.03.24309914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
Background Treatment-resistant depression (TRD) is a major challenge in mental health, affecting a significant number of patients and leading to considerable economic and social burdens. The etiological factors contributing to TRD are complex and not fully understood. Objective To investigate the genetic factors associated with TRD using polygenic scores (PGS) across various traits, and to explore their potential role in the etiology of TRD using large-scale genomic data from the All of Us Research Program (AoU). Methods Data from 292,663 participants in the AoU were analyzed using a case-cohort design. Treatment resistant depression (TRD), treatment responsive Major Depressive Disorder (trMDD), and all others who have no formal diagnosis of Major Depressive Disorder (non-MDD) were identified through diagnostic codes and prescription patterns. Polygenic scores (PGS) for 61 unique traits from seven domains were used and logistic regressions were conducted to assess associations between PGS and TRD. Finally, Cox proportional hazard models were used to explore the predictive value of PGS for progression rate from the diagnostic event of Major Depressive Disorder (MDD) to TRD. Results In the discovery set (104128 non-MDD, 16640 trMDD, and 4177 TRD), 44 of 61 selected PGS were found to be significantly associated with MDD, regardless of treatment responsiveness. Eleven of them were found to have stronger associations with TRD than with trMDD, encompassing PGS from domains in education, cognition, personality, sleep, and temperament. Genetic predisposition for insomnia and specific neuroticism traits were associated with increased TRD risk (OR range from 1.05 to 1.15), while higher education and intelligence scores were protective (ORs 0.88 and 0.91, respectively). These associations are consistent across two other independent sets within AoU (n = 104,388 and 63,330). Among 28,964 individuals tracked over time, 3,854 developed TRD within an average of 944 days (95% CI: 883 ~ 992 days) after MDD diagnosis. All eleven previously identified and replicated PGS were found to be modulating the conversion rate from MDD to TRD. Thus, those having higher education PGS would experiencing slower conversion rates than those who have lower education PGS with hazard ratios in 0.79 (80th versus 20th percentile, 95% CI: 0.74 ~ 0.85). Those who had higher insomnia PGS experience faster conversion rates than those who had lower insomnia PGS, with hazard ratios in 1.21 (80th versus 20th percentile, 95% CI: 1.13 ~ 1.30). Conclusions Our results indicate that genetic predisposition related to neuroticism, cognitive function, and sleep patterns play a significant role in the development of TRD. These findings underscore the importance of considering genetic and psychosocial factors in managing and treating TRD. Future research should focus on integrating genetic data with clinical outcomes to enhance our understanding of pathways leading to treatment resistance.
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Affiliation(s)
- Bohan Xu
- Population Neuroscience and Genetics Center, Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
| | | | - Rayus Kuplicki
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
| | - Jonathan Ahern
- Population Neuroscience and Genetics Center, Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
- Center for Human Development, University of California, San Diego, La Jolla, California, USA
| | - Robert Loughnan
- Population Neuroscience and Genetics Center, Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
- Center for Human Development, University of California, San Diego, La Jolla, California, USA
| | - Firas Naber
- Population Neuroscience and Genetics Center, Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
| | - Wesley K. Thompson
- Population Neuroscience and Genetics Center, Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
- Division of Biostatistics and Bioinformatics, the Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, California, USA
| | - Charles B. Nemeroff
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - Martin P. Paulus
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Chun Chieh Fan
- Population Neuroscience and Genetics Center, Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
- Department of Radiology, University of California, San Diego, La Jolla, California, USA
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Lieber SR, Jones AR, Jiang Y, Gowda P, Patel M, Lippe B, Shenoy A, Evon DM, Gurley T, Ngo V, Olumesi M, Trudeau RE, Noriega Ramirez A, Jordan-Genco L, Mufti A, Lee SC, Singal AG, VanWagner LB. Psychiatric diagnoses are common after liver transplantation and are associated with increased health care utilization and patient financial burden. Liver Transpl 2024:01445473-990000000-00373. [PMID: 38713020 DOI: 10.1097/lvt.0000000000000390] [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] [Received: 12/21/2023] [Accepted: 04/09/2024] [Indexed: 05/08/2024]
Abstract
Psychiatric disorders after liver transplantation (LT) are associated with worse patient and graft outcomes, which may be amplified by inadequate treatment. We aimed to characterize the burden of psychiatric disorders, treatment patterns, and associated financial burden among liver transplantation recipients (LTRs). IQVIA PharMetrics (R) Plus for Academics-a large health plan claims database representative of the commercially insured US population-was used to identify psychiatric diagnoses among adult LTRs and assess treatment. Multivariable logistic regression analysis identified factors associated with post-LT psychiatric diagnoses and receipt of pharmacotherapy. Patient financial liability was estimated using adjudicated medical/pharmacy claims for LTRs with and without psychiatric diagnoses. Post-LT psychiatric diagnoses were identified in 395 (29.5%) of 1338 LTRs, of which 106 (26.8%) were incident cases. Treatment varied, with 67.3% receiving pharmacotherapy, 32.1% psychotherapy, 21.0% combination therapy, and 21.5% no treatment. Among 340 LTRs on psychotropic medications before transplant, 24% did not continue them post-LT. Post-LT psychiatric diagnoses were independently associated with female sex, alcohol-associated liver disease (ALD), prolonged LT hospitalization (>2 wk), and pre-LT psychiatric diagnosis. Incident psychiatric diagnoses were associated with female sex, ALD, and prolonged LT hospitalization. Patients with a post-LT psychiatric diagnosis had higher rates of hospitalization (89.6% vs. 81.5%, p <0.001) and financial liability (median $5.5K vs. $4.6K USD, p =0.006). Having a psychiatric diagnosis post-LT was independently associated with experiencing high financial liability >$5K. Over 1 in 4 LTRs had a psychiatric diagnosis in a large national cohort, yet nearly a quarter received no treatment. LTRs with psychiatric diagnoses experienced increased health care utilization and higher financial liability. Sociodemographic and clinical risk factors could inform high-risk subgroups who may benefit from screening and mitigation strategies.
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Affiliation(s)
- Sarah R Lieber
- Department of Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Alex R Jones
- Department of Medicine, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Yue Jiang
- Department of Statistical Science, Duke University, Durham, North Carolina, USA
| | - Prajwal Gowda
- Department of Medicine, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Madhukar Patel
- Department of Surgery, Division of Surgical Transplantation, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Ben Lippe
- Department of Psychiatry, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Akhil Shenoy
- Department of Psychiatry, Columbia University Medical Center, New York, New York, USA
| | - Donna M Evon
- Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Tami Gurley
- Department of Public Health, Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Van Ngo
- Department of Pharmacy, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Mary Olumesi
- Department of Pharmacy, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Raelene E Trudeau
- Department of Pharmacy, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Alvaro Noriega Ramirez
- Department of Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Layne Jordan-Genco
- Department of Medicine, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
- Department of Psychiatry, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Arjmand Mufti
- Department of Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Simon C Lee
- Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Amit G Singal
- Department of Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Lisa B VanWagner
- Department of Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
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Joshi K, Pilon D, Shah A, Holiday C, Karkare S, Zhdanava M. Treatment patterns, healthcare utilization, and costs of patients with treatment-resistant depression initiated on esketamine intranasal spray and covered by US commercial health plans. J Med Econ 2023; 26:422-429. [PMID: 36924214 DOI: 10.1080/13696998.2023.2188845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
AIMS To describe real-world use of esketamine (ESK) intranasal spray and healthcare outcomes among patients with treatment-resistant depression (TRD) in the United States (US). METHODS Adults with TRD initiated on ESK (index date) between 5 March 2019 (US approval date for TRD) and 31 October 2020 were sampled from IBM MarketScan Research Databases. TRD was defined as claims for ≥2 unique antidepressants during the same major depressive episode. Subgroups of the TRD cohort with comorbid cardiometabolic conditions, pain, anxiety disorder, and substance use disorder (SUD) were identified. Patients had ≥6 months of continuous health plan eligibility pre- and post-index. RESULTS The TRD cohort comprised 269 patients; comorbidity subgroups included 123 (cardiometabolic), 144 (pain), 189 (anxiety disorder), and 58 (SUD) patients. Proportion of patients completing ≥8 ESK sessions (number of sessions in induction phase) was 61.3% in the TRD cohort and ranged from 60.2% (cardiometabolic subgroup) to 72.4% (SUD subgroup) in subgroups. Median frequency of induction sessions was every 5-8 days among the TRD cohort and subgroups. Mean mental health-related inpatient costs reduced from pre- to post-index periods in the TRD cohort (mean ± standard deviation [median] costs per-patient-per-6-months: $3,480 ± $13,328 [$0] pre-ESK initiation; $3,262 ± $16,666 [$0] post-ESK initiation; mean difference: -$218) and subgroups (largest decrease in cardiometabolic subgroup: $4,864 ± $14,271 [$0]; $2,792 ± $15,757 [$0]; -$2,072). Mean mental health-related emergency department (ED) costs decreased in the TRD cohort ($608 ± $2,525 [$0]; $269 ± $1,143 [$0]; -$339) and subgroups (largest decrease in the SUD subgroup: $1,403 ± $3,752 [$0]; $351 ± $868 [$0]; -$1,052). LIMITATIONS This is a descriptive analysis; sample size for some comorbidity subgroups is small. CONCLUSIONS The majority of patients completed ESK induction phase, and most dosing intervals were longer than the label recommendation. In this descriptive analysis, mental health-related inpatient and ED costs trended lower post-ESK initiation.
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Affiliation(s)
- Kruti Joshi
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | | | - Aditi Shah
- Analysis Group, Inc., Montréal, QC, Canada
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Thakre TP, Kulkarni H, Adams KS, Mischel R, Hayes R, Pandurangi A. Polysomnographic identification of anxiety and depression using deep learning. J Psychiatr Res 2022; 150:54-63. [PMID: 35358832 DOI: 10.1016/j.jpsychires.2022.03.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/10/2022] [Accepted: 03/21/2022] [Indexed: 10/18/2022]
Abstract
Anxiety and depression are common psychiatric conditions associated with significant morbidity and healthcare costs. Sleep is an evolutionarily conserved health state. Anxiety and depression have a bidirectional relationship with sleep. This study reports on the use of analysis of polysomnographic data using deep learning methods to detect the presence of anxiety and depression. Polysomnography data on 940 patients performed at an academic sleep center during the 3-year period from 01/01/2016 to 12/31/2018 were identified for analysis. The data were divided into 3 subgroups: 205 patients with Anxiety/Depression, 349 patients with no Anxiety/Depression, and 386 patients with likely Anxiety/Depression. The first two subgroups were used for training and testing of the deep learning algorithm, and the third subgroup was used for external validation of the resulting model. Hypnograms were constructed via automatic sleep staging, with the 12-channel PSG data being transformed into three-channel RGB (red, green, blue channels) images for analysis. Composite patient images were generated and utilized for training the Xception model, which provided a validation set accuracy of 0.9782 on the ninth training epoch. In the independent test set, the model achieved a high accuracy (0.9688), precision (0.9533), recall (0.9630), and F1-score (0.9581). Classification performance of most other mainstream deep learning models was comparable. These findings suggest that machine learning techniques have the potential to accurately detect the presence of anxiety and depression from analysis of sleep study data. Further studies are needed to explore the utility of these techniques in the field of psychiatry.
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Affiliation(s)
- Tushar P Thakre
- Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA, USA; Center for Sleep Medicine, Virginia Commonwealth University Health, Richmond, VA, USA
| | | | - Katie S Adams
- Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA, USA; Department of Pharmacy Services, Virginia Commonwealth University Health, Richmond, VA, USA
| | - Ryan Mischel
- Department of Psychiatry, Washington University at St. Louis School of Medicine, St. Louis, MO, USA
| | - Ronnie Hayes
- Center for Sleep Medicine, Virginia Commonwealth University Health, Richmond, VA, USA
| | - Ananda Pandurangi
- Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
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The Economic Burden of Recurrence in Triple-Negative Breast Cancer Among Working Age Patients in the United States. Adv Ther 2022; 39:943-958. [PMID: 34918193 DOI: 10.1007/s12325-021-01913-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 09/01/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Triple-negative breast cancer (TNBC) is associated with a high recurrence risk. However, the magnitude of direct and indirect costs associated with recurrence is lacking in the literature. METHODS Adults 18-65 years old diagnosed with TNBC were identified from the OptumHealth Reporting and Insights claims database (1999-2017) and stratified by recurrence. For patients with recurrence, the index date was defined as 30 days before recurrence; for patients without recurrence, it was randomly assigned based on the distribution of time between first treatments and index dates of the recurrence cohort. All-cause and breast cancer-related healthcare resource utilization (HRU), direct and indirect costs, and work loss up to 1 year were compared between cohorts using generalized linear models. Kaplan-Meier analyses and Cox proportional hazards models compared the risk of leaving the workforce. RESULTS Among the 2340 patients analyzed, mean age was 54 years and > 75% of patients had stage 0-2 cancer. Among the 1170 patients with recurrence, 236 were categorized as having metastatic recurrence and 934 as having locoregional recurrence. Relative to patients without recurrence, those with recurrence had significantly higher all-cause and breast cancer-related HRU. For instance, adjusted incidence rates (IRs) for all-cause inpatient admissions were 3.67 and 10.19 times higher for patients with locoregional and metastatic recurrence, respectively (p < 0.001). Adjusted all-cause healthcare costs were $8575/month higher for metastatic recurrence and $3609/month higher for locoregional recurrence vs. patients without recurrence (p < 0.001). Adjusted IRs for work loss days were approximately two times higher for locoregional and metastatic recurrence vs. without recurrence (p < 0.001). Patients with locoregional recurrence incurred $335/month more indirect costs vs. patients without recurrence; those with metastatic recurrence incurred $769/month more (p < 0.05). Patients with recurrence had a 63% higher rate of leaving the work force (p = 0.003). CONCLUSION The incremental direct and indirect economic burden associated with recurrent TNBC is substantial relative to non-recurrence.
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Zhang Q, O'Hara M, McCormick C, Lingohr-Smith M, Borentain S, Mathews M, Joshi K, Anjo J, Lin J. Patient profiles, initial hospital encounter characteristics, and hospital re-encounters of patients with a hospital emergency department visit or inpatient admission for major depressive disorder. J Med Econ 2022; 25:172-181. [PMID: 35048772 DOI: 10.1080/13696998.2022.2031202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To gain a better understanding of the characteristics of patients with a hospital encounter for major depressive disorder (MDD) and evaluate associated hospital resource utilization, hospital charges and costs, and hospital re-encounters. METHODS Adult patients with a hospital encounter (i.e. emergency department [ED] visit only or inpatient admission) with MDD as the primary discharge diagnosis (index event) during July 2018‒March 2019 were selected from the Premier Healthcare Database. Patient characteristics, hospital resource utilization, and hospital charges and costs were evaluated during index events. During a 12-month follow-up, hospital re-encounters (MDD-related and all-cause ED visit only or inpatient readmissions) were examined. RESULTS The study population included 77,178 patients with an index hospital encounter (ED visit only: 49.9%; inpatient admission: 50.1%) for MDD. The most common secondary mental health-related diagnosis was suicidal ideation/behavior, which was recorded in 51.8% of patients. The mean age was 38.2 years, 53.0% were female, and 72.1% were Caucasian. Among patients with an ED visit only, the mean index hospital charges and costs were $3,608 and $639, respectively. Among those with inpatient admissions, the mean length of stay was 4.9 days, and the mean index hospital charges and costs were $17,107 and $6,095, respectively. During the 12-month follow-up, 13.3% of patients in the overall study population had an MDD-related hospital re-encounter (primary or secondary discharge diagnosis code indicating MDD); nearly one-third (31.3%) occurred within 30 days post-discharge. During the follow-up, 28.1% had an all-cause hospital re-encounter with 29.7% having occurred within 30 days post-discharge. LIMITATIONS Due to constraints of the Premier Healthcare Database, healthcare resource utilization and costs outside of the hospital could not be evaluated. CONCLUSIONS Patients with a hospital encounter for MDD are relatively young, commonly have suicidal ideation/behavior, utilize substantial hospital resources, and have a high risk for a hospital re-encounter in the 30 days post-discharge.
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Affiliation(s)
- Qiaoyi Zhang
- Janssen Global Services, LLC, Global Market Access; Global Medical Affairs, Titusville, NJ, USA
| | - Marguerite O'Hara
- Janssen Global Services, LLC, Global Market Access; Global Medical Affairs, Titusville, NJ, USA
| | - Carter McCormick
- Janssen Global Services, LLC, Global Market Access; Global Medical Affairs, Titusville, NJ, USA
| | | | - Stephane Borentain
- Janssen Global Services, LLC, Global Market Access; Global Medical Affairs, Titusville, NJ, USA
| | - Maju Mathews
- Janssen Global Services, LLC, Global Market Access; Global Medical Affairs, Titusville, NJ, USA
| | - Kruti Joshi
- Janssen Scientific Affairs, LLC, Value and Evidence, Titusville, NJ, USA
| | - Joana Anjo
- Janssen Portugal, Health Economics, Market Access, and Reimbursement, Porto Salvo, Portugal
| | - Jay Lin
- Novosys Health, Health Economics & Outcomes Research, Green Brook, NJ, USA
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Fang X, Wang D, Tang W, Liu H, Zhang X, Zhang C. Anhedonia difference between major depressive disorder and bipolar disorder II. BMC Psychiatry 2021; 21:531. [PMID: 34706699 PMCID: PMC8555067 DOI: 10.1186/s12888-021-03548-w] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 10/14/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE This study aims to explore the difference in anhedonia between Major Depressive Disorder (MDD) and Bipolar Disorder II (BD-II), and attempt to distinguish the two diseases through Snaith-Hamilton Pleasure Scale (SHAPS). METHODS A total of 164 drug-free depressive patients (98 MDD patients, 66 BD-II patients) completed the investigation. 17-item Hamilton Depression Scale (HAMD-17) and Hamilton Anxiety Scale (HAMA) and SHAPS were assessed in all participants. RESULTS Our results showed that BD-II patients had higher SHAPS scores than MDD patients. The stepwise logistic regression analysis further revealed that SHAPS score, drinking habit, and extroversion as influencing factors for the identification of BD-II. The ROC curve analysis indicated that SHAPS could differentiate BD-II from MDD patients (AUC = 0.655, P = 0.001, 95% CI = 0.568 to 0.742), with the best screening cutoff at 26, and the corresponding sensitivity and specificity was 0.788 and 0.520, respectively. CONCLUSION Our results suggest that BD-II patients had more severe anhedonia compared to MDD patients, and the difference in anhedonia may help clinicians preliminary identify BD patients from MDD patients. The preliminary findings are worthly of further exploration.
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Affiliation(s)
- Xinyu Fang
- grid.89957.3a0000 0000 9255 8984Department of Geriatric Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, People’s Republic of China ,grid.16821.3c0000 0004 0368 8293Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Dandan Wang
- grid.16821.3c0000 0004 0368 8293Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Wei Tang
- grid.268099.c0000 0001 0348 3990The Affiliated Kangning Hospital of Wenzhou Medical University, Wenzhou, People’s Republic of China
| | - Hongyang Liu
- grid.268099.c0000 0001 0348 3990The Affiliated Kangning Hospital of Wenzhou Medical University, Wenzhou, People’s Republic of China
| | - Xiangrong Zhang
- Department of Geriatric Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, People's Republic of China.
| | - Chen Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.
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Zhdanava M, Karkare S, Pilon D, Joshi K, Rossi C, Morrison L, Sheehan J, Lefebvre P, Lopena O, Citrome L. Prevalence of Pre-existing Conditions Relevant for Adverse Events and Potential Drug-Drug Interactions Associated with Augmentation Therapies Among Patients with Treatment-Resistant Depression. Adv Ther 2021; 38:4900-4916. [PMID: 34368919 PMCID: PMC8408057 DOI: 10.1007/s12325-021-01862-z] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/13/2021] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Pre-existing conditions relevant for adverse events (AE) and the potential for drug-drug interactions (DDIs) may limit safe pharmacotherapeutic augmentation options for patients with major depressive disorder (MDD). This concern may be heightened among patients with treatment-resistant depression (TRD), who often have comorbid medical disorders. METHODS Adults with MDD and ≥ 1 antidepressant claim within the first observed major depressive episode were identified in the MarketScan® Databases. Those initiating a new regimen after two regimens at adequate dose and duration were considered to have TRD. The index date was defined at TRD onset or on a random antidepressant claim among patients with non-TRD MDD. Pre-existing conditions 12 months pre-index and potential DDIs 3 months pre/post-index associated with specific non-antidepressant augmentation therapies, including atypical antipsychotics (APs), buspirone, psychostimulants, anticonvulsants, thyroid hormone, and lithium were compared between 1:1 matched TRD and non-TRD MDD cohorts. RESULTS Overall, 3414 patients with TRD and non-TRD MDD (mean age 39.7 years, 69% female) were matched. Relative to non-TRD MDD, patients with TRD had 33% higher likelihood of ≥ 1 pre-existing condition relevant for AEs listed in product labels of non-antidepressant augmentation therapies (p < 0.001). Patients with TRD vs. non-TRD MDD had 12.9 and 6.4 times higher likelihood of ≥ 2 and ≥ 3 DDIs, respectively, based on their medication regimen (all p < 0.001). CONCLUSION Pre-existing conditions relevant for listed AEs and potential DDIs limit safe augmentation options in MDD, particularly among patients with TRD. Payer prior authorization policies requiring several augmentation therapy trials to access novel treatments may complicate clinical management of this population.
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Affiliation(s)
- Maryia Zhdanava
- Analysis Group, Inc, 1190 avenue des Canadiens-de-Montréal, Deloitte Tower, Suite 1500, Montreal, QC, H3B 0G7, Canada.
| | - Swapna Karkare
- Real-World Value and Evidence, Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | - Dominic Pilon
- Analysis Group, Inc, 1190 avenue des Canadiens-de-Montréal, Deloitte Tower, Suite 1500, Montreal, QC, H3B 0G7, Canada
| | - Kruti Joshi
- Real-World Value and Evidence, Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | - Carmine Rossi
- Analysis Group, Inc, 1190 avenue des Canadiens-de-Montréal, Deloitte Tower, Suite 1500, Montreal, QC, H3B 0G7, Canada
| | - Laura Morrison
- Analysis Group, Inc, 1190 avenue des Canadiens-de-Montréal, Deloitte Tower, Suite 1500, Montreal, QC, H3B 0G7, Canada
| | - John Sheehan
- Real-World Value and Evidence, Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | - Patrick Lefebvre
- Analysis Group, Inc, 1190 avenue des Canadiens-de-Montréal, Deloitte Tower, Suite 1500, Montreal, QC, H3B 0G7, Canada
| | - Oliver Lopena
- Real-World Value and Evidence, Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | - Leslie Citrome
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, NY, USA
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Perrone V, Sangiorgi D, Andretta M, Ducci G, Forti B, Francesa Morel PC, Gambera M, Maina G, Mencacci C, Mennini FS, Zanalda E, Degli Esposti L. Healthcare Resource Consumption and Related Costs of Patients Estimated with Treatment-Resistant Depression in Italy. CLINICOECONOMICS AND OUTCOMES RESEARCH 2021; 13:629-635. [PMID: 34262308 PMCID: PMC8275098 DOI: 10.2147/ceor.s314111] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/17/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To analyse the healthcare resource consumption and related costs for the Italian National Health System of patients estimated to be affected by treatment-resistant depression (TRD) in Italy. Patients and Methods This was an observational retrospective study based on administrative databases, including those related to residential/semiresidential structures, of Veneto Region and the Local Health Unit of Bergamo in Italy (for a total of around 6 million health-assisted subjects). Between July 2011 and December 2017, all adult patients with a third antidepressant (AD) after ≥2 AD (each one with at least ≥4 weeks duration, ≥1 prescription at maximum dosage reported in datasheets, a grace period ≤30 days when switching AD and treatment maintained ≥9 months) were included. Overall and psychiatry-related healthcare resources consumption and related costs were estimated on a 12-months based analysis. Data were re-proportioned to the Italian population. Results We have previously estimated a total of 101,455 patients with TRD in Italy (130,049 considering the mean maximum dosage of AD). Of them, 44.2% had at least a psychiatric hospitalization/visit or accessed a residential/semiresidential structure, and 31% added another AD or a mood stabilizer/antipsychotic drug. Patients with at least one psychiatry-related hospitalization increased over the number of antidepressant lines from 12.0% during first line up to 24.5% during fourth line. Direct healthcare costs increased from €4,405 for first line to €9,251 from fifth line onwards. Psychiatry-related costs went from €1,817 (first line) to €4,606 (fifth line onwards) and were mainly driven by residential/semiresidential structures and hospitalizations. Conclusion An upward trend with number of AD lines was observed for all healthcare resource utilization and consequently for all direct costs, thus indicating an increasing burden for patients as they move forward AD lines.
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Affiliation(s)
- Valentina Perrone
- CliCon S.r.l., Health, Economics & Outcomes Research, Bologna, Italy
| | - Diego Sangiorgi
- CliCon S.r.l., Health, Economics & Outcomes Research, Bologna, Italy
| | - Margherita Andretta
- UOC Assistenza Farmaceutica Territoriale, Azienda ULSS 8 Berica, Vicenza, Italy
| | | | - Bruno Forti
- Mental Health Department - Azienda ULSS n 1 "Dolomiti", Veneto Region, Italy
| | | | - Marco Gambera
- "OSPEDALE P. PEDERZOLI" Casa di Cura Privata S.p.A., Peschiera del Garda, Verona, Italy
| | - Giuseppe Maina
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, University Hospital San Luigi Gonzaga, Turin, Italy
| | - Claudio Mencacci
- Department of Neuroscience, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Francesco Saverio Mennini
- EEHTA - CEIS (Centre for Economic and International Studies), Faculty of Economics, University of Rome "Tor Vergata", Rome, Italy.,Institute for Leadership and Management in Health Care, Kingston University, London, UK
| | - Enrico Zanalda
- Department of Mental Health ASL TO3 & AOU San Luigi Gonzaga, Collegno, TO, Italy
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Stoyanov D, Aryutova K, Kandilarova S, Paunova R, Arabadzhiev Z, Todeva-Radneva A, Kostianev S, Borgwardt S. Diagnostic Task Specific Activations in Functional MRI and Aberrant Connectivity of Insula with Middle Frontal Gyrus Can Inform the Differential Diagnosis of Psychosis. Diagnostics (Basel) 2021; 11:95. [PMID: 33435624 PMCID: PMC7827259 DOI: 10.3390/diagnostics11010095] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/05/2021] [Accepted: 01/06/2021] [Indexed: 12/19/2022] Open
Abstract
We constructed a novel design integrating the administration of a clinical self-assessment scale with simultaneous acquisition of functional Magnetic Resonance Imaging (fMRI), aiming at cross-validation between psychopathology evaluation and neuroimaging techniques. We hypothesized that areas demonstrating differential activation in two groups of patients (the first group exhibiting paranoid delusions in the context of paranoid schizophrenia-SCH-and second group with a depressive episode in the context of major depressive disorder or bipolar disorder-DEP) will have distinct connectivity patterns and structural differences. Fifty-one patients with SCH (n = 25) or DEP (n = 26) were scanned with three different MRI sequences: a structural and two functional sequences-resting-state and task-related fMRI (the stimuli represent items from a paranoid-depressive self-evaluation scale). While no significant differences were found in gray matter volumes, we were able to discriminate between the two clinical entities by identifying two significant clusters of activations in the SCH group-the left Precuneus (PreCu) extending to the left Posterior Cingulate Cortex (PCC) and the right Angular Gyrus (AG). Additionally, the effective connectivity of the middle frontal gyrus (MFG), a part of the Dorsolateral Prefrontal Cortex (DLPFC) to the Anterior Insula (AI), demonstrated a significant difference between the two groups with inhibitory connection demonstrated only in SCH. The observed activations of PreCu, PCC, and AG (involved in the Default Mode Network DMN) might be indirect evidence of the inhibitory connection from the DLPFC to AI, interfering with the balancing function of the insula as the dynamic switch in the DMN. The findings of our current study might suggest that the connectivity from DLPFC to the anterior insula can be interpreted as evidence for the presence of an aberrant network that leads to behavioral abnormalities, the manifestation of which depends on the direction of influence. The reduced effective connectivity from the AI to the DLPFC is manifested as depressive symptoms, and the inhibitory effect from the DLPFC to the AI is reflected in the paranoid symptoms of schizophrenia.
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Affiliation(s)
- Drozdstoy Stoyanov
- Department of Psychiatry and Medical Psychology, and Research Institute, Medical University Plovdiv, 4002 Plovdiv, Bulgaria; (K.A.); (S.K.); (R.P.); (Z.A.); (A.T.-R.)
| | - Katrin Aryutova
- Department of Psychiatry and Medical Psychology, and Research Institute, Medical University Plovdiv, 4002 Plovdiv, Bulgaria; (K.A.); (S.K.); (R.P.); (Z.A.); (A.T.-R.)
| | - Sevdalina Kandilarova
- Department of Psychiatry and Medical Psychology, and Research Institute, Medical University Plovdiv, 4002 Plovdiv, Bulgaria; (K.A.); (S.K.); (R.P.); (Z.A.); (A.T.-R.)
| | - Rositsa Paunova
- Department of Psychiatry and Medical Psychology, and Research Institute, Medical University Plovdiv, 4002 Plovdiv, Bulgaria; (K.A.); (S.K.); (R.P.); (Z.A.); (A.T.-R.)
| | - Zlatoslav Arabadzhiev
- Department of Psychiatry and Medical Psychology, and Research Institute, Medical University Plovdiv, 4002 Plovdiv, Bulgaria; (K.A.); (S.K.); (R.P.); (Z.A.); (A.T.-R.)
| | - Anna Todeva-Radneva
- Department of Psychiatry and Medical Psychology, and Research Institute, Medical University Plovdiv, 4002 Plovdiv, Bulgaria; (K.A.); (S.K.); (R.P.); (Z.A.); (A.T.-R.)
| | - Stefan Kostianev
- Department of Pathophysiology, and Research Institute, Medical University Plovdiv, 4002 Plovdiv, Bulgaria;
| | - Stefan Borgwardt
- Klinik für Psychiatrie und Psychotherapie, Universität zu Lübeck, 23538 Lübeck, Germany;
- Department of Psychiatry, University of Basel, 4001 Basel, Switzerland
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