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Valachová M, Lisá E. Dispositional mindfulness and BIS/BAS up-close: can the self-regulation of people be seen in the eyes? Front Psychol 2023; 14:1217129. [PMID: 37637927 PMCID: PMC10448391 DOI: 10.3389/fpsyg.2023.1217129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/31/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction Pigmentation in animal models is related to behavioral regulation and development, suggesting that both may belong to the same biological system. However, such models are poorly documented in humans. The current study explored personality and group differences in self-regulation among healthy subjects and their specific eye structures (contraction furrows and pigment spots). Three objectives were proposed: to analyze statistical differences in dispositional mindfulness (DM), behavioral inhibition system (BIS), and behavioral approach system (BAS) among subjects with a specific iris type of contraction furrows and pigment spots. Methods The study sample consisted of 194 university students. One month after taking photographs of their eyes, the students completed the online scales of DM, BIS, and BAS. Results DM was negatively related to pigment spots (rs = -0.193; p < 0.01). Cluster analysis of the iris structures converged at a four-cluster solution. The cluster types 2 (absence of pigment spots and contraction furrows extending 8/10 of iris circle or more) and 3 (one or more pigment spots and contraction furrows extending 8/10 of iris circle or more) significantly differed in DM with a small effect size (F = 3.37; p = 0.021; η2 = 0.051). Participants with contraction furrows (8/10 or more circle extent) and without pigment spots had a significantly higher DM than those with pigment spots. No significant differences existed among the iris types in BIS/BAS. Discussion Future research directions are suggested.
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Affiliation(s)
| | - Elena Lisá
- Institute of Applied Psychology, Faculty of Social and Economic Sciences, Comenius University in Bratislava, Bratislava, Slovakia
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2
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Storosum BWC, Steinz C, Cohen SE, Mattila T, Brink WVD, Roes K, de Haan L, Denys DAJP, Zantvoord JB. Ethnic differences in response to atypical antipsychotics in patients with schizophrenia: individual patient data meta-analysis of randomised placebo-controlled registration trials submitted to the Dutch Medicines Evaluation Board. BJPsych Open 2023; 9:e45. [PMID: 36861144 PMCID: PMC10044330 DOI: 10.1192/bjo.2023.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Little is known about the effect of ethnicity on the response to antipsychotic medication in patients with schizophrenia. AIMS To determine whether ethnicity moderates the response to antipsychotic medication in patients with schizophrenia, and whether this moderation is independent of confounders. METHOD We analysed 18 short-term, placebo-controlled registration trials of atypical antipsychotic medications in patients with schizophrenia (N = 3880). A two-step, random-effects, individual patient data meta-analysis was applied to establish the moderating effect of ethnicity (White versus Black) on symptom improvement according to the Brief Psychiatric Rating Scale (BPRS) and on response, defined as >30% BPRS reduction. These analyses were corrected for baseline severity, baseline negative symptoms, age and gender. A conventional meta-analysis was performed to determine the effect size of antipsychotic treatment for each ethnic group separately. RESULTS In the complete data-set, 61% of patients were White, 25.6% of patients were Black and 13.4% of patients were of other ethnicities. Ethnicity did not moderate the efficacy of antipsychotic treatment: pooled β-coefficient for the interaction between treatment and ethnic group was -0.582 (95% CI -2.567 to 1.412) for mean BPRS change, with an odds ratio of 0.875 (95% CI 0.510-1.499) for response. These results were not modified by confounders. CONCLUSIONS Atypical antipsychotic medication is equally effective in both Black and White patients with schizophrenia. In registration trials, White and Black patients were overrepresented relative to other ethnic groups, limiting the generalisability of our findings.
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Affiliation(s)
- Bram W C Storosum
- Department of Psychiatry, Amsterdam UMC, The Netherlands; and Amsterdam Neuroscience, University of Amsterdam, The Netherlands
| | - Cedrine Steinz
- Department of Psychiatry, Amsterdam UMC, The Netherlands; and Amsterdam Neuroscience, University of Amsterdam, The Netherlands
| | - Sem E Cohen
- Department of Psychiatry, Amsterdam UMC, The Netherlands; and Amsterdam Neuroscience, University of Amsterdam, The Netherlands
| | - Taina Mattila
- Department of CNS Products, Medicines Evaluation Board, The Netherlands
| | - Wim van den Brink
- Department of Psychiatry, Amsterdam UMC, The Netherlands; and Amsterdam Neuroscience, University of Amsterdam, The Netherlands
| | - Kit Roes
- Biostatistics Research Group, Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, The Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry, Amsterdam UMC, The Netherlands; Amsterdam Neuroscience, University of Amsterdam, The Netherlands; and Department of Research, Arkin Institute for Mental Health, The Netherlands
| | - Damiaan A J P Denys
- Department of Psychiatry, Amsterdam UMC, The Netherlands; Amsterdam Neuroscience, University of Amsterdam, The Netherlands; and Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, The Netherlands
| | - Jasper B Zantvoord
- Department of Psychiatry, Amsterdam UMC, The Netherlands; and Amsterdam Neuroscience, University of Amsterdam, The Netherlands
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Lehti V, Taipale H, Gissler M, Tanskanen A, Elonheimo M, Tiihonen J, Suvisaari J. Continuity of antipsychotic medication use among migrant and Finnish-born populations with a psychotic disorder: a register-based study. Psychol Med 2023; 53:833-843. [PMID: 34074352 DOI: 10.1017/s003329172100218x] [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: 11/07/2022]
Abstract
BACKGROUND Higher incidence of psychotic disorders and underuse of mental health services have been reported among many migrant populations. This study examines the initiation and continuity of antipsychotic treatment among migrants and non-migrants with a non-affective psychosis during a new treatment episode. METHODS This study is based on a nationwide sample of migrants and Finnish-born controls. Participants who were diagnosed with a psychotic disorder in 2011-2014 were identified from the Care Register for Health Care (n = 1693). Information on purchases of antipsychotic drugs in 2011-2015 was collected from the National Prescription Register. The duration of antipsychotic treatment since diagnosis was estimated using the PRE2DUP model. Cox regression analysis was used to study factors that are associated with discontinuing the use of medication. RESULTS There were fewer initiators of antipsychotic treatment after being diagnosed with psychosis among migrants (68.1%) than among Finnish-born patients (73.6%). After controlling for sociodemographic background and factors related to the type of disorder and treatment, migrants were more likely to discontinue medication (adjusted hazard ratio 1.28, 95% confidence interval 1.08-1.52). The risk of discontinuation was highest among migrants from North Africa and the Middle East and Sub-Saharan Africa and among recent migrants. Non-use of antipsychotic treatment before being diagnosed with psychosis, involuntary hospitalization and diagnosis other than schizophrenia were associated with earlier discontinuation both among migrants and non-migrants. CONCLUSIONS Migrants with a psychotic disorder are less likely to continue antipsychotic treatment than non-migrants. The needs of migrant patients have to be addressed to improve adherence.
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Affiliation(s)
- Venla Lehti
- Equality Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Heidi Taipale
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Mika Gissler
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
- Information Services Department, Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Antti Tanskanen
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Impact Assessment Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Martta Elonheimo
- Equality Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- Specialized Psychiatric Services, Helsinki, Finland
- Doctoral Programme in Clinical Research, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jari Tiihonen
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden
| | - Jaana Suvisaari
- Equality Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
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Oh S, Byeon SJ, Chung SJ. Characteristics of adverse reactions among antipsychotic drugs using the Korean Adverse Event Reporting System database from 2010 to 2019. J Psychopharmacol 2022; 36:1041-1050. [PMID: 35695641 DOI: 10.1177/02698811221104055] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Retrospective studies using spontaneous reporting system databases have provided a great understanding of adverse drug reactions (ADRs) in the real world, complementing the data obtained from randomized controlled trials. However, there have been few reports on large-scale epidemiological studies on the adverse effects of antipsychotics in Asia. AIM This study aimed to investigate the characteristics of antipsychotic ADRs using a nationwide pharmacovigilance database. METHODS Data were collected from the Korea Adverse Event Reporting System database between 2010 and 2019. The study subjects were selected using the International Classification of Disease codes for diseases related to psychosis and Electronic Data Interchange codes for amisulpride, aripiprazole, clozapine, haloperidol, olanzapine, paliperidone, quetiapine, risperidone, and ziprasidone. The causality assessment of "possible," "probable," or "certain" by the World Health Organization-Uppsala Monitoring Center System causality category was selected. All data were descriptively analyzed. RESULTS In total, 5067 adverse events associated with antipsychotic drugs were reported. The antipsychotics that commonly resulted in ADRs were quetiapine (47.7%), olanzapine (11.3%), and clozapine (10.7%). Serious ADRs were most commonly observed with clozapine. Gastrointestinal and central nervous system problems occurred within a month when ADRs were classified according to the time of onset. In contrast, metabolic and bone marrow-related symptoms occurred after long-term use. Sedation and nausea were the most common ADRs in children and adolescents, whereas constipation and dizziness were common in adults and the elderly. CONCLUSIONS This study extends our knowledge of antipsychotic ADRs in the Asian population.
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Affiliation(s)
- Sanghoon Oh
- Department of Psychiatry, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, South Korea
| | - Sun-Ju Byeon
- Department of Pathology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, South Korea
| | - Soo Jie Chung
- Department of Pulmonology and Allergy, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, South Korea
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Sacha M, Sandahl H, Harck L, Carlsson J. Treatment adherence to psychotropic drugs among non-Western migrants: a systematic review. Nord J Psychiatry 2022; 76:250-262. [PMID: 34369289 DOI: 10.1080/08039488.2021.1954689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Low medication adherence is a significant challenge in all medical fields and particularly in mental health treatment, where a lack of insight into one's own disease can repress the ability to adhere. In recent years, the increase in migration combined with a high prevalence of mental illnesses among migrants and the possible consequences of nonadherence, point towards the need for a focus on adherence with psychotropic drugs among migrants. AIM To review current literature, exploring the potential impact of being a migrant from a non-Western country living in a Western country on the level of adherence to psychotropic medication and subsequently to discuss these findings. METHODS A systematic review of studies investigating adherence among non-western migrants was conducted. The literature search was conducted using PubMed and Embase databases in October 2020. RESULTS Seven observational studies were included, all ranging from moderate to high-quality. Six out of seven studies found an association between being a non-Western migrant in a Western country and low adherence to psychotropic drugs. CONCLUSION Studies indicate an association between being a non-Western migrant in a Western country and low adherence to psychotropic drugs. None of the included studies investigated possible causes of the low adherence in migrants. Communication difficulties are, however, considered possible barriers to healthcare access and a contributing factor to nonadherence. There is a need for studies assessing the possible impact of interventions aiming at increasing adherence such as intercultural mediators and training of healthcare providers in cultural competencies.
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Affiliation(s)
- Maria Sacha
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services in the Capital Region of Denmark, Ballerup, Denmark
| | - Hinuga Sandahl
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services in the Capital Region of Denmark, Ballerup, Denmark
| | - Line Harck
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services in the Capital Region of Denmark, Ballerup, Denmark
| | - Jessica Carlsson
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services in the Capital Region of Denmark, Ballerup, Denmark
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Ordak M, Tkacz D, Golub A, Nasierowski T, Bujalska-Zadrozny M. Polypharmacotherapy in Psychiatry: Global Insights from a Rapid Online Survey of Psychiatrists. J Clin Med 2022; 11:jcm11082129. [PMID: 35456222 PMCID: PMC9025459 DOI: 10.3390/jcm11082129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/01/2022] [Accepted: 04/10/2022] [Indexed: 12/02/2022] Open
Abstract
In recent years, an increase in the problem of polypharmacotherapy in psychiatric patients has been observed, including the widespread problem of groups of people taking new psychoactive substances. One reason for this problem may be the poor knowledge of pharmacological interactions in psychiatry. The aim of this study was to explore the opinions and knowledge of psychiatrists from around the world on various aspects related to polypharmacotherapy. A total of 1335 psychiatrists from six continents were included in the study. The respondents’ opinion on the problem of hepatotoxicity in psychiatry was also examined. The greatest discrepancy among psychiatrists from different continents in the answers given concerned the definition of polypharmacotherapy (p < 0.001) and the approach to hepatotoxicity (p < 0.001). It is noteworthy that only about 20% of the psychiatrists surveyed (p < 0.001) believe that polypharmacotherapy is associated with a higher rate of patients’ hospitalisations. The most commonly used type of polypharmacy by psychiatrists was antidepressants and antipsychotics. Most of them also stated that polypharmacy was associated with reduced patient compliance with the doctor’s recommendations related to taking medications due to the increased complexity of the therapy. The continent that diversified the analysed questions to the greatest extent was Africa. Future educational activities for trainee psychiatrists should include more discussion of polypharmacotherapy in psychiatry.
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Affiliation(s)
- Michal Ordak
- Department of Pharmacodynamics, Centre for Preclinical, Research and Technology (CePT), Medical University of Warsaw, 1B Banacha Street, 02-097 Warsaw, Poland; (D.T.); (A.G.); (M.B.-Z.)
- Correspondence:
| | - Daria Tkacz
- Department of Pharmacodynamics, Centre for Preclinical, Research and Technology (CePT), Medical University of Warsaw, 1B Banacha Street, 02-097 Warsaw, Poland; (D.T.); (A.G.); (M.B.-Z.)
| | - Aniela Golub
- Department of Pharmacodynamics, Centre for Preclinical, Research and Technology (CePT), Medical University of Warsaw, 1B Banacha Street, 02-097 Warsaw, Poland; (D.T.); (A.G.); (M.B.-Z.)
| | - Tadeusz Nasierowski
- Department of Psychiatry, Medical University of Warsaw, 1B Banacha Street, 02-097 Warsaw, Poland;
| | - Magdalena Bujalska-Zadrozny
- Department of Pharmacodynamics, Centre for Preclinical, Research and Technology (CePT), Medical University of Warsaw, 1B Banacha Street, 02-097 Warsaw, Poland; (D.T.); (A.G.); (M.B.-Z.)
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Joubert FP, Chiliza B, Emsley R, Asmal L. Extrapyramidal side effects in first-episode schizophrenia treated with flupenthixol decanoate. S Afr J Psychiatr 2021; 27:1568. [PMID: 33604077 PMCID: PMC7876946 DOI: 10.4102/sajpsychiatry.v27i0.1568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 10/02/2021] [Indexed: 11/01/2022] Open
Abstract
Background Concern for the development of extrapyramidal side effects (EPSEs) represents a barrier to the routine use of long-acting injectable (LAI) antipsychotic medication in patients with first-episode schizophrenia (FES). Flupenthixol decanoate is a first-generation antipsychotic, which is readily available in the public healthcare system in South Africa. Aim The aim of this study was to describe the nature, occurrence and severity of EPSEs and their impact on patients with FES over 12 months of treatment with flupenthixol decanoate (fluanxol depot). Setting The study was based in Cape Town, South Africa, and patients with FES were recruited from inpatient services at Stikland and Tygerberg Hospitals and surrounding psychiatric clinics. This was a sub-study of a larger study, which examined several outcomes in patients with FES treated with the lowest effective dose of flupenthixol decanoate. Methods The Extrapyramidal Symptom Rating Scale (ESRS) was used to assess both subjective experience and objective measures of EPSEs in a cohort of patients with FES (N = 130). The relationship between demographic and clinical risk factors for individual subsets of EPSEs was also determined. Results In the context of an overall good 12-month tolerability, EPSEs peaked at month 3. Patients with akathisia were more likely to have greater symptoms of depression, and Parkinsonism was predicted by higher Positive and Negative Syndrome Scale scores (independent of medication dosage). Black and white patients showed higher total ESRS and higher subjective ESRS scores, compared with patients of mixed ancestry, and white patients scored higher on Parkinsonism ratings. Conclusion Flupenthixol decanoate is well tolerated in patients with FES. Certain clinical features of schizophrenia may be related to EPSEs. Ethnicity is a socio-cultural construct, and hence the differential risk of EPSEs should be interpreted according to ethnicity. Variations in the environment, diet, substance use and genetics may all affect the pharmacokinetics and pharmacodynamics of psychotropic drugs and warrant further investigation.
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Affiliation(s)
- Francois-Pierre Joubert
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Bonginkosi Chiliza
- Department of Psychiatry, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Robin Emsley
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Laila Asmal
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Bhattacharya R, White L, Pisaneschi L. Clozapine prescribing: comparison of clozapine dosage and plasma levels between White British and Bangladeshi patients. BJPsych Bull 2021; 45:22-27. [PMID: 32605689 PMCID: PMC8058897 DOI: 10.1192/bjb.2020.59] [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: 11/03/2019] [Revised: 05/18/2020] [Accepted: 05/28/2020] [Indexed: 12/13/2022] Open
Abstract
AIMS AND METHOD To compare differences in clozapine doses and plasma levels between Bangladeshi and White British patients. Following ethical approval we identified all current Bangladeshi and White British patients on clozapine maintenance in an east London clinic. We carried out univariate and multivariate regression analyses to examine associations between clozapine doses and ethnicity, age, gender, smoking status and weight. We also compared plasma clozapine levels of the two groups. RESULTS On univariate analysis White British patients had on average 85 mg higher doses than Bangladeshi patients (P = 0.004). Older age, male gender and smoking were also associated with higher dose. On multivariate analysis only age and smoking status remained significant. A greater proportion of Bangladeshi patients had high plasma clozapine levels compared with White British (30.76% v. 20.75%), although the difference was not statistically significant. CLINICAL IMPLICATIONS Our findings point to the need for the broadening of data collection on ethnic differences in clozapine prescribing within big data-sets such as Prescribing Observatory for Mental Health (POM-UK). Ethnopharmacological variations can inform more person-centred guidance on prescribing.
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Affiliation(s)
- Rahul Bhattacharya
- Tower Hamlets Community Services, East London NHS Foundation Trust; and Barts and the London School of Medicine, UK
| | | | - Laura Pisaneschi
- Tower Hamlets Clozapine Clinic, East London NHS Foundation Trust, UK
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Pharmacokinetics and Pharmacodynamics of the Dual Orexin Receptor Antagonist Daridorexant in Japanese and Caucasian Subjects. J Clin Psychopharmacol 2020; 40:157-166. [PMID: 32134851 DOI: 10.1097/jcp.0000000000001182] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE/BACKGROUND Daridorexant is a dual orexin receptor antagonist in development for the treatment of sleep disorders. Thus far, it has not yet been studied in Japanese subjects. Study objectives were to evaluate the pharmacokinetics (PK), pharmacodynamics (PD), and safety of single- and multiple-dose administration of daridorexant in healthy Caucasian and Japanese subjects. METHODS/PROCEDURES This was a double-blind, placebo-controlled, randomized study. Subjects received once-daily doses of daridorexant (25 or 50 mg) or placebo for 5 days. Pharmacokinetics and safety were investigated using standard assessments. To assess PD effects, a battery of tests (saccadic peak velocity, body sway, adaptive tracking performance, and visual analog scales for alertness, mood, and calmness), known to be sensitive to sleep-promoting drugs was used. FINDINGS/RESULTS On day 1, PK variables were similar between Caucasian and Japanese subjects. On day 5, slight accumulation occurred in Japanese but not in Caucasian subjects, resulting in a higher maximum concentration (1403 vs 1006 ng/mL) and area under the curve (8256 vs 6306 ng·h/mL) at a dose of 50 mg, whereas values for time to maximum concentration and half-life were similar. Daridorexant dose-dependently reduced vigilance, attention, visuomotor coordination, and postural stability. Pharmacokinetic effects were detectable within 1 hour after drug administration and returned to baseline 4 to 8 hours postdose. Overall, Japanese showed slightly larger PD effects and reported more adverse events than Caucasians. The most frequently reported were somnolence, fatigue, and headache. Changes in other safety assessments were unremarkable. IMPLICATIONS/CONCLUSIONS The PK, PD, and safety profile of daridorexant were similar in Japanese and Caucasian subjects.
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Iqbal E, Govind R, Romero A, Dzahini O, Broadbent M, Stewart R, Smith T, Kim CH, Werbeloff N, MacCabe JH, Dobson RJB, Ibrahim ZM. The side effect profile of Clozapine in real world data of three large mental health hospitals. PLoS One 2020; 15:e0243437. [PMID: 33290433 PMCID: PMC7723266 DOI: 10.1371/journal.pone.0243437] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 11/22/2020] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Mining the data contained within Electronic Health Records (EHRs) can potentially generate a greater understanding of medication effects in the real world, complementing what we know from Randomised control trials (RCTs). We Propose a text mining approach to detect adverse events and medication episodes from the clinical text to enhance our understanding of adverse effects related to Clozapine, the most effective antipsychotic drug for the management of treatment-resistant schizophrenia, but underutilised due to concerns over its side effects. MATERIAL AND METHODS We used data from de-identified EHRs of three mental health trusts in the UK (>50 million documents, over 500,000 patients, 2835 of which were prescribed Clozapine). We explored the prevalence of 33 adverse effects by age, gender, ethnicity, smoking status and admission type three months before and after the patients started Clozapine treatment. Where possible, we compared the prevalence of adverse effects with those reported in the Side Effects Resource (SIDER). RESULTS Sedation, fatigue, agitation, dizziness, hypersalivation, weight gain, tachycardia, headache, constipation and confusion were amongst the highest recorded Clozapine adverse effect in the three months following the start of treatment. Higher percentages of all adverse effects were found in the first month of Clozapine therapy. Using a significance level of (p< 0.05) our chi-square tests show a significant association between most of the ADRs and smoking status and hospital admission, and some in gender, ethnicity and age groups in all trusts hospitals. Later we combined the data from the three trusts hospitals to estimate the average effect of ADRs in each monthly interval. In gender and ethnicity, the results show significant association in 7 out of 33 ADRs, smoking status shows significant association in 21 out of 33 ADRs and hospital admission shows the significant association in 30 out of 33 ADRs. CONCLUSION A better understanding of how drugs work in the real world can complement clinical trials.
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Affiliation(s)
- Ehtesham Iqbal
- The Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Risha Govind
- The Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Alvin Romero
- SLAM BioResource for Mental Health, South London and Maudsley NHS Foundation Trust and King’s College London, London, United Kingdom
| | - Olubanke Dzahini
- Pharmacy Department, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Matthew Broadbent
- NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation, London, United Kingdom
- Biomedical Research Unit for Dementia, South London and Maudsley NHS Foundation, London, United Kingdom
| | - Robert Stewart
- NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation, London, United Kingdom
- Biomedical Research Unit for Dementia, South London and Maudsley NHS Foundation, London, United Kingdom
- Department of Health Service & Population Research, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Tanya Smith
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
- NIHR Oxford Health Biomedical Research Centre, University of Oxford and Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Chi-Hun Kim
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Nomi Werbeloff
- UCL Division of Psychiatry, University College London, London, United Kingdom
- Camden and Islington, NHS Foundation Trust, London, United Kingdom
| | - James H. MacCabe
- NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation, London, United Kingdom
- Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, London, United Kingdom
| | - Richard J. B. Dobson
- The Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation, London, United Kingdom
- Biomedical Research Unit for Dementia, South London and Maudsley NHS Foundation, London, United Kingdom
- The Farr Institute of Health Informatics Research, UCL Institute of Health Informatics, University College London, London, United Kingdom
- NIHR Biomedical Research Centre, University College London Hospitals, London, United Kingdom
| | - Zina M. Ibrahim
- The Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation, London, United Kingdom
- Biomedical Research Unit for Dementia, South London and Maudsley NHS Foundation, London, United Kingdom
- The Farr Institute of Health Informatics Research, UCL Institute of Health Informatics, University College London, London, United Kingdom
- NIHR Biomedical Research Centre, University College London Hospitals, London, United Kingdom
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Marazziti D, Stahl SM, Simoncini M, Baroni S, Mucci F, Palego L, Betti L, Massimetti G, Giannaccini G, Dell'Osso L. Psychopharmacology and ethnicity: A comparative study on Senegalese and Italian men. World J Biol Psychiatry 2020; 21:300-307. [PMID: 31012797 DOI: 10.1080/15622975.2019.1583373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: Ethnicity represents a crucial factor in influencing response to psychotropic drugs. Some data indicate that functional polymorphisms of two candidate genes of the serotonin (5-HT) transporter (SERT) may affect the response to selective 5-HT reuptake inhibitors (SSRIs). The present study aimed to compare the platelet SERT, through the specific [3H]paroxetine ([3H]Par) binding, and plasma oxytocin (OT) levels in 20 Senegalese and in 20 Italian men.Methods: No subjects had family or personal history of any major psychiatric disorder, or had ever regularly taken psychotropic drugs, or were suffering from any physical illness.Results: Senegalese men showed statistically significant higher density (Bmax, fmol/mg protein, mean ± SD) of [3H]Par binding sites (2105.00 ± 473.15 vs 1139.85 ± 213.58, P < 0.001), as well as more elevated plasma OT levels (pg/ml, mean ± SD) (OT: 18.08 ± 4.46 vs 6.62 ± 2.91) than Italian men.Conclusions: These differences, possibly due to genetic or dietary reasons, or even to gender, might affect the response to psychopharmacological compounds. Our findings would suggest specific caution when administering psychotropic compounds to non-European individuals, and the need of further studies in this emerging field of neuropsychopharmacology.
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Affiliation(s)
- Donatella Marazziti
- Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Stephen M Stahl
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA.,Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Marly Simoncini
- Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Stefano Baroni
- Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Federico Mucci
- Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, University of Pisa, Pisa, Italy
| | | | - Laura Betti
- Department of Pharmacy, University of Pisa, Pisa, Italy
| | - Gabriele Massimetti
- Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, University of Pisa, Pisa, Italy
| | | | - Liliana Dell'Osso
- Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, University of Pisa, Pisa, Italy
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AlBreiki M, AlMaqbali M, AlRisi K, AlSinawi H, Al Balushi M, Al Zakwani W. Prevalence of antidepressant-induced sexual dysfunction among psychiatric outpatients attending a tertiary care hospital. NEUROSCIENCES (RIYADH, SAUDI ARABIA) 2020; 25:55-60. [PMID: 31982896 PMCID: PMC8015629 DOI: 10.17712/nsj.2020.1.20190058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objectives: To measure the prevalence of sexual dysfunction in psychiatric outpatients treated with fluoxetine, paroxetine, venlafaxine or mirtazapine. Methods: This is a retrospective cross-sectional study conducted in Sultan Qaboos University Hospital, Muscat, Oman. All patients above 18 years of age, attending psychiatric clinic and taking fluoxetine, paroxetiene, venlafaxine or mirtazapine for various indications were invited to participate in the study. A data collection sheet was designed to document the patients’ demographic features, psychiatric diagnosis, type, dose and duration of antidepressant treatment. Sexual side effects’ part of Toronto Side Effect Scale (TSES) was used to assess the presence of sexual dysfunction. Results: A total of 137 patients (Male: 51%, Female: 49%) were included in the study. The mean age for the participants was 38 years (range: 19-72 years). The number of patients for each antidepressant was as follows: paroxetine (52 patients), fluoxetine (36), mirtazapine (36 patients) and venlafaxine (17 patients). The average duration of the antidepressant use was 3.9 years. The overall prevalence of sexual dysfunction was 39%. Paroxetine was the most common antidepressant associated with sexual dysfunction especially for decreased libido (59.6%) and delayed ejaculation (34.4%). In contrary, mirtazapine was the lowest among antidepressants to cause sexual dysfunction. Conclusion: Sexual dysfunction is common among patients treated with antidepressants particularly selective serotonin reuptake inhibitors (SSRIs). Addressing this side effects early in treatment can improve compliance to treatment and prevent relapse.
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Affiliation(s)
- Mohammed AlBreiki
- Psychiatry Residency Training Program, Oman Medical Specialty Board, Muscat, Oman
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13
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Kato T, Furukawa TA, Mantani A, Kurata K, Kubouchi H, Hirota S, Sato H, Sugishita K, Chino B, Itoh K, Ikeda Y, Shinagawa Y, Kondo M, Okamoto Y, Fujita H, Suga M, Yasumoto S, Tsujino N, Inoue T, Fujise N, Akechi T, Yamada M, Shimodera S, Watanabe N, Inagaki M, Miki K, Ogawa Y, Takeshima N, Hayasaka Y, Tajika A, Shinohara K, Yonemoto N, Tanaka S, Zhou Q, Guyatt GH. Optimising first- and second-line treatment strategies for untreated major depressive disorder - the SUN☺D study: a pragmatic, multi-centre, assessor-blinded randomised controlled trial. BMC Med 2018; 16:103. [PMID: 29991347 PMCID: PMC6040068 DOI: 10.1186/s12916-018-1096-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 06/05/2018] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND For patients starting treatment for depression, current guidelines recommend titrating the antidepressant dosage to the maximum of the licenced range if tolerated. When patients do not achieve remission within several weeks, recommendations include adding or switching to another antidepressant. However, the relative merits of these guideline strategies remain unestablished. METHODS This multi-centre, open-label, assessor-blinded, pragmatic trial involved two steps. Step 1 used open-cluster randomisation, allocating clinics into those titrating sertraline up to 50 mg/day or 100 mg/day by week 3. Step 2 used central randomisation to allocate patients who did not remit after 3 weeks of treatment to continue sertraline, to add mirtazapine or to switch to mirtazapine. The primary outcome was depression severity measured with the Patient Health Questionnaire-9 (PHQ-9) (scores between 0 and 27; higher scores, greater depression) at week 9. We applied mixed-model repeated-measures analysis adjusted for key baseline covariates. RESULTS Between December 2010 and March 2015, we recruited 2011 participants with hitherto untreated major depression at 48 clinics in Japan. In step 1, 970 participants were allocated to the 50 mg/day and 1041 to the 100 mg/day arms; 1927 (95.8%) provided primary outcomes. There was no statistically significant difference in the adjusted PHQ-9 score at week 9 between the 50 mg/day arm and the 100 mg/day arm (0.25 point, 95% confidence interval (CI), - 0.58 to 1.07, P = 0.55). Other outcomes proved similar in the two groups. In step 2, 1646 participants not remitted by week 3 were randomised to continue sertraline (n = 551), to add mirtazapine (n = 537) or to switch to mirtazapine (n = 558): 1613 (98.0%) provided primary outcomes. At week 9, adding mirtazapine achieved a reduction in PHQ-9 scores of 0.99 point (0.43 to 1.55, P = 0.0012); switching achieved a reduction of 1.01 points (0.46 to 1.56, P = 0.0012), both relative to continuing sertraline. Combination increased the percentage of remission by 12.4% (6.1 to 19.0%) and switching by 8.4% (2.5 to 14.8%). There were no differences in adverse effects. CONCLUSIONS In patients with new onset depression, we found no advantage of titrating sertraline to 100 mg vs 50 mg. Patients unremitted by week 3 gained a small benefit in reduction of depressive symptoms at week 9 by switching sertraline to mirtazapine or by adding mirtazapine. TRIAL REGISTRATION ClinicalTrials.gov, NCT01109693 . Registered on 23 April 2010.
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Affiliation(s)
| | - Toshi A Furukawa
- Department of Health Promotion of Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
| | | | | | | | | | | | | | | | | | | | | | - Masaki Kondo
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yasumasa Okamoto
- Department of Neuropsychiatry, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan
| | - Hirokazu Fujita
- Center to Promote Creativity in Medical Education, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Motomu Suga
- Department of Neuropsychiatry, University of Tokyo Hospital, Tokyo, Japan
| | - Shingo Yasumoto
- Department of Neuropsychiatry, Kurume University Medical School, Kurume, Japan
| | - Naohisa Tsujino
- Department of Psychiatry, Toho University School of Medicine, Tokyo, Japan
| | - Takeshi Inoue
- Department of Neuropsychiatry, Tokyo Medical University, Tokyo, Japan
| | - Noboru Fujise
- Department of Neuropsychiatry, Kumamoto University Graduate School of Medicine, Kumamoto, Japan
| | - Tatsuo Akechi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Mitsuhiko Yamada
- Department of Neuropsychopharmacology, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Shinji Shimodera
- Center to Promote Creativity in Medical Education, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Norio Watanabe
- Department of Health Promotion of Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Masatoshi Inagaki
- Department of Neuropsychiatry, Okayama University Hospital, Okayama, Japan
| | | | - Yusuke Ogawa
- Department of Health Promotion of Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Nozomi Takeshima
- Department of Health Promotion of Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Yu Hayasaka
- Department of Health Promotion of Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Aran Tajika
- Department of Health Promotion of Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Kiyomi Shinohara
- Department of Health Promotion of Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Naohiro Yonemoto
- Department of Biostatistics, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan
| | - Shiro Tanaka
- Department of Clinical Biostatistics, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan
| | - Qi Zhou
- Departments of Clinical Epidemiology and Biostatistics and of Medicine, McMaster University, Hamilton, Canada
| | - Gordon H Guyatt
- Departments of Clinical Epidemiology and Biostatistics and of Medicine, McMaster University, Hamilton, Canada
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Murphy E, Gangwisch JE, Matsunaga JT, Ottman R. Familial aggregation of major depressive disorder in an African-American community. Depress Anxiety 2018; 35:674-684. [PMID: 29782058 PMCID: PMC6035763 DOI: 10.1002/da.22775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 04/17/2018] [Accepted: 04/23/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND African Americans (AAs) with major depressive disorder (MDD) experience more impairment and poorer treatment outcomes relative to Whites, yet are underrepresented in family studies of MDD. This is the first study to investigate the familial aggregation of major depression among AAs. METHODS Participants' reports of depression from clinical and family history (FH) interviews were used to examine depression rates among 435 first-degree relatives and half-siblings of 63 depressed cases and 222 relatives of 33 nondepressed controls. Binary logistic regression was used to compute odds ratios (ORs) for FH of MDD and level of trauma exposure (high and low) in cases versus controls. Poisson regression models with generalized estimating equations were used to assess MDD in relatives of cases versus relatives of controls. RESULTS Cases and controls did not differ in either FH of MDD (OR = 1.2, 95% confidence interval [CI] = 0.5-2.9), or prevalence of MDD in relatives (relative risk [RR] = 1.5, 95% CI = 0.8-2.5). However, exposure to high trauma was associated with increased risk of MDD (OR = 3.0, 95% CI = 1.22-7.17) and the combined effect of FH and trauma was greater than expected under an additive model. Similarly, the RR for MDD among relatives of cases with high-trauma levels was 2.2 (1.24-4.2), compared to relatives of controls with low trauma. CONCLUSION The effect of FH of MDD appears to be exacerbated among individuals exposed to high trauma. Replication and further research on the chronology and subtypes of trauma and MDD, and their interactions, remain essential in AA populations.
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Affiliation(s)
- Eleanor Murphy
- New York State Psychiatric Institute, Unit 24, 1051 Riverside Drive, New York, NY, 10032,Corresponding Author. ;
| | - James E. Gangwisch
- New York State Psychiatric Institute, Unit 24, 1051 Riverside Drive, New York, NY, 10032
| | - Janet T. Matsunaga
- New York State Psychiatric Institute, Unit 24, 1051 Riverside Drive, New York, NY, 10032
| | - Ruth Ottman
- New York State Psychiatric Institute, Unit 24, 1051 Riverside Drive, New York, NY, 10032,G.H. Sergievsky Center and Departments of Epidemiology and Neurology, Columbia University, 630 W. 168 Street, P&S Box 16, New York, NY 10032
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Lv D, Zhao M, Chen L, Yu D, Yun X, Yang Q, Huang X. An Inter-Ethnic Comparison Study of Ziprasidone Plasma Levels, Dosage and Clinical Response in Patients with Schizophrenia. Psychiatry Investig 2017; 14:360-367. [PMID: 28539955 PMCID: PMC5440439 DOI: 10.4306/pi.2017.14.3.360] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 04/14/2016] [Accepted: 05/25/2016] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate ziprasidone plasma concentration, daily dose and clinical efficacy and safety in Han Chinese and Mongolian patients with first-episode schizophrenia. METHODS A total of 123 inpatients affected by schizophrenia were recruited from the Mental Health Center of Inner Mongolia in China. Ziprasidone plasma concentration, clinical efficacy and side effects were systematically evaluated at baseline, and at 1, 2, 4, and 6 weeks. Metabolic measures such as changes in weight, body mass index (BMI), fasting blood glucose (FBG), triglycerides, and cholesterol, were also recorded. RESULTS 90 patients completed the study. Compared with Han patients, on average, Mongolian patients received a significantly higher ziprasidone dosage for adequate symptom control during the 6-week period and had a lower plasma concentration-to-dose ratio. The Mongolian patients also experienced greater increases in weight and BMI. No significant differences between the two ethnic groups were found in the rate of reduction in the Positive and Negative Syndrome Scale (PANSS) score, Treatment Emergent Symptom Scale (TESS) total score, FBG, triglycerides, cholesterol or Q-Tc interval. CONCLUSION Compared to Han Chinese patients, Mongolian patients appeared to have increased ziprasidone clearance and require higher doses to achieve effective treatment for schizophrenia.
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Affiliation(s)
- Dongsheng Lv
- Department of Psychiatry, Mental Health Center of Inner Mongolia, Inner Mongolia, Hohhot, China
- Department of Psychiatry, Second Xiangya Hospital of Central South University, Changsha, China
| | - Meirong Zhao
- Department of Psychiatry, Mental Health Center of Inner Mongolia, Inner Mongolia, Hohhot, China
- Department of Psychiatry, the First Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, Hohhot, China
| | - Lixia Chen
- Department of Psychiatry, Mental Health Center of Inner Mongolia, Inner Mongolia, Hohhot, China
| | - Dongsheng Yu
- Department of Psychiatry, Mental Health Center of Inner Mongolia, Inner Mongolia, Hohhot, China
| | - Xiaobin Yun
- Department of Psychiatry, Mental Health Center of Inner Mongolia, Inner Mongolia, Hohhot, China
| | - Qing Yang
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Xiaojun Huang
- Department of Psychiatry, Second Xiangya Hospital of Central South University, Changsha, China
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Metakognitive Therapie und Pharmakotherapie – adaptiert für unbegleitete minderjährige Flüchtlinge. Prax Kinderpsychol Kinderpsychiatr 2017; 66:287-303. [DOI: 10.13109/prkk.2017.66.4.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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17
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Adjunctive Brexpiprazole as a Novel Effective Strategy for Treating Major Depressive Disorder: A Systematic Review and Meta-Analysis. J Clin Psychopharmacol 2017; 37:46-53. [PMID: 27941419 DOI: 10.1097/jcp.0000000000000622] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE/BACKGROUND Brexpiprazole was approved for adjunctive treatment of major depressive disorder (MDD) in 2015. Because only a small number of randomized controlled trials have investigated the use of brexpiprazole in MDD, we performed a meta-analysis. METHODS/PROCEDURES We systematically searched literatures in PubMed, Cochrane Library database, EMBASE, Google Scholar, and clinicaltrials.gov up to January 2016. The primary efficacy measure was the mean change in total Montgomery-Åsberg Depression Rating Scale (MADRS) score from baseline. Secondary efficacy measures were the mean change in total Hamilton Rating Scale for Depression (17 items) score from baseline and the response (≥50% reduction in MADRS total score) and remission (MADRS total score ≤ 10 with ≥50% reduction) rates. FINDINGS/RESULTS Four studies fulfilled the inclusion criteria and were included in the analysis. Brexpiprazole showed superior efficacy over placebo with effect sizes (mean differences) of -1.76 (95% confidence interval [CI], -2.45 to -1.07) for MADRS and -1.21 (95% CI, -1.71 to -0.72) for the 17-item Hamilton Rating Scale for Depression. The risk ratios for response and remission were 1.57 (95% CI, 1.29-1.91) and 1.55 (95% CI, 1.22-1.96), respectively. The incidences of discontinuation due to adverse events, akathisia, and weight increase were higher in the brexpiprazole group than in the placebo group, with risk ratios of 3.44 (95% CI, 1.52-7.80), 3.39 (95% CI, 2.08-5.51), and 4.36 (95% CI, 2.45-7.77), respectively, and the incidence of akathisia was related to the brexpiprazole dose. IMPLICATIONS/CONCLUSIONS Although our results suggest that brexpiprazole could be an effective adjunctive agent for MDD, they should be cautiously translated into clinical practice because the meta-analysis was based on only a handful of randomized controlled trials.
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18
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Murphy E. African-American representation in family and twin studies of mood and anxiety disorders: A systematic review. J Affect Disord 2016; 205:311-318. [PMID: 27559631 PMCID: PMC5048573 DOI: 10.1016/j.jad.2016.08.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 07/09/2016] [Accepted: 08/14/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE Mood and anxiety disorders are common and disabling psychiatric disorders with known heritable risk factors. But the extent to which their heritability and familial risks can be generalized across ethnic/racial groups is still largely unknown, but remains of considerable scientific and clinical interest. The main objective in this review was to evaluate African-American (AA) representation in family and twin studies of major mood and anxiety disorders. METHOD We conducted key word-driven computerized searches in MEDLINE and PsycINFO and manual searches from reference lists of selected articles. Search parameters included family or twin studies, mood or anxiety disorders, and familial aggregation or heritability. US-based studies published from 1980 to 2015 were included. RESULTS The final selection yielded 209 studies, of which 88 did not report race/ethnicity or only reported Caucasian/white race. Of the remaining 121 studies, 66% did not include AAs, 24% included 1-10% AA, 8% included greater than 10% AA and 2 studies were exclusively AA. These trends were similar across study type, disorder and time periods spanning 35 years. LIMITATIONS Small samples, including the large number of studies without race/ethnicity reports, limited detailed analyses of change across time by disorder and study type. Adoption studies were not included in this review. CONCLUSIONS Underrepresentation of AAs in family and twin studies of affective disorders is substantial and can limit generalizability of established heritability and familial risk estimates across clinical and research settings. Additional twin and family studies focusing on AAs can be of benefit in closing this gap.
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Affiliation(s)
- Eleanor Murphy
- New York State Psychiatric University - Columbia University, 1051 Riverside Drive, Unit 24, New York, NY 10032, United States.
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19
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Bernal DR, Becker Herbst R, Lewis BL, Feibelman J. Ethical Care for Vulnerable Populations Receiving Psychotropic Treatment. ETHICS & BEHAVIOR 2016. [DOI: 10.1080/10508422.2016.1224187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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20
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Rossom RC, Shortreed S, Coleman KJ, Beck A, Waitzfelder BE, Stewart C, Ahmedani BK, Zeber JE, Simon GE. ANTIDEPRESSANT ADHERENCE ACROSS DIVERSE POPULATIONS AND HEALTHCARE SETTINGS. Depress Anxiety 2016; 33:765-74. [PMID: 27320786 PMCID: PMC5618693 DOI: 10.1002/da.22532] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 05/13/2016] [Accepted: 05/27/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Early adherence is key to successful depression treatment, but nearly 60% of patients discontinue antidepressants within 3 months. Our study aimed to determine factors associated with poor early adherence to antidepressants in a large diverse sample of patients. METHODS Six Mental Health Research Network healthcare systems contributed data for adults with depression and a new antidepressant start, defined by a washout period of at least 270 days, between January 1, 2010 and December 31, 2012. Pharmacy fill and self-reported race/ethnicity data were obtained from the electronic medical record. Patients had early adherence if they had a second antidepressant fill within 180 days of the first. We used logistic regression to investigate the relationship between early adherence and patient characteristics. RESULTS A total of 177,469 adult patients had 184,967 new episodes of depression with a filled antidepressant prescription. Patients refilled their antidepressants within 180 days in 71% of episodes. Race/ethnicity was a strong predictor of early adherence, with patients from racial/ethnic minorities other than Native Americans/Alaskan Natives less likely (adjusted odd ratios 0.50-0.59) to refill their antidepressants than non-Hispanic whites. Age, neighborhood education, comorbidity burden, provider type and engagement in psychotherapy were also associated with adherence. Other apparent predictors of early adherence, including neighborhood income, gender, and prior mental health hospitalizations, were no longer significant in the fully adjusted model. CONCLUSIONS Race/ethnicity was a robust predictor of early antidepressant adherence, with minority groups other than Native Americans/Alaskan Natives less likely to be adherent. Further research is needed to determine whether early nonadherence in specific minority populations is intentional, due to side effects or patient preference, or unintentional and appropriate for targeted interventions to improve adherence.
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Affiliation(s)
| | | | - Karen J Coleman
- Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, CA
| | - Arne Beck
- Kaiser Permanente Colorado, Institute for Health Research, Denver, CO
| | | | | | - Brian K Ahmedani
- Henry Ford Health System, Behavioral Health Services and Center for Health Policy and Health Services Research, Detroit, MI
| | - John E Zeber
- Baylor Scott & White Health, Center for Applied Health Research; Central Texas Veterans Health Care System; Temple, TX
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Schofield P, Das-Munshi J, Mathur R, Congdon P, Hull S. Does depression diagnosis and antidepressant prescribing vary by location? Analysis of ethnic density associations using a large primary-care dataset. Psychol Med 2016; 46:1321-1329. [PMID: 26879871 PMCID: PMC4828938 DOI: 10.1017/s0033291715002913] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 10/09/2015] [Accepted: 11/28/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Studies have linked ethnic differences in depression rates with neighbourhood ethnic density although results have not been conclusive. We looked at this using a novel approach analysing whole population data covering just over one million GP patients in four London boroughs. METHOD Using a dataset of GP records for all patients registered in Lambeth, Hackney, Tower Hamlets and Newham in 2013 we investigated new diagnoses of depression and antidepressant use for: Indian, Pakistani, Bangladeshi, black Caribbean and black African patients. Neighbourhood effects were assessed independently of GP practice using a cross-classified multilevel model. RESULTS Black and minority ethnic groups are up to four times less likely to be newly diagnosed with depression or prescribed antidepressants compared to white British patients. We found an inverse relationship between neighbourhood ethnic density and new depression diagnosis for some groups, where an increase of 10% own-ethnic density was associated with a statistically significant (p < 0.05) reduced odds of depression for Pakistani [odds ratio (OR) 0.81, 95% confidence interval (CI) 0.70-0.93], Indian (OR 0.88, CI 0.81-0.95), African (OR 0.88, CI 0.78-0.99) and Bangladeshi (OR 0.94, CI 0.90-0.99) patients. Black Caribbean patients, however, showed the opposite effect (OR 1.26, CI 1.09-1.46). The results for antidepressant use were very similar although the corresponding effect for black Caribbeans was no longer statistically significant (p = 0.07). CONCLUSION New depression diagnosis and antidepressant use was shown to be less likely in areas of higher own-ethnic density for some, but not all, ethnic groups.
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Affiliation(s)
- P. Schofield
- Division of Health & Social Care
Research, Faculty of Life Sciences & Medicine,
King's College London, Addison House,
Guy's Campus, London, UK
| | - J. Das-Munshi
- Institute of Psychiatry, Psychology &
Neuroscience, King's College London,
UK
| | - R. Mathur
- Centre for Primary Care and Public
Health, Queen Mary University of London,
UK
| | - P. Congdon
- Centre for Primary Care and Public
Health, Queen Mary University of London,
UK
| | - S. Hull
- Centre for Primary Care and Public
Health, Queen Mary University of London,
UK
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Grover S, Balachander S, Chakarabarti S, Avasthi A. Prescription practices and attitude of psychiatrists towards clozapine: A survey of psychiatrists from India. Asian J Psychiatr 2015; 18:57-65. [PMID: 26498722 DOI: 10.1016/j.ajp.2015.09.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 09/20/2015] [Accepted: 09/28/2015] [Indexed: 01/17/2023]
Abstract
AIM To assess the attitude of psychiatrists towards clozapine and also to evaluate the prescription practices of psychiatrists for clozapine. METHODOLOGY An email survey was sent to 3381 psychiatrists from India, of whom 548 (16.2%) responded. RESULTS Mean number of years in clinical practice was 12.59 (SD-10.1) for participating psychiatrists. Majority of the participants rated their knowledge about clozapine to be good (61.5%)/very good (34.5%). The primary indication for use of clozapine for almost all the participants was treatment resistance and most of the psychiatrists initiated clozapine either in the dose of 25mg OD (44.3%) or 12.5mg OD (37%). Half (51.8%) of the psychiatrists preferred to use clozapine as BD dosing schedule, and median doses required to stabilize the patients ranged from 137.5 to 400mg/day. Once the clozapine dose had been stabilized, about half (51%) of the psychiatrists advised blood monitoring at monthly intervals. Almost all psychiatrists rated effectiveness of clozapine to be better than other antipsychotics. In terms of tolerability, 45.3% of the psychiatrists rated it as 'same as other antipsychotics' and 15.9% rated it as better than other antipsychotics. Most common patient and therapist related factors associated with reluctance to start clozapine were history of poor medication compliance and need for monitoring, respectively. Upon reviewing the prescription of other psychiatrists, participating psychiatrists reported that in about 28.46% of patients clozapine was not prescribed though indicated. CONCLUSIONS This survey suggests that clozapine is underused in India, although psychiatrists have adequate knowledge about the drug but many psychiatrists have negative attitude towards clozapine.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - Srinivas Balachander
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Subho Chakarabarti
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Ajit Avasthi
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
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Ruglass LM, Pedersen A, Cheref S, Hu MC, Hien DA. Racial differences in adherence and response to combined treatment for full and subthreshold post-traumatic stress disorder and alcohol use disorders: A secondary analysis. J Ethn Subst Abuse 2015; 15:434-448. [PMID: 26422415 DOI: 10.1080/15332640.2015.1056927] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We conducted a secondary data analysis to examine whether there were racial differences in adherence and treatment outcomes for participants with co-occurring full and subthreshold post-traumatic stress disorder (PTSD) and alcohol/substance use disorders (A/SUD) who were treated with Seeking Safety (a cognitive-behavioral therapy) and sertraline or Seeking Safety and placebo as part of a clinical trial. Bivarate analyses examined the association between race and adherence, and generalized estimating equations assessed whether race moderated the effect of combination treatment on PTSD and alcohol use outcomes. Except for education, there were no statistically significant racial differences in baseline demographic and psychiatric characteristics. African Americans and Caucasians were equally adherent in number of psychotherapy and medication sessions attended and medication compliance. After controlling for baseline demographics and psychiatric symptoms, however, a race by treatment condition interaction emerged suggesting that African Americans who received the Seeking Safety and sertraline treatment had significantly lower PTSD symptom severity posttreatment and at six months follow-up compared to their counterparts who received Seeking Safety and placebo. No differential effect of treatment condition was found for Caucasians. Moreover, results indicated that a diagnosis of major depressive disorder negatively impacted PTSD symptom recovery for African American participants but not for Caucasians. In conclusion, no differences emerged between African Americans and Caucasians in adherence to combination treatments for PTSD and A/SUD. Findings also suggest assessment and treatment of MDD among African Americans may improve treatment outcomes. More research is needed to determine whether the differential response to Seeking Safety and sertraline among African Americans compared to Caucasians can be replicated.
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Affiliation(s)
- Lesia M Ruglass
- a Department of Psychology , City College of New York of CUNY , New York , NY
| | - Annelisa Pedersen
- a Department of Psychology , City College of New York of CUNY , New York , NY
| | - Soumia Cheref
- b Department of Psychology , University of Houston , Houston , TX
| | - Mei-Chen Hu
- c Department of Psychiatry , Columbia University College of Physicians and Surgeons , New York , NY
| | - Denise A Hien
- d Gordon F. Derner Institute for Advanced Psychological Studies, Adelphi University and Department of Psychiatry , Columbia University College of Physicians and Surgeons , New York , NY
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Woo YS, Wang HR, Yoon BH, Lee SY, Lee KH, Seo JS, Bahk WM. Bioequivalence of Generic and Brand Name Clozapine in Korean Schizophrenic Patients: A Randomized, Two-Period, Crossover Study. Psychiatry Investig 2015; 12. [PMID: 26207129 PMCID: PMC4504918 DOI: 10.4306/pi.2015.12.3.356] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Clozapine is the treatment of choice for refractory schizophrenia. The aim of this study was to compare the pharmacokinetics of the brand name (Clozaril) formulation and a generic formulation (Clzapine) of clozapine in Korean schizophrenic patients. METHODS A prospective, randomized, crossover study was conducted to evaluate the steady-state pharmacokinetic profiles of Clozaril and Clzapine. Schizophrenic patients were randomized to receive either the brand name or generic formulation (100 mg twice daily) for 10 days, followed by the other formulation for 10 days. Plasma samples were collected on the last day of each treatment period. RESULTS Twenty-two of 28 patients (78.6%) completed the study. The mean Cmax,ss values for Clzapine and Clozaril were 524.62 and 551.18 ng/mL, and the mean AUC0-12 values were 4479.90 hr·ng/mL and 4724.56 hr·ng/mL, respectively. The 90% CI values for the natural logarithmically transformed Cmax,ss and AUC0-12 ratios (Clzapine to Clozaril) after a single oral dose (100 mg) were 0.934 (0.849-1.028) and 0.936 (0.869-1.008), respectively. Five patients (20.8%) among 24 patients who took Clzapine reported 11 adverse events and six adverse events were reported by four patients (15.4%) among 26 who took Clozaril; there were no significant differences on physical examination or in vital signs, ECG, and laboratory tests between groups. CONCLUSION Generic clozapine (Clzapine) appears to be bioequivalent to brand name clozapine (Clozaril).
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Affiliation(s)
- Young Sup Woo
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hee-Ryung Wang
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Bo-Hyun Yoon
- Department of Psychiatry, Naju National Hospital, Naju, Republic of Korea
| | - Sang-Yeol Lee
- Department of Psychiatry, School of Medicine, Wonkwang University, Iksan, Republic of Korea
| | - Kwang Hun Lee
- Department of Psychiatry, College of Medicine, Dongguk University, Gyeongju, Republic of Korea
| | - Jeong Seok Seo
- Department of Psychiatry, School of Medicine, Konkuk University, Chungju, Republic of Korea
| | - Won-Myong Bahk
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Zhang W, Xu H, Zhao S, Yin S, Wang X, Guo J, Zhang S, Zhou H, Wang F, Gu L, Zhu L, Yu H, Qu Z, Tian D. Prevalence and influencing factors of co-morbid depression in patients with type 2 diabetes mellitus: a General Hospital based study. Diabetol Metab Syndr 2015; 7:60. [PMID: 26167205 PMCID: PMC4499190 DOI: 10.1186/s13098-015-0053-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 06/17/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Depression and diabetes have been recognized as major public health issues in China, however, no studies to date examined the factors associated with the development of depression in patients with diabetes in China. This study aimed to estimate the prevalence of co-morbid depression among adults with type 2 diabetes mellitus (DM) and to examine the influence factors of co-morbid depression in a group of patients with type 2 DM. METHODS The study was conducted from March l to May 31, 2012, in the Department of Endocrinology of the First Affiliated Hospital of the General Hospital of the People's Liberation Army (PLA). A systematic random sample of 412 type 2 DM patients aged over 18 years was selected. A structured questionnaire was used for collecting the information about socio-demographic data, lifestyle factors and clinical characteristics. Depression and social support was evaluated by using the Chinese version of Beck Depression Inventory (BDI) and Social Support Rate Scale (SSRS), respectively. Weights and heights were measured. Hemoglobin A1c (HbA1c) was abstracted from each patient directly after the interview. RESULTS Of the total sample, 142 patients had depression according to the BDI scores (BDI scores ≥14), the prevalence of co-morbid depression in this study population was 5.7 % (142/2500). Of which, 56 had major depression (BDI ≥ 21), and 86 had moderate depression (BDI ≥ 14&BDI < 21). Logistic regression analysis indicated that a high HbA1c level, a high BMI, low quality health insurance, and being single, were significantly associated with the development of depression. However, a family history of diabetes and a high social support level are likely protective factors. CONCLUSIONS The prevalence of co-morbid depression was 5.7 % among Chinese subjects with type 2 DM in this study. High HbA1c level, high BMI score, being single, low social support level, and low quality health insurance were associated with the presence of depression. These findings support a recommendation for routine screening and management in China for depression in patients with diabetes, especially for those in primary care, to reduce the number of the depressed or the misrecognized depressed diabetic patients.
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Affiliation(s)
- Weijun Zhang
- />School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing, 100875 China
| | - Huiwen Xu
- />Department of Public Health Sciences, University of Rochester School of Medicine & Dentistry, Rochester, NY 14642 USA
| | - Shuliang Zhao
- />School of Public Administration, Yunnan University of Finance and Economics, Kunming, 650221 China
| | - Shinan Yin
- />Department of Endocrinology, First Affiliated Hospital of the General Hospital of the People’s Liberation Army (PLA), Beijing, 100853 China
| | - Xiaohua Wang
- />School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing, 100875 China
| | - Jing Guo
- />Department of Sociology, Huazhong University of Science and Technology, 1037 Luoyu Road, Wuhan, 430074 China
| | - Shengfa Zhang
- />School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing, 100875 China
| | - Huixuan Zhou
- />School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing, 100875 China
| | - Fugang Wang
- />School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing, 100875 China
| | - Linni Gu
- />School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing, 100875 China
| | - Lei Zhu
- />School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing, 100875 China
| | - Haibo Yu
- />School of Government, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing, 100875 China
| | - Zhiyong Qu
- />School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing, 100875 China
| | - Donghua Tian
- />School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing, 100875 China
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26
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Sacchetti E, Galluzzo A, Valsecchi P. Oral ziprasidone in the treatment of patients with bipolar disorders: a critical review. Expert Rev Clin Pharmacol 2014; 4:163-79. [DOI: 10.1586/ecp.10.139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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27
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Adam UU, Husain N, Haddad PM, Munshi T, Tariq F, Naeem F, Chaudhry IB. Tardive dyskinesia in a South Asian population with first episode psychosis treated with antipsychotics. Neuropsychiatr Dis Treat 2014; 10:1953-9. [PMID: 25342903 PMCID: PMC4206401 DOI: 10.2147/ndt.s68297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Tardive dyskinesia (TD) is a side effect of antipsychotic treatment that often only appears after months or years of treatment. A systematic review of randomized controlled trials lasting more than 1 year showed that second-generation antipsychotics (SGAs) were associated with an approximately fivefold lower risk of TD compared to haloperidol in patients with chronic schizophrenia. In contrast, there is little research on the risk of TD with other first-generation antipsychotics (FGAs), and this applies especially to their use in the treatment of patients with first episode psychosis (FEP). OBJECTIVES To determine the severity and point prevalence of TD in a naturalistic sample of patients with FEP in Pakistan treated with FGAs or SGAs. METHODS This was an observational study. TD was assessed by trained clinicians using the Abnormal Involuntary Movement Scale. RESULTS In the total sample (number =86) the mean age of patients was 26 years and the prevalence of TD (Schooler Kane criteria) was 29% with no significant difference between those treated with FGAs and SGAs (31% FGAs versus 26% SGAs; P=0.805). The Abnormal Involuntary Movement Scale total score (items 1-7), a measure of the severity of TD, was significantly higher for patients treated with FGAs versus those treated with SGAs (P=0.033). Scores on specific items showed that this reflected higher scores for dyskinesia affecting the muscles of facial expression, as well as of the upper and lower limb, whereas scores did not differ significantly in other body areas. CONCLUSION FGAs were associated with greater severity, though not prevalence, of TD than SGAs. The study highlights the relatively high rate of TD in Asian FEP patients and the need for clinicians to monitor for this and other potential antipsychotic side effects during treatment.
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Affiliation(s)
| | | | | | - Tariq Munshi
- Correspondence: Tariq Munshi, Department of Psychiatry, Queen’s University, 385 Princess Street, Kingston, Ontario K7L1B9, Canada, Tel +1 613 5441356, Fax +1 613 5442162, Email
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28
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Chan LF, Zai C, Monda M, Potkin S, Kennedy JL, Remington G, Lieberman J, Meltzer HY, De Luca V. Role of ethnicity in antipsychotic-induced weight gain and tardive dyskinesia: genes or environment? Pharmacogenomics 2013; 14:1273-81. [DOI: 10.2217/pgs.13.127] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: This study explored the role of self-reported ethnicity and genetic ancestry on antipsychotic (AP)-induced weight gain and tardive dyskinesia (TD) in schizophrenia. Patients & methods: Ethnicity was determined by self-report as well as Structure analysis of 190 SNPs selected from HapMap3, genotyped using a customized Illumina BeadChip. Age, gender, baseline weight and AP response using Brief Psychiatric Rating Scale were assessed. Multivariate regression models for AP-induced weight gain and TD, based on the Abnormal Involuntary Movement Scale were constructed. Results: African–American ethnicity (self-report, p = 0.021 and Structure analysis, p = 0.042) predicted AP-induced weight gain but not TD (self-report, p = 0.408 and Structure analysis, p = 0.714). Conclusion: Self-reported African–American ethnicity seemed to better predict AP-induced weight gain in schizophrenia compared with genetic ancestry, suggesting a possible role of environmental in addition to genetic factors. Future larger studies are needed to clarify specific gene–environment mechanisms mediating the effect of ethnicity on AP-induced weight gain. Original submitted 1 January 2013; Revision submitted 17 June 2013
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Affiliation(s)
- Lai Fong Chan
- Centre for Addiction & Mental Health, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia
| | - Clement Zai
- Centre for Addiction & Mental Health, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Marcellino Monda
- Department of Experimental Medicine, Second University of Naples, Naples, Italy
| | - Steven Potkin
- University of California, Irvine California, CA, USA
| | - James L Kennedy
- Centre for Addiction & Mental Health, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Gary Remington
- Centre for Addiction & Mental Health, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Jeffrey Lieberman
- Department of Psychiatry, College of Physicians & Surgeons, Columbia University & the New York State Psychiatric Institute, New York City, NY, USA
| | | | - Vincenzo De Luca
- Centre for Addiction & Mental Health, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
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Czerniak E, Davidson M. Placebo, a historical perspective. Eur Neuropsychopharmacol 2012; 22:770-4. [PMID: 22608298 DOI: 10.1016/j.euroneuro.2012.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 03/22/2012] [Accepted: 04/06/2012] [Indexed: 10/28/2022]
Abstract
Substances and interventions with no specific therapeutic effect have been in use since the dawn of history. The term placebo has first been mentioned in the Scriptures, but it was not until the 19th century that it appeared in a medical context. Although lay people like Voltaire, and physicians such as Sir William Osler, have raised the possibility that much of what physicians did had no specific therapeutic effect, this notion was not shared by the public at large or by the medical profession. It was only by the end of the 18th century that a placebo-controlled trial has been conducted, repudiating the therapeutic effect of mesmerism. The advent, in the late 1940s, of effective treatments, which also had serious adverse effects, made the distinction between placebo and putative, active drug effects more relevant and urgent, and cleared the way for double-blind, randomized, placebo-controlled trials. This in turn triggered an ethical debate on the use of placebo, both in research and in clinical practice. Anthropologists, sociologists, physiologists, and medical researchers are all focusing their efforts on understanding the mechanism, role and modulating factors of placebo.
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Affiliation(s)
- Efrat Czerniak
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Piatkov I, Jones T, McLean M. Cases of adverse reaction to psychotropic drugs and possible association with pharmacogenetics. J Pers Med 2012; 2:149-57. [PMID: 25562357 PMCID: PMC4251377 DOI: 10.3390/jpm2040149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 09/21/2012] [Accepted: 09/21/2012] [Indexed: 11/24/2022] Open
Abstract
Thousands of samples for pharmacogenetic tests have been analysed in our laboratory since its establishment. In this article we describe some of the most interesting cases of CYP poor metabolisers associated with adverse reactions to psychotropic drugs. Prevention of disease/illness, including Adverse Drug Reaction (ADR), is an aim of modern medicine. Scientific data supports the fact that evaluation of drug toxicology includes several factors, one of which is genetic variations in pharmacodynamics and pharmacokinetics of drug pathways. These variations are only a part of toxicity evaluation, however, even if it would help to prevent only a small percentage of patients from suffering adverse drug reactions, especially life threatening ADRs, pharmacogenetic testing should play a significant role in any modern psychopharmacologic practice. Medical practitioners should also consider the use of other medications or alternative dosing strategies for drugs in patients identified as altered metabolisers. This will promise not only better and safer treatments for patients, but also potentially lowering overall healthcare costs.
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Affiliation(s)
- Irina Piatkov
- University of Western Sydney Clinic and Research Centre Blacktown, Western Sydney Local Health District, Blacktown 2148, NSW, Australia.
| | - Trudi Jones
- University of Western Sydney Clinic and Research Centre Blacktown, Western Sydney Local Health District, Blacktown 2148, NSW, Australia.
| | - Mark McLean
- University of Western Sydney Clinic and Research Centre Blacktown, Western Sydney Local Health District, Blacktown 2148, NSW, Australia.
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Wong FK, Pi EH. Ethnopsychopharmacology considerations for Asians and Asian Americans. Asian J Psychiatr 2012; 5:18-23. [PMID: 26878942 DOI: 10.1016/j.ajp.2012.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Revised: 01/04/2012] [Accepted: 01/19/2012] [Indexed: 11/16/2022]
Abstract
Asians comprise more than 60% of the world's population and are the fastest growing minority group in the United States. Today's psychiatrist must learn to recognize and appreciate the unique factors that influence mental health outcomes in this group. Asian Americans are affected by psychiatric disorders at similar rates as non-Asians, but are significantly underrepresented in psychiatric clinics. When Asians and Asian Americans do present for psychiatric treatment, they often do so with higher severity of illness, and variable levels of compliance. Studies over the past three decades have suggested that pharmacokinetic and pharmacodynamic profiles of various psychotropic medications may be different in Asians, leading to differences in dosage requirements and side-effect profiles. These variations appear to be largely determined by genetic predisposition, but are also influenced by other factors such as environment, social support, cultural perceptions, and physicians' prescribing habits. In this paper, we provide an overview of biological and socio-cultural issues as they relate to psychopharmacology in Asians and Asian Americans, with the hope that a better understanding of these issues will lead to improved mental health care delivery to this population both in the United States, as well as in Asian countries.
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Affiliation(s)
- Felicia K Wong
- Kaiser Foundation Hospital - West Los Angeles, Department of Psychiatry, 5105 W Goldleaf Circle, Los Angeles, CA 90056, USA
| | - Edmond H Pi
- University of Southern California (USC), Keck School of Medicine, Department of Psychiatry, Los Angeles County+USC Medical Center, 2010 Zonal Ave., Suite 1P-12, Los Angeles, CA 90033, USA
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Malik M, Lake J, Lawson WB, Joshi SV. Culturally adapted pharmacotherapy and the integrative formulation. Child Adolesc Psychiatr Clin N Am 2010; 19:791-814. [PMID: 21056347 DOI: 10.1016/j.chc.2010.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
There are important ethnic variations in metabolism, response, and tolerability of psychotropic medications. There has been a dramatic expansion of use of psychotropic medications in children in recent years. This article reviews the literature on the role of race and ethnicity in psychopharmacology as it relates to children and adolescents, examines what is known thus far about complementary and alternative medicine approaches in pediatric psychopharmacology, and presents a method to engage patients and families of varying educational and cultural backgrounds in pharmacotherapeutic treatment.
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Affiliation(s)
- Mansoor Malik
- Department of Psychiatry and Behavioral Sciences, Howard University, 2041 Georgia Avenue Northwest, Washington, DC 20060, USA.
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Abstract
This article considers disparities in the psychiatric care of racial and ethnic children and adolescents, with respect to their under-utilization and under-treatment, especially with psychotropic medications. Culturally adapted psychotherapeutic approaches are discussed, as well as the notion of a culturally competent clinician who strives to apply his or her clinical skills while constantly making adjustments to the beliefs, habits, and circumstances of culturally diverse children and their parents, one patient at a time.
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Affiliation(s)
- David S Rue
- Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, CA 95831, USA.
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