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Cederlöf E, Holm M, Taipale H, Tiihonen J, Tanskanen A, Lähteenvuo M, Lahdensuo K, Kampman O, Wegelius A, Isometsä E, Kieseppä T, Palotie A, Suvisaari J, Paunio T. Antipsychotic medications and sleep problems in patients with schizophrenia. Schizophr Res 2024; 267:230-238. [PMID: 38579432 DOI: 10.1016/j.schres.2024.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 02/22/2024] [Accepted: 03/15/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Sleep problems are common and related to a worse quality of life in patients with schizophrenia. Almost all patients with schizophrenia use antipsychotic medications, which usually increase sleep. Still, the differences in subjective sleep outcomes between different antipsychotic medications are not entirely clear. METHODS This study assessed 5466 patients with schizophrenia and is part of the nationwide Finnish SUPER study. We examined how the five most common antipsychotic medications (clozapine, olanzapine, quetiapine, aripiprazole, and risperidone) associate with questionnaire-based sleep problems in logistic regression analyses, including head-to-head analyses between different antipsychotic medications. The sleep problems were difficulties initiating sleep, early morning awakenings, fatigue, poor sleep quality, short (≤6 h) and long sleep duration (≥10 h). RESULTS The average number of antipsychotic medications was 1.59 per patient. Clozapine was associated with long sleep duration (49.0 % of clozapine users vs 30.2 % of other patients, OR = 2.05, 95 % CI 1.83-2.30, p < .001). Olanzapine and risperidone were in head-to-head analyses associated with less sleep problems than patients using aripiprazole, quetiapine, or no antipsychotic medication. Aripiprazole and quetiapine were associated with more insomnia symptoms and poorer sleep quality. Patients without antipsychotic medications (N = 159) had poorer sleep quality than patients with antipsychotic use, and short sleep duration was common (21.5 % of patients not using antipsychotics vs 7.8 % of patients using antipsychotics, OR = 2.97, 95 % CI 1.98-4.44, p < .001). CONCLUSIONS Prevalence of sleep problems is markedly related to the antipsychotic medication the patient uses. These findings underline the importance of considering and assessing sleep problems when treating schizophrenia patients with antipsychotics.
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Affiliation(s)
- Erik Cederlöf
- Finnish Institute for Health and Welfare, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Finland; SleepWell Research Program, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, Finland.
| | - Minna Holm
- Finnish Institute for Health and Welfare, Finland
| | - Heidi Taipale
- Karolinska Institutet, Sweden; Niuvanniemi Hospital, University of Eastern Finland, Finland
| | | | | | | | - Kaisla Lahdensuo
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Finland
| | - Olli Kampman
- University of Tampere, Faculty of Medicine and Health Technology, Finland; University of Turku, Faculty of Medicine, Finland; The Pirkanmaa Wellbeing Services County, Department of Psychiatry, Tampere, Finland; Umeå University, Department of Clinical Sciences, Psychiatry, Sweden; The Wellbeing Services County of Ostrobothnia, Department of Psychiatry, Finland
| | - Asko Wegelius
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Finland
| | - Erkki Isometsä
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Finland
| | | | | | | | - Tiina Paunio
- Finnish Institute for Health and Welfare, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Finland; SleepWell Research Program, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, Finland
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2
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Vos CF, Birkenhäger TK, Nolen WA, van den Broek WW, ter Hark SE, Schellekens AF, Verkes RJ, Janzing JG. The Relationship of Early Sleep Improvement With Response to Pharmacotherapy in Unipolar Psychotic Depression. J Clin Psychopharmacol 2023; 43:486-492. [PMID: 37930199 PMCID: PMC10662627 DOI: 10.1097/jcp.0000000000001756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/08/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Since insomnia and depression are interrelated, improved sleep early in antidepressant pharmacotherapy may predict a positive treatment outcome. We investigated whether early insomnia improvement (EII) predicted treatment outcome in psychotic depression (PD) and examined if there was an interaction effect between EII and treatment type to assess if findings were treatment-specific. METHODS This study is a secondary analysis of a randomized trial comparing 7 weeks treatment with the antidepressants venlafaxine, imipramine and venlafaxine plus the antipsychotic quetiapine in PD ( n = 114). Early insomnia improvement, defined as ≥20% reduced insomnia after 2 weeks, was assessed by the Hamilton Rating Scale for Depression (HAM-D-17). Associations between EII and treatment outcome were examined using logistic regressions. Subsequently, we added interaction terms between EII and treatment type to assess interaction effects. The predictive value of EII was compared with early response on overall depression (≥20% reduced HAM-D-17 score after 2 weeks). RESULTS EII was associated with response (odds ratio [OR], 7.9; 95% confidence interval [CI], 2.7-23.4; P = <0.001), remission of depression (OR, 6.1; 95% CI, 1.6-22.3; P = 0.009), and remission of psychosis (OR, 4.1; 95% CI, 1.6-10.9; P = 0.004). We found no interaction effects between EII and treatment type on depression outcome. Early insomnia improvement and early response on overall depression had a comparable predictive ability for treatment outcome. CONCLUSIONS Early insomnia improvement was associated with a positive outcome in pharmacotherapy of PD, regardless of the medication type. Future studies are needed to confirm our findings and to examine the generalizability of EII as predictor in treatment of depression.
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Affiliation(s)
- Cornelis F. Vos
- From the Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
| | - Tom K. Birkenhäger
- Department of Psychiatry, Erasmus University Medical Centre, Rotterdam, the Netherlands
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium
| | - Willem A. Nolen
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Sophie E. ter Hark
- From the Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
| | - Arnt F.A. Schellekens
- From the Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
| | - Robbert-Jan Verkes
- From the Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
| | - Joost G.E. Janzing
- From the Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
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3
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Drager LF, Assis M, Bacelar AFR, Poyares DLR, Conway SG, Pires GN, de Azevedo AP, Carissimi A, Eckeli AL, Pentagna Á, Almeida CMO, Franco CMR, Sobreira EST, Stelzer FG, Mendes GM, Minhoto GR, Linares IMP, Sousa KMM, Gitaí LLG, Sukys-Claudino L, Sobreira-Neto MA, Zanini MA, Margis R, Martinez SCG. 2023 Guidelines on the Diagnosis and Treatment of Insomnia in Adults - Brazilian Sleep Association. Sleep Sci 2023; 16:507-549. [PMID: 38370879 PMCID: PMC10869237 DOI: 10.1055/s-0043-1776281] [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] [Indexed: 02/20/2024] Open
Abstract
Chronic insomnia disorder (simplified in this document as insomnia) is an increasingly common clinical condition in society and a frequent complaint at the offices of different areas of health practice (particularly Medicine and Psychology). This scenario has been accompanied by a significant evolution in treatment, as well as challenges in approaching patients in an appropriately way. This clinical guideline, coordinated by the Brazilian Sleep Association and the Brazilian Association of Sleep Medicine and counting on the active participation of various specialists in the area, encompasses an update on the diagnosis and treatment of insomnia in adults. To this end, it followed a structured methodology. Topics of interest related to diagnosis were written based on theoretical framework, evidence in the literature, and professional experience. As for the topics related to the treatment of insomnia, a series of questions were developed based on the PICO acronym (P - Patient, problem, or population; I - Intervention; C - Comparison, control, or comparator; O - Outcome). The work groups defined the eligible options within each of these parameters. Regarding pharmacological interventions, only the ones currently available in Brazil or possibly becoming available in the upcoming years were considered eligible. Systematic reviews were conducted to help prepare the texts and define the level of evidence for each intervention. The final result is an objective and practical document providing recommendations with the best scientific support available to professionals involved in the management of insomnia.
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Affiliation(s)
- Luciano Ferreira Drager
- Associação Brasileira do Sono, São Paulo, SP, Brazil.
- Unidades de HipertenSão, Instituto do Coração (InCor) e Disciplina de Nefrologia, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Márcia Assis
- Associação Brasileira do Sono, São Paulo, SP, Brazil.
- Clínica do Sono de Curitiba, Hospital São Lucas, Curitiba, Brazil.
| | - Andrea Frota Rego Bacelar
- Associação Brasileira do Sono, São Paulo, SP, Brazil.
- Clínica Bacelar - Neuro e Sono, Rio de Janeiro, RJ, Brazil.
| | - Dalva Lucia Rollemberg Poyares
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil.
- Instituto do Sono, São Paulo, SP, Brazil.
| | - Silvia Gonçalves Conway
- Instituto de Psiquiatria (IPq), Universidade de São Paulo, São Paulo, SP, Brazil.
- Departamento de Otoneurologia, Universidade de São Paulo, São Paulo, SP, Brazil.
- AkasA - Formação e Conhecimento, São Paulo, SP, Brazil.
| | - Gabriel Natan Pires
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil.
- Instituto do Sono, São Paulo, SP, Brazil.
| | | | - Alicia Carissimi
- Faculdade Dom Bosco, Porto Alegre, RS, Brazil.
- Cronosul Clínica de Psicologia do Sono, Psicoterapia e Neuropsicologia, Porto Alegre, RS, Brazil.
| | - Allan Luiz Eckeli
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
| | - Álvaro Pentagna
- Hospital das Clínicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | | | | | - Emmanuelle Silva Tavares Sobreira
- AkasA - Formação e Conhecimento, São Paulo, SP, Brazil.
- Universidade Federal do Ceará, Fortaleza, CE, Brazil.
- Clínica Sinapse Diagnóstico, Fortaleza, CE, Brazil.
| | - Fernando Gustavo Stelzer
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
| | | | | | - Ila Marques Porto Linares
- Instituto de Psiquiatria (IPq), Universidade de São Paulo, São Paulo, SP, Brazil.
- Instituto da Criança, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil.
| | - Ksdy Maiara Moura Sousa
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil.
- SleepUp Tecnologia e Saúde LTDA, São Paulo, SP, Brazil.
| | | | - Lucia Sukys-Claudino
- Disciplina de Neurologia, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil.
| | | | - Marcio Andrei Zanini
- Instituto de Assistência Médica ao Servidor Público Estadual (IAMPSE), São Paulo, SP, Brazil.
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Lin CY, Chiang CH, Tseng MCM, Tam KW, Loh EW. Effects of quetiapine on sleep: A systematic review and meta-analysis of clinical trials. Eur Neuropsychopharmacol 2023; 67:22-36. [PMID: 36463762 DOI: 10.1016/j.euroneuro.2022.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 12/03/2022]
Abstract
Quetiapine is a common off-label antipsychotic drug for treating insomnia. Its effects in different disease conditions and dosages remain unclear. We conducted a systematic review and meta-analysis in clinical trials examining the efficacy of low-dose quetiapine in sleep. We obtained 21 clinical trials. Mean difference (MD), standard mean difference (SMD), and odds ratio (OR) were used to estimate the effect sizes using a random-effects model. The pooled results showed that quetiapine improved sleep quality compared with placebo (SMD: -0.57 [95%CI: -0.75, -0.4]). The SMD of sleep quality was correlated with age (coefficient: -0.0174) and sex (coefficient: -0.012). The significant effects were observed in the general anxiety disorder (SMD: -0.59 [95%CI: -0.92, -0.27]), major depressive disorder (SMD: -0.47 [95%CI: -0.66, -0.28]), and healthy (SMD: -1.33, [95%CI [-2.12, -0.54]) subgroups, at the dosage of 50 mg (SMD: -0.36 [95%CI: -0.36, -0.11]), 150 mg (SMD: -0.4 [95%CI: -0.52, -0.29]), and 300 mg (SMD: -0.17 [95%CI: -0.31,-0.04]). Quetiapine increased total sleep time compared with placebo (MD: 47.91 [95%CI: 28.06, 67.76]) but not when compared with other psychiatric drugs (MD: -4.19 [95%CI: -19.43, 11.05]). Adverse events (AEs) and discontinuation due to AEs were common among the quetiapine users. Quetiapine is effective as a sleep-helping drug. Precaution is suggested when interpreting the results on the elderly due to the high heterogeneity caused by incorporating patients over 66 years in the meta-analyses. We recommend an initial dosage of 50-150 mg/day with priority consideration for the elderly with GAD or MDD while monitoring its potential AEs.
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Affiliation(s)
- Che-Yin Lin
- Department of Psychiatry, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan
| | - Cheng-Hen Chiang
- Department of Radiology, Taipei Medical University Shuang-Ho Hospital, New Taipei City, Taiwan
| | - Mei-Chih Meg Tseng
- Department of Psychiatry, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Psychiatry, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ka-Wai Tam
- Center for Evidence-Based Health Care, Department of Medical Research, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan; Division of General Surgery, Department of Surgery, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan; Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
| | - El-Wui Loh
- Center for Evidence-Based Health Care, Department of Medical Research, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan; Department of Medical Imaging, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan.
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5
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Carli M, Weiss F, Grenno G, Ponzini S, Kolachalam S, Vaglini F, Viaggi C, Pardini C, Tidona S, Longoni B, Maggio R, Scarselli M. Pharmacological Strategies for Bipolar Disorders in Acute Phases and Chronic Management with a Special Focus on Lithium, Valproic Acid, and Atypical Antipsychotics. Curr Neuropharmacol 2023; 21:935-950. [PMID: 36825703 PMCID: PMC10227916 DOI: 10.2174/1570159x21666230224102318] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 02/25/2023] Open
Abstract
Bipolar disorders (BDs) are a heterogeneous group of severe affective disorders generally described by the alternation of (hypo)manic, depressive, and mixed phases, with euthymic intervals of variable duration. BDs are burdened with high psychiatric and physical comorbidity, increased suicide risk and reduced life expectancy. In addition, BDs can progress into complicated forms (e.g., mixed states, rapid/irregular cycling), which are more difficult to treat and often require personalized pharmacological combinations. Mood stabilizers, particularly Lithium and Valproic acid (VPA), still represent the cornerstones of both acute and chronic pharmacotherapies of BDs. Lithium is the gold standard in BD-I and BDII with typical features, while VPA seems more effective for atypical forms (e.g., mixed-prevalence and rapid-cycling). However, despite appropriate mood stabilization, many patients show residual symptoms, and more than a half recur within 1-2 years, highlighting the need of additional strategies. Among these, the association of atypical antipsychotics (AAPs) with mood stabilizers is recurrent in the treatment of acute phases, but it is also being growingly explored in the maintenance pharmacotherapy. These combinations are clinically more aggressive and often needed in the acute phases, whereas simplifying pharmacotherapies to mood stabilizers only is preferable in the long-term, whenever possible. When mood stabilizers are not enough for maintenance treatment, Quetiapine and, less consistently, Aripiprazole have been proposed as the most advisable adjunctive strategies, for their safety and tolerability profiles. However, in view of the increased risk of serious adverse effects, a careful patient-centered balance between costs and benefits is mandatory.
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Affiliation(s)
- Marco Carli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Francesco Weiss
- Psychiatry Unit 2, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giovanna Grenno
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Sergio Ponzini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Shivakumar Kolachalam
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Francesca Vaglini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Cristina Viaggi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Carla Pardini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Simone Tidona
- Psychiatry Unit 2, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Biancamaria Longoni
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Roberto Maggio
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Marco Scarselli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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6
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Bajor LA, Balsara C, Osser DN. An evidence-based approach to psychopharmacology for posttraumatic stress disorder (PTSD) - 2022 update. Psychiatry Res 2022; 317:114840. [PMID: 36162349 DOI: 10.1016/j.psychres.2022.114840] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 09/05/2022] [Accepted: 09/07/2022] [Indexed: 01/04/2023]
Abstract
Algorithms for posttraumatic stress disorder were published by this team in 1999 and 2011. Developments since then warrant revision. New studies and review articles from January 2011 to November 2021 were identified via PubMed and analyzed for evidence supporting changes. Following consideration of variations required by special patient populations, treatment of sleep impairments remains as the first recommended step. Nightmares and non-nightmare disturbed awakenings are best addressed with the anti-adrenergic agent prazosin, with doxazosin and clonidine as alternatives. First choices for difficulty initiating sleep include hydroxyzine and trazodone. If significant non-sleep PTSD symptoms remain, an SSRI should be tried, followed by a second SSRI or venlafaxine as a third step. Second generation antipsychotics can be considered, particularly for SSRI augmentation when PTSD-associated psychotic symptoms are present, with the caveat that positive evidence is limited and side effects are considerable. Anti-adrenergic agents can also be considered for general PTSD symptoms if not already tried, though evidence for daytime use lags that available for sleep. Regarding other pharmacological and procedural options, e.g., transcranial magnetic stimulation, cannabinoids, ketamine, psychedelics, and stellate ganglion block, evidence does not yet support firm inclusion in the algorithm. An interactive version of this work can be found at www.psychopharm.mobi.
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Affiliation(s)
- Laura A Bajor
- James A. Haley VA Hospital, Tampa, FL, United States; University of South Florida Morsani School of Medicine, Tampa, FL, United States; VA Boston Healthcare System and Harvard South Shore Psychiatry Residency Training Program, Brockton, MA, United States.
| | - Charmi Balsara
- HCA Healthcare East Florida Division GME/HCA FL Aventura Hospital, United States
| | - David N Osser
- VA Boston Healthcare System and Harvard South Shore Psychiatry Residency Training Program, Brockton, MA, United States
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7
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Duis J, Nespeca M, Summers J, Bird L, Bindels‐de Heus KG, Valstar MJ, de Wit MY, Navis C, ten Hooven‐Radstaake M, van Iperen‐Kolk BM, Ernst S, Dendrinos M, Katz T, Diaz‐Medina G, Katyayan A, Nangia S, Thibert R, Glaze D, Keary C, Pelc K, Simon N, Sadhwani A, Heussler H, Wheeler A, Woeber C, DeRamus M, Thomas A, Kertcher E, DeValk L, Kalemeris K, Arps K, Baym C, Harris N, Gorham JP, Bohnsack BL, Chambers RC, Harris S, Chambers HG, Okoniewski K, Jalazo ER, Berent A, Bacino CA, Williams C, Anderson A. A multidisciplinary approach and consensus statement to establish standards of care for Angelman syndrome. Mol Genet Genomic Med 2022; 10:e1843. [PMID: 35150089 PMCID: PMC8922964 DOI: 10.1002/mgg3.1843] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/13/2021] [Accepted: 10/17/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Angelman syndrome (AS) is a rare neurogenetic disorder present in approximately 1/12,000 individuals and characterized by developmental delay, cognitive impairment, motor dysfunction, seizures, gastrointestinal concerns, and abnormal electroencephalographic background. AS is caused by absent expression of the paternally imprinted gene UBE3A in the central nervous system. Disparities in the management of AS are a major problem in preparing for precision therapies and occur even in patients with access to experts and recognized clinics. AS patients receive care based on collective provider experience due to limited evidence-based literature. We present a consensus statement and comprehensive literature review that proposes a standard of care practices for the management of AS at a critical time when therapeutics to alter the natural history of the disease are on the horizon. METHODS We compiled the key recognized clinical features of AS based on consensus from a team of specialists managing patients with AS. Working groups were established to address each focus area with committees comprised of providers who manage >5 individuals. Committees developed management guidelines for their area of expertise. These were compiled into a final document to provide a framework for standardizing management. Evidence from the medical literature was also comprehensively reviewed. RESULTS Areas covered by working groups in the consensus document include genetics, developmental medicine, psychology, general health concerns, neurology (including movement disorders), sleep, psychiatry, orthopedics, ophthalmology, communication, early intervention and therapies, and caregiver health. Working groups created frameworks, including flowcharts and tables, to help with quick access for providers. Data from the literature were incorporated to ensure providers had review of experiential versus evidence-based care guidelines. CONCLUSION Standards of care in the management of AS are keys to ensure optimal care at a critical time when new disease-modifying therapies are emerging. This document is a framework for providers of all familiarity levels.
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Affiliation(s)
- Jessica Duis
- Section of Genetics & Inherited Metabolic DiseaseSection of Pediatrics, Special CareDepartment of PediatricsChildren’s Hospital ColoradoUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Mark Nespeca
- Department of NeurologyRady Children’s HospitalSan DiegoCaliforniaUSA
| | - Jane Summers
- Department of PsychiatryThe Hospital for Sick ChildrenTorontoOntarioCanada
| | - Lynne Bird
- Department of PediatricsClinical Genetics / DysmorphologyUniversity of California, San DiegoRady Children’s Hospital San DiegoSan DiegoCaliforniaUSA
| | - Karen G.C.B. Bindels‐de Heus
- Department of PediatricsErasmus MC SophiaChildren’s HospitalRotterdamNetherlands,ENCORE Expertise Center for Neurodevelopmental DisordersErasmus MC University Medical CenterRotterdamThe Netherlands
| | - M. J. Valstar
- Department of PediatricsErasmus MC SophiaChildren’s HospitalRotterdamNetherlands
| | - Marie‐Claire Y. de Wit
- Department of PediatricsErasmus MC SophiaChildren’s HospitalRotterdamNetherlands,Department of Neurology and Pediatric NeurologyErasmus MCRotterdamThe Netherlands
| | - C. Navis
- Department of PediatricsErasmus MC SophiaChildren’s HospitalRotterdamNetherlands,Department of ENT (Speech & Language Pathology)Erasmus MCRotterdamThe Netherlands
| | - Maartje ten Hooven‐Radstaake
- Department of PediatricsErasmus MC SophiaChildren’s HospitalRotterdamNetherlands,ENCORE Expertise Center for Neurodevelopmental DisordersErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Bianca M. van Iperen‐Kolk
- ENCORE Expertise Center for Neurodevelopmental DisordersErasmus MC University Medical CenterRotterdamThe Netherlands,Department of Physical TherapyErasmus MCRotterdamThe Netherlands
| | - Susan Ernst
- Department of Obstetrics and GynecologyUniversity of MichiganAnn ArborMichiganUSA
| | - Melina Dendrinos
- Department of Obstetrics and GynecologyUniversity of MichiganAnn ArborMichiganUSA
| | - Terry Katz
- Developmental PediatricsDepartment of PediatricsChildren’s Hospital ColoradoUniversity of Colorado Anschutz Medical CampusAuroraCOUSA
| | - Gloria Diaz‐Medina
- Division of Neurology and Developmental PediatricsDepartment of PediatricsBaylor College of MedicineHoustonTexasUSA,NeurologyTexas Children's HospitalHoustonTexasUSA
| | - Akshat Katyayan
- Division of Neurology and Developmental PediatricsDepartment of PediatricsBaylor College of MedicineHoustonTexasUSA,NeurologyTexas Children's HospitalHoustonTexasUSA
| | - Srishti Nangia
- Department of PediatricsDivision of Child NeurologyWeill Cornell MedicineNew York‐Presbyterian HospitalNew YorkNew YorkUSA
| | - Ronald Thibert
- Angelman Syndrome ProgramLurie Center for AutismMassachusetts General Hospital for ChildrenBostonMassachusettsUSA
| | - Daniel Glaze
- Division of Neurology and Developmental PediatricsDepartment of PediatricsBaylor College of MedicineHoustonTexasUSA,NeurologyTexas Children's HospitalHoustonTexasUSA
| | - Christopher Keary
- Angelman Syndrome ProgramLurie Center for AutismMassachusetts General Hospital for ChildrenBostonMassachusettsUSA
| | - Karine Pelc
- Department of NeurologyHôpital Universitaire des Enfants Reine FabiolaUniversité Libre de Bruxelles (ULB)BrusselsBelgium
| | - Nicole Simon
- Department of PsychiatryBoston Children’s HospitalBostonMAUSA
| | - Anjali Sadhwani
- Department of PsychiatryBoston Children’s HospitalBostonMAUSA
| | - Helen Heussler
- UQ Child Health Research CentreFaculty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
| | - Anne Wheeler
- Center for Newborn ScreeningRTI InternationalResearch Triangle ParkNorth CarolinaUSA
| | - Caroline Woeber
- Audiology, Speech & Learning ServicesChildren’s Hospital ColoradoAuroraColoradoUSA
| | - Margaret DeRamus
- Department of PsychiatryCarolina Institute for Developmental DisabilitiesUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Amy Thomas
- New York League for Early Learning William O'connor SchoolNew YorkNew YorkUSA
| | | | - Lauren DeValk
- Occupational TherapyChildren’s Hospital ColoradoAuroraColoradoUSA
| | - Kristen Kalemeris
- Department of Pediatric RehabilitationMonroe Carell Jr. Children's Hospital at VanderbiltNashvilleTennesseeUSA
| | - Kara Arps
- Department of Physical TherapyChildren’s Hospital ColoradoUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Carol Baym
- Physical TherapyChildren’s Hospital ColoradoAuroraColoradoUSA
| | - Nicole Harris
- Physical TherapyChildren’s Hospital ColoradoAuroraColoradoUSA
| | - John P. Gorham
- Department of Ophthalmology and Visual SciencesUniversity of MichiganAnn ArboMichiganUSA
| | - Brenda L. Bohnsack
- Division of OphthalmologyDepartment of OphthalmologyAnn & Robert H. Lurie Children’s Hospital of ChicagoNorthwestern University Feinberg School of MedicineAnn ArboMichiganUSA
| | - Reid C. Chambers
- Department of Orthopedic Surgery Nationwide Children’s HospitalColumbusOhioUSA
| | - Sarah Harris
- Division of Neurology and Developmental PediatricsDepartment of PediatricsBaylor College of MedicineHoustonTexasUSA,NeurologyTexas Children's HospitalHoustonTexasUSA
| | - Henry G. Chambers
- Orthopedic SurgerySan Diego Department of Pediatric OrthopedicsUniversity of CaliforniaRady Children’s HospitalSan DiegoCaliforniaUSA
| | - Katherine Okoniewski
- Center for Newborn ScreeningRTI InternationalResearch Triangle ParkNorth CarolinaUSA
| | | | - Allyson Berent
- Foundation for Angelman Syndrome TherapeuticsChicagoIllinoisUSA
| | - Carlos A. Bacino
- Department of Molecular and Human GeneticsBaylor College of MedicineHoustonTexasUSA
| | - Charles Williams
- Raymond C. Philips UnitDivision of Genetics and MetabolismDepartment of PediatricsUniversity of FloridaGainesvilleFloridaUSA
| | - Anne Anderson
- Division of Neurology and Developmental PediatricsDepartment of PediatricsBaylor College of MedicineHoustonTexasUSA,NeurologyTexas Children's HospitalHoustonTexasUSA
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Abdel-Wahab M, Okasha T, Shaheen M, Nasr M, Molokheya T, Omar AE, Rabie MA, Samy V, Hamed H, Ali M. Clinical Guidelines of the Egyptian Psychiatric Association for the Management of Treatment-Resistant Unipolar Depression in Egypt. Front Psychiatry 2022; 13:797150. [PMID: 35370819 PMCID: PMC8964405 DOI: 10.3389/fpsyt.2022.797150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 02/04/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is a public health burden that creates a strain not only on individuals, but also on the economy. Treatment-resistant depression in the course of major depressive disorder represents a clinically challenging condition that is defined as insufficient response to two or more antidepressant trails with antidepressants of the same or different classes that were administered at adequate daily doses for at least 4 weeks. OBJECTIVE/HYPOTHESIS To develop a treatment guideline for Treatment Resistant Depression (TRD). METHODOLOGY Experts in the field gathered and reviewed the available evidence about the subject. Then, a series of meetings were held to create recommendations that can be utilized by Egyptian psychiatrists. RESULTS The guidelines provide recommendations in various clinical settings. It evaluates different situations, such as patients at risk of resistance, those with resistance and recommends strategies to resolve the clinical case. CONCLUSION The consensus guidelines will improve the outcomes of patients, as they provide recommendations across various domains that are of concern for the practicing psychiatrist.
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Affiliation(s)
- Momtaz Abdel-Wahab
- Department of Psychiatry, Kasr El-Aini Medical School, Cairo University, Giza, Egypt
| | - Tarek Okasha
- Okasha Institute of Psychiatry, Medical School, Ain Shams University, Cairo, Egypt
| | - Mostafa Shaheen
- Department of Psychiatry, Kasr El-Aini Medical School, Cairo University, Cairo, Egypt
| | - Mohamed Nasr
- Department of Psychiatry, Kasr El-Aini Medical School, Cairo University, Cairo, Egypt
| | - Tarek Molokheya
- Department of Psychiatry, Alexandria Medical School, Alexandria University, Alexandria, Egypt
| | - Abd ElNasser Omar
- Department of Psychiatry, Ain Shams Medical School, Ain Shams University, Cairo, Egypt
| | - Menan A Rabie
- Department of Psychiatry, Ain Shams Medical School, Ain Shams University, Cairo, Egypt
| | - Victor Samy
- Department of Psychiatry, Banha Medical School, Banha University, Benha, Egypt
| | - Hany Hamed
- Department of Psychiatry, Beni-Suef Medical School, Beni-Suef University, Beni-Suef, Egypt
| | - Mohamed Ali
- Faculty of Pharmacy, German University of Cairo, Cairo, Egypt
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9
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Rios P, Cardoso R, Morra D, Nincic V, Goodarzi Z, Farah B, Harricharan S, Morin CM, Leech J, Straus SE, Tricco AC. Comparative effectiveness and safety of pharmacological and non-pharmacological interventions for insomnia: an overview of reviews. Syst Rev 2019; 8:281. [PMID: 31730011 PMCID: PMC6857325 DOI: 10.1186/s13643-019-1163-9] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 09/13/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND This review aimed to assess the existing evidence regarding the clinical effectiveness and safety of pharmacological and non-pharmacological interventions in adults with insomnia and identify where research or policy development is needed. METHODS MEDLINE, Embase, PsycINFO, The Cochrane Library, and PubMed were searched from inception until June 14, 2017, along with relevant gray literature sites. Two reviewers independently screened titles/abstracts and full-text articles, and a single reviewer with an independent verifier completed charting, data abstraction, and quality appraisal. RESULTS A total of 64 systematic reviews (35 with meta-analysis) were included after screening 5024 titles and abstracts and 525 full-text articles. Eight of the included reviews were rated as high quality using the Assessment of Multiple Systematic Reviews 2 (AMSTAR2) tool, and over half of the included articles (n = 40) were rated as low or critically low quality. Consistent evidence of effectiveness across multiple outcomes based on more than one high- or moderate quality review with meta-analysis was found for zolpidem, suvorexant, doxepin, melatonin, and cognitive behavioral therapy (CBT), and evidence of effectiveness across multiple outcomes based on one high-quality review with meta-analysis was found for temazepam, triazolam, zopiclone, trazodone, and behavioral interventions. These interventions were mostly evaluated in the short term (< 16 weeks), and there was very little harms data available for the pharmacological interventions making it difficult to evaluate their risk-benefit ratio. CONCLUSIONS Assuming non-pharmacological interventions are preferable from a safety perspective CBT can be considered an effective first-line therapy for adults with insomnia followed by other behavioral interventions. Short courses of pharmacological interventions can be supplements to CBT or behavioral therapy; however, no evidence regarding the appropriate duration of pharmacological therapy is available from these reviews. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017072527.
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Affiliation(s)
- Patricia Rios
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, 209 Victoria Street, East Building, Toronto, Ontario M5B 1W8 Canada
| | - Roberta Cardoso
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, 209 Victoria Street, East Building, Toronto, Ontario M5B 1W8 Canada
| | - Deanna Morra
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, 209 Victoria Street, East Building, Toronto, Ontario M5B 1W8 Canada
| | - Vera Nincic
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, 209 Victoria Street, East Building, Toronto, Ontario M5B 1W8 Canada
| | - Zahra Goodarzi
- Division of Geriatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Bechara Farah
- The Canadian Agency for Drugs and Technologies in Health, 865 Carling Ave., Suite 600, Ottawa, Ontario K1S 5S8 Canada
| | - Sharada Harricharan
- The Canadian Agency for Drugs and Technologies in Health, 865 Carling Ave., Suite 600, Ottawa, Ontario K1S 5S8 Canada
| | - Charles M. Morin
- École de Psychologie, 2325, rue des Bibliothèques, Québec, Québec G1V 0A6 Canada
| | - Judith Leech
- Division of Respirology, Department of Medicine, University of Ottawa, Ottawa, ON Canada
| | - Sharon E. Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, 209 Victoria Street, East Building, Toronto, Ontario M5B 1W8 Canada
- Department of Geriatric Medicine, University of Toronto, Toronto, Ontario Canada
| | - Andrea C. Tricco
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, 209 Victoria Street, East Building, Toronto, Ontario M5B 1W8 Canada
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada
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10
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Comparative effectiveness and safety of pharmacological and non-pharmacological interventions for insomnia: an overview of reviews. Syst Rev 2019. [PMID: 31730011 DOI: 10.1186/s13643‐019‐1163‐9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND This review aimed to assess the existing evidence regarding the clinical effectiveness and safety of pharmacological and non-pharmacological interventions in adults with insomnia and identify where research or policy development is needed. METHODS MEDLINE, Embase, PsycINFO, The Cochrane Library, and PubMed were searched from inception until June 14, 2017, along with relevant gray literature sites. Two reviewers independently screened titles/abstracts and full-text articles, and a single reviewer with an independent verifier completed charting, data abstraction, and quality appraisal. RESULTS A total of 64 systematic reviews (35 with meta-analysis) were included after screening 5024 titles and abstracts and 525 full-text articles. Eight of the included reviews were rated as high quality using the Assessment of Multiple Systematic Reviews 2 (AMSTAR2) tool, and over half of the included articles (n = 40) were rated as low or critically low quality. Consistent evidence of effectiveness across multiple outcomes based on more than one high- or moderate quality review with meta-analysis was found for zolpidem, suvorexant, doxepin, melatonin, and cognitive behavioral therapy (CBT), and evidence of effectiveness across multiple outcomes based on one high-quality review with meta-analysis was found for temazepam, triazolam, zopiclone, trazodone, and behavioral interventions. These interventions were mostly evaluated in the short term (< 16 weeks), and there was very little harms data available for the pharmacological interventions making it difficult to evaluate their risk-benefit ratio. CONCLUSIONS Assuming non-pharmacological interventions are preferable from a safety perspective CBT can be considered an effective first-line therapy for adults with insomnia followed by other behavioral interventions. Short courses of pharmacological interventions can be supplements to CBT or behavioral therapy; however, no evidence regarding the appropriate duration of pharmacological therapy is available from these reviews. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017072527.
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11
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Choi Y, Raymer BK. Sleep modulating agents. Bioorg Med Chem Lett 2019; 29:2025-2033. [PMID: 31307886 DOI: 10.1016/j.bmcl.2019.06.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/17/2019] [Accepted: 06/22/2019] [Indexed: 12/28/2022]
Abstract
Sleep and wake are two fundamental states of human existence. Conditions such as insomnia and hypersomnia can have profound negative effects on human health. Many pharmacological interventions impacting sleep and wake are available or are under development. This brief digest surveys early approaches to sleep modulation and highlights recent developments in sleep modulating agents.
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Affiliation(s)
- Younggi Choi
- Discovery Chemistry, Alkermes, 852 Winter Street, Waltham, MA, United States
| | - Brian K Raymer
- Discovery Research, Alkermes, 852 Winter Street, Waltham, MA, United States.
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12
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Cornelis C, Van Gastel A, Dumont G, Coppens V, Sabbe B, Morrens M, Van Den Eede F. A case of dose escalation of quetiapine in persistent insomnia disorder. Acta Clin Belg 2017; 72:346-348. [PMID: 27960654 DOI: 10.1080/17843286.2016.1252546] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Quetiapine, an atypical antipsychotic drug, is recommended for the treatment of schizophrenia and mood disorders. In addition, given its sedative effects, a low dose of the agent is also widely used in the treatment of anxiety disorders, personality disorders, substance abuse, and sleep disturbances. In this case study, quetiapine was the first effective drug in reducing chronic insomnia in a male patient with a long treatment history. Because its effect declined over time, in the course of two years, a gradual dose increase led to a posology 50 times higher than the off-label dosage used to obtain sedation, i.e. 25-100 mg quetiapine administered once daily. This case raises awareness of the ease with which dose escalation of quetiapine occurs. The risk of side effects and, possibly, dependence and abuse underlines the importance of regular and careful patient monitoring. Given the unexpected effectiveness of the agent and the absence of side effects in the described case, we argue that in treatment-resistant insomnia, a high dose of quetiapine may be justifiable in selected cases but also urge that further research on the long-term effects and potential adverse events of quetiapine for this indication is of the utmost importance.
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Affiliation(s)
- Claudia Cornelis
- Department of Adult Psychiatry, Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, Antwerp, Belgium
- University Department of Psychiatry, Campus Psychiatric Hospital, Duffel, Belgium
| | - Ann Van Gastel
- Department of Adult Psychiatry, Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, Antwerp, Belgium
- University Department of Psychiatry, Campus Antwerp University Hospital, Edegem, Belgium
| | - Glenn Dumont
- Department of Clinical Pharmacology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Violette Coppens
- Department of Adult Psychiatry, Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, Antwerp, Belgium
- University Department of Psychiatry, Campus Psychiatric Hospital, Duffel, Belgium
| | - Bernard Sabbe
- Department of Adult Psychiatry, Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, Antwerp, Belgium
- University Department of Psychiatry, Campus Psychiatric Hospital, Duffel, Belgium
- University Department of Psychiatry, Campus Antwerp University Hospital, Edegem, Belgium
| | - Manuel Morrens
- Department of Adult Psychiatry, Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, Antwerp, Belgium
- University Department of Psychiatry, Campus Psychiatric Hospital, Duffel, Belgium
| | - Filip Van Den Eede
- Department of Adult Psychiatry, Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, Antwerp, Belgium
- University Department of Psychiatry, Campus Antwerp University Hospital, Edegem, Belgium
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13
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The effects of second generation antipsychotic drugs on sleep variables in healthy subjects and patients with schizophrenia. Sleep Med Rev 2017; 33:51-57. [DOI: 10.1016/j.smrv.2016.05.002] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 05/06/2016] [Accepted: 05/10/2016] [Indexed: 11/23/2022]
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14
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Bauer MS, Miller CJ, Li M, Bajor LA, Lee A. A population-based study of the comparative effectiveness of second-generation antipsychotics vs older antimanic agents in bipolar disorder. Bipolar Disord 2016; 18:481-489. [PMID: 27650468 DOI: 10.1111/bdi.12425] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 07/25/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Numerous antimanic treatments have been introduced over the past two decades, particularly second-generation antipsychotics (SGAs). However, it is not clear whether such newer agents provide any advantage over older treatments. METHODS A historical cohort design investigated the nationwide population of outpatients with bipolar disorder treated in the Department of Veterans Affairs who were newly initiated on an antimanic agent between 2003 and 2010 (N=27 727). The primary outcome was likelihood of all-cause hospitalization during the year after initiation, controlling for numerous demographic, clinical, and treatment characteristics. Potential correlates of effect were explored by investigating time to initiation of a second antimanic agent or antidepressant. RESULTS After control for covariates, those initiated on lithium or valproate monotherapy, compared to those beginning SGA monotherapy, were significantly less likely to be hospitalized, had a longer time to hospitalization, and had fewer hospitalizations in the subsequent year. Those on combination treatment had a significantly higher likelihood of hospitalization, although they also had a longer time to addition of an additional antimanic agent or antidepressant. CONCLUSIONS The present analysis of a large and unselected nationwide population provides important complementary data to that from controlled trials. Although various mechanisms may be responsible for the results, the data support the utilization of lithium or valproate, rather than SGAs, as the initial antimanic treatment in bipolar disorder. A large-scale, prospective, randomized, pragmatic clinical trial comparing the initiation of SGA monotherapy to that of lithium or valproate monotherapy is a logical next step.
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Affiliation(s)
- Mark S Bauer
- The Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA. .,Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Christopher J Miller
- The Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Mingfei Li
- Department of Mathematical Sciences, Bentley University, Boston, MA, USA
| | - Laura A Bajor
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.,CORE Military Mental Health Program, North Tampa Behavioral Health, Wesley Chapel, FL, USA
| | - Austin Lee
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.,School of Insurance and Economics, University of International Business and Economics, Beijing, China
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15
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Monti JM. The effect of second-generation antipsychotic drugs on sleep parameters in patients with unipolar or bipolar disorder. Sleep Med 2016; 23:89-96. [PMID: 27692282 DOI: 10.1016/j.sleep.2016.04.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Revised: 04/07/2016] [Accepted: 04/11/2016] [Indexed: 11/28/2022]
Abstract
Sleep disturbances predominantly take the form of insomnia in patients with unipolar disorder, while patients with bipolar disorder show a decreased need for sleep. Sleep impairment in these patients is a risk factor for the development of a major depressive episode and suicidal behavior. Administration of second-generation antipsychotics (SGAs) olanzapine, quetiapine, and ziprasidone as augmentation therapy or monotherapy to unipolar and bipolar disorder patients, respectively, has been shown to improve sleep continuity and sleep architecture. Thus, their use by these patients could ameliorate their sleep disorder.
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Affiliation(s)
- Jaime M Monti
- Department of Pharmacology and Therapeutics, School of Medicine, Clinics Hospital, Montevideo, Uruguay.
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16
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Abstract
INTRODUCTION Knowledge of the factors affecting the adoption of new medications can enhance mental health care and guide quality improvement and policy development. Food and Drug Administration indications for treating bipolar disorder with several second-generation antipsychotics (SGAs) in the 2000s represent an opportunity to identify factors that impact the spread of a then-innovative treatment through a new population. METHODS Analysis of Department of Veterans Affairs administrative data identified the population of 170,811 veterans diagnosed with bipolar disorder from 2003 to 2010. We analyzed time trends and predictors of antimanic choice (SGA vs other) among the 40,512 outpatients with bipolar disorder who initiated their first VA outpatient antimanic prescription, using multinomial logistic regression in month-by-month analyses. We conducted classwise analyses and investigated prespecified predictors among specific agents. RESULTS In classwise analyses, SGAs supplanted lithium, valproate, and carbamazepine/oxcarbazepine as the most commonly initiated antimanics by 2007. Psychosis, but not other indices of severity, predicted SGA initiation. Demographic analyses did not identify substantial disparities in initiation of SGAs. Drug-specific analyses revealed some consideration of medical comorbidities in choosing among specific antimanic agents, although effect sizes were small. Most patients initiating an antimanic had received an antidepressant in the previous year. DISCUSSION Second-generation antipsychotics quickly became the frontline antimanic treatment for bipolar disorder, although antidepressants most commonly predated antimanic prescriptions. Second-generation antipsychotics were used for a broad range of patients rather than being restricted to a severely ill subpopulation. The modest association of antimanic choice with relevant medical comorbidities suggests that continued attention to quality prescribing practices is warranted.
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Abstract
Musculoskeletal pain is common and often occurs at multiple sites. Persons with chronic widespread pain (CWP) often report disturbed sleep. Until recently, the relationship between sleep disturbance and CWP has been unclear: does poor sleep increase the risk of developing CWP, do people with CWP develop poor sleep as a consequence of their pain, or is the relationship bi-directional? In this article, we have focused on the relationship between insomnia and CWP. We briefly present descriptive epidemiological data for insomnia and CWP. We then summarise the available evidence which supports the hypothesis that the relationship is bi-directional. Finally, we discuss the clinical management of CWP and insomnia in primary care, where the vast majority of cases of CWP are managed.
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Brutcher RE, Nader MA. Effects of quetiapine treatment on cocaine self-administration and behavioral indices of sleep in adult rhesus monkeys. Psychopharmacology (Berl) 2015; 232:411-20. [PMID: 25030802 PMCID: PMC4297597 DOI: 10.1007/s00213-014-3672-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 06/27/2014] [Indexed: 10/25/2022]
Abstract
RATIONALE Clinical literature suggests a link between substance abuse and sleep disturbances. Quetiapine, an atypical antipsychotic, has shown efficacy in treating sleep disturbances, with clinical studies showing promise for quetiapine as a treatment for cocaine abuse. OBJECTIVE The goal of this study was to examine the effects of quetiapine on cocaine self-administration and behavioral indices of sleep in monkeys. METHODS Seven adult male rhesus monkeys, fitted with Actical® activity monitors, were trained to respond under a choice paradigm of food (1.0-g pellets) and cocaine (0.003-0.3 mg/kg per injection) presentation. First, monkeys received acute pretreatment (45 min) with quetiapine (25-75 mg, p.o.) prior to choice sessions; three cocaine doses were studied in combination with quetiapine. Next, the effect of chronic (14-16 days) quetiapine treatment (25-250 mg, p.o., BID) was examined in combination with the lowest preferred cocaine dose (≥80 % cocaine choice). Behavioral indices of sleep, based on activity measures obtained during lights-out, were recorded throughout the study. RESULTS Acute quetiapine decreased cocaine choice in four of the seven monkeys. Chronic quetiapine treatment resulted in initial decreases in cocaine choice, but tolerance developed to these effects. Acute doses of quetiapine did not improve sleep efficiency the following night nor did chronic quetiapine. The first night after discontinuing quetiapine treatment resulted in significant decreases in sleep efficiency and increases in nighttime activity. CONCLUSIONS These findings do not offer support for the use of quetiapine as a monotherapy for treatment of cocaine abuse nor as an adjunct therapy to treat sleep disturbances associated with stimulant abuse.
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Affiliation(s)
- Robert E Brutcher
- Department of Physiology and Pharmacology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1083, USA
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19
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McKean A, Monasterio E. Indications of atypical antipsychotics in the elderly. Expert Rev Clin Pharmacol 2014; 8:5-7. [DOI: 10.1586/17512433.2015.974557] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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21
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Abstract
Use of antipsychotics for treatment of behavioral and psychological symptoms of dementia is frequent among persons with Alzheimer disease (AD). Doses used in long-term therapy have not been previously reported. We describe antipsychotic doses used among community-dwelling persons with AD and investigate factors associated with high-dose use. The MEDALZ-2005 (Medication use and Alzheimer disease) cohort is a nationwide sample including all persons with clinically diagnosed AD at the end of year 2005 in Finland (n = 28,093). Data including prescriptions, comorbidities, and hospital discharge diagnoses were collected from nationwide registers. Antipsychotic doses in monotherapy were investigated during 2006 to 2009. Among 8920 antipsychotic users, 4% (n = 336) used antipsychotics with high dose. Typical antipsychotics were more often used with high dose than atypical antipsychotics. High-dose use was associated with younger age (<80 years) (odds ratio [OR], 1.71; 95% confidence interval [CI], 1.36-2.15]), male sex (OR, 1.52; CI, 1.21-1.91), history of psychiatric disorder (OR, 3.25; CI, 2.54-4.15), and inversely associated with Charlson Comorbidity Index score (score 1: OR, 0.74; CI, 0.57-0.97; score ≥2: OR, 0.68; CI, 0.47-0.97). In conclusion, the majority of persons with AD used antipsychotics with low or medium dose. Typical antipsychotics were more often used with high dose than atypical antipsychotics, which indicates a need for precise dosing instructions in the treatment of behavioral and psychological symptoms of dementia. Clinicians should regularly assess dosing levels especially among men and those with history of psychiatric disorder.
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22
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Morin AK. Off-label use of atypical antipsychotic agents for treatment of insomnia. Ment Health Clin 2014. [DOI: 10.9740/mhc.n190091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Despite limited supporting evidence, off-label uses of atypical or second generation antipsychotics (particularly olanzapine, quetiapine, and risperidone) are not uncommon. The off-label use of these agents for the treatment of insomnia is the focus of this review. While atypical antipsychotics are associated with a lower risk of tardive dyskinesia, extrapyramidal side effects, and more favorable effects on cognitive deficits and negative symptomatology in schizophrenic patients compared to typical or first generation antipsychotic agents, they are not without risks. Metabolic adverse effects are particularly problematic with atypical antipsychotics, even at doses lower than those used to treat FDA-approved indications. The receptor affinity profiles of most atypical antipsychotic agents promote sedation. The level of H1-histamine receptor blockade is believed to be most associated with somnolence and sedation. Several studies evaluating the safety and efficacy of the atypical antipsychotics quetiapine, olanzapine, and risperidone for the treatment of insomnia were identified and are summarized in this article.
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23
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Neuroscience-driven discovery and development of sleep therapeutics. Pharmacol Ther 2014; 141:300-34. [DOI: 10.1016/j.pharmthera.2013.10.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 10/25/2013] [Indexed: 01/18/2023]
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24
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Schwartz TL, Goradia V. Managing insomnia: an overview of insomnia and pharmacologic treatment strategies in use and on the horizon. Drugs Context 2013; 2013:212257. [PMID: 24432044 PMCID: PMC3884958 DOI: 10.7573/dic.212257] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 08/30/2013] [Accepted: 09/06/2012] [Indexed: 11/21/2022] Open
Abstract
This review explores basic sleep physiology, the mechanism of action for each class of hypnotic agents, their clinical application based on pharmacodynamic and pharmacokinetic factors, and potential pharmacologic sleep-inducing mechanisms of future hypnotics. The paper challenges the reader to understand the neuroscientific basis of insomnia and use this knowledge to guide prescription of hypnotic agents. Currently indicated hypnotic agents are discussed with regard to their mechanism of drug action and clinical application. A broader discussion is developed throughout this paper regarding other non-indicated agents that may improve sleep and describing newer pharmacological treatments that may become available in the future for use in sleep disorders and their comorbid conditions.
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Affiliation(s)
- Thomas L Schwartz
- SUNY Upstate Medical University, Psychiatry Department, Syracuse, NY 13210, USA
| | - Viral Goradia
- SUNY Upstate Medical University, Psychiatry Department, Syracuse, NY 13210, USA
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25
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Fung V, Price M, Busch AB, Landrum MB, Fireman B, Nierenberg A, Dow WH, Hui R, Frank R, Newhouse JP, Hsu J. Adverse clinical events among medicare beneficiaries using antipsychotic drugs: linking health insurance benefits and clinical needs. Med Care 2013; 51:614-21. [PMID: 23752219 PMCID: PMC3687515 DOI: 10.1097/mlr.0b013e31829019c5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Medicare Part D provides formulary protections for antipsychotics but does not exempt these drugs from cost-sharing. We investigated the impact of Part D coverage on antipsychotic drug spending, adherence, and clinical outcomes among beneficiaries with varying indications for use. METHODS We conducted a historical cohort study of Medicare Advantage beneficiaries who received antipsychotic drugs, with diagnoses of schizophrenia or bipolar disorder or with no mental health diagnoses (N=10,190). Half had a coverage gap; half had no gap because of low-income subsidies. Using fixed effects regression models, we examined changes in spending and adherence as beneficiaries experienced cost-sharing increases after reaching the gap. We examined changes in hospitalizations and emergency department visits using proportional hazard models. RESULTS Across all diagnostic groups, total monthly expenditure on antipsychotic drugs decreased with cost-sharing increases in the gap compared with those with no gap (eg, schizophrenia: -$123 95% confidence interval [-$138, -$108]), and out-of-pocket spending increased (eg, schizophrenia: $104 [$98, $110]). Adherence similarly decreased, with the largest declines among those with schizophrenia (-20.6 percentage points [-22.3, -18.9] in proportion of days covered). Among beneficiaries with schizophrenia and bipolar disorder, hospitalizations and emergency department visit rates increased with cost-sharing increases (eg, schizophrenia: hazard ratio=1.32 [1.06, 1.65] for all hospitalizations), but did not among subjects without mental health diagnoses. Clinical event rates did not change among beneficiaries with low-income subsidies without gaps. CONCLUSIONS There is evidence of interruptions in antipsychotic use attributable to Part D cost-sharing. Adverse events increased among beneficiaries with approved indications for use, but not among beneficiaries without such indications.
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Affiliation(s)
- Vicki Fung
- Mid-Atlantic Permanente Research Institute, Mid-Atlantic Permanente Medical Group, Rockville, MD, USA.
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Add-on treatment of quetiapine for fibromyalgia: a pilot, randomized, double-blind, placebo-controlled 12-week trial. J Clin Psychopharmacol 2012; 32:684-7. [PMID: 22926604 DOI: 10.1097/jcp.0b013e318267b8ca] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Recently, second-generation antipsychotic drugs have attracted interest in the treatment of chronic pain, including fibromyalgia (FM). Preliminary uncontrolled studies have shown that quetiapine treatment may be helpful for FM patients. In this trial, we sought to examine-for the first time-the efficacy and tolerability of quetiapine as a treatment for FM and its associated psychiatric symptoms. This was a 12-week double-blind, randomized, placebo-controlled trial of quetiapine XR as an add-on treatment for FM syndrome. Fifty-one female FM patients were randomized, and a flexible dosage of 50 to 300 mg/d was used. The primary outcome was the change from baseline to end point in the Fibromyalgia Impact Questionnaire total score. Secondary outcomes included mood symptoms, sleep disturbances, and tender points. Using a low dose (mean = 132.2 mg) of quetiapine, we observed significant benefits of drug treatment on sleep, uncertain effects on FM and mood symptoms, but no effects on pain, in a small group of polymedicated FM patients. Quetiapine was generally well tolerated.
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Gyllenberg D, Sourander A. Psychotropic drug and polypharmacy use among adolescents and young adults: findings from the Finnish 1981 Nationwide Birth Cohort Study. Nord J Psychiatry 2012; 66:336-42. [PMID: 22212103 DOI: 10.3109/08039488.2011.644809] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Little is known about the timing of the start of psychotropic drug use and psychotropic polypharmacy use. AIMS This study describes these patterns in a Finnish representative cohort aged between 12 and 25. METHODS 5525 subjects born in 1981 were followed up between 1994 and 2005 using the Finnish National Prescription Register. RESULTS Survival analysis revealed that the cumulative incidence of any psychotropic drug use was 1.3% by age 15, 6.1% by age 20 and 15.2% by age 25. Antidepressants and benzodiazepines were the most used drug groups, with cumulative incidences of 12.2% and 5.2%, respectively, by age 25. The cumulative incidence of polypharmacy was 0.02% by age 15, 0.9% by age 20 and 4.1% by age 25, i.e. having purchased at least two psychotropic drugs from different classes during the same day. Polypharmacy occurred among the majority of antipsychotic and benzodiazepine users, but among a minority of antidepressant users. More females than males had used any psychotropic drug, antidepressants, the antidepressant-benzodiazepine combination and the antidepressant-mood stabilizer combination. CONCLUSIONS Both general psychotropic drug use and psychotropic polypharmacy use was often started in late adolescence.
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Affiliation(s)
- David Gyllenberg
- Department of Child Psychiatry, University of Helsinki, Helsinki, Finland.
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The comorbidity of insomnia, chronic pain, and depression: dopamine as a putative mechanism. Sleep Med Rev 2012; 17:173-83. [PMID: 22748562 DOI: 10.1016/j.smrv.2012.03.003] [Citation(s) in RCA: 235] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Revised: 03/02/2012] [Accepted: 03/13/2012] [Indexed: 02/04/2023]
Abstract
Epidemiological, cross-sectional, and prospective studies suggest that insomnia, chronic pain, and depression frequently co-occur and are mutually interacting conditions. However, the mechanisms underlying these comorbid disorders have yet to be elucidated. Overlapping mechanisms in the central nervous system suggest a common neurobiological substrate(s) may underlie the development and interplay of these disorders. We propose that the mesolimbic dopamine system is an underappreciated and attractive venue for the examination of neurobiological processes involved in the interactions, development, exacerbation, and maintenance of this symptom complex. In the present article, studies from multiple disciplines are reviewed to highlight the role of altered dopaminergic function in the promotion of arousal, pain sensitivity, and mood disturbance. We argue that studies aiming to elucidate common factors accounting for the comorbidity of insomnia, chronic pain, and depression should evaluate functioning within the mesolimbic dopaminergic system and its effect on common processes known to be dysregulated in all three disorders.
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Kronholm E, Markkula J, Virta LJ. What is Behind the Seeming Cessation of the Increase in Sleep Medicine Consumption in Finland During the Last Years? J Public Health Res 2012; 1:149-54. [PMID: 25170458 PMCID: PMC4140366 DOI: 10.4081/jphr.2012.e23] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 04/04/2012] [Indexed: 12/03/2022] Open
Abstract
In Finland, between 2003 and 2010 and parallel to the increase in the prevalence of insomnia-related symptoms among the general population, there has been a cessation of growth and even a decrease in the consumption of traditional hypnotics. The reasons behind this seemingly paradoxical situation are not known. We analyzed trends over the period 2000-2010 in the estimated consumption of traditional hypnotics and some new drugs that are destined for use in insomnia treatment. We used the annual wholesale statistical database compiled by the Finnish Medicine Agency, FIMEA, and data from the Finnish Drug Prescription Register. We found evidence to support two parallel trends in Finnish outpatient care. First, there seems to be a trend in which physicians increasingly comply with official guidelines for insomnia treatment, which partly accounts for the decrease in the consumption of traditional hypnotics. Second, at the same time, the first trend seems to be resulting in an increasing trend to treat insomnia patients with some new drugs that were not originally developed for insomnia treatment by prescribing these non-hypnotic drugs in small, sub-clinical doses. The current trend in practice may have contradictory effects on the treatment of insomnia. The long-term consequences of using low doses of drugs other than hypnotics to treat insomnia are not known and the situation should, therefore, be followed-up in subsequent studies. However, pharmacological treatment should never be a substitute for non-pharmacological treatments of insomnia.
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Affiliation(s)
- Erkki Kronholm
- National Institute for Health and Welfare , Department of Chronic Disease Prevention, Turku, Finland
| | - Juha Markkula
- Turku University Hospital, Kotka Outpatient Clinic of Adolescent Psychiatry , Carea, Kotka, Finland ; Neuropsychiatric Outpatient Clinic, Kotka Outpatient Clinic of Adolescent Psychiatry , Carea, Kotka, Finland
| | - Lauri J Virta
- Social Insurance Institution , Research Department, Turku, Finland
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Coe HV, Hong IS. Safety of Low Doses of Quetiapine When Used for Insomnia. Ann Pharmacother 2012; 46:718-22. [DOI: 10.1345/aph.1q697] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objective: To evaluate the safety of low doses of quetiapine when used for insomnia. Data Sources: A literature search was performed using PubMed and EMBASE (January 1990-November 2011) using the terms quetiapine, insomnia, sleep, low-dose, subtherapeutic, safety, and weight gain. Study Selection And Data Extraction:: Two prospective trials were identified that evaluated the effect of quetiapine in primary insomnia. In addition, 2 retrospective cohort studies were identified that evaluated the safety of low doses of quetiapine when used for Insomnia. Several case reports on adverse effects with low doses of the drug were also Included. Data Synthesis: Quetiapine is commonly used off-label for treatment of insomnia. When used for sleep, doses typically seen are less than the Food and Drug Administration-recommended dosage of 150-800 mg/day; those evaluated in the studies reviewed here were 25-200 mg/day). At recommended doses, atypical antipsychotics such as quetiapine are associated with metabolic adverse events (diabetes, obesity, hyperlipidemia). Adverse effects in the prospective trials were patient-reported and were minor, including drowsiness and dry mouth; however, tha trials were limited by their small sample size and short duration. The retrospective cohort studies found that quetiapine was associated with significant increases in weight compared to baseline. Serious adverse events identified from case reports included fatal hepatotoxicity, restless legs syndrome, akathisia, and weight gain. Conclusions: There are potential safety concerns when using low-dose quetiapine for treatment of insomnia. These concerns should be evaluated in further prospective studies. Based on limited data and potential safety concerns, use of low-dose quetiapine for insomnia is not recommended.
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Affiliation(s)
- Holly V Coe
- School of Pharmacy and Pharmaceutical Sciences, State University of New York at Buffalo
| | - Irene S Hong
- School of Pharmacy and Pharmaceutical Sciences, State University of New York at Buffalo
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Gyllenberg D, Sourander A, Helenius H, Sillanmäki L, Huttunen J, Piha J, Kumpulainen K, Tamminen T, Moilanen I, Almqvist F. Childhood predictors of antipsychotic use among young people in Finland. Pharmacoepidemiol Drug Saf 2012; 21:964-71. [DOI: 10.1002/pds.3265] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Revised: 01/25/2012] [Accepted: 02/29/2012] [Indexed: 11/08/2022]
Affiliation(s)
| | - Andre Sourander
- Department of Child Psychiatry; University of Turku and Turku University Central Hospital; Finland
| | - Hans Helenius
- Department of Biostatistics; University of Turku; Finland
| | - Lauri Sillanmäki
- Department of Child Psychiatry; University of Turku and Turku University Central Hospital; Finland
| | - Jukka Huttunen
- Department of Child Psychiatry; University of Turku and Turku University Central Hospital; Finland
| | - Jorma Piha
- Department of Child Psychiatry; University of Turku and Turku University Central Hospital; Finland
| | | | - Tuula Tamminen
- Department of Child Psychiatry; University of Tampere and Tampere University Hospital; Finland
| | - Irma Moilanen
- Department of Child Psychiatry; University of Oulu and Oulu University Hospital; Finland
| | - Fredrik Almqvist
- Department of Child Psychiatry; University of Helsinki and Helsinki University Central Hospital; Finland
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Abstract
Insomnia is a prevalent complaint in clinical practice that can present independently or comorbidly with another medical or psychiatric disorder. In either case, it might need treatment of its own. Of the different therapeutic options available, benzodiazepine-receptor agonists (BzRAs) and cognitive-behavioural therapy (CBT) are supported by the best empirical evidence. BzRAs are readily available and effective in the short-term management of insomnia, but evidence of long-term efficacy is scarce and most hypnotic drugs are associated with potential adverse effects. CBT is an effective alternative for chronic insomnia. Although more time consuming than drug management, CBT produces sleep improvements that are sustained over time, and this therapy is accepted by patients. Although CBT is not readily available in most clinical settings, access and delivery can be made easier through use of innovative methods such as telephone consultations, group therapy, and self-help approaches. Combined CBT and drug treatment can optimise outcomes, although evidence to guide clinical practice on the best way to integrate these approaches is scarce.
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Arnold RM, Miller M, Mehta RS. Insomnia: Drug Therapies #105. J Palliat Med 2012; 15:243-4. [DOI: 10.1089/jpm.2011.9611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Peacey J, Miller H, Huthwaite MA, Romans SE. Sleep medication in acute psychiatric illness: patient's knowledge and prescription patterns in New Zealand. J Nerv Ment Dis 2012; 200:83-7. [PMID: 22210367 DOI: 10.1097/nmd.0b013e31823e6552] [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] [Indexed: 11/25/2022]
Abstract
Adult patients (N = 100) being treated for acute psychiatric illness were interviewed about their sleep problems and attitudes toward available treatments. Most (74%) were using at least one prescribed psychotropic drug with hypnotic or sedative effects. Participants prescribed three or more drugs were less likely to name them correctly compared with those prescribed less. One quarter (24%) did not know that they were on a hypnosedative; more than half of those not prescribed a hypnosedative thought they were. Most participants found their medication effective; however, 54% wished to discontinue it. Two fifths of zopiclone users had been using it for more than 12 months. Although subjective sleep problems are very common in this patient group, they have limited accurate knowledge about their medication treatments. Many want to try alternative nonpharmacological ways to manage their sleep problems.
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Affiliation(s)
- Judith Peacey
- Department of Psychological Medicine, University of Otago School of Medicine, Wellington, New Zealand
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Huffman JC, Chang TE, Durham LE, Weiss AP. Antipsychotic polytherapy on an inpatient psychiatric unit: how does clinical practice coincide with Joint Commission guidelines? Gen Hosp Psychiatry 2011; 33:501-8. [PMID: 21762994 DOI: 10.1016/j.genhosppsych.2011.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Revised: 05/20/2011] [Accepted: 05/24/2011] [Indexed: 02/06/2023]
Abstract
OBJECTIVE A recently developed quality measure set for inpatient psychiatric care includes measurement of antipsychotic polytherapy at discharge. Our objective was to use detailed chart reviews to assess the use of antipsychotic polytherapy and place this use in the context of these measures. METHODS Patients (N=75) discharged on multiple antipsychotics and a comparable set (N=114) of comparison patients (a randomly selected set of all admitted inpatients) were identified from consecutive admissions to a psychiatric inpatient unit. Medical records were reviewed to ascertain the clinical rationale for antipsychotic polytherapy and assess differences in characteristics between these groups. RESULTS Patients discharged on antipsychotic polytherapy were more likely to have public insurance, longer lengths of stay, psychotic illness, more prior admissions, and state-funded services for persons with chronic mental illness. We identified subgroups of patients based on the clinical rationale for the antipsychotic co-prescription (refractory illness, regimen unchanged from admission and use of antipsychotic for nonpsychosis symptoms). Some, but not all, such rationales appeared to be clinically justified. CONCLUSIONS The majority of patients discharged on antipsychotic polytherapy had justifiable clinical rationales that were concordant with the new quality measures. However, two additional subsets were identified, one where quality improvement efforts may be warranted and another where revision of existing quality measure definitions should be considered. Given the implications of public reporting of quality measures, further study and refinement of these measures are required to provide meaningful information to all concerned stakeholders.
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Bajor LA, Ticlea AN, Osser DN. The Psychopharmacology Algorithm Project at the Harvard South Shore Program: an update on posttraumatic stress disorder. Harv Rev Psychiatry 2011; 19:240-58. [PMID: 21916826 DOI: 10.3109/10673229.2011.614483] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND This project aimed to provide an organized, sequential, and evidence-supported approach to the pharmacotherapy of posttraumatic stress disorder (PTSD), following the format of previous efforts of the Psychopharmacology Algorithm Project at the Harvard South Shore Program. METHOD A comprehensive literature review was conducted to determine the best pharmacological choices for PTSD patients and to update the last published version (1999) of the algorithm. We focused on optimal pharmacological interventions to address the prominent symptoms of PTSD, with additional attention to the impact that common comorbidities have on treatment choices. RESULTS We found that SSRIs and SNRIs are not as effective as previously thought, and that awareness of their long-term side effects has increased. New evidence suggests that addressing fragmented sleep and nightmares can improve symptoms (in addition to insomnia) that are frequently seen with PTSD (e.g., hyperarousal, reexperiencing). Prazosin and trazodone are emphasized at this initial step; if significant PTSD symptoms remain, an antidepressant may be tried. For PTSD-related psychosis, an antipsychotic may be added. In resistant cases, two or three antidepressants may be used in sequence. Following that, or with partial improvement and residual symptomatology, augmentation may be tried; the best options are antipsychotics, clonidine, topiramate, and lamotrigine. CONCLUSION This heuristic may be helpful in producing faster symptom resolution, fewer side effects, and increased compliance.
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Affiliation(s)
- Laura A Bajor
- Harvard Medical School, Harvard South Shore Psychiatry Residency Training Program, Brockton, MA 02301, USA
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Abstract
OBJECTIVE to examine the use of quetiapine for sleep in patients with dementia admitted to a geriatric psychiatry ward. DESIGN retrospective cross-sectional study (January 2007 to December 2009). SETTING geriatric psychiatric unit located near a metropolitan city in North Carolina. PARTICIPANTS all patients admitted with a diagnosis of dementia who were also receiving quetiapine were eligible. One hundred one patients met the criteria and were included in the study. INTERVENTION none. MAIN OUTCOME MEASURES descriptive statistics defining quetiapine prescribing. Based on a priori criteria, quetiapine was considered to be used for sleep if it were prescribed: 1) only at bedtime, as needed, for sleep, 2) once daily, only at bedtime, or 3) multiple times daily, but with at least 75% of the daily dose administered at bedtime. RESULTS forty-three of the 101 patients included in the study were prescribed quetiapine, probably for sleep. Quetiapine, when used as a sedative-hypnotic, was generally employed at doses between 50 mg and 100 mg nightly. Several published studies report beneficial sleep-promoting effects of quetiapine and other atypical antipsychotics for primary and secondary sleep complaints; however, most of these trials involve young and middle-aged adults, have diagnostic variability, and are limited methodologically. CONCLUSION quetiapine prescribed as a sedative-hypnotic in patients with dementia, while common, is understudied and not without risk.
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Affiliation(s)
- Christian R Dolder
- Wingate University School of Pharmacy, Wingate, North Carolina 28174, USA.
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Zarowitz BJ. Quetiapine Not Quiet-a-pine—Not a Sleeper. Geriatr Nurs 2011; 32:46-8. [DOI: 10.1016/j.gerinurse.2010.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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