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Huang Y, Bruera S, Agarwal SK, Suarez-Almazor ME, Bazzazzadehgan S, Ramachandran S, Bhattacharya K, Bentley JP, Yang Y. Opioid Treatment for Adults With and Without Systemic Autoimmune/Inflammatory Rheumatic Diseases: Analysis of 2006-2019 United States National Data. Arthritis Care Res (Hoboken) 2024; 76:1427-1435. [PMID: 38766880 DOI: 10.1002/acr.25378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 04/29/2024] [Accepted: 05/10/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVES This study compared opioid prescribing among ambulatory visits with systemic autoimmune/inflammatory rheumatic diseases (SARDs) or without and assessed factors associated with opioid prescribing in SARDs. METHODS This cross-sectional study used the National Ambulatory Medical Care Survey between 2006 and 2019. Adult (≥18 years) visits with a primary diagnosis of SARDs, including rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, or systemic lupus erythematosus were included in the study. Opioid prescribing was compared between those with vs without SARDs using multivariable logistic regression accounting for the complex survey design and adjusting for predisposing, enabling, and need factors within Andersen's Behavioral Model of Health Services Use. Another multivariable logistic regression examined the predictors associated with opioid prescribing in SARDs. RESULTS Annually, an average of 5.20 million (95% confidence interval [CI] 3.58-6.82) visits were made for SARDs, whereas 780.14 million (95% CI 747.56-812.72) visits were made for non-SARDs. The SARDs group was more likely to be prescribed opioids (22.53%) than the non-SARDs group (9.83%) (adjusted odds ratio [aOR] 2.65; 95% CI 1.68-4.18). Among the SARDs visits, patient age from 50 to 64 (aOR 1.95; 95% CI 1.05-3.65 relative to ages 18-49) and prescribing of glucocorticoids (aOR 1.75; 95% CI 1.20-2.54) were associated with an increased odd of opioid prescribing, whereas private insurance relative to Medicare (aOR 0.50; 95% CI 0.31-0.82) was associated with a decreased odds of opioid prescribing. CONCLUSION Opioid prescribing in SARDs was higher compared to non-SARDs. Concerted efforts are needed to determine the appropriateness of opioid prescribing in SARDs.
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Affiliation(s)
- Yinan Huang
- The University of Mississippi School of Pharmacy, University, Mississippi
| | | | | | | | | | | | | | - John P Bentley
- The University of Mississippi School of Pharmacy, University, Mississippi
| | - Yi Yang
- The University of Mississippi School of Pharmacy, University, Mississippi
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2
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Rhee TG, Bommersbach TJ, Rosenheck RA, Nierenberg AA, McIntyre RS. National trends and correlates of treatment resistance in major depressive episode and associated suicidal ideation and behaviors among adults in the United States. J Affect Disord 2024; 358:342-349. [PMID: 38734245 DOI: 10.1016/j.jad.2024.05.044] [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: 10/03/2023] [Revised: 05/05/2024] [Accepted: 05/07/2024] [Indexed: 05/13/2024]
Abstract
OBJECTIVE To examine recent 12-year trends in prevalence of suicidal ideation and behaviors (SIBs) among US adults experiencing a past-year treatment-resistant depression (TRD). METHODS Using data from the National Survey of Drug Use and Health, we estimated the annual percentage of individuals aged ≥18 with TRD who reported past-year SIBs, and estimated linear trends adjusting for potentially confounding factors from 2009 to 2020. RESULTS Of estimated 237.5 million US adults, 7.1 % met diagnostic criteria for a past-year major depressive episode (MDE) between 2009 and 2020. Of these, 9.7 % met criteria for TRD. The proportion reporting past-year suicidal ideation in TRD ranged from 39.5 % (95 % confidence interval [CI], 32.1-47.3 %) in 2009-2010 to 43.4 % (95 % CI, 36.7-503 %) in 2019-2020, with an average annual percent change (AAPC) of 1.3 % (95 % CI, -0.7 % to 3.3 %). The prevalence of past-year suicide attempts in TRD was 7.3 % across the study period (AAPC, 0.1 %; 95 % CI, -4.3 % to 4.7 %). Past-year SIBs were significantly associated with an increased likelihood of meeting criteria for TRD among adults with MDE (adjusted odds ratio [AOR], 1.53; 95 % CI, 1.35-1.75 for suicidal ideation; AOR, 2.17; 95 % CI, 1.79-2.62 for suicide attempts). No significant differences were observed between 2019 and 2020, reflecting the COVID-19 pandemic. CONCLUSION Among individuals with TRD, proportions of SIBs are high. These findings underscore an urgent need for suicide prevention efforts in this high-risk population, including preventive services across diverse settings and accessibility to evidence-based pharmacological and non-pharmacological interventions.
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Affiliation(s)
- Taeho Greg Rhee
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; VA New England Mental Illness, Research, Education and Clinical Center (MIRECC), VA Connecticut Healthcare System, West Haven, CT, USA; Department of Public Health Sciences, School of Medicine, University of Connecticut, Farmington, CT, USA.
| | | | - Robert A Rosenheck
- VA New England Mental Illness, Research, Education and Clinical Center (MIRECC), VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
| | - Andrew A Nierenberg
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston, MA, USA
| | - Roger S McIntyre
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Brain and Cognition Discovery Foundation, Toronto, ON, Canada
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Driscoll DJO, McCarthy S. Antipsychotic prescribing: national findings of children and adolescents attending mental health services in Ireland. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02428-4. [PMID: 38607458 DOI: 10.1007/s00787-024-02428-4] [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] [Received: 11/19/2023] [Accepted: 03/23/2024] [Indexed: 04/13/2024]
Abstract
Antipsychotic prescribing trends vary internationally, albeit off-label use remains high (i.e., target symptoms). We aim to describe antipsychotic use, target conditions, target symptoms and dosing regimens in children and adolescents in Ireland. We used a sampled cohort from a national audit of children and adolescents attending mental health services with predefined inclusion and exclusion criteria from Jul-2021 to Dec-2021 who were prescribed at least one psychotropic medication and up to and including 17-years of age (n = 3528). Each service provided anonymised data. We described the frequency of antipsychotic medication, medication type, target condition, target symptom and medication doses. We used multivariable logistic regression, adjusted with available co-variates to assess the association of being prescribed an antipsychotic medication. Twelve percentage (n = 437) were prescribed an antipsychotic and 16-17-years (n = 211, 48.3%) was the most common age category. The commonest reason for prescribing an antipsychotic was target symptoms (i.e., off-label use) (n = 329; 75.%) and of these symptoms, agitation (n = 77/329; 25%) and irritability (56/239; 25%) were the most common. Quetiapine (n = 127; 29%) was the most common antipsychotic, followed by risperidone (n = 125; 28.6%), aripiprazole (n = 107; 24.5%), and olanzapine (n = 66; 15.1%). In adjusted analysis, having a psychotic disorder ((adjusted-odds-ratio) aOR: 39.63, CI 95%, 13.40-117.22), bipolar disorder (aOR: 16.96, CI 95%, 3.60-80.00), autism spectrum disorder (aOR: 3.24, CI 95%, 2.45-4.28) or aggression symptoms (aOR: 16.75, CI 95%, 7.22-38.89) was associated with prescribing an antipsychotic medication. This is the first study in children and adolescents that describes the target conditions and target symptoms for antipsychotic use in Ireland. Our results show a high proportion of antipsychotic prescribing based on target symptoms rather than target condition or diagnosis.
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Affiliation(s)
- David J O Driscoll
- School of Public Health, Western Gateway Building, University College Cork, Cork, Ireland.
- Specialist Neurodevelopmental ADHD Pathway (SNAP), Cork and Kerry Mental Health Services, Cork, Ireland.
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4
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Bazargan-Hejazi S, Shirazi A, Hampton D, Pan D, Askharinam D, Shaheen M, Ebrahim G, Shervington D. Examining racial disparity in psychotic disorders related ambulatory care visits: an observational study using national ambulatory medical care survey 2010-2015. BMC Psychiatry 2023; 23:601. [PMID: 37592201 PMCID: PMC10436449 DOI: 10.1186/s12888-023-05095-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/08/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND One of the most consistent research findings related to race and mental health diseases is the disproportionately high rate of psychotic disorder diagnoses among people of color, specifically people of African descent. It is important to examine if a similar pattern exists among specific psychotic disorders. We aimed to examine the racial/ethnic differences in ambulatory care visits diagnosed with schizophrenia-spectrum disorders (SSDs). METHODS We analyzed data from the National Ambulatory Medical Care Survey (NAMCS) 2010-2015. The study sample included physician office-based visits by individuals diagnosed with SSDs, including schizophrenia, schizoaffective, and unspecified psychotic disorder (n = 1155). We used descriptive and bivariate analysis by race/ethnicity and three multinomial logistic regression models to test the association between the SSDs and race/ethnicity, adjusting for age, gender, insurance, disposition, medication Rx, and co-morbidity, considering the design and weight. RESULT Of the 1155 visits for SSDs, 44.8% had schizophrenia, 37.4% had schizoaffective disorder diagnosis, and 19.0% had unspecified psychosis disorder. We found significant racial disparities in the diagnosis of SSDs. Black patients were overrepresented in all three categories: schizophrenia (24%), schizoaffective disorder (17%), and unspecified psychosis disorder (26%). Also, a notable percentage of Black patients (20%) were referred to another physician in cases of schizophrenia compared to other ethnoracial groups (p < 0.0001). Moreover, we found a significant disparity in insurance coverage for schizoaffective disorder, with a higher percentage of Black patients (48%) having Medicaid insurance compared to patients from other ethnoracial groups (p < 0.0001). Black patients had nearly twice the odds of receiving a diagnosis of schizophrenia compared to White patients [AOR = 1.94; 95% CI: 1.28-2.95; P = 0.001]. However, they had significantly lower odds of being diagnosed with schizoaffective disorder [AOR = 0.42, 95% CI: 0.26-0.68; P = 0.003]. Race/ethnicity was not associated with receiving an unspecified psychosis disorder. CONCLUSIONS Our results show that SSDs, more specifically schizophrenia, continue to burden the mental health of Black individuals. Validation of our findings requires rigorous research at the population level that reveals the epidemiological difference of SSDs diagnoses in different race/ethnicity groups. Also, advancing our understanding of the nature of disparity in SSDs diagnoses among the Black population requires disentangling etiologic and systemic factors in play. This could include psychological stress, the pathway to care, services use, provider diagnostic practice, and experiencing discrimination and institutional and structural racism.
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Affiliation(s)
- Shahrzad Bazargan-Hejazi
- Department of Psychiatry, College of Medicine, Charles R. Drew University of Medicine and Science and UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Anaheed Shirazi
- Department of Psychiatry, School of Medicine, University of California San Diego, San Diego, CA, USA
| | - David Hampton
- Department of Family Medicine, College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Deyu Pan
- Charles R Drew University of Medicine and Science, Los Angeles, CA, USA
| | | | - Magda Shaheen
- College of Medicine, Charles R. Drew University of Medicine and Science, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
| | - Gul Ebrahim
- Kedren Community Care Clinic and Charles R Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Denese Shervington
- Department Psychiatry, College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
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5
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Bommersbach TJ, Rosenheck RA, Rhee TG. Rising Rates of Suicidal Behaviors and Large Unmet Treatment Needs Among US Adults With a Major Depressive Episode, 2009 to 2020. Mayo Clin Proc 2023; 98:969-984. [PMID: 37419587 DOI: 10.1016/j.mayocp.2023.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 01/16/2023] [Accepted: 02/14/2023] [Indexed: 07/09/2023]
Abstract
OBJECTIVE To examine recent 12-year trends in the incidence of suicidal ideation (SI) and suicide attempts (SAs) and receipt of mental health treatment among individuals experiencing a past-year major depressive episode (MDE). PATIENTS AND METHODS Using data from the National Survey of Drug Use and Health, we estimated the annual percentage of individuals with MDE who reported past-year SI or SAs and their use of mental health services from 2009 to 2020 and calculated odds ratios (ORs) for longitudinal change adjusting for potentially confounding factors. RESULTS During our study period, the weighted unadjusted proportion of patients with a past-year MDE who reported SI increased from 26.2% (668,690 of 2,550,641) to 32.5% (1,068,504 of 3,285,986; OR, 1.38; 95% CI, 1.25 to 1.51) and remained significant in the multivariable-adjusted analysis (P<.001). The greatest increase in SI was seen among Hispanic patients, young adults, and individuals with alcohol use disorder. Similar trends were seen for past-year SAs, increasing from 2.7% (69,548 of 2,550,641) to 3.3% (108,135 of 3,285,986; OR, 1.29; 95% CI, 1.04 to 1.61), especially among Black individuals, patients with incomes greater than $75,000, and those with substance use disorders. In multivariable-adjusted analyses, the temporal trend of increasing SI and SAs remained significant (P<.001 and P=0.04, respectively). Among individuals with past-year SI or SAs, there was no notable change in the mental health service use, and over 50% of individuals with MDE and SI (2,472,401 of 4,861,298) reported unmet treatment needs. No notable differences were observed between 2019 and 2020, reflecting the coronavirus disease 2019 pandemic. CONCLUSION Among individuals with MDE, rates of SI and SAs have increased, especially among racial minorities and individuals with substance use disorders, without a corresponding change in mental health service use.
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Affiliation(s)
| | - Robert A Rosenheck
- New England Mental Illness, Research Education, and Clinical Center, VA Connecticut Healthcare System, West Haven, CT
| | - Taeho Greg Rhee
- New England Mental Illness, Research Education, and Clinical Center, VA Connecticut Healthcare System, West Haven, CT; Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT.
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Johnson BO, Orji G, Johnson OO, Petion J, Oke O, Kazi SE, Nwabueze C, Jolayemi A. Rebound Catatonia Associated With Injectable Paliperidone. Cureus 2023; 15:e40478. [PMID: 37456389 PMCID: PMC10349681 DOI: 10.7759/cureus.40478] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2023] [Indexed: 07/18/2023] Open
Abstract
Paliperidone is an atypical antipsychotic medication commonly used to treat schizophrenia, schizoaffective disorder, and bipolar disorder. It is a metabolite of risperidone and has a similar mechanism of action, primarily blocking dopamine 2 receptors (D2 receptors) in the brain. Paliperidone has various adverse effects, including extrapyramidal symptoms, weight gain, and metabolic disturbances. Catatonia is rare but severe side effects can occur in the context of an underlying psychiatric, neurologic, or general medical condition. Paradoxically, antipsychotics for treating schizophrenia or bipolar spectrum disorders can precipitate or worsen catatonic symptoms. The report suggests that 17-19% of all cases diagnosed as catatonia due to other medical conditions are medication-induced. Catatonia is a neuropsychiatric syndrome that presents as a cluster of psychomotor signs and symptoms resulting in movement and behavior aberrations. Various symptoms, including mutism, stupor, rigidity, and abnormal movements, characterize catatonia. Catatonia is a potentially life-threatening condition requiring prompt recognition and management. Here, we present a case of a patient with catatonia associated with long-acting injectable paliperidone intramuscular therapy in a patient with schizophrenia.
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Affiliation(s)
| | - Godwin Orji
- Psychiatry, Interfaith Medical Center, Brooklyn, USA
| | | | - Jacky Petion
- Psychiatry, Interfaith Medical Center, Brooklyn, USA
| | - Oluwaseun Oke
- Psychiatry, Interfaith Medical Center, Brooklyn, USA
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7
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Omlor N, Richter M, Goltermann J, Steinmann LA, Kraus A, Borgers T, Klug M, Enneking V, Redlich R, Dohm K, Repple J, Leehr EJ, Grotegerd D, Kugel H, Bauer J, Dannlowski U, Opel N. Treatment with the second-generation antipsychotic quetiapine is associated with increased subgenual ACC activation during reward processing in major depressive disorder. J Affect Disord 2023; 329:404-412. [PMID: 36842646 DOI: 10.1016/j.jad.2023.02.102] [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: 09/08/2022] [Revised: 02/10/2023] [Accepted: 02/20/2023] [Indexed: 02/28/2023]
Abstract
BACKGROUND The second-generation antipsychotic (SGA) quetiapine is an essential option for antidepressant augmentation therapy in major depressive disorder (MDD), yet neurobiological mechanisms behind its antidepressant properties remain unclear. As SGAs interfere with activity in reward-related brain areas, including the anterior cingulate cortex (ACC) - a key brain region in antidepressant interventions, this study examined whether quetiapine treatment affects ACC activity during reward processing in MDD patients. METHODS Using the ACC as region of interest, an independent t-test comparing reward-related BOLD response of 51 quetiapine-taking and 51 antipsychotic-free MDD patients was conducted. Monetary reward outcome feedback was measured in a card-guessing paradigm using pseudorandom blocks. Participants were matched for age, sex, and depression severity and analyses were controlled for confounding variables, including total antidepressant medication load, illness chronicity and acute depression severity. Potential dosage effects were examined in a 3 × 1 ANOVA. Differences in ACC-related functional connectivity were assessed in psycho-physiological interaction (PPI) analyses. RESULTS Left subgenual ACC activity was significantly higher in the quetiapine group compared to antipsychotic-free participants and dependent on high-dose quetiapine intake. Results remained significant after controlling for confounding variables. The PPI analysis did not yield significant group differences in ACC-related functional connectivity. LIMITATIONS Causal interpretation is limited due to cross-sectional findings. CONCLUSION Elevated subgenual ACC activity to rewarding stimuli may represent a neurobiological marker and potential key interface of quetiapine's antidepressant effects in MDD. These results underline ACC activity during reward processing as an investigative avenue for future research and therapeutic interventions to improve MDD treatment outcomes.
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Affiliation(s)
- Nicola Omlor
- Institute for Translational Psychiatry, University of Münster, Germany
| | - Maike Richter
- Institute for Translational Psychiatry, University of Münster, Germany; Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Janik Goltermann
- Institute for Translational Psychiatry, University of Münster, Germany
| | | | - Anna Kraus
- Institute for Translational Psychiatry, University of Münster, Germany
| | - Tiana Borgers
- Institute for Translational Psychiatry, University of Münster, Germany
| | - Melissa Klug
- Institute for Translational Psychiatry, University of Münster, Germany
| | - Verena Enneking
- Institute for Translational Psychiatry, University of Münster, Germany
| | - Ronny Redlich
- Institute for Translational Psychiatry, University of Münster, Germany; Department of Psychology, Martin-Luther University of Halle, Germany; German Center for Mental Health (DZPG), Site Jena-Magdeburg-Halle, Germany
| | - Katharina Dohm
- Institute for Translational Psychiatry, University of Münster, Germany
| | - Jonathan Repple
- Institute for Translational Psychiatry, University of Münster, Germany
| | - Elisabeth J Leehr
- Institute for Translational Psychiatry, University of Münster, Germany
| | - Dominik Grotegerd
- Institute for Translational Psychiatry, University of Münster, Germany
| | - Harald Kugel
- University Clinic for Radiology, University of Münster, Germany
| | - Jochen Bauer
- University Clinic for Radiology, University of Münster, Germany
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster, Germany
| | - Nils Opel
- Institute for Translational Psychiatry, University of Münster, Germany; Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany; Center for Intervention and Research on adaptive and maladaptive brain Circuits underlying mental health (C-I-R-C), Jena-Magdeburg-Halle, Germany; German Center for Mental Health (DZPG), Site Jena-Magdeburg-Halle, Germany.
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8
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Jang SH, Bahk WM, Woo YS, Seo JS, Park YM, Kim W, Jeong JH, Shim SH, Lee JG, Jon DI, Min KJ. The Korean Medication Algorithm Project for Depressive Disorder (KMAP-DD): Changes in Preferred Treatment Strategies and Medications over 20 Years and Five Editions. J Clin Med 2023; 12:jcm12031146. [PMID: 36769798 PMCID: PMC9917906 DOI: 10.3390/jcm12031146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The Korean Medication Algorithm Project for Depressive Disorder (KMAP-DD) is an expert consensus guideline for depressive disorder created in 2002, and since then, four revisions (2006, 2012, 2017, 2021) have been published. In this study, changes in the content of the KMAP-DD survey and recommendations for each period were examined. METHODS The development process of the KMAP-DD was composed of two stages. First, opinions from experts with abundant clinical experience were gathered through surveys. Next, a final guideline was prepared through discussion within the working committee regarding the suitability of the results with reference to recent clinical studies or other guidelines. RESULTS In mild depressive symptoms, antidepressant (AD) monotherapy was preferred, but when severe depression or when psychotic features were present, a combination of AD and atypical antipsychotics (AD + AAP) was preferred. AD monotherapy was preferred in most clinical subtypes. AD monotherapy was preferred for mild depressive symptoms, and AD + AAP was preferred for severe depression and depression with psychotic features in children, adolescents, and the elderly. CONCLUSIONS This study identified the changes in the KMAP-DD treatment strategies and drug preferences in each period over the past 20 years. This work is expected to aid clinicians in establishing effective treatment strategies.
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Affiliation(s)
- Seung-Ho Jang
- Department of Psychiatry, Wonkwang University Hospital, School of Medicine, Wonkwang University, Iksan 54538, Republic of Korea
| | - Won-Myong Bahk
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
- Correspondence:
| | - Young Sup Woo
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Jeong Seok Seo
- Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul 06974, Republic of Korea
| | - Young-Min Park
- Department of Psychiatry, Ilsan Paik Hospital, Inje University College of Medicine, Goyang 10380, Republic of Korea
| | - Won Kim
- Department of Psychiatry, Sanggye Paik Hospital, Inje University College of Medicine, Seoul 01757, Republic of Korea
| | - Jong-Hyun Jeong
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Se-Hoon Shim
- Department of Psychiatry, Soonchunhyang University Cheonan Hospital, College of Medicine, Soonchunhyang University, Cheonan 31151, Republic of Korea
| | - Jung Goo Lee
- Department of Psychiatry, Haeundae Paik Hospital, College of Medicine, Inje University, Busan 48108, Republic of Korea
| | - Duk-In Jon
- Department of Psychiatry, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
| | - Kyung Joon Min
- Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul 06974, Republic of Korea
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9
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Lee K, Abraham S, Cleaver R. A systematic review of licensed weight-loss medications in treating antipsychotic-induced weight gain and obesity in schizophrenia and psychosis. Gen Hosp Psychiatry 2022; 78:58-67. [PMID: 35863294 DOI: 10.1016/j.genhosppsych.2022.07.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/24/2022] [Accepted: 07/12/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Schizophrenia and antipsychotic use are associated with clinically significant weight gain and subsequent increased mortality. Despite weight loss medications (WLMs) licensed by regulatory bodies (FDA, EMA, and MHRA) being available, current psychiatric guidelines recommend off-label alternatives, which differ from non-psychiatric guidelines for obesity. OBJECTIVE Evaluate the efficacy of licensed WLMs on treating antipsychotic-induced weight gain (AIWG) and obesity in schizophrenia and psychosis (OSP). METHOD A literature search was conducted using Medline, EMBASE, PsycINFO and Cochrane Library online databases for human studies using licensed WLMs to treat AIWG and OSP. RESULTS Three RCTs (two liraglutide, one naltrexone-bupropion), one unpublished open-label trial (naltrexone-bupropion), and seven observational studies (five liraglutide, one semaglutide, one multiple WLMs) were identified. Results for liraglutide showed statistically significant improvement in weight, BMI, waist circumference, HbA1c, cholesterol, and LDL readings on meta-analysis. Evidence was mixed for naltrexone-bupropion with no detailed studies conducted for setmelanotide, or stimulants. CONCLUSION Evidence is strongest for liraglutide compared to other licensed WLMs. The findings, particularly the inclusion of human trial data, provide evidence for liraglutide use in treating AIWG and OSP, which would better align psychiatric practice with non-psychiatric practices around obesity. The findings also identify continued literature gaps regarding other licensed WLMs.
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Affiliation(s)
- Kenn Lee
- Liaison Mental Health Service, Royal Oldham Hospital, Pennine Care NHS Foundation Trust, United Kingdom.
| | - Seri Abraham
- Liaison Mental Health Service, Royal Oldham Hospital, Pennine Care NHS Foundation Trust, United Kingdom; School of Psychiatry, Health Education England North West, United Kingdom; Manchester Metropolitan University, United Kingdom
| | - Robert Cleaver
- Liaison Mental Health Service, Royal Oldham Hospital, Pennine Care NHS Foundation Trust, United Kingdom
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10
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Fiedorowicz JG, Brown L, Li J, Parikh SV, Dunlop BW, Forester BP, Shelton RC, Thase ME, Macaluso M, Yu K, Greden JF. Obesogenic Medications and Weight Gain Over 24 Weeks in Patients with Depression: Results from the GUIDED Study. PSYCHOPHARMACOLOGY BULLETIN 2021; 51:8-30. [PMID: 34887596 PMCID: PMC8601756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Weight gain is a common side-effect of medications used to treat major depressive disorder (MDD). We sought to estimate the frequency of weight gain for obesogenic medications prescribed for MDD and to evaluate if bupropion mitigated risk for weight gain. We analyzed a prospective cohort of patients with weight available at baseline and 12 weeks (n = 1,032) or 24 weeks (n = 871) in a post hoc analysis of the Genomics Used to Improve DEpression Decisions (GUIDED) study of patients with MDD who failed at least one medication trial. We compared weight gain between those on versus not on medications with high risk for weight gain, including a subgroup receiving combination treatment with bupropion. A second analysis evaluated weight gain across traditional medication classes, adjusting for potential confounding variables. Those on medications identified as high risk for weight gain were significantly more likely to experience clinically significant weight gain (≥3%) at 12 weeks (29.3% vs. 16.3%, p < .001) and 24 weeks (33.5% vs. 23.5%, p = .015). No protection from clinically significant weight gain was observed among patients treated with a high-risk medication concomitantly with bupropion (N = 31, 35% and 52% with clinically significant weight gain at 12 and 24 weeks). Antipsychotic medications and tricyclic antidepressants were most often associated with clinically significant weight gain. This study helps quantify the real-world risk of weight gain for patients with MDD on medications with high risk for weight gain, especially for patients taking antipsychotics. Concurrent treatment with bupropion does not appear to mitigate the weight gain risk.
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Affiliation(s)
- Jess G Fiedorowicz
- Fiedorowicz, University of Ottawa, The Ottawa Hospital, Ottawa Hospital Research Institute; Brown, Li, Yu, Myriad Genetics, Inc.; Parikh, Greden, University of Michigan; Dunlop, Emory University School of Medicine; Forester, McLean Hospital and Harvard Medical School; Shelton, University of Alabama at Birmingham; Thase, University of Pennsylvania, Macaluso, UAB
| | - Lisa Brown
- Fiedorowicz, University of Ottawa, The Ottawa Hospital, Ottawa Hospital Research Institute; Brown, Li, Yu, Myriad Genetics, Inc.; Parikh, Greden, University of Michigan; Dunlop, Emory University School of Medicine; Forester, McLean Hospital and Harvard Medical School; Shelton, University of Alabama at Birmingham; Thase, University of Pennsylvania, Macaluso, UAB
| | - James Li
- Fiedorowicz, University of Ottawa, The Ottawa Hospital, Ottawa Hospital Research Institute; Brown, Li, Yu, Myriad Genetics, Inc.; Parikh, Greden, University of Michigan; Dunlop, Emory University School of Medicine; Forester, McLean Hospital and Harvard Medical School; Shelton, University of Alabama at Birmingham; Thase, University of Pennsylvania, Macaluso, UAB
| | - Sagar V Parikh
- Fiedorowicz, University of Ottawa, The Ottawa Hospital, Ottawa Hospital Research Institute; Brown, Li, Yu, Myriad Genetics, Inc.; Parikh, Greden, University of Michigan; Dunlop, Emory University School of Medicine; Forester, McLean Hospital and Harvard Medical School; Shelton, University of Alabama at Birmingham; Thase, University of Pennsylvania, Macaluso, UAB
| | - Boadie W Dunlop
- Fiedorowicz, University of Ottawa, The Ottawa Hospital, Ottawa Hospital Research Institute; Brown, Li, Yu, Myriad Genetics, Inc.; Parikh, Greden, University of Michigan; Dunlop, Emory University School of Medicine; Forester, McLean Hospital and Harvard Medical School; Shelton, University of Alabama at Birmingham; Thase, University of Pennsylvania, Macaluso, UAB
| | - Brent P Forester
- Fiedorowicz, University of Ottawa, The Ottawa Hospital, Ottawa Hospital Research Institute; Brown, Li, Yu, Myriad Genetics, Inc.; Parikh, Greden, University of Michigan; Dunlop, Emory University School of Medicine; Forester, McLean Hospital and Harvard Medical School; Shelton, University of Alabama at Birmingham; Thase, University of Pennsylvania, Macaluso, UAB
| | - Richard C Shelton
- Fiedorowicz, University of Ottawa, The Ottawa Hospital, Ottawa Hospital Research Institute; Brown, Li, Yu, Myriad Genetics, Inc.; Parikh, Greden, University of Michigan; Dunlop, Emory University School of Medicine; Forester, McLean Hospital and Harvard Medical School; Shelton, University of Alabama at Birmingham; Thase, University of Pennsylvania, Macaluso, UAB
| | - Michael E Thase
- Fiedorowicz, University of Ottawa, The Ottawa Hospital, Ottawa Hospital Research Institute; Brown, Li, Yu, Myriad Genetics, Inc.; Parikh, Greden, University of Michigan; Dunlop, Emory University School of Medicine; Forester, McLean Hospital and Harvard Medical School; Shelton, University of Alabama at Birmingham; Thase, University of Pennsylvania, Macaluso, UAB
| | - Matthew Macaluso
- Fiedorowicz, University of Ottawa, The Ottawa Hospital, Ottawa Hospital Research Institute; Brown, Li, Yu, Myriad Genetics, Inc.; Parikh, Greden, University of Michigan; Dunlop, Emory University School of Medicine; Forester, McLean Hospital and Harvard Medical School; Shelton, University of Alabama at Birmingham; Thase, University of Pennsylvania, Macaluso, UAB
| | - Kunbo Yu
- Fiedorowicz, University of Ottawa, The Ottawa Hospital, Ottawa Hospital Research Institute; Brown, Li, Yu, Myriad Genetics, Inc.; Parikh, Greden, University of Michigan; Dunlop, Emory University School of Medicine; Forester, McLean Hospital and Harvard Medical School; Shelton, University of Alabama at Birmingham; Thase, University of Pennsylvania, Macaluso, UAB
| | - John F Greden
- Fiedorowicz, University of Ottawa, The Ottawa Hospital, Ottawa Hospital Research Institute; Brown, Li, Yu, Myriad Genetics, Inc.; Parikh, Greden, University of Michigan; Dunlop, Emory University School of Medicine; Forester, McLean Hospital and Harvard Medical School; Shelton, University of Alabama at Birmingham; Thase, University of Pennsylvania, Macaluso, UAB
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11
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Gerhard T, Stroup TS, Correll CU, Setoguchi S, Strom BL, Huang C, Tan Z, Crystal S, Olfson M. Mortality Risk of Antipsychotic Augmentation for Adult Depression. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2021; 19:86-94. [PMID: 34483774 DOI: 10.1176/appi.focus.19101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
(Reprinted with permission from PLOS ONE 2020).
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12
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Asp M, Ambrus L, Reis M, Manninen S, Fernström J, Lindqvist D, Westrin Å. Differences in antipsychotic treatment between depressive patients with and without a suicide attempt. Compr Psychiatry 2021; 109:152264. [PMID: 34271258 DOI: 10.1016/j.comppsych.2021.152264] [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: 01/23/2021] [Revised: 05/26/2021] [Accepted: 07/05/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Depressed suicide attempters are, according to some earlier studies, treated more often with antipsychotics than depressive non-suicide attempters. Cluster B personality disorders, especially borderline personality disorder, are associated with a high suicide risk, and antipsychotics are commonly used for the reduction of symptoms. However, no previous study has taken comorbid personality disorders into account when assessing the use of antipsychotics in patients with unipolar depression. Therefore, the aim of this study was to investigate the clinical selection of pharmacotherapy in unipolar depression with and without a previous suicide attempt, taking into account potential confounders such as cluster B personality disorders. METHODS The study sample consisted of 247 patients with unipolar depression. The study was approved by the Regional Ethical Review Board in Lund, Sweden. Study participants were recruited from 4 different secondary psychiatric care clinics in Sweden and were diagnosed according to the DSM-IV-TR with the MINI and SCID II. Previous and ongoing psychiatric treatments were investigated in detail and medical records were assessed. RESULTS Thirty percent of the patients had made previous suicide attempts. Depressed suicide attempters underwent both lifetime treatment with antipsychotics and an ongoing antipsychotic treatment significantly more often than non-attempters. Significances remained after a regression analysis, adjusting for cluster B personality disorders, symptom severity, age at the onset of depression, and lifetime psychotic symptoms. CONCLUSIONS This is the first study to consider the effect of comorbidity with cluster B personality disorders when comparing treatment of depressive suicide and non-suicide attempters. Our findings suggest that suicide attempters are more frequently treated with antipsychotics compared to non-suicide attempters, regardless of cluster B personality disorder comorbidity. These findings are important for clinicians to consider and would also be relevant to future studies evaluating reduction of suicide risk with antipsychotics in patients with psychiatric comorbidity and a history of attempted suicide.
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Affiliation(s)
- Marie Asp
- Department of Clinical Sciences Lund, Psychiatry, Lund University, Sweden; Office of Psychiatry and Habilitation, Psychiatric Clinic Lund, Region Skåne, Sweden.
| | - Livia Ambrus
- Department of Clinical Sciences Lund, Psychiatry, Lund University, Sweden; Office of Psychiatry and Habilitation, Psychiatric Clinic Lund, Region Skåne, Sweden
| | - Margareta Reis
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Sofie Manninen
- Department of Clinical Sciences Lund, Psychiatry, Lund University, Sweden
| | - Johan Fernström
- Department of Clinical Sciences Lund, Psychiatry, Lund University, Sweden; Office of Psychiatry and Habilitation, Psychiatric Clinic Lund, Region Skåne, Sweden
| | - Daniel Lindqvist
- Department of Clinical Sciences Lund, Psychiatry, Lund University, Sweden; Office for Psychiatry and Habilitation, Psychiatry Research Skåne, Region Skåne, Sweden
| | - Åsa Westrin
- Department of Clinical Sciences Lund, Psychiatry, Lund University, Sweden; Office for Psychiatry and Habilitation, Psychiatry Research Skåne, Region Skåne, Sweden
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13
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Escudero J, Muñoz JL, Morera-Herreras T, Hernandez R, Medrano J, Domingo-Echaburu S, Barceló D, Orive G, Lertxundi U. Antipsychotics as environmental pollutants: An underrated threat? THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 769:144634. [PMID: 33485196 DOI: 10.1016/j.scitotenv.2020.144634] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/18/2020] [Accepted: 12/18/2020] [Indexed: 06/12/2023]
Abstract
The heterogeneous class of what we nowadays call antipsychotics was born almost 70 years ago with the serendipitous discovery of chlorpromazine. Their utilization is constantly growing because they are used to treat a diverse group of diseases and patients across all age groups: schizophrenia, bipolar disease, depression, autism, attention deficit hyperactivity disorder, behavioural and psychological symptoms in dementia, among others. They possess a complex pharmacological profile, acting on multiple receptors: dopaminergic, serotoninergic, histaminergic, adrenergic, and cholinergic, leading scientists to call them "agents with rich pharmacology" or "dirty drugs". Serotonin, dopamine, acetylcholine, noradrenaline, histamine and their respective receptors are evolutionary ancient compounds, and as such, are found in many different living beings in the environment. Antipsychotics do not disappear once excreted by patient's urine or faeces and are transported to wastewater treatment plants. But as these plant's technology is not designed to eliminate drugs and their metabolites, a variable proportion of the administered dose ends up in the environment, where they have been found in almost every matrix: municipal wastewater, hospital sewage, rivers, lakes, sea and even drinking water. We believe that reported concentrations found in the environment might be high enough to exert significant effect to aquatic wildlife. Besides, recent studies suggest antipsychotics, among others, are very likely bioaccumulating through the web food. Crucially, psychotropics may provoke behavioural changes affecting populations' dynamics at lower concentrations. We believe that so far, antipsychotics have not received the attention they deserve with regards to drug pollution, and that their role as environmental pollutants has been underrated.
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Affiliation(s)
- J Escudero
- Bioaraba Health Research Institute, Epidemiology and Public Health, Vitoria-Gasteiz, Spain
| | - J L Muñoz
- Department of Pharmacology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - T Morera-Herreras
- Department of Pharmacology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain; Neurodegenerative Diseases Group, BioCruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | - R Hernandez
- Internal Medicine Service, Araba Psychiatric Hospital, Araba Mental Health Network, C/Álava 43, 01006 Vitoria-Gasteiz, Alava, Spain
| | - J Medrano
- Biocruces Bizkaia Health Research Institute, Mental Health Network Research Group, Osakidetza, Bizkaia, Spain
| | - S Domingo-Echaburu
- Pharmacy Service, Alto Deba-Integrated Health Care Organization, Arrasate, Gipuzkoa, Spain
| | - D Barceló
- Water and Soil Quality Research Group, Department of Environmental Chemistry, IDAEA-CSIC, C/Jordi Girona 18-26, 08034 Barcelona, Spain; Catalan Institute for Water Research (ICRA), C/Emili Grahit 101, 17003 Girona, Spain
| | - G Orive
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country UPV/EHU, Paseo de la Universidad 7, Vitoria-Gasteiz 01006, Spain; Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Vitoria-Gasteiz, Spain; University Institute for Regenerative Medicine and Oral Implantology - UIRMI (UPV/EHU-Fundación Eduardo Anitua), Vitoria, Spain; Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, Singapore.; Bioaraba, NanoBioCel Research Group, Vitoria-Gasteiz, Spain
| | - U Lertxundi
- Bioaraba Health Research Institute; Osakidetza Basque Health Service, Araba Mental Health Network, Araba Psychiatric Hospital, Pharmacy Service, c/Alava 43, 01006 Vitoria-Gasteiz, Alava, Spain.
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14
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Malhi GS, Morris G, Bell E, Hamilton A. A New Paradigm for Achieving a Rapid Antidepressant Response. Drugs 2020; 80:755-764. [PMID: 32347475 DOI: 10.1007/s40265-020-01303-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The substantive delay (often 4-6 weeks) between the commencement of an antidepressant and any discernible improvement in depressive symptoms is an ongoing concern in the management of depressive disorders. This delay incurs the risk of cessation of medication, self-harm/suicide and ongoing 'damage' to the brain caused by the illness. Both historically and now, off-label polypharmacy has been used in clinical practice in an attempt to facilitate both immediate- and long-term relief from symptoms. While somewhat effective, this strategy was unregulated and associated with severe adverse side effects for patients. In this article we proffer an alternative paradigm to achieve a more rapid antidepressant response by conceptualising the gap in terms of windows of response. The Windows of Antidepressant Response Paradigm (WARP) frames treatment response as windows of time in which a clinical response can be expected following initiation of an antidepressant. The paradigm defines three distinct windows-the immediate-response window (1-2 days), fast-response window (up to 1 week) and slow-response window (from 1 week onwards). Newer agents such as rapid-acting antidepressants are considered to act within the immediate-response window, whereas atypical antipsychotic augmentation strategies are captured within the fast-response window. The slow-response window represents the delay experienced with conventional antidepressant monotherapy. Novel agents such as esketamine and brexpiprazole are discussed as examples to better understand the clinical utility of WARP. This framework can be used to guide research in this field and aide the development of newer, more effective antidepressant agents as well as providing a strategy to guide the prescription of multiple agents in clinical practice.
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Affiliation(s)
- Gin S Malhi
- Department of Psychiatry, Faculty of Medicine and Health, Northern Clinical School, University of Sydney, Sydney, NSW, Australia. .,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia. .,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.
| | - Grace Morris
- Department of Psychiatry, Faculty of Medicine and Health, Northern Clinical School, University of Sydney, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Erica Bell
- Department of Psychiatry, Faculty of Medicine and Health, Northern Clinical School, University of Sydney, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Amber Hamilton
- Department of Psychiatry, Faculty of Medicine and Health, Northern Clinical School, University of Sydney, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
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15
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Wang C, Cheng SF, Hung JL, Tang PL. Highly frequent utilization of outpatient services in a national health insurance system - analysis of associated factors and underlying co-morbidity. Curr Med Res Opin 2020; 36:1761-1767. [PMID: 33017273 DOI: 10.1080/03007995.2020.1832057] [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: 10/23/2022]
Abstract
OBJECTIVE We aimed to identify associated factors of highly frequent use of outpatient services and explore how they were impacted to provide policy references for government and medical institutes in their efforts to seek provision of reasonable medical services, continuous care and integrated outpatient services. METHODS The Taiwanese national health insurance database was used and 661,125 patients were identified in 2009. The patients with ≥100 internal medicine outpatient (IMO) visits were defined as the highly frequent group and they were matched at a ratio of 1:4 with patients of 1-99 IMO visits based on demographic characteristics. Multivariate logistic regression was used to estimate adjusted odds ratios with 95% confidence intervals. RESULTS Among 1 million patients in the outpatient department, 0.05% had at least 100 visits. These patients with highly frequent IMO visits had significantly higher rates of emergency department (ED) visits, hospitalization, psychiatric disorders and possession of a catastrophic illness card as well as a significantly lower level of continuity of care index (COCI). Multivariate analysis showed that ED visits (adjusted OR [AOR] = 1.63), psychiatric disorders (AOR = 7.13), low COCI (AOR = 1.69), and several comorbidities including peripheral vascular diseases (AOR = 4.33), dementia (AOR = 0.04), chronic pulmonary disease (AOR = 3.02), peptic ulcer diseases (AOR = 3.70), diabetes mellitus (AOR = 3.45) and renal disease (AOR = 2.43) were significant associated factors. CONCLUSIONS To rationalize use and distribution of medical resources, we suggest proper regular care and health education to those with mental disabilities and multiple chronic conditions, which may not only improve the situation of highly frequent hospital visits but also effectively control incidence of acute conditions and reduce their ED visits. In addition, improving the continuity of care is vital, and the best way to do this is to promote family medicine as the primary form of healthcare.
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Affiliation(s)
- Chi Wang
- Department of Nursing, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan, ROC
| | - Su-Fen Cheng
- Department of Nursing, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Jui-Lan Hung
- Department of Nursing, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Pei-Ling Tang
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- Department of Health-Business Administration, Fooyin University, Kaohsiung, Taiwan, ROC
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
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16
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Gerhard T, Stroup TS, Correll CU, Setoguchi S, Strom BL, Huang C, Tan Z, Crystal S, Olfson M. Mortality risk of antipsychotic augmentation for adult depression. PLoS One 2020; 15:e0239206. [PMID: 32997687 PMCID: PMC7526884 DOI: 10.1371/journal.pone.0239206] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/01/2020] [Indexed: 12/28/2022] Open
Abstract
Importance Randomized controlled trials have demonstrated increased all-cause mortality in elderly patients with dementia treated with newer antipsychotics. It is unknown whether this risk generalizes to non-elderly adults using newer antipsychotics as augmentation treatment for depression. Objective This study examined all-cause mortality risk of newer antipsychotic augmentation for adult depression. Design Population-based new-user/active comparator cohort study. Setting National healthcare claims data from the US Medicaid program from 2001–2010 linked to the National Death Index. Participants Non-elderly adults (25–64 years) diagnosed with depression who after ≥3 months of antidepressant monotherapy initiated either augmentation with a newer antipsychotic or with a second antidepressant. Patients with alternative indications for antipsychotic medications, such as schizophrenia, psychotic depression, or bipolar disorder, were excluded. Exposure Augmentation treatment for depression with a newer antipsychotic or with a second antidepressant. Main outcome All-cause mortality during study follow-up ascertained from the National Death Index. Results The analytic cohort included 39,582 patients (female = 78.5%, mean age = 44.5 years) who initiated augmentation with a newer antipsychotic (n = 22,410; 40% = quetiapine, 21% = risperidone, 17% = aripiprazole, 16% = olanzapine) or with a second antidepressant (n = 17,172). The median chlorpromazine equivalent starting dose for all newer antipsychotics was 68mg/d, increasing to 100 mg/d during follow-up. Altogether, 153 patients died during 13,328 person-years of follow-up (newer antipsychotic augmentation: n = 105, follow-up = 7,601 person-years, mortality rate = 138.1/10,000 person-years; antidepressant augmentation: n = 48, follow-up = 5,727 person-years, mortality rate = 83.8/10,000 person-years). An adjusted hazard ratio of 1.45 (95% confidence interval, 1.02 to 2.06) indicated increased all-cause mortality risk for newer antipsychotic augmentation compared to antidepressant augmentation (risk difference = 37.7 (95%CI, 1.7 to 88.8) per 10,000 person-years). Results were robust across several sensitivity analyses. Conclusion Augmentation with newer antipsychotics in non-elderly patients with depression was associated with increased mortality risk compared with adding a second antidepressant. Though these findings require replication and cannot prove causality, physicians managing adults with depression should be aware of this potential for increased mortality associated with newer antipsychotic augmentation.
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Affiliation(s)
- Tobias Gerhard
- Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research; Rutgers University, New Brunswick, NJ, United States of America
- Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ, United States of America
- * E-mail:
| | - T. Scott Stroup
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University and the New York State Psychiatric Institute, New York, NY, United States of America
| | - Christoph U. Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY, United States of America
- Department of Psychiatry and Molecular Psychiatry, Hofstra Northwell School of Medicine, Hempstead, NY, United States of America
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Soko Setoguchi
- Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research; Rutgers University, New Brunswick, NJ, United States of America
| | - Brian L. Strom
- Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research; Rutgers University, New Brunswick, NJ, United States of America
| | - Cecilia Huang
- Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research; Rutgers University, New Brunswick, NJ, United States of America
| | - Zhiqiang Tan
- Department of Statistics and Biostatistics, Rutgers University, Piscataway, NJ, United States of America
| | - Stephen Crystal
- Center for Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, United States of America
| | - Mark Olfson
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University and the New York State Psychiatric Institute, New York, NY, United States of America
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17
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Rhee TG. Coprescribing of Benzodiazepines and Opioids in Older Adults: Rates, Correlates, and National Trends. J Gerontol A Biol Sci Med Sci 2020; 74:1910-1915. [PMID: 30561526 DOI: 10.1093/gerona/gly283] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To estimate prescribing trends of and correlates independently associated with coprescribing of benzodiazepines and opioids among adults aged 65 years or older in office-based outpatient visits. METHODS I examined a nationally representative sample of office-based physician visits by older adults between 2006 and 2015 (n = 109,149 unweighted) using data from the National Ambulatory Medical Care Surveys (NAMCS). National rates and prescribing trends were estimated. Then, I used multivariable logistic regression analyses to identify demographic and clinical factors associated with coprescriptions of benzodiazepines and opioids. RESULTS From 2006 to 2015, 15,954 (14.6%) out of 109,149 visits, representative of 39.3 million visits nationally, listed benzodiazepine, opioid, or both medications prescribed. The rate of prescription benzodiazepines only increased monotonically from 4.8% in 2006-2007 to 6.2% in 2014-2015 (p < .001), and the rate of prescription opioids only increased monotonically from 5.9% in 2006-2007 to 10.0% in 2014-2015 (p < .001). The coprescribing rate of benzodiazepines and opioids increased over time from 1.1% in 2006-2007 to 2.7% in 2014-2015 (p < .001). Correlates independently associated with a higher likelihood of both benzodiazepine and opioid prescriptions included: female sex, a visit for chronic care, receipt of six or more concomitantly prescribed medications, and clinical diagnoses of anxiety and pain (p < .01 for all). CONCLUSION The coprescribing rate of benzodiazepines and opioids increased monotonically over time in outpatient care settings. Because couse of benzodiazepines and opioids is associated with medication burdens and potential harms, future research is needed to address medication safety in these vulnerable populations.
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Affiliation(s)
- Taeho Greg Rhee
- Section of Geriatrics, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut.,Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Health System, New Haven, Connecticut
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18
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Bazargan M, Cobb S, Wisseh C, Assari S. Psychotropic and Opioid-Based Medication Use among Economically Disadvantaged African-American Older Adults. PHARMACY 2020; 8:E74. [PMID: 32349239 PMCID: PMC7355863 DOI: 10.3390/pharmacy8020074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 03/28/2020] [Accepted: 04/25/2020] [Indexed: 01/09/2023] Open
Abstract
African-American older adults, particularly those who live in economically deprived areas, are less likely to receive pain and psychotropic medications, compared to Whites. This study explored the link between social, behavioral, and health correlates of pain and psychotropic medication use in a sample of economically disadvantaged African-American older adults. This community-based study recruited 740 African-American older adults who were 55+ yeas-old in economically disadvantaged areas of South Los Angeles. Opioid-based and psychotropic medications were the outcome variables. Gender, age, living arrangement, socioeconomic status (educational attainment and financial strain), continuity of medical care, health management organization membership, sleeping disorder/insomnia, arthritis, back pain, pain severity, self-rated health, depressive symptoms, and major chronic conditions were the explanatory variables. Logistic regression was used for data analyses. Arthritis, back pain, severe pain, and poor self-rated health were associated with opioid-based medications. Pain severity and depressive symptoms were correlated with psychotropic medication. Among African-American older adults, arthritis, back pain, poor self-rated health, and severe pain increase the chance of opioid-based and psychotropic medication. Future research should test factors that can reduce inappropriate and appropriate use and prescription of opioid-based and psychotropic medication among economically disadvantaged African-American older adults.
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Affiliation(s)
- Mohsen Bazargan
- Department of Family Medicine, College of Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA; (M.B.); (C.W.)
- Department of Family Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA
| | - Sharon Cobb
- School of Nursing, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA;
| | - Cheryl Wisseh
- Department of Family Medicine, College of Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA; (M.B.); (C.W.)
- Department of Pharmacy Practice, West Coast University School of Pharmacy, Los Angeles, CA 90004, USA
| | - Shervin Assari
- Department of Family Medicine, College of Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA; (M.B.); (C.W.)
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19
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Rhee TG, Rosenheck RA. Buprenorphine prescribing for opioid use disorder in medical practices: can office-based out-patient care address the opiate crisis in the United States? Addiction 2019; 114:1992-1999. [PMID: 31307111 PMCID: PMC6800773 DOI: 10.1111/add.14733] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 02/05/2019] [Accepted: 06/28/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND AIMS Opioid use disorder (OUD) remains a serious public health issue, and treating adults with OUD is a major priority in the United States. Little is known about trends in the diagnosis of OUD and in buprenorphine prescribing by physicians in office-based medical practices. We sought to characterize OUD diagnoses and buprenorphine prescribing among adults with OUD in the United States between 2006 and 2015. DESIGN AND SETTINGS We used a repeated cross-sectional design, based on data from the 2006-15 National Ambulatory Medical Care Surveys that surveyed nationally representative samples of office-based out-patient physician visits. PARTICIPANTS Adult patients aged 18 years or older with a diagnosis of OUD (n = 1034 unweighted) were included. MEASUREMENTS Buprenorphine prescribing was defined by whether visits involved buprenorphine or buprenorphine-naloxone, or not. We also examined other covariates (e.g. age, gender, race and psychiatric comorbidities). FINDINGS We observed an almost tripling of the diagnosis of OUD from 0.14% in 2006-10 to 0.38% in 2011-15 in office-based medical practices (P < 0.001). Among adults diagnosed with OUD, buprenorphine prescribing increased from 56.1% in 2006-10 to 73.6% in 2011-15 (P = 0.126). Adults with OUD were less likely to receive buprenorphine prescriptions if they were Hispanic [adjusted odds ratio (aOR) = 0.26; 95% confidence interval (CI) = 0.11, 0.60], had Medicaid insurance (aOR = 0.27; 95% CI = 0.10, 0.74) or were diagnosed with other psychiatric disorders (aOR = 0.45; 95% CI = 0.25, 0.83) or substance use disorders (aOR = 0.19; 95% CI = 0.09, 0.41). CONCLUSIONS In office-based medical practices in the United States, diagnoses for opioid use disorder and buprenorphine prescriptions for adults with opioid use disorder increased from 0.14 and 56.1%, respectively, in 2006-10 to 0.38 and 73.6% in 2011-15.
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Affiliation(s)
- Taeho Greg Rhee
- Department of Community Medicine and Health Care, School of Medicine, University of Connecticut, Farmington, CT,Department of Psychiatry, School of Medicine, Yale University, New Haven, CT,Veterans Affairs (VA) New England Mental Illness Research, Education and Clinical Centers (MIRECC), West Haven, CT,Veterans Affairs (VA) Connecticut Healthcare System, West Haven, CT
| | - Robert A. Rosenheck
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT,Veterans Affairs (VA) New England Mental Illness Research, Education and Clinical Centers (MIRECC), West Haven, CT,Veterans Affairs (VA) Connecticut Healthcare System, West Haven, CT
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20
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Palleria C, Roberti R, Iannone LF, Tallarico M, Barbieri MA, Vero A, Manti A, De Sarro G, Spina E, Russo E. Clinically relevant drug interactions between statins and antidepressants. J Clin Pharm Ther 2019; 45:227-239. [PMID: 31587356 DOI: 10.1111/jcpt.13058] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/05/2019] [Accepted: 09/09/2019] [Indexed: 12/24/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Statins, also known as 3-hydroxy-3-methylglutaryl-CoA reductase inhibitors, and antidepressant drugs are frequently used in combination due to the high and growing incidence of cardiovascular diseases and psychiatric disorders worldwide. Several aspects on management, the risk of adverse events (AEs) occurrence and the potential clinically relevant pharmacokinetic (PK) and pharmacodynamic (PD) drug-drug interactions (DDIs) between these two classes have not been well investigated. The aim of the present review was to describe the PK and PD interactions, of clinical relevance, between statins and antidepressant drugs and provide a comprehensive overview of their pharmacological features for appropriate multiple drug regimens. METHODS Relevant studies were identified through a literature search of PubMed and the Cochrane databases focusing on clinically relevant DDIs between statins and antidepressants. Only papers in English were included in the search. RESULTS AND DISCUSSION Pharmacodynamic (PD) drug-drug interactions (DDIs) are unlikely to occur as statins are highly selective inhibitors of HMG-CoA reductase with no relevant effect on other enzymes or receptor systems. Despite the numerous PK studies on individual drugs belonging to statins and antidepressant agents, only a few case reports regarding specific DDIs are present in the literature and no clinical studies have been performed. PK data allow to speculate on potential DDIs, comparing the metabolic pathways, intestinal and liver transporters and elimination routes. Overall, second-generation antidepressants, in particular citalopram, escitalopram, mirtazapine, reboxetine and venlafaxine, have weak inhibitory effects on various cytochrome (CYP) isozymes and seem to have a more advantageous DDIs profile in vivo. Conversely, nefazodone, fluoxetine, paroxetine and fluvoxamine influence considerably CYPs activity with potential effects on statins plasma levels, although pravastatin, pitavastatin and rosuvastatin are not susceptible to inhibition by any CYP. Albeit no studies have been performed on P-glycoprotein (P-gp), interactions of clinical relevance are unlikely. WHAT IS NEW AND CONCLUSION Although DDIs with antidepressants are potentially, but rarely clinically significant, the use of antidepressants with a more favourable drug interaction profile is advisable. An evaluation on DDIs between these drugs can be useful for future PK/PD studies on drug-drug interaction to provide clinicians with more data for appropriate multiple drug regimens.
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Affiliation(s)
- Caterina Palleria
- Science of Health Department, School of Medicine, University of Catanzaro, Catanzaro, Italy
| | - Roberta Roberti
- Science of Health Department, School of Medicine, University of Catanzaro, Catanzaro, Italy
| | | | - Martina Tallarico
- Science of Health Department, School of Medicine, University of Catanzaro, Catanzaro, Italy
| | | | - Ada Vero
- Science of Health Department, School of Medicine, University of Catanzaro, Catanzaro, Italy
| | - Antonia Manti
- Science of Health Department, School of Medicine, University of Catanzaro, Catanzaro, Italy
| | | | - Edoardo Spina
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Emilio Russo
- Science of Health Department, School of Medicine, University of Catanzaro, Catanzaro, Italy
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Speen AM, Hoffman JR, Kim HYH, Escobar YN, Nipp GE, Rebuli ME, Porter NA, Jaspers I. Small Molecule Antipsychotic Aripiprazole Potentiates Ozone-Induced Inflammation in Airway Epithelium. Chem Res Toxicol 2019; 32:1997-2005. [PMID: 31476115 DOI: 10.1021/acs.chemrestox.9b00149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Inhaled ground level ozone (O3) has well described adverse health effects, which may be augmented in susceptible populations. While conditions, such as pre-existing respiratory disease, have been identified as factors enhancing susceptibility to O3-induced health effects, the potential for chemical interactions in the lung to sensitize populations to pollutant-induced responses has not yet been studied. In the airways, inhaled O3 reacts with lipids, such as cholesterol, to generate reactive and electrophilic oxysterol species, capable of causing cellular dysfunction and inflammation. The enzyme regulating the final step of cholesterol biosynthesis, 7-dehydrocholesterol reductase (DHCR7), converts 7-dehydrocholesterol (7-DHC) to cholesterol. Inhibition of DHCR7 increases the levels of 7-DHC, which is much more susceptible to oxidation than cholesterol. Chemical analysis established the capacity for a variety of small molecule antipsychotic drugs, like Aripiprazole (APZ), to inhibit DHCR7 and elevate circulating 7-DHC. Our results show that APZ and the known DHCR7 inhibitor, AY9944, increase 7-DHC levels in airway epithelial cells and potentiate O3-induced IL-6 and IL-8 expression and cytokine release. Targeted immune-related gene array analysis demonstrates that APZ significantly modified O3-induced expression of 16 genes, causing dysregulation in expression of genes associated with leukocyte recruitment and inflammatory response. Additionally, we find that APZ increases O3-induced IL-6 and IL-8 expression in human nasal epithelial cells from male but not female donors. Overall, the evidence we provide describes a novel molecular mechanism by which chemicals, such as APZ, that perturb cholesterol biosynthesis affect O3-induced biological responses.
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Affiliation(s)
| | | | - Hye-Young H Kim
- Department of Chemistry and Center for Molecular Toxicology , Vanderbilt University , Nashville , Tennessee 37235 , United States
| | | | | | | | - Ned A Porter
- Department of Chemistry and Center for Molecular Toxicology , Vanderbilt University , Nashville , Tennessee 37235 , United States
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22
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Rhee TG, Rosenheck RA. Psychotropic polypharmacy reconsidered: Between-class polypharmacy in the context of multimorbidity in the treatment of depressive disorders. J Affect Disord 2019; 252:450-457. [PMID: 31004825 PMCID: PMC6520147 DOI: 10.1016/j.jad.2019.04.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 02/26/2019] [Accepted: 04/07/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Both psychiatric polypharmacy and multimorbidity are common in depressed adults. We examine recent patterns of psychotropic polypharmacy with attention to concurrent multimorbidity in the treatment of depressive disorders in outpatient psychiatric care. METHODS Data from the 2006-2015 National Ambulatory Medical Care Survey offer nationally representative samples of office-based psychiatric care in adults with depressive disorders (ICD-9-CM codes 296.20-296.26, 296.30-296.36, 300.4, 311, and 301.10-301.13) (n = 6,685 unweighted). These data allowed estimation of the prevalence of polypharmacy (within-class, between-class, and both) involving four major psychotropic classes: antidepressants, antipsychotics, mood-stabilizers, and sedative-hypnotics. We further evaluated the proportion of within-class and between-class psychotropic prescription combinations that were potentially justifiable, taking FDA-approved indications and multimorbidity into consideration. RESULTS Prescribing two or more psychotropic medications for depressed adults remained substantial and stable ranging from 59.0% in 2006-2007 to 58.0% in 2014-2015. The most common within-class polypharmacy types were: antidepressants (22.7%) and sedative-hypnotics (14.8%). The most common between-class polypharmacy types were: an antidepressant and a sedative-hypnotic (30.7%), an antidepressant and an antipsychotic (16.4%), and an antipsychotic and a sedative-hypnotic (9.0%). In visits in which between-class psychotropics were prescribed, 53.9% were potentially justified by FDA-approved augmentation and/or adjunctive treatment strategies or by psychiatric multimorbidities. CONCLUSION Psychotropic polypharmacy affects more than half of depressed adults. Between-class polypharmacy is the most common pattern and in over 50% of instances may be justified by augmentation strategies or considerations of psychiatric multimorbidity. Future research is needed to address effectiveness, safety, and cost-effectiveness of polypharmaceutical care for depression, especially those occurring with psychiatric co-morbididities.
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Affiliation(s)
- Taeho Greg Rhee
- Department of Community Medicine and Health Care, School of Medicine, University of Connecticut, 263 Farmington Avenue, Farmington, CT 06030, United States; Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, United States; Veterans Affairs (VA) New England Mental Illness Research, Education and Clinical Centers (MIRECC), West Haven, CT, United States; Veterans Affairs (VA) Connecticut Healthcare System, West Haven, CT, United States.
| | - Robert A. Rosenheck
- Veterans Affairs (VA) New England Mental Illness Research, Education and Clinical Centers (MIRECC), West Haven, CT,Veterans Affairs (VA) Connecticut Healthcare System, West Haven, CT
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23
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Bjornestad J, Lavik KO, Davidson L, Hjeltnes A, Moltu C, Veseth M. Antipsychotic treatment – a systematic literature review and meta-analysis of qualitative studies. J Ment Health 2019; 29:513-523. [DOI: 10.1080/09638237.2019.1581352] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Jone Bjornestad
- Department of Social Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Kristina O. Lavik
- Department of Psychiatry, District General Hospital of F⊘rde, F⊘rde, Norway
| | | | - Aslak Hjeltnes
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Christian Moltu
- Department of Psychiatry, District General Hospital of F⊘rde, F⊘rde, Norway
| | - Marius Veseth
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
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24
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Rhee TG, Capistrant BD, Schommer JC, Hadsall RS, Uden DL. Effects of the 2009 USPSTF Depression Screening Recommendation on Diagnosing and Treating Mental Health Conditions in Older Adults: A Difference-in-Differences Analysis. J Manag Care Spec Pharm 2018; 24:769-776. [PMID: 30058984 PMCID: PMC6084471 DOI: 10.18553/jmcp.2018.24.8.769] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Depression is a common mental condition in U.S. older adults. To improve rates of underdiagnosis and undertreatment for depression and other mental health conditions in primary care settings, the U.S. Preventive Services Task Force (USPSTF) updates and disseminates its depression screening guideline regularly. OBJECTIVE To examine the effects of the 2009 USPSTF depression screening recommendation on the 3 following outcomes: diagnoses of mental health conditions, antidepressant prescriptions (overall and potentially inappropriate), and provision of nonpharmacological psychiatric services in office-based outpatient primary care visits made by adults aged 65 or older. METHODS Data from the 2006-2012 National Ambulatory Medical Care Survey (NAMCS), a nationally representative sample of office-based outpatient primary care visits among older adults (n = 15,596 unweighted), were used. NAMCS represents physician practicing patterns of ambulatory medical care services utilization at the national level. Using a series of multivariate difference-in-differences analyses, we estimated effects of the USPSTF depression screening recommendation on the previously mentioned outcomes by comparing pre- (2006-2009) and post- (2010-2012) periods to describe primary care physician practice patterns. RESULTS Differences in any mental health diagnosis by the depression screening status were -34.7% in the pre-2009 period and -20.2% in the post-2009 period, resulting in a differential effect of -14.4% (95% CI = -28.2, -0.6; P = 0.040). No differential effect was found in other outcomes. CONCLUSIONS While there are mixed findings about efficacy and effectiveness of depression screening in the existing literature, more population-based observational research is needed to strengthen and support current USPSTF depression screening recommendation statements in the United States. DISCLOSURES Funding for this study was provided by the National Institute on Aging of the National Institutes of Health (#T32AG019134). The authors declare that they do not have any conflicts of interest. Publicly available data were obtained from the National Center for Health Statistics (NCHS) of the Centers for Disease Control and Prevention (CDC). Analyses, interpretation, and conclusions are solely those of the authors and do not necessarily reflect the views of the Division of Health Interview Statistics or NCHS of the CDC.
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Affiliation(s)
- Taeho Greg Rhee
- 1 Section of Geriatrics, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut; Yale Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, New Haven, Connecticut; and Department of Pharmaceutical Care and Health Systems, College of Pharmacy, University of Minnesota, Minneapolis
| | | | - Jon C Schommer
- 3 Department of Pharmaceutical Care and Health Systems, College of Pharmacy, University of Minnesota, Minneapolis
| | - Ronald S Hadsall
- 3 Department of Pharmaceutical Care and Health Systems, College of Pharmacy, University of Minnesota, Minneapolis
| | - Donald L Uden
- 3 Department of Pharmaceutical Care and Health Systems, College of Pharmacy, University of Minnesota, Minneapolis
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Rhee TG, Rosenheck RA. Initiation of new psychotropic prescriptions without a psychiatric diagnosis among US adults: Rates, correlates, and national trends from 2006 to 2015. Health Serv Res 2018; 54:139-148. [PMID: 30334247 DOI: 10.1111/1475-6773.13072] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To estimate rates and national trends of initiation of new psychotropic medications without a psychiatric diagnosis and to identify demographic and clinical correlates independently associated with such use among US adults in outpatient settings. DATA SOURCE Data were gathered from the 2006-2015 National Ambulatory Medical Care Survey (NAMCS), a nationally representative sample of office-based U.S. outpatient care. The sample was limited to adults aged 18 or older who received a new psychotropic drug prescription (n = 8618 unweighted). STUDY DESIGN Using a repeated cross-sectional design with survey sampling techniques, we estimated prescription initiation rates and national trends. Multivariable-adjusted logistic regression analysis was used to identify correlates independently associated with initiation of new psychotropic prescriptions without a psychiatric diagnosis. DATA COLLECTION/EXTRACTION METHODS Data were publicly available, and we extracted them from the Centers for Disease Control and Prevention website. PRINCIPAL FINDINGS Altogether, at 60.4% of visits at which a new psychotropic prescription was initiated, no psychiatric diagnosis was recorded for the visit. Overall, the rate increased from 59.1% in 2006-2007 to 67.7% in 2008-2009 and then decreased to 52.0% in 2014-2015. Visits to psychiatrists were associated with very low odds of having no psychiatric diagnosis when compared to primary care visits (OR = 0.02; 95% CI, 0.01-0.04). Visits to non-psychiatric specialists showed 6.90 times greater odds of not having a psychiatric diagnosis when compared to primary care visits (95% CI, 5.38-8.86). CONCLUSION New psychotropic medications are commonly initiated without any psychiatric diagnosis, especially by non-psychiatrist physicians. Non-psychiatrists should document relevant diagnoses more vigilantly to prevent potentially inappropriate use or misuse.
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Affiliation(s)
- Taeho Greg Rhee
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut.,Yale Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Health Systems, New Haven, Connecticut
| | - Robert A Rosenheck
- Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut.,Veterans Affairs (VA) New England Mental Illness, Research, Education and Clinical Center (MIRECC), West Haven, Connecticut.,Veterans Affairs (VA) Connecticut Healthcare System, West Haven, Connecticut
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Rhee TG. Continuing versus New Antidepressant Use in Older Adults: US Prescribing Trends from 2006 to 2015. Eur Geriatr Med 2018; 9:551-555. [PMID: 30524610 DOI: 10.1007/s41999-018-0075-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Objectives Antidepressant use has increased in older adults recently. This study examines the trends of antidepressant prescribing by prescription status (continuing vs. new prescriptions). Methods Data were collected from 2006-2015 National Ambulatory Medical Care Survey (NAMCS), a nationally representative sample of office-based outpatient visits. I limited the sample to adults aged 65 or older (n=10,708 unweighted). Using a repeated cross-sectional design with survey sampling techniques, prevalence rates of antidepressant prescriptions were estimated by prescription status. Stratified analyses were also performed by key variables (e.g., age, gender, and race/ethnicity). Results Continuing antidepressant prescriptions increased over time significantly (OR=1.07; 95% CI, 1.03-1.11), and no temporal trend was found in new antidepressant prescriptions. In stratified analyses, the increasing trends of continuing antidepressant prescriptions were pronounced in visits to primary care physicians (OR=1.06; 95% CI, 1.01-1.12). Conclusion Increasing antidepressant prescribing trends were found in continuing prescriptions. Continued antidepressant prescribing among older adults should be monitored for appropriate use.
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Affiliation(s)
- Taeho Greg Rhee
- Section of Geriatrics, Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA. .,Yale Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA. .,Department of Pharmaceutical Care and Health Systems, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA.
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