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Dangayach NS, Grewal HS, De Marchis GM, Sefcik RK, Bruce R, Chhatlani A, Connolly ES, Falo MC, Agarwal S, Claassen J, Schmidt JM, Mayer SA. Does the obesity paradox predict functional outcome in intracerebral hemorrhage? J Neurosurg 2019; 129:1125-1129. [PMID: 29219759 DOI: 10.3171/2017.5.jns163266] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 05/23/2017] [Indexed: 12/28/2022]
Abstract
OBJECTIVEBeing overweight or mildly obese has been associated with a decreased risk of death or hospitalization in patients with cardiovascular disease. Similarly, overweight patients admitted to an intensive care unit (ICU) have improved survival up to 1 year after admission. These counterintuitive observations are examples of the "obesity paradox." Does the obesity paradox exist in patients with intracerebral hemorrhage (ICH)? In this study the authors examined whether there was an association between obesity and functional outcome in patients with ICH.METHODSThe authors analyzed 202 patients admitted to the neurological ICU (NICU) who were prospectively enrolled in the Columbia University ICH Outcomes Project between September 2009 and December 2012. Patients were categorized into 2 groups: overweight (body mass index [BMI] ≥ 25 kg/m2) and not overweight (BMI < 25 kg/m2). The primary outcome was defined as survival with favorable outcome (modified Rankin Scale [mRS] score 0-3) versus death or severe disability (mRS score 4-6) at 3 months.RESULTSThe mean age of the patients in the study was 61 years. The mean BMI was 28 ± 6 kg/m2. The mean Glasgow Coma Scale score was 10 ± 4 and the mean ICH score was 1.9 ± 1.3. The overall 90-day mortality rate was 41%. Among patients with a BMI < 25 kg/m2, 24% (17/70) had a good outcome, compared with 39% (52/132) among those with a BMI ≥ 25 kg/m2 (p = 0.03). After adjusting for ICH score, sex, do-not-resuscitate code status, and history of hypertension, being overweight or obese (BMI ≥ 25 kg/m2) was associated with twice the odds of having a good outcome compared with patients with BMI < 25 kg/m2 (adjusted odds ratio 2.05, 95% confidence interval 1.03-4.06, p = 0.04).CONCLUSIONSIn patients with ICH admitted to the NICU, being overweight or obese (BMI ≥ 25 kg/m2) was associated with favorable outcome after adjustment for established predictors. The reason for this finding requires further study.
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Affiliation(s)
- Neha S Dangayach
- 1Departments of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai and Mount Sinai Health System, New York, New York
| | - Harpreet Singh Grewal
- 2Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | | | | | - Rachel Bruce
- 5Department of Neurology, Division of Neurocritical Care, and Department of Neurosurgery, College of Physicians and Surgeons, Columbia University, New York, New York; and
| | - Aarti Chhatlani
- 6Department of Psychiatry, MetroHealth System, Cleveland, Ohio
| | - E Sander Connolly
- 5Department of Neurology, Division of Neurocritical Care, and Department of Neurosurgery, College of Physicians and Surgeons, Columbia University, New York, New York; and
| | - M Cristina Falo
- 5Department of Neurology, Division of Neurocritical Care, and Department of Neurosurgery, College of Physicians and Surgeons, Columbia University, New York, New York; and
| | - Sachin Agarwal
- 5Department of Neurology, Division of Neurocritical Care, and Department of Neurosurgery, College of Physicians and Surgeons, Columbia University, New York, New York; and
| | - Jan Claassen
- 5Department of Neurology, Division of Neurocritical Care, and Department of Neurosurgery, College of Physicians and Surgeons, Columbia University, New York, New York; and
| | - J Michael Schmidt
- 5Department of Neurology, Division of Neurocritical Care, and Department of Neurosurgery, College of Physicians and Surgeons, Columbia University, New York, New York; and
| | - Stephan A Mayer
- 1Departments of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai and Mount Sinai Health System, New York, New York
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Tampi RR, Chhatlani A, Ahmad H, Balaram K, Dey J, Escobar R, Lingamchetty T. Substance use disorders among older adults: A review of randomized controlled pharmacotherapy trials. World J Psychiatry 2019; 9:78-82. [PMID: 31559148 PMCID: PMC6757194 DOI: 10.5498/wjp.v9.i5.78] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 08/01/2019] [Accepted: 08/07/2019] [Indexed: 02/05/2023] Open
Abstract
Substance use disorders (SUDs) are a growing problem among older adults. Acamprosate, disulfiram, and naltrexone are United States Food and Drug Administration (referred to as FDA) approved for the treatment of alcohol use disorder, and buprenorphine is approved for the treatment of opiate use disorder among adults. However, the data on the use of these medications for the treatment of SUDs among older adults are unclear from randomized controlled trials (referred to as RCTs). A review of the literature indicates that there are only two RCTs that evaluated the use of pharmacologic agents for SUDs among older adults (≥ 50 years). One trial evaluated the use of naltrexone when compared to placebo for the treatment of alcohol use disorder among individuals, 50-70 years in age. The other trial evaluated the use of naltrexone or placebo as adjuncts with sertraline in the treatment of alcohol use disorder among individuals older than 55 years in age. Both trials indicated that the use of naltrexone reduced the rates of relapse among older adults with alcohol use disorder. However, we did not identify any RCTs that studied the use of buprenorphine, acamprosate, or disulfiram for SUDs among older adults. Based on available evidence, it would be safe to conclude that limited data indicate some efficacy for naltrexone in the treatment of alcohol use disorder among older adults. However, data from controlled trials on the use of other medications that are FDA approved for the treatment of SUDs among younger adults are nonexistent among older adults with SUDs.
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Affiliation(s)
- Rajesh R Tampi
- Department of Psychiatry and Behavioral Sciences, Cleveland Clinic Akron General, Ohio, NH 44106, United States
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH 44109, United States
| | | | - Hajra Ahmad
- Department of Psychiatry, MetroHealth, Cleveland, OH 44109, United States
- Case Western Reserve University School of Medicine, Cleveland, OH 44109, United States
| | - Kripa Balaram
- Department of Psychiatry, MetroHealth, Cleveland, OH 44109, United States
- Case Western Reserve University School of Medicine, Cleveland, OH 44109, United States
| | - Joel Dey
- Department of Psychiatry, MetroHealth, Cleveland, OH 44109, United States
- Case Western Reserve University School of Medicine, Cleveland, OH 44109, United States
| | - Ricardo Escobar
- Department of Psychiatry, MetroHealth, Cleveland, OH 44109, United States
- Case Western Reserve University School of Medicine, Cleveland, OH 44109, United States
| | - Thejasvi Lingamchetty
- Department of Psychiatry, MetroHealth, Cleveland, OH 44109, United States
- Case Western Reserve University School of Medicine, Cleveland, OH 44109, United States
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Tampi R, Chhatlani A, Ahmad H, Balaram K, Dey J, Escobar R, Lingamchetty T. PHARMACOTHERAPY FOR SUBSTANCE USE DISORDERS AMONG OLDER ADULTS: A SYSTEMATIC REVIEW OF RANDOMIZED CONTROLLED TRIALS. The American Journal of Geriatric Psychiatry 2019. [DOI: 10.1016/j.jagp.2019.01.072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Dasarathy J, Young J, Chhatlani A, Raddock M, Tampi R. Alcohol use disorder: How best to screen and intervene. J Fam Pract 2019; 68:35-39. [PMID: 30724900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The USPSTF recommends the AUDIT, the AUDIT-C, or the single-question NIAAA screen. The CAGE screening tool has low sensitivity at lower levels of alcohol intake.
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Affiliation(s)
- Jaividhya Dasarathy
- Metro Health Medical Center, Case Western Reserve University, Cleveland, OH, USA.
| | - Juan Young
- Metro Health Medical Center, Case Western Reserve University, Cleveland, OH, USA.
| | - Aarti Chhatlani
- Metro Health Medical Center, Case Western Reserve University, Cleveland, OH, USA.
| | - Michael Raddock
- Metro Health Medical Center, Case Western Reserve University, Cleveland, OH, USA.
| | - Rajesh Tampi
- Metro Health Medical Center, Case Western Reserve University, Cleveland, OH, USA.
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Chhatlani A, Farheen SA, Setty MJ, Tampi RR. Use of cariprazine in psychiatric disorders: A systematic review. Ann Clin Psychiatry 2018; 30:326-334. [PMID: 30372510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND Cariprazine was approved for treating schizophrenia and bipolar disorder, and currently is being evaluated for treating depression in clinical trials in the United States. We systematically reviewed the literature on the efficacy and safety of cariprazine. METHODS We performed a literature search of the PubMed, MEDLINE, PsycINFO, EMBASE, and Cochrane collaboration databases through August 31, 2016. The search was not restricted by patient age. Articles published in English or official English translations were included. RESULTS Eleven articles that evaluated the use of cariprazine in the treatment of psychiatric disorders were identified. Four trials evaluated the safety and efficacy of cariprazine in bipolar disorder. One trial investigated its use as an adjunct to antidepressants in major depressive disorder. Three trials evaluated its use in the treatment of acute exacerbations of schizophrenia. Two studies used risperidone or aripiprazole as comparators. Both low- and high-dose cariprazine were more effective than placebo in the treatment of acute mania, mixed episodes, and acute psychosis. Additionally, cariprazine showed efficacy as an adjunctive treatment for depression. CONCLUSIONS Our review indicates that cariprazine demonstrates superior efficacy and good tolerability, both at low and high doses, in the treatment of individuals with psychosis, mania, and depression.
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Affiliation(s)
| | | | | | - Rajesh R Tampi
- Chairman, Department of Psychiatry and Behavioral Sciences, Cleveland Clinic Akron General, Akron, Ohio 44307 USA; E-MAIL:
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Chhatlani A, Farheen SA, Manikkara G, Setty MJ, DeOreo E, Tampi RR. Anticonvulsants as monotherapy or adjuncts to treat alcohol withdrawal: A systematic review. Ann Clin Psychiatry 2018; 30:312-325. [PMID: 30372509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND This systematic review evaluates current literature on anticonvulsants to treat alcohol withdrawal symptoms (AWS). METHODS We performed a literature search of PubMed, MEDLINE, PsycINFO, EMBASE, and Cochrane collaboration databases through September 30, 2016. The search was not restricted by patients' age. Articles published in English or with official English translations were included. RESULTS We found 16 double-blind randomized controlled trials (RCTs) that evaluated the use of anticonvulsants as treatment of AWS. Available data indicates that anticonvulsants are as effective as sedatives/hypnotics in treating mild or moderate AWS. Two studies evaluated the use of anticonvulsants as adjuncts. Combining anticonvulsants with sedatives decreases the quantity of sedatives required and AWS may resolve quicker. There is some data that anticonvulsants can be used to treat AWS as monotherapy. Fourteen of these studies assessed adverse effects of these medications; 13 studies identified minor adverse effects and one found the adverse effects to be intolerable. CONCLUSIONS Available evidence indicates that anticonvulsants have good efficacy as monotherapy and as adjuncts with sedatives/hypnotics in treating mild to moderate AWS.
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Affiliation(s)
| | | | | | | | | | - Rajesh R Tampi
- Chairman, Department of Psychiatry and Behavioral Sciences, Cleveland Clinic Akron General, Akron, Ohio 44307 USA; E-MAIL:
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