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Fitzke RE, Bouskill KE, Sedano A, Tran DD, Saba SK, Buch K, Hummer JF, Davis JP, Pedersen ER. Barriers and Facilitators to Behavioral Healthcare for Women Veterans: a Mixed-Methods Analysis of the Current Landscape. J Behav Health Serv Res 2024; 51:164-184. [PMID: 37798569 PMCID: PMC10940443 DOI: 10.1007/s11414-023-09862-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 10/07/2023]
Abstract
Women veterans have historically faced barriers to behavioral health treatment, particularly through the VA. In conjunction, there have been changes in behavioral healthcare delivery resulting from efforts to improve care for women veterans and the COVID-19 pandemic (e.g., widespread telehealth implementation). The current study draws on a quantitative and qualitative study centering current perspectives of women veterans in their choices to seek or not seek behavioral healthcare in VA and non-VA settings through interviewing 18 women recruited from a larger survey study on veteran behavioral health (n = 83 women, n = 882 men) on their experiences with behavioral health care access and satisfaction, including barriers and facilitators to seeking care. Quantitative findings are descriptively reported from the larger study, which outlined screening for behavioral health problems, behavioral health utilization, treatment modality preferences, and barriers/facilitators to care. While women in the survey sample screened for various behavioral health disorders, rates of treatment seeking remained relatively low. Women reported positive and negative experiences with telehealth and endorsed many barriers to treatment seeking in interviews not captured by survey findings, including lack of women-specific care (e.g., care for military sexual trauma, women-only groups), reports of stranger harassment at the VA, and lack of female providers. Women veterans continue to face barriers to behavioral healthcare; however, ongoing efforts to improve care access and quality, including the implementation of telehealth, show promise in reducing these obstacles. Continued efforts are needed to ensure diverse treatment modalities continue to reach women veterans as this population grows.
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Affiliation(s)
- Reagan E Fitzke
- Department of Psychiatry and Behavioral Sciences, University of Southern California Keck School of Medicine, 2250 Alcazar St., Suite 2200, Los Angeles, CA, 90089, USA.
| | | | - Angeles Sedano
- University of Southern California, Suzanne Dworak-Peck School of Social Work, 669 W. 34th St, Los Angeles, CA, 90089, USA
| | - Denise D Tran
- Department of Psychiatry and Behavioral Sciences, University of Southern California Keck School of Medicine, 2250 Alcazar St., Suite 2200, Los Angeles, CA, 90089, USA
| | - Shaddy K Saba
- University of Southern California, Suzanne Dworak-Peck School of Social Work, 669 W. 34th St, Los Angeles, CA, 90089, USA
| | - Keegan Buch
- Department of Psychiatry and Behavioral Sciences, University of Southern California Keck School of Medicine, 2250 Alcazar St., Suite 2200, Los Angeles, CA, 90089, USA
| | - Justin F Hummer
- RAND Corporation, 1776 Main St, Santa Monica, CA, 90401, USA
| | - Jordan P Davis
- University of Southern California, Suzanne Dworak-Peck School of Social Work, 669 W. 34th St, Los Angeles, CA, 90089, USA
| | - Eric R Pedersen
- Department of Psychiatry and Behavioral Sciences, University of Southern California Keck School of Medicine, 2250 Alcazar St., Suite 2200, Los Angeles, CA, 90089, USA
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Davis JP, Canning L, Saba SK, Bravo AJ, Amone-P'Olak K, Sedano A, Tran D, Castro C, Pedersen ER. Associations between trauma-related guilt, symptoms of posttraumatic stress disorder, and problematic alcohol use. Psychiatry Res 2023; 326:115350. [PMID: 37487463 PMCID: PMC10752625 DOI: 10.1016/j.psychres.2023.115350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/13/2023] [Accepted: 07/16/2023] [Indexed: 07/26/2023]
Abstract
Trauma-related guilt, or a belief that one should have felt, thought, or acted differently during a traumatic event in which someone's life or physical integrity was threatened, has been consistently associated with mental health disorders such as posttraumatic stress disorder (PTSD). Theories of trauma-related guilt suggest that some avoidant coping behaviors, such as problematic alcohol use, are crucial pathways connecting trauma-related guilt to PTSD but have not been thoroughly investigated. The present study uses data from a longitudinal cohort of veterans to examine two models: the first assessed problematic alcohol use as a mechanism linking trauma-related guilt and PTSD. The second explored PTSD as a mechanism linking trauma-related guilt to problematic alcohol use. Results indicated that problematic alcohol use was a significant mechanism linking global guilt and guilt cognitions with PTSD. Further, results indicated that PTSD was a significant mechanism linking global guilt and distress with problematic alcohol use. Results of our study indicate that alcohol use is a key construct that has been overlooked in the trauma-related guilt literature, despite the high prevalence of co-occurring PTSD and alcohol use (and alcohol use disorder). Targeting trauma-related guilt during integrated treatments for PTSD and alcohol use disorder may be particularly important for veterans.
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Affiliation(s)
- Jordan P Davis
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles California, United Sates.
| | - Liv Canning
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles California, United Sates
| | - Shaddy K Saba
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles California, United Sates
| | - Adrian J Bravo
- Department of Psychological Sciences, College of William & Mary, Williamsburg VA, United States
| | - Kennedy Amone-P'Olak
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles California, United Sates; Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, 669W 34th street, Los Angeles CA 90089, United Sates; Department of Psychological Sciences, College of William & Mary, Williamsburg VA, United States; Department of Psychology, Kyambogo University, Kampala, Uganda
| | - Angeles Sedano
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles California, United Sates
| | - Denise Tran
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, 669W 34th street, Los Angeles CA 90089, United Sates
| | - Carl Castro
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles California, United Sates
| | - Eric R Pedersen
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, 669W 34th street, Los Angeles CA 90089, United Sates
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Davis JP, Prindle J, Saba S, Lee DS, Leightley D, Tran DD, Sedano A, Fitzke R, Castro CA, Pedersen ER. Childhood adversity, combat experiences, and military sexual trauma: a test and extension of the stress sensitization hypothesis. Psychol Med 2023; 53:4055-4063. [PMID: 35440343 DOI: 10.1017/s0033291722000733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND U.S. veterans report high rates of traumatic experiences and mental health symptomology [e.g. posttraumatic stress disorder (PTSD)]. The stress sensitization hypothesis posits experiences of adversity sensitize individuals to stress reactions which can lead to greater psychiatric problems. We extend this hypothesis by exploring how multiple adversities such as early childhood adversity, combat-related trauma, and military sexual trauma related to heterogeneity in stress over time and, subsequently, greater risk for PTSD. METHODS 1230 veterans were recruited for an observational, longitudinal study. Veterans responded to questionnaires on PTSD, stress, and traumatic experiences five times over an 18-month study period. We used latent transition analysis to understand how heterogeneity in adverse experiences is related to transition into stress trajectory classes. We also explored how transition patterns related to PTSD symptomology. RESULTS Across all models, we found support for stress sensitization. In general, combat trauma in combinations with other types of adverse experiences, namely early childhood adversity and military sexual trauma, imposed a greater probability of transitioning into higher risk stress profiles. We also showed differential effects of early childhood and military-specific adversity on PTSD symptomology. CONCLUSION The present study rigorously integrates both military-specific and early life adversity into analysis on stress sensitivity, and is the first to examine how sensitivity might affect trajectories of stress over time. Our study provides a nuanced, and specific, look at who is risk for sensitization to stress based on previous traumatic experiences as well as what transition patterns are associated with greater PTSD symptomology.
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Affiliation(s)
- Jordan P Davis
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - John Prindle
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Shaddy Saba
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Daniel S Lee
- Keck School of Medicine, Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, CA, USA
| | | | - Denise D Tran
- Keck School of Medicine, Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, CA, USA
| | - Angeles Sedano
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Reagan Fitzke
- Keck School of Medicine, Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, CA, USA
| | - Carl A Castro
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Eric R Pedersen
- Keck School of Medicine, Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, CA, USA
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Davis JP, Pedersen ER, Borsari B, Bowen S, Owen J, Sedano A, Fitzke R, Delacruz J, Tran DD, Buch K, Saba S, Canning L, Bunyi J. Development of a mobile mindfulness smartphone app for post-traumatic stress disorder and alcohol use problems for veterans: Beta test results and study protocol for a pilot randomized controlled trial. Contemp Clin Trials 2023; 129:107181. [PMID: 37059261 DOI: 10.1016/j.cct.2023.107181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/30/2023] [Revised: 04/04/2023] [Accepted: 04/08/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) and alcohol use disorder (AUD) are highly prevalent, and co-occurring among post-9/11 veterans. Mobile health (mHealth) applications, specifically those focused on mindfulness-based techniques, may be an effective avenue to intervene with veterans who cannot or will not seek care at traditional in-person settings. Thus, to address areas of improvement in mHealth for veterans, we developed Mind Guide and prepared it for testing in a pilot randomized controlled trial (RCT) with veterans. METHODS We have completed phase 1 (treatment development) and Phase 2 (beta test) of our mobile mHealth app, Mind Guide. In this paper we describe the methods for Phase 1 as well as results for our beta test (n = 16; inclusion criteria included screen for PTSD, AUD, a post-9/11 veteran, and not currently receiving treatment) for Mind Guide as well as outline procedures for our pilot RCT of Mind Guide (Phase 3). The PTSD Checklist, self-reported alcohol use, the Perceived Stress Scale, Penn Alcohol Craving Scale, and the Emotion Regulation Questionnaire were used. RESULTS Results of our beta test of Mind Guide show promising past 30 day effects on PTSD (d = -1.12), frequency of alcohol use (d = -0.54), and alcohol problems (d = -0.44), and related mechanisms of craving (d = -0.53), perceived stress (d = -0.88), and emotion regulation (d = -1.22). CONCLUSION Our initial beta-test of Mind Guide shows promise for reducing PTSD and alcohol related problems among veterans. Recruitment is ongoing for our pilot RCT in which 200 veterans will be recruited and followed up for 3 months. CLINICALTRIALS gov Identifier: NCT04769986.
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Affiliation(s)
- Jordan P Davis
- University of Southern California, Suzanne Dworak-Peck School of Social Work, Los Angeles, CA, USA.
| | - Eric R Pedersen
- University of Southern California, Keck School of Medicine, Department of Psychiatry and Behavioral Sciences, Los Angeles, CA, USA
| | - Brian Borsari
- Mental Health Service, San Francisco VA Health Care System, San Francisco, CA, USA; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | | | - Jason Owen
- National Center for PTSD, Veteran Affairs Palo Alto Healthcare System, Palo Alto, CA, USA
| | - Angeles Sedano
- University of Southern California, Suzanne Dworak-Peck School of Social Work, Los Angeles, CA, USA
| | - Reagan Fitzke
- University of Southern California, Keck School of Medicine, Department of Psychiatry and Behavioral Sciences, Los Angeles, CA, USA
| | - Joannalyn Delacruz
- Mental Health Service, San Francisco VA Health Care System, San Francisco, CA, USA; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Denise D Tran
- University of Southern California, Keck School of Medicine, Department of Psychiatry and Behavioral Sciences, Los Angeles, CA, USA
| | - Keegan Buch
- University of Southern California, Keck School of Medicine, Department of Psychiatry and Behavioral Sciences, Los Angeles, CA, USA
| | - Shaddy Saba
- University of Southern California, Suzanne Dworak-Peck School of Social Work, Los Angeles, CA, USA
| | - Liv Canning
- University of Southern California, Suzanne Dworak-Peck School of Social Work, Los Angeles, CA, USA
| | - John Bunyi
- University of Southern California, Suzanne Dworak-Peck School of Social Work, Los Angeles, CA, USA
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Davis JP, Prindle J, Saba SK, Tran DD, Lee DS, Sedano A, Castro CA, Pedersen ER. Changes in perceived stress during the COVID-19 pandemic among American veterans. Stress Health 2022; 38:1014-1028. [PMID: 35460535 PMCID: PMC9111081 DOI: 10.1002/smi.3153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 03/16/2022] [Accepted: 04/12/2022] [Indexed: 12/16/2022]
Abstract
American veterans are a population that suffer from both context specific stressors as well as many population-specific major-life events. The present exploratory study utilises a longitudinal cohort of 1230 U.S. veterans surveyed from February 2020 through February 2021. We sought to understand heterogeneity in perceived stress, using growth mixture modelling, over this time period, how COVID-specific factors such as negative reactions to the pandemic, loneliness, and employment disruptions influence perceived stress trajectories, and how veterans vary across distal outcomes including posttraumatic stress disorder (PTSD), pain, depression, sleep problems, physical health, and alcohol use disorder. Results revealed a 4-class solution: Stable High, Stable Low, Steady Increasing, and Steady Decreasing classes. In terms of COVID specific factors, negative reactions to COVID were consistently associated with perceived stress for those in the Stable High and Steady Increasing classes whereas loneliness was associated with stress trajectories for all emergent classes. Finally, in terms of our distal outcomes, results showed a relatively robust pattern with veterans in the Stable High or Steady Increasing classes reporting worse scores across all outcomes including PTSD, pain, sleep problems, physical health, depression, and alcohol use disorder. Understanding the interplay between existing vulnerabilities, ongoing stressors, and behavioural health outcomes among veterans is crucial for prevention and intervention efforts.
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Affiliation(s)
- Jordan P. Davis
- Suzanne Dworak‐Peck School of Social WorkUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - John Prindle
- Suzanne Dworak‐Peck School of Social WorkUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Shaddy K. Saba
- Suzanne Dworak‐Peck School of Social WorkUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Denise D. Tran
- Department of Psychiatry and Behavioral SciencesUniversity of Southern CaliforniaKeck School of MedicineLos AngelesCaliforniaUSA
| | - Daniel S. Lee
- Department of Psychiatry and Behavioral SciencesUniversity of Southern CaliforniaKeck School of MedicineLos AngelesCaliforniaUSA
| | - Angeles Sedano
- Department of Psychiatry and Behavioral SciencesUniversity of Southern CaliforniaKeck School of MedicineLos AngelesCaliforniaUSA
| | - Carl A. Castro
- Suzanne Dworak‐Peck School of Social WorkUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Eric R. Pedersen
- Department of Psychiatry and Behavioral SciencesUniversity of Southern CaliforniaKeck School of MedicineLos AngelesCaliforniaUSA
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Davis JP, Prindle J, Saba SK, DiGuiseppi GT, Hummer J, Lee DS, Fitzke R, Sedano A, Castro CA, Pedersen ER. What's sleep got to do with it? Longitudinal associations between insomnia, PTSD, and alcohol use among U.S. Veterans. Addict Behav 2022; 132:107358. [PMID: 35552069 DOI: 10.1016/j.addbeh.2022.107358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/20/2022] [Accepted: 05/03/2022] [Indexed: 12/30/2022]
Abstract
U.S. veterans are at risk for insomnia, which often co-occurs with symptoms of posttraumatic stress disorder (PTSD) and alcohol use. Much of the research on veterans and these three constructs is cross-sectional and focused on unidirectional pathways. Recent theoretical and empirical evidence suggests a dynamic interplay between insomnia, PTSD, and alcohol use, yet few longitudinal studies exist. A clearer understanding of these pathways is needed to help inform integrated treatments. Using a sample of 1,230 post-9/11 veterans assessed over four time points across 12 months, we used a latent difference score modeling approach to examine proportional and dynamic change between insomnia, PTSD, and alcohol. Results revealed a complex interplay between all three constructs. Higher prior levels of both PTSD and alcohol use were associated with greater subsequent changes in insomnia symptoms (i.e., worse sleep). Moreover, although veterans drank less frequently as their insomnia symptoms worsened over time, greater changes in insomnia symptoms (i.e., worse symptoms) was a mechanism linking PTSD and more frequent drinking. As the research on interventions addressing insomnia, PTSD, and alcohol is limited, there are opportunities for researchers and clinicians to develop programs that effectively target all three in integrated treatments.
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Pedersen ER, Davis JP, Hummer JF, DiGuiseppi G, Sedano A, Rodriguez A, Clapp JD. Development of a Measure to Assess Protective Behavioral Strategies for Pregaming among Young Adults. Subst Use Misuse 2020; 55:534-545. [PMID: 31847662 PMCID: PMC7310598 DOI: 10.1080/10826084.2019.1686025] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Although most young adults drink alcohol, there are specific drinking contexts that are associated with increased risk for alcohol-related consequences. One such drinking context is pregaming, which typically involves heavy drinking in brief periods of time and has consistently been linked to consequences within the pregaming event itself, on a night after pregaming, and in the long-term. Intervention efforts that specifically target this risky behavior are needed, but these efforts need to be informed by empirical work to better understand what behaviors young people engage in that can protect them from pregaming-related harms. Purpose: We designed this study to create a measure of protective behavioral strategies that young people use before, during, and after pregaming to inform future intervention work. Methods: We tested an item pool with 363 young adult college students who engaged in pregaming in the past year and conducted exploratory factor analysis to develop a 19-item Protective Behavioral Strategies for Pregaming (PBSP) scale, which featured four subscales of safety and familiarity, setting drink limits, pacing strategies, and minimizing intoxication. Results: Each subscale negatively and significantly correlated with measures of alcohol use and consequences, though subscales differed in their associations with specific pregaming outcomes and by sex. Conclusion: This initial exploratory examination of the PBSP scale's psychometric properties suggests that use of protective behavioral strategies used specifically during pregaming events may protect young people from heavy drinking and harms. More research with the PBSP scale is encouraged to determine its practical utility as a clinical and assessment tool with young people.
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Affiliation(s)
| | - Jordan P Davis
- University of Southern California, Suzanne Dworak-Peck School of Social Work; USC Institute for Addiction Science, Los Angeles, California, USA
| | | | - Graham DiGuiseppi
- University of Southern California, Suzanne Dworak-Peck School of Social Work; USC Institute for Addiction Science, Los Angeles, California, USA
| | - Angeles Sedano
- University of Southern California, Suzanne Dworak-Peck School of Social Work; USC Institute for Addiction Science, Los Angeles, California, USA
| | | | - John D Clapp
- University of Southern California, Suzanne Dworak-Peck School of Social Work; Department of Preventive Medicine, Keck School of Medicine; USC Institute for Addiction Science, Los Angeles, California, USA
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Davis JP, Diguiseppi G, De Leon J, Prindle J, Sedano A, Rivera D, Henwood B, Rice E. Understanding pathways between PTSD, homelessness, and substance use among adolescents. Psychol Addict Behav 2019; 33:467-476. [PMID: 31343198 DOI: 10.1037/adb0000488] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Youth experiencing homelessness have been shown to experience high levels of both trauma and substance use. However, prior work has yet to consider how substance use, posttraumatic stress disorder (PTSD) symptoms, and homelessness are temporally, or reciprocally, associated over time. The current study uses symptom-driven and experience-driven models to examine the reciprocal relationships between substance use, PTSD symptoms, and homelessness among a large sample of adolescents receiving substance use treatment in the United States. Adolescents (n = 20,069; Mage = 15.6; 74% male) completed baseline, 3-, 6-, and 12-month assessments. Autoregressive latent trajectory with structured residual (ALT-SR) models were used to examine within- and between-person relationships. We found continued support for prior work at the between-person level of analysis. At the within-person level, during the treatment phase, PTSD emerged as a key mechanism predicting both return to use and increased days of homelessness posttreatment. Further, greater substance use at treatment completion was associated with greater PTSD symptoms and homelessness, prospectively. The current study extends the previous work to consider individual level processes in conjunction with overarching event level predictors of homelessness. We found that PTSD symptomology is a driving factor that influences, both directly and indirectly, experiences of homelessness posttreatment. Interventions may wish to incorporate trauma informed approaches for youth entering treatment as this may mitigate long-term experiences of homelessness and return to substance use. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | | | | | | | - Eric Rice
- Suzanne Dworak-Peck School of Social Work
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Ovejero S, Iza M, Vallejo S, Vera C, Sedano A, Álvarez R, Mata L, Sánchez-Alonso S. Use of inhaled loxapine in acute psychiatric agitation. Eur Psychiatry 2016. [DOI: 10.1016/j.eurpsy.2016.01.564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
ObjectivesThe aim of this work is to study the efficacy of loxapine inhalation powder on agitated patients in a psychiatric inpatient unit.MethodsNineteen patients sample, with an average age of 39.4 years old, diagnosed with schizophrenia, bipolar disorder or schizoaffective disorder. Patients inhaled loxapine 10 mg, using the staccato system, when they suffered a psychomotor agitation. The clinical efficacy was measured as a change from baseline in the Positive and Negative Syndrome Scale-Excited Component (PANSS-EC) and in the Young Mania Rating Scale (YMRS) one hour after the administration of loxapine.ResultsA mean of 9.8 points reduction (22.6 at baseline and 12.7 one hour after the administration) was found on the PANSS-EC (t-test, P < .001) and 68.4% of the patients were considered responders as they obtained a reduction of at least 40% of the basal score. On 10 of the total of the agitated patients showed an improvement of the psychomotor excitement, and this allowed the clinicians to remove the physical restraint; on 6 of the agitated patients the physical restraint could be avoided during the whole treatment; and 3 of the patients experienced a reduction of the excitement. The reduction on PANNS-EC on the latest group was not statistically significant (t-test, P = .121).ConclusionsInhaled loxapine was a non-invasive, rapid and effective alternative treatment for acute agitation in a psychiatric inpatient unit. It resulted more effective on mild and moderate cases; not been significantly effective on the severe cases of agitation.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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