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Eder J, Glocker C, Barton B, Sarisik E, Popovic D, Lämmermann J, Knaf A, Beqiri-Zagler A, Engl K, Rihs L, Pfeiffer L, Schmitt A, Falkai P, Simon MS, Musil R. Who is at risk for weight gain after weight-gain associated treatment with antipsychotics, antidepressants, and mood stabilizers: A machine learning approach. Acta Psychiatr Scand 2024. [PMID: 38561235 DOI: 10.1111/acps.13684] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 03/05/2024] [Accepted: 03/20/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Weight gain is a common side effect in psychopharmacology; however, targeted therapeutic interventions and prevention strategies are currently absent in day-to-day clinical practice. To promote the development of such strategies, the identification of factors indicative of patients at risk is essential. METHODS In this study, we developed a transdiagnostic model using and comparing decision tree classifiers, logistic regression, XGboost, and a support vector machine to predict weight gain of ≥5% of body weight during the first 4 weeks of treatment with psychotropic drugs associated with weight gain in 103 psychiatric inpatients. We included established variables from the literature as well as an extended set with additional clinical variables and questionnaires. RESULTS Baseline BMI, premorbid BMI, and age are known risk factors and were confirmed by our models. Additionally, waist circumference has emerged as a new and significant risk factor. Eating behavior next to blood glucose were found as additional potential predictor that may underlie therapeutic interventions and could be used for preventive strategies in a cohort at risk for psychotropics induced weight gain (PIWG). CONCLUSION Our models validate existing findings and further uncover previously unknown modifiable factors, such as eating behavior and blood glucose, which can be used as targets for preventive strategies. These findings underscore the imperative for continued research in this domain to establish effective preventive measures for individuals undergoing psychotropic drug treatments.
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Affiliation(s)
- Julia Eder
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU, Munich, Germany
- Graduate Program "POKAL - Predictors and Outcomes in Primary Care" (DFG-GrK 2621), Munich, Germany
| | - Catherine Glocker
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU, Munich, Germany
| | - Barbara Barton
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU, Munich, Germany
| | - Elif Sarisik
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU, Munich, Germany
- International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany
- Max Planck Institute of Psychiatry, Munich, Germany
| | - David Popovic
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU, Munich, Germany
- International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany
- Max Planck Institute of Psychiatry, Munich, Germany
| | - Jana Lämmermann
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU, Munich, Germany
- Graduate Program "POKAL - Predictors and Outcomes in Primary Care" (DFG-GrK 2621), Munich, Germany
| | - Alexandra Knaf
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU, Munich, Germany
- Graduate Program "POKAL - Predictors and Outcomes in Primary Care" (DFG-GrK 2621), Munich, Germany
| | - Anja Beqiri-Zagler
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU, Munich, Germany
| | - Katharina Engl
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU, Munich, Germany
| | - Leonie Rihs
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU, Munich, Germany
| | - Lisa Pfeiffer
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU, Munich, Germany
- Graduate Program "POKAL - Predictors and Outcomes in Primary Care" (DFG-GrK 2621), Munich, Germany
| | - Andrea Schmitt
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU, Munich, Germany
- Graduate Program "POKAL - Predictors and Outcomes in Primary Care" (DFG-GrK 2621), Munich, Germany
- Laboratory of Neuroscience (LIM27), Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU, Munich, Germany
- Graduate Program "POKAL - Predictors and Outcomes in Primary Care" (DFG-GrK 2621), Munich, Germany
- International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany
- Max Planck Institute of Psychiatry, Munich, Germany
| | - Maria S Simon
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU, Munich, Germany
| | - Richard Musil
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU, Munich, Germany
- Oberberg Fachklinik Bad Tölz, Bad Tölz, Germany
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Engel J, Haack B, Zolk O, Greiner T, Heinze M, Toto S, Seifert J, Bleich S, Glocker C, Grohmann R, Schneider M, Stübner S. Edema related to treatment with psychotropic drugs. J Neural Transm (Vienna) 2024; 131:253-266. [PMID: 38353811 PMCID: PMC10874320 DOI: 10.1007/s00702-024-02738-6] [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] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 01/02/2024] [Indexed: 02/18/2024]
Abstract
Edema as an adverse drug reaction is a commonly underestimated yet potentially debilitating condition. This study analyzes the incidence of severe psychotropic drug-induced edema (e.g., edema affecting the face, legs, or multiple body parts and lasting for more than 1 week, or in any case necessitating subsequent diuretic use) among psychiatric inpatients. The cases under examination are derived from an observational pharmacovigilance program conducted in German-speaking countries ("Arzneimittelsicherheit in der Psychiatrie", AMSP) from 1993 to 2016. Among the 462,661 inpatients monitored, severe edema was reported in 231 cases, resulting in an incidence of 0.05%. Edema occurred more frequently in women (80% of all cases) and older patients (mean age 51.8 years). Pregabalin had the highest incidence of severe edema, affecting 1.46‰ of patients treated with pregabalin, followed by mirtazapine (0.8‰). The majority of edema cases showed a positive response to appropriate countermeasures, such as dose reduction and drug discontinuation, and resolved by the end of the observation period. While most instances of drug-induced edema are reversible, they can have a significant impact on patient well-being and potentially result in decreased treatment adherence. It is, therefore, crucial to remain vigilant regarding risk-increasing circumstances during treatment with psychotropic drugs.
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Affiliation(s)
- Johanna Engel
- Brandenburg Medical School, University Clinic for Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf bei Berlin, Germany.
| | - Beatrice Haack
- Brandenburg Medical School, University Clinic for Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf bei Berlin, Germany
| | - Oliver Zolk
- Institute of Clinical Pharmacology of the Brandenburg Medical School, Immanuel Klinik Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf bei Berlin, Germany
| | - Timo Greiner
- Brandenburg Medical School, University Clinic for Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf bei Berlin, Germany
| | - Martin Heinze
- Brandenburg Medical School, University Clinic for Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf bei Berlin, Germany
| | - Sermin Toto
- Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Johanna Seifert
- Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Catherine Glocker
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Nussbaumstr. 7, 80336, Munich, Germany
| | - Renate Grohmann
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Nussbaumstr. 7, 80336, Munich, Germany
| | - Michael Schneider
- Brandenburg Medical School, University Clinic for Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf bei Berlin, Germany
| | - Susanne Stübner
- Maßregelvollzugsleitung, Klinik für Forensische Psychiatrie, Bezirksklinikum Ansbach, Ludwig-Maximilians-Universität München, Feuchtwanger Straße 38, 91522, Ansbach, Germany
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3
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Eder J, Simon MS, Glocker C, Musil R. [Weight gain and treatment with psychotropic drugs : Background and management]. Nervenarzt 2023; 94:859-869. [PMID: 37672085 DOI: 10.1007/s00115-023-01534-z] [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] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/21/2023] [Indexed: 09/07/2023]
Abstract
Psychotropic drug-induced weight gain (PIWG) is a well-known and frequent side effect which is relevant for the prognosis of patients. Individual medications have varying risks for the occurrence of PIWG, and at the same time there are individual risk factors on the part of patients, such as age, gender, metabolic and genetic factors. As the metabolic changes in the context of PIWG result in increased mortality in the long term, it is important to prevent PIWG by appropriate prevention and to intervene in a targeted manner if PIWG has already occurred. Appropriate monitoring is therefore essential. This article provides an overview of underlying mechanisms, risk constellations and possible countermeasures.
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Affiliation(s)
- J Eder
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität (LMU) München, Nußbaumstraße 7, 80336, München, Deutschland
| | - M S Simon
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität (LMU) München, Nußbaumstraße 7, 80336, München, Deutschland
| | - C Glocker
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität (LMU) München, Nußbaumstraße 7, 80336, München, Deutschland.
| | - R Musil
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität (LMU) München, Nußbaumstraße 7, 80336, München, Deutschland
- Oberberg Fachklinik Bad Tölz, Bad Tölz, Deutschland
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Glocker C, Grohmann R, Burkhardt G, Seifert J, Bleich S, Held T, Toto S, Stübner S, Schüle C. Antipsychotic drug-induced neutropenia: results from the AMSP drug surveillance program between 1993 and 2016. J Neural Transm (Vienna) 2023; 130:153-163. [PMID: 36653686 PMCID: PMC9902410 DOI: 10.1007/s00702-023-02589-7] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/09/2023] [Indexed: 01/20/2023]
Abstract
Neutropenia and agranulocytosis (N&A) are relatively rare, but potentially fatal adverse drug reactions (ADR). This study presents cases of N&A related to one or more antipsychotic drugs (APDs) in psychiatric inpatients. Data on APD utilization and reports of N&A caused by APDs were analyzed by using data from an observational pharmacovigilance program in German-speaking countries-Arzneimittelsicherheit in der Psychiatrie (AMSP)-from 1993 to 2016. 333,175 psychiatric inpatients were treated with APDs for schizophrenia and other indications during the observation period. A total of 124 cases of APD-induced N&A were documented, 48 of which fulfilled the criteria for agranulocytosis, corresponding to a rate of 0.37, respectively, 0.14 in 1000 inpatients treated with APDs. Neutropenia was more often detected in women, whereas there was no difference regarding sex in cases of agranulocytosis. Clozapine had the highest relative risk for inducing N&A and was imputed alone as a probable cause of N&A in 60 cases (1.57‰ of all patients exposed). Perazine showed the second highest relative risk with 8 cases and an incidence 0.52‰, followed by quetiapine (15 cases resp. 0.23‰ of all patients exposed) and olanzapine (7 cases; 0.13‰ of all patients exposed). N&A most often occurred during the first 3 months of treatment. Overall N&A are severe and potentially fatal complications that can occur during treatment with APDs. The results from this study largely agree with the currently available literature, highlighting the positive effects of alertness and established appropriate monitoring.
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Affiliation(s)
- Catherine Glocker
- Department of Psychiatry und Psychotherapy, LMU Klinikum, Nußbaumstraße 7, 80336, Munich, Germany.
| | - R. Grohmann
- Department of Psychiatry und Psychotherapy, LMU Klinikum, Nußbaumstraße 7, 80336 Munich, Germany
| | - G. Burkhardt
- Department of Psychiatry und Psychotherapy, LMU Klinikum, Nußbaumstraße 7, 80336 Munich, Germany
| | - J. Seifert
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - S. Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - T. Held
- Department of Hematology and Cell Therapy, Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125 Berlin, Germany
| | - S. Toto
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - S. Stübner
- Department of Forensic Psychiatry, Bezirksklinikum Ansbach, Feuchtwanger Str. 38, 91522 Ansbach, Germany
| | - C. Schüle
- Department of Psychiatry und Psychotherapy, LMU Klinikum, Nußbaumstraße 7, 80336 Munich, Germany
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Simon MS, Barton BB, Glocker C, Musil R. A comprehensive approach to predicting weight gain and therapy response in psychopharmacologically treated major depressed patients: A cohort study protocol. PLoS One 2022; 17:e0271793. [PMID: 35862413 PMCID: PMC9302848 DOI: 10.1371/journal.pone.0271793] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 07/07/2022] [Indexed: 11/22/2022] Open
Abstract
Background A subgroup of patients with Major Depressive Disorder shows signs of low-grade inflammation and metabolic abberances, while antidepressants can induce weight gain and subsequent metabolic disorders, and lacking antidepressant response is associated with inflammation. Objectives A comprehensive investigation of patient phenotypes and their predictive capability for weight gain and treatment response after psychotropic treatment will be performed. The following factors will be analyzed: inflammatory and metabolic markers, gut microbiome composition, lifestyle indicators (eating behavior, physical activity, chronotype, patient characteristics (childhood adversity among others), and polygenic risk scores. Methods Psychiatric inpatients with at least moderate Major Depressive Disorder will be enrolled in a prospective, observational, naturalistic, monocentric study using stratified sampling. Ethical approval was obtained. Primary outcomes at 4 weeks will be percent weight change and symptom score change on the Montgomery Asberg Depression Rating Scale. Both outcomes will also be binarized into clinically relevant outcomes at 5% weight gain and 50% symptom score reduction. Predictors for weight gain and treatment response will be tested using multiple hierachical regression for continuous outcomes, and multiple binary logistic regression for binarized outcomes. Psychotropic premedication, current medication, eating behavior, baseline BMI, age, and sex will be included as covariates. Further, a comprehensive analysis will be carried out using machine learning. Polygenic risk scores will be added in a second step to estimate the additional variance explained by genetic markers. Sample size calculation yielded a total amount of N = 171 subjects. Discussion Patient and physician expectancies regarding the primary outcomes and non-random sampling may affect internal validity and external validity, respectively. Through the prospective and naturalistic design, results will gain relevance to clinical practice. Examining the predictive value of patient profiles for weight gain and treatment response during pharmacotherapy will allow for targeted adjustments before and concomitantly to the start of treatment.
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Affiliation(s)
- Maria S. Simon
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University, Munich, Germany
- * E-mail:
| | - Barbara B. Barton
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Catherine Glocker
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Richard Musil
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University, Munich, Germany
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Simon MS, Barton B, Zagler A, Engl K, Rihs L, Glocker C, Musil R. Lifestyle behaviors, metabolic disturbances, and weight gain in psychiatric inpatients treated with weight gain-associated medication. Eur Arch Psychiatry Clin Neurosci 2022:10.1007/s00406-022-01442-4. [PMID: 35778522 DOI: 10.1007/s00406-022-01442-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 05/29/2022] [Indexed: 11/03/2022]
Abstract
Many psychiatric patients suffer from overweight/obesity and subsequent metabolic disturbances, where psychotropic medication is one of the main contributors. However, the magnitude of weight gain ranges individually, which leads to questioning the role of other contributors like lifestyle factors. The present study investigated several lifestyle factors among psychiatric inpatients, their relation to biological factors, and their predictive capability for weight gain during treatment. Using a naturalistic observational study design, psychiatric inpatients of all diagnoses were followed for 4 weeks from the start of treatment with weight gain-associated medication. N = 163 participants entered the study. Lifestyle factors were assessed by patient self-report questionnaires. Body weight change over time was calculated relative to baseline body weight. Our study provides three main findings: (1) Obesity and/or metabolic syndrome (metSy) were associated with emotional eating (disinhibition), craving for fast food and sweets, and weight cycling. (2) Patients without metSy and normal BMI experienced increased sweets craving (also for women), a more positive attitude towards drugs, and an improvement of affect (also for men). (3) Sex, presence of metSy and/or drug dosage interacted with disinhibition change, sweets craving change (trend), and fast food craving change to predict weight change over time. Furthermore, drug attitude change interacted with BMI, drug dosage, and presence of metSy to predict weight change. Lifestyle factors, especially eating behaviors, are related to metabolic disturbances and predict weight gain in interaction with clinical parameters.
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Affiliation(s)
- Maria S Simon
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nußbaumstraße 7, 80336, Munich, Germany.
| | - Barbara Barton
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nußbaumstraße 7, 80336, Munich, Germany
| | - Anja Zagler
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nußbaumstraße 7, 80336, Munich, Germany
| | - Katharina Engl
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nußbaumstraße 7, 80336, Munich, Germany
| | - Leonora Rihs
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nußbaumstraße 7, 80336, Munich, Germany
| | - Catherine Glocker
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nußbaumstraße 7, 80336, Munich, Germany
| | - Richard Musil
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nußbaumstraße 7, 80336, Munich, Germany
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Baumgärtner J, Grohmann R, Bleich S, Glocker C, Seifert J, Toto S, Rüther E, Engel RR, Stübner S. Atypical dyskinesias under treatment with antipsychotic drugs: Report from the AMSP multicenter drug safety project. World J Biol Psychiatry 2022; 23:151-164. [PMID: 34096837 DOI: 10.1080/15622975.2021.1938213] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The aim of this study was to describe atypical dyskinesias (AtypDs) occurring during treatment with antipsychotic drugs (APDs). AtypDs are dyskinesias showing either an unusual temporal relationship between onset of treatment and start of the adverse drug reaction (ADR) or an unusual presentation of clinical symptoms. METHODS Data on the utilisation of APDs and reports of severe APD-induced AtypDs were collected using data from the observational pharmacovigilance programme - 'Arzneimittelsicherheit in der Psychiatrie (English: drug safety in psychiatry)' (AMSP) - from 1993 to 2016. RESULTS A total of 495,615 patients were monitored, of which 333,175 were treated with APDs. Sixty-seven cases (0.020%) of severe AtypDs under treatment with APDs were registered. The diagnoses of schizophrenic disorders as well as organic mental disorders were related to significantly higher rates of AtypDs. Second-generation antipsychotic drugs (SGAs) showed slightly higher rates of AtypDs (0.024%) than high-potency (0.011%) or low-potency first-generation antipsychotic drugs (FGAs; 0.006%). In 41 cases (61.2%), two or more drugs were found to cause AtypDs. CONCLUSIONS Our study indicates that AtypDs are rare ADRs. SGAs may have a higher risk for the occurrence of AtypDs than FGAs. Clinicians should be aware of this ADR and patients should be monitored and examined carefully.
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Affiliation(s)
- Jessica Baumgärtner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Renate Grohmann
- Department of Psychiatry, Ludwig-Maximilians-University, Munich, Germany
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover, Germany
| | - Catherine Glocker
- Department of Psychiatry, Ludwig-Maximilians-University, Munich, Germany
| | - Johanna Seifert
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover, Germany
| | - Sermin Toto
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover, Germany
| | - Eckart Rüther
- Department of Psychiatry, Ludwig-Maximilians-University, Munich, Germany.,Prosomno, Clinic for Sleep Medicine, Munich, Germany
| | - Rolf R Engel
- Department of Psychiatry, Ludwig-Maximilians-University, Munich, Germany
| | - Susanne Stübner
- Department of Psychiatry, Ludwig-Maximilians-University, Munich, Germany.,Department of Forensic Psychiatry, Bezirksklinikum Ansbach, Ansbach, Germany
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Heck J, Seifert J, Stichtenoth DO, Schroeder C, Groh A, Szycik GR, Degner D, Adamovic I, Schneider M, Glocker C, Rüther E, Bleich S, Grohmann R, Toto S. A case series of serious and unexpected adverse drug reactions under treatment with cariprazine. Clin Case Rep 2021; 9:e04084. [PMID: 34084502 PMCID: PMC8142394 DOI: 10.1002/ccr3.4084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/15/2021] [Accepted: 03/14/2021] [Indexed: 01/20/2023] Open
Abstract
Reporting of new or unexpected adverse drug reactions of medicines that are subject to additional monitoring ("black triangle" label), such as the antipsychotic drug cariprazine, is of paramount importance to improve pharmacotherapy safety.
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Affiliation(s)
- Johannes Heck
- Institute for Clinical PharmacologyHannover Medical SchoolHannoverGermany
| | - Johanna Seifert
- Department of PsychiatrySocial Psychiatry and PsychotherapyHannover Medical SchoolHannoverGermany
| | - Dirk O. Stichtenoth
- Institute for Clinical PharmacologyHannover Medical SchoolHannoverGermany
- Drug Commissioner of Hannover Medical SchoolHannoverGermany
| | - Christoph Schroeder
- Institute for Clinical PharmacologyHannover Medical SchoolHannoverGermany
- Head of Pharmacovigilance of Hannover Medical SchoolHannoverGermany
| | - Adrian Groh
- Department of PsychiatrySocial Psychiatry and PsychotherapyHannover Medical SchoolHannoverGermany
| | - Gregor R. Szycik
- Department of PsychiatrySocial Psychiatry and PsychotherapyHannover Medical SchoolHannoverGermany
| | - Detlef Degner
- Department of Psychiatry and PsychotherapyGeorg August University of GöttingenGöttingenGermany
| | - Ivana Adamovic
- Department of Psychiatry and PsychotherapyGeorg August University of GöttingenGöttingenGermany
| | - Michael Schneider
- University Clinic for Psychiatry and PsychotherapyBrandenburg Medical SchoolImmanuel KlinikRüdersdorfGermany
| | - Catherine Glocker
- Department of Psychiatry and PsychotherapyLudwig Maximilian University of MunichMunichGermany
| | - Eckart Rüther
- Department of Psychiatry and PsychotherapyLudwig Maximilian University of MunichMunichGermany
- Prosomno Klinik und Poliklinik für SchlafmedizinMunichGermany
| | - Stefan Bleich
- Department of PsychiatrySocial Psychiatry and PsychotherapyHannover Medical SchoolHannoverGermany
| | - Renate Grohmann
- Department of Psychiatry and PsychotherapyLudwig Maximilian University of MunichMunichGermany
| | - Sermin Toto
- Department of PsychiatrySocial Psychiatry and PsychotherapyHannover Medical SchoolHannoverGermany
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Glocker C, Kirchberger I, Gläßel A, Fincziczki A, Stucki G, Cieza A. Content validity of the comprehensive international classification of functioning, disability and health (ICF) core set for low back pain from the perspective of physicians: a Delphi survey. Chronic Illn 2013; 9:57-72. [PMID: 22689356 DOI: 10.1177/1742395312451280] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The 'Comprehensive ICF Core Set for low back pain (LBP)' is an application of the International Classification of Functioning, Disability and Health (ICF) and represents the typical spectrum of problems in functioning of patients with LBP. The objective of this study was to validate this ICF Core Set from the perspective of physicians. METHODS Physicians experienced in the treatment of LBP were asked about the patients' problems, patients' resources and aspects of environment that physicians take care of in a three-round survey using the Delphi technique. Responses were linked to the ICF. RESULTS Seventy-one physicians in 36 countries named 707 concepts that covered all ICF components. One hundred ninety-three ICF categories were linked to these answers. Three ICF categories were not represented in the Comprehensive ICF Core Set for LBP although at least 75% of the participants have rated them as important. Twenty-six concepts were linked to the not yet developed ICF component personal factors and 21 issues were not covered by the ICF. DISCUSSION The high percentage of ICF categories represented in the ICF Core Set for LBP indicates good content validity from the perspective of the physicians. However, some issues were raised that were not covered and need to be investigated further.
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Affiliation(s)
- Catherine Glocker
- Department of Medical Informatics, Biometry and Epidemiology, Chair for Public Health and Health Care Research, Unit for Biopsychosocial Health, Ludwig-Maximilians Universität, Munich, Germany
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Nagy Z, Leine RI, Frutiger DR, Glocker C, Nelson BJ. Modeling the Motion of Microrobots on Surfaces Using Nonsmooth Multibody Dynamics. IEEE T ROBOT 2012. [DOI: 10.1109/tro.2012.2199010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Transeth A, Leine R, Glocker C, Pettersen K, Liljeback P. Snake Robot Obstacle-Aided Locomotion: Modeling, Simulations, and Experiments. IEEE T ROBOT 2008. [DOI: 10.1109/tro.2007.914849] [Citation(s) in RCA: 161] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Ammon HP, Glocker C, Waldner RG, Wahl MA. Insulin release from pancreatic islets of fetal rats mediated by leucine b-BCH, tolbutamide, glibenclamide, arginine, potassium chloride, and theophylline does not require stimulation of Ca2+ net uptake. Cell Calcium 1989; 10:441-50. [PMID: 2505929 DOI: 10.1016/0143-4160(89)90035-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
In pancreatic islets of fetal rats the effect of glucose (3 and 16.7 mM), glyceraldehyde (10 mM), leucine (20 mM), b-BCH (20 mM), tolbutamide (100 micrograms/ml), glibenclamide (0.5 and 5.0 micrograms/ml) arginine (20 mM), KCl (20 mM) and theophylline (2.5 mM) on 45Ca2+ net uptake and secretion of insulin was studied. All compounds tested failed to stimulate 45Ca2+ net uptake. However, in contrast to glucose and glyceraldehyde, leucine, b-BCH, tolbutamide, glibenclamide, arginine, KCl and theophylline significantly stimulated release of insulin. This effect could not be inhibited by the calcium antagonist verapamil (20 microM). Elevation of the glucose concentration from 3 to 5.6 mM did not alter 86Rb+ efflux of fetal rat islets but inhibited 86Rb+ efflux of adult rat islets. Stimulation of 86Rb+ efflux with tolbutamide (100 micrograms/ml), leucine (20 mM) or b-BCH (20 mM) in the presence of 3 mM glucose was also ineffective in fetal rat islets. Our data suggest that stimulation of calcium uptake via the voltage dependent calcium channel is not possible in the fetal state. They also provide evidence that stimulators of insulin release which are thought not to act through their metabolism, initiate insulin secretion from fetal islets by a mechanism which is different from stimulation of calcium influx.
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Affiliation(s)
- H P Ammon
- Department of Pharmacology, University of Tübingen, Federal Republic of Germany
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