1
|
Beiter KJ, Wiedemann RP, Thomas CL, Conrad EJ. Alcohol Consumption and COVID-19-Related Stress Among Health Care Workers: The Need for Continued Stress-Management Interventions. Public Health Rep 2022; 137:326-335. [PMID: 35023422 DOI: 10.1177/00333549211058176] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Although a known association exists between stress and alcohol consumption among health care workers (HCWs), it is not known how the COVID-19 pandemic has affected this association. We assessed pandemic work-related stress and alcohol consumption of HCWs. METHODS We emailed a cross-sectional, anonymous survey in June 2020 to approximately 550 HCWs at an academic hospital in New Orleans, Louisiana. HCWs from all departments were eligible to complete the survey. Questions measured work-related stress and emotional reactions to the pandemic (using the Middle East Respiratory Syndrome [MERS-CoV] Staff Questionnaire), depressive symptoms (using the Patient Health Questionnaire-9 [PHQ-9]), coping habits (using the Brief COPE scale), and pre-COVID-19 (March 2020) and current (June 2020) alcohol consumption. We measured alcohol consumption using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C), with scores >3 considered positive. We asked 4 open-ended questions for in-depth analysis. RESULTS One-hundred two HCWs participated in the survey. The average AUDIT-C scores for current and pre-COVID-19 alcohol consumption were 3.1 and 2.8, respectively. The level of current alcohol consumption was associated with avoidant coping (r = 0.46, P < .001). Relative increases in alcohol consumption from March to June 2020 were positively associated with PHQ-9 score and greater emotional reactions to the pandemic. Availability of mental health services was ranked second to last among desired supports. Qualitative data demonstrated high levels of work-related stress from potential exposure to COVID-19 and job instability, as well as social isolation and negative effects of the pandemic on their work environment. CONCLUSIONS Ongoing prevention-based interventions that emphasize stress management rather than mental or behavioral health conditions are needed.
Collapse
Affiliation(s)
- Kaylin J Beiter
- School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Ross P Wiedemann
- Department of Psychiatry, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Casey L Thomas
- School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Erich J Conrad
- Department of Psychiatry, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| |
Collapse
|
2
|
Bodola R, Conrad EJ. Letter to Editor: Book Review. J Acad Consult Liaison Psychiatry 2021. [DOI: 10.1016/j.jaclp.2021.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
3
|
Conrad EJ, Hansel TC, Pejic NG, Constans J. Assessment of Psychiatric Symptoms at a Level I Trauma Center Surgery Follow-up Clinic: A Preliminary Report. Am Surg 2020. [DOI: 10.1177/000313481307900524] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
At Level I trauma centers, psychiatric consultation is readily available to inpatient surgical services. This study sought to characterize the psychiatric symptoms present in the surgical follow-up clinic. Patients aged 18 years and older were assessed over one month for symptoms of posttraumatic stress disorder (PTSD) with the Short PTSD Rating Interview (SPRINT), depression with the Patient Health Questionnaire (PHQ-9), alcohol abuse with the Alcohol Use Disorder Identification Test (AUDIT), and the presence of violence using the MacArthur Community Violence Instrument (MCVIa [victimization] MCVIb [perpetration]). Twenty-five individuals participated. Using the SPRINT, 13 (52.0%) met the cutoff for PTSD. For PHQ-9 depression, 11 (44%) were in the moderate to severe range. For AUDIT, five (20.0%) likely had an alcohol problem. Using the MCVI, 15 (60.0%) reported victimization and 12 (48.0%) reported perpetration. Elevated levels of psychiatric symptoms were found in the trauma surgery follow-up clinic. Psychiatric care embedded in this setting may be warranted.
Collapse
Affiliation(s)
- Erich J. Conrad
- Department of Psychiatry, Louisiana State University School of Medicine, New Orleans, Louisiana
| | - Tonya C. Hansel
- Department of Psychiatry, Louisiana State University School of Medicine, New Orleans, Louisiana
| | - Nicholas G. Pejic
- Department of Psychiatry, Louisiana State University School of Medicine, New Orleans, Louisiana
| | - Joseph Constans
- Department of Psychiatry, Louisiana State University School of Medicine, New Orleans, Louisiana
- Southeast Louisiana Veterans Health Care System, South Central VA Mental Illness Research, Education, and Clinical Center, New Orleans, Louisiana
| |
Collapse
|
4
|
Conrad EJ, McGee BL. Book Review. Psychosomatics 2019. [DOI: 10.1016/j.psym.2019.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
5
|
Nanney JT, Conrad EJ, Reuther ET, Wamser-Nanney RA, McCloskey M, Constans JI. Motivational Interviewing for Victims of Armed Community Violence: A Nonexperimental Pilot Feasibility Study. Psychol Violence 2018; 8:259-268. [PMID: 30140548 PMCID: PMC6101037 DOI: 10.1037/vio0000103] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The present study aimed to develop a novel, hospital-based motivational interviewing (MI) intervention for victims of armed community violence (MI-VoV) targeting patient-specific risk factors for future violence or violent victimization. METHOD This uncontrolled pilot feasibility study examined a sample of patients (n = 71) hospitalized due to violent injury at a Level 1 Trauma Center in [Location Redacted for Masked Review] between January 2013 and May 2014. Patients first participated in a brief assessment to identify risk factors for violence/violent injury. A single MI session then targeted risk behaviors identified for each patient. Proximal outcomes, including motivation for change and behaviors to reduce risk, were examined at 2 weeks and 6-12 weeks post-discharge. Distal outcomes, including fighting, weapon-carrying, and gun-carrying, and other violence risk factors were examined at 6-12 week follow-up. RESULTS Ninety-five patients were offered participation, 79 (83.2%) agreed to participate, and 73 (76.8%) completed the risk assessment. Of these, 71 had at least one violence/violent injury risk factor. Behaviors to reduce risk were significantly greater at two-week and 6-12 week follow-up (ps < .05). Fighting, weapon-carrying, gun-carrying were significantly reduced at 6-12 week follow-up (p < .05). CONCLUSIONS This intervention appears to be feasible to implement and acceptable to patients. A randomized controlled trial evaluating efficacy appears warranted.
Collapse
Affiliation(s)
- John T Nanney
- Southeastern Louisiana Veterans Healthcare System, New Orleans, LA
- Department of Psychiatry, Louisiana State University School of Medicine, New Orleans, LA
- Department of Psychological Sciences, University of Missouri-St. Louis, Saint Louis, MO
- South Central VA Mental Illness Research, Education, and Clinical Center, New Orleans, LA
| | - Erich J Conrad
- Southeastern Louisiana Veterans Healthcare System, New Orleans, LA
- Department of Psychiatry, Louisiana State University School of Medicine, New Orleans, LA
- Department of Psychological Sciences, University of Missouri-St. Louis, Saint Louis, MO
- South Central VA Mental Illness Research, Education, and Clinical Center, New Orleans, LA
- Department of Psychology, Temple University, Philadelphia, PA
- Department of Psychiatry, Tulane University, New Orleans, LA
| | - Erin T Reuther
- Department of Psychiatry, Louisiana State University School of Medicine, New Orleans, LA
| | | | | | - Joseph I Constans
- Southeastern Louisiana Veterans Healthcare System, New Orleans, LA
- Department of Psychiatry, Louisiana State University School of Medicine, New Orleans, LA
- South Central VA Mental Illness Research, Education, and Clinical Center, New Orleans, LA
- Department of Psychiatry, Tulane University, New Orleans, LA
| |
Collapse
|
6
|
Yu M, Tadin D, Conrad EJ, Lopez FA. Clinical Case of the Month: A 48-Year-Old Man With Fever and Abdominal Pain of One Day Duration. J La State Med Soc 2015; 167:237-240. [PMID: 27159603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A 48-year-old man residing in a mental health department inpatient program with a history of schizoaffective disorder presented to the emergency department with a chief complaint of fever and intense abdominal pain for one day. The patient stated he initially fell in the shower and afterwards experienced back pain. He was transferred to an acute care unit within the facility for further evaluation. The facility physician noted that the patient had a mild temperature elevation and abdominal rigidity on exam. At that time, he was given two doses of benztropine intramuscularly, and transferred to our hospital for further evaluation. The patient exhibited fever, diffuse abdominal pain and a nonproductive cough, but denied chills, dysuria, urinary frequency, hematuria, weakness, diarrhea, melena or hematochezia. He did have a one-week history of constipation for which he was given sodium phosphate enemas, magnesium citrate and docusate sodium, eventually resulting in a bowel movement. He also complained of new onset dysphagia. There were no recent changes to his medications, which included clonazepam, divalproex sodium extended release, olanzapine and risperidone. He denied use of tobacco, alcohol or illicit drugs.
Collapse
|
7
|
Nanney JT, Conrad EJ, McCloskey M, Constans JI. Criminal Behavior and Repeat Violent Trauma: A Case-Control Study. Am J Prev Med 2015; 49:395-401. [PMID: 25896195 DOI: 10.1016/j.amepre.2015.02.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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] [Received: 10/10/2014] [Revised: 02/09/2015] [Accepted: 02/18/2015] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Repeat violent injury is common among young urban men and is increasingly a focus of trauma center-based injury prevention efforts. Though understanding risk factors for repeat violent injury may be critical in designing such interventions, this knowledge is limited. This study aims to determine which criminal behaviors, both before and after the initial trauma, predict repeat violent trauma. Gun, violent, and drug crimes are expected to increase risk of subsequent violent injury among victims of violence. METHODS A case-control design examined trauma registry and publicly available criminal data for all male patients aged <40 years presenting for violent trauma between April 2006 and December 2011 (N=1,142) to the sole Level 1 trauma center in a city with high rates of violence. Logistic regression was used to determine criminal behaviors predictive of repeat violent injury. Data were obtained and analyzed between January 2013 and June 2014. RESULTS Regarding crimes committed before the first injury, only drug crime (OR=5.32) predicted repeat violent trauma. With respect to crimes committed after the initial injury, illegal gun possession (OR=2.70) predicted repeat victimization. Initiating gun (OR=3.53) or drug crime (OR=5.12) was associated with increased risk. CONCLUSIONS Prior drug involvement may identify young male victims of violence as at high risk of repeat violent injury. Gun carrying and initiating drug involvement after the initial injury may increase risk of repeat injury and may be important targets for interventions aimed at preventing repeat violent trauma.
Collapse
Affiliation(s)
- John T Nanney
- Southeastern Louisiana Veterans Healthcare System, Tulane University, New Orleans, Louisiana; Department of Psychiatry, Louisiana State University School of Medicine, Tulane University, New Orleans, Louisiana; South Central Veterans Affairs Mental Illness Research, Education, and Clinical Center, Tulane University, New Orleans, Louisiana; Department of Psychological Sciences, University of Missouri-Saint Louis, Saint Louis, Missouri.
| | - Erich J Conrad
- Department of Psychiatry, Louisiana State University School of Medicine, Tulane University, New Orleans, Louisiana
| | - Michael McCloskey
- Department of Psychology, Temple University, Philadelphia, Pennsylvania
| | - Joseph I Constans
- Southeastern Louisiana Veterans Healthcare System, Tulane University, New Orleans, Louisiana; Department of Psychiatry, Louisiana State University School of Medicine, Tulane University, New Orleans, Louisiana; South Central Veterans Affairs Mental Illness Research, Education, and Clinical Center, Tulane University, New Orleans, Louisiana; Department of Psychology, Tulane University, New Orleans, Louisiana
| |
Collapse
|
8
|
Torous J, Chan SR, Yee-Marie Tan S, Behrens J, Mathew I, Conrad EJ, Hinton L, Yellowlees P, Keshavan M. Patient Smartphone Ownership and Interest in Mobile Apps to Monitor Symptoms of Mental Health Conditions: A Survey in Four Geographically Distinct Psychiatric Clinics. JMIR Ment Health 2014; 1:e5. [PMID: 26543905 PMCID: PMC4607390 DOI: 10.2196/mental.4004] [Citation(s) in RCA: 131] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Revised: 12/07/2014] [Accepted: 12/08/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite growing interest in mobile mental health and utilization of smartphone technology to monitor psychiatric symptoms, there remains a lack of knowledge both regarding patient ownership of smartphones and their interest in using such to monitor their mental health. OBJECTIVE To provide data on psychiatric outpatients' prevalence of smartphone ownership and interest in using their smartphones to run applications to monitor their mental health. METHODS We surveyed 320 psychiatric outpatients from four clinics around the United States in order to capture a geographically and socioeconomically diverse patient population. These comprised a state clinic in Massachusetts (n=108), a county clinic in California (n=56), a hybrid public and private clinic in Louisiana (n=50), and a private/university clinic in Wisconsin (n=106). RESULTS Smartphone ownership and interest in utilizing such to monitor mental health varied by both clinic type and age with overall ownership of 62.5% (200/320), which is slightly higher than the average United States' rate of ownership of 58% in January 2014. Overall patient interest in utilizing smartphones to monitor symptoms was 70.6% (226/320). CONCLUSIONS These results suggest that psychiatric outpatients are interested in using their smartphones to monitor their mental health and own the smartphones capable of running mental healthcare related mobile applications.
Collapse
Affiliation(s)
- John Torous
- Harvard Longwood Psychiatry Residency Training Program Boston, MA United States ; Beth Israel Deaconess Medical Center Department of Psychiatry Harvard Medical School Boston, MA United States
| | - Steven Richard Chan
- General Psychiatry Residency Training Program UC Davis School of Medicine Sacramento, CA United States ; Department of Psychiatry and Behavioral Sciences UC Davis School of Medicine Sacramento, CA United States
| | - Shih Yee-Marie Tan
- Louisiana State University-Ochsner Psychiatry Residency Program Louisiana State University Health Sciences Center Louisiana State University New Orleans, LA United States ; Department of Psychiatry Louisiana State University Health Sciences Center New Orleans, LA United States
| | - Jacob Behrens
- Department of Psychiatry University of Wisconsin School of Medicine and Public Health Madison, WI United States
| | - Ian Mathew
- Beth Israel Deaconess Medical Center Department of Psychiatry Harvard Medical School Boston, MA United States
| | - Erich J Conrad
- Department of Psychiatry Louisiana State University Health Sciences Center New Orleans, LA United States
| | - Ladson Hinton
- Department of Psychiatry and Behavioral Sciences UC Davis School of Medicine Sacramento, CA United States
| | - Peter Yellowlees
- Department of Psychiatry and Behavioral Sciences UC Davis School of Medicine Sacramento, CA United States
| | - Matcheri Keshavan
- Beth Israel Deaconess Medical Center Department of Psychiatry Harvard Medical School Boston, MA United States
| |
Collapse
|
9
|
Conrad EJ, Hansel TC, Pejic NG, Constans J. Assessment of psychiatric symptoms at a level I trauma center surgery follow-up clinic: a preliminary report. Am Surg 2013; 79:492-494. [PMID: 23635584] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
At Level I trauma centers, psychiatric consultation is readily available to inpatient surgical services. This study sought to characterize the psychiatric symptoms present in the surgical follow-up clinic. Patients aged 18 years and older were assessed over one month for symptoms of posttraumatic stress disorder (PTSD) with the Short PTSD Rating Interview (SPRINT), depression with the Patient Health Questionnaire (PHQ-9), alcohol abuse with the Alcohol Use Disorder Identification Test (AUDIT), and the presence of violence using the MacArthur Community Violence Instrument (MCVIa [victimization] MCVIb [perpetration]). Twenty-five individuals participated. Using the SPRINT, 13 (52.0%) met the cutoff for PTSD. For PHQ-9 depression, 11 (44%) were in the moderate to severe range. For AUDIT, five (20.0%) likely had an alcohol problem. Using the MCVI, 15 (60.0%) reported victimization and 12 (48.0%) reported perpetration. Elevated levels of psychiatric symptoms were found in the trauma surgery follow-up clinic. Psychiatric care embedded in this setting may be warranted.
Collapse
Affiliation(s)
- Erich J Conrad
- Department of Psychiatry, Louisiana State University School of Medicine, New Orleans, LA 70112, USA.
| | | | | | | |
Collapse
|
10
|
Barbee JG, Thompson TR, Jamhour NJ, Stewart JW, Conrad EJ, Reimherr FW, Thompson PM, Shelton RC. A double-blind placebo-controlled trial of lamotrigine as an antidepressant augmentation agent in treatment-refractory unipolar depression. J Clin Psychiatry 2011; 72:1405-12. [PMID: 21367355 DOI: 10.4088/jcp.09m05355gre] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [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] [Received: 05/08/2009] [Accepted: 04/06/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Previous reports have suggested that lamotrigine is effective as an antidepressant augmentation agent in patients with treatment-resistant unipolar depression. This study is the largest double-blind placebo-controlled study conducted to date of lamotrigine in this role. METHOD In this multicenter trial, conducted at 19 sites, patients aged 18-65 years with a DSM-IV/ICD-10 diagnosis of unipolar, nonpsychotic major depressive disorder (confirmed by the Mini-International Neuropsychiatric Interview) who had failed at least 1 adequate trial of an antidepressant (N = 183) were first treated for 8 weeks with open-label paroxetine or paroxetine controlled-release in dosages up to 50 mg/d or 62.5 mg/d, respectively. Individuals with a 17-item Hamilton Depression Rating Scale (HDRS-17) score ≥ 15 (n = 96) were then randomized on a double-blind basis to receive either placebo or lamotrigine in dosages titrated upward to a maximum of 400 mg/d for 10 weeks. Sixty-five patients completed the study. The primary outcome measure was the Montgomery-Asberg Depression Rating Scale (MADRS), and the main secondary outcome measures were the HDRS-17 and Clinical Global Impressions-Severity of Illness (CGI-S) and Clinical Global Impressions-Improvement (CGI-I) ratings. Data were collected from 2003 to 2006. RESULTS Results of the primary efficacy analysis of the randomized patients using the MADRS, HDRS-17, CGI-S, and CGI-I did not demonstrate a statistically significant difference between lamotrigine and placebo groups, although some secondary analyses were suggestive of efficacy, particularly in those patients who completed the study (completer analysis) and in more severely ill patients (HDRS-17 ≥ 25). CONCLUSIONS This add-on study of patients with treatment-resistant depression failed to detect a statistically significant difference between lamotrigine and placebo given for 10 weeks. However, post hoc analyses suggest that future studies of lamotrigine's efficacy might focus on specific subgroups with depression. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00901407.
Collapse
Affiliation(s)
- James G Barbee
- Department of Psychiatry, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
| | | | | | | | | | | | | | | |
Collapse
|
11
|
|
12
|
Abstract
Panic disorder is a chronic and disabling condition that is often accompanied by other psychiatric and medical conditions. The serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) have been used effectively with panic disorder (PD) and conditions in which panic attacks frequently occur. Escitalopram is the most selective SSRI and a variety of evidence suggests it is of great value in the treatment of panic disorder. In this paper, we review the theoretical and practical implications of its use.
Collapse
Affiliation(s)
- Mark H Townsend
- Department of Psychiatry, Louisiana State University Health Sciences Center New Orleans, New Orleans, Louisiana, USA
| | | |
Collapse
|
13
|
Abstract
BACKGROUND Evidence is accumulating to support the use of atypical neuroleptics as adjunctive treatment for refractory mood disorders, although there are currently no published data on the efficacy of an atypical neuroleptic in treatment-resistant depression when a previous trial of drug from the same class has failed. The authors hypothesized that aripiprazole would be efficacious in augmenting antidepressant treatment in resistant patients with non-psychotic unipolar depression who had previously failed a trial of another atypical neuroleptic. METHODS This study was a retrospective chart review of the efficacy of aripiprazole augmentation in 30 treatment-resistant unipolar depression patients who had failed multiple previous antidepressant trials and had also failed augmentation with at least one other atypical neuroleptic. Prospective Global Assessment of Functioning and Clinical Global Impressions-Improvement scores were completed on each patient throughout treatment. RESULTS Utilizing an intent-to-treat analysis (including 9 patients who dropped out prior to completion of 6 weeks), 46.7% (14/30) patients were rated much improved or very much improved with treatment. This improvement negatively correlated with Thase-Rush staging of treatment resistance. GAF scores also showed a significant improvement. Six of the 14 patients who initially improved subsequently relapsed (yielding a long-term net response rate of 26.7%). CONCLUSION Aripiprazole may be effective as an antidepressant augmentation agent in highly treatment resistant patients who had failed a prior trial of another atypical neuroleptic.
Collapse
Affiliation(s)
- James G Barbee
- Department of Psychiatry, Louisiana State University Health Sciences Center, New Orleans, Louisiana 70112, USA.
| | | | | |
Collapse
|
14
|
Barbee JG, Conrad EJ, Jamhour NJ. The effectiveness of olanzapine, risperidone, quetiapine, and ziprasidone as augmentation agents in treatment-resistant major depressive disorder. J Clin Psychiatry 2004; 65:975-81. [PMID: 15291687 DOI: 10.4088/jcp.v65n0714] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Many questions remain regarding the use of atypical neuroleptics as antidepressant augmentation agents. To date, there have been no reports in the literature regarding the effectiveness of these drugs when trials of one or more of them have failed previously as antidepressant augmentation. METHOD This retrospective chart review was conducted to determine the effectiveness of olanzapine, risperidone, quetiapine, and ziprasidone when given in a fee-for-service setting as anti-depressant augmentation agents to patients with treatment-resistant, nonpsychotic major depressive disorder (DSM-IV). Prospective (Global Assessment of Functioning [GAF]) along with retrospective (Clinical Global Impressions-Improvement [CGI-I] and -Severity of Illness scales) ratings were completed for each patient. Analyses were conducted in an attempt to identify factors that appeared to correlate with response, including order of administration and Thase-Rush staging of treatment resistance. RESULTS In this study of 76 medication trials in 49 patients, the overall response rate based on the CGI-I ratings was 65% (32/49). Individual rates of response were 57% (21/37) for olanzapine, 50% (7/14) for risperidone, 33% (6/18) for quetiapine, and 10% (1/10) for ziprasidone. None of the differences between neuroleptics in rates of response were significant. The difference between baseline and final GAF scores was statistically significant only in the olanzapine (p <.001) and risperidone (p =.047) groups. Rates of discontinuation did not vary significantly between agents, though trends were present. Crossover trials from one atypical neuroleptic to another in the event of nonresponse appeared to be effective. CONCLUSIONS Although limited by its design, this study suggests atypical neuroleptic augmentation of antidepressants may be a viable option in treatment-resistant major depressive disorder.
Collapse
Affiliation(s)
- James G Barbee
- Department of Psychiatry, Louisiana State University Health Sciences Center, New Orleans 70112, USA.
| | | | | |
Collapse
|
15
|
Handler DS, Chassie MB, Watkins BL, Anderson RJ, Conrad EJ. Health career preview: a summer internship for minority students in a teaching hospital. J Natl Med Assoc 1983; 75:1007-9, 1013-4. [PMID: 6644833 PMCID: PMC2561611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A summer internship program designed to encourage qualified minority students to pursue careers in health professions is described. Initial goals for the program were met, and the first year of the program was considered a success.
Collapse
|
16
|
Handler DS, Chassie MB, Watkins BL, Anderson RJ, Conrad EJ. Internship program exposes teenagers to hospital life. Hospitals 1983; 57:57-8. [PMID: 6862410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|