Use Of Antipsychotic Medications Research Articles

Quetiapine and other antipsychotic medications during pregnancy: a 15-year follow-up of a university hospital birth register

Purpose To survey trends of antipsychotic use during pregnancy and examine the associations between the use of quetiapine or any antipsychotic and adverse obstetric and neonatal outcomes. Methods Birth register study of 36,083 women who gave birth at Kuopio University Hospital, Finland, between 2002 and 2016. Obstetric and neonatal outcomes between women using quetiapine (N = 152) or any antipsychotic (N = 227) were compared to controls (N = 35,133). Results Altogether 246 (0.7%) women used antipsychotic medications during pregnancy and 153 (62,2%) of these women used quetiapine. Antipsychotic usage increased from 0.4% to 1.0% during the 15-year follow-up. Women using antipsychotics were more likely to smoke, drink alcohol, use illicit drugs, use other psychotropic medications, and have higher pre-pregnancy body mass index. Quetiapine use was associated with higher risk of increased postpartum bleeding in vaginal delivery (aOR 1.65; 95%CI 1.13–2.42), prolonged neonatal hospitalization (≥5 days) (aOR 1.54; 95%CI 1.10–2.15), and higher placental to birth weight ratio (PBW ratio) (aB 0.009; 95%CI 0.002–0.016). Use of any antipsychotic was associated with a higher risk of gestational diabetes mellitus (aOR 1.64; 95%CI 1.19–2.27), increased postpartum bleeding in vaginal delivery (aOR 1.50; 95%CI 1.09–2.07), prolonged neonatal hospitalization (≥5 days) (aOR 2.07; 95%CI 1.57–2.73), and higher PBW ratio (aB 0.007; 95%CI 0.001–0.012). Conclusion The use of antipsychotic medications increased among Finnish pregnant women from 2002 to 2016. Pregnant women using antipsychotics appear to have a higher risk for some adverse pregnancy and birth outcomes and may benefit from more frequent maternity care follow-ups.

Psychotropic Medication Use and Changes During Hospitalization for Older Adults Living With Dementia.

To describe the use of psychotropic medications among older hospitalized patients. This was a descriptive study using baseline data from the first 308 older patients in a function focused care intervention study. Age, gender, race, comorbidities, admitting diagnosis, and medications (antidepressants, antianxiety medications, anticonvulsants, dementia drugs, antipsychotics, sedative-hypnotics, and opioids) were obtained at baseline and discharge. To compare change over time, generalized estimating equations were used. Participants were mostly female (63%) and White (69%) and were 83.1 years old on average. Antidepressant, antianxiety, anticonvulsant, dementia medication, sedative-hypnotic, and opioid use remained essentially unchanged between admission and discharge. Antipsychotic medication use increased significantly from 16% to 21% at discharge. There was persistent use of psychotropic medication among hospitalized older adults living with dementia and little evidence of deprescribing. There was some indication of changes made during hospitalization that may be appropriate, even without a focused deprescribing initiative.

Study Finds Higher-Dose Antipsychotic Polypharmacy Does Not Increase Hospitalization

Study Finds Higher-Dose Antipsychotic Polypharmacy Does Not Increase Hospitalization

Sex difference in association between tardive dyskinesia and cognitive deficits in patients with chronic schizophrenia.

Tardive dyskinesia (TD), a side effect due to long-term use of antipsychotic medication, is associated with cognitive impairment. Several studies have found sex differences in cognitive impairment in schizophrenia patients, while whether there are sex differences in cognitive performance in schizophrenia patients with TD has not been reported. A total of 496 schizophrenia inpatients and 362 healthy controls were recruited for this study. We used the Positive and Negative Syndrome Scale (PANSS) to assess patients' psychopathological symptoms and the Abnormal Involuntary Movement Scale (AIMS) to assess the severity of TD. Cognitive function was measured in 313 of these inpatients and 310 of healthy controls using the Repeatable Battery for Assessment of Neuropsychological Status (RBANS). Patients with schizophrenia performed worse in all cognitive domains than healthy controls(all p<0.001). Compared to patients without TD, patients with TD had higher PANSS total, PANSS negative symptom subscale and AIMS scores (all p<0.001), while RBANS total, visuospatial/constructional and attention subscale scores were significantly lower (all p<0.05). In addition, the visuospatial/constructional and attention indices remained significantly lower in male patients with TD than those without TD (both p<0.05), but these results were not observed in female patients. Moreover, visuospatial/constructional and attention indices were negatively correlated with total AIMS scores only in male patients (both p<0.05). Our results suggest that there may be sex differences in cognitive impairment in schizophrenia patients with comorbid TD, indicating that female gender may have a protective effect on cognitive impairment in schizophrenia patients caused by TD.

A Systematic Review on the Duration of Antipsychotic Exposure and the Risk of Cerebrovascular Events in Elderly Patients (P11-5.020)

<h3>Objective:</h3> To evaluate the impact of duration of exposure to antipsychotic medications on the risk of cerebrovascular events (CVE) in elderly patients. <h3>Background:</h3> The FDA issued black box warnings for typical (1st generation) and atypical (2nd generation) antipsychotic medications (APM) regarding an increased risk of stroke and death in elderly patients with dementia. Several studies have compared the cerebrovascular risk profiles of typical and atypical antipsychotic agents in elderly patients, but the influence of duration of antipsychotic exposure on this risk remains unclear. <h3>Design/Methods:</h3> A comprehensive literature search was performed on PubMed in June 2022, the results of which were systematically screened using predefined inclusion and exclusion criteria. Included articles adequately controlled for confounding variables and reported on the duration of continuous exposure to APM and the risk of CVE in patients over 65. Quality assessment of the included studies was performed using the Newcastle-Ottawa scoring system. <h3>Results:</h3> From the 7,515 articles generated by the search, five observational studies reporting on APM duration and CVE in elderly patients were selected based on quality as they satisfied the inclusion criteria. Four studies found that long-term (&gt; 90 days), but not short-term, use of typical APM conferred a greater CVE risk than atypical APM used for the same duration. One study including only patients with dementia did not identify a difference with short or long-term use of typical versus atypical APM. <h3>Conclusions:</h3> The duration of therapy with APM may influence the risk of CVE in elderly patients. Although atypical agents are associated with the development of metabolic syndrome, long-term use of typical APM may confer a greater risk of CVE than atypical APM. Differences in the risk of CVE are less salient in short-term use of APM. <b>Disclosure:</b> Mr. Devine has nothing to disclose. Dr. Memon has nothing to disclose.

Hepatitis B and C in individuals with a history of antipsychotic medication use: A population-based evaluation.

A better understanding of links between mental illness and risk of bloodborne infectious disease could inform preventive and therapeutic strategies in individuals with mental illness. We performed a cross-sectional study using the National Health and Nutrition Examination Survey (NHANES) to estimate the seroprevalence of hepatitis B and C in individuals with and without a prior prescription for antipsychotic medications, and to determine whether differences in seroprevalence could be explained by differential distribution in known infection risk factors. Multivariable logistic regression models were used to examine the association between receipt of antipsychotic medication and HBV and HCV seropositivity. Those who had HBV core antibody had 1.64 (95% CI: 0.89, 3.02) times the odds and those with HCV antibody (anti-HCV) had 3.48 (95% CI: 1.71, 7.09) times the odds of having a prescription for at least one antipsychotic medication compared to those who did not have HBV core antibody or HCV antibody, respectively. While prior antipsychotic receipt was a potent risk marker for HCV seropositivity, risk was explained by adjusting for known bloodborne infection risk factors (adjusted ORs 1.01 [95% CI: 0.50, 2.02] and 1.38 [95% CI: 0.44, 4.36] for HBV and HCV, respectively). Prior receipt of antipsychotic medications is a strong predictor of HCV (and to a lesser extent HBV) seropositivity. Treatment with antipsychotic medications should be considered as additional risk markers for individuals who may benefit from targeted prevention, screening, and harm reduction interventions for HCV.

Frequency of delirium and its associated factors among COVID-19 inpatients in Iran.

Delirium has been presented as the leading cause of sudden change in the mental state of patients with coronavirus disease 2019 (COVID-19). Given that the delayed diagnosis of such a dysfunction is often associated with excess mortality, it seems essential to devote vastly more attention to this significant clinical characteristic. This cross-sectional study was performed on 309 patients [viz. 259 cases hospitalized in general wards and 50 individuals admitted to the intensive care unit (ICU)]. For this purpose, a Demographic-Clinical Information Questionnaire, the Confusion Assessment Method (CAM), the Confusion Assessment Method for the ICU (CAM-ICU), the Richmond Agitation-Sedation Scale (RASS) and face-to-face interviews were completed by a trained senior psychiatry resident. The data analysis was further done with the SPSS Statistics V22.0 software package. Out of 259 patients admitted to the general wards and 50 cases in the ICU due to COVID-19, 41 (15.8%) and 11 (22%) individuals were diagnosed with delirium, respectively. As well, a significant relationship was observed between the incidence rate of delirium and age (p< 0.001), level of education (p< 0.001), hypertension (HTN) (p= 0.029), a history of stroke (p= 0.025), a history of ischemic heart disease (IHD) (p= 0.007), a history of psychiatric disorders, a history of cognitive impairment (p< 0.001), use of hypnotic and antipsychotic medications (p< 0.001) and a history of substance abuse (p= 0.023). Among 52 patients with delirium, only 20 cases had received psychiatric consultation by consultation-liaison psychiatry service for the possibility of delirium. In view of the high frequency of delirium among COVID-19 inpatients, their screening for this important mental state should be a priority in clinical settings.

Mortality risk in adults with intellectual disabilities and epilepsy: an England and Wales case-control study.

People with epilepsy (PWE) and people with intellectual disabilities (ID) both live shorter lives than the general population and both conditions increase the risk of death further. We aimed to measure associations between certain risk factors for death in PWE and ID. A retrospective case-control study was conducted in ten regions in England and Wales. Data were collected on PWE registered with secondary care ID and neurology services between 2017 and 2021. Prevalence rates of neurodevelopmental, psychiatric and medical diagnoses, seizure frequency, psychotropic and antiseizure medications (ASM) prescribed, and health activity (epilepsy reviews/risk assessments/care plans/compliance etc.) recorded were compared between the two groups. 190 PWE and ID who died were compared with 910 living controls. People who died were less likely to have had an epilepsy risk assessment but had a greater prevalence of genetic conditions, older age, poor physical health, generalized tonic-clonic seizures, polypharmacy (not ASMs) and antipsychotic use. The multivariable logistic regression for risk of epilepsy-related death identified that age over 50, medical condition prevalence, antipsychotic medication use and the lack of an epilepsy review in the last 12months as associated with increased risk of death. Reviews by psychiatrists in ID services was associated with a 72% reduction in the odds of death compared neurology services. Polypharmacy and use of antipsychotics may be associated with death but not ASMs. Greater and closer monitoring by creating capable health communities may reduce the risk of death. ID services maybe more likely to provide this holistic approach.

Assessment of Neuroanatomical Endophenotypes of Autism Spectrum Disorder and Association With Characteristics of Individuals With Schizophrenia and the General Population

Autism spectrum disorder (ASD) is associated with significant clinical, neuroanatomical, and genetic heterogeneity that limits precision diagnostics and treatment. To assess distinct neuroanatomical dimensions of ASD using novel semisupervised machine learning methods and to test whether the dimensions can serve as endophenotypes also in non-ASD populations. This cross-sectional study used imaging data from the publicly available Autism Brain Imaging Data Exchange (ABIDE) repositories as the discovery cohort. The ABIDE sample included individuals diagnosed with ASD aged between 16 and 64 years and age- and sex-match typically developing individuals. Validation cohorts included individuals with schizophrenia from the Psychosis Heterogeneity Evaluated via Dimensional Neuroimaging (PHENOM) consortium and individuals from the UK Biobank to represent the general population. The multisite discovery cohort included 16 internationally distributed imaging sites. Analyses were performed between March 2021 and March 2022. The trained semisupervised heterogeneity through discriminative analysis models were tested for reproducibility using extensive cross-validations. It was then applied to individuals from the PHENOM and the UK Biobank. It was hypothesized that neuroanatomical dimensions of ASD would display distinct clinical and genetic profiles and would be prominent also in non-ASD populations. Heterogeneity through discriminative analysis models trained on T1-weighted brain magnetic resonance images of 307 individuals with ASD (mean [SD] age, 25.4 [9.8] years; 273 [88.9%] male) and 362 typically developing control individuals (mean [SD] age, 25.8 [8.9] years; 309 [85.4%] male) revealed that a 3-dimensional scheme was optimal to capture the ASD neuroanatomy. The first dimension (A1: aginglike) was associated with smaller brain volume, lower cognitive function, and aging-related genetic variants (FOXO3; Z = 4.65; P = 1.62 × 10-6). The second dimension (A2: schizophrenialike) was characterized by enlarged subcortical volumes, antipsychotic medication use (Cohen d = 0.65; false discovery rate-adjusted P = .048), partially overlapping genetic, neuroanatomical characteristics to schizophrenia (n = 307), and significant genetic heritability estimates in the general population (n = 14 786; mean [SD] h2, 0.71 [0.04]; P < 1 × 10-4). The third dimension (A3: typical ASD) was distinguished by enlarged cortical volumes, high nonverbal cognitive performance, and biological pathways implicating brain development and abnormal apoptosis (mean [SD] β, 0.83 [0.02]; P = 4.22 × 10-6). This cross-sectional study discovered 3-dimensional endophenotypic representation that may elucidate the heterogeneous neurobiological underpinnings of ASD to support precision diagnostics. The significant correspondence between A2 and schizophrenia indicates a possibility of identifying common biological mechanisms across the 2 mental health diagnoses.

Abstract 1932: Evaluation of racial and ethnic psychotropic medication use among patients with colorectal cancer

Abstract Background: Colorectal cancer (CRC) is the 4th most common cancer type in the US. Following CRC treatment, about 37% of CRC survivors experience symptoms associated with anxiety and depression. Additionally, psychosocial distress is especially prevalent among CRC survivors with a stoma, and those reporting CRC-induced sexual dysfunction. Pharmacotherapy is one of the mainstay treatment options for psychological distress among patients with CRC. Research has shown that racial disparities are present with the use of supportive care medications in other cancer types. However, this has not been explored with the use of psychotropic medication for patients with CRC. The purpose of this research is to evaluate the presence of racial disparities in psychotropic medication use among patients with CRC. Methods: Utilizing the National Cancer Institute Surveillance Epidemiology and End Results (NCI SEER)- Medicare linked database, our analysis included all patients with a CRC diagnosis and an active outpatient prescription claims for psychotropic medications from 2009-2018. Prescription claims were specific to patients diagnosed with CRC and stratified by self-identified race and ethnicity. Patients who were on psychotropic medications before CRC diagnosis, or unspecified race or ethnicity were excluded from the analysis. Psychotropic medications consisted of anxiolytics, antidepressants, and antipsychotic medications. Results: 136,014 participants were included in the analysis. The racial and ethnic breakdown comprised of 81.56% White, 11.22% African American (AA), 2.66% Hispanic, 4.27% Asian/Pacific Islander (API), and 0.25% Native American (NA). Results are presented as unadjusted odds ratios (OR) and 95% confidence intervals (CI). Compared to White patients, AA (OR 0.53; 95% CI 0.50-0.56), API (OR 0.50; 95% CI 0.46-0.54), Hispanic (OR 0.64; 95% CI 0.58-0.71), and NA (OR 0.59; 95% CI 0.43-0.81) patients had lower utilization of anxiolytic medications. Regarding antidepressant use, AA (OR 0.55; 95% CI 0.53-0.57), API (OR 0.46; 95% CI 0.43-0.49), Hispanic (OR 0.73; 95% CI 0.68-0.79), and NA (OR 0.78; 95% CI 0.63-0.96) had lower utilization compared to White patients. Differences in antipsychotic medication use was observed with Asian/Pacific Islanders (OR 0.71; 95% CI 0.64-0.78) and Native Americans (OR 0.49; 95% CI 0.31-0.76) compared to White patients. No other racial differences in antipsychotic medications were identified. Conclusion: The study showed that racial and ethnic disparities are present with the use of psychotropic medications among patients with CRC. Racial and ethnic minority patients had lower use for most of the drug classes evaluated. Further research is warranted to assess the potential barriers and facilitators of psychotropic medication use among patients belonging to historically minoritized racial and ethnic groups. Citation Format: MegCholack Awunti, Yi Guo, Sherise Rogers, Lisa Scarton, Diana Wilkie, John Allen. Evaluation of racial and ethnic psychotropic medication use among patients with colorectal cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1932.

Effect of a Delirium Screening Tool on Antipsychotic Medication Use in a Pediatric Intensive Care Unit.

Intensive care unit (ICU) delirium has been associated with increased length of hospital stay, morbidity, mechanical ventilation, and health care resource utilization. Antipsychotics are frequently used for ICU delirium management, despite a lack of robust evidence in the literature to support their benefit. Delirium screening may result in pharmacologic or non-pharmacologic treatment. In January 2019 we began screening patients admitted to the pediatric ICU (PICU) for delirium using the Cornell Assessment for Pediatric Delirium (CAPD). We compared prescribing rates of antipsychotic medications before and after implementation. We also assessed length of hospital and ICU stay prior to initiating therapy, delirium score prior to initiation of therapy, time after initiation of therapy until score decreased to a level not suggestive of delirium, and continuation of antipsychotics outside of the PICU. We did not observe a difference in the rate of antipsychotics use. There was, however, an increase in variability between pre- and post-intervention rates of prescribing. Patients who received an antipsychotic medication were hospitalized for an average of 18 days and in the ICU for 14 days prior to the first dose of an antipsychotic agent. They had an average CAPD score of 16, and had an average of 4 scores above 8 prior to starting treatment. This study highlights the need for additional research to demonstrate the role of antipsychotic medications in managing delirium in the PICU.

Large-scale analysis of structural brain asymmetries in schizophrenia via the ENIGMA consortium

Left-right asymmetry is an important organizing feature of the healthy brain that may be altered in schizophrenia, but most studies have used relatively small samples and heterogeneous approaches, resulting in equivocal findings. We carried out the largest case-control study of structural brain asymmetries in schizophrenia, with MRI data from 5,080 affected individuals and 6,015 controls across 46 datasets, using a single image analysis protocol. Asymmetry indexes were calculated for global and regional cortical thickness, surface area, and subcortical volume measures. Differences of asymmetry were calculated between affected individuals and controls per dataset, and effect sizes were meta-analyzed across datasets. Small average case-control differences were observed for thickness asymmetries of the rostral anterior cingulate and the middle temporal gyrus, both driven by thinner left-hemispheric cortices in schizophrenia. Analyses of these asymmetries with respect to the use of antipsychotic medication and other clinical variables did not show any significant associations. Assessment of age- and sex-specific effects revealed a stronger average leftward asymmetry of pallidum volume between older cases and controls. Case-control differences in a multivariate context were assessed in a subset of the data (N = 2,029), which revealed that 7% of the variance across all structural asymmetries was explained by case-control status. Subtle case-control differences of brain macrostructural asymmetry may reflect differences at the molecular, cytoarchitectonic, or circuit levels that have functional relevance for the disorder. Reduced left middle temporal cortical thickness is consistent with altered left-hemisphere language network organization in schizophrenia.

Psychiatric Morbidity in Women With Previous Gestational Diabetes Mellitus: A Nationwide Register-Based Cohort Study.

To investigate associations between previous gestational diabetes mellitus (GDM) and incident psychiatric morbidity, and to explore the role of subsequent diabetes development in psychiatric morbidity risk. A nationwide register-based cohort study including all women delivering in Denmark from 1997 to 2018 was conducted. GDM exposure was based on diagnosis code, whereas psychiatric morbidity outcome was based on diagnosis code and psychopharmacological medication use. Multiple Cox regression and mediation analyses were performed. In a study population of 660,017 women, previous GDM was associated with increased risk of depression based on diagnosis code and/or medication use (adjusted hazard ratio [aHR] 1.22 [95% CI 1.18-1.27]), any psychiatric diagnosis (aHR 1.20 [95% CI 1.13-1.27]), and any psychopharmacological medication use (aHR 1.21 [95% CI 1.17-1.25]). Moreover, risk of depressive and anxiety disorders, as well as antidepressant and antipsychotic medication use, was increased, with aHRs ranging from 1.14 (95% CI 1.05-1.25) to 1.32 (95% CI 1.22-1.42). No associations were found regarding substance use disorders, psychotic disorders, bipolar disorders, postpartum psychiatric disease, or anxiolytic medication use. Psychiatric morbidity risk was higher in women with versus without subsequent diabetes development. However, GDM history affected risk estimates only in women without subsequent diabetes. Subsequent diabetes mediated 35-42% of the associations between GDM and psychiatric morbidity. GDM was associated with increased psychiatric morbidity risk. Subsequent diabetes development played a significant role in future psychiatric morbidity risk after GDM, although it only partly explained the association.

The effect of telemental versus in-person mental health consults in the emergency department on 30-day utilization and processes of care.

We sought to characterize how telemental health (TMH) versus in-person mental health consults affected 30-day postevaluation utilization outcomes and processes of care in Veterans presenting to the emergency department (ED) and urgent care clinic (UCC) with acute psychiatric complaints. This exploratory retrospective cohort study was conducted in an ED and UCC located in a single Veterans Affairs system. A mental health provider administered TMH via iPad. The primary outcome was a composite of return ED/UCC visits, rehospitalizations, or death within 30 days. The following processes of care were collected during the index visit: changes to home psychiatric medications, admission, involuntary psychiatric hold placement, parenteral benzodiazepine or antipsychotic medication use, and physical restraints or seclusion. Data were abstracted from the Veterans Affairs electronic health record and the Clinical Data Warehouse. Multivariable logistic regression was performed. Adjusted odds ratios (aORs) with their 95% confidence intervals (95% CIs) were reported. Of the 496 Veterans in this analysis, 346 (69.8%) received TMH, and 150 (30.2%) received an in-person mental health evaluation. There was no significant difference in the primary outcome of 30-day return ED/UCC, rehospitalization, or death (aOR 1.47, 95% CI 0.87-2.49) between the TMH and in-person groups. TMH was significantly associated with increased ED/UCC length of stay (aOR 1.46, 95% CI 1.03-2.06) and decreased use of involuntary psychiatric holds (aOR 0.42, 95% CI 0.23-0.75). There were no associations between TMH and the other processes-of-care outcomes. TMH was not significantly associated with the 30-day composite outcome of return ED/UCC visits, rehospitalizations, and death compared with traditional in-person mental health evaluations. TMH was significantly associated with increased ED/UCC length of stay and decreased odds of placing an involuntary psychiatric hold. Future studies are required to confirm these findings and, if confirmed, explore the potential mechanisms for these associations.

Association between priapism and HIV disease and treatment.

Priapism, a urologic emergency, has known associations with certain medical conditions. Many cases are idiopathic, suggesting an opportunity to identify novel risk factors. We sought to identify medical conditions and pharmaceutical treatments that are associated with priapism using data-mining techniques. Using deidentified data in a large insurance claims database, we identified all men (age ≥20 years) with a diagnosis of priapism from 2003 to 2020 and matched them to cohorts of men with other diseases of male genitalia: erectile dysfunction, Peyronie disease, and premature ejaculation. All medical diagnoses and prescriptions used prior to first disease diagnosis were examined. Predictors were selected by random forest, and conditional multivariate logistic regressions were applied to assess the risks of each predictor. We identified novel relationships of HIV and some HIV treatments with priapism and confirmed existing associations. An overall 10 459 men with priapism were identified and matched 1:1 to the 3 control groups. After multivariable adjustment, men with priapism had high associations of hereditary anemias (odds ratio [OR], 3.99; 95% CI, 2.73-5.82), use of vasodilating agents (OR, 2.45; 95% CI, 2.01-2.98), use of HIV medications (OR, 1.95; 95% CI, 1.36-2.79), and use of antipsychotic medications (OR, 1.90; 95% CI, 1.52-2.38) as compared with erectile dysfunction controls. Similar patterns were noted when compared with premature ejaculation and Peyronie disease controls. HIV and its treatment are associated with priapism, which may affect patient counseling. To our knowledge, this is the first study to identify risk factors for priapism utilizing machine learning. All men in our series were commercially insured, which limits the generalizability of our findings. Using data-mining techniques, we confirmed existing associations with priapism (eg, hemolytic anemias, antipsychotics) and identified novel relationships (eg, HIV disease and treatment).

Antipsychotic Medication Use Among Older Adults Following Infection-Related Hospitalization

There are limited data on discontinuation rates of antipsychotic medications (APMs) used to treat delirium due to acute hospitalization in the routine care of older adults. To investigate discontinuation rates and patient characteristics of APMs used to treat delirium following infection-related hospitalization among older US adults. This retrospective cohort study was conducted using US claims data (Optum's deidentified Clinformatics Data Mart database) for January 1, 2004, to May 31, 2022. Patients were aged 65 years or older without prior psychiatric disorders and had newly initiated an APM prescription within 30 days of an infection-related hospitalization. Statistical analysis was performed on December 15, 2022. New use (no prior use any time before cohort entry) of oral haloperidol and atypical APMs (aripiprazole, olanzapine, quetiapine, risperidone, etc). The primary outcome was APM discontinuation, defined as a gap of more than 15 days following the end of an APM dispensing. Survival analyses and Kaplan-Meier analyses were used. Our study population included 5835 patients. Of these individuals, 790 (13.5%) were new haloperidol users (mean [SD] age, 81.5 [6.7] years; 422 women [53.4%]) and 5045 (86.5%) were new atypical APM users (mean [SD] age, 79.8 [7.0] years; 2636 women [52.2%]). The cumulative incidence of discontinuation by 30 days after initiation was 11.4% (95% CI, 10.4%-12.3%) among atypical APM users and 52.1% (95% CI, 48.2%-55.7%) among haloperidol users (P < .001 for difference between haloperidol vs atypical APMs). We observed an increasing trend in discontinuation rates from 2004 to 2022 (5% increase [95% CI, 3%-7%] per year) for haloperidol users (adjusted hazard ratio, 1.05 [1.03-1.07]; P < .001) but not for atypical APM users (1.00 [0.99-1.01]; P = .67). Prolonged hospitalization and dementia were inversely associated with the discontinuation of haloperidol and atypical APMs. The findings of this cohort study suggest that the discontinuation rate of newly initiated APMs for delirium following infection-related hospitalization was lower in atypical APM users than in haloperidol users, with prolonged hospitalization and dementia as major associated variables. The discontinuation rate was substantially higher in recent years for haloperidol but not for atypical APMs.

The temporal dynamics of mood and their association with depressive symptoms in Huntington's disease

BackgroundHuntington's disease (HD) is an inherited neurodegenerative disorder characterised by progressive motor abnormalities, cognitive decline, and neuropsychiatric disturbances. Depression is among the most common neuropsychiatric syndromes in HD. Research in neurologically healthy samples has shown that depression is associated with distinct patterns of short-term fluctuations in mood, which may exacerbate negative effects on psychological wellbeing. The short-term dynamics of mood and their relationship with depression have not yet been investigated in HD. MethodsFifty-five adults with the HD CAG expansion (33 pre-manifest, 22 manifest) completed single timepoint measures of depression, demographic factors, and clinical disease outcomes on day 1, then rated their mood daily for 28 consecutive days. Average mood, mood variability, and mood inertia (auto-correlation) were calculated across the 28 days. ResultsDepression severity on day 1 was significantly associated with average mood across the 28 days, but not with day-to-day mood variability or inertia. Additionally, female HD CAG expansion carriers experienced more day-to-day variability in mood compared to males. LimitationsOur sample did not include HD CAG expansion carriers with severe depressive symptoms or advanced HD, which limits the generalisability of the findings. Additionally, findings may have been affected by antidepressant and antipsychotic medication use among many participants. ConclusionsIn HD, short-term patterns of change in mood appear to be relatively independent of depression severity. Moreover, in female CAG-expansion carriers particularly, mood variability may warrant further clinical attention. These findings should be replicated in larger and more diverse samples, with different timescales and measures for assessing mood.

A Systematic Review of the Need for Guideline Recommendations; Slow Tapering vs. Maintenance Dose in Long-Term Antipsychotic Treatment: 2022.

The act of discontinuing the antipsychotic medication may be directlyassociated with relapse. This relationship might be due to adaptations that continue to exist after treatment is stopped, such as dopaminergic hypersensitivity. Therefore, more progressive weaning off antipsychotic medication may help reduce the likelihood of relapse when the medication is stopped. As there is a need to gradually reduce or stop using antipsychotic medication, our team tried to conduct a more in-depth search to give further answers to the suggested recommendations. Around 192 articles were gathered for our research, but we could only narrow our search to 36, which were further filtered, and eight were used.We went through all of the pertinent information available until May 2022 and reviewed it to determine the risks associated with prolonged antipsychotic usage and abrupt cessation in the psychotic spectrum of diseases. PubMed, Google Scholar, and Psychiatry Online were the databases used, and the keywords that were looked for and utilized were antipsychotics, tapering, relapse, maintenance dosage, schizophrenia, and psychosis. The recurrence incidence was high in patients in whom antipsychotics were stopped and in whom the dosage was quickly lowered.Patients who were gradually weaned off their antipsychotic medication and kept on the lowest effective dose had a much lower risk of experiencing a relapse. We suggest more studies, including randomized clinical trials and monitoring, considering the enhancement of guidelines for the total cessation of antipsychotic medication use.

Comparative Study of Extrapyramidal Side Effects, Sexual Dysfunctions and Hyperprolactinaemia Using Typical and Atypical Antipsychotic Medications Among Patients with Schizophrenia in Maiduguri.

Extra-pyramidal side effects, sexual dysfunctions and hyperprolactinaemia are major side effects with the use of antipsychotic medications that impede treatment adherence leading to relapse, increased cost of care and rehospitalization among patients with schizophrenia on antipsychotic medications. The study aims to compare the prevalence of extra-pyramidal side effects (EPSE), sexual dysfunctions (SD) and hyperprolactinaemia (HPRL) among patients with schizophrenia spectrum disorders on typical and atypical antipsychotic medications. The secondary aim is to determine if any associations exist between extra-pyramidal side effects, sexual dysfunctions and hyperprolactinaemia. A cross-sectional hospital-based survey involving 209 patients with schizophrenia were interviewed with structured instruments for the assessment of sexual dysfunction, EPSE and the estimation of serum prolactin was done using Enzyme-linked Immunosorbent Assay. Frequencies and Chi-square analysis were used to compare differences in EPSE, SD & HPRL. The study revealed non-statistically significant differences as a group between typical and atypical antipsychotic medication in terms of extra-pyramidal side effects, sexual dysfunction and hyperprolactinaemia. However, a significant association was observed when individual drugs were compared with haloperidol causing the highest frequency of hyperprolactinaemia (χ 2 = 14.9, P = 0.011). A significant relationship between sexual dysfunction and hyperprolactinaemia, sexual dysfunction and extra-pyramidal side effects as well as extra-pyramidal and hyperprolactinaemia was found when individual items for sexual functionin were used. The significant relationships between sexual dysfunction only in the domains of sexual desire and arousal with hyperprolactinaemia and extrapyramidal side effects as well as hyperprolactinaemia with extrapyramidal side effects point to a common anti-dopaminergic activity of antipsychotics via different pathways. Prospective studies among a larger sample of patients with schizophrenia are needed to unfold these relationships.

Psychological distress during the Covid-19 pandemic: an analysis of antipsychotic drug usage patterns in a sample of Italian residents.

The ongoing pandemic has not only placed significant strain on healthcare systems and global economies but has also exacerbated psychiatric issues, undermining the mental well-being of countless individuals. It is widely recognized that epidemic events, particularly periods of lockdown, heighten the risk of developing anxiety disorders, depression, and aggressive behaviors. In an Italian cohort, a retrospective study was conducted to examine the consumption and costs of antipsychotic medications during and after the Covid-19 pandemic, specifically in the years 2020-2022. Utilizing a database known as the "Sistema Tessere Sanitaria", data on medication dispensations from publicly accessible community pharmacies were extracted, covering a population of approximately one million individuals. The findings for the years 2020-2021 showed relatively stable patterns, with overall consumption and expenditure slightly decreasing from 2020 to 2021. However, it is worth noting that the antipsychotic drug aripiprazole exhibited an opposite trend, with an increase in consumption. Despite expectations of heightened antipsychotic medication use, real-world evidence indicates a different phenomenon, suggesting that the pandemic might not have significantly influenced the consumption of these medications. The limited accessibility to healthcare and medical appointments likely played a role in this observation, potentially masking the therapeutic needs of the population. It will be crucial to monitor the situation in the upcoming years, as normal clinical activities resume, to determine whether there will be an upsurge in the consumption of antipsychotic drugs, which represent a significant portion of the National Healthcare System's expenditure.