Prescription Of Anxiolytics Research Articles

Fall-risk-increasing drugs and falls requiring health care among older people with intellectual disability in comparison with the general population: A register study.

BackgroundFalls are the most common cause of injury for older people in the general population as well as among those with intellectual disability. There are many risk factors for falls, including a range of drugs which are considered to be fall-risk-increasing (FRIDs). The aim of the present study was to describe prescription patterns of FRIDs in itself as well as in relation to falls requiring health care among older people with intellectual disability and their age-peers in the general population. Moreover, to investigate possible differences between the two groups.MethodsA cohort of people with intellectual disability and a referent cohort, one-to-one-matched by sex and year of birth, were established. Each cohort comprised 7936 people aged 55+ years at the end of 2012. Register data were collected for 2006–2012 on prescription of antidepressants, anxiolytics, hypnotics and sedatives, opioids, and antipsychotics, as well as for fall-related health care contacts. Analyses were performed on yearly data, using repeated measures models.ResultsPeople with intellectual disability were more likely to be prescribed at least one FRID (Relative Risk [RR] 2.31). The increase was highest for antipsychotics (RR 25.0), followed by anxiolytics (RR 4.18), antidepressants (RR 2.72), and hypnotics and sedatives (RR 1.42). For opioids, however, a lower prevalence (RR 0.74) was found. In both cohorts, those with prescription of at least one FRID were more likely to have a fall-related injury that required health care. The increased risk was higher in the referent cohort (RR 3.98) than among people with intellectual disability (RR 2.27), although people with intellectual disability and prescription still had a higher risk of falls than those with prescription in the referent cohort (RR 1.27). A similar pattern was found for all drug groups, except for opioids, where prescription carried the same risk of having a fall-related injury that required health care in both cohorts.ConclusionsWith or without prescription of FRIDs, older people with ID have a higher risk of falls requiring health care than their age-peers in the general population. It is important to be aware of this when prescribing drugs that further increase the risk of falls.

MS 20171377 / Smitherman et al - Increased prescription drug use immediately after childhood cancer

The Childhood Cancer Survivorship Study (https://ccss.stjude.org/) has documented the many long-term effects of childhood cancer and therapy among a cohort of survivors treated multiple years earlier. Do these chronic medical morbidities arise early in the post-therapy period and what is the extent of prescription drug use starting in the first year off therapy? Smitherman et al report in this volume of The Journal an historical cohort study, using MarketScan commercial data base claims, to identify children who had leukemia, lymphoma, central nervous system tumors, bone cancers, or gonadal cancers, completed therapy from 2000 to 2011, and then had 3 years of follow up. Throughout the study period, survivors were at significantly higher risk for filling prescriptions for opioids, antidepressants, anxiolytics, and angiotensin-converting enzyme inhibitors. These findings suggest the emergence of chronic medical morbidities very early in post-therapy period. Furthermore, even though prior studies have shown increased use of drugs among survivors of childhood cancer, this study shows high rates of physical and psychological morbidity immediately after treatment in a cohort of patients treated in a very recent epoch. The heightened used of anxiolytics and opioids is striking and might even hint at overuse or over-prescription. Further understanding of these drug prescription patterns is warranted. Article page 161 ▶ Early Post-Therapy Prescription Drug Usage among Childhood and Adolescent Cancer SurvivorsThe Journal of PediatricsVol. 195PreviewTo describe the patterns of prescription drug use among child and adolescent survivors of cancer in the early post-therapy period compared with matched peers without a cancer history. Full-Text PDF

Distress screening, intervention, and follow-up outcomes among Hispanic and Caucasian women with newly diagnosed breast cancer.

163 Background: We describe acceptance and impact of mental health (MH) interventions provided to an English speaking Caucasian and Spanish speaking Hispanic female breast cancer (BC) population reporting symptoms of depression and anxiety. Methods: Records of 170 women with newly diagnosed BC at Cancer Centers of Colorado at SCL Health/Saint Joseph Hospital in 2015 were retrospectively assessed for record of a distress screening questionnaire (DSQ), administered in each patients’ native language. Among patients who reported psychosocial distress (PD), records were reviewed for an outreach phone call and visit with social work (SW) or MH, new antidepressant or anxiolytic prescription, and completion of a second DSQ. SCL Health IRB approval obtained. Results: Of 170 subjects, 94 (68% (n = 64) Caucasian, 19% (n = 18) Hispanic, 13% (n = 12) other) completed an initial DSQ. Scores reflecting PD were seen in 57 DSQs; 15 were high-grade PD (HPD). Nearly half (49%; n = 28) of those with PD had been called by MH or SW; 93% (n = 14) with HPD were called. Anxiety scores (AS) improved in 78% (n = 18) and depression scores (DS) in 74% (n = 17) of subjects called. AS and DS improved in 67% (n = 8) and 75% (n = 9), respectively, of Caucasian patients and in 89% (n = 8) and 67% (n = 6) of Hispanic patients called. Of 35 patients who completed follow-up DSQ, 17 visited with MH or SW. AS and DS improved in 65% (n = 11) of these. Improved AS and DS were seen in 38% (n = 3) and 63% (n = 5) of Caucasian patients, respectively, and 88% (n = 7) and 63% (n = 5) of Hispanic patients who had a visit. An antidepressant or anxiolytic was prescribed for 7 patients; AS and DS improved for 33% (n = 1) of Caucasian patients and 67% (n = 2) of Hispanic patients given prescriptions. Conclusions: Outreach to patients with PD and HPD correlated with improved AS and DS. Hispanics were more likely than Caucasians to accept a visit from MH or SW and were more likely to improve AS and DS following a visit with these services or antidepressant or anxiolytic prescription, demonstrating the importance of intervention in this group. This study does not account for patients’ initial staging, progression or regression, therapy pursued, nor presence of other psychosocial concern.

No Impact of Preadmission Anti-Inflammatory Drug Use on Risk of Depression and Anxiety After Critical Illness.

Risk of depression and anxiety is elevated after intensive care. Drugs with anti-inflammatory properties may have antidepressant and anxiolytic effects. The aim of this study was to investigate the association between preadmission use of drugs with anti-inflammatory effects and risk of new-onset depression and anxiety among adult patients admitted to an ICU. Propensity score-matched, population-based cohort study. All ICUs in Denmark from 2005 to 2013. Adults receiving mechanical ventilation in an ICU. None. A total of 48,207 ICU patients were included. Exposures were preadmission single-agent or combined use of statins, nonsteroidal anti-inflammatory drugs, or glucocorticoids. Outcomes were cumulative incidence (risk) and risk ratio of new-onset psychiatrist-diagnosed depression or anxiety or prescriptions for antidepressants or anxiolytics. Propensity score matching yielded 6,088 statin user pairs, 2,886 nonsteroidal anti-inflammatory drug user pairs, 1,440 glucocorticoid user pairs, and 1,743 combination drug user pairs. The cumulative incidence of anxiety and depression during the 3 years following intensive care was 18.0% (95% CI, 17.0-19.0%) for statin users, 21.3% (95% CI, 19.8-22.9%) for nonsteroidal anti-inflammatory drug users, 17.4% (95% CI, 15.4-19.5%) for glucocorticoid users, and 19.0% (95% CI, 16.3-20.2%) for combination users. The cumulative incidence was similar in nonusers compared with users in all drug groups. The risk ratio of depression and anxiety 3 years after admission to ICU was 1.04 (95% CI, 0.96-1.13) for statin users, 1.00 (95% CI, 0.90-1.11) for nonsteroidal anti-inflammatory drug users, 0.97 (95% CI, 0.82-1.14) for glucocorticoid users, and 1.05 (95% CI, 0.90-1.21) for combination users, compared with nonusers. Results were consistent across subgroups (gender, age, preadmission diseases, type of admission) and sensitivity analyses (depression and anxiety separately). Preadmission use of statins, nonsteroidal anti-inflammatory drugs, glucocorticoids, or combinations did not alter the risk of depression and anxiety after critical illness.

Depression and Anxiety in the Postpartum Period and Risk of Bipolar Disorder: A Danish Nationwide Register-Based Cohort Study.

The first-onset affective episode requiring inpatient treatment in the postpartum period can be a marker of bipolar disorder, but it is unknown whether milder postpartum affective episodes are also indicators of underlying bipolarity. Therefore, we aimed to study whether women with a nonpsychotic postpartum affective episode treated with antidepressants have an increased risk of bipolar disorder. A register-based cohort study was conducted in Denmark of 122,622 parous women without psychiatric history who received a first-time antidepressant prescription during 1997-2012. We compared women with a first-time antidepressant prescription, which was our indicator of a first-onset affective disorder, within 1 year postpartum to women with a first-time antidepressant prescription outside the postpartum period. Our outcome was psychiatric contact for bipolar disorder (ICD-10 criteria) during follow-up, and we estimated hazard ratios using Cox regressions. The risk of bipolar disorder among women with a postpartum affective episode was higher than that in women with an affective episode outside the postpartum period. The risk of bipolar disorder was 1.66 (95% CI, 1.12-2.48) for postpartum antidepressant monotherapy and 10.15 (95% CI, 7.13-14.46) for postpartum antidepressant therapy plus a subsequent prescription for anxiolytics when these therapies were compared to antidepressant monotherapy outside the postpartum period. First-onset nonpsychotic postpartum affective disorder can be a marker of underlying bipolarity. Women who fill an antidepressant prescription following childbirth should be asked about hypomanic or manic symptoms and monitored long term. Clinically, when antidepressant monotherapy is ineffective or the individual woman experiences persistent and concerning symptoms, health professionals should consider a possible bipolar spectrum disorder.

Association between bystander cardiopulmonary resuscitation and redeemed prescriptions for antidepressants and anxiolytics in out-of-hospital cardiac arrest survivors

AimThis study aimed to examine rates of redeemed prescriptions of antidepressants and anxiolytics, used as markers for cerebral dysfunction in out-of-hospital cardiac arrest (OHCA) survivors, and examine the association between bystander CPR and these psychoactive drugs. MethodsWe included all 30-day survivors of OHCA in Denmark between 2001 and 2011, who had not redeemed prescriptions for antidepressants or anxiolytics in the last six months prior to OHCA. Main outcome measures were redeemed prescriptions of antidepressants and anxiolytics within one year after OHCA. ResultsAmong 2,001 30-day survivors, 174 (8.6% died and 12.0% redeemed a first prescription for an antidepressant and 8.2% for an anxiolytic drug within one year after arrest. The corresponding frequencies for redeemed prescribed drugs among age- and sex-matched population controls were 7.5% and 5.2%, respectively. Among survivors who received bystander CPR, prescriptions for antidepressants and anxiolytics were redeemed in 11.1% [95% CI 9.2–13.3%] and 6.3% [95% CI 4.9–8.0%] of the cases, respectively, versus 17.2% [95% CI 13.9–21.1%] and 13.4% [95% CI 10.5–17.0%], respectively, among patients who had not received bystander CPR. Adjusted for age, sex, year of arrest, comorbidity, witnessed status and socioeconomic status, bystander CPR was associated with significant reductions in redeemed prescriptions for antidepressants, Hazard Ratio (HR) 0.71 [95% CI 0.52–0.98], P=0.031; and anxiolytics, HR 0.55 [95% CI 0.38–0.81], P=0.002. ConclusionRelative to no bystander CPR, redeemed prescriptions for antidepressants and anxiolytics were significantly lower among 30-day survivors of OHCA who received bystander CPR, suggesting a cerebral dysfunction-lowering potential of bystander CPR.

The Use of Antidepressants, Anxiolytics, and Hypnotics in People with Type 2 Diabetes and Patterns Associated with Use: The Hoorn Diabetes Care System Cohort.

Objective. With depression being present in approximately 20% of people with type 2 diabetes mellitus (T2DM), we expect equally frequent prescription of antidepressants, anxiolytics, and hypnotics. Nevertheless, prescription data in people with T2DM is missing and the effect of depression on glycaemic control is contradictory. The aim of this study was to assess the prevalence of antidepressants, anxiolytics, and/or hypnotics use in a large, managed, primary care system cohort of people with T2DM and to determine the sociodemographic characteristics, comorbidities, T2DM medication, and metabolic control associated with its use. Method. The prevalence of antidepressants, anxiolytics, and/or hypnotics use in the years 2007–2012 was assessed in the Hoorn Diabetes Care System Cohort from the Netherlands. Results. From the 7016 people with T2DM, 500 people (7.1%) used antidepressants only, 456 people (6.5%) used anxiolytics and/or hypnotics only, and 254 people (3.6%) used a combination. Conclusion. We conclude that in our managed, primary care system 17% of all people with T2DM used antidepressants, anxiolytics, and/or hypnotics. Users of antidepressants, anxiolytics, and/or hypnotics were more often female, non-Caucasian, lower educated, and more often treated with insulin.

Prevalence and correlates of coprescribing anxiolytic medications with extensive prescription opioid use in Veterans Health Administration patients with metastatic cancer.

To examine the prevalence and correlates of concomitant anxiolytic prescription fills in Veterans Health Administration (VHA) patients with metastatic cancer who have extensive prescription opioid use. National VHA data for fiscal year 2012 were used to identify veterans diagnosed with metastatic cancer (ICD-9 codes 196-199) who also had extensive prescription opioid use (at least 10 opioid prescriptions during the year, comprising the highest 29 percent of opioid users). Bivariate and multivariate analyses were used to examine correlates of receiving anxiolytic medication among veterans with metastatic cancer and extensive prescription opioid use. Of the 5,950 veterans with metastatic cancer and extensive prescription opioid use, 51 percent also received anxiolytic medication, of whom 64 percent had a medical indication and 85 percent had a psychiatric or medical indication for psychotropics. Of those with extensive prescription opioid use who filled an anxiolytic, 64 percent also received antidepressants and 38 percent received three or more classes of psychotropic medication (ie, polypharmacy). In multivariate analyses, factors associated with receipt of an anxiolytic included any anxiety disorder, insomnia, the prescription of antidepressants or antipsychotics, bipolar disorder, younger age, more emergency department visits, and greater number of opioid prescriptions. VHA patients with metastatic cancer and extensive prescription opioid use who are prescribed anxiolytics are likely to have a Food and Drug Administration-approved indication for psychotropics, and anxiolytics in particular, but represent a clinically vulnerable group which merits careful monitoring.

Multimorbidity and use of hypnotic and anxiolytic drugs: cross-sectional and follow-up study in primary healthcare in Iceland.

BackgroundThe prevalence of multimorbidity is increasing worldwide, presumably leading to an increased use of medicines. During the last decades the use of hypnotic and anxiolytic benzodiazepine derivatives and related drugs has increased dramatically. These drugs are frequently prescribed for people with a sleep disorder often merely designated as “insomnia” in the medical records and lacking a clear connection with the roots of the patients’ problems. Our aim was to analyse the prevalence of multimorbidity in primary healthcare in Iceland, while concurrently investigating a possible association with the prevalence and incidence of hypnotic/anxiolytic prescriptions, short-term versus chronic use.MethodsData were retrieved from a comprehensive database of medical records from primary healthcare in Iceland to find multimorbid patients and prescriptions for hypnotics and anxiolytics, linking diagnoses (ICD-10) and prescriptions (2009–2012) to examine a possible association. Nearly 222,000 patients, 83 % being local residents in the capital area, who contacted 16 healthcare centres served in total by 140 general practitioners, were set as a reference to find the prevalence of multimorbidity as well as the prevalence and incidence of hypnotic/anxiolytic prescriptions.ResultsThe prevalence of multimorbidity in the primary care population was 35 %, lowest in the young, increasing with age up to the 80+ group where it dropped somewhat. The prevalence of hypnotic/anxiolytic prescriptions was 13.9 %. The incidence rate was 19.4 per 1000 persons per year in 2011, and 85 % of the patients prescribed hypnotics/anxiolytics were multimorbid. Compared to patients without multimorbidity, multimorbid patients were far more likely to be prescribed a hypnotic and/or an anxiolytic, OR = 14.9 (95 % CI = 14.4–15.4).ConclusionsPatients with multiple chronic conditions are common in the primary care setting, and prevalence and incidence of hypnotic/anxiolytic prescriptions are high. Solely explaining use of these drugs by linear thinking, i.e. that “insomnia” leads to their prescription is probably simplistic, since the majority of patients prescribed these drugs are multimorbid having several chronic conditions which could lead to sleeping problems. However, multimorbidity as such is not an indication for hypnotics, and doctors should be urged to greater caution in their prescribing, bearing in mind non-pharmacological therapy options.

Primary care hypnotic and anxiolytic prescription: Reviewing prescribing practice over 8 years.

Introduction:Over the last few years, hypnotic and anxiolytic medications have had their clinical efficacy questioned in the context of concerns regarding dependence, tolerance alongside other adverse effects. It remains unclear how these concerns have impacted clinical prescribing practice.Materials and Methods:This is a study reviewing community-dispensed prescribing data for patients on the East Practice Medical Center list in Arbroath, Scotland, in 2007, 2011 and 2015. Anxiolytic and hypnotic medications were defined in accordance with the British National Formulary chapter 4.1.1 and chapter 4.1.2. All patients receiving a drug within this class in any of the study years were collated and anonymized using primary care prescribing data. The patients’ age, gender, name of the prescribed drug(s), and total number of prescriptions in this class over the year were extracted.Results:The proportion of patients prescribed a benzodiazepine medication decreased between 2007 and 2015: 83.8% (n = 109) in 2007, 70.5% (n = 122) in 2011, and 51.7% (n = 138) in 2015 (P = 0.006). The proportion of these patients prescribed a nonbenzodiazepine drug increased between 2007 and 2015: 30% (n = 39) in 2007, 46.2% (n = 80) in 2011, and 52.4% (n = 140) in 2015 (P = 0.001). There was a significant increase in the number of patients prescribed melatonin (P = 0.020).Discussion:This study reports a reduction in benzodiazepine prescriptions in primary care alongside increases in nonbenzodiazepine and melatonin prescribing, with an increase in prescribing rates of this drug class overall.Conclusion:Changes in this prescribing practice may reflect the medicalization of insomnia, local changes in prescribing practice and alongside national recommendations.

Usage and cost of first-line drugs for patients referred to inpatient anthroposophic integrative care or inpatient conventional care for stress-related mental disorders--a register based study.

BackgroundStress-related mental disorders (SRMD) are common and costly. Rehabilitation strategies, including pharmacotherapy, may be complicated to evaluate. Previous research has indicated increased quality of life and self-rated health for SRMD patients that receive a combination of conventional and complementary therapies, i.e. integrative care. The aim of this retrospective registry study was to explore and contrast the prescription of first-line drugs for SRMD patients referred to hospital inpatient anthroposophic integrative care (AIC) or inpatient conventional care (CC).MethodsSRMD patients that had received AIC or CC were identified through high-quality inpatient registry data from Stockholm County Council and matched by available background characteristics including diagnosis (ICD-10: F43), age, gender and socio-economics. General disease load was estimated by analysis of ICD-10 chapter data. The Swedish Prescribed Drug Register was then used to investigate purchased defined daily doses (DDD) and cost of drugs from 90-days before/after, and 180-days before/after, the first visits (index) to AIC and CC respectively. First-line drug categories were Anatomical Therapeutic Chemical classification codes N05A (antipsychotics), N05B (anxiolytics), N05C (hypnotics and sedatives) and N06A (antidepressants).ResultsThere were no statistically significant differences between the AIC (n = 161) and the CC (n = 1571) cohorts in terms of background characteristics and the overall disease loads were similar between the groups the preceding year. At baseline, the prescription of first-line anxiolytics and antidepressants were not statistically different between groups whereas the prescription of antipsychotics and hypnotics/sedatives were lower for the AIC cohort. The overall change in drug prescriptions and costs during the investigated periods, both for the 90-days before/after and for the 180-days before/after the index visit, showed a general decrease within the AIC cohort with significantly less prescribed anxiolytics and hypnotics/sedatives. During the same time periods there was a general increase in prescriptions and costs of first-line drugs within the CC cohort. The overall disease loads were generally stable within both cohorts over time, except that the CC cohort had increased visits registered with an ICD-10 F-chapter diagnosis the year after index.ConclusionsThe results suggests that there may be different drug utilization patterns for SRMD patients referred to AIC or CC. Different management strategies between AIC and CC providers, different SRMD disease severities and different preferences of patients referred to AIC and CC are hypothetical differentiating factors that may influence drug outcomes over time. Additional studies including prospective and randomized clinical trials are warranted to determine if there is a causal link between inpatient AIC and reduced drug utilization.

Trend and ratio of prescription of antidepressants and anxiolytics in Slovenia from 2009 to 2013

Trend and ratio of prescription of antidepressants and anxiolytics in Slovenia from 2009 to 2013

Prescriptions of antidepressants and anxiolytics in survivors of out-of-hospital cardiac arrest - a nationwide register-based follow-up study

Methods Nationwide data on OHCA from the years 2001-2011 was available from the Danish Cardiac Arrest Registry. We linked data to the Danish National Prescription Registry and excluded patients with prior prescriptions of antidepressants and/or anxiolytics within half a year before OHCA. We calculated time to the first prescription of antidepressants and/or anxiolytics following OHCA. Multivariable analyses were carried out using cause-specific Cox regression methods, taking competing risk of death into consideration.

Osteoarthritis, Drug use and risk of Cardiac Ischaemic events: a case-control study

e126 Volume 37 Number 8S were more frequently women, especially those treated with antidepressants. In addition, those treated with antipsychotics were older, and were less often visited by a GP but were more often admitted to hospital the month prior to admission. Both, those treated with antipsychotics and those treated with antidepressants more often lived in and were discharged to nursing home facilities. Furthermore, those treated with antipsychotics more often died during admission. Conclusions: The prevalence of psychotropic medicines prescription was high in the elderly, especially the prescription of anxiolytics or hypnotics-sedatives and antidepressants. Women were more frequently prescribed than men, especially for antidepressants, and patients treated with antipsychotics had worse outcomes.

Psychiatric co-morbidity in multiple sclerosis: The risk of depression and anxiety before and after MS diagnosis

Background: Studies of depression and anxiety in multiple sclerosis (MS) patients have reported higher rates in MS patients than the general population. Objective: To estimate the risk of depression and anxiety and the use of tricyclic antidepressant and selective serotonin reuptake inhibitors (SSRI) prescriptions, in the pre-diagnostic and the post-diagnostic period of MS compared to the background population. Methods: A cohort of 5084 MS patients was included and matched with a control population of 24,771 persons linked to nationwide registers. Logistic regression analyses were performed estimating odds ratios (OR). Results: In the pre-diagnostic period, the OR for having a diagnosis of depression and anxiety is 1.4 (95% confidence interval (CI) =1.05–1.88), and the OR of redemption prescriptions of TCAs is 1.90 (CI=1.54–2.34) and OR is 1.34 (CI= 1.20–1.51) for SSRI. In the post-diagnostic period the OR is 1.23 (CI= 0.92–1.64) for depression and anxiety diagnosis. The OR is 6.70 (CI=5.81–7.72) for TCA and OR is 2.46 (CI= 2.25–2.69) for SSRI. Conclusion: During both the pre- diagnostic and post-diagnostic period, MS patient have increased risk of depression and anxiety diagnoses and redemption of antidepressant and anxiolytic prescriptions, compared to the background population.

Recent trends in the incidence of anxiety and prescription of anxiolytics and hypnotics in children and young people: An e-cohort study

BackgroundLittle is known regarding the recognition of anxiety in children and young people (CYP) in primary care. This study examined trends in the presentation, recognition and recording of anxiety and of anxiolytic and hypnotic prescriptions for CYP in primary care. MethodA population-based retrospective electronic cohort of individuals aged 6–18 years between 2003 and 2011 within the Secure Anonymised Information Linkage (SAIL) Databank primary care database was created. Incidence rates were calculated using person years at risk (PYAR) as a denominator accounting for deprivation, age and gender. ResultsWe identified a cohort of 311,343 registered individuals providing a total of 1,546,489 person years of follow up. The incidence of anxiety symptoms more than tripled over the study period (Incidence Rate Ratio (IRR)=3.55, 95% CI 2.65–4.77) whilst that of diagnosis has remained stable. Anxiolytic/hypnotic prescriptions for the cohort as a whole did not change significantly over time; however there was a significant increase in anxiolytic prescriptions for the 15–18 year age group (IRR 1.62, 95% CI 1.30–2.02). LimitationsThere was a lack of reliable information regarding other interventions available or received at a primary, secondary or tertiary level such as psychological treatments. ConclusionsThere appears to be a preference over time for the recording of general symptoms over diagnosis for anxiety in CYP. The increase in anxiolytic prescriptions for 15–18 year olds is discrepant with current prescribing guidelines. Specific guidance is required for the assessment and management of CYP presenting with anxiety to primary care, particularly older adolescents.

Sick-leave measures, socio-demographic factors and health care as risk indicators for suicidal behavior in patients with depressive disorders – a nationwide prospective cohort study in Sweden

BackgroundStudies based on large data sets investigating a wide range of risk indicators on suicidal behavior in patients with depressive disorders are sparse. This study aimed to examine the association of sick-leave measured in different ways on one hand and socio-demographics, medication, and health care on the other hand with suicide attempt and suicide among patients with depressive disorders. MethodsThis is a population-based prospective cohort study using nationwide register data. All individuals who lived in Sweden 31.12.2004, then aged 16–64 years, and had psychiatric in- or out-patient care due to depressive disorders in 2005 were included (N=21,096). Univariate and multivariate hazard ratios (HR) and 95% Confidence Intervals (CI) with regard to suicide attempt and suicide during 2006–2010 were estimated by Cox regression. ResultsThose with new sick-leave spells, full-time spells, spells due to mental diagnoses and exceeding one year and those having ≥1 sick-leave spells had a higher risk of suicide attempt. Female sex, young age, lower education, living alone, prescription of antidepressants and anxiolytics, inpatient health care, and suicide attempts resulted in higher HRs of suicide attempt in the multivariate analyses (range of HRs 1.17–3.28). Male sex, combined antidepressant and anxiolytic prescription, mental inpatient health care, and suicide attempts predicted subsequent suicide (range of HRs 1.84–3.33). LimitationsFocus on specialized health care limited generalization. ConclusionsSickness absence, social-demographics, and medical determinants were associated with suicidal behavior. These risk indicators should be considered when monitoring individuals with depressive disorders and assessing suicide risk.

North Carolina Medicaid recipient management lock-in program: the pharmacist's perspective.

The misuse and abuse of prescription opioids have become an urgent health issue in North Carolina (NC), particularly among Medicaid patients who suffer high rates of morbidity and mortality due to abuse and overdose. The NC Division of Medical Assistance (DMA) implemented a recipient management lock-in program, which limits identified patients for a 12-month period to 1 prescriber and 1 pharmacy for benzodiazepine, opiate, and certain anxiolytic prescriptions in order to prevent misuse and reduce overutilization of Medicaid benefits. To (a) evaluate pharmacists' perceptions of the implementation of the NC recipient management lock-in program (MLIP) and (b) determine how the beliefs and attitudes of pharmacists could promote or inhibit its success. We conducted 12 structured phone interviews with NC pharmacists serving lock-in patients. Interview responses were analyzed through construct analysis, which identified themes organized into 3 domains: organization and implementation, perceived effectiveness, and acceptability. Most respondents reported a positive experience with the program but expressed doubt concerning its impact on prescription drug abuse. The program successfully utilized the pharmacist role as a gatekeeper of controlled substances, and the procedures of the program required no active effort on pharmacists' part. However, respondents suggested that the DMA improve communication and outreach to address pharmacists' lack of knowledge about the program's purpose and confusion over remediating problems that arise with lock-in patients. The DMA should also address the ways in which the program can interfere with access to health care and treatment, allow patients to see multiple physicians within the same clinic, and clarify procedures for patients whose complex health issues require multiple specialists. Although possible improvements were identified, the NC MLIP has strong potential for success as it utilizes pharmacists' medication gate-keeping role, while minimizing the effort required for successful implementation.

Risk of hip fracture among older people using anxiolytic and hypnotic drugs: a nationwide prospective cohort study.

PurposeAnxiolytics and hypnotics are widely used and may cause injurious falls. We aimed to examine associations between exposure to anxiolytics and hypnotics and the risk of hip fracture among all older people in Norway. Further, we wanted to examine associations between exposure to hypnotics and time of fracture.MethodsA nationwide prospective cohort study of people in Norway born before 1945 (n = 906,422) was conducted. We obtained information on all prescriptions of anxiolytics and hypnotics dispensed in 2004–2010 (the Norwegian Prescription Database) and all primary hip fractures in 2005–2010 (the Norwegian Hip Fracture Registry). We compared the incidence rates of hip fracture during drug exposure and non-exposure by calculating the standardized incidence ratio (SIR).ResultsAltogether, 39,938 people (4.4 %) experienced a primary hip fracture. The risk of hip fracture was increased for people exposed to anxiolytics (SIR 1.4, 95 % confidence interval (CI) 1.4–1.5) and hypnotics (SIR 1.2, 95 % CI 1.1–1.2); the excess risk was highest regarding short-acting benzodiazepine anxiolytics (SIR 1.5, 95 % CI 1.4–1.6). Benzodiazepine-like hypnotics (z-hypnotics) were associated with higher excess risk of hip fracture at night (SIR 1.3, 95 % CI 1.2–1.4) than during the day (SIR 1.1, 95 % CI 1.1–1.2).ConclusionsOlder people had an increased risk of hip fracture during anxiolytic or hypnotic drug use, including short-acting benzodiazepine anxiolytics and z-hypnotics that were previously considered less harmful; cautious prescribing is therefore needed. People using z-hypnotics were at greatest excess risk at night; this association deserves further investigation.

Neighborhood linking social capital as a predictor of psychiatric medication prescription in the elderly: A Swedish national cohort study

ObjectivesLittle is known about the association between neighborhood linking social capital and psychiatric medication in the elderly. The present study analyzes whether there is an association between linking social capital (a theoretical concept describing the amount of trust between individuals and societal institutions) and prescription of antipsychotics, anxiolytics, hypnotics/sedatives, antidepressants, or anti-dementia drugs. Design, setting, participants and measurementsThe entire Swedish population aged 65+, a total of 1,292,816 individuals, were followed from 1 July 2005 until first prescription of psychiatric medication, death, emigration, or the end of the study on 31 December 2010. Small geographic units were used to define neighborhoods. The definition of linking social capital was based on mean voting participation in each neighborhood unit, categorized in three groups. Multilevel logistic regression was used to estimate odds ratios (ORs) and between-neighborhood variance in three different models. ResultsThere was an inverse association between the level of linking social capital and prescription of psychiatric medications (except for anti-dementia drugs). The associations decreased, but remained significant, after accounting for age, sex, family income, marital status, country of birth, and education level (except for antidepressants). The OR for prescription of antipsychotics in the crude model was 1.65 (95% CI 1.53–1.78) and decreased, but remained significant (OR = 1.26; 95% CI 1.17–1.35), after adjustment for the individual-level sociodemographic variables. ConclusionsDecision-makers should take into account the potentially negative effect of linking social capital on psychiatric disorders when planning sites of primary care centers and psychiatric clinics, as well as other kinds of community support for elderly patients with such disorders.