Number Of Psychiatric Medications Research Articles

Preventive effect of aripiprazole once-monthly on relapse into mood episodes in bipolar disorder: A multicenter, one-year, retrospective, mirror image study

BackgroundWe conducted a one-year, retrospective, mirror-image study to investigate the clinical effectiveness and safety of aripiprazole once monthly (AOM) in patients with bipolar disorder (BD). We compared pre-treatment conditions with outcomes after 12 months of AOM treatment. MethodsSeventy-five bipolar patients were recruited from 12 hospitals in Korea. We included 75 patients with BD who had received at least three AOM treatments from September 2019 to September 2022 and had accessible electronic medical record (EMRs) for the year before and after the baseline visit. ResultsThe overall number of mood episodes significantly decreased from a mean of 1.5 ± 1.2 episodes pre-AOM to 0.5 ± 1.2 episodes post-AOM. Manic episodes significantly decreased from 0.8 ± 0.8 episodes pre-AOM to 0.2 ± 0.5 episodes post-AOM, and depressive episodes significantly decreased from 0.5 ± 0.8 episodes pre-AOM to 0.2 ± 0.6 episodes post-AOM (p = 0.017). Moreover, the number of psychiatric medications and pills and the proportion of patients treated with complex polypharmacy were significantly decreased post-AOM. LimitationsThe small sample size was insufficient to fully represent the entire population of individuals with BD, and potential selection bias was introduced due to only including subjects who received AOM three or more times. ConclusionThe results of this study suggest that AOM can reduce mood episode relapse and may be clinically beneficial in the treatment of BD patients, potentially reducing issues associated with polypharmacy in some individuals.

Başkentte bir psikiyatri polikliniğine bakış: Başvuranların tanı ve sosyodemografik özelliklerinin değerlendirilmesi

Objective: The aim of this study was to investigate admissions to a psychiatry outpatient clinic in an urban area through one year period and analyze sociodemographic characteristics, diagnosis, and treatment protocols of individual patients with an emphasis on age and gender.
 Material and Method: Patients who applied to University of Health Sciences, Ankara Numune, Education and Research Hospital Kolej Psychiatry outpatient clinic between February 2016 and February 2017 were included in the study. The patient files were retrospectively reviewed in terms of sociodemographic characteristics, diagnoses, treatment protocols and the number of admissions within one year.
 Results: Retrospective evaluation of hospital records yielded 1247 patients. Among these patients, 66.5% were female and 85.2% were under 65 years old. The most common diagnoses were depressive and anxiety disorders with a percentage of 42% and 40.3%, respectively. Anxiety disorders (66.4%, 33.6%, p<0.001, respectively), depressive disorders (72.7%, 27.3%, p<0.001, respectively) and somatic symptom disorders (90.9%, 9.1%, p=0.007, respectively) were significantly more frequent in females compared to male gender. On the other hand, all psychiatric diagnoses except normal psychiatric examination were significantly higher in patients <65 years old compared to patients ≥65 years of age. There was a positive and moderate correlation between age and number of comorbid conditions (r=0.57, p<0.001) and positive and weak correlation between age and number of psychiatric medications (r=0.07, p=0.006). However, there was no correlation between age and number of control visits. 
 Conclusion: Depressive and anxiety disorders were the most common diagnoses both in adult and elderly patient populations among patients who admitted to a district outpatient clinic of a tertiary hospital within one year period. Female gender admissions were more prevalent than males.

The association between mood state and chronobiological characteristics in bipolar I disorder: a naturalistic, variable cluster analysis-based study

BackgroundMultiple types of chronobiological disturbances have been reported in bipolar disorder, including characteristics associated with general activity levels, sleep, and rhythmicity. Previous studies have focused on examining the individual relationships between affective state and chronobiological characteristics. The aim of this study was to conduct a variable cluster analysis in order to ascertain how mood states are associated with chronobiological traits in bipolar I disorder (BDI). We hypothesized that manic symptomatology would be associated with disturbances of rhythm.ResultsVariable cluster analysis identified five chronobiological clusters in 105 BDI subjects. Cluster 1, comprising subjective sleep quality was associated with both mania and depression. Cluster 2, which comprised variables describing the degree of rhythmicity, was associated with mania. Significant associations between mood state and cluster analysis-identified chronobiological variables were noted. Disturbances of mood were associated with subjectively assessed sleep disturbances as opposed to objectively determined, actigraphy-based sleep variables. No associations with general activity variables were noted. Relationships between gender and medication classes in use and cluster analysis-identified chronobiological characteristics were noted. Exploratory analyses noted that medication class had a larger impact on these relationships than the number of psychiatric medications in use.ConclusionsIn a BDI sample, variable cluster analysis was able to group related chronobiological variables. The results support our primary hypothesis that mood state, particularly mania, is associated with chronobiological disturbances. Further research is required in order to define these relationships and to determine the directionality of the associations between mood state and chronobiological characteristics.

An audit of general practitioner involvement in public community mental health care.

Existing guidelines suggest that collaboration between general practitioners and mental health services may improve the physical health of people with serious mental illness. This study investigated the extent of general practitioner involvement in a community mental health centre and examined whether the presence of a documented general practitioner in the patient's medical records was associated with markers of better health outcomes. The medical records of current patients were audited, including those receiving medical care and case management and those only receiving medical care. The demographic and diagnostic information, evidence of metabolic screening, blood test results, and medications of patients with a recorded general practitioner were compared with those of patients with no recorded general practitioner. Ninety-eight of 191 (51%) of patients had details of a general practitioner documented in their medical records. There were no significant differences in rates of metabolic screening between the two groups. Those with a general practitioner had more medical diagnoses and were taking a greater number of psychiatric medications. Although the medical comorbidities of serious mental illness are becoming increasingly recognised, our findings suggest the need for ongoing and coordinated efforts by policymakers, general practitioners, mental health services and patients to ensure the health and longevity of people with serious mental illness.

Predictors of start of different antidepressants in patient charts among patients with depression.

In usual psychiatric care, antidepressant treatments are selected based on physician and patient preferences rather than being randomly allocated, resulting in spurious associations between these treatments and outcome studies. To identify factors recorded in electronic medical chart progress notes predictive of antidepressant selection among patients who had received a depression diagnosis. This retrospective study sample consisted of 556 randomly selected Veterans Health Administration patients diagnosed with depression from April 1, 1999, to September 30, 2004, stratified by the antidepressant agent, geographic region, gender, and year of depression cohort entry. Predictors were obtained from administrative data, and additional variables were abstracted from electronic medical chart notes in the year prior to the start of the antidepressant in 5 categories: clinical symptoms and diagnoses, substance use, life stressors, behavioral/ideation measures (e.g., suicide attempts), and treatments received. Multinomial logistic regression analysis was used to assess the predictors associated with different antidepressant prescribing, and adjusted relative risk ratios (RRR) were reported. Of the administrative data-based variables, gender, age, illicit drug abuse or dependence, and number of psychiatric medications in the prior year were significantly associated with antidepressant selection. After adjusting for administrative data-based variables, sleep problems (relative risk ratio [RRR] = 2.47) or marital issues (RRR = 2.64) identified in the charts were significantly associated with prescribing mirtazapine rather than sertraline; however, no other chart-based variables showed a significant association or an association with a large magnitude. Some chart data-based variables were predictive of antidepressant selection, but we neither found many nor found them highly predictive of antidepressant selection in patients treated for depression.

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AbstractYouth with psychosis‐spectrum symptoms found to have neurocognitive delaysSuicide attempts no greater with some antidepressants than othersAnxiety and disruptive behavior increase risk of subsequent depression in children with ADHDStudy finds long‐lasting effects of SSRIs in brains of monkeysSide effects increase with number of psychiatric medications in childrenADHD medications increasing among young womenAtomoxetine‐induced hypomania in a 10‐year‐old boy with ADHD and social anxietyEffexor recall

Psychiatric Resident and Attending Diagnostic and Prescribing Practices

This study investigates whether two patient population groups, under resident or attending treatment, are equivalent or different in the distribution of patient characteristics, diagnoses, or pharmacotherapy. Demographic data, psychiatric diagnoses, and pharmacotherapy data were collected for 100 random patient charts of psychiatric residents, and were then compared with 100 random patient charts of attending psychiatrists. Student's t test and chi square analysis suggested no statistically significant differences in the average number of comorbid Axis I diagnoses, percentages of patients with Axis II diagnoses, or major differences in the specific percentages of the 10 most common Axis I diagnoses. Furthermore, there were no statistically significant differences in the average number of psychiatric medications prescribed for pharmacological management of mental illness, or ratios of specific drug classes utilized. There seems to be no major differences in patient characteristics or in the treatment techniques that were utilized.

Assessment of Medication Management Ability in Middle-Aged and Older Adults With Bipolar Disorder

Medication nonadherence is a key clinical concern in bipolar disorder (BD) across the life span. Cognitive deficits in older adults with BD may hinder medication management ability, which, in turn, may lead to nonadherence. Using an innovative performance-based measure of medication management ability, the Medication Management Ability Assessment (MMAA), we compared performance of 29 middle-aged older community-dwelling outpatients with BD who were clinically stable (mean age, 61 years; SD, 11 years; range, 45-86 years) with those of 59 normal control subjects (NCs) and 219 outpatients with schizophrenia. The MMAA is a role-play task that simulates a medication regimen likely to be encountered by older adults. Within the BD group, we examined the relationships of MMAA scores to demographic, psychiatric symptoms severity, and the Mattis Dementia Rating Scale (DRS) scores. The BD group made 2.8 times the errors on the MMAA than NCs (BD group, 6.2; SD, 5.5 vs NCs, 2.2; SD, 2.5) and did not significantly differ from the Schizophrenia group in errors on the MMAA. Errors in the BD group were more likely to be taking in too few medications as taking in too many. Within the BD group, a significant correlation was seen between MMAA scores and the DRS Total score, but not with age, education, Brief Psychiatric Rating Scale, Hamilton Depression Rating Scale, number of psychiatric medications, or medical conditions. Among DRS subscales, the Memory Subscale correlated most strongly with MMAA errors. This small cross-sectional study suggests that deficits in medication management ability may be present in later-life BD. Neurocognitive deficits may be important in understanding problems with unintentional nonadherence.

Characteristics associated with involuntary versus voluntary legal status at admission and discharge among psychiatric inpatients

BackgroundThe objective of this analysis was to determine the ways in which patients’ legal statuses at hospital admission and discharge are associated with select sociodemographic and clinical variables. This study specifically investigated differences between patients who were voluntary during both admission and discharge, patients who were involuntary on admission but voluntary on discharge (having converted to voluntary status during hospitalization), and patients who were involuntary during both admission and discharge.MethodData were collected from the charts and treating clinicians of 227 consecutively discharged patients from two psychiatric units in a large, urban, county hospital in the southeastern United States. Based on results of bivariate tests, sociodemographic and clinical factors were entered into a polytomous logistic regression model to determine effect estimates (adjusted odds ratios).ResultsIn the bivariate analyses, 15 variables were significantly associated with the trichotomous legal status. In the model, three factors were independently significantly associated with legal status, while controlling for four potential confounders: (1) whether or not the patient was experiencing psychotic symptoms at discharge, (2) whether or not the patient had documented medical problems requiring medication at discharge, and (3) the number of psychiatric medications.ConclusionsA generalized lack of treatment engagement and adherence among involuntary patients likely underlies significant differences between the groups in terms of psychotic symptoms, diagnosed medical problems requiring medications, and number of psychiatric medications at discharge. Studying legal status (and the process of legal status conversion from involuntary to voluntary) and its correlates is an important topic for further research.

Characterizing Aggressive and Noncompliant Behaviors in a Children’s Psychiatric Inpatient Setting

This study was conducted to evaluate aggression and noncompliance among child psychiatric inpatients in relation to demographic, clinical, and hospitalization characteristics, including the use of restraints and seclusion. Eighty six children (10.8+/-2.4 years old, 67% male) consecutively admitted to an inpatient psychiatric unit were rated weekly using the Modified Overt Aggression Scale (MOAS) and the Disruptive Behavior Rating Scale (DBRS) between November 1, 2002 and June 30, 2003. Moderate to high correlations were observed between the four types of aggression (verbal, and physical against self, others, or objects) and noncompliant behavior. In hierarchical regression analyses, only mental retardation emerged as a significant predictor of aggression and noncompliance. Aggression and noncompliance were associated with different characteristics of inpatient treatment. Aggressive behavior was significantly associated with the use of restraints and seclusion, and noncompliant behavior with length of hospitalization and number of psychiatric medications at time of discharge. Modifying milieu interventions for youths with mental retardation, and adapting behavioral interventions empirically proven to target noncompliance may be effective loci for reducing aggression in child psychiatric inpatient units.

Hepatic Disease and Psychiatric Illness: Relationships and Treatment

A relationship between hepatic diseases and psychiatric symptoms has long been speculated. While liver detoxication makes the exogenous substances harmless for the body, there are occasions where the liver may convert a harmless substance into a more toxic substance. With such an important role, the liver protects all the organs of the body. When liver is malfunctioning, toxic metabolites injurious to the brain may be produced. As the brain receives a high blood supply, a large amount of metabolites reach this organ. Hence, the metabolic function of the liver keeps a delicate reciprocal relationship between the two organs. In addition, a number of psychiatric medications affect liver functions. Another perplexing clinical problem is the difficulty in treating psychiatric symptoms in patients with liver disease. For example, benzodiazepines which do not affect the liver function in physically healthy psychiatric patients, may induce hepatic coma in patients with liver disease. Benzodiazepine antagonists produce dramatic and temporary improvement in patients with hepatic coma. Clinically, many psychoactive drugs produce hepatic complications. The very same drugs which produce hepatic side effects are required for the treatment of psychiatric symptoms in patients with hepatic disorders. To appropriately handle these situations, a thorough knowledge of the side effects of these drugs is necessary.