Psychiatric Medication Prescription Research Articles

Brief Report: Self-Reported Medication Use in Individuals Diagnosed with Autism Spectrum Disorder in Adulthood: A U.S. Clinic Sample from 2012 to 2022.

As the understanding of autism spectrum disorder (ASD) across the lifespan has increased, so has the number of individuals being identified with ASD for the first time in adulthood. Understanding co-occurring psychiatric conditions in this subset of the ASD population is a growing focus of research; however, little is known about the rate at which psychiatric medications are prescribed to adults with a first-time diagnosis of ASD. The purpose of this study was to examine self-reported medication use in persons diagnosed with ASD in adulthood in a clinic sample (2012-2022) in the United States. The present study was a retrospective record review. Participants (n = 281) were drawn from an outpatient clinic specializing in the diagnosis of ASD in adults. Participants self-reported previous and current psychiatric medication prescription using a medication checklist. Approximately 50% of participants self-reported being prescribed at least one psychiatric medication at the time of their initial evaluation appointment. The most commonly prescribed psychiatric medications were antidepressants (23.8%), followed by stimulants (16.7%). Similar to individuals diagnosed with ASD in childhood, those identified with ASD for the first time in adulthood are prescribed psychiatric medication at a much higher rate than their same-age non-autistic peers. These results can inform future research and practice for improving outcomes for autistic adults, particularly those who were undiagnosed for much of their lives.

Spillovers and Training Effects on Mental Health Prescribing for Children

We use data on all prescriptions filled at U.S. retail pharmacies from 2006-2018 to examine deviations from best practice in the prescription of psychiatric medications to children. The results demonstrate the importance of spillovers from other doctors in the same area. However, individual doctor fixed effects remain extremely important. We also show that the practice styles of doctors who graduated in the same year from schools of the same rank evolve in a similar way across the country. Psychiatrists are less affected by area-level prescribing than general practitioners suggesting that specific training can reduce spillovers in questionable prescribing practices.

Patterns of Psychiatric Medication Prescriptions for Veterans in Treatment Courts and Other Specialty Courts.

Psychiatric medications can serve as important tools for addressing behavioral health issues among criminal justice-involved (CJI) veterans. This study used national data on 12,790 CJI veterans in the U.S. Department of Veterans Affairs (VA) Veterans Justice Outreach program from 2019 to 2020 to compare patterns of psychiatric medication prescriptions among veterans who entered a veterans treatment court (n = 6975), another specialty court (SC; n = 414), or no-SC (n = 5401). Different classes of medications were examined, including antidepressants, stimulants, antipsychotics, benzodiazepines, and medications for substance use disorders. The results showed that 60.2% of the total sample was prescribed a psychiatric medication within 1 year of entering the Veterans Justice Outreach program. There was no significant difference in overall psychiatric prescribing among veterans treatment court, other SC, and no-SC groups, but there were a few differences in certain classes of psychiatric medications. Moreover, about 7.8% of veterans who were in the no-SC group and were prescribed psychiatric medications did not have a psychiatric diagnosis. Veterans who were younger, non-Hispanic white, married, with a VA service-connected disability rating, had a diagnosis of mental and/or substance use disorder, and used more VA health care services were more likely to have been prescribed psychiatric medication. Together, these findings illustrate the essential role of psychiatric medications in courts and programs that serve CJI veterans, as well as the important link between VA service engagement and psychiatric prescriptions.

Mapping the Relationship of White Matter Lesions to Depression in Multiple Sclerosis

BackgroundMultiple sclerosis (MS) is an immune-mediated neurological disorder, and up to 50% of patients experience depression. We investigated how white matter network disruption is related to depression in MS. MethodsUsing electronic health records, 380 participants with MS were identified. Depressed individuals (MS+Depression group; n = 232) included persons who had an ICD-10 depression diagnosis, had a prescription for antidepressant medication, or screened positive via Patient Health Questionnaire (PHQ)-2 or PHQ-9. Age- and sex-matched nondepressed individuals with MS (MS−Depression group; n = 148) included persons who had no prior depression diagnosis, had no psychiatric medication prescriptions, and were asymptomatic on PHQ-2 or PHQ-9. Research-quality 3T structural magnetic resonance imaging was obtained as part of routine care. We first evaluated whether lesions were preferentially located within the depression network compared with other brain regions. Next, we examined if MS+Depression patients had greater lesion burden and if this was driven by lesions in the depression network. Primary outcome measures were the burden of lesions (e.g., impacted fascicles) within a network and across the brain. ResultsMS lesions preferentially affected fascicles within versus outside the depression network (β = 0.09, 95% CI = 0.08 to 0.10, p < .001). MS+Depression patients had more lesion burden (β = 0.06, 95% CI = 0.01 to 0.10, p = .015); this was driven by lesions within the depression network (β = 0.02, 95% CI = 0.003 to 0.040, p = .020). ConclusionsWe demonstrated that lesion location and burden may contribute to depression comorbidity in MS. MS lesions disproportionately impacted fascicles in the depression network. MS+Depression patients had more disease than MS−Depression patients, which was driven by disease within the depression network. Future studies relating lesion location to personalized depression interventions are warranted.

Psychiatric medication prescriptions increasing for college students above and beyond the COVID-19 pandemic

Psychiatric medication prescriptions for college students have been rising since 2007, with approximately 17% of college students prescribed medication for a mental health issue. This increase mirrors overall increases in both mental health diagnoses and treatment of university students. As psychiatric medication prescriptions for college students were increasing prior to pandemic, the goal of this study was to compare these prescriptions over the years, while accounting for the added stressor of the COVID-19 pandemic. This study utilized cross-sectional, retrospective data from a cohort of college students receiving care from the university’s health service. We examined prescriptions for mental healthcare from 2015 to 2021. There was a significant increase in the percentage of psychiatric medication prescriptions in 2020 (baseline 15.8%; threshold 3.5%) and 2021 (baseline 41.3%; threshold 26.3%) compared to the historical baseline average for the whole sample and as well as for female students (2020 baseline 21.3% and threshold 4.6%; 2021 baseline 55.1% and threshold 33.7%). Within these years, we found higher trends for prescriptions in April–May as well as September–December. Overall, we found that psychiatric medication prescriptions have continued to rise through the years, with a large increase occurring during the pandemic. In addition, we found that these increases reflect the academic year, which is important for university health centers to consider when they are planning to staff clinics and plan the best way to treat college students with mental health difficulties in the future.

Body Mass Index Categories of Transgender and Gender Diverse Youth: Clinical Associations and Predictors.

Background: Transgender/gender diverse (TGD) youth are at risk for weight-related problems. We describe factors associated with their body mass index (BMI) category. Methods: Chart review of 228 TGD patients, 12-20 years (u = 15.7, standard deviation 1.3), 72% female assigned at birth. BMI percentile was calculated using CDC growth charts. We examined bivariate relationships of 18 clinically derived factors, utilizing analysis of variance (ANOVA) for continuous variables and chi-squared/Fisher's exact test for categorical variables. Nonparametric Classification and Regression Tree (CART) analyses were used to predict BMI category. Results: Almost half (49.6%) of TGD youth presenting for their initial visit for pediatric gender-affirming care fell in the healthy weight range, 4.4% in the underweight range, 16.7% in the overweight range, and 29.4% in the obese range. Self-described weight, weight management intentions, unhealthy weight management, prescription of psychiatric medications, and medications associated with weight gain were associated with BMI category. Use of psychiatric medications (54.8%) and medications associated with weight gain (39.5%) was associated with BMI in the overweight/obese categories. Youth with obesity most often reported unhealthy weight management. In CART models, self-described weight was the strongest predictor of BMI category. Conclusion: TGD youth have high rates of underweight and overweight/obesity. Unhealthy BMI should be treated as part of gender-affirming care. Self-described body weight is associated with weight category. More than half of TGD youth were prescribed psychiatric medications; those with overweight and obesity were more likely prescribed psychiatric and medications with associated weight gain. Youth with obesity were most likely to use unhealthy weight management.

A Collaborative Approach in Prescribing Psychotropics for Persons Experiencing Homelessness.

A Collaborative Approach in Prescribing Psychotropics for Persons Experiencing Homelessness.

Impacto del confinamiento por COVID-19 en la prescripción de benzodiacepinas

ObjectiveTo evaluate the effect of COVID-19 lockdown on the prescription of benzodiazepines by gender, age and district health departments. DesignLongitudinal observational study. LocationPrimary care. Asturias (Spain) health district V. ParticipantsPeople over 15 years of age with filled benzodiazepine prescriptions in between 2017 and 2020. Main measurementsBenzodiazepine DHD (defined daily dose per 1000 habitants) mean difference between the period defined as pre-lockdown and lockdown. Additionally, the difference was adjusted for gender, sex and district health department and also with the interaction among them. ResultsDHD mean pre-lockdown was 131.3 and 139.5 in the lockdown; this difference was significant in the global analysis (95% CI: 4.1–12.1). There was an increase in the DHD mean in the 60–74 age group (95% CI: 2.28–21.42), in the group over 90 years old (95% CI: 21.31–40.63) and in women (95% CI: 3.51–14.59). Finally, a decrease in the DHD mean of V11 (95% CI: -29 to -0.66) and V14 (95% CI: -54.28 to -25.04) district health departments was observed. ConclusionsCertain subgroups show a change in the pattern of benzodiazepine prescription without being able to relate this to the lockdown. We believe that there could be some inertia in the prescription of psychiatric medication according to the biopsychosocial characteristics of the patients; it is important to detect this in order to avoid the medicalization of psychological disorders.

Evaluation of Psychiatric Diagnoses as a Source of Bias in Prognostication and Decision-Making for Palliative Radiotherapy

<h3>Purpose/Objective(s)</h3> Up to half of patients with advanced cancer may meet diagnostic criteria for a psychiatric disorder. Yet, the impact of psychiatric diagnosis and/or medication prescription (psych Dx/Rx) on decision-making and outcomes for radiotherapy (RT) are not well-characterized. Statistical models and decision tools can be skewed when built from source data that has been influenced by implicit and explicit biases in medical diagnoses and treatment. We investigate the impact of psych Dx/Rx on palliative RT outcomes and decisions to ascertain whether this may serve as a source of bias in prognostication and decision-making in this patient population. <h3>Materials/Methods</h3> Retrospective review identified patients treated with conventional external beam (cEBRT) or stereotactic body RT (SBRT) for bone metastases at 3 radiation oncology facilities from 5/2013-12/2019. Prevalence of psych Dx/Rx was collected, along with 27 other patient, disease, and treatment characteristics that were identified as collectively predictive of survival using the validated Bone Metastases Ensemble Trees for Survival (BMETS) machine-learning model and decision support platform. RT details were documented. Overall survival from consultation to death or last follow up was estimated using the Kaplan-Meier method. Uni- and multivariable regressions evaluated associations between psych Dx/Rx, survival, and RT fractionation and modality. Reported statistics are p<.05. <h3>Results</h3> 346 treated patients were evaluated, including 178 patients with cEBRT and 168 patients with SBRT (median 10 vs. 3 fractions). Psych Dx/Rx was more prevalent among patients treated with cEBRT vs. SBRT (40% vs. 28.6%). On univariate analysis, odds of psych Dx/Rx was significantly higher for patients requiring opiate analgesics, females, white (vs. black) race, and breast (vs. prostate) cancer (OR 2.0, 3.7, 4.3, 5.6). Psych Dx/Rx was associated with use of fewer fractions for cEBRT (β coefficient -1.0) but not SBRT. On multivariable analyses for the cEBRT cohort controlling for other univariable associations, use of fewer fractions remained significantly associated with psych Dx/Rx (β coefficient -1.1). While overall survival was significantly longer for patients treated with SBRT (median 3.3 vs. 0.8 years for cEBRT), psych Dx/Rx was not associated with survival or strongly linked to other predictors of advanced disease for either RT cohort. <h3>Conclusion</h3> Psych Dx/Rx does not appear to impact survival for patients undergoing palliative bone RT, arguing against its direct role as a source of bias in survival models like BMETS. However, given that psych Dx/Rx is associated with lower use of SBRT and foreshortened cEBRT regimens, this variable may serve a source of bias in treatment selection, albeit perhaps concordant with the patient's best interest. This highlights the importance of enhanced shared decision-making in this potentially vulnerable patient population.

Transversus abdominus plane blocks do not reduce rates of postoperative prolonged opioid use following abdominally based autologous breast reconstruction: a nationwide longitudinal analysis.

BackgroundThe transversus abdominus plane (TAP) block reduces postoperative donor site pain in patients undergoing autologous breast reconstruction with an abdominally based flap. This study aimed to determine the effect of TAP blocks on rates of conversion to chronic opioid use.MethodsThe Clinformatics Data Mart was queried from 2003 to 2019, extracting adult encounters for abdominally based free and pedicled flaps based on common procedural terminology (CPT) codes. Patients were excluded if they had filled a narcotic prescription 1 year to 30 days prior to surgery. The exposure variable—TAP block—was identified by CPT codes. Outcomes were evaluated using morphine milligram equivalents (MME) from prescriptions filled between 30 days prior to and 30 days after surgery. Chronic opioid use (COU) was defined as receiving 4 unique prescriptions or a 60-day supply between 30 and 180 days after surgery.ResultsOf the 4091 patients, (mean age 51.2 ± 9.0 years), 181 (4.4%) had a TAP block placed. Perioperative MMEs/day, postoperative COU, and length of stay did not differ in patients who received a TAP block (p = 0.142; p = 0.271). Significant predictors of risk of conversion to COU included younger age, pedicled abdominal flap, Elixhauser comorbidity index score > 3, filling a psychiatric medication prescription, and filling a benzodiazepine prescription.ConclusionsIn patients undergoing autologous breast reconstruction with abdominally based flap reconstruction, TAP blocks do not decrease perioperative MME/day, conversion to chronic opioid use, or length of stay. These data suggest that intraoperative TAP block placement may be a low-yield opioid-reduction strategy.Level of evidence: Level III, risk/prognostic study

Longitudinal analysis of the relationship between motor and psychiatric symptoms in idiopathic dystonia.

Although psychiatric diagnoses are recognized in idiopathic dystonia, no previous studies have examined the temporal relationship between idiopathic dystonia and psychiatric diagnoses at scale. Here, we determine rates of psychiatric diagnoses and psychiatric medication prescription in those diagnosed with idiopathic dystsuponia compared to matched controls. A longitudinal population-based cohort study using anonymized electronic health care data in Wales (UK) was conducted to identify individuals with idiopathic dystonia and comorbid psychiatric diagnoses/prescriptions between 1 January 1994 and 31 December 2017. Psychiatric diagnoses/prescriptions were identified from primary and secondary health care records. Individuals with idiopathic dystonia (n= 52,589) had higher rates of psychiatric diagnosis and psychiatric medication prescription when compared to controls (n= 216,754, 43% vs. 31%, p&lt; 0.001; 45% vs. 37.9%, p&lt; 0.001, respectively), with depression and anxiety being most common (cases: 31% and 28%). Psychiatric diagnoses predominantly predated dystonia diagnosis, particularly in the 12 months prior to diagnosis (incidence rate ratio [IRR] = 1.98, 95% confidence interval [CI] = 1.9-2.1), with an IRR of 12.4 (95% CI=11.8-13.1) for anxiety disorders. There was, however, an elevated rate of most psychiatric diagnoses throughout the study period, including the 12 months after dystonia diagnosis (IRR=1.96, 95% CI=1.85-2.07). This study suggests a bidirectional relationship between psychiatric disorders and dystonia, particularly with mood disorders. Psychiatric and motor symptoms in dystonia may have common aetiological mechanisms, with psychiatric disorders potentially forming prodromal symptoms of idiopathic dystonia.

A Rapid Review of "Low-Threshold" Psychiatric Medication Prescribing: Considerations for Street Medicine and Beyond.

No widely accepted clinical guidelines, and scant directly applicable pragmatic research, are available to guide the prescription of psychiatric medications in "low-threshold" outpatient settings, such as street outreach, urgent care, and crisis care, as well as walk-in, shelter, and bridge and transition clinics. Providers frequently prescribe medications in these settings without patients' having firm psychiatric diagnoses and without medical records to guide clinical decision making. Persons who receive medications in these settings often seek help voluntarily and intermittently for mental illness symptoms. However, because of structural and individual factors, such patients may not engage in longitudinal outpatient psychiatric care. The authors reviewed the literature on psychiatric medication prescribing in low-threshold settings and offer clinical considerations for such prescribing. The authors conducted a rapid literature review (N=2,215 abstracts), which was augmented with up-to-date clinical prescribing literature, the authors' collective clinical experience, and DSM-5 section II diagnostic criteria to provide considerations for prescribing medications in low-threshold settings. For individuals for whom diagnostic uncertainty is prominent, a symptom-based diagnostic and treatment approach may be best suited to weigh the risks and benefits of medication use in low-threshold settings. Practical considerations for treating patients with clinical presentations of psychosis and trauma, as well as mood, anxiety, and substance use disorders, in low-threshold settings are discussed. An urgent need exists to invest in pragmatic research and guideline development to delineate best-practice prescribing in low-threshold settings.

The Trend of Psychiatric Visits and Psychiatric Medication Prescription Among People Tested for SARS-CoV-2 During the Initial Phase of COVID-19 Pandemic in South Korea.

ObjectiveThe objective of this study was to monitor the trend of psychiatric visits and medication prescriptions among people tested for SARS-CoV-2 during the initial phase of coronavirus disease 2019 (COVID-19) pandemic in South Korea. MethodsWe conducted a population-based cohort study using data from the National Health Insurance Service (NHIS) linked to the Korea Disease Control and Prevention Agency (KDCA) data. The overall trend of psychiatric visits during COVID-19 for each month was compared to the month prior to COVID-19. The number of psychiatric medication prescription records was monitored from January 2019 to May 2020. ResultsA total of 212,678 individuals were tested for SARS-CoV-2 between January 2020 and May 2020. Among these individuals, 72.1% (n=153,309) did not have pre-existing mental illness, and 27.9% (n=59,369) had pre-existing mental illness. We found that most psychiatric visits were made in March, and patients without pre-existing mental illness significantly increased in psychiatric outpatients during the COVID-19 pandemic (p trend<0.001). In addition, psychiatric medication prescriptions were the most prescribed between March and April 2020. ConclusionWe identified a rising trend in psychiatric visits and medication prescriptions among people who were tested for SARS-CoV-2 during the initial phase of COVID-19 pandemic in South Korea.

Abstract 10322: Mental Health Conditions Are Associated with Underuse of Rhythm Control Therapies in Patients with Atrial Fibrillation: The FinACAF Study

Introduction: Mental health conditions (MHCs) have been associated with undertreatment of unrelated medical conditions, but whether patients with MHCs face disparities in receiving antiarrhythmic therapies (AATs) for atrial fibrillation (AF) is currently unknown. We assessed the hypothesis that MHCs are associated with decreased use of AATs. Methods: The FinACAF cohort included records on all AF patients in Finland during 2007-2018 identified from nationwide registries covering all levels of care as well as their drug purchases. The main exposure was any MHC (previous diagnosis of depression, bipolar disorder, anxiety disorder or schizophrenia or fulfilled prescription of psychiatric medication within preceding year from first AF diagnosis) and the main outcome was use of any AAT, including cardioversion, catheter ablation, and fulfilled antiarrhythmic drug (AAD) prescription. Results: We identified 239 222 patients with incident AF and the prevalence of any MHC was 19.9%. Mean age was 72.6 years (SD 13.2). Lower overall rate of any AAT use was observed in patients with any MHC than in those without MHC (16.9% vs. 22.9%, p&lt;0.001). Cumulative five-year incidence curve of any AAT is presented in Figure 1. Any MHC was associated with decreased use of any AAT, AADs, cardioversion and catheter ablation (adjusted hazard ratios (aHR) 95% CI 0.804 (0.784-0.823), 0.870 (0.839-0.902), 0.784 (0.762-0.806) and 0.832 (0.771-0.899), respectively). Depression, bipolar disorder, anxiety disorder and schizophrenia were individually associated with decreased use of any AAT (aHR 95% CI 0.879 (0.837-0.922), 0.871 (0.760-0.998), 0.786 (0.731-0.845), and 0.423 (0.358-0.500), respectively). A lower rate of AAT use was observed in patients with MHC across the study period and no meaningful temporal change was noted in the MHC related deficit. Conclusions: MHCs are associated with decreased use of rhythm control therapies in patients with AF.

Abstract 10464: Mental Health Conditions Are Associated with Underuse of Oral Anticoagulation Therapy in Patients with Atrial Fibrillation: The FinACAF Study

Introduction: Little is known about the effects of mental health conditions (MHC) on the utilization of oral anticoagulant (OAC) therapy in patients with atrial fibrillation (AF). We assessed the hypothesis that MHCs are associated with a lower rate of OAC initiation in patients with incident AF. Methods: The FinACAF registry included all 239 756 patients with incident AF during 2007-2018 in Finland identified from national registries covering all levels of care as well as their drug purchases. The main exposure was any MHC (previous diagnosis of depression, bipolar disorder, anxiety disorder or schizophrenia or fulfilled prescription of psychiatric medication within preceding year from first AF diagnosis) and the outcome OAC initiation (first fulfilled OAC prescription after AF diagnosis). Results: The patients’ mean age was 72.6 years (SD 13.2), 49.7% were female and 95.0% had CHA 2 DS 2 -VASc score ≥1. The prevalence of any MHC was 19.9%. A lower rate of OAC initiation was observed in patients with any MCH than in those without MHC (64.9% vs. 73.1%, p&lt;0.001) during the entire follow-up. Any MHC was associated with lower cumulative incidence of OAC initiation (adjusted subdistribution hazard ratio (aSHR) 0.783; 95% CI 0.774-0.794, Figure) during the entire follow-up, as were depression (aSHR 0.833; 95% CI 0.813-0.852), bipolar disorder (aSHR 0.807; 95% CI 0.778-0.838), anxiety disorder (aSHR 0.816; 95% CI 0.758-0.878) and schizophrenia (aSHR 0.743; 95% CI 0.698-0.792) individually. By 2018, 89.9% of OAC initiations were with a non-vitamin K antagonist oral anticoagulant (NOAC) in patients with any MHC and 92.4% in patients with no MHC. Any MHC remained associated with impaired cumulative incidence of OAC initiation also in the NOAC-era during 2015-2018 (aSHR 0.821; 95% CI 0.805-0.837). Conclusions: MHCs are common among AF patients, and they are associated with a lower rate of OAC initiation even during the NOAC-era.

Epidemiological characteristics and hospitalization trajectories prior to suicide in Galicia between 2013 and 2016

IntroductionAddressing suicide requires an understanding of regional patterns of epidemiology, with health variables being central. However, the clinical profile of people who commit suicide has received little attention. The objectives of this study were to analyze the sociodemographic, clinical, and forensic characteristics of persons who committed suicide in Galicia between 2013 and 2016, analyze suicide mortality rates, and identify trajectories of hospitalizations and associated variables. Material and methodsA population study was carried out on the 1354 people who died by suicide in Galicia. ResultsThe most common profile was a retired man, 57.9 years old (SD=18.5), from an urban and inner area. 43.6% had been previously hospitalized, 41.6% had been diagnosed with physical disorders, and 26.8% with mental disorders. 48.2% had been prescribed psychiatric medications and 29.6% had received outpatient psychiatric care. The highest prevalence of death by suicide (27.5%) was in 2014, with the predominant method being hanging (59.1%). The average raw rate was 12.3/100,000. Three trajectories of hospitalizations emerged: 94.83% had experienced few hospitalizations; 2.95% an increasing pattern; and 2.22% a decreasing pattern. These trajectories were associated with number of psychiatric appointments, prescription of psychiatric medications, and diagnoses of physical and mental disorders. ConclusionsThese findings are crucial for detection and prevention.

The effect of mental health conditions on the use of oral anticoagulation therapy in patients with atrial fibrillation: the FinACAF study.

AimsLittle is known about the effects of mental health conditions (MHCs) on the utilization of oral anticoagulation (OAC) therapy in atrial fibrillation (AF) patients. We aimed to assess whether MHCs affect initiation of OAC therapy among AF patients with special focus on non-vitamin K antagonist oral anticoagulants (NOACs).Methods and resultsThe Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) registry included all 239 222 patients diagnosed with incident AF during 2007–18 in Finland identified from national registries covering primary to tertiary care and drug purchases. Patients with previous depression, bipolar disorder, anxiety disorder, or schizophrenia diagnosis or a fulfilled psychiatric medication prescription within the year preceding the AF diagnosis were classified to have any MHC. The main outcome was OAC initiation, defined as first fulfilled OAC prescription after AF diagnosis. The patients’ mean age was 72.7 years and 49.8% were female. The prevalence of any MHC was 19.9%. A lower proportion of patients with any MHC compared with those without MHCs were initiated on OAC therapy (64.9% vs. 73.3%, P < 0.001). Any MHC was associated with lower incidence of OAC initiation [adjusted subdistribution hazard ratio (aSHR) 0.867; 95% confidence interval (CI) 0.856–0.880], as were depression (aSHR 0.868; 95% CI 0.856–0.880), bipolar disorder (aSHR 0.838; 95% CI 0.824–0.852), anxiety disorder (aSHR 0.840; 95% CI 0.827–0.854), and schizophrenia (aSHR 0.838; 95% CI 0.824–0.851), during the entire follow-up. Any MHC remained associated with impaired incidence of OAC initiation also in the NOAC era during 2015–18 (aSHR 0.821; 95% CI 0.805–0.837).ConclusionMHCs are common among AF patients, and they are associated with a lower rate of OAC initiation even during the NOAC era.

Pattern of Medicine Prescribing in PHC Facilities before and after earthquake in Nepal

Introduction: On April and May 2015, Nepal experienced two earthquakes. Many studies have focused on acute care delivery, disease outbreaks, mental health issues, and disaster relief post-earthquakes. Few others have looked at psychiatric medication prescription and health aid distribution pattern, only one study has addressed the effects of an earthquake on medication prescribing patterns and compared them to the post earthquake setting. This paper aims to examine common health problems and prescribing practices before and after the earthquake.&#x0D; Methods: This descriptive retrospective study was conducted within seven randomly selected health posts (HPs) located in the three most earthquake-affected districts of Bhaktapur, Kathmandu and Dhading. The patient records per month from each HP were selected from the out patient department (OPD) register by systematic random sampling for three months prior and three months after the earthquake. There were 584 and 654 encounters in the pre and post earthquake period respectively. Each patient record was analysed using WHO drug use indicators and national treatment guidelines.&#x0D; Results: A significant decrease in encounters receiving antibiotics and cases receiving albendazole alone in worm infestation was found in the post-earthquake period. A significant increase in prescribing antibiotics in cases of common cold was found. &#x0D; Conclusions: The common health problems were similar in both periods. However, prescribing practices were changed. As prescriptions related to mental health problems were lacking, there is a need for improving mental health education to the health workers.

The Impact of Parental Injury on Children's Mental Health Diagnoses and Classes of Psychotropic Medication by Child Age.

Civilian and military research has linked parental illness and injury with increased overall mental health care and psychiatric medication use in children. Care for specific mental health conditions and medications by child age have not been reported. We sought to quantify the effect of parental illness and injury on child mental health care and psychiatric medication use in children overall and stratified by age. A self-controlled case series analyzed the impact of parental illness/injury on mental health and psychiatric medication use of military dependent children. Children were aged 2-16 years (51% male) when their parents were injured and received care in the Military Health System for 2 years before and 2 years after their parent's illness/injury. We used International Classification of Diseases 9th edition codes to identify outpatient mental healthcare visits. Outpatient care for 14 specific mental health diagnoses was classified using the Agency for Healthcare Research and Quality clinical classification system. Outpatient pharmacy records identified psychiatric medication prescriptions by therapeutic class. Parental illness/injury was identified by inclusion in the Military Health System Ill, Injured, and Wounded Warrior database. Adjusted negative binomial regression analysis compared rates of outpatient visits and medication days in the 2 years following parental illness/injury to the 2 years before the parent's illness/injury overall. Secondary analyses were stratified by age groups of 2-5 years (n = 158,620), 6-12 years (n = 239,614), and 13-16 years n = 86,768) and adjusted for parental pre-injury/illness deployment and child sex. Additional secondary analysis compared post-parental injury/illness care of children whose parents had post-traumatic stress disorder or traumatic brain injury to children of parents with physical/mental health injury/illness. There were 485,002 children of 272,211 parents injured during the study period. After adjustment for child sex, years of pre-injury/illness parental deployment, and child age, parental illness/injury was associated with increased mental visits across all categories of care except developmental diagnoses. Post-parental injury visits for suicidal ideation, alcohol abuse, mood, and anxiety disorders were all doubled. For children aged 2-5 years at parental illness/injury, the largest increases in care were in psychotic, anxiety, attention deficit, and mood disorders. In children aged 6-12 years, the largest increases were in psychotic conditions, suicidal ideation, and personality disorders. In adolescents aged 13-16 years, the largest increases were for alcohol and substance abuse disorders, with visits increasing by 4-5 times. For children of all ages, parental injury was associated with increased use of all therapeutic classes of psychiatric medications; use of stimulant medications was increased in younger children and decreased in older children following parental injury (P < .001). Parental illness/injury is associated with increased mental health care and days of psychiatric medication use in dependent children. Practitioners who care for families impacted by parental illness/injury should be cognizant of children's mental health risk. Early identification and treatment of child-related mental health issues can improve family functioning and increase military family readiness.

Patients with chronic urticaria have a higher risk of psychiatric disorders: a population-based study.

The prevalence of psychiatric comorbidities in patients with chronic urticaria (CU) in a national population is largely unknown. To investigate the prevalence of psychiatric disorders and psychiatric medication use in patients with CU in Taiwan. Data were sourced from Taiwan's National Health Insurance Research Database for 2011. Patients who had a primary/secondary International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code of 708·1, 708·8 or 708·9 during 2011 with at least two outpatient visits and an antihistamine prescription were identified as CU cases. Patients with CU were classified into three disease severity groups according to their medication types. Psychiatric disorders were identified by patients having three outpatient visits with a primary or secondary diagnosis of a given psychiatric disease. Psychiatric medication use was defined by having at least four outpatient visits with prescriptions for anxiolytics, antidepressants or sleeping pills in 2010 or 2011. Of the 167 132 patients with CU, 82·5% had mild CU, 17·0% had moderate CU and 0·4% had severe CU. Patients with CU had a higher prevalence of psychiatric disorders and psychiatric medication prescription than control groups. The relative risk (RR) of psychiatric disorders was 1·43 for patients with mild, 1·50 for patients with moderate and 2·32 for patients with severe CU vs. the controls (P < 0·001). For psychiatric medication prescription, the RRs were 1·95, 2·70 and 2·09, respectively, vs. controls (P < 0·001). Patients with CU had a higher prevalence and risk of psychiatric disorders and psychiatric medication prescription than control groups. What's already known about this topic? Previous studies have shown a high prevalence of psychiatric comorbidities in patients with chronic urticaria (CU), with rates ranging from 35% to 60%. Anxiety, depression and somatoform disorders have been reported as the most prevalent mental disorders in patients with CU. What does this study add? Patients with CU had a higher prevalence of psychiatric disorders and psychiatric medication use than control groups in the general population. The relative risk (RR) of psychiatric disorders was 1·43 for those with mild CU, 1·50 for those with moderate CU and 2·32 for those with severe CU vs. controls. The RR for psychiatric medication use was 1·95 for those with mild CU, 2·70 for those with moderate CU and 2·09 for those with severe CU vs. controls. Mental health evaluations and management are important elements in CU management.