Psychiatric Medication Use Research Articles

What we have learned from the Methadone Maintenance Treatment of Dual Disorder Heroin Use Disorder patients.

Mental Disorders and Heroin Use Disorder (HUD) often co-occur and constitute correlated risk factors that the authors believe are best considered from a unitary perspective. In this article we review and discuss data collected by the V.P. Dole Research Group in Dual Disorder (V.P. Dole DD-RG) patients according to the following six discussion points: (1) Treatment of personality disorders during Methadone Maintenance Treatment (MMT); (2) Treatment of Mood Disorders during MMT; (3) Treatment of Anxiety Disorders during MMT; (4) Treatment of Psychotic Disorders during MMT; (5) Treatment of violence during MMT; (6) Treatment of Alcohol Use Disorder (AUD) during MMT. In treating Mood Disorder in HUD patients, we must bear in mind the interactions (potentiation and side effects) between psychopharmacology, used substances and agonist opioid medications; the use of psychiatric medications as an anti-craving drug, and the possible use of agonist and antagonist opioid medications in treating the other mental disorders. In treating chronic psychosis in HUD patients, we must consider the potentiation and side effects of antipsychotic drugs consequent on HUD treatment, worsening addiction hypophoria and inducing a more severe reward deficiency syndrome (RDS) in hypophoric patients. Violence and AUD during MMT can benefit from adequate dosages of methadone and co-medication with Sodium gamma-hydroxybutyrate (GHB). The experience of our V.P. Dole DD-RG suggests the following: (a) DD is the new paradigm in neuroscience in deepening our understanding of mental health; (b) To successfully treat DD patients a double competence is needed; (c) In managing DD patients priority must be given to Substance Use Disorder (SUD) treatment (stabilizing patients); (d) Antidepressant use is ancillary to SUD treatment; antipsychotic use must be restricted to acute phases; mood stabilizers must be preferred; any use of Benzodiazepines (BDZs) must be avoided.

M84 - EXOCYTOSIS-RELATED GENE-SETS AND RESPONSE TO METHYLPHENIDATE TREATMENT IN ADULTS WITH ADHD

Background Substantial interindividual variability is observed in treatment response to Methylphenidate (MPH), which is considered the first-line pharmacological treatment for adults with ADHD. In addition to its main known mechanism of action involving the blockade of the dopamine transporter, experimental studies have also indicated an ability of MPH to affect vesicle synaptic transmission. Consistently with this hypothesis, genes involved in calcium-triggered vesicle exocytosis have been implicated on pharmacogenetics of MPH. In genomic approaches, pathways involved in the neurotransmitter release are therefore promising to be investigated in MPH response. The aim of this study was to assess the influence of exocytosis-related gene-sets on response to MPH. Methods The sample with genome-wide data and immediate-release MPH response comprised 189 adults with ADHD. The outcome measure was the change (∆) in severity scores of ADHD symptoms of SNAP-IV from baseline to endpoint (at least 30 days of treatment). Subsets of inattention and hyperactivity/impulsivity symptoms was also evaluated separately. Samples were genotyped on PsychChip array and imputed using the Ricopili pipeline. The resulting dataset consisted of 5,842,472 SNPs after quality control. For SNP annotation to genes, gene locations for build 37 (hg19) and a 2 kb upstream/1 kb downstream window were used. Competitive gene-set analyses were performed in MAGMA v1.06 using the principal components regression as the gene-based model. Concomitant use of psychiatric medication and baseline scores of symptoms were included as covariates, as well as the 10 first principal components. Eight annotated gene-sets related to function and regulation of calcium-triggered vesicle exocytosis derived from Gene Ontology (biological process) and collected from Molecular Signatures Database were analyzed. Bonferroni was applied for multiple testing correction. Results Gene-set analysis for the change in severity scores of ADHD resulted in nominal associations for calcium ion regulated exocytosis (GO:0017156; p=0.0189), presynaptic process involved in synaptic transmission (GO:0099531; p=0.0153) and neurotransmitter transport (GO:0006836; p=0.0231) gene-sets. Analyzing specific ADHD dimensions, the same gene-sets were associated to change of inattention symptoms only, where GO:0099531 remained significant after Bonferroni correction (p=0.0012). There was considerable overlap of genes within the tested gene-sets, therefore the gene analysis revealed a shared group of nominally associated genes among the significant sets for both inattention and ADHD, including STX11, STX19, PSEN1, CACNA1A and NRXN1. Discussion Our results suggest an involvement of neurotransmitter release genes in MPH treatment response. The lack of association for hyperactivity/impulsivity symptoms might point out different treatment underlying mechanisms between ADHD dimensions. Despite the evaluation of combined effects of multiple genetic variants grouped into predefined gene-sets is an alternative strategy to GWAS to reach increased statistical power, our small sample size should be considered in the interpretation of the results. Moreover, as the selected gene-sets are not independent, an increased precision in pathway definition would be benefic to these analyses. Notwithstanding, pathways involved in neurotransmitter release emerge as important candidates to be explored in further pharmacogenetic studies of ADHD.

QTc Prolongation Associated With Psychiatric Medications: A Retrospective Cross-Sectional Study of Adult Inpatients.

The aim of our study was to assess the impact of psychiatric medications and concomitant risk factors on the prevalence of QTc prolongation and torsades de pointes (TdP) in hospitalized subjects. We examined the association between individual risk scores and QTc prolongation and proposed an evidence-based protocol for electrocardiogram monitoring on psychotropic medications. Electrocardiograms (ECGs) of subjects hospitalized over a 1-year period were analyzed for QTc prolongation, associated risk factors, and use of medications. Analysis was performed using logistic regression to identify independent predictors of QTc prolongation, and the Pearson χ test was used for risk score assessment. A total of 1249 ECGs of 517 subjects were included in this study. Eighty-seven subjects had QTcB intervals greater than 470 milliseconds for females and greater than 450 milliseconds for males. Twelve (2.3%) subjects had QTcB of 500 milliseconds or greater, or greater than 60 milliseconds of change from baseline. Of these subjects, only 1 case of QTc interval change was related to routine use of psychiatric medications. There were no incidents of TdP. Age, diabetes, hypokalemia, overdose, diphenhydramine, and haloperidol were significant independent predictors of QTc prolongation. Risk scores were significantly correlated with QTc prolongation (P = 0.001). Our retrospective review study found that the occurrence of TdP and QTc prolongation was low in this subject population. QT abnormalities were associated with known risk factors, and risk scores correlated well with QTc prolongation. Providers can use the protocol proposed in this study, which incorporates risk scores and the CredibleMeds classification system to determine the need for ECG monitoring and to guide treatment.

Aberrant striatal tracking of reward magnitude in youth with current or past-year depression.

Reward dysfunction is often present in youth with major depressive disorder (MDD), but the specific neurobiological bases underlying reward valuation deficits remain unclear. The current study examined whether adolescents and young adults with MDD track brain and behavioral responses according to relative reward magnitude-a neurocognitive valuation process known as magnitude tracking. Female adolescents and young adults ages 15-20 years (n = 56 with current or past-year MDD; n = 26 healthy controls [HCs]) completed a task during functional neuroimaging in which they could win or lose money at high stakes (+$1/-50¢) and low stakes (+20¢/-10¢). Behaviorally, HC accelerated button press responses on high stakes compared to low-stakes trials, whereas MDD did not alter response speed across stakes. Neurally, HC increased recruitment of the ventral and dorsal striatum, canonical reward-processing regions, for high-magnitude versus low-magnitude rewards. However, the MDD group did not exhibit striatal magnitude tracking for low versus high rewards-an effect independent of MDD recency, MDD symptom severity, comorbid anxiety and substance use disorders, and psychiatric medication use. In contrast, striatal recruitment for overall reward reactivity, measured by comparing striatal activity for reward and loss feedback, was similar in the MDD and HC groups. However, reward reactivity was negatively correlated with current depression symptom severity in the MDD group. Taken together, these findings suggest that whereas reward reactivity may vary with current depression severity, reward magnitude tracking may represent an important aberrant valuation process in youth with depression-independent of symptom severity and recency. This valuation deficit may have implications for maladaptive motivation and learning observed in youth with MDD. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Medicaid's Institutions for Mental Diseases (IMD) Exclusion Rule: A Policy Debate-Argument to Retain the IMD Rule.

Medicaid's Institutions for Mental Diseases (IMD) Exclusion Rule: A Policy Debate-Argument to Retain the IMD Rule.

Prevalence and Factors Associated With Psychiatric Medication Use in Bariatric Surgery Candidates

We aimed to describe the rates of psychiatric medication use in bariatric surgery candidates and factors associated with psychiatric medication use. Patients from the Toronto Western Hospital Bariatric Surgery Program were recruited from 2011 to 2014. Data extracted included demographics, clinical factors (e.g., mood disorder, anxiety disorder, eating disorder, Patient Health Questionnaire-9, Generalized Anxiety Disorder 7), and psychiatric medication use. Logistic regression analyses were used to examine the relationship between demographic variables, clinical factors, and psychiatric medication use. Multiple logistic regression was conducted to determine the predictors of clinical factors from demographic variables with psychiatric medication use. A total of 262 (35.1%) patients were taking at least 1 psychiatric medication and 105 patients (14.1%) were taking more than 1 psychiatric medication. Antidepressants were the most common psychiatric medication reported. The majority of patients taking a psychiatric medication had a psychiatric illness, with 16.0% not having a lifetime diagnosis of a mental illness. Being male and being employed significantly predicted lower odds of being on a psychiatric medication. Older age significantly predicted higher odds of being on a psychiatric medication. Psychiatric disorders were significantly associated with psychiatric medication use independent of demographic variables. Our study provides insights into clinical and demographic factors related to psychiatric medication use in bariatric surgery patients. The findings support careful screening and clarification of psychiatric medications, especially in patients without a formal psychiatric diagnosis.

The impact of financial strain on medication non-adherence: Influence of psychiatric medication use

Non-adherence to prescribed medications is a systemic public health concern. Financial strain, the extent to which an individual is unable to afford necessary items, may represent an important factor related to adherence. This study evaluated the association between financial strain and medication adherence as a function of medication type. Participants reporting a daily prescription for psychiatric or other chronic health conditions (N = 231) were sampled from the crowdsourcing website Amazon Mechanical Turk (mTurk). All participants completed measures of financial strain and other individual-difference factors related to adherence. Medication adherence was evaluated using a subjective scale (i.e., ARMS) and past month non-adherence rates. General financial strain showed a modest relationship with subjective scales of adherence, but not past month non-adherence rates. Medication-specific financial strain was associated with greater non-adherence, even after controlling for relevant demographic, socio-economic, and personality factors. Medication-specific financial strain also disproportionately affected individuals taking psychiatric medications relative to those not taking psychiatric medications. These findings emphasize the role that financial strain plays in medication adherence, and in particular, in psychiatric conditions. Future studies could design interventions targeting financial strain to improve clinical adherence, broadly, and psychiatric medication adherence, specifically.

Antiepileptic and psychiatric medication in a nationwide cohort of patients with glioma WHO grade II-IV.

Glioma is the most common intracranial primary brain tumor. Patients with glioma often suffer from epilepsy, anxiety and depression. Aims of this study were to identify risk factors for drug-treated anxiety and depression, and to determine the use of psychiatric medication in a national glioma cohort. Data from the Cancer Registry of Norway on all persons diagnosed with glioma WHO grade II-IV 2004-2010 were linked with data from the Norwegian Prescription Database. Cox regression analysis was used to assess risk factors for drug-treated anxiety and depression. Standardized incidence ratios were calculated for psychiatric medication dispensed to glioma patients and compared to the general population. The glioma cohort consisted of 1056 males and 772 females. Of the 1828 patients, 565 had glioma grade II-III, and 1263 had grade IV. The patients with glioma grade II-III who were treated with levetiracetam had an increased risk for drug-treated anxiety compared to patients without levetiracetam; hazard ratio 2.8 (95% confidence interval 1.7-4.9). Female gender increased the risk for drug-treated anxiety compared to males in patients with glioma grade IV; hazard ratio 1.5 (95% confidence interval 1.2-2.0). Antidepressants were less frequently dispensed to patients with glioma grade II-III and epilepsy than to the general population. Patients with glioma grade II-III on levetiracetam had an increased risk for drug-treated anxiety. The subgroup of patients with glioma grade II-III and epilepsy received less antidepressants than the general population.

Psychosexual Correlates of Unwanted Sexual Experiences in Women Consulting for Female Sexual Dysfunction According to Their Timing Across the Life Span

BackgroundComparative data on the psychopathologic and sexual correlates of unwanted sexual experiences (USEs) occurring during childhood, adolescence, or adult life are lacking. AimTo investigate the prevalence of USEs in a setting of female sexual dysfunction (FSD) and to examine whether they are associated with different psychosexual parameters depending on the timing of occurrence. MethodsA consecutive series of 200 heterosexual women attending our clinic for FSD was consecutively recruited. Main Outcome MeasurePatients underwent a structured interview and completed the Female Sexual Function Index, the Middlesex Hospital Questionnaire, the Female Sexual Distress Scale–Revised, the Body Uneasiness Test, and the Childhood Experience of Care and Abuse questionnaire. USEs were classified as occurring in adult life (≥17), adolescence (<17 and ≥14), or childhood (<14 years). Results47 women (23.5%) reported USEs, occurring in childhood, adolescence, and adult life in 38.3% (n = 18), 31.9% (n = 15), and 29.8% (n = 14) of cases, respectively. We observed an association between history of lifetime USEs and indexes of psychopathology, specifically diagnosis of psychiatric diseases, use of psychiatric medications, and anxiety symptoms (Middlesex Hospital Questionnaire free-floating anxiety score). USEs were associated with lower orgasm ability (Female Sexual Function Index orgasm domain), higher sexually related distress levels (Female Sexual Distress Scale–Revised total score), and higher body image concerns (Body Uneasiness Test) including depersonalization symptoms. Notably, women exposed to USEs in adolescence reported a stronger impairment of arousal, orgasm, and satisfaction domains and higher sexual distress when compared to women without a history of USEs or reporting USEs in childhood. Women exposed to USEs in childhood exhibited higher body image concerns and depersonalization symptoms when compared to those not reporting USEs. Clinical ImplicationsUSEs should be investigated in women consulting for FSD because patients who had USEs may require unique strategies to optimize the diagnostic and therapeutic work-up of their sexual symptoms. Strength & LimitationsOur main contribution is that we addressed the different impacts of USEs depending on their timing across the life span. However, the cross-sectional nature of the study does not allow determination of the cause-and-effect nature of the associations, and the selectivity of the sample (women consulting for FSD) limits the generalizability of the results. ConclusionThe negative outcomes of USEs vary according to their timing of occurrence: adolescence appears as the most sensitive temporal window for USEs to exert their deleterious effects on female sexuality, whereas childhood USEs are more tightly related to a severe body uneasiness in adult life.Maseroli M, Scavello I, Campone B, et al. Psychosexual Correlates of Unwanted Sexual Experiences in Women Consulting for Female Sexual Dysfunction According to Their Timing Across the Life Span. J Sex Med 2018;15:1739–1751.

Impact of Sleeve Gastrectomy on Psychiatric Medication Use and Symptoms.

Background Sleeve gastrectomy (SG) has become the primary bariatric surgery procedure in the U.S. Over 50% of people presenting for surgery have psychiatric diagnoses. The study purpose was to evaluate change in anxiety and depression symptoms and medication use after SG. Methods Subjects completing SG with a diagnosis of anxiety and/or depression treated with medication were retrospectively identified from the electronic medical record (EMR) of Synergy Bariatrics, a department of the Erie County Medical Center. Phone outreach was made to complete seven-point global impression of change scale classifying symptom improvement or worsening in the 3- to 6-month postoperative period. Improvement or worsening was defined as either all reported symptoms improving or worsening or ≥1 improving or worsening while remaining unchanged. If ≥1 symptom improved and worsened, it was classified as mixed. No change required the same profile before and after surgery. Medication, dose, and changes were identified by EMR, verified during interview and classified as no change, discontinued, decreased, or increased. Results 59 subjects completed the interview. 21 subjects were diagnosed with anxiety. 13 (62%) had no change in therapy and 5 (24%) decreased. Symptoms improved in 12 (57%), worsened in 3 (14%), and mixed in 5 (24%). When symptoms improved, the same dose was present in 7/12 (58%) and dose decreased in 3 (25%). 51 subjects were diagnosed with depression. 32 (63%) had no change in therapy, 11 (21%) discontinued, and 4 (8%) decreased. Symptoms improved in 34 (67%), mixed in 10 (20%), worsened in 4 (8%), and unchanged in 3 (6%). When symptoms improved, the same regimen and dose was present in 21/34 cases (62%) and discontinued in 9 (26%). Conclusion Anxiety symptoms improved in >50% of subjects at predominantly the same or reduced dosage. Depression symptoms improved in 67% and commonly without therapy change. These data suggest evidence that patients undergoing SG while on medication for anxiety or depression may have early symptom improvement on the same or lessened dosage.

Deprescribing in Psychiatry

With the growth of polypharmacy across medicine, the concept of <italic>deprescribing</italic>—reducing or eliminating the use of medication—is gaining traction among prescribers in a range of specialties. Applying this concept to psychiatry is more complex than in other fields of medicine and requires expanding the intervention to include consideration of psychological, social, environmental, and cultural factors. Taking a recovery-oriented and strengths-based approach, this book outlines the need for deprescribing in psychiatry and expands on the intervention to look at barriers and strategies for addressing them, as well as specific considerations for classes of psychotropic medications. The book is explicitly not against the use of medications but instead promotes a rational approach to considering the reduction of medications when indicated and when agreed upon by both prescriber and patient by promoting the use of shared decision-making and working to minimize risk while maximizing quality of life. The book includes learning objectives, self-assessment quizzes, and case examples to support the reader and provide concrete illustrations of implementation. It is geared toward all prescribers of psychiatric medications and is useful as well for patients, family members, and other mental health practitioners interested in learning more about approaches to making the best, most judicious use of psychiatric medications in mental health.

DU1 - Early Initiation of Long-Acting Injectable Antipsychotic Treatment is Associated with Lower Healthcare Resource Use and Costs in Patients with Schizophrenia

To determine if early initiation of long-acting injectable (LAI) antipsychotic treatment is associated with lower healthcare resource use and cost in patients with schizophrenia. This retrospective cohort analysis used 9.5 years of claims data (1/1/2007–6/30/2016) from Truven Health MarketScan® Commercial, Medicaid, and Medicare Supplemental databases. In patients ≥18 years with a new episode of schizophrenia, two mutually exclusive cohorts were identified based on time from date of first schizophrenia diagnosis (the new episode) to first date of starting a LAI (index date): ≤1 year (early initiators) and >1 year (late initiators). Patients were required to have continuous enrollment between the new episode of schizophrenia and LAI initiation and for ≥1 year before (baseline) and after (follow-up) index date. Logistic and general linear regression models were performed to estimate the adjusted hospitalization rate and healthcare costs, controlling patient demographic and clinical characteristics, insurance type, baseline all-cause hospitalizations and emergency department visits, and baseline psychiatric medication use (including oral antipsychotic use). 31% (n=1,388) initiated treatment early and 68% (n=2,978) initiated later. In risk-adjusted models, all-cause hospitalization rates were 22.1% (95%CI, 19.8%-24.5%) in early initiators and 26.9% (95%CI 25.2%-28.7%) in late initiators (p<0.001). 14.0% (95%CI, 12.2%-16.0%) of early initiators had a psychiatric hospitalization compared with 19.2% (95%CI 17.7%-20.8%) of late initiators (p<0.001). Adjusted psychiatric healthcare costs were significantly lower in early initiators compared with late initiators [mean (95%CI) $21,337 (20,135-22,539) vs. $24,228 (23,419-25,038)] (p<0.001). Adjusted all-cause healthcare costs were lower in early initiators compared with late initiators [mean (95%CI) $34,661 (32,531-36,791) vs. $36,342 (34,907-37,777)], but the difference was not statistically significant (p=0.21). Schizophrenia patients who initiated a LAI early had lower hospitalization rates and healthcare costs compared with late LAI initiators.

Impact of psychiatric medication co-exposure on Neonatal Abstinence Syndrome severity

BackgroundAmong opioid-exposed infants, psychiatric medication co-exposure is common. Our objective was to compare Neonatal Abstinence Syndrome (NAS) outcomes based on individual psychiatric medication co-exposures. MethodsA retrospective study of 744 opioid-exposed mother-infant dyads from a single institution was performed. Mothers on pharmacotherapy with methadone or buprenorphine at delivery were included. Data were collected on maternal demographics, psychiatric medication use, and NAS outcomes, including any medication treatment, adjunctive medication treatment, length of hospital stay (LOS), and opioid treatment days. The extent to which individual psychiatric medication and polypharmacy exposure were associated with NAS outcomes was assessed using multivariable regression. ResultsFifty-four percent of the mothers were on ≥1 psychiatric medication, with 32% on ≥2 or psychiatric medications (polypharmacy group). In adjusted models, polypharmacy exposure was associated with longer LOS (β = 4.31 days, 95% CI 2.55–6.06) and opioid treatment days (β = 3.98 days, 95% CI 2.24–5.72) and more treatment with adjunctive medication for NAS (aOR = 2.49, 95% CI 1.57–3.95). Benzodiazepines were associated with longer LOS (β = 4.94, 95% CI 2.86–7.03) and opioid treatment days (β = 4.86, 95% CI 2.61–6.75), and more adjunctive medication treatment (aOR = 2.57, 95% CI 1.49–4.42). Gabapentin was associated with longer LOS (β = 2.79, 95% CI 0.54–5.03), more NAS medication treatment (aOR = 2.96, 95% CI 1.18–7.42) including more adjunctive medications (aOR = 1.92, 95% CI 1.05–3.53). ConclusionFor infants of mothers with OUD who are also on concurrent psychiatric medications, polypharmacy was associated with worse NAS severity. When medically indicated, limiting use of multiple psychiatric medications, particularly benzodiazepines and gabapentin, during pregnancy should be considered to improve NAS outcomes.

Psychiatric medication use during pregnancy and lactation

Psychiatric medication use during pregnancy and lactation

Interventions for perinatal depression in low and middle-income countries: A systematic review.

Perinatal depression has been associated with infant low birth weight and with multiple health indicators affecting childhood morbidity and mortality. The condition is twice as prevalent in low and middle-income countries (LMICs) compared to high-income countries but poorly studied. To conduct a review of published literature on interventions for perinatal depression in LMICs. A search of the literature was performed for articles published up to October 2017. The key inclusion criteria were peer-reviewed studies focusing on interventions for perinatal depression during pregnancy and/or up to one-year postpartum. 1088 citations were retrieved, of which 18 studies with representation from countries in Africa, Asia, North America (Mexico) and South America were included. The majority of interventions were conducted in lower-income settings. Most were psychosocial in nature and often provided by lay health workers and in the community. Interventions integrated as part of general health programs and employing psychotherapeutic approaches were more effective and were also preferred. Only one study incorporated the use of psychiatric medications. Despite the limited publications, there is reasonable evidence for the benefit of psychological interventions in perinatal depression in LMICs. More research is needed to verify and extend these results and, in particular, to evaluate the benefit of adjunctive medications when treating moderate to severe depression and whether interventions can increase social supports.

Impact of psychiatric comorbidities on outcomes of elderly liver transplant recipients

ObjectivesThis study evaluated the impact of psychiatric comorbidities in liver transplant (LT) recipients aged ≥65 years (elderly) on length of hospital-stay (LOS), death, and a composite outcome of graft loss or death. MethodsThis retrospective study assessed impact of psychiatric comorbidities in 122 elderly LT recipients and a matched group of 122 LT recipients aged <65 years (younger). Associations were assessed using adjusted multivariable regression models. ResultsAmong elderly, median age at LT was 68 years, most were males (62%), white (85%) and 61.7% had a history of any psychiatric diagnosis. Among younger, median age was 55, most were males (67.2%), white (77.5%) and 61.5% had any psychiatric diagnosis. Median LOS was 8 days for both groups. Among elderly, after a median follow-up of 5 years, 25.4% died and 29.5% experienced graft loss or death. History of adjustment disorder, history of depression, past psychiatric medication use, and pain prior to LT were associated with an increased risk of death or the composite graft loss or death. Perioperative use of SSRIs and lack of sleeping medication use were associated with longer LOS. Among aged <65, after median follow-up of 4.7 years, 21 patients (17%) died and 25 (20%) experienced graft loss or death; history of depression, perioperative SSRIs or sleeping medications use was associated with increased mortality and graft-loss or death. ConclusionSix out of 10 patients among both elderly and younger cohorts had pre-LT psychiatric comorbidities, some of which adversely affected outcomes after LT.

Psychiatric disorders among children of parents with cancer: A Swedish register-based matched cohort study.

To investigate the risk of psychiatric disorders among children of parents with cancer in a nationwide population-based setting. Based on Swedish national registers, the study included 101339 children with parental cancer diagnosed either during pregnancy (N=1047) or after birth (N=100292) that were born during 1983 to 2000. For each exposed child, we randomly selected 10 unexposed children from the general population after individual matching by year of birth and sex. The matched cohort was followed during 2001 to 2010. Clinical diagnoses of psychiatric disorders and use of prescribed psychiatric medications were identified for all children. Cox regression and logistic regression were used to evaluate the associations of parental cancer with psychiatric disorder diagnosis and psychiatric medication use, respectively. Parental cancer during pregnancy was not associated with the risk of psychiatric disorders overall, although paternal cancer during pregnancy was associated with a higher risk of psychiatric medication use among females. Parental cancer after birth was associated with higher risks of psychiatric disorder diagnoses, particularly stress reaction and adjustment disorders (males: hazard ratio [HR]: 1.24, 95% confidence interval [CI], 1.08-1.43; females: HR: 1.27, 95% CI, 1.14-1.41), and use of psychiatric medication (males: odds ratio [OR]: 1.09, 95% CI, 1.04-1.13; females: OR: 1.14, 95% CI, 1.10-1.18). The positive associations were stronger for parental cancer with poor expected survival and for parental death after cancer diagnosis. Parental cancer, primarily the life-threatening cancer, might confer a higher risk of psychiatric disorders among children. These findings have potential implications for health care professionals in providing targeted support to children living with a parent with cancer.

0738 Sarcopenia, Frailty, and Cognitive Dysfunction in Adults with Untreated Sleep Apnea

Sleep apnea is a common disorder that increases with age, in frequency and severity. Poor sleep causes imbalance, autonomic dysfunction and problems with concentration and memory and thereby contributes to falls and decline in functional and cognitive decline. The purpose of this study is to investigate prevalence of cognitive dysfunction, sarcopenia, and frailty in a population with sleep apnea. Validated questionnaires known as FRAIL, SARC-F, and RCS, as well as measurement of grip strength were used to assess frailty, sarcopenia, and cognitive function in subjects over 40 y with untreated obstructive sleep apnea. Medication, blood pressure, HbA1c, and sleep-related comorbidities were also recorded. Results were analyzed for the first 113 subjects (56% female) of median age 55 y. 48% were pre-frail, 28% frail; 23% had sarcopenia, and 40% had cognitive impairment. Mean grip strength for men was 382 N (SD 112 N) and for women was 222 N (SD of 80 N). Of 41 subjects aged 40 to 49 years, 22% were frail, 17% had sarcopenia, and 37% had cognitive impairment. Mean grip strength for men was 444N (SD 92N) and for women was 225N (SD 75N). Of 37 subjects aged 50 to 59 years, 32% were frail; 24% had sarcopenia, and 35% had cognitive impairment. Mean grip strength for men was 352N (SD 120N) and for women was 242N (SD of 84N). 32% of participants were prescribed SSRIs or SNRIs, 5% were prescribed anti-psychotics, 15% were prescribed GABA-modulators, 19% were prescribed opioids or narcotics, 9% were prescribed sex steroid hormones, 4% prescribed trazodone. Patients with untreated sleep apnea between ages 40 and 59y demonstrate a high prevalence of frailty, sarcopenia, and cognitive impairment. Association with a high rate of utilization of psychiatric and opioid medication use is noted. Saint Louis University School of Medicine Summer Research Fellowship.

The Economic Impact of New Therapeutic Interventions on Neuropsychiatric Inventory (NPI) Symptom Scores in Patients with Alzheimer Disease

Background/Aims: Few studies have modeled individual Neuropsychiatric Inventory (NPI) symptom scores for Alzheimer disease (AD) patients and assessed the value of therapeutic interventions that can potentially impact them. The main objective of this study was to evaluate the impact of new AD symptomatic treatments on relevant health economic outcomes via their potential effects on cognition and neuropsychiatric symptoms such as depression, irritability, anxiety, and sleep disorder. Methods: We enhanced the previously published AHEAD model (Assessment of Health Economics in Alzheimer’s Disease) by including new variables and functional relations to capture the NPI’s individual neuropsychiatric symptoms in addition to the total NPI score. This update allowed us to study the longitudinal effect of improvements in specific NPI subscale scores and the downstream impact on outcomes such as psychiatric medication use, survival, and institutional placement. Results: The model base-case results showed that a hypothetical treatment with symptomatic effects on anxiety, depression, and irritability NPI subscales was not cost-effective; however, the treatment’s cost-effectiveness was improved once a direct link between NPI subscales and mortality was explored or under relatively stronger treatment effects. Conclusion: Treatments that influence specific symptoms within the overall NPI have the potential to improve patient outcomes in a cost-effective way. This model is a useful tool for evaluating target product profiles of drugs with effect on NPI symptoms in early stages of development.

Olfactory processing in bipolar disorder, major depression, and anxiety.

Although olfactory abnormalities are well established in schizophrenia, considerably less work has examined olfactory performance in other neuropsychiatric conditions. In the current study, we examined odor identification, odor discrimination, detection threshold, and odor hedonic processing performance in individuals with bipolar I disorder (n=43; n=13 with psychotic features), bipolar II disorder (n=48), major depressive disorder (MDD) (n=134), anxiety (n=48), and no mental disorder (n=72) who participated in a community-based family study. Best estimate DSM-IV diagnoses were based on in-depth personal interviews as well as interviews with family members. Olfactory tests were administered during an in-person clinical visit and were compared using robust linear regression adjusting for age, sex, and psychiatric medication use, as well as nicotine use when necessary. Compared to controls, odor identification performance was lower among individuals with MDD (b=-1.37, 95% confidence interval [CI]: -2.50, -0.24) and bipolar I disorder (b=-1.79, 95% CI: -3.51, -0.67). Among the latter group, performance was only reduced among those with psychotic features (b=-3.49, 95% CI: -6.33, -0.65), particularly for pleasant odors (b=-1.46, 95% CI: -2.51, -0.42). Those with MDD showed lower identification accuracy for neutral odors (b=-0.63, 95% CI: -1.20, -0.06). Performances on measures of odor discrimination and detection threshold did not differ by diagnostic group. Collectively, these findings indicate that odor identification difficulties may exist in mood disorders, especially when psychotic features are present. In contrast, the global olfactory dysfunction observed in schizophrenia may not be a feature of other neuropsychiatric conditions.