Use Of Mood Stabilizers Research Articles

Study Assessing Use of Mood Stabilizers (Sodium Valproate and Oxcarbazepine) as an Augmentation Strategy in Patients of Treatment-resistant Depression

Study Assessing Use of Mood Stabilizers (Sodium Valproate and Oxcarbazepine) as an Augmentation Strategy in Patients of Treatment-resistant Depression

Psychotropic drug use among children and adolescents in the Nordic countries: a systematic review.

The Nordic countries have rather homogenous populations and similar health care systems, and one could therefore expect comparable levels of psychopathology and psychotropic drug use. However, recent studies show pronounced variations in psychotropic drug use among children and adolescents from different Nordic countries. Therefore, we aimed to conduct a systematic review of the literature examining the use of psychotropic drugs among children and adolescents in the Nordic countries. This review followed PRISMA guidelines. We searched PsycINFO, EMBASE and MEDLINE for population-based studies published 2010 or later that investigated prevalent or incident use of antidepressants, psychostimulants, antipsychotics, hypnotics, anxiolytics, and mood stabilizers among 0-19-year-olds in the Nordic countries. Two reviewers assessed all studies. Twenty-two out of 2142 eligible studies were included in the final review covering data collected from 1995 to 2018. The use of psychotropic drugs, except for anxiolytics, increased in most of the Nordic countries, but at different rates. Prevalent use of antidepressants was two to four times higher among Swedish children and adolescents compared to Danish and Norwegian peers. Prevalent use of psychostimulants, on the other hand, was two to sixfold higher in Iceland compared to the other Nordic countries. Finally, the prevalence of antipsychotic use was threefold higher in Finland compared to Sweden, Denmark, and Norway. This systematic review provides a thorough overview of psychotropic treatment of youths in the Nordic countries. We demonstrate a pronounced national variation in use of psychotropics that should be addressed further to facilitate rational pharmacotherapy in youths with psychiatric disorders.

Risk of Suicidal Ideation and Behavior Following Early-Onset Idiopathic Restless Legs Syndrome Treatment.

To estimate incidence rates of suicidal ideation and behavior following treatment initiation with gabapentinoids or dopamine agonists (DAs) in patients with newly diagnosed early-onset idiopathic restless legs syndrome (RLS) and to examine suicidal behavior risk, comparing between those receiving gabapentinoids and DAs. A new user retrospective cohort study using MarketScan claims data from 2012 to 2019 was conducted. Exposures were monotherapy gabapentinoids or DAs initiated within 60 days of new RLS diagnosis. Three varying outcome measures of suicidality were examined and incidence rates were calculated for each. A log-binomial regression model the estimated relative risk (RR) of the outcomes with gabapentinoids. Propensity score weighting adjusted for baseline covariates, including age, substance use disorders, hyperlipidemia, antipsychotic use, hypnotic/sedative use, and mood stabilizer use, which were most imbalanced before weighting. The cohort included 6672 patients, with 4986 (74.7%) initiating a DA and 1686 (25.3%) initiating a gabapentinoid. Incidence rates for all outcome measures were higher in the gabapentinoid group (suicidality: 21.6 vs. 10.7 per 1000 person-years; suicidality with self-harm: 23.0 vs. 11.1 per 1000 person-years; overdose- and suicide-related events: 30.0 vs. 15.5 person-years). Associated risk of suicidality (adjusted RR, 1.27 [95% CI, 0.86-1.88]); suicidality with self-harm (adjusted RR, 1.30 [95% CI, 0.89-1.90]); or overdose- and suicide-related events (adjusted RR, 1.30 [95% CI, 0.93-1.80]) was not significant with gabapentinoids. Incidence rates for suicidal ideation and behavior were higher among the gabapentinoid group, although increased risk was not detected after adjustment. A possible signal cannot be ruled out given limitations of the data and rarity of the outcome.

Risk of adverse pregnancy, delivery and neonatal outcomes associated with bipolar disorder and prenatal use of mood stabilizers: A population-based cohort study

Previous research examining bipolar-disorder (BD) and pregnancy/neonatal outcomes yielded mixed results, were mostly derived from Western countries and rarely delineated effect between disorder and mood-stabilizers. This population-based study identified women age 15-50 years who delivered first/singleton child in 2003-2018 in Hong Kong, utilizing territory-wide medical-record database of public healthcare services. Propensity-score weighted logistic-regression analyses adjusted for confounders were employed to examine risk of adverse pregnancy, delivery and neonatal outcomes associated with BD and mood-stabilizers (lithium, anticonvulsants and antipsychotics). Exploratory unadjusted-analyses were conducted to assess risk for congenital-malformations. Of 465,069 women, 302 had BD-diagnosis, including 168 redeemed ≥ 1 prescription of mood-stabilizers during pregnancy (treated-BD) and 134 gestationally-unexposed to mood-stabilizers (untreated-BD). BD was significantly-associated with increased risk of gestational-diabetes (adjusted-odds-ratio: 1.75 [95 % CI: 1.15–2.70]) and maternal somatic hospitalization ≤ 90 days post-discharge from index-delivery (2.12 [1.19–3.90]). In treatment status-stratified analyses, treated-BD women exhibited significantly-increased rate of gestational-diabetes (2.09 [1.21–3.70]) relative to controls (non-BD and gestationally-unexposed to mood-stabilizers). No significant association of BD or mood-stabilizers with other adverse outcomes was observed. Overall, our findings indicate that BD and mood-stabilizers are not associated with most adverse pregnancy, delivery and neonatal outcomes. Further research clarifying comparative safety of individual mood-stabilizing agents on pregnancy/neonatal outcomes is required.

The use of psychotropic medication in the perinatal period

Key content: The perinatal period confers an elevated risk of both relapses and new onset of mental illness. Suboptimal treatment can have a profound impact on maternal mortality and morbidity, neonatal outcomes and longer term child development. Most psychotropic medication can be used safely in pregnancy, with some notable exceptions. While decisions on the use of psychotropic medications in pregnancy are often complex and should be multidisciplinary, it is imperative that obstetricians and gynaecologists familiarise themselves with current literature to provide evidence‐based counselling and care. Existing guidelines on the use of psychotropic medication are largely aimed at psychiatrists, and to date there has been a lack of concise, digestible information with a focus on core knowledge for obstetricians and gynaecologists. We summarise existing evidence on the use of antidepressants, antipsychotics, mood stabilisers and sedatives in the perinatal period. For each drug class we describe the teratogenicity, impact on pregnancy, breastfeeding and the newborn. Learning objectives: To be familiar with common psychotropic medication used in pregnancy and the postpartum period. To understand key evidence on the safety profile of psychiatric medication in the perinatal period and apply this to individualised counselling.

Prevalence and Correlates of Eating Disorder Symptoms in Adolescents with Bipolar I Disorder.

Objective: To investigate the prevalence and correlates of eating disorder symptoms in adolescents with bipolar I disorder (BP I). Methods: We retrospectively collected a DSM-IV-TR-based diagnostic assessment of 179 adolescents with BP I and evaluated clinical variables in those with and without eating disorder symptoms. For comparison, we retrospectively evaluated eating disorder symptoms in adolescents with generalized anxiety disorder (GAD). Results: Thirty-six percent of adolescents with BP I experienced lifetime eating disorder symptoms; among comorbid adolescents, 74% reported eating disorder cognitions and 40% reported symptoms related to bingeing, 25% purging, and 17% restricting. BP I adolescents with (vs. without) eating disorder symptoms had higher Children's Depression Rating Scale-Revised scores (40.5 vs. 34.5; p < 0.001; effect size = 0.59) and were more likely to be female (75% vs. 45%; p < 0.001; odds ratio = 3.8). There were no differences in Young Mania Rating Scale scores (p = 0.70); lifetime presence of attention-deficit/hyperactivity disorder (p = 0.86) and alcohol (p = 0.59) or substance (p = 0.89) abuse/dependence symptoms; age of BP I onset (p = 0.14); inpatient hospitalization status at baseline (p = 0.53); presence of lifetime inpatient hospitalization (p = 0.64) or suicide attempt (p = 0.35); seriousness of suicidality (p = 0.86); body mass index (p = 0.48); and second-generation antipsychotic (SGA; p = 0.32) or non-SGA mood stabilizer (p = 0.09) use. Eating disorder cognitions (rather than behaviors) were higher in the GAD group (58%) compared with the BP I group (27%; p = 0.004). Limitations: A retrospective study is subject to recall bias and limits our understanding of the temporal relationship between eating disorder and mood symptoms. Conclusions: Eating disorder symptoms are frequently comorbid in adolescents with BP I. The comorbidity is associated with more severe depression but does not confer a more severe illness course.

The real-world use of mood stabilisers as an augmentation strategy in Psychosis: a mirror design

The real-world use of mood stabilisers as an augmentation strategy in Psychosis: a mirror design

Digital Phenotyping of Behavior and Clinical Decision Making in Psychogeriatrics: Towards Precision Care

Introduction:Appropriate and personalized pharmacologic management of behavioral and psychologic symptoms in dementia (BPSD) is among the most complex clinical challenges in dementia care. Use of antipsychotics and mood stabilizers is common but accompanied by risk, including high likelihood of adverse effects that can lead to hospitalization or institutionalization. Information to support decision-making in these scenarios is typically obtained from self-report/caregiver report. This presentation will focus on demonstrating how data obtained through digital phenotyping may augment clinical decision making.Methods:This presentation will include information from 3 completed or ongoing studies. The first looks at radio wave based sensing as a way of passively monitoring behavior and dementia. The second uses wearables to track the impact of psychopharmacologic changes in dementia. The third study focuses on incorporating data from electronic media (e-mail, text messages) impact psychotherapy in early and late lifeResults and Discussion:Preliminary results indicate that passive sensing is able to accurately identify patterns of behavior as well as circumscribed clinical events with a precision that exceeds the current standard of care. Data and insights gained from these three ongoing studies are helping develop best practice models that can impact clinical outcomes.Conclusions:Collectively, the data in this presentation will demonstrate to clinicians a range of approaches towards developing precision care for older adults with dementia and psychiatric diagnosis. These approaches share the common theme of emphasizing the human element in care, while augmenting it with a range of data that provide objective collateral information to guide more precise decision making. The session will also discuss issues that will impact precision care, including the potential for creating inequities, translation to low income settings and countries as well as the matter of data privacy and security.

Psychotropic medication use pre and post-diagnosis of cluster B personality disorder: a Quebec’s health services register cohort

BackgroundCluster B personality disorders (PDs) are considered some of the most severe mental health conditions. Scarce evidence exists about the real-world utilization of psychotropics for cluster B PD individuals.ObjectiveWe aimed to uncover trends and patterns of psychotropic medication use among individuals diagnosed with cluster B PD in the year before and after their diagnosis and to identify factors associated with medication use in a large cohort of individuals newly diagnosed with cluster B PDs.MethodsWe conducted a population-based observational study using Quebec’s health services register. We identified Quebec residents aged ≥14 years and insured with the provincial drug plan with a first diagnosis of cluster B PD recorded between April 1, 2002, and March 31, 2019. Cluster B PD was defined with ICD-9/10 diagnostic codes. We retrieved all claims for the main psychotropic medication classes: antipsychotics, antidepressants, anxiolytics, mood stabilizers, and attention-deficit/hyperactivity disorder (ADHD) medications. We calculated the proportion of individuals exposed to these medication classes and analyzed trends over the years using robust Poisson regression models, adjusting for potential confounders. We used robust Poisson regression to identify factors associated with medication class use.ResultsWe identified 87,778 new cases of cluster B PD, with a mean age of 44.5 years; 57.5% were women. Most frequent psychiatric comorbidities in the five years before cluster B PD diagnosis were depression (50.9%), anxiety (49.7%), and psychotic disorders (37.5%). Most individuals (71.0%) received at least one psychotropic during the year before cluster B PD diagnosis, and 78.5% received at least one of these medications in the subsequent year. The proportion of users increased after the diagnosis for antidepressants (51.6–54.7%), antipsychotics (35.9–45.2%), mood stabilizers (14.8–17.0%), and ADHD medications (5.1–5.9%), and remained relatively stable for anxiolytics (41.4–41.7%). Trends over time showed statistically significant increased use of antipsychotics and ADHD medications, decreased use of anxiolytics and mood stabilizers, and a stable use of antidepressants.ConclusionPsychotropic medication use is highly prevalent among cluster B PD individuals. We observed an increase in medication use in the months following the diagnosis, particularly for antipsychotics, antidepressants, and mood stabilizers.

Protocolo terapéutico de los trastornos del humor

The treatment of mood disorders includes the use of antidepressants and mood stabilizers in bipolar disorder and, in some cases, treatment-resistant depression. Treatment must be in accordance with severity, personalized for each case, comprehensive, and based on scientific evidence. Therapeutic measures also include hygiene and dietary measures, physical exercise, psychotherapy, functional rehabilitation, and, on occasion, electroconvulsive therapy. This protocol includes algorithms, tables, and figures with the aim of facilitating the decision on which pharmacological treatment to use.

Risk of periodontitis in adolescents with bipolar disorder: a cohort study of 21,255 subjects.

Although a growing number of studies have investigated the relationship between psychosocial factors and periodontitis, studies investigating the association between bipolar disorder (BD) and periodontitis are lacking. Using the Taiwan National Health Insurance Research Database, 4251 adolescents with BD and 17,004 age- and sex-matched controls were included. They were followed up from enrollment to the end of 2011 or death. Periodontitis was diagnosed during the follow-up. Cox regression analysis indicated that adolescents with BD had a higher risk of periodontitis (hazard ratio [HR]: 2.96, 95% confidence interval [CI] 2.77-3.17) than did controls. Subanalyses stratified by sex revealed a higher risk of periodontitis in male (HR: 2.83, 95% CI 2.56-3.14) and female (HR: 3.01, 95% CI 2.74-3.30) adolescents with BD than their respective controls. The long-term use of mood stabilizers was associated with a higher risk of periodontitis (HR: 1.19, 95% CI 1.06-1.35) in the BD cohort. Our study highlighted an increased risk of periodontitis in adolescents with BD compared with controls during the follow-up. We recommend that more attention should be paid to the prevention of periodontitis in adolescents with BD, especially those who are female or receiving mood stabilizers.

Use of Psychoactive Medications and Risk of Suicide in Late Life (75+): A Total Population Study.

Psychoactive medications play an important role for the mental health and risk of suicidal behaviour in the oldest segment of the population (75+). A better understanding of psychoactive medication use is advocated to prevent suicide in this age group. We investigated the risk of suicide associated with the use of psychoactive medications in the total population aged ≥75 years, with and without exposure to antidepressants. A national population-based register study, including all Swedish residents aged ≥75 years between 2006 and 2014 (N = 1,413,806). A nested case-control design was used to investigate psychoactive medications associated with suicide among users and non-users of antidepressants. Risk estimates were calculated in adjusted conditional logistic regression models for the entire cohort and by gender. Suicide occurred in 1305 persons (907 men and 398 women). Among them, 555 (42.5%) were on an antidepressant at the time of suicide. Adjusted incidence rate ratio (aIRR) for suicide was increased in those who were on hypnotics in the total cohort (aIRR 2.05, 95% confidence interval 1.74 to 2.41), in both users and non-users of antidepressants and for both genders. Elevated suicide risk was observed in those who concomitantly used anxiolytics with antidepressants (1.51, 1.25 to 1.83). Decreased risk of suicide was observed among those who were on anti-dementia drugs, in the total cohort (0.33, 0.21 to 0.52) and in both users and non-users of antidepressants. Use of antipsychotics and mood stabilisers showed no effect on suicide risk. Use of hypnotics and concomitant use of anxiolytics with antidepressants was associated with increased risk of late-life suicide. Our findings suggest the need for careful evaluation of the benefit-risk balance of psychoactive medications as well as their availability as a possible suicide means. Future research should consider the indication of use of the psychoactive medications and the severity of psychiatric and medical illnesses of the patients.

Clinical use of mood stabilizers beyond treatment for bipolar disorder: The REAP-MS study.

Mood stabilizers are psychotropic drugs mainly used to treat bipolar disorder in the acute phase or for maintenance therapy to prevent relapse. In clinical practice, mood stabilizers are commonly prescribed for conditions other than bipolar disorder. This study investigated the distribution of mood stabilizer prescriptions for different psychiatric diagnoses and studied differences in the drugs, dosage, and plasma concentration in 10 Asian countries including Taiwan, South Korea, Malaysia, China, Thailand, India, Pakistan, Singapore, Indonesia, and Myanmar. Patients prescribed mood stabilizers (lithium, carbamazepine, valproic acid, or lamotrigine) for a psychiatric condition other than bipolar disorder (codes F31.0-F31.9 in the International Classification of Diseases, 10th Edition, Clinical Modification) were recruited through convenience sampling. A website-based data entry system was used for data collection. In total, 1557 psychiatric patients were enrolled. Schizophrenia, schizotypal, delusional, and other non-mood psychotic disorders (F20-F29, 55.8 %) was the most common diagnosis, followed by non-bipolar mood disorders (F30, F31- F39, 25.3 %), organic mental disorder (F00-F09, 8.8 %), mental retardation (F70-F79, 5.8 %) and anxiety, dissociative, stress-related, somatoform and other nonpsychotic mental disorders (F40-F48, 4.4 %). The most frequently targeted symptoms (>20 %) were irritability (48 %), impulsivity (32.4 %), aggression (29.2 %), anger (20.8 %), and psychosis (24.1 %). Valproic acid was the most frequently used medication. Clinicians typically prescribe mood stabilizers as empirically supported treatment to manage mood symptoms in patients with diagnoses other than bipolar disorders, though there is on official indication for these disorders. The costs and benefits of this add-on symptomatic treatment warrant further investigation.

Treatment in obsessive–compulsive disorder

ABSTRACT Background: Obsessive-compulsive disorder (OCD) is characterised by affective and cognitive symptoms that impair overall functioning and cause psychological discomfort. Due to the use of medical services, these entail high societal costs. Objective: Our goal was to provide a thorough overview of this topic while evaluating the effectiveness of pharmacological therapies in OCD and clinical recommendations. Methods: We looked for papers on the use of drugs to treat OCD in the pubmed database, with an emphasis on clinical guidelines, the use of antidepressants, antipsychotics, mood stabilisers, off-label drugs, and pharmacogenomics. Results: Selective serotonin reuptake inhibitors (SSRIs) work best when taken for a lengthy period of time. A SSRI combination with cognitive behavioural therapy (CBT) or the similarly orientated exposure and response prevention (ERP) can produce better outcomes. Treatment options for refractory OCD include switching to a different SSRI or clomipramine or supplementing with an atypical antipsychotic. Further research is necessary because there is conflicting information about the use of antidepressants intravenously or in addition to antipsychotics. Treatment customization and pharmacogenomics may lessen treatment resistance. Conclusions: When compared to each treatment separately or to other treatments, SSRI/clomipramine combined with CBT/ERP produces the best results. For refractory OCD, new approaches are required. In the upcoming years, pharmacogenomics may play a more significant role.

Clinicodemographic correlates of psychotic features in bipolar disorder – a multicenter study in China

BackgroundPsychotic symptoms are prevalent in patients with bipolar disorder (BD). However, nearly all previous studies on differences in sociodemographic and clinical factors between patients with (BD P +) and without (BD P-) psychotic symptoms were conducted in Western populations, and limited information is known in China.MethodA total of 555 patients with BD from seven centers across China were recruited. A standardized procedure was used to collect patients’ sociodemographic and clinical characteristics. The patients were divided into BD P + or BD P- groups based on the presence of lifetime psychotic symptoms. Mann–Whitney U test or chi-square test was used to analyze differences in sociodemographic and clinical factors between patients with BD P + and BD P-. Multiple logistic regression analysis was conducted to explore factors that were independently correlated with psychotic symptoms in BD. All the above analyses were re-conducted after the patients were divided into BD I and BD II group according to their types of diagnosis.ResultsA total of 35 patients refused to participate, and the remaining 520 patients were included in the analyses. Compared with patients with BD P-, those with BD P + were more likely to be diagnosed with BD I and mania/hypomania/mixed polarity in the first mood episode. Moreover, they were more likely to be misdiagnosed as schizophrenia than major depressive disorder, were hospitalized more often, used antidepressants less frequently, and used more antipsychotics and mood stabilizers. Multivariate analyses revealed that diagnosis of BD I, more frequent misdiagnosis as schizophrenia and other mental disorders, less frequent misdiagnosis as major depressive disorder, more frequent lifetime suicidal behavior, more frequent hospitalizations, less frequent use of antidepressants, more frequent use of antipsychotics and mood stabilizers were independently correlated with psychotic symptoms in BD. After dividing the patients into BD I and BD II groups, we observed notable differences in sociodemographic and clinical factors, as well as clinicodemographic correlates of psychotic features between the two groups.ConclusionsDifferences in clinical factors between patients with BD P + and BD P- showed cross-cultural consistency, but results on the clinicodemographic correlates of psychotic features were not. Notable differences between patients with BD I and BD II were found. Future work exploring the psychotic features of BD needs to take types of diagnosis and cultural differences into consideration.Trial registrationThis study was first registered on the website of the ClinicalTrials.gov (https://clinicaltrials.gov/) on 18/01/2013. Its registration number is NCT01770704.

The Role of Mood Stabilizers in Children and Adolescents with Anorexia Nervosa: A 1-year Follow-Up, Propensity Score-Matched Study.

The existing literature on the use of mood stabilizers (MS) in children and adolescents with anorexia nervosa (AN) is limited, for the most part, to small case studies. This was an observational, naturalistic, propensity score-matched study. Subjects treated and not-treated with MS were compared by being matched via propensity score on age, sex, concurrent atypical antipsychotics, and concurrent antidepressants. General and AN-specific psychopathology was assessed with Symptom Check List-90-R, Beck Depression Inventory-II, Eating Disorders Inventory-3, and Body Uneasiness Test-A. Potential differences in admission-discharge modifications (body mass index (BMI), psychopathology) among the two groups were assessed. Finally, re-hospitalizations after 1-year follow-up were assessed with Kaplan-Meier analyses. The study enrolled 234 hospitalized patients (15.9+/-3.3 years; 26, 11.1% receiving MS). After propensity-score matching, 26 MS patients matched with 26 MS-not-treated subjects were included. MS were used for a mean of 126.1 (+/-87.3) days, and two cases of side effects were documented (alopecia and somnolence with valproate). No significant difference between MS-treated and not-treated patients emerged concerning admission-discharge improvements in BMI and AN-specific or general psychopathology. The cumulative survival from re-hospitalization at 12 months was 64,4% (95%-CI, 31.3-97.5) for MS and 58.7% (95%-CI, 22.2-95.2) for MS-not-treated subjects. No significant difference in survival rate emerged (hazard ratio, 0.04; Log-rank test: p=0.846). This propensity score-matched study expands on the scant existing evidence of the use and side effects of MS in children and adolescents with AN. These results should be assessed in wider longitudinal samples.

Prescribing Trends for the Same Patients with Schizophrenia Over 20 Years.

Recent pharmacoepidemiology data show an increase in the proportion of patients receiving second-generation antipsychotic (SGA) monotherapy, but no studies have analyzed the same patients over a long period of time. Therefore, in this study, we retrospectively evaluated schizophrenia patients with available data for 20 years to determine whether the drug treatments in the same patients have changed in the past 20 years. The study began in April 2021 and was conducted in 15 psychiatric hospitals in Japan. Schizophrenia patients treated in the same hospital for 20 years were retrospectively examined for all prescriptions in 2016, 2011, 2006, and 2001 (ie, every 5 years). The mean age of the 716 patients surveyed in 2021 was 61.7 years, with 49.0% being female. The rate of antipsychotic monotherapy use showed a slight increasing trend over the past 20 years; the rate of SGA use showed a marked increasing trend from 28.9% to 70.3% over the past 20 years, while the rate of SGA monotherapy use showed a gradual increasing trend over the past 20 years. The rates of concomitant use of anticholinergics, antidepressants, anxiolytics/sleep medications, and mood stabilizers showed decreasing, flat, flat, and flat trends over the past 20 years, respectively. The results of this study showed a slow but steady substitution of SGAs for first-generation antipsychotics (FGAs) over time, even in the same patients.

The risk of developing diabetes during antipsychotic drug treatment: A nationwide study among 31,856 patients with schizophrenia

IntroductionAntipsychotics (AP) are the primary pharmacological treatment for schizophrenia but increase the risk for diabetes, with recent meta-analyses indicating important differences between specific APs. However, these findings are based on randomized clinical trials, which only include 20% of patients seen in everyday clinical settings, and are hence prone to selection bias.ObjectivesWe aim to investigate 1) the actual risk of developing diabetes in patients treated with APs using real-world data and 2) whether there are risk differences between specific APs.MethodsWe conducted a retrospective cohort study using Danish nationwide healthcare registers. We identified all individuals receiving a schizophrenia diagnosis from January 1, 1999, to January 1, 2019 and an age- and sex-matched reference population from the general population. The primary outcome was diabetes, identified via hospital discharge diagnoses and redeemed prescriptions for glucose-lowering drugs. First, we compared the risk of developing diabetes between patients with schizophrenia and the age- and sex-matched reference population. Second, among the patients with schizophrenia, the association between AP drug treatment and the risk of diabetes were analyzed. Third, risk differences for developing diabetes between specific AP drugs were investigated. We used cox regression for all analyses, the latter adjusted for age, sex, year of schizophrenia diagnosis, Charlson Comorbidity Index (CCI), occupational status, marital status, education and schizophrenia severity (use of antipsychotics, antidepressants, anxiolytics/hypnotics/sedatives, mood stabilizers and number of psychiatric admissions in the year preceding the diagnosis of schizophrenia).ResultsWe identified 31,856 patients with schizophrenia and 159,280 reference individuals. Patients with schizophrenia had an increased risk of developing diabetes compared with the reference individuals (unadjusted HRR: 3.12, 95%CI: 2.98-3.28). Treatment with AP in patients with schizophrenia, compared to periods with no AP use, was associated with an increased risk of developing diabetes (adjusted HRR: 2.04, 95%CI: 1.75-2.38). This risk was particularly increased among individuals treated with lurasidone (HRR: 2.66, 95%CI: 1.10-6.42), sertindole (HRR: 2.10, 95%CI 1.51-2.93), paliperidone (HRR: 1.84, 95%CI 1.47-2.31), clozapine (HRR: 1.74, 95%CI 1.49-2.03) and aripiprazole (HRR: 1.54, 95%CI 1.35-1.75), whereas treatment with zuclopenthixol (HRR: 1.00, 95%CI 0.82-1.23), flupentixol (HRR: 0.71, 95%CI 0.40-1.25) and pimozide (HRR: 0.74, 95%CI 0.31-1.78) were not associated with an increased risk of diabetes.ConclusionsThis real-world study indicates differences in the risk of developing diabetes between specific AP compounds. Further analyses will be presented at the conference.Disclosure of InterestNone Declared

Benzodiazepines and Mood Stabilizers in Schizophrenia Patients Treated with Oral versus Long-Acting Injectable Antipsychotics—An Observational Study

Schizophrenia is a chronic, invalidating, and polymorphic disease, characterized by relapses and remission periods. The main treatment option in schizophrenia are antipsychotics, administered as an oral or as a long-acting injectable (LAI) formulation. Although international guidelines rarely recommend it, mood stabilizers (MS) and/or benzodiazepines (BZD) are frequently prescribed as adjunctive therapy in schizophrenia patients for various reasons. This is an observational, cross-sectional study including stabilized schizophrenia patients. A total of 315 patients were enrolled. Of these, 77 patients (24.44%) were stabilized on LAIs and 238 (75.56%) patients on oral antipsychotics (OAP). Eighty-four patients (26.66%) had concomitant treatment with MS and 119 patients (37.77%) had concomitant benzodiazepine treatment. No statistical significance was observed in MS or BZD use between LAIs and OAPs. In total, 136 patients (43.17%) were stabilized on antipsychotic monotherapy. Our study shows that the long-term use of benzodiazepines and mood stabilizers remains elevated among stabilized schizophrenia patients, regardless of the antipsychotic formulation (oral or LAI). Patients receiving second-generation LAI antipsychotics (SGA-LAI) seem to be more likely to be stabilized on monotherapy compared to those receiving oral antipsychotics. Further randomized controlled trials are necessary in order to clarify the benefits of the current drug polypharmacy trends.

Şizofreni ve şizoafektif bozukluğu olan yaşlı ve genç hastalarda psikotrop ilaç tercihleri ve yan etkilerinin karşılaştırılması

Purpose: The current study investigates the preferred psychotropic drug treatments and their tolerability in elderly patients (EP) with a diagnosis of schizophrenia or schizoaffective disorder compared to younger patients (YP).&#x0D; Materials and Methods: The study included 154 EP and 195 YP with schizophrenia/schizoaffective disorder admitted to the outpatient unit at a university hospital in the last decade. The medical records of the patients were reviewed. The types and doses of antipsychotic drugs used by each patient, use of other psychotropic drugs, ongoing complaints, drug-related side effects and compliance with treatment were also examined.&#x0D; Results: Second generation antipsychotic use was higher in YP (88% in YP, 80% in EP). Antipsychotic equivalent doses were found 266.63 mg in EP, 522.21 mg in YP, that also higher in the YP group. The use of clozapine (7% in EP, 37% in YP) and mood stabilizers (4.5% in EP, 18% in YP) were higher in YP. There was a higher rate of dose reduction of antipsychotic drugs in EP (21.5% in YP, 52% in EP). When the groups were compared in terms of the reasons of antipsychotic dose reduction, it was more frequent in EP due to side effects (21.4% in YP, 40% in EP), while the dose reduction due to remission was more common in YP (78.6% in YP, 60% in EP) .&#x0D; Conclusion: Lower doses of antipsychotics in EP suggests milder symptoms or lower tolerability. The higher clozapine and mood stabilizer use in YP can be explained by avoiding side effects like extrapyramidal, cardiovascular and metabolic side effects that are more frequent in EP.