SSRI Use Research Articles

Prenatal SSRI antidepressant use and maternal internalizing symptoms during pregnancy and postpartum: Exploring effects on infant temperament trajectories for boys and girls

BackgroundThe severity and treatment of depression/anxiety during pregnancy and postpartum has important implications for maternal and child well-being. Yet, little is known about prenatal SSRI use and early child socioemotional development. This study explores effects of prenatal SSRI exposure, and pre- and postnatal internalizing symptoms on trajectories of infant temperament, identifying potential differences for boys and girls. MethodsUsing latent growth models, sex differences in infant temperament trajectories from 3- to 10-months were examined in relation to prenatal and postpartum internalizing symptoms and prenatal SSRI exposure among 185 mother-infant dyads. ResultsFor girls, prenatal internalizing symptoms were associated with greater initial distress to limitations, and lower duration of orienting, smiling/laughter, and soothability. Postnatal symptoms predicted slower decreases in girls’ duration of orienting. SSRI exposure predicted decreases in distress to limitations and slower increases in smiling and laughter. For boys, maternal internalizing symptoms did not generally affect temperament profiles. SSRI exposure was associated with higher initial activity level and slower declines in distress to limitations. LimitationsOnly parent-report indicators of infant temperament across 10 months of infancy were provided. Maternal internalizing symptoms were measured at discrete times during pregnancy and postpartum, with no analysis of changes in symptoms across time. ConclusionsPrenatal SSRI treatment, and both prenatal and postpartum internalizing symptoms, exert unique effects on infant temperament. Overall, the present study suggests sex-dependent fetal programming effects that should be further evaluated in future research. Results have implications for perinatal mental health treatment and perceived impacts on child socioemotional development.

Association between First Trimester Antidepressant Use and Risk of Spontaneous Abortion.

The potential for maternal antidepressant use to influence the risk of spontaneous abortion, one of the most important adverse pregnancy outcomes, is not clear. We aimed to assess whether first trimester antidepressant exposure was associated with an increased risk of spontaneous abortion. Community-based prospective cohort study (Right from the Start). Eight metropolitan areas in North Carolina, Tennessee, and Texas. A total of 5451 women (18years of age or older) who were planning to conceive or were pregnant (before 12weeks of completed gestation) and were enrolled in the study between 2000 and 2012; of those women, 223 used antidepressants (selective serotonin reuptake inhibitors [SSRIs] only [170], SSRIs and non-SSRIs [9], and non-SSRIs only [44]) during their first trimester, and 5228 did not (never users). Measurements and Main Results First trimester antidepressant use was determined during a first trimester telephone interview. Spontaneous abortion was self-reported and verified by medical records. The association of first trimester antidepressant use and spontaneous abortion was assessed by using Cox proportional hazard regression. Among the 5451 women enrolled, 223 (4%) reported first trimester antidepressant use, and 659 (12%) experienced a spontaneous abortion. SSRIs were the most common class of antidepressants used (179 [80%]). Compared with women who never used antidepressants during the first trimester of pregnancy, women who reported antidepressant use were 34% (adjusted hazard ratio [aHR] 1.34, 95% confidence interval [CI] 0.97-1.85) more likely to experience a spontaneous abortion after adjusting for covariates. Women who reported ever using SSRIs were 45% (aHR 1.45, 95% CI 1.02-2.06) more likely to experience a spontaneous abortion compared with never users. When time of loss relative to the time of interview was taken into consideration, the association between first trimester SSRI use and spontaneous abortion was significant only among those with losses before the interview (aHR 1.49, 95% CI 1.04-2.13) but was not significant among those with losses after the interview (aHR 0.43, 95% CI 0.06-3.15). The association between use of first trimester antidepressants, particularly SSRI use, and spontaneous abortion was significant only among women whose exposure status was assessed after loss. In this instance, reporting bias may create a spurious association. Future studies should take the timing of data collection relative to the timing of loss into consideration.

PO-02-006 Evaluation of sexual functions of female patients using systemic retinoid for acne vulgaris treatment

Acne vulgaris is a common skin disease, especially in young adults. The retinoids used in the treatment of acne are the class of chemicals that consist of vitamin A and all its derivatives. Although many side effects related to retinoid treatment have been specified in the literature, there is no study evaluating the effect of this treatment on sexual function, especially in women. The aim of this study is to investigate the effect of retinoid, which is used systemically in the treatment of acne vulgaris, on female sexual functions. Between January 2018 and June 2018, 46 women with acne vulgaris diagnosis and systemic retinoid treatment were included in the study. Medical and sexual history of the patients and physical examination findings were recorded. Global Acne Grading Scale (GAGS) was used to determine the degree of acne. Systemic retinoid therapy was administered (0.5-1.0 mg/kg/day). In each patient, the Female Sexual Function Index (FSFI) and the BECK depression scale were filled before and 2 months after retinoid treatment. Patients with regular sexual intercourse, hormonal disorders, chronic SSRI use and pelvic surgery / radiotherapy history were excluded from the study.

SUN-356 The Effects of Selective Serotonin Reuptake Inhibitors on Urinary Free Cortisol in Patients with Carney Complex and Primary Pigmented Nodular Adrenocortical Disease

PPNAD is a rare cause of ACTH-independent Cushing syndrome mainly associated with Carney complex (CNC). It is diagnosed by histologic examination or a 6-day Liddle test (LT) showing a paradoxical increase of >50% in 24-h urinary free cortisol (UFC) on the 2nd day of high-dose dexamethasone administration (Day 6 [D6]). PPNAD tissue has neuroendocrine features and can overexpress the serotonin (5-HT) synthesizing enzyme tryptophan hydroxylase type 2 and the 5-HT receptors types 4, 6, and 7, with formation of an illicit stimulatory serotonergic loop whose pharmacological inhibition in vitro decreases cortisol production [1]. SSRIs inhibit the reuptake of 5-HT and are used as 1st-line antidepressants. This is a retrospective cohort study of patients with CNC and PPNAD that underwent a LT with the objective to evaluate the effect of SSRIs on UFCs in these patients. Of the 34 patients (4-65 y) with CNC and PPNAD that had a LT at our institution between 2004 and 2018, 4 patients took an SSRI during testing. No statistically significant differences were demonstrated between the SSRI (S) group and the non-SSRI (NS) group in baseline UFCs and urine 17-hydroxycorticosteroids (17OHS) and the percent increase in UFC and 17OHS on D6. Specifically, the median (IQR) baseline UFC in the S group was 36 (13-252) mcg/24h (nl 4-56) vs 35 (13-98) mcg/24h in the NS group (P=0.95). Baseline 17OHS were 11 (8-18) mg/mg creatinine (Cr) (nl ≤6) in the S group vs 8 (5-11) mg/mgCr in the NS group (P=0.27). The percent change in UFC was 208 (93-683)% in the S group and 185 (28-364)% in the NS group (P=0.89), while the percent change in 17OHS was 56 (40-87)% in the S group and 67 (16-92)% in the NS group (P=0.91). On D6, the S group appeared to have higher UFC [118 (63-635) mcg/24h vs 112 (58-201) mcg/24h; P=0.64] and 17OHS [16 (10-39) mg/mgCr vs 13 (7-17) mg/mgCr; P=0.25] than the NS group, but these were not statistically significant. Though these data do not confirm an effect of SSRIs on UFC and ultimately cortisol production in PPNAD, and the percent change in UFC during the LT was similar between both groups, the higher D6 UFC in the S group, when the baseline UFCs between the 2 groups were similar may suggest a degree of increased cortisol production in the S group. The data are limited by the small number of patients in the S group (n=4). In addition, 50% of patients in the S group vs 77% in the NS group underwent adrenalectomy, which is indicative of more severe disease in the NS group. More data are needed from this cohort to determine if SSRI use affects cortisol production in vivo, as this may have significant diagnostic and therapeutic implications for patients with CNC and PPNAD. Reference: 1. Bram, Z., et al., PKA regulatory subunit 1A inactivating mutation induces serotonin signaling in primary pigmented nodular adrenal disease. JCI Insight, 2016. 1(15): p. e87958.

SUN-435 SIADH Precipitated by Pneumonia in a Background of Hypothyroidism and SSRI Use

Introduction: Hyponatremia is serum sodium levels below 135 meq/L. SIADH is a disorder of impaired water excretion caused by the inability to suppress the secretion of ADH leading to hyponatremia. Important causes of hyponatremia are heart failure, cirrhosis, diuretic induced, hypothyroids, cortisol deficiency and SIADH. Causes of SIADH are CNS disorders, malignancies, surgery, pulmonary disease (particularly pneumonia), hormone deficiency (both hypopituitarism, hypothyroidsm), HIV, drugs- esp. SSRIs. Clinical Case: 74 y/o F with past medical history of Diabetes, HTN, hypothyroidism, depression and chronic compensated hyponatremia under carvedilol, losartan, levothyroxine, citalopram, presented to ER with SOB with wheezing. Patient was admitted for pneumonia and treated with azithromycin and ceftriaxone. In Day 2, he developed intractable nausea and vomiting despite zofran and phenargan. IV NS was started. Patient developed hyponatremia, Na of 126 mEq/L, serum osmolality 240, Urine osm 457 mOsm/, TSH was 41 mIU/L. Levothyroxine was increased to 175 mcg. Fluid & Citalopram was stopped. Na was closely monitored. Over the next few days, patient and Na levels slowly improved with fluid restriction and Na tablets. Conclusion: Not all hyponatremia is SIADH while SIADH is a cause of hyponatremia. The diagnosis is often confusing. SIADH should be suspected in any patient with serum Na <135 mmol/L, serum osmolality <280 mOsm, and a inappropriate and relatively high urine osmolality (compared to serum osmolality). SIADH is more common in patients above age 65 years. Finding out the cause and fluid restriction is the mainstay of treatment in SIADH. Exception to this is brain surgeries & Sub Arachnoid Hemorrhage where there may be ongoing cerebral salt wasting and, fluid restriction can be deleterious as it can cause cerebral vasospasm. However for most cases of non-SIADH hyponatremia, Sodium chloride, (oral tablet or isotonic saline) is the therapy. Other ways to treat hyponatremia would be treating the underlying cause, restricting water intake or vasopressin receptor antagonist. For severe case (with seizure and severe neurological abnormalities) of any hyponatremia, intravenous hypertonic saline is the choice.

Selective Serotonin Reuptake Inhibitor Use During Pregnancy and Major Malformations: The Importance of Serotonin for Embryonic Development and the Effect of Serotonin Inhibition on the Occurrence of Malformations.

Bioelectric signaling is transduced by neurotransmitter pathways in many cell types. One of the key mediators of bioelectric control mechanisms is serotonin, and its transporter SERT, which is targeted by a broad class of blocker drugs (selective serotonin reuptake inhibitors [SSRIs]). Studies showing an increased risk of multiple malformations associated with gestational use of SSRI have been accumulating but debate remains on whether SSRI as a class has the potential to generate these malformations. This review highlights the importance of serotonin for embryonic development; the effect of serotonin inhibition during early pregnancy on the occurrence of multiple diverse malformations that have been shown to occur in human pregnancies; that the risks outweigh the benefits of SSRI use during gestation in populations of mild to moderately depressed pregnant women, which encompass the majority of pregnant depressed women; and that the malformations seen in human pregnancies constitute a pattern of malformations consistent with the known mechanisms of action of SSRIs. We present at least three mechanisms by which SSRI can affect development. These studies highlight the relevance of basic bioelectric and neurotransmitter mechanism for biomedicine.

Abstract WP194: Influence of Selective Seratonin Reuptake Inhibitors on Aphasia Recovery: Preliminary Data From a Clinical Trial

Background: In an ongoing trial on the effects of transcranial direct current stimulation (tDCS vs sham) plus language therapy on aphasia recovery in subacute stroke, we are evaluating the effects of SSRI use (with or without tDCS) on aphasia recovery. Hypothesis: Mean change in correct Content Units (CU) produced in a picture description (primary outcome variable) is influenced by SSRI use, independently of depression, age, and sex. Methods: We analyzed data from 17 participants (with aphasia within 3 months of single left hemisphere ischemic stroke) who have completed 2-month post-treatment follow-up. We expect to have data on 30 by February, 2019. Participants described a picture (scored for CU), and were administered the Philadelphia Naming Test (PNT), Hopkins Assessment of Naming Actions (HANA), and retold the Cinderella Story (scored for CU per minute) before treatment and 2 months post-treatment. They were also administered the Patient Health Questionnaire-9 at each time point to evaluate depression. Treatment was a computer-delivered naming treatment plus either tDCS (1 mA, for first 30 minutes) or sham (randomly assigned), for 15 sessions. SSRI use depended on physician’s discretion. We remain blinded to treatment group; but we analyzed effects of SSRI (independent of depression, age, and sex) on achieving highest quartile change in CU using logistic regression. We compared mean change in each test in SSRI users vs nonusers with Wilcoxon Rank Sum tests. Results: Five participants took daily SSRI. There were no significant differences between SSRI users and nonusers in age, education, or any test at baseline. Together, SSRI use, PHQ9, age, and education predicted highest quartile of change in CU; pseudo r2 = 0.62 (p=0.016). SSRI users were more likely to achieve the highest quartile in CU (OR: 50.9; 95%CI: 0.15-16975), compared to nonusers. Although there were no significant differences between SSRI users and nonusers in change on any of the tests (likely due to low power), SSRI users showed higher mean improvements on all tests compared to nonusers; CU: 6.5 vs 1.7; PNT: 68.6 vs 50.9; HANA: 7.4 vs 1.8; Cinderella Story: 12.1 vs 10.9. Conclusions: Preliminary data indicate that daily SSRI may positively affect language gains with subacute aphasia treatment.

Selective Serotonin Reuptake Inhibitor Use and Risk of Gastrointestinal and Intracranial Bleeding.

Selective serotonin reuptake inhibitors (SSRIs) are among the most commonly prescribed medications in the United States. Although SSRIs are highly tolerable relative to other antidepressants, they are associated with a number of adverse effects, including increased gastrointestinal tract bleeding and intracranial bleeding. Mechanisms include increased gastric acid secretion and inhibition of serotonin entrance into platelets. Patients with other bleeding risk factors, such as warfarin, clopidogrel, or aspirin use, may be at heightened risk of these adverse effects. The purpose of this article is to review the incidence of gastrointestinal tract bleeding or intracranial bleeding associated with concomitant SSRI use, the proposed mechanisms of, and the potential pharmacokinetic/pharmacodynamic interactions with anticoagulants and antiplatelets. Given the prevalence of SSRI use in the ambulatory setting, osteopathic physicians should be aware of potential drug-drug interactions and the clinical implications of SSRI-associated bleeding risk.

Abstract TP522: Clopidogrel Use and Smoking Cessation Result in Lower Coated-Platelet Levels After Stroke

Introduction: Coated-platelets are a subset of highly procoagulant platelets observed upon dual-agonist stimulation with collagen and thrombin. Coated-platelet levels are elevated in patients with ischemic stroke and associated with stroke recurrence. Cross-sectional studies in controls showed that smoking was associated with higher coated-platelet levels whereas chronic use of serotonin reuptake inhibitors (SSRIs), statins or aspirin was associated with lower coated-platelet levels. Limited data in patients with coronary artery disease have shown an inhibitory effect on coated-platelet potential at 24 hours following the administration of a 300 mg single dose of clopidogrel. We now investigate if initiation of pertinent medications and smoking cessation result in long-term changes in coated-platelet levels following ischemic stroke. Methods: Coated-platelet levels, reported as percent of cells converted to coated-platelets, were measured in 87 consecutive patients with non-lacunar stroke at baseline and repeated at 90 days. Repeated-measure ANOVA was used to determine if initiation of treatment with SSRIs, statins, clopidogrel, aspirin, oral anticoagulants or smoking cessation impacted changes in coated-platelet levels. Results: Initiation of treatment with clopidogrel (absolute decrease = 8.9%, relative decrease = 20.9%, p = 0.0001, partial η 2 = 0.17) and smoking cessation (absolute decrease = 8%, relative decrease = 18.2%, p = 0.014, partial η 2 = 0.10) resulted in decreased coated-platelets levels at 90 days as compared to baseline. Use of SSRIs, statins, aspirin or oral anticoagulants did not result in significant changes. Conclusions: Clopidogrel use and smoking cessation attenuate coated-platelet potential at 90 days after ischemic stroke. These data suggest that both pharmacological agents and behavioral modification result in long-term modulation of coated-platelet production likely through inhibition of the P2Y12 receptor and inflammatory pathways. Future studies are needed to better define mechanisms involved.

Research Roundup

Repeated oral dosing of ketamine improved symptoms of depression Cannabinoids may prevent onset of laboratory‐induced pain Long‐term SSRI use exacerbates risk of fractures in adults Some mood stabilizers increase risk of stroke in bipolar disorder patients

Escitalopram Induced Pancreatitis: An Unusual Culprit

Drug-induced pancreatitis accounts for 3-5% of all cases of acute pancreatitis. Over 12% of US adolescents and adults use antidepressants. We hereby report a case of acute Escitalopram-induced non-necrotizing pancreatitis in a 27-year-old male complaining of epigastric pain. He had no family history of pancreatitis or pancreatic cancer, and reported drinking less than 2 alcoholic drinks weekly. His only medication was Escitalopram, which he started 2 weeks prior for panic disorder and denied any supplement use. His diagnostic evaluation revealed (a)A normal CBC and kidney function (b)Serum lipase of 1746 U/L (c) Abdomen CT-scan with no pancreatic masses and evidence of acute pancreatitis(d) Absence of gallstones, biliary sludge or CBD dilation on ultrasound (e)Normal serum glucose,calcium and triglyceride levels (f)Normal IgG and IgG subclass levels. Intravenous hydration was initiated, and Escitalopram was discontinued with complete symptom resolution in 4 days. No re-challenge was performed. A Naranjo adverse drug reaction score was 6 suggesting a probable reaction given no previous reports on Escitalopram. Three cases of sertraline-induced pancreatitis have been reported in the literature with a latency period of a few days to 4 weeks reported [1,2]. A population study in Taiwan suggest a class effect given an association between recent SSRI use and risk of acute pancreatitis [3]. This wasn't re-demonstrated in a different population cohort in Sweden, however, a much longer latency period was studied which is inconsistent with the reported cases [4]. Further research and population studies are required to better characterize the risk of drug-induced acute pancreatitis with SSRI use, given the high prevalence of use of these agents and the significant morbidity with this adverse effect.

Gastrointestinal Bleeding Is Common in Children With Familial Dysautonomia: A Case-Control Study (1980-2017): Presidential Poster Award

Introduction: Familial dysautonomia (FD) is a rare hereditary disorder caused by mutations in the IKBKAP gene. The disease is characterized by sensory and afferent autonomic abnormalities. Clinical observations suggest that GI bleeds are not infrequent in patients with FD, but their actual frequency is unknown. We aimed to define the incidence of GI bleeding in patients with FD and its associated risk factors. Methods: Cases and age/sex matched controls were retrospectively identified using the NYU FD registry, which includes over 600 patients with genetically confirmed FD. Cases were defined as patients with FD with at least one episode of GI bleeding between January 1, 1980 and September 25, 2017. For each case we selected one to two age-matched controls with FD and no history of GI bleeding. Data on medication use, gastrostomy (G) tube placement, fundoplication, and ambulatory laboratory values obtained within one year before the GI bleed (or matched time period) were compared using univariate logistic regression models. Retinal fundus tortuosity scores (a noninvasive surrogate marker for the microcirculation) were collected from the most recent clinical visit. Continuous variables were evaluated with t-test and categorical variables by Chi squared test. Multivariate analysis was performed. Results: Thirty-nine FD patients with Gl bleeding and 52 controls were included. 62 GI bleeds occurred in 2,144 observed years (28.0 per 1000 person year) with a median age of bleeding at 11 years old (Figure 1). Fifty-three cases (85.5%) were upper GI bleeds from gastric and duodenal ulcers (Figure 2). Bleeds in patients with FD were more likely to occur in those with a G tube (p<0.01) or with a fundoplication (p<0.01) (Table 1). There were no differences in NSAID or SSRI use, age at fundoplication, or age of G tube placement. For a subset of the FD cohort with available ophthalmic fundus imaging (n=61), cases with GI bleeding had no difference in average arteriolar tortuosity score. Conclusion: The incidence of GI bleeding in FD is considerably higher than in the general pediatric population, which has been reported as 0.2 per 1000 person year. Rather than medications, G-tube and fundoplication appear to be the most important risk factors for gastrointestinal bleeding in patients with FD. Moreover, these procedures did not appear to be direct complications of these procedures. The potential role of other factors leading to mucosal injury remain important targets for study and potential interventions.1054_A Demographics. Bleeds in FD patients were more likely to occur in those with a G tube (p<0.01) and in those with a fundoplication (p<0.01). Statistical tests were not performed to compare medications given that zero cases had history of NSAID or SSRI use.1054_B Distribution of gastrointestinal bleed by age frequency. A total of 62 GI bleeds occurred with a median age of bleeding at 13.09 years old.1054_C Location of gastric ulcers. Fifty-three cases (85.5%) were upper GI bleeds from gastric and duodenal ulcers.

5.2 Ssris and Suicidality: Cause or Cure?

Significant concerns about the relationship between the use of SSRIs and suicidal risk in adolescents have emerged over the past decade. This presentation will review the extent of the relationship; examine the risks versus the benefits of SSRIs for adolescent depression; discuss the possible explanations for the relationship; and make recommendations for clinical management, public health messaging, and future research.

5.44 Telomere Length in Older Adolescents With Internalizing Disorders

The goal of this study is to examine the longitudinal relationship between depressive and anxiety symptoms, SSRI use, and telomere length in a well-characterized sample group of adolescents.

Depression is associated with self-rated frailty in older adults from an outpatient clinic: a prospective study.

Prospective cohort study, 12-month follow-up. Geriatric outpatient clinic in São Paulo, Brazil. A total of 811 elderly adults aged 60 or older. Depression was diagnosed as follows: (1) a diagnosis of major depression disorder (MDD) according to DSM-5; or (2) an incomplete diagnosis of MDD, referred to as minor or subsyndromic depression, plus Geriatric Depression Scale 15-itens ≥ 6 points, and social or functional impairment secondary to depressive symptoms and observed by relatives. Frailty evaluation was performed through the FRAIL questionnaire, which is a self-rated scale. Trained investigators blinded to the baseline assessment conducted telephone calls to evaluate frailty after 12-month follow-up. The association between depression and the use of SSRI with frailty was estimated through a generalized estimating equation adjusted for age, gender, total drugs, and number of comorbidities. Depression with SSRI use was associated with frailty at baseline (OR 2.82, 95% CI = 1.69-4.69) and after 12 months (OR 2.75, 95% CI = 1.84-4.11). Additionally, depression with SSRI monotherapy was also associated with FRAIL subdomains Physical Performance (OR 1.99, 95% CI = 1.29-3.07) and Health Status (OR 4.64, 95% CI = 2.11-10.21). SSRI use, without significant depressive symptoms, was associated with subdomain Health Status (OR 1.52, 95% CI = 1.04-2.23). It appears that depression with SSRI is associated to frailty, and this association cannot be explained only by antidepressant use.

VITamin D and OmegA-3 TriaL (VITAL) bone health ancillary study: clinical factors associated with trabecular bone score in women and men.

We investigated whether TBS differs by sex, race, body mass index (BMI), and other clinical variables. The VITamin D and OmegA-3 TriaL (VITAL) is determining effects of vitamin D3 and/or omega-3 fatty acid (FA) supplements in reducing risks of cancer and cardiovascular disease. In the VITAL: Effects on Bone Structure/Architecture ancillary study, effects of these interventions on bone will be investigated. Here, we examine the associations of clinical risk factors with TBS assessments at baseline in the bone health sub-cohort, comprised of 672 participants (369 men and 303 women), mean (± SD) age 63.5 ± 6.0years; BMI ≤ 37kg/m2, no bisphosphonates within 2years or other bone active medications within 1year. TBS was greater in men than women (1.311 vs. 1.278, P < 0.001) and lower with elevated BMIs (P < 0.001), higher age (P = 0.004), diabetes (P = 0.008), SSRI use (P = 0.044), and high alcohol intake (P = 0.009). There was a trend for history of fragility fractures (P = 0.072), and lower TBS. TBS did not vary when analyzed by race, smoking, history of falls, and multivitamin or caffeine use. Lower TBS was associated with female sex, aging, BMI ≥ 25kg/m2, SSRI use, alcohol use, and presence of diabetes; there was a trend between lower TBS and history of fragility fractures. TBS may be useful clinically to assess structural changes that may be associated with fractures among patients who are overweight or obese, those on SSRIs, or with diabetes. Ongoing follow-up studies will clarify the effects of supplemental vitamin D3 and/or FA's on TBS and other bone health measures. NCT01747447.

Maternal Depression and SSRI Use: Proceed With Caution

Maternal Depression and SSRI Use: Proceed With Caution

AN EXAMINATION OF THE RELATIONSHIP BETWEEN WEIGHT CHANGES AND DRUG TREATMENT IN PATIENTS WITH PROFOUND, REFRACTORY OBSESSIVE COMPULSIVE DISORDER (OCD) TREATED IN A SPECIALISED INPATIENT SERVICE

Aims and Hypothesis The National Inpatient Unit based at South West London and St George’s Mental Health NHS Trust treats people with the most refractory and profoundly severe OCD Symptoms. Previous studies from this Unit noted a high number of individuals had raised blood lipids. In light of this finding, the weight of all patients was regularly monitored throughout their admission. We decided to look at any changes in weight and other factors which may influence this including medication and severity of OCD. Background Concern about the health and high lipids discovered amongst patients admitted to our service led to a number of preventative measures. Booklets about healthy living were written and distributed, and both exercise and healthy-eating is promoted by staff. There are regular interventions by a dietician and an exercise therapist. Despite these interventions, a pattern of excess weight gain was still observed in patients, we decided to explore the extent of this weight gain and whether any pattern could be established between this and specific medication regimes. Methods The electronic records of 217 successive patients admitted in to the National Inpatient Unit for OCD between 2009 and 2016 were examined. BMI, Yale-Brown Obsessive Compulsive scale (Y-BOCs) on admission and discharge, age, sex, use of SSRI’s, dopamine blockers and other augmentation to medication (including drug type and dosage) were recorded into SPSS. Univariate Analysis of variance was used. Results Of the 217 patients admitted over the 7 year period 127 of them were males and 90 females. Their ages ranged from 19-71 years with the average age being 40. Mean YBOCS score on admission was 35.21 and on discharge was 23.22 (34% reduction). The mean BMI on admission was 26.25 and on discharge was 26.89. The weight changes were not related to any specific drug. No relationship was found between severity of OCD as measured by YBOCS and the tendency to gain or lose weight. Similarly age and sex did not appear to be predictive factors. Conclusion Overall, despite considerable attempts to prevent this, most patients gained weight following admission. Possible causes of this weight gain include the social effect of communal living, the availability of many food outlets in the vicinity and a lack of impulse control in some of these patients. Patients on medication had greater improvements shown in reduction in YBOCS scores, that those not on medication.

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.

Abstract TP113: Elevated Coated-Platelets and SSRI Use Are Associated with Silent Brain Infarction in Asymptomatic Carotid Artery Stenosis

Background: Silent brain infarction (SBI) is a marker of stroke risk in asymptomatic carotid stenosis. Increased SBI burden downstream of stenosis has not been consistently shown, emphasizing that mechanisms of SBI formation in carotid stenosis remain unclear. Coated-platelets are a subset of procoagulant platelets observed upon dual agonist stimulation with collagen and thrombin, and elevated levels are associated with TIA/stroke in asymptomatic carotid stenosis. We now examine if coated-platelet levels are associated with SBI in asymptomatic carotid stenosis. Methods: Consecutive asymptomatic ≥50% carotid stenosis patients were enrolled and coated-platelets assayed. Brain MRI or CT scans within 12 months of enrollment were reviewed by a blinded neurologist for SBI, defined as a focal, ≥ 3mm, cavitary lesion with T1 hypointensity and T2 hyperintensity features on MRI or hypodense on CT. Demographics, medications and comorbidities were recorded. The optimal coated-platelet cutoff was determined by ROC analysis. Logistic regression analysis included variables having significant (p&lt;.05) bivariate correlations with SBI as potential predictors. Variables with p&lt;0.05 were retained in the final model. Results: Brain imaging was available for 64 subjects. The optimal coated-platelet cutoff for predicting SBI was 52.7% (p=0.0002) by ROC analysis. Both elevated coated-platelets (OR=10.4, p=0.043) and SSRI use (OR=3.8, p=0.027) were associated with increased odds of SBI (p=0.005). Stenosis ≥70% was associated with presence (p=0.0005) and number (p&lt;0.0001) of downstream SBI on bivariate analysis, but was no longer significant in the multivariate model (p=0.14). Conclusions: Elevated coated-platelets and SSRI use were associated with SBI in this asymptomatic carotid stenosis cohort. Interestingly, presence of ≥70% stenosis was no longer significantly associated with SBI after accounting for coated-platelet levels and SSRI use by multivariate analysis. SSRI use has been linked to recurrent stroke previously, although results have varied. Our findings are the first showing a strong association between platelet procoagulant potential and SBI and warrant further study to confirm our results and explore mechanisms involved.