The mental health clinician最新文献

{"title":"Impact of sex on antidepressant discontinuation in groups of similar cytochrome P450 phenotypes.","authors":"Dylan L Kosaski, Kristin C Cole, Jessica A Wright, Razan M El Melik, Simon Kung, Wayne T Nicholson, Jonathan G Leung","doi":"10.9740/mhc.2023.12.303","DOIUrl":"10.9740/mhc.2023.12.303","url":null,"abstract":"<p><strong>Introduction: </strong>Although there are studies assessing reasons for antidepressant discontinuation, little is known about the impact of sex differences or cytochrome P450 phenotypes. Our objective is to assess discontinuation rates between males and females and whether CYP450 phenotype influences discontinuation.</p><p><strong>Methods: </strong>This is a retrospective review of patients previously enrolled in the Right Drug, Right Dose, Right Time: Using Genomic Data to Individualize Treatment database with major depressive disorder. Patients were evaluated for antidepressants trialed between January 1, 2009, and September 30, 2019. Survival analyses with competing risks were used to analyze discontinuation reasons. A Kaplan-Meier estimation method was used to assess the time to discontinuation and discontinuation rates. Analyses were also completed to assess discontinuation between men and women by phenotypic groups. All tests were two-sided, and <i>p</i>-values ≤ .05 were considered statistically significant.</p><p><strong>Results: </strong>There were 620 antidepressant discontinuation events discovered from 1015 antidepressant trials included. Overall, the median time to discontinuation for males was 2.6 years and 1.9 years for females (hazard ratio [HR] 0.97 [95% confidence interval (CI): 0.80, 1.19], <i>p</i> = .77). The risk of discontinuation was not different between males and females in any of the phenotype groups, which was consistent in the multivariable analyses. Concomitant use of medications that inhibited or induced antidepressant metabolism increased the overall risk of discontinuation (HR 1.45, 95% CI [1.06, 1.99], <i>p</i> = .020) in a time-dependent analysis.</p><p><strong>Discussion: </strong>We did not detect a significant difference in risk of antidepressant discontinuation rates between males and females even when accounting for cytochrome P450 phenotype. Future studies should account for whether medications that inhibit or induce antidepressant metabolism may be a crucial factor in antidepressant discontinuation.</p>","PeriodicalId":101313,"journal":{"name":"The mental health clinician","volume":"13 6","pages":"303-310"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10696171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138500668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concurrent opioid and alcohol withdrawal management.","authors":"Michelle Colvard","doi":"10.9740/mhc.2023.12.268","DOIUrl":"10.9740/mhc.2023.12.268","url":null,"abstract":"<p><p>Concurrent alcohol and opioid withdrawal syndrome is a common and challenging clinical scenario with little published evidence or guidance to inform pharmacotherapy strategies. Concurrent use of benzodiazepines and opioid agonists, which are considered first-line agents for management of each withdrawal syndrome independently, is controversial and often avoided in clinical practice. Strategies to provide effective, simultaneous medication treatment of alcohol and opioid withdrawal while optimizing patient safety are demonstrated through 3 patient cases.</p>","PeriodicalId":101313,"journal":{"name":"The mental health clinician","volume":"13 6","pages":"268-275"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10696169/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138500666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of persistence and adherence to deutetrabenazine among patients with Huntington disease or tardive dyskinesia.","authors":"Daniel O Claassen, Rajeev Ayyagari, Viviana García-Horton, Su Zhang, Sam Leo","doi":"10.9740/mhc.2023.10.207","DOIUrl":"10.9740/mhc.2023.10.207","url":null,"abstract":"<p><strong>Introduction: </strong>Deutetrabenazine is approved for treatment of Huntington disease (HD)-related chorea and tardive dyskinesia (TD) in adults. Factors associated with deutetrabenazine persistence and adherence are not well understood.</p><p><strong>Methods: </strong>Claims data from the Symphony Health Solutions Integrated Dataverse (2017-2019) were analyzed to identify real-world predictors of deutetrabenazine persistence and adherence in adults with HD or TD in the United States. Predictive models for persistence and adherence that considered patient demographics, payer type, comorbidities, treatment history, and health care resource use were developed.</p><p><strong>Results: </strong>In HD, use of anticonvulsants (HR = 2.00 [95% CI = 1.03, 3.85]; <i>P </i>< .05), lipid-lowering agents (2.22 [1.03, 4.76]; <i>P </i>< .05), and Medicaid versus Medicare insurance (2.27 [1.03, 5.00]; <i>P </i>< .05) predicted persistence, whereas only comorbid anxiety disorders predicted discontinuation (0.46 [0.23, 0.93]; <i>P</i> < .05). Of these patients, 62.5% were adherent at 6 months. Use of ≤2 treatments for chronic diseases (OR = 0.18 [95% CI = 0.04, 0.81]; <i>P</i> < .05) and Medicaid versus Medicare insurance (0.27 [0.09, 0.75]; <i>P</i> < .05) was associated with lower odds of adherence. In TD, use of lipid-lowering agents (HR = 4.76 [95% CI = 1.02, 20.00]; <i>P</i> < .05) predicted persistence, while comorbid schizoaffective disorder and/or schizophrenia (0.16 [0.14, 0.69]; <i>P</i> < .05) and sleep-wake disorders (0.18 [0.04, 0.82]; <i>P</i> < .05) predicted discontinuation. Of these patients, 46.7% were adherent at 6 months. Comorbid schizoaffective disorder and/or schizophrenia was associated with lower odds of adherence (OR = 0.26 [0.07, 0.91]; <i>P</i> < .05).</p><p><strong>Discussion: </strong>Identifying factors predictive of discontinuation and/or nonadherence to deutetrabenazine may facilitate the development of personalized support programs that seek to improve outcomes in patients with HD or TD.</p>","PeriodicalId":101313,"journal":{"name":"The mental health clinician","volume":"13 5","pages":"207-216"},"PeriodicalIF":0.0,"publicationDate":"2023-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10732128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138833886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"Opioid antagonists to prevent olanzapine-induced weight gain: A systematic review\".","authors":"Mark S Todtenkopf,&nbsp;Christoph U Correll,&nbsp;Marni E Harris-White,&nbsp;Michael J Doane,&nbsp;David McDonnell","doi":"10.9740/mhc.2023.08.196","DOIUrl":"https://doi.org/10.9740/mhc.2023.08.196","url":null,"abstract":"","PeriodicalId":101313,"journal":{"name":"The mental health clinician","volume":"13 4","pages":"196-197"},"PeriodicalIF":0.0,"publicationDate":"2023-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/27/14/i2168-9709-13-4-196.PMC10583260.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49687249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diltiazem for clozapine-induced generalized hyperhidrosis.","authors":"Emma M Kenton,&nbsp;Samantha M Zoellner,&nbsp;Leigh Anne Nelson","doi":"10.9740/mhc.2023.08.193","DOIUrl":"https://doi.org/10.9740/mhc.2023.08.193","url":null,"abstract":"<p><strong>Background: </strong>Clozapine can be associated with significant side effects and tolerability issues. Hyperhidrosis occurs less commonly and is unanticipated by clinicians because of clozapine's significant anticholinergic activity.</p><p><strong>Case report: </strong>A 34-year-old female developed clozapine-induced nocturnal, generalized hyperhidrosis following initial titration to 400 mg/day. Dose reduction did not decrease the side effect. Treatment with an anticholinergic medication could not be initiated because of constipation. Treatment with a beta blocker resulted in worsening of asthma. Treatment with a calcium channel blocker, diltiazem CD 180 mg/day, resulted in a significant reduction in hyperhidrosis.</p><p><strong>Conclusion: </strong>This case supports the use of calcium channel blockers to reduce clozapine-induced hyperhidrosis and offers an alternative to anticholinergic medications that may negatively impact clozapine tolerability.</p>","PeriodicalId":101313,"journal":{"name":"The mental health clinician","volume":"13 4","pages":"193-195"},"PeriodicalIF":0.0,"publicationDate":"2023-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/61/3e/i2168-9709-13-4-193.PMC10583255.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49687251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increasing access to psychiatric care during the COVID-19 pandemic through mental health clinical pharmacy specialist services.","authors":"P Brittany Vickery,&nbsp;Kacie Godwin,&nbsp;J Kyle Roach","doi":"10.9740/mhc.2023.08.176","DOIUrl":"https://doi.org/10.9740/mhc.2023.08.176","url":null,"abstract":"<p><strong>Introduction: </strong>Higher rates of mental health conditions, increased incidence of psychiatric diagnoses, and symptom relapse with minimal access to psychotherapeutic services are reported during the COVID-19 pandemic. A local area clinic in the United States that exists to serve underprivileged patients helps to combat poor psychiatric outcomes by offering psychiatric clinics, pharmacotherapy management, and medications at reduced or no cost.</p><p><strong>Methods: </strong>Recruitment and data collection were conducted from May 3, 2021, to March 3, 2022. Patients were seen by psychiatrists or the mental health clinical pharmacy specialist (MHCPS), and consent was obtained for the completion of satisfaction surveys. Five-point Likert scale comparisons were utilized to assess patient-perceived differences in clinician care. The primary study objective was to determine if access to care could be increased with the addition of an MHCPS, and secondary objectives included evaluating patient perceptions of clinician care as well as reporting MHCPS interventions.</p><p><strong>Results: </strong>Participant baseline demographics and common psychiatric diagnoses are reported. An MHCPS was incorporated into the clinic during the study allowing for 1 additional patient care period per month. The most frequent score among all surveys was 4.8 (<i>P</i> > .05) on a 5-point scale, indicating no statistically significant differences between clinician care. MHCPS interventions are reported.</p><p><strong>Discussion: </strong>The addition of an MHCPS allowed for additional patient care appointments for the clinic each month. MHCPS care offered no significant differences from psychiatrist care based on patient satisfaction surveys, highlighting the utility of pharmacist involvement for managing psychiatric disease states and increasing access to mental health services.</p>","PeriodicalId":101313,"journal":{"name":"The mental health clinician","volume":"13 4","pages":"176-182"},"PeriodicalIF":0.0,"publicationDate":"2023-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e9/15/i2168-9709-13-4-176.PMC10583258.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49687252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Racial and ethnic differences in patterns of use and discontinuation of long-acting injectable antipsychotics using Medicaid claims data.","authors":"Joshua Caballero,&nbsp;Jianing Xu,&nbsp;Daniel B Hall,&nbsp;Xianyan Chen,&nbsp;Henry N Young","doi":"10.9740/mhc.2023.08.183","DOIUrl":"https://doi.org/10.9740/mhc.2023.08.183","url":null,"abstract":"<p><strong>Introduction: </strong>In general, racial and ethnic differences exist in antipsychotic prescription practices. However, little is known about such differences between individual long-acting injectable (LAI) antipsychotic formulations, specifically. This study's primary objective was to determine racial and ethnic differences among LAI antipsychotic use. Secondary objectives were to identify if discontinuation rates differed between agents and by race or ethnicity.</p><p><strong>Methods: </strong>International Classification of Diseases, 10th edition (ICD-10) codes were used to identify patients with schizophrenia and related disorders (18-64 years) who received an LAI antipsychotic between 2016 and 2020 using Merative Multi-State Medicaid databases. Using National Drug Code numbers for LAI antipsychotics, pharmacy claims were identified and data analyzed. Cochran-Mantel-Haenszel tests and odds ratio estimators were used to investigate conditional association between race or ethnicity and medication, while controlling for age, sex, health plan, and prescription year. Kaplan-Meier survival curves were examined, and stratified log-rank tests were conducted to compare the time until discontinuation distributions by race or ethnicity.</p><p><strong>Results: </strong>The analysis included 37 712 patients. Blacks received an LAI first-generation antipsychotic more often than Whites (OR: 1.64, 95% CI: [1.56, 1.73], Hispanics (OR: 1.46, 95% CI: [1.21, 1.75]) and others (OR: 1.44, 95% CI: [1.20, 1.73]). Aside from fluphenazine decanoate showing earlier discontinuation rates for Whites over Blacks (<i>P</i> = .02), no significant differences in discontinuation across race or ethnicity were identified.</p><p><strong>Discussion: </strong>Despite no significant differences in second-generation antipsychotic LAI discontinuation rates between Blacks and other racial or ethnic groups, Blacks received second-generation antipsychotic LAIs significantly less often than other groups. Further studies are needed to determine why differences may be occurring.</p>","PeriodicalId":101313,"journal":{"name":"The mental health clinician","volume":"13 4","pages":"183-189"},"PeriodicalIF":0.0,"publicationDate":"2023-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/31/30/i2168-9709-13-4-183.PMC10583257.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49687254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Offering a combined resident research training program and pharmacy student elective may help improve resident publication rates.","authors":"Geoffrey Brown,&nbsp;Stephanie Seyse,&nbsp;Ashley Woodruff","doi":"10.9740/mhc.2023.08.198","DOIUrl":"https://doi.org/10.9740/mhc.2023.08.198","url":null,"abstract":"","PeriodicalId":101313,"journal":{"name":"The mental health clinician","volume":"13 4","pages":"198-199"},"PeriodicalIF":0.0,"publicationDate":"2023-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/42/6a/i2168-9709-13-4-198.PMC10583254.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49687253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case report on the effects of COVID-19 on ANC monitoring in a patient on long-term clozapine treatment.","authors":"Lauren Denton,&nbsp;Amber Kapuganti,&nbsp;Sarah Kim","doi":"10.9740/mhc.2023.08.190","DOIUrl":"https://doi.org/10.9740/mhc.2023.08.190","url":null,"abstract":"<p><strong>Background: </strong>Clozapine carries a US boxed warning for severe neutropenia, and strict monitoring is required through the FDA's Risk Evaluation and Mitigation Strategy (REMS) program. Patients with confirmed diagnosis of COVID-19 are also at risk for neutropenia. For patients on clozapine, the diagnosis of this novel virus may require an increase in the frequency of scheduled ANC monitoring. A case report of moderate neutropenia following COVID-19 diagnosis that required an increase in the frequency of ANC monitoring in a patient on long-term clozapine treatment is discussed.</p><p><strong>Case report: </strong>A 33-year-old white man with schizophrenia had been on clozapine for more than 2 years, with an ANC monitoring schedule once every 4 weeks. The patient was admitted to the hospital for worsening aggressive behavior. On day 11 of hospital admission, he tested positive for COVID-19. Five days following this diagnosis, the patient's ANC dropped from 2.2/L to 0.8/L. This decrease led to daily ANC labs and the clozapine regimen being held for 1 day. Throughout the patient's admission adjustments were made to the frequency of lab monitoring based on fluctuations in his ANC levels.</p><p><strong>Discussion: </strong>There have been limited case reports on patients receiving clozapine experiencing neutropenia following the diagnosis of COVID-19. To the authors knowledge, this is the first case report from the United States that specifically discusses the required changes to ANC monitoring.</p><p><strong>Conclusions: </strong>Patients on clozapine who test positive for COVID-19 may be at an even greater risk for neutropenia, compared with clozapine patients without COVID-19. Increasing the frequency of ANC monitoring should be considered in the weeks following the diagnosis to ensure that clozapine treatment can be safely adjusted, or even discontinued.</p>","PeriodicalId":101313,"journal":{"name":"The mental health clinician","volume":"13 4","pages":"190-192"},"PeriodicalIF":0.0,"publicationDate":"2023-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a4/7c/i2168-9709-13-4-190.PMC10583256.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49687248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of inpatient psychiatric medication management in gender diverse youth with cisgender peers.","authors":"Nina Carrillo,&nbsp;Maren McGurran,&nbsp;Brittany L Melton,&nbsp;Karen E Moeller","doi":"10.9740/mhc.2023.08.169","DOIUrl":"https://doi.org/10.9740/mhc.2023.08.169","url":null,"abstract":"<p><strong>Introduction: </strong>The primary objective was to determine if gender diverse (GD) youth receive different psychotropic prescribing compared with cisgender (CG) peers with the same diagnosis. Secondary objectives include evaluation of readmission rates and the effect of gender-affirming hormone therapy (GAHT) on psychiatric outcomes in transgender (TG) patients.</p><p><strong>Methods: </strong>A total of 255 GD youth patients were retrospectively matched to CG controls based on age, primary discharge diagnosis, and year of admission. Data collection included psychotropic medications at admission and discharge, baseline demographics, time to readmission, and total number of readmissions within 6 months. Use of GAHT was also documented. Wilcoxon signed rank test was used for continuous and χ² for nominal data with an a priori α of 0.05.</p><p><strong>Results: </strong>MDD was the primary discharge diagnosis in 74% of patients. GD youth were more likely to present on antidepressants (<i>P</i> = .031) and antipsychotics (<i>P</i> = .007), and to be discharged with antipsychotics (<i>P</i> = .003). They were additionally more likely to be readmitted within 30 days of discharge (<i>P</i> = .032). TG youth on GAHT (13%) had fewer readmissions (<i>P</i> = .046) than those not on GAHT, but there were no differences in psychotropic prescribing.</p><p><strong>Discussion: </strong>Higher antipsychotic and antidepressant prescribing were seen in the GD population despite the same mental health diagnosis. Despite higher prescribing in the GD population, patients presented for readmission within 30 days more frequently, which may represent a need for more rigorous transitions-of-care practices in this population.</p>","PeriodicalId":101313,"journal":{"name":"The mental health clinician","volume":"13 4","pages":"169-175"},"PeriodicalIF":0.0,"publicationDate":"2023-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5b/25/i2168-9709-13-4-169.PMC10583259.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49687250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}