The Journal of Clinical Psychiatry最新文献

{"title":"A Retrospective Observational Study to Understand Medication Utilization and Lines of Treatment in Patients With Insomnia Disorder.","authors":"Laveena Kamboj,Barbara Ramos,Adam Haynes,Gurjeev Sohi,Huijuan Yang,Juejing Ling,Purva Barot,Brad Millson,Shabbir Amanullah","doi":"10.4088/jcp.23m15015","DOIUrl":"https://doi.org/10.4088/jcp.23m15015","url":null,"abstract":"Background: Insomnia is a common sleep disorder, associated with multiple health concerns. Current medications for insomnia are associated with higher safety risks if clinical practice guidelines or monograph recommendations are not followed. This study aims to understand real-world prescribing practices among patients with insomnia in Canada, including medication utilization, potentially inappropriate medication use, cost incurred, and lines of treatment.Methods: This retrospective observational study utilized longitudinal drug claims data from 2018 to 2020 from the Canadian IQVIA National Private Drug Plan and Ontario Drug Benefit databases. Patients with any claims for medications approved for insomnia in Canada were identified. Four types of inappropriate medication usage were defined: (1) elevated daily dose; (2) extended duration of use for benzodiazepines (BZD) and/or Z-drugs; (3) combination use; and (4) opioid overlap with BZD and/or Z-drugs.Results: In 2019, 597,222 patients with insomnia were identified; 64% were female, with an average age of 55 years. Inappropriate medication use was noted in 52.5% of adult patients (aged 18-65 years) and 69.5% of senior patients (aged >65 years). Extended duration was the most common inappropriate medication usage category. The annual cost of medications for insomnia was $54.8 million, and $30.3 million (55.2%) met inappropriate medication use criteria.Conclusion: High prevalence of inappropriate medications usage in insomnia raises serious safety concerns for patients suffering from insomnia, particularly seniors, while also placing a substantial burden on the Canadian public and private health systems. This highlights an unmet need for better education regarding current guidelines and more effective and safer treatment options.","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":"101 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142259705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying Bridge Symptoms Between Borderline Personality Disorder and Posttraumatic Stress Disorder: A Network Analysis From a National Cohort.","authors":"Mahdi Fayad,Valentin Scheer,Carlos Blanco,Patrice Louville,Marina Sánchez-Rico,Katayoun Rezaei,Nicolas Hoertel,Frédéric Limosin","doi":"10.4088/jcp.23m15079","DOIUrl":"https://doi.org/10.4088/jcp.23m15079","url":null,"abstract":"Objective: Borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD) share common risk factors, including exposure to traumatic events. We aim to estimate networks of DSM-IV BPD and PTSD to describe the interactions between the symptoms of these 2 disorders and identify bridging symptoms between the 2 diagnoses that may play critical roles in their co-occurrence.Methods: We performed a network analysis of data from the second wave of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC 2004-2005), a nationally representative sample of the US adult population. We calculated network stability using a bootstrap method and centrality measures for each symptom across 3 different network estimations.Results: The networks were very stable. The symptom \"chronic feelings of emptiness\" was the most central in the BPD network. The symptoms \"feeling of intense fear or horror\" and \"recurrent and intrusive memories of the traumatic event\" were the most central in the PTSD network. The symptoms \"self aggression,\" \"severe dissociation,\" \"chronic feelings of emptiness,\" and \"feelings of detachment\" had significantly higher bridge expected influence than most other symptoms in the network in both the full sample and the subsample of participants who responded to all PTSD and BPD symptoms.Conclusion: Self-aggression, chronic feelings of emptiness, dissociation symptoms, and feelings of detachment represent bridge symptoms between BPD and PTSD. These symptoms could potentially trigger and perpetuate the manifestations of one disorder in the presence of the other. Targeting these symptoms might allow better prevention and management of both disorders.","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":"102 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142259706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prescription Opioid Use Disorder Among Adults Reporting Prescription Opioid Use With or Without Misuse in the United States","authors":"Beth Han, Christopher M Jones, Emily B. Einstein, Deborah Dowell, Wilson M Compton","doi":"10.4088/jcp.24m15258","DOIUrl":"https://doi.org/10.4088/jcp.24m15258","url":null,"abstract":"","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":"31 31","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141645634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Low-Dose Ketamine Infusion on the Positive and Negative Domains of Hopelessness and Suicidal Thoughts","authors":"Wei-Chen Lin, Mu-Hong Chen, T. Su, Cheng-Ta Li, Hui-Ju Wu, S. Tsai, Ya-Mei Bai, Wei-Chung Mao, P. Tu","doi":"10.4088/jcp.24m15257","DOIUrl":"https://doi.org/10.4088/jcp.24m15257","url":null,"abstract":"","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":" June","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141669965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Clozapine Exposure and Risk of Hematologic Malignancies in Veterans With Schizophrenia","authors":"Delaney R. Brainerd, Bruce Alexander, Marshall J. Tague, Brian C Lund","doi":"10.4088/jcp.23m15149","DOIUrl":"https://doi.org/10.4088/jcp.23m15149","url":null,"abstract":"","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":"62 23","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140975388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antipsychotic Medication Continuation vs Taper and Discontinuation in Patients With Schizophrenia and Other Nonaffective Psychotic Disorders","authors":"Chittaranjan Andrade","doi":"10.4088/jcp.24f15363","DOIUrl":"https://doi.org/10.4088/jcp.24f15363","url":null,"abstract":"","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":"124 51","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140977517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of a Multicomponent Intervention With Cognitive Training and Lifestyle Guidance for Older Adults at Risk of Dementia","authors":"Pengfei Wang, Tingting Yang, Wenjia Peng, Meng Wang, Xiaoli Chen, Yinghua Yang, Yanyan Huang, Yihua Jiang, Feng Wang, Shuangyuan Sun, Ye Ruan, Yan Ding, Ye Yao, Ying Wang","doi":"10.4088/jcp.23m15112","DOIUrl":"https://doi.org/10.4088/jcp.23m15112","url":null,"abstract":"","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":"90 13","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140984683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Time From Onset of Major Depressive Disorder on the Therapeutic Response to Esmethadone (REL-1017)","authors":"C. Guidetti, Sara De Martin, Giulia Serra, Massimo Apicella, L. Pani, M. Pappagallo, A. Mattarei, F. Folli, Paolo L. Manfredi, M. Fava","doi":"10.4088/jcp.22m14735","DOIUrl":"https://doi.org/10.4088/jcp.22m14735","url":null,"abstract":"","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":"114 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140985713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beneficial Effects of Concomitant Long-Acting Injectable Antipsychotics on Time to Rehospitalization in Patients With Treatment-Resistant Schizophrenia Receiving Clozapine: A Retrospective Cohort Study.","authors":"Yun Tien, Xi-Yu Wang, Shang-Chien Huang, Hsiang-Ping Huang","doi":"10.4088/jcp.23m15071","DOIUrl":"https://doi.org/10.4088/jcp.23m15071","url":null,"abstract":"<b>Introduction:</b> This study aimed to assess the association between long-acting injectable (LAI) antipsychotic prescription and the risk of psychiatric hospitalization in patients with treatment-resistant schizophrenia (TRS) receiving clozapine. <b>Methods:</b> In this retrospective cohort study at a single tertiary psychiatric center, we analyzed rehospitalization hazard ratios (HRs) in refractory schizophrenia patients, classified by <i>DSM-IV-TR</i> and <i>DSM-5</i> criteria. We examined various psychotropic regimens-clozapine with or without other oral antipsychotics (OAPs) or LAI antipsychotics. Subgroups were stratified by daily clozapine dosage and previous admissions. <b>Results:</b> A total of 719 patients were included in the study. Analyses were conducted on all the patients over 3- month, 6-month, and 1-year periods. Patients treated with a combination of clozapine and LAI antipsychotics (CLO + LAI) had a significantly higher number of previous hospitalizations (<i>P</i> = .003), and a higher daily dose of clozapine (<i>P</i> &lt; .001) was found in the CLO + OAP group than in the CLO (monotherapy) group and the CLO + LAI group. Patients treated with LAI antipsychotic comedication had significantly lower HRs for rehospitalization in 1 year among 3 studied groups. Moreover, the protective effects of LAI antipsychotics were observed in all the subgroups stratified by daily clozapine dosage and number of previous admissions to represent disease severity. <b>Conclusion:</b> The combination of clozapine and LAI antipsychotics was associated with a significantly lower risk of rehospitalization compared to both the combination of clozapine and OAPs and clozapine monotherapy. The use of LAI antipsychotics should be considered to prevent rehospitalization in patients with TRS who are already being treated with clozapine.","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":"81 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140828783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clozapine Use Among People With Psychotic Disorders Who Experience Specific Indications for Clozapine.","authors":"Gregory E Simon, Rebecca C Rossom, Esti Iturralde, Brian K Ahmedani, Stephen C Waring, Ashli A Owen-Smith, Stacy A Sterling, Kathleen Miley, Cheryl D Stults, Yihe G Daida, Frances L Lynch, Arne Beck, Katherine Sanchez, Karen J Coleman, Susan M Shortreed","doi":"10.4088/jcp.23m14833","DOIUrl":"https://doi.org/10.4088/jcp.23m14833","url":null,"abstract":"<b>Objective:</b> To examine rates of clozapine use among people with psychotic disorders who experience specific indications for clozapine. <b>Methods:</b> Records data from 11 integrated health systems identified patients aged 18 years or older with recorded <i>International Classification of Diseases, Tenth Revision, Clinical Modification</i>, diagnoses of schizophrenia, schizoaffective disorder, or other psychotic disorder who experienced any of the 3 events between January 1, 2019, and December 31, 2019, suggesting indications for clozapine: a diagnosis of self-harm injury or poisoning, suicidal ideation diagnosed or in response to standardized assessments, and hospitalization or emergency department (ED) care for psychotic disorder despite treatment with 2 or more antipsychotic medications. Prescription dispensing data identified all clozapine use prior to or in the 12 months following each indication event. Analyses were conducted with aggregate data from each health system; no individual data were shared. <b>Results:</b> A total of 7,648 patients with psychotic disorder diagnoses experienced at least 1 indication event. Among 1,097 experiencing a self-harm event, 32 (2.9%) had any prior clozapine use, and 10 (0.9%) initiated clozapine during the following 12 months. Among 6,396 with significant suicidal ideation, 238 (3.7%) had any prior clozapine use, and 70 (1.1%) initiated clozapine over 12 months. Among 881 with hospitalization or ED visit despite pharmacotherapy, 77 (8.7%) had any prior clozapine treatment, and 41 (4.7%) initiated clozapine over 12 months. Among those with significant suicidal ideation, rates of both prior clozapine treatment and subsequent initiation varied significantly by race and ethnicity, with rates among Hispanic and non-Hispanic Black patients lower than among non Hispanic White patients. <b>Conclusions:</b> Initiating clozapine treatment is uncommon among people with psychotic disorders who experience events suggesting clozapine is indicated, with even lower rates among Black and Hispanic patients.","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":"81 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140828744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}