scholarly journals CYP2D6-inhibiting drugs and risk of fall injuries after newly initiated antidepressant and antipsychotic therapy in a Swedish, register-based case-crossover study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Marja-Liisa Dahl ◽  
Karin Leander ◽  
Max Vikström ◽  
Clara Frumerie ◽  
Sofia Nordenmalm ◽  
...  
Keyword(s):  
Washout Period ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Control Period ◽  
Antipsychotic Treatment ◽  
Antipsychotic Therapy ◽  
Fall Injuries ◽  
Fall Injury ◽  
Case Crossover ◽  
Drug Register ◽  
Risk Of Fall

AbstractDrug-drug interactions have been shown to affect the risk of fall injuries when opioids are used concomitantly with drugs inhibiting the cytochrome P450 2D6 (CYP2D6) enzyme in a previous pharmacoepidemiological study. The aim of this study was to determine whether CYP2D6-inhibiting drugs reinforce the risk of fall injuries when used concomitantly with antidepressants or antipsychotics. We identified all 252,704 adults with a first fall injury leading to hospitalisation from the National Patient Register in Sweden 2006–2013. Data on dispensed drugs was linked from the Swedish Prescribed Drug Register. We applied a case-crossover design to analyse newly dispensed (28 days preceding the fall injury, preceded by a 12-week washout period) antidepressants and antipsychotics, respectively, in relation to risk of a fall injury and according to concomitant use of CYP2D6-inhibiting drugs. Newly dispensed drugs were assessed correspondingly in a control period of equal length, 28 days prior to the 12-week washout period. Overall, the risk of fall injury was increased after newly initiated antidepressant and antipsychotic treatment. For antidepressants, concomitant CYP2D6 inhibitor use further elevated the risk estimates compared to non-use, most pronounced for the groups selective serotonin reuptake inhibitors (sertraline excluded) [OR = 1.47 (95% CI 1.19–1.80) vs. OR = 1.19 (95% CI 1.13–1.26)], and tricyclic antidepressants [OR = 1.71 (95% CI 1.17–2.51) vs. 1.27 (95% CI 1.11–1.47)] as well as for sertraline [OR = 1.61 (95% CI 1.05–2.38) vs. 1.12 (95% CI 1.00–1.26)]. For antipsychotics, the risk of fall injury was not altered by concomitant use of CYP2D6-inhibiting drugs. In conclusion, concomitant use of CYP2D6 inhibiting drugs tends to further increase the risk of fall injury in newly initiated antidepressant treatment, but not in antipsychotic treatment.

Antipsychotic-induced supersensitivity – A reappraisal

2021 ◽  
pp. 000486742110256
Author(s):  
William Lugg
Keyword(s):  
Tardive Dyskinesia ◽  
Significant Proportion ◽  
Underlying Mechanism ◽  
Antipsychotic Treatment ◽  
Physiological Changes ◽  
Antipsychotic Therapy ◽  
Neurotransmitter Systems ◽  
Potential Benefits ◽  
Treatment Refractory ◽  
Brain Pathways

Objectives: Tardive dyskinesia, psychotic relapse and treatment-refractory psychosis have long been associated. A common underlying mechanism involving antipsychotic-induced ‘supersensitivity’, albeit in different brain pathways, was proposed as early as 1978. This piece seeks to reappraise the concept and potential implications of antipsychotic-induced supersensitivity. Conclusions: Evidence increasingly suggests that chronic antipsychotic exposure induces neuroadaptive physiological changes in dopaminergic, and other, neurotransmitter systems that may render some individuals more vulnerable to psychotic relapse - including those receiving continuous antipsychotic treatment. It is possible that in treating every episode of psychosis with prolonged or indefinite antipsychotic therapy, we paradoxically increase the risk of psychotic relapse in a significant proportion of people. A greater appreciation of supersensitivity may allow us to optimise any potential benefits of antipsychotics while minimising the risk of inadvertent iatrogenic harms. More research is needed to improve our understanding of the underlying neurophysiology of supersensitivity and to better identify which individuals are most vulnerable to its development. It is time we paid more attention to the concept, emerging evidence and potential implications of antipsychotic-induced supersensitivity and, where appropriate, adjusted our practice accordingly.

scholarly journals Psychotropic drugs and the risk of fall injuries, hospitalisations and mortality among older adults

2016 ◽  
Vol 32 (4) ◽  
pp. 414-420 ◽  
Author(s):  
Kristina Johnell ◽  
Gudrun Jonasdottir Bergman ◽  
Johan Fastbom ◽  
Bengt Danielsson ◽  
Natalia Borg ◽  
...  
Keyword(s):  
Older Adults ◽  
Psychotropic Drugs ◽  
Fall Injuries ◽  
Risk Of Fall

Chronic Medical Conditions and Risk of Fall Injury Events at Home in Older Adults

1997 ◽  
Vol 45 (6) ◽  
pp. 739-743 ◽  
Author(s):  
James G. Herndon ◽  
Charles G. Helmick ◽  
Richard W. Sattin ◽  
Judy A. Stevens ◽  
Carolee DeVito ◽  
...  
Keyword(s):  
Older Adults ◽  
Chronic Medical Conditions ◽  
Medical Conditions ◽  
Fall Injury ◽  
Risk Of Fall ◽  
At Home

scholarly journals Reply: Risk of fall injury in patients taking proton pump inhibitors—a meta-analysis

QJM ◽  
2018 ◽  
Vol 112 (4) ◽  
pp. 319-319
Author(s):  
K Lapumnuaypol ◽  
C Thongprayoon ◽  
K Wijarnpreecha ◽  
A Tiu ◽  
W Cheungpasitporn
Keyword(s):  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Meta Analysis ◽  
Fall Injury ◽  
Risk Of Fall

scholarly journals Abnormalities in Glucose Blood Level during Antipsychotic Treatment in Schizophrenia Patients

2021 ◽  
Vol 9 (T3) ◽  
pp. 340-344
Author(s):  
Faisal Idrus ◽  
Theodorus Singara ◽  
Dwiwahyu Sunarto ◽  
Saidah Syamsuddin ◽  
Sonny T. Lisal
Keyword(s):  
Side Effects ◽  
Blood Sugar ◽  
Blood Sugar Level ◽  
Fasting Blood Glucose ◽  
Antipsychotic Treatment ◽  
Antipsychotic Therapy ◽  
Potential Health ◽  
Sugar Levels ◽  
Risperidone Group ◽  
Haloperidol Group

Background: Schizophrenia is one of the mental disorder with many problematic issues, in both psychologically and socially. This disease requires provision of long-term antipsychotic therapy, hence could rise other potential health problems. Antipsychotic treatment can cause serious glucometabolic side-effects, including type 2 diabetes and hyperglycemic emergency. Recent attention has also been focused on antipsychotic-induced hyperglycemic emergencies experienced by new users of typical and atypical antipsychotic. Patients treated with atypical APDs have ~10 times higher risk in developing hyperglycaemic emergencies. In our pre-eliminary study, hyperglycemia condition in new patients occurs in four  in seven patients who received typical and atypical antipsychotics. This condition is often overlooked and is not routinely evaluated. Moreover, it can develop into diabetes and increase the risk of morbidity and mortality in schizophrenia patients. In this study, we would like to determine the acute effects of metabolic (hyperglycemia) in patients treated with antipsychotic (Risperidone and Haloperidol) Measurement of blood sugar levels was performed in groups treated with haloperidol (N = 15) and treated with risperidone (N = 15). Plasma samples were taken at the beginning of treatment, in week IV, and in week VIII. The measurement of glucose levels was performed after meal and in early morning before breakfast (fasting blood glucose level 8 hours). Results: The blood sugar level after meals was significantly higher in the Risperidone group compared to the Haloperidol group  (p <0.001) after IV and VIII weeks. Meanwhile, the fasting blood sugar level was significantly higher in the Risperidone group compared to the Haloperidol group after VIII weeks of treatment ( p <0.001). Conclusions: Both antipsychotics can cause an increase in blood sugar levels. Treatment with Risperidone significantly increased the blood sugar levels compared to treatment with haloperidol. Measurement of blood sugar level is needed to monitor the metabolic effect of antipsychotic, especially in patients treated with Risperidone. It is necessary to have dietary regulation and physical activities to prevent undesired metabolic side effects.

scholarly journals Use of Antipsychotics in Dementia Patients: A Descriptive Study

2020 ◽  
Vol 1 (4) ◽  
pp. 9-19
Author(s):  
Ziske Maritska ◽  
Muhammad Hilal Atthariq Ramadhan ◽  
Bintang Arroyantri Prananjaya
Keyword(s):  
Antipsychotic Drug ◽  
Cognitive Abilities ◽  
Secondary Data ◽  
Descriptive Study ◽  
Antipsychotic Treatment ◽  
Dopamine Antagonist ◽  
Elderly Age ◽  
Antipsychotic Therapy ◽  
Behavioural Symptoms ◽  
Dementia Patients

ABSTRACT Introduction. Dementia is a chronic progressive syndrome in which there is a decrease in the function of cognitive abilities including memory impairment, thinking ability, orientation, understanding, calculation, language, and assessment but without impaired consciousness. Apart from cognitive impairment, dementia is often accompanied by psychological symptoms and behavioural symptoms so that antipsychotic therapy is needed to overcome this. This study aims to identify the description of the use of antipsychotics in patients with dementia at Dr Mohammad Hoesin Palembang in the period 1 January 2014-31 December 2018. Methods. This research was a descriptive study using secondary data in the form of medical records of dementia patients receiving antipsychotic therapy at Dr Mohammad Hoesin General Hospital, Palembang. Samples were taken using a total sampling method. Results. There were 29 dementia patients (38.67%) receiving antipsychotic therapy. Most of the dementia patients who received antipsychotic therapy were in the late elderly age (27.59%) and were female (55.17%). The most commonly administered antipsychotic drug is haloperidol from the dopamine receptor antagonist (60%) with the most frequent dose of 0.5 mg (34.48%). Risperidone from the serotonin-dopamine antagonist class is the second most frequently prescribed antipsychotic drug (34.28%) at a dose of 1 mg (17.28%). The mean of haloperidol was 425 days, and risperidone was 295.5 days. Conclusion. Although in theory, psychological and behavioural symptoms are often found in dementia cases, not all dementia patients in RSUP Dr Mohammad Hoesin Palembang received antipsychotic therapy. People living with dementia who receive antipsychotic treatment get various types of drugs, dosages, and frequencies.

scholarly journals Understanding Modifiable and Unmodifiable Older Adult Fall Risk Factors to Create Effective Prevention Strategies

2019 ◽  
pp. 155982761988052 ◽  
Author(s):  
Gwen Bergen ◽  
Mark R. Stevens ◽  
Ramakrishna Kakara ◽  
Elizabeth R. Burns
Keyword(s):  
Risk Factors ◽  
Older Adult ◽  
Health Care Providers ◽  
Fall Risk ◽  
The United States ◽  
Adult Patients ◽  
Care Providers ◽  
Effective Prevention ◽  
Fall Injuries ◽  
Fall Injury

Each year, more than 1 in 4 older adults in the United States report a fall and 1 in 10 a fall injury. Using nationally representative data from the 2016 US Behavioral Risk Factor Surveillance System, we evaluated demographic, geographic, functional, and health characteristics associated with falls and fall injuries among adults aged 65 years and older. Analyses included descriptive statistics and multivariable logistic regression to produce crude and adjusted percentages by characteristic. Characteristics most strongly associated with increased fall risk in order of adjusted percentage were depression, difficulty doing errands alone, and difficulty dressing or bathing. Characteristics most strongly associated with fall injury risk in order of adjusted percentage were depression, difficulty dressing or bathing, and being a member of an unmarried couple. The diverse health and functional characteristics associated with increased falls and fall injuries confirm the importance of screening and assessing older adult patients to determine their individual unique risk factors. Health care providers can use tools and resources from the Centers for Disease Control and Prevention’s STEADI (Stopping Elderly Accidents, Deaths, and Injuries) initiative to screen their older adult patients for fall risk, assess at-risk patients’ modifiable risk factors, and intervene to reduce risk by prescribing evidence-based interventions.

scholarly journals Changes in drinking as predictors of changes in sickness absence: a case-crossover study

2017 ◽  
Vol 72 (1) ◽  
pp. 61-67 ◽  
Author(s):  
Jenni Ervasti ◽  
Mika Kivimäki ◽  
Jaana Pentti ◽  
Jaana I Halonen ◽  
Jussi Vahtera ◽  
...  
Keyword(s):  
Alcohol Use ◽  
Sickness Absence ◽  
Control Period ◽  
Heavy Drinking ◽  
Short Term ◽  
Case Crossover ◽  
Increased Risk ◽  
Case Period ◽  
Drinking Session

BackgroundWe investigated whether changes in alcohol use predict changes in the risk of sickness absence in a case-crossover design.MethodsFinnish public sector employees were surveyed in 2000, 2004 and 2008 on alcohol use and covariates. Heavy drinking was defined as either a weekly intake that exceeded recommendations (12 units for women; 23 for men) or having an extreme drinking session. The responses were linked to national sickness absence registers. We analysed the within-person relative risk of change in the risk of sickness absence in relation to change in drinking. Case period refers to being sickness absent within 1 year of the survey and control period refers to not being sickness absent within 1 year of the survey.ResultsPeriods of heavy drinking were associated with increased odds of self-certified short-term (1–3 days) sickness absence (multivariable-adjusted OR 1.21, 95% CI 1.07 to 1.38 for all participants; 1.62, 95% CI 1.19 to 2.21 for men and 1.15, 95% CI 1.00 to 1.33 for women). A higher risk of short-term sickness absence was also observed after increase in drinking (OR=1.27, 95% CI 1.07 to 1.52) and a lower risk was observed after decrease in drinking (OR=0.83, 95% CI 0.69 to 1.00). Both increase (OR=1.38, 95% CI 1.21 to 1.57) and decrease (OR=1.27, 95% CI 1.19 to 1.43) in drinking were associated with increased risk of long-term (>9 days) medically certified all-cause sickness absence.ConclusionIncrease in drinking was related to increases in short-term and long-term sickness absences. Men and employees with a low socioeconomic position in particular seemed to be at risk.

scholarly journals Serum Cortisol and DHEA-S Levels in Schizophrenic Patients with Different Response to Antipsychotic Therapy: Association with Psychopathology / Серумски Концентрации На Кортизол И DHEA-S Кал Пациенти Со Шизофренша Со Различен Одговор На Антипсихотичната Терапша Асоци.1Аци.1А Со Психопатологшата

PRILOZI ◽  
2015 ◽  
Vol 36 (1) ◽  
pp. 175-182 ◽  
Author(s):  
Zoja Babinkostova ◽  
Branislav Stefanovski ◽  
Danijela Janicevic-Ivanovska ◽  
Valentina Samardziska ◽  
Lila Stojanovska
Keyword(s):  
Elevated Serum ◽  
Serum Cortisol ◽  
Control Group ◽  
Antipsychotic Treatment ◽  
Healthy Controls ◽  
Symptom Scale ◽  
Antipsychotic Therapy ◽  
Schizophrenic Patients ◽  
Different Response ◽  
Age And Sex

Abstract Background: Previous studies suggested that alterations in serum cortisol and DHEA-S levels may play a role in the pathophysiology of schizophrenia. Imbalance in serum cortisol and DHEA-S levels may be related to responsivity to antipsychotic treatment. Aim: To compare serum cortisol and DHEA-S levels between patients with schizophrenia and healthy controls and to evaluate their association with psychopathology in schizophrenic patients with different response to antipsychotic treatment. Material and Methods: This clinical prospective study included 60 patients with schizophrenia and 40 healthy age and sex matched controls. All patients experienced an acute exacerbation of the illness (PANSS: P1 and P3 ≥ 4). Clinical evaluation of patients was performed using the Positive and Negative Symptom Scale. A questionnaire for socio-demographic and clinical data collection was used. For the purposes of the study, the examined group was divided in two subgroups: responders and nonresponders. Serum cortisol and DHEA-S levels were measuredat baseline in all participants and after 3 and 6 weeks of the antipsychotic treatment in patients with schizophrenia. Results: Patients with schizophrenia had significantly higher serum cortisol and DHEA-S levels comparedwith control group. Responders had significantly higher serum cortisol and DHEA-S levels compared with nonresponders. Responders group had significant correlation between serum cortisol and PANSS positive scale score as well as between hostility and serum DHEA-S. Conclusion: Elevated serum cortisol and DHEA-S levels may play a role in the pathophysiology of schizophrenia. Serum cortisol and DHEA-S are associated with psychopathology in schizophrenic patients with different response to antipsychotic therapy.

scholarly journals Post-stroke psychosis: how long should we treat?

2017 ◽  
Vol 39 (2) ◽  
pp. 144-146 ◽  
Author(s):  
Maria do Céu Ferreira ◽  
Célia Machado ◽  
Beatriz Santos ◽  
Álvaro Machado
Keyword(s):  
Low Dose ◽  
Rare Complication ◽  
Acute Onset ◽  
Psychotic Symptoms ◽  
Antipsychotic Treatment ◽  
Antipsychotic Therapy ◽  
Post Stroke ◽  
History Of ◽  
One Year

Abstract Objective: To describe a rare case of a patient who developed psychotic symptoms after a right stroke that disappeared with antipsychotic treatment, but appears to need low-dose maintenance antipsychotic therapy. Case description: A 65-year-old man presented at the psychiatric emergency service with a history of persistent delusional jealousy, visual illusions and agitation with onset about 1 month after a right posterior cerebral artery ischemic stroke. These symptoms only disappeared with therapeutic dosages of an antipsychotic drug (3 mg/day of risperidone). At 2-year follow-up, he no longer had delusional activity and the antipsychotic treatment was gradually discontinued over the following year. However, 1 week after full cessation, the patient once more became agitated and suspicious and was put back on risperidone at 0.25 mg/day, resulting in rapid clinical remission. One year after the return to low-dose risperidone, the patient's psychopathology is still under control and he is free from psychotic symptoms. Comments: Psychosis is a relatively rare complication after stroke. To our knowledge, no cases of post-stroke psychosis that apparently require continuous low-dose antipsychotic treatment have been reported to date. Our case suggests that low-dose maintenance antipsychotic therapy may be needed for certain patients with post-stroke psychosis, especially for those with risk factors and non-acute onset.

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