scholarly journals Mortality in association with antipsychotic medication use and clinical outcomes among geriatric psychiatry outpatients with COVID-19

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0258916
Author(s):  
Bienvenida Austria ◽  
Rehana Haque ◽  
Sukriti Mittal ◽  
Jamie Scott ◽  
Aninditha Vengassery ◽  
...  
Keyword(s):  
New York ◽  
Behavioral Health ◽  
Antipsychotic Medication ◽  
Older Patients ◽  
Psychiatric Symptoms ◽  
Medication Use ◽  
Psychiatric Clinic ◽  
Antipsychotic Treatment ◽  
Negative Consequences ◽  
Exact Test

Objectives Older adults are particularly vulnerable to the negative consequences of antipsychotic exposure and are disproportionally affected by higher mortality from coronavirus disease 2019 (COVID-19). Our goal was to determine whether concurrent antipsychotic medication use was associated with increased COVID-19 mortality in older patients with preexisting behavioral health problems. We also report on findings from post-COVID follow-ups. Design Retrospective observational study. Participants Outpatients at a geriatric psychiatric clinic in New York City. Measurements Demographic and clinical data including medication, diagnosis and Clinical Global Impression Severity (CGI-S) scales on outpatients who had COVID-19 between February 28th and October 1st 2020 were extracted from the electronic health records (EHR) from the hospital. Results A total of 56 patients were diagnosed with COVID-19 (mean age 76 years; median age 75 years) and 13 (23.2%) died. We found an increased mortality risk for patients who were prescribed at least one antipsychotic medication at the time of COVID-19 infection (Fisher’s exact test P = 0.009, OR = 11.1, 95% confidence interval: 1.4–96.0). This result remains significant after adjusting for age, gender, housing context and dementia (Logistic regression P = 0.035, Beta = 2.4). Furthermore, we found that most patients who survived COVID-19 (88.4%) recovered to pre-COVID baseline in terms of psychiatric symptoms. Comparison of pre- and post-COVID assessments of CGI-S for 33 patients who recovered from COVID-19 were not significantly different. Conclusion We observed a higher COVID-19 mortality associated with concurrent antipsychotics use in older patients receiving behavioral health services. The majority of patients in our geriatric clinic who recovered from COVID-19 appeared to return to their pre-COVID psychiatric function. More precise estimates of the risk associated with antipsychotic treatment in older patients with COVID-19 and other underlying factors will come from larger datasets and meta-analyses.

scholarly journals Perinatal Mood and Anxiety Disorder Management in Multicenter Community Practices: Clinicians’ Training, Current Practices and Perceived Strategies to Improve Future Implementation

2021 ◽  
Vol 12 ◽  
pp. 215013272199688
Author(s):  
Ajeng J. Puspitasari ◽  
Dagoberto Heredia ◽  
Elise Weber ◽  
Hannah K Betcher ◽  
Brandon J. Coombes ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Health Services ◽  
Behavioral Health ◽  
Psychiatric Symptoms ◽  
Medical Center ◽  
Academic Medical Center ◽  
Management Training ◽  
The United States ◽  
Behavioral Health Services ◽  
Perinatal Women

Background: This study aimed to explore clinicians’ perspectives on the current practice of perinatal mood and anxiety disorder (PMAD) management and strategies to improve future implementation. Methods: This study had a cross-sectional, descriptive design. A 35-item electronic survey was sent to clinicians (N = 118) who treated perinatal women and practiced at several community clinics at an academic medical center in the United States. Results: Among clinicians who provided care for perinatal women, 34.7% reported never receiving PMAD management training and 66.3% had less than 10 years of experience. Out of 10 patients who reported psychiatric symptoms, 47.8% of clinicians on average reported providing PMAD management to 1 to 3 patients and 40.7% noted that they conducted screening only when patient expresses PMAD symptoms. Suggested future improvements were providing training, developing a referral list, and establishing integrated behavioral health services. Conclusions: Results from this study indicated that while PMAD screening and management was implemented, improvements are warranted to meet established guidelines. Additionally, clinicians endorsed providing PMAD management to a small percentage of perinatal patients. Suggested strategies to increase adoption and implementation of PMAD management should be explored to improve access to behavioral health services for perinatal women.

scholarly journals Evaluating Dental Faculty’s Perspective regarding Emergency Introduction of Online Teaching and Learning: Early Experience during COVID-19 Lockdown in United States

2022 ◽  
Vol 2022 ◽  
pp. 1-10
Author(s):  
Aman Gupta ◽  
Ana Janic ◽  
Joshua Thomson
Keyword(s):  
New York ◽  
Student Learning ◽  
Teaching Methods ◽  
Online Teaching ◽  
Teaching And Learning ◽  
Social Impact ◽  
Teaching Experience ◽  
Exact Test ◽  
Holistic Understanding ◽  
Age Range

Objectives. The March 2020 lockdown mandated institution closures and forced educators to provide remote instruction. We intended to gain an in-depth and holistic understanding of dental faculty’s experience and perceptions during this mandatory shift. Insights were gathered in 6 key areas: prior remote instruction experience; magnitude of transition and frequency of instruction methods used; training received; preferred teaching methods based on how they promote student learning, interaction, engagement, and performance; social impact; and future of teaching. Methods. An anonymous QualtricsXM survey was distributed to all dental faculties at University of Detroit Mercy in May 2020. Data was collected over a three-week period and analyzed using Statistical Package for the Social Sciences (SPSS) Statistics 26 (IBM; Armonk, New York, USA). Pearson chi-squared test and Fisher’s exact test were used to evaluate categorical data. Results. Out of the 30 participants who transitioned to online remote instruction, 16 (53.3%) reported an age between 30 and 49 years and 14 (46.7%) reported ≥50 years of age. Our analysis revealed that faculty in 30–49-year age range had no prior online synchronous teaching experience. The transition was described as interesting, useful, time-consuming, and challenging. In-person live teaching received highest number of first place rankings (50%), and online asynchronous method received highest number of last place rankings (42.86%). Faculties in >50 year age range expressed maximum satisfaction with online small-group discussions, and those in 30–49 years age group were more satisfied with one-on-one online discussion. Conclusion. Our study finds that the faculty tends to gravitate to online methods that are similar to or mimic their past in-person teaching environment. Forced remote instruction gave new content delivery experiences to faculties of all ranges of age and experience in teaching. This exposure is likely to result in a more widespread adoption of a variety of instructional methods in future. Our study strongly suggests that traditional in-person instruction is the preferred method for delivery of content and is likely better for student learning. Majority of the faculties believed that the future of dental education would be a mix of both in-class and online instruction. In summer and fall 2021, our institution adopted hybrid, flexible models for didactic instruction to allow students the opportunity to digest content in their preferred method. Careful planning and systematic, continued training will be required to enhance technological skills and to incorporate newer models into didactic and clinical instruction. For the success of blended learning, courses will need redesigning of assessment methods, commitment, and support from administrators.

scholarly journals Before writing that script: use of antipsychotic medication in patients with dementia in a CMHTOA

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S96-S96
Author(s):  
Adaora Obiekezie ◽  
Roohi Afshan ◽  
Jack Healy
Keyword(s):  
Antipsychotic Medication ◽  
Psychological Symptoms ◽  
Antipsychotic Treatment ◽  
Community Mental Health Team ◽  
Mental Health Team ◽  
Diagnosis Of Dementia ◽  
Independent Review ◽  
The Common ◽  
The Uk ◽  
Current Guidelines

AimsA 2009 independent review commissioned by the UK government to review the use of antipsychotic medication in patients diagnosed with dementia produced the Time for Action report, often referred to as the Banerjee Report. It highlighted the common practise of using antipsychotics in the treatment of Behavioural and Psychological Symptoms of Dementia (BPSD) and the clinical issues this could raise especially when these medications were not being regularly reviewed. The audti was therefore carried out to determine whether patinets with BPSD in a Community Mental Health Team for Older adults (CMHTOA) in Mid Surrey, who had been diagnosed with BPSD, were being adequately assessed and managed in line with the current guidelines.MethodPatients with a diagnosis of dementia open to one of three teams in the CMHTOA during the months of October and November 2019 were identified, those being prescribed antipsychotic medication were selected and data from their electronic records collected and analysed to determine if clinicians: a) identified and documented the target behaviours, b) carried out a structured assessment using an ABC chart before commencing medication, c) reviewed the antipsychotic medication 6 weeks after it was commenced.ResultOf the 87 patients with a diagnosis of Dementia from October to November 2019, 18 were on antipsychotic medication. 100% of these had target behaviours identified and clearly documented, a sixth had a structured assessment prior to starting medication and 61% had been reviewed after the first 6 weeks of starting antipsychotics.ConclusionThe findings showed that a good proprotion of patients did not have the required structured assessment before commencement of treatment and that more needed to be done by way of improving regular reviews after antipsychotic treatment is commenced.

scholarly journals Reducing the use of high dose antipsychotic medication in acute adult inpatient psychiatric units

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S341-S341
Author(s):  
Shay-Anne Pantall ◽  
Sarah Warwicker ◽  
Lisa Brownell
Keyword(s):  
Antipsychotic Medication ◽  
Psychiatric Inpatient ◽  
Electronic Prescribing ◽  
Antipsychotic Treatment ◽  
High Dose ◽  
Junior Doctors ◽  
List Type ◽  
Increased Risk ◽  
Adult Inpatient ◽  
Inpatient Units

AimsTo evaluate the use of antipsychotics, and high dose antipsychotic treatment (HDAT) in psychiatric inpatient unitsBackgroundThe Royal College of Psychiatrists published a consensus statement on high dose antipsychotic medication in October 1993. Such treatment carries an increased risk of adverse effects including towards ventricular tachycardia and sudden death.MethodA retrospective case note review of all male patients on acute adult inpatient units in a psychiatric hospital in South Birmingham on a date in June 2018 (n = 45) including review of electronic patient records and prescriptions. This was compared with the results of an earlier study, with identical methods, undertaken in June 2015.Result•In both 2015 and 2018, only a minority of patients (20% and 11% respectively) were informal.•In both 2015 and 2018, the majority of inpatients had a diagnosis of schizophrenia (54% and 67%)•In both 2015 and 2018, 93% inpatients were prescribed antipsychotic medication.•In 2015, 56% patients were prescribed HDAT. This reduced in 2018 to 16%.•This reduction in use of HDAT was almost entirely due to a reduction in the prescription of PRN antipsychotic medication.•In terms of regularly prescribed antipsychotic medication, in both years, the most commonly prescribed drug was flupentixol, with a range of other second generation oral and long acting medications being prescribed, usually at doses within BNF limits.Between the two years, there was a substantial change in the prescribing of PRN antipsychotics. In 2015, 59% individuals were prescribed at least one PRN antipsychotic (27% were prescribed two). In 2018, this reduced to 40% prescribed at least one, and only 2% being prescribed 2 PRN antipsychotics. In both years, oral quetiapine was a common choice (39% patients in 2015 prescribed oral quetiapine, and 34% in 2018). In 2015, 39% patients were prescribed oral or intramuscular aripiprazole, while this reduced to 7% in 2018.ConclusionThe vast majority of psychiatric inpatients were being prescribed antipsychotic medication. Prescription of high dose antipsychotic medication was common in 2015, and this was largely attributable to high levels of prescribing of PRN antipsychotics. Following an educational programme for junior doctors and ward nurses, and the introduction of electronic prescribing, we achieved a significant change in practice, particularly in the prescribing of PRN antipsychotics, which has reduced our patients’ risk of receiving high dose antipsychotic medication.

scholarly journals Time course of improvement with antipsychotic medication in treatment-resistant schizophrenia

2011 ◽  
Vol 199 (4) ◽  
pp. 275-280 ◽  
Author(s):  
Takefumi Suzuki ◽  
Gary Remington ◽  
Tamara Arenovich ◽  
Hiroyuki Uchida ◽  
Ofer Agid ◽  
...  
Keyword(s):  
Antipsychotic Medication ◽  
Time Course ◽  
Rating Scale ◽  
Antipsychotic Treatment ◽  
Treatment Resistant ◽  
Item Score ◽  
Double Blind ◽  
The Mean ◽  
Meta Regression ◽  
Item Scores

BackgroundImprovements are greatest in the earlier weeks of antipsychotic treatment of patients with non-resistant schizophrenia.AimsTo address the early time-line for improvement with antipsychotics in treatment-resistant schizophrenia.MethodRandomised double-blind trials of antipsychotic medication in adult patients with treatment-resistant schizophrenia were investigated (last search June 2010). A series of meta-regression analyses were carried out to examine the effect of time on the average item scores in the Positive and Negative Syndrome Scale (PANSS) or Brief Psychiatric Rating Scale (BPRS) at three or more distinct time points within the first 6 weeks of treatment.ResultsStudy duration varied from 4 weeks to 1 year and the definitions of treatment resistance as well as of treatment response were not necessarily consistent across 19 identified studies, resulting in highly variable rates of response (0–76%). The mean standardised baseline item score in the PANSS or BPRS was 3.4 (s.e. = 0.06) in the five studies included in the meta-regression analysis, with the average baseline Clinical Global Impression – Severity score being 5.2 (marked illness). For the pooled population treated with a range of antipsychotics (n = 1019), significant reductions in the mean item scores occurred during the first 4 weeks; improvements observed in later weeks were smaller and non-significant. In contrast, weekly improvement with clozapine was significant throughout (n = 356).ConclusionsOur findings provide preliminary evidence that the majority of improvement with antipsychotics may occur relatively early. More consistent improvements with clozapine may be associated with a gradual titration. To further elucidate response patterns, future studies are needed to provide data over regular intervals during earlier stages of treatment.

Fortitude

2019 ◽  
pp. 194-226
Author(s):  
Robert S. Kurtz
Keyword(s):  
New York ◽  
Medical Education ◽  
New York City ◽  
African American ◽  
Behavioral Health ◽  
York City ◽  
Residency Education ◽  
Educational Process ◽  
Health Issues ◽  
Covert Racism

In New York City, from the 1990s to the present, covert racism is alive and well in the field of medicine and medical education. The most heavily impacted are African American and Caribbean American females and males. The inequitable treatment thus engendered has concrete results ranging from unwarranted criticism in residency education to forced changes of medical occupations and jobs, to false attributions of behavioral health issues. Combating these challenges requires fortified character armor, seeking percipient well positioned minority, white and off-whites allies, and a willingness to maintain continued vigilance. With persistence and tenacity, success is possible in terms of protecting minorities both in the educational process, and in a mature medical life.

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