scholarly journals Appraisal and discernment of prevalent drug-drug interactions in patients with psychiatric disorders

2021 ◽  
Vol 10 (8) ◽  
pp. 1005
Author(s):  
Axa Jacob ◽  
Cristin Simon Thomas ◽  
Anay Deore ◽  
Prasanna Deshpande
Keyword(s):  
Drug Interactions ◽  
Hospital Admissions ◽  
Psychiatric Patients ◽  
Medical Complications ◽  
Medical Illness ◽  
Inclusion Criteria ◽  
Potential Ddis ◽  
Careful Monitoring ◽  
Mechanistic Approach ◽  
High Prevalence

Background: Drug-drug interactions (DDIs) contribute majorly to hospital admissions, treatment failures, avoidable medical complications and subsequent healthcare costs. Thus, we employ a mechanistic approach to prospectively investigate the incidence of potential DDIs in the psychiatric patients in a clinical setting.Methods: In this prospective, observational, multi centred study conducted for a span of 6 months, psychiatric inpatients (≥18 years) prescribed with 2 or more medications daily for any medical illness were included. The secured prescriptions of the inpatients selected in accordance to the inclusion criteria were then assessed for DDIs using Micromedex(TM) as a standard.Results: Of the total 400 enrolled participants, 383 (95%) of them showed at least one pDDI regardless of the severity. An average of 7.33 interactions per patient was also deduced. A high prevalence of pDDIs totalling to 2900 was recorded in our study with an average of 7.33 interactions per patient.  Most of the interactions were of major (56.52%) and moderate severity (39.07) followed by contraindicated (2.55) and minor (1.83). Cardiovascular system (41.77%) had the highest potential to be affected due to the pDDIs identified. Trihexyphenidyl, haloperidol, promethazine, amisulpride, risperidone, divalproex, trifluoperazine, olanzapine and clozapine where among the most commonly encountered drugs in these interactions.Conclusions: A high prevalence of pDDIs totalling to 2900 was recorded in our study with an average of 7.33 interactions per patient.  A significant association of the pDDIs with variables such as age, gender, diagnosis and total number of drugs used was identified. More studies are required to explore the overall pattern of DDIs in psychiatric patients along with their levels and correlation with different risk factors. Careful monitoring and documentation are necessary to prevent further complications thereby improving the therapeutic outcome.

Outpatient Psychotropic Drug Interactions in a Public Psychiatry Hospital in Bahrain: An Audit Study

2021 ◽  
Vol 10 ◽  
Author(s):  
Yasin Tayem ◽  
Saeed Aljaberi ◽  
Ali Alfehaid ◽  
Abdulaziz Almekhyal ◽  
Haitham Jahrami ◽  
...  
Keyword(s):  
Drug Interactions ◽  
Psychotropic Drugs ◽  
Psychiatric Patients ◽  
Psychotropic Medications ◽  
Outpatient Psychiatry ◽  
High Prevalence ◽  
Public Psychiatry ◽  
And Gender ◽  
Potential Interactions ◽  
Outpatient Prescriptions

Background: Psychotropic polypharmacy is particularly common which puts psychiatric patients at high risk for developing drug-drug interactions. Objective: We aimed to study potential interactions between psychotropic medications prescribed within the outpatient psychiatry setting. Method: This was an audit study, which targeted a sample of outpatient prescriptions ordered within the outpatient clinics of the main psychiatry hospital in Bahrain over 2017. We studied the degree and correlation between psychotropic drugs. Results: The total number of prescriptions in our sample was 992 (56.1% males, 43.9% females). Psychotropic polypharmacy was detected in 842 prescriptions (84.9%). Potential interactions between psychotropic drugs were observed in 550 prescriptions (56.4%). The degree of interaction was minor in 43 prescriptions (7.8%), significant in 419 prescriptions (76.2%), and serious in 88 prescriptions (16%). Schizoaffective disorder subjects were the most likely to suffer from interactions (64.6%), whereas prescriptions issued for those who had schizophrenia contained the least number of interactions (51.6%). The total number of interactions was strongly associated with polypharmacy (p < .001), and gender (p < .01), but not with age (p > .05) or diagnosis (p > .05). Conclusion: High prevalence of polypharmacy and interactions between psychotropic medications were observed in our sample, particularly of the significant grade.

scholarly journals The interface of psychiatry and COVID-19: Challenges for management of psychiatric patients

2020 ◽  
Vol 36 (5) ◽  
Author(s):  
Afzal Javed ◽  
E. Mohandas ◽  
Avinash De Sousa
Keyword(s):  
Side Effects ◽  
Open Access ◽  
Drug Interactions ◽  
Viral Infection ◽  
Original Work ◽  
Psychiatric Patients ◽  
Medical Complications ◽  
Creative Commons ◽  
Psychiatric Side Effects ◽  
Open Access Article

COVID-19 is a viral infection that has multisystemic physical and psychological complications. The following paper looks at the various challenges seen while treating psychiatric patients during the COVID pandemic. There is a need for physician to be aware of the drug interactions between psychiatric medications and the medications used routinely in the management of COVID. There is also the concern of psychiatric side effects of medications used to manage COVID and medical complications caused by some side effects of psychiatric drugs. The telepsychiatry and telemedicine paradigm has made it mandatory for physicians to be vigilant of the same. doi: https://doi.org/10.12669/pjms.36.5.3073 How to cite this:Javed A, Mohandas E, De-Sousa A. The interface of psychiatry and COVID-19: Challenges for management of psychiatric patients. Pak J Med Sci. 2020;36(5):---------. doi: https://doi.org/10.12669/pjms.36.5.3073 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Severe Sepsis Attributable to Community-Associated Methicillin-Resistant Staphylococcus aureus: An Emerging Fatal Problem

2007 ◽  
Vol 73 (7) ◽  
pp. 684-687 ◽  
Author(s):  
Eric T. Castaldo ◽  
Edmund Y. Yang
Keyword(s):  
Staphylococcus Aureus ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Soft Tissues ◽  
Hospital Admissions ◽  
Primary Source ◽  
Necrotizing Pneumonia ◽  
Inclusion Criteria ◽  
Methicillin Resistant ◽  
Cardiorespiratory Failure ◽  
Source Of Infection

We observed a number of cases of sepsis from bacteremia in children from community-associated methicillin-resistant Staphylococcus aureus (MRSA), which led us to study its patterns of infection and outcome. A retrospective review identifying children admitted to our institution with blood culture-proven community-associated MRSA sepsis over a 2-year period was performed. The inclusion criteria were younger than 19 years old, two or more blood cultures for MRSA within 48 hours of admission, evidence of systemic inflammatory response syndrome, and no prior hospital admissions within 6 months. Eight patients were included; seven required mechanical ventilation. Vasopressors were required in seven patients. Four patients required extra-corporeal membrane oxygenation. Four patients had culture-proven septic arthritis or thrombophlebitis and three of these patients developed bilateral necrotizing pneumonia. Bilateral necrotizing pneumonia was identified in the other four patients, but the primary source of infection was never identified. The overall intact neurologic survival was 50 per cent. Children with severe community-associated MRSA sepsis can rapidly progress to cardiorespiratory failure. Mortality appears to be high, and children may benefit from a search of their soft tissues and joints to identify the source of infection to prevent embolic dissemination.

scholarly journals 1683. Hospital Admission Patterns in Adult Patients with Complicated Urinary Tract Infections (cUTIs): Identification of Potentially Avoidable Hospital Admissions Across United States (US) Hospitals

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S825-S826
Author(s):  
Thomas Lodise ◽  
Teena Chopra ◽  
Brian Nathanson ◽  
Katherine Sulham
Keyword(s):  
Hospital Admission ◽  
Hospital Admissions ◽  
Panel Member ◽  
Inclusion Criteria ◽  
Independent Contractor ◽  
Healthcare Database ◽  
Admission Rates ◽  
Comorbidity Index ◽  
Multi Center Study ◽  
Tract Infections

Abstract Background There is an increase in hospital admissions for cUTI in the US despite apparent reductions in the severity of admissions. However, there are scant data on cUTI hospital admission rates from the emergency department (ED) stratified by age, infection severity, and presence of comorbidities. This study described US hospitalization patterns among adults who present to the ED with a cUTI. We sought to quantify the proportion of admissions that were potentially avoidable based on presence of sepsis and associated symtpoms as well as Charlston Comorbidity Index (CCI) scores. Methods A retrospective multi-center study using data from the Premier Healthcare Database (2013-18) was performed. Inclusion criteria: (1) age ≥ 18 years, (2) primary cUTI ED/inpatient discharge diagnosis, (3) positive blood or urine culture between index ED service days -5 to +2. Transfers from acute care facilities were excluded. Based on ICD-9/10 diagnosis codes present on admission, incidence of hospital admissions were stratified by age (≥ 65 years vs. &lt; 65 years), presence of sepsis (S), sepsis symptoms but no sepsis codes (SS) (e.g., fever, tachycardia, tachypnea, leukocytosis, etc.), and CCI. Results 187,789 patients met inclusion criteria. The mean (SD) age was 59.7 (21.9), 40.4% were male, 29.4% had sepsis, 16.7% had at least 1 SS symptom (but no S), and 53.9% had no evidence of S or SS. The median [IQR] CCI was 1 [0, 3]. 119,668 out of 187,789 (63.7%) were admitted to hospital. Among inpatients, median [IQR] length of stay (LOS) and total costs were 5 [3, 7] days and $7,956 [$4,834, $13,960] USD. Incidence of hospital admissions by age, presence of S/SS, and CCI score are shown in the Table. 18.9% of admissions (22,644/119,668) occurred in patients with no S/SS and a CCI ≤ 2. Their median [IQR] LOS and total costs were 3 [2, 5] days and $5,575 [$3,607, $9,133]. Incidence of Hospital Admission by Age, Charlson comorbidity index (CCI), Presence of Sepsis (S), and Presence of Sepsis Symptoms (SS) Conclusion Nearly 1 in 5 cUTI hospital admissions may be avoidable. Given the resources associated with the management of inpatients with cUTIs, these findings highlight the critical need for healthcare systems to develop well-defined criteria for hospital admission based on presence of comorbid conditions and infection severity. Preventing avoidable hospital admissions has the potential to save the healthcare system substantial costs. Disclosures Thomas Lodise, PharmD, PhD, Paratek Pharmaceuticals, Inc. (Consultant) Teena Chopra, MD, MPH, Spero Therapeutics (Consultant, Advisor or Review Panel member) Brian Nathanson, PhD, Spero Therapeutics (Independent Contractor) Katherine Sulham, MPH, Spero Therapeutics (Independent Contractor)

Prevalence of Somatic Indicators of Distress in Diabetes Patients: Comparison to Psychiatric Patients and Community Nonpatients

1998 ◽  
Vol 28 (3) ◽  
pp. 265-272 ◽  
Author(s):  
James E. Aikens
Keyword(s):  
Psychiatric Patients ◽  
Screening Methods ◽  
Medical Illness ◽  
Medically Ill ◽  
Somatic Distress ◽  
Memory Problems ◽  
Insulin Dependent ◽  
Patient Groups ◽  
Case Classification ◽  
Diabetes Patients

Objective: Because psychiatric screening methods are usually developed using psychiatric samples but not medical samples, they often include distress indicators that overlap with medical illness. This potentially inflates psychopathology estimates for medically ill patient groups. The objective of this study was to determine whether somatic distress indicator base rates are elevated in diabetes patients. Method: The occurrence of Symptom Checklist 90-R (SLC-90-R) somatic symptoms was studied in fifty-six diabetes mellitus patients (27 insulin dependent, 29 non-insulin dependent) with non-elevated SLC-90-R profiles, as compared to both community nonpatient and psychiatric patient norms. Results: Of the fifteen SCL-90-R items rated by endocrinologists as most likely to be diabetes-related, nine were endorsed more frequently by diabetes patients than by nonpatients: faintness/dizziness (endorsed by 36% of diabetics), reduced libido (endorsed by 41%), anenergia (68%), memory problems (66%), trembling (18%), numbness (55%), weakness (39%), overeating (59%), and somatic concerns (41%). Anergia and faintness/dizziness were endorsed more frequently by psychiatric patients than diabetes patients, whereas numbness was endorsed more often by diabetes patients. Conclusions: Conservatism is warranted when applying these somatic indicators of distress to diabetes patients. Further studies are needed to determine whether such illness overlap biases case classification.

Characteristics of Readmitted Psychiatric Inpatients

2003 ◽  
Vol 93 (1) ◽  
pp. 235-238 ◽  
Author(s):  
Kaye Baron ◽  
J. Ray Hays
Keyword(s):  
Clinical Utility ◽  
Hospital Admissions ◽  
Psychiatric Patients ◽  
Prediction Equation ◽  
Short Length ◽  
Cognitive Resources ◽  
Common Variance ◽  
Younger Age ◽  
The Common ◽  
Initial Hospitalization

This study examined sociodemographic, diagnostic, psychological, and episode-based variables in a sample of 130 psychiatric patients admitted to treatment at least twice in a 6-yr. period. Short length of initial hospitalization ( r = -.30, p <.01) and younger age on initial admission ( r = -.20, p <.05) were significantly correlated with frequent hospital admissions. Scores on four of the subscales of the WAIS-R were significantly correlated with readmission, confirming that patients who have fewer cognitive resources are at risk of frequent admissions. A multiple regression analysis combining variables to predict readmission accounted for only 12% of the common variance ( r128 = .34, p <.01), however, indicating that a prediction equation with these variables has limited clinical utility.

scholarly journals The use of qualitative approach to detect and assess potential drug-drug interactions which may decrease the effectiveness of oral contraceptives – pilot study and literature review

2014 ◽  
Vol 83 (3) ◽  
pp. 238-243
Author(s):  
Karolina Kilińska ◽  
Magdalena Cerbin-Koczorowska ◽  
Arleta Matschay ◽  
Michał Mierzwicki ◽  
Karolina Chmaj-Wierzchowska
Keyword(s):  
Pilot Study ◽  
Drug Interactions ◽  
Oral Contraceptives ◽  
Study Protocol ◽  
Qualitative Data ◽  
Potential Drug ◽  
Inclusion Criteria ◽  
Medicinal Products ◽  
Cross Sectional ◽  
Unintended Pregnancies

Aim. The aim of the pilot study was to assess the effectiveness of the tool designed for detecting potential drug-drug interactions of combined oral contraceptives (COCs) with particular emphasis on those which can affect their contraceptive action. A proper study protocol design seems to be essential for further analysis of more data and for establishing correlations between observed interactions and demographic variables.Material and methods. The cross-sectional descriptive, retrospective study was carried out on Polish females from March to May 2013. Gathered data, including products used concomitantly with contraceptive drugs, were derived electronically by patients and underwent thematic analysis.Results. Out of 49 respondents who agreed to participate in the study and fit the inclusion criteria only 15 derived qualitative data about other medicinal products they used. However, some of them sent their monthly report more than once, which gave the total of 158 drugs listed in 25 forms gathered during the whole pilot study. Fifty-three potential drug interactions were found, including 13 (24.53%) which could have decreased the effectiveness of contraceptive drugs.Conclusions. Continuation of the study in accordance with the study protocol will result in identification of common potential drug-related problems, which may enable development of an educational solution for gynecologists, pharmacists and patients increasing their awareness of the potential risk of contraceptive failures and unintended pregnancies.

scholarly journals SURVEY OF PATTERN OF DRUG INTERACTIONS IN PATIENTS BEING PRESCRIBED ANTI-DIABETIC MEDICATIONS IN A TERTIARY CARE HOSPITAL: PROSPECTIVE CROSS SECTIONAL STUDY

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Sujeet A. Divhare ◽  
Satyashil Ingale
Keyword(s):  
Diabetes Mellitus ◽  
Drug Interactions ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Care Hospital ◽  
Sectional Study ◽  
Potential Ddis ◽  
Cross Sectional

Background: Potential importance of drug –drug interactions (DDIs) is increasing as polypharmacy becomes more prevalent. Because additional data on the incidence and pattern of potential DDIs among diabetic patients are lacking in India, and supplemental pharmacodynamic or clinical outcome information is needed to address importance of a drug- drug interaction. Aim and objectives: To identify and analyze the pattern of DDIs in patients being prescribed anti-diabetic drugs in a tertiary care hospital. Material and Methods: This prospective cross-sectional study was carried out for a period of three months in 200 Type 2 diabetes mellitus (Type 2 DM) patients who were taking at least one antidiabetic agent during the period of past six months, of any age and either sex admitted in medicine ward of a tertiary care teaching hospital. Only one prescription was included for each patient on his/her 3rd day of hospitalization in the ward. Results: A total of 1217 drugs were prescribed in 200 prescriptions, resulting in an average of 6.1 drugs per prescription. A total of 637 potential DDIs were noted. The majority were seen in middle aged and elderly people. No overall difference was detected in the patients on insulin or metformin therapy taking or not taking additional drugs with the potential to interact. Worse control was found in the group of patients on sulphonylurea therapy taking interacting drugs (P <0.05). This difference was most marked in the group of patients over 60 years of age, who also had the highest intake of potentially interacting drugs (57%; <35 years-37%). Conclusion: Antidiabetic drugs have numerous interactions. A good practice is to use a drug­–drug interaction checker if any questions arise, several are available online. Quality care starts with the clinician obtaining a complete medication list for each patient at the start of each visit. Keywords: diabetes mellitus, drug interactions, hypoglycemic agents, drug therapy, co-morbidity, polypharmacy

scholarly journals Comparison of the Contamination Rate and Risk Factor Profile of Blood Culture Done in Emergency Department and MHDU/MICUs

2021 ◽  
pp. 1-8
Author(s):  
Dr. Pankaj Kumar Singh
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Risk Factor ◽  
Blood Culture ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Contamination Rate ◽  
Medical Illness ◽  
Inclusion Criteria ◽  
Factors Associated

Aims and objectives: To determine the risk factors of blood culture contamination done in ED and those done in the MHDU/MICU among patients admitted with medical illness. Material and Methods: This is a two months’ prospective observational study comparing blood culture contamination rate and risk factors associated with contamination between ED and MICU/MHDU. A total of 998 patients were included in the study who underwent blood culture in ED and MICU/MHDU. 570 in ED and 428 in MICU/MHDU were included after meeting exclusion and inclusion criteria. Results: Blood culture growths were higher in ED (19%). Most common growth was CoNS (4%). The overall contamination rate in this study was (4.8%) The contamination rate was lower in ED (4.4%) when compared to MICU/MHDU (5.4%).

Abstract 5133: Does Public Smoking Ban Reduce the Incidence of Myocardial Infarction in Michigan? A Systematic Review and Attributable Risk Analysis

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Mouaz Al-Mallah ◽  
Fadi Alqaisi ◽  
David Nerenz ◽  
Stephanie Boedeker ◽  
W. Douglas Weaver
Keyword(s):  
Hospital Admissions ◽  
Health Care Cost ◽  
Meta Analysis ◽  
Attributable Risk ◽  
Smoking Ban ◽  
Random Effects Model ◽  
Inclusion Criteria ◽  
Established Risk Factor ◽  
Potential Impact ◽  
The Impact

Background: Smoking is a well-established risk factor for cardiovascular disease. The Michigan legislature is currently considering a proposal for a comprehensive smoking ban (CSB) in Michigan. The potential impact of such a law on the incidence AMI is not known. We conducted a meta-analysis to study the impact of CSB on the incidence of AMI and calculated the impact of potential CSB on the incidence of AMI in Michigan. Methods: We searched MEDLINE, EMBASE, and Cochrane databases from inception till May 2008 for studies comparing the rates of AMI hospital admissions before and in the year after the implementation of CSB legislation. Of 135 potentially relevant articles screened initially, 5 studies met the inclusion criteria. A random-effects model meta-analysis was done and between-studies heterogeneity was compared with I2. The attributable risk (AR) of CSB on AMI incidence was calculated and multiplied with the number of AMI admissions in Michigan. Results: In the published studies, a CSB was associated with a decrease in the incidence of AMI (RR 96%, 95% CI 93%–100%, p=0.05). There was no heterogeneity between the included studies (I2<50%). The AR of CSB on the incidence of AMI is −4.2%. The average number of hospital admissions for AMI as first-listed diagnosis in Michigan between 1999 and 2006 was 27,007 per year. Thus, if a CSB legislation is implemented in Michigan in 2008, the calculated reduction of hospital admissions for AMI is 1130 admissions per year as of 2009.. Conclusion: CSB is associated with a significant reduction of annual hospital admissions for AMI. The financial impact of this reduction on health care cost is yet to be determined.

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