The impact of paliperidone palmitate long acting injection on hospital admissions in a mental health setting

Background: To examine the risk of infection in patients prescribed clozapine compared with patients prescribed paliperidone palmitate long-acting injection (PPLAI). Method: A retrospective, 1-year, cohort study conducted on events occurring in eligible patients beginning treatment for the first time with clozapine or PPLAI between June 2017 and June 2019 in a UK mental health trust providing in-patient and out-patient services. Results: The study included 64 patients starting clozapine and 120 patients starting PPLAI. Incidence of infection was greater in clozapine starters than in PPLAI starters (28% vs 6%; p = 0.001; adjusted odds ratio 5.82 (95% confidence interval (CI) = 2.15–15.76, p = 0.001). Infectious episodes in clozapine patients were not related to changes in neutrophil counts. Incident infection in the clozapine group was highest in the first 3 months of treatment. The most commonly reported infection in the clozapine group was chest infection; however, the majority of infections were non-chest-related. Conclusion: Patients starting clozapine showed a substantially increased likelihood of infection compared with patients starting PPLAI.

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Is paliperidone palmitate more effective than other long-acting injectable antipsychotics?

Psychological Medicine ◽

10.1017/s0033291717003051 ◽

2017 ◽

Vol 48 (10) ◽

pp. 1616-1623 ◽

Cited By ~ 6

Author(s):

R. Patel ◽

E. Chesney ◽

M. Taylor ◽

D. Taylor ◽

P. McGuire

Keyword(s):

Rate Ratio ◽

Hospital Admissions ◽

Incidence Rate Ratio ◽

Psychiatric Inpatient ◽

The Other ◽

Paliperidone Palmitate ◽

Before And After ◽

Long Acting ◽

Few Data ◽

The Uk

AbstractBackgroundPaliperidone palmitate is one of the most widely prescribed long-acting injectable (LAI) antipsychotics in the UK. However, it is relatively expensive and there are few data comparing its effectiveness to that of other LAI antipsychotics. We sought to address this issue by analyzing a large anonymized electronic health record (EHR) dataset from patients treated with LAI antipsychotics.MethodsEHR data were obtained from 1281 patients in the South London and Maudsley NHS Foundation Trust (SLaM) who started treatment with a LAI antipsychotic between 1 April 2011 and 31 January 2015. The number of days spent as a psychiatric inpatient and the number of admissions to a psychiatric hospital were analyzed in each of the 3 years before and after LAI prescription.ResultsPatients treated with paliperidone palmitate (n = 430; 33.6%) had a greater number of inpatient days and a greater number of admissions in the year prior to treatment than those treated with other LAI antipsychotics. Nevertheless, in the 3 years after initiation there were no significant differences between paliperidone and the other LAI antipsychotics in the number of days as an inpatient (B coefficient 5.4 days, 95% confidence interval (CI) −57.3 to 68.2, p = 0.86) or number of hospital admissions (Incidence rate ratio 1.07, 95% CI 0.62 to 1.83, p = 0.82).ConclusionPaliperidone palmitate was more likely to be prescribed in patients with more frequent and lengthy hospital admissions prior to initiation. However, the absence of differences in outcomes after initiation indicates that paliperidone palmitate was not more effective than other cheaper LAI antipsychotics.

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Paliperidone palmitate: Experience in a community mental health unit

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1556 ◽

2017 ◽

Vol 41 (S1) ◽

pp. s804-s805

Author(s):

L. Carrión Expósito ◽

G.M. Chauca Chauca ◽

E.L. Guadalupe

Keyword(s):

Mental Health ◽

Retrospective Study ◽

Maintenance Dose ◽

Lower Number ◽

Paliperidone Palmitate ◽

Health Unit ◽

Dose Number ◽

Competing Interest ◽

Long Acting ◽

Mental Health Unit

IntroductionThere are many jobs that offer advantages of treatment with long-acting injectable in psychosis.ObjectiveTo know the changes in the different variables after the start of paliperidone palmitate (PP).Material and methodWe performed a descriptive and retrospective study. Were evaluated patients who received maintenance therapy with PP during 48 months.ResultsThe sample was composed of 29 patients: 72.4% men and 27.6% women. Average age of 46.21 years. In Figures 1, 2 and 3 show data obtained in relation to compliance with treatment, relapse, maintenance dose, number of admissions and visits to emergency departments respectively.ConclusionsThe administration of PP is associated with a higher level of compliance with treatment. The patients presented a lower number of relapses, hospitalizations and visits to the emergency room. The maintenance dose more used is 150 mg.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Quantifying the Impact of Phenoconversion on Medications With Actionable Pharmacogenomic Guideline Recommendations in an Acute Aged Persons Mental Health Setting

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.724170 ◽

2021 ◽

Vol 12 ◽

Author(s):

Sam Mostafa ◽

Thomas M. Polasek ◽

Leslie J. Sheffield ◽

David Huppert ◽

Carl M. J. Kirkpatrick

Keyword(s):

Mental Health ◽

Genetic Variants ◽

Cytochrome P450 Enzyme ◽

Mental Health Setting ◽

Care Model ◽

Collaborative Care Model ◽

Mental Health Patients ◽

P450 Enzyme ◽

Potential Benefits ◽

The Impact

Introduction: Polypharmacy and genetic variants that strongly influence medication response (pharmacogenomics, PGx) are two well-described risk factors for adverse drug reactions. Complexities arise in interpreting PGx results in the presence of co-administered medications that can cause cytochrome P450 enzyme phenoconversion.Aim: To quantify phenoconversion in a cohort of acute aged persons mental health patients and evaluate its impact on the reporting of medications with actionable PGx guideline recommendations (APRs).Methods: Acute aged persons mental health patients (N = 137) with PGx and medication data at admission and discharge were selected to describe phenoconversion frequencies for CYP2D6, CYP2C19 and CYP2C9 enzymes. The expected impact of phenoconversion was then assessed on the reporting of medications with APRs.Results: Post-phenoconversion, the predicted frequency at admission and discharge increased for CYP2D6 intermediate metabolisers (IMs) by 11.7 and 16.1%, respectively. Similarly, for CYP2C19 IMs, the predicted frequency at admission and discharge increased by 13.1 and 11.7%, respectively. Nineteen medications with APRs were prescribed 120 times at admission, of which 50 (42%) had APRs pre-phenoconversion, increasing to 60 prescriptions (50%) post-phenoconversion. At discharge, 18 medications with APRs were prescribed 122 times, of which 48 (39%) had APRs pre-phenoconversion, increasing to 57 prescriptions (47%) post-phenoconversion.Discussion: Aged persons mental health patients are commonly prescribed medications with APRs, but interpretation of these recommendations must consider the effects of phenoconversion. Adopting a collaborative care model between prescribers and clinical pharmacists should be considered to address phenoconversion and ensure the potential benefits of PGx are maximised.

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Characteristics and Co-Admissions of Mothers and Babies Admitted to Residential Parenting Services in the Year Following Birth in NSW: A Linked Population Data Study (2000-2012).

10.21203/rs.3.rs-1065990/v1 ◽

2021 ◽

Author(s):

Hannah Dahlen ◽

Virginia Schmied ◽

Cathrine Fowler ◽

Lilian Peters ◽

Simone Ormsby ◽

...

Keyword(s):

Mental Health ◽

Neonatal Intensive Care ◽

Hospital Admissions ◽

Population Data ◽

Male Infant ◽

Limited Information ◽

Psychiatric Facility ◽

Private Patient ◽

Cohort Differences ◽

The Impact

Abstract Background There is a tiered healthcare system in Australia to support maternal and child health, including, non-psychiatric day stay and residential parenting services (RPS) such as Tresillian and Karitane (in New South Wales [NSW]). RPS are unique to Australia, and currently there is limited information regarding the healthcare trajectory of women accessing RPS and if they are more likely to have admissions to other health facilities within the first-year post-birth. This study aimed to examine differences in hospital co-admissions for women and babies admitted to RPS in NSW in the year following birth compared to non-RPS admitted women. Methods A linked population data study of all women giving birth in NSW 2000-2012. Statistical differences were calculated using chi-square and student t-tests. Results In total 32 071 women and 33 035 babies were admitted to RPS with 5191 RPS women also having one or more hospital admissions (7607 admissions). There were 99 242 women not admitted to RPS but having hospital admissions (136 771 admissions). Women admitted to RPS who had a co-admission to a hospital were significantly more likely to be older, admitted as a private patient, born in Australia, having their first baby and be socially advantaged (p≤.001) compared to non-RPS admitted women also having a hospital admission. They also experienced more labour and birth interventions (induction, instrumental birth, caesarean section, epidural, episiotomy), and were more likely to have multiple births, a male infant and babies admitted to Special Care Nursery/Neonatal Intensive Care (p≤.001). Additionally, these women were more likely to have another admission for mental health and behavioural disorders (p≤.001), and this appeared to increase over time. There was no between cohort differences regarding the number of women admitted to a psychiatric facility; however, women attending RPS were more likely to have mood affective, or behavioural and personality disorder diagnoses. Conclusion Women accessing RPS in the year post-birth were more socially advantaged, had higher birth intervention and more co-admissions and treatment for mental health disorders than those not accessing RPS. More research is needed into the impact of birth intervention and mental health issues on subsequent parenting difficulties.

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Impact of economic crises on mental health care: a systematic review

Epidemiology and Psychiatric Sciences ◽

10.1017/s2045796018000641 ◽

2018 ◽

Vol 29 ◽

Cited By ~ 12

Author(s):

M. Silva ◽

D. M. Resurrección ◽

A. Antunes ◽

D. Frasquilho ◽

G. Cardoso

Keyword(s):

Mental Health ◽

Systematic Review ◽

Health Care ◽

Mental Health Care ◽

Economic Crisis ◽

Mental Health Problems ◽

Hospital Admissions ◽

Health Problems ◽

Economic Crises ◽

The Impact

Abstract Aims Unmet needs for mental health treatment are large and widespread, and periods of economic crisis may increase the need for care and the treatment gap, with serious consequences for individuals and society. The aim of this systematic review was to summarise the empirical evidence on the association between periods of economic crisis and the use of mental health care. Methods Following the PRISMA statement, MEDLINE, Embase, Scopus, Open Grey and Cochrane Database were searched for relevant publications, published between 1990 and 2018, from inception to June 2018. Search terms included (1) economic crisis, (2) use of mental health services and (3) mental health problems. Study selection, data extraction and the assessment of study quality were performed in duplicate. Results Seventeen studies from different countries met the inclusion criteria. The results from the included articles suggest that periods of economic crisis might be linked to an increase of general help sought for mental health problems, with conflicting results regarding the changes in the use of specialised psychiatric care. The evidence on the use of mental health care specifically due to suicide behaviour is mixed. The results also suggest that economic crises might be associated with a higher use of prescription drugs and an increase in hospital admissions for mental disorders. Conclusions Research on the impact of economic crises on the use of mental health care is scarce, and methodologies of the included papers are prone to substantial bias. More empirical and long-term studies on this topic are needed, in order to adapt mental health care systems to the specific needs of the population in times of economic crisis.

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Partial compliance with long-acting paliperidone palmitate and impact on hospitalization: a 6-year mirror-image study

Therapeutic Advances in Psychopharmacology ◽

10.1177/2045125320924789 ◽

2020 ◽

Vol 10 ◽

pp. 204512532092478 ◽

Cited By ~ 1

Author(s):

Sofia Pappa ◽

Katy Mason

Keyword(s):

Hospital Admissions ◽

Mirror Image ◽

Poor Compliance ◽

Paliperidone Palmitate ◽

Image Study ◽

Partial Compliance ◽

Before And After ◽

The Mean ◽

Oral Antipsychotic ◽

Long Acting

Background: Previous studies showed a linear correlation between partial compliance with an oral antipsychotic medication and hospitalisation risk among patients with schizophrenia. Long-acting injections (LAIs) may significantly improve adherence and reduce relapse in patients with psychosis. The aim of this study was to evaluate the relationship between the level of compliance with 1-monthly paliperidone palmitate (PP1M) and hospitalisation rates. Methods: This was a naturalistic, mirror-image study examining retention, compliance and hospitalisation rates 3 years pre- and 3 years post-PP1M initiation. Compliance was divided in three groups: full (no missed dose/year), good (6–11injections/year), poor (<6 injections/year). Results: A total of 173 patients suffering from a severe mental illness (70% with a diagnosis of schizophrenia and 30% with other diagnoses) were included; 77% of patients continued PP1M for 1 year, 66% for 2 years and 55% for 3 years. Of the 95 patients who remained on PP1 throughout the 3 years of follow up, 81% showed full, 13% good, and only 6% poor compliance. In the patients who were fully compliant, the mean number of hospital admissions decreased from 1.34 to 0.43, and the mean number of bed days from 82 to 19 days per patient 3 years before and 3 years after PP1M initiation ( p < 0.001). It is noteworthy that the reductions in hospital stay were statistically significant for the group of patients with full compliance but not for the other two groups. In fact, patients with poor compliance demonstrated higher hospitalisation rates both before and after PPM1 initiation. These findings were similar in the subgroup of patients with schizophrenia who continued treatment for 3 years ( n = 68). Conclusion: There was a direct association between partial compliance and re-hospitalisation; fully compliant patients maintained the best outcomes in terms of reduced bed use following PPM1 initiation.

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12 Impact of Aripiprazole Long-acting Injectable (ALAI) Initiation on Hospitalizations and Visits to Emergency

CNS Spectrums ◽

10.1017/s1092852919000087 ◽

2019 ◽

Vol 24 (1) ◽

pp. 179-180

Author(s):

Carlos Parro-Torres ◽

Elena Ros-Cucurull ◽

Sergio Arques-Egea

Keyword(s):

Blood Pressure ◽

Emergency Service ◽

Hospital Admissions ◽

Psychiatric Service ◽

Mirror Image ◽

Wilcoxon Test ◽

Dual Disorders ◽

Long Acting ◽

Clinical Records ◽

The Impact

AbstractBackgroundAripiprazole once-monthly is an LAI formulation of aripiprazole that is currently approved in the USA and Europe for the treatment of schizophrenia. Some studies have reported a decline in hospital admissions and emergency use after initiation on long-acting injectable (LAI) antipsychotics, but the effects of using recently commercialised LAI aripiprazole remains uncertain.AimsTo characterize the impact of ALAI initiation on number of hospitalizations and visits to the emergency service, among patients suffering from schizophrenia attending regularly to psychiatric consultations of Gregorio Marañón University General Hospital (Madrid, Spain).MethodsPatients initiated on (ALAI) were studied in an observational mirror-image design to assess changes in number of hospitalizations and visits to the emergency service in the 12months pre- vs 12months post-depot initiation. Other sociodemographic, physical and clinical variables such as age, gender, weight, blood pressure and presence of dual disorders were also gathered. Variables were collected reviewing clinical records.Wilcoxon test was used to assess hospitalizations and visits to the emergency. Paired t-tests were used to assess changes in weight and blood pressure. Non parametric Mann-Whitney U test was used to compare aripiprazole doses between genders and in order to assess de influence of dual disorders. In order to perform the statistical analysis, IBM SPSS statistics v.20 was used.Results31 patients were included in the final analysis. Mean age was 44.67 (SD=15.57) years. Most of the patients were male (54.8% vs 45.2%). 71% were previously receiving oral antipsychotics treatment, whereas 29% were receiving other LAI antipsychotic: no significant differences were observed when comparing hospitalizations (p=0.74) or emergency use (p=0.98) in the 12months post-initiation between these groups. Mean dosage was 352.67mg/28days (SD=0.461), and 38.7% needed an adjustment during the first year of treatment (dosage increased in 76.9%). A combination of two or more antipsychotics was prescribed in 64.5% of the patients. Mean psychiatric number of hospitalizations a year declined from 0.483/year pre-initiation to 0.224/year post-initiation (P<0.05), whereas mean visits a year to the emergency psychiatric service declined from 1.419 pre-initiation to 1.032 post-initiation (P<0.1). No significant changes in weight (p=0.82), systolic (p=0.56) or diastolic (p=0.29) blood pressure were observed. No gender differences in dosage were observed (p=0.246). Suffering from dual disorders had no influence on dosage either (p=0.68).ConclusionsLAI aripiprazole initiation appears to provide a benefit decreasing hospitalization needs and emergency services consumption and it was well tolerated. This data supports previous evidence indicating superiority of LAI antipsychotics.

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