Comorbidity and Treatment in Older Psychiatric In-patients—A Retrospective Study in a Chinese Psychiatric Hospital

Background: Comorbid somatic diseases increase the death risk and affect the condition, treatment, and prognosis of older psychiatric patients. We investigated the comorbidity and drug treatment in older patients with psychosis.Methods: This retrospective study used data from 3,115 older psychiatric in-patients hospitalized at the Shanghai Mental Health Center Affiliated to Shanghai Jiaotong University School of Medicine, China discharged from 2005 to 2015. Descriptive analyses of patients' age, sex, treatment drugs, diagnoses (based on ICD-10), and time trend were performed.Results: Patients' median age was 56 (range, 50-98) years; 1,824 (58.6%) were female. The top five first-level diagnoses were schizophrenia (F20) (n = 1,818, 58.3%), depressive episode (F32) (n = 457, 14.6%), bipolar affective disorder (F31) (n = 151, 4.8%), manic episode (F30), (n = 143, 4.6%), and vascular dementia (F01) (n = 136, 4.4%). Mental (99.9%), central nervous system (85.2%), digestive system (83.5%), cardiovascular system (72.5%), and anti-infective (59.6%) drugs had the highest prescription rates. The combined use of antidepressants, anti-anxiety, anti-arrhythmic, hormones and endocrine system drugs were significantly higher in female than in male patients, while mood stabilizers and genitourinary system drugs significantly more frequent in men. With increasing age, the F20-F29 patients decreased, while F00-F09 patients increased, with the corresponding changes to prescription in those patients. In comparison to that in 2005-2010, the combined prescriptions for genitourinary and cardiovascular drugs increased between 2011 and 2015, and F00-F09 and F40-F48 older patients doubled, accordingly anti-Alzheimer's disease drugs and antidepressants more than doubled. F30-F39 patients increased by 49.1%, and anti-anxiety drugs, mood stabilizers, etc. increased by ≥50%; F20-F29 older patients decreased by 26.7%, while antipsychotics only increased by 4.4%.Conclusions: This study found the combined drug treatment of somatic diseases, particularly for central nervous, digestive, cardiovascular, respiratory and genitourinary drugs were extremely common among older psychiatric in-patients in China. With increasing age, the F20-F29 patients decreased, while F00-F09 patients increased; the antipsychotics prescriptions decreased, and almost all comorbidity drugs increased. Compared with that in 2005-2010, the older patients with all diagnosis except F20-F29 increased in 2011-2015, and the prescriptions for psychotropic, genitourinary, and cardiovascular drugs increased.

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Analisis Efektivitas Biaya Terapi Kombinasi Mood Stabilizer dan Antipsikotik pada Pasien Gangguan Afektif Bipolar di Rawat Inap RSJ Grhasia Yogyakarta

Jurnal Surya Medika ◽

10.33084/jsm.v6i2.1967 ◽

2021 ◽

Vol 6 (2) ◽

pp. 210-216

Author(s):

Novi Milasari ◽

Dyah Aryani Perwitasari ◽

Sawitri Sawitri

Keyword(s):

Bipolar Disorder ◽

Direct Medical Cost ◽

Affective Disorder ◽

Medical Cost ◽

Average Length ◽

Bipolar Affective Disorder ◽

Mood Stabilizer ◽

Manic Episode ◽

Mood Stabilizers ◽

Antipsychotic Therapy

Bipolar affective disorder is an episodic mental disorder characterized by manic, hypomanic, depressive, and mixed episodes, usually recurring and can last a lifetime. Patients with bipolar disorder have annual medical costs that were four times those of patients without bipolar disorder. The aim of this study is to analyze the cost-effectiveness of combination therapy between mood stabilizers and antipsychotics in patients with the bipolar affective disorder at Grhasia Mental Hospital Yogyakarta. This study is a retrospective with cohort study design using medical records and direct medical cost data during Januari-December 2018 period. Subjects are patients who were diagnosed with bipolar affective disorder manic episode (F31.2) and received a combination of mood stabilizer and antipsychotic therapy. The results were obtained in 46 patients with the affective disorder who met the inclusion criteria. The average direct medical cost of the sodium divalproate group was IDR 6.319.933 per day and in the lithium group was IDR 5.705.953 per day. The average length of stay in the sodium divalproate group was 25,79 days and in the lithium group was 25,75 days (P = 0,991). The Average Cost Effectivity Ratio (ACER) sodium divalproat group is lower than the lithium group (IDR 221.246 per day and IDR 245.434 per day, respectively). The conclusion of this study is that the combination of sodium divalproate-antipsychotic therapy is more cost-effective than lithium-antipsychotic therapy in a patient with bipolar affective disorder manic episode

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Associations Between Self-Report of Emotional State and the EEG Patterns in Affective Disorders Patients

Journal of Psychophysiology ◽

10.1027/0269-8803/a000004 ◽

2010 ◽

Vol 24 (1) ◽

pp. 33-40 ◽

Cited By ~ 7

Author(s):

Miroslaw Wyczesany ◽

Jan Kaiser ◽

Anton M. L. Coenen

Keyword(s):

State Energy ◽

Emotional State ◽

Spectral Power ◽

Bipolar Affective Disorder ◽

Affective State ◽

Manic Episode ◽

High Energy ◽

Self Report ◽

Major Depressive ◽

High Tension

The study determines the associations between self-report of ongoing emotional state and EEG patterns. A group of 31 hospitalized patients were enrolled with three types of diagnosis: major depressive disorder, manic episode of bipolar affective disorder, and nonaffective patients. The Thayer ADACL checklist, which yields two subjective dimensions, was used for the assessment of affective state: Energy Tiredness (ET) and Tension Calmness (TC). Quantitative analysis of EEG was based on EEG spectral power and laterality coefficient (LC). Only the ET scale showed relationships with the laterality coefficient. The high-energy group showed right shift of activity in frontocentral and posterior areas visible in alpha and beta range, respectively. No effect of ET estimation on prefrontal asymmetry was observed. For the TC scale, an estimation of high tension was related to right prefrontal dominance and right posterior activation in beta1 band. Also, decrease of alpha2 power together with increase of beta2 power was observed over the entire scalp.

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Comprehensive Assessment of Compliance with Antimuscarinic Drug Treatment in the Case of Urge Urinary Incontinence of Older Patients

Current Aging Science ◽

10.2174/1874609808666161124143150 ◽

2017 ◽

Vol 10 (2) ◽

pp. 149-156

Author(s):

Kirill V. Kosilov ◽

Sergey A. Loparev ◽

Irina G. Kuzina ◽

Olga V. Shakirova ◽

Natalya S. Zhuravskaya ◽

...

Keyword(s):

Urinary Incontinence ◽

Drug Treatment ◽

Older Patients ◽

Urge Urinary Incontinence ◽

Comprehensive Assessment ◽

Assessment Of Compliance

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Trends in treatment for patients with depression in general practice in Norway, 2009–2015: nationwide registry-based cohort study (The Norwegian GP-DEP Study)

BMC Health Services Research ◽

10.1186/s12913-021-06712-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sabine Ruths ◽

Inger Haukenes ◽

Øystein Hetlevik ◽

Tone Smith-Sivertsen ◽

Stefan Hjørleifsson ◽

...

Keyword(s):

Mental Health ◽

Health Care ◽

General Practice ◽

Cohort Study ◽

Drug Treatment ◽

Time Trends ◽

Older Patients ◽

Antidepressant Drug ◽

Depression Care ◽

Patient Gender

Abstract Background Depression is highly prevalent, but knowledge is scarce as to whether increased public awareness and strengthened government focus on mental health have changed how general practitioners (GPs) help their depressed patients. This study aimed to examine national time trends in GP depression care and whether trends varied regarding patient gender, age, and comorbidity. Methods Nationwide registry-based cohort study, Norway. The study population comprised all residents aged 20 years or older with new depression diagnoses recorded in general practice, 2009–2015. We linked reimbursement claims data from all consultations in general practice for depression with information on demographics and antidepressant medication. The outcome was type(s) of GP depression care during 12 months from the date of diagnosis: (long) consultation, talking therapy, antidepressant drug treatment, sickness absence certification, and referral to secondary mental health care. Covariates were patient gender, age, and comorbidity. The data are presented as frequencies and tested with generalized linear models. Results We included 365,947 new depression diagnoses. Mean patient age was 44 years (SD = 16), 61.9 % were women, 41.2 % had comorbidity. From 2009 to 2015, proportions of patients receiving talking therapy (42.3–63.4 %), long consultations (56.4–71.8 %), and referral to secondary care (16.6–21.6 %) increased, while those receiving drug treatment (31.3–25.9 %) and sick-listing (58.1–50 %) decreased. The trends were different for gender (women had a greater increase in talking therapy and a smaller decrease in sick-listing, compared to men), age (working-aged patients had a smaller increase in talking therapy, a greater increase in long consultations, and a smaller decrease in antidepressant drug use, compared to older patients) and comorbidity (patients with mental comorbidity had a smaller increase in talking therapy and a greater increase in long consultations, compared to those with no comorbidity and somatic comorbidity). Conclusions The observed time trends in GP depression care towards increased provision of psychological treatment and less drug treatment and sick-listing were in the desired direction according to Norwegian health care policy. However, the large and persistent differences in treatment rates between working-aged and older patients needs further investigation.

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Mania with Bupropion: A Dose-Related Phenomenon?

Annals of Pharmacotherapy ◽

10.1345/aph.19313 ◽

2000 ◽

Vol 34 (5) ◽

pp. 619-621 ◽

Cited By ~ 7

Author(s):

Jessica L Goren ◽

Gary M Levin

Keyword(s):

Affective Disorder ◽

Bipolar Depression ◽

Bipolar Affective Disorder ◽

Antidepressant Drug ◽

Manic Episode ◽

Total Daily Dose ◽

High Dose ◽

Related Phenomenon ◽

Increased Risk ◽

Daily Dose

OBJECTIVE: To report a case in which bipolar depression was resistant to usual therapies, requiring dosages of bupropion >450 mg/d and to review the literature on mania associated with bupropion and propose a potential theory of a dose-related threshold associated with bupropion and mania. CASE SUMMARY: A 44-year-old white man with a 25-year history of bipolar affective disorder presented with depression resistant to usual therapies. Bupropion therapy was initiated and the dosage was titrated to 600 mg/d. After exceeding the maximum recommended daily dose (450 mg/d), he experienced a manic episode attrib uted to high-dose bupropion. DISCUSSION: Due to increased risk of seizures, current prescribing guidelines state that the total daily dose of bupropion is not to exceed 450 mg/d. Since bupropion is the agent least likely to cause a manic switch in bipolar disorder, this agent seemed a logical choice to treat the patient's depression. Due to a lack of response, the bupropion dosage was titrated to a maximum of 600 mg/d. Since the patient did not switch into mania until the dosage exceeded 450 mg/d, we speculate that this adverse reaction is a dose-related phenomenon. Scientific literature supports this theory. CONCLUSIONS: A switch into mania is a potential risk associated with antidepressant drug use in bipolar affective disorder. Bupropion is believed to be associated with a decreased risk compared with other antidepressant therapies. However, our case report as well as others support the theory that this decreased risk may be due to dosages not exceeding the recommended daily dose (450 mg/d). Doses of bupropion >450 mg/d should be used with caution in depressed patients with bipolar affective disorder.

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Lithium use in a patient on haemodialysis with bipolar affective disorder and lithium-induced nephropathy

BMJ Case Reports ◽

10.1136/bcr-2021-242841 ◽

2021 ◽

Vol 14 (7) ◽

pp. e242841

Author(s):

Sam Topp ◽

Emma Salisbury

Keyword(s):

Affective Disorder ◽

Bipolar Affective Disorder ◽

Manic Episode ◽

Dose Titration ◽

Dialysis Session ◽

Treatment Resistant ◽

History Of ◽

End Stage ◽

Level Monitoring

Lithium is an effective mood stabiliser used to treat bipolar affective disorder (BPAD); however, it can also adversely affect the kidneys, causing acute toxic effects, nephrogenic diabetes insipidus, chronic renal dysfunction and end-stage kidney disease (ESKD) in a minority of patients. We describe the case of a man with a 34-year history of BPAD type-1 and a 2-year history of ESKD secondary to lithium-induced nephropathy who experienced a manic relapse. He previously responded well to lithium but, following a deterioration in kidney function, was switched to olanzapine and sodium valproate. This precipitated a period of instability, which culminated in a treatment-resistant manic episode requiring hospital admission. After a multidisciplinary team discussion, lithium therapy was restarted and provided remission. This was achieved safely through a reduced dosing schedule of three times a week post dialysis, slow dose titration and blood level monitoring prior to each dialysis session.

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Fever of unknown origin in the elderly: nine years experience in China

Tropical Doctor ◽

10.1258/td.2007.070293 ◽

2008 ◽

Vol 38 (4) ◽

pp. 221-222 ◽

Cited By ~ 4

Author(s):

Minghua Zheng ◽

Hailong Lin ◽

Sheng Luo ◽

Lihua Xu ◽

Yanjun Zeng ◽

...

Keyword(s):

Retrospective Study ◽

Connective Tissue ◽

Connective Tissue Disease ◽

Older Patients ◽

Fever Of Unknown Origin ◽

Unknown Origin ◽

The Elderly ◽

Medical College ◽

Frequent Type ◽

Wenzhou Medical College

This is a retrospective study of older patients admitted to the First and Second Affiliated Hospitals of Wenzhou Medical College, China, with a diagnosis of fever of unknown origin. The study took place from January 1998 to December 2006 among 102 patients who fulfilled the criteria. Infections were responsible for 50 cases (49.1%), followed by no diagnosis in 27 (26.5%), miscellaneous in nine (8.8%), neoplasms in eight (7.8%) and connective tissue disease in another eight (7.8%). Mycobacterium TB was the most frequent type of infection diagnosed.

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Neurocysticercosis presenting as bipolar disorder: a case report

General Psychiatry ◽

10.1136/gpsych-2021-100663 ◽

2021 ◽

Vol 34 (6) ◽

pp. e100663

Author(s):

Surbhi Batra ◽

Sumit Kumar ◽

Lokesh Singh Shekhawat

Keyword(s):

Bipolar Disorder ◽

Case Report ◽

Depressive Symptoms ◽

Affective Disorder ◽

Postpartum Period ◽

Bipolar Affective Disorder ◽

Taenia Solium ◽

Manic Episode ◽

Symptoms And Signs ◽

Rule Out

Neurocysticercosis is the most common neuro-parasitosis caused by the larval stage of Taenia solium. The most common manifestations include seizures and hydrocephalus. Psychiatric abnormalities are relatively rare but depressive symptoms are frequent in patients with neurocysticercosis. However, mania as a presentation is relatively rare. Pregnancy and the postpartum period are relatively vulnerable times and they can lead to reactivation of existing neurocysterci lesions. We are discussing the case of a 23-year-old female patient with neurocysticercosis leading to the reactivation of lesions in the peripartum and postpartum period leading to bipolar affective disorder. Improvement in the patient was seen with a combination of antipsychotics, antihelmintics, antiepileptics and steroids, along with improved radiological signs of neurocysterci lesions. Although neurocysticercosis is a common illness, its prevalence presenting as a manic episode is merely 2.6% and, hence, missed easily. Therefore, it is important to rule out organic aetiology in patients even with a classic presentation of bipolar affective disorder and those having any other neurological symptoms and signs.

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Prognosis of older patients with low-grade glioma: A retrospective study

Integrative Cancer Science and Therapeutics ◽

10.15761/icst.1000255 ◽

2017 ◽

Vol 4 (5) ◽

Author(s):

Priya Kumthekar ◽

Vaibhav Patel ◽

Carly Bridge ◽

Alfred Rademaker ◽

Irene Helenowski ◽

...

Keyword(s):

Retrospective Study ◽

Older Patients ◽

Low Grade Glioma ◽

Low Grade

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Kluver-Bucy Syndrome in a Patient with Bipolar Affective Disorder

Journal of Lumbini Medical College ◽

10.22502/jlmc.v6i1.183 ◽

2018 ◽

Vol 6 (1) ◽

pp. 36-40

Author(s):

Madhur Basnet ◽

Luna Paudel ◽

Bikram Prasad Gajurel ◽

Nidesh Sapkota ◽

Raj Kumar Rauniyar

Keyword(s):

Rhesus Monkeys ◽

Dietary Habits ◽

Bipolar Affective Disorder ◽

Cerebral Atrophy ◽

Manic Episode ◽

Temporal Lobectomy ◽

Bipolar Illness ◽

Close Relatives ◽

Increased Activity ◽

Lobe Atrophy

Introduction: Kluver and Bucy described a behavioral syndrome in rhesus monkeys following bilateral temporal lobectomy which included psychic blindness, hyperorality, hypermetamorphosis, hypersexuality, and emotional unresponsiveness. Case report: A 44 years old right handed male of Indo-aryan origin, blacksmith by profession, had presented in manic phase of bipolar illness. He had hypersexuality, hypermetamorphosis, hyperorality, and altered dietary habits along with amnesia and fleeting misrecognition of even his close relatives. MRI of the patient showed mild cerebral atrophy with right temporal lobe atrophy. The patient was treated with lithium and olanzapine along with benzodiazepines. The symptoms resolved gradually with resolution of the manic phase. Patient had similar features in the previous manic episode as well that resolved with resolution of mania. Conclusion: The symptoms of Kluver-Bucy syndrome like increased libido, increased activity might be confused with that of mania. Other features of Kluver-Bucy syndrome and the overt hypersexuality could help identify it even during manic phase of bipolar illness.

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