scholarly journals The Association between Use of ICS and Psychiatric Symptoms in Patients with COPD—A Nationwide Cohort Study of 49,500 Patients

Biomedicines ◽  
2021 ◽  
Vol 9 (10) ◽  
pp. 1492
Author(s):  
Alexander Jordan ◽  
Pradeesh Sivapalan ◽  
Josefin Eklöf ◽  
Jakob B. Vestergaard ◽  
Howraman Meteran ◽  
...  
Keyword(s):  
Cohort Study ◽  
Side Effects ◽  
Psychiatric Symptoms ◽  
Psychiatric Hospitals ◽  
High Dose ◽  
Moderate Increase ◽  
High Exposure ◽  
Increased Risk ◽  
Antidepressant Use ◽  
Psychiatric Side Effects

Psychiatric side effects are well known from treatment with systemic corticosteroids. It is, however, unclear whether inhaled corticosteroids (ICS) have psychiatric side effects in patients with COPD. We conducted a nationwide cohort study in all Danish COPD outpatients who had respiratory medicine specialist-verified COPD, age ≥40 years, and no previous cancer. Prescription fillings of antidepressants and risk of admissions to psychiatric hospitals with either depression, anxiety or bipolar disorder were assessed by Cox proportional hazards models. We observed a dose-dependent increase in the risk of antidepressant-use with ICS cumulated dose (HR 1.05, 95% CI 1.03–1.07, p = 0.0472 with low ICS exposure, HR 1.10, 95% CI 1.08–1.12, p < 0.0001 with medium exposure, HR 1.15, 95% CI 1.11–1.15, p < 0.0001 with high exposure) as compared to no ICS exposure. We found a discrete increased risk of admission to psychiatric hospitals in the medium and high dose group (HR 1.00, 95% CI 0.98–1.03, p = 0.77 with low ICS exposure, HR 1.07, 95% CI 1.05–1.10, p < 0.0001 with medium exposure, HR 1.13, 95% CI 1.10–1.15, p < 0.0001 with high exposure). The association persisted when stratifying for prior antidepressant use. Thus, exposure to ICS was associated with a small to moderate increase in antidepressant-use and psychiatric admissions.

High on steroids: manische episode na gebruik van corticosteroïden

2021 ◽  
Author(s):  
K. DE QUEECKER ◽  
J. VANDENBERGHE
Keyword(s):  
Side Effects ◽  
Psychiatric Symptoms ◽  
Specific Treatment ◽  
Hospital Setting ◽  
General Medicine ◽  
Manic Episode ◽  
Significant Degree ◽  
Convincing Evidence ◽  
Increased Risk ◽  
Psychiatric Side Effects

High on steroids: manic episode after using corticosteroids This article describes a case of a severe manic episode with a patient using corticosteroids which were one of the precipitating factors. Since the first use of corticosteroids in medicine, psychiatric side effects as well as a myriad of somatic side effects have been known to occur. The neuropsychiatric side effects are situated within both the affective as well as the psychotic spectrum. While mostly mild and transient, these side effects can be severe, as glucocorticoids increase the risk of suicide to a significant degree. The risk of developing side effects is dose-dependent and a psychiatric history can be considered a risk factor. The HPA-axis and a potential inbalance between different glucocortoid receptors play a role in causing these side effects. While convincing evidence exists for the increased risk of psychiatric symptoms caused by systemic use of corticosteroids, far less scientific literature exists regarding the specific treatment. In addition, the case in this article demonstrates how psychiatric symptoms can severely interfere with the course and treatment of a pneumonia. Such cases remain a challenge in a hospital setting where departments (psychiatry or general medicine) are never completely tailored to the needs of these patients who thereby tend to fall between two stools.

Celecoxib, ibuprofen, and indomethacin alleviate depression-like behavior induced by interferon-alfa in mice

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Azadeh Mesripour ◽  
Shahrzad Shahnooshi ◽  
Valiollah Hajhashemi
Keyword(s):  
Side Effects ◽  
Forced Swimming Test ◽  
Interferon Alfa ◽  
Interferon Α ◽  
High Dose ◽  
Antidepressant Effects ◽  
Immobility Time ◽  
Inflammatory Drugs ◽  
Swimming Test ◽  
Psychiatric Side Effects

AbstractBackgroundInterferon-α (IFNα) therapy causes psychiatric side effects, including depression that may result in poor compliance of therapy. It is important to find alternative therapies for the prevention of IFNα induced depression. Non-steroidal anti-inflammatory drugs (NSAIDs) have been useful in depressive disorder. Therefore the effects of celecoxib, ibuprofen, and indomethacin were evaluated following IFNα-induced depression in mice.MethodsMale albino mice weighing 26 ± 2 g were used. Depression was induced by IFNα (16 × 105 IU/kg, SC) for six consecutive days. Animals were first subject to the locomotor test, then the splash test and finally the forced swimming test (FST) on the 7th day. The NSAIDs were administered (IP) either one single dose before the test, or simultaneously with IFNα.Resultslocomotor activity was only impaired by ibuprofen high dose (75 mg/kg), thus it was not further evaluated. Following IFNα therapy depression-like behaviors were observed; significant changes during the splash test (grooming time 24 ± 7 sec vs. control 63 ± 7 sec), the FST (immobility time 166  ± 15 sec vs. control 128  ± 6 sec), and sucrose preference reduced to 64 ± 0.8%. The NSAIDs noticeably reduced the immobility time in FST, while grooming time was increased. Celecoxib and indomethacin single doses were effective while ibuprofen showed better antidepressant effects when it was administered along with IFNα.ConclusionsThe NSAIDs were able to prevent IFNα induced depression in mice. NSAIDs administration with IFNα does not interfere with clinical benefit effects of IFNα and they could also be useful to prevent IFNα psychiatric side effects, thus further clinical trials are suggested.

scholarly journals Depression as a risk factor for the development of rheumatoid arthritis: a population-based cohort study

RMD Open ◽  
2018 ◽  
Vol 4 (2) ◽  
pp. e000670 ◽  
Author(s):  
Isabelle A Vallerand ◽  
Ryan T Lewinson ◽  
Alexandra D Frolkis ◽  
Mark W Lowerison ◽  
Gilaad G Kaplan ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Cohort Study ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Future Research ◽  
Health Improvement ◽  
Proportional Hazards Models ◽  
Cox Proportional Hazards Models ◽  
Increased Risk ◽  
Antidepressant Use

ObjectivesMajor depressive disorder (MDD) is associated with increased levels of systemic proinflammatory cytokines, including tumour necrosis factor alpha. As these cytokines are pathogenic in autoimmune diseases such as rheumatoid arthritis (RA), our aim was to explore on a population-level whether MDD increases the risk of developing RA.MethodsA retrospective cohort study was conducted using The Health Improvement Network (THIN) database (from 1986 to 2012). Observation time was recorded for both the MDD and referent cohorts until patients developed RA or were censored. Cox proportional hazards models were used to determine the risk of developing RA among patients with MDD, accounting for age, sex, medical comorbidities, smoking, body mass index and antidepressant use.ResultsA cohort of 403 932 patients with MDD and a referent cohort of 5 339 399 patients without MDD were identified in THIN. Cox proportional hazards models revealed a 31% increased risk of developing RA among those with MDD in an unadjusted model (HR=1.31, 95% CI 1.25 to 1.36, p<0.0001). When adjusting for all covariates, the risk remained significantly increased among those with MDD (HR=1.38, 95% CI 1.31 to 1.46, p<0.0001). Antidepressant use demonstrated a confounding effect that was protective on the association between MDD and RA.ConclusionMDD increased the risk of developing RA by 38%, and antidepressants may decrease this risk in these patients. Future research is necessary to confirm the underlying mechanism of MDD on the pathogenesis of RA.

scholarly journals Antidepressant Use in Siblings of Children With Cancer: A Danish Population-Based Cohort Study

2020 ◽  
Vol 4 (5) ◽  
Author(s):  
Lasse Wegener Lund ◽  
Jeanette Falck Winther ◽  
Luise Cederkvist ◽  
Catherine Rechnitzer ◽  
Susanne Oksbjerg Dalton ◽  
...  
Keyword(s):  
Cohort Study ◽  
Mental Health Problems ◽  
Proportional Hazards Model ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Cancer Type ◽  
Children With Cancer ◽  
Increased Risk ◽  
Antidepressant Use

Abstract Siblings of children with cancer experience severe stress early in life. Most studies of mental health problems in these siblings are limited by being small, cross-sectional, or self-reporting. In a population-based cohort study, we investigated the risk for antidepressant use by linking several nationwide, population-based registries comparing 6644 siblings of children diagnosed with cancer from 1991-2009 with 128 436 population-based sibling comparisons using the Cox proportional hazards model. Irrespective of cancer type, no increased risk of antidepressant use in siblings of children with cancer was found (hazard ratio = 1.00, 95% confidence interval = 0.91 to 1.11). However, data suggested that siblings being young at cancer diagnosis had an increased risk (2-sided Ptrend = .01). Interaction analyses showed no modifying effect of parental socioeconomic position or antidepressant use. Findings from this study with a very low risk of bias are reassuring and important for families facing childhood cancer and for clinicians counseling these families.

Increased risk of antidepressant use in childhood cancer survivors: A Danish population-based cohort study

2015 ◽  
Vol 51 (5) ◽  
pp. 675-684 ◽  
Author(s):  
Lasse Wegener Lund ◽  
J.F. Winther ◽  
L. Cederkvist ◽  
K.K. Andersen ◽  
S.O. Dalton ◽  
...  
Keyword(s):  
Cohort Study ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Childhood Cancer Survivors ◽  
Population Based ◽  
Danish Population ◽  
Increased Risk ◽  
Antidepressant Use

scholarly journals Begleiterkrankungen oder Folgeerkrankungen – das Phänomen der Komorbidität bei autoimmun blasenbildenden Dermatosen

2021 ◽  
pp. 1-3
Author(s):  
Michael Sticherling
Keyword(s):  
Mental Health ◽  
Cohort Study ◽  
Psychiatric Disorders ◽  
Psychiatric Symptoms ◽  
Integrated Approach ◽  
Hazard Ratios ◽  
Increased Risk ◽  
Bidirectional Association ◽  
Broad Array ◽  
Subsequent Onset

<b>Background:</b> Bullous pemphigoid (BP) is an autoimmune blistering skin disease that takes a profound physical and mental toll on those affected. The aim of the study was to investigate the bidirectional association between BP and all bullous disorders (ABD) with a broad array of psychiatric disorders, exploring the influence of prescribed medications. <b>Methods:</b> This nationwide, register-based cohort study encompassed 6,470,450 individuals born in Denmark and alive from 1994 to 2016. The hazard ratios (HRs) of a subsequent psychiatric disorder in patients with BP/ABD and the reverse exposure and outcome were evaluated. <b>Results:</b> Several psychiatric disorders were associated with increased risk of subsequent BP (4.18-fold for intellectual disorders, 2.32-fold for substance use disorders, 2.01-fold for schizophrenia and personality disorders, 1.92–1.85–1.49-fold increased risk for organic disorders, neurotic and mood disorders), independent of psychiatric medications. The association between BP and subsequent psychiatric disorders was not significant after adjusting for BP medications, except for organic disorders (HR 1.27, CI 1.04–1.54). Similar results emerged with ABD. <b>Summary:</b> Psychiatric disorders increase the risk of a subsequent diagnosis of BP/ABD independent of medications, whereas medications used for the treatment of BP/ABD appear to account for the subsequent onset of psychiatric disorders. Clinically, an integrated approach attending to both dermatological and psychiatric symptoms is recommended, and dermatologists should remain vigilant for early symptoms of psychiatric disorders to decrease mental health comorbidity.

scholarly journals High dose antipsychotic treatment monitoring audit

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S348-S348
Author(s):  
Jake Scott ◽  
Jose Belda
Keyword(s):  
Side Effects ◽  
Physical Health ◽  
Health Monitoring ◽  
Clinical Benefit ◽  
Health Assessment ◽  
Antipsychotic Treatment ◽  
High Dose ◽  
Health Checks ◽  
Increased Risk ◽  
Multi Disciplinary Team

AimsTo quantify how many patients were prescribed high dose antipsychotic treatment (HDAT) and establish whether guidance for monitoring HDAT was being followed in an Assertive Outreach Team.BackgroundSevere mental health disorders are associated with significant premature mortality, predominantly due to physical health conditions. Antipsychotic medications are associated with side effects, including metabolic syndrome and QT prolongation, which increase the risk of serious physical illness. HDAT is defined as when the total dose of antipsychotics prescribed exceeds 100% of the maximum BNF dose, if each dose is expressed a percentage of its maximum dose. There is limited evidence of clinical benefit with HDAT but an increased risk of side effects. Patients prescribed HDAT should therefore be monitored for side effects and clinical benefit. Sussex Partnership NHS Foundation Trust developed a form specifically for this purpose, to be completed in addition to a physical health assessment.MethodAll patients on caseload were audited using the electronic notes. Current inpatients were excluded, as inpatient HDAT monitoring forms are attached to paper drug charts and therefore were not available for review.ResultA total of 61 patients were audited. Nine were excluded due to being inpatients. 16 were on community treatment orders and 26 were prescribed a long-acting antipsychotic injection. 10 were prescribed clozapine. The median number of medications prescribed was one. Four patients were prescribed HDAT ranging from 117-150% of the maximum BNF dose. Of these four, one had a HDAT form but this was out of date. 39 of 52 (75%) patients audited had had a physical health assessment in the past 12 months. Two of the 13 missing a physical health assessment were on HDAT.ConclusionPhysical health monitoring should be carried out for all patients on antipsychotics, but is particularly important for patients on HDAT. This audit identified a problem in both general physical health checks and HDAT monitoring. On discussion with the multi-disciplinary team a number of barriers to appropriate physical health monitoring were identified. There was a lack of awareness within the multi-disciplinary team that patients were receiving HDAT and regarding the implications for side effects. A reliable system to highlight the need for physical health checks was also missing and the team did not have sufficient equipment to perform the necessary checks. Identifying these barriers should enable improvements in physical health and HDAT monitoring which can be re-audited.

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