General hospital psychiatry最新文献

英文中文

Risk of falls associated with non-GABAergic hypnotics and benzodiazepines in hospitalized patients

IF 4.1 2区医学 Q1 PSYCHIATRY

General hospital psychiatry

Pub Date : 2025-02-13 DOI: 10.1016/j.genhosppsych.2025.02.004

Kazuhiro Shishida , Waka Nishimura , Yutaro Shimomura , Masayuki Murayama , Kimio Yoshimura , Hiroyuki Uchida , Masaru Mimura , Hiroyoshi Takeuchi

Objective

Non-GABAergic hypnotics introduced into clinical practice within the last two decades are pharmacologically presumed to have a lower risk of falls, but clinical investigations are scarce. We aimed to evaluate the risk of falls associated with different classes of hypnotics, namely benzodiazepines, ramelteon, suvorexant, and trazodone, in hospitalized individuals at a general hospital.

Method

In this retrospective cohort study, data on the incidence of falls, hypnotic use, age, sex, body mass index (BMI), activities of daily living (ADL) score, presence of surgery, emergency admission, and ambulance use were collected for hospitalized patients aged 20 years or older who had been discharged from a tertiary general hospital in Japan between April 1, 2014, and March 31, 2019. The Cox proportional hazards model was used to examine factors associated with falls, adjusting for other demographics as covariates.

Results

Among 28,029 patients, 383 falls occurred in 322 patients. Ramelteon or suvorexant was not associated with an elevated incidence of falls (adjusted hazard ratio [aHR], 0.78; 95 % CI, 0.34 to 1.81 and 0.44; 95 % CI, 0.13–1.46, respectively), in contrast to benzodiazepines (aHR, 2.17; 95 % CI 1.67–2.83) or trazodone (aHR, 1.96; 95 % CI 1.25–3.07). Advanced age, lower BMI, wheelchair dependency, non-surgical status, absence of emergency admissions, and ambulance use were also associated with the elevated incidence of falls.

Conclusions

In hospitalized patients at general hospitals, ramelteon and suvorexant may not increase the risk of falls, while the use of benzodiazepines and trazodone requires careful attention to minimize this risk.

{"title":"Risk of falls associated with non-GABAergic hypnotics and benzodiazepines in hospitalized patients","authors":"Kazuhiro Shishida , Waka Nishimura , Yutaro Shimomura , Masayuki Murayama , Kimio Yoshimura , Hiroyuki Uchida , Masaru Mimura , Hiroyoshi Takeuchi","doi":"10.1016/j.genhosppsych.2025.02.004","DOIUrl":"10.1016/j.genhosppsych.2025.02.004","url":null,"abstract":"<div><h3>Objective</h3><div>Non-GABAergic hypnotics introduced into clinical practice within the last two decades are pharmacologically presumed to have a lower risk of falls, but clinical investigations are scarce. We aimed to evaluate the risk of falls associated with different classes of hypnotics, namely benzodiazepines, ramelteon, suvorexant, and trazodone, in hospitalized individuals at a general hospital.</div></div><div><h3>Method</h3><div>In this retrospective cohort study, data on the incidence of falls, hypnotic use, age, sex, body mass index (BMI), activities of daily living (ADL) score, presence of surgery, emergency admission, and ambulance use were collected for hospitalized patients aged 20 years or older who had been discharged from a tertiary general hospital in Japan between April 1, 2014, and March 31, 2019. The Cox proportional hazards model was used to examine factors associated with falls, adjusting for other demographics as covariates.</div></div><div><h3>Results</h3><div>Among 28,029 patients, 383 falls occurred in 322 patients. Ramelteon or suvorexant was not associated with an elevated incidence of falls (adjusted hazard ratio [aHR], 0.78; 95 % CI, 0.34 to 1.81 and 0.44; 95 % CI, 0.13–1.46, respectively), in contrast to benzodiazepines (aHR, 2.17; 95 % CI 1.67–2.83) or trazodone (aHR, 1.96; 95 % CI 1.25–3.07). Advanced age, lower BMI, wheelchair dependency, non-surgical status, absence of emergency admissions, and ambulance use were also associated with the elevated incidence of falls.</div></div><div><h3>Conclusions</h3><div>In hospitalized patients at general hospitals, ramelteon and suvorexant may not increase the risk of falls, while the use of benzodiazepines and trazodone requires careful attention to minimize this risk.</div></div>","PeriodicalId":12517,"journal":{"name":"General hospital psychiatry","volume":"94 ","pages":"Pages 10-15"},"PeriodicalIF":4.1,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143422465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The longitudinal association of optimism with quality of life after percutaneous coronary intervention for coronary heart disease; The THORESCI study

IF 4.1 2区医学 Q1 PSYCHIATRY

General hospital psychiatry

Pub Date : 2025-02-12 DOI: 10.1016/j.genhosppsych.2025.02.008

Nina Kupper , Nienke Post , Willem J. Kop , Jos Widdershoven

Background

Positive psychological factors such as optimism are predictive of favorable clinical outcomes in patients with cardiac disease. Evidence suggests that trait optimism can vary over time, especially after a coronary event. We therefore examined whether the level and change in optimism across the one-year time period after percutaneous coronary intervention (PCI) were associated with changes in quality of life (QoL) over time. The analyses were adjusted for negative psychological functioning and health behavior adherence as potential explanatory factors.

Methods

Patients who underwent PCI (n = 1759, 21 % female, mean age = 64 ± 10 years) filled out a psychological survey including positive (optimism; LOT-R) and negative psychological factors (depression (PHQ9) and anxiety (GAD7)), QoL (WHOQOL-BREF), and health behavior adherence (MOS-GAS) at inclusion and one year later (n = 1474). Data were analyzed using hierarchical linear mixed modeling with time-varying predictors and covariates.

Results

Optimism levels increased from baseline (Mean_BL = 7.6 (SD = 2.1) to 1-year follow-up in 43 % of the patients, whereas optimism decreased in 36 %; r_intraclass = 0.53). Optimism was associated with a higher level of overall QoL (B = 1.96, se = 0.09, p < .001) and more positive 1-year change in QoL (B = 0.55, se = 0.09, p < .001), adjusting for demographic and clinical covariates, with similar findings for all subdomains. Adding depression and anxiety (both significant negatively correlated with of QoL) explained part of the associations of optimism with physical, psychological and environmental QoL, but not with social QoL. Health behavior adherence was significantly correlated with most QoL components, but adherence did not affect the association between optimism and QoL.

Conclusion

These data indicate marked individual differences in the magnitude of changes in optimism following PCI. Both higher levels and increases in optimism were associated with higher and improving QoL. Depression and anxiety, but not health behavior adherence, explained part of this relationship. Optimism might be an important psychological factor to address in cardiac rehabilitation.

{"title":"The longitudinal association of optimism with quality of life after percutaneous coronary intervention for coronary heart disease; The THORESCI study","authors":"Nina Kupper , Nienke Post , Willem J. Kop , Jos Widdershoven","doi":"10.1016/j.genhosppsych.2025.02.008","DOIUrl":"10.1016/j.genhosppsych.2025.02.008","url":null,"abstract":"<div><h3>Background</h3><div>Positive psychological factors such as optimism are predictive of favorable clinical outcomes in patients with cardiac disease. Evidence suggests that trait optimism can vary over time, especially after a coronary event. We therefore examined whether the level and change in optimism across the one-year time period after percutaneous coronary intervention (PCI) were associated with changes in quality of life (QoL) over time. The analyses were adjusted for negative psychological functioning and health behavior adherence as potential explanatory factors.</div></div><div><h3>Methods</h3><div>Patients who underwent PCI (<em>n</em> = 1759, 21 % female, mean age = 64 ± 10 years) filled out a psychological survey including positive (optimism; LOT-R) and negative psychological factors (depression (PHQ9) and anxiety (GAD7)), QoL (WHOQOL-BREF), and health behavior adherence (MOS-GAS) at inclusion and one year later (<em>n</em> = 1474). Data were analyzed using hierarchical linear mixed modeling with time-varying predictors and covariates.</div></div><div><h3>Results</h3><div>Optimism levels increased from baseline (Mean<sub>BL</sub> = 7.6 (SD = 2.1) to 1-year follow-up in 43 % of the patients, whereas optimism decreased in 36 %; <em>r</em><sub>intraclass</sub> = 0.53). Optimism was associated with a higher level of overall QoL (B = 1.96, se = 0.09, <em>p</em> < .001) and more positive 1-year change in QoL (B = 0.55, se = 0.09, p < .001), adjusting for demographic and clinical covariates, with similar findings for all subdomains. Adding depression and anxiety (both significant negatively correlated with of QoL) explained part of the associations of optimism with physical, psychological and environmental QoL, but not with social QoL. Health behavior adherence was significantly correlated with most QoL components, but adherence did not affect the association between optimism and QoL.</div></div><div><h3>Conclusion</h3><div>These data indicate marked individual differences in the magnitude of changes in optimism following PCI. Both higher levels and increases in optimism were associated with higher and improving QoL. Depression and anxiety, but not health behavior adherence, explained part of this relationship. Optimism might be an important psychological factor to address in cardiac rehabilitation.</div></div>","PeriodicalId":12517,"journal":{"name":"General hospital psychiatry","volume":"94 ","pages":"Pages 1-9"},"PeriodicalIF":4.1,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143422464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Transforming primary care with transdiagnostic approaches: The future of mental health treatment through technology

IF 4.1 2区医学 Q1 PSYCHIATRY

General hospital psychiatry

Pub Date : 2025-02-10 DOI: 10.1016/j.genhosppsych.2025.02.007

Dwi Sri Rahayu , Erfan Ramadhani , Nila Zaimatus Septiana , Palasara Brahmani Laras , Rosalia Dewi Nawantara , Laelatul Arofah

引用次数: 0

Transforming mental health: The impact of sensory substitution technologies on suicide ideation in hearing-impaired individuals

IF 4.1 2区医学 Q1 PSYCHIATRY

General hospital psychiatry

Pub Date : 2025-02-08 DOI: 10.1016/j.genhosppsych.2025.02.005

Nila Zaimatus Septiana , Luthfi Atmasari , Dwi Sri Rahayu , Laelatul Arofah , Rosalia Dewi Nawantara

引用次数: 0

A systematic review of randomized controlled trials in a general practice setting aiming to reduce excess all-cause and enhance cardiovascular health in patients with severe mental illness

IF 4.1 2区医学 Q1 PSYCHIATRY

General hospital psychiatry

Pub Date : 2025-02-07 DOI: 10.1016/j.genhosppsych.2025.01.013

Kristina Langkilde , Maria Haahr Nielsen , Sofie Damgaard, Anne Møller, Maarten Pieter Rozing

Objective

People with severe mental illness (SMI) have a reduced life expectancy, primarily due to chronic somatic diseases like cardiovascular disorders. Integrated care in general practice addressing mental and physical health may reduce excess mortality in this population. This review assessed the effectiveness of collaborative care, general integrated care, and physical health interventions in reducing overall mortality in patients with SMI. Secondary outcomes included disease-specific mortality, cardiovascular health indicators, and health-related quality of life.

Methods

We searched PubMed, PsycINFO, Cochrane Library, and Embase for randomized controlled trials published before April 24, 2024. Eligible studies focused on integrated care interventions targeting somatic health in patients with SMI. Two reviewers independently conducted data extraction and risk of bias assessment. The study was registered with PROSPERO (CRD42022328464).

Results

Of 2904 identified publications, 17 were included (covering 13 studies). Seven studies reported mortality data, with one showing reduced mortality in patients with major depressive disorder receiving collaborative care. No studies examined disease-specific mortality. Nine studies assessed cardiovascular outcomes, with three reporting reduced cardiovascular risk in collaborative care interventions simultaneously targeting depression and cardiovascular factors. Seven studies reported on quality of life, with three finding improvements. Study quality was rated moderate to high.

Conclusion

We found low-certainty evidence that collaborative care reduces mortality in depression. There was moderate evidence that collaborative care models, simultaneously addressing mental and cardiovascular health could potentially improve cardiovascular health in depression. The limited number of studies and their focus on depression limit the generalizability of these findings to other SMIs.

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引用次数: 0

Mental health in the first year after ICU-treated sepsis: Analysis of administrative diagnoses in German health claims data

IF 4.1 2区医学 Q1 PSYCHIATRY

General hospital psychiatry

Pub Date : 2025-02-07 DOI: 10.1016/j.genhosppsych.2025.02.001

S. Sell , C. Fleischmann-Struzek , M. Spoden , J. Rosendahl

Objective

We aimed to quantify the (co-)occurrence of and risk factors for mental health impairments (MHI) in a cohort of sepsis survivors within 12 months after ICU stay in Germany.

Method

Population-based cohort study using nationwide de-identified health claims data of the German AOK health insurance. Patients with sepsis hospitalization and ICU treatment were identified by ICD-10 and procedural codes. Among 12-months survivors, we assessed new and prevalent MHI by ICD-10 diagnoses in the outpatient and inpatient health sector. Risk factors for MHI were assessed by multiple logistic regression analyses.

Results

Of 21,980 sepsis survivors, 54.8 % were diagnosed with any MHI in the 12 months post-discharge. 25.4 % of patients without pre-existing MHI had a new MHI diagnosis. Co-occurrence of MHI was common. Pre-existing depression, anxiety disorder, PTSD, substance use disorder and sleep disorder significantly increased the odds for a diagnosis of any MHI post-sepsis between six- and nine-fold, while treatment-related factors had no influence.

Conclusions

MHI is common among sepsis survivors, particularly in those affected by any pre-existing psychological diagnoses. Early assessment of pre-existing psychopathology might help to identify patients at risk for prevention or treatment interventions.

{"title":"Mental health in the first year after ICU-treated sepsis: Analysis of administrative diagnoses in German health claims data","authors":"S. Sell , C. Fleischmann-Struzek , M. Spoden , J. Rosendahl","doi":"10.1016/j.genhosppsych.2025.02.001","DOIUrl":"10.1016/j.genhosppsych.2025.02.001","url":null,"abstract":"<div><h3>Objective</h3><div>We aimed to quantify the (co-)occurrence of and risk factors for mental health impairments (MHI) in a cohort of sepsis survivors within 12 months after ICU stay in Germany.</div></div><div><h3>Method</h3><div>Population-based cohort study using nationwide de-identified health claims data of the German AOK health insurance. Patients with sepsis hospitalization and ICU treatment were identified by ICD-10 and procedural codes. Among 12-months survivors, we assessed new and prevalent MHI by ICD-10 diagnoses in the outpatient and inpatient health sector. Risk factors for MHI were assessed by multiple logistic regression analyses.</div></div><div><h3>Results</h3><div>Of 21,980 sepsis survivors, 54.8 % were diagnosed with any MHI in the 12 months post-discharge. 25.4 % of patients without pre-existing MHI had a new MHI diagnosis. Co-occurrence of MHI was common. Pre-existing depression, anxiety disorder, PTSD, substance use disorder and sleep disorder significantly increased the odds for a diagnosis of any MHI post-sepsis between six- and nine-fold, while treatment-related factors had no influence.</div></div><div><h3>Conclusions</h3><div>MHI is common among sepsis survivors, particularly in those affected by any pre-existing psychological diagnoses. Early assessment of pre-existing psychopathology might help to identify patients at risk for prevention or treatment interventions.</div></div>","PeriodicalId":12517,"journal":{"name":"General hospital psychiatry","volume":"93 ","pages":"Pages 109-115"},"PeriodicalIF":4.1,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143372861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The reliability and validity of the Chinese version of premenstrual dysphoric disorder questionnaire for DSM-5

IF 4.1 2区医学 Q1 PSYCHIATRY

General hospital psychiatry

Pub Date : 2025-02-07 DOI: 10.1016/j.genhosppsych.2025.01.021

Shanyi Huang , Qiao Zhang , Leire Aperribai , Itziar Alonso-Arbiol , Nekane Balluerka , Ying Chen , Yuecheng Wang , Yuqun Zhang

Objective

Premenstrual dysphoric disorder (PMDD) seriously affects women's work and life, and early screening and diagnosis of PMDD can improve the quality of life of potential PMDD patients. The Premenstrual Dysphoric Disorder Questionnaire for DSM-5 (CTDP-DSM-5) is a validated screening tool for PMDD based on the DSM-5. This study intends to conduct reliability testing and validity evaluation of the scale after translation and revision in Chinese women.

Methods

669 Chinese female college students were evaluated by a set of questionnaires including the Chinese version of CTDP-DSM-5 (CTDP-C), Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 (GAD-7) and Premenstrual Symptoms Screening Tool (PSST).

Results

CTDP-C is a bi-dimensional screening instrument with 25 items. The factor structure of the CTDP-C fits well to the factor model of the original Spanish version (CFI = 0.957; TLI = 0.953; RMSEA = 0.036; χ² = 5983.585, df = 300, p < 0.0001). The McDonald's omega reliability index obtained in this study was good (0.8) for both dimensions. In terms of convergent validity, the CTDP-C is significantly positively correlated with PSST (r = 0.533, p < 0.01). Furthermore, the instrument correlates positively with depression and anxiety. Finally, the CTDP-C scores can sensitively differentiate depressed from non-depressed patients (Cohen's d = 0.72). Similarly, sensitively differentiated anxious from non-anxious patients (Cohen's d = 0.80).

Conclusions

CTDP-C has good validity and reliability and it is an effective screening tool to identify Chinese patients with PMDD among college students, providing a basis for early detection, early diagnosis and early treatment of PMDD.

{"title":"The reliability and validity of the Chinese version of premenstrual dysphoric disorder questionnaire for DSM-5","authors":"Shanyi Huang , Qiao Zhang , Leire Aperribai , Itziar Alonso-Arbiol , Nekane Balluerka , Ying Chen , Yuecheng Wang , Yuqun Zhang","doi":"10.1016/j.genhosppsych.2025.01.021","DOIUrl":"10.1016/j.genhosppsych.2025.01.021","url":null,"abstract":"<div><h3>Objective</h3><div>Premenstrual dysphoric disorder (PMDD) seriously affects women's work and life, and early screening and diagnosis of PMDD can improve the quality of life of potential PMDD patients. The Premenstrual Dysphoric Disorder Questionnaire for DSM-5 (CTDP-DSM-5) is a validated screening tool for PMDD based on the DSM-5. This study intends to conduct reliability testing and validity evaluation of the scale after translation and revision in Chinese women.</div></div><div><h3>Methods</h3><div>669 Chinese female college students were evaluated by a set of questionnaires including the Chinese version of CTDP-DSM-5 (CTDP-C), Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 (GAD-7) and Premenstrual Symptoms Screening Tool (PSST).</div></div><div><h3>Results</h3><div>CTDP-C is a bi-dimensional screening instrument with 25 items. The factor structure of the CTDP-C fits well to the factor model of the original Spanish version (CFI = 0.957; TLI = 0.953; RMSEA = 0.036; <em>χ</em><sup><em>2</em></sup> = 5983.585, <em>df</em> = 300, <em>p</em> < 0.0001). The McDonald's omega reliability index obtained in this study was good (0.8) for both dimensions. In terms of convergent validity, the CTDP-C is significantly positively correlated with PSST (<em>r</em> = 0.533, <em>p</em> < 0.01). Furthermore, the instrument correlates positively with depression and anxiety. Finally, the CTDP-C scores can sensitively differentiate depressed from non-depressed patients (<em>Cohen's d</em> = 0.72). Similarly, sensitively differentiated anxious from non-anxious patients (<em>Cohen's d</em> = 0.80).</div></div><div><h3>Conclusions</h3><div>CTDP-C has good validity and reliability and it is an effective screening tool to identify Chinese patients with PMDD among college students, providing a basis for early detection, early diagnosis and early treatment of PMDD.</div></div>","PeriodicalId":12517,"journal":{"name":"General hospital psychiatry","volume":"93 ","pages":"Pages 122-126"},"PeriodicalIF":4.1,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143395435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Alcohol use disorder and initiation of oral anticoagulant therapy in patients with atrial fibrillation: A nationwide cohort study 心房颤动患者的酒精使用障碍与口服抗凝疗法的启动：一项全国性队列研究

IF 4.1 2区医学 Q1 PSYCHIATRY

General hospital psychiatry

Pub Date : 2025-02-04 DOI: 10.1016/j.genhosppsych.2025.01.017

Miika Vanhanen , Jussi Jaakkola , Juhani K.E. Airaksinen , Olli Halminen , Jukka Putaala , Pirjo Mustonen , Jari Haukka , Juha Hartikainen , Alex Luojus , Mikko Niemi , Miika Linna , Mika Lehto , Konsta Teppo

Objective

Patients with alcohol use disorders (AUD) often receive inferior care for somatic comorbidities. Our objective was to explore whether AUDs influence oral anticoagulant (OAC) initiation for stroke prevention among atrial fibrillation (AF) patients, using a nationwide dataset to assess treatment disparities.

Methods

The Finnish AntiCoagulation in Atrial Fibrillation registry includes data on all 229,565 patients diagnosed with incident AF in Finland during 2007–2018, identified from national registries covering all levels of care. The main outcome was OAC initiation compared between patients with and without AUD.

Results

The patients' mean age was 72.7 years, 50 % were female, 85.0 % were eligible for OAC therapy (CHA₂DS₂-VA score ≥ 1), and 4.7 % had AUD. OAC therapy was initiated in a smaller proportion of patients with AUD compared to those without (52.5 % vs. 71.4 %, p < 0.001). This disparity remained significant even after adjusting for comorbidities, socioeconomic status, and laboratory values influencing OAC initiation (adjusted hazard ratio [HR] 0.68; 95 % confidence interval [0.66–0.71]). The absolute difference in OAC initiation between groups stayed consistent at approximately 20 % throughout the study period. Interaction analyses indicated that the association between AUD and lower OAC initiation was stronger in patients with lower income, lower educational attainment, and lower thrombocyte levels, but there was no significant interaction with sex, bleeding history, or hemoglobin levels.

Conclusions

AUDs are associated with a significantly lower rate of OAC initiation even after accounting for comorbidities that influence OAC initiation.

{"title":"Alcohol use disorder and initiation of oral anticoagulant therapy in patients with atrial fibrillation: A nationwide cohort study","authors":"Miika Vanhanen , Jussi Jaakkola , Juhani K.E. Airaksinen , Olli Halminen , Jukka Putaala , Pirjo Mustonen , Jari Haukka , Juha Hartikainen , Alex Luojus , Mikko Niemi , Miika Linna , Mika Lehto , Konsta Teppo","doi":"10.1016/j.genhosppsych.2025.01.017","DOIUrl":"10.1016/j.genhosppsych.2025.01.017","url":null,"abstract":"<div><h3>Objective</h3><div>Patients with alcohol use disorders (AUD) often receive inferior care for somatic comorbidities. Our objective was to explore whether AUDs influence oral anticoagulant (OAC) initiation for stroke prevention among atrial fibrillation (AF) patients, using a nationwide dataset to assess treatment disparities.</div></div><div><h3>Methods</h3><div>The Finnish AntiCoagulation in Atrial Fibrillation registry includes data on all 229,565 patients diagnosed with incident AF in Finland during 2007–2018, identified from national registries covering all levels of care. The main outcome was OAC initiation compared between patients with and without AUD.</div></div><div><h3>Results</h3><div>The patients' mean age was 72.7 years, 50 % were female, 85.0 % were eligible for OAC therapy (CHA<sub>2</sub>DS<sub>2</sub>-VA score ≥ 1), and 4.7 % had AUD. OAC therapy was initiated in a smaller proportion of patients with AUD compared to those without (52.5 % vs. 71.4 %, <em>p</em> < 0.001). This disparity remained significant even after adjusting for comorbidities, socioeconomic status, and laboratory values influencing OAC initiation (adjusted hazard ratio [HR] 0.68; 95 % confidence interval [0.66–0.71]). The absolute difference in OAC initiation between groups stayed consistent at approximately 20 % throughout the study period. Interaction analyses indicated that the association between AUD and lower OAC initiation was stronger in patients with lower income, lower educational attainment, and lower thrombocyte levels, but there was no significant interaction with sex, bleeding history, or hemoglobin levels.</div></div><div><h3>Conclusions</h3><div>AUDs are associated with a significantly lower rate of OAC initiation even after accounting for comorbidities that influence OAC initiation.</div></div>","PeriodicalId":12517,"journal":{"name":"General hospital psychiatry","volume":"93 ","pages":"Pages 116-121"},"PeriodicalIF":4.1,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143387288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Strategies to safeguard psychiatric units in general hospitals: Overcoming closure risks for community support

IF 4.1 2区医学 Q1 PSYCHIATRY

General hospital psychiatry

Pub Date : 2025-01-31 DOI: 10.1016/j.genhosppsych.2025.01.014

Michitaka Funayama , Fumi Maruyama , Shigeru Nohara , Naoko Satake , Shigeki Sato , Hiraki Koishikawa , Ken Wada , Yusuke Hasegawa , On Kato , Takaki Akahane , Hisashi Wada , Naohisa Tsujino , Masayuki Noguchi , Tomoji Takata , Katsuji Nishimura

引用次数: 0

Enhancing the efficacy of information technology-based CBT for older adults: Key considerations for future research

IF 4.1 2区医学 Q1 PSYCHIATRY

General hospital psychiatry

Pub Date : 2025-01-30 DOI: 10.1016/j.genhosppsych.2025.01.019

Wikan Galuh Widyarto , Mufti Rasyid , Muslihati , IM. Hambali , Adi Atmoko , Dzinnun Hadi , Muhammad Sholihuddin Zuhdi

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General hospital psychiatry

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