Human Psychopharmacology: Clinical and Experimental最新文献

Objective: Peripartum depression is a leading contributor to peripartum morbidity and mortality. Despite the evidence for relative safety, many patients and providers remain reluctant to use or modify psychotropics in the peripartum period. We hypothesized that depressed women in the peripartum period taking psychiatric medications would not experience dose adjustments.

Methods: Women with a prior history of either Major Depressive Disorder or Bipolar Affective Disorder were followed through pregnancy and the postpartum period (N = 229). Depressive symptoms were measured with the Edinburgh Postnatal Depression Scale (EPDS), with a score ≥ 13 indicating likely depression. Data analysis included descriptive statistics, chi-square tests, and logistic regression.

Results: Antepartum depression was more common than postpartum depression (PPD; 29% vs. 20%); 38% of women with antepartum depression also had PPD. Regression analysis revealed that, although depressed women in pregnancy were not more likely to have a dose adjustment than nondepressed women (OR: 1.9, 95% CI: 0.8-4.6), depressed women in the postpartum were more likely to receive a medication change than nondepressed women (OR: 6.3, 95% CI: 2.0-20.4).

Conclusions: In a naturalistic study, more medication adjustments for depression occurred in the postpartum than in pregnancy. This may indicate that antepartum depression is undertreated.

Background: Various factors affecting the development of delirium have been identified. However, the associations between the severity of delirium and potentially related factors have not been adequately investigated. The aim of the present study was to explore factors associated with the severity of delirium and to identify the reversible contributing factors.

Methods: A total of 577 patients with delirium referred to the Department of Psychiatry during the 5 years from May 2015 to April 2020 at a general hospital were included. The Delirium Rating Scale-revised-98 (DRS-R-98) was used to measure the severity of delirium. Multiple regression analysis was used to determine whether individual factors were associated with the severity of delirium.

Results: Intensive care unit admission (p = 0.003), use of benzodiazepines (p = 0.01), dementia (p = 0.02), and older age (p = 0.045) were all positively associated the severity of delirium, while use of β-blockers (p = 0.001) was negatively associated with the severity of delirium.

Conclusions: Reversible contributing factors, that is use of benzodiazepines, should be avoided as much as possible, especially in elderly patients or patients with dementia or patients who need critical care in ICU. Reducing the dose of benzodiazepines or switching them to other drugs should be a priority.

Introduction: Inpatients with coronavirus disease 2019 (COVID-19) show a high rate of neuropsychiatric manifestations, possibly related to a higher risk of serious illness or death. Use of psychotropic medications (PMs) indicates the presence of neuropsychiatric symptoms in COVID-19 patients. So far, potential clinical predictors of use of PMs have not been much investigated. In order to extend research in this area, we aimed to investigate the prevalence of PM prescription among a sample of inpatients with COVID-19 and to find potential predictors of initiation of PMs in these individuals.

Methods: This is a cross-sectional single-center study, conducted during the first outbreak peak in a hospital of northern Italy. Information on socio-demographic characteristics, comorbidities, routine blood test, use of potential COVID-19 treatments, and length of stay were retrieved from medical records.

Results: Data were available for 151 inpatients. Forty-seven of them (31.1%) started at least one prescription of a PM. PM prescription was significantly inversely associated with lymphocyte and platelet counts. A significant association was also found for lactate dehydrogenase (LDH).

Conclusion: Our findings suggest that the initiation of PMs could be common among COVID-19 inpatients. Lymphocyte and platelet counts as well as LDH levels may reflect neuropsychiatric complications of COVID-19.

Objective: To evaluate the efficacy of prazosin for posttraumatic stress disorder (PTSD)-related nightmares in veterans and to analyze subgroup benefit/risk to guide prescribing.

Methods: Patients with a previous prescription for prazosin between 1 June 2007 and 30 June 2017 were collected from the institution's electronic records. Efficacy (including nightmare frequency, and clinical PTSD rating scales) and safety (including blood pressure) data were retrospectively analyzed.

Results: Eighty-four patients were included in the analysis. The primary outcome, item 2 of the PTSD checklist, decreased from 4.00 to 3.19 (on a scale of 1-5), which was statistically significant (p < 0.05). Nightmare frequency was found to have a statistically significant decrease from four to two times per week on average (p = 0.00002, 95% CI 2.36 [1.39-3.33]). Of the patients who reported the greatest response (n = 23), 91% (n = 21) were on an antidepressant and 61% (n = 14) were receiving concurrent psychotherapy. This is compared to 90% (n = 76) and 44% (n = 37) of the total cohort, respectively. No significant differences were found in blood pressure or suicidal ideation (p = 0.58 and p = 0.22, respectively).

Conclusion: Prazosin may be considered as an adjunct option to decrease nightmare frequency in patients already receiving first-line treatment.