Pub Date : 2024-10-16DOI: 10.1001/jamapsychiatry.2024.3076
Erin L Winstanley,Angela Gray,Douglas Thornton
{"title":"Addressing the Escalating Problems That Patients Encounter When Filling Buprenorphine Prescriptions.","authors":"Erin L Winstanley,Angela Gray,Douglas Thornton","doi":"10.1001/jamapsychiatry.2024.3076","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2024.3076","url":null,"abstract":"","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"74 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-16DOI: 10.1001/jamapsychiatry.2024.3194
Charlotte M Pretzsch,Martina Arenella,Jason P Lerch,Michael V Lombardo,Christian Beckmann,Tim Schaefer,Johanna Leyhausen,Caroline Gurr,Anke Bletsch,Lisa M Berg,Hanna Seelemeyer,Dorothea L Floris,Bethany Oakley,Eva Loth,Thomas Bourgeron,Tony Charman,Jan Buitelaar,Grainne McAlonan,Declan Murphy,Christine Ecker,
ImportanceIn the neurotypical brain, regions develop in coordinated patterns, providing a fundamental scaffold for brain function and behavior. Whether altered patterns contribute to clinical profiles in neurodevelopmental conditions, including autism, remains unclear.ObjectivesTo examine if, in autism, brain regions develop differently in relation to each other and how these differences are associated with molecular/genomic mechanisms and symptomatology.Design, Setting, and ParticipantsThis study was an analysis of one the largest deep-phenotyped, case-control, longitudinal (2 assessments separated by approximately 12-24 months) structural magnetic resonance imaging and cognitive-behavioral autism datasets (EU-AIMS Longitudinal European Autism Project [LEAP]; study dates, February 2014-November 2017) and an out-of-sample validation in the Brain Development Imaging Study (BrainMapASD) independent cohort. Analyses were performed during the 2022 to 2023 period. This multicenter study included autistic and neurotypical children, adolescents, and adults. Autistic participants were included if they had an existing autism diagnosis (DSM-IV/International Statistical Classification of Diseases and Related Health Problems, Tenth Revision or DSM-5 criteria). Autistic participants with co-occurring psychiatric conditions (except psychosis/bipolar disorder) and those taking regular medications were included.ExposuresNeuroanatomy of neurotypical and autistic participants.Main Outcomes and MeasuresIntraindividual changes in surface area and cortical thickness over time, analyzed via surface-based morphometrics.ResultsA total of 386 individuals in the LEAP cohort (6-31 years at first visit; 214 autistic individuals, mean [SD] age, 17.3 [5.4] years; 154 male [72.0%] and 172 neurotypical individuals, mean [SD] age, 16.35 [5.7] years; 108 male [62.8%]) and 146 individuals in the BrainMapASD cohort (11-18 years at first visit; 49 autistic individuals, mean [SD] age, 14.31 [2.4] years; 42 male [85.7%] and 97 neurotypical individuals, mean [SD] age, 14.10 [2.5] years; 58 male [59.8%]). Maturational between-group differences in cortical thickness and surface area were established that were mostly driven by sensorimotor regions (eg, across features, absolute loadings for early visual cortex ranged from 0.07 to 0.11, whereas absolute loadings for dorsolateral prefrontal cortex ranged from 0.005 to 0.06). Neurodevelopmental differences were transcriptomically enriched for genes expressed in several cell types and during various neurodevelopmental stages, and autism candidate genes (eg, downregulated genes in autism, including those regulating synaptic transmission; enrichment odds ratio =3.7; P =2.6 × -10). A more neurotypical, less autismlike maturational profile was associated with fewer social difficulties and more typical sensory processing (false discovery rate P <.05; Pearson r ≥0.17). Results were replicated in the independently collected BrainMapASD cohort.Conclu
{"title":"Patterns of Brain Maturation in Autism and Their Molecular Associations.","authors":"Charlotte M Pretzsch,Martina Arenella,Jason P Lerch,Michael V Lombardo,Christian Beckmann,Tim Schaefer,Johanna Leyhausen,Caroline Gurr,Anke Bletsch,Lisa M Berg,Hanna Seelemeyer,Dorothea L Floris,Bethany Oakley,Eva Loth,Thomas Bourgeron,Tony Charman,Jan Buitelaar,Grainne McAlonan,Declan Murphy,Christine Ecker,","doi":"10.1001/jamapsychiatry.2024.3194","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2024.3194","url":null,"abstract":"ImportanceIn the neurotypical brain, regions develop in coordinated patterns, providing a fundamental scaffold for brain function and behavior. Whether altered patterns contribute to clinical profiles in neurodevelopmental conditions, including autism, remains unclear.ObjectivesTo examine if, in autism, brain regions develop differently in relation to each other and how these differences are associated with molecular/genomic mechanisms and symptomatology.Design, Setting, and ParticipantsThis study was an analysis of one the largest deep-phenotyped, case-control, longitudinal (2 assessments separated by approximately 12-24 months) structural magnetic resonance imaging and cognitive-behavioral autism datasets (EU-AIMS Longitudinal European Autism Project [LEAP]; study dates, February 2014-November 2017) and an out-of-sample validation in the Brain Development Imaging Study (BrainMapASD) independent cohort. Analyses were performed during the 2022 to 2023 period. This multicenter study included autistic and neurotypical children, adolescents, and adults. Autistic participants were included if they had an existing autism diagnosis (DSM-IV/International Statistical Classification of Diseases and Related Health Problems, Tenth Revision or DSM-5 criteria). Autistic participants with co-occurring psychiatric conditions (except psychosis/bipolar disorder) and those taking regular medications were included.ExposuresNeuroanatomy of neurotypical and autistic participants.Main Outcomes and MeasuresIntraindividual changes in surface area and cortical thickness over time, analyzed via surface-based morphometrics.ResultsA total of 386 individuals in the LEAP cohort (6-31 years at first visit; 214 autistic individuals, mean [SD] age, 17.3 [5.4] years; 154 male [72.0%] and 172 neurotypical individuals, mean [SD] age, 16.35 [5.7] years; 108 male [62.8%]) and 146 individuals in the BrainMapASD cohort (11-18 years at first visit; 49 autistic individuals, mean [SD] age, 14.31 [2.4] years; 42 male [85.7%] and 97 neurotypical individuals, mean [SD] age, 14.10 [2.5] years; 58 male [59.8%]). Maturational between-group differences in cortical thickness and surface area were established that were mostly driven by sensorimotor regions (eg, across features, absolute loadings for early visual cortex ranged from 0.07 to 0.11, whereas absolute loadings for dorsolateral prefrontal cortex ranged from 0.005 to 0.06). Neurodevelopmental differences were transcriptomically enriched for genes expressed in several cell types and during various neurodevelopmental stages, and autism candidate genes (eg, downregulated genes in autism, including those regulating synaptic transmission; enrichment odds ratio =3.7; P =2.6 × -10). A more neurotypical, less autismlike maturational profile was associated with fewer social difficulties and more typical sensory processing (false discovery rate P <.05; Pearson r ≥0.17). Results were replicated in the independently collected BrainMapASD cohort.Conclu","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"68 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-16DOI: 10.1001/jamapsychiatry.2024.3049
Jessica Girault
{"title":"Development of Sensory Regions vs the Rest of the Cortex in Autism.","authors":"Jessica Girault","doi":"10.1001/jamapsychiatry.2024.3049","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2024.3049","url":null,"abstract":"","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"1 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-16DOI: 10.1001/jamapsychiatry.2024.2890
Lena Feber,Natalie L Peter,Virginia Chiocchia,Johannes Schneider-Thoma,Spyridon Siafis,Irene Bighelli,Wulf-Peter Hansen,Xiao Lin,Daniel Prates-Baldez,Georgia Salanti,Richard S E Keefe,Rolf R Engel,Stefan Leucht
ImportanceCognitive deficits are a substantial part of the symptoms of schizophrenia spectrum disorders (SSDs) and contribute heavily to the burden of disease. Antipsychotic drugs are not cognitive enhancers, but due to their different receptor-binding profiles, they could differ in their effects on cognition. No previous network meta-analysis compared antipsychotics to placebo, which is important to determine whether use of these drugs is associated with cognitive performance in SSDs at all.ObjectiveTo determine the association of treatment with various antipsychotics and cognition in patients with SSDs.Data SourcesCochrane Schizophrenia Trials Register through June 25, 2023.Study SelectionRandomized clinical trials examining the effects on cognition of antipsychotic drugs or placebo in participants with SSD.Data Extraction and SynthesisA systematic review and random-effects frequentist network meta-analysis was performed following Preferred Reporting Items for Systematic Reviews and Meta-analyses-Network Meta-analysis reporting guideline.Main Outcomes and MeasuresThe primary outcome was change in overall cognition score calculated for each study. Secondary outcomes included cognitive domains, quality of life, and functioning.ResultsThis study included 68 studies involving 9525 participants (mean [SD] age, 35.1 [8.9] years; 5878 male [70%] and 2890 [30%] female; some studies did not provide this information). There were few clear differences between antipsychotics, but first-generation dopamine antagonists haloperidol (standardized mean difference [SMD], 0.04; 95% CI, -0.25 to 0.33) and fluphenazine (SMD, 0.15; 95% CI, -0.39 to 0.69) as well as clozapine (SMD, 0.12; 95% CI, -0.23 to 0.48) ranked low. No individual antipsychotic was associated with a clearly better outcome than placebo, but antipsychotics as a group were, with small effect sizes (mean SMDs: adrenergic/low dopamine, 0.21; serotonergic/dopaminergic, 0.26; muscarinic, 0.28; dopaminergic, 0.40).Conclusion and RelevanceAlthough data are relatively sparse, those reviewed in this study suggest that first-generation dopamine antagonists and clozapine should be avoided when cognitive deficits are a concern. Antipsychotics are not procognitive drugs. The overall small superior outcomes compared to placebo may be explained by less disordered thought patterns associated with fewer positive symptoms rather than cognitive deficits in the proper sense. The findings also suggest that harmonizing measurement of cognitive function in randomized clinical trials would be beneficial.
{"title":"Antipsychotic Drugs and Cognitive Function: A Systematic Review and Pairwise Network Meta-Analysis.","authors":"Lena Feber,Natalie L Peter,Virginia Chiocchia,Johannes Schneider-Thoma,Spyridon Siafis,Irene Bighelli,Wulf-Peter Hansen,Xiao Lin,Daniel Prates-Baldez,Georgia Salanti,Richard S E Keefe,Rolf R Engel,Stefan Leucht","doi":"10.1001/jamapsychiatry.2024.2890","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2024.2890","url":null,"abstract":"ImportanceCognitive deficits are a substantial part of the symptoms of schizophrenia spectrum disorders (SSDs) and contribute heavily to the burden of disease. Antipsychotic drugs are not cognitive enhancers, but due to their different receptor-binding profiles, they could differ in their effects on cognition. No previous network meta-analysis compared antipsychotics to placebo, which is important to determine whether use of these drugs is associated with cognitive performance in SSDs at all.ObjectiveTo determine the association of treatment with various antipsychotics and cognition in patients with SSDs.Data SourcesCochrane Schizophrenia Trials Register through June 25, 2023.Study SelectionRandomized clinical trials examining the effects on cognition of antipsychotic drugs or placebo in participants with SSD.Data Extraction and SynthesisA systematic review and random-effects frequentist network meta-analysis was performed following Preferred Reporting Items for Systematic Reviews and Meta-analyses-Network Meta-analysis reporting guideline.Main Outcomes and MeasuresThe primary outcome was change in overall cognition score calculated for each study. Secondary outcomes included cognitive domains, quality of life, and functioning.ResultsThis study included 68 studies involving 9525 participants (mean [SD] age, 35.1 [8.9] years; 5878 male [70%] and 2890 [30%] female; some studies did not provide this information). There were few clear differences between antipsychotics, but first-generation dopamine antagonists haloperidol (standardized mean difference [SMD], 0.04; 95% CI, -0.25 to 0.33) and fluphenazine (SMD, 0.15; 95% CI, -0.39 to 0.69) as well as clozapine (SMD, 0.12; 95% CI, -0.23 to 0.48) ranked low. No individual antipsychotic was associated with a clearly better outcome than placebo, but antipsychotics as a group were, with small effect sizes (mean SMDs: adrenergic/low dopamine, 0.21; serotonergic/dopaminergic, 0.26; muscarinic, 0.28; dopaminergic, 0.40).Conclusion and RelevanceAlthough data are relatively sparse, those reviewed in this study suggest that first-generation dopamine antagonists and clozapine should be avoided when cognitive deficits are a concern. Antipsychotics are not procognitive drugs. The overall small superior outcomes compared to placebo may be explained by less disordered thought patterns associated with fewer positive symptoms rather than cognitive deficits in the proper sense. The findings also suggest that harmonizing measurement of cognitive function in randomized clinical trials would be beneficial.","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"109 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-16DOI: 10.1001/jamapsychiatry.2024.3206
Ulrich Reininghaus,Annika S Reinhold,Stefan Priebe,Christian Rauschenberg,Leonie Fleck,Anita Schick,Frederike Schirmbeck,Inez Myin-Germeys,Craig Morgan,Jessica A Hartmann
ImportanceThe field of public mental health is evolving to tackle the profound impact of global challenges such as climate change, migration, and health crises. These issues accentuate health and social inequities, necessitating a focus on how to achieve interventions that are equitable and enhance mental health across all societal strata.ObservationsPopulation-based interventions can inadvertently exacerbate mental health inequities if they are primarily assessed by, and beneficial to, the most advantaged. Dimensional approaches such as the Hierarchical Taxonomy of Psychopathology offer a more nuanced understanding of mental health, capturing the whole spectrum of symptom severity in a culturally sensitive and less stigmatizing way. In addition, adopting intersectional, participatory, and settings-based approaches can help tailor interventions to the unique needs of marginalized groups.Conclusions and RelevanceIn moving toward more equitable interventions in public mental health, it is imperative to adopt an approach that integrates multiple frameworks to address the complexity of mental health inequities. At the core of this integrated approach is the recognition that mental health exists on a continuum. Intersectionality theory can help to identify the root (fundamental) causes of mental health while participatory and settings-based approaches ensure that interventions are relevant, culturally sensitive, and accessible to all. By adopting these approaches, interventions that are not only effective in "shifting the curve" toward better mental health, but are also equitable in their reach and impact, can be developed.
{"title":"Toward Equitable Interventions in Public Mental Health: A Review.","authors":"Ulrich Reininghaus,Annika S Reinhold,Stefan Priebe,Christian Rauschenberg,Leonie Fleck,Anita Schick,Frederike Schirmbeck,Inez Myin-Germeys,Craig Morgan,Jessica A Hartmann","doi":"10.1001/jamapsychiatry.2024.3206","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2024.3206","url":null,"abstract":"ImportanceThe field of public mental health is evolving to tackle the profound impact of global challenges such as climate change, migration, and health crises. These issues accentuate health and social inequities, necessitating a focus on how to achieve interventions that are equitable and enhance mental health across all societal strata.ObservationsPopulation-based interventions can inadvertently exacerbate mental health inequities if they are primarily assessed by, and beneficial to, the most advantaged. Dimensional approaches such as the Hierarchical Taxonomy of Psychopathology offer a more nuanced understanding of mental health, capturing the whole spectrum of symptom severity in a culturally sensitive and less stigmatizing way. In addition, adopting intersectional, participatory, and settings-based approaches can help tailor interventions to the unique needs of marginalized groups.Conclusions and RelevanceIn moving toward more equitable interventions in public mental health, it is imperative to adopt an approach that integrates multiple frameworks to address the complexity of mental health inequities. At the core of this integrated approach is the recognition that mental health exists on a continuum. Intersectionality theory can help to identify the root (fundamental) causes of mental health while participatory and settings-based approaches ensure that interventions are relevant, culturally sensitive, and accessible to all. By adopting these approaches, interventions that are not only effective in \"shifting the curve\" toward better mental health, but are also equitable in their reach and impact, can be developed.","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"68 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1001/jamapsychiatry.2024.2315
Kevin Y Xu, Sonya E Gabrielian, Tashalee R Brown
{"title":"Mental Health Diagnoses in People Experiencing Homelessness.","authors":"Kevin Y Xu, Sonya E Gabrielian, Tashalee R Brown","doi":"10.1001/jamapsychiatry.2024.2315","DOIUrl":"10.1001/jamapsychiatry.2024.2315","url":null,"abstract":"","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":"1047"},"PeriodicalIF":22.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11446641/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141975680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1001/jamapsychiatry.2024.2162
Robert A Kleinman, Brian S Barnett
{"title":"Smoking Cessation as a Priority for Psychiatrists.","authors":"Robert A Kleinman, Brian S Barnett","doi":"10.1001/jamapsychiatry.2024.2162","DOIUrl":"10.1001/jamapsychiatry.2024.2162","url":null,"abstract":"","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":"951-952"},"PeriodicalIF":22.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141855613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1001/jamapsychiatry.2024.1441
Jurjen J Luykx, Christoph U Correll, Peter Manu, Antti Tanskanen, Alkomiet Hasan, Jari Tiihonen, Heidi Taipale
<p><strong>Importance: </strong>Antipsychotic drugs (particularly clozapine) have been associated with pneumonia in observational studies. Despite studies of the associations between antipsychotic use and incident pneumonia, it remains unclear to what degree antipsychotic use is associated with increased risk of pneumonia, whether dose-response associations exist, and what agents are specifically associated with incident pneumonia.</p><p><strong>Objective: </strong>To estimate pneumonia risk associated with specific antipsychotics and examine whether polytherapy, dosing, and receptor binding properties are associated with pneumonia in patients with schizophrenia.</p><p><strong>Design, setting, and participants: </strong>This cohort study identified patients with schizophrenia or schizoaffective disorder (hereafter, schizophrenia) aged 16 years or older from nationwide Finnish registers from 1972 to 2014. Data on diagnoses, inpatient care, and specialized outpatient care were obtained from the Hospital Discharge Register. Information on outpatient medication dispensing was obtained from the Prescription Register. Study follow-up was from 1996 to 2017. Data were analyzed from November 4, 2022, to December 5, 2023.</p><p><strong>Exposures: </strong>Use of specific antipsychotic monotherapies; antipsychotics modeled by dosage as low (<0.6 of the World Health Organization defined daily dose [DDD] per day), medium (0.6 to <1.1 DDDs per day), or high dose (≥1.1 DDDs per day); antipsychotic polypharmacy; and antipsychotics categorized according to their anticholinergic burden as low, medium, and high.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was hospitalization for incident pneumonia. Pneumonia risk was analyzed using adjusted, within-individual Cox proportional hazards regression models, with no antipsychotic use as the reference.</p><p><strong>Results: </strong>The study included 61 889 persons with schizophrenia (mean [SD] age, 46.2 [16.0] years; 31 104 men [50.3%]). During 22 years of follow-up, 8917 patients (14.4%) had 1 or more hospitalizations for pneumonia and 1137 (12.8%) died within 30 days of admission. Compared with no antipsychotic use, any antipsychotic use overall was not associated with pneumonia (adjusted hazard ratio [AHR], 1.12; 95% CI, 0.99-1.26). Monotherapy use was associated with increased pneumonia risk compared with no antipsychotic use (AHR, 1.15 [95% CI, 1.02-1.30]; P = .03) in a dose-dependent manner, but polytherapy use was not. When categorized by anticholinergic burden, only the use of antipsychotics with a high anticholinergic burden was associated with pneumonia (AHR, 1.26 [95% CI, 1.10-1.45]; P < .001). Of specific drugs, high-dose quetiapine (AHR, 1.78 [95% CI, 1.22-2.60]; P = .003), high- and medium-dose clozapine (AHR, 1.44 [95% CI, 1.22-1.71]; P < .001 and AHR, 1.43 [95% CI, 1.18-1.74]; P < .001, respectively), and high-dose olanzapine (AHR, 1.29 [95% CI, 1.05-1.58]; P = .02) were assoc
{"title":"Pneumonia Risk, Antipsychotic Dosing, and Anticholinergic Burden in Schizophrenia.","authors":"Jurjen J Luykx, Christoph U Correll, Peter Manu, Antti Tanskanen, Alkomiet Hasan, Jari Tiihonen, Heidi Taipale","doi":"10.1001/jamapsychiatry.2024.1441","DOIUrl":"10.1001/jamapsychiatry.2024.1441","url":null,"abstract":"<p><strong>Importance: </strong>Antipsychotic drugs (particularly clozapine) have been associated with pneumonia in observational studies. Despite studies of the associations between antipsychotic use and incident pneumonia, it remains unclear to what degree antipsychotic use is associated with increased risk of pneumonia, whether dose-response associations exist, and what agents are specifically associated with incident pneumonia.</p><p><strong>Objective: </strong>To estimate pneumonia risk associated with specific antipsychotics and examine whether polytherapy, dosing, and receptor binding properties are associated with pneumonia in patients with schizophrenia.</p><p><strong>Design, setting, and participants: </strong>This cohort study identified patients with schizophrenia or schizoaffective disorder (hereafter, schizophrenia) aged 16 years or older from nationwide Finnish registers from 1972 to 2014. Data on diagnoses, inpatient care, and specialized outpatient care were obtained from the Hospital Discharge Register. Information on outpatient medication dispensing was obtained from the Prescription Register. Study follow-up was from 1996 to 2017. Data were analyzed from November 4, 2022, to December 5, 2023.</p><p><strong>Exposures: </strong>Use of specific antipsychotic monotherapies; antipsychotics modeled by dosage as low (<0.6 of the World Health Organization defined daily dose [DDD] per day), medium (0.6 to <1.1 DDDs per day), or high dose (≥1.1 DDDs per day); antipsychotic polypharmacy; and antipsychotics categorized according to their anticholinergic burden as low, medium, and high.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was hospitalization for incident pneumonia. Pneumonia risk was analyzed using adjusted, within-individual Cox proportional hazards regression models, with no antipsychotic use as the reference.</p><p><strong>Results: </strong>The study included 61 889 persons with schizophrenia (mean [SD] age, 46.2 [16.0] years; 31 104 men [50.3%]). During 22 years of follow-up, 8917 patients (14.4%) had 1 or more hospitalizations for pneumonia and 1137 (12.8%) died within 30 days of admission. Compared with no antipsychotic use, any antipsychotic use overall was not associated with pneumonia (adjusted hazard ratio [AHR], 1.12; 95% CI, 0.99-1.26). Monotherapy use was associated with increased pneumonia risk compared with no antipsychotic use (AHR, 1.15 [95% CI, 1.02-1.30]; P = .03) in a dose-dependent manner, but polytherapy use was not. When categorized by anticholinergic burden, only the use of antipsychotics with a high anticholinergic burden was associated with pneumonia (AHR, 1.26 [95% CI, 1.10-1.45]; P < .001). Of specific drugs, high-dose quetiapine (AHR, 1.78 [95% CI, 1.22-2.60]; P = .003), high- and medium-dose clozapine (AHR, 1.44 [95% CI, 1.22-1.71]; P < .001 and AHR, 1.43 [95% CI, 1.18-1.74]; P < .001, respectively), and high-dose olanzapine (AHR, 1.29 [95% CI, 1.05-1.58]; P = .02) were assoc","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":"967-975"},"PeriodicalIF":22.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11209197/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141450507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1001/jamapsychiatry.2024.2412
Sri Mahavir Agarwal, Margaret Hahn
{"title":"Semaglutide in Psychiatry-Opportunities and Challenges.","authors":"Sri Mahavir Agarwal, Margaret Hahn","doi":"10.1001/jamapsychiatry.2024.2412","DOIUrl":"10.1001/jamapsychiatry.2024.2412","url":null,"abstract":"","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":"955-956"},"PeriodicalIF":22.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142017593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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