Objective: Although substance use disorder (SUD) among older adults is increasing, little has been documented about recent increases in admissions to treatment facilities and associated patient and population characteristics. Methods: We used nationwide data from the Treatment Episode Data Set: Admissions to examine annual admissions to SUD treatment facilities between 2000-2001 and 2016-2017 among adults 55 years and older compared to those aged 21 to 54. Analyses addressed the impact on admission rates of increases in the general older adult population and in sociodemographic and clinical characteristics of those admitted using bivariate and multivariate logistic regressions. Results: From 2000 to 2017, the number of older adults admitted to SUD treatment facilities increased by 203.7% as compared to 13.0% among younger adults. Admissions per 1,000 adults in the general population moderated these differences to 98.4% vs 7.2%. Older adults showed greater increases relative to younger adults in proportions admitted for cocaine/crack (odds ratio [OR], 5.35; 95% confidence interval [CI], 5.20-5.51) and cannabis (OR, 1.81; 95% CI, 1.72-1.91) use and a relative decrease in admission for opiates (OR, 0.76; 95% CI, 0.73-0.80) and alcohol (OR, 0.79; 95% CI, 0.78-0.80) along with changes in some demographics. Multivariate analysis showed that the OR for admission among older adults, as compared to younger adults, was 1.73 (95% CI, 1.65-1.80) in 2016-2017 compared to 2000-2001, adjusting for other factors. Conclusions: The number and proportion of older adults admitted to SUD treatment facilities increased substantially from 2000 to 2017 and were associated with changes in both population numbers and patient characteristics, especially a relative increase among older adults in cocaine/crack and cannabis use and a relative decrease for use of alcohol and opioids.
{"title":"Increased Admissions of Older Adults to Substance Use Treatment Facilities and Associated Changes in Admission Characteristics, 2000-2017.","authors":"Peter J. Na, R. Rosenheck, T. G. Rhee","doi":"10.4088/jcp.21m13938","DOIUrl":"https://doi.org/10.4088/jcp.21m13938","url":null,"abstract":"Objective: Although substance use disorder (SUD) among older adults is increasing, little has been documented about recent increases in admissions to treatment facilities and associated patient and population characteristics.\u0000Methods: We used nationwide data from the Treatment Episode Data Set: Admissions to examine annual admissions to SUD treatment facilities between 2000-2001 and 2016-2017 among adults 55 years and older compared to those aged 21 to 54. Analyses addressed the impact on admission rates of increases in the general older adult population and in sociodemographic and clinical characteristics of those admitted using bivariate and multivariate logistic regressions.\u0000Results: From 2000 to 2017, the number of older adults admitted to SUD treatment facilities increased by 203.7% as compared to 13.0% among younger adults. Admissions per 1,000 adults in the general population moderated these differences to 98.4% vs 7.2%. Older adults showed greater increases relative to younger adults in proportions admitted for cocaine/crack (odds ratio [OR], 5.35; 95% confidence interval [CI], 5.20-5.51) and cannabis (OR, 1.81; 95% CI, 1.72-1.91) use and a relative decrease in admission for opiates (OR, 0.76; 95% CI, 0.73-0.80) and alcohol (OR, 0.79; 95% CI, 0.78-0.80) along with changes in some demographics. Multivariate analysis showed that the OR for admission among older adults, as compared to younger adults, was 1.73 (95% CI, 1.65-1.80) in 2016-2017 compared to 2000-2001, adjusting for other factors.\u0000Conclusions: The number and proportion of older adults admitted to SUD treatment facilities increased substantially from 2000 to 2017 and were associated with changes in both population numbers and patient characteristics, especially a relative increase among older adults in cocaine/crack and cannabis use and a relative decrease for use of alcohol and opioids.","PeriodicalId":20409,"journal":{"name":"Primary care companion to the Journal of clinical psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85823654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Cardiovascular Health in Severe Mental Illness: Potential Role for Metformin.","authors":"S. Agarwal, N. Stogios","doi":"10.4088/jcp.22ac14419","DOIUrl":"https://doi.org/10.4088/jcp.22ac14419","url":null,"abstract":"","PeriodicalId":20409,"journal":{"name":"Primary care companion to the Journal of clinical psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74884844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Christine Y. Lu, Fang Zhang, Jamie Wallace, R. Lecates, Alisa B. Busch, Jeanne M. Madden, Matthew X Callahan, P. Foxworth, S. Soumerai, D. Ross-Degnan, J. Wharam
Objective: High-deductible health plans paired with health savings accounts (HSA-HDHPs) require substantial out-of-pocket spending for most services, including medications. We examined effects of HSA-HDHPs on medication out-of-pocket spending and use among people with bipolar disorder. Methods: This quasi-experimental study used claims data for January 2003 through December 2014. We studied a national sample of 348 members with bipolar disorder (defined based on International Classification of Diseases, 9th Revision), aged 12 to 64 years, who were continuously enrolled for 1 year in a low-deductible plan (≤ $500) then 1 year in an HSA-HDHP (≥ $1,000) after an employer-mandated switch. HSA-HDHP members were matched to 4,087 contemporaneous controls who remained in low-deductible plans. Outcome measures included out-of-pocket spending and use of bipolar disorder medications, non-bipolar psychotropics, and all other medications. Results: Mean pre-to-post out-of-pocket spending per person for bipolar disorder medications increased by 149.7% among HSA-HDHP versus control members (95% confidence interval [CI], 109.9% to 189.5%). Specifically, out-of-pocket spending increased for antipsychotics (220.9% [95% CI, 150.0% to 291.8%]) and anticonvulsants (109.6% [95% CI, 67.3% to 152.0%]). Both higher-income and lower-income HSA-HDHP members experienced increases in out-of-pocket spending for bipolar disorder medications (135.2% [95% CI, 86.4% to 184.0%] and 164.5% [95% CI, 100.9% to 228.1%], respectively). We did not detect statistically significant changes in use of bipolar disorder medications, non-bipolar psychotropics, or all other medications in this study population of HSA-HDHP members. Conclusions: HSA-HDHP members with bipolar disorder experienced substantial increases in out-of-pocket burdens for medications essential for their functioning and well-being. Although HSA-HDHPs were not associated with detectable reductions in medication use, high out-of-pocket costs could cause financial strain for lower-income enrollees.
{"title":"High-Deductible Health Plans Paired With Health Savings Accounts Increased Medication Cost Burden Among Individuals With Bipolar Disorder.","authors":"Christine Y. Lu, Fang Zhang, Jamie Wallace, R. Lecates, Alisa B. Busch, Jeanne M. Madden, Matthew X Callahan, P. Foxworth, S. Soumerai, D. Ross-Degnan, J. Wharam","doi":"10.4088/jcp.20m13865","DOIUrl":"https://doi.org/10.4088/jcp.20m13865","url":null,"abstract":"Objective: High-deductible health plans paired with health savings accounts (HSA-HDHPs) require substantial out-of-pocket spending for most services, including medications. We examined effects of HSA-HDHPs on medication out-of-pocket spending and use among people with bipolar disorder.\u0000Methods: This quasi-experimental study used claims data for January 2003 through December 2014. We studied a national sample of 348 members with bipolar disorder (defined based on International Classification of Diseases, 9th Revision), aged 12 to 64 years, who were continuously enrolled for 1 year in a low-deductible plan (≤ $500) then 1 year in an HSA-HDHP (≥ $1,000) after an employer-mandated switch. HSA-HDHP members were matched to 4,087 contemporaneous controls who remained in low-deductible plans. Outcome measures included out-of-pocket spending and use of bipolar disorder medications, non-bipolar psychotropics, and all other medications.\u0000Results: Mean pre-to-post out-of-pocket spending per person for bipolar disorder medications increased by 149.7% among HSA-HDHP versus control members (95% confidence interval [CI], 109.9% to 189.5%). Specifically, out-of-pocket spending increased for antipsychotics (220.9% [95% CI, 150.0% to 291.8%]) and anticonvulsants (109.6% [95% CI, 67.3% to 152.0%]). Both higher-income and lower-income HSA-HDHP members experienced increases in out-of-pocket spending for bipolar disorder medications (135.2% [95% CI, 86.4% to 184.0%] and 164.5% [95% CI, 100.9% to 228.1%], respectively). We did not detect statistically significant changes in use of bipolar disorder medications, non-bipolar psychotropics, or all other medications in this study population of HSA-HDHP members.\u0000Conclusions: HSA-HDHP members with bipolar disorder experienced substantial increases in out-of-pocket burdens for medications essential for their functioning and well-being. Although HSA-HDHPs were not associated with detectable reductions in medication use, high out-of-pocket costs could cause financial strain for lower-income enrollees.","PeriodicalId":20409,"journal":{"name":"Primary care companion to the Journal of clinical psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74886555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Khanna, Lyndsi White, Flora Y. Bessey, Elizabeth Borntrager, Amber R Hoberg, Jason P. Caplan
Importance: Most people with dementia will experience neuropsychiatric symptoms, including psychosis characterized by hallucinations and delusions. Across dementia subtypes, hallucinations and delusions are common, though their prevalence and presentation may vary. These symptoms have been associated with worse outcomes compared with dementia alone, including accelerated functional decline and mortality. Many people with dementia reside in long-term care facilities, and identification and management of hallucinations and delusions in this setting are critical. Observations: For residents in long-term care facilities, the following factors can hinder management of hallucinations and delusions related to dementia: (1) delayed recognition of symptoms; (2) reluctance of staff and family members to acknowledge psychiatric issues; (3) lack of approved pharmacotherapies to treat hallucinations and delusions associated with dementia-related psychosis; and (4) regulatory and institutional guidelines, including the long-term care regulatory guidelines established by the Centers for Medicare and Medicaid Services and the 5-star rating system. Conclusions and Relevance: Barriers to the treatment of hallucinations and delusions in patients with dementia in the long-term care setting are myriad and complex. Early diagnosis of dementia-related psychosis and new treatment options for managing hallucinations and delusions are needed to improve care of this patient population.
{"title":"Barriers to Treatment of Hallucinations and Delusions in People With Dementia Residing in Long-Term Care.","authors":"R. Khanna, Lyndsi White, Flora Y. Bessey, Elizabeth Borntrager, Amber R Hoberg, Jason P. Caplan","doi":"10.4088/jcp.21m14050","DOIUrl":"https://doi.org/10.4088/jcp.21m14050","url":null,"abstract":"Importance: Most people with dementia will experience neuropsychiatric symptoms, including psychosis characterized by hallucinations and delusions. Across dementia subtypes, hallucinations and delusions are common, though their prevalence and presentation may vary. These symptoms have been associated with worse outcomes compared with dementia alone, including accelerated functional decline and mortality. Many people with dementia reside in long-term care facilities, and identification and management of hallucinations and delusions in this setting are critical.\u0000Observations: For residents in long-term care facilities, the following factors can hinder management of hallucinations and delusions related to dementia: (1) delayed recognition of symptoms; (2) reluctance of staff and family members to acknowledge psychiatric issues; (3) lack of approved pharmacotherapies to treat hallucinations and delusions associated with dementia-related psychosis; and (4) regulatory and institutional guidelines, including the long-term care regulatory guidelines established by the Centers for Medicare and Medicaid Services and the 5-star rating system.\u0000Conclusions and Relevance: Barriers to the treatment of hallucinations and delusions in patients with dementia in the long-term care setting are myriad and complex. Early diagnosis of dementia-related psychosis and new treatment options for managing hallucinations and delusions are needed to improve care of this patient population.","PeriodicalId":20409,"journal":{"name":"Primary care companion to the Journal of clinical psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79799470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Correll, Ying He, F. Therrien, Erin M Mackenzie, S. Meehan, C. Weiss, N. Hefting, M. Hobart
Objective: To evaluate the short- and long-term effects of brexpiprazole on patient functioning in schizophrenia. Methods: Data were included from three 6-week, randomized, double-blind, placebo-controlled studies (hospitalized patients); a 52-week, randomized, double-blind, placebo-controlled maintenance treatment study (terminated early by the study sponsor based on the positive result of an interim analysis); and two 52-week, open-label extension studies-all in patients with schizophrenia (DSM-IV-TR criteria) and conducted from July 2011-February 2016. Patients allocated to oral brexpiprazole received 2-4 mg/d (short-term studies) or 1-4 mg/d (long-term studies). Functioning was measured using the Personal and Social Performance (PSP) and Global Assessment of Functioning (GAF) scales, with response defined as a PSP/GAF increase of ≥ 10 points and remission as PSP score ≥ 71 or GAF score ≥ 61. Results: Patients receiving brexpiprazole (n = 831) showed greater improvement than those receiving placebo (n = 490) from baseline to week 6 in PSP score (least squares mean difference, 3.20; 95% confidence interval, 1.82-4.58; P < .0001; Cohen d = 0.31) and in all 4 PSP domains. At week 52 of the maintenance study (which had a low completion rate primarily due to the early termination), GAF functional remission was achieved by 65.3% (62/95) of stabilized patients randomized to brexpiprazole and 47.1% (48/102) of stabilized patients randomized to placebo, with a number needed to treat of 6 (95% confidence interval, 4-22; P = .0076). At week 52 of the open-label studies (n = 177), PSP functional response and remission were achieved by 84.2% and 41.8% of patients receiving brexpiprazole, respectively. Conclusions: Although limited by the lack of an active comparator, analyses of this large dataset demonstrate that brexpiprazole treatment is associated with clinically relevant improvement in functioning among patients with schizophrenia, in the short term and long term. Trial Registration: Data used in this post hoc analysis were from studies with ClinicalTrials.gov identifiers: NCT01396421, NCT01393613, NCT01810380, NCT01668797, NCT01397786, and NCT01810783.
{"title":"Effects of Brexpiprazole on Functioning in Patients With Schizophrenia: Post Hoc Analysis of Short- and Long-Term Studies.","authors":"C. Correll, Ying He, F. Therrien, Erin M Mackenzie, S. Meehan, C. Weiss, N. Hefting, M. Hobart","doi":"10.4088/jcp.20m13793","DOIUrl":"https://doi.org/10.4088/jcp.20m13793","url":null,"abstract":"Objective: To evaluate the short- and long-term effects of brexpiprazole on patient functioning in schizophrenia.\u0000Methods: Data were included from three 6-week, randomized, double-blind, placebo-controlled studies (hospitalized patients); a 52-week, randomized, double-blind, placebo-controlled maintenance treatment study (terminated early by the study sponsor based on the positive result of an interim analysis); and two 52-week, open-label extension studies-all in patients with schizophrenia (DSM-IV-TR criteria) and conducted from July 2011-February 2016. Patients allocated to oral brexpiprazole received 2-4 mg/d (short-term studies) or 1-4 mg/d (long-term studies). Functioning was measured using the Personal and Social Performance (PSP) and Global Assessment of Functioning (GAF) scales, with response defined as a PSP/GAF increase of ≥ 10 points and remission as PSP score ≥ 71 or GAF score ≥ 61.\u0000Results: Patients receiving brexpiprazole (n = 831) showed greater improvement than those receiving placebo (n = 490) from baseline to week 6 in PSP score (least squares mean difference, 3.20; 95% confidence interval, 1.82-4.58; P < .0001; Cohen d = 0.31) and in all 4 PSP domains. At week 52 of the maintenance study (which had a low completion rate primarily due to the early termination), GAF functional remission was achieved by 65.3% (62/95) of stabilized patients randomized to brexpiprazole and 47.1% (48/102) of stabilized patients randomized to placebo, with a number needed to treat of 6 (95% confidence interval, 4-22; P = .0076). At week 52 of the open-label studies (n = 177), PSP functional response and remission were achieved by 84.2% and 41.8% of patients receiving brexpiprazole, respectively.\u0000Conclusions: Although limited by the lack of an active comparator, analyses of this large dataset demonstrate that brexpiprazole treatment is associated with clinically relevant improvement in functioning among patients with schizophrenia, in the short term and long term.\u0000Trial Registration: Data used in this post hoc analysis were from studies with ClinicalTrials.gov identifiers: NCT01396421, NCT01393613, NCT01810380, NCT01668797, NCT01397786, and NCT01810783.","PeriodicalId":20409,"journal":{"name":"Primary care companion to the Journal of clinical psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82529453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: Measurement-based care (MBC) improves patient outcomes. However, there has been minimal focus on MBC for psychotic disorders. This study examines the use of patient-reported outcome measures (PROMs) in the Veterans Health Administration (VHA) to characterize their use among Veterans with psychotic disorders and to inform candidate measures for psychosis-related MBC. Methods: Data on Veterans with and without ICD-10 psychotic disorders and at least 1 PROM during fiscal years (FYs) 2016-2019 (FY16-FY19) were collected. The sample included 3,935,504 PROM administrations among 1,192,897 Veterans. Included PROMs spanned multiple symptom and non-symptom domains. Percentages of total PROM administrations were calculated by aggregating across time and diagnosis. Facility-level statistics were also calculated. Absolute change in the percentage of unique Veterans administered a particular and repeated PROMs over time were calculated. Results: The core PROMs for VHA MBC (Patient Health Questionnaire-9 [PHQ-9], General Anxiety Disorder-7 Scale, PTSD Checklist-5, and Brief Addiction Monitor) accounted for the majority of PROMs for Veterans with (88.18%) and without (92.56%) psychotic disorders. The PHQ-9 accounted for the largest proportion (psychotic disorder: 45.89%; other diagnosis: 46.70%). The absolute changes in percentages of repeated PROM administration were similar over time across groups. Conclusions: The use of PROMs in VHA mental health care increased during FY16-FY19 for Veterans with and without psychosis. The rates of PROM use were similar for both groups, and PROM use predominately consisted of the core measures. While the similar rates of PROM administration are encouraging, these findings highlight the need for psychosis-specific measures to tailor MBC for Veterans with these diagnoses.
{"title":"Measurement-Based Care for Psychotic Disorders in the Veterans Health Administration: Current Practices and Future Directions.","authors":"Edward P. Liebmann, S. Resnick, Meaghan A Stacy","doi":"10.4088/JCP.21m14274","DOIUrl":"https://doi.org/10.4088/JCP.21m14274","url":null,"abstract":"Objective: Measurement-based care (MBC) improves patient outcomes. However, there has been minimal focus on MBC for psychotic disorders. This study examines the use of patient-reported outcome measures (PROMs) in the Veterans Health Administration (VHA) to characterize their use among Veterans with psychotic disorders and to inform candidate measures for psychosis-related MBC.\u0000Methods: Data on Veterans with and without ICD-10 psychotic disorders and at least 1 PROM during fiscal years (FYs) 2016-2019 (FY16-FY19) were collected. The sample included 3,935,504 PROM administrations among 1,192,897 Veterans. Included PROMs spanned multiple symptom and non-symptom domains. Percentages of total PROM administrations were calculated by aggregating across time and diagnosis. Facility-level statistics were also calculated. Absolute change in the percentage of unique Veterans administered a particular and repeated PROMs over time were calculated.\u0000Results: The core PROMs for VHA MBC (Patient Health Questionnaire-9 [PHQ-9], General Anxiety Disorder-7 Scale, PTSD Checklist-5, and Brief Addiction Monitor) accounted for the majority of PROMs for Veterans with (88.18%) and without (92.56%) psychotic disorders. The PHQ-9 accounted for the largest proportion (psychotic disorder: 45.89%; other diagnosis: 46.70%). The absolute changes in percentages of repeated PROM administration were similar over time across groups.\u0000Conclusions: The use of PROMs in VHA mental health care increased during FY16-FY19 for Veterans with and without psychosis. The rates of PROM use were similar for both groups, and PROM use predominately consisted of the core measures. While the similar rates of PROM administration are encouraging, these findings highlight the need for psychosis-specific measures to tailor MBC for Veterans with these diagnoses.","PeriodicalId":20409,"journal":{"name":"Primary care companion to the Journal of clinical psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81861823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Functional Outcomes of an Antipsychotic Medication in Schizophrenia: A Generalizable or Specific Effect?","authors":"N. Schooler","doi":"10.4088/JCP.21com14349","DOIUrl":"https://doi.org/10.4088/JCP.21com14349","url":null,"abstract":"","PeriodicalId":20409,"journal":{"name":"Primary care companion to the Journal of clinical psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82063059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. Fairbrother, Fanie Collardeau, S. Woody, D. Wolfe, J. Fawcett
Objective: Unwanted intrusive thoughts (UITs) of intentional infant-related harm are ubiquitous among new mothers and frequently raise concerns about infant safety. The purpose of this research was to assess the relation of new mothers' UITs of intentional, infant-related harm and obsessive-compulsive disorder (OCD) with maternal aggression toward the infant and to document the prevalence of maternal aggression toward the infant. Methods: From a prospective, province-wide, unselected sample of 763 English-speaking postpartum women, a total of 388 participants provided data for this portion of the research. Participants completed 2 questionnaires and interviews postpartum to assess UITs of infant-related harm, OCD (based on DSM-5 criteria), and maternal aggression toward the infant. Data for this research were collected from February 9, 2014, to February 14, 2017. Results: Overall, few participants (2.9%; 95% CI, 1.5% to 4.7%) reported behaving aggressively toward their infant. Participants who reported UITs of intentional, infant-related harm (44.4%; 95% CI, 39.2% to 49.7%) were not more likely to report aggression toward their newborn compared with women who did not report this ideation (2.6%; 95% CI, 0.9% to 5.8%; and 3.1%; 95% CI, 1.3% to 6.2%, respectively). The same was true for women with and without OCD (1.9%; 95% CI, 0.3% to 6.4%; and 3.5%; 95% CI, 1.8% to 6.0%), respectively. Conclusions: This study found no evidence that the occurrence of either UITs of intentional, infant-related harm or OCD is associated with an increased risk of infant harm. The prevalence of child abuse of infants in this sample (2.9%) is lower than reported in others (4%-9%). Findings provide critical and reassuring information regarding the relation between new mothers' UITs of intentional harm and risk of physical violence toward the infant.
{"title":"Postpartum Thoughts of Infant-Related Harm and Obsessive-Compulsive Disorder: Relation to Maternal Physical Aggression Toward the Infant.","authors":"N. Fairbrother, Fanie Collardeau, S. Woody, D. Wolfe, J. Fawcett","doi":"10.4088/jcp.21m14006","DOIUrl":"https://doi.org/10.4088/jcp.21m14006","url":null,"abstract":"Objective: Unwanted intrusive thoughts (UITs) of intentional infant-related harm are ubiquitous among new mothers and frequently raise concerns about infant safety. The purpose of this research was to assess the relation of new mothers' UITs of intentional, infant-related harm and obsessive-compulsive disorder (OCD) with maternal aggression toward the infant and to document the prevalence of maternal aggression toward the infant.\u0000Methods: From a prospective, province-wide, unselected sample of 763 English-speaking postpartum women, a total of 388 participants provided data for this portion of the research. Participants completed 2 questionnaires and interviews postpartum to assess UITs of infant-related harm, OCD (based on DSM-5 criteria), and maternal aggression toward the infant. Data for this research were collected from February 9, 2014, to February 14, 2017.\u0000Results: Overall, few participants (2.9%; 95% CI, 1.5% to 4.7%) reported behaving aggressively toward their infant. Participants who reported UITs of intentional, infant-related harm (44.4%; 95% CI, 39.2% to 49.7%) were not more likely to report aggression toward their newborn compared with women who did not report this ideation (2.6%; 95% CI, 0.9% to 5.8%; and 3.1%; 95% CI, 1.3% to 6.2%, respectively). The same was true for women with and without OCD (1.9%; 95% CI, 0.3% to 6.4%; and 3.5%; 95% CI, 1.8% to 6.0%), respectively.\u0000Conclusions: This study found no evidence that the occurrence of either UITs of intentional, infant-related harm or OCD is associated with an increased risk of infant harm. The prevalence of child abuse of infants in this sample (2.9%) is lower than reported in others (4%-9%). Findings provide critical and reassuring information regarding the relation between new mothers' UITs of intentional harm and risk of physical violence toward the infant.","PeriodicalId":20409,"journal":{"name":"Primary care companion to the Journal of clinical psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75185066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Although antipsychotics have been available for almost 70 years and greatly improved outcomes for individuals with schizophrenia, all currently available options derive their efficacy from blockade of dopaminergic receptors. However, this mechanism of action leaves many symptoms unresolved and is associated with a significant side effect burden. The mechanisms underlying schizophrenia, which were initially thought to be related to excessive presynaptic dopamine in specific areas of the brain, are now understood to be much more complex and involve structural and molecular changes throughout brain circuits. Consequently, drug discovery efforts have sought new targets in the search for safer and more effective medications that can improve symptoms of schizophrenia and psychosis, including trace amine-associated receptors (TAARs), muscarinic receptors, and serotonergic receptors. Positive phase 2 trial results indicating efficacy and safety of the TAAR1 agonist ulotaront (SEP-363856) and of the muscarinic M1/M4 agonist KarXT (xanomeline plus trospium) for total, positive, and negative symptoms in patients with acute exacerbation of schizophrenia, and of the serotonin 5-HT2A agonist/antagonist pimavanserin in patients with schizophrenia and predominant negative symptoms for negative symptom control are encouraging. Taken together, these data indicate in the context of ongoing phase 3 trial programs that patients with schizophrenia may soon have access to the first non-D2 blocking medication, which could drastically change the treatment landscape and improve outcomes for many of the individuals with schizophrenia who do not fully respond to or cannot tolerate currently available antipsychotic agents that currently all act via postsynaptic dopamine D2 receptor blockade.
{"title":"Emerging Treatments in Schizophrenia.","authors":"C. Correll, A. Abi-Dargham, O. Howes","doi":"10.4088/jcp.su21204ip1","DOIUrl":"https://doi.org/10.4088/jcp.su21204ip1","url":null,"abstract":"Although antipsychotics have been available for almost 70 years and greatly improved outcomes for individuals with schizophrenia, all currently available options derive their efficacy from blockade of dopaminergic receptors. However, this mechanism of action leaves many symptoms unresolved and is associated with a significant side effect burden. The mechanisms underlying schizophrenia, which were initially thought to be related to excessive presynaptic dopamine in specific areas of the brain, are now understood to be much more complex and involve structural and molecular changes throughout brain circuits. Consequently, drug discovery efforts have sought new targets in the search for safer and more effective medications that can improve symptoms of schizophrenia and psychosis, including trace amine-associated receptors (TAARs), muscarinic receptors, and serotonergic receptors. Positive phase 2 trial results indicating efficacy and safety of the TAAR1 agonist ulotaront (SEP-363856) and of the muscarinic M1/M4 agonist KarXT (xanomeline plus trospium) for total, positive, and negative symptoms in patients with acute exacerbation of schizophrenia, and of the serotonin 5-HT2A agonist/antagonist pimavanserin in patients with schizophrenia and predominant negative symptoms for negative symptom control are encouraging. Taken together, these data indicate in the context of ongoing phase 3 trial programs that patients with schizophrenia may soon have access to the first non-D2 blocking medication, which could drastically change the treatment landscape and improve outcomes for many of the individuals with schizophrenia who do not fully respond to or cannot tolerate currently available antipsychotic agents that currently all act via postsynaptic dopamine D2 receptor blockade.","PeriodicalId":20409,"journal":{"name":"Primary care companion to the Journal of clinical psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81366472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"In Memoriam: Aaron T. Beck, MD, 1921-2021.","authors":"M. Thase","doi":"10.4088/JCP.20f14370","DOIUrl":"https://doi.org/10.4088/JCP.20f14370","url":null,"abstract":"","PeriodicalId":20409,"journal":{"name":"Primary care companion to the Journal of clinical psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88699028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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