Strategies to improve anxiety and depression in patients with COPD: a mental health perspective.

Chronic obstructive pulmonary disease (COPD) is a pulmonary disease characterized by progressive and potentially reversible symptoms.  In COPD, anxiety and depression are surprisingly common.  This article aimed to comment on the lack of literature of psychological disorders associated with COPD.  First, this study stressed that patients prefer to be treated by non-pharmacological means instead of drug therapy.  Individual and group therapy are useful in treating patients with COPD.  Most antidepressants work the same on depression but have different side effects based on drug class.  This article also stressed that one-third of patients suffering from anxiety and depression due to COPD are untreated.  It also states that one-third of patients with COPD have related anxiety and depression.  Despite all the research conducted by this article it was not able to provide a concise treatment plan but it did specify that mental illness is widely under-diagnosed and under-treated.

This article was interesting to me becasue it was a review article about a topic that I had heard about but had very little knowledge on the matter beforehand.  I heard of COPD but did not know there was such a high correlation between between depression and anxiety and COPD.  I was also curious to see that drug therapy was not the primary source of treatment for this disease state and it was instead preferred to treat using group and individual therapy.  Considering we rarely discuss that form of treatment it was interesting to see that as the principle treatment and learn more about it.

Tselebis A, Pachi A, Ilias I, et al. Strategies to improve anxiety and depression in patients with COPD: a mental health perspective. Neuropsychiatric Disease and Treatment. 2016;12:297-328 

Prescription medication misuse among opioid dependent patients seeking inpatient detoxification

The goal of this article was to examine the extent to which patients who are opioid dependent and seeking detoxification are misusing other treatments such as clonazepam and gabapentin.  The study tested 196 patients.  Of the 196 patients, 162 had opioid dependency.  The data showed that of the patients who had suffered from opioid dependency were much more likely to misuse medication than those suffering from alcohol dependency (30% vs 0%).  Of the patients using opioids, 28% of the patients used higher amounts of the medication than prescribed.  They used such medication as gabapentin, clonazepam, and and pregabalin.  This study concluded, that despite the nonaddictive nature of some drugs they were still misused drastically by opioid dependents.

This article is interesting to me because it specifically touches on the possible addictive nature of gabapentin.  This is interesting because gabapentin is just starting to become a controlled substance due to its recent abuse in the past years.  This article provided some insight onto how a seemingly safe drug could become abused and lead to its future controlled status.

Wilens T, Zulauf C, Ryland D, et al. Prescription medication misuse among opioid dependent patients seeking inpatient detoxification. American Journal on Addictions. 2015; 24(2): 173-177.

Differences in prescribing psychotropic drugs for elderly with depression.

This study’s purpose was to address the prevalence of depression and inadequacy it is treated in most cases.  It analyzed the different types of drug classes that are prescribed to elderly patients.  A random sampling of 5% of inpatients was selected from the NHI in Taiwan.  Of the 5%, 1058 were geriatric patients with some form of mental depression.  The prescribing patterns were examined and compared.  Some of the most commonly prescribed psychotropics were: antidepressants (71.4%), anxiolytics (62.6%) and hypnotics (51.4%).  Varying types of medications were prescribed and it depends on the the type of medical professional.  This study concluded psychiatrist generally prescribe newer antidepressants than other physician specialties.

This article is interesting because it discussed the varying types of drugs that are prescribed.  It shows that there is a difference between the types of medications prescribed based on the type of specialty instead of having a standard that all prescriptions is based off of.  I believe that this is bad for the healthcare industry and could lead to problems across the industry.

Huang YC, Wang LJ, Chong MY.  Differences in prescribing psychotropic drugs for elderly with depression. Acta NeuroPsychiatry. 2016; 22: 1-8.

The type and prevalence of the use of analgesics among inpatients in a geriatric psychiatry department

There is a strong correlation between and pain and mental disorders.  So it is expected that patient in psychiatric hospitals will be on some form of pain medication.  This study was done on 89 patients aged 68 or older.  There were 51.7% of the patients use analgesics.  Paracetamol was the most used drug followed by opioids.  This study concluded that analgesics were associated with adverse effects and so the less used on patients the better.  Thus, the study confirmed that analgesics were being used too frequently and should be addressed.

I have some disagreements with this article.  The amount of pain medication used on patients is a controversial subject.  Personally, I believe that pain medication is a necessary evil.  Better to deal with some adverse side effects than to deal with constant pain and analgesics are non-addictive for the most part.  Especially, since these are geriatric patients I believe that their comfort level should take top priority.  Overall, I believe this article to be eye-opening to the beliefs about pain medication in the hospital setting.

Østergaard PJ, Gustafsson LN, Høyer EH, Munk-Jørgensen P. The type and prevalence of the use of analgesics among inpatients in a geriatric psychiatry department. Therapeutic Advances in Psychopharmacology. 2016;6(1):13-21. doi:10.1177/2045125315619557.

Duration of diabetes and its association with depression in later life: The Health In Men Study (HIMS).

This study compared the diagnosis of diabetes and it’s relationship to depression in men.  It was a cross-sectional study of 5462 men between the age of 70-89 years old.  The rate of these men’s depression was based on the Geriatric Depression Scale and diabetes was measured with fasting blood glucose levels.  There is a “J-shaped” curve relationship between depression and age with men with diabetes.  That means that depression increases as the men get older.  Although some other factors most likely play a pivotal role.

I was interested in this article because these disease states are treated by medications that pharmacists deal with on a daily basis.  To me, this emphasizes the importance of the pharmacist role in patient’s lives.  The better the patient’s diabetes is managed, the better their related depression might be treated.  if the diabetes is under control, the depression will not occur hopefully and therefore, there will not be a need for additional medical treatment.  The less medication needed, the better the life of the patient.

Almeida OP, McCaul K, Hankey GJ, et al.  Duration of diabetes and its association with depression in later life: The Health In Men Study (HIMS). 2016; 86: 3-9

Comparison between Transdermal Buprenorphine and Transdermal Fentanyl for Postoperative Pain Relief after Major Abdominal Surgeries

Opioid medication has been used since its discovery as the necessary treatment for moderate and severe pain, especially post-operative pain.  It is one of the main concerns for patients who undergo such major surgeries such as abdominal surgery.  This study compares the effectiveness of two transdermal medications and their effectiveness on 60 patients.  Half the population was given transdermal fentanyl and half the population was given transdermal buprenorphine.  The results were to be expected.  Around 20% of fentanyl and 16.7% of buprenorphine patients experienced adverse effects, nausea and vomiting being the main adverse effects for most patients.  In general, however, fentanyl was reported to be better at controlling post-operative pain than buprenorphine.  This study also proved that transdermal patches are preferable to oral and IV administration.  This is due to the avoidance of multiple dosing and skin punctures.

I find this article interesting because opioid medications interest me and their varying effectiveness.  Pain is the most common effect patients experience and its management can be a difficult task.  So this study interested me since it compared two different pain medications for post-operative abdominal pain.  I was familiar with fentanyl but not buprenorphine.  Overall, fentanyl still proved to be the most effective.

 

Arshad Z, Prakash R, Gautam S, Kumar S. Comparison between Transdermal Buprenorphine and Transdermal Fentanyl for Postoperative Pain Relief after Major Abdominal Surgeries. Journal of Clinical and Diagnostic Research : JCDR. 2015;9(12):UC01-UC04. doi:10.7860/JCDR/2015/16327.6917.

Oxytocin for Male Subjects with Autism Spectrum Disorder and Comorbid Intellectual Disabilities: A Randomized Pilot Study

Individuals who are the autistic spectrum also have a high likelihood of suffering from co-morbid intellectual disabilities (ID).  Oxytocin (OXT) receptors play a likely role in excitatory/inhibitory responses in humans.  This study that Oxytocin can be given therapeutically to increase social interaction in individuals on the autistic spectrum.  This study’s purpose was to determine the effectiveness and adverse effects of intranasal OXT.  29 males (age 15-40) were tested in a double blind, placebo-controlled study.  This is simply a pilot study.

The conclusion of the study was that there is reason for future multi-center clinical trials to determine further the efficacy of OXT on individuals with ASD and ID to determine if social interactions differ and improve.  There was a correlation between plasma OXT levels and levels of social interactions between the men studied.  

This is important because it is calling for long-term clinical trials of OXT plasma levels effects on social interactions.   This is a possible way to treat those on the autistic spectrum and increase their ability for social interaction thus making their quality of life improve drastically.  This is interesting that a simple Oxytocin imbalance could help to treat these individuals.  

Munesue T, Nakamura H, Kikuchi M, et al. Oxytocin for Male Subjects with Autism Spectrum Disorder and Comorbid Intellectual Disabilities: A Randomized Pilot Study. Frontiers in Psychiatry. 2016;7:2. doi:10.3389/fpsyt.2016.00002.

Opioid-induced hyperalgesia in chronic pain patients and the mitigating effects of gabapentin

Ever since the discovery of opioid medication it has been a staple in the treatment of acute and chronic pain.  However, patients who are experiencing chronic pain can experience Opioid-induced hyperalgesia (OIH).  This leads to a paradoxical chronic pain state for the patient.  The challenge is to find a way to nullify the effect of opioid medication on the patient without removing the analgesic effect.  Gabapentin, which is used to treat neuropathic pain, has been shown to limit OIH in animals receiving fentanyl and has been shown in chronic pain patients to limit their opioid consumption.  There have not been studies in the recent years on this topic.

The mechanism of OIH and the anti-hyperalgesia effects of gabapentin are not well understood but there are many studies, according to this review article, that prove its efficacy.  However, it is believed that gabapentin binds to the dorsal horn VCGGs diminishing the pain regulation pathways.  Despite this, there have not been a wide-range of standardized patient studies to definitely prove this.

This review is important because pain control is one the biggest responsibilities of a healthcare provider.  Chronic pain management will continue to be an issue in the future and opioids will be one of the ways physicians and pharmacists to treat it.  Because of this, OIH will continue to be a problem.  More research should be put into gabapentin’s effect on OIH to create a definitive therapy strategy to be used by healthcare professionals.

Stoicea N, Russell D, Weidner G, et al. Opioid-induced hyperalgesia in chronic pain patients and the mitigating effects of gabapentin. Frontiers in Pharmacology. 2015;6:104. doi:10.3389/fphar.2015.00104.