Persistence of metabolic monitoring for psychiatry inpatients treated with second-generation antipsychotics utilizing a computer-based intervention

This article goes over a novel technique to try and improve the quality of patient metabolic monitoring during the use of 2nd generation antipsychotics by using a computer interface and pop-up alert system. Patients taking 2nd generation psychotics can have side effects related to essential metabolic processes. These effects can include weight gain, diabetes occurrence, and others. Therefore the efficiency and rate at which metabolic parameters are important to prevention of further health problems. The metabolic parameters being measured were blood glucose levels, hemoglobin A1C, and a lipid panel, which were then compared to to the initial implementation.

The goal of the study was to determine if the computer system with pop-up alerts was a better option than conventional methods by measuring the rate of monitoring in an inpatient setting. A total of 129 patients (159 in the initial cohort) were monitored and the study was carried out over a period of 4 years. A comparison was done between the computerized physician order entry (CPOE) pop-up alert system and the conventional systems via long term chart reviews. Patient chart reviews were also used to determine if monitoring improved patient outcomes or alerted medical personnel to health risks.

The end result of the study is that the new computer pop-up alert system to did not significantly change monitoring rates. Although there were interventions from the psychiatry team as a result of the computerized system, which shows potential for the use of the system in the future.

We are learning about 2nd generation antipsychotics currently in POP.

How do you think techonology could be better implemented in this special patient population to improve outcomes?

Find this article here:

Lee J, Dalack GW, Casher MI, et al. Persistence of metabolic monitoring for psychiatry inpatients treated with second generation antipsychotics utilizing a computer-based intervention.            J Clin Pharm Ther. 2016 Feb 26. doi: 10.1111/jcpt.12368.

Cannabis Use and Risk of Psychiatric Disorders Prospective Evidence From a US National Longitudinal Study

With many states beginning to legalize cannabis, whether medicinal or recreational, there has been an increase in interest as to what kind of consequences it might have.  This particular study wanted to test the psychiatry of those smoking cannabis–particularly if it would affect their tendencies to abuse other drugs afterwards.  They also attempted to evaluate whether smoking marijuana would cause mood disorders, like bipolar disorder or anxiety, as some studies have previously.

The study was conducted in two “waves.” One was held 2001-2002 and the second was held from 2004-2005 with the same participants to make it a longitudinal study.  The participants were screened for psychiatric disorders like depression, anxiety, substance abuse, etc. and assessed according to the DSM-IV.  This was done at the onset of the trial and again at the end.  34,653 participants were interviewed, and of those 1,279 used cannabis.

Those who were smoking cannabis at the time of Wave 1 were much more likely to struggle with mental health issues or substance abuse by the time of Wave 2.  However, after adjusting their data, the only firm conclusion they made was that smoking cannabis indeed increased the risk of abusing other substances like alcohol, nicotine, or other drugs.  They did not conclude that marijuana induced or worsened mental disorders.  They reasoned that maybe the mental health issues came first and the cannabis use was a result, making this relationship correlational but NOT causal.

 

Blanco C, Hasin DS, Wall MM, et al. Cannabis Use and Risk of Psychiatric Disorders-Prospective Evidence From a US National Longitudinal Study. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2015.3229 (published 17 February 2016).

Increased Risk of Mortality in Patients Diagnosed with Obsessive-Compulsive Disorder

Obsessive-Compulsive Disorder (OCD) is a mental disorder that is characterized by intrusive thoughts or feelings which are accompanied by certain behaviors in attempt to relieve anxiety. This disorder is very debilitating, so researchers in Denmark set out to find if a diagnosis with OCD had an increased risk of mortality. This prospective cohort study looked at people born in Denmark between January 1, 1955 and November 31, 2006. The study included 3,270,650 people. Of the total population being studied, 10,155 people were diagnosed with OCD. The maximum age for any the cohort member was 57, because the researchers didn’t want to include older adults due to higher instances of mortality among that population. The researchers utilized a “follow-up” period, which began at January 1, 2002 and ended when the subjects either died, moved out of Denmark, or on December 31, 2011. The causes of death were placed into certain categories, such as deaths from physical conditions, deaths from external causes, and deaths from unnatural causes.

During the study follow-up period, 27,236 people died. Of these deaths, 110 of them were people who were diagnosed with OCD. The study also took into account how many of those people had received a comorbid diagnosis of another mental disorder; 82 of the 110 deaths were people with comorbid diagnosis. The results of the study concluded that people with diagnosed OCD had an increased risk of premature death in comparison to people that were not diagnosed with the disorder. Of these deaths, 40% of them were a result of unnatural causes, such as suicides, homicides, or accidents. Additionally, since 82 of the 110 deaths were people with comorbid mental disorder, the study suggests that comorbidity has a strong influence on mortality in people diagnosed with OCD.

I didn’t think the results of this study were very surprising, because the study starts out by saying that there are a number of mental disorders that are associated with an increased rate of mortality. OCD is considered to be one of the most debilitating mental disorders, so it comes as no surprise that it would have an effect on one’s life expectancy. Also, I think this article demonstrates the importance of increasing the awareness of mental illness. If caught early, sufferers of OCD have a better chance of living a more normal, functional life. On the other hand, the longer the disorder persists without treatment, the more debilitating the disorder ends up being. Therefore, consideration should be given to promoting the importance of mental health so that patients could have a increased chance of getting the proper treatment and medication for their disorder.

Meier SM, Mattheisen M, Mors O, et al. Mortality Among Persons With Obsessive-Compulsive Disorder in Denmark. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2015.3105. (Published 27 January 2016).