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Forester BP, Mathias L, Mellen E, Monette P, Rahman A, Harper DG, Seiner S, Mueller M, Knapp R, Hermida A, Nykamp L, Lapid MI, Petrides G. P3-017: ELECTROCONVULSIVE THERAPY FOR THE TREATMENT OF ACUTE AGITATION AND AGGRESSION IN ALZHEIMER'S DEMENTIA (ECT-AD). Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.3043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | - Rebecca Knapp
- Medical University of South Carolina; Charleston SC USA
| | | | - Louis Nykamp
- Pine Rest Christian Mental Health Center; Grand Rapids MI USA
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Chen Q, Boeve BF, Senjem ML, Tosakulwong N, Lesnick TG, Brushaber D, Dheel C, Fields JA, Forsberg LK, Gavrilova RH, Gearhart D, Graff-Radford J, Graff-Radford NR, Jack CR, Jones DT, Knopman DS, Kremers WK, Lapid MI, Rademakers R, Syrjanen J, Boxer AL, Rosen HJ, Wszolek Z, Kantarci K. P3-364: RATES OF LOBAR ATROPHY IN ASYMPTOMATIC MAPT
MUTATION CARRIERS. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.3397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Qin Chen
- West China Hospital; Chengdu China
- Mayo Clinic; Rochester MN USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Adam L. Boxer
- University of California, San Francisco; San Francisco CA USA
| | - Howard J. Rosen
- Department of Neurology; University of California, San Francisco; San Francisco CA USA
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Lapid MI, Clarke BL, Wright RS. Institutional Review Boards: What Clinician Researchers Need to Know. Mayo Clin Proc 2019; 94:515-525. [PMID: 30832791 DOI: 10.1016/j.mayocp.2019.01.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 12/21/2018] [Accepted: 01/10/2019] [Indexed: 11/28/2022]
Abstract
The institutional review board (IRB) is a group federally mandated to review and monitor research involving humans to ensure protection of their rights and welfare as research participants. Clinicians engaged in research require IRB approval for all research involving human participants, whether living individuals, data, or specimens. The process for obtaining IRB approval may seem like a daunting task. However, it is critical for clinical researchers to conduct research in a manner that protects human participants, and it is the mission of the IRB to help researchers accomplish this task. The purpose of this article is to review the role and purpose of the IRB, highlight federal and regulatory standards in human research participants protection, and help clinical researchers have a broader understanding of IRB functions that will help them conduct high-quality research with human participants.
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Affiliation(s)
- Maria I Lapid
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN; Mayo Clinic Institutional Review Board, Mayo Clinic, Rochester, MN.
| | - Bart L Clarke
- Department of Medicine, Division of Endocrinology, Mayo Clinic, Rochester, MN; Mayo Clinic Institutional Review Board, Mayo Clinic, Rochester, MN
| | - R Scott Wright
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Mayo Clinic Institutional Review Board, Mayo Clinic, Rochester, MN
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Bobo WV, Grossardt BR, Lapid MI, Leung JG, Stoppel C, Takahashi PY, Hoel RW, Chang Z, Lachner C, Chauhan M, Flowers L, Brue SM, Frye MA, St. Sauver J, Rocca WA, Sutor B. Frequency and predictors of the potential overprescribing of antidepressants in elderly residents of a geographically defined U.S. population. Pharmacol Res Perspect 2019; 7:e00461. [PMID: 30693088 PMCID: PMC6344796 DOI: 10.1002/prp2.461] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/07/2018] [Accepted: 12/18/2018] [Indexed: 12/20/2022] Open
Abstract
The purpose of this study was to estimate the extent of potential antidepressant overprescribing in a geographically defined U.S. population, and to determine the indications and factors that account for it. We conducted a cohort study of new antidepressant prescriptions for elderly residents of Olmsted County, Minnesota, 2005-2012, using the Rochester Epidemiology Project medical records-linkage system. Indications for antidepressants were abstracted from health records for all cohort members. Potential antidepressant overprescribing was defined based on regulatory approval, the level of evidence identified from a standardized drug information database, and multidisciplinary expert review. Predictors of potential antidepressant overprescribing were investigated using logistic regression models, stratified by general antidepressant indication (general medical indication, specific psychiatric diagnosis, and non-specific psychiatric symptoms). Potential antidepressant overprescribing occurred in 24% of 3199 incident antidepressant prescriptions during the study period, and involved primarily newer antidepressants that were prescribed for non-specific psychiatric symptoms and subthreshold diagnoses. Potential antidepressant overprescribing was associated with nursing home residence, having a higher number of comorbid medical conditions and outpatient prescribers, taking more concomitant medications, having greater use of urgent or acute care services in the year preceding the index antidepressant prescription, and being prescribed antidepressants via telephone, e-mail, or patient portal. In conclusion, potential antidepressant overprescribing occurred in elderly persons and involved mainly newer antidepressants used for non-specific psychiatric symptoms and subthreshold diagnoses, and was associated with indicators of higher clinical complexity or severity and with prescribing without face-to-face patient contact.
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Affiliation(s)
- William V. Bobo
- Department of Psychiatry & PsychologyMayo ClinicJacksonvilleFlorida
| | - Brandon R. Grossardt
- Division of Biomedical Statistics and InformaticsDepartment of Health Sciences ResearchMayo ClinicRochesterMinnesota
| | - Maria I. Lapid
- Department of Psychiatry & PsychologyMayo ClinicRochesterMinnesota
| | | | - Cynthia Stoppel
- Department of Psychiatry & PsychologyMayo ClinicRochesterMinnesota
| | - Paul Y. Takahashi
- Department of Primary Care Internal MedicineMayo ClinicRochesterMinnesota
| | - Robert W. Hoel
- Department of Pharmacy ServicesMayo ClinicRochesterMinnesota
| | - Zheng Chang
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | | | - Mohit Chauhan
- Department of Psychiatry & PsychologyMayo ClinicJacksonvilleFlorida
| | - Lee Flowers
- Department of Psychiatry & PsychologyMayo ClinicRochesterMinnesota
| | - Scott M. Brue
- Biomedical Informatics Support SystemMayo ClinicRochesterMinnesota
| | - Mark A. Frye
- Department of Psychiatry & PsychologyMayo ClinicRochesterMinnesota
| | - Jennifer St. Sauver
- Division of EpidemiologyDepartment of Health Sciences ResearchMayo ClinicRochesterMinnesota
| | - Walter A. Rocca
- Division of EpidemiologyDepartment of Health Sciences ResearchMayo ClinicRochesterMinnesota
- Department of NeurologyMayo ClinicRochesterMinnesota
| | - Bruce Sutor
- Department of Psychiatry & PsychologyMayo ClinicRochesterMinnesota
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Gentry MT, Lapid MI, Rummans TA. Geriatric Telepsychiatry: Systematic Review and Policy Considerations. Am J Geriatr Psychiatry 2019; 27:109-127. [PMID: 30416025 DOI: 10.1016/j.jagp.2018.10.009] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 10/12/2018] [Accepted: 10/12/2018] [Indexed: 01/02/2023]
Abstract
Telemental health (TMH) for older patients has the potential to increase access to geriatric specialists, reduce travel times for patients and providers, and reduce ever growing healthcare costs. This systematic review article examines the literature regarding psychiatric assessment and treatment via telemedicine for geriatric patients. English language literature was searched using Ovid Medline, PubMed, and PsycINFO with search terms including telemedicine, telemental health, aging, and dementia. Abstracts were reviewed for relevance based on inclusion criteria. Multiple study types were reviewed, including open label, qualitative and randomized controlled trial study designs. Data was compiled regarding participants, study intervention, and outcomes. 76 articles were included. TMH was shown to be feasible and well accepted in the areas of inpatient and nursing home consultation, cognitive testing, dementia diagnosis and treatment, depression in integrated and collaborative care models, and psychotherapy. There is limited data on cost-effectiveness of TMH in the elderly. This article will discuss the current barriers to broader implementation of telemedicine for geriatric patients including reimbursement from the Medicare program. Medicare reimbursement for telemedicine is limited to rural areas, which does not allow for the widespread development of telemedicine programs. All Medicare beneficiaries would benefit from increased access to telemedicine services, not only those living in rural areas. As many elderly and disabled individuals have mobility problems, home-based telemedicine services should also be made available. There are efforts in Congress to expand the coverage of these services under Medicare, but strong advocacy will be needed to ensure these efforts are successful.
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Affiliation(s)
- Melanie T Gentry
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota.
| | - Maria I Lapid
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Teresa A Rummans
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
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56
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Schoonover KL, Lapid MI. Clinical Phenomenology and Characteristics of Centenarians in Hospice. J Palliat Care 2018; 34:47-51. [PMID: 30229699 DOI: 10.1177/0825859718800491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES: Little is known about the hospice experience of centenarians. As the population of centenarians is projected to increase, understanding their unique end-of-life needs will be important to inform delivery of quality end-of-life care. Our objective was to characterize the hospice experience of centenarians. METHODS: A retrospective single-institution cohort study of centenarians enrolled in hospice from January 1, 2015, to December 31, 2017, was conducted to collect demographic and clinical information. RESULTS: Seventeen centenarians, who comprised 1.4% of hospice admissions, had an average age of 102 years, were mostly female (71%) and widowed (76%), and all caucasian. Upon hospice admission, centenarians resided in nursing (8, 47%) and assisted living (4, 24%) residencies as well as at home (4, 24%) and in senior independent living (1, 6%). Sixty percent of centenarians died in a nursing home. The most common hospice admission diagnosis was dementia (35%). Median length of stay on hospice was 41 days (range: 16-85) for 15 persons who died or discharged live. CONCLUSIONS: In this group of centenarians, dementia was the most common condition for hospice enrollment. Slightly less than half resided in nursing homes on admission, although death occurred most frequently in a nursing home. Centenarians were generally able to remain out of the hospital at their time of death.
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Affiliation(s)
| | - Maria I Lapid
- 1 Center for Palliative Medicine, Mayo Clinic, Rochester, MN, USA.,2 Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.,3 Mayo Clinic Hospice, Mayo Clinic, Rochester, MN, USA
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Chu SA, Flagan TM, Jiskoot LC, Seeley WW, Papma JM, Deng J, Rosen HJ, Boeve BF, Boxer AL, Heuer HW, Brushaber D, Grossman M, Coppola G, Dickerson BC, Bordelon YM, Dheel C, Faber K, Feldman HH, Fields JA, Fong J, Foroud TM, Forsberg LK, Gavrilova RH, Ghoshal N, Graff-Radford NR, Robin Hsiung GY, Huey ED, Irwin D, Kantarci K, Kaufer D, Karydas AM, Klein A, Knopman DS, Kornak J, Kramer JH, Kukull WA, Lapid MI, Laxineta S, Litvan I, Mackenzie IR, Mendez MF, Miller BL, Onyike CU, Pantelyat A, Potter M, Rademakers R, Roberson ED, Tartaglia MC, Tatton N, Toga AW, Vetor A, Weintraub S, Wong B, Wszolek Z, Swieten JC, Lee SE. P1‐433: GRAY MATTER DEFICITS IN SYMPTOMATIC AND PRESYMPTOMATIC
MAPT
MUTATION CARRIERS. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | - Taru M. Flagan
- University of California San FranciscoSan FranciscoCAUSA
| | | | | | - Janne M. Papma
- Alzheimer Center and Department of NeurologyErasmus University Medical CenterRotterdamNetherlands
| | - Jersey Deng
- University of California San FranciscoSan FranciscoCAUSA
| | | | | | - Adam L. Boxer
- University of California San FranciscoSan FranciscoCAUSA
| | | | | | - Murray Grossman
- Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Giovanni Coppola
- University of CaliforniaLos Angeles School of MedicineLos AngelesCAUSA
| | | | | | | | - Kelley Faber
- Indiana University School of MedicineIndianapolisINUSA
| | | | | | - Jamie Fong
- University of California San FranciscoSan FranciscoCAUSA
| | | | | | | | - Nupur Ghoshal
- Washington University School of MedicineSt. LouisMOUSA
| | | | | | - Edward D. Huey
- Gertrude H. Sergievsky Center at Columbia UniversityNew YorkNYUSA
| | | | | | | | | | | | | | - John Kornak
- University of California San FranciscoSan FranciscoCAUSA
| | - Joel H. Kramer
- University of California San FranciscoSan FranciscoCAUSA
| | - Walter A. Kukull
- National Alzheimer's Coordinating CenterUniversity of WashingtonSeattleWAUSA
| | | | | | - Irene Litvan
- University of California San DiegoSan DiegoCAUSA
| | | | | | - Bruce L. Miller
- Memory and Aging Center, UCSF Weill Institute for NeurosciencesUniversity of California, San FranciscoSan FranciscoCAUSA
| | | | - Alex Pantelyat
- Johns Hopkins University School of MedicineBaltimoreMDUSA
| | | | | | | | | | | | - Arthur W. Toga
- Stevens Neuroimaging and Informatics Institute, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Ashley Vetor
- Indiana University School of MedicineIndianapolisINUSA
| | | | | | | | - John C. Swieten
- Department of NeurologyErasmus University Medical CenterRotterdamNetherlands
| | - Suzee E. Lee
- University of California San FranciscoSan FranciscoCAUSA
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Kornak J, Fields JA, Farmer S, Boeve BF, Rosen HJ, Boxer AL, Bove J, Brushaber D, Coppola G, Dheel C, Dickerson BC, Dickinson S, Faber K, Fong J, Foroud TM, Forsberg LK, Gavrilova RH, Gearhart D, Ghoshal N, Goldman J, Graff-Radford J, Graff-Radford NR, Grossman M, Haley D, Heuer HW, Hsiao J, Robin Hsiung GY, Huey ED, Irwin D, Jones DT, Jones L, Kantarci K, Karydas AM, Knopman DS, Kramer JH, Kremers WK, Kukull WA, Lapid MI, Lucente D, Mackenzie IR, Manoochehri M, Miller BL, Pearlman R, Petrucelli L, Potter M, Rademakers R, Rankin K, Rascovsky K, Sengdy P, Shaw LM, Sutherland M, Syrjanen J, Tatton N, Taylor J, Toga AW, Trojanowski JQ, Weintraub S, Wong B, Wszolek Z. P1‐281: NONLINEAR N‐SCORE ESTIMATION FOR ESTABLISHING COGNITIVE NORMS FROM THE NATIONAL ALZHEIMER'S COORDINATING CENTER (NACC) DATASET. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- John Kornak
- University of California San FranciscoSan FranciscoCAUSA
| | | | | | | | | | - Adam L. Boxer
- University of California San FranciscoSan FranciscoCAUSA
| | | | | | - Giovanni Coppola
- University of CaliforniaLos Angeles School of MedicineLos AngelesCAUSA
| | | | | | | | - Kelley Faber
- Indiana University School of MedicineIndianapolisINUSA
| | - Jamie Fong
- University of California San FranciscoSan FranciscoCAUSA
| | | | | | | | | | - Nupur Ghoshal
- Washington University School of MedicineSt. LouisMOUSA
| | - Jill Goldman
- Gertrude H. Sergievsky Center at Columbia UniversityNew YorkNYUSA
| | | | | | - Murray Grossman
- Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | | | | | | | - Ging-Yuek Robin Hsiung
- University of British ColumbiaVancouverBCCanada
- Vancouver Coastal Health Research InstituteVancouverBCCanada
| | - Edward D. Huey
- Gertrude H. Sergievsky Center at Columbia UniversityNew YorkNYUSA
| | | | | | | | | | - Anna M. Karydas
- Memory and Aging Center, UCSF Weill Institute for NeurosciencesUniversity of California, San FranciscoSan FranciscoCAUSA
| | | | - Joel H. Kramer
- University of California San FranciscoSan FranciscoCAUSA
| | | | - Walter A. Kukull
- National Alzheimer's Coordinating CenterUniversity of WashingtonSeattleWAUSA
| | | | - Diane Lucente
- The Harvard Clinical and Translational Science CenterBostonMAUSA
| | | | | | - Bruce L. Miller
- Memory and Aging Center, UCSF Weill Institute for NeurosciencesUniversity of California, San FranciscoSan FranciscoCAUSA
| | | | | | | | | | | | | | | | - Leslie M. Shaw
- Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | | | - Jeremy Syrjanen
- Department of Health Sciences ResearchMayo ClinicRochesterMNUSA
| | | | - Joanne Taylor
- University of California San FranciscoSan FranciscoCAUSA
| | - Arthur W. Toga
- Stevens Neuroimaging and Informatics Institute, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCAUSA
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Staffaroni AM, Bajorek L, Ljubenkov P, Casaletto K, Elahi F, Rascovsky K, Boeve BF, Boxer AL, Bove J, Brushaber D, Coppola G, Dheel C, Dickerson BC, Fields JA, Fong J, Forsberg LK, Gavrilova RH, Gearhart D, Ghoshal N, Goldman J, Radford JG, Graff-Radford NR, Grossman M, Haley D, Heuer HW, Hsiao J, Robin Hsiung GY, Huey E, Irwin DJ, Jones DT, Jones L, Kantarci K, Karydas AM, Knopman DS, Kornak J, Kremers WK, Kukull WA, Lapid MI, Lucente D, Mackenzie IR, Manoochehri M, Miller BL, Potter M, Rademakers R, Rankin K, Sutherland M, Syrjanen J, Taylor J, Weintraub S, Wong B, Wszolek Z, Rosen HJ, Kramer JH. O1‐08‐01: THE NIH‐EXAMINER IS SENSITIVE TO COGNITIVE CHANGES IN ASYMPTOMATIC AND MILDLY SYMPTOMATIC FAMILIAL FRONTOTEMPORAL DEMENTIA. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.2372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | - Lynn Bajorek
- University of California San FranciscoSan FranciscoCAUSA
| | | | | | - Fanny Elahi
- University of California San FranciscoSan FranciscoCAUSA
| | | | | | - Adam L. Boxer
- University of California San FranciscoSan FranciscoCAUSA
| | | | | | - Giovanni Coppola
- University of CaliforniaLos Angeles School of MedicineLos AngelesCAUSA
| | | | | | | | - Jamie Fong
- University of California San FranciscoSan FranciscoCAUSA
| | | | | | | | - Nupur Ghoshal
- Washington University School of MedicineSt. LouisMOUSA
| | | | | | | | - Murray Grossman
- Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | | | | | | | | | | | - David J. Irwin
- Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | | | | | | | | | | | - John Kornak
- University of California San FranciscoSan FranciscoCAUSA
| | | | - Walter A. Kukull
- National Alzheimer's Coordinating CenterUniversity of WashingtonSeattleWAUSA
| | | | - Diane Lucente
- The Harvard Clinical and Translational Science CenterBostonMAUSA
| | | | | | | | | | | | | | | | - Jeremy Syrjanen
- Department of Health Sciences ResearchMayo ClinicRochesterMNUSA
| | - Joanne Taylor
- University of California San FranciscoSan FranciscoCAUSA
| | | | | | | | | | - Joel H. Kramer
- University of California San FranciscoSan FranciscoCAUSA
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Abstract
PURPOSE OF REVIEW Dementia is a progressive and life-limiting condition that can be described in three stages: early, middle, and late. This article reviews current literature on late-stage dementia. RECENT FINDINGS Survival times may vary across dementia subtypes. Yet, the overall trajectory is characterized by progressive decline until death. Ideally, as people with dementia approach the end of life, care should focus on comfort, dignity, and quality of life. However, barriers prevent optimal end-of-life care in the final stages of dementia. Improved and earlier advanced care planning for persons with dementia and their caregivers can help delineate goals of care and prepare for the inevitable complications of end-stage dementia. This allows for timely access to palliative and hospice care, which ultimately improves dementia end-of-life care.
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Affiliation(s)
| | - Laura Suarez
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Reem M A Shafi
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Joshua M Baruth
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Amanda J M Benarroch
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Maria I Lapid
- Center for Palliative Medicine, Mayo Clinic, Rochester, MN, USA. .,Department of Psychiatry and Psychology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
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Abstract
Background Interest in the use of telehealth interventions to increase access to healthcare services is growing. Group-based interventions have the potential to increase patient access to highly needed services. The aim of this study was to systematically review the available literature on group-based video teleconference services. Methods The English-language literature was searched using Ovid MEDLINE, PubMed, PsycINFO and CINAHL for terms related to telehealth, group therapy and support groups. Abstracts were reviewed for relevance based on inclusion criteria. Multiple study types were reviewed, including open-label, qualitative and randomised controlled trial study designs. Data were compiled regarding participants, study intervention and outcomes. Specific areas of interest were the feasibility of and satisfaction with telehealth technology, as well as the effect of video teleconference delivery on group dynamics, including therapeutic alliance. Results Forty published studies met the inclusion criteria and were included in the review. Six were randomised controlled trials. Among the studies, there was a broad range of study designs, participants, group interventions and outcome measures. Video teleconference groups were found to be feasible and resulted in similar treatment outcomes to in-person groups. However, few studies were designed to demonstrate noninferiority of video teleconference groups compared with in-person groups. Studies that examined group process factors showed small decreases in therapeutic alliance in the video teleconference participants. Conclusions Video teleconference groups are feasible and produce outcomes similar to in-person treatment, with high participant satisfaction despite technical challenges. Additional research is needed to identify optimal methods of video teleconference group delivery to maximise clinical benefit and treatment outcomes.
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Affiliation(s)
| | - Maria I Lapid
- Department of Psychiatry and Psychology, Mayo Clinic, USA
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Sytsma TT, Schmelkin LA, Jenkins SM, Lovejoy LA, Lapid MI, Piderman KM. “Keep the faith”: Spirituality as a contributor to resiliency in five elderly people. Journal of Religion, Spirituality & Aging 2018. [DOI: 10.1080/15528030.2018.1441095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Vork DL, Schneekloth TD, Bartley AC, Vaughan LE, Lapid MI, Jowsey-Gregoire SG, El-Zoghby ZM, Herrmann SM, Tran CL, Albright RC, Hickson LJ. Younger Adults Initiating Hemodialysis: Antidepressant Use for Depression Associated With Higher Health Care Utilization. Mayo Clin Proc 2018; 93:321-332. [PMID: 29502562 PMCID: PMC5854145 DOI: 10.1016/j.mayocp.2017.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 11/23/2017] [Accepted: 12/05/2017] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To examine associations between antidepressant use and health care utilization in young adults beginning maintenance hemodialysis (HD) therapy. PATIENTS AND METHODS Antidepressant use, hospitalizations, and emergency department (ED) visits were examined in young adults (N=130; age, 18-44 years) initiating HD (from January 1, 2001, through December 31, 2013) at a midwestern US institution. Primary outcomes included hospitalizations and ED visits during the first year. RESULTS Depression diagnosis was common (47; 36.2%) at HD initiation, yet only 28 patients (21.5%) in the cohort were receiving antidepressant therapy. The antidepressant use group was more likely to have diabetes mellitus (18 [64.3%] vs 33 [32.4%]), coronary artery disease (8 [28.6%] vs 12 [11.8%]), and heart failure (9 [32.1%] vs 15 [14.7%]) (P<.05 for all) than the untreated group. Overall, 68 (52.3%) had 1 or more hospitalizations and 33 (25.4%) had 1 or more ED visits in the first year. The risk of hospitalization during the first year was higher in the antidepressant use group (hazard ratio, 2.35; 95% CI, 1.39-3.96; P=.001), which persisted after adjustment for diabetes, coronary artery disease, and heart failure (hazard ratio, 1.94; 95% CI, 1.22-3.10; P=.006). Emergency department visit rates were similar between the groups. CONCLUSION Depression and antidepressant use for mood indication are common in young adult incident patients initiating HD and and are associated with higher hospitalization rates during the first year. Further research should determine whether antidepressants are a marker for other comorbidities or whether treated depression affects the increased health care use in these individuals.
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Affiliation(s)
| | | | - Adam C Bartley
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Lisa E Vaughan
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Maria I Lapid
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | | | - Ziad M El-Zoghby
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | | | - Cheryl L Tran
- Division of Pediatric Nephrology, Department of Pediatrics, Mayo Clinic, Rochester, MN
| | | | - LaTonya J Hickson
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
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Kayhart B, Lapid MI, Nelson S, Cunningham JL, Thompson VH, Leung JG. A Lack of Systemic Absorption Following the Repeated Application of Topical Quetiapine in Healthy Adults. Am J Hosp Palliat Care 2018; 35:1076-1080. [DOI: 10.1177/1049909117753828] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
In the absence of suitable oral or intravenous access for medication administration and when the intramuscular medications are undesirable, alternative routes for drug delivery may be considered. Antipsychotics administered via an inhaled, intranasal, rectal, or topical route have been described in the literature. Topically administered antipsychotics have been previously reported to produce negligible systemic absorption despite being used in clinical practice for nausea and behavioral symptoms associated with dementia. Additionally, the American Academy of Hospice and Palliative Medicine recommends against the use of topical medications that lack supporting literature. Three studies have assessed the systemic absorption of different antipsychotics after administration of only a single, topically applied dose. To evaluate whether the repeated administration of a topically applied antipsychotic may result in detectable serum levels in an accumulating fashion, a pharmacokinetic study was conducted. Five healthy, adult participants consented to receive extemporaneously prepared topical quetiapine in Lipoderm every 4 hours for a total of 5 doses. Blood samples were drawn at baseline and hours 2, 4, 8, 12, 16, and 24, and serum quetiapine concentrations were measured using high-performance liquid chromatography. Quetiapine was undetectable in every sample from 3 participants. Two participants had minimally detectable serum quetiapine levels no sooner than hour 12 of the study period. Extemporaneously prepared quetiapine in Lipoderm resulted in nonexistent or minimal serum level following repeated topical administration. The use of topically applied quetiapine should still be questioned.
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Affiliation(s)
- Bryce Kayhart
- Hospital Pharmacy Services, Mayo Clinic Hospital, Rochester, MN, USA
| | - Maria I. Lapid
- Mayo Clinic Department of Psychiatry and Psychology, Rochester, MN, USA
| | - Sarah Nelson
- Hospital Pharmacy Services, Mayo Clinic Hospital, Rochester, MN, USA
| | | | | | - Jonathan G. Leung
- Hospital Pharmacy Services, Mayo Clinic Hospital, Rochester, MN, USA
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Baruth JM, Lapid MI. Capacity Determinations and Elder Self-Neglect. AMA J Ethics 2017; 19:1047-1050. [PMID: 29028474 DOI: 10.1001/journalofethics.2017.19.10.corr2-1710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Joshua M Baruth
- A resident in the Department of Psychiatry & Psychology at the Mayo Clinic in Rochester, Minnesota
| | - Maria I Lapid
- A geriatric psychiatrist and palliative care specialist at the Mayo Clinic in Rochester, Minnesota
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Abstract
How psychiatric symptoms affect patients' decision making in practice can inform how we think-theoretically and conceptually-about what it means for those patients to have decision-making capacity. Assessment of a patient's decisional capacity allows those with adequate capacity to make choices regarding treatment and protects those who lack capacity from potential harm caused by impaired decision making. In analyzing a case in which a patient with stage II breast cancer refuses further treatment, we review the conceptual model of informed consent and approaches to assessing decision-making capacity that are in accordance with the American Medical Association Code of Medical Ethics as well as tools to assess decisional capacity.
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Affiliation(s)
- Joshua M Baruth
- Resident in the Department of Psychiatry & Psychology at the Mayo Clinic in Rochester, Minnesota
| | - Maria I Lapid
- Geriatric psychiatrist and palliative care specialist at the Mayo Clinic in Rochester, Minnesota
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67
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Lapid MI, Kuntz KM, Mason SS, Aakre JA, Lundt ES, Kremers W, Allen LA, Drubach DA, Boeve BF. Efficacy, Safety, and Tolerability of Armodafinil Therapy for Hypersomnia Associated with Dementia with Lewy Bodies: A Pilot Study. Dement Geriatr Cogn Disord 2017; 43:269-280. [PMID: 28448998 PMCID: PMC5503747 DOI: 10.1159/000471507] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND/AIMS Hypersomnia is common in dementia with Lewy bodies (DLB). We assessed the efficacy, safety, and tolerability of armodafinil for hypersomnia associated with DLB. METHODS We performed a 12-week pilot trial of armodafinil therapy (125-250 mg orally daily) in DLB outpatients with hypersomnia. The patients underwent neurologic examinations, a neuropsychological battery, laboratory testing, electrocardiography, and polysomnography. Efficacy was assessed at 2, 4, 8, and 12 weeks. Safety assessment included laboratory examinations, QTc interval, and heart rate. Tolerability was assessed by analysis of adverse events. Data were analyzed using the last-observation-carried-forward method. RESULTS Of 20 participants, 17 completed the protocol. The median age was 72 years, most of the participants were men (80%), and most had spouses as caregivers. The Epworth Sleepiness Scale (p < 0.001), Maintenance of Wakefulness Test (p = 0.003), and Clinical Global Impression of Change (p < 0.001) scores improved at week 12. The Neuropsychiatric Inventory total score (p = 0.003), visual hallucinations (p = 0.003), and agitation (p = 0.02) improved at week 4. Caregiver overall quality of life improved at week 12 (p = 0.004). No adverse events occurred. CONCLUSION These pilot data suggest improvements in hypersomnia and wakefulness and reasonable safety and tolerability of armodafinil therapy in hypersomnolent patients with DLB. Our findings inform the use of pharmacologic strategies for managing hypersomnolence in these patients.
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Affiliation(s)
- Maria I Lapid
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
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Markota M, Rummans TA, Bostwick JM, Lapid MI. Benzodiazepine Use in Older Adults: Dangers, Management, and Alternative Therapies. Mayo Clin Proc 2016; 91:1632-1639. [PMID: 27814838 DOI: 10.1016/j.mayocp.2016.07.024] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 07/18/2016] [Accepted: 07/22/2016] [Indexed: 01/27/2023]
Abstract
Several major medical and psychiatric organizations, including the American Geriatrics Society, advise against using benzodiazepines or nonbenzodiazepine hypnotics in older adults. Despite these recommendations, benzodiazepines continue to be massively prescribed to a group with the highest risk of serious adverse effects from these medications. This article summarizes legitimate reasons for prescribing benzodiazepines in the elderly, serious associated risks of prescribing them, particularly when not indicated, barriers physicians encounter in changing their prescription patterns, and evidence-based strategies on how to discontinue benzodiazepines in older patients. Although more research is needed, we propose several alternatives for treating insomnia and anxiety in older adults in primary care settings. These include nonpharmacological approaches such as sleep restriction-sleep compression therapy and cognitive behavioral therapy for anxiety or insomnia, and as well as alternative pharmacological agents.
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Affiliation(s)
- Matej Markota
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Teresa A Rummans
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN.
| | | | - Maria I Lapid
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
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69
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Piderman KM, Egginton JS, Ingram C, Dose AM, Yoder TJ, Lovejoy LA, Swanson SW, Hogg JT, Lapid MI, Jatoi A, Remtema MS, Tata BS, Breitkopf CR. I’m Still Me: Inspiration and Instruction from Individuals with Brain Cancer. J Health Care Chaplain 2016; 23:15-33. [DOI: 10.1080/08854726.2016.1196975] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bommersbach TJ, Lapid MI, Leung JG, Cunningham JL, Rummans TA, Kung S. Management of Psychotropic Drug-Induced DRESS Syndrome: A Systematic Review. Mayo Clin Proc 2016; 91:787-801. [PMID: 27126302 DOI: 10.1016/j.mayocp.2016.03.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 03/01/2016] [Accepted: 03/08/2016] [Indexed: 11/18/2022]
Abstract
Drug rash with eosinophilia and systemic symptoms (DRESS) is a severe cutaneous eruption that has been linked to several common drugs and drug categories, including antiepileptics, allopurinol, sulfonamides, and various antibiotics; however, because of a number of recent case reports linking psychotropic medications to this condition, DRESS is increasingly recognized among psychiatrists. We systematically reviewed all psychotropic drugs linked to DRESS syndrome, and this article summarizes the clinical management relevant to psychiatric professionals. A comprehensive search was performed using Ovid MEDLINE, Ovid EMBASE, Ovid Cochrane Database of Systematic Reviews, Web of Science, Scopus, and Litt's Drug Eruption and Reaction Database for articles published in English during the past 20 years (1996-2015) using the search terms (1) psychotropic drugs OR serotonin uptake inhibitors AND DRESS or (2) psychotropic drugs AND drug reaction (or rash) eosinophilia systemic syndrome, and all article abstracts were screened for inclusion and exclusion criteria by 3 reviewers. Two independent reviewers examined the full text of 163 articles, of which 96 (25 original articles, 12 review articles, 55 case reports, and 4 letters to the editor) were included in the systematic review. We identified 1072 cases of psychotropic drug-induced DRESS, with carbamazepine, lamotrigine, phenytoin, valproate, and phenobarbital being the most implicated drugs. Based on our review of the literature, we outline management principles that include prompt withdrawal of the causative drug, hospitalization, corticosteroid therapy, and novel treatments, including intravenous immunoglobulin, cyclophosphamide, and cyclosporine, for corticosteroid-resistant DRESS. Finally, we outline strategies for treating comorbid psychiatric illness after a DRESS reaction to the psychotropic medication.
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Affiliation(s)
- Tanner J Bommersbach
- Mayo Medical School, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN
| | - Maria I Lapid
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN.
| | | | | | - Teresa A Rummans
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Simon Kung
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
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71
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Josephs KA, Whitwell JL, Parisi JE, Lapid MI. Coprophagia in neurologic disorders. J Neurol 2016; 263:1008-1014. [PMID: 27017341 DOI: 10.1007/s00415-016-8096-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 03/09/2016] [Accepted: 03/10/2016] [Indexed: 11/25/2022]
Abstract
We report on the unusual behavior of coprophagia (eating one's own feces) in neurologic disorders. The Mayo Clinic Health Sciences-computerized clinical database was queried for all patients evaluated at our institution between 1995 and 2015 in which coprophagia was documented in the medical records. Twenty-six patients were identified of which 17 had coprophagia. Of the 17 patients, five were excluded due to age at onset less than 10 years, leaving 12 adult patients for this study. The median age at onset of coprophagia in the 12 patients was 55 years (range 20-88 years), and half were female. Additional behaviors were common including scatolia (fecal smearing), hypersexuality, aggression, and pica (eating objects of any kind). Coprophagia was associated with neurodegenerative dementia in six patients, developmental delay in two, and one each with seizures, steroid psychosis, frontal lobe tumor, and schizoaffective disorder. Brain imaging in the six patients with dementia showed moderate-to-severe medial temporal lobe atrophy, as well as mild frontal lobe atrophy. Autopsy examination was performed in one patient and revealed frontotemporal lobar degeneration pathology. Many different behavioral and pharmacologic therapies were implemented, yet only haloperidol was associated with discontinuation of the behavior. Coprophagia is associated with different neurologic disorders, particularly neurodegenerative dementias. The behavior may be related to medial temporal lobe atrophy, similar to the Klüver-Bucy syndrome. Haloperidol appears to be effective in treating the behavior, at least in some patients.
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Affiliation(s)
- Keith A Josephs
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | | | - Joseph E Parisi
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Maria I Lapid
- Department of Psychiatry, Mayo Clinic, Rochester, MN, USA
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72
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Leung JG, Nelson S, Cunningham JL, Thompson VH, Bobo WV, Kung S, Dierkhising RA, Plevak MF, Lapid MI. A Single-Dose Crossover Pharmacokinetic Comparison Study of Oral, Rectal and Topical Quetiapine in Healthy Adults. Clin Pharmacokinet 2016; 55:971-6. [PMID: 26873228 DOI: 10.1007/s40262-016-0368-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Quetiapine is an oral atypical antipsychotic drug commonly used to treat a large number of neuropsychiatric disorders and conditions. However, a substantial number of patients who may benefit from treatment with quetiapine are unable to ingest quetiapine or other medications by mouth and thus require alternative routes of administration. There are currently no studies evaluating non-oral compounded dosage forms of quetiapine. METHODS We conducted a single-dose open-label crossover pharmacokinetic study in 10 healthy adults to determine whether quetiapine compounded as a rectal suppository or a topical cream achieved absorption similar to that achieved by a commercially available oral formulation. RESULTS Rectal quetiapine produced an area under the plasma concentration-time curve from time zero to infinity (AUC∞) approximately 90 % greater than that produced by an equal (milligram per milligram) dose of oral quetiapine (15,333 ng/mL versus 8118.8 ng/mL, p = 0.005). However, only two of ten subjects who received topical quetiapine had detectable serum levels. When detected, serum levels achieved with topical quetiapine were delayed and low in comparison with those produced by the oral and rectal dosage forms. CONCLUSION Our results suggest that rectal, but not topical, quetiapine may be useful in clinical settings. Clinical outcome studies of rectal quetiapine are needed.
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Affiliation(s)
- Jonathan G Leung
- Department of Pharmacy, Mayo Clinic Hospital-Rochester, 1216 2nd Street SW, Rochester, MN, 55902, USA.
| | - Sarah Nelson
- Department of Pharmacy, Mayo Clinic Hospital-Rochester, 1216 2nd Street SW, Rochester, MN, 55902, USA
| | - Julie L Cunningham
- Department of Pharmacy, Mayo Clinic Hospital-Rochester, 1216 2nd Street SW, Rochester, MN, 55902, USA
| | - Virginia H Thompson
- Department of Pharmacy, Mayo Clinic Hospital-Rochester, 1216 2nd Street SW, Rochester, MN, 55902, USA
| | - William V Bobo
- Department of Psychiatry and Psychology, Mayo Clinic Hospital-Rochester, 1216 2nd Street SW, Rochester, MN, 55902, USA
| | - Simon Kung
- Department of Psychiatry and Psychology, Mayo Clinic Hospital-Rochester, 1216 2nd Street SW, Rochester, MN, 55902, USA
| | - Ross A Dierkhising
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, 55902, USA
| | - Matthew F Plevak
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, 55902, USA
| | - Maria I Lapid
- Department of Psychiatry and Psychology, Mayo Clinic Hospital-Rochester, 1216 2nd Street SW, Rochester, MN, 55902, USA
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Piderman KM, Radecki Breitkopf C, Jenkins SM, Lapid MI, Kwete GM, Sytsma TT, Lovejoy LA, Yoder TJ, Jatoi A. The impact of a spiritual legacy intervention in patients with brain cancers and other neurologic illnesses and their support persons. Psychooncology 2015; 26:346-353. [DOI: 10.1002/pon.4031] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 09/01/2015] [Accepted: 10/16/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Katherine M. Piderman
- Chaplain Services; Mayo Clinic Rochester; 200 First Street SW EI 2-130 Rochester MN USA
| | - Carmen Radecki Breitkopf
- Division of Health Care Policy and Research, Health Sciences Research; Mayo Clinic Rochester; 200 First St. SW Charlton 6-235 Rochester MN USA 55905
| | - Sarah M. Jenkins
- Biostatistics and Informatics; Mayo Clinic Rochester; Rochester MN USA
| | - Maria I. Lapid
- Psychiatry and Psychology; Mayo Clinic Rochester; Rochester MN USA
| | - Gracia M. Kwete
- Mayo Medical School; Mayo Clinic Rochester; Rochester MN USA
| | | | - Laura A. Lovejoy
- Chaplain Services; Mayo Clinic Rochester; 200 First Street SW EI 2-130 Rochester MN USA
| | - Timothy J. Yoder
- Chaplain Services; Mayo Clinic Rochester; 200 First Street SW EI 2-130 Rochester MN USA
| | - Aminah Jatoi
- Medical Oncology; Mayo Clinic Rochester; Rochester MN USA
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74
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Kung S, Palmer BA, Lapid MI, Poppe KA, Alarcon RD, Frye MA. Screening for bipolar disorders: Clinical utilization of the Mood Disorders Questionnaire on an inpatient mood disorders unit. J Affect Disord 2015; 188:97-100. [PMID: 26344754 DOI: 10.1016/j.jad.2015.08.060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 08/23/2015] [Accepted: 08/25/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The Mood Disorders Questionnaire (MDQ) is a widely used screening instrument for bipolar disorders. The MDQ has seldom been used in the inpatient setting, and we report a clinical, real-world inpatient validation. METHODS Between April 2011 and August 2013, patients admitted to the inpatient Mood Disorders Unit completed an MDQ as part of their admission process. Patients with a discharge diagnosis of unipolar or bipolar disorders were included. The sensitivity and specificity were calculated for each number of questionnaire items checked positive, as well as the symptoms clustered around the same time and with moderate impairment in functioning. RESULTS A total of 1330 patient MDQ's were identified, and after excluding incomplete MDQ's and non-unipolar or bipolar diagnoses (e.g. anxiety, adjustment, or schizoaffective diagnoses), 860 MDQ's remained. One hundred fifty four patients (18%) were diagnosed with bipolar disorder, and 706 (82%) with unipolar depressive disorder. The average length of stay was 7.6 days. The optimal cutoff score was 8, resulting in a sensitivity/specificity of 86%/71%, compared to 92%/64% with a cutoff of 7. LIMITATIONS Retrospective study using clinical diagnoses instead of research instrument diagnoses. CONCLUSIONS The sensitivity of the MDQ in an inpatient mood disorders setting was higher than an outpatient psychiatric population, but the specificity was lower. A cutoff of 8 instead of the recommended outpatient cutoff of 7 was optimal. In today's busy clinical practices, a screening instrument for bipolar disorder is still useful, and the MDQ can be effectively utilized on an inpatient psychiatry mood disorders unit.
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Affiliation(s)
- Simon Kung
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
| | - Brian A Palmer
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Maria I Lapid
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | | | - Renato D Alarcon
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Mark A Frye
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
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75
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Lapid MI, Atherton PJ, Clark MM, Kung S, Sloan JA, Rummans TA. Cancer Caregiver: Perceived Benefits of Technology. Telemed J E Health 2015; 21:893-902. [PMID: 26075800 PMCID: PMC4649772 DOI: 10.1089/tmj.2014.0117] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 01/15/2015] [Accepted: 01/16/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The burden associated with caregiving has been well documented. Caregivers have multiple responsibilities, and technology may be accessible as a potential burden-alleviating resource. MATERIALS AND METHODS We surveyed cancer caregivers regarding current technology use and willingness to use technology for easing burden or distress. Because age has been associated with technology use, responses were compared between geriatric (≥65 years old) and nongeriatric (18-64 years old) caregivers. RESULTS We had 112 respondents. Based on nonmissing responses, 66% (n=71) were women, 95% (n=106) were white, and 84% (n=91) had post-high school education. Almost all caregivers reported having Internet (105 [94%]) and e-mail (102 [91%]) access. Nongeriatric caregivers indicated more willingness to access Internet-based tools that help caregivers (54 [93%] versus 41 [76%]; p=0.04) and were more frequent users of social media (37 [64%] versus 16 [30%]; p=0.01), smartphones (33 [57%] versus 16 [30%]; p=0.01), and other mobile wireless devices (42 [72%] versus 19 [35%]; p<0.001) than geriatric caregivers. They also more frequently expected technologies to improve their own quality of life (p=0.009), increase their feelings of being effective as a caregiver (p=0.02), and save time (p=0.003). Regardless of age, a majority of caregivers (67 [62%]) endorsed the potential benefit of caregiving technologies in preventing burnout. CONCLUSIONS Most caregivers have high access to and use of technology. Geriatric and nongeriatric caregivers were receptive to technology-based tools to help with their caregiving roles. Although nongeriatric caregivers expected to derive more benefit from such tools, both groups believed that caregiving technologies could reduce burden.
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Affiliation(s)
- Maria I. Lapid
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Pamela J. Atherton
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Matthew M. Clark
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Simon Kung
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Jeff A. Sloan
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Teresa A. Rummans
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
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Lapid MI, Atherton PJ, Kung S, Sloan JA, Shahi V, Clark MM, Rummans TA. Cancer caregiver quality of life: need for targeted intervention. Psychooncology 2015; 25:1400-1407. [PMID: 26360934 DOI: 10.1002/pon.3960] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 06/10/2015] [Accepted: 08/05/2015] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Caregiving can negatively impact well-being. Cancer caregivers face unique challenges given the intense nature of cancer and treatment, which increases their risk for burden, poor quality of life (QOL), and burnout. Studies to reduce caregiver burden demonstrate QOL improvement and distress reduction in the short term. However, few studies exist to address long-term benefits. We assessed changes in various QOL domains after participation in a QOL intervention for caregivers of patients having newly diagnosed advanced cancer. METHODS Our institutional review board-approved study randomized patient-caregiver dyads to either usual care or an in-person group intervention composed of six 90-min sessions of structured multidisciplinary QOL components delivered over 4 weeks, with 10 follow-up phone calls within 20 weeks. Caregivers attended four of the six sessions attended by patients. Sessions included physical therapy, coping and communication strategies, mental health education, spirituality, and social needs. Caregiver QOL (Caregiver Quality of Life Index-Cancer Scale [CQOLC] and Linear Analogue Self-Assessment [LASA]) and mood (Profile of Mood States-Brief [POMS-B]) were measured at baseline and 4, 27, and 52 weeks. Wilcoxon tests and effect sizes were used to compare the caregiver groups. RESULTS Of the 131 caregivers (65 intervention and 66 usual care), 116 completed the study. Caregivers post-intervention (at 4 weeks) had improved scores on LASA Spiritual Well-being; POMS-B total score, Vigor/Activity, and Fatigue/Inertia; and CQOLC Adaptation. At long term (at 27 weeks), caregivers retained improvement in POMS-B Fatigue/Inertia and gained improvements in CQOLC Disruptiveness and Financial Concerns. CONCLUSIONS Caregivers who received the intervention had higher QOL ratings for specific QOL domains but not for overall QOL. Although a comprehensive intervention was helpful, more specific, targeted interventions tailored for individual needs are recommended. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Maria I Lapid
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Pamela J Atherton
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Simon Kung
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Jeff A Sloan
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Varun Shahi
- Mayo Medical School, Mayo Clinic, Rochester, MN, USA
| | - Matthew M Clark
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Teresa A Rummans
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
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Cheville AL, Alberts SR, Rummans TA, Basford JR, Lapid MI, Sloan JA, Satele DV, Clark MM. Improving Adherence to Cancer Treatment by Addressing Quality of Life in Patients With Advanced Gastrointestinal Cancers. J Pain Symptom Manage 2015; 50:321-7. [PMID: 25975643 PMCID: PMC5557268 DOI: 10.1016/j.jpainsymman.2015.03.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 03/02/2015] [Accepted: 03/12/2015] [Indexed: 01/14/2023]
Abstract
CONTEXT Many patients with potentially curable cancer do not complete their prescribed treatment regimens because of the toxicity. There is evidence that the common endpoints of many of these toxicities are amenable to quality of life (QOL)-directed interventions. OBJECTIVES This study was conducted to determine the effect of a multidisciplinary QOL-directed intervention on patients' adherence to planned chemoradiation (CR) regimens. METHODS The results of two randomized controlled trials that used the same QOL intervention were pooled to form a cohort of 61 patients with advanced localized gastrointestinal cancer. Of these 61 subjects, 29 participated in six to eight bi- to triweekly sessions that included exercise, education, and relaxation, and 32 received usual medical care. The primary endpoint was completion of their prescribed CR regimens. Secondary outcomes included hospitalization during CR, rates of adverse postoperative events, and complete pathological response in those undergoing neoadjuvant therapy. RESULTS Significantly, more members of the intervention than the control group completed their planned CR regimens (77.8 vs. 38.2%, P = 0.003). More participants in the control (n = 14) than the intervention (n = 5) group (P = 0.063) required hospitalization. Among those undergoing neoadjuvant CR, those in the intervention group were significantly more likely to complete CR as planned (81.0% vs. 37.5%, P = 0.005) and less likely to be hospitalized (14.3% vs. 50.0%, P = 0.011). CONCLUSION A structured multidisciplinary QOL-directed intervention delivered to patients undergoing CR may increase the proportion of patients who complete CR as planned and reduce unplanned hospitalizations. Utilization is an important outcome in QOL-directed intervention trials.
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Affiliation(s)
- Andrea L Cheville
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA.
| | - Steven R Alberts
- Department of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Teresa A Rummans
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeffrey R Basford
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Maria I Lapid
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeff A Sloan
- Department of Health Service Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel V Satele
- Department of Health Service Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew M Clark
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
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Piderman KM, Breitkopf CR, Jenkins SM, Lovejoy LA, Dulohery YM, Marek DV, Durland HL, Head DL, Swanson SW, Hogg JT, Evans JL, Jorgenson SE, Bunkowski LJ, Jones KL, Euerle TT, Kwete GM, Miller KA, Morris JR, Yoder TJ, Lapid MI, Jatoi A. The feasibility and educational value of Hear My Voice, a chaplain-led spiritual life review process for patients with brain cancers and progressive neurologic conditions. J Cancer Educ 2015; 30:209-12. [PMID: 24952300 DOI: 10.1007/s13187-014-0686-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Research continues to establish the importance of spirituality for many persons with medical illnesses. This paper describes a pilot study titled, "Hear My Voice," designed to provide an opportunity for persons with progressive neurologic illnesses, including brain tumors and other neurodegenerative diseases, to review and discuss their spirituality with a board-certified chaplain, and to prepare a spiritual legacy document (SLD). First, we provide background information that underscores the importance of such a project for this patient population that is particularly vulnerable to cognitive impairment and communication difficulties. Second, we provide detailed methodology, including the semi-structured interview format used, the development of the SLD, and an overview of responses from participants and investigators. We also describe the quantitative and qualitative approaches to analysis taken with the aim of developing scientific validation in support of the Hear My Voice project.
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Affiliation(s)
- Katherine M Piderman
- Department of Chaplain Services, Mayo Clinic, EI-2-130, 200 First St. SW, Rochester, MN, 55905, USA,
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79
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Bommersbach TJ, Lapid MI, Rummans TA, Morse RM. Geriatric alcohol use disorder: a review for primary care physicians. Mayo Clin Proc 2015; 90:659-66. [PMID: 25939937 DOI: 10.1016/j.mayocp.2015.03.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 03/16/2015] [Accepted: 03/17/2015] [Indexed: 11/26/2022]
Abstract
Alcohol use disorder in the geriatric population is a growing public health problem that is likely to continue to increase as the baby boomer generation ages. Primary care providers play a critical role in the recognition and management of these disorders. This concise review will focus on the prevalence, risk factors, screening, and clinical management of geriatric alcohol use disorder from a primary care perspective.
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Affiliation(s)
| | - Maria I Lapid
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN.
| | - Teresa A Rummans
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Robert M Morse
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
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80
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Kruse JL, Lapid MI, Lennon VA, Klein CJ, Toole OO, Pittock SJ, Strand EA, Frye MA, McKeon A. Psychiatric Autoimmunity: N-Methyl-d-Aspartate Receptor IgG and Beyond. Psychosomatics 2015; 56:227-41. [DOI: 10.1016/j.psym.2015.01.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 01/27/2015] [Accepted: 01/28/2015] [Indexed: 11/26/2022]
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81
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Schoonover K, Burton MC, Larson SA, Cha SS, Lapid MI. Depression and alcohol withdrawal syndrome: is antidepressant therapy associated with lower rates of hospital readmission? Ir J Med Sci 2015; 185:573-579. [PMID: 25916789 DOI: 10.1007/s11845-015-1304-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 04/18/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Alcohol withdrawal syndrome (AWS) is a frequent cause of admission to acute care hospitals and many of these patients have a history of depression. AIM Our objective was to determine if antidepressant use in patients with a history of depression is associated with lower rates of hospital readmission for AWS. METHODS A retrospective study was performed of patients admitted with AWS between January 1, 2006 and December 31, 2008 to an academic tertiary referral hospital. RESULTS Three hundred and twenty-two patients were admitted with AWS during the study period. One hundred and sixty-one patients (50 %) had no history of depression, 111 patients (34 %) had a history of depression and antidepressant use, and 50 patients (16 %) had a history of depression and no antidepressant use. There was no significant difference in the number of hospitalizations for AWS between these three groups. Patients with a history of depression on antidepressant medication were more likely to be retired or work disabled compared to the other two groups (p < 0.05). The antidepressant class most commonly used was SSRI (63 %). CONCLUSION Our study highlights the high frequency of depression and antidepressant use in patients admitted with AWS to an acute care hospital. As alcohol withdrawal is associated with increased morbidity and mortality and depression is common in those with alcohol use disorder, further research is necessary to clarify the optimal treatment of comorbid depression and alcohol use disorder in reducing these revolving door admissions.
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Affiliation(s)
- K Schoonover
- Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - M C Burton
- Department of Medicine, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA
| | - S A Larson
- Department of Internal Medicine, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA
| | - S S Cha
- Division of Biostatistics, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - M I Lapid
- Department of Psychiatry, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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82
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McKean AJS, Lapid MI, Geske JR, Kung S. The importance of code status discussions in the psychiatric hospital: results of a single site survey of psychiatrists. Acad Psychiatry 2015; 39:200-203. [PMID: 25142252 DOI: 10.1007/s40596-014-0218-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 07/28/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Documentation of code status is a requirement with hospital admission, yet this discussion may present unique challenges with psychiatric inpatients. Currently, no standards exist on conducting these discussions with psychiatric inpatients. The authors surveyed psychiatry trainees and faculty regarding their perceptions and practice to gain further insight into the types of approaches used. METHODS The authors conducted an IRB-approved, Web-based survey of psychiatry faculty and trainees using a 25-item questionnaire of demographics and opinions about code status among psychiatric inpatients. RESULTS The response rate was 36.1 % (n = 30; 15 faculty and 15 trainees). Respondents felt that it was important to discuss code status with each admission. Faculty placed a higher emphasis on assessing patients with a recent suicide attempt (p = 0.024). CONCLUSION Psychiatric faculty and trainees endorsed the importance of assessing code status with each admission. The authors suggest that educational programs are needed on strategies to conduct code status discussions properly and effectively in psychiatric populations.
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83
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Piderman KM, Kung S, Jenkins SM, Euerle TT, Yoder TJ, Kwete GM, Lapid MI. Respecting the Spiritual Side of Advanced Cancer Care: a Systematic Review. Curr Oncol Rep 2015; 17:6. [DOI: 10.1007/s11912-014-0429-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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84
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Moyer AM, Walker DL, Avula R, Lapid MI, Kung S, Bryant SC, Edwards KK, Black JL, Karpyak VM, Shinozaki G, Jowsey-Gregoire SG, Ehlers SL, Romanowicz M, Litzow MR, Hogan WJ, Rundell JR, Hooten WM, Baudhuin LM. Relationship of genetic variation in the serotonin transporter gene (SLC6A4) and congenital and acquired cardiovascular diseases. Genet Test Mol Biomarkers 2015; 19:115-23. [PMID: 25671637 DOI: 10.1089/gtmb.2014.0250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Recent reports have suggested an association between variation in the serotonin transporter and primary pulmonary hypertension and myocardial infarction. We set out to determine whether these associations were present in a population of patients who underwent SLC6A4 genotyping and to explore whether genetic variation in the serotonin transporter might be also associated with other cardiovascular functional and structural abnormalities. Included were 3473 patients who were genotyped for the SLC6A4 5HTTLPR polymorphism and a subset for rs25531 (n=816) and STin2 (n=819). An association was observed between 5HTTLPR and primary pulmonary hypertension (p=0.0130), anomalies of the cerebrovascular system (p<0.0001), and other anomalies of great veins (p=0.0359). The combined 5HTTLPR and rs25531 genotype was associated with tachycardia (p=0.0123). There was an association of the STin2 genotype with abnormal electrocardiogram (ECG) (p=0.0366) and abnormal cardiac study (0.0311). Overall, these results represent a step toward the understanding of the impact of SLC6A4 variation on cardiovascular pathology.
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Affiliation(s)
- Ann M Moyer
- 1 Department of Laboratory Medicine and Pathology, Mayo Clinic , Rochester, Minnesota
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85
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Archer SJ, Barna AE, Holper RM, Forsyth DM, Ellenbecker SM, Smith LK, Clobes JE, Meiers SJ, Malone C, Lapid MI. Associations among fluid intake, cognitive function, and length of stay in psychogeriatric inpatients. Perspect Psychiatr Care 2015; 51:52-6. [PMID: 24605762 DOI: 10.1111/ppc.12065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 01/08/2014] [Accepted: 01/16/2014] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The purpose of this study was to examine differences, interactions, and associations among cognition, fluid intake, and demographic variables that may affect length of stay (LOS) for psychogeriatric inpatients aged 65 years or older. DESIGN AND METHODS Descriptive, comparative, correlational secondary analysis of data from a primary study of 202 inpatients. FINDINGS Older adults with and without cognitive impairment had different fluid intake over time (F = 3.50; p = .03), but had no difference in LOS in relation to cognitive functioning (p = .23); additional factors may predict LOS. PRACTICE IMPLICATIONS Care providers must monitor the fluid intake of elderly patients with and without cognitive impairment throughout their hospitalization.
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Affiliation(s)
- Sarah J Archer
- Department of Nursing, Winona State University-Rochester Center, Rochester, Minnesota, USA
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86
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Warren MB, Lapid MI, McKean AJ, Cha SS, Stevens MA, Brekke FM, Hegard TL, Kung S, Burton MC. Code status discussions in psychiatric and medical inpatients. J Clin Psychiatry 2015; 76:49-53. [PMID: 25562447 DOI: 10.4088/jcp.13m08912] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 04/24/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND The Patient Self-Determination Act along with regulatory standards and institutional standards of care highlight the need for collaboration between care providers and patients with respect to goals of care and, in emergency situations, code status and measures to be taken in keeping with patients' wishes. Addressing code status may be lacking in patients who require psychiatric hospitalization due to the nature of psychiatric illness, relative medical stability, and a general expectation of survival. We sought to compare code status documentation and discussion between psychiatric and medical inpatients, as this knowledge will help shape future interventions for process improvement. METHOD We conducted a retrospective chart review of hospitalized patients in psychiatric and medical units during a 12-month period in 2008. For those with multiple admissions, we reviewed only the index (or first) hospitalization. Data collected included demographic information, clinical information regarding cancer as a primary diagnosis or a diagnosis that met National Hospice and Palliative Care Organization (NHPCO) guidelines, code status order and discussion documentation, the presence of an advance directive, length of stay, and 1-year mortality. Data were summarized using mean values, percentages, and frequencies. The 2 groups (psychiatric and medical groups) were compared. RESULTS The charts of 276 psychiatric patients and 317 general medical patients were reviewed. More psychiatric patients had dementia (P < .001). Medical inpatients had a higher rate of code status order documented on admission (96% vs 65%, P < .001) and "full-code, discussed" order (67% vs 33%, P < .001). Psychiatric inpatients had more "do not resuscitate/do not intubate" orders (20% vs 13%, P = .037), more frequent changes in code status order (18% vs 7%, P < .001), and a higher percentage of advance directives (46% vs 25%, P < .001). CONCLUSIONS A code status discussion with hospitalized patients needs to occur at admission regardless of reason for admission. Strategies are needed to improve this process for psychiatric inpatients.
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87
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Burton MC, Warren MB, Lapid MI, Bostwick JM. Munchausen syndrome by adult proxy: a review of the literature. J Hosp Med 2015; 10:32-5. [PMID: 25274180 DOI: 10.1002/jhm.2268] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 08/28/2014] [Accepted: 09/13/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Munchausen syndrome by proxy (MSBP), more formally known as factitious disorder imposed on another, is a form of abuse in which a caregiver deliberately produces or feigns illness in a person under his or her care so that the proxy will receive medical care that gratifies the caregiver. Although well documented in the pediatric literature, few cases of MSBP with adult proxies (MSB-AP) have been reported. This study reviews existing literature on MSB-AP to provide a framework for clinicians to recognize this disorder. METHODS We searched Ovid MEDLINE, Ovid EMBASE, PubMed, Web of Knowledge, and PsychINFO, supplemented by bibliographic examination. RESULTS We identified 13 cases of MSB-AP. Perpetrators were caregivers, most (62%) were women, and many worked in healthcare. The age range of the victims was 21 to 82 years. Most were unaware of the abuse, although in 2 cases the victim may have colluded with the perpetrator. Disease fabrication most often resulted from poisoning. CONCLUSIONS MSB-AP should be included in the differential diagnosis of patients presenting with a complex constellation of symptoms without a unifying etiology and an overly involved caregiver with suspected psychological gain. Early identification is necessary so that healthcare providers do not unknowingly perpetuate harm through treatments that satisfy the perpetrator's psychological needs at the proxy's expense.
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Affiliation(s)
- M Caroline Burton
- Division of Hospital Medicine, Department of Medicine, Mayo Clinic, Jacksonville, Florida
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88
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Burton MC, Warren M, Cha SS, Stevens M, Blommer M, Kung S, Lapid MI. Identifying Patients in the Acute Psychiatric Hospital Who May Benefit From a Palliative Care Approach. Am J Hosp Palliat Care 2014; 33:228-32. [PMID: 25318929 DOI: 10.1177/1049909114554795] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Identifying patients who will benefit from a palliative care approach is the first critical step in integrating palliative with curative therapy. Criteria are established that identify hospitalized medical patients who are near end of life, yet there are no criteria with respect to hospitalized patients with psychiatric disorders. The records of 276 consecutive patients admitted to a dedicated inpatient psychiatric unit were reviewed to identify prognostic criteria predictive of mortality. Mortality predictors were 2 or more admissions in the past year (P = .0114) and older age (P = .0006). Twenty-two percent of patients met National Hospice and Palliative Care Organization noncancer criteria for dementia. Palliative care intervention should be considered when treating inpatients with psychiatric disorders, especially older patients who have a previous hospitalization or history of dementia.
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Affiliation(s)
| | - Mark Warren
- Department of Psychiatry, Mayo Clinic, Rochester, MN, USA
| | - Stephen S Cha
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Maria Stevens
- Minnesota State University, Mankato Undergraduate University, Mankato, MN, USA
| | | | - Simon Kung
- Department of Psychiatry, Mayo Clinic, Rochester, MN, USA
| | - Maria I Lapid
- Department of Psychiatry, Mayo Clinic, Rochester, MN, USA
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89
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Hu C, Kung S, Rummans TA, Clark MM, Lapid MI. Reducing caregiver stress with internet-based interventions: a systematic review of open-label and randomized controlled trials. J Am Med Inform Assoc 2014; 22:e194-209. [PMID: 25125686 DOI: 10.1136/amiajnl-2014-002817] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 07/25/2014] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The high level of stress associated with caring for others with medical conditions has been recognized for some time. Reducing caregiver stress can improve caregiver quality of life as well as improve the care they provide to loved ones. This systematic review assesses the effectiveness of internet-based interventions to decrease caregiver stress. MATERIALS AND METHODS A comprehensive literature search of Ovid MEDLINE (1946-2013), Embase (1988-2013), PsycINFO (1987-2013), and CINAHL was conducted using terms related to caregiver and internet-based interventions. Internet-based interventions involving informal caregivers in an open-label or randomized controlled trial setting were included. A pair of raters independently reviewed all published abstracts. Data regarding participants, interventions, and outcomes were extracted and, for randomized trials, methodology quality was also reviewed. RESULTS Eight open-label trials met the review criteria: three showed positive benefit in reducing caregiver stress, four were partially positive (some outcomes positive, others negative), and one was a negative study. Sixteen randomized trials met the review criteria: six showed positive benefit, five were partially positive, and five were negative. There were no clear patterns as to the variables (such as study duration and complexity of intervention) associated with better outcomes, although earlier studies typically had more negative outcomes. DISCUSSION Internet-based interventions were mostly effective in reducing aspects of caregiver stress and improving their well-being. Further studies to assess outcomes for caregivers and their recipients' health, different technology delivery methods, and the cost of such interventions are needed.
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Affiliation(s)
- Chunling Hu
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Simon Kung
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Teresa A Rummans
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew M Clark
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Maria I Lapid
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
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90
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Parsaik AK, Singh B, Murad MH, Singh K, Mascarenhas SS, Williams MD, Lapid MI, Richardson JW, West CP, Rummans TA. Statins use and risk of depression: a systematic review and meta-analysis. J Affect Disord 2014; 160:62-7. [PMID: 24370264 DOI: 10.1016/j.jad.2013.11.026] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 10/17/2013] [Accepted: 11/30/2013] [Indexed: 02/07/2023]
Abstract
IMPORTANCE Statin use has been associated with depression; however studies of the association between statin use and depression have yielded mixed results. OBJECTIVE To determine whether statin use is associated with depression and to evaluate the evidence supporting this association. DATA SOURCES Ovid MEDLINE In-Process & Other Non-Indexed Citations, Ovid MEDLINE, EMBASE, PsycInfo, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus were searched through December 28, 2012. STUDY SELECTION We included studies that evaluated exposure to statins, reported the development of depression, and relative risks or odds ratios (ORs) or provided data for their estimation. Two reviewers screened 981 abstracts independently using a standardized form, reviewed full text of 59 selected articles, and included 7 studies in this metaanalysis. DATA EXTRACTION AND SYNTHESIS Study design, statin exposure, development of depression, and study quality were extracted by 2 independent reviewers. A pooled OR with 95% confidence interval (CI) was estimated using the random-effects model and heterogeneity was assessed using Cochran's Q test and the I(2) statistic. RESULTS Seven observational studies (4 cohort, 2 nested case-control, and 1 cross-sectional) from 5 countries enrolling 9187 patients were included. Statin users were 32% less likely to develop depression than nonusers (adjusted OR, 0.68; 95% CI, 0.52-0.89). Modest heterogeneity was observed between the studies (I(2)=55%, P=0.01), which could be accounted for by one study, exclusion of which removed the heterogeneity (P=0.40, I(2)=2%) and further strengthened the antidepressant effect of statin (adjusted OR, 0.63; 95% CI, 0.43-0.93). Heterogeneity could not be explained by study design or study population. The quality of supporting evidence was fair. CONCLUSIONS AND RELEVANCE This systematic review and meta-analysis suggests that statin use is associated with lower risk for depression. However, higher-quality studies are needed to confirm the magnitude of this association.
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Affiliation(s)
- Ajay K Parsaik
- Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, TX, United States; Mayo Alzheimer's Disease Research Center, Mayo Clinic, Rochester, MN, United States
| | - Balwinder Singh
- Mayo Alzheimer's Disease Research Center, Mayo Clinic, Rochester, MN, United States
| | - M Hassan Murad
- Knowledge and Evaluation Research, Mayo Clinic, Rochester, MN, United States; Division of Preventive Medicine, Mayo Clinic, Rochester, MN, United States
| | - Kuljit Singh
- Department of Cardiology, Queen Elizabeth Hospital, Woodville South, SA, Australia
| | | | - Mark D Williams
- Department of Psychiatry, Mayo Clinic, Rochester, MN, United States
| | - Maria I Lapid
- Department of Psychiatry, Mayo Clinic, Rochester, MN, United States
| | | | - Colin P West
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, United States; Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States
| | - Teresa A Rummans
- Department of Psychiatry, Mayo Clinic, Rochester, MN, United States; Department of Psychiatry, Mayo Clinic, Jacksonville, FL, United States.
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91
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Shahi V, Lapid MI, Kung S, Atherton PJ, Sloan JA, Clark MM, Rummans TA. Do age and quality of life of patients with cancer influence quality of life of the caregiver? J Geriatr Oncol 2014; 5:331-6. [PMID: 24726867 DOI: 10.1016/j.jgo.2014.03.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 12/06/2013] [Accepted: 03/21/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE There are significant burdens associated with providing care for loved ones with cancer. However, caregiver quality of life (QOL) is often overlooked. With the increasing number of older adults with cancer, it is important to determine whether a patient's age and QOL have any association with the caregiver's QOL. The objective of our study was to describe caregiver QOL and explore whether patient age and other psychosocial factors impact caregiver QOL. MATERIALS AND METHODS Baseline information from patients with advanced cancer undergoing radiation and their caregivers, who were enrolled in a randomized, controlled clinical trial to test the effectiveness of a structured, multidisciplinary QOL intervention, was analyzed for this study. Caregivers completed the Caregiver Quality of Life Index-Cancer (CQOLC) Scale. Both patients and caregivers completed the Linear Analogue Self-Assessment (LASA) to measure QOL, and Profile of Mood States (POMS) to measure mood states. RESULTS Overall, 131 patient-caregiver pairs participated in the study. At baseline, caregivers of older adults (≥65years) had higher mental (P=0.01), emotional (P=0.003), spiritual (P<0.01), and social support (P=0.03) LASA QOL scores. Caregivers of older adults also had higher baseline QOL (CQOLC, P=0.003) and mood (POMS, P=0.04) than caregivers of younger adults. Caregivers of patients with higher LASA QOL scores had higher overall (P=0.02), mental (P=0.006), physical (P=0.02), emotional (P=0.002), and spiritual LASA QOL scores (P=0.047). CONCLUSIONS Caregivers of older adults with advanced cancer demonstrated better QOL and fewer mood disturbances compared to caregivers of younger patients. When patients have good QOL, caregivers also had good QOL.
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Affiliation(s)
- Varun Shahi
- Mayo Medical School, Mayo Clinic, Rochester, MN, USA
| | - Maria I Lapid
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA.
| | - Simon Kung
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Pamela J Atherton
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Jeff A Sloan
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Matthew M Clark
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Teresa A Rummans
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
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92
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Piderman KM, Sontag LF, Hsu J, Lapid MI. Relationship between medical burden, depression, and quality of life in psychogeriatric inpatients: implications for providers of pastoral care. J Pastoral Care Counsel 2014; 68:2. [PMID: 25241489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This study describes medical burden among individuals > or = 65 years hospitalized for depression in order to determine its associations with depression and quality of life (QOL) and thus provide suggestions for spiritual care providers. Using reliable, validated measures, the 45 participants who completed the study demonstrated moderate medical burden that was significantly associated with physical QOL but not with mental QOL or depression. Irrespective of the level of medical burden, subjects exhibited significant improvement of both depression and QOL during hospitalization. Results suggest that advocacy by spiritual care providers is essential.
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93
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Rasmussen KG, Kung S, Lapid MI, Oesterle TS, Geske JR, Nuttall GA, Oliver WC, Abenstein JP. A randomized comparison of ketamine versus methohexital anesthesia in electroconvulsive therapy. Psychiatry Res 2014; 215:362-5. [PMID: 24388729 DOI: 10.1016/j.psychres.2013.12.027] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 11/11/2013] [Accepted: 12/12/2013] [Indexed: 11/29/2022]
Abstract
To assess the clinical utility of ketamine as an anesthetic agent for electroconvulsive therapy (ECT), based upon recent findings that ketamine may have antidepressant properties. Depressed ECT patients were randomly assigned to receive anesthesia with either ketamine or methohexital. Outcome measures included assessments of depressive severity, cognition, post-anesthesia side effects, and hemodynamics. Twenty one patients were treated with ketamine and 17 with methohexital. There were no significant differences in depression or cognitive outcomes between the two drugs. Additionally, there were no measures of post-anesthesia tolerability or hemodynamics which favored ketamine. Ketamine anesthesia does not accelerate the antidepressant effect of ECT or diminish the cognitive side effects, at least as measured in this study. Furthermore, there is no apparent benefit of ketamine for speed or quality of post-ECT recovery, and it is associated with higher systolic blood pressures after the treatments. Ketamine is associated with longer motor seizure duration than methohexital.
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Affiliation(s)
- Keith G Rasmussen
- Mayo Clinic Departments of Psychiatry and Psychology, Rochester, MN 55905, USA.
| | - Simon Kung
- Mayo Clinic Departments of Psychiatry and Psychology, Rochester, MN 55905, USA
| | - Maria I Lapid
- Mayo Clinic Departments of Psychiatry and Psychology, Rochester, MN 55905, USA
| | - Tyler S Oesterle
- Mayo Clinic Departments of Psychiatry and Psychology, Rochester, MN 55905, USA
| | - Jennifer R Geske
- Mayo Clinic Departments of Psychiatry and Biostatistics, Rochester, MN, USA
| | - Gregory A Nuttall
- Mayo Clinic Departments of Psychiatry and Anesthesiology, Rochester, MN, USA
| | - William C Oliver
- Mayo Clinic Departments of Psychiatry and Anesthesiology, Rochester, MN, USA
| | - John P Abenstein
- Mayo Clinic Departments of Psychiatry and Anesthesiology, Rochester, MN, USA
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94
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Piderman KM, Johnson ME, Frost MH, Atherton PJ, Satele DV, Clark MM, Lapid MI, Sloan JA, Rummans TA. Spiritual quality of life in advanced cancer patients receiving radiation therapy. Psychooncology 2013; 23:216-21. [PMID: 24019196 DOI: 10.1002/pon.3390] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 08/02/2013] [Accepted: 08/08/2013] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The aim of this randomized controlled trial for patients with advanced cancer receiving radiation therapy was to determine the effect of a multidisciplinary intervention on spiritual quality of life (QOL) at the end of the intervention (week 4) and at two follow-up time points (weeks 26 and 52). METHODS One hundred thirty-one persons were randomized to either the intervention or control (forms only) groups. The intervention included six 90-min in-person sessions based on the physical, emotion, social, and spiritual domains of QOL. Three sessions included the spiritual component. Caregivers were present for four sessions, one which included a spiritual component. Ten follow-up phone calls were made to the patients in the intervention group during the 6-month follow-up period. Patients completed the Functional Assessment of Cancer Therapy: General Scale, the Linear Analog Self-Assessment which includes an assessment of spiritual QOL, and the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp) at enrollment, and weeks 4, 27, and 52. RESULTS Following the intervention, the intervention group demonstrated improved spiritual QOL on the FACIT-Sp, whereas the spiritual QOL of the control group decreased, resulting in significant mean changes between groups (total score: 1.7 vs. -2.9; p < 0.01; meaning/peace subscale: 1.0 vs. -3.5; p < 0.01; faith subscale: 3.1 vs. -1.7; p = 0.04). CONCLUSIONS The results indicate that a multidisciplinary intervention which includes a spiritual component can maintain the spiritual QOL of patients with advanced cancer during radiation therapy.
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Affiliation(s)
- Katherine M Piderman
- Department of Chaplain Services, Mayo Clinic, Rochester, MN, USA; Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
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95
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Schmidt ST, Lapid MI, Sundsted KK, Cunningham JL, Ryan DA, Burton MC. Safety of electroconvulsive therapy in patients receiving dabigatran therapy. Psychosomatics 2013; 55:400-403. [PMID: 23932534 DOI: 10.1016/j.psym.2013.06.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 06/10/2013] [Accepted: 06/11/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Scott T Schmidt
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Maria I Lapid
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN.
| | | | | | - Debra A Ryan
- Department of Nursing, Mayo Clinic, Rochester, MN
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96
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Abstract
PURPOSE Vitamin D deficiency is common in the elderly. Vitamin D deficiency may affect the mood of people who are deficient. We investigated vitamin D status in older primary care patients and explored associations with depression. PATIENTS AND METHODS A cross-sectional study was conducted and association analyses were performed. Primary care patients at a single academic medical center who were ≥60 years with serum total 25-hydroxyvitamin D (25[OH]D) levels were included in the analysis. The primary outcome was a diagnosis of depression. Frailty scores and medical comorbidity burden scores were collected as predictors. RESULTS There were 1618 patients with a mean age of 73.8 years (±8.48). The majority (81%) had optimal (≥25 ng/mL) 25(OH)D range, but 17% met mild-moderate (10-24 ng/mL) and 3% met severe (<10 ng/mL) deficiencies. Those with severe deficiency were older (P < 0.001), more frail (P < 0.001), had higher medical comorbidity burden (P < 0.001), and more frequent depression (P = 0.013). The 694 (43%) with depression had a lower 25(OH)D than the nondepressed group (32.7 vs 35.0, P = 0.002). 25(OH)D was negatively correlated with age (r = -0.070, P = 0.005), frailty (r = -0.113, P < 0.001), and medical comorbidity burden (r = -0.101, P < 0.001). A 25(OH)D level was correlated with depression (odds ratio = 0.990 and 95% confidence interval [CI] = 0.983-0.998, P = 0.012). Those with severe vitamin D deficiency were twice as likely to have depression (odds ratio = 2.093 with 95% CI 1.092-4.011, P = 0.026). CONCLUSION Vitamin D deficiency was present in a fifth of this older primary care population. Lower vitamin D levels were associated with depression. Those with severe deficiency were older and more likely had depression.
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Affiliation(s)
- Maria I Lapid
- Division of Outpatient Consultation, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA.
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97
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Leedahl DD, Cunningham JL, Drake MT, Mundis CB, Kung S, Frye MA, Lapid MI. Hypovitaminosis D in Psychiatric Inpatients: Clinical Correlation with Depressive Symptoms, Cognitive Impairment, and Prescribing Practices. Psychosomatics 2013. [DOI: 10.1016/j.psym.2012.07.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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98
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Rasmussen KG, Lineberry TW, Galardy CW, Kung S, Lapid MI, Palmer BA, Ritter MJ, Schak KM, Sola CL, Hanson AJ, Frye MA. Serial infusions of low-dose ketamine for major depression. J Psychopharmacol 2013; 27:444-50. [PMID: 23428794 DOI: 10.1177/0269881113478283] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Single infusions of ketamine have been used successfully to achieve improvement in depressed patients. Side effects during the infusions have been common. It is not known whether serial infusions or lower infusion rates result in greater efficacy. METHODS Ten depressed patients were treated with twice weekly ketamine infusions of ketamine 0.5 mg/kg administered over 100 min until either remission was achieved or four infusions were given. Side effects were assessed with the Young Mania Rating Scale (YMRS) and the Brief Psychiatric Rating Scale (BPRS). Patients were followed naturalistically at weekly intervals for four weeks after completion of the infusions. RESULTS Five of 10 patients achieved remission status. There were no significant increases on the BPRS or YMRS. Two of the remitting patients sustained their improvement throughout the four week follow-up period. CONCLUSIONS Ketamine infusions at a lower rate than previously reported have demonstrated similar efficacy and excellent tolerability and may be more practically available for routine clinical care. Serial ketamine infusions appear to be more effective than a single infusion. Further research to test relapse prevention strategies with continuation ketamine infusions is indicated.
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Affiliation(s)
- Keith G Rasmussen
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, USA.
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99
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Feely MA, Havyer RDA, Lapid MI, Swetz KM. Management of end-of-life care and of difficult behaviors associated with borderline personality disorder. J Pain Symptom Manage 2013; 45:934-8. [PMID: 22921178 DOI: 10.1016/j.jpainsymman.2012.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 04/05/2012] [Accepted: 04/23/2012] [Indexed: 11/19/2022]
Affiliation(s)
- Molly A Feely
- Department of Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
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100
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Lapid MI, Atherton PJ, Kung S, Cheville AL, McNiven M, Sloan JA, Clark MM, Rummans TA. Does gender influence outcomes from a multidisciplinary intervention for quality of life designed for patients with advanced cancer? Support Care Cancer 2013; 21:2485-90. [PMID: 23609927 DOI: 10.1007/s00520-013-1825-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 04/12/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Cancer treatment can profoundly impact the patient's quality of life (QOL). It has been well documented that there are gender differences in the symptoms associated with cancer treatment. This study explores the impact of gender on QOL for patients with newly diagnosed advanced cancer. METHODS A randomized, controlled clinical trial in patients receiving radiotherapy for advanced cancer demonstrated maintenance of QOL with a six session multidisciplinary structured intervention compared to controls. This current study reports the gender differences in that trial. Outcome measures included the functional assessment of cancer therapy-general (FACT-G), linear analog self-assessment (LASA), and profile of mood states (POMS) at baseline and weeks 4, 27, and 52. Kruskal-Wallis was used to compare QOL scores. RESULTS One hundred thirty-one patients (45 women and 86 men, mean age 58.7) participated in the clinical trial. At week 4 postintervention, women in the intervention group had statistically significant improvement in their FACT-G score, FACT-G physical well-being subscale, LASA fatigue, POMS total score, POMS fatigue-inertia subscale, and POMS confusion-bewilderment subscale (p < 0.05). Men receiving the intervention had a smaller decrease in FACT-G score compared to controls (p = 0.048) and also worsened on the LASA financial (p = 0.02). At week 27, the only gender difference was that intervention group men had more POMS anger-hostility (p = 0.009). By week 52, there were no statistically significant gender differences in any of the QOL measures. CONCLUSIONS Gender-based differences appear to play a role in the early, but not late, response to a multidisciplinary intervention to improve QOL for patients with advanced cancer, suggesting that early interventions can be tailored for each gender.
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Affiliation(s)
- Maria I Lapid
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
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