Gender differences in antipsychotics prescribed to veterans with serious mental illness

Doenças cardiovasculares e uso de antipsicóticos na esquizofrenia: uma revisão

RESUMO Objetivo Realizar uma revisão de escopo a respeito dos efeitos adversos cardiovasculares e metabólicos associados ao uso de antipsicóticos em pessoas com o diagnóstico de esquizofrenia. Métodos Foi realizada uma revisão de escopo utilizando-se da base de dados PubMed, com descritores MeSH relacionados às doenças cardiovasculares e antipsicóticos. Foram encontrados 976 artigos, os quais foram filtrados por títulos, seguidos dos resumos e, na sequência, lidos na íntegra. Ao final, foram selecionados 71 artigos para a análise. Resultados O uso de antipsicóticos típicos e atípicos para tratamento da esquizofrenia associa-se a alterações glicêmicas e lipídicas, síndrome metabólica, hipertensão, ganho de peso e morbidade cardiovascular. Os estudos evidenciaram a existência de subdiagnóstico e subtratamento de doenças crônicas nessa população. A mortalidade por doença cardiovascular demonstrou aumento considerável nos pacientes em tratamento com agentes antipsicóticos, em comparação com a população geral. Conclusão Alguns fatores dos antipsicóticos, ainda não completamente determinados na psicofarmacologia, vêm se mostrando relacionados a maior risco de distúrbios metabólicos, comportamentais e intrínsecos às pessoas diagnosticadas com esquizofrenia, os quais podem agravar o curso clínico de tais doenças. Reconhece-se a necessidade de aprimorar o acompanhamento e o diagnóstico de doenças cardiovasculares e metabólicas entre pessoas com diagnóstico de esquizofrenia em tratamento com antipsicóticos típicos e atípicos.

Switching Between Second-Generation Antipsychotics in Patients with Schizophrenia and Schizoaffective Disorder: 10-Year Cohort Study in Brazil

Objective: Switching between second-generation antipsychotics (SGAs) is a common clinical practice in the treatment of schizophrenia and schizoaffective disorders due to differences in the drugs’ tolerability and safety profiles as well as the challenge of obtaining an ideal response. However, the factors associated with SGA switching remain uncertain and related real-world data are scarce. The main objective was to identify the factors associated with the switching of SGAs in patients with schizophrenia or schizoaffective disorder.

Methods: We conducted a retrospective cohort study of outpatients with schizophrenia or schizoaffective disorder, who were aged ≥18 years and received a SGA (clozapine, olanzapine, risperidone, quetiapine or ziprasidone) from a Brazilian pharmaceutical assistance program for at least 3 months. We identified SGA users from 2008 to 2017 by using a national administrative database (Ambulatory Information System-SIA/SUS). The factors associated with the switches were evaluated by Cox proportional hazards regression and adjusted for sex and age; the confidence interval was set at 95% (95% CI).

Results: In total, 563,765 patients were included. Female sex, advanced age of ≥70 years, residence in the Brazilian northeast region, and the type of antipsychotic used were associated with an increased risk of switching (p < 0.001). The incidence of switching ranged from 37.6/100 person-years for clozapine users to 58.2/100 person-years for risperidone users. Compared to the adjusted hazard ratio, for clozapine users, the corresponding ratios for risperidone, ziprasidone, quetiapine and olanzapine were 1.59 (95% CI, 1.57–1.61), 1.41 (95% CI, 1.39–1.44), 1.25 (95% CI, 1.23–1.26) and 1.11 (95% CI, 1.10–1.12) respectively.

Conclusion: The groups most susceptible to SGA switching in real-life setting were older individuals, women, and those living in the Brazilian northeast region. Risperidone was associated with the highest risk of switching and as expected, clozapine was associated with the lowest risk of switching than that associated with the other SGAs.

Understanding women veterans' experiences with and management of weight gain from medications for serious mental illness: A qualitative study

OBJECTIVE

More women veterans than men use Veterans Health Administration (VHA) mental health services. Some psychiatric medications are associated with weight gain and other metabolic side effects, with women more susceptible and reporting more distress than men. We sought to explore how women experience and manage medication-induced weight gain to identify strategies for improving its prevention and management in women.

METHOD

We completed semistructured, qualitative interviews with 30 female veterans with serious mental illnesses prescribed antipsychotic or mood stabilizer medications and 18 mental health prescribers. Interview transcripts were summarized and coded via principles of phenomenological inquiry to develop themes reflecting the study purpose.

RESULTS

We identified 5 themes related to females' experiences with medication-induced weight gain. Female veterans described considerable psychological and physical distress associated with weight gain. However, many expressed a willingness to accept weight gain as a trade-off for medications' therapeutic effects, a theme echoed by prescribers. Both described primarily using reactive rather than proactive or preventative weight management approaches and described the limited effectiveness of reactive approaches. Other contributing factors, including the multiple and uncertain causes of weight gain, uneven quality and quantity of weight loss information, lack of social support, and environmental barriers, add to the difficulty and complexity of their struggles.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

These findings improve our understanding of numerous veteran-, prescriber-, and environmental-level factors in the management of medication-associated weight gain in women that may be useful in designing gender-specific interventions. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

No differences in olanzapine- and risperidone-related weight gain between women and men: a meta-analysis of short- and middle-term treatment

OBJECTIVE

A plethora of data deriving from single studies as well as meta-analyses demonstrates that weight gain is associated with the exposure to the majority of antipsychotics (AP). However, potential sex differences have widely evaded the attention of AP treatment trials. It is hypothesised that female patients gain more weight compared with male patients due to their enhanced susceptibility to adverse drug reactions.

METHOD

A meta-analysis was conducted using clinical trials of AP that reported weight change separately for female and male patients. Duration of AP use was stratified in four categories: <6 weeks, 6-16 weeks, 16-38 weeks and >38 weeks. Forest plots were generated for men and women separately, stratified by AP as well as by duration of use. Sex differences were tested by performing meta-regression.

RESULTS

Data of 26 studies were used in the present analysis because sufficient data were available only for olanzapine, risperidone and the no-medication group. Both female and male patients showed considerable weight gain after switch or initiate of olanzapine or risperidone, but meta-regression analyses did not show significant sex differences.

CONCLUSION

The present meta-analysis revealed that sex differences in AP-related weight gain have been under investigated hampering the detection of sex-specific patterns. In chronic patients switching to olanzapine or risperidone receiving short-or middle-term treatment, AP were associated with weight gain in both sex subgroups and no significant differences were reported.

An Evidence Map of the Women Veterans' Health Research Literature (2008-2015)

BACKGROUND

Women comprise a growing proportion of Veterans seeking care at Veterans Affairs (VA) healthcare facilities. VA initiatives have accelerated changes in services for female Veterans, yet the corresponding literature has not been systematically reviewed since 2008. In 2015, VA Women's Health Services and the VA Women's Health Research Network requested an updated literature review to facilitate policy and research planning.

METHODS

The Minneapolis VA Evidence-based Synthesis Program performed a systematic search of research related to female Veterans' health published from 2008 through 2015. We extracted study characteristics including healthcare topic, design, sample size and proportion female, research setting, and funding source. We created an evidence map by organizing and presenting results within and across healthcare topics, and describing patterns, strengths, and gaps.

RESULTS

We identified 2276 abstracts and assessed each for relevance. We excluded 1092 abstracts and reviewed 1184 full-text articles; 750 were excluded. Of 440 included articles, 208 (47%) were related to mental health, particularly post-traumatic stress disorder (71 articles), military sexual trauma (37 articles), and substance abuse (20 articles). The number of articles addressing VA priority topic areas increased over time, including reproductive health, healthcare organization and delivery, access and utilization, and post-deployment health. Three or fewer articles addressed each of the common chronic diseases: diabetes, hypertension, depression, or anxiety. Nearly 400 articles (90%) used an observational design. Eight articles (2%) described randomized trials.

CONCLUSIONS

Our evidence map summarizes patterns, progress, and growth in the female Veterans' health and healthcare literature. Observational studies in mental health make up the majority of research. A focus on primary care delivery over clinical topics in primary care and a lack of sex-specific results for studies that include men and women have contributed to research gaps in addressing common chronic diseases. Interventional research using randomized trials is needed.

A systematic review of sex and age factors in neuroleptic malignant syndrome diagnosis frequency

OBJECTIVE

To examine sex and age distributions in neuroleptic malignant syndrome (NMS) patients based on a systematic literature review.

METHOD

EMBASE and PubMed databases were searched to identify any observation of NMS published from January 1, 1998 through November 1, 2014 that was accessible and interpretable (using language translation software). Redundant and equivocal reports were excluded. Sex ratio and age distributions were examined using standard graphical techniques and measures of association.

RESULTS

Twenty-eight independent sex ratio estimates were included. Males predominated in most (75%) estimates with an overall median sex ratio of 1.47 (95% CI, 1.20-1.80). NMS incidence peaked at age 20-25 years and declined steadily thereafter, with males consistently outnumbering females at all but the oldest age intervals.

CONCLUSION

NMS patients are 50% more likely to be males, and NMS is most likely to occur in young adulthood.

Sex Differences in Weight Loss among Veterans with Serious Mental Illness: Observational Study of a National Weight Management Program

PURPOSE

Obesity disproportionately burdens individuals with serious mental illness (SMI), especially women. This observational study investigated whether there were sex differences in weight loss and program participation among veterans with SMI enrolled in the Veterans Health Administration's (VHA) MOVE! weight management program.

PROCEDURES

Participants were identified from a national cohort of 148,254 veterans enrolled in MOVE! during fiscal years 2008 through 2012 who attended two or more sessions within 12 months of enrollment. The cohort included those with International Classification of Disease, 9th Edition, Clinical Modification (ICD-9-CM) diagnoses for SMI, age less than 70 years, and weight data at baseline and one or more follow-up timepoints within approximately 1 year of enrollment (n = 8,943 men; n = 2,245 women). Linear mixed models assessed associations of sex with 6- and 12-month weight change from baseline, adjusting for demographic- and site-level variables.

FINDINGS

Both sexes averaged 6.4 (standard deviation, 4.6) sessions within 12 months; however, women with and without SMI participated at rates double their respective proportion rates among all VHA users. Participants averaged statistically significant weight loss at 6 months (men, -2.5 lb [95% CI, -2.8 to -2.1]; women, -2.4 lb [95% CI, -3.1 to -1.7]) and 12 months (men, -2.5 lb [95% CI, -2.8 to -2.2]; women, -2.9 lb [95% CI, -3.6 to -2.2]), but no sex-based difference in absolute weight loss at either timepoint. Slightly more women achieved 5% or greater (clinically significant) weight loss at the 12-month follow-up than did men (25.7% vs. 23.0%; p < .05).

CONCLUSIONS

Women with SMI participated in MOVE! at rates equivalent to or greater than men with SMI, with comparable weight loss. More women were Black, single, had bipolar and posttraumatic stress disorder, and higher service-connected disability, suggesting areas for program customization.