Diagnostic Assessment via Live Telehealth (Phone or Video) Versus Face-to-Face for the Diagnoses of Psychiatric Conditions: A Systematic Review.

被引量：- 发表：1970

Regression: Understanding What Covariates and Confounds Do in Adjusted Analyses.

被引量：- 发表：1970

Identifying Bridge Symptoms Between Borderline Personality Disorder and Posttraumatic Stress Disorder: A Network Analysis From a National Cohort.

Objective: Borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD) share common risk factors, including exposure to traumatic events. We aim to estimate networks of DSM-IV BPD and PTSD to describe the interactions between the symptoms of these 2 disorders and identify bridging symptoms between the 2 diagnoses that may play critical roles in their co-occurrence. Methods: We performed a network analysis of data from the second wave of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC 2004-2005), a nationally representative sample of the US adult population. We calculated network stability using a bootstrap method and centrality measures for each symptom across 3 different network estimations. Results: The networks were very stable. The symptom "chronic feelings of emptiness" was the most central in the BPD network. The symptoms "feeling of intense fear or horror" and "recurrent and intrusive memories of the traumatic event" were the most central in the PTSD network. The symptoms "self aggression," "severe dissociation," "chronic feelings of emptiness," and "feelings of detachment" had significantly higher bridge expected influence than most other symptoms in the network in both the full sample and the subsample of participants who responded to all PTSD and BPD symptoms. Conclusion: Self-aggression, chronic feelings of emptiness, dissociation symptoms, and feelings of detachment represent bridge symptoms between BPD and PTSD. These symptoms could potentially trigger and perpetuate the manifestations of one disorder in the presence of the other. Targeting these symptoms might allow better prevention and management of both disorders.

被引量：- 发表：1970

A Retrospective Observational Study to Understand Medication Utilization and Lines of Treatment in Patients With Insomnia Disorder.

Background: Insomnia is a common sleep disorder, associated with multiple health concerns. Current medications for insomnia are associated with higher safety risks if clinical practice guidelines or monograph recommendations are not followed. This study aims to understand real-world prescribing practices among patients with insomnia in Canada, including medication utilization, potentially inappropriate medication use, cost incurred, and lines of treatment. Methods: This retrospective observational study utilized longitudinal drug claims data from 2018 to 2020 from the Canadian IQVIA National Private Drug Plan and Ontario Drug Benefit databases. Patients with any claims for medications approved for insomnia in Canada were identified. Four types of inappropriate medication usage were defined: (1) elevated daily dose; (2) extended duration of use for benzodiazepines (BZD) and/or Z-drugs; (3) combination use; and (4) opioid overlap with BZD and/or Z-drugs. Results: In 2019, 597,222 patients with insomnia were identified; 64% were female, with an average age of 55 years. Inappropriate medication use was noted in 52.5% of adult patients (aged 18-65 years) and 69.5% of senior patients (aged >65 years). Extended duration was the most common inappropriate medication usage category. The annual cost of medications for insomnia was $54.8 million, and $30.3 million (55.2%) met inappropriate medication use criteria. Conclusion: High prevalence of inappropriate medications usage in insomnia raises serious safety concerns for patients suffering from insomnia, particularly seniors, while also placing a substantial burden on the Canadian public and private health systems. This highlights an unmet need for better education regarding current guidelines and more effective and safer treatment options.

被引量：- 发表：1970

Safe Ketamine Use and Pregnancy: A Nationwide Survey and Retrospective Review of Informed Consent, Counseling, and Testing Practices.

Objective: Ketamine is contraindicated in pregnancy given the lack of knowledge about potential effects on a developing fetus. This study aimed to characterize current clinical practices specific to pregnancy and reproduction related to the use of ketamine for the treatment of psychiatric illness. Methods: Online surveys were sent to outpatient ketamine clinics across the United States inquiring about practices related to pregnancy. Responses were collected between September and November 2023. Additionally, a retrospective medical record review was conducted to ascertain the frequency of pregnancy testing and contraception use with ketamine treatments administered at a large academic health system. Online, publicly available informed consent documents were also reviewed for language related to pregnancy. Results: Fewer than half of survey respondents (n = 126) discuss specific risks related to pregnancy and fetal ketamine exposure during the informed consent process. Twenty percent of clinics require pregnancy tests prior to treatment, and 10.5% require subsequent testing during treatment; however, 22.9% of clinics do not have a standard process for testing. Only 13.7% of clinics specifically recommend or require use of contraception. Retrospective record review revealed that all patients who received intravenous ketamine for psychiatric indications in an academic medical center were pregnancy tested weekly, but only half were using contraception during treatment. Conclusion: Many women with the potential to become pregnant are treated with ketamine for psychiatric illness. Results of the present study reveal that risks of fetal ketamine exposure are often overlooked, indicating a need for increased awareness about reproductive concerns when prescribing ketamine for the treatment of psychiatric disorders.

被引量：- 发表：1970