[Safe discontinuation of psychotropic drugs in older people? : New evidence and practical approach]. / Sicheres Absetzen von Psychopharmaka bei älteren Menschen? : Neue Evidenz und praktisches Vorgehen.

BACKGROUND: Many older patients are permanently prescribed one or more psychotropic drugs for treatment of symptoms, such as behavioral and psychological symptoms in dementia, depressive symptoms, anxiety, and insomnia. They therefore contribute to the risk of polypharmacy. Recently, deprescribing studies have been published in order to clarify if inadequate medications can be safely discontinued. This mini-review summarizes the study results and derives practical recommendations for routine use. METHOD: A literature search was carried out in PubMed for clinical studies on deprescribing in association with psychotropic substances. RESULTS: After removal of duplications, 12 heterogeneous clinical studies were identified and reduction of psychotropic substances could be successfully achieved in 8 studies. In four of these studies psychological, behavioral and functional endpoints were reported. Criteria for successful deprescribing of sedatives were in particular motivation, information and sufficient cooperation of the patients and for antipsychotic drugs in people with dementia, the sustainable establishment of nonpharmaceutical treatment strategies. Deprescribing was not attempted in cases of a history of severe chronic mental illness and in cases of severe behavioral symptoms in dementia. Evidence for antidepressants was not sufficient to extract practical recommendations. CONCLUSION: Safe deprescribing of antipsychotic drugs in patients with dementia is justified if non-pharmacological treatment options are sustainably implemented, and for sedative drugs in well-informed, highly motivated and cooperative patients.

[Safe discontinuation of psychotropic drugs in older people? : New evidence and practical approach]. / Sicheres Absetzen von Psychopharmaka bei älteren Menschen? : Neue Evidenz und praktisches Vorgehen.

BACKGROUND: Many older patients are permanently prescribed one or more psychotropic drugs for treatment of symptoms, such as behavioral and psychological symptoms in dementia, depressive symptoms, anxiety, and insomnia. They therefore contribute to the risk of polypharmacy. Recently, deprescribing studies have been published in order to clarify if inadequate medications can be safely discontinued. This mini-review summarizes the study results and derives practical recommendations for routine use. METHOD: A literature search was carried out in PubMed for clinical studies on deprescribing in association with psychotropic substances. RESULTS: After removal of duplications, 12 heterogeneous clinical studies were identified and reduction of psychotropic substances could be successfully achieved in 8 studies. In four of these studies psychological, behavioral and functional endpoints were reported. Criteria for successful deprescribing of sedatives were in particular motivation, information and sufficient cooperation of the patients and for antipsychotic drugs in people with dementia, the sustainable establishment of nonpharmaceutical treatment strategies. Deprescribing was not attempted in cases of a history of severe chronic mental illness and in cases of severe behavioral symptoms in dementia. Evidence for antidepressants was not sufficient to extract practical recommendations. CONCLUSION: Safe deprescribing of antipsychotic drugs in patients with dementia is justified if non-pharmacological treatment options are sustainably implemented, and for sedative drugs in well-informed, highly motivated and cooperative patients.

[Special care units for patients with cognitive impairment : Results of a nationwide survey in geriatric hospitals in Germany]. / Spezialstationen für Patienten mit kognitiver Einschränkung : Ergebnisse einer Umfrage in Kliniken für Geriatrie in Deutschland.

BACKGROUND: A large number of older acutely ill patients with cognitive impairment are treated in geriatric care units. Since 1990 some geriatric departments in Germany have established special care units (SCU) for this patient population. In 2010 the first inventory of SCUs in Germany was carried out, which was not based on a nationwide systematic survey. OBJECTIVE: Nationwide systematic survey of SCUs for patients with cognitive impairment in geriatric institutions in Germany. METHODS: An online questionnaire (SurveyMonkey®, San Mateo, CA, USA) was sent to all heads of geriatric departments that provide advanced education in geriatric medicine of at least 12 months as registered by the German Society for Geriatric Medicine (DGG). RESULTS: The questionnaire was sent to 495 geriatric institutions of which 161 answered (response rate 32.5%). Additionally, 13 institutions answered through a weblink sent in a newsletter by the DGG. In 2017 a total of 42 SCUs existed with a mean size of 13.5 ± 4.7 beds. A further 15 hospitals plan to install an SCU in the near future, 5 probably in 2018. In four geriatric departments an existing SCU was closed down. All SCUs implemented special architectural, structural and personnel measures as recommended by the position paper of the DGG. The few conducted evaluations indicated beneficial results for mobility and disruptive behavior. CONCLUSION: In recent years the number of SCUs has increased considerably. A methodologically sound evaluation with respect to patient-related outcomes including follow-up and cost-effectiveness is lacking and should be carried out in the near future.

Prevalence of metabolic syndrome in patients with schizophrenia, and metabolic changes after 3 months of treatment with antipsychotics--results from a German observational study.

BACKGROUND: This observational study explored the prevalence of metabolic syndrome (MetS) in adult in- and outpatients with untreated or treated schizophrenia at baseline, and month-3 after initiation or switch of antipsychotic treatment. METHODS: MetS-prevalence (AHA/NHLB-definition) was assessed and Clopper-Pearson 95% confidence intervals (CIs) were calculated. Factors associated with MetS were explored through univariate and multivariate logistic regressions (both visits). RESULTS: MetS-prevalence was 44.3% (CI 39.8;48.9) at baseline and 49.6% (CI 45.0;54.2) at month-3. Previously unmedicated patients showed the lowest baseline MetS-prevalence (24.7%, CI 18.3;32.1). MetS-prevalence was not significantly different, regardless if patients previously received typical or atypical antipsychotics. Increased MetS-risk was associated with somatic comorbidity and non-smoking at both visits, and with non-psychiatric co-medication, male sex, and increased C-reactive protein at month-3. CONCLUSIONS: At baseline, MetS was most prevalent in patients with previous antipsychotic medication. Limited metabolic changes were observed 3 months after switch/initiation of antipsychotic therapy. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Identifier: n.a.

Impact of early parental child-rearing behavior on young adults' cardiometabolic risk profile: a prospective study.

OBJECTIVE: To examine prospectively whether early parental child-rearing behavior is a predictor of cardiometabolic outcome in young adulthood when other potential risk factors are controlled. Metabolic factors associated with increased risk for cardiovascular disease have been found to vary, depending on lifestyle as well as genetic predisposition. Moreover, there is evidence suggesting that environmental conditions, such as stress in pre- and postnatal life, may have a sustained impact on an individual's metabolic risk profile. METHODS: Participants were drawn from a prospective, epidemiological, cohort study followed up from birth into young adulthood. Parent interviews and behavioral observations at the age of 3 months were conducted to assess child-rearing practices and mother-infant interaction in the home setting and in the laboratory. In 279 participants, anthropometric characteristics, low-density lipoprotein and high-density lipoprotein cholesterol, apolipoproteins, and triglycerides were recorded at age 19 years. In addition, structured interviews were administered to the young adults to assess indicators of current lifestyle and education. RESULTS: Adverse early-life interaction experiences were significantly associated with lower levels of high-density lipoprotein cholesterol and apolipoprotein A1 in young adulthood. Current lifestyle variables and level of education did not account for this effect, although habitual smoking and alcohol consumption also contributed significantly to cardiometabolic outcomes. CONCLUSIONS: These findings suggest that early parental child-rearing behavior may predict health outcome in later life through its impact on metabolic parameters in adulthood.

Resistin and adiponectin in major depression: the association with free cortisol and effects of antidepressant treatment.

Major depression is associated with an increased risk for myocardial infarction. Adipokines have been shown to link obesity with metabolic disturbances. Based on this finding the present study was designed to investigate the effect of antidepressive treatment with either amitriptyline or paroxetine on circulating concentrations of resistin and adiponectin in depressed patients, and to establish, whether these adipokines are associated with the activation of the hypothalamic-pituitary-adrenal (HPA)-system. Thirty-seven depressed in-patients were treated in a double-blind, randomized protocol with either amitriptyline or paroxetine over a period of five weeks. After six drug free days blood was drawn on day 1 and again 36 days after antidepressive treatment for the measurement of resistin and adiponectin, fasting glucose and insulin concentrations. For quantification of free cortisol levels saliva was obtained daily at 0800 hours during weeks 1 and 5. While resistin concentrations decreased in patients remitting under amitriptyline and paroxetine (p<0.03), no changes were observed in non-remitters. At baseline, though not during treatment, circulating resistin concentrations correlated positively with free cortisol levels and with BMI (p<0.01). Adiponectin levels, however, did not change during treatment and were not associated with free cortisol concentrations but were instead positively related to QUICKI (p<0.03). In conclusion, the present data revealed resistin but not adiponectin to be related to free cortisol concentrations and to decline in remitters to antidepressive treatment.