Comparison of Weight-Based Valproic Acid Dosing in Treatment of Mental Illness Among Obese and Nonobese Patients.

PURPOSE/BACKGROUND: A weight-based dosing approach of 20-30 mg/kg per day of valproic acid (VPA) has been shown to achieve rapid attainment of mood symptom control. Due to interindividual pharmacokinetic variability, therapeutic drug monitoring may be a useful tool to avoid VPA toxicity. Limited research exists on the impact of patient body weight on VPA pharmacokinetic profiles. This analysis aims to explore the correlation between steady-state serum levels of VPA and weight-based dosing strategies, including total body weight (TBW), ideal body weight (IBW), and adjusted body weight (AdjBW), between obese and nonobese patients. METHODS/PROCEDURES: This single-center, retrospective, observational cohort analysis evaluated weight-based dosing of VPA in obese and nonobese patients admitted to inpatient psychiatry at a large academic medical center between July 1, 2017, and July 1, 2022. FINDINGS/RESULTS: This analysis included 93 obese and 93 nonobese patients. No significant difference in median VPA serum concentrations was observed between groups ( P = 0.82). However, the obese group received a lower median weight-based dose (15.6 mg/kg) compared with the nonobese group (19.5 mg/kg, P < 0.001). A stronger correlation was found between VPA dose and therapeutic serum levels in the obese group compared with the nonobese group regardless of weight-based dosing strategy. Dosing with AdjBW in obese patients most closely approximated dosing with TBW in nonobese patients. IMPLICATIONS/CONCLUSIONS: In obese patients, our analysis suggests dosing VPA using AdjBW may be considered as the preferred dosing strategy over IBW or TBW to minimize toxicity risk. Further research is needed with larger sample sizes and diverse patient populations to confirm these findings.

Management of delirium at an academic medical center: Plans for antipsychotic prescribing upon discharge.

INTRODUCTION: Delirium is an acute, fluctuating change in mental status, often associated with behavioral manifestations such as agitation. Literature suggests that many patients who continue on antipsychotics for extended management of delirium are not provided instructions for discontinuation. However, there is a positive correlation between consult services and instructions for discontinuation. The objective of this study was to determine the frequency at which patients with delirium were prescribed an antipsychotic at hospital discharge and to characterize discharge antipsychotic prescribing for psychiatric consult and nonconsult cohorts. METHODS: This study was a retrospective chart review of adult patients with an International Classification of Diseases 10th revision code of delirium who received at least 1 dose of antipsychotic during their admission. Inclusion criteria were all patients aged 18 years or older with a diagnosis of or relating to delirium who were administered antipsychotics during their admission. RESULTS: A total of 152 patients were included, of which 43 received a psychiatric consult. Antipsychotics were prescribed at discharge for management of delirium for 52 (34.2%) of 152 total patients. More patients in the psychiatric consult cohort were discharged with an antipsychotic as compared to those in the nonconsult cohort (53.3% vs 26.6%, P = .02). DISCUSSION: Compared to previous studies, patients in this retrospective review were more likely to be discharged on an antipsychotic that was initiated during admission for management of delirium. Findings from this study also align with prior research demonstrating a positive association between antipsychotic discharge instructions and specialty consult recommendations.

Current and future trends in electronic cigarette use.

The controversy regarding the use of electronic cigarettes as a possible modality for smoking cessation has grown in recent years. Epidemiologic surveys indicate that usage rates in both adults and adolescents have increased substantially as the popularity of these devices continues to rise. At present, there is a small but growing body of evidence studying the possible role that these "e-cigarettes" may have as a nicotine replacement tool. Much of the existing data are from observational studies and surveys which track the epidemiologic and demographic trends of e-cigarette users. More recently-published articles have begun to utilize randomized, experimental designs to directly compare the efficacy of e-cigarettes to active and passive controls in outcome measures such as conventional cigarette quit rates and time to relapse. Barriers to widespread adoption of e-cigarette use as a smoking cessation modality include a lack of long-term safety and toxicology data, a lack of standardization of devices, and a debate regarding whether devices can be marketed for both social nicotine use, as well as nicotine replacement. A possible role of e-cigarettes that has not yet been explored is in the primary prevention of conventional cigarette use among young adults that are smoking-naïve.