School Year and Suicidal Behaviors Among Youth: Insight From a National Dataset.

Objective: To compare suicidal behaviors that occur during the school year with those during school break and to examine demographic characteristics and comorbidities of the suicidal behaviors by time period.Methods: This retrospective cross-sectional analysis of a nationwide US sample included 74,385 inpatients (aged 10-18 years) who were admitted to the hospital with primary ICD-9 codes of suicidal ideation or suicide and self-inflicted injury including poisoning between January and December 2014. For this study, the sample was further subgrouped based on school year (September to May) and school break (June to August).Results: Suicidal behaviors were higher during the school year (average of 6,761/month) compared to school break (average of 4,512/month). Prevalence of suicidal behaviors was highest in October for both hospitalization and primary diagnosis of mood disorder. Among the school year cohort, the rate of suicidal behaviors was higher in youth with mood disorders (91.6% vs 90%). During school break, the suicidal behavior rate was higher for youth with disruptive behavior disorders (34.6% vs 31.5%) and comorbid alcohol (7.9% vs 5.7%) and other substance use disorders (21.7% vs 18.4%).Conclusions: Suicidal behaviors were higher (1.5 times) during the school year compared to school break. Given the finding that suicidal behaviors are higher among students with mood disorders during the school year, schools should implement universal depression and suicide screening. Youth with disruptive behavior disorders and substance use disorders are at higher risk for suicidal behaviors during school break, thus increased outreach and monitoring during extended breaks seems warranted for these high-risk youth during unstructured times.

Real-world effectiveness of long-acting injectable antipsychotics to reduce 90-day and annual readmission in psychotic disorders: insights from a state psychiatric hospital.

BACKGROUND: To evaluate the effectiveness of long-acting injectable antipsychotics (LAI-a) in reducing the 90-day and annual readmission rates in schizophrenia inpatients. METHODS: We conducted a cross-sectional study and included 180 adult patients with psychotic disorders discharged from 2018 to 2019 at a state psychiatric hospital. Descriptive statistics were used to measure the differences between the readmit and nonreadmit cohorts. Logistic regression model was used to measure the odds ratio (OR) for 90-day and annual readmission and was controlled for potential readmission risk factors. RESULTS: A lower proportion of patients receiving LAI-a were readmitted within 90-day (28.6%) and 1-year (32.4%) periods. Patients receiving LAI-a had lower odds of association for 90-day (OR 0.36, 95% confidence intervals [CI] 0.139-0.921) and annual (OR 0.35, 95% CI 0.131-0.954) readmissions compared to those discharged on oral antipsychotics. A higher proportion of inpatients who received fluphenazine LAI had 90-day (25%) and annual (18.2%) readmissions compared to other LAI-a. CONCLUSION: Utilization of LAI-a in patients with psychotic disorders can decrease both 90-day and annual psychiatric readmissions by 64% to 65%. Physicians should prefer LAI-a to reduce the readmission rate and improve the quality of life, and decrease the healthcare-related financial burden.

Eating Disorders and Suicidal Behaviors in Adolescents with Major Depression: Insights from the US Hospitals.

OBJECTIVE: To evaluate the odds of association between suicidal ideation and/or attempt with comorbid eating disorders in adolescents with major depressive disorder (MDD). METHODS: We conducted a cross-sectional study and included 122,020 adolescents with a primary diagnosis of MDD from the nationwide inpatient sample (NIS, 2012-2014). They were sub-grouped by a comorbid diagnosis of eating disorders (N = 1675). We calculated the adjusted odds ratio (aOR) using a logistic regression model with demographic confounders for associations of eating disorders with suicidal ideation and attempt. RESULTS: Suicidal ideations were seen in a higher proportion of adolescents with eating disorders (46.3% vs. 14.2% in those without eating disorders). On the contrary, a low proportion of adolescents with eating disorders had suicidal attempts (0.9% vs. 39.4% in those without eating disorders). Overall, eating disorders were associated with higher odds for suicidal ideations (aOR 5.36, 95% CI 4.82-5.97) compared to those without eating disorders, but with lower odds of suicidal attempt (aOR 0.02, 95% CI 0.01-0.03). CONCLUSIONS: Adolescents with MDD and comorbid eating disorders had five-times increased odds of suicidal ideations but lower odds of a suicide attempt. Self-harm/injurious behaviors are early signs of suicidal ideations in these patients. A collaborative care model is required for the screening, early diagnosis, and management of adolescents with eating disorders to improve their quality of life.

Relationship of Cannabis Use Disorder and Irritable Bowel Syndrome (IBS): An Analysis of 6.8 Million Hospitalizations in the United States.

Background: Irritable bowel syndrome (IBS) is a chronic multifactorial gastrointestinal condition that substantially affects the quality of life. Research have suggested an increasing trend in cannabis use to alleviate IBS-related psychiatric symptoms. Objectives: We aim to investigate the association of psychiatric comorbidities and cannabis use disorders (CUD) in hospitalized IBS patients. Methods: We analyzed 31,272 IBS hospitalizations in patients (aged 15-54 years) from the Nationwide Inpatient Sample (NIS). We utilized logistic regression to evaluate the adjusted odds ratio (aOR) of CUD and psychiatric comorbidities. Results: Anxiety (26.3%) and depressive (24.8%) disorders were prevalent and increased the odds for IBS-hospitalization by 2.5 and 1.8 times respectively. Tobacco use disorder was most prevalent (24.5%) followed by CUD (3.7%). After controlling for demographics, psychiatric and medical comorbidities, and other substance use disorders, CUD had higher odds for IBS hospitalizations (aOR 1.407, 95% CI 1.32-1.50). IBS hospitalizations with CUD increased by 32.8% from 2010 to 2014. CUD patients were younger (15-24 years, aOR 5.4, 95% CI 4.27-6.77), males (aOR 1.8, 95% CI 1.59-2.09) and African Americans (aOR 2.8, 95% CI 1.45-2.23) and from low-income families (aOR 1.9, 95% CI 1.58-2.39). Conclusions: We found that patients with CUD have 40.7% higher odds for IBS-hospitalizations with a rising trend of CUD and related psychiatric comorbidities which may further worsen IBS and health quality of life. With limited evidence of efficacy and safety of cannabis in IBS, larger, randomized controlled studies are required to examine its therapeutic efficacy.

Marijuana use and acute myocardial infarction: A systematic review of published cases in the literature.

BACKGROUND AND OBJECTIVE: Marijuana use has gained popularity following legalization in the US. Marijuana can affect the heart through various mechanisms. This study aims to conduct a systematic review of published case reports of individuals with acute myocardial infarction (AMI) following marijuana use. METHODS: We conducted a systematic review of literature, including case reports, case series, and the letter to the editor on MEDLINE. Forty-six studies were included, with a total number of 62 patients with AMI and marijuana use. RESULTS: The mean age was 27.7 (±10.3) years with male predominance. About 3.7 g marijuana was used for an average of 9.7 years by the patients. From the cases reporting the onset of AMI symptoms, the average time was within 5 h after last marijuana use. The angiographic findings were normal in 36.8% of cases. In 42.1% of individuals, the left anterior descending coronary artery was occluded, making it the most common artery involved, followed by the right coronary artery (10.5%). Most cases were managed medically, followed by thrombectomy and stent placement, and percutaneous transluminal coronary angioplasty (PTCA). Complications included cardio-embolic stroke, and seven deaths were reported. CONCLUSION: It is important to consider episodic marijuana use as a significant risk factor of AMI, particularly in individuals with no cardiac risk factors, as delay in management can result in fatal outcomes including increased risk of mortality.

Cannabis Use Is an Independent Predictor for Acute Myocardial Infarction Related Hospitalization in Younger Population.

PURPOSE: This study aimed to evaluate the risk of various substances in young acute myocardial infarction (AMI) inpatients and analyze patient demographics and hospital outcomes for significant substance use risk factors. METHODS: We conducted a retrospective analysis of the Nationwide Inpatient Sample data (2010-2014). Patients (aged 15-22 years) with a primary diagnosis for AMI (N = 1,694) were compared with non-AMI (N = 9,465,255) inpatients for odds ratio (OR) of substance use by logistic regression model, adjusted for demographics, medical risk factors, and comorbid substance use. RESULTS: Tobacco (28.4%) and cannabis (14.9%) use were most prevalent in AMI inpatients. Cocaine (OR = 3.9), amphetamine (OR = 2.3), and cannabis (OR = 1.3) users were at higher risk of AMI hospitalizations. Higher proportion of cannabis users (14.7%) had major severity of illness at admission and higher mean total charge ($53,608) compared with that seen in cocaine and amphetamine users. Angioplasty was used more in cannabis users (19.4%) than others. The in-hospital mortalities were 2.7% and 2% in overall AMI cohort and cannabis users, respectively, and none in cocaine and amphetamine users. CONCLUSIONS: Our study demonstrates a higher prevalence and significant odds of AMI inpatients with cannabis use, along with the potential cost burdens because of severe morbidity and higher use of treatment modalities. Physicians need to familiarize themselves with rising use of cannabis and other substances in adolescent and younger population and the typical presentations of cannabis-induced myocardial infarction.

Burden of Persistent Vomiting With Cannabis Use Disorder: Report From 55,549 Hospitalizations in the United States.

BACKGROUND: With increase in incidence rate of persistent vomiting (PV) in the post-legalization period it is important to understand adverse effects of cannabis use and its relationship with PV. OBJECTIVE: We investigated the relationship between cannabis use disorder (CUD) and PV-related hospitalization. METHODS: A Nationwide Inpatient Sample was analyzed from 2010 to 2014 for patients (aged 15-54 y) with a primary diagnosis of PV (N = 55,549), and a comparison was made between patients with the International Classification of Diseases, Ninth Edition classification of CUD versus non-CUD cohorts. We used logistic regression to study the odds ratio between CUD and PV. RESULTS: The number of PV-related hospitalizations with CUD had a significantly increased trend (P < 0.001), with a 286% increase over 5 years. A higher proportion of these patients with CUD were younger (15-24 y), female, and African American/Hispanic. In regression analysis, cannabis was associated with a seven-fold higher odds (95% confidence interval: 6.931-7.260) of PV-related hospitalization. CONCLUSIONS: This study found that CUD was independently associated with a 609% increased likelihood of PV-related hospitalization, and this association persisted even after adjusting for known risk factors and other substances.

Cannabis Use Disorder and Epilepsy: A Cross-National Analysis of 657 072 Hospitalized Patients.

BACKGROUND AND OBJECTIVES: Recent evidence has suggested that cannabis use precipitates cerebrovascular events. We investigated the relationship between cannabis use disorder (CUD) and hospitalization for epilepsy. METHODS: Nationwide inpatient sample (NIS) was analyzed from 2010 to 2014 for patients (age 15-54) with a primary diagnosis of epilepsy (N = 657 072) and comparison was made between patients with ICD-9 classification of CUD and without CUD. We utilized logistic regression to study the association (odds ratio [OR]) between CUD and epilepsy. RESULTS: The incidence of CUD in epilepsy patients was 5.77%, and patients with CUD had a threefold higher likelihood of emergency admissions. Patients with CUD were younger (25-34 years), male and African American. In regression analysis, adjusted for confounders, cannabis (OR, 1.56), tobacco (OR, 1.20), and alcohol (OR, 1.63) use disorders were found to be associated with higher odds of epilepsy hospitalization, but lower odds with cocaine (OR, 0.953), amphetamine (OR, 0.893), and opioid (OR, 0.828) use disorders. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: With the increasing prevalence of medical marijuana legalization, there is increased use of medicinal marijuana. Studies of cannabidiol and marijuana for epilepsy have been highly publicized, leading to its off-label use for treatment. There is limited evidence to suggest that the cannabinoids may also induce a seizure. This study found that CUD is independently associated with a 56% increased likelihood of epilepsy hospitalization and this association persists even after adjusting for other substance use disorders and confounders. (Am J Addict 2019;28:353-360).

Using an Accountability Program to Improve Psychiatry Resident Scores on In-Service Examinations.

BACKGROUND: The Psychiatry Resident-In-Training Examination (PRITE) is a standardized examination that measures residents' educational progress during residency training. It also serves as a moderate-to-strong predictor of later performance on the board certification examination. OBJECTIVE: This study evaluated the effectiveness of an accountability program used by a public psychiatric hospital to increase its residents' PRITE scores. METHODS: A series of consequences and incentives were developed based on levels of PRITE performance. Poor performance resulted in consequences, including additional academic assignments. Higher performance led to residents earning external moonlighting privileges. Standardized PRITE scores for all residents (N = 67) over a 10-year period were collected and analyzed. The PRITE examination consists of 2 subscales-psychiatry and neurology. Change in the overall level of PRITE scores following the implementation of the accountability program was estimated using a discontinuous growth curve model for each subscale. RESULTS: Standardized scores on the psychiatry subscale were 51.09 points, approximately 0.50 SD change, which was higher after the accountability program was implemented. Standardized scores on the neurology subscale did not change. CONCLUSIONS: An accountability program that assigns consequences based on examination performance may be moderately successful in improving scores on the psychiatry subscale scores of the PRITE. This likely has longer-term benefits for residents due to the relationship between PRITE and board certification examination performance.