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  • 1
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    Online Resource
    Characterisation of Alzheimer’s disease patients with agitation and their antipsychotic use: A study using the UK Clinical Practice Research Datalink : Managing dementia‐related behaviors
    Wiley ; 2020
    In:  Alzheimer's & Dementia Vol. 16, No. S8 ( 2020-12)
    Details
    In: Alzheimer's & Dementia, Wiley, Vol. 16, No. S8 ( 2020-12)
    Abstract: There are few data on patients with agitation in Alzheimer’s disease (AD) and their use of antipsychotics (APs). This study characterised patients with agitation in AD (AAD) in terms of falls, and disease duration and examined their AP use compared to AD patients with other neuropsychiatric symptoms (NPS) and no NPS. Methods Data from the UK Clinical Practice Research Datalink were analysed in two ways. Cross‐sectionally to characterise patients with AAD, other NPS and no NPS on 01/07/2016, using chi‐square and ANOVA for differences in proportions and means between groups, respectively. Retrospectively between 01/01/2015 and 31/12/2017 to compare AP use between AD patients with agitation, other NPS and no NPS using a Cox proportional hazards model adjusted for covariates. Results At 01/07/2016, there were 10,573 AD patients with a mean age of 83 years. Patients with AAD (n=605) had longer mean duration of disease (4.3 years) versus patients with other NPS (n=5102, 2.8 years) and no NPS (n=4772, 2.5 years) (p 〈 0.001); more falls (53%) versus patients with other NPS (47%) and no NPS (33%) (p 〈 0.001); were more likely to be prescribed atypical APs within last 60 days (24%) versus patients with other NPS (7%) and no NPS (4%) (p 〈 0.001); and were more likely to have ever been prescribed benzodiazepine (64%) versus patients with other NPS (52%) and no NPS (24%) (p 〈 0.001). During the 3‐year follow‐up, there were 24,464 AD patients with median follow‐up of 1.1 years. The proportion of patients with an AP prescription during follow‐up was: 38% (AAD, n=2432), 20% (other NPS, n=13,076) and 12% (no NPS, n=11,816). Compared to patients with no NPS, the adjusted hazard ratio for AP use was 3.45 (95% CI 2.86‐4.17) for patients with AAD and 1.31 (95% CI 1.19‐1.44) for patients with other NPS. Conclusion Patients with AAD are a particularly difficult to manage group. More patients with AAD had experienced falls and had a longer duration of AD than patients with other or no NPS. At the same time AP use was more than 3‐fold higher in patients with AAD than in patients without NPS.
    Type of Medium: Online Resource
    ISSN: 1552-5260 , 1552-5279
    URL: Issue
    URL: Article
    DOI: 10.1002/alz.v16.S8
    DOI: 10.1002/alz.042548
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 2201940-6
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  • 2
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    Online Resource
    Transdiagnostic individualized clinically-based risk calculator for the automatic detection of individuals at-risk and the prediction of psychosis: external replication in 2,430,333 US patients
    Springer Science and Business Media LLC ; 2020
    In:  Translational Psychiatry Vol. 10, No. 1 ( 2020-10-29)
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    In: Translational Psychiatry, Springer Science and Business Media LLC, Vol. 10, No. 1 ( 2020-10-29)
    Abstract: The real-world impact of psychosis prevention is reliant on effective strategies for identifying individuals at risk. A transdiagnostic, individualized, clinically-based risk calculator to improve this has been developed and externally validated twice in two different UK healthcare trusts with convincing results. The prognostic performance of this risk calculator outside the UK is unknown. All individuals who accessed primary or secondary health care services belonging to the IBM ® MarketScan ® Commercial Database between January 2015 and December 2017, and received a first ICD-10 index diagnosis of nonorganic/nonpsychotic mental disorder, were included. According to the risk calculator, age, gender, ethnicity, age-by-gender, and ICD-10 cluster diagnosis at index date were used to predict development of any ICD-10 nonorganic psychotic disorder. Because patient-level ethnicity data were not available city-level ethnicity proportions were used as proxy. The study included 2,430,333 patients with a mean follow-up of 15.36 months and cumulative incidence of psychosis at two years of 1.43%. There were profound differences compared to the original development UK database in terms of case-mix, psychosis incidence, distribution of baseline predictors (ICD-10 cluster diagnoses), availability of patient-level ethnicity data, follow-up time and availability of specialized clinical services for at-risk individuals. Despite these important differences, the model retained accuracy significantly above chance (Harrell’s C = 0.676, 95% CI: 0.672–0.679). To date, this is the largest international external replication of an individualized prognostic model in the field of psychiatry. This risk calculator is transportable on an international scale to improve the automatic detection of individuals at risk of psychosis.
    Type of Medium: Online Resource
    ISSN: 2158-3188
    URL: Article
    DOI: 10.1038/s41398-020-01032-9
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 2609311-X
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  • 3
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    Predicting time to relapse in patients with schizophrenia according to patients’ relapse history: a historical cohort study using real-world data in Sweden
    Springer Science and Business Media LLC ; 2021
    In:  BMC Psychiatry Vol. 21, No. 1 ( 2021-12)
    Details
    In: BMC Psychiatry, Springer Science and Business Media LLC, Vol. 21, No. 1 ( 2021-12)
    Abstract: For patients with schizophrenia, relapse is a recurring feature of disease progression, often resulting in substantial negative impacts for the individual. Although a patient’s relapse history (specifically the number of prior relapses) has been identified as a strong risk factor for future relapse, this relationship has not yet been meticulously quantified. The objective of this study was to use real-world data from Sweden to quantify the relationship of time to relapse in schizophrenia with a patient’s history of prior relapses. Methods Data from the Swedish National Patient Register and Swedish Prescribed Drug Register were used to study relapse in patients with schizophrenia with a first diagnosis recorded from 2006–2015, using proxy definitions of relapse. The primary proxy defined relapse as a psychiatric hospitalisation of ≥7 days’ duration. Hazard ratios (HRs) were calculated for risk of each subsequent relapse, and Aalen-Johansen estimators were used to estimate time to next relapse. Results 2,994 patients were included, and 5,820 relapse episodes were identified using the primary proxy. As the number of previous relapses increased, there was a general trend of decreasing estimated time between relapses. Within 1.52 years of follow-up, 50% of patients with no history of relapse were estimated to have suffered their first relapse episode. 50% of patients with one prior relapse were estimated to have a second relapse within 1.23 years (HR: 1.84 [1.71–1.99]) and time to next relapse further decreased to 0.89 years (HR: 2.77 [2.53–3.03] ) and 0.22 years (HR: 18.65 [15.42–22.56]) for 50% of patients with two or ten prior relapses, respectively. Supplementary analyses using different inclusion/exclusion criteria for the study population and redefined proxies of relapse reflected the pattern observed with the primary analyses of a higher number of prior relapses linked with increased risk of/reduced estimated time to the next relapse. Conclusions The results suggested a trend of accelerating disease progression in schizophrenia, each relapse episode predisposing an individual to the next within a shorter time period. These results emphasise the importance of providing early, effective, and tolerable treatments that better meet a patient’s individual needs.
    Type of Medium: Online Resource
    ISSN: 1471-244X
    URL: Article
    DOI: 10.1186/s12888-021-03634-z
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 2050438-X
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  • 4
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    Online Resource
    Antipsychotic treatment patterns in Alzheimer’s disease patients with agitation: a cohort study using the UK clinical practice research datalink
    Informa UK Limited ; 2022
    In:  Current Medical Research and Opinion Vol. 38, No. 3 ( 2022-03-04), p. 409-416
    Details
    In: Current Medical Research and Opinion, Informa UK Limited, Vol. 38, No. 3 ( 2022-03-04), p. 409-416
    Type of Medium: Online Resource
    ISSN: 0300-7995 , 1473-4877
    URL: Article
    DOI: 10.1080/03007995.2022.2029381
    Language: English
    Publisher: Informa UK Limited
    Publication Date: 2022
    detail.hit.zdb_id: 2034331-0
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  • 5
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    GWAS for autoimmune Addison’s disease identifies multiple risk loci and highlights AIRE in disease susceptibility
    Springer Science and Business Media LLC ; 2021
    In:  Nature Communications Vol. 12, No. 1 ( 2021-02-11)
    Details
    In: Nature Communications, Springer Science and Business Media LLC, Vol. 12, No. 1 ( 2021-02-11)
    Abstract: Autoimmune Addison’s disease (AAD) is characterized by the autoimmune destruction of the adrenal cortex. Low prevalence and complex inheritance have long hindered successful genetic studies. We here report the first genome-wide association study on AAD, which identifies nine independent risk loci ( P   〈  5 × 10 −8 ). In addition to loci implicated in lymphocyte function and development shared with other autoimmune diseases such as HLA , BACH2 , PTPN22 and CTLA4 , we associate two protein-coding alterations in Autoimmune Regulator ( AIRE ) with AAD. The strongest, p.R471C (rs74203920, OR = 3.4 (2.7–4.3), P  = 9.0 × 10 −25 ) introduces an additional cysteine residue in the zinc-finger motif of the second PHD domain of the AIRE protein. This unbiased elucidation of the genetic contribution to development of AAD points to the importance of central immunological tolerance, and explains 35–41% of heritability ( h 2 ).
    Type of Medium: Online Resource
    ISSN: 2041-1723
    URL: Article
    DOI: 10.1038/s41467-021-21015-8
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 2553671-0
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