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1. Vasculopathy Related to Manic/Hypomanic Symptom Burden and First-Generation Antipsychotics in a Sub-Sample from the Collaborative Depression Study 
FIEDOROWICZ, Jess G, CORYELL, William H, RICE, John P, WARREN, Lois L, and HAYNES, William G
- Psychotherapy and psychosomatics. 81(4):235-243
Homme, Human, Hombre, Traitement, Treatment, Tratamiento, Trouble de l'humeur, Mood disorder, Trastorno humor, Adulte, Adult, Adulto, Antipsychotique, Antipsychotic, Antipsicótico, Etat dépressif, Depression, Estado depresivo, Hypomanie, Hypomania, Hipomanía, Manie, Mania, Mortalité, Mortality, Mortalidad, Neuroleptique, Neuroleptic, Neuroléptico, Pathologie de l'appareil circulatoire, Cardiovascular disease, Aparato circulatorio patología, Pathologie des vaisseaux sanguins, Vascular disease, Vaso sanguíneo patología, Pharmacothérapie, Pharmacotherapy, Farmacoterapia, Psychotrope, Psychotropic, Psicotropo, Symptomatologie, Symptomatology, Sintomatología, Trouble bipolaire, Bipolar disorder, Trastorno bipolar, Antipsychotics, Cardiovascular mortality, Major depression, Sciences biologiques et medicales, Biological and medical sciences, Sciences medicales, Medical sciences, Pharmacologie. Traitements medicamenteux, Pharmacology. Drug treatments, Neuropharmacologie, Neuropharmacology, Psycholeptiques: tranquillisant, neuroleptique., Psycholeptics: tranquillizer, neuroleptic., Psychopathologie. Psychiatrie, Psychopathology. Psychiatry, Etude clinique de l'adulte et de l'adolescent, Adult and adolescent clinical studies, Troubles de l'humeur, Mood disorders, Troubles bipolaires, Bipolar disorders, Psychologie. Psychanalyse. Psychiatrie, Psychology. Psychoanalysis. Psychiatry, PSYCHOPATHOLOGIE. PSYCHIATRIE, Psychopharmacologie, Psychopharmacology, Psycholeptiques: tranquillisant, neuroleptique…, Psycholeptics: tranquillizer, neuroleptic…, Cognition, Psychology, psychopathology, psychiatry, and Psychologie, psychopathologie, psychiatrie
Background: Mood disorders substantially increase the risk of cardiovascular disease, though the mechanisms are unclear. We assessed for a dose-dependent relationship between course of illness or treatment with vasculopathy in a well-characterized cohort. Methods: Participants with mood disorders were recruited for the National Institute of Mental Health Collaborative Depression Study (CDS) and followed prospectively. A cross-sectional metabolic and vascular function evaluation was performed on a sub-sample near completion after a mean follow-up of 27 years. Results: A total of 35 participants from the University of Iowa (33) and Washington University (2) sites of the CDS consented to a metabolic and vascular function assessment at the Iowa site. In multivariate linear regression, controlling for age, gender, and smoking, manic/hypomanic, but not depressive, symptom burden was associated with lower flow-mediated dilation. Cumulative exposure to antipsychotics and mood stabilizers was associated with elevated augmentation pressure and mean aortic systolic blood pressure. This appeared specifically related to first-generation antipsychotic exposure and mediated by increases in brachial systolic pressure. Although second-generation antipsychotics were associated with dyslipidemia and insulin resistance, they were not associated with vasculopathy. Conclusions: These results provide evidence that chronicity of mood symptoms contribute to vasculopathy in a dose-dependent fashion. Patients with more manic/hypomanic symptoms had poorer endothelial function. First-generation antipsychotic exposure was associated with arterial stiffness, evidenced by higher augmentation pressure, perhaps secondary to elevated blood pressure. Vascular phenotyping methods may provide a promising means of elucidating the mechanisms linking mood disorders to vascular disease.
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2. Factors Associated with the Prescribing of Olanzapine, Quetiapine, and Risperidone in Patients with Bipolar and Related Affective Disorders 
PRABHAKAR, Maithri, HAYNES, William G, CORYELL, William H, CHRISCHILLES, Elizabeth A, MILLER, Del D, ARNDT, Stephan, ELLINGROD, Vicki L, WARREN, Lois, and FIEDOROWICZ, Jess G
- Pharmacotherapy. 31(8):806-812
Antagoniste dopamine, Dopamine antagonist, Antagonista dopamina, Antagoniste sérotonine, Serotonin antagonist, Antagonista serotonina, Benzisoxazole dérivé, Benzisoxazole derivatives, Benzisoxazol derivado, Dérivé de la dibenzodiazépine, Dibenzodiazepine derivatives, Dibenzodiazepina derivado, Dérivé de la dibenzothiazépine, Dibenzothiazepine derivatives, Dibenzotiazepina derivado, Dérivé de la thiénobenzodiazépine, Thienobenzodiazepine derivatives, Tienobenzodiazepina derivado, Récepteur dopaminergique D2, D2 Dopamine receptor, Receptor dopaminérgico D2, Récepteur sérotoninergique, Serotonine receptor, Receptor serotoninérgico, Ambulatoire, Ambulatory, Ambulatorio, Antipsychotique atypique, Atypical antipsychotic, Antipsicótico atípico, Etat dépressif, Depression, Estado depresivo, Homme, Human, Hombre, Hypnotique, Hypnotic, Hipnótico, Hôpital, Hospital, Modèle, Models, Modelo, Neuroleptique, Neuroleptic, Neuroléptico, Olanzapine, Olanzapina, Prescription médicale, Medical prescription, Prescripción médica, Psychose, Psychosis, Psicosis, Psychotrope, Psychotropic, Psicotropo, Quétiapine, Quetiapine, Quetiapina, Rispéridone, Risperidone, Risperidona, Tranquillisant, Tranquillizer, Tranquilizante, Trouble affectif, Affective disorder, Trastorno afectividad, Trouble bipolaire, Bipolar disorder, Trastorno bipolar, Trouble de l'humeur, Mood disorder, Trastorno humor, Score, antipsychotic agents, bipolar disorder, inpatients, logistic models, major depressive disorder, outpatients, propensity score, psychotic disorders, Sciences biologiques et medicales, Biological and medical sciences, Sciences medicales, Medical sciences, Pharmacologie. Traitements medicamenteux, Pharmacology. Drug treatments, Psychopathologie. Psychiatrie, Psychopathology. Psychiatry, Etude clinique de l'adulte et de l'adolescent, Adult and adolescent clinical studies, Troubles de l'humeur, Mood disorders, Troubles bipolaires, Bipolar disorders, Psychologie. Psychanalyse. Psychiatrie, Psychology. Psychoanalysis. Psychiatry, PSYCHOPATHOLOGIE. PSYCHIATRIE, Pharmacology drugs, and Pharmacologie, galénique
Study Objective. To identify the factors associated with newly prescribed, first-line, second-generation antipsychotics (SGAs) associated with weight gain—olanzapine, risperidone, and quetiapine. Design. Retrospective medical record review. Setting. Outpatient and inpatient psychiatry services at a tertiary care, academic medical center. Patients. Three hundred forty consecutive adults who had major depressive disorder with psychotic features, bipolar I, bipolar II, bipolar not otherwise specified, or schizoaffective disorder over two time periods (August 30-October 30, 2009, and April 1-May 31, 2010). Measurements and Main Results. Clinical and sociodemographic variables associated with newly prescribed olanzapine, risperidone, and quetiapine were identified by using univariate and multivariate logistic regression. Several clinical factors were individually associated with initiation of these SGAs: mania (odds ratio [OR] 3.6, 95% confidence interval [CI] 1.2-10.8, p=0.02), psychosis (OR 3.3, 95% CI 1.5-6.9, p=0.002), and inpatient treatment (OR 3.8, 95% CI 1.8-7.9, p=0.0005). Prevalent use of lithium (OR 0.3, 95% CI 0.1-0.9, p=0.03) and being married (OR 0.3, 95% CI 0.1-0.8, p=0.02) were inversely associated with new use of an SGA. Mania, psychosis, married status, and lithium use remained independently associated on multivariate analysis. Factors related to metabolic or vascular risk were not associated with SGA initiation. Conclusion. Psychiatric clinicians were influenced heavily by clinical features related to mental status and acuity when determining whether to prescribe SGAs. However, factors related to vascular risk were not associated. Future observational studies should consider current clinical status as an important factor in determining propensity to receive antipsychotics or other short-term treatments for bipolar and related disorders.
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