Journal of clinical psychopharmacology
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J Clin Psychopharmacol · Feb 2012
Variation in antipsychotic treatment choice across US nursing homes.
Despite serious safety concerns, antipsychotic medications continue to be used widely in US nursing homes. The objective of this study was to quantify the variation in antipsychotic treatment choice across US nursing homes, and to characterize its correlates. ⋯ These findings indicate that antipsychotic treatment choice is to some extent influenced by a nursing home's underling prescribing "culture." This culture may reveal strategies for targeting quality improvement interventions. In addition, these findings suggest that a nursing home's tendency for specific antipsychotics merits further exploration as an instrumental variable for improved confounding adjustment in comparative effectiveness studies.
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J Clin Psychopharmacol · Feb 2012
Randomized Controlled Trial Multicenter Study Comparative StudyTreating depression after initial treatment failure: directly comparing switch and augmenting strategies in STAR*D.
Augmenting and switching antidepressant medications are the 2 most common next-step strategies for depressed patients failing initial medication treatment. These approaches have not been directly compared; thus, our objectives are to compare outcomes for medication augmentation versus switching for patients with major depressive disorder in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) clinical trial. ⋯ For patients receiving and tolerating aggressive initial antidepressant trials, there is no clear preference for next-step augmentation versus switching. Findings tentatively suggest that those who complete an initial treatment of 12 weeks or more and have a partial response with residual mild depressive severity may benefit more from augmentation relative to switching.
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J Clin Psychopharmacol · Feb 2012
Comparative StudyTreatment with duloxetine in adults and the incidence of cardiovascular events.
Cardiovascular events are inconclusively associated with duloxetine use in clinical trials and spontaneous reports. This analysis of cardiovascular events in relation to duloxetine use within a large health insurance database provides further data on the association. ⋯ The incidence of cardiovascular events did not differ among duloxetine initiators relative to other antidepressant comparators or those with untreated depression but was higher than those without depression, suggesting that depression itself (or associated morbidities) may affect the risk of cardiovascular events.