The incidence of new and persistent benzodiazepine use after surgery.

BACKGROUND: It is possible that a portion of new and new persistent use of benzodiazepines is among individuals who start using the medications before or after surgery. We studied the incidence of new and new persistent benzodiazepine use among patients undergoing surgery. METHODS: Retrospective, single-center, population-based cohort of all individuals ≥18 years undergoing first surgery between January 2, 2006 and December 31, 2018 with a year of follow-up for filled medications. Benzodiazepine-naïve patients were defined as not filling a prescription from a year to 31 days before surgery. Patients with new use were naïve patients who filled a prescription between 30 days before and 14 days after surgery, and patients with new persistent use were patients with new use who filled a prescription between 15 days and a year after surgery. Patient and procedural characteristics and prescription filling patterns between the groups were compared. RESULTS: A total of 55,997 patients (32,136 women [57.4%]; median [interquartile range] age, 55 [39, 69] years) were included. The incidence of new use among naïve patients was 2.7% (95% confidence interval, 2.6%-2.8%; n = 1,311), and, of those, 43.7% (95% confidence interval, 41.0%-46.5%; n = 571) had new persistent benzodiazepine use. Approximately 10% of patients with new use filled a prescription for benzodiazepine in every 30-day window during the follow-up period. CONCLUSION: A small portion of surgical patients begin benzodiazepine use perioperatively, but subsequently half fill criteria for persistent use. This highlights the importance of identifying strategies to minimize both new use and the progression of new use into persistent use in surgical patients.

Physician benzodiazepine self-use prior to and during the COVID-19 pandemic in Ontario, Canada: a population-level cohort study.

OBJECTIVES: The aim of this study was to investigate physician benzodiazepine (BZD) self-use pre-COVID-19 pandemic and to examine changes in BZD self-use during the first year of the pandemic. DESIGN: Population-based retrospective cohort study using linked routinely collected administrative health data comparing the first year of the pandemic to the period before the pandemic. SETTING: Province of Ontario, Canada between March 2016 and March 2021. PARTICIPANTS: INTERVENTION: Onset of the COVID-19 pandemic in March 2020. OUTCOMES MEASURES: The primary outcome measure was the receipt of one or more prescriptions for BZD, which was captured via the Narcotics Monitoring System. RESULTS: In a cohort of 30 798 physicians (mean age 42, 47.8% women), we found that during the year before the pandemic, 4.4% of physicians had 1 or more BZD prescriptions. Older physicians (6.8% aged 50+ years), female physicians (5.1%) and physicians with a prior mental health (MH) diagnosis (12.4%) were more likely than younger (3.7% aged <50 years), male physicians (3.8%) and physicians without a prior MH diagnosis (2.9%) to have received 1 or more BZD prescriptions. The first year of the COVID-19 pandemic was associated with a 10.5% decrease (adjusted OR (aOR) 0.85, 95% CI: 0.80 to 0.91) in the number of physicians with 1 or more BZD prescriptions compared with the year before the pandemic. Female physicians were less likely to reduce BZD self-use (aORfemale=0.90, 95% CI: 0.83 to 0.98) compared with male physicians (aORmale=0.79, 95% CI: 0.72 to 0.87, pinteraction=0.046 during the pandemic. Physicians presenting with an incident MH visit had higher odds of filling a BZD prescription during COVID-19 compared with the prior year. CONCLUSIONS: Physicians' BZD prescriptions decreased during the first year of the COVID-19 pandemic in Ontario, Canada. These findings suggest that previously reported increases in mental distress and MH visits among physicians during the pandemic did not lead to greater self-use of BZDs.

[Impact of COVID-19 lockdown on the prescription of benzodiazepines]. / Impacto del confinamiento por COVID-19 en la prescripción de benzodiacepinas.

OBJECTIVE: To evaluate the effect of COVID-19 lockdown on the prescription of benzodiazepines by gender, age and district health departments. DESIGN: Longitudinal observational study. LOCATION: Primary care. Asturias (Spain) health district V. PARTICIPANTS: People over 15 years of age with filled benzodiazepine prescriptions in between 2017 and 2020. MAIN MEASUREMENTS: Benzodiazepine DHD (defined daily dose per 1000 habitants) mean difference between the period defined as pre-lockdown and lockdown. Additionally, the difference was adjusted for gender, sex and district health department and also with the interaction among them. RESULTS: DHD mean pre-lockdown was 131.3 and 139.5 in the lockdown; this difference was significant in the global analysis (95% CI: 4.1-12.1). There was an increase in the DHD mean in the 60-74 age group (95% CI: 2.28-21.42), in the group over 90 years old (95% CI: 21.31-40.63) and in women (95% CI: 3.51-14.59). Finally, a decrease in the DHD mean of V11 (95% CI: -29 to -0.66) and V14 (95% CI: -54.28 to -25.04) district health departments was observed. CONCLUSIONS: Certain subgroups show a change in the pattern of benzodiazepine prescription without being able to relate this to the lockdown. We believe that there could be some inertia in the prescription of psychiatric medication according to the biopsychosocial characteristics of the patients; it is important to detect this in order to avoid the medicalization of psychological disorders.

Agitation in schizophrenia: origins and evidence-based treatment.

PURPOSE OF REVIEW: Agitation associated with schizophrenia remains an important clinical concern and if not managed effectively, can escalate into aggressive behavior. This is a review of the recent biomedical literature on agitation in individuals with schizophrenia. RECENT FINDINGS: Themes in the recent literature include consideration of comorbidities such as cigarette smoking and cannabis use. Surveys reveal that pharmacological approaches to manage agitation have changed little, with haloperidol remaining in common use and intramuscular administration of antipsychotics and/or benzodiazepines being frequently administered to more severely agitated/aggressive individuals. Of note, ketamine has been recently adopted for use in severe agitation in medical emergency departments, but the risk of this medication for people with schizophrenia is unclear. At present, inhaled loxapine remains the only rapidly acting noninjectable FDA-approved treatment for agitation associated with schizophrenia. In development is an intranasal formulation for olanzapine (a well characterized atypical antipsychotic already approved to treat agitation) and a sublingual film for dexmedetomidine (an α2-adrenergic agonist used as an anesthetic and now being repurposed). SUMMARY: Comorbidities can contribute to agitation and can make an accurate differential diagnosis challenging. The ongoing development of rapidly acting novel formulations of antiagitation medications, if successful, may facilitate clinical treatment by providing additional options.

Pharmacological Treatment for Pediatric Anxiety Disorders.

Pediatric anxiety disorders (PADs) occur in up to 20% of youth and can cause impairment across the lifespan. Coronavirus disease 2019 (COVID-19) added unique pressures on those with PADs, as children and adolescents endured the longest pandemic restrictions, stymieing their ability to develop socially, emotionally, and cognitively. Although first-line treatment for PADs is psychotherapy, those with severe anxiety symptoms will require pharmacological interventions. Selective serotonin reuptake inhibitor and serotonin norepinephrine reuptake inhibitor (SNRI) medications are effective in treating PADs, yet only duloxetine (a SNRI) is approved by the U.S. Food and Drug Administration for children aged >7 years with generalized anxiety disorder. Treatment of children and adolescents with benzodiazepines for PADs presents unique challenges with potential paradoxical reactions. Caution must be observed as well due to risk for misuse related to long-term use of benzodiazepines with PADs. [Journal of Psychosocial Nursing and Mental Health Services, 60(9), 6-9.].

Acute mania following COVID-19 in a woman with no past psychiatric history case report.

BACKGROUND: The COVID-19 pandemic that began in late 2019 is caused by infection with the severe acute respiratory syndrome coronavirus-2. Since that time, many neuropsychiatric sequelae including psychosis, neurocognitive disorders, and mood disorders have been observed. The mechanism underlying these effects are currently unknown, however several mechanisms have been proposed. CASE PRESENTATION: A 47-year-old woman with past medical history including hypertension and premenstrual syndrome but no psychiatric history presented to the psychiatric hospital with new onset mania. She had developed symptoms of COVID-19 and was later diagnosed with COVID pneumonia. During quarantine, she reported high levels of stress, grief, and anxiety. Seventeen days into her illness, she developed altered mental status, sleeplessness, elevated mood, talkativeness, and preoccupations. Her spouse was concerned for her safety and contacted emergency medical services who brought her to the psychiatric hospital. She had not slept for five days prior to her arrival and exhibited flight of ideas, talkativeness, and grandiose ideas. She reported a family history of bipolar disorder but no past manic or depressive episodes. She was diagnosed with acute mania and stabilized using antipsychotics, a mood stabilizer, and a short course of a benzodiazepine. Many of her symptoms improved, including her elevated mood, increased activity level, and flight of ideas though she continued to have decreased need for sleep as her benzodiazepine was tapered. She and her partner were agreeable to transitioning to outpatient care after her mood stabilized. CONCLUSIONS: This report emphasizes the link between COVID-19 and neuropsychiatric symptoms. Acute mania has no recognized association with COVID-19, but similar presentations have been reported. The patient's age and time to onset of psychiatric symptoms is consistent with previous reports. Given the growing body of evidence, this association warrants further investigation. Severe acute respiratory syndrome coronavirus-2 causes systemic inflammation and has been shown to be neurotropic. In addition, patients undergoing quarantine experience anxiety related to the disease in addition to social isolation. Psychiatric practitioners should be aware of these effects and advocate for psychiatric evaluation following COVID-19 infection. Understanding the sequelae of infectious disease is crucial for responding to future pandemics.

Benzodiazepine and antipsychotic use among hospitalized older adults before versus after restricting visitation: March to May 2020.

BACKGROUND: Hospital visitation restrictions during the COVID-19 pandemic prompted concerns about unintended consequences for older patients, including an increased incidence of delirium and agitation. While first-line interventions for these conditions are non-pharmacologic, a lack of family support could result in increased use of benzodiazepines and antipsychotics, which are associated with poor outcomes in older adults. Little is known about the association of visitation policies with use of these medications among older adults. METHODS: We conducted a retrospective cross-sectional study among adults aged ≥65 hospitalized from March 1 through May 31, 2020 at four hospitals in the Mid-Atlantic. The dates of onset of visitation restrictions (i.e., hospital-wide guidelines barring visitors) were collected from hospital administrators. Outcomes were use of benzodiazepines and antipsychotics, assessed using patient-level electronic health record data. Using multivariable logistic regression with hospital and study-day fixed effects, the quasi-experimental study design leveraged the staggered onset of visitation restrictions across the hospitals to measure the odds of receiving each medication when visitors were versus were not allowed. RESULTS: Among 2931 patients, mean age was 76.6 years (SD, 8.3), 51.6% were female, 58.6% white, 32.5% black, and 2.6% Hispanic. Overall, 924 (31.5%) patients received a benzodiazepine and 298 (10.2%) an antipsychotic. The adjusted odds of benzodiazepine use was lower on days when visitors were versus were not allowed (adjusted odds ratio [AOR], 0.62; 95% CI, 0.39, 0.99). Antipsychotic use did not significantly differ between days when visitors were versus were not allowed (AOR, 0.98; 95% CI, 0.43, 2.21). CONCLUSIONS: Among older patients hospitalized during the first wave of the pandemic, benzodiazepine use was lower on days when visitors were allowed. These findings suggest that the presence of caregivers impacts use of potentially inappropriate medications among hospitalized older adults, supporting efforts to recognize caregivers as essential members of the care team.

Opioid and benzodiazepine prescribing after COVID-19 hospitalization.

Opioid and benzodiazepine prescribing after COVID-19 hospitalization is not well understood. We aimed to characterize opioid and benzodiazepine prescribing among naïve patients hospitalized for COVID and to identify the risk factors associated with a new prescription at discharge. In this retrospective study of patients across 39 Michigan hospitals from March to November 2020, we identified 857 opioid- and benzodiazepine-naïve patients admitted with COVID-19 not requiring mechanical ventilation. Of these, 22% received opioids, 13% received benzodiazepines, and 6% received both during the hospitalization. At discharge, 8% received an opioid prescription, and 3% received a benzodiazepine prescription. After multivariable adjustment, receipt of an opioid or benzodiazepine prescription at discharge was associated with the length of inpatient opioid or benzodiazepine exposure. These findings suggest that hospitalization represents a risk of opioid or benzodiazepine initiation among naïve patients, and judicious prescribing should be considered to prevent opioid-related harms.

The impact of COVID-19 on benzodiazepine usage in psychiatric inpatient units.

OBJECTIVE: This study aims to investigate whether COVID-19 has led to increased usage of benzodiazepines in acute psychiatric settings. METHOD: We evaluated the rates of benzodiazepine usage in two acute psychiatric inpatient units over a period of two years, 2019 and 2020 (the year of the pandemic). Rates of oral atorvastatin usage over the same period were used as a comparator. RESULTS: We saw a significant increase in the usage of benzodiazepines in the period between April and December 2020 compared to the same period in 2019 despite a decline in the total number of admissions in 2020. Usage peaked further at the time of eased pandemic restrictions which coincided with higher rates of emergency department mental health (MH) presentations and acute MH hospital admissions. We also noticed higher rates of substance use disorder recorded on admission. Hospital leave restrictions due to COVID-19 also led to further restrictions on smoking. CONCLUSION: Benzodiazepine usage increased in the context of the COVID-19 pandemic. The study encourages more research to better understand the impact of the pandemic on acute psychiatric settings.

The effects of COVID-19 on the dispensing rates of antidepressants and benzodiazepines in Canada.

BACKGROUND: Population studies have shown that rates of depressive and anxious symptoms have increased as a result of COVID-19. We analyzed trends in the dispensing rates of antidepressants and benzodiazepines in Canada to determine whether the pandemic has caused changes in rates of pharmacological treatment for depression and anxiety. METHODS: We conducted a population-based, cross-sectional time-series analysis of antidepressants and benzodiazepines dispensed monthly by Canadian community pharmacies between January 2017 and December 2020. We used March 2020 as the intervention month to determine if there were any significant changes in the national rate of antidepressant and benzodiazepine tablets dispensed as the result of the COVID-19 pandemic. RESULTS: There was a temporary reduction in the dispensing rate of antidepressants in April 2020 (from 489 tablets per 100 in March 2020 to 356 tablets per 100 in April 2020; p ≤ .0001); however, the rate returned to its previous level by August 2020. There were no detectable deviations in benzodiazepine dispensing after the declaration of the state of emergency in Ontario. CONCLUSIONS: Despite the increased reporting of depressive and anxious symptoms during the COVID-19 pandemic, there have been no changes in the dispensing trends of medications used to treat these disorders. As the pandemic continues to evolve, future research is needed to monitor the prevalence of depression and anxiety, and associated medication use, in the Canadian population.

Prevention of alcohol withdrawal seizure recurrence and treatment of other alcohol withdrawal symptoms in the emergency department: a rapid review.

BACKGROUND: Patients who experience harms from alcohol and other substance use often seek care in the emergency department (ED). ED visits related to alcohol withdrawal have increased across the world during the COVID-19 pandemic. ED clinicians are responsible for risk-stratifying patients under time and resource constraints and must reliably identify those who are safe for outpatient management versus those who require more intensive levels of care. Published guidelines for alcohol withdrawal are largely limited to the primary care and outpatient settings, and do not provide specific guidance for ED use. The purpose of this review was to synthesize published evidence on the treatment of alcohol withdrawal syndrome in the ED. METHODS: We conducted a rapid review by searching MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials (1980 to 2020). We searched for grey literature on Google and hand-searched the conference abstracts of relevant addiction medicine and emergency medicine professional associations (2015 to 2020). We included interventional and observational studies that reported outcomes of clinical interventions aimed at treating alcohol withdrawal syndrome in adults in the ED. RESULTS: We identified 13 studies that met inclusion criteria for our review (7 randomized controlled trials and 6 observational studies). Most studies were at high/serious risk of bias. We divided studies based on intervention and summarized evidence narratively. Benzodiazepines decrease alcohol withdrawal seizure recurrence and treat other alcohol withdrawal symptoms, but no clear evidence supports the use of one benzodiazepine over another. It is unclear if symptom-triggered benzodiazepine protocols are effective for use in the ED. More evidence is needed to determine if phenobarbital, with or without benzodiazepines, can be used safely and effectively to treat alcohol withdrawal in the ED. Phenytoin does not have evidence of effectiveness at preventing withdrawal seizures in the ED. CONCLUSIONS: Few studies have evaluated the safety and efficacy of pharmacotherapies for alcohol withdrawal specifically in the ED setting. Benzodiazepines are the most evidence-based treatment for alcohol withdrawal in the ED. Pharmacotherapies that have demonstrated benefit for treatment of alcohol withdrawal in other inpatient and outpatient settings should be evaluated in the ED setting before routine use.

Trends in the Use of Benzodiazepines, Z-Hypnotics, and Serotonergic Drugs Among US Women and Men Before and During the COVID-19 Pandemic.

Importance: The ongoing COVID-19 pandemic and associated mitigation measures have disrupted access to psychiatric medications, particularly for women. Objective: To assess the sex differences in trends in the prescribing of benzodiazepines, Z-hypnotics and serotonergic (selective serotonin reuptake inhibitors [SSRIs] and serotonin and norepinephrine reuptake inhibitors [SNRIs]), which are commonly prescribed for anxiety, insomnia, and depression. Design, Setting, and Participants: This cohort study used data from Clinformatics Data Mart, one of the largest commercial health insurance databases in the US. Enrollees 18 years or older were required to have complete enrollment in a given month during our study period, January 1, 2018, to March 31, 2021, to be included for that month. Main Outcomes and Measures: Prescription of a benzodiazepine, Z-hypnotic, or SSRI or SNRI. For each month, the percentage of patients with benzodiazepine, Z-hypnotic, or SSRI or SNRI prescriptions by sex was calculated. Results: The records of 17 255 033 adults (mean [SD] age, 51.7 [19.5] years; 51.3% female) were examined in 2018, 17 340 731 adults (mean [SD] age, 52.5 [19.7] years; 51.6% female) in 2019, 16 916 910 adults (mean [SD] age, 53.7 [19.8] years; 51.9% female) in 2020, and 15 135 998 adults (mean [SD] age, 56.2 [19.8] years; 52.5% female) in 2021. Compared with men, women had a higher rate of prescriptions for all 3 drugs classes and had larger changes in prescription rates over time. Benzodiazepine prescribing decreased from January 2018 (women: 5.61%; 95% CI, 5.60%-5.63%; men: 3.03%; 95% CI, 3.02%-3.04%) to March 2021 (women: 4.91%; 95% CI, 4.90%-4.93%; men: 2.66%; 95% CI, 2.65%-2.67%), except for a slight increase in April 2020 among women. Z-hypnotic prescribing increased from January 2020 for women (1.39%; 95% CI, 1.38%-1.40%) and February 2020 for men (0.97%; 95% CI, 0.96%-0.98%) to October 2020 (women: 1.46%; 95% CI, 1.46%-1.47%; men: 1.00%; 95% CI, 0.99%-1.01%). Prescribing of SSRIs and SNRIs increased from January 2018 (women: 12.77%; 95% CI; 12.75%-12.80%; men: 5.56%; 95% CI, 5.44%-5.58%) to April 2020 for men (6.73%; 95% CI, 6.71%-6.75%) and October 2020 for women (15.18%; 95% CI, 15.16%-15.21%). Conclusions and Relevance: In this cohort study, coinciding with the COVID-19 pandemic onset was an increase in Z-hypnotic as well as SSRI and SNRI prescriptions in both men and women along with an increase in benzodiazepine prescriptions in women, findings that suggest a substantial mental health impact of COVID-19-associated mitigation measures.

Cognitive Behavioral Therapy and Acceptance and Commitment Therapy for the Discontinuation of Long-Term Benzodiazepine Use in Insomnia and Anxiety Disorders.

Benzodiazepines have proven to be highly effective for treating insomnia and anxiety. Although considered safe when taken for a short period of time, a major risk-benefit dilemma arises in the context of long-term use, relating to addiction, withdrawal symptoms, and potential side effects. For these reasons, benzodiazepines are not recommended for treating chronic sleep disorders, anxiety disorders, nor for people over the age of 65, and withdrawal among long-term users is a public health issue. Indeed, only 5% of patients manage to discontinue using these drugs on their own. Even with the help of a general practitioner, this rate does not exceed 25 to 30% of patients, of which approximately 7% manage to remain drug-free in the long term. Cognitive Behavioral Therapies (CBT) offer a crucial solution to this problem, having been shown to increase abstinence success to 70-80%. This article examines traditional and novel CBT techniques in this regard, such as Acceptance and Commitment Therapy, which address both the underlying condition (insomnia/anxiety) and the substance-related disorder. The theoretical framework and evidence supporting the use of these approaches are reviewed. Finally, current research gaps are discussed, and key research perspectives are proposed.

Systematic review of benzodiazepines for anxiety disorders in late life.

BACKGROUND: Benzodiazepines are currently the most commonly prescribed medication for the treatment of anxiety in older adults, although there is a dearth of good-quality data on this subject. The aim of this review was to systematically review studies examining the efficacy and tolerability of benzodiazepines for the treatment of anxiety disorders among older adults. METHODS: The authors conducted a systematic review, searching PubMed, Ovid MEDLINE, Ovid Embase, Web of Science, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials. All searches were limited to English-language articles. The quality of each study was appraised using criteria developed by the Centre for Evidence-Based Medicine for randomized controlled trials. RESULTS: A total of 8,785 citations were retrieved and pooled in EndNote and de-duplicated to 3,753. This set was uploaded to Covidence for screening. Two separate screeners (AG and SAF) evaluated the titles, abstracts, and full text of the eligible articles. Five studies met the inclusion criteria. Across all studies, benzodiazepines were associated with decreased anxiety at the end of the study period. The limited tolerability data show mild adverse effects from the benzodiazepines studied. Limitations of the trials included limited data on the long-term use of benzodiazepines for anxiety and a preponderance of trials examining generalized anxiety disorder, with relatively less data on other anxiety disorders. CONCLUSIONS: Benzodiazepines are effective for treating anxiety disorders in late life, at least in the short term, but more data is needed to establish tolerability and their long-term benefits.

Opioid agonist treatment and patient outcomes during the COVID-19 pandemic in south east Sydney, Australia.

INTRODUCTION: In early 2020, many services modified their delivery of opioid treatment in response to the COVID-19 pandemic, to limit viral spread and maintain treatment continuity. We describe the changes to treatment and preliminary analysis of the association with patients' substance use and well-being. METHODS: A pre-post comparison of treatment conditions and patient self-reported outcomes using data extracted from electronic medical records in the 5 months before (December 2019-April 2020) and after (May 2020-September 2020) changes were implemented in three public treatment services in South Eastern Sydney Local Health District. RESULTS: Data are available for 429/460 (93%) patients. Few (21, 5%) dropped out of treatment. In the 'post' period there was significantly more use of depot buprenorphine (12-24%), access to any take-away doses (TAD; 24-69%), access to ≥6 TAD per week (7-31%), pharmacy dosing (24-52%) and telehealth services. There were significant reductions in average opioid and benzodiazepine use, increases in cannabis use, with limited group changes in social conditions, or quality of life, psychological and physical health. At an individual level, 22% of patients reported increases in their use of either alcohol, opioids, benzodiazepines or stimulants of ≥4 days in the past 4 weeks. Regression analysis indicates increases in substance use were associated with higher levels of supervised dosing. DISCUSSION AND CONCLUSIONS: These preliminary findings suggest that the modified model of care continued to provide safe and effective treatment, during the pandemic. Notably, there was no association between more TAD and significant increases in substance use. Limitations are discussed and further evaluation is needed.

[Effect of treatment with benzodiazepines on the hospital prognosis of Coronavirus disease 2019]. / Efecto del tratamiento con benzodiacepinas en el pronóstico hospitalario de la enfermedad por coronavirus 2019.

INTRODUCTION: The consequences of the use of of benzodiazepines in coronavirus disease 2019 have not yet been studied. We compared the hospital prognosis of patients hospitalized for coronavirus disease 2019 in benzodiazepine users and non-users. PATIENTS AND METHODS: Observational study with a retrospective cohort design. All consecutive patients admitted with a confirmed diagnosis of coronavirus disease 2019 were included. The patients under chronic treatment with benzodiazepines at the time of admission were studied and compared with non-users. The primary objective was to analyze the mortality of patients who used chronic benzodiazepines at the time of admission and compare them with those who did not use them. The secondary objective was to analyze the risk of severe disease due to coronavirus 2019, acute respiratory distress syndrome and admission to the Intensive Care Unit in both groups of patients. RESULTS: We included 576 patients, 138 (24.0%) used benzodiazepines. After adjusting for sex, age, baseline situation and all the different variables between both groups, benzodiazepine users did not show a higher odds of mortality (OR: 1,1, IC 95%: 0,7-1,9, p = 0,682) or higher risk of severe disease due to coronavirus 2019 (OR: 1.2, 95% CI: 0.7-1.8, p = 0.523). They also did not have a higher risk of acute respiratory distress syndrome (OR: 1.2, IC 95%: 0.8-1.9, p = 0.315) or more admission to the Intensive Care Unit (OR: 0.8, 95% CI: 0.4-1.4, p = 0.433). CONCLUSION: In our sample, treatment with benzodiazepines at the time of admission was not associated with a worse hospital prognosis in patients with coronavirus disease 2019.

TITLE: Efecto del tratamiento con benzodiacepinas en el pronóstico hospitalario de la enfermedad por coronavirus 2019.Introducción. Las consecuencias del consumo de benzodiacepinas en el marco de la la enfermedad por coronavirus 2019 (COVID-19) no se habían estudiado hasta ahora. En el presente estudio se comparó el pronóstico hospitalario de pacientes ingresados por COVID-19 que tomaban benzodiacepinas con el de otros ingresados por idéntico motivo que no las tomaban. Pacientes y métodos. Estudio observacional de cohortes retrospectivo. En el estudio se admitió a todos los pacientes consecutivos ingresados con un diagnóstico confirmado de COVID-19. Se estudió a los pacientes que en el momento del ingreso estaban en tratamiento crónico con benzodiacepinas en comparación con otros que no las tomaban. El objetivo principal fue analizar la mortalidad de dichos pacientes con uso crónico de benzodiacepinas y compararla con la mortalidad de los que no tomaban. El objetivo secundario fue analizar en ambos grupos de pacientes el riesgo de padecer un cuadro grave por COVID-19, el síndrome de dificultad respiratoria aguda o el ingreso en la unidad de cuidados intensivos. Resultados. Se admitieron 576 pacientes, 138 (24,0%) de los cuales tomaban benzodiacepinas. Después del ajuste por sexo, edad, situación inicial y todas las variables diferentes entre ambos grupos, los pacientes que tomaban benzodiacepinas no mostraron una probabilidad mayor de muerte (odds ratio: 1,1; IC 95%: 0,7-1,9; p = 0,682) ni un riesgo más acusado de COVID-19 grave (odds ratio: 1,2; IC 95%: 0,7-1,8; p = 0,523). Tampoco presentaron un riesgo mayor de síndrome de dificultad respiratoria aguda (odds ratio: 1,2; IC 95%: 0,8-1,9; p = 0,315) ni de ingreso en la unidad de cuidados intensivos (odds ratio: 0,8; IC 95%: 0,4-1,4; p = 0,433). Conclusión. En esta muestra de pacientes con COVID-2019, el tratamiento con benzodiacepinas en el momento del ingreso no apareció asociado con un empeoramiento del pronóstico hospitalario.

Comparison of Medication Prescribing Before and After the COVID-19 Pandemic Among Nursing Home Residents in Ontario, Canada.

Importance: COVID-19 has had devastating effects on the health and well-being of older adult residents and health care professionals in nursing homes. Uncertainty about the associated consequences of these adverse effects on the use of medications common to this care setting remains. Objective: To examine the association between the COVID-19 pandemic and prescription medication changes among nursing home residents. Design, Setting, and Participants: This population-based cohort study with an interrupted time-series analysis used linked health administrative data bases for residents of all nursing homes (N = 630) in Ontario, Canada. During the observation period, residents were divided into consecutive weekly cohorts. The first observation week was March 5 to 11, 2017; the last observation week was September 20 to 26, 2020. Exposures: Onset of the COVID-19 pandemic on March 1, 2020. Main Outcomes and Measures: Weekly proportion of residents dispensed antipsychotics, benzodiazepines, antidepressants, anticonvulsants, opioids, antibiotics, angiotensin receptor blockers (ARBs), and angiotensin-converting enzyme (ACE) inhibitors. Autoregressive integrated moving average models with step and ramp intervention functions tested for level and slope changes in weekly medication use after the onset of the pandemic and were fit on prepandemic data for projected trends. Results: Across study years, the annual cohort size ranged from 75 850 to 76 549 residents (mean [SD] age, 83.4 [10.8] years; mean proportion of women, 68.9%). A significant increased slope change in the weekly proportion of residents who were dispensed antipsychotics (parameter estimate [ß] = 0.051; standard error [SE] = 0.010; P < .001), benzodiazepines (ß = 0.026; SE = 0.003; P < .001), antidepressants (ß = 0.046; SE = 0.013; P < .001), trazodone hydrochloride (ß = 0.033; SE = 0.010; P < .001), anticonvulsants (ß = 0.014; SE = 0.006; P = .03), and opioids (ß = 0.038; SE = 0.007; P < .001) was observed. The absolute difference in observed vs estimated use in the last week of the pandemic period ranged from 0.48% (for anticonvulsants) to 1.52% (for antipsychotics). No significant level or slope changes were found for antibiotics, ARBs, or ACE inhibitors. Conclusions and Relevance: In this population-based cohort study, statistically significant increases in the use of antipsychotics, benzodiazepines, antidepressants, anticonvulsants, and opioids followed the onset of the COVID-19 pandemic, although absolute differences were small. There were no significant changes for antibiotics, ARBs, or ACE inhibitors. Studies are needed to monitor whether changes in pharmacotherapy persist, regress, or accelerate during the course of the pandemic and how these changes affect resident-level outcomes.

The effect of prohibiting outside food during COVID-19 pandemic on the body weight of schizophrenic patients taking olanzapine or clozapine: a retrospective self-controlled study.

BACKGROUND: Olanzapine and clozapine are atypical antipsychotics (AAPs) with the greatest risk of weight gain, and changes in feeding behavior are among the most important underlying mechanisms. However, few studies have investigated the role of diet-alone interventions in improving individuals' weight gain by taking AAPs. In closed management mental hospitals of China, family members are allowed to bring food to patients regularly, causing patients to have caloric intake added to their 3 daily meals. However, during the global pandemic of coronavirus disease 2019 (COVID-19), bringing food to the hospital was temporarily prohibited in mental health institutions in China to prevent the spread of the virus. This study sought to compare the body weight and body mass index (BMI) changes of patients taking olanzapine or clozapine undergoing diet-alone interventions caused by this prohibition. METHODS: A retrospective self-controlled study was conducted on 90 patients with schizophrenia from a single-center treated with olanzapine or clozapine monotherapy, or combined with aripiprazole or ziprasidone which has a small metabolic impact. A paired-samples t-test was used to compare the changes in body weight and BMI before and after the 3-month prohibition, and general linear regression was used to analyze the effects of gender, age, disease course, duration of drug exposure, and equivalent dose on the BMI improvement. Also, the percentage of people who lost weight and that of individuals who lost 5% of their pre-prohibition body weight were calculated. RESULTS: Paired-samples t-test showed that after 3-month prohibition, the patients' body weight (71.68±6.83 vs. 66.91±7.03, P<0.001) and BMI (26.43±2.11 vs. 24.63±1.81, P<0.001) decreased significantly. Weight loss rate accounted for 99.1%, and weight loss of 5% from the pre-prohibition body weight accounted for 71.8%. General linear regression showed that the duration of drug exposure (ß =-0.678, P<0.001) was significantly and negatively correlated with the BMI changes. No significant correlation of gender, age, disease course, or equivalent dose with BMI changes was found. CONCLUSIONS: Diet-alone interventions facilitate weight loss in chronically hospitalized schizophrenia patients taking AAPs. Conduction of dietary intervention in the early stages of medication may yield greater benefits.

Comparing actual and forecasted numbers of unique patients dispensed select medications for opioid use disorder, opioid overdose reversal, and mental health, during the COVID-19 pandemic, United States, January 2019 to May 2020.

BACKGROUND: COVID-19 community mitigation measures (e.g., stay-at-home orders) may worsen mental health and substance use-related harms such as opioid use disorder and overdose and limit access to medications for these conditions. We used nationally-representative data to assess dispensing of select substance use and mental health medications during the pandemic in the U.S. METHODS: IQVIA Total Patient Tracker data were used to calculate U.S. monthly numbers of unique patients dispensed buprenorphine, extended-release (ER) intramuscular naltrexone, naloxone, selective serotonin or serotonin-norepinephrine reuptake inhibitors, benzodiazepines, and for comparison, HMG-CoA reductase inhibitors (statins) and angiotensin receptor blockers (ARBs) between January 2019-May 2020. Forecasted estimates of number of unique patients dispensed medications, generated by exponential smoothing statistical forecasting, were compared to actual numbers of patients by month to examine access during mitigation measures (March 2020-May 2020). RESULTS: Between March 2020-May 2020, numbers of unique patients dispensed buprenorphine and numbers dispensed naloxone were within forecasted estimates. Numbers dispensed ER intramuscular naltrexone were significantly below forecasted estimates in March 2020 (-1039; 95 %CI:-1528 to -550), April 2020 (-2139; 95 %CI:-2629 to -1650), and May 2020 (-2498; 95 %CI:-2987 to -2009). Numbers dispensed antidepressants and benzodiazepines were significantly above forecasted estimates in March 2020 (977,063; 95 %CI:351,384 to 1,602,743 and 450,074; 95 % CI:189,999 to 710,149 additional patients, respectively), but were within forecasted estimates in April 2020-May 2020. Dispensing patterns for statins and ARBs were similar to those for antidepressants and benzodiazepines. CONCLUSIONS: Ongoing concerns about the impact of the COVID-19 pandemic on substance use and mental health underscore the need for innovative strategies to facilitate continued access to treatment.