ABSTRACT
Background Risperidone and aripiprazole have been established as standard pharmacological treatments for irritability and associated aggressive behaviors in individuals with autism spectrum disorder (ASD), and are the only drugs approved by the United States Food and Drug Administration for those purposes. However, the rates of readmission with the use of these drugs in the pediatric population have not been studied, leaving a gap in the knowledge of antipsychotic effects. Readmission rates are a valuable metric of treatment efficacy that also reflect the financial burden, morbidity, and medical complications associated with multiple hospitalizations. Methodology A retrospective study was conducted in 65 Hospital Corporation of America Healthcare hospitals within the United States from 2016 to 2019. Patients aged 6-17 years with a diagnosis of ASD with irritability were included. The primary outcome was 30-, 60-, and 90-day readmission rates. Chi-square tests of independence and post-hoc analyses were used to assess the relatedness between readmission rate and antipsychotic use, as well as the type of antipsychotic medication if used. A binary regression analysis was used to analyze the relationship between demographic characteristics and readmission rate in this population. Patients on antidepressants, anxiolytics, or medications primarily used as mood stabilizers were excluded from the study to reduce confounding effects of such medications. Results A total of 2,375 patients aged 6-17 years were admitted for irritability and a diagnosis of ASD. In total 323 (13.8%) patients were readmitted from this group within 30 days of discharge. After controlling for age, sex, and gender, the use of antipsychotic medication was found to decrease 30- and 90-day readmission rates with an odds ratio of 1.2 to 1.4 times compared to no antipsychotic use (p < 0.04). In patients with autism not on antipsychotics, regression analysis revealed that older age (p = 0.0471) and White race (p = 0.0471) were associated with 30-day readmission (a = 0.05). For these patients, race was also significantly associated with 60-day (p = 0.0494) and 90-day (p = 0.0416) readmission rates. In patients with autism on either risperidone or aripiprazole, age (p = 0.0393) and race (p = 0.0316) were significantly associated with 30-day readmission rate. Conclusions Antipsychotic use reduced readmission rates within 30 days and 90 days in patients with irritability and ASD. Additionally, oral aripiprazole and oral risperidone were found to be equally effective in reducing the 30-day readmission rate, and neither was superior in comparison to the other in 30-, 60-, or 90-day readmission rates. The reduced 30- and 90-day readmission rates seen in our study with the use of antipsychotic medications emphasize the importance of antipsychotic use for individuals with ASD and irritability, even if the antipsychotic is not risperidone or aripiprazole. Groups who can particularly benefit from antipsychotic use include individuals who are refractory to first- and second-line therapies, such as behavioral interventions, or for those who present with persistent and serious risk of harm to themselves or others. Additionally, the use of antipsychotic medications in this scenario may reduce hospitalizations within 30 days of discharge, allowing reduction of the financial and emotional strain associated with these readmissions.
ABSTRACT
Background: Alcohol use disorder (AUD) results in frequent hospital readmissions. Although the literature has shown the efficacy of anti-craving medications (ACM), they are infrequently prescribed upon discharge. The outcomes of discharge to substance use treatment facilities (STF) have also not been fully explored. This study seeks to determine the impact of ACM as well as discharge to STF on readmissions for people with AUD. Methods: This retrospective case-control study analyzed encounters made within HCA Healthcare hospitals across the United States from 2016 to 2018 for adults with AUD. The case definition was the presence of ACM defined as acamprosate or naltrexone upon discharge as well as discharge disposition (STF vs. all others). The main outcomes were the likelihood of 30- and 90-day readmission and blood alcohol concentration (BAC) on 30-day readmission in cases versus adults with AUD declining/not referred to an STF or not using ACM. The controlled variables included age, sex, race, and insurance status. Results: A total of 14 691 patients were identified for the study. Of these, 3308 patients were prescribed ACM and 1125 patients were discharged to an STF. Patients without ACM were 1.18 times more likely to be readmitted within 30 days (95% CI, 1.07-1.30; P = .0005). Patients discharged to an STF were 1.57 times more likely to be readmitted within 30 days (95% CI, 1.37-1.79; P < .0001), but these patients had a BAC that was 26.74 units lower on 30-day readmission than those who were not discharged to an STF. Conclusion: The prescription of ACM on discharge was associated with decreased 30-day readmission rates. The lower BAC of those who were readmitted within 30 days suggests discharge to STF may be beneficial for the treatment of AUD in the longer term. Practitioners are encouraged to prescribe ACM for people admitted with AUD to reduce the likelihood of 30-day readmission.
ABSTRACT
Alcohol use disorder (AUD), a chronic condition that affects many people worldwide, is characterized most commonly by a preoccupation with alcohol, an irresistible craving for or the inability to control the consumption of alcohol, and the marked resultant disturbance it bestows upon one's life. Although a difficult and time-consuming condition to attempt to treat, there are currently three FDA-approved medications for AUD, including naltrexone, acamprosate, and disulfiram. However, literature points towards another agent, gabapentin, that may be efficacious in preventing relapse symptoms and cravings with enhanced effectivity in reducing post-hospitalization alcohol consumption behaviors. In this paper, we discuss a case presentation and literature review demonstrating the role of gabapentin in treating AUD and symptoms associated with alcohol withdrawal, along with its potential use in relapse prevention.
