Atypical antipsychotic-induced mania: A systematic review and meta-analysis.

BACKGROUND: The possibility of atypical antipsychotics (AA) to induce manic symptoms has been raised by several articles. The objective of this study was to describe whether exposure to AA may induce mania in mood disorders. METHODS: We performed a systematic review following the preferred reporting items for systematic reviews and meta-analysis guidelines. The systematic search encompassed all relevant studies published until April 4th, 2022. A meta-analysis testing whether treatment emergent mania (TEM) is more frequent with the use of AA compared with placebo was performed. RESULTS: A total of 52 studies were included in the systematic review. We found 24 case reports or case series describing 40 manic/hypomanic episodes allegedly induced by AA. Twenty-one placebo-controlled trials were included in a meta-analysis including 4823 individuals treated with AA and 3252 individuals receiving placebo. Our meta-analysis showed that the use of AA protects against the development of TEM (OR: 0.68 [95 % CI: 0.52-0.89], p = 0.005). LIMITATIONS: AA-induced mania/hypomania was not the primary outcome in any of the observational or interventional studies. TEM was not homogeneously defined across studies. In most case reports it was not possible to establish causality between the use of AA and the development of manic symptoms. CONCLUSIONS: TEM is more frequent with placebo than with AA, which suggests that AA exposure does not represent a relevant risk for TEM. Mania/hypomania induced by an AA seems to be rare events, since anecdotal evidence from case reports and case series were not observed in observational prospective and interventional studies.

Long Time, No Sleep: Sleep in Older Adults During the COVID-19 Pandemic.

Objective: The coronavirus disease 2019 (COVID-19) pandemic has had a major impact globally. While sleep problems have increased during the pandemic, their impact on specific populations is less well known. The objective of this study was to measure the impact of the COVID-19 pandemic on sleep and how it correlates with the feeling of isolation in individuals aged ≥ 50 years.Methods: A cross-sectional study was conducted using data from the Survey of Health, Aging, and Retirement conducted between June and August 2020. A multivariate logistic regression model was performed to analyze the outcome "more or less trouble sleeping since the outbreak" and its main predictors.Results: The mean ± SD age of the participants was 71 ± 9 years. Since the outbreak, 29% reported a deterioration of their quality of sleep. Being male and older were found to be significant predictors of more sleep complaints (OR = 1.13; P = .004; CI, 1.04-1.23 and OR = 1.02; P = .000; CI, 1.02-1.03, respectively). Moreover, those who claimed that they often felt alone or more loneliness since the beginning of the outbreak also had more trouble sleeping (OR = 1.21; P = .002; CI, 1.07-1.37 and OR = 4.06; P = .000; CI, 2.75-5.99, respectively).Conclusions: Male sex, older age, and loneliness are associated with more sleeping difficulties since the beginning of the COVID-19 pandemic. These findings can aid health authorities to address sleep issues in this vulnerable population more directly.