Increased Risk for Death in Youths Taking High-Dose Antipsychotics

By Psychiatry Advisor

In youths taking a high dose of antipsychotic medication, the risk for an unexpected death is >3.5-fold than in youths not taking one, according to study results published in JAMA Psychiatry.

Researchers retrospectively analyzed Medicaid data to create 3 study cohorts of youths 5 to 24 years old not diagnosed with schizophrenia or related psychoses. The first cohort was composed of young people taking an oral antipsychotic at a dosage >50 mg; the second cohort was composed of children taking an oral antipsychotic medication ≤50 mg; the third cohort was composed of children taking a control medication, such as attention-deficit/hyperactivity disorder medications, antidepressants, or mood stabilizers. Deaths during the study were classified as either injury or suicide, unexpected death not because of overdose, or unexpected death because of cardiovascular or metabolic causes.

Of the 30,120 participants taking a high dose of antipsychotic medication, 39.2% were women, the mean age was 14.5±4.8 years old, and the most commonly prescribed medication was quetiapine. Of the 28,377 participants taking a low dose of antipsychotic medication, 32.3% were women, the mean age was 11.7±4.4 years old, and the most commonly prescribed medication was risperidone. Of the 189,361 participants taking a control medication, 43.4% were women, the mean age was 12±5.1 years old, 49.6% were prescribed antidepressants, 42.9% were prescribed attention-deficit/hyperactivity disorder medications, and 7.5% were prescribed mood stabilizers.

The high-dose cohort had 40 deaths, which translated to 146.2 per 100,000 person-years (95% CI, 107.3-199.4), which was significantly higher than the control cohort (P <.001). The low-dose cohort had 8 deaths, which translated to 49.5 (95% CI, 24.8-99.0) per 100,000 person-years. The control-medication cohort had 67 deaths, which translated to 54.5 (95% CI, 42.9-69.2) per 100,000 person-years. The risk for death was 80% greater in the high-dose cohort than in the control cohort (hazard ratio (HR)1.80; 95% CI, 1.06-3.07), for any type of unexpected death (HR 3.51; 95% CI, 1.54-7.96), for injury or suicide (HR 1.03; 95% CI, 0.53-2.01), for unexpected deaths from unintentional drug overdose (HR 3.51; 95% CI, 0.99-12.43), and for unexpected death because of cardiovascular or metabolic causes (HR 4.29; 95% CI, 1.33-13.89).

Future studies should consider increasing sample size to further evaluate the association of specific antipsychotic medications, analyze potential drug interactions, and differentiate between cardiovascular and metabolic events.

The researchers concluded young people prescribed a high dose of antipsychotic medication “had a 3.5-fold increased risk [for] unexpected deaths… [and t]hese results appear to reinforce recommendations for careful prescribing and monitoring of antipsychotic regimens for children and youths and the need for larger antipsychotic safety studies in this population.”

Reference

Ray WA, Stein CM, Murray KT, et al. Association of antipsychotic treatment with risk of unexpected death among children and youths [published online December 12, 2018]. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2018.3421

Nigeria: Know your HIV status through self-testing, experts counsel youths

A Public Health Specialist, Dr. Oliver Ezechi, has encouraged Nigerian youths to know their HIV status through self-testing to help in eliminating the infection.

Ezechi, a member of the Nigerian National HIV Treatment Task Team at the Nigerian Institute of Medical Research, Yaba, spoke on Friday in Lagos at a programme tagged: 4 Youth by Youth Designathon 2019.

The News Agency of Nigeria reports that the programme was organised by NIMR, in conjunction with the Saint Louis University, Missouri; University of North Caroline and New York University; and it is the first Designathon for health in Nigeria.

It is similar to a Hackathon, a 48-hour event in which young people from all over Nigeria will ideate, design and present their self-devised solutions to social and health issues.

This Designathon is dedicated to developing new services or products that can promote self-testing for HIV and other Sexually Transmitted Diseases.

Ezechi said that knowing your HIV status, especially youths was the best way to help in eliminating HIV completely in the country.

“We are all aware of the recent HIV reports which says HIV has dropped in the country.

“There is a particular groups, which is the young persons, because new infections are still occurring among young persons, women and young girls.

“If we really want to get to the 9090 targets of eliminating HIV/AIDS, the first 90, meaning 90 per cent of people who have HIV, should know their status.

“The entry point for the treatment is HIV counsel and testing; we noticed that young people are not coming forward to our hospitals and clinics to get tested because of stigma.

“What we are doing today is to bring up a competition in which young persons assemble together, design and get best strategy for them on HIV self testing,” Ezechi said.

He also said that NIMR was charged for research on national health, and part of the mandate was to bring in international and national bodies on the best move to implement HIV self testing.

In her remarks, Dr Juliet Iwelunmor, a global health implementation scientist, said their goals were to encourage and let everyone to know their HIV status.

Iwelunmor, an Associate Professor in Global Health at Saint Louis University in Missouri, said that the way by which they could easily know their status was through HIV self testing.

“Our idea is to work with the Nigerian youths and expand HIV oral self testing in Nigeria.

“The data basically says one in five youths have never been tested for HIV; they don’t know their HIV status.

“The beauty of our project is that we the researchers do not want to tell youths to go for test, but they can come up with ideas on HIV self testing.

“The innovation of the self testing for HIV in Nigeria should be low cost, accessible, youth friendly and confidential.

“To ultimately make them apply the HIV self testing, the idea we are having today, is to bring in young Nigerians between the ages of 14 and 25 years.

“For the next couple of days, we will be working with them to design products, services and technology which will make their fellow Nigeria youths to also embrace self test for HIV,” she said.

Iwelunmor said that about 127 entries from Nigeria youths were submitted, but 13 youths were qualified to show case their ideas and techniques.

“After sharing their ideas and techniques, they will move to the third phase, which is the entrepreneur phase; we are going to work with them.

“HIV testing usually occurs in so many places, especially in clinics settings, but we find out that many young people do not show up for testing.

“HIV self testing kits will help people to do the testing in their privacy and get their results within 20 minutes,” she said.

Also speaking, Dr Joseph Tucker, an infectious diseases physician, said that HIV self testing would help every Nigeria youths to know their HIV status.

Tucker, who works with London School of Hygiene and Tropical Medicine and University of North Carolina at Chapel Hill, said the aim was to create health services that were more youths friendly.

“We discovered that across sub-Saharan Africa countries, many of their focus is on adult and thereby neglect the youth.

“We need to involve youths in eliminating and preventing HIV in Nigeria,” he said.

Source Punch

Zimbabweans Unite to Ease Cyclone Idai’s Effects

By Columbus Mavhunga

Zimbabweans have started raising funds and donating goods to provide relief to those who have been affected by Cyclone Idai, which the government says has killed nearly 100 people and displaced hundreds. The government says people are wary of who receives the donations.

At a local church, volunteers arrange donated items destined for places affected by Cyclone Idai in Zimbabwe. Food, water, blankets, clothing – are all found here. The volunteers then load them onto waiting trucks – provided by donors – to head to Zimbabwe’s eastern border where Cyclone Idai ravaged homes and left dozens dead.

One of the volunteers – Johanne Chapungu Oposi – is from the affected region. The 43-year-old man tells me that his former classmate and neighbor – together with the classmate’s wife and three children, were buried alive when a hill collapsed on them while they slept.

“But my elder brother and our family survived, when they saw that that’s what was about to happen they quickly escaped. I want to say that the food supplies there and where to stay are a challenge, or even where to buy food; there is nowhere they can buy because the shops are at the steep slopes so they were destroyed too. I feel quite relieved to be seeing these efforts.”

Tadzi Madzima of the non-governmental organization Ignite Youth says she is happy that Zimbabweans have responded to her calls for people to donate to ease the effects of Cyclone Idai.

“We reached out to the youths in Zimbabwe. We went out mainly on social media where most youths are,” she said. “The response has been overwhelming. We plan to give everything that has been collected here to people affected by Cyclone Idai. We felt that this is the role that we have to play as young people, to help where we can.”

The Red Cross is one of the aid organizations leading efforts to bring relief to Cyclone Idai’s victims. Karikoga Kutadzaushe, the Zimbabwe Red Cross Society operations director, says his organization has deployed teams to ensure that the injured are treated and that there is clean drinking water.

“The situation on the ground is quite dire in that accessibility has been one of the biggest challenges considering Tsinde Eastern is a mountainous area and there have been serious landslides, damaged roads and inaccessibility is one of the worst situations,” he said. “To date, we have almost closer to 100 people who have been confirmed dead, 200 closer to 250 are also currently missing and with regards to people who are currently displaced, we have plus or minus 600 who are actually only currently staying on higher ground within the area.”

Government spokesman Ndavaningi Nick Mangwana told reporters that Harare has deployed army engineers to ensure that damaged roads and bridges are fixed so that assistance can reach the needy. On Zimbabweans responding to calls on social media from organizations and individuals to assist victims of Cyclone Idai, he said:

“It’s good that we have got such goodwill among Zimbabweans; it’s good that we are all running altogether in one accord to help our vulnerable others, our compatriots who are in a bad state at the moment and in a bad place,” he said. “The only thing is we need accountability – we know that in situations like this there is the very fringe minority who will take advantage of the situation…that’s why we say corruption is one of our issues so we hope that there will be systems in place to make sure that whatever is donated, whatever is given ends up at the end user to the point of need where it’s needed most.”

As the truck leaves Harare for Chimanimani and other affected areas, it is hoped the donations reach the intended recipients – those affected by Cyclone Idai. Nancy Kachingwe is among those who donated items.

“The sense of if it was if this happens to me what would I do, you know this happens to families and households so we all have to all understand that, you know, in these days of disasters and climate change, it can happen to anybody; any of us can be next where we end up finding ourselves losing everything, so solidarity has to be part of how we live,” she said

Emergency workers have described flooding spawned by the cyclone as the region’s most destructive in 20 years. Zimbabwean President Emmerson Mnangagwa visited the affected region Tuesday.

Source VOA News