abril atherton - Academia.edu (original) (raw)
Papers by abril atherton
Mental Health Clinician, 2017
Introduction: Opioid-related overdoses have risen despite extensive media coverage and apparent a... more Introduction: Opioid-related overdoses have risen despite extensive media coverage and apparent awareness of this public health crisis. Emergency department visits related to opioid use nearly tripled from 2004 to 2011. Patients with mental illness are more likely to be prescribed opioids and have higher rates of overdose. This retrospective chart review sought to determine if opioid represcribing occurred after patients were treated for a nonfatal opioid overdose (NFO) at a Veterans Affairs hospital. Methods: Patients who experienced an NFO between 2009 and 2013 were included and charts reviewed until January 1, 2016. Review of the electronic medical record (EMR) was performed to determine if and when opioids were again prescribed after NFO. Results: Fifty-six veterans met the inclusion criteria. A new opioid prescription was issued to 82% of patients within 3 months following the index NFO date. The average daily morphine equivalent dose prescribed before (122 mg) and after (120 m...
The Journal of Clinical Psychiatry, 2018
OBJECTIVE To evaluate the relationships between benzodiazepine use and (1) health care utilizatio... more OBJECTIVE To evaluate the relationships between benzodiazepine use and (1) health care utilization and (2) suicide risk in veterans diagnosed with posttraumatic stress disorder (PTSD). METHODS This propensity-matched retrospective cohort study included veterans diagnosed with 1 ICD-9 code for PTSD who were active users of the Veterans Affairs health care system between January 1, 2001, and December 31, 2014. Exposure included at least 1 thirty-day prescription of a benzodiazepine within 1 year following PTSD diagnosis among patients with no recent history of benzodiazepine use. The primary outcomes were health care utilization and suicidal behavior. RESULTS A total of 242,493 of 1,134,201 eligible veterans were included in the propensity-matched cohort, 80,831 (7.13%) of whom were prescribed benzodiazepines. Veterans with PTSD who received benzodiazepines had significantly more hospitalizations (incident rate ratio [IRR] = 1.27; 95% CI, 1.10-1.47) and emergency department (IRR = 1.16; 95% CI, 1.13-1.20), general outpatient (IRR = 1.19; 95% CI, 1.16-1.21), outpatient mental health (IRR = 1.49; 95% CI, 1.41-1.57), and total mental health (IRR = 1.37; 95% CI, 1.34-1.40) visits. Benzodiazepine users had a significantly greater risk of death due to suicide (hazard ratio [HR] = 2.74; 95% CI, 2.40-3.13) and were significantly more likely to have medically documented suicide attempts (HR = 1.85; 95% CI, 1.65-2.08) and suicidal ideation (HR = 1.57; 95% CI, 1.48-1.67). CONCLUSIONS Benzodiazepine users had higher rates of health care utilization and were more likely to attempt and complete suicide than patients without benzodiazepine exposure. This study strengthens the empirical evidence against the use of benzodiazepines in veterans with PTSD. Prescribers should weigh the benefits and risks-especially the almost 3-fold increase in suicide risk-when prescribing benzodiazepines in these patients.
The Journal of Clinical Psychiatry, 2016
See article by Bergman et al I n this month's Journal of Clinical Psychiatry, Bergman et al 1 rep... more See article by Bergman et al I n this month's Journal of Clinical Psychiatry, Bergman et al 1 report on the long-term mental health of military veterans matched with nonveterans with a focus on the impact of the length of the veterans' military service. Using data from the Scottish Veterans Health Study, some 57,000 veterans and 173,000 nonveterans were matched. The authors report that military service was correlated with increased mental health problems among veterans in general and among "early service leavers" in particular. 1 Matching of the exact same 2 groups had been used in a previous study on myocardial infarction, 2 which demonstrates that the methodology is sound and flexible and could be applied to a variety of medical issues. Reviewing the references to the article reveals that sources included many British and American studies, which appeared in both British and American journals. This might arguably suggest that the findings would be generalizable to US Armed Forces, who are also North Atlantic Treaty Organization members and use a common military doctrine with similar training and weapons. But the issue of service in wartime, particularly service in areas of active combat, is not addressed in this article. For countries that have been at war and actively engaged in combat operations for the past 14 years, 3,4 the quantitative effects on mental health are a critically important issue. It is made even more important as many of the troops are sent for repeated combat deployments in what are euphemistically referred to as the "sandboxes" of Iraq and Afghanistan. The United States, United Kingdom, and Canada have engaged in combat operations in both of these areas as allies. The psychological trauma of war, now called posttraumatic stress disorder (PTSD), has quite likely been recognized for millennia. In the US Civil War (1861-1865), it was called "soldier's heart. " 5 Then, in World War I and early in World War II, it became "shell shock" or "war neurosis. " 6,7 Later in World War II, the appellation evolved to "battle fatigue" or "combat stress. " 8 But it was essentially the same disorder and led to large numbers of casualties.
The Journal of Clinical Psychiatry, 2016
Mental Health Clinician, 2017
Introduction: Opioid-related overdoses have risen despite extensive media coverage and apparent a... more Introduction: Opioid-related overdoses have risen despite extensive media coverage and apparent awareness of this public health crisis. Emergency department visits related to opioid use nearly tripled from 2004 to 2011. Patients with mental illness are more likely to be prescribed opioids and have higher rates of overdose. This retrospective chart review sought to determine if opioid represcribing occurred after patients were treated for a nonfatal opioid overdose (NFO) at a Veterans Affairs hospital. Methods: Patients who experienced an NFO between 2009 and 2013 were included and charts reviewed until January 1, 2016. Review of the electronic medical record (EMR) was performed to determine if and when opioids were again prescribed after NFO. Results: Fifty-six veterans met the inclusion criteria. A new opioid prescription was issued to 82% of patients within 3 months following the index NFO date. The average daily morphine equivalent dose prescribed before (122 mg) and after (120 m...
The Journal of Clinical Psychiatry, 2018
OBJECTIVE To evaluate the relationships between benzodiazepine use and (1) health care utilizatio... more OBJECTIVE To evaluate the relationships between benzodiazepine use and (1) health care utilization and (2) suicide risk in veterans diagnosed with posttraumatic stress disorder (PTSD). METHODS This propensity-matched retrospective cohort study included veterans diagnosed with 1 ICD-9 code for PTSD who were active users of the Veterans Affairs health care system between January 1, 2001, and December 31, 2014. Exposure included at least 1 thirty-day prescription of a benzodiazepine within 1 year following PTSD diagnosis among patients with no recent history of benzodiazepine use. The primary outcomes were health care utilization and suicidal behavior. RESULTS A total of 242,493 of 1,134,201 eligible veterans were included in the propensity-matched cohort, 80,831 (7.13%) of whom were prescribed benzodiazepines. Veterans with PTSD who received benzodiazepines had significantly more hospitalizations (incident rate ratio [IRR] = 1.27; 95% CI, 1.10-1.47) and emergency department (IRR = 1.16; 95% CI, 1.13-1.20), general outpatient (IRR = 1.19; 95% CI, 1.16-1.21), outpatient mental health (IRR = 1.49; 95% CI, 1.41-1.57), and total mental health (IRR = 1.37; 95% CI, 1.34-1.40) visits. Benzodiazepine users had a significantly greater risk of death due to suicide (hazard ratio [HR] = 2.74; 95% CI, 2.40-3.13) and were significantly more likely to have medically documented suicide attempts (HR = 1.85; 95% CI, 1.65-2.08) and suicidal ideation (HR = 1.57; 95% CI, 1.48-1.67). CONCLUSIONS Benzodiazepine users had higher rates of health care utilization and were more likely to attempt and complete suicide than patients without benzodiazepine exposure. This study strengthens the empirical evidence against the use of benzodiazepines in veterans with PTSD. Prescribers should weigh the benefits and risks-especially the almost 3-fold increase in suicide risk-when prescribing benzodiazepines in these patients.
The Journal of Clinical Psychiatry, 2016
See article by Bergman et al I n this month's Journal of Clinical Psychiatry, Bergman et al 1 rep... more See article by Bergman et al I n this month's Journal of Clinical Psychiatry, Bergman et al 1 report on the long-term mental health of military veterans matched with nonveterans with a focus on the impact of the length of the veterans' military service. Using data from the Scottish Veterans Health Study, some 57,000 veterans and 173,000 nonveterans were matched. The authors report that military service was correlated with increased mental health problems among veterans in general and among "early service leavers" in particular. 1 Matching of the exact same 2 groups had been used in a previous study on myocardial infarction, 2 which demonstrates that the methodology is sound and flexible and could be applied to a variety of medical issues. Reviewing the references to the article reveals that sources included many British and American studies, which appeared in both British and American journals. This might arguably suggest that the findings would be generalizable to US Armed Forces, who are also North Atlantic Treaty Organization members and use a common military doctrine with similar training and weapons. But the issue of service in wartime, particularly service in areas of active combat, is not addressed in this article. For countries that have been at war and actively engaged in combat operations for the past 14 years, 3,4 the quantitative effects on mental health are a critically important issue. It is made even more important as many of the troops are sent for repeated combat deployments in what are euphemistically referred to as the "sandboxes" of Iraq and Afghanistan. The United States, United Kingdom, and Canada have engaged in combat operations in both of these areas as allies. The psychological trauma of war, now called posttraumatic stress disorder (PTSD), has quite likely been recognized for millennia. In the US Civil War (1861-1865), it was called "soldier's heart. " 5 Then, in World War I and early in World War II, it became "shell shock" or "war neurosis. " 6,7 Later in World War II, the appellation evolved to "battle fatigue" or "combat stress. " 8 But it was essentially the same disorder and led to large numbers of casualties.
The Journal of Clinical Psychiatry, 2016