Background: Extrapyramidal Symptoms (EPS) are unwanted symptoms commonly originating from the use of certain medications. The symptoms can range from minimal discomfort to permanent involuntary muscular movements. The aims of the study were to examine the incidence of drug-induced extrapyramidal symptoms (di-EPS), associated risk factors, and clinical characteristics. Methods: This is a retrospective, observational study of di-EPS conducted in outpatient clinics of Jordan using the longitudinal health database (Hakeem®) for data collection. Patients who received drugs with the risk of EPS during the period 2010-2020 were included and followed. Patients with any of the known underlying conditions that may cause EPS or were currently taking drugs that may mask the symptoms were excluded. Gender and age-matched control subjects were included in the study. The Statistical Package for Social Science (SPSS®) version 26 was used for data analysis. Results: The final dataset included 34898 exposed patients and 69796 matched controls. The incidence of di-EPS ranged from 9.8% [Amitriptyline 25mg] to 28.9% (Imipramine 25mg). Baseline factors associated with a significantly higher risk of developing di-EPS were age {HR: 1.1 [95%CI: 0.8-1.2, p=0.003], smoking {HR: 1.7 (95%CI: 1.3-2.2), p=0.02}, tremor history {HR: 7.4 (95%CI: 5.9-8.3), p=.002} and history of taking antipsychotics {HR: 3.9, (95% CI: 2.5-4.6), p=0.001}. Patients taking paroxetine {HR: 8.6 [95%CI: 7.4-9.8], p=.0002},imipramine {HR: 8.3, [7.1-10.5], p=0.01}, or fluoxetine {HR: 8.2 (95%CI: 6.8-9.3), p=.006} had a significantly higher risk of developing di-EPS compared to patients taking citalopram. Myoclonus, blepharospasm, symptoms of the basal ganglia dysfunction, and organic writers' cramp were reported among participants. Conclusion: Patients treated with paroxetine, imipramine, fluoxetine, or clomipramine had a higher risk of developing di-EPS than patients treated with citalopram. The difference in gender was not significantly related to di-EPS development. Whereas age, smoking, and history of taking antipsychotics were significantly associated with di-EPS development. Key findings: • High incidence of drug-induced extrapyramidal symptoms (di-EPS) was reported • Age, smoking, tremor history, and history of taking antipsychotics were risk factors of drug-induced extrapyramidal symptoms. • Patients taking paroxetine, imipramine or fluoxetine had a significantly higher risk of developing di-EPS compared to patients taking citalopram
Background Substantial evidence supports a bidirectional relationship between diabetes and clinical depression. However, little is known about the effect of treating one condition on the control of the other. Thus, this study aimed to determine the prevalence of depression among Type II diabetes mellitus (T2DM) patients and to assess the efficacy and feasibility of escitalopram treatment of depression on their metabolic control parameters. Methods T2DM patients attending primary care clinics in the North of Jordan were enrolled in a cross‐sectional study during the period from February to December 2019 (n = 157). Depressive symptoms were screened utilising the patient health questionnaire‐9 (PHQ‐9) tool. Metabolic control was assessed by measurement of glycated haemoglobin (HbA1c), triglycerides, cholesterol, low‐density lipoprotein (LDL) and high‐density lipoprotein (HDL). Patients with moderate to severe depressive symptoms by PHQ‐9 (n = 58) were interviewed by a psychiatrist to confirm a clinical diagnosis of depression. Eligible depressed patients were administered escitalopram 10 mg orally once daily for 3 months (n = 12). Thereafter, depressive symptoms and metabolic control measures were reassessed. Results The prevalence of moderate to severe depressive symptoms among T2DM patients, according to PHQ‐9, was 36.94%, while the prevalence of clinical depression based on interview was 7.64%. Baseline PHQ‐9 scores correlated significantly with baseline levels of HbA1c, HDL, cholesterol and triglycerides. Escitalopram treatment intervention resulted in significant improvement of PHQ‐9 scores without significantly improving any of the metabolic control measures. Conclusion The relationship between depression and T2DM in the context of metabolic syndrome is plausible. However, our results show that escitalopram treatment may not be associated with significant improvement in metabolic control parameters among these patients. Our study has laid the groundwork for future randomised clinical trials with larger sample size and longer follow‐up.
Background: While clinical pharmacists are expected to have a potential role in minimizing prescribing errors (PEs) in patients with diabetes, the effectiveness of their interventions on the incidence and clinical significance of PEs remains unclear. Objectives: To investigate the effectiveness of clinical pharmacist interventions in correcting PEs in diabetic patients with major polypharmacy. Methods: This was a prospective pre-post study conducted in a secondary care hospital in Jordan over 4 months. There were 2 phases: Control, in which PEs were identified and categorized and active, in which clinical pharmacists intercepted and corrected PEs. Clinical severity of prescribing incidents was evaluated by an expert panel, comprising a senior clinical pharmacist, an internist, and cardiologist. SPSS V26 was used for data analysis. Results: Of 928 patients, 432 were followed and reviewed during the control phase and 496 during the active phase. Clinical pharmacist interventions reduced PEs by 89.5%; from 27.6% (control) to 2.9% (active). PEs per patient and PEs per medication orders were reduced from 2.1 to 0.2 and from 0.3 to 0.03, respectively. Electronic selection errors, wrong dose frequency, duplicate drugs, and allergy errors disappeared in the active phase. Significant, serious, and lethal errors were significantly reduced from 35.4%, 11.6%, and 0.2% (control) to 13.5%, 3.1%, and 0.0% (active), respectively. drugs related to CVS (OR = 5.2; 95% CI, 3.1-8.6; P < .05) versus drugs related to endocrine system was more likely to be associated with the occurrence of PEs versus no PEs. However, drug belonging to infectious (OR = 0.6; 95% CI, 0.1-0.9; P < .05) versus drugs related to endocrine system was less likely to be associated with the occurrence PEs versus no PEs. Conclusion: Clinical pharmacist interventions significantly reduced PEs in patients with diabetes by 89.5% and most of these interventions were clinically significant.
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