Impact of Hyponatremia on Resource Utilization in State Psychiatric Hospitals

Josiassen, Richard C.; Filmyer, Dawn M.; Geboy, Alexander; Martin, Danielle; Curtis, Jessica; Shaughnessy, Rita A.

doi:10.1097/jcp.0b013e31825e002a

Cited by 3 publications

(2 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Bun et al 16 recently reported that, among psychiatric inpatients, 12.09% (11/91) of the hyponatremia cases had a history of falls, compared to 2.55% (4/157) of the controls. Our group 17 found that treating CHN in psychotic inpatients reduced the number of falls and overall resource utilization. Psychiatric inpatients with CHN require emergency transfer to a general hospital twice as often (26.7% vs 13.1%) as normonatremic inpatients.…”

Section: Understanding the Risk Of Chronic Hyponatremia In Psychosismentioning

confidence: 80%

Reconsidering Chronic Hyponatremia in Psychosis

Josiassen

Filmyer²,

Geboy³

et al. 2013

J. Clin. Psychiatry

View full text Add to dashboard Cite

medical patients) showing that patients with CHN had an increased risk of death in the hospital, at 1 year, and at 5 years. These findings have obvious implications for quality of life and raise numerous questions. When does CHN become symptomatic in psychotic populations? Is the CNS of psychotic individuals unusually vulnerable to the consequences of CHN? When should CHN be treated with medications? What dosage and duration are appropriate? A New Treatment OptionVaptans have generated great expectation as a treatment option for CHN. 21 One US Food and Drug Administration (FDA)-approved vaptan, tolvaptan, is a selective vasopressin (V 2 ) receptor antagonist. 22 It works by blocking the effects of the pituitary hormone arginine vasopressin (AVP) on the V 2 receptors on the renal collecting duct cells. The Study of Ascending Levels of Tolvaptan (SALT) trial established short-term (30 days) efficacy of tolvaptan for elevating and maintaining serum sodium levels among patients with CHN of diverse etiologies. The SALT trial included a subgroup of psychotic patients with idiopathic CHN and demonstrated that short-term treatment with tolvaptan is effective and safe in this population as well. 23 A multiyear study with psychotic patients confirmed that tolvaptan is effective and safe over long periods of time. 24 Another oral vaptan, lixivaptan, is effective and safe when used to treat CHN in psychotic patients 25,26 but is not yet FDA-approved.Vaptans are seldom used in psychiatric institutions. The available information regarding vaptans and psychosis comes almost entirely from pharmaceutical industry-sponsored clinical trials, and, as a result, little "real-world" experience has been reported. The metric used to demonstrate vaptan efficacy has been serum sodium levels, which are thought to be of limited clinical value within the mental health context. There are no specific guidelines regarding treatment of CHN in psychotic populations, which means that clinicians need to rely solely on their clinical experience and good judgment on a case-by-case basis. Finally, the cost of tolvaptan ($250 per tablet) has raised significant cost-benefit considerations.Addendum: As this article was going to press, the authors were notified that 3 patients enrolled in a 3-year tolvaptan study and its extension trial of about 1,400 patients with autosomal dominant polycystic kidney disease (ADPKD) developed significant (> 3 × ULN) increases in serum alanine aminotransferase with concomitant, clinically significant (> 2 × ULN) increases in serum total bilirubin. Two of these cases were previously reported in the publication of the placebo-controlled study in ADPKD. 1 These patients were treated with doses between 60 and 120 mg/d. The maximum FDA-approved dose of tolvaptan in the US for the indication of euvolemic and hypervolemic hyponatremia is 60 mg/d. Tolvaptan is not currently approved for the treatment of ADPKD. Also, in published results from populations with other diseases treated with tolvaptan over multiple years, liver enzyme a...

show abstract

Section: Understanding the Risk Of Chronic Hyponatremia In Psychosismentioning

confidence: 80%

Reconsidering Chronic Hyponatremia in Psychosis

Josiassen

Filmyer²,

Geboy³

et al. 2013

J. Clin. Psychiatry

View full text Add to dashboard Cite

show abstract

“…This finding seems to be of particular clinical importance because subtle gait impairment may easily be overlooked, and special precautions may prevent significant consecutive morbidity and socioeconomic consequences. 30,31 In fact, it has been shown earlier that even chronic hyponatremia conveys a considerable risk of falls due to gait and attention impairment. 32 As expected, symptom occurrence recorded in the charts clearly correlated with hyponatremia severity.…”

Section: Symptomsmentioning

confidence: 99%

Epidemiology, Symptoms, and Treatment Characteristics of Hyponatremic Psychiatric Inpatients

Lange-Asschenfeldt

Kojda

Cordes³

et al. 2013

Journal of Clinical Psychopharmacology

View full text Add to dashboard Cite

Hyponatremia is a common phenomenon in psychiatry occurring as an adverse effect to drugs or following polydipsia. We performed a retrospective in-depth analysis of hyponatremia cases in a large unselected population of psychiatric inpatients. During a 3-year period, all cases of hyponatremia were identified among patients admitted to a large psychiatric state and university hospital by the institution's electronic laboratory database. Demographic, treatmentrelated, and laboratory data were obtained by consecutive chart review, respectively. Hyponatremia occurred in 347 (4.9%) of 7113 cases, of which the majority (78%) displayed only a mild manifestation. Symptoms were recorded in 28.8% of cases, already occurred in mild forms, and comprised gait impairment (45%, including falls), confusion (30%), sedation (26%), and dyspepsia (41%). Age, female sex, nonpsychiatric drug polypharmacyVparticularly with thiazides and/or angiotensinconverting enzyme inhibitorsVand diagnosis of a mood disorder were associated with more severe hyponatremia, respectively. The proportion of hyponatremic patients treated with venlafaxine, trazodone, carbamazepine, oxcarbazepine, and first-generation antipsychotics, respectively, was significantly higher in the hyponatremia sample than in the normonatremic population. This was, surprisingly, not the case with selective serotonin reuptake inhibitors or any other antidepressant drug class. We found prescription with second-generation antipsychotics to be significantly associated with less severe hyponatremia.Hyponatremia may be mainly attributed to the syndrome of inappropriate antidiuretic hormone secretion, as indicated by decreased serum osmolarity in our sample. Besides old age and female sex, treatment with certain drugsVrather than whole drug classesVcarries a substantially increased risk. ] is maintained within tight limits through a complex homeostatic system involving hypothalamic osmoreceptors and peripheral baroreceptors regulating water intake and urine output via changes in thirst and the neurohypophyseal secretion of the antidiuretic hormone arginine-vasopressin (AVP).8 Thus, excessive water intake or inappropriate release of AVP in the absence of osmotic stimuli, respectively are among the most common pathomechanisms of hyponatremia. The latter condition is known as the syndrome of inappropriate antidiuretic hormone secretion (SIADH) and occurs, among an array of other causes, as an adverse effect of a large number of psychotropic and other drugs. 7,9,10 Above all, a wealth of case reports, casecontrol, and population-based studies have implicated antidepressants, such as tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), selective serotonin and norepinephrine reuptake inhibitors (SNRIs), and certain anticonvulsantsVmainly carbamazepine and oxcarbazepineV in hyponatremia of this origin. 11Y13 The most prevalent nonpsychiatric drugs associated with SIADH-induced hyponatremia are thiazide diuretics and angiotensin-converting enzyme inh...

show abstract