Predicting Falls Among Psychiatric Inpatients: A Case-Control Study at a State Psychiatric Facility

Estrin, Irene Rn; Goetz, Raymond R.; Hellerstein, David J.; Bennett-Staub, Amy Rn; Seirmarco, Gretchen

doi:10.1176/ps.2009.60.9.1245

Cited by 25 publications

(29 citation statements)

References 11 publications

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“…For clonazepam, the duration of past treatment was found to be a more important risk factor over the dose. Estrin et al (2009) suggested a fall prevention program at psychiatric hospitals to identify patients at high risk of falling. Our present work provided clear evidence for that the inter-individual variability in clonazepam metabolism can be estimated by the analysis of patients’ CYP3A4 expression.…”

Section: Discussionmentioning

confidence: 99%

Optimization of Clonazepam Therapy Adjusted to Patient’s CYP3A Status andNAT2Genotype

Tóth

Csukly

Sirok

et al. 2016

IJNPPY

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Background:The shortcomings of clonazepam therapy include tolerance, withdrawal symptoms, and adverse effects such as drowsiness, dizziness, and confusion leading to increased risk of falls. Inter-individual variability in the incidence of adverse events in patients partly originates from the differences in clonazepam metabolism due to genetic and nongenetic factors.Methods:Since the prominent role in clonazepam nitro-reduction and acetylation of 7-amino-clonazepam is assigned to CYP3A and N-acetyl transferase 2 enzymes, respectively, the association between the patients’ CYP3A status (CYP3A5 genotype, CYP3A4 expression) or N-acetyl transferase 2 acetylator phenotype and clonazepam metabolism (plasma concentrations of clonazepam and 7-amino-clonazepam) was evaluated in 98 psychiatric patients suffering from schizophrenia or bipolar disorders.Results:The patients’ CYP3A4 expression was found to be the major determinant of clonazepam plasma concentrations normalized by the dose and bodyweight (1263.5±482.9 and 558.5±202.4ng/mL per mg/kg bodyweight in low and normal expressers, respectively, P<.0001). Consequently, the dose requirement for the therapeutic concentration of clonazepam was substantially lower in low-CYP3A4 expresser patients than in normal expressers (0.029±0.011 vs 0.058±0.024mg/kg bodyweight, P<.0001). Furthermore, significantly higher (about 2-fold) plasma concentration ratio of 7-amino-clonazepam and clonazepam was observed in the patients displaying normal CYP3A4 expression and slower N-acetylation than all the others.Conclusion:Prospective assaying of CYP3A4 expression and N-acetyl transferase 2 acetylator phenotype can better identify the patients with higher risk of adverse reactions and can facilitate the improvement of personalized clonazepam therapy and withdrawal regimen.

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Section: Discussionmentioning

confidence: 99%

Optimization of Clonazepam Therapy Adjusted to Patient’s CYP3A Status andNAT2Genotype

Tóth

Csukly

Sirok

et al. 2016

IJNPPY

View full text Add to dashboard Cite

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“…Other than poor physical health (Estrin et al, 2009;Lord et al, 1991), depression (Gassmann et al, 2009;Launay et al, 2013;Tsai et al, 1998), and insomnia (Avidan et al, 2005;Mahgoub et al, 2012), most antidepressants, especially selective serotonin reuptake inhibitors, have long been recognized as a contributory factor to falls (Coupland et al, 2011;Darowski et al, 2009). The use of benzodiazepine or non-benzodiazepine sedative-hypnotics for severe insomnia would also further increase the risk of falling (Diem et al, 2014;Estrin et al, 2009;Obayashi et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

“…The use of benzodiazepine or non-benzodiazepine sedative-hypnotics for severe insomnia would also further increase the risk of falling (Diem et al, 2014;Estrin et al, 2009;Obayashi et al, 2013). A convergence of these factors would synergistically increase the risk of falls in patients with comorbid MDD and severe insomnia.…”

Section: Discussionmentioning

confidence: 99%

Clinical and sociodemographic correlates of severe insomnia in psychotropic drug-free, Asian outpatients with major depressive disorder

Srisurapanont

Likhitsathian

Chua

et al. 2015

Journal of Affective Disorders

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“…Psychiatric illnesses could lead to perceptual changes and temporary impairment in their judgment and ability to recognize hazards. Patients who fell were commonly diagnosed with depression, 19,[22][23][24] bipolar disorder, [24][25][26] and dementia or Alzheimer's disease. 22,25,27 Neglect of one's safety and unawareness of surround- ing environment in patients with depression were also identified as contributing factors to falls.…”

Section: Risk Factorsmentioning

confidence: 99%

Translating evidence from a systematic review to the development of an evidence-based fall prevention program in a tertiary psychiatric hospital

Xie

2015

Nurs Rep

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Falls have been a major safety concern in view of its high incidences and potential detrimental consequences. This article described a systematic review about effectiveness of interventions for the assessment and prevention of falls in adult psychiatric patients conducted previously. These patients possessed unique fall-related risk factors such as altered mental status, physiological symptoms, past history of falls, mobility and gait problems, concurrent medical conditions, and polypharmacy that might warrant specific tailored fall prevention interventions. Following the systematic review, a care bundle for fall prevention in a tertiary psychiatric hospital would be implemented, taking into account these risk factors and evidence relating to fall prevention.

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Predicting Falls Among Psychiatric Inpatients: A Case-Control Study at a State Psychiatric Facility

Abstract: Risk factors identified in this study should be assessed in replication studies. Psychiatric clinicians can use such risk factors to create evidence-based fall prevention programs.

Cited by 25 publications

References 11 publications

Optimization of Clonazepam Therapy Adjusted to Patient’s CYP3A Status andNAT2Genotype

Optimization of Clonazepam Therapy Adjusted to Patient’s CYP3A Status andNAT2Genotype

Clinical and sociodemographic correlates of severe insomnia in psychotropic drug-free, Asian outpatients with major depressive disorder

Translating evidence from a systematic review to the development of an evidence-based fall prevention program in a tertiary psychiatric hospital

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