warfarin and Psychotic-Disorders

To characterize warfarin eligibility and receipt among Veterans Health Administration (VHA) patients with and without mental health conditions (MHCs).. Retrospective cohort study.. This observational study identified VHA atrial fibrillation (AF) patients with and without MHCs in 2004. We examined unadjusted MHC-related differences in warfarin eligibility and warfarin receipt among warfarin-eligible patients, using logistic regression for any MHC and for specific MHCs (adjusting for sociodemographic and clinical characteristics).. Of 125,670 patients with AF, most (96.8%) were warfarin-eligible based on a CHADS2 stroke risk score. High stroke risk and contraindications to anticoagulation were both more common in patients with MHC. Warfarin-eligible patients with MHC were less likely to receive warfarin than those without MHC (adjusted odds ratio [AOR], 0.90; 95% CI, 0.87-0.94). The association between MHC and warfarin receipt among warfarin-eligible patients varied by specific MHC. Patients with anxiety disorders (AOR, 0.86; 95% CI, 0.80-0.93), psychotic disorders (AOR, 0.77; 95% CI, 0.65-0.90), and alcohol use disorders (AOR 0.62, 95% CI 0.54-0.72) were less likely to receive warfarin than patients without these conditions, whereas patients with depressive disorders and posttraumatic stress disorder were no less likely to receive warfarin than patients without these conditions.. Compared with patients with AF without MHCs, those with MHCs are less likely to be eligible for warfarin receipt and, among those eligible, are less likely to receive such treatment. Although patients with AF with MHC need careful assessment of bleeding risk, this finding suggests potential missed opportunities for more intensive therapy among some individuals with MHCs.

Topics: Aged; Alcoholism; Anticoagulants; Anxiety Disorders; Atrial Fibrillation; Depressive Disorder; Female; Humans; Male; Mental Disorders; Middle Aged; Psychotic Disorders; Retrospective Studies; Stress Disorders, Post-Traumatic; Warfarin

Psychotic patients are at increased risk of thromboembolism that cannot be ascribed to physical restraint or medication. Patients with chronic schizophrenia or long-term depressive illness do not display ischemic brain injuries on magnetic resonance imaging, as expected in patients with thrombotic tendency, but atrophy of specific brain regions, which indicates abnormal neuronal plasticity.. We postulate that a relationship between psychosis pathophysiology and thrombotic tendency may comprise proteins that participate not only in the anticoagulation-fibrinolysis mechanism, but also in neuronal plasticity.. Five psychotic patients with thrombotic episodes on chronic warfarin therapy attained remission of psychotic symptoms and are free of psychotropic medication from 2 to 11years. All patients have at least one thrombophilia related to inhibition of plasminogen activators, including prothrombin G20.210A polymorphism, hyperhomocysteinemia, antiphospholipid antibody syndrome and protein C deficiency.. Plasminogen activators participate in blood clot dissolution and tissue repair, such as remodeling of hippocampus after stress, trauma, stroke or seizures. A significant prevalence of both thromboembolism and psychotic events can be seen in circumstances characterized by physiological or pathological inhibition of plasminogen activators, such as puerperium, confinement, polycystic ovary syndrome, antiphospholipid antibody syndrome and chronic inflammatory disorders.. Our findings suggest that normalization of plasminogen activator levels in the brain may induce long-term remission of psychotic symptoms. Randomized controlled studies may help clarify the role of anticoagulation in the treatment of psychosis.

Topics: Adolescent; Adult; Brazil; Female; Humans; Male; Middle Aged; Neuronal Plasticity; Plasminogen Activators; Psychotic Disorders; Remission Induction; Thromboembolism; Warfarin

Idiopathic thromboembolism can occur in psychiatric patients who have been inactive during a period of inpatient hospital treatment. These patients are usually treated with antipsychotic medication which has also been reported to increase risk for thromboembolic disease. Here the authors describe a patient with neither prior history of thromboembolism nor any medical risk factors for thromboembolic disease, who was admitted with an acute relapse of psychotic illness. During the course of her intensive psychiatric treatment, she had chest pain and CT-pulmonary arteriogram revealed bilateral lower lobe pulmonary embolism. She was anticoagulated and made a full medical recovery. Treatment with high dosages of typical and atypical antipsychotic medication and a lack of mobility related to intensive nursing care and sedation were likely risk factors in her development of pulmonary emboli.

Topics: Adult; Anticoagulants; Antipsychotic Agents; Female; Hospitalization; Humans; Medication Adherence; Practice Guidelines as Topic; Psychotic Disorders; Pulmonary Embolism; Radiography; Recurrence; Risk Factors; Warfarin

Topics: Anticoagulants; Celecoxib; Cyclooxygenase Inhibitors; Drug Interactions; Drug Therapy, Combination; Humans; International Normalized Ratio; Male; Middle Aged; Prothrombin Time; Psychotic Disorders; Pyrazoles; Sulfonamides; Warfarin

Topics: Aged; Blood Coagulation Tests; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Female; Fluphenazine; Humans; Psychotic Disorders; Schizophrenia; Thrombophlebitis; Valproic Acid; Warfarin

A case of surreptitious ingestion of oral anticoagulants is presented. The patient, a 31-year-old nurse, was followed for more than 3 years and underwent thorough psychological and psychiatric evaluation. Anticoagulant malingerers are by no means rare; however, little is known about the psychiatric disturbances in these patients. The tendency has been to regard these patients as having neurotic or personality disturbances. The data in the present case suggest that factitious hemorrhagic disease is caused by a psychotic disturbance. The results of psychiatric therapy are discussed.

Topics: Adult; Denial, Psychological; Diagnosis, Differential; Female; Haloperidol; Hemorrhage; Humans; Psychological Tests; Psychotherapy, Group; Psychotic Disorders; Substance-Related Disorders; Warfarin

Topics: Aged; Aortic Valve; Aortic Valve Stenosis; Arrhythmias, Cardiac; Cardiac Catheterization; Cardiac Surgical Procedures; Digoxin; Endocarditis; Endocarditis, Bacterial; Heart Failure; Heart Valve Diseases; Heart Valve Prosthesis; Heart, Artificial; Humans; Isoproterenol; Methicillin; Middle Aged; Postoperative Complications; Psychoses, Substance-Induced; Psychotic Disorders; Thoracic Surgery; Warfarin