@article{KonradJacobRappetal.2016, author = {Konrad, Marcel and Jacob, Louis and Rapp, Michael Armin and Kostev, Karel}, title = {Treatment of depression in patients with cardiovascular diseases by German psychiatrists}, series = {International journal of clinical pharmacology and therapeutics}, volume = {54}, journal = {International journal of clinical pharmacology and therapeutics}, publisher = {Dustri-Verlag Dr. Karl Feistle}, address = {Deisenhofen-M{\~A}¼nchen}, issn = {0946-1965}, doi = {10.5414/CP202591}, pages = {557 -- 563}, year = {2016}, abstract = {Objective: To estimate the prevalence and the type of antidepressant medication prescribed by German psychiatrists to patients with depression and cardiovascular diseases (CVD). Methods: This study was a retrospective database analysis in Germany using the Disease Analyzer Database (IMS Health, Germany). The study population included 2,288 CVD patients between 40 and 90 years of age from 175 psychiatric practices. The observation period was between 2004 and 2013. Follow-up lasted up to 12 months and ended in April 2015. Also included were 2,288 non-CVD controls matched (1 : 1) to CVD cases on the basis of age, gender, health insurance coverage, depression severity, and diagnosing physician. Results: Mean age was 68.6 years. 46.2\% of patients were men, and 5.9\% had private health insurance coverage. Mild, moderate, or severe depression was present in 18.7\%, 60.7\%, and 20.6\% of patients, respectively. Most patients had treatment within a year, many of them immediately after depression diagnosis. Patients with moderate and severe depression were more likely to receive treatment than patients with mild depression. There was no difference between CVD and non-CVD in the proportion of patients treated. Nonetheless, CVD patients received selective serotonin reuptake inhibitors / serotonin-noradrenaline reuptake inhibitors (SSRIs/SNRIs) significantly more frequently. Conversely, patients without CVD were more often treated with TCA. Conclusion: There was no association between CVD and the initiation of depression treatment. Furthermore, CVD patients received SSRIs/SNRIs more frequently.}, language = {en} } @article{KonradJacobRappetal.2016, author = {Konrad, Marcel and Jacob, Louis and Rapp, Michael Armin and Kostev, Karel}, title = {Depression risk in patients with coronary heart disease in Germany}, series = {World Journal of Cardiology}, volume = {8}, journal = {World Journal of Cardiology}, publisher = {Baishideng Publishing Group}, address = {Pleasanton}, issn = {1949-8462}, doi = {10.4330/wjc.v8.i9.547}, pages = {547 -- 552}, year = {2016}, abstract = {AIM To determine the prevalence of depression and its risk factors among patients with coronary heart disease (CHD) treated in German primary care practices. METHODS Longitudinal data from nationwide general practices in Germany (n = 1072) were analyzed. Individuals initially diagnosed with CHD (2009-2013) were identified, and 59992 patients were included and matched (1: 1) to 59992 controls. The primary outcome measure was an initial diagnosis of depression within five years after the index date among patients with and without CHD. Cox proportional hazards models were used to adjust for confounders. RESULTS Mean age was equal to 68.0 years (SD = 11.3). A total of 55.9\% of patients were men. After a five-year follow-up, 21.8\% of the CHD group and 14.2\% of the control group were diagnosed with depression (P < 0.001). In the multivariate regression model, CHD was a strong risk factor for developing depression (HR = 1.54, 95\% CI: 1.49-1.59, P < 0.001). Prior depressive episodes, dementia, and eight other chronic conditions were associated with a higher risk of developing depression. Interestingly, older patients and women were also more likely to be diagnosed with depression compared with younger patients and men, respectively. CONCLUSION The risk of depression is significantly increased among patients with CHD compared with patients without CHD treated in primary care practices in Germany. CHD patients should be routinely screened for depression to ensure improved treatment and management.}, language = {en} } @article{KonradBohlkenRappetal.2016, author = {Konrad, Marcel and Bohlken, Jens and Rapp, Michael Armin and Kostev, Karel}, title = {Depression risk in patients with heart failure in primary care practices in Germany}, series = {International psychogeriatrics}, volume = {28}, journal = {International psychogeriatrics}, publisher = {Cambridge Univ. Press}, address = {New York}, issn = {1041-6102}, doi = {10.1017/S1041610216000867}, pages = {1889 -- 1894}, year = {2016}, abstract = {Background: The goal of this study was to estimate the prevalence of and risk factors for diagnosed depression in heart failure (HF) patients in German primary care practices. Methods: This study was a retrospective database analysis in Germany utilizing the Disease Analyzer (R) Database (IMS Health, Germany). The study population included 132,994 patients between 40 and 90 years of age from 1,072 primary care practices. The observation period was between 2004 and 2013. Follow-up lasted up to five years and ended in April 2015. A total of 66,497 HF patients were selected after applying exclusion criteria. The same number of 66,497 controls were chosen and were matched (1:1) to HF patients on the basis of age, sex, health insurance, depression diagnosis in the past, and follow-up duration after index date. Results: HF was a strong risk factor for diagnosed depression (p < 0.0001). A total of 10.5\% of HF patients and 6.3\% of matched controls developed depression after one year of follow-up (p < 0.001). Depression was documented in 28.9\% of the HF group and 18.2\% of the control group after the five-year follow-up (p < 0.001). Cancer, dementia, osteoporosis, stroke, and osteoarthritis were associated with a higher risk of developing depression. Male gender and private health insurance were associated with lower risk of depression. Conclusions: The risk of diagnosed depression is significantly increased in patients with HF compared to patients without HF in primary care practices in Germany.}, language = {en} } @misc{KonradBohlkenRappetal.2016, author = {Konrad, Marcel and Bohlken, Jens and Rapp, Michael Armin and Kostev, Karel}, title = {Depression risk in patients with heart failure in primary care practices in Germany}, series = {Postprints der Universit{\"a}t Potsdam : Humanwissenschaftliche Reihe}, journal = {Postprints der Universit{\"a}t Potsdam : Humanwissenschaftliche Reihe}, number = {458}, url = {http://nbn-resolving.de/urn:nbn:de:kobv:517-opus4-414159}, pages = {6}, year = {2016}, abstract = {Background: The goal of this study was to estimate the prevalence of and risk factors for diagnosed depression in heart failure (HF) patients in German primary care practices. Methods: This study was a retrospective database analysis in Germany utilizing the Disease Analyzer (R) Database (IMS Health, Germany). The study population included 132,994 patients between 40 and 90 years of age from 1,072 primary care practices. The observation period was between 2004 and 2013. Follow-up lasted up to five years and ended in April 2015. A total of 66,497 HF patients were selected after applying exclusion criteria. The same number of 66,497 controls were chosen and were matched (1:1) to HF patients on the basis of age, sex, health insurance, depression diagnosis in the past, and follow-up duration after index date. Results: HF was a strong risk factor for diagnosed depression (p < 0.0001). A total of 10.5\% of HF patients and 6.3\% of matched controls developed depression after one year of follow-up (p < 0.001). Depression was documented in 28.9\% of the HF group and 18.2\% of the control group after the five-year follow-up (p < 0.001). Cancer, dementia, osteoporosis, stroke, and osteoarthritis were associated with a higher risk of developing depression. Male gender and private health insurance were associated with lower risk of depression. Conclusions: The risk of diagnosed depression is significantly increased in patients with HF compared to patients without HF in primary care practices in Germany.}, language = {en} } @article{DrosselmeyerRappKostev2016, author = {Drosselmeyer, Julia and Rapp, Michael Armin and Kostev, Karel}, title = {Prevalence and type of antidepressant therapy used by German general practitioners to treat female patients with osteoporosis}, series = {International journal of clinical pharmacology and therapeutics}, volume = {54}, journal = {International journal of clinical pharmacology and therapeutics}, publisher = {Dustri-Verlag Dr. Karl Feistle}, address = {Deisenhofen-M{\~A}¼nchen}, issn = {0946-1965}, doi = {10.5414/CP202610}, pages = {743 -- 749}, year = {2016}, abstract = {Objective: To estimate the prevalence and type of antidepressant medication prescribed by German primary care physicians for patients with depression and osteoporosis. Methods: This study was a retrospective database analysis conducted in Germany utilizing the Disease Analyzer (R) Database (IMS Health, Germany). The study population included 3,488 female osteoporosis patients aged between 40 and 90 years recruited from 1,179 general practitioner practices and who were initially diagnosed with depression during the index period (January 2004 to December 2013). Follow-up lasted up to 12 months and was completed in August 2015. Also included in this study were 3,488 nonosteoporosis controls who were matched (1 : 1) to osteoporosis cases on the basis of age, health insurance coverage, severity of depression, and physician carrying out the diagnosis. Results: After 12 months of followup, 30.1\% of osteoporosis and 29.9\% of nonosteoporosis patients with mild depression (p = 0.783), 52.4\% of osteoporosis and 48.0\% of non-osteoporosis patients with moderate depression (p = 0.003), and 39.4\% of osteoporosis and 35.1\% of nonosteoporosis patients with severe depression (p = 0.147) were being treated with antidepressants. Osteoporosis patients with moderate depression had a higher chance of being prescribed antidepressant therapy at the initial diagnosis (hazard ratio (HR): 1.12, p = 0.014). No differences were found between osteoporosis and nonosteoporosis patients regarding the proportion of patients receiving selective serotonin reuptake inhibitors (SSRI)/serotonin-noradrenaline reuptake inhibitors (SNRI), tricyclic antidepressant (TCA), or other antidepressants. Osteoporosis patients were more often referred to hospitals or psychiatrists for consultation. Conclusion: Osteoporosis patients are more often treated initially with antidepressants than non-osteoporosis patients, especially within the groups of patients with moderate or severe depression. TCA was the most frequently used antidepressant therapy class on initial diagnosis in both patient groups. Osteo-porosis patients receive referrals to hospitals or psychiatrists more often than patients without osteoporosis.}, language = {en} } @article{BookersJacobBohlkenetal.2016, author = {Bookers, Anke and Jacob, Louis and Bohlken, Jens and Rapp, Michael Armin and Kostev, Karel}, title = {Persistence with antipsychotics in dementia patients in Germany}, series = {International journal of clinical pharmacology and therapeutics}, volume = {54}, journal = {International journal of clinical pharmacology and therapeutics}, publisher = {Dustri-Verlag Dr. Karl Feistle}, address = {Deisenhofen-M{\~A}¼nchen}, issn = {0946-1965}, doi = {10.5414/CP202631}, pages = {835 -- 840}, year = {2016}, abstract = {Background/Aims: To analyze the duration of treatment with antipsychotics in German dementia patients. Methods: This study included patients aged 60 years and over with dementia who received a first-time antipsychotic prescription by psychiatrists between 2009 and 2013. The main outcome measure was the treatment rate for more than 6 months following the index date. Results: A total of 12,979 patients with dementia (mean age 82 years, 52.1\% living in nursing homes) were included. After 2 years of follow-up, 54.8\%, 57.2\%, 61.1\%, and 65.4\% of patients aged 60 - 69, 70 - 79, 80 - 89, and 90 - 99 years, respectively, received antipsychotic prescriptions. 63.9\% of subjects living in nursing homes and 55.0\% of subjects living at home also continued their treatment (p-value < 0.001). Conclusion: The percentage of dementia patients treated with anti psychotics is very high.}, language = {en} } @article{BookerJacobRappetal.2016, author = {Booker, Anke and Jacob, Louis E. C. and Rapp, Michael Armin and Bohlken, Jens and Kostev, Karel}, title = {Risk factors for dementia diagnosis in German primary care practices}, series = {International psychogeriatrics}, volume = {28}, journal = {International psychogeriatrics}, publisher = {Cambridge Univ. Press}, address = {New York}, issn = {1041-6102}, doi = {10.1017/S1041610215002082}, pages = {1059 -- 1065}, year = {2016}, abstract = {Background: Dementia is a psychiatric condition the development of which is associated with numerous aspects of life. Our aim was to estimate dementia risk factors in German primary care patients. Methods: The case-control study included primary care patients (70-90 years) with first diagnosis of dementia (all-cause) during the index period (01/2010-12/2014) (Disease Analyzer, Germany), and controls without dementia matched (1:1) to cases on the basis of age, sex, type of health insurance, and physician. Practice visit records were used to verify that there had been 10 years of continuous follow-up prior to the index date. Multivariate logistic regression models were fitted with dementia as a dependent variable and the potential predictors. Conclusions: Risk factors for dementia found in this study are consistent with the literature. Nevertheless, the associations between statin, PPI and antihypertensive drug use, and decreased risk of dementia need further investigations.}, language = {en} } @misc{BookerJacobRappetal.2016, author = {Booker, Anke and Jacob, Louis E. C. and Rapp, Michael Armin and Bohlken, Jens and Kostev, Karel}, title = {Risk factors for dementia diagnosis in German primary care practices}, series = {Postprints der Universit{\"a}t Potsdam : Humanwissenschaftliche Reihe}, journal = {Postprints der Universit{\"a}t Potsdam : Humanwissenschaftliche Reihe}, number = {449}, url = {http://nbn-resolving.de/urn:nbn:de:kobv:517-opus4-413441}, pages = {7}, year = {2016}, abstract = {Background: Dementia is a psychiatric condition the development of which is associated with numerous aspects of life. Our aim was to estimate dementia risk factors in German primary care patients. Methods: The case-control study included primary care patients (70-90 years) with first diagnosis of dementia (all-cause) during the index period (01/2010-12/2014) (Disease Analyzer, Germany), and controls without dementia matched (1:1) to cases on the basis of age, sex, type of health insurance, and physician. Practice visit records were used to verify that there had been 10 years of continuous follow-up prior to the index date. Multivariate logistic regression models were fitted with dementia as a dependent variable and the potential predictors. Results: The mean age for the 11,956 cases and the 11,956 controls was 80.4 (SD: 5.3) years. 39.0\% of them were male and 1.9\% had private health insurance. In the multivariate regression model, the following variables were linked to a significant extent with an increased risk of dementia: diabetes (OR: 1.17; 95\% CI: 1.10-1.24), lipid metabolism (1.07; 1.00-1.14), stroke incl. TIA (1.68; 1.57-1.80), Parkinson's disease (PD) (1.89; 1.64-2.19), intracranial injury (1.30; 1.00-1.70), coronary heart disease (1.06; 1.00-1.13), mild cognitive impairment (MCI) (2.12; 1.82-2.48), mental and behavioral disorders due to alcohol use (1.96; 1.50-2.57). The use of statins (OR: 0.94; 0.90-0.99), proton-pump inhibitors (PPI) (0.93; 0.90-0.97), and antihypertensive drugs (0.96, 0.94-0.99) were associated with a decreased risk of developing dementia. Conclusions: Risk factors for dementia found in this study are consistent with the literature. Nevertheless, the associations between statin, PPI and antihypertensive drug use, and decreased risk of dementia need further investigations.}, language = {en} } @article{BookerBohlkenRappetal.2016, author = {Booker, Anke and Bohlken, Jens and Rapp, Michael Armin and Kostev, Karel}, title = {Persistence with antidepressant drugs in patients with dementia: a retrospective database analysis}, series = {International journal of clinical pharmacology and therapeutics}, volume = {54}, journal = {International journal of clinical pharmacology and therapeutics}, publisher = {Dustri-Verlag Dr. Karl Feistle}, address = {Deisenhofen-M{\~A}¼nchen}, issn = {0946-1965}, doi = {10.5414/CP202572}, pages = {323 -- 329}, year = {2016}, abstract = {Background: The aims of the present study are to determine what proportion of patients with dementia receives antidepressants, how long the treatment is administered, and what factors increase the risk of discontinuation. Methods: The study was based on Disease Analyzer database and included 1,203 general practitioners (GP) and 209 neurologists/psychiatrists (NP). 12,281 patients with a diagnosis of dementia and an initial prescription of an antidepressant drug between January 2004 and December 2013 were included. The main outcome measure was antidepressant discontinuation rates within 6 months of the index date. Results: After 6 months of follow-up, 52.7\% of dementia patients treated with antidepressants had stopped medication intake. There was a significantly decreased risk for treatment discontinuation for patients using selective serotonin reuptake inhibitors (SSRRIs) or serotonin and norepinephrine reuptake inhibitors (SSNRIs) compared to tricyclic antidepressants. There was a significantly increased risk of treatment discontinuation for older patients and patients treated in NP practice. Comorbidity of diabetes or history of stroke was associated with a decreased risk of treatment discontinuation. Conclusion: The study results show insufficient persistence in antidepressant treatment in dementia patients in a real world setting. The improvement must be achieved to ensure the treatment recommended in the guidelines.}, language = {en} }