2022
Effect of Pharmacogenomic Testing for Drug-Gene Interactions on Medication Selection and Remission of Symptoms in Major Depressive Disorder
Oslin DW, Lynch KG, Shih MC, Ingram EP, Wray LO, Chapman SR, Kranzler HR, Gelernter J, Pyne JM, Stone A, DuVall SL, Lehmann LS, Thase ME, Aslam M, Batki S, Bjork J, Blow F, Brenner L, Chen P, Desai S, Dieperink E, Fears S, Fuller M, Goodman C, Graham D, Haas G, Hamner M, Helstrom A, Hurley R, Icardi M, Jurjus G, Kilbourne A, Kreyenbuhl J, Lache D, Lieske S, Lynch J, Meyer L, Montalvo C, Muralidhar S, Ostacher M, Paschall G, Pfeiffer P, Prieto S, Przygodzki R, Ranganathan M, Rodriguez-Suarez M, Roggenkamp H, Schichman S, Schneeweis J, Simonetti J, Steinhauer S, Suppes T, Umbert M, Vassy J, Voora D, Wiechers I, Wood A. Effect of Pharmacogenomic Testing for Drug-Gene Interactions on Medication Selection and Remission of Symptoms in Major Depressive Disorder. JAMA 2022, 328: 151-161. PMID: 35819423, PMCID: PMC9277497, DOI: 10.1001/jama.2022.9805.Peer-Reviewed Original ResearchConceptsMajor depressive disorderPatient Health Questionnaire-9Usual care groupUsual carePharmacogenomic testingDrug-gene interactionsRemission rateMedication selectionCare groupDepressive disorderVeterans Affairs Medical CenterActive substance use disorderCo-primary outcomesPrescription of medicationsBetter clinical outcomesProportion of prescriptionsRemission of symptomsSubstance use disordersEligible patientsWeek 24Effective antidepressantSingle antidepressantClinical outcomesInitial treatmentQuestionnaire-9
2021
Trends in Medication Prescribing in Patients With PTSD From 2009 to 2018: A National Veterans Administration Study.
Holder N, Woods A, Neylan TC, Maguen S, Seal KH, Bernardy N, Wiechers I, Ryder A, Urbieta AM, Cohen BE. Trends in Medication Prescribing in Patients With PTSD From 2009 to 2018: A National Veterans Administration Study. The Journal Of Clinical Psychiatry 2021, 82 PMID: 34004087, DOI: 10.4088/jcp.20m13522.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAntipsychotic AgentsDrug PrescriptionsHumansLongitudinal StudiesMaleMiddle AgedPractice Patterns, Physicians'Psychotropic DrugsRetrospective StudiesSelective Serotonin Reuptake InhibitorsSerotonin and Noradrenaline Reuptake InhibitorsStress Disorders, Post-TraumaticUnited StatesUnited States Department of Veterans AffairsVeteransConceptsPosttraumatic stress disorderPercentage of patientsVeterans Health AdministrationVHA careAdjunctive medicationsOutpatient prescription recordsSSRIs/SNRIsVeterans Administration studyClinical practice guidelinesICD-10 codesAdverse side effectsEvidence-based psychotherapiesPsychotic spectrum disordersAAP useMedication classesBenzodiazepine prescriptionsMedication prescribingPrescription recordsSymptom improvementNational cohortPractice guidelinesMedicationsSide effectsICD-9Patients
2020
Benzodiazepine Use among Medicare, Commercially Insured, and Veteran Older Adults, 2013–2017
Maust DT, Kim HM, Wiechers IR, Ignacio RV, Bohnert ASB, Blow FC. Benzodiazepine Use among Medicare, Commercially Insured, and Veteran Older Adults, 2013–2017. Journal Of The American Geriatrics Society 2020, 69: 98-105. PMID: 32951209, PMCID: PMC7856043, DOI: 10.1111/jgs.16825.Peer-Reviewed Original Research
2018
Patient centered medical homes did not improve access to timely follow-up after ED visit
Chou SC, Rothenberg C, Agnoli A, Wiechers I, Lott J, Voorhees J, Bernstein SL, Venkatesh AK. Patient centered medical homes did not improve access to timely follow-up after ED visit. The American Journal Of Emergency Medicine 2018, 36: 854-858. PMID: 29452920, DOI: 10.1016/j.ajem.2018.01.070.Peer-Reviewed Original ResearchConceptsPrimary care followPrimary care practicesPCMH designationCare followAffordable Care ActAppointment availabilityCare practicesEmergency department dischargeGreater New HavenED visitsED patientsTimely followInsurance statusOutpatient practiceInsurance typeHours appointmentED diagnosisMedical homeLocal cliniciansPractice characteristicsSignificant associationPatientsFollowStandardized scriptPractice improvement
2017
National Trends in Antidepressant, Benzodiazepine, and Other Sedative-Hypnotic Treatment of Older Adults in Psychiatric and Primary Care.
Maust DT, Blow FC, Wiechers IR, Kales HC, Marcus SC. National Trends in Antidepressant, Benzodiazepine, and Other Sedative-Hypnotic Treatment of Older Adults in Psychiatric and Primary Care. The Journal Of Clinical Psychiatry 2017, 78: e363-e371. PMID: 28448697, PMCID: PMC5408458, DOI: 10.4088/jcp.16m10713.Peer-Reviewed Original ResearchConceptsPrimary care providersPrimary carePain diagnosisCare providersOlder adultsClinical characteristicsNational Ambulatory Medical Care SurveyNon-Hispanic white patientsAmbulatory Medical Care SurveyMental healthCommon psychotropic medicationsOutpatient physician visitsPrimary care visitsUse of antidepressantsMental health treatmentCare visitsMedication usePhysician visitsWhite patientsPsychotropic medicationsCare SurveyPsychotropic useHealth treatmentVisit ratesAntidepressantsDevelopment and Applications of the Veterans Health Administration’s Stratification Tool for Opioid Risk Mitigation (STORM) to Improve Opioid Safety and Prevent Overdose and Suicide
Oliva EM, Bowe T, Tavakoli S, Martins S, Lewis ET, Paik M, Wiechers I, Henderson P, Harvey M, Avoundjian T, Medhanie A, Trafton JA. Development and Applications of the Veterans Health Administration’s Stratification Tool for Opioid Risk Mitigation (STORM) to Improve Opioid Safety and Prevent Overdose and Suicide. Psychological Services 2017, 14: 34-49. PMID: 28134555, DOI: 10.1037/ser0000099.Peer-Reviewed Original ResearchConceptsVeterans Health AdministrationSuicide-related eventsPredictive risk modelAdverse eventsRisk factorsRisk mitigation interventionsOpioid-related adverse eventsVHA electronic medical recordsSuicide-related adverse eventsOpioid risk mitigationOpioid Safety InitiativeHigh-risk patientsNaloxone distribution programsElectronic medical recordsOpioid prescribingOpioid analgesicsVHA patientsStratification toolMedical recordsOverdose educationPatientsHealth AdministrationMortality dataPatient identificationRisk model
2016
No End in Sight: Benzodiazepine Use in Older Adults in the United States
Maust DT, Kales HC, Wiechers IR, Blow FC, Olfson M. No End in Sight: Benzodiazepine Use in Older Adults in the United States. Journal Of The American Geriatrics Society 2016, 64: 2546-2553. PMID: 27879984, PMCID: PMC5173408, DOI: 10.1111/jgs.14379.Peer-Reviewed Original ResearchConceptsMental health diagnosesBenzodiazepine useBenzodiazepine usersOlder adultsNonpsychiatrist physiciansNational Ambulatory Medical Care SurveyVisit ratesAmbulatory Medical Care SurveyAnnual visit rateHealth diagnosisEffective alternative treatmentCross-sectional analysisPatient ageOutpatient encountersClinical mental health diagnosisCare SurveyVisit characteristicsChronic usersAlternative treatmentYoung adultsVisitsDecades of evidenceOverall proportionAdultsSafety concernsPrevalence and correlates of coprescribing anxiolytic medications with extensive prescription opioid use in Veterans Health Administration patients with metastatic cancer.
Barry DT, Sofuoglu M, Kerns RD, Wiechers IR, Rosenheck RA. Prevalence and correlates of coprescribing anxiolytic medications with extensive prescription opioid use in Veterans Health Administration patients with metastatic cancer. Journal Of Opioid Management 2016, 12: 259-68. PMID: 27575827, DOI: 10.5055/jom.2016.0341.Peer-Reviewed Original ResearchConceptsPrescription opioid useVeterans Health Administration patientsOpioid useMetastatic cancerAnxiolytic medicationMedical indicationsMultivariate analysisMore emergency department visitsNational VHA dataEmergency department visitsPrescription of antidepressantsAnxiolytic prescriptionsOpioid prescriptionsDepartment visitsVHA patientsPsychotropic medicationsFiscal year 2012VHA dataDrug AdministrationMedicationsBipolar disorderCareful monitoringYounger ageAnxiolyticsCancer
2015
Prevalence and correlates of co-prescribing psychotropic medications with long-term opioid use nationally in the Veterans Health Administration
Barry DT, Sofuoglu M, Kerns RD, Wiechers IR, Rosenheck RA. Prevalence and correlates of co-prescribing psychotropic medications with long-term opioid use nationally in the Veterans Health Administration. Psychiatry Research 2015, 227: 324-332. PMID: 25863822, DOI: 10.1016/j.psychres.2015.03.006.Peer-Reviewed Original ResearchMeSH KeywordsAdultAnti-Anxiety AgentsAntidepressive AgentsDrug PrescriptionsFemaleHumansHypnotics and SedativesMaleMental DisordersOpioid-Related DisordersPrevalencePsychotropic DrugsSleep Initiation and Maintenance DisordersUnited StatesUnited States Department of Veterans AffairsVeteransVeterans HealthConceptsMental health clinicsPsychotropic medicationsOpioid prescriptionsHealth clinicsMedical indicationsAnxiolytics/sedatives/hypnoticsLong-term opioid useSpecialty mental health clinicsService use correlatesRelated adverse eventsSedative/hypnoticsVeterans Health AdministrationMental health treatmentAdverse eventsOpioid useHarmful side effectsFiscal year 2012More psychotropicsSide effectsPsychiatric diagnosisHealth treatmentMedicationsHealth AdministrationPsychotropicsAnxiety disorders
2013
Prescribing of Psychotropic Medications to Patients Without a Psychiatric Diagnosis
Wiechers IR, Leslie DL, Rosenheck RA. Prescribing of Psychotropic Medications to Patients Without a Psychiatric Diagnosis. Psychiatric Services 2013, 64: 1243-1248. PMID: 23999894, DOI: 10.1176/appi.ps.201200557.Peer-Reviewed Original ResearchConceptsMental health specialty carePotential medical indicationsProportion of patientsPsychotropic medicationsPsychiatric diagnosisSpecialty careMedical indicationsComorbid medical conditionsGeneral medical illnessMajority of recipientsOlder patientsYounger patientsMedical illnessClaims databaseResults AltogetherDesirable careMedical conditionsMedicationsPatientsMultivariate analysisPrivate insuranceDiagnosisCareFurther studiesSeverityIncreased Risk Among Older Veterans of Prescribing Psychotropic Medication in the Absence of Psychiatric Diagnoses
Wiechers IR, Kirwin PD, Rosenheck RA. Increased Risk Among Older Veterans of Prescribing Psychotropic Medication in the Absence of Psychiatric Diagnoses. American Journal Of Geriatric Psychiatry 2013, 22: 531-539. PMID: 24211029, DOI: 10.1016/j.jagp.2013.10.007.Peer-Reviewed Original ResearchConceptsPsychotropic medicationsPsychiatric diagnosisOlder veteransNational VHA administrative dataAge groupsOverall medical comorbidityVHA administrative dataLogistic regression analysisDiabetes medicationsMedical comorbiditiesVHA patientsEncounter claimsMedicationsMedical indicationsMental illnessMultivariate analysisMental healthcareFiscal year 2010Unnecessary useDiagnosisIncomplete documentationVeteransHIVStrongest predictorRegression analysis
2012
Impact of a Metabolic Screening Bundle on Rates of Screening for Metabolic Syndrome in a Psychiatry Resident Outpatient Clinic
Wiechers IR, Viron M, Stoklosa J, Freudenreich O, Henderson DC, Weiss A. Impact of a Metabolic Screening Bundle on Rates of Screening for Metabolic Syndrome in a Psychiatry Resident Outpatient Clinic. Academic Psychiatry 2012, 36: 118-121. PMID: 22532201, DOI: 10.1176/appi.ap.10090138.Peer-Reviewed Original ResearchConceptsElectronic medical recordsAntipsychotic medicationMedical recordsMetabolic syndromeIndividual patient electronic medical recordsMetabolic screeningSecond-generation antipsychoticsMetabolic syndrome screeningPatients' electronic medical recordsCardiometabolic side effectsRate of documentationRates of screeningQuality improvement interventionsResident outpatient clinicOutpatient clinicResident clinicQI interventionsAudit periodSide effectsQuarterly auditsPatientsMedicationsAntipsychoticsSyndromeClinic
2008
Behavioral observations reflected on consultation requests from primary medical-surgical services: Are they predictive of delirium diagnosis and outcomes?
Xiong GL, Wiechers IR, Bourgeois JA, Gagliardi JP. Behavioral observations reflected on consultation requests from primary medical-surgical services: Are they predictive of delirium diagnosis and outcomes? Journal Of Psychosomatic Research 2008, 66: 177-181. PMID: 19154861, DOI: 10.1016/j.jpsychores.2008.08.003.Peer-Reviewed Original ResearchConceptsMedical-surgical teamConsultation requestsHighest likelihood ratioDiagnosis of deliriumSystemic medical conditionsFinal clinical diagnosisMedical-surgical servicesClassification of patientsLower mortality rateDelirium subtypesLikelihood ratioReadmission ratesClinical outcomesDEP groupDelirium outcomesDelirium diagnosisMultivariate regression modelCognitive dysfunctionMedical conditionsPsychosomatic servicesDeliriumConsult requestsMortality rateBehavior disturbancesPatients
2000
If patients with schizophrenia have small brains, why don't they have small heads?
Friedman L, Wiechers I, Cerny C, Schulz S, Buckley P. If patients with schizophrenia have small brains, why don't they have small heads? Schizophrenia Research 2000, 42: 1-6. PMID: 10706980, DOI: 10.1016/s0920-9964(99)00098-5.Peer-Reviewed Original Research
1999
Sexual Behavior of Psychiatric Inpatients: Hospital Responses and Policy Formulation
Buckley P, Wiechers I. Sexual Behavior of Psychiatric Inpatients: Hospital Responses and Policy Formulation. Community Mental Health Journal 1999, 35: 531-536. PMID: 10863989, DOI: 10.1023/a:1018711318128.Peer-Reviewed Original Research