2024
Difficult to Treat Depression: Focus on Approach, Algorithms, and Access.
Karp J, Brinton R, Fournier J, Harding L, Jha M, Lenze E, Mathew S, Meltzer-Brody S, Mohr D, Riva-Posse P, Wiechers I, Williams N. Difficult to Treat Depression: Focus on Approach, Algorithms, and Access. The Journal Of Clinical Psychiatry 2024, 85 PMID: 39630090, DOI: 10.4088/jcp.psprmdd2408ah.Peer-Reviewed Original ResearchConceptsTreating depressionSpectrum of clinical severityTreatment of depressionEvolving treatment landscapeDepartment of PsychiatryBurden of depressionOral pharmacotherapyTreatment landscapeAdult patientsClinical severityCommunity health agenciesDepressionIncreased prevalenceHealth care systemPatientsDepression carePsychiatric workforcePsychiatryPatient advocatesCare systemTherapeutic engineeringHealth agenciesTelemedicine platformDo IRemissionThe Management of Posttraumatic Stress Disorder and Acute Stress Disorder: Synopsis of the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline.
Schnurr P, Hamblen J, Wolf J, Coller R, Collie C, Fuller M, Holtzheimer P, Kelly U, Lang A, McGraw K, Morganstein J, Norman S, Papke K, Petrakis I, Riggs D, Sall J, Shiner B, Wiechers I, Kelber M. The Management of Posttraumatic Stress Disorder and Acute Stress Disorder: Synopsis of the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline. Annals Of Internal Medicine 2024, 177: 363-374. PMID: 38408360, DOI: 10.7326/m23-2757.Peer-Reviewed Original ResearchConceptsClinical practice guidelinesU.S. Department of Veterans AffairsDepartment of Veterans AffairsVeterans AffairsPosttraumatic stress disorderManagement of posttraumatic stress disorderAcute stress disorderExternal group of expertsPractice guidelinesDefense Clinical Practice GuidelinesStress disorderPatient-centered careIndividual health outcomesRevised CPGDepartment of Defense Clinical Practice GuidelinesVideo teleconferencingStrength of evidenceQuality of lifeCo-occurring conditionsHealth outcomesPatient perspectiveEvidence-basedPosttraumatic stress disorder treatmentSystematic searchCognitive processing therapyClinical Outcomes of Intravenous Ketamine Treatment for Depression in the VA Health System.
Pfeiffer P, Geller J, Ganoczy D, Jagusch J, Carty J, Festin F, Gilmer W, Martis B, Ranganathan M, Wiechers I, Hosanagar A. Clinical Outcomes of Intravenous Ketamine Treatment for Depression in the VA Health System. The Journal Of Clinical Psychiatry 2024, 85 PMID: 38206011, DOI: 10.4088/jcp.23m14984.Peer-Reviewed Original ResearchConceptsPHQ-9 scoresKetamine infusionClinical outcomesSymptom improvementInfusion frequencyPatient Health Questionnaire-9 scoreVeterans Health Administration electronic medical recordsBaseline PHQ-9 scoreShort-term clinical trialsAntidepressant medication trialsFirst ketamine infusionIntravenous ketamine treatmentMonths of infusionFrequency of infusionsMinority of patientsVA health systemWeeks of treatmentRoutine clinical practiceMajor depressive disorderNumber of infusionsElectronic medical recordsIntravenous ketamineKetamine treatmentFirst infusionMedication trialsA clinician's guide to the 2023 VA/DoD Clinical Practice Guideline for Management of Posttraumatic Stress Disorder and Acute Stress Disorder
Lang A, Hamblen J, Holtzheimer P, Kelly U, Norman S, Riggs D, Schnurr P, Wiechers I. A clinician's guide to the 2023 VA/DoD Clinical Practice Guideline for Management of Posttraumatic Stress Disorder and Acute Stress Disorder. Journal Of Traumatic Stress 2024, 37: 19-34. PMID: 38184799, DOI: 10.1002/jts.23013.Peer-Reviewed Original ResearchClinical practice guidelinesAcute stress disorderPractice guidelinesPosttraumatic stress disorderStress disorderCPG recommendationsVA/DOD Clinical Practice GuidelineDefense Clinical Practice GuidelineFeasibility of interventionsEvidence-based practiceClinical algorithmClinician's GuideAvailable evidenceDisordersGuidelinesPatientsCliniciansRecommendationsContextual assessment
2022
The Management of Major Depressive Disorder: Synopsis of the 2022 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline.
McQuaid JR, Buelt A, Capaldi V, Fuller M, Issa F, Lang AE, Hoge C, Oslin DW, Sall J, Wiechers IR, Williams S. The Management of Major Depressive Disorder: Synopsis of the 2022 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline. Annals Of Internal Medicine 2022, 175: 1440-1451. PMID: 36122380, DOI: 10.7326/m22-1603.Peer-Reviewed Original ResearchConceptsClinical practice guidelinesMajor depressive disorderVeterans AffairsDepressive disorderPractice guidelinesDefense Clinical Practice GuidelineJoint clinical practice guidelineManagement of MDDTrustworthy clinical practice guidelinesUse of telemedicineMedicine's tenetsPharmacologic managementGuideline panelAlternative therapiesGRADE systemKey recommendationsPrior recommendationsClinical stakeholdersImportant new evidenceDisordersSelect recommendationsDepartmentGuidelinesManagementRecommendationsStrategies Associated With Reducing Benzodiazepine Prescribing to Older Adults: A Mixed Methods Study
Maust DT, Takamine L, Wiechers IR, Blow FC, Bohnert ASB, Strominger J, Min L, Krein SL. Strategies Associated With Reducing Benzodiazepine Prescribing to Older Adults: A Mixed Methods Study. The Annals Of Family Medicine 2022, 20: 328-335. PMID: 35879067, PMCID: PMC9328717, DOI: 10.1370/afm.2825.Peer-Reviewed Original ResearchConceptsAverage daily doseDaily doseOlder adultsVeterans Health AdministrationHealth care facilitiesCommunity-based settingsLorazepam equivalentsAppropriate prescribingPrescribing practicesBZD prescribingBZD treatmentOlder veteransCare facilitiesMethods studyHealth AdministrationPotential patientsBenzodiazepinesPrescribingPatient identificationIndividualized recommendationsMixed-methods studyAdultsCliniciansDoseVeteransEffect 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-9Comparison of mental health outcomes of augmenting medications for patients with posttraumatic stress disorder: A national veterans affairs study
Ranney R, Maguen S, Woods A, Seal K, Neylan T, Bernardy N, Wiechers I, Ryder A, Cohen B. Comparison of mental health outcomes of augmenting medications for patients with posttraumatic stress disorder: A national veterans affairs study. Journal Of Evaluation In Clinical Practice 2022, 29: 191-202. PMID: 35709244, DOI: 10.1111/jep.13726.Peer-Reviewed Original ResearchConceptsEmergency room visitsPosttraumatic stress disorderPsychiatric emergency room visitsAugmenting medicationsRoom visitsMental health outcomesPsychiatric hospitalizationHospitalization/emergency room visitsHealth outcomesStress disorderPTSD symptomsVeterans Affairs studyDiagnosis of PTSDMedication groupClinical trialsAdditional interventionsMedicationsBaseline levelsPatientsVeterans AffairsNew prescriptionsElectronic recordsVisitsHospitalizationSymptomsEvaluation of Antipsychotic Reduction Efforts in Patients With Dementia in Veterans Health Administration Nursing Homes
Gerlach LB, Maust DT, Kales HC, Chang M, Kim HM, Wiechers IR, Zivin K. Evaluation of Antipsychotic Reduction Efforts in Patients With Dementia in Veterans Health Administration Nursing Homes. American Journal Of Psychiatry 2022, 179: 544-552. PMID: 35615813, PMCID: PMC9349465, DOI: 10.1176/appi.ajp.21060591.Peer-Reviewed Original ResearchConceptsVeterans Health AdministrationCNS-active medicationsVHA Nursing HomesNursing homesAnxiolytic prescribingOverall prescribingVeterans Health Administration nursing homesNursing home patientsNursing home residentsInterrupted time series designAntipsychotic reductionQuarterly prevalenceMedication classesOpioid medicationsAntidepressant prescribingAntipsychotic useMedication prescribingHome patientsPsychotropic medicationsLabel useHome residentsSimilar riskMedicationsPrescribingHealth Administration
2021
Impact of an interdisciplinary intervention for distress behaviors in dementia on psychotropic drug use in Veterans Health Administration Community Living Centers STAR-VA impact on psychotropic drug utilization
McConeghy KW, Curyto K, Jedele J, Intrator O, Mohr DC, Wiechers IR, Karel MJ. Impact of an interdisciplinary intervention for distress behaviors in dementia on psychotropic drug use in Veterans Health Administration Community Living Centers STAR-VA impact on psychotropic drug utilization. Geriatric Nursing 2021, 42: 1533-1540. PMID: 34739929, DOI: 10.1016/j.gerinurse.2021.10.009.Peer-Reviewed Original ResearchConceptsPsychotropic drug useDrug useVeterans Health Administration nursing homesPsychotropic medication usePsychotropic drug utilizationDistress behaviorsSTAR-VAMedication usePsychotropic useDrug utilizationCohort analysisNursing homesInterdisciplinary interventionEligible residentsStudy designTreatment effectsDementiaImportant optionResidentsBehavioral approachCasesAverage reductionDosesMonthsBenzodiazepine Prescribing from VA and Medicare to Dually Enrolled Older Veterans: A Retrospective Cohort Study
Lei L, Strominger J, Wiechers IR, Kim HM, Blow FC, Bohnert ASB, Min L, Krein SL, Maust DT. Benzodiazepine Prescribing from VA and Medicare to Dually Enrolled Older Veterans: A Retrospective Cohort Study. Journal Of General Internal Medicine 2021, 36: 3689-3696. PMID: 34047924, PMCID: PMC8642498, DOI: 10.1007/s11606-021-06780-y.Peer-Reviewed Original ResearchConceptsBZD prescriptionOlder veteransBZD prescribingHigher oddsPart DVeterans Affairs Health Care SystemRetrospective cohort studyPart D coverageMedicare Part D prescriptionsSubstance use disordersHealth care systemDesignRetrospective cohortPrescription prevalenceQuarterly prevalenceBenzodiazepine prescribingPart D prescriptionsCohort studyPatient characteristicsBZD useUse disordersFacility variationOlder agePrescribingBZDCare systemTrends 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-9PatientsComment on “Do Benzodiazepines Cause Alzheimer’s Disease?”
Maust DT, Wiechers IR. Comment on “Do Benzodiazepines Cause Alzheimer’s Disease?”. American Journal Of Psychiatry 2021, 178: 205-206. PMID: 33517758, DOI: 10.1176/appi.ajp.2020.20070989.Peer-Reviewed Original Research
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
An Unconventional Path
Wiechers I. An Unconventional Path. American Journal Of Geriatric Psychiatry 2018, 27: 167-169. PMID: 30558851, DOI: 10.1016/j.jagp.2018.12.009.Peer-Reviewed Original ResearchEngage for Change: The Imperative to Increase Our Efforts in Geriatric Mental Health Policy
Wiechers I, Epstein-Lubow G, Thielke S. Engage for Change: The Imperative to Increase Our Efforts in Geriatric Mental Health Policy. American Journal Of Geriatric Psychiatry 2018, 27: 97-99. PMID: 30558850, DOI: 10.1016/j.jagp.2018.12.006.Peer-Reviewed Original ResearchPrescription Benzodiazepine Use Among Older Adults
Gerlach L, Wiechers I, Maust D. Prescription Benzodiazepine Use Among Older Adults. Harvard Review Of Psychiatry 2018, 26: 264-273. PMID: 30188338, PMCID: PMC6129989, DOI: 10.1097/hrp.0000000000000190.Peer-Reviewed Original ResearchConceptsUse of benzodiazepinesOlder adultsAvailable evidenceAnxiety disordersPsychological symptomsPlacebo-controlled trialPubMed/MEDLINETreatment of insomniaYears of ageImproved sleep outcomesBZD useFuture trialsPsychotropic medicationsBenzodiazepine useClinical indicationsChronic benzodiazepinesInclusion criteriaBehavioral disturbancesEligibility criteriaElectronic databasesSleep outcomesPsychiatric conditionsSystematic reviewTreatment alternativesBenzodiazepinesPatient 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