PubMed · 16620472
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Louise Howard. 2005. Postnatal depression.. https://pubmed.ncbi.nlm.nih.gov/16620472/
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We use the concept of latent variables to derive the joint distribution of bivariate ordinal outcomes, and then extend the model to allow for longitudinal data. Specifically, we relate the observed ordinal outcomes using threshold values to a bivariate latent variable, which is then modelled as a linear mixed model. Random effects terms are used to tie all together repeated observations from the same subject. The cross-sectional association between the two outcomes is modelled through the correlation coefficient of the bivariate latent variable, conditional on random effects. Assuming conditional independence given random effects, the marginal likelihood, under the missing data at random assumption, is approximated using an adaptive Gaussian quadrature for numerical integration. The model provides fixed effects parameters that are subject-specific, but retain the population-averaged interpretation when properly scaled. This is particularly well suited for the situation in which population comparisons and individual level contrasts are of equal importance. Data from a psychiatric trial, the Fluvoxamine (an antidepressant drug) study, are used to illustrate the methodology.
In this review we investigate whether sex differences exist for side effects of second-generation antipsychotics. Results are based on a MEDLINE search for the years 1974 through 2005. Even if pharmacokinetics differ between females and males, significantly higher plasma levels for women have been demonstrated only for olanzapine and clozapine. Hyperprolactinaemia is mainly induced by treatment with risperidone and amisulpride, and there is evidence for more pronounced prolactin levels in females. Most studies reviewed indicate that clozapine and olanzapine are associated with more body weight gain, once more especially in female patients. Furthermore, the few published studies indicate that metabolic syndrome is more frequent in females and there are likely no gender-specific differences between the new antipsychotic medications concerning frequency and degree of acute or chronic movement disturbance. The risk of QT prolongation with torsades de pointes arrhythmia is again higher in females. In conclusion, there is some evidence of sex differences in the side effects of second-generation antipsychotics. For better understanding of the basic mechanisms in sex differences, future studies with a primary focus on this topic are required. More specific data will help to determine how these differences shall affect clinical management.
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