Social inequalities and correlates of psychotropic drug use among young adults: a population-based questionnaire study

PubMed Central

Chau, Nearkasen; Baumann, Michèle; Falissard, Bruno; Choquet, Marie

2008-01-01

Background Use of psychotropic drugs is widespread in Europe, and is markedly more common in France than elsewhere. Young adults often fare less well than adolescents on health indicators (injury, homicide, and substance use). This population-based study assessed disparities in psychotropic drug use among people aged 18–29 from different socio-occupational groups and determined whether they were mediated by educational level, health status, income, health-related behaviours, family support, personality traits, or disability. Methods A total of 1,257 people aged 18–29, randomly selected in north-eastern France completed a post-mailed questionnaire covering sex, date of birth, height, weight, educational level, occupation, smoking habit, alcohol abuse, income, health-status, diseases, reported disabilities, self-reported personality traits, family support, and frequent psychotropic medication for tiredness, nervousness/anxiety or insomnia. The data were analyzed using the adjusted odds ratios (ORa) computed with logistic models. Results Use of psychotropic drugs was common (33.2%). Compared with upper/intermediate professionals, markedly high odds ratios adjusted for sex were found for manual workers (2.57, 95% CI 1.02–6.44), employees (2.58, 1.11–5.98), farmers/craftsmen/tradesmen (4.97, 1.13–21.8), students (2.40, 1.06–5.40), and housewives (3.82, 1.39–10.5). Adjusting for all the confounders considered reduced the estimates to a pronounced degree for manual workers (adjusted OR 1.49, non-significant) but only slightly for the other socio-occupational groups. The odds ratio for unemployed people did not reach statistical significance. The significant confounders were: sex, not-good health status, musculoskeletal disorders and other diseases, being worried, nervous or sad, and lack of family support (adjusted odds ratios between 1.60 and 2.50). Conclusion There were marked disparities among young adults from different socio-occupational groups. Sex, health status, musculoskeletal diseases, family support, and personality traits were related to use of psychotropic drugs. These factors mediated the higher risk strongly among manual workers and slightly among the other groups. PMID:18205942

Psychotropic Medication Adherence among Community-Based Individuals with Developmental Disabilities and Mental Illness

ERIC Educational Resources Information Center

Tan, Xi; Marshall, Vincent D.; Balkrishnan, Rajesh; Patel, Isha; Chang, Jongwha; Erickson, Steven R.

2015-01-01

Psychotropic medications are a common treatment for mental illness in people with developmental disabilities. Medication adherence is a critical determinant of the effectiveness of psychotropic drugs, but psychotropic medication adherence research specific to this population remains limited. This retrospective study analyzed Marketscan®…

A qualitative study exploring visible components of organizational culture: what influences the use of psychotropic medicines in nursing homes?

PubMed

Sawan, Mouna J; Jeon, Yun-Hee; Fois, Romano J; Chen, Timothy F

2016-10-01

The influence of organizational culture on how psychotropic medicines are used in nursing homes has not been extensively studied. Schein's theory provides a framework for examining organizational culture which begins with the exploration of visible components of an organization such as behaviors, structures, and processes. This study aimed to identify key visible components related to the use of psychotropic medicines in nursing homes. A qualitative study was conducted in eight nursing homes in Sydney, Australia. Purposive sampling was used to conduct semi-structured interviews with 40 participants representing a broad range of health disciplines. Thematic analysis was used to derive concepts. Three visible components were related to psychotropic medicine use. These were drugs and therapeutics committee meetings, pharmacist led medication management reviews and formal and informal meetings with residents and their families. We found that only a few nursing homes utilized drugs and therapeutics committee meetings to address the overuse of psychotropic medicines. Pharmacist led medication management reviews provided a lever to minimize inappropriate psychotropic prescribing for a number of nursing homes; however, in others it was used as a box-ticking exercise. We also found that some nursing homes used meetings with residents and their families to review the use of psychotropic medicines. This study was the first to illustrate that visible components of organizational culture do influence the use of psychotropic medicines and explains in detail what of the culture needs to be addressed to reduce inappropriate psychotropic prescribing.

Drug interactions between hormonal contraceptives and psychotropic drugs: a systematic review.

PubMed

Berry-Bibee, Erin N; Kim, Myong-Jin; Simmons, Katharine B; Tepper, Naomi K; Riley, Halley E M; Pagano, H Pamela; Curtis, Kathryn M

2016-12-01

To examine whether the co-administration of hormonal contraceptives (HC) and psychotropic drugs commonly used to treat anxiety and/or depression results in safety or efficacy concerns for either drug. We searched PubMed and Cochrane libraries for clinical or pharmacokinetic (PK) studies that examined co-administration of any HC with psychotropic drugs [selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), oral benzodiazepines, bupropion, mirtazapine, trazadone, buspirone, hydroxyzine, monoamine oxidase inhibitors (MAOIs), or atypical antipsychotics] in reproductive aged women. Of 555 articles identified, 22 articles (18 studies) met inclusion criteria. We identified 5 studies on SSRIs, four on TCAs, one on bupropion, three on atypical antipsychotics and five on oral benzodiazepines. No articles met inclusion criteria for SNRIs, mirtazapine, trazadone, buspirone, hydroxyzine or MAOIs. Overall, clinical studies did not demonstrate differences in unintended pregnancy rates when HCs were administered with and without psychotropic drugs or in psychotropic drug treatment outcomes when psychotropic drugs were administered with and without HCs. PK studies did not demonstrate changes in drug exposure related to contraceptive safety, contraceptive effectiveness or psychotropic drug effectiveness for most classes of psychotropic drugs. However, limited PK data raise concern for HCs increasing systemic exposure of amitriptyline and imipramine (both TCAs), theoretically posing safety concerns. Limited quality and quantity evidence on use of psychotropic drugs and HCs suggests low concern for clinically significant interactions, though no data exist specifically for non-oral formulations of HC. Given the high frequency of use for both HCs and psychotropic drugs among reproductive-age women in the US, this review highlights a need for further research in this area. Copyright © 2016 Elsevier Inc. All rights reserved.

Relationship between Organizational Culture and the Use of Psychotropic Medicines in Nursing Homes: A Systematic Integrative Review.

PubMed

Sawan, Mouna; Jeon, Yun-Hee; Chen, Timothy F

2018-03-01

Psychotropic medicines are commonly used in nursing homes, despite marginal clinical benefits and association with harm in the elderly. Organizational culture is proposed as a factor explaining the high-level use of psychotropic medicines. Schein describes three levels of culture: artifacts, espoused values, and basic assumptions. This integrative review aimed to investigate the facets and role of organizational culture in the use of psychotropic medicines in nursing homes. Five databases were searched for qualitative, quantitative, and mixed method empirical studies up to 13 February 2017. Articles were included if they examined an aspect of organizational culture according to Schein's theory and the use of psychotropic medicines in nursing homes for the management of behavioral and sleep disturbances in residents. Article screening and data extraction were performed independently by one reviewer and checked by the research team. The integrative review method, an approach similar to the method of constant comparison analysis was utilized for data analysis. Twenty-four studies met the inclusion criteria: 13 used quantitative methods, 9 used qualitative methods, 1 was quasi-qualitative, and 1 used mixed methods. Included studies were found to only address two aspects of organizational culture in relation to the use of psychotropic medicines: artifacts and espoused values. No studies addressed the basic assumptions, the unsaid taken-for-granted beliefs, which provide explanations for in/consistencies between the ideal use of psychotropic medicines and the actual use of psychotropic medicines. Previous studies suggest that organizational culture influences the use of psychotropic medicines in nursing homes; however, what is known is descriptive of culture only at the surface level, that is the artifacts and espoused values. Hence, future research that explains the impact of the basic assumptions of culture on the use of psychotropic medicines is important.

[Psychotropic drugs in the Family Health Strategy: profile of use, access and strategies to promote rational use].

PubMed

da Rocha, Bruno Simas; Werlang, Maria Cristina

2013-11-01

The use of psychotropic drugs is on the increase, and there are few studies in Brazil investigating their use in the population and in Primary Health Care (PHC). This study aimed to determine the prevalence and patterns of psychotropic drug use by patients of a Family Health Unit in Porto Alegre, through an observational, descriptive, retrospective and cross-sectional study. The sample consisted of patients who received prescriptions for controlled psychotropic drugs and the data collected from medical records. The study included 329 patients, with prevalence of the use of psychotropic drugs of 7.30%, mean age of 53.14 (SD = 18.58) years and 72% female. The average number of prescribed drugs and psychotropic drugs per user was 3.56 (SD = 2.36) and 1.66 (SD = 0.90), respectively. The most widely used class was antidepressants, followed by antiepileptics, anxiolytics and antipsychotics. It is necessary to develop strategies to improve access, treatment of patients and rational use of psychotropic drugs, including the revision of lists of essential drugs and training of professionals in PHC.

Benefits of adherence to psychotropic medications on depressive symptoms and antiretroviral medication adherence among men and women living with HIV/AIDS.

PubMed

Cruess, Dean G; Kalichman, Seth C; Amaral, Christine; Swetzes, Connie; Cherry, Chauncey; Kalichman, Moira O

2012-04-01

Psychotropic medications are commonly used for depressive symptoms among people living with HIV/AIDS. We examined the relationships between adherence to psychotropic medications, depressive symptoms, and antiretroviral adherence. We assessed depressive symptoms among 324 people living with HIV/AIDS across a 3-month period (70% men; mean age 45 years; 90% African-American). Psychotropic and antiretroviral adherence was assessed using monthly, unannounced telephone pill counts. Multiple-regression and mediation analyses were utilized to examine associations under investigation. Greater depressive symptoms were associated with lower antiretroviral and psychotropic medication adherence. Greater adherence to psychotropic medications regardless of medication class was positively related to higher antiretroviral adherence. Greater adherence to psychotropic medications also significantly mediated the association between depressive symptoms and antiretroviral adherence. This study demonstrates the benefits of adherence to psychotropic medications on both depressive symptoms and antiretroviral adherence. Future work examining psychotropic medication adherence on disease outcomes in people living with HIV/AIDS is warranted.

Bidirectional longitudinal relationship between leisure-time physical activity and psychotropic medication usage: A register linked follow-up study.

PubMed

Stubbs, Brendon; Vancampfort, Davy; Mänty, Minna; Svärd, Anna; Rahkonen, Ossi; Lahti, Jouni

2017-01-01

This study aimed to examine the bidirectional relationship between psychotropic medication use and changes in leisure-time physical activity (LTPA) among a population cohort study. Phase 1 data were collected by mail surveys in 2000-2002 among 40-60-year-old employees of the City of Helsinki, Finland, and phase 2 follow up survey was conducted in 2007. Based on self-report, the respondents were classified as inactive and active (≥14.75 MET-hours/week) at the phases 1 and 2. Hazard ratios (HR) were calculated for subsequent (2007-10) psychotropic medication purchasing according to changes in physical activity (phases 1-2). Odds ratios (OR) for physical inactivity at phase 2 were calculated according to the amount of psychotropic medication between phases 1-2. Overall, 5361 respondents were included (mean age 50 years, 80% women). Compared with the persistently active, the persistently inactive, those decreasing and adopting LTPA had an increased risk for psychotropic medication. Only the persistently inactive remained at increased risk for psychotropic medication use, following the adjustment for prior psychotropic medication use. Compared with those having no medication, the risk for physical inactivity increased as the psychotropic medication increased. Our data suggest that physical activity has an important role in maintaining wellbeing and reducing psychotropic medication usage. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Psychotropic drugs in Nepal: perceptions on use and supply chain management.

PubMed

Upadhaya, Nawaraj; Jordans, Mark J D; Gurung, Dristy; Pokhrel, Ruja; Adhikari, Ramesh P; Komproe, Ivan H

2018-01-24

Psychotropic drugs play an important role in the treatment of mental, neurological and substance use disorders. Despite the advancement of the use of psycho-pharmaceuticals in the developed countries, the psychotropic drug production and supply chain management in low- and middle- income countries are still poorly developed. This study aims to explore the perceptions of stakeholders involved in all stages of the psychotropic drug supply chain about the need, quality, availability and effectiveness of psychotropic drugs, as well as barriers to their supply chain management. The study was conducted among 65 respondents from the Kathmandu, Chitwan and Pyuthan districts, grouped into four categories: producers, promoters and distributors (N = 22), policy makers and government actors (N = 8), service providers (N = 21) and service users/family members (N = 14). The respondents reported that psychotropic drugs, despite having side effects, are 1) needed, 2) available in major regional centers and 3) are effective for treating mental health problems. The stigma associated with mental illness, however, forces patients and family members to hide their use of psychotropic drugs. The study found that the process of psychotropic drug supply chain management is similar to other general drugs, with the exceptions of strict pre-approval process, quantity restriction (for production and import), and mandatory record keeping. Despite these regulatory provisions, respondents believed that the misuse of psychotropic drugs is widespread and companies are providing incentives to prescribers and retailers to retain their brand in the market. The production and supply chain management of psychotropic drugs is influenced by the vested interests of pharmaceutical companies, prescribers and pharmacists. In the context of the government of Nepal's policy of integrating mental health into primary health care and increased consumption of psychotropic drugs in Nepal, there is a need for massive education and awareness as well as strict monitoring and supervision to avoid the misuse of psychotropic drugs.

IMPLEMENTATION OF DRUG ADDICTS RIGHT TO HEALTH PROTECTION (SEPARATE ASPECTS).

PubMed

Shevchuk, O; Rzhevska, O; Korop, O; Pyliuha, L

2018-03-01

The purpose of the research is to analyze specific problems of the realization of the right to protect the health of people who take narcotic drugs or psychotropic substances. To achieve this goal, statistics have been analyzed on the number of people using narcotic drugs or psychotropic substances (including drug-addicted children) placed on medical records and the number of their applications for medical care. It has been found out that people in this category often face a denial of medical care that causes extremely strong physical and mental suffering. The analysis of the understanding of the legal design of the «right to health care» in the scientific literature, national legislation and international legal documents was made. State institutions and local authorities providing «the right to health care» of people taking narcotic or psychotropic drugs are singled out. The absence of grounds for restricting the right to protect the health of people who take narcotic or psychotropic drugs who are not registered is justified. In the course of the research, it was found out that people who take narcotic drugs or psychotropic substances are more likely than other patients to need medical assistance and, when requesting the right to health care, face a number of problems that require immediate solution: incomplete provision of quality free medical care; unimplementation of rehabilitation programs for such categories of patients; the lack of the right of children who take narcotic drugs or psychotropic substances to make their own decisions at the age of 14 and apply to public health institutions for the treatment of drug addiction; violations of the continuity of SMT programs and their absence in penal institutions for drug dependent people. It was proposed to introduce a number of changes in the relevant normative legal acts.

Working conditions and psychotropic drug use: cross-sectional and prospective results from the French national SIP study.

PubMed

Lassalle, Marion; Chastang, Jean-François; Niedhammer, Isabelle

2015-04-01

Prospective studies exploring the associations between a large range of occupational factors and psychotropic drug use among national samples of workers are seldom. This study investigates the cross-sectional and prospective associations between occupational factors, including a large set of psychosocial work factors, and psychotropic drug use in the national French working population. The study sample comprised 7542 workers for the cross-sectional analysis and 4213 workers followed up for a 4-year period for the prospective analysis. Psychotropic drug use was measured within the last 12 months and defined by the use of antidepressants, anxiolytics or hypnotics. Three groups of occupational factors were explored: classical and emergent psychosocial work factors, working time/hours and physical work exposures. Weighted Poisson regression analyses were performed to adjust for covariates. In the cross-sectional analysis, psychological demands, low social support and hiding emotions were associated with psychotropic drug use. Job insecurity for men and night work for women were associated with psychotropic drug use. In the prospective analysis, hiding emotions and physical exposure were predictive of psychotropic drug use. Dose-response associations were observed for the frequency/intensity of exposure and repeated exposure to occupational factors. This study underlines the role of psychosocial work factors, including emergent factors, in psychotropic drug use. Prevention policies oriented toward psychosocial work factors comprehensively may be useful to reduce this use. Copyright © 2015 Elsevier Ltd. All rights reserved.

Variability in market uptake of psychotropic medications in Europe reflects cultural diversity.

PubMed

Hoebert, J M; Mantel-Teeuwisse, A K; Leufkens, H G M; van Dijk, L

2017-11-06

In the last 20-30 years, many international studies have found substantial differences in the use of (older) psychotropic medication between European countries. The majority mentioned an important role for attitudes and beliefs towards psychotropic medication. So far, no studies have looked into the effects of cultural diversity on the use of new medications entering the market. As national cultures relate deeply to held values regarding, for example, what is seen as effective versus ineffective or safe versus dangerous, (cultural) diversity in decision making around the role of new medications in clinical practice may already be expected from the first day after market authorization. This study examined the relation between cultural diversity, described in Hofstede's model of cultural dimensions (Power Distance, Individualism, Masculinity, Uncertainty Avoidance, Indulgence and Long-Term Orientation) and utilization of three new psychotropic medications, namely aripiprazole, duloxetine and pregabalin in Europe. Country level sales data of the case study medications were correlated to country-specific scores of Hofstede's cultural dimensions. IMS Health's MIDAS database has been used for sales data (converted to Defined Daily Doses/1000 inhabitants/day) for the case study medications from the market authorization date in 2004 until December 2009 for 23 EU member states. Consumption of the case study medications was seen in all countries. In general, pregabalin was used more often than aripiprazole and duloxetine. In 2 years after market authorization, approximately 80% of all countries have reported use of all three molecules. Correlations between Hofstede dimensions individualism, long-term orientation and indulgence and total use of the case study medications tended to become stronger over time, but they were only statistically significant for indulgence at two years after market authorization (rho = 0.51, p = 0.014) and three years after market authorization (rho = 0.54, p = 0.008). A more detailed analysis showed (slight) variation by molecule. This study is a first step in including cultural dimensions when explaining cross-national variation in the use of new medications. The results indicate that indulgence, however marginally, is a cultural aspect that relates to the utilization of new psychotropic medications, suggesting that within the cultural context, less regulation of social norms is a main factor in explaining cross-national variation in uptake of these medications.

The public debate on psychotropic medication and changes in attitudes 1990-2011.

PubMed

Angermeyer, Matthias C; Van der Auwera, Sandra; Matschinger, Herbert; Carta, Mauro G; Baumeister, Sebastian E; Schomerus, Georg

2016-03-01

Over the last 25 years, the appraisal of psychotropic drugs within the scientific community and their representation in the media has changed considerably. The initial optimism in the wake of the introduction of second-generation drugs has increasingly made room for a more critical evaluation of alleged advantages of these drugs. The question arises as to what extent this is reflected in similar changes in the public's attitudes towards psychiatric medication. Three representative population surveys on attitudes towards psychotropic medication were carried out in Germany in 1990 (N = 3075), 2001 (N = 2610) and 2011 (N = 1223), using the same sampling procedure, interview mode and instrument for assessing attitudes. In order to disentangle time-related effects, an age-period-cohort analysis was performed. Over the time period of 21 years, the German public's evaluation of psychotropic medication has become markedly more favourable. This change was mostly due to a period effect, i.e. concurrent influences of the social environment people are exposed to. Changes were much more pronounced in the 1990s, while over the following decade only a small, although statistically significant, increase in the favourable appraisal of medication was found. Age and birth cohort had only a minor effect on public attitudes. Our findings suggest that changes in the evaluation of the effects of psychotropic drugs within the psychiatric community and their representation in the media also affect public opinion. Given the ongoing debate about side effects and efficacy of psychiatric medication, future changes of public opinion can be expected.

The impact of the 1987 federal regulations on the use of psychotropic drugs in Minnesota nursing homes.

PubMed Central

Garrard, J; Chen, V; Dowd, B

1995-01-01

OBJECTIVES. The purpose of this study was to examine prevalence rates of psychotropic drug use by elderly nursing home residents 3 years before and 1 year after implementation of the 1987 Omnibus Budget Reconciliation Act drug regulations throughout the United States on October 1, 1990. METHODS. A cohort study was conducted of elderly nursing home residents, for each of 4 study years (approximately 33,000 residents per year), of all nursing homes (n = 372) in Minnesota certified by Medicare and Medicaid. Data included (1) health status assessment and psychotropic drug use; (2) nursing home and care characteristics; and (3) county geographic and population characteristics. RESULTS. Annual rates of antipsychotic drug use declined by one third over the 4-year period (23%, 22%, 19%, and 15% from 3 years before enforcement of the regulations to 1 year afterward). All differences were statistically significant. Antianxiety use rates were 11%, 12%, 12%, and 12%, respectively, and antidepressant use rates were 14%, 15%, 16%, 16%, respectively, for the 4 years. The latter two classes of drugs were not affected directly by the regulations. CONCLUSIONS. Declines in the rates of antipsychotic drug use appear to be associated with anticipation of the regulations the year before and as the result of the regulations the year after the October 1990 implementation. A hypothesized medication shift to benzodiazepine drugs was not observed. PMID:7762708

Public health nurses' perception of their roles in relation to psychotropic drug use by adolescents: a phenomenographic study.

PubMed

Steffenak, Anne Kjersti Myhrene; Nordström, Gun; Hartz, Ingeborg; Wilde-Larsson, Bodil

2015-04-01

The purpose of the paper was to describe the perceptions of public health nurses' roles in relation to psychotropic drug use by adolescents. Mental health problems among adolescents are documented with studies indicating an increased use of psychotropic drugs. In Norway, care for such adolescents may fall naturally into the remit of public health nurses. A phenomenographic approach was used to analyse the data. A qualitative interview study was made of 20 Norwegian public health nurses, strategically chosen using phenomenographic methodology. The public health nurses described three categories: discovering public health nurses who become aware of psychotropic drug use in the health dialogue with adolescents and choose to either act or not act in relation to psychotropic drug use. Those public health nurses who take action are cooperating public health nurses, who cooperate with adolescents, their families, schools and others. If cooperation has been established, supporting public health nurses teach and support the adolescent in relation to psychotropic drug use. The public health nurses who do not act can hinder or delay further treatment. Public health nurses need to acquire knowledge about psychotropic drugs, to fulfil their role in nursing mental health problems among adolescents and the increasing use of psychotropic drugs. The results demonstrated that public health nurses, working in health centres and schools, have the responsibility and the opportunity to identify young people struggling with mental health problems and psychotropic drug use as well as teach and support significant others, e.g. parents and siblings. Intervention studies are needed with regard to health promotion programmes aimed at fortifying young people's mental health. © 2014 The Authors. Journal of Clinical Nursing Published by John Wiley & Sons Ltd.

Psychotropic drug use among people with intellectual disability before and after deinstitutionalization.

PubMed

Nøttestad, J Aa; Linaker, O M

2003-09-01

The use of psychotropic medication among people with intellectual disability (ID) is widespread, and they are one of the most medicated groups in society. A substantial number of individuals with ID receive psychotropic medications that may be inappropriate for their diagnosis. One of the main reasons for the use of psychotropic medication is challenging behaviours. Almost all prevalence studies show higher prevalence rates of psychotropic medication in institutions compared with community living. Studies on deinstitutionalization and the use of psychotropic medication are few and inconclusive. The present study is a prospective cohort study without control group. It examines the use of psychotropic medication among 109 subjects aged between 16 and 65 years before (1987) and after (1995) deinstitutionalization. Psychotropic drug dosages were transformed to percentage of defined daily dosage. We found no major changes in the use of neuroleptics after deinstitutionalization neither in frequency nor in dosages, and the trend seemed indiscriminate in relation to diagnosis. The people with schizophrenia or an anxiety disorder did not receive proper drug treatment, nor did they before deinstitutionalization. The main predictor variable for neuroleptic dosage both before and after deinstitutionalization was challenging behaviour. The reason for this may be the difficulties in determining the extent to which presenting behaviours are the result of a psychiatric disorder or a behaviour disorder, the lack of knowledge among the caretakers and the ensuing referral practice, the lack of knowledge among the general practitioners, and the lack of access to specialized health services.

Psychotropic medicine prescriptions in Italian youths: a multiregional study.

PubMed

Piovani, Daniele; Clavenna, Antonio; Cartabia, Massimo; Bonati, Maurizio

2016-03-01

The aim of the study was to evaluate the trend of paediatric psychotropic drug prescriptions in Italy. Data sources were regional, outpatient prescription databases. Seven Italian regions, covering 50 % of the Italian population, provided data from 2006 to 2011. Prevalence and incidence of prescriptions by age and gender were evaluated for psychotropic, antidepressant, antipsychotic, and attention-deficit/hyperactivity disorders (ADHD) medications. The hospital admission rate for psychiatric conditions was calculated, also at the local health unit (LHU) level. The presence of trends in prescription prevalence and incidence during the 6 year period was assessed. Finally, the correlation between prevalence, prescription, hospital admission rates, latitude, longitude, and average annual income at the LHU level was also investigated. In 2011, 8834 youths received at least one psychotropic drug prescription, with a prevalence of 1.76 ‰ (95 % CI 1.72-1.80). The incidence of new psychotropic drug users was 1.03 ‰ (1.00-1.06). The prevalence of antidepressants was 1.02 ‰ (0.99-1.04), while that of antipsychotics was 0.70 ‰ (0.68-0.72), and that of ADHD medications 0.19 ‰ (0.18-0.21). The psychotropic drug prevalence increased with increasing age. Males were more exposed to psychotropic drugs than females (AUC0-17 male/female = 1.23). Antipsychotics were the most prescribed psychotropic drugs in males, while antidepressants were in females. Between-region prevalence ranged from 1.56 to 2.17 ‰. The overall prevalence of psychotropic drug from 2006 to 2011 was stable (χ(t)2 ≤ 0.001, p = 0.97). No correlation was found between prevalence and the variables investigated. Psychotropic drug prescription was very limited and stable. No geographical patterns were found.

Prevalence and characteristics of psychotropic drug use in institutionalized children and adolescents with mild intellectual disability.

PubMed

Scheifes, Arlette; de Jong, Daniël; Stolker, Joost Jan; Nijman, Henk L I; Egberts, Toine C G; Heerdink, Eibert R

2013-10-01

Psychotropic drugs are a cornerstone in the treatment of psychopathology and/or behavioral problems in children with intellectual disability (ID), despite concerns about efficacy and safety. Studies on the prevalence of psychotropic drug use have mainly been focused on adults with ID or children without ID. Therefore the aim of this cross sectional study was to assess the prevalence and characteristics of psychotropic drug use in children with mild ID who were institutionalized in specialized inpatient treatment facilities in The Netherlands. Demographic data, psychiatric diagnoses, the nature of the behavioral problems, level of intellectual functioning, and medication data were extracted from medical records using a standardized data collection form. Adjusted relative risks (ARR) for the association between patient characteristics and psychotropic drug use were estimated with Cox regression analysis. Of the 472 included children, 29.4% (n=139) used any psychotropic drug, of which 15.3% (n=72) used antipsychotics (mainly risperidone), and 14.8% (n=70) used psychostimulants (mainly methylphenidate). Age, sex, and behavioral problems were associated with psychotropic drug use. Boys had a 1.7 (95%CI 1.1-2.4) higher probability of using psychotropic drugs, compared to girls adjusted for age and behavioral problems. Having any behavioral problem was associated with psychotropic drug use with an ARR of 2.1 (95%CI 1.3-3.3), adjusted for sex and age. The high prevalence of psychotropic drug use in children with ID is worrisome because of the lack of evidence of effectiveness (especially for behavioral problems) at this young age, and the potential of adverse drug reactions. Copyright © 2013 Elsevier Ltd. All rights reserved.

Shaping the use of psychotropic medicines in nursing homes: A qualitative study on organisational culture.

PubMed

Sawan, Mouna; Jeon, Yun-Hee; Chen, Timothy F

2018-04-01

Psychotropic medicines have limited efficacy in the management of behavioural and psychological disturbances, yet they are commonly used in nursing homes. Organisational culture is an important consideration influencing use of psychotropic medicines. Schein's theory elucidates that organisational culture is underpinned by basic assumptions, which are the taken for granted beliefs driving organisational members' behaviour and practices. By exploring the basic assumptions of culture we are able to find explanations for why psychotropic medicines are prescribed contrary to standards. A qualitative study guided by Schein's theory was conducted using semi-structured interviews with 40 staff representing a broad range of roles from eight nursing homes. Findings from the study suggest two basic assumptions influenced the use of psychotropic medicines: locus of control and necessity for efficiency or comprehensiveness. Locus of control pertained to whether staff believed they could control decisions when facing negative work experiences. Necessity for efficiency or comprehensiveness concerned how much time and effort was spent on a given task. Participants' arrived at decisions to use psychotropic medicines that were inconsistent with ideal standards when they believed they were helpless to do the right thing by the resident and it was necessary to restrict time on a given task. Basic assumptions tended to provide the rationale for staff to use psychotropic medicines when it was not compatible with standards. Organisational culture is an important factor that should be addressed to optimise psychotropic medicine use. Copyright © 2018 Elsevier Ltd. All rights reserved.

Psychotropic and Opioid Medication Use in Older Patients With Breast Cancer Across the Care Trajectory: A Population-Based Cohort Study.

PubMed

Syrowatka, Ania; Chang, Sue-Ling; Tamblyn, Robyn; Mayo, Nancy E; Meguerditchian, Ari N

2016-11-01

Older patients with breast cancer represent a vulnerable population at higher risk of experiencing distress and pain, as well as medication-related adverse events from pharmacological treatment of these symptoms. The purpose of this study is to estimate the prevalence of psychotropic (anxiolytic, antidepressant, and antipsychotic) and opioid medication use by older women diagnosed with breast cancer. This population-based cohort study followed 19,353 women older than 65 years diagnosed with incident, nonmetastatic breast cancer in Quebec, Canada. Data were obtained from provincial, universal health and drug insurance plans covering all medical and pharmaceutical care. Descriptive statistics were calculated for demographic information, breast cancer characteristics, and treatments. Psychotropic and opioid medication use was assessed across the care trajectory: precancer baseline, active care, and first-year survivorship. There was a marked increase in the prevalence of medication use from precancer baseline to active care, followed by a decrease into first-year survivorship. Anxiolytics were used most often across the care trajectory (36.3%, 50.6%, and 44.4% at baseline, active care, and survivorship, respectively). In contrast, antipsychotic and opioid medications were sought primarily during active care (4.5- and 7-fold increases from baseline, respectively), with opioid use during active care increasing dramatically over the study period (9.0% to 40.9% from 1998 to 2010). Unlike other drugs, antidepressant use peaked in active care but persisted into survivorship (14.7%, 22.4%, and 22.3% at baseline, active care, and survivorship, respectively). A substantial proportion of older patients with breast cancer use psychotropic and opioid medications. The different patterns of medication use represent distress and pain experienced by patients across the care trajectory. Given that medication use in this vulnerable population is associated with an increased risk of adverse events, a multidimensional approach integrating psychological interventions in cancer care may better address psychosocial needs of older patients with breast cancer. Copyright © 2016 by the National Comprehensive Cancer Network.

Workplace bullying and subsequent psychotropic medication: a cohort study with register linkages

PubMed Central

Lallukka, Tea; Haukka, Jari; Partonen, Timo; Rahkonen, Ossi; Lahelma, Eero

2012-01-01

Objectives We aimed to examine longitudinally whether workplace bullying was associated with subsequent psychotropic medication among women and men. Design A cohort study. Setting Helsinki, Finland. Participants Employees of the City of Helsinki, Finland (n=6606, 80% women), 40–60 years at baseline in 2000–2002, and a register-based follow-up on medication. Primary and secondary outcome measures Workplace bullying comprised questions about current and earlier bullying as well as observing bullying. The Finnish Social Insurance Institution's register data on purchases of prescribed reimbursed psychotropic medication were linked with the survey data. All psychotropic medication 3 years prior to and 5 years after the baseline survey was included. Covariates included age, prior psychotropic medication, childhood bullying, occupational class, and body mass index. Cox proportional hazard models (HR, 95% CI) were fitted and days until the first purchase of prescribed psychotropic medication after baseline were used as the time axis. Results Workplace bullying was associated with subsequent psychotropic medication after adjusting for age and prior medication among both women (HR 1.51, 95% CI 1.18 to 1.93) and men (HR 2.15, 95% CI 1.36 to 3.41). Also observing bullying was associated with subsequent psychotropic medication among women (HR 1.53, 95% CI 1.25 to 1.88) and men (HR 1.92, 95% CI 1.23 to 2.99). The associations only modestly attenuated after full adjustment. Conclusions Our findings highlight the significance of workplace bullying to subsequent psychotropic medication reflecting medically confirmed mental problems. Tackling workplace bullying likely helps prevent mental problems among employees. PMID:23242240

Medication use in US youth with mental disorders.

PubMed

Merikangas, Kathleen R; He, Jian-ping; Rapoport, Judith; Vitiello, Benedetto; Olfson, Mark

2013-02-01

To evaluate the prevalence, demographic and clinical correlates, and specificity of classes of psychotropic medications indicated for mental disorders. Cross-sectional survey. Direct household interviews of combined household and school samples representative of the general population of adolescents in the United States. Ten thousand one hundred twenty-three adolescents aged 13 to 18 years who participated in the National Comorbidity Survey Adolescent Supplement. Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) (DSM-IV) mental disorders and neurodevelopmental disorders. Psychotropic medication use in the past 12 months. Among youth with any DSM-IV mental disorder, 14.2% reported that they had been treated with a psychotropic medication in the past 12 months. Strong associations emerged between specific disorders and classes of medications with evidence for efficacy. Antidepressants were most frequently used among those with primary mood disorders (14.1%); stimulant use was most common among those with attention-deficit/hyperactivity disorder (20.4%); and antipsychotic use was infrequent and mostly seen among those with serious developmental disorders. Less than 2.5% of adolescents without a 12-month mental disorder had been prescribed psychotropic medications, and most had evidence of psychological distress or impairment reflected in a previous mental disorder, subthreshold condition, or developmental disorder. Appropriate medication use was significantly more frequent among those in treatment in the mental health specialty sector than general medicine or other settings. These findings challenge recent concerns over widespread overmedication and misuse of psychotropic medications in US youth. In fact, these data highlight the need for greater recognition and appropriate treatment of youth with mental health disorders.

Prevalence of Psychotropic Drug Use in Adults with Intellectual Disability: Positive and Negative Findings from a Large Scale Study

ERIC Educational Resources Information Center

Tsiouris, John A.; Kim, Soh-Yule; Brown, W. Ted; Pettinger, Jill; Cohen, Ira L.

2013-01-01

The use of psychotropics by categories and the reason for their prescription was investigated in a large scale study of 4,069 adults with ID, including those with autism spectrum disorder, in New York State. Similar to other studies it was found that 58 % (2,361/4,069) received one or more psychotropics. Six percent received typical, 6 % received…

The effect of mental illness and psychotropic medication on gametes and fertility: a systematic review.

PubMed

Worly, Brett L; Gur, Tamar L

2015-07-01

Psychiatric disorders during the reproductive years and their treatment with psychotropic medications are increasingly common, and their effect on the reproductive system is an important area of research. To review the effect of mental illness and psychotropic medication on gametes and fertility. Searches of the PubMed database were conducted for English-language articles containing the keywords gametes, fertility, psychotropic, oocyte, sperm, mental illness, depression, and/or anxiety, in the title or abstract. The searches yielded 3,603 citations. Studies were evaluated for relevance. Those not pertinent to the clinical question, not written in English, and focusing on invertebrates were excluded. Full texts of 50 articles were obtained for further evaluation. Additional articles were identified from reference lists. Ultimately, a total of 37 studies were deemed suitable and reviewed. Clinical studies have not demonstrated a deleterious effect of psychotropic medication on oocytes in terms of retrieval and pregnancy rates. Clinical studies demonstrate inconclusive results regarding the effect on sperm, with several studies suggesting increased sperm motility and quantity with certain psychotropics. Decreased sperm quantity and motility are described in a number of studies, including in vitro and in vivo studies. Maternal psychiatric illness is associated with decreased reproductive success, including lower rates of oocyte retrieval, lower rates of ongoing pregnancy, and dysregulation of the stress system in a majority (n = 11) but not all (n = 3) studies reviewed. Male depression did not appear to affect sperm, but anxiety did have an effect (n = 1). Given the detrimental effect of untreated mental illness, current literature is not robust enough to influence the use of psychotropics in males or females who are considering reproduction. © Copyright 2015 Physicians Postgraduate Press, Inc.

Psychopharmacologic Services for Homeless Veterans: Comparing Psychotropic Prescription Fills Among Homeless and Non-Homeless Veterans with Serious Mental Illness.

PubMed

Hermes, Eric; Rosenheck, Robert

2016-02-01

Using national Veterans Health Administration (VHA) administrative data, this study evaluated differences in psychotropic medication use between homeless and non-homeless adults with serious mental illness (SMI) who used VHA services in 2010. The adjusted mean number of psychotropic prescription fills associated with homeless individuals were identified using regression models adjusted for socio-demographics, diagnoses, and use of health services. Of the 876,989 individuals with SMI using VHA services, 7.2 % were homeless at some time during 2010. In bivariate analysis, homeless individuals filled more psychotropic medication prescriptions compared with non-homeless individuals. However, after adjusting for potentially confounding variables, homeless individuals were found to have filled 16.2 % fewer prescriptions than non-homeless individuals when all psychotropics were analyzed together (F = 6947.1, p < .001) and for most individual classes of psychotropics. Greater use of residential/inpatient mental health services by the homeless was the most important single factor associated with filling more psychotropic prescriptions than non-homeless individuals.

Improving psychotropic drug prescription in nursing home patients with dementia: design of a cluster randomized controlled trial

PubMed Central

2013-01-01

Background Neuropsychiatric symptoms are highly prevalent in nursing home patients with dementia. Despite modest effectiveness and considerable side effects, psychotropic drugs are frequently prescribed for these neuropsychiatric symptoms. This raises questions whether psychotropic drugs are appropriately prescribed. The aim of the PROPER (PRescription Optimization of Psychotropic drugs in Elderly nuRsing home patients with dementia) II study is to investigate the efficacy of an intervention for improving the appropriateness of psychotropic drug prescription in nursing home patients with dementia. Methods/design The PROPER II study is a multi-center cluster randomized controlled, pragmatic trial using parallel groups. It has a duration of eighteen months and four six-monthly assessments. Six nursing homes will participate in the intervention and six will continue care as usual. The nursing homes will be located throughout the Netherlands, each participating with two dementia special care units with an average of fifteen patients per unit, resulting in 360 patients. The intervention consists of a structured and repeated multidisciplinary medication review supported by education and continuous evaluation. It is conducted by pharmacists, physicians, and nurses and consists of three components: 1) preparation and education, 2) conduct, and 3) evaluation/guidance. The primary outcome is the proportion of patients with appropriate psychotropic drug use. Secondary outcomes are the overall frequency of psychotropic drug use, neuropsychiatric symptoms, quality of life, activities of daily living, psychotropic drug side effects and adverse events (including cognition, comorbidity, and mortality). Besides, a process analysis on the intervention will be carried out. Discussion This study is expected to improve the appropriateness of psychotropic drug prescription for neuropsychiatric symptoms in nursing home patients with dementia by introducing a structured and repeated multidisciplinary medication review supported by education and continuous evaluation. Trial registration Netherlands Trial Registry (NTR): NTR3569. PMID:24180295

Psychotropic Medication Use among Insured Children with Autism Spectrum Disorder

ERIC Educational Resources Information Center

Madden, Jeanne M.; Lakoma, Matthew D.; Lynch, Frances L.; Rusinak, Donna; Owen-Smith, Ashli A.; Coleman, Karen J.; Quinn, Virginia P.; Yau, Vincent M.; Qian, Yinge X.; Croen, Lisa A.

2017-01-01

This study examined psychotropic medication use among 7901 children aged 1-17 with autism spectrum disorder (ASD) in five health systems, comparing to matched cohorts with no ASD. Nearly half (48.5%) of children with ASD received psychotropics in the year observed; the most common classes were stimulants, alpha-agonists, or atomoxetine (30.2%),…

Palestinian pharmacists' knowledge of issues related to using psychotropic medications in older people: a cross-sectional study.

PubMed

Shawahna, Ramzi; Khaskiyyi, Mais; Abdo, Hadeel; Msarwe, Yasmen; Odeh, Rania; Salame, Souad

2017-01-01

The purpose of this study was to assess the knowledge of pharmacists practicing in Palestine of issues related to using psychotropic medications in older people. The study was conducted with a cross-sectional observational design using a questionnaire. A total of 400 pharmacists responded to a 19-statement knowledge test related to the use of psychotropic medications in older people. The study was conducted from July 2016 to February 2017. The reliability and internal consistency of the study tool was assessed using the test-retest method and the Cronbach alpha. Categorical groups were compared using the chi-square test and the Spearman rank correlation. On the 19-statement knowledge test, the median score was 55.3% with an interquartile range of 21.9%. In a comparison of the demographic and practice-related variables of the pharmacists who scored ≥ 50% on the 19-statement knowledge test with those who scored < 50%, age, gender, and having taken a course on psychotropic medications were found to be significantly associated with performance, as shown by the chi-square test and Spearman correlation. Pharmacists practicing in Palestine possess less than optimal knowledge of issues related to the use of psychotropic medications in older people. Continuing educational interventions and/or training might be helpful in improving pharmacists' knowledge of issues related to using psychotropic medications in older people.

Palestinian pharmacists’ knowledge of issues related to using psychotropic medications in older people: a cross-sectional study

PubMed Central

2017-01-01

Purpose The purpose of this study was to assess the knowledge of pharmacists practicing in Palestine of issues related to using psychotropic medications in older people. Methods The study was conducted with a cross-sectional observational design using a questionnaire. A total of 400 pharmacists responded to a 19-statement knowledge test related to the use of psychotropic medications in older people. The study was conducted from July 2016 to February 2017. The reliability and internal consistency of the study tool was assessed using the test-retest method and the Cronbach alpha. Categorical groups were compared using the chi-square test and the Spearman rank correlation. Results On the 19-statement knowledge test, the median score was 55.3% with an interquartile range of 21.9%. In a comparison of the demographic and practice-related variables of the pharmacists who scored ≥ 50% on the 19-statement knowledge test with those who scored < 50%, age, gender, and having taken a course on psychotropic medications were found to be significantly associated with performance, as shown by the chi-square test and Spearman correlation. Conclusion Pharmacists practicing in Palestine possess less than optimal knowledge of issues related to the use of psychotropic medications in older people. Continuing educational interventions and/or training might be helpful in improving pharmacists’ knowledge of issues related to using psychotropic medications in older people. PMID:28835016

Mental Illness and Psychotropic Medication use Among People Assessed for Bariatric Surgery in Ontario, Canada.

PubMed

Hensel, Jennifer; Selvadurai, Melanie; Anvari, Mehran; Taylor, Valerie

2016-07-01

Studies completed outside of Canada have reported a high rate of mental illness and psychotropic medication use among bariatric surgery candidates with variable impacts on surgical and mental health outcomes. To our knowledge, there has been no published Canadian data on this issue. We conducted a secondary analysis of de-identified data from the Ontario Bariatric Registry for all individuals who completed both a baseline and psychological assessment between April 1, 2010, and February 9, 2015 (N = 10,698). We determined the rates of reported mental illness and psychotropic medication use overall and by fiscal year of assessment. A past or present mental illness, most commonly depression, was recorded for 51 % of individuals. At baseline, 38 % were taking at least one psychotropic medication, most commonly antidepressants. Only a small proportion of the population were taking psychotropic medications known to be associated with high potential for weight gain. Although the prevalence of mental illness increased steadily from 35 % in 2010/2011 to 63 % in 2014/2015, there was no corresponding increase in reported medication use. Of those taking psychotropic medications, 13 % did not have a recorded history of mental illness. Consistent with other international studies, our results indicate a high prevalence of mental illness and psychotropic medication use among people referred for bariatric surgery in Ontario, Canada. This supports that accurate screening practices, knowledge about how to manage psychotropic medication pre- and post-operatively and recognition for opportunities to change medications that may be associated with weight gain are required.

Multi-exposure and clustering of adverse childhood experiences, socioeconomic differences and psychotropic medication in young adults.

PubMed

Björkenstam, Emma; Hjern, Anders; Mittendorfer-Rutz, Ellenor; Vinnerljung, Bo; Hallqvist, Johan; Ljung, Rickard

2013-01-01

Stressful childhood experiences have negative long-term health consequences. The present study examines the association between adverse childhood experiences, socioeconomic position, and risk of psychotropic medication in young adulthood. This register-based cohort study comprises the birth cohorts between 1985 and 1988 in Sweden. We followed 362 663 individuals for use of psychotropic medication from January 2006 until December 2008. Adverse childhood experiences were severe criminality among parents, parental alcohol or drug abuse, social assistance recipiency, parental separation or single household, child welfare intervention before the age of 12, mentally ill or suicidal parents, familial death, and number of changes in place of residency. Estimates of risk of psychotropic medication were calculated as odds ratio (OR) with 95% confidence intervals (CIs) using logistic regression analysis. Adverse childhood experiences were associated with increased risks of psychotropic medication. The OR for more than three adverse childhood experiences and risk of psychotropic medication was for women 2.4 (95% CI 2.3-2.5) and for men 3.1 (95% CI 2.9-3.2). The risk of psychotropic medication increased with a higher rate of adverse childhood experiences, a relationship similar in all socioeconomic groups. Accumulation of adverse childhood experiences increases the risk of psychotropic medication in young adults. Parental educational level is of less importance when adjusting for adverse childhood experiences. The higher risk for future mental health problems among children from lower socioeconomic groups, compared to peers from more advantaged backgrounds, seems to be linked to a higher rate of exposure to adverse childhood experiences.

Multi-Exposure and Clustering of Adverse Childhood Experiences, Socioeconomic Differences and Psychotropic Medication in Young Adults

PubMed Central

Björkenstam, Emma; Hjern, Anders; Mittendorfer-Rutz, Ellenor; Vinnerljung, Bo; Hallqvist, Johan; Ljung, Rickard

2013-01-01

Purpose Stressful childhood experiences have negative long-term health consequences. The present study examines the association between adverse childhood experiences, socioeconomic position, and risk of psychotropic medication in young adulthood. Methods This register-based cohort study comprises the birth cohorts between 1985 and 1988 in Sweden. We followed 362 663 individuals for use of psychotropic medication from January 2006 until December 2008. Adverse childhood experiences were severe criminality among parents, parental alcohol or drug abuse, social assistance recipiency, parental separation or single household, child welfare intervention before the age of 12, mentally ill or suicidal parents, familial death, and number of changes in place of residency. Estimates of risk of psychotropic medication were calculated as odds ratio (OR) with 95% confidence intervals (CIs) using logistic regression analysis. Results Adverse childhood experiences were associated with increased risks of psychotropic medication. The OR for more than three adverse childhood experiences and risk of psychotropic medication was for women 2.4 (95% CI 2.3–2.5) and for men 3.1 (95% CI 2.9–3.2). The risk of psychotropic medication increased with a higher rate of adverse childhood experiences, a relationship similar in all socioeconomic groups. Conclusions Accumulation of adverse childhood experiences increases the risk of psychotropic medication in young adults. Parental educational level is of less importance when adjusting for adverse childhood experiences. The higher risk for future mental health problems among children from lower socioeconomic groups, compared to peers from more advantaged backgrounds, seems to be linked to a higher rate of exposure to adverse childhood experiences. PMID:23341951

Psychotropic medication patterns among youth in foster care.

PubMed

Zito, Julie M; Safer, Daniel J; Sai, Devadatta; Gardner, James F; Thomas, Diane; Coombes, Phyllis; Dubowski, Melissa; Mendez-Lewis, Maria

2008-01-01

Studies have revealed that youth in foster care covered by Medicaid insurance receive psychotropic medication at a rate > 3 times that of Medicaid-insured youth who qualify by low family income. Systematic data on patterns of medication treatment, particularly concomitant drugs, for youth in foster care are limited. The purpose of this work was to describe and quantify patterns of psychotropic monotherapy and concomitant therapy prescribed to a randomly selected, 1-month sample of youth in foster care who had been receiving psychotropic medication. METHODS. Medicaid data were accessed for a July 2004 random sample of 472 medicated youth in foster care aged 0 through 19 years from a southwestern US state. Psychotropic medication treatment data were identified by concomitant pattern, frequency, medication class, subclass, and drug entity and were analyzed in relation to age group; gender; race or ethnicity; International Classification of Diseases, Ninth Revision, psychiatric diagnosis; and physician specialty. Of the foster children who had been dispensed psychotropic medication, 41.3% received > or = 3 different classes of these drugs during July 2004, and 15.9% received > or = 4 different classes. The most frequently used medications were antidepressants (56.8%), attention-deficit/hyperactivity disorder drugs (55.9%), and antipsychotic agents (53.2%). The use of specific psychotropic medication classes varied little by diagnostic grouping. Psychiatrists prescribed 93% of the psychotropic medication dispensed to youth in foster care. The use of > or = 2 drugs within the same psychotropic medication class was noted in 22.2% of those who were given prescribed drugs concomitantly. Concomitant psychotropic medication treatment is frequent for youth in foster care and lacks substantive evidence as to its effectiveness and safety.

Survey on the use of psychotropic drugs by twelve military police units in the municipalities of Goiânia and Aparecida de Goiânia, state of Goiás, Brazil.

PubMed

Costa, Sérgio Henrique Nascente; Cunha, Luiz Carlos da; Yonamine, Maurício; Pucci, Liuba Laxor; Oliveira, Fernando Gomes Ferreira; Souza, Camila Gabriela de; Mesquita, Guilherme Alves; Vieira, Ana Paula de Toledo; Vinhal, Ludmilla Barros; Dalastra, Janayna; Leles, Cláudio Rodrigues

2010-12-01

To determine the prevalence of psychotropic drug use among military police officers in the state of Goiás, Brazil. Study carried out at twelve military police units located in the municipalities of Goiânia and Aparecida de Goiânia between March to October 2008. Volunteers (n=221) were interviewed about drug use using a questionnaire especially designed by the Centro Brasileiro de Informações sobre Drogas Psicotrópicas (CEBRID). Descriptive statistics was used to determine the prevalence of licit and illicit drug use in the study sample. The frequency of use was divided into: 1) lifetime use: tobacco-39.9%, alcohol-87.8%, cannabis-8.1%, cocaine-1.8%, stimulants-7.2%, solvents-10.0%, sedatives, anxiolytics, antidepressants-6.8%, LSD-0.5%, Bentyl®-0.5%, anabolic steroids-5.4%; 2) use in the previous year: tobacco-15.4%, alcohol-72.9%, stimulants-6.3%, solvents-0.5%, sedatives, anxiolytics, antidepressants-3.7%; 3) use in the previous 30 days: tobacco-14.5%, alcohol-57.5%, stimulants-5.0%, solvents-0.5, sedatives, anxiolytics, antidepressants-3.7%. The high prevalence rate of psychotropic drug use found amoung military police officers in two cities of the state of Goiás in Brazil can be considered an important factor with potential influence on job activities.

Cardiometabolic disease and features of depression and bipolar disorder: population-based, cross-sectional study.

PubMed

Martin, Daniel J; Ul-Haq, Zia; Nicholl, Barbara I; Cullen, Breda; Evans, Jonathan; Gill, Jason M R; Roberts, Beverly; Gallacher, John; Mackay, Daniel; McIntosh, Andrew; Hotopf, Matthew; Craddock, Nick; Deary, Ian J; Pell, Jill P; Smith, Daniel J

2016-04-01

The relative contribution of demographic, lifestyle and medication factors to the association between affective disorders and cardiometabolic diseases is poorly understood. To assess the relationship between cardiometabolic disease and features of depresion and bipolar disorder within a large population sample. Cross-sectional study of 145 991 UK Biobank participants: multivariate analyses of associations between features of depression or bipolar disorder and five cardiometabolic outcomes, adjusting for confounding factors. There were significant associations between mood disorder features and 'any cardiovascular disease' (depression odds ratio (OR) = 1.15, 95% CI 1.12-1.19; bipolar OR = 1.28, 95% CI 1.14-1.43) and with hypertension (depression OR = 1.15, 95% CI 1.13-1.18; bipolar OR = 1.26, 95% CI 1.12-1.42). Individuals with features of mood disorder taking psychotropic medication were significantly more likely than controls not on psychotropics to report myocardial infarction (depression OR = 1.47, 95% CI 1.24-1.73; bipolar OR = 2.23, 95% CI 1.53-3.57) and stroke (depression OR = 2.46, 95% CI 2.10-2.80; bipolar OR = 2.31, 95% CI 1.39-3.85). Associations between features of depression or bipolar disorder and cardiovascular disease outcomes were statistically independent of demographic, lifestyle and medication confounders. Psychotropic medication may also be a risk factor for cardiometabolic disease in individuals without a clear history of mood disorder. © The Royal College of Psychiatrists 2016.

Associations Between Magnitude of Child Maltreatment and Medicaid Expenditures for Psychotropic Medications.

PubMed

Raghavan, Ramesh; Brown, Derek S; Allaire, Benjamin T; Ross, Raven E; Landsverk, John

2016-08-01

This study examined relationships between various measures of the severity of child maltreatment and expenditures on psychotropic drugs among children in the welfare system. Child participants (N=4,453) in the first National Survey of Child and Adolescent Well-Being (NSCAW) were linked to their Medicaid claims from 36 states. Three specifications for severity of maltreatment were developed. A two-part regression of logistic and generalized linear models of expenditures on psychotropic medications was estimated for each specification. Physically abused children had higher odds (odds ratio [OR]=1.34) and neglected children had lower odds (OR=.76) of incurring psychotropic drug expenditures. Children who experienced the most severe level of harm had higher odds (OR=1.33) of medication use, compared with children without appreciable harm. No maltreatment specifications were associated with increased expenditures on psychotropic drugs. The magnitude of maltreatment affected odds of use of psychotropic drugs but had no effect on Medicaid expenditures for these drugs.

[Misuse of psychotropic medications in a population of subjects held for custody in the city of Paris].

PubMed

Sec, Isabelle; Questel, Frank; Rey, Caroline; Pourriat, Jean-Louis

2009-01-01

Identify which psychotropic medications are misused and peddled in a population of subjects held for custody in the city of Paris. Subjects held for custody in the Medico-Legal Emergency Unit of the Paris Hôtel-Dieu hospital were examined and interrogated between March 2006 and March 2007 in order to assess their consumption of psychotropic medications. Sixty one of the 659 subjects (9.2%) interrogated were included in the study. Their main source of psychotropic medications was street dealers. The most frequently misused psychotropic agent was clonazepam (42.6%), followed by buprenorphine (30.65%) and methadone (21.3%). Clonazepam appears to have replaced flunitrazepam which now only comes in fifth position (11.4%). The finding that methadone is the third most misused drug should lead us to query this medication's dispensing method. Practitioners should remain vigilant regarding the potential misuse of psychotropic medications, particularly since they may induce severe undesirable events (addiction, neurological disorders, possibly lethal overdosage).

Patterns of psychotropic medicine use in pregnancy in the United States from 2006 to 2011 among women with private insurance.

PubMed

Hanley, Gillian E; Mintzes, Barbara

2014-07-22

Psychiatric disorders are equally common during pregnancy as among non-pregnant women, and many of these conditions are treated with psychotropic medicines. Relatively little is known about patterns of use of many these agents during pregnancy, and specifically of how rates may have shifted during the last decade. We aimed to quantify the rate of pregnancy related exposures to categories of psychotropic medicines stratified according to the primary indication for use (antidepressants, antipsychotics, anxiolytics, and psychostimulants), trimester of pregnancy, trends over time and region, and indication for use. We conducted a retrospective cohort study of pregnancies among women in the Truven Health MarketScan database (source population 70 million Americans), which captures person-specific clinical use and includes detailed information on filled prescriptions, hospitalizations and outpatient visits for all privately insured employees and their dependents. We classified psychotropic medicines of interest using ATC level 3 accordingly: antipsychotics (N05A); anxiolytics (N05B); antidepressants (N06A); psychostimulants, agents used for ADHD and cognitive enhancement (N06B). We also examined temporal and regional trends in use. We included 343,299 women who had a live birth between Jan 1, 2006 and Dec 31, 2011, of whom 10.3% were dispensed one or more psychotropic medicines during pregnancy. This rate varied from 6% to 15% between states. The rate of use of psychotropic medicines was relatively stable between 2006 and 2011. The most commonly used psychotropic medicines were selective serotonin reuptake inhibitors (5.1%) and benzodiazepine or benzodiazepine-like medicines (3.9%). Among psychotropic users, the most commonly associated psychiatric diagnosis was depression (25.0%), followed by anxiety disorders (24.4%). Approximately 1.6% of women used more than one category of psychotropic medicine in pregnancy, most commonly an antidepressant and an anxiolytic medicine (1.2%). Given this relatively high rate of use, the lack of evidence that the most frequently used medications improve birth outcomes and the safety concerns associated with both early and late pregnancy use for many frequently-used medications, there is a need for further study of factors driving psychotropic medication use during pregnancy.

Past and present socioeconomic circumstances and psychotropic medication: a register-linkage study.

PubMed

Mauramo, Elina; Lallukka, Tea; Laaksonen, Mikko; Martikainen, Pekka; Rahkonen, Ossi; Lahelma, Eero

2012-12-01

Various domains of socioeconomic circumstances are associated with self-reported mental health, but we lack evidence from studies using medically confirmed mental health outcomes. This longitudinal study aimed to examine the associations of multiple domains of socioeconomic circumstances with subsequent prescribed psychotropic medication among Finnish public sector employees. Baseline survey data among 40-60-year-old employees of City of Helsinki were linked with Social Insurance Institution of Finland register data on psychotropic medication purchases (n=5563). HRs were calculated using Cox regression to examine associations of parental and own education, childhood and current economic difficulties, occupational class, household income and housing tenure with antidepressants, sleeping pills and sedatives and any psychotropic medication during a 5-year follow-up. In age and previous psychotropic medication adjusted models, the risk of antidepressant medication was higher in those with childhood (women: HR=1.29, men: HR=1.64) and current economic difficulties (women: HR=1.30-1.54), rented housing (women: HR=1.20, men: HR=1.45) and the second lowest income group (men: HR=1.71). Gradual adjustments had little effect on the associations. For sleeping pills and sedatives, similar associations were found in women for current economic difficulties, and in men for housing tenure. Results for any psychotropic medication reflected those observed for antidepressants. Past and present economic difficulties and housing tenure were more important determinants of subsequent psychotropic medication among employees than the conventional socioeconomic determinants. The associations were somewhat inconsistent between the medication groups and the sexes. The results support the importance of examining multiple domains of socioeconomic circumstances simultaneously.

Psychotropic Medication Use Among Medicaid-Enrolled Children With Autism Spectrum Disorders

PubMed Central

Mandell, David S.; Morales, Knashawn H.; Marcus, Steven C.; Stahmer, Aubyn C.; Doshi, Jalpa; Polsky, Daniel E.

2010-01-01

OBJECTIVE The objective of this study was to provide national estimates of psychotropic medication use among Medicaid-enrolled children with autism spectrum disorders and to examine child and health system characteristics associated with psychotropic medication use. METHODS This cross-sectional study used Medicaid claims for calendar year 2001 from all 50 states and Washington, DC, to examine 60 641 children with an autism spectrum disorder diagnosis. Logistic regression with random effects was used to examine the child, county, and state factors associated with psychotropic medication use. RESULTS Of the sample, 56% used at least 1 psychotropic medication, 20% of whom were prescribed ≥3 medications concurrently. Use was common even in children aged 0 to 2 years (18%) and 3 to 5 years (32%). Neuroleptic drugs were the most common psychotropic class (31%), followed by antidepressants (25%) and stimulants (22%). In adjusted analyses, male, older, and white children; those who were in foster care or in the Medicaid disability category; those who received additional psychiatric diagnoses; and those who used more autism spectrum disorder services were more likely to have used psychotropic drugs. Children who had a diagnosis of autistic disorder or who lived in counties with a lower percentage of white residents or greater urban density were less likely to use such medications. CONCLUSIONS Psychotropic medication use is common among even very young children with autism spectrum disorders. Factors unrelated to clinical presentation seem highly associated with prescribing practices. Given the limited evidence base, there is an urgent need to assess the risks, benefits, and costs of medication use and understand the local and national policies that affect medication use. PMID:18310165

Factors associated with the consumption of psychotropic drugs in a cohort of men and women aged 50 and over.

PubMed

Empereur, F; Baumann, M; Alla, F; Briançon, S

2003-02-01

The use of psychotropic drugs has increased continuously over recent years in industrialized countries. In Europe, France has the highest consumption of such drugs. The aim of this study was to identify the sociodemographic and medical factors associated with the use of psychotropic agents. Data, collected as part of the SUVIMAX (SUpplementation en VItamines et sels Mineraux AntioXydants) prevention trial, from a self- administered questionnaire involving 7299 subjects aged 45-60 years, were subjected to logistic regression analysis. A total of 467 subjects used psychotropic drugs (8.4% of the women, 4.6% of the men). Use of psychotropic drugs increased in subjects of both sexes with past history of depression, perception of poor health and use of other drug treatments. Widowhood in men [odds ratio (OR) = 3.4; 95% CI = 1.6-7.3] and divorce in women (OR = 2; 95% CI = 1.2-3.2) were also associated with an increased use of psychotropic drugs. Interaction was demonstrated between educational level and occupational satisfaction in men (OR = 2.9; 95% CI = 1.5-5.8) and between perception of health status and use of other types of medication in women (OR = 6.5; 95% CI = 4.6-9.5). The results of our study are consistent with those of others in demonstrating that specific socio-occupational factors in men and specific medical factors in women influence extent of use of psychotropic drugs.

[Prescription of Psychotropic Drugs with Potentially Restraining Effect: An Analysis of Care Need Assessment Data by MDK Bayern].

PubMed

Ezzat, Nadja; Müller-Barna, Peter; Krüger, Cornelia; Randzio, Ottilie

2018-06-12

Physical restraints in home care and residential care settings in the form of restraining devices have been reduced in the last years. Now psychotropic drugs with sedating and thus potentially restraining effect are of increasing interest. The objective of this study was to describe prescription of psychotropic drugs for insurants in need of care and factors influencing such prescription. On the "Annual Word Elder Abuse Awareness Day", the Medical Service of the Statutory Health Insurance undertook a reference day analysis. During the regular assessment of care needs, distribution of psychotropic drugs according to relevant aspects of care were analyzed. Additionally, prescribed drugs were rated with respect to inappropriateness for elder people according to the Priscus list. Data on 706 insured people were analyzed; 43% of them received at least one psychotropic drug as a regular medication, 22% of them at least one potentially sedating drug. According to the Priscus list, 16% of prescribed drugs were identified as potentially inappropriate for elder people. Significant correlation was shown between prescription of psychotropic drugs and location of assessment, care need, diagnosis and the degree of limitation in daily living skills. This paper supports results in literature and emphasizes the discrepancy between restraint in the prescription of psychotropic drugs as advised by experts and distribution of these drugs in reality. Further studies analyzing the quality of prescriptions taking into consideration the individual circumstances of patients are desirable. © Georg Thieme Verlag KG Stuttgart · New York.

Variation in psychotropic drug use in nursing homes.

PubMed

Castle, N G

1998-01-01

Numerous studies of health service use reveal considerable variation in the degree of services provided. In this article the variation in psychotropic drug use in nursing homes is examined. First, a descriptive analysis of nursing homes with and without high levels of psychotropic drug use is provided. Second, an analysis of the determinants of high levels of psychotropic drug use in nursing homes is provided. Factors such as ownership, staffing levels, having special care units, case-mix intensity, competitiveness of the nursing home market, and the state Medicaid reimbursement rate structure are examined. The results of these analyses are discussed in terms of their policy issues.

Assessing the Impact of Psychotropic Medication Changes on Challenging Behavior of Individuals with Intellectual Disabilities

PubMed Central

Valdovinos, Maria G.; Henninger-McMahon, Meara; Schieber, Elizabeth; Beard, Lisa; Conley, Brenna; Haas, Annette

2016-01-01

Objective The use of psychotropic medication to address challenging behavior in individuals diagnosed with intellectual disabilities is common practice; however, very few studies have examined how multiple medication use (or combination treatment) impacts the behaviors these medications are prescribed to treat. Method The current study followed eight individuals over a two-year period as they experienced changes in their psychotropic medication regimens. During that time, data from functional analyses and indirect assessments of challenging behavior were collected. Results The results suggest that changes in psychotropic medication regimens can produce changes in functional assessment outcomes, suggesting a need for continued behavioral assessment to better inform medication practices and behavioral treatment. Of the eight participants in the study, five participants’ behaviors varied in rate of responding in FAs across all medication changes. Additionally, three participants’ FAs produced changes in outcomes; however, those changes were not consistent across all medication changes, that is, not every medication change yielded different outcomes from previous assessments. Conclusion This study demonstrates how the outcome of an FA can be used to monitor the effects of psychotropic medication changes, specifically when medications are combined, on challenging behavior in individuals with intellectual and developmental disabilities. PMID:27429750

Pediatric psychotropic medication initiation and adherence: a literature review based on social exchange theory.

PubMed

Hamrin, Vanya; McCarthy, Erin M; Tyson, Veda

2010-08-01

Psychotropic medication initiation and adherence is an identified problem. This literature review explores factors that determine families' decisions to initiate, sustain, or discontinue use of psychotropic medication in children and adolescents. Social exchange theory is used as a framework to explore decisions to initiate and adhere to psychotropic medications. Contributing factors related to psychotropic medication initiation, adherence, and discontinuation are explored. Themes in the literature encompassing costs and benefits of psychotropic medication adherence include family experiences with adverse effects, previous psychotropic medication experience, medication psychoeducation, stigma, societal views about psychotropic medication, particular diagnosis, the effect of comorbid diagnosis on adherence, attitudes and beliefs about medication by both children and parents, and relationships with the provider. The impact of family demographics including parent gender, age of the child, ethnicity, and parent educational level on psychotropic medication adherence is evaluated. International and U.S. studies from Medline, Cumulative Index for Nursing and Allied Health Literature and PsychInfo evaluating medication initiation and adherence in the pediatric psychiatric population and social exchange theory was incorporated from relevant textbook resources. Rewards experienced from medication treatment include improvement in symptoms, school performance and family relationships, and reduced level of parenting stress. Identified costs include impact of adverse side effects, social stigma, lack of response, fears of addiction, and changing the child's personality. Acceptance of the diagnosis influences adherence while medication education has varying effects. Families' attitudes, beliefs and perceptions about psychiatric illness and treatment play a large role in medication treatment decisions. A trusting provider relationship has a positive effect on adherence. Psychosocial treatment alternatives are preferred. With maturation, adolescents have more influence on decisions related to adherence.

An Examination of Psychotropic Medication Side Effects: Does Taking a Greater Number of Psychotropic Medications from Different Classes Affect Presentation of Side Effects in adults with ID?

ERIC Educational Resources Information Center

Mahan, Sara; Holloway, Jodie; Bamburg, Jay W.; Hess, Julie A.; Fodstad, Jill C.; Matson, Johnny L.

2010-01-01

This study examined whether the number of psychotropic medications an individual is taking across classes influences side effects among adults with Intellectual Disability (ID). Participants were 80 adults diagnosed with ID. Dependent variables were the composite score and domain scores of the "Matson Evaluation of Drug Side-Effects" ("MEDS"),…

Medication challenges for patients with severe mental illness: experience and views of patients, caregivers and mental health care workers in Dar es Salaam, Tanzania.

PubMed

Iseselo, Masunga K; Ambikile, Joel Seme

2017-01-01

Management of patients with mental disorders is inadequate in the majority of low and middle income countries. The main treatment modality for patients with severe mental disorders in these countries is mainly pharmacological approach. Patients face many challenges in meeting medication needs. In this context, high percentages of individuals who have severe mental disorders are not treated. Regular and adequate supplies of appropriate, safe and affordable medications are some of the important aspects required for provision of quality mental health services. Psychotropic medications are an important component of holistic care that provides treatment options for those suffering from mental illnesses. In Tanzania, mental health services face many challenges including inadequate mental health care providers, infrastructure, and medication supply. Relapse is a common problem among patients attending mental health facilities. This study is aimed at exploring views and experiences of patients, caregivers and mental health care providers on the psychotropic medication in Dar es Salaam, Tanzania. A qualitative study was conducted, involving two focus group discussions with seven and nine caregivers in each group. Eleven in-depth interviews with four patients and seven mental health care providers at Temeke Municipality, Dar es Salaam, were conducted. Convenient sampling procedure was used to select participants for the study. Discussion and interview guides were used during data collection. Interviews were audio-recorded in Kiswahili with all study participants. The recorded interviews were transcribed and qualitative content thematic analysis was used to analyze data after translation. Four themes were identified. These include attitudes of patients towards psychotropic medication, availability of psychotropic medications, financial concerns towards psychotropic medications, and coverage of free treatment policy. The availability and affordability of psychotropic medications to patients are big problems. This was partly attributed to insufficient funds to support the budget of health facilities and technical challenges contributed by both the health facilities and other stakeholders. To improve mental health services in the country, it is important to ensure adequate supply of psychotropic medications in the health facilities. Access to psychotropic medications is essential in addressing the public health problem of untreated mental illnesses. These findings call for the government and other stakeholders to increase funding for essential psychotropic medications.

Mental distress and subsequent use of psychotropic drugs among adolescents-a prospective register linkage study.

PubMed

Steffenak, Anne Kjersti Myhrene; Nordström, Gun; Wilde-Larsson, Bodil; Skurtveit, Svetlana; Furu, Kari; Hartz, Ingeborg

2012-06-01

To investigate the association between mental distress, other factors, and subsequent use of psychotropic drugs in adolescents aged 15-16 years. This study is based on information retrieved from the Norwegian Youth Health Surveys (2000-2003) and linked to prescription data from the Norwegian Prescription Database (2004-2009). The study population included 11,620 adolescents aged 15-16 (87% response rate) years. Self-reported mental distress (Hopkins Symptom Checklist-10 score 1.85) was recorded along with health and lifestyle habits, education plans, and family economics. Incident psychotropic drug use (outcome measure) was defined ≥1 prescriptions of one of the following psychotropic drugs: anxiolytics, hypnotics, antidepressants, or phenothiazines registered in the Norwegian Prescription Database. Overall, 15.5% of the adolescents reported mental distress, 75% of them were girls. For both genders, incident psychotropic use was significantly higher among those reporting mental distresses at baseline, compared with the rest of the participants. The highest psychotropic drug use was observed among mentally distressed girls (27.7%). Mental distress was significantly associated with incident use of psychotropic drugs (odds ratio: 2.25, 95% confidence interval: 1.97-2.55). After adjustment for confounding factors and inclusion of potential mediating factors, the odds ratio attenuated to 1.59 (95% confidence interval: 1.35-1.86). The prevalence of mental distress among adolescents may have consequences for health promotion. Public health nurses in Norway, working in health centers and schools, have a responsibility to promote health and prevent health problems. They have the opportunity and a responsibility to identify vulnerable young people. Copyright © 2012 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Consistency of psychotropic drug-drug interactions listed in drug monographs.

PubMed

Liu, Xinyue; Hatton, Randy C; Zhu, Yanmin; Hincapie-Castillo, Juan M; Bussing, Regina; Barnicoat, Marie; Winterstein, Almut G

With an increasing prevalence of psychotropic polypharmacy, clinicians depend on drug-drug interaction (DDI) references to ensure safe regimens, but the consistency of such information is frequently questioned. To evaluate the consistency of psychotropic DDIs documented in Clinical Pharmacology (CP), Micromedex (MM), and Lexicomp (LC) and summarize consistent psychotropic DDIs. In May 2016, we extracted severe or major psychotropic DDIs for 102 psychotropic drugs, including central nervous system (CNS) stimulants, antidepressants, an antimanic agent (lithium), antipsychotics, anticonvulsants, and anxiolytics-sedatives-hypnotics from CP, MM, and LC. We then summarized the psychotropic DDIs that were included in all 3 references and with evidence quality of "excellent" or "good" based on MM. We identified 1496, 938, and 1006 unique severe or major psychotropic DDIs from CP, MM, and LC, respectively. Common adverse effects related to psychotropic DDIs include increased or decreased effectiveness, CNS depression, neurotoxicity, QT prolongation, serotonin syndrome, and multiple adverse effects. Among these interactions, only 371 psychotropic DDIs were documented in all 3 references, 59 of which had "excellent" or "good" quality of evidence based on MM. The consistency of psychotropic DDI documentation across CP, MM, and LC is poor. DDI documentations need standards that would encourage consistency among drug information references. The list of the 59 DDIs may be useful in the assessment of psychotropic polypharmacy and highlighting DDI alerts in clinical practice. Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

Obesity and psychotropic medication: a prospective register linkage study among midlife women and men.

PubMed

Svärd, Anna; Lahti, Jouni; Rahkonen, Ossi; Lahelma, Eero; Lallukka, Tea

2016-06-06

Both obesity and mental health are major public health issues. This study aimed to examine whether overweight and obesity among midlife employees are associated with subsequent psychotropic medication. A further aim was to examine the potential effect of key covariates on the association. The Helsinki Health Study baseline survey was conducted in 2000-2002 among 40-60-year-old employees of the City of Helsinki, Finland (n = 8960). The participants were classified as of normal weight (18.5-24.9 kg/m(2)), overweight (25-29.9 kg/m(2)), obese (30-34.9 kg/m(2)) or severely obese (≥35 kg/m(2)) based on self-reported body mass index. Data on psychotropic medication purchases from baseline to 2009 were derived from registers of the Social Insurance Institution of Finland. The final analysis included 4760 women and 1338 men. Antidepressants and sedatives were examined separately. Covariates included socio-demographic factors, workload, health behaviours, physical functioning, somatic ill-health and psychotropic medication prior to baseline. Hazard ratios (HR) for the first psychotropic medication purchase were calculated using Cox regression analysis. Third of women and quarter of men made at least one psychotropic medication purchase during the follow-up. Adjusting for age, obese (HR = 1.57; 95 % CI = 1.10-2.24) and severely obese (HR = 2.15; 95 % CI = 1.29-3.56) men were at risk of having psychotropic medication compared to men of normal weight. These associations disappeared after further adjustment. Severe obesity remained associated with subsequent sedative medication among the men even after full adjustment (HR = 2.12; 95 % CI = 1.17-3.84). No associations were found among the women. Obese and severely obese men, but not women, were at risk of psychotropic medication. Further studies are needed to deepen understanding of the relationship between obesity and mental ill-health, and the possible protecting effects of age, employment, and living environment.

Childhood adversities predict strongly the use of psychotropic drugs in adulthood: a population-based cohort study of 24,284 Finns.

PubMed

Koskenvuo, Karoliina; Koskenvuo, Markku

2015-04-01

Exposure to adverse childhood experiences has been shown to be associated with negative health outcomes including mental health problems, but only a few studies with register-based data have used psychotropic drugs as an outcome variable. The purpose of this study is to examine whether adverse emotional childhood experiences, such as serious conflicts in the family and frequent fear of a family member, predict the use of psychotropic drugs in adulthood. In addition, the association of a child-parent relationship during childhood with the use of psychotropic drugs is studied. The participants of the population-based Health and Social Support Study (24,284 working aged Finns) were followed up for 9 years. The information on childhood experiences and child-parent relationships was obtained from the questionnaires in 1998 and 2003. The number of psychotropic purchases (antipsychotics, drugs for bipolar disorder, antidepressants, anxiolytics, hypnotics and sedatives) was obtained from the National-Drug-Prescription-Register. Logistic and multinomial regression models were used. A graded association between childhood adversities and the use of psychotropic drugs was found, even after adjustments for occupational training, work status, recent life events and health behaviour. Frequent fear of a family member showed the strongest association: the OR for multiple use of antidepressants was 3.08 (95% CI 2.72 to 3.49) and 2.69 (2.27 to 3.20) for multiple use of anxiolytics. Use of psychotropic drugs was clearly increased among those with poor child-parent relationship and multiple childhood adversities. The results highlight the effect of environmental factors during childhood on mental health and the need for early recognition of families at risk. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

[Counselling customers with psychotropic vs. cardiovascular prescriptions: a survey among Austrian community pharmacists].

PubMed

Hagmair, Gisela; Amering, Michaela; Kaiser, Gerda; Katschnig, Heinz

2014-01-01

Prescriptions for psychotropic drugs in general and their share of all prescriptions have substantially risen over the last decades. Thus, also counselling by pharmacists becomes more important in this area. This study focuses on how community pharmacists see their own role when counselling persons with prescriptions for psychotropic medication and how this differs from counselling persons with other types of prescriptions. Based on the Toronto Community Pharmacists' Questionnaire an online questionnaire was developed with the assistance of the Austrian Pharmacists Association. This instrument elicits pharmacists' attitudes toward and professional interactions with users of psychotropic drugs on the one hand and of cardiovascular medication on the other. After a pilot study the questionnaire - which was to be filled in anonymously - was put on a web portal for six months and Austrian community pharmacists were invited to answer it. 125 pharmacists completed the questionnaire. Overall it was reported, that new customers with psychotropic prescriptions were less often counselled than those with prescriptions for cardiovascular medication. The main reasons for this difference seem to be the lack of privacy in public pharmacies, the fear of stigmatising customers with psychotropic medication and a perceived lack of training concerning the treatment of mental disorders. In addition to improving such training, it was suggested that seminars and workshops for communication skills should be organised. The reduced frequency in counselling new customers with psychotropic medication is related to a lack of privacy in public pharmacies, fear of stigmatising customers and a perceived need for improving the training on the treatment of mental disorders.

Changes in Body Weight and Psychotropic Drugs: A Systematic Synthesis of the Literature

PubMed Central

Dent, Robert; Blackmore, Angelique; Peterson, Joan; Habib, Rami; Kay, Gary Peter; Gervais, Alan; Taylor, Valerie; Wells, George

2012-01-01

Introduction Psychotropic medication use is associated with weight gain. While there are studies and reviews comparing weight gain for psychotropics within some classes, clinicians frequently use drugs from different classes to treat psychiatric disorders. Objective To undertake a systematic review of all classes of psychotropics to provide an all encompassing evidence-based tool that would allow clinicians to determine the risks of weight gain in making both intra-class and interclass choices of psychotropics. Methodology and Results We developed a novel hierarchical search strategy that made use of systematic reviews that were already available. When such evidence was not available we went on to evaluate randomly controlled trials, followed by cohort and other clinical trials, narrative reviews, and, where necessary, clinical opinion and anecdotal evidence. The data from the publication with the highest level of evidence based on our hierarchical classification was presented. Recommendations from an expert panel supplemented the evidence used to rank these drugs within their respective classes. Approximately 9500 articles were identified in our literature search of which 666 citations were retrieved. We were able to rank most of the psychotropics based on the available evidence and recommendations from subject matter experts. There were few discrepancies between published evidence and the expert panel in ranking these drugs. Conclusion Potential for weight gain is an important consideration in choice of any psychotropic. This tool will help clinicians select psychotropics on a case-by-case basis in order to minimize the impact of weight gain when making both intra-class and interclass choices. PMID:22719834

High Prevalence of Psychotropics Overdose among Suicide Attempters in Korea.

PubMed

Kim, Jinyoung; Kim, Minseob; Kim, Yoo-Ra; Choi, Kyoung Ho; Lee, Kyoung-Uk

2015-12-31

The availability of suicide methods affects the risk of suicide attempts. This study examined the patterns of substances ingested by suicide attempters (SAs) and the characteristics of SAs using psychotropic overdoses. Data for 384 of the 462 eligible SAs who used self-poisoning were analyzed. Demographic variables, clinical characteristics, and factors related to the suicide attempts were examined. There were 256 (66.7%) females and 128 (33.3%) males. Roughly half the SAs ingested psychotropics (n=179, 46.6%). Agricultural chemicals (n=84, 21.9%) were the second most frequently ingested substances, followed by analgesics (n=62, 16.1%), household products (n=27, 7.0%), and other prescribed medications (n=23, 6.0%). Among psychotropics, the most frequently overdosed drugs were sedative-hypnotics, including hypnotics (n=104) and benzodiazepines (n=78). SAs favored Z-drugs and alprazolam. When compared with SAs with non-psychotropic overdoses, significantly more SAs with psychotropic overdoses were female (76% vs. 58.5%, p<0.001) and had a psychiatric history (59.8% vs. 29.8%, p<0.001). They had significantly more previous suicide attempts (0.52±1.02 vs. 0.32±0.80, p<0.05) and lower risk (7.96±1.49 vs. 8.44±1.99, p<0.01) and medical severity (3.06±0.81 vs. 3.37±0.93, p<0.005) scores. Psychotropic overdose, especially with sedative-hypnotics, was a major method in suicide attempts. It is important that psychiatric patients are carefully evaluated and monitored for suicidality when prescribing psychotropics.

Psychotropics in different causes of itch: systematic review with controlled studies*

PubMed Central

Brasileiro, Lízie Emanuelle Eulalio; Barreto, Dayanna Patrícia de Carvalho; Nunes, Emerson Arcoverde

2016-01-01

Among the wide range of symptoms neglected or resistant to conventional treatments in clinical practice, itch is emerging gradually as a theme to be studied. Itch complaints and the negative effects in the quality of life are observed in several medical fields. Although the partially obscure pathophysiology, some researchers decided to check and test the use of psychotropic drugs in resistant itch to conventional topical treatments and antihistamines. The objective of this study was to evaluate scientific evidence in psychotropic use in the treatment of itch of various causes. This is a systematic review of scientific literature. The following databases were used: PubMed, Web of Science, Scopus and Scielo. Randomized controlled trials that should focus on treatment with psychotropic drugs of pruritus of various causes were the inclusion criteria. All articles were analyzed by the authors, and the consensus was reached in cases of disagreement. Fifteen articles were included after analysis and selection in databases, with the majority of clinical trials focusing on psychopharmacological treatment of itch on account of chronic kidney disease. Clinical trials with psychotropic drugs mostly indicated significant improvement in the itching. In most trials of chronic kidney disease as basal disease for itch, greater effectiveness was observed with the use of psychotropic drugs compared with placebo or other antipruritic. However, the small amount of controlled trials conducted precludes the generalization that psychiatric drugs are effective for itch of various causes. PMID:28099602

Pattern of psychotropic medication use over two decades in Australian women.

PubMed

Stuart, Amanda L; Mohebbi, Mohammadreza; Pasco, Julie A; Quirk, Shae E; Brennan-Olsen, Sharon L; Berk, Michael; Williams, Lana J

2017-12-01

Few population-based studies have been used to investigate secular trends in psychotropic medication use. Therefore, the aim of this study was to examine psychotropic medication use over time using data from the Geelong Osteoporosis Study, an on-going, population-based, cohort study of Australian women. Of the 1494 women recruited at Time 1 (1993-1997), self-reported medication use from Time 2 (2004-2008) and/or Time 3 (2011-2014) was available for 889 women. Prevalence of antidepressant/antipsychotic/anxiolytic/sedative/anticonvulsant use by age and cohort strata was calculated using bootstrapping methods. Simultaneous age-cohort patterns were evaluated using logistic regression techniques. The prevalence of any psychotropic medication use increased from 8.0% (95% confidence interval = [6.3, 9.8]) at Time 1 to 26.0% (95% confidence interval = [22.4, 29.4]) at Time 3, translating to a 4.3-fold increase in the likelihood of psychotropic medication use over the study period (odds ratio = 4.3, 95% confidence interval = [3.2, 5.8], p < 0.001). This increase was driven by the use of antidepressants (odds ratio = 6.4, 95% confidence interval = [4.2, 9.5], p < 0.001) and anticonvulsants (odds ratio = 4.4, 95% confidence interval = [1.8, 11.1]) and modest increases in the use of anxiolytic agents (odds ratio = 1.9, 95% confidence interval = [1.1, 3.1]) and sedatives (odds ratio = 1.7, 95% confidence interval = [1.6, 1.9]). The prevalence of any psychotropic medication use increased with increasing age (40-59.9 years: odds ratio = 1.9, 95% confidence interval = [1.5, 2.6]; 60-79.9 years: odds ratio = 2.6, 95% confidence interval = [1.9, 3.5], compared to the 20- to 39.9-year group). Use of selective serotonin reuptake inhibitors increased dramatically over the study period (odds ratio = 15.3, 95% confidence interval = [7.0, 33.4]). Use of psychotropic medication has increased substantially over the past two decades, especially among older women. Further investigations into the correlates and outcomes of the increased use of psychotropic medications are warranted.

Risks and benefits of psychotropic medication in pregnancy: cohort studies based on UK electronic primary care health records.

PubMed

Petersen, Irene; McCrea, Rachel L; Sammon, Cormac J; Osborn, David P J; Evans, Stephen J; Cowen, Phillip J; Freemantle, Nick; Nazareth, Irwin

2016-03-01

Although many women treated with psychotropic medication become pregnant, no psychotropic medication has been licensed for use in pregnancy. This leaves women and their health-care professionals in a treatment dilemma, as they need to balance the health of the woman with that of the unborn child. The aim of this project was to investigate the risks and benefits of psychotropic medication in women treated for psychosis who become pregnant. (1) To provide a descriptive account of psychotropic medication prescribed before pregnancy, during pregnancy and up to 15 months after delivery in UK primary care from 1995 to 2012; (2) to identify risk factors predictive of discontinuation and restarting of lithium (multiple manufacturers), anticonvulsant mood stabilisers and antipsychotic medication; (3) to examine the extent to which pregnancy is a determinant for discontinuation of psychotropic medication; (4) to examine prevalence of records suggestive of adverse mental health, deterioration or relapse 18 months before and during pregnancy, and up to 15 months after delivery; and (5) to estimate absolute and relative risks of adverse maternal and child outcomes of psychotropic treatment in pregnancy. Retrospective cohort studies. Primary care. Women treated for psychosis who became pregnant, and their children. Treatment with antipsychotics, lithium or anticonvulsant mood stabilisers. Discontinuation and restarting of treatment; worsening of mental health; acute pre-eclampsia/gestational hypertension; gestational diabetes; caesarean section; perinatal death; major congenital malformations; poor birth outcome (low birthweight, preterm birth, small for gestational age, low Apgar score); transient poor birth outcomes (tremor, agitation, breathing and muscle tone problems); and neurodevelopmental and behavioural disorders. Clinical Practice Research Datalink database and The Health Improvement Network primary care database. Prescribing of psychotropic medication was relatively constant before pregnancy, decreased sharply in early pregnancy and peaked after delivery. Antipsychotic and anticonvulsant treatment increased over the study period. The recording of markers of worsening mental health peaked after delivery. Pregnancy was a strong determinant for discontinuation of psychotropic medication. However, between 40% and 76% of women who discontinued psychotropic medication before or in early pregnancy restarted treatment by 15 months after delivery. The risk of major congenital malformations, and neurodevelopmental and behavioural outcomes in valproate (multiple manufacturers) users was twice that in users of other anticonvulsants. The risks of adverse maternal and child outcomes in women who continued antipsychotic use in pregnancy were not greater than in those who discontinued treatment before pregnancy. A few women would have received parts of their care outside primary care, which may not be captured in this analysis. Likewise, the analyses were based on prescribing data, which may differ from usage. Psychotropic medication is prescribed before, during and after pregnancy. Many women discontinue treatment before or during early pregnancy and then restart again in late pregnancy or after delivery. Our results support previous associations between valproate and adverse child outcomes but we found no evidence of such an association for antipsychotics. Future research should focus on (1) curtailing the use of sodium valproate; (2) estimating the benefits of psychotropic drug use in pregnancy; and (3) investigating the risks associated with lifestyle choices that are more prevalent among women using psychotropic drugs. The National Institute for Health Research Health Technology Assessment programme.

Psychotropic Medication Use during Inpatient Rehabilitation for Traumatic Brain Injury

PubMed Central

Hammond, Flora M.; Barrett, Ryan S.; Shea, Timothy; Seel, Ronald T.; McAlister, Thomas W.; Kaelin, Darryl; Ryser, David; Corrigan, John D.; Cullen, Nora; Horn, Susan D.

2015-01-01

Objective To describe psychotropic medication administration patterns during inpatient rehabilitation for traumatic brain injury (TBI) and their relationship to patient pre-injury and injury characteristics. Design Prospective observational cohort. Setting multiple acute inpatient rehabilitation units or hospitals. Participants 2,130 individuals with TBI (complicated mild, moderate, or severe) admitted for inpatient rehabilitation. Interventions NA Main Outcome Measure(s) NA Results Most frequently administered was narcotic analgesics (72% of sample) followed by antidepressants (67%), anticonvulsants (47%), antianxiolytics (33%), hypnotics (30%), stimulants (28%), antipsychotics (25%), antiparkinson agents (25%), and miscellaneous psychotropics (18%). The psychotropic agents studied were administered to 95% of the sample with 8.5% receiving only 1 and 31.8% receiving 6 or more. Degree of psychotropic medication administration varied widely between sites. Univariate analyses indicated younger patients were more likely to receive anxiolytics, antidepressants, antiparkinson agents, stimulants, antipsychotics, and narcotic analgesics, while those older were more likely to receive anticonvulsants and miscellaneous psychotropics. Men were more likely to receive antipsychotics. All medication classes were less likely administered to Asians, and more likely to those with more severe functional impairment. Use of anticonvulsants was associated with having seizures at some point during acute care or rehabilitation stays. Narcotic analgesics were more likely for those with history of drug abuse, history of anxiety and depression (premorbid or during acute care), and severe pain during rehabilitation. Psychotropic medication administration increased rather than decreased during the course of inpatient rehabilitation in each of the medication categories except for narcotics. This observation was also true for medication administration within admission functional levels (defined by cognitive Functional Independence Measure (FIM) scores), except for those with higher admission cognitive FIM scores. Conclusion(s) Many psychotropic medications are used during inpatient rehabilitation. In general, lower admission FIM Cognitive groups were administered more of the medications under investigation, compared to those with higher cognitive function at admission. Considerable site variation existed regarding medications administered. The current investigation provides baseline data for future studies of effectiveness. PMID:26212402

Psychotropic medication use among patients with celiac disease.

PubMed

Zylberberg, Haley M; Ludvigsson, Jonas F; Green, Peter H R; Lebwohl, Benjamin

2018-03-27

Celiac disease is a multi-system disorder with manifestations that may result in psychiatric disorders. We assessed the prevalence of medication use to treat psychiatric disorders in celiac disease patients. We conducted a cross-sectional study of patients undergoing esophagogastroduodenoscopy over 9-years at a celiac disease referral center. We compared the prevalence of psychotropic medication use among celiac disease patients (n = 1293) to a control group (n = 1401) with abdominal pain or reflux. Among all patients the mean age was 48.4 years, most were female (69.5%), and 22.7% used any psychotropic medication. There was no difference between overall psychotropic medication use among celiac disease patients and controls (23.9% vs 21.8%, OR 1.16; 95% CI 0.96-1.39, p = 0.12). However, those with celiac disease were more likely to use antidepressants on univariate (16.4% vs 13.4%, p = 0.03) and multivariate analysis (OR 1.28; 95% CI 1.03-1.59; p = 0.03). Use of psychotropic medications was not associated with disease duration or mode of presentation of celiac disease. Celiac disease patients use psychotropic medications at similar rates as those with other gastrointestinal diseases, though subgroup analysis suggests they may use more antidepressants. Future studies should investigate whether celiac disease is associated with mood disorders that are not treated with medications.

A narrative review of studies of refusal of psychotropic medication in acute inpatient psychiatric care.

PubMed

Owiti, J A; Bowers, L

2011-09-01

This paper offers a narrative review of the 22 studies of medication refusal in acute psychiatry. Because of varied definitions of medication refusal, diverse methodologies and few rigorous studies, it has not been possible to draw firm conclusions on the average rate of refusal of psychotropic medications in acute psychiatry. However, it is clear that medication refusal is common and leads to poor outcomes characterized by higher rates of seclusion, restraint, threats of, and actual, assaults and longer hospitalizations. There are no statistically significant differences between refusers and acceptors in gender, marital status and preadmission living arrangements. Although no firm conclusions on the influence of ethnicity, status at admission and diagnosis on refusal, the refusers are more likely to have higher number of previous hospitalizations and history of prior refusal. The review indicates that staff factors such as the use of temporary staff, lack of confidence in ward staff and ineffective ward structure are associated with higher rates of medication refusal. Comprehensive knowledge of why, and how, patients refuse medication is lacking. Research on medication refusal is still fragmented, of variable methodological quality and lacks an integrating model. © 2011 Blackwell Publishing.

Psychotropic polypharmacy in Australia, 2006 to 2015: a descriptive cohort study.

PubMed

Brett, Jonathan; Daniels, Benjamin; Karanges, Emily A; Buckley, Nicholas A; Schneider, Carl; Nassir, Atheer; McLachlan, Andrew J; Pearson, Sallie-Anne

2017-11-01

To describe psychotropic polypharmacy in Australia between 2006 and 2015. We used pharmaceutical claims from a national 10% sample of people with complete dispensing histories to estimate the annual prevalence of the combined use (overlap of >60 days exposure) of ≥2 psychotropics overall and within the same class or subclass (class and subclass polypharmacy). We also estimated the proportion of polypharmacy episodes involving one, two, three and four or more unique prescribers. The prevalence of class polypharmacy between 2006 and 2015 in people dispensed specific psychotropic classes was 5.9-7.3% for antipsychotics, 2.1-3.7% for antidepressants and 4.3-2.9% for benzodiazepines. The prevalence of antipsychotic polypharmacy was higher than expected given the prevalence of antipsychotic exposure and combinations of sedating agents were notably common. Overall, 26.7% of polypharmacy episodes involved multiple prescribers but having multiple prescribers occurred more frequently for class and subclass polypharmacy and people with four or more concomitant psychotropics. Psychotropic polypharmacy is common, despite limited evidence of risks and benefits. Increases in polypharmacy with multiple prescribers may be due to poor communication with patients and between health care professionals. © 2017 The British Pharmacological Society.

Managing psychotropic drug costs: will formularies work?

PubMed

Huskamp, Haiden A

2003-01-01

Payers of pharmaceutical benefits are increasingly turning to drug formularies in an attempt to control rising pharmacy costs, including those for psychotropic drugs. In this paper I examine several issues that policymakers should consider when addressing formulary design for psychotropic drugs: heterogeneity within mental health disorders and limited information about treatment effectiveness for individual patients; the potential for plans to try to use formularies to avoid adverse selection and implications for psychotropic coverage; the interaction of Medicaid formulary policy and manufacturers' incentives for psychotropic innovation; and incentives created by mental health institutions that decrease formularies' potential effectiveness in controlling psychotropic drug costs.

Lactating Mother and Psychotropic Drugs

PubMed Central

Tripathi, B. M.; Majumder, Pradipta

2010-01-01

Usage of psychotropics during pregnancy and lactation has always been a topic of debate and controversy. The debate stems from the potential adverse effects on the growing fetus or infants due to the transfer of psychotropic drugs through placenta or breast milk of mothers receiving them; and the problem of discontinuing psychotropics in lactating mother considering chances of relapse. However, most of the psychotropics are found to be relatively safe when used cautiously during the lactation phase. This article describes available data on the use of psychotropics in lactating mothers, in particular, in relation to the safety profile of infants. PMID:21327172

Differences in psychotropic drug prescriptions among ethnic groups in the Netherlands.

PubMed

Wittkampf, Laura Christina; Smeets, Hugo M; Knol, Mirjam J; Geerlings, Mirjam I; Braam, Arjan W; De Wit, Niek J

2010-08-01

Psychotropic drug use in Europe and the USA has increased in the past 20 years. The rise in mental health-care use instigated a debate about possible differences in prevalence rates between different ethnic groups in the Netherlands, although the exact differences were unknown. The aim of this study was to determine whether these minority groups were more or less likely than the native population to receive psychotropic drugs. A descriptive population study was conducted using the Agis Health Database, containing demographic and health-care consumption data of approximately 1.5 million inhabitants of the Netherlands. Rates of prescriptions of psychotropic drugs from 2001 to 2006 and adjusted odds ratios for psychotropic drug prescriptions among native Dutch, Turkish and Moroccan ethnic groups were calculated. These data were analysed using logistic regression, after being adjusted for age, gender and socioeconomic status. The mean year prevalence of psychotropic drug prescriptions from 2001 to 2006 was 14.0%. Except for a decrease in anxiolytic drugs, the prescriptions of psychotropic drugs increased from 2001 to 2006. These trends were the same for all of the ethnic groups considered. Among both the Moroccan and Turkish populations, there was a higher risk of antidepressant and antipsychotic drug prescriptions, and a pronounced lower risk of ADHD medication and lithium prescriptions compared to the native population. Among the Turkish population, the risk of anxiolytic drug prescriptions was greater than in the native population. Compared to the native population in the Netherlands, first- and second-generation Turkish and Moroccan immigrants had an increased risk of antidepressant and antipsychotic drug prescriptions and a decreased risk of ADHD medication and Lithium prescriptions. Further research is needed to clarify whether patients of different ethnic backgrounds with the same symptoms receive similar diagnosis and adequate treatment.

Medicare Part D Benzodiazepine Exclusion and Use of Psychotropic Medication by Patients With New Anxiety Disorders

PubMed Central

Ong, Michael K.; Zhang, Lily; Xu, Haiyong; Azocar, Francisca; Ettner, Susan L.

2015-01-01

Objective The Medicare Modernization Act (MMA) specifically excluded benzodiazepines from Medicare Part D coverage starting in 2006; however, benzodiazepines are an effective, low-cost treatment for anxiety. This study evaluated the effect of the Medicare Part D benzodiazepine coverage exclusion among patients with new anxiety disorders. Methods The authors used a quasi-experimental cohort design to study patients with new anxiety diagnoses from a large national health plan during the first six months of 2005, 2006, and 2007. Logistic and zero-truncated negative-binomial regression models using covered claims for behavioral, medical, and pharmaceutical care linked with eligibility files were used to estimate utilization and costs of psychotropic medication and health care utilization among elderly Medicare Advantage enrollees (N=8,397) subject to the MMA benzodiazepine exclusion and a comparison group of near-elderly (ages 60–64) enrollees (N=1,657) of a managed care plan. Results Medicare Advantage enrollees diagnosed in 2005 had significantly (p<.05) higher rates of covered claims for benzodiazepines and all psychotropic drugs, lower rates of covered claims for nonbenzodiazepines, and lower expenditures for psychotropic drugs than enrollees diagnosed in 2006 and 2007. There were no significant differences over time in utilization or expenditures related to psychotropic medication among the comparison group. There also were no significant changes over time in outpatient visits for behavioral care by either cohort. Conclusions Among elderly patients with new anxiety diagnoses, the MMA benzodiazepine exclusion increased use of nonbenzodiazepine psychotropic drugs without substitution of increased behavioral care. Overall, the exclusion was associated with a modest increase in covered claims for psychotropic medication. PMID:22549332

Psychotropic medications for highly vulnerable children.

PubMed

McLaren, Jennifer L; Barnett, Erin R; Concepcion Zayas, Milangel T; Lichtenstein, Jonathan; Acquilano, Stephanie C; Schwartz, Lisa M; Woloshin, Steven; Drake, Robert E

2018-04-01

At least 20% of children in the U.S. are highly vulnerable because they lack healthcare and protection. Several factors produce vulnerability: trauma, disruptions of parenting, poverty, involvement in the juvenile justice and/or child welfare systems, residence in restrictive settings, and problems related to developmental disabilities. These children receive psychotropic medications at high rates, raising numerous concerns. Areas covered: The authors begin this review with a description of the population of highly vulnerable children. They then follow this with a review of the effectiveness and side effects of psychotropic medications for their most common diagnoses, using the highest-quality systematic reviews identified by multiple database searches. Expert opinion: Highly vulnerable children receive numerous psychotropic medications with high rates of polypharmacy, off-label use, and long-term use, typically in the absence of adjunctive psychosocial interventions. The current evidence contravenes these trends. Future studies of psychotropic medications in vulnerable children should include long-term effectiveness trials and polypharmacy in conjunction with evidence-based, family-centered, psychosocial treatments.

Staff and patient perspectives on the purpose of psychotropic prescribing in prisons: care or control?

PubMed

Hassan, Lamiece; Edge, Dawn; Senior, Jane; Shaw, Jenny

2013-01-01

The objective was to explore perspectives on reasons for psychotropic medication use in prisons. We recruited a purposive sample of healthcare staff and patients prescribed psychotropic medicines from four East of England prisons. Participants took part in qualitative, semistructured interviews, which were recorded, transcribed and analyzed thematically. While patients and healthcare staff viewed psychotropic medicines primarily as a treatment for reducing symptoms of mental illness, they were also used as a coping strategy and to reduce insomnia. Appropriate psychotropic prescribing was also thought to contribute towards the rehabilitation agenda and helped to maintain order in prisons. Staff voiced concerns regarding possible overreliance on psychotropic medicines. However, patients perceived insufficient access to alternative, nonpharmacological forms of treatment and support in prison. Psychotropic medicines are used for multiple purposes in prisons and are generally considered a useful resource. Nonetheless, further work may be needed to find the right balance between psychotropic medicines and alternative, nonpharmacological therapies. Copyright © 2013 Elsevier Inc. All rights reserved.

[Retrospective study of clozapine use in Ile-de-France].

PubMed

Hiltgen, S; Mantelet, S; Pinabel, F; Enjaume, F

2006-10-01

Clozapine, synthesized in the sixties, is an atypical antipsychotic drug whose history has been marked by its haematological toxicity. The purpose of this study was, ten years after it had been replaced at French psychiatrists' disposal, to gather data on the prescription modalities of clozapine, assess whether some factors could affect its efficacy, and describe the population of schizophrenic patients concerned. Psychiatrists in the Paris region were asked to answer a questionnaire about their patients treated with clozapine. The information collected was about socio-demographic data, history of psychiatric disorder and the way clozapine was used. It was a retrospective study concerning 98 patients. Subjects were 57 men and 41 women, with a mean age of 38 years. The majority of patients came from metropolitan France. Patients suffered from various clinical subtypes of schizophrenia, as assessed according to DSM IV criteria. Predominant symptomatology during lifetime was most often auditory hallucinations (41%). Mean duration of lifetime neuroleptic treatment was 10.3 years and breaks in follow-up were rare. Mean number of hospitalisations was 6.9 and a little less than half of the patients had been committed involuntarily. Lastly, 38% of patients had attempted suicide at least once and 35% had expressed hetero-agressive behavior. Main indication of clozapine was resistant schizophrenia (88.5% of patients) and mean duration of treatment was 2 years and 4 months. Treatment efficacy was assessed as good or medium in 77.9% of patients, at mean doses (322 mg per day) in keeping with data from the literature. Tolerance was considered on the whole as satisfactory by half of the clinicians. Among the 98 patients of the study, 21.6% had stopped taking clozapine. The reasons for withdrawal were: inefficacy (6.2%), granulopenia (5.2%), epilepsy (1%) and 8.2% for various reasons (half of these cases being non-compliance with treatment). The study of the 5 cases of granulopenia showed that 3 patients had another associated psychotropic medication: 1 patient received only clozapine as monotherapy, 1 data was missing. Two thirds of all patients were receiving another psychotropic drug in association with clozapine, mainly benzodiazepines (18.4%), antidepressants (15.3%) or mood stabilizers (7.1%). The "therapeutic efficacy" variable was compared with some variables in order to isolate factors possibly associated with a better efficacy of clozapine or, on the contrary, with a population of patients poorly responding to treatment. However, no statistically significant difference appeared according to the variables studied, such as gender or lifetime duration of neuroleptic treatment. Moreover, there was no statistically significant difference in efficacy according to schizophrenia subtype, main symptomatology during the course of illness or substance abuse. We studied whether any factor could affect the occurrence of granulopenia. No statistically significant difference was found. The mean age of patients having stopped the treatment because of granulopenia was higher than in the group with other reasons for interruption, but did not reach statistical significance. A trend also appeared towards female predominance (60% of women in the granulopenia group) and 3/4 of patients who had stopped their treatment because of agranulocytosis received another psychotropic drug in association with clozapine. As expected, the main indication for prescribing clozapine was resistant schizophrenia, but contrary to data from the international literature, the efficacy profile was the same whatever the clinical subtype of schizophrenia. The tolerance to clozapine was considered on the whole as satisfactory, but the high proportion of granulopenias leading to treatment withdrawal (5.2% of patients) confirms the need to remain cautious and stresses the importance of regular haematological monitoring. Furthermore, the study of the prescription modalities of clozapine shows that contrary to the guidelines, clozapine is often associated with other psychotropic drugs. In this study, it is striking to note that 75% of granulopenias occurred in a coprescription situation.

Prevalence of Psychotropic Medication Use Among Dutch Military Personnel Between 2003 and 2012 and Its Comparison to the Dutch General Population.

PubMed

Janssen, Debbie G A; Vermetten, Eric; Egberts, Toine C G; Heerdink, Eibert R

2017-01-01

The armed forces work under high pressure and in stressful environments and it is well known that being in the military is a risk factor for psychiatric problems. However, it remains unknown how prevalent psychotropic medication use is in military personnel. To assess prevalence of psychotropic medication use in Dutch military personnel and compare to the Dutch general population. Data were obtained from the military pharmacy. From 2003 to 2012, the year-prevalence of psychotropic medication use was calculated from the number of distributed psychotropic medications and the number of Dutch military personnel. For the year 2011, the year-prevalence of psychotropic medication use in the military was compared to that of the Dutch general population. The year-prevalence of psychotropic medication use increased by 55%, from 1.64% in 2003 to 2.54% in 2012 in Dutch military personnel. An increase is seen in the number of users of psychotropic medication. Also the use of antidepressants and attention deficit hyperactivity disorder medication increased. Over the last decade, there has been a 1.5-fold increase in psychotropic medication dispensed to Dutch military personnel. However, Dutch military personnel were significantly less likely to use psychotropic medications compared to the Dutch general population. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.

Non-psychotropic medication and risk of suicide or attempted suicide: a systematic review

PubMed Central

Gorton, Hayley C; Webb, Roger T; Kapur, Navneet; Ashcroft, Darren M

2016-01-01

Objectives To establish which non-psychotropic medications have been assessed in relation to risk of suicide or attempted suicide in observational studies, document reported associations and consider study strengths and limitations. Design Systematic review. Methods Four databases (Embase, Medline, PsycINFO and International Pharmaceutical Abstracts) were searched from 1990 to June 2014, and reference lists of included articles were hand-searched. Case–control, cohort and case only studies which reported suicide or attempted suicide in association with any non-psychotropic medication were included. Outcome measures The outcomes eligible for inclusion were suicide and attempted suicide, as defined by the authors of the included study. Results Of 11 792 retrieved articles, 19 were eligible for inclusion. Five studies considered cardiovascular medication and antiepileptics; two considered leukotriene receptor antagonists, isotretinoin and corticosteroids; one assessed antibiotics and another assessed varenicline. An additional study compared multiple medications prescribed to suicide cases versus controls. There was marked heterogeneity in study design, outcome and exposure classification, and control for confounding factors; particularly comorbid mental and physical illness. No increased risk was associated with cardiovascular medications, but associations with other medications remained inconclusive and meta-analysis was inappropriate due to study heterogeneity. Conclusions Whether non-psychotropic medications are associated with increased risk of suicide or attempted suicide remains largely unknown. Robust identification of suicide outcomes and control of comorbidities could improve quantification of risk associated with non-psychotropic medication, beyond that conferred by underlying physical and mental illnesses. PMID:26769782

A current review of cytochrome P450 interactions of psychotropic drugs.

PubMed

Madhusoodanan, Subramoniam; Velama, Umamaheswararao; Parmar, Jeniel; Goia, Diana; Brenner, Ronald

2014-05-01

The number of psychotropic drugs has expanded tremendously over the past few decades with a proportional increase in drug-drug interactions. The majority of psychotropic agents are biotransformed by hepatic enzymes, which can lead to significant drug-drug interactions. Most drug-drug interactions of psychotropics occur at metabolic level involving the hepatic cytochrome P450 enzyme system. We searched the National Library of Medicine, PsycINFO, and Cochrane reviews from 1981 to 2012 for original studies including clinical trials, double-blind, placebo-controlled studies, and randomized controlled trials. In addition, case reports, books, review articles, and hand-selected journals were utilized to supplement this review. Based on the clinical intensity of outcome, cytochrome interactions can be classified as severe, moderate, and mild. Severe interactions include effects that might be acutely life threatening. They are mainly inhibitory interactions with cardiovascular drugs. Moderate interactions include efficacy issues. Mild interactions include nonserious side effects, such as somnolence. Psychotropic drugs may interact with other prescribed medications used to treat concomitant medical illnesses. A thorough understanding of the most prescribed medications and patient education will help reduce the likelihood of potentially fatal drug-drug interactions.

The risk of falls and fractures associated with persistent use of psychotropic medications in elderly people.

PubMed

Vitry, Agnes I; Hoile, Annabel P; Gilbert, Andrew L; Esterman, Adrian; Luszcz, Mary A

2010-01-01

The aim of this study was to examine the effect of psychotropic medications (antipsychotics, antidepressants, anxiolytics, hypnotics and sedatives) on the risk of falls and fractures in a cohort of elderly people in South Australia. A retrospective cohort study was undertaken using the wave 1 (1992) and wave 3 (1994) data of the Australian Longitudinal Study of Ageing (ALSA). Persistent use of psychotropic medicines was defined as use of one or more psychotropic medications at both wave 1 and wave 3. A comprehensive list of potential confounding variables was individually entered into regression models to examine effects on risk ratios. The results showed that the use of psychotropic medications was associated with an increased risk of falls in females (IRR=1.47, 95% CI=1.31-1.64) but not in males (IRR=1.03, 95% CI=0.85-1.26). The use of psychotropic medications was also associated with an increased risk of a fracture in females (RR 2.54; CI 1.57-4.11; p<0.0001) but not in males (RR=0.66; p=0.584; CI 0.15-2.86). In both analyses, the body mass index (BMI) was determined to be the only confounding variable. After adjusting for BMI, the IRR in females decreased to 1.22 (95% CI 1.02-1.45; p<0.015) for falls and the RR decreased to 1.92 (p<0.015, CI 1.13-3.24) for fractures. Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.

The prevalence of alcohol and psychotropic drugs in fatalities of road-traffic accidents in Jordan during 2008-2014.

PubMed

Al-Abdallat, Imad M; Al Ali, Rayyan; Hudaib, Arwa A; Salameh, Ghada A M; Salameh, Rakiz J M; Idhair, Ahmed K F

2016-04-01

Several studies confirmed alcohol and psychotropic drug consumption as important risk factors underlying fatal accidents. This paper presents updated toxicological findings in the fatalities of road traffic accidents of Amman district, in order to have an overall picture of the occurrence of these substances in these victims in Jordan. Over a seven-year period (2008-2014), 2743, autopsies were conducted at Jordan University Hospital in which the sum of n = 311 (11.38%) were victims of road traffic accidents. Blood samples from these victims were collected. Toxicology screening for psychotropic drugs and alcohol was conducted on these samples, and the results were analyzed according to age, sex and victim's status. This study revealed that Alcohol and psychotropic drugs were positive in 36.5%, (n = 58) of the cases, and for alcohol alone (n = 13, 37.1%). The majority of the victims were pedestrians (n = 155, 49.8%). Additionally, 29.6% (n = 92) of the cases were of ages 19-29. Detected psychotropic drugs were benzodiazepines, barbiturates. None of the collected specimens were positive for illicit cocaine, amphetamines or cannabis. The results from this study proved the existence of alcohol and psychotropic drugs in the victims of road traffic accidents; Indicating an association between the uses of these substances in accident involvement. Though having some limitations, other conclusions require further data collection, cooperation with related parties in Jordan, and utilizing simple extended toxicological screens. Copyright © 2016 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

Use of psychotropic drugs before pregnancy and the risk for induced abortion: population-based register-data from Finland 1996-2006.

PubMed

Gissler, Mika; Artama, Miia; Ritvanen, Annukka; Wahlbeck, Kristian

2010-06-30

Some, though not all studies have reported an increased risk for mental health problems after an induced abortion. Problems with design and data have compromised these studies and the generalisation of their results. The Finnish Medication and Pregnancy database (N = 622 671 births and 114 518 induced abortions for other than fetal reasons) in 1996-2006 was utilised to study the use of psychotropic drugs in the three months before a pregnancy ending in a birth or an induced abortion. In total 2.1% of women with a birth and 5.1% of women with an induced abortion had used a psychotropic medicine 0-3 months before pregnancy. Psychotropic drug users terminated their pregnancies (30.9%) more often than other pregnant women (15.5%). Adjustment for background characteristics explained one third of this elevated risk, but the risk remained significantly increased among users of psychotropic medicine (OR 1.94, 95% confidence intervals 1.87-2.02). A similar risk was found for first pregnancies (30.1% vs. 18.9%; adjusted OR 1.53, 95% confidence intervals 1.42-1.65). The rate for terminating pregnancy was the highest for women using hypnotics and sedatives (35.6% for all pregnancies and 29.1% for first pregnancies), followed by antipsychotics (33.9% and 36.0%) and antidepressants (32.0% and 32.1%). The observed increased risk for induced abortion among women with psychotropic medication highlights the importance to acknowledge the mental health needs of women seeking an induced abortion. Further studies are needed to establish the impact of pre-existing differences in mental health on mental health outcomes of induced abortions compared to outcomes of pregnancies ending in a birth.

Use of psychotropic drugs before pregnancy and the risk for induced abortion: population-based register-data from Finland 1996-2006

PubMed Central

2010-01-01

Background Some, though not all studies have reported an increased risk for mental health problems after an induced abortion. Problems with design and data have compromised these studies and the generalisation of their results. Methods The Finnish Medication and Pregnancy database (N = 622 671 births and 114 518 induced abortions for other than fetal reasons) in 1996-2006 was utilised to study the use of psychotropic drugs in the three months before a pregnancy ending in a birth or an induced abortion. Results In total 2.1% of women with a birth and 5.1% of women with an induced abortion had used a psychotropic medicine 0-3 months before pregnancy. Psychotropic drug users terminated their pregnancies (30.9%) more often than other pregnant women (15.5%). Adjustment for background characteristics explained one third of this elevated risk, but the risk remained significantly increased among users of psychotropic medicine (OR 1.94, 95% confidence intervals 1.87-2.02). A similar risk was found for first pregnancies (30.1% vs. 18.9%; adjusted OR 1.53, 95% confidence intervals 1.42-1.65). The rate for terminating pregnancy was the highest for women using hypnotics and sedatives (35.6% for all pregnancies and 29.1% for first pregnancies), followed by antipsychotics (33.9% and 36.0%) and antidepressants (32.0% and 32.1%). Conclusions The observed increased risk for induced abortion among women with psychotropic medication highlighs the importance to acknowledge the mental health needs of women seeking an induced abortion. Further studies are needed to establish the impact of pre-existing differences in mental health on mental health outcomes of induced abortions compared to outcomes of pregnancies ending in a birth. PMID:20591182

Clinical characteristics of patients who overdose on multiple psychotropic drugs in Tokyo.

PubMed

Hori, Satoshi; Kinoshita, Kosaku

2016-01-01

The purpose of this study was to identify the clinical aspects leading to overdose of multiple psychotropic drugs, in order to determine areas which need attention in the proper treatment of overdose patients. Patients who were treated for overdose of psychotropic drugs at our emergency and critical center over two years were targeted. The clinical data was gathered from the medical records and database of all patients, including age, gender, vital signs, and laboratory data, drugs, and medical complications during hospital stay. In addition primary patient care at the emergency department was examined. Among the 277 patients treated during this study period, 255 (74.0%) used two or more types of psychotropic drugs. Risk factors associated with endotracheal intubation and aspiration pneumonitis included the use of antipsychotics and/or barbiturates as types of overdose drugs. The mean number of days in the ICU was 3.4 days. Seventy-four patients (26.7%) stayed 4 days or more in the ICU of which 16 patients (5.8%) still had suicidal thoughts. A significantly higher incidence of extended ICU stay or endotracheal intubation and aspiration pneumonitis was observed in the group who overdosed on more than 50 or 60 tablets of psychotropic drugs, respectively. Patients who ingested an overdose of more than 60 tablets of psychotropic drugs should be considered a high-risk group requiring intensive care with extended ICU stay. In case of including antipsychotics and/or barbiturates, the patient should be observed carefully due to a higher risk of medical complications.

Shortage of psychotropic medications in community pharmacies in Saudi Arabia: Causes and solutions.

PubMed

Al-Ruthia, Yazed Sulaiman; Mansy, Wael; Barasin, Mohammad; Ghawaa, Yazeed Mohammad; AlSultan, Mohammed; Alsenaidy, Mohammad A; Alhawas, Solaiman; AlGhadeer, Sultan

2017-07-01

Background: Patients with mental disorders, such as depression and anxiety, who seek medical care in private psychiatric clinics in Riyadh, Saudi Arabia, have recently expressed concerns to doctors about difficulty in filling psychotropic medications, such as Amitriptyline and Aripiprazole, at retail community pharmacies. Objectives: The aim of this study was to investigate whether there is a shortage of some commonly prescribed psychotropic medications in retail community pharmacies in Saudi Arabia, and if so, to explore the possible reasons behind the shortage of these medications. Methods: The availability of 28 commonly prescribed psychotropic medications was checked in multiple retail community pharmacies in 4 different regions of Saudi Arabia. Further, potential reasons behind the shortage of some psychotropic medications in retail community pharmacies were also explored. Results: Amitriptyline, Amoxapine, Aripiprazole, Bupropion, Buspirone, Duloxetine, Haloperidol, Hydroxyzine, Lithium, Prochlorperazine, Procyclidine, Promethazine, Thioridazine, Trazodone, and Trifluoperazine were unavailable in over half of the 248 community pharmacies surveyed. Four possible reasons behind the shortage of these medications were reported by 31 pharmacists working in different retail community pharmacies' purchasing departments, with a majority (58.06%) reporting the primary reason for a shortage of these medications that they are slow-moving items with low profit margins. Conclusions: The findings of this study should expedite the reform process in both the Ministry of Health and the Saudi Food and Drug Authority (SFDA) to publish and enforce an essential list of medications for retail community pharmacies, which should include the most commonly prescribed psychotropic medications.

Questioning the causal link between maternal smoking during pregnancy and offspring use of psychotropic medication: a sibling design analysis.

PubMed

Söderström, Lovisa; Perez-Vicente, Raquel; Juárez, Sol; Merlo, Juan

2013-01-01

A recent population-based, longitudinal study from Finland observed a dose-response association between smoking during pregnancy (SDP) and use of psychotropic medications in exposed children and young adults. However, this association may be confounded by unmeasured familial characteristics related to both SDP and offspring mental health. Consequently, we aim to investigate the effect of SDP by means of a sibling design that to some extent allows controlling for unknown environmental and genetic confounders. Using the Swedish Medical Birth Register (1987-1993), which was linked to the Swedish Prescribed Drugs Register (July 2005-December 2008), we investigated 579,543 children and among them 39, 007 were discordant for use of psychotropic medication and 4,021 siblings discordant for both use of psychotropic medication and for smoking exposure. Replicating the Finnish study using traditional logistic regression methods we found an association between exposure to ≥10 cigarettes per day during pregnancy and psychotropic drug use (odds ratio = 1.61, 95% confidence interval 1.56, 1.66). Similar in size to the association reported from Finland (odds ratio = 1.63; 95% confidence interval 1.53, 1.74). However, in the adjusted sibling analysis using conditional logistic regression, the association was considerably reduced (odds ratio 1.22; 95% confidence interval 1.08, 1.38). Preventing smoking is of major public health importance. However, SDP per se appears to have less influence on offspring psychotropic drug use than previously suggested.

Deprescribing psychotropic medications in aged care facilities: the potential role of family members.

PubMed

Plakiotis, Christos; Bell, J Simon; Jeon, Yun-Hee; Pond, Dimity; O'Connor, Daniel W

2015-01-01

There is widespread concern in Australia and internationally at the high prevalence of psychotropic medication use in residential aged care facilities. It is difficult for nurses and general practitioners in aged care facilities to cease new residents' psychotropic medications when they often have no information about why residents were started on the treatment, when and by whom and with what result. Most existing interventions have had a limited and temporary effect and there is a need to test different strategies to overcome the structural and practical barriers to psychotropic medication cessation or deprescribing. In this chapter, we review the literature regarding psychotropic medication deprescribing in aged care facilities and present the protocol of a novel study that will examine the potential role of family members in facilitating deprescribing. This project will help determine if family members can contribute information that will prove useful to clinicians and thereby overcome one of the barriers to deprescribing medications whose harmful effects often outweigh their benefits. We wish to understand the knowledge and attitudes of family members regarding the prescribing and deprescribing of psychotropic medications to newly admitted residents of aged care facilities with a view to developing and testing a range of clinical interventions that will result in better, safer prescribing practices.

Mental illness, challenging behaviour, and psychotropic drug prescribing in people with intellectual disability: UK population based cohort study

PubMed Central

Hassiotis, Angela; Walters, Kate; Osborn, David; Strydom, André; Horsfall, Laura

2015-01-01

Objectives To describe the incidence of recorded mental illness and challenging behaviour in people with intellectual disability in UK primary care and to explore the prescription of psychotropic drugs in this group. Design Cohort study. Setting 571 general practices contributing data to The Health Improvement Network clinical database. Participants 33 016 adults (58% male) with intellectual disability who contributed 211 793 person years’ data. Main outcome measures Existing and new records of mental illness, challenging behaviour, and psychotropic drug prescription. Results 21% (7065) of the cohort had a record of mental illness at study entry, 25% (8300) had a record of challenging behaviour, and 49% (16 242) had a record of prescription of psychotropic drugs. During follow-up, the rate of new cases of mental illness in people without a history at cohort entry was 262 (95% confidence interval 254 to 271) per 10 000 person years and the rate of challenging behaviour was 239 (231 to 247) per 10 000 person years. The rate of new psychotropic drug prescription in those without a previous history of psychotropic drug treatment was 518 (503 to 533) per 10 000 person years. Rates of new recording of severe mental illness declined by 5% (95% confidence interval 3% to 7%) per year (P<0.001), and new prescriptions of antipsychotics declined by 4% (3% to 5%) per year P<0.001) between 1999 and 2013. New prescriptions of mood stabilisers also decreased significantly. The rate of new antipsychotic prescribing was significantly higher in people with challenging behaviour (incidence rate ratio 2.08, 95% confidence interval 1.90 to 2.27; P<0.001), autism (1.79, 1.56 to 2.04; P<0.001), and dementia (1.42, 1.12 to 1.81; P<0.003) and in those of older age, after control for other sociodemographic factors and comorbidity. Conclusions The proportion of people with intellectual disability who have been treated with psychotropic drugs far exceeds the proportion with recorded mental illness. Antipsychotics are often prescribed to people without recorded severe mental illness but who have a record of challenging behaviour. The findings suggest that changes are needed in the prescribing of psychotropics for people with intellectual disability. More evidence is needed of the efficacy and safety of psychotropic drugs in this group, particularly when they are used for challenging behaviour. PMID:26330451

The effects of Psychotropic drugs On Developing brain (ePOD) study: methods and design.

PubMed

Bottelier, Marco A; Schouw, Marieke L J; Klomp, Anne; Tamminga, Hyke G H; Schrantee, Anouk G M; Bouziane, Cheima; de Ruiter, Michiel B; Boer, Frits; Ruhé, Henricus G; Denys, Damiaan; Rijsman, Roselyne; Lindauer, Ramon J L; Reitsma, Hans B; Geurts, Hilde M; Reneman, Liesbeth

2014-02-19

Animal studies have shown that methylphenidate (MPH) and fluoxetine (FLX) have different effects on dopaminergic and serotonergic system in the developing brain compared to the developed brain. The effects of Psychotropic drugs On the Developing brain (ePOD) study is a combination of different approaches to determine whether there are related findings in humans. Animal studies were carried out to investigate age-related effects of psychotropic drugs and to validate new neuroimaging techniques. In addition, we set up two double-blind placebo controlled clinical trials with MPH in 50 boys (10-12 years) and 50 young men (23-40 years) suffering from ADHD (ePOD-MPH) and with FLX in 40 girls (12-14 years) and 40 young women (23-40 years) suffering from depression and anxiety disorders (ePOD-SSRI). Trial registration numbers are: Nederlands Trial Register NTR3103 and NTR2111. A cross-sectional cohort study on age-related effects of these psychotropic medications in patients who have been treated previously with MPH or FLX (ePOD-Pharmo) is also ongoing. The effects of psychotropic drugs on the developing brain are studied using neuroimaging techniques together with neuropsychological and psychiatric assessments of cognition, behavior and emotion. All assessments take place before, during (only in case of MPH) and after chronic treatment. The combined results of these approaches will provide new insight into the modulating effect of MPH and FLX on brain development.

The effects of Psychotropic drugs On Developing brain (ePOD) study: methods and design

PubMed Central

2014-01-01

Background Animal studies have shown that methylphenidate (MPH) and fluoxetine (FLX) have different effects on dopaminergic and serotonergic system in the developing brain compared to the developed brain. The effects of Psychotropic drugs On the Developing brain (ePOD) study is a combination of different approaches to determine whether there are related findings in humans. Methods/Design Animal studies were carried out to investigate age-related effects of psychotropic drugs and to validate new neuroimaging techniques. In addition, we set up two double-blind placebo controlled clinical trials with MPH in 50 boys (10–12 years) and 50 young men (23–40 years) suffering from ADHD (ePOD-MPH) and with FLX in 40 girls (12–14 years) and 40 young women (23–40 years) suffering from depression and anxiety disorders (ePOD-SSRI). Trial registration numbers are: Nederlands Trial Register NTR3103 and NTR2111. A cross-sectional cohort study on age-related effects of these psychotropic medications in patients who have been treated previously with MPH or FLX (ePOD-Pharmo) is also ongoing. The effects of psychotropic drugs on the developing brain are studied using neuroimaging techniques together with neuropsychological and psychiatric assessments of cognition, behavior and emotion. All assessments take place before, during (only in case of MPH) and after chronic treatment. Discussion The combined results of these approaches will provide new insight into the modulating effect of MPH and FLX on brain development. PMID:24552282

Spiritual beliefs near the end of life: a prospective cohort study of people with cancer receiving palliative care.

PubMed

King, Michael; Llewellyn, Henry; Leurent, Baptiste; Owen, Faye; Leavey, Gerard; Tookman, Adrian; Jones, Louise

2013-11-01

Despite growing research interest in spirituality and health, and recommendations on the importance of spiritual care in advanced cancer and palliative care, relationships between spiritual belief and psychological health near death remain unclear. We investigated (i) relationships between strength of spiritual beliefs and anxiety and depression, intake of psychotropic/analgesic medications and survival in patients with advanced disease; and (ii) whether the strength of spiritual belief changes as death approaches. We conducted a prospective cohort study of 170 patients receiving palliative care at home, 97% of whom had a diagnosis of advanced cancer. Data on strength of spiritual beliefs (Beliefs and Values Scale [BVS]), anxiety and depression (Hospital Anxiety and Depression Scale [HADS]), psychotropic/analgesic medications, daily functioning, global health and social support were collected at recruitment then 3 and 10 weeks later. Mortality data were collected up to 34 months after the first patient was recruited. Regression analysis showed a slight increase in strength of spiritual belief over time approaching statistical significance (+0.16 BVS points per week, 95% CI [-0.01, 0.33], p = 0.073). Belief was unrelated to anxiety and depression (-0.15 points decrease in HADS for 10 points increased in BVS (95% CI [-0.57, 0.27], p = 0.49) or consumption of psychotropic medication). There was a non-significant trend for decreasing analgesic prescription with increasing belief. Mortality was higher over 6 months in participants with lower belief at recruitment. Results suggest that although religious and spiritual beliefs might increase marginally as death approaches, they do not affect levels of anxiety or depression in patients with advanced cancer. © 2013 The Authors. Psycho-Oncology published by John Wiley & Sons, Ltd.

Spiritual beliefs near the end of life: a prospective cohort study of people with cancer receiving palliative care†

PubMed Central

King, Michael; Llewellyn, Henry; Leurent, Baptiste; Owen, Faye; Leavey, Gerard; Tookman, Adrian; Jones, Louise

2013-01-01

Objectives Despite growing research interest in spirituality and health, and recommendations on the importance of spiritual care in advanced cancer and palliative care, relationships between spiritual belief and psychological health near death remain unclear. We investigated (i) relationships between strength of spiritual beliefs and anxiety and depression, intake of psychotropic/analgesic medications and survival in patients with advanced disease; and (ii) whether the strength of spiritual belief changes as death approaches. Methods We conducted a prospective cohort study of 170 patients receiving palliative care at home, 97% of whom had a diagnosis of advanced cancer. Data on strength of spiritual beliefs (Beliefs and Values Scale [BVS]), anxiety and depression (Hospital Anxiety and Depression Scale [HADS]), psychotropic/analgesic medications, daily functioning, global health and social support were collected at recruitment then 3 and 10 weeks later. Mortality data were collected up to 34 months after the first patient was recruited. Results Regression analysis showed a slight increase in strength of spiritual belief over time approaching statistical significance (+0.16 BVS points per week, 95% CI [−0.01, 0.33], p = 0.073). Belief was unrelated to anxiety and depression (−0.15 points decrease in HADS for 10 points increased in BVS (95% CI [−0.57, 0.27], p = 0.49) or consumption of psychotropic medication). There was a non-significant trend for decreasing analgesic prescription with increasing belief. Mortality was higher over 6 months in participants with lower belief at recruitment. Conclusion Results suggest that although religious and spiritual beliefs might increase marginally as death approaches, they do not affect levels of anxiety or depression in patients with advanced cancer. © 2013 The Authors. Psycho-Oncology published by John Wiley & Sons, Ltd. PMID:23775823

Characteristics and the trajectory of psychotropic medication use in general and antipsychotics in particular among adults with an intellectual disability who exhibit aggressive behaviour.

PubMed

Deb, S; Unwin, G; Deb, T

2015-01-01

A high proportion of adults with an intellectual disability (ID) are known to receive psychotropic medications for the management of aggressive behaviour in the absence of any psychiatric diagnosis. Despite this widespread use of psychotropic medication in general and antipsychotic medication in particular, no study has reported the trajectory of psychotropic medication use using a prospective design. We have prospectively studied a community, clinic-based sample of 100 adults with ID and aggressive behaviour over a 6-month period for use of psychotropic medication in general and antipsychotics in particular, and compared them with demographic, psychiatric and behavioural variables. Psychotropic medications were used for 89% of patients at baseline (T1) and 90% at 6 months' (T2) follow-up. Risperidone was the most commonly used antipsychotic medication followed by chlorpromazine, haloperidol, olanzapine, zuclopenthixol and quetiapine. Other commonly used medications were SSRI antidepressants such as citalopram, paroxetine and fluoxetine followed by mood stabilisers such as carbamazepine and sodium valproate. Although in a high proportion of cases carbamazepine and sodium valproate were used to treat epilepsy per se. A high proportion (45%) received more than one (polypharmacy) psychotropic medication at T1; however, this proportion decreased slightly to 41% at T2. As for antipsychotic prescribing specifically, a similar proportion received them at T1 (75%) and T2 (73%), with polypharmacy of antipsychotics remaining similar at T1 (10%) and at T2 (9%). Twenty-three per cent and 20% of patients received over 300 mg/day of chlorpromazine equivalent dose of antipsychotics at T1 and T2 respectively. However, there was an overall significant reduction in the severity of aggressive behaviour between T1 and T2. Higher doses of antipsychotic prescribing were positively correlated with more severe aggressive behaviour, physical aggression towards objects, self-injurious behaviour and increasing age. There was no significant association with other demographic variables, physical health conditions or psychiatric diagnosis. Neither was there any significant correlation between mean aggression severity score change and antipsychotic daily dose change between T1 and T2. To our knowledge, this is the first ever comprehensive follow-up study of use of psychotropic medications in general but antipsychotics in particular over a 6-month period in adults with ID and aggressive behaviour, in a clinic-based community setting which also compared the trajectory of severity of aggressive behaviour with that of antipsychotic medication dose. Our study shows that not only the use of psychotropic medication is common among adults with ID who attend psychiatric clinics for aggressive behaviour, the use of polypharmacy of psychotropic medications in general and high dose of antipsychotics in particular are equally prevalent. However, in some cases two antipsychotics may have been prescribed simultaneously as the psychiatrist is in the process of switching from one to another. © 2014 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

Period prevalence of concomitant psychotropic medication usage among children and adolescents with attention-deficit/hyperactivity disorder during 2009.

PubMed

Betts, Keith A; Sikirica, Vanja; Hodgkins, Paul; Zhou, Zhou; Xie, Jipan; DeLeon, Anthony; Erder, M Haim; Wu, Eric Q

2014-06-01

Stimulants are recommended as a first-line treatment for attention- deficit/hyperactivity disorder (ADHD); however, a subset of the patient population augments their stimulant treatment with other medications. The objective of this study was to estimate the 1 year period prevalence of concomitant psychotropic medication use among children and adolescents with ADHD during 2009. Patients 6-17 years of age with one or more primary ADHD diagnoses between July 1, 2008 and December 31, 2009 and one or more stimulant prescription fills during 2009 were identified from a large United States commercial claims database. Concomitant psychotropic medication use, defined as 30 days of continuous medication supply overlap between the augmenting agent and stimulant, was evaluated for 14 distinct psychotropic medication categories (6 with a United States Food and Drug Administration (FDA) approved indication for ADHD, 8 without an indication for ADHD). The 1 year period prevalence of concomitant psychotropic medication use (both overall and within each medication category) was calculated and compared between patients with and without psychiatric or neurologic comorbidities. Children (6-12 years) and adolescents (13-17 years) were evaluated separately. A total of 71,201 children and 49,959 adolescents met the inclusion criteria. The 1 year period prevalence of concomitant psychotropic medication use among children and adolescents was 20.3% and 23.4%, with 5.7% and 6.7% augmenting with two or more medication categories, respectively. The most common concomitant medication categories were selective serotonin reuptake inhibitors (SSRIs) (children: 6.2%; adolescents: 11.4%), atypical antipsychotics (5.8%; 6.8%) and clonidine immediate release (5.4%; 2.9%). Children and adolescents with psychiatric or neurologic comorbidities had higher rates of augmentation than did those without comorbidities (all p<0.001). This epidemiologic study found that the prevalence of concomitant psychotropic medication use in children and adolescents ranged from 12.6% for noncomorbid ADHD to 41.7% for comorbid ADHD, in 2009. Future research is warranted to evaluate the rationale for, and clinical benefit of, concomitant psychotropic medication usage in patients with ADHD.

Comparison of psychotropic prescriptions between oncology and cardiology inpatients: result from a pharmacy database in a teaching hospital in Malaysia.

PubMed

Ng, Chong Guan; Mohamed, Salina; Wern, Tai Yi; Haris, Azwa; Zainal, Nor Zuraida; Sulaiman, Ahmad Hatim

2014-01-01

To examine the prescription rates in cancer patients of three common psychotropic drugs: anxiolytic/ hypnotic, antidepressant and antipsychotic. In this retrospective cohort study, data were extracted from the pharmacy database of University Malaya Medical Center (UMMC) responsible for dispensing records of patients stored in the pharmacy's Medication Management and Use System (Ascribe). We analyzed the use of psychotropics in patients from the oncology ward and cardiology from 2008 to 2012. Odds ratios (ORs) were adjusted for age, gender and ethnicity. A total of 3,345 oncology patients and 8,980 cardiology patients were included. Oncology patients were significantly more often prescribed psychotropic drugs (adjusted OR: anxiolytic/hypnotic=5.55 (CI: 4.64-6.63); antidepressants=6.08 (CI: 4.83-7.64) and antipsychotics=5.41 (CI: 4.17-7.02). Non-Malay female cancer patients were at significantly higher risk of anxiolytic/hypnotic use. Psychotropic drugs prescription is common in cancer patients. Anxiolytic/hypnotic prescription rates are significantly higher in non-Malay female patients in Malaysia.

Use of psychotropic medicines in residential care facilities for older people in Hawke's Bay, New Zealand.

PubMed

Tucker, Marilyn; Hosford, Ian

2008-05-23

To audit the use of various categories of psychotropic medicines in residential care facilities in Hawke's Bay. Data on psychotropic medicines use for all residents in participating residential care facilities were extracted from community pharmacy records and analysed. These data were compared to a similar study performed in 1990. 54.7% of residents were prescribed one or more psychotropic medicines, a similar proportion to that recorded in 1990. The use of regular benzodiazepines reduced from 29.6% to 12.4% while the use of antidepressant medicines increased from 15.5% to 30.6%. Most residents on antipsychotic medicines are now on 'atypical' agents at relatively low doses, and overall use of antipsychotic medication has not changed significantly. The use of psychotropic medicines in Hawke's Bay, New Zealand does not differ much from other countries where similar audits have been performed. The increase in use of antidepressants is likely to reflect better diagnosis and management of depression in nursing homes. The use of benzodiazepines and sedative medication is probably still excessive.

Changes in psychosocial and physical working conditions and psychotropic medication in ageing public sector employees: a record-linkage follow-up study.

PubMed

Kouvonen, Anne; Mänty, Minna; Lallukka, Tea; Pietiläinen, Olli; Lahelma, Eero; Rahkonen, Ossi

2017-07-12

To investigate whether changes in psychosocial and physical working conditions are associated with subsequent psychotropic medication in ageing employees. Data were from the Helsinki Health Study, a cohort study of Finnish municipal employees, aged 40-60 years at phase 1 (2000-2002). Changes in psychosocial and physical working conditions were measured between phase 1 and phase 2 (2007). Survey data were longitudinally linked to data on prescribed, reimbursed psychotropic medication purchases (Anatomical Therapeutic Chemical) obtained from the registers of the Social Insurance Institution of Finland between the phase 2 survey and December 2013 (N=3587; 80% women). Outcomes were any psychotropic medication; antidepressants (N06A); anxiolytics (N05B); and sedatives and hypnotics (N05C). Cox regression analyses were performed. During the follow-up, 28% of the participants were prescribed psychotropic medication. Repeated exposures to low job control, high job demands and high physical work load were associated with an increased risk of subsequent antidepressant and anxiolytic medication. Increased and repeated exposure to high physical work load, increased job control and repeated high job demands were associated with subsequent sedative and hypnotic medication. Age and sex-adjusted HR varied from 1.18 to 1.66. Improvement in job control was associated with a lower risk of anxiolytic, but with a higher risk of sedatives and hypnotic medication. Decreased physical work load was associated with a lower risk of antidepressant and anxiolytic medications. Improvement in working conditions could lower the risk of mental ill-health indicated by psychotropic medication. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Psychotropic Drug Prescription in Adolescents: A Retrospective Study in a Swiss Psychiatric University Hospital.

PubMed

Ansermot, Nicolas; Jordanov, Véronique; Smogur, Michal; Holzer, Laurent; Eap, Chin B

2018-04-01

This retrospective study aims to evaluate off-label prescriptions and administrations of psychotropic medications in adolescents in a university psychiatric hospital in Switzerland. Data were collected during the entire stays from the electronic database for 76 inpatients in 2008 and 76 inpatients in 2014. Data collected included gender, age, psychiatric diagnosis, duration of hospitalization, and psychotropic drug prescriptions and administrations. A total of 224 psychotropic drugs (mean 2.9 drugs/patient) were prescribed in 2008 and 268 (mean 3.5 drugs/patient) in 2014. Due to the prescriptions of some drugs as required, only 76% of the prescriptions were actually administered in 2008 (mean 2.3 drugs/patient) and 55% in 2014 (mean 1.9 drugs/patient). Antipsychotics were the most frequently prescribed drugs in 2008 (74% of patients) and 2014 (86% of patients). Anxiolytics were also highly prescribed in 2008 (54% of patients) and 2014 (66% of patients), as well as antidepressants in 2008 (30% of patients), but less in 2014 (13% of patients). Overall, 69% of prescriptions were found to be off label in 2008 and 68% in 2014, according to age, diagnosis, dose, or formulation as approved by Swissmedic. The medication classes with the highest rate of off-label prescriptions were antidepressants (100% for both years), antipsychotics (94% in 2008 and 92% in 2014), and hypnotics (67% in 2008 and 100% in 2014). For both study periods, at least one off-label psychotropic drug prescription and administration was recorded in 96% and 79% of the patients, respectively. The high rate of off-label psychotropic drug use strengthens the need for clinical trials to better evaluate the efficacy and safety of these treatments in adolescents.

"Psychiatry is not a science like others" - a focus group study on psychotropic prescribing in primary care.

PubMed

Hedenrud, Tove M; Svensson, Staffan A; Wallerstedt, Susanna M

2013-08-12

Psychotropic drug prescribing is problematic and knowledge of factors affecting the initiation and maintenance of such prescribing is incomplete. Such knowledge could provide a basis for the design of interventions to change prescribing patterns for psychotropics. The aim of this study was to explore the views of general practitioners (GPs), GP interns, and heads of primary care units on factors affecting the prescribing of psychotropic drugs in primary care. We performed four focus group discussions in Gothenburg, Sweden, with a total of 21 participants (GPs, GP interns, and heads of primary care units). The focus group discussions were transcribed verbatim and analyzed using manifest content analysis. Three different themes emerged from the focus group discussions. The first theme Seeking care for symptoms, reflects the participants' understanding of why patients approach primary care and comprised categories such as knowledge, attitudes, and society and the media. The second theme, Lacking a framework, resources, and treatment alternatives, which reflects the conditions for the physician-patient interaction, comprised categories such as economy and resources, technology, and organizational aspects. The third theme, Restricting or maintaining prescriptions, with the subthemes Individual factors and External influences, reflects the physicians' internal decision making and comprised categories such as emotions, knowledge, and pharmaceutical industry. The results of the present study indicate that a variety of factors may affect the prescribing of psychotropic medications in primary care. Many factors were related to characteristics of the patient, the physician or their interaction, rather than the patients' medical needs per se. The results may be useful for interventions to improve psychotropic prescribing in primary care.

More action needed: Psychotropic prescribing in Australian residential aged care.

PubMed

Westbury, Juanita; Gee, Peter; Ling, Tristan; Kitsos, Alex; Peterson, Gregory

2018-02-01

For at least two decades, concerns have been raised about inappropriate psychotropic prescribing in Australian residential aged care facilities, due to their modest therapeutic benefit and increased risk of falls and mortality. To date, the majority of prevalence data has been collected in Sydney exclusively and it is not known if recent initiatives to promote appropriate psychotropic prescribing have impacted utilisation. Thus, we aimed to comprehensively analyse psychotropic use in a large national sample of residential aged care facility residents. A cross-sectional, retrospective cohort study of residents from 150 residential aged care facilities distributed nationally during April 2014-October 2015. Antipsychotic, anxiolytic/hypnotic and antidepressant utilisation was assessed, along with anticonvulsant and anti-dementia drug use. Negative binomial regression analysis was used to examine variation in psychotropic use. Full psychotropic prescribing data was available from 11,368 residents. Nearly two-thirds (61%) were taking psychotropic agents regularly, with over 41% prescribed antidepressants, 22% antipsychotics and 22% of residents taking benzodiazepines. Over 30% and 11% were charted for 'prn' (as required) benzodiazepines and antipsychotics, respectively. More than 16% of the residents were taking sedating antidepressants, predominantly mirtazapine. South Australian residents were more likely to be taking benzodiazepines ( p < 0.05) and residents from New South Wales/Australian Capital Territory less likely to be taking them ( p < 0.01), after adjustment for rurality and size of residential aged care facility. Residents located in New South Wales/Australian Capital Territory were also significantly less likely to take antidepressants ( p < 0.01), as were residents from outer regional residential aged care facilities ( p < 0.01). Antipsychotic use was not associated with State, rurality or residential aged care facility size. Regular antipsychotic use appears to have decreased in residential aged care facilities but benzodiazepine prevalence is higher, particularly in South Australian residential aged care facilities. Sedating antidepressant and 'prn' psychotropic prescribing is widespread. Effective interventions to reduce the continued reliance on psychotropic management, in conjunction with active promotion of non-pharmacological strategies, are urgently required.

Adverse Childhood Experiences and Prescribed Psychotropic Medications in Adults

PubMed Central

Anda, Robert F.; Brown, David W.; Felitti, Vincent J.; Bremner, J. Douglas; Dube, Shanta R.; Giles, Wayne H.

2011-01-01

Background Prescription drugs are one of the fastest growing healthcare costs in the United States. However, the long-term influence of child abuse and related traumatic stressors on prescriptions for psychotropic medications in adults has not been described. This study assessed the relationship of eight adverse childhood experiences (ACEs) to rates of prescriptions for psychotropic medications throughout adulthood. These ACEs included: abuse (emotional, physical, or sexual), witnessing domestic violence, growing up with substance abusing, mentally ill, or criminal household members, and parental separation/ divorce. Methods Data about ACEs were collected between 1995 and 1997 from adult health maintenance organization patients; prescription data were available from 1997 to 2004. The number of ACEs (ACE Score: maximum 8) was used as a measure of cumulative traumatic stress during childhood. The relationship of the score to rates of prescribed psychotropic drugs was prospectively assessed among 15,033 adult patients eligible for the follow-up phase of the study (mean follow-up: 6.1 years). Data were analyzed in 2006. Multivariate models were adjusted for age, race, gender, and education. Results Prescription rates increased yearly during the follow-up and in a graded fashion as the ACE Score increased (p for trend <0.001). After adjusting compared with persons with an ACE Score of 0, persons with a score of equal to or more than 5 had a nearly threefold increase in rates of psychotropic prescriptions. Graded relationships were observed between the score and prescription rates for antidepressant, anxiolytic, antipsychotic, and mood-stabilizing/bipolar medications; rates for persons with a score of equal to or more than 5 for these classes of drugs increased 3-, 2-, 10-, and 17-fold, respectively. Conclusions The strong relationship of the ACE Score to increased utilization of psychotropic medications underscores the contribution of childhood experience to the burden of adult mental illness. Moreover, the huge economic costs associated with the use of psychotropic medications provide additional incentive to address the high prevalence and consequences of childhood traumatic stressors. PMID:17478264

Physicians’ response to computerised alerts for psychotropic drugs in older persons: a multilevel analysis of the associated alert, patient and physician characteristics

PubMed Central

Tamblyn, Robyn; Reidel, Kristen; Patel, Vaishali

2012-01-01

Objective Computerised drug alerts are expected to reduce patients’ risk of adverse drug events. However, physicians over-ride most drug alerts, because they believe that the benefit exceeds the risk. The purpose of this study was to determine the drug alert, patient and physician characteristics associated with the: (1) occurrence of psychotropic drug alerts for elderly patients and the (2) response to these alerts by their primary care physicians. Setting Primary care, Quebec, Canada. Design Prospective cohort study. Participants Sixty-one physicians using an electronic prescribing and drug alert decision-support system in their practice, and 3413 elderly patients using psychotropic drugs. Primary and secondary measures Psychotropic drug class, alert severity, patient risk for fall injuries and physician experience, practice volume and computer use were evaluated in relationship to the likelihood of having: (1) a psychotropic drug alert, (2) the prescription revised in response to an alert. Cluster-adjusted alternating logistic regression was used to assess multilevel predictors of alert occurrence and response. Results In total 13 080 psychotropic drug alerts were generated in 8931 visits. Alerts were more likely to be generated for male patients at higher risk of fall-related injury and for physicians who established the highest alert threshold. In 9.9% of alerts seen, the prescription was revised. The highest revision rate was for antipsychotic alerts (22.6%). Physicians were more likely to revise prescriptions for severe alerts (OR 2.03; 95%CI 1.39 to 2.98), if patients had cognitive impairment (OR 1.95; 95%CI 1.13 to 3.36), and if they made more visits to their physician (OR 1.05 per 5 visits; 95%CI 1 to 1.09). Conclusions Physicians view and respond to a small proportion of alerts, mainly for higher-risk patients. To reduce the risk of psychotropic drug-related fall injuries, a new generation of evidence-based drug alerts should be developed. PMID:23024254

[Adaptations of psychotropic drugs in patients aged 75 years and older in a departement of geriatric internal medecine: report of 100 cases].

PubMed

Couderc, Anne-Laure; Bailly-Agaledes, Cindy; Camalet, Joëlle; Capriz-Ribière, Françoise; Gary, André; Robert, Philippe; Brocker, Patrice; Guérin, Olivier

2011-06-01

The elderly often with multiple diseases are particularly at risk from adverse drug reactions. Nearly half of iatrogenic drug in the elderly are preventable. Some medications such as psychotropic drugs are particularly involved in iatrogenic accidents. We wanted to know if the tools of the comprehensive geriatric assessment or other factors could influence the changes of psychotropic drugs in a geriatric departement. Our prospective study of four months in 100 patients aged 75 years and older hospitalized in the Geriatric Internal Medecine Departement of University Hospital of Nice investigated what were the clinical or biological reasons and tools used during changes of psychotropic drugs. We compared these changes according to the comprehensive geriatric assessment tools and we analyzed the changes based on lists of potentially inappropriate medications by Laroche et al. and from the instrument STOPP/START. The Mini Mental State Examination (MMSE) was the tool that has most influenced the changes in psychotropic including a tendency to increase and the introduction of anxiolytics when MMSE < 20 (p = 0.007) while neuroleptics instead arrested and decreased (p = 0.012). The comprehensive geriatric assessment has its place in decision support during the potentially iatrogenic prescriptions of drugs such as psychotropic and new tools such as STOPP/START can also be a help to the prescriber informed.

Organisational downsizing and increased use of psychotropic drugs among employees who remain in employment.

PubMed

Kivimäki, Mika; Honkonen, Teija; Wahlbeck, Kristian; Elovainio, Marko; Pentti, Jaana; Klaukka, Timo; Virtanen, Marianna; Vahtera, Jussi

2007-02-01

Organisational downsizing is common in modern work life, but its effect on employees' mental health is not known. The authors examined whether working in downsizing organisations predicts use of psychotropic drugs among employees who remain in employment. Prospective cohort study of municipal employees in Finland. 4783 employees worked in downsized units but kept their jobs after downsizing in 1993, 4271 employees lost their jobs during the downsizing, and 17 599 employees did not experience downsizing. The outcome was psychotropic drug prescriptions (antidepressants, anxiolytics and hypnotics) during 1994-2000 extracted from nationwide registers and linked to the data by means of each participant's personal identification number. After adjustment for predownsizing characteristics, employees who were exposed to downsizing but kept their jobs were at a higher risk of being prescribed psychotropic drugs (rate ratio 1.49, 95% CI 1.10 to 2.02 in men and 1.12, 95% CI 1.00 to 1.27 in women) than those not exposed to downsizing. The association of downsizing was strongest with hypnotics among the men and with anxiolytics among the women. An increased rate of psychotropic prescriptions after downsizing was also seen in male workers who lost their job (rate ratio 1.64, 95% CI 1.19 to 2.25). The association between organisational downsizing and increased use of psychotropic drugs suggests that this managerial strategy may pose mental health risks among employees.

28 CFR 549.40 - Use of psychotropic medications.

Code of Federal Regulations, 2010 CFR

2010-07-01

... MEDICAL SERVICES Administrative Safeguards for Psychiatric Treatment and Medication § 549.40 Use of psychotropic medications. Psychotropic medication is to be used only for a diagnosable psychiatric disorder or...

Psychotropic drugs and bruxism.

PubMed

Falisi, Giovanni; Rastelli, Claudio; Panti, Fabrizio; Maglione, Horacio; Quezada Arcega, Raul

2014-10-01

Sleep and awake bruxism is defined as 'a parafunctional activity including clenching, bracing, gnashing, and grinding of the teeth'. Some evidence suggests that bruxism may be caused by, or associated with, alterations in the CNS neurotransmission. Several classes of psychotropic drugs interfering with CNS activity may potentially contribute to bruxism. Thus, the purpose of this study was to examine relevant peer-reviewed papers to identify and describe the various classes of psychotropic substances that may cause, exacerbate or reduce bruxism as the result of their pharmacological action in CNS neurons. A literature search from 1980 to the present was performed using PubMed database. The term 'bruxism' was used in association with 'psychotropic', 'dopamine (DA)', 'serotonin', 'histamine', 'antipsychotics', 'antidepressants', 'antihistaminergics' and 'stimulants'. Studies on the effects of DA agonists (Levo-DOPA, psychostimulants) and antagonists (antipsychotics) identified a central role of DA in the pathogenesis of pharmacologically induced bruxism. Important information from studies on drugs acting on serotonin neurotransmission (antidepressants) was recognized. Other mechanisms involving different neurotransmitters are emerging. This is the case of antihistaminergic drugs which may induce bruxism as a consequence of their disinhibitory effect on the serotonergic system.

Psychotropic drug initiation or increased dosage and the acute risk of falls: a prospective cohort study of nursing home residents

PubMed Central

2013-01-01

Background Previous studies suggest that psychotropic drug changes may signal an acute period of time whereby a person is highly vulnerable to fall. It is unknown whether certain classes of psychotropic agents are less safe with respect to the acute risk of falls. Our purpose was to compare fall rates in the 7 days following a change of an antidepressant, antipsychotic, or benzodiazepine. We also identified specific times when residents are at high risk for falls with respect to a psychotropic drug change. Methods Residents in our one-year study included 851 long term care residents from two nursing home facilities in Boston, MA, U.S.A. (May 2010 - May 2011). Drug changes (i.e., new prescriptions or increased dose of a previously used drug) were ascertained using the computerized provider order entry system, whereas falls were ascertained by incident reports. Negative binomial regression was used to compare the rate of falls following a drug change between medication classes. Further, we calculated the rate of falls for each of the 7 days before and 7 days after a psychotropic drug change. Results Forty-eight percent of residents were prescribed a new prescription or increased dose of a psychotropic drug during the study. The rate of falls was similar in the 7 days following a change to a SSRI versus non-SSRI antidepressant (11.9 versus 14.4 falls/1,000 person years; p = 0.58), a typical versus an atypical antipsychotic (25.4 versus 17.1 falls/1,000 person years; p = 0.10), or a short versus long acting benzodiazepine (15.2 versus 13.9 falls/1,000 person years; p = 0.23). Fall risk was highest on day 4 before the drug change (19.0 falls/1,000 person days), on the day of the drug change through 2 days after the drug change (17.6-20.3 falls/1,000 person days), and 5-6 days after the drug change (17.6-19.0 falls/1,000 person days). Conclusions In the nursing home, risk of falls was similar following a psychotropic drug change of any class. We observed higher fall risk in the days before, but mostly after the drug change. We recommend that nursing home residents be closely monitored following a psychotropic drug change in an effort to reduce falls. PMID:23432790

Multi-psychotropic drug prescription and the association to neuropsychiatric symptoms in three Norwegian nursing home cohorts between 2004 and 2011.

PubMed

Gulla, Christine; Selbaek, Geir; Flo, Elisabeth; Kjome, Reidun; Kirkevold, Øyvind; Husebo, Bettina S

2016-06-01

Neuropsychiatric symptoms, such as affective symptoms, psychosis, agitation, and apathy are common among nursing home patients with and without dementia. Treatment with one or more psychotropic drug is often without explicit clinical indication, despite low treatment efficacy, and potential side effects. We aim to investigate the multi-psychotropic drug use to identify factors and patient characteristics associated with multi-use. We analysed three cohorts from 129 Norwegian nursing homes, collected between 2004 and 2011. Patients (N = 4739) were assessed with the Neuropsychiatric Inventory - Nursing Home version (NPI-NH), Clinical Dementia Rating scale, and Physical Self Maintenance Scale. We used ordinal logistic regression to analyse associations between psychotropics (antidepressants, antipsychotics, anxiolytics, hypnotics, and anti-dementia drugs), patient characteristics, and neuropsychiatric symptoms. Patients used on average 6.6 drugs; 27 % used no psychotropics, 32 % one, and 41 % multiple psychotropic drugs (24 % two, 17 % ≥3). Thirty-nine percent were prescribed antidepressants, 30 % sedatives, 24 % anxiolytics, and 20 % antipsychotics. The total NPI-NH score was associated with multi-use (OR 1.02, 95 % CI 1.02-1.03), and increased from a mean of 13.5 (SD 16.3) for patients using none, to 25.5 (21.8) for patients using ≥3 psychotropics. Affective symptoms (depression and anxiety) were most strongly associated with multi-psychotropic drug use (OR 1.10, 95 % CI: 1.09-1.12). Female gender, independency in daily living, younger age, dementia, and many regular drugs were also associated with multi-use. Forty-one percent were exposed to multi-psychotropic drug prescriptions. Contrary to current evidence and guidelines, there is an extensive use of multiple psychotropic drugs in patients with severe NPS and dementia.

Association between prescribing of cardiovascular and psychotropic medications and hospital admission for falls or fractures.

PubMed

Payne, Rupert A; Abel, Gary A; Simpson, Colin R; Maxwell, Simon R J

2013-04-01

Falls are a major cause of morbidity and mortality in the elderly. This study examined the frequency of hospital admission for falls or fractures, and the association with a recent change in the use of cardiovascular and psychotropic medications. We conducted a retrospective case-cohort study of 39,813 patients aged >65 years from 40 Scottish general practices. Data on current prescriptions, dates of drug changes (defined as increases in dose or starting new drugs), diagnoses and clinical measurements were extracted from primary care electronic records, linked to national hospital admissions data. Multivariable logistic regression was used to model the association of change in prescribing of cardiovascular or psychotropic medication with admission to hospital for falls or fractures in the following 60 days. A total of 838 patients (2.1 %) were admitted in the 1-year study period. Following adjustment for factors including age, sex, socioeconomic deprivation, co-morbidity and current prescribing, changes in both cardiovascular and psychotropic medications were associated with subsequent admission for falls or fractures (odds ratio [OR] 1.54 [95 % confidence interval (CI) 1.17-2.03] and 1.68 [95 % CI 1.28-2.22], respectively). There was no evidence for a difference in the effect of change in medication for different cardiovascular drug types (p = 0.86), but there was evidence (p = 0.003) for variation in the association between change in different psychotropic medications and admission; the strongest associations were observed for changes in selective serotonin reuptake inhibitor (SSRI) antidepressants (OR 1.99 [95 % CI 1.29-3.08]), non-SSRI/tricyclic antidepressants (OR 4.39 [95 % CI 2.21-8.71]) and combination psychotropic medication (OR 3.05 [95 % CI 1.66-5.63]). Recent changes in psychotropic and cardiovascular medications are associated with a substantial increase in risk of hospital admission for falls and fractures. Caution should thus be taken when instigating prescribing changes in relation to these medicines, particularly in individuals already considered to be at high risk, such as those with multiple co-morbidities and the oldest old.

A Pilot Investigation of Teachers' Perceptions of Psychotropic Drug Use in Schools

ERIC Educational Resources Information Center

Lien, My T.; Carlson, John S.; Hunter-Oehmke, Shana; Knapp, Kelly A.

2007-01-01

Objective: Children's behavior at school often leads to parental interest in seeking physician treatment. This study examines teachers' knowledge and perceptions of psychotropic drug use in schools. Method: Structured interviews were conducted with 27 general education teachers from a diverse representation of elementary schools within central…

Lessons Learned from Our Elders: How to Study Polypharmacy in Populations with Intellectual and Developmental Disabilities

ERIC Educational Resources Information Center

Stortz, Jessica N.; Lake, Johanna K.; Cobigo, Virginie; Ouellette-Kuntz, Hélène M. J.; Lunsky, Yona

2014-01-01

"Polypharmacy" is the concurrent use of multiple medications, including both psychotropic and non-psychotropic drugs. Although it may sometimes be clinically indicated, polypharmacy can have a number of negative consequences, including medication nonadherence, adverse drug reactions, and undesirable drug--drug interactions. The objective…

Prescribing of psychotropic medication for nursing home residents with dementia: a general practitioner survey.

PubMed

Cousins, Justin M; Bereznicki, Luke Re; Cooling, Nick B; Peterson, Gregory M

2017-01-01

The aim of this study was to identify factors influencing the prescribing of psychotropic medication by general practitioners (GPs) to nursing home residents with dementia. GPs with experience in nursing homes were recruited through professional body newsletter advertising, while 1,000 randomly selected GPs from southeastern Australia were invited to participate, along with a targeted group of GPs in Tasmania. An anonymous survey was used to collect GPs' opinions. A lack of nursing staff and resources was cited as the major barrier to GPs recommending non-pharmacological techniques for behavioral and psychological symptoms of dementia (BPSD; cited by 55%; 78/141), and increasing staff levels at the nursing home ranked as the most important factor to reduce the usage of psychotropic agents (cited by 60%; 76/126). According to GPs, strategies to reduce the reliance on psychotropic medication by nursing home residents should be directed toward improved staffing and resources at the facilities.

Is Early Prescribing of Opioid and Psychotropic Medications Associated With Delayed Return to Work and Increased Final Workers' Compensation Cost?

PubMed

Tao, Xuguang Grant; Lavin, Robert A; Yuspeh, Larry; Weaver, Virginia M; Bernacki, Edward J

2015-12-01

To explore the association between the initial 60 days of prescriptions for psychotropic medications and final workers' compensation claim outcomes. A cohort of 11,394 claimants involved in lost time injuries between 1999 and 2002 were followed through December 31, 2009. Logistic regressions and Cox Proportional Hazard Models were used in the analysis. The initial 60 days of prescriptions for psychotropic medications were significantly associated with a final claim cost at least $100,000. Odds ratios were 1.88 for short-acting opioids, 2.14 for hypnotics, antianxiety agents, or antidepressants, and 3.91 for long-acting opioids, respectively. Significant associations were also found between decreased time lost from work and decreased claim closures during the study period. Early prescription of opioids and other psychotropic drugs may be useful predictors of high claim costs and time lost from work.

Attitudes toward psychotropic medications among patients with chronic psychiatric disorders and their family caregivers

PubMed Central

Grover, Sandeep; Chakrabarti, Subho; Sharma, Aarti; Tyagi, Shikha

2014-01-01

Aim: To examine attitudes towards psychotropic medications among patients with chronic psychiatric disorders as well as their family caregivers by using factor analysis. Materials and Methods: The study included 200 patients and their family caregivers with chronic psychiatric disorders who are attending the psychiatry outpatient services. A self-designed 18-item self-rated questionnaire was used to evaluate the attitude toward psychotropics and factor analysis was done to study the different models of attitudes. Results: In general both patients and caregivers had positive attitude toward the psychotropic medications and there was no significant difference between the patients and caregivers on the various items of the questionnaire assessing the attitude. Factor analysis of the questionnaire indicated that either two-factor or four-factor models explained the attitude of the patients and caregivers. In the two-factor model there was one positive and one negative attitude factor, whereas the four-factor model comprised of two positive and two negative attitude factors. The four-factor model of attitudes provided a more comprehensive solution to how attitudes might be formed among patients and their family caregivers. Factors one and four in the four-factor solution still reflected positive attitudes, but appeared to portray a risk-benefit approach, in which benefits such as the efficacy of psychotropic medications in treating mental illnesses and preventing relapse, and medications being better than other options were being contrasted with the risks of side effects and permanent damage or harm. Conclusion: Attitudes of patients with chronic psychiatric disorders and their caregivers toward psychotropic medications appear to be shaped by factors such as perceived efficacy or benefit from medicines, the necessity for taking treatment and concerns such as side effects, harm or expense. PMID:25288840

Psychiatric comorbidity among terminally ill patients in general practice in the Netherlands: a comparison between patients with cancer and heart failure.

PubMed

Ng, Chong Guan; Dijkstra, Ellen; Smeets, Hugo; Boks, Marco P M; de Wit, Niek J

2013-01-01

It is unclear whether psychiatric disorders are specifically related to the terminal phase of cancer, or independent of the underlying disease. To investigate the rate of psychiatric comorbidity and psychotropic drugs prescription in terminally ill patients in the GP setting, comparing both patients with terminal cancer and heart failure. Retrospective cohort study using the Utrecht General Practitioner Research Network. Equally-sized groups of patients with terminal cancer and heart failure were randomly selected from the database of four general practices over the years 2005-2009. Psychiatric comorbidities were determined using the International Classification for Primary Care (ICPC) codes and psychotropic drugs prescriptions using the Anatomical Therapeutic Chemical (ATC) Classification System codes. A total of 191 terminally ill patients were included in the study (111 with cancer and 80 with heart failure). The mean age for patients with terminal cancer (70.8 years, standard deviation [SD] = 12.8) was 15 years younger than that of patients with heart failure (85.6 years, SD = 9.2). Half of the terminally ill patients (50.3 %) were prescribed psychotropics, but only 13.6% of them had obtained a psychiatric diagnosis. There were no significant differences in prevalence of psychiatric disease and psychotropic drug prescription between patients with terminal cancer and heart failure. The results demonstrate a high use of psychotropic drugs in terminally ill patients, often in the absence of a formal diagnosis of a psychiatric disorder. The absence of differences between patients with cancer and heart failure suggests that psychiatric diagnoses and increased psychotropic prescriptions are primarily related to the terminal stage of the disease and not to the background of cancer or heart failure.

Hormonal contraception increases the risk of psychotropic drug use in adolescent girls but not in adults: A pharmacoepidemiological study on 800 000 Swedish women.

PubMed

Zettermark, Sofia; Perez Vicente, Raquel; Merlo, Juan

2018-01-01

The burden of depression and anxiety disorders is greater in women, and female sex hormones have been shown to affect mood. Psychological side effects of hormonal contraception (HC) are also a common complaint in the clinic, but few previous studies have investigated this subject. We therefore wanted to investigate whether use of HC was associated with adverse psychological health outcomes, and whether this association was modified by age. All women aged 12-30 years on 31 December 2010, residing in Sweden for at least four years and with no previous psychiatric morbidity (n = 815 662), were included. We followed the women from their first HC use (or 31 December 2010, if they were non-users) at baseline, until a prescription fill of psychotropic drugs or the end of the one-year follow-up. We performed age-stratified logistic regression models and estimated odds ratios (OR) to measure the association between different HC methods and psychotropic drug use, as well as the area under the receiver operating curve to estimate discriminatory accuracy of HC in relation to psychotropic drugs. Overall, we found an association between HC and psychotropic drugs (adjusted OR 1.34, 95% confidence interval [CI] 1.30-1.37). In the age-stratified analysis, the strongest association was found in adolescent girls (adjusted OR 3.46, 95% CI 3.04-4.94 for age 12 to 14 years), while it was non-existent for adult women. We conclude that hormonal contraception is associated with psychotropic drug use among adolescent girls, suggesting an adverse effect of HC on psychological health in this population.

Psychotropic Medication Use Among Adults With Schizophrenia and Schizoaffective Disorder in the United States.

PubMed

Stroup, T Scott; Gerhard, Tobias; Crystal, Stephen; Huang, Cecilia; Tan, Zhiqiang; Wall, Melanie M; Mathai, Chacku M; Olfson, Mark

2018-05-01

The authors examined the use of different classes of psychotropic medication in outpatient treatment of schizophrenia and schizoaffective disorder. Data from the United States Medicaid program were used to examine psychotropic medication use in a cohort of patients who had a diagnosis of schizophrenia or schizoaffective disorder in the calendar year 2010. The cohort of Medicaid recipients who filled one or more prescriptions for a psychotropic medication in 2010 included 116,249 patients classified as having schizophrenia and 84,537 classified as having schizoaffective disorder. During 2010, 86.1% of patients with schizoaffective disorder and 70.1% with schizophrenia were treated with two or more different classes of psychotropic. Psychotropic medications other than antipsychotics were commonly prescribed for individuals with a diagnosis of schizophrenia or schizoaffective disorder. Their widespread use and uncertainty about their net benefits signal a need for research on their efficacy, safety, and appropriate use in these conditions.

Brains, Bones, and Aging: Psychotropic medications and bone health among older adults

PubMed Central

Brown, Monique J.; Mezuk, Briana

2012-01-01

Psychotropic drugs are a crucial element of treatment for psychiatric disorders; however there is an established association between many classes of psychotropic medications and fracture risk among older adults, and growing evidence that some classes of medications may also impact bone mineral density (BMD). In this paper we review recent epidemiologic research on the association between psychotropic medications and osteoporosis, and discuss current controversies and unresolved issues surrounding this relationship. Key areas in need of focused inquiry include resolving whether the apparent association between psychotropic medications and BMD is due to confounding by indication, whether this relationship differs for men and women, and whether the implications of these medications for bone health vary over the life course. Clinical research to delineate the risk/benefit ratio of psychotropic medications for older adults, particularly those who are at high risk for fracture, is also needed to facilitate prescribing decisions between patients and physicians. PMID:23001917

Prevalence of use of erectile dysfunction medication by Dutch military personnel between 2003 and 2012.

PubMed

Janssen, D G A; Vermetten, E; Egberts, T C G; Heerdink, E R

2017-03-01

Use of ED medication can be seen as a marker for ED. ED is associated with increasing age, exposure to traumatic events and physical injuries in military veterans. The objective of this study was to assess the prevalence of use of ED medication in Dutch military personnel in the period 2003-2012 and to assess its association with age and psychotropic medication use. Data on dispensing of ED medication, age and co-medication with psychotropic medication of all Dutch military personnel between 2003 and 2012 were collected. The prevalence of ED medication use in each year was estimated, stratified for age and use of psychotropic medication. The number of ED medication users increased a hundredfold from 0.09 to 9.29 per 1000 per year between 2003 and 2012. ED medication was more often used by men over 40 than under 40 (prevalence in 2012: 2.4% vs 0.2%, OR (2003-2012, adjusted for calendar year) 15.6, 95% CI 13.5-17.9) and by men using psychotropic medication (prevalence in 2012: 3.8% vs 0.9%, OR (2003-2012, adjusted for calendar year) 3.13, 95% CI 2.66-3.67). This study shows a strong increase between 2003 and 2012 in a number of ED medication users in male Dutch military personnel. ED medication use increases with age and with psychotropic medication use.

Organisational downsizing and increased use of psychotropic drugs among employees who remain in employment

PubMed Central

Kivimäki, Mika; Honkonen, Teija; Wahlbeck, Kristian; Elovainio, Marko; Pentti, Jaana; Klaukka, Timo; Virtanen, Marianna; Vahtera, Jussi

2007-01-01

Objective Organisational downsizing is common in modern work life, but its effect on employees' mental health is not known. The authors examined whether working in downsizing organisations predicts use of psychotropic drugs among employees who remain in employment. Design, setting and participants Prospective cohort study of municipal employees in Finland. 4783 employees worked in downsized units but kept their jobs after downsizing in 1993, 4271 employees lost their jobs during the downsizing, and 17 599 employees did not experience downsizing. The outcome was psychotropic drug prescriptions (antidepressants, anxiolytics and hypnotics) during 1994–2000 extracted from nationwide registers and linked to the data by means of each participant's personal identification number. Main results After adjustment for predownsizing characteristics, employees who were exposed to downsizing but kept their jobs were at a higher risk of being prescribed psychotropic drugs (rate ratio 1.49, 95% CI 1.10 to 2.02 in men and 1.12, 95% CI 1.00 to 1.27 in women) than those not exposed to downsizing. The association of downsizing was strongest with hypnotics among the men and with anxiolytics among the women. An increased rate of psychotropic prescriptions after downsizing was also seen in male workers who lost their job (rate ratio 1.64, 95% CI 1.19 to 2.25). Conclusions The association between organisational downsizing and increased use of psychotropic drugs suggests that this managerial strategy may pose mental health risks among employees. PMID:17234876

Marriage and Family Therapists and Psychotropic Medications: Practice Patterns from a National Study

ERIC Educational Resources Information Center

Hernandez, Barbara Couden; Doherty, William J.

2005-01-01

A national sample of marriage and family therapists (MFTs) was used to describe practice patterns of MFTs whose clients use psychotropics and to compare medicated and nonmedicated clients. Marriage and Family Therapists (n = 283) reported on 195 medicated and 483 nonmedicated adult clients. Clients (n = 375) rated their improvement and…

Knowledge and Expectations of Direct Support Professionals towards Effects of Psychotropic Drug Use in People with Intellectual Disabilities

ERIC Educational Resources Information Center

de Kuijper, Gerda; van der Putten, Annette A. J.

2017-01-01

Background/Introduction: In this study, we investigated intellectual disability support professionals' knowledge and expectations towards effects of psychotropic drug use on behaviour and drug use in their clients, because shortcomings may lead to misinterpretations of behavioural symptoms and inappropriate drug use. Methods: Two self-designed…

Psychotropic Medication Management in a Residential Group Care Program

ERIC Educational Resources Information Center

Spellman, Douglas F.; Griffith, Annette K.; Huefner, Jonathan C.; Wise, Neil, III; McElderry, Ellen; Leslie, Laurel K.

2010-01-01

This article presents a psychotropic medication management approach that is used within a residential care program. The approach is used to assess medications at youths' times of entry and to facilitate decision making during care. Data from a typical case study have indicated that by making medication management decisions slowly, systematically,…

Adolescents' Commitment to Continuing Psychotropic Medication: A Preliminary Investigation of Considerations, Contradictions, and Correlates

ERIC Educational Resources Information Center

Moses, Tally

2011-01-01

This mixed-method study examines (1) the extent to which fifty adolescents receiving wraparound treatment and prescribed psychotropic medication for various psychiatric disorders report that they would continue taking medication if the decision was entirely their own (termed "medication commitment"); (2) their general subjective experiences with…

Longitudinal Effects of Activities, Social Environment, and Psychotropic Medication Use on Behavioral Symptoms of Individuals With Alzheimer's Disease in Nursing Homes.

PubMed

Inventor, Ben R; Farran, Carol J; Paun, Olimpia; Cothran, Fawn; Rajan, Kumar; Swantek, Sandra S; McCann, Judith J

2018-05-08

A secondary data analysis of 25,560 minutes of structured clinical observations from a longitudinal study examined the impact of time-varying background factors, social environment, and psychotropic medication use on behavioral symptoms of nursing home residents with Alzheimer's disease (AD). Data were collected at baseline (N = 177), 12 months (N = 138), and 24 months (N = 111). Mixed-effects regression modeling showed that at 24 months: (a) higher cognitive and physical function and having a private bedroom/bathroom had the most positive influence on resident positive behaviors; (b) use of antipsychotic medications and solitary activities had the most negative influence on resident positive behaviors; (c) higher cognitive function significantly decreased negative behaviors; and (d) care-related activities and total number of psychotropic medications significantly increased negative behaviors. The current study describes risk factors for behavioral disturbances and the impact of activities, social environment, and psychotropic medications on behavioral outcomes in nursing home residents with AD. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx-xx.]. Copyright 2018, SLACK Incorporated.

Psychotropic Drug Use in São Paulo, Brazil – An Epidemiological Survey

PubMed Central

Quintana, Maria Ines; Andreoli, Sergio Baxter; Peluffo, Marcela Poctich; Ribeiro, Wagner Silva; Feijo, Marcelo M.; Bressan, Rodrigo Affonseca; Coutinho, Evandro S. F.; Mari, Jair de Jesus

2015-01-01

Objective To estimate the prevalence of one month psychotropic drug use in São Paulo, Brazil, and to assess the gap treatment between the presence of mental disorders and psychotropic drug users. Method A probabilistic sample of non-institutionalized individuals from the general population of São Paulo (n = 2336; turnout: 84.5%) who were 15 years or older were interviewed by a trained research staff, applying the Composite International Diagnostic Interview 2.1 (CIDI WHO) (depression, anxiety-phobia, OCD\\PTSD, alcoholism sections), and an inventory investigating psychotropic drug use during the 12-month and one-month periods immediately preceding the interview. Logistic models were fitted to investigate associations between psychotropic drug use as well as socio-demographic and clinical variables. Results The one month prevalence of psychotropic drug use in São Paulo was 5.89%, the most commonly used drugs were antidepressants (3.15%) and tranquilizers (2.67%). A higher consumption of psychotropic drugs (overall, antidepressants and tranquilizers) was observed among women (OR:2.42), older individuals (OR:1.04), individuals with higher levels of formal education (1.06), and individuals with a family (OR:2.29) or personal history of mental illness (OR:3.27). The main psychotropic drug prescribers were psychiatrists (41%), followed by general practitioners (30%); 60% of psychotropic drugs were obtained through a government-run dispensing program. Most individuals who obtained a positive diagnosis on the CIDI 2.1 during the previous month were not using psychotropic medication (85%). Among individuals with a diagnosis of moderate to severe depression, 67.5% were not on any pharmacological treatment. Conclusion There is a change in the type of psychotropic more often used in São Paulo, from benzodiazepines to antidepressants, this event is observed in different cultures. The prevalence of use is similar to other developing countries. Most of the patients presenting a psychiatric illness in the month prior to testing were not receiving any sort of psychiatric medication. This may be explained by a failure to identify cases in primary care, which could be improved (and access to treatment could be facilitated) if professionals received more specialized training in managing cases with mental health problems. PMID:26252517

Psychotropic Drug Use in São Paulo, Brazil--An Epidemiological Survey.

PubMed

Quintana, Maria Ines; Andreoli, Sergio Baxter; Peluffo, Marcela Poctich; Ribeiro, Wagner Silva; Feijo, Marcelo M; Bressan, Rodrigo Affonseca; Coutinho, Evandro S F; Mari, Jair de Jesus

2015-01-01

To estimate the prevalence of one month psychotropic drug use in São Paulo, Brazil, and to assess the gap treatment between the presence of mental disorders and psychotropic drug users. A probabilistic sample of non-institutionalized individuals from the general population of São Paulo (n = 2336; turnout: 84.5%) who were 15 years or older were interviewed by a trained research staff, applying the Composite International Diagnostic Interview 2.1 (CIDI WHO) (depression, anxiety-phobia, OCD\\PTSD, alcoholism sections), and an inventory investigating psychotropic drug use during the 12-month and one-month periods immediately preceding the interview. Logistic models were fitted to investigate associations between psychotropic drug use as well as socio-demographic and clinical variables. The one month prevalence of psychotropic drug use in São Paulo was 5.89%, the most commonly used drugs were antidepressants (3.15%) and tranquilizers (2.67%). A higher consumption of psychotropic drugs (overall, antidepressants and tranquilizers) was observed among women (OR:2.42), older individuals (OR:1.04), individuals with higher levels of formal education (1.06), and individuals with a family (OR:2.29) or personal history of mental illness (OR:3.27). The main psychotropic drug prescribers were psychiatrists (41%), followed by general practitioners (30%); 60% of psychotropic drugs were obtained through a government-run dispensing program. Most individuals who obtained a positive diagnosis on the CIDI 2.1 during the previous month were not using psychotropic medication (85%). Among individuals with a diagnosis of moderate to severe depression, 67.5% were not on any pharmacological treatment. There is a change in the type of psychotropic more often used in São Paulo, from benzodiazepines to antidepressants, this event is observed in different cultures. The prevalence of use is similar to other developing countries. Most of the patients presenting a psychiatric illness in the month prior to testing were not receiving any sort of psychiatric medication. This may be explained by a failure to identify cases in primary care, which could be improved (and access to treatment could be facilitated) if professionals received more specialized training in managing cases with mental health problems.

Gender differences in depressive symptom profiles and patterns of psychotropic drug usage in Asian patients with depression: Findings from the Research on Asian Psychotropic Prescription Patterns for Antidepressants study.

PubMed

Park, Seon-Cheol; Lee, Min-Soo; Shinfuku, Naotaka; Sartorius, Norman; Park, Yong Chon

2015-09-01

The purpose of this study was to investigate whether there were gender-specific depressive symptom profiles or gender-specific patterns of psychotropic agent usage in Asian patients with depression. Clinical data from the Research on Asian Psychotropic Prescription Patterns for Antidepressant study (1171 depressed patients) were used to determine gender differences by analysis of covariates for continuous variables and by logistic regression analysis for discrete variables. In addition, a binary logistic regression model was fitted to identify independent clinical correlates of the gender-specific pattern on psychotropic drug usage. Men were more likely than women to have loss of interest (adjusted odds ratio = 1.379, p = 0.009), fatigue (adjusted odds ratio = 1.298, p = 0.033) and concurrent substance abuse (adjusted odds ratio = 3.793, p = 0.008), but gender differences in other symptom profiles and clinical features were not significant. Men were also more likely than women to be prescribed adjunctive therapy with a second-generation antipsychotic (adjusted odds ratio = 1.320, p = 0.044). However, men were less likely than women to have suicidal thoughts/acts (adjusted odds ratio = 0.724, p = 0.028). Binary logistic regression models revealed that lower age (odds ratio = 0.986, p = 0.027) and current hospitalization (odds ratio = 3.348, p < 0.0001) were independent clinical correlates of use of second-generation antipsychotics as adjunctive therapy for treating depressed Asian men. Unique gender-specific symptom profiles and gender-specific patterns of psychotropic drug usage can be identified in Asian patients with depression. Hence, ethnic and cultural influences on the gender preponderance of depression should be considered in the clinical psychiatry of Asian patients. © The Royal Australian and New Zealand College of Psychiatrists 2015.

Prevalence and patterns of use of psychoactive medicines among individuals with autism in the Autism Society of Ohio.

PubMed

Aman, Michael G; Lam, Kristen S L; Collier-Crespin, Angie

2003-10-01

To date, there have been few surveys of psychotropic and antiepileptic drug (AED) prevalence in individuals with autism-spectrum conditions. We surveyed 747 families in the Autism Society of Ohio regarding the use of psychotropic drugs, AEDs, and over-the-counter (OTC) preparations for autism. In all, 417 families (55.8%) replied. A total of 45.6% were taking some form of psychotropic agent (including St. John's wort and melatonin), whereas 11.5% were taking AEDs, and 10.3% took OTC autism preparations. The most common psychotropic agents included antidepressants (21.6%), antipsychotics (14.9%), antihypertensives (12.5%), and stimulants (11.3%). Some 51.6% were prescribed psychotropic drugs or AEDs, and 55.4% took psychotropic drugs, AEDs, or autism supplements. Demographic variables frequently found to be associated with medication use included greater age, more severe autism, more severe intellectual handicap, and housing outside the family home. Whereas there is empirical support for the use of some of these psychotropic agents in autism, others are being prescribed with minimal research support. OTC autism preparations were used in substantial numbers of individuals, despite limited research support and the possibility of toxic effects.

Association of Psychiatric Illness or Psychotropic Medication Usage with Calcaneus Fracture.

PubMed

Janney, Cory F; Goodrum, Jason T; Jupiter, Daniel; Wigg, Cindy L; Carmichael, Kelly

2017-12-21

Background There is a noticeable lack of studies examining the connection between psychiatric illness and orthopaedic injury. The goal of this study is to determine if a relationship exists between calcaneus fracture and psychiatric illness or use of psychotropic medication.  Methods A retrospective review was undertaken of calcaneus fracture patients at our institution from January 2011 through January 2014, and those with a diagnosis of psychiatric illness or history of psychotropic medication usage were identified. Medication records were analyzed along with medical histories taken during the initial encounter. If the patient was admitted, hospital notes for the hospitalization were reviewed to determine if any information was missed during the initial encounter. The date of injury, age, sex, insurance status at the time of initial encounter, psychiatric diagnoses or psychotropic medication use, and mechanism of injury were recorded. Any specific psychiatric diagnoses were collected from the patient charts, as was the presence of any specific prescribed psychotropic medications. After completion of the data collection, an attending psychiatrist verified the recorded data to ensure an accurate psychiatric assessment. Results A total of 85 calcaneus fractures met the inclusion criteria. In the population, there were 71 males and 14 females. The average age of the patients was 41.74 years, with 24% of patients having a diagnosis of psychiatric illness at the time of injury. The relative risk of a psychiatric illness in males compared to females was 0.31 (p = 0.009) while the relative risk of using psychotropic medication in males compared to females was 0.17 (p = 0.0007). Males were less likely to undergo operative intervention than females (p = 0.0001). The average age of a patient who either had a diagnosis or took medication for a psychiatric illness was 48.4 years, as compared to 39.7 years in those who did not (p = 0.014). Conclusion Males were less likely to have a psychiatric illness or be currently treated with psychotropic medications. A dedicated review of psychiatric history and prior medication may be useful during preoperative, perioperative, and postoperative treatment planning.  Level of Clinical Evidence: 4.

Association of Psychiatric Illness or Psychotropic Medication Usage with Calcaneus Fracture

PubMed Central

Goodrum, Jason T; Jupiter, Daniel; Wigg, Cindy L; Carmichael, Kelly

2017-01-01

Background There is a noticeable lack of studies examining the connection between psychiatric illness and orthopaedic injury. The goal of this study is to determine if a relationship exists between calcaneus fracture and psychiatric illness or use of psychotropic medication.  Methods A retrospective review was undertaken of calcaneus fracture patients at our institution from January 2011 through January 2014, and those with a diagnosis of psychiatric illness or history of psychotropic medication usage were identified. Medication records were analyzed along with medical histories taken during the initial encounter. If the patient was admitted, hospital notes for the hospitalization were reviewed to determine if any information was missed during the initial encounter. The date of injury, age, sex, insurance status at the time of initial encounter, psychiatric diagnoses or psychotropic medication use, and mechanism of injury were recorded. Any specific psychiatric diagnoses were collected from the patient charts, as was the presence of any specific prescribed psychotropic medications. After completion of the data collection, an attending psychiatrist verified the recorded data to ensure an accurate psychiatric assessment. Results A total of 85 calcaneus fractures met the inclusion criteria. In the population, there were 71 males and 14 females. The average age of the patients was 41.74 years, with 24% of patients having a diagnosis of psychiatric illness at the time of injury. The relative risk of a psychiatric illness in males compared to females was 0.31 (p = 0.009) while the relative risk of using psychotropic medication in males compared to females was 0.17 (p = 0.0007). Males were less likely to undergo operative intervention than females (p = 0.0001). The average age of a patient who either had a diagnosis or took medication for a psychiatric illness was 48.4 years, as compared to 39.7 years in those who did not (p = 0.014). Conclusion Males were less likely to have a psychiatric illness or be currently treated with psychotropic medications. A dedicated review of psychiatric history and prior medication may be useful during preoperative, perioperative, and postoperative treatment planning.  Level of Clinical Evidence: 4 PMID:29492366

Influence of Urban Residence on Use of Psychotropic Medications in Pennsylvania, USA: Cross-sectional Comparison of Older Adults Attending Senior Centers

PubMed Central

Edelstein, Offer; Pater, Karen; Sharma, Ravi; Albert, Steven M.

2014-01-01

Background Differences in medication use by geographic region may indicate differences in access to specialist medical care, especially in the case of prescriptions for psychotropic medications. We assessed the effect of more or less urbanized residence on likelihood of psychotropic medication use in a large cohort of older adults in Pennsylvania, USA. Methods Community-dwelling older adults were recruited from senior centers across PA. Participant residences were geocoded and categorized according to U.S. Department of Agriculture Rural-Urban Continuum Codes. We used the codes to identify respondents who live in relatively urban counties with 250,000 or more residents (n=1360) or less urban counties with fewer than 250,000 residents (n=401). Participants reported prescription medications in a clinical interview. Psychotropic medications were categorized by class. Logistic regression models were estimated to assess the independent effect of residence on likelihood of psychotropic medication use. Results Geographic region was significantly associated with use of psychotropic medications. Psychotropic medication use was higher in less urban areas (19.7%) relative to more urban areas (14.2%), p =.007. In adjusted models, degree of urban residence was a significant correlate in models that adjusted for sociodemographic features and medical status (odds ratio, 1.62; 95% confidence interval 1.13–2.31, p < .01). Use of psychotropic medications on the Beers list also increased with less urban residence (13.0% vs. 8.3%, p = .005). Conclusions Older adults living in less urbanized areas are more likely to be prescribed psychotropic drugs. This difference may indicate a health disparity based on access to geriatric specialists or mental health care. PMID:24357135

Influence of urban residence on use of psychotropic medications in Pennsylvania, USA: cross-sectional comparison of older adults attending senior centers.

PubMed

Edelstein, Offer; Pater, Karen; Sharma, Ravi; Albert, Steven M

2014-02-01

Differences in medication use by geographic region may indicate differences in access to specialist medical care, especially in the case of prescriptions for psychotropic medications. We assessed the effect of more or less urbanized residence on likelihood of psychotropic medication use in a large cohort of older adults in Pennsylvania, USA. Community-dwelling older adults were recruited from senior centers across Pennsylvania. Participant residences were geocoded and categorized according to US Department of Agriculture Rural-Urban Continuum Codes. We used the codes to identify respondents who live in relatively urban counties with 250,000 or more residents (n = 1,360) or less urban counties with fewer than 250,000 residents (n = 401). Participants reported prescription medications in a clinical interview. Psychotropic medications were categorized by class. Logistic regression models were estimated to assess the independent effect of residence on likelihood of psychotropic medication use. Geographic region was significantly associated with use of psychotropic medications. Psychotropic medication use was higher in less urban areas (19.7%) relative to more urban areas (14.2%), p = 0.007. In adjusted models, degree of urban residence was a significant correlate in models that adjusted for sociodemographic features and medical status (odds ratio 1.62; 95% confidence interval 1.13-2.31, p < 0.01). Use of psychotropic medications on the Beers list also increased with less urban residence (13.0 vs. 8.3%, p = 0.005). Older adults living in less urbanized areas are more likely to be prescribed psychotropic drugs. This difference may indicate a health disparity based on access to geriatric specialists or mental health care.

Mental health policy and psychotropic drugs.

PubMed

Frank, Richard G; Conti, Rena M; Goldman, Howard H

2005-01-01

The pace of innovation in psychotropic drugs has been rapid over the past 15 years. There also have been unprecedented increases in spending on prescription drugs generally and psychotropic medications specifically. Psychotropic medications are playing a more central role in treatment. They also are receiving close scrutiny from health insurers, state budget makers, and ordinary citizens. Public policy actions regarding prescription drugs have the potential to significantly affect clinical care for mental disorders, the costs of this care to individuals and society at large, and the prospects for future scientific advances. This article outlines the policy issues related to psychotropic drugs with respect to their role in determining access to mental health treatment and the cost and quality of mental health care.

Mental Health Policy and Psychotropic Drugs

PubMed Central

Frank, Richard G; Conti, Rena M; Goldman, Howard H

2005-01-01

The pace of innovation in psychotropic drugs has been rapid over the past 15 years. There also have been unprecedented increases in spending on prescription drugs generally and psychotropic medications specifically. Psychotropic medications are playing a more central role in treatment. They also are receiving close scrutiny from health insurers, state budget makers, and ordinary citizens. Public policy actions regarding prescription drugs have the potential to significantly affect clinical care for mental disorders, the costs of this care to individuals and society at large, and the prospects for future scientific advances. This article outlines the policy issues related to psychotropic drugs with respect to their role in determining access to mental health treatment and the cost and quality of mental health care. PMID:15960772

CLINICALLY SIGNIFICANT PSYCHOTROPIC DRUG-DRUG INTERACTIONS IN THE PRIMARY CARE SETTING

PubMed Central

English, Brett A.; Dortch, Marcus; Ereshefsky, Larry; Jhee, Stanford

2014-01-01

In recent years, the growing numbers of patients seeking care for a wide range of psychiatric illnesses in the primary care setting has resulted in an increase in the number of psychotropic medications prescribed. Along with the increased utilization of psychotropic medications, considerable variability is noted in the prescribing patterns of primary care providers and psychiatrists. Because psychiatric patients also suffer from a number of additional medical comorbidities, the increased utilization of psychotropic medications presents an elevated risk of clinically significant drug interactions in these patients. While life-threatening drug interactions are rare, clinically significant drug interactions impacting drug response or appearance of serious adverse drug reactions have been documented and can impact long-term outcomes. Additionally, the impact of genetic variability on the psychotropic drug’s pharmacodynamics and/or pharmacokinetics may further complicate drug therapy. Increased awareness of clinically relevant psychotropic drug interactions can aid clinicians to achieve optimal therapeutic outcomes in patients in the primary care setting. PMID:22707017

Psychotropic Medication Trends among Children and Adolescents with Autism Spectrum Disorder in the Medicaid Program

ERIC Educational Resources Information Center

Schubart, Jane R.; Camacho, Fabian; Leslie, Douglas

2014-01-01

This study characterized psychotropic medication use among Medicaid-enrolled children and adolescents with autism spectrum disorders by examining trends over time, including length of treatment and polypharmacy using 4 years of administrative claims data from 41 state Medicaid programs (2000-2003). The data set included nearly 3 million children…

Antiepileptic Drugs with Mood Stabilizing Properties and Their Relation with Psychotropic Drug Use in Institutionalized Epilepsy Patients with Intellectual Disability

ERIC Educational Resources Information Center

Leunissen, C. L. F.; de la Parra, N. M.; Tan, I. Y.; Rentmeester, Th. W.; Vader, C. I.; Veendrick-Meekes, M. J. B. M.; Aldenkamp, A. P.

2011-01-01

A large number of patients with epilepsy and intellectual disability take medication, amongst which antiepileptic and psychotropic drugs, often simultaneously. Certain antiepileptic drugs have mood-stabilizing properties, e.g. carbamazepine, valproic acid and lamotrigine. The aim of this study was to investigate whether the use of these…

Increase in the prescription rate of antidepressants after the Sewol Ferry disaster in Ansan, South Korea.

PubMed

Han, Kyu-Man; Kim, Kyoung-Hoon; Lee, Mikyung; Lee, Sang-Min; Ko, Young-Hoon; Paik, Jong-Woo

2017-09-01

Previous pharmaco-epidemiological studies have reported increases in the prescription of psychotropic medications after a disaster, reflecting post-disaster changes in psychiatric conditions and mental health service utilization. We investigated changes in the prescription of psychotropic medications in the Danwon district of Ansan city (Ansan Danwon) compared to a control community before and after the Sewol Ferry disaster on April 16, 2014. Data was collected from the Korean Health Insurance Review and Assessment Service database. We analyzed the prescription rates of psychotropic medications including antidepressants, anxiolytics, and sedatives/hypnotics, and investigated whether the time-series pattern of monthly prescriptions per 100,000 people was different in Ansan Danwon compared to that in Cheonan city after the Sewol Ferry disaster through difference-in-differences regression analysis. Ansan Danwon showed a significantly greater increase (5.6%) in the prescription rate of antidepressants compared to Cheonan city following the Sewol Ferry disaster. There were no significant differences in changes in the prescription rates of anxiolytics or sedatives/hypnotics. In the secondary analysis, a significantly greater increase in the prescription rate of antipsychotics was observed in Ansan Danwon compared to a control community after the disaster. We could not exclude the possibility that other events influenced changes in the prescription rates of psychotropic medications during the study period. Pharmaco-epidemiological studies on psychotropic medication prescription after a disaster provide important information about population-level mental health. Our results suggest that the Sewol Ferry disaster exerted a harmful effect on the mental health status of the affected community. Copyright © 2017 Elsevier B.V. All rights reserved.

Non-adherence to Psychotropic Medication Among Adolescents - A Systematic Review of the Literature.

PubMed

Häge, Alexander; Weymann, Lisa; Bliznak, Lucia; Märker, Viktoria; Mechler, Konstantin; Dittmann, Ralf W

2018-01-01

Whether patients take their medication as prescribed is of increasing importance in adolescent psychiatry since both the number of efficacious pharmaceutical treatments and the rate of prescriptions of psychotropic compounds are on the rise. Previous research showed high rates of medication nonadherence among both adolescents with medical disorders and adult patients with psychiatric disorders. The present review was performed according to PRISMA guidelines and evaluates existing scientific literature concerning adherence to psychotropic medication among adolescents. The goal was to determine rates of nonadherence in this age group as well as the factors associated with it. Therefore, we conducted a comprehensive literature search of PubMed from its inception until 15 September 2015 using the keywords "adherence," "compliance," "adolescent," and "psychotropic medication." A total of 607 pertinent articles were collected and screened; 15 publications were selected for detailed review. The studies differed, among other things, regarding sample characteristics, medication type, and indications. Furthermore, the definitions of what constitutes nonadherence and the methods used to assess it varied widely. Nonadherence rates ranged from 6 % to 62 % (median 33 %). Nonadherence to psychotropic medication is a clinically relevant problem among adolescents. Because of the methodological heterogeneity across studies and partially contradictory results, no conclusions could be drawn concerning the influence of factors such as psychopathology, medication type, side effects, the effectiveness of treatment, or family-related factors. Well-designed long-term studies of large patient samples and a consensus regarding definitions are therefore warranted. Such research would facilitate the design of tailored strategies to improve adherence in these patients.

Racial and ethnic differences in psychotropic medication use among community-dwelling persons with dementia in the United States.

PubMed

Grace, Elsie L; Allen, Rebecca S; Ivey, Keisha; Knapp, Shannon M; Burgio, Louis D

2018-04-01

Little is known about the patterns of psychotropic medication use in community-dwelling minority persons with dementia (PWD). The purpose of this study was to investigate racial/ethnic differences in psychotropic medication use across a diverse population of community-dwelling PWD and to examine the extent to which caregiver characteristics influence this use. Data were drawn from the baseline assessment of the Resources for Enhancing Alzheimer's Caregiver Health II trial. Generalized linear models were used to identify racial/ethnic differences in psychotropic medication use. Akaike Information Criterion (AIC) model selection was used to evaluate possible explanations for observed differences across racial/ethnic group. Differences in anxiolytic and antipsychotic medication use were observed across racial/ethnic groups; however, race/ethnicity alone was not sufficient to explain those differences. Perceptions of caregiving and caregiver socioeconomic status were important predictors of anxiolytic use while PWD characteristics, including cognitive impairment, functional impairment, problem behavior frequency, pain, relationship to the caregiver, sex, and age were important for antipsychotic use. Racial/ethnic differences in psychotropic medication use among community-dwelling PWD cannot be explained by race/ethnicity alone. The importance of caregiver characteristics in predicting anxiolytic medication use suggest that interventions aimed at caregivers may hold promise as an effective alternative to pharmacotherapy.

Prevention of overlapping prescriptions of psychotropic drugs by community pharmacists.

PubMed

Shimane, Takuya; Matsumoto, Toshihiko; Wada, Kiyoshi

2012-10-01

The nonmedical use or abuse of prescription drugs, including psychotropic medicines, is a growing health problem in Japan. Patient access to psychotropic drugs, specifically from the oversupply of medications due to overlapping prescriptions, may increase the risk of drug abuse and dependence. However, very little is known about such overlapping prescriptions. Today, the dispensing of prescriptions is generally moving from inside to outside of hospitals, with psychotropic drugs mainly dispensed at community pharmacies. In this study, we used health insurance claims (i.e., receipts) for dispensing as the main source of information in an investigation of overlapping prescriptions of psychotropic drugs. A total of 119 patients were found to have received overlapping prescriptions, as identified by community pharmacists who were members of the Saitama Pharmaceutical Association, using patient medication records, followed by medication counseling and prescription notes for the patient. According to our findings, the most frequently overlapping medication was etizolam. Etizolam can be prescribed for more than 30 days since it is not regulated under Japanese law as a "psychotropic drug." Generally, when a drug can be prescribed for a greater number of days, it increases the likelihood of an overlapping prescription during the same period. As a result, the long-term prescription of etizolam increases the risk of overlapping prescriptions. We also found that the patients who received overlapping prescriptions of etizolam were mostly elderly and the most common pattern was prescription from both internal medicine and orthopedics physicians. Etizolam has wide range of indications that are covered by health insurance. Our results suggest that patients who received overlapping prescriptions of etizolam may receive prescriptions from different prescribers for different purposes. Therefore, it may be appropriate to regulate etizolam as a "psychotropic drug" under Japanese law, thus setting a limit on the period for which it can be prescribed in order to help prevent long-term and overlapping prescriptions.

Endocrine and Metabolic Adverse Effects of Psychotropic Medications in Children and Adolescents

ERIC Educational Resources Information Center

Correll, Christoph U.; Carlson, Harold E.

2006-01-01

Objective: Despite increasing use of psychotropic medications in children and adolescents, data regarding their efficacy and safety are limited. Endocrine and metabolic adverse effects are among the most concerning adverse effects of commonly used psychotropic medications. Method: Selective review of endocrine and metabolic effects of psychotropic…

Psychotropic and Anticonvulsant Drug Usage in Early Childhood Special Education Programs I. Phase One: A Preliminary Report: Prevalence, Attitude, Training, and Problems.

ERIC Educational Resources Information Center

Gadow, Kenneth D.

As part of a three phase study designed to survey the teachers and parents of children receiving psychotropic and anticonvulsant drugs, 208 teachers of preschool special education children on medication were mailed questionnaires. The Early Childhood Medication Questionnaire used in the survey included items relating to teacher, program, and…

Mental health issues among college students: who gets referred for psychopharmacology evaluation?

PubMed

Kirsch, Daniel J; Doerfler, Leonard A; Truong, Debbie

2015-01-01

To describe diagnostic and psychotropic medication prescription characteristics among college students referred by college counseling centers for psychopharmacologic evaluation. Participants were 540 college students referred by 6 college counseling centers in Massachusetts between November 2005 and May 2011. Students completed self-report measures of depression, anxiety, suicidal ideation and attempts, and substance use. Information regarding DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th edition) diagnosis, previous history of medication prescription, and current psychotropic medication(s) prescribed by the consulting psychiatrist was obtained from medical records. Depression, anxiety, and attention-deficit/hyperactivity disorder (ADHD) were the most common psychiatric problems identified in students. Half of these students had been prescribed mediation prior to evaluation. Antidepressant medication was the most frequently prescribed medication. A large proportion of students reported previous thoughts of suicide, and 12% had made at least 1 suicide attempt. Depression, anxiety, and ADHD are common among students referred by college counseling centers for medication evaluation and treatment.

Experience of Psychotropic Medication -An Interview Study of Persons with Psychosis.

PubMed

Bülow, Per; Andersson, Gunnel; Denhov, Anne; Topor, Alain

2016-11-01

Psychotropic drugs, particularly antipsychotic types, are a cornerstone of the treatment of people with psychosis. Despite numerous studies showing that drug treatment with psychotropic drugs initially alleviates psychiatric symptoms, the proportion of people with mental health problems and symptoms that do not follow doctors' prescriptions, thus exhibiting so-called non-adherence, is considerable. Non-adherence is predominantly seen as a clinical feature and as a patient characteristic that is especially due to patients' poor understanding that they are ill. There is also a widespread notion that non-adherence is of great disadvantage to the patient. This article is based on interviews with 19 persons diagnosed with psychosis. It challenges the notion of patients being either adherent or non-adherent to the doctor's orders. The findings show that persons with psychosis are active agents when it comes to adjusting medication. The interviewees created their own strategies to gain power over treatment with psychotropic drugs. The most common strategies were to adjust the doses or take breaks of varying lengths from the medication. These deviations from prescriptions were important to conceal, not only from their own psychiatrists, but from all psychiatric staff.

Drug-drug interactions as a result of co-administering Δ9-THC and CBD with other psychotropic agents.

PubMed

Rong, Carola; Carmona, Nicole E; Lee, Yena L; Ragguett, Renee-Marie; Pan, Zihang; Rosenblat, Joshua D; Subramaniapillai, Mehala; Shekotikhina, Margarita; Almatham, Fahad; Alageel, Asem; Mansur, Rodrigo; Ho, Roger C; McIntyre, Roger S

2018-01-01

To determine, via narrative, non-systematic review of pre-clinical and clinical studies, whether the effect of cannabis on hepatic biotransformation pathways would be predicted to result in clinically significant drug-drug interactions (DDIs) with commonly prescribed psychotropic agents. Areas covered: A non-systematic literature search was conducted using the following databases: PubMed, PsycInfo, and Scopus from inception to January 2017. The search term cannabis was cross-referenced with the terms drug interactions, cytochrome, cannabinoids, cannabidiol, and medical marijuana. Pharmacological, molecular, and physiologic studies evaluating the pharmacokinetics of Δ 9 -tetrahydrocannabinol (Δ 9 -THC) and cannabidiol (CBD), both in vitro and in vivo, were included. Bibliographies were also manually searched for additional citations that were relevant to the overarching aim of this paper. Expert opinion: Δ 9 -Tetrahydrocannabinol and CBD are substrates and inhibitors of cytochrome P450 enzymatic pathways relevant to the biotransformation of commonly prescribed psychotropic agents. The high frequency and increasing use of cannabis invites the need for healthcare providers to familiarize themselves with potential DDIs in persons receiving select psychotropic agents, and additionally consuming medical marijuana and/or recreational marijuana.

The prognostic impact of psychotropic drugs in intentional drug overdose.

PubMed

Tournier, M; Grolleau, A; Cougnard, A; Verdoux, H; Molimard, M

2009-03-01

Psychotropic drugs belong to the drugs most frequently involved in intentional drug overdose (IDO). Few studies have explored their prognostic impact during hospitalisation for IDO. In order to assess which types of psychotropic drugs ingested during IDOs were associated with an increased morbidity, a cohort study included 1,974 patients consecutively hospitalised for IDO. IDOs were categorised as serious if associated with one of the following criteria: death, hospitalisation longer than 48 h, respiratory support, vasopressive drugs, cardiac massage or dialysis. Nearly all the patients ingested psychotropic medications during the IDO (88.4%), most often benzodiazepines (71.6%). Serious IDO was associated with tricyclics (OR 5.7; 95% CI 3.3-9.8), lithium (OR 4.3; 95% CI 1.6-11.6), carbamates (OR 2.7; 95% CI 1.8-4), anticonvulsants (OR 2.4: 95% CI 1.4-4.3), first-generation antipsychotics (OR 2.4; 95% CI 1.7-3.5) or selective serotonin reuptake inhibitors (SSRIs) (OR 1.6; 95% CI 1.1-2.3). Some drugs may be dangerous because of low toxic doses; hence, prescriptions of short duration may be recommended. Moreover, for safety reasons, prescribers may prefer SSRIs to tricyclics and benzodiazepines to carbamates or phenothiazines.

The impact of a good practice manual on professional practice associated with psychotropic PRN in acute mental health wards: an exploratory study.

PubMed

Baker, J A; Lovell, K; Harris, N

2008-10-01

As required or pro re nata (PRN) psychotropic medicines are frequently used in acute mental health wards. PRN is known to contribute to polypharmacy and high doses of antipsychotic medication. Few studies have attempted to improve clinician's use of these potentially harmful drugs. The objectives of the study were to determine the impact and acceptability of a good practice manual on prescribing and administration practices of PRN psychotropic medication in acute mental health wards. The study used a pre-post exploratory design with two acute mental health wards in the NW of England. Over the total trial period of 10 weeks, 28 of 35 patients received 484 doses of PRN. Patients had a mean of 3.6 prescriptions of 14 different PRN medications in 34 different dose combinations prescribed. Medication errors beyond poor quality of prescribing occurred in 23 of the 35 patients (65.7%). Prescription quality improved following the introduction of the intervention but quality of nursing notes reduced. Acceptability of the manual to both nursing and medical staff was high. The introduction of the manual appeared to influence some of the practices associated with the prescribing and administration of PRN psychotropic medications. Further, larger, more robust studies are required in this area. In particular research is required to identify the reasons why professionals continue to rely so heavily on using PRN medication.

Joint association of physical activity and overweight with subsequent psychotropic medication: a register-linked follow-up study among employees.

PubMed

Loponen, Tiina; Lallukka, Tea; Holstila, Ansku; Lahti, Jouni

2015-10-03

Physical activity level and overweight have shown associations with mental health problems but it is not known whether the risk of mental health problems due to overweight varies by physical activity. We examined joint association of physical activity and overweight with subsequent psychotropic medication among 40-60-year-old employees. The questionnaire survey data were derived from Helsinki Health Study baseline postal questionnaires in 2000-02 among employees of the City of Helsinki aged 40-60 years (n = 8960, response rate 67%). Baseline survey data were linked with prospective register data on prescribed psychotropic medication (ATC-codes N05 and N06, except N06D) among those with written consent (74%) for such linkage. The analyses included 6169 responders (78% women, corresponding to the target population). We divided participants into six groups according to their baseline self-reported body mass index and leisure-time physical activity using physically highly active normal-weight participants as a reference group. We used Cox regression analysis adjusted for age, gender, psychotropic medication prior to baseline, and socioeconomic position, marital status, working conditions, limiting long-standing illness, alcohol use, and smoking. At baseline, 49% were overweight and 23% were physically inactive. After adjusting for age and gender, inactive normal-weight (hazard ratio (HR) 1.3, 95% CI 1.1-1.5), moderately active overweight (HR 1.3, 95% CI 1.1-1.5) and inactive overweight (HR 1.4, 95% CI 1.2-1.6) had higher risk for any psychotropic medication compared with group of highly active normal-weight. After adjusting for prior medication, only the inactive overweight group had higher risk (HR 1.4, 95% CI 1.2-1.6). Other covariates made but a minor contribution to the examined associations. For antidepressants the associations were somewhat stronger than for sedatives. Both normal-weight and physical activity help prevent psychotropic medication but physical activity dominates the association over normal-weight.

The Role of Health Systems Factors in Facilitating Access to Psychotropic Medicines: A Cross-Sectional Analysis of the WHO-AIMS in 63 Low- and Middle-Income Countries

PubMed Central

McBain, Ryan; Norton, Daniel J.; Morris, Jodi; Yasamy, M. Taghi; Betancourt, Theresa S.

2012-01-01

Background Neuropsychiatric conditions comprise 14% of the global burden of disease and 30% of all noncommunicable disease. Despite the existence of cost-effective interventions, including administration of psychotropic medicines, the number of persons who remain untreated is as high as 85% in low- and middle-income countries (LAMICs). While access to psychotropic medicines varies substantially across countries, no studies to date have empirically investigated potential health systems factors underlying this issue. Methods and Findings This study uses a cross-sectional sample of 63 LAMICs and country regions to identify key health systems components associated with access to psychotropic medicines. Data from countries that completed the World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS) were included in multiple regression analyses to investigate the role of five major mental health systems domains in shaping medicine availability and affordability. These domains are: mental health legislation, human rights implementations, mental health care financing, human resources, and the role of advocacy groups. Availability of psychotropic medicines was associated with features of all five mental health systems domains. Most notably, within the domain of mental health legislation, a comprehensive national mental health plan was associated with 15% greater availability; and in terms of advocacy groups, the participation of family-based organizations in the development of mental health legislation was associated with 17% greater availability. Only three measures were related with affordability of medicines to consumers: level of human resources, percentage of countries' health budget dedicated to mental health, and availability of mental health care in prisons. Controlling for country development, as measured by the Human Development Index, health systems features were associated with medicine availability but not affordability. Conclusions Results suggest that strengthening particular facets of mental health systems might improve availability of psychotropic medicines and that overall country development is associated with affordability. Please see later in the article for the Editors' Summary PMID:22303288

Psychotropic Medication Management for Youth in State Care: Consent, Oversight, and Policy Considerations

ERIC Educational Resources Information Center

Naylor, Michael W.; Davidson, Christine V.; Ortega-Piron, D. Jean; Bass, Arin; Gutierrez, Alice; Hall, Angela

2007-01-01

The use of psychotropic medications in youth with emotional disturbances in state custody is increasing and presents unique challenges concerning consent and oversight. We examine various means that state child welfare agencies use to provide consent for and oversight of psychotropic medications for children in state custody and describe benefits…

A Comparison of Psychotropic Drug Side Effect Profiles in Adults Diagnosed with Intellectual Disabilities and Autism Spectrum Disorders

ERIC Educational Resources Information Center

Hess, Julie; Matson, Johnny; Neal, Daniene; Mahan, Sara; Fodstad, Jill; Bamburg, Jay; Holloway, Jodie

2010-01-01

Forty-eight adults diagnosed with intellectual disabilities and Autistic Disorder or Pervasive Developmental Disorder-Not Otherwise Specified were examined with regard to psychotropic medication side effects. Participants were divided into 4 groups: no psychotropic medication group (n = 9); atypical antipsychotic medication group (n = 13);…

An Outline on Psychotropic Drug Use in the Developmentally Disabled Patient. Monograph #102.

ERIC Educational Resources Information Center

Vander Zanden, Jeanne A.

This introduction to basic principles of psychotropic drug use in developmentally disabled patients is intended to provide personnel working in the field with information on appropriate clinical use as well as potential risks. Presented in outline form, information is provided on five classes of psychotropic drugs: antipsychotics; antidepressants;…

Psychotropic Drug Patterns in a Large ICF/MR Facility: A Ten-Year Experience.

ERIC Educational Resources Information Center

Poindexter, Ann R.

1989-01-01

Psychotropic drug-prescribing patterns for 474 adults with mental retardation residing at an intermediate-care facility were examined for a 10-year period. Results indicated a progressive, marked decrease in total psychotropic drug usage and changes in the type of drugs prescribed with overall decline in drug usage. (Author/DB)

National Trends in Child and Adolescent Psychotropic Polypharmacy in Office-Based Practice, 1996-2007

ERIC Educational Resources Information Center

Comer, Jonathan S.; Olfson, Mark; Mojtabai, Ramin

2010-01-01

Objective: To examine patterns and recent trends in multiclass psychotropic treatment among youth visits to office-based physicians in the United States. Method: Annual data from the 1996-2007 National Ambulatory Medical Care Surveys were analyzed to examine patterns and trends in multiclass psychotropic treatment within a nationally…

Psychotropic Drug Use among College Students: Patterns of Use, Misuse, and Medical Monitoring

ERIC Educational Resources Information Center

Oberleitner, Lindsay M. S.; Tzilos, Golfo K.; Zumberg, Kathryn M.; Grekin, Emily R.

2011-01-01

Objective: To assess whether college students who use psychotropic drugs are (1) aware of potential side effects, (2) appropriately monitored by prescribing physicians, and (3) taking medications as prescribed. Participants: Fifty-five college students, currently taking psychotropic medications, were recruited between Summer 2008 and Fall 2009.…

Issues in Integrating Psychotropic and Intensive Behavioral Interventions for Students with Emotional and Behavioral Challenges in Schools

ERIC Educational Resources Information Center

Lloyd, Blair P.; Torelli, Jessica N.; Symons, Frank J.

2016-01-01

The prevalence of psychotropic medication use among students with emotional and behavioral challenges continues to increase as intensive behavioral interventions are designed and evaluated in schools. There is general consensus among clinical professionals that psychotropic medications are not "silver bullets" but should be expected to…

Competent Psychopharmacology

PubMed Central

Gardner, David M

2014-01-01

There is little doubt that undergraduate and post-graduate training of physicians, pharmacists, and nurses is insufficient to prepare them to use psychotropics safely and effectively, especially in the context of their expanded off-label uses. Therefore, the development of competencies in psychotropic prescribing needs to be approached as a long-term, practice-based learning commitment. Proposed are the abilities and knowledge components necessary for safe and effective use of psychotropics. Typical challenges in prescribing for chronic and recurrent illnesses include highly variable responses and tolerability, drug interactions, and adverse effects that can be serious, irreversible, and even fatal. Prescribing psychotropics is further complicated by negative public and professional reports and growing patient concerns about the quality of care, and questions about the efficacy, safety, and addictive risks of psychotropics. Increased efforts are needed to enhance clinical training and knowledge in psychopharmacology among trainees and practising clinicians, with more comprehensive and sustained attention to the assessment of individual patients, and greater reliance on patient education and collaboration. Improved competence in psychotropic prescribing should lead to more informed, thoughtful, and better-targeted applications as one component of more comprehensive clinical care. PMID:25161064

Effects of Psychosocial Interventions for Behavioral and Psychological Symptoms in Dementia on the Prescription of Psychotropic Drugs: A Systematic Review and Meta-Analyses.

PubMed

Birkenhäger-Gillesse, Elizabeth G; Kollen, Boudewijn J; Achterberg, Wilco P; Boersma, Froukje; Jongman, Lydia; Zuidema, Sytse U

2018-03-01

Dementia is often accompanied by neuropsychiatric symptoms. Psychotropic drugs for the treatment of neuropsychiatric symptoms are frequently used to manage these problems, but they are of limited effectiveness and can have serious side effects. Psychosocial interventions are advocated as first line treatment and may help to reduce psychotropic drug use. To assess the effect of multidisciplinary psychosocial interventions in nursing homes on the psychotropic drug prescription rate. Literature obtained from searches in 9 electronic databases was systematically reviewed. In addition, the pooled effects of specific psychosocial interventions in homogenous subgroups were analyzed (meta-analysis). Eleven randomized controlled studies that investigated multiple psychotropic drugs interventions (psychotropic drugs in 3, antipsychotics in 9, and antidepressants in 5 studies) as well as different types of psychosocial interventions were included. We separately analyzed interventions directed at the care staff level (educational programs in 3, in-reach services or consultation in 1, cultural or process change in 6 studies) and the individual resident level in 1 study. In 7 out of 9 studies reporting on antipsychotic drug use, the physician was actively involved. Nine studies in which antipsychotic drug use was specified reported a significant decrease in prescription rate as a result of psychosocial interventions [relative risk (RR) 0.71, 95% confidence interval (CI) 0.59-0.88], whereas meta-analysis of 5 studies investigating antidepressant drug use failed to show a significant effect (RR 0.82, 95% CI 0.64-1.02). Pooled effect sizes of 6 studies investigating cultural change, showed a significant decrease in antipsychotic drug use (RR 0.65, 95% CI 0.57-0.73). Effect sizes of 2 studies on educational programs on antipsychotic use were nonsignificant (RR 1.50, 95% CI 0.49-4.64). Sensitivity analysis of 7 studies reporting on antipsychotic drug use involving prescribing physicians showed a more robust decrease (RR 0.66, 95% CI 0.54-0.80). The results of this study show that psychosocial interventions may lead to a substantial reduction of antipsychotic drug prescription, especially in studies that reported on cultural change and that involved prescribing physicians. Conspicuously, a profound lack of information was observed in many studies as to what exactly constituted the care-as-usual treatment in the control group. Copyright © 2018 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Risk of low bone mineral density associated with psychotropic medications and mental disorders in postmenopausal women.

PubMed

Bolton, James M; Targownik, Laura E; Leung, Stella; Sareen, Jitender; Leslie, William D

2011-02-01

Independent reports suggest that various psychotropic medications and psychiatric disorders are associated with changes in bone mineral density (BMD). The objective of this study was to clarify the independent effects of a range of mental illnesses and psychotropic medications on BMD among postmenopausal women. Women 50 years or older with baseline BMD measured by dual-energy x-ray absorptiometry were identified in a database containing all clinical dual-energy x-ray absorptiometry test results for the Province of Manitoba, Canada. Records were linked with population-based administrative health databases to provide detailed information on sociodemographic factors, mental and physical health diagnoses, and prescription medication usage. Osteoporotic cases (n = 6820) were matched on age, sex, and ethnicity to 3 control subjects with normal BMD (n = 20,247). Multivariable conditional logistic regression compared cases and control subjects on diagnosed mental illnesses and use of psychotropic medications. Selective serotonin reuptake inhibitors (adjusted odds ratios, 1.46; 95% confidence interval [CI], 1.25-1.69), atypical antipsychotics (AOR, 1.55; 95% CI, 1.06-2.28), and benzodiazepines (AOR, 1.17; 95% CI, 1.06-1.29) were associated with higher risk of osteoporosis. Tricyclic antidepressants were associated with lower odds of osteoporosis (AOR, 0.57; 95% CI, 0.49-0.65). These drug effects were independent of mental illness diagnoses including depression (AOR, 0.86; 95% CI, 0.75-0.98) and schizophrenia (AOR, 1.98; 95% CI, 1.04-3.77). Some psychotropic medications are associated with an increased risk of osteoporotic BMD, whereas tricyclic antidepressants may be protective against osteoporosis, and these effects are independent of mental illness diagnoses. Clinicians should consider these effects when prescribing psychotropic medications in postmenopausal women.

Psychotropic Polypharmacy Among Youths With Serious Emotional and Behavioral Disorders Receiving Coordinated Care Services.

PubMed

Wu, Benjamin; Bruns, Eric J; Tai, Ming-Hui; Lee, Bethany R; Raghavan, Ramesh; dosReis, Susan

2018-06-01

The study examined differences in psychotropic polypharmacy among youths with serious emotional and behavioral disorders who received coordinated care services (CCS) that used a wraparound model and a matched sample of youths who received traditional services. A quasi-experimental design compared psychotropic polypharmacy one year before and one year after discharge from CCS. The cohort was youths with serious emotional and behavioral disorders who were enrolled in CCS from December 2009 through May 2014. The comparison group was youths with serious emotional and behavioral disorders who received outpatient mental health services during the same time. Administrative data from Medicaid, child welfare, and juvenile justice services were used. A difference-in-difference analysis with propensity score matching evaluated the CCS intervention by time effect on psychotropic polypharmacy. In both groups, most youths were male, black, and 10-18 years old, with attention-deficit hyperactivity disorder (54%-55%), mood disorder (39%-42%), depression (26%-27%), and bipolar disorder (25%-26%). About half of each group was taking an antipsychotic. The percentage reduction in polypharmacy from one year before CCS enrollment to one year after discharge was 28% for the CCS group and 29% for the non-CCS group, a nonsignificant difference. CCS youths excluded from the analysis had more complex mental health needs and a greater change in polypharmacy than the CCS youths who were included in the analytic sample. Mental health care coordination had limited impact in reducing psychotropic polypharmacy for youths with less complex mental health needs. Further research is needed to evaluate the effect on psychotropic polypharmacy among youths with the greatest mental health needs.

Educational gradients in psychotropic medication use among older adults in Costa Rica and the United States.

PubMed

Domino, Marisa Elena; Dow, William H; Coto-Yglesias, Fernando

2014-10-01

The relationship of education, psychiatric diagnoses, and use of psychotropic medication has been explored in the United States, but little is known about this relationship in poorer countries, despite the high burden of mental illness in these countries. This study estimated educational gradients in diagnosis and psychotropic drug use in the United States and Costa Rica, a middle-income country with universal health insurance. Analyses were conducted by using data of older adults (≥60) from the 2005 U.S. Medical Expenditure Panel Survey (N=4,788) and the 2005 Costa Rican Longevity and Healthy Aging Study (N=2,827). Logistic regressions examined the effect of education level (low, medium, or high) and urban residence on the rates of self-reported mental health diagnoses, screening diagnosis, and psychotropic medication use with and without an associated psychiatric diagnosis. Rates of self-reported diagnoses were lower in the United States (12%) than in Costa Rica (20%), possibly reflecting differences in survey wording. In both countries, the odds of having depression were significantly lower among persons with high education. In Costa Rica, use of psychotropic medication among persons with self-reported diagnoses increased by education level. The educational gradients in medication use were different in the United States and Costa Rica, and stigma and access to care in these countries may play an important role in these differences, although type of insurance did not affect educational gradients in the United States. These analyses increase the evidence of the role of education in use of the health care system.

Prescribing pattern of psychotropic medications in child psychiatric practice in a mental referral hospital in Botswana

PubMed Central

Olashore, Anthony; Ayugi, James; Opondo, Philip

2017-01-01

Introduction There is a growing preference for psycho-pharmacological therapy over non-pharmacological care. The prescription pattern and the choice of psychotropic medications vary in different settings. Whilst newer agents and rational prescribing are favored in the more specialized settings, the pattern remains unclear in less specialized units, largely due to lack of data. The aims were to conduct a treatment audit in the only mental referral hospital in Botswana, which is a non-specialized child and adolescent care setting and see how it conforms to best practice. Methods A retrospective audit which involved the extraction of socio-demographic and clinical information from the records of patients who were ≤ 17 years and seen from January 1, 2012-July 31, 2016. Results A total of 238 files were used for this report. Mean age (SD) was 12.41 (4.1) years. Of the 120 (50.4%) patients who had pharmacological intervention, only 85(70.8%) had monotherapy. The most commonly prescribed psychotropic agents were antipsychotics (40%). Off-label use of antipsychotics and polypharmacy were 31.2% and 29.2% respectively. Conclusion The level of conformity to standard practice in terms of psychotropic prescribing in our setting is consistent with the reports from developed countries where more specialized care ostensibly exists. Further studies will be necessary to determine the scope of psychotropic use. PMID:28491214

Use and Cost of Psychotropic Drugs among Recipients with Autism in a State Medicaid Fee-for-Service Programme

ERIC Educational Resources Information Center

Khanna, R.; Jariwala, K.; West-Strum, D.

2013-01-01

Background: There has been a significant increase in the prevalence of autism in the USA in the past few decades. The purpose of this study was to provide recent estimates of psychotropic drug use and costs among individuals with autism enrolled in the Medicaid programme. Method: A cross-sectional analysis of 2007 Mississippi (MS) Medicaid…

Psychotropic Medication Use among Children with Autism Spectrum Disorders Enrolled in a National Registry, 2007-2008

ERIC Educational Resources Information Center

Rosenberg, Rebecca E.; Mandell, David S.; Farmer, Janet E.; Law, J. Kiely; Marvin, Alison R.; Law, Paul A.

2010-01-01

Patterns of current psychotropic medication use among 5,181 children with autism spectrum disorders (ASD) enrolled in a Web-based registry were examined. Overall, 35% used at least one psychotropic medication, most commonly stimulants, neuroleptics, and/or antidepressants. Those who were uninsured or exclusively privately insured were less likely…

Adverse events and the relation with quality of life in adults with intellectual disability and challenging behaviour using psychotropic drugs.

PubMed

Scheifes, Arlette; Walraven, Sanne; Stolker, Joost Jan; Nijman, Henk L I; Egberts, Toine C G; Heerdink, Eibert R

2016-01-01

Psychotropic drugs are prescribed to approximately 30-40% of adults with intellectual disability (ID) and challenging behaviour, despite the limited evidence of effectiveness and the potential of adverse events. To assess the prevalence of adverse events in association with psychotropic drug use in adults with ID and challenging behaviour and to examine the relation of these adverse events with the person's quality of life. The presence of adverse events was measured with a questionnaire that had to be filled in by the physicians of the participants. Movement disorders were measured separately with a standardised protocol. The strength of the association between adverse events and Intellectual Disability Quality of Life-16 (IDQOL-16), and daily functioning was investigated using linear regression analyses, taking into account the severity of disease (CGI-S) as potential confounder. Virtually all of 103 adults with ID and challenging behaviour had at least one adverse event (84.4%) and almost half had ≥3 adverse events (45.6%) across different subclasses. Using psychotropic drugs increased the prevalence of adverse events significantly. Respectively 13% of the patients without psychotropic drugs and 61% of the patients with ≥2 psychotropic drugs had ≥3 adverse events. Having adverse events had a significantly negative influence on the quality of life. A large majority of all patients had at least one adverse event associated with psychotropic drug use. More attention is needed for these adverse events and their negative influence on the quality of life of these patients, taking into account the lack of evidence of effectiveness of psychotropic drugs for challenging behaviour. Copyright © 2015. Published by Elsevier Ltd.

The association of tanning behavior with psycho-tropic medication use among young adult women.

PubMed

Heckman, Carolyn J; Munshi, Teja; Darlow, Susan; Kloss, Jacqueline D; Manne, Sharon L; Perlis, Clifford; Oslin, David

2016-01-01

Despite its known association with skin cancer, tanning remains popular among young adult women. Indoor tanning behavior has been found to be associated with affective and addictive disorders. To better understand potential psychological and biological mechanisms of tanning behavior, we investigated associations between tanning and medication (psychotropic and other) use among young women. Two hundred and fifty-three women age 18-29 years old were recruited from two northeastern university campus communities. Women self-reported tanning frequency and chronic medication use. In both univariate and multivariate analyses, indoor tanning ≥12 times last year was significantly associated with use of psychotropic medication and anti-depressants in particular. Sunbathing was not associated with medication use. Potential reasons for associations between tanning and psychotropic medication use are discussed. Indoor tanners should be warned that some psychotropic medications are photosensitizing, thus increasing risk for burns and other skin damage from indoor tanning.

Accounting for psychotropic medication changes in prisons: patient and doctor perspectives.

PubMed

Hassan, Lamiece; Edge, Dawn; Senior, Jane; Shaw, Jenny

2015-07-01

Psychotropic medicines are widely used to treat mental illness; however, people entering prison commonly report that prescribed psychotropic medicines are changed or withdrawn, adding to their distress in difficult times. Drawing on three extracts from a larger qualitative dataset in which patients and doctors were interviewed about psychotropic medication use in English prisons, we combined discursive psychological and Foucauldian discourse analysis techniques to examine how individuals accounted for medication changes. Patients used four discursive strategies to organize descriptions of medication changes: they established entitlement to psychotropic medication, questioned the clinical judgment of prison doctors; highlighted communication problems; and attributed negative health outcomes to medication regime changes. In contrast, we examined an effective defense by a general practitioner, which showed how clinical needs were prioritized over previously held prescriptions when making prescribing decisions. Wider implications for continuity and equivalence of care between prisons and the wider community are discussed. © The Author(s) 2014.

Effect of Psychopharmacotherapy on Body Mass Index Among Children and Adolescents with Bipolar Disorders.

PubMed

Patel, Ayush; Chan, Wenyaw; Aparasu, Rajender R; Ochoa-Perez, Melissa; Sherer, Jeff T; Medhekar, Rohan; Chen, Hua

2017-05-01

To assess the long-term effect of all treatment options for pediatric bipolar disorders on body mass index (BMI) and to explore individual characteristics associated with less BMI increase during psychotropic medication exposures. A retrospective cohort study was conducted by using the 1995 to 2010 General Electric Electronic Medical Record database. Individuals aged 18 years or younger who had a new bipolar disorder episode were identified. Treatment exposure was defined based on the medication regimens patients received, which include atypical antipsychotic (AT) monotherapy, mood stabilizer (MS) monotherapy, antidepressant (AD) monotherapy, AT+MS polytherapy, AT+AD polytherapy, MS+AD polytherapy, and no treatment. Both treatment exposure and BMI were coded as time varying, which could change from month to month. According to the duration of treatment and the availability of BMI measures, individuals were followed for up to 3, 6, 9, and 12 months since the treatment initiation. Repeated-measures mixed models were applied to compare the impact of different medication regimens and the length of drug exposure on BMI after adjusting for the baseline BMI, sociodemographic factors, comorbidities, and psychotherapy. A total of 2299 treated and 4544 untreated children and adolescents who met the inclusion criteria were identified. Analysis using repeated-measures mixed models showed that those on AT monotherapy (the reference group) had a gradually diminished, but statistically significant, monthly increase in BMI during all durations of drug exposure (3 months: 0.36 kg/m 2 , 6 months: 0.20 kg/m 2 , 9 months: 0.17 kg/m 2 , and 12 months: 0.16 kg/m 2 ). As compared with AT monotherapy, the magnitude of increase in BMI associated with MS, AD monotherapy, and no treatment was significantly less at all time points, indicating less steep slopes of BMI change over time compared with AT monotherapy, especially during the short-term exposure. The combinations of AT with other psychotropic medications (ATMS, ATAD) were associated with a similar BMI increase as AT monotherapy. Individual characteristics found to be associated with a less increase in BMI during psychotropic medication exposure were being younger and having a higher baseline BMI. The long-term use of atypical antipsychotics, both as monotherapy or in combination with other psychotropic medications in children and adolescents with bipolar disorder, was associated with a steady and cumulative increase in BMI.

Psychotropic drug treatment in anorexia nervosa. Search for differences in efficacy/tolerability between adolescent and mixed-age population.

PubMed

Balestrieri, Matteo; Oriani, Maria Ginevra; Simoncini, Annalisa; Bellantuono, Cesario

2013-09-01

During the last 10 years, the use of psychotropic medications in youth with psychiatric disorders, including eating disorders, has significantly increased, but their role in the treatment of adolescent anorexia nervosa is still controversial. This paper aims to review the literature on the use of antidepressants and antipsychotics in adolescents with anorexia nervosa, comparing the efficacy and tolerability in this population with those reported in trials with patients not selected by age. A systematic review of the available literature published so far. Only few studies met the selection criteria. No strong evidence of beneficial effects was found in using antidepressants and antipsychotics neither in adults nor in adolescents. Side effects were more frequently reported in studies including adolescent population. Among psychotropic drugs, the majority of studies focused on olanzapine, which seems to have, in some studies, only positive effects on body mass index, eating disorder symptoms and functional impairment in both age groups. Copyright © 2013 John Wiley & Sons, Ltd and Eating Disorders Association.

[Daytime consequences of insomnia complaints in the French general population].

PubMed

Ohayon, M M; Lemoine, P

2004-01-01

Insomnia is a frequent symptom in the general population; numerous studies have proven this. In the past years, classifications have gradually given more emphasis to daytime repercussions of insomnia and to their consequences on social and cognitive functioning. They are now integrated in the definition of insomnia and are used to quantify its severity. If the daytime consequences of insomnia are well known at the clinical level, there are few epidemiological data on this matter. The aim of this study was to assess the daytime repercussions of insomnia complaints in the general population of France. A representative sample (n=5,622) aged 15 or older was surveyed by telephone with the help of the sleep-EVAL expert system, a computer program specially designed to evaluate sleep disorders and to manage epidemiological investigations. Interviews have been completed for 80.8% of the solicited subjects (n=5,622). The variables considered comprised insomnia and its daytime repercussions on cognitive functioning, affective tone, daytime sleepiness and diurnal fatigue. Insomnia was found in 18.6% of the sample. The prevalence was higher in women (22.4%) than in men (14.5%, p<0.001) with a relative risk of 1.7 (95% confidence interval 1.5 to 2) and was twice more frequent for subjects 65 years of age or older compared to subjects younger than 45 years. Approximately 30% of subjects reporting insomnia had difficulties initiating sleep. Nearly 75% of insomnia complainers reported having a disrupted sleep or waking up too early in the morning and about 40% said they had a non-restorative sleep. Repercussions on daytime functioning were reported by most insomnia subjects (67%). Repercussions on cognitive functioning changed according age, number of insomnia symptoms and the use of a psychotropic medication. A decreased efficiency was more likely to be reported by subjects between 15 and 44 years of age (OR: 2.9), those using a psychotropic (OR: 1.5), those reporting at least three insomnia symptoms (OR: 1.4) and women (OR: 1.4). The highest probability of the appearance of concentration difficulties was found in subjects younger than 65 Years, having a depressive disorder and using a psychotropic (15-44 years: OR 19.1; 45-64 years: OR 46.6). Difficulties maintaining attention were 15 times higher in subjects aged between 45 and 64 who were using a psychotropic and had also a depressive disorder. Memory difficulties were three times more likely to be reported by subjects using a psychotropic. At the affective level, irritability was 10 times more likely to be reported by subjects younger than 65 Years who were also using a psychotropic and had a depressive disorder. Independent of the presence of a mental disorder and the use of a psychotropic, subjects between 15 and 44 Years were five times more likely to be irritable following a bad sleep. Feeling depressed after a bad night's sleep was 18 times more likely to occur in subjects aged between 45 and 64 who were using a psychotropic and had a depressive disorder. Feeling anxious after a bad night's sleep was seven times more likely to occur in subjects with a depressive disorder. Daytime sleepiness was reported by approximately 20% of insomnia subjects. This rate was relatively comparable among gender, age groups, presence/absence of a mental disorder and use or not of a psychotropic. However, taking into account the interaction between age, use of a psychotropic and the presence of a mental disorder, subjects younger than 65 years, using a psychotropic and having a depressive disorder were at least 10 times more likely to report daytime sleepiness. Subjects who were suffering the most diurnal symptoms of insomnia were those younger than 65 years. Several factors can be evoked to explain this fact. These subjects were, for the most part, likelier to have a stricter sleep/wake schedule because of constraints imposed by work, studies, child care, etc. Subjects older than 65 Years were generally retired and therefore less prone to sleepiness and to cognitive difficulties. Insomnia consequences were limited due to their inactivity. Complementary studies should be undertaken to describe the daytime repercussions of insomnia for this specific age group of the general population and to measure these repercussions.

The association of the use of opioid and psychotropic medications with workers' compensation claim costs and lost work time.

PubMed

Tao, Xuguang Grant; Lavin, Robert A; Yuspeh, Larry; Weaver, Virginia M; Bernacki, Edward J

2015-02-01

To study the relationship between the use of psychotropic and opioid medications with workers' compensation disability and costs. The study population included lost time claimants injured between 1999 and 2002 followed to closing in December 31, 2009. Controlling for age, sex, marital status, attorney involvement, and spinal surgeries, multivariate logistic regression revealed that odds ratios (95% confidence interval) of claim costs ≥$100,000 compared with claimants who were never prescribed opioids were 4.3 for short-acting opioids only; 8.6 for any use of long-acting opioids; 2.8 for any use of hypnotics; 2.6 for any use of antipsychotics; 1.6 for any use of anti-anxiety agents; and 2.9 for any use of antidepressants. The use of psychotropic and opioid medications was associated with high workers' compensation costs and prolonged disability.

Changes in Psychotropic Drug Use in Long-Term Residents of an ICF/MR Facility.

ERIC Educational Resources Information Center

Hancock, Robert D.; And Others

1991-01-01

Psychotropic drug use was monitored for 139 persons residing continuously over a 10-year period in an Intermediate Care Facility for mentally retarded persons. Results indicated an ongoing decrease in psychotropic drug use, with usage decreasing from 30-12 percent. Antipsychotic medication was discontinued for 73 percent of the clients over the 10…

National Trends in Concomitant Psychotropic Medication with Stimulants in Pediatric Visits: Practice versus Knowledge

ERIC Educational Resources Information Center

Bhatara, Vinod; Feil, Michael; Hoagwood, Kimberly; Vitiello, Benedetto; Zima, Bonnie

2004-01-01

Objectives: (1) To examine U.S. national trends in the use of concomitant pharmacotherapy with the stimulant class of psychotropic drugs in youth; and (2) to present these trends in the context of (a) extant safety and efficacy data, and (b) overall trends in concomitant pharmacotherapy with psychotropic drugs for youth. Methods: Prescribing data…

Psychotropic drugs and the risk of fractures in old age: a prospective population-based study.

PubMed

Nurminen, Janne; Puustinen, Juha; Piirtola, Maarit; Vahlberg, Tero; Kivelä, Sirkka-Liisa

2010-07-06

There is evidence that the use of any psychotropic and the concomitant use of two or more benzodiazepines are related to an increased risk of fractures in old age. However, also controversial results exist. The aim was to describe associations between the use of a psychotropic drug, or the concomitant use of two or more of these drugs and the risk of fractures in a population aged 65 years or over. This study was a part of a prospective longitudinal population-based study carried out in the municipality of Lieto, South-Western Finland. The objective was to describe gender-specific associations between the use of one psychotropic drug [benzodiazepine (BZD), antipsychotic (AP) or antidepressant (AD)] or the concomitant use of two or more psychotropic drugs and the risk of fractures in a population 65 years or over. Subjects were participants in the first wave of the Lieto study in 1990-1991, and they were followed up until the end of 1996. Information about fractures confirmed with radiology reports in 1,177 subjects (482 men and 695 women) during the follow-up was collected from medical records. Two follow-up periods (three and six years) were used, and previously found risk factors of fractures were adjusted as confounding factors separately for men and women. The Poisson regression model was used in the analyses. The concomitant use of two or more BZDs and the concomitant use of two or more APs were related to an increased risk of fractures during both follow-up periods after adjusting for confounding factors in men. No similar associations were found in women. The concomitant use of several BZDs and that of several APs are associated with an increase in the risk of fractures in older men. Our findings show only risk relations. We cannot draw the conclusion that these drug combinations are causes of fractures.

Drug use during early pregnancy: cross-sectional analysis from the Childbirth and Health Study in Primary Care in Iceland.

PubMed

Axelsdottir, Thury O; Sigurdsson, Emil L; Gudmundsdottir, Anna M; Kristjansdottir, Hildur; Sigurdsson, Johann A

2014-09-01

To analyse drug use in early pregnancy with special focus on socio-demographic factors associated with psychotropic and analgesic drug use. Cross-sectional study. A total of 1765 women were invited via their local health care centres, and 1111 participated at 11-16 weeks of pregnancy by filling out a postal questionnaire concerning socio-demographic and obstetric background, stressful life events, and drug use. Drug use prior to and early on in pregnancy, socio-demographic factors, smoking, and adverse life events were investigated. Drug categories screened for were psychotropics (collective term for antidepressants, relaxants, and sleep medication), analgesics, hormones, nicotine, vitamins/minerals, and homeopathic medicine. Drug use from the aforementioned drug categories, excluding vitamins/minerals and homeopathic medicine, was reduced by 18% during early pregnancy, compared with six months prior to conception (49% vs. 60%). Psychotropic drug use during early pregnancy was associated with elementary maternal education (p < 0.5), being unemployed (p < 0.001), being single/divorced/separated (p < 0.01), smoking prior to or during pregnancy (p < 0.01), forced to change job/move house (p < 0.001), and psychotropic drug use six months prior to pregnancy (p < 0.001). No items on the stressful life events scale were associated with increased analgesic use, which increased only with multiparity. Use of analgesics and psychotropic drugs seems common in pregnancy. Our results indicate that lack of a support network, stressful life events, and lower status in society may predispose women to more drug use. GPs and midwives responsible for maternity care could take this into account when evaluating risk and gain for women and foetuses in the primary care setting.

Association of variants in SH2B1 and RABEP1 with worsening of low-density lipoprotein and glucose parameters in patients treated with psychotropic drugs.

PubMed

Delacrétaz, Aurélie; Zdralovic, Adna; Vandenberghe, Frederik; Saigi-Morgui, Nuria; Glatard, Anaïs; Quteineh, Lina; Gholam-Rezaee, Mehdi; Raffoul, Wassim; Applegate, Lee Ann; Jafari, Paris; Gamma, Franziska; von Gunten, Armin; Conus, Philippe; Eap, Chin B

2017-09-10

Genetic factors associated with Body Mass Index (BMI) have been widely studied over the last decade. We examined whether genetic variants previously associated with BMI in the general population are associated with cardiometabolic parameter worsening in the psychiatric population receiving psychotropic drugs, a high-risk group for metabolic disturbances. Classification And Regression Trees (CARTs) were used as a tool capable of describing hierarchical associations, to pinpoint genetic variants best predicting worsening of cardiometabolic parameters (i.e total, HDL and LDL-cholesterol, triglycerides, body mass index, waist circumference, fasting glucose, and blood pressure) following prescription of psychotropic drugs inducing weight gain in a discovery sample of 357 Caucasian patients. Significant findings were tested for replication in a second Caucasian psychiatric sample (n=140). SH2B1 rs3888190C>A was significantly associated with LDL levels in the discovery and in the replication sample, with A-allele carriers having 0.2mmol/l (p=0.005) and 0.36mmol/l (p=0.007) higher LDL levels compared to others, respectively. G-allele carriers of RABEP1 rs1000940A>G had lower fasting glucose levels compared to others in both samples (-0.16mmol/l; p<0.001 and -0.77mmol/l; p=0.03 respectively). The present study is the first to observe such associations in human subjects, which may in part be explained by a high risk towards dyslipidemia and diabetes in psychiatric patients receiving psychotropic treatments compared to population-based individuals. These results may therefore give new insight into the etiology of LDL-cholesterol and glucose regulation in psychiatric patients under psychotropic drug therapy. Copyright © 2017 Elsevier B.V. All rights reserved.

Prevalence of psychotropic medication use and association with challenging behaviour in adults with an intellectual disability. A total population study.

PubMed

Bowring, D L; Totsika, V; Hastings, R P; Toogood, S; McMahon, M

2017-06-01

There is a high prevalence of psychotropic medication use in adults with Intellectual Disabilities (ID), often in the absence of psychiatric disorder, also associated with challenging behaviour. Previous research has focused on specific sample frames or data from primary care providers. There is also a lack of consistency in the definition of challenging behaviour used. We adopted a total population sampling method. Medication data on 265 adults with ID were classified according to the Anatomical Therapeutic Chemical classification system. The Behaviour Problems Inventory - short form classified challenging behaviours. We examined the association between challenging behaviour and the use of psychotropic medication, and whether any association would still be present after accounting for socio-demographic and clinical characteristics. 70.57% of adults with ID were prescribed at least one class of any medication (mean per person =2.62; range 0-14). Psychotropic medications were used by 37.73% of participants with antipsychotics the commonest type used by 21.89% of individuals. Polypharmacy and high dosages were common. Generalised Linear Models indicated significant associations between psychotropic medication and the presence of a psychiatric diagnosis, challenging behaviour, older age and type of residence. Male gender was additionally associated with antipsychotic medication. The use of a total population sample identified via multiple routes is less likely to overestimate prevalence rates of medication use. Current challenging behaviour was a predictor of medication use after controlling for other variables. Data indicate that there may be differences in prescribing patterns associated with different topographies of challenging behaviours. © 2017 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

Unemployment and initiation of psychotropic medication: a case-crossover study of 2 348 552 Norwegian employees.

PubMed

Kaspersen, Silje L; Pape, Kristine; Ose, Solveig O; Gunnell, David; Bjørngaard, Johan Håkon

2016-11-01

The study investigated initiation of psychotropic medication in relation to unemployment in the months before, during and after job loss, to detect the period of greatest risk. The Norwegian working population in 2004 (N=2 348 552) was observed from 2005 to 2010 through administrative registries linked to the Norwegian Prescription Database. A case-crossover design was used to analyse within-person relative risk of incident purchases of prescribed psychotropic drugs in relation to timing of unemployment. Control periods were defined 12, 24 and 36 months before the drug purchase. Supplementary analyses were performed on medication for cardiovascular disease, diabetes, obesity, thyroid disorder, pain and musculoskeletal conditions. Purchases of all psychotropic drugs increased 1-3 months before job loss. Antidepressants had the highest estimate in the month before job loss (OR 2.68, 95% CIs 2.39 to 3.01), followed by hypnotics/sedatives (OR 2.21, 95% CI 1.97 to 2.48), anxiolytics (OR 2.18, 95% CI 1.91 to 2.48) and antipsychotics (OR 2.09, 95% CI 1.76 to 2.48). Rises were greatest in men. Risk of starting psychotropic medication remained raised during a spell of unemployment, but returned to close-to-baseline levels following re-employment. Drugs used to treat somatic and pain conditions showed similar trends but with weaker associations. Concerns about impending unemployment may influence mental health several months prior to job loss, especially around the time of notification. The clinical implications of this might be a strengthening of preventive health initiatives early in the unemployment process. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Exposure to reactive intermediate-inducing drugs during pregnancy and the incident use of psychotropic medications among children.

PubMed

Tran, Yen-Hao; Groen, Henk; Bergman, Jorieke E H; Hak, Eelko; Wilffert, Bob

2017-03-01

Our study aimed to investigate the association between prenatal exposure to reactive intermediate (RI)-inducing drugs and the initiation of psychotropic medications among children. We designed a cohort study using a pharmacy prescription database. Pregnant women were considered exposed when they received a prescription of RI-inducing drugs. These drugs could be either used alone (RI+/FAA-) or combined with drugs exhibiting folic acid antagonism (FAA, RI+/FAA+). The reference group included pregnant women who did not receive any RI-inducing drugs or FAA drugs. We analyzed 4116 exposed and 30 422 reference pregnancies. The hazard ratio (HR) with 95% confidence interval (CI) was 1.27 (95%CI 1.15-1.41) for pregnancies exposed to RI-inducing drugs as a whole. Considering subgroups of RI-inducing drugs, prenatal exposure to both RI+/FAA+ and RI+/FAA- was associated with the children's initiation of psychotropic medications, HRs being 1.35 (95%CI 1.10-1.66) and 1.26 (1.13-1.41), respectively. The HRs were increased with prolonged exposure to RI-inducing drugs, especially in the first and second trimesters. In a detailed examination of the psychotropics, the incidences of receiving antimigraine preparations and psychostimulants were significantly increased for the exposed children, compared with the reference children. The incidences of receiving antipsychotics and hypnotics were also higher for the exposed children; however, the HRs did not reach significance after adjustment. We found a significantly increased incident use of psychotropic medications among children prenatally exposed to RI-inducing drugs, especially during the first and second trimesters. This suggests a detrimental effect during critical periods of brain development. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

Implementation of a psychotropic drug review service in a mental retardation facility.

PubMed

Marcoux, A W

1985-11-01

A redesigned psychotropic drug review service was needed for our 650-bed intermediate care facility for the mentally retarded (ICF/MR). A committee consisting of a client's rights monitor, pharmacist, and psychologist prepared the necessary policy and procedure as well as data collection sheets. Meetings are now conducted in a semiformal fashion, with each discipline contributing in tis area of expertise. Since the inception of the restructured psychotropic drug review service, psychotropic medication dosages (neuroleptic agents only) have decreased at a projected annual rate of 17% and there have been no significant withdrawal reactions. This dosage decrease has saved the institution approximately $2800 to $3200 in medication costs after a 10-month period.

[An analysis of advertisements for psychotropic drugs in the Dutch Journal of Psychiatry ('Tijdschrift voor Psychiatrie')].

PubMed

Vandereycken, W; Kuyken, K

2009-01-01

Through the marketing of psychotropics the pharmaceutical industry is able to influence the way in which psychiatrists practise their profession. To look at the image of psychiatry as reflected in advertisements for psychotropics. method Quantitative and qualitative analysis of the advertisements for psychotropics in the Tijdschrift voor Psychiatrie between 1999 and 2006. On average 6 per cent of the total number of pages was given over annually to advertisements of psychotropics. The number of pages used for these advertisements changed over the years, with a sharp decline between 2002 and 2004. Before 2002 the majority of advertisements was for antidepressants, but later most of them were for antipsychotics. Three-quarters of the illustrations for antidepressants featured women whereas three-quarters of the illustrations for antipsychotics featured men. In general, the advertisements were of an 'emotional' nature and surprisingly few of them contained any scientific information. The advertisements for psychotropics portrayed a stereotyped image implying that it is mainly women who are depressed and mainly men who are psychotic. In its advertisements the pharmaceutical industry seeks primarily emotional reactions and uses hardly any scientific arguments. We wonder if the editorial boards of scientific journals should perhaps adopt a more critical attitude to these kinds of advertisements.

Mental health treatment patterns in perinatally HIV-infected youth and controls.

PubMed

Chernoff, Miriam; Nachman, Sharon; Williams, Paige; Brouwers, Pim; Heston, Jerry; Hodge, Janice; Di Poalo, Vinnie; Deygoo, Nagamah Sandra; Gadow, Kenneth D

2009-08-01

Youths perinatally infected with HIV often receive psychotropic medication and behavioral treatment for emotional and behavioral symptoms. We describe patterns of intervention for HIV-positive youth and youth in a control group in the United States. Three hundred nineteen HIV-positive youth and 256 controls, aged 6 to 17 years, enrolled in the International Maternal Adolescent AIDS Clinical Trials 1055, a prospective, 2-year observational study of psychiatric symptoms. One hundred seventy-four youth in the control group were perinatally exposed to HIV, and 82 youth were uninfected children living in households with HIV-positive members. Youth and their primary caregivers completed Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-referenced symptom-rating scales. Children's medication and behavioral psychiatric intervention histories were collected at entry. We evaluated the association of past or current psychiatric treatment with HIV status, baseline symptoms, and impairment by using multiple logistic regression, controlling for potential confounders. HIV-positive youth and youth in the control group had a similar prevalence of psychiatric symptoms (61%) and impairment (14% to 15%). One hundred four (18%) participants received psychotropic medications (stimulants [14%], antidepressants [6%], and neuroleptic agents [4%]), and 127 (22%) received behavioral treatment. More HIV-positive youth than youth in the control group received psychotropic medication (23% vs 12%) and behavioral treatment (27% vs 17%). After adjusting for symptom class and confounders, HIV-positive children had twice the odds of children in the control group of having received stimulants and >4 times the odds of having received antidepressants. Caregiver-reported symptoms or impairment were associated with higher odds of intervention than reports by children alone. HIV-positive children are more likely to receive mental health interventions than control-group children. Pediatricians and caregivers should consider available mental health treatment options for all children living in families affected by HIV.

Is psychotropic medication use related to organisational and treatment culture in residential care.

PubMed

Peri, Kathryn; Kerse, Ngaire; Moyes, Simon; Scahill, Shane; Chen, Charlotte; Hong, Jae Beom; Hughes, Carmel M

2015-01-01

The purpose of this paper is to establish the relationship between organisational culture and psychotropic medication use in residential care. Cross-sectional analyses of staff and resident's record survey in residential aged care facilities in Auckland, New Zealand (NZ). The competing values framework categorised organisational culture as clan, hierarchical, market driven or adhocracy and was completed by all staff. The treatment culture tool categorised facilities as having resident centred or traditional culture and was completed by registered nursing staff and general practitioners (GP). Functional and behavioural characteristics of residents were established by staff report and health characteristics and medications used were ascertained from the health record. Multiple regression was used to test for associations between measures of culture with psychotropic medication use (anxiolytics, sedatives, major tranquillisers). In total 199 staff, 27 GP and 527 residents participated from 14 facilities. On average 8.5 medications per resident were prescribed and 42 per cent of residents received psychotropic medication. Having a diagnosis of anxiety or depression (odds ratio (OR) 3.18, 95 per cent confidence interval (CI) 1.71, 5.91), followed by persistent wandering (OR 2.53, 95 per cent CI 1.59, 4.01) and being in a dementia unit (OR 2.45, 95 per cent CI 1.17, 5.12) were most strongly associated with psychotropic use. Controlling for resident- and facility-level factors, health care assistants' assignation of hierarchical organisational culture type was independently associated with psychotropic medication use, (OR 1.29, CI 1.08, 1.53) and a higher treatment culture score from the GP was associated with lower use of psychotropic medication (OR 0.95, CI 0.92, 0.98). Psychotropic medication use remains prevalent in residential care facilities in NZ. Interventions aimed at changing organisational culture towards a less hierarchical and more resident-centred culture may be another avenue to improve prescribing in residential aged care.

Effect of Post-Traumatic Stress Disorder on Cognitive Function and Covert Hepatic Encephalopathy Diagnosis in Cirrhotic Veterans.

PubMed

Burroughs, Thomas K; Wade, James B; Ellwood, Michael S; Fagan, Andrew; Heuman, Douglas M; Fuchs, Michael; Bajaj, Jasmohan S

2018-02-01

In veterans, post-traumatic stress disorder (PTSD) is often associated with substance abuse, which in turn can lead to cirrhosis. Cirrhotic patients are prone to cognitive impairment, which is typically due to covert hepatic encephalopathy (CHE), but can also be affected by PTSD. The aim was to define the impact of PTSD on cognitive performance and the diagnosis of CHE in cirrhotic patients. Outpatient veterans with cirrhosis underwent two separate modalities for CHE cognitive testing [Psychometric Hepatic Encephalopathy Scale (PHES) and Inhibitory Control Test (ICT)]. ICT tests for inhibitory control and response inhibition, while PHES tests for attention and psychomotor speed. Comparisons were made between patients with/without PTSD. Multivariable logistic regression with CHE on PHES and CHE on ICT as dependent variables including prior OHE, demographics, PTSD and psychotropic medications was performed. Of 402 patients with cirrhosis, 88 had evidence of PTSD. Fifty-five of these were on psychoactive medications, 15 were undergoing psychotherapy, while no specific PTSD-related therapy was found in 28 patients. Cirrhotic patients with/without PTSD were statistically similar on demographics and cirrhosis severity, but cirrhotic subjects with PTSD had a higher frequency of alcoholic cirrhosis etiology and psychotropic drug use. PTSD cirrhosis had higher ICT lure and switching errors (NCT-B response), but on regression, there was no significant impact of PTSD on CHE diagnosis using either the ICT or PHES. Veterans with cirrhosis and PTSD have a higher frequency of psychotropic drug use and alcoholic cirrhosis etiology. CHE diagnosis using PHES or ICT is not affected by concomitant PTSD.

Prevalence of use, abuse and dependence on legal and illegal psychotropic substances in an adolescent inpatient psychiatric population.

PubMed

Niethammer, Oliver; Frank, Reiner

2007-06-01

To examine the prevalence of use, abuse, and dependence on legal and illegal psychotropic substances in an adolescent in-patient psychiatric population in relation to age and gender. Participants were all consecutive admissions (patients aged from 14 to 17) to the adolescent psychiatric in-patient unit. Of the 86 patients who met all the criteria for taking part in the study 70 were interviewed, giving a response rate of 81%. Prevalence of use and of substance use disorders were assessed through structured diagnostic interviews (M-CIDI), conducted from March 2000 through July 2000. We found high prevalence of use and of the diagnosis of legal and illegal psychotropic substances. Around 76% reported a regular use of tobacco, 44% regular alcohol use, and 40% regular use of illegal substances. Diagnosis (abuse or dependence) was found in 50% of cases for nicotine, 29% for alcohol, and 26% for illegal substances. The adolescent in-patient psychiatric population is at high risk of use, abuse, and dependence on legal and illegal psychotropic substances. It is important to diagnose these disorders (anamnesis, screening tools) and to install preventive and therapeutic programs in clinical therapeutic settings.

Use of a computerized medication shared decision making tool in community mental health settings: impact on psychotropic medication adherence.

PubMed

Stein, Bradley D; Kogan, Jane N; Mihalyo, Mark J; Schuster, James; Deegan, Patricia E; Sorbero, Mark J; Drake, Robert E

2013-04-01

Healthcare reform emphasizes patient-centered care and shared decision-making. This study examined the impact on psychotropic adherence of a decision support center and computerized tool designed to empower and activate consumers prior to an outpatient medication management visit. Administrative data were used to identify 1,122 Medicaid-enrolled adults receiving psychotropic medication from community mental health centers over a two-year period from community mental health centers. Multivariate linear regression models were used to examine if tool users had higher rates of 180-day medication adherence than non-users. Older clients, Caucasian clients, those without recent hospitalizations, and those who were Medicaid-eligible due to disability had higher rates of 180-day medication adherence. After controlling for sociodemographics, clinical characteristics, baseline adherence, and secular changes over time, using the computerized tool did not affect adherence to psychotropic medications. The computerized decision tool did not affect medication adherence among clients in outpatient mental health clinics. Additional research should clarify the impact of decision-making tools on other important outcomes such as engagement, patient-prescriber communication, quality of care, self-management, and long-term clinical and functional outcomes.

Population-based survey of the prevalence of lower urinary tract symptoms in adolescents with and without psychotropic substance abuse.

PubMed

Tam, Y H; Ng, C F; Wong, Y S; Pang, K Ky; Hong, Y L; Lee, W M; Lai, P T

2016-10-01

To investigate the prevalence of lower urinary tract symptoms in adolescents and the effects of psychotropic substance use. This was a population-based cross-sectional survey using a validated questionnaire in students from 45 secondary schools in Hong Kong randomly selected over the period of January 2012 to January 2014. A total of 11 938 secondary school students (response rate, 74.6%) completed and returned a questionnaire that was eligible for analysis. Individual lower urinary tract symptoms and history of psychotropic substance abuse were documented. In this study, 11 617 non-substance abusers were regarded as control subjects and 321 (2.7%) were psychotropic substance users. Among the control subjects, 2106 (18.5%) had experienced at least one lower urinary tract symptom with urinary frequency being the most prevalent symptom (10.2%). Females had more daytime urinary incontinence (P<0.001) and males had more voiding symptoms (P=0.01). Prevalence of lower urinary tract symptoms increased with age from 13.9% to 25.8% towards young adulthood and age of ≥18 years (P<0.001). Among the substance users, ketamine was most commonly abused. Substance users had significantly more lower urinary tract symptoms than control subjects (P<0.001). In multivariate analysis, increasing age and psychotropic substance abuse increased the odds for lower urinary tract symptoms. Non-ketamine substance users and ketamine users were respectively 2.8-fold (95% confidence interval, 2.0-3.9) and 6.2-fold (4.1-9.1) more likely than control subjects to develop lower urinary tract symptoms. Females (odds ratio=9.9; 95% confidence interval, 5.4-18.2) were more likely to develop lower urinary tract symptoms than males (4.2; 2.5-7.1) when ketamine was abused. Lower urinary tract symptoms are prevalent in the general adolescent population. It is important to obtain an accurate history regarding psychotropic substance use when treating teenagers with lower urinary tract symptoms.

Psychotropic substance abuse among adolescents: a structural equation model on risk and protective factors.

PubMed

Rumpold, Gerhard; Klingseis, Michael; Dornauer, Kurt; Kopp, Martin; Doering, Stephan; Höfer, Stefan; Mumelter, Birgit; Schüssler, Gerhard

2006-01-01

The use of psychotropic substances in adolescents represents a serious public health problem. In this study a representative sample of 485 Austrian students between 14 and 18 years of age were investigated with a semistructured interview about substance-related issues and completed the general health questionnaire. The following rates of regular psychotropic substance use were found: cigarettes 41.4%, alcohol 44.5%, cannabis 10.1%, and other illicit substances 3%. Logistic regression analyses and structural equation modeling revealed the following major risk factors for substance use: peer pressure, negative family atmosphere, school difficulties, and psychopathology. Knowledge about substance use acted as a protective factor. Prevention of adolescent substance use and misuse should aim at these different targets. Information about coping with peer pressure may be a particularly promising route of intervention.

Concomitant use of analgesics and psychotropics in home-dwelling elderly people – Kuopio 75 + study

PubMed Central

Hartikainen, Sirpa; Mäntyselkä, Pekka; Louhivuori-Laako, Kirsti; Enlund, Hannes; Sulkava, Raimo

2005-01-01

Aims To investigate the extent of concomitant use of analgesic and psychotropic medicines among home-dwelling elderly people aged at least 75 years in Finland. Methods This was a population-based study in Finland, performed as part of Kuopio 75 + study focusing on the clinical epidemiology of diseases, medication and functional capacity. A random sample of 700 persons was drawn from the total population of the city of Kuopio, eastern Finland, aged 75 years on January 1, 1998 (n = 4518). Ninety-nine persons could not be examined and 78 were living in long-term institutions, so that the number of home-dwelling elderly persons amounted to 523. A trained nurse interviewed the participants about their use of medicines, and a geriatrician examined their overall physical and mental status. Dementia and depression were diagnosed according to the DSM IV criteria. Both regular and irregular prescribed and nonprescribed drug use was recorded. Results Every fourth elderly person (27.2%) used analgesics and psychotropics concomitantly, this use becoming twice as common with advancing age (19.6% in the age group 75–79 years, 38.2% among the oldest, aged 85 + years). Concomitant use of psychotropics and opioids also became more common with increasing age (2.8% in age group 75–79 years and 9.6% in the oldest group, aged 85 + years). The use of opioids was nearly twice as common among concomitant users (19.7%) than among those using only analgesics (11.3%). Concomitant users suffered from interfering daily pain and daily pain at rest more commonly than nonusers of analgesics. Depression, sleeping problems and polypharmacy were more common among the concomitant users, who had also had more hip fractures than the rest. Conclusions Concomitant use of analgesics and psychotropics becomes more common with advancing age and is a potential risk factor for adverse drug effects. PMID:16120070

[Nursing homes and fall in the consumption of psychotropic medications].

PubMed

Giet, Régis; Bonet, Claudine

The consumption of psychotropic drugs in elderly people remains a concern in France, including in nursing homes. A comparative analysis of prescriptions for psychotropic medication in nursing homes in 2013 and 2015 based on the computer system of the French national health insurance scheme shows a significant reduction in the prescribing of these medications. Example of a nursing home in Dijon. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Psychotropic drugs in opioid addicts on methadone treatment.

PubMed

Ferris, G N

1976-07-01

Psychotropic drug treatment of persons on methadone maintenance is discussed. Patients with clear target symptoms, such as anxiety, depression, or psychosis responded just as non-opioid addicts would to the major psychotropic agents. The minor tranquilizers are felt to be of doubtful value, and subject to abuse. Sleep disturbances cannot be treated by the usual means, as the drugs needed again are abused. However, chlorpromazine shows some promise here. Methods of drug delivery and goals of treatment must be adapted to the realities of this patient-group's characteristics, particularly anti-social traits, poor motivation and unreliability. Psychotropic drugs are unlikely to be of aid in multiple drug abusers, personality and character disorders, and opioid withdrawal. Four case histories are presented.

The use of psychotropic medications in young children: the facts, the controversy, and the practice.

PubMed

Stubbe, D E; Martin, A

2000-06-01

There has been recent concern by the public and physicians alike over reports that increasing numbers of young children are being prescribed psychotropic medications. The report by Zito and colleagues addressing this subject that appeared in the 23 February 2000 issue of JAMA sparked enormous controversy and was the impetus for a White House Conference just one month in its wake (20 March 2000). State and federal agencies have considered legislation to regulate the practice of prescribing psychotropic medications to preschool children. Special aspects of the use of psychotropic medication in preschool children are reviewed, with recommendations for evaluation and treatment decisions. The need for data and research in this area is highlighted.

Is the treatment worse than the cure? Attitudes toward medications among persons with severe mental illness.

PubMed

Van Dongen, C J

1997-03-01

1. Patients' attitudes toward taking long-term psychotropic medications and factors that may influence drug attitudes are important factors in compliance. 2. Patients in this study had generally positive drug attitudes and perceived their medications as important in preventing relapse. 3. Attitudes toward psychotropic medications may be more positive than has been assumed by mental health professionals, as patients seem to realize that the advantages of medications outweight side effects.

Prescribing patterns of psychotropic medications and clinical features in patients with major depressive disorder with and without comorbid dysthymia in China.

PubMed

Feng, Yuan; Sha, Sha; Hu, Chen; Wang, Gang; Ungvari, Gabor S; Chiu, Helen F K; Ng, Chee H; Si, Tian-Mei; Chen, Da-Fang; Fang, Yi-Ru; Lu, Zheng; Yang, Hai-Chen; Hu, Jian; Chen, Zhi-Yu; Huang, Yi; Sun, Jing; Wang, Xiao-Ping; Li, Hui-Chun; Zhang, Jin-Bei; Xiang, Yu-Tao

2017-03-01

Little has been reported about the demographic and clinical features of major depressive disorder (MDD) with comorbid dysthymia in Chinese patients. This study examined the frequency of comorbid dysthymia in Chinese MDD patients together with the demographic and clinical correlates and prescribing patterns of psychotropic drugs. Consecutively collected sample of 1178 patients with MDD were examined in 13 major psychiatric hospitals in China. Patients' demographic and clinical characteristics and psychotropic drugs prescriptions were recorded using a standardized protocol and data collection procedure. The diagnosis of dysthymia was established using the Mini International Neuropsychiatric Interview. Medications ascertained included antidepressants, antipsychotics, benzodiazepines, and mood stabilizers. One hundred and three (8.7%) patients fulfilled criteria for dysthymia. In multiple logistic regression analyses, compared to non-dysthymia counterparts, MDD patients with dysthymia had more depressive episodes with atypical features including increased appetite, sleep, and weight gain, more frequent lifetime depressive episodes, and less likelihood of family history of psychiatric disorders. There was no significant difference in the pattern of psychotropic prescription between the 2 groups. There are important differences in the demographic and clinical features of comorbid dysthymia in Chinese MDD patients compared with previous reports. The clinical profile found in this study has implications for treatment decisions. © 2016 John Wiley & Sons Australia, Ltd.

Patients with Korsakoff syndrome in nursing homes: characteristics, comorbidity, and use of psychotropic drugs.

PubMed

Gerridzen, Ineke J; Goossensen, M Anne

2014-01-01

Very limited literature exists on the care and course of patients with Korsakoff syndrome (KS) living in long-term care facilities (LTCFs). Even less literature can be found on the pharmacological treatment of behavioral symptoms of KS. The purpose of the present study was to describe baseline characteristics, comorbidity, and the use of psychotropic drugs in institutionalized patients with KS. In this cross-sectional descriptive study, 556 patients were included living in ten specialized care units in Dutch nursing homes. Data were collected by means of a retrospective chart review. The majority of patients were men (75%) and single (78%) with a mean age on admission of 56.7 years (SD 8.9, range 29.8-85.3). Mean length of stay was 6.0 years (SD 5.4, range 0.2-33.3). Sixty-eight percent of patients suffered from at least one somatic disease and 66% from at least one extra psychiatric disorder. One or more psychotropic drugs were prescribed to 71% of patients with a great variation in prescription patterns between the different nursing homes. Patients with KS depending on long-term care usually have comorbidity in more than one domain (somatic and psychiatric). The indications for prescribing psychotropic drugs are in many cases unclear and it seems probable that they are often given to manage challenging behavior. Longitudinal studies on the evidence for this prescription behavior and possible alternatives are recommended.

Management of Psychotropic Drug-Induced DRESS Syndrome: A Systematic Review.

PubMed

Bommersbach, Tanner J; Lapid, Maria I; Leung, Jonathan G; Cunningham, Julie L; Rummans, Teresa A; Kung, Simon

2016-06-01

Drug rash with eosinophilia and systemic symptoms (DRESS) is a severe cutaneous eruption that has been linked to several common drugs and drug categories, including antiepileptics, allopurinol, sulfonamides, and various antibiotics; however, because of a number of recent case reports linking psychotropic medications to this condition, DRESS is increasingly recognized among psychiatrists. We systematically reviewed all psychotropic drugs linked to DRESS syndrome, and this article summarizes the clinical management relevant to psychiatric professionals. A comprehensive search was performed using Ovid MEDLINE, Ovid EMBASE, Ovid Cochrane Database of Systematic Reviews, Web of Science, Scopus, and Litt's Drug Eruption and Reaction Database for articles published in English during the past 20 years (1996-2015) using the search terms (1) psychotropic drugs OR serotonin uptake inhibitors AND DRESS or (2) psychotropic drugs AND drug reaction (or rash) eosinophilia systemic syndrome, and all article abstracts were screened for inclusion and exclusion criteria by 3 reviewers. Two independent reviewers examined the full text of 163 articles, of which 96 (25 original articles, 12 review articles, 55 case reports, and 4 letters to the editor) were included in the systematic review. We identified 1072 cases of psychotropic drug-induced DRESS, with carbamazepine, lamotrigine, phenytoin, valproate, and phenobarbital being the most implicated drugs. Based on our review of the literature, we outline management principles that include prompt withdrawal of the causative drug, hospitalization, corticosteroid therapy, and novel treatments, including intravenous immunoglobulin, cyclophosphamide, and cyclosporine, for corticosteroid-resistant DRESS. Finally, we outline strategies for treating comorbid psychiatric illness after a DRESS reaction to the psychotropic medication. Copyright © 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Therapeutic drug monitoring of psychotropic medications

PubMed Central

Mitchell, Philip B

2000-01-01

Therapeutic drug monitoring (TDM) of a number of psychotropic medications has proven to be of value, enabling minimization of the limitations of considerable genetic variability in their metabolism and the high rates of poor compliance with many psychiatric disorders. Therapeutic ranges have been established for lithium, some of the tricyclic antidepressants, and clozapine. TDM has also been shown to be useful in avoiding toxicity (as many psychotropics have narrow therapeutic indices), particularly that due to interactions with other compounds. PMID:10759685

Psychotropic medication patterns among youth in juvenile justice.

PubMed

Lyons, Camilla L; Wasserman, Gail A; Olfson, Mark; McReynolds, Larkin S; Musabegovic, Hana; Keating, Joseph M

2013-03-01

This paper aims to determine the prevalence, patterns, and demographic and diagnostic correlates of psychotropic medication use in a sample of youth in one state's post-adjudicatory secure facilities. The health records database of the facilities was the source of linked demographic, diagnostic and pharmacy information for the 1-year period ending June 30, 2008. Age, gender, race, offense, prior petitions and diagnoses were examined across groups, and concomitant psychotropic pharmacotherapy patterns were identified. Period prevalence was 10.2% for youth ranging in age from 12 through 22 years who had any psychotropic drug prescribed during the first 30 days after intake to the facility. Among medicated youths, almost half received concomitant therapy. Medicated youth were significantly less likely to be Hispanic and more likely to endorse one or more diagnoses. Antidepressants, antipsychotics and antihistamines were the most commonly dispensed agents. Our findings revealed that the rate of psychotropic medication use was low, concomitant medication use was common, and ethnic/race differences in psychopharmacologic treatment were present in this sample of youths in post-adjudicatory secure facilities.

Characterization of Medication Use in a Multicenter Sample of Pediatric Inpatients with Autism Spectrum Disorder.

PubMed

Wink, Logan K; Pedapati, Ernest V; Adams, Ryan; Erickson, Craig A; Pedersen, Kahsi A; Morrow, Eric M; Kaplan, Desmond; Siegel, Matthew

2017-05-17

Nearly 11% of youth with Autism Spectrum Disorder (ASD) undergo psychiatric hospitalization, and 65% are treated with psychotropic medication. Here we characterize psychotropic medication usage in subjects enrolled in the Autism Inpatient Collection. Participant psychotropic medication usage rates topped 90% at admission and discharge, though there was a decline at 2-month follow-up. Antipsychotics, ADHD medications, and sleep aids were the most commonly reported classes of medications. The impact of age, gender, and non-verbal IQ on medication usage rates was minimal, though age and IQ may play a role in prescribing practices. Future work is indicated to explore medication usage trends, the impact of clinical factors on medication use rates, and the safety of psychotropic medications in youth with ASD.

[Safety and tolerability of psychotropic medications in childhood: preliminary data of a pharmacovigilance study].

PubMed

Magazù, A; Masi, G; Germanò, E; Gagliostro, M S; Siracusano, R; Arcoraci, V; Spina, E; Gagliano, A

2014-06-01

The aim of this study was to evaluate adverse drug reactions (ADRs) of psychotropic medications in childhood. One hundred and two children and adolescents (M 82.4%, F 17.6%) followed-up at the Division of Child Neurology and Psychiatry at the University of Messina, and at the Scientific Institute Child Neurology and Psychiatry, IRCCS Stella Maris, Calambrone, Pisa, were recruited between January 2009 and December 2011. All participants met DSM-IV diagnostic criteria for psychiatric disorders. The data were collected using a recording sheet for ADRs. An electronic database was also used. The recording sheet was designed to note all relevant information about drug treatment and ADRs according to AIFA (Agenzia Italiana del Farmaco) suggestions. The most prescribed drugs were: risperidone (19.6%), aripiprazole (18.4%) and valproic acid (14.8%). The ADRs more frequently recorded had been: weight gain (12.6%), sleepiness (8.4%), and irritability (6.7%). None of recorded ADRs were classified as "serious". This study can provide a basic model to collect information on safety and tolerability of psychotropic drugs in childhood.

[Effect of psychotropic drugs on activity of anticonvulsants in maximal electroshock test].

PubMed

Alikina, N A; Tregubov, A L; Kotegov, V P

2010-08-01

The effect ofpsychotropic drugs on the pharmacological properties of anticonvulsants was studied on white mice under maximal electroshock (ME) test conditions. Changes in the anticonvulsant effect of phenobarbital, diphenin, carbamazepine, hexamidine were traced upon their joint administration with psychotropic drugs, including piracetam, aminalon, amitriptyline, imizine, levomepromazine, and lithium oxybutyrate. An important result of research is the fact, that in no one of combinations the basic pharmacological effect of anticonvulsants was decreased. Based on the results of experiments, the most rational combinations of anticonvulsants with psychotropic preparations were revealed as manifested in the ME test. As criterion of rational combination was the increase in the activity of anticonvulsants and reduction of their toxicity in combination or at least invariance of this parameter. Rational combinations include (i) phenobarbital with piracetam, amitriptyline, levomepromazine, and lithium oxybutyrate; (ii) carbamazepine with piracetam; and (iii) hexamidine with amitriptyline, levomepromazine and imizine.

Psychotropic substances in indoor environments.

PubMed

Cecinato, Angelo; Romagnoli, Paola; Perilli, Mattia; Patriarca, Claudia; Balducci, Catia

2014-10-01

The presence of drugs in outdoor air has been established, but few investigations have been conducted indoors. This study focused on psychotropic substances (PSs) at three schools, four homes and one office in Rome, Italy. The indoor drug concentrations and the relationships with the outdoor atmosphere were investigated. The optimised monitoring procedure allowed for the determination of cocaine, cannabinoids and particulate fractions of nicotine and caffeine. In-field experiments were performed during the winter, spring and summer seasons. Psychotropic substances were observed in all indoor locations. The indoor concentrations often exceeded those recorded both outdoors at the same sites and at the atmospheric pollution control network stations, indicating that the drugs were released into the air at the inside sites or were more persistent. During winter, the relative concentrations of cannabinol, cannabidiol and tetrahydrocannabinol depended on site and indoor/outdoor location at the site. Copyright © 2014 Elsevier Ltd. All rights reserved.

Psychiatric disorders are overlooked in patients with drug abuse.

PubMed

Kruckow, Line; Linnet, Kristian; Banner, Jytte

2016-03-01

Psychiatric disease is overlooked in drug users. Patients with both drug abuse and a psychiatric disease - dual diagnosis - suffer decreased compliance to treatment and decreased life expectancy compared with single-diagnosis patients. Identifying the patients among either drug addicts or mentally ill patients is difficult. All drug addicts autopsied at the Department of Forensic Medicine, University of Copenhagen, Denmark, in the years 1992, 2002 and 2012 were included. The group was divided into two subpopulations of possible dual diagnosis patients either according to police reports stating mental illness or to psychotropics found in the toxicology screening after autopsy. We found a rise in possible mental illness in both subpopulations in the study period. Drug addicts with psychotropics in the blood at the time of death increased from 3.1% in 1992 to 48.1% in 2012, and this group was significantly younger at the time of death than those without psychotropics in the blood. Suspected dual diagnosis patients have increased in number. They die earlier than their drug addict counterparts. Methadone remains the leading cause of death in all subpopulations. Possible causes are misuse of treatment and/or illegally bought methadone, wrongly assigned cause of death due to unknown tolerance and/or polydrug toxicity in combination with psychotropic medicine. none. not relevant.

Oral health in patients taking psychotropic medications: Results from a pharmacy-based pilot study.

PubMed

Heaton, Lisa J; Swigart, Kimberly; McNelis, Gavin; Milgrom, Peter; Downing, Donald F

2016-01-01

Individuals with mental illness face an increased risk of oral disease compared with those without mental illness. The goals of this study were to examine the self-reported oral health and dental access of individuals filling psychotropic medication prescriptions and to determine whether pharmacy patients would choose to speak with a pharmacist about their oral health if given the option to do so. Pharmacists across 6 community pharmacies within a local chain identified and surveyed adult patients filling prescriptions for psychotropic medications. Surveys included questions about oral health, dry mouth, and dental care utilization. Six community pharmacy locations. Adults (≥18 years of age) filling prescriptions for psychotropic medications. Not applicable. Self-reported oral health, dental utilization, desire to discuss oral health with a pharmacist. Participants (N = 178) filling prescriptions were mostly (65.9%) female with a mean age of 48.2 years (SD 14.3, range 19-82 years). One in 4 (24.9%) said their mouths "always" or "frequently" felt dry; these individuals were significantly more likely to have last seen a dentist for emergency (rather than routine) treatment (P <0.01) and rated their oral health as significantly worse (P <0.001) than participants whose mouths "never" or "occasionally" feel dry. A small percentage (5.7%) requested to speak with pharmacists about oral health; they reported poorer oral health than those who opted not to speak with a pharmacist (P <0.05). One in 4 patients reported having dry mouth, and those with dry mouth reported significantly worse oral health than patients without dry mouth. Although dry mouth and poor oral health were common in this sample of individuals taking psychotropic medications, this did not consistently translate into seeking information regarding oral health. Future research will focus on pharmacist-initiated oral health interventions with high-risk patients. Copyright © 2016 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

Oral Health in Patients taking Psychotropic Medications: Results from a Pharmacy-Based Pilot Study

PubMed Central

Heaton, Lisa J.; Swigart, Kimberly; McNelis, Gavin; Milgrom, Peter; Downing, Donald F.

2016-01-01

Objectives Individuals with mental illness face an increased risk of oral disease compared to those without mental illness. The goals of this study were to examine the self-reported oral health and dental access of individuals filing psychotropic medication prescriptions; and to determine whether pharmacy patients would choose to speak with a pharmacist about their oral health if given the option to do so. Design Pharmacists across 6 community pharmacies within a local chain identified and surveyed adult patients filling prescriptions for psychotropic medications. Surveys included questions about oral health, dry mouth, and dental care utilization. Setting Six community pharmacy locations. Participants Adults (18+ years) filling prescriptions for psychotropic medications. Intervention Not applicable. Main Outcome Measures Self-reported oral health, dental utilization, desire to discuss oral health with a pharmacist. Results Participants (N=178) filling prescriptions were mostly (65.9%) female with a mean age of 48.2 years (s.d.=14.3; range 19–82 years). One in four (24.9%) said their mouths “always” or “frequently” felt dry; these individuals were significantly more likely to have last seen a dentist for emergency (rather than routine) treatment (p<0.01) and rated their oral health as significantly worse (p<0.001) than participants whose mouths “never” or “occasionally” feel dry. A small percentage (5.7%) requested to speak with pharmacists about oral health; they reported poorer oral health than those who opted not to speak with a pharmacist (p<0.05). Conclusions One in four patients reported having dry mouth, and those with dry mouth reported significantly worse oral health than patients without dry mouth. While dry mouth and poor oral health were common in this sample of individuals taking psychotropic medications, this did not consistently translate into information seeking regarding oral health. Future research will focus on pharmacist-initiated oral health interventions with high-risk patients. PMID:27263421

Early changes of blood lipid levels during psychotropic drug treatment as predictors of long-term lipid changes and of new onset dyslipidemia.

PubMed

Delacrétaz, Aurélie; Vandenberghe, Frederik; Gholam-Rezaee, Mehdi; Saigi Morgui, Nuria; Glatard, Anaïs; Thonney, Jacques; Solida-Tozzi, Alessandra; Kolly, Stéphane; Gallo, Sylfa Fassassi; Baumann, Philipp; Berney, Sylvie; Zulauff, Sandrine Valloton; Aubry, Jean-Michel; Hasler, Roland; Ebbing, Karsten; von Gunten, Armin; Conus, Philippe; Eap, Chin B

Cardiovascular diseases and dyslipidemia represent a major health issue in psychiatry. Many psychotropic drugs can induce a rapid and substantial increase of blood lipid levels. This study aimed to determine the potential predictive power of an early change of blood lipid levels during psychotropic treatment on long-term change and on dyslipidemia development. Data were obtained from a prospective study including 181 psychiatric patients with metabolic parameters monitored during the first year of treatment and with adherence ascertained. Blood lipid levels (ie, total cholesterol [TC], low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], non-high-density lipoprotein cholesterol [non-HDL-C], and fasting triglycerides [TGs]) were measured at baseline and after 1, 3, and/or 12 months of treatment. Receiver-operating characteristic analyses indicated that early (ie, after 1 month of psychotropic treatment) increases (≥5%) for TC, LDL-C, TG, and non-HDL-C and decrease (≥5%) for HDL-C were the best predictors for clinically relevant modifications of blood lipid levels after 3 months of treatment (≥30% TC, ≥40% LDL-C, ≥45% TG, ≥55% non-HDL-C increase, and ≥20% HDL-C decrease; sensitivity 70%-100%, specificity 53%-72%). Predictive powers of these models were confirmed by fitting longitudinal multivariate models in the same cohort (P ≤ .03) as well as in a replication cohort (n = 79; P ≤ .003). Survival models showed significantly higher incidences of new onset dyslipidemia (TC, LDL-C, and non-HDL-C hypercholesterolemia, HDL-C hypocholesterolemia, and hypertriglyceridemia) for patients with early changes of blood lipid levels compared to others (P ≤ .01). Early modifications of blood lipid levels following prescription of psychotropic drugs inducing dyslipidemia should therefore raise questions on clinical strategies to control long-term dyslipidemia. Copyright © 2017 National Lipid Association. Published by Elsevier Inc. All rights reserved.

Psychotropic Medication Burden and Factors Associated with Antipsychotic Use: An Analysis of a Population-Based Sample of Community-Dwelling Older Persons with Dementia

PubMed Central

Rhee, YongJoo; Csernansky, John G.; Emanuel, Linda L.; Chang, Chang-Gok; Shega, Joseph W.

2011-01-01

Objectives To estimate the proportion of community dwelling older adults with dementia being prescribed a psychotropic and identify patient and caregiver factors associated with antipsychotics use. Methods Retrospective cohort study of The Aging, Demographics, and Memory Study (ADAMS) from 2002 to 2004 designed to assess dementia severity and service use among community-dwelling older adults. The frequency of psychotropic medication (antipsychotics, antidepressants, anticonvulsants and benzodiazepines) use was tabulated and weighted to the US population by dementia diagnosis. Logistic regression analysis identified factors associated with antipsychotic use. Results The 307 participants of ADAMS had the following dementia diagnosis: Alzheimer’s disease (69.29%), vascular dementia (17.74%) and other dementia (12.39%). The proportion of participants prescribed a psychotropic medication broken down by therapeutic class was as 19.07% antipsychotics, 29.08% antidepressants, 9.84% benzodiazepines, and 8.85% anticonvulsants. Older adults with dementia were significantly more likely to receive an antipsychotic if they had moderate dementia (OR =7.4, p<0.05), or severe dementia (OR=5.80, p<0.05), compared to mild dementia or were diagnosed with Alzheimer (OR =6.7, p<0.05) dementia compared to vascular dementia. Older adults with dementia who lived with their caregivers in were significantly less likely to be medicated with antipsychotics (OR= 0.19, p<0.05) compared to those who lived alone. Also, persons with dementia were significantly less likely to be prescribed an antipsychotic if the caregivers were clinically depressed (OR=0.03, p<0.05) compared to those who were not depressed. Conclusion We found psychotropic medication use is common among community-dwelling older adults with dementia. Caregivers appear to have a substantial impact on whether or not an antipsychotic is prescribed, which adds additional complexity to conversations discussing the risk-benefit ratio of this medication class. PMID:22092099

An Original Stepwise Multilevel Logistic Regression Analysis of Discriminatory Accuracy: The Case of Neighbourhoods and Health

PubMed Central

Wagner, Philippe; Ghith, Nermin; Leckie, George

2016-01-01

Background and Aim Many multilevel logistic regression analyses of “neighbourhood and health” focus on interpreting measures of associations (e.g., odds ratio, OR). In contrast, multilevel analysis of variance is rarely considered. We propose an original stepwise analytical approach that distinguishes between “specific” (measures of association) and “general” (measures of variance) contextual effects. Performing two empirical examples we illustrate the methodology, interpret the results and discuss the implications of this kind of analysis in public health. Methods We analyse 43,291 individuals residing in 218 neighbourhoods in the city of Malmö, Sweden in 2006. We study two individual outcomes (psychotropic drug use and choice of private vs. public general practitioner, GP) for which the relative importance of neighbourhood as a source of individual variation differs substantially. In Step 1 of the analysis, we evaluate the OR and the area under the receiver operating characteristic (AUC) curve for individual-level covariates (i.e., age, sex and individual low income). In Step 2, we assess general contextual effects using the AUC. Finally, in Step 3 the OR for a specific neighbourhood characteristic (i.e., neighbourhood income) is interpreted jointly with the proportional change in variance (i.e., PCV) and the proportion of ORs in the opposite direction (POOR) statistics. Results For both outcomes, information on individual characteristics (Step 1) provide a low discriminatory accuracy (AUC = 0.616 for psychotropic drugs; = 0.600 for choosing a private GP). Accounting for neighbourhood of residence (Step 2) only improved the AUC for choosing a private GP (+0.295 units). High neighbourhood income (Step 3) was strongly associated to choosing a private GP (OR = 3.50) but the PCV was only 11% and the POOR 33%. Conclusion Applying an innovative stepwise multilevel analysis, we observed that, in Malmö, the neighbourhood context per se had a negligible influence on individual use of psychotropic drugs, but appears to strongly condition individual choice of a private GP. However, the latter was only modestly explained by the socioeconomic circumstances of the neighbourhoods. Our analyses are based on real data and provide useful information for understanding neighbourhood level influences in general and on individual use of psychotropic drugs and choice of GP in particular. However, our primary aim is to illustrate how to perform and interpret a multilevel analysis of individual heterogeneity in social epidemiology and public health. Our study shows that neighbourhood “effects” are not properly quantified by reporting differences between neighbourhood averages but rather by measuring the share of the individual heterogeneity that exists at the neighbourhood level. PMID:27120054

Children and Psychotropic Medication: A Cautionary Note

ERIC Educational Resources Information Center

Morris, James; Stone, George

2011-01-01

This report addresses how the mental health field is organized in terms of the use of psychotropic medications with children and adolescents, and the ethical challenge this presents to marriage and family therapists.

Prescribing psychotropic drugs to adults with an intellectual disability

PubMed Central

Trollor, Julian N; Salomon, Carmela; Franklin, Catherine

2016-01-01

SUMMARY Mental illness is common in people with intellectual disability. They may also have physical health problems which can affect their mental state. Difficulties in communication can contribute to mental health problems being overlooked. These may present with changes in behaviour. Psychological management is usually preferable to prescribing psychotropic drugs. Behavioural approaches are the most appropriate way to manage challenging behaviour. If a drug is considered, prescribers should complete a thorough diagnostic assessment, exclude physical and environmental contributions to symptoms, and consider medical comorbidities before prescribing. Where possible avoid psychotropics with the highest cardiometabolic burden. Prescribe the minimum effective dose and treatment length, and regularly monitor drug efficacy and adverse effects. There is insufficient evidence to support the use of psychotropics for challenging behaviour. They should be avoided unless the behaviour is severe and non-responsive to other treatments. PMID:27756975

EEG topography and tomography (LORETA) in the classification and evaluation of the pharmacodynamics of psychotropic drugs.

PubMed

Saletu, Bernd; Anderer, Peter; Saletu-Zyhlarz, Gerda M

2006-04-01

By multi-lead computer-assisted quantitative analyses of human scalp-recorded electroencephalogram (QEEG) in combination with certain statistical procedures (quantitative pharmaco-EEG) and mapping techniques (pharmaco-EEG mapping or topography), it is possible to classify psychotropic substances and objectively evaluate their bioavailability at the target organ, the human brain. Specifically, one may determine at an early stage of drug development whether a drug is effective on the central nervous system (CNS) compared with placebo, what its clinical efficacy will be like, at which dosage it acts, when it acts and the equipotent dosages of different galenic formulations. Pharmaco-EEG maps of neuroleptics, antidepressants, tranquilizers, hypnotics, psychostimulants and nootropics/cognition-enhancing drugs will be described. Methodological problems, as well as the relationships between acute and chronic drug effects, alterations in normal subjects and patients, CNS effects and therapeutic efficacy will be discussed. Imaging of drug effects on the regional brain electrical activity of healthy subjects by means of EEG tomography such as low-resolution electromagnetic tomography (LORETA) has been used for identifying brain areas predominantly involved in psychopharmacological action. This will be shown for the representative drugs of the four main psychopharmacological classes, such as 3 mg haloperidol for neuroleptics, 20 mg citalopram for antidepressants, 2 mg lorazepam for tranquilizers and 20 mg methylphenidate for psychostimulants. LORETA demonstrates that these psychopharmacological classes affect brain structures differently. By considering these differences between psychotropic drugs and placebo in normal subjects, as well as between mental disorder patients and normal controls, it may be possible to choose the optimum drug for a specific patient according to a key-lock principle, since the drug should normalize the deviant brain function. Thus, pharmaco-EEG topography and tomography are valuable methods in human neuropsychopharmacology, clinical psychiatry and neurology.

Complex psychotropic polypharmacy in bipolar disorder across varying mood polarities: A prospective cohort study of 2712 inpatients.

PubMed

Golden, Julia C; Goethe, John W; Woolley, Stephen B

2017-10-15

It is common for patients with bipolar disorder (BP) to receive multiple psychotropics, but few studies have assessed demographic and clinical features associated with risk for receiving complex psychotropic polypharmacy. This longitudinal cohort study examined 2712 inpatients with a DSM-IV clinical diagnosis of BP to assess associations between complex polypharmacy (defined as ≥4 psychotropics) and demographic and clinical features; associations with risk of rehospitalization were also examined. Logistic regressions were performed with the sample as a whole and with each of four DSM-IV BP subtypes individually. Complex polypharmacy was present in 21.0%. BP-I depressed patients were more likely to receive complex regimens than BP-I manic, BP-I mixed or BP-II patients. In the sample as a whole, variables significantly associated with complex polypharmacy included female, white, psychotic features and a co-diagnosis of borderline personality, post-traumatic stress or another anxiety disorder. The only examined medication not significantly associated with complex polypharmacy was lithium, although only in BP-I depressed and BP-I mixed. Complex polypharmacy was associated with rehospitalization in BP-I mania within 15 and 30days post index hospitalization. All data were from one clinical facility; results may not generalize to other settings and patient populations. BP-I depression may pose a greater treatment challenge than the other BP subtypes. Lithium may confer an overall advantage compared to other medications in BP-I depressed and BP-I mixed. Further research is needed to guide pharmacotherapy decisions in BP patients. Copyright © 2017 Elsevier B.V. All rights reserved.

Dementia, neuropsychiatric symptoms, and the use of psychotropic drugs among older people who receive domiciliary care: a cross-sectional study.

PubMed

Wergeland, Jon N; Selbæk, Geir; Høgset, Lisbeth D; Söderhamn, Ulrika; Kirkevold, Øyvind

2014-03-01

The objective of this study was to (a) determine the prevalence of cognitive impairment, dementia, and neuropsychiatric symptoms (NPSs) among home-dwelling people, 70 years and older (70+ years), who receive domiciliary care, and (b) describe their use of psychotropic drugs. Few studies have investigated dementia among people receiving in-home care. A sample (N = 1,000) representative of people aged 70+ years receiving domiciliary care was randomly recruited for participation. A standardized interview with the participants and their next of kin were performed using well-established assessment scales. Two clinical experts independently diagnosed dementia according to ICD-10 criteria. Of the 415 participants (41.5%) with dementia according to ICD-10 criteria, 19.5% had a dementia diagnosis known to the patient themselves, their caregiver, or health workers in the domiciliary care service. In the previous month, 72.1% exhibited NPSs (21.1% rated as clinically significant), with depression (47.5%), apathy (33.7%), anxiety (33.0%), and irritability (31.1%) being the most common. Psychotropic drugs were regularly used by 40.1% of the sample. Antidepressants (p = 0.001) and cognitive enhancers (p < 0.001) were more often given to people with dementia than to those without dementia. Dementia and NPSs are highly prevalent among people who receive domiciliary care, and diagnostic disclosure is low. People with dementia constitute a distinct group with respect to NPSs and psychotropic drug use. Early detection and correct diagnosis might increase the understanding of their everyday challenges and enable families to alleviate consequences of dementia and NPSs.

A rapid appraisal of access to and utilisation of psychotropic medicines in Bihar, India

PubMed Central

2014-01-01

Background A major aspect of providing mental healthcare is access to and use of psychotropic medications. Bihar is a state in northeast India with limited mental healthcare provision; consequently access to and utilisation of psychotropic medications are likely to be limited. However, to date there has been no research assessing the situation. This study therefore aims to analyse the psychotropic medications management cycle (selection, procurement, distribution and use), and identify the barriers to access and utilisation, and their underlying causes. Method A rapid appraisal method was used in which primary and secondary data sources were collected and analysed. Semi-structured interviews were conducted with twenty-two stakeholders and twenty-one service users from the government, non-governmental organisation (NGO) and private sectors. The qualitative data collected was analysed using a comparative thematic approach. The research was supported by the NGOs BasicNeeds and Nav Bharat Jagriti Kendra. Results Availability, distance and cost were the main barriers to access and utilisation. At the medical college hospital level a lack of supply appears to be due to a discrepancy between orders made by the hospital and medications supplied by the manufacturers. At the primary health centre and district hospital level the main barrier is a cycle between lack of demand for treatments for mental illness by doctors and patients. Conclusion Further investigation and monitoring is necessary to ensure the availability of psychotropic medications at the medical college hospital level. In addition, implementation of the District Mental Health Programme is likely to address the access and utilisation barriers due to its potential to break the current cycle of lack of demand. PMID:25053976

Psychotropic medication use in French children and adolescents.

PubMed

Kovess, Viviane; Choppin, Sabine; Gao, Fei; Pivette, Mathilde; Husky, Mathilde; Leray, Emmanuelle

2015-03-01

The purpose of this study was to describe the patterns of psychotropic drug use in a large representative population of children and adolescents drawn from the French National Health Insurance databank. Data were drawn from a sample of 1% of the beneficiaries of the French national health insurance, selecting those 0-17 years old in 2010 (n=128,298). In addition to age and gender, data included the identification number of each drug allowing a European Pharmaceutical Marketing Research Association (EphMRA) classification, as well as the type of the prescriber. Overall, 2.5% of children and adolescents had been prescribed psychotropic medication. A majority were prescribed anxiolytics (1.9%), followed by antidepressants (0.3%), antipsychotics (0.3%), and stimulants (0.2%). Between the ages of 15 and 17, 6.1% of girls were prescribed anxiolytics and 1.1% were prescribed antidepressants. For boys, the anxiolytics remained the most prescribed psychotropic medication; however, between the ages of 11 and 14, and between the ages of 15 and 17 they received more antipsychotics (0.7% and 0.8%) and between the ages of 6 and 10, and between the ages of 11 and 14 (0.7% and 0.6%), they were prescribed more stimulants than were girls. Among those who received a prescription, a majority of youth (84.6%) received only one class of drugs, and general practitioners were found to be prescribing most of these prescriptions (81.7%). The prevalence of psychotropic drug use in France is similar to that of the Netherlands and much lower than what is observed in the United States. Stimulants are less frequently prescribed in France than in other European countries, but anxiolytics are prescribed considerably more in France than in any other country.

Effects of the Financial Crisis on Psychotropic Drug Consumption in a Cohort from a Semi-Urban Region in Catalonia, Spain

PubMed Central

Barceló, Maria A.; Coll-Negre, Montserrat; Coll-de-Tuero, Gabriel; Saez, Marc

2016-01-01

Purpose Evidence of whether the recent economic crisis has or has not had an effect on psychotropic drug consumption is very scarce. Our objective was to determine if there had in fact been an increase in psychotropic drug use as a result of the financial crisis. Methods In our study a retrospective cohort (between January 1, 2005, and December 31, 2012) was made up of individuals from the general population in a region in the northeast of Catalonia, Spain. We specified a generalized linear mixed model along with combined ‘selection on observables’ as (propensity scoring) matching and ‘selection on unobservables’ as (random coefficient) the panel data model methods, and performed inferences using a Bayesian framework. Results In the period following the economic crisis (post 2009), there was an increase in the consumption of psychotropic drugs which was significantly higher among those who had already been consuming psychotropic drugs prior to 2009 and those most likely to be unemployed. The increase was of greater significance when consumption was measured by the number of drugs being taken, rather than by the defined daily dose (DDD), with the greatest increase occurring in 2011; the very year in which Spain was most affected by the crisis. Conclusions Once the financial crisis had ended, there was an increase in the severity, rather than the intensity, of mental health disorders in individuals who had already had disorders before the crisis. This increase occurred in those most likely to be unemployed, and the severity was accentuated in the toughest year of the economic crisis. PMID:26872210

Trends in psychotropic polypharmacy among youths enrolled in Ohio Medicaid, 2002-2008.

PubMed

Fontanella, Cynthia A; Warner, Lynn A; Phillips, Gary S; Bridge, Jeffrey A; Campo, John V

2014-11-01

This study examined polypharmacy patterns and rates over time among Medicaid-enrolled youths by comparing three enrollment groups (youths in foster care, with a disability, or from a family with low income). Serial cross-sectional trend analyses of Medicaid claims data were conducted for youths age 17 and younger who were continuously enrolled in Ohio Medicaid for a one-year period and prescribed one or more psychotropic medications during fiscal years 2002 (N=26,252) through 2008 (N=50,311). Outcome measures were any polypharmacy (three or more psychotropic medications from any drug class) and multiclass polypharmacy (three or more psychotropic medications from different drug classes). Both types of polypharmacy increased across all three eligibility groups. Any polypharmacy increased from 8.8% to 11.5% for low-income youths (adjusted odds ratio [AOR]=1.12, 99% confidence interval [CI]=1.10-1.13), from 18.0% to 24.9% for youths with a disability (AOR=1.11, CI=1.09-1.13), and from 19.8% to 27.3% for youths in foster care (AOR=1.09, CI=1.07-1.11). Combinations associated with positive increases were two or more antipsychotics, two or more stimulants, and antipsychotics with stimulants. Polypharmacy increased across all enrollment groups, with the highest absolute rates for youths in foster care. Both the overall prevalence and increases in prescriptions for drug combinations with limited evidence of safety and efficacy, such as the prescription of two or more antipsychotics, underscore the need for targeted quality improvement efforts. System oversight and monitoring of psychotropic medication use appears to be warranted, especially for higher-risk groups, such as youths in foster care and those from low-income households who were prescribed multiple antipsychotics.

Educational Gradients in Psychotropic Medication Use Among Older Adults in Costa Rica and the United States†

PubMed Central

Domino, Marisa E.; Dow, William H.; Coto-Yglesias, Fernando

2014-01-01

Objective The relationship among education, psychiatric diagnoses and psychotropic medication use has been explored in the United States, but little is known about patterns in poorer countries, despite their high documented burden of mental illness. Educational gradients in diagnosis and psychotropic use were estimated in the United States and Costa Rica – a middle-income country with universal health insurance. Methods Analyses were conducted using data on older adults (ages 60+) in nationally representative surveys from each country: the 2005 U.S. Medical Expenditures Panel Survey (n=4788) and the 2005 Costa Rican Longevity and Healthy Aging Study (n=2827). Logistic regressions examined the effect of lower educational attainment, income and urban residence on diagnosis and on psychotropic medication use with and without an associated mental illness diagnosis. Results Rates of self-reported diagnoses were lower in the U.S. (12% U.S.; n=598) than in, Costa Rica (20%; n=526), but may reflect differences in survey wording. Measures of self-reported and screened depression decreased with education in both countries. Psychotropic medication use among those with diagnoses increased with education in Costa Rica only. Conclusions We find similar patterns of educational gradients in diagnosis and screening between the U.S. and Costa Rica, but different patterns of medication use by education. Differences in stigma and access to care may play an important role in explaining differences between the countries, though we did not find evidence that insurance affected educational gradients in the U.S. These analyses increase the evidence on the role of education in the use of the health care system. PMID:24932755

Divorce and changes in the prevalence of psychotropic medication use: a register-based longitudinal study among middle-aged Finns.

PubMed

Metsä-Simola, Niina; Martikainen, Pekka

2013-10-01

The annual prevalence of psychotropic medication use exceeds 10 percent in Europe and the United States, the prevalence being higher among the divorced than the married. We analysed changes in the three-month prevalence of psychotropic medication use (psycholeptics and psychoanaleptics excluding medication for dementia) by proximity to divorce, sex, medication type and socio-demographic characteristics, using register-data on 304,111 Finns between 25 and 64 years of age, of whom 23,956 divorced between 1995 and 2003 and 142,093 were continuously married from 1995 to 2004. Five years before divorce, men and women already displayed about one percentage point higher prevalence of psychotropic medication use than those who continued their marriage. The excess prevalence increased with approaching divorce and peaked six to nine months before divorce, reaching 7.3 percent (95% CI 6.8-8.0) among divorcing men and 8.1 percent (95% CI 7.5-8.8) among divorcing women. The peak was followed by an 18-month decline, after which the excess compared to the continuously married settled at nearly three percentage points. The excess was not due to being socio-economically disadvantaged, and socio-demographic factors also seemed to have few modifying effects. The changes in prevalence were largest for antidepressants and almost non-existent for antipsychotics. Our results suggest that the high prevalence of psychotropic medication use among the divorced results both from selective factors already present five years before divorce and the acute and long-term causal effects of becoming and being divorced. Counselling is needed for individuals in the process of divorce, rather than economic support for divorced individuals. Copyright © 2013 Elsevier Ltd. All rights reserved.

Associations of social and material deprivation with tobacco, alcohol, and psychotropic drug use, and gender: a population-based study.

PubMed

Baumann, Michèle; Spitz, Elisabeth; Guillemin, Francis; Ravaud, Jean-François; Choquet, Marie; Falissard, Bruno; Chau, Nearkasen

2007-11-09

The aim was to assess the relationships between social and material deprivation and the use of tobacco, excessive alcohol and psychotropic drugs by both sexes and in various age groups. Greater knowledge concerning these issues may help public health policy-makers design more effective means of preventing substance abuse. The sample comprised 6,216 people aged > or 15 years randomly selected from the population in north-eastern France. Subjects completed a post-mailed questionnaire covering socio-demographic characteristics, occupation, employment, income, smoking habit, alcohol abuse and "psychotropic" drug intake (for headache, tiredness, nervousness, anxiety, insomnia). A deprivation score (D) was defined by the cumulative number of: low educational level, manual worker, unemployed, living alone, nationality other than western European, low income, and non-home-ownership. Data were analysed using adjusted odds ratios (ORa) computed with logistic models. Deprivation was common: 37.4% of respondents fell into category D = 1, 21.2% into D = 2, and 10.0% into D > or 3a re men than women reported tobacco use (30.2% vs. 21.9%) and alcohol abuse (12.5% vs. 3.3%), whereas psychotropic drug use was more common among women (23.8% vs. 41.0%). Increasing levels of deprivation were associated with a greater likelihood of tobacco use (ORa vs. D = 0: 1.16 in D = 1, 1.49 in D = 2, and 1.93 in D > or = 3), alcohol abuse (1.19 in D = 1, 1.32 in D = 2, and 1.80 in D > or = 3) and frequent psychotropic drug intake (1.26 in D = 1, 1.51 in D = 2, and 1.91 in D > or = 3). These patterns were observed in working/other non-retired men and women (except for alcohol abuse in women). Among retired people, deprivation was associated with tobacco and psychotropic drug use only in men. Preventive measures should be designed to improve work conditions, reduce deprivation, and help deprived populations to be more aware of risk and to find remedial measures.

Psychotropic drugs in patients with Alzheimer's Disease: a longitudinal study by the Registry of Dementias of Girona (ReDeGi) in Catalonia, Spain.

PubMed

Calvó-Perxas, Laia; Turró-Garriga, Oriol; Aguirregomozcorta, Maria; Bisbe, Josep; Hernández, Erélido; López-Pousa, Secundino; Manzano, Anna; Palacios, Mónica; Pericot-Nierga, Imma; Perkal, Héctor; Ramió, Lluís; Vilalta-Franch, Joan; Garre-Olmo, Josep

2014-07-01

Psychotropic drugs are usually prescribed to deal with behavioral and psychological symptoms of dementia, especially when nonpharmacologic approaches are not available or have limited efficacy. Poor outcomes and serious adverse events of the drugs used must be addressed, and risk-benefit ratios need to be considered. The aim of this longitudinal study was to describe the evolution of dispensation of psychotropic drugs in patients with Alzheimer's disease (AD) and to identify the associated demographic and clinical variables. Longitudinal study using 698 cases with AD included in the Registry of Dementias of Girona in 2007 and 2008 and followed up during 3 years. Drugs were categorized according to the Anatomical Therapeutic Chemical classification. Binary logistic regression analyses were used to detect the variables associated with the use of antipsychotics, selective serotonin reuptake inhibitors (SSRIs), anxiolytics, and hypnotics. Of the patients, 51.2% consumed antipsychotics at least once during the three years of the study, whereas 73.3% and 58.2% consumed SSRIs and anxiolytics, respectively; 32.8% used hypnotics. Antipsychotic use was associated with a diagnosis of AD with delusions) [odds ratio (OR) = 5.7] and with increased behavior disorders (OR = 1.2). Patients with AD with depressed mood were more likely to be treated with SSRIs (OR = 3.1), while being a woman was associated with increased dispensation of anxiolytics (OR = 1.9) and SSRIs (OR = 2.2). Consumption of psychotropic drugs by the patients with AD registered in the Registry of Dementias of Girona is very high. Despite all the described adverse effects and recommendations of caution in their use, antipsychotics still are extensively used. Copyright © 2014 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Psychotropics without borders: ethics and legal implications of internet-based access to psychiatric medications.

PubMed

Klein, Carolina A

2011-01-01

Medical practitioners are revisiting many of the ethics and the legal implications surrounding the clinical frameworks within which we operate. In today's world, distinguishing between virtual and physical reality continues to be increasingly difficult. The physician may be found grappling with the decision of whether to continue to treat a patient who may be obtaining psychotropic medications through the Internet. This article approaches some of the clinical and legal implications and the ethics regarding the availability of prescription psychotropics over the Internet.

[Medical Treatment of Newly Arrived Refugees in Erlangen: A Study of Drug Prescription Rates Focused on Psychotropic Drugs].

PubMed

Kahl, Fabian; Frewer, Andreas

2017-04-01

Background: In 2015 the number of refugees who sought asylum in Germany has increased dramatically. Therefore, the medical care for these refugees faces huge challenges. The treatment of mental illness of refugees is a particular difficult topic. Objective of this study is the acquisition of the outpatient prescriptions of drugs for newly arrived refugees in Erlangen, focused on psychotropic drugs. Methods: Evaluation of all outpatient prescribed drugs (n=1 137), which were prescribed between 10/01/2014 and 09/30/2015 for asylum seekers living in the refugee center in Erlangen, a branch of the "Central Admission Institution" ("ZAE") Zirndorf. Funding organization of this treatment is the City of Erlangen. Settlement documents of the City of Erlangen were used for the analysis. Results: The prescribed drugs cover the spectrum of acute primary care. Big parts of the prescription rates are antiinfectives (ATC-Code: J), medication for the respiratory system (ATC: R), as well as non-steroidal anti-inflammatory drug (NSAID's: ibuprofen, paracetamol, metamizole). The prescription of psychotropic drugs is relatively underrepresented. © Georg Thieme Verlag KG Stuttgart · New York.

The Effects of Psychotropic Drugs.

ERIC Educational Resources Information Center

Bonnardeaux, Jef-Louis

1984-01-01

Presents information on psychotropic drugs for individuals who are not specialists in pharmacology. Discusses: alcohol and barbituates; dependence and withdrawal; central nervous system depressors (anaesthetics, narcotic analgesics, sedatives and hypnotic drugs, tranquilizers), central nervous stimulants (amphetamines, cocaine, tobacco, caffeine),…

Epigenetic developmental programs and adipogenesis: implications for psychotropic induced obesity.

PubMed

Chase, Kayla; Sharma, Rajiv P

2013-11-01

Psychotropic agents are notorious for their ability to increase fat mass in psychiatric patients. The two determinants of fat mass are the production of newly differentiated adipocytes (adipogenesis), and the volume of lipid accumulation. Epigenetic programs have a prominent role in cell fate commitments and differentiation required for adipogenesis. In parallel, epigenetic effects on energy metabolism are well supported by several genetic models. Consequently, a variety of psychotropics, often prescribed in combinations and for long periods, may utilize a common epigenetic effector path causing an increase in adipogenesis or reduction in energy metabolism. In particular, the recent discovery that G protein coupled signaling cascades can directly modify epigenetic regulatory enzymes implicates surface receptor activity by psychotropic medications. The potential therapeutic implications are also suggested by the effects of the clinically approved antidepressant tranylcypromine, also a histone demethylase inhibitor, which has impressive therapeutic effects on metabolism in the obese phenotype.

Combined cannabis/methaqualone withdrawal treated with psychotropic analgesic nitrous oxide.

PubMed

Gillman, Mark A; Harker, Nadine; Lichtigfeld, Frederick J

2006-07-01

This article reports the first single-blind study using psychotropic analgesic nitrous oxide (PAN) for treating acute withdrawal states following the abuse of methaqualone combined and smoked with cannabis. Smoked methaqualone combined with cannabis is called "white pipe" (WP). South Africa is the only country in the world where WP is a major form of substance abuse. This article demonstrates in 101 consecutively treated patients given placebo (100% oxygen) followed by PAN that this therapy produced a measurable therapeutic effect (more than 50% improvement) in 87 patients. This study confirms that WP is a form of substance abuse confined mainly to young adult male subjects.

Neurocognitive performance in unmedicated patients with hoarding disorder.

PubMed

Sumner, Jennifer M; Noack, Carolyn G; Filoteo, J Vincent; Maddox, W Todd; Saxena, Sanjaya

2016-02-01

Hoarding disorder (HD) is an often incapacitating psychiatric illness associated with a wide range of neurocognitive abnormalities. Some prior neuropsychological studies have found executive dysfunction in HD, but no clear pattern has emerged. One potential reason for discrepant results in previous studies might be the inclusion of patients on psychotropic and other medications that can affect neurocognitive performance. Therefore, we examined neurocognitive functioning in medication-free HD patients. We also added a novel investigation of implicit learning, which has been found to be abnormal in obsessive-compulsive disorder (OCD) and related disorders. Twenty-six participants meeting the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013) diagnostic criteria for HD and 23 normal controls were administered a battery of neuropsychological tests and symptom rating scales. All participants were free of psychotropic medications for at least 6 weeks prior to the study. HD participants showed no significant differences from normal controls on measures of verbal memory, attention, or executive functioning, including response inhibition, planning, organization, and decision making. However, HD participants demonstrated a trend toward less implicit learning and greater use of explicit learning strategies during perceptual categorization compared to normal controls. HD participants who used an implicit strategy performed significantly worse than controls who used an implicit strategy. Hoarding symptom severity was not associated with neurocognitive performance. HD patients may have a tendency to use explicit rather than implicit learning strategies for perceptual categorization but perform as well as normal controls on many other neurocognitive measures. Future studies should assess unmedicated participants and examine test strategies, not just outcomes. PsycINFO Database Record (c) 2016 APA, all rights reserved.

Psychotropic medication use among adolescents and young adults with an autism spectrum disorder: parent views about medication use and healthcare services.

PubMed

Lake, Johanna K; Vogan, Vanessa; Sawyer, Amanda; Weiss, Jonathan A; Lunsky, Yona

2015-04-01

Psychotropic medications are frequently used to treat mental health and behavioral issues in adolescents and adults with an autism spectrum disorder (ASD). Although parents of individuals with ASD frequently take on medication management for their child, there is limited literature on parent perspectives of their child's medication use or their views about the healthcare services they receive, particularly in adulthood. The current study examined and compared parents of adolescents and of young adults with ASD regarding their child's psychotropic medication use and their views about healthcare services. One hundred parents of adolescents and young adults with ASD (ages 12-30 years) completed an online survey about their experience with their child's healthcare services and medication use. Parents of young adults were less likely to use nonpharmacological services before using a psychotropic medication than were parents of adolescents. Parents of young adults were also less likely to believe that their prescribing healthcare provider had adequate expertise in ASD, and were less satisfied with how their prescriber monitored their child's medication use. Findings highlight the need to build capacity among healthcare providers supporting individuals with ASD as they transition into adulthood. There is also a need for improved medication monitoring and increased awareness of the different mental health challenges that individuals with ASD encounter as they age.

[Rational use of psychotropic medications and sedative load in older adults with and without dementia].

PubMed

Rattagan, María L; Lisei, Darío; Rojas, Galeno J; Persi, Gabriel G; Parisi, Virginia L; López Vicchi, Martín; Da Prat de Magalhaes, Gustavo; Bres Bullrich, María; Gatto, Emilia M

2016-09-01

Sedative drugs use has been associated with more cognitive impairment and increased mortality. Sedative load refers to cumulative exposure to multiple drugs with sedative properties. Describe the use of psychotropic drugs and sedative load in older adults with and without dementia. We conducted a cross-sectional study from 2014-2015 (Sanatorio Trinidad Mitre), in hospitalized patients older than 65 years old. Drugs were classified according to the WHO ATC system. The sedative load of drugs was calculated using the Linjakumpu model. 152 PsD and 35 PcD patients were registered, mean age 80.8±8.42. Polypharmacy was present in 44.39% being higher in patients with dementia than without dementia (62.80% vs 40.13%, p=0.0147). In 40.64% at least one psychotropic/sedative medication was used, greater in PcD (60% vs 36.18%, p=0.0097). The CS was: 1.32±1.59; 2.14 in PcD and 1.13 in PsD (p<0.001). Atypical antipsychotics and benzodiazepines were the most common (51.43 and 40% respectively) in patients without dementias. we evidenced a high level of prescription psychotropic or sedative drugs, mostly in patients with dementia. In those, the sedative load was greater. This finding highlights the importance of implementing strategies to optimize sedative drug use among older people.

Cognitive correlates in panic disorder as related to impulsivity - preliminary report.

PubMed

Jakuszkowiak-Wojten, Katarzyna; Gałuszko-Węgielnik, Maria; Raczak, Alicja; Cubała, Wiesław Jerzy; Wiglusz, Mariusz Stanisław; Herstowska, Marta; Landowski, Jerzy

2012-09-01

Impulsivity is the neurophysiologically based inability to confirm behaviour to its context or consequences. Overimpulsiveness characterizes many mental disorders and poses an important clinical dilemma. Although the relationship between mood disorders and impulsivity has been well studied the relationship between anxiety and impulsivity is controversial and not well explored. Some studies hypothesise that patients with the diagnosis of panic disorders are characterised by higher levels of impulsivity as a trait as compared to healthy individuals. The aim of this study was to assess cognitive correlates in panic disorder as related to impulsivity measures. Within the preliminary studies four patients diagnosed with panic disorder (DSM-IV-TR) were studied. The severity measure was the Panic and Agoraphobia Scale. The experimental group comprised of psychotropic drug naive patients. Impulsiveness was evaluated with the Barrat Impulsiveness Scale - 11th version (BIS-11). To asses cognitive functions we used CANTAB (Cambridge Neuropsychological Test Automated Battery). BIS-11 scores observed in the group of psychotropic drug naive patients with panic disorder were higher than the adjusted average for the population and correlated with the number of mistakes in CANTAB (Spatial Working Memory Test); rs=0.949; p=0.0513. The preliminary findings indicate a correlation between impulsivity and cognitive deficits in panic disorder in psychotropic drug naive patients.

Preference for brand-name buprenorphine is related to severity of addiction among outpatients in opioid maintenance treatment.

PubMed

Binder, Philippe; Messaadi, Nassir; Perault-Pochat, Marie-Christine; Gagey, Stéphanie; Brabant, Yann; Ingrand, Pierre

2016-01-01

As a form of opioid maintenance treatment, high-dose buprenorphine is increasingly being used in the United States. On the French market since 1996, it is the most commonly prescribed and frequently employed opioid maintenance treatment. For unknown reasons, the brand-name form is used far more often than the generic form (76-24%). The objective was to show that the patients' levels of addiction were differentiated according to the form of buprenorphine currently being used and to their previous experience of a different form. An observational study in 9 sites throughout France used self-assessment questionnaires filled out in retail pharmacies by all patients to whom their prescribed buprenorphine treatment was being delivered. The 151 canvassed pharmacies solicited 879 patients, of whom 724 completed the questionnaires. Participants were statistically similar to non-participants. The patients using the brand-name form subsequent to experience with the generic form exhibited a more elevated addiction severity index and a higher dosage than brand-name form users with no experience of a different form. Compared to generic users, their doses were higher, their was addiction more severe, and their alcohol consumption was more excessive; they were also more likely to make daily use of psychotropic substances. However, the level of misuse or illicit consumption was similar between these groups. Preferring the brand-name buprenorphine form to the generic form is associated with a higher level of severe addiction, a more frequent need for daily psychotropics, and excessive drinking; but the study was unable to show a causal link.

Perspectives on zebrafish models of hallucinogenic drugs and related psychotropic compounds.

PubMed

Neelkantan, Nikhil; Mikhaylova, Alina; Stewart, Adam Michael; Arnold, Raymond; Gjeloshi, Visar; Kondaveeti, Divya; Poudel, Manoj K; Kalueff, Allan V

2013-08-21

Among different classes of psychotropic drugs, hallucinogenic agents exert one of the most prominent effects on human and animal behaviors, markedly altering sensory, motor, affective, and cognitive responses. The growing clinical and preclinical interest in psychedelic, dissociative, and deliriant hallucinogens necessitates novel translational, sensitive, and high-throughput in vivo models and screens. Primate and rodent models have been traditionally used to study cellular mechanisms and neural circuits of hallucinogenic drugs' action. The utility of zebrafish ( Danio rerio ) in neuroscience research is rapidly growing due to their high physiological and genetic homology to humans, ease of genetic manipulation, robust behaviors, and cost effectiveness. Possessing a fully characterized genome, both adult and larval zebrafish are currently widely used for in vivo screening of various psychotropic compounds, including hallucinogens and related drugs. Recognizing the growing importance of hallucinogens in biological psychiatry, here we discuss hallucinogenic-induced phenotypes in zebrafish and evaluate their potential as efficient preclinical models of drug-induced states in humans.

Perspectives on Zebrafish Models of Hallucinogenic Drugs and Related Psychotropic Compounds

PubMed Central

2013-01-01

Among different classes of psychotropic drugs, hallucinogenic agents exert one of the most prominent effects on human and animal behaviors, markedly altering sensory, motor, affective, and cognitive responses. The growing clinical and preclinical interest in psychedelic, dissociative, and deliriant hallucinogens necessitates novel translational, sensitive, and high-throughput in vivo models and screens. Primate and rodent models have been traditionally used to study cellular mechanisms and neural circuits of hallucinogenic drugs’ action. The utility of zebrafish (Danio rerio) in neuroscience research is rapidly growing due to their high physiological and genetic homology to humans, ease of genetic manipulation, robust behaviors, and cost effectiveness. Possessing a fully characterized genome, both adult and larval zebrafish are currently widely used for in vivo screening of various psychotropic compounds, including hallucinogens and related drugs. Recognizing the growing importance of hallucinogens in biological psychiatry, here we discuss hallucinogenic-induced phenotypes in zebrafish and evaluate their potential as efficient preclinical models of drug-induced states in humans. PMID:23883191

Effects of psychotropic drugs and psychiatric illness on vocational aptitude and interest assessment.

PubMed

Helmes, E; Fekken, G C

1986-07-01

This study examined the vocational aptitude and interest scores of 326 inpatients at a large urban psychiatric hospital. The inpatient group performed significantly below the adult normative mean on eight of nine General Aptitude Test Battery (GATB) aptitude measures; the single exception was Verbal Aptitude. Further, GATB aptitude scores (adjusted for age and education) were significantly lower for patients who were receiving (N = 210) psychotropic medication than for patients who were not receiving (N = 114) psychotropic medication, again with the exception of Verbal Aptitude. Differentiation of patients into subsamples who were receiving particular drugs or drug combinations indicated that phenothiazines in combination with Anti-Parkinsonians were associated with the poorest GATB performances. Interestingly, self-reported vocational interests were not related in any systematic fashion to receiving medication. A variety of explanations that may account for these findings, including drug side-effects and severity or type of psychiatric disorder, were investigated. Implications for vocational counselors were discussed.

Gender differences in demographic and clinical features and prescribing patterns of psychotropic medications in patients with major depressive disorder in China.

PubMed

Xiang, Yu-Tao; Wang, Gang; Guo, Tong; Hu, Chen; Ungvari, Gabor S; Kilbourne, Amy M; Lai, Kelly Y C; Wong, Samuel Y S; Si, Tian-Mei; Zheng, Qi-Wen; Chen, Da-Fang; Fang, Yi-Ru; Lu, Zheng; Yang, Hai-Chen; Hu, Jian; Chen, Zhi-Yu; Huang, Yi; Sun, Jing; Wang, Xiao-Ping; Li, Hui-Chun; Zhang, Jin-Bei; Chiu, Helen F K

2013-11-01

Little is known about gender differences associated with major depressive disorder (MDD) in China. This study examined gender differences associated with other demographic and clinical characteristics and psychotropic drug treatment in Chinese patients with MDD. A total of 1178 patients with MDD from 13 psychiatric hospitals or psychiatric units of general hospitals in China nationwide were enrolled. Cross-sectional data including patients' demographic and clinical characteristics and prescriptions of psychotropic medications were recorded using a standardized protocol and data collection procedure. The sample consisted of 793 female and 385 male patients. Univariate analyses revealed that male patients were younger than female patients, had a younger age of onset of depression, had less lifetime depressive episodes and had more bipolar features (i.e. patients who screened positive for hypomanic symptoms on the 32-item Hypomania Checklist, but did not meet the diagnostic criteria for DSM-IV bipolar disorders as measured by the Mini International Neuropsychiatric Interview). Also, men were more likely to be employed than women and less likely to have depressive episodes following stressful life events. In multivariate analyses, being employed, having bipolar features and not having depressive episodes following stressful life events were independently associated with being a male patient with major depressive disorder. There was no difference in use of psychotropic medications by gender. Most gender differences in MDD patients in this study are not consistent with findings of Western studies suggesting that gender differences in MDD may be determined by both biological and sociocultural differences among ethnically different patient populations. Copyright © 2013 Elsevier Inc. All rights reserved.

[Rational use of psychotropic drugs and social communication role].

PubMed

Montero, F

1994-06-01

Extra-clinical factors about the influences affecting the prescription and use of drugs are reviewed. Special attention is given to regulatory agencies, the pharmaceutical industry, and mass media. The problems and public health consequences of the irrational use of drugs are rarely documented in Latin America. Analysis of these factors, information sources, and rational use of psychotropic drugs will require multiple strategies such as social communication and policy formulation to define goals and objectives related to population information, doctors' and individual citizens' decision making processes, and participation of consumers in improving the use of psychotropic drugs.

Instrumental variable applications using nursing home prescribing preferences in comparative effectiveness research.

PubMed

Huybrechts, Krista F; Gerhard, Tobias; Franklin, Jessica M; Levin, Raisa; Crystal, Stephen; Schneeweiss, Sebastian

2014-08-01

Nursing home residents are of particular interest for comparative effectiveness research given their susceptibility to adverse treatment effects and systematic exclusion from trials. However, the risk of residual confounding because of unmeasured markers of declining health using conventional analytic methods is high. We evaluated the validity of instrumental variable (IV) methods based on nursing home prescribing preference to mitigate such confounding, using psychotropic medications to manage behavioral problems in dementia as a case study. A cohort using linked data from Medicaid, Medicare, Minimum Data Set, and Online Survey, Certification and Reporting for 2001-2004 was established. Dual-eligible patients ≥65 years who initiated psychotropic medication use after admission were selected. Nursing home prescribing preference was characterized using mixed-effects logistic regression models. The plausibility of IV assumptions was explored, and the association between psychotropic medication class and 180-day mortality was estimated. High-prescribing and low-prescribing nursing homes differed by a factor of 2. Each preference-based IV measure described a substantial proportion of variation in psychotropic medication choice (β(IV → treatment): 0.22-0.36). Measured patient characteristics were well balanced across patient groups based on instrument status (52% average reduction in Mahalanobis distance). There was no evidence that instrument status was associated with markers of nursing home quality of care. Findings indicate that IV analyses using nursing home prescribing preference may be a useful approach in comparative effectiveness studies, and should extend naturally to analyses including untreated comparison groups, which are of great scientific interest but subject to even stronger confounding. Copyright © 2014 John Wiley & Sons, Ltd.

Relationship between xerostomia and psychotropic drugs in patients with schizophrenia: evaluation using an oral moisture meter.

PubMed

Okamoto, A; Miyachi, H; Tanaka, K; Chikazu, D; Miyaoka, H

2016-12-01

Patients with schizophrenia are most commonly treated with antipsychotic medications, often with the addition of anxiolytics. This study used an oral moisture meter to evaluate xerostomia in patients with schizophrenia taking typical and atypical antipsychotics, anxiolytics and non-psychotropic medications. Patients diagnosed with schizophrenia according to ICD-10 criteria in the Department of Psychiatry, Kitasato University East, and affiliated hospitals were studied. All patients were on psychotropic medications. Patients with diseases associated with xerostomia, such as Sjögren's syndrome I, were excluded. A total of 127 patients were enrolled. Mean oral moisture was 27·81 ± 2·27% (normal, ≥30·0%). A significant association was observed between objective oral moisture and the subjective sense of dry mouth. Multivariate analysis revealed a negative correlation between the number of antipsychotics and, especially, anxiolytics, and the degree of oral moisture. Drug dosages themselves were not significantly correlated with dry mouth. These findings suggest that objective oral moisture measurements show decreased moisture in patients on these medications and that the degree of moisture shows a greater negative correlation with the number, as opposed to the dosages, of psychotropic drugs administered. When patients with schizophrenia visit a dental clinic, it is important for the dentist to accurately assess the degree of oral moisture and to determine the medications being taken. Based on these findings of the association of polypharmacy with xerostomia, dentists are encouraged to inform the psychiatrist of the need to actively manage patients' xerostomia. © 2016 John Wiley & Sons Ltd.

Treatment pathway and patterns of clozapine prescribing for schizophrenia in New Zealand.

PubMed

Wheeler, Amanda J

2008-06-01

To describe the treatment pathway and patterns of clozapine use in patients with schizophrenia, including coprescribed psychotropic medications, and compare the extent of coprescribing of clozapine with that of non-clozapine schizophrenia treatment in community mental health services in the Auckland and Northland regions of New Zealand. A retrospective chart review was conducted for adult outpatients receiving care from community mental health services on October 31, 2004. Data collected for all patients prescribed an antipsychotic included demographics (sex, age, ethnicity); principal diagnosis (Diagnostic and Statistical Manual of Mental Disorders, 4th edition); comorbid conditions; duration of mental illness; psychiatric admissions; and treatment information (psychotropic medications, with dose and route of administration). If clozapine had been started after the introduction of full government prescription subsidy (February 1999), additional data, including year of initiation and prior antipsychotic history, were collected. Analysis included all outpatients with a diagnosis of schizophrenia (including schizoaffective disorder). Antipsychotics were prescribed for 2796 schizophrenia patients; 32.8% were prescribed clozapine, with a mean dose of 372 mg/day and an average duration of illness of 9.7 years before starting clozapine. Patients who had started treatment after clozapine was funded by the government (59.3%) had received a median of 3 antipsychotic drugs prior to starting clozapine; most of the treatment regimens included 1 second-generation antipsychotic (91.2%). Clozapine patients were less likely to be coprescribed another antipsychotic compared with non-clozapine patients (11.7% vs 17.6%; p < 0.001). Both the clozapine and non-clozapine groups had a low total number of psychotropic medications prescribed (median 2); for clozapine patients, the second drug was most likely to be for treatment of hypersalivation. Outpatients with treatment-resistant schizophrenia were prescribed clozapine at expected rates; however, treatment was delayed longer than recommended. There is some evidence that access to clozapine for treatment-resistant schizophrenia has improved, possibly as the result of the introduction of government subsidy, guideline dissemination, or increasing experience of clinicians with use of clozapine. In this real-world environment, the number of concomitant psychotropic medications for outpatients with schizophrenia was found to be low; when used concomitantly with clozapine, they were most commonly used to manage adverse effects.

Management of reticular oral lichen planus patients with burning mouth syndrome-like oral symptoms: a pilot study.

PubMed

Adamo, Daniela; Mignogna, Michele Davide; Pecoraro, Giuseppe; Aria, Massimo; Fortuna, Giulio

2018-01-31

We sought to determine the efficacy of psychotropic drug in the management of BMS-like oral symptoms in patients with reticular oral lichen planus (R-OLP) refractory to conventional therapies, and its impact on anxious and depressive symptoms. We enrolled 28 cases of symptomatic R-OLP. The Numeric Rating Scale (NRS), the Total Pain Rating Index (T-PRI), the Hamilton rating scales for Depression (HAM-D) and Anxiety (HAM-A) were performed at baseline (time 0), after 2 months of topical clonazepam (time 1) and after 6 months of benzodiazepine and antidepressant drugs (time 2). R-OLP patients showed a statistically significant improvement in the NRS and T-PRI scores from time 0 [median: 9.0 (IQR: 7.2-10.0) and 10.5 (IQR: 7.0-13.0), respectively] to time 2 [(median: 2.0 (IQR: 2.0-3.0) (p < .001) and 3.0 (IQR: 2.0-4.7) (p < .001), respectively]. Similarly, the HAM-A and HAM-D scores showed an improvement from time 0 [(median: 15.0 (IQR: 10.2-17.8) and 13.0 (IQR: 12.0-15.0), respectively] to time 2 [median: 6.0 (IQR: 4.0-7.0) (p < .001) and 5.5 (IQR: 4.25-6.0) (p < .001), respectively]. Psychotropic drugs turned out to be effective in the management of BMS-like oral symptoms in R-OLP patients refractory to conventional immunosuppressive therapy, although in a long-term period.

Safety of Carbamazepine Extended-Release Capsules Used in Combination with Other Psychotropic Medications for the Treatment of Bipolar I Disorder

PubMed Central

Weisler, Richard H.; Kalali, Amir H.; Cutler, Andrew J.; Gazda, Thomas D.; Ginsberg, Lawrence

2008-01-01

Objective To evaluate the safety and efficacy of carbamazepine extended-release capsules (CBZ-ERC) in combination with other psychotropic medications for the treatment of bipolar I disorder. Design In this Phase IIIb, open-label, eight-week, observational, polypharmacy study, adult subjects were started on CBZ-ERC 200mg and titrated over four weeks to optimal dose (1600mg/d maximum). Concomitant lithium and atypical antipsychotics (olanzapine, risperidone, quetiapine, aripiprazole) were permitted. Safety assessments included adverse events, laboratory parameters, physical examination, medication history, vital signs, and electrocardiogram. Efficacy measures included the Young Mania Rating Scale (YMRS), Hamilton Rating Scale for Depression (HAM-D), Montgomery-Åsberg Depression Rating Scale (MADRS), and Clinical Global Impressions Scale–Bipolar Version (CGI-BP). All data were summarized using descriptive statistics. Results Overall, 45 (84.9%) subjects reported treatment-emergent adverse events (TEAEs); most were mild or moderate in severity. The most commonly reported TEAEs were somnolence (n=14, 26.4%), sedation (n=12, 22.6%), dizziness (n=11, 20.8%), headache (n=9, 17.0%), and nausea (n=7, 13.2%). There were no clinically significant changes in vital signs, including weight. Mean changes in laboratory parameters were small, with values that were within the normal range for the majority of subjects. Few changes relative to screening for other safety parameters occurred. Mean total YMRS score decreased from baseline at each study visit. HAM-D and MADRS scores decreased from baseline at Weeks 4 and 8, and all three CGI-BP components (overall bipolar disorder, mania, and depression) improved during the study. Conclusion CBZ-ERC appears to be safe and effective for use in combination with atypical antipsychotics and lithium for treatment of bipolar I disorder. PMID:19727252

Poor self-reported health and sleeping difficulties among Kurdish immigrant men in Sweden.

PubMed

Taloyan, Marina; Johansson, Leena Maria; Johansson, Sven-Erik; Sundquist, Jan; Koctürk, Tahire O

2006-09-01

This study explores the association between ethnicity and poor self-reported health and psychological distress, sleeping difficulties, and use of psychotropic drugs among immigrant Kurdish men and native Swedish men, based on data from the first Swedish National Survey of Immigrants and the Swedish Level-of-Living Surveys collected in 1996 by Statistics Sweden. The age-adjusted odds of poor self-reported health and sleeping difficulties among Kurdish men was about 3.5 times higher than among Swedish men. The odds ratio decreased to 2.1 and 2.7 respectively in a model adjusted for age and the other explanatory variables. Yearning for the home country, perceived discrimination and unemployment in the host country seem to be possible explanations for the higher levels of distress among Kurdish immigrants to Sweden.

A new US-UK diagnostic project: mood elevation and depression in first-year undergraduates at Oxford and Stanford universities.

PubMed

Chandler, R A; Wang, P W; Ketter, T A; Goodwin, G M

2008-07-01

To investigate differences in prevalence of mood elevation, distress and depression among first-year undergraduates at Oxford and Stanford universities. An online survey was sent to Oxford and Stanford first-year undergraduate students for two consecutive years in the winter of 2005 and 2006. Students completed a survey that assessed mood symptoms and medication use. Both universities had similar rates of distress by General Health Questionnaire (Oxford - 42.4%; Stanford - 38.3%), depression by Primary Care Evaluation of Mental Disorders (Oxford - 6.2%; Stanford - 6.6%), and psychotropic and non-psychotropic medication usage (psychotropic: Oxford - 1.5%; Stanford 3.5%; nonpsychotropic: Oxford - 13.3%; Stanford - 18%). Oxford had higher rates of mood elevation by Mood Disorder Questionnaire (MDQ) (Oxford - 4%; Stanford - 1.7%). Oxford and Stanford students have similar rates of mood distress, depression and general medication usage. Students at Oxford have a higher prevalence of MDQ scores that possibly indicate a bipolar disorder, while Stanford students are prescribed more psychotropics.

Psychopharmacological enhancement: a conceptual framework

PubMed Central

2012-01-01

The availability of a range of new psychotropic agents raises the possibility that these will be used for enhancement purposes (smart pills, happy pills, and pep pills). The enhancement debate soon raises questions in philosophy of medicine and psychiatry (eg, what is a disorder?), and this debate in turn raises fundament questions in philosophy of language, science, and ethics. In this paper, a naturalistic conceptual framework is proposed for addressing these issues. This framework begins by contrasting classical and critical concepts of categories, and then puts forward an integrative position that is based on cognitive-affective research. This position can in turn be used to consider the debate between pharmacological Calvinism (which may adopt a moral metaphor of disorder) and psychotropic utopianism (which may emphasize a medical metaphor of disorder). I argue that psychiatric treatment of serious psychiatric disorders is justified, and that psychotropics are an acceptable kind of intervention. The use of psychotropics for sub-threshold phenomena requires a judicious weighing of the relevant facts (which are often sparse) and values. PMID:22244084

[The actual Russian legislation in sphere of turn-over of drug agents and psychotropic substances].

PubMed

Abramov, A Yu; Kosolapova, N V; Mikhaiylova, Yu V

2014-01-01

The drug abuse is a social occurrence. Hence, the social economic methods are the first of all means of combating this evil. At the same time, measures of especially juridical character possess significant value since they develop corresponding legal base for applying another measures. In the Russian Federation, during fifteen years the new policy of public regulation and normative legal base in the area of legal turn-over of drug agents, psychotropic substances and their precursors were developed factually from zero ground. However, the current national legislation is not deprived of some flaws and contradictions. Frequently a uniform practice of interpretation and application of legal rules regulating the controlled turn-over is lacking. On the one hand, this circumstance decreases effectiveness of action of such rules and on the other hand favors development of situations for outflow of pharmaceuticals from legal turn-over to illegal traffic. The becoming of the Russian legislation in the area of turn-over of drug agents, precursors and psychotropic substances relates to the period of late 1990s when the Federal Law No 3 FZ "On drug agents and psychotropic substances" of January 8 1998 was developed and passed by the State Duma of the Russian Federation. The given law completely conforms to principles of legal regulation of turn-over of drug agents and psychotropic substances determined by the Constitution of the Russian Federation (provisions 76, 90, 104, 105) and federal laws ("On the government of the Russian Federation" of December 17 1997, "On the ombudsman in the Russian Federation" of February 26 1997). The main characteristic of legal rules included into given group of sources of law is that they contain regulations of general disposition as basic ones for inferior sources of law. The analysis of basic Federal law No 3 FZ "On drug agents and psychotropic substances" of January 8 1998 makes it possible to conclude that in in Russia the international legal acts are in the foundation of actual legal regulation of turn-over of drug agents and psychotropic substances.

International guide to prescribing psychotropic medication for the management of problem behaviours in adults with intellectual disabilities

PubMed Central

DEB, SHOUMITRO; KWOK, HENRY; BERTELLI, MARCO; SALVADOR-CARULLA, LUIS; BRADLEY, ELSPETH; TORR, JENNIFER; BARNHILL, JARRET

2009-01-01

Psychotropic medications are used regularly to manage problem behaviours among people with intellectual disabilities. This causes concern because often these medications are used out of their licensed indications in this context. The WPA Section on Psychiatry of Intellectual Disability has recently developed an evidence and consensus-based international guide for practitioners for the use of psychotropic medications for problem behaviours among adults with intellectual disabilities. This guide advises on assessment of behaviours, producing a formulation, initiation of treatment, assessment of out-come and adverse effects, follow-up arrangements, and possibility of discontinuation of treatment. PMID:19812757

Short- and long-term use of medication for psychological distress after the diagnosis of cancer.

PubMed

Wang, Cheng-Hsu; Huang, Lynn Chu; Yang, Chen-Chang; Chen, Chi-Liang; Chou, Yiing-Jenq; Chen, Yen-Yuan; Yang, Wei-Chih; Chen, Likwang

2017-03-01

This study investigated the short- and long-term use of medication for psychological distress after the diagnosis of cancer. Longitudinal data from the Taiwan National Health Insurance database were used to follow 35,137 cancer patients for 2.5 years after being diagnosed in 2006 and 2007. Among those patients who survived for at least 180 days, 20.9 % had used psychotropic medications; sedatives were the most frequently prescribed (14.3 %), followed by antidepressants (5.5 %), anxiolytics (3.6 %), and antipsychotics (2.7 %). Lung cancer, prostate cancer, and oral cancer showed a significant association with the regular use of medication in the first 180 days. Among patients who survived for at least 2.5 years, 4.8 % still used psychotropic medication on a regular basis. Lung cancer and prostate cancer were associated with such prolonged use. This longitudinal study found that the type of cancer was significantly associated with the use of psychotropic drugs after the diagnosis was made. It provided information about the trajectory of that use and found that a small number of patients were still using those medications after 2.5 years.

Recent Advances in Pharmacotherapies for the Externalizing Disorders

ERIC Educational Resources Information Center

Brown, Ronald T.

2006-01-01

This article provides a review of various psychotropic agents employed for children and adolescents with externalizing disorders. With the exception of the stimulants, clinical use of psychotropic medications for children with externalizing disorders far exceeds the available empirical literature. Further, there are insufficient data pertaining to…

78 FR 9397 - International Drug Scheduling; Convention on Psychotropic Substances; World Health Organization...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-08

...] International Drug Scheduling; Convention on Psychotropic Substances; World Health Organization Scheduling... written comments and to request an informal public meeting concerning recommendations by the World Health... Director-General of the World Health Organization ``With reference to article 2 of the Convention on...

Co-morbidity and patterns of care in stimulant-treated children with ADHD in the Netherlands.

PubMed

Faber, Adrianne; Kalverdijk, Luuk J; de Jong-van den Berg, Lolkje T W; Hugtenburg, Jacqueline G; Minderaa, Ruud B; Tobi, Hilde

2010-02-01

This study aimed at investigating the use of psychosocial interventions and psychotropic co-medication among stimulant-treated children with attention-deficit hyperactivity disorder (ADHD) in relation to the presence of psychiatric co-morbidity. Stimulant users younger than 16 years were identified in 115 pharmacies and a questionnaire was sent to their stimulant prescribing physician. Of 773 questionnaires sent out, 556 were returned and were suitable for analysis (72%). The results are based on 510 questionnaires concerning stimulant-treated children for whom a diagnosis of ADHD was reported. Of the 510 children diagnosed with ADHD, 31% had also received one or more other psychiatric diagnoses, mainly pervasive developmental disorder or oppositional defiant disorder/conduct disorder. We found an association between the presence of co-morbidity and the use of psychosocial interventions for the child (P < 0.001) and the parents (P < 0.001). In the ADHD-only group, 26% did not receive any form of additional interventions, while psychosocial interventions varied from 8 to 18% in children with ADHD and psychiatric co-morbidity. The presence of diagnostic co-morbidity was also associated with the use of psychotropic co-medication (overall, P = 0.012) and antipsychotics (P < 0.001). Stimulant-treated youths with ADHD and psychiatric co-morbidity received more psychosocial interventions and psychotropic co-medication than children with ADHD-only. The type of psychosocial interventions and psychotropic co-medication received by the children and their parents, depended on the specific co-morbid psychiatric disorder being present.

The use of psychological supportive care services and psychotropic drugs in patients with early-stage breast cancer: a comparison between two institutions on two continents.

PubMed

Kaidar-Person, Orit; Meattini, Icro; Deal, Allison M; Francolini, Giulio; Carta, Giulio; Terzo, Lauren; Camporeale, Jayne; Muss, Hyman; Marks, Lawrence B; Livi, Lorenzo; Mayer, Deborah K; Zagar, Timothy M

2017-08-01

The aim of this study was to evaluate the mental health consumption among patients with early-stage breast cancer in two radiation oncology departments in two countries (USA and Italy). Data were extracted from the medical records of consecutive patients treated between 2014 and 2015 in two centers. Extracted data included patient's demographics, treatment, referral to psychological supportive care programs, and prescribed psychotropic drugs. Data from the two centers were compared using Student's t, Wilcoxon, Fisher's exact, and Jonckheere-Terpstra tests. Adjusted relative risks (RR) were estimated using Poisson regression. A total of 231 (Italy = 110, USA = 121) patients were included, with a mean age of 60 years. The crude rate of psychological supportive care visits was similar in the US versus the Italian cohort (28.9 vs. 21.8%, p = 0.23). The crude rate of prescribed psychotropic drug was higher in the US cohort versus Italian cohort (43.8 vs. 18.2%, p < 0.0001). These differences remained significant after adjusting for breast cancer subtype, stage, and treatment (RR 1.8, 95 CI 1.17-2.76). Between 20 and 30% of patients receive psychological supportive care during treatment for breast cancer. The use of psychotropic medication was higher in the US cohort than the cohort from Italy. The reasons for these differences might be related to social and cultural differences and the method of prescribing medication.

Individual music therapy for agitation in dementia: an exploratory randomized controlled trial.

PubMed

Ridder, Hanne Mette O; Stige, Brynjulf; Qvale, Liv Gunnhild; Gold, Christian

2013-01-01

Agitation in nursing home residents with dementia leads to increase in psychotropic medication, decrease in quality of life, and to patient distress and caregiver burden. Music therapy has previously been found effective in treatment of agitation in dementia care but studies have been methodologically insufficient. The aim of this study was to examine the effect of individual music therapy on agitation in persons with moderate/severe dementia living in nursing homes, and to explore its effect on psychotropic medication and quality of life. In a crossover trial, 42 participants with dementia were randomized to a sequence of six weeks of individual music therapy and six weeks of standard care. Outcome measures included agitation, quality of life and medication. Agitation disruptiveness increased during standard care and decreased during music therapy. The difference at -6.77 (95% CI (confidence interval): -12.71, -0.83) was significant (p = 0.027), with a medium effect size (0.50). The prescription of psychotropic medication increased significantly more often during standard care than during music therapy (p = 0.02). This study shows that six weeks of music therapy reduces agitation disruptiveness and prevents medication increases in people with dementia. The positive trends in relation to agitation frequency and quality of life call for further research with a larger sample.

Impulsive aggression, delay discounting, and adolescent suicide attempts: effects of current psychotropic medication use and family history of suicidal behavior.

PubMed

Bridge, Jeffrey A; Reynolds, Brady; McBee-Strayer, Sandra M; Sheftall, Arielle H; Ackerman, John; Stevens, Jack; Mendoza, Kristen; Campo, John V; Brent, David A

2015-03-01

Impulsive-aggressive behaviors have been consistently implicated in the phenomenology, neurobiology, and familial aggregation of suicidal behavior. The purpose of this study was to extend previous work by examining laboratory behavioral measures of delayed reward impulsivity and impulsive aggression in adolescent suicide attempters and never-suicidal comparison subjects. Using the Point Subtraction Aggression Paradigm (PSAP) and the Delay Discounting Task (DDQ), the authors examined delay discounting and impulsive aggression in 40 adolescent suicide attempters, ages 13-18, and 40 never-suicidal, demographically matched psychiatric comparison subjects. Overall, suicide attempters and comparison subjects performed similarly on the PSAP and DDQ. There was a significant group by current psychotropic medication use interaction (p=0.013) for mean aggressive responses on the PSAP. Group comparisons revealed that attempters emitted more aggressive responses per provocation than comparison subjects, only in those not on psychotropic medication (p=0.049), whereas for those currently treated with psychotropic medication, there were no group differences (p>0.05). This interaction effect was specific to current antidepressant use. Among all subjects, family history of suicidal behavior (suicide or suicide attempt) in first degree relatives was significantly correlated with both delay discounting (r=-0.22, p=0.049), and aggressive responding (r=0.27, p=0.015). Family history of suicidal behavior was associated with delay discounting, but not with aggressive responding on the PSAP, after controlling for relevant covariates. In this study, impulsive-aggressive responding was associated with suicide attempt only in those not being treated with antidepressants. Future work to replicate and extend these findings could have important therapeutic implications for the treatment of depressed suicide attempters, many of whom are affected by impulsive aggression.

Prediction of early weight gain during psychotropic treatment using a combinatorial model with clinical and genetic markers.

PubMed

Vandenberghe, Frederik; Saigí-Morgui, Núria; Delacrétaz, Aurélie; Quteineh, Lina; Crettol, Séverine; Ansermot, Nicolas; Gholam-Rezaee, Mehdi; von Gunten, Armin; Conus, Philippe; Eap, Chin B

2016-12-01

Psychotropic drugs can induce significant (>5%) weight gain (WG) already after 1 month of treatment, which is a good predictor for major WG at 3 and 12 months. The large interindividual variability of drug-induced WG can be explained in part by genetic and clinical factors. The aim of this study was to determine whether extensive analysis of genes, in addition to clinical factors, can improve prediction of patients at risk for more than 5% WG at 1 month of treatment. Data were obtained from a 1-year naturalistic longitudinal study, with weight monitoring during weight-inducing psychotropic treatment. A total of 248 Caucasian psychiatric patients, with at least baseline and 1-month weight measures, and with compliance ascertained were included. Results were tested for replication in a second cohort including 32 patients. Age and baseline BMI were associated significantly with strong WG. The area under the curve (AUC) of the final model including genetic (18 genes) and clinical variables was significantly greater than that of the model including clinical variables only (AUCfinal: 0.92, AUCclinical: 0.75, P<0.0001). Predicted accuracy increased by 17% with genetic markers (Accuracyfinal: 87%), indicating that six patients must be genotyped to avoid one misclassified patient. The validity of the final model was confirmed in a replication cohort. Patients predicted before treatment as having more than 5% WG after 1 month of treatment had 4.4% more WG over 1 year than patients predicted to have up to 5% WG (P≤0.0001). These results may help to implement genetic testing before starting psychotropic drug treatment to identify patients at risk of important WG.

Pharmacotherapy for the treatment of aggression in pediatric and adolescent patients with autism spectrum disorder comorbid with attention-deficit hyperactivity disorder: A questionnaire survey of 571 psychiatrists.

PubMed

Yamamuro, Kazuhiko; Tsujii, Noa; Ota, Toyosaku; Kishimoto, Toshifumi; Iida, Junzo

2017-08-01

Both attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) are frequently accompanied by serious aggression that requires psychiatric treatment. However, little is known about the experiences psychiatrists have had using pharmacotherapy to treat aggression in patients who have both ASD and ADHD (ASD/ADHD). The purpose of this study was to examine the experiences of Japanese child and adolescent psychiatrists in prescribing medication for aggression in patients with ASD/ADHD. A prospective questionnaire was mailed to 2001 psychiatrists affiliated with the Japanese Society for Child and Adolescent Psychiatry. Multivariate logistic regression analysis was used to identify factors predicting the outcome of pharmacotherapeutic treatment of aggression in pediatric and adolescent patients with ASD/ADHD. Of 2001 psychiatrists, 571 (28.5%) completed the full questionnaire (final sample). Of these, 488 (85.4%) prescribed psychotropic medication in treating pediatric and adolescent patients with ASD/ADHD, 299 (61.3%) of them doing so to treat aggression. Prescribers' duration of practice (odds ratio, 1.055; P = 0.038) and patient symptoms of residual impulsivity (odds ratio, 2.479; P = 0.039) increased the odds of prescribing psychotropic medications to treat aggression in these patients. The respondents reported a similar effect for patients with ADHD/ASD compared with those with ADHD only in treating aggression. Japanese psychiatrists tended to prescribe psychotropic medication for aggression in pediatric and adolescent patients with ASD/ADHD. Future studies examining aggression in pediatric and adolescent patients with ASD/ADHD should aim to accumulate evidence for the use of psychotropic medications, which could help clinicians make better decisions. © 2017 The Authors. Psychiatry and Clinical Neurosciences © 2017 Japanese Society of Psychiatry and Neurology.

Impulsive Aggression, Delay Discounting, and Adolescent Suicide Attempts: Effects of Current Psychotropic Medication Use and Family History of Suicidal Behavior

PubMed Central

Reynolds, Brady; McBee-Strayer, Sandra M.; Sheftall, Arielle H.; Ackerman, John; Stevens, Jack; Mendoza, Kristen; Campo, John V.; Brent, David A.

2015-01-01

Abstract Objective: Impulsive-aggressive behaviors have been consistently implicated in the phenomenology, neurobiology, and familial aggregation of suicidal behavior. The purpose of this study was to extend previous work by examining laboratory behavioral measures of delayed reward impulsivity and impulsive aggression in adolescent suicide attempters and never-suicidal comparison subjects. Methods: Using the Point Subtraction Aggression Paradigm (PSAP) and the Delay Discounting Task (DDQ), the authors examined delay discounting and impulsive aggression in 40 adolescent suicide attempters, ages 13–18, and 40 never-suicidal, demographically matched psychiatric comparison subjects. Results: Overall, suicide attempters and comparison subjects performed similarly on the PSAP and DDQ. There was a significant group by current psychotropic medication use interaction (p=0.013) for mean aggressive responses on the PSAP. Group comparisons revealed that attempters emitted more aggressive responses per provocation than comparison subjects, only in those not on psychotropic medication (p=0.049), whereas for those currently treated with psychotropic medication, there were no group differences (p>0.05). This interaction effect was specific to current antidepressant use. Among all subjects, family history of suicidal behavior (suicide or suicide attempt) in first degree relatives was significantly correlated with both delay discounting (r=−0.22, p=0.049), and aggressive responding (r=0.27, p=0.015). Family history of suicidal behavior was associated with delay discounting, but not with aggressive responding on the PSAP, after controlling for relevant covariates. Conclusions: In this study, impulsive-aggressive responding was associated with suicide attempt only in those not being treated with antidepressants. Future work to replicate and extend these findings could have important therapeutic implications for the treatment of depressed suicide attempters, many of whom are affected by impulsive aggression. PMID:25745870

The prevalence and determinants of overweight and obesity among French youths and adults with intellectual disabilities attending special education schools.

PubMed

Bégarie, Jérôme; Maïano, Christophe; Leconte, Pascale; Ninot, Grégory

2013-05-01

This study examines the prevalence of overweight and obesity and a panel of potential determinants among French youths and adults with an intellectual disability (ID). The sample used consisted of 1120 youths and adults with an ID, from 5 to 28 years old, attending a French special education school. The results indicated that 19.8% of the participants with an ID are classified as overweight and 8.6% as obese. Multivariate logistic regression analyses revealed that there are nearly three times more girls/women classified as overweight than boys/men. Additionally, they showed that there are nearly two times more participants from southern France classified as overweight than from northern France, and that the risk of being classified as overweight significantly increases with seniority in the school. Next, the interaction effects observed indicated first that there are nearly two times more boys/men on psychotropic medication classified as overweight than boys/men not on psychotropic medication. Second, they revealed that the odds of being classified as overweight for boys/men not on psychotropic medication are 47% lower than for girls/women not on psychotropic medication. Third, they indicated that there are nearly two times more boys/men from southern France classified as obese than boys/men from northern France. Fourth, they showed that the odds of being classified as obese for boys/men from northern France are 52% lower than for girls/women from northern France. In conclusion, these results should be viewed as preliminary and need to be replicated since, to our knowledge, this study is the first one to examine this topic while simultaneously controlling for all of the potential determinants and relying on a sample of youths and adults. Copyright © 2013 Elsevier Ltd. All rights reserved.

A Behavior-Analytic Conceptualization of the Side Effects of Psychotropic Medication

ERIC Educational Resources Information Center

Valdovinos, Maria G.; Kennedy, Craig H.

2004-01-01

A range of behavior--much deemed problematic by society--is treated with behavioral methods or psychotropic medications. Although the processes associated with behavioral interventions have been investigated using conceptual, experimental, and applied analyses, less is known about the behavioral processes associated with the use of psychotropic…

AEDS and Psychotropic Drugs in Children with Autism and Epilepsy

ERIC Educational Resources Information Center

Tuchman, Roberto

2004-01-01

The efficacy of antiepileptic drugs (AEDs) and psychotropic medications in children with autism is limited to the treatment of seizures or to specific behaviors such as irritability, impulsivity, hyperactivity, repetitive behaviors, or aggression. The reliability and value of the available data--to determine the efficacy of these medications in…

Psychotropic Medications and Substances of Abuse Interactions in Youth

ERIC Educational Resources Information Center

Kaminer, Yifrah; Goldberg, Pablo; Connor, Daniel F.

2010-01-01

The majority of youth with substance use disorders (SUDs) manifest one or more co-occurring psychiatric disorders. Consequently, many of these youths are being prescribed with psychotropic medications. As prescribing rates continue to increase for early-onset psychiatric disorders, potential risk for substance of abuse-psychiatric medication…

Student Knowledge of and Attitudes toward Psychotropic Drugs.

ERIC Educational Resources Information Center

Bentley, Kia J.; And Others

1991-01-01

A survey of 260 graduate social work students found their knowledge of and attitudes toward psychotropic medication uneven and lower than desirable. Results also suggest personal and professional experiences influence knowledge and attitudes. It is recommended that social work course content be expanded to include relevant information on these…

Adolescent Attitudes toward Psychiatric Medication: The Utility of the Drug Attitude Inventory

ERIC Educational Resources Information Center

Townsend, Lisa; Floersch, Jerry; Findling, Robert L.

2009-01-01

Background: Despite the effectiveness of psychotropic treatment for alleviating symptoms of psychiatric disorders, youth adherence to psychotropic medication regimens is low. Adolescent adherence rates range from 10-80% (Swanson, 2003; Cromer & Tarnowski, 1989; Lloyd et al., 1998; Brown, Borden, and Clingerman, 1985; Sleator, 1985) depending on…

Comparative Survey of Drug Use in a Community Service System.

ERIC Educational Resources Information Center

Zaharia, E. S.; Struxness, L.

1991-01-01

Drug use patterns were surveyed in Colorado's community services system for 1,282 individuals with developmental disabilities. A psychotropic drug use rate of 18.6 percent compared favorably to other reported rates and rates in Colorado's institutional settings. Substantial experience with psychotropic and anticonvulsant medications across all…

Significant Differences in Pediatric Psychotropic Side Effects: Implications for School Performance

ERIC Educational Resources Information Center

Kubiszyn, Thomas; Mire, Sarah; Dutt, Sonia; Papathopoulos, Katina; Burridge, Andrea Backsheider

2012-01-01

Some side effects (SEs) of increasingly prescribed psychotropic medications can impact student performance in school. SE risk varies, even among drugs from the same class (e.g., antidepressants). Knowing which SEs occur significantly more often than others may enable school psychologists to enhance collaborative risk-benefit analysis, medication…

Findings From a Prospective Randomized Controlled Trial of an Individualized Music Listening Program for Persons With Dementia.

PubMed

Kwak, Jung; Anderson, Keith; O'Connell Valuch, Katharine

2018-06-01

Music & Memory (M&M) is a passive music intervention that uses personalized music playlists delivered on digital music players. This program has been increasingly adopted in nursing homes across the United States to facilitate communication, engagement, and socialization among persons with dementia (PWDs); however, few studies have evaluated the program's effect on PWDs' outcomes. In the present study, a randomized controlled crossover design was used to examine the impact of the M&M program on 59 PWDs in 10 nursing homes over a 14-week period. Residents' evaluated outcomes included agitation, behavioral symptoms, and use of psychotropic medications. Although trends supported the positive effects of M&M, no statistically significant differences were found in any of the outcomes measured over time. Methodological limitations withstanding, these findings call into question the effectiveness of the M&M program and the ability of facility staff to implement this intervention with fidelity.

Ethnicity, music experience, and depression.

PubMed

Werner, Paul D; Swope, Alan J; Heide, Frederick J

2009-01-01

The researchers studied differences in self-reported music experience and depression across ethnic groups, as well as differences in the relationship between music experience and depression across groups. College participants (78 African Americans, 111 Asian Americans, 218 Whites, and 87 in other ethnic groups) completed the Music Experience Questionnaire (MEQ) and the Center for Epidemiological Studies Depression scale. Statistically significant differences across groups were found on depression as well as on the MEQ factor for Subjective/Physical Reactions to music and on MEQ scales for Commitment to Music, Affective Reactions, Positive Psychotropic Effects, and Reactive Musical Behavior. A distinctive pattern of relationship was found between music variables and depression in the Asian American group, relative to the White and Other group. In particular, among Asian Americans there were negative correlations between depression and the MEQ Subjective/ Physical Reactions factor as well as the Affective Reactions scale. Implications were discussed for the literature on ethnicity and depression, music experience, and music therapy.

Psychotropic medication, psychiatric disorders, and higher brain functions

PubMed Central

Schulz, Pierre; Steimer, Thierry

2000-01-01

Conventional psychiatric diagnosis is founded on symptom description; this then governs the choice of psychotropic medication. This purely descriptive approach resembles a description of diphtheria from the premicrobiology era. Based on current advances in basic and clinical neuroscience, we propose inserting an intermediate level of analysis between psychiatric symptoms and pharmacologic modes of action. Paradigm 1 is to analyze psychiatric symptoms in terms of which higher brain function(s) is (are) abnormal, ie, symptoms should be analyzed as higher brain dysfunction: a case study in obsessive-compulsive disorder reveals pointers in four common symptoms to the higher functions of working memory, emotional overlay, absence of voluntary control, and the ability to evaluate personal mental phenomena. Paradigm 2 is to view psychotropic drugs as modifying normal higher brain functions, rather than merely treating symptoms, which they do only secondarily: thus depression may respond to agents that act on related aspects of mental life derived from higher brain functions, eg, the ability to enhance bonding. We advocate a strategy in which psychiatric illness is progressively reclassified through knowledge in clinical neuroscience and treatment targets are revised accordingly. PMID:22034249

Memory, forgetting, and economic crisis: drug use and social fragmentation in an Argentine shantytown.

PubMed

Epele, Maria E

2010-03-01

Closely linked to the increase in psychotropic pill consumption, forgetting and remembering emerged from devastated social scenarios as a new local idiom among poor youth in the late 1990s and the new millennium. Drawing on ethnographic fieldwork carried out during the years of the deepest economic crisis in Argentina (2001-03), I argue that psychotropic pill consumption is associated with not only deteriorating economic conditions but also changes in the quality and price of cocaine, and in the scarcity and subsequent change of status of medications during the economic breakdown. Taking into account developments in the field of memory studies, I examine the relationship among political economy, social memory work, and changing drug-use practices. Regarding memory as a social practice, I argue that the growth of psychotropic pill consumption in the late 1990s can be understood through the interplay of Paul Ricoeur's notions regarding different kinds and levels of forgetting. By analyzing changing survival strategies, social network dismantlement, changing mortality patterns, and abusive police repression, I discuss how social fragmentation engendered by structural reforms has modified social memory work.

Disability Support Workers' Knowledge and Education Needs about Psychotropic Medication

ERIC Educational Resources Information Center

Donley, Mandy; Chan, Jeffrey; Webber, Lynne

2012-01-01

Disability support workers are the predominant workforce employed to support people with an intellectual disability in Australia. Many support workers are required to assist people they support to take psychotropic medications in the form of chemical restraint. Support workers in Australia receive limited education and training in this area and as…

Special Educators' Knowledge regarding Psychotropic Interventions for Students with Emotional and Behavioral Disorders

ERIC Educational Resources Information Center

Ryan, Joseph B.; Reid, Robert; Ellis, Cynthia

2008-01-01

The use of psychotropic interventions to manage the inappropriate behaviors displayed by students with emotional and behavior disorders has become more common over the past several decades. The efficacious use of these medications requires monitoring students for desired behavioral outcomes as well as potential side effects. Educators are in an…

Rates and Predictors of Adherence to Psychotropic Medications in Children with Autism Spectrum Disorders

ERIC Educational Resources Information Center

Logan, Sarah L.; Carpenter, Laura; Leslie, R. Scott; Hunt, Kelly S.; Garrett-Mayer, Elizabeth; Charles, Jane; Nicholas, Joyce S.

2014-01-01

Medication adherence in children is poor, particularly among those with chronic or mental health disorders. However, adherence has not been fully assessed in autism spectrum disorders (ASDs). The validated proportion of days covered method was used to quantify adherence to psychotropic medication in Medicaid-eligible children who met diagnostic…

Children and Psychotropic Medication: What Role Should Advocacy Counseling Play? (

ERIC Educational Resources Information Center

Ingersoll, R. Elliott; Bauer, Ann; Burns, Laura

2004-01-01

There are currently millions of children with mental and emotional symptoms who are being treated with psychotropic medication. The authors critique such treatment and suggest that advocacy counseling is a responsible approach to balance the power of both the pharmaceutical companies and the medical model in the mental health arena.

Psychotropic Medication Treatment of Adolescents: Results from the National Comorbidity Survey-Adolescent Supplement

ERIC Educational Resources Information Center

Olfson, Mark; He, Jian-ping; Merikangas, Kathleen Ries

2013-01-01

Objective: To examine the 12-month prevalence of psychotropic medication use among adolescents, and the match between mental disorder diagnoses and past-year antidepressant and stimulant use. Method: Data are from the National Comorbidity Survey--Adolescent Supplement (2002-2004), a nationally representative survey of 10,123 adolescents aged 13 to…

On cannabis, chloral hydrate, and career cycles of psychotropic drugs in medicine.

PubMed

Snelders, Stephen; Kaplan, Charles; Pieters, Toine

2006-01-01

This article compares the careers of two psychotropic drugs in Western psychiatry, with a focus on the nineteenth century: Cannabis indica and chloral hydrate. They were used by doctors for similar indications, such as mania, delirium tremens, and what we would now call drug dependence. The two show similar career paths consisting of three phases: initial enthusiasm and therapeutic optimism; subsequent negative appraisal; and finally, limited use. These cycles, which we term "Seige cycles," are generally typical of the careers of psychotropic drugs in modern medicine. However, differences in the careers of both drugs are also established. The phases of chloral show relatively higher peaks and lower valleys than those of cannabis. Chloral is the first typically "modern" psychotropic drug; a synthetic, it was introduced in 1869 at a time of growing asylum populations, pharmaceutical interests, and high cultural expectations of scientific medicine. Cannabis indica, introduced in the 1840s, is typically a "premodern" drug steeped in the climate of cultural Romanticism. We conclude that the analytical concept of the Seige cycle is a useful tool for future research into drug careers in medicine.

Quality of life and attitudes towards psychotropics and dependency: consumers vs. non-consumers aged 50 and over.

PubMed

Baumann, M; Bonnetain, F; Briançon, S; Alla, F

2004-10-01

To assess the relationships between socio-demographic factors, quality of life and attitudes towards psychotropic drugs and dependency and to compare those relationships in continuous consumers (CC), occasional consumers (OC) and non-consumers (NC) of those drugs. Quality of life (SF36) and attitudes (14 statements) were measured in 601 subjects (45-60 years old) from the SUVIMAX cohort (SUpplementation en VItamines et en sels Mineraux AntioXydants). Data were obtained on 334 NC, 142 CC, 125 OC from the inclusion questionnaire and the monthly consumption report notebooks kept by subjects between 1994 and 1998. Dichotomous and polychotomous logistic regressions were used for the analysis. The lower the quality of life score the more frequent was consumption. NC tended to be men, with high quality of life scores. They entertained negative attitudes towards psychotropics and dependency. OC tended to be women reporting a chronic pathology, with fairly high social status. They had intermediate quality of life and denied dependency. CC tended to be men with no professional activity and low quality of life scores in particular for mental health and perceived health. They had positive attitudes towards psychotropics and accept dependency. Assessment of patients' quality of life and understanding of their attitudes towards psychotropics can provide essential information for those in charge of health promotion programmes and may help in identifying new intervention strategies. Preventive education and follow-up of therapy may be better suited to the needs of patients.

Fall-Risk-Increasing Drugs: A Systematic Review and Meta-Analysis: II. Psychotropics.

PubMed

Seppala, Lotta J; Wermelink, Anne M A T; de Vries, Max; Ploegmakers, Kimberley J; van de Glind, Esther M M; Daams, Joost G; van der Velde, Nathalie

2018-04-01

Falls are a major public health problem in older adults. Earlier studies showed that psychotropic medication use increases the risk of falls. The aim of this study is to update the current knowledge by providing a comprehensive systematic review and meta-analysis on psychotropic medication use and falls in older adults. This study is a systematic review and meta-analysis. A search was conducted in Medline, PsycINFO, and Embase. Key search concepts were "falls," "aged," "medication," and "causality." Studies were included that investigated psychotropics (antipsychotics, antidepressants, anxiolytics, sedatives, and hypnotics) as risk factors for falls in participants ≥60 years of age or participants with a mean age of ≥70 years. Meta-analyses were performed using generic inverse variance method pooling unadjusted and adjusted odds ratio (OR) estimates separately. In total, 248 studies met the inclusion criteria for qualitative synthesis. Meta-analyses using adjusted data showed the following pooled ORs: antipsychotics 1.54 [95% confidence interval (CI) 1.28-1.85], antidepressants 1.57 (95% Cl 1.43-1.74), tricyclic antidepressants 1.41 (95% CI 1.07-1.86), selective serotonin reuptake inhibitors 2.02 (95% CI 1.85-2.20), benzodiazepines 1.42 (95%, CI 1.22-1.65), long-acting benzodiazepines 1.81 (95%, CI 1.05-3.16), and short-acting benzodiazepines 1.27 (95%, CI 1.04-1.56) Most of the meta-analyses resulted in substantial heterogeneity that did not disappear after stratification for population and healthcare setting. Antipsychotics, antidepressants, and benzodiazepines are consistently associated with a higher risk of falls. It is unclear whether specific subgroups such as short-acting benzodiazepines and selective serotonin reuptake inhibitors are safer in terms of fall risk. Prescription bias could not be accounted for. Future studies need to address pharmacologic subgroups as fall risk may differ depending on specific medication properties. Precise and uniform classification of target medication (Anatomical Therapeutic Chemical Classification) is essential for valid comparisons between studies. Copyright © 2018 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Light microscopy can reveal the consumption of a mixture of psychotropic plant and fungal material in suspicious death.

PubMed

Wiltshire, Patricia E J; Hawksworth, David L; Edwards, Kevin J

2015-08-01

Light microscopical examination of plant and fungal remains in the post mortem gut may be capable of demonstrating the ingestion of unexpected natural psychotropic materials. This is demonstrated here in a case in which a 'shaman' was accused of causing the death of a young man. The deceased had participated in a ceremony which involved the drinking of ayahuasca in order to induce a psychotropic experience. Ayahuasca is an infusion of Banisteriopsis caapi (ayahuasca vine), which produces a monoamine oxidase inhibitor, and one or more additional tropical plants, generally Psychotria viridis (chacruna) which produces dimethyltryptamine (DMT). The monoamine oxidase inhibitor prevents DMT from being broken down in the gut, so enabling its passage into the bloodstream and across the blood/brain barrier. Toxicological tests for DMT demonstrated the presence of this compound in the body. The deceased was reported to be in the habit of using Psilocybe semilanceata (liberty cap). This fungus (popularly called magic mushroom) contains psilocybin which is hydrolysed in the gut to psilocin; this compound mimics a serotonin uptake inhibitor, and also invokes psychotropic experiences. Microscopical examination established that the ileum and colon contained spores of Psilocybe and, in addition, pollen of Cannabis sativa and seeds of Papaver cf. somniferum (opium poppy). Both the plant species yield psychotropic substances. Palynological and mycological analysis of containers from the deceased person's dwelling also yielded abundant trace evidence of pertinent pollen and spores. The police had requested analysis for DMT but there was no screening for other psychotropic substances. Investigators were surprised that a mixture of hallucinogenic materials had been consumed by the deceased. The charge was modified from manslaughter to possession of a 'Class A' drug as the deceased had been consuming psychotropic substances not administered by the 'shaman'. Where death involving drugs from plants or fungi is suspected, microscopical examination of samples from the gut can provide a rapid and effective method for assessing, in a temporal context, the presence of ingested materials that may not have been previously suspected. The example presented here also demonstrates the need for caution in interpreting toxicological results where screening for unusual compounds has been limited. Copyright © 2015 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

Epidemiology of psychotropic medication use: comparison of sales, prescriptions and survey data in Iceland.

PubMed

Tómasson, Kristinn; Tómasson, Helgi; Zoëga, Tómas; Sigfússon, Eggert; Helgason, Tómas

2007-01-01

Public health issues, medical and socio-demographics, related to use of psychotropic medications and to increasing sale of antidepressants and hypnotics need to be explored. The aim of this study was to investigate the use of antidepressants, tranquillizers and sedatives nationally and its connection with health and demographic factors, by comparing: 1) sales data and 2) prescription data for outpatients with 3) self-reported use of a random sample of the population aged 18-75 years. In 2001, the sales of psychopharmaca was 168.8 daily defined doses (DDD)/1000/day, thereof 46.6% were antidepressants mainly for outpatients; one-third of hypnotics and tranquillizers were used for inpatients; 134.2 DDD/1000/day were filled by outpatients. Almost 20% of the respondents in the survey had used one or more of these drugs for some time during the preceding 12 months. Treatment adherence for antidepressants was 56%, lower for women than men. The probability of psychotropic drug use for mental complaints is 52% when controlled for other covariates. Any observed gender difference in the community survey is related to differences in the covariates, e.g. women are more likely to seek a doctor than men. The age effect on self-reported use in the community survey is related to hypnotics. The use of psychotropic medicaments is primarily driven by mental health complaints, but not by gender or age, except the use of hypnotics, which increases with age. The difference between self-reported use and prescriptions filled may reflect compliance problems in psychiatric treatment.

Importance of early weight changes to predict long-term weight gain during psychotropic drug treatment.

PubMed

Vandenberghe, Frederik; Gholam-Rezaee, Mehdi; Saigí-Morgui, Núria; Delacrétaz, Aurélie; Choong, Eva; Solida-Tozzi, Alessandra; Kolly, Stéphane; Thonney, Jacques; Gallo, Sylfa Fassassi; Hedjal, Ahmed; Ambresin, Anne-Emmanuelle; von Gunten, Armin; Conus, Philippe; Eap, Chin B

2015-11-01

Psychotropic drugs can induce substantial weight gain, particularly during the first 6 months of treatment. The authors aimed to determine the potential predictive power of an early weight gain after the introduction of weight gain-inducing psychotropic drugs on long-term weight gain. Data were obtained from a 1-year longitudinal study ongoing since 2007 including 351 psychiatric (ICD-10) patients, with metabolic parameters monitored (baseline and/or 1, 3, 6, 9, 12 months) and with compliance ascertained. International Diabetes Federation and World Health Organization definitions were used to define metabolic syndrome and obesity, respectively. Prevalences of metabolic syndrome and obesity were 22% and 17%, respectively, at baseline and 32% and 24% after 1 year. Receiver operating characteristic analyses indicated that an early weight gain > 5% after a period of 1 month is the best predictor for important long-term weight gain (≥ 15% after 3 months: sensitivity, 67%; specificity, 88%; ≥ 20% after 12 months: sensitivity, 47%; specificity, 89%). This analysis identified most patients (97% for 3 months, 93% for 12 months) who had weight gain ≤ 5% after 1 month as continuing to have a moderate weight gain after 3 and 12 months. Its predictive power was confirmed by fitting a longitudinal multivariate model (difference between groups in 1 year of 6.4% weight increase as compared to baseline, P = .0001). Following prescription of weight gain-inducing psychotropic drugs, a 5% threshold for weight gain after 1 month should raise clinician concerns about weight-controlling strategies. © Copyright 2015 Physicians Postgraduate Press, Inc.

[Psychiatric polypharmacy: hazard through drug-drug-interaction and possibilities for prevention].

PubMed

Hahn, M; Braus, D F

2012-09-01

Psychiatric diseases and comorbidity have increased over the past years. Commonly used psychotropic drugs contain a high risk of drug interactions and adverse drug events (ADE). With a frequency of 10-12% psychotropic drugs are, among all pharmaceuticals, the most common cause of hospitalisation due to ADE. During a hospital stay the application of psychotropic drugs can also lead to adverse drug events--sometimes due to drug interactions. Currently, ADEs and drug interactions are the most frequent cause of death for in-patients (18% of all causes of death) with an overall mortality of 0.95%. As studies have shown, hospitals as well as insurers could save a considerable amount of resources by implementing a system with on-ward pharmacists, hereby reducing ADE and re-hospitalisation rates. In recent studies a large amount of current ADEs were rated as preventable. Patient impairment due to ADE is leading to an increase in liability cases with an expected 5% increase of compensation payments in 2011. To evaluate these ADE-related cases, a pharmaceutical assessment should be included in the expert trials, especially since a lack of awareness of medication errors is prevalent. When aiming towards a successful drug therapy, physicians must also consider that cheaper substances may often have an unfavourable drug interaction profile.

[Parental socialization styles and psychosocial development in 16 to 19 year old adolescents].

PubMed

Sepúlveda, G; Almonte, C; Valenzuela, C; Avendaño, A

1991-01-01

To study relationships between perceptions that 16 to 19 year old adolescents have about socialization styles and disciplinary methods used by their parents, with their view of the world, interpersonal relations, moral development, use of psychotropic substances and maladjusted behaviours, 241 adolescents--123 males--which belong to a follow up study on growth and development from northern metropolitan Santiago, Chile, were asked to answer a questionary of psychosocial development, previously elaborated by two of the authors (GS and CA). The most used socialization styles by these fathers and mothers were the negative power one (39.2% and 38.5%) and the inductive one (23.8% and 30.0%), while permissive styles occurred at much lower frequency (1.5% and 1.1%). Coincidence among parents in socialization styles was found in 47.7% and disagreement in 19.2% of cases. The inductive style and coincidence in it's use by both parents, were frequently associated to idealistic world views, autonomous and conventional moral development, satisfactory interpersonal relationships and low frequency of psychotropic consumption, and maladjusted behaviours while negative power based styles by both parents and disagreement of styles among them were rather related to realistic or negative world view, preconventional moral development, higher frequency of relational problems, psychotropic consumption and maladjusted behaviours.

High Prescription Drug Utilization and Associated Costs among Medicaid-eligible Children with Autism Spectrum Disorders Identified by a Population-based Surveillance Network

PubMed Central

Logan, Sarah L.; Nicholas, Joyce S.; Carpenter, Laura A.; King, Lydia B.; Garrett-Mayer, Elizabeth; Charles, Jane M.

2011-01-01

Purpose This study assessed medication use and associated costs among 8- and 15-yearold children with autism spectrum disorders (ASD) identified by the South Carolina Autism and Developmental Disabilities Monitoring (SCADDM) Network. Methods All Medicaid-eligible SCADDM-identified children with ASD from surveillance years 2006 and 2007 were included (n=263). Children were classified as ASD cases when documented behaviors consistent with the DSM-IV-TR criteria for autistic disorder, Asperger disorder, or pervasive developmental disorder- not otherwise specified (PDD-NOS) were present in health and education evaluation records. Medication and cost data were obtained by linking population-based and Medicaid data. Results All 263 SCADDM-identified children had Medicaid data available; 56% (n=147) had a prescription of any type, 40% (n=105) used psychotropic medication, and 20% (n=52) used multiple psychotropic classes over the study period. Common combinations were (1) attention deficit hyperactivity disorder (ADHD) medications and an antihypertensive, antidepressant or antipsychotic; and (2) antidepressants and an antipsychotic. Multiple psychotropic classes were more common among older children. Both the overall distribution of the number of prescription claims and medication costs varied significantly by age. Conclusions Results confirm that medication use in ASD, alone or in combination, is common, costly, and may increase with age. PMID:22153288

Mental health, stress correlates and psychotropic drug use or non-use among aged caregivers to elders with dementia.

PubMed

Pérodeau, G; Lauzon, S; Lévesque, L; Lachance, L

2001-08-01

The goal of the study was to compare caregivers who used psychotropic drugs with caregivers who were non-users in order to pinpoint differences in coping styles between the two groups. We performed a secondary analysis of a study on the stress and psychological well-being of persons caring for relatives with dementia. We compared elderly caregivers, as either psychotropic drug users (n = 61) or non-users (n = 133), over various psychosocial characteristics relating to the care-giving context. Results reveal that users, as compared to non-users were: (a) more disturbed (appraised a greater stress) by the relative's dysfunctional behaviours, after controlling for the frequency of the behaviours; and (b) experienced more conflict during interpersonal interactions, although their appraisal of self-satisfaction with formal and informal support to their care-giving activities did not differ significantly. Strikingly, users combined and called on a greater number of problem-focused and emotion-reducing coping strategies than did non-users. They more frequently used affective regulation and information seeking coping styles. Stress-related measures (especially stress appraisal and conflict) contributed more to the variation in mental distress of users than of non-users. Results provide a theoretical and empirical rationale for therapeutic interventions such as the cognitive behavioural approach.

Assessing Racial/Ethnic Disparities in Treatment across Episodes of Mental Health Care

PubMed Central

Cook, Benjamin Lê; Zuvekas, Samuel H; Carson, Nicholas; Wayne, Geoffrey Ferris; Vesper, Andrew; McGuire, Thomas G

2014-01-01

ObjectiveTo investigate disparities in mental health care episodes, aligning our analyses with decisions to start or drop treatment, and choices made during treatment. Study DesignWe analyzed whites, blacks, and Latinos with probable mental illness from Panels 9–13 of the Medical Expenditure Panel Survey, assessing disparities at the beginning, middle, and end of episodes of care (initiation, adequate care, having an episode with only psychotropic drug fills, intensity of care, the mixture of primary care provider (PCP) and specialist visits, use of acute psychiatric care, and termination). FindingsCompared with whites, blacks and Latinos had less initiation and adequacy of care. Black and Latino episodes were shorter and had fewer psychotropic drug fills. Black episodes had a greater proportion of specialist visits and Latino episodes had a greater proportion of PCP visits. Blacks were more likely to have an episode with acute psychiatric care. ConclusionsDisparities in adequate care were driven by initiation disparities, reinforcing the need for policies that improve access. Many episodes were characterized only by psychotropic drug fills, suggesting inadequate medication guidance. Blacks’ higher rate of specialist use contradicts previous studies and deserves future investigation. Blacks’ greater acute mental health care use raises concerns over monitoring of their treatment. PMID:23855750

Psychotropic Medications in Children with Autism Spectrum Disorders: A Systematic Review and Synthesis for Evidence-Based Practice

ERIC Educational Resources Information Center

Siegel, Matthew; Beaulieu, Amy A.

2012-01-01

This paper presents a systematic review, rating and synthesis of the empirical evidence for the use of psychotropic medications in children with autism spectrum disorders (ASD). Thirty-three randomized controlled trials (RCTs) published in peer-reviewed journals qualified for inclusion and were coded and analyzed using a systematic evaluative…

Overuse of Psychotropic Medications among Children and Adolescents with Autism Spectrum Disorders: Perspective from a Developing Country

ERIC Educational Resources Information Center

Memari, Amir Hossein; Ziaee, Vahid; Beygi, Sara; Moshayedi, Pouria; Mirfazeli, Fatemeh Sadat

2012-01-01

Psychopharmacotherapy can be an effective part of the treatment for individuals with autism spectrum disorders (ASDs). However debate continues over the potential benefits and costs of these treatments; additionally little is known about the pattern of psychotropic medication use in developing countries. We aimed to survey the use of psychotropic…

Understanding the Assessment of Psychotropic Drug Harms in Clinical Trials to Improve Social Workers' Role in Medication Monitoring

ERIC Educational Resources Information Center

Hughes, Shannon; Cohen, David

2010-01-01

The purpose of this integrative review is to facilitate social work practitioners' understanding of how psychotropic drug harms are assessed in clinical trials and to make specific suggestions for social workers' increased involvement in detecting drug harms in their clients. The authors undertook a comprehensive review of interdisciplinary…

Off-Label Prescribing, Polypharmacy, and Black-Box Warnings: A Primer for School Psychologists

ERIC Educational Resources Information Center

Shahidullah, Jeffrey D.

2012-01-01

Psychotropic medications are increasingly used to treat children and adolescents with mental health conditions. Between the years 1994 and 2001, there was a 191.7% increase in number of office visits resulting in a psychotropic medication prescription among children and adolescents. Many drugs are prescribed to children "off-label", whereby they…

Individual music therapy for agitation in dementia: an exploratory randomized controlled trial

PubMed Central

Stige, Brynjulf; Qvale, Liv Gunnhild; Gold, Christian

2013-01-01

Objectives: Agitation in nursing home residents with dementia leads to increase in psychotropic medication, decrease in quality of life, and to patient distress and caregiver burden. Music therapy has previously been found effective in treatment of agitation in dementia care but studies have been methodologically insufficient. The aim of this study was to examine the effect of individual music therapy on agitation in persons with moderate/severe dementia living in nursing homes, and to explore its effect on psychotropic medication and quality of life. Method: In a crossover trial, 42 participants with dementia were randomized to a sequence of six weeks of individual music therapy and six weeks of standard care. Outcome measures included agitation, quality of life and medication. Results: Agitation disruptiveness increased during standard care and decreased during music therapy. The difference at −6.77 (95% CI (confidence interval): −12.71, −0.83) was significant (p = 0.027), with a medium effect size (0.50). The prescription of psychotropic medication increased significantly more often during standard care than during music therapy (p = 0.02). Conclusion: This study shows that six weeks of music therapy reduces agitation disruptiveness and prevents medication increases in people with dementia. The positive trends in relation to agitation frequency and quality of life call for further research with a larger sample. PMID:23621805

Potentially inappropriate medication use in nursing homes: an observational study using the NORGEP-NH criteria.

PubMed

Nyborg, Gunhild; Brekke, Mette; Straand, Jørund; Gjelstad, Svein; Romøren, Maria

2017-09-19

Frail residents in the nursing home sector call for extra care in prescribing. The Norwegian General Practice Nursing Home (NORGEP-NH) list of 34 explicit criteria for potentially inappropriate medication use in nursing homes was developed explicitly for this population. The aim of this study was to employ the NORGEP-NH Criteria to study the extent of potentially inappropriate medication use among nursing home residents and explore possible associated factors. Cross-sectional observational pharmacoepidemiological study from residents in nursing homes in the county of Vestfold, Norway. Data collected 2009-11 included residents' demographic and clinical status and all medications, regular and on demand. 881 patients from 30 institutions (mean 85.9 years, 68.6% female), were included. According to NORGEP-NH, 43.8% were prescribed at least one potentially inappropriate regular medication, and 9.9% regularly received three or more potentially inappropriate medications. When also including a) the NORGEP-NH Deprescribing Criteria and b) including drugs prescribed for use as needed, 92.7% of all residents received medication that needs particular surveillance according to the NORGEP-NH. 69.7% of the nursing home residents used at least one psychotropic drug regularly. Female residents received more often than males at least one potentially inappropriate regular medication (OR 1.60, p=0.007). Regarding the prescription of three or more concomitant psychotropic medications, odds ratio for females was 1.79 (p=0.03) compared to males. Residents with the best performance in activities of daily living, and residents residing in long-term wards, had higher risk of using three or more psychotropic drugs. Use of multiple psychoactive drugs increased the risk of falls in the course of an acute episode of infection or dehydration (odds ratio 1.70, p=0.009). Prevalence of potentially inappropriate medications in nursing homes according to the NORGEP-NH was extensive, and especially the use of multiple psychotropic drugs. The high prevalence found in this study shows that there is a need for higher awareness of medication use and side effects in the elderly population. Retrospectively registered. Data obtained from clinical trial NCT01023763 registered with ClinicalTrials.gov 12/01/2009.

[Psychotropic medication use by French active self-employed workers].

PubMed

Ha-Vinh, Philippe; Régnard, Pierre; Sauze, Laurent

2011-04-01

INTERESTS OF THE STUDY: In the self-employed workers population (shop keepers, craft men, industrialists and liberal professions), psychotropic medications use and discrepancies between occupational situations have never been evaluated before. It is nevertheless a prerequisite in preventive actions against addictions, stress and injuries caused by disorders of attentiveness at work. The French Self Employed Workers Health Care Insurance Fund affiliate members data base was analysed for active workers from 18 to 60 years of age living in the Provence Alpes Côte d'Azur Region. From this population the cases were defined as having refunded ambulatory prescription of behind the counter psychotropic treatment during the year 2009 (anxiolytic, antidepressant, hypnotic, neuroleptic, lithium, alcoholic or opioid dependance therapy) and the randomised control sample was constituted by drawing the key of the social security number. A case-control multivariate logistic regression adjusted for gender, age and place of abode was used for searching discrepancy between occupational situations. Anxiolytic, antidepressant or hypnotic consumers are the most numerous (906; 557 and 446 consumers per 10 000 persons-year respectively). Antidepressant, neuroleptic and opioid dependance therapy are the three main posts of expense for the health insurance (584 505; 169 947 and 151 201 € per year respectively). When compared to workers of the construction sector, workers of retail trade of clothes had an Odd Ratio of 2,04 [95%CI 1,46-2,85] for anxiolytics consumption and 2,29 [95%CI 1,67-3,14] for antidepressants consumption, workers in the sector of the hotel and catering had an Odd Ratio of 1,62 [95%CI 1,19-2,22] for alcoholic dependance therapy medicines consumption, workers in the accountant, legal and financial sector had an Odd Ratio of 0,05 [95%CI 0,01-0,32] for opioid dependence therapy medicines consumption. Occupations associated with increased psychotropic medicines consumption are important to consider when assessing or fighting against psychotropic or addictive substance consumption, psychological stress and vigilance or attention perturbation at work. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

Cannabidiol in medicine: a review of its therapeutic potential in CNS disorders.

PubMed

Scuderi, Caterina; Filippis, Daniele De; Iuvone, Teresa; Blasio, Angelo; Steardo, Antonio; Esposito, Giuseppe

2009-05-01

Cannabidiol (CBD) is the main non-psychotropic component of the glandular hairs of Cannabis sativa. It displays a plethora of actions including anticonvulsive, sedative, hypnotic, antipsychotic, antiinflammatory and neuroprotective properties. However, it is well established that CBD produces its biological effects without exerting significant intrinsic activity upon cannabinoid receptors. For this reason, CBD lacks the unwanted psychotropic effects characteristic of marijuana derivatives, so representing one of the bioactive constituents of Cannabis sativa with the highest potential for therapeutic use.The present review reports the pharmacological profile of CBD and summarizes results from preclinical and clinical studies utilizing CBD, alone or in combination with other phytocannabinoids, for the treatment of a number of CNS disorders.

Coverage and prior authorization of psychotropic drugs under Medicare Part D.

PubMed

Huskamp, Haiden A; Stevenson, David G; Donohue, Julie M; Newhouse, Joseph P; Keating, Nancy L

2007-03-01

This study examined formulary coverage and use of utilization management tools for three classes of psychotropic medications (antidepressants, antipsychotics, and anticonvulsants) among Medicare Part D prescription drug plans serving individuals dually eligible for the Medicare and Medicaid programs. Plans must cover "all or substantially all" molecules (distinct drugs) in these classes. Plans serving "dual eligibles" generally covered at least one formulation of all molecules in the three classes. However, certain product formulations were not covered by a number of plans, and use of prior authorization was common for a minority of plans. The effect of Part D will depend on the restrictiveness of the prior authorization and appeals processes, which is currently unknown.

The Effectiveness of Mood Stabilizers and Antiepileptic Medication for the Management of Behaviour Problems in Adults with Intellectual Disability: A Systematic Review

ERIC Educational Resources Information Center

Deb, S.; Chaplin, R.; Sohanpal, S.; Unwin, G.; Soni, R.; Lenotre, L.

2008-01-01

Background: Psychotropic medications are used to manage behaviour problems in adults with intellectual disability (ID). One group of psychotropic medication are mood stabilizers such as lithium and some antiepileptic drugs. Method: A comprehensive systematic review was performed to determine the evidence base for the effectiveness of mood…

Brief Review of Current Research in FXS: Implications for Treatment with Psychotropic Medication

ERIC Educational Resources Information Center

Valdovinos, Maria G.

2007-01-01

The purpose of this paper is to provide a brief review of current research in fragile X syndrome (FXS) with regards to the morphology and behavioral phenotype associated with FXS and the use of psychotropic medication for the treatment of behavior problems (e.g., aggression) often seen in FXS (full mutation). The lack of production of the fragile…

Using Analogue Functional Analysis to Measure Variations in Problem Behavior Rate and Function after Psychotropic Medication Changes: A Clinical Demonstration

ERIC Educational Resources Information Center

Valdovinos, Maria G.; Nelson, Samantha M.; Kuhle, Jennifer L.; Dierks, Abigail M.

2009-01-01

Individuals with intellectual and developmental disabilities are often prescribed psychotropic medication to treat behaviors such as aggression and self-injury. Evaluation of these medications is often based on caregiver report or changes in frequency of behavior. The purpose of this research was to characterize the rate and function of problem…

The Neuroprotective Disease-Modifying Potential of Psychotropics in Parkinson's Disease

PubMed Central

Lauterbach, Edward C.; Fontenelle, Leonardo F.; Teixeira, Antonio L.

2012-01-01

Neuroprotective treatments in Parkinson's disease (PD) have remained elusive. Psychotropics are commonly prescribed in PD without regard to their pathobiological effects. The authors investigated the effects of psychotropics on pathobiological proteins, proteasomal activity, mitochondrial functions, apoptosis, neuroinflammation, trophic factors, stem cells, and neurogenesis. Only findings replicated in at least 2 studies were considered for these actions. Additionally, PD-related gene transcription, animal model, and human neuroprotective clinical trial data were reviewed. Results indicate that, from a PD pathobiology perspective, the safest drugs (i.e., drugs least likely to promote cellular neurodegenerative mechanisms balanced against their likelihood of promoting neuroprotective mechanisms) include pramipexole, valproate, lithium, desipramine, escitalopram, and dextromethorphan. Fluoxetine favorably affects transcription of multiple genes (e.g., MAPT, GBA, CCDC62, HIP1R), although it and desipramine reduced MPTP mouse survival. Haloperidol is best avoided. The most promising neuroprotective investigative priorities will involve disease-modifying trials of the safest agents alone or in combination to capture salutary effects on H3 histone deacetylase, gene transcription, glycogen synthase kinase-3, α-synuclein, reactive oxygen species (ROS), reactive nitrogen species (RNS), apoptosis, inflammation, and trophic factors including GDNF and BDNF. PMID:22254151

Racial and socioeconomic differences in psychiatric symptoms in nursing home residents: a minimum data set-based pilot study.

PubMed

Zisselman, Marc H; Smith, Robert V; Smith, Stephanie A; Daskalakis, Constantine; Sanchez, Francisco

2006-01-01

Little research has explored racial and socioeconomic differences in the presence, detection, and treatment of neuropsychiatric symptoms in nursing home residents. To evaluate racial and socioeconomic differences on mood and behavior Minimum Data Set (MDS) recorded symptoms, MDS recorded psychiatric diagnoses, and MDS identified psychotropic medication use. Data were obtained through a cross-sectional review of MDS data of 290 African-American and white residents of 2 nursing homes. The association between age, gender, race, and pay status with mood and behavior patterns, psychiatric diagnoses, and use of psychotropic medication was evaluated. White residents were more likely than African American residents to have MDS recorded psychiatric diagnoses (odds ratio, OR = 3.24), but there were no significant racial differences in recorded mood or behavior symptomatology or in the pharmacologic treatment of mental illness. Medicaid recipients were more likely than nonrecipients to have behavior symptoms (OR = 2.09), have a psychiatric diagnosis (OR = 2.91), and receive psychotropic medications in the absence of a psychiatric diagnosis (OR = 3.62). Pay status was associated with recorded symptoms, diagnoses, and medications, but racial differences were found only for recorded diagnoses.

Pharmacogenomic Testing for Psychotropic Medication Selection: A Systematic Review of the Assurex GeneSight Psychotropic Test

PubMed Central

Brener, Stacey; Holubowich, Corinne

2017-01-01

Background A large proportion of the Ontario population lives with a diagnosed mental illness. Nearly 5% of Ontarians have major depressive disorder, and another 5% have another type of depressive disorder, bipolar disorder, schizophrenia, anxiety, or some other disorder not otherwise specified. Medications are commonly used to treat mental illness, but choosing the right medication for each patient is challenging, and more than 40% of patients discontinue their medication within 90 days because of adverse effects or lack of response. The Assurex GeneSight Psychotropic test is a pharmacogenomic panel that provides clinicians with a report to guide medication selection that is unique to each patient based on their individual genetic profile. However, it is uncertain whether guided treatment using GeneSight is effective compared with unguided treatment (usual care). Methods We performed a systematic review to identify English-language studies published before February 22, 2016, that compared GeneSight-guided care and usual care among people with mood disorders, anxiety, or schizophrenia. Primary outcomes of interest were prevention of suicide, remission of depression symptoms, response to depression therapy, depression score, and quality of life. Secondary outcomes of interest were impact on therapeutic decisions and patient and clinician satisfaction. Risk of bias was evaluated, and the quality of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) working group criteria. Results Four studies met the inclusion criteria. These studies used a version of GeneSight that included the CYP2D6, CYP2C19, CYP1A2, SLC6A4, and HTR2A genes; one of the studies also included CYP2C9. Patients who received the GeneSight test to guide psychotropic medication selection had improved response to depression treatment, greater improvements in measures of depression, and greater patient and clinician satisfaction compared with patients who received treatment as usual. We observed no differences in rates of complete remission from depression. The findings were based on GRADE assessment of low to very low quality evidence, and the body of evidence had several limitations: the included studies used an older version of GeneSight and were limited to a population with major depression, so results may not be generalizable to other versions of the test or different populations such as patients with anxiety or schizophrenia. Conclusions There is uncertainty about the use of GeneSight Psychotropic pharmacogenomic genetic panel to guide medication selection. It was associated with improvements in some patient outcomes, but not others. As well, our confidence in these findings is low because of limitations in the body of evidence. PMID:28515818

Identification of N,N-dimethyltryptamine and beta-carbolines in psychotropic ayahuasca beverage.

PubMed

Gambelunghe, Cristiana; Aroni, Kyriaki; Rossi, Riccardo; Moretti, Luca; Bacci, Mauro

2008-10-01

Recently many people have shown great interest in traditional indigenous practices and popular medicine, involving the ingestion of natural psychotropic drugs. We received a request to analyze and determine the nature of a dark green liquid with a dark brown plant sediment, which the police had seized at an airport and inside the home of a person belonging to the 'Santo Daime' religious movement. Gas chromatography/mass spectrometry analysis of the extract identified N,N-dimethyltryptamine, a potent hallucinogen, and the beta-carboline alkaloids harmine and harmaline, revealing monoamine oxidase A-inhibiting properties. These substances are typical components of Ayahuasca, a South American psychotropic beverage obtained by boiling the bark of the liana Banisteriopsis caapi together with the leaves of various admixture plants, principally Psychotria viridis.

Successful Management of Psychotropics Induced Stuttering Priapism with Pseudoephedrine in a Patient with Schizophrenia.

PubMed

Thippaiah, Srinagesh Mannekote; Nagaraja, Soumya; Birur, Badari; Pandurangi, Ananda

2018-02-05

Stuttering Priapism is a recurrent, persistent penile erection in the absence of sexual desire due to altered genital hemodynamics, affecting the arterial component (high flow, non-ischemic) or the veno-occlusive mechanism (low flow, ischemic). Both typical and atypical antipsychotics increase the risk for priapism with greater implications in typicals than atypicals. Prompt recognition and treatment are important as 40% to 50% of patients with stuttering priapism may develop an erectile dysfunction if left untreated. There are several case reports in the literature about the association between psychotropic agents and priapism. However, there are no reports of successfully treating stuttering priapism using pseudoephedrine (sudafed) in the adult population. Here we present successful management of psychotropics induced stuttering priapism with pseudoephedrine in a male patient with schizophrenia.

Medication Use before, during, and after Pregnancy among Women with Eating Disorders: A Study from the Norwegian Mother and Child Cohort Study

PubMed Central

Lupattelli, Angela; Spigset, Olav; Torgersen, Leila; Zerwas, Stephanie; Hatle, Marianne; Reichborn-Kjennerud, Ted; Bulik, Cynthia M.; Nordeng, Hedvig

2015-01-01

Introduction Little is known about medication use among women with eating disorders in relation to pregnancy. Aims To explore patterns of and associations between use of psychotropic, gastrointestinal and analgesic medications and eating disorders in the period before, during and after pregnancy. Method This study is based on the Norwegian Mother and Child Cohort Study (MoBa). A total of 62,019 women, enrolled at approximately 17 weeks' gestation, had valid data from the Norwegian Medical Birth Registry and completed three MoBa questionnaires. The questionnaires provided diagnostic information on broadly defined anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED) and recurrent self-induced purging in the absence of binge eating (EDNOS-P), along with self-reported use of medication six months before, during, and 0–6 months after pregnancy. Results The prevalence of eating disorder subtypes before and/or during pregnancy was: 0.09% AN (n = 54), 0.94% BN (n = 585), 0.10% EDNOS-P (n = 61) and 5.00% BED (n = 3104). The highest over-time prevalence of psychotropic use was within the AN (3.7–22.2%) and EDNOS-P (3.3–9.8%) groups. Compared to controls, BN was directly associated with incident use of psychotropics in pregnancy (adjusted RR: 2.25, 99% CI: 1.17–4.32). Having AN (adjusted RR: 5.11, 99% CI: 1.53–17.01) or EDNOS-P (adjusted RR: 6.77, 99% CI: 1.41–32.53) was directly associated with use of anxiolytics/sedatives postpartum. The estimates of use of analgesics (BED) and laxatives (all eating disorders subtypes) were high at all time periods investigated. Conclusions Use of psychotropic, gastrointestinal, and analgesic medications is extensive among women with eating disorders in the period around pregnancy. Female patients with eating disorders should receive evidence-based counseling about the risk of medication exposure versus the risk of untreated psychiatric illness during pregnancy and postpartum. PMID:26200658

[Sleep disorders and impaired sleep as adverse drug reactions of psychotropic drugs: an evaluation of data of summaries of product characteristics].

PubMed

Gahr, Maximilian; Connemann, Bernhard J; Zeiss, René; Fröhlich, Albrecht

2018-03-02

 Psychopharmacotherapy is essential in the treatment of many mental disorders. Adverse drug reactions (ADR) have impact on compliance and tolerability. Sleep disorders or impaired sleep may occur as ADRs of psychopharmacotherapy. Sleep disorders are associated with an increased risk for physical and mental illness and may impair cognition, impulse control, emotion regulation and mood. Objective of the following study was the systematic presentation of type and risk of sleep disorders/impairments of sleep of frequently prescribed psychotropic drugs.  Psychotropic agents that are most frequently prescribed in Germany were identified by using the Arzneiverordnungs-Report 2016. Summaries of product characteristics (SmPC) of corresponding original products were analyzed regarding presence and frequency of sleep disorders/impairments of sleep according to the International Classification of Sleep Disorders 3 (ICSD-3).  N = 64 SmPCs were analyzed. In most of the analyzed SmPCs, at least one sleep disorder (50/64; 78 %) was listed. At least one SmPC with a corresponding ADR was found in the categories insomnia (52 %), parasomnias (33 %), and sleep-related movement disorders (20 %); sleep-related breathing disorders (6 %) and central disorders of hypersomnolence (5 %) were rarely listed; circadian rhythm sleep-wake disorder was not found. The SmPCs of the four most frequently prescribed agents (citalopram > venlafaxine > mirtazapine > sertraline) listed insomnia as an ADR. Nearly all analysed hypnotics (except chloral hydrate) were associated with nightmares.  Most of the psychotropic agents frequently prescribed in Germany may induce sleep disorders/impairments of sleep. The four most frequently prescribed agents were antidepressants and all of the corresponding SmPCs listed insomnia as a possible ADR. Sleep disorders should be taken seriously as possible ADRs of psychopharmacotherapy. © Georg Thieme Verlag KG Stuttgart · New York.

[Common mental disorders and the use of psychoactive drugs: the impact of socioeconomic conditions].

PubMed

Lima, Maria Cristina Pereira; Menezes, Paulo Rossi; Carandina, Luana; Cesar, Chester Luiz Galvão; Barros, Marilisa Berti de Azevedo; Goldbaum, Moisés

2008-08-01

To evaluate the influence of socioeconomic conditions on the association between common mental disorders and the use of health services and psychoactive drugs. This was a population-based cross-sectional study conducted in the city of Botucatu, Southeastern Brazil. The sample was probabilistic, stratified and cluster-based. Interviews with 1,023 subjects aged 15 years or over were held in their homes between 2001 and 2002. Common mental disorders were evaluated using the Self-Reporting Questionnaire (SRQ-20). The use of services was investigated in relation to the fortnight preceding the interview and the use of psychotropic drugs, over the preceding three days. Logistic regression was used for multivariable analysis, and the design effect was taken into consideration. Out of the whole sample, 13.4% (95% CI: 10.7;16.0) had sought health services over the fortnight preceding the interview. Seeking health services was associated with female gender (OR=2.0) and the presence of common mental disorders (OR=2.2). 13.3% of the sample (95% CI: 9.2;17.5) said they had used at least one psychotropic drug, especially antidepressives (5.0%) and benzodiazepines (3.1%). In the multivariable analysis, female gender and the presence of common mental disorders remained associated with the use of benzodiazepines. Per capita income presented a direct and independent association with the use of psychoactive drugs: the greater the income, the greater the use of these drugs was. Lower income was associated with the presence of common mental disorders, but not with the use of psychotropic drugs. The association of common mental disorders and the use of psychotropic drugs in relation to higher income strengthens the hypothesis that inequality of access to medical services exists among this population.

Mental health among currently enrolled medical students in Germany.

PubMed

Wege, N; Muth, T; Li, J; Angerer, P

2016-03-01

The study identifies the prevalence of common mental disorders according to the patient health questionnaire (PHQ) and the use of psychotropic substances in a sample of currently enrolled medical students. A cross-sectional survey with a self-administrated questionnaire. All newly enrolled medical students at the University of Dusseldorf, with study beginning either in 2012 or 2013, respectively, were invited to participate. The evaluation was based on 590 completed questionnaires. Mental health outcomes were measured by the PHQ, including major depression, other depressive symptoms (subthreshold depression), anxiety, panic disorders and psychosomatic complaints. Moreover, information about psychotropic substances use (including medication) was obtained. Multiple logistic regression analysis was used to estimate associations between sociodemographic and socio-economic factors and mental health outcomes. The prevalence rates, measured by the PHQ, were 4.7% for major depression, 5.8% for other depressive symptoms, 4.4% for anxiety, 1.9% for panic disorders, and 15.7% for psychosomatic complaints. These prevalence rates were higher than those reported in the general population, but lower than in medical students in the course of medical training. In all, 10.7% of the students reported regular psychotropic substance use: 5.1% of students used medication 'to calm down,' 4.6% 'to improve their sleep,' 4.4% 'to elevate mood,' and 3.1% 'to improve cognitive performance.' In the fully adjusted model, expected financial difficulties were significantly associated with poor mental health (odds ratio [OR]: 2.14; 95% confidence interval [CI]: 1.31-3.48), psychosomatic symptoms (OR:1.85; 95% CI: 1.11-3.09) and psychotropic substances use (OR: 2.68; 95% CI: 1.51-4.75). The high rates of mental disorders among currently enrolled medical students call for the promotion of mental health, with a special emphasis on vulnerable groups. Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

The Use of Psychotropic Medication for People with Intellectual Disabilities and Behaviours That Challenge in the Context of a Community Multidisciplinary Team Approach

ERIC Educational Resources Information Center

Niven, Abigail; Goodey, Rebecca; Webb, Alison; Shankar, Rohit

2018-01-01

Background: The use of psychotropic medication to manage challenging behaviours of people with intellectual disabilities is a contentious issue which NHS England has now focused on. This paper looks to evaluate this within the multidisciplinary context. Method: Records of clients (n = 106) open to a Community Intellectual Disabilities team for…

[Psychotropic drugs for children - a brief historical review].

PubMed

Nissen, Gerhardt

2009-01-01

Already in the ancient world psychiatric disorders of children have been reported. However, only in the last decades the effectiveness of specific psychotropic drugs for the affected children have been investigated systematically. Especially in Germany there has been a controversial discussion about the application of neuroleptics in child and adolescent psychiatry. Important aspects of psychopharmacological therapy in childhood and adolescents are illustrated and discussed.

[Effects of a physical restraint removal program on older people with dementia in residential care].

PubMed

Tortosa, M Ángeles; Granell, Rafael; Fuenmayor, Amadeo; Martínez, Mary

2016-01-01

To analyse the results of removing physical restraints from elderly patients with dementia living in nursing homes. This objective is part of a wider process of change in residential care. Quasi-experimental study conducted in two residences from May 2010 to May 2012. Information was collected at 7 time points and longitudinal analyses were performed. After training staff, the physical restraints in El Puig centre were phased out, while in the Conarda centre, restraints were still applied to elderly people. The main variables studied were: falls, psychotropic medication prescriptions, different indicators of mental impairment, and degree of dependence (Norton, NPI, Mini-mental, Tinetti, Barthel). In the El Puig centre all the physical restraints were removed. A slight improvement was seen in the number of falls, and their consequences. The ANOVA showed significant improvements in the centre that removed restraints in prescribing psychotropic medications, cognitive impairment, and behavioural changes. It is shown that removing physical restraints do not cause negative effects as regards the number of falls, and also positively affects the welfare and independence of elderly people (through changes in behaviour and mental impairment). Furthermore, it is demonstrated that this program must be accompanied by the reduction and control of medicines (withdrawal of the number of psychotropic prescriptions). Copyright © 2014 SEGG. Published by Elsevier Espana. All rights reserved.

A computerized stroop test for the evaluation of psychotropic drugs in healthy participants.

PubMed

Pilli, Raveendranadh; Naidu, Mur; Pingali, Usha Rani; Shobha, J C; Reddy, A Praveen

2013-04-01

The Stroop paradigm evaluates susceptibility to interference and is sensitive to dysfunction in frontal lobes and drug effects. The aim of the present study was to establish a simple and reliable computerized version of Stroop color-word test, which can be used for screening of various psychotropic drugs. The standardized method was followed in all cases, by recording the reaction time (RT) in msec in 24 healthy participants using computerized version of Stroop color-word test. Reproducibility of the test procedure was evaluated by recording the RTs by a single experimenter on two sessions (interday reproducibility). Validity of the model was further tested by evaluating the psychotropic effect of Zolpidem 5 mg, Caffeine 500 mg, or Placebo on 24 healthy subjects in a randomized, double blind three-way crossover design. The method was found to produce low variability with coefficient of variation less than 10%. Interday reproducibility was very good as shown by Bland-Altman plot with most of the values within ±2SD. There was a significant increase in RTs in Stroop performance with Zolpidem at 1 hr and 2 hrs; in contrast, caffeine significantly decreased RTs in Stroop performance at 1 hr only compared to placebo. The Stroop color-word recording and analysis system is simple, sensitive to centrally acting drug effects, and has potential for future experimental psychomotor assessment studies.

[Pregnancy and substance use in France: a literature review].

PubMed

Dumas, A; Simmat-Durand, L; Lejeune, C

2014-11-01

Substance use during pregnancy is an important public health issue. It requires identifying at-risk populations and risk perception among women. A literature review was conducted. It included French studies conducted since 2000 on substance use during pregnancy (tobacco, alcohol, marijuana, psychotropic drugs) and risk perception. In France, in 2010, 24% of pregnant women smoke--17% in the 3rd trimester. Depending on studies, the prevalence of alcohol use ranged from 12 to 63% and binge drinking ranged from 1 to 7%; daily drinking was below 0.5%. Marijuana use ranged from 1 to 3%, and psychotropic drugs ranged from 2 to 4%. Little research has been dedicated to risk perception. Studies show a lack of awareness about the equivalence of risks between fermented and distilled beverages and about the risks of moderate smoking during pregnancy. Data is lacking to characterize at-risk populations and mechanisms underlying risky behaviors. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Psychotropics and weak opioid analgesics in plasma samples of older hip fracture patients - detection frequencies and consistency with drug records.

PubMed

Waade, Ragnhild Birkeland; Molden, Espen; Martinsen, Mette Irene; Hermann, Monica; Ranhoff, Anette Hylen

2017-07-01

To determine use of psychotropic drugs and weak opioids in hip fracture patients by analysing plasma samples at admission, and compare detected drug frequencies with prescription registry data and drug records. Plasma from 250 hip fracture patients aged ≥65 years sampled at hospital admission were analysed by ultra-performance liquid chromatography-tandem mass spectrometry methods for detection of psychotropic drugs and weak opioid analgesics (alcohol also determined). Odds ratios for drugs detected in plasma of hip fracture patients vs. prescription frequencies of the same drugs in an age-, time- and region-matched reference population were calculated. Moreover, recorded and measured drugs were compared. Psychotropic drugs and/or weak opioid analgesics were detected in 158 (63%) of the patients (median age 84 years; 76% females), while alcohol was found in 19 patients (7.6%). The occurrence of diazepam (odds ratio 1.6; 95% confidence interval 1.1-2.4), nitrazepam (2.3; 1.3-4.1), selective serotonin reuptake inhibitors (1.9; 1.3-2.9) and mirtazapine (2.3; 1.2-4.3) was significantly higher in plasma samples of hip fracture patients than in prescription data from the reference population. Poor consistency between recorded and measured drugs was disclosed for z-hypnotics and benzodiazepines; e.g. diazepam was detected in 29 (11.6%), but only recorded in six (2.4%) of the patients. Plasma analysis shows that use of antidepressants and benzodiazepines in hip fracture patients is significantly more frequent than respective prescription frequencies in the general elderly population. Moreover, consistency between recorded and actual use of psychotropic fall-risk drugs is poor at hospital admission of hip fracture patients. © 2017 The British Pharmacological Society.

Nonalcoholic Fatty Liver Disease and Fibrosis in Youth Taking Psychotropic Medications: Literature Review, Case Reports, and Management.

PubMed

Gracious, Barbara L; Bhatt, Ramona; Potter, Carol

2015-10-01

Nonalcoholic fatty liver disease (NAFLD) has become a worldwide epidemic because of the greater prevalence of obesity. Despite implications for youth with severe mental disorders, little has been published in the psychiatric literature about this increasingly common medical comorbidity. The goals of this article are to: 1) provide an overview of the epidemiology and pathophysiology of NAFLD, including progression to nonalcoholic steatohepatitis (NASH); 2) describe two clinical cases illustrating difficulties faced in management; and 3) review screening recommendations, differential diagnosis, and monitoring and intervention approaches. A literature review was conducted, including guidelines and recommendations, with case presentations including case and control liver histology biopsy photographs. NAFLD in childhood and adolescence, as a precursor to NASH, progresses to fibrosis in a small percentage of youth, leading to risk for early onset cirrhosis and the need for transplantation. The cases presented raise concern that youth with severe mental health disorders, already at greater risk for obesity and its sequelae, may be at higher risk for progression to NASH, potentially because of greater rates of weight gain on top of overweight or obese status, and to liver metabolism changes from psychotropic medications favoring fat deposition. Patients with rapid weight gain into the overweight or obese categories, or who develop elevated liver transaminases that persist across 3-6 months, should be screened or referred for screening by their psychotropic-providing clinicians for early detection, diagnosis, and co-management by a pediatric gastroenterologist, to decrease risk of progression to NASH, which is reversible if early and sufficient lifestyle change results in significant weight loss. There is urgent need for controlled research on the relationships among weight gain, psychotropic medications, ultrasound and biopsy findings, and rates of progression to NAFLD and NASH in youth taking weight-gain-inducing psychotropic medications.

The monitoring of trade in and control of psychotropic substances to guard against their diversion.

PubMed

Bayer, I

1983-01-01

The establishment of international control of opiates has been an important achievement of the international community; this is substantiated by the fact that, at the beginning of this century, legally manufactured morphine and heroin were the principal sources of illicit supply, whereas at present the illicit traffic in these drugs is supplied from illicit sources. The poppy straw process has helped to promote measures to control opium poppy cultivation in a number of European countries; Turkey has been a successful example of such control. The present large-scale illicit traffic in cannabis resin and cocaine is the consequence of the lack of the implementation of provisions of the Single Convention on Narcotic Drugs, 1961, to control the cannabis plant and the coca bush at the national level. The provisions of the 1971 Convention on Psychotropic Substances, being largely a result of international compromise, are not designed in the best possible way to prevent the diversion of psychotropic substances from legal sources to illicit channels. There are no appropriate provisions for the control and monitoring of international transactions. There is a discrepancy between the rather limited scope of international control of substances listed in schedules III and IV of the 1971 Convention and the much larger scope of control of hypnotics, sedatives and tranquillizers at national levels. The provisions of the 1971 Convention, however, constitute a legal basis for bilateral and multilateral actions for the detection of suspected diversion cases, and offer possibilities of promoting the prevention of diversion of psychotropic substances. At present, the relationship between the control of psychotropic drugs, including the prevention of diversion and the organization of the national drug supply system, as well as the efficacy of national control over pharmaceutical products, has not been fully recognized by the international community.

Variations in Mental Health Diagnosis and Prescribing Across Pediatric Primary Care Practices

PubMed Central

Mayne, Stephanie L.; Ross, Michelle E.; Song, Lihai; McCarn, Banita; Steffes, Jennifer; Liu, Weiwei; Margolis, Benyamin; Azuine, Romuladus; Gotlieb, Edward; Grundmeier, Robert W.; Leslie, Laurel K.; Localio, Russell; Wasserman, Richard

2016-01-01

BACKGROUND: Primary care pediatricians increasingly care for children’s mental health problems, but little is known about practice-level variation in diagnosis and psychotropic medication prescribing practices. METHODS: This retrospective review of electronic heath records from 43 US primary care practices included children aged 4 to 18 years with ≥1 office visit from January 1, 2009, to June 30, 2014. We examined variability in diagnosis and psychotropic prescribing across practices using logistic regression with practice fixed effects and evaluated associations of the availability of colocated or community-based mental health providers or the proportion of children in foster care with diagnosis and prescribing using generalized linear mixed models. RESULTS: Among 294 748 children, 40 932 (15%) received a mental health diagnosis and 39 695 (14%) were prescribed psychotropic medication. Attention deficit/hyperactivity disorder was most commonly diagnosed (1%–16% per practice). The proportion of children receiving any psychotropic medication (4%-26%) and the proportion receiving ≥2 medication classes (1%-12%) varied across practices. Prescribing of specific medication classes also varied (stimulants, 3%–18%; antidepressants, 1%–12%; α-agonists, 0%–8%; second-generation antipsychotics, 0%–5%). Variability was partially explained by community availability of psychiatrists (significantly higher odds of a diagnosis or prescription when not available) but not by colocation of mental health professionals or percentage of children in foster care. CONCLUSIONS: The prevalence of mental health diagnosis and psychotropic medication prescribing varies substantially across practices and is only partially explained by psychiatrist availability. Research is needed to better define the causes of variable practice-level diagnosis and prescribing and implications for child mental health outcomes. PMID:27244791

Analytical validation of a psychiatric pharmacogenomic test.

PubMed

Jablonski, Michael R; King, Nina; Wang, Yongbao; Winner, Joel G; Watterson, Lucas R; Gunselman, Sandra; Dechairo, Bryan M

2018-05-01

The aim of this study was to validate the analytical performance of a combinatorial pharmacogenomics test designed to aid in the appropriate medication selection for neuropsychiatric conditions. Genomic DNA was isolated from buccal swabs. Twelve genes (65 variants/alleles) associated with psychotropic medication metabolism, side effects, and mechanisms of actions were evaluated by bead array, MALDI-TOF mass spectrometry, and/or capillary electrophoresis methods (GeneSight Psychotropic, Assurex Health, Inc.). The combinatorial pharmacogenomics test has a dynamic range of 2.5-20 ng/μl of input genomic DNA, with comparable performance for all assays included in the test. Both the precision and accuracy of the test were >99.9%, with individual gene components between 99.4 and 100%. This study demonstrates that the combinatorial pharmacogenomics test is robust and reproducible, making it suitable for clinical use.

Studies on photodegradation process of psychotropic drugs: a review.

PubMed

Trawiński, Jakub; Skibiński, Robert

2017-01-01

Consumption of psychotropic drugs is still increasing, especially in high-income countries. One of the most crucial consequences of this fact is significant release of them to the environment. Considerable amounts of atypical antipsychotics, benzodiazepines, antidepressants, and their metabolites were detected in river, lake, and sea water, as well as in tissues of aquatic organisms. Their ecotoxicity was proved by numerous studies. It should be noticed that interaction between psychotropic pharmaceuticals and radiation may lead to formation of potentially more toxic intermediates. On the other hand, photo-assisted wastewater treatment methods can be used as an efficient way to eliminate them from the environment. Many methods based on photolysis and photocatalysis were proposed and developed recently; nevertheless, the problem is still unsolved. However, according to recent studies, photocatalysis could be considered as the most promising and far more effective than regular photolysis. An overview on photolytic as well as homogenous and heterogeneous photocatalytic degradation methods with the use of various catalysts is presented. The photostability and phototoxicity of pharmaceuticals were also discussed. Various analytical methods were used for the photodegradation research, and this issue was also compared and summarized. Use of high-resolution multistage mass spectrometry (Q-TOF, ion trap, Orbitrap) was suggested. The combined techniques such as LC-MS, GC-MS, and LC-NMR, which enable qualitative and quantitative analyses in one run, proved to be the most valuable in this case. Assembling of MS/MS spectra libraries of drug molecules and their phototransformation products was identified as the future challenge.

Campania Region (Italy) spontaneous reporting system and preventability assessment through a case-by-case approach: a pilot study on psychotropic drugs.

PubMed

Sessa, Maurizio; Rafaniello, Concetta; Sportiello, Liberata; Mascolo, Annamaria; Scavone, Cristina; Maccariello, Alessandra; Iannaccone, Teresa; Fabrazzo, Michele; Berrino, Liberato; Rossi, Francesco; Capuano, Annalisa

2016-12-01

We conducted the first pilot Italian study to assess the preventability of adverse drug reactions involving psychotropic drugs reported through spontaneous reporting system from 01/07/2012 to 31/12/2014 in Campania Region. Preventability was assessed, case-by-case, using an adapted version of the P-method. The evaluation was performed only for those reports that had, as suspected drug, antipsychotics, mood stabilizers, antidepressants, anxiolytic and/or sedative-hypnotic. Eighty-one cases (19.2%) out of 421 reported during the study period were preventable. In seventy-seven (95.1%) out of 81 preventable cases, the underlying mechanism of the adverse drug reactions was dose-related, in four (4.9%) preventable cases the underlying mechanism of the adverse drug reactions was respectively susceptibility- (1; 1.2%), unknown- (1; 1.2%) and time-related (2; 2.5%). In the 81 preventable cases, 97 critical criteria were detected of which 29/97 (29.9%) related to healthcare professionals' practices, 0/97 (0.0%) to drug quality and 68/97 (70.1%) to patient behaviour. We proved that it was possible to apply and adapt the P-Method to assess the preventability of the adverse drug reactions involving psychotropic drugs, analysing individual case safety report sent through Campania Region spontaneous reporting system. Information acquired will be used to organize educational activities for both physicians and patients to promote a more appropriate drug use.

The relative contributions of psychiatric symptoms and psychotropic medications on the sleep-wake profile of young persons with anxiety, depression and bipolar disorders.

PubMed

Robillard, Rébecca; Oxley, Cristal; Hermens, Daniel F; White, Django; Wallis, Ryan; Naismith, Sharon L; Whitwell, Bradley; Southan, James; Scott, Elizabeth M; Hickie, Ian B

2016-09-30

This study investigated the relative contribution of psychiatric symptoms and psychotropic medications on the sleep-wake cycle. Actigraphy and clinical assessments (Brief Psychiatric Rating Scale) were conducted in 146 youths with anxiety, depression or bipolar disorders. Independently of medications, mania symptoms were predictive of lower circadian amplitude and rhythmicity. Independently of diagnosis and symptoms severity: i) antipsychotics were related to longer sleep period and duration, ii) serotonin-norepinephrine reuptake inhibitors to longer sleep period, and iii) agomelatine to earlier sleep onset. Manic symptoms and different subclasses of medications may have independent influences on the sleep-wake cycle of young people with mental disorders. Copyright © 2016. Published by Elsevier Ireland Ltd.

Pregabalin Use Among Users of Illicit Drugs: A Cross-Sectional Survey in Southern Germany.

PubMed

Snellgrove, Brendan J; Steinert, Tilman; Jaeger, Susanne

2017-10-01

The antiepileptic drug pregabalin is one of the best-selling pharmaceutical products worldwide. There are increasing concerns about its potential for misuse and dependence especially among patients with former or current substance use disorders (SUDs). Our objective was to clarify the extent and pattern of pregabalin use as well as motives and predictors in this population. We conducted a cross-sectional study with patients on a detoxification ward for illicit drugs at the Center for Psychiatry, Südwürttemberg, Ravensburg in southern Germany from August 2012 until July 2013. We used an extensive questionnaire, part of the Structured Clinical Interview for DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th edition) Axis I Disorders (SCID-I) and urine samples. Of the 253 participating patients, 56% had used pregabalin at least once. Of these, 92% had acquired it at least in part from illegal sources. The main motives for the use of pregabalin were the attenuation of opioid withdrawal symptoms, the augmentation of other psychotropic substances, and the psychotropic effects of pregabalin itself. Predictors for pregabalin use were opioid and sedative use as well as younger age. The criteria of dependency according to DSM-IV was met by 11% of pregabalin users and 13% of urine samples were positive for pregabalin. Use of pregabalin is common among users of illicit drugs in large parts of southern Germany, with motives for use, acquisition, and mode of use suggesting misuse. The mode of use, especially intake of high doses and concomitant use of other drugs, poses a serious risk to this population, including the development of dependency.

A review of geographic variation and Geographic Information Systems (GIS) applications in prescription drug use research.

PubMed

Wangia, Victoria; Shireman, Theresa I

2013-01-01

While understanding geography's role in healthcare has been an area of research for over 40 years, the application of geography-based analyses to prescription medication use is limited. The body of literature was reviewed to assess the current state of such studies to demonstrate the scale and scope of projects in order to highlight potential research opportunities. To review systematically how researchers have applied geography-based analyses to medication use data. Empiric, English language research articles were identified through PubMed and bibliographies. Original research articles were independently reviewed as to the medications or classes studied, data sources, measures of medication exposure, geographic units of analysis, geospatial measures, and statistical approaches. From 145 publications matching key search terms, forty publications met the inclusion criteria. Cardiovascular and psychotropic classes accounted for the largest proportion of studies. Prescription drug claims were the primary source, and medication exposure was frequently captured as period prevalence. Medication exposure was documented across a variety of geopolitical units such as countries, provinces, regions, states, and postal codes. Most results were descriptive and formal statistical modeling capitalizing on geospatial techniques was rare. Despite the extensive research on small area variation analysis in healthcare, there are a limited number of studies that have examined geographic variation in medication use. Clearly, there is opportunity to collaborate with geographers and GIS professionals to harness the power of GIS technologies and to strengthen future medication studies by applying more robust geospatial statistical methods. Copyright © 2013 Elsevier Inc. All rights reserved.

Psychotropic Drugs: Implications For Dental Practice

PubMed Central

Becker, Daniel E

2008-01-01

Appropriate preoperative assessment of dental patients should always include analysis of their medications. Psychiatric illnesses including panic/anxiety disorder, depression, psychoses, and manic disorders are prevalent within our society. An impressive number of drug formulations are prescribed for these disorders, and they introduce concern regarding side effects and possible drug interactions with medications the dentist may deem necessary for dental care. This article will address essential pharmacology of these psychotropic medications. PMID:18788844

The comparative pharmacology of some psychotropic drugs*

PubMed Central

Jacobsen, Erik

1959-01-01

Interest in the mode of action of the psychotropic drugs has been growing rapidly during the last few years and at the same time the number of compounds known to be capable of affecting the higher centres of the central nervous system has greatly increased. The diversity of psychic and somatic effects produced by these drugs, the fact that they may have similar effects on some functions but opposite effects on others, and the lack of a precise and universally accepted terminology to describe these properties have led to much confusion and thwarted attempts to arrive at a satisfactory classification. As a contribution to a clearer understanding of the relationships between the psychotropic drugs the author of this review has undertaken a systematic examination of the effects of a number of the better known compounds on the various levels of the central nervous system. The antagonistic and synergistic effects of giving the drugs in combination are also discussed, as well as the possible relationships between the central effects and certain “basic” effects on somatic functions. Although the picture revealed is a very complex one and there are still many gaps, it is possible to recognize a number of characteristic types of psychotropic drug on the basis of which a system of classification may be developed. PMID:14406391

Neuroprotective Effects of Psychotropic Drugs in Huntington’s Disease

PubMed Central

Lauterbach, Edward C.

2013-01-01

Psychotropics (antipsychotics, mood stabilizers, antidepressants, anxiolytics, etc.) are commonly prescribed to treat Huntington’s disease (HD). In HD preclinical models, while no psychotropic has convincingly affected huntingtin gene, HD modifying gene, or huntingtin protein expression, psychotropic neuroprotective effects include upregulated huntingtin autophagy (lithium), histone acetylation (lithium, valproate, lamotrigine), miR-222 (lithium-plus-valproate), mitochondrial protection (haloperidol, trifluoperazine, imipramine, desipramine, nortriptyline, maprotiline, trazodone, sertraline, venlafaxine, melatonin), neurogenesis (lithium, valproate, fluoxetine, sertraline), and BDNF (lithium, valproate, sertraline) and downregulated AP-1 DNA binding (lithium), p53 (lithium), huntingtin aggregation (antipsychotics, lithium), and apoptosis (trifluoperazine, loxapine, lithium, desipramine, nortriptyline, maprotiline, cyproheptadine, melatonin). In HD live mouse models, delayed disease onset (nortriptyline, melatonin), striatal preservation (haloperidol, tetrabenazine, lithium, sertraline), memory preservation (imipramine, trazodone, fluoxetine, sertraline, venlafaxine), motor improvement (tetrabenazine, lithium, valproate, imipramine, nortriptyline, trazodone, sertraline, venlafaxine), and extended survival (lithium, valproate, sertraline, melatonin) have been documented. Upregulated CREB binding protein (CBP; valproate, dextromethorphan) and downregulated histone deacetylase (HDAC; valproate) await demonstration in HD models. Most preclinical findings await replication and their limitations are reviewed. The most promising findings involve replicated striatal neuroprotection and phenotypic disease modification in transgenic mice for tetrabenazine and for sertraline. Clinical data consist of an uncontrolled lithium case series (n = 3) suggesting non-progression and a primarily negative double-blind, placebo-controlled clinical trial of lamotrigine. PMID:24248060

[The use of psychotropic drugs during breast-feeding].

PubMed

Filip, Maria; Kuśmierek, Maciej; Orzechowska, Agata; Błaszczyk, Justyna; Zajączkowska, Marlena; Gałecki, Piotr

2015-07-01

Breast milk is the best source of nutrients and provides much better protection than immune modified milk. In the United States around 500 000 cases of mental disorders affecting pregnant women are diagnosed each year. It is estimated that approximately 1/3 of these women need psychotropic drugs in a period of breast-feeding. Despite the serious consequences of depression and its well-known effect on a newborn, the women are still reluctant to begin pharmacological treatment. The fear of side effects unfortunately still plays an important role in making such a decision. It has been proved that all psychiatric drugs can transfer into breast milk, but their levels are very low or even negligible for the newborn. Most laboratory tests do not reveal an adequate sensitivity to detect these low concentrations. One have to remember that in case of any disturbing symptoms which may result from the use of these drugs, the only procedure is to discontinue breastfeeding immediately. The knowledge of these effects of particular groups of psychotropic drugs in breast-feeding mothers is essential for every practitioner. This knowledge should also be available not only to psychiatrists, but gynecologists and pediatricians as well. For this reason, it seems to be reasonable to summarize the results of previously published studies dealing with the topic. © 2015 MEDPRESS.

The role of psychotropic drugs in the insidious deconstruction of the Kraepelinian dichotomy.

PubMed

Vinar, Oldrich

2007-12-01

62 patients suffering from mood disorders or schizophrenia diagnosed retrospectively according to DSM-4 as 295.xx or 296.xx were followed up by the author personally for 20 years. The DSM-IV diagnosis of schizophrenia (295.xx) was changed to a diagnosis of a mood disorder in 13 patients (26%). If schizoaffective disorder is classified as a mood disorder to form a group of periodic disorders, 41% of patients diagnosed as "pure" schizophrenia (295.xx without 295.70) at the start of the observation period were re-diagnosed as periodic disorder over 20 years. This "retrogression" of schizophrenia is seen as a result of the treatment with psychotropic drugs. The Kraepelian dichotomy is based on the relationship between the symptomatic pattern (syndrome) and the course of the illness. This relationship is disrupted by long-term treatment with psychotropic drugs.

[Psychotropic drugs in prison].

PubMed

Fovet, Thomas; Amad, Ali; Adins, Catherine; Thomas, Pierre

2014-05-01

Respect for guidelines and recommendations is the rule for prescribing psychotropic drugs in prison. The prevalence of psychiatric disorders and suicide in prison is higher than in general population. In France, 50 % of prisoners are treated with a psychotropic medication. Insomnia is a common complaint. It should not be trivialized and clinical psychiatric examination should be complete particularly in search of an underlying depressive syndrome. The lifestyle and dietary rules should not be neglected despite the difficulties associated with living conditions in prison and expectations of immediate results from both patients and sometimes the prison administration or justice. Given the prevalence of addictions in the prison population, vigilance is required in preventing withdrawal, especially at the beginning of incarceration. Indications for initiation and the prescription of opioid substitution treatment are the same as free environment. Individualization of delivery and confidentiality must be applied. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Psychotropic marketing practices and problems: implications for DSM-5.

PubMed

Raven, Melissa; Parry, Peter

2012-06-01

The descriptive diagnostic model since DSM-III has often led to "cookbook" diagnosis and assumptions of "chemical imbalance" for psychiatric disorders. Pharmaceutical companies have exploited this in their marketing. This includes promoting self-diagnosis with online checklists. Significant overprescribing of psychotropics has resulted. DSM-5 will provide new disorders and broader diagnostic criteria that will likely exacerbate this. Most psychotropic prescribing is done by primary care physicians, who are problematically excluded from DSM-5 field trials and are influenced by industry funded key opinion leaders who may promote diagnosis of subthreshold cases. More lax criteria will increase diagnosis of subthreshold cases. Expansion of not otherwise specified (NOS) categories can be used to justify off-label promotion. Pediatric bipolar disorder, constructed within the bipolar disorder NOS category, became an "epidemic" in the United States, fuelled by diagnostic upcoding pressures. Disruptive mood dysregulation disorder may similarly cause overdiagnosis and excessive prescribing, as will other new disorders and lower diagnostic thresholds.

Autonomic nervous system dysfunction in psychiatric disorders and the impact of psychotropic medications: a systematic review and meta-analysis

PubMed Central

Alvares, Gail A.; Quintana, Daniel S.; Hickie, Ian B.; Guastella, Adam J.

2016-01-01

Background Autonomic nervous system (ANS) dysfunction is a putative underlying mechanism for increased cardiovascular disease risk in individuals with psychiatric disorders. Previous studies suggest that this risk may be related to psychotropic medication use. In the present study we systematically reviewed and analyzed published studies of heart rate variability (HRV), measuring ANS output, to determine the effect of psychiatric illness and medication use. Methods We searched for studies comparing HRV in physically healthy adults with a diagnosed psychiatric disorder to controls and comparing HRV pre- and post-treatment with a psychotropic medication. Results In total, 140 case–control (mood, anxiety, psychosis, dependent disorders, k = 151) and 30 treatment (antidepressants, antipsychotics; k = 43) studies were included. We found that HRV was reduced in all patient groups compared to controls (Hedges g = −0.583) with a large effect for psychotic disorders (Hedges g = −0.948). Effect sizes remained highly significant for medication-free patients compared to controls across all disorders. Smaller and significant reductions in HRV were observed for specific antidepressants and antipsychotics. Limitations Study quality significantly moderated effect sizes in case–control analyses, underscoring the importance of assessing methodological quality when interpreting HRV findings. Conclusion Combined findings confirm substantial reductions in HRV across psychiatric disorders, and these effects remained significant even in medication-free individuals. Reductions in HRV may therefore represent a significant mechanism contributing to elevated cardiovascular risk in individuals with psychiatric disorders. The negative impact of specific medications on HRV suggest increased risk for cardiovascular disease in these groups, highlighting a need for treatment providers to consider modifiable cardiovascular risk factors to attenuate this risk. PMID:26447819

Elicitation of cognitions related to HIV risk behaviors in persons with mental illnesses: implications for prevention.

PubMed

Tennille, Julie; Solomon, Phyllis; Fishbein, Martin; Blank, Michael

2009-01-01

An important step in research using the Theory of Reasoned Action and Theory of Planned Behavior (TRA/TPB) is conducting an elicitation process to identify topic and population specific cognitions. This study explored HIV risk behaviors in persons with mental illnesses and introduces findings from focus groups conducted during the development phase of an HIV primary and secondary prevention intervention study. Researchers held four focus groups with persons with mental illnesses focused on HIV risks and condom use. Participants discussed sexual side effects of psychotropic medications as a potential cause of both medication non-adherence and HIV risk behaviors. The intersection of these two issues is specific to this population. We conclude with the recommendation that HIV primary and secondary prevention intervention for persons with mental illnesses must incorporate the promotion of healthy sexuality, including attention to sexual side effects of psychotropic medications.

Decision models in the evaluation of psychotropic drugs : useful tool or useless toy?

PubMed

Barbui, Corrado; Lintas, Camilla

2006-09-01

A current contribution in the European Journal of Health Economics employs a decision model to compare health care costs of olanzapine and risperidone treatment for schizophrenia. The model suggests that a treatment strategy of first-line olanzapine is cost-saving over a 1-year period, with additional clinical benefits in the form of avoided relapses in the long-term. From a clinical perspective this finding is indubitably relevant, but can physicians and policy makers believe it? The study is presented in a balanced way, assumptions are based on data extracted from clinical trials published in major psychiatric journals, and the theoretical underpinnings of the model are reasonable. Despite these positive aspects, we believe that the methodology used in this study-the decision model approach-is an unsuitable and potentially misleading tool for evaluating psychotropic drugs. In this commentary, taking the olanzapine vs. risperidone model as an example, arguments are provided to support this statement.

Falls and Depression in Men: A Population-Based Study.

PubMed

Stuart, Amanda L; Pasco, Julie A; Jacka, Felice N; Berk, Michael; Williams, Lana J

2018-01-01

The link between falls and depression has been researched in the elderly; however, little information is available on this association in younger adults, particularly men. This study sought to investigate the link between major depressive disorder (MDD) and falls in a population-based sample of 952 men (24-97 years). MDD was diagnosed utilizing the Structured Clinical Interview for DSM-IV-TR Research Version, Non-Patient edition, and categorized as 12-month/past/never. Body mass index and gait were measured; falls, smoking status, psychotropic medication use, and alcohol intake were self-reported as part of the Geelong Osteoporosis Study 5-year follow-up assessment. Thirty-four (3.6%) men met criteria for 12-month MDD, and 110 (11.6%) for past MDD. Of the 952 men, 175 (18.4%) reported falling at least once during the past 12 months. Fallers were older (66 [interquartile range: 48-79] vs. 59 [45-72] years, p = .001) and more likely to have uneven gait ( n = 16, 10% vs. n = 31, 4%, p = .003) than nonfallers. Participants with 12-month MDD had more than twice the odds of falling (age-adjusted odds ratio: 2.22, 95% confidence interval [1.03, 4.80]). The odds of falling were not associated with past depression ( p = .4). Further adjustments for psychotropic drug use, gait, body mass index, smoking status, blood pressure, and alcohol did not explain these associations. Given the 2.2-fold greater likelihood of falling associated with depression was not explained by age or psychotropic drug use, further research is warranted.

How complete is the information on preadmission psychotropic medications in inpatients with dementia? A comparison of hospital medical records with dispensing data.

PubMed

Pisa, Federica Edith; Palese, Francesca; Romanese, Federico; Barbone, Fabio; Logroscino, Giancarlo; Riedel, Oliver

2018-06-05

Reliable information on preadmission medications is essential for inpatients with dementia, but its quality has hardly been evaluated. We assessed the completeness of information and factors associated with incomplete recording. We compared preadmission medications recorded in hospital electronic medical records (EMRs) with community-pharmacy dispensations in hospitalizations with discharge code for dementia at the University Hospital of Udine, Italy, 2012-2014. We calculated: (a) prevalence of omissions (dispensed medication not recorded in EMRs), additions (medication recorded in EMRs not dispensed), and discrepancies (any omission or addition); (b) multivariable logistic regression odds ratio, with 95% confidence interval (95% CI), of ≥1 omission. Among 2,777 hospitalizations, 86.1% had ≥1 discrepancy for any medication (Kappa 0.10) and 33.4% for psychotropics. When psychotropics were recorded in EMR, antipsychotics were added in 71.9% (antidepressants: 29.2%, antidementia agents: 48.2%); when dispensed, antipsychotics were omitted in 54.4% (antidepressants: 52.7%, antidementia agents: 41.5%). Omissions were 92% and twice more likely in patients taking 5 to 9 and ≥10 medications (vs. 0 to 4), 17% in patients with psychiatric disturbances (vs. none), and 41% with emergency admission (vs. planned). Psychotropics, commonly used in dementia, were often incompletely recorded. To enhance information completeness, both EMRs and dispensations should be used. Copyright © 2018 John Wiley & Sons, Ltd.

Classification and evaluation of the pharmacodynamics of psychotropic drugs by single-lead pharmaco-EEG, EEG mapping and tomography (LORETA).

PubMed

Saletu, B; Anderer, P; Saletu-Zyhlarz, G M; Arnold, O; Pascual-Marqui, R D

2002-01-01

Utilizing computer-assisted quantitative analyses of human scalp-recorded electroencephalogram (EEG) in combination with certain statistical procedures (quantitative pharmaco-EEG) and mapping techniques (pharmaco-EEG mapping), it is possible to classify psychotropic substances and objectively evaluate their bioavailability at the target organ: the human brain. Specifically, one may determine at an early stage of drug development whether a drug is effective on the central nervous system (CNS) compared with placebo, what its clinical efficacy will be like, at which dosage it acts, when it acts and the equipotent dosages of different galenic formulations. Pharmaco-EEG profiles and maps of neuroleptics, antidepressants, tranquilizers, hypnotics, psychostimulants and nootropics/cognition-enhancing drugs will be described in this paper. Methodological problems, as well as the relationships between acute and chronic drug effects, alterations in normal subjects and patients, CNS effects, therapeutic efficacy and pharmacokinetic and pharmacodynamic data will be discussed. In recent times, imaging of drug effects on the regional brain electrical activity of healthy subjects by means of EEG tomography such as low-resolution electromagnetic tomography (LORETA) has been used for identifying brain areas predominantly involved in psychopharmacological action. This will be demonstrated for the representative drugs of the four main psychopharmacological classes, such as 3 mg haloperidol for neuroleptics, 20 mg citalopram for antidepressants, 2 mg lorazepam for tranquilizers and 20 mg methylphenidate for psychostimulants. LORETA demonstrates that these psychopharmacological classes affect brain structures differently.

Significant differences in pediatric psychotropic side effects: Implications for school performance.

PubMed

Kubiszyn, Thomas; Mire, Sarah; Dutt, Sonia; Papathopoulos, Katina; Burridge, Andrea Backsheider

2012-03-01

Some side effects (SEs) of increasingly prescribed psychotropic medications can impact student performance in school. SE risk varies, even among drugs from the same class (e.g., antidepressants). Knowing which SEs occur significantly more often than others may enable school psychologists to enhance collaborative risk-benefit analysis, medication monitoring, data-based decision-making, and inform mitigation efforts. SE data from Full Prescribing Information (PI) on the FDA website for ADHD drugs, atypical antipsychotics, and antidepressants with pediatric indications were analyzed. Risk ratios (RR) are reported for each drug within a category compared with placebo. RR tables and graphs inform the reader about SE incidence differences for each drug and provide clear evidence of the wide variability in SE incidence in the FDA data. Breslow-Day and Cochran Mantel-Haenszel methods were used to test for drug-placebo SE differences and to test for significance across drugs within each category based on odds ratios (ORs). Significant drug-placebo differences were found for each drug compared with placebo, when odds were pooled across all drugs in a category compared with placebo, and between some drugs within categories. Unexpectedly, many large RR differences did not reach significance. Potential explanations are offered, including limitations of the FDA data sets and statistical and methodological issues. Future research directions are offered. The potential impact of certain SEs on school performance, mitigation strategies, and the potential role of the school psychologist is discussed, with consideration for ethical and legal limitations. (c) 2012 APA, all rights reserved.

Pharmacological treatment of severe psychiatric disorders in the developing world : lessons from India.

PubMed

Patel, Vikram; Andrade, Chittaranjan

2003-01-01

Severe psychiatric disorders (schizophrenia, bipolar disorder and major depressive disorder) cause much morbidity and disability in developing countries. Most of the evidence on the efficacy and effectiveness of drug treatments for these disorders is based on trials conducted in Western countries. Cultural, biological and health system factors may profoundly influence the applicability of such evidence in developing countries. Attitudes towards, and concepts about, psychiatric disorders vary across cultures, and these may influence the acceptability of drug treatments. Genetic and environmental factors may lead to variations in the pharmacodynamics and pharmacokinetics of psychotropic drugs across ethnic groups. This may explain why lower doses of psychotropic drugs tend to be used for non-Caucasian patients. There is a dearth of mental health professionals and care facilities in developing countries, especially in rural areas. Epidemiological studies show that, despite this lack of services, the outcome of schizophrenia is favourable in developing countries. This suggests that cultural, genetic or environmental factors may play as much of a role in influencing outcome as access to antipsychotic treatment. Regional drug policies may influence the availability and cost of psychotropic drugs. In particular, the Indian experience, where drugs are manufactured by several local pharmaceutical firms, thus bringing their cost down, may represent a unique deregulated drug industry. However, the impending impact of the Trade-Related Aspects of Intellectual Property Rights (TRIPS) agreement, with the strict enforcement of patent laws, will almost certainly lead to a rise in drug costs in the coming years. This may influence the choice and cost effectiveness of various drugs. The implications of these cross-cultural variations for policy and practice are the need to ensure a reliable supply of affordable psychotropic drugs in developing countries, trained healthcare professionals to use these drugs rationally, a concerted advocacy campaign to exclude drugs for severe psychiatric disorders from patent protection, and the development of psychosocial programmes to improve global outcomes.

When and where do hip fractures occur? A population-based study.

PubMed

Leavy, B; Åberg, A C; Melhus, H; Mallmin, H; Michaëlsson, K; Byberg, L

2013-09-01

We investigated the effects of socio-demographic and health factors on timing and location of hip fracture among 484 subjects. Time of fracture varied between community dwellers and residential care facility dwellers, and in relation to subjects' psychotropic drug status. Indoor hip fracture incidence increased on snow-covered days. This paper aims to describe the timing and whereabouts of hip fracture cases in a population-based setting and to relate these factors with residential and health status, seasonal variation, and snow-covered ground. We consecutively included 484 incident hip fracture events (age ≥50 years) admitted to a Swedish orthopedic department during a 1-year period. Data concerning socio-demographic details, fall location, time of fracture, comorbidity, and medications were collected from in-patient medical records and through patient or caregiver interviews. The expected peak in fracture occurrence during daytime was observed among community dwellers but not among subjects living in residential care. Hip fracture was twice as likely to occur during nighttime hours among psychotropic drug users (adjusted odds ratio (Adj. OR), 2.20; 95% confidence interval (CI), 1.12-4.30) compared to those not receiving these medications. Subjects without dementia, taking psychotropic drugs, were also more likely to fracture during nighttime hours (Adj. OR, 2.91; 95% CI, 1.40-6.0). We observed an increase in indoor hip fracture incidence on snow-covered days among community dwellers (incidence rate ratio, 1.34; 95% CI, 1.02-1.74). We observed only a weak seasonal trend in hip fracture incidence, based on month, among community dwellers who fractured indoors. Special attention and possibly fall-preventive efforts should be directed not only toward those living in residential care facilities but also toward community-dwelling subjects taking psychotropic drugs since these groups have a higher incidence of nighttime hip fracture. Further research aiming to explain the seasonal variation of indoor fracture incidence among community dwellers is warranted.

Psychotropic drug use among persons with mental distress symptoms: a population-based study in Norway.

PubMed

Hausken, Anne M; Skurtveit, Svetlana; Rosvold, Elin O; Bramness, Jørgen G; Furu, Kari

2007-01-01

To explore psychotropic drug use in the general population and in particular among non-institutionalized persons with mental distress symptoms. A total of 14,139 women and 11,665 men participating in the Oslo Health Study or the Oppland/Hedmark Study 2000-2001 submitted a self-administered questionnaire on health status and drug use, lifestyle, and socioeconomic factors. Respondents using antidepressants, hypnotics, and/or anxiolytics during the last four weeks were defined as users. A high Hopkins Symptoms Checklist-10 score indicated mental distress. The 15% with the highest score in each gender and age group (adults: 30/40/45 years; elderly: 60 years) were studied. The prevalence of antidepressant use among those with mental distress was, for women: adults 21%; elderly 30%; and for men, adults 15%; elderly 15%. These figures were nearly four times higher than in the general population. Not participating in the labour market was the main factor associated with use of antidepressants for subjects with mental distress: adult women (odds ratio (OR) 3.5; 95% confidence interval (CI) 2.5-5.0); elderly women (OR 5.2; CI 2.7-10.2); adult men (OR 4.7; CI 3.0-7.3); and elderly men (OR 2.9; CI 1.4-6.0). Use of analgesics was the main factor associated with use of anxiolytics/hypnotics: adult women (OR 2.4; CI 1.7-3.4); elderly women (OR 2.3; CI 1.4-3.8); adult men (OR 2.1; CI 1.3-3.3); and elderly men (OR 3.4; CI 1.9-6.0). Among individuals with mental distress, not participating in the labour market and regular use of analgesics were the main factors associated with use of psychotropics in both genders regardless of age.

Use of drugs for ADHD among adults-a multinational study among 15.8 million adults in the Nordic countries.

PubMed

Karlstad, Øystein; Zoëga, Helga; Furu, Kari; Bahmanyar, Shahram; Martikainen, Jaana E; Kieler, Helle; Pottegård, Anton

2016-12-01

The use of ADHD drugs among adults is controversial and has until recently not been approved for use in adults in most countries. The aim was to investigate use of ADHD drugs (stimulants and atomoxetine) among the entire adult population in the Nordic countries. We conducted a multinational population-based prescription register study based on the entire adult population in the five Nordic countries (Denmark, Finland, Iceland, Norway and Sweden). All users of ADHD drugs aged 18-64 years during 2008-2012 were included, which for 2012 comprised 76,896 drug users among 15.8 million adult inhabitants. Annual prevalence of drug use increased during the study period for both genders and all age groups. The overall prevalence increased from 2.4 to 5.3 per 1000 men and 1.8 to 4.4 per 1000 women. Incidence also increased, but to a lesser extent in the last part of the study period. Methylphenidate was used by 88 % of drug users. Treatment was discontinued within the first year by 21 % of new drug users. Among all users of ADHD drugs, 53 % of men and 64 % of women concurrently used other psychotropic drugs, most frequently antidepressants and hypnotics. Psychotropic co-medication increased with age and was more pronounced among women than men. Use of ADHD drug among adults more than doubled over a 5-year period, and a majority were concurrently treated with other psychotropics. Adults constitute a substantial proportion of persons treated with ADHD drugs. Thus, evidence for long-term efficacy and safety in adults is urgently needed.

The Relevance of Arieti's Work in the Age of Medication.

PubMed

Balbuena Rivera, Francisco

2016-09-01

This paper looks at the relevance of psychoanalysis as a treatment option for psychotic individuals at a time when psychosis is invariably considered to be a biologically-based brain disease, for which the preferred course of treatment is psychotropic medication. In recent years, the use of psychoanalysis has declined noticeably in favor of evidenced-based biomedical approaches, which rely heavily upon statistical probabilities for ameliorating specific psychotic symptoms. Well-publicized biological approaches have proliferated, often to the detriment of the psychotic individual's general health, emotional recovery, and long-term rehabilitation. Sadly, these approaches may also be a significant factor affecting mortality rates in those suffering with psychosis, known to be about 25 years shorter, on average, than the general population.

[Side effects of psychotropic medication: Suggestions for clinical practice].

PubMed

Grunze, Anna; Mago, Rajnish; Grunze, Heinz

2017-11-01

Psychotropics are highly effective medications that, however, have adverse drug reactions attached to them. They are indispensable for many patients. How to cope with side effects - watchful waiting, dose reduction, change of medication, addition of an "antidote" and behavioural modifications - depends on their nature, severity and finally the patients wish. This review is meant to aid clinician's and patient's decisions in case of the occurrence of compromising, frequent adverse drug reactions. © Georg Thieme Verlag KG Stuttgart · New York.

Psychotropic drugs in mixture alter swimming behaviour of Japanese medaka (Oryzias latipes) larvae above environmental concentrations.

PubMed

Chiffre, Axelle; Clérandeau, Christelle; Dwoinikoff, Charline; Le Bihanic, Florane; Budzinski, Hélène; Geret, Florence; Cachot, Jérôme

2016-03-01

Psychiatric pharmaceuticals, such as anxiolytics, sedatives, hypnotics and antidepressors, are among the most prescribed active substances in the world. The occurrence of these compounds in the environment, as well as the adverse effects they can have on non-target organisms, justifies the growing concern about these emerging environmental pollutants. This study aims to analyse the effects of six psychotropic drugs, valproate, cyamemazine, citalopram, sertraline, fluoxetine and oxazepam, on the survival and locomotion of Japanese medaka Oryzias latipes larvae. Newly hatched Japanese medaka were exposed to individual compounds for 72 h, at concentrations ranging from 10 μg L(-1) to 10 mg L(-1). Lethal concentrations 50 % (LC50) were estimated at 840, 841 and 9,136 μg L(-1) for fluoxetine, sertraline and citalopram, respectively, while other compounds did not induce any significant increase in mortality. Analysis of the swimming behaviour of larvae, including total distance moved, mobility and location, provided an estimated lowest observed effect concentration (LOEC) of 10 μg L(-1) for citalopram and oxazepam, 12.2 μg L(-1) for cyamemazine, 100 μg L(-1) for fluoxetine, 1,000 μg L(-1) for sertraline and >10,000 μg L(-1) for valproate. Realistic environmental mixture of the six psychotropic compounds induced disruption of larval locomotor behaviour at concentrations about 10- to 100-fold greater than environmental concentrations.

Development of a chemotherapy regimen interaction database for the mobile internet: detecting interactions with psychotropics through OncoRx-MI.

PubMed

Yap, Kevin Yi-Lwern; Chui, Wai Keung; Chan, Alexandre

2011-09-01

Cancer patients are at high risks of drug-drug interactions (DDIs). Clinicians need to know the magnitude of DDIs so as to better manage their patients' drug therapies. We have previously created a novel interaction database for oncology prescriptions (OncoRx). In this project, we leverage on 3G networks to further develop this database into an iPhone-specific application for the mobile internet (OncoRx-MI). Data on anticancer drugs (ACDs), chemotherapy regimens (CRegs) and DDIs with psychotropics were compiled from various hardcopy and online resources, and published articles from PubMed, Scopus and Science Direct. The database and iPhone web documents were designed using Adobe Dreamweaver CS4 and associated with a combination of open-source programming scripts. OncoRx-MI currently detects over 5000 DDIs (69.3% pharmacokinetic, 30.7% pharmacodynamic) between 256 single-agent and combination CRegs with 51 psychotropic drugs. OncoRx-MI fits the iPhone screen configuration, and displays information regarding the regimen, pharmacokinetics of the drugs and detected DDIs in tabular format for improved usability. OncoRx-MI is the first mobile DDI application of its kind which detects interactions for combination CRegs. Future versions will include DDIs with other drug categories. Usability studies on its impact in clinical practice will also be carried out.

An analysis of psychotropic drug sales. Increasing sales of selective serotonin reuptake inhibitors are closely related to number of products.

PubMed

Nielsen, Margrethe; Gøtzsche, Peter

2011-01-01

Prescribing of selective serotonin reuptake inhibitors (SSRIs) has increased dramatically. To compare the sales of benzodiazepines and SSRIs within the primary care sector in Denmark and relate changes in usage to number of indications and products on the market. We used data from various sources to establish the sales curves of psychotropic drugs in the period 1970 to 2007, based on the Anatomic Therapeutic Classification system and Defined Daily Doses. Fluctuations in sales of psychotropic drugs that cannot be explained by disease prevalence were caused by changes in sales of the benzodiazepines and SSRIs. We found a decline in the sales of benzodiazepines after a peak in 1986, likely due to the recognition that they cause dependence. From a low level in 1992, we found that the sales of SSRIs increased almost linearly by a factor of 18, up to 44 DDD per 1000 inhabitants, which was closely related to the number of products on the market that increased by a factor of 16. Sales of antidepressant drugs are mainly determined by market availability of products indicating that marketing pressures are playing an important role. Thus the current level of use of SSRIs may not be evidence-based, which is supported by studies showing that the effect of SSRIs has been overestimated.

Work-related violence and incident use of psychotropics.

PubMed

Madsen, Ida E H; Burr, Hermann; Diderichsen, Finn; Pejtersen, Jan H; Borritz, Marianne; Bjorner, Jakob B; Rugulies, Reiner

2011-12-15

Although the mental health consequences of domestic violence are well documented, empirical evidence is scarce regarding the mental health effects of violence in the workplace. Most studies have used data from small occupation-specific samples, limiting their generalizability. This article examines whether direct exposure to work-related violence is associated with clinically pertinent mental health problems, measured by purchases of psychotropics (antidepressants, anxiolytics, hypnotics), in a cross-occupational sample of 15,246 Danish employees free from using psychotropics at baseline. Self-reported data on work-related violence were merged with other data on purchases of medications through a national registry to estimate cause-specific hazard ratios during 3.6 years (1,325 days) of follow-up in the years 1996-2008. Outcomes were examined as competing risks, and analyses were adjusted for gender, age, cohabitation, education, income, social support from colleagues, social support from supervisor, and influence and quantitative demands at work. Work-related violence was associated with purchasing antidepressants alone (hazard ratio = 1.38, 95% confidence interval: 1.09, 1.75) or in combination with anxiolytics (hazard ratio = 1.74, 95% confidence interval: 1.13, 2.70) but not with purchasing anxiolytics or hypnotics only. The frequency of violent episodes and risk of caseness were unrelated. Work-related violence is associated with increased risk of clinically pertinent mental health problems. Reducing levels of work-related violence may help to prevent mental disorders in the working population.

[Use of the new psychotropic preparation bemitil in treating asthenic disorders (clinico-pharmacological research)].

PubMed

Aleksandrovskiĭ, Iu A; Bobkov, Iu G; Neznamov, G G; Serebriakova, T V; Boĭko, S S

1988-01-01

In a series of 130 patients with asthenic conditions related to borderline forms of neuro-mental disturbances the authors compared clinico-pharmacological action of the actoprotector bemitil with that of nootropic drugs (piracetam and piridotol). The treatment with bemitil was either continuous or intermittent, being conducted according to the scheme elaborated in the course of the study. Bemitil proved to be more effective than piracetam and piriditol in relation to its influence on the manifestations of the asthenic symptom complex in general. Its application was characterized by a faster onset of the therapeutic effect and a peculiar mild psychostimulating action, primarily manifested in the impact on obligate manifestations of the asthenic disorders. The degree of the psychotropic action of the drug was found to be subject to changes depending on the scheme of its use.

DYNAMICS OF OPIOID SUBSTITUTION TREATMENTIN DIFFERENT INITIAL SUBSTANCE USER OPIOID DEPENDENT PATIENTS.

PubMed

Todadze, Kh; Mosia, S

2016-05-01

Injecting drug user size estimation studies carried out in 2009, 2012 and 2015 revealed growing trends of drug abuse in Georgia:estimated number of people who inject drugs (PWID) have been increased from 40000 and 45000 to 50000. Since Soviet period the most popular injective narcotics have been opioids: home-made opium, heroine, buprenorphine and home-made desomorphine ("Krokodile") replacing each other on the black market. Self-made desomorphine typically contains big amounts of different toxic substances and causes significant somatic disorders, especially skin, bone, blood infections, liver and kidney failure; is highly addictive, associates with frequent injections that enhance injecting-related harm, including the risk of HIV transmission, in comparison with typical opioids. The aim of the study was to determine the effectiveness of opioid substitution treatment (OST) on depression and anxiety in opioid dependent clients with history of different opioid substance use. 104 opioid drug users undergoing OST with intensive psychological counseling have been divided in 5 groups according to the principal opioid drug that was abused during past 6 months before starting treatment: heroine, desomorphine, illicit methadone injectors, illicit buprenorphine injectors, and multiple drug abusers consuming opioids as primary drugs. Level of depression (Beck Depression Inventory), anxiety (Spielberger Anxiety Inventory) as well as clinical symptoms, risky behavior, quality of life (WHO), and other data were measured before starting and after 3, 9, 15, 21 months of treatment. The illegal use of psychotropic-narcotics was checked through random urine-testing 1-2 times per patient per month. In all five groups remarkable decrease of depression and anxiety was observed in comparison with the starting data. Before inclusion desomorphine and poly-drug users had the highest scores of depression and anxiety while buprenorphine users manifested the lowest rate. Improvement of figures was observed in all groups in three month period that have been continuing during 21 month of treatment process. Study revealed normalization of scores forbothstatesin groups of heroine, desomorphine, methadone and buprenorphine users. The highest scores of depression and anxiety were observed in the group of poly-drug abusers andwhile depression rate hesitated in the range of clear "no-depression", anxiety index still remained close to the clinical important threshold after 21 month of treatment. Urine-testingon psychotropic-narcotic substances indicated remarkable decrease of illegal drug abuse in all studied groups in three month and although abuse of benzodiazepine drugs was highest in desomorphine and poly-drug abusers, the difference between groups was not statistically significant. Although some disparities have been observed in dynamics of subjects with different spectrum of initial opioid substance use, including homemade desomorphine, there is no significant difference between groups and OST effectively supports to improve depression and anxiety indices, and dramatically decreases use of illegal psychotropic-narcotic drugs during treatment. However poly-drug users seems to be the most resistant to achieve stabilization and require more treatment time and targeted interventions.

Akt/GSK3 signaling in the action of psychotropic drugs.

PubMed

Beaulieu, Jean-Martin; Gainetdinov, Raul R; Caron, Marc G

2009-01-01

Psychotropic drugs acting on monoamine neurotransmission are major pharmacological treatments for neuropsychiatric conditions such as schizophrenia, depression, bipolar disorder, Tourette syndrome, ADHD, and Alzheimer disease. Independent lines of research involving biochemical and behavioral approaches in normal and/or genetically modified mice provide converging evidence for an involvement of the signaling molecules Akt and glycogen synthase kinase-3 (GSK3) in the regulation of behavior by dopamine and serotonin (5-HT). These signaling molecules have also received attention for their role in the actions of psychoactive drugs such as antidepressants, antipsychotics, lithium, and other mood stabilizers. Furthermore, investigations of the mechanism by which D2 dopamine receptors regulate Akt/GSK3 signaling strongly support the physiological relevance of a new modality of G protein-coupled receptor (GPCR) signaling involving the multifunctional scaffolding protein beta-arrestin 2. Elucidation of the contribution of multiple signaling pathways to the action of psychotropic drugs may provide a better biological understanding of psychiatric disorders and lead to more efficient therapeutics.

Determinants of ambulatory treatment mode for mental illness.

PubMed

Freiman, M P; Zuvekas, S H

2000-07-01

We estimate a reduced-form bivariate probit model to analyse jointly the choice of ambulatory treatment from the specialty mental health sector and/or the use of psychotropic drugs for a nationally representative sample of US household residents. We find significant differences in treatment choice by education, gender, race and ethnicity, while controlling for several aspects of self-reported mental health and treatment attitudes. For example, while women are more likely than men to use the specialty mental health sector and more likely to take psychotropic medications, this difference between men and women is much greater for psychotropic medications. The estimated differences may reflect patient preferences in a manner traditionally assumed when interpreting these coefficients in such equations, but we discuss how they may also reflect biases and misperceptions on the parts of patients and providers. We also discuss how our results relate to some findings and policies in the general health care sector. Copyright 2000 John Wiley & Sons, Ltd.

Impact of hospital type II violent events: use of psychotropic drugs and mental health services.

PubMed

Dement, John M; Lipscomb, Hester J; Schoenfisch, Ashley L; Pompeii, Lisa A

2014-06-01

While violence can adversely affect mental health of victims, repercussions of violence against workers is not as well characterized. We explored relationships between workplace violent events perpetrated by patients or visitors (Type II) against hospital employees and the employee use of psychotropic medications or mental health services using a data system that linked violent events with health claims. Significant associations were observed between reported Type II workplace violent events and employee prescription claims for anti-depressants and anxiolytics combined (RR = 1.45, 95% CI = 1.01-2.33) and anti-depressants alone (RR = 1.65, 95% CI = 1.10-2.48). No significant association between reported violent events and health claims for treatment of depression or anxiety was observed. Type II violence experienced by hospital workers may lead to increased use of psychotropic drugs, particularly anti-depressants but also anxiolytics. Our results suggest an important role of employee assistance programs in mitigating the psychological consequences of workplace violent events. © 2014 Wiley Periodicals, Inc.

Non-psychotropic plant cannabinoids: new therapeutic opportunities from an ancient herb.

PubMed

Izzo, Angelo A; Borrelli, Francesca; Capasso, Raffaele; Di Marzo, Vincenzo; Mechoulam, Raphael

2009-10-01

Delta(9)-tetrahydrocannabinol binds cannabinoid (CB(1) and CB(2)) receptors, which are activated by endogenous compounds (endocannabinoids) and are involved in a wide range of physiopathological processes (e.g. modulation of neurotransmitter release, regulation of pain perception, and of cardiovascular, gastrointestinal and liver functions). The well-known psychotropic effects of Delta(9)-tetrahydrocannabinol, which are mediated by activation of brain CB(1) receptors, have greatly limited its clinical use. However, the plant Cannabis contains many cannabinoids with weak or no psychoactivity that, therapeutically, might be more promising than Delta(9)-tetrahydrocannabinol. Here, we provide an overview of the recent pharmacological advances, novel mechanisms of action, and potential therapeutic applications of such non-psychotropic plant-derived cannabinoids. Special emphasis is given to cannabidiol, the possible applications of which have recently emerged in inflammation, diabetes, cancer, affective and neurodegenerative diseases, and to Delta(9)-tetrahydrocannabivarin, a novel CB(1) antagonist which exerts potentially useful actions in the treatment of epilepsy and obesity.

Learning the effects of psychotropic drugs during pregnancy using real-world safety data: a paradigm shift toward modern pharmacovigilance.

PubMed

Lupattelli, Angela; Spigset, Olav; Nordeng, Hedvig

2018-06-15

The growing evidence on psychotropic drug safety in pregnancy has been possible thanks to the increasing availability of real-world data, i.e. data not collected in conventional randomised controlled trials. Use of these data is a key to establish psychotropic drug effects on foetal, child, and maternal health. Despite the inherent limitations and pitfalls of observational data, these can still be informative after a critical appraisal of the collective body of evidence has been done. By valuing real-world safety data, and making these a larger part of the regulatory decision-making process, we move toward a modern pregnancy pharmacovigilance. The recent uptake of real-world safety data by health authorities has set the basis for an important paradigm shift, which is integrating such data into drug labelling. The recent safety assessment of sodium valproate in pregnant and childbearing women is probably one of the first examples of modern pregnancy pharmacovigilance.

Rapid determination of some psychotropic drugs in complex matrices by tandem dispersive liquid-liquid microextraction followed by high performance liquid chromatography.

PubMed

Asghari, Alireza; Fahimi, Ebrahim; Bazregar, Mohammad; Rajabi, Maryam; Boutorabi, Leila

2017-05-01

Simple and rapid determinations of some psychotropic drugs in some pharmaceutical wastewater and human plasma samples were successfully accomplished via the tandem dispersive liquid-liquid microextraction combined with high performance liquid chromatography-ultraviolet detection (TDLLME-HPLC-UV). TDLLME of the three psychotropic drugs clozapine, chlorpromazine, and thioridazine was easily performed through two consecutive dispersive liquid-liquid microextractions. By performing this convenient method, proper sample preconcentrations and clean-ups were achieved in just about 7min. In order to achieve the best extraction efficiency, the effective parameters involved were optimized. The optimal experimental conditions consisted of 100μL of CCl 4 (as the extraction organic solvent), and the pH values of 13 and 2 for the donor and acceptor phases, respectively. Under these optimum experimental conditions, the proposed TDLLME-HPLC-UV technique provided a good linearity in the range of 5-3000ngmL -1 for the three psychotropic drugs with the correlation of determinations (R 2 s) higher than 0.996. The limits of quantification (LOQs) and limits of detection (LODs) obtained were 5.0ngmL -1 and 1.0-1.5ngmL -1 , respectively. Also the proper enrichment factors (EFs) of 96, 99, and 88 for clozapine, chlorpromazine, and thioridazine, respectively, and good extraction repeatabilities (relative standard deviations below 9.3%, n=5) were obtained. Copyright © 2017 Elsevier B.V. All rights reserved.

[Ethical, technical and legal procedures of the medical doctor responsibility to accomplish the road enforcement law about driving under the influence of alcohol and psychotropic substances].

PubMed

Dinis-Oliveira, Ricardo Jorge; Nunes, Rui; Carvalho, Félix; Santos, Agostinho; Teixeira, Helena; Vieira, Duarte Nuno; Magalhães, Teresa

2010-01-01

The forensic toxicology (TF) is a science of analytical basis, aiming to clarify legal issues related to poisoning, whether or not fatal, within the various areas of law (criminal, civil, labor, etc.). The analysis that are more often requested (with a tendency to increase and gaining rising attention) are those concerning the procedures involving supervision of driving under the influence of alcohol and psychotropic substances, in the living individual and in the cadaver. The key players in this process, are: (a) the police agents carrying out the screening and quantification of alcohol on the exhaled breath and the screening of psychotropic and stupefacient substances in saliva; (b) the public health services that perform qualitative analysis of these substances in urine (if the test was not previously performed in saliva); (c) the doctor that collects blood samples from the living, or the dead victim; (d) the forensic toxicologist who conducts toxicological analysis in blood (or, eventually in another biological sample) and (e) the magistrate prosecutors that ultimately will receive the toxicological report to apply the law. Therefore it is important to understand and be acquainted with the road law enforcement of driving under the influence of alcohol and psychotropic substances, particularly in what concerns to the role of the medical doctor. Consequently, this paper aimed to review these topics, namely highlighting the necessary information to clarify the interested parties about the technical, ethical and legal procedures to consider.

Herbal medicine for hospitalized patients with severe depressive episode: a retrospective controlled study.

PubMed

Liu, Lan-Ying; Feng, Bin; Chen, Jiong; Tan, Qing-Rong; Chen, Zheng-Xin; Chen, Wen-Song; Wang, Pei-Rong; Zhang, Zhang-Jin

2015-01-01

Herbal medicine is increasingly used in depressed patients. The purpose of this retrospective controlled study was to evaluate the efficacy and safety of herbal medicine treatment of severe depressive episode. A total of 146 severely depressed subjects were selected from patients who were admitted to the Department of Psychosomatics of Tongde Hospital at Hangzhou, China between 1st September 2009 and 30th November 2013. While all were medicated with psychotropic drugs, 78 received additional individualized herbal medicine. The severity of depressive symptoms was measured using 24-item Hamilton Rating Scale for Depression (HAMD-24) at admission and thereafter once weekly during hospital stay. The proportion of patients achieving clinical response and remission and incidence of adverse events were compared. The two groups had similar average length of hospital stay for approximately 28 days and were not different in the use of psychotropic medications. Survival analysis revealed that patients with herbal medicine had significantly higher chance of achieving clinical response [relative risk (RR)=2.179, P<0.001] and remission (RR=5.866, P<0.001) compared to those without herbal medicine. Patients with herbal medicine experienced remarkably fewer incidences of physical tiredness, headache, palpitation, dry mouth and constipation, but had a significantly higher incidence of digestive discomfort compared to patients without herbal medicine. These results indicate that additional treatment with individualized herbal medicine enhances antidepressant response and reduces certain side effects associated with psychotropic medications. Herbal medicine is an effective and relatively safe therapy for severe depressive episode (Trial Registration: ChiCTR-OCH-13003864). Copyright © 2014 Elsevier B.V. All rights reserved.

A process evaluation of START NOW Skills Training for inmates with impulsive and aggressive behaviors.

PubMed

Shelton, Deborah; Wakai, Sara

2011-01-01

To conduct a formative evaluation of a treatment program designed for inmates with impulsive and aggressive behavior disorders in high-security facilities in Connecticut correctional facilities. Pencil-and-paper surveys and in-person inmate interviews were used to answer four evaluation questions. Descriptive statistics and content analyses were used to assess context, input, process, and products. A convenience sample of 26 adult male (18) and female (8) inmates participated in the study. Inmates were satisfied with the program (4-point scale, M = 3.38, SD = 0.75). Inmate hospital stays were reduced by 13.6%, and psychotropic medication use increased slightly (0.40%). Improved outcomes were noted for those inmates who attended more sessions. The findings of the formative evaluation were useful for moving the START NOW Skills Training treatment to the implementation phase. Recommendations for implementation modifications included development of an implementation team, reinforcement of training, and attention applied to uniform collection of outcome data to demonstrate its evidence base.

Psychiatric Comorbidity and Medication Use in Adults with Autism Spectrum Disorder

ERIC Educational Resources Information Center

Buck, Tara R.; Viskochil, Joseph; Farley, Megan; Coon, Hilary; McMahon, William M.; Morgan, Jubel; Bilder, Deborah A.

2014-01-01

The purpose of this study was to investigate comorbid psychiatric disorders and psychotropic medication use among adults with autism spectrum disorder (ASD) ascertained as children during a 1980's statewide Utah autism prevalence study (n = 129). Seventy-three individuals (56.6%) met criteria for a current psychiatric disorder; 89 participants…

[Pregnancy and psychoactives substances: prevalence study based on the declared consumption].

PubMed

Dumas, A; Lejeune, C; Simmat-Durand, L; Crenn-Hébert, C; Mandelbrot, L

2008-12-01

Evaluate substance use (tobacco, alcohol, psychotropic drugs, illicit drugs) declared before and during pregnancy. Two hundred and forty-five pregnant women were interviewed through a self-administered and anonymous questionnaire as they were going to a prenatal consultation in a maternity hospital in the Parisian area. Before pregnancy, 16.3% of women reported smoking and 10.2% carried on smoking during pregnancy. Altogether, 40.8% of women reported alcohol consumption before pregnancy; 25.3% of women had contact with alcohol during pregnancy; 4.5% reported tobacco and alcohol consumption during pregnancy. During the month preceding the study, the consumption of psychotropic drugs (hypnotics, antidepressants or sedatives) was reported by 3.7% of women and that of marijuana by 2.4%. Moreover, the marijuana consumers, who tend to drink alcohol more often, combine important social and familial difficulties and represent a high-risk group. Tobacco and alcohol use in this study were lower than in any previously conducted French surveys. Methodological specificities and cultural factors might explain those results. However, this is the first study that asses substance use and marijuana use, in particular, by French pregnant women.

Sodium Valproate Withdrawal Correlates with Reduced Aggression

ERIC Educational Resources Information Center

Pritchard, Duncan; Hoerger, Marguerite; Dyer, Tim; Graham, Nicola; Penney, Heather; Mace, F. Charles

2014-01-01

People with learning disabilities are sometimes prescribed psychotropic medication to help manage their challenging behaviour. This case study describes how a multicomponent behavioural intervention in conjunction with the systematic withdrawal of sodium valproate was strongly correlated with reduced aggression. No symptoms of bipolar disorder or…

A register-based 13-year to 43-year follow-up of 70 patients with obsessive-compulsive disorder treated with capsulotomy.

PubMed

Rück, Christian; Larsson, Johan K; Mataix-Cols, David; Ljung, Rickard

2017-06-06

Little is known about the long-term medical status of patients with severe obsessive-compulsive disorder (OCD) undergoing capsulotomy, a neurosurgical last-resort treatment. The present study used national registers to identify all operated patients with OCD in Sweden and evaluated their long-term medical status, including mortality, hospital admissions and psychotropic medication after capsulotomy for OCD. Register-based long-term follow-up cohort study. We used the procedural and diagnostic codes in the Swedish National Patient Register to define the study population between 1970 and March 2013. Verification by manual review of medical records of the indication for surgery in those identified by the register yielded the final study cohort of 70 patients, followed 13-43 years after surgery. The sensitivity of the case selection method was 86%. We studied hospitalisation 5 years before and after surgery. Mortality data were derived from the Causes of Death Register. The Prescribed Drug Register was used to study psychotropic drug utilisation. By March 2013, 29 of the 70 patients were deceased. Their mean age at the time of death was 68 years (SD=14). Two patients had committed suicide and one had died of suspected suicide. Seventy per cent had been admitted to a psychiatric ward in the 5 years preceding surgery, and 84% in the first five postoperative years. Seventy-five per cent of those alive in 2012 were prescribed at least two psychotropic medications, often at high doses, the most common being antidepressants. Malignant OCD has a poor long-term prognosis. Patients who are candidates for surgery should be informed that, while OCD symptoms may be ameliorated with surgery, they should not expect long-term freedom from medication and psychiatric care. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Brain talk: power and negotiation in children’s discourse about self, brain and behaviour

PubMed Central

Singh, Ilina

2013-01-01

This article examines children’s discourse about self, brain and behaviour, focusing on the dynamics of power, knowledge and responsibility articulated by children. The empirical data discussed in this article are drawn from the study of Voices on Identity, Childhood, Ethics and Stimulants, which included interviews with 151 US and UK children, a subset of whom had a diagnosis of attention deficit/hyperactivity disorder. Despite their contact with psychiatric explanations and psychotropic drugs for their behaviour, children’s discursive engagements with the brain show significant evidence of agency and negotiated responsibility. These engagements suggest the limitations of current concepts that describe a collapse of the self into the brain in an age of neurocentrism. Empirical investigation is needed in order to develop agent-centred conceptual and theoretical frameworks that describe and evaluate the harms and benefits of treating children with psychotropic drugs and other brain-based technologies. PMID:23094965

[Traumatic Events, Posttraumatic Stress Disorder and Utilization of Psychotherapy in Immigrants of Polish Origin in Germany].

PubMed

Morawa, Eva; Erim, Yesim

2016-09-01

In 253 persons of Polish origin in Germany traumatic events and posttraumatic stress disorder (PTSD) were examined with the Essen Trauma Inventory (ETI). The utilization of psychotherapy and psychotropic drugs as well as the preferred language in the psychotherapy were also measured. At least one traumatic event was reported in 77.5% of the probands. Severe disease (52.6%) and death or loss of an important person (32.0%) were reported most frequently. In the psychometric assessment indices for a positive PTSD diagnosis were given among 6.2%. At the time of investigation, 3.6% of the immigrants were in psychiatric/psychotherapeutic treatment or were taking psychotropic drugs, respectively. More than half (53.9%) of the sample preferred Polish as the language for the psychotherapy. The study demonstrates a high frequency of PTSD in immigrants of Polish origin. © Georg Thieme Verlag KG Stuttgart · New York.

Mental Health of Refugees and Non-refugees from War-Conflict Countries: Data from Primary Healthcare Services and the Norwegian Prescription Database.

PubMed

Straiton, Melanie L; Reneflot, Anne; Diaz, Esperanza

2017-06-01

High rates of mental health problems are consistently found among immigrants from refugee generating countries. While refugees and their family members may have experienced similar traumas, refugees are more likely to have undergone a stressful asylum period. This study aims to determine whether their mental health differs. Using national registry data, refugees and non-refugees from the same countries were compared on primary healthcare service use for mental health problems and purchase of psychotropic medicine. Refugees had higher odds of using primary health care services than non-refugees. Refugee women were more likely to purchase psychotropic medicine than non-refugee women. Refugee men were more likely to purchase anti-depressants. The findings suggest that refugees have poorer mental health than non-refugees. This may be due to a combination of greater pre-migration trauma and post-migration stressors such as enduring a difficult asylum period.

Male fertility: psychiatric considerations.

PubMed

Hall, Elise; Burt, Vivien K

2012-02-01

To examine: 1) current knowledge on normal biologic variation of seminal parameters; 2) how stress and psychological factors affect sperm quality in fertile and infertile males; and 3) how mental illness and psychopharmacologic agents can affect male fertility. English-language Medline, Embase, and Psycinfo were searched for relevant publications (from 1970 to January 2011) for systematic review. None. None. None. Possible effects of stress, mood, and psychotropic medications on male factor fertility. Male-factor infertility is influenced by myriad factors (obesity, tobacco, etc.). Stress alone may reduce testosterone levels and spermatogenesis. Infertility assessment and treatment can lead to distress and negatively affect sperm samples. Available research has failed to control for potentially confounding variables. Although some trends have been identified, larger-scale studies that adequately control all confounding variables are needed before conclusions can be made about the relationship between stress, psychotropic agents, and male infertility. Copyright © 2012 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Effect of an interactive therapeutic robotic animal on engagement, mood states, agitation and psychotropic drug use in people with dementia: a cluster-randomised controlled trial protocol

PubMed Central

Moyle, Wendy; Beattie, Elizabeth; Draper, Brian; Shum, David; Thalib, Lukman; Jones, Cindy; O'Dwyer, Siobhan; Mervin, Cindy

2015-01-01

Introduction Apathy, agitated behaviours, loneliness and depression are common consequences of dementia. This trial aims to evaluate the effect of a robotic animal on behavioural and psychological symptoms of dementia in people with dementia living in long-term aged care. Methods and analysis A cluster-randomised controlled trial with three treatment groups: PARO (robotic animal), Plush-Toy (non-robotic PARO) or Usual Care (Control). The nursing home sites are Australian Government approved and accredited facilities of 60 or more beds. The sites are located in South-East Queensland, Australia. A sample of 380 adults with a diagnosis of dementia, aged 60 years or older living in one of the participating facilities will be recruited. The intervention consists of three individual 15 min non-facilitated sessions with PARO or Plush-Toy per week, for a period of 10 weeks. The primary outcomes of interest are improvement in agitation, mood states and engagement. Secondary outcomes include sleep duration, step count, change in psychotropic medication use, change in treatment costs, and staff and family perceptions of PARO or Plush-Toy. Video data will be analysed using Noldus XT Pocket Observer; descriptive statistics will be used for participants’ demographics and outcome measures; cluster and individual level analyses to test all hypotheses and Generalised Linear Models for cluster level and Generalised Estimation Equations and/or Multi-level Modeling for individual level data. Ethics and dissemination The study participants or their proxy will provide written informed consent. The Griffith University Human Research Ethics Committee has approved the study (NRS/03/14/HREC). The results of the study will provide evidence of the efficacy of a robotic animal as a psychosocial treatment for the behavioural and psychological symptoms of dementia. Findings will be presented at local and international conference meetings and published in peer-reviewed journals. Trial registration number Australian and New Zealand Clinical Trials Registry number ACTRN12614000508673 date registered 13/05/2014. PMID:26270953

Effect of an interactive therapeutic robotic animal on engagement, mood states, agitation and psychotropic drug use in people with dementia: a cluster-randomised controlled trial protocol.

PubMed

Moyle, Wendy; Beattie, Elizabeth; Draper, Brian; Shum, David; Thalib, Lukman; Jones, Cindy; O'Dwyer, Siobhan; Mervin, Cindy

2015-08-12

Apathy, agitated behaviours, loneliness and depression are common consequences of dementia. This trial aims to evaluate the effect of a robotic animal on behavioural and psychological symptoms of dementia in people with dementia living in long-term aged care. A cluster-randomised controlled trial with three treatment groups: PARO (robotic animal), Plush-Toy (non-robotic PARO) or Usual Care (Control). The nursing home sites are Australian Government approved and accredited facilities of 60 or more beds. The sites are located in South-East Queensland, Australia. A sample of 380 adults with a diagnosis of dementia, aged 60 years or older living in one of the participating facilities will be recruited. The intervention consists of three individual 15 min non-facilitated sessions with PARO or Plush-Toy per week, for a period of 10 weeks. The primary outcomes of interest are improvement in agitation, mood states and engagement. Secondary outcomes include sleep duration, step count, change in psychotropic medication use, change in treatment costs, and staff and family perceptions of PARO or Plush-Toy. Video data will be analysed using Noldus XT Pocket Observer; descriptive statistics will be used for participants' demographics and outcome measures; cluster and individual level analyses to test all hypotheses and Generalised Linear Models for cluster level and Generalised Estimation Equations and/or Multi-level Modeling for individual level data. The study participants or their proxy will provide written informed consent. The Griffith University Human Research Ethics Committee has approved the study (NRS/03/14/HREC). The results of the study will provide evidence of the efficacy of a robotic animal as a psychosocial treatment for the behavioural and psychological symptoms of dementia. Findings will be presented at local and international conference meetings and published in peer-reviewed journals. Australian and New Zealand Clinical Trials Registry number ACTRN12614000508673 date registered 13/05/2014. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Medication Treatment Outcomes for School-Aged Children Diagnosed with Autism

ERIC Educational Resources Information Center

Carlson, John S.; Brinkman, Tara; Majewicz-Hefley, Amy

2006-01-01

Recent studies on the prevalence of autism indicate that approximately 1 in 200 children meet diagnostic criteria, significantly greater than rates reported just a decade ago (Blanchard, Gurka, & Blackman, 2006). Concurrently, biomedical treatments including psychotropic medication have been used with increased frequency to treat children…

Alcohol, nicotine, caffeine, and mental disorders

PubMed Central

Crocq, Marc-Antoine

2003-01-01

Alcohol, nicotine, and caffeine are the most widely consumed psychotropic drugs worldwide. They are largely consumed by normal individuals, but their use is even more frequent in psychiatric patients, Thus, patients with schizophrenia tend to abuse all three substances. The interrelationships between depression and alcohol are complex. These drugs can all create dependence, as understood in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Alcohol abuse is clearly deleterious to the brain, provoking acute and chronic mental disorders, ranging from intoxication with impairment of cognition, to delirium tremens, halluosis, and dementia. In contrast, the main health consequences of nicotine, notably cancer and cardiovascular disases, lie outside the realm of psychiatry However, the mes of nicotine dependence and motivation to smoke or quit are of concern to psychiatrists. PMID:22033899

Psychotropic Pharmacotherapy Associated With QT Prolongation Among Veterans With Posttraumatic Stress Disorder.

PubMed

Stock, Eileen M; Zeber, John E; McNeal, Catherine J; Banchs, Javier E; Copeland, Laurel A

2018-04-01

In 2012, the Food and Drug Administration issued Drug Safety Communications on several drugs associated with QT prolongation and fatal ventricular arrhythmias. Among these was citalopram, a selective serotonin reuptake inhibitor (SSRI) approved for depression and commonly used for posttraumatic stress disorder (PTSD). Evaluation of the risk for QT prolongation among other psychotropic drugs for individuals with PTSD remains limited. Explore psychotropic drugs associated with QT prolongation among veterans with PTSD. Patients in the Veterans Health Administration in 2006-2009 with PTSD and QT prolongation (176 cases) were matched 1:4 on age, gender, visit date and setting, and physical comorbidity. Classification trees assessed QT prolongation risk among prescribed medications (n=880). Receipt of any drug with known risk of QT prolongation varied by group (23% QT cases vs 15% control, p<0.01). Psychotropic medications conferring significant risks included ziprasidone (3% vs 1%, p=0.02) and buspirone (6% vs 2%, p=0.01). Increased risk was not observed for the SSRIs, citalopram and fluoxetine. Classification trees found that sotalol and amitriptyline carried greater risk among cardiac patients and methadone, especially if prescribed with quetiapine, among noncardiac patients. Per adjusted survival model, patients with QT prolongation were at increased risk for death (hazard ratio=1.60; 95% CI=1.04-2.44). Decision models are particularly advantageous when exploring nonlinear relationships or nonadditive interactions. These findings may potentially affect clinical decision-making concerning treatment for PTSD. For patients at higher risk of QT prolongation, antidepressants other than amitriptyline should be considered. Medications for comorbid conditions should also be closely monitored for heightened QT prolongation risk.

Trends in Racial-Ethnic Disparities in Access to Mental Health Care, 2004-2012.

PubMed

Cook, Benjamin Lê; Trinh, Nhi-Ha; Li, Zhihui; Hou, Sherry Shu-Yeu; Progovac, Ana M

2017-01-01

This study compared trends in racial-ethnic disparities in mental health care access among whites, blacks, Hispanics, and Asians by using the Institute of Medicine definition of disparities as all differences except those due to clinical appropriateness, clinical need, and patient preferences. Racial-ethnic disparities in mental health care access were examined by using data from a nationally representative sample of 214,597 adults from the 2004-2012 Medical Expenditure Panel Surveys. The main outcome measures included three mental health care access measures (use of any mental health care, any outpatient care, and any psychotropic medication in the past year). Significant disparities were found in 2004-2005 and in 2011-2012 for all three racial-ethnic minority groups compared with whites in all three measures of access. Between 2004 and 2012, black-white disparities in any mental health care and any psychotropic medication use increased, respectively, from 8.2% to 10.8% and from 7.6% to 10.0%. Similarly, Hispanic-white disparities in any mental health care and any psychotropic medication use increased, respectively, from 8.4% to 10.9% and 7.3% to 10.3%. No reductions in racial-ethnic disparities in access to mental health care were identified between 2004 and 2012. For blacks and Hispanics, disparities were exacerbated over this period. Clinical interventions that improve identification of symptoms of mental illness, expansion of health insurance, and other policy interventions that remove financial barriers to access may help to reduce these disparities.

Screening for mental illness: the merger of eugenics and the drug industry.

PubMed

Sharav, Vera Hassner

2005-01-01

The implementation of a recommendation by the President's New Freedom Commission (NFC) to screen the entire United States population--children first--for presumed, undetected, mental illness is an ill-conceived policy destined for disastrous consequences. The "pseudoscientific" methods used to screen for mental and behavioral abnormalities are a legacy from the discredited ideology of eugenics. Both eugenics and psychiatry suffer from a common philosophical fallacy that undermines the validity of their theories and prescriptions. Both are wed to a faith-based ideological assumption that mental and behavioral manifestations are biologically determined, and are, therefore, ameliorated by biological interventions. NFC promoted the Texas Medication Algorithm Project (TMAP) as a "model" medication treatment plan. The impact of TMAP is evident in the skyrocketing increase in psychotropic drug prescriptions for children and adults, and in the disproportionate expenditure for psychotropic drugs. The New Freedom Commission's screening for mental illness initiative is, therefore, but the first step toward prescribing drugs. The escalating expenditure for psychotropic drugs since TMAP leaves little doubt about who the beneficiaries of TMAP are. Screening for mental illness will increase their use.

Patients with Posttraumatic Stress Disorder with Comorbid Major Depressive Disorder Require a Higher Dose of Psychotropic Drugs.

PubMed

Chiba, Hiromi; Oe, Misari; Uchimura, Naohisa

2016-01-01

Major depressive disorder (MDD) has been associated with stressful life events and with posttraumatic stress disorder (PTSD). PTSD and MDD comorbidity was also reported to be associated with greater symptom severity and lower levels of functioning. However, the characteristics of pharmacotherapy for PTSD with MDD are not fully understood. To understand this relationship, we conducted a retrospective review using medical charts at the Department of Neuropsychiatry, Kurume University Hospital. Information from 55 patients with PTSD was analyzed. Five cases were excluded after re-evaluation of the PTSD diagnosis. A higher rate of type II trauma was observed in the PTSD with MDD group (50.0%) than in the PTSD-only group [13.6%; χ(2) (1, n =50) = 7.26, p<0.01]. Patients with comorbid MDD were significantly older, had more severe PTSD symptomatology, and a longer duration of treatment. They also received higher doses of psychotropic drugs, regardless of the type (antidepressants, antipsychotics, benzodiazepines), than the PTSD-only group. Our results showed that comorbid MDD is associated with higher doses of psychotropic drugs, suggesting difficulties in treatment.

Use of psychotropic drugs during pregnancy and breast-feeding.

PubMed

Larsen, E R; Damkier, P; Pedersen, L H; Fenger-Gron, J; Mikkelsen, R L; Nielsen, R E; Linde, V J; Knudsen, H E D; Skaarup, L; Videbech, P

2015-01-01

To write clinical guidelines for the use of psychotropic drugs during pregnancy and breast-feeding for daily practice in psychiatry, obstetrics and paediatrics. As we wanted a guideline with a high degree of consensus among health professionals treating pregnant women with a psychiatric disease, we asked the Danish Psychiatric Society, the Danish Society of Obstetrics and Gynecology, the Danish Paediatric Society and the Danish Society of Clinical Pharmacology to appoint members for the working group. A comprehensive review of the literature was hereafter conducted. Sertraline and citalopram are first-line treatment among selective serotonin reuptake inhibitor for depression. It is recommended to use lithium for bipolar disorders if an overall assessment finds an indication for mood-stabilizing treatment during pregnancy. Lamotrigine can be used. Valproate and carbamazepin are contraindicated. Olanzapine, risperidone, quetiapine and clozapine can be used for bipolar disorders and schizophrenia. It is important that health professionals treating fertile women with a psychiatric disease discuss whether psychotropic drugs are needed during pregnancy and how it has to be administered. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Medication Use among Australian Adults with Intellectual Disability in Primary Healthcare Settings: A Cross-Sectional Study

ERIC Educational Resources Information Center

Doan, Tan N.; Lennox, Nicholas G.; Taylor-Gomez, Miriam; Ware, Robert S.

2013-01-01

Background: There is concern about widespread medication use by people with intellectual disability (ID), especially psychotropic and anticonvulsant agents. However, there is sparse information on prescribing patterns in Australia. Method: This cross-sectional study was conducted between 2000 and 2002 among adults with ID who live in the community…

Drug Treatment with Children in Programs for the Trainable Mentally Handicapped.

ERIC Educational Resources Information Center

Gadow, Kenneth D.

In order to describe the extent of drug treatment with mentally retarded children in public schools and the involvement of teachers in the drug regimen, a study was designed to survey teachers of the trainable mentally handicapped by mail about psychotropic and anticonvulsant drug use with the children they were teaching. The study was divided…

Psychopharmacology of Autism Spectrum Disorders: A Selective Review

ERIC Educational Resources Information Center

Mohiuddin, Sarah; Ghaziuddin, Mohammad

2013-01-01

While there is no cure for autism spectrum disorder, psychopharmacologic agents are often used with behavioral and educational approaches to treat its comorbid symptoms of hyperactivity, irritability, and aggression. Studies suggest that at least 50% of persons with autism spectrum disorder receive psychotropic medications during their life span.…

Environmental Factors Associated with Psychotropic Drug Use in Brazilian Nightclubs.

PubMed

Carlini, Claudia; Andreoni, Solange; Sanchez, Zila M

2017-08-01

The purpose of this study was to identify environmental factors associated with patterns of psychotropic drug use in nightclubs. Mixed methods were used to investigate psychotropic drugs consumption among patrons of 31 nightclubs in São Paulo, Brazil. A total of 1822 patrons at the entrance and exit of the venues and 30 staff members of the nightclubs were interviewed. The observational data were collected through 307 h of observational research using a structured guide to register environmental measures. Psychotropic drug use in nightclubs was classified into three categories (1: no drugs; 2: legal drugs [e.g., alcohol and tobacco]; or 3: illicit drugs regardless of alcohol and tobacco use). Illicit drugs used were self-reported by patrons, and alcohol use was measured using a breathalyzer. The data were analyzed in clusters using correlated multinomial logistic regression models. The following environmental variables were associated with illicit drug use in nightclubs: all-you-can-drink service (adjusted odds ratio (aOR) = 11.84, 95%CI [4.06;34.57]) and light effects, such as laser and "disco lights" (aOR = 24.49, 95%CI [8.48;70.77]). The number of bouncers per capita × 100 and the presence of two or more dance floors were inversely associated with the use of illicit drugs (aOR = 0.26, 95%CI [0.11;0.65], and aOR = 0.13, 95%CI [0.06;0.29], respectively). Legal drug use was associated with all-you-can-drink service (aOR = 2.17, 95%CI [1.43;5.04]), the presence of two or more dance floors (aOR = 2.06, 95%CI [1.40;3.05]), and the number of bouncers per capita × 100 (aOR = 1.39, 95%CI [1.22;1.59]). These findings suggest that this is a multivariate phenomenon that would require an integrated approach involving the venue owners, staff members, patrons, local governments, and law enforcement agencies.

Industrial hemp decreases intestinal motility stronger than indian hemp in mice.

PubMed

Sabo, A; Horvat, O; Stilinovic, N; Berenji, J; Vukmirovic, S

2013-02-01

Indian hemp has shown beneficial effects in various gastrointestinal conditions but it is not widely accepted due to high content of tetrahydrocannabinol resulting in unwanted psychotropic effects. Since industrial hemp rich in cannabidiol lacks psychotropic effects the aim of research was to study the effects of industrial hemp on intestinal motility. Animals were randomly divided in six groups (each group consisting of 6 animals): Control group, Cind group - receiving indian hemp infuse for 20 days, Cids group-receiving industrial hemp infuse for 20 days, M group - treated with single dose of morphine (5 mg/kg i.m.) Cind+M group - treated with indian hemp infuse and single dose of morphine (5 mg/kg i.m.), Cids+M - treated with industrial hemp infuse and single dose of morphine (5 mg/kg i.m.). On the 20th day of the study animals were administered charcoal meal, and were sacrificed 35 minutes after administration. Intestinal motility was estimated according to distance between carbo medicinalis and cecum in centimeters. Decrease of intestinal motility in animals treated with indian hemp infuse was not significant compared to controls and it was smaller compared to animals treated with morphine (Indian hemp =15.43±10.5 cm, morphine = 20.14±5.87 cm). Strongest decrease of intestinal motility was recorded in animals treated with industrial hemp infuse, and it was significant compared to controls and morphine (industrial hemp = 26.5±9.90 cm, morphine = 20.14±5.87 cm; p < 0.005). Although not completely without psychotropic activity cannabidiol could be a potential replacement for tetrahydrocannabinol. Since industrial hemp infuse rich in cannabidiol reduces intestinal motility in healthy mice cannabidiol should be further evaluated for the treatment of intestinal hypermotility.

Acute liver failure following recreational use of psychotropic "head shop" compounds.

PubMed

Fröhlich, S; Lambe, E; O'Dea, J

2011-03-01

The recreational use of the so-called "legal-highs" has been in both the medical and political arena over the last year as a result of the appearance of "head shops" in many towns in Ireland. These shops specialized in selling new psychotropic compounds that circumvented established drug legislation. Little is known about the potentially harmful effects of these substances but case reports suggest a plethora of harmful psychological and physical effects. Our case describes for the first time acute liver failure associated with the ingestion of two of these amphetamine type compounds.

Sex-specific substance abuse treatment for female healthcare professionals: implications.

PubMed

Koos, Erin; Brand, Michael; Rojas, Julio; Li, Ji

2014-01-01

Gender plays a significant role in the development and treatment of substance abuse disorders. Sex-specific treatment for girls and women has recurrently proven more effective, with better outcomes than traditional treatment. Research on impaired healthcare professionals (HCPs) has largely focused on men, garnering little attention for women and sex differences. With the increasing numbers of female HCPs, it is imperative to identify potential sex differences that may have implications for treatment. Our study compared a convenience sample of male and female HCPs with substance abuse disorders treated in an outpatient program to identify sex differences that may have implications for treatment. Our sample consisted of 96 HCPs (54 men, 42 women) and 17 non-healthcare professional (N-HCP) women. All of the participants were evaluated using the program's clinical interview and the Personality Assessment Inventory (PAI). Chart review data contained categorical variables, qualitative variables, diagnoses, and psychological test scores. A second analysis was conducted through two separate comparisons: the PAI results of comparing impaired female HCPs with impaired male HCPs and the PAI results of comparing impaired female HCPs with impaired female N-HCPs. Statistically significant differences indicated more male participants received prior treatment and more intensive treatment than female participants. More female subjects reported being diagnosed as having a comorbid psychiatric condition and taking psychotropic medications. Several statistically significant differences in the PAI scores were found. Among female HCPs, elevations were found in anxiety, depression, paranoia, and borderline personality disorder. Substantive differences, although not statistically significant, were elevations in somatic complaints and anxiety disorders in female HCPs. In the comparison of female HCPs and N-HCPs, the only statistically significant difference was the significantly higher anxiety score of N-HCPs. The results indicate greater differences between female HCPs and male HCPs than between female HCPs and N-HCPs.

Psychotropic effects of Lactobacillus plantarum PS128 in early life-stressed and naïve adult mice.

PubMed

Liu, Yen-Wenn; Liu, Wei-Hsien; Wu, Chien-Chen; Juan, Yi-Chen; Wu, Yu-Chen; Tsai, Huei-Ping; Wang, Sabrina; Tsai, Ying-Chieh

2016-01-15

Ingestion of specific probiotics, namely "psychobiotics", produces psychotropic effects on behavior and affects the hypothalamic-pituitary-adrenal axis and neurochemicals in the brain. We examined the psychotropic effects of a potential psychobiotic bacterium, Lactobacillus plantarum strain PS128 (PS128), on mice subjected to early life stress (ELS) and on naïve adult mice. Behavioral tests revealed that chronic ingestion of PS128 increased the locomotor activities in both ELS and naïve adult mice in the open field test. In the elevated plus maze, PS128 significantly reduced the anxiety-like behaviors in naïve adult mice but not in the ELS mice; whereas the depression-like behaviors were reduced in ELS mice but not in naïve mice in forced swimming test and sucrose preference test. PS128 administration also reduced ELS-induced elevation of serum corticosterone under both basal and stressed states but had no effect on naïve mice. In addition, PS128 reduced inflammatory cytokine levels and increased anti-inflammatory cytokine level in the serum of ELS mice. Furthermore, the dopamine level in the prefrontal cortex (PFC) was significantly increased in PS128 treated ELS and naïve adult mice whereas serotonin (5-HT) level was increased only in the naïve adult mice. These results suggest that chronic ingestion of PS128 could ameliorate anxiety- and depression-like behaviors and modulate neurochemicals related to affective disorders. Thus PS128 shows psychotropic properties and has great potential for improving stress-related symptoms. Copyright © 2015 The Authors. Published by Elsevier B.V. All rights reserved.

Correlates of residual fatigue in patients with major depressive disorder: The role of psychotropic medication.

PubMed

Chung, Ka-Fai; Yu, Yee-Man; Yeung, Wing-Fai

2015-11-01

Fatigue is not only a core symptom of major depressive disorder (MDD), but also a common residual symptom. We determined the sociodemographic, clinical, and pharmacologic factors that were associated with fatigue in patients with remission or partial remission of MDD. Data was derived from a randomized controlled trial of acupuncture in 137 MDD patients with residual symptoms. Fatigue was measured by Multidimensional Fatigue Inventory (MFI-20). Self-report and clinician-rated scales were used to assess psychopathology. 17-item Hamilton Depression Rating Scale (HDRS17) score≤7 denoted MDD remission. Participants' average HDRS17 score was 10.5; 29.2% were in remission. The average MFI-20 score was 71.8; 83.2% had severe fatigue, defined as MFI-20 score≥60. Fifty-two of 137 participants (38%) were using sedating psychotropic medications. Antidepressant dosage ranged from 1-90mg fluoxetine equivalent and sedatives/hypnotics from 1-60mg diazepam equivalent. There were significant correlations between MFI-20 score and HDRS17 depression and anxiety subscores, Hospital Anxiety and Depression Scale (HADS) depression and anxiety subscores, and Pain Catastrophizing Scale score, but insomnia and daytime sleepiness, sociodemographics, current medical conditions, and psychotropic medication use were not significant correlates. Upon multiple regression, HADS and HDRS17 depression scores independently predicted MFI-20 score. In remission and partial remission subgroups, HADS depression score was an independent predictor. Participants were recruited from specialty psychiatric units; hence the findings may not be applicable in non-specialized settings. Fatigue was predicted by depression severity in remitted or partially remitted MDD. Psychotropic medication and higher dosage were not associated with greater fatigue. Copyright © 2015 Elsevier B.V. All rights reserved.

Clinical and sociodemographic correlates of severe insomnia in psychotropic drug-free, Asian outpatients with major depressive disorder.

PubMed

Srisurapanont, Manit; Likhitsathian, Surinporn; Chua, Hong Choon; Udomratn, Pichet; Chang, Sungman; Maneeton, Narong; Maneeton, Benchaluk; Chen, Chia-Hui; Shih-Yen Chan, Edwin; Bautista, Dianne; Bin Sulaiman, Ahmad Hatim

2015-11-01

Little has been known regarding the correlates of severe insomnia in major depressive disorder (MDD). This post-hoc analysis aimed to examine the sociodemographic and clinical correlates of severe insomnia in psychotropic drug-free, Asian adult outpatients with MDD. Participants were psychotropic drug-free patients with MDD, aged 18-65 years. By using the Symptom Checklist-90 Items, Revised (SCL-90-R), a score of 4 (severe distress) on any one of three insomnia items was defined as severe insomnia. Other measures included the Montgomery-Asberg Depression Rating Scale (MADRS), the Fatigue Severity Scale (FSS), the nine psychopathology subscales of SCL-90-R, the Physical and Mental Component Summaries of Short Form Health Survey (SF-36 PCS and SF-36 MCS), and the Sheehan Disability Scale (SDS). Of 528 participants, their mean age being 39.5 (SD=13.26) years, 64.2% were females, and 239 (45.3%) had severe insomnia. The logistic regression model revealed that low educational qualifications (less than secondary school completion), high SCL-90-R Depression scores, high SCL-90-R Anxiety scores, and low SF-36 PCS scores were independently correlated with severe insomnia (p's<.05). Insomnia was determined only by the patient's distress. Middle insomnia was not assessed. Psychotropic drug-free patients with MDD are not commonly seen in psychiatric practice. Severe insomnia is common in patients with MDD. It is closely related with low educational qualification, subjective depression and anxiety severity, and poor physical health. These findings may implicate the treatment of comorbid MDD and severe insomnia, for example, sleep hygiene education, pharmacological treatment. Copyright © 2015 Elsevier B.V. All rights reserved.

The Course and Outcome of Psychiatric Illness in People with Prader-Willi Syndrome: Implications for Management and Treatment

ERIC Educational Resources Information Center

Soni, S.; Whittington, J.; Holland, A. J.; Webb, T.; Maina, E.; Boer, H.; Clarke, D.

2007-01-01

Background: This study is part of a larger UK-wide study investigating psychiatric illness in people with Prader-Willi syndrome (PWS), and describes the longitudinal aspect of psychiatric illness, in particular psychotic illness, and examines the use and role of psychotropic medication. Method: A total of 119 individuals with genetically confirmed…

Factors Associated With Antidepressant Dosing in Asia: Findings From the Research on Asian Psychotropic Prescription Study.

PubMed

Rajaratnam, Kamini; Xiang, Yu-Tao; Tripathi, Adarsh; Chiu, Helen Fung Kum; Si, Tian-Mei; Chee, Kok-Yoon; Avasthi, Ajit; Grover, Sandeep; Chong, Mian-Yoon; Kuga, Hironori; Kanba, Shigenobu; He, Yan-Ling; Lee, Min-Soo; Yang, Shu-Yu; Udomratn, Pichet; Kallivayalil, Roy Abraham; Tanra, Andi J; Maramis, Margarita; Shen, Winston Wu-Dien; Sartorius, Norman; Kua, Ee-Heok; Tan, Chay-Hoon; Mahendran, Rathi; Shinfuku, Naotaka; Sum, Min Yi; Baldessarini, Ross J; Sim, Kang

2016-12-01

In this study, we sought to examine factors associated with dosing of antidepressants (ADs) in Asia. Based on reported data and clinical experience, we hypothesized that doses of ADs would be associated with demographic and clinical factors and would increase over time. This cross-sectional, pharmacoepidemiological study analyzed data collected within the Research Study on Asian Psychotropic Prescription Pattern for Antidepressants from 4164 participants in 10 Asian countries, using univariate and multivariate methods. The AD doses varied by twofold among countries (highest in PR China and RO Korea, lowest in Singapore and Indonesia), and averaged 124 (120-129) mg/d imipramine-equivalents. Average daily doses increased by 12% between 2004 and 2013. Doses were significantly higher among hospitalized patients and ranked by diagnosis: major depression > anxiety disorders > bipolar disorder, but were not associated with private/public or psychiatric/general-medical settings, nor with age, sex, or cotreatment with a mood stabilizer. In multivariate modeling, AD-dose remained significantly associated with major depressive disorder and being hospitalized. Doses of ADs have increased somewhat in Asia and were higher when used for major depression or anxiety disorders than for bipolar depression and for hospitalized psychiatric patients.

Melatonin for Sleep in Children with Autism: A Controlled Trial Examining Dose, Tolerability, and Outcomes

ERIC Educational Resources Information Center

Malow, Beth; Adkins, Karen W.; McGrew, Susan G.; Wang, Lily; Goldman, Suzanne E.; Fawkes, Diane; Burnette, Courtney

2012-01-01

Supplemental melatonin has shown promise in treating sleep onset insomnia in children with autism spectrum disorders (ASD). Twenty-four children, free of psychotropic medications, completed an open-label dose-escalation study to assess dose-response, tolerability, safety, feasibility of collecting actigraphy data, and ability of outcome measures…

Factors Influencing the Use of Psychotropic Medication for Challenging Behaviour in the United Kingdom: A Q Method Investigation

ERIC Educational Resources Information Center

Wastell, Sarah; Skirrow, Paul; Hare, Dougal Julian

2016-01-01

Objectives: The use of pharmacological interventions to manage challenging behaviour displayed by adults with intellectual disabilities remains controversial, with current clinical guidelines in the United Kingdom advocating the use of less invasive psychological interventions. This exploratory study aimed to discover what views and beliefs are…

[Impact of psychotropic drugs on breast-fed Infants: international perspective].

PubMed

Yoshida, Keiko

2014-01-01

The benefit of breast-feeding has been established, and it has recently been strongly encouraged internationally. However, new mothers have more risks of developing psychiatric symptoms than in any other period of their life, and some of them require psychopharmacotherapy. There are some clinical dilemmas regarding the benefit of such therapy and possible adverse effects on infants when mothers want to breast-feed their infants. Most drugs are transferred to breast-milk and, eventually, low levels of maternal daily doses can be taken by breast-fed infants. Having considered this issue and based on several studies, the authors of studies report that breast-feeding can be carried out by mothers who take psychotropic drugs. More research data accumulation, including individual case observations and follow-ups, is necessary to guarantee the safety of breast-feeding by a mother on medication; however, in the current clinical setting, decision-making is essential to plan treatment. Such mothers are allowed to breast-feed infants who can be monitored by pediatricians. The critical matter is that clinicians should not hesitate to prescribe optimal doses to mothers for effective treatment.

Improving relapse prevention after successful electroconvulsive therapy for patients with severe depression: completed audit cycle involving 102 full electroconvulsive therapy courses in West Sussex, United kingdom.

PubMed

Atiku, Leonard; Gorst-Unsworth, Caroline; Khan, Barkath Ulla; Huq, Fuad; Gordon, Jackie

2015-03-01

The aim of this study was to determine whether current guidance or consensus regarding continuation pharmacotherapy after successful electroconvulsive therapy (ECT) was being followed by referring clinicians in West Sussex, United Kingdom. A complete audit cycle examining psychotropic medication after successful ECT for patients with severe depression was performed. Clinical and ECT records (electronic and paper) were reviewed, and relapse rates in the 4 commonly prescribed psychotropic medication groups were compared. The pattern of relapse in the 4 groups was similar for both audits 1 and 2. Taking the 102 patients as a whole, the lowest relapse rates were recorded for patients taking a combination of an antidepressant and lithium (16% relapsed within 6 months of successful ECT). Patients taking a combination of antipsychotic and antidepressants fared the worst with 75% relapse rate. This was followed by those taking a combination of antidepressant and a mood stabilizer (other than lithium) (69%). Patients taking antidepressant(s) only were associated with a relapse rate of 60%. Audit 2 demonstrated that clinicians did not change their prescribing practices for their patients after successful ECT despite the efforts made in widely disseminating the results of audit 1. In particular, there was no increase in the use of lithium. Not all psychotropic medication prescribing for patients receiving ECT for depression followed available and current guidance or consensus. More needs to be done to understand the reasons for the reluctance to use lithium if relapse rates after ECT are to improve.

Identifying clinical net benefit of psychotropic medication use with latent variable techniques: Evidence from Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD).

PubMed

Bareis, Natalie; Lu, Juan; Kirkwood, Cynthia K; Kornstein, Susan G; Wu, Elwin; Mezuk, Briana

2018-05-29

Poor medication adherence is common among individuals with Bipolar Disorder (BD). Understanding the sources of heterogeneity in clinical net benefit (CNB) and how it is related to psychotropic medications can provide new insight into ways to improve adherence. Data come from the baseline assessments of the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Latent class analysis identified groups of CNB, and validity of this construct was assessed using the SF-36. Adherence was defined as taking 75% or more of medications as prescribed. Associations between CNB and adherence were tested using multiple logistic regression adjusting for sociodemographic characteristics. Five classes of CNB were identified: High (24%), Moderately high (12%), Moderate (26%), Moderately low (27%) and Low (12%). Adherence to psychotropic medications did not differ across classes (71% to 75%, χ 2   = 3.43, p = 0.488). Medication regimens differed by class: 57% of the High CNB were taking ≤2 medications, whereas 49% of the Low CNB were taking ≥4. CNB classes had good concordance with the SF-36. Missing data limited measures used to define CNB. Participants' perceptions of their illness and treatment were not assessed. This novel operationalization of CNB has construct validity as indicated by the SF-36. Although CNB and polypharmacy regimens are heterogeneous in this sample, adherence is similar across CNB. Studying adherent individuals, despite suboptimal CNB, may provide novel insights into aspects influencing adherence. Copyright © 2018 Elsevier B.V. All rights reserved.

Purified Cannabidiol, the main non-psychotropic component of Cannabis sativa, alone, counteracts neuronal apoptosis in experimental multiple sclerosis.

PubMed

Giacoppo, S; Soundara Rajan, T; Galuppo, M; Pollastro, F; Grassi, G; Bramanti, P; Mazzon, E

2015-12-01

Multiple Sclerosis (MS) is a global concern disease leading to a progressive, chronic and demyelinating condition, affecting the central nervous system (CNS). The pathology has an inflammatory/autoimmune origin; nevertheless, neuronal cell death mechanisms are not to be underestimated. The present study was designed to test the effects of intraperitoneal administration of cannabidiol (CBD), the main non-psychotropic cannabinoid of Cannabis sativa (CS), in an experimental model of MS. The aim is to evaluate the capability of CBD administration to thwart the cascade of mediators involved in MS-induced apoptosis. Experimental Autoimmune Encephalomyelitis (EAE) was induced by immunization with myelin oligodendroglial glycoprotein (MOG)35-55 peptide in mice. After immunization, mice were observed daily for signs of EAE and weight loss. Disease signs were evaluated using a standardized scoring system. Immunohistochemical and Western blot assessments of key apoptotic markers reveal that CBD treatment is able to avoid Fas pathway activation, phospho-ERK p42/44 and cleaved caspase-3 triggering as well as alterations in mitochondrial permeability due to Bax/Bcl-2 unbalance. Moreover, CBD interferes with p53-p21 axis activation. As results, the absence of tissue apobody formation in spinal cord tissues of EAE-mice treated with CBD was established. Most of therapeutic properties of CS are currently ascribed to the psychotropic effects of phenylterpenoid delta-9 tetrahydrocannabinol. We have demonstrated that, alone, purified CBD possesses an anti-apoptotic power against the neurodegenerative processes underlying MS development. This represents an interesting new profile of CBD that could lead to its introduction in the clinical management of MS.

Motivational interviewing: a tool for increasing psychotropic medication adherence for youth.

PubMed

Hamrin, Vanya; McGuinness, Teena M

2013-06-01

There are serious outcomes to nonadherence to psychotropic medications in children and adolescents, including poor school performance, prolonged duration of illness, increased psychopathology, poor interpersonal relationships, increased psychiatric episodes, and suicide attempts. Medication treatment has demonstrated improved psychiatric functioning and a 50% reduction in suicidal behavior. more than 50% of youth with mental health problems are nonadherent with psychiatric medications. A review of literature examining motivational interviewing (MI) for the problem of treatment adherence in children and adolescents is discussed. MI has great potential to improve psychiatric medication adherence in adolescents. An example of how to implement MI with youth is provided.

MEDNET: A Multi-State Policymaker/Researcher Collaboration to Improve Prescribing Practices

PubMed Central

Finnerty, Molly; Neese-Todd, Sheree; Bilder, Scott; Olfson, Mark; Crystal, Stephen

2015-01-01

States face new federal requirements to monitor psychotropic prescribing practices for children and adults in Medicaid. Effective use of quality measurement and quality improvement strategies hold the promise of improved outcomes for public mental health systems. The Medicaid/Mental Health Network for Evidence Based Treatment (MEDNET) is an AHRQ funded multi-state Medicaid quality collaborative with the Rutgers University Center for Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes. We review the development, infrastructure, challenges, and early evidence of success of this public-academic partnership, the first multi-state Medicaid quality improvement collaborative to focus on psychotropic medications. PMID:25756882

Dual-eligibles with Mental Disorders and Medicare Part D: How are they faring?

PubMed Central

Donohue, Julie M.; Huskamp, Haiden A.; Zuvekas, Samuel H.

2009-01-01

In 2006, 6 million beneficiaries who were dually eligible for Medicare and Medicaid switched from Medicaid to Medicare Part D coverage of their prescription drugs. This change led to a significant expansion of Medicare’s role in financing psychotropic medications for this group. A reduction in the number of plans serving dual-eligibles and an increase in utilization restrictions for some psychotropics since 2006 raises concerns about medication access for dual-eligibles with mental disorders and point to potential problems with adverse selection. To improve access to medication for this population, Medicare might consider changes to the enrollment and risk-sharing systems. PMID:19414883

Pharmacological action of Panax ginseng on the behavioral toxicities induced by psychotropic agents.

PubMed

Kim, Hyoung-Chun; Shin, Eun-Joo; Jang, Choon-Gon; Lee, Myung-Koo; Eun, Jae-Soon; Hong, Jin-Tae; Oh, Ki-Wan

2005-09-01

Morphine-induced analgesia has been shown to be antagonized by ginseng total saponins (GTS), which also inhibit the development of analgesic tolerance to and physical dependence on morphine. GTS is involved in both of these processes by inhibiting morphine-6-dehydrogenase, which catalyzes the synthesis of morphinone from morphine, and by increasing the level of hepatic glutathione, which participates in the toxicity response. Thus, the dual actions of ginseng are associated with the detoxification of morphine. In addition, the inhibitory or facilitated effects of GTS on electrically evoked contractions in guinea pig ileum (mu-receptors) and mouse vas deferens (delta-receptors) are not mediated through opioid receptors, suggesting the involvement of non-opioid mechanisms. GTS also attenuates hyperactivity, reverse tolerance (behavioral sensitization), and conditioned place preference induced by psychotropic agents, such as methamphetamine, cocaine, and morphine. These effects of GTS may be attributed to complex pharmacological actions between dopamine receptors and a serotonergic/adenosine A2A/ delta-opioid receptor complex. Ginsenosides also attenuate the morphine-induced cAMP signaling pathway. Together, the results suggest that GTS may be useful in the prevention and therapy of the behavioral side effects induced by psychotropic agents.

Cannabis and its derivatives: review of medical use.

PubMed

Leung, Lawrence

2011-01-01

Use of cannabis is often an under-reported activity in our society. Despite legal restriction, cannabis is often used to relieve chronic and neuropathic pain, and it carries psychotropic and physical adverse effects with a propensity for addiction. This article aims to update the current knowledge and evidence of using cannabis and its derivatives with a view to the sociolegal context and perspectives for future research. Cannabis use can be traced back to ancient cultures and still continues in our present society despite legal curtailment. The active ingredient, Δ9-tetrahydrocannabinol, accounts for both the physical and psychotropic effects of cannabis. Though clinical trials demonstrate benefits in alleviating chronic and neuropathic pain, there is also significant potential physical and psychotropic side-effects of cannabis. Recent laboratory data highlight synergistic interactions between cannabinoid and opioid receptors, with potential reduction of drug-seeking behavior and opiate sparing effects. Legal rulings also have changed in certain American states, which may lead to wider use of cannabis among eligible persons. Family physicians need to be cognizant of such changing landscapes with a practical knowledge on the pros and cons of medical marijuana, the legal implications of its use, and possible developments in the future.

Psychotropic treatments in Prader-Willi syndrome: a critical review of published literature.

PubMed

Bonnot, O; Cohen, D; Thuilleaux, D; Consoli, A; Cabal, S; Tauber, M

2016-01-01

Prader-Willi syndrome (PWS) is a rare genetic syndrome. The phenotype includes moderate to intellectual disability, dysmorphia, obesity, and behavioral disturbances (e.g., hetero and self-injurious behaviors, hyperphagia, psychosis). Psychotropic medications are widely prescribed in PWS for symptomatic control. We conducted a systematic review of published literature to examine psychotropic medications used in PWS. MEDLINE was searched to identify articles published between January 1967 and December 2014 using key words related to pharmacological treatments and PWS. Articles with original data were included based on a standardized four-step selection process. The identification of studies led to 241 records. All selected articles were evaluated for case descriptions (PWS and behavioral signs) and treatment (type, titration, efficiency, and side effects). Overall, 102 patients were included in these studies. Treatment involved risperidone (three reports, n = 11 patients), fluoxetine (five/n = 6), naltrexone (two/n = 2), topiramate (two/n = 16), fluvoxamine (one/n = 1), mazindol (one/n = 2), N-acetyl cysteine (one/n = 35), rimonabant (one/n = 15), and fenfluramine (one/n = 15). We identified promising treatment effects with topiramate for self-injury and impulsive/aggressive behaviors, risperidone for psychotic symptoms associated with uniparental disomy (UPD), and N-acetyl cysteine for skin picking. The pharmacological approach of behavioral impairment in PWS has been poorly investigated to date. Further randomized controlled studies are warranted. Behavioral disturbances in Prader-Willi syndrome including aggressive reactions, skin picking, and hyperphagia might be very difficult to manage. Antipsychotic drugs are widely prescribed, but weight gain and increased appetite are their major side effects. Topiramate might be efficient for self-injury and impulsive/aggressive behaviors, N-acetyl cysteine is apromising treatment for skin picking and Antidepressants are indicated for OCD symptoms. Risperidone is indicated in case of psychotic symptoms mainly associated with uniparental disomy.

The Impact of Medication Anticholinergic Burden on Cognitive Performance in People With Schizophrenia.

PubMed

Ang, Mei San; Abdul Rashid, Nur Amirah; Lam, Max; Rapisarda, Attilio; Kraus, Michael; Keefe, Richard S E; Lee, Jimmy

2017-12-01

Cognitive deficits are prevalent in people with schizophrenia and associated with functional impairments. In addition to antipsychotics, pharmacotherapy in schizophrenia often includes other psychotropics, and some of these agents possess anticholinergic properties, which may impair cognition. The objective of this study was to explore the association between medication anticholinergic burden and cognition in schizophrenia. Seven hundred five individuals with schizophrenia completed a neuropsychological battery comprising Judgment of Line Orientation Test, Wechsler Abbreviated Scale of Intelligence Matrix Reasoning, Continuous Performance Test-Identical Pairs Version, and the Brief Assessment of Cognition in Schizophrenia. Cognitive g and 3 cognitive factor scores that include executive function, memory/fluency, and speed of processing/vigilance, which were derived from a previously published analysis, were entered as cognitive variables. Anticholinergic burden was computed using 2 anticholinergic scales: Anticholinergic Burden Scale and Anticholinergic Drug Scale. Duration and severity of illness, antipsychotic dose, smoking status, age, and sex were included as covariates. Anticholinergic burden was associated with poorer cognitive performance in cognitive g, all 3 cognitive domains and most cognitive tasks in multivariate analyses. The associations were statistically significant, but the effect sizes were small (for Anticholinergic Burden Scale, Cohen f = 0.008; for Anticholinergic Drug Scale, Cohen f = 0.017). Although our results showed a statistically significant association between medications with anticholinergic properties and cognition in people with schizophrenia, the impact is of doubtful or minimal clinical significance.

Importance of a specialty clinic for individuals with fragile X syndrome.

PubMed

Visootsak, Jeannie; Kidd, Sharon A; Anderson, Tovi; Bassell, Julia L; Sherman, Stephanie L; Berry-Kravis, Elizabeth M

2016-12-01

Advances in human genetics have identified a significant number of genetic disorders associated with intellectual disability. As a result, appropriate clinical management of these affected individuals and their family members have become critical in addressing medical needs to improve quality of life. We examine the importance of a Fragile X Clinic for individuals with fragile X syndrome (FXS) and their family members by conducting a retrospective chart review of 123 new patients with FXS evaluated at the Fragile X Clinic at Emory University. After the initial diagnosis of a proband with FXS with cascade testing, there were 345 family members identified with a mutation (70% with premutations; 30% with full mutations). In terms of the impact of the clinic visit, males had a substantial number of new diagnoses in all behavioral disorders (P < 0.001), with anxiety (62%) being the most common. For female probands, the most frequent diagnosis was also anxiety (87%). Prior to the clinic visit, very few patients were prescribed psychotropic medications. After the clinic visit, the most frequently prescribed psychotropic medications for males were stimulants (41%; P < 0.001) and SSRIs (40%; P < 0.001). For females, only stimulants (33%; P = 0.03) and SSRIs (44%; P = 0.008) were statistically significantly prescribed. Our results revealed that there is a gap in care to address the co-morbid behavioral issues, psychopharmacologic medication management, and genetic counseling needs regarding FXS. A multidisciplinary setting and approach, such as that offered by a Fragile X Clinic, is one method of treating the complex needs of patients with FXS. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Utilisation of psychotropic drugs in patients of the long stay ward.

PubMed

El Hefny, F; Al Haddad, M K; Mathur, V

1992-03-01

A survey of the prescribing of psychotropic drugs was carried out at the Psychiatric Hospital of Bahrain. This retrospective study on 60 inpatients of the Long Stay Ward revealed a man:woman ratio of 2.7. 91% of the men and 88% of the women were over 40 years old. 44 of the 60 patients had a diagnosis of schizophrenia, the rest had dementia, depression, schizoaffective disorders, drug-induced psychosis, general paralysis or Huntington's chorea. 95% of patients received antipsychotic drugs. Thioridazine was the most common drug followed by chlorpromazine. The mean number of drugs/patient was 1.7, with 41.7% of patients receiving only 1 drug. Tardive dyskinesia was observed in 11 patients and 9 experienced varying degrees of tremor. The findings confirm that psychiatric illness treated by psychiatrists need not lead to polypharmacy. As a consequence, its treatment may be less likely to result in adverse reactions than when patients are treated by general practitioners.

Brain talk: power and negotiation in children's discourse about self, brain and behaviour.

PubMed

Singh, Ilina

2013-07-01

This article examines children's discourse about self, brain and behaviour, focusing on the dynamics of power, knowledge and responsibility articulated by children. The empirical data discussed in this article are drawn from the study of Voices on Identity, Childhood, Ethics and Stimulants, which included interviews with 151 US and UK children, a subset of whom had a diagnosis of attention deficit/hyperactivity disorder. Despite their contact with psychiatric explanations and psychotropic drugs for their behaviour, children's discursive engagements with the brain show significant evidence of agency and negotiated responsibility. These engagements suggest the limitations of current concepts that describe a collapse of the self into the brain in an age of neurocentrism. Empirical investigation is needed in order to develop agent-centred conceptual and theoretical frameworks that describe and evaluate the harms and benefits of treating children with psychotropic drugs and other brain-based technologies. © 2012 The Author. Sociology of Health & Illness © 2012 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd.

A clinical genetic method to identify mechanisms by which pain causes depression and anxiety

PubMed Central

Max, Mitchell B; Wu, Tianxia; Atlas, Steven J; Edwards, Robert R; Haythornthwaite, Jennifer A; Bollettino, Antonella F; Hipp, Heather S; McKnight, Colin D; Osman, Inge A; Crawford, Erin N; Pao, Maryland; Nejim, Jemiel; Kingman, Albert; Aisen, Daniel C; Scully, Michele A; Keller, Robert B; Goldman, David; Belfer, Inna

2006-01-01

Background Pain patients are often depressed and anxious, and benefit less from psychotropic drugs than pain-free patients. We hypothesize that this partial resistance is due to the unique neurochemical contribution to mood by afferent pain projections through the spino-parabrachial-hypothalamic-amygdalar systems and their projections to other mood-mediating systems. New psychotropic drugs for pain patients might target molecules in such brain systems. We propose a method to prioritize molecular targets by studying polymorphic genes in cohorts of patients undergoing surgical procedures associated with a variable pain relief response. We seek molecules that show a significant statistical interaction between (1) the amount of surgical pain relief, and (2) the alleles of the gene, on depression and anxiety during the first postoperative year. Results We collected DNA from 280 patients with sciatica due to a lumbar disc herniation, 162 treated surgically and 118 non-surgically, who had been followed for 10 years in the Maine Lumbar Spine Study, a large, prospective, observational study. In patients whose pain was reduced >25% by surgery, symptoms of depression and anxiety, assessed with the SF-36 Mental Health Scale, improved briskly at the first postoperative measurement. In patients with little or no surgical pain reduction, mood scores stayed about the same on average. There was large inter-individual variability at each level of residual pain. Polymorphisms in three pre-specified pain-mood candidate genes, catechol-O-methyl transferase (COMT), serotonin transporter, and brain-derived neurotrophic factor (BDNF) were not associated with late postoperative mood or with a pain-gene interaction on mood. Although the sample size did not provide enough power to persuasively search through a larger number of genes, an exploratory survey of 25 other genes provides illustrations of pain-gene interactions on postoperative mood – the mu opioid receptor for short-term effects of acute sciatica on mood, and the galanin-2 receptor for effects of unrelieved post-discectomy pain on mood one year after surgery. Conclusion Genomic analysis of longitudinal studies of pain, depression, and anxiety in patients undergoing pain-relieving surgery may help to identify molecules through which pain alters mood. Detection of alleles with modest-sized effects will require larger cohorts. PMID:16623937

[Basic thoughts on psychopharmacological interventions through psychotherapy of severe forms of post-traumatic stress disorder: a case study].

PubMed

Joksimovic, Ljiljana; Wöller, Wolfgang; Kunzke, Dieter

2013-01-01

The present paper focuses on clinical issues concerning the psychopharmacological treatment of severe forms of post-traumatic stress disorder (PTSD).Using a case study, we discuss problems in this field against the background of psychodynamic and psychotraumatological theories. We also present strategies for the appropriate use of psychotropic drugs in the psychotherapy of PTSD.

Predictive factors for dementia and cognitive impairment among residents living in the veterans' retirement communities in Taiwan: Implications for cognitive health promotion activities.

PubMed

Chen, Liang-Yu; Wu, Yi-Hui; Huang, Chung-Yu; Liu, Li-Kuo; Hwang, An-Chun; Peng, Li-Ning; Lin, Ming-Hsieh; Chen, Liang-Kung

2017-04-01

To identify potentially modifiable risk factors for cognitive decline among veterans' home residents in Taiwan METHODS: The present retrospective cohort study was part of the Veteran Affairs-Comprehensive Geriatric Assessment study that retrieved data of the comprehensive geriatric assessment for 946 residents living at four veterans' homes in Taiwan. The study participants were interviewed every 3-6 months from January 2012 and December 2014. Demographic characteristics,multimorbidity by Charlson's Comorbidities Index, physical function by the Barthel Index, cognition by the Mini-Mental State Examination (MMSE), depression by the five-item Geriatric Depression Scale and nutritional status by the Mini-Nutrition Assessment-Short Form were collected for analysis. A generalized estimating equation model was used after it was adjusted for age, educational level, five-item Geriatric Depression Scale, and problem of communication difficulty to identify potential modifiable risk factors for cognitive decline. The mean age of the participants was 85.7 ± 5.2 years, with a mean follow-up period of 41 ± 21.6 weeks. The prevalence of cognitive impairment (defined by MMSE <24) was 65.6%, whereas 34% of the study participants were positive for depressive symptoms. Approximately one-fifth of the study participants were using psychotropic agents, which was higher among participants with cognitive impairment (23.6% vs 15.6%, P < 0.05) than those without. In the generalized estimating equation model, physical function, nutritional status, depressive symptoms, ex-drinker, multimorbidity and stool incontinence were positively correlated with MMSE score; whereas advanced age, low educational level (<6 years), presence of communication difficulty and use of psychotropic agents were inversely associated with the MMSE score. Physical function and nutritional status were positively associated with the MMSE score, and use of psychotropic agents was negatively correlated with cognitive function. Further intervention study is required to improve the cognitive health of older adults living in the veterans' retirement communities. Geriatr Gerontol Int 2017: 17 (Suppl. 1): 7-13. © 2017 Japan Geriatrics Society.

Association of Mental Disorders and Related Medication Use With Risk for Major Osteoporotic Fractures.

PubMed

Bolton, James M; Morin, Suzanne N; Majumdar, Sumit R; Sareen, Jitender; Lix, Lisa M; Johansson, Helena; Odén, Anders; McCloskey, Eugene V; Kanis, John A; Leslie, William D

2017-06-01

Osteoporotic fractures are a leading cause of disability, costs, and mortality. FRAX is a tool used to assess fracture risk in the general population. Mental disorders and medications to treat them have been reported to adversely affect bone health, but, to date, they have not been systematically studied in relation to osteoporotic fractures. To examine the association of mental disorders and psychotropic medication use with osteoporotic fracture risk in routine clinical practice. In this population-based cohort study, bone mineral density and risk factors were used to calculate FRAX scores using data from the Manitoba Bone Density Program database of all women and men 40 years of age or older in Manitoba, Canada, referred for a baseline dual-energy x-ray absorptiometry scan from January 1, 1996, to March 28, 2013. Population-based health services data were used to identify primary mental disorders during the 3 prior years, psychotropic medication use during the prior year, and incident fractures. Cox proportional hazards regression models estimated the risk for incident fractures based on mental disorders and use of psychotropic medications. Data analysis was conducted from November 25, 2013, to October 15, 2016. Incident nontraumatic major osteoporotic fractures (MOFs) and hip fractures. Of the 68 730 individuals (62 275 women and 6455 men; mean age, 64.2 [11.2] years) in the study, during 485 322 person-years (median, 6.7 years) of observation, 5750 (8.4%) sustained an incident MOF, 1579 (2.3%) sustained an incident hip fracture, and 8998 (13.1%) died. In analyses adjusted for FRAX score, depression was associated with MOF (adjusted hazard ratio [aHR], 1.39; 95% CI, 1.27-1.51; P < .05) and hip fracture (aHR, 1.43; 95% CI, 1.22-1.69; P < .05) before adjustment for medication use, but these associations were not significant after adjustment for medication use. In contrast, the use of selective serotonin reuptake inhibitors (aHR for MOF, 1.43; 95% CI, 1.27-1.60; P < .05; aHR for hip fracture, 1.48; 95% CI, 1.18-1.85; P < .05), antipsychotics (aHR for MOF, 1.43; 95% CI, 1.15-1.77; P < .05; aHR for hip fracture, 2.14; 95% CI, 1.52-3.02; P < .05), and benzodiazepines (aHR for MOF, 1.15; 95% CI, 1.04-1.26; P < .05; aHR for hip fracture, 1.24; 95% CI, 1.05-1.47; P < .05) were each independently associated with significantly increased risk for both MOF and hip fracture. FRAX significantly underestimated the 10-year risk of MOF by 29% and of hip fracture by 51% for those with depression. It also underestimated the 10-year risk of MOF by 36% for use of selective serotonin reuptake inhibitors, by 63% for use of mood stabilizers, by 60% for use of antipsychotics, and by 13% for use of benzodiazepines. FRAX underestimated the 10-year risk of hip fracture by 57% for use of selective serotonin reuptake inhibitors, by 98% for use of mood stabilizers, by 171% for use of antipsychotics, and by 31% for use of benzodiazepines. FRAX correctly estimated fracture risk in people without mental disorders and those not taking psychotropic medications. Mental disorders and medication use were associated with an increased risk for fracture, but in simultaneous analyses, only medication use was independently associated with fracture. Depression and psychotropic medication use are potential risk indicators that are independent of FRAX estimates.

[The role of bemitil pharmacokinetics in realizing its therapeutic efficacy].

PubMed

Boĭko, S S; Zherdev, V P; Neznamov, G G

1991-01-01

The pharmacokinetics of a new psychotropic drug bemithil was studied after single and long-term administrations under monotherapy and in combination with phenazepam in patients with asthenoneurotic disturbances. A high degree of correlation for some pharmacokinetic parameters of bemithil following the administration of the drug test dose and its global therapeutic effect was established.

Evaluation of self-esteem among homosexuals in the southern region of the state of Santa Catarina, Brazil.

PubMed

Canali, Tiago José; Oliveira, Sylvia Marina Soares de; Reduit, Deivid Montero; Vinholes, Daniele Botelho; Feldens, Viviane Pessi

2014-11-01

This study seeks to evaluate self-esteem in homosexuals from southern Santa Catarina and relate it to several variables such as gender, age, bullying and psychiatric treatment. Participants were selected using the "Snowball" technique. The Rosenberg self-esteem scale was used for self-esteem assessment with subsequent comparison with other variables. A total of 403 individuals were interviewed, including 310 males with a mean age of 24.02. Most of the population studied (80.9%) had high self-esteem, with a mean score of 5.55 on the Rosenberg scale. Individuals who had only studied up to primary school level, were unemployed, evangelicals, with a history of psychotherapeutic and psychiatric treatment, or who had been subjected to bullying in the last year and those who wished to change their sexual orientation, had significantly lower self-esteem than the others. 114 people had used psychotropic drugs, 47.58% of which were benzodiazepine-based, primarily Clonazepam (27.58%). Most of this population had high self-esteem. There was a difference between some categories of the variables studied, however, all averages corresponded to high self-esteem on the Rosenberg scale. Benzodiazepines were the psychotropic drugs most often used by the individuals in this study.

Four-year follow-up study of pharmacological treatment in pathological gamblers.

PubMed

Rosenberg, Oded; Dinur, Limor Klein; Dannon, Pinhas N

2013-01-01

In the past decade, we have witnessed the emergence of pharmacological treatments for pathological gambling with some success but many question marks. We aimed to explore pharmacological treatments that have been previously explored with some success, with the intent of comparing their efficacy and pave the way to larger placebo-controlled trials. In this study, we allocated 78 patients to 4 different types of psychotropic medications: naltrexone, topiramate, bupropion, and escitalopram. We treated patients for more than 2 years, with additional 2-year follow-ups without medication. The sample was evaluated using the 21-item Hamilton Depression Rating Scale, the Hamilton Anxiety Rating Scale, the Global Assessment of Functioning, and the Visual Analog Scale to measure general well-being before enrollment as well as at 1 month, 6 months, 24 months, and 48 months after beginning medication treatment. During the first 2 years of treatment, 34 patients dropped out, with one more dropping out during the additional 2 years of follow-up. Significant improvement on all rating scales was seen in all groups after 2 years, except HAMD in the group that received topiramate. We found the naltrexone-treated group of patients to have a statistically significant lower dropout rate compared with other groups, statistically significant lower HAMD scores in comparison to the group treated with bupropion, statistically significant lower Hamilton Anxiety Rating Scale score compared to the groups treated with escitalopram and topiramate, and significantly higher Visual Analog Scale scores compared to the groups treated with bupropion and topiramate. Pathological gambling is essentially a biopsychological disorder that may be attenuated provided that patients adhere to medication. In our study, among 4 medications with different mechanisms of action, naltrexone was found to be the most effective. Placebo-controlled studies involving large numbers of subjects are required before naltrexone's efficacy can be established.

Utilization of psychiatric services integrated with primary care by persons of color with HIV in the inner city.

PubMed

Budin, John; Boslaugh, Sarah; Beckett, Emily; Winiarski, Mark G

2004-08-01

We identify the psychiatric diagnoses and utilization patterns of HIV-positive persons of color who received culturally responsive mental health services integrated into a community medical clinic. Ninety-three patients were referred and 86% (n = 80) appeared for at least one encounter. Hispanics, compared with African-Americans, and HIV patients, compared with AIDS patients, were more likely to receive psychotropic prescriptions. Patients with six or more visits were defined as high utilizers: they comprised 27.5% of the patients but used 67.3% of the services. Development of a broader range of psychiatric interventions that address diagnoses, utilization, and psychotropics will better meet these patients' needs.

Medicines and Drugs from Plants

NASA Astrophysics Data System (ADS)

Agosta, William C.

1997-07-01

Natural preparations have been used for thousands of ages for a variety of purposes including as medicines, poisons, and psychotropic drugs. The largest grouped of preparations from living organisms are medicines, and historically these have come from plants. Quinine and aspirin are two examples of medicines which were extracted originally from plants. Mind-altering, or psychotropic, drugs come mostly from plants or fungi. In many traditional cultures, sickness and death are attributed to maligned spirits so that medicine and religion become inseparable. Uses of cohohba, snakeplant, coca, and peyote are discussed. The process by which new pharmaceuticals are discovered from natural products is described. The implications of an agreement between a major pharmaceutical company and a country in the tropics are discussed.

Inhibitory effects of psychotropic drugs on the acetylcholine receptor-operated potassium current (IK.ACh) in guinea-pig atrial myocytes.

PubMed

Okada, Muneyoshi; Watanabe, Shinya; Matada, Takashi; Asao, Yoko; Hamatani, Ramu; Yamawaki, Hideyuki; Hara, Yukio

2013-01-01

Influences of psychotropic drugs, six antipsychotics and three antidepressants, on acetylcholine receptor-operated potassium current (IK.ACh) were examined by a whole-cell patch clamp method in freshly isolated guinea-pig atrial myocyte. IK.ACh was induced by a superfusion of carbachol (CCh) or by an intracellular application of guanosine 5'-[thio] triphosphate (GTPγS). To elucidate mechanism for anticholinergic action, IC50 ratio, the ratio of IC50 for GTPγS-activated IK.ACh to CCh-induced IK.ACh, was calculated. Antipsychotics and antidepressants inhibited CCh-induced IK.ACh in a concentration-dependent manner. The IC50 values were as follows; chlorpromazine 0.53 μM, clozapine 0.06 μM, fluphenazine 2.69 μM, haloperidol 2.66 μM, sulpiride 42.3 μM, thioridazine 0.07 μM, amitriptyline 0.03 μM, imipramine 0.22 μM and maprotiline 1.81 μM. The drugs, except for sulpiride, inhibited GTPγS-activated IK.ACh with following IC50 values; chlorpromazine 1.71 μM, clozapine 14.9 μM, fluphenazine 3.55 μM, haloperidol 2.73 μM, thioridazine 1.90 μM, amitriptyline 7.55 μM, imipramine 7.09 μM and maprotiline 5.93 μM. The IC50 ratio for fluphenazine and haloperidol was close to unity. The IC50 ratio for chlorpromazine, clozapine, thioridazine, amitriptyline, imipramine and maprotiline was much higher than unity. The present findings suggest that the psychotropics studied suppress IK.ACh. Chlorpromazine, clozapine, thioridazine, amitriptyline, imipramine, maprotiline and sulpiride are preferentially acting on muscarinic receptor. Fluphenazine and haloperidol may act on G protein and/or potassium channel.

Differential effectiveness of selected non-psychotropic phytocannabinoids on human sebocyte functions implicates their introduction in dry/seborrhoeic skin and acne treatment.

PubMed

Oláh, Attila; Markovics, Arnold; Szabó-Papp, Judit; Szabó, Pálma Tímea; Stott, Colin; Zouboulis, Christos C; Bíró, Tamás

2016-09-01

Acne is a common skin disease characterized by elevated sebum production and inflammation of the sebaceous glands. We have previously shown that a non-psychotropic phytocannabinoid ((-)-cannabidiol [CBD]) exerted complex anti-acne effects by normalizing 'pro-acne agents'-induced excessive sebaceous lipid production, reducing proliferation and alleviating inflammation in human SZ95 sebocytes. Therefore, in this study we aimed to explore the putative anti-acne effects of further non-psychotropic phytocannabinoids ((-)-cannabichromene [CBC], (-)-cannabidivarin [CBDV], (-)-cannabigerol [CBG], (-)-cannabigerovarin [CBGV] and (-)-Δ(9) -tetrahydrocannabivarin [THCV]). Viability and proliferation of human SZ95 sebocytes were investigated by MTT and CyQUANT assays; cell death and lipid synthesis were monitored by DilC1 (5)-SYTOX Green labelling and Nile Red staining, respectively. Inflammatory responses were investigated by monitoring expressions of selected cytokines upon lipopolysaccharide treatment (RT-qPCR, ELISA). Up to 10 μm, the phytocannabinoids only negligibly altered the viability of the sebocytes, whereas high doses (≥50 μm) induced apoptosis. Interestingly, basal sebaceous lipid synthesis was differentially modulated by the substances: CBC and THCV suppressed it, and CBDV had only minor effects, whereas CBG and CBGV increased it. Importantly, CBC, CBDV and THCV significantly reduced arachidonic acid (AA)-induced 'acne-like' lipogenesis. Moreover, THCV suppressed proliferation, and all phytocannabinoids exerted remarkable anti-inflammatory actions. Our data suggest that CBG and CBGV may have potential in the treatment of dry-skin syndrome, whereas CBC, CBDV and especially THCV show promise to become highly efficient, novel anti-acne agents. Moreover, based on their remarkable anti-inflammatory actions, phytocannabinoids could be efficient, yet safe novel tools in the management of cutaneous inflammations. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

State Variation in Increased ADHD Prevalence: Links to NCLB School Accountability and State Medication Laws.

PubMed

Fulton, Brent D; Scheffler, Richard M; Hinshaw, Stephen P

2015-10-01

The study's objective was to investigate whether attention-deficit hyperactivity disorder (ADHD) diagnoses from 2003 to 2011 were associated with either public school consequential accountability reforms initiated by the No Child Left Behind (NCLB) Act, particularly for low-income children, or with state psychotropic medication laws that prohibit public schools from recommending or requiring medication use. Logistic regression difference-in-differences models were estimated with repeated U.S. and state-representative cross-sections of responses to the 2003, 2007, and 2011 National Survey of Children's Health. Each wave included approximately 35,000 public school children between ages six and 13. From 2003 to 2007, the change in adjusted diagnostic prevalence was 2.8 percentage points higher for children ages six to 13 in households with incomes ≤185% of the federal poverty level residing in states first exposed to consequential accountability through NCLB (from 8.5% to 13.2%), compared with demographically similar children residing in other states (from 10.2% to 12.1%). From 2003 to 2011, the change in adjusted diagnostic prevalence was 2.2 percentage points lower for children ages six to 13 residing in states with a psychotropic medication law (from 8.1% to 7.8%), compared with children residing in other states (from 8.1% to 10.1%). NCLB-initiated consequential accountability reforms were associated with more ADHD diagnoses among low-income children, consistent with increased academic pressures from NCLB for this subgroup. In contrast, psychotropic medication laws were associated with fewer ADHD diagnoses, because they may indirectly reduce diagnoses via restrictions on recommending or requiring medication use. Future research should investigate whether children most affected by these policies are receiving appropriate diagnoses.

Association of anxiety disorders and depression with incident heart failure.

PubMed

Garfield, Lauren D; Scherrer, Jeffrey F; Hauptman, Paul J; Freedland, Kenneth E; Chrusciel, Tim; Balasubramanian, Sumitra; Carney, Robert M; Newcomer, John W; Owen, Richard; Bucholz, Kathleen K; Lustman, Patrick J

2014-02-01

Depression has been associated with increased risk of heart failure (HF). Because anxiety is highly comorbid with depression, we sought to establish if anxiety, depression, or their co-occurrence is associated with incident HF. A retrospective cohort (N = 236,079) including Veteran's Administration patients (age, 50-80 years) free of cardiovascular disease (CVD) at baseline was followed up between 2001 and 2007. Cox proportional hazards models were computed to estimate the association between anxiety disorders alone, major depressive disorder (MDD) alone, and the combination of anxiety and MDD, with incident HF before and after adjusting for sociodemographics, CVD risk factors (Type 2 diabetes, hypertension, hyperlipidemia, obesity), nicotine dependence/personal history of tobacco use, substance use disorders (alcohol and illicit drug abuse/dependence), and psychotropic medication. Compared with unaffected patients, those with anxiety only, MDD only, and both disorders were at increased risk for incident HF in age-adjusted models (hazard ratio [HR] = 1.19 [ 95% confidence interval {CI} = 1.10-1.28], HR = 1.21 [95% CI = 1.13-1.28], and HR = 1.24 [95% CI = 1.17-1.32], respectively). After controlling for psychotropics in a full model, the association between anxiety only, MDD only, and both disorders and incident HF increased (HRs = 1.46, 1.56, and 1.74, respectively). Anxiety disorders, MDD, and co-occurring anxiety and MDD are associated with incident HF in this large cohort of Veteran's Administration patients free of CVD at baseline. This risk of HF is greater after accounting for protective effects of psychotropic medications. Prospective studies are needed to clarify the role of depression and anxiety and their pharmacological treatment in the etiology of HF.

Efficacy of a new oral lubricant solution in the management of psychotropic drug-induced xerostomia: a randomized controlled trial.

PubMed

Mouly, Stéphane J; Orler, Jean-Baptiste; Tillet, Yves; Coudert, Anne-Claude; Oberli, Frantz; Preshaw, Phillip; Bergmann, Jean-François

2007-10-01

Xerostomia is a subjective sensation of mouth dryness often occurring as an unwanted effect of psychotropic drugs. The clinical efficacy and acceptability of a new oxygenated glycerol triester (OGT) oral spray (1 or 2 sprays up to 4 times daily) in the treatment of xerostomia was compared with those of a commercially available artificial saliva substitute (ASS [Saliveze]) in a 2-week, open-labeled, randomized, parallel-group study. Clinical assessment of xerostomia included evaluation of mouth dryness by means of a 10-cm-long visual analog scale, objective blinded assessment of the oral tissue condition by a dental hygienist by means of a 4-point ordinal scale, and subjective patient-based assessment of dry mouth symptoms by means of dichotomous responses to a questionnaire. [Day 14 - baseline] patient-based mouth dryness score was the primary end point. Seventy-four patients (41 women and 33 men, 44 +/- 15 years) undergoing long-term psychotropic drug treatment were consecutively enrolled. At day 14, OGT resulted in better efficacy than ASS in mouth dryness score (mean difference, 1.2 +/- 0.4; P = 0.006), speech difficulties (mean difference, 1.2 +/- 0.4; P = 0.005), taste (mean difference, 1.1 +/- 0.4; P = 0.02), and overall mouth condition (mean difference, 1.4 +/- 0.9; P = 0.005). Taste of OGT was better than that of ASS (mean difference, 1.4 +/- 0.6; P = 0.04), as was OGT acceptability (mean difference, 1.4 +/- 0.9; P = 0.005). Oxygenated glycerol triester lubricant oral spray was superior to a commercially available ASS in improving xerostomia and overall condition of the oral tissue.

Psychiatric services in primary care settings: a survey of general practitioners in Thailand

PubMed Central

Lotrakul, Manote; Saipanish, Ratana

2006-01-01

Background General Practitioners (GPs) in Thailand play an important role in treating psychiatric disorders since there is a shortage of psychiatrists in the country. Our aim was to examine GP's perception of psychiatric problems, drug treatment and service problems encountered in primary care settings. Methods We distributed 1,193 postal questionnaires inquiring about psychiatric practices and service problems to doctors in primary care settings throughout Thailand. Results Four hundred and thirty-four questionnaires (36.4%) were returned. Sixty-seven of the respondents (15.4%) who had taken further special training in various fields were excluded from the analysis, giving a total of 367 GPs in this study. Fifty-six per cent of respondents were males and they had worked for 4.6 years on average (median = 3 years). 65.6% (SD = 19.3) of the total patients examined had physical problems, 10.7% (SD = 7.9) had psychiatric problems and 23.9% (SD = 16.0) had both problems. The most common psychiatric diagnoses were anxiety disorders (37.5%), alcohol and drugs abuse (28.1%), and depressive disorders (29.2%). Commonly prescribed psychotropic drugs were anxiolytics and antidepressants. The psychotropic drugs most frequently prescribed were diazepam among anti-anxiety drugs, amitriptyline among antidepressant drugs, and haloperidol among antipsychotic drugs. Conclusion Most drugs available through primary care were the same as what existed 3 decades ago. There should be adequate supply of new and appropriate psychotropic drugs in primary care. Case-finding instruments for common mental disorders might be helpful for GPs whose quality of practice was limited by large numbers of patients. However, the service delivery system should be modified in order to maintain successful care for a large number of psychiatric patients. PMID:16867187

Mental illness and suicide after self-harm among young adults: long-term follow-up of self-harm patients, admitted to hospital care, in a national cohort.

PubMed

Beckman, K; Mittendorfer-Rutz, E; Lichtenstein, P; Larsson, H; Almqvist, C; Runeson, B; Dahlin, M

2016-12-01

Self-harm among young adults is a common and increasing phenomenon in many parts of the world. The long-term prognosis after self-harm at young age is inadequately known. We aimed to estimate the risk of mental illness and suicide in adult life after self-harm in young adulthood and to identify prognostic factors for adverse outcome. We conducted a national population-based matched case-cohort study. Patients aged 18-24 years (n = 13 731) hospitalized after self-harm between 1990 and 2003 and unexposed individuals of the same age (n = 137 310 ) were followed until December 2009. Outcomes were suicide, psychiatric hospitalization and psychotropic medication in short-term (1-5 years) and long-term (>5 years) follow-up. Self-harm implied an increased relative risk of suicide during follow-up [hazard ratio (HR) 16.4, 95% confidence interval (CI) 12.9-20.9). At long-term follow-up, 20.3% had psychiatric hospitalizations and 51.1% psychotropic medications, most commonly antidepressants and anxiolytics. There was a six-fold risk of psychiatric hospitalization (HR 6.3, 95% CI 5.8-6.8) and almost three-fold risk of psychotropic medication (HR 2.8, 95% CI 2.7-3.0) in long-term follow-up. Mental disorder at baseline, especially a psychotic disorder, and a family history of suicide were associated with adverse outcome among self-harm patients. We found highly increased risks of future mental illness and suicide among young adults after self-harm. A history of a mental disorder was an important indicator of long-term adverse outcome. Clinicians should consider the substantially increased risk of suicide among self-harm patients with psychotic disorders.

Observational evidence that urbanisation and neighbourhood deprivation are associated with escalation in chronic pharmacological pain treatment: a longitudinal population-based study in the Netherlands.

PubMed

Leue, Carsten; Buijs, Servaas; Strik, Jacqueline; Lousberg, Richel; Smit, Jasper; van Kleef, Maarten; van Os, Jim

2012-01-01

To examine, in the light of the association between urban environment and poor mental health, whether urbanisation and neighbourhood deprivation are associated with analgesic escalation in chronic pharmacological pain treatment and whether escalation is associated with prescriptions of psychotropic medication. Longitudinal analysis of a population-based routine dispensing database in the Netherlands. Representative sample of pharmacies, covering 73% of the Dutch nationwide medication consumption in the primary care and hospital outpatient settings. 449 410 patients aged 15-85 years were included, of whom 166 374 were in the Starter group and 283 036 in the Continuation group of chronic analgesic treatment. Escalation of analgesics (ie, change to a higher level of analgesic potency, classified across five levels) in association with urbanisation (five levels) and dichotomous neighbourhood deprivation was analysed over a 6-month observation period. Ordered logistic multivariate model evaluating analgesic treatment. In both Starter and Continuation groups, escalation was positively associated with urbanisation in a dose-response fashion (Starter group: OR (urbanisation level 1 compared with level 5): 1.24, 95% CI 1.18 to 1.30; Continuation group: OR 1.18, 95% CI 1.14 to 1.23). An additional association was apparent with neighbourhood deprivation (Starter group: OR 1.07, 95% CI 1.02 to 1.11; Continuation group: OR 1.04, 95% CI 1.01 to 1.08). Use of somatic and particularly psychotropic co-medication was associated with escalation in both groups. Escalation of chronic analgesic treatment is associated with urban and deprived environments and occurs in a context of adding psychotropic medication prescriptions. These findings suggest that pain outcomes and mental health outcomes share factors that increase risk and remedy suffering.

Treatment recommendations for schizophrenia, major depression and alcohol dependence and stigmatizing attitudes of the public: results from a German population survey.

PubMed

Speerforck, Sven; Schomerus, Georg; Matschinger, Herbert; Angermeyer, Matthias C

2017-06-01

In addition to mental health literacy, several potentially conflicting emotions and attitudes among the public are hypothesized to guide their recommendations for specific mental health treatments. It is unclear whether evidence-based treatment strategies are guided by pro-social or stigmatizing attitudes and emotions. In a representative population survey in Germany (n = 3642), we asked respondents to what extent they would recommend psychotropic medication, psychotherapy and relaxation techniques for a person with mental illness described in an unlabelled vignette. For each treatment recommendation, we used multinomial logistic regression analyses to obtain predicted probabilities. Predictors comprised illness recognition, vignette condition, causal beliefs (current stress, childhood adversities, biogenetic), emotions (fear, anger, pro-social reactions), social distance, age, gender and education. Fear predicted greater probability for recommending psychotropic drugs in all investigated illnesses (p < 0.001), whereas associations of fear with recommending psychotherapy were generally lower and no associations with the recommendation for relaxation techniques were found. Anger was related to fewer recommendations for psychotherapy in all illnesses (p < 0.01). Pro-social reactions were predominantly related to the recommendation of relaxation techniques for a person with schizophrenia or major depression (p < 0.001). Higher desire for social distance predicted fewer recommendations for relaxation techniques in all three vignette conditions (p < 0.05). Our study corroborates findings that treatment recommendations are not necessarily linked to pro-social reactions or mental health literacy. The recommendation for a treatment modality like psychotropic medication or psychotherapy can be linked to underlying fear, possibly reflecting a public desire for protection against people with mental illness.

Anxiety, depression, and cognitive impairment in dementia-specific and traditional assisted living.

PubMed

Kang, Hyunwook; Smith, Marianne; Buckwalter, Kathleen C; Ellingrod, Vicki; Schultz, Susan K

2010-01-01

With the rapid growth of the assisted living (AL) industry, the number of AL residences providing dementia care continues to increase. The purpose of this article is to describe and compare demographic characteristics; frequency and type of psychiatric diagnoses; level of cognition, depression, and anxiety symptoms; and use of psychotropic medication among older adults in dementia-specific assisted living (DSAL) and traditional assisted living (TAL) residences. Secondary analysis of screening data collected during a cross-sectional, descriptive pilot project compared 18 participants from two DSAL facilities and 28 participants from three TAL facilities. DSAL participants with dementia were more cognitively impaired than TAL participants with dementia (p < 0.001) and used more antipsychotic (67%), anxiolytic (60%), antidepressant (53%), and cognitive-enhancing (87%) medications. No statistically significant differences in demographic factors or levels of anxiety or depression were observed among residents in either setting. Copyright 2010, SLACK Incorporated.

Obesity, cardiovascular disease and type 2 diabetes in people with a mental illness: a need for primary health care.

PubMed

Stanley, Susanne H; Laugharne, Jonathan D E

2012-01-01

People with a mental illness show a growing incidence of obesity, and higher rates of metabolic syndrome when compared with the general population. This paper reviews research on obesity, cardiovascular disease and type 2 diabetes, with the aim of directing clinical attention towards the improvement of patient physical health. A systematic search of cross-discipline databases and journals provided peer-reviewed research for analysis, and national statistics allowed for the investigation of differences in rates of occurrence between people experiencing a mental illness and the general population. Treatment effects via psychotropic medications and lifestyle factors such as poor diet and low levels of exercise suggest that ongoing monitoring is necessary to prevent major physical disorders in people experiencing a mental illness. To aid clinicians, a comprehensive set of clinical guidelines have been developed for the physical assessment and ongoing monitoring of mental health patients.

Anxiety, Depression, and Cognitive Impairment in Dementia-Specific and Traditional Assisted Living

PubMed Central

Kang, Hyunwook; Smith, Marianne; Buckwalter, Kathleen C.; Ellingrod, Vicki; Schultz, Susan K.

2010-01-01

With the rapid growth of the assisted living (AL) industry, the number of AL residences providing dementia care continues to increase. The purpose of this article is to describe and compare demographic characteristics; frequency and type of psychiatric diagnoses; level of cognition, depression, and anxiety symptoms; and use of psychotropic medication among older adults in dementia-specific assisted living (DSAL) and traditional assisted living (TAL) residences. Secondary analysis of screening data collected during a cross-sectional, descriptive pilot project compared 18 participants from two DSAL facilities and 28 participants from three TAL facilities. DSAL participants with dementia were more cognitively impaired than TAL participants with dementia (p < 0.001) and used more antipsychotic (67%), anxiolytic (60%), antidepressant (53%), and cognitive-enhancing (87%) medications. No statistically significant differences in demographic factors or levels of anxiety or depression were observed among residents in either setting. PMID:20047249

[Costs of Mental Health Care in Patients with Posttraumatic Stress Disorder Related to Sexual Abuse One Year Before and After Inpatient DBT-PTSD].

PubMed

Priebe, Kathlen; Roth, Mascha; Krüger, Antje; Glöckner-Fink, Kristina; Dyer, Anne; Steil, Regina; Salize, Hans-Joachim; Kleindienst, Nikolaus; Bohus, Martin

2017-03-01

Objective In Germany, patients with posttraumatic stress disorder (PTSD) related to childhood sexual abuse (CSA) often receive inpatient treatment. However, data on utilization and costs of mental health care as well as on the impact of trauma-focused treatment are missing. Methods Within the context of a randomized controlled trial mental health service utilization was assessed in female patients with PTSD related to CSA. Data on psychiatric-psychotherapeutic inpatient and outpatient treatment and psychotropic medication was obtained for the year before and after inpatient DBT-PTSD. Results The mean total costs of utilization of psychiatric-psychotherapeutic care and use of psychotropics were € 18.100 per patient in the year before and € 7.233 in the year after DBT-PTSD. The significant cost decrease was due to large reductions in inpatient treatment days (on average 57 days before and 14 days after DBT-PTSD), while outpatient treatment and psychotropic medication remained unchanged. Conclusion PTSD related to CSA is associated with high utilization and costs of mental health care. The results suggest that DBT-PTSD might contribute to reducing the mental health care costs. © Georg Thieme Verlag KG Stuttgart · New York.

Safety reports on the off-label use of baclofen for alcohol-dependence: recommendations to improve causality assessment.

PubMed

Rolland, Benjamin; Auffret, Marine; Franchitto, Nicolas

2016-06-01

The off-label use of high-dose baclofen (HDB) for alcohol-dependence has recently spread. However, HDB has been associated with numerous reports of adverse events (AEs). Pharmacovigilance reporting is supposed to differentiate AEs from adverse drug reactions (ADRs), for which the causality of the drug is determined using validated methods. Since 2010, we found 20 publications on baclofen-related AEs in alcohol dependence, in Medline-referenced journals or national pharmacovigilance reports. We focused on whether these reports used causality algorithms, and provided essential elements for determining baclofen causality and excluding the involvement of alcohol and other psychoactive substances or psychotropic drugs. In half of the cases, no causality algorithm was used. Detailed information on baclofen dosing was found in 17 out of 20 (85%) articles, whereas alcohol doses were given only in 10 (50%) publications. Other psychoactive substances and psychotropic drugs were broached in 14 (70%) publications. future publications reporting suspected HDB-induced ADRs should use validated causality algorithms and provide sufficient amount of contextual information for excluding other potential causes. For HDB, the psychiatric history, and the longitudinal description of alcohol consumptions and associated doses of psychoactive substances or psychotropic medications should be detailed for every reported case.

Pharmacological treatment of disruptive behavior in Smith-Magenis syndrome.

PubMed

Laje, Gonzalo; Bernert, Rebecca; Morse, Rebecca; Pao, Maryland; Smith, Ann C M

2010-11-15

Smith-Magenis syndrome (SMS) is a complex genetic syndrome caused by an interstitial deletion of chromosome 17p11.2. Children and adults with SMS appear to have unique neurobehavioral problems that include: sleep disturbance, self-injurious and maladaptive behaviors, stereotypies, and sensory integration disorders. We gathered retrospective psychotropic use information from parents or other caregivers of 62 individuals with SMS who were asked about use of psychotropic medication from a list of commonly used psychiatric medications. For those drugs identified, respondents were asked to rate the experience with the particular medication using a likert-type scale. Drugs were grouped into seven main categories: (1) stimulants; (2) antidepressants; (3) antipsychotics; (4) sleep aides; (5) mood stabilizers; (6) alpha 2 agonists; and (7) benzodiazepines. Relative frequencies, means and standard deviations pertaining to age and medication effect were derived for each medication category. Six of the seven medication categories examined showed no meaningful deviations from the "no change" score. The benzodiazepine group showed a mild detrimental effect. There were no gender differences in efficacy. Use of psychotropic medication started early in life (mean age 5 years), particularly with sleep aides. Although no medication category was identified as efficacious in SMS, all the categories reported herein may be considered as an option for brief symptomatic relief.

Non-psychotropic analgesic drugs from the endocannabinoid system: "magic bullet" or "multiple-target" strategies?

PubMed

Starowicz, Katarzyna; Di Marzo, Vincenzo

2013-09-15

The exploitation of preparations of Cannabis sativa to combat pain seems to date back to time immemorial, although their psychotropic effects, which are at the bases of their recreational use and limit their therapeutic use, are at least as ancient. Indeed, it has always been different to tease apart the unwanted central effects from the therapeutic benefits of Δ⁹-tetrahydrocannabinol (THC), the main psychotropic component of cannabis. The discovery of the cannabinoid receptors and of their endogenous ligands, the endocannabinoids, which, unlike THC, play a pro-homeostatic function in a tissue- and time-selective manner, offered the opportunity to develop new analgesics from synthetic inhibitors of endocannabinoid inactivation. The advantages of this approach over direct activation of cannabinoid receptors as a therapeutic strategy against neuropathic and inflammatory pain are discussed here along with its potential complications. These latter have been such that clinical success has been achieved so far more rapidly with naturally occurring THC or endocannabinoid structural analogues acting at a plethora of cannabinoid-related and -unrelated molecular targets, than with selective inhibitors of endocannabinoid enzymatic hydrolysis, thus leading to revisit the potential usefulness of "multi-target" versus "magic bullet" compounds as new analgesics. © 2013 Elsevier B.V. All rights reserved.

Psychotropic drugs and risk of motor vehicle accidents: a population-based case-control study

PubMed Central

Chang, Chia-Ming; Wu, Erin Chia-Hsuan; Chen, Chuan-Yu; Wu, Kuan-Yi; Liang, Hsin-Yi; Chau, Yeuk-Lun; Wu, Chi-Shin; Lin, Keh-Ming; Tsai, Hui-Ju

2013-01-01

Aim To examine comprehensively the relationship between exposure to four classes of psychotropic drugs including antipsychotics, antidepressants, benzodiazepines (BZDs) and Z-drugs, and motor vehicle accidents (MVAs). Method The authors conducted a matched case-control study of 5183 subjects with MVAs and 31 093 matched controls, identified from the claims records of outpatient service visits during the period from 2000 to 2009. Inclusion criteria were defined as subjects aged equal to or more than 18 years and involved in MVAs. Conditional logistic regressions with covariates adjustment (including urbanity, psychiatric and non-psychiatric outpatient visits and Charlson comorbidity score) were applied to examine the effect of four classes of psychotropic drugs on MVAs. Results Significant increased risk of MVAs was found in subjects taking antidepressants within 1 month (adjusted odds ratio (AOR) 1.73, 95% confidence interval (CI) 1.34, 2.22), 1 week (AOR 1.71, 95% CI 1.29, 2.26), and 1 day (AOR 1.70, 95% CI 1.26, 2.29) before MVAs occurred. Similar results were observed in subjects taking benzodiazepines (BZDs) (AOR 1.56, 95% CI 1.38, 1.75 for 1 month; AOR 1.64, 95% CI 1.43, 1.88 for 1 week, and AOR 1.62, 95% CI 1.39, 1.88 for 1 day) and Z-drugs (AOR 1.42, 95% CI 1.14, 1.76 for 1 month, AOR 1.37, 95% CI 1.06, 1.75 for 1 week, AOR 1.34, 95% CI 1.03, 1.75 for 1 day), but not antipsychotics. Moreover, significant dose effects of antidepressants (equal to or more than 0.6–1.0 DDD), BZDs (equal to or more than 0.1–0.5 DDD) and Z-drugs (more than 1 DDD) were observed, respectively, on the risk of experiencing an MVA. Conclusion Taken together, subjects taking antidepressants, BZDs and Z-drugs, separately, should be particularly cautioned for their increasing risk of MVAs. PMID:22971090

Does an 8-week home-based exercise program affect physical capacity, quality of life, sick leave, and use of psychotropic drugs in patients with pulmonary embolism? Study protocol for a multicenter randomized clinical trial.

PubMed

Rolving, Nanna; Brocki, Barbara C; Mikkelsen, Hanne R; Ravn, Pernille; Bloch-Nielsen, Jannie Rhod; Frost, Lars

2017-05-30

The existing evidence base in pulmonary embolism (PE) is primarily focused on diagnostic methods, medical treatment, and prognosis. Only a few studies have investigated how everyday life is affected by PE, although many patients are negatively affected both physically and emotionally after hospital discharge. Currently, no documented rehabilitation options are available for these patients. We aim to examine whether an 8-week home-based exercise intervention can influence physical capacity, quality of life, sick leave, and use of psychotropic drugs in patients medically treated for PE. One hundred forty patients with incident first-time PE will be recruited in five hospitals. After inclusion, patients will be randomly allocated to either the control group, receiving usual care, or the intervention group, who will be exposed to an 8-week home-based exercise program in addition to usual care. The intervention includes an initial individual exercise planning session with a physiotherapist, leading to a recommended exercise program of a minimum of three weekly training sessions of 30-60 minutes' duration. The patients have regular telephone contact with the physiotherapist during the 8-week program. At the time of inclusion, after 2 months, and after 6 months, the patients' physical capacity is measured using the Incremental Shuttle Walk test. Furthermore the patients' quality of life, sick leave, and use of psychotropic drugs is measured using self-reported questionnaires. In both randomization arms, all follow-up measurements and visits will take place at the hospital from which the patient was discharged. Levels of eligibility, consent, adherence, and retention will be used as indicators of study feasibility. We expect that the home-based exercise program will improve the physical capacity and quality of life for the patients in the intervention group. The study will furthermore contribute significantly to the limited knowledge about the optimal rehabilitation of PE patients, and may thereby form the basis of future recommendations in this field. ClinicalTrials.gov, NCT02684721 . Registered on 20 January 2016.

Diagnosis and Medication Overload? A Nurse Review of the Psychiatric Histories of Older Youth in Treatment Foster Care

ERIC Educational Resources Information Center

Narendorf, Sarah Carter; Bertram, Julie; McMillen, J. Curtis

2011-01-01

Prior research has raised concern about the appropriateness of psychotropic medication use and the validity of psychiatric diagnosing for youth in child welfare but has lacked in-depth case information. This study reports results from a psychiatric nurse review conducted with eight youth entering a foster care intervention using case records and…

Age, Race, and Gender Differences in Antipsychotic Medication Use among Children Prior to Entry to Out-of-Home Care

ERIC Educational Resources Information Center

Robst, John; Armstrong, Mary; Dollard, Norin

2009-01-01

There is growing literature examining the use of psychotropic medications and specifically antipsychotic medications among youth in the United States. This study uses administrative claims data to assess antipsychotic medication use among children prior to being served in therapeutic out-of-home care settings and whether there are utilization…

Clinical Use of Mood Stabilizers With Antidepressants in Asia: Report From the Research on Asian Psychotropic Prescription Patterns for Antidepressants (REAP-AD) Projects in 2004 and 2013.

PubMed

Rajaratnam, Kamini; Xiang, Yu-Tao; Tripathi, Adarsh; Chiu, Helen F K; Si, Tian-Mei; Chee, Kok-Yoon; Avasthi, Ajit; Grover, Sandeep; Chong, Mian-Yoon; Kuga, Hironori; Kanba, Shigenobu; He, Yan-Ling; Lee, Min-Soo; Yang, Shu-Yu; Udomratn, Pichet; Kallivayalil, Roy A; Tanra, Andi J; Maramis, Margarita M; Shen, Winston W; Sartorius, Norman; Kua, Ee-Heok; Tan, Chay-Hoon; Mahendran, Rathi; Shinfuku, Naotaka; Sum, Min Yi; Baldessarini, Ross J; Sim, Kang

2017-04-01

As most reports concerning treatment with combinations of mood stabilizer (MS) with antidepressant (AD) drugs are based in the West, we surveyed characteristics of such cotreatment in 42 sites caring for the mentally ill in 10 Asian countries. This cross-sectional, pharmacoepidemiologic study used 2004 and 2013 data from the REAP-AD (Research Study on Asian Psychotropic Prescription Patterns for Antidepressants) to evaluate the rates and doses of MSs given with ADs and associated factors in 4164 psychiatric patients, using standard bivariate methods followed by multivariable logistic regression modeling. Use of MS + AD increased by 104% (5.5% to 11.2%) between 2004 and 2013 and was much more associated with diagnosis of bipolar disorder than major depression or anxiety disorder, as well as with hospitalization > outpatient care, psychiatric > general-medical programs, and young age (all P < 0.001), but not with country, sex, or AD dose. The findings provide a broad picture of contemporary use of MSs with ADs in Asia, support predictions that such treatment increased in recent years, and was associated with diagnosis of bipolar disorder, treatment in inpatient and psychiatric settings, and younger age.

Antipsychotic medication and length of stay at a psychiatric maximum-security unit in Norway (1987-2000).

PubMed

Renkel, Sabine; Rasmussen, Kirsten

2006-01-01

The aim of this study was to evaluate psychopharmacological treatment and the length of stay (LOS) of patients with schizophrenia in a maximum-security psychiatric unit. Data were collected from the hospital files of 82 consecutively admitted patients with schizophrenia who were both admitted and discharged between the years 1987 and 2000. Psychotropic medication and LOS at the time of discharge were registered. Ninety-five per cent of the patients received antipsychotic medication. Zuclopenthixol was the most frequent medication, given to 43% of the patients. Antipsychotic polypharmacy was found in 20% of the cases. Twenty-seven per cent of the patients were medicated with doses above the recommended therapeutic dose range. During the study period, there was no change in the administration and number of psychotropics, but there was an increase in the dosage of antipsychotics. However, LOS was unchanged during the same time. This supports other findings, which suggest that there is no clinical benefit of higher antipsychotic dosage. It is suggested that an optimized medication practice could yield beneficiary effects, not only for schizophrenic symptoms, but also for violence in schizophrenic patients.

A guide to psychopharmacological treatment of patients with intellectual disability in psychiatry.

PubMed

Molina-Ruiz, Rosa M; Martín-Carballeda, Julia; Asensio-Moreno, Inmaculada; Montañés-Rada, Francisco

2017-03-01

Background Subjects with intellectual disability are at increased risk of having comorbid psychiatric disorders and worse response to psychotherapeutic and psychopharmacological treatment interventions. On the other hand, available data on best treatment approach in this population are scarce and lack scientific evidence due to methodological limitations. The present study aims to perform a systematic review of the literature to facilitate the use of psychotropic drugs in clinical practice and better establish future research targets in this field. Objectives To review the available psychopharmacological strategies for patients with intellectual disabilities, psychiatric disorders, and behavioural disturbances. Serve as a quick guide for clinicians working in the field of intellectual disability. Methods We conducted a selective evidence-based review of the literature using Pubmed and EMBASE databases and selected most recent and relevant papers for this review. Results There are several available psychotropic drugs for the treatment of patients with intellectual disability and comorbid psychiatric disorders, although scientific evidence is limited. Treatment should be individualized according to risk-benefit balance. Discussion Further studies are needed and new available drugs should be considered to gain knowledge in effectiveness of different therapeutic approaches available in this population.

Phylogenetic and chemical studies in the potential psychotropic species complex of Psilocybe atrobrunnea with taxonomic and nomenclatural notes.

PubMed

Borovička, J; Oborník, M; Stříbrný, J; Noordeloos, M E; Parra Sánchez, L A; Gryndler, M

2015-06-01

Five Psilocybe species with unresolved systematic position (P. atrobrunnea, P. laetissima, P. medullosa, P. pelliculosa, and P. silvatica) were investigated using four molecular markers (EF1-α, ITS, LSU, and IGS). Phylogenetic analysis revealed that with the exception of P. laetissima, which is now rightfully classified in the genus Leratiomyces, all investigated species belong to Psilocybe sect. Psilocybe. For the first time, psychotropic compounds psilocin and psilocybin were detected in P. medullosa using gas chromatography-mass spectrometry. On the contrary, neither psilocin, nor psilocybin was detected in P. atrobrunnea and negative results were also obtained from mycelia grown in vitro on tryptamine/tryptophan-amended media. These results strongly suggest that biosynthesis of these alkaloids was lost in P. atrobrunnea. With the exception of minor differences detected in EF1-α marker, all sequences of American and European collections of P. atrobrunnea were identical. On the other hand, a thorough nomenclatural study revealed that the name P. atrobrunnea must be considered dubious; the oldest available candidate name, P. fuscofulva, was therefore adopted. The molecular data suggests that morphologically identical American P. silvatica and European P. medullosa likely represent distinct species; epitypes of both taxa were therefore designated.

Gray Matter Differences between Pediatric Obsessive-Compulsive Disorder Patients and High-Risk Siblings: A Preliminary Voxel-Based Morphometry Study

PubMed Central

Gilbert, Andrew R.; Keshavan, Matcheri S.; Diwadkar, Vaibhav; Nutche, Jeffrey; MacMaster, Frank; Easter, Phillip C.; Buhagiar, Christian J.; Rosenberg, David R.

2008-01-01

Neuroimaging studies have identified alterations in frontostriatal circuitry in OCD. Voxel-based morphometry (VBM) allows for the assessment of differences in gray matter density across the whole brain. VBM has not previously been used to examine regional gray matter density in pediatric OCD patients and the siblings of pediatric OCD patients. Volumetric magnetic resonance imaging (MRI) studies were conducted in 10 psychotropic-naïve pediatric patients with OCD, 10 unaffected siblings of pediatric patients with OCD, and 10 healthy controls. VBM analysis was conducted using SPM2. Statistical comparisons were performed with the general linear model, implementing small volume random field corrections for a priori regions of interest (anterior cingulate cortex or ACC, striatum and thalamus). VBM analysis revealed significantly lower gray matter density in OCD patients compared to healthy in the left ACC and bilateral medial superior frontal gyrus (SFG). Furthermore, a small volume correction was used to identify a significantly greater gray matter density in the right putamen in OCD patients as compared to unaffected siblings of OCD patients. These findings in patients, siblings, and healthy controls, although preliminary, suggest the presence of gray matter structural differences between affected subjects and healthy controls as well as between affected subjects and individuals at risk for OCD. PMID:18314272

ECT IN MENTALLY RETARDED SUBJECTS WITH PSYCHIATRIC ILLNESS

PubMed Central

Chopra, V.K; Sinha, V.K.

2002-01-01

The mentally retarded subjects show a much higher prevalence of full range of psychiatric disorders than the non-retarded population. Whereas the role of psychotropic drugs in such patients is well discussed, the reports on the use of ECT are scarce. Many psychiatrists dealing with the mentally retarded psychiatric patients are reluctant to consider ECT due to lack of adequate experience. We report five mentally retarded patients with different psychiatric disorders who were successfully treated with ECT after failing adequate trials of pharmacotherapy. No disproportionately higher adverse events on account of mental retardation were observed. ECT need to be favorably considered in mentally retarded persons with psychiatric morbidity especially when treatment with psychotropic drugs either fail or is intolerable. PMID:21206883

The prescriber as moralist: values in the antidepressant debate.

PubMed

Scheurich, Neil

2006-01-01

The past decade has seen a growing debate about the expanding use of psychotropic medications. Of particular concern are current antidepressants, as well as hypothetical "mood brighteners" that could modify affect and behavior in people heretofore classified as being within the normal range. This paper argues that objections to such pharmacologic applications are based on appeals to cultural values--authenticity, diversity, inwardness, and stoicism among others--that are viewed as being under increasing threat in contemporary American culture. Critiques of mood brighteners, like critiques of technological, consumer-driven culture, repudiate the ideals of shallow satisfaction and of the self as commodity. The decision to prescribe or not to prescribe a psychotropic medication in any given case is based on cultural values as well as clinical judgment.

Adolescent Experience of Psychotropic Treatment

PubMed Central

Floersch, Jerry; Townsend, Lisa; Longhofer, Jeffrey; Munson, Michelle; Winbush, Victoria; Kranke, Derrick; Faber, Rachel; Thomas, Jeremy; Jenkins, Janis H.; Findling, Robert L.

2009-01-01

Despite growing concern over the treatment of adolescents with psychiatric medications, little research has examined youth understandings and interpretations of mental illness and psychotropic treatment. This article reports the exploratory findings of semi-structured and open-ended interviews carried out with 20 adolescents diagnosed with one or more psychiatric disorders, and who were currently prescribed psychiatric medications. Grounded theory coding procedures were used to identify themes related to adolescent subjective experience with psychiatric medications. The categories identified are interpreted as different points of view through which adolescents understand and take action upon their illness concerns; their need for medication treatment; their perceptions of how medications work; their responses to parental and other influences upon medication treatment; and, their everyday management activities. PMID:19293284

Psychological effects of MDE in normal subjects. Are entactogens a new class of psychoactive agents?

PubMed

Hermle, L; Spitzer, M; Borchardt, D; Kovar, K A; Gouzoulis, E

1993-02-01

The so-called entactogens 3,4-methylenedioxymethamphetamine ([MDMA] also known as "Ecstasy," or "Adam") and its analog 3,4-methylenedioxyethamphetamine ([MDE] also known as "Eve") exert similar psychotropic effects in humans. Two double-blind placebo-controlled psychometric studies with normal control subjects were conducted. Placebo or MDE (140 mg) was administered orally to eight male volunteers at 1:30 P.M. and to six subjects (3 male, 3 female) at 11 P.M. Psychologic tests and clinical ratings were performed 1 hour before the administration of the drugs, as well as 2, 5, and 24 hours after drug intake and 7 days thereafter in the first study. In the second study, measures were taken at times -1, +8.5, +24 hours, and +7 days. The majority of the psychotropic effects resembled those that have already been described in anecdotal reports. The substance produced a partially controllable state of enhanced insight, empathy, and peaceful feelings. All subjects displayed a general stimulation with increased psychomotor drive, logorrhea, and facilitation of communication. One of the fourteen volunteers developed a toxic psychosis. One volunteer displayed a dysphoric reaction, one suffered from episodes of anxiety for some days after the experiment. The findings support the hypothesis that MDMA and MDE represent a novel pharmacologic class.

Positive perception of pharmacogenetic testing for psychotropic medications

PubMed Central

Lanktree, Matthew B; Zai, Gwyneth; VanderBeek, Laura E; Giuffra, Daniel E; Smithson, David S; Kipp, Lucas B; Dalseg, Timothy R; Speechley, Mark; Kennedy, James L

2014-01-01

Introduction Pharmacogenetics attempts to identify inter-individual genetic differences that are predictive of variable drug response and propensity to side effects, with the prospect of assisting physicians to select the most appropriate drug and dosage for treatment. However, many concerns regarding genetic tests exist. We sought to test the opinions of undergraduate science and medical students in southern Ontario universities toward pharmacogenetic testing. Methods and Results Questionnaires were completed by 910 undergraduate medicine and science students from 2005 to 2007. Despite students' concerns that the results of genetic tests may be used for other purposes without consent (71%) or lead to discrimination (78%), an overwhelming number of students were in favor of pharmacogenetic testing (90%). Discussion To our knowledge, this study is the first to survey a large sample for their attitude toward pharmacogenetic testing for psychotropic medications. Our results indicate that, although concerns remain and scientific advancements are required, respondents were in support of pharmacogenetic testing for medications used to treat schizophrenia. © 2014 The Authors. Human Psychopharmacology: Clinical and Experimental published by John Wiley & Sons, Ltd. PMID:24604560

Challenging behavior and related factors in people with intellectual disability living in residential care centers in Israel.

PubMed

Sinai, Amanda; Tenenbaum, Ariel; Aspler, Shoshana; Lotan, Meir; Morad, Mohammed; Merrick, Joav

2013-01-01

Adults with intellectual disabilities have higher rates of mental ill-health and problem behaviors than the general population. In this study, we present data on trends in challenging behavior in residential care centers in Israel from 1998 to 2008 and further data on trends in employment of psychiatrists from 1998 to 2009 and psychotropic medication use from 1998 to 2008. Data was collected from annual questionnaires sent out to all residential care centers in Israel, from the Office of the Medical Director, Division for Intellectual and Developmental Disabilities, Ministry of Social Affairs and Social Services. Rates of challenging behaviors in people with intellectual disabilities living in residential care centers in Israel continues to rise. Alongside this, trends in regular psychotropic medication use also continues to increase. Consideration of biological, psychological, social, and environmental factors in the assessment and management of people with intellectual disabilities and challenging behaviors is important. This is best conducted using a multidisciplinary approach, which may include psychiatric assessment. Non-pharmacological interventions should always be considered either alongside, or instead of medication.

Challenging Behavior and Related Factors in People with Intellectual Disability Living in Residential Care Centers in Israel

PubMed Central

Sinai, Amanda; Tenenbaum, Ariel; Aspler, Shoshana; Lotan, Meir; Morad, Mohammed; Merrick, Joav

2013-01-01

Introduction: Adults with intellectual disabilities have higher rates of mental ill-health and problem behaviors than the general population. Method: In this study, we present data on trends in challenging behavior in residential care centers in Israel from 1998 to 2008 and further data on trends in employment of psychiatrists from 1998 to 2009 and psychotropic medication use from 1998 to 2008. Data was collected from annual questionnaires sent out to all residential care centers in Israel, from the Office of the Medical Director, Division for Intellectual and Developmental Disabilities, Ministry of Social Affairs and Social Services. Results: Rates of challenging behaviors in people with intellectual disabilities living in residential care centers in Israel continues to rise. Alongside this, trends in regular psychotropic medication use also continues to increase. Conclusion: Consideration of biological, psychological, social, and environmental factors in the assessment and management of people with intellectual disabilities and challenging behaviors is important. This is best conducted using a multidisciplinary approach, which may include psychiatric assessment. Non-pharmacological interventions should always be considered either alongside, or instead of medication. PMID:24350182

The impact of the Canterbury earthquakes on prescribing for mental health.

PubMed

Beaglehole, Ben; Bell, Caroline; Frampton, Christopher; Hamilton, Greg; McKean, Andrew

2015-08-01

The aim of this study is to evaluate the impact of the Canterbury earthquakes on the mental health of the local population by examining prescribing patterns of psychotropic medication. Dispensing data from community pharmacies for antidepressants, antipsychotics, anxiolytics and sedatives/hypnotics are routinely recorded in a national database. The close relationship between prescribing and dispensing provides the opportunity to assess prescribing trends for Canterbury compared to national data and therefore examines the longitudinal impact of the earthquakes on prescribing patterns. Short-term increases in the use of anxiolytics and sedatives/hypnotics were observed after the most devastating February 2011 earthquake, but this effect was not sustained. There were no observable effects of the earthquakes on antidepressant or antipsychotic dispensing. Short-term increases in dispensing were only observed for the classes of anxiolytics and sedatives/hypnotics. No sustained changes in dispensing occurred. These findings suggest that long-term detrimental effects on the mental health of the Canterbury population were either not present or have not resulted in increased prescribing of psychotropic medication. © The Royal Australian and New Zealand College of Psychiatrists 2015.

The prevalence of novel psychoactive substances (NPS) use in non-clinical populations: a systematic review protocol.

PubMed

Khaled, Salma M; Hughes, Elizabeth; Bressington, Dan; Zolezzi, Monica; Radwan, Ahmed; Badnapurkar, Ashish; Gray, Richard

2016-11-21

Novel psychoactive substances (NPS) are new narcotic or psychotropic drugs that are not controlled by the United Nations drug convention that may pose a serious public health threat due to their wide availability for purchase on the internet and in so called "head shops." Yet, the extent of their global use remains largely unknown. The aim of this study is to conduct a systematic review of the prevalence of NPS use in non-clinical populations. This is a systematic review of observational studies. Embase, MEDLINE, PubMed, Cumulative Index to Nursing and Allied Health (CINAHL), Cochrane Library, Lilacs, Scopus, Global Health, PsychINFO, Web of Science, and the World Health Organization (WHO) regional databases will be searched for eligible prevalence studies published between 2010 and 2016. Data from cross-sectional studies that report the prevalence of NPS use (one or more types) in participants (of any age) from censuses or probabilistic or convenience samples will be included. Data will be extracted from eligible publications, using a data extraction tool developed for this study. Visual and statistical approaches will be adopted instead of traditional meta-analytic approaches. This review will describe the distributions of various types of prevalence estimates of NPS use and explore the impact of different population groups and study-related and tempo-geographical variables on characteristics of these distributions over the period of 2010 to 2016. PROSPERO CRD42016037020.

The Convergent and Divergent Validity of the Matson Evaluation of Drug Side-Effects (MEDS) and the Dyskinesia Identification System: Condensed User Scale (DISCUS)

ERIC Educational Resources Information Center

Matson, Johnny L.; Fodstad, Jill C.; Rivet, Tessa T.

2008-01-01

Background: Medication side-effects such as tardive dyskinesia (TD) are known to occur in individuals with a history of psychotropic drug use. This study aimed to contribute to the development of measures for assessing TD by examining the validity of the "Matson Evaluation of Drug Side-effects" (MEDS) with the "Dyskinesia…

Association of the Centers for Medicare & Medicaid Services' National Partnership to Improve Dementia Care With the Use of Antipsychotics and Other Psychotropics in Long-term Care in the United States From 2009 to 2014.

PubMed

Maust, Donovan T; Kim, H Myra; Chiang, Claire; Kales, Helen C

2018-03-17

The Centers for Medicare & Medicaid Services' National Partnership to Improve Dementia Care in Nursing Homes (hereafter referred to as the partnership) was established to improve the quality of care for patients with dementia, measured by the rate of antipsychotic prescribing. To determine the association of the partnership with trends in prescribing of antipsychotic and other psychotropic medication among older adults in long-term care. This interrupted time-series analysis of a 20% Medicare sample from January 1, 2009, to December 31, 2014, was conducted among 637 426 fee-for-service Medicare beneficiaries in long-term care with Part D coverage. Data analysis was conducted from May 1, 2017, to January 9, 2018. Quarterly prevalence of use of antipsychotic and nonantipsychotic psychotropic medications (antidepressants, mood stabilizers [eg, valproic acid and carbamazepine], benzodiazepines, and other anxiolytics or sedative-hypnotics). Among the 637 426 individuals in the study (446 538 women and 190 888 men; mean [SD] age at entering nursing home, 79.3 [12.1] years), psychotropic use was declining before initiation of the partnership with the exception of mood stabilizers. In the first quarter of 2009, a total of 31 056 of 145 841 patients (21.3%) were prescribed antipsychotics, which declined at a quarterly rate of -0.53% (95% CI, -0.63% to -0.44%; P < .001) until the start of the partnership. At that point, the quarterly rate of decline decreased to -0.29% (95% CI, -0.39% to -0.20%; P < .001), a postpartnership slowing of 0.24% per quarter (95% CI, 0.09%-0.39%; P = .003). The use of mood stabilizers was growing before initiation of the partnership and then accelerated after initiation of the partnership (rate, 0.22%; 95% CI, 0.18%-0.25%; P < .001; rate change, 0.14%; 95% CI, 0.10%-0.18%; P < .001), reaching 71 492 of 355 716 patients (20.1%) by the final quarter of 2014. Antidepressants were the most commonly prescribed medication overall: in the beginning of 2009, a total of 75 841 of 145 841 patients (52.0%) were prescribed antidepressants. As with antipsychotics, antidepressant use declined both before and after initiation of the partnership, but the decrease slowed (rate change, 0.34%; 95% CI, 0.18%-0.50%; P < .001). Findings were similar when limited to patients with dementia. Prescribing of psychotropic medications to patients in long-term care has declined, although the partnership did not accelerate this decrease. However, the use of mood stabilizers, possibly as a substitute for antipsychotics, increased and accelerated after initiation of the partnership in both long-term care residents overall and in those with dementia. Measuring use of antipsychotics alone may be an inadequate proxy for quality of care and may have contributed to a shift in prescribing to alternative medications with a poorer risk-benefit balance.

Pre-injury depression and anxiety in patients with orthopedic trauma and their treatment.

PubMed

Haupt, Edward; Vincent, Heather K; Harris, Andrew; Vasilopoulos, Terrie; Guenther, Robert; Sharififar, Sharareh; Hagen, Jennifer E

2018-03-27

Depressive symptoms have a known negative impact on outcomes following musculoskeletal injury. This study determined the pre-injury prevalence of psychiatric diagnoses of depression and anxiety, medication lapses and psychiatric consult services among patients admitted for orthopaedic trauma. This is a retrospective study of data from our Level-1 trauma center. Patients admitted to the orthopaedic trauma service during 2010-2015 were included (N = 4053). Demographics, Injury Severity Scores (ISS), mental health diagnoses, psychotropic medications, medication type and delay, psychiatric consultation use, intensive care unit (ICU) stay and total hospital length of stay (LOS) were abstracted from medical records and the institutional trauma registry. The 12-month prevalence of a major depressive episode is 6.6%-8.6% in adults in the United States. In our database, only 152/4053 (3.8%) of the patients had documented medical history of depression (80%) or anxiety (30%), and these patients had a 32% longer LOS (p < 0.016). Nearly two-thirds of patients who used psychotropic medications prior to injury experienced a delay in receiving these medications in the hospital (median = 1.0 day, range 0-14 days). Sixteen percent of patients also received a new psychotropic medication while hospitalized: an antipsychotic (8/16 patients, to treat delirium), an anxiolytic (3/16 patients for acute anxiety), or an antidepressant (1/16). Among patients with depression or anxiety, 16.7% received a psychiatric consult. Patients with psychiatric consults had higher ISS, were more likely to have longer ICU LOS and had longer hospital LOS than those without consults (all p < 0.05). The prevalence of depression and anxiety is grossly under-reported in our registry compared to national prevalence data. Patients with pre-existing disease had longer LOS and a higher rate of extended ICU care. Further studies are needed to characterize the true prevalence of disease in this patient population and its effect on patient outcomes after traumatic orthopaedic injury. Copyright © 2018 Elsevier Ltd. All rights reserved.

Association Between Psychotropic and Cardiovascular Iatrogenic Alerts and Risk of Hospitalizations in Elderly People Treated for Dementia: A Self-Controlled Case Series Study Based on the Matching of 2 French Health Insurance Databases.

PubMed

Zerah, Lorene; Boddaert, Jacques; Leperre-Desplanques, Armelle; Bonnet-Zamponi, Dominique; Verny, Marc; Deligne, Jean; Boelle, Pierre-Yves

2017-06-01

Elderly people are at risk of repeated hospitalizations, some of which may be drug related and preventable. In 2011, a group of French healthcare experts selected 5 iatrogenic alerts (IAs), based on criteria identified in a literature search and from their professional experience, to assess the appropriateness of medication in elderly patients. Our objective was to examine the association between hospitalizations and IAs in elderly patients treated for Alzheimer disease who are particularly sensitive to adverse drug events. A 2-year (January 1, 2011, to December 31, 2012) longitudinal national database study, with a study design similar to self-controlled case series, was performed to analyze data on drug prescriptions and hospitalization. IAs were defined as (1) long half-life benzodiazepine; (2) antipsychotic drugs in patients with Alzheimer disease; (3) co-prescription of 3 or more psychotropic drugs; (4) co-prescription of 2 or more diuretics; and (5) co-prescription of 4 or more antihypertensive drugs. Data were obtained by matching of 2 French National Health Insurance Databases. France. All affiliates, aged ≥75 years, receiving treatment for Alzheimer disease, alive on January 1, 2011 were included. We calculated the relative increase in the number of hospitalizations in patients with IAs. The analysis was performed over four 6-month periods. A total of 10,754 patients were included. During the periods with IAs, hospitalization rates increased by 0.36/year compared with 0.23/year in the periods without for the same patient, and the number of hospitalizations doubled [proportional fold change = 1.9, 95% confidence interval (1.8, 2.1)]. We estimated that 22% [95% confidence interval (20%, 23%)] of all hospitalizations were associated with IAs, 80% of which were due to psychotropic IAs. The IAs could be used as a simple and clinically relevant tool by prescribing physicians to assess the appropriateness of the prescription in elderly patients treated for Alzheimer disease. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

28 CFR 549.41 - Voluntary admission and psychotropic medication.

Code of Federal Regulations, 2010 CFR

2010-07-01

... INSTITUTIONAL MANAGEMENT MEDICAL SERVICES Administrative Safeguards for Psychiatric Treatment and Medication... admitted for psychiatric treatment and medication when, in the professional judgment of qualified health...

Mining the topography and dynamics of the 4D Nucleome to identify novel CNS drug pathways.

PubMed

Higgins, Gerald A; Allyn-Feuer, Ari; Georgoff, Patrick; Nikolian, Vahagn; Alam, Hasan B; Athey, Brian D

2017-07-01

The pharmacoepigenome can be defined as the active, noncoding province of the genome including canonical spatial and temporal regulatory mechanisms of gene regulation that respond to xenobiotic stimuli. Many psychotropic drugs that have been in clinical use for decades have ill-defined mechanisms of action that are beginning to be resolved as we understand the transcriptional hierarchy and dynamics of the nucleus. In this review, we describe spatial, temporal and biomechanical mechanisms mediated by psychotropic medications. Focus is placed on a bioinformatics pipeline that can be used both for detection of pharmacoepigenomic variants that discretize drug response and adverse events to improve pharmacogenomic testing, and for the discovery of novel CNS therapeutics. This approach integrates the functional topology and dynamics of the transcriptional hierarchy of the pharmacoepigenome, gene variant-driven identification of pharmacogenomic regulatory domains, and mesoscale mapping for the discovery of novel CNS pharmacodynamic pathways in human brain. Examples of the application of this pipeline are provided, including the discovery of valproic acid (VPA) mediated transcriptional reprogramming of neuronal cell fate following injury, and mapping of a CNS pathway glutamatergic pathway for the mood stabilizer lithium. These examples in regulatory pharmacoepigenomics illustrate how ongoing research using the 4D nucleome provides a foundation to further insight into previously unrecognized psychotropic drug pharmacodynamic pathways in the human CNS. Copyright © 2017. Published by Elsevier Inc.

A clinical communication tool for the assessment of psychotropic medication side effects.

PubMed

Ashoorian, Deena; Davidson, Rowan; Rock, Daniel; Dragovic, Milan; Clifford, Rhonda

2015-12-15

The primary aim was to assess usability of the My Medicines and Me Questionnaire (M3Q) as a self-reported questionnaire for mental health patients to subjectively express side effects experienced with their psychotropic medications. The secondary aim was to evaluate patients' attitudes towards treatment and psychotropic medications following dialogue with their clinicians about side effects. Questionnaires were administered at six adult mental health facilities. A total of 205 participants were divided into intervention (facilitated dialogue) and non-intervention groups (no facilitated dialogue). The mean completion time for the M3Q was 15min (SD=6.5) with only 11 (5%) patients requiring assistance. The most commonly reported side effect was sedation (77%) and weight gain was ranked as the most bothersome (23%). The previously validated M3Q provided patients with the opportunity to express the impact these effects had on their lives. Side effects were the most common reason given for non-adherence. There were no significant changes in patient attitudes towards treatment and medications in the intervention group, mainly due to the logistical challenges in the clinicians' ability to view the questionnaire for the subsequent meeting with the patient. The M3Q demonstrated its usability in allowing patients to easily express their subjective experiences with side effects. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Antisaccade and smooth pursuit eye movements in healthy subjects receiving sertraline and lorazepam.

PubMed

Green, J F; King, D J; Trimble, K M

2000-03-01

Patients suffering from some psychiatric and neurological disorders demonstrate abnormally high levels of saccadic distractibility when carrying out the antisaccade task. This has been particularly thoroughly demonstrated in patients with schizophrenia. A large body of evidence has been accumulated from studies of patients which suggests that such eye movement abnormalities may arise from frontal lobe dysfunction. The psychopharmacology of saccadic distractibility is less well understood, but is relevant both to interpreting patient studies and to establishing the neurological basis of their findings. Twenty healthy subjects received lorazepam 0.5 mg, 1 mg and 2 mg, sertraline 50 mg and placebo in a balanced, repeated measures study design. Antisaccade, no-saccade, visually guided saccade and smooth pursuit tasks were carried out and the effects of practice and drugs measured. Lorazepam increased direction errors in the antisaccade and no-saccade tasks in a dose-dependent manner. Sertraline had no effect on these measures. Correlation showed a statistically significant, but rather weak, association between direction errors and smooth pursuit measures. Practice was shown to have a powerful effect on antisaccade direction errors. This study supports our previous work by confirming that lorazepam reliably worsens saccadic distractibility, in contrast to other psychotropic drugs such as sertraline and chlorpromazine. Our results also suggest that other studies in this field, particularly those using parallel groups design, should take account of practice effects.

Systematic Review of the Use of Phytochemicals for Management of Pain in Cancer Therapy.

PubMed

Harrison, Andrew M; Heritier, Fabrice; Childs, Bennett G; Bostwick, J Michael; Dziadzko, Mikhail A

2015-01-01

Pain in cancer therapy is a common condition and there is a need for new options in therapeutic management. While phytochemicals have been proposed as one pain management solution, knowledge of their utility is limited. The objective of this study was to perform a systematic review of the biomedical literature for the use of phytochemicals for management of cancer therapy pain in human subjects. Of an initial database search of 1,603 abstracts, 32 full-text articles were eligible for further assessment. Only 7 of these articles met all inclusion criteria for this systematic review. The average relative risk of phytochemical versus control was 1.03 [95% CI 0.59 to 2.06]. In other words (although not statistically significant), patients treated with phytochemicals were slightly more likely than patients treated with control to obtain successful management of pain in cancer therapy. We identified a lack of quality research literature on this subject and thus were unable to demonstrate a clear therapeutic benefit for either general or specific use of phytochemicals in the management of cancer pain. This lack of data is especially apparent for psychotropic phytochemicals, such as the Cannabis plant (marijuana). Additional implications of our findings are also explored.

[Studies on the identification of psychotropic substances. VIII. Preparation and various analytical data of reference standard of some stimulants, amfepramone, cathinone, N-ethylamphetamine, fenethylline, fenproporex and mefenorex].

PubMed

Shimamine, M; Takahashi, K; Nakahara, Y

1992-01-01

The Reference Standards for amfepramone, cathinone, N-ethylamphetamine, fenethylline, fenproporex and mefenorex were prepared. Their purities determined by HPLC were more than 99.5%. For the identification and determination of these six drugs, their analytical data were measured and discussed by TLC, UV, IR, HPLC, GC/MS and NMR.

Botany meets archaeology: people and plants in the past.

PubMed

Day, Jo

2013-12-01

This paper explores the close links between botany and archaeology, using case studies from the ancient Mediterranean. It explains the kinds of palaeobotanical remains that archaeologists can recover and the methods used to analyse them. The importance of iconographic and textual evidence is also underlined. Examples of key research areas that focus on ancient plants are discussed: diet and palaeoeconomy; medicines, poisons, and psychotropics; perfumes, cosmetics, and dyes; and prestige.

Prescribing Pattern of Antidepressants in Children and Adolescents: Findings from the Research on Asia Psychotropic Prescription Pattern.

PubMed

Chee, K Y; Tripathi, A; Avasthi, A; Chong, M Y; Xiang, Y T; Sim, K; Kanba, S; He, Y L; Lee, M S; Chiu, H F K; Yang, S Y; Kuga, H; Udomratn, P; Tanra, A J; Maramis, M M; Grover, S; Mahendran, R; Kallivayalil, R A; Shen, W W; Shinfuku, N; Tan, C H; Sartorius, N

2016-03-01

Pharmacotherapy of depression in children and adolescents is complex. In the absence of research into the efficacy and safety of antidepressants in this group of patients, their off-label prescription is common. This paper aimed to illustrate the prescription pattern of antidepressants in children and adolescents from major psychiatric centres in Asia. The Research on Asia Psychotropic Prescription Pattern on Antidepressants worked collaboratively in 2013 to study the prescription pattern of antidepressants in Asia using a unified research protocol and questionnaire. Forty psychiatric centres from 10 Asian countries / regions participated and 2321 antidepressant prescriptions were analysed. A total of 4.7% antidepressant prescriptions were for children and adolescents. Fluoxetine, sertraline, and escitalopram were the most common antidepressants prescribed for children and adolescents. Almost one-third (30.3%) of prescriptions were for diagnoses other than depressive and anxiety disorders. There was less antidepressant polypharmacy and concomitant use of benzodiazepine, but more concomitant use of antipsychotics in children and adolescents compared with adults. Off-label use of antidepressants in children and adolescents was reported by 40 Asian psychiatric institutions that participated in the study. In-service education and regulatory mechanisms should be reinforced to ensure efficacy and safety of antidepressants in children and adolescents.

Not forgetting severe mental disorders in humanitarian emergencies: a descriptive study from the Philippines

PubMed Central

Weintraub, Ana Cecilia Andrade de Moraes; Garcia, Mariana Gaspar; Birri, Elisa; Severy, Nathalie; Ferir, Marie-Christine; Ali, Engy; Tayler-Smith, Katie; Nadera, Dinah Palmera; Van Ommeren, Mark

2016-01-01

Background Severe mental disorders are often neglected following a disaster. Based on Médecins Sans Frontières’ (MSF) experience of providing mental health (MH) care after the 2013 typhoon in the Philippines, we describe the monthly volume of MH activities and beneficiaries; characteristics of people seeking MH care; profile and outcomes of people with severe mental disorders; prescription of psychotropic medication; and factors facilitating the identification and management of individuals with severe mental disorders. Methods A retrospective review of programme data was carried out. Results In total, 172 persons sought MH care. Numbers peaked three months into MSF's intervention and decreased thereafter. Of 134 (78%) people with complete data, 37 (28%) had a severe mental disorder, often characterised by psychotic symptoms (n=24, 64%) and usually unrelated to the typhoon (n=32, 86%). Four people (11%) were discharged after successful treatment, two (5%) moved out of the area, 20 (54%) were referred for follow-up on cessation of MSF activities and 10 (27%) were lost-to-follow-up. Psychotropic treatment was prescribed for 33 (75%) people with mental disorders and for 11 with non-severe mental disorders. Conclusions This study illustrates how actors can play an important role in providing MH care for people with severe mental disorders in the aftermath of a disaster. PMID:27620925

Psychopharmacology of aggression in children and adolescents with primary neuropsychiatric disorders: a review of current and potentially promising treatment options.

PubMed

Nevels, Robert M; Dehon, Erin E; Alexander, Katrina; Gontkovsky, Samuel T

2010-04-01

Research examining the role of pharmacological therapy in the treatment of children and adolescents with clinical disorders is growing. Clinical disorders that present with comorbid aggression can add a challenge to treatment. Child and adolescent neuropsychiatric disorders associated with aggression include attention-deficit hyperactivity disorder, various mood disorders and in particular bipolar disorders/pediatric mania, schizophrenia, mental retardation, oppositional defiant disorder, conduct disorder, and autism spectrum disorders. This review describes the psychopharmacy to treat these disorders and the aggression that often appears comorbidly. Existing literature regarding the efficacy and safety of psychotropics for youth with neuropsychiatric disorders also is discussed. In addition, general guidelines for psychopharmacy of aggression in children and adolescents are presented. Studies reviewed in this article provide evidence for the use of psychostimulants, alpha-2 agonists, beta blockers, lithium, anticonvulsant mood-stabilizers, atypical antipsychotics, traditional antipsychotics, and selective serotonin reuptake inhibitors in treating pediatric aggression with the choice of medication dependent on symptomology. Despite increased support for pediatric psychotropic use, there is a need for more long-term safety and efficacy studies of existing medications and newer, safer, and more effective agents with fewer side effects for the pharmacological treatment of all childhood disorders in which aggression is prominent. 2010 APA, all rights reserved

Impact of HSD11B1 polymorphisms on BMI and components of the metabolic syndrome in patients receiving psychotropic treatments.

PubMed

Quteineh, Lina; Vandenberghe, Frederik; Saigi Morgui, Nuria; Delacrétaz, Aurélie; Choong, Eva; Gholam-Rezaee, Mehdi; Magistretti, Pierre; Bondolfi, Guido; Von Gunten, Armin; Preisig, Martin; Castelao, Enrique; Vollenweider, Peter; Waeber, Gerard; Bochud, Murielle; Kutalik, Zoltán; Conus, Philippe; Eap, Chin B

2015-05-01

Metabolic syndrome (MetS) associated with psychiatric disorders and psychotropic treatments represents a major health issue. 11β-Hydroxysteroid dehydrogenase type 1 (11β-HSD1) is an enzyme that catalyzes tissue regeneration of active cortisol from cortisone. Elevated enzymatic activity of 11β-HSD1 may lead to the development of MetS. We investigated the association between seven HSD11B1 gene (encoding 11β-HSD1) polymorphisms and BMI and MetS components in a psychiatric sample treated with potential weight gain-inducing psychotropic drugs (n=478). The polymorphisms that survived Bonferroni correction were analyzed in two independent psychiatric samples (nR1=168, nR2=188) and in several large population-based samples (n1=5338; n2=123 865; n3>100 000). HSD11B1 rs846910-A, rs375319-A, and rs4844488-G allele carriers were found to be associated with lower BMI, waist circumference, and diastolic blood pressure compared with the reference genotype (Pcorrected<0.05). These associations were exclusively detected in women (n=257) with more than 3.1 kg/m, 7.5 cm, and 4.2 mmHg lower BMI, waist circumference, and diastolic blood pressure, respectively, in rs846910-A, rs375319-A, and rs4844488-G allele carriers compared with noncarriers (Pcorrected<0.05). Conversely, carriers of the rs846906-T allele had significantly higher waist circumference and triglycerides and lower high-density lipoprotein-cholesterol exclusively in men (Pcorrected=0.028). The rs846906-T allele was also associated with a higher risk of MetS at 3 months of follow-up (odds ratio: 3.31, 95% confidence interval: 1.53-7.17, Pcorrected=0.014). No association was observed between HSD11B1 polymorphisms and BMI and MetS components in the population-based samples. Our results indicate that HSD11B1 polymorphisms may contribute toward the development of MetS in psychiatric patients treated with potential weight gain-inducing psychotropic drugs, but do not play a significant role in the general population.

Patient satisfaction with psychotropic drugs: sensitivity to change and relationship to clinical status, quality-of-life, compliance and effectiveness of treatment. Results from a nation-wide 6-month prospective study.

PubMed

Gasquet, Isabelle; Tcherny-Lessenot, Stéphanie; Lépine, Jean-Pierre; Falissard, Bruno

2006-12-01

To see if patient satisfaction with psychotropics (PSP) could be used as a patient-oriented outcome variable in the evaluation of PSP drugs in clinical epidemiological studies, relationships between PSP, clinical status, QoL, compliance and the type of antipsychotic were analyzed. Elements of validation of PSP were also assessed. In a 6-month prospective study, 933 schizophrenic outpatients with initiation or change to their antipsychotic treatment were enrolled. Psychiatrists completed five CGI-SCH scales (positive, negative, cognitive, depressive and global), hospitalization, compliance, and prescription variables. Patients completed PSP, EuroQoL scales, sexual function and compliance variables. A satisfactory structural equation model was obtained showing significant relationships PSP/compliance (coef.=0.16), QoL/PSP (coef.=0.37), clinical status/QoL (coef.=0.61), clinical status/compliance (coef.=0.09). Patients receiving olanzapine were more satisfied than patients receiving other atypicals (coef.=012) and had better clinical status than patients treated with typicals (coef.=0.08). Evolution of PSP was related to clinical status, QoL, and continuation of treatment (all P<001). Sensitivity to change of PSP was moderate (effect size=0.2). PSP produced consistent results in relation to validated outcome variables. However, a single-item measure was not sufficiently sensitive to change. Multi-item questionnaires evaluating different dimensions are needed.

[Environmental and genetic factors associated with psychoactive medication use in adult females. A population-based twin study].

PubMed

Rosagro Escámez, Francisco; González-Javier, Francisca; Ordoñana, Juan R

2013-01-01

Our objective is to determine the prevalence and factors associated to psychotropic medication consumption in a sample of adult females. Additionally, this study seeks to analyze the relative contribution of environmental and genetic factors to psychoactive medication use. Sample consists of a population-based cohort comprising 437 pairs of female twins born between 1940 and 1966. Information is collected through individual interviews, and it includes employment status, educational level, partner status, menopause, presence of mental disorders and psychoactive medication use. Logistic regression models are applied. The relative contribution of genetic and environmental factors to interindividual variation is analyzed through the classical twin design. In the past month, 34.0% of the women interviewed had consumed psychoactive medication. Consumption increases with age, in women out of the labor market, menopausal, and reporting a history of mental disorders. When controlling for age, all variables lost significance, except the presence of mental health problems. Heritability estimates for psychoactive medication use was 52%. This estimate is similar (46%) for consumption in the two categories studied. There is a high prevalence of psychoactive medication use in this sample. This consumption is mainly associated with age and presence of mental disorders. About half of the interindividual variation in psychotropic medication use is attributable to genetic factors, while the rest of the variance would be due to environmental factors unique to each individual.

The effects of becoming an entrepreneur on the use of psychotropics among entrepreneurs and their spouses.

PubMed

Dahl, Michael S; Nielsen, Jimmi; Mojtabai, Ramin

2010-12-01

Entering entrepreneurship (i.e. becoming an entrepreneur) is known to be a demanding activity with increased workload, financial uncertainty and increased levels of stress. However, there are no systematic studies on how entering entrepreneurship affects the people involved. The authors investigated prescriptions of psychotropics for 6,221 first-time entrepreneurs from 2001-2004 and their 2,381 spouses in the first two years after becoming entrepreneurs in a matched case-control study using linked data from three Danish national registries: The Danish database for Labor Market Research, the Danish Entrepreneurship database and the Danish Prescription database. Entrepreneurs were more likely to fill prescriptions at pharmacies for sedatives/hypnotics (adjusted odds ratio (AOR): 1.45 [95% CI: 1.26-1.66], p < .0001). However, they were less likely to fill prescriptions for antidepressants (AOR: 0.74 [95% CI: 0.59-0.92] p = 0.007). Spouses of these entrepreneurs were also more likely to fill prescriptions for sedatives/hypnotics (AOR: 1.36 [95% CI: 1.10-1.67], p = 0.005). No difference in prescription of antidepressants was found for spouses. This study showed that there was a significant relation between entering entrepreneurship and receiving prescriptions for sedative/ hypnotics both among the entrepreneurs themselves and their spouses, suggesting that entering entrepreneurship may be associated with increased stress for both the entrepreneurs and their families.

Affective and behavioral dysfunction under antiepileptic drugs in epilepsy: Development of a new drug-sensitive screening tool.

PubMed

Mertens, Lea Julia; Witt, Juri-Alexander; Helmstaedter, Christoph

2018-06-01

Behavioral problems and psychiatric symptoms are common in patients with epilepsy and have a multifactorial origin, including adverse effects of antiepileptic drugs (AEDs). In order to develop a screening tool for behavioral AED effects, the aim of this study was to identify behavioral problems and symptoms particularly sensitive to AED drug load and the presence/absence of AEDs with known negative psychotropic profiles. Four hundred ninety-four patients with epilepsy were evaluated who had been assessed with three self-report questionnaires on mood, personality, and behavior (Beck Depression Inventory, BDI; Neurological Disorders Depression Inventory for Epilepsy extended, NDDI-E; and Fragebogen zur Persönlichkeit bei zerebralen Erkrankungen, FPZ). Drug-sensitive items were determined via correlation analyses and entered into an exploratory factor analysis for scale construction. The resulting scales were then analyzed as a function of drug treatment. Analyses revealed 30 items, which could be allocated to six behavioral domains: Emotional Lability, Depression, Aggression/Irritability, Psychosis & Suicidality, Risk- & Sensation-seeking, and Somatization. Subsequent analysis showed significant effects of the number of AEDs on behavior, as in Emotional Lability (F=2.54, p=.029), Aggression/Irritability (F=2.29, p=.046), Psychosis & Suicidality (F=2.98, p=.012), and Somatization (F=2.39, p=.038). Affective and behavioral difficulties were more prominent in those patients taking AEDs with supposedly negative psychotropic profiles. These effects were largely domain-unspecific and primarily manifested in polytherapy. Drug-sensitive behavioral domains and items were identified which qualify for a self-report screening tool. The tool indicates impairments with a higher drug load and when administering AEDs with negative psychotropic profiles. The next steps require normalization in healthy subjects and the clinical validation of the newly developed screening tool PsyTrack along with antiepileptic drug treatment. Copyright © 2018 Elsevier Inc. All rights reserved.

Observational evidence that urbanisation and neighbourhood deprivation are associated with escalation in chronic pharmacological pain treatment: a longitudinal population-based study in the Netherlands

PubMed Central

Buijs, Servaas; Strik, Jacqueline; Lousberg, Richel; Smit, Jasper; van Kleef, Maarten; van Os, Jim

2012-01-01

Objective To examine, in the light of the association between urban environment and poor mental health, whether urbanisation and neighbourhood deprivation are associated with analgesic escalation in chronic pharmacological pain treatment and whether escalation is associated with prescriptions of psychotropic medication. Design Longitudinal analysis of a population-based routine dispensing database in the Netherlands. Setting Representative sample of pharmacies, covering 73% of the Dutch nationwide medication consumption in the primary care and hospital outpatient settings. Participants 449 410 patients aged 15–85 years were included, of whom 166 374 were in the Starter group and 283 036 in the Continuation group of chronic analgesic treatment. Main outcome measure Escalation of analgesics (ie, change to a higher level of analgesic potency, classified across five levels) in association with urbanisation (five levels) and dichotomous neighbourhood deprivation was analysed over a 6-month observation period. Methods Ordered logistic multivariate model evaluating analgesic treatment. Results In both Starter and Continuation groups, escalation was positively associated with urbanisation in a dose–response fashion (Starter group: OR (urbanisation level 1 compared with level 5): 1.24, 95% CI 1.18 to 1.30; Continuation group: OR 1.18, 95% CI 1.14 to 1.23). An additional association was apparent with neighbourhood deprivation (Starter group: OR 1.07, 95% CI 1.02 to 1.11; Continuation group: OR 1.04, 95% CI 1.01 to 1.08). Use of somatic and particularly psychotropic co-medication was associated with escalation in both groups. Conclusions Escalation of chronic analgesic treatment is associated with urban and deprived environments and occurs in a context of adding psychotropic medication prescriptions. These findings suggest that pain outcomes and mental health outcomes share factors that increase risk and remedy suffering. PMID:22815464

[The psychiatric comorbidity of anorexia nervosa: A comparative study in a population of French and Greek anorexic patients].

PubMed

Kountza, M; Garyfallos, G; Ploumpidis, D; Varsou, E; Gkiouzepas, I

2017-11-01

The current study had two objectives: (1) to access the psychiatric comorbidity in axis I and axis II (according to DSM-IV) of anorexia nervosa in a sample of 60 anorexic patients; (2) to compare the features of the psychiatric comorbidity between the two groups of French and Greek anorexic patients who participated in the study, as well as to compare some psychological and behavioral aspects of their anorectic psychopathology. Sixty anorexic patients, thirty French and thirty Greek, aged between 18 and 60 years, referred for evaluation and therapy at the unit of eating disorders at the "Institut national Marcel-Rivière of the MGEN" (hôpital de La Verrière, France) and at the unit of eating disorders of the First Department of Psychiatry of EGINITIO University Psychiatric Hospital in Athens (Greece), were accessed with the Eating Attitudes Test-26 (EAT26), Eating Disorder Inventory (EDI), Symptom Checklist-90-Revised (SCL90R), Mini International Neuropsychiatric Interview, Version 5.0.0 and the International Personality Disorder Examination. The comparison between the Greek and French patient populations did not show significant differences in age, socio-educational status, family status and BMI. French patients were hospitalized more regularly than Greek patients (χ 2 (1)=6.65, P=0.01) and psychotropic drug therapy was more common in French anorexic patients (χ 2 (1)=4.59, P=0.06). The results of the EAT 26 questionnaire in Greek and French patients show an average of 34.93 (±18.54) in total, with no statistically significant difference between the two groups. The results of EDI show a statistically significant difference between the two groups in the subscale 3 (body dissatisfaction) in which the Greeks scored on average at 9.40 and the French at 14.90 (t (58)=3.09, P<0.01). According to the results of the MINI scale, 47% of the patients in our total sample had a restrictive anorexia nervosa and 47% had anorexia nervosa of binge-eating/purging type. The most frequent comorbid disorder was the major depressive episode (40%) and the obsessive compulsive disorder (18.3%). The only statistically significant difference between the two groups was the frequency of the major depressive episode, which appeared statistically higher among the French (χ 2 (1)=6.94, P=0.01). According to the results of IPDE, 73.3% of patients in total (76.6% of the French and 70% of the Greeks) showed a personality disorder. The most common personality disorder was borderline personality disorder (40%), followed by obsessive-compulsive personality disorder (26.6%) and avoidant personality disorder (21.7%), with no statistically significant differences between the two groups. The profile of anorexic patients who are addressed to the specialized units of eating disorders in both cities (Paris, Athens) had many points in common (demographic parameters, BMI, subtype of anorexia). The results of the EAT-26 and EDI questionnaires did not differ between the two groups, except for the EDI questionnaire subscale 3, which showed body dissatisfaction, where the French had higher scores; this fact underlines the influence of cultural factors on some psychological and behavioral aspects of the psychopathology of the anorexia nervosa. The rates of comorbidity of anorexia nervosa in axis I and axis II found in our study are in agreement with data from various literature reviews and studies in the recent years. The most interesting point of the comorbidity comparison on axis I between the two groups of patients concerns the difference in the frequency of the major depressive episode, for which the results show higher rates in French patients. We can consider that this finding follows the general trend of mood disorder rates in Western countries and we can assume an explanation based on cultural influences. Finally, we can consider that the differences concerning the hospitalization of French patients in a more regular way than Greek patients and the higher rates of psychotropic treatment in French patients reflect the differences in the health systems between the two countries. Our study has shown high rates of major depressive episode, as well as personality disorders. There were statistically significant differences in four parameters between our two patient groups, explained by the influence of cultural factors. Copyright © 2017 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

Improving the management of behaviour that challenges associated with dementia in care homes: protocol for pharmacy-health psychology intervention feasibility study.

PubMed

Maidment, Ian D; Shaw, Rachel L; Killick, Kirsty; Damery, Sarah; Hilton, Andrea; Wilcock, Jane; Barnes, Nigel; Brown, Graeme; Gillespie, Sarah; Fox, Chris; Barton, Garry; Iliffe, Steve; Seare, Nichola

2016-03-23

The inappropriate use of antipsychotics in people with dementia for behaviour that challenges is associated with an estimated 1800 deaths annually. However, solely focusing on antipsychotics may transfer prescribing to other equally dangerous psychotropics. Little is known about the role of pharmacists in the management of psychotropics used to treat behaviours that challenge. This research aims to determine whether it is feasible to implement and measure the effectiveness of a combined pharmacy-health psychology intervention incorporating a medication review and staff training package to limit the prescription of psychotropics to manage behaviour that challenges in care home residents with dementia. 6 care homes within the West Midlands will be recruited. People with dementia receiving medication for behaviour that challenges, or their personal consultee, will be approached regarding participation. Medication used to treat behaviour that challenges will be reviewed by the pharmacist, in collaboration with the general practitioner (GP), person with dementia and carer. The behavioural intervention consists of a training package for care home staff and GPs promoting person-centred care and treating behaviours that challenge as an expression of unmet need. The primary outcome measure is the Neuropsychiatric Inventory-Nursing Home version (NPI-NH). Other outcomes include quality of life (EQ-5D and DEMQoL), cognition (sMMSE), health economic (CSRI) and prescribed medication including whether recommendations were implemented. Outcome data will be collected at 6 weeks, and 3 and 6 months. Pretraining and post-training interviews will explore stakeholders' expectations and experiences of the intervention. Data will be used to estimate the sample size for a definitive study. The project has received a favourable opinion from the East Midlands REC (15/EM/3014). If potential participants lack capacity, a personal consultee will be consulted regarding participation in line with the Mental Capacity Act. Results will be published in peer-reviewed journals and presented at conferences. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

The effects of marriage and separation on the psychotropic medication use of non-married cohabiters: a register-based longitudinal study among adult Finns.

PubMed

Metsä-Simola, Niina; Martikainen, Pekka

2014-11-01

Non-marital cohabitation has become increasingly common and is suggested to offer similar mental-health benefits as marriage does. We studied levels and changes in cohabiters' mental health five years before and five years after entering into marriage or separating, and compared long-term non-married and married cohabiters. We analysed changes in the three-month prevalence of psychotropic medication use (psycholeptics and psychoanaleptics, excluding medication for dementia) by proximity to non-marital transition and gender, using register data on 189,394 Finns aged 25 to 64. Similar levels of psychotropic-medication use were found among individuals in long unions that continued throughout the follow-up and were non-marital, marital, or changed from non-marital to marital. Among men and women who separated from longer cohabiting unions of more than five years, however, an increase in medication prevalence was observed immediately before separation, followed by a similar decline after separation. At the time of separation the level of medication use was 9.9 per cent (95% CI = 8.7 - 11.3) among men and 15.7 per cent (95% CI = 14.2 - 17.4) among women compared to 4.3 per cent (95% CI = 3.7 - 5.0) and 8.0 per cent (95% CI = 7.2 - 9.0), respectively, among those who cohabited continuously. No changes in medication use were observed before or after separation among those leaving shorter cohabiting unions of less than five years. Among those marrying following shorter cohabiting unions a positive effect of approaching marriage was observed only among women. Compared to continuous cohabiters, the level of medication use was higher among men and women separating from both short-term and long-term cohabiting unions five years before separation. This selective effect suggests that cohabiters with mental-health problems might benefit from relationship counselling. In a long-term stable union it seems to matter little for mental health whether the union is marital or non-marital, the break-up of a long-term non-marital union being strongly associated with adverse mental-health effects. Copyright © 2014 Elsevier Ltd. All rights reserved.

White matter network alterations in patients with depersonalization/derealization disorder.

PubMed

Sierk, Anika; Daniels, Judith K; Manthey, Antje; Kok, Jelmer G; Leemans, Alexander; Gaebler, Michael; Lamke, Jan-Peter; Kruschwitz, Johann; Walter, Henrik

2018-06-06

Depersonalization/derealization disorder (DPD) is a chronic and distressing condition characterized by detachment from oneself and/or the external world. Neuroimaging studies have associated DPD with structural and functional alterations in a variety of distinct brain regions. Such local neuronal changes might be mediated by altered interregional white matter connections. However, to our knowledge, no research on network characteristics in this patient population exists to date. We explored the structural connectome in 23 individuals with DPD and 23 matched, healthy controls by applying graph theory to diffusion tensor imaging data. Mean interregional fractional anisotropy (FA) was used to define the network weights. Group differences were assessed using network-based statistics and a link-based controlling procedure. Our main finding refers to lower FA values within left temporal and right temporoparietal regions in individuals with DPD than in healthy controls when using a link-based controlling procedure. These links were also associated with dissociative symptom severity and could not be explained by anxiety or depression scores. Using network-based statistics, no significant results emerged. However, we found a trend for 1 subnetwork that may support the model of frontolimbic dysbalance suggested to underlie DPD symptomatology. To ensure ecological validity, patients with certain comorbidities or psychotropic medication were included in the study. Confirmatory replications are necessary to corroborate the results of this explorative investigation. In patients with DPD, the structural connectivity between brain regions crucial for multimodal integration and emotion regulation may be altered. Aberrations in fibre tract communication seem to be not solely a secondary effect of local grey matter volume loss, but may present a primary pathophysiology in patients with DPD.

Biophysical Intervention Strategies.

ERIC Educational Resources Information Center

Benson, Scott

1987-01-01

Biophysical interventions as part of an ecological approach to intervention with handicapped children include psychotropic medications (neuroleptics, antidepressants, stimulants, minor tranquilizers and sedatives, lithium); nutritional agents (sugar, vitamins, food allergies); and physical therapies (patterning, optometric training). (DB)

76 FR 5340 - Federal Advisory Committee; Defense Health Board (DHB) Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-31

... Board: Trauma and Injury, Psychotropic Medication and Complementary and Alternative Medicine Work Groups... recommendation regarding the proposed research priorities of the Trauma and Injury Subcommittee. Pursuant to 5 U...

Zebrafish Behavioral Profiling Links Drugs to Biological Targets and Rest/Wake Regulation

PubMed Central

Rihel, Jason; Prober, David A.; Arvanites, Anthony; Lam, Kelvin; Zimmerman, Steven; Jang, Sumin; Haggarty, Stephen J.; Kokel, David; Rubin, Lee L.; Peterson, Randall T.; Schier, Alexander F.

2010-01-01

A major obstacle for the discovery of psychoactive drugs is the inability to predict how small molecules will alter complex behaviors. We report the development and application of a high-throughput, quantitative screen for drugs that alter the behavior of larval zebrafish. We found that the multi-dimensional nature of observed phenotypes enabled the hierarchical clustering of molecules according to shared behaviors. Behavioral profiling revealed conserved functions of psychotropic molecules and predicted the mechanisms of action of poorly characterized compounds. In addition, behavioral profiling implicated new factors such as ether-a-go-go-related gene (ERG) potassium channels and immunomodulators in the control of rest and locomotor activity. These results demonstrate the power of high-throughput behavioral profiling in zebrafish to discover and characterize psychotropic drugs and to dissect the pharmacology of complex behaviors. PMID:20075256

Gamma-irradiation enhances apoptosis induced by cannabidiol, a non-psychotropic cannabinoid, in cultured HL-60 myeloblastic leukemia cells.

PubMed

Gallily, Ruth; Even-Chena, Tal; Katzavian, Galia; Lehmann, Dan; Dagan, Arie; Mechoulam, Raphael

2003-10-01

Two non-psychotropic cannabinoids, cannabidiol (CBD) and cannabidiol-dimethylheptyl (CBD-DMH), induced apoptosis in a human acute myeloid leukemia (AML) HL-60 cell line. Apoptosis was determined by staining with bisBenzimide and propidium iodide. A dose dependent increase of apoptosis was noted, reaching 61 and 43% with 8 microg/ml CBD and 15 microg/ml CBD-DMH, respectively, after a 24 h treatment. Prior exposure of the cells to gamma-irradiation (800 cGy) markedly enhanced apoptosis, reaching values of 93 and 95%, respectively. Human monocytes from normal individuals were resistant to either cannabinoids or gamma-irradiation. Caspase-3 activation was observed after the cannabinoid treatment, and may represent a mechanism for the apoptosis. Our data suggest a possible new approach to treatment of AML.

Deep pharma: psychiatry, anthropology, and pharmaceutical detox.

PubMed

Oldani, Michael

2014-06-01

Psychiatric medication, or psychotropics, are increasingly prescribed for people of all ages by both psychiatry and primary care doctors for a multitude of mental health and/or behavioral disorders, creating a sharp rise in polypharmacy (i.e., multiple medications). This paper explores the clinical reality of modern psychotropy at the level of the prescribing doctor and clinical exchanges with patients. Part I, Geographies of High Prescribing, documents the types of factors (pharmaceutical-promotional, historical, cultural, etc.) that can shape specific psychotropic landscapes. Ethnographic attention is focused on high prescribing in Japan in the 1990s and more recently in the Upper Peninsula of Michigan, in the US. These examples help to identify factors that have converged over time to produce specific kinds of branded psychotropic profiles in specific locales. Part II, Pharmaceutical Detox, explores a new kind of clinical work being carried out by pharmaceutically conscious doctors, which reduces the number of medications being prescribed to patients while re-diagnosing their mental illnesses. A high-prescribing psychiatrist in southeast Wisconsin is highlighted to illustrate a kind of med-checking taking place at the level of individual patients. These various examples and cases call for a renewed emphasis by anthropology to critically examine the "total efficacies" of modern pharmaceuticals and to continue to disaggregate mental illness categories in the Boasian tradition. This type of detox will require a holistic approach, incorporating emergent fields such as neuroanthropology and other kinds of creative collaborations.

QT Prolongation, Torsades de Pointes, and Psychotropic Medications: A 5-Year Update.

PubMed

Beach, Scott R; Celano, Christopher M; Sugrue, Alan M; Adams, Caitlin; Ackerman, Michael J; Noseworthy, Peter A; Huffman, Jeff C

Some psychotropic medications have been associated with prolongation of the QT interval and QT prolongation, especially in those with medical illness, and are linked to lethal ventricular arrhythmias, such as Torsades de Pointes (TdP). In 2013, we published a review of QT prolongation, TdP, and psychotropic medications. We provide an update over the past 5 years on the specific concerns most relevant to clinicians who see medically ill patients. In this nonsystematic review, we aimed to carefully and intensively identify new articles by utilizing a structured PubMed search from 2012-present. QT prolongation remains an imperfect, though well-established marker of risk for TdP. Among antidepressant medications, citalopram does appear to prolong the QT interval more than other selective serotonin reuptake inhibitors, though the clinical significance of this prolongation remains unclear. Escitalopram appears to prolong the QT interval to a lesser extent. Haloperidol carries a risk for QT prolongation, but the assertion that intravenous haloperidol is inherently riskier may be confounded by its primary use in medically ill populations. Among atypical antipsychotic agents, ziprasidone-and possibly iloperidone-is associated with the greatest QT prolongation, whereas aripiprazole appears safest from this standpoint. The evidence for clinically meaningful QT prolongation with most classes of psychiatric agents remains minimal. The most important risk-reducing intervention clinicians can make is undertaking a careful analysis of other QT risk factors when prescribing psychiatric medications. Copyright © 2017 Academy of Consultation-Liaison Psychiatry. Published by Elsevier Inc. All rights reserved.

Factors associated with mouth breathing in children with -developmental -disabilities.

PubMed

de Castilho, Lia Silva; Abreu, Mauro Henrique Nogueira Guimarães; de Oliveira, Renata Batista; Souza E Silva, Maria Elisa; Resende, Vera Lúcia Silva

2016-01-01

To investigate the prevalence and factors associated with mouth breathing among patients with developmental disabilities of a dental service. We analyzed 408 dental records. Mouth breathing was reported by the patients' parents and from direct observation. Other variables were as -follows: history of asthma, bronchitis, palate shape, pacifier use, thumb -sucking, nail biting, use of medications, gastroesophageal reflux, bruxism, gender, age, and diagnosis of the patient. Statistical analysis included descriptive analysis with ratio calculation and multiple logistic regression. Variables with p < 0.25 were included in the model to estimate the adjusted OR (95% CI), calculated by the forward stepwise method. Variables with p ​​< 0.05 were kept in the model. Being male (p = 0.016) and use of centrally acting drugs (p = 0.001) were the variables that remained in the model. Among patients with -developmental disabilities, boys and psychotropic drug users had a greater chance of being mouth breathers. © 2016 Special Care Dentistry Association and Wiley Periodicals, Inc.

No association between prenatal exposure to psychotropics and intelligence at age five.

PubMed

Eriksen, Hanne-Lise Falgreen; Kesmodel, Ulrik Schiøler; Pedersen, Lars Henning; Mortensen, Erik Lykke

2015-05-01

To examine associations between prenatal exposure to selective serotonin reuptake inhibitors (SSRIs)/anxiolytics and intelligence assessed with a standard clinical intelligence test at age 5 years. Longitudinal follow-up study. Denmark, 2003-2008. A total of 1780 women and their children sampled from the Danish National Birth Cohort. Self-reported information on use of SSRI and anxiolytics was obtained from the Danish National Birth Cohort at the time of consent and from two prenatal interviews. Intelligence was assessed at age 5 years, and parental education, maternal intelligence quotient (IQ), maternal smoking and alcohol consumption in pregnancy, the child's age at testing, sex, and tester were included in the full model. The IQ of 13 medication-exposed children was compared with the IQ of 19 children whose mothers had untreated depression and 1748 control children. Wechsler Preschool and Primary Scale of Intelligence - Revised. In unadjusted analyses, children of mothers who used antidepressants or anxiolytics during pregnancy had higher verbal IQ; this association, however, was insignificant after adjustment for potentially confounding maternal and child factors. No consistent associations between IQ and fetal exposure to antidepressants and anxiolytics were observed, but the study had low statistical power, and there is an obvious need to conduct long-term follow-up studies with comprehensive cognitive assessment and sufficiently large samples of adolescent or adult offspring. © 2015 Nordic Federation of Societies of Obstetrics and Gynecology.

Do organizational strategies mediate nonverbal memory impairment in drug-naïve patients with obsessive-compulsive disorder?

PubMed

Shin, Na Young; Kang, Do-Hyung; Choi, Jung-Seok; Jung, Myung Hun; Jang, Joon Hwan; Kwon, Jun Soo

2010-07-01

The present study aimed to examine nonverbal memory and organizational skill functions in psychotropic-naïve patients with OCD. Forty-one drug-naïve, 41 medicated OCD patients and 41 healthy controls, all of whom were matched for gender, age, education and intelligence, were included in the study. The Rey-Osterrieth Complex Figure Test (RCFT) was administered to evaluate nonverbal memory ability and organizational skill. OCD patients demonstrated impaired nonverbal memory irrespective of medication status (F = 6.54, p < .01, eta(2)p = .098 for immediate recall; F = 7.76, p < .01, eta(2)p = .114 for delayed recall). Medicated patients showed deficits in organizational strategies (eta(2)p = .079), which mediated nonverbal memory impairment (Z = -2.20, p = .027). The difference of organizational skill between drug-naïve and control groups did not reach statistical significance (eta(2)p = .054) and the association between organization and nonverbal memory was weak in the drug-naïve sample (Z = -1.74, = .081). There was no significant difference between the patient groups in RCFT indices. Our findings suggest that the organizational strategies may not be an effective mediator of nonverbal memory impairment in OCD and indicate that the clinical characteristics may be important to be considered in future research. Further studies are needed to improve understanding of the nature of nonverbal memory dysfunction in OCD.

Psychotropic Medication Use among Adolescents: United States, 2005-2010

MedlinePlus

... social worker about your health?" Data source and methods NHANES is a continuous, multipurpose cross-sectional survey ... percentages are estimated using Taylor series linearization, a method that takes into consideration the sample weights and ...

Experience sampling and ecological momentary assessment studies in psychopharmacology: A systematic review.

PubMed

Bos, Fionneke M; Schoevers, Robert A; aan het Rot, Marije

2015-11-01

Experience sampling methods (ESM) and ecological momentary assessment (EMA) offer insight into daily life experiences, including symptoms of mental disorders. The application of ESM/EMA in psychopharmacology can be a valuable addition to more traditional measures such as retrospective self-report questionnaires because they may help reveal the impact of psychotropic medication on patients' actual experiences. In this paper we systematically review the existing literature on the use of ESM/EMA in psychopharmacology research. To this end, we searched the PsycInfo and Medline databases for all available ESM/EMA studies on the use of psychotropic medication in patients with DSM-III-R and DSM-IV disorders. Dissertations were excluded. We included 18 studies that applied ESM/EMA to study the effects of medication on patients with major depressive disorder, substance use disorder, attention-deficit hyperactivity disorder, psychotic disorder, and anxiety disorder. We found that ESM/EMA may allow researchers and clinicians to track patients during different phases of treatment: before treatment to predict outcome, during treatment to examine the effects of treatment on symptoms and different aspects of daily life experience, and after treatment to detect vulnerability for relapse. Moreover, ESM/EMA can potentially help determine how long and in what contexts medications are effective. Thus, ESM/EMA may benefit both researchers and clinicians and might prove to be an effective tool for improving the treatment of psychiatric patients. Copyright © 2015 Elsevier B.V. and ECNP. All rights reserved.

Trends in the psychopharmacological treatment of bipolar disorder: a nationwide register-based study.

PubMed

Bjørklund, Louise; Horsdal, Henriette Thisted; Mors, Ole; Østergaard, Søren Dinesen; Gasse, Christiane

2016-04-01

In bipolar disorder, treatment with antidepressants without concomitant use of mood stabilisers (antidepressant monotherapy) is associated with development of mania and rapid cycling and is therefore not recommended. The present study aimed to investigate the psychopharmacological treatment patterns in bipolar disorder over time, with a focus on antidepressant monotherapy. Cohort study with annual cross-sectional assessment of the use of psychotropic medications between 1995 and 2012 for all Danish residents aged 10 years or older with a diagnosis of bipolar disorder registered in the Danish Psychiatric Central Research Register. Users of a given psychotropic medication were defined as individuals having filled at least one prescription for that particular medication in the year of interest. We identified 20 618 individuals with bipolar disorder. The proportion of patients with bipolar disorder using antidepressants, atypical antipsychotics and anticonvulsants increased over the study period, while the proportion of patients using lithium, typical antipsychotics and benzodiazepines/sedatives decreased. The proportion of patients treated with antidepressant monotherapy decreased from 20.5% in 1997 to 12.1% in 2012, and among antidepressant users, the proportion in monotherapy decreased from 47.7% to 23.9%, primarily driven by a decrease in the use of tricyclic antidepressants. The results show an increase in the proportion of patients with bipolar disorder being treated with antidepressants in the period from 1997 to 2012. However, in accordance with international treatment guidelines, the extent of antidepressant monotherapy decreased during the same period.

Proton magnetic resonance spectroscopy of prefrontal white matter in psychotropic naïve children and adolescents with obsessive-compulsive disorder.

PubMed

Weber, Alexander Mark; Soreni, Noam; Stanley, Jeffrey A; Greco, Alessia; Mendlowitz, Sandra; Szatmari, Peter; Schachar, Russell; Mannasis, Katharina; Pires, Paulo; Swinson, Richard; Noseworthy, Michael D

2014-04-30

Obsessive-compulsive disorder (OCD) has a typical onset during childhood or adolescence. Although recent in-vivo proton magnetic resonance spectroscopy ((1)H-MRS) studies report gray matter metabolite abnormalities in children and adolescents with OCD, there are no existing (1)H-MRS studies that measure white matter (WM) metabolite levels in this population. In the present study, we measured metabolite levels in the left and right prefrontal WM (LPFWM and RPFWM, respectively) of psychotropic-naïve children and adolescents with OCD (LPFWM: N=15, mean age 13.3±2.4 years; right RPFWM: N=14, mean age 13.0±2.3 years) and healthy controls (LPFWM: N=17, mean age 11.8±2.7 years; RPFWM: N=18, mean age 12.2±2.8 years). Spectra were acquired using a 3T single voxel PRESS sequence (1.5×2.0×2.0cm(3)). When age and sex effects were controlled, OCD patients had higher levels of RPFWM choline and N-acetyl-aspartate (NAA). In addition, RPFWM levels of NAA, creatine and myo-inositol were positively and significantly correlated with severity of OCD symptoms. In summary, this is the first published study of WM metabolite levels in children and adolescents with OCD. Our preliminary findings lend further support to the previous findings of WM abnormalities in OCD. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

[Acting out and psychoactive substances: alcohol, drugs, illicit substances].

PubMed

Gillet, C; Polard, E; Mauduit, N; Allain, H

2001-01-01

In humans, some psychotropic agents (alcohol, drugs, illicit substances) have been suggested to play a role in the occurrence of major behavioural disorders, mainly due to the suppression of psychomotor inhibition. Behavioural disinhibition is a physiological mechanism which allows humans to behave appropriately according to a given environmental situation. The behavioural disinhibition induced by either therapeutic dosage or misuse involves the loss of restraint over certain types of social behaviour and may increase the risk of auto or hetero-aggression and acting out. The increased use of psychotropic agents in recent years and the occurrence of unwanted effects are worrying and must be detected and evaluated. The objective of the present study was to establish a causal relationship between psychoactive substance use and occurrence of major behavioural disorders, such as paradoxical rage reactions and suicidal behaviour, based on a literature analysis. It consisted of reviewing reports of drug-induced violent reactions in healthy volunteers and demonstrating, where possible, a cause-effect relationship. Patients with schizophrenia and psychopathic personalities were not included in our study since psychiatric comorbidity could influence behavioural responses. Psychotropic agents included drugs, licit and illicit substances already associated with violence in the past. Many reports used the "Go/No Go test" to evaluate the disinhibiting effect of psychotropic substances; this allows the "cognitive mapping" of drugs. The results suggest that only alcohol, antidepressants, benzodiazepines and cocaïne are related to aggressive behaviour. The best known precipitant of behavioural disinhibition is alcohol, which induces aggressive behaviour. However, there are large differences between individuals, and attentional mechanisms are now recognised as being important in mediating the effects of alcohol. Suicidal tendency as an adverse antidepressant reaction is rare, especially with atypical antidepressants. However, the risk of acting out exists and the responsibility of antidepressant agents in the genesis of suicidal tendencies is now established. The disinhibiting effects of benzodiazepines are well-known and proven by clinical trials. It's a "model" of acting out, and the causal relationship is undeniable. That cocaïne is related to violent behaviour is demonstrated by its pharmacological actions on CNS. The chronic use of cocaïne induces "a limbic dyscontrol syndrome" based on the altered activity of limbic structures. On the contrary, we could not demonstrate a causal relationship between aggression and either cannabis, ecstasy or phencyclidine. Cannabis abusers look particularly for euphoria and relaxing effects. Aggression as an adverse cannabis reaction is very rare and occurs in most cases in association with other drugs and in predisposed individuals. Ecstasy use may lead to long-term alterations of neuronal function in the human CNS and cause psychiatric disorders. However, there is insufficient information about long-term use of ecstasy to estimate its role in the occurrence of behavioural disorders. Clinical and forensic assumptions about phencyclidine and violence were not warranted. However, the substance-effect relationships can be criticized in the case of alcohol, antidepressants, benzodiazepines and cocaïne. In fact, individual, social and psychiatric factors exert an influence on behaviour that is superior to the pharmacological effect of psychotropic agents. The most important parameter in drug-induced behavioural disinhibition is dosage, but mode of administration is also important. In addition, polysubstance abuse is very common. Substances may be taken simultaneously and alcohol is frequently combined with drugs. The combinations of substances result in multiple interactions, and very little is known about the effects of these interactions on violence in humans. Co-occurrence of substance abuse and other mental disorders is also very frequent. Multiple substance abuse should be avoided, because potential interactions between two or more drugs are more likely to cause violent behaviour. In the future, a specific treatment of these deleterious phenomena will have to be considered in order to reduce drug-induced iatrogenic behavioural disorders.

Psychopharmacologic Treatment: A Note on Classroom Effects.

ERIC Educational Resources Information Center

Forness, Steven R.; Kavale, Kenneth A.

1988-01-01

Intended for teachers, the article provides an introduction to the four major classes of psychotropic medication (stimulants, tranquilizers, anticonvulsants, and antidepressants) commonly prescribed for children with learning or behavioral disorders. Specific effects on the classroom are addressed. (DB)

Diagnostic instruments for behavioural addiction: an overview

PubMed Central

Albrecht, Ulrike; Kirschner, Nina Ellen; Grüsser, Sabine M.

2007-01-01

In non-substance-related addiction, the so-called behavioural addiction, no external psychotropic substances are consumed. The psychotropic effect consists of the body’s own biochemical processes induced only by excessive activities. Until recently, knowledge was limited with respect to clinically relevant excessive reward-seeking behaviour, such as pathological gambling, excessive shopping and working which meet diagnostic criteria of dependent behaviour. To date, there is no consistent concept for diagnosis and treatment of excessive reward-seeking behaviour, and its classification is uncertain. Therefore, a clear conceptualization of the so-called behavioural addictions is of great importance. The use of adequate diagnostic instruments is necessary for successful therapeutical implications. This article provides an overview of the current popular diagnostic instruments assessing the different forms of behavioural addiction. Especially in certain areas there are only few valid and reliable instruments available to assess excessive rewarding behaviours that fulfill the criteria of addiction. PMID:19742294

Sense and Sensibility When Prescribing 'Off-Label' to Psychiatric Patients.

PubMed

Baldwin, David S; Tiwari, Nupur; Gordon, Robert

2015-01-01

Pharmacological treatment forms part of much routine psychiatric practice. Many psychotropic drugs and psychotherapies are available for treating patients with mental disorders, but considerable numbers of individuals remain troubled by incapacitating symptoms even after a succession of evidence-based treatments. In this situation, many doctors consider prescribing a psychotropic medication outside the narrow terms of its market authorisation or 'product licence', in an attempt to optimise clinical outcomes and increase the chance of recovery. Despite expressed concerns about potential hazards and increased physician liability, many authorities agree that using a drug outside the narrow terms of its product licence can be an important part of clinical practice. This paper illustrates the nature and extent of the use of licensed drugs for unlicensed applications in psychiatric and other medical settings, indicates potential drawbacks and hazards, and makes recommendations for a suggested process when prescribing 'off-label', as an appropriate part of the overall management of individual patients.

Psychiatric disorders and menopause symptoms in Brazilian women.

PubMed

Barazzetti, Lidiane; Pattussi, Marcos Pascoal; Garcez, Anderson da Silva; Mendes, Karina Giane; Theodoro, Heloísa; Paniz, Vera Maria Vieira; Olinto, Maria Teresa Anselmo

2016-04-01

This study investigated the association between minor psychiatric disorders and menopause symptoms and their associated factors. A cross-sectional study was conducted with 615 women aged 40 to 65 years treated in a public menopause and gynecological outpatient clinic in the South Region of Brazil. Minor psychiatric disorders were assessed using the Self-Reporting Questionnaire (SRQ-20) and menopause symptoms using the Menopause Rating Scale. Score for menopause symptoms was categorized into three levels of symptoms: mild, moderate, and severe. Multivariate analyses used ordinal logistic regression. The prevalence of mild, moderate, and severe menopause symptoms was 34.1% (95% CI 30.3-37.9), 29.6% (95% CI 25.8-33.1), and 36.3% (95% CI 32.4-40.0), respectively. The overall prevalence of minor psychiatric disorders was 66.6% (95% CI 62.8-70.3). After adjustment, the odds ratio (OR) of the occurrence of menopause symptoms were approximately eight times higher in women relating minor psychiatric disorders compared with those without such disorders (OR = 7.76; 95% CI 5.27-11.44). The following factors were also associated with the menopause symptoms: women older than 50 years, living with a partner, lower educational level, smokers, larger number of pregnancies, obese, and those using psychotropic and/or postmenopause medication. The minor psychiatric disorders exhibited strong association with the presence of menopause symptoms independently of sociodemographic, behavioral, and reproductive factors, and of use of psychotropic medication.

Not forgetting severe mental disorders in humanitarian emergencies: a descriptive study from the Philippines.

PubMed

Weintraub, Ana Cecilia Andrade de Moraes; Garcia, Mariana Gaspar; Birri, Elisa; Severy, Nathalie; Ferir, Marie-Christine; Ali, Engy; Tayler-Smith, Katie; Nadera, Dinah Palmera; Van Ommeren, Mark

2016-09-01

Severe mental disorders are often neglected following a disaster. Based on Médecins Sans Frontières' (MSF) experience of providing mental health (MH) care after the 2013 typhoon in the Philippines, we describe the monthly volume of MH activities and beneficiaries; characteristics of people seeking MH care; profile and outcomes of people with severe mental disorders; prescription of psychotropic medication; and factors facilitating the identification and management of individuals with severe mental disorders. A retrospective review of programme data was carried out. In total, 172 persons sought MH care. Numbers peaked three months into MSF's intervention and decreased thereafter. Of 134 (78%) people with complete data, 37 (28%) had a severe mental disorder, often characterised by psychotic symptoms (n=24, 64%) and usually unrelated to the typhoon (n=32, 86%). Four people (11%) were discharged after successful treatment, two (5%) moved out of the area, 20 (54%) were referred for follow-up on cessation of MSF activities and 10 (27%) were lost-to-follow-up. Psychotropic treatment was prescribed for 33 (75%) people with mental disorders and for 11 with non-severe mental disorders. This study illustrates how actors can play an important role in providing MH care for people with severe mental disorders in the aftermath of a disaster. © The Author 2016. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.