Showing papers on "Psychotropic drug published in 1988"

Psychotropic Drug Practice In Nursing Homes

Abstract: This study examined the administration of psychotropic medication to Medicaid recipients who resided continuously in an Illinois nursing home during 1984. Of these residents, 20,037 (60%) received at least one such medication during the year, with administration most likely for those from the ages of 45 to 74 years. Haloperidol, thioridazine, and flurazepam were the most frequently prescribed drugs of those examined. The study also investigated the relationship of demographic and institutional variables to the probability of drug administration and the amount administered. These variables were most strongly related to the probability of antipsychotic, antiparkinson, and antimanic (lithium) administration. The association of these variables with the amount of drug administered was strongest for antimanic and antipsychotic medications, particularly the latter. In all analyses, the addition of institutional variables increased goodness of fit minimally over that produced by demographic variables alone. This finding supports the conclusion that the prescription of psychotropic medication is more influenced by individual patient characteristics than by the nature of the institutional setting in which the patient resides.

Prescribing of Psychotropic Medication by Primary Care Physicians and Psychiatrists

Abstract: This study investigates the prescribing of psychotropic medications by primary care physicians and psychiatrists using the National Ambulatory Medical Care Survey database. Results indicate that primary care practitioners provide a larger percentage of psychotropic drug visits than psychiatrists in every psychotropic class except for those patients prescribed lithium. In addition, the two provider groups differed in the relative proportions of the classes of psychotropic drugs prescribed. Primary care physicians prescribed anxiolytics most frequently, while psychiatrists prescribed antidepressants most often. Finally, in all therapeutic classes, when a psychotropic medication was prescribed, psychiatrists typically provided a mental health diagnosis, while primary care physicians did not.

Psychiatric aspects of terrorist violence: Northern Ireland 1969-1987.

Abstract: For 18 years, Northern Ireland has suffered a changing pattern of civil disorder. Early years were marked by widespread sectarian rioting, shootings, and bombings, which heightened community tension and caused much social and commercial disruption. However, in recent years, terrorist organisations have been more selective in their acts of violence. There are methodological difficulties in assessing the psychological impact of civil disorder and terrorism. But, as well as can be judged from community surveys, hospital admissions and referral data, psychotropic drug usage, suicide and attempted suicide rates, and from assessment of the actual victims of violence, society has not 'broken down' nor has the impact been judged considerable. Possible explanations are discussed.

Patterns of Drug Use, Methodological Considerations, Measurement Techniques, and Future Trends

Abstract: The prevalence of psychotropic and antiepileptic drug use with developmentally disabled people is comprehensively reviewed. Pharmacotherapy has been documented to be very common with mentally retarded individuals (especially those in institutions) but has not been well studied in other forms of developmental disabilities. Demographic, medical, and behavioral variables are examined with respect to medication use in an effort to indentify patterns of drug prescription. A number of programs which succeeded in reducing inappropriate medication use are also described. Some of the more frequently used measures for assessing drug change in this field are outlined. Future needs and trends, such as more attention to dual diagnosis, more work with noninstitutionalized populations, and greater attention to the quality-of-care dimension are addressed. In addition, more work in the areas of neurochemistry, pharmacokinetics, and psychophysiology is expected, with the inevitable consequence of a more interdisciplinary approach to the field.

Psychotropic drug prescriptions for nursing home residents.

Abstract: Previous work has indicated that psychotropic medications may be misused in nursing homes. Utilizing data from the National Nursing Home Study Pretest, this analysis examined the frequency, indications, and appropriateness of psychotropic drug prescriptions for a random group of 526 US nursing home residents. One third of the sample residents were receiving a psychotropic medication, and 8 percent were receiving more than one. Twenty-one percent of those without a listed mental disorder diagnosis received psychotropic medications, almost one third of which were antipsychotic medications. With no corresponding notation of a related symptom or diagnosis in the chart, 30 percent of 212 psychotropic prescriptions were judged inappropriate by a three-physician panel. Although more research should be done, these results suggest the need for better and more careful charting in nursing homes as well as better training for primary care physicians in the proper prescribing of psychotropic drugs.

Psychopharmacology and reaction time

Abstract: Pharmacosensitivity of the simple reaction time test compared with other speed loaded psychometric tasks the evaluation of drug effects in laboratory tasks two experimental approaches to specifying drug effects physiological and subjective state versus information processing age-related visual information processing in tasks of different complexity age-related automatic versus controlled visual search some boundary conditions of choice-reaction performance some comments on the use of information processing rate as an index of change and individual differences in performance reaction time with distractors some possibilities for drug assessment the effects of time of day, age and anxiety on a choice reaction task relative advantages and disadvantages of various performance measures in the assessment of psychotropic drug effects localization in the stimulus and response-contingent brain post ingestion effects of benzodiazepines in evoked potentials and reaction times in discrimination tasks visual evoked potentials and reaction times to chromatic and achromatic stimulation psychopharmacological applications explaining the common effect of sedative drugs on driving using performance models.

Psychotropic drug induced weight gain: mechanisms and management.

Abstract: Most of the drugs commonly used in the treatment and prophylaxis of depression, mania, and psychotic illness have, as one of their prominent side effects, the ability to increase appetite, stimulate carbohydrate craving, and promote weight gain These side effects are troublesome to patients, and frequently constitute a major reason for premature discontinuation of therapy This review examines the relative likelihood of the occurrence of appetite stimulation and weight gain with various psychotropic medications Potential mechanisms of these effects and strategies to minimize or avoid weight gain during pharmacotherapy of psychiatric illness are examined Evidence suggests that those compounds, which either antagonize or downregulate serotonin receptors, are more likely to stimulate carbohydrate hunger and weight gain Amitriptyline, chlorpromazine, mesoridazine, thioridazine, and lithium are most likely to produce weight gain Compounds that have more pronounced serotonergic action, such as fluoxetine and fenfluramine, are more likely to decrease carbohydrate craving and promote weight loss

Serial Partial Sleep Deprivation in Depression – Clinical Effects and Dexamethasone Suppression Test Results

Abstract: Thirty depressed patients were deprived of sleep during the second half of the night after they were characterized according to their Research Diagnostic Criteria diagnosis, severity of depression, current medication and dexamethasone suppression test status. After applying partial sleep deprivation (PSD) treatment three times within 1 week, we observed in 17 patients an improvement of their initial depressive symptomatology of 50% or more. No pretreatment variable except the degree of improvement after the first PSD was predictive for therapeutic effects of the entire PSD series. Beneficial effects of PSDs were not specific for the endogenous type of depression. A trend was found indicating that concurrent psychotropic drug treatment enhances the beneficial effect of serial PSDs.

Social Work and Psychotropic Drug Treatments

Abstract: This article reviews the recent history of somatic treatment of mental illness and discusses possible roles for social workers in the prescription of psychotropic drugs. Social work has neglected drug treatments partly because of the way social workers of an earlier era resolved doubts about the immediate predecessor of drugs, shock treatment. Today, the prevalence and misdiagnosis of treatment-induced adverse effects, the unique perspective of social work, the blurring of functions, and the interprofessional competition in mental health-as well as the goal of enhancing our clients' welfare-have removed practical and scientific obstacles to social work's serious and autonomous study of psychotropic drug treatments.

Psychopharmacological treatment of elderly demented patients.

Abstract: Elderly demented patients often suffer from accompanying psychiatric symptoms, including disturbances of mood and behavior, that may respond to psychotropic drug treatment. Despite the wide use of several medication groups--including antipsychotics, antidepressants, and sedative-hypnotics--data from double-blind clinical trials are limited. Some relevant controlled studies are reviewed, and guidelines for treatment based on the available data and clinical experience are described. Elderly demented patients can be treated psychopharmacologically. The choice of medication depends partly on its side effects. Initial dosages for the elderly should be lower than for younger adults.

Diagnoses associated with the prescription of psychotropic drugs at a Swedish health centre.

Abstract: Data on drug prescribing to residents of the municipality of Tierp in 1978 were linked to data on visits to the Tierp health centre in order to examine which diagnoses were associated with psychotropic drug prescribing. The diagnostic patterns were analyzed with respect to sex, age, and level of drug use of patients. Only one quarter of the patients for whom psychotropic drugs were prescribed in connection with a visit to the health centre were also given a psychiatric diagnosis. Even among those patients who were prescribed five or more psychotropic drugs, only four out of ten had a psychiatric diagnosis. Among those patients who were prescribed an antidepressant, only six out of ten had a psychiatric diagnosis. A relation between psychotropic drug use and certain non-psychiatric diagnoses such as hypertension, diabetes and ischaemic heart disease was observed.

4‐(O‐Benzylphenoxy)‐N‐Methylbutylamine (Bifemelane) and Other 4‐(O‐Benzylphenoxy)‐N‐Methylalkylamines as New Inhibitors of Type A and B Monoamine Oxidase

Abstract: 4-(O-Benzylphenoxy)-N-methylbutylamine (Bifemelane, BP-N-methylbutylamine), a new psychotropic drug, was found to inhibit monoamine oxidase (MAO) in human brain synaptosomes. It inhibited type A MAO (MAO-A) competitively and type B (MAO-B) noncompetitively. BP-N-methylbutylamine had a much higher affinity to MAO-A than an amine substrate, kynuramine, and it was a more potent inhibitor of MAO-A than of MAO-B. The Ki values of MAO-A and -B were determined to be 4.20 and 46.0 microM, respectively, while the Km values of MAO-A and -B with kynuramine were 44.1 and 90.0 microM, respectively. The inhibition of MAO-A and -B by BP-N-methylbutylamine was found to be reversible by dialysis of the incubation mixture. MAO-A in human placental and liver mitochondria and in a rat clonal pheochromocytoma cell line, PC12h, was inhibited competitively by BP-N-methylbutylamine, while MAO-B in human liver mitochondria was inhibited noncompetitively, as in human brain synaptosomes. BP-N-methylbutylamine was not oxidized by MAO-A and -B. The effects of other BP-N-methylalkylamines, such as BP-N-methylethylamine, -propylamine, and -pentanylamine, on MAO activity were examined. BP-N-methylbutylamine was the most potent inhibitor of MAO-A, and BP-N-methylethylamine and -propylamine inhibited MAO-B competitively, whereas BP-N-methylbutylamine and -pentanylamine inhibited it noncompetitively. Inhibition of these BP-N-methylalkylamines on MAO-A and -B is discussed in relation to their chemical structure.

Urban-rural differences in psychotropic drug prescribing in northern Italy.

Abstract: Urban-rural differences in psychotropic drug prescribing were examined by comparing data from general practices in two contrasting areas of northern Italy. Patients attending the urban doctors were 1.5 times more likely to be prescribed a psychotropic drug than their rural counterparts. We also explored urban-rural differences in factors influencing psychotropic prescribing. Such influences were more numerous and complex in the urban than the rural setting.

Other Psychotropic Drugs: Stimulants, Antidepressants, the Anxiolytics, and Lithium Carbonate

Abstract: This chapter is really four small papers about medications that have received comparatively little attention in the mental retardation literature. However, this relative in attention should not be taken as a measure of the weakness of the agents or of their limited utility. They all may be of benefit when properly prescribed and managed. In view of a shallow research base, however, prescription must be guided as the writers are guided by clinical experience and the collective wisdom of colleagues in practice, as well as by research from other areas of psychopharmacology.

Consultation for physical illnesses by patients diagnosed and treated for psychiatric disorders by a general practitioner: 20 year follow up study.

Abstract: Patterns of consultation for physical illness were analysed in a body of consultation data covering a continuous 20 year period from a single general practitioner in south London. Three groups of adult patients were identified: patients with a psychiatric disorder and a new prescription for a psychotropic drug; patients with a psychiatric disorder but no new prescription for a psychotropic drug; and a control group without psychiatric disorder. The percentages of patients having one or more consultation for physical illnesses were stable over the years studied, being roughly 90%, 85%, and 60% respectively. For groups identified in 1972 their patterns of consultation for physical illness were examined in 1957, 1962, and annually from 1967 to 1976. In every year studied except 1957 the group with a psychiatric disorder and a new prescription for a psychotropic drug exceeded both other groups in the percentage of patients having one or more consultations for physical illnesses. Both groups with psychiatric disorders had an excess of consultations over the control group; this excess halved in about four years for the group with a new prescription and in about one year for the group without a new prescription. Mental health care by general practitioners for patients with psychiatric disorders does not seem to have an offset effect on general health care of these patients.

Direct HPLC resolution of racemic nomifensine hydrogen maleate using a chiral beta-cyclodextrin-bonded stationary phase

Abstract: A direct liquid chromatographic method was developed for the optimization of separation of racemic S, R-nomifensine hydrogen maleate, a psychotropic drug, this was achieved without any derivatization, using a β-cyclodextrin-bonded phase column. A separation factor of 1.46 and resolution of 4.30 were obtained for the enantiomers of nomifensine hydrogen maleate. The effect of pH, temperature and methanol content in mobile phase on retention and enantioselectivity of nomifensine hydrogen maleate was also demonstrated.

Social factors associated with the use of psychotropic drugs: Alcohol abuse and minor psychiatric morbidity in the community

Abstract: The association of socio-demographic factors and life events with psychotropic drug consumption, alcohol abuse and minor psychiatric morbidity was investigated in a representative community sample of 181 respondents. The statistical model used was a logistic multiple regression analysis. Psychotropic drug use was best predicted by family size and employment status; alcohol abuse by sex, family size and "exit" events; and minor psychiatric morbidity by sex, marital status and undesirable life events. Language: en

Patterns of Psychotropic Drug Use in a Swedish Community

Abstract: In this study individual data on prescription drug purchases in the total population of a Swedish municipality have been analyzed in order to study changes in the use of psychotropic drugs (in this study mainly hypnotics, sedatives and minor tranquillizers) over time. The number of psychotropic prescriptions decreased by 27% during the twelve-year period 1972-1983. The proportion of psychotropic drug users in the total population decreased from 16 to 11%. This decrease in psychotropic drug use was not evenly distributed within the population. The proportion of users decreased from 10 to 4% in the age group 15-44 years and from 23 to 15% in the age group 45-64 years, while the higher proportion of users in the oldest age group, 65 years and older, only decreased from 33 to 28%. Psychotropic drug use was almost twice as common among females as compared to males throughout the study period. Psychotropic drug use among heavy users of prescription drugs in general--identified with the use of a sex- and age-specific definition--was also studied. The decrease in psychotropic drug use during the time period studied was much greater among non-heavy users as compared to heavy users.

CEEG Dynamic Brain Mapping, a New Method to Evaluate Brain Function in Different Psychological and Drug Conditions,

Abstract: : The electroencephalogram (EEG), discovered more than half a century ago, is still the only non-invasive, simple and objective method to continuously and repetitively study brain function, and has recently gained new significance since quantification by microprocessors was developed Quantification of single-lead EEG proved to be of significant value in psychotropic drug development Discoveries of the psychotropic properties of drugs and the determination of the bioavailability of CNS-active compounds validated this method They demonstrated that the brain's bioelectrical activity, even recorded in only one area of the brain, can represent brain function and is closely associated with human behavior A newly-developed brain function monitoring system using multi-lead, broad frequency spectrum computer-analyzed EEG (CEEG) with Dynamic Brain Mapping seems to be a very promising methodology to study human behavior and to monitor its changes due to external and internal factors (js)

Carbamazepine Regulates Feline Aggression Elicited From the Midbrain Periaqueductal Gray

Abstract: Carbamazepine has been utilized both as an anticonvulsant and as a psychotropic drug for the treatment of complex partial seizures and various mood and other emotional disorders such as the episodic dyscontrol syndrome. In the present study, we sought to identify the role of carbamazepine in the regulation of two forms of aggressive behavior--affective defense and quiet biting attack behavior--elicited by electrical stimulation of the midbrain periaqueductal gray matter of the cat in the absence of convulsive activity. The experimental paradigm involved establishment of stable baseline thresholds for affective defense and quiet biting attack responses. Following establishment of a stable baseline, carbamazepine (2.5, 5, or 10 mg/kg) and propylene glycol (vehicle control) were administered peripherally (IP). The response thresholds were tested 5-30, 30-60, 60-90, 120-150, 1440-1470, and 2160-2190 minutes following drug administration. It was observed that carbamazepine administration at 5 and 10 mg/kg dose levels preferentially suppressed affective defense behavior but had no effect upon quiet biting attack, indicating that the selective effects of carbamazepine upon affective attack are not due to any possible sedative effects upon motor responses. The effects of carbamazepine upon affective defense were dose dependent and of long duration when administered at the highest dose level (10 mg/kg).

Psychotropic Drug Blood Levels: Measurement and Relation to Behavioral Outcome in Mentally Retarded Persons

Abstract: A major factor determining response to pharmacotherapy is the quantity of drug (and sometimes active metabolite) that is available to be taken up into the brain. Drug and metabolite measurements in blood are necessary to determine this bioavailability. This chapter is concerned with issues relevant to the measurement and clinical utility of blood concentrations of psychotropic drugs and their metabolites in mentally retarded persons. Much of the discussion addresses several confounding factors that can adversely affect the relationship between blood levels and behavioral outcome. However, despite technical and theoretical difficulties inherent in blood level measurements, such studies may improve pharmacotherapy by (a) establishing “therapeutic windows” for specific behavioral or psychiatric disorders, (b) preventing behavioral toxicity, (c) identifying non-responders or negative responders, and (d) ascertaining compliance. Relatively little research has been done quantifying drug concentrations with mentally retarded subjects as compared with other clinical populations, and many basic questions remain to be answered. The application of pharmacokinetics to drug treatment of retarded persons (who often cannot relate toxic effects or subjective indices of improvement) can only improve clinical practice and provide rational empirical criteria for treatment decisions in this field.

Behavioral Assessment Technology for Pharmacotherapy in Developmental Disabilities

Abstract: The burgeoning field of behavioral assessment in behavioral medicine and in developmental disabilities requires that, for a meaningful discussion within a brief chapter, the topic must be restricted even further. We have chosen behavioral assessment of pharmacotherapy with persons who have developmental disabilities because it is currently a very visible and controversial topic, with a rich research literature. The plan of this paper is to review the necessary behavioral and pharmacological issues that need to be considered when evaluating or conducting research in this area. It is not an exhaustive review. More complete treatment of our approach to behavioral assessment in mental retardation can be found in Rojahn and Schroeder (1983) and to behavioral pharmacotherapy with developmental disabilities in Schroeder, Lewis, and Lipton (1983). We will recommend several other current topical reviews as the various topics are treated. Five textbooks are recommended: Gadow and Poling (1988), Gadow (1986), Gualtieri, Schroeder, & Keppel (1987); Hersen (1986), and Werry (1978).