Showing papers on "Psychotropic drug published in 1994"

Causes of Weight Loss in a Community Nursing Home

Abstract: Objective: To determine the causes of weight loss in nursing home residents. Design: Retrospective chart review of all weights over the previous 6 months and an in-depth examination of all residents who lost 5 or more pounds over that period. Setting: A for-profit community nursing home in an urban area. Subjects: All residents who had been in the nursing home for 3 or more months. Their mean age was 80.1 years, and 89% were female. Results: Weight loss of 5 pounds or more occurred in 19% of subjects. Only 15% of subjects had lost 5% of body weight, and 4% had lost more than 10% of their body weight. Depression accounted for 36% of the weight loss. Other causes of anorexia included medications, psychotropic drug reduction, swallowing disorders, paranoia, dementia with apraxia, gallstones, and obsessive-compulsive disorder. Increased energy utilization as a cause of weight loss was seen in two residents who wandered incessantly, one with tardive dyskinesia and one with chronic obstructive pulmonary disease. Dehydration was the cause of weight loss in two residents, and one resident had intentional weight loss for obesity. Cancer was the cause of weight loss in two residents. Four of 30 residents had more than one cause of weight loss. One of 25 tube-fed residents displayed weight loss. Conclusions: A single cause of weight loss can be identified in most nursing home residents. Depression is the most common cause of weight loss. Psychotropic drug reduction may cause weight loss. The majority of causes of weight loss in a community nursing home are potentially treatable.

Questionable prescribing for elderly patients in Quebec.

Abstract: OBJECTIVE: To estimate the prevalence of questionable and rational high-risk prescribing among elderly people of the three drug groups most commonly implicated in drug-related illness: cardiovascular drugs, psychotropic drugs and nonsteroidal anti-inflammatory drugs (NSAIDs). DESIGN: Retrospective prevalence study; all prescription and billing records for the period Jan. 1 to Dec. 31, 1990, for the study sample were retrieved from the relevant provincial databases of the Regie de l9assurance-maladie du Quebec. SETTING: Quebec. PARTICIPANTS: Regionally stratified random sample of 63,268 elderly medicare registrants who made at least one visit to physician in 1990 and were not living in a health care institution for the entire year. MAIN OUTCOME MEASURE: Prescription information was examined for three types of high-risk prescribing: rational and questionable drug combinations, excessive treatment duration and drugs relatively contraindicated for use in elderly people. RESULTS: Overall, 52.6% of the patients experienced one or more events of high-risk prescribing, and 45.6% experienced at least one that was questionable. High-risk prescribing was most prevalent for psychotropic drugs, and questionable prescribing was more frequent than rational prescribing in this drug group. An estimated 30.8% of the total elderly population in Quebec received benzodiazepines for more than 30 consecutive days, 12.9% received a long-acting benzodiazepine, and 13.0% received a questionable high-risk psychotropic drug combination. The prevalence of high-risk prescribing was higher among the women than among the men and increased with age until 75 to 84 years. There were significant unexplained differences between regions in the regional prevalence of high-risk prescribing, particularly of psychotropic drugs. CONCLUSION: The prevalence of questionable high-risk prescribing, especially of psychotropic drugs, is substantial among elderly people. This may be a potentially important and avoidable risk factor for drug-related illness in elderly people.

Transmitting, analyzing and reporting EEG data

Abstract: A method and system for acquisition, transmission, analysis, and analysis reporting of patient bioelectrical data, including electroencephalogram (EEG), computer-enhanced and expanded EEG (CEEG), dynamic brain mapping, evoked potentials (EP) and event related potential (ERP) data, with or without dynamic brain mapping, between a remote site where the physician and patient are located and a data collection and analysis center where the data can be analyzed by high-level computer analysis and/or expert technicians using an available communications channel. The EP, ERP and/or EEG data signals are gathered locally and transmitted using a local computer unit to control stimulus generation, data acquisition, and transmission functions. The high-level or computationally-intensive computer at the data collection and analysis center can also generate brain mapping analysis. The analysis results, along with statistical comparisons of the patient condition at the remote site with the data bases (normals, diagnostic groups, psychotropic drug data bases) at the receiving center are transmitted back over a communications channel to the remote site for display to the physician and patient.

Clinical Evaluation of Psychotropic Drugs: Principles and Guidelines

Abstract: Part 1 Historical perspectives: history and role of guidelines and guidance of drug evaluation, Jerome Levine decision processes in establishing the efficacy and safety of psychotropic drugs, Louis Lasagna. Part 2 General principles in the evaluation of psychotropic drugs: design issues for the clinical evaluation of psychotropic drugs, Eugene M. Laska et al classification issues in patient selection and description, Jean Endicott et al assessment and measurement of clinical change, A. John Rush et al pharmacologic considerations, David J. Grenblatt et al statistical issues for the clinical evaluation of psychotropic drugs, Philip W. Lavori et al clinical trial implementation, Ronald Kartzinel et a premarketing safety evaluation of psychotropic drugs, Thomas P. Laughren et al post-marketing surveillance of drugs, Leo E. Hollister et al documenting and reporting the study results of a randomized clinical trial (spicy meatballs, not pabulum), David J. Kupfer et al ethical and legal considerations in drug trials, Don Gallant and Susan Krinsky. Part 3 Specific patient groups - application of general methodologic principles: evaluating drug treatments of depressive disorders, Gerals L. Klerman et al evaluating pharmacologic treatments for bipolar disorder, Alan J. Gelenberg et al methods for clinical evaluation of pharmacologic treatments of schizophrenia, John M. Kane et al evaluating drug treatments of generalized anxiety disorder and adjustment disorders with anxious mood, Karl Rickels et al evaluation of psychotropic drug treatment of panic-related disorders and social phobia, Donald F. Klein et al obsessive-compulsive disorder, Wayne K. Goodman et al methods for the evaluation of pharmacologic agents in the treatment of cognitive and other deficits in dementia, Samuel Gershon et al clinical trials in children and adolescents, Rachel G. Klein et al evaluation of pharmacolocig treatments in eating disorders, Katherine A. Hamli et al evaluation of hypnotic medications, Thomas Roth et al establishing the efficacy and safety of medications for the treatment of drug dependence and abuse - methodologic issues, Jack D. Blaine et al evaluation of pharmacological treatments for alcohol abuse, dependence and their complications, Markku Linnoila et al evaluation of pharmacologic treatments in personality disorders, Paul H. Soloff et al.

Symptoms of depression, suicidal behaviour and use of substances in Greece: a nationwide general population survey

Abstract: This study aimed at investigating the relationship between the use of unprescribed licit and illicit drugs and problematic drinking with reported depressive symptoms and suicidal behaviour in a nationwide general population sample of 4291 respondents aged 12 to 64. Depressive symptoms were detected by the use of the Center for Epidemiological Studies Depression Scale (CES-D). A higher proportion of respondents who have reported illicit drug use in their lifetime were found to be depressed with a > 16 score in the CES-D in all age groups and both sexes, than of the other categories of substance use. A multiple range test revealed 3 groups of substance users. The more frequent illicit drug users together with the problematic drinkers exhibited the higher average depressive symptoms scores. The 12-month prevalence of suicidal ideation and suicide attempts was found to be in accordance with the severity and frequency of substance consumption.

The effect of silymarin on plasma levels of malon-dialdehyde in patients receiving long-term treatment with psychotropic drugs

Abstract: The efficacy of the antioxidant silymarin in preventing psychotropic drug-induced hepatic damage was evaluated in a double-blind, placebo-controlled study. Sixty patients receiving chronic psychotropic drug therapy were randomly divided into four groups and were treated for 90 days with silymarin or placebo as follows: group IA—treatment with psychotropic drugs and silymarin, 800 mg/d; group IB—treatment with psychotropic drugs and placebo; group IIA—suspension of psychotropic drugs plus treatment with silymarin, 800 mg/d; and group IIB—suspension of psychotropic drugs plus treatment with placebo. Serum levels of malon-dialdehyde (the end product of the oxidation of polyunsaturated fatty acids) and the indices of hepatocellular function were assessed in each patient at baseline (day 0), on days 15, 30, 60, and 90, and 1 month after the completion of treatment. Our data show that silymarin, when used at submaximal doses, reduces the lipoperoxidative hepatic damage that occurs during treatment with butyrophenones or phenothiazines. The study results also suggest that increased lipoperoxidation may contribute to psychotropic drug-induced hepatotoxicity.

Concurrent use of more than one major psychotropic drug (polypsychopharmacy) in out-patients--a prescription database study.

Abstract: 1. In order to assess the prevalence of concurrent use of more than one major psychotropic drug (polypsychopharmacy) in out-patients, a prescription database study was conducted in the Odense area for a period of 2 years. 2. During the index period 5.12% of the inhabitants purchased major psychotropic drugs. Of these, 14% had a period of polypsychopharmacy recorded. The age-specific prevalence of users increased with age, the prevalence for over 90 years of age was 18%. Sixty-seven per cent of the psychotropic drug users were women. 3. For neuroleptic and antidepressant users, about 20% were subject to polypsychopharmacy, for lithium 61%. The most prevalent combination was neuroleptics-neuroleptics. In none of the 10 most prevalent combinations were the mean daily doses significantly lower on polypsychopharmacy compared with single drug regimens, in two they were higher. 4. Polypsychopharmacy with psychotropic drugs was frequent in out-patients. In polypsychopharmacy daily doses were not lowered in order to limit side effects.

Instrumental assessment of psychomotor functions and the effects of psychotropic drugs

Abstract: The basic assumption underlying psychopharmacology is that the effects of psychoactive drugs can be assessed by measuring the changes produced on aspects of human behaviour and cognitive function. This review concentrates on 3 established psychometric tests that have been shown over a long period of time to be not only valid and reliable measures of aspects of behaviour relevant to the daily activities of patients taking such drugs but also appropriate indicators of any countertherapeutic effects or side effects of medication. Choice reaction time (CRT) is a reliable index of sedation directly related to accident risk situations at home, on the road or at work. Critical flicker fusion threshold (CFFT), a direct measure of the capacity for processing cognitive information, is an accurate measure of various aspects of mental illness and drug effects, and the continuous daytime EEG (c-EEG) is a truly objective measure of CNS activity on a continuous 24-h basis. The judicious use of CRT, CFFT, CFFT and c-EEG not only demonstrates the inherent potential of certain molecules to adversely affect the performance of certain daily activities but also helps identify the drugs with profiles of activity or side effects that are likely to be countertherapeutic.

Effects of an infusion of branched-chain amino acids on neurophysiological and psychometric testings in cirrhotic patients with mild hepatic encephalopathy

Abstract: Psychotropic action of a branched-chain-enriched amino acid solution (Aminoleban) was quantitatively and visually examined in six cirrhotic patients with mild hepatic encephalopathy (grades I and II) using electrophysiological and psychometric methods. Neurophysiological effects of the amino acid solution were observed by comparing topographic spectrum analyses of electroencephalography (EEG) before and immediately after an intravenous 3 h infusion of the solution. The delta wave in the frontal region diminished from 61 +/- 13 to 12 +/- 4% (P < 0.01) and the alpha wave in the occipital region increased from 11 +/- 3 to 51 +/- 11% (P < 0.01). Latencies of the P3 wave in visual evoked potentials, which were topographically recorded in the occipital region, shortened from 220 +/- 32 to 148 +/- 19 ms (P < 0.01). Latencies of the P300 wave in event-related potentials, which were topographically recorded in the centro-temporal region, shortened from 493 +/- 81 to 360 +/- 93 ms (P < 0.05). Topographic reaction pattern of P300 was irregular toward the occipital or parietal region in cirrhotic patients. The EEG frequency power spectrum, illustrated by the colour density spectral array of computer-aided polysomnography analysis, clearly showed a gradual increase of the alpha wave spectrum and a gradual decrease of the delta wave spectrum after initiation of the infusion. These immediate neurophysiological changes were confirmed by improvement of quantitative psychometric tests including number connection test, reaction time to sound, and digit symbol and block design tests of Wechsler Adult Intelligence Scale.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of the placebo control condition in neuroendocrine challenge studies

Abstract: Neuroendocrine challenge studies are frequently used to make inferences about the pathophysiology of psychiatric illness or about the effects of chronic psychotropic drug treatment on brain monoamine function. The outcome of these exploratory neuroendocrine tests, however, may be influenced by the effects of confounding variables, such as specific stress effects and variations in basal hormone levels. The inclusion of a placebo control condition minimizes the variability due to these variables. A number of recent neuroendocrine studies have omitted the placebo control condition. Based on experimental data, it can be shown that failure to include a placebo control condition may result in both Type I and Type II errors of inference. These results suggest a placebo control condition should be included in exploratory neuroendocrine challenge studies.

Social Pharmacology: Unresolved Critical Issues

Abstract: This article describes and analyzes decision-making by patients, physicians, and drug information providers about registered medical drugs. Based on a cognitive psychology perspective, cognitive variables (the individual's mediating system) are assumed to be critical factors determining both patient and physician behavior. The individual's psychological functioning is seen as a continuous reciprocal interaction between behavioral, cognitive, and environmental influences; i.e., an interactional paradigm is applied. The importance of research models including cognitive and situation variables to guide the search for appropriate research methods is stressed. An intensive research strategy with a small sample of respondents will often be necessary. Also, respondents should be asked to describe their reactions to specific medical situations. The drug information sender has to select a set of goals for disseminating information to patients. Among the goals most often selected are: message comprehension, receiver satisfaction, changes in knowledge, attitudes, and drug behavior, as well as health effects. More research is needed on how the patient's mediating system, the actual situation, and the perceived situation steer his search for the use of new drug information. A different set of factors influence the patient's decision to start a medicinal or drug treatment than the factors that influence his decision to continue a treatment. The latter factors include forgetfulness, misunderstandings, and the patient's interpretation of physiological signs. More cognitive-oriented research about drug compliance must be undertaken. In such studies the mediating systems of a group of patients could be considered before and after intervention. There are a great number of types of inappropriate (irrational) prescribing. However, a physician may prescribe rationally in one area but irrationally in another. Face-to-face education of physicians has been shown to be effective in reducing inappropriate prescribing in a number of studies. "Overprescribing" of benzodiazepine has been an issue of intensive professional debate during the last decades. The two groups who criticize and defend the existing use of benzodiazepines build their views on different assumptions about the interaction between mind and brain as well as making different value assumptions regarding the use of a psychotropic drug. There is a need for prescription studies where a cognitive and interactional perspective is combined with an information-processing and a normative perspective. The benzodiazepines dependency problem has provoked lively discussion among professionals and the general public. Long-term benzodiazepine use and personality disorders increase the risk of the patient becoming dependent. A great number of research models have been suggested for the analysis of prescription drug dependency and as guides to the treatment of dependency.(ABSTRACT TRUNCATED AT 400 WORDS)

Falls and fractures in nursing home patients receiveing psychotropic drugs

Abstract: Falls in 44 matched control patients (average age 87.1) were statistically compared to 38 patients (average age 85.3) who received scheduled or as needed (prn) single-agent psychotropics over a 6-month period. Prospective assessments of psychotropic drug therapy were made on a monthly basis, and data on falls and fractures were retrospectively gathered. Both scheduled and prn single-agent usage of benzodiazepine (BZ) hypnotics, and scheduled usage of BZ anxiolytics and thioridazine increased the incidence and episodes of falls over the frequency of falls found in the control group. Fractures were more prevalent in the treatment group over the 6-month period, but half the falls in the control group resulted in fractures. Longer-acting BZs, both prn and scheduled, resulted in a greater rate of falls than the shorter-acting BZs, but even the shorter-acting (SA) BZs given on a scheduled basis more often than three times a week had a greater rate of falls than the control group. When not more than 3 SABZ doses per week were given, no falls were noted for the follow-up 6-month period. It appears that most single psychotropics, except the SABZs given no more often than three times a week, haloperidol and desipramine, increase the risk of falls and fractures in a very old frail nursing home population.

[Psychotropic drug use in adolescence: why more girls? Study of a sample of 12-20-year-old students in Haute-Marne (France)].

Abstract: As part of a cross-sectional survey on adolescent health, psychotropic drug use was investigated by a self-administered questionnaire on school based adolescents aged 12-20 years (N = 3,279). 27.5% of the girls and 13.8% of the boys had taken a psychotropic drug during the 12 previous months. Female overuse was observed for different types of drugs (for distress/anxiety, sleep disturbance...) whether prescribed or not. Increased use with age was more marked for girls (14.3% to 36.2%) than for boys (10.7 to 16.9%). Psychotropic drug use increased with depressiveness, somatic complaints and medical care. A logistic regression analysis showed that female consumption was still slightly higher than that of boys after adjustment on other related factors.

Regulation of feeding behavior, with special reference to histamine.

Abstract: Treatment with psychotropic or antiallergic drugs which block histamine H1-receptors is known to be connected with weight gain Also in experimental animals food intake is changed after manipulation of the histaminergic system, food intake may be decreased by various treatments with increase histaminergic activity and increased if histaminergic activity is reduced Recent studies are reviewed illustrating the potential role of brain histaminergic system in the fascinating and complicated regulation of feeding

Health problems and policies for older women : an emerging issue in developing countries

Abstract: Health problems of older women will become an increasingly important issue in developing countries partially because of the sheer increase in absolute numbers. Today, two out of three of the world's 469 million women older than 50 already reside in developing countries. By 2020, three out of four will reside in developing countries, an absolute increase of 408 million. It is imperative to keep in mind the heterogeneity of developing countries. Older women constitute a distinct population that requires interventions very different from a population of younger women, who need an emphasis on maternity care. Obviously health problems of women are not homogeneous and cannot all be addressed through the traditional maternal and child health services. The pattern of health problems older women face reflects to a large extent the level of development of their region and country. Additionally, a woman's well-being is a result of all her previous experiences, including factors such as urban or rural residence, marital status, number of children, education, income, and nutrition. Furthermore, work has a tremendous influence on women's physical and mental health. Indeed, occupational health problems are emerging as a result of the increased number of women in urban industrial jobs. This report confines the discussion of women's health to the major causes of disease burden with the recognition that this is a narrow description of women's well-being. It presents possible policy directions and programs for prevention of mortality and morbidity among women older than 50 according to the typology of the country in which they reside.

Evidence of lipid peroxidation in patients taking neuroleptic drugs

Abstract: This study investigated the effect of chronic neuroleptic therapy on hepatic glutathione concentration in relation to lipid peroxidation. Hepatic malondialdehyde (MDA) and glutathione (GSH) concentrations were measured in liver biopsies from a group of patients receiving chronic psychotropic drug therapy. The results were compared with values obtained from a selected group of controls and correlated to liver histology and blood biochemistry. Patients taking neuroleptics exhibited increased hepatic MDA and decreased total GSH levels when compared with controls. The reduction of GSH was accompanied by a 25% increase in oxidized glutathione (GSSG) concentrations. In addition, a positive correlation between liver MDA and GSSG concentrations was observed in the group receiving neuroleptic therapy. The study results suggest that an increased lipid peroxidation may represent a contributory mechanism for neuroleptic drug toxicity.

Survey for participation in therapeutic trials in psychiatry

Abstract: In collaboration with the Sofres Institute, a two-phase population survey was conducted in 1991. During the first phase, 10,000 households representative of the French population and regularly surveyed by the Sofres Institute answered five questions by mail. The purpose was to identify subgroups regularly receiving psychotropic drugs and followed up by a physician. They were identified according to whether they used any of some 30 neuroleptic and antidepressant drugs, the most frequently prescribed in their class. According to their answers returned by post, the subjects were classified into three groups: regular psychotropic drug users followed by general practitioners, regular psychotropic drug users followed by specialists (these subjects being considered possibly more severely ill), and non users of these drugs, subjects considered as controls. In the second phase, a random sample of these groups received a detailed questionnaire including 14 questions related to clinical trials. In addition the same questionnaire was given to hospitalised patients in three different psychiatric units. Out of total of 958 subjects who received the detailed questionnaire, 712 answered (a 74% response rate). Results indicate that a majority of the subjects (50% to 74% depending on the subgroups) have already heard about the need for clinical trials to test new drugs. However, less than 20% of these subjects are aware of a recent French law protecting patient rights in clinical trials. This awareness appears to be quite insufficient A large number of subjects do not know whether they have been part of a clinical trial in the past.(ABSTRACT TRUNCATED AT 250 WORDS)

Factors associated with low cognitive performance in general practice

Abstract: In the preparatory phase of a randomised controlled trial data were collected to assess the magnitude of changes on cognitive functions in 1628 volunteers (age range 45–75 years) that were recruited from general practitioners' patient population. Subjects were administered a short neuropsychological battery of tests including three paper-and-pencil tests, which assessed immediate recall, delayed memory, and attention. Being on antihypertensive medication was associated with low results for all three tests in every age group, and in all strata according to blood pressure levels. Psychotropic drug use was correlated with low results for all three tests. Differences between psychotropic drug users and nonusers increased with age. Antihypertensive treatment and psychotropic drug use seem to be important to consider in longitudinal studies of cognitive decline in aging.

Prevalence and pattern of prescribed medication in 2-year-old children

Abstract: The parents of 1601 two-year-old children, randomly sampled from Ohio birth records, were surveyed regarding the children’s current medications. Use of antibiotics and analgesics was noted only if taken for more than 3 months, whereas all other medications were recorded if taken within 24 hours of the interview. In all, 5.6% of the children were taking some prescribed medication. The most prevalent drug groups were allergy/asthma drugs (2.50%), antibiotics (1.44%), antihistamines (1.00%), vitamins (0.87%), and anticonvulsants (0.56%). No instances of psychotropic drug prescription were recorded. A broad array of survey variables was analyzed for their possible relationship to drug variables. A variety of physical variables such as presence of a “chronic limiting condition” (problem expected to last 3 or more months), developmental delay, history of CAT scan or EEG, and history of serious sickness were all associated with use of two or more types of medication. Certain variables suggestive of social disadvantage or lower SES were also linked to greater medication use.

Pharmacological treatment and ECT

Abstract: Many years ago doctors used to devise their own prescriptions. The symbol used for prescribing, Rx, stands for ‘recipe’ and many early prescriptions were individual concoctions of various substances. Now, with a wide range of active and standardized drugs, prescribing has a strong scientific basis in the discipline of pharmacology. The emphasis on effective pharmacology has, however, tended to detract from other aspects of treatment, including the relationship between health worker and patient, the reduction of stress for the individual and the family and the provision of a healthy social context. Just as we now have a better understanding of pharmacology, we also have a better understanding of the psychological and social principles of non-pharmaceutical treatment. This has been dealt with in earlier chapters. Here we deal with some of the problems of prescribing medication for old people and some of the principles that can minimize these problems. For convenience we include the treatment of electroplexy in this section.

Indeling, werkingen en bijwerkingen van psychofarmaca

Abstract: Psychotropic drugs can be classified according to their chemical structures, their neurochemical characteristics, their pharmacological effects, and their clinical qualities. A categorization corresponding to their principal fields of indication results in the following classes: antipsychotic drugs, antidepressive drugs, mood stabilizers, antipanic drugs, anxiolytic drugs, anticonvulsant drugs, drugs for movement disorders, and a residual drug class. Both the chemical structure and the pharmacological properties offer clues to subdivide these psychotropic drug classes. This subdividion is clinically relevant as it corresponds to the efficacy in certain psychic and behavioural disorders and also with the occurrence of certain side effects. Desired and undesired effects are discussed in a general sense.