Showing papers on "Psychotropic drug published in 2000"
TL;DR: In this paper, the prevalence of psychotropic medications for preschool-aged children with behavioral and emotional disorders was determined by analyzing three 1-year cross-sectional data sets (for the years 1991, 1993, and 1995).
Abstract: ContextRecent reports on the use of psychotropic medications for preschool-aged
children with behavioral and emotional disorders warrant further examination
of trends in the type and extent of drug therapy and sociodemographic correlates.ObjectivesTo determine the prevalence of psychotropic medication use in preschool-aged
youths and to show utilization trends across a 5-year span.DesignAmbulatory care prescription records from 2 state Medicaid programs
and a salaried group-model health maintenance organization (HMO) were used
to perform a population-based analysis of three 1-year cross-sectional data
sets (for the years 1991, 1993, and 1995).Setting and ParticipantsFrom 1991 to 1995, the number of enrollees aged 2 through 4 years in
a Midwestern state Medicaid (MWM) program ranged from 146,369 to 158,060;
in a mid-Atlantic state Medicaid (MAM) program, from 34,842 to 54,237; and
in an HMO setting in the Northwest, from 19,107 to 19,322.Main Outcome MeasuresTotal, age-specific, and gender-specific utilization prevalences per
1000 enrollees for 3 major psychotropic drug classes (stimulants, antidepressants,
and neuroleptics) and 2 leading psychotherapeutic medications (methylphenidate
and clonidine); rates of increased use of these drugs from 1991 to 1995, compared
across the 3 sites.ResultsThe 1995 rank order of total prevalence in preschoolers (per 1000) in
the MWM program was: stimulants (12.3), 90% of which represents methylphenidate
(11.1); antidepressants (3.2); clonidine (2.3); and neuroleptics (0.9). A
similar rank order was observed for the MAM program, while the HMO had nearly
3 times more clonidine than antidepressant use (1.9 vs 0.7). Sizable increases
in prevalence were noted between 1991 and 1995 across the 3 sites for clonidine,
stimulants, and antidepressants, while neuroleptic use increased only slightly.
Methylphenidate prevalence in 2 through 4-year-olds increased at each site:
MWM, 3-fold; MAM, 1.7-fold; and HMO, 3.1-fold. Decreases occurred in the relative
proportions of previously dominant psychotherapeutic agents in the stimulant
and antidepressant classes, while increases occurred for newer, less established
agents.ConclusionsIn all 3 data sources, psychotropic medications prescribed for preschoolers
increased dramatically between 1991 and 1995. The predominance of medications
with off-label (unlabeled) indications calls for prospective community-based,
multidimensional outcome studies.
825 citations
TL;DR: Antipsychotic drugs cause QTc lengthening in a dose-related manner, and risks are substantially higher for thioridazine and droperidol, which may confer an increased risk of drug-induced arrhythmia.
557 citations
TL;DR: In this paper, the authors discuss the constraints of using Diagnostic and Statistical Manual of Mental Disorders diagnoses in randomized clinical trials (RCTs), the importance of basic and process research, the unintended negative effects of exaggerated claims of effectiveness and efficiency, the limits of RCTs in evaluating improvement and deterioration, the self-correcting nature of stepped care, the link between stepped care and empirically supported treatments, clinical judgment in clinical work, the concept of the least restrictive alternative, the costs of using low-intensity but ineffective psychosocial treatments, and costs of both ineffective and
Abstract: Several issues concerning stepped care are discussed: the constraints of using Diagnostic and Statistical Manual of Mental Disorders diagnoses in randomized clinical trials (RCTs), the importance of basic and process research, the unintended negative effects of exaggerated claims of effectiveness and efficiency, the limits of RCTs in evaluating improvement and deterioration, the self-correcting nature of stepped care, the link between stepped care and empirically supported treatments, clinical judgment in clinical work, the concept of the least restrictive alternative, the costs of using low-intensity but ineffective psychosocial treatments, and the costs of both ineffective and effective psychotropic drug therapy. An analysis of stepped care can lead to an appreciation that the dialectic operating between science and practice affords an opportunity to synthesize the seemingly irreconcilable standards and needs of researchers and clinicians.
182 citations
TL;DR: The potential risk factors for tobacco, alcohol, and illicit drug use were age, psychosomatic status and psychotropic drug consumption, boring family atmosphere, not living with both father and mother, and health perception, while Mother being a housewife was a protective factor.
Abstract: Despite abundant literature the respective roles of psychosomatic status, personality, health perception, family environment, and sport activity in tobacco, alcohol and illicit drug use have not been well known. To assess their roles, an epidemiological cross-sectional study was conducted in 3294 middle and high school adolescents, 2396 (73%) of whom agreed to participate. The standardized questionnaire was filled out by the teenagers under the supervision of the teachers. Strong associations were found between tobacco, alcohol, and illicit drug use. The prevalence of alcohol use and illicit drug use were respectively 7 and 10 times higher in smokers than in non-smokers. On the whole, the potential risk factors for tobacco, alcohol, and illicit drug use were age, psychosomatic status and psychotropic drug consumption, boring family atmosphere, not living with both father and mother, and health perception. Mother being a housewife was a protective factor. No marked role was noted for the head of family's socio-occupational category. Personality would be indicators of self-control ability. Indeed, some self-reported personalities (serious, attentive, calm, organized) had protection roles whereas some others (easily irritable, aggressive, worried, clumsy, careless, solitary, etc.) were risk factors (risk-taking or deviant behaviors). Some sports activities were found to be negatively related, but some others related positively with drug use, possibly due to repetitive meetings between the adolescents at risk. Preventive measures may be targeted at these risk factors.
144 citations
TL;DR: In dermatitis artefacta, the patient creates skin lesions to satisfy an internal psychological need, usually a need to be taken care of, which differs from that of neurotic excoriations, delusional disorders, malingering, and Munchausen’s syndrome.
Abstract: In dermatitis artefacta, the patient creates skin lesions to satisfy an internal psychological need, usually a need to be taken care of. The clinical presentation is characteristic, and differs from that of neurotic excoriations, delusional disorders, malingering, and Munchausen’s syndrome. Munchausen’s syndrome by proxy is a form of dermatitis artefacta. Except where disease is mimicked, lesions that do not conform to those of known dermatoses are shrouded in mystery, appearing fully formed on accessible skin, within the context of a characteristic psychological constellation. The patient is friendly but bewildered, and the relatives, angry and frustrated. Because of lack of diagnostic stringency, quoted female-to-male ratios range from 3: 1 to 20: 1, with the highest incidence of onset in late adolescence to early adult life. Most patients have a personality disorder; borderline features are common. The patient’s denial of psychic distress, and negative feelings aroused in healthcare personnel, make management difficult. Limit-setting for the protection of both the physician and patient; creation of an accepting, empathic, and nonjudgmental environment; and close supervision of symptomatic dermatologic care will permit development of a therapeutic relationship in which psychological issues may gradually be introduced, that may occasionally permit psychiatric referral. Issues of etiology should be sidestepped because confrontation is counter productive. When psychiatric referral is refused by the patient, the use of psychotropic drugs by dermatologists is helpful and appropriate. The upper dose range of selective serotonin reuptake inhibitors (SSRIs), or low dose atypical antipsychotic agents, may be effective. Except in mild transient cases triggered by an immediate stress, the prognosis for cure is poor. The condition tends to wax and wane with the circumstances of the patient’s life. Lesions can be kept to a minimum, the patient can be protected from unnecessary and intrusive studies, and society can be protected from escalating and unnecessary expenditure of medical resources if, rather than discharging the patient, the dermatologist continues to see the patient on an ongoing basis for supervision and support, whether or not lesions are present. Research studies are necessary to document more accurately the expectable cause, treatment outcome, and prognosis for this group of patients.
121 citations
TL;DR: Demography appears to have a minimal impact on cross-sectional prescription patterns in subjects with bipolar disorder, and data confirm that combination treatment is far more common than monotherapy.
Abstract: Introduction: Combination treatment, rather than monotherapy, is prevalent in the treatment of subjects with bipolar disorder, probably due to the complex and phasic nature of the illness. In general, prescription patterns may be influenced by the demographic characteristics of patients as well. We evaluated prescription patterns and the influence of demographic variables on these patterns in a voluntary registry of subjects with bipolar disorder. Methods: A subset of data from a larger voluntary registry was extracted for demographic variables and psychotropic medication use that had been reported in the month prior to registration by ambulatory, non-hospitalized subjects with bipolar I disorder in 1995/96 (n=457). Results: Among the thymoleptic agents, lithium was prescribed in over 50% of subjects, valproate in approximately 40%, and carbamazepine in 11% of subjects. Eighteen percent of subjects had no prescription for thymoleptic agents. Nearly one-third of all subjects were receiving antipsychotic agents, of whom two-thirds were receiving the traditional neuroleptic agents. More than half of all subjects were receiving concomitant antidepressants, of whom nearly 50% received the SSRI antidepressants and nearly 25% received buproprion. Approximately 40% of subjects received benzodiazepines. Only 18% of subjects received monotherapy, and nearly 50% received three or more psychotropic agents. In general, no associations were noted between demographic parameters including age, gender, marital or educational status, and psychotropic prescriptions. Conclusion: Consistent with the anecdotal reports, these data confirm that combination treatment is far more common than monotherapy. Demography appears to have a minimal impact on cross-sectional prescription patterns in subjects with bipolar disorder. Given that combination treatments are the rule rather than the exception, we should strive to achieve rational, yet pragmatic, treatment guidelines and algorithms to minimize the risks while maximizing the benefits of these combination treatments for patients with bipolar disorder.
110 citations
TL;DR: The evidence reviewed seems to suggest that dopamine acts, overall, to promote stimulus-induced responding for conditioned or reward-related stimuli by integrative actions at multiple forebrain sites, and the post-synaptic consequences of prolonged and supranormal dopaminergic activation need to be investigated.
Abstract: We have discussed the role of dopamine in modulating the interactions between cortical and striatal regions that are involved in behavioral regulation. The evidence reviewed seems to suggest that dopamine acts, overall, to promote stimulus-induced responding for conditioned or reward-related stimuli by integrative actions at multiple forebrain sites. It is thus not surprising that dopaminergic dysfunction has been implicated in a number of neuropsychiatric disorders that involve abnormal cognitive and affective function. Future studies aimed at pinpointing the precise anatomical sites of action and molecular mechanisms involved in dopaminergic transmission within the corticolimbic circuit are critical for trying to disentangle the cellular mechanisms by which dopamine exerts its actions. Moreover, the afferent control of dopamine neurons from brainstem and forebrain sites need to be fully explored in order to begin to understand what mechanisms are involved in regulating the dopaminergic response to stimuli with incentive value. Finally, the post-synaptic consequences of prolonged and supranormal dopaminergic activation need to be investigated in order to understand what persistent neuroadaptations result from chronic activation of this neuromodulatory system (e.g. in drug addiction). Answers to these sorts of questions will undoubtedly provide important insights into the nature of dopaminergic function in the animal and human brain.
97 citations
TL;DR: An isolated, small rise in INR is common after acetaminophen poisoning without hepatic injury and appears to be caused by inhibition of Vitamin K–dependent activation of coagulation factors, which suggests a possible mechanism for the observed interaction betweenacetaminophen and warfarin.
Abstract: Acetaminophen may increase International Normalized Ratio (INR) in patients taking anticoagulation medication, and in patients with acetaminophen poisoning without hepatic injury. The objective of this study was to describe and investigate the effect of acetaminophen on INR. The authors studied patients admitted to a regional toxicology treatment center with acetaminophen poisoning with INR and without potentially confounding coingestion or hepatic injury. Exposed and nonexposed (control) cohorts were recruited from admissions with acetaminophen poisoning and psychotropic drug poisoning, respectively. From 1,437 acetaminophen poisonings, after exclusions, there were 143 admissions with 205 estimations of INR. INR showed a time-dependent increase. Fifty percent of all patients and 66% of those with an extrapolated 4-hour acetaminophen concentration > or = 150 mg/L had an abnormal INR at some time. Dose ingested (p = 0.01) and nomogram-based risk (p for trend = 0.005) were correlated with the effect. N-acetylcysteine had a protective effect. Functional factor VII was lower (p = 0.005) in exposed patients (n = 30) than controls (n = 8), and less than antigenic factor VII in exposed patients (p = 0.03). Factor IX was lower (p = 0.02). Factor VIIIc was not significantly different. The authors concluded that an isolated, small rise in INR is common after acetaminophen poisoning without hepatic injury. It appears to be caused by inhibition of Vitamin K-dependent activation of coagulation factors. This effect suggests a possible mechanism for the observed interaction between acetaminophen and warfarin.
80 citations
TL;DR: It is concluded that cytochrome P450 activity in the brain is very low, but that psychotropic drugs could undergo a local cerebral metabolism which could have pharmacological and/or toxicological consequences.
78 citations
TL;DR: Observations support the hypothesis that seizures are the mechanism of many cases of SUDEP, and highlight the need for case-control studies of risk factors for SUDEP.
75 citations
TL;DR: The results indicate little difference between the sexes in clinical response to lithium treatment of bipolar and related affective disorders.
Abstract: OBJECTIVE: Although sex differences occur with some psychotropic drug treatments, they are not well defined for mood-stabilizing agents, including lithium. The authors’ goal was to investigate whether there are differences between the sexes in response to lithium. METHOD: Studies identified in a literature search were analyzed for reports of sex differences in clinical response to lithium in major affective syndromes. RESULTS: Data from 17 studies published in 1967–1998, involving 1,548 adults treated with lithium for a mean of 38.6 months (SD=30.5), yielded similar weighted response rates to lithium in 1,043 women (65.6% [N=684]) and 505 men (61.0% [N=308]). CONCLUSIONS: The results indicate little difference between the sexes in clinical response to lithium treatment of bipolar and related affective disorders.
TL;DR: Chlorpromazine-HCl (CPZ), an amphipathic cationic psychotropic drug of the phenothiazine group, is known to partition into lipid bilayer membranes of liposomes with partition coefficients depending on the acyl chain length and to alter the bilayer structure in a mannerDepending on the phospholipid headgroups.
TL;DR: An analytical method was developed that provided sufficient sensitivity to measure low levels of the active parent drug and the inactive metabolite, ritalinic acid, in monkey plasma as well as the ability to conveniently analyze large numbers of samples and demonstrates robust MS performance for rapid determination of MP/RA plasma levels.
Abstract: Methylphenidate (MP, Ritalin®) is a psychotropic drug widely prescribed to children for treating the symptoms of attention deficit disorder with and without hyperactivity. Because little information exists about the effects of chronic MP administration on cognitive function in children, measures of behavior changes in non-human primates are important surrogates. An essential component of such studies is the determination of MP plasma levels under chronic and acute dosing conditions. An analytical method was developed that provided sufficient sensitivity to measure low levels of the active parent drug (lower limit of quantitation = 0.25 ng/mL) and the inactive metabolite, ritalinic acid (RA), in monkey plasma as well as the ability to conveniently analyze large numbers of samples. The method uses a polymeric reversed-phase sorbent for solid phase extraction, an efficient reverse-phase high performance liquid chromatography (HPLC) separation, deuterated internal standards for isotope dilution quantification of MP and RA, and detection by sensitive electrospray ionization mass spectrometry (ES-MS) with a single quadrupole instrument. The method responses are linear over the range of plasma concentrations of MP and RA observed in monkeys, gives respective analyte recoveries of 75 and 60% with reasonable precision and accuracy, and demonstrates robust MS performance for rapid determination of MP/RA plasma levels. The average peak MP concentration (ca. 16 ng/mL) and half-lives for MP and RA elimination in monkeys (1.79 and 2.31 h, respectively) were not significantly different under acute vs. chronic dosing conditions and were comparable to values previously reported from human studies. Copyright © 2000 John Wiley & Sons, Ltd.
TL;DR: The purpose of this paper is to review the research on the relationships among ethnicity, culture, neuropsychiatric diagnosis, and treatment and study cross-ethnic differences and similarities in biological markers of mental illness.
Abstract: The purpose of this paper is to review the research on the relationships among ethnicity, culture, neuropsychiatric diagnosis, and treatment. Psychiatric nurses provide care to an ethnically and culturally diverse group of clients. Knowledge of ethnic and cultural differences are essential to diagnosis and treatment. Ethnic diversity affects psychiatric diagnosis. Cross-ethnic differences in genetics, diet, environmental exposure, and fetal, childhood, and adolescent development may result in varied experiences of psychiatric illness among ethnic groups. Ethnic diversity also affects psychiatric treatment. There are dramatic ethnic differences in the metabolism of psychotropic medications and the effects of drugs on target organs. These differences are again due to genetic variation, exposure to different diets and environments, and other medications in use. Cultural diversity influences both diagnosis and treatment. Cultural forces shape symptom formation and the expression of distress, creating many sources for misdiagnosis based on DSM-IV criteria. The culture-bound syndromes represent unique illness forms with a natural history distinct from DSM classification. Culture also influences treatment expectations, therapeutic compliance, family involvement, and the interpretation of side effects, all of which help determine whether or not treatment will be effective. Neuropsychiatric nurses can contribute to research by studying cross-ethnic differences and similarities in biological markers of mental illness. A second significant area for research is that of ethnicity and psychotropic drug metabolism and pharmacodynamics.
TL;DR: Three studies are reviewed to demonstrate the suitability of WAY as radioligand for quantification of central 5-HT(1A) receptors in brain and as an applicable tool for drug development and corroborate that quantitative neuroimaging of receptor binding has potential for the evaluation and dose finding of new central nervous system drugs.
TL;DR: The authors examine the advertisements for psychotropic drugs in the major medical journals of Denmark, Finland, Norway, and Sweden in 1975, 1985, and 1995, with the object of illuminating the gender construction of the portrayed user.
Abstract: The authors examine the advertisements for psychotropic drugs in the major medical journals of Denmark, Finland, Norway, and Sweden in 1975, 1985, and 1995, with the object of illuminating the gender construction of the portrayed user. Using both a longitudinal and a cross-sectional approach, the study looked for a common Nordic gender display and whether it varied over time. The Nordic journals clearly conveyed a message that psychotropics are a gendered product, but without any uniform pattern. In 1975, men dominated the gender portrayals in Finland and Denmark, and women in Norway and Sweden. In 1985, the pattern was reversed: women dominated in Finland and Denmark, and men in Sweden and Norway. By 1995, the advertisements were mainly for antidepressants, and women were portrayed as the predominant users in Denmark, Finland, and Norway; the Swedish journal displayed couples only. In advertisements with dual-gender positions, however, the focus was on the female; they showed that the drug would assist h...
TL;DR: Results support the position that psychotropic medications, introduced slowly in low to moderate doses, can be safely used in epilepsy patients with comorbid psychiatric pathology during the regular course of clinical care.
Abstract: Physicians are often reluctant to use psychotropic medications in epilepsy patients with psychiatric disorders because of concern over the potential risk for lowering seizure threshold. This study assesses retrospectively the impact of psychotropic medications on seizure frequency in 57 patients seen consecutively at an epilepsy center. During psychotropic drug therapy, seizure frequency decreased in 33% of patients, was unchanged in 44%, and increased in 23%. Mean seizure frequency was not statistically different between pre-treatment and treatment periods (t = 0.23, df = 56). Simultaneous adjustments in antiepileptic drug regimen could not account for the findings. Results support the position that psychotropic medications, introduced slowly in low to moderate doses, can be safely used in epilepsy patients with comorbid psychiatric pathology during the regular course of clinical care.
TL;DR: In this article, a study aimed to determine if self-reported social support and life events explained differences in levels of anxiety and depression among 109 elderly psychotropic drug users compared to 90 nonusers (aged 62 to 98).
Abstract: This study aimed to determine if self-reported social support and life events explained differences in levels of anxiety and depression among 109 elderly psychotropic drug users compared to 90 nonusers (aged 62 to 98). Two thirds of the respondents were French-speaking, mostly female (82.1%) and widowed (57.4%), and recipients of a home care program in Montreal, Canada. The life event and social support scales, broken down by item value, did not differentiate users from nonusers, except for feelings of loneliness reported by 40% of users compared to only 16% of nonusers (p < .001). Analysis of the relation between psychiatric symptomatology and psychosocial variables, broken down by item value, showed greater sensitivity among users to perceived (subjective) lack in social support. In contrast, only “feelings of loneliness” had an effect on the level of mental health of nonusers. There was no effect with regard to objective items of social support.
TL;DR: The seizure threshold measured by set charge did not change in 15 patients, and there was no significant relation betweenchange in seizure threshold and patient sex, change in seizure duration measured by cuff technique, or global clinical improvement during the course of treatment.
Abstract: Seizure threshold was measured by empirical titration in 28 patients referred for bilateral electroconvulsive therapy to treat depressive illness at the outset of treatment and after another six treatments. No patient was given antiepileptic drug treatment, and anesthetic technique and concomitant psychotropic drug treatment were fixed. The average (+/- SD) initial seizure threshold measured by set charge was 79.5 mC (+/- 33.4 mC), and this increased to 95.5 mC (+/- 37.9 mC). The average percentage increase was 22.8% (95% confidence interval, 13.7% to 31.8%). The seizure threshold measured by set charge did not change in 15 patients (54%), and there was no significant relation between change in seizure threshold and patient sex, change in seizure duration measured by cuff technique, or global clinical improvement during the course of treatment.
TL;DR: In the face of a continuing rise in deliberate self-poisoning, which is effecting both urban and rural areas, care should be taken to prescribe the least toxic agent available as this is associated with likely frequency of self-Poisoning for most classes of psychotropic drug.
Journal Article•
TL;DR: An intermediate level of analysis is proposed between psychiatric symptoms and pharmacologic modes of action, in which psychiatric illness is progressively reclassified through knowledge in clinical neuroscience and treatment targets are revised accordingly.
Abstract: 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.
TL;DR: Using Kansas Medicaid data for 1995-1996, a methodology to apply pharmacoepidemiological research toward understanding and improving psychotropic drug use among children enrolled in Medicaid found disproportionate numbers of children receiving psychotropic drugs who were young boys and larger numbers of white children receivingPsychotropic prescriptions relative to their Medicaid enrollment than either African-American or Hispanic children.
Abstract: This study's objective was to develop a methodology to apply pharmacoepidemiological research toward understanding and improving psychotropic drug use among children enrolled in Medicaid. Using Kansas Medicaid data for 1995-1996, we summarized drug claims, diagnoses, and demographics for children under 20 who received at least one psychotropic drug prescription over either year. The sequence of steps needed to assure a quality improvement role is discussed. Use of key personnel in less regulatory and more clinical data applications is critical. Illustrating this approach, we found disproportionate numbers of children receiving psychotropic drugs who were young boys and larger numbers of white children receiving psychotropic prescriptions relative to their Medicaid enrollment than either African-American or Hispanic children. Medicaid agencies can expand epidemiological capacity to understand service use among segments of the population they insure as part of an overall commitment to improving quality.
Journal Article•
TL;DR: The authors summarize the potential interactions of psychoactive drugs with cardiovascular medications, and an awareness of these interactions will improve knowledgeable prescribing for medically ill patients with comorbid mental disorders.
Abstract: Recent advances in our understanding of the hepatic cytochrome P450 inhibitory effects of the newer antidepressants have increased concern about drug interactions in the practice of psychiatry. The authors summarize the potential interactions of psychoactive drugs with cardiovascular medications. Practicing psychiatrists encounter many patients with cardiovascular disease, and an awareness of these interactions will improve knowledgeable prescribing for medically ill patients with comorbid mental disorders.
TL;DR: Correlations between drug dosage and plasma drug levels were significant for haloperidol and thioridazine, but not for lorazepam, and prolactin levels decreased when participants were on placebo.
Abstract: This study aimed to characterize the relationships between administered dosages of psychotropic drugs, plasma drug concentration, and prolactin levels in a group of elderly nursing home residents. In a randomized, placebo-controlled, double-blind crossover design study, blood samples were drawn from 47 nursing home residents at least 6 hours after taking either haloperidol, thioridazine, or lorazepam. Correlations between drug dosage and plasma drug levels were significant for haloperidol and thioridazine, but not for lorazepam. Plasma drug levels were below the levels of detection for most of those taking haloperidol. Lorazepam was detected in the blood of 4 of the participants even after 3 weeks of downward titration to placebo and 6 weeks of placebo. Prolactin level was related to administered dosage only in those who were taking haloperidol. For those taking haloperidol or thioridazine, prolactin levels decreased when participants were on placebo. When an older person is taken off lorazepam, the possibility of residual drug in their bodies even 6 weeks after termination of drug use should be considered. Haloperidol may be clinically active in the brain despite no currently detectable plasma drug concentration.
Journal Article•
TL;DR: Les nouveaux neuroleptiques, antidepresseurs, thymoregulateurs et certaines benzodiazepines ouvrent manifestement des perspectives bien plus favorables au traitement de ces jeunes patients.
Abstract: La psychopharmacologie en psychiatrie de l'adolescence reste aujourd'hui largement determinee par l'experience personnelle de chaque clinicien, son appreciation de l'amelioration clinique et des effets secondaires, et l'extrapolation enfin des etudes realisees chez l'adulte. Cependant quelques etudes medicamenteuses commencent a etre realisees en pedopsychiatrie. Les nouveaux neuroleptiques, antidepresseurs, thymoregulateurs et certaines benzodiazepines ouvrent manifestement des perspectives bien plus favorables au traitement de ces jeunes patients. Mais c'est la qualite du contexte meme de la prescription, la prise en compte des particularites de l'adolescence et de sa psychopathologie: tant pour l'indication que pour mettre en oeuvre et conduire le traitement, qui peuvent garantir la reussite de l'ensemble du traitement. Nous soulignons dans cet article l'interet des prises en charge bifocales pour les adolescents qui presentent les troubles les plus graves et justifient de traitements medicamenteux.
TL;DR: Fluorine‐19 NMR spectra were acquired from extracts of tissues from heads of rats given the antipsychotic drug trifluoperazine, and multiple resonances in vitro partially explain the relatively large line width seen in vivo for TFP.
Abstract: Fluorine-19 NMR spectra were acquired from extracts of tissues from heads of rats given the antipsychotic drug trifluoperazine (TFP). Contributions to the in vivo 19F spectra from tissues other than brain were negligible. The in vivo 19F resonance at -62.3 ppm from CCl3F consisted of 6–8 resolved resonances in vitro. Some in vitro resonances were assigned to previously identified TFP metabolites. Multiple resonances in vitro partially explain the relatively large line width seen in vivo for TFP. Unidentified metabolites were observed at about -74 to -75 ppm in a number of spectra of extracts of brain and muscle. Magn Reson Med 43:756–759, 2000. © 2000 Wiley-Liss, Inc.
TL;DR: It is indicated that the most effective technique to produce plasma concentrations of alprazolam that are reproducible, clinically pertinent, and consistent between rats is to incorporate the drug into a liquid diet.
Abstract: Rationale: Benzodiazepines are effective in the treatment of anxiety disorders over a prolonged period of time. This results in relatively stable plasma concentrations over the course of a day. However, due to differences in drug clearance in rats, which generally metabolize and clear drugs much more rapidly than humans, it is difficult to model this steady level in rats. Objectives: Several methods of chronic alprazolam administration were compared to determine which would best result in reproducible, therapeutically relevant levels of the drug. Methods: Male Sprague-Dawley rats were administered alprazolam via two subcutaneous routes, Alzet 2ML2 osmotic minipumps and commercially produced slow-release pellets, for 1 week and 2 weeks, respectively. Additionally, alprazolam was orally administered for 2 weeks by mixing the compound into a commercially available liquid, fat emulsion-based diet. The use of silastic implants to deliver several different benzodiazepines was also evaluated in vitro. Results: Following 7 days of alprazolam administration at 2 mg/kg per day via osmotic minipump, plasma concentrations in ten identically treated rats ranged from <1 ng/ml to 97 ng/ml. Slow-release pellets produced more consistent plasma concentrations, but were only minimally effective at raising plasma concentrations. In vitro studies utilizing silastic implants containing 90 mg drug in 6 cm of tubing revealed stable release of only 45–55 µg/day alprazolam versus 625–650 µg/day diazepam. In contrast to these methodologies, incorporation of alprazolam into a commercially available liquid diet (~25–150 mg/kg per day) provided consistent, dose-dependent increases in plasma concentrations of alprazolam and its metabolites in a range appropriate for mimicking clinical exposure. Conclusions: These findings indicate that the most effective technique to produce plasma concentrations of alprazolam that are reproducible, clinically pertinent, and consistent between rats is to incorporate the drug into a liquid diet. These findings may also be of value in determining dosing routes for other benzodiazepines or psychotropic drugs.
TL;DR: There is recognition in Australian hospitals that DUE is a valuable tool for improving prescribing practice, and to progress DUE it is critical to advance and standardise hospital systems and in particular to introduce electronic prescribing.
Abstract: Objective: To gain an insight into current practice of drug audit/drug usage evaluation (DUE) in Australian hospitals with a particular focus on psychotropic drugs. Method: All Australian hospitals with greater than 150 beds were surveyed by questionnaire to ascertain the level of drug audit activity and the strategies used to support quality prescribing. Twenty two pharmacists from 18 different hospitals in 5 States participated in a structured follow-up interview. Results: Pharmacists from 73 (49%) of the 150 hospitals surveyed responded. Drug audit activity varied widely across hospitals and did not necessarily relate to the size or demographics of the hospital. While there was increasing use of well-structured DUE, simple one-day 'snapshots' of drug usage were also common. Interviewees reported that the focus of DUE was primarily on cost containment, with a secondary element of quality prescribing. Pharmacists were closely involved, but little training or additional resources were provided for these activities. Successful DUE was seen to depend heavily on hospital culture and in particular on the support of key clinicians and senior managers. Psychotropic drug audit was not a high priority for DUE outside the stand-alone psychiatric institutions. Lack of resources and incentives coupled with inadequate information technology have limited DUE progress. Conclusion: There is recognition in Australian hospitals that DUE is a valuable tool for improving prescribing practice. To progress DUE it is critical to advance and standardise hospital systems and in particular to introduce electronic prescribing. In addition there is scope to improve policy agendas relating to accreditation requirements and national standards to enhance the development of DUE. (author abstract)