Showing papers on "Psychotropic drug published in 2002"

Effects of psychotropic drugs on seizure threshold.

Abstract: Psychotropic drugs, especially antidepressants and antipsychotics, may give rise to some concern in clinical practice because of their known ability to reduce seizure threshold and to provoke epileptic seizures. Although the phenomenon has been described with almost all the available compounds, neither its real magnitude nor the seizurogenic potential of individual drugs have been clearly established so far. In large investigations, seizure incidence rates have been reported to range from ∼0.1 to ∼1.5% in patients treated with therapeutic doses of most commonly used antidepressants and antipsychotics (incidence of the first unprovoked seizure in the general population is 0.07 to 0.09%). In patients who have taken an overdose, the seizure risk rises markedly, achieving values of ∼4 to ∼30%. This large variability, probably due to methodological differences among studies, makes data confusing and difficult to interpret. Agreement, however, converges on the following: seizures triggered by psychotropic drugs are a dose-dependent adverse effect; maprotiline and clomipramine among antidepressants and chlorpromazine and clozapine among antipsychotics that have a relatively high seizurogenic potential; phenelzine, tranylcypromine, fluoxetine, paroxetine, sertraline, venlafaxine and trazodone among antidepressants and fluphenazine, haloperidol, pimozide and risperidone among antipsychotics that exhibit a relatively low risk. Apart from drug-related factors, seizure precipitation during psychotropic drug medication is greatly influenced by the individual’s inherited seizure threshold and, particularly, by the presence of seizurogenic conditions (such as history of epilepsy, brain damage, etc.). Pending identification of compounds with less or no effect on seizure threshold and formulation of definite therapeutic guidelines especially for patients at risk for seizures, the problem may be minimised through careful evaluation of the possible presence of seizurogenic conditions and simplification of the therapeutic scheme (low starting doses/slow dose escalation, maintenance of the minimal effective dose, avoidance of complex drug combinations, etc.). Although there is sufficient evidence that psychotropic drugs may lower seizure threshold, published literature data have also suggested that an appropriate psychotropic therapy may not only improve the mental state in patients with epilepsy, but also exert antiepileptic effects through a specific action. Further scientific research is warranted to clarify all aspects characterising the complex link between seizure threshold and psychotropic drugs.

Design and reporting modifications in industry-sponsored comparative psychopharmacology trials.

Abstract: This review of recently published pharmaceutical industry-sponsored comparative psychotropic drug trials aims to classify apparent design and reporting modifications that favor the sponsor's product. The modifications have been grouped into 13 discrete categories, and representative examples of each are presented. Strong circumstantial evidence suggests that marketing goals led to these adjustments. The consequences of marketing influences on comparative psychopharmacology trials are discussed in terms of conflicts of interest, the integrity of the scientific literature, and costs to consumers, as well as their impact on physician practice.

The reproductive safety profile of mood stabilizers, atypical antipsychotics, and broad-spectrum psychotropics

Abstract: There has been growing concern about the potential iatrogenic effects of several newer psychotropic drugs on reproductive health safety in women. Areas of particular concern in this regard include (1) controversies about a potential association between the use of valproate and development of polycystic ovary syndrome (PCOS), (2) the safety of use of newer psychotropic medications during pregnancy, and (3) safety issues with these medications in women while breastfeeding. This review summarizes current information about each of these areas. In particular, existing data suggest that (1) PCOS very likely represents a complex neuroendocrine disorder with multiple determinants; (2) menstrual irregularities may be a frequently seen phenomenon in women with bipolar illness, at least partially independent of psychotropic drug therapy; (3) potential central nervous system teratogenicity remains substantial during first-trimester exposure to valproate or carbamazepine; (4) with newer agents used for bipolar disorder and schizophrenia, safety data during pregnancy, while not definitive, are most abundant with olanzapine and with lamotrigine; relatively less is known about systematic pregnancy outcomes with other atypical antipsychotics or newer anticonvulsants; and (5) risks for neonatal safety during lactation continue to appear substantial with lithium, are of potential concern with lamotrigine and clozapine, are quite likely minimal with valproate or carbamazepine, and are indeterminate with most other new anticonvulsants or atypical antipsychotics. Recommendations are presented for clinical management in each of these instances.

Psychotropics among the home-dwelling elderly: increasing trends

Abstract: Objective To assess the level of and changes in the use of psychotropics among the home-dwelling elderly in the 1990s. Methods A descriptive analysis based on data from two cross-sectional interview and health examination surveys of elderly persons aged 64 years or over conducted in Lieto, a typical semi-rural Finnish municipality, in 1990–91 and 1998–99. National prescription data were utilized to compare the use of psychotropics in the late 1990s by all Finnish home-dwelling elderly and the elderly in Lieto. In Lieto drug information was obtained from 1131 persons in 1990–91 and from 1197 in 1998–99, and the mean age of the informants was 73 years in both surveys. The brand names of the prescription drugs (both irregular and regular medication) taken by each interviewee during seven days prior to the interview were recorded and categorized by the Anatomical Therapeutic Chemical (ATC) classification system. Results Every fourth person was taking at least one psychotropic drug in both surveys. Most users were on regular psychotropic medication. The use of hypnotics and antidepressants increased most during the study period. Polypharmacy and the use of psychotropics were most prevalent among those aged 85 years or over, with women predominating. Concomitant use of two or more psychotropics increased statistically significantly from 7% to 10% between the surveys. The young elderly, aged 64–71 years, used cyclic antidepressants equally commonly in both surveys. None of the young elderly used new atypical antipsychotics in 1998–99. Conclusions Psychotropics tend to be overprescribed and overused among the elderly, a group at the highest risk of adverse drug reactions. The tendency of prescribing for the elderly is not going in a better direction. New-generation psychotropics were not used. The need for long-standing use of psychotropics should be assessed regularly. Copyright © 2002 John Wiley & Sons, Ltd.

Psychotropic medication use in a population of children who have attention-deficit/hyperactivity disorder.

Abstract: Objective. Recent reports suggest a trend of increasing prevalence of psychotropic drug prescriptions among children with attention-deficit/hyperactivity disorder (ADHD); however, reasons for the increased use of such medications is unclear. The objectives of this study were to examine differences in nonstimulant psychotropic medication fills between children with and without identified ADHD and to assess associations with non-ADHD neurobehavioral disorders. Methods. A population-based retrospective matched cohort study was conducted of a large group model health maintenance organization located in western Washington State. Eligible patients were children who were ages 3 to 17 years and were continuously enrolled and used services from January 1 to December 31, 1997 (N = 57 216). Children with ADHD were identified by a diagnosis of ADHD or a pharmacy fill for a stimulant medication using automated patient files. Children without ADHD were randomly selected and matched 4:1 to children with ADHD on age and gender. Neurobehavioral disorders and pharmacy fills for psychotropic medications were measured. Results. During 1997, 2992 children were identified as having ADHD (5.2%). These children were more likely to have a diagnosis of a non-ADHD neurobehavioral disorders (adjusted odds ratio: 6.3; 95% confidence interval: 5.4–7.3) than children without ADHD. Although most (78%) were treated with stimulant medications, children who were identified as having ADHD were also more likely to receive pharmacy fills for nonstimulant medications than were children without ADHD. Nonstimulant medications were more often used along with stimulant medications and were frequently prescribed in association with ADHD after controlling for other disorders. Conclusions. Children who were identified as having ADHD were more likely to have a diagnosis of other neurobehavioral disorders and to receive nonstimulant psychotropic medications than were children without ADHD. Because many of these drugs have little or no empirical basis in the treatment of ADHD, the rationale for their use is less clear. Future research to examine the use, effectiveness, and safety of these medications alone and in combination in children with ADHD is urgently needed.

Ethnomedicine and drug discovery

Abstract: Introduction, M. Iwu drugs from nature - past achievements, future prospects, G. Cragg, D.J. Newman natural products for high throughput screening, A.L. Harvey medical ethnobotanical research as a method to identify bioactive plants to treat infectious diseases, T.J.S. Carlson development of Herbmedr, an interactive, evidence-based herbal database, J. Wootton natural products - a continuing source of inspiration for the medicinal chemist, S. Mbua Ngale Efange integrating African ethnomedicine into primary healthcare - a framework for South-Eastern Nigeria, Chioma Obijiofor current initiatives in the protection of indigenous and local community knowledge - problems, concepts and lessons for the future, R. Lettington bioprospecting - using Africa's genetic resources as a new basis for economic development and regional cooperation, A. Onugu balancing conservation with utilization - restoring populations of commercially valuable medicinal herbs in forests and agroforests, R.A. Cech ethnomedicine of the Cherokee - historical and current applications, J. Jo traditional medicines and the new paradigm of psychotropic drug action, E. Elisabetsky drug discovery through ethnobotany in Nigeria - some results, J.I. Okogun plants, products and people - Southern African perspectives, N. Gericke development of antimalarial agents and drugs from parasitic infections based on leads from traditional medicine - the Walter Reed experience, B.G. Schuster health foods in anti-aging therapy - reducers of physiological decline and degenerative diseases, L. Meserole indigenous peoples and local communities embodying traditional lifestyles. (Part Contents). definitions under article 8(j) of the Convention on Biological Diversity (K. Moran). 17. Garcinia kola a new look at an old adaptogenic agent (M.M. Iwu, A. Duncan Diop, L. Meserole, C.O. Okunji). 18. Linking intellectual property rights with traditional medicine (M.A. Gollin). 19. The use of conservation trust funds for sharing financial benefits in bioprospecting projects (M. Guerin-McManus, K.C. Nnadozie, S.A. Laird).

Pharmacogenetics of Psychotropic Drugs

Abstract: Part I. Introduction: 1. Genes and psychopharmacology: exploring the interface Bernard Lerer Part II. Clinical Background and Research Design: 2. From pharmacogenetics to pharmacogenomics of psychotropic drug response Anil K. Malhotra 3. Neuropsychopharmacology: the interface between genes and psychiatric nosology Thomas A. Ban 4. Methodological issues in psychopharmacogenetics Sheldon H. Preskorn 5. Statistical approaches in psychopharmacogenetics Fabio Macciardi Part III. Molecular Background: 6. The psychopharmacogenetic-neurodevelopmental interface in serotonergic gene pathways K. Peter Lesch, Jens Benninghoff and Angelika Schmitt 7. RNA processing regulation and interindividual variation Colleen M. Niswender and Linda K. Hutchinson Part IV. Pharmacokinetics: 8. Pharmacogenetics of psychotropic drug metabolism Vural Ozdemir, Angela D. M. Kashuba, Vincenzo S. Basile and James L . Kennedy 9. Pharmacogenetics of chiral psychotropic drugs Pierre Baumann and Chin B. Eap Part V. Specific Psychotropic Drugs and Disorders: 10. Clozapine response and genetic variation in neurotransmitter receptor targets David A. Collier, Maria J. Arranz, Sarah Osborne, Katherine J. Aitchison, Janet Munro, Dalu Mancama and Robert W. Kerwin 11. Genetic factors underlying drug-induced tardive dyskinesia Ronnen H. Segman and Bernard Lerer 12. Functional gene-linked polymorphic regions in pharmacogenetics Marco Catalano 13. Alternative phenotypes and the pharmacogenetics of mood and anxiety disorders Emanuela Mundo and James L. Kennedy 14. Pharmacogenetics of anxiolytic drugs and the GABA-benzodiazepine receptor complex Smita A. Pandit, Spilios V. Argyropoulous, Patrick G. Kehoe and David J. Nutt 15. Genetic factors and long-term prophylaxis in bipolar disorder Martin Alda 16. Genetic influences on responsiveness to anticonvulsant drugs Thomas N. Ferraro 17. Apolipoprotein E as a marker in the treatment of Alzheimer's disease Keith Schappert, Pierre Sevigny and Judes Poirier 18. Genetic variation and drug dependence risk factors Joel Gelernter and Henry Kranzler Part VI. Pharmacogenetics and Brain Imaging: 19. Brain imaging and pharmacogenetics in Alzheimer's disease and schizophrenia Steven G. Potkin, James L. Kennedy and Vincenzo S. Basile Part VII. Industry perspectives: 20. Pharmacogenetics in psychotropic drug discovery and development William Z. Potter, AnnCatherine Van Lone and Larry Altstiel 21. High-throughput single nucleotide polymorphism genotyping Anne Shalom and Ariel Darvasi Index.

The quality of psychotropic drug prescribing in patients in psychiatric units for the elderly.

Abstract: The quality of written prescriptions has not been examined in a psychiatric setting. The aim of this study was to examine the quality of drug prescribing by medical staff for elderly patients hospitalized with dementia in comparison with the quality of prescribing for elderly patients hospitalized for functional psychiatric illness (depression, anxiety and psychosis). We studied a cohort of 112 elderly psychiatric inpatients in two hospitals over a seven-year period. A standardized assessment sheet was used to assess 320 prescriptions of psychotropic drugs, using medical notes and drug charts. Patients with dementia and functional illness were defined by ICD-9 or ICD-10 criteria. Severity of illness was measured by the presence or absence of symptoms in six discrete symptom clusters. Two raters examined prescription quality. Twenty percent of prescriptions for patients with dementia were illegible, significantly higher than in functional illness. In both groups, among prescriptions of regular medication, ...

Utilization of psychotropic drugs in Taiwan: an overview of outpatient sector in 2000.

Abstract: Background Development of pharmacological treatment in mental disorders has risen drastically over the past decade in Taiwan. We performed a survey of the National Health Insurance claims for outpatient psychiatric services to study the utilization of psychotropic drugs. The analysis followed the drug classification and standardized measurements proposed by the World Health Organization. Methods The sampling datasets from the National Health Insurance Research Database served as data sources. They represented 0.2% of the entire claims for outpatient medical services in 2000. The measurement units used for psychotropic drugs were either prescription volumes (drug items) or the number of defined daily doses (DDDs). To estimate the proportion of the population treated daily with psychotropic drugs, numbers of DDDs per 1000 inhabitants per day were also calculated. Beside overall description, the data of psychotropic substance prescriptions were analyzed by stratifying patient's age, physician's specialty, accreditation status of hospital, and chemical subgroup of psychotropic drugs. Results Prescription of psychotropic drug items (n = 63,539) was 3.24% of the total drug items (n = 1,958,820) claimed. The psychotropic drugs were prescribed to 9.2% of the total patients and in 9% of the total visits. Major consumers of psychotropic drugs were between 35-74 years of age and there were more women than men. The psychiatrist was the largest group of physicians who had prescribed psychotropic drugs and contributed 18.5% of all drug items and 38.3% of total DDDs of psychotropic drugs. The number of DDDs per 1000 inhabitants per day for all kinds of psychotropic drugs was estimated to be 32.94 in Taiwan, where anxiolytics accounted 14.30, hypnotics and sedatives 10.64, antipsychotics 3.41, antidepressants 3.06 and mood stabilizers 1.43. Ordered by total DDDs, the top 10 most frequently used chemical substances were flunitrazepam, alprazolam, fludiazepam, oxazolam, lorazepam, diazepam, zolpidem, estazolam, zopiclone, and haloperidol. Conclusions The usage level of psychotropic drugs in Taiwan was lower than in most industrialized countries, especially for antidepressants. The future goals are to focus on the longitudinal analysis of general trend for each psychotropic substance and to associate the pharmacoepidemiological data in parallel with the upcoming epidemiological study of mental disorders in Taiwan.

Relationships between serum magnesium levels and clinical background factors in patients with mood disorders

Abstract: We measured serum magnesium (Mg) levels in 71 in-patients and out-patients with mood disorders and in 30 healthy controls and investigated the relationships between serum Mg levels and clinical background factors. Serum Mg levels were found to be significantly higher in patients with mood disorders than in controls. Serum Mg levels showed no significant correlation with patient sex, age, diagnosed subtype and disease phase in the mood disorder group. Serum Mg levels in patients with major depressive disorder who were taking psychotropic drugs were not significantly different from levels seen in patients with major depressive disorder who were not taking psychotropic drugs. These results suggest that the high serum Mg levels noted in patients with mood disorder are related to the underlying disorder itself and are not influenced by clinical background factors.

Citalopram-induced severe hyponatraemia with coma and seizure: Case report with literature and spontaneous reports review

Abstract: Numerous case reports of hyponatraemia followed increasing use of selective serotonin re-uptake inhibitors (SSRIs) but this adverse effect was only rarely observed in relation to citalopram. We report a case of severe hyponatraemia associated with deep coma, seizure, atrial fibrillation and muscle damage in a 92-year-old woman after only two doses of citalopram, and review 14 cases previously published in the literature and 28 cases spontaneously reported to Australian Drug Reaction Advisory Committee (ADRAC). The data presented suggest that citalopram, as well as SSRIs may cause hyponatraemia secondary to syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The majority of symptomatic cases occurred in elderly patients (79% were older than 70 years) and in women (74%). Polymedication and concomitant use of another psychotropic drug or thiazide diuretic may precipitate and/or augment the development of hyponatraemia/SIADH. In 84% of cases, the hyponatraemia associated with citalopram was detected during the first month of treatment. High level of suspicion, close and careful monitoring of serum sodium concentration particularly in elderly patients and especially in the first month of therapy with citalopram may reduce the incidence of this serious and likely not rare adverse effect.

The prescribing of psychotropic drugs in mental health services in Trinidad

Abstract: Objective. To describe, analyze, and interpret patterns of psychotropic drug prescribing in new psychiatric patients attending psychiatric outpatient clinics in the Caribbean island of Trinidad. Design and Methods. This was a cross-sectional study of psychotropic drug prescribing by psychiatrists for 132 new psychiatric outpatients who were seen at the outpatient clinics surveyed and who were entering the mental health system during the period of research, November 1998 through February 1999. Results. A single patient could be prescribed more than one psychotropic drug. Antidepressant drugs were the class of psychotropic drugs most prescribed (79 of 132 patients, 59.8%), followed by antipsychotic drugs (67 of 132 patients, 50.8%). Tricyclic antidepressants (TCAs) were the antidepressants most prescribed (58 of the 79 patients), mainly amitriptyline (53 of the 58). Fluoxetine was the only selective serotonin reuptake inhibitor (SSRI) prescribed (21 of the 79 patients prescribed antidepressants). Of the 67 patients receiving antipsychotic drugs, phenothiazines accounted for 41 of those 67, including trifluoperazine (14 of the 41) and thioridazine (13 of the 41). The individual antipsychotic most prescribed was sulpiride (21 of the 67 patients). Anticholinergic drugs were prescribed to 20 of the 132 patients (15.1%). Eighty-three of the patients were prescribed more than one drug concomitantly (either more than one psychotropic or a combination of psychotropic(s) and nonpsychotropic(s)). Prescription by ethnicity, age, and gender coincided with the morbidity rates encountered in these patients. The prescribing of SSRIs to persons of African or East Indian ethnicity was significantly lower than it was for persons of mixed heritage. Conclusions. The prescription patterns of psychotropic drugs in Trinidad revealed the psychiatrists' preferences for traditional psychotropic drugs, the moderate use of anticholinergic drugs, and polypharmacy in some cases, with probable predisposition to adverse drug reactions. Given our results and based on the evaluation of individual patients, consideration should be given to a broader use of the newer antidepressants (SSRIs) and antipsychotics. Unless justified, polypharmacy should be avoided.

No long-term effect of behavioral treatment on psychotropic drug use for agitation in Alzheimer's disease patients.

Abstract: To determine if teaching caregivers behavior management techniques (BMTs) reduces long-term psychotropic use in Alzheimer's disease (AD) patients, we examined 12-month follow-up data from a 4-month randomized study com paring placebo, BMTs, trazodone, and haloperidol for the treatment of agitated behaviors in persons with AD. After 4 months, treatment was allowed with any agent. Between 42.8% and 51% of AD patients received additional psy chotropics between 4 and 12 months. The relative risk of being prescribed any psychotropic drug after the 4-month trial was at or about 1.0 for subjects in each drug arm or placebo arm versus BMTs. We concluded that teaching caregivers BMTs did not diminish long-term prescription of psychotropic drugs. (J Geriatr Psychiatry Neurol 2002; 15:95-98).

Traditional medicines and the new paradigm of psychotropic drug action.

Abstract: The pharmaceutical industry exploits traditional remedies for the development of new drugs, especially chasing for unusual molecules with interesting and innovative mechanisms of action. Even when traditional formulations – rather than just plant species – are taken into consideration, traditional medical systems are not regarded as potential sources of new paradigms for drug usage. Although the phytotherapy industry is more likely to innovate, and more easily accepts less conventional concepts of treatment and drug action, pharmacology as a discipline is refractory to the potential contribution of ethnopharmacology. These complex patterns suggest that the effects of plant drugs may often be based on a more diverse pharmacodynamic basis than the usual understanding of drug/effect relationships. In fact, the unusual pharmacological activity observed with plant formulations may result from effects of more than one active ingredient, from drug interactions among ingredients, from active ingredients possessing multiple mechanisms of action, or even from interference with targets not yet recognized by the current biomedical understanding of cell biology modulation. This paper explores the idea that the understanding of traditional medical concepts of health and disease in general, and traditional medical practices in particular, can lead to true innovation in paradigms of drug usage and development. Diet, prevention, well-being maintenance, low-dose/long-term posologies, and complex mixtures, often central to traditional medical treatments, are discussed. Traditionally used adaptogens, analgesics, antipsychotics, and anticonvulsants, discussed in the light of the current understanding of drug/receptor interactions and mental disorders, are remarkably well in line with newer paradigms of psychotropic drug action and therapy.

Discovery and utilization of haplotypes for pharmacogenetic studies of psychotropic drug response

Abstract: The treatment of seriously mentally ill patients is complicated by variability in individual response to psychotropic drugs. Some patients remain treatment refractory even after two to three therapeutic modalities. Other patients experience adverse events that range from mild discomfort, to poor compliance, to life threatening. Genaissance Pharmaceuticals is actively engaged in a candidate gene-based haplotype (HAP Marker) approach to the pharmacogenetics of drug response and adverse events. In the present article, we review reasons why HAP Markers are more useful than single nucleotide polymorphisms (SNPs) for discovering genetic correlations to clinical response. In addition, we review our approach to HAP Marker discovery, which involves discovering SNPs in the functional regions of genes by sequencing, organizing these SNPs into HAP Markers for an index population of ethnically diverse individuals and calculating population frequencies for these HAP Markers. For clinical correlations, HAP Markers are defined and correlated to clinical data using the in-house DecoGen Informatics System. This approach has clear implications for the discovery of psychiatric disease-associated genes as well as for the development of safer, more efficacious psychiatric drugs.

Differential effects of high-dose amisulpride versus flupentixol on latent dimensions of depressive and negative symptomatology in acute schizophrenia: an evaluation using confirmatory factor analysis.

Abstract: While many acutely ill schizophrenic patients suffer from depressive symptoms, most studies on the efficacy of antipsychotic drugs focus on positive and negative symptoms Dimensional models of schizophrenic symptoms, based on confirmatory factor analysis (CFA) using structural equation modelling, offer a methodological alternative to compare antipsychotics on empirically justified latent factors The present report is a refined analysis of a published double-blind study on the D 2 /D 3 -selective antagonist amisulpride (ASP) versus the mixed D 1-5 /5-HT 2 antagonist flupentixol (FPX) CFA was applied to Brief Psychiatric Rating Scale, Scale for the Assessment of Negative Symptoms, Bech-Rafaelsen Melancholia Scale and Simpson-Angus Scale subscores to examine differential effects of high doses of ASP and FPX on negative and depressive symptom dimensions in 126 acutely ill schizophrenic patients A four-factor model comprising the full spectrum of acute symptomatology and a three-factor model ('negative', 'anhedonia-apathy', 'depressive') restricted to negative and depressive symptoms were yielded with an identical 'depressive'dimension in both models Analyses of CFA-derived factor scores showed that ASP was significantly superior to FPX regarding the latent 'depressive' dimension, independent of baseline scores, dosage and changes in akinesia Neither the negative' dimension nor 'anhedonia-apathy' showed significantly different treatment effects CFA-based analyses appear to be suitable for psychotropic drug evaluation when more refined and data-related information on drug efficacy profiles are required

Les attitudes d'autonomie dans l'observance thérapeutique d'une cohorte de consommateurs continus de psychotropes

Abstract: Prescriptions for psychotropic drugs are part of a general practitioner's daily routine. As with all drugs, they need to be controlled by a phenomenon of observance. Respecting prescriptions is in fact a major public health concern. Our problematic is centred on the analysis of the association between observance and autonomy in order to gain a better understanding of the links between the drug, how it is to be taken, and how the patients adapt and control it. Identifying and comparing autonomous practices psychotrope users associated with attitudes put into play by those who claim to observe or not to observe their treatment is the aim of this project. The qualitative analysis of the speech is based on the categorial analysis of the contents of 46 transcriptions of 23 women et 23 men continuous (regular monthly intake for at least 5 years), aged between 50 and 65. The majority live in couples, have professional activities, and are executives. The psychotropes with the largest consumption are: anxiolytics and antidepressors. The average duration of their consumption is more than 17 years. Two types of attitude can be distinguished through the qualitative analyse. The attitudes of non-observers towards the psychotropic drug and dependence show controlled, autonomous acts. Autonomy is an influencing factor in their observation of the prescribed treatment, it is a major component of their non-observance regarding psychotropes; thus our hypothesis is confirmed. The strategy adopted around the medication arises from autonomy of action. Organising the treatment is seen as a sign of autonomy, as taking an initiative in relation to the medical prescription, and not as rebellious, or carefree behaviour, or as a sign of inconsistency. Non-observers seem more to be involved in a step towards self-regulation. Active taking verbs such as stop, diminish, increase , and success verbs succeed the I is greatly used, reinforced in some cases by myself ; this vocabulary situates the patient as an actor facing the drug and shows that he is capable of action. For observers, taking the drug is qualified as regular and some users categorically refuse to bypass the doctor's advice never . Looking for additional information is an act of autonomy. It is found partly with the doctor; but also from the media, the exchanges with the others and the reading of the notes. But talking to other people and reading the information leaflets are more often done by non-observers. Recognizing oneself in the indications and the dosage marked on the leaflet seems to be the first step to adopting the drug so as to know it better and to gain mastery of it. Autonomy is gained through finding alternative, substitutive or complementary solutions with a large share left to herbal medicine and homeopathy. Non-observers seem to be more active than observers in diminishing or stopping taking psychotropes. Affirming one's autonomy is also shown in the direction given to each person's trajectory of life, behaviour referring to it, the projection into the future, and the dynamics of life. These actions underlie a capacity of resistance, non-observers using evocative terms such as taking things in hand , recognizing the while, in certain cases, the need to be supported. This capacity of action is far less present in observers who acknowledge their difficulties in facing up to events. The intentionality and the determination of their behaviour and their choices depend on the autonomy of willpower. Adjusting the amount taken is shown by expressions of intention, and justifies self-regulation. Non-observers direct their behaviour towards a reduction in the medication and commit themselves not to go over a certain amount. Stopping usage is declared as certain , it is planned. On the other hand, it remains unpredictable for observers for whom consumption is linked to the description of a need to have long-lasting health. Observers describe taking their medication as automatic, routine, and easy. A sort of fatality and resignation is attached to the prescription, linked to a negative perception of their health. The medication is at the same time nourishing and destructive . The disagreeable sensations caused by its suppression and the secondary effects appear less important than the benefits to be had from it. Autonomy can be recognized in the type of commitment established with the professional. It can be shown around a prescription negociated for treatment and delivered in mutual agreement. It places the patient in an active partnership. The presence of I and of more frequent active verbs in non-observers shows the role played by the patient. His conversation organizes itself round how the medication is to be taken. Systematic use of the prescription reinforces the instrumental recourse to the doctor for a renewal especially for non-observers. For observers, the prescription is followed despite disagreements. The professional is appreciated for his expertise in advice, how to use the medication . Confidence results from this know-how. The feeling of fear inspired by the psychotrope puts taking the medication into perspective and removes the guilt from non-observance. This process contributes to the patient's carrying on taking the medication. The positive effects found again thanks to the medication strengthen the later's perpetuation. When the patient is asked to participate in the prescription, this participation is described differently in the two groups. In observers, it is understood from the viewpoint of the doctor-patient association with, us and for the other group from the viewpoint of cooperation I, one . In non-observers, a type of delegation is highlighted leave it to be managed , the patient's confidence in the doctor lets him manage his medication under medical control . The autonomy of willpower is shown by the degree of openness to the Other Person. Non-observers have quite open and trendy character traits and give a rather positive image of themselves. These elements are absent from the speech of observers in favour of a negative self-image. The autonomy of willpower shows up in their free expression within the family, and with friends, the patient is freed from the influence of other people. For non-observers it is admitted easily . Observers show reserve through a concern of being discrete; rules of good behaviour do not allow them to speak about their consumption since it lifts the veil on their person and its affects. Two types of attitude can be distinguished: Observers for whom the psychotrope supports them against an unhappy life and is part of a habit which is hidden from other people, they keep to the prescribed doses and don't try to change them, they have absolute confidence in the medical profession; non-observers for whom psychotropes are a crutch which they mistrust. They are conscious of the bad effects and state their intention and their will to control this medication by planning on a reduction in, or even an end to, consumption. In order to give a meaning to the prescription and to avoid too great a feeling of guilt, they legitimize the later by an obligation created by a need, and by an improvement in symptomatology, and they minimize the quantity and the effects of taking the medication. They cooperate with the doctor and are involved in a close relationship with my doctor . They show a certain familiarity to the medication and talk openly about their consumption. Autonomy is a means to responsibility and to valorise a part of the patients in particular those which are non-observing so as to strengthen their capacity to manage their health as best they can. It contributes to a better observance of treatment in as much as autonomous patients are more inclined to negotiate with their doctors. Looking for self-regulatory behaviour allows us a better understanding of those patients non-observers who are willing, and helps them to develop their aptitude to face up to their illness.

Prozac and crime: who is the victim?

Abstract: Prozac has been cited in more medication defense criminal cases in the United States than has any other psychotropic drug. In the majority of these cases, defendants are arguing that they are the victims of the drug. Defendants assert that they are victimized by their own involuntary intoxication or that of witnesses and crime victims who have been adversely influenced by Prozac. This article reviews 12 criminal cases in the United States in which Prozac victimization is a salient theme, and it calls for mental health professional organizations to intervene in a growing legal conundrum.

Biomarkers in Psychotropic Drug Development

Abstract: The authors review the use of biomarkers in the development of novel psychotropic agents. They briefly review clinical drug development, emphasizing the importance of incorporating biomarkers. For the development of psychotropic agents, biomarkers are particularly useful for assessing central nervous system exposure and effects and for serving as surrogate measures for safety and efficacy. Collectively, biomarkers allow for more accurate estimation of doses for clinical trials as drug development progresses. For drugs that target the pathophysiology of Alzheimer disease, several promising biomarkers are becoming available that may allow improved signal detection in clinical trials. Procedures for developing new drugs are evolving rapidly. Technical advances in the field are making it possible to shift from empirically-based methods to mechanistically-driven schemes. Biomarkers enhance the quality and safety of clinical drug development and reduce its cost and duration.

Current update of hormonal and psychotropic drug treatment of premenstrual dysphoric disorder.

Abstract: This review discusses the current status of diagnosis and treatment of premenstrual dysphoric disorder (PMDD), with an emphasis on studies that have been published in the medical literature during the 2001 to 2002 interval. Serotonergic antidepressants are effective for PMDD, and are currently considered the first-line treatment. Recent clinical trials have shown that selective serotonin reuptake inhibitors, taken only during the symptomatic luteal phase, are also effective for PMDD. One study reported efficacy for a slow-release formulation of fluoxetine that was taken two times during the menstrual cycle. Oral contraceptives still lack definitive evidence of efficacy as a treatment for PMDD, although a new contraceptive formulation has appeared promising for the mood and behavioral symptoms of the disorder. The results of a meta-analysis of the published trials of progesterone and progestins further indicate that these hormones are not effective in the management of PMDD.

Behavioral effects of novel enterosorbent Noolit on mice with mixed depression/anxiety-like state.

Abstract: The aim of this work was to examine the behavioral effects of a novel lithium-based enterosorbent, Noolit (665 mg/kg), on male mice with mixed depression/anxiety-like state evoked by exposure to repeated social defeats in daily agonistic confrontations. The lithium component allows Noolit to be used as a psychotropic drug. Two experiments are described, in which the therapeutic and preventative effects of chronic Noolit treatment were examined. Response to Noolit was assessed in the plus maze, open field, partition test, and Porsolt's test. In both experiments, Noolit produced obvious anxiolytic and antidepressant effects. Treatment with Noolit fully restored some behavioral parameters in the plus maze and open field in depressed mice and prevented depression that would otherwise have developed. It has been suggested that enterosorbent Noolit can be a potent drug for the treatment of mixed anxiety/depression pathologies and for prevention of mood disorders.