Showing papers on "Psychotropic drug published in 2003"
TL;DR: Although no clear relationship exists between the clinical efficacy, plasma concentration of SSRIs, nor any threshold that defines toxic concentrations, therapeutic drug monitoring (TDM) may be useful in special populations, such as in elderly patients, poor metabolizers (PM) of sparteine or mephenytoin (CYP2C19), and patients with liver and kidney impairment.
Abstract: The selective serotonin reuptake inhibitors (SSRIs) have emerged as a major therapeutic advance in psychopharmacology. As a result, the discovery of these agents marks a milestone in neuropsychopharmacology and rational drug design, and has launched a new era in psychotropic drug development. Prior to the SSRIs, all psychotropic medications were the result of chance observation. In an attempt to develop a SSRI, researchers discovered a number of nontricyclic agents with amine-uptake inhibitory properties, acting on both noradrenergic and serotonergic neurons with considerable differences in potency. A given drug may affect one or more sites over its clinically relevant dosing range and may produce multiple and different clinical effects. The enhanced safety profile includes a reduced likelihood of pharmacodynamically mediated adverse drug-drug interactions by avoiding affects on sites that are not essential to the intended outcome. SSRIs were developed for inhibition of the neuronal uptake pump for serotonin (5-HT), a property shared with the TCAs, but without affecting the other various neuroreceptors or fast sodium channels. The therapeutic mechanism of action of SSRIs involves alteration in the 5-HT system. The plethora of biological substrates, receptors and pathways for 5-HT are candidates to mediate not only the therapeutic actions of SSRIs, but also their side effects. A hypothesis to explain these immediate side effects is that 5-HT is increased at specific 5-HT receptor subtypes in discrete regions of the body where the relevant physiologic processes are regulated. Marked differences exist between the SSRIs with regard to effects on specific cytochrome P450 (CYP) enzymes, and thus the likelihood of clinically important pharmacokinetic drug-drug interactions. Although no clear relationship exists between the clinical efficacy, plasma concentration of SSRIs, nor any threshold that defines toxic concentrations, but therapeutic drug monitoring (TDM) may be useful in special populations, such as in elderly patients, poor metabolizers (PM) of sparteine (CYP2D6) or mephenytoin (CYP2C19), and patients with liver and kidney impairment. Several meta-analyses have reviewed the comparative efficacy of TCAs and SSRIs, and concluded that both TCAs and SSRIs have similar efficacy in the treatment of depression. SSRIs have demonstrated better efficacy and tolerability in the treatment of obsessive compulsive disorder (OCD). They have also been found to be effective in the treatment for social anxiety disorder both in reducing total levels of social anxiety and in improving overall clinical condition. The benefit of SSRIs in anorexia nervosa (AN) is apparently short-term unless medication is given in the context of nutritional or behavioral therapy. No single antidepressant can ever be recommended for every patient, but in a vast majority of patients, SSRIs should be considered as one of the first-line drugs in the treatment of depression.
584 citations
TL;DR: To examine psychotropic prescription use in community‐dwelling elderly in the United States and its association with predisposing, enabling, and need factors.
Abstract: OBJECTIVES: To examine psychotropic prescription use in community-dwelling elderly in the United States and its association with predisposing, enabling, and need factors. DESIGN: Retrospective analysis of the 1996 Medical Expenditure Survey (MEPS). SETTING: A national representative sample survey of the United States non-institutionalized population. PARTICIPANTS: Community-dwelling persons aged 65 and older participating in the MEPS. MEASUREMENTS: Psychotropic prescription use patterns and factors associated with the use of psychotropics in general as well as of individual classes, specifically antidepressants, antianxiety agents, and sedative/hypnotics. RESULTS: According to the MEPS, more than 6 million (19%) community-dwelling elderly persons used psychotropic medications in 1996. Nearly 3 million (9.1%) elderly were taking antidepressants, almost 2.5 million (7.5%) antianxiety agents, and 1.5 million (4.8%) sedative/hypnotics. Several correlates of psychotropic prescription use were identified. Enabling (e.g., prescription insurance) and need (e.g., health status) factors were found to be consistently associated with the use of antidepressant, antianxiety, and sedative/hypnotic agents. Predisposing factors such as sex, race, region, and education varied with the type of psychotropic drug class examined. CONCLUSION: Nearly one in five community-dwelling elderly persons used psychotropic medications, primarily antidepressants followed by antianxiety agents. Enabling and need factors were consistently associated with psychotropic classes examined, whereas most predisposing factors varied with the type of psychotropic drug class.
140 citations
TL;DR: The data support the view that SUDEP is a seizure-related event and suggest that attempts to better treat patients' epilepsy with AEDs might decrease the risk of SUDEP, as well as finding a correlation with seizure frequency suggesting that other clinical indices may be more important.
Abstract: We performed a controlled prospective study of pathologically verified sudden unexpected death in epilepsy (SUDEP) in a coronial setting, to identify risk factors. We prospectively studied coronial deaths of people with epilepsy in Vic., Australia, during a 21-month period. Fifty SUDEP and 50 subjects with epilepsy who died of other causes (controls) were collected sequentially. Clinical data was obtained shortly after death from questionnaires completed by treating doctors, discussion with family members and coronial files, including police reports of death, autopsy and toxicology reports. Factors assessed were age, sex, duration of epilepsy, type of seizure(s), seizure frequency, symptomatic epilepsy, including post-traumatic epilepsy, presence of structural brain lesion, idiopathic epilepsy, mental retardation, psychiatric illness, including dementia, recent stressful life event, particular antiepileptic drugs (AEDs) and AED polytherapy, compliance with AED treatment, psychotropic drug prescription, alcohol and other substance abuse, place of death and evidence of terminal seizure. The SUDEP group was characterised by younger age and higher proportion found dead in bed and with evidence of terminal seizure compared to controls. The profile of patients at risk for SUDEP are young people with epilepsy. They are most likely to die in sleep and our data support the view that SUDEP is a seizure-related event. This, taken in conjunction with the finding that there was no increased risk associated with a particular AED in monotherapy or multiple AEDs suggests that attempts to better treat patients' epilepsy with AEDs might decrease the risk of SUDEP. Although the literature suggests that SUDEP is more frequent in patients with severe epilepsy, we did not find a correlation with seizure frequency suggesting that other clinical indices may be more important.
136 citations
TL;DR: Multivariate logistic regression revealed that participants who received psychotropics, alone or in combination, were significantly more likely to be in state custody, male, and older than other participants and less likely to being African American or Hispanic.
Abstract: Objectives: The authors sought to determine the prevalence, patterns, and demographic correlates of multiple psychotropic pharmacotherapy in a statewide sample of low-income children and adolescents in community-based clinical care. Methods: The Medicaid managed care database of the Connecticut Department of Social Services was the source of linked encounter and pharmacy information for the one-year period ending June 30, 1999. Period prevalence was calculated for children and adolescents ranging in age from newborn through 18 years who had any psychotropic drug prescription claims during the study period. For each participant, multiple psychotropic pharmacotherapy was defined as having claims for prescriptions for medications in two or more different psychotropic drug classes during a seven-day period. Age, gender, race, and state custody status were examined across groups, and multiple psychotropic pharmacotherapy patterns were identified. Results: Of the 196,505 youths in Medicaid managed care, 9,447 received at least one psychotropic medication, yielding a period prevalence of 4.8 percent. Among youths who received psychotropics, 13.6 percent had received multiple psychotropic pharmacotherapy. Multivariate logistic regression revealed that participants who received psychotropics, alone or in combination, were significantly more likely to be in state custody, male, and older than other participants and less likely to be African American or Hispanic. Stimulants, antidepressants, and mood stabilizers were the most commonly dispensed agents. The most common drug class combinations were an antidepressant plus an antipsychotic, a stimulant plus an antidepressant, and a stimulant plus an alpha 2 agonist. Conclusions: Our findings revealed sociodemographic differences in psychopharmacological care among young Medicaid managed care enrollees and the common occurrence of multiple psychotropic pharmacotherapy. (Psychiatric Services 54:72–77, 2003)
111 citations
TL;DR: The clinician must weigh the relative risks of various treatment options and take into account individual patient wishes to lead to thoughtful treatment choices, which with close clinical follow-up can minimize the risk for maternal morbidity.
105 citations
TL;DR: Bomb attack exposure resulted in persisting PTSD in a significant proportion of victims; the severity was predicted at 32 months by physical injuries and psychotropic drug use before the terrorism attack and by the PTSD score few months after the bomb attack.
94 citations
TL;DR: This paper examines several issues that policymakers should consider when addressing formulary design for psychotropic drugs: heterogeneity within mental health disorders and limited information about treatment effectiveness for individual patients; the potential for plans to try to use formularies to avoid adverse selection and implications for psychotrop coverage.
Abstract: Payers of pharmaceutical benefits are increasingly turning to drug formularies in an attempt to control rising pharmacy costs, including those for psychotropic drugs. In this paper I examine several issues that policymakers should consider when addressing formulary design for psychotropic drugs: heterogeneity within mental health disorders and limited information about treatment effectiveness for individual patients; the potential for plans to try to use formularies to avoid adverse selection and implications for psychotropic coverage; the interaction of Medicaid formulary policy and manufacturers’ incentives for psychotropic innovation; and incentives created by mental health institutions that decrease formularies’ potential effectiveness in controlling psychotropic drug costs.
62 citations
TL;DR: Psychotropic drug expenditure increases during the late 1990s resulted from more youths being prescribed drugs, a preference for newer and costlier medications, and the net effects of inflation.
Abstract: Objective To examine trends in psychotropic medication utilization and costs for children and adolescents between January 1, 1997, and December 31, 2000. Methods Pharmacy claims were analyzed for mental health users 17 years and younger (N = 83 039) from a national database covering 1.74 million privately insured youths. Utilization rates and costs for dispensed medications were compared across psychotropic drug categories and individual agents over time. Results Overall use of psychotropic drugs increased from 59.5% of mental health outpatients in 1997 (a 1-year prevalence of 28.7 per 1000) to 62.3% in 2000 (33.7 per 1000), a 4.7% increase. The largest changes in utilization were seen for atypical antipsychotics (138.4%), atypical antidepressants (42.8%), and selective serotonin reuptake inhibitors (18.8%). The average prescription price increased by 17.6% ($7.90 per prescription), a change in turn attributed to a shift toward costlier medications within the same category (55.1% of the increase, or $4.35) and to pure inflation (44.9% of the increase, or $3.55; P for trend Conclusions Psychotropic drug expenditure increases during the late 1990s resulted from more youths being prescribed drugs, a preference for newer and costlier medications, and the net effects of inflation. The impact of managed care and pharmaceutical marketing effects on these trends warrants further study.
55 citations
TL;DR: Patients seizure-free during psychopathology were more likely to have a diagnosis of idiopathic generalized epilepsy, to be in co-therapy with vigabatrin, and to remit after drug reduction.
51 citations
TL;DR: The main predictor variable for neuroleptic dosage both before and after deinstitutionalization was challenging behaviour, and the trend seemed indiscriminate in relation to diagnosis.
Abstract: Background The use of psychotropic medication among people with intellectual disability (ID) is widespread, and they are one of the most medicated groups in society. A substantial number of individuals with ID receive psychotropic medications that may be inappropriate for their diagnosis. One of the main reasons for the use of psychotropic medication is challenging behaviours. Almost all prevalence studies show higher prevalence rates of psychotropic medication in institutions compared with community living. Studies on deinstitutionalization and the use of psychotropic medication are few and inconclusive.
Method The present study is a prospective cohort study without control group. It examines the use of psychotropic medication among 109 subjects aged between 16 and 65 years before (1987) and after (1995) deinstitutionalization. Psychotropic drug dosages were transformed to percentage of defined daily dosage.
Results We found no major changes in the use of neuroleptics after deinstitutionalization neither in frequency nor in dosages, and the trend seemed indiscriminate in relation to diagnosis. The people with schizophrenia or an anxiety disorder did not receive proper drug treatment, nor did they before deinstitutionalization.
Conclusions The main predictor variable for neuroleptic dosage both before and after deinstitutionalization was challenging behaviour. The reason for this may be the difficulties in determining the extent to which presenting behaviours are the result of a psychiatric disorder or a behaviour disorder, the lack of knowledge among the caretakers and the ensuing referral practice, the lack of knowledge among the general practitioners, and the lack of access to specialized health services.
46 citations
Journal Article•
TL;DR: Orlistat, a reversible inhibitor of lipases approved by the US Food and Drug Administration for obesity management, was safe, well-tolerated, and effective, resulting in an average weight loss of 35% during an acute treatment period of about 3 months.
Abstract: Weight gain is a common side effect associated with antidepressant, anxiolytic, and antipsychotic drug use. Obesity is a risk factor for several other disorders, including hypertension, diabetes, and coronary artery disease. To date, there have been few safe, well-tolerated, and effective pharmacological agents available to alleviate weight gain in general, and virtually no studies specific to psychiatric drug-induced weight gain. This case series looks at the use of orlistat, a reversible inhibitor of lipases approved by the US Food and Drug Administration for obesity management, naturalistically in 13 patients with weight gain secondary to psychotropic drug use. The results showed that orlistat, administered in 3 daily doses with meals, was safe, well-tolerated, and effective, resulting in an average weight loss of 35% during an acute treatment period of about 3 months.
TL;DR: Findings show that functional regulation of presynaptic CaM kinase II is selectively affected by different psychotropic drugs, and suggest local synaptic mechanisms for pharmacological regulation of the kinase.
TL;DR: This study supports the implementation of better prevention programs regarding drug abuse in Sõ Paulo state by determining the incidence of illegal drug, alcohol, tobacco and psychotropic medication use and thus the number of persons dependent on drugs, alcohol and nicotine, and to evaluate how easy it is to obtain psychotropic drugs.
Abstract: CONTEXT: In order to establish prevention programs regarding psychotropic drug use that are adapted to specific populations it is, first of all, important to have data on the realities of such consumption. Single data points are not enough for drawing up a profile of society in relation to drugs. OBJECTIVE: The aim of this household survey was to determine the incidence of illegal drug, alcohol, tobacco and psychotropic medication use, and thus the number of persons dependent on drugs, alcohol and nicotine, and to evaluate their perception regarding how easy it is to obtain psychotropic drugs. TYPE OF STUDY: Epidemiological survey. SETTING: All of the 24 cities in the State of Sao Paulo with more 200,000 inhabitants participated in the study. METHOD: The sampling was constructed from weighted probabilistic stratified conglomerates obtained via two-stage selection. In each municipality sampled, census sectors (generally 200-300 households) were first selected. Then, households and a respondent were selected to provide information from his/her point of view. The SAMHSA questionnaire (Substance Abuse and Mental Health Services Administration) of the U.S. Department of Public Health was used, after translation and adaptation to Brazilian conditions. RESULTS: A total of 2,411 persons aged 12-65 years old were interviewed, of whom 39.9% weremen. Lifetime use of any psychotropic drug other than alcohol and tobacco was 11.6%: much less than in the U.S. (34.8%). The alcohol dependence rate was 6%, similar to findings from other countries. Marijuana was the illegal drug most cited as used daily (6.6%): a prevalence much lower than in the U.S. (32.0%). Inhalant use was next in frequency of use (2.7%): about 10 times less than in the United Kingdom (20%). Cocaine use (2.1%) was about 5 times less than in the U.S. (10.6%). There was no report of heroin use, although there was a surprisingly high perception regarding the ease of obtaining heroin: 38.3% said it was easy to obtain. CONCLUSION: This study supports the implementation of better prevention programs regarding drug abuse in Sao Paulo state.
TL;DR: The most effective treatment for SIB that is resistant to environment changes and behavior modification in persons with developmental disabilities is the treatment of their psychiatric disorders with the appropriate psychotropics.
Abstract: Background: Self-injurious behavior (SIB) is one of the most common challenging behaviors in persons with autistic disorder or severe/profound mental retardation. Many psychotropic drugs have been evaluated for their effectiveness in SIB. Results have varied, and no one psychotropic drug has been indicated for SIB. In this prospective, open clinical study, psychotropic drugs were used to treat the previously undiagnosed psychiatric disorder in persons exhibiting SIB. Method: Data were collected from 26 individuals with mental retardation (14 males, 12 females), 7 to 45 years of age (mean = 30.3 years), who exhibited SIB. Psychiatric diagnosis was made according to DSM-III-R and DSM-IV criteria. The Behavior Problem Inventory, Yudofsky's Overt Aggression Scale, repeated direct observation, and information on use of protective devices and Likert scales from log books were used to evaluate degree of SIB. Most of the patients were treated with different psychotropic drugs and behavior modification before they were evaluated for this study, but only 7 of them carried a psychiatric diagnosis. Data were collected between 1987 and 1997. Results: Depressive disorders, impulse-control disorder, and anxiety disorder were the most common final diagnoses. Neuroleptics were discontinued in 5 patients and tapered by 50% to 75% in 14 patients. Antidepressants were added in 12 patients. Treatment of psychiatric disorders produced significant (p <.001) decrease in the severity of SIB in the 26 patients, and SIB was eliminated in 12 patients. The severity of SIB decreased to mild from a moderate, severe, or extreme degree in 11 patients and from an extreme to a severe degree in 3 patients. Conclusion: The most effective treatment for SIB that is resistant to environment changes and behavior modification in persons with developmental disabilities is the treatment of their psychiatric disorders with the appropriate psychotropics.
TL;DR: In this paper, the authors examined the relationship between serious arrhythmias in patients with psychotropic drug overdose and electrocardiography (ECG) findings that have been suggested previously to predict this complication.
Abstract: Objective The aim of the present study was to examine the relationship between serious arrhythmias in patients with psychotropic drug overdose and electrocardiography (ECG) findings that have been suggested previously to predict this complication. Methods Thirty-nine patients with serious arrhythmias (ventricular tachycardia, supraventricular tachycardia or cardiac arrest) after tricyclic antidepressant overdose or thioridazine overdose were compared with 117 controls with clinically significant overdose matched to each case for the drug ingested. These patients with psychotropic drug overdose had presented for treatment to the Department of Clinical Toxicology, Newcastle and to the Princess Alexandra Hospital, Brisbane. The heart rate, the QRS width, the QTc and QT intervals, the QT dispersion, and the R wave and R/S ratios in aVR on the initial ECGs were compared in cases and controls. Results The cases had taken dothiepin (16 patients), doxepin (six patients), thioridazine (five patients), amitriptyline (five patients), nortriptyline (three patients), imipramine (one patient) and a combination of dothiepin and thioridazine (three patients). In 20 of the 39 patients with arrhythmias, the arrhythmia had been a presumed ventricular tachycardia. Of the other 19 patients, 15 patients had a supraventricular tachycardia, two patients had cardiac arrests (one asystole, one without ECG monitoring) and two patients had insufficient data recorded to make classification of the arrhythmias possible. The QRS was ≥ 100 ms in 82% of cases but also in 76% of controls. QRS ≥ 160 ms had a sensitivity of only 13% and occurred in 2% of controls. QRS > 120 ms, QTc > 500 and the R/S ratio in aVR appeared to have a stronger association with the occurrence of arrhythmia: QRS > 120 ms (odds ratio [OR], 3.56; 95% confidence interval [CI], 1.46–8.68), QTc > 500 (OR, 3.07; 95% CI, 1.33–7.07), and R/S ratio in aVR > 0.7 (OR, 16; 95% CI, 3.47–74). Excluding thioridazine overdoses and performing the analysis for tricyclic antidepressant overdoses alone gave increased odds ratios for QRS > 120 ms (OR, 4.83; 95% CI, 1.73–13.5) and QTc > 500 (OR, 4.5; 95% CI, 1.56–13) but had little effect on that for the R/S ratio in aVR > 0.7 (OR, 14.5; 95% CI, 3.10–68). Conclusion ECG measurements were generally weakly related to the occurrence of arrhythmia and should not be used as the sole criteria for risk assessment in tricyclic antidepressant overdose. The frequently recommended practice of using either QRS ≥ 100 ms or QRS ≥ 160 ms to predict arrhythmias is not supported by our study. R/S ratio in aVR > 0.7 was most strongly related to arrhythmia but had estimated positive and negative predictive values of only 41% and 95%, respectively. The use of these specific predictors in other drug overdoses is not recommended without specific studies.
Journal Article•
TL;DR: ECG measurements were generally weakly related to the occurrence of arrhythmia and should not be used as the sole criteria for risk assessment in tricyclic antidepressant overdose.
Abstract: Objective The aim of the present study was to examine the relationship between serious arrhythmias in patients with psychotropic drug overdose and electrocardiography (ECG) findings that have been suggested previously to predict this complication. Methods Thirty-nine patients with serious arrhythmias (ventricular tachycardia, supraventricular tachycardia or cardiac arrest) after tricyclic antidepressant overdose or thioridazine overdose were compared with 117 controls with clinically significant overdose matched to each case for the drug ingested. These patients with psychotropic drug overdose had presented for treatment to the Department of Clinical Toxicology, Newcastle and to the Princess Alexandra Hospital, Brisbane. The heart rate, the QRS width, the QTc and QT intervals, the QT dispersion, and the R wave and R/S ratios in aVR on the initial ECGs were compared in cases and controls. Results The cases had taken dothiepin (16 patients), doxepin (six patients), thioridazine (five patients), amitriptyline (five patients), nortriptyline (three patients), imipramine (one patient) and a combination of dothiepin and thioridazine (three patients). In 20 of the 39 patients with arrhythmias, the arrhythmia had been a presumed ventricular tachycardia. Of the other 19 patients, 15 patients had a supraventricular tachycardia, two patients had cardiac arrests (one asystole, one without ECG monitoring) and two patients had insufficient data recorded to make classification of the arrhythmias possible. The QRS was ≥ 100 ms in 82% of cases but also in 76% of controls. QRS ≥ 160 ms had a sensitivity of only 13% and occurred in 2% of controls. QRS > 120 ms, QTc > 500 and the R/S ratio in aVR appeared to have a stronger association with the occurrence of arrhythmia: QRS > 120 ms (odds ratio [OR], 3.56; 95% confidence interval [CI], 1.46–8.68), QTc > 500 (OR, 3.07; 95% CI, 1.33–7.07), and R/S ratio in aVR > 0.7 (OR, 16; 95% CI, 3.47–74). Excluding thioridazine overdoses and performing the analysis for tricyclic antidepressant overdoses alone gave increased odds ratios for QRS > 120 ms (OR, 4.83; 95% CI, 1.73–13.5) and QTc > 500 (OR, 4.5; 95% CI, 1.56–13) but had little effect on that for the R/S ratio in aVR > 0.7 (OR, 14.5; 95% CI, 3.10–68). Conclusion ECG measurements were generally weakly related to the occurrence of arrhythmia and should not be used as the sole criteria for risk assessment in tricyclic antidepressant overdose. The frequently recommended practice of using either QRS ≥ 100 ms or QRS ≥ 160 ms to predict arrhythmias is not supported by our study. R/S ratio in aVR > 0.7 was most strongly related to arrhythmia but had estimated positive and negative predictive values of only 41% and 95%, respectively. The use of these specific predictors in other drug overdoses is not recommended without specific studies.
TL;DR: The implications of cross-cultural variations for policy and practice are the need to ensure a reliable supply of affordable psychotropic drugs in developing countries, trained healthcare professionals to use these drugs rationally, a concerted advocacy campaign to exclude drugs for severe psychiatric disorders from patent protection, and the development of psychosocial programmes to improve global outcomes.
Abstract: Severe psychiatric disorders (schizophrenia, bipolar disorder and major depressive disorder) cause much morbidity and disability in developing countries. Most of the evidence on the efficacy and effectiveness of drug treatments for these disorders is based on trials conducted in Western countries. Cultural, biological and health system factors may profoundly influence the applicability of such evidence in developing countries. Attitudes towards, and concepts about, psychiatric disorders vary across cultures, and these may influence the acceptability of drug treatments. Genetic and environmental factors may lead to variations in the pharmacodynamics and pharmacokinetics of psychotropic drugs across ethnic groups. This may explain why lower doses of psychotropic drugs tend to be used for non-Caucasian patients. There is a dearth of mental health professionals and care facilities in developing countries, especially in rural areas. Epidemiological studies show that, despite this lack of services, the outcome of schizophrenia is favourable in developing countries. This suggests that cultural, genetic or environmental factors may play as much of a role in influencing outcome as access to antipsychotic treatment. Regional drug policies may influence the availability and cost of psychotropic drugs. In particular, the Indian experience, where drugs are manufactured by several local pharmaceutical firms, thus bringing their cost down, may represent a unique deregulated drug industry. However, the impending impact of the Trade-Related Aspects of Intellectual Property Rights (TRIPS) agreement, with the strict enforcement of patent laws, will almost certainly lead to a rise in drug costs in the coming years. This may influence the choice and cost effectiveness of various drugs. The implications of these cross-cultural variations for policy and practice are the need to ensure a reliable supply of affordable psychotropic drugs in developing countries, trained healthcare professionals to use these drugs rationally, a concerted advocacy campaign to exclude drugs for severe psychiatric disorders from patent protection, and the development of psychosocial programmes to improve global outcomes.
TL;DR: Benzodiazepine use continues to be highly prevalent in primary care patients, in spite of the nationwide implementation of controlled prescriptions, and is observed in women and in urban areas.
Abstract: Background: Benzodiazepine use is associated to a risk of abuse of dependency. In Chile benzodiazepine abuse is a public health issue. In an attempt to overcome this problem, several restrictions in their prescription were implemented by the health authority. Despite these measures, inadequate use of benzodiazepines in primary care continues to be frequent. Aim: To study the frequency of benzodiazepine use among primary care patients. Material and methods: Cross sectional survey done during two days, with seven physicians working in public primary care clinics. They applied a structured questionnaire about psychotropic medication use. Results: One hundred eighty eight subjects aged 46.8±17.5 years, 66% women, were interviewed. Thirty two percent were consuming a psychotropic drug and 82% of these corresponded to benzodiazepines. General practitioners and psychiatrists prescribed the drug to 75% and 13% of subjects, respectively. A higher frequency of benzodiazepine use was observed in women and in urban areas. Conclusions: Benzodiazepine use continues to be highly prevalent in primary care patients, in spite of the nationwide implementation of controlled prescriptions (Rev Med Chile 2003; 131: 535-40).
TL;DR: This is the first meta‐analysis showing the significant effectiveness of diazepam in the treatment of neurosis or psychosomatic disease, and caution should be exercised in assessing these results.
Abstract: Diazepam is one of the most widely used, broad-spectrum anti-anxiety agents The aim of this study was to evaluate the efficacy of diazepam, and to establish whether it is more effective than a placebo in improving the various neurotic anxiety states seen in patients with neurosis or psychosomatic disease Of the recently established comprehensive register of psychotropic drug trials carried out in Japan, a total of 17 double-blind, randomized controlled trials were identified on the treatment of neurosis using anti-anxiety compounds, in which both diazepam and placebos were used Meta-analysis of these 17 studies demonstrated that diazepam is significantly more effective than a placebo (relative risk 135, 95% confidence interval 121-151, number needed to treat 9) The maximal effective dose of diazepam seems to be 12 or 18 mg/day with a treatment duration of 2 or more weeks There was no significant difference between the effects of placebo and a diazepam dose of 6 mg/day Caution should be exercised in assessing these results, however, since this is the first meta-analysis showing the significant effectiveness of diazepam in the treatment of neurosis or psychosomatic disease
TL;DR: This case demonstrates that, while today bromism occurs infrequently, it should still be included in the differential diagnosis of neuropsychiatric symptoms, and an elimination half-life of bromide in blood of approximately of 10 days is found.
Abstract: Bromide intoxication today is an infrequent disease, but preparations containing bromide are still available in nonprescription compounds, on the French market. We report a casewith bromide intoxication due to daily over intake (approximately 20 tablets per day; i.e. total elemental bromide intake approximately 6 g/day) of calcium bromo-galactogluconate (Calcibronat) for 1.5 months. A 30-year-old woman with a long history of psychotropic drug abuse was hospitalized in a psychiatric department for neuropsychological manifestations. She presented a seriously disturbed mental status with confusion, disorientation, auditory and visual hallucinations, and loss of short-time memory. A markedly increased serum bromide level of 1717 mg/L (21.5 mEq/L) measured on the first day after her admission confirmed the diagnosis of chronic bromism suspected based on her symptomatology. During her hospitalization, bromide plasma concentrations were measured and monitored using inductively coupled plasma mass spectrometry, a sensitive and very specific method. After withdrawal of the drug, the symptoms improved within 8 days. Serial bromide concentrations gradually declined throughout nearly 2 months of monitoring, until she was discharged from the hospital. We found an elimination half-life of bromide in blood of approximately of 10 days. This case demonstrates that, while today bromism occurs infrequently, it should still be included in the differential diagnosis of neuropsychiatric symptoms.
TL;DR: Both clozapine and olanzapine but not haloperidol, reverse physiologically induced cutaneous sympathetic vasomotor discharge, suggesting that similar neuropharmacological mechanisms might underly the cutaneous vasodilating action and the psychotropic actions of atypical antipsychotic drugs.
Abstract: Reduction of body temperature is used as predictor of psychotropic drug action. The cutaneous circulation functions as a heat-loss component of temperature regulation. Clozapine and olanzapine reverse hyperthermia and sympathetically-mediated cutaneous vasoconstriction induced by MDMA (3,4-methylenedioxymethamphetamine, ecstasy), suggesting that these drugs might reverse other forms of sympathetically mediated cutaneous vasoconstriction. Clozapine and olanzapine were compared with haloperidol with respect to their ability to reverse cold-induced and LPS (lipopolysaccharide)-induced cutaneous vasoconstriction in rabbits. Cutaneous blood flow was measured in conscious rabbits by Doppler ultrasonic flow probe implanted around the central ear artery, and body temperature was measured telemetrically. After control observations, animals were transferred from 26 to 10°C, or LPS (0.5 μg/kg IV) was administered. After 30 min, clozapine, olanzapine or haloperidol was administered and ear pinna blood flow and body temperature were measured for another 30 min. Clozapine, in a dose responsive manner (1, 2.5 and 5 mg/kg IV), substantially reversed cold-induced ear pinna vasoconstriction and reduced body temperature. Clozapine (1 mg/kg IV) reversed LPS-induced cutaneous vasoconstriction and reduced the LPS-induced rise in body temperature. Olanzapine had generally similar effects. Haloperidol (1 mg/kg IV in cold experiments and 0.2 mg/kg IV in LPS experiments) did not reverse ear pinna vasoconstriction, or affect body temperature. Both clozapine and olanzapine, but not haloperidol, reverse physiologically induced cutaneous sympathetic vasomotor discharge. Because of the close link between psychological function and sympathetic regulation of cutaneous blood flow, similar neuropharmacological mechanisms might underly the cutaneous vasodilating action and the psychotropic actions of atypical antipsychotic drugs.
TL;DR: It is concluded that tablet splitting does not generally produce uniform and equal half tablet doses, and that split tablets should be evaluated using weight variation criteria before tablet splitting programs are initiated.
Abstract: The authors investigated the weight variation of split scored and unscored tablets of several dosages of three costly psychotropic drugs, using weight variation criteria based on the United States Pharmacopoeia 26 (USP) Content Uniformity of Dosage Units. Whole tablets of Paxil 20 and 40 mg, Risperdal 2 and 4 mg, and Zoloft 100 mg that had been split with a widely available device by pharmacy technicians in a managed care pharmacy were evaluated. Each half tablet weight was recorded using a digital electronic balance. Weight variability was determined by comparing actual half tablet weight to the theoretical half tablet weight and calculating the relative standard deviation. Results showed that weight variability occurred in half tablets of unscored tablets of Paxil 40 mg, Risperdal 2 and 4 mg, and scored tablets of Zoloft 100 mg. Half tablets of scored Paxil 20 mg tablets did not show weight variability, resulting in uniform half tablet dosages. The authors concluded that tablet splitting does not generally produce uniform and equal half tablet doses, and that split tablets should be evaluated using weight variation criteria before tablet splitting programs are initiated.
Patent•
24 Dec 2003
TL;DR: A Chinese medicine as the mate of antipsychotics for lowering their toxic by-effect and improving the tolerance of patient is prepared from 17 Chinesemedicinal materials including liquorice root, American ginseng, earthworm, wolfberry fruit, etc.
Abstract: A Chinese medicine as the mate of antipsychotics for lowering their toxic by-effect and improving the tolerance of patient is prepared from 17 Chinese-medicinal materials including liquorice root, American ginseng, earthworm, wolfberry fruit, etc.
Journal Article•
TL;DR: In this paper, the authors discuss aspects of the relationship of psychiatric services and the general hospital in Germany, and comment on peculiarities of the German health care system, regarding the existence of two separate disciplines, "psychiatry and psychotherapy" and "psychotherapeutic medicine", within the training of physicians.
TL;DR: To fully predict clinical response to psychotropic drug treatment the authors must consider social, demographic and clinical factors such as compliance, social support and history of birth trauma, in addition to genetic influence on susceptibility and etiology.
Abstract: Pharmacogenetics uses genetic information to tailor drug treatment to the individual, maximizing clinical response and minimizing side effects. Failure to respond to medication and adverse side effects are common problems in psychiatry. Intolerable side effects can lead to discontinuation of medication. Individual genetic differences can determine both clinical responses to medications and the adverse side effects experienced. To fully predict clinical response to psychotropic drug treatment we must consider social, demographic and clinical factors such as compliance, social support and history of birth trauma, in addition to genetic influence on susceptibility and etiology.
Book•
01 Jun 2003
TL;DR: The Psychotropic Drug Information Handbook (PDI Handbook) as discussed by the authors is a book about psychotropic drug information and its application in the field of medical information.http://www.psychedelicdruginformation.org.
Abstract: Psychotropic Drug Information Handbook , Psychotropic Drug Information Handbook , کتابخانه مرکزی دانشگاه علوم پزشکی تهران
TL;DR: The well-tolerated anxiolytic opipramol is the first psychotropic drug with proven efficacy in somatoform disorders with effects on symptoms of somatization, anxiety, and depression.
Abstract: Background: The psychopharmacotherapy of somatoform disorders (SD; ICD-10: F45) has been less frequently investigated and is not as well established as in other (neurotic) disorders of ICD-10 section F4, i.e. generalized anxiety disorder (GAD; ICD-10: F41.1). The atypical compound opipramol is very often used to treat SD and GAD in clinical practice in Germany. However, state-of-the-art controlled clinical trials have not yet been performed.
Objectives: Two clinical trials were performed with the aim of confirming the efficacy and tolerability of opipramol in SD and GAD.
Methods: Both trials were performed as randomized, double-blind, placebo-controlled, multicenter studies. While the GAD trial was a three-arm study with opipramol (200 mg/day) vs. placebo and alprazolam (2 mg/day) for 28 days, the SD trial was a placebo-controlled two-arm study with a treatment duration of 42 days. Each group consisted of about 100 patients.
Results: Significant differences (alpha = 0.05) were found for the primary efficacy criteria (HAMA total score in GAD, HAMA somatic subscore in SD) and most of the secondary criteria in favor of the active drug therapies. Considerable differences between the psychopathology of SD and GAD were detected.
Conclusion: The well-tolerated anxiolytic opipramol is the first psychotropic drug with proven efficacy in somatoform disorders with effects on symptoms of somatization, anxiety, and depression. The compound is also effective and safe in GAD.
TL;DR: A 32-year-old woman was brought to the emergency room with hemiplegia on the left and consciousness disturbance, and was discharged 40 days after admission with a highly elevated serum concentration of methamphetamine.
Abstract: A 32-year-old woman was brought to the emergency room with hemiplegia on the left and consciousness disturbance. Her prior medical history and the circumstances of the onset were unknown. Brain computed tomography showed intracerebral hemorrhage (ICH) with a midline shift of more than 10 mm in the right parietal lobe. Cerebral angiography failed to show any vascular anomalies. Urine analysis with the triage system, a qualitative screening test for psychotropic drug abuse, showed positive reaction for amphetamines. Subsequent laboratory examination confirmed a highly elevated serum concentration of methamphetamine. The patient underwent evacuation of the hemorrhage via a craniotomy, and was discharged 40 days after admission. Abuse of illegal drugs including amphetamines among young adults is increasing in many developed countries, and the suspicion of possible drug abuse should always be raised in young patients with angiographically negative ICH. A urinalysis screening test for psychotropic agents should be a part of routine emergency room diagnostic procedures for such patients.
Journal Article•
TL;DR: Looking across the years, the MAOIs and tricyclics act primarily to increase functional availability of brainserotonin and catecholamines (particularly noradren-aline, in this context), and the approach appears to have turned full circle.
Abstract: Department of Psychiatry and Centre for Neuroscience, University of Alberta, Edmonton, Alta.A frequent topic of discussion among research clini-cians and other scientists engaged in basic psychiatricresearch is the extent of real advances in approaches todrug therapy in psychiatry. After the serendipitousdiscovery of some major avenues of drug treatmentfor psychiatric disorders in the 1950s, a wide range ofprescription drugs became available for treating mooddisorders and schizophrenia. Nevertheless, it is diffi-cult to deny that the most significant advances havebeen in reducing the unwanted side effects of thesetherapeutic agents. The provocative argument that wehave really seen relatively little advance in therapeuticmechanisms for drug treatment is often based on thestriking observation that many of the primary neuraltargets for treating depression and schizophreniaremain unchanged.Soon after the introduction of monoamine oxidaseinhibitors (MAOIs) and tricyclic antidepressants, nor-adrenaline and serotonin emerged as the primary can-didates for the biochemicals that may be imbalancedand underlie depression. The MAOIs and tricyclics actprimarily to increase functional availability of brainserotonin and catecholamines (particularly noradren-aline, in this context). Looking across the years, ourapproach appears to have turned full circle. This isclear from a comparison of early tricyclics such asimipramine with drugs such as venlafaxine. Imip-ramine is a strong inhibitor of serotonin and noradren-aline uptake into the presynaptic terminal, and themajor primary metabolite, desmethylimipramine(desipramine), is a very potent inhibitor of synapticnoradrenaline uptake, with less effect on serotonin.Venlafaxine blocks the synaptic uptake of both sero-tonin and noradrenaline and has a much “cleaner”spectrum of action in terms of improved side-effectprofile compared with tricyclic antidepressants.