Showing papers on "Psychotropic drug published in 2010"
TL;DR: Over one in six patients are currently prescribed antipsychotic drugs known to be of little benefit and causing significant harm, with other psychotropics equally commonly used.
Abstract: Objective: to compare psychotropic prescribing in older people with dementia and the general elderly population. Design and setting: retrospective population database study in 315 General Practices. Subjects: there were 271,365 patients aged ≥65, of which 10,058 (3.7%) recorded as having dementia. Methods: epidemiology of psychotropic prescribing in older people with and without dementia; multilevel modelling of patient and practice characteristics associated with antipsychotic prescribing. Results: people with dementia were currently prescribed an antipsychotic drug (17.7%), an antidepressant (28.7%) and a hypnotic/anxiolytic (16.7%). Compared to the general elderly population, antipsychotic prescribing was 17.4 [95% confidence interval (CI) 16.4–18.4], antidepressant prescribing 2.7 (95% CI 2.6–1.8) and hypnotic/anxiolytics 2.2 (95% 2.1–2.3) times more likely in people with dementia. Most antipsychotic prescribing in people with dementia was prolonged (>16 weeks). Patients living in more deprived areas and registered with larger and more remote practices were more likely to be prescribed prolonged antipsychotics. Conclusions: over one in six patients are currently prescribed antipsychotic drugs known to be of little benefit and causing significant harm, with other psychotropics equally commonly used. Changing this will require investment in services to support alternative management strategies for people with behavioural and psychological disturbance associated with dementia.
106 citations
TL;DR: In this paper, the authors outline the key social and ethical concerns raised by the use of stimulant drugs for neuroenhancement in young people and make specific research, practice, and policy recommendations.
Abstract: Psychotropic neuroenhancement by young people under 18 is growing, and is certain to increase further with the availability of effective drugs and increasing tolerance for neuroenhancement practices. Use of these agents by young people for purposes of enhancement has social and ethical implications that require scrutiny and analysis. It is particularly important that these analyses do not simply translate normative judgments on adult neuroenhancement practices or intentions to young people. In this article, we outline the key social and ethical concerns raised by the use of stimulant drugs for neuroenhancement in young people and make specific research, practice, and policy recommendations. We also suggest a rationale for clinical management of psychotropic drug neuroenhancers for young people, attending closely to the necessary boundaries on such practice asserted by organizational and clinical factors, as well as by potential ethical conflicts.
104 citations
TL;DR: Clinicians should screen for mental illness when prescribing opioids and recommend psychotherapy as an adjunct or an alternate to pharmacotherapy and Restricting benzodiazepine prescriptions to a 30-day supply with no refills might be considered.
Abstract: OBJECTIVE: Between 1999 and 2006, there was a 120% increase in the rate of unintentional drug overdose deaths in the United States. This study identifies the prevalence of mental illness, a risk factor for substance abuse, and chronic pain among prescription drug overdose deaths in West Virginia and ascertains whether psychotropic drugs contributing to the deaths were used to treat mental illness or for nonmedical purposes. METHOD: In 2007, we abstracted data on mental illness, pain, and drugs contributing to death from all unintentional prescription drug overdose deaths in 2006 recorded by the West Virginia Office of the Chief Medical Examiner. Decedent prescription records were obtained from the state prescription drug monitoring program. RESULTS: Histories of mental illness and pain were documented in 42.7% and 56.6% of 295 decedents, respectively. Psychotropic drugs contributed to 48.8% of the deaths, with benzodiazepines involved in 36.6%. Benzodiazepines contributing to death were not associated with mental illness (adjusted odds ratio [AOR] = 1.1; 95% CI, 0.6-1.8), while all other psychotropic drugs were (AOR = 3.9; 95% CI, 2.0-7.6). Of decedents with contributory benzodiazepines, 46.3% had no prescription for the drug. CONCLUSIONS: Mental illness may have contributed to substance abuse associated with deaths. Clinicians should screen for mental illness when prescribing opioids and recommend psychotherapy as an adjunct or an alternate to pharmacotherapy. Benzodiazepines may have been used nonmedically rather than as a psychotropic drug, reflecting drug diversion. Restricting benzodiazepine prescriptions to a 30-day supply with no refills might be considered. Language: en
95 citations
TL;DR: Using self-reported data as a reference standard, the Prescription Register provides valid information on current exposures to antidepressants and antipsychotics in elderly people if the time window is selected with adequate consideration, but the validity is lower for benzodiazepines.
Abstract: Pharmacoepidemiological studies assessing the associations between psychotropic drug use and adverse events in the elderly frequently employ automated pharmacy databases as the source of exposure data. However, information on the validity of these databases for estimating psychotropic drug exposures in elderly people is scarce. This study evaluated the validity of the Finnish Prescription Register for estimating current exposures to psychotropic drugs in elderly people. Furthermore, the potential change in the validity over time was determined. This was a population-based intervention study (GeMS; Geriatric Multidisciplinary Strategy for the Good Care of the Elderly) conducted between 2004 and 2007. Initially, 1000 randomly selected persons aged ≥75 years living in the City of Kuopio, Finland, in November 2003 were invited to participate in the study. Of these, 716 agreed to participate at baseline (2004) and 570 were still available for 3-year follow-up (2007). The validity of the Prescription Register was assessed by comparing it with the self-reported information collected by interviews in 2004 and in 2007 in the GeMS study. Using the self-reported data as a reference standard, sensitivity, specificity and Cohen’s κ statistic (measure of inter-rater agreement for qualitative [categorical] items) with 95% confidence intervals were computed for different categories and subcategories of psychotropic drugs, applying fixed-time windows of 4, 6 and 12 months. In 2007, the sensitivity varied between psychotropic categories and subcategories, being generally highest with the 12-month time window (0.57–0.96). The specificity was highest with the 4-month time window (0.94–0.99), showing a slight tendency to decrease with an extended time window. The sensitivity and specificity were highest for antidepressants and antipsychotics, followed by benzodiazepines. The agreement was almost perfect (κ=0.81–1.00) or substantial (κ=0.61–0.80) for all categories and subcategories of psychotropic drugs. Few differences in validity were observed between the two years. Using self-reported data as a reference standard, the Prescription Register provides valid information on current exposures to antidepressants and antipsychotics in elderly people if the time window is selected with adequate consideration. However, the validity is lower for benzodiazepines, suggesting that other sources of information should be considered when performing pharmacoepidemiological studies.
87 citations
TL;DR: Effective reduction will probably require reductions in overall PPD consumption volumes, although such will need to be accomplished without compromising standards of good medical care.
Abstract: Aims North America features some of the world's highest consumption levels for controlled psychoactive prescription drugs (PPDs; e.g. prescription opioids, benzodiazepines, stimulants), with non-medical use and related harms (e.g. morbidity, mortality) rising in key populations in recent years. While the determinants, characteristics and impacts of these ‘use’ problems are increasingly well documented, little is known about the ‘supply’ side of non-medical PPD use, much of which is facilitated by ‘diversion’ as a key sourcing route. This paper provides a select review of the phenomenon of PPD diversion in North America, also considering interventions and policy implications.
Methods A conceptual and empirical review of select-peer- and non-peer-reviewed research literature from 1991 to 2010 focusing upon PPD diversion in North America was conducted.
Results The phenomenon of PPD diversion is heterogeneous. Especially among general populations, a large proportion of PPDs for non-medical use are obtained from friends or family members. Other PPD diversion routes involve ‘double doctoring’ or ‘prescription shopping’; street drug markets; drug thefts, prescription forgeries or fraud; as well as PPD purchases from the internet.
Conclusions The distinct nature and heterogeneity make PPD diversion a complex and difficult target for interventions. Prescription monitoring programs (PMPs) appear to reduce overall PPD use, yet their impact on reducing diversion or non-medical use is not clear. Law enforcement is unlikely to reach PPD diversion effectively. Effective reduction will probably require reductions in overall PPD consumption volumes, although such will need to be accomplished without compromising standards of good medical (e.g. pain) care.
86 citations
TL;DR: The serotonin re-uptake inhibitor fluoxetine was selected for an environmental risk assessment, using the most recent European guideline (EMEA 2006), due to its environmental persistence, acute toxicity to nontarget organisms, and unique pharmacokinetics associated with a readily ionizable compound.
Abstract: The serotonin re-uptake inhibitor fluoxetine was selected for an environmental risk assessment, using the most recent European guideline (EMEA 2006) within the European Union (EU)-funded Environmental Risk Assessment of Pharmaceuticals (ERAPharm) project due to its environmental persistence, acute toxicity to nontarget organisms, and unique pharmacokinetics associated with a readily ionizable compound. As a widely prescribed psychotropic drug, fluoxetine is frequently detected in surface waters adjacent to urban areas because municipal wastewater effluents are the primary route of entry to aquatic environments. In Phase I of the assessment, the initial predicted environmental concentration of fluoxetine in surface water (initial PECSW) reached or exceeded the action limit of 10 ng/L, when using both a default market penetration factor and prescription data for Sweden, Germany, and the United Kingdom. Consequently, a Phase II risk assessment was conducted in which green algae were identified as the most sensitive species with a NOEC of <0.6 µg/L. From this value, a predicted no effect concentration for surface waters (PNECSW) of 0.012 µg/L was derived. The PEC/PNEC ratio was above the trigger value of 1 in worst-case exposure scenarios indicating a potential risk to the aquatic compartment. Similarly, risks of fluoxetine for sediment-dwelling organisms could not be excluded. No risk assessment was conducted for the terrestrial compartment due to a lack of data on effects of fluoxetine on soil organisms. The need for a separate risk assessment for the main metabolite of fluoxetine, norfluoxetine, was not conducted because of a lack of fate and effect studies. Based on published data, fluoxetine and norfluoxetine appeared to have a low to moderate bioaccumulation potential, which should be confirmed in formal studies according to OECD guidelines. Exposure assessments for fluoxetine according to the current framework rely heavily on KOC and KOW values. This approach is problematic, because fluoxetine is predominantly a cationic substance at environmental pH values. Consequently, the fate of fluoxetine (and other ionic substances) cannot be predicted using partition coefficients established for nonionic compounds. Further, published estimates for partition coefficients of fluoxetine vary, resulting in considerable uncertainties in both the exposure and environmental risk assessments of fluoxetine. Integr Environ Assess Manag 2010;6:524–539. © 2009 SETAC
81 citations
TL;DR: In an 8-week, open-label trial, lamotrigine was added to ongoing psychotropic drug regimens in schizophrenia and schizoaffective disorder patients with clinically significant OCS and was safe and well tolerated.
Abstract: Obsessive-compulsive symptoms (OCS) are clinically important phenomena in schizophrenia patients. Lamotrigine has a modulating effect on glutamatergic neurotransmission relevant to pathophysiology of both schizophrenia and OCD. Efficacy and tolerability of lamotrigine in schizophrenia and schizoaffective patients with comorbid OCS were evaluated. In an 8-week, open-label trial, lamotrigine (25 mg/day for 1 week, 50 mg for 2 weeks, 100 mg for 2 weeks, 200 mg for 3 weeks) was added to ongoing psychotropic drug regimens in schizophrenia (N = 5) and schizoaffective disorder (N = 6) patients with clinically significant OCS [Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score > 16]. The Y-BOCS score for nine completers decreased significantly from baseline to week 8 (22.9 +/- 6.1 vs 17.4 +/- 3.6; t = 2.33, df = 1, P = 0.033). Five patients, all with schizoaffective disorder, were responders (>or=35% decrease in Y-BOCS score). No significant changes were detected in schizophrenia symptom severity. Depressive symptoms, assessed with the Calgary Depression Rating Scale, improved significantly (6.4 +/- 1.5 vs 4.0 +/- 2.5; t = 3.19, df = 1, P = 0.013); this change positively correlated with OCS improvement (r = 0.69, P = 0.04). Lamotrigine was safe and well tolerated. Explicit evaluation of therapeutic efficacy of adjunctive lamotrigine in schizoaffective disorder patients with comorbid OCS merits further investigation.
76 citations
TL;DR: Evaluating the appropriateness and amount of prescription of psychotropic drugs in people with lifetime diagnosis of Major Depressive Disorder by means of community survey with a semi-structured interview as a diagnostic instrument, administered by clinicians finds that ADs use was higher and tallied well with the data regarding antidepressant sales in Italy.
Abstract: Background: The increased use of antidepressant drugs (ADs) improved the response to the needs of care although some community surveys have shown that subjects without lifetime psychiatric diagnosis (anxiety/depression) used ADs. Objectives: To evaluate the appropriateness and amount of prescription of psychotropic drugs in people with lifetime diagnosis of Major Depressive Disorder (MDD) by means of community survey with a semi-structured interview as a diagnostic instrument, administered by clinicians. Methods: Study design: community survey. Study population: samples randomly drawn, after stratification from the adult population of municipal records. Sample size: 4.999 people were drawn in 7 centres of 6 Italian regions. Tools: questionnaire on psychotropic drug consumption, prescription, health services utilization; Structured Clinical Interview for DSM-IV modified (ANTAS); Training: interviewers were trained psychologists or medical doctors. Results: 3.398 subjects were interviewed (68% of the recruited sample). The lifetime prevalence of DSM-IV MDD was 4.3% in males and 11.5% in females; antidepressant drugs were taken by 4.7% of subjects, 2.9% male and 5.9% female. 38% of males and 57% of females with lifetime diagnosis of MDD were taking ADs. Conclusions: Compared with studies using lay interviewers and structured tools the prevalence of the MDD was quite lower; ADs use was higher and tallied well with the data regarding antidepressant sales in Italy; the correspondence between lifetime diagnosis of MDD and ADs use was closer.
58 citations
TL;DR: Progress has been made in research toward understanding how genetic factors influence psychotropic drug responses and the challenges that lie ahead in translating the research findings into clinical practices that yield tangible benefits for patients with mental illnesses are reviewed.
55 citations
TL;DR: Comprehensive medication reviews may be a valuable strategy to identify and resolve drug-related problems among clients of community mental health teams (CMHTs) and likely to result in improved clinical outcomes.
Abstract: Few studies have investigated strategies to identify and resolve drug-related problems among clients of community mental health teams (CMHTs). The objective of this study was to evaluate the clinical impact and appropriateness of comprehensive medication reviews for clients of CMHTs. Trained pharmacists conducted interviews (30–45 min each) with clients of CMHTs to identify actual and potential drug-related problems. The pharmacists prepared medication review reports that detailed their findings and recommendations to optimize drug therapy. An expert panel comprising a psychiatrist, general medical practitioner, mental health pharmacist and medication review pharmacist evaluated reviews for 48 clients of 5 CMHTs. Panelists independently assessed review findings, review recommendations, likelihood of recommendation implementation and the overall expected clinical impact. Two hundred and nine medication review findings and 208 medication review recommendations were evaluated. Panelists agreed with 76% of findings and considered that 81% of recommendations were appropriate. Collectively, 69% of recommendations were considered likely to be implemented. Thirty-seven (77%) reviews were deemed potentially to have a positive clinical impact. The agreement between panelists was statistically significant (P < 0.01) for the assessment of the findings, recommendations and likelihood of recommendation implementation. Pharmacists’ findings and recommendations to optimize drug therapy were considered appropriate and likely to result in improved clinical outcomes. Comprehensive medication reviews may be a valuable strategy to identify and resolve drug-related problems among clients of CMHTs.
52 citations
TL;DR: A mismatch exists between GPs' intent and practice regarding reduction of psychotrop prescription in individuals aged > or =65 years, and the barriers encountered should be examined further to help physicians improve management of psychotropic prescription.
Abstract: Background The use of psychotropic drugs has increased over recent years in France. GPs are the first prescribers, especially for older patients. Aim To analyse discrepancies between GPs9 opinions and practice when prescribing psychotropic drugs to older patients. Setting Postal surveys sent to GPs all over mainland France. Design of study Cross-sectional postal study. Method A questionnaire collected data on characteristics of GPs9 practices, their opinions about psychotropic drug consumption in older people, and a full description of their last older patient receiving a psychotropic drug and seen last by the GP on that particular day. Results A total of 350 participating GPs saw 2498 patients aged ≥65 years. Among these patients, the prevalence of psychotropic use was 32.1% (803/2498) for anxiolytics/hypnotics, and 17.5% for antidepressants (438/2498). A total of 91% of GPs agreed that it was possible to reduce or stop psychotropic drugs for these patients. Characteristics of 339 patients taking psychotropic drug were reported: 85.8% (291/339) received at least one anxiolytic/hypnotic and 56.9% (193/339) received at least one antidepressant; there were prescribed for more than 1 year in 68.4% (199/291) and 43.5% (84/193) of the cases respectively. GPs stated that it was possible to reduce or stop anxiolytic/hypnotic drugs for only 27% (79/291) of these patients. Barriers to doing this were patients9 refusal (79%), and the absence of any local offer of psychotherapy (73%) or alternative therapy (70%). Conclusion A mismatch exists between GPs9 intent (91%) and practice (27%) regarding reduction of psychotropic prescription in individuals aged ≥65 years. The barriers encountered should be examined further to help physicians improve management of psychotropic prescription.
TL;DR: Results showed that the hyponatremia observed in patients using this anticonvulsant drug, at least in part, is due to the Carba capacity to increase IMCD's Pf and that the Lithium-Carbamazepine association is beneficial to the patient.
Abstract: Background. Carbamazepine (Carba) is an anticonvulsant and psychotropic drug used widely for the treatment of intellectual disability and severe pains, but the incidence of hyponatremia is a common related occurrence. This hyponatremia is frequently attributed to a SIADH induced by this drug. It is also known that Carba is used to decrease the urinary volume in Diabetes Insipidus (DI) because it has an antidiuretic effect. Lithium (Li) is one of the most important drugs used to treat bipolar mood disorders. However Li has the undesirable capacity to induce DI. Nowadays, the association of these drugs is used in the treatment of patients with psychiatric and neurological problems. Methods. In vivo and in vitro (microperfusion) experiments were developed to investigate the effect of Carba in the rat Inner Medullary Collecting Duct (IMCD). Results. The results revealed that Carba was able to stimulate the V2 vasopressin receptor-Protein G complex increasing the water permeability (Pf) and water absorption. In vivo studies showed that in rats with lithium-induced DI, Carba decreased the urinary volume and increased the urinary osmolality. AQP2 expression was increased both in normal IMCD incubated with Carba and in IMCD from lithium-induced DI after Carba addition to the diet, when compared with the control. Conclusion. These results showed that the hyponatremia observed in patients using this anticonvulsant drug, at least in part, is due to the Carba capacity to increase IMCD's Pf and that the Lithium-Carbamazepine association is beneficial to the patient.
TL;DR: Prospective studies with anti-dementia drugs or with multifactorial strategies have revealed that the therapeutic response to conventional drugs in Alzheimer’s disease is genotype-specific, with APOE-4 carriers acting as the worst responders.
Abstract: About 80% of functional genes in the human genome are expressed in the brain and over 1,200 different genes have been associated with the pathogenesis of CNS disorders and dementia. Pharmacogenetic studies of psychotropic drug response have focused on determining the relationship between variations in specific candidate genes and the positive and adverse effects of drug treatment. Approximately, 18% of neuroleptics are substrates of CYP1A2 enzymes, 40% of CYP2D6, and 23% of CYP3A4; 24% of antidepressants are substrates of CYP1A2 enzymes, 5% of CYP2B6, 38% of CYP2C19, 85% of CYP2D6, and 38% of CYP3A4; 7% of benzodiazepines are substrates of CYP2C19 enzymes, 20% of CYP2D6, and 95% of CYP3A4. 10-20% of Western populations are defective in genes of the CYP superfamily; and the pharmacogenomic response of psychotropic drugs also depends on genetic variants associated with dementia. Prospective studies with anti-dementia drugs or with multifactorial strategies have revealed that the therapeutic response to conventional drugs in Alzheimer’s disease is genotype-specific. The disease-modifying effects (cognitive performance, biomarker modification) of therapeutic intervention are APOE-dependent, with APOE-4 carriers acting as the worst responders (APOE-3/3 > APOE-3/4 > APOE-4/4). APOE-CYP2D6 interactions also influence the therapeutic outcome in patients with dementia.
TL;DR: The concomitant use of several BZDs and that of several APs are associated with an increase in the risk of fractures in older men, and the findings cannot draw the conclusion that these drug combinations are causes of fractures.
Abstract: There is evidence that the use of any psychotropic and the concomitant use of two or more benzodiazepines are related to an increased risk of fractures in old age. However, also controversial results exist. The aim was to describe associations between the use of a psychotropic drug, or the concomitant use of two or more of these drugs and the risk of fractures in a population aged 65 years or over. This study was a part of a prospective longitudinal population-based study carried out in the municipality of Lieto, South-Western Finland. The objective was to describe gender-specific associations between the use of one psychotropic drug [benzodiazepine (BZD), antipsychotic (AP) or antidepressant (AD)] or the concomitant use of two or more psychotropic drugs and the risk of fractures in a population 65 years or over. Subjects were participants in the first wave of the Lieto study in 1990-1991, and they were followed up until the end of 1996. Information about fractures confirmed with radiology reports in 1,177 subjects (482 men and 695 women) during the follow-up was collected from medical records. Two follow-up periods (three and six years) were used, and previously found risk factors of fractures were adjusted as confounding factors separately for men and women. The Poisson regression model was used in the analyses. The concomitant use of two or more BZDs and the concomitant use of two or more APs were related to an increased risk of fractures during both follow-up periods after adjusting for confounding factors in men. No similar associations were found in women. The concomitant use of several BZDs and that of several APs are associated with an increase in the risk of fractures in older men. Our findings show only risk relations. We cannot draw the conclusion that these drug combinations are causes of fractures.
TL;DR: There was an association between socioeconomic determinants and psychotropic drug utilisation, and the probability for utilising potentially inappropriate psychotropics was higher among individuals with low income and among the non-married.
Abstract: Background: Psychotropic drugs are commonly utilised among the elderly. This study aimed to analyse whether two socioeconomic determinants - income and marital status - are associated with differences in utilisation of psychotropic drugs and potentially inappropriate psychotropic drugs among elderly in Sweden. Methods: All individuals aged 75 years and older who had purchased a psychotropic drug in Sweden during 2006 were included (68.7% women, n = 384712). Data was collected from national individual-based registers. Outcome measures were utilisation of three or more psychotropic drugs and utilisation of potentially inappropriate psychotropic drugs, as classified by the Swedish National Board of Health and Welfare. Results: Individuals with low income were more likely to utilise three or more psychotropic drugs compared to those with high income; adjusted odds ratio (aOR) 1.12 (95% confidence interval [CI] 1.10-1.14). The non-married had a higher probability for utilising three or more psychotropic drugs compared to the married (aOR 1.22; CI 1.20-1.25). The highest probability was observed among the divorced and the never married. Potentially inappropriate psychotropic drugs were more common among individuals with low compared to high income (aOR 1.14; CI 1.13-1.16). Compared to the married, potentially inappropriate psychotropic drug utilisation occurred more commonly among the nonmarried (aOR 1.08; CI 1.06-1.10). The never married and the divorced had the highest probability. Conclusions: There was an association between socioeconomic determinants and psychotropic drug utilisation. The probability for utilising potentially inappropriate psychotropics was higher among individuals with low income and among the non-married.
TL;DR: Compared to the native population in the Netherlands, first- and second-generation Turkish and Moroccan immigrants had an increased risk of antidepressant and antipsychotic drug prescriptions and a decreased risk of ADHD medication and Lithium prescriptions.
Abstract: Psychotropic drug use in Europe and the USA has increased in the past 20 years. The rise in mental health-care use instigated a debate about possible differences in prevalence rates between different ethnic groups in the Netherlands, although the exact differences were unknown. The aim of this study was to determine whether these minority groups were more or less likely than the native population to receive psychotropic drugs. A descriptive population study was conducted using the Agis Health Database, containing demographic and health-care consumption data of approximately 1.5 million inhabitants of the Netherlands. Rates of prescriptions of psychotropic drugs from 2001 to 2006 and adjusted odds ratios for psychotropic drug prescriptions among native Dutch, Turkish and Moroccan ethnic groups were calculated. These data were analysed using logistic regression, after being adjusted for age, gender and socioeconomic status. The mean year prevalence of psychotropic drug prescriptions from 2001 to 2006 was 14.0%. Except for a decrease in anxiolytic drugs, the prescriptions of psychotropic drugs increased from 2001 to 2006. These trends were the same for all of the ethnic groups considered. Among both the Moroccan and Turkish populations, there was a higher risk of antidepressant and antipsychotic drug prescriptions, and a pronounced lower risk of ADHD medication and lithium prescriptions compared to the native population. Among the Turkish population, the risk of anxiolytic drug prescriptions was greater than in the native population. Compared to the native population in the Netherlands, first- and second-generation Turkish and Moroccan immigrants had an increased risk of antidepressant and antipsychotic drug prescriptions and a decreased risk of ADHD medication and Lithium prescriptions. Further research is needed to clarify whether patients of different ethnic backgrounds with the same symptoms receive similar diagnosis and adequate treatment.
TL;DR: The results of this study suggest that although both groups misuse drugs and have personal difficulties, some mothers will not need support from social services to take care of their children.
Abstract: The purpose of this study is to identify which personal, familial, environmental, and social factors are associated with the utilization of child protection services, including parental support programs, by mothers who misuse illicit substances. Participants are 56 mothers with substance use and addiction-related problems, of whom 32 were receiving, voluntarily or otherwise, child protection services while 24 mothers had psychotropic drug use-related problems but were receiving no psychosocial services. Data were collected in the province of Quebec, Canada, between August 1998 and August 1999 . Results indicate that mothers who receive services are younger, have fewer interpersonal resources, live in lower socioeconomic conditions, and have greater family dysfunction (less parental supervision and more inconsistent discipline) than mothers who do not receive services from child protection agencies. However, there are no significant differences between groups with regards to maternal childhood trauma, psychological distress, antisocial behavior and the quality of the parent-child bond. The results of this study suggest that although both groups misuse drugs and have personal difficulties, some mothers will not need support from social services to take care of their children. Implications of these findings for prevention are discussed. The study's limitations are noted.
TL;DR: Residents with dementia were less frequent users of sedative-hypnotic drugs than residents without dementia, and Clinicians should be aware of the extent to which all individual drugs, not only those prescribed for intentional sedation, contribute to a resident’s sedative load.
Abstract: Background and Objective: People with cognitive impairment are particularly susceptible to adverse drug events linked to sedative and psychotropic drugs. A model to calculate sedative load has been developed to quantify the cumulative effect of taking multiple drugs with sedative properties. The objective of this study was to describe the sedative load and use of sedative and psychotropic drugs among long-term care facility residents with and without dementia.
01 Apr 2010
TL;DR: The prescription pattern of psychotropic drugs changes considerably over time, even in the same clinical setting, and mental health professionals need to keep up with changes in the prescription patterns in order to serve their patients at the best possible level.
Abstract: Background To date, no study has investigated how prescription patterns change over time in Chinese patients with schizophrenia. This study aimed to determine psychotropic drug prescription patterns and the use of electroconvulsive therapy (ECT) for schizophrenia and their changes over time in a large psychiatric institution in Beijing, China. Methods The case notes of inpatients with schizophrenia were scrutinized to identify psychotropic drug prescription patterns and the use of ECT on November 10, 1999 and the same calendar day in 2008 and to compare the two surveys. Results In 1999, 45.1% of inpatients with schizophrenia were on first-generation antipsychotic drugs (FGA), while 52.9% were on second-generation antipsychotic drugs (SGA). In 2008, the percentage of patients on FGAs decreased to 15.1%, while those on SGAs increased to 77.2%. The proportion of schizophrenia patients on mood stabilizers and antidepressants rose from 3.3% and 4.3% in 1999 to 18% and 9.5% by 2008, respectively. Use of ECT grew from 0.5% in 1999 to 5.6% by 2008. The proportion of schizophrenia patients not prescribed antipsychotic drugs changed from 5.6% in 1999 to 13.7% in 2008. Conclusions The prescription pattern of psychotropic drugs changes considerably over time, even in the same clinical setting. Mental health professionals need to keep up with changes in the prescription patterns of psychotropic drugs in order to serve their patients at the best possible level. The socio-economic reasons for not prescribing antipsychotic drugs to schizophrenia patients should be further explored.
TL;DR: In this article, the authors assess the prevalence of alcohol, tobacco and psychotropic drug consumption by students of the Medical School of the Federal University of Minas Gerais, Brazil, and verify aspects related to those addictions.
Abstract: Objective The purpose of this study was to assess the prevalence of alcohol, tobacco and psychotropic drug consumption by students of the Medical School of the Federal University of Minas Gerais, Brazil, and to verify aspects related to those addictions. Methods This study was carried out with students of all years of the medical course invited to participate anonymously, by answering a self-applied questionnaire which was previously evaluated and adapted to Brazilian reality. It was based upon the World Health Organization's Guidelines for Student Substance Use Survey and included 25 questions about drug addiction. Student's t test and chi-square test were applied to assess differences between the mean and proportions of data. Results Alcohol and tobacco were the more frequently used by the students, 85.2% and 16.3% respectively. Among psychotropic drugs, marijuana was reported by 16.5% of students, LSD by 6.9%, sedatives by 12%, amphetamines by 7.5% and inhalant substances by 16.8%. Cocaine, crack, opiates, anticholinergics and anabolics consumption were rarely mentioned. Conclusion Alcohol was the drug most used and was related to other drug addictions. Drugs were most frequently used by single, male students, who live alone and do not support themselves.
TL;DR: The results suggest that most young patrons drinking in Perth metropolitan hotels and taverns consume alcohol on such occasions in excess of limits currently recommended by health authorities and attain blood alcohol levels dangerous for driving.
Abstract: We aimed to determine the alcohol consumption, blood alcohol levels (BALs) and subsequent driving of patrons leaving 15 hotels and taverns in Perth, Western Australia. Of the 414 patrons approached by interviewers on Friday and Saturday evenings, 307 (74 per cent) consented to take part. Self-reported alcohol consumption, driving intentions, perceived levels of fitness to drive and demographic information were collected using an interviewer-administered questionnaire. Observations of subsequent driving were recorded and BALs were measured by breath-alcohol meter. The patrons surveyed were predominantly male (76 per cent) and aged between 18 and 35 (87 per cent). Average reported alcohol consumption was 7.6 standard drinks for males and 4.9 drinks for females, around double the daily amount recommended by the National Health and Medical Research Council. Further, 23 per cent of the sample had consumed more than 10 drinks (male) and 6 drinks (female). With respect to BALs, 37 per cent of patrons exceeded the drink-drive limit then in force of 0.087 and 56 per cent exceeded 0.05. Of greater concern, 23 per cent who were over the 0.08 legal limit were subsequently observed to drive even though they had been informed of their BAL and legal status with respect to driving. The results suggest that most young patrons drinking in Perth metropolitan hotels and taverns consume alcohol on such occasions in excess of limits currently recommended by health authorities and attain blood alcohol levels dangerous for driving. This is likely to remain unchanged without public debate as to the responsibility of licensees in serving a potentially harmful psychotropic drug and effective enforcement of liquor licensing laws.
TL;DR: A combination of effects by quetiapine-norquetiAPine at dopaminergic, serotonergic, and noradrenergic targets may explain the antipsychotic, antidepressant, and anxiolytic properties of quetuapine.
TL;DR: Women exposed to IPV were more likely to report use of psychotropic drugs, even after adjusting for mental distress, and this study indicates that exposure to IPv; including psychological abuse should be evaluated as a possible source of distress when psychotropic drug treatment is considered.
Abstract: Aims: To investigate psychotropic drug use among women ever exposed to intimate partner violence (IPV) in relation to mental distress and sociodemographic, lifestyle and somatic health characteristics, and to assess whether drug use differed for physical and/or sexual violence compared with psychological abuse alone. Methods: Cross-sectional data from women aged 30-60 years were drawn from self-reported questionnaires in the Oslo Health study 2000-2001. Women reporting hypnotic, anxiolytic and/or antidepressant drug use in the previous four weeks were defined as users. Differences in psychotropic drug use by IPV exposure were examined by logistic regression analyses. Results: In total, 880 (14%) of 6,471 included women reported ever experiencing IPV; 494 (8%) reported physical and/or sexual IPV, and 386 (6%) reported psychological IPV alone. Physical and/or sexual IPV was significantly associated with use of all psychotropic drugs: hypnotics (odds ratio (OR) 2.28; 95% confidence interval (95% CI), 1.73-3.00); anxiolytics (OR 3.29; 95% CI, 2.43-4.44); and antidepressants (OR 2.72; 95% CI, 1.97-3.76). The associations remained significant for anxiolytics (OR 1.67; 95% CI, 1.14-2.45) and antidepressants (OR 1.50; 95% CI, 1.02-2.19) after adjusting for mental distress, sociodemographic, lifestyle and somatic health characteristics. Psychological IPV alone was associated with use of anxiolytics (OR 1.81; 95% CI, 1.20-2.75) and antidepressants (OR 2.38; 95% CI, 1.64-3.45). After adjustments the association persisted for use of antidepressants only (OR 1.64; 95% CI, 1.05-2.55). Conclusions: Women exposed to IPV were more likely to report use of psychotropic drugs, even after adjusting for mental distress. The study indicates that exposure to IPV; including psychological abuse should be evaluated as a possible source of distress when psychotropic drug treatment is considered.
TL;DR: On-line ion mobility filtering showed to be advantageous in reducing the background chemical noise in the analysis of the psychotropic drug diazepam in urine using nanoelectrospray ionization as well as in some cross-interference in the MS data due to facile ionization of the neutral form of the compound even when the ionic form had been separated by DMS.
TL;DR: Data show an interaction of glutathione depletion with the effects of amphetamine treatment on PPI in rats, which could reflect loss of plasticity in PPI regulation caused by the additive effects of CHX-induced glutATHione depletion and additional oxidative stress caused by amphetamine-induced dopamine release.
Abstract: Oxidative stress has been implicated in several psychiatric illnesses, including schizophrenia. Glutathione is the brain's primary antioxidant and decreased levels of brain glutathione are reported in schizophrenia. Prepulse inhibition (PPI) is a measure of sensory gating, and PPI is reduced in schizophrenia. This study aimed to investigate the effects of brain glutathione depletion on PPI regulation. Rats and mice were treated with the glutathione-depleting agent, 2-cyclohexene-1-one (CHX), and tested for baseline PPI and its disruption by treatment with amphetamine and MK-801. Treatment with CHX caused significant depletion of GSH in frontal cortex and striatum of rats and mice. Baseline PPI and startle were not altered. However, the disruption of PPI after treatment with amphetamine was absent in CHX-treated rats. In contrast, the effect of MK-801 was not altered by CHX-treatment, nor was there any effect of CHX treatment in mice. These data show an interaction of glutathione depletion with the effects of amphetamine treatment on PPI in rats. This effect could reflect loss of plasticity in PPI regulation caused by the additive effects of CHX-induced glutathione depletion and additional oxidative stress caused by amphetamine-induced dopamine release. The significance of these results for schizophrenia is discussed.
TL;DR: This manuscript overviews the psychopharmacology of developmental disabilities and considers how practitioners can assist in improving the quality of the pharmacological treatments that their clients receive.
Abstract: Many people with developmental disabilities receive medications prescribed to improve behavior This manuscript overviews the psychopharmacology of developmental disabilities and considers how practitioners can assist in improving the quality of the pharmacological treatments that their clients receive
TL;DR: The most commonly prescribed drugs were fluoxetine and olanzapine, but 26 different drugs were used, and the most common indications were depression, anxiety and 'pseudo-psychotic' concerns about weight.
Abstract: Background: Psychotropic drugs are not recommended for child and adolescent eating disorders, though they are used empirically for symptomatic treatment and co-morbid conditions. Little is known about rates of prescribing or the beneficial and adverse effects. Objective: To ascertain rates and outcomes of psychotropic drug prescribing in child and adolescent eating disorder services. Method: Retrospective case note study of eating disorder cases (n = 308), seen in one year in seven specialist UK services, covering indications, response to treatment, beneficial and adverse effects. Results: Drugs were prescribed for 27%, (mainly anorexia nervosa), 12% before referral to specialist services. The most commonly prescribed drugs were fluoxetine and olanzapine, but 26 different drugs were used. The most common indications were depression, anxiety and 'pseudo-psychotic' concerns about weight. Drugs were generally well tolerated, but their effectiveness was uncertain. Conclusions: Non-specialists commonly prescribe psychotropic medication to this vulnerable group without reference to specialist services. Specialists prescribe regularly on empirical grounds, without apparent undue consequences, though these may be under-reported. A prospective clinical trial would further clarify risks and benefits. Key Practitioner Message: • Guidelines do not recommend the use of psychotropic drugs as first line treatments for child and adolescent eating disorders. • Nevertheless drugs are often prescribed on symptomatic grounds, in Primary Care and General CAMHS and more commonly by specialist eating disorder services. • Despite concerns about physical health, psychotropic drugs appear to be tolerated well, though adverse effects may be under-reported. • Antidepressants and major tranquillisers are considered by clinicians to often have beneficial effects on the symptoms they target, though other concurrent treatments may confound these impressions.
TL;DR: The aim of this work was to examine the prevalence, cumulative incidence, use of monotherapy and combination therapy, and treatment duration of frequently prescribed psychoactive drug classes in the Netherlands.
TL;DR: It is shown that zuclopenthixol is inactivated essentially completely by only two enzymes, CYP 2D6 and CYP 3A4, that can be profoundly influenced by drugs and by inheritance, which will cause revisions in the dosing and drug interaction recommendations for this agent in future prescribing guidelines and books.
Abstract: The study of Davies et al. (1) published in this issue of the Acta Psychiatrica Scandinavica characterizes the drug metabolism pathways for an old firstgeneration antipsychotic zuclopenthixol that is still in widespread use inmany countries, both because it is relatively inexpensive and because it is available in a long-acting depot injection. Davies et al. (1) show that zuclopenthixol is inactivated essentially completely by only two enzymes, CYP 2D6 and CYP 3A4, that can be profoundly influenced by drugs and by inheritance. The impact of this findingwill be to cause revisions in the dosing and drug interaction recommendations for this agent in future prescribing guidelines and books including those of this editorialist (2). The report of Davies et al. (1) may even encourage others to look more carefully at the neglected drug metabolism pathways for older psychotropic drugs, particularly those in continued use today. First-generation antipsychotics were all developed prior to the careful characterization of cytochrome P 450 (CYP) drug metabolizing enzymes and their genes. The result is that clinicians have often been flying blind to the impact that drug interactions or hereditary variations in drug metabolism could have on dosing of many first-generation antipsychotics. Although the newer second-generation atypical antipsychotics are much better characterized in terms of their drug interactions (3), many older psychotropic agents still suffer from incomplete information about how they are metabolized, and thus how to dose them, particularly in patients receiving concomitant medications, who have unusually severe side effects, or who do not respond to standard doses.
TL;DR: It is recommended that social workers contribute to a fuller understanding of drug effects by eliciting clients' own views of treatment effects and by monitoring ongoing effects using a concise yet comprehensive treatment emergent effects checklist.
Abstract: For the past generation, drug therapy has become a primary form of helping mental health clients, many of whom derive substantial benefits from it. The responsible use of modern medications for all of the helping professions, however, requires ongoing education that includes not only the intended effects of psychotropic medications, but also any unintended, harmful effects. Based on a largely unmet need in the social work literature, the purpose of this integrative review is to facilitate social work practitioners' understanding of current practices in clinical trial research for assessing psychotropic drugs' harm. This could lead to more significant involvement of practitioners in detecting psychotropic drug harms in their clients, thereby contributing to improved practices in mental health. We performed a comprehensive review of interdisciplinary sources on the policies, procedures, and practices of assessing harms in clinical drug testing, including U.S. Food and Drug Administration (FDA) guidelines for safety analyses, biomedical and statistical reviews of trial design limitations and possibilities for assessing harms, and descriptions of actual practices in assessing and reporting harms of psychotropic drugs. This integrative review is presented in the spirit of advancing evidence-based practice, in which highlighting what we do not know is as important in informing clients as is sharing what we do know, both desirable and undesirable (Gambrill, 2006). The review concludes with recommendations for social work practice, research, and policy. Extensive pharmaceutical industry involvement in producing prescription drug knowledge and disseminating it to professionals, policymakers, and the public has resulted in well-documented publication biases and considerable uncertainty about drug efficacy and safety (Medawar, Hardon, & Herxheimer, 2004; Melander, Ahlqvist-Rastad, Meijer, & Beermann, 2003; Perlis et al., 2005; Turner, Matthews, Linardatos, Tell, & Rosenthal, 2008; Wazana, 2000). There have been publicized concerns about the association of suicidal thinking and behavior with antidepressant, stimulant, and anticonvulsant drugs (Alonso-Zaldivar, 2006; Healy & Whitaker, 2003; Mundy, 2008), and discoveries during litigation against drug companies about hidden or minimized adverse events (AEs) (Avorn, 2006; Kesselheim & Avorn, 2007; Kondro & Sibbald, 2004; State of Connecticut v. Eli Lilly and Company, 2008). As a result, professionals and the public are alert to the fact that some drug effects, especially of a behavioral or psychological nature, remain unrecognized at the time of drug approval and are too tardily recognized after a drug has reached the market. Such uncertainty as to the nature and intensity of drug effects poses a serious problem for making informed decisions about the drug treatment of distress and disorder. As a preliminary to this review, we sought to assess social work's involvement in evaluating drug safety issues by searching Social Work Abstracts, Social Services Abstracts, and Sociological Abstracts (for the previous 15 years) for the key words side effects, adverse effects, harm, safety, and psychopharmacology along with medication or psychotropic. We retrieved 38, 175, and 120 citations, respectively. Reviewing this literature, we concluded that current textbooks (Bentley & Walsh, 2006; Dziegelewski & Leon, 2001) and review articles (Bentley, 2003; Farmer, Bentley, & Walsh, 2006; Walsh, 1999) on psychopharmacology and social work largely aim to educate social workers on types of medication, indications, known side effects, concerns for special populations, and ethical issues with regard to professional values. Few reports, however, scrutinize clinical trials. Otis and King (2006) advised counselors on various unanticipated effects and discontinuation reactions that remain unaccounted for in clinical trials. Cohen (2002) and Cohen and Jacobs (2007) outlined methodological and conceptual limitations of randomized controlled drug trials, raising doubts about the scientific evidence supporting widespread drug use. …