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Showing papers on "Psychotropic drug published in 2013"


Journal ArticleDOI
Allen Frances1
TL;DR: Modern descriptive psychiatry was born two centuries ago in the classification of Pinel, was later systematized in the textbook of Kraepelin, and was then expanded by Freud to include outpatient presentations previously seen by neurologists, and is facing another serious crisis of confidence, this time caused by diagnostic inflation.

85 citations


Journal ArticleDOI
TL;DR: It can be concluded that psychotropic drugs cause impairments in postural control, which is probably one of the mediating factors for the increased fall risk these FRIDs are associated with.
Abstract: Meta-analyses showed that psychotropic drugs (antidepressants, neuroleptics, benzodiazepines, antiepileptic drugs) and some cardiac drugs (digoxin, type IA anti-arrhythmics, diuretics) are associated with increased fall risk. Because balance and gait disorders are the most consistent predictors of future falls, falls due to use of these so-called fall-risk-increasing drugs (FRIDs) might be partly caused by impairments of postural control that these drugs can induce. Therefore, the effects of FRIDs on postural control were examined by reviewing literature. Electronic databases and reference lists of identified papers were searched until June 2013. Only controlled research papers examining the effects of FRIDs on postural control were included. FRIDs were defined according to meta-analyses as antidepressants, neuroleptics, benzodiazepines, antiepileptic drugs, digoxin, type IA anti-arrhythmics, and diuretics. Ninety-four papers were included, of which study methods for quantifying postural control, and the effects of FRIDs on postural control were abstracted. Postural control was assessed with a variety of instruments, mainly evaluating aspects of body sway during quiet standing. In general, postural control was impaired, indicated by an increase in parameters quantifying body sway, when using psychotropic FRIDs. The effects were more pronounced when people were of a higher age, used psychotropics at higher daily doses, with longer half-lives, and administered for a longer period. From the present literature review, it can be concluded that psychotropic drugs cause impairments in postural control, which is probably one of the mediating factors for the increased fall risk these FRIDs are associated with. The sedative effects of these drugs on postural control are reversible, as was proven in intervention studies where FRIDs were withdrawn. The findings of the present literature review highlight the importance of using psychotropic drugs in the older population only at the lowest effective dose and for a limited period of time.

81 citations


Journal ArticleDOI
TL;DR: Exposure to both IPV and depression before age 3 years is associated with preschool-aged onset of attention-deficit/hyperactivity disorder; early exposure to parental depression isassociated with being prescribed psychotropic medication.
Abstract: IMPORTANCE Children with known exposure to intimate partner violence (IPV) or maternal depression are at risk for negative mental health outcomes as early as preschool age. Active ongoing surveillance for these risk factors can lead to earlier mental health intervention for children. OBJECTIVE To examine the association between parent reports of IPV and depressive symptoms within the first 3 years of a child's life with subsequent mental health conditions and psychotropic drug treatment. DESIGN Prospective cohort study linking parental IPV and depression with subsequent billing and pharmacy data between November 1, 2004, and June 7, 2012. SETTING Four pediatric clinics. PARTICIPANTS A total of 2422 children receiving care from clinics that implemented the Child Health Improvement Through Computer Automation (CHICA) system. MAIN OUTCOME MEASURES Any report of IPV and/or parental depressive symptoms from birth to age 3 years, mental health diagnoses made with International Classification of Diseases, Ninth Revision criteria, and any psychotropic drug treatment between ages 3 and 6 years. RESULTS Fifty-eight caregivers (2.4%) reported both IPV and depressive symptoms before their children were aged 3 years, 69 (2.8%) reported IPV only, 704 (29.1%) reported depressive symptoms only, and 1591 (65.7%) reported neither exposure. Children of parents reporting both IPV and depressive symptoms were more likely to have a diagnosis of attention-deficit/hyperactivity disorder (adjusted odds ratio = 4.0; 95% CI, 1.5-10.9), even after adjusting for the child's sex, race/ethnicity, and insurance type. Children whose parents reported depressive symptoms were more likely to have been prescribed psychotropic medication (adjusted odds ratio = 1.9; 95%, CI 1.0-3.4). CONCLUSIONS AND RELEVANCE Exposure to both IPV and depression before age 3 years is associated with preschool-aged onset of attention-deficit/hyperactivity disorder; early exposure to parental depression is associated with being prescribed psychotropic medication. Pediatricians play a critical role in performing active, ongoing surveillance of families with these known social risk factors and providing early intervention to negate long-term sequelae. Language: en

71 citations


Journal ArticleDOI
TL;DR: Given the complexity of bipolar disorder and its management, a switch of a mood stabilizer would be best done by a psychiatrist and take into account status of the condition being treated, efficacy, side effect profile, required laboratory monitoring and cost of the drug(s) being considered, and patient's pregnancy status or plan.
Abstract: Our review describes potential weight-altering effects of psychotropic medications (antipsychotics, antidepressants, anti-anxiety medications, mood stabilizers, sedative-hypnotics, medications for attention-deficit/hyperactivity disorder, and other psychotropic medications) and offers guidance on switching a medication if its weight-altering effect becomes problematic. For second-generation antipsychotics, the risk of weight gain is high with clozapine and olanzapine, low with amisulpride, aripiprazole, and ziprasidone, and medium with other second-generation antipsychotics. Switching from a high-risk antipsychotic to a low-risk antipsychotic usually mitigates or reverses weight gain. For second-generation antidepressants, there may be modest weight loss with bupropion and modest weight gain with mirtazapine and paroxetine. Other second-generation antidepressants are weight neutral but individual variations can occur. If significant change in weight occurs, switching to or adding a low-risk second-generation antidepressant should be considered. Mood stabilizers include lithium, valproate, carbamazepine, lamotrigine, oxcarbazepine, and most second-generation antipsychotics. Risk of weight gain is high with lithium and valproate and low with carbamazepine, lamotrigine, and oxcarbazepine. Given the complexity of bipolar disorder and its management, a switch of a mood stabilizer would be best done by a psychiatrist. Benzodiazepines, non-benzodiazepine and melatonergic hypnotics, doxepin, and trazodone are weight neutral. Diphenhydramine may cause weight-gain and can be switched to a weight-neutral hypnotic if needed. Stimulants can cause varying degrees of weight loss and switching to atomoxetine or bupropion may reverse this problem. If that fails, switching to clonidine or guanfacine can be tried. Switching must be evidence-based and take into account status of the condition being treated, efficacy, side effect profile, potential drug-drug interactions, required laboratory monitoring and cost of the drug(s) being considered, and patient's pregnancy status or plan. Non-pharmacological interventions both for mental disorders and overweight/obesity must be fully availed.

70 citations


Journal ArticleDOI
TL;DR: In this article, the interaction between alprazolam (Alp) and bovine serum albumin (BSA) has been investigated under physiological conditions by UV-vis, steady state as well as time-resolved fluorescence, circular dichroism (CD) spectroscopic and molecular docking studies.

64 citations


Journal ArticleDOI
TL;DR: This work aims to examine the prescription pattern in cancer patients of three common psychotropic drugs: benzodiazepine, antidepressant and antipsychotic.
Abstract: BACKGROUND: Psychotropic drugs are commonly prescribed for various psychological complaints in cancer patients. We aim to examine the prescription pattern in cancer patients of three common psychotropic drugs: benzodiazepine, antidepressant and antipsychotic. METHODS: This is a retrospective case-control study. Data were extracted from the Agis Health Database. This insurance database contains the healthcare consumption of 1.3 million inhabitants of the Netherlands. We analyzed the use of psychotropics in cancer patients and an equally sized randomly selected control group of noncancer patients from 2006 to 2008. Odds ratio (OR) were adjusted for age, gender, immigrant status, neighborhood socio-economic status, and premorbid medical condition. Additionally, the numbers of new user in the 3 months after cancer was diagnosed and in the 3 months before death were compared. RESULTS: A total of 113 887 cancer patients and 121 395 control subjects were included. Cancer patients were significantly more often prescribed psychotropic drugs (adjusted OR: benzodiazepines = 1.70, CI = 1.67-1.74; antidepressants = 1.38, CI = 1.34-1.42; and antipsychotics = 1.70, CI = 1.62-1.77). Lower socio-economic status, immigrant, and premorbid chronic medical conditions were significantly associated with higher risk of psychotropic use. Odds for a new prescription for all three psychotropic drugs were significantly less in the first 3 months after cancer diagnosis than the 3 months before death (benzodiazepine, OR = 0.673, CI = 0.647-0.705; antidepressant, OR = 0.592, CI = 0.544-0.644; antipsychotic, OR = 0.177, CI = 0.165-0.190) CONCLUSIONS: Psychotropic drug prescription is common in cancer patients, starts soon after diagnosis, and increases in the terminal stage. Prescription rates were significantly higher in patients from lower socio-economic group, immigrants, or with premorbid chronic medical condition.Copyright © 2012 John Wiley & Sons, Ltd.

58 citations


Journal ArticleDOI
TL;DR: Psychotropic drugs are extensively prescribed for the treatment of neuropsychiatric symptoms, despite modest efficacy and severe side effects.
Abstract: Background Psychotropic drugs are extensively prescribed for the treatment of neuropsychiatric symptoms, despite modest efficacy and severe side effects Aims We examined trends in psychotropic drug prescribing in Norwegian nursing homes from 1997 to 2009, in order to gain insight in practice development Methods The study is a secondary data analysis of six cross-sectional nursing home studies conducted between 1997 and 2009 Patients aged >65 years were included We compared the prevalence of psychotropic drugs (antipsychotics, anxiolytics, hypnotics, and antidepressants) Associations between prescription of psychotropics, and patients' age, gender, type of ward, and year of data collection were examined by univariate analysis and logistic regression Results Altogether, 7 661 patients (mean age 852 years, 726% women) were included Prevalence of all psychotropic drugs combined increased from 576% to 705%, anxiolytics from 149% to 219%, hypnotics from 145% to 229%, and antidepressants from 315% to 509% Prevalence of antipsychotics varied between extremes 211% and 256% Less prescribing of older drugs was exceeded by an increase in newer drug types Concomitant prescribing of two or more psychotropic drugs increased from 21% to 33% Predictors of psychotropic drugs were female gender (except antipsychotics), as well as age <80 years, and residency in special care units (except hypnotics) Conclusions Prescribing of psychotropic drugs in nursing homes has increased considerably, especially regarding antidepressants Explanations for this trend need to be further explored Copyright © 2012 John Wiley & Sons, Ltd

57 citations


Journal ArticleDOI
TL;DR: Results show that genetically-induced reduction of BDNF caused changes in a behavioral endophenotype relevant to the positive symptoms of schizophrenia, however, major sex differences were observed in the effects of a psychotropic drug challenge on this behavior.
Abstract: Brain-derived neurotrophic factor (BDNF) has been implicated in the pathophysiology of schizophrenia, yet its role in the development of specific symptoms is unclear. Methamphetamine (METH) users have an increased risk of psychosis and schizophrenia, and METH-treated animals have been used extensively as a model to study the positive symptoms of schizophrenia. We investigated whether METH treatment in BDNF heterozygous mutant mice (HET) has cumulative effects on sensorimotor gating, including the disruptive effects of psychotropic drugs. BDNF HETs and WT littermates were treated during young-adulthood with METH and, following a two-week break, prepulse inhibition (PPI) was examined. At baseline, BDNF HETs showed reduced PPI compared to WT mice irrespective of METH pre-treatment. An acute challenge with amphetamine (AMPH) disrupted PPI but male BDNF HETs were more sensitive to this effect, irrespective of METH pre-treatment. In contrast, female mice treated with METH were less sensitive to the disruptive effects of AMPH, and there were no effects of BDNF genotype. Similar changes were not observed in the response to an acute apomorphine or MK-801 challenge. These results show that genetically-induced reduction of BDNF caused changes in a behavioural endophenotype relevant to the positive symptoms of schizophrenia. However, major sex differences were observed in the effects of a psychotropic drug challenge on this behaviour. These findings suggest sex differences in the effects of BDNF depletion and METH treatment on the monoamine signaling pathways that regulate PPI. Given that these same pathways are thought to contribute to the expression of positive symptoms in schizophrenia, this work suggests that there may be significant sex differences in the pathophysiology underlying these symptoms. Elucidating these sex differences may be important for our understanding of the neurobiology of schizophrenia and developing better treatments strategies for the disorder.

51 citations


Journal ArticleDOI
18 Mar 2013-PLOS ONE
TL;DR: Findings from this nationwide study are in line with previous studies showing that persons with AD, regardless of sex or age, have higher risk of hip fracture in comparison to general population.
Abstract: Background Previous cohort studies have shown that persons with Alzheimer’s disease (AD) have a higher risk of hip fractures but recent data from large representative cohorts is scarce. Methods We investigated the association between AD and prevalent and incident hip fractures in an exposure-matched cohort study conducted in Finland 2002–2009 (the Medication and Alzheimer’s disease in 2005 study; MEDALZ-2005). The study population included all community-dwelling persons with verified AD diagnosis in Finland on December 31, 2005 and one matched comparison person per AD case (N = 56,186, mean age 79.9 (SD 6.8) years, range 42–101 years). The diagnosis of AD was extracted from a special reimbursement register. Data on hip fractures during 2002–2009 was extracted from the Finnish National hospital discharge register. Analyses of incident hip fractures (n = 2,861) were restricted to years 2006–2009. Results Persons with AD were twice as likely to have previous hip fracture in 2005 (odds ratio, 95% confidence interval 2.00, 1.82–2.20) than matched aged population without AD. They were also more likely to experience incident hip fracture during the four-year follow-up (hazard ratio, 95% confidence interval 2.57, 2.32–2.84, adjusted for health status, psychotropic drug and bisphosphonate use). The AD-associated risk increase decreased linearly across age groups. Although people with AD had higher risk of hip fractures regardless of sex, the risk increase was larger in men than women. Conclusion Findings from our nationwide study are in line with previous studies showing that persons with AD, regardless of sex or age, have higher risk of hip fracture in comparison to general population. Although there was some suggestion of effect modification by age or sex, AD was consistently associated with doubling of the risk of incident hip fracture.

46 citations


Journal ArticleDOI
TL;DR: To determine whether excessive and often inappropriate or dangerous psychotropic drug dispensing to older adults is unique to care homes or is a continuation of community treatment, a study of care homes and community treatment is needed.
Abstract: Objectives: To determine whether excessive and often inappropriate or dangerous psychotropic drug dispensing to older adults is unique to care homes or is a continuation of community treatment. Design: Population-based data-linkage study using prescription drug information. Setting: Northern Ireland's national prescribing database and care home information from the national inspectorate. Participants: Two hundred fifty thousand six hundred seventeen individuals aged 65 and older. Measurements: Prescription information was extracted for all psychotropic drugs included in the British National Formulary (BNF) categories 4.1.1, 4.1.2, and 4.2.2 (hypnotics, anxiolytics, and antipsychotics) dispensed over the study period. Repeated cross-sectional analysis was used to monitor changes in psychotropic drug dispensing over time. Results: Psychotropic drug use was higher in care homes than the community; 20.3% of those in care homes were dispensed an antipsychotic in January 2009, compared with 1.1% of those in the community. People who entered care had higher use of psychotropic medications before entry than those who did not enter care, but this increased sharply in the month of admission and continued to rise. Antipsychotic drug dispensing increased from 8.2% before entry to 18.6% after entering care (risk ratio (RR) = 2.26, 95% confidence interval (CI)=1.96�2.59) and hypnotic drug dispensing from 14.8% to 26.3% (RR=1.78, 95% CI=1.61�1.96). Conclusion: A continuation of high use before entry cannot wholly explain the higher dispensing of psychotropic drugs to individuals in care homes. Although drug dispensing is high in older people in the community, it increases dramatically on entry to care. Routine medicine reviews are necessary in older people and are especially important during transitions of care.

45 citations


Journal Article
TL;DR: Adolescents using psychotropic drugs are examined by sex, race and Hispanic origin, and mental health professional consultation, and psychotropic medication types addressed are antidepressants; medications for attention deficit hyperactive disorder (ADHD); anxiolytics, sedatives, and hypnotics (ASH); antimanics; and antipsychotics.
Abstract: Approximately 6.0% of U.S. adolescents aged 12-19 reported psychotropic drug use in the past month. The use of antidepressants (3.2%) and attention deficit hyperactive disorder (ADHD) drugs (3.2%) was highest, followed by antipsychotics (1.0%); anxiolytics, sedatives, and hypnotics (0.5%); and antimanics (0.2%). Males (4.2%) were more likely than females (2.2%) to use ADHD drugs. Females (4.5%) were more likely than males (2.0%) to use antidepressants. Psychotropic drug use was higher among non-Hispanic white (8.2%) adolescents than non-Hispanic black (3.1%) and Mexican-American (2.9%) adolescents. About one-half of U.S. adolescents using psychotropic drugs in the past month had seen a mental health professional in the past year (53.3%). Prior studies have shown an increase in psychotropic medication use among adolescents. However, most studies were based on clinical samples or high-risk populations. This report provides the estimate of any psychotropic medication use in the past month among U.S. noninstitutionalized adolescents aged 12-19 during 2005-2010, using National Health and Nutrition Examination Survey (NHANES) data. Psychotropic medication is a type of drug used to treat clinical psychiatric symptoms or mental disorders. Specific psychotropic drug types addressed are antidepressants; medications for attention deficit hyperactive disorder (ADHD); anxiolytics, sedatives, and hypnotics (ASH); antimanics; and antipsychotics. Adolescents using psychotropic drugs are further examined by sex, race and Hispanic origin, and mental health professional consultation.

Patent
09 Aug 2013
Abstract: The present invention provides methods and systems or apparatuses, to analyze multiple molecular and clinical variables from an individual diagnosed with a psychiatric disorder, such as post-traumatic stress disorder (PTSD), in order to optimize medication selection for therapeutic response. Molecular co-variables include polymorphisms in genes including those involved in central control and mediation of the hypothalamic-pituitary axis (HPA) stress response, the density of methylation in regulatory regions of said polymorphic genes, polymorphisms in genes that encode cytochrome P450 enzymes responsible for drug metabolism, and drug-drug and drug-gene interactions. Clinical co-variables include but are not limited to the sex, age and ethnicity of that individual, medication history, family history, diagnostic codes, Pittsburgh insomnia rating score, and Charlson index score. The system makes a determination based on unstructured and structured data types derived from internal and external knowledge resources to determine psychotropic drug choice that best matches the molecular and clinical variation profile of an individual patient. The decision support system provides a therapeutic recommendation for a clinician based on the patient's variation profile.

Journal ArticleDOI
TL;DR: Psychotropic drug use was high among people with dementia living in specialized care units and in many cases the drugs were used for extended periods and associations were found between behavioral and psychological symptoms and different psychotropic drugs.
Abstract: Background: Psychotropic drugs are widely used among old people with dementia but few studies have described long-term treatment in this group of patients. The purpose of this study was to explore the long-term use of psychotropic drugs in old people with dementia. Methods: Data on psychotropic drug use, functioning in the activities of daily living (ADL), cognitive function and behavioral and psychological symptoms were collected at baseline and six months later, using the MultiDimensional Dementia Assessment Scale (MDDAS). The data were collected in 2005–2006. Detailed data about the prescribing of psychotropic drugs were collected from prescription records. This study was conducted in 40 specialized care units in northern Sweden, with a study population of 278 people with dementia. Results: At the start of the study, 229 of the participants (82%) were prescribed at least one psychotropic drug; 150 (54%) used antidepressants, 43 (16%) used anxiolytics, 107 (38%) used hypnotics and sedatives, and 111 (40%) used antipsychotics. Among the baseline users of antidepressants, anxiolytics, hypnotics and sedatives and antipsychotics, 67%, 44%, 57% and 57% respectively, still used the same dose of the same psychotropic drug after six months. Associations were found between behavioral and psychological symptoms and different psychotropic drugs. Conclusion: Psychotropic drug use was high among people with dementia living in specialized care units and in many cases the drugs were used for extended periods. It is very important to monitor the effects and adverse effects of the prescribed drug in this frail group of people.

Journal ArticleDOI
TL;DR: Special attention and possibly fall-preventive efforts should be directed not only toward those living in residential care facilities but also toward community-dwelling subjects taking psychotropic drugs since these groups have a higher incidence of nighttime hip fracture.
Abstract: Summary We investigated the effects of socio-demographic and health factors on timing and location of hip fracture among 484 subjects. Time of fracture varied between com- munity dwellers and residential care facility dwellers, and in relation to subjects' psychotropic drug status. Indoor hip fracture incidence increased on snow-covered days. Introduction This paper aims to describe the timing and whereabouts of hip fracture cases in a population-based setting and to relate these factors with residential and health status, seasonal variation, and snow-covered ground. Methods We consecutively included 484 incident hip frac- ture events (age ≥50 years) admitted to a Swedish orthope- dic department during a 1-year period. Data concerning socio-demographic details, fall location, time of fracture, comorbidity, and medications were collected from in- patient medical records and through patient or caregiver interviews. Results The expected peak in fracture occurrence during daytime was observed among community dwellers but not among subjects living in residential care. Hip fracture was twice as likely to occur during nighttime hours among psychotropic drug users (adjusted odds ratio (Adj. OR), 2.20; 95 % confidence interval (CI), 1.12-4.30) compared to those not receiving these medications. Subjects without dementia, taking psychotropic drugs, were also more likely to fracture during nighttime hours (Adj. OR, 2.91; 95 % CI, 1.40-6.0). We observed an increase in indoor hip fracture incidence on snow-covered days among community dwellers (incidence rate ratio, 1.34; 95 % CI, 1.02-1.74). We observed only a weak seasonal trend in hip fracture incidence, based on month, among community dwellers who fractured indoors. Conclusions Special attention and possibly fall-preventive efforts should be directed not only toward those living in residential care facilities but also toward community- dwelling subjects taking psychotropic drugs since these groups have a higher incidence of nighttime hip fracture. Further research aiming to explain the seasonal variation of indoor fracture incidence among community dwellers is warranted.

Journal ArticleDOI
TL;DR: The comparison of gene expression alterations between various drugs opened a new means to classify the different psychoactive compounds and to predict their cellular targets; this work represents the first proof-of-concept study of a molecular classification of psychoactive drugs.
Abstract: Despite their widespread use, the biological mechanisms underlying the efficacy of psychotropic drugs are still incompletely known; improved understanding of these is essential for development of novel more effective drugs and rational design of therapy. Given the large number of psychotropic drugs available and their differential pharmacological effects, it would be important to establish specific predictors of response to various classes of drugs. To identify the molecular mechanisms that may initiate therapeutic effects, whole-genome expression profiling (using 324 Illumina Mouse WG-6 microarrays) of drug-induced alterations in the mouse brain was undertaken, with a focus on the time-course (1, 2, 4 and 8 h) of gene expression changes produced by eighteen major psychotropic drugs: antidepressants, antipsychotics, anxiolytics, psychostimulants and opioids. The resulting database is freely accessible at http://www.genes2mind.org . Bioinformatics approaches led to the identification of three main drug-responsive genomic networks and indicated neurobiological pathways that mediate the alterations in transcription. Each tested psychotropic drug was characterized by a unique gene network expression profile related to its neuropharmacological properties. Functional links that connect expression of the networks to the development of neuronal adaptations (MAPK signaling pathway), control of brain metabolism (adipocytokine pathway), and organization of cell projections (mTOR pathway) were found. The comparison of gene expression alterations between various drugs opened a new means to classify the different psychoactive compounds and to predict their cellular targets; this is well exemplified in the case of tianeptine, an antidepressant with unknown mechanisms of action. This work represents the first proof-of-concept study of a molecular classification of psychoactive drugs.

Journal ArticleDOI
14 May 2013-PLOS ONE
TL;DR: Almost 84% of individuals displaying some mental disorder did not use psychotropic drugs, which indicates an important gap between demand and access to treatment in the health system for patients with mental disorders.
Abstract: Objective Estimate the prevalence of psychotropic drugs use in the city of Rio de Janeiro, Brazil, and establish its relationship with the presence of mental disorders. Methods A probabilistic sample of non-institutionalized individuals, from the general population of Rio de Janeiro (n = 1208;turn out:81%), 15 years or older, who were interviewed using the Composite International Diagnostic Interview 2.1 (depression, anxiety-phobia, OCD\PTSD, alcoholism sections), and asked about their psychotropic use during a 12 and one-month period before the interview. Data were collected between June/2007-February/2008.The prevalence was estimated with a confidence interval of 95%. The associations between psychotropics use and mental disorders were analyzed through a logistic regression model (Odds Ration – OR). Results The one-month prevalence of psychotropic drug use was 6.55%, 3.19% for men and 9.13% for women. Antidepressants were the most frequently used drug (2.78%), followed by anorectics (1.65%), tranquilizers (1.61%) and mood stabilizers (1.23%). General practitioners issued the highest number of prescriptions (46.3%), followed by psychiatrists (29.3%); 86.6% of the psychotropic drugs used were paid for by the patient himself. Individuals with increased likelihood of using psychotropic drugs were those that had received a psychiatric diagnosis during a one-month period before the study (OR:3.93), females (OR:1.82), separated/divorced (OR:2.23), of increased age (OR:1.03), with higher income (OR:2.96), and family history of mental disorder (OR:2.59); only 16% of the individuals with a current DSM IV diagnosis were using a psychotropic drug; 17% among individuals with a depression-related diagnosis and 8% with Phobic Anxiety Disorders-related diagnosis used psychotropics. Conclusion Approximately 84% of individuals displaying some mental disorder did not use psychotropic drugs, which indicates an important gap between demand and access to treatment. A significant failure is evident in the health system for patients with mental disorders; this could be due to health workers' inability to recognize mental disorders among individuals.

Journal ArticleDOI
TL;DR: The findings suggest that characteristic elevations in Adr, Nad, and DA levels in PCF and CSF are involved in systemic responses to fatal stress and toxic neuronal dysfunction, reflecting the magnitude of such responses in individual cases.

Journal ArticleDOI
TL;DR: The high prevalence of psychotropic drug use in children with mild ID who were institutionalized in specialized inpatient treatment facilities in The Netherlands is worrisome because of the lack of evidence of effectiveness at this young age, and the potential of adverse drug reactions.

Journal ArticleDOI
TL;DR: Comparing fall rates in the 7 days following a change of an antidepressant, antipsychotic, or benzodiazepine in long term care residents in Boston, MA, U.S.A. recommended that nursing home residents be closely monitored following a psychotropic drug change in an effort to reduce falls.
Abstract: Previous studies suggest that psychotropic drug changes may signal an acute period of time whereby a person is highly vulnerable to fall. It is unknown whether certain classes of psychotropic agents are less safe with respect to the acute risk of falls. Our purpose was to compare fall rates in the 7 days following a change of an antidepressant, antipsychotic, or benzodiazepine. We also identified specific times when residents are at high risk for falls with respect to a psychotropic drug change. Residents in our one-year study included 851 long term care residents from two nursing home facilities in Boston, MA, U.S.A. (May 2010 - May 2011). Drug changes (i.e., new prescriptions or increased dose of a previously used drug) were ascertained using the computerized provider order entry system, whereas falls were ascertained by incident reports. Negative binomial regression was used to compare the rate of falls following a drug change between medication classes. Further, we calculated the rate of falls for each of the 7 days before and 7 days after a psychotropic drug change. Forty-eight percent of residents were prescribed a new prescription or increased dose of a psychotropic drug during the study. The rate of falls was similar in the 7 days following a change to a SSRI versus non-SSRI antidepressant (11.9 versus 14.4 falls/1,000 person years; p = 0.58), a typical versus an atypical antipsychotic (25.4 versus 17.1 falls/1,000 person years; p = 0.10), or a short versus long acting benzodiazepine (15.2 versus 13.9 falls/1,000 person years; p = 0.23). Fall risk was highest on day 4 before the drug change (19.0 falls/1,000 person days), on the day of the drug change through 2 days after the drug change (17.6-20.3 falls/1,000 person days), and 5-6 days after the drug change (17.6-19.0 falls/1,000 person days). In the nursing home, risk of falls was similar following a psychotropic drug change of any class. We observed higher fall risk in the days before, but mostly after the drug change. We recommend that nursing home residents be closely monitored following a psychotropic drug change in an effort to reduce falls.

Journal ArticleDOI
TL;DR: Proof-of-concept web pages were created for all 1,102 drug product labels that demonstrate one possible approach to presenting information that dynamically enhances drug product labeling, and identify several cases where all of the drug-drug interaction claims linked to the Drug Interactions section for a drug were potentially novel.
Abstract: Out-of-date or incomplete drug product labeling information may increase the risk of otherwise preventable adverse drug events. In recognition of these concerns, the United States Federal Drug Administration (FDA) requires drug product labels to include specific information. Unfortunately, several studies have found that drug product labeling fails to keep current with the scientific literature. We present a novel approach to addressing this issue. The primary goal of this novel approach is to better meet the information needs of persons who consult the drug product label for information on a drug’s efficacy, effectiveness, and safety. Using FDA product label regulations as a guide, the approach links drug claims present in drug information sources available on the Semantic Web with specific product label sections. Here we report on pilot work that establishes the baseline performance characteristics of a proof-of-concept system implementing the novel approach. Claims from three drug information sources were linked to the Clinical Studies, Drug Interactions, and Clinical Pharmacology sections of the labels for drug products that contain one of 29 psychotropic drugs. The resulting Linked Data set maps 409 efficacy/effectiveness study results, 784 drug-drug interactions, and 112 metabolic pathway assertions derived from three clinically-oriented drug information sources (ClinicalTrials.gov, the National Drug File – Reference Terminology, and the Drug Interaction Knowledge Base) to the sections of 1,102 product labels. Proof-of-concept web pages were created for all 1,102 drug product labels that demonstrate one possible approach to presenting information that dynamically enhances drug product labeling. We found that approximately one in five efficacy/effectiveness claims were relevant to the Clinical Studies section of a psychotropic drug product, with most relevant claims providing new information. We also identified several cases where all of the drug-drug interaction claims linked to the Drug Interactions section for a drug were potentially novel. The baseline performance characteristics of the proof-of-concept will enable further technical and user-centered research on robust methods for scaling the approach to the many thousands of product labels currently on the market.

Journal ArticleDOI
TL;DR: The attitude to combination pharmacotherapy should be conservative, and combining psychotropic medications should be considered as an ‘n of 1’ trial to be closely monitored.
Abstract: Polypharmacy, defined as the concomitant use of two or more psychotropic drugs, has become increasingly common in the paediatric and adolescent population over the past two decades. Combining psychotropic drugs leads to possible increases in benefits, but also in risks, particularly given the potential for psychotropic drug interactions. Despite the increasing use of concomitant therapy in children and adolescents, there is very little evidence from controlled clinical trials to provide guidance for prescribers. Even while acknowledging the small evidence base, clinical practice guidelines from eminent medical organizations are either relatively silent on or tend to support the use of concomitant treatments more enthusiastically than the evidence would warrant, so that practice and guidance are running ahead of the science. Our narrative review shows that the published evidence for efficacy and safety of concomitant psychotropic drugs in children and adolescents is scanty. A comprehensive search located 37 studies published over the last decade, of which 18 were randomized controlled trials (RCTs). These focused mainly on stimulants, central sympatholytics (such as clonidine), antipsychotics and ‘mood stabilizers’. While several small, often methodologically weak, RCTs demonstrated statistically significant advantages for dual pharmacotherapy over monotherapy, only adding central sympatholytics to stimulants for treating attention-deficit hyperactivity disorder (ADHD) symptoms was supported by substantial studies with an effect size large enough to suggest clinical importance. Non-randomized studies tended to have results that supported concomitant treatment, but all have design-related problems that decrease the reliability of the results. Two studies that specifically examined tolerability of combination pharmacotherapy compared with monotherapy showed significant increases in adverse effects, both subjective and objective, and other studies confirmed a statistically significant increase in adverse effects, including sedation and self-harm. Given the extent of combination therapy occurring, particularly in conditions such as ADHD, and the ambiguous evidence for benefit with clear evidence of harm, we propose that further research should be carried out as a matter of urgency. Until such a time, the attitude to combination pharmacotherapy should be conservative, and combining psychotropic medications should be considered as an ‘n of 1’ trial to be closely monitored.

Journal ArticleDOI
TL;DR: No strong evidence of beneficial effects was found in using antidepressants and antipsychotics neither in adults nor in adolescents, and the majority of studies focused on olanzapine, which seems to have only positive effects on body mass index, eating disorder symptoms and functional impairment in both age groups.
Abstract: Background During the last 10 years, the use of psychotropic medications in youth with psychiatric disorders, including eating disorders, has significantly increased, but their role in the treatment of adolescent anorexia nervosa is still controversial. Objective This paper aims to review the literature on the use of antidepressants and antipsychotics in adolescents with anorexia nervosa, comparing the efficacy and tolerability in this population with those reported in trials with patients not selected by age. Method A systematic review of the available literature published so far. Results Only few studies met the selection criteria. No strong evidence of beneficial effects was found in using antidepressants and antipsychotics neither in adults nor in adolescents. Side effects were more frequently reported in studies including adolescent population. Among psychotropic drugs, the majority of studies focused on olanzapine, which seems to have, in some studies, only positive effects on body mass index, eating disorder symptoms and functional impairment in both age groups. Copyright © 2013 John Wiley & Sons, Ltd and Eating Disorders Association.

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TL;DR: The concomitant use of an opioid with an antipsychotic, or with a benzodiazepine may increase the risk of fractures in men aged 65 years and older.
Abstract: Background in men, the concomitant use of two or more benzodiazepines or two or more antipsychotics is associated with an increased risk of fracture(s). Potential associations between the concomitant use of drugs with central nervous system effects and fracture risk have not been studied. Objective the purpose was to describe the gender-specific risk of fractures in a population aged 65 years or over associated with the use of an opioid, antiepileptic or anticholinergic drug individually; or, their concomitant use with each other; or the concomitant use of one of these with a psychotropic drug. Methods this study was part of a prospective, population-based study performed in Lieto, Finland. Information about fractures in 1,177 subjects (482 men and 695 women) was confirmed with radiology reports. Results at 3 years of follow-up, the concomitant use of an opioid with an antipsychotic was associated with an increased risk of fractures in men. During the 6-year follow-up, the concomitant use of an opioid with a benzodiazepine was also related to the risk of fractures for males. No significant associations were found for females. Conclusion the concomitant use of an opioid with an antipsychotic, or with a benzodiazepine may increase the risk of fractures in men aged 65 years and older.

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TL;DR: To optimize outcomes, clinicians need to consider that when using generic psychotropic medications, a change in the patient’s clinical status can be related to psychological, interactional, physiological, and pharmacological factors that may or may not berelated to the change to a generic drug.
Abstract: For economic reasons, the generic substitution of branded medications is common and welcome. These replacements are based on the concept of bioequivalence, which is considered equal to therapeutic equivalence. Regulatory standards for bioequivalence require the 90 % confidence intervals of group averages of pharmacokinetic measures of a generic and the original drug to overlap within ±20 %. However, therapeutic equivalence has been challenged for several psychotropic agents by retrospective studies and case reports. To evaluate the degree of bioequivalence and therapeutic equivalence of branded and generic psychotropic drugs, we performed an electronic search (from database inception until 24 May 2012 and without language restrictions) in PubMed/MEDLINE, Cochrane Library, and Web of Science. Search terms were “(generic) AND (psychotropic OR psychoactive OR antipsychotic OR antiepileptic OR antidepressant OR stimulant OR benzodiazepine)” or the respective individual substances. We included clinical studies, regardless of design, comparing branded with generic psychotropic drug formulations, identifying 35 such studies. We also included case reports/series reporting on outcomes after a switch between brand and generic psychotropics, identifying 145 clinical cases. Bioequivalence studies in healthy controls or animals, in-vitro studies, and health economics studies without medical information were excluded. An overview of the few randomized controlled studies supports that US FDA regulations assure clinically adequate drug delivery in the majority of patients switched from brand to generic. However, with a growing number of competing generic products for one substance, and growing economic pressure to substitute with the currently cheapest generic, frequent generic-generic switches, often unbeknownst to prescribing clinicians, raise concerns, particularly for antiepileptics/mood stabilizers. Generic-generic switches may vary by more than ±20 % from each other in individual patients since the pharmacokinetic properties of each generic may differ from the innovator drug in opposing directions. Ideally, therapeutic equivalence studies in addition to pharmacokinetic equivalence studies would be performed for each generic, reflecting the full variability of clinical responses due to changes of pharmacokinetic properties related to age, sex, ethnicity, genetic factors, and body mass index. This is particularly relevant, as bioequivalence studies are based on single-dose studies in healthy controls who are likely not representative of the patients who are prescribed the psychotropic medications. Additionally, individual case reports suggest potential clinical effects during brand-generic switches. Knowledge and consideration of intra-individual variations can help guide the clinical management during brand-generic or generic-generic switch periods. To optimize outcomes, clinicians need to consider that when using generic psychotropic medications, a change in the patient’s clinical status can be related to psychological, interactional, physiological, and pharmacological factors that may or may not be related to the change to a generic drug. In addition, throughout all treatment periods, clinicians need to be aware of the currently dispensed product (i.e., branded or exact generic formulation), particularly when evaluating clinical changes in efficacy, tolerability, and adherence. If clinical problems occur, the first response should be an assessment of adherence and a careful dose adjustments of the generic drug rather than an immediate switch back to the originator.

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TL;DR: Efficacy and safety issues in the pharmacological treatment of SCZ are directly linked to genetic clusters involved in the Pharmacogenomics of antipsychotic drugs and also to environmental factors.
Abstract: Antipsychotic drugs are the neuroleptics currently used in the treatment of schizophrenia (SCZ) and psychotic disorders. SCZ has a heritability estimated at 70% - 90%; and pharmacogenomics accounts for 60% - 90% variability in the pharmacokinetics and pharmacodynamics of psychotropic drugs. Personalized therapeutics based on individual genomic profiles in SCZ entails the characterization of 5 types of gene clusters and their related metabolomic profiles: 1) genes associated with disease pathogenesis; 2) genes associated with the mechanism of action of drugs; 3) genes associated with drug metabolism (phase I and II reactions); 4) genes associated with drug transporters; and 5) pleiotropic genes involved in multifaceted cascades and metabolic reactions. Genetic studies in SCZ have revealed the presence of chromosome anomalies, copy number variants, multiple single-nucleotide polymorphisms of susceptibility distributed across the human genome, aberrant single-nucleotide polymorphisms in microRNA genes, mitochondrial DNA mutations, and epigenetic phenomena. Pharmacogenetic studies of psychotropic drug response have focused on determining the relationship between variation in specific candidate genes and the positive and adverse effects of drug treatment. Approximately 18% of neuroleptics are major substrates of CYP1A2 enzymes, 40% of CYP2D6, and 23% of CYP3A4. About 10% - 20% of Western populations are defective in genes of the CYP superfamily. Only 26% of Southern Europeans are pure extensive metabolizers for the trigenic cluster integrated by the CYP2D6 + CYP2C19 + CYP2C9 genes. Efficacy and safety issues in the pharmacological treatment of SCZ are directly linked to genetic clusters involved in the pharmacogenomics of antipsychotic drugs and also to environmental factors. Consequently, the incorporation of pharmacogenomic procedures both to drugs under development and drugs on the market would help to optimize therapeutics in SCZ and other central nervous system disorders.

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TL;DR: In this paper, a new crystalline phase of iloperidone, an atypical psychotropic drug with known problems related to poor dissolution and absorption profile, was used to facilitate the supramolecular synthesis.
Abstract: The crystal engineering strategy was used to facilitate the supramolecular synthesis of a new crystalline phase of iloperidone, an atypical psychotropic drug with known problems related to poor dissolution and absorption profile. The novel crystal forms Jilin University China-Cocrystal-1 (JUC-C1), Jilin University China-Cocrystal-2 (JUC-C2), and Jilin University China-Cocrystal-3 (JUC-C3) of iloperidone with 3-hydroxybenzoic acid (3-HBA), 2,3-dihydroxybenzoic acid (2,3-DHBA), and 3,5-dihydroxybenzoic acid (3,5-DHBA) were obtained using the reaction crystallization method (RCM). The dissolution and pharmacokinetics studies were performed to exploit this atypical psychotropic drug. In the dissolution experiment, JUC-C1, JUC-C2, and JUC-C3 (JUC-C1–3) showed a much faster dissolution rate than the original active pharmaceutical ingredient (API) in simulated gastric fluid media (pH = 1.2). Furthermore, pharmacokinetic behavior of JUC-C1–3 and API was investigated to evaluate the effectiveness of this strategy ...

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TL;DR: It is indicated that a variety of factors may affect the prescribing of psychotropic medications in primary care, and many factors were related to characteristics of the patient, the physician or their interaction, rather than the patients’ medical needs per se.
Abstract: Psychotropic drug prescribing is problematic and knowledge of factors affecting the initiation and maintenance of such prescribing is incomplete. Such knowledge could provide a basis for the design of interventions to change prescribing patterns for psychotropics. The aim of this study was to explore the views of general practitioners (GPs), GP interns, and heads of primary care units on factors affecting the prescribing of psychotropic drugs in primary care. We performed four focus group discussions in Gothenburg, Sweden, with a total of 21 participants (GPs, GP interns, and heads of primary care units). The focus group discussions were transcribed verbatim and analyzed using manifest content analysis. Three different themes emerged from the focus group discussions. The first theme Seeking care for symptoms, reflects the participants’ understanding of why patients approach primary care and comprised categories such as knowledge, attitudes, and society and the media. The second theme, Lacking a framework, resources, and treatment alternatives, which reflects the conditions for the physician-patient interaction, comprised categories such as economy and resources, technology, and organizational aspects. The third theme, Restricting or maintaining prescriptions, with the subthemes Individual factors and External influences, reflects the physicians’ internal decision making and comprised categories such as emotions, knowledge, and pharmaceutical industry. The results of the present study indicate that a variety of factors may affect the prescribing of psychotropic medications in primary care. Many factors were related to characteristics of the patient, the physician or their interaction, rather than the patients’ medical needs per se. The results may be useful for interventions to improve psychotropic prescribing in primary care.

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TL;DR: The proportion of youths who received care for mental disorders in the Lombardy Region seems lower than in other countries, however, the fact that many children were prescribed psychotropic drugs without the supervision of a child psychiatrist is a reason for concern.

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TL;DR: This study is expected to improve the appropriateness of psychotropic drug prescription for neuropsychiatric symptoms in nursing home patients with dementia by introducing a structured and repeated multidisciplinary medication review supported by education and continuous evaluation.
Abstract: Neuropsychiatric symptoms are highly prevalent in nursing home patients with dementia. Despite modest effectiveness and considerable side effects, psychotropic drugs are frequently prescribed for these neuropsychiatric symptoms. This raises questions whether psychotropic drugs are appropriately prescribed. The aim of the PROPER (PRescription Optimization of Psychotropic drugs in Elderly nuRsing home patients with dementia) II study is to investigate the efficacy of an intervention for improving the appropriateness of psychotropic drug prescription in nursing home patients with dementia.

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TL;DR: A high use of psychotropic drugs among individuals with autism enrolled in a state Medicaid programme and an urgent need to study the risk-benefit profile of these drugs in this growing population is indicated.
Abstract: Background There has been a significant increase in the prevalence of autism in the USA in the past few decades. The purpose of this study was to provide recent estimates of psychotropic drug use and costs among individuals with autism enrolled in Medicaid programme. Method A cross-sectional analysis of 2007 Mississippi (MS) Medicaid fee-for-service (FFS) programme administrative-claims data was performed. Study sample included recipients (<65 years) who had a medical services claim with a diagnosis of autism in 2007. Psychotropic drug patterns of use and costs were studied. Factors predicting the use of psychotropic drugs were identified using logistic regression analyses. Average number and cost of psychotropic drug claims per recipient were reported. Costs were reported from the perspective of MS Medicaid. Results In 2007, there were 1330 recipients with a diagnosis of autism in MS Medicaid FFS programme. Among these recipients, 66.32% had a claim for psychotropic drug during the year. Roughly 39% of recipients with autism had a claim for antipsychotics, 31.58% for stimulants, 19.55% for antidepressants, 19.40% for other psychotropics and 14.81% for anxiolytics/hypnotics/sedatives. Results from regression analyses highlighted variation in psychotropic drug use by demographic and co-morbid factors. There were a total of 12 618 claims for psychotropic drugs filled by recipients with autism in 2007, at an average of 14 (±12) claims per recipient. The total cost of these claims paid for by MS Medicaid FFS programme was ∼$2 million. Antipsychotics accounted for more than half (∼58%) of the total costs, and had the highest average cost per claim ($291 ± 205). Conclusions The results of this study indicate a high use of psychotropic drugs among individuals with autism enrolled in a state Medicaid programme. There is an urgent need to study the risk–benefit profile of these drugs in this growing population. Psychotropic drug use was found to vary by demographic and co-morbid factors. Among the different classes of psychotropic drugs, antipsychotics were the most commonly used and had the highest cost per claim.