Showing papers on "Psychotropic drug published in 2015"

Mental illness, challenging behaviour, and psychotropic drug prescribing in people with intellectual disability: UK population based cohort study

Abstract: Objectives To describe the incidence of recorded mental illness and challenging behaviour in people with intellectual disability in UK primary care and to explore the prescription of psychotropic drugs in this group. Design Cohort study. Setting 571 general practices contributing data to The Health Improvement Network clinical database. Participants 33 016 adults (58% male) with intellectual disability who contributed 211 793 person years’ data. Main outcome measures Existing and new records of mental illness, challenging behaviour, and psychotropic drug prescription. Results 21% (7065) of the cohort had a record of mental illness at study entry, 25% (8300) had a record of challenging behaviour, and 49% (16 242) had a record of prescription of psychotropic drugs. During follow-up, the rate of new cases of mental illness in people without a history at cohort entry was 262 (95% confidence interval 254 to 271) per 10 000 person years and the rate of challenging behaviour was 239 (231 to 247) per 10 000 person years. The rate of new psychotropic drug prescription in those without a previous history of psychotropic drug treatment was 518 (503 to 533) per 10 000 person years. Rates of new recording of severe mental illness declined by 5% (95% confidence interval 3% to 7%) per year (P Conclusions The proportion of people with intellectual disability who have been treated with psychotropic drugs far exceeds the proportion with recorded mental illness. Antipsychotics are often prescribed to people without recorded severe mental illness but who have a record of challenging behaviour. The findings suggest that changes are needed in the prescribing of psychotropics for people with intellectual disability. More evidence is needed of the efficacy and safety of psychotropic drugs in this group, particularly when they are used for challenging behaviour.

Clinical applications of CYP genotyping in psychiatry.

Abstract: A critical review of the limited available evidence and the authors’ experience and judgment are used to summarize the role of cytochrome P450 (CYP) genetic variants in the pharmacokinetics of and clinical response to psychotropic medications. CYP1A2, CYP2B6, CYP2C9, CYP2C19, CYP2D6 and CYP3A4 genetic polymorphisms and their contributions to the metabolism of psychotropic drugs are reviewed. CYP1A2, CYP2B6 and CYP3A4 genotyping have limited current clinical utility. CYP2C9 genotyping has no utility in psychiatry. Psychiatrists should master tricyclic antidepressant (TCA) prescription, and if they use TCAs, they should have expertise in CYP2D6 and CYP2C19 genotyping and in TCA therapeutic drug monitoring (TDM) to safely dose TCAs. Practice guidelines recommend dose changes, TDM or alternate drugs for (1) CYP2C19 ultrarapid metabolizers (UM) taking citalopram or escitalopram; (2) CYP2C19 poor metabolizers (PMs) taking sertraline; (3) CYP2D6 PMs taking venlafaxine, aripiprazole, haloperidol, risperidone or zuclopenthixol; and (4) CYP2D6 UMs taking venlafaxine, aripiprazole, haloperidol, risperidone, zuclopenthixol or atomoxetine. According to the prescribing information, CYP2D6 PMs should receive 75 % of the average long-acting aripiprazole dose and pimozide doses >4 mg/day should not be prescribed without CYP2D6 genotyping. In a situation of limited evidence, there is need to use the available pharmacological mechanistic information for better personalizing treatment in psychiatry. This is best done by combining CYP genotyping with TDM. Clozapine and risperidone concentration-to-dose ratios are provided as two examples of this approach of how to integrate CYP genotyping and TDM in psychiatry. New studies are needed to verify that CYP2C19 PM genotyping may have potential to identify clozapine PMs and explain the lower clozapine metabolic capacity in East Asians.

Trends in Psychotropic Dispensing Among Older Adults with Dementia Living in Long-Term Care Facilities: 2004–2013

Abstract: Objective Guidelines worldwide have cautioned against the use of antipsychotics as first-line agents to treat neuropsychiatric symptoms of dementia. We aimed to investigate the changes over time in the dispensing of antipsychotics and other psychotropics among older adults with dementia living in long-term care facilities. Methods We used drug claims data from Ontario, Canada, to calculate quarterly rates of prescription dispensing of six psychotropic drug classes among all elderly (≥65 years of age) long-term care residents with dementia from January 1, 2004, to March 31, 2013. Psychotropic drugs were classified into the following categories: atypical and conventional antipsychotics, non-sedative and sedative antidepressants, anti-epileptics, and benzodiazepines. We used time-series analysis to assess trends over time. Results The study sample increased by 21% over the 10-year study period, from 49,251 patients to 59,785 patients. The majority of patients (within the range of 75%–79%) were dispensed at least one psychotropic medication. At the beginning of the study period atypical antipsychotics (38%) were the most frequently dispensed psychotropic, followed by benzodiazepines (28%), non-sedative antidepressants (27%), sedative antidepressants (17%), anti-epileptics (7%), and conventional antipsychotics (3%). Dispensing of anti-epileptics (2% increase) and conventional antipsychotics (1% decrease) displayed modest changes over time, but we observed more pronounced changes in dispensing of benzodiazepines (11% decrease) and atypical antipsychotics (4% decrease). Concurrently, we observed a substantial growth in the dispensing of both sedative (15% increase) and non-sedative (9% increase) antidepressants. The proportion of patients dispensed two or more psychotropic drug classes increased from 42% in 2004 to 50% in 2013. Conclusions Utilization patterns of psychotropic drugs in institutionalized patients with dementia have changed over the past decade. Although their use declined slightly over the study period, atypical antipsychotics continue to be used at a high rate. A decline in the use of benzodiazepines along with an increased use of sedative and non-sedative antidepressants suggests that the latter class of drugs is being substituted for the former in the management of neuropsychiatric symptoms. Psychotropic polypharmacy continues to be highly prevalent in these patient samples.

Importance of early weight changes to predict long-term weight gain during psychotropic drug treatment.

Abstract: BACKGROUND: Psychotropic drugs can induce substantial weight gain, particularly during the first 6 months of treatment. The authors aimed to determine the potential predictive power of an early weight gain after the introduction of weight gain-inducing psychotropic drugs on long-term weight gain. METHOD: Data were obtained from a 1-year longitudinal study ongoing since 2007 including 351 psychiatric (ICD-10) patients, with metabolic parameters monitored (baseline and/or 1, 3, 6, 9, 12 months) and with compliance ascertained. International Diabetes Federation and World Health Organization definitions were used to define metabolic syndrome and obesity, respectively. RESULTS: Prevalences of metabolic syndrome and obesity were 22% and 17%, respectively, at baseline and 32% and 24% after 1 year. Receiver operating characteristic analyses indicated that an early weight gain > 5% after a period of 1 month is the best predictor for important long-term weight gain (≥ 15% after 3 months: sensitivity, 67%; specificity, 88%; ≥ 20% after 12 months: sensitivity, 47%; specificity, 89%). This analysis identified most patients (97% for 3 months, 93% for 12 months) who had weight gain ≤ 5% after 1 month as continuing to have a moderate weight gain after 3 and 12 months. Its predictive power was confirmed by fitting a longitudinal multivariate model (difference between groups in 1 year of 6.4% weight increase as compared to baseline, P = .0001). CONCLUSION: Following prescription of weight gain-inducing psychotropic drugs, a 5% threshold for weight gain after 1 month should raise clinician concerns about weight-controlling strategies.

Patterns and factors associated with low adherence to psychotropic medications during pregnancy--a cross-sectional, multinational web-based study.

Abstract: Background: No previous studies have explored how closely women follow their psychotropic drug regimens during pregnancy. This study aimed to explore patterns of and factors associated with low adherence to psychotropic medication during pregnancy. Methods: Multinational web-based study was performed in 18 countries in Europe, North America, and Australia. Uniform data collection was ensured via an electronic questionnaire. Pregnant women were eligible to participate. Adherence was measured via the 8-item Morisky Medication Adherence Scale (MMAS-8). The Beliefs about Prescribed Medicines Questionnaire (BMQ-specific), the Edinburgh Postnatal Depression Scale (EPDS), and a numeric rating scale were utilized to measure women's beliefs, depressive symptoms, and antidepressant risk perception, respectively. Participants reporting use of psychotropic medication during pregnancy (n = 160) were included in the analysis. Results: On the basis of the MMAS-8, 78 of 160 women (48.8%, 95% CI: 41.1–56.4%) demonstrated low adherence during pregnancy. The rates of low adherence were 51.3% for medication for anxiety, 47.2% for depression, and 42.9% for other psychiatric disorders. Smoking during pregnancy, elevated antidepressant risk perception (risk≥6), and depressive symptoms were associated with a significant 3.9-, 2.3-, and 2.5-fold increased likelihood of low medication adherence, respectively. Women on psychotropic polytherapy were less likely to demonstrate low adherence. The belief that the benefit of pharmacotherapy outweighed the risks positively correlated (r = .282) with higher medication adherence. Conclusions: Approximately one of two pregnant women using psychotropic medication demonstrated low adherence in pregnancy. Life-style factors, risk perception, depressive symptoms, and individual beliefs are important factors related to adherence to psychotropic medication in pregnancy.

Palladium-Catalyzed Cs2CO3-Promoted Arylation of Unactivated C(sp3)–H Bonds by (Diacetoxyiodo)arenes: Shifting the Reactivity of (Diacetoxyiodo)arenes from Acetoxylation to Arylation

Abstract: PdCl2(CH3CN)2-catalyzed arylation of unactivated C(sp3)–H bonds using (diacetoxyiodo)arenes as arylation reagents is reported. The reactivity of (diacetoxyiodo)arenes as arylation reagents is enabled in the presence of Cs2CO3 under the reaction conditions. This arylation method is highly efficient and occurs without the use of silver salt. The reaction tolerates a broad substrate scope that was not demonstrated by other silver salt-free C(sp3)–H bond arylation conditions. The synthetic utility of the method is further illustrated in the synthesis of the psychotropic drug phenibut. A detailed mechanism study has been conducted to understand the reaction pathway.

Understanding the relationship between walking aids and falls in older adults : a prospective cohort study

Abstract: BACKGROUND:: A substantial proportion of older adults living in residential aged care facilities are use wheelchairs or walk with aids. The relationship between using walking aids and falling is somewhat inconsistent and poorly understood. PURPOSE:: To investigate the use of walking aids as a risk factor for future falls among older adults living in residential aged care facilities and to identify spatiotemporal gait parameters that mediate the potential relationship between walking aids and falling. METHODS:: Forty-three older adults (22 using walking aids and 21 not using walking aids) living in residential aged care facilities were enrolled in this study. Fall history, fear of falling, and the use of psychotropic agents were registered. Spatiotemporal gait (GAITRite®), grip strength (Jamar®), and cognitive status (Mini-Mental State Examination and Clock Drawing Test) were assessed. Falls were prospectively recorded during a 12-month follow-up period using monthly calendars. RESULTS:: Individuals using walking aids were older (P =.012), had a greater fear of falling (P =.017), and demonstrated a more conservative gait pattern compared with those not using walking aids. They walked slower (P CONCLUSIONS:: Using walking aids is a risk factor for future falls among the older population living in residential settings. A substantial proportion of the relationship between walking aids and future falls could be explained by an altered spatiotemporal gait pattern, increased age, and psychotropic drug intake. This finding supports the aim of extensive training periods and appropriate instructions on the proper use of walking aids in terms of adequate and safe gait patterns. Language: en

Impact of prenatal exposure to psychotropic drugs on neonatal outcome in infants of mothers with serious psychiatric illnesses.

Abstract: Objective To assess whether prenatal exposure to 4 major classes of psychotropic drugs compared with no exposure differed with respect to neonatal outcome. Method We used the database collected from 13 mother-baby units (MBUs) by the French Network of MBUs. The Marce Clinical Checklist was used to collect data from maternal interview and clinical record with respect to maternal demographic and clinical characteristics, prenatal exposure to psychotropic drugs, and neonatal outcome (birth weight, preterm birth, neonatal hospitalization). Multivariate logistic regression was used to explore the independent impact of each therapeutic class of psychotropic drug (antipsychotics, antidepressants, mood stabilizers, and anxiolytics/hypnotics) on infant outcomes. All the models were adjusted for maternal confounding factors. Results The sample included 1,071 women and their infants. Nearly half (40.2%) used at least 1 psychotropic drug during pregnancy. The risk of low birth weight was increased by antenatal exposure to mood stabilizers (adjusted odds ratio [aOR] = 2.04, 95% confidence interval [CI] = 1.03-4.04, P = .04). The risk of neonatal hospitalization was increased by prenatal exposure to antipsychotics (aOR = 1.74, 95% CI = 1.19-2.54, P = .004), antidepressants (aOR = 1.59, 95% CI = 1.05-2.41, P = .03) or anxiolytics/hypnotics (aOR = 1.89, 95% CI = 1.30-2.75, P = .001), independent of birth weight and term delivery status. Conclusions Infants exposed to psychotropic drugs during pregnancy have less optimal neonatal outcome than unexposed infants and should be considered as a high-risk population.

Psychotropic drug use among preschool children in the medicaid program from 36 states

Abstract: Objectives. We determined the prevalence of and indications for psychotropic medication among preschool children in Medicaid.Methods. We obtained 2000 to 2003 Medicaid Analytic Extract data from 36 states. We followed children in 2 cohorts, born in 1999 and 2000, up to age 4 years. We used logistic regression to model odds of receiving medications for (1) attention-deficit disorder/attention-deficit hyperactivity disorder, (2) depression or anxiety, and (3) psychotic illness or bipolar.Results. Overall, 1.19% of children received at least 1 psychotropic drug. Medications for attention-deficit disorder/attention-deficit hyperactivity disorder treatment were most common (0.61% of all children), followed by depression or anxiety (0.59%) and psychotic illness or bipolar (0.24%). Among children, boys, those of other or unknown race compared with White, and those with other insurance compared with fee for service–only had higher odds of receiving a prescription (odds ratio [OR] = 1.80 [95% confidence interval (...

Psychotropic Drug Prescription in Patients with Dementia: Nursing Home Residents Versus Patients Living at Home.

Abstract: Background Psychotropic drugs are frequently prescribed in nursing homes (NH). Nonetheless, we hoped that institutionalization decreases the number of psychotropic drug classes prescribed, because NH residents may have more psychosocial interventions than patients living at home. Objective The aim was to compare the type and number of psychotropic drugs prescribed in elderly NH residents with dementia with those in community-living patients. Methods This cross-sectional study included elderly patients (at least 75 years old) with dementia recorded in the National Alzheimer's data Bank ("Banque Nationale Alzheimer") during the year 2012 and who were taking at least one psychotropic drug. Psychotropic drugs were classified as follows: antidepressant, anxiolytic, hypnotic, and antipsychotic drugs. Patients were classified into three categories of dementia severity according to the MMSE score. Results Among the 50,932 patients with dementia recorded in the BNA, 40.1% had at least one psychotropic drug prescribed. Most of the patients who were treated by at least one psychotropic drug class had antidepressant therapy (69.0%), whatever their residence type, and 16.1% were treated with antipsychotics. Among the study population, 51.9% of the NH residents and 67.4% of the patients living at home had only one psychotropic drug class prescribed. Living in a NH was significantly associated with the more frequent prescription of anxiolytic, hypnotic, and antipsychotic drugs, and with a greater number of psychotropic drug classes prescribed, whatever the severity of the dementia. Conclusion We underlined the more frequent prescription of psychotropic drugs in NH residents regardless of MMSE scores.

Epigenomic mapping and effect sizes of noncoding variants associated with psychotropic drug response

Abstract: Aim: To provide insight into potential regulatory mechanisms of gene expression underlying addiction, analgesia, psychotropic drug response and adverse drug events, genome-wide association studies searching for variants associated with these phenotypes has been undertaken with limited success. We undertook analysis of these results with the aim of applying epigenetic knowledge to aid variant discovery and interpretation. Methods: We applied conditional imputation to results from 26 genome-wide association studies and three candidate gene-association studies. The analysis workflow included data from chromatin conformation capture, chromatin state annotation, DNase I hypersensitivity, hypomethylation, anatomical localization and biochronicity. We also made use of chromatin state data from the epigenome roadmap, transcription factor-binding data, spatial maps from published Hi-C datasets and ‘guilt by association’ methods. Results: We identified 31 pharmacoepigenomic SNPs from a total of 2024 variants in lin...

Risk factors for QT prolongation associated with acute psychotropic drug overdose

Abstract: Background Antipsychotic/Antidepressant use is a risk factor for QT interval (QT) prolongation and sudden cardiac death. However, it is unclear which drugs are risk factors for QT prolongation and torsades de pointes in cases of psychotropic drug overdose. Methods After correction of QT data by Bazett formula (QTc), QTc was classified into 3 categories (QTc Results A total of 649 patients were enrolled in the study. The independent risk factors for QTc prolongation were therapeutic and toxic range of phenotiazine antipsychotic drug (therapeutic range: odds ratio [OR], 1.56 [ P = .039]; toxic range: OR, 3.85 [ P P = .018). In addition, toxic range of phenotiazine antipsychotic drug (OR, 3.87; P = .012) and tricyclic antidepressants (OR, 4.94; P Conclusions The possibility of QT prolongation and torsades de pointes due to overdose of phenotiazine antipsychotic drug or tricyclic antidepressants requires particular consideration.

Clinical Methodology Matters in Epidemiology: Not All Benzodiazepines Are the Same.

Abstract: Whitlock [1] emphasized the importance of specifying and testing explicit hypotheses in clinical epidemiology, particularly if such hypotheses might lead to practical measures to prevent and treat mental disorders. Pharmacoepidemiology, with particular reference to benzodiazepines, may illustrate the value of Whitlock’s considerations. For a long time benzodiazepines have provided an effective treatment for anxiety disorders [5] , sleep disorders and a variety of medical conditions such as epilepsy and alcohol withdrawal [6] . Their large number of prescriptions raised many concerns and attempts at limiting their use [5] . The introduction of second-generation antidepressant and antipsychotic drugs has provided more expensive modalities of addressing anxiety disorders [7] . Substituting benzodiazepines with selective serotonin reuptake inhibitors (SSRI) and serotonin-noradrenaline reuptake inhibitors (SNRI) clearly appeared the commercial way to go. Such a road would have been difficult when new medications had to be compared to a gold standard, since direct comparisons clearly indicated higher efficacy and tolerability of benzodiazepines over antidepressants [8] . However, when such superiority was no longer required by regulatory agencies, alternative routes appeared. One was to perform comparisons by meta-analytic methods that are liable to manipulation instead of head-toIn 1977, at a time when psychiatric epidemiology was not as fashionable as it is today, Whitlock [1] outlined its aims and limitations. He criticized a narrow view of psychiatric epidemiology as concerned with the incidence, prevalence and distribution of mental disorders in the general population. He found ‘the pursuit of investigations of this kind a singularly sterile activity, largely because it is difficult to see what possible purpose such enterprises have [...]. Head counting to establish prevalence norms is tedious and can rarely be carried out in any comprehensive fashion by those trained to recognize and treat mental disorders’ [ 1 , p. 11]. Studies concerned with prevalence rates, however, achieved a prominent role in the subsequent decades [2] . Even though such studies were not driven by financial conflicts of interest, they served an important commercial purpose. Expanding the target of psychotropic drug prescription to potentially universal consumption is facilitated by showing that psychiatric illness is widespread, undetected and undertreated [3] . Epidemiological studies are generally conducted using lay or poorly trained interviewers who cannot translate obtained data into clinical context and do not have the skills to judge whether the symptoms they elicit are severe enough to cause clinically significant distress or impairment [3] . There are very few exceptions to this rule [4] . Received: June 10, 2015 Accepted after revision: June 25, 2015 Published online: August 6, 2015

Psychotropic Drug Use in São Paulo, Brazil – An Epidemiological Survey

Abstract: Objective To estimate the prevalence of one month psychotropic drug use in Sao Paulo, Brazil, and to assess the gap treatment between the presence of mental disorders and psychotropic drug users. Method A probabilistic sample of non-institutionalized individuals from the general population of Sao Paulo (n = 2336; turnout: 84.5%) who were 15 years or older were interviewed by a trained research staff, applying the Composite International Diagnostic Interview 2.1 (CIDI WHO) (depression, anxiety-phobia, OCD\PTSD, alcoholism sections), and an inventory investigating psychotropic drug use during the 12-month and one-month periods immediately preceding the interview. Logistic models were fitted to investigate associations between psychotropic drug use as well as socio-demographic and clinical variables. Results The one month prevalence of psychotropic drug use in Sao Paulo was 5.89%, the most commonly used drugs were antidepressants (3.15%) and tranquilizers (2.67%). A higher consumption of psychotropic drugs (overall, antidepressants and tranquilizers) was observed among women (OR:2.42), older individuals (OR:1.04), individuals with higher levels of formal education (1.06), and individuals with a family (OR:2.29) or personal history of mental illness (OR:3.27). The main psychotropic drug prescribers were psychiatrists (41%), followed by general practitioners (30%); 60% of psychotropic drugs were obtained through a government-run dispensing program. Most individuals who obtained a positive diagnosis on the CIDI 2.1 during the previous month were not using psychotropic medication (85%). Among individuals with a diagnosis of moderate to severe depression, 67.5% were not on any pharmacological treatment. Conclusion There is a change in the type of psychotropic more often used in Sao Paulo, from benzodiazepines to antidepressants, this event is observed in different cultures. The prevalence of use is similar to other developing countries. Most of the patients presenting a psychiatric illness in the month prior to testing were not receiving any sort of psychiatric medication. This may be explained by a failure to identify cases in primary care, which could be improved (and access to treatment could be facilitated) if professionals received more specialized training in managing cases with mental health problems.

Postmortem distribution of PV9, a new cathinone derivative, in human solid tissues in a fatal poisoning case

Abstract: In our previous study, we identified PV9 [1-phenyl-2-(pyrrolidin-1-yl)octan-1-one] in human blood and urine in a fatal poisoning case. The victim was an 18-year-old woman. After ingesting “aroma liquid” solution, the victim showed various symptoms including low levels of consciousness, and was taken to a hospital emergency department. Although the victim received intensive medical treatment including an intravenous drip infusion of a large volume of transfusion solution, she was pronounced dead about 20 h after admission. In this study, we carefully examined the postmortem distribution of PV9 in nine solid tissues of the victim collected at forensic autopsy. The extraction of PV9 and internal standard (IS) PV8 [1-phenyl-2-(1-pyrrolidinyl)-1-heptanone] was performed by acetonitrile deproteinization, followed by modified QuEChERS dispersive solid-phase extraction and filtration through Captiva ND Lipids cartridges. Anaysis was performed by liquid chromatography–tandem mass spectrometry. Because this study dealt with various kinds of human matrices, we used the standard addition method to overcome matrix effects. After thorough validations, such as checking the product ion mass spectra, selected reaction monitoring chromatograms, linearity of the standard addition calibration curves, the intraday and interday repeatability, matrix effects, and recovery rates for the method, the concentrations of PV9 in nine solid tissue specimens were measured using PV8 as IS. The highest level of PV9 was found in the kidney at 907 ± 19.5 ng/g followed by the skeletal muscle, pancreas, adipose tissue, liver, lung, spleen, heart muscle, and brain. The lowest level of PV9 in the brain was 212 ± 11.9 ng/g. The high level of PV9 in the kidney suggests that this drug tends to be rapidly excreted into urine via the kidney as was the case for α-pyrrolidinovalerophenone. The low concentration of PV9 in the brain was unexpected, because this drug is a psychotropic drug with a long hydrophobic side chain, and is considered to cross the blood–brain barrier very easily. To our knowledge, this is the first demonstration of the distribution of the new pyrrolidinophenone derivative PV9 in human solid tissues in a poisoning case.

Gender differences in depressive symptom profiles and patterns of psychotropic drug usage in Asian patients with depression: Findings from the Research on Asian Psychotropic Prescription Patterns for Antidepressants study

Abstract: Objectives:The purpose of this study was to investigate whether there were gender-specific depressive symptom profiles or gender-specific patterns of psychotropic agent usage in Asian patients with depression.Method:Clinical data from the Research on Asian Psychotropic Prescription Patterns for Antidepressant study (1171 depressed patients) were used to determine gender differences by analysis of covariates for continuous variables and by logistic regression analysis for discrete variables. In addition, a binary logistic regression model was fitted to identify independent clinical correlates of the gender-specific pattern on psychotropic drug usage.Results:Men were more likely than women to have loss of interest (adjusted odds ratio = 1.379, p = 0.009), fatigue (adjusted odds ratio = 1.298, p = 0.033) and concurrent substance abuse (adjusted odds ratio = 3.793, p = 0.008), but gender differences in other symptom profiles and clinical features were not significant. Men were also more likely than women to b...

The Association in Elderly Hospitalized Patients, Between Psychotropic Drugs and Hip Fractures Resulting from Falls

Abstract: Background/Study Context: Psychotropic drug treatment has been associated with increased risk for falls and hip fractures in elderly patients. The authors examined the association between drug treatment and hip fractures resulting from falls in elderly hospitalized patients, focusing on the medications’ anticholinergic properties.Methods: This retrospective case-control study was conducted in an acute geriatric ward in a general medical center. Medical records, including demographic, clinical, biochemical, and pharmacological variables, of elderly patients with hip fractures from falls (N = 185), admitted during a 2-year period, were reviewed and compared with a control group (N = 187) of patients matched for age and gender and without hip fractures.Results: The usage rates of antipsychotics, antidepressants, mood stabilizers, and various nonpsychiatric medications were similar in the two groups, except for hypnotics-anxiolytics (higher rates in hip-fracture patients). The Cumulative Illness Rating Scale ...

Involvement of 2-arachidonoylglycerol signaling in social challenge responding of male CD1 mice

Abstract: Endocannabinoids are strong modulators of emotionality and present a novel target for psychotropic drug development. Increasing evidence suggests that endocannabinoids anandamide and 2-arachidonoylglycerol (2-AG) affect behavior differentially. While the roles of anandamide have been investigated extensively, studies regarding the specific roles of 2-AG became possible only recently, and its involvement in social behaviors has not yet been studied. We studied the impact of 2-AG signaling on aggression as a first attempt to characterize the role of this endocannabinoid in social behaviors. 2-AG signaling was enhanced by the monoacylglycerol lipase inhibitor JZL184 (8, and 16 mg/kg) in mice later submitted to the resident/intruder paradigm. JZL184 near completely abolished aggressiveness in residents and increased victimization (i.e., attacks by the opponent). Interestingly, the level of defensiveness remained unaltered, despite the large increase in bites received. The CB1 receptor blocker AM251 (0.5 mg/kg) did not influence the effects of JZL184. In intruders, JZL184 near completely suppressed bites and offensive behavior in a fashion similar to residents, but it also increased agitation and defensiveness during, and the corticosterone response to, aggressive encounters. Experiments involving the corticosterone synthesis inhibitor metyrapone (30 mg/kg) suggest that the suppression of biting and offensive behavior is directly influenced by JZL184, whereas increased agitation and defensiveness (seen in intruders only) are a secondary development of the stress-endocrine effects of JZL184. 2-AG signaling emerges as a surprisingly strong negative modulator of aggressiveness, which warrants further studies into its general role in social behavior and the target receptors involved.

Nocebo effects and psychotropic drug action.

Abstract: The role of psychosocial context around patient and therapy can be studied through randomized clinical trials. The analysis of the results of clinical trials, and considering the adverse events (AEs) in the placebo groups, provides an important perspective of study for this phenomenon. In double-blind, randomized clinical trials, the side effects reported in placebo-treated groups are not associated with pharmacological treatment, but other factors should be taken into account to explain these symptoms. This phenomenon may be conceptualized as ‘nocebo effects’ relating to negative expectations for treatment outcome, even though a role of prior learning in the form of conditioning with active treatments cannot be excluded. This approach makes it possible to observe how associating the placebo groups with a particular drug can cause specific AEs that are consistent with those observed in the active group. This phenomenon was described in a systematic review that examined placebo AEs in tricyclic antidepress...

Prevalence and Prescription of Antidepressants in Depression with Somatic Comorbidity in Asia: The Research on East Asian Psychotropic Prescription Patterns Study

Abstract: Background: Depression is often comorbid with chronic somatic diseases. Few previous studies have investigated the prevalence of somatic diseases in depression or the prescription pattern of antidepressants in comorbidly depressed patients in Asia. This study aimed to investigate the prevalence of somatic comorbidity (SC) in depression and compared the prescriptions of antidepressants in depressed patients with and without SC. Methods: A total of 2320 patients treated with antidepressants in 8 Asian countries were examined, and a diagnosis was based on the International Classification of Disease, 10 th revision. We listed 17 common chronic somatic diseases. Patients' socio-demographic and clinical characteristics and psychotropic drug prescriptions were recorded using a standardized protocol and data collection procedure. Results: Of the patients examined, 1240 were diagnosed with depression and 30% of them ( n = 375) had SC. The most common comorbid condition was diabetes (23.7%). The patients with SC were more likely to seek help at a general hospital (74.7% vs. 47.2%), and had a higher incidence of symptoms involving sadness, disturbed sleep, and poor appetite. Noradrenergic and specific serotonergic antidepressant was prescribed more for patients with SC than for those without SC (30.4% vs. 22.9%). Conclusions: SC is common in depressed Asian patients. It is important to strengthen the recognition of depression, especially in general hospitals and when patients report some somatic discomfort. It is also a matter of urgency to establish evidence-based guidelines for the use of new antidepressants in depressed patients with SC.

Teaching the Teachers of Clinical Psychopharmacology

Abstract: This commentary focuses on psychopharmacology teachers and their teaching. The authors offer broadly based pedagogic suggestions on how to deliver evidence-based and neurobiologically informed prescribing information to clinicians at all levels of experience. They argue that teaching essential psychopharmacology knowledge and practice must be up-to-date, accurate, and consistent with the reality of an individual patient’s life experience and beliefs. They stress that educators must teach that nonpsychopharmacological factors in a patient’s life may be as relevant to the treatment setting as the actual pharmacological basis of psychotropic drug therapeutics.

Comparison of chromatographic conditions for analysis of selected psychotropic drugs in human serum.

Abstract: Retention parameters of psychotropic drug standards were determined on different stationary phases: octadecyl silica, polar octadecyl silica, cyanopropyl silica and phenyl-hexyl silica using aqueous eluent systems containing acetonitrile, methanol or mixture of acetonitrile and methanol as organic modifiers; acetic buffer at pH 3.5 and diethylamine. The influence of stationary phases, kind of organic modifier and concentration of methanol and acetonitrile in mobile phases on retention, separation selectivity, peak symmetry and system efficiency was examined. These chromatographic parameters were significantly changed when analyses were performed on different stationary phases, when acetonitrile or methanol was used as organic modifier and when proportions of acetonitrile and methanol in eluent were different. The most efficient and selective systems were applied for quantification of the selected psychotropic drugs in fortified samples of human serum.

Vortioxetine in the treatment of major depressive disorder

Abstract: Vortioxetine is a novel psychotropic drug, with evidence of efficacy in acute treatment of major depressive episodes and in prevention of relapse in major depressive disorder. It has been described as having a ‘multimodal’ serotonergic mechanism of action, involving reuptake inhibition and a range of effects on presynaptic and postsynaptic receptors. It also has important effects on other neurotransmitters thought to be important in the neurobiology of depression and response to antidepressant treatment. It is efficacious in reducing anxiety symptom severity in depressed patients. The tolerability profile of vortioxetine appears predictable from its pharmacological properties. It may have beneficial effects in improving ‘cognition’ in depression, and a lower incidence of treatment-emergent sexual dysfunction, but these potential benefits require further investigation.

[Comparison of behavioral effects of fluoxetine, imipramine and new psychotropic drug TC-2153 on mice with hereditary predisposition to catalepsy].

Abstract: Behavioral effects of classic antidepressants, fluoxetine and imipramine, and new psychotropic benzopentathiepin TC-2153 (20 mg/kg, per os) were studied on mice differing in the predisposition to catalepsy-noncataleptic AKR strain and cataleptic strains CBA and AKR.CBA-D13Mit76 (D13). Mice of D13 strain was created by transferring the CBA-allele of major locus of catalepsy to AKR genome. In the forced swim test (FST) fluoxetine showed antidepressant effect on mice of all three strains, imipramine was effective only in D13 mice, while TC-2153 produced antidepressant effect on AKR and D13 mice. Unlike to imipramine and fluoxetine, TC-2153 did not produce negative side effects in the open field and elevated plus-maze tests. Thus, TC-2153 produces antidepressant effects similar to imipramine and fluoxetine, without any visible negative side effect on locomotory activity and anxiety. The D13 mice in the FST showed high sensitivity to the studied drugs in comparison to the parent strains and can be used as new genetic model for investigation of the mechanism of antidepressant effects.