Psychotropic drug

About: Psychotropic drug is a research topic. Over the lifetime, 2309 publications have been published within this topic receiving 54070 citations.

Lipogenic effects of psychotropic drugs: focus on the SREBP system.

Abstract: Antipsychotics, antidepressants and mood stabilizers are psychotropic drugs widely used in the treatment of psychiatric disorders, such as schizophrenia, bipolar disorder and major depressive disorder. Such drugs have been used since the early 1950s, and it is now well established that they target neurotransmitter receptors and/or transporters located on central nervous system (CNS) neurons. However, their mechanism of action is still not fully understood, and there is large inter-individual variation in therapeutic response. Psychotropic drugs are also associated with numerous adverse effects, of which weight gain and metabolic disturbances have gained increased focus during the last decade. Based on studies in cultured cells, we have demonstrated that several psychotropic drugs upregulate the expression of genes involved in cellular fatty acid and cholesterol biosynthesis, controlled by the SREBP transcription factors. Lipogenic effects were also observed in vivo, in rat liver and in lymphocytes from drug-treated patients. These results provide new insight into the molecular mechanisms of psychotropic drug action and could be relevant both for their therapeutic action and metabolic adverse effects.

Sedative Load among Community-Dwelling People Aged 75 Years and Older: A Population-Based Study

Abstract: Background: Drugs with sedative properties are among the most widely used drugs in community-dwelling older people. Use of sedative drugs has been associated with falls and fractures, cognitive and memory impairment and impaired physical function among older people. The sedative load model has been developed to quantify the cumulative effect of taking multiple drugs with sedative properties. Objective: The objective of the study was to investigate factors associated with sedative load among community-dwelling older people, using data collected as part of the Finnish Geriatric Multidisciplinary Strategy for the Good Care of the Elderly (GeMS) study. Methods: The GeMS study was a randomized, comparative study that evaluated a model for geriatric assessment, care and rehabilitation using a study sample of 1000 persons aged ≥75 years who were living in Kuopio, Finland. Of these, 700 people consented to participate and were community-dwelling. Demographic, diagnostic and drug use data (both regular and when-required drugs) were elicited during nurse interviews. For the current analysis, sedative load was computed using a previously published model, in which drugs taken on a regular and when-required basis were classified into one of four groups according to their sedative potential. Group 1 included primary sedatives (sedative rating 2) and group 2 included drugs with sedation as a prominent side effect (sedative rating 1). Each participant’s sedative load was calculated by summing the sedative ratings of group 1 and 2 drugs. Logistic regression models were used to investigate factors associated with sedative load. Results: Twenty-nine percent of participants (n = 205) had a sedative load of ≥1 (i.e. used one or more drugs with sedative properties), and 22% (n = 158) had a sedative load of ≥2 (i.e. used either one primary sedative or two drugs with sedation as a prominent adverse effect or preparations with a sedating component) when considering regularly used drugs. A sedative load of ≥2 that related to regularly used drugs was associated with female sex (odds ratio [OR] 1.65; 95% CI 1.02, 2.67), poor self-perceived health (OR 2.06; 95% CI 1.25, 3.38), impaired instrumental activities of daily living [IADL] (OR 1.89; 95% CI 1.18, 3.01) and often feeling lonely (OR 4.72; 95% CI 2.15, 10.40). The same factors remained significantly associated with a sedative load of ≥2 after drugs used on a when-required basis were included in the analyses. Conclusions: The advantages of the sedative load model were that it included drugs with sedative properties prescribed for somatic diseases, described cumulative exposure to drugs that exert sedative effects through multiple mechanisms in the CNS, and incorporated a sedative rating for each drug. In an older population, female sex, impaired IADL, poor self-perceived health, and loneliness were associated with higher sedative load. Clinicians should remain cognizant of these factors when reviewing drug regimens and targeting interventions to optimize sedative use.

Medicating Children: The Case of Ritalin

Abstract: In response to recent concerns about the overmedication of children, this paper considers ethical and conceptual issues that arise in the issue of when children who are diagnosed with attention deficit hyperactivity disorder should be given stimulants such as the psychotropic drug Ritalin as part of their treatment. There is considerable resistance and worry about the possibility of overmedication. This is linked to the worry that the diagnosis of ADHD is overused, and the paper considers some reasons to worry about the overuse of the diagnosis itself. The paper then focuses on the resistance to the use of drugs, which is particularly strong for children in the gray area of diagnosis, where it is dubious whether the children really meet the strict diagnostic criteria. The reasons behind such resistance are often not well articulated, so part of the task of the paper is spell out what they might be. The reasons are given the following labels: side effects, unnaturalness, profit motives, thought control, competitiveness, and doctors' power. The paper ends in taking the polemical position that while there is some legitimate concern about possible short and long term side effects of children taking psychotropic drugs, the other reasons for resistance are not well-founded.

Psychotropics and sexuality.

Abstract: Relatively little is known about the sexual side-effects of psychotropic drugs, probably due to the taboos surrounding discussion of sexual matters. However, there is a growing interest in this topic. The antidepressants are probably the most widely studied class of psychotropic drug and evidence suggests that all commonly used classes are associated with some sexual side-effects. However, there may well be differences between the effects of different drugs in the same class. The study of sexual side-effects in bipolar patients taking mood stabilizers is complicated by the existence of numerous confounding variables and only limited data are currently available on the sexual side-effects of benzodiazepines and antipsychotics. It is also important to take into account a number of methodological considerations when interpreting data on the sexual side-effects of psychotropic drugs.

The effect of a doctor's personal characteristics and working circumstances on the prescribing of psychotropic drugs.

Abstract: The purpose of this study has been to unravel factors contributing to the question of the quantity of psychotropic drug prescribing. Forty-seven general practitioners (71% of the sample) participated. The information on the doctors' characteristics was collected by anonymous questionnaires. Also, each doctor registered all his patients, their biographical data, diagnosed diseases, and treatment on one day. Drug prescribing frequencies indicating the number of drugs per diagnosis were counted from these registers afterwards. On average, one drug was prescribed for each diagnosis, one psychotropic drug for every tenth diagnosis, and one hidden psychotropic drug for every fourteenth diagnosis. These drug prescribing frequencies differed greatly from doctor to doctor. However, a little of this variation could be explained by the variables chosen. The length of the surgery hours seemed to best explain the drug prescribing frequencies: the longer the day, the more drugs prescribed. Doctors who were cautious and uncertain in deciding had lower frequencies in prescribing psychotropic drugs. The more positive the attitude which the doctor had towards the use of drugs for social problems and everyday stress, the more psychotropic drugs were prescribed. The estimated amounts of psychic disturbances among patients were not correlated to psychotropic drug frequency.