Psychotropic drug

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

Prediction of early weight gain during psychotropic treatment using a combinatorial model with clinical and genetic markers.

Abstract: BACKGROUND: Psychotropic drugs can induce significant (>5%) weight gain (WG) already after 1 month of treatment, which is a good predictor for major WG at 3 and 12 months. The large interindividual variability of drug-induced WG can be explained in part by genetic and clinical factors. AIM: The aim of this study was to determine whether extensive analysis of genes, in addition to clinical factors, can improve prediction of patients at risk for more than 5% WG at 1 month of treatment. METHODS: Data were obtained from a 1-year naturalistic longitudinal study, with weight monitoring during weight-inducing psychotropic treatment. A total of 248 Caucasian psychiatric patients, with at least baseline and 1-month weight measures, and with compliance ascertained were included. Results were tested for replication in a second cohort including 32 patients. RESULTS: Age and baseline BMI were associated significantly with strong WG. The area under the curve (AUC) of the final model including genetic (18 genes) and clinical variables was significantly greater than that of the model including clinical variables only (AUCfinal: 0.92, AUCclinical: 0.75, P<0.0001). Predicted accuracy increased by 17% with genetic markers (Accuracyfinal: 87%), indicating that six patients must be genotyped to avoid one misclassified patient. The validity of the final model was confirmed in a replication cohort. Patients predicted before treatment as having more than 5% WG after 1 month of treatment had 4.4% more WG over 1 year than patients predicted to have up to 5% WG (P≤0.0001). CONCLUSION: These results may help to implement genetic testing before starting psychotropic drug treatment to identify patients at risk of important WG.

Epidemiologie des Gebrauchs von Psychopharmaka in Altenheimen

Abstract: Cross-sectional studies conducted in 1988 and 1992 using identical assessment methods also determined the prevalence of psychotropic drug consumption by the residents of homes for the elderly in the city of Mannheim. Another purpose of the studies was to find out the extent of a possible interrelation between treatment with psychotropics on the one hand and sociodemographic characteristics and behaviour problems of the residents on the other. In addition, in all consecutive new admissions to the homes not only the prevalence of consumption of psychotropics was investigated, but also the question to what extent the use of psychotropic drugs increases the mortality rate. In a total of 12 Mannheim old-age homes each in 1988 (n = 542) and 1992 (n = 497) all the residents older than 65 years of age were investigated. Between 1986 and 1988 all consecutive admissions (n=239) to Mannheim old-age homes were interviewed and the mortality risk determined in a subsequent investigation in 1992. Taking a period of four weeks as reference period, 42.1% of the residents were treated during that period with psychotropics in 1988, of which 13.3% received neuroleptics, 11.7% hypnotics, 8.9% antidepressants and 13.0% tranquilizers. There were considerable variations between the individual homes in respect of the intake of psychotropics (minimum 18,2%, maximum 58.3%). In 1992 the prevalence of the use of psychotropics rose to 47.6%, the increase being mainly due to neuroleptics (23.8%) and, to a lesser extent, to antidepressants (12.9%). Compared with 1988 there was a slight decrease in the consumption of tranquilizers (10.9%) and hypnotics (10.7%). In 1988 there was no statistically significant connection between intake of psychotropics and gender, age, frequency of visits by relatives/friends, duration of residence and behaviour problems (aggression, suspiciousness, wandering, depression, dementia) of the residents. This result was also confirmed for 1992, albeit with two exceptions: a significantly higher consumption of psychotropic drugs by home residents characterised by the behaviour problems wandering and depression. Examination of the consecutively newly admitted inmates revealed that psychotropic drug consumption was already relatively high (38.0%) at the time of admission. The mortality risk, determined after having checked on possibly confounding variables, was not significantly enhanced in residents who had already been treated with psychotropics at the time of admission (odds ratio: 0.52; Cl: 0.25-1.08). Compared with elderly persons in private households the consumption of psychotropics is markedly higher in old-age homes. However, the intake is not due to institutionalisation, but had already been high at the time of admission. Prospective studies of the course with relatively short follow-up intervals would be necessary for a differentiated examination of the determinants and effects of high psychotropics consumption and to establish a sound foundation for an appropriate prescription of psychotropics for home residents.

The effect of sedative agents in psychotropic drugs on acoustically evoked responses

Abstract: All of the drugs used (Atosil, Nembutal, Mandrax, and Valium) tend to attenuate the acoutically-evoked responses. As was observed in monkeys at an earlier occasion, there are large fluctuations in response magnitude under the affect of Nembutal. It appears therefore that Nembutal is not a suitable sedating agent for the present purposes. Whereas Mandrax attenuates the response potentials strongly for period of up to 4 h, they begin to recover already about 3 h after the administration of Valium. (For details on the effects of these drugs upon the response latencies, cf. the paper by Karnahl and Benning in the same issue.) The situation was best when Atosil was being used-which is known Phenergan in English-speaking countries. In that case, response amplitudes were reduced by a mere 20-300/0 during the first 90–120 min after medication; otherwise, thresholds and ERA characteristics were registered in a normal manner. If registrations were continued for longer periods of time, the depressing effect of Atosil became more marked, although responses remain generally superior to those obtainable under the effects of Valium or Mandrax. The combination of electronic rejection of response artifacts and slight sedation by means of Atosil appears to be quite promising at the present time, especially with respect to evoked-response audiometry in children.

Cytochromes and psychotropic drug interactions.

Abstract: Sm: The editorial on cytochromes and psycho tropic drug interactions (Taylor & Lader, 1996) is timely. The recent advances in molecular biology and in the understanding of the cytochrome p450 system, in particular, need to be brought into the clinical arena. However, the implications of this work go beyond potential drug interactions. The genotyping of the CYP2D locus has led to the exciting discovery not only of poor and extensive metabolisers but also of ultra-rapid metabolisers of the phenotypic probe, debrisoquine (Johansson et al, 1993). These show one or more copies of the CYP2D6 gene, the expression of which causes the hydroxylation of desbrisoquine (the first step in its breakdown). Since the oxidative metabolism and elimination of most phenothiazines is known to be mediated by the CYP2D6 isoenzyme, there is now a framework to understand patients who are treatment-resistant or who respond only to high levels of antipsychotic medication and appear un affected by extrapyramidal or other side-effects (Bertilsson et a!, 1993). Furthermore, recent studies have found an association between the poor debriso quine metaboliser phenotype and increased likeli hood of extrapyramidal side-effects (Arthur et al, 1995). It may be that once testing becomes more widely available outside specialist centres, genotyp ing of the CYP2D locus will become commonplace, providing predictive testing for concentration dependent side-effects such as Parkinsonism, and in forming clinical decisions on dosage of antipsychotic medication.