Psychotropic drug

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

Safety of psychotropic medicines: contribution from observational evidence.

Abstract: The risks associated with psychotropic drugs use should be accurately documented at the population level in view of the growing number of persons exposed to these drugs. The strengths of observational studies regarding the identification of drug-related harms mirror the limitations of randomised controlled trials and vice-versa. Observational studies can be carried out in large samples of unselected participants treated in real-life conditions and who may be followed up over long periods. Serious adverse effects undetected during pre-marketing clinical trials may be observed only in post-marketing use, such as metabolic effects of second-generation antipsychotics. Observational studies play a key role in the identification of teratogenic risks, such as those induced by prenatal exposure to anticonvulsants. These studies are the main source of information to investigate the long-term effects of drugs, such as the possible increased risk of dementia in benzodiazepine users. They may also contribute to the accurate assessment at population level of risks overestimated by studies carried out in non-representative samples, such as the risk of congenital heart diseases in babies prenatally exposed to lithium. Owing to the lack of random allocation of drugs, confounding by indication or by disease severity are the major sources of biases in observational studies exploring drug safety. An adverse outcome may be wrongly imputed to drug exposure while it is a symptom/outcome of the disease motivating the decision to prescribe. Such a bias may occur in studies investigating the link between exposure to antidepressants and suicidality. As several methods have been developed to lessen the impact of such biases, pharmaco-epidemiological studies based upon stringent methodological designs should be regarded as a valid approach for assessing psychotropic drug safety.

Give my head peace: psychotropic drug uptake around the ‘peace-lines’ in Northern Ireland

Abstract: Background Although Northern Ireland can, after 30 years of violence, be described as a ‘post-conflict’ society it remains intensely segregated with over 15 km of concrete and metal barriers (‘Peace-lines’) erected to reduce the inter-communal tension at so-called interface areas. To date there has been no exploration of the health of the communities at these interface areas. Objectives This study aims to use the consumption of antidepressant and anxiolytic medication as proxy indicators of mental health to determine if living close to or very close to a peace-line affects mental health. Design Data relating to the consumption of antidepressant and anxiolytic medication over the 2 year period October 2008 to September 2010 was provided by an electronic prescribing database covering the entire population. Peace-lines were mapped using geographic information system techniques. Individuals were deemed to be living very close to or close to a peace-line if one passed through their Census Output Area (average population 336) or Super Output Area (average population 1900) of residence. Logistic regression analysis with adjustment for area deprivation was carried out and multi-level modelling to adjust for clustering within General Practitioner (GP) practices. Results Peace-lines are predominantly located in the most deprived areas with 87% in the most deprived quintile. Overall, 19% of those not close to a peace-line received an antidepressant over the study period compared to 27% of individuals living close or very close to a peace-line. After adjustment for age and sex, the likelihood of receiving an antidepressant increases in areas with proximity to a peace-line, OR=1.67 (95% CI 1.58 to 1.77) and OR=1.76 (95% CI 1.63 to 1.91) for those living close and those living very close a peace-line respectively, compared to the rest of the population. Further adjustment for deprivation attenuated but did not eliminate the relationship; OR=1.14 (95% CI 1.08 to 1.21) and OR= 1.18 (95% CI 1.10 to 1.27). The findings for anxiolytic drug uptake were very similar. Conclusion The residents of areas near to the peace-lines appear to have worse than expected mental health. However, as these data are cross-sectional it is not possible to determine whether the peace-lines are contributing to or ameliorating health status. This record linkage methodology could be used to examine the effect of selective migration in producing these patterns and any future erection or demolition of these walls.

Prescribing Patterns in a Hong Kong Institution for Adults with Severe to Profound Learning Disabilities

Abstract: There has been increasing concern about inappropriate or excessive medication of people with learning disabilities. Audits of prescribing practice may guide clinicians towards a more rational use of psychotropic drugs. Most previous studies have come from North America or Europe. This paper reports on a survey of prescribing patterns in an institution that cares for adults with severe to profound learning disabilities in Hong Kong. The survey found that 27% of the 294 hospital patients were receiving psychotropic drugs, but this rate was significantly higher (90%) in the ward for people with challenging behaviours. Most patients (67%) received a single psychotropic drug, 26% received two and 7%, three. Around half the patients (151) had epilepsy, of whom 90% received anticonvulsants. Of these, 52% received a single anticonvulsant, 37% received two and 11% received three or more. Dosages were generally within the recommended ranges. This survey revealed several good aspects of prescribing practice at Siu Lam Hospital, but also areas that need improvement. The latter include a drug‐reduction programme for the people with challenging behaviours, trials of drug‐free periods for seizure‐free patients receiving anticonvulsants and replacement of phenytoin and phenobarbitone with safer alternatives.

How to Make Effective Evaluation of Psychotropic Drug Effects in People with Developmental Disabilities and Self-Injurious Behavior

Abstract: This chapter covers the basic considerations necessary to make an effective evaluation of psychopharmacological and behavioral interventions for people with developmental disabilities (DD), with emphasis on self-injurious behavior (SIB), a particularly difficult behavior problem. It is written for the evidence-based clinical researcher and practitioner who encounters these cases frequently. In it we cover a host of issues affecting outcomes: theoretical orientation of the practitioners, design and analysis issues, especially those relevant to the DD population, common pharmacological issues, common behavioral evaluation issues, political and funding issues, and helpful resource materials. Treatment of the topics is slanted toward the behavior analytic approach, since that is the one most commonly used with SIB; but this chapter is also relevant to other approaches and to other populations with DD besides the SIB population.