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Psychotropic drug

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


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TL;DR: This commentary considers two largely untapped resources that could help to identify, in an unbiased manner, high-quality candidate biomarkers for prospective pharmacogenomic studies of psychotropic drugs in psychiatry.
Abstract: Variation in individual clinical response to psychotropic drug treatment remains a critical problem in psychiatry. In general, only a minority of patients experience complete symptom remission while a larger proportion of patients continue to experience significant psychiatric symptoms. In addition, significant subsets of patients often develop drug-induced adverse events that range from troublesome to life threatening. Moreover, psychotropic drugs generally require weeks of treatment before therapeutic responses are expected, so critical time is often lost before a clinician can determine whether a specific treatment is effective or not and consider alternative pharmacotherapy. During this period, treated patients may experience the substantial morbidity associated with these conditions continue. Therefore, psychiatry is one specialty where pharmacogenomic results are highly likely to be applied for improved patient outcome. However, the current published findings are inadequate and insufficient for utilization as routine clinical predictors of treatment efficacy, safety or dosing [1, 2]. Therefore, it is timely to reconsider and revise current approaches to pharmacogenomic discovery in psychiatry before expensive and ethically problematic prospective studies are undertaken. In this commentary, we consider two largely untapped resources that could help to identify, in an unbiased manner, high-quality candidate biomarkers for prospective pharmacogenomic studies of psychotropic drugs. Behavioral neuroscientists have developed dozens of well-validated and carefully controlled methods for measuring the therapeutic and adverse effects of nearly all classes of psychotropic agents in laboratory mice [3]. For example, therapeutic responses to antidepressants, antipsychotics, and anxiolytics can be monitored using the tail suspension test, pre-pulse inhibition of the acoustic startle response and the elevated plus-maze, respectively. Over the past 30+ years, these methods have yielded important insights into psychotropic pharmacology and now, with recent advancements in mouse genomics, these behavioral assays are poised to increase our understanding of individual variation in drug response. The mouse has recently become a powerful tool for pharmacogenomic studies, due to the genetic diversity found among inbred strains and the development of powerful new gene mapping technologies, such as haplotype association mapping (HAM)[4]. HAM is a genetic mapping methodology that uses the phenotypic and genotypic variation occurring in common laboratory inbred mouse strains to calculate measures of genetic association (i.e., in silico mapping). HAM has many advantages over traditional murine QTL mapping strategies, including no need to breed or genotype animals, increased levels of phenotypic diversity, a high recombination frequency, and availability of a dense genotype map. These characteristics result in more precisely defined QTL regions, facilitating identification of genes underlying QTL, which has traditionally been the rate-limiting step [5]. We believe there is great promise in using HAM to identify genes that explain variation in the therapeutic and adverse responses to psychotropic drugs. In particular, studies of this sort minimize several factors that often confound human pharmacogenomic studies, including treatment adherence, diet and other environmental influences, and ancestral background. Nevertheless, mice are not humans, and therefore might not always be appropriate models of a given disease or appropriate surrogates for humans in pharmacogenomic studies. A second avenue that we feel has been underutilized in psychiatric pharmacogenomic discovery is the study of peripheral blood and lymphoblastoid cell lines (LCL) from human patients with variable responses to psychotropics. Peripheral blood represents an attractive tissue source in clinical pharmacogenomic studies, given the feasibility of its collection from patients and its potential as a sentinel tissue to monitor perturbations of physiology in many disease states [6]. This is particularly true for psychiatric disorders, for which the tissue presumably involved (brain) is inaccessible. Indeed, a growing number of studies are rapidly identifying transcriptional biomarkers in peripheral blood cells and Epstein-Barr virus (EBV) transformed LCL that function as biomarkers of disease [7–10], evidence of pharmacodynamic effect [11], predictors of clinical outcomes [12–14], and risk of toxicity [15]. Among the advantages of ex-vivo LCL based studies are: 1) the cells can be grown under identical conditions eliminating in vivo confounders; 2) they represent an unlimited resource; 3) genome-wide SNP data are often available; and 4) they offer ease of experimental manipulation and established methodologies to study gene expression and pharmacodynamic effects. Among the disadvantages of LCL studies are: 1) they represent one tissue type which may not be the most appropriate for the phenotype; 2) information on confounding factors that may alter the phenotype of interest, such as smoking or other drug use, may not be available; 3) EBV transformation can introduce phenotypic and gene expression changes; and 4) drug studies must take into account the lack of significant metabolic activities. Furthermore, a number of methodological issues and hurdles need to be overcome, with issues of standardizing blood sample collection and processing of paramount importance. The specificity of gene expression signatures for individual disease states also needs to be established. Despite these limitations, we feel that peripheral blood holds great promise for biomarker discovery and as with gene discovery, it may be best to perform these studies in mice before embarking on a prospective study in humans. Psychiatry has a particularly high need for routine clinical predictors of treatment efficacy and adverse events, but these are severely lacking at the present time. While the ideal study may perhaps be a genome-wide association study of several thousand patients all taking the same medication in a highly-controlled, long-term clinical study, the unfortunate fact is that even if a large discovery study is constructed, there remains a challenge to secure appropriate patient cohorts for validation. We believe that these problems can be circumvented by utilizing animal and peripheral blood models to identify high-priority candidate biomarkers prior to human trials. This would effectively reduce the search space necessary for prospective pharmacogenomic studies of psychotropic drugs in human patients.
Book ChapterDOI
01 Jan 1985
TL;DR: The effects of stress on organic illnesses, as for example, cardiovascular disorders, are not fully appreciated and these effects have never been systematically investigated from a clinical point of view.
Abstract: Although stress is an inescapable component of life and its adverse effects in some individuals at some times are well appreciated, these effects have never been systematically investigated from a clinical point of view. In particular, the effects of stress on organic illnesses, as for example, cardiovascular disorders, are not fully appreciated.
Journal ArticleDOI
01 Apr 2023-Cureus
TL;DR: In this article , the authors analyzed the dispensation of psychotropic drugs to outpatients at three pharmacies in the central headquarters of Hospital Clínica Bíblica in San José, Costa Rica, from 2017 to 2021.
Abstract: Introduction Mental health problems affect millions worldwide, and the prescription of psychotropic drugs is increasing globally. The World Health Organization (WHO) has emphasized the need for proper monitoring of psychotropic drug prescriptions. This study aims to characterize and find trends in the prescription of psychotropics in a Latin American General Hospital. Methods The study analyzed the dispensation of psychotropic prescriptions to outpatients at three pharmacies in the central headquarters of Hospital Clínica Bíblica in San José, Costa Rica, from 2017 to 2021. Psychotropic drugs were classified by the Anatomical Therapeutic Chemical (ATC) code, and the amount of each medication dispensed was standardized using the defined daily dose per 10,000 population per day metric. Patients' ages were categorized into four groups: under 18 years, 18 to 39 years, 40 to 64 years, and 65 years and above. The prescriptions were categorized according to medical specialty. Regression analyses were performed to determine the significance of trends observed in the data Results A total of 5793 psychotropic prescriptions were recorded. The average age of the patients was 58 years. The total consumption of psychotropics decreased by 33.94% from 2017 to 2021, with the most significant decline until 2020. However, there was an increase in consumption in 2021. Clonazepam was the most consumed medication, followed by bromazepam and alprazolam, which was the sole drug to exhibit an escalation in usage between 2017 and 2021. Regression analysis showed that only alprazolam and zopiclone had statistically significant trends. The highest number of prescriptions was dispensed to patients aged between 40 and 64 years, followed by those aged over 65 years. Anxiolytics were also the most commonly prescribed group of drugs. General medicine (20.22%), psychiatry (19.95%), and internal medicine (12.73%) were the primary specialties that prescribed psychotropic; 38.6% of prescriptions were associated with the 10th decile of patients, and 44.9% of prescriptions were issued by the 10th decile of physicians. Conclusion The consumption of psychotropic drugs decreased from 2017 to 2020 but increased in 2021, with alprazolam being the only drug that showed an increase in consumption throughout the entire period. General practitioners and psychiatrists were found to be the specialties that most commonly prescribe these medications. The study found significant trends only for the consumption of alprazolam and zopiclone and for prescription patterns among psychiatrists and internal medicine physicians.
Journal ArticleDOI
TL;DR: In this article , the authors present the data of criminal statistics in Kazakhstan for 2015-2018, identifies the most typical conditions conducive to the creation and functioning of drug traffickers, makes reasonable proposals for amending Article 302 of the Criminal Code of the Republic of Kazakhstan, aimed at improving the current criminal law.
Abstract: The main aim of the study is to consider problematic issues related to the qualification of a criminal offense, provided for in Article 302 of the Criminal Code of the Republic of Kazakhstan “Organization or maintenance of dens for the consumption of narcotic drugs, psychotropic substances, their analogues and the provision of premises for the same purposes”. This article describes the circumstances that make it difficult to prosecute persons who provide their homes or other premises for the consumption of narcotic drugs, psychotropic substances, their analogues, as well as the organizers of this type of illegal activity, creating conditions for anesthesia of the population. Through the study and analysis of statistical information, available approaches to this issue, as well as materials of judicial investigative practice in cases of this category, an attempt was made to consider the causes and conditions conducive to the commission of this offense, an author’s vision of resolving the situation was proposed. The article presents the data of criminal statistics in Kazakhstan for 2015-2018, identifies the most typical conditions conducive to the creation and functioning of drug traffickers, makes reasonable proposals for amending Article 302 of the Criminal Code of the Republic of Kazakhstan, aimed at improving the current criminal law. The materials of the article can be of practical value for law enforcement officers fighting the specified type of crime.
Book ChapterDOI
01 Jan 1990
TL;DR: The main aim of the study was to assess data on adverse drug reactions (ADRs) under conditions of everyday clinical practice.
Abstract: In 1979 a study for drug surveillance in psychiatric patients (Arzneimitteluberwachung in der Psychiatrie, AMUP) was initiated by the Arbeitsgemeinschaft fur Neuropsychopharmakologie und Pharmakopsychiatrie, financed by the Federal Health Agency (Bundesgesundheitsamt) of the Federal Republic of Germany. The main aim of the study was to assess data on adverse drug reactions (ADRs) under conditions of everyday clinical practice. Data on type and frequency of ADRs for various psychotropic drugs are available from clinical trials, however in everyday clinical practice patients of all age groups, including the elderly, are treated; some patients have concomitant physical diseases, and frequently drug combinations are used, as polypharmacy is a common practice in psychiatry worldwide (Clark and Holden 1987; Grohmann et al. 1986; Schmidt et al. 1987; Swett 1979). As the need for additional information on the occurence of ADR under these treatment conditions had not previously been met by any large-scale drug surveillance study, the AMUP study was undertaken.

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Performance
Metrics
No. of papers in the topic in previous years
YearPapers
202332
202268
202175
202058
201960
201876