Projected Spending on Psychotropic Medications 2013-2020

The Association of Outdoor Walking Per Week with Mental Health and Costs of Psychotropic Drugs in Adults

Regular walking confers many physical health benefits, including a reduced risk of disease-specific and all-cause mortality and better physical fitness. However, less is known about its role in mental health. Thus, the aims of this study were to determine the associations of outdoor walking per week with costs of psychotropic drugs used and mental health in adults. 500 adults aged 18 to 64 years in Hangzhou (China) reported sex, age, the name of the psychotropic drugs used and their dosage, and outdoor walking during the past 7 days. The cost that a person spends on buying psychotropic drugs for a month was considered psychotropic drugs costs. Overall mental health was assessed using the Chinese Version of the 12-Item General Health Questionnaire. The levels of walking in participants taking psychotropic were significantly lower than participants who did not taking psychotropic (p = 0.002). There was a significant negative correlation between mental health scores and minutes of walking per week and a significant positive correlation between the number of psychotropic drugs used and walking per week (p < 0.05). However, no particular associations were found between costs of psychotropic drug used and walking per week. Outdoor walking is prospectively associated with better overall mental health in adults. Then, awareness should be raised about the possible positive effects of outdoor walking on the mental health of adults.

History of Psychopharmacology

We live in an age of psychopharmacology. One in six persons currently takes a psychotropic drug. These drugs have profoundly shaped our scientific and cultural understanding of psychiatric disease. By way of a historical review, we try to make sense of psychiatry's dependency on psychiatric drugs in the care of patients. Modern psychopharmacology began in 1950 with the synthesis of chlorpromazine. Over the course of the next 50 years, the psychiatric understanding and treatment of mental illness radically changed. Psychotropic drugs played a major part in these changes as state hospitals closed and psychotherapy gave way to drug prescriptions. Our review suggests that the success of psychopharmacology was not the consequence of increasingly more effective drugs for discrete psychiatric diseases. Instead, a complex mix of political economic realities, pharmaceutical marketing, basic science advances, and changes in the mental health-care system have led to our current infatuation with psychopharmacology.

Initiation of new psychotropic prescriptions without a psychiatric diagnosis among US adults: Rates, correlates, and national trends from 2006 to 2015

OBJECTIVES

To estimate rates and national trends of initiation of new psychotropic medications without a psychiatric diagnosis and to identify demographic and clinical correlates independently associated with such use among US adults in outpatient settings.

DATA SOURCE

Data were gathered from the 2006-2015 National Ambulatory Medical Care Survey (NAMCS), a nationally representative sample of office-based U.S. outpatient care. The sample was limited to adults aged 18 or older who received a new psychotropic drug prescription (n = 8618 unweighted).

STUDY DESIGN

Using a repeated cross-sectional design with survey sampling techniques, we estimated prescription initiation rates and national trends. Multivariable-adjusted logistic regression analysis was used to identify correlates independently associated with initiation of new psychotropic prescriptions without a psychiatric diagnosis.

DATA COLLECTION/EXTRACTION METHODS

Data were publicly available, and we extracted them from the Centers for Disease Control and Prevention website.

PRINCIPAL FINDINGS

Altogether, at 60.4% of visits at which a new psychotropic prescription was initiated, no psychiatric diagnosis was recorded for the visit. Overall, the rate increased from 59.1% in 2006-2007 to 67.7% in 2008-2009 and then decreased to 52.0% in 2014-2015. Visits to psychiatrists were associated with very low odds of having no psychiatric diagnosis when compared to primary care visits (OR = 0.02; 95% CI, 0.01-0.04). Visits to non-psychiatric specialists showed 6.90 times greater odds of not having a psychiatric diagnosis when compared to primary care visits (95% CI, 5.38-8.86).

CONCLUSION

New psychotropic medications are commonly initiated without any psychiatric diagnosis, especially by non-psychiatrist physicians. Non-psychiatrists should document relevant diagnoses more vigilantly to prevent potentially inappropriate use or misuse.

Association of Focused Medication Review With Optimization of Psychotropic Drug Prescribing: A Systematic Review and Meta-analysis

IMPORTANCE

Medication review has been proposed to achieve improved use of psychotropic drugs, but benefits have not been confirmed.

OBJECTIVE

To synthesize evidence for focused psychotropic medication review in medication optimization.

DATA SOURCES

Medline, PsycINFO, EMBASE, and CINAHL Plus were searched from inception to February 2018 using the index terms "drug utilization review" and "psychotropic drugs" and synonyms. Additional articles were retrieved using citation tracking and reference checking.

STUDY SELECTION

Full-length, peer-reviewed articles that reported focused psychotropic medication review were included. Inclusion was determined against prespecified criteria and assessed independently.

DATA EXTRACTION AND SYNTHESIS

Study quality was assessed using National Institutes for Health appraisal tools and informed a structured synthesis of results. Meta-analysis using a random effects model was conducted.

MAIN OUTCOMES AND MEASURES

Change in the number or dosage of psychotropic medications, change in clinical parameters, change in patient-reported outcomes, and economic data were collected.

RESULTS

A total of 26 studies met the inclusion criteria. Four studies were randomized clinical trials (n = 712 participants), while the remainder were before-after studies (n = 7844 participants). Most studies were conducted in elderly individuals, people with dementia, and adults with intellectual disability. Focused psychotropic medication review is a complex intervention; the professional(s) involved, target drug, degree of integration with usual care, and participant involvement varied greatly among the studies. Meta-analysis included 3 studies (n = 652 participants). Psychotropic medication review was associated with a reduction in prescribing of psychotropic drugs compared with control (pooled odds ratio, 0.24; 95% CI, 0.14-0.39) in elderly participants with cognitive impairment living in nursing homes. Before-after studies consistently reported a change in psychotropic drug prescribing after medication review, regardless of the population. Studies that reported the effects of psychotropic medication review on clinical outcomes failed to demonstrate benefit. Economic implications of focused psychotropic medication review were not adequately assessed. The quality of evidence is poor and studies are at risk of bias.

CONCLUSIONS AND RELEVANCE

Focused psychotropic medication review was associated with a reduction in prescribing of psychotropic drugs, but has not been shown to improve clinical outcomes or to provide economic benefit. More robust evidence is needed before programs of focused psychotropic medication review can be recommended as part of routine care for any patient group.