The benzodiazepine nation of Croatia: an observational, comparative study of psychotropic drug utilization between Croatia and Sweden 2014-2015

Drug Safety and Suicidality Risk of Chronic Pain Medications

Chronic pain is one of the main leading causes of disability in the world at present. A variety in the symptomatology, intensity and duration of this phenomenon has led to an ever-increasing demand of pharmacological treatment and relief. This demand for medication, ranging from well-known groups, such as antidepressants and benzodiazepines, to more novel drugs, was followed by a rise in safety concerns of such treatment options. The validity, frequency, and diversity of such concerns are discussed in this paper, as well as their possible effect on future prescription practices. A specific caution is provided towards the psychological safety and toll of these medications, regarding suicidality and suicidal ideation. Most significantly, this paper highlights the importance of pharmacovigilance and underscores the necessity of surveillance programs when considering chronic pain medication.

Self-poisoning as a cause of admission in a medical intensive care unit and a question of misuse of prescription medications

BACKGROUND

Self-poisoning accounts for between 3 and 17% of intensive care unit (ICU) admissions.

OBJECTIVES

To display the misused substances, intention, and outcome of patients admitted to the ICU due to self-poisoning.

METHODS

A retrospective review of ICU admissions using an electronic patient database was performed.

RESULTS

A total of 149 patients were admitted, accounting for 4.6% of ICU admissions. Self-poisoning with self-harm was more frequent than without self-harm intent (62.4% vs. 37.6%). 64.4% of ingested substances were misused prescribed drugs. Females used antipsychotics (X² = 15, p< 0.05) and benzodiazepines (X² =11.52, p< 0.05), and males ingested antipsychotics (X² = 12, p< 0.05) with a self-harm intent. Antipsychotics were always used with a self-harm intent. Illicit drugs (X² =9.14, p< 0.05) and ethanol (X² =7.34, p< 0.05) were mostly used without self-harm intent. 102 patients (68.5%) continued treatment in a psychiatric clinic, more often women (X² (1,N = 145)=7.94, p< 0.005). The readmission rate was low. Mortality was 2.6%.

CONCLUSION

Self-poisoning is an infrequent cause of ICU admission. Prescribed psychotropic medications, including benzodiazepines, antipsychotics, and antidepressants were the most frequently misused substances. Psychiatric consultation before the ICU discharge and subsequent psychiatric treatment might lower the repetition and readmission rate.

Comparison of psychotropic medication use in the Baltic countries

Purpose: While the pivotal role of pharmacotherapy in psychiatry is universal, significant regional differences exist in drug use patterns. Herewith we compare the use of ATC psychotropic drugs (N05, psycholeptics and N06A, antidepressants) in 2010-2015 in the three Baltic Countries with reference to the Nordic Countries.Methods: Data were obtained from the national authorities on medicines as expressed in DDD per 1000 inhabitants per day. A semi-structured questionnaire was used for expert statements on the rationale of current use of medicines.Results: During the observation period the use of antipsychotics, anxiolytics, hypnotics and sedatives, and antidepressants steadily increased, while the growth in use of anxiolytics stagnated in the more recent years. Antipsychotic use was the largest in Lithuania and the lowest in Estonia. The use on anxiolytics in Lithuania was more than twice of that in Estonia and Latvia. Conversely, the use of hypnotics and sedatives was about three times higher in Estonia than in Latvia or Lithuania. Antidepressant use was dominated by the selective serotonin reuptake inhibitors in all three countries, but overall was much lower in Latvia as compared to Lithuania and Estonia. As compared to the Nordic Countries in 2015, antidepressants are used at much lower level throughout Baltics, probably reflecting underdiagnostics of depression and anxiety disorders.Conclusion: While the health-care expenditures in Estonia, Latvia and Lithuania are largely similar, as is the cultural and recent political background of these EU member countries, the extent and the pattern of psychotropic drug use is remarkably variable.