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Barros JC, Silva SN. Use of Psychotropic Drugs during the COVID-19 pandemic in Minas Gerais, Brazil. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2023; 26:e230059. [PMID: 38088718 PMCID: PMC10715318 DOI: 10.1590/1980-549720230059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE To describe the profile of dispensation of mental health drugs by analyzing trends in use before and during the COVID-19 pandemic within the Unified Health System (Sistema Único de Saúde [SUS]). METHODS Pharmacoepidemiological study based on the retrospective analysis of records regarding the dispensation of psychotropic medicines in the SUS database in the state of Minas Gerais between 2018 and 2021, considering the periods before (2018-2019) and during the COVID-19 pandemic (2020-2021). A database with the records of dispensation of municipalities was created, and the consistency of releases was verified using the Analysis of Variance (ANOVA) test. Medicine consumption was measured in a defined daily dose (DDD) per 1,000 inhabitants/day for SUS, and the difference between periods was evaluated using Student's t-test. RESULTS During the COVID-19 pandemic, there was an increase in the consumption of psychotropic drugs in SUS-MG. The most consumed medicines were fluoxetine hydrochloride, diazepam and phenobarbital sodium (DDD=5.89; 3.42; 2.49) in the Basic Pharmaceutical Services Component(CBAF), and olanzapine, risperidone and quetiapine hemifumarate (DDD=0.80; 0.47; 0.38) in the Specialized Pharmaceutical Services Component (CEAF). The highest percentage increase in consumption was attributed to clonazepam (75.37%) and lithium carbonate (35.35%), in CBAF, and levetiracetam (3,000.00%) and memantine hydrochloride (340.0%) in CEAF. CONCLUSION The change in the psychotropic drug dispensation profile during the COVID-19 pandemic highlights the need to produce more studies to complete, confirm or rule out this profile and monitor the use of psychotropic drugs by the population in the post-pandemic context.
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Affiliation(s)
| | - Sarah Nascimento Silva
- Fundação Oswaldo Cruz, Instituto René Rachou, Health Technology Assessment Unit – Belo Horizonte (MG), Brazil
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2
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Tiguman GMB, Hoefler R, Silva MT, Lima VG, Ribeiro-Vaz I, Galvão TF. Prevalence of antidepressant use in Brazil: a systematic review with meta-analysis. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2023; 46:e20233095. [PMID: 37718462 PMCID: PMC11189131 DOI: 10.47626/1516-4446-2023-3095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 07/27/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVES To estimate the prevalence of antidepressant use in Brazil. METHODS We conducted a systematic review with searches in MEDLINE, Embase, Scopus, LILACS, and SciELO up to May 2023. Two researchers independently selected studies, extracted data, and assessed the methodological quality. We pooled the prevalence of antidepressant use using meta-analyses of proportions (Freeman-Tukey transformation) and estimated heterogeneity by the I2 statistic. OR meta-analyses of antidepressant use by sex were calculated (men as reference) and between-study variation was explored by meta-regressions. RESULTS Out of 3,299 records retrieved, 23 studies published in 28 reports were included, with a total of 75,061 participants. The overall prevalence of antidepressant use was 4.0% (95%CI 2.7-5.6%; /² = 98.5%). Use of antidepressants in the previous 3 days was higher in women (12.0%; 95%CI 9.5-15.1%; /² = 0%) than men (4.6%; 95%CI 3.1-6.8%; /² = 0%) (p < 0.001; OR = 2.82; 95%CI 1.72-4.62). Gender differences were particularly higher for antidepressant use in the previous year (women: 2.3%; 95%CI 1.6-3.1; /² = 37.6% vs. men: 0.5%; 95%CI 0.2-1.0%; /² = 0%, p < 0.001; OR = 4.18; 95%CI 2.10-8.30). Between-study variation in the overall prevalence of antidepressant use significantly increased with mean participant age (p = 0.035; residual /² = 0%; regression coefficient = 0.003). CONCLUSION Four out of every 100 Brazilians used antidepressants in this 3-decade assessment. Use increased with age and was more prevalent in women compared to men. REGISTRATION NUMBER PROSPERO CRD42022345332.
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Affiliation(s)
| | - Rogério Hoefler
- Departamento de Medicina da Comunidade, Informação e Decisão em Saúde, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Marcus Tolentino Silva
- Departamento de Saúde Coletiva, Faculdade de Ciências da Saúde, Universidade de Brasília, Brasília, DF, Brazil
| | - Vanessa Gomes Lima
- Faculdade de Ciências Farmacêuticas, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Inês Ribeiro-Vaz
- Unidade de Farmacovigilância do Porto, Centro de Investigação em Tecnologias e Serviços de Saúde, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Taís Freire Galvão
- Faculdade de Ciências Farmacêuticas, Universidade Estadual de Campinas, Campinas, SP, Brazil
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Gibson LL, Grinberg LT, Ffytche D, Leite REP, Rodriguez RD, Ferretti-Rebustini REL, Pasqualucci CA, Nitrini R, Jacob-Filho W, Aarsland D, Suemoto CK. Neuropathological correlates of neuropsychiatric symptoms in dementia. Alzheimers Dement 2023; 19:1372-1382. [PMID: 36150075 PMCID: PMC10033459 DOI: 10.1002/alz.12765] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/23/2022] [Accepted: 07/08/2022] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Neuropsychiatric symptoms (NPS) are common in Lewy body disease (LBD), but their etiology is poorly understood. METHODS In a population-based post mortem study neuropathological data was collected for Lewy body (LB) neuropathology, neurofibrillary tangles (NFT), amyloid beta burden, TDP-43, lacunar infarcts, cerebral amyloid angiopathy (CAA), and hyaline atherosclerosis. Post mortem interviews collected systematic information regarding NPS and cognitive status. A total of 1038 cases were included: no pathology (NP; n = 761), Alzheimer's disease (AD; n = 189), LBD (n = 60), and AD+LBD (n = 28). RESULTS Hallucinations were associated with higher LB Braak stages, while higher NFT Braak staging was associated with depression, agitation, and greater number of symptoms in the Neuropsychiatric Inventory. Cases with dual AD+LBD pathology had the highest risk of hallucinations, agitation, apathy, and total symptoms but a multiplicative interaction between these pathologies was not significant. DISCUSSION LB and AD pathology contribute differentially to NPS likely with an additive process contributing to the increased burden of NPS.
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Affiliation(s)
- Lucy L Gibson
- Old Age Psychiatry Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Lea T Grinberg
- Memory and Aging Center, Department of Neurology and Pathology, University of California San Francisco, San Francisco, California, USA
- University of São Paulo Medical School, São Paulo, Brazil
| | - Dominic Ffytche
- Old Age Psychiatry Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | | | | | | | | | | | - Dag Aarsland
- Old Age Psychiatry Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Centre for Age-Related Disease, Stavanger University Hospital, Stavanger, Norway
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Loyola Filho AID, Firmo JOA, Mambrini JVDM, Peixoto SV, Souza Junior PRBD, Nascimento MMGD. Use of psychotropic drugs by population in an area affected by the tailings dam rupture: Brumadinho Health Project. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2022; 25:e220012. [PMID: 36327417 DOI: 10.1590/1980-549720220012.supl.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/17/2022] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVE To describe the consumption of psychotropic drugs in the adult population residing in Brumadinho, Minas Gerais, after the Vale dam collapse, which occurred in 2019. METHODS This is a cross-sectional study, part of the Brumadinho Health Project, developed in 2021, with a representative population-based sample of adults (18 years and over) residing in Brumadinho. A total of 2,805 adults with information on self-reported use of psychotropic drugs (antidepressants and anxiolytics-hypnotics/sedatives) in the last 15 days were included in the analysis. The prevalence of psychotropic drug use was estimated, and the most used psychotropic drugs were identified. Pearson's chi-square test (with Rao-Scott correction) was used to test associations between exposures and use of psychotropic drugs, considering a significance level of p<0.05. RESULTS The use of antidepressants (14.2%) was more common than the use of anxiolytics or hypnotics/sedatives (5.2%), with sertraline and fluoxetine being the most used antidepressants. The use of anxiolytics and hypnotics/sedatives was higher among residents who lived in the area directly affected by the dam's mud, and the use of any psychotropic drug was higher among those who lost a relative/friend in the disaster and assessed that their health worsened after the disaster, and among women. CONCLUSION The results of the study corroborate what was observed in other populations exposed to similar tragedies, regarding the pattern of associations and the of use of psychotropic drugs.
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Affiliation(s)
- Antônio Ignácio de Loyola Filho
- Fundação Oswaldo Cruz, Instituto René Rachou - Belo Horizonte (MG), Brazil
- Universidade Federal de Minas Gerais, School of Nursing - Belo Horizonte (MG), Brazil
| | | | | | - Sérgio Viana Peixoto
- Fundação Oswaldo Cruz, Instituto René Rachou - Belo Horizonte (MG), Brazil
- Universidade Federal de Minas Gerais, School of Nursing - Belo Horizonte (MG), Brazil
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Siani-Morello MR, Pereira LB, Ferreira IMDL, Aliste MJ, Pereira LRL. Psychoactive drugs in the Brazilian public health system: Use profile and associated factors. BRAZ J PHARM SCI 2022. [DOI: 10.1590/s2175-97902022e19739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Does the use of antidepressants change the subjective well- being of individuals with ICD-10 depressive disorder identified in the general population? JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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7
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Mari JJ, Gadelha A, Kieling C, Ferri CP, Kapczinski F, Nardi AE, Almeida-Filho N, Sanchez ZM, Salum GA. Translating science into policy: mental health challenges during the COVID-19 pandemic. ACTA ACUST UNITED AC 2021; 43:638-649. [PMID: 33710250 PMCID: PMC8639016 DOI: 10.1590/1516-4446-2020-1577] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 12/02/2020] [Indexed: 12/20/2022]
Abstract
Several stressors associated with the coronavirus disease 2019 (COVID-19) are expected to affect the mental health of global populations: the effects of physical distancing, quarantine, and social isolation; the emotional suffering of health and other frontline workers; neuropsychiatric sequelae in those affected by the virus; the impact to families of lives lost to the disease; differential effects for those with severe mental disorders; and the consequences of social and economic deterioration. In this context, we sought: to form a panel of Brazilian experts on child and adolescent health, neurodevelopment, health services, and adult and elderly mental health; and to compile evidence-based interventions to support suggested policy changes in Brazil to mitigate the expected increase in mental health disorders during the pandemic and its mental health consequences. The following actions are recommended: 1) invest in prevention programs for the safe return of students to schools; 2) adopt evidence-based psychosocial interventions to maintain an adequate environment for child and adolescent development; 3) target socially vulnerable populations and those experiencing discrimination; 4) train primary care teams to solve common mental health problems, provide needs-based assessments, and manage long-term, at-home care for older patients; 5) invest in technological advancements (e.g., telemedicine, e-Health, and web-based algorithms) to promote coordinated care; 6) increase access to and literacy in the use of computers and mobile phones, especially among older adults; 7) expand protocols for remote, brief psychotherapy interventions and psychoeducation to manage common mental health problems.
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Affiliation(s)
- Jair J Mari
- Departamento de Psiquiatria e Psicologia Médica, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Ary Gadelha
- Departamento de Psiquiatria e Psicologia Médica, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Christian Kieling
- Serviço de Psiquiatria da Infância e Adolescência, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Departamento de Psiquiatria e Medicina Legal, UFRGS, Porto Alegre, RS, Brazil
| | - Cleusa P Ferri
- Departamento de Psiquiatria e Psicologia Médica, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Flavio Kapczinski
- Departamento de Psiquiatria, UFRGS, Porto Alegre, RS, Brazil.,McMaster University, Hamilton, Canada
| | - Antonio E Nardi
- Instituto de Psiquiatria, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.,Academia Nacional de Medicina, Rio de Janeiro, RJ, Brazil.,Academia Brasileira de Ciências, Rio de Janeiro, RJ, Brazil
| | - Naomar Almeida-Filho
- Instituto de Estudos Avançados, Universidade de São Paulo, São Paulo, SP, Brazil.,Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Zila M Sanchez
- Departamento de Medicina Preventiva, Escola Paulista de Medicina, UNIFESP, São Paulo, SP, Brazil
| | - Giovanni A Salum
- Seção de Afeto Negativo e Processos Sociais, Departamento de Psiquiatria e Medicina Legal, HCPA, UFRGS, Porto Alegre, RS, Brazil
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Maia LO, Daldegan-Bueno D, Fischer B. Opioid use, regulation, and harms in Brazil: a comprehensive narrative overview of available data and indicators. Subst Abuse Treat Prev Policy 2021; 16:12. [PMID: 33499891 PMCID: PMC7836143 DOI: 10.1186/s13011-021-00348-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Global opioid consumption increased multifold post-2000, disproportionately in high-income countries, with severe mortality/morbidity consequences. Latin America features comparatively low opioid availability; Brazil, the region's most populous country, makes an interesting case study concerning opioid use/harms. In this comprehensive overview, we aimed to identify and summarize medical and non-medical data and indicators of opioid availability and use, regulation/control, and harm outcomes in Brazil since 2000. METHODS We searched multiple scientific databases to identify relevant publications and conducted additional 'grey' literature searches to identify other pertinent information. RESULTS Despite some essential indicators, opioid-related data are limited for Brazil. Data indicate that population-level availability of prescription opioids represents only a small fraction of use in comparison to high-income countries. However, within Latin America, Brazil ranks mid-level for opioid consumption, indicating relatively moderate consumption compared to neighboring jurisdictions. Brazil has implemented restrictive regulations to opioid prescribing and is considered 'highly restricted' for opioid access. Codeine remains the major opioid analgesic utilized, but stronger opioids such as oxycodone are becoming more common. Professional knowledge regarding medical opioid use and effects appears limited. National surveys indicate increases in non-medical use of prescription opioids, albeit lower than observed in North America, while illicit opioids (e.g., heroin) are highly uncommon. CONCLUSIONS Overall population-level opioid availability and corresponding levels of opioid-related harms in Brazil remain substantially lower than rates reported for North America. However, the available surveillance and analytical data on opioid use, policy/practice, and harms in Brazil are limited and insufficient. Since existing and acute (e.g., pain-related) needs for improved opioid utilization and practice appear to be substantiated, improved indicators for and understanding of opioid use, practice, and harms in Brazil are required.
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Affiliation(s)
- Lucas O. Maia
- Centre for Applied Research in Mental Health and Addiction, SFU Faculty of Health Sciences, Simon Fraser University, 515 W. Hastings Street, V6B 5K3 Vancouver, BC Canada
| | - Dimitri Daldegan-Bueno
- Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, 1023 Grafton, Auckland New Zealand
| | - Benedikt Fischer
- Centre for Applied Research in Mental Health and Addiction, SFU Faculty of Health Sciences, Simon Fraser University, 515 W. Hastings Street, V6B 5K3 Vancouver, BC Canada
- Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, 1023 Grafton, Auckland New Zealand
- Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, M5T 1R8 Toronto, ON Canada
- Department of Psychiatry, Federal University of São Paulo, R. Dr. Ovídio Pires de Campos, 785, 05403-903 São Paulo, Brazil
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Coledam DHC, Silva YMD. Prescribed medication use among elementary teachers: Prevalence and associated factors. CIENCIA & SAUDE COLETIVA 2020; 25:5051-5064. [PMID: 33295522 DOI: 10.1590/1413-812320202512.20912018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 04/15/2019] [Indexed: 11/21/2022] Open
Abstract
The aims of the study were to assess the prevalence and analyze the associated factors of medication use among teachers. A cross-sectional study was carried out, involving 530 teachers from Londrina city, Paraná, Brazil. The dependent variable was prescribed medication use and the independent variables were sociodemographic, work-related, lifestyle, health disorders, and chronic diseases, all assessed through questionnaires. Prevalence of medication use was 59.1%. Chronic disease was associated with all medications analyzed. Variables positively associated with medication use according to health disorder type were: Cardiometabolic (Length of employment, overweight, not current tobacco use, and TV viewing); Psychological (Length of employment, common mental disorders, current tobacco use, and disability); Orthopedic (Length of employment, health insurance, overweight, musculoskeletal pain, low job support, and disability); Respiratory (TV viewing and problems related to dust or chalk powder); and Gastrointestinal (common mental disorders and physical activity [negative association]). Support for access, the appropriate use of medicines, and a reduction in medication use should consider work-related, lifestyle, and health disorders, as well as chronic diseases.
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Affiliation(s)
- Diogo Henrique Constantino Coledam
- Instituto Federal de Educação, Ciência e Tecnologia de São Paulo. Av. Zélia de Lima Rosa 100, Portal dos Pássaros. 18550-000 Boituva SP Brasil.
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10
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Ramos LR, Mari JDJ, Fontanella AT, Pizzol TDSD, Bertoldi AD, Mengue SS. Nationwide use of psychotropic drugs for treatment of self-reported depression in the Brazilian urban adult population. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2020; 23:e200059. [PMID: 32578675 DOI: 10.1590/1980-549720200059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 01/07/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Antidepressant use is increasing worldwide, but national data on psychotropic drug use by depressed patients in Brazil is lacking. METHODOLOGY Between 2013 and 2014, a representative sample of urban adult individuals were asked if they had a diagnosis of chronic disease, had a medical indication for drug treatment, and were taking chronic medications at the time for each reported diagnosis. We analyzed the frequencies of reported depression and the medications related to this disease. RESULTS Overall, 6.1% of respondents reported depression. The prevalence increased with age - 9.5% among the elders - was higher among women (8.9%) and in the south of the country (8.9%). As a single disease, the prevalence of depression was higher among young people (17.6%). Among those with multimorbidity, the prevalence of depression rose to 25.7%. Of those who reported depression, 81.3% had medical indication for treatment and 90.3% were under treatment - this proportion was lower among young people (84.5%) and those living in the poorest region (78.6%). Antidepressants accounted for 47.2% of psychotropic drugs taken by respondents with depression, with regional differences - only 30% used antidepressants in the North. Polypharmacy was reported by 22% of those with depression and other chronic diseases. CONCLUSION Depression in Brazil, is common among young adults as a single chronic disease and highly prevalent among people with chronic multimorbidity, especially the young. The treatment gap was larger among young people and in the less developed regions of the country.
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Affiliation(s)
- Luiz Roberto Ramos
- Department of Preventive Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo - São Paulo (SP), Brazil
| | - Jair de Jesus Mari
- Department of Psychiatry, Escola Paulista de Medicina, Universidade Federal de São Paulo - São Paulo (SP), Brazil
| | - Andréia Turmina Fontanella
- Graduate Program in Epidemiology, School of Medicine, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brazil
| | - Tatiane da Silva Dal Pizzol
- Department of Drug Manufacturing and Control, School of Pharmacy, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brazil
| | - Andréa Dâmaso Bertoldi
- Department of Social Medicine, School of Medicine, Universidade Federal de Pelotas - Pelotas (RS), Brazil
| | - Sotero Serrate Mengue
- Graduate Program in Epidemiology, School of Medicine, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brazil
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Alcantara GDC, Coutinho ESF, Faerstein E. Pattern evolution of antidepressants and benzodiazepines use in a cohort. Rev Saude Publica 2020; 54:40. [PMID: 32294666 PMCID: PMC7112744 DOI: 10.11606/s1518-8787.2020054001887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 08/29/2019] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE In recent decades there has been an increase in the use of antidepressants (AD) and a decrease in the use of benzodiazepines (BDZ). Prevalence, cumulative incidence, and factors associated with the incidence of AD and BDZ use in a Brazilian population were estimated in this article. METHODS Data were collected with a self-administered questionnaire in a cohort of employees from a university in Rio de Janeiro. The prevalence of the use of AD and BDZ was calculated for 1999 (4,030), 2001 (3,574), 2006-07 (3,058), and 2012 (2,933). The cumulative incidences of the use of AD and BDZ between 1999 and 2007 were estimated by the Poisson models with robust variance estimates. RESULTS In 1999, the prevalence of the use of AD and BDZ were 1.4% (95%CI: 1.1–1.8) and 4.7% (95%CI: 4.1–5.4), respectively; in 2012, they were 5.4% (95%CI: 5.5–6.2) and 6.8% (95%CI: 6.0–7.8). The incidence of use, between 1999 and 2007, was 4.9% (95%CI: 4.2–5.7) for AD and 8.3% (95%CI: 7.3–9.3) for BDZ. The incidences of AD and BDZ use were higher among women and participants with a positive General Health Questionnaire. CONCLUSION In this population, the increase in the use of AD was not accompanied by a decrease in the use of BDZ, showing the prescriptions for psychotropic medication do not follow the currently recommended guidelines for treatment of common mental health disorders.
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Affiliation(s)
- Geisy de Carvalho Alcantara
- Universidade do Estado do Rio de Janeiro. Instituto de Medicina Social. Programa de Pós-Graduação em Saúde Coletiva. Rio de Janeiro, RJ, Brasil
| | - Evandro Silva Freire Coutinho
- Universidade do Estado do Rio de Janeiro. Instituto de Medicina Social. Departamento de Epidemiologia. Rio de Janeiro, RJ, Brasil
| | - Eduardo Faerstein
- Universidade do Estado do Rio de Janeiro. Instituto de Medicina Social. Departamento de Epidemiologia. Rio de Janeiro, RJ, Brasil
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Fernandes CSE, Lima MG, Barros MBDA. Emotional problems and the use of psychotropic drugs: investigating racial inequality. CIENCIA & SAUDE COLETIVA 2020; 25:1677-1688. [PMID: 32402020 DOI: 10.1590/1413-81232020255.33362019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 08/07/2019] [Indexed: 01/08/2023] Open
Abstract
The aim of the present study was to investigate the existence of racial inequalities in the prevalence of emotional problems, the search for healthcare services and the use of psychotropic drugs. A population-based, cross-sectional study was conducted with data from the 2014/15 Campinas Health Survey. Sample of 1953 individuals aged 20 years or older was analyzed. We estimated the prevalence of common mental disorders (CMDs), the reporting of emotional problems, insomnia, the search for and the use of healthcare services and the use of psychotropic drugs according to self-reported skin color (white and black/brown). Prevalence ratios were estimated using "Poisson" multiple regression. The prevalence of CMDs was higher among blacks/brown compared to whites but no difference was found regarding the reporting of emotional problems and insomnia. Whites sought healthcare services more due to emotional problems. The use of psychotropic drugs was also higher among whites. The results revealed racial inequalities in the presence of CMDs, the search for healthcare services and the use of psychotropics drugs, highlighting the need for actions to identify and overcome barriers that hinder access to mental health care by different racial segments of the population.
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Affiliation(s)
| | - Margareth Guimarães Lima
- Departamento de Saúde Coletiva, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil,
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Campanha AM, Ravagnani B, Milhorança IA, Bernik MA, Viana MC, Wang YP, Andrade LH. Benzodiazepine use in Sao Paulo, Brazil. Clinics (Sao Paulo) 2020; 75:e1610. [PMID: 32667494 PMCID: PMC7337218 DOI: 10.6061/clinics/2020/e1610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 04/02/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To report the prevalence and factors associated with the use of benzodiazepines in the general population and those with a mental health condition in the metropolitan area of São Paulo, Brazil. METHODS 5,037 individuals from the Sao Paulo Megacity Mental Health Survey data were interviewed using the Composite International Diagnostic Interview, designed to generate DSM-IV diagnoses. Additionally, participants were asked if they had taken any medication in the previous 12 months for the treatment of any mental health condition. RESULTS The prevalence of benzodiazepine use ranged from 3.6% in the general population to 7.8% among subjects with a mental health condition. Benzodiazepine use was more prevalent in subjects that had been diagnosed with a mood disorder as opposed to an anxiety disorder (14.7% vs. 8.1%, respectively). Subjects that had been diagnosed with a panic disorder (33.7%) or bipolar I/II (23.3%) reported the highest use. Individuals aged ≥50 years (11.1%), those with two or more disorders (11.2%), those with moderate or severe disorders (10%), and those that used psychiatric services (29.8%) also reported higher use. CONCLUSION These findings give an overview of the use of benzodiazepines in the general population, which will be useful in the public health domain. Benzodiazepine use was higher in those with a mental health condition, with people that had a mood disorder being the most vulnerable. Furthermore, females and the elderly had high benzodiazepine use, so careful management in these groups is required.
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Affiliation(s)
- Angela Maria Campanha
- Nucleo de Epidemiologia Psiquiatrica (LIM-23), Departamento e Instituto de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Departamento de Farmacia, Universidade Estadual de Maringa, Maringa, PR, BR
- *Corresponding author. E-mail:
| | - Beatriz Ravagnani
- Nucleo de Epidemiologia Psiquiatrica (LIM-23), Departamento e Instituto de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Igor André Milhorança
- Nucleo de Epidemiologia Psiquiatrica (LIM-23), Departamento e Instituto de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Instituto de Matematica e Estatistica, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Márcio Antonini Bernik
- Programa de Ansiedade, Departamento e Instituto de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Maria Carmen Viana
- Departamento de Medicina Social, Programa de Pos-Graduacao em Saude Coletiva, Centro de Estudos e Pesquisa em Epidemiologia Psiquiatrica (CEPEP), Universidade Federal do Espirito Santo, Vitoria, ES, BR
| | - Yuan-Pang Wang
- Nucleo de Epidemiologia Psiquiatrica (LIM-23), Departamento e Instituto de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Laura Helena Andrade
- Nucleo de Epidemiologia Psiquiatrica (LIM-23), Departamento e Instituto de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Estancial Fernandes CS, de Azevedo RCS, Goldbaum M, Barros MBDA. Psychotropic use patterns: Are there differences between men and women? PLoS One 2018; 13:e0207921. [PMID: 30475871 PMCID: PMC6257918 DOI: 10.1371/journal.pone.0207921] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 11/08/2018] [Indexed: 01/08/2023] Open
Abstract
This study analyzed differences between men and women regarding the use of psychotropic drugs and associated factors in a population of adults and seniors in the city of Campinas, Brazil. A population-based, cross-sectional study was conducted using data from the ISACamp 2014/2015 health survey in the city of Campinas. The sample was composed of 1999 individuals aged 20 years or older. For each sex, prevalence rates and prevalence ratios were estimated for the use of psychotropic drugs according to demographic characteristics, socioeconomic characteristics, health problems, degree of limitation and type of emotional/mental problem. The most used classes of medications were also determined. The prevalence of the use of psychotropic drugs was 11.7% (7.3% among men and 15.8% among women). The most common therapeutic classes were antidepressants (38.2%) and benzodiazepines (24.0%). The frequency of antidepressant use was higher among women (44.3%) than men (25.5%). Regarding associated factors, reports of emotional/mental problems were associated with the greater use of this type of drug in both sexes. Among the men, white skin color, a lack of an occupational activity, a greater number of complaints of health problems and the occurrence of insomnia were associated with the use psychotropic drugs. Among the women, a significant increase in the use of these drugs was found with the increase in age and higher prevalence rates were found among those with a higher level of schooling, those with a greater number of diagnosed chronic diseases and those with a common mental disorder. The present results confirm the greater use of psychotropic agents, especially antidepressants, in the female sex and reveal that the pattern of associated factors differs between sexes. It is therefore necessary to understand the peculiarities of each sex that exert an influence on the perception of health problems and the desire to seek care, which, in turn, affect the use of psychotropic agents.
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Affiliation(s)
| | - Renata Cruz Soares de Azevedo
- Department of Medical Psychology and Psychiatry, School of Medical Sciences, State University of Campinas, Campinas, Sao Paulo, Brazil
| | - Moisés Goldbaum
- Department of Preventive Medicine, Medical School, University of Sao Paulo, Sao Paulo, Brazil
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15
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Menezes ALDA, Muller MR, Soares TRDA, Figueiredo AP, Correia CRDM, Corrêa LM, Ortega F. Parallels between research in mental health in Brazil and in the field of Global Mental Health: an integrative literature review. CAD SAUDE PUBLICA 2018; 34:e00158017. [PMID: 30484560 DOI: 10.1590/0102-311x00158017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 06/28/2018] [Indexed: 12/13/2022] Open
Abstract
Global Mental Health is a field of teaching, research, and practice whose goal is to improve access to mental health and reduce inequalities in mental health outcomes for all people worldwide, especially proposing action in low- and middle-income countries like Brazil. Given this global scenario and Brazil's progress in health and psychiatric reforms, it is important to investigate the current status of the Brazilian mental health literature and its relationship to Global Mental Health, describing how Brazilian research deals with key topics in the Global Mental Health field. The authors performed an integrative literature review using a qualitative and descriptive approach. The article search was performed for the years 2014 and 2015 in Portuguese and English, using the terms "mental health" and "Brazil", combined with key words corresponding to the principal themes addressed by authors in Global Mental Health. The search yielded 88 articles, which were analyzed according to authorship, periodicals and regions, and the analytical categories of access, primary care, community mental health services, social determinants of health, human rights, and equity. Brazil's mental health research revealed a rich and diverse body of studies, showing parallels with the literature on global mental health, but with limited systematization. Although the review revealed efforts to generate knowledge in this field within Brazil, some barriers may be limiting Brazil's participation in the international debate on Global Mental Health.
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Affiliation(s)
- Alice Lopes do Amaral Menezes
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil.,Laboratório Interdisciplinar de Pesquisa em Atenção Primária à Saúde, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Manuela R Muller
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil.,Faculdade de Medicina, Universidade Estácio de Sá, Rio de Janeiro, Brasil
| | | | | | | | - Letícia Moraes Corrêa
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Francisco Ortega
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
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16
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Fulone I, Silva MT, Lopes LC. Long-term benzodiazepine use in patients taking antidepressants in a public health setting in Brazil: a cross-sectional study. BMJ Open 2018; 8:e018956. [PMID: 29627806 PMCID: PMC5892742 DOI: 10.1136/bmjopen-2017-018956] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The aims of the study were to investigate the prevalence of long-term use of benzodiazepines in patients taking antidepressants and to identify the risk factors associated with the prolonged use of benzodiazepines. DESIGN Cross-sectional study. SETTING Public health system in Brazil. PARTICIPANTS Outpatients using antidepressants from January 2008 to December 2009 were included. The data were obtained from pharmacy databases and medical records. All individuals in the database were included in the study and were classified into two categories: (1) patients who had not used benzodiazepines combined with antidepressants or had combined the use of antidepressants with benzodiazepines for a short period (up to 4 weeks), and (2) those who used antidepressants plus benzodiazepines for a longer period (more than 4 weeks). MAIN OUTCOME MEASURE The outcome measure is prolonged use of benzodiazepines (more than 4 weeks). We conducted a multivariate analysis to identify the factors associated with prolonged use of benzodiazepines. RESULTS Forty per cent of the 870 patients evaluated had prolonged use of benzodiazepines (more than 4 weeks). The risk factors associated with prolonged use were age above 35 years (prevalence ratio (PR): 2.18, 95% CI 1.55 to 3.06, P<0.001), female sex (PR: 1.47, 95% CI 1.07 to 2.02, P=0.019), diagnosis at least 3 years prior (PR: 2.1, 95% CI 1.6 to 2.8, P<0.001), use of selective serotonin reuptake inhibitor antidepressants (PR: 1.7, 95% CI 1.3 to 2.2, P<0.001) and having a prescription from a psychiatrist (PR: 6.5, 95% CI 3.2 to 13.2, P<0.001). CONCLUSIONS Prolonged use of benzodiazepines occurs more frequently in women, adults diagnosed several years earlier, users of selective serotonin reuptake inhibitor antidepressants and those who received a prescription from a psychiatrist. Education of clinicians, especially with regard to these populations, may decrease the overuse and misuse of benzodiazepines.
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Affiliation(s)
- Izabela Fulone
- Pharmaceutical Sciences Master Course, University of Sorocaba, UNISO, Sorocaba, São Paulo, Brazil
| | - Marcus Tolentino Silva
- Pharmaceutical Sciences Master Course, University of Sorocaba, UNISO, Sorocaba, São Paulo, Brazil
| | - Luciane Cruz Lopes
- Pharmaceutical Sciences Master Course, University of Sorocaba, UNISO, Sorocaba, São Paulo, Brazil
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17
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Laurito LD, Loureiro CP, Dias RV, Vigne P, de Menezes GB, Freire RC, Stangier U, Fontenelle LF. Predictors of benzodiazepine use in a transdiagnostic sample of panic disorder, social anxiety disorder, and obsessive-compulsive disorder patients. Psychiatry Res 2018; 262:237-245. [PMID: 29475102 DOI: 10.1016/j.psychres.2018.02.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 01/13/2018] [Accepted: 02/02/2018] [Indexed: 01/04/2023]
Abstract
We investigated the rates of current and past benzodiazepine (BZD) use in a sample of 102 subjects attending specialized anxiety disorder clinics, including panic disorder (PD; N = 36), social anxiety disorder (SAD; N = 28) and obsessive-compulsive disorder (OCD; N = 38) patients. Almost 56% of the entire sample was using BZDs at the moment of the assessment, and 74.5% described having used them at some point during their lifetimes. The duration of psychiatric treatment and a lifetime history of PD, but not any other "transdiagnostic" measure of severity (such as the Panic and Agoraphobia Scale, the Social Phobia Inventory, the Dimensional Obsessive-Compulsive Scale, the Anxiety Sensitivity Index-36, and the Beck Inventories) were independent risk factors for current prescription of BZDs. Patients who continued to use BZDs differed from patients who stopped them by being older (both currently and when firstly seen in the clinic), by having a later age at onset of their most significant anxiety disorder, by being more agoraphobic/avoidant, and by believing to be less capable of stopping their BZDs for the fear of not being able to sleep.
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Affiliation(s)
- Luana D Laurito
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil
| | - Carla P Loureiro
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil
| | - Rafaela V Dias
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil
| | - Paula Vigne
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil
| | - Gabriela B de Menezes
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil
| | - Rafael C Freire
- Laboratory of Panic and Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ulrich Stangier
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Frankfurt, Varrentrappstr. 40-42, 60486 Frankfurt, Germany
| | - Leonardo F Fontenelle
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil; D'Or Institute for Research and Education, Rio de Janeiro, Brazil; Brain & Mental Health Laboratory, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Victoria, Australia.
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18
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Filho PCPT, Borges TL, Pereira ADC, Vedana KGG, Shasanmi RO, Gimenes FRE, Miasso AI. Factors Associated With Psychotropic Medication Use in Individuals in Brazilian Primary Health Care Units: A Descriptive, Cross-Sectional Study. J Psychosoc Nurs Ment Health Serv 2017; 55:38-45. [PMID: 28287674 DOI: 10.3928/02793695-20170301-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 01/16/2017] [Indexed: 11/20/2022]
Abstract
The current descriptive, cross-sectional study aimed to investigate the rate of psychotropic medication use and its association with sociodemographic factors, pharmacotherapy, health history, and presence of common mental disorders in individuals in Brazilian primary health care (PHC) units. A sample of 442 individuals was interviewed in 10 PHC units. Tools used included a structured questionnaire and the Self Reporting Questionnaire-20. The rate of psychotropic medication use was 38.7%. Demographic characteristics associated with psychotropic medication use were age 60 or older with common mental disorders and physical illness, a primary-level education or less, no occupation, and family income greater than three times the minimum wage. The strongest predictor of psychotropic medication use was monthly family income. The results highlight the need for interventions to improve patient outcomes. [Journal of Psychosocial Nursing and Mental Health Services, 55(3), 38-45.].
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