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Madeira L, Queiroz G, Henriques R. Prepandemic psychotropic drug status in Portugal: a nationwide pharmacoepidemiological profile. Sci Rep 2023; 13:6912. [PMID: 37106018 PMCID: PMC10139661 DOI: 10.1038/s41598-023-33765-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
The prescription of psychotropic drugs has been rising in Europe over the last decade. This study provides a comprehensive profile of prepandemic consumption patterns of antidepressant, antipsychotic, and anxiolytic drugs in Portugal considering full nationwide psychotropic drug prescription and dispensing records (2016-2019) against several criteria, including active ingredient, sociodemographics, medical specialty, and incurred costs. An increase of 29.6% and 34.7% in the consumption of antipsychotics and antidepressants between 2016 and 2019 is highlighted, accompanied by an increase of 37M Eur in total expenditure (> 20M Eur in public copay) for these classes of drugs. Disparities in sociodemographic and geographical incidence are identified. Amongst other pivotal results, 64% of psychotropic drug prescriptions are undertaken by general practitioners, while only 21% undertaken by neurological and psychiatric specialties. Nationwide patterns of psychotropic drug prescription further reveal notable trends and determinants, establishing a reference point for cross-regional studies and being currently assessed at a national level to establish psychosocial initiatives and guidelines for medical practice and training.
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Affiliation(s)
- Luís Madeira
- Instituto de Medicina Preventiva, Faculdade de Medicina da Universidade de Lisboa; Hospital CUF Descobertas, Lisbon, Portugal
| | | | - Rui Henriques
- INESC-ID and Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal.
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Xu X, Xu J, Li C, Wang G, Wang W, Ye Y, Chen Y, Liu T, Zhao M, Wang X, Zhong N, Jiang H. Hazardous use of benzodiazepine receptor agonists in psychiatric clinics in China: electronic prescription database study. BJPsych Open 2022; 8:e188. [PMID: 36254807 PMCID: PMC9634586 DOI: 10.1192/bjo.2022.589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Benzodiazepine receptor agonists (BZRAs) are commonly used clinically and data on their hazardous use from large populations of psychiatric patients is limited. AIMS To assess the current status of hazardous BZRA use and related factors in Chinese out-patient psychiatric settings. METHOD The study included out-patients with at least one BZRA prescription from five psychiatric settings in east, central and west China in 2018. Demographic and prescription information were extracted from the electronic prescription database. We defined the co-occurrence of overdose and long-term use as hazardous use, and patients whose recorded diagnoses did not meet any indications approved by the Chinese Food and Drug Administration as over-indication users. Additionally, 200 hazardous users were randomly selected for follow-up interview to confirm the actual situation. RESULTS Among 720 054 out-patients, 164 450 (22.8%) had at least one BZRA prescription; 55.9% of patients were prescribed over-indication and 3% were defined as hazardous users. Multilevel multivariate regression analysis with hospital as a random effect showed that factors associated with hazardous use were older age (18-64 years: β = 0.018; 95% CI 0.013-0.023; >65 years: β = 0.015; 95% CI 0.010-0.021), male (β = 0.005, 95% CI 0.003-0.007), over-indication (β = 0.013, 95% CI 0.012-0.015), more out-patient visits (β = 0.006, 95% CI 0.006-0.006) and more visits to different doctors (β = 0.007, 95% CI 0.007-0.008); 98.5% of hazardous users (197/200) could not be contacted. CONCLUSIONS BZRAs are commonly used and there is a relatively large proportion of over-indication users among Chinese psychiatric out-patients. However, only a small proportion of hazardous users were detected. The study highlights how to use prescription data to support improvements in clinical practice.
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Affiliation(s)
- Xiaomin Xu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiajun Xu
- Mental Health Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Chuanwei Li
- Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Gang Wang
- Wuhan Mental Health Center, Wuhan, China
| | - Wenzhe Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yujian Ye
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yong Chen
- Department of Patient & Health Impact, Pfizer Inc., Collegeville, Pennsylvania, USA
| | - Tieqiao Liu
- Mental Health Institute, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Min Zhao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China; and CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China
| | - Xuyi Wang
- Mental Health Institute, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Na Zhong
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haifeng Jiang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; and Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
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Damba JJ, Bodenstein K, Lavin P, Drury J, Sekhon H, Renoux C, Trinh E, Rej S, Greenway KT. Psychotropic Drugs and Adverse Kidney Effects: A Systematic Review of the Past Decade of Research. CNS Drugs 2022; 36:1049-1077. [PMID: 36161425 DOI: 10.1007/s40263-022-00952-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Psychotropic drugs are a heterogenous group of treatments prescribed for many psychiatric disorders, often for long periods. Their effects on the kidney and its functioning are complex and a source of significant research and debate. This article aims to review recent evidence of the acute and chronic kidney adverse events of diverse psychotropes. METHODS A systematic search of randomized controlled trials and large observational studies (n ≥ 100) reporting the effects of psychotropic drugs on the kidney was conducted. The MEDLINE, PsycInfo, and EMBASE databases from 2011 to 2021, inclusive, were broadly searched with few restrictions and no prespecified outcomes. Two or more independent reviewers assessed and summarized all eligible studies, including risks of bias and levels of evidence. RESULTS In all, 1999 abstracts were screened for eligibility and 47 articles were included, which examined lithium (33), antiepileptics (10), antipsychotics (13), and antidepressants (9). No studies examining kidney adverse effects of other psychotropes, such as benzodiazepines, met inclusion criteria. Study populations were adult (8), geriatric (9), and mixed (30). Lithium was almost unanimously associated with (1) chronic kidney disease and (2) nephrogenic diabetes insipidus in methodologically diverse studies. The most supported risk factors for declining kidney functioning with lithium were advanced age, duration of lithium treatment, acute lithium toxicity, female sex, medications with known renal interactions, diabetes mellitus/hyperglycemia, and overall medical comorbidity. Supratherapeutic lithium concentrations are both the causes and consequences of acute kidney injury. Once significant chronic kidney disease has developed, four studies found that replacing lithium with other mood stabilizers does not slow progression, and the evolution to end-stage kidney disease is rare overall with modern practices. Compared to lithium, fewer studies examined antipsychotics and antiepileptics but found relatively less direct kidney harms. Antidepressants were not associated with acute or chronic kidney harms. CONCLUSIONS Despite the heterogeneity of findings, owing to varying methodologies and research challenges, recent studies strongly suggest that lithium is associated with an increased risk of chronic kidney disease and nephrogenic diabetes insipidus, especially in older adults and long-term lithium users. Clinicians should balance the harms of lithium against its established benefits, and ensure adequate monitoring and management of comorbidities in all patients. Weaker evidence suggests that antiepileptics such as valproate and antipsychotics result in comparatively less harm to the kidney than lithium, but warrant monitoring because of multiple direct and indirect mechanisms for potential kidney adverse events. Antidepressants do not have clear kidney adverse effects and appear safe (though potentially less effective) in the setting of kidney disease. Other classes of psychotropic drugs have received little research interest. Further research is warranted, particularly into specific antiepileptics and antipsychotics, and careful attention should be paid to mitigating important sources of bias such as confounding by indication.
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Affiliation(s)
- Joseph Junior Damba
- Geri-PARTy Research Group, Lady Davis Research Institute/Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Katie Bodenstein
- Geri-PARTy Research Group, Lady Davis Research Institute/Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Paola Lavin
- Geri-PARTy Research Group, Lady Davis Research Institute/Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Jessica Drury
- Geri-PARTy Research Group, Lady Davis Research Institute/Jewish General Hospital, McGill University, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Harmehr Sekhon
- Geri-PARTy Research Group, Lady Davis Research Institute/Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Christel Renoux
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Emilie Trinh
- Division of Nephrology, Department of Medicine, McGill University Health Center, Montreal, QC, Canada
| | - Soham Rej
- Geri-PARTy Research Group, Lady Davis Research Institute/Jewish General Hospital, McGill University, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Kyle T Greenway
- Geri-PARTy Research Group, Lady Davis Research Institute/Jewish General Hospital, McGill University, Montreal, QC, Canada.
- Department of Psychiatry, McGill University, Montreal, QC, Canada.
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