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Beydoun HA, Beydoun MA, Kwon E, Alemu BT, Zonderman AB, Brunner R. Relationship of psychotropic medication use with physical function among postmenopausal women. GeroScience 2024:10.1007/s11357-024-01141-z. [PMID: 38517642 DOI: 10.1007/s11357-024-01141-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 03/15/2024] [Indexed: 03/24/2024] Open
Abstract
To examine cross-sectional and longitudinal relationships of psychotropic medications with physical function after menopause. Analyses involved 4557 Women's Health Initiative Long Life Study (WHI-LLS) participants (mean age at WHI enrollment (1993-1998): 62.8 years). Antidepressant, anxiolytic, and sedative/hypnotic medications were evaluated at WHI enrollment and 3-year follow-up visits. Performance-based physical function [Short Physical Performance Battery (SPPB)] was assessed at the 2012-2013 WHI-LLS visit. Self-reported physical function [RAND-36] was examined at WHI enrollment and the last available follow-up visit-an average of 22 [±2.8] (range: 12-27) years post-enrollment. Multivariable regression models controlled for socio-demographic, lifestyle, and health characteristics. Anxiolytics were not related to physical function. At WHI enrollment, antidepressant use was cross-sectionally related to worse self-reported physical function defined as a continuous (β = -6.27, 95% confidence interval [CI]: -8.48, -4.07) or as a categorical (< 78 vs. ≥ 78) (odds ratio [OR] = 2.10, 95% CI: 1.48, 2.98) outcome. Antidepressant use at WHI enrollment was also associated with worse performance-based physical function (SPPB) [< 10 vs. ≥ 10] (OR = 1.53, 95% CI: 1.05, 2.21) at the 2012-2013 WHI-LLS visit. Compared to non-users, those using sedative/hypnotics at WHI enrollment but not at the 3-year follow-up visit reported a faster decline in physical function between WHI enrollment and follow-up visits. Among postmenopausal women, antidepressant use was cross-sectionally related to worse self-reported physical function, and with worse performance-based physical function after > 20 years of follow-up. Complex relationships found for hypnotic/sedatives were unexpected and necessitate further investigation.
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Affiliation(s)
- Hind A Beydoun
- Department of Research Programs, A.T. Augusta Military Medical Center, 9300 DeWitt Loop, Fort Belvoir, VA, 22060, USA.
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD, USA.
| | - May A Beydoun
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD, USA
| | - Edward Kwon
- Department of Family Medicine, A.T. Augusta Military Medical Center, 9300 DeWitt Loop, Fort Belvoir, VA, 22060, USA
| | - Brook T Alemu
- Health Sciences Program, School of Health Sciences, Western Carolina University, Cullowhee, NC, USA
| | - Alan B Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD, USA
| | - Robert Brunner
- Department of Family and Community Medicine (Emeritus), School of Medicine, University of Nevada Reno, Reno, NV, USA
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Dumba J, Barimah AJ, Ibrahim MM, Allotey SS, Alorvi S, Appertey W, Sopaal L, Acheampong F, Commey RD, Boakye Nketiah Y, Ampofo D, Amoah BO, Agyemang L. Prevalence and prescribers' knowledge of psychotropic polypharmacy in the Bono, Bono East, and Ahafo Regions, Ghana. Heliyon 2024; 10:e24243. [PMID: 38293502 PMCID: PMC10825345 DOI: 10.1016/j.heliyon.2024.e24243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/04/2024] [Accepted: 01/04/2024] [Indexed: 02/01/2024] Open
Abstract
The use of psychotropic medications for treating simple and complex psychological and emotional problems is common and relevant among prescribers. This, therefore, come with the tendency to prescribe many medications to a patient on a single visit due to varied reasons. The study, therefore, sought to ascertain the prevalence and prescribers' knowledge of psychotropic polypharmacy. A quantitative, descriptive study was conducted using a simple random approach to select and review the prescription records (both regular and prn basis) of three hundred and nine (309) patients' folders retrospectively within seven (7) mental health units across the study area to ascertain the prevalence of Psychotropic Polypharmacy (PP). Fifty-eight (58) prescribers were selected using probability method (simple random) to respond to the study questionnaire. Psychotropic Polypharmacy was prevalent (66.0 %) in the study area with antipsychotic polypharmacy (74.0 %) being the common form with the co-prescription of chlorpromazine (CPZ) + haloperidol (70.0 %) being frequent. This was more predominant among male patients (78.0 %) than female patients (22.0 %). Prescribers had high (82.8 %) knowledge of Psychotropic Polypharmacy and the majority (68.9 %) disagreed that the practice of Psychotropic Polypharmacy should be promoted. The continuous training of prescribers (i.e. mental health officers) on rational prescriptions would help reduce the prevalence of Psychotropic Polypharmacy.
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Waheed U, Stedman M, Davies M, Solomon E, Taylor D, Heald A, Narayanan RP, Warner-Levy J. Changes in prescribing of psychotropic vs some physical health medication in primary care through the COVID-19 pandemic in England: a national-level survey. J Pharm Policy Pract 2023; 16:169. [PMID: 38124123 PMCID: PMC10734137 DOI: 10.1186/s40545-023-00655-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 11/07/2023] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic globally impacted healthcare provision. Prescribing changes in common medications can be used as a marker for new diagnoses. We describe how the prescribing of specific psychotropics was impacted by the pandemic. METHODS Primary Care Prescribing data for different classes of drugs from March 2017 to February 2022 were considered. To capture the impact during periods of restricted access to health services for new diagnoses/existing conditions, repeat prescriptions/episodic prescribing were included with account taken of historical trends. The pre-pandemic prescriptions issued each month from March 2018 to February 2020 were linearly extrapolated forward to give an expected annual growth (EAG). The monthly average expected prescriptions for the pandemic period (March 2020-February 2022) were compared. RESULTS Physical health medications had lower monthly prescriptions during the pandemic, most markedly for antibiotics - 12.5% (EAG - 1.3%). Bronchodilator prescribing showed a marked increase in the early pandemic months from March 2020 of 5% (EAG 0.1%). Mental health medication prescribing increased above trend for hypnotics/anxiolytics by 0.2% (EAG - 2.3%), while antidepressants fell by - 0.2% (EAG 5.0%), with no net change for antipsychotics (EAG 2.8%), but a temporary increase in antipsychotic prescribing in the early pandemic period. For all the main antidepressants prescribed in England (Sertraline, Mirtazapine, Venlafaxine, Fluoxetine and Citalopram), prescribing actually decreased in the main pandemic period vs historical trend. CONCLUSIONS The increase in anxiolytic/hypnotic prescribing above trend links to pandemic effects on anxiety/worry. If anything, there was a slight fall in prescribing of the main antidepressants prescribed, which given prevailing circumstances at the time, suggests that access to services may have restricted access to timely assessment.
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Affiliation(s)
- Unaiza Waheed
- Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, M6 8HD, UK
| | - Mike Stedman
- The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | | | - Emma Solomon
- Department of Clinical Psychology, Salford Royal Hospital, Salford, UK
| | | | - Adrian Heald
- Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, M6 8HD, UK.
- The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK.
| | - Ram Prakash Narayanan
- St Helens and Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - John Warner-Levy
- The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
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Febrinasari N, Widayanti AW, Prabandari YS, Satibi S. Role and challenges of community pharmacists in managing mental health care in Indonesia: A mix-method study. Asian J Psychiatr 2023; 89:103773. [PMID: 37827062 DOI: 10.1016/j.ajp.2023.103773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/23/2023] [Accepted: 09/19/2023] [Indexed: 10/14/2023]
Abstract
This research aims to explore roles and challenges faced by Indonesian community pharmacists in mental healthcare management. A sequential mixed method study was conducted. This study found that drug counselling as a pharmaceutical care service that is often given to patients with mental disorder. Nonetheless, inadequate training and concern of psychotropic drug abused were identified as a major barrier hindering effective service delivery. These finding suggests that there is a need for pharmacists to gain additional education and training in mental health, as well as implement a system that integrates patient medical records across all healthcare settings.
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Affiliation(s)
- Nisa Febrinasari
- Faculty of Pharmacy, Gadjah Mada University, Faculty of Pharmacy, Sultan Agung Islamic University, Yogyakarta, Semarang, Indonesia
| | - Anna Wahyuni Widayanti
- Department of Pharmaceutics, Faculty of Pharmacy, Gadjah Mada University, Yogyakarta, Indonesia
| | - Yayi Suryo Prabandari
- Department Health Behaviour, Environment and Social Medicine, Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Yogyakarta, Indonesia
| | - Satibi Satibi
- Department of Pharmaceutics, Faculty of Pharmacy, Gadjah Mada University, Yogyakarta, Indonesia.
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Siraj J. Assessment of psychotropic medications prescribing pattern in Gebretsadik Shawo General Hospital, South West Ethiopia. Pan Afr Med J 2023; 45:165. [PMID: 37900209 PMCID: PMC10611909 DOI: 10.11604/pamj.2023.45.165.30374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/30/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction due to the widespread prescription of antipsychotic medications, their usage is cumulative. Evidence on the trends of medication use in Ethiopia and other parts of the world is lacking. The scant information on prescription trends and medication usage suggests that drug use is generally not sensible in both industrialized and emerging nations. So, the aim of this study was to assess the psychotropic medications prescribing pattern in Gebretsadik Shawo General Hospital, South West Ethiopia. Methods from June 1st to July 31st, 2019, a cross-sectional study on prescriptions for psychiatric drugs was conducted at Gebretsadik Shawo General Hospital. Using systematic random sampling, prescription records were obtained from the pharmacy dispensing book. Version 21 of the statistical program for social science was used to code and analyze the data. Results the study included 355 prescription records containing psychotropic drugs in total. The bulk of those taking the psychotropic medication were aged 20 to 49. The most often administered classes of drugs remained antipsychotic, followed by tricyclic antidepressants, antiepileptics, anxiolytics/sedatives, anticholinergic and selective serotonin reuptake inhibitors. The most often ordered antipsychotic medication, which included 102 (23.18%) medications, was chlorpromazine. Tricyclic antidepressants, which included 56 medicines (12.73%) and 24 medications (5.45%), included amitriptyline and imipramine. Conclusion the results of this investigation showed that psychiatrists preferred traditional psychotropic medications, such as Antipsychotic tricyclic, antidepressants (TCAs) and phenothiazines, in high amounts possibly because these medications were readily available in this hospital and their prices suited patients' needs. Health care workers' interdisciplinary relationships and coherence would improve for the benefit of patients and services of higher quality.
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Affiliation(s)
- Jafer Siraj
- Department of Pharmacy, School of Applied Natural Science, Adama Science and Technology University, Adama, Ethiopia
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Gallagher E, Mehmood M, Lavan A, Kenny RA, Briggs R. Psychotropic medication use and future unexplained and injurious falls and fracture amongst community-dwelling older people: data from TILDA. Eur Geriatr Med 2023:10.1007/s41999-023-00786-x. [PMID: 37157012 DOI: 10.1007/s41999-023-00786-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 04/13/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE Psychotropic medications (antidepressants, anticholinergics, benzodiazepines, 'Z'-drugs and antipsychotics) are frequently identified as Falls Risk Increasing Drugs. The aim of this study is to clarify the association of psychotropic medication use with future falls/fracture amongst community-dwelling older people. METHODS Participants ≥ 65 years from TILDA were included and followed from Waves 1 to 5 (8-year follow-up). Incidence of falls (total falls/unexplained/injurious) and fracture was by self-report; unexplained falls were falls not caused by a slip/trip, with no apparent cause. Poisson regression models reporting incidence rate ratios (IRR) assessed the association between medications and future falls/fracture, adjusted for relevant covariates. RESULTS Of 2809 participants (mean age 73 years), 15% were taking ≥ 1 psychotropic medication. During follow-up, over half of participants fell, with 1/3 reporting injurious falls, over 1/5 reporting unexplained falls and almost 1/5 reporting fracture. Psychotropic medications were independently associated with falls [IRR 1.15 (95% CI 1.00-1.31)] and unexplained falls [IRR 1.46 (95% CI 1.20-1.78)]. Taking ≥ 2 psychotropic medications was further associated with future fracture (IRR 1.47 (95% CI 1.06-2.05)]. Antidepressants were independently associated with falls [IRR 1.20 (1.00-1.42)] and unexplained falls [IRR 2.12 (95% CI 1.69-2.65)]. Anticholinergics were associated with unexplained falls [IRR 1.53 (95% CI 1.14-2.05)]. 'Z'-drug and benzodiazepine use were not associated with falls or fractures. CONCLUSION Psychotropic medications, particularly antidepressants and anticholinergic medications, are independently associated with falls and fractures. Regular review of ongoing need for these medications should therefore be central to the comprehensive geriatric assessment.
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Affiliation(s)
- Eleanor Gallagher
- Mercer's Institute of Successful Ageing, St James's Hospital, Dublin, Ireland
| | - Mustafa Mehmood
- Department of Emergency Medicine, St James's Hospital, Dublin, Ireland
| | - Amanda Lavan
- Mercer's Institute of Successful Ageing, St James's Hospital, Dublin, Ireland
- Discipline of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
| | - Rose Anne Kenny
- Mercer's Institute of Successful Ageing, St James's Hospital, Dublin, Ireland
- Discipline of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
| | - Robert Briggs
- Mercer's Institute of Successful Ageing, St James's Hospital, Dublin, Ireland.
- Discipline of Medical Gerontology, Trinity College Dublin, Dublin, Ireland.
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland.
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7
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Orta J, Barton C, Ilao P, Apollonio DE. A review of policies on the involuntary use of psychotropic medications among persons experiencing incarceration in the United States. Health Justice 2023; 11:9. [PMID: 36807842 PMCID: PMC9938563 DOI: 10.1186/s40352-023-00204-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 01/06/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND In Harper v. Washington (1990), the United States Supreme Court established the right of states to involuntary medicate incarcerated individuals in emergency situations without a court order. The extent to which states have implemented this in correctional facilities has not been well characterized. This exploratory qualitative study sought to identify state and federal corrections policies relating to involuntary psychotropic medication for individuals who are incarcerated and classify them by scope. METHODS State Department of Corrections (DOC) and Federal Bureau of Prisons (BOP) policies relating to mental health, health services, and security were collected between March and June 2021 and coded using Atlas.ti software. The primary outcome was whether states allowed emergency involuntary use of psychotropic medications; secondary outcomes pertained to use of restraint and "use of force" policies. RESULTS Of the 35 states plus the Federal BOP that made policies publicly available, 35 out of 36 (97%) allowed the involuntary use of psychotropic medications in emergency situations. The extent of detail contained in these policies varied, with 11 states providing minimal information to guide use. One state (3%) did not allow public review of "use of restraint" policies, and 7 states (19%) did not allow public review of "use of force" policies. CONCLUSIONS More explicit criteria for emergency involuntary use of psychotropic medications are needed to better protect individuals who are incarcerated, and states should provide more transparency regarding use of restraint and use of force in corrections.
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Affiliation(s)
- Joana Orta
- School of Pharmacy, University of California. UCSF Clinical Sciences Box 1390, 530 Parnassus Avenue, Suite 366, San Francisco, CA, 94143, USA
| | - Catherine Barton
- School of Pharmacy, University of California. UCSF Clinical Sciences Box 1390, 530 Parnassus Avenue, Suite 366, San Francisco, CA, 94143, USA
| | - Patricia Ilao
- School of Pharmacy, University of California. UCSF Clinical Sciences Box 1390, 530 Parnassus Avenue, Suite 366, San Francisco, CA, 94143, USA
| | - Dorie E Apollonio
- Department of Clinical Pharmacy, University of California. UCSF Clinical Sciences Box 1390, 530 Parnassus Avenue, Suite 366, San Francisco, CA, 94143, USA.
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8
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Crismon ML, Walkow J, Sommi RW. Drug Development for New Psychiatric Drug Therapies. Adv Neurobiol 2023; 30:131-167. [PMID: 36928848 DOI: 10.1007/978-3-031-21054-9_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Drug development is an expensive, high risk, and highly regulated process. Only about 6.2% of new molecules tested for mental disorders eventually achieve Food and Drug Administration (FDA) approval. New molecular entities are produced, and extensive in vitro animal testing is performed before they are evaluated in humans. The compound is used in animals to predict clinical effects in humans, and studies addressing pharmacodynamics, pharmacokinetics, toxicology, and mutagenicity are conducted. Human research proceeds in three stages with the ultimate goal of proving that a new agent is efficacious and safe for a treatment of a specific disease in humans. If efficacy and safety are demonstrated in two Phase III studies, then the sponsor can submit a new drug application (NDA) to the FDA. The FDA oversees each step of the process to assure that good research practices are followed, data integrity is assured, and human research subjects are protected.
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Affiliation(s)
| | - Janet Walkow
- The University of Texas at Austin, Austin, TX, USA
| | - Roger W Sommi
- University of Missouri at Kansas City, Kansas City, MO, USA
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9
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Kyou Y, Yasui-Furukori N, Hasegawa N, Ide K, Ichihashi K, Hashimoto N, Hori H, Shimizu Y, Imamura Y, Muraoka H, Iida H, Ohi K, Yasuda Y, Ogasawara K, Numata S, Iga JI, Tsuboi T, Ochi S, Kodaka F, Furihata R, Onitsuka T, Makinodan M, Komatsu H, Takeshima M, Kubota C, Hishimoto A, Atake K, Yamagata H, Kido M, Nagasawa T, Usami M, Kishimoto T, Kikuchi S, Matsumoto J, Miura K, Yamada H, Watanabe K, Inada K, Hahimoto R. The characteristics of discharge prescriptions including pro re nata psychotropic medications for patients with schizophrenia and major depressive disorder from the survey of the "Effectiveness of guidelines for dissemination and education in psychiatric treatment (EGUIDE)" project. Ann Gen Psychiatry 2022; 21:52. [PMID: 36567327 PMCID: PMC9791735 DOI: 10.1186/s12991-022-00429-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/16/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Several guidelines recommend monotherapy in pharmacotherapy for schizophrenia and major depressive disorder. The content of regular prescriptions has been reported in several studies, but not enough research has been conducted on the content of pharmacotherapy, including pro re nata (PRN) medications. The purpose of this study was to evaluate the content of pharmacotherapy, including PRN medications, and to clarify the relationship with regular prescriptions. METHODS We used data from the "Effectiveness of Guidelines for Dissemination And Education in psychiatric treatment" (EGUIDE) project to investigate the presence or absence of PRN psychotropic medications at discharge for each drug category. We compared the PRN psychotropic prescription ratio at discharge by diagnosis for each drug category. The antipsychotic monotherapy ratio and no prescription ratio of other psychotropics for schizophrenia at discharge and the antidepressant monotherapy ratio and no prescription ratio of other psychotropics for major depressive disorder at discharge were calculated for each regular prescription, including PRN psychotropic medications, as quality indicators (QIs). Spearman's rank correlation test was performed for QI values of regular prescriptions and the QI ratio between regular prescriptions and prescriptions including PRN medications for each diagnosis. RESULTS The PRN psychotropic prescription ratio at discharge was 28.7% for schizophrenia and 30.4% for major depressive disorder, with no significant differences by diagnosis. The prescription ratios of PRN antipsychotic medications and PRN antiparkinsonian medications were significantly higher for schizophrenia. The prescription ratios of PRN anxiolytic and hypnotic and PRN antidepressant medications were significantly higher for patients with major depressive disorder. For both schizophrenia and major depressive disorder, the QI was lower for discharge prescriptions, including PRN medications, than for regular prescriptions. QI values for regular prescriptions and the QI ratio were positively correlated. CONCLUSIONS Considering PRN psychotropic medications, the monotherapy ratio and no prescription ratio of other psychotropics at discharge decreased in pharmacotherapy for schizophrenia and major depressive disorder. A higher ratio of monotherapy and no prescription of other psychotropics on regular prescriptions may result in less concomitant use of PRN psychotropic medications. Further studies are needed to optimize PRN psychotropic prescriptions.
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Affiliation(s)
- Yoshitaka Kyou
- Department of Psychiatry, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Norio Yasui-Furukori
- Department of Psychiatry, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Shimotsuga, Mibu, Tochigi, 321-0293, Japan.
| | - Naomi Hasegawa
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, Tokyo, 187-8553, Japan
| | - Kenta Ide
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, Tokyo, 187-8553, Japan.,Department of Hospital Pharmacy, Hospital of University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-Ku, Kitakyushu-Shi, Fukuoka, 807-8555, Japan
| | - Kayo Ichihashi
- Department of Neuropsychiatry, University of Tokyo Hospital, 7-3-1 Hongo, Tokyo, 113-8655, Japan
| | - Naoki Hashimoto
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-Ku, Sapporo, 060-8638, Japan
| | - Hikaru Hori
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jyonan-Ku, Fukuoka City, Fukuoka, 814-0180, Japan
| | - Yoshihito Shimizu
- Department of Pharmacy, Kanazawa Medical University Hospital, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, 920-0293, Japan
| | - Yayoi Imamura
- Department of Neuropsychiatry, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-Shi, Tokyo, 181-8611, Japan
| | - Hiroyuki Muraoka
- Department of Psychiatry, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Hitoshi Iida
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jyonan-Ku, Fukuoka City, Fukuoka, 814-0180, Japan
| | - Kazutaka Ohi
- Department of Psychiatry, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan
| | - Yuka Yasuda
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, Tokyo, 187-8553, Japan.,Life Grow Brilliant Mental Clinic, Medical Corporation Foster, 1-3-11 Oyodominami, Kitaku, Osaka, 531-0075, Japan
| | - Kazuyoshi Ogasawara
- Center for Postgraduate Clinical Training and Career Development, Nagoya University Hospital, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
| | - Shusuke Numata
- Department of Psychiatry, Graduate School of Biomedical Science, Tokushima University, 3-8-15 Kuramoto-Cho, Tokushima, 770-8503, Japan
| | - Jun-Ichi Iga
- Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Takashi Tsuboi
- Department of Neuropsychiatry, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-Shi, Tokyo, 181-8611, Japan
| | - Shinichiro Ochi
- Department of Neuropsychiatry, Molecules and Function, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Fumitoshi Kodaka
- Department of Psychiatry, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minatoku, Japan
| | - Ryuji Furihata
- Agency for Health, Safety and Environment, Kyoto University, Yoshida Honmachi, Sakyo-Ku, Kyoto, 606-8501, Japan
| | - Toshiaki Onitsuka
- Department of Neuroimaging Psychiatry, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashiku, Fukuoka, 812-8582, Japan
| | - Manabu Makinodan
- Department of Psychiatry, Nara Medical University School of Medicine, 840 Shijocho Kashihara, Nara, 634-8522, Japan
| | - Hiroshi Komatsu
- Department of Psychiatry, Tohoku University Hospital, 1-1 Seiryo-Machi, Aobaku, Sendai, 980-8573, Japan
| | - Masahiro Takeshima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, 1-1-1, Hondo, Akita City, Akita, 010-8543, Japan
| | - Chika Kubota
- Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, 4-1-1- Ogawahigashi, Kodaira, Tokyo, 187-8553, Japan
| | - Akitoyo Hishimoto
- Department of Psychiatry, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa, Yokohama, 236-0004, Japan
| | - Kiyokazu Atake
- Health Administration Center (Kyusyu Region), Nippon Telegraph and Telephone West Corporation, 13-8 DOIMACHI Bld.2F, Kamikawabatamachi, Hakata-Ku, Fukuoka, 812-0026, Japan
| | - Hirotaka Yamagata
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Mikio Kido
- Kido Clinic, 244 Hounoki, Imizu, Toyama, 934-0053, Japan.,Department of Neuropsychiatry, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Tatsuya Nagasawa
- Department of NeuroPsychiatry, Kanazawa Medical University, 1-1 Daigaku, Uchinada-Machi, Ishikawa, 920-0293, Japan
| | - Masahide Usami
- Department of Child and Adolescent Psychiatry, Kohnodai Hospital, National Center for Global Health and Medicine, 1-7-1 Kohnodai, Ichikawa, Chiba, 272-8516, Japan
| | - Taishiro Kishimoto
- Hills Joint Research Laboratory for Future Preventive Medicine and Wellness, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Saya Kikuchi
- Department of Psychiatry, Tohoku University Hospital, 1-1 Seiryo-Machi, Aobaku, Sendai, 980-8573, Japan
| | - Junya Matsumoto
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, Tokyo, 187-8553, Japan
| | - Kenichiro Miura
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, Tokyo, 187-8553, Japan
| | - Hisashi Yamada
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, Tokyo, 187-8553, Japan.,Department of Neuropsychiatry, Hyogo Medical University, 1-1, Mukogawa-Cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Koichiro Watanabe
- Department of Neuropsychiatry, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-Shi, Tokyo, 181-8611, Japan
| | - Ken Inada
- Department of Psychiatry, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Ryota Hahimoto
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, Tokyo, 187-8553, Japan
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Arkell TR, Brooks-Russell A, Downey LA, Shiferaw B, Brown T, Sherrick J, Hayley AC. Effects of psychotropic drugs on ocular parameters relevant to traffic safety: A systematic review. Neurosci Biobehav Rev 2022; 141:104831. [PMID: 35995080 DOI: 10.1016/j.neubiorev.2022.104831] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/11/2022] [Accepted: 08/15/2022] [Indexed: 11/23/2022]
Abstract
Driving is a complex neurobehavioural task necessitating the rapid selection, uptake, and processing of visual information. Eye movements that are critical for the execution of visually guided behaviour such as driving are also sensitive to the effects of psychotropic substances. The Embase (via Ovid), EBSCOHost, Psynet, Pubmed, Scopus and Web of Science databases were examined from January 01st, 2000 to December 31st, 2021. Study selection, data extraction and Cochrane Risk of Bias (RoB2) assessments were conducted according to PRISMA guidelines. The review was prospectively registered (CRD42021267554). In total, 36 full-text articles examined the effects of six principal psychotropic drug classes on measures of oculomotor parameters relevant to driving. Centrally depressing substances affect oculomotor responses in a dose-dependent manner. Psychostimulants improve maximal speed, but not accuracy, of visual search behaviours. Inhaled Δ-9-tetrahydrocannabinol (THC) increases inattention (saccadic inaccuracy) but does not consistently affect other oculomotor parameters. Alterations to composite ocular parameters due to psychoactive substance usage likely differently compromises performance precision during driving through impaired ability to select and process dynamic visual information.
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Suyal DC, Joshi D, Kumar S, Bhatt P, Narayan A, Giri K, Singh M, Soni R, Kumar R, Yadav A, Devi R, Kaur T, Kour D, Yadav AN. Himalayan Microbiomes for Agro-environmental Sustainability: Current Perspectives and Future Challenges. Microb Ecol 2022; 84:643-675. [PMID: 34647148 DOI: 10.1007/s00248-021-01849-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 08/23/2021] [Indexed: 06/13/2023]
Abstract
The Himalayas are one of the most mystical, yet least studied terrains of the world. One of Earth's greatest multifaceted and diverse montane ecosystems is also one of the thirty-four global biodiversity hotspots of the world. These are supposed to have been uplifted about 60-70 million years ago and support, distinct environments, physiography, a variety of orogeny, and great biological diversity (plants, animals, and microbes). Microbes are the pioneer colonizer of the Himalayas that are involved in various bio-geological cycles and play various significant roles. The applications of Himalayan microbiomes inhabiting in lesser to greater Himalayas have been recognized. The researchers explored the applications of indigenous microbiomes in both agricultural and environmental sectors. In agriculture, microbiomes from Himalayan regions have been suggested as better biofertilizers and biopesticides for the crops growing at low temperature and mountainous areas as they help in the alleviation of cold stress and other biotic stresses. Along with alleviation of low temperature, Himalayan microbes also have the capability to enhance plant growth by availing the soluble form of nutrients like nitrogen, phosphorus, potassium, zinc, and iron. These microbes have been recognized for producing plant growth regulators (abscisic acid, auxin, cytokinin, ethylene, and gibberellins). These microbes have been reported for bioremediating the diverse pollutants (pesticides, heavy metals, and xenobiotics) for environmental sustainability. In the current perspectives, present review provides a detailed discussion on the ecology, biodiversity, and adaptive features of the native Himalayan microbiomes in view to achieve agro-environmental sustainability.
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Affiliation(s)
- Deep Chandra Suyal
- Department of Microbiology, Akal College of Basic Sciences, Eternal University, Sirmaur, Himachal Pradesh, India
| | - Divya Joshi
- Uttarakhand Pollution Control Board, Regional Office, Kashipur, Uttarakhand, India
| | - Saurabh Kumar
- Division of Crop Research, Research Complex for Eastern Region, Patna, Bihar, India
| | - Pankaj Bhatt
- State Key Laboratory for Conservation and Utilization of Subtropical Agro-Bioresources, Guangdong Laboratory for Lingnan Modern Agriculture, Integrative Microbiology Research Centre, South China Agricultural University, Guangzhou, 510642, China
| | - Arun Narayan
- Forest Research Institute, Dehradun, 2480 06, India
| | - Krishna Giri
- Rain Forest Research Institute, Jorhat, 785 010, India
| | - Manali Singh
- Department of Biotechnology, Invertis Institute of Engineering and Technology (IIET), Invertis University, Bareilly, 243123, Uttar Pradesh, India
| | - Ravindra Soni
- Department of Agricultural Microbiology, College of Agriculture, Indira Gandhi Krishi Vishwa Vidyalaya, Raipur, Chhattisgarh, India
| | - Rakshak Kumar
- Department of Biotechnology, CSIR-Institute of Himalayan Bioresource Technology, Palampur, India
| | - Ashok Yadav
- Department of Botany, Institute of Science, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Rubee Devi
- Microbial Biotechnology Laboratory, Department of Biotechnology, Dr. Khem Singh Gill Akal College of Agriculture, Eternal University, Baru Sahib, Sirmour, Himachal Pradesh, India
| | - Tanvir Kaur
- Microbial Biotechnology Laboratory, Department of Biotechnology, Dr. Khem Singh Gill Akal College of Agriculture, Eternal University, Baru Sahib, Sirmour, Himachal Pradesh, India
| | - Divjot Kour
- Microbial Biotechnology Laboratory, Department of Biotechnology, Dr. Khem Singh Gill Akal College of Agriculture, Eternal University, Baru Sahib, Sirmour, Himachal Pradesh, India
| | - Ajar Nath Yadav
- Microbial Biotechnology Laboratory, Department of Biotechnology, Dr. Khem Singh Gill Akal College of Agriculture, Eternal University, Baru Sahib, Sirmour, Himachal Pradesh, India.
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12
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Tidmore LM, Keast SL, Waters HC, Pareja KL, Cothran T, Skrepnek GH. Readmissions, costs, and duration to subsequent outpatient visit after hospital discharge among Medicaid beneficiaries utilizing oral versus long-acting injectable antipsychotics in bipolar disorder or schizophrenia. Curr Med Res Opin 2022; 38:1621-1630. [PMID: 35833696 DOI: 10.1080/03007995.2022.2101819] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Long-acting injectable antipsychotics (LAIs) may reduce hospitalizations versus oral formulations (OAP) in bipolar disorder (BP) and schizophrenia/schizoaffective disorder (SCZ), but the impact on time to outpatient follow-up is less understood. OBJECTIVES To assess hospital readmissions and medical costs among Medicaid beneficiaries with BP or SCZ utilizing OAP or LAI SGAs. METHODS Cross-sectional and longitudinal analyses utilized comprehensive administrative claims of Oklahoma Medicaid beneficiaries (≥18 years) with BP or SCZ between 1 January 2013 and 31 December 2017. Readmissions, total direct medical costs, and psychiatry-related outpatient visits were assessed via generalized linear models and generalized estimating equations, controlling for demographic and clinical covariates. RESULTS Among 2523 included members, LAI utilization was associated with 1.50 and 1.73 times higher odds of any hospitalization and any readmission, respectively (p < .05). Cases involving both BP and SCZ were associated with a 2.40 times higher odds of any readmission, 2.26 times higher number of readmissions, and 24.5% higher costs (p < .001). Of the 468 members with a subsequent psychiatry-related outpatient visit, LAIs were associated with a 23.9% shorter duration to outpatient visit and 16.4% lower costs (p < .05). CONCLUSION In contrast to prior studies, this real-world investigation noted higher hospitalizations and readmissions among LAIs relative to OAP medications, but among members with a hospitalization or ED visit, LAIs were associated with shorter durations to outpatient visits and lower costs. Those with diagnoses of both BP with SCZ had higher odds of any readmission, number of readmissions, and costs relative to those with bipolar disorder alone and may be a key target for interventions.
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Affiliation(s)
- Laura M Tidmore
- Department of Clinical and Administrative Sciences, University of Oklahoma College of Pharmacy, Oklahoma City, OK, USA
| | - Shellie L Keast
- Government Human Services Consulting, Mercer LLC, Phoenix, AZ, USA
| | - Heidi C Waters
- Health Outcomes, Otsuka Pharmaceutical Development and Commercialization, Inc., Princeton, NJ, USA
| | - Kristin L Pareja
- Health Outcomes, Otsuka Pharmaceutical Development and Commercialization, Inc., Princeton, NJ, USA
| | - Terry Cothran
- Department of Pharmacy, Oklahoma Health Care Authority, Oklahoma City, OK, USA
| | - Grant H Skrepnek
- Department of Clinical and Administrative Sciences, University of Oklahoma College of Pharmacy, Oklahoma City, OK, USA
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13
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Van Gastel A. Drug-Induced Insomnia and Excessive Sleepiness. Sleep Med Clin 2022; 17:471-484. [PMID: 36150808 DOI: 10.1016/j.jsmc.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Undesirable side effects of insomnia and/or sleepiness may occur with many prescribed drugs, psychotropics as well as non-psychotropics. These central nervous system effects can be explained by the interactions of the drug with any of the numerous neurotransmitters and receptors that are involved in sleep and wakefulness. Also a close - sometimes bidirectional - relationship between disease and (disturbed) sleep/wakefulness is often present e.g. in chronic pain; drug effects may lead this vicious circle in both ways. Besides the importance for health and quality of life, effects on sleep or waking function can be a potential source of non-compliance.
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Affiliation(s)
- Ann Van Gastel
- Multidisciplinary Sleep Disorders Centre and University Department of Psychiatry, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Antwerp, Belgium; Faculty of Medicine and Health Sciences, Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp (UA), Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium.
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14
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Bellot M, Gómez-Canela C, Barata C. Phototactic behaviour and neurotransmitter profiles in two Daphnia magna clones: Vertical and horizontal responses to fish kairomones and psychotropic drugs. Sci Total Environ 2022; 830:154684. [PMID: 35314222 DOI: 10.1016/j.scitotenv.2022.154684] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/15/2022] [Accepted: 03/15/2022] [Indexed: 06/14/2023]
Abstract
Animal behavioural responses are increasingly being used in environmental risk assessment. Nevertheless, behavioural responses are still hampered by a lack of standardisation. Phototactic behaviour in zooplankton and in particular in Daphnia has often been associated to vertical migration but there is also 'shore-avoidance' horizontal behaviour: Daphnia uses shades along the shore to swim either to or away from the shore and predators. Previously, we develop a vertical oriented behavioural hardware able to reproduce phototactic fish induced depth selection in Daphnia magna, its modulation by fish kairomones and psychotropic drugs and the neurotransmitter profiles associated to those responses. This study aims to test if it is possible to use an horizontal 24 multi-well plate maze set up to assess phototactic fish induced responses in D. magna. The study was conducted using two clones with opposed phototaxis upon exposure to fish kairomones and using psychotropic drugs known to modulate phototaxis. Acrylic strips opaque to visible light but not to the infrared one were used to cover half of the arena of each of the wells of the multi-well plate. Clone P132,85 showed positive phototaxis in either the vertical and horizontal set up and negative phototaxis when exposed to fish kairomones or to the muscarinic acetylcholine receptor antagonist's scopolamine and atropine. The opposite behaviour was observed for clone F. Diazepam and pilocarpine ameliorate fish kairomone induced negative phototaxis and picrotoxin increased it only in clone P132,85 in the vertical set up. The determination of neurotransmitters showed much greater concentrations of dopamine and of glycine in clone F, which may be relate to its negative phototaxis and its observed lower responsiveness to fish kairomones. The results from this study suggest a simple, fast, and high throughput phototactic behaviour assay for D. magna that can be easily adapted to other species.
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Affiliation(s)
- Marina Bellot
- Department of Analytical and Applied Chemistry (Chromatography Section), School of Engineering, Institut Químic de Sarrià-Universitat Ramon Llull, Via Augusta 390, 08017 Barcelona, Spain; Institute for Environmental Assessment and Water Research (IDAEA-CSIC), Jordi Girona 18, 08034 Barcelona, Spain.
| | - Cristian Gómez-Canela
- Department of Analytical and Applied Chemistry (Chromatography Section), School of Engineering, Institut Químic de Sarrià-Universitat Ramon Llull, Via Augusta 390, 08017 Barcelona, Spain.
| | - Carlos Barata
- Institute for Environmental Assessment and Water Research (IDAEA-CSIC), Jordi Girona 18, 08034 Barcelona, Spain.
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15
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Ichihashi K, Kyou Y, Hasegawa N, Yasui-Furukori N, Shimizu Y, Hori H, Hashimoto N, Ide K, Imamura Y, Yamada H, Ochi S, Iga JI, Takaesu Y, Ohi K, Tsuboi T, Iida H, Yamagata H, Hishimoto A, Horai T, Usami M, Makinodan M, Nagasawa T, Komatsu H, Kido M, Muraoka H, Atake K, Takeshima M, Kubota C, Inagaki T, Tamai S, Kishimoto T, Furihata R, Matsumoto J, Miura K, Inada K, Watanabe K, Kasai K, Hashimoto R. The characteristics of patients receiving psychotropic pro re nata medication at discharge for the treatment of schizophrenia and major depressive disorder: A nationwide survey from the EGUIDE project. Asian J Psychiatr 2022; 69:103007. [PMID: 35051727 DOI: 10.1016/j.ajp.2022.103007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/31/2021] [Accepted: 01/10/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Although several guidelines indicate that daily pharmacotherapy is an important part of the treatment of schizophrenia and major depressive disorder, there are few reports regarding pro re nata (PRN) prescriptions. The purpose of this study is to clarify the characteristics of patients receiving psychotropic PRN prescription for the treatment of schizophrenia and major depressive disorder. METHOD We used data from 'the effectiveness of guideline for dissemination and education in psychiatric treatment' (EGUIDE) project to evaluate the presence or absence of psychotropic PRN prescription at the time of discharge, the age and sex of patients receiving PRN prescription for each diagnosis, and the association between PRN prescription and regular daily psychotropics. RESULTS The psychotropic PRN prescription ratio was 29.9% among 2617 patients with schizophrenia and 31.1% among 1248 patients with major depressive disorder at discharge. In schizophrenia, the psychotropic PRN prescription ratio was 21.6% for patients aged 65 years or older, which was lower than that of all other age groups. In major depressive disorder, the psychotropic PRN prescription ratio was 34.2% for female patients, which was significantly higher than that for male patients (25.5%). In schizophrenia, there was an association between psychotropic PRN prescription and regular use of multiple psychotropic medications. CONCLUSIONS Psychotropic PRN prescription was less common in elderly patients with schizophrenia and more common in female patients with major depressive disorder. In schizophrenia, psychotropic PRN prescription led to polypharmacy of psychotropics. Further studies are needed to accumulate evidence and to provide education on appropriate PRN prescriptions.
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16
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Pineau G, Jean E, Romo L, Villemain F, Poupon D, Gorwood P. Skin conductance while facing emotional pictures at day 7 helps predicting antidepressant response at three months in patients with a major depressive episode. Psychiatry Res 2022; 309:114401. [PMID: 35101794 DOI: 10.1016/j.psychres.2022.114401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 01/14/2022] [Accepted: 01/15/2022] [Indexed: 10/19/2022]
Abstract
There are currently no reliable biological markers to identify antidepressant responders in patients suffering from major depressive disorder. In this longitudinal pilot study, we measured skin conductance response (SCR) to assess patients' emotional reactivity after antidepressant treatment initiation. Fifty-four adult patients with a major depressive episode were recruited and followed up for 3 months. After one day of antidepressant treatment (D1) and then at day 7 (D7), emotional stimuli were presented on a computer screen while SCR and subjective emotional response were recorded. Three months later, we used Montgomery and Åsberg Depression Rating Scale (MADRS) to screen patients for treatment response, and distinguished responders (N = 28) from non-responders (N = 15). While SCR at D1 did not differ between responders and non-responders, SCR at D7 was higher in responders for both positive, negative and neutral stimuli. Skin conductance rates at D7 had a relatively poor negative predictive value (38%) but a strong positive predictive value (95%). Further studies are needed to replicate in a larger sample, and validate, these preliminary results which suggest that electrodermal activity after treatment initiation could help predict antidepressant efficacy.
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Affiliation(s)
- G Pineau
- GHU Paris Psychiatrie et Neurosciences, CMME, Hôpital Sainte-Anne, F-75014 Paris, France; Etablissement public de santé Barthélémy-Durand, avenue du 8-Mai-1945, 91150 Etampes, France.
| | - E Jean
- Etablissement public de santé Barthélémy-Durand, avenue du 8-Mai-1945, 91150 Etampes, France; Service universitaire de psychiatrie de l'adolescent, centre hospitalier d'Argenteuil, 9 Rue du Lieutenant Colonel Prudhon, 95107 Argenteuil, France
| | - L Romo
- GHU Paris Psychiatrie et Neurosciences, CMME, Hôpital Sainte-Anne, F-75014 Paris, France
| | - F Villemain
- Etablissement public de santé Barthélémy-Durand, avenue du 8-Mai-1945, 91150 Etampes, France
| | - D Poupon
- GHU Paris Psychiatrie et Neurosciences, CMME, Hôpital Sainte-Anne, F-75014 Paris, France
| | - P Gorwood
- GHU Paris Psychiatrie et Neurosciences, CMME, Hôpital Sainte-Anne, F-75014 Paris, France; Université de Paris, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, F-75014 Paris, France
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17
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Thapaliya K, Harris ML, Forder PM, Byles JE. Medications use among women with dementia: a cohort study. Aging Clin Exp Res 2022; 34:55-64. [PMID: 34037977 DOI: 10.1007/s40520-021-01892-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 05/18/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Older population with dementia use huge range of medications. In this study, we aimed to determine the prevalence of commonly used medications a year before and after first recorded dementia diagnosis among older Australian women. METHODS The study utilized Australian Longitudinal Study on Women's Health (ALSWH) data from 2090 women with known dementia, linked with administrative health datasets. The Pharmaceutical Benefits Scheme (PBS) data provided detailed information about prescribed medications. We applied latent class analysis (LCA) to the post-dementia data to identify patterns of medication use. Logistic regression model was used to explore the impact of potential predictors for medication utilization. RESULTS Antipsychotic use increased from 5% before dementia to 19% after dementia, while antidementia medication use increased from < 1 to 28%. There was a modest increase in benzodiazepines and antidepressants. Post-dementia, four distinct groups were identified using LCA (names based on probabilities of medications use) as: "High Psychotropic-Low Cardiovascular" (16% of the sample); "Moderate Psychotropic-High Cardiovascular" (12%); "Low Psychotropic-High Cardiovascular" (27%); and "Low Psychotropic-Low Cardiovascular" (45%). Living in Residential Aged Care (RAC) and frailty were associated with increased odds of being in the higher psychotropic use groups. CONCLUSIONS Substantial utilization of psychotropic medications by older people with dementia indicates a need for a careful review of the use of these medications. Appropriate alternative approaches to the management of dementia should be practiced with a special focus on RAC residents with frailty.
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18
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Miles LW, Knox E, Downing N, Valentine JL. Ability to consent to a sexual assault medical forensic examination in adult patients with serious mental illness. J Forensic Leg Med 2021; 85:102285. [PMID: 34826782 DOI: 10.1016/j.jflm.2021.102285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/07/2021] [Accepted: 11/11/2021] [Indexed: 11/18/2022]
Abstract
When a patient reporting a sexual assault (SA) presents with signs and symptoms of serious mental illness (MI), medical providers or forensic examiners may have concerns regarding the ability to legally consent to a sexual assault medical forensic examination (SAMFE). Numerous encounters have occurred where a SAMFE was not offered to a cooperative adult patient because the patient exhibited signs and symptoms of MI. Medical providers and examiners may be motivated by beneficence (believing that treating the patient's MI must take priority over the SAMFE) and/or non-maleficence (a concern that the in-depth SAMFE may worsen the patient's psychological state). Situations where a patient has received psychiatric medications or is under involuntary psychiatric detention also raise capacity to consent to SAMFE concerns. This review explored these concerns and provides recommendations for conducting SAMFEs in adult patients with MI. In instances where a patient has the capacity and is cooperative, the decision to undergo, postpone, or decline a SAMFE ought to be ultimately made by the patient, rather than on their behalf by the provider, SANE or forensic examiner.
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Affiliation(s)
- Leslie W Miles
- Department of Nursing, Faculty of Nursing, Brigham Young University, Provo, UT 500 KMBL, Provo, UTAH, 84602, USA.
| | - Eleanore Knox
- University of Texas Southwestern Medical Center, Department of Psychiatry, 5323 Harry Hines Blvd, Dallas, TX, 75390-9070, USA.
| | - Nancy Downing
- Center of Excellence in Forensic Nursing, College of Nursing, Texas A&M University, 8447 Riverside Parkway, Bryan, TX, 77807, USA.
| | - Julie L Valentine
- Department of Nursing, Faculty of Nursing, Brigham Young University, Provo, UT 500 KMBL, Provo, UTAH, 84602, USA.
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Broughton LC, Medlicott NJ, Smith AJ. Effectiveness of patient decision aids in women considering psychotropic medication use during pregnancy: a literature review. Arch Womens Ment Health 2021; 24:569-78. [PMID: 33751206 DOI: 10.1007/s00737-021-01118-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 02/26/2021] [Indexed: 10/22/2022]
Abstract
Women face complicated decisions regarding psychotropic medication use during pregnancy. Patient decision aids (PDAs) could be a valuable tool to assist with decision-making. The objective of this review was to evaluate the effectiveness of PDAs in this population. A systematic search of the literature was conducted using PRISMA guidelines. Three major databases were searched to identify articles published between 2006 and June 2020. Studies were included if they evaluated use of a PDA for women considering medication for mental illness during pregnancy. A total of 4629 titles were returned from the search; however, only three studies met inclusion criteria and were selected for analysis. Two were pilot randomised controlled trials in women considering antidepressant use during pregnancy, and one was a non-randomised study in women considering medication for the treatment of opioid use disorder (OUD). The PDAs had good acceptability across all three studies. The randomised trials assessed knowledge, decisional conflict, depression, and anxiety, with non-significant trends towards reduced decisional conflict and anxiety in the PDA groups. PDAs have the potential to assist women with mental illnesses to make decisions regarding medication use during pregnancy; however, current evidence is too limited to evaluate the effectiveness of PDAs for this population.
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Pivetta RC, Rodrigues-Silva C, Ribeiro AR, Rath S. Tracking the occurrence of psychotropic pharmaceuticals in Brazilian wastewater treatment plants and surface water, with assessment of environmental risks. Sci Total Environ 2020; 727:138661. [PMID: 32334225 DOI: 10.1016/j.scitotenv.2020.138661] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 04/08/2020] [Accepted: 04/10/2020] [Indexed: 05/06/2023]
Abstract
According to the World Health Organization, >360 million people worldwide suffer from mental diseases such as depression, anxiety, or bipolar disorder, for which psychotropic drugs are frequently prescribed. Despite being highly metabolized in the human organism, non-metabolized portions of these drugs are excreted, subsequently reaching wastewater treatment plants (WWTPs), where they may be incompletely removed during treatment, leading to the contamination of surface waters. In this work, ten psychotropic drugs widely consumed in Brazil (alprazolam, amitriptyline, bupropion, carbamazepine, clonazepam, escitalopram, fluoxetine, nortriptyline, sertraline, and trazadone) were monitored at five WWTPs located in the metropolitan region of Campinas (São Paulo State, Brazil). The drugs were determined in the influents, at different stages of the treatments, and in the effluents. Surface waters from the Atibaia River and the Anhumas Creek were also monitored. Quantitation of the pharmaceuticals was carried out by online solid-phase extraction coupled with ultra-high performance liquid chromatography and tandem mass spectrometry. The method was validated and presented a limit of quantitation of 50 ng L-1 for all the drugs assessed. Six of the substances monitored were quantified in the samples collected from the different treatment processes employed at the WWTPs. These technologies were unable to act as barriers for these psychotropics drugs. The concentrations ranged from 50 to 3000 ng L-1 in the WWTP effluents, while the main contaminants were found in surface waters at concentrations from 25 to 3530 ng L-1. The levels of the psychotropic detected in this work did not appear to present risks to the aquatic biota.
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Affiliation(s)
- Rhannanda Copetti Pivetta
- Institute of Chemistry, Department of Analytical Chemistry, University of Campinas, P.O. Box 6154, 13084-971 Campinas, SP, Brazil
| | - Caio Rodrigues-Silva
- Institute of Chemistry, Department of Analytical Chemistry, University of Campinas, P.O. Box 6154, 13084-971 Campinas, SP, Brazil.
| | - Alyson Rogério Ribeiro
- Institute of Chemistry, Department of Analytical Chemistry, University of Campinas, P.O. Box 6154, 13084-971 Campinas, SP, Brazil
| | - Susanne Rath
- Institute of Chemistry, Department of Analytical Chemistry, University of Campinas, P.O. Box 6154, 13084-971 Campinas, SP, Brazil.
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Hou PH, Mao FC, Chang GR, Huang MW, Wang YT, Huang SS. Newly Diagnosed Bipolar Disorder and the Subsequent Risk of Erectile Dysfunction: A Nationwide Cohort Study. J Sex Med 2019; 15:183-191. [PMID: 29425665 DOI: 10.1016/j.jsxm.2017.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 11/15/2017] [Accepted: 12/13/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although erectile dysfunction (ED) is a common problem in men with mental disorders, there are few reports in the literature on the relation between bipolar disorder (BD) and ED. AIMS To establish the incidence rate of ED in men with BD and assess the risk of ED in patients with BD according to type of treatment offered or no active treatment with medication during the 1st year of onset. METHODS We identified 5,150 men with newly diagnosed BD using Taiwan's National Health Insurance Research Database. 2 matched controls per case were selected using the propensity score and a greedy matching method to obtain a balanced control group. Multivariate Cox regression analysis was used to examine the independent risk factors for ED, including obesity and comorbidities. Hazard ratios (HRs) for ED risk were calculated for the different psychotropic therapy groups, including antidepressants, antipsychotics, and mood stabilizers. OUTCOME HRs for ED risk were calculated for the different psychotropic therapy groups, including antidepressants, antipsychotics, and mood stabilizers. Patients with BD had a significantly higher HR for an ED diagnosis than controls. RESULTS Patients with BD had a higher HR for an ED diagnosis than controls. Although some psychotropic medications can increase the risk of ED, patients with BD not actively treated with medication still showed a higher risk of ED than controls. CLINICAL IMPLICATIONS Because ED might be more prevalent in patients with BD than in the general population, clinicians should assess erectile function when selecting appropriate treatment for patients with BD to minimize the risk of ED as an annoying side effect and improve treatment compliance. STRENGTHS AND LIMITATIONS This is the first large-scale population-based study to explore the association between BD and ED. A particular strength of this study is its nationwide, population-based study design, which afforded substantial statistical power for detecting subtle differences between the 2 cohorts, thereby minimizing selection bias. There are some limitations to the present study. (i) Data on other potential risk factors is lacking. (ii) Patient compliance and dose effect between psychotropic medication and ED could not be established. (iii) We could not assess the relation between ED and the severity and phases of BD. CONCLUSION This cohort study found a temporal association between BD and subsequent ED in a large national sample of men. Clinicians should consider the risk of ED when choosing treatment for patients with BD. Hou P-H, Mao FC, Chang G-R, et al. Newly Diagnosed Bipolar Disorder and the Subsequent Risk of Erectile Dysfunction: A Nationwide Cohort Study. J Sex Med 2018;15:183-191.
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Affiliation(s)
- Po-Hsun Hou
- Department of Veterinary Medicine, National Chung Hsing University, Taichung, Taiwan; Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Social Work and Child Welfare, Providence University, Taichung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Frank Chiahung Mao
- Department of Veterinary Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Geng-Ruei Chang
- Department of Veterinary Medicine, National Chung Hsing University, Taichung, Taiwan; Department of Veterinary Medicine, National Chiayi University, Chiayi City, Taiwan
| | - Min-Wei Huang
- Department of Psychiatry, Taichung Veterans General Hospital, Chiayi Branch, Chiayi City, Taiwan
| | - Yao-Ting Wang
- Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shiau-Shian Huang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Bali Psychiatric Center, Ministry of Health and Welfare, New Taipei City, Taiwan; Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan.
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Langford AV, Chen TF, Roberts C, Schneider CR. Measuring the impact of system level strategies on psychotropic medicine use in aged care facilities: A scoping review. Res Social Adm Pharm 2019; 16:746-759. [PMID: 31473109 DOI: 10.1016/j.sapharm.2019.08.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 08/05/2019] [Accepted: 08/19/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Psychotropic medication use in the elderly population is associated with significant adverse effects. Robust evidence for the efficacy of psychotropic medications for behavioural and psychological symptoms of dementia is lacking. Despite national bodies, governments, and policymakers employing interventions to optimise the use of psychotropic medicines in this population, there is little research on their overall impact. OBJECTIVE To identify and categorise system level strategies that have been implemented internationally and assess their impact on psychotropic medicine use in aged care facilities. METHODS A systematic search of health-related databases including Medline, Embase, CINAHL, Web of Science and Scopus was performed. Empirical studies published in English prior to March 2019 that reported on the impact of system level strategies on psychotropic medicine use in aged care facilities were included. Studies were mapped to the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework to measure impact and were assessed for risk of bias. RESULTS This review identified 36 studies which examined mandatory (n = 22) and non-mandatory (n = 14) system level strategies. The impact of strategies was highly dependent on implementation as well as organisational and patient factors. Mandatory strategies had greater evidence of impact on drug utilisation patterns compared to non-mandatory strategies which primarily focussed on adoption and implementation, rather than outcomes. The Omnibus Budget Reconciliation Act 1987 (OBRA-87) in the United States of America had the greatest reach and implementation of the interventions examined, with an observed reduction in psychotropic medicine use post-implementation. There was no substantive body of evidence reporting on the sustainability of strategies or the influence of cost on outcomes. CONCLUSIONS Despite the implementation of system level strategies, psychotropic medicine use in aged care facilities remains problematic. There is a need for revised or novel system level strategies which consider sustainability, economic influences and patient outcomes in their design and implementation.
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Affiliation(s)
- Aili V Langford
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia.
| | - Timothy F Chen
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia.
| | - Chris Roberts
- The University of Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia.
| | - Carl R Schneider
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia.
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23
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Montejo AL, Calama J, Rico-Villademoros F, Montejo L, González-García N, Pérez J. A Real-World Study on Antidepressant-Associated Sexual Dysfunction in 2144 Outpatients: The SALSEX I Study. Arch Sex Behav 2019; 48:923-933. [PMID: 30790204 DOI: 10.1007/s10508-018-1365-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 11/07/2018] [Accepted: 11/28/2018] [Indexed: 06/09/2023]
Abstract
The objective of this cross-sectional study was to evaluate the frequency, impact, and management of sexual dysfunction associated with commonly prescribed antidepressants available in psychiatry outpatient clinics in Spain. We recruited 2163 adult patients who had undergone treatment with antidepressants for at least 8 weeks and had a history of normal sexual functioning before the prescription of the antidepressant, except for mildly impaired libido. We used the Psychotropic-Related Sexual Dysfunction Questionnaire (PRSexDQ-SALSEX) for evaluating the frequency and tolerance of sexual dysfunction and whether this side effect was spontaneously reported. Overall, 79% patients showed sexual dysfunction, as indicated by a total score ≥ 3 on the PRSexDQ-SALSEX; 64% showed moderate-severe sexual dysfunction, with no differences between men and women on these outcomes. In the multivariate logistic regression analysis, treatment with a serotonergic antidepressant and having a severe clinical state of psychiatric illness were the factors associated with the highest likelihood of presenting with sexual dysfunction. Sexual dysfunction was spontaneously reported by 838 (41%) of the 2066 evaluable patients for this outcome. Among patients with sexual dysfunction, this condition was poorly tolerated by 22% of the patients, with these frequencies being significantly higher in men than in women. The most frequently used strategies employed by the psychiatrists in our study for dealing with sexual dysfunction were switching to another antidepressant (34%) and waiting for spontaneous resolution (33%). In conclusion, our results indicate that despite being a well-known, long-standing side effect of antidepressants, sexual dysfunction continues to be extremely common in patients receiving antidepressants, especially serotonergic ones, potentially jeopardizing treatment success in a substantial proportion of patients. There are important sex differences in the reporting and tolerance of sexual dysfunction that require further investigation.
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Affiliation(s)
- Angel L Montejo
- Neurosciences Area, Instituto de Investigación Biomédica de Salamanca, University of Salamanca, Salamanca, Spain.
- Psychiatry Department, University Hospital of Salamanca, Paseo de San Vicente, 58-182, 37007, Salamanca, Spain.
| | - Julia Calama
- Neurosciences Area, Instituto de Investigación Biomédica de Salamanca, University of Salamanca, Salamanca, Spain
- Psychiatry Department, University Hospital of Salamanca, Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
| | | | - Laura Montejo
- Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain
| | - Nerea González-García
- Neurosciences Area, Instituto de Investigación Biomédica de Salamanca, University of Salamanca, Salamanca, Spain
- Department of Statistics, School of Medicine, University of Salamanca, Salamanca, Spain
| | - Jesús Pérez
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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Abstract
The human gut contains trillions of symbiotic bacteria that play a key role in programming different aspects of host physiology in health and disease. Psychotropic medications act on the central nervous system (CNS) and are used in the treatment of various psychiatric disorders. There is increasing emphasis on the bidirectional interaction between drugs and the gut microbiome. An expanding body of evidence supports the notion that microbes can metabolise drugs and vice versa drugs can modify the gut microbiota composition. In this review, we will first give a comprehensive introduction about this bidirectional interaction, then we will take into consideration different classes of psychotropics including antipsychotics, antidepressants, antianxiety drugs, anticonvulsants/mood stabilisers, opioid analgesics, drugs of abuse, alcohol, nicotine and xanthines. The varying effects of these widely used medications on microorganisms are becoming apparent from in vivo and in vitro studies. This has important implications for the future of psychopharmacology pipelines that will routinely need to consider the host microbiome during drug discovery and development.
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Affiliation(s)
- Sofia Cussotto
- APC Microbiome Ireland, University College Cork, Cork, Ireland ,Department of Anatomy and Neuroscience, University College Cork, Room 3.86, Western Gateway Building, Cork, Ireland
| | - Gerard Clarke
- APC Microbiome Ireland, University College Cork, Cork, Ireland ,Department of Psychiatry and Neurobehavioural Science, University College Cork, Cork, Ireland
| | - Timothy G. Dinan
- APC Microbiome Ireland, University College Cork, Cork, Ireland ,Department of Psychiatry and Neurobehavioural Science, University College Cork, Cork, Ireland
| | - John F. Cryan
- APC Microbiome Ireland, University College Cork, Cork, Ireland ,Department of Anatomy and Neuroscience, University College Cork, Room 3.86, Western Gateway Building, Cork, Ireland
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25
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Affiliation(s)
- Sarah Tebeka
- AP-HP, Department of Psychiatry, Louis-Mourier Hospital, Colombes, France; University Paris 7 Denis Diderot, Faculty of Medicine, Paris, France; INSERM U894, Centre for Psychiatry and Neurosciences, 2 ter rue d'Alesia, 75014, Paris, France.
| | - Yann Le Strat
- AP-HP, Department of Psychiatry, Louis-Mourier Hospital, Colombes, France; University Paris 7 Denis Diderot, Faculty of Medicine, Paris, France; INSERM U894, Centre for Psychiatry and Neurosciences, 2 ter rue d'Alesia, 75014, Paris, France
| | - Caroline Dubertret
- AP-HP, Department of Psychiatry, Louis-Mourier Hospital, Colombes, France; University Paris 7 Denis Diderot, Faculty of Medicine, Paris, France; INSERM U894, Centre for Psychiatry and Neurosciences, 2 ter rue d'Alesia, 75014, Paris, France
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Sheikh MA. Leisure time physical activity and incident use of prescription tranquilizers: A longitudinal population-based study. J Affect Disord 2018; 238:327-35. [PMID: 29902737 DOI: 10.1016/j.jad.2018.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/13/2018] [Accepted: 06/04/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Physical inactivity is a major public health problem associated with an increased risk of several psychiatric and physical conditions. This study investigated the association between leisure time physical activity (PA) and incident use of prescription tranquilizers in a regionally representative and prospective cohort. METHODS A total of 4043 men and women (mean age: 61.3 years; 57% women) from the Tromsø Study were followed for six years. Leisure time PA was captured at baseline. Psychiatric morbidity was measured by use of prescription tranquilizers, captured at both baseline and follow-up. Leisure time PA at baseline was used as a predictor of subsequent (incident) use of prescription tranquilizers. We used multinomial regression models and Poisson regression models to estimate relative risk-ratios (RRRs), and relative risks (RRs), respectively, and their corresponding 95% confidence intervals (CIs). RESULTS In the fully-adjusted model, accounting for socio-demographic factors, parental history of psychopathology, years of education, smoking, respondent's psychopathology at baseline, and occupational PA, a lower leisure time PA conferred a 41% increased risk of incident use of prescription tranquilizers at follow-up (RR = 1.41, 95% CI: 1.09, 1.83; p = 0.010). CONCLUSIONS These findings suggest that physical inactivity increases the risk of psychiatric morbidity (albeit, measured via use of prescription tranquilizers). Future regionally representative and longitudinal research is required to confirm/refute our findings and explore underlying mechanisms.
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Abstract
PURPOSE OF REVIEW Psychotropics are prescribed to youth at rapidly growing rates and may negatively impact bone health. Little awareness exists of this association among prescribing providers. Childhood and adolescence are critical times for bone development. Understanding these effects and their management is important to informed psychotropic use. RECENT FINDINGS Through a variety of mechanisms, antidepressants, benzodiazepines, mood stabilizers, neuroleptics, and stimulants may all negatively impact pediatric bone health. This confers added risk of osteoporosis in a population already at high risk for suboptimal bone health. Awareness of psychotropic-mediated effects on pediatric bone development is clinically relevant to the use and monitoring of these agents. Clinicians can manage these effects through informed consent, vitamin D supplementation, lifestyle modifications, and reducing polypharmacy. For mood stabilizers, vitamin D level monitoring and secondary prevention is indicated. Future longitudinal studies and development of monitoring guidelines regarding psychotropic impact on bone health are necessary.
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Affiliation(s)
- Jessie N Rice
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Road, SPC 5766, Ann Arbor, MI, 48109-2700, USA.
| | - Carrie B Gillett
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Road, SPC 5766, Ann Arbor, MI, 48109-2700, USA
| | - Nasuh M Malas
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Road, SPC 5766, Ann Arbor, MI, 48109-2700, USA.,Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, MI, USA
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Al-Ruthia YS, Mansy W, Barasin M, Ghawaa YM, AlSultan M, Alsenaidy MA, Alhawas S, AlGhadeer S. Shortage of psychotropic medications in community pharmacies in Saudi Arabia: Causes and solutions. Saudi Pharm J 2017; 25:744-749. [PMID: 28725147 PMCID: PMC5506735 DOI: 10.1016/j.jsps.2016.10.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 10/29/2016] [Indexed: 11/18/2022] Open
Abstract
Background: Patients with mental disorders, such as depression and anxiety, who seek medical care in private psychiatric clinics in Riyadh, Saudi Arabia, have recently expressed concerns to doctors about difficulty in filling psychotropic medications, such as Amitriptyline and Aripiprazole, at retail community pharmacies. Objectives: The aim of this study was to investigate whether there is a shortage of some commonly prescribed psychotropic medications in retail community pharmacies in Saudi Arabia, and if so, to explore the possible reasons behind the shortage of these medications. Methods: The availability of 28 commonly prescribed psychotropic medications was checked in multiple retail community pharmacies in 4 different regions of Saudi Arabia. Further, potential reasons behind the shortage of some psychotropic medications in retail community pharmacies were also explored. Results: Amitriptyline, Amoxapine, Aripiprazole, Bupropion, Buspirone, Duloxetine, Haloperidol, Hydroxyzine, Lithium, Prochlorperazine, Procyclidine, Promethazine, Thioridazine, Trazodone, and Trifluoperazine were unavailable in over half of the 248 community pharmacies surveyed. Four possible reasons behind the shortage of these medications were reported by 31 pharmacists working in different retail community pharmacies' purchasing departments, with a majority (58.06%) reporting the primary reason for a shortage of these medications that they are slow-moving items with low profit margins. Conclusions: The findings of this study should expedite the reform process in both the Ministry of Health and the Saudi Food and Drug Authority (SFDA) to publish and enforce an essential list of medications for retail community pharmacies, which should include the most commonly prescribed psychotropic medications.
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Affiliation(s)
- Yazed Sulaiman Al-Ruthia
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Wael Mansy
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Mohammad Barasin
- Drug Information Center, Saudi Food and Drug Authority (SFDA), Riyadh, Saudi Arabia
| | - Yazeed Mohammad Ghawaa
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed AlSultan
- Department of Clinical Pharmacy, College of Pharmacy, University of Dammam, Dammam, Saudi Arabia
| | - Mohammad A. Alsenaidy
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Solaiman Alhawas
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Sultan AlGhadeer
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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29
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Brijnath B, Xia T, Turner L, Mazza D. Trends in GP prescribing of psychotropic medications among young patients aged 16-24 years: a case study analysis. BMC Psychiatry 2017; 17:214. [PMID: 28587610 PMCID: PMC5461626 DOI: 10.1186/s12888-017-1375-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 05/31/2017] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Current clinical guidelines recommend non-pharmacological interventions as first-line treatments for young patients aged 16-24 years with a mental health condition (MHC). However, several studies have noted increasing trends in psychotropic prescribing for this age group, especially in antidepressant prescribing. In Australia, the vast majority of psychotropic medications prescribed to young people come from the general practice setting. To assess whether Australian General Practitioners (GPs) are prescribing in accordance with clinical guideline recommendations, this study examined trends in GP prescribing of psychotropic medications to young patients aged 16-24 years. METHODS We performed a retrospective analysis of routine general practice data from 9112 patients aged 16-24 years with a MHC. Data were extracted from the Melbourne East Monash General Practice Database from 1/01/2009 to 31/12/2014. The main outcome measures included the number of consultations for patients with MHCs, psychotropic prescribing by GPs, and patient characteristics associated with the likelihood of being prescribed a psychotropic. RESULTS In total, 9112 out of a total of 77,466 young patients were identified as having a MHC in this study, and 11,934 psychotropic prescriptions were provided to 3967 (43.5%) of them over the study period. Antidepressants accounted for 81.4% of total psychotropic prescriptions, followed by anxiolytics (9.6%) and antipsychotics (9.0%). The number of prescriptions issued to individuals with MHCs increased over time. Women and patients aged 21-24 years had higher incidence rates for prescription than men and those aged 16-17 (IRR: 1.15, 95% CI 1.08-1.22, IRR: 1.93, 95% CI 1.750-2.11). CONCLUSIONS Our findings demonstrate an increasing trend in GP prescribing of psychotropics to young people over the study period with higher levels of prescribing to women and those 21-24 years of age. Although GP prescribing corresponded with guideline recommendations on the whole, there were discrepancies between GP's antidepressant prescribing and guideline recommendations, reasons for which were unclear. Research is needed to investigate GPs decision-making processes underlying their prescribing, to target interventions to improve existing data in GP records to improve management, and to identify areas of further training if needed to facilitate greater concordance between clinical practice and guideline recommendations.
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Affiliation(s)
- Bianca Brijnath
- School of Occupational Therapy and Social Work, Faculty of Health Sciences, Curtin University, Building 401, Bentley Campus, Perth, 6152, Australia. .,Department of General Practice, School of Primary Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia.
| | - Ting Xia
- 0000 0004 1936 7857grid.1002.3Department of General Practice, School of Primary Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Lyle Turner
- 0000 0004 1936 7857grid.1002.3Department of General Practice, School of Primary Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Danielle Mazza
- 0000 0004 1936 7857grid.1002.3Department of General Practice, School of Primary Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia
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Ayalon L, Karkabi K, Bleichman I, Fleischmann S, Goldfracht M. Barriers to the Treatment of Mental Illness in Primary Care Clinics in Israel. Adm Policy Ment Health 2017; 43:231-40. [PMID: 25652444 DOI: 10.1007/s10488-015-0634-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The present study examined physicians' perceived barriers to the management of mental illness in primary care settings in Israel. Seven focus groups that included a total of 52 primary care Israeli physicians were conducted. Open coding analysis was employed, consisting of constant comparisons within and across interviews. Three major themes emerged: (a) barriers to the management of mental illness at the individual-level, (b) barriers to the management of mental illness at the system-level, and (c) the emotional ramifications that these barriers have on physicians. The findings highlight the parallelism between the experiences of primary care physicians and their patients. The findings also stress the need to attend to physicians' emotional reactions when working with patients who suffer from mental illness and to better structure mental health treatment in primary care.
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Affiliation(s)
- Liat Ayalon
- School of Social Work, Bar Ilan University, 52900, Ramat Gan, Israel.
| | - Khaled Karkabi
- Clalit Health Services, Tel Aviv, Israel.,Technion-Israel Institute of Technology, Haifa, Israel
| | - Igor Bleichman
- Medical Social Work Department, Clalit Health Services, Tel Aviv, Israel
| | | | - Margalit Goldfracht
- Technion-Israel Institute of Technology, Haifa, Israel.,Community Division, Headquarters Clalit Health Services, Tel Aviv, Israel
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Laforgue EJ, Bulteau S, Cholet J, Victorri-Vigneau C, Guitteny M, Mauduit N, Vanelle JM, Sauvaget A. [Concordance between hospital prescriptions and recommendations in the treatment of mania]. Therapie 2016; 72:327-337. [PMID: 27726886 DOI: 10.1016/j.therap.2016.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 06/27/2016] [Accepted: 07/08/2016] [Indexed: 11/18/2022]
Abstract
PURPOSE There are differences between recommendations and practice in the pharmacological treatment of acute mania. OBJECTIVE The objective was to assess conformity of the anti-manic prescription between national recommendations (Haute Autorité de santé [French health authority, HAS] and "résumé des caractéristiques du produit" [product characteristics, RCP]) and clinical practice. METHODS We observed the drug prescriptions of in-patients for a manic episode. The main outcome measure was the concordance rate with the recommendations of the drugs prescriptions at the 48th hour. The secondary outcome repeated the same process with the hospital discharge statement of switches, associations, the presence of symptomatic and antidepressant treatments. RESULTS Sixty-six episodes were included, 40 patients (60%) had a prescription complies with RCP recommendations H48 and 46 patients (70%) to HAS. These rates fall at hospital discharge. CONCLUSIONS Off-label prescriptions, drug combinations and choices of not listed molecules are the most common reasons for non-conformity.
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Affiliation(s)
- Edouard-Jules Laforgue
- Centre d'évaluation et de traitement des troubles de l'humeur complexes, CAPPA Jacques-Prévert, Hôtel-Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
| | - Samuel Bulteau
- Centre d'évaluation et de traitement des troubles de l'humeur complexes, CAPPA Jacques-Prévert, Hôtel-Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - Jennyfer Cholet
- Service universitaire d'addictologie, hôpital Saint-Jacques, CHU de Nantes, 44093 Nantes, France; EA 4275 SPHERE « bioStatistics, Pharmacoepidemiology and Human sciEnces REsearch », faculté de médecine et pharmacie, université de Nantes, 44093 Nantes, France
| | - Caroline Victorri-Vigneau
- EA 4275 SPHERE « bioStatistics, Pharmacoepidemiology and Human sciEnces REsearch », faculté de médecine et pharmacie, université de Nantes, 44093 Nantes, France; Service de pharmacologie clinique, institut de biologie, CHU de Nantes, 9, quai Moncousu, 44093 Nantes, France
| | - Marie Guitteny
- Centre d'évaluation et de traitement des troubles de l'humeur complexes, CAPPA Jacques-Prévert, Hôtel-Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - Nicolas Mauduit
- Service d'information médicale, CHU de Nantes, immeuble Deurbroucq, 44093 Nantes, France
| | - Jean-Marie Vanelle
- Centre d'évaluation et de traitement des troubles de l'humeur complexes, CAPPA Jacques-Prévert, Hôtel-Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France; Service d'information médicale, CHU de Nantes, immeuble Deurbroucq, 44093 Nantes, France
| | - Anne Sauvaget
- Centre d'évaluation et de traitement des troubles de l'humeur complexes, CAPPA Jacques-Prévert, Hôtel-Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France; EA 4275 SPHERE « bioStatistics, Pharmacoepidemiology and Human sciEnces REsearch », faculté de médecine et pharmacie, université de Nantes, 44093 Nantes, France
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Hassan L, Senior J, Webb RT, Frisher M, Tully MP, While D, Shaw JJ. Prevalence and appropriateness of psychotropic medication prescribing in a nationally representative cross-sectional survey of male and female prisoners in England. BMC Psychiatry 2016; 16:346. [PMID: 27724879 PMCID: PMC5057241 DOI: 10.1186/s12888-016-1055-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 09/29/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mental illness is highly prevalent among prisoners. Although psychotropic medicines can ameliorate symptoms of mental illness, prescribers in prisons must balance clinical needs against risks to safety and security. Concerns have been raised at the large number of prisoners reportedly receiving psychotropic medicines in England. Nonetheless, unlike for the wider community, robust prescribing data are not routinely available for prisons. We investigated gender-specific patterns in the prevalence and appropriateness of psychotropic prescribing in English prisons. METHODS We studied 6052 men and 785 women in 11 prisons throughout England. This represented 7.9 % of male and 20.5 % of female prisoners nationally. Using a cross-sectional design, demographic and prescription data were collected from clinical records of all prisoners prescribed psychotropic medicines, including hypnotic, anxiolytic, antipsychotic, anti-manic, antidepressant and Central Nervous System stimulant medications. Percentages and 95 % CIs were used to estimate the prevalence of prescribing. The Prescribing Appropriate Indicators tool was used to determine appropriateness. Prevalence Ratios (PR) were generated to make age-adjusted comparisons between prisoners and the general population using a dataset supplied by the Clinical Practice Research Datalink. RESULTS Overall, 47.9 % (CI 44.4-51.4) of women and 16.9 % (CI 16.0-17.9) of men in prison were prescribed one or more psychotropic medicines. Compared with the general population, age-adjusted prescribing prevalence was six times higher among women (PR 5.95 CI 5.36-6.61) and four times higher among men (PR 4.02 CI 3.75-4.30). Undocumented or unapproved indications for prescriptions, not listed in the British National Formulary, were recorded in a third (34.7 %, CI 32.5-37.0) of cases, most commonly low mood and personality disorder. CONCLUSIONS Psychotropic medicines were prescribed frequently in prisons, especially among women, and for a wider range of indications than are currently recommended. These findings raise questions about whether the prescribing of psychotropic medicines in prisons is wholly appropriate and proportionate to the level of clinical need. Prisons need to develop a wider array of treatment responses, other than medicines, to effectively tackle mental illness, challenging behaviours and distress.
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Affiliation(s)
- Lamiece Hassan
- Faculty for Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
| | - Jane Senior
- Faculty for Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - Roger T. Webb
- Faculty for Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - Martin Frisher
- School of Pharmacy, Keele University, Hornbeam Building, Keele, Staffordshire ST5 5BG UK
| | - Mary P. Tully
- The Manchester Pharmacy School, The University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - David While
- Faculty for Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - Jenny J. Shaw
- Faculty for Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester, M13 9PL UK
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Abstract
Psychoactive plants contain chemicals that presumably evolved as allelochemicals but target certain neuronal receptors when consumed by humans, altering perception, emotion and cognition. These plants have been used since ancient times as medicines and in the context of religious rituals for their various psychoactive effects (e.g., as hallucinogens, stimulants, sedatives). The ubiquity of psychoactive plants in various cultures motivates investigation of the commonalities among these plants, in which a phylogenetic framework may be insightful. A phylogeny of culturally diverse psychoactive plant taxa was constructed with their psychotropic effects and affected neurotransmitter systems mapped on the phylogeny. The phylogenetic distribution shows multiple evolutionary origins of psychoactive families. The plant families Myristicaceae (e.g., nutmeg), Papaveraceae (opium poppy), Cactaceae (peyote), Convolvulaceae (morning glory), Solanaceae (tobacco), Lamiaceae (mints), Apocynaceae (dogbane) have a disproportionate number of psychoactive genera with various indigenous groups using geographically disparate members of these plant families for the same psychoactive effect, an example of cultural convergence. Pharmacological traits related to hallucinogenic and sedative potential are phylogenetically conserved within families. Unrelated families that exert similar psychoactive effects also modulate similar neurotransmitter systems (i.e., mechanistic convergence). However, pharmacological mechanisms for stimulant effects were varied even within families suggesting that stimulant chemicals may be more evolutionarily labile than those associated with hallucinogenic and sedative effects. Chemically similar psychoactive chemicals may also exist in phylogenetically unrelated lineages, suggesting convergent evolution or differential gene regulation of a common metabolic pathway. Our study has shown that phylogenetic analysis of traditionally used psychoactive plants suggests multiple ethnobotanical origins and widespread human dependence on these plants, motivating pharmacological investigation into their potential as modern therapeutics for various neurological disorders.
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Affiliation(s)
| | - Jeanmaire Molina
- Department of Biology, Long Island University, Brooklyn, NY, United States
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Gandhi S, McArthur E, Reiss JP, Mamdani MM, Hackam DG, Weir MA, Garg AX. Atypical antipsychotic medications and hyponatremia in older adults: a population-based cohort study. Can J Kidney Health Dis 2016; 3:21. [PMID: 27069639 PMCID: PMC4827184 DOI: 10.1186/s40697-016-0111-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Accepted: 03/24/2016] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND A number of case reports have suggested a possible association between atypical antipsychotic medications and hyponatremia. Currently, there are no reliable estimates of hyponatremia risk from atypical antipsychotic drugs. OBJECTIVE The objective of this study was to examine the 30-day risk of hospitalization with hyponatremia in older adults dispensed an atypical antipsychotic drug relative to no antipsychotic use. DESIGN The design of this study was a retrospective, population-based cohort study. SETTING The setting of this study was in Ontario, Canada, from 2003 to 2012. PATIENTS Adults 65 years or older with an identified psychiatric condition who were newly dispensed risperidone, olanzapine, or quetiapine in the community setting compared to adults with similar indicators of baseline health who were not dispensed such a prescription. MEASUREMENTS The primary outcome was the 30-day risk of hospitalization with hyponatremia. The tracer outcome (an outcome that is not expected to be influenced by the study drugs) was the 30-day risk of hospitalization with bowel obstruction. These outcomes were assessed using hospital diagnosis codes. METHODS Using health administrative data, we applied a propensity score technique to match antipsychotic users 1:1 to non-users of antipsychotic drugs (58,008 patients in each group). We used conditional logistic regression to compare outcomes among the matched users and non-users. RESULTS A total of 104 baseline characteristics were well-balanced between the two matched groups. Atypical antipsychotic use compared to non-use was associated with an increased risk of hospitalization with hyponatremia within 30 days (86/58,008 (0.15 %) versus 53/58,008 (0.09 %); relative risk 1.62 (95 % confidence interval (CI) 1.15 to 2.29); absolute risk increase 0.06 % (95 % CI 0.02 to 0.10)). The limited number of events precluded some additional analyses to confirm if the association was robust. Atypical antipsychotic use compared to non-use was not associated with hospitalization with bowel obstruction within 30 days (55/58,008 (0.09 %) versus 44/58,008 (0.08 %); relative risk 1.25 (95 % CI 0.84 to 1.86)). LIMITATIONS We could only study older adults within our data sources. CONCLUSIONS In this study, the use of an atypical antipsychotic was associated with a modest but statistically significant increase in the 30-day risk of a hospitalization with hyponatremia. The association was less pronounced than that described with other psychotropic drugs.
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Affiliation(s)
- Sonja Gandhi
- Department of Epidemiology and Biostatistics, Western University, London, Ontario Canada ; Division of Nephrology, Department of Medicine, Western University, London, Ontario Canada
| | - Eric McArthur
- Division of Nephrology, Department of Medicine, Western University, London, Ontario Canada ; Institute for Clinical Evaluative Sciences, Toronto, Ontario Canada
| | - Jeffrey P Reiss
- Department of Psychiatry, Western University, London, Ontario Canada
| | - Muhammad M Mamdani
- Institute for Clinical Evaluative Sciences, Toronto, Ontario Canada ; Keenan Research Centre in the Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario Canada
| | - Daniel G Hackam
- Institute for Clinical Evaluative Sciences, Toronto, Ontario Canada ; Division of Clinical Pharmacology, Department of Medicine, Western University, London, Ontario Canada
| | - Matthew A Weir
- Department of Epidemiology and Biostatistics, Western University, London, Ontario Canada ; Division of Nephrology, Department of Medicine, Western University, London, Ontario Canada
| | - Amit X Garg
- Department of Epidemiology and Biostatistics, Western University, London, Ontario Canada ; Division of Nephrology, Department of Medicine, Western University, London, Ontario Canada ; Institute for Clinical Evaluative Sciences, Toronto, Ontario Canada ; Institute for Clinical Evaluative Sciences, Room ELL-101, Westminster, London Health Sciences Centre, 800 Commissioners Road East, London, Ontario N6A 4G5 Canada
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Kitahata R, Nakajima S, Suzuki T, Plitman E, Mimura M, Uchida H. Relapse of ileus in patients with psychiatric disorders: A 2-year chart review. Gen Hosp Psychiatry 2016; 38:31-6. [PMID: 26589763 DOI: 10.1016/j.genhosppsych.2015.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 09/10/2015] [Accepted: 09/15/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To explore risk factors for relapse of paralytic ileus in a psychiatric population. METHOD We conducted a systematic chart-review to examine two-year relapse rates in psychiatric patients who received treatment for ileus from 2008 to 2012. Binary logistic regression analyses were performed to evaluate associations between sociodemographic and clinical characteristics and relapse of ileus. RESULTS Sixty-three subjects (38 women; age, 66.0 ± 11.3 years) were included; 62 subjects recovered from ileus. During the subsequent 2 years, 26 (41.3%) subjects experienced relapse. In the entire sample, relapse of ileus was associated with history of abdominal surgery (P=.03, odds ratio=4.34, 95% CI=1.15-16.42) and duration of psychiatric disorders (P=.02, odds ratio=1.00, 95% CI=1.00-1.00). In a subgroup of 43 subjects with schizophrenia, history of abdominal surgery (P=.01, odds ratio=12.09, 95% CI=1.78-82.15) and age (P=.02, odds ratio=1.12, 95% CI=1.02-1.23) predicted relapse of ileus. CONCLUSIONS Since relapse of ileus is common and can be serious in psychiatric patients, special attention is warranted to those who are old, have a history of abdominal surgery or a longer duration of psychiatric disorders to prevent relapse of ileus.
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Mamat CFB, Jamshed SQ, El Syed T, Khan TM, Othman N, Al-Shami AK, Zaini SB, Siddiqui MJ. The use of psychotropic substances among students: The prevalence, factor association, and abuse. J Pharm Bioallied Sci 2015; 7:181-7. [PMID: 26229351 PMCID: PMC4517319 DOI: 10.4103/0975-7406.160011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Revised: 02/18/2015] [Accepted: 04/21/2015] [Indexed: 11/06/2022] Open
Abstract
This detailed review analyzed the previously published studies related to the prevalence of psychotropic substances use, associated factors, and the misuse of the psychotropics among students. A comprehensive literature search covering six databases was performed. References from published articles and reports were extracted. This helped in identifying the available information on the use of psychotropic drugs. A total of 16 articles were included in this review. There is an upsurge of using psychotropics with the preceding years. More students are exposed to the risk of using psychotropic substances due to the multiple factors like stress, increased academic workload, etc. The misuse is found to be common with prescribed psychotropic substances. Students need to be aware of the bad outcomes of using psychotropic substances. Participation of every stakeholder to curb this menace needs to be emphasized. More extensive studies are required to know about the increasing prevalence, factors, and misuse of psychotropics.
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Affiliation(s)
- Che Fadhilah Bt Mamat
- Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Shazia Qasim Jamshed
- Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Tarek El Syed
- Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Tahir Mehmood Khan
- Department of Pharmacy, Monash University, Sunway Campus, Kuala Lumpur, Malaysia
| | - Noordin Othman
- Department of Clinical and Hospital Pharmacy, College of Pharmacy, Taibah University, Almadinah Almunawwarah, Kingdom of Saudi Arabia
| | - Abdul Kareem Al-Shami
- Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Syahrir Bin Zaini
- Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Mohammad Jamshed Siddiqui
- Department of Pharmaceutical Chemistry, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Malaysia
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Barry DT, Sofuoglu M, Kerns RD, Wiechers IR, Rosenheck RA. Prevalence and correlates of co-prescribing psychotropic medications with long-term opioid use nationally in the Veterans Health Administration. Psychiatry Res 2015; 227:324-32. [PMID: 25863822 DOI: 10.1016/j.psychres.2015.03.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 01/12/2015] [Accepted: 03/06/2015] [Indexed: 10/23/2022]
Abstract
We used national data for fiscal year 2012 to examine demographic, psychiatric and medical diagnoses, indications for psychotropics, and service use correlates of psychotropic medication fills in Veterans with at least 10 opioid prescriptions during the year (the highest 29% of opioid users); and whether the Veteran was treated in a specialty mental health clinic. Of the 328,398 Veterans who filled at least 10 opioid prescriptions, 77% also received psychotropics, of whom: 74% received antidepressants, 55% anxiolytics/sedatives/hypnotics, and 26% three or more classes of psychotropic medications. Altogether, 87% had a psychiatric or medical indication; and 54% received mental health treatment. Veterans treated in a mental health clinic were prescribed more psychotropics and were more likely to have a documented psychiatric or medical indication than those treated solely in other settings. Indicated psychiatric diagnoses were the strongest predictors of specific class of psychotropics prescribed; anxiety disorder and insomnia were most strongly associated with anxioloytics/sedatives/hypnotics receipt. Since psychotropics and opioids can produce harmful side effects, especially when combined, and since they are likely prescribed by separate providers in different settings, coordinated consideration of the risks and benefits of co-prescribing these medications may be needed, along with further study of related adverse events.
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Affiliation(s)
- Declan T Barry
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; APT Foundation Pain Treatment Services, New Haven, CT, USA
| | - Mehmet Sofuoglu
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Veterans Health Administration Mental Illness Research, Education and Clinical Center (MIRECC), West Haven, CT, USA
| | - Robert D Kerns
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; VA Connecticut Healthcare System, West Haven, CT, USA
| | - Ilse R Wiechers
- VA Connecticut Healthcare System, West Haven, CT, USA; Robert Wood Johnson Foundation Clinical Scholars Program, Yale University School of Medicine, New Haven, CT, USA
| | - Robert A Rosenheck
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Veterans Health Administration Mental Illness Research, Education and Clinical Center (MIRECC), West Haven, CT, USA
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Ashoorian D, Davidson R, Rock D, Gudka S, Clifford R. A review of self-report medication side effect questionnaires for mental health patients. Psychiatry Res 2014; 219:664-73. [PMID: 25034414 DOI: 10.1016/j.psychres.2014.05.060] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 05/04/2014] [Accepted: 05/30/2014] [Indexed: 11/18/2022]
Abstract
Side effects of psychotropic medications are important determinants of adherence to treatment. Discussion between the patient and clinician facilitated through the use of a side effect self-report questionnaire (SRQ) could lead to improved communications and treatment adherence. The aim of this review was to 1) identify all currently available side effect SRQs used in the assessment of mental health patients' subjective experiences, 2) evaluate the characteristics of the studies and 3) assess the psychometric properties of each of the questionnaires. Eight electronic databases were searched for peer-reviewed published articles. Six side effect SRQs were identified. Two independent reviewers assessed the quality of the study designs and psychometric properties of the identified SRQs. All questionnaires consisted of closed questions relating to antipsychotic side effects and completion times ranged from 5 to 20 min. Five questionnaires had undergone some form of psychometric testing, ranging from basic to comprehensive. There is a need in everyday clinical practice for a side effect communication tool applicable to all psychotropic medications, which allows the patient to express their subjective beliefs about their medications. This could provide an important contribution to the working relationship between patients and clinicians leading to informed decision-making and improved adherence.
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Affiliation(s)
- Deena Ashoorian
- Pharmacy Program, Center for Optimization of Medicines, School of Medicine and Pharmacology, The University of Western Australia, M315, 35 Stirling Highway, Crawley, WA 6009, Australia.
| | - Rowan Davidson
- North Metropolitan Health Service Mental Health, WA 6016, Australia; School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Crawley, WA 6009, Australia
| | - Daniel Rock
- North Metropolitan Health Service Mental Health, WA 6016, Australia; School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Crawley, WA 6009, Australia; School of Population Health, The University of Western Australia, Crawley, WA 6009, Australia
| | - Sajni Gudka
- Pharmacy Program, Center for Optimization of Medicines, School of Medicine and Pharmacology, The University of Western Australia, M315, 35 Stirling Highway, Crawley, WA 6009, Australia
| | - Rhonda Clifford
- Pharmacy Program, Center for Optimization of Medicines, School of Medicine and Pharmacology, The University of Western Australia, M315, 35 Stirling Highway, Crawley, WA 6009, Australia
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Alessi-Severini S, Dahl M, Schultz J, Metge C, Raymond C. Prescribing of psychotropic medications to the elderly population of a Canadian province: a retrospective study using administrative databases. PeerJ 2013; 1:e168. [PMID: 24109553 PMCID: PMC3792174 DOI: 10.7717/peerj.168] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 08/31/2013] [Indexed: 11/21/2022] Open
Abstract
Background. Psychotropic medications, in particular second-generation antipsychotics (SGAs) and benzodiazepines, have been associated with harm in elderly populations. Health agencies around the world have issued warnings about the risks of prescribing such medications to frail individuals affected by dementia and current guidelines recommend their use only in cases where the benefits clearly outweigh the risks. This study documents the use of psychotropic medications in the entire elderly population of a Canadian province in the context of current clinical guidelines for the treatment of behavioural disturbances. Methods. Prevalent and incident utilization of antipsychotics, benzodiazepines and related medications (zopiclone and zaleplon) were determined in the population of Manitobans over age 65 in the time period 1997/98 to 2008/09 fiscal years. Comparisons between patients living in the community and those living in personal care (nursing) homes (PCH) were conducted. Influence of sociodemographic characteristics on prescribing was assessed by generalized estimating equations. Non-optimal use was defined as the prescribing of high dose of antipsychotic medications and the use of combination therapy of a benzodiazepine (or zopiclone/zaleplon) with an antipsychotic. A decrease in intensity of use over time and lower proportions of patients treated with antipsychotics at high dose or in combination with benzodiazepines (or zopiclone/zaleplon) was considered a trend toward better prescribing. Multiple regression analysis determined predictors of non-optimal use in the elderly population. Results. A 20-fold greater prevalent utilization of SGAs was observed in PCH-dwelling elderly persons compared to those living in the community. In 2008/09, 27% of PCH-dwelling individuals received a prescription for an SGA. Patient characteristics, such as younger age, male gender, diagnoses of dementia (or use of an acetylcholinesterase inhibitor) or psychosis in the year prior the prescription, were predictors of non-optimal prescribing (e.g., high dose antipsychotics). During the period 2002/3 and 2007/8, amongst new users of SGAs, 10.2% received high doses. Those receiving high dose antipsychotics did not show high levels of polypharmacy. Conclusions. Despite encouraging trends, the use of psychotropic medications remains high in elderly individuals, especially in residents of nursing homes. Clinicians caring for such patients need to carefully assess risks and benefits.
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