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Xin Y, Zhu JL, Huang QZ, Chen Y, Chen C, Lu W. Medical expenses of patients with severe mental disorders in Beijing, China. Public Health 2024; 229:50-56. [PMID: 38401192 DOI: 10.1016/j.puhe.2024.01.022] [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: 07/16/2023] [Revised: 12/13/2023] [Accepted: 01/23/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVES Mental health has become a significant public health problem that impacts both economic and social development, with severe mental disorders (SMDs) being the top priority. Over recent years, Beijing, China, has introduced several policies to reduce the economic burden on patients with mental health disorders. The aim of this study was to investigate the current status and composition of patients' medical expenses following the introduction of multiple medical policies, explore the factors that may impact the utilisation of medical services and provide a reference and basis for subsequent policy improvements. STUDY DESIGN Multistage sampling was used to select a representative study population. A retrospective survey was used to collect patient information and data on medical expenses in 2019. METHODS Descriptive statistics were applied to analyse the current status of patients' medical expenses, and a two-part model was used to examine the factors influencing healthcare utilisation and to model predicted expenses. RESULTS Among 4940 participants, the average outpatient expenses of patients with SMD who incurred medical expenses were 8373.61 Yuan, and the average hospitalisation expenses were 81,594.05 Yuan. The out-of-pocket expenses were 29.22% of outpatient expenses and 8.13% of inpatient expenses. Factors such as age, household status, economic status, marital status, participation in the Community Free-Medication Service (CFMS) and the type of disease diagnosed influenced the differences in medical expenses and utilisation of services. CONCLUSIONS The medical expenses of patients with SMD in Beijing are high, but a number of introduced policies have effectively reduced these costs for patients. Future studies should focus on the impact of factors such as age, economic status, participation in the CFMS and the type of disease diagnosed on medical expenses.
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Affiliation(s)
- Y Xin
- School of Public Health, Capital Medical University & Research Center for Capital Health Management and Policy, Beijing, People's Republic of China
| | - J-L Zhu
- School of Public Health, Capital Medical University & Research Center for Capital Health Management and Policy, Beijing, People's Republic of China; Research Center for Capital Health Management and Policy, Beijing, People's Republic of China.
| | - Q-Z Huang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, People's Republic of China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, People's Republic of China
| | - Y Chen
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, People's Republic of China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, People's Republic of China
| | - C Chen
- School of Public Health, Capital Medical University & Research Center for Capital Health Management and Policy, Beijing, People's Republic of China; Research Center for Capital Health Management and Policy, Beijing, People's Republic of China
| | - W Lu
- School of Public Health, Capital Medical University & Research Center for Capital Health Management and Policy, Beijing, People's Republic of China; Research Center for Capital Health Management and Policy, Beijing, People's Republic of China
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Högberg B, Baranowska-Rataj A. Effects of parental job loss on psychotropic drug use in children: Long-term effects, timing, and cumulative exposure. Adv Life Course Res 2024; 60:100607. [PMID: 38569249 DOI: 10.1016/j.alcr.2024.100607] [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] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 01/26/2024] [Accepted: 02/23/2024] [Indexed: 04/05/2024]
Abstract
Intra-family crossover effects triggered by job losses have received growing attention across scientific disciplines, but existing research has reached discrepant conclusions concerning if, and if so how, parental job losses affect child mental health. Drawing on sociological models of stress and life course epidemiology, we ask if parental job losses have long-term effects on child mental health, and if these effects are conditional on the timing of, or the cumulative exposure to, job losses. We use intergenerationally linked Swedish register data combined with entropy balance and structural nested mean models for the analyses. The data allow us to track 400,000 children over 14 years and thereby test different life-course models of cross-over effects. We identify involuntary job losses using information on workplace closures, thus reducing the risk of confounding. Results show that paternal but not maternal job loss significantly increases the risk of psychotropic drug use among children, that the average effects are modest in size (less than 4% in relative terms), that they may persist for up to five years, and that they are driven by children aged 6-10 years. Moreover, cumulative exposure to multiple job losses are more harmful than zero or one job loss.
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Affiliation(s)
- Björn Högberg
- Department of Social Work, Umeå University, and Centre for Demographic and Ageing Research, Umeå University, Sweden.
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Istvan M, Duval M, Hodel K, Aquizerate A, Chaslerie A, Artarit P, Laforgue EJ, Victorri-Vigneau C. Evolution of the profiles of new psychotropic drug users before and during the COVID-19 crisis: an original longitudinal approach through multichannel sequence analysis using the French health-care database. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-024-01774-3. [PMID: 38499795 DOI: 10.1007/s00406-024-01774-3] [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: 02/28/2023] [Accepted: 02/02/2024] [Indexed: 03/20/2024]
Abstract
The COVID-19 pandemic has had a substantial impact on mental health. An increase in the use of anxiolytic, hypnotic, and antidepressant drugs has been highlighted in France, but with no information at the individual level (trajectories) or concerning patient characteristics. The objective of this study was to describe the profile of new psychotropic drug users since the beginning of the pandemic. We formed two historical cohorts using the Pays-de-la-Loire regional component of the National Health Data System (SNDS): a "COVID-19 crisis cohort" (2020-2021) and a "control cohort" (2018-2019). We analyzed reimbursements for psychotropic medications (anxiolytics, antidepressants, hypnotics, mood stabilizers, and antipsychotics) using a multichannel sequence analysis and performed clustering analysis of sequences. The proportion of new consumers of psychotropic drugs was higher in the COVID-19 crisis cohort (18.0%) than that in the control cohort (16.0%). In the COVID-19 cohort, three clusters of psychotropic drug users were identified, whereas four clusters were identified in the control cohort. A time lag in treatment initiation was observed in the COVID-19 crisis cohort (September) compared with the control cohort (July). This study is one of the first to analyze the profile of psychotropic treatment users during the COVID-19 crisis. Our analysis sheds light on changes in patterns of psychotropic drug use during the COVID-19 pandemic, possibly associated with changes in prescribing conditions and mental health conditions during the crisis. This study also provides an example of the application of an innovative longitudinal analysis methodology in the field of pharmacoepidemiology.
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Affiliation(s)
- Marion Istvan
- Nantes Université, CHU Nantes, Centre d'Évaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Service de Pharmacologie Clinique, F-44000, Nantes, France.
- Nantes Université, Univ Tours, CHU Nantes, CHU Tours, INSERM, MethodS in Patients-centered outcomes and HEalth Research, SPHERE, F-44000, Nantes, France.
| | - Mélanie Duval
- Nantes Université, CHU Nantes, Centre d'Évaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Service de Pharmacologie Clinique, F-44000, Nantes, France
| | - Karl Hodel
- Direction Régionale du Service Médical des Pays de la Loire, F-44034, Nantes, France
| | - Aurélie Aquizerate
- Nantes Université, CHU Nantes, Centre d'Évaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Service de Pharmacologie Clinique, F-44000, Nantes, France
| | - Anicet Chaslerie
- Direction Régionale du Service Médical des Pays de la Loire, F-44034, Nantes, France
| | - Pascal Artarit
- Direction Régionale du Service Médical des Pays de la Loire, F-44034, Nantes, France
| | - Edouard-Jules Laforgue
- Nantes Université, CHU Nantes, Centre d'Évaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Service de Pharmacologie Clinique, F-44000, Nantes, France
- Nantes Université, Univ Tours, CHU Nantes, CHU Tours, INSERM, MethodS in Patients-centered outcomes and HEalth Research, SPHERE, F-44000, Nantes, France
| | - Caroline Victorri-Vigneau
- Nantes Université, CHU Nantes, Centre d'Évaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Service de Pharmacologie Clinique, F-44000, Nantes, France
- Nantes Université, Univ Tours, CHU Nantes, CHU Tours, INSERM, MethodS in Patients-centered outcomes and HEalth Research, SPHERE, F-44000, Nantes, France
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4
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Bell JS, La Caze A, Steeper M, Haines TP, Hilmer SN, Troeung L, Quirke L, Wesson J, Pond CD, Buys L, Ghahreman-Falconer N, Lawless MT, Shrestha S, Martini A, Ochieng N, Glamorgan F, Lagasca C, Walton R, Cenin D, Kitson A, Jung M, Bennett A, Cross AJ. Evidence-based Medication knowledge Brokers in Residential Aged CarE (EMBRACE): protocol for a helix-counterbalanced randomised controlled trial. Implement Sci 2024; 19:24. [PMID: 38438918 PMCID: PMC10913248 DOI: 10.1186/s13012-024-01353-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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 02/13/2024] [Indexed: 03/06/2024] Open
Abstract
INTRODUCTION Clinical practice guidelines recommend against the routine use of psychotropic medications in residential aged care facilities (RACFs). Knowledge brokers are individuals or groups who facilitate the transfer of knowledge into practice. The objective of this trial is to evaluate the effectiveness and cost-effectiveness of using knowledge brokers to translate Australia's new Clinical Practice Guidelines for the Appropriate Use of Psychotropic Medications in People Living with Dementia and in Residential Aged Care. METHODS AND ANALYSIS The Evidence-based Medication knowledge Brokers in Residential Aged CarE (EMBRACE) trial is a helix-counterbalanced randomised controlled trial. The 12-month trial will be conducted in up to 19 RACFs operated by four Australian aged care provider organisations in Victoria, New South Wales, Western Australia and Queensland. RACFs will be randomised to receive three levels of implementation strategies (knowledge broker service, pharmacist-led quality use of medications education activities and distribution of the Guidelines and supporting materials) across three medication contexts (antipsychotics, benzodiazepines and antidepressants). Implementation strategies will be delivered by an embedded on-site aged care pharmacist working at a system level across each participating RACF. All RACFs will receive all implementation strategies simultaneously but for different medication contexts. The primary outcome will be a composite dichotomous measure of 6-month RACF-level concordance with Guideline recommendations and good practice statements among people using antipsychotics, benzodiazepines and antidepressants for changed behaviours. Secondary outcomes will include proportion of residents with Guideline concordant use of antipsychotics, benzodiazepines and antidepressants measured at the RACF-level and proportion of residents with psychotropic medication use, hospitalisation, falls, falls with injury, polypharmacy, quality of life, activities of daily living, medication incidents and behavioural incidents measured at the RACF-level. DISCUSSION The EMBRACE trial investigates a novel guideline implementation strategy to improve the safe and effective use of psychotropic medications in RACFs. We anticipate that the findings will provide new information on the potential role of knowledge brokers for successful and cost-effective guideline implementation. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12623001141639. Registered 6 November 2023 - retrospectively registered, https://www.anzctr.org.au/TrialSearch.aspx .
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Affiliation(s)
- J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville Campus, Parkville, VIC, 3052, Australia.
| | - Adam La Caze
- School of Pharmacy, The University of Queensland, Dutton Park, QLD, Australia
| | - Michelle Steeper
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville Campus, Parkville, VIC, 3052, Australia
| | - Terry P Haines
- Faculty of Medicine Nursing and Health Sciences, School of Primary and Allied Health Care, Monash University, Clayton, VIC, Australia
- National Centre for Healthy Ageing, Frankston, VIC, Australia
| | - Sarah N Hilmer
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney and Northern Sydney Local Health District, St Leonards, NSW, Australia
- New South Wales Therapeutic Advisory Group, Sydney, NSW, Australia
| | - Lakkhina Troeung
- Brightwater Research Centre, Brightwater Care Group, Inglewood, WA, Australia
| | | | - Jacqueline Wesson
- Ageing and Health Research Unit, Discipline of Occupational Therapy, Faculty of Medicine and Health, Sydney School of Health Sciences, University of Sydney, Camperdown, NSW, Australia
| | - Constance Dimity Pond
- Wicking Dementia Research and Teaching Centre, University of Tasmania, Hobart, TAS, Australia
| | - Laurie Buys
- Faculty of Health Sciences, Australian Catholic University, Brisbane, QLD, Australia
| | - Nazanin Ghahreman-Falconer
- School of Pharmacy, The University of Queensland, Dutton Park, QLD, Australia
- Pharmacy Department, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Michael T Lawless
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, South Australia, Australia
| | - Shakti Shrestha
- School of Pharmacy, The University of Queensland, Dutton Park, QLD, Australia
| | - Angelita Martini
- Brightwater Research Centre, Brightwater Care Group, Inglewood, WA, Australia
| | - Nancy Ochieng
- Lifeview Corporate Lifeview Pty Ltd., Carnegie, VIC, Australia
| | | | - Carmela Lagasca
- Anglicare Southern Queensland, Fortitude Valley, QLD, Australia
| | - Rebecca Walton
- Brightwater Research Centre, Brightwater Care Group, Inglewood, WA, Australia
| | - Dayna Cenin
- Brightwater Research Centre, Brightwater Care Group, Inglewood, WA, Australia
| | - Alison Kitson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, South Australia, Australia
| | - Monica Jung
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville Campus, Parkville, VIC, 3052, Australia
| | | | - Amanda J Cross
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville Campus, Parkville, VIC, 3052, Australia.
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Engel J, Haack B, Zolk O, Greiner T, Heinze M, Toto S, Seifert J, Bleich S, Glocker C, Grohmann R, Schneider M, Stübner S. Edema related to treatment with psychotropic drugs. J Neural Transm (Vienna) 2024; 131:253-266. [PMID: 38353811 PMCID: PMC10874320 DOI: 10.1007/s00702-024-02738-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 01/02/2024] [Indexed: 02/18/2024]
Abstract
Edema as an adverse drug reaction is a commonly underestimated yet potentially debilitating condition. This study analyzes the incidence of severe psychotropic drug-induced edema (e.g., edema affecting the face, legs, or multiple body parts and lasting for more than 1 week, or in any case necessitating subsequent diuretic use) among psychiatric inpatients. The cases under examination are derived from an observational pharmacovigilance program conducted in German-speaking countries ("Arzneimittelsicherheit in der Psychiatrie", AMSP) from 1993 to 2016. Among the 462,661 inpatients monitored, severe edema was reported in 231 cases, resulting in an incidence of 0.05%. Edema occurred more frequently in women (80% of all cases) and older patients (mean age 51.8 years). Pregabalin had the highest incidence of severe edema, affecting 1.46‰ of patients treated with pregabalin, followed by mirtazapine (0.8‰). The majority of edema cases showed a positive response to appropriate countermeasures, such as dose reduction and drug discontinuation, and resolved by the end of the observation period. While most instances of drug-induced edema are reversible, they can have a significant impact on patient well-being and potentially result in decreased treatment adherence. It is, therefore, crucial to remain vigilant regarding risk-increasing circumstances during treatment with psychotropic drugs.
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Affiliation(s)
- Johanna Engel
- Brandenburg Medical School, University Clinic for Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf bei Berlin, Germany.
| | - Beatrice Haack
- Brandenburg Medical School, University Clinic for Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf bei Berlin, Germany
| | - Oliver Zolk
- Institute of Clinical Pharmacology of the Brandenburg Medical School, Immanuel Klinik Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf bei Berlin, Germany
| | - Timo Greiner
- Brandenburg Medical School, University Clinic for Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf bei Berlin, Germany
| | - Martin Heinze
- Brandenburg Medical School, University Clinic for Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf bei Berlin, Germany
| | - Sermin Toto
- Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Johanna Seifert
- Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Catherine Glocker
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Nussbaumstr. 7, 80336, Munich, Germany
| | - Renate Grohmann
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Nussbaumstr. 7, 80336, Munich, Germany
| | - Michael Schneider
- Brandenburg Medical School, University Clinic for Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf bei Berlin, Germany
| | - Susanne Stübner
- Maßregelvollzugsleitung, Klinik für Forensische Psychiatrie, Bezirksklinikum Ansbach, Ludwig-Maximilians-Universität München, Feuchtwanger Straße 38, 91522, Ansbach, Germany
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Dubath C, Porcu E, Delacrétaz A, Grosu C, Laaboub N, Piras M, von Gunten A, Conus P, Plessen KJ, Kutalik Z, Eap CB. DNA methylation may partly explain psychotropic drug-induced metabolic side effects: results from a prospective 1-month observational study. Clin Epigenetics 2024; 16:36. [PMID: 38419113 PMCID: PMC10903022 DOI: 10.1186/s13148-024-01648-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 02/19/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Metabolic side effects of psychotropic medications are a major drawback to patients' successful treatment. Using an epigenome-wide approach, we aimed to investigate DNA methylation changes occurring secondary to psychotropic treatment and evaluate associations between 1-month metabolic changes and both baseline and 1-month changes in DNA methylation levels. Seventy-nine patients starting a weight gain inducing psychotropic treatment were selected from the PsyMetab study cohort. Epigenome-wide DNA methylation was measured at baseline and after 1 month of treatment, using the Illumina Methylation EPIC BeadChip. RESULTS A global methylation increase was noted after the first month of treatment, which was more pronounced (p < 2.2 × 10-16) in patients whose weight remained stable (< 2.5% weight increase). Epigenome-wide significant methylation changes (p < 9 × 10-8) were observed at 52 loci in the whole cohort. When restricting the analysis to patients who underwent important early weight gain (≥ 5% weight increase), one locus (cg12209987) showed a significant increase in methylation levels (p = 3.8 × 10-8), which was also associated with increased weight gain in the whole cohort (p = 0.004). Epigenome-wide association analyses failed to identify a significant link between metabolic changes and methylation data. Nevertheless, among the strongest associations, a potential causal effect of the baseline methylation level of cg11622362 on glycemia was revealed by a two-sample Mendelian randomization analysis (n = 3841 for instrument-exposure association; n = 314,916 for instrument-outcome association). CONCLUSION These findings provide new insights into the mechanisms of psychotropic drug-induced weight gain, revealing important epigenetic alterations upon treatment, some of which may play a mediatory role.
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Affiliation(s)
- Céline Dubath
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, University of Lausanne, Hôpital de Cery, 1008, Prilly, Lausanne, Switzerland.
| | - Eleonora Porcu
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
- Center for Integrative Genomics, University of Lausanne, Lausanne, Switzerland
- Department of Computational Biology, University of Lausanne, Lausanne, Switzerland
| | - Aurélie Delacrétaz
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, University of Lausanne, Hôpital de Cery, 1008, Prilly, Lausanne, Switzerland
| | - Claire Grosu
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, University of Lausanne, Hôpital de Cery, 1008, Prilly, Lausanne, Switzerland
| | - Nermine Laaboub
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, University of Lausanne, Hôpital de Cery, 1008, Prilly, Lausanne, Switzerland
| | - Marianna Piras
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, University of Lausanne, Hôpital de Cery, 1008, Prilly, Lausanne, Switzerland
| | - Armin von Gunten
- Service of Old Age Psychiatry, Department of Psychiatry, Lausanne University Hospital, University of Lausanne, Prilly, Switzerland
| | - Philippe Conus
- Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital, University of Lausanne, Prilly, Switzerland
| | - Kerstin Jessica Plessen
- Service of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Zoltán Kutalik
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
- Department of Computational Biology, University of Lausanne, Lausanne, Switzerland
- University Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Chin Bin Eap
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, University of Lausanne, Hôpital de Cery, 1008, Prilly, Lausanne, Switzerland.
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland.
- Center for Research and Innovation in Clinical Pharmaceutical Sciences, University of Lausanne, Lausanne, Switzerland.
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland.
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Mazza M, De Berardis D, Marano G. Keep in mind sex differences when prescribing psychotropic drugs. World J Psychiatry 2024; 14:194-198. [PMID: 38464773 PMCID: PMC10921286 DOI: 10.5498/wjp.v14.i2.194] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 12/02/2023] [Accepted: 01/02/2024] [Indexed: 02/06/2024] Open
Abstract
Women represent the majority of patients with psychiatric diagnoses and also the largest users of psychotropic drugs. There are inevitable differences in efficacy, side effects and long-term treatment response between men and women. Psychopharmacological research needs to develop adequately powered animal and human trials aimed to consider pharmacokinetics and pharmacodynamics of central nervous system drugs in both male and female subjects. Healthcare professionals have the responsibility to prescribe sex-specific psychopharmacotherapies with a priority to differentiate between men and women in order to minimize adverse drugs reactions, to maximize therapeutic effectiveness and to provide personalized management of care.
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Affiliation(s)
- Marianna Mazza
- Department of Neurosciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | | | - Giuseppe Marano
- Department of Neurosciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy
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Michaelis L, Berg L, Maier L. Confounder or Confederate? The Interactions Between Drugs and the Gut Microbiome in Psychiatric and Neurological Diseases. Biol Psychiatry 2024; 95:361-369. [PMID: 37331548 DOI: 10.1016/j.biopsych.2023.06.004] [Citation(s) in RCA: 2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/06/2023] [Accepted: 06/08/2023] [Indexed: 06/20/2023]
Abstract
The gut microbiome is emerging as an important factor in signaling along the gut-brain axis. The intimate physiological connection between the gut and the brain allows perturbations in the microbiome to be directly transmitted to the central nervous system and thereby contribute to psychiatric and neurological diseases. Common microbiome perturbations result from the ingestion of xenobiotic compounds including pharmaceuticals such as psychotropic drugs. In recent years, a variety of interactions between these drug classes and the gut microbiome have been reported, ranging from direct inhibitory effects on gut bacteria to microbiome-mediated drug degradation or sequestration. Consequently, the microbiome may play a critical role in influencing the intensity, duration, and onset of therapeutic effects, as well as in influencing the side effects that patients may experience. Furthermore, because the composition of the microbiome varies from person to person, the microbiome may contribute to the frequently observed interpersonal differences in the response to these drugs. In this review, we first summarize the known interactions between xenobiotics and the gut microbiome. Then, for psychopharmaceuticals, we address the question of whether these interactions with gut bacteria are irrelevant for the host (i.e., merely confounding factors in metagenomic analyses) or whether they may even have therapeutic or adverse effects.
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Affiliation(s)
- Lena Michaelis
- Interfaculty Institute for Microbiology and Infection Medicine Tübingen, University of Tübingen, Tübingen, Germany; and the Cluster of Excellence EXC 2124 (Controlling Microbes to Fight Infections), University of Tübingen, Tübingen, Germany
| | - Lara Berg
- Interfaculty Institute for Microbiology and Infection Medicine Tübingen, University of Tübingen, Tübingen, Germany; and the Cluster of Excellence EXC 2124 (Controlling Microbes to Fight Infections), University of Tübingen, Tübingen, Germany
| | - Lisa Maier
- Interfaculty Institute for Microbiology and Infection Medicine Tübingen, University of Tübingen, Tübingen, Germany; and the Cluster of Excellence EXC 2124 (Controlling Microbes to Fight Infections), University of Tübingen, Tübingen, Germany.
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Couderc S, Djerada Z, Rivals F, Lemaire-Hurtel AS, Lelong-Boulouard V, Lelièvre B, Abbara C, Lafay C, Abe E, Libert F, Pressiat C, Montange D, Imbert L, Tonini J, Lenski M, Guilhaumou R, Mathieu O. Questionnaire about therapeutic drug monitoring (TDM) of psychotropics for a panel of French psychiatrists. Therapie 2024:S0040-5957(24)00008-8. [PMID: 38355346 DOI: 10.1016/j.therap.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/05/2024] [Accepted: 01/25/2024] [Indexed: 02/16/2024]
Affiliation(s)
- Sylvain Couderc
- Department of Pharmacology and Toxicology, University Hospital, 87000 Limoges, France.
| | - Zoubir Djerada
- Department of Pharmacology and Toxicology, University Hospital, 51092 Reims, France
| | - Florence Rivals
- Department of Pharmacology and Toxicology, University Hospital, 87000 Limoges, France
| | | | | | - Bénédicte Lelièvre
- Department of Pharmacology and Toxicology, University Hospital, 49100 Angers, France
| | - Chadi Abbara
- Department of Pharmacology and Toxicology, University Hospital, 49100 Angers, France
| | - Claire Lafay
- Department of Pharmacology and Toxicology, University Hospital, 86000 Poitiers, France
| | - Emuri Abe
- Department of Pharmacology and Toxicology, University Hospital, Raymond Poincare Hospital, AP-HP, 92380 Garches, France
| | - Frédéric Libert
- Department of Pharmacology, University Hospital, 63000 Clermont-Ferrand, France
| | - Claire Pressiat
- Department of Pharmacology, University Hospital, Henri-Mondor Hospital, AP-HP, 94010 Créteil, France
| | - Damien Montange
- Department of Pharmacology and Toxicology, University Hospital, 25030 Besançon, France
| | - Laurent Imbert
- Department of Pharmacology and Toxicology, University Hospital, 76000 Rouen, France
| | - Julia Tonini
- Department of Pharmacology and Toxicology, University Hospital, 38000 Grenoble, France
| | - Marie Lenski
- Department of Toxicology, University hospital, 59045 Lille, France
| | - Romain Guilhaumou
- Department of Pharmacology, University Hospital, La Timone Hospital, AP-HM, 13005 Marseille, France
| | - Olivier Mathieu
- Department of Pharmacology and Toxicology, University Hospital, 34090 Montpellier, France
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Du J, Burger H, Kupers T, Sulim K, Homburg MT, Muris JWM, Olde Hartman TC, Zuidema SU, Peters LL, Janus SIM. Patterns of psychotropic drug prescriptions and general practice consultations among community-dwelling older people with dementia during the first two years of the COVID-19 pandemic. BMC Geriatr 2024; 24:120. [PMID: 38297202 PMCID: PMC10832125 DOI: 10.1186/s12877-024-04708-9] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 01/14/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic and subsequent lockdown measures had serious implications for community-dwelling older people with dementia. While the short-term impacts of the pandemic on this population have been well studied, there is limited research on its long-term impacts. Quantifying the long-term impacts may provide insights into whether healthcare adaptations are needed after the acute phase of the pandemic to balance infection prevention measures with healthcare provision. This study aims to examine patterns of psychotropic drug prescriptions and general practice consultations in community-dwelling older people with dementia during the first two years of the pandemic. METHODS We utilised routine electronic health records from three Dutch academic general practice research networks located in the North, East, and South, between 2019 and 2021. We (1) compared the weekly prescription rates of five groups of psychotropic drugs and two groups of tracer drugs, and weekly general practice consultation rates per 1000 participants, between the first two years of the pandemic and the pre-pandemic phase, (2) calculated changes in these rates during three lockdowns and two relaxation phases relative to the corresponding weeks in 2019, and (3) employed interrupted time series analyses for the prescription rates. Analyses were performed for each region separately. RESULTS The study population sizes in the North, East, and South between 2019 and 2021 were 1726 to 1916, 93 to 117, and 904 to 960, respectively. Data from the East was excluded from the statistical analyses due to the limited sample size. During the first two years of the pandemic, the prescription rates of psychotropic drugs were either lower or similar to those in the pre-pandemic phase, with differences varying from -2.6‰ to -10.2‰. In contrast, consultation rates during the pandemic were higher than in the pre-pandemic phase, increasing by around 38‰. CONCLUSIONS This study demonstrates a decrease in psychotropic drug prescriptions, but an increase in general practice consultations among community-dwelling older people with dementia during the first two years of the pandemic. However, reasons for the decrease in psychotropic drug prescriptions are unclear due to limited information on the presence of neuropsychiatric symptoms and the appropriateness of prescribing.
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Affiliation(s)
- Jiamin Du
- Department of Primary and Long-Term Care, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Huibert Burger
- Department of Primary and Long-Term Care, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Thijmen Kupers
- Department of Primary and Long-Term Care, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Karina Sulim
- Department of Primary and Long-Term Care, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Maarten T Homburg
- Department of Primary and Long-Term Care, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Jean W M Muris
- Department of Family Medicine, Maastricht University Medical Centre, CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands
| | - Tim C Olde Hartman
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Sytse U Zuidema
- Department of Primary and Long-Term Care, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
- Alzheimer Centre Groningen, Groningen, the Netherlands
| | - Lilian L Peters
- Department of Primary and Long-Term Care, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
- Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Midwifery Science, AVAG, Amsterdam Public Health, Amsterdam, the Netherlands
| | - Sarah I M Janus
- Department of Primary and Long-Term Care, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands.
- Alzheimer Centre Groningen, Groningen, the Netherlands.
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Vidal N, Brunet-Gouet E, Frileux S, Aouizerate B, Aubin V, Belzeaux R, Courtet P, D'Amato T, Dubertret C, Etain B, Haffen E, Januel D, Leboyer M, Lefrere A, Llorca PM, Marlinge E, Olié E, Polosan M, Schwan R, Walter M, Passerieux C, Roux P. Comparative analysis of anticholinergic burden scales to explain iatrogenic cognitive impairment and self-reported side effects in the euthymic phase of bipolar disorders: Results from the FACE-BD cohort. Eur Neuropsychopharmacol 2023; 77:67-79. [PMID: 37741163 DOI: 10.1016/j.euroneuro.2023.08.502] [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: 04/11/2023] [Revised: 08/21/2023] [Accepted: 08/29/2023] [Indexed: 09/25/2023]
Abstract
Bipolar disorders (BD) are characterized by cognitive impairment during the euthymic phase, to which treatments can contribute. The anticholinergic properties of medications, i.e., the ability of a treatment to inhibit cholinergic receptors, are associated with cognitive impairment in elderly patients and people with schizophrenia but this association has not been well characterized in individuals with remitted BD. Moreover, the validity of only one anticholinergic burden scale designed to assess the anticholinergic load of medications has been tested in BD. In a literature review, we identified 31 existing scales. We first measured the associations between 27 out of the 31 scales and objective cognitive impairment in bivariable regressions. We then adjusted the bivariable models with covariates: the scales significantly associated with cognitive impairment in bivariable and multiple logistic regressions were defined as having good concurrent validity to assess cognitive impairment. In a sample of 2,031 individuals with euthymic BD evaluated with a neuropsychological battery, two scales had good concurrent validity to assess cognitive impairment, whereas chlorpromazine equivalents, lorazepam equivalents, the number of antipsychotics, or the number of treatments had not. Finally, similar analyses with subjective anticholinergic side-effects as outcome variables reported 14 scales with good concurrent validity to assess self-reported peripheral anticholinergic side-effects and 13 to assess self-reported central anticholinergic side-effects. Thus, we identified valid scales to monitor the anticholinergic burden in BD, which may be useful in estimating iatrogenic cognitive impairment in studies investigating cognition in BD.
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Affiliation(s)
- N Vidal
- Fondation FondaMental, Créteil, France; Centre Hospitalier de Versailles, Service Hospitalo-Universitaire de Psychiatrie d'Adultes et d'Addictologie, Le Chesnay; Université Paris-Saclay, Université de Versailles Saint-Quentin-En-Yvelines; DisAP-DevPsy-CESP, INSERM UMR 1018, Villejuif, France.
| | - E Brunet-Gouet
- Fondation FondaMental, Créteil, France; Centre Hospitalier de Versailles, Service Hospitalo-Universitaire de Psychiatrie d'Adultes et d'Addictologie, Le Chesnay; Université Paris-Saclay, Université de Versailles Saint-Quentin-En-Yvelines; DisAP-DevPsy-CESP, INSERM UMR 1018, Villejuif, France
| | - S Frileux
- Fondation FondaMental, Créteil, France; Centre Hospitalier de Versailles, Service Hospitalo-Universitaire de Psychiatrie d'Adultes et d'Addictologie, Le Chesnay; Université Paris-Saclay, Université de Versailles Saint-Quentin-En-Yvelines; DisAP-DevPsy-CESP, INSERM UMR 1018, Villejuif, France
| | - B Aouizerate
- Fondation FondaMental, Créteil, France; Centre Hospitalier Charles Perrens, Laboratoire NutriNeuro (UMR INRA 1286), Université de Bordeaux, Bordeaux, France
| | - V Aubin
- Fondation FondaMental, Créteil, France; Pôle de Psychiatrie, Centre Hospitalier Princesse Grace, Monaco
| | - R Belzeaux
- Fondation FondaMental, Créteil, France; Pôle universitaire de psychiatrie, CHU de Montpellier, Montpellier, France; INT-UMR7289, CNRS Aix-Marseille Université, Marseille, France
| | - P Courtet
- Fondation FondaMental, Créteil, France; CHU Montpellier, Hôpital Lapeyronie, Psychiatric Emergency and Post Emergency Department, Pole Urgence; IGF, Université de Montpellier, CNRS, INSERM, Montpellier, France
| | - T D'Amato
- Fondation FondaMental, Créteil, France; University Lyon 1, Villeurbanne; INSERM, U1028; CNRS, UMR5292, Lyon Neuroscience Research Center, Psychiatric Disorders: From Resistance to Response Team, Lyon, France
| | - C Dubertret
- Fondation FondaMental, Créteil, France; AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, DMU ESPRIT, Service de Psychiatrie et Addictologie, Hôpital Louis Mourier, Colombes, France, Université de Paris, Inserm UMR1266, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
| | - B Etain
- Fondation FondaMental, Créteil, France; Assistance publique des Hôpitaux de Paris, Groupe Hospitalo-universitaire AP-HP Nord, DMU Neurosciences, Hôpital Fernand Widal, Département de Psychiatrie et de Médecine Addictologique, Université de Paris, INSERM UMR-S 1144, Optimisation Thérapeutique en Neuropsychopharmacologie OTeN, Paris, France
| | - E Haffen
- Fondation FondaMental, Créteil, France; Service de Psychiatrie de l'Adulte, CIC-1431 INSERM, CHU de Besançon, Laboratoire de Neurosciences, UFC, UBFC, Besançon, France
| | - D Januel
- Fondation FondaMental, Créteil, France; Unité de Recherche Clinique, EPS Ville-Evrard, 93332 Neuilly-sur-Marne, France
| | - M Leboyer
- Fondation FondaMental, Créteil, France; Univ Paris Est Créteil, INSERM U955, IMRB, Translational NeuroPsychiatry Laboratory,; AP-HP, Hôpitaux Universitaires Henri Mondor, Département Médico-Universitaire de Psychiatrie et d'Addictologie (DMU IMPACT), Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Créteil, France
| | - A Lefrere
- Fondation FondaMental, Créteil, France; Pôle de Psychiatrie, Assistance Publique Hôpitaux de Marseille, Marseille, France, INT-UMR7289, CNRS Aix-Marseille Université, Marseille, France
| | - P M Llorca
- Fondation FondaMental, Créteil, France; Centre Hospitalier et Universitaire, Département de Psychiatrie, Université d'Auvergne, EA 7280, Clermont-Ferrand, France
| | - E Marlinge
- Fondation FondaMental, Créteil, France; Assistance publique des Hôpitaux de Paris, Groupe Hospitalo-universitaire AP-HP Nord, DMU Neurosciences, Hôpital Fernand Widal, Département de Psychiatrie et de Médecine Addictologique, Université de Paris, INSERM UMR-S 1144, Optimisation Thérapeutique en Neuropsychopharmacologie OTeN, Paris, France
| | - E Olié
- Fondation FondaMental, Créteil, France; CHU Montpellier, Hôpital Lapeyronie, Psychiatric Emergency and Post Emergency Department, Pole Urgence; IGF, Université de Montpellier, CNRS, INSERM, Montpellier, France
| | - M Polosan
- Fondation FondaMental, Créteil, France; Univ. Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France
| | - R Schwan
- Fondation FondaMental, Créteil, France; Université de Lorraine, Centre Psychothérapique de Nancy, Inserm U1254, Nancy, France
| | - M Walter
- Fondation FondaMental, Créteil, France; Service Hospitalo-Universitaire de Psychiatrie Générale et de Réhabilitation Psycho Sociale 29G01 et 29G02, CHRU de Brest, Hôpital de Bohars, Brest, France
| | - C Passerieux
- Fondation FondaMental, Créteil, France; Centre Hospitalier de Versailles, Service Hospitalo-Universitaire de Psychiatrie d'Adultes et d'Addictologie, Le Chesnay; Université Paris-Saclay, Université de Versailles Saint-Quentin-En-Yvelines; DisAP-DevPsy-CESP, INSERM UMR 1018, Villejuif, France
| | - P Roux
- Fondation FondaMental, Créteil, France; Centre Hospitalier de Versailles, Service Hospitalo-Universitaire de Psychiatrie d'Adultes et d'Addictologie, Le Chesnay; Université Paris-Saclay, Université de Versailles Saint-Quentin-En-Yvelines; DisAP-DevPsy-CESP, INSERM UMR 1018, Villejuif, France
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12
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Hughes PM, Annis IE, McGrath RE, Thomas KC. Psychotropic Medication Prescribing Across Medical Providers, 2016-2019. Psychiatr Serv 2023:appips20230156. [PMID: 38018151 DOI: 10.1176/appi.ps.20230156] [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] [Indexed: 11/30/2023]
Abstract
OBJECTIVE The authors sought to provide updated estimates of the proportion of psychotropic medications prescribed by different medical providers. METHODS This pooled cross-sectional study used data from the Medical Expenditure Panel Survey (2016-2019). Nationally representative estimates of the percentages of all psychotropic medications prescribed by each provider type were calculated, and analyses stratified by medication type, insurance type, and age were conducted. RESULTS Data from 58,547 psychotropic prescriptions reported by 7,693 unique individuals were analyzed. More than 60% of psychotropic medications were prescribed by providers other than psychiatrists (33.5%) or psychologists (2.2%), such as general practitioners, nurse practitioners, and physician assistants. This distribution varied significantly by medication, insurance, and patient age. CONCLUSIONS Most psychotropic medication prescribing occurs in primary care; however, notable differences by medication, insurance, and age were observed, suggesting areas for future research.
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Affiliation(s)
- Phillip M Hughes
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill (Hughes, Annis, Thomas); Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill (Hughes); School of Psychology and Counseling, Fairleigh Dickinson University, Teaneck, New Jersey (McGrath)
| | - Izabella E Annis
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill (Hughes, Annis, Thomas); Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill (Hughes); School of Psychology and Counseling, Fairleigh Dickinson University, Teaneck, New Jersey (McGrath)
| | - Robert E McGrath
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill (Hughes, Annis, Thomas); Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill (Hughes); School of Psychology and Counseling, Fairleigh Dickinson University, Teaneck, New Jersey (McGrath)
| | - Kathleen C Thomas
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill (Hughes, Annis, Thomas); Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill (Hughes); School of Psychology and Counseling, Fairleigh Dickinson University, Teaneck, New Jersey (McGrath)
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13
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Zhu X, Luo T, Wang D, Zhao Y, Jin Y, Yang G. The occurrence of typical psychotropic drugs in the aquatic environments and their potential toxicity to aquatic organisms - A review. Sci Total Environ 2023; 900:165732. [PMID: 37495145 DOI: 10.1016/j.scitotenv.2023.165732] [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] [Received: 05/23/2023] [Revised: 07/18/2023] [Accepted: 07/20/2023] [Indexed: 07/28/2023]
Abstract
Psychotropic drugs (PDs) and their bioactive metabolites often persist in aquatic environments due to their typical physical properties, which made them resistant to removal by traditional wastewater treatment plants (WWTPs). Consequently, such drugs and/or their metabolites are frequently detected in both aquatic environments and organisms. Even at low concentrations, these drugs can exhibit toxic effects on non-target organisms including bony fish (zebrafish (Danio rerio) and fathead minnows) and bivalves (freshwater mussels and clams). This narrative review focuses on the quintessential representatives of three different categories of PDs-antiepileptics, antidepressants, and antipsychotics. The data regarding their concentrations occurring in the environment, patterns of distribution, the degree of enrichment in various tissues of aquatic organisms, and the toxicological effects on them are summarized. The toxicological assessments of these drugs included the evaluation of their effects on the reproductive, embryonic development, oxidative stress-related, neurobehavioral, and genetic functions in various experimental models. However, the mechanisms underlying the toxicity of PDs to aquatic organisms and their potential health risks to humans remain unclear. Most studies have focused on the effects caused by acute short-term exposure due to limitations in the experimental conditions, thus making it necessary to investigate the chronic toxic effects at concentrations that are in coherence with those occurring in the environment. Additionally, this review aims to raise awareness and stimulate further research efforts by highlighting the gaps in the understanding of the mechanisms behind PD-induced toxicity and potential health risks. Ultimately, the study underscores the importance of developing advanced remediation methods for the removal of PDs in WWTPs and encourages a broader discussion on mitigating their environmental impacts.
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Affiliation(s)
- Xianghai Zhu
- College of Biotechnology and Bioengineering, Zhejiang University of Technology, Hangzhou 310032, China; State Key Laboratory for Managing Biotic and Chemical Threats to the Quality and Safety of Agro-products, Laboratory (Hangzhou) for Risk Assessment of Agricultural Products of Ministry of Agriculture, Institute of Agro-product Safety and Nutrition, Zhejiang Academy of Agricultural Sciences, Hangzhou 310021, Zhejiang, China
| | - Ting Luo
- State Key Laboratory for Managing Biotic and Chemical Threats to the Quality and Safety of Agro-products, Laboratory (Hangzhou) for Risk Assessment of Agricultural Products of Ministry of Agriculture, Institute of Agro-product Safety and Nutrition, Zhejiang Academy of Agricultural Sciences, Hangzhou 310021, Zhejiang, China
| | - Dou Wang
- State Key Laboratory for Managing Biotic and Chemical Threats to the Quality and Safety of Agro-products, Laboratory (Hangzhou) for Risk Assessment of Agricultural Products of Ministry of Agriculture, Institute of Agro-product Safety and Nutrition, Zhejiang Academy of Agricultural Sciences, Hangzhou 310021, Zhejiang, China
| | - Yao Zhao
- State Key Laboratory for Managing Biotic and Chemical Threats to the Quality and Safety of Agro-products, Laboratory (Hangzhou) for Risk Assessment of Agricultural Products of Ministry of Agriculture, Institute of Agro-product Safety and Nutrition, Zhejiang Academy of Agricultural Sciences, Hangzhou 310021, Zhejiang, China
| | - Yuanxiang Jin
- College of Biotechnology and Bioengineering, Zhejiang University of Technology, Hangzhou 310032, China; Xianghu Laboratory, Hangzhou, 311231, China
| | - Guiling Yang
- State Key Laboratory for Managing Biotic and Chemical Threats to the Quality and Safety of Agro-products, Laboratory (Hangzhou) for Risk Assessment of Agricultural Products of Ministry of Agriculture, Institute of Agro-product Safety and Nutrition, Zhejiang Academy of Agricultural Sciences, Hangzhou 310021, Zhejiang, China; Xianghu Laboratory, Hangzhou, 311231, China.
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14
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Vukićević T, Draganić P, Škribulja M, Puljak L, Došenović S. Consumption of psychotropic drugs in Croatia before and during the COVID-19 pandemic: a 10-year longitudinal study (2012-2021). Soc Psychiatry Psychiatr Epidemiol 2023:10.1007/s00127-023-02574-1. [PMID: 37847256 DOI: 10.1007/s00127-023-02574-1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/28/2023] [Indexed: 10/18/2023]
Abstract
PURPOSE This longitudinal study aimed to examine the trends in antipsychotics, antidepressants, anxiolytics, and hypnotics/sedatives consumption in Croatia over a 10-year period (2012-2021). The study also assessed whether the COVID-19 pandemic had an impact on the yearly consumption of psychotropic drugs. METHODS Data were collected from Croatian Agency for Medicinal Products and Medical Devices (HALMED) and presented as defined daily doses per 1000 inhabitants per day (DDD/TID). The consumption before (2012-2019) and during the COVID-19 pandemic (2020-2021) was compared with interrupted time series analysis. RESULTS There was an increase in total consumption of analyzed psychotropic drugs in Croatia between the years 2012 and 2021, from 115.47 DDD/TID in 2012 to 155.50 DDD/TID in 2021. An increasing trend was observed in the consumption of all 4 analyzed groups of medicines (antipsychotics, anxiolytics, hypnotics and sedatives, and antidepressants). Anxiolytics accounted for 59% (68.29/115.47 DDD/TID), and hypnotics and sedatives for 8.5% (9.76/115.47 DDD/TID) of total consumption in 2012. At the end of a 10-year period, hypnotics and sedatives represented 12% (19.05/155.50 DDD/TID) and anxiolytics 54% (83.53/155.50 DDD/TID) of psychotropic drugs consumption. The total consumption of psychotropic drugs was not significantly different before and during COVID-19 pandemic (estimate ± standard error = 5.029 ± 6.899, t = 0.729, P = 0.490). CONCLUSION Croatia had a high, continuously increasing consumption of psychotropic drugs. National anxiolytics consumption was one of the highest globally, while consumption of antidepressants was rather low compared to other high-income countries. The COVID-19 pandemic did not seem to influence the yearly utilization of psychotropic drugs in Croatia.
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Affiliation(s)
- Tea Vukićević
- Ministry of Defence of the Republic of Croatia, Zagreb, Croatia
| | - Pero Draganić
- Agency for Medicinal Products and Medical Devices of Croatia, Zagreb, Croatia
| | - Marija Škribulja
- Agency for Medicinal Products and Medical Devices of Croatia, Zagreb, Croatia
| | - Livia Puljak
- Center for Evidence-Based Medicine and Health Care, Catholic University of Croatia, Zagreb, Croatia
| | - Svjetlana Došenović
- Department of Anesthesiology and Intensive Care, University Hospital Split, Split, Croatia.
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Rasing N, Janus S, Smalbrugge M, Koopmans R, Zuidema S. Usability of an app-based clinical decision support system to monitor psychotropic drug prescribing appropriateness in dementia. Int J Med Inform 2023; 177:105132. [PMID: 37364356 DOI: 10.1016/j.ijmedinf.2023.105132] [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: 02/09/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Guidelines recommend reluctant psychotropic drug (PD) prescribing in nursing home residents with dementia and neuropsychiatric symptoms (NPS), as efficacy of PDs is limited, and side effects are common. Nevertheless, PDs are commonly prescribed to reduce NPS. A smartphone application that evaluates appropriateness of PD prescriptions and provides recommendations from the revised Dutch guideline on problem behaviour in dementia may promote guideline adherence and increase appropriate prescribing. OBJECTIVE This study aimed to assess user experiences, barriers and facilitators of the Dutch 'Psychotropic Drug Tool' smartphone application (PDT) in the context of appropriate prescribing of PDs to nursing home residents with dementia and NPS. METHODS/DESIGN The PDT was developed according to the recommendations of the Dutch guideline for treatment of NPS in people with dementia. Feedback provided during usability testing with two end-users was applied to improve the PDT before implementation in day-to-day practice. Sixty-three prescribers were asked to use the PDT at their own convenience for four months. User expectations and experiences were assessed at baseline and after four months with the System Usability Scale and the Assessment of Barriers and Facilitators for Implementation. RESULTS Expected usability (M = 72.59; SD = 11.84) was similar to experienced usability after four months (M = 69.13; SD = 16.48). Appreciation of the PDTs user-friendliness (on average 6.7 out of 10) and design (7.3) were moderately positive, in contrast to the global rating of the PDT (5.7). Perceived barriers for PDT use were time consumption and lack of integration with existing electronic systems. Perceived facilitators were ease of use and attractive lay out. For broader implementation, physicians suggested a change in direction of the PDT: start assessment of appropriateness based on the list of NPS instead of PD as primary input. CONCLUSIONS In this pragmatic prospective cohort study we found that the PDT was used by elderly care physicians, with mediocre user satisfaction. The PDT will be optimized based on user feedback regarding experienced usability, barriers and facilitators, after which broader implementation can be initialized. The Medical Ethics Review Board of the University Medical Center Groningen declared this is a non-WMO study (UMCG RR Number: 201800284).
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Affiliation(s)
- Naomi Rasing
- Department of Primary and Long-term Care, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Alzheimer Center Groningen, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Sarah Janus
- Department of Primary and Long-term Care, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Alzheimer Center Groningen, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Martin Smalbrugge
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Medicine for Older People, de Boelelaan 1117, Amsterdam, Netherlands; Amsterdam Public Health Research Institute, Aging & Later Life, Amsterdam, Netherlands
| | - Raymond Koopmans
- Department of Primary and Community Care, Radboudumc Alzheimer Center, Radboud University Medical Center, Joachim en Anna, Centre for Specialized Geriatric Care, Nijmegen, the Netherlands
| | - Sytse Zuidema
- Department of Primary and Long-term Care, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Alzheimer Center Groningen, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
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Chatterjee S, Kar SK, Prakash AJ, Bansal T, Singh G. Drug-drug Interaction between Psychotropic Medications and Medications Used in COVID-19: Comparison of Online Databases. Clin Psychopharmacol Neurosci 2023; 21:534-543. [PMID: 37424421 PMCID: PMC10335911 DOI: 10.9758/cpn.22.1014] [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] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/23/2022] [Accepted: 11/15/2022] [Indexed: 07/11/2023]
Abstract
Objective COVID-19 has gravely affected patients with psychiatric conditions. Potential interactions may occur between psychotropic medications and medications used in treatment of COVID-19. This study aimed to compare the online databases in terms of the quality of drug-drug interaction related information available on them. Methods 216 drug interactions which included fifty-four psychotropic medication interactions with four COVID-19 drugs across six databases were analyzed by four authors independently. The overall grading of the databases was done on Likert scale independently by the authors using the parameters of ease of understanding for consumers and professionals, level of completeness, discussion on level of evidence and the number of available drugs, congruity with other databases and the mean score was tabulated. Results Drugbank and Lexicomp had maximum discrepancy. The safety profile of Hydroxychloroquine was the best (eighteen moderate/severe psychotropic medication reactions) while Ritonavir has worst profile with thirty-nine medications. Drugbank had the highest SCOPE score (1.00) for completeness and covid19druginteractions.com had least (0.81). Overall, Liverpool© Drug Interaction Group and Lexicomp scored the highest (23/30 each) and were the best interaction checker software closely followed by Drugs.com (22/30). Medscape and WebMD were the poorest interaction checker databases. Conclusion There is significant variability in the available online databases. Liverpool© Drug Interaction Group and Lexicomp were the most reliable sources for healthcare workers whereas for patients, Drugs.com was the easiest to understand (as it segregates the needs of general consumers and professionals distinctly to explain the interaction).
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Affiliation(s)
- Surobhi Chatterjee
- Department of Psychiatry, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Sujita Kumar Kar
- Department of Psychiatry, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Aathira Jaya Prakash
- Department of Psychiatry, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Teena Bansal
- Department of Psychiatry, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Garima Singh
- Department of Psychiatry, King George’s Medical University, Lucknow, Uttar Pradesh, India
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17
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Bushnell G, Sun JW, dosReis S, Castillo WC, Czaja AS, Durrieu G, Gerhard T, Lee H, Kaguelidou F, Pudasainee-Kapri S, Raman S, Spence O, Horton DB. Geographic Trends in Pediatric Psychotropic Medication Dispensing Before and After the Start of the COVID-19 Pandemic. Psychiatr Serv 2023; 74:880-884. [PMID: 36751905 PMCID: PMC10403367 DOI: 10.1176/appi.ps.20220314] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVE This study examined trends and geographic variability in dispensing of prescription psychotropic medications to U.S. youths before and after the start of the COVID-19 pandemic. METHODS Using national data on prescription medication dispensing, the authors performed a cross-sectional study examining the monthly percent change in psychotropic medications dispensed (total N=95,639,975) to youths (ages 5-18 years) in 2020 versus 2019, across medication classes and geographic regions. RESULTS For many medications, more were dispensed in March 2020 than in March 2019 and fewer in April-May 2020 versus April-May 2019. Stimulants had the largest decline: -26.4% in May 2020 versus May 2019. The magnitude of the monthly percent change varied by region. CONCLUSIONS Fewer psychotropic medications were dispensed to U.S. youths after the start of the COVID-19 pandemic compared with 2019. Although some medication classes rebounded to prepandemic dispensing levels by September 2020, dispensing varied by class and region.
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Affiliation(s)
- Greta Bushnell
- Rutgers Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research; New Brunswick, NJ, USA
- Department of Biostatistics and Epidemiology; Rutgers School of Public Health; Piscataway, NJ, USA
| | - Jenny W Sun
- Safety Surveillance Research, Pfizer Inc., New York, NY, USA
| | - Susan dosReis
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Wendy Camelo Castillo
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Angela S. Czaja
- Department of Pediatrics, Critical Care section; University of Colorado School of Medicine, Aurora, CO, USA
| | - Geneviève Durrieu
- Department of Medical and Clinical Pharmacology, Centre of PharmacoVigilance and Pharmacoepidemiology; Faculty of Medicine, Toulouse University Hospital (CHU), Toulouse, France
| | - Tobias Gerhard
- Rutgers Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research; New Brunswick, NJ, USA
- Ernest Mario School of Pharmacy, Rutgers University; New Brunswick, NJ, USA
| | - Haeyoung Lee
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Florentia Kaguelidou
- Center of Clinical Investigations, INSERM CIC1426, Robert Debre Hospital, APHP.Nord, Paris Cité University, Paris, France
| | | | - Sudha Raman
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | | | - Daniel B. Horton
- Rutgers Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research; New Brunswick, NJ, USA
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School; New Brunswick, NJ, USA
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18
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Hazell PL. Increased prescribing of psychotropic medication for children and adolescents during the COVID-19 pandemic: no cause for alarm. Med J Aust 2023; 219:16-17. [PMID: 37221448 DOI: 10.5694/mja2.51977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/24/2023] [Indexed: 05/25/2023]
Affiliation(s)
- Philip L Hazell
- Concord Clinical School, the University of Sydney, Sydney, NSW
- Charles Darwin University, Darwin, NT
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19
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Meißner C, Warren C, Fadai T, Müller A, Zapf A, Lezius S, Ozga AK, Falkenberg I, Kircher T, Nestoriuc Y. Disentangling pharmacological and expectation effects in antidepressant discontinuation among patients with fully remitted major depressive disorder: study protocol of a randomized, open-hidden discontinuation trial. BMC Psychiatry 2023; 23:457. [PMID: 37344789 DOI: 10.1186/s12888-023-04941-3] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 06/08/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Antidepressants are established as an evidence-based, guideline-recommended treatment for Major Depressive Disorder. Prescriptions have markedly increased in past decades, with a specific surge in maintenance prescribing. Patients often remain on antidepressants longer than clinically necessary. When attempting to stop, many patients experience adverse discontinuation symptoms. Discontinuation symptoms can be debilitating and hinder successful discontinuation. While discontinuation symptoms can result from pharmacological effects, evidence on nocebo-induced side effects of antidepressant use suggests that patients' expectations may also influence occurrence. METHODS To disentangle pharmacological and expectation effects in antidepressant discontinuation, patients with fully remitted Major Depressive Disorder who fulfill German guideline recommendations to discontinue will either remain on or discontinue their antidepressant. Participants' expectations will be manipulated by varying verbal instructions using an open-hidden paradigm. Within the open trial arms, participants will receive full information about treatment, i.e., high expectation. Within the hidden trial arms, participants will be informed about a 50% chance of discontinuing versus remaining on their antidepressant, i.e., moderate expectation. A total of N = 196 participants will be randomly assigned to either of the four experimental groups: open discontinuation (OD; n = 49), hidden discontinuation (HD; n = 49), open continuation (OC; n = 49), or hidden continuation (HC; n = 49). Discontinuation symptom load during the 13-week experimental phase will be our primary outcome measure. Secondary outcome measures include discontinuation symptom load during the subsequent 39-week clinical observation phase, recurrence during the 13-week experimental period, recurrence over the course of the complete 52-week trial evaluated in a time-to-event analysis, and stress, anxiety, and participants' attentional and emotional processing at 13 weeks post-baseline. Blood and saliva samples will be taken as objective markers of antidepressant blood serum level and stress. Optional rsfMRI measurements will be scheduled. DISCUSSION Until today, no study has explored the interplay of pharmacological effects and patients' expectations during antidepressant discontinuation. Disentangling their effects has important implications for understanding mechanisms underlying adverse discontinuation symptoms. Results can inform strategies to manage discontinuation symptoms and optimize expectations in order to help patients and physicians discontinue antidepressants more safely and effectively. TRIAL REGISTRATION ClinicalTrials.gov (NCT05191277), January 13, 2022.
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Affiliation(s)
- Carina Meißner
- Clinical Psychology, Helmut-Schmidt-University/University of the Federal Armed Forces Hamburg, Holstenhofweg 85, 22043, Hamburg, Germany.
- Institute of Systems Neuroscience, University-Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Claire Warren
- Clinical Psychology, Helmut-Schmidt-University/University of the Federal Armed Forces Hamburg, Holstenhofweg 85, 22043, Hamburg, Germany
- Institute of Systems Neuroscience, University-Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Tahmine Fadai
- Institute of Systems Neuroscience, University-Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Amke Müller
- Clinical Psychology, Helmut-Schmidt-University/University of the Federal Armed Forces Hamburg, Holstenhofweg 85, 22043, Hamburg, Germany
- Institute of Systems Neuroscience, University-Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Antonia Zapf
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Lezius
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ann-Kathrin Ozga
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Irina Falkenberg
- Department of Psychiatry, University of Marburg, Marburg, Germany
| | - Tilo Kircher
- Department of Psychiatry, University of Marburg, Marburg, Germany
| | - Yvonne Nestoriuc
- Clinical Psychology, Helmut-Schmidt-University/University of the Federal Armed Forces Hamburg, Holstenhofweg 85, 22043, Hamburg, Germany
- Institute of Systems Neuroscience, University-Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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20
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Ooms GI, van Oirschot J, de Kant D, van den Ham HA, Mantel-Teeuwisse AK, Reed T. Barriers to accessing internationally controlled essential medicines in sub-saharan Africa: A scoping review. Int J Drug Policy 2023; 118:104078. [PMID: 37276779 DOI: 10.1016/j.drugpo.2023.104078] [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: 11/28/2022] [Revised: 05/14/2023] [Accepted: 05/22/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Access to internationally controlled essential medicines (ICEMs), medicines that are listed on both the World Health Organization's Essential Medicines List and one of three international drug control conventions, remains problematic in Sub-Saharan Africa (SSA). Previous reviews have focused only on specific ICEMs or ICEM-related healthcare fields, but none have focused on all ICEMs as a distinct class. This scoping review therefore aims to identify the barriers to accessing ICEMs across all relevant healthcare fields in SSA. METHODS A scoping review was conducted across indexing platforms Embase, PubMed, Scopus and Web of Science of studies published between January 1 2012 and February 1 2022. Articles were eligible if they mentioned barriers to accessing ICEMs and/or ICEM-related healthcare fields, if studies were conducted in SSA, or included data on an SSA country within a multi-country study. The review was guided by the Access to Medicines from a Health System Perspective framework. RESULTS The search identified 5519 articles, of which 97 met the inclusion criteria. Many barriers to access were reported and were common across the ICEMs drug class. Main barriers were: at the individual level, the lack of knowledge about ICEMs; at the health service delivery level, low availability, stockouts, affordability, long distances to health facilities, insufficient infrastructure to store and distribute ICEMs, and lack of ICEM knowledge and training among healthcare workers; at the health sector level, lack of prioritisation of ICEM-related healthcare fields by governments and subsequent insufficient budget allocation. Cross-cutting, governance-related barriers pertained to lack of proper quantification systems, cumbersome procurement processes, and strict national laws controlling ICEMs, leading to overly restrictive prescription practices. CONCLUSION This review showed that there are a multitude of barriers to accessing ICEMs in SSA across all health system levels. Many of the barriers identified are applicable to all ICEMs, highlighting the importance of tackling barriers for this entire class of drugs together.
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Affiliation(s)
- Gaby I Ooms
- Utrecht WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands; Health Action International, Amsterdam, the Netherlands.
| | | | | | - Hendrika A van den Ham
- Utrecht WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands
| | - Aukje K Mantel-Teeuwisse
- Utrecht WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands
| | - Tim Reed
- Health Action International, Amsterdam, the Netherlands
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21
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Casas Martínez MDLL. The medicalization of life: An interdisciplinary approach. Heliyon 2023; 9:e16637. [PMID: 37292280 PMCID: PMC10245052 DOI: 10.1016/j.heliyon.2023.e16637] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 05/14/2023] [Accepted: 05/23/2023] [Indexed: 06/10/2023] Open
Abstract
In recent years, consumption of antidepressant and psychotropic drugs has skyrocketed and, although contemporary life clearly involves countless conflicts, the same can be said of human beings throughout their respective historical moments. Part of the human condition is recognizing that we are vulnerable and dependent beings, thus philosophical reflection brings us to an important ontological point of consideration. The World Health Organization has expressed its regarding the medicalization of life, as have many renowned psychiatrists who subscribe to the philosophical idea of naturally overcoming life's conflicts through resilience. In this paper, we analyze the anthropological view of the human being as a being in need, the problem of the medicalization of emotional life in contemporary society, and the psychological position of resilience. We conclude that psychology and philosophy hold similar personal development tools for people without significant psychiatric or psychological problems in order to face the problems of human existence with self-government.
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22
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Kyou Y, Oishi S, Takizawa T, Yoshimura Y, Hashimoto I, Suzuki R, Demizu R, Ono T, Noguchi Y, Kimura T, Inada K, Miyaoka H. Influence of Psychotropic Pro Re Nata Drug Use on Outcomes in Hospitalized Patients with Schizophrenia. Clin Psychopharmacol Neurosci 2023; 21:332-339. [PMID: 37119226 PMCID: PMC10157018 DOI: 10.9758/cpn.2023.21.2.332] [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] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/14/2022] [Accepted: 05/19/2022] [Indexed: 05/01/2023]
Abstract
Objective In the treatment of patients with schizophrenia, pro re nata (PRN) drugs are commonly prescribed for medical indications such as agitation, acute psychiatric symptoms, insomnia, and anxiety. However, high-quality evidence supporting the use of PRN medications is lacking, and these drugs are administered on the basis of clinical experience and habits. Therefore, the actual use of psychotropic PRN drugs and its influence on the patients' outcomes need to be investigated. Methods This study included 205 patients who underwent inpatient treatment for schizophrenia. We investigated the prescription of psychotropic drugs before admission and at discharge, as well as the dosing frequency of PRN drugs during hospitalization. We also examined the influence of psychotropic PRN drug use on hospitalization days, antipsychotic polypharmacy, and readmission rates. Results Patients who used psychotropic PRN drugs during hospitalization had significantly longer hospitalization days (p = 7.5 × 10-4) and significantly higher rates of antipsychotic polypharmacy (p = 2.4 × 10-4) at discharge than those who did not use psychotropic PRN drugs. Moreover, a higher number of psychotropic PRN drugs used per day was associated with higher readmission rates within 3 months of discharge (p = 4.4 × 10-3). Conclusion Psychotropic PRN drug use is associated with prolonged hospitalization, antipsychotic polypharmacy, and increased readmission rates in inpatients with schizophrenia. Therefore, psychiatric symptoms should be stabilized with regularly prescribed medications without the extensive use of psychotropic PRN drugs. Moreover, a system for monitoring and reexamining PRN drug use needs to be established.
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Affiliation(s)
- Yoshitaka Kyou
- Department of Psychiatry, Kitasato University School of Medicine, Sagamihara, Japan
| | - Satoru Oishi
- Department of Psychiatry, Kitasato University School of Medicine, Sagamihara, Japan
| | - Takeya Takizawa
- Department of Medical Psychology, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Yuki Yoshimura
- Department of Psychiatry, Kitasato University School of Medicine, Sagamihara, Japan
| | - Itsuki Hashimoto
- Department of Psychiatry, Kitasato University School of Medicine, Sagamihara, Japan
| | - Ryutaro Suzuki
- Department of Psychiatry, Kitasato University School of Medicine, Sagamihara, Japan
| | - Reina Demizu
- Department of Psychiatry, Kitasato University School of Medicine, Sagamihara, Japan
| | - Tsuyoshi Ono
- Department of Psychiatry, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yuka Noguchi
- Department of Psychiatry, Kitasato University School of Medicine, Sagamihara, Japan
| | - Tomohiko Kimura
- Department of Psychiatry, Kitasato University School of Medicine, Sagamihara, Japan
- Department of Psychiatry, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Ken Inada
- Department of Psychiatry, Kitasato University School of Medicine, Sagamihara, Japan
| | - Hitoshi Miyaoka
- Department of Psychiatry, Kitasato University School of Medicine, Sagamihara, Japan
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23
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Merrill RM, Ashton MK, Angell E. Sleep disorders related to index and comorbid mental disorders and psychotropic drugs. Ann Gen Psychiatry 2023; 22:23. [PMID: 37245028 DOI: 10.1186/s12991-023-00452-3] [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: 01/14/2023] [Accepted: 05/13/2023] [Indexed: 05/29/2023] Open
Abstract
PURPOSE Mental disorders positively associate with sleep disorders. This study will explore the moderating influence of comorbid mental disorders and whether selected psychotropic drugs correlate with sleep disorders after adjusting for mental disorders. METHODS A retrospective cohort study design was employed using medical claim data from the Deseret Mutual Benefit Administrators (DMBA). Mental disorders, psychotropic drug use, and demographic data were extracted from claim files for ages 18-64, years 2016-2020. RESULTS Approximately 11.7% filed one or more claims for a sleep disorder [insomnia (2.2%) and sleep apnea (9.7%)]. Rates for selected mental disorders ranged from 0.09% for schizophrenia to 8.4% for anxiety. The rate of insomnia is greater in those with bipolar disorder or schizophrenia than in other mental disorders. The rate of sleep apnea is greater in those with bipolar disorder and depression. There is a significantly positive association between mental disorders and insomnia and sleep apnea, more so for insomnia, especially if they had other comorbid mental disorders. Psychotropic drugs other than CNS stimulants, primarily sedatives (non-barbiturate) and psychostimulants, explain much of the positive association between anxiety, depression, and bipolar disorder with insomnia. Psychotropic drugs with the largest effect on sleep disorders are sedatives (non-barbiturate) and psychostimulants for insomnia and psychostimulants and anticonvulsants for sleep apnea. CONCLUSION Mental disorders positively correlate with insomnia and sleep apnea. The positive association is greater when multiple mental illness exists. Bipolar disorder and schizophrenia are most strongly associated with insomnia, and bipolar disorder and depression are most strongly associated with sleep disorders. Psychotropic drugs other than CNS stimulants, primarily sedatives (non-barbiturate) and psychostimulants for treating anxiety, depression, or bipolar disorder are associated with higher levels of insomnia and sleep apnea.
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Affiliation(s)
- Ray M Merrill
- Department of Public Health, College of Life Sciences, Brigham Young University, Provo, UT, 84602, USA.
| | - McKay K Ashton
- Department of Public Health, College of Life Sciences, Brigham Young University, Provo, UT, 84602, USA
| | - Emily Angell
- Department of Public Health, College of Life Sciences, Brigham Young University, Provo, UT, 84602, USA
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24
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Wood SJ, Ilomäki J, Gould J, Tan GS, Raven M, Jureidini JN, Grzeskowiak LE. Dispensing of psychotropic medications to Australian children and adolescents before and during the COVID-19 pandemic, 2013-2021: a retrospective cohort study. Med J Aust 2023. [PMID: 37182907 DOI: 10.5694/mja2.51948] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/30/2023] [Accepted: 03/01/2023] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To determine longitudinal patterns of dispensing of antidepressant, anxiolytic, antipsychotic, psychostimulant, and hypnotic/sedative medications to children and adolescents in Australia during 2013-2021. DESIGN Retrospective cohort study; analysis of 10% random sample of Pharmaceutical Benefits Scheme (PBS) dispensing data. PARTICIPANTS, SETTING People aged 18 years or younger dispensed PBS-subsidised psychotropic medications in Australia, 2013-2021. MAIN OUTCOME MEASURES Population prevalence of dispensing of psychotropic medications to children and adolescents, by psychotropic class, gender, and age group (0-6, 7-12, 13-18 years). RESULTS The overall prevalence of psychotropic dispensing to children and adolescents was 33.8 per 1000 boys and 25.2 per 1000 girls in 2013, and 60.0 per 1000 boys and 48.3 per 1000 girls in 2021. The prevalence of psychotropic polypharmacy was 5.4 per 1000 boys and 3.7 per 1000 girls in 2013, and 10.4 per 1000 boys and 8.3 per 1000 girls in 2021. Prevalent dispensing during 2021 was highest for psychostimulants (boys, 44.0 per 1000; girls, 17.4 per 1000) and antidepressants (boys, 20.4 per 1000; girls, 33.8 per 1000). During 2021, the prevalence of dispensing was higher than predicted by extrapolation of 2013-2019 data for many classes, including antidepressants (boys: +6.1%; 95% CI, 1.1-11.1%; girls: +22.2%; 95% CI, 17.4-26.9%), and psychostimulants (boys: +14.5%; 95% CI, 8.0-21.1%; girls: +27.7%; 95% CI, 18.9-36.6%). The increases were greatest for girls aged 13-18 years (antidepressants: +20.3%; 95% CI, 16.9-23.7%; psychostimulants: +39.0%; 95% CI, 27.9-50.0%). CONCLUSIONS The prevalence of both psychotropic dispensing and psychotropic polypharmacy for children and adolescents were twice as high in 2021 as in 2013. The reasons and appropriateness of the marked increases in psychotropic dispensing during the COVID-19 pandemic, particularly to adolescent girls, should be investigated.
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Affiliation(s)
- Stephen J Wood
- Centre for Medicine Use and Safety, Monash University, Melbourne, VIC
| | - Jenni Ilomäki
- Centre for Medicine Use and Safety, Monash University, Melbourne, VIC
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC
| | - Jacqueline Gould
- South Australian Health and Medical Research Institute, Adelaide, SA
- Robinson Research Institute, University of Adelaide, Adelaide, SA
| | - George Sq Tan
- Centre for Medicine Use and Safety, Monash University, Melbourne, VIC
| | - Melissa Raven
- Robinson Research Institute, University of Adelaide, Adelaide, SA
| | - Jon N Jureidini
- Robinson Research Institute, University of Adelaide, Adelaide, SA
| | - Luke E Grzeskowiak
- Centre for Medicine Use and Safety, Monash University, Melbourne, VIC
- College of Medicine and Public Health, Flinders University, Adelaide, SA
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25
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Nishio T, Toukairin Y, Hoshi T, Arai T, Nogami M. Quantification of nine psychotropic drugs in postmortem dried blood spot samples by liquid chromatography-tandem mass spectrometry for simple toxicological analysis. J Pharm Biomed Anal 2023; 233:115438. [PMID: 37167768 DOI: 10.1016/j.jpba.2023.115438] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 03/20/2023] [Revised: 04/25/2023] [Accepted: 05/01/2023] [Indexed: 05/13/2023]
Abstract
Dried blood spot (DBS) sampling has evolved to become the method of choice for collecting samples for newborn screening and therapeutic drug monitoring worldwide. The major advantage of this approach is that it requires only a small amount of blood. In addition, the collection of DBSs on filter paper is simple, sample storage costs are small, and the process deactivates microorganisms and viruses. However, despite these advantages, DBS sampling is seldom used in forensic toxicological analyses. Here, we developed and validated an approach that uses liquid chromatography coupled with electrospray ionization-tandem mass spectrometry for quantifying nine psychotropic drugs (citalopram, duloxetine, mirtazapine, olanzapine, paroxetine, quetiapine, sertraline, zolpidem and zopiclone) in cadaveric DBS samples. Most of them are frequently used by self-harm but are not already targeted by an existing drug screening kit. Our method use only one 3-mm disk excised from each DBS and does not require the troublesome purification process. The linearities of the calibration curves were good in the concentration range of 0.05-1.0 μg/mL. Our method allows for repeatable and accurate quantification with intra- and inter-assay coefficients of variation of below 11.9% and below 12.5%, respectively, for each of the target drugs. In addition, the target drug concentrations in the DBSs remained stable for at least one month when stored at - 80 °C. Compared with our institute's routine method for cadaveric blood sampling, the QuEChERS method, quantifiable concentrations showed a good positive correlation for each of the target drugs. In addition, the concentrations of almost all the target drugs obtained with DBS sampling method were comparable with those obtained with the QuEChERS sampling method. Thus, the present findings extend the possible uses of DBS sampling to the quantification of multiple psychotropic drugs in the field of forensic toxicological testing.
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Affiliation(s)
- Tadashi Nishio
- Department of Legal Medicine, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo 173-8605, Japan.
| | - Yoko Toukairin
- Department of Legal Medicine, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo 173-8605, Japan
| | - Tomoaki Hoshi
- Department of Legal Medicine, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo 173-8605, Japan
| | - Tomomi Arai
- Department of Legal Medicine, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo 173-8605, Japan
| | - Makoto Nogami
- Department of Legal Medicine, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo 173-8605, Japan
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Hardie RA, Sezgin G, Pont LG, Thomas J, Prgomet M, McGuire P, Pearce C, Georgiou A. Psychotropic medication prescribing for children and adolescents by general practitioners during the COVID-19 pandemic. Med J Aust 2023. [PMID: 37106508 DOI: 10.5694/mja2.51942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 04/29/2023]
Affiliation(s)
- Rae-Anne Hardie
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW
| | - Gorkem Sezgin
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW
| | - Lisa G Pont
- Graduate School of Health, University of Technology Sydney, Sydney, NSW
| | - Judith Thomas
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW
| | - Mirela Prgomet
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW
| | | | | | - Andrew Georgiou
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW
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Thürmann PA, Bergner S, Jaehde U. [Polypharmacy in nursing homes: options to improve drug therapy safety]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023; 66:530-539. [PMID: 37042988 DOI: 10.1007/s00103-023-03694-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 03/24/2023] [Indexed: 04/13/2023]
Abstract
Patients in need of care usually suffer from multiple chronic conditions and therefore receive a high number of drugs. Polypharmacy involves multiple risks, for example, drug-drug and drug-disease interactions, adverse effects and potentially inappropriate medication (PIM), more hospital admissions, and increased mortality.Residents in long-term care facilities are particularly sensitive to adverse drug reactions because of age-related changes, frailty, and the high prevalence of dementia. Numerous drugs have side effects that lead to sedation, particularly in old age, and increase the risk of falls. In addition, anticholinergic effects negatively modify cognition. These PIMs are frequently prescribed to nursing home residents.The medication process in long-term care facilities is complex and requires numerous coordinated processes. In addition to the correct administration, the nursing staff have other important tasks such as monitoring the effects and potential adverse drug reactions and communicating their observations to the prescribing physicians and home-supplying pharmacists. The nursing staff therefore play a crucial role in the prescription of psychotropic drugs and contribute to the medication quality for nursing home residents. National and international studies indicate that improvements of polypharmacy and drug therapy safety in nursing homes can only be achieved by interprofessional collaboration.
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Affiliation(s)
- Petra A Thürmann
- Lehrstuhl für Klinische Pharmakologie, Fakultät für Gesundheit, Universität Witten/Herdecke, Helios Universitätsklinikum Wuppertal, Alfred-Herrhausen-Straße 50, 58455, Witten, Deutschland.
| | - Simone Bergner
- Abteilung Pharmakovigilanz, Bundesinstitut für Arzneimittel und Medizinprodukte (BfArM), Bonn, Deutschland
| | - Ulrich Jaehde
- Abteilung Klinische Pharmazie, Pharmazeutisches Institut, Universität Bonn, Bonn, Deutschland
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Schetz D, Scott TE, Waldman W, Sein Anand J, Wiergowski M, Kocić I. Reports analysis of psychotropic drugs related adverse reactions in Australia and Poland during the COVID 19 pandemic. Biomed Pharmacother 2023; 162:114681. [PMID: 37058823 PMCID: PMC10080277 DOI: 10.1016/j.biopha.2023.114681] [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: 01/16/2023] [Revised: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has caused significant changes to the global health care system AIMS: It is unknown whether the COVID-19 pandemic influenced the occurrence of adverse drug reactions (ADR) of antidepressive agents, benzodiazepines, and antipsychotics plus mood stabilizers (AaMS). The study was designed in order to compare the incidence of ADR during the COVID-19 pandemic with the period preceding the pandemic in Poland and Australia, different in terms of their COVID-19 prevention strategy. METHOD We analysed ADR from the three surveyed pharmacological groups of drugs observed in Poland and Australia in the period prior to, and during the COVID-19 pandemic RESULTS: In Poland, a noticeable increase in the reported ADR of the assessed drug groups was observed during the COVID-19 pandemic. The highest was for antidepressive agents, but the reporting of ADR for benzodiazepines and AaMS drugs also increased significantly. In the case of ADR in Australian patients, the increase in the number of reported ADR for antidepressive agents was modest compared to that seen in Poland, but still noticeable, and there was a significant increase in ADR for benzodiazepines CONCLUSIONS: This study showed that the COVID-19 pandemic has had an impact on the incidence of ADR reported among both Polish and Australian patients but the modality of this was different.
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Affiliation(s)
- Daria Schetz
- Department of Pharmacology, Faculty of Medicine, Medical University of Gdańsk, Poland.
| | - Tara Elizabeth Scott
- Department of Pharmacology, Faculty of Medicine, Medical University of Gdańsk, Poland
| | - Wojciech Waldman
- Division of Clinical Toxicology, Faculty of Health Sciences with the Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, Poland
| | - Jacek Sein Anand
- Division of Clinical Toxicology, Faculty of Health Sciences with the Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, Poland
| | - Marek Wiergowski
- Department of Forensic Medicine, Faculty of Medicine, Medical University of Gdańsk, Poland
| | - Ivan Kocić
- Department of Pharmacology, Faculty of Medicine, Medical University of Gdańsk, Poland
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Girma B, Wondie A, Debebe W, Juhar A, Tegene E, Bedane D, Mulat E. Electrocardiogram abnormalities and associated factors among psychiatric patients attending follow up at Jimma Medical Center Psychiatry Clinic, Jimma, Ethiopia: an institution-based cross-sectional study. BMC Cardiovasc Disord 2023; 23:178. [PMID: 37005595 PMCID: PMC10066966 DOI: 10.1186/s12872-023-03092-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 01/24/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND Psychiatric patients have two to three-fold higher risk of cardiovascular morbidity and mortality as compared to the general population. Despite the high rate of cardiovascular disease, about 80% of patients with psychiatric disorders have fewer opportunities for cardiovascular disease screening. Early detection of subclinical cardiovascular disease using an electrocardiogram can improve the clinical outcomes of these patients. However, in Ethiopia, no previous study had been conducted on electrocardiogram abnormalities and associated factors among psychiatric patients. Hence, this study aimed to assess the electrocardiogram abnormalities and associated factors among psychiatric patients attending follow-up at Jimma Medical Center, Jimma, Ethiopia. METHODS An institution-based cross-sectional study was carried out among psychiatric patients attending Jimma Medical Center Psychiatry Clinic from October 14 to December 10, 2021. An interviewer-administered structured questionnaire was used to collect socio-demographic data, behavioral factors, disease-related and medication-related data. Anthropometry and blood pressure were measured following the standard protocols. A resting 12 lead ECG was recorded according to the standard recording protocol of the Minnesota code. Data were entered into Epi data version 4.6 and exported to SPSS version 25. Results of the descriptive analysis were summarized by frequencies, means, and proportions, and presented by using tables and figures. Bivariable and multivariable logistic regressions were performed. p value < 0.05 was considered statistically significant. RESULT A total of 315 psychiatric patients were included in the present study. The mean age (SD) of the respondents was 36.27 ± 10.85 years. ECG abnormalities were identified among 191 (60.6%) respondents. Age older than 40 years [AOR = 3.31: 95% CI 1.58-6.89], treatment with antipsychotics [AOR = 4.16: 95% CI 1.25-13.79], polytherapy [AOR = 3.13: 95% CI 1.15-8.62], having schizophrenia [AOR = 3.11: 95% CI 1.20-8.11], and illness duration of > 10 years [AOR = 4.25: 95% CI 1.72-10.49] were significantly associated with ECG abnormalities. CONCLUSIONS In the present study, six out of ten respondents had ECG abnormalities. Age of the respondents, treatment with antipsychotics, having schizophrenia, polytherapy and illness duration of > 10 years were significant predictors of ECG abnormalities. Routine ECG investigation should be performed in the psychiatry treatment setting and further studies are recommended to delineate factors affecting ECG abnormalities.
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Affiliation(s)
- Betemariam Girma
- Department of Biomedical Sciences, College of Medicine and Health Sciences, Wolkite University, P.O. Box 07, Wolkite, Ethiopia.
| | - Alemayehu Wondie
- Department of Biomedical Sciences, College of Medicine and Health Sciences, Wolkite University, P.O. Box 07, Wolkite, Ethiopia
| | - Wondwosen Debebe
- Department of Biomedical Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Ahmed Juhar
- Department of Biomedical Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Elsah Tegene
- Department of Internal Medicine, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Deriba Bedane
- Department of Biomedical Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Elias Mulat
- Department of Biomedical Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
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Tärnhäll A, Björk J, Wallinius M, Gustafsson P, Billstedt E, Hofvander B. Healthcare utilization and psychiatric morbidity in violent offenders: findings from a prospective cohort study. Soc Psychiatry Psychiatr Epidemiol 2023; 58:617-628. [PMID: 36574014 PMCID: PMC10066109 DOI: 10.1007/s00127-022-02408-6] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 12/12/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE Although persistent offenders with histories of imprisonment and violence have disproportionate high rates of psychiatric disorders, little is known of their psychiatric healthcare utilization (HCU) and HCU-associated factors. This study aimed to explore psychiatric HCU, psychiatric morbidity, and psychotropic prescription drugs in violent offenders with a history of incarceration. METHODS Male offenders aged 18-25 (n = 266) imprisoned for violent and/or physical sexual offenses were clinically assessed in 2010-2012 and prospectively followed in Swedish national registries through 2017. Register-based information regarding HCU, psychiatric morbidity, and psychotropic drugs was tracked and compared with a general population group (n = 10,000) and across offending trajectory groups. Baseline risk factors were used to explain prospective psychiatric HCU in violent offenders. RESULTS Violent offenders used less general healthcare and psychiatric outpatient care, but more psychiatric inpatient care and were more often given psychiatric diagnoses and psychotropic drugs than the general population. Participants previously assigned to persisting offending trajectory groups had higher rates of psychiatric HCU than those assigned to a desisting trajectory. In multivariable regression models, psychiatric HCU was associated with anxiety disorders, prior psychiatric contact, placement in a foster home, psychopathic traits, low intellectual functioning, and persistent offending. CONCLUSIONS Violent offenders are burdened by extensive and serious psychiatric morbidity and typically interact with psychiatric healthcare as inpatients rather than outpatients. Knowledge about their backgrounds, criminal behaviors, and psychiatric statuses can aid the planning of psychiatric services for this troublesome group.
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Affiliation(s)
- André Tärnhäll
- Lund Clinical Research on Externalizing and Developmental Psychopathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
- Department of Forensic Psychiatry, Region Skåne, Malmö, Sweden.
- Centre of Ethics, Law and Mental Health, Department of Psychiatry and Neurochemistry, University of Gothenburg, Gothenburg, Sweden.
| | - Jonas Björk
- Department of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Märta Wallinius
- Lund Clinical Research on Externalizing and Developmental Psychopathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Centre of Ethics, Law and Mental Health, Department of Psychiatry and Neurochemistry, University of Gothenburg, Gothenburg, Sweden
- Research Department, Regional Forensic Psychiatric Clinic, Växjö, Sweden
| | - Peik Gustafsson
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Eva Billstedt
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Björn Hofvander
- Lund Clinical Research on Externalizing and Developmental Psychopathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Forensic Psychiatry, Region Skåne, Malmö, Sweden
- Centre of Ethics, Law and Mental Health, Department of Psychiatry and Neurochemistry, University of Gothenburg, Gothenburg, Sweden
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D'Andrea G, Pascale R, Vatamanu O, Giacomini ME, Caroccia N, Giannella M, Carloni AL, Cesa F, Mordenti O, Muratori R, Tarricone I, Viale P. Exposure to psychotropic medications and COVID-19 course after hospital admission: Results from a prospective cohort study. J Psychosom Res 2023; 167:111199. [PMID: 36827888 PMCID: PMC9938755 DOI: 10.1016/j.jpsychores.2023.111199] [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: 03/26/2022] [Revised: 02/08/2023] [Accepted: 02/13/2023] [Indexed: 02/21/2023]
Abstract
OBJECTIVE There is evidence of a bidirectional association between COVID-19 disease and psychiatric disorders. We aimed to assess whether exposure to psychotropic medications prior to hospitalization was associated with mortality or discharge within 30 days after hospital admission. METHODS In this prospective study, we included all individuals with a laboratory-confirmed COVID-19 infection who were admitted to the Bologna University Hospital between 1st March 2020 and 31st January 2021. We collected data about pre-existing psychiatric disorders and the use of psychotropic medications at the admission. As univariate analyses, we estimated cumulative incidence functions for 30-day mortality and discharge stratifying by exposure to each of the psychotropic medication classes. Finally, we fitted Cox regression models to estimate cause-specific Hazard Ratios (HR) of 30-day mortality and discharge. Results were adjusted for sociodemographic (age, sex), clinically relevant variables (comorbidity, c-reactive protein levels, severity of disease at presentation, history of smoking, study period), and psychiatric variables (psychiatric disorder diagnosis, number of psychotropic medications). RESULTS Out of a total of 1238 hospitalized patients, 316 were prescribed psychotropic medications at the time of admission. Among these, 45 (3.6%) were taking a first-generation antipsychotics (FGA) and 66 (5.3%) a second generation antipsychotic (SGA). Exposure to SGA was associated with increased rates of 30-day mortality (HR = 2.01, 95%CI = 1.02-3.97) and exposure to FGA was associated with decreased rates of 30-day discharge (HR = 0.55, 95%CI = 0.33-0.90). CONCLUSION Patients with COVID-19 infection exposed to FGA and SGA may have worse COVID-19 infection outcomes.
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Affiliation(s)
- G D'Andrea
- Community Mental Health Center of Sassuolo, Department of Mental Health and Drug Abuse, AUSL Modena, Modena, Italy; Department of Medical and Surgical Sciences, Bologna Transcultural Psychosomatic Team (BoTPT), University of Bologna, Bologna, Italy.
| | - R Pascale
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - O Vatamanu
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - M E Giacomini
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - N Caroccia
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - M Giannella
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - A L Carloni
- Department of Medical and Surgical Sciences, Bologna Transcultural Psychosomatic Team (BoTPT), University of Bologna, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - F Cesa
- Department of Medical and Surgical Sciences, Bologna Transcultural Psychosomatic Team (BoTPT), University of Bologna, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - O Mordenti
- Department of Medical and Surgical Sciences, Bologna Transcultural Psychosomatic Team (BoTPT), University of Bologna, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - R Muratori
- Department of Mental Health of Bologna, AUSL Bologna, Bologna, Italy
| | - I Tarricone
- Department of Medical and Surgical Sciences, Bologna Transcultural Psychosomatic Team (BoTPT), University of Bologna, Bologna, Italy; Department of Mental Health of Bologna, AUSL Bologna, Bologna, Italy
| | - P Viale
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
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Du J, Janus SIM, de Boer M, Zuidema SU. The longitudinal patterns of psychotropic drug prescriptions for subpopulations of community-dwelling older people with dementia: electronic health records based retrospective study. BMC Prim Care 2023; 24:69. [PMID: 36907845 PMCID: PMC10009999 DOI: 10.1186/s12875-023-02021-9] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/27/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Studies focusing on patterns of psychotropic drug prescriptions (PDPs) for subpopulations of community-dwelling older people with dementia are lacking. OBJECTIVE The aim of this study was to identify the longitudinal patterns of PDPs in subpopulations. METHODS This retrospective study used electronic health records from general practitioners (GPs) in the Netherlands. People (N = 1278) firstly diagnosed with dementia between 2013 and 2015, aged 65 years or older, were selected and categorized into four subpopulations: community-dwelling (CD) group throughout follow-up, ultimately admitted to nursing homes (NH) group, ultimately died (DIE) group, and ultimately deregistered for unclear reasons (DeR) group. Generalised estimating equations were used to estimate the patterns of psychotropic drug prescriptions, after the diagnosis of dementia for a five-year follow-up, and 0-3 months before institutionalisation or death. RESULTS Over the five-year follow-up, antipsychotic prescriptions increased steadily in CD (OR = 1.07 [1.04-1.10]), NH (OR = 1.10 [1.04-1.15]), and DIE (OR = 1.05 [1.02-1.08]) groups. Similarly, prescriptions of antidepressants also showed upward trends in CD (OR = 1.04 [1.02-1.06]), NH (OR = 1.10 [1.02-1.18]), and DIE (OR = 1.04 [1.00-1.08]) groups. The other psychotropic drugs did not show clear changes over time in most of the subpopulations. In the three months before institutionalisation, antipsychotic prescriptions increased (OR = 2.12 [1.26-3.57]) in the NH group compared to prior periods. Likewise, before death, prescriptions of antipsychotics (OR = 1.74 [1.28-2.38]) and hypnotics and sedatives (OR = 2.11 [1.54-2.90]) increased in the DIE group, while anti-dementia drug prescriptions decreased (OR = 0.42 [0.26-0.69]). CONCLUSIONS After community-dwelling older people are diagnosed with dementia, all subpopulations' prescriptions of antipsychotics and antidepressants increase continuously during the follow-up. While we cannot judge whether these prescriptions are appropriate, GPs might consider a more reluctant use of psychotropic drugs and use alternative psychosocial interventions. Additionally, antipsychotic prescriptions rise considerably shortly before institutionalisation or death, which might reflect that older people experience more neuropsychiatric symptoms during this period.
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Affiliation(s)
- Jiamin Du
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Sarah I M Janus
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands.
- Alzheimer Centre Groningen, Groningen, the Netherlands.
| | - Michiel de Boer
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Sytse U Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
- Alzheimer Centre Groningen, Groningen, the Netherlands
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Schulz RN, Jannace KC, Hisle-Gorman EJ, Pasquina PF. Retrospective Examination of Service Dog Training Program Participation and Mental Healthcare Utilization. Arch Phys Med Rehabil 2023; 104:237-244. [PMID: 35917950 DOI: 10.1016/j.apmr.2022.07.009] [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: 02/14/2022] [Revised: 07/14/2022] [Accepted: 07/17/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate the association between Service Dog Training Program (SDTP) participation and mental health care utilization. DESIGN Retrospective cohort study. SETTING Outpatient rehabilitation clinic at a large military treatment facility. PARTICIPANTS Military Health System beneficiaries who attended at least 1 SDTP session at a large military treatment facility (N=597). SDTP program enrollment records identified participants. INTERVENTION The SDTP, a unique application of animal-assisted therapy, is intended to improve the mental and cognitive health for individuals with war-related trauma. MAIN OUTCOME MEASURES Negative binomial regression calculated the associations between the SDTP participation rate and 2 mental health care utilization outcomes: mental health encounter days and psychotropic medication months' supply. RESULTS Most of the 597 participants were male, enlisted service members, and aged 25-34 years. Approximately 46% had a posttraumatic stress disorder diagnosis, 21% had a traumatic brain injury diagnosis, 47% had an opioid prescription, and 58% had a sleep aid prescription pre-SDTP participation. Participation was categorized into low (≤1 sessions), medium (>1 and ≤2 sessions), and high (>2 sessions) monthly participation. In adjusted analysis, high monthly SDTP participation was associated with 18% fewer post-SDTP mental health encounter days (rate ratio [RR], 0.82; 95% confidence interval [CI], 0.68-0.96) than low monthly SDTP participation. High monthly SDTP participation was also associated with a 22% fewer post-SDTP psychotropic prescription months' supply (RR, 0.78; 95% CI, 0.64-0.95) than low monthly SDTP participation in adjusted analysis. CONCLUSIONS Results suggest that participants who attend more than 2 SDTP sessions monthly encounter mental health care differently post SDTP than participants who attended 1 or fewer monthly sessions. Adjunct therapies, such as the SDTP, may offer patients a nonstigmatizing way to engage in mental health care.
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Affiliation(s)
- Rebecca N Schulz
- Uniformed Services University of Health Sciences, Bethesda, Maryland; Walter Reed National Military Medical Center, Bethesda, Maryland; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland.
| | - Kalyn C Jannace
- Uniformed Services University of Health Sciences, Bethesda, Maryland; Walter Reed National Military Medical Center, Bethesda, Maryland; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | | | - Paul F Pasquina
- Uniformed Services University of Health Sciences, Bethesda, Maryland; Walter Reed National Military Medical Center, Bethesda, Maryland
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Chen Y, Ding L. Potential drug-drug interactions in outpatients with depression of a psychiatry department. Saudi Pharm J 2023; 31:207-213. [PMID: 36942274 PMCID: PMC10023543 DOI: 10.1016/j.jsps.2022.12.004] [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: 06/14/2022] [Accepted: 12/09/2022] [Indexed: 12/16/2022] Open
Abstract
Objective This study aims to explore the prevalence and associated risk factors for potential drug-drug interactions (pDDIs) in prescriptions among outpatients with depression, and report the widespread relevant drug interactions. Methods The cross-sectional retrospective study was conducted on outpatients in a psychiatric hospital. We included prescriptions of outpatients with a principal diagnosis of depression from April 1st to June 30th in 2021. The patients were ≥ 18 years old and treated with two or more drugs including at least one psychotropic drug. pDDIs were detected and identified mainly using Medscape's drug interactions checker. Gender, the number of concomitant drugs, age and diagnosis were analysed as potential risk factors for the occurrence of pDDIs by logistic regression. Results A total of 13,617 prescriptions were included in the present analysis, and 4222 prescriptions (31.0%) were at risk of 8557 pDDIs. The risk of pDDIs in patients who were prescribed 4-6 drugs (OR: 3.49, 95% CI: 3.11-3.91, p < 0.001) or 7 or more drugs simultaneously (OR: 7.86, 95% CI: 1.58-39.04, p < 0.05) increased compared with patients prescribed 2-3 drugs. Patients with recurrent depressive disorders (OR: 1.18, 95% CI: 1.02-1.36, p < 0.05) had an increased risk of pDDIs compared with patients with depressive episodes. In terms of severity of pDDIs identified by Medscape's drug interactions checker, 0.7%, 16.4%, 77.5% and 5.4% of pDDIs were classified as contraindicated, serious, monitor closely and minor, respectively. The most common pDDI was escitalopram + quetiapine (374 prescriptions), which was classified as serious and monitor closely due to different mechanisms of interaction. Increased central nervous system (CNS)-depressant effect was the most frequent potential clinical adverse outcome of the identified pDDIs. Conclusions pDDIs in outpatients with depression were prevalent in this retrospective study. The number of concomitant drugs and severity of the disease were important risk factors for pDDIs. The pDDIs of the category monitor closely were the most common, and the CNS-depressant effect was the most frequent potential clinical adverse outcome.
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Antoniou T, McCormack D, Kitchen S, Pajer K, Gardner W, Lunsky Y, Penner M, Tadrous M, Mamdani M, Juurlink DN, Gomes T. Geographic variation and sociodemographic correlates of prescription psychotropic drug use among children and youth in Ontario, Canada: a population-based study. BMC Public Health 2023; 23:85. [PMID: 36631810 PMCID: PMC9832754 DOI: 10.1186/s12889-022-14677-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 07/19/2022] [Accepted: 11/21/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Population-based research examining geographic variability in psychotropic medication dispensing to children and youth and the sociodemographic correlates of such variation is lacking. Variation in psychotropic use could reflect disparities in access to non-pharmacologic interventions and identify potentially concerning use patterns. METHODS We conducted a population-based study of all Ontario residents aged 0 to 24 years who were dispensed a benzodiazepine, stimulant, antipsychotic or antidepressant between January 1, 2018, and December 31, 2018. We conducted small-area variation analyses and identified determinants of dispensing using negative binomial generalized estimating equation models. RESULTS The age- and sex-standardized rate of psychotropic dispensing to children and youth was 76.8 (range 41.7 to 144.4) prescriptions per 1000 population, with large variation in psychotropic dispensing across Ontario's census divisions. Males had higher antipsychotic [rate ratio (RR) 1.40; 95% confidence interval (CI) 1.36 to 1.44) and stimulant (RR 1.75; 95% CI 1.70 to 1.80) dispensing rates relative to females, with less use of benzodiazepines (RR 0.85; 95% CI 0.83 to 0.88) and antidepressants (RR 0.81; 95% CI 0.80 to 0.82). Lower antipsychotic dispensing was observed in the highest income neighbourhoods (RR 0.72; 95% CI 0.70 to 0.75) relative to the lowest. Benzodiazepine (RR 1.12; 95% CI 1.01 to 1.24) and stimulant (RR 1.11; 95% CI 1.01 to 1.23) dispensing increased with the density of mental health services in census divisions, whereas antipsychotic use decreased (RR 0.82; 95% CI 0.73 to 0.91). The regional density of child and adolescent psychiatrists and developmental pediatricians (RR 1.00; 95% CI 0.99 to 1.01) was not associated with psychotropic dispensing. CONCLUSION We found significant variation in psychotropic dispensing among young Ontarians. Targeted investment in regions with long wait times for publicly-funded non-pharmacological interventions and novel collaborative service models may minimize variability and promote best practices in using psychotropics among children and youth.
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Affiliation(s)
- Tony Antoniou
- grid.415502.7Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario Canada ,grid.418647.80000 0000 8849 1617ICES, Toronto, Ontario Canada ,grid.17063.330000 0001 2157 2938Department of Family and Community Medicine, University of Toronto, Toronto, Ontario Canada ,grid.415502.7Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, Ontario Canada
| | | | - Sophie Kitchen
- grid.418647.80000 0000 8849 1617ICES, Toronto, Ontario Canada
| | - Kathleen Pajer
- grid.414148.c0000 0000 9402 6172Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario Canada ,grid.28046.380000 0001 2182 2255Department of Psychiatry, University of Ottawa, Ottawa, Ontario Canada
| | - William Gardner
- grid.418647.80000 0000 8849 1617ICES, Toronto, Ontario Canada ,grid.28046.380000 0001 2182 2255School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario Canada
| | - Yona Lunsky
- grid.418647.80000 0000 8849 1617ICES, Toronto, Ontario Canada ,grid.155956.b0000 0000 8793 5925Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, Ontario Canada
| | - Melanie Penner
- grid.414294.e0000 0004 0572 4702Autism Research Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada ,grid.17063.330000 0001 2157 2938Department of Pediatrics, University of Toronto, Toronto, Ontario Canada
| | - Mina Tadrous
- grid.418647.80000 0000 8849 1617ICES, Toronto, Ontario Canada ,grid.17063.330000 0001 2157 2938Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario Canada
| | - Muhammad Mamdani
- grid.415502.7Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario Canada ,grid.418647.80000 0000 8849 1617ICES, Toronto, Ontario Canada ,grid.17063.330000 0001 2157 2938Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario Canada ,Li Ka Shing Centre for Healthcare Analytics Research & Training, Unity Health Toronto, Toronto, Ontario Canada ,grid.17063.330000 0001 2157 2938Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario Canada ,grid.17063.330000 0001 2157 2938Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario Canada
| | - David N. Juurlink
- grid.418647.80000 0000 8849 1617ICES, Toronto, Ontario Canada ,grid.17063.330000 0001 2157 2938Department of Pediatrics, University of Toronto, Toronto, Ontario Canada ,grid.17063.330000 0001 2157 2938Department of Medicine, University of Toronto, Toronto, Ontario Canada
| | - Tara Gomes
- grid.415502.7Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario Canada ,grid.418647.80000 0000 8849 1617ICES, Toronto, Ontario Canada ,grid.17063.330000 0001 2157 2938Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario Canada ,grid.17063.330000 0001 2157 2938Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario Canada
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Robiyanto R, Schuiling-Veninga CCM, Bos JHJ, Hak E, van Puijenbroek EP. Exposure to psychotropic drugs before and during pregnancy: what has changed over the last two decades? Arch Womens Ment Health 2023; 26:39-48. [PMID: 36640183 PMCID: PMC9908723 DOI: 10.1007/s00737-023-01290-8] [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: 10/13/2022] [Accepted: 01/04/2023] [Indexed: 01/15/2023]
Abstract
Trends in prescribing psychotropic drugs before and during pregnancy may have changed over the years, but actual information is lacking. We therefore compared and assessed the exposure and acceptance rates of classes of antipsychotic (+ lithium), anxiolytic, sedative/hypnotic, antidepressant, and psychostimulant before and during pregnancy in the past two decades. All singleton pregnancies with ≥1 prescription of psychotropic drug from six months before pregnancy until child's birthdate were identified in the pregnancy subset of the IADB.nl prescription database. The prescription patterns of psychotropics were distinguished as continuation rate (CR), initiation rate (IR), discontinuation rate (DR), total exposure rate (TER), and acceptance rate. Singleton pregnancies exposed to psychotropic drugs before and during pregnancy increased from 118.4 to 136.5 (per 1000 singleton pregnancies) between decades. Changing trends were observed in decade 2, including a high increase in the TER of antipsychotic class (3.3 to 6.8) and antidepressant class (23.0 to 40.6). A marked increase for individual drugs was seen for sertraline (TER: 0.6 to 6.6 and PAT: 35.3% to 82.5%), citalopram (TER: 2.3 to 10.0 and PAT: 51.1% to 74.6%), and quetiapine (TER: 0.4 to 3.1 and PAT: 57.1% to 66.0%). Although the total exposure rates of five classes of psychotropics in singleton pregnancies increased in decade 2, only antidepressant class had a higher acceptance rate during pregnancy. Certain SSRI antidepressants and atypical antipsychotics were more frequently prescribed in decade 2 than in decade 1, reflecting that treatment options were preferred for safer treatment choices.
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Affiliation(s)
- Robiyanto Robiyanto
- Unit of Pharmacotherapy, -Epidemiology, & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands. .,Program Studi Farmasi, Fakultas Kedokteran, Universitas Tanjungpura, Pontianak, Indonesia.
| | - Catharina C M Schuiling-Veninga
- Unit of Pharmacotherapy, -Epidemiology, & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Jens H J Bos
- Unit of Pharmacotherapy, -Epidemiology, & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Eelko Hak
- Unit of Pharmacotherapy, -Epidemiology, & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Eugène P van Puijenbroek
- Unit of Pharmacotherapy, -Epidemiology, & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands ,Netherlands Pharmacovigilance Centre Lareb, ‘s-Hertogenbosch, The Netherlands
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Fekete S, Kulpok C, Taurines R, Egberts K, Geissler J, Gerlach M, Malonga Makosi D, König J, Urschitz MS, Toni I, Neubert A, Romanos M. Value of a web-based pediatric drug information system to prevent serious adverse drug reactions in child and adolescent psychiatry. J Neural Transm (Vienna) 2023; 130:53-63. [PMID: 36324035 DOI: 10.1007/s00702-022-02563-9] [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: 08/27/2022] [Accepted: 10/25/2022] [Indexed: 01/05/2023]
Abstract
Psychotropic drugs are frequently prescribed 'off-label' to children and adolescents and carry the risk of serious adverse drug reactions (sADR). We examined the frequency of sADRs of psychotropic drugs in pediatric inpatients and explored their potential preventability through following the recommendations of a web-based pediatric drug information system (PDIS). The potential socio-economic impacts of using this online system is also addressed. Routine clinical data from all inpatients treated in a child and adolescent psychiatry department between January 2017 and December 2018 were retrospectively examined for the occurrence of sADRs as defined by the European Medicines Agency. The preventability of the sADRs was assessed based on the information of the PDIS. Furthermore, the expected prolongation of the hospital stay due to sADRs was calculated as well as the associated treatment costs. The study was supported by the Innovation Fund of the Joint Federal Committee, grant number 01NVF16021. In total, 1036 patients were screened of whom 658 (63.5%) received psychopharmacological treatment. In 53 (8.1%) of these patients 54 sADRs were documented, of which 37 sADRs were identified as potentially preventable through PDIS. Mitigating sADR through PDIS would likely have prevented prolonged hospital stays and conferred considerable savings for health insurance companies. PDIS provides systematic and evidence-based information about pediatric psychopharmacotherapy and helps to prevent prescribing errors. Therefore, PDIS is a useful tool to increase drug therapy safety in child and adolescent psychiatry. Further prospective studies are needed to confirm the results.
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Affiliation(s)
- Stefanie Fekete
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Wuerzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany.
| | - Christine Kulpok
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Wuerzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany
| | - Regina Taurines
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Wuerzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany
| | - Karin Egberts
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Wuerzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany
| | - Julia Geissler
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Wuerzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany
| | - Manfred Gerlach
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Wuerzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany
| | - Dorothée Malonga Makosi
- Division of Paediatric Epidemiology, Institute of Medical Biostatistics, Epidemiology, and Informatics, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Jochem König
- Division of Paediatric Epidemiology, Institute of Medical Biostatistics, Epidemiology, and Informatics, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Michael S Urschitz
- Division of Paediatric Epidemiology, Institute of Medical Biostatistics, Epidemiology, and Informatics, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Irmgard Toni
- Department of Paediatrics and Adolescent Medicine, Universitätsklinikum Erlangen, Loschgestraße 15, 91054, Erlangen, Germany
| | - Antje Neubert
- Department of Paediatrics and Adolescent Medicine, Universitätsklinikum Erlangen, Loschgestraße 15, 91054, Erlangen, Germany
| | - Marcel Romanos
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Wuerzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany
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Hannerz H, Burr H, Nielsen ML, Garde AH, Flyvholm MA. Mental illness rates among employees with fixed-term versus permanent employment contracts: a Danish cohort study. Int Arch Occup Environ Health 2023; 96:451-62. [PMID: 36416975 DOI: 10.1007/s00420-022-01936-7] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/08/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE It has been hypothesized that employment in a fixed-term instead of permanent contract position is associated with an increased risk of development of mental health problems. The present study aimed at estimating rate ratios between fixed-term and permanent employees in the Danish labor force, for use of psychotropic drugs and psychiatric hospital treatment due to mood, anxiety or stress-related disorders, respectively. METHODS Employment data were drawn from the Danish Labor Force Survey of 2001-2013, which is a part of the European Labor Force Survey. Full-time employed survey participants without mental illness at the baseline interview (N = 106,501) were followed in national health registers for up to 5 years. Poisson regressions were used to estimate rate ratios for redeemed prescriptions of psychotropic drugs and psychiatric hospital treatments due to mood, anxiety or stress-related disease. The analyses were controlled for age, gender, industrial sector, nighttime work, level of education, calendar year, disposable family income and social transfer payments within 1 year prior to the baseline interview. RESULTS The rate ratio for hospital diagnosed mood, anxiety or stress-related disorders among employees with fixed-term vs. permanent employment contracts was estimated at 1.39 (99.5% CI 1.04-1.86), while the corresponding rate ratio for redeemed prescriptions of psychotropic drugs was estimated at 1.12 (99.5% CI 1.01-1.24). CONCLUSION The present study supports the hypothesis that employment in a fixed-term rather than permanent contract position is associated with an increased risk of developing mental health problems. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR2-10.2196/24392.
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Bhatt S, Dhar AK, Samanta MK, Suttee A. Effects of Current Psychotropic Drugs on Inflammation and Immune System. Adv Exp Med Biol 2023; 1411:407-434. [PMID: 36949320 DOI: 10.1007/978-981-19-7376-5_18] [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] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
The immune system and inflammation are involved in the pathological progression of various psychiatric disorders such as depression or major depressive disorder (MDD), generalized anxiety disorder (GAD) or anxiety, schizophrenia, Alzheimer's disease (AD), and Huntington's disease. It is observed that levels of inflammatory cytokines such as tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and other markers are highly increased in the abovementioned disorders. The inflammation and immune component also lead to enhance the oxidative stress. The oxidative stress and increased production of reactive oxygen species (ROS) are considered as important factors that are involved in pathological progression of psychiatric disorders. Increase production of ROS is associated with excessive inflammation followed by cell necrosis and death. The psychotropic drugs are mainly work through modulations of neurotransmitter system. However, it is evident that inflammation and immune modulation are also having important role in the progression of psychiatric disorders. Rationale of the use of current psychotropic drugs is modulation of immune system by them. However, the effects of psychotropic drugs on the immune system and how these might contribute to their efficacy remain largely unclear. The drugs may act through modification of inflammation and related markers. The main purpose of this book chapter is to address the role of current psychotropic drugs on inflammation and immune system. Moreover, it will also address the role of inflammation in the progression of psychiatric disorders.
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Affiliation(s)
- Shvetank Bhatt
- School of Pharmacy, Dr. Vishwanath Karad MIT World Peace University, Pune, Maharashtra, India
- Amity Institute of Pharmacy, Amity University Madhya Pradesh, Gwalior, India
| | | | | | - Ashish Suttee
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab, India
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Fico G, Isayeva U, De Prisco M, Oliva V, Solè B, Montejo L, Grande I, Arbelo N, Gomez-Ramiro M, Pintor L, Carpiniello B, Manchia M, Vieta E, Murru A. Psychotropic drug repurposing for COVID-19: A Systematic Review and Meta-Analysis. Eur Neuropsychopharmacol 2023; 66:30-44. [PMID: 36399837 PMCID: PMC9581805 DOI: 10.1016/j.euroneuro.2022.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 06/20/2022] [Revised: 10/05/2022] [Accepted: 10/09/2022] [Indexed: 01/11/2023]
Abstract
Several psychotropic drugs, including antidepressants (AD), mood stabilizers, and antipsychotics (AP) have been suggested to have favorable effects in the treatment of COVID-19. The aim of this systematic review and meta-analysis was to collect evidence from studies concerning the scientific evidence for the repurposing of psychotropic drugs in COVID-19 treatment. Two independent authors searched PubMed-MEDLINE, Scopus, PsycINFO, and ClinicalTrials.gov databases, and reviewed the reference lists of articles for eligible articles published up to 13th December 2021. All computational, preclinical and clinical (observational and/or RCTs) studies on the effect of any psychotropic drug on Sars-CoV-2 or patients with COVID-19 were considered for inclusion. We conducted random effect meta-analyses on clinical studies reporting the effect of AD or AP on COVID-19 outcomes. 29 studies were included in the synthesis: 15 clinical, 9 preclinical, and 5 computational studies. 9 clinical studies could be included in the quantitative analyses. AD did not increase the risk of severe COVID-19 (RR= 1.71; CI 0.65-4.51) or mortality (RR=0.94; CI 0.81-1.09). Fluvoxamine was associated with a reduced risk of mortality for COVID-19 (OR=0.15; CI 0.02-0.95). AP increased the risk of severe COVID-19 (RR=3.66; CI 2.76-4.85) and mortality (OR=1.53; CI 1.15-2.03). Fluvoxamine might be a possible candidate for psychotropic drug repurposing in COVID-19 due to its anti-inflammatory and antiviral potential, while evidence on other AD is still controversial. Although AP are associated with worse COVID-19 outcomes, their use should be evaluated case to case and ongoing treatment with antipsychotics should be not discontinued in psychiatric patients.
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Affiliation(s)
- Giovanna Fico
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain
| | - Ulker Isayeva
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Via Liguria 13, 09121, Cagliari, Italy
| | - Michele De Prisco
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain; Section of Psychiatry, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University of Naples, Naples, Italy
| | - Vincenzo Oliva
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Brisa Solè
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain
| | - Laura Montejo
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain
| | - Iria Grande
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain
| | - Nestor Arbelo
- Barcelona Clínic Schizophrenia Unit, Department of Clinical Foundations, Pharmacology Unit, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Consultation-Liaison Psychiatry Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain
| | - Marta Gomez-Ramiro
- Barcelona Clínic Schizophrenia Unit, Department of Clinical Foundations, Pharmacology Unit, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Department of Psychiatry, Servizo Galego de Saúde (SERGAS), Pontevedra, Spain; Psychiatric Diseases Research Group, Galicia Sur Health Research Institute, Vigo, Spain
| | - Luis Pintor
- Consultation-Liaison Psychiatry Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain
| | - Bernardo Carpiniello
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Via Liguria 13, 09121, Cagliari, Italy
| | - Mirko Manchia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Via Liguria 13, 09121, Cagliari, Italy; Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain.
| | - Andrea Murru
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain
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Clavenna A, Cartabia M, Fortino I, Leoni O, Bonati M. Delay in pharmacological treatment of autistic children after recognition of the disorder. Eur Neuropsychopharmacol 2022; 65:54-55. [PMID: 36371960 DOI: 10.1016/j.euroneuro.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/20/2022] [Accepted: 10/25/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Antonio Clavenna
- Laboratory of Pharmacoepidemiology, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Massimo Cartabia
- Laboratory of Pharmacoepidemiology, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Ida Fortino
- Directorate General for Health, Lombardy Region, Milan, Italy
| | - Olivia Leoni
- Directorate General for Health, Lombardy Region, Milan, Italy
| | - Maurizio Bonati
- Laboratory of Mother and Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
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Eggart V, Cordier S, Hasan A, Wagner E. Psychotropic drugs for the treatment of non-suicidal self-injury in children and adolescents: a systematic review and meta-analysis. Eur Arch Psychiatry Clin Neurosci 2022; 272:1559-68. [PMID: 35174411 DOI: 10.1007/s00406-022-01385-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 06/04/2021] [Accepted: 02/01/2022] [Indexed: 11/03/2022]
Abstract
Non-suicidal self-injury (NSSI) in children and adolescents is a frequent phenomenon. NSSI at any time is a significant predictor of future NSSI but also, and more importantly, for suicide attempts. Less evidence is available for the impact, or more specifically, the therapeutic effect of psychotropic drugs on the emergence of NSSI in this population. The phenomenon is clinically highly relevant since adolescent psychiatric inpatients are often affected by NSSI and most of them are treated with psychotropic drugs. While previous reviews on NSSI comprised suicidal self-injury (SSI), this review aims at elucidating the potential impact of psychotropic drugs on the emergence of specifically NSSI in children and adolescents. Systematic searches of articles indexed electronically in PubMed, Embase and PsycInfo were conducted (PROSPERO CRD42020209505). Studies included in the quantitative synthesis were evaluated using the SIGN level of evidence rating. Meta-analyses were performed using RevMan (Version 5.4). 2227 records were identified through database searches. Two additional records were identified manually. In total, seven studies were included in qualitative and four studies in quantitative analyses. In a meta-analysis, selective serotonin reuptake inhibitors (SSRIs) were compared vs. control medication (placebo or serotonin-norepinephrine reuptake inhibitor) and here, no statistically significant difference between the groups could be observed regarding the frequency of NSSI events (Risk Ratio (RR) = 1.07, 95% confidence interval (CI) 0.60-1.91, p = 0.82, I2 = 12%). Evidence regarding the association of SSRI use and NSSI among children and adolescents is sparse and the impact of psychotropic drugs in general on NSSI rates in this population should be addressed in future clinical and observational studies.
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Villanueva-Blasco VJ, Villanueva-Silvestre V, Vázquez-Martínez A, de Vicente LP, Pérez-Gálvez B. Depression, Suicidal Ideation, and Consumption of Psychotropic Drugs During Lockdown by COVID-19 According to Gender and Age. Int J Ment Health Addict 2022:1-17. [PMID: 36465995 PMCID: PMC9684782 DOI: 10.1007/s11469-022-00962-3] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/10/2022] [Indexed: 11/24/2022] Open
Abstract
The objective was to analyze the relationship between depression and suicidal ideation and psychotropic drugs use during COVID-19 lockdown in adult population considering gender and age. The method used is a descriptive and non-probabilistic study, with a convenience sampling of 3780 participants (70.1% female), aged 18-64 years (M = 37.8). 18.3% participants presented depression and 5.1% exhibited suicidal ideation. The depression rate for female was double (21.4%) than male and 5 times higher (30.2%) for the youngest participants (18-24 years old) compared to oldest (55-64 years old), being this rate triple in suicidal ideation (9%). Depression correlated positively with tranquilizers and sleeping pills' consumption; and suicidal ideation did so with tranquilizers and sedatives. The rate of tranquilizer users was 8 times higher for severe depression compared to those who did not present depression, 5 times higher for sleeping pills, and 6 times higher for sedatives. The rate of tranquilizer users exhibiting suicidal ideation was more than triple than those who did not present suicidal ideation, between 3 and 4 times higher for sleeping pills, and almost 7 times higher for sedatives. The higher the level of depression and suicidal ideation during lockdown, the greater the consumption of psychotropic drugs. The consumption of psychotropic drugs should be monitored in people with depression and suicidal ideation during periods of crisis.
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Affiliation(s)
- Víctor J. Villanueva-Blasco
- Faculty of Health Sciences, Valencian International University, C/ Pintor Sorolla, 21, 46002 Valencia, Spain
| | | | - Andrea Vázquez-Martínez
- Faculty of Health Sciences, Valencian International University, C/ Pintor Sorolla, 21, 46002 Valencia, Spain
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Sanchez MA, Fuchs B, Tubert-Bitter P, Mariet AS, Jollant F, Mayet A, Quantin C. Trends in psychotropic drug consumption among French military personnel during the COVID-19 epidemic. BMC Med 2022; 20:306. [PMID: 36100914 PMCID: PMC9470234 DOI: 10.1186/s12916-022-02497-9] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 07/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The coronavirus disease (COVID-19) pandemic may have had significant mental health consequences for military personnel, which is a population already exposed to psychological stress. To assess the potential impact of the COVID-19 pandemic, we analyzed the dispensing of three classes of psychotropic drugs (anxiolytics, hypnotics, and antidepressants) among French military personnel. METHODS A retrospective analysis was conducted using the individualized medico-administrative data of persons insured by the National Military Social Security Fund from the National Health Data System. All active French military personnel aged 18-64 who received outpatient care and to whom drugs were dispensed between January 1, 2019, and April 30, 2021, were included from the French national health database. Rate ratios of dispensed anxiolytics, hypnotics and antidepressants (based on drug reimbursement) were estimated from negative binomial regressions before and after the start of the COVID-19 pandemic. RESULTS Three hundred eighty-one thousand seven hundred eleven individuals were included. Overall, 45,148 military personnel were reimbursed for anxiolytics, 10,637 for hypnotics, and 4328 for antidepressants. Drugs were dispensed at a higher rate in 2020 and 2021 than in 2019. There was a notable peak at the beginning of the first lockdown followed by a decrease limited to the duration of the first lockdown. During the first lockdown only, there were temporary phenomena including a brief increase in drug dispensing during the first week followed by a decrease during the rest of lockdown, possibly corresponding to a stocking-up effect. For the study period overall, while there was a significant downward trend in psychotropic drug dispensing before the occurrence of COVID-19 (p < 0.001), the pandemic period was associated with an increase in dispensed anxiolytics (rate ratio, 1.03; 95% CI, 1.02-1.04, p < 0.05), hypnotics (rate ratio, 1.13; 95% CI, 1.11-1.16, p < 0.001) and antidepressants (rate ratio, 1.12; 95% CI, 1.10-1.13, p < 0.001) in the military population. CONCLUSIONS The COVID-19 pandemic has probably had a significant impact on the mental health of French military personnel, as suggested by the trends in dispensed psychotropic drugs. The implementation of mental health prevention measures should be investigated for this population.
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Affiliation(s)
- Marc-Antoine Sanchez
- Information Systems and Digital Department, French Military Health Service, Saint-Mandé, France.,Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, High-Dimensional Biostatistics for Drug Safety and Genomics, CESP, Villejuif, France
| | - Basile Fuchs
- Centre Hospitalo-Universitaire Cochin, Paris, Assistance Publique Des Hôpitaux de Paris, Paris, France
| | - Pascale Tubert-Bitter
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, High-Dimensional Biostatistics for Drug Safety and Genomics, CESP, Villejuif, France
| | - Anne-Sophie Mariet
- Service de Biostatistiques Et d'Information Médicale (DIM), CHU Dijon Bourgogne, INSERM, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, 21000, Dijon, France
| | - Fabrice Jollant
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany.,Université de Paris, Paris, France & GHU Paris Psychiatrie Et Neurosciences, Hôpital Sainte-Anne, CMME, Paris, France.,McGill Group for Suicide Studies, McGill University, Montréal, Canada.,Nîmes Academic Hospital (CHU), Nîmes, France.,Moods Team, INSERM UMR-1018, CESP, Le Kremlin-Bicêtre, France
| | - Aurélie Mayet
- French Armed Forces Center for Epidemiology and Public Health (CESPA), French Military Health Service, Marseille, France.,INSERM-IRD-Aix-Marseille université - SESSTIM, Marseille, France
| | - Catherine Quantin
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, High-Dimensional Biostatistics for Drug Safety and Genomics, CESP, Villejuif, France. .,Service de Biostatistiques Et d'Information Médicale (DIM), CHU Dijon Bourgogne, INSERM, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, 21000, Dijon, France.
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Holm M, Tanskanen A, Lähteenvuo M, Tiihonen J, Taipale H. Comparative effectiveness of mood stabilizers and antipsychotics in the prevention of hospitalization after lithium discontinuation in bipolar disorder. Eur Neuropsychopharmacol 2022; 61:36-42. [PMID: 35763976 DOI: 10.1016/j.euroneuro.2022.05.012] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/27/2022] [Accepted: 05/30/2022] [Indexed: 11/19/2022]
Abstract
The aim of the study was to compare the real-world effectiveness of mood stabilizers and antipsychotics in the prevention of psychiatric hospitalizations and treatment failure after lithium discontinuation in a nationwide bipolar cohort. Using health-care registers, we identified everyone in Finland diagnosed with bipolar disorder during 1987-2018 who discontinued lithium after using it for at least one year (n = 4 052, median period of lithium use before discontinuation 2.7 years). The risk of psychiatric hospitalization and treatment failure (psychiatric hospitalization, death or change in medication) were investigated with within-individual Cox regression. Of mood stabilizer monotherapies, the periods of valproate use (HR = 0.83, 95% CI = 0.71 - 0.97) had lower risk of hospitalization than nonuse of mood stabilizers. Of antipsychotic monotherapies, the use of long-acting injectable (LAI) antipsychotics (HR = 0.48, 95% CI = 0.26 - 0.88) and chlorprothixene (HR = 0.62, 95% CI = 0.44 - 0.88) were associated with lower risk and the use of quetiapine (HR = 1.26, 95% CI = 1.07 - 1.48) and oral olanzapine (HR = 1.23, 95% CI = 1.01 - 1.49) with higher risk of psychiatric hospitalizations than nonuse of antipsychotics. Of mood stabilizer monotherapies, lithium use was associated with lower risk of treatment failure (HR = 0.82, 95% CI = 0.76 - 0.88) than valproate use. The results suggest that antipsychotic LAIs are especially effective in the prevention of psychiatric hospitalizations after lithium discontinuation. The need to alter used medications may be the lowest when lithium is restarted.
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Affiliation(s)
- M Holm
- Finnish Institute for Health and Welfare, Mental Health Unit, Helsinki, Finland; Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden.
| | - A Tanskanen
- Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden; Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland; Karolinska Institutet, Center for Psychiatry Research, Stockholm, Sweden
| | - M Lähteenvuo
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
| | - J Tiihonen
- Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden; Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland; Karolinska Institutet, Center for Psychiatry Research, Stockholm, Sweden
| | - H Taipale
- Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden; Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland; Karolinska Institutet, Center for Psychiatry Research, Stockholm, Sweden; University of Eastern Finland, School of Pharmacy, Kuopio, Finland
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Cáceres-Matos R, Gil-García E, Vázquez-Santiago S, Cabrera-León A. Alcohol, Tobacco and Psychotropic Drugs Use Among a Population with Chronic Pain in Southern Spain. A Cross-Sectional Study. Pain Manag Nurs 2022; 23:494-503. [PMID: 34857475 DOI: 10.1016/j.pmn.2021.10.006] [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: 04/14/2021] [Revised: 10/13/2021] [Accepted: 10/26/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Substance use seems to be higher among populations with chronic pain. AIM The aim of this study is to examine the relationship between the quantity of alcohol, tobacco, and psychotropic drugs consumed and chronic pain among women and men. METHOD Linear and logistic regression analyses were carried out using data from the 2015-2016 adults' version of the Andalusian Health Survey which is a representative cross-sectional population-based study (n = 6,569 adults aged >16 years; 50.8% women; 49.2% men). RESULTS Disabling chronic pain was statistically associated with higher tobacco consumption among men (β = -30.0, 95% confidenct interval [CI] -59.5 to -0.60; t = -2.0; p < .05). Regarding alcohol, non-disabling chronic pain and a higher quantity of alcohol consumed are statistically associated for both sexes (women: β = 30.4, 95% CI 2.3-58.6; t = 2.12; p < .05 vs. men: β = 164.2, 95% CI 24.3-340.1); t = 2.30; p < .05). For women and men, both disabling chronic pain (women: odds ratio [OR] = 8.7, 95% CI 6.0-12.7); p < .05 vs. men: OR = 3.5, 95% CI 1.5-8.2); p < .05) and non-disabling chronic pain (women: OR = 3.7, 95% CI 2.0-7.0); p <.05 vs. men: OR = 4.7, 95% CI 95% CI 1.5-14.9); p < .05) were statistically significantly associated with a higher consumption of psychotropic drugs. CONCLUSIONS Chronic pain may be related to the quantity of alcohol, tobacco, and psychotropic drugs consumed, and disability appears to be one of the factors that modulates this relationship.
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Affiliation(s)
| | | | | | - Andrés Cabrera-León
- Andalusian School of Public Health, Granada, Spain; Biomedical Research Consortium in Epidemiology and Public Health Network (CIBERESP), Madrid, Spain.
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Yan QT, Chen MC, Hsieh MM. Ultrasensitive analysis of mirtazapine and its metabolites enantiomers in body fluids using ultrasound-enhanced and surfactant-assisted dispersive liquid-liquid microextraction followed by polymer-mediated stacking in capillary electrophoresis. J Chromatogr A 2022; 1678:463328. [PMID: 35914407 DOI: 10.1016/j.chroma.2022.463328] [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: 05/06/2022] [Revised: 06/20/2022] [Accepted: 07/09/2022] [Indexed: 11/21/2022]
Abstract
A simple, rapid, and sensitive technique for measuring mirtazapine and its metabolites enantiomers in human fluids, such as urine and serum, was developed by applying ultrasound-enhanced and surfactant-assisted dispersive liquid-liquid microextraction (USA-DLLME) integrated with poly(diallyldimethylammonium chloride) (PDDAC)-mediated stacking in capillary electrophoresis (CE). The parameters that affect extraction and stacking performance, such as the extraction volume, surfactant types, surfactant concentrations, salt additives, extraction time, solution pH, and background electrolytes, were comprehensively studied and optimized to achieve optimal detection performance. Under optimal extraction conditions (injection of 120 µL of C2H2Cl4 into 1 mL of a sample solution containing 0.05 mM Brij-35 at pH 10.0) and separation conditions (0.9% PDDAC, 10 mM phosphate, pH 3.0, and 20 mM dimethyl-β-cyclodextrin), on-line CE stacking of mirtazapine-related chiral drugs was achieved by the two strategies: (i) neutral DM-β-CD sweep low concentrations of DL-NaSSA and (ii) DL-NASSA is stacked by the difference in the viscosity between the PDDAC and sample zone. An approximately 2,800-4000-fold improvement in detection sensitivity was revealed for mirtazapine, N-demethylmirtazapine, and 8-hydroxymirtazapine enantiomers. The linear ranges for the quantification of all analyte enantiomers were 1.2-150 nM, with a coefficient of determination higher than 0.99; the relative standard deviations in the migration time and peak areas for six analytes were less than 1.8% and 5.8%, respectively. The proposed system provided the limits of detection (signal-to-noise ratio of 3) of the six analytes as 0.3-0.5 nM. The recovery of the six separated analytes spiked in urine and serum samples was revealed to be 82.7%-109.5% and 91%-112.8%, respectively. This advanced technique with high sensitivity enhancement factors was successfully employed to analyze mirtazapine and its metabolites enantiomers in urine and serum samples with reliability.
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Chantanachai T, Taylor ME, Lord SR, Menant J, Delbaere K, Sachdev PS, Kochan NA, Brodaty H, Sturnieks DL. Risk factors for falls in community-dwelling older people with mild cognitive impairment: a prospective one-year study. PeerJ 2022; 10:e13484. [PMID: 35663527 PMCID: PMC9161814 DOI: 10.7717/peerj.13484] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/03/2022] [Indexed: 01/17/2023] Open
Abstract
Objective Mild cognitive impairment (MCI) is considered an intermediate stage between normal cognitive function and dementia. Fall risk is increased in this group, but there is limited literature exploring specific fall risk factors that may be addressed in fall prevention strategies. The aim of this study was to examine risk factors for falls in older people with MCI, focusing on cognitive, psychological and physical factors. Methods Participants (n = 266, 45% women) were community-dwelling older people aged 70-90 years who met the criteria for MCI. Cognitive, psychological, sensorimotor and physical assessments, physical activity levels, medication use, general health and disability were ascertained at baseline. Falls were monitored prospectively for 12 months. Results During follow-up, 106 (40%) participants reported one or more falls. Poorer visual contrast sensitivity, increased postural sway, lower levels of weekly walking activity, higher levels of depressive symptoms and psychotropic medication use were significantly associated with faller status (≥1 falls) in univariable analyses. Of these factors, poor visual contrast sensitivity, increased postural sway and psychotropic medication use were found to be significant independent predictors of falls in multivariable analysis while controlling for age and sex. No measures of cognitive function were associated with falls. Conclusions Poor visual contrast sensitivity, impaired balance and psychotropic medication use predicted falls in community-dwelling people with MCI. These risk factors may be amenable to intervention, so these factors could be carefully considered in fall prevention programs for this population.
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Affiliation(s)
- Thanwarat Chantanachai
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia,School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Morag E. Taylor
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia,Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Stephen R. Lord
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia,School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Jasmine Menant
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia,School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Kim Delbaere
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia,School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Perminder S. Sachdev
- Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, New South Wales, Australia,Faculty of Medicine and Health, University of New South Wales, Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, Sydney, New South Wales, Australia
| | - Nicole A. Kochan
- Faculty of Medicine and Health, University of New South Wales, Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, Sydney, New South Wales, Australia
| | - Henry Brodaty
- Faculty of Medicine and Health, University of New South Wales, Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, Sydney, New South Wales, Australia
| | - Daina L. Sturnieks
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia,School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
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Gedde MH, Husebo BS, Mannseth J, Naik M, Selbaek G, Vislapuu M, Berge LI. The impact of medication reviews by general practitioners on psychotropic drug use and behavioral and psychological symptoms in home-dwelling people with dementia: results from the multicomponent cluster randomized controlled LIVE@Home.Path trial. BMC Med 2022; 20:186. [PMID: 35614509 PMCID: PMC9132600 DOI: 10.1186/s12916-022-02382-5] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 04/25/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND There is limited knowledge regarding the process of deprescribing psychotropic drugs to people with dementia (PwD) conducted by general practitioners (GP). We investigated the impact of a multicomponent intervention, emphasizing medication reviews, on psychotropic drugs and behavioral and psychological symptoms (BPSD) in home-dwelling PwD and quantified change in patient-GP communication evaluated by their informal caregivers. METHODS LIVE@Home.Path is a stepped-wedge closed-cohort cluster randomized controlled trial for people with mild to moderate dementia aged ≥65 and their informal caregivers (dyads) in Norway. Complementary to health care as usual (control condition), municipal coordinators implemented the multicomponent LIVE intervention: Learning, Innovation, Volunteer support, and Empowerment (including medication review by the PwD's regular GPs). Block-randomization was used to allocate dyads in three groups receiving the intervention sequentially in periods of 6 months duration. Prepandemic data from the first period is reported, resulting in a 1:2 intervention-to-control ratio. Primary outcome was change in psychotropic drug use. Secondary outcomes were changes in BPSD by Neuropsychiatric Inventory and Cornell Scale of Depression in Dementia and patient-GP communication by an adaption of the Clinical Global Impression of Change. RESULTS Four hundred thirty-eight dyads were screened, 280 included, and 237 participated at 6 months (intervention group n=67; control condition n=170). At baseline, 63% used psychotropic medication regularly: antidementia drugs (47%), antidepressants (13%), hypnotics/sedatives (13%), antipsychotics (5%), and anxiolytics (2%). At 6 months, medication reviews were more frequently conducted in the intervention group compared to control (66% vs 42%, P=0.001). We found no differences regarding a change in drug use and BPSD. Patient-GP communication enhanced in the intervention group (mean score 0.95 [standard deviation 1.68] vs 0.41 [1.34], P=0.022). In the intervention group, control group, and overall sample, the informal caregivers of those who had their medications reviewed reported improved patient-GP communication compared to those who did not. CONCLUSIONS Change in psychotropic drug use and BPSD did not differ, even though patient-GP communication improved with medication reviews. Restricted psychotropic drug use among PwD likely reflects more judicious prescribing practices in recent years. Nevertheless, medication reviews could be cultivated to optimize pharmacologic treatment for this complex population. TRIAL REGISTRATION ClinicalTrials.gov : NCT04043364 ; registered 15/03/2019.
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Affiliation(s)
- Marie H Gedde
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway. .,Haraldsplass Deaconess Hospital, Bergen, Norway.
| | - Bettina S Husebo
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway.,Municipality of Bergen, Bergen, Norway
| | - Janne Mannseth
- Section for Epidemiology and Medical Statistic, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Mala Naik
- Haraldsplass Deaconess Hospital, Bergen, Norway.,Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Geir Selbaek
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Geriatric Department, Oslo University Hospital, Oslo, Norway
| | - Maarja Vislapuu
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Line Iden Berge
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway.,NKS Olaviken Gerontopsychiatric Hospital, Askøy, Norway
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Osman A, Kamkar N, Speechley M, Ali S, Montero-Odasso M. Fall risk-increasing drugs and gait performance in community-dwelling older adults: A systematic review. Ageing Res Rev 2022; 77:101599. [PMID: 35219903 DOI: 10.1016/j.arr.2022.101599] [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: 08/07/2021] [Revised: 02/12/2022] [Accepted: 02/23/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE Medication use, and gait impairment are two major risk factors for falls in older adults. There are several mechanisms linking fall risk-increasing drugs (FRIDs) and increased fall risk. One pathway involves gait performance as an intermediate variable. It is plausible that FRIDs indirectly increase fall risk by causing gait impairment. The purpose of this review was to systematically review the existing evidence on the association between FRIDs and gait performance in community-dwelling older adults without neurological movement disorders. METHODS Two searches were performed using MeSH terms and keywords in the electronic databases MEDLINE, EMBASE, PsycINFO, CINAHL and grey literature. We included clinical trials and observational studies that assessed the association between a FRID class and any quantitative measure of gait performance. Quality assessment was performed using the Newcastle-Ottawa scale for observational studies and the Cochrane risk-of-bias tool for clinical trials. Study characteristics and findings were summarized in a descriptive approach for each drug class. RESULTS A total of 11,197 studies were retrieved from both searches at the first step and a total of 23 studies met the final inclusion criteria. Fourteen studies assessed the association between psychotropic FRIDs and gait performance and nine assessed cardiovascular FRIDs. Four out of five studies found that drugs with sedative properties are associated with reduced gait speed in older adults. Three out of four studies found no association between statin use and gait speed. There is insufficient evidence on the association between FRIDs and other gait performance measures. CONCLUSION Caution should be taken when prescribing drugs with sedative properties to older adults at risk of falls. Further research is required to assess the impact of the use FRIDs on gait performance measures other than gait speed.
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