-
International Psychogeriatrics Nov 2016Despite the numerous warnings of European and national drug agencies as well as clinical guidelines since the year 2004, psychotropic drugs are still frequently used in... (Review)
Review
BACKGROUND
Despite the numerous warnings of European and national drug agencies as well as clinical guidelines since the year 2004, psychotropic drugs are still frequently used in dementia. A systematic review comparing the use of psychotropic drugs in nursing homes from different European countries is lacking.
OBJECTIVE
The aim of this study was to examine prescription rates of psychotropic drug use in nursing home patients between different Western European countries since the first warnings were published.
METHODS
A literature review was performed and the various psychotropic prescribing rates in European nursing homes were investigated. The prescription rates of antipsychotic and antidepressants were pooled per country. Other classes of psychotropic drugs could not be pooled because of the limited number of studies found.
RESULTS
Thirty-seven studies on antipsychotic drug use and 27 studies on antidepressant drug use conducted in 12 different European countries. The antipsychotic use in nursing homes ranged from 12% to 59% and antidepressant use from 19% to 68%. The highest rates of antipsychotic drug prescription were found in Austria, Ireland, and Belgium while for antidepressants in Belgium, Sweden, and France.
CONCLUSIONS
Despite warnings about the side effects and recommendation to focus on non-pharmacological interventions, antipsychotics and antidepressants are commonly used drugs in nursing homes. The data suggest that Norway does best with regards having a low antipsychotic drug usage. Studies are needed to explain the differences between Norway and other European countries.
Topics: Cross-Cultural Comparison; Dementia; Europe; Homes for the Aged; Humans; Inappropriate Prescribing; Nursing Homes; Potentially Inappropriate Medication List; Psychotropic Drugs
PubMed: 27469071
DOI: 10.1017/S1041610216001150 -
Journal of Psychosocial Nursing and... Aug 2014Liver toxicity is the leading reason for withdrawal of marketed drugs and is a common reason for terminating the development of new drugs. Anticonvulsant,... (Review)
Review
Liver toxicity is the leading reason for withdrawal of marketed drugs and is a common reason for terminating the development of new drugs. Anticonvulsant, antidepressant, and antipsychotic drugs can be associated with significant liver injury or liver failure, but this is relatively rare compared to other non-psychotropic drug classes. More commonly, mild asymptomatic elevations in liver function tests are seen and these are not predictive of progression to more severe liver injury. Laboratory monitoring of liver function before and during treatment is recommended with the use of valproic acid and carbamazepine, but not for other psychotropic drugs, although regular laboratory testing is not a reliable method for detecting or preventing severe liver injury. Clinical monitoring for signs and symptoms suggesting hepatotoxicity or hypersensitivity reactions that affect the liver is more important.
Topics: Anticonvulsants; Antidepressive Agents; Antipsychotic Agents; Chemical and Drug Induced Liver Injury; Humans; Liver; Liver Function Tests; Psychotropic Drugs
PubMed: 25106054
DOI: 10.3928/02793695-20140722-01 -
European Neuropsychopharmacology : the... Jan 2023Several psychotropic drugs, including antidepressants (AD), mood stabilizers, and antipsychotics (AP) have been suggested to have favorable effects in the treatment of... (Meta-Analysis)
Meta-Analysis
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.
Topics: Humans; COVID-19; SARS-CoV-2; Fluvoxamine; COVID-19 Drug Treatment; Drug Repositioning; Psychotropic Drugs; Antipsychotic Agents
PubMed: 36399837
DOI: 10.1016/j.euroneuro.2022.10.004 -
International Journal of Clinical... Jun 2021Polypharmacy and drug-drug interactions (DDIs) are important problems that necessitate more attention in paediatric inpatients. This study aimed to determine and...
AIMS
Polypharmacy and drug-drug interactions (DDIs) are important problems that necessitate more attention in paediatric inpatients. This study aimed to determine and evaluate DDIs in paediatric inpatients using psychotropic drugs.
METHODS
It was conducted as a retrospective cross-sectional study. Inpatients consulted by child and adolescent psychiatrists (CAPs) and had at least one psychotropic drug-using between January 2016 and September 2017 were retrospectively included. To determine the clinical significance of DDIs by Micromedex and DDI Predictor online databases. DDIs between psychotropic and other drugs, the type, severity, and duration of potential DDIs were evaluated.
RESULTS
During the study period, 564 patients' records were reviewed and 200 patients were considered eligible and included in the study. The median (min-max) age was 13.70 (1.5-17.83) years. The mean (SD) number of psychotropics used during hospitalisation was 1.29 (0.55) and the total number of drugs was 7.39 (4.45). A total of 336 potential DDIs were detected (2.19 DDIs/patient) in all patients. The most common potential outcome of psychotropic DDIs was drug-induced QTc prolongation (67.56%). While 92.85% of the potential DDIs were "contraindicated" or "major," only 18.46% had a "good" or "excellent" strength of evidence. The risk of psychotropic polypharmacy (OR:0.73, 95% CI 0.59-0.92; p:0.006) and DDIs (OR:0.69, 95% CI 0.35-0.76; p:0.033) was significantly higher in patients without primary psychiatric disorders. When the total number of drugs and the total number of potential DDIs were compared amongst all inpatient units, significant differences were found between paediatric hematology-general paediatrics (mean difference: 2.002; P < .001) and paediatric hematology-paediatric ICU (mean difference: 1.650; P = .012), respectively.
CONCLUSION
Psychotropic drug-related DDI is a major problem in the paediatric population and the clinical significance of the potential DDIs' risk should be determined in patient-centred care and managed by the multidisciplinary team.
Topics: Adolescent; Child; Cross-Sectional Studies; Drug Interactions; Humans; Inpatients; Pediatrics; Pharmaceutical Preparations; Psychotropic Drugs; Retrospective Studies
PubMed: 33624394
DOI: 10.1111/ijcp.14107 -
Clinical Psychology & Psychotherapy Mar 2018Despite the fact that today most of the patients with psychological disturbances assume some form of psychotropic drug treatment, clinical psychologists may have little... (Review)
Review
Despite the fact that today most of the patients with psychological disturbances assume some form of psychotropic drug treatment, clinical psychologists may have little familiarity with psychopharmacology and are substantially unaware of subtle and yet pervasive potential effects of medications in clinical presentations. In their training, psychologists are generally exposed, at best, to some general principles of drug action. Standard psychopharmacology textbooks tend to omit the subtle psychological changes that may occur during psychotropic drug treatment. Clinical pharmacopsychology consists of the application of clinical psychology to the full understanding of pharmacological effects. The domains of clinical pharmacopsychology encompass the clinical benefits of psychotropic drugs, the characteristics that predict responsiveness to treatment, the vulnerabilities induced by treatment (side effects, behavioural toxicity, iatrogenic comorbidity), and the interactions between drug treatment and psychological variables. The DSM-5 refers to a patient population that no longer exists: subjects who display various manifestations of psychological distress who do not receive any form of drug treatment for it. Any type of psychotropic drug treatment, particularly after long-term use, may increase the risk of experiencing additional psychopathological problems that do not necessarily subside with discontinuation of the drug. The changes may be persistent and not limited to a short phase, such as in the case of withdrawal reactions, and cannot be subsumed under the generic rubrics of adverse events or side effects.
Topics: Humans; Mental Disorders; Psychology; Psychology, Clinical; Psychotropic Drugs; Substance Withdrawal Syndrome
PubMed: 29168605
DOI: 10.1002/cpp.2154 -
Trends in Pharmacological Sciences Jul 2016Novel psychoactive substances flood worldwide markets faster than they can be banned. Legislators struggle to find a balance between free availability, prescription... (Review)
Review
Novel psychoactive substances flood worldwide markets faster than they can be banned. Legislators struggle to find a balance between free availability, prescription systems, and criminalisation, while physicians try to balance risks and benefits of drug treatment and identify drug abuse - a tightrope walk. Classification of psychoactive substances is central to these decision-making processes but existing classifications rely on unrelated, inconsistent, and shifting guidelines that categorise drugs by chemical structure, toxicity, or addictive potency. We propose that a new categorisation of drugs based on neurobiological mechanisms of action may help to simplify the regulation of drug use, delivers a neurobiological context, and streamlines classification and future regulatory directions. We provide guidelines to distinguish between drug abuse and treatment and to navigate the controversies over legalising or banning drugs. Finally, we comment on the role neuroscientific research can play in the future to solve imminent problems in this highly important field.
Topics: Humans; Neurosciences; Psychotropic Drugs
PubMed: 27156438
DOI: 10.1016/j.tips.2016.04.004 -
DNA and Cell Biology Nov 2022Psychotropic drugs have long been known to possess antimicrobial activity against several groups of microorganisms. Although this property has been extensively studied... (Review)
Review
Psychotropic drugs have long been known to possess antimicrobial activity against several groups of microorganisms. Although this property has been extensively studied both alone and when combined with antibiotics against antimicrobial-resistant bacterial and fungal species, relatively little attention has been given to their ability to contribute to the emergence of antimicrobial resistance (AMR). We have recently reported the acquisition of multidrug resistance in after exposure to gut-relevant concentrations of the antipsychotic quetiapine. Considering these observations, this review attempts to establish if a relationship between psychotropics and AMR in microorganisms has been defined in the scientific literature.
Topics: Drug Resistance, Bacterial; Escherichia coli; Anti-Bacterial Agents; Psychotropic Drugs
PubMed: 36251740
DOI: 10.1089/dna.2022.0471 -
The International Journal of... Sep 2019Multiple initiatives at the national and international level support natural drug discovery. Psychiatrists and patients are not well informed about natural psychotropics... (Review)
Review
Multiple initiatives at the national and international level support natural drug discovery. Psychiatrists and patients are not well informed about natural psychotropics in general. Existing antidepressant and antipsychotic drugs were developed from atropine, a natural product. Subsequent drug developments were largely based on extension and modification of earlier molecular scaffolds. This limits their mechanisms of action to similar neuropathways. Natural psychotropic substances, particularly those with hallucinogenic and psychedelic properties and different chemical structures, may serve as new paths to novel psychotropic drug development.
Topics: Biological Products; Drug Design; Drug Development; Humans; Phytochemicals; Psychotropic Drugs
PubMed: 31353393
DOI: 10.1093/ijnp/pyz042 -
Expert Review of Clinical Pharmacology Feb 2020
Topics: Humans; Nocebo Effect; Placebo Effect; Psychotropic Drugs; Randomized Controlled Trials as Topic
PubMed: 31995411
DOI: 10.1080/17512433.2020.1722100 -
CNS Drugs Sep 2017Bipolar disorder is associated with high morbidity and mortality. The management of bipolar disorder includes a broad approach involving psychoeducation, psychological... (Review)
Review
Bipolar disorder is associated with high morbidity and mortality. The management of bipolar disorder includes a broad approach involving psychoeducation, psychological therapies and psychotropic medication. The management of bipolar disorder in pregnancy is challenging; there is an increase in the rate of relapse of bipolar disorder in the perinatal period and treatment decisions are complex as clinicians are required to weigh up the risks of untreated illness versus unwanted treatment effects on both the mother and the developing fetus. Whilst depressive relapses are more common, women are also at an increased risk of postpartum psychosis, which is a psychiatric emergency that almost always requires inpatient treatment. This paper discusses the limited evidence base regarding the safety of psychotropic medication in the perinatal period, including challenges in perinatal mental health research and the lack of robust evidence. The general principles of prescribing in pregnancy, the importance of preconception counselling, and the risks and benefits associated with antipsychotics, mood stabilisers and antidepressants are addressed.
Topics: Animals; Antidepressive Agents; Antimanic Agents; Antipsychotic Agents; Bipolar Disorder; Female; Humans; Pregnancy; Pregnancy Complications; Psychotropic Drugs; Recurrence
PubMed: 28786084
DOI: 10.1007/s40263-017-0452-x