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Psychological Medicine Jan 2021The present paper provides an updated review of both the large number of new/novel/emerging psychoactive substances (NPS) and their associated psychopathological... (Review)
Review
BACKGROUND
The present paper provides an updated review of both the large number of new/novel/emerging psychoactive substances (NPS) and their associated psychopathological consequences. Focus was here given on identification of those NPS being commented in specialised online sources and the related short-/long-term psychopathological and medical ill-health effects.
METHODS
NPS have been identified through an innovative crawling/navigating software, called the 'NPS.Finder®', created in order to facilitate the process of early recognition of NPS online. A range of information regarding NPS, including chemical and street names; chemical formula; three-dimensional image and anecdotally reported clinical/psychoactive effects, were here made available.
RESULTS
Using the 'NPS.Finder®' approach, a few thousand NPS were here preliminarily identified, a number which is about 4-fold higher than those figures suggested by European and international drug agencies. NPS most commonly associated with the onset of psychopathological consequences included here synthetic cannabinoids/cannabimimetics; new synthetic opioids; ketamine-like dissociatives; novel stimulants; novel psychedelics and several prescription and over-the-counter medicines.
CONCLUSIONS
The ever-increasing changes in terms of recreational psychotropics' availability represent a relatively new challenge for psychiatry, as the pharmacodynamics and pharmacokinetics of many NPS have not been thoroughly understood. Health/mental health professionals should be informed about the range of NPS; their intake modalities; their psychoactive sought-after effects; the idiosyncratic psychotropics' combinations and finally, their medical and psychopathological risks.
Topics: Humans; Illicit Drugs; Psychopathology; Psychotropic Drugs; Recreational Drug Use; Substance-Related Disorders
PubMed: 31327332
DOI: 10.1017/S0033291719001727 -
Nederlands Tijdschrift Voor Geneeskunde Jul 2021Assessment of the risk for arrhythmias requires knowledge of QTc interval prolonging drugs and baseline clinical risk factors for QTc prolongation. The combination of...
Assessment of the risk for arrhythmias requires knowledge of QTc interval prolonging drugs and baseline clinical risk factors for QTc prolongation. The combination of both determines whether ECG-monitoring is necessary at the start of a psychotropic drug. In this article, we summarize current literature regarding appropriate methods of calculating the QTc interval, risk factors for QTc prolongation and QTc-prolonging psychotropic drugs. The frequency of cardiac monitoring for patients receiving psychotropic drugs should be individually determined, based on the prescribed agent(s) and additional risk factors for TdP. In patients without baseline clinical risk factors for QTc prolongation or cardiac arrhythmias, starting a single psychotropic drug with a low risk profile, ECG-monitoring might not be necessary.
Topics: Antipsychotic Agents; Arrhythmias, Cardiac; Electrocardiography; Humans; Long QT Syndrome; Psychotropic Drugs; Risk Factors
PubMed: 34346615
DOI: No ID Found -
Mayo Clinic Proceedings Jun 2016Drug rash with eosinophilia and systemic symptoms (DRESS) is a severe cutaneous eruption that has been linked to several common drugs and drug categories, including... (Review)
Review
Drug rash with eosinophilia and systemic symptoms (DRESS) is a severe cutaneous eruption that has been linked to several common drugs and drug categories, including antiepileptics, allopurinol, sulfonamides, and various antibiotics; however, because of a number of recent case reports linking psychotropic medications to this condition, DRESS is increasingly recognized among psychiatrists. We systematically reviewed all psychotropic drugs linked to DRESS syndrome, and this article summarizes the clinical management relevant to psychiatric professionals. A comprehensive search was performed using Ovid MEDLINE, Ovid EMBASE, Ovid Cochrane Database of Systematic Reviews, Web of Science, Scopus, and Litt's Drug Eruption and Reaction Database for articles published in English during the past 20 years (1996-2015) using the search terms (1) psychotropic drugs OR serotonin uptake inhibitors AND DRESS or (2) psychotropic drugs AND drug reaction (or rash) eosinophilia systemic syndrome, and all article abstracts were screened for inclusion and exclusion criteria by 3 reviewers. Two independent reviewers examined the full text of 163 articles, of which 96 (25 original articles, 12 review articles, 55 case reports, and 4 letters to the editor) were included in the systematic review. We identified 1072 cases of psychotropic drug-induced DRESS, with carbamazepine, lamotrigine, phenytoin, valproate, and phenobarbital being the most implicated drugs. Based on our review of the literature, we outline management principles that include prompt withdrawal of the causative drug, hospitalization, corticosteroid therapy, and novel treatments, including intravenous immunoglobulin, cyclophosphamide, and cyclosporine, for corticosteroid-resistant DRESS. Finally, we outline strategies for treating comorbid psychiatric illness after a DRESS reaction to the psychotropic medication.
Topics: Administration, Intravenous; Adrenal Cortex Hormones; Comorbidity; Cyclophosphamide; Cyclosporine; Dermatologic Agents; Diagnosis, Differential; Drug Hypersensitivity Syndrome; Exanthema Subitum; Humans; Immunoglobulins; Immunosuppressive Agents; Mental Disorders; Plasma Exchange; Psychotropic Drugs
PubMed: 27126302
DOI: 10.1016/j.mayocp.2016.03.006 -
Aging & Mental Health Jan 2021The aim of this study was to describe the course of psychotropic drug use in people with young-onset dementia and to explore possible associations with age, sex,...
OBJECTIVES
The aim of this study was to describe the course of psychotropic drug use in people with young-onset dementia and to explore possible associations with age, sex, dementia severity, dementia subtype and neuropsychiatric symptoms.
METHODS
Psychotropic drug use was studied in 198 community-dwelling persons participating in the Needs in Young-onset Dementia study. Data about psychotropic drug use were retrieved at baseline, as well as at 6, 12, 18 and 24 months and was classified into five groups (antiepileptics, antipsychotics, anxiolytics, hypnotics/sedatives and antidepressants) and quantified as 'present' or 'absent'. Generalized Estimating Equation modeling and chi-square tests were used to study associations between the determinants and psychotropic drug use.
RESULTS
There was a statistically significant increase in the prevalence of psychotropic drug use from 52.3% to 62.6% during the course of the study. Almost three-quarters (72.4%) of the participants were treated with any psychotropic drug during the study, and more than one-third (37.4%) received psychotropic drugs continuously. Antipsychotics were used continuously in more than 10% of the participants and antidepressants in more than 25%. Increasing age was positively associated ( = .018) with psychotropic drug use at baseline, while apathy symptoms were negatively associated ( = .018).
CONCLUSIONS
Despite the recommendations of various guidelines, the prolonged use of psychotropic drugs in community-dwelling people with young-onset dementia is high. Therefore, more attention is needed to timely evaluate psychotropic drug use and the introduction of self-management programs for caregivers should be encouraged to support caregivers in dealing with the neuropsychiatric symptoms caused by the dementia.
Topics: Antidepressive Agents; Antipsychotic Agents; Dementia; Humans; Independent Living; Psychotropic Drugs
PubMed: 31746238
DOI: 10.1080/13607863.2019.1691145 -
Basic & Clinical Pharmacology &... Jun 2023This study explores the role of steroid administration in identifying distressed or even mentally disordered cancer patients (so-called case finding). Charts of 12 298...
This study explores the role of steroid administration in identifying distressed or even mentally disordered cancer patients (so-called case finding). Charts of 12 298 cancer patients (4499 treated with prednisone equivalents) were analysed descriptively. A subset of 10 945 was further explored via latent class analysis (LCA). LCA avoids confounding by indication because it subgroups patients without prior preconceptions based on homogeneous expression of traits (i.e. the variables examined). LCA identified four subgroups: two subgroups with high dosages of prednisone equivalent (≥80 mg/day on average over all treatment days) and two with low dosages. The two subgroups with high average dosages had an increased likelihood of psychotropic drug administration, but only one was more likely to require 1:1 observation. In one subgroup, low dosages of prednisone equivlents correlated with a slightly increased probability for a psychiatric assessment and psychotropic drug administration. The subgroup least likely to receive steroid treatment was also the least likely to receive a psychiatric assessment and psychotropic drug administration. Descriptive statistics on age, sex, cumulative inpatient treatment, type of cancer, stage of cancer at first diagnosis, mental disorders, severe mental disorders and psychotropic drug administration (antidepressants, antipsychotics, benzodiazepines, anticonvulsants/mood stabilizers, opioids) are provided for patients receiving no, less and more than 80 mg of prednisone equivalent.
Topics: Humans; Prednisone; Psychotropic Drugs; Antipsychotic Agents; Mental Disorders; Anticonvulsants; Neoplasms
PubMed: 36878670
DOI: 10.1111/bcpt.13853 -
International Clinical... Mar 2017Populations using herbs and herbal preparations are widespread and growing. As many herbal ingredients exert actions on psychotropic drug targets, psychiatrists should... (Review)
Review
Populations using herbs and herbal preparations are widespread and growing. As many herbal ingredients exert actions on psychotropic drug targets, psychiatrists should be well informed and aware of potential drug-drug interactions in clinical practice. Reliable and clinically useful information in this area, however, is fragmented, if not deficient. This paper reviewed the clinical aspects of herb-drug interactions, focusing in particular on the monoamine oxidase enzyme and P450 cytochrome enzyme-inhibitory properties of herbs and their potential interference with psychotropic drug actions and clinical judgement.
Topics: Herb-Drug Interactions; Humans; Mental Disorders; Monoamine Oxidase Inhibitors; Phytotherapy; Plant Preparations; Psychotropic Drugs
PubMed: 27902536
DOI: 10.1097/YIC.0000000000000158 -
Human Psychopharmacology May 2017
Topics: Congresses as Topic; Humans; Psychotropic Drugs; Risk
PubMed: 28657179
DOI: 10.1002/hup.2616 -
Journal of Child and Adolescent... Mar 2022The decision to prescribe a medication and the choice of which one are often complex, particularly in the field of child and adolescent psychiatry where evidence is... (Review)
Review
The decision to prescribe a medication and the choice of which one are often complex, particularly in the field of child and adolescent psychiatry where evidence is scarce. The aim of this review is to provide a synthesis of psychotropic drugs approved in children and adolescents for psychiatric indications in several countries. All psychopharmacological treatments used in child and adolescent psychiatry, approved by at least one regulatory agency from Switzerland, the United Kingdom, France, the European Union, or the United States, were considered. A comprehensive review of the summaries of product characteristics was performed. A total of 143 psychotropic drugs were included: 47 anxiolytics/hypnotics, 45 antidepressants, 37 antipsychotics, 10 medications for attention-deficit/hyperactivity disorder (ADHD), and 4 mood stabilizers. Only a few of these drugs were approved for use in children or adolescents (38%) at least for a single psychiatric diagnosis in at least one country. The therapeutic class with the lowest rate of approved status was antidepressants (20%), followed by mood stabilizers (25%), anxiolytics/hypnotics (28%), antipsychotics (57%), and medications for ADHD (100%). Important differences in approved diagnoses, ages, and doses were observed between regulatory agencies. Tables presenting drugs for approved diagnoses based on age and regulatory agencies are presented in this article. Drugs classified by regulatory agencies, with complete data on diagnoses, ages, doses, pharmaceutical forms, and particular restrictions, are presented as Supplementary Material. This article provides an overview to prescribers with respect to the approved medications in children and adolescents in selected European countries and the United States.
Topics: Adolescent; Anti-Anxiety Agents; Anticonvulsants; Antidepressive Agents; Antimanic Agents; Antipsychotic Agents; Child; Drug Prescriptions; Humans; Hypnotics and Sedatives; Pharmaceutical Preparations; Psychotropic Drugs; United States
PubMed: 35138922
DOI: 10.1089/cap.2021.0027 -
Psychological Medicine Dec 2021Approval and prescription of psychotropic drugs should be informed by the strength of evidence for efficacy. Using a Bayesian framework, we examined (1) whether... (Meta-Analysis)
Meta-Analysis Review
Approval and prescription of psychotropic drugs should be informed by the strength of evidence for efficacy. Using a Bayesian framework, we examined (1) whether psychotropic drugs are supported by substantial evidence (at the time of approval by the Food and Drug Administration), and (2) whether there are systematic differences across drug groups. Data from short-term, placebo-controlled phase II/III clinical trials for 15 antipsychotics, 16 antidepressants for depression, nine antidepressants for anxiety, and 20 drugs for attention deficit hyperactivity disorder (ADHD) were extracted from FDA reviews. Bayesian model-averaged meta-analysis was performed and strength of evidence was quantified (i.e. ). Strength of evidence and trialling varied between drugs. Median evidential strength was extreme for ADHD medication ( = 1820.4), moderate for antipsychotics ( = 365.4), and considerably lower and more frequently classified as weak or moderate for antidepressants for depression ( = 94.2) and anxiety ( = 49.8). Varying median effect sizes ( = 0.45, = 0.30, = 0.37, = 0.72), sample sizes ( = 324, = 218, = 254, = 189.5), and numbers of trials ( = 3, = 5.5, = 3, = 2) might account for differences. Although most drugs were supported by strong evidence at the time of approval, some only had moderate or ambiguous evidence. These results show the need for more systematic quantification and classification of statistical evidence for psychotropic drugs. Evidential strength should be communicated transparently and clearly towards clinical decision makers.
Topics: Humans; Antipsychotic Agents; Bayes Theorem; Psychotropic Drugs; Antidepressive Agents; Attention Deficit Disorder with Hyperactivity
PubMed: 34620261
DOI: 10.1017/S0033291721003950 -
Expert Opinion on Drug Safety Jul 2020The use of psychotropic drugs in children and adolescents is widespread but associated with suboptimal treatment effects. Therapeutic drug monitoring (TDM) can improve...
INTRODUCTION
The use of psychotropic drugs in children and adolescents is widespread but associated with suboptimal treatment effects. Therapeutic drug monitoring (TDM) can improve safety of psychotropic drugs in children and adolescents but is not routinely performed. A major reason is that the relationship between drug concentrations and effects is not well known.
AREAS COVERED
This systematic review evaluated studies assessing the relationship between psychotropic drug concentrations and clinical outcomes in children and adolescents, including antipsychotics, psychostimulants, alpha-agonists, antidepressants, and mood-stabilizers. PRISMA guidelines were used and a quality assessment of the retrieved studies was performed. Sixty-seven eligible studies involving 24 psychotropic drugs were identified from 9,298 records. The findings were generally heterogeneous and the majority of all retrieved studies were not of sufficient quality. For 11 psychotropic drugs, a relationship between drug concentrations and side-effects and/or effectiveness was evidenced in reasonably reported and executed studies, but these findings were barely replicated.
EXPERT OPINION
In order to better support routine TDM in child- and adolescent psychiatry, future work must improve in aspects of study design, execution and reporting to demonstrate drug concentration-effect relationships. The quality criteria proposed in this work can guide future TDM research. Systematic review protocol and registration PROSPERO CRD42018084159.
Topics: Adolescent; Age Factors; Child; Drug Monitoring; Humans; Mental Disorders; Psychotropic Drugs
PubMed: 32421365
DOI: 10.1080/14740338.2020.1770224