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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 -
CNS Drugs Mar 2021This article provides a practical review of the diagnosis and management of angle closure induced by psychotropic agents, including tricyclic antidepressants,... (Review)
Review
This article provides a practical review of the diagnosis and management of angle closure induced by psychotropic agents, including tricyclic antidepressants, antipsychotics and anticonvulsants. Selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, monoamine oxidase inhibitors and antipsychotics may trigger angle closure by influencing pupil configuration through adrenergic, anticholinergic, serotonergic or dopaminergic mechanisms. Patients with narrow iridocorneal angles are at risk, and these are more common in people with hypermetropia (near-sightedness), older people and individuals with an Asian background. These patients may benefit from a laser peripheral iridotomy, either prophylactically or to relieve an acute angle-closure episode. An idiosyncratic reaction to medications such as topiramate may lead to angle closure through an alternate mechanism, leading to a uveal effusion. Ophthalmological review may be considered prior to commencing medications in high-risk patients.
Topics: Acute Disease; Animals; Anticonvulsants; Glaucoma; Humans; Psychotropic Drugs; Topiramate
PubMed: 33604881
DOI: 10.1007/s40263-020-00790-w -
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 -
Drug and Alcohol Dependence Sep 2021Drug overdoses have contributed to considerable years of life lost. However, focusing solely on drug overdoses, whereby drug poisoning defines the underlying cause of...
BACKGROUND
Drug overdoses have contributed to considerable years of life lost. However, focusing solely on drug overdoses, whereby drug poisoning defines the underlying cause of death, obscures the wider burden of the drug mortality crisis. We aim to describe 21 years of trends in "psychotropic-drug-implicated deaths," those where psychotropic drugs are a contributing (but not the underlying) cause of death.
METHODS
We analyze deaths extracted from CDC WONDER from 1999-2019 to generate annual counts and rates for psychotropic-drug-implicated deaths in the United States, including by underlying cause of death and drug implicated.
RESULTS
Over 21 years, 51,446 psychotropic-drug-implicated deaths occurred (33,885 medical; 17,561 external). Both medical and external psychotropic-drug-implicated deaths rose dramatically, increasing 2.5 and 5.0 times, respectively. Diseases of the circulatory system predominated underlying causes of medical deaths (74 %). Non-drug suicide, transport accidents, and drownings constitute 54 % of external underlying causes. Among the various underlying causes of death, psychotropic-drug-implicated deaths represent a considerable proportion, especially among external causes, with the proportion greatly increasing over the observation period. The drug implicated evolves from cocaine to opioids to psychostimulants, with the latter rising considerably.
CONCLUSIONS
The drug mortality crisis extends beyond overdose and may temper improvements observed within other causes of mortality, such as cardiovascular disease, transport accidents, and drownings. As with overdoses, psychotropic-drug-implicated deaths have risen dramatically during the 21 century. They include striking increases for drugs, such as psychostimulants, receiving less attention with overdoses. Research is needed to address prevention, intervention, and policy for psychotropic-drug-implicated deaths beyond overdose mortality.
Topics: Analgesics, Opioid; Cause of Death; Drug Overdose; Humans; Mortality; Pharmaceutical Preparations; Psychotropic Drugs; United States
PubMed: 34218006
DOI: 10.1016/j.drugalcdep.2021.108843 -
Scientific Reports Apr 2023The prescription of psychotropic drugs has been rising in Europe over the last decade. This study provides a comprehensive profile of prepandemic consumption patterns of...
The prescription of psychotropic drugs has been rising in Europe over the last decade. This study provides a comprehensive profile of prepandemic consumption patterns of antidepressant, antipsychotic, and anxiolytic drugs in Portugal considering full nationwide psychotropic drug prescription and dispensing records (2016-2019) against several criteria, including active ingredient, sociodemographics, medical specialty, and incurred costs. An increase of 29.6% and 34.7% in the consumption of antipsychotics and antidepressants between 2016 and 2019 is highlighted, accompanied by an increase of 37M Eur in total expenditure (> 20M Eur in public copay) for these classes of drugs. Disparities in sociodemographic and geographical incidence are identified. Amongst other pivotal results, 64% of psychotropic drug prescriptions are undertaken by general practitioners, while only 21% undertaken by neurological and psychiatric specialties. Nationwide patterns of psychotropic drug prescription further reveal notable trends and determinants, establishing a reference point for cross-regional studies and being currently assessed at a national level to establish psychosocial initiatives and guidelines for medical practice and training.
Topics: Portugal; Psychotropic Drugs; Antipsychotic Agents; Antidepressive Agents; Medicine; Drug Prescriptions
PubMed: 37106018
DOI: 10.1038/s41598-023-33765-0 -
Epidemiology and Psychiatric Sciences Aug 2019Children exposed to trauma are predisposed to develop a number of mental health syndromes. They are prone to under-treatment with effective psychosocial interventions... (Review)
Review
Children exposed to trauma are predisposed to develop a number of mental health syndromes. They are prone to under-treatment with effective psychosocial interventions and over-treatment with high-risk psychotropic medications, especially polypharmacy and the use of antipsychotics for unapproved conditions. We review the evidence for psychosocial and pharmacological treatments for mental health problems associated with high exposure to childhood trauma - identifying those in foster care as an index group - and the frequency of high-risk pharmacological practices. We describe current efforts to reduce over-treatment of children with high-risk psychotropic medications and propose further recommendations to protect and provide effective care for these vulnerable children.
Topics: Antipsychotic Agents; Child; Child Psychiatry; Evidence-Based Medicine; Humans; Medical Overuse; Mental Disorders; Psychotropic Drugs; Stress Disorders, Traumatic
PubMed: 30392479
DOI: 10.1017/S2045796018000616 -
Journal of Psychosocial Nursing and... Apr 2019Pharmacogenetic testing to aid in making decisions about prescribing medications was approved by the U.S. Food and Drug Administration in 2005 and gradually became a...
Pharmacogenetic testing to aid in making decisions about prescribing medications was approved by the U.S. Food and Drug Administration in 2005 and gradually became a common practice. However, an innovation that was thought to help individualize prescribing psychotropic medications with fewer trials and errors soon became a disappointment to clinicians. Current pharmacogenetic testing assesses how the liver metabolizes drugs through the cytochrome p 450 system; however, much of the variability in how a drug affects an individual also relies on the pharmacodynamics of the drug (i.e., the specific ways the drug changes the body). The current article discusses the advantages and disadvantages of pharmacogenetic testing to aid in prescribing psychotropic medications. [Journal of Psychosocial Nursing and Mental Health Services, 57(4), 9-12.].
Topics: Drug Monitoring; Genetic Testing; Humans; Mental Health Services; Pharmacogenetics; Pharmacogenomic Testing; Psychiatric Nursing; Psychotropic Drugs; United States; United States Food and Drug Administration
PubMed: 30933297
DOI: 10.3928/02793695-20190312-01 -
Ciencia & Saude Coletiva Nov 2020The aim of the present study was to estimate the prevalence of psychotropic drug utilization among adults and seniors and determine associated factors, therapeutic...
The aim of the present study was to estimate the prevalence of psychotropic drug utilization among adults and seniors and determine associated factors, therapeutic classes and sources of acquisition. Data from the Brazilian National Survey on Access, Use and Promotion of the Rational Use of Medicines (2013-2014) were analyzed. The prevalence of use of at least one psychotropic drug in the overall sample (adults and seniors) was 8.7%. In the adjusted analyses, positive associations were found between the use of psychotropic drugs and the female sex, poorer self-rated health and chronic diseases (p < 0.05). The most frequently used therapeutic classes were antidepressants (55.3%) by the adults and anxiolytics (59.3%) by the seniors. Approximately 23.0% of psychotropic drugs were obtained exclusively from pharmacies of the public healthcare system and 77.0% were acquired from other sources. The findings reveal a low proportion of attaining psychotropic drugs through the Brazilian public healthcare system as well as the need for public policies that encourage the rational use of prescriptions and treatments to promote a better quality of life and ensure the population's right to health.
Topics: Adult; Antidepressive Agents; Brazil; Drug Utilization; Female; Humans; Psychotropic Drugs; Quality of Life
PubMed: 33175066
DOI: 10.1590/1413-812320202511.35962018 -
Journal of Psychiatric Research Aug 2023We examined the income gradient changes in the use of long-term rehabilitative psychotherapy and psychotropic drug purchases in men and women during a 9-year follow-up.
OBJECTIVE
We examined the income gradient changes in the use of long-term rehabilitative psychotherapy and psychotropic drug purchases in men and women during a 9-year follow-up.
METHODS
We used register data from a random sample of the working-age population (18-64 years) with information on annual income, psychotherapy use and psychotropic drug purchases from 2011 to 2019 (N = 736 613, 49.7% women). Sex-stratified generalized estimating equations logistic regression models with predicted marginal probabilities were used to examine change in the treatment use rates over time for income quartiles.
RESULTS
Treatment rates increased during the follow-up, with men having lower rates than women. There were no significant differences in psychotherapy use rates between the income quartiles during the follow-up in men. A small income gradient in women (the wealthiest group with the highest use rate) remained stable throughout the follow-up. As for psychotropic drug purchases, the rates increased more among the poorest income quartile compared to the wealthiest quartile in both men and women. In the last year of the follow-up, the initial income gradient (wealthiest group having the highest psychotropic drug purchase rate) had become reversed, and the poorest group had the highest psychotropic drug purchase rate.
CONCLUSION
In psychotherapy use, no income gradient was found in men, while a stable income gradient was found in women. Psychotropic drug purchases have previously been more common in the wealthiest groups, but more recently among the poorest. The findings indicate that gender and income have distinct relationships with the treatment modality over time.
Topics: Male; Humans; Female; Adolescent; Young Adult; Adult; Middle Aged; Finland; Psychotropic Drugs; Longitudinal Studies; Probability; Psychotherapy
PubMed: 37352809
DOI: 10.1016/j.jpsychires.2023.06.001