-
Journal of Clinical Psychopharmacology
Topics: Female; Humans; Placenta; Pregnancy; Pregnancy Complications; Psychotropic Drugs
PubMed: 34369906
DOI: 10.1097/JCP.0000000000001451 -
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 -
Der Nervenarzt May 2021The benefits and risks of treatment with antipsychotics during pregnancy must be weighed up carefully and individually because antipsychotics can penetrate the placental... (Review)
Review
BACKGROUND
The benefits and risks of treatment with antipsychotics during pregnancy must be weighed up carefully and individually because antipsychotics can penetrate the placental barrier and prescription is off-label.
OBJECTIVE
Evaluation of the risks and benefits of administering antipsychotics during pregnancy or for women who wish to become pregnant regarding teratogenic effects, risk of fetal death and stillbirths, perinatal complications, persisting postnatal impairments or disorders and gestational diabetes.
METHODS
A systematic review of the literature is provided to aid the selection of psychotropic drugs during pregnancy and in determining whether to begin, continue or switch an antipsychotic treatment during pregnancy.
RESULTS
Large, well-designed and controlled studies are missing; however, most studies suggest that the group of antipsychotics seem to be safe in terms of teratogenicity during pregnancy, at least in monotherapy.
CONCLUSION
Treating mental illnesses during pregnancy requires an individual assessment of the benefits and risks. The risk of an untreated mental illness versus the benefit of a suitable treatment with antipsychotics and the potential harm to the infant must be evaluated. If certain rules are observed and a suitable antipsychotic is selected the risk to the newborn child and/or mother during pregnancy can be minimized, however, a decision about subsequent medication can only be indirectly made from the results of this study.
Topics: Antipsychotic Agents; Female; Humans; Infant, Newborn; Mental Disorders; Pregnancy; Pregnancy Complications; Psychotropic Drugs
PubMed: 33000289
DOI: 10.1007/s00115-020-01006-8 -
Seminars in Perinatology Apr 2020Optimal dose management of psychotropic drugs during the perinatal period reduces the risk for recurrence of mood episodes in women with Bipolar Disorder. Physiological... (Review)
Review
Optimal dose management of psychotropic drugs during the perinatal period reduces the risk for recurrence of mood episodes in women with Bipolar Disorder. Physiological changes during pregnancy are associated with decreases in the plasma concentrations of the majority of mood stabilizing medications. Regular symptom and drug concentration monitoring for lithium and anticonvulsants with reflexive dose adjustment improves the probability of sustained symptom remission across pregnancy. The elimination clearance trajectory across pregnancy for psychotropics dictates the frequency of laboratory monitoring and dose adjustment. The literature on the pharmacokinetics of lithium, lamotrigine, carbamazepine and atypical antipsychotics during pregnancy and postpartum are reviewed, recommendations for symptom and laboratory monitoring are proposed and recommendations for dose adjustments are presented.
Topics: Antimanic Agents; Antipsychotic Agents; Bipolar Disorder; Carbamazepine; Drug Elimination Routes; Female; Humans; Lactation; Lamotrigine; Lithium Compounds; Perinatal Care; Pregnancy; Pregnancy Complications; Prenatal Exposure Delayed Effects; Puerperal Disorders
PubMed: 32151481
DOI: 10.1016/j.semperi.2020.151230 -
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 -
Nordic Journal of Psychiatry May 2022Low medication adherence is a significant challenge in all medical fields and particularly in mental health treatment, where a lack of insight into one's own disease can... (Review)
Review
BACKGROUND
Low medication adherence is a significant challenge in all medical fields and particularly in mental health treatment, where a lack of insight into one's own disease can repress the ability to adhere. In recent years, the increase in migration combined with a high prevalence of mental illnesses among migrants and the possible consequences of nonadherence, point towards the need for a focus on adherence with psychotropic drugs among migrants.
AIM
To review current literature, exploring the potential impact of being a migrant from a non-Western country living in a Western country on the level of adherence to psychotropic medication and subsequently to discuss these findings.
METHODS
A systematic review of studies investigating adherence among non-western migrants was conducted. The literature search was conducted using PubMed and Embase databases in October 2020.
RESULTS
Seven observational studies were included, all ranging from moderate to high-quality. Six out of seven studies found an association between being a non-Western migrant in a Western country and low adherence to psychotropic drugs.
CONCLUSION
Studies indicate an association between being a non-Western migrant in a Western country and low adherence to psychotropic drugs. None of the included studies investigated possible causes of the low adherence in migrants. Communication difficulties are, however, considered possible barriers to healthcare access and a contributing factor to nonadherence. There is a need for studies assessing the possible impact of interventions aiming at increasing adherence such as intercultural mediators and training of healthcare providers in cultural competencies.
Topics: Humans; Medication Adherence; Mental Disorders; Psychotropic Drugs; Transients and Migrants; Treatment Adherence and Compliance
PubMed: 34369289
DOI: 10.1080/08039488.2021.1954689 -
Legal Medicine (Tokyo, Japan) Nov 2021In this study, sensitive analytical procedure for detection and quantification of etaqualone in human hair samples using gas chromatography tandem mass spectrometry...
In this study, sensitive analytical procedure for detection and quantification of etaqualone in human hair samples using gas chromatography tandem mass spectrometry (GC-MS/MS) was newly established, and applied it to authentic human samples obtained from an abuser. In this method, the hair samples were treated with hydrochloric acid and then extracted with ethyl ether. The ether layer was dried in a warm water bath, and the residue was reconstituted in ethyl acetate, followed by GC-MS/MS analysis. Multiple reaction monitoring (MRM) mode was used for data collection, and quantitative analysis was performed using internal standard method. Good linear relationship within the concentration range of 1-100 pg/mg were obtained in calibrators for the hair samples showing its correlation coefficient value was 0.9993. The lower limit of quantitation in this study was 1 pg/mg and the recovery rate examined ranged from 100.4% to 108.5%. The intra-day precision and accuracy were less than 5.0% and 5.8%, respectively. The inter-day precision and accuracy were lower than 6.4% and 4.6%, respectively. Using this established method, etaqualone could be detected in the hair sample obtained from a suspected user to be level of 65.2 pg/mg. It should be expected that the method established in this study would contribute to rapid detection and identification of psychotropic drug etaqualone among multiple fields including forensic investigation, clinical application and of course public health matters.
Topics: Gas Chromatography-Mass Spectrometry; Hair; Humans; Limit of Detection; Psychotropic Drugs; Reproducibility of Results; Tandem Mass Spectrometry
PubMed: 34521032
DOI: 10.1016/j.legalmed.2021.101964