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Naunyn-Schmiedeberg's Archives of... Aug 2020Antidepressants, antiepileptics, mood stabilizers, and antipsychotics are extremely broadly used psychoactive drugs. These drug terms are universally used in the... (Review)
Review
Antidepressants, antiepileptics, mood stabilizers, and antipsychotics are extremely broadly used psychoactive drugs. These drug terms are universally used in the literature. However, the indications of these drugs have broadened substantially and overlap. The mismatch between drug classification and clinical uses causes a lot of confusion in communication and renders literature searches increasingly difficult. Therefore, we propose to drop the above terms altogether and replace them by simple mechanistic terms. Antidepressants are re-named as norepinephrine/serotonin (NE/5-HT) enhancers, antiepileptics comprising drugs with different mechanisms become neuronal inhibitors with pleiotropic effects (NIPEs), and antipsychotics become antagonists at multiple G protein-coupled receptors (mGPCR antagonists). Alkali metal ions, comprising lithium, are integrated into NIPEs. The terms "typical/first-generation/conventional" and "atypical/second-generation/non-conventional" antipsychotics should be dropped, because the original criterion for distinction, i.e., the presence and absence of extrapyramidal motor effects, respectively, is not valid anymore. The suggested changes in drug nomenclature have already been implemented into a recent textbook (Seifert R, Basic Knowledge of Pharmacology). The revised nomenclature ensures consistency with other fields of pharmacology and assignment of drug classes to indications without causing confusion. The authors acknowledge that the change in drug nomenclature is a cultural process that will take time and openly discuss the problems associated with the proposal. Ultimately, international learned societies will have to agree on a new nomenclature.
Topics: Consensus; Humans; Psychotropic Drugs; Terminology as Topic
PubMed: 32535698
DOI: 10.1007/s00210-020-01918-x -
Psychiatria Polska Apr 2021The study reviews the literature on false-positive drug test results in patients taking psychotropic medications. (Review)
Review
INTRODUCTION
The study reviews the literature on false-positive drug test results in patients taking psychotropic medications.
METHOD
A narrative review of available literature in English and Polish was conducted by searching MEDLINE/PubMed and Google Scholar databases using the search phrase ‛falsepositive drug test' and names of selected registered antidepressant, antipsychotic and mood stabilizing medications as well as pharmaceuticals used in the treatment of ADHD. Review articles, case reports and original papers from years 1990-2019 were analyzed.
RESULTS
False-positive drug test results have been reported for many psychiatric drugs: clomipramine, amitriptyline, bupropion, trazodone, sertraline, venlafaxine, hydroxyzine, haloperidol, sulpiride, perazine, levomepromazine, aripiprazole, risperidone, amisulpride, quetiapine, lamotrigine, carbamazepine, methylphenidate, and atomoxetine. No such reports have been found for other drugs considered in this study.
CONCLUSIONS
When interpreting urine drug tests, caution should be exercised, especially when the tested person categorically denies the use of psychoactive substances. In such situations, the patient's medication list should be analyzed to ascertain that the obtained result is not false-positive. When test results are unclear, the presence of drugs in the urine can be effectively confirmed or excluded using gas chromatography. Unfortunately, most of the data available in the literature are case reports, which means they require further support from studies of large cohorts of patients taking psychotropic medications.
Topics: Antipsychotic Agents; Benzodiazepines; Humans; Pharmaceutical Preparations; Psychotropic Drugs; Risperidone
PubMed: 34365490
DOI: 10.12740/PP/113173 -
European Neuropsychopharmacology : the... Apr 2022Despite growing concern about reproductive safety of psychotropic drugs, there is a paucity of research assessing prenatal prescribing practices for bipolar disorder... (Review)
Review
Despite growing concern about reproductive safety of psychotropic drugs, there is a paucity of research assessing prenatal prescribing practices for bipolar disorder (BD). This population-based cohort study identified women aged 15-50 years with BD diagnosis, who delivered their first and singleton child between 2003 and 2018 in Hong Kong, with an aim to examine temporal trends and predictors of prenatal psychotropic drug use as well as drug utilization patterns before and during pregnancy were evaluated. Data were retrieved from territory-wide medical-record database of public healthcare services. Of 302 identified women, 202 (66.9%) and 180 (59.6%) redeemed at least 1 prescription for psychotropic drugs in 12 months pre-pregnancy and during pregnancy, respectively. Psychotropic drug treatment (OR = 16.14 [95% CI: 8.79-29.65]) and psychiatric admission (OR = 4.12 [95% CI: 1.66-10.24]) within 12 months pre-pregnancy were associated with prenatal drug use. Second-generation antipsychotic use during pregnancy increased over time, while prenatal use of lithium, anti-epileptics and first-generation-antipsychotics showed declining trend. Use of psychotropic drugs progressively decreased across pre-pregnancy and trimesters of pregnancy. Forty-two (23.3%) women received polypharmacy during pregnancy. Antidepressant use accounted for 17% of all monotherapy episodes. A significant proportion of women exposed to valproate in 12 months pre-pregnancy (27.2%) and first-trimester (16%). In conclusion, our results generally indicate trajectories of reduced psychotropic drug use across pregnancy. Deviations between real-world prescribing patterns and treatment guidelines underscore the need for comprehensive review of current clinical practices. Further research clarifying relationships of prenatal psychotropic drug exposure with maternal and fetal outcomes is warranted.
Topics: Antipsychotic Agents; Bipolar Disorder; Child; Cohort Studies; Drug Utilization; Female; Humans; Pregnancy; Pregnant Women; Psychotropic Drugs
PubMed: 35151952
DOI: 10.1016/j.euroneuro.2022.01.115 -
Current Medicinal Chemistry 2022Oxytocin is a nonapeptide synthesized in the paraventricular and supraoptic nuclei of the hypothalamus. Historically, this molecule has been involved as a key factor in... (Review)
Review
BACKGROUND
Oxytocin is a nonapeptide synthesized in the paraventricular and supraoptic nuclei of the hypothalamus. Historically, this molecule has been involved as a key factor in the formation of infant attachment, maternal behavior and pair bonding and, more generally, in linking social signals with cognition, behaviors and reward. In the last decades, the whole oxytocin system has gained a growing interest as it was proposed to be implicated in etiopathogenesis of several neurodevelopmental and neuropsychiatric disorders.
METHODS
With the main goal of an in-depth understanding of the oxytocin role in the regulation of different functions and complex behaviors as well as its intriguing implications in different neuropsychiatric disorders, we performed a critical review of the current state of the art. We carried out this work through the PubMed database up to June 2021 with the search terms: 1) "oxytocin and neuropsychiatric disorders"; 2) "oxytocin and neurodevelopmental disorders"; 3) "oxytocin and anorexia"; 4) "oxytocin and eating disorders"; 5) "oxytocin and obsessive- compulsive disorder"; 6) "oxytocin and schizophrenia"; 7) "oxytocin and depression"; 8) "oxytocin and bipolar disorder"; 9) "oxytocin and psychosis"; 10) "oxytocin and anxiety"; 11) "oxytocin and personality disorder"; 12) "oxytocin and PTSD".
RESULTS
Biological, genetic, and epigenetic studies highlighted quality and quantity modifications in the expression of oxytocin peptide or in oxytocin receptor isoforms. These alterations would seem to be correlated with a higher risk of presenting several neuropsychiatric disorders belonging to different psychopathological spectra. Collaterally, the exogenous oxytocin administration has shown to ameliorate many neuropsychiatric clinical conditions.
CONCLUSION
Finally, we briefly analyzed the potential pharmacological use of oxytocin in a patient with severe symptomatic SARS-CoV-2 infection due to its anti-inflammatory, antioxidative and immunoregulatory properties.
Topics: Anti-Obesity Agents; COVID-19; DNA-Binding Proteins; Female; Humans; Infant; Mental Disorders; Oxytocin; Psychotropic Drugs; Receptors, Oxytocin; SARS-CoV-2
PubMed: 35894453
DOI: 10.2174/0929867329666220727120646 -
European Journal of Hospital Pharmacy :... Mar 2021The aims of the present study were: (1) to describe psychotropic drug consumption patterns in an outpatient population aged 65 years and older; (2) to determine the... (Review)
Review
OBJECTIVES
The aims of the present study were: (1) to describe psychotropic drug consumption patterns in an outpatient population aged 65 years and older; (2) to determine the impact of a number of demographic and clinical factors on psychotropic consumption; and (3) to determine the ratio of potentially inappropriate psychotropic agents prescribed to the above population.
METHODS
Cross-sectional, observational study of outpatients aged 65 years and older. Data on sociodemographic and clinical variables were collected. Psychotropic drugs were classified into three categories: anxiolytics-hypnotics, antidepressants, and antipsychotics. To determine the risk factors for psychotropic drug use among these patients, a multivariate logistic regression model was developed and subsequently validated using bootstrap resampling techniques. To identify the psychotropic drugs to be avoided, a review of treatments received by the patients was performed based on the 2015 version of the Beers criteria.
RESULTS
The study included 225 outpatients of whom 30.7% were on psychotropic drugs for chronic treatment. The highest likelihood of psychotropic utilisation corresponded to the following profile: female, living in a nursing home, having two or more prescribing physicians, and having received six or more different diagnoses. According to Beers criteria, 51 patients (22.7% of the sample and 73.9% of patients on psychotropic drugs) had been prescribed at least one potentially inappropriate psychotropic drug.
CONCLUSION
Elderly patients commonly use psychotropic medications and are the most vulnerable to the adverse effects of these drugs. It is necessary to re-evaluate the pertinence and accuracy of these medical prescriptions.
Topics: Aged; Cross-Sectional Studies; Female; Humans; Observational Studies as Topic; Psychotropic Drugs; Risk Factors
PubMed: 33608436
DOI: 10.1136/ejhpharm-2019-001927 -
Journal of Psychosocial Nursing and... Feb 2020Many clients do not take their medications as prescribed. One of the reasons may be the common adverse drug effects and drug-drug interactions of certain medications....
Many clients do not take their medications as prescribed. One of the reasons may be the common adverse drug effects and drug-drug interactions of certain medications. This article reviews adverse drug effects (including less serious side effects), the pharmacokinetics and pharmacodynamics involved in adverse effects, and the pharmacokinetics of drug interactions. For medications to be effective in treating mental disorders, nurses need to carefully assess clients and their motivations for taking medications, routinely inquire about when and how they are taking their prescriptions, any adverse effects they are experiencing, and how they are managing common, less severe adverse effects. [Journal of Psychosocial Nursing and Mental Health Services, 58(2), 9-13.].
Topics: Drug Interactions; Drug-Related Side Effects and Adverse Reactions; Humans; Mental Disorders; Psychiatric Nursing; Psychotropic Drugs; Treatment Adherence and Compliance
PubMed: 32003860
DOI: 10.3928/02793695-20200117-02 -
International Journal of Molecular... Jun 2024Drug repurposing, rebranding an existing drug for a new therapeutic indication, is deemed a beneficial approach for a quick and cost-effective drug discovery process by... (Review)
Review
Drug repurposing, rebranding an existing drug for a new therapeutic indication, is deemed a beneficial approach for a quick and cost-effective drug discovery process by skipping preclinical, Phase 1 trials and pharmacokinetic studies. Several psychotropic drugs, including selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs), were studied for their potential application in different diseases, especially in cancer therapy. Fluoxetine (FLX) is one of the most prescribed psychotropic agents from the SSRIs class for the treatment of several neuropsychiatric disorders with a favorable safety profile. FLX exhibited different oncolytic effects via mechanisms distinct from its main serotonergic activity. Taking advantage of its ability to rapidly penetrate the blood-brain barrier, FLX could be particularly useful in brain tumors. This was proved by different in vitro and in vivo experiments using FLX as a monotherapy or combination with temozolomide (TMZ) or radiotherapy. In this review of the literature, we summarize the potential pleiotropic oncolytic roles of FLX against different cancers, highlighting the multifaceted activities of FLX and its ability to interrupt cancer proliferation via several molecular mechanisms and even surmount multidrug resistance (MDR). We elaborated on the successful synergistic combinations such as FXR/temozolomide and FXR/raloxifene for the treatment of glioblastoma and breast cancer, respectively. We showcased beneficial pharmaceutical trials to load FLX onto carriers to enhance its safety and efficacy on cancer cells. This is the first review article extensively summarizing all previous FLX repurposing studies for the management of cancer.
Topics: Humans; Drug Repositioning; Fluoxetine; Animals; Neoplasms; Antineoplastic Agents; Psychotropic Drugs; Selective Serotonin Reuptake Inhibitors
PubMed: 38928021
DOI: 10.3390/ijms25126314 -
Parkinsonism & Related Disorders Dec 2022Whereas the treatment of motor symptoms in Huntington's disease (HD) receives much attention, less is known about the treatment of neuropsychiatric symptoms.
BACKGROUND
Whereas the treatment of motor symptoms in Huntington's disease (HD) receives much attention, less is known about the treatment of neuropsychiatric symptoms.
OBJECTIVE
We aim to give an overview of psychotropic drug use in the treatment of neuropsychiatric symptoms across disease stages in HD.
METHODS
We conducted a descriptive cross-sectional study of psychotropic drug prescriptions in a large longitudinal database of HD patients, Enroll HD. Across disease stages, the number of prescriptions per medication class, as well as the registered indications for these prescriptions were listed, and compared with that in gene negative participants.
RESULTS
Of the 8967 included HD patients, 80% were using at least one psychotropic drug, compared to 27% of gene negative participants. In HD patients, 51% of all drug prescriptions was for psychotropic drugs. The average number of psychotropic drugs used per patient increased from 1.3 in the premanifest stage to 2.5 in stage 5. With progressing disease stages, the proportion of antidepressant drug prescriptions gradually decreased from 74.1% of all prescriptions to 27.3%, and antipsychotic drug prescriptions increased from 7.0% to 38.7%. In line with this, depression and anxiety as listed indications for prescription decreased with advancing disease stages (from 63.0% to 31.5% and from 30.0% to 15.4% respectively), whereas irritability and psychosis increased (from 3.1% to 28.6% and from 0.9% to 16.0% respectively).
CONCLUSIONS
Psychotropic medication is widely prescribed in HD, for various indications. Antidepressant use decreases proportionally and antipsychotic use increases with advancing disease stages, suggesting a relative decrease in prevalence of anxiety and depression over disease stages on one hand, and a relative increase in prevalence of irritability and delusions on the other.
Topics: Humans; Huntington Disease; Cross-Sectional Studies; Retrospective Studies; Psychotropic Drugs; Antipsychotic Agents; Antidepressive Agents
PubMed: 36379156
DOI: 10.1016/j.parkreldis.2022.11.004 -
European Geriatric Medicine Jun 2023Psychotropic medications (antidepressants, anticholinergics, benzodiazepines, 'Z'-drugs and antipsychotics) are frequently identified as Falls Risk Increasing Drugs. The...
PURPOSE
Psychotropic medications (antidepressants, anticholinergics, benzodiazepines, 'Z'-drugs and antipsychotics) are frequently identified as Falls Risk Increasing Drugs. The aim of this study is to clarify the association of psychotropic medication use with future falls/fracture amongst community-dwelling older people.
METHODS
Participants ≥ 65 years from TILDA were included and followed from Waves 1 to 5 (8-year follow-up). Incidence of falls (total falls/unexplained/injurious) and fracture was by self-report; unexplained falls were falls not caused by a slip/trip, with no apparent cause. Poisson regression models reporting incidence rate ratios (IRR) assessed the association between medications and future falls/fracture, adjusted for relevant covariates.
RESULTS
Of 2809 participants (mean age 73 years), 15% were taking ≥ 1 psychotropic medication. During follow-up, over half of participants fell, with 1/3 reporting injurious falls, over 1/5 reporting unexplained falls and almost 1/5 reporting fracture. Psychotropic medications were independently associated with falls [IRR 1.15 (95% CI 1.00-1.31)] and unexplained falls [IRR 1.46 (95% CI 1.20-1.78)]. Taking ≥ 2 psychotropic medications was further associated with future fracture (IRR 1.47 (95% CI 1.06-2.05)]. Antidepressants were independently associated with falls [IRR 1.20 (1.00-1.42)] and unexplained falls [IRR 2.12 (95% CI 1.69-2.65)]. Anticholinergics were associated with unexplained falls [IRR 1.53 (95% CI 1.14-2.05)]. 'Z'-drug and benzodiazepine use were not associated with falls or fractures.
CONCLUSION
Psychotropic medications, particularly antidepressants and anticholinergic medications, are independently associated with falls and fractures. Regular review of ongoing need for these medications should therefore be central to the comprehensive geriatric assessment.
Topics: Humans; Aged; Accidental Falls; Independent Living; Psychotropic Drugs; Fractures, Bone; Antidepressive Agents; Benzodiazepines; Cholinergic Antagonists
PubMed: 37157012
DOI: 10.1007/s41999-023-00786-x -
Journal of the American Psychiatric... 2020Prolonged QT interval (PQTI) is a cardiac condition widely documented in the mental health literature and linked to psychotropic medication use. Medications notable for... (Review)
Review
Prolonged QT interval (PQTI) is a cardiac condition widely documented in the mental health literature and linked to psychotropic medication use. Medications notable for contributing to the condition are antipsychotics, antidepressants, and some mood stabilizers. Although additional medication classes and other contributing risk factors are often present, the prudent mental health provider benefits from having a basic understanding of this condition and how to prevent and manage it with safe prescribing practices. This guide seeks to provide mental health prescribers with a basic understanding of the risk factors, pathophysiology, identification, and management of PQTI. Relevant literature and practice guidelines were reviewed and summarized with a focus on practical interventions for the psychiatric mental health nurse practitioner (PMHNP). One of the primary contributing factors to PQTI development and complications is polypharmacy. Patients with co-occurring medical, mental health, and/or substance use disorders may receive medications from multiple providers. Anticancer drugs, antiarrhythmic medications, and even a number of common antibiotics can increase the QT interval, making it a challenge for even the most experienced mental health provider to monitor medication interactions and side effects that contribute to PQTI. Having a sound knowledge base of these factors can guide safe PMHNP practice. Decision-making trees grounded in evidence-based research were developed in order to direct thorough assessment and safe treatment of patients requiring psychotropic medications.
Topics: Antidepressive Agents; Antipsychotic Agents; Guidelines as Topic; Humans; Long QT Syndrome; Mental Disorders; Polypharmacy; Psychotropic Drugs; Risk Factors
PubMed: 31509051
DOI: 10.1177/1078390319873049