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Journal of Child and Adolescent... Apr 2023Knowledge is limited regarding the adverse effects of therapeutic glucocorticoids on pediatric mental health outcomes. Glucocorticoid-induced psychosis (GIP) is a rare... (Review)
Review
Knowledge is limited regarding the adverse effects of therapeutic glucocorticoids on pediatric mental health outcomes. Glucocorticoid-induced psychosis (GIP) is a rare but severe side effect of high-dose glucocorticoid therapy in children and adolescents. This study identified reported pediatric cases of GIP, based on DSM-5 criteria, and defined its presentation, treatments, and outcomes. A systematic review was completed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, including pediatric patients with incident psychosis following glucocorticoid treatment. Patient demographics, clinical presentation, interventions, outcomes, and long-term management were extracted from individual cases. Of 1131 articles screened, 28 reports were included, comprising of 31 patients. The mean age was 13 years, and 61% of patients were male. The most common medical illnesses requiring administration of high dose glucocorticoids were asthma (23%) and acute lymphoblastic leukemia (23%). The most common glucocorticoid used was prednisone (35%), and most patients (91%) received doses greater than or equal to 40 mg/day of prednisone. The range of time to symptom onset was 1 day to 7 months. Hallucinations alone (45%) were the most reported feature of GIP. Glucocorticoids were discontinued in 52% of cases, reduced in dosage in 32%, and 81% of affected patients were prescribed psychotropic medications. Long-term management plans and prophylactic psychotropic use were not mentioned in 52% of cases. Symptoms resolved in 90% of patients, and the majority (71%) had no recurrence of psychiatric symptoms. GIP can generally be managed by tapering the causative agent with adjunctive second-generation antipsychotics if psychotic symptoms persist. All patients in this review had complete resolution or improvement of their psychotic symptoms; however, there is likely reporting bias due to the expected underreporting of negative outcomes. Managing clinicians must take a circumspect approach when prescribing high-dose glucocorticoids to minimize the risk of serious but preventable side effects.
Topics: Child; Humans; Adolescent; Male; Female; Glucocorticoids; Prednisone; Psychotic Disorders; Antipsychotic Agents; Psychotropic Drugs
PubMed: 37074331
DOI: 10.1089/cap.2022.0077 -
The Journal of Clinical Psychiatry Feb 2021To compare efficacy and safety of single daily dosing (Single-DD) vs multiple daily dosing (Multiple-DD) regimens of psychotropic drugs, the authors conducted a... (Comparative Study)
Comparative Study Meta-Analysis
OBJECTIVE
To compare efficacy and safety of single daily dosing (Single-DD) vs multiple daily dosing (Multiple-DD) regimens of psychotropic drugs, the authors conducted a systematic review and meta-analysis.
DATA SOURCES
A systematic literature search of MEDLINE and Embase was conducted with keywords related to dosing regimens and psychotropic drugs (last search: December 30, 2019).
STUDY SELECTION
Randomized controlled trials comparing clinical outcomes between Single-DD and Multiple-DD of the same formulation of the same psychotropic drugs in patients with psychiatric disorders were included.
DATA EXTRACTION
Data on study discontinuation, psychopathology, and treatment-emergent adverse events (TEAEs) were extracted.
RESULTS
A total of 32 studies with 34 paired comparisons involving 3,142 patients met the eligibility criteria and were included in the meta-analysis. Various types of psychotropic drugs were examined: antidepressants (22 comparisons), antipsychotics (7 comparisons), benzodiazepines (2 comparisons), mood stabilizers (2 comparisons), and antidepressant-benzodiazepine combination (1 comparison). There was no significant difference in study discontinuation due to all causes (30 comparisons, N = 2,883, risk ratio [RR] = 1.01, 95% CI = 0.94 to 1.09, P = .77), lack of efficacy (22 comparisons, N = 2,307, RR = 1.06, 95% CI = 0.84 to 1.33, P = .62), or adverse events (25 comparisons, N = 2,571, RR = 0.93, 95% CI = 0.75 to 1.14, P = .47) between the Single-DD and Multiple-DD groups. No significant difference was found in changes in psychopathology (8 comparisons, N = 1,337, standardized mean difference = 0.00, 95% CI = -0.11 to 0.11, P = .99) between the 2 groups. These results were also true for any type of psychotropic drugs. In terms of TEAEs, however, there were significant differences in anxiety (4 comparisons, N = 347, RR = 0.53, 95% CI = 0.33 to 0.84, P = .007) and sleepiness (3 comparisons, N = 934, RR = 0.82, 95% CI = 0.68 to 0.99, P = .04) in favor of the Single-DD group.
CONCLUSIONS
The findings suggest Single-DD can be clinically adopted regardless of type of psychotropic drugs in patients with psychiatric disorders in general.
Topics: Drug Administration Schedule; Humans; Mental Disorders; Psychotropic Drugs; Treatment Outcome
PubMed: 33988935
DOI: 10.4088/JCP.20r13503 -
Neuroscience and Biobehavioral Reviews Aug 2022This network meta-analysis compares the efficacy and acceptability of all published psychotherapeutic and pharmacological interventions for trauma-related nightmares... (Meta-Analysis)
Meta-Analysis Review
This network meta-analysis compares the efficacy and acceptability of all published psychotherapeutic and pharmacological interventions for trauma-related nightmares (TRN) in adults. The analysis included data from 29 randomized clinical trials involving 14 psychotherapeutic and pharmacological interventions and involved 2214 trauma survivors. Prazosin and image rehearsal therapy (IRT) were found to be the two effective interventions for TRN. Other interventions such as risperidone, paroxetine, cognitive behavioral therapy for insomnia (CBT-I), CBT-I+IRT, prolonged exposure (PE), and IRT+PE, did not show significantly greater efficacy compared with control conditions. The rates of all-cause discontinuations were comparable among majority of the interventions and did not show significant differences compared with control conditions. Prazosin and IRT should be considered as the initial choice of pharmacological and psychotherapeutic interventions for TRN. The efficacy of other pharmacological and psychotherapeutic interventions remains to be demonstrated. Future guidelines and daily clinical decision making on the choice of interventions for TRN should consider these findings.
Topics: Adult; Dreams; Humans; Implosive Therapy; Network Meta-Analysis; Prazosin; Psychotropic Drugs; Stress Disorders, Post-Traumatic
PubMed: 35661755
DOI: 10.1016/j.neubiorev.2022.104717 -
Journal of Preventive Medicine and... Jun 2019Few studies have assessed the extent of psychoactive drug consumption in the occupational setting. The trucking sector, in particular, is an important cause for concern,... (Meta-Analysis)
Meta-Analysis
Few studies have assessed the extent of psychoactive drug consumption in the occupational setting. The trucking sector, in particular, is an important cause for concern, since psychoactive substance use has a relevant impact on the drivers' health and safety, increasing the risk of injuries and traffic accidents, potentially affecting the general public health as well. A systematic review of the literature and meta-analysis was performed in order to provide Occupational Health Professionals and policy-makers with an updated epidemiological perspective regarding this important issue. The results showed a prevalence of overall drug consumption of 27.6% [95%CI 17.8-40.1], particularly high considering illicit CNS-stimulants (amphetamine consumption of 21.3% [95%CI 15.7-28.1], and cocaine consumption of 2.2% [95%CI 1.2-4.1]). It appears that truck-drivers choose stimulant substances as a form of performance enhancing drug, in order to increase productivity. However, chronic and high dose consumption has been shown to decrease driving skills, placing these professional drivers at risk for health and road safety. Further research is required, particularly in Europe, in order to fill the knowledge gap and improve the strength of evidence.
Topics: Amphetamine-Related Disorders; Automobile Driving; Cocaine-Related Disorders; Humans; Occupational Diseases; Psychotropic Drugs; Substance-Related Disorders
PubMed: 31312742
DOI: 10.15167/2421-4248/jpmh2019.60.2.1245 -
Health Technology Assessment... Sep 2020People with a history of complex traumatic events typically experience trauma and stressor disorders and additional mental comorbidities. It is not known if existing...
BACKGROUND
People with a history of complex traumatic events typically experience trauma and stressor disorders and additional mental comorbidities. It is not known if existing evidence-based treatments are effective and acceptable for this group of people.
OBJECTIVE
To identify candidate psychological and non-pharmacological treatments for future research.
DESIGN
Mixed-methods systematic review.
PARTICIPANTS
Adults aged ≥ 18 years with a history of complex traumatic events.
INTERVENTIONS
Psychological interventions versus control or active control; pharmacological interventions versus placebo.
MAIN OUTCOME MEASURES
Post-traumatic stress disorder symptoms, common mental health problems and attrition.
DATA SOURCES
Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1937 onwards); Cochrane Central Register of Controlled Trials (CENTRAL) (from inception); EMBASE (1974 to 2017 week 16); International Pharmaceutical Abstracts (1970 onwards); MEDLINE and MEDLINE Epub Ahead of Print and In-Process & Other Non-Indexed Citations (1946 to present); Published International Literature on Traumatic Stress (PILOTS) (1987 onwards); PsycINFO (1806 to April week 2 2017); and Science Citation Index (1900 onwards). Searches were conducted between April and August 2017.
REVIEW METHODS
Eligible studies were singly screened and disagreements were resolved at consensus meetings. The risk of bias was assessed using the Cochrane risk-of-bias tool and a bespoke version of a quality appraisal checklist used by the National Institute for Health and Care Excellence. A meta-analysis was conducted across all populations for each intervention category and for population subgroups. Moderators of effectiveness were assessed using metaregression and a component network meta-analysis. A qualitative synthesis was undertaken to summarise the acceptability of interventions with the relevance of findings assessed by the GRADE-CERQual checklist.
RESULTS
One hundred and four randomised controlled trials and nine non-randomised controlled trials were included. For the qualitative acceptability review, 4324 records were identified and nine studies were included. The population subgroups were veterans, childhood sexual abuse victims, war affected, refugees and domestic violence victims. Psychological interventions were superior to the control post treatment for reducing post-traumatic stress disorder symptoms (standardised mean difference -0.90, 95% confidence interval -1.14 to -0.66; number of trials = 39) and also for associated symptoms of depression, but not anxiety. Trauma-focused therapies were the most effective interventions across all populations for post-traumatic stress disorder and depression. Multicomponent and trauma-focused interventions were effective for negative self-concept. Phase-based approaches were also superior to the control for post-traumatic stress disorder and depression and showed the most benefit for managing emotional dysregulation and interpersonal problems. Only antipsychotic medication was effective for reducing post-traumatic stress disorder symptoms; medications were not effective for mental comorbidities. Eight qualitative studies were included. Interventions were more acceptable if service users could identify benefits and if they were delivered in ways that accommodated their personal and social needs.
LIMITATIONS
Assessments about long-term effectiveness of interventions were not possible. Studies that included outcomes related to comorbid psychiatric states, such as borderline personality disorder, and populations from prisons and humanitarian crises were under-represented.
CONCLUSIONS
Evidence-based psychological interventions are effective and acceptable post treatment for reducing post-traumatic stress disorder symptoms and depression and anxiety in people with complex trauma. These interventions were less effective in veterans and had less of an impact on symptoms associated with complex post-traumatic stress disorder.
FUTURE WORK
Definitive trials of phase-based versus non-phase-based interventions with long-term follow-up for post-traumatic stress disorder and associated mental comorbidities.
STUDY REGISTRATION
This study is registered as PROSPERO CRD42017055523.
FUNDING
This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in ; Vol. 24, No. 43. See the NIHR Journals Library website for further project information.
Topics: Adult; Cognitive Behavioral Therapy; Comorbidity; Evidence-Based Medicine; Female; Humans; Male; Middle Aged; Non-Randomized Controlled Trials as Topic; Psychotherapy; Psychotropic Drugs; Randomized Controlled Trials as Topic; Stress Disorders, Post-Traumatic
PubMed: 32924926
DOI: 10.3310/hta24430 -
Postgraduate Medicine Sep 2016It is known that psychotropic medications have an impact on the readings found in Electroencephalogram (EEG). In the field of psychiatry, there are several psychotropics... (Review)
Review
OBJECTIVES
It is known that psychotropic medications have an impact on the readings found in Electroencephalogram (EEG). In the field of psychiatry, there are several psychotropics utilized by clinicians. This review seeks to investigate all the available data for psychotropic drugs and their impact on EEG changes.
METHODS
A systematic review of all the published and ongoing literature was conducted via PubMed. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method was used for each search. Key words for searches include 'EEG and Psychotropics', 'EEG and Mood Stabilizers', 'EEG and Clozapine', 'EEG and Bupropion', 'EEG and SSRI', 'EEG and Lamotrigine', 'EEG and Carbamazepine', 'EEG and Lithium' and 'EEG and Valproate', 'EEG and Haloperidol', 'EEG and Aripiprazole', 'EEG and Methylphenidate', 'EEG and Topiramate', 'EEG and Gabapentin' and 'EEG and Oxcarbamazepine'. After applying the inclusion criteria, 201 articles were eligible and reviewed.
RESULTS
Following an extensive review of selected studies from the 201 articles, the studies indicate that each of the psychotropic medications reviewed impact alpha, beta, delta and theta waves independently and differently from each other. Additionally, certain medications, particularly haloperidol and valproic acid, have dissimilar results exemplified in all waveforms.
CONCLUSIONS
This PRISMA systematic review illustrates that while there is available data on psychotropic medications and their proposed effect on EEG activity, further research is needed to confirm these findings to help allow clinical correlations to be made between the patient's response and the psychotropic agent.
Topics: Electroencephalography; Humans; Mental Disorders; Psychotropic Drugs
PubMed: 27467441
DOI: 10.1080/00325481.2016.1218261 -
Actas Espanolas de Psiquiatria Sep 2023RESUMEN Objective. The misuse of prescription psychotropic drugs is a major health problem.
RESUMEN Objective. The misuse of prescription psychotropic drugs is a major health problem.
Topics: Humans; Prescription Drugs; Prevalence; Prescriptions; Risk Factors; Mental Disorders; Psychotropic Drugs
PubMed: 38117263
DOI: No ID Found -
International Review of Psychiatry... Oct 2013Desirable and undesirable effects of a drug are related to its concentration at various sites of actions. For many psychotropic drugs, it has been shown that drug... (Review)
Review
Desirable and undesirable effects of a drug are related to its concentration at various sites of actions. For many psychotropic drugs, it has been shown that drug concentration in brain correlates with concentration in blood. The latter is also an available estimate of clearance and bioavailability. Its monitoring enables identification of multiple factors that have an impact on clinical outcomes, especially uncertain compliance and pharmacokinetic peculiarities. For this review we analysed for antidepressants if drug concentration in blood can be used as biomarker for psychopharmacological treatment. Systematic review of the literature revealed for new and old antidepressant drugs that drug and metabolite concentrations in blood are measures of the pharmacokinetic phenotype and related differentially to occupancy of primary target structures, therapeutic effects and unwanted anticholinergic, cardiac and other side effects. Drug concentration in blood can therefore be used as biomarker in clinical practice to guide psychopharmacological treatment with established antidepressant drugs. Monitoring of drug concentration is suitable to improve efficacy and safety of the pharmacotherapy, especially in elderly patients who require complex pharmacological therapies.
Topics: Antidepressive Agents; Biomarkers; Humans; Psychopharmacology
PubMed: 24151798
DOI: 10.3109/09540261.2013.836475 -
Current Psychiatry Reports Jul 2016Clozapine is exceptionally effective in psychotic disorders and can reduce suicidal risk. Nevertheless, its use is limited due to potentially life-threatening adverse... (Review)
Review
Clozapine is exceptionally effective in psychotic disorders and can reduce suicidal risk. Nevertheless, its use is limited due to potentially life-threatening adverse effects, including myocarditis and cardiomyopathy. Given their clinical importance, we systematically reviewed research on adverse cardiac effects of clozapine, aiming to improve estimates of their incidence, summarize features supporting their diagnosis, and evaluate proposed monitoring procedures. Incidence of early (≤2 months) myocarditis ranges from <0.1 to 1.0 % and later (3-12 months) cardiomyopathy about 10 times less. Diagnosis rests on relatively nonspecific symptoms, ECG changes, elevated indices of myocardial damage, cardiac MRI findings, and importantly, echocardiographic evidence of developing ventricular failure. Treatment involves stopping clozapine and empirical applications of steroids, diuretics, beta-blockers, and antiangiotensin agents. Mortality averages approximately 25 %. Safety of clozapine reuse remains uncertain. Systematic studies are needed to improve knowledge of the epidemiology, avoidance, early identification, and treatment of these adverse effects, with effective and practicable monitoring protocols.
Topics: Adverse Drug Reaction Reporting Systems; Antipsychotic Agents; Cardiomyopathies; Cardiotoxicity; Clozapine; Drug Monitoring; Humans; Psychotic Disorders
PubMed: 27222142
DOI: 10.1007/s11920-016-0704-3 -
International Journal of Psychiatry in... Jun 2023Knowledge about the neurobiology of psychiatric disorders is increasing in the last decades and evidence from literature suggests a central role for immuno-inflammatory... (Review)
Review
INTRODUCTION
Knowledge about the neurobiology of psychiatric disorders is increasing in the last decades and evidence from literature suggests a central role for immuno-inflammatory mechanisms in these illnesses. The antipsychotic quetiapine acts on dopamine and serotonin signalling and well-established evidence demonstrates that these neurotransmitters can modulate immune functions in healthy and diseased conditions. Starting from this perspective, in the last few decades, a number of studies attempted to identify quetiapine effects on immune functions in order to highlight a possible additional effect of this drug in psychotic diseases, although no conclusive results were obtained.
METHODS
We critically reviewed preclinical and clinical studies evaluating quetiapine effects on immune systems, suggesting strategies for future work in this field.
RESULTS
Computerised search, in PubMed and Embase databases, was performed in March 2020: 120 studies were identified but only 29 relevant papers were selected for detailed review.
CONCLUSION
Despite some interesting preliminary findings about anti-inflammatory effects of quetiapine, mainly supported by preclinical studies, it is possible to conclude further studies are needed to investigate the immunomodulatory effects of this drug and achieve a better understanding of its relevance on clinical outcomes to finally identify new therapeutic approaches in psychiatric treatment. KeypointsMounting evidence points to a role for immuno-inflammatory mechanisms in psychiatric disorders.Quetiapine (QUE) acts on catecholamine (dopamine and norepinephrine) and serotonin signalling.The immunomodulatory effects of catecholamines are well established.Treatment with QUE in psychiatric disorders could leverage immunomodulatory effects.QUE unclear role in immune function modulation suggests future work.
Topics: Humans; Quetiapine Fumarate; Serotonin; Dopamine; Antipsychotic Agents; Inflammation; Dibenzothiazepines
PubMed: 35913757
DOI: 10.1080/13651501.2022.2101928