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The British Journal of Psychiatry.... May 1991The reasons for women in Europe and North America being prescribed over twice as many psychotropic drugs as men are complex. Psychiatric disorders such as depression and...
The reasons for women in Europe and North America being prescribed over twice as many psychotropic drugs as men are complex. Psychiatric disorders such as depression and anxiety appear to be more common in women than in men, and women more commonly complain of psychological symptoms. There may be a gender bias in medical diagnosis and choice of medication. Sociological factors may also be involved, including the likelihood that women have fewer outlets than men for symptom control by activities outside the home (e.g. the social use of alcohol). Women also have special problems including pregnancy, lactation, child rearing and pre-menstrual tension. Probably, much use of psychotropic-drug use for women (and men) is inappropriate and not closely related to the symptoms or conditions for which they are prescribed. Furthermore, the chronic use of some psychotropic drugs, especially benzodiazepines, may compound the problem by inducing dependence and withdrawal symptoms.
Topics: Drug Prescriptions; Europe; Female; Gender Identity; Humans; Mental Disorders; Psychotropic Drugs; Sex Ratio; United States
PubMed: 1840742
DOI: No ID Found -
BMJ (Clinical Research Ed.) Sep 1997
Review
Topics: Anti-Anxiety Agents; Antidepressive Agents; Antipsychotic Agents; Cholinergic Antagonists; Humans; Mental Disorders; Patient Compliance; Psychotropic Drugs
PubMed: 9310571
DOI: 10.1136/bmj.315.7109.661 -
The American Journal of Geriatric... 2002The authors review the use of biomarkers in the development of novel psychotropic agents. They briefly review clinical drug development, emphasizing the importance of... (Review)
Review
The authors review the use of biomarkers in the development of novel psychotropic agents. They briefly review clinical drug development, emphasizing the importance of incorporating biomarkers. For the development of psychotropic agents, biomarkers are particularly useful for assessing central nervous system exposure and effects and for serving as surrogate measures for safety and efficacy. Collectively, biomarkers allow for more accurate estimation of doses for clinical trials as drug development progresses. For drugs that target the pathophysiology of Alzheimer disease, several promising biomarkers are becoming available that may allow improved signal detection in clinical trials. Procedures for developing new drugs are evolving rapidly. Technical advances in the field are making it possible to shift from empirically-based methods to mechanistically-driven schemes. Biomarkers enhance the quality and safety of clinical drug development and reduce its cost and duration.
Topics: Aged; Biomarkers; Drug Design; Humans; Mental Disorders; Psychotropic Drugs
PubMed: 12427576
DOI: No ID Found -
JAMA Network Open Oct 2018Medication review has been proposed to achieve improved use of psychotropic drugs, but benefits have not been confirmed. (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Medication review has been proposed to achieve improved use of psychotropic drugs, but benefits have not been confirmed.
OBJECTIVE
To synthesize evidence for focused psychotropic medication review in medication optimization.
DATA SOURCES
Medline, PsycINFO, EMBASE, and CINAHL Plus were searched from inception to February 2018 using the index terms "drug utilization review" and "psychotropic drugs" and synonyms. Additional articles were retrieved using citation tracking and reference checking.
STUDY SELECTION
Full-length, peer-reviewed articles that reported focused psychotropic medication review were included. Inclusion was determined against prespecified criteria and assessed independently.
DATA EXTRACTION AND SYNTHESIS
Study quality was assessed using National Institutes for Health appraisal tools and informed a structured synthesis of results. Meta-analysis using a random effects model was conducted.
MAIN OUTCOMES AND MEASURES
Change in the number or dosage of psychotropic medications, change in clinical parameters, change in patient-reported outcomes, and economic data were collected.
RESULTS
A total of 26 studies met the inclusion criteria. Four studies were randomized clinical trials (n = 712 participants), while the remainder were before-after studies (n = 7844 participants). Most studies were conducted in elderly individuals, people with dementia, and adults with intellectual disability. Focused psychotropic medication review is a complex intervention; the professional(s) involved, target drug, degree of integration with usual care, and participant involvement varied greatly among the studies. Meta-analysis included 3 studies (n = 652 participants). Psychotropic medication review was associated with a reduction in prescribing of psychotropic drugs compared with control (pooled odds ratio, 0.24; 95% CI, 0.14-0.39) in elderly participants with cognitive impairment living in nursing homes. Before-after studies consistently reported a change in psychotropic drug prescribing after medication review, regardless of the population. Studies that reported the effects of psychotropic medication review on clinical outcomes failed to demonstrate benefit. Economic implications of focused psychotropic medication review were not adequately assessed. The quality of evidence is poor and studies are at risk of bias.
CONCLUSIONS AND RELEVANCE
Focused psychotropic medication review was associated with a reduction in prescribing of psychotropic drugs, but has not been shown to improve clinical outcomes or to provide economic benefit. More robust evidence is needed before programs of focused psychotropic medication review can be recommended as part of routine care for any patient group.
Topics: Drug Utilization Review; Drug-Related Side Effects and Adverse Reactions; Humans; Practice Guidelines as Topic; Psychotropic Drugs
PubMed: 30646263
DOI: 10.1001/jamanetworkopen.2018.3750 -
The Medical Journal of Australia Apr 2014
Topics: Homes for the Aged; Humans; Psychotropic Drugs
PubMed: 24702085
DOI: 10.5694/mja14.00091 -
European Review For Medical and... Feb 2019
Topics: Drug Monitoring; Humans; Psychotropic Drugs; Sex Offenses; Unconsciousness
PubMed: 30779054
DOI: 10.26355/eurrev_201902_16973 -
Acta Psychiatrica Scandinavica.... 2004To assess psychotropic drug utilization in the general population of six European countries, and the pattern of use in individuals with different DSM-IV diagnoses of...
OBJECTIVE
To assess psychotropic drug utilization in the general population of six European countries, and the pattern of use in individuals with different DSM-IV diagnoses of 12-month mental disorders.
METHOD
Data were derived from the European Study of the Epidemiology of Mental Disorders (ESEMeD/MHEDEA 2000), a cross-sectional psychiatric epidemiological study in a representative sample of 21 425 adults aged 18 or older from six European countries (e.g. Belgium, France, Germany, Italy, the Netherlands and Spain). Individuals were asked about any psychotropic drug use in the past 12 months, even if they used the drug(s) just once. A colour booklet containing high-quality pictures of psychotropic drugs commonly used to treat mental disorders was provided to help respondents recall drug use.
RESULTS
Psychotropic drug utilization is generally low in individuals with any 12-month mental disorder (32.6%). The extent of psychotropic drug utilization varied according to the specific DSM-IV diagnosis. Among individuals with a 12-month diagnosis of pure major depression, only 21.2% had received any antidepressants within the same period; the exclusive use of antidepressants was even lower (4.6%), while more individuals took only anxiolytics (18.4%).
CONCLUSION
These data question the appropriateness of current pharmacological treatments, particularly for major depression, in which under-treatment is coupled with the high use of non-specific medications, such as anxiolytics.
Topics: Adolescent; Adult; Aged; Europe; Female; Humans; International Cooperation; Male; Mental Disorders; Middle Aged; Psychotropic Drugs
PubMed: 15128388
DOI: 10.1111/j.1600-0047.2004.00331.x -
The Medical Journal of Australia Jul 1995To determine the current prevalence of psychotropic drug use by women and any association between use and demographic variables. (Comparative Study)
Comparative Study
OBJECTIVE
To determine the current prevalence of psychotropic drug use by women and any association between use and demographic variables.
DESIGN
A cross-sectional, questionnaire-based survey.
SETTING
Metropolitan Melbourne between November 1993 and February 1994.
SUBJECTS
Consecutive women aged over 18, attending 15 randomly selected general practices for a consultation.
OUTCOME MEASURES
Psychotropic drugs taken in the last year and duration of their use, reported by the doctor from the patients' clinical notes and patient interview. Patient demographic characteristics.
RESULTS
The questionnaire was returned complete for 2048/3026 women. Of these, 20.4% had taken at least one psychotropic drug for at least a month in the past year. Most of these women had taken the drug for longer than 12 months and a quarter had taken more than one psychotropic drug in the past year. Psychotropic drug use by women was significantly associated with increasing age, having been married, parity, lower educational attainment, manual occupation, unemployment and being supported by a government pension.
CONCLUSIONS
Psychotropic drug use by women is common and mostly long term. Psychotropic drugs should be prescribed carefully and judiciously, with continual review of the indications for their use and with an awareness of the association with social situation.
Topics: Adult; Aged; Cross-Sectional Studies; Drug Utilization; Family Practice; Female; Humans; Male; Middle Aged; Psychotropic Drugs; Socioeconomic Factors; Surveys and Questionnaires; Victoria; Women
PubMed: 7616904
DOI: 10.5694/j.1326-5377.1995.tb126121.x -
International Psychogeriatrics Oct 2011The prevalence of psychotropic drug use is high among the elderly, but research on how psychotropic drugs are used among individuals aged 90 years and older is limited....
BACKGROUND
The prevalence of psychotropic drug use is high among the elderly, but research on how psychotropic drugs are used among individuals aged 90 years and older is limited. An increased knowledge on this topic may contribute to improved prescribing patterns in this vulnerable population. The aim of this study was to assess the use of psychotropic drugs in relation to mental disorders and institutionalization among 95-year-olds and to identify use of potentially inappropriate psychotropic drugs.
METHODS
All 95-year-olds born in 1901-1903 living in nursing homes or community settings in Gothenburg, Sweden were invited to participate. The response rate was 65% and 338 95-year-olds were examined (263 women, 75 men). Psychotropic drug use in relation to mental disorders and institutionalization was assessed. Information on drug use was collected primarily from multi-dose drug dispensing lists. Participants were examined by trained psychiatrists using the Comprehensive Psychopathological Rating Scale and a battery of cognitive tests. Dementia, depression, anxiety and psychotic disorders were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, third edition, revised (DSM-III-R).
RESULTS
Sixty percent of the 95-year-old participants used psychotropic drugs; hypnotics were most common (44%). Potentially inappropriate psychotropics were observed in one third (33%). Antidepressants were used by 7% of the participants without dementia who fulfilled criteria for a depressive disorder, while 56% used hypnotics and 30% used anxiolytics.
CONCLUSIONS
The high prevalence of psychotropic drug use and the nonspecific nature of these treatments among 95-year-olds indicate a need for improvement in prescribing patterns.
Topics: Aged, 80 and over; Anti-Anxiety Agents; Antidepressive Agents; Female; Homes for the Aged; Humans; Hypnotics and Sedatives; Inappropriate Prescribing; Institutionalization; Male; Mental Disorders; Neuropsychological Tests; Nursing Homes; Practice Patterns, Physicians'; Psychiatric Status Rating Scales; Psychotropic Drugs
PubMed: 21447258
DOI: 10.1017/S1041610211000524 -
Expert Opinion on Drug Safety Nov 2016Off-label or unlicensed use of psychotropic drugs is common rather than the exception in child and adolescent psychiatry. This use exposes patients to an unknown... (Review)
Review
Off-label or unlicensed use of psychotropic drugs is common rather than the exception in child and adolescent psychiatry. This use exposes patients to an unknown additional risk of ineffective or even harmful treatment. In addition, treatment with psychotropic drugs during a period of life when the patient undergoes marked developmental hormonal and neurobiological changes often requires different dosing regimes in later life and may result in adverse drug reactions, which are either not seen in adults at all or not in the same frequency. Areas covered: Given these critical safety issues, efficient pharmacovigilance methods as part of routine practice are essential for the improvement of patient care. The purpose of this article is to introduce methods to increase the safety of psychotropic drug use in youngsters. In particular, therapeutic drug monitoring (TDM) as a routine measure of proactive pharmacovigilance is discussed. Expert opinion: Given the special features of psychopharmacological therapy in children and adolescents in day-to-day clinical practise, proactive surveillance by using a close standardized 'patient monitoring' and long-term follow-up with TDM is very important. This approach could minimize the risk of exposing paediatric patients to ineffective treatments of uncertain or unknown risks.
Topics: Adolescent; Age Factors; Child; Dose-Response Relationship, Drug; Drug Monitoring; Humans; Off-Label Use; Pharmacovigilance; Psychotropic Drugs
PubMed: 27551945
DOI: 10.1080/14740338.2016.1225721