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European Eating Disorders Review : the... Sep 2013During the last 10 years, the use of psychotropic medications in youth with psychiatric disorders, including eating disorders, has significantly increased, but their... (Review)
Review
BACKGROUND
During the last 10 years, the use of psychotropic medications in youth with psychiatric disorders, including eating disorders, has significantly increased, but their role in the treatment of adolescent anorexia nervosa is still controversial.
OBJECTIVE
This paper aims to review the literature on the use of antidepressants and antipsychotics in adolescents with anorexia nervosa, comparing the efficacy and tolerability in this population with those reported in trials with patients not selected by age.
METHOD
A systematic review of the available literature published so far.
RESULTS
Only few studies met the selection criteria. No strong evidence of beneficial effects was found in using antidepressants and antipsychotics neither in adults nor in adolescents. Side effects were more frequently reported in studies including adolescent population. Among psychotropic drugs, the majority of studies focused on olanzapine, which seems to have, in some studies, only positive effects on body mass index, eating disorder symptoms and functional impairment in both age groups.
Topics: Adolescent; Adult; Anorexia Nervosa; Antipsychotic Agents; Humans; Psychotropic Drugs; Treatment Outcome
PubMed: 23733453
DOI: 10.1002/erv.2240 -
Expert Review of Clinical Pharmacology Feb 2020
Topics: Humans; Nocebo Effect; Placebo Effect; Psychotropic Drugs; Randomized Controlled Trials as Topic
PubMed: 31995411
DOI: 10.1080/17512433.2020.1722100 -
Epilepsy & Behavior : E&B Aug 2023Patients with epilepsy are likely to suffer from psychiatric comorbidities, including depression and anxiety. They often require treatment with multiple psychotropic...
RATIONALE
Patients with epilepsy are likely to suffer from psychiatric comorbidities, including depression and anxiety. They often require treatment with multiple psychotropic drugs (PDs). While it is clear that CYP-inducing ASMs (EIASMs) can increase the oral clearance of multiple medications (thus lowering systemic exposure), it is less clear that all PK interactions are clinically meaningful (e.g. lower efficacy). As a first step in addressing this issue, this study sought to quantify the potential impact of ASM choice, whether EIASM or non-inducer (NIASM), on surrogate markers of suggestive of clinical use, including resultant antidepressant (AD) or antipsychotic (AP) dose, frequency of combination use of AD & AP, and number of multiple drug switches of PDs. Our hypothesis is that because of PK interactions, EIAED treatment would be associated with higher psychotropic drug doses, more frequent Rx adjustments and poly psychotropic comedication, all in order to optimize therapeutic response.
METHODS
Using VA pharmacy and national encounter databases, veterans with epilepsy were identified based on having a seizure diagnosis and being prescribed concomitantly an ASM and a psychotropic drug for at least 365 days between 10/1/2010 and 9/30/2014. Patients for whom psychotropic drugs were prescribed any time between beginning and end prescriptions dates of ASMs were considered. Among those, patients receiving both an EIASM + NEIASM concomitantly were categorized with the EIASM group. Patients were evaluated for AD only, AP only and both (AD & AP). To compute average drug doses per day, averages for each patient were computed and averaged again. Multiple drug switches were defined to be for patients who had been prescribed more than three psychotropic drugs during the observation period. Pearson's Chi-Square test was used to compare relative proportions of AD, AP and AD + AP in both groups.
RESULTS
In all, 16,188 patients were identified (57.0% on EIASM, 43.0% on NIASM) with a mean age of 58.7 years (91.2% male). A larger proportion of patients on EIASM received mono treatment with any psychotropic drug, as compared to NIASM (42.0% vs 36.1%). Among all, 59.6% received AD only, 6.5% received AP only, and 33.8% received both concurrently. Of EIASM, 62.5% were on AD, 5.9% on AP, and 31.7% on both AP & AD. For NIASM, 55.9% received AD, 7.4% AP, and 36.7% on AD & AP.Chi-square showed that the distribution of PD was statistically different between EIASM and NIASM groups. Z tests showed that each difference (AD, AP and both) in proportions was statistically significant (p values (4 tests, one Chi-square, 3 Z tests <0.001) between EIASM vs NIASM. Interestingly, mean doses of AD or AP did not appear to differ between ASM groups.
CONCLUSIONS
Concurrent psychotropic drug use is quite common in the VA population with epilepsy, and a large number of patients still receive enzyme-inducing ASMs that may complicate other medical therapies. Interestingly, in seeming contradiction to our hypothesis, mean daily doses of either AD or AP did not appear to differ between inducers vs non-inducers. Similarly, use of polytherapy, and/or multiple trials of various psychotropic drugs did not appear increased in the CYP-induced group. In fact, combination therapy of AD + AP was higher in NIASM than EIASM. These data suggest that perhaps these types of PK interactions may not in fact result in meaningful clinical differences. Since the present analyses did not include clinical psychiatric measures, future analyses examining direct clinical outcomes are clearly warranted.
Topics: Humans; Male; Middle Aged; Female; Veterans; Psychotropic Drugs; Antipsychotic Agents; Antidepressive Agents; Epilepsy; Drug Interactions
PubMed: 37429123
DOI: 10.1016/j.yebeh.2023.109335 -
Psycho-oncology 1998An overview of drug metabolism, with particular focus on the cytochrome p450 system, is provided in this review. To date, there has been a growing body of literature... (Review)
Review
An overview of drug metabolism, with particular focus on the cytochrome p450 system, is provided in this review. To date, there has been a growing body of literature concerning the cytochrome p450 enzyme, drug-drug interactions and the role of psychotropic medications when co-administered with medications prescribed in the medically ill population. The article provides an ability to cross-reference commonly prescribed medications to their known involvement as substrates, inhibitors or inducers of p450 enzymes. This information will permit the clinician working in an oncologic setting to better predict potential interactions based on available in vitro and in vivo data and choose psychotropics analytically when confronted with a situation of polypharmacy. A knowledge of drug interactions will decrease the uncertainty in prescription of multidrug therapies and minimize the likelihood of diminished drug efficacy or toxic reactions.
Topics: Cytochrome P-450 Enzyme System; Drug Interactions; Drug Therapy, Combination; Forecasting; Humans; Mental Disorders; Neoplasms; Psychotropic Drugs
PubMed: 9741070
DOI: 10.1002/(SICI)1099-1611(199807/08)7:4<307::AID-PON366>3.0.CO;2-3 -
International Journal of Clinical... Oct 2018Background Psychotropic drugs were associated with greater risks of adverse drug reactions, including lower the level of consciousness, cause cognitive dysfunction,...
Background Psychotropic drugs were associated with greater risks of adverse drug reactions, including lower the level of consciousness, cause cognitive dysfunction, relax muscles, cause hypotension and others. However, the effect of psychotropic drug use on rehabilitation outcomes is poorly documented in Japan. Objective To assess the association of increased psychotropic drugs during hospitalization with activities of daily living among elderly patients. Setting This study was conducted at the convalescent rehabilitation ward in the Hitachinaka General Hospital in Japan. Method This retrospective longitudinal cohort study included consecutive patients aged ≥ 65 years between 2010 and 2016. Participants were divided based on presence or absence of increased psychotropic drugs including benzodiazepines, antidepressants, antipsychotics, and antiepileptic drugs during hospitalization. Functional recovery was assessed by the Functional Independence Measure (FIM). Multivariate analyses were performed, adjusting for confounding factors. Main outcome measures Cognitive gain in the Functional Independence Measure. Results We included 631 participants (227 males, 404 females) with a median age of 78 years (interquartile range 73-84 years). Multiple regression analysis revealed that change in psychotropic drug use, cognitive FIM at admission, and age were independently and negatively correlated with cognitive FIM gain. Multiple logistic regression analysis indicated that the "Comprehension" and "Memory" items of the cognitive FIM gain were independently and negatively associated with increased psychotropic drug use. Conclusion Increased psychotropic drug use during hospitalization may predict limited the improvement of cognitive activities of daily living in geriatric patients.
Topics: Activities of Daily Living; Aged; Aged, 80 and over; Cognition; Female; Hospitalization; Humans; Japan; Logistic Models; Longitudinal Studies; Male; Multivariate Analysis; Psychotropic Drugs; Recovery of Function; Regression Analysis; Retrospective Studies; Treatment Outcome
PubMed: 30132235
DOI: 10.1007/s11096-018-0718-5 -
European Journal of Clinical... Mar 2022Psychotropic medications include many drugs that may be inappropriate for older individuals with cognitive impairment. In Sweden, many people become registered in the...
AIM
Psychotropic medications include many drugs that may be inappropriate for older individuals with cognitive impairment. In Sweden, many people become registered in the Swedish Dementia Registry when they are diagnosed with major neurocognitive disorder (NCD). In this study, we aim to describe psychotropic drug use and associated factors among older Swedish people with major NCD.
METHODS
This study included 38,251 people ≥ 65 years from the Swedish registry for cognitive/dementia disorders diagnosed during 2007-2017. Drug use was defined as one or more filled prescription(s) recorded in the Swedish Prescribed Drug Register during 1 July to 31 December 2017. Associations between psychotropics and age, sex, diagnosis date, Mini-Mental State Examination score and major NCD subtype were analysed through multiple logistic regression.
RESULTS
We found that 12.0% of the individuals filled at least one prescription for antipsychotics, 22.0% for anxiolytics, 23.0% for sedatives or hypnotics, 43.2% for antidepressants and 56.7% for antidementia drugs. In brief, psychotropic use was associated with female sex, higher age, longer time since diagnosis and specific subtypes of major NCD; the strongest association was found between antipsychotics and Lewy body dementia (odds ratio 2.40, 95% confidence interval 2.04-2.82).
CONCLUSION
Psychotropic drugs were frequently dispensed among older Swedish people with major NCD. The use of antipsychotics and medications with sedative properties warrants concern, especially among those with Lewy body dementia who are severely sensitive to antipsychotics. A more restrictive prescribing pattern regarding these medications might reduce the risk of drug-related problems in this vulnerable group of people.
Topics: Age Factors; Aged; Aged, 80 and over; Cross-Sectional Studies; Drug Utilization; Female; Humans; Male; Mental Status and Dementia Tests; Neurocognitive Disorders; Psychotropic Drugs; Registries; Sex Factors; Sweden
PubMed: 34738182
DOI: 10.1007/s00228-021-03241-7 -
Heart Disease (Hagerstown, Md.) 2001Understanding cardiac drug interactions with concurrent psychotropic prescriptions is essential for the practicing cardiologist, primary care physician, and... (Review)
Review
Understanding cardiac drug interactions with concurrent psychotropic prescriptions is essential for the practicing cardiologist, primary care physician, and psychiatrist. There has been an explosion in the use of new drugs in both psychiatry and cardiology without widespread knowledge of their potential interactions. The increasing tendency toward polypharmacy, the use of psychotropic medications by cardiologists and primary care physicians caring for cardiac patients, and the growth of the aging population present major challenges for the practitioner. Finally, there is a need to have models and paradigms for predicting potential drug interactions-the cytochrome P450 schema. This article describes a method to identify, understand, and codify the interactions between psychotropic and cardiac drugs, a systematic approach for updating this key database, and specific cardiac-psychotropic drug interactions. Specifically, this paper 1) details the interactions, 2) addresses the level of their clinical significance, 3) describes the potential mechanism(s) of the interactions, and 4) offers recommendations to the clinician (Appendix). Because the majority of the original clinical trials, either for cardiac medications or for psychotropic drugs, did not include studies comparing these two drug domains contemporaneously, their interactions often become known only with their combined use in the clinical arena, using the patient as "guinea pig" and through subsequent reporting.
Topics: Animals; Cardiovascular Agents; Databases, Factual; Drug Interactions; Humans; Internet; Psychotropic Drugs; Treatment Outcome; United States; United States Food and Drug Administration
PubMed: 11975802
DOI: 10.1097/00132580-200107000-00008 -
Clinical Neuropharmacology 2005Valproate is a well-established anticonvulsant that is increasingly being employed, often in combination with other psychotropics, for its mood-stabilizing properties.... (Review)
Review
Valproate is a well-established anticonvulsant that is increasingly being employed, often in combination with other psychotropics, for its mood-stabilizing properties. This compound is metabolized by conjugation, beta-oxidation, and cytochrome P450 oxidation (CYP2C9, CYP2C19, and CYP2A6) and also acts as a broad-spectrum inhibitor of a variety of hepatic enzymes including glucoronyltransferase, epoxide hydrolase, and the CYP2C enzymes. In addition, it exhibits saturable protein binding and competes with many drugs for protein binding sites. It is therefore not surprising that valproate has been noted to interact with psychotropic medications of all classes. This article provides an overview of the noted pharmacokinetic psychotropic interactions with valproate, with a particular focus on the mechanisms of these interactions and potential clinical consequences.
Topics: Anticonvulsants; Aryl Hydrocarbon Hydroxylases; Drug Interactions; Humans; Psychotropic Drugs; Valproic Acid
PubMed: 15795555
DOI: 10.1097/01.wnf.0000154221.37887.73 -
The Journal of Clinical Psychiatry 1998Although psychotropic drugs have not been tested or approved by the Food and Drug Administration for use during pregnancy, some women continue to take these medications... (Review)
Review
Although psychotropic drugs have not been tested or approved by the Food and Drug Administration for use during pregnancy, some women continue to take these medications while they are pregnant, particularly since mood and anxiety disorders cluster in women during childbearing years. The relative risks and benefits of drug therapy for these women must be weighed with each patient and treatment limited to those situations in which risks to mother and fetus from the disorder are presumed to exceed the risk of drug treatment. Risks of psychotropic drug use during pregnancy include teratogenic effects, direct neonatal toxicity, and the potential for longer term neurobehavioral sequelae. Of growing concern is the risk of untreated psychiatric disorder as it may potentially affect fetoplacental integrity and fetal central nervous system development. Coordination of care with the patient, her husband or partner, and the obstetrician is essential, as is careful medical record documentation when treating pregnant patients with psychiatric disorders.
Topics: Antidepressive Agents; Antipsychotic Agents; Anxiety Disorders; Benzodiazepines; Depressive Disorder; Female; Humans; Lithium; Mental Disorders; Pregnancy; Pregnancy Complications; Psychotropic Drugs; Risk Assessment
PubMed: 9559756
DOI: No ID Found -
Neuropsychopharmacology Reports Dec 2021The White Paper on Crime 2019 from the Japanese Ministry of Justice reported that the percentage of crimes committed by people with mental disabilities was only 1.0%. In...
AIM
The White Paper on Crime 2019 from the Japanese Ministry of Justice reported that the percentage of crimes committed by people with mental disabilities was only 1.0%. In contrast, the findings of a statistical survey of correctional facilities reported that 15.1% of the prisoners were diagnosed with a mental illness. This study aimed at clarifying the relationship between mental illness and crime among suspects in a detention house and explaining this large gap.
METHODS
Criminal suspects who were newly admitted in the Gifu detention house in Japan were eligible for the study. The status of psychotropic drug use was investigated, and its relationship with age, sex, offense history, and type of crime was analyzed. Newly prescribed medications in detention houses or police stations were excluded.
RESULTS
In total, 26.5% of the residents in a detention house used psychotropic drugs. The psychotropic drug use rate was 16.7% (excluding the sleeping pill use rate). The use rates of sleeping pills, anxiolytics, antidepressants, and antipsychotics were 22.6%, 11.1%, 3.0%, and 9.6%, respectively. Psychotropic drug use was high in illicit drug users and low in suspects for immigration violence. Psychotropic drug use was higher among female suspects, suspects in their 40s and 50s, and suspects with a multiple crime history. Anxiolytic (17.0%) and antipsychotic (11.9%) use rates were high among suspects for violence.
CONCLUSION
In total, 26.5% of the subjects used psychotropic drugs. Psychotropic drug use was high in illicit drug users and low in suspects for immigration violence.
Topics: Crime; Female; Humans; Japan; Mental Disorders; Prisoners; Psychotropic Drugs
PubMed: 34432387
DOI: 10.1002/npr2.12203