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Psychotherapy and Psychosomatics 2005Theoretical assumptions about how psychotropic drugs 'work' are rarely discussed explicitly. In a 'disease-centred model,' drugs are believed to work by acting on a... (Review)
Review
Theoretical assumptions about how psychotropic drugs 'work' are rarely discussed explicitly. In a 'disease-centred model,' drugs are believed to work by acting on a disease process. In contrast, in a 'drug-centred model,' the characteristic physiological, behavioural and subjective effects of drugs are used to define drug action. The therapeutic value of a drug stems from the usefulness of these effects in clinical situations. The disease-centred model appears dominant but has weaknesses: (1) it cannot logically justify the use of drugs since major pathophysiological hypotheses were derived from selectively observed actions of drugs; (2) comparisons between drugs believed to have specific effects in certain conditions and drugs thought to have non-specific effects fail to support it; (3) outcome measures for various disorders include items responsive to non-specific drug effects; (4) studies with healthy volunteers describe characteristic drug-induced states independently of a psychiatric diagnosis; (5) animal tests show effects with agents not usually thought of as specific treatments for the conditions modelled by tests. This article offers suggestions to develop a drug-centred model and discusses its potential impact on clinical practice.
Topics: Humans; Mental Disorders; Psychotropic Drugs
PubMed: 15832065
DOI: 10.1159/000083999 -
Postgraduate Medicine Sep 2013Our review describes potential weight-altering effects of psychotropic medications (antipsychotics, antidepressants, anti-anxiety medications, mood stabilizers,... (Review)
Review
Our review describes potential weight-altering effects of psychotropic medications (antipsychotics, antidepressants, anti-anxiety medications, mood stabilizers, sedative-hypnotics, medications for attention-deficit/hyperactivity disorder, and other psychotropic medications) and offers guidance on switching a medication if its weight-altering effect becomes problematic. For second-generation antipsychotics, the risk of weight gain is high with clozapine and olanzapine, low with amisulpride, aripiprazole, and ziprasidone, and medium with other second-generation antipsychotics. Switching from a high-risk antipsychotic to a low-risk antipsychotic usually mitigates or reverses weight gain. For second-generation antidepressants, there may be modest weight loss with bupropion and modest weight gain with mirtazapine and paroxetine. Other second-generation antidepressants are weight neutral but individual variations can occur. If significant change in weight occurs, switching to or adding a low-risk second-generation antidepressant should be considered. Mood stabilizers include lithium, valproate, carbamazepine, lamotrigine, oxcarbazepine, and most second-generation antipsychotics. Risk of weight gain is high with lithium and valproate and low with carbamazepine, lamotrigine, and oxcarbazepine. Given the complexity of bipolar disorder and its management, a switch of a mood stabilizer would be best done by a psychiatrist. Benzodiazepines, non-benzodiazepine and melatonergic hypnotics, doxepin, and trazodone are weight neutral. Diphenhydramine may cause weight-gain and can be switched to a weight-neutral hypnotic if needed. Stimulants can cause varying degrees of weight loss and switching to atomoxetine or bupropion may reverse this problem. If that fails, switching to clonidine or guanfacine can be tried. Switching must be evidence-based and take into account status of the condition being treated, efficacy, side effect profile, potential drug-drug interactions, required laboratory monitoring and cost of the drug(s) being considered, and patient's pregnancy status or plan. Non-pharmacological interventions both for mental disorders and overweight/obesity must be fully availed.
Topics: Female; Humans; Male; Mental Disorders; Obesity; Pregnancy; Psychotropic Drugs; Weight Gain
PubMed: 24113670
DOI: 10.3810/pgm.2013.09.2706 -
The Journal of the Royal College of... Apr 1984This study was based on the recording of psychotropic drug prescribing over two weeks by 269 doctors using practice activity analysis (PAA) data sheets. The overall mean...
This study was based on the recording of psychotropic drug prescribing over two weeks by 269 doctors using practice activity analysis (PAA) data sheets. The overall mean rates for patients receiving one or more psychotropic drugs were 17.5 per 1,000 list size and 130 per 1,000 consultations; and for prescriptions issued the rates were 20.6 per 1,000 list size and 153 per 1,000 consultations. Recorders were classified into five categories ;low' to ;high', by the volume of prescribing and this paper is concerned with the comparison between them. Between the high and low categories there was a twofold difference in the prescribing of new prescriptions, a fourfold difference for continuing prescriptions and a tenfold difference for repeat prescriptions; 51 per cent of all prescriptions were issued as ;repeats'.Other features of prescribing have been studied in each of the categories. Prescribing rates vary little with workload. Increasing trends are evident from the low to high categories for the use of polytherapy and for the proportion of elderly persons who received prescriptions; the proportion of male patients (28 per cent) was consistent in all categories. The relative proportion of prescriptions by drug group (tranquillizers, antidepressants and hypnotics) was reasonably uniform in all categories.
Topics: Adult; Aged; Drug Prescriptions; Drug Utilization; England; Family Practice; Humans; Middle Aged; Psychotropic Drugs
PubMed: 6502559
DOI: No ID Found -
Psychopharmacology Series 1993
Review
Topics: Antidepressive Agents, Tricyclic; Antipsychotic Agents; Drug Monitoring; Haloperidol; Humans; Hydroxylation; Methylation; Phenothiazines; Psychotropic Drugs
PubMed: 8103224
DOI: 10.1007/978-3-642-78010-3_20 -
The Australian and New Zealand Journal... May 2012To conduct a review of the literature on prescribing psychotropic drugs for prisoners. (Review)
Review
OBJECTIVE
To conduct a review of the literature on prescribing psychotropic drugs for prisoners.
METHODS
Articles were retrieved from nine databases, reference lists, citations, governmental prison websites, and contact with authors. The articles included were written in English, focused on adults' time as prisoners, included at least one drug of interest, and discussed prescribing. Thirty-two articles met these inclusion criteria.
RESULTS
Five main themes were identified from the reviewed studies: polypharmacy, high-dose therapy, duration of treatment, documentation and monitoring, and issues associated with the prisoners' environment.
CONCLUSIONS
Consideration of these themes within the included studies identified areas for future research, particularly models of good practice, as numerous descriptions of poor practice exist. Policy-makers and prescribers should review current systems and practices, to ensure the care being offered to prisoners is optimal.
Topics: Databases, Factual; Humans; Polypharmacy; Practice Patterns, Physicians'; Prisoners; Psychotropic Drugs; Time Factors
PubMed: 22535291
DOI: 10.1177/0004867411433893 -
Psychosomatics 1990Underlying medical illness and drug interactions may make the use of psychotropic agents in some physically ill patients problematic. This overview, published in two... (Review)
Review
Underlying medical illness and drug interactions may make the use of psychotropic agents in some physically ill patients problematic. This overview, published in two parts, discusses six major classes of psychotropic medications (cyclic antidepressants, monoamine oxidase inhibitors, benzodiazepines, neuroleptics, lithium, psychostimulants, and carbamazepine) and examines their use in the setting of specific types of medical illnesses (e.g., cardiovascular, pulmonary, hepatic, and renal disease). Practical considerations in using psychotropic medications in medical-surgical patients, particularly those who are elderly or medically debilitated, receive special emphasis. In part I, the use of cyclic antidepressants, monoamine oxidase inhibitors, benzodiazepines, and buspirone are discussed.
Topics: Drug Interactions; Humans; Neurocognitive Disorders; Psychotropic Drugs; Risk Factors; Sick Role
PubMed: 2247565
DOI: 10.1016/S0033-3182(90)72132-9 -
Psychosomatics 1991Underlying medical illness and drug interactions may make the use of psychotropic agents problematic in some physically ill patients. This overview, published in two... (Review)
Review
Underlying medical illness and drug interactions may make the use of psychotropic agents problematic in some physically ill patients. This overview, published in two parts, discusses six major classes of psychotropic medications (cyclic antidepressants, monoamine oxidase inhibitors, benzodiazepines, neuroleptics, lithium, psychostimulants, and carbamazepine) and examines their use in the setting of specific types of medical illnesses (e.g., cardiovascular, pulmonary, hepatic, and renal disease). Practical considerations in using psychotropic medications in medical-surgical patients--particularly those who are elderly or medically debilitated--will receive special emphasis.
Topics: Drug Interactions; Humans; Neurocognitive Disorders; Psychotropic Drugs; Sick Role
PubMed: 2003136
DOI: 10.1016/S0033-3182(91)72109-9 -
BMC Psychiatry Jan 2016Time-trend studies on psychotropic drugs among children and adolescents are scarce, and most of them are outdated. The purpose of this study was to study prevalences of...
BACKGROUND
Time-trend studies on psychotropic drugs among children and adolescents are scarce, and most of them are outdated. The purpose of this study was to study prevalences of psychotropic drug use during 2004-2014 among Norwegians aged <18 years, overall and in psychotropic sub-groups.
METHODS
Data were obtained from the Norwegian Prescription Database, which covers all dispensed prescription drugs in Norway from 2004 and onwards. Psychotropic drugs included: antipsychotics (ATC-group N05A), anxiolytics (N05B), hypnotic/sedatives (N05C), antidepressants (N06A), stimulants (N06BA), and alimemazine (R06AD01). Period (1-year) prevalence of use, overall and in subgroups of psychotropic drugs, was estimated by identifying individuals <18 years who had at least one psychotropic drug dispensed during each year.
RESULTS
Psychotropic drug use increased in 0-17 year olds over an 11-year period, in which the main contributing drugs were stimulants (boys overall; 15.0 to 20.8/1000, girls overall; 3.8 to 8.5/1000), hypnotic/sedative drugs in adolescents (boys overall; 4.2 to 10.8/1000, girls overall; 2.6 to 8.8/1000) and to some extent antidepressants among adolescent girls (girls overall from 3.1 to 4.0/1000). Psychotropic drug use was, however, reduced by half in the youngest children, attributed to reduction of alimemazine only (1-year olds: boys; from 36.6 to 10.2/1000, girls; 26.9 to 7.2/1000). A higher level of psychotropic drug use was observed among younger boys, but there is a shift towards girls using more psychotropic drugs than boys during adolescence for all psychotropic drugs except for stimulants.
CONCLUSION
Different trends in psychotropic drug use exist in age and gender subgroups. Psychotropic drug use has decreased among the youngest children, attributed to alimemazine, and increased in older children and adolescents, attributed mainly to stimulants and hypnotics/sedatives.
Topics: Adolescent; Anti-Anxiety Agents; Antidepressive Agents; Antipsychotic Agents; Central Nervous System Stimulants; Child; Databases, Factual; Female; Humans; Hypnotics and Sedatives; Infant; Male; Norway; Practice Patterns, Physicians'; Prevalence; Psychotropic Drugs
PubMed: 26822371
DOI: 10.1186/s12888-016-0716-x -
The Gerontologist Dec 1992We reviewed 19 studies of psychotropic drug use for residents of long-term care facilities, located through a MEDLINE search of the literature published between 1978 and... (Review)
Review
We reviewed 19 studies of psychotropic drug use for residents of long-term care facilities, located through a MEDLINE search of the literature published between 1978 and 1990. The review compares each study in terms of its sample, research design, and findings. The studies reviewed found that a substantial proportion of nursing home residents are taking psychotropic drugs on a regular, long-term basis and this usage is accompanied by prescribing and monitoring problems and many potential adverse risks.
Topics: Aged; Drug Utilization; Female; Health Services Misuse; Humans; Long-Term Care; Male; Nursing Homes; Practice Patterns, Physicians'; Psychotropic Drugs
PubMed: 1478502
DOI: 10.1093/geront/32.6.822 -
Revista Brasileira de Epidemiologia =... 2017Investigating the prevalence of psychotropic drug use among older adults and factors associated with it.
OBJECTIVE:
Investigating the prevalence of psychotropic drug use among older adults and factors associated with it.
METHODS:
This study was based on the Belo Horizonte Metropolitan Area Health Survey, conducted in 2003. It involved 1,635 elderly (60 years or older) citizens, who were residents of cities within the Belo Horizonte Metropolitan Area and were selected using complex randomize sampling. Logistic regression models were used to identify factors associated with psychotropic drug use, with a 5.0% significance level.
RESULTS:
The prevalence of psychotropic drug use in the sample was 13.4%; specifically, 8.3% of individuals surveyed used benzodiazepines, whereas 5.0% used antidepressants. The following factors were independently associated with the use of psychotropic drugs: female gender (OR = 2.20; 95%CI 1.49 - 3.27), medical diagnosis of depression (OR = 6.42; 95%CI 4.31 - 9.55), 5 or more medical appointments in the last 12 months (OR = 2.15; 95%CI 1.32 - 3.53), and subscription to private health insurance (OR = 2.69; 95%CI 1.86 - 3.88).
CONCLUSION:
The prevalence observed was similar to the one verified in other elderly Brazilian populations and the pattern of associated factors was consistent with the one detected for older populations of higher-income countries. Medical diagnosis of depression was the factor most strongly associated with psychotropic drug use.
Topics: Aged; Aged, 80 and over; Brazil; Cross-Sectional Studies; Depression; Drug Utilization; Female; Humans; Male; Middle Aged; Psychotropic Drugs
PubMed: 28513794
DOI: 10.1590/1980-5497201700010005