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Drugs & Aging Aug 2019Psychotropic drug use is high in nursing homes in Belgium. A practice improvement initiative (including education, professional support and the transition towards...
BACKGROUND AND OBJECTIVE
Psychotropic drug use is high in nursing homes in Belgium. A practice improvement initiative (including education, professional support and the transition towards person-centred care) achieved significant reductions in psychotropic drug use. The initiative outline was transcribed into a general intervention template, and consequently implemented in five nursing homes (in mixed locations and with a mixed character) in preparation for a future broader roll-out in Belgium. The impact of the intervention on the use of psychotropic drugs in these five nursing homes is reported in this paper.
METHODS
The general intervention template was fitted into the individual nursing home setting. Education for the nursing home personnel on psychotropic drugs and non-pharmacological alternatives, as well as details for a transition to person-centred care was provided. Psychotropic drug use was recorded using a dynamic cohort study design with cross-sectional observations (November 2016-November 2017).
RESULTS
At baseline, participants' (n = 677) mean age was 85.6 years (range 54-109 years), with 72.6% female. Mean medication intake was 8.5 (range 1-22), predominantly central nervous system drugs (Anatomic Therapeutic Chemical classification N, 88.8%). Long-term (> 3 months) psychotropic drug use (62.0%) and concomitant psychotropic drug use (31.5% taking two or more medications) were high. After 12 months, the prevalence of long-term psychotropic drug use decreased significantly (from 62.0 to 52.9%, p < 0.001), likewise the combined use of psychotropic drugs (from 31.5 to 24.0%, p = 0.001). The decrease in the prevalence of antidepressant and hypnosedative use was significant (respectively, from 32.2 to 23.4%, p < 0.001, and from 35.3 to 28.7%, p = 0.006) in contrast to antipsychotic use (from 17.1 to 15.9%, p = 0.522).
CONCLUSIONS
The stand-alone adaptation of the previously reported initiative using a general template was possible. This intervention resulted in a significant decrease in psychotropic drug use (predominantly hypnosedatives and antidepressants) among nursing home residents after 12 months.
Topics: Aged; Aged, 80 and over; Antidepressive Agents; Antipsychotic Agents; Belgium; Cohort Studies; Cross-Sectional Studies; Drug Utilization; Female; Humans; Male; Middle Aged; Nursing Homes; Prevalence; Psychotropic Drugs
PubMed: 31209735
DOI: 10.1007/s40266-019-00686-5 -
Clinical Neuropharmacology 1988Most of the drugs commonly used in the treatment and prophylaxis of depression, mania, and psychotic illness have, as one of their prominent side effects, the ability to... (Review)
Review
Most of the drugs commonly used in the treatment and prophylaxis of depression, mania, and psychotic illness have, as one of their prominent side effects, the ability to increase appetite, stimulate carbohydrate craving, and promote weight gain. These side effects are troublesome to patients, and frequently constitute a major reason for premature discontinuation of therapy. This review examines the relative likelihood of the occurrence of appetite stimulation and weight gain with various psychotropic medications. Potential mechanisms of these effects and strategies to minimize or avoid weight gain during pharmacotherapy of psychiatric illness are examined. Evidence suggests that those compounds, which either antagonize or downregulate serotonin receptors, are more likely to stimulate carbohydrate hunger and weight gain. Amitriptyline, chlorpromazine, mesoridazine, thioridazine, and lithium are most likely to produce weight gain. Compounds that have more pronounced serotonergic action, such as fluoxetine and fenfluramine, are more likely to decrease carbohydrate craving and promote weight loss.
Topics: Humans; Psychotropic Drugs; Weight Gain
PubMed: 3052818
DOI: No ID Found -
Current Psychiatry Reports Aug 2012In recent years, the growing numbers of patients seeking care for a wide range of psychiatric illnesses in the primary care setting has resulted in an increase in the...
In recent years, the growing numbers of patients seeking care for a wide range of psychiatric illnesses in the primary care setting has resulted in an increase in the number of psychotropic medications prescribed. Along with the increased utilization of psychotropic medications, considerable variability is noted in the prescribing patterns of primary care providers and psychiatrists. Because psychiatric patients also suffer from a number of additional medical comorbidities, the increased utilization of psychotropic medications presents an elevated risk of clinically significant drug interactions in these patients. While life-threatening drug interactions are rare, clinically significant drug interactions impacting drug response or appearance of serious adverse drug reactions have been documented and can impact long-term outcomes. Additionally, the impact of genetic variability on the psychotropic drug's pharmacodynamics and/or pharmacokinetics may further complicate drug therapy. Increased awareness of clinically relevant psychotropic drug interactions can aid clinicians to achieve optimal therapeutic outcomes in patients in the primary care setting.
Topics: Drug Interactions; Drug Therapy, Combination; Humans; Mental Disorders; Practice Patterns, Physicians'; Primary Health Care; Psychotropic Drugs
PubMed: 22707017
DOI: 10.1007/s11920-012-0284-9 -
The New England Journal of Medicine Jan 1983
Review
Topics: Aged; Antidepressive Agents; Antidepressive Agents, Tricyclic; Antipsychotic Agents; Drug Interactions; Humans; Lithium; Lithium Carbonate; Psychotropic Drugs
PubMed: 6129574
DOI: 10.1056/NEJM198301273080405 -
Fortschritte Der Neurologie-Psychiatrie Feb 2007The purpose of this study is to give a systematic review of change of weight associated with commonly used psychotropic drugs. (Review)
Review
OBJECTIVE
The purpose of this study is to give a systematic review of change of weight associated with commonly used psychotropic drugs.
METHODS
Mainly based on a MEDLINE-supported review until April 2005, data from clinical studies with antidepressants, anticonvulsants, mood stabilizers and neuroleptics were scanned for change of weight during treatment.
RESULTS
Among antidepressants amitryptiline and nortriptyline have the highest incidence of weight gain followed by imipramine. Maprotiline and mirtazapine have an intermediate weight increasing potential. SSRI (except paroxetine) and MAOI had no or only slight weight inducing effects. In contrary, bupropion was associated with weight reduction. Regarding mood stabilizers and anticonvulsants, a marked gain in weight with lithium and sodium valproate was reported frequently. With gabapentin and vigabatrin a slight to moderate gain in weight was found. Minor changes of weight were found with carbamazepine and lamotrigine. Treatment with topiramate and felbamate reportedly lead to weight loss. The atypical neuroleptics clozapine and olanzapine were frequently related to a strong gain in weight followed by risperidone. Quetiapine has intermediate effects. Stable weight was found with aripiprazole and ziprasidone. A gain in weight is less frequent with older/typical neuroleptics.
CONCLUSION
Beside some methodological restrictions like inconsistent information of weight changes (e. g. percent vs. mass) and the small sample of available long term studies, this review specifies the incidence of weight changes for commonly used psychotropic drugs and might be helpful to look for alternatives.
Topics: Animals; Anticonvulsants; Antidepressive Agents, Tricyclic; Antipsychotic Agents; Humans; Psychotropic Drugs; Selective Serotonin Reuptake Inhibitors; Weight Gain
PubMed: 16586261
DOI: 10.1055/s-2005-919109 -
The New England Journal of Medicine Jan 1983
Review
Topics: Aged; Anti-Anxiety Agents; Benzodiazepines; Diagnosis; Humans; Hypnotics and Sedatives; Kinetics; Psychotropic Drugs
PubMed: 6129573
DOI: 10.1056/NEJM198301203080305 -
Aging & Mental Health Apr 2020: Over the past decade, a trend has been noticed in the Netherlands to replace large-scaled special care units (SCUs) caring for 20-30 residents with dementia by...
: Over the past decade, a trend has been noticed in the Netherlands to replace large-scaled special care units (SCUs) caring for 20-30 residents with dementia by small-scaled SCUs caring for up to 8 residents. Systematic evaluations, however, have yielded a differentiated picture of the effects. As the impact on psychotropic drug use has hardly been addressed thus far, we examined the (potential) impact of psychotropic drug use when moving residents with dementia from large-scaled to small-scaled SCUs.: We conducted a non-randomized, controlled study with a six-month follow-up. Among 145 residents with dementia living a large-scaled SCUs for dementia caring for 20-30 residents per unit, a total of 77 residents were moved to small-scaled SCUs caring for up to 8 residents per unit. Psychotropic drug use, classified according to the Anatomical Therapeutic Chemical Classification (ATC) system was monitored at 2 months before replacement, as well as at 3 and 6 months thereafter. Repeated measures ANOVAs were conducted for the mean Defined Daily Doses (DDDs) of both groups.: No significant differences between both groups in psychotropic medication use were found over a period of 8 months.: Prescription of psychotropic drugs does not change after a transfer from a large-scaled SCU to a small-scaled SCU of patients with moderate to severe dementia.Current Controlled Trials: ISRCTN11151241.
Topics: Dementia; Humans; Longitudinal Studies; Netherlands; Nursing Homes; Psychotropic Drugs
PubMed: 30835505
DOI: 10.1080/13607863.2019.1584784 -
Revue Medicale Suisse Jan 2015
Review
Topics: Comorbidity; Drug Prescriptions; Humans; Mental Disorders; Polypharmacy; Psychotropic Drugs; Risk Factors
PubMed: 25845164
DOI: No ID Found -
BMC Pharmacology & Toxicology Nov 2013Psychotropic drugs are widely used among old people with dementia but few studies have described long-term treatment in this group of patients. The purpose of this study...
BACKGROUND
Psychotropic drugs are widely used among old people with dementia but few studies have described long-term treatment in this group of patients. The purpose of this study was to explore the long-term use of psychotropic drugs in old people with dementia.
METHODS
Data on psychotropic drug use, functioning in the activities of daily living (ADL), cognitive function and behavioral and psychological symptoms were collected at baseline and six months later, using the Multi-Dimensional Dementia Assessment Scale (MDDAS). The data were collected in 2005-2006. Detailed data about the prescribing of psychotropic drugs were collected from prescription records. This study was conducted in 40 specialized care units in northern Sweden, with a study population of 278 people with dementia.
RESULTS
At the start of the study, 229 of the participants (82%) were prescribed at least one psychotropic drug; 150 (54%) used antidepressants, 43 (16%) used anxiolytics, 107 (38%) used hypnotics and sedatives, and 111 (40%) used antipsychotics. Among the baseline users of antidepressants, anxiolytics, hypnotics and sedatives and antipsychotics, 67%, 44%, 57% and 57% respectively, still used the same dose of the same psychotropic drug after six months. Associations were found between behavioral and psychological symptoms and different psychotropic drugs.
CONCLUSION
Psychotropic drug use was high among people with dementia living in specialized care units and in many cases the drugs were used for extended periods. It is very important to monitor the effects and adverse effects of the prescribed drug in this frail group of people.
Topics: Activities of Daily Living; Aged; Aged, 80 and over; Cognition; Dementia; Drug Prescriptions; Drug Utilization Review; Follow-Up Studies; Health Services for the Aged; Homes for the Aged; Humans; Logistic Models; Psychotropic Drugs; Social Behavior; Sweden
PubMed: 24196341
DOI: 10.1186/2050-6511-14-56 -
Social Work Apr 2010The purpose of this integrative review is to facilitate social work practitioners' understanding of how psychotropic drug harms are assessed in clinical trials and to... (Review)
Review
The purpose of this integrative review is to facilitate social work practitioners' understanding of how psychotropic drug harms are assessed in clinical trials and to make specific suggestions for social workers' increased involvement in detecting drug harms in their clients. The authors undertook a comprehensive review of interdisciplinary sources relating to policies, procedures, and evidence of current practices in adverse event assessment in clinical trial research. Results revealed that few guidelines exist for assessing harms in clinical drug research. Current practices consist primarily of asking research trial subjects general, open-ended questions or relying on spontaneous patient reports. These methods produce inconsistent data and are inadequate to fully inform. Meta-analysis of adverse effect rates across studies has further proven difficult and inconclusive. To address some of these limitations, the authors recommend that social workers contribute to a fuller understanding of drug effects by eliciting clients' own views of treatment effects and by monitoring ongoing effects using a concise yet comprehensive treatment emergent effects checklist. Social workers should also support policy initiatives that lessen or remove control over drug testing from pharmaceutical companies.
Topics: Clinical Trials as Topic; Drug-Related Side Effects and Adverse Reactions; Health Policy; Humans; Professional Role; Psychopharmacology; Psychotropic Drugs; Social Work; United States; United States Food and Drug Administration
PubMed: 20408352
DOI: 10.1093/sw/55.2.105