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Acta Psychiatrica Scandinavica Aug 1983A study of prescribing practice in three psychiatric institutions in Nigeria revealed high frequency of polypharmacy liberal routine use of antiparkinsonian agents and...
A study of prescribing practice in three psychiatric institutions in Nigeria revealed high frequency of polypharmacy liberal routine use of antiparkinsonian agents and daily multiple administration of drugs. In the treatment of depression and schizophrenia older and better known oral neuroleptics were preferred to newer ones, but there was apparent tendency for depressives to be under-treated and long-acting depot preparations were seldom administered to schizophrenics. Several aspects of drug use were similar to those observed elsewhere, particularly in the Anglo-American practice - an observation presumed explicable in terms of common psychiatry training background. The need for clinicians to comply with acceptable pharmacokinetic principles of drug treatment is stressed.
Topics: Adolescent; Adult; Antiparkinson Agents; Antipsychotic Agents; Depressive Disorder; Drug Prescriptions; Drug Therapy, Combination; Female; Humans; Inpatients; Male; Middle Aged; Nigeria; Psychotropic Drugs; Schizophrenia
PubMed: 6137939
DOI: 10.1111/j.1600-0447.1983.tb06984.x -
European Neuropsychopharmacology : the... Jul 2022
Topics: Goals; Humans; Mental Disorders; Psychotropic Drugs
PubMed: 35550449
DOI: 10.1016/j.euroneuro.2022.03.009 -
General Hospital Psychiatry 1999Understanding cardiac drug interactions with concurrent psychotropic prescriptions is essential for the practicing cardiologist and primary care physician, as well as...
Understanding cardiac drug interactions with concurrent psychotropic prescriptions is essential for the practicing cardiologist and primary care physician, as well as for the psychiatrist. There has been an explosive use of new drugs in both psychiatry and cardiology without widespread knowledge of their potential interactions. The increasing tendency toward poly-pharmacy, 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/paradigms for predicting potential drug interactions--e.g., the Cytochrome p450 schema. This paper 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. Since the majority of the original clinical trials, either for cardiac medications or psychotropic drugs, do 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: Cardiovascular Agents; Databases as Topic; Drug Interactions; Food-Drug Interactions; Guidelines as Topic; Humans; Internet; Psychotropic Drugs
PubMed: 10664901
DOI: 10.1016/s0163-8343(00)00049-9 -
General Hospital Psychiatry Mar 1981This paper presents the usage of psychotropic drugs by all general inpatients of a Boston teaching and referral hospital on a randomly chosen weekday. Of all surveyed...
This paper presents the usage of psychotropic drugs by all general inpatients of a Boston teaching and referral hospital on a randomly chosen weekday. Of all surveyed inpatients, 42.8% were receiving at least one psychotropic medication. Sleep medications were the most frequently prescribed class of psychotropic drugs and flurazepam was the most commonly prescribed of all drugs. Phenothiazine and neuroleptics were given to control agitation, pain, or nausea, rather than psychosis. Antidepressants were prescribed without notated justification in the medical record, and if given for depression, were underdosed. Diazepam was the most frequently prescribed antianxiety drug and was the most frequently prescribed psychotropic drug after flurazepam. Psychotropic drug polypharmacy was common, with the average patient receiving seven different drugs. Remedial approaches to this widespread problem are recommended.
Topics: Anti-Anxiety Agents; Antidepressive Agents; Antipsychotic Agents; Anxiety; Barbiturates; Depression; Drug Therapy, Combination; Drug Utilization; Humans; Psychotropic Drugs; Sleep Wake Disorders; Stress, Psychological
PubMed: 6111514
DOI: 10.1016/0163-8343(81)90016-5 -
The Consultant Pharmacist : the Journal... Jun 2014To describe rates of inpatient prescribing of psychotropic drugs in a rehabilitation and complex continuing care setting.
OBJECTIVE
To describe rates of inpatient prescribing of psychotropic drugs in a rehabilitation and complex continuing care setting.
DESIGN
Cross-sectional, observational study.
SETTING
Providence Healthcare, Toronto, Ontario, Canada.
PATIENTS
Inpatients registered in the hospital on each of four annual audit dates.
INTERVENTION
An audit of medication profiles for the presence of psychotropic prescriptions, done yearly on a single day in May 2007, 2008, 2010, and 2011.
MAIN OUTCOME MEASURES
The percentage of inpatients prescribed at least one antidepressant, antipsychotic, benzodiazepine, or zopiclone.
RESULTS
The percentage of inpatients with at least one prescription for each class of psychotropic drug (ranging from the lowest to highest audit-year results) were as follows: any psychotropic (55% to 63%), benzodiazepines or zopiclone (31% to 40%), antidepressants (24% to 32%), antipsychotics (7% to 13%). Rates of polypharmacy within classes was highest with antidepressants, followed by benzodiazepines (including zopiclone), then antipsychotics.
CONCLUSION
Despite the limitations associated with cross-sectional, observational data, rates of prescribing of psychotropic medication, apart from antipsychotics, were high. Future research will be performed to assess appropriateness of prescribing and adverse events.
Topics: Cross-Sectional Studies; Humans; Medical Audit; Ontario; Polypharmacy; Practice Patterns, Physicians'; Psychotropic Drugs; Rehabilitation Centers
PubMed: 25202892
DOI: 10.4140/TCP.n.2014.387 -
Acta Psychiatrica Scandinavica Dec 2010
Topics: Antipsychotic Agents; Clopenthixol; Drug Monitoring; Genotype; Humans; Psychotropic Drugs
PubMed: 20880158
DOI: 10.1111/j.1600-0447.2010.01606.x -
Clinical Psychology & Psychotherapy Mar 2018Despite the fact that today most of the patients with psychological disturbances assume some form of psychotropic drug treatment, clinical psychologists may have little... (Review)
Review
Despite the fact that today most of the patients with psychological disturbances assume some form of psychotropic drug treatment, clinical psychologists may have little familiarity with psychopharmacology and are substantially unaware of subtle and yet pervasive potential effects of medications in clinical presentations. In their training, psychologists are generally exposed, at best, to some general principles of drug action. Standard psychopharmacology textbooks tend to omit the subtle psychological changes that may occur during psychotropic drug treatment. Clinical pharmacopsychology consists of the application of clinical psychology to the full understanding of pharmacological effects. The domains of clinical pharmacopsychology encompass the clinical benefits of psychotropic drugs, the characteristics that predict responsiveness to treatment, the vulnerabilities induced by treatment (side effects, behavioural toxicity, iatrogenic comorbidity), and the interactions between drug treatment and psychological variables. The DSM-5 refers to a patient population that no longer exists: subjects who display various manifestations of psychological distress who do not receive any form of drug treatment for it. Any type of psychotropic drug treatment, particularly after long-term use, may increase the risk of experiencing additional psychopathological problems that do not necessarily subside with discontinuation of the drug. The changes may be persistent and not limited to a short phase, such as in the case of withdrawal reactions, and cannot be subsumed under the generic rubrics of adverse events or side effects.
Topics: Humans; Mental Disorders; Psychology; Psychology, Clinical; Psychotropic Drugs; Substance Withdrawal Syndrome
PubMed: 29168605
DOI: 10.1002/cpp.2154 -
International Clinical... Mar 2017Populations using herbs and herbal preparations are widespread and growing. As many herbal ingredients exert actions on psychotropic drug targets, psychiatrists should... (Review)
Review
Populations using herbs and herbal preparations are widespread and growing. As many herbal ingredients exert actions on psychotropic drug targets, psychiatrists should be well informed and aware of potential drug-drug interactions in clinical practice. Reliable and clinically useful information in this area, however, is fragmented, if not deficient. This paper reviewed the clinical aspects of herb-drug interactions, focusing in particular on the monoamine oxidase enzyme and P450 cytochrome enzyme-inhibitory properties of herbs and their potential interference with psychotropic drug actions and clinical judgement.
Topics: Herb-Drug Interactions; Humans; Mental Disorders; Monoamine Oxidase Inhibitors; Phytotherapy; Plant Preparations; Psychotropic Drugs
PubMed: 27902536
DOI: 10.1097/YIC.0000000000000158 -
BMC Family Practice Jan 2019The prescribing of psychotropic drugs, i.e. antidepressants, sedatives (anxiolytics, hypnotics), and antipsychotics is considerable and a large proportion is prescribed...
BACKGROUND
The prescribing of psychotropic drugs, i.e. antidepressants, sedatives (anxiolytics, hypnotics), and antipsychotics is considerable and a large proportion is prescribed by general practitioners (GPs). There are concerns about dependency and medicalisation, and treatment decisions in psychiatry may appear arbitrary. Increased knowledge of GPs' opinions on the prescribing of psychotropics may lead to more rational use of these drugs. We aimed to quantify GPs' attitudes, beliefs and behaviour towards various aspects of psychotropic drug prescribing.
METHODS
A questionnaire was distributed to physicians in all 199 GP practices in Region Västra Götaland, Sweden. The questions concerned determinants of psychotropic drug prescribing that had been identified in a previous, qualitative study.
RESULTS
Questionnaires from 516 physicians (64% of whom were specialists in family medicine, 21% interns in family medicine, 15% others) at 152 GP practices (59% of which were state owned, 72% in an urban area, with a median of 7808 registered patients) were returned (estimated response rate: 48%). A majority - 62% - of GPs found it easier to start prescribing psychotropic drugs than to stop (95% confidence interval, 57%, 66%) vs. 8% (6%, 10%). Most GPs considered psychotherapy more suitable than psychotropic drugs in cases of mild psychiatric disease: 81% (77%, 84%) vs. 4% (3%, 6%). The problems treated with psychotropic drugs were considered to be mostly socioeconomic, or mostly medical, by similar proportions of physicians: 38% (34%, 42%) vs. 40% (36%, 45%). GPs were on average satisfied with their levels of antidepressant and sedative prescribing in relation to medical needs. More GPs regarded their prescribing of antipsychotics as being too low rather than too high: 33% (28%, 39%) vs. 7% (4%, 10%).
CONCLUSIONS
This study illustrates the complexities of psychiatric drug treatment in primary care and identifies potential drivers of increased prescribing of psychotropics. The manifold factors, medical and non-medical, that affect prescribing decisions may explain a sense of arbitrariness surrounding psychotropic drug treatment. This notwithstanding, GPs seem mostly content with their prescribing.
Topics: Anti-Anxiety Agents; Antidepressive Agents; Antipsychotic Agents; Attitude of Health Personnel; Female; General Practitioners; Humans; Hypnotics and Sedatives; Male; Practice Patterns, Physicians'; Primary Health Care; Psychotropic Drugs; Surveys and Questionnaires; Sweden
PubMed: 30611211
DOI: 10.1186/s12875-018-0885-4 -
The British Journal of General Practice... Apr 2010The use of psychotropic drugs has increased over recent years in France. GPs are the first prescribers, especially for older patients.
BACKGROUND
The use of psychotropic drugs has increased over recent years in France. GPs are the first prescribers, especially for older patients.
AIM
To analyse discrepancies between GPs' opinions and practice when prescribing psychotropic drugs to older patients.
SETTING
Postal surveys sent to GPs all over mainland France.
DESIGN OF STUDY
Cross-sectional postal study.
METHOD
A questionnaire collected data on characteristics of GPs' practices, their opinions about psychotropic drug consumption in older people, and a full description of their last older patient receiving a psychotropic drug and seen last by the GP on that particular day.
RESULTS
A total of 350 participating GPs saw 2498 patients aged > or =65 years. Among these patients, the prevalence of psychotropic use was 32.1% (803/2498) for anxiolytics/hypnotics, and 17.5% for antidepressants (438/2498). A total of 91% of GPs agreed that it was possible to reduce or stop psychotropic drugs for these patients. Characteristics of 339 patients taking psychotropic drug were reported: 85.8% (291/339) received at least one anxiolytic/hypnotic and 56.9% (193/339) received at least one antidepressant; there were prescribed for more than 1 year in 68.4% (199/291) and 43.5% (84/193) of the cases respectively. GPs stated that it was possible to reduce or stop anxiolytic/hypnotic drugs for only 27% (79/291) of these patients. Barriers to doing this were patients' refusal (79%), and the absence of any local offer of psychotherapy (73%) or alternative therapy (70%).
CONCLUSION
A mismatch exists between GPs' intent (91%) and practice (27%) regarding reduction of psychotropic prescription in individuals aged > or =65 years. The barriers encountered should be examined further to help physicians improve management of psychotropic prescription.
Topics: Adult; Aged; Attitude of Health Personnel; Attitude to Health; Cross-Sectional Studies; Female; France; General Practice; Humans; Male; Mental Disorders; Middle Aged; Practice Patterns, Physicians'; Psychotropic Drugs
PubMed: 20353661
DOI: 10.3399/bjgp10X483922