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Therapeutic Drug Monitoring Dec 2019The aim of this pilot study was to investigate whether psychotropic drugs frequently analyzed in a routine therapeutic drug monitoring laboratory bind to low-density...
AIM
The aim of this pilot study was to investigate whether psychotropic drugs frequently analyzed in a routine therapeutic drug monitoring laboratory bind to low-density lipoproteins/very-low-density lipoproteins (LDL/VLDL) in human serum.
METHODS
Drug concentrations in 20 serum sample pools containing one psychotropic drug each, and in the LDL/VLDL fractions extracted from the same samples, were measured by triple quadrupole liquid chromatography tandem mass spectrometry. The membrane permeability of the drugs was measured using a Parallel Artificial Membrane Permeability Assay.
RESULTS
Of the 20 antidepressants, antipsychotics, and antiepileptics examined, 7 drugs were detected in both the pooled serum samples and in the LDL/VLDL fraction. Binding of drugs to LDL/VLDL significantly correlated with high octanol: water partition coefficient (logP), high degree of protein binding, and a low polar surface area. The drugs found in LDL/VLDL, with the exception of aripiprazole, were also characterized by high or intermediate membrane permeability.
CONCLUSIONS
The present results indicate that psychotropic drugs with certain characteristics bind to LDL/VLDL in blood. This further implies that lipoproteins could play an important role in drug transport.
Topics: Humans; Lipoproteins, LDL; Lipoproteins, VLDL; Membranes, Artificial; Pilot Projects; Protein Binding; Psychotropic Drugs
PubMed: 31725695
DOI: 10.1097/FTD.0000000000000660 -
BMC Primary Care Mar 2023Studies focusing on patterns of psychotropic drug prescriptions (PDPs) for subpopulations of community-dwelling older people with dementia are lacking.
The longitudinal patterns of psychotropic drug prescriptions for subpopulations of community-dwelling older people with dementia: electronic health records based retrospective study.
BACKGROUND
Studies focusing on patterns of psychotropic drug prescriptions (PDPs) for subpopulations of community-dwelling older people with dementia are lacking.
OBJECTIVE
The aim of this study was to identify the longitudinal patterns of PDPs in subpopulations.
METHODS
This retrospective study used electronic health records from general practitioners (GPs) in the Netherlands. People (N = 1278) firstly diagnosed with dementia between 2013 and 2015, aged 65 years or older, were selected and categorized into four subpopulations: community-dwelling (CD) group throughout follow-up, ultimately admitted to nursing homes (NH) group, ultimately died (DIE) group, and ultimately deregistered for unclear reasons (DeR) group. Generalised estimating equations were used to estimate the patterns of psychotropic drug prescriptions, after the diagnosis of dementia for a five-year follow-up, and 0-3 months before institutionalisation or death.
RESULTS
Over the five-year follow-up, antipsychotic prescriptions increased steadily in CD (OR = 1.07 [1.04-1.10]), NH (OR = 1.10 [1.04-1.15]), and DIE (OR = 1.05 [1.02-1.08]) groups. Similarly, prescriptions of antidepressants also showed upward trends in CD (OR = 1.04 [1.02-1.06]), NH (OR = 1.10 [1.02-1.18]), and DIE (OR = 1.04 [1.00-1.08]) groups. The other psychotropic drugs did not show clear changes over time in most of the subpopulations. In the three months before institutionalisation, antipsychotic prescriptions increased (OR = 2.12 [1.26-3.57]) in the NH group compared to prior periods. Likewise, before death, prescriptions of antipsychotics (OR = 1.74 [1.28-2.38]) and hypnotics and sedatives (OR = 2.11 [1.54-2.90]) increased in the DIE group, while anti-dementia drug prescriptions decreased (OR = 0.42 [0.26-0.69]).
CONCLUSIONS
After community-dwelling older people are diagnosed with dementia, all subpopulations' prescriptions of antipsychotics and antidepressants increase continuously during the follow-up. While we cannot judge whether these prescriptions are appropriate, GPs might consider a more reluctant use of psychotropic drugs and use alternative psychosocial interventions. Additionally, antipsychotic prescriptions rise considerably shortly before institutionalisation or death, which might reflect that older people experience more neuropsychiatric symptoms during this period.
Topics: Humans; Aged; Antipsychotic Agents; Retrospective Studies; Independent Living; Electronic Health Records; Psychotropic Drugs; Antidepressive Agents; Hypnotics and Sedatives; Drug Prescriptions
PubMed: 36907845
DOI: 10.1186/s12875-023-02021-9 -
The Medical Journal of Australia May 2018
Topics: Antipsychotic Agents; Benzodiazepines; Psychotropic Drugs
PubMed: 29764352
DOI: 10.5694/mja18.00037 -
International Journal of Geriatric... Sep 2001To determine the prevalence of psychotropic drug use in very old persons with and without dementia in two time periods, and describe the patterns of psychotropic drug...
OBJECTIVE
To determine the prevalence of psychotropic drug use in very old persons with and without dementia in two time periods, and describe the patterns of psychotropic drug use between institutions and non-institutions.
METHODS
Descriptive analysis on a sample of subjects aged 81+ from a population-based study in Stockholm, Sweden. Psychotropic drug use data were collected from the 1987-1989 and 1994-1996 periods of the study. The diagnosis of dementia was based on the DSM III-R.
RESULTS
About 41% of the subjects used at least one psychotropic drug in both periods. Women and subjects in institutions more commonly used psychotropic drugs. The most commonly reported were, in rank order, hypnotics-sedatives, anxiolytics, antipsychotics and antidepressants. Hypnotics-sedatives and anxiolytics were the most commonly used in both institutions and non-institutions. More persons with dementia used psychotropic drugs in both periods. The use of newer drugs, for example, SSRI, was evident. Multivariate analyses showed increased risk for psychotropic drug use among subjects in institutions.
CONCLUSIONS
This study confirms the high rate of psychotropic drug use in the very old, particularly in persons with dementia. Psychotropic drug use was high among subjects living in institutions.
Topics: Age Factors; Aged; Aged, 80 and over; Cross-Sectional Studies; Dementia; Female; Humans; Institutionalization; Male; Prevalence; Psychotropic Drugs; Sex Factors
PubMed: 11571771
DOI: 10.1002/gps.438 -
International Journal of Geriatric... Nov 2023Psychotropic drugs are utilized against neuropsychiatric symptoms among people with major neurocognitive disorder (NCD) despite well-documented risks, and older people...
INTRODUCTION
Psychotropic drugs are utilized against neuropsychiatric symptoms among people with major neurocognitive disorder (NCD) despite well-documented risks, and older people in nursing homes are expected to be more frequently exposed to those medicines. This study compared psychotropic drug use and associated factors between older people with major NCD and matched references.
METHODS
This cross-sectional study included individuals from three national registries in Sweden. References were randomly matched 1:1 by age and sex from the Swedish Total Population Register. Drug use was defined as at least one prescription fill from 1 July to 31 December 2019 and presented as proportion of drug users. In addition, ORs regarding psychotropic drug use and associated factors use were analysed using generalized estimating equations.
RESULTS
There were 102,419 complete matching pairs alive on 31 December 2019. The proportions of psychotropic drug users were 59% in the population of people with major NCD and 28% in the reference group. Moreover, there was a substantial number of individuals in nursing homes who had been treated with antipsychotics but who, for unknown reasons, had not been diagnosed with major NCD. Psychotropic drug use was positively associated with both major NCD and nursing home residency. The difference in drug use in relation to major NCD was more pronounced among people living in ordinary homes.
CONCLUSION
Despite well-documented risks in people with cognitive impairment, psychotropic drug use was overall high and positively associated with both major NCD and nursing home residency. Taken together, interventions to better target neuropsychiatric symptoms in older people are warranted. Hypnotic drug use among older people in general as well as antipsychotic drug exposure among older people in nursing homes appear to be two important focus areas.
Topics: Humans; Aged; Cross-Sectional Studies; Internship and Residency; Psychotropic Drugs; Nursing Homes; Antipsychotic Agents; Dementia
PubMed: 37909144
DOI: 10.1002/gps.6018 -
Perspectives in Psychiatric Care 2002
Topics: Humans; Psychotropic Drugs; Vitis
PubMed: 11939084
DOI: No ID Found -
Nordic Journal of Psychiatry Oct 2012Little is known about the timing of the start of psychotropic drug use and psychotropic polypharmacy use.
BACKGROUND
Little is known about the timing of the start of psychotropic drug use and psychotropic polypharmacy use.
AIMS
This study describes these patterns in a Finnish representative cohort aged between 12 and 25.
METHODS
5525 subjects born in 1981 were followed up between 1994 and 2005 using the Finnish National Prescription Register.
RESULTS
Survival analysis revealed that the cumulative incidence of any psychotropic drug use was 1.3% by age 15, 6.1% by age 20 and 15.2% by age 25. Antidepressants and benzodiazepines were the most used drug groups, with cumulative incidences of 12.2% and 5.2%, respectively, by age 25. The cumulative incidence of polypharmacy was 0.02% by age 15, 0.9% by age 20 and 4.1% by age 25, i.e. having purchased at least two psychotropic drugs from different classes during the same day. Polypharmacy occurred among the majority of antipsychotic and benzodiazepine users, but among a minority of antidepressant users. More females than males had used any psychotropic drug, antidepressants, the antidepressant-benzodiazepine combination and the antidepressant-mood stabilizer combination.
CONCLUSIONS
Both general psychotropic drug use and psychotropic polypharmacy use was often started in late adolescence.
Topics: Adolescent; Adult; Antidepressive Agents; Antipsychotic Agents; Benzodiazepines; Cohort Studies; Drug Utilization; Female; Finland; Humans; Male; Mental Disorders; Polypharmacy; Psychiatry; Psychotropic Drugs; Sex Factors; Young Adult
PubMed: 22212103
DOI: 10.3109/08039488.2011.644809 -
MedGenMed : Medscape General Medicine Oct 2005A substantial number of women of childbearing age are prescribed psychotropic drugs, and because nearly 50% of pregnancies are unplanned, many women are still taking... (Review)
Review
A substantial number of women of childbearing age are prescribed psychotropic drugs, and because nearly 50% of pregnancies are unplanned, many women are still taking them upon becoming pregnant. This article reviews the various classes of psychotropic drugs that are commonly used to treat psychiatric disorders--antidepressants, benzodiazepines, antipsychotics, antiepileptics, lithium and monoamine oxidase (MAO) inhibitors--in terms of their safety during pregnancy. Evidence-based information from epidemiologic studies indicates that most psychotropic drugs are relatively safe for use during pregnancy. There is also an increasingly large body of evidence-based information in the literature indicating that it may be more harmful to both the mother and her baby if she is not treated appropriately when suffering from a severe psychiatric disorder. Therefore, it is important for women with psychiatric disorders and their healthcare providers to have access to evidenced-based information about the safety of these drugs when taken during pregnancy to ensure that women make an informed decision as to whether they should continue with the pharmacotherapy they have been using to treat their condition.
Topics: Clinical Trials as Topic; Female; Humans; Mental Disorders; Practice Guidelines as Topic; Practice Patterns, Physicians'; Pregnancy; Pregnancy Complications; Psychotropic Drugs; Risk Assessment; Risk Factors
PubMed: 16614625
DOI: No ID Found -
International Psychogeriatrics Mar 2018ABSTRACTBackground:We aimed to assess whether there were any changes in the use of psychotropic drugs in Norwegian nursing homes between 2004 and 2011. Also, we...
UNLABELLED
ABSTRACTBackground:We aimed to assess whether there were any changes in the use of psychotropic drugs in Norwegian nursing homes between 2004 and 2011. Also, we investigated whether the predictors of use of specific psychotropic drug groups have changed.
METHODS
We conducted a secondary analysis of two cohort studies of two Norwegian nursing home samples (2004/05 and 2010/11). Multivariate models were applied.
RESULTS
We found a significant decrease in the prescription of antipsychotic drugs between 2004 and 2011 (0.63 OR, 95%CI = 0.49-0.82, p < 0.001) even after adjusting for relevant demographic and clinical variables. There are only minor changes for the other psychotropic drugs. We found that (1) the use of specific psychotropic drug groups as well as the number of psychotropic drugs used was associated with more affective symptoms and (2) the use of specific psychotropic drug groups as well as the number of psychotropic drugs used was associated with lower scores on the Physical Self-Maintenance scale.
CONCLUSION
This is the first study to show a robust decrease in antipsychotic drug use in nursing home patients with dementia unrelated to possible changes in case mix. The change might be explained by treatment recommendations against its use except in the most severe conditions of aggression or psychosis. Our findings indicate that it takes several years to implement scientific knowledge in clinical practice in nursing homes.
Topics: Aged; Aged, 80 and over; Antipsychotic Agents; Behavioral Symptoms; Cognition Disorders; Cohort Studies; Dementia; Drug Utilization; Female; Homes for the Aged; Humans; Length of Stay; Male; Norway; Nursing Homes; Psychotic Disorders; Psychotropic Drugs
PubMed: 28988552
DOI: 10.1017/S1041610217001788 -
Psychosomatics 1989Despite the apparent risks of psychotropic drug exposure in pregnancy, many pregnant women receive psychotropics. The major concerns associated with the use of... (Review)
Review
Despite the apparent risks of psychotropic drug exposure in pregnancy, many pregnant women receive psychotropics. The major concerns associated with the use of antipsychotics, antidepressants, benzodiazepines, and lithium carbonate in pregnancy are reviewed, with clinical approaches for assessing the relative risks and benefits of treatment of psychiatrically ill pregnant patients and for choosing and instituting therapy with these agents.
Topics: Abnormalities, Drug-Induced; Female; Humans; Infant, Newborn; Mental Disorders; Pregnancy; Pregnancy Complications; Psychotropic Drugs
PubMed: 2643809
DOI: 10.1016/S0033-3182(89)72314-8