Effects of psychotropic medications on electrocardiography

To the Editor: As part of the Epidemiology of Vascular Aging (EVA) Study, a large study of cognitive decline in older adults, we examined cognitive performance similarities in married couples, taking into account the potential confound-ers that might be shared by spouses. This led us to investigate concordance among couples for psychotropic drug use, a major risk factor for cognitive impairment in older adults.1 The EVA study is a longitudinal study of vascular aging and cognitive decline conducted in a community sample of 1389 subjects, born between 1922 and 1932, recruited from the electoral rolls of the city of Nantes (Western France). An extensive questionnaire was administered by a research assistant at study entry. Data regarding education, self-reported sleep disorders, and treatments were used for this analysis. Medication use during the month before the interview was recorded from both subject interview and original medical prescriptions. Drugs were classified according to the French National Prescription Dictionary (1991). Psychotropic drugs included anxiolytic, hypnotic, sedative, antidepressant, normothimic, and neuroleptic drugs. The name of the subject's general practitioner was also recorded. The study also included an assessment of depressive symptoms using the Center for Epidemiologic Study-Depression (CES-D) scale; high depressive symptomatology was defined as a CES-D score higher than 16 in men or 22 in women.2 There were 318 married couples in the EVA study. Husbands were slightly older than wives (mean ages: 65.7 years (Standard Deviation (SD) = 2.8) vs 64.2 years (SD = 2.8), P < .001). The prevalence of psychotropic drug use was 13.8% among husbands and 25.8% among wives (P < .001); these rates were similar to those found in the whole EVA population (13.9% in men and 27.0% in women). The frequency of spouses having the same general practitioner was 77.7%. Multivariate logistic regression models showed that independent of depression and sleep disorders, men whose wives take psychotropic drugs had a 3.5 times increased risk of psychotropic drug use compared with men whose wives did not. Similarly, the odds ratio associated with husbands' psychotropics drug use was equal to 2.9 in women (Table 1). All analyses were adjusted for age, education level, and concordance for general practitioner. Numbers were too small to perform separate analysis by psychotropic drug category. The effect of a spouse's use was similar in magnitude (even greater in women) than personal determinants of psychotropic use such as depressive symptoms or sleep complaints. No similarity among spouses was found for other categories of drugs (odds ratio = 1.2, P = .5 in men; odds ratio = 1.3, P = .4 in women). Psychotropic drug use may have various negative consequences in older adults, including cognitive impairment,1 falls,3 or motor vehicle accidents.4 The risk of adverse reactions as a result of pharmacological interactions between psychotropic and other drugs is particularly high in older people who take medications for treating a variety of age-related disorders.5 Thus, the rationale for prescribing psychotropic drugs to older people must be critically analyzed. Our study showed high concordance for psychotropic drug use among married couples that was not explained by potential shared confounders such as sleep disorders, depressive symptoms, or same general practitioner. Concordance might result from either common attitude toward psychotropic drugs in married couples or self-prescription of the psychotropic drug used by his/her spouse. The public health importance of psychotropic drug use in older persons suggests the need for investigating this finding further in order to define appropriate information to be given both to prescribers and to older users.

Association between behavioral and psychological symptoms and psychotropic drug use among old people with cognitive impairment living in geriatric care settings.

African-American older adults, particularly those who live in economically deprived areas, are less likely to receive pain and psychotropic medications, compared to Whites. This study explored the link between social, behavioral, and health correlates of pain and psychotropic medication use in a sample of economically disadvantaged African-American older adults. This community-based study recruited 740 African-American older adults who were 55+ yeas-old in economically disadvantaged areas of South Los Angeles. Opioid-based and psychotropic medications were the outcome variables. Gender, age, living arrangement, socioeconomic status (educational attainment and financial strain), continuity of medical care, health management organization membership, sleeping disorder/insomnia, arthritis, back pain, pain severity, self-rated health, depressive symptoms, and major chronic conditions were the explanatory variables. Logistic regression was used for data analyses. Arthritis, back pain, severe pain, and poor self-rated health were associated with opioid-based medications. Pain severity and depressive symptoms were correlated with psychotropic medication. Among African-American older adults, arthritis, back pain, poor self-rated health, and severe pain increase the chance of opioid-based and psychotropic medication. Future research should test factors that can reduce inappropriate and appropriate use and prescription of opioid-based and psychotropic medication among economically disadvantaged African-American older adults.

This study describes the differences between male and female children in the receipt of prescriptions for psychotropic and controlled-analgesic drugs in office practice. The study encompassed 341,422 children of ages 0 through 17 years enrolled in the Tennessee Medicaid program during the 5 years 1977-1981. These children made 1,342,573 office visits and received 1,636,127 prescriptions during the study. There were 18,023 (5.3%) children who received prescriptions for psychotropic drugs and 18,744 (5.5%) who received prescriptions for combination products containing psychotropic drugs. There were 26,071 (7.6%) children who were prescribed controlled analgesics and 50,240 (14.7%) who received prescriptions for these substances as fixed combination medications. In this population, proportions of male and female children who received prescriptions for psychotropic and controlled-analgesic drugs were similar through age 11. After age 11, females were increasingly more likely to receive prescriptions for drugs from both categories than were males of the same age. By age 17, the rate of psychotropic drug prescription receipt for female children (6.3%) was nearly twice that for males (3.3%), a ratio consistent with numerous studies in adults. These differences were consistent over diagnostic categories and were only partially explained by differences in office-visit rates. These findings suggest that the known greater rates of psychotropic drug use among adult females are the result of factors whose influence begins at puberty, not before.

Rhabdomyolysis is characterized by a muscle injury that leads to the release of intracellular muscle contents/constituents into the systemic circulation.

Psychoactive substances pose significant challenges and dangers to society due to their impact on perception, mood, and behavior, leading to health and life disturbances. The consumption of these substances is largely influenced by their legal status, cultural norms, and religious beliefs. Continuous development and chemical modifications of psychoactive substances complicate their control, detection, and determination in the human body. This paper addresses the terminological distinctions between psychoactive and psychotropic substances and drugs. It provides a comprehensive review of analytical methods used to identify and quantify 25 psychoactive substances in various biological matrices, including blood, urine, saliva, hair, and nails. The analysis categorizes these substances into four primary groups: stimulants, neuroleptics, depressants, and hallucinogens. The study specifically focuses on chromatographic and spectrophotometric methods, as well as other novel analytical techniques. Methodology includes a review of scientific articles containing validation studies of these methods and innovative approaches to psychoactive substance determination. Articles were sourced from the PubMed database, with most research originating from the twenty first century. The paper discusses the limits of detection and quantitation for each method, along with current trends and challenges in the analytical determination of evolving psychoactive substances.

Psychotropic Drug Consumption at Admission and Discharge of Nursing Home Residents

We present a brief historical overview of the prevalence studies of psychotropic drugs in individuals with mental retardation that were published between 1966 and 1985, and a more comprehensive review of the prevalence studies from 1986 to 1995. During the 1966 to 1985 period, typical prevalence rates of drug treatments in institutions (children and adults analyzed together) were found to range from 30% to 40% for psychotropic drugs, 25% to 45% for anticonvulsants, and 50% to 70% for psychotropic and/or anticonvulsant drugs (i.e., psychotropics, anticonvulsants, or their combinations). In the community during the same period, prevalence rates in children were typically 2% to 7% for psychotropics, 12% to 31% for anticonvulsants, and 18% to 33% for psychotropic and/or anticonvulsant drugs. For adults in the community, prevalence rates ranged from 26% to 36% for psychotropics, 18% to 24% for anticonvulsants, and 36% to 48% for psychotropic and/or anticonvulsant drugs. In contrast, during the 1986 to 1995 period, typical prevalence rates in institutions ranged from 12% to 40% for psychotropics, 24% to 41% for anticonvulsants, and 44% to 60% for psychotropic and/or anticonvulsant drugs. In the same period, the prevalence rates in the community (for adults and children analyzed together) ranged from 19% to 29% for psychotropics, 18% to 23% for anticonvulsants, and 35% to 45% for psychotropic and/or anticonvulsant drugs. An analysis of the patterns of medication use showed that patient demographic, physical, social, behavioral, and psychiatric variables, as well as a number of staff variables, were correlated with use of pharmacotherapy in the entire population of individuals with mental retardation. A substantial number of individuals with mental retardation appeared to be prescribed psychotropic medications that may have been inappropriate for their diagnosis.

Prescription Patterns of Antidementia and Psychotropic Drugs in People Living With Dementia: Findings From the Clinical Pathway Study of Alzheimer's Disease in China.

Falls are a major cause of morbidity and mortality in the elderly. This study examined the frequency of hospital admission for falls or fractures, and the association with a recent change in the use of cardiovascular and psychotropic medications. We conducted a retrospective case-cohort study of 39,813 patients aged >65 years from 40 Scottish general practices. Data on current prescriptions, dates of drug changes (defined as increases in dose or starting new drugs), diagnoses and clinical measurements were extracted from primary care electronic records, linked to national hospital admissions data. Multivariable logistic regression was used to model the association of change in prescribing of cardiovascular or psychotropic medication with admission to hospital for falls or fractures in the following 60 days. A total of 838 patients (2.1 %) were admitted in the 1-year study period. Following adjustment for factors including age, sex, socioeconomic deprivation, co-morbidity and current prescribing, changes in both cardiovascular and psychotropic medications were associated with subsequent admission for falls or fractures (odds ratio [OR] 1.54 [95 % confidence interval (CI) 1.17-2.03] and 1.68 [95 % CI 1.28-2.22], respectively). There was no evidence for a difference in the effect of change in medication for different cardiovascular drug types (p = 0.86), but there was evidence (p = 0.003) for variation in the association between change in different psychotropic medications and admission; the strongest associations were observed for changes in selective serotonin reuptake inhibitor (SSRI) antidepressants (OR 1.99 [95 % CI 1.29-3.08]), non-SSRI/tricyclic antidepressants (OR 4.39 [95 % CI 2.21-8.71]) and combination psychotropic medication (OR 3.05 [95 % CI 1.66-5.63]). Recent changes in psychotropic and cardiovascular medications are associated with a substantial increase in risk of hospital admission for falls and fractures. Caution should thus be taken when instigating prescribing changes in relation to these medicines, particularly in individuals already considered to be at high risk, such as those with multiple co-morbidities and the oldest old.

Clinical considerations with use of psychotropic medications in COVID-19 patients

The problem of defining what psychoactive products and substances should be covered by legislation aimed at controlling new psychoactive substances (NPS; 'legal highs') is central to the current debate on designing new legislative responses to NPS. In New Zealand, implementation of the Psychoactive Substances Act 2013 (PSA) revealed uncertainties about which psychoactive products are covered by the new regime, with important implications for legal penalties. We reviewed five pieces of legislation which can cover substances with psychoactive properties: PSA, Misuse of Drugs Act (MODA), Food Act, Dietary Supplements Regulations and Medicines Act. Our analysis revealed that a number of psychoactive substances which are not MODA-scheduled may potentially fall under more than one regulatory regime, including kava, Salvia divinorum, nitrous oxide, 25I-NBOMe, and 1,3-dimethylbutylamine (DMBA). For example, kava may be classified as a food, a dietary supplement, a herbal remedy, or a psychoactive substance, depending on how it is presented (including advertising and labelling). There are considerable differences in penalties and regulatory requirements between the different legislative regimes and these may result in unnecessary prosecutions or 'gaming' of the system. We discuss a number of ways to more clearly categorize products, including a public schedule of psychoactive substances and products, demarcation criteria based on the quantity of the active ingredient, and demarcation based on 'discernible intoxication'. Routine use of forensic testing is essential to ensure appropriate prosecutions and penalties. Robust safety standards are also required in legislative regimes exempted from psychoactive substances regime to prevent 'creative compliance'. Copyright © 2016 John Wiley & Sons, Ltd.

The aim of this study was to explore perceptions and understanding of the impact of drug and psychoactive substance abuse among Secondary School students Kilolo district of Iringa Tanzania. The study was guided by the following specific objectives: to identify the commonly used psychoactive drug and substances; to explore students’ perceptions on psychoactive substance use; to examine students’ knowledge of the impact of psychoactive substance abuse on academic achievement; and to explore the strategies used in preventing use of drugs and substance abuse at Secondary School level. The study was guided by the Self-Medication Theory of Addiction. The theory that provides a valuable investigative and clinical paradigm to address the challenging issue of drug addiction. The study used a quantitative approach with a cross-section descriptive design. Employing simple random sampling, a total sample of 400 respondents were drawn from five secondary schools of Kilolo district. The data were obtained through questionnaire-based survey. The data were analysed using descriptive statistics with the aid of IBM SPSS Statistics version 20. The findings revealed that the commonly used psychoactive substances by secondary school students were alcohol, marijuana, snuff, and cigarettes. The students had the knowledge of drugs and substance abuse and perceive that they are not good for their academics and health. The study further unveiled that some students used the substances sparingly and while others used them on a daily basis. The findings showed that students had knowledge of the impact of psychoactive substance abuse on academic achievement. The findings also revealed that mechanism are in place at the school level to prevent drugs and psychoactive substance abuse. In view of the findings of this study it is recommended that families should be involved in the fight against use of drugs and psychoactive substances and provide counsel for the students. Schools should strive at encouraging positive peer relationships and networks among students who do not use psychoactive substances.

Widespread negative attitudes and irrational beliefs about psychotropic drugs held by the public affect patients' treatment compliance. This study was an attempt to identify factors influencing people's acceptance or rejection of psychotropic drugs. An opinion poll was taken by a representative group of 2,176 adults in Germany. In addition to their attitudes toward psychotropic and cardiac drugs and their ratings of perceived risks and benefits, they were also asked about their drug knowledge, their fear of losing self-control, and their fundamental political values. Our results show that even for the treatment of severe mental disease, psychotropic drugs generally are not well accepted compared to cardiac drugs. Psychotropic drugs are believed to cause significantly more severe side effects and provoke more fear of losing control compared with cardiac drugs. Knowledge about psychotropic drugs and experiences with patients suffering from mental disorders are rather limited. Therefore, other sources of information such as negatively tainted reports in the mass media have a significant impact on opinions about psychotropic drugs. Unexpectedly, negative media reports are even more important for the discrimination of distinct subtypes like "acceptors" and "rejecters" of psychotropic drugs than fundamental value orientation. It is recommended that educational and information measures must be enacted to achieve balanced presentation of psychotropic drugs, their effects, and their side effects in the mass media. Improved communication and linguistic elements used in psychotherapeutic settings should be integrated into biological psychiatry to improve understanding of the concepts of mental diseases and their treatment.

Introduction: Administration of psychotropic pro re nata (PRN) medications is influenced by diverse factors such as legal use of PRN medications, the attitude of patients, personal bias, and stigma toward such medication use. While PRN prescriptions increase the efficiency of care and encourage patients to participate in self-care, the use of psychotropic PRN medications by outpatients has raised concerns about its risks of harm, especially for the outpatients. This study explored the use of psychotropic PRN medications by patients attending the outpatient clinic in a hospital.Methods: Qualitative in-depth interviews were conducted. Purposeful sampling was done to achieve cases with enriched information. Participants were chosen regardless of their ethnicity and were selected using the database and patient records in the clinic. Patients 18 years of age prescribed PRN psychotropic medications attending outpatient clinics in a hospital were included. Vulnerable patients (e.g., pregnant ladies, prisoners, cognitively impaired individual, AIDS/HIV subjects, and terminally ill subjects) were excluded.Results: This study revealed the patients' perspectives and experiences on self-management of psychotropic PRN medications. The themes that emerged were clustered as education and background, knowledge on psychotropic medications, frequency of medication intake, underuse of medication, the overdose of medication, side effects concern, source of information, and personal experience.Conclusions: Patients' understanding of medication, inappropriate medication use, cues to action, and use of alternatives are the factors that affected the self-management of psychotropic PRN medications by the patients.