Overlooked Medication Effects and Editorial Asymmetry in Psychiatric Research: A Case Study

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The adverse effects of psychotropic drugs as an endocrine disrupting chemicals on the hypothalamic-pituitary regulation in male

IntroductionSomatic complications account for the majority of the 13–30 years shortened life expectancy in psychiatric patients compared to the general population. The study aim was to assess to which extent patients visiting outpatient departments for mood and anxiety disorders were monitored for relevant somatic comorbidities and (adverse) effects of psychotropic drugs–more specifically a) metabolic parameters, b) lithium safety and c) ECGs—during their treatment.MethodsWe performed a retrospective clinical records review and cross-sectional analysis to assess the extent of somatic monitoring at four outpatient departments for mood and anxiety disorders in The Netherlands. We consecutively recruited adult patients visiting a participating outpatient department between March and November 2014. The primary outcome was percentage of patients without monitoring measurements. Secondary outcomes were number of measurements per parameter per patient per year and time from start of treatment to first measurement.ResultsWe included 324 outpatients, of whom 60.2% were female. Most patients were treated for depressive disorders (39.8%), anxiety disorders (16.7%) or bipolar or related disorders (11.7%) and 198 patients (61.1%) used at least one psychotropic drug. For 186 patients (57.4%), no monitoring records were recorded (median treatment period 7.3 months, range 0–55.6). The median number of measurements per parameter per year since the start of outpatient treatment for patients with monitoring measurements was 0.31 (range 0.0–12.9). The median time to first monitoring measurement per parameter for patients with monitoring measurements was 3.8 months (range 0.0–50.7).DiscussionSomatic monitoring in outpatients with mood and anxiety disorders is not routine clinical practice. Monitoring practices need to be improved to prevent psychiatric outpatients from undetected somatic complications.

Public trust in research depends on implementation of research protections. Genetic and psychiatric research may elicit "exceptionalism," the belief that these types of research deserve special protections. Genetic information has been viewed as different from other health information. Psychiatric research has been scrutinized based on concerns about the impact of psychiatric illness on individuals' abilities to make decisions. This study compared four stakeholder groups' attitudes toward research safeguards. Psychiatric genetic researchers and institutional review board chairs received structured surveys. Individuals with mental illness and family members participated in semistructured interviews. Paired sample t-tests were used to compare mean ratings of importance of safeguard procedures for genetic versus nongenetic research on physical versus mental illnesses. All groups provided higher ratings for the importance of safeguards for genetic research and for mental illness. Individuals with mental illness and family members rated the importance of safeguards more highly than researchers and chairs did. Results of generalized linear models showed significant effects of gender and ethnicity.

Цель исследования. Изучить и обобщить имеющуюся доказательную базу для применения мелатонина в качестве корректора побочных эффектов психотропных лекарств и электросудорожной терапии, и представить читателю соответствующие выводы.Методология проведения работы. Авторами был проведён поиск литературы о применении мелатонина в качестве корректора побочных эффектов психотропных лекарств и электросудорожной терапии в PubMed и Google Scholar. Найденные в результате этого поиска литературные данные представлены в настоящей статье.Результаты. Полученные нами в результате данного обзора литературы данные свидетельствуют о том, что мелатонин может быть эффективно использован как в монотерапии, так и в комбинации с другими корректорами с целью уменьшения ряда побочных эффектов психотропных лекарств и электросудорожной терапии, и заслуживает дальнейшего изучения в этом качестве. Доказательная база по его применению различна для различных побочных эффектов. Наибольшая доказательная база имеется об эффективности применения мелатонина в предотвращении и лечении диссомнических нарушений, нарушений памяти и когнитивных функций, акатизии, поздних дискинезий, а также метаболического синдрома.Область применения результатов. Полученные нами результаты могут применяться в психиатрии, неврологии и наркологии, а также во всех тех областях общесоматической медицины, в которых находят своё применение психотропные препараты.

Multidisciplinary research priorities for the COVID-19 pandemic

Psychotropic drugs are associated with adverse effects. Mostly adverse effects are reported by patients or elicited by clinicians. For many other adverse effects, it is necessary to do baseline blood tests to avoid giving a medication to patients who are at a high risk of a particular adverse effects and to monitor blood tests to either avoid or to manage specific adverse effects. Most treatment guidelines recommend blood tests to monitor adverse effects of psychotropic drugs. However, mostly these recommendations are based on low levels of scientific evidence and expert opinions. Hence, it is not uncommon to see significant variations amongst different guidelines. Ideally, the monitoring recommendations should take in to account clinical significance and pathophysiology of the adverse effects. Moreover, before proposing any form of monitoring, we must be reasonably sure that such monitoring will be beneficial for patients and lastly monitoring should be cost effective as well. In the field of medicine, monitoring recommendations are increasingly subjected to scientific rigour. In this review, we have compared blood tests monitoring recommendations, by various national and international treatment guidelines, of commonly used psychotropic drugs such as antipsychotic drugs, lithium, and valproate. This is a narrative review, in which we have critically appraised the recommendations and highlighted the need for evidence-based monitoring of adverse effects of psychotropic drugs.

This article reports on the outcome of an expert consensus meeting in August 2005 sponsored by the National Institute of Mental Health, which assembled 15 senior researchers with a background in treatment and services research with the Hispanic population. The purpose of the workshop was to identify research issues most pertinent for improving quality and effectiveness of treatment for Hispanics experiencing persistent mental disorders, defined as psychiatric syndromes that are of sufficient severity and duration to cause long-term impairment in social and occupational functioning and significant disability. The spectrum of ideas and recommendations advanced at the one-day meeting was wide and overlapping; therefore, the rich body of material was subsequently organized into five topics: diagnosis, quality of care and culturally appropriate services, psychosocial intervention development, psychopharmacologic interventions, and access to care. Although the authors recognize that the review was broad and the agenda presented is ambitious and in many instances generalizes to priority areas in overall mental health services and treatment research, the recommendations are intended to stimulate research for addressing the unique problems and research deficits that affect Hispanics with persistent mental disorders.

The aim of the study is to describe the experience of psychotropic drug use among young people with mental health problems. Young people experience mental health problems, and some will need to take psychotropic drugs for either a short or a long time. Psychotropic drugs may be effective in reducing mental distress, but raise questions about increasing use, side effects, long-term treatment and off-label use. Qualitative interviews were accomplished with eight young people who had taken psychotropic drugs. Three categories were identified: ‘Effects of psychotropic drugs’, ‘Access of professional care and follow-up’ and ‘Social life and psychotropic drug use’. The young people experienced both beneficial and undesired effects from the psychotropic drugs. They experienced lack of access to professional support and follow-up. Life with family and friends was influenced negatively by psychotropic drug use and the young people were afraid of being lonely and stigmatized. The results may have implications for those who work with young people. Young people striving with mental health problems and psychotropic drug use have to have access to professional support and follow-up. Knowledge about effects of psychotropic drug use among young people is needed. The work about openness about mental health problems among young people has to continue.

Internationalization of psychiatric research - the prospective for the European Association of Psychiatrists.

The immune system and inflammation are involved in the pathological progression of various psychiatric disorders such as depression or major depressive disorder (MDD), generalized anxiety disorder (GAD) or anxiety, schizophrenia, Alzheimer's disease (AD), and Huntington's disease. It is observed that levels of inflammatory cytokines such as tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and other markers are highly increased in the abovementioned disorders. The inflammation and immune component also lead to enhance the oxidative stress. The oxidative stress and increased production of reactive oxygen species (ROS) are considered as important factors that are involved in pathological progression of psychiatric disorders. Increase production of ROS is associated with excessive inflammation followed by cell necrosis and death. The psychotropic drugs are mainly work through modulations of neurotransmitter system. However, it is evident that inflammation and immune modulation are also having important role in the progression of psychiatric disorders. Rationale of the use of current psychotropic drugs is modulation of immune system by them. However, the effects of psychotropic drugs on the immune system and how these might contribute to their efficacy remain largely unclear. The drugs may act through modification of inflammation and related markers. The main purpose of this book chapter is to address the role of current psychotropic drugs on inflammation and immune system. Moreover, it will also address the role of inflammation in the progression of psychiatric disorders.

Mirtazapine is a noradrenergic and specific serotonergic antidepressant, and it has been used to manage the side effects of many psychotropic drugs. This paper reviews the application of mirtazapine in the management of antipsychotic-induced akathisia, selective serotonin reuptake inhibitor-induced syndrome of inappropriate secretion of antidiuretic hormone, hyperhidrosis, nausea, vomiting, urinary retention, paroxetine-induced hyper-prolactinemic galactorrhoea, psychotropic drug-induced sexual dysfunction, and clozapine-induced sialorrhea, as well as in aiding benzodiazepine withdrawal. Key words: Mirtazapine; Psychotropic drug-induced side effects; Progress

Brain neurotransmitter dysfunctions involved in the pathophysiological processes of psychiatric disorders are likely to be reflected by concomitant alterations in sleep continuity and architecture. Since the corrective effects of psychotropic drugs on dysfunctional neurotransmission systems can be evidenced through polysomnographic recordings, one may consider sleep as a kind of "window" on the neurobiology of psychiatric disorders. During the last 10 years, major breakthroughs in our understanding of sleep-wake mechanisms have provided some indications on how psychotropic drugs could influence the sleep-wake cycle. In this review, recent inroads into the understanding of sleep regulatory neural mechanisms are introduced and discussed in terms of the effects of psychotropic drugs. The relationship between the pathophysiological process of a disease, its consequence on sleep, and the corrective effect of a psychotropic drug are exemplified by two psychopathological states: substance withdrawal and major depression. One may conclude that polysomnographic recordings are a unique noninvasive tool to analyze brain functioning, and are particularly well suited to evaluating the objective effects of new psychotropic drugs.

This study examined differences in the types of mental health research that were conducted in the states and territories of Australia in 2008. Differences in both the disorder focus (e.g. depression, psychosis) and goal or methodology (e.g. epidemiological, biological) of published papers were examined. The structural differences underlying research output were examined by comparing output with funding and research infrastructure. A random sample of 1008 Australian-authored mental health research publications and all 126 competitive mental-health related research grants from 2008 were coded in terms of their state or territory of origin, disorder focus and research goal. Victoria and the Australian Capital Territory had the highest per capita rates of mental health research publications in 2008, while Tasmania and the Northern Territory had less per capita output. Research in New South Wales had greater focus on substance use and anxiety disorders, while Victoria was dominant in research on affective disorders and psychosis. Research in Queensland and Western Australia was broader in scope. Research output was more closely linked with number of successful grants than amount of funding. State and territory support for mental health research may have important implications for research output.

The prevalence of mental disorders in 76 first-degree relatives (parents and nontwin siblings) of 33 subjects with anxiety disorder was compared with the prevalence of mental disorders in 45 first-degree relatives of 20 subjects with mood disorder and 13 first-degree relatives of 6 subjects with psychoactive substance use disorder. All subjects were personally interviewed with the Structured Clinical Interview for DSM-III-R Axis I (SCID I). Interrater reliability was high for most diagnoses. Significantly more first-degree relatives of subjects with anxiety disorder had panic disorder and generalized anxiety disorder compared with relatives of probands with mood disorder. Significantly more female than male relatives of anxiety subjects suffered from anxiety disorders; there were no gender differences in the prevalence of anxiety disorders in relatives of mood and psychoactive substance use disorder (PSUD) subjects. The combination of anxiety and mood disorder was overrepresented in first-degree relatives of subjects with the same type of comorbidity. In relatives of subjects with mixed anxiety and psychoactive substance use disorder, but no mood disorder, there was an overrepresentation of PSUD; mainly alcohol abuse or dependence.