Use Of Anxiolytics Research Articles

A life course perspective on mental disorders and psychopharmacologic drug use among persons living with cerebral palsy

In this study, we investigated the prevalence of mental disorders and the use of psychopharmacologic drugs among individuals with cerebral palsy (CP). We studied how the association between CP and mental illness develops over the life course (between ages 5 and 65 years), and how it varies across disability specific factors (intellectual disability, gross motor function and communicative ability). We used logistic regression models on a longitudinal matched case-control data material on all persons with CP in Sweden linked to several administrative registers including, the national patient registers and the pharmaceutical registers.Our results showed that the probability of being diagnosed with mental disorders and being dispensed psychopharmacologic drug was significantly higher among persons with CP compared to persons without CP across the different outcomes [OR=1.52–4.7]. For some mental and neurodevelopmental disorders including sleep disorders, autism, and ADHD, and for the use of anxiolytics and sedatives, there was a sizeable gap already in childhood. However, the excess burden of mental illness appeared to grow over the life course, indicating that adults with CP may be a particularly disadvantaged group. Diagnosis for mental disorders and dispensation for psychopharmacologic drugs were not consistent with respect to disability specific factors, especially communicative and intellectual function, which indicates the need for systematic approaches in the mental health care of individuals with CP.

THE RELATIONSHIP BETWEEN WORKLOAD AND USE OF ANXIOLYTICS AND ANTIDEPRESSANTS IN NURSING: AN INTEGRATIVE REVIEW

Introduction: Nursing professionals face high levels of stress and work overload, which can affect their mental health and lead to the use of anxiolytics and antidepressants. However, the relationship between workload and the use of these medications is not yet completely clear. Objective: This study aims to explore the relationship between nurses' workload and the use of anxiolytics and antidepressants, in addition to identifying the main factors that influence this use. Methodology: An integrative literature review was carried out, searching the PubMed and CINAHL databases, using specific descriptors. The studies were selected based on the relationship between workload and medication use, and analyzed for quality and relevance. Conclusion: The data suggest a significant association between high workload and the use of psychotropic medications, highlighting factors such as long working hours and high demand in the health environment. The review suggests that work overload is linked to the use of anxiolytics and antidepressants by nurses, reinforcing the need for interventions to improve working conditions and support the mental health of these professionals.

The effect of virtual reality hypnosis (HypnoVR) in patients undergoing inguinal hernia repair under local anesthesia. A preliminary report.

Surgical procedures, even under local anesthesia, can induce significant stress and anxiety in patients. Innovative approaches to alleviate anxiety are crucial for improving patient outcomes. Sedatives and anxiolytics may alleviate this discomfort, but they can also subject patients to undesirable side effects, diminishing their overall effectiveness, and, finally, delaying discharge. We present the first case series of a patients underwent inguinal hernia surgical repair under local anesthesia using VRH (HypnoVR) to avoid use of sedatives and anxiolytics. 12 consecutive patients were enrolled to undergo elective monolateral inguinal hernia repair surgery via an open approach using HypnoVR, at Colorectal Surgery Unit of Fondazione Policlinico Universitario Campus Bio-Medico di Roma. Vital signs (heart rate, SpO2, blood pressure) were detected for all patients before surgery, during local anesthesia, during the whole intervention and after surgery. No intraoperative or postoperative complications have been recorded and only one postoperative complication occurred (seroma), which not required invasive treatment but only drug administration. All patient's vital parameters were recorded during all operative and perioperative phasis. No use of intraoperative analgesic, sedative or anxiolytic were needed. All patients were discharged no later than 3h after surgery. Virtual Reality Hypnosis is a promising tool for anxiety management in surgical settings. Our series highlights the positive impact of HypnoVR in reduction and management of surgical patient anxiety and discomfort, allowing to perform inguinal hernia repair using only local anesthesia, with good patients' satisfaction.

AUMENTO DO USO DE ANSIOLÍTICOS APÓS A PANDEMIA – REVISÃO DA LITERATURA

Introduction: Anxiety disorders are significant areas of research due to the high incidence of anxiety being diagnosed in the population, leading to temporary or permanent disability. Investigations conducted on the mental health of Brazilian residents during the COVID-19 outbreak indicate an increase in diagnoses of anxiety, depression, and stress. The deterioration of mental well-being was influenced by multiple factors, including the absence of proper funeral ceremonies, the escalation of unemployment, and the decline in financial capacity, which heightened tension and anguish among those needing a source of income to support their families. This scenario significantly contributed to the increase in the use of anxiolytics, as many individuals resorted to these medications as a form of immediate relief for the symptoms of anxiety and stress exacerbated by the pandemic, highlighting the need for a broader and more integrated approach to mental health treatment in the current context. Objectives: To analyze the increase in the use of anxiolytics after the COVID-19 pandemic and its implications for public health. Methodology: This study is structured as a literature review, aiming to compile and analyze existing information on the topic. Additionally, the research is exploratory and descriptive, with the objective of mapping existing knowledge on the subject and outlining its nuances. The platforms Scielo, Portal de Periódicos CAPES, and Medline were used. The period considered was from 2018 to 2023, with texts fully available online, in Portuguese. Results: The results indicate a significant increase in the use of anxiolytics during and after the COVID-19 pandemic, especially among more vulnerable groups, such as the elderly and people with pre-existing health conditions. The use of medications like Alprazolam increased by 35% in 2020, reflecting the intensification of anxiety in the population. Conclusion: The pandemic exposed the fragility of mental health systems, highlighting the need for public policies that combine pharmacological treatment with continuous support. Future research is essential to monitor the long-term effects of anxiolytic use in the post-pandemic period.

MEDICATION IN THE COVID-19 PANDEMIC: Consumption of psychodrugs in two pharmacies in south fluminense

Social isolation and changes in routine during the COVID-19 pandemic had impacts on the mental health of the population and medicalization was used as a response to this problem. It is understandable that people face difficulties during periods of social deprivation, which can lead to symptoms such as fear, sadness and anxiety. However, it is important to emphasize that the approach to mental health should not be limited to medicalization alone. A study was carried out through document analysis in two pharmacies in the municipality of Barra Mansa, in Rio de Janeiro, in which the psychotropic drugs dispensed before, during and after the COVID-19 pandemic were quantified. The results obtained revealed that in pharmacy A from 2018 to 2019 there was a tendency towards an increase in the consumption of psychotropic drugs, with emphasis on antipsychotics, however the total consumption from 2019 to 2020 during the COVID-19 pandemic fell by 9.02%. In pharmacy B, in 2020, at the height of the COVID-19 pandemic in Brazil in 2021, there was a 26.35% reduction in the total consumption of psychotropic drugs. During the period of decline in cases of the disease in 2022, a 3.14% drop in the consumption of these medications was observed, but the consumption of anxiolytics increased by 149%. These results only show an increase in the consumption of antipsychotics in the pre-crisis period and an increase in the consumption of anxiolytics in the post-crisis period, highlighting medicalization, especially in the use of anxiolytics due to the dependence and tolerance that lead to prolonged use of these drugs.

The Connection Between Depression and Ischemic Heart Disease: Analyzing Demographic Characteristics, Risk Factors, Symptoms, and Treatment Approaches to Identify Their Relationship.

Background: This study investigates the association between depression and ischemic heart disease (IHD), conditions that often coexist and complicate patient management. Understanding the impact of demographic factors, risk factors, symptoms, and medical approaches in these patients is essential to develop effective clinical strategies. Objectives: The aim of this study is to investigate how demographic characteristics, risk factors, symptoms, and treatment methods differ between patients with depression alone and those with both depression and IHD. It seeks to identify how these factors influence patient outcomes, providing insights to improve management and treatment approaches for this complex patient group. Materials and Methods: This cross-sectional study included a sample of 332 patients diagnosed with depression, with a specific subgroup consisting of individuals who also had comorbid IHD. Statistical analyses were performed to compare the patients with depression, focusing on those with IHD. Data on demographic characteristics (e.g., gender, environment, social status), risk factors (e.g., hypertension, diabetes), symptom severity, and treatments (e.g., antidepressants, antipsychotics, anxiolytics, hypnotics) were analyzed. The study also evaluated the frequency of cardiac examinations and emergency hospitalizations. Results: Significant demographic differences were found between the two groups. Patients with both depression and IHD had higher rates of hypertension and diabetes mellitus and experienced more severe depressive symptoms, including reduced mood, energy, and activity levels. The treatment patterns were similar in terms of antidepressant use, but the IHD group had a higher use of antipsychotics, anxiolytics, and hypnotics. Additionally, these patients required more cardiac examinations and emergency hospitalizations. Conclusions: Comorbidity between depression and IHD presents complex clinical challenges, and it is crucial to implement an integrated management approach that addresses both mental and physical health. This study highlights the need for comprehensive therapeutic strategies to improve the quality of life and outcomes for patients with these coexisting conditions.

Perception of the Capixaba population regarding the use and benefits of antidepressants and anxiolytics

Depression is a routine disorder characterized by at least two weeks of loss of pleasure, mood, and interest in basic daily activities. Treatment involves psychotherapy, lifestyle changes, and medication therapy with antidepressants. These medications increase the availability of neurotransmitters in the central nervous system through different mechanisms of action, such as Monoamine Oxidase Inhibitors, Tricyclic Antidepressants, Selective Serotonin Reuptake Inhibitors, and Atypicals. Studies indicate that, after the pandemic, mental health issues such as anxiety and depression became more frequent in society, leading to greater use of antidepressants, especially clonazepam, sertraline, and amitriptyline. This project aims to investigate this usage, focusing on the benefits and drawbacks from the user’s perspective. To this end, it was submitted to the Ethics and Human Research Council of UNESC, with a bibliographic review conducted in the PubMed, Lilacs, and Scielo databases during the approval period. After approval, the research was conducted through structured questionnaires, made available online to the Capixaba society. The study evaluated the rate of use of these psychotropic drugs in the region, the benefits, risks, and behaviors regarding the use of antidepressants and anxiolytics from the perspective of patients. The use of psychotropic drugs by the population can be satisfactory for treating mental disorders, but it is essential that these medications are used with caution and under the guidance of a healthcare professional. Regular monitoring helps to manage adverse effects, ensure the medication is working properly, and prevent long-term medication-related problems.

Frailty and Medication Appropriateness in Rural Adults: Proposing Interventions through Pharmacist-Physician Collaborative Efforts.

Background: Frailty and polymedication are closely interrelated. Addressing these concurrent conditions in primary care settings relies on the utilization of potentially inappropriate medication (PIM) lists and medication reviews (MRs), particularly in rural areas, where healthcare professionals serve as the sole point of access to the medical system. The aim of this study was to examine the relationship between medication appropriateness and variables related to frailty in a rural municipality in order to propose potential strategies for therapy optimization. Methods: This cross-sectional study included all adult community dwellers aged 50 and above officially registered in the municipality of Tiriez (Albacete, Spain) in 2023 (n = 241). The primary outcome variable was frailty (assessed using the fatigue, resistance, ambulation, illness, and loss of weight (FRAIL) scale). The independent variables were age, gender, medication regimen, history of falls, comorbidities, PIMs (evaluated using the screening tool of older persons' prescriptions (STOPP) 2023 criteria), fall-risk-increasing drugs (FRID), and anticholinergic burden (ACB). Results: The prevalence of frailty was approximately 20%. FRID and ACB scores were statistically associated (p-value < 0.001) with frailty, 1.1 ± 1.3 vs. 2.5 ± 1.7, and 1.0 ± 1.3 vs. 2.8 ± 2.5, respectively. Regardless of age, frailty was observed to be more prevalent among females (odds ratio (OR) [95% confidence interval (CI)]: 3.5 [1.5, 9.0]). On average, 2.1 ± 1.6 STOPP criteria were fulfilled, with the prolonged use of anxiolytics and anti-peptic-ulcer agents being the most frequent. Priority interventions (PIs) included opioid dose reduction, benzodiazepine withdrawal, and the assessment of antidepressant and antiplatelet treatment plans. Conclusions: The optimization of medication in primary care is of paramount importance for frail patients. Interventional measures should focus on ensuring the correct dosage and combination of drugs for each therapeutic regimen.

Cluster B personality disorders and psychotropic medications: a focused analysis of trends and patterns across sex and age groups.

This study investigated sex and age differences in patterns of psychotropic medication use before and after the initial diagnosis of Cluster B personality disorders (PDs) and analyzed trends over time. Analyzing data from the Quebec Integrated Chronic Disease Surveillance System for individuals newly diagnosed with Cluster B PD (≥ 14 years) between 2002 and 2018 and under the provincial public drug plan, we calculated yearly and monthly proportions of individuals exposed to psychotropic medications during the year before and after their diagnosis by sex and age. Robust Poisson regression models assessed the association between sex and exposure to psychotropic medications after the diagnosis of Cluster B PD. Among 87,778 individuals with a first Cluster B PD diagnosis (mean age: 44.5 years; 57.5% women), the proportion of users increased post-diagnosis. Notably, after diagnosis, females were more likely to receive psychiatric medications (between 78.9% and 83.7% during the study period vs. 72.8% and 76.8%). Males were less likely than females to receive antidepressants (adjusted prevalence ratio (aPR): 0.83; 99% confidence interval (CI): 0.82-0.85) and anxiolytics (aPR: 0.86; 99%CI: 0.84-0.88), whereas they had higher exposure to antipsychotics (aPR: 1.04; 99%CI: 1.02-1.06) and ADHD medications (aPR: 1.14; 99%CI: 1.07-1.2). Age-specific trends showed increased ADHD medication use among younger patients (14-24 years), and anxiolytic use predominated in those aged ≥ 65 years. Psychotropic medication use was high among Cluster B PD patients, with differences in medication classes according to age and sex. The marked sex and age differences in psychotropic medication use among Cluster B PD patients underscore the need for a sex-sensitive and age-specific approach in psychiatric care.

Psychotropic drug use among children and adolescents in the Nordic countries: a systematic review.

The Nordic countries have rather homogenous populations and similar health care systems, and one could therefore expect comparable levels of psychopathology and psychotropic drug use. However, recent studies show pronounced variations in psychotropic drug use among children and adolescents from different Nordic countries. Therefore, we aimed to conduct a systematic review of the literature examining the use of psychotropic drugs among children and adolescents in the Nordic countries. This review followed PRISMA guidelines. We searched PsycINFO, EMBASE and MEDLINE for population-based studies published 2010 or later that investigated prevalent or incident use of antidepressants, psychostimulants, antipsychotics, hypnotics, anxiolytics, and mood stabilizers among 0-19-year-olds in the Nordic countries. Two reviewers assessed all studies. Twenty-two out of 2142 eligible studies were included in the final review covering data collected from 1995 to 2018. The use of psychotropic drugs, except for anxiolytics, increased in most of the Nordic countries, but at different rates. Prevalent use of antidepressants was two to four times higher among Swedish children and adolescents compared to Danish and Norwegian peers. Prevalent use of psychostimulants, on the other hand, was two to sixfold higher in Iceland compared to the other Nordic countries. Finally, the prevalence of antipsychotic use was threefold higher in Finland compared to Sweden, Denmark, and Norway. This systematic review provides a thorough overview of psychotropic treatment of youths in the Nordic countries. We demonstrate a pronounced national variation in use of psychotropics that should be addressed further to facilitate rational pharmacotherapy in youths with psychiatric disorders.

Evaluating the Cognitive Impact of Anxiolytics on Elderly Patients: A prospective observational study.

Background: The cognitive effects of anxiolytics in older adults are an important domain to research given the high rates of anxiety disorders and these medications commonly prescribed. Benzodiazepines, and some of the newer non-benzo" sedative anxiolytic agents have been associated with cognitive effects as a potential side effect. This study is going to be conducted in Lady Reading Hospital (LRH) Peshawar; thus the data will reflect upon population served by this particular hospital. Objectives: To assess the cognitive impact of anxiolytic medication in geriatric patients, specifically on short-term memory (STM), attention and executive functions. Design: A observational study. Place and Duration of Study: Department of Pharmacy, Lady Reading Hospital-Peshawar starting from January 05th 2021 to July 05th ,2022. Methods: This was an observational study conducted on 150 elderly patients at Lady Reading Hospital through non probability sampling, comparing cognitive domain of functioning between 75 users and rest controls. Cognitive function was evaluated by Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment before and after the medication. Results - This section will describe the cognitive score changes in relation to anxiolytic use. One-way ANOVA will be utilized to examine the differences in cognitive outcomes according drug type, dosage and duration of use. Conclusions: The use of anxiolytics in elderly patients is associated with deterioration cognitive function, which was confirmed by a decrease MMSE and MoCA scores during the course of treatment. The potential cognitive side effects when prescribing anxiolytics to the elderly requires a nuanced approach by healthcare providers. Keywords: Anxiolytics; older adult patients; cognitive performance, MMSE/MoCA.

Traumatic Brain Injury, Seizures, and Cognitive Impairment Among Older Adults

Traumatic brain injury (TBI), seizures, and dementia increase with age. There is a gap in understanding the associations of TBI, seizures, and medications such as antiseizure and antipsychotics with the progression of cognitive impairment across racial and ethnic groups. To investigate the association of TBI and seizures with the risk of cognitive impairment among cognitively normal older adults and the role of medications in moderating the association. This multicenter cohort study was a secondary analysis of the Uniform Data Set collected between June 1, 2005, and June 30, 2020, from the National Alzheimer's Coordination Center. Statistical analysis was performed from February 1 to April 3, 2024. Data were collected from participants from 36 Alzheimer's Disease Research Centers in the US who were 65 years or older at baseline, cognitively normal at baseline (Clinical Dementia Rating of 0 and no impairment based on a presumptive etiologic diagnosis of AD), and had complete information on race and ethnicity, age, sex, educational level, and apolipoprotein E genotype. Health history of TBI, seizures, or both conditions. Progression to cognitive impairment measured by a Clinical Dementia Rating greater than 0. Among the cohort of 7180 older adults (median age, 74 years [range, 65-102 years]; 4729 women [65.9%]), 1036 were African American or Black (14.4%), 21 were American Indian or Alaska Native (0.3%), 143 were Asian (2.0%), 332 were Hispanic (4.6%), and 5648 were non-Hispanic White (78.7%); the median educational level was 16.0 years (range, 1.0-29.0 years). After adjustment for selection basis using propensity score weighting, seizure was associated with a 40% higher risk of cognitive impairment (hazard ratio [HR], 1.40; 95% CI, 1.19-1.65), TBI with a 25% higher risk of cognitive impairment (HR, 1.25; 95% CI, 1.17-1.34), and both seizure and TBI were associated with a 57% higher risk (HR, 1.57; 95% CI, 1.23-2.01). The interaction models indicated that Hispanic participants with TBI and seizures had a higher risk of cognitive impairment compared with other racial and ethnic groups. The use of antiseizure medications (HR, 1.23; 95% CI, 0.99-1.53), antidepressants (HR, 1.32; 95% CI, 1.17-1.50), and antipsychotics (HR, 2.15; 95% CI, 1.18-3.89) was associated with a higher risk of cognitive impairment, while anxiolytic, sedative, or hypnotic use (HR, 0.88; 95% CI, 0.83-0.94) was associated with a lower risk. This study highlights the importance of addressing TBI and seizures as risk factors for cognitive impairment among older adults. Addressing the broader social determinants of health and bridging the health divide across various racial and ethnic groups are essential for the comprehensive management and prevention of dementia.

Profile of chronic pain patients with opioid withdrawal syndrome according to psychological factors: a Latent Class Analysis.

Withdrawal syndrome stands out as the strongest risk factor for Prescription Opioid-Use Disorder (POUD) and is related to psychological and pain impairment in chronic pain population. This study aimed to identify profiles of chronic pain patients with opioid withdrawal based on psychological factors, and to explore the association between the classes and demographic, clinical, and substance use variables. This cross-sectional descriptive study involved 391 patients, 221 of them with interdose withdrawal (mean age=57.91±13.61 years; 68.3% female). Latent Class Analysis (LCA) and bivariate and logistic regression analyses were performed. Two latent classes were identified (BIC=4020.72, entropy=0.70, LRTs p<0.01): Withdrawal syndrome with No Psychological Distress (WNPD; 45.2%, n=100) and Withdrawal syndrome with Psychological Distress (WPD; 54.8%, n=121). The WPD class was more likely to experience craving, anxiety, and depression, and to report higher levels of pain intensity and interference (p<0.01). Patients in this class were younger, visited a higher number of specialists, and showed higher rates of high-dose opioid use, misuse, moderate-severe POUD, and tobacco and anxiolytics use (p<0.05). Only moderate-severe POUD (OR=2.64) and tobacco use (OR=2.28) increased the risk of WPD class membership. Although it is common for chronic pain patients to experience withdrawal symptoms during opioid treatment, more than a half of the participants reported concomitant psychological distress. Establishing differential profiles can help to improve withdrawal syndrome management during the treatment of chronic pain with opioids.

P-727 The impact of antidepressants and anxiolytics on assisted reproductive technology treatment outcomes

Abstract Study question Does antidepressant and anxiolytic use impact the chance of live birth after assisted reproductive technology (ART) treatment? Summary answer For women using antidepressants, ART treatment is as successful as for others. However, concomitant anxiolytic use was associated with failure to succeed. What is known already Infertility and depression are prevalent disorders in women of reproductive age and may occur coincidently. Antidepressants constitute the mainstay in treatment for moderate-severe depression, and selective serotonin reuptake inhibitors (SSRIs) are among the most commonly used antidepressants because they, in general, cause few side effects. However, antidepressant use in women undergoing ART treatment may be considered to balance the possible risks of untreated depression against fetal drug exposure and the efficacy of ART treatment. Furthermore, up to 50% of patients with depression also meet the criteria for anxiety disorders and may be treated with anxiolytics. Study design, size, duration This is an observational cohort study based on the Danish health registries. The use of antidepressants, i.e. as current or recent users, and anxiolytics or hypnotics at embryo transfer was obtained from the prescription register and information on all ART treatments and childbirths between 2006 and 2019 from the Danish ART register and the Danish birth register. Participants/materials, setting, methods The study population included 130,170 embryo transfers in 48,156 women undergoing ART treatment. A total of 1505 women were exposed to antidepressants at the time of embryo transfer, and 1160 women were recent users who discontinued before embryo transfer. We used mixed-effects logistic regression analyses. The association between antidepressants and anxiolytics respectively and ART was analyzed taking potential confounders into account estimating the odds ratios(OR) of either a biochemical pregnancy, clinical pregnancy, or live birth. Main results and the role of chance The adjusted OR(aOR) and corresponding 95% confidence interval (CI) of a biochemical-, and clinical pregnancy in women with current use of antidepressants at time of embryo transfer were 0.87 (95% CI: 0.73-1.04) and 0.84 (95% CI: 0.57-1.20), respectively, and 0.90 (95% CI: 0.67-1.19) for live birth. For women who discontinued antidepressant use before embryo transfer (labeled recent users), the aORs for a biochemical-, clinical pregnancy and live birth were 0.95 (95% CI: 0.76-1.17), 0.71 (95% CI: 0.46-1.09) and 1.02 (95% CI: 0.72-1.45), respectively. When analyzing women who use or recently used antidepressants in combination with anxiolytics or hypnotics the chance of a live birth was decreased markedly with an aOR of 0.15 (95% CI: 0.04-0.51). Based on nationwide data from more than a decade of ART treatments, we found that the use of antidepressants at the time of embryo transfer was not associated with a decreased chance of biochemical or clinical pregnancy, or live birth. However, when women treated with antidepressants also used anxiolytics or hypnotics, the chance of a live birth was significantly decreased though based on a limited number of patients suggesting a point of further investigation and attention. Limitations, reasons for caution As in all observational studies, it can never be ensured that the patients take the medicine, but we used information on prescriptions for antidepressants/anxiolytics from the prescription register using at least two redeemed prescriptions within 182 days before, and until 182 days after the date of embryo transfer. Wider implications of the findings Use of antidepressants at the time of embryo transfer was not associated with a decreased chance of biochemical or clinical pregnancy, or live birth. However, when antidepressants are used concomitantly with anxiolytics or hypnotics, the chance of live birth is significantly decreased suggesting the need for further investigation and attention. Trial registration number The study was funded by The Region of Southern Denmark and Merck.

Benzodiazepine use in relation to long-term dementia risk and imaging markers of neurodegeneration: a population-based study

BackgroundBenzodiazepine use is common, particularly in older adults. Benzodiazepines have well-established acute adverse effects on cognition, but long-term effects on neurodegeneration and dementia risk remain uncertain.MethodsWe included 5443 cognitively healthy (MMSE ≥ 26) participants from the population-based Rotterdam Study (57.4% women, mean age 70.6 years). Benzodiazepine use from 1991 until baseline (2005–2008) was derived from pharmacy dispensing records, from which we determined drug type and cumulative dose. Benzodiazepine use was defined as prescription of anxiolytics (ATC-code: N05BA) or sedative-hypnotics (ATC-code: N05CD) between inception of pharmacy records and study baseline. Cumulative dose was calculated as the sum of the defined daily doses for all prescriptions. We determined the association with dementia risk until 2020 using Cox regression. Among 4836 participants with repeated brain MRI, we further determined the association of benzodiazepine use with changes in neuroimaging markers using linear mixed models.ResultsOf all 5443 participants, 2697 (49.5%) had used benzodiazepines at any time in the 15 years preceding baseline, of whom 1263 (46.8%) used anxiolytics, 530 (19.7%) sedative-hypnotics, and 904 (33.5%) used both; 345 (12.8%) participants were still using at baseline assessment. During a mean follow-up of 11.2 years, 726 participants (13.3%) developed dementia. Overall, use of benzodiazepines was not associated with dementia risk compared to never use (HR [95% CI]: 1.06 [0.90–1.25]), irrespective of cumulative dose. Risk estimates were somewhat higher for any use of anxiolytics than for sedative-hypnotics (HR 1.17 [0.96–1.41] vs 0.92 [0.70–1.21]), with strongest associations for high cumulative dose of anxiolytics (HR [95% CI] 1.33 [1.04–1.71]). In imaging analyses, current use of benzodiazepine was associated cross-sectionally with lower brain volumes of the hippocampus, amygdala, and thalamus and longitudinally with accelerated volume loss of the hippocampus and to a lesser extent amygdala. However, imaging findings did not differ by type of benzodiazepines or cumulative dose.ConclusionsIn this population-based sample of cognitively healthy adults, overall use of benzodiazepines was not associated with increased dementia risk, but potential class-dependent adverse effects and associations with subclinical markers of neurodegeneration may warrant further investigation.

Temporal trends in medication and service use patterns for mental health issues among men with prostate cancer.

Prostate cancer can significantly impact mental wellbeing, creating uncertainty and morbidity. This study described patterns of psychotropic medication and mental health service use, as a proxy measure for mental health problems, 5years before and 5years after prostate cancer diagnosis. Population-based registry data were linked with Pharmaceutical Benefits Scheme and Medicare Benefits Schedule data for all prostate cancer patients diagnosed in South Australia between 2012 and 2020 (n=13,693). We estimated the proportion and rates of psychotropic medication and mental health service use before and after diagnosis. Multivariable adjusted interrupted time series analyses (ITSA) were conducted to uncover temporal patterns. Fifteen percent of men commenced psychotropic medications and 6.4% sought out mental health services for the first time after diagnosis. Psychotropic medication use rose from 34.5% 5years before to 40.3% 5years after diagnosis, including an increase in use of antidepressants (from 20.7% to 26.0%) and anxiolytics (from 11.3% to 12.8%). Mental health service use increased from 10.2% to 12.1%, with the increase mostly being general practice mental health visits (from 7.8% to 10.6%). Multivariable ITSA indicated a significant rise in medication and service utilisation immediately before and in the first 2years following prostate cancer diagnosis. There is a clear increase in psychotropic medication use and mental health service use around the time of prostate cancer diagnosis. Mental health outcomes of men with prostate cancer may be improved with early mental health screening, particularly during the diagnosis process, to enable early intervention.

The use of neuroleptics, sedatives and anesthetics for anxiolytic therapy in animals

An important area for improving antidepressant treatment is the expansion of the indications for neuroleptics, anesthetics and sedatives. All these drugs have pronounced neurotropic effects. The aim of our work is to study the published scientifc evidence on the potential of neuroleptics, anesthetics and sedatives for anxiolytic therapy. A systematic literature review was used to search for publications on the topic of the study. The PubMed database (https://pubmed.ncbi.nlm.nih.gov) was used to search for scientifc articles. The literature data indicates that ketamine is used to treat recurrent anxiety in both humans and animals. It provides rapid and sustained relief of anxiety symptoms in a variety of its clinical presentations. The anxiolytic effect occurs within the frst 12 hours after administration and remains effective for 1 to 2 weeks. The anxiolytic effect of ketamine is due to its effect on hippocampal neurotropic factor activity. Diazepam can signifcantly reduce anxiety and depressive symptoms as well as neuroinflammation in brain-injured mice. It causes a dose-dependent increase in motor activity. In combination with metformin, diazepam is the preferred treatment for type 2 diabetes mellitus in stressed animals. Intermittent use of diazepam is useful to avoid the development of physical dependence when the drug is used for a long period of time. Acepromazine is promising to be used for anxiolytic effect in animals. A combined protocol with acepromazine signifcantly reduced signs of stress, anxiety and aggression during veterinary visits and had an anxiolytic effect in dogs. Acepromazine reduces the negative effects of transport stress in wild ungulates. Dexmedetomidine is used for sedation in both human and veterinary medicine. This drug is a promising candidate for the experimental treatment of stress-related diseases such as anxiety disorders or post-traumatic stress disorder. We believe that further research in this area should be conducted in controlled comparative studies to determine the optimal doses and duration of administration of potential anxiolytics, considering the species, age, sex, physiological state and other relevant clinical parameters of the animals studied. Therefore, systematic and detailed studies will help us not only to understand the effectiveness, but also to provide safe and individualized treatment. This research can improve our understanding of the use of anxiolytics in veterinary practice, which is of key importance for improving the quality of animal welfare. In our opinion, the use of anesthetics, neuroleptics and sedatives, which are now widely used for sedation or general anesthesia, opens new possibilities for the treatment of behavioral and anxiety disorders in animals. Key words: anxiety, veterinary medicine, neuroleptics, sedatives, ketamine, acepromazine, diazepam, medetomidine.

A Contemporary Analysis of Mental Well-being Among Living Donor Kidney Applicants.

Living donation is paramount for expanding the donor pool. The aim of this study was to assess changes over time in self-reported mental health of living donor kidney applicants in efforts to inform patient-centered discussions with potential donors. Kidney donor applications from 2017 through 2021 were compiled. Data included age, gender, race, ethnicity, applicant-recipient relationship, medical history, and medications. Trends over time were analyzed and post hoc analyses were performed. During the study period, 2479 applicants to the living donor kidney program were evaluated; 73% of applicants were female individuals. More than half of applicants were not related to their intended recipient; this fraction increased from 46% in 2017 to 58% in 2021 (P < 0.01). A similar decline in family relations was not present among Black and Latino applicants. Of all applicants, 18% reported depression and 18% reported anxiety; 20% reported taking antidepressants or anxiolytics. Depression and anxiety increased 170% (P < 0.001) and 136% (P < 0.001) from 2018 to 2019, respectively; antidepressant and anxiolytic use rose 138% (P < 0.001) between 2018 and 2020. The profile of living donor applicants has changed in recent years, with approximately 1 in 5 requiring antidepressants or anxiolytics. Predonation counseling and postdonation monitoring are imperative to decrease adverse psychological outcomes for living donors.

Consensus Panel Recommendations for the Pharmacological Management of Breastfeeding Women with Postpartum Depression

Introduction: Our consensus statement aims to clarify the use of antidepressants and anxiolytics during breastfeeding amidst clinical uncertainty. Despite recent studies, potential harm to breastfed newborns from these medications remains a concern, leading to abrupt discontinuation of necessary treatments or exclusive formula feeding, depriving newborns of benefits from mother’s milk. Methods: A panel of 16 experts, representing eight scientific societies with a keen interest in postpartum depression, was convened. Utilizing the Nominal Group Technique and following a comprehensive literature review, a consensus statement on the pharmacological treatment of breastfeeding women with depressive disorders was achieved. Results: Four key research areas were delineated: (1) The imperative to address depressive and anxiety disorders during lactation, pinpointing the risks linked to untreated maternal depression during this period. (2) The evaluation of the cumulative risk of unfavorable infant outcomes associated with exposure to antidepressants or anxiolytics. (3) The long-term impact on infants’ cognitive development or behavior due to exposure to these medications during breastfeeding. (4) The assessment of pharmacological interventions for opioid abuse in lactating women diagnosed with depressive disorders. Conclusions: The ensuing recommendations were as follows: Recommendation 1: Depressive and anxiety disorders, as well as their pharmacological treatment, are not contraindications for breastfeeding. Recommendation 2: The Panel advocates for the continuation of medication that has demonstrated efficacy during pregnancy. If initiating an antidepressant during breastfeeding is necessary, drugs with a superior safety profile and substantial epidemiological data, such as SSRIs, should be favored and prescribed at the lowest effective dose. Recommendation 3: For the short-term alleviation of anxiety symptoms and sleep disturbances, the Panel determined that benzodiazepines can be administered during breastfeeding. Recommendation 4: The Panel advises against discontinuing opioid abuse treatment during breastfeeding. Recommendation 5: The Panel endorses collaboration among specialists (e.g., psychiatrists, pediatricians, toxicologists), promoting multidisciplinary care whenever feasible. Coordination with the general practitioner is also recommended.

Rest-activity rhythm disruption and metabolic health in schizophrenia: a cross-sectional actigraphy study of community-dwelling people living with schizophrenia and nonpsychiatric comparison participants.

People living with schizophrenia (PLWS) have increased physical comorbidities and premature mortality which may be linked to dysregulated rest-activity rhythms (RARs). This study aimed to compare RARs between PLWS and nonpsychiatric comparison participants (NCs) and to examine the relationships of RARs with age, sleep, metabolic, and physical health outcomes and, among PLWS, relationships of RARs with illness-related factors. The study sample included 26 PLWS and 36 NCs, assessed with wrist-worn actigraphy to compute RAR variables and general sleep variables. Participants completed assessments for clinical symptoms, physical health, sleep quality, medication use, and assays for fasting glycosylated hemoglobin (hemoglobin A1c) levels. We examined group differences in RAR and sleep variables, relationships of RAR variables with metabolic and physical health measures, and, among PLWS, relationships between RAR variables and illness-related measures. PLWS had significantly shorter active periods, lower relative amplitude, and lower mean activity during their most active 10 hours compared to the NCs (Cohen's d = 0.79, 0.58, and 0.62, respectively). PLWS had poorer sleep quality, greater mean percent sleep, less wake after sleep onset, and higher total sleep time variability compared to NCs. PLWS had higher rates of antidepressant, anxiolytic, and antipsychotic medication use compared to NCs, which may have impacted sleep quality and objective sleep measures. Across both groups, more fragmented and variable RARs were associated with higher HbA1c levels (ηp2 = .10) and worse physical health (ηp2 = .21). Among PLWS, RARs were correlated with total sleep time (rs = .789, P < .01) and percent sleep (rs = .509, P < .05), but not with age, sleep quality, or other illness-related factors. RARs provide unique information about sleep and activity for PLWS and have the potential for targeted interventions to improve metabolic health and mortality. Mahmood Z, Ramsey A, Kidambi N, etal. Rest-activity rhythm disruption and metabolic health in schizophrenia: a cross-sectional actigraphy study of community-dwelling people living with schizophrenia and nonpsychiatric comparison participants. J Clin Sleep Med. 2024;20(9):1505-1516.