Classes Of Psychotropic Drugs Research Articles

Side effects associated with psychotropic medications in patients with bipolar disorder: evidence from two independent samples

Available evidence concerning the side effects experienced by bipolar disorder (BD) patients under naturalistic conditions has been poorly investigated. The aim of this study was therefore to investigate side effects related to major psychotropic drugs in two independent samples of BD patients naturalistically treated with mood stabilizers, antidepressants, antipsychotics and/or anxiolytics. Overall, 3654 patients from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) sample and 282 patients from the Clinical Outcome and Psycho-Education for Bipolar Disorder (COPE-BD) sample were included. The primary outcome measure was the influence of each class of psychotropic drugs under investigation on the emergence of any side effect, as measured with the monitoring form in the STEP-BD study and the Udvalg for Kliniske Undersøgelser Side Effect Rating Scale in the COPE-BD study. Secondary outcome measures included the effects of such drugs on psychic, neurologic, autonomic and other side effects. Mood stabilizers and antipsychotics were associated with high rates of side effects in both samples. Furthermore, antipsychotics were specifically associated with psychic side effects, whereas mood stabilizers were specifically associated with neurologic side effects. Our results largely confirm in a naturalistic setting results previously observed in randomized controlled trials focusing on BD patients.

The origins of molecular psychiatry.

The origins of molecular psychiatry.

Psychotropic drugs and risk of motor vehicle accidents: a population‐based case‐control study

To examine comprehensively the relationship between exposure to four classes of psychotropic drugs including antipsychotics, antidepressants, benzodiazepines (BZDs) and Z-drugs, and motor vehicle accidents (MVAs). The authors conducted a matched case-control study of 5183 subjects with MVAs and 31 093 matched controls, identified from the claims records of outpatient service visits during the period from 2000 to 2009. Inclusion criteria were defined as subjects aged equal to or more than 18 years and involved in MVAs. Conditional logistic regressions with covariates adjustment (including urbanity, psychiatric and non-psychiatric outpatient visits and Charlson comorbidity score) were applied to examine the effect of four classes of psychotropic drugs on MVAs. Significant increased risk of MVAs was found in subjects taking antidepressants within 1 month (adjusted odds ratio (AOR) 1.73, 95% confidence interval (CI) 1.34, 2.22), 1 week (AOR 1.71, 95% CI 1.29, 2.26), and 1 day (AOR 1.70, 95% CI 1.26, 2.29) before MVAs occurred. Similar results were observed in subjects taking benzodiazepines (BZDs) (AOR 1.56, 95% CI 1.38, 1.75 for 1 month; AOR 1.64, 95% CI 1.43, 1.88 for 1 week, and AOR 1.62, 95% CI 1.39, 1.88 for 1 day) and Z-drugs (AOR 1.42, 95% CI 1.14, 1.76 for 1 month, AOR 1.37, 95% CI 1.06, 1.75 for 1 week, AOR 1.34, 95% CI 1.03, 1.75 for 1 day), but not antipsychotics. Moreover, significant dose effects of antidepressants (equal to or more than 0.6-1.0 DDD), BZDs (equal to or more than 0.1-0.5 DDD) and Z-drugs (more than 1 DDD) were observed, respectively, on the risk of experiencing an MVA. Taken together, subjects taking antidepressants, BZDs and Z-drugs, separately, should be particularly cautioned for their increasing risk of MVAs.

Pharmacotherapy may be useful in the management of patients with volatile substance misuse

Volatile substance misuse (VSM) is an understudied yet prevalent form of substance abuse, particularly among adolescents and young adults from impoverished communities. Limited clinical evidence supports the use of various classes of psychotropic drugs that target some of the underlying neuropharmacological mechanisms of VSM to treat the condition.

Mechanisms of antidepressant resistance

Depression is one of the most frequent and severe mental disorder. Since the discovery of antidepressant (AD) properties of the imipramine and then after of other tricyclic compounds, several classes of psychotropic drugs have shown be effective in treating major depressive disorder (MDD). However, there is a wide range of variability in response to ADs that might lead to non response or partial response or in increased rate of relapse or recurrence. The mechanisms of response to AD therapy are poorly understood, and few biomarkers are available than can predict response to pharmacotherapy. Here, we will first review markers that can be used to predict response to pharmacotherapy, such as markers of drug metabolism or blood-brain barrier (BBB) function, the activity of specific brain areas or neurotransmitter systems, hormonal dysregulations or plasticity, and related molecular targets. We will describe both clinical and preclinical studies and describe factors that might affect the expression of these markers, including environmental or genetic factors and comorbidities. This information will permit us to suggest practical recommendations and innovative treatment strategies to improve therapeutic outcomes.

Pattern of prescription and drug use in psychiatry out patient department of private practitioners of Central India

Background: Psychotropic drugs have had a remarkable impact in psychiatric practice. The continuous monitoring of prescription and drug utilization studies may help to identify the problem involved in therapeutic decision and promote rational prescribing. Very few studies from India have evaluated the prescription pattern of Psychiatrists. P resent study was undertaken to analyze the prescription pattern and drug used in psychiatric Out Patients of private practitioners of Central India. Methods: One thousand prescriptions were collected by undergraduate students from chemist and analysed. Study parameter like demographic profile of patients viz. age, sex, diagnosis were recorded. Basic drug indicators, the prescribing pattern of antipsychotics and other categories of drugs were also recorded. The most common and, top brands of anti psychotics were analyzed .Inappropriate prescription if any were recorded and analyzed further. Result: The most common psychotropic drugs were anti-anxiety in 361(36.1%) and antidepressants 130 (13%) prescribed for various psychiatric disorder. Usage of Sedative Hypnotics 104(10.4%), anti-psychotics 90(9%) and anticonvulsants 80 (8%) drugs in prescriptions. The incidence of polypharmacy (22%) was common occurrence in prescriptions. The commonest combination prescribed was of tricyclic antidepressant with benzodiazepines. Central anti-cholinergic was commonly prescribed with anti psychotics. Conclusions: Anti-anxiety drug ( benzodiazepines) was the most frequently prescribed class of psychotropic drugs in various psychiatry disorders. The prescribing prevalence of Alprazolam with different brand names was more than that of other benzodiazepines. The combination of different psychotropic drugs were also prescribed.

Prevalence of Bipolar Disorder Diagnoses and Psychotropic Drug Therapy Among Privately Insured Children and Adolescents

To estimate the treated prevalence of bipolar disorder in a privately insured population, describe the characteristics of children and adolescents receiving these diagnoses, and describe patterns of their psychotropic drug therapy. Retrospective, repeated cross-sectional study. MarketScan Commercial Claims and Encounters inpatient, outpatient, and pharmacy claims databases. A total of 22,360 children and adolescents (aged 0-17yrs) with one inpatient or two or more outpatient claims for any bipolar spectrum disorder between January 1, 2005, and December 31, 2007. Annual cross-sections were used to estimate the treated prevalence of bipolar disorder diagnoses, patient characteristics, and psychotropic drugs used 30days after a child's latest recorded bipolar disorder diagnosis within each year. The annual treated prevalence of any bipolar spectrum disorder in this privately insured population was 0.24% in 2005 and 0.26% in 2006 and 2007. Approximately 25% of diagnoses were for children younger than 13years. Approximately 30% of children had coexisting attention-deficit-hyperactivity disorder during the year. In each year, 35% of patients used no psychotropic drug therapy in the 30-day period after their most recent diagnosis. Twenty-five percent used one psychotropic drug, and 40% used two or more drugs. The most common drug regimens were antipsychotic or mood stabilizer (lithium or anticonvulsant) monotherapy and the combination of mood stabilizers and antipsychotics. Drug therapy patterns suggest that children and adolescents with bipolar diagnoses receive complex treatment regimens, often involving multiple classes of psychotropic drugs. Research on treatment combinations, particularly antipsychotic and mood stabilizer combinations, should be prioritized to better understand the safety and effectiveness of commonly prescribed treatments.

Psychotropics and Methadone in Acquired Long QT Syndrome

There has long been a concern that all psychotropics may have adverse cardiac effects including prolongation of the QT interval. The recent expanded use of the atypical antipsychotics has increased these concerns. This is a selective review of the effect of the major classes of psychotropic drugs on the QT interval. The review also includes a review of methadone given the high co-morbidity between major psychiatric disorders and substance use disorders.

Use and cost of psychotropic drugs among recipients with autism in a state Medicaid fee‐for‐service programme

There has been a significant increase in the prevalence of autism in the USA in the past few decades. The purpose of this study was to provide recent estimates of psychotropic drug use and costs among individuals with autism enrolled in Medicaid programme. A cross-sectional analysis of 2007 Mississippi (MS) Medicaid fee-for-service (FFS) programme administrative-claims data was performed. Study sample included recipients (<65 years) who had a medical services claim with a diagnosis of autism in 2007. Psychotropic drug patterns of use and costs were studied. Factors predicting the use of psychotropic drugs were identified using logistic regression analyses. Average number and cost of psychotropic drug claims per recipient were reported. Costs were reported from the perspective of MS Medicaid. In 2007, there were 1330 recipients with a diagnosis of autism in MS Medicaid FFS programme. Among these recipients, 66.32% had a claim for psychotropic drug during the year. Roughly 39% of recipients with autism had a claim for antipsychotics, 31.58% for stimulants, 19.55% for antidepressants, 19.40% for other psychotropics and 14.81% for anxiolytics/hypnotics/sedatives. Results from regression analyses highlighted variation in psychotropic drug use by demographic and co-morbid factors. There were a total of 12,618 claims for psychotropic drugs filled by recipients with autism in 2007, at an average of 14 (±12) claims per recipient. The total cost of these claims paid for by MS Medicaid FFS programme was ∼$2 million. Antipsychotics accounted for more than half (∼58%) of the total costs, and had the highest average cost per claim ($291 ± 205). The results of this study indicate a high use of psychotropic drugs among individuals with autism enrolled in a state Medicaid programme. There is an urgent need to study the risk-benefit profile of these drugs in this growing population. Psychotropic drug use was found to vary by demographic and co-morbid factors. Among the different classes of psychotropic drugs, antipsychotics were the most commonly used and had the highest cost per claim.

Eating Disorders and Obesity

It is popularly stated that there is an ‘epidemic’ of obesity, with great concern because of the health problems associated with it. Different classes of psychotropic drugs have been used to decrease appetite and assist with weight loss whereas other psychotherapeutic agents produce weight gain, often significant, as a serious side effect. This month's thematic section contains five articles dealing with eating disorders and obesity. Two are reviews with one being part of the series “evidence-based pharmacotherapy of …” That review primarily covers short-term efficacy of drugs in various eating disorders …

A short update on the structure of drug binding sites on neurotransmitter transporters

BackgroundThe dopamine (DAT), noradrenalin (NET) and serotonin (SERT) transporters are molecular targets for different classes of psychotropic drugs. Cocaine and the SSRI (S)-citalopram block neurotransmitter reuptake competitively, but while cocaine is a non-selective reuptake inhibitor, (S)-citalopram is a selective SERT inhibitor.FindingsHere we present comparisons of the binding sites and the electrostatic potential surfaces (EPS) of DAT, NET and SERT homology models based on two different LeuTAa templates; with a substrate (leucine) in an occluded conformation (PDB id 2a65), and with an inhibitor (tryptophan) in an open-to-out conformation (PDB id 3f3a). In the occluded homology models, two conserved aromatic amino acids (tyrosine and phenylalanine) formed a gate between the putative binding pockets, and this contact was interrupted in the open to out conformation. The EPS of DAT and NET were generally negative in the vestibular area, whereas the EPS of the vestibular area of SERT was more neutral.ConclusionsThe findings presented here contribute as an update on the structure of the binding sites of DAT, NET and SERT. The updated models, which have larger ligand binding site areas than models based on other templates, may serve as improved tools for virtual ligand screening.

Effects of Stimulants and SSRIs on Brain Function in Children: Emerging Clues from fMRI studies

Free AccessEffects of Stimulants and SSRIs on Brain Function in Children: Emerging Clues from fMRI studiesMichael S. Gaffrey, Rivfka Shenoy and Joan L. LubyMichael S. GaffreySearch for more papers by this author, Rivfka ShenoySearch for more papers by this author and Joan L. Luby1 Department of Psychiatry, Washington University School of Medicine.2 Undergraduate student at Washington University.Address correspondence to Joan L. Luby, M.D., Professor of Psychiatry (Child); Director, Early Emotional Development Program; Washington University School of Medicine, 660 S. Euclid Box 8134, St. Louis, MO 63110. E-mail: [email protected]Search for more papers by this authorPublished Online::November 2011https://doi.org/10.1521/capn.2011.16.5.3PDFPDF PLUS ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations About Previous article Next article FiguresReferencesRelatedDetails Cited byCited by1. Visuomotor Activation of Inhibition-Processing in Pediatric Obsessive Compulsive Disorder: A Magnetoencephalography StudyOnline publication date: 29 April 2021. Go to citation Crossref Google Scholar Volume 16Issue 5Oct 2011 Information© 2011 Guilford Publications Inc.PDF download

Grau de conhecimento e consumo de psicofármacos dos alunos da Escola Superior de Tecnologia da Saúde de Coimbra

IntroductionThe purpose of this study was to analyse the degree of knowledge and use of psychotropic drugs among students of the College of Health Technology of Coimbra (ESTESC). The study lasted nine months and involved 417 ESTESC students. Material and methodsThe data collection, conducted between February and March 2009, consisted of a self-administered questionnaire. ResultsIt was found that 374 (89.7%) of the students had a positive knowledge about psychotropic drugs, of which 245 (65.5%) had sufficient knowledge and 129 (34.5%) a good knowledge. It was found that the good level of knowledge had the largest portion of individuals belonging to the Pharmacy course (68.3%) and those who had a high self-rating of knowledge (54.9%). In fact, 53 students (12.7%) had taken psychotropic drugs in the previous 6 months. DiscussionThe overall prevalence was higher in females (14.2%) in the course of pharmacy (25.0%) and those presenting a good level of knowledge (22.5%). The class of psychotropic drugs most commonly used was anxiolytics, with 23 registered drugs (47.9%). The prevalence of psychotropic drugs utilization can be considered high, taking into account the age of the individuals included in this study and their state of health.

The chromatographic identification of psychotropic drugs.

Abstract The thin-layer chromatography of three classes of psychotropic drugs—phenethylamines, tryptamines and erganes—has been investigated. Published methods are reviewed and Rf data, normalized by a graphical technique, are reported for extensions and modifications of some of these systems. Optimum forensic sorting procedures are recommended.

Transition in care in persons with antidepressant prescription in naturalistic conditions

Few studies have explored transition to psychiatric care in persons treated by antidepressants in primary care. To assess the rates of transition in care after a dispensing of antidepressant and the characteristics associated with transition from primary to psychiatric care. A follow-up study of persons (n = 19 975) starting antidepressant treatment was carried out on a representative sample of the 2005-07 French Social Security Insurance national database. Prescribers were categorized as GPs, hospital practitioners (as a proxy for public psychiatrist), private psychiatrists and other private specialists. Transition in care was defined as a prescription of psychotropic drugs by a prescriber belonging to a category different from that of the index antidepressant prescriber. Eighty per cent of incident antidepressant treatments were initiated by a GP and 28% of persons transited in care. The most frequent pattern was transition from a GP to a hospital practitioner (8%) or to a private psychiatrist (5%). Transition to psychiatric care was independently associated with younger age and markers of illness severity (psychiatric chronic illness status, duration of the index antidepressant treatment >6 months and prescription of other classes of psychotropic drugs). Almost all treatments with antipsychotics or mood stabilizers were initiated after the transition to a specialist. Transition to psychiatric care seemed coherent with distribution of tasks between primary and secondary care according to illness severity. Further studies using detailed clinical information are required to assess not only the clinical appropriateness of psychiatric referral but also lack of referral in antidepressant users.

Prevalence, Cumulative Incidence, Monotherapy and Combination Therapy, and Treatment Duration of Frequently Prescribed Psychoactive Medications in the Netherlands: Retrospective Database Analysis for the Years 2000 to 2005

Background Psychoactive drugs have been reported to impair daily activities (eg, driving), but data regarding the use of such drugs in the Netherlands are lacking. Objective The aim of this work was to examine the prevalence, cumulative incidence, use of monotherapy and combination therapy, and treatment duration of frequently prescribed psychoactive drug classes in the Netherlands. Methods Data for the years 2000 through 2005 were derived from IADB.nl, a database with pharmacy dispensing data from a population of ∼500,000 people in the northern region of the Netherlands. The following prescription psychotropic drug classes were considered: antidepressants (as a total group and the 2 subgroups of nonselective monoamine reuptake inhibitors and selective serotonin reuptake inhibitors), antipsychotics, anxiolytics, and hypnotics and sedatives. Patients aged 18 to 89 years who received ≥1 prescription for a psychoactive medication of interest were selected, and prevalence and cumulative incidence were calculated per 1000 patients per year. The treatment duration was analyzed by means of Kaplan-Meier survival analysis. Age, sex, and drug class stratifications were performed. Results There was a slight increase in the prevalence of antipsychotics (final median [95% CI] prevalence in 2000 vs 2005: 16.9 [16.5–17.3] vs 18.7 [18.3–19.1]) and antidepressants (60.4 [59.7–61.2] vs 67.1 [66.4–67.9]), with selective serotonin reuptake inhibitors being the most frequently prescribed drugs in these classes (35.2 [34.6–35.7] vs 37.5 [36.9–38.1] in 2000 and 2005, respectively). At the same time, there was a slight decrease in the prevalence of anxiolytics (95.1 [94.2–96.0] vs 83.2 [82.3–84.0]), hypnotics and sedatives (68.1 [67.3–68.9] vs 60.9 [60.1–61.6]), and nonselective monoamine reuptake inhibitors (20.3 [19.8–20.7] vs 19.2 [18.8–19.7]). The data also suggested that women had more prescriptions for the psychoactive medications of interest than did men, although these observations were not assessed for statistical significance. The only increase from 2000 to 2005 in median (95% CI) incidence per 1000 people in prescriptions was for antipsychotics (4.1 [3.9–4.3] vs 4.9 [4.6–5.0]); a decrease was noted in the incidence of antidepressants (18.6 [18.2–19.1] vs 16.2 [15.8–16.6]), nonselective monoamine reuptake inhibitors (7.1 [6.9–7.4] vs 6.8 [6.6–7.1]), selective serotonin reuptake inhibitors (12.0 [11.6–12.3] vs 8.6 [8.3–8.9]), anxiolytics (34.6 [34.1–35.2] vs 30.2 [29.7–30.7]), and hypnotics and sedatives (21.2 [20.8–21.7] vs 18.4 [18.0–18.9]). Combination therapy was most common among those aged 30 to 44 years (6.5%) and those aged 45 to 59 years (6.1%). The longest median (95% CI) treatment duration was noted for antipsychotic use (1781.8 days [1755.2–1808.4]); the shortest was observed for anxiolytic use (617.4 days [608.9–625.9]). Conclusions From 2000 to 2005 in the Netherlands, the yearly prevalence and cumulative incidence of prescriptions for psychoactive drugs were relatively stable, although there were some changes within specific drug classes. Monotherapy was more prevalent than combination therapy. Antipsychotics had the longest median duration of use; anxiolytics had the shortest duration.

Mental Disorders and Service Use Among Welfare and Disability Program Participants in Fee-for-Service Medicaid

Mental Disorders and Service Use Among Welfare and Disability Program Participants in Fee-for-Service Medicaid

Anticoagulation and Psychotropic Medications

Anticoagulants and psychotropic medications are commonly prescribed together. Thus, the potential for interaction exists. Whereas thrombolytics and heparins are implicated in few pharmacokinetic interactions, warfarin and platelet inhibitors have been implicated in various interactions with psychotropic medications. In this article, I review the various psychotropic drug classes' relationships to anticoagulants. In a field devoid of randomized, placebo-controlled trials, clinical vigilance is advised when managing patients on concomitant therapy.

Antidepressants, but not antipsychotics, modulate GR function in human whole blood: An insight into molecular mechanisms

Clinical studies have demonstrated an impairment of glucocorticoid receptor (GR)-mediated negative feedback on the hypothalamic-pituitary-adrenal (HPA) axis in patients with major depression (GR resistance), and its resolution by antidepressant treatment. Recently, we showed that this impairment is indeed due to a dysfunction of GR in depressed patients (Carvalho et al., 2009), and that the ability of the antidepressant clomipramine to decrease GR function in peripheral blood cells is impaired in patients with major depression who are clinically resistant to treatment (Carvalho et al. 2008). To further investigate the effect of antidepressants on GR function in humans, we have compared the effect of the antidepressants clomipramine, amytriptiline, sertraline, paroxetine and venlafaxine, and of the antipsychotics, haloperidol and risperidone, on GR function in peripheral blood cells from healthy volunteers (n=33). GR function was measured by glucocorticoid inhibition of lypopolysaccharide (LPS)-stimulated interleukin-6 (IL-6) levels. Compared to vehicle-treated cells, all antidepressants inhibited dexamethasone (DEX, 10-100nM) inhibition of LPS-stimulated IL-6 levels (p values ranging from 0.007 to 0.1). This effect was specific to antidepressants, as antipsychotics had no effect on DEX-inhibition of LPS-stimulated IL-6 levels. The phosphodiesterase (PDE) type 4 inhibitor, rolipram, potentiated the effect of antidepressants on GR function, while the GR antagonist, RU-486, inhibited the effect of antidepressants on GR function. These findings indicate that the effect of antidepressants on GR function are specific for this class of psychotropic drugs, and involve second messenger pathways relevant to GR function and inflammation. Furthermore, it also points towards a possible mechanism by which one maybe able to overcome treatment-resistant depression. Research in this field will lead to new insights into the pathophysiology and treatment of affective disorders.

Expression of sigma receptor 1 mRNA and protein in rat retina

Sigma receptor (σR), known as a unique nonopiate, nonphencyclidine brain receptor, can bind diverse classes of psychotropic drugs, neurosteroids and other synthetic compounds, such as (+)pentazocine, etc. Two types of σRs have been identified: σR1 and σR2. In this work, we examined the expression of σR1 in rat retina by reverse transcription-polymerase chain reactive (RT-PCR) analysis and immunofluorescence double labeling. RT-PCR analysis showed that σR1 mRNA was present in rat retina. Furthermore, labeling for σR1 was diffusely distributed in the outer and inner plexiform layers. The σR1-immunoreactivity (IR) was also observed in many cells in the inner nuclear layer and the ganglion cell layer. In the outer retina σR1 was expressed in all horizontal cells labeled by calbindin. In contrast, no σR1-IR was detected in several subtypes of bipolar cells, including rod-dominant ON-type bipolar cells, types 2, 3, 5 and 8 bipolar cells, labeled by protein kinase C (PKC), recoverin and hyperpolarization-activated cyclic nucleotide-gated potassium channel 4 (HCN4) respectively. In the inner retina, most of GABAergic amacrine cells, including dopaminergic and cholinergic ones, stained by tyrosine hydroxylase (TH) and choline acetyltransferase (ChAT) respectively, expressed σR1. Some glycinergic amacrine cells were also labeled by σR1, but glycinergic AII amacrine cells were not labeled. In addition, σR1-IR was seen in almost all somata of the ganglion cells retrogradely labeled by fluorogold. These results suggest that σR1 may have neuromodulatory and neuroprotective roles in the retina.