Classes Of Psychotropic Medications Research Articles

Increased Risk Among Older Veterans of Prescribing Psychotropic Medication in the Absence of Psychiatric Diagnoses

This study uses Veterans Health Administration (VHA) pharmacy and encounter claims to evaluate the use of psychotropic medications without a psychiatric diagnosis across age groups. National VHA administrative data for fiscal year 2010 (FY2010) were used to identify all veterans who filled a prescription for at least one psychotropic medication from VHA (N = 1.85 million). Bivariate and multivariate analyses were used to compare the proportion of these veterans without any psychiatric diagnosis, across age groups, adjusting for possible medical indications. Analyses were repeated for six different classes of psychotropic medications and comparing mental health utilizers and non-mental health utilizers. Comparisons were made to prescribing of HIV and diabetes medications without an indicated diagnosis. Of all VHA patients prescribed a psychotropic medication in FY2010, 30% had no psychiatric diagnosis, with highest proportions among veterans ages 65-85. This practice was most frequent among nonmental health utilizers and far more prevalent for psychotropic medications than for HIV or diabetes medications. Logistic regression analysis found that age greater than 65 was the strongest predictor of being prescribed a psychotropic without a psychiatric diagnosis. Adjustment for possible medical use of psychotropics and overall medical comorbidity did not substantially alter these trends. Older veterans, especially those not using specialty mental healthcare, are more likely to be prescribed psychotropic medications in the absence of a psychiatric diagnosis, perhaps representing unnecessary use, under-diagnosis of mental illness, or incomplete documentation.

Psychotropic medication use among children with autism spectrum disorders within the Simons Simplex Collection: Are core features of autism spectrum disorder related?

Psychotropic medication use and its relationship to autism spectrum core features were examined in a well-characterized but nonstratified North American sample (N = 1605) of children/adolescents diagnosed with autism spectrum disorders utilizing the Autism Diagnostic Observation Schedule and the Autism Diagnostic Interview-Revised, from the multisite Simons Simplex Collection. Analyses included (a) prevalence of psychotropic use (overall, and by classes), (b) correlations between prevalence of use and autism spectrum core features, age, and cognitive functioning, and (c) logistic regression to identify whether these factors were predictive of psychotropic use. Results indicated 41.7% ever used one or more classes of psychotropic medications, with attention deficit hyperactivity disorder medications used most. Small but significant correlations between psychotropic medication use and (a) social impairment (p < .001) and (b) repetitive behaviors (p < .001) were found. Overall, however, autism spectrum disorder core features are weakly related to medication use. Older children used more psychotropics (p < .001), and higher cognitive functioning was associated with less overall psychotropic use (p < .001). Logistic regression indicated that use of psychotropics was predicted by repetitive behaviors (both clinician-observed and parent-reported), age, and cognitive ability level. Limitations inherent to the Simons Simplex Collection sample, methodology, and the correlational analyses are discussed. Directions for future research include investigation of factors more influential than core symptoms on psychotropic treatment (e.g. parent perceptions, comorbid symptoms).

The Association of Age and Clinical Factors in Psychotropic Prescribing Nationwide

The Association of Age and Clinical Factors in Psychotropic Prescribing Nationwide

Medication Use in US Youth With Mental Disorders

To evaluate the prevalence, demographic and clinical correlates, and specificity of classes of psychotropic medications indicated for mental disorders. Cross-sectional survey. Direct household interviews of combined household and school samples representative of the general population of adolescents in the United States. Ten thousand one hundred twenty-three adolescents aged 13 to 18 years who participated in the National Comorbidity Survey Adolescent Supplement. Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) (DSM-IV) mental disorders and neurodevelopmental disorders. Psychotropic medication use in the past 12 months. Among youth with any DSM-IV mental disorder, 14.2% reported that they had been treated with a psychotropic medication in the past 12 months. Strong associations emerged between specific disorders and classes of medications with evidence for efficacy. Antidepressants were most frequently used among those with primary mood disorders (14.1%); stimulant use was most common among those with attention-deficit/hyperactivity disorder (20.4%); and antipsychotic use was infrequent and mostly seen among those with serious developmental disorders. Less than 2.5% of adolescents without a 12-month mental disorder had been prescribed psychotropic medications, and most had evidence of psychological distress or impairment reflected in a previous mental disorder, subthreshold condition, or developmental disorder. Appropriate medication use was significantly more frequent among those in treatment in the mental health specialty sector than general medicine or other settings. These findings challenge recent concerns over widespread overmedication and misuse of psychotropic medications in US youth. In fact, these data highlight the need for greater recognition and appropriate treatment of youth with mental health disorders.

Psychotropic medications, including short acting benzodiazepines, strongly increase the frequency of falls in elderly

ObjectivesFalls in the elderly are common and often serious. The aim of this study was to examine the association between the use of different classes of psychotropic medications, especially short acting benzodiazepines, and the frequency of falling in elderly.Study design This retrospective cohort study was performed with patients who visited the day clinic of the department of geriatric medicine of the University Medical Center Utrecht in the Netherlands between 1 January 2011 and 1 April 2012.Measurements Frequencies of falling in the past year and medication use were recorded. Logistic regression analysis was performed to assess the relationship between the frequency of falling in the past year and the use of psychotropic medications. ResultsDuring this period 404 patients were included and 238 (58.9%) of them had experienced one or more falls in the past year. After multivariate adjustment, frequent falls remained significantly associated with exposure to psychotropic medications (odds ratio [OR] 1.96; 95% confidence interval [CI] 1.17–3.28), antipsychotics (OR 3.62; 95% CI 1.27–10.33), hypnotics and anxiolytics (OR 1.81; 95% CI 1.05–3.11), short-acting benzodiazepines or Z-drugs (OR 1.94; 95% CI 1.10–3.42) and antidepressants (OR 2.35; 95% CI 1.33–4.16). ConclusionsThis study confirms that taking psychotropic medication, including short-acting benzodiazepines, strongly increases the frequency of falls in elderly. This relation should be explicitly recognized by doctors prescribing for older people, and by older people themselves. If possible such medication should be avoided for elderly patients especially with other risk factors for falling.

Quetiapine associated dyslipidemia and hyperglycemia in a pediatric overweight patient

Introduction: Atypical antipsychotics like quetiapine, can cause undesirable alterations in lipid profile and hyperglycemia. They are associated with metabolic and cardiovascular­ related adverse events in pediatric population, especially when multiple antipsychotics or classes of psychotropic medications are co­ prescribed. Case Report: A 15­year­old, overweight, Hispanic male child was referred to the endocrinology clinic by his primary care provider due to high serum cholesterol, triglyceride and glucose levels. Past history was significant for autism, anxiety with depression and attention deficit disorder for which he was getting psychiatric care and was receiving quetiapine 50 mg daily for more than two years. Physical examination was significant for increased adiposity and overweight. Fasting laboratory studies showed elevated cholesterol and triglycerides. In addition to lifestyle modification including diet and exercise, quetiapine was discontinued and replaced by aripiprazole. Repeat testing after four months showed normalized cholesterol and triglyceride levels. Conclusion: The use of atypical antipsychotics prescribed to children and adolescents with neuropsychiatric disorders has been associated with various adverse effects, including significant weight gain. These adverse effects are of particular concern in children and adolescents due to the immediate and long term health risks associated with weight gain, including obesity, diabetes mellitus and hyperlipidemia.

Trends in the utilisation of psychotropic medications in Australia from 2000 to 2011

This study examined longitudinal trends in the dispensing of psychotropic medications in Australia from January 2000 to December 2011. Dispensing data for the major classes of psychotropic medications (antidepressants, anxiolytics, sedatives, antipsychotics, mood stabilisers and attention-deficit hyperactivity disorder (ADHD) medications) were obtained from the Drug Utilisation Sub-Committee of the Australian Department of Health and Ageing. Results were expressed in terms of defined daily doses/1000 population/day (DDDs/1000/day). There was a 58.2% increase in the dispensing of psychotropic drugs in Australia from 2000 to 2011, driven by major increases in antidepressants (95.3% increase in DDDs/1000/day), atypical antipsychotics (217.7% increase) and ADHD medications (72.9% increase). Dispensing of anxiolytics remained largely unchanged, while sedatives and typical antipsychotics decreased by 26.4% and 61.2%, respectively. Lithium dispensing remained static while valproate and lamotrigine increased markedly. In 2011, antidepressants accounted for 66.9% of total psychotropic DDDs/1000/day totals, far greater than anxiolytics (11.4%), antipsychotics (7.3%), mood stabilisers (5.8%), sedatives (5.5%), or ADHD medications (3.0%). Sertraline, olanzapine, valproate and methylphenidate were the most frequently dispensed antidepressant, antipsychotic, mood stabiliser and ADHD medication, respectively, while diazepam and temazepam were the most commonly dispensed anxiolytic and sedative. Psychotropic utilisation markedly increased in Australia between 2000 and 2011. Some potential concerns include: (1) the continuing high use of benzodiazepines, particularly alprazolam, despite their problematic effects; (2) the rapid increase in serotonin noradrenaline reuptake inhibitor (SNRI) use, given their more complex side-effect profile relative to selective serotonin reuptake inhibitors (SSRIs); and (3) the dramatic increase in antidepressant prescriptions despite questions about the efficacy of these drugs in mild to moderate depression. Finally, some limitations are identified regarding use of the DDDs/1000/day metric, which can distort estimates of utilisation of specific drugs when the defined daily dose is higher or lower than the formulation most commonly dispensed by pharmacies.

Brains, Bones, and Aging: Psychotropic Medications and Bone Health Among Older Adults

Psychotropic drugs are a crucial element of treatment for psychiatric disorders; however there is an established association between many classes of psychotropic medications and fracture risk among older adults, and growing evidence that some classes of medications may also impact bone mineral density (BMD). In this paper we review recent epidemiologic research on the association between psychotropic medications and osteoporosis, and discuss current controversies and unresolved issues surrounding this relationship. Key areas in need of focused inquiry include resolving whether the apparent association between psychotropic medications and BMD is due to confounding by indication, whether this relationship differs for men and women, and whether the implications of these medications for bone health vary over the life course. Clinical research to delineate the risk/benefit ratio of psychotropic medications for older adults, particularly those who are at high risk for fracture, is also needed to facilitate prescribing decisions between patients and physicians.

O3‐10‐05: Prevalence of mild cognitive impairment and its etiological subtypes in rural and urban populations in China

(NPI-Q) total score. We modeled medication use and then used the resulting propensity scores to match individuals with PI>1⁄4.3 to those never exposed (PI1⁄40) on a 1:1 basis. Associations between medication use and outcomes were estimated with random-effects models controlling for baseline age, sex, education, and use of anti-dementia medications. Results: 4457 participants with AD had at least one follow up visit. Mean (SD) age at baseline was 75.9(9.4), 14.3(3.8) years education, and 2081(57.1%) were male. Mean (SD) MMSE was 21.1(6.4), CDR-Sum 5.8(4.2), and NPI-Q Total 4.2(4.4). The mean (median) duration of follow up was 2.2 (2.08) years. Use of all psychotropic medication classes was associated with more rapid rate of increase in CDR-Sum and with more rapid rate of decrease in MMSE. High PI for SSRIs antipsychotics, and atypical antipsychotics was associated with more rapid rate of increase in NPI-Q Total. Conclusions: The use of PS matching allowed us to control for clinical variables and confounding by indication thus providing a stronger level of inference than prior studies. Thus, psychotropic medication use may be associated with poorer AD outcomes and merit further study, ideally in randomized controlled trials.

Interstate variation in trends of psychotropic medication use among Medicaid-enrolled children in foster care

High rates of treating children in foster care with second-generation antipsychotics, both singly and in combination with other psychotropics, have focused public interest on the use of these medications, and motivated some states to implement programs to curtail usage. To estimate any antipsychotic use and psychotropic polypharmacy among children in foster care during the last decade and to characterize interstate variation in these trends. Centers for Medicare and Medicaid Services Medicaid Analytic Extract data files for 47 states and the District of Columbia for years 2002–2007. The study sample included an average of 686,080 children annually aged 3–18 years of age with foster care Medicaid eligibility. Repeated cross-sectional design conducted with multilevel logistic regression, clustered at the state level and controlling for patient demographics. Main outcome measures were rates of filled prescriptions for any antipsychotic medication and for psychotropic polypharmacy (defined as concurrent use of 3 or more psychotropic medication classes for at least 30 days during the year). State-level rate trajectories over time were classified as increased (≥ 5% relative increase over interval), decreased (≥ 5% relative decrease over the interval), or stable. The rate of any antipsychotic use increased from 8.9% in 2002 to 11.8% in 2007 (P < .001 for temporal trend). In contrast, the rate of psychotropic polypharmacy was 5.2% in 2002, peaked in 2004 at 5.9%, and fell to 5.3% in 2007 (P < .001 for trend). State-specific rates of any antipsychotic use were significantly increased in 45 states over the period, while rates of psychotropic polypharmacy increased in only 18 states and declined in 19. Although absolute rates of any antipsychotic use and psychotropic polypharmacy among children in foster care remained high, psychotropic polypharmacy began to abate during the last decade, as rates of antipsychotic use continued to rise. ► We describe national trends in psychotropic medication use in youth in foster care. ► We examine interstate variation in antipsychotic use and polypharmacy trends. ► In aggregate, rates of antipsychotic use increased, while polypharmacy declined. ► We found notable interstate variation in medication trends for foster care youth.

Risperidone in the Treatment of Corticosteroid-Induced Mood Disorders, Manic/Mixed Episodes, in Systemic Lupus Erythematosus: A Case Series

Corticosteroid therapy is frequently associated with adverse psychiatric effects, including dysregulated mood psychosis and delirium. Recent reports have shown that the effects of short-term, high-dose corticosteroid therapy appear to be primarily associated with manic rather than depressive or psychotic symptoms, or delirium, while depressive symptoms may be more common and severe than manic symptoms during long-term corticosteroid therapy at relatively low dosages. Management includes tapering corticosteroids, with or without the addition of medications to treat acute psychiatric symptoms. Use of adjunctive psychotropic medications may be necessary, particularly if corticosteroids cannot be tapered or discontinued. However, little information is available on the treatment of corticosteroid-induced mood disorders (CIMDs). One controlled study suggested lithium therapy may prevent CIMDs. None of the 27 patients given open-label lithium developed CIMDs while receiving corticosteroids, whereas 6 (14%) of 44 retrospectively reviewed patients not receiving lithium developed CIMDs. One open-label trial on olanzapine has been conducted in 12 patients with multiple medical diagnoses. In several case reports/series, various classes of psychotropic medications, including second-generation antipsychotics (SGAs), e.g., olanzapine, risperidone, and quetiapine, have been successfully used to treat CIMDs, mainly for manic symptoms. Mood stabilizers, e.g., lithium, valproate, and carbamazepine, have also been used to treat CIMDs. Overall, these reports have had methodical limitations that complicate the assessment of the effects of psychotropic medications, namely multiple medical diagnoses, as well as the parallel effects of tapering the corticosteroids dosage during the study because of CIMDs dose-

Psychotropic Drug-Induced Falls in Older People

Falls are a common health problem for older people, and psychotropic medications have been identified as an important independent fall risk factor. The objective of this paper was to review the literature relating to the effect of psychotropic medications on falls in older people, with a particular focus on evidence supporting minimization of their use to reduce risk of falls. A literature search identified 18 randomized trials meeting the inclusion criteria for the review of effectiveness of psychotropic medication withdrawal studies, including four with falls outcomes. One of these, which targeted reduced psychotropic medication use in the community, reported a 66% reduction in falls, while the other studies demonstrated some success in reducing psychotropic medication use but with mixed effects on falls. Other randomized trials evaluated various approaches to reducing psychotropic medications generally or specific classes of psychotropic medications (e.g. benzodiazepines), but did not report fall-related outcomes. Overall, these studies reported moderate success in reducing psychotropic medication use, and a number reported no or limited worsening of key outcomes such as sleep quality or behavioural difficulties associated with withdrawal of psychotropic medication use. Reduced prescription of psychotropic medications (e.g. seeking non-pharmacological alternatives to their use in place of prescription in the first place or, for those patients for whom these medications are deemed necessary, regular monitoring and efforts to cease use or wean off use over time) needs to be a strong focus in clinical practice for three reasons. Firstly, psychotropic medications are commonly prescribed for older people, both in the community and especially in the residential care setting, and their effectiveness in a number of clinical groups has been questioned. Secondly, there is strong evidence of an association between substantially increased risk of falls and use of a number of psychotropic medications, including benzodiazepines (particularly, the long-acting agents), antidepressants and antipsychotic drugs. Finally, the largest effect of any randomized trial of falls prevention to date was achieved with a single intervention consisting of weaning psychotropic drug users off their medications.

Prevalence of Psychotropic Medication Use among German and Austrian Nursing Home Residents: A Comparison of 3 Cohorts

Despite increasing knowledge about the limited effectiveness and severe adverse effects, the prescription rate of psychotropic medications in frail elderly persons remains high. Prescriptions are mainly made to control behavioral and psychological symptoms of dementia, although factors associated with prescriptions are rarely reported. However, such information is a prerequisite to develop intervention programs aiming to safely reduce psychotropic medication in nursing home residents. We report the comparison of cross-sectional data of psychotropic medication prescription rates from 3 large studies including nursing home residents in Germany and Austria. We aimed to compare the prevalence of (1) psychotropic medication, (2) different classes of psychotropic medication, (3) psychotropic medication administered for bedtime use, and (4) associations between prescription of psychotropics and institutional and residents' characteristics. Confidence intervals of prevalences and multiple logistic regression analyses were adjusted for cluster correlation. Data from 5336 residents in 136 long term care facilities were included. In Austria, 74.6% (95% CI 72.0-77.2%) of all residents had a prescription of at least one psychotropic medication compared to Germany with about 51.8% (95% CI 48.3-55.2%) and 52.4% (95% CI 48.7-56.1%). Of all antipsychotics, 66% (Austria) and 47% (Germany) were prescribed for bedtime use. Most prescriptions were conventional, low-potency antipsychotics. In all 3 studies, there was no statistically significant association between psychotropic medication prescription and nursing home characteristics. On the level of residents, consistent positive associations were found for higher level of care dependency and permanent restlessness. Consistent negative associations were found for older age and male gender. Frequency of psychotropic and especially antipsychotic medication is substantial in nursing home residents in Germany and Austria. The high number of prescriptions is likely to be an indicator for a perceived or actual lack of strategies to handle behavioral and psychological symptoms of dementia.

Limitations of Retrospective Research

Back to table of contents Previous article Next article Communications and UpdatesFull AccessLimitations of Retrospective ResearchPaulo R. Correa, M.D.Paulo R. CorreaBristol, Conn.Search for more papers by this author, M.D.Published Online:1 Apr 2011https://doi.org/10.1176/appi.ajp.2011.10111681AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: There are several issues with the article by Tami L. Mark and colleagues (1) published in the October 2010 issue of the Journal that deserve attention. The first issue is that of validity. The statistical analyses performed do not solve the concerns with the validity of the fundamental question in this paper: Does it make clinical sense that the branded antidepressant medications available between 2003 and 2006 would outperform the generic antidepressants in effectiveness? Or, even if that argument was valid for that period of time, does it make clinical sense that the currently available branded medications would be able to outperform the currently available generic antidepressants in effectiveness, to the point of affecting outcomes?The article has other limitations. The most concerning is the significant difference in baseline characteristics between the two groups. The group who received step therapy had a lower average income, higher levels of comorbidity, and a higher burden of chronic illness, indicating that the group that received step therapy might have been at higher risk for worse outcomes and higher utilization. Although the study used statistical models to adjust for the differences between the two groups, it is likely that baseline differences in the two groups explain the difference in outcomes. The currently available models for risk adjustment in psychiatry perform poorly and usually do not explain more than one-third of the variance (2).Another piece of information missing is the baseline utilization of the two groups prior to the implementation of step therapy. Prior year expenditures have been shown to outperform any other risk-adjustment model when analyzing utilization and expenditure (3, 4). It would be important to know if the group in which step therapy was implemented already had higher levels of utilization.The article did not consider the complexity of the treatment of depression, including the use of polypharmacy. Patients treated for depression commonly receive prescriptions for several other psychotropic medications (5). Any attempt to understand the effects of change in pharmacy benefits, including step therapy, should include a broader analysis of all classes of psychotropic medications, especially antipsychotics, which have been increasingly used in combination with antidepressants.Hopefully, the issues raised above will help readers better understand the complexity of this kind of study.Bristol, Conn.Dr. Correa reports no financial relationships with commercial interests.Accepted for publication in January 2011.

Risk of death and hospital admission for major medical events after initiation of psychotropic medications in older adults admitted to nursing homes

Despite safety-related concerns, psychotropic medications are frequently prescribed to manage behavioural symptoms in older adults, particularly those with dementia. We assessed the comparative safety of different classes of psychotropic medications used in nursing home residents. We identified a cohort of patients who were aged 65 years or older and had initiated treatment with psychotropics after admission to a nursing home in British Columbia between 1996 and 2006. We used proportional hazards models to compare rates of death and rates of hospital admissions for medical events within 180 days after treatment initiation. We used propensity-score adjustments to control for confounders. Of 10,900 patients admitted to nursing homes, atypical antipsychotics were initiated by 1942, conventional antipsychotics by 1902, antidepressants by 2169 and benzodiazepines by 4887. Compared with users of atypical antipsychotics, users of conventional antipsychotics and antidepressants had an increased risk of death (rate ratio [RR] 1.47, 95% confidence interval [CI] 1.14-1.91 for conventional antipsychotics and RR 1.20, 95% CI 0.96-1.50 for antidepressants), and an increased risk of femur fracture (RR 1.61, 95% CI 1.03-2.51 for conventional antipsychotics and RR 1.29, 95% CI 0.86-1.94 for antidepressants). Users of benzodiazepines had a higher risk of death (RR 1.28, 95% CI 1.04-1.58) compared with users of atypical antipsychotics. The RR for heart failure was 1.54 (95% CI 0.89-2.67), and for pneumonia it was 0.85 (95% CI 0.56-1.31). Among older patients admitted to nursing homes, the risks of death and femur fracture associated with conventional antipsychotics, antidepressants and benzodiazepines are comparable to or greater than the risks associated with atypical antipsychotics. Clinicians should weigh these risks against the potential benefits when making prescribing decisions.

Does managed care affect the diffusion of psychotropic medications?

Newer technologies to treat many mental illnesses have shown substantial heterogeneity in diffusion rates across states. In this paper, I investigate whether variation in the level of managed care penetration is associated with changes in state-level diffusion of three newer classes of psychotropic medications in fee-for-service Medicaid programs from 1991 to 2005. Three different types of managed care programs are examined: capitated managed care, any type of managed care and behavioral health carve-outs. A fourth-order polynomial fixed effect regression model is used to model the diffusion path of newer antidepressant and antipsychotic medications controlling for time-varying state characteristics. Substantial differences are found in the diffusion paths by the degree of managed care use in each state Medicaid program. The largest effect is seen through spillover effects of capitated managed care programs; states with greater capitated managed care have greater initial shares of newer psychotropic medications. The influence of carve-outs and of all types of managed care combined on the diffusion path was modest.

Prescribing psychotropic medication for problem behaviours in adults with intellectual disabilities in a specialist psychiatric unit in Hong Kong

Psychotropic medications are often used to treat problem behaviours in people with intellectual disability which not only occur frequently but also tend to persist over time. This study examined the pattern of prescription of such medications to manage problem behaviours for adults with intellectual disabilities in a specialist psychiatric unit in Hong Kong. Individuals aged 18 or above with problem behaviours and receiving psychotropic medication for treatment in hospital, outpatient and community settings were studied. Their demographic and clinical information was collected. The type and dosage of medications were retrieved from the computer database and analysed. Those with psychotic disorder and mood (affective disorder) were excluded. After screening, 236 patients met the inclusion criteria. People with moderate intellectual disability accounted for most of the cohort (46%). Autism spectrum disorder was the commonest psychiatric diagnosis (35%) and aggression the commonest problem behaviour (52%). Antipsychotics, mood stabilisers and antidepressants were prescribed to 96%, 20% and 13% of the subjects respectively. The profile of problem behaviour in the Chinese population with intellectual disability is consistent with the findings reported in the world literature. Antipsychotic drugs are the most commonly prescribed class of psychotropic medication used to treat such behaviours. Although the current evidence is not strong enough to support a clear‐cut recommendation on the use of medications, the dichotomous notion of ‘prescription’ or ‘no prescription’ for problem behaviours may be simplistic.

The Pharmacologic Treatment of Anxiety Disorders

Anxiety disorders, as a group, are among the most common mental health conditions and frequently cause significant functional impairment. Both psychotherapeutic and pharmacologic techniques are recognized to be effective management strategies. This review provides a discussion of the major classes of psychotropic medications investigated in clinical trials of the following anxiety disorders: panic disorder, social anxiety disorder, generalized anxiety disorder, posttraumatic stress disorder, and obsessive-compulsive disorder. Findings suggest that both selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors are useful first-line agents for most of the anxiety disorders, particularly given the frequent comorbidity with mood disorders. Highly serotonergic agents are preferred for obsessive-compulsive disorder. Other antidepressants, such as tricyclic antidepressants or monoamine oxidase inhibitors, are generally reserved as second- and third-line strategies due to tolerability issues. Evidence for other agents, including anticonvulsants and atypical antipsychotics, suggests that they may have an adjunctive role to antidepressants in cases of treatment resistance, while azapirones have been used effectively for generalized anxiety disorder, and a substantial body of evidence supports benzodiazepine use in panic disorder and generalized anxiety disorder. Despite notable advances, many patients with anxiety disorders fail to adequately respond to existing pharmacologic treatments. Increased research attention should be focused on systematizing pharmacologic and combined pharmacologic-psychosocial strategies to address treatment resistance and developing novel treatments for anxiety disorders.

An Examination of Psychotropic Medication Side Effects: Does taking a greater number of psychotropic medications from different classes affect presentation of side effects in adults with ID?

This study examined whether the number of psychotropic medications an individual is taking across classes influences side effects among adults with Intellectual Disability (ID). Participants were 80 adults diagnosed with ID. Dependent variables were the composite score and domain scores of the Matson Evaluation of Drug Side-effects (MEDS), which is an instrument used to assess side effects. There were three levels of the independent variable: Group 1 – those taking zero psychotropic medications, Group 2 – those taking one psychotropic medication, and Group 3 – those taking two psychotropic medications across different medication classes. There was a significant main effect regarding number of psychotropic medication classes prescribed. Further analysis revealed that four of the nine MEDS domains had significantly different mean scores for number of psychotropic medication classes. For the majority of MEDS domains, such as Central Nervous System-General, Parkinsonism/Dyskinesia, and Behavioral/Akathesia domains, participants in the no psychotropic medication group had significantly lower mean scores than those in the one and two psychotropic medication groups. Only two MEDS domains, Cardiovascular and Hematologic Effects as well as Skin, Allergies, and Temperature, were significantly different between participants taking one psychotropic medication as compared with two psychotropic medications from different classes. Implications of these findings and recommendations for future research are discussed.

Psychotropic medication use mediates the relationship between mood and anxiety disorders and obesity: Findings from a nationally representative sample

Growing evidence points to a relationship between obesity and both mood and anxiety disorders, but the question of what accounts for this association remains unanswered. The present study examined the use of psychotropic medications as a mediator of the mood/anxiety disorder–obesity relationship. Data came from the public use dataset of the Canadian Community Health Survey Cycle 1.2 (age 15 years and older, N = 36,984). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition psychiatric diagnoses of 12-month mood disorders (e.g., major depressive disorder, mania) and anxiety disorders (e.g., panic attacks, panic disorder, social phobia, agoraphobia) were examined as was use of psychotropic medications (e.g., antidepressants, antipsychotics, anxiolytics, hypnotics, mood stabilizers) and obesity (defined as body mass index ≥30). A series of multiple logistic regression analyses were completed to test study hypotheses. Covariates in these analyses included sociodemographic factors, physical activity, and physical illness burden. The use of two medication classes, namely antidepressants and antipsychotics, emerged as significant predictors of obesity as well as mediators of the psychiatric diagnosis–obesity relationship after evaluating all psychotropic medication classes simultaneously, while also controlling for other theoretically relevant variables. The use of these two medications accounted for 86% of the relationship between mood disorders and obesity and 32% of the relationship between anxiety disorders and obesity. The study findings guide advances in the theoretical conceptualization of the mechanisms involved in mood/anxiety disorder–obesity relations. Clinical implications are discussed.