Drugs In Psychiatric Patients Research Articles

Abstract 4147606: The Risk of Cardiac Events Associated with Psychiatric Drugs in Patients with Long QT Syndrome.

Introduction: Long QT syndrome (LQTS) is a potentially life-threatening genetic heart disease. Patients with LQTS may also have co-existent mental health illnesses that may benefit from psychiatric medications. However, because many of these medications have QT-prolonging potential (www.crediblemeds.org), many of these patients receive suboptimal mental health care. Objective: To evaluate the frequency, management, and incidence of breakthrough cardiac events (BCEs) in patients with LQTS and concomitant mental health issues treated with psychiatric medications. Methods: A retrospective review was conducted on patients cared for in Mayo Clinic's Windland Smith Rice Genetic Heart Rhythm Clinic between 2000 and 2024 focusing on patients with LQTS and a concomitant psychiatric diagnosis requiring medication with known, possible or conditional risk of torsades de pointes (TdP). Electronic medical records were reviewed for data. BCEs were defined as LQTS-triggered syncope, seizures, appropriate ICD therapy, sudden cardiac arrest (SCA), or sudden cardiac death (SCD). Patients with missing information were excluded. Results: Overall, 195 /1899 LQTS patients [10%, 86 (43%) with LQT1, 83 (42%) with LQT2, and 16 (8%) with LQT3] had a concomitant psychiatric diagnosis requiring medication [150 female (76%), mean age at diagnosis 27 ± 18 years, median follow-up time 6.6 years (IQR 2.9-13)]. The most common psychiatric conditions were depression (71%), anxiety (62%), and ADHD (9%). The mean duration of therapy was 3.36 +/- 3.48 years and the most common medications used were fluoxetine (26%), sertraline (14%), and escitalopram (11%). There was no significant difference in QTc after starting the first psychiatric medication when compared to baseline (473 ± 33 vs 474 ± 35 ms, p=0.6). Prior to their LQTS diagnosis and while therefore untreated, 61/195 (31%) had at least 1 LQTS-associated cardiac event. This occurred in the setting of a psychiatric drug in 7 patients (11%). Following LQTS diagnosis and treatment, 14/195 patients (7%) have experienced a non-lethal BCE of which only 3/14 (21%) while on psychiatric medications. Conclusions: Although avoidance of medications with known QT-prolonging potential is prudent, attention to patient’s overall well-being besides just their LQTS must be given. After correct diagnosis and treatment, LQTS patients with concomitant mental health issues may be safely and effectively treated with medications known to prolong QTc.

A STUDY OF OFF LABEL DRUG USE IN PSYCHIATRY DEPARTMENT AT TERTIARY CARE HOSPITAL

Background: US-Food and Drug Administration has dened off-label drug as “use of drugs for the indication, dosage form, regimen, patient or other use constraint not mentioned in the approved labeling.” Off-label prescription is common in Psychiatry. The aim of this study is to evaluate such off-label drug use in psychiatry department of a tertiary care teaching hospital. An observational, cross sectional study was Methods: conducted among 150 patients attending Psychiatry outpatient department for the period of 3 months. Data related to demographic parameters, diagnosis and prescription details were collected directly from the patient's medical records and entered in Case Record Form (CRF).The off-label drugs were categorized as per National Formulary of India and CDSCO list of approved drug use. Total 150 patients were included in this Results: study with mean age of 43.6 years. Most of the patients were diagnosed with Schizophrenia [N=36, 24%]. Out of 150, 90 patients [60%] received at least 1 off label drug. Total 478 drugs were prescribed, out of which 144 [30.12%] were off label according to CDSCO and 145 [30.33%] were off label according to NFI. The drugs most frequently prescribed as off label drug according to CDSCO were Vitamins & Minerals [13.59%], Clonazepam [2.92%], Trihexyphenidyl HCL [2.09%], Diazepam [1.88%]. The drugs most frequently prescribed as off label according to NFI were Vitamins & Minerals [12.76%], Aripiprazole [2.09%], and Trihexyphenidyl HCL [2.09%]. Off label drug Conclusion: s used among psychiatry patients was 30.12%. The most frequently used off-label drugs were Vitamins & Minerals followed by Clonazepam & Trihexyphenidyl HCL. The use of off-label drugs in psychiatric patients has been reportedly increasing which warrant national drug regulatory authorities to review and revise safe administration such drugs.

P171 EVALUATION OF ARRHYTHMIC RISK IN THE PSYCHOPHARMACOLOGIC–TREATED PATIENT

Abstract Background Neuroleptics (NRL) and Tricyclic Antidepressants (TCA) could be related to the QT prolongation although the risk of ventricular arrhythmias and sudden death caused by these drugs was not clearly described in literature. Corrected QT (QTc), is the major marker of arrhythmic risk; Qt dispersion (QTd) is defined as the dispersion of the QT interval on 12–lead electrocardiogram (ECG) and is predictive of mortality if > 58; the heart rate variability (HRV) is indicative of the sympathetic/vagal tone and of the arrhythmic risk. Aim of the study. Evaluation of the main effects of psychotropic drugs in psychiatric patients on the following parameters: QT interval, QTc using 4 formulas (Bazett, Fridericia, Framingham e Hodges), Qtd and HRV depending on time and heart rate. Materials and Methods Data from 167 patients treated with typical and atypical NRL, TCA, and mood stabilizers have been collected. The observational study consisted in these phases: 1) chart review of 84 patients admitted in day hospital to detect sex, age, diagnosis, therapy and Qtc; 2) evaluation of the same parameters in 83 of them, to whom an ECG was performed at the discharge; 3) ECG Holter in a subgroup of 17 patients who have given consent to the exam, to highlith the incidence of arrhythmias and to investigate the HRV. Results No significant QTc alterations related to therapy were detected at the admission or at the discharge. Moreover, no statistically significant differences emerged among NRL classes nor an increased arrhythmic risk in polypharmacy. The use of different formulas has confirmed an overestimation of the QTc according to the Bazett formula. QTd was altered in 67 patients ( QTd ≥50 in 51 subjects; QTd>60 in 12 subjects)and the HRV was lower compared to the general population regardless of the therapies. Conclusions The psychopharmacological therapy in a “real world setting” didn’t show a signiticative influence on the evaluated parameters of arrhythmic risk. The arrhythmic risk is low in absence of other risk factors or comorbidities. QT correction using FRI or HOD, the QTd if QTc >450–470 ms and the HRV in patients with arrhythmic risk factors, should be considered as parameters to evaluate in the clinic routine of follow–up of psychopharmacologic–treated patient.

Drug-induced arrhythmia: Are we cautious enough?

Dear Editor, Many drugs, like antiarrhythmic agents, psychotropic medications, neurological drugs, and even antimicrobial agents, may trigger multiple types of arrhythmias.[1] Some arrhythmias may cause serious consequences, including death. We report a rare incident where psychotropic medications not only precipitated a life-threatening arrhythmia but also a stroke! A 64-year-old man with a history of bipolar disorder had no other comorbidity. He presented to the ER (emergency room) with hypotension and bradycardia. His GCS (Glasgow Coma Scale) score was 15/15 and had no neuro-deficit. We detected idioventricular rhythm, and a temporary pacemaker was implanted. His hypotension improved, and it stabilized him. We planned a permanent pacemaker the next morning. The family gave a history that he was on 400 mg of lithium and 400 mg of carbamazepine for more than a year. Considering their arrhythmogenic potential, they were withheld. (Blood lithium level was in the normal range.) The next morning we detected him to have right gaze deviation and left-sided complete hemiplegia (NIHSS of 17). He had established an infarct at the right frontal–temporal region with hemorrhagic conversion in the MRI (magnetic resonance imaging) brain [Figure 1a]. MRA (magnetic resonance angiography) brain revealed right M2 occlusion [Figure 1b]. Conservative stroke treatment along with rehabilitation was executed. TEE (transesophageal echocardiography) ruled out intracardiac clot and other cardiac pathology. Details of stroke workup were also not contributory. Since his sinus rhythm persisted even after removal of the temporary pacemaker, we canceled a permanent pacemaker implantation. We withdrew his offending drugs permanently. Henceforth, the cardiology team monitored the cardiac rhythm and until 2 years of follow-up, he had no further event. His Modified Rankin Scale (mRS), however, remained 5 (with no significant improvement).Figure 1: (a) Acute infarct with hemorrhagic conversion in the right frontal and temporal region. (b) Right M2 division of middle cerebra artery occludedThey associated junctional bradycardia with ischemic stroke, particularly in the absence of an identifiable retrograde P-wave.[2] He had the stroke just after his rhythm got converted to sinus rhythm from junctional bradycardia (like thromboembolism as happens in AF (atrial fibrillation) patients shortly after they get cardioverter).[3] Carbamazepine and lithium both can precipitate bradyarrhythmia.[45] Although we found his lithium level to be within range, there are reports where lithium has precipitated bradyarrhythmia even when the drug level was within therapeutic range.[5] The drugs might have had a synergistic action in our case causing precipitation of the bradyarrhythmia. Interesting learning points in our case are as follows: Arrhythmogenic drugs can precipitate stroke. While on these types of drugs, caregivers should monitor the heart rate and blood pressure regularly. Careful selection of drugs in psychiatric patients is important because they may have a synergistic action in causing arrhythmogenic insults. Before opting for a permanent pacemaker, careful history taking is important to isolate culprit drugs if any which might have precipitated arrhythmia. The status of the arrhythmia needs to be observed after their withdrawal before taking further action. In cardioversion, conversion to sinus rhythm may cause sudden dislodgement of clots from the heart, leading to systemic embolization. Similarly, the stoppage of the arrhythmogenic drugs may precipitate a similar event. So, we need to be more cautious during this time. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. Acknowledgement We acknowledge the faith the patient and family kept on us during difficult times.

Association between Adherence with an Atypical Antipsychotic and with Other Psychiatric Drugs in Patients with Bipolar Disorder.

Using U.S. pharmacy and medical claims, medication adherence patterns of patients with serious mental illness suggest that adherence to atypical antipsychotics may be related to adherence to other prescription drugs. This study investigated whether adherence to an atypical antipsychotic was related to adherence to other prescribed psychiatric drugs using self-reported data from patients with bipolar disorder. Daily self-reported medication data were available from 123 patients with a diagnosis of bipolar disorder receiving treatment as usual who took at least 1 atypical antipsychotic over a 12-week period. Patients took a mean of 4.0±1.7 psychiatric drugs including the antipsychotic. The adherence rate for the atypical antipsychotic was compared to that for other psychiatric drugs to determine if the adherence rate for the atypical antipsychotic differed from that of the other psychiatric drug by at least ±10%. Of the 123 patients, 58 (47.2%) had an adherence rate for the atypical antipsychotic that differed from the adherence rate for at least 1 other psychiatric drug by at least±10%, and 65 (52.8%) patients had no difference in adherence rates. The patients with a difference took a larger total number of psychiatric drugs (p<0.001), had a larger daily pill burden (p=0.020) and a lower adherence rate with the atypical antipsychotic (p=0.007), and were more likely to take an antianxiety drug (p<0.001). Adherence with an atypical antipsychotic was not useful for estimating adherence to other psychiatric drugs in about half of the patients with bipolar disorder.

A drug utilization study of antidepressant drugs in a tertiary care hospital

Background: In psychiatric practice, antidepressant drugs are widely used group of drugs. Number of drugs are available in this group with diverse type of mechanisms and efficacy/safety profile. The objective for the study was to identify the prescribing pattern of antidepressant drugs in psychiatric patients at a tertiary care hospital and to see the distribution of antidepressant drugs in the sociodemographic group.Methods: It was a record based descriptive study which was carried out at NKP Salve Institute of Medical Sciences and Research Centre, Nagpur. Case record files of all the patients suffering from depression and other psychiatric disorders and treated with antidepressant drugs during the period of from 1st January 2015 to 31st December 2015 by institutional psychiatrists were analyzed for prescription pattern of antidepressant drugs and their age and sex wise distribution.Results: A total no. of 300 patients received antidepressant drugs. The most commonly prescribed drug was escitalopram in 121 (40.3%) patients followed by fluoxetine in 61 (20.3%) and clomipramine in 30 (10%) patients. Other drugs that were prescribed were mirtazapine in 24 (8%), nortryptiline in 21 (7%), venlafaxine in 13 (4.3%), fluvoxamine in 12 (4%), amitryptiline in 9 (3%), dothiepin in 5 (1.6%) and duloxetine in 4 (1.3%) patients. Also patients in the age group of 31-40 yrs and 21-30 yrs received most number of antidepressants i.e. 129 (40.3%) and 83 (27.6%) patients respectively. Females have received more antidepressant drugs as compared to males.Conclusions: Selective Serotonin Reuptake Inhibitors (SSRIs) are the most commonly prescribed group of antidepressant drugs. Escitalopram followed by Fluoxetine were the most commonly prescribed drugs for the management of depression and other psychiatric disorders because of their better efficacy, safety, tolerability and less side effects as compared to TCAs. Females suffer more from depression and other psychiatric disorders as compared to males and the most vulnerable is 21 to 40 yrs of age.

Drug utilization study of off-label drug use in outpatient department of psychiatry: a prospective study at a tertiary care teaching hospital

Background: In the absence of standard psychiatric prescribing information, physician often use drugs in an off-label way. Many studies have been published across the globe reporting different rates of off-label use. There is currently no study based on Indian Drug Formulary.Methods: After taking permission from Institutional Ethics Committee (IEC), a prospective study was conducted among 285 patients attending Psychiatry outpatient department for the period of 4 months. Data related to demographic parameters, diagnosis of psychiatry conditions and drugs details were collected directly from the patient's medical records and entered in Case Record Form (CRF).The off-label drugs were categorized as per National Formulary of India. Multivariate binary logistic regression model was used to determine the predictors of off- label drug prescribing. The data were statistically analyzed using SPSS version 19 and chi-square test.Results: A total of 285 patients (169 males, 116 females) were included in the study with mean age of 36.54±13.91 years. Most of the patients (n=65, 22.8%) were diagnosed as schizophrenic. Out of 285 patients, 133(46.6%) received at least one off-label drug. A total 841 drugs were prescribed out of which 167(19.85%) were off-label. The drug most frequently prescribed as off-label were trihexiphenidyl HCL 29 (10.2%), clozapine 23 (8.1%) and clonazepam 13 (4.6%).Conclusions: Off label drugs used among psychiatry patients was 19.85%. The most frequently used off-label drugs was trihexiphenidyl HCL. The use of off-label drugs in psychiatric patients has been reportedly increasing which warrant national drug regulatory authorities to review and revise safe administration such drugs.

Overweight and the use of psychiatric drugs in patients with mental disorders attended at psychosocial care center, Teresina, Piauí, Brazil.

Psychopharmacology brought numerous benefits to people with mental disorders, although undesirable side effects have arisen, including weight gain. Identify the overweight frequency in individuals with mental disorders and its relation with the use of psychiatric drugs. Cross-sectional study with patients with mental disorders of both sexes, older than 18 years. Body Mass Index (BMI) used to diagnose overweight (BMI > 25 kg/m2). Chi-square test of Pearson (c²) and Poisson regression were used for analytical statistics for association between variables. the study involved 109 individuals. Overweight was found in 70.7% of the study population, 29.4% presented pre-obesity, 26.6% were obese class I, 8.3%, obese class II, and 6.4% obese grade III (morbid). The overweight prevalence was significantly higher among patients who used selective serotonin reuptake inhibitor antidepressants (PR = 1,42, 95% CI 1,12 to 1,80, p = 0,004), typical antipsychotics (PR = 1,43, 95% CI 1,13 to 1,80, p = 0,003), atypical antipsychotics (PR = 1,24, 95% CI 1,01 to 1,54, p = 0,045) and benzodiazepines (PR = 1,37, 95% CI 1,10 to 1,71, p = 0,004) when compared to those who used tricycle antidepressants ((PR=1,20, 95% CI 0,93 to 1,54, p=0,153) and mood stabilizers (PR=1,09, 95% IC 0,88 to 1,35, p=0,416) . High prevalence of overweight significantly higher among patients who used selective serotonin reuptake inhibitor antidepressants, typical and atypical antipsychotics and benzodiazepines.

Drugs pharmacokinetics interactions with cardiac and renal disease patients in consultation-liaison psychiatry

The prevalence of psychiatric disturbances in patients with cardiovascular disease is elevated. For example the prevalence of major depression can reach 15–20% and of anxiety disturbances 5–20%.When we treat psychiatric symptoms in cardiovascular disease we must have in mind four particular effects of psychiatric drugs: (1) disturbances of atrial-ventricular conduction; (2) QTc interval prolongation that can lead to torsade de pointes and ventricular fibrillation; (3) hypertension; (4) changes in platelet aggregation.On the other hand, there is a great prevalence of psychiatric disease in patients with renal disease. For example, about 5–25% of the patients with advanced renal disease have major depression.Renal disease patients can evidence changes in several pharmacokinetic parameters such as: (1) biodisponibility; (2) distribution; (3) metabolism; (4) excretion. Therefore, when we treat these patients we have to keep in mind the effect of psychiatric drugs over the renal functioning, but also the effect of the deficient renal function in the pharmacokinetics of the drugs.I this presentation we intend to reveal what are the main concerns when we prescribe psychiatric drugs in patients with cardiovascular and renal disease.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Use of Psychiatric Drugs in Patients With Hepatitis C Review and Recommendations

Use of Psychiatric Drugs in Patients With Hepatitis C Review and Recommendations

Use of Psychiatric Drugs in Patients With Hepatitis C Review and Recommendations

Psychopharm Review: March 2010 - Volume 45 - Issue 3 - p 24 doi: 10.1097/01.IDT.0000368373.97969.50

Vital Signs: Wholesale Price Increases for Psychiatric Drugs In Patients Aged 50 and Older

Vital Signs: Wholesale Price Increases for Psychiatric Drugs In Patients Aged 50 and Older

Antipsychotic medication and venous thrombosis.

In an autopsy series, 10 out of 27 deaths in which 'idiopathic' pulmonary emboli were discerned as the sole cause of death had occurred in psychiatric patients. To investigate whether antipsychotic medication is a risk factor for venous thrombosis. A description of the 10 psychiatric patients was obtained from the pulmonary emboli autopsy reports. We carried out a brief historic overview of the literature. We re-analysed data from the Leiden Thrombophilia Study (LETS), a case-control study on patients with venous thrombosis. In the autopsy reports, five out of 10 psychiatric patients with fatal pulmonary embolism had confirmed use of antipsychotic drugs. After the application of chlorpromazine and its analogues a higher incidence of venous thrombosis in psychiatric patients was described in the German literature between 1953 and 1977. In the re-analysis of the LETS case-control study, four patients used antipsychotic drugs versus none in the control group. Recent epidemiological studies of good methodological quality have confirmed these findings. Venous thrombosis appears to be associated with the use of antipsychotic drugs in psychiatric patients.

脳機能イメージングの進歩

Positron emission tomography (PET) and functional magnetic resonance imaging (MRI) have been introduced into the field of brain science as an noninvasive approach to visualize brain function, focusing on the regional distribution of neuronal activity and its connectivity. Measurement of regional cerebral blood flow with PET has been established for mapping human brain function covering the whole brain with various task conditions. Recently introduced functional MRI technique can also detect the signal changes due to the local increase of blood flow by brain activation. Both PET and MRI provide similar activation patterns in cerebral cortical areas, and the study should be designed by considering the characteristics of each modality. Although PET continues to play a major role in imaging of the neurotransmission process, the efforts are now being made to apply this exciting technique to clinical diagnosis by means of single photon emission computed tomography (SPECT). Neuroreceptor imaging is now applied not only for differential diagnosis of neurological diseases but also for determination of optimal dose of appropriate therapeutic drugs in psychiatric patients. Combined use of activation studies with neurotransmission imaging will provide a new insight in understanding the brain mechanism of emotion and behavior.

The reliability of 5-hydroxytryptamine induced platelet aggregation responses in schizophrenic patients treated with neuroleptic drugs.

1 The reliability of 5-hydroxytryptamine induced platelet aggregation responses in psychiatric patients treated with neuroleptic drugs was investigated by examining the effects of a number of technical factors which could account for the variability of responses observed in some patients. 2 Variation in incubation time, temperature, aggregometer stirrer speed, and in the time interval between withdrawal of the blood sample and testing, had no significant effects on the consistency of responses. 3 Dilution of platelet rich plasma (PRP) led to enhanced platelet aggregation responses becoming non-enhanced. 4 Overcentrifugation of blood samples during the preparation of PRP caused a decrease in the incidence of enhanced platelet aggregation responses observed in chronic schizophrenic patients receiving chlorpromazine. 5 The reliability of platelet aggregation responses as indices of the action of neuroleptic drugs in psychiatric patients remains doubtful.

The Collaborative Neuropsychological Study of Polydrug Users

• A controlled three-month prospective collaborative investigation involving eight National Institute on Drug Abusesupported polydrug units was carried out. Clinical review of test protocols assessed 37% of polydrug users, 26% of psychiatric patients, and 8% of nonpatients as impaired on the Halstead-Reitan Battery. Impairment in test performance was related to increasing age, educational deprivation, and premorbid medical factors in all groups, extensive use of CNS depressants and opiates among polydrug users, and extensive use of antipsychotic drugs in psychiatric patients. Both language-related and perceptuomotor neuropsychological test deficits were found in polydrug users, but only the latter in psychiatric patients. At three-month follow-up 34% of polydrug users, 27% of psychiatric patients, and 4% of nonpatients were impaired in these test performances. Recent drug-taking (polydrug group) and schizophrenia diagnosis (psychiatric patients) were additional correlates of test impairment. Persistence of performance deficit in polydrug users raises the possibility that CNS depressants and opiates may have longer-term, slowly reversible, or even permanent effects on neuropsychological tests. The same possibility exists for antipsychotic drugs. The link of these test deficits to other specific neuropsychological functions, to performance in life situations generally, or to specific brain dysfunction, as well as the basis for a lack of test impairments in the majority of polydrug subjects remain to be determined.

Conflict and creativity; man and civilization. Part 2 of control of the mind. A symposium. University of California, San Francisco Medical Center.

The title does not really indicate the content of this stimulating book. Actually, it is the report of a symposium held in January, 1962, which discussed various topics related to the use of drugs as they influenced behavior, mood, and thought. The first such conference, in 1961, was reported in<i>Man and Civilization: Control of the Mind</i>. The present volume contains nineteen papers and six panel discussions by an assortment of well-known professional men, including physicians, psychologists, social scientists, pharmacologists, writers, a musician, and a diplomat. The topics vary from such specific matters as the evaluation of particular drugs in psychiatric patients to such general topics as the psychological bases of freedom. While a few papers deal with some aspects of creative work and methods of resolving differences, most bear only remote relation to "conflict and creativity," the subtitle. Several contributions were of special interest to this reviewer. Benjamin Passamanick