Long-term Use Of Antipsychotic Drugs Research Articles

Progress in diagnosis and treatment of delayed movement disorder

Delayed movement disorder is an involuntary movement syndrome after long-term use of antipsychotic drugs, and also a serious adverse drug reaction. The treatment of delayed movement disorder has been an important issue. How to carry out related prevention is directly related to the vital interests of patients. This article reviews the etiology, pathogenesis, clinical features, diagnosis and treatment of tardive dyskinesia. Keywords: delayed movement disorder; diagnosis; treatment.

Vitamin E in the treatment of tardive dyskinesia: a meta-analysis.

Long-term use of antipsychotic drugs is associated with tardive dyskinesia. At present, there is no satisfactory treatment for tardive dyskinesia. Some randomized trials suggested that vitamin E can improve tardive dyskinesia. This study was undertaken to evaluate the effects of vitamin E treatment for tardive dyskinesia. We searched internet databases for randomized controlled trials. A total of 21 studies including 854 patients with tardive dyskinesia were included in this meta-analysis. Eighteen studies reported the Abnormal Involuntary Movements Scale (AIMS) as the primary outcome. After vitamin E treatment, a decrease of 2.36 (95% CI = -3.27 to -1.45; P < 0.00001) in the AIMS was observed in the treatment group, compared with the control group. Vitamin E may offer a new avenue treatment for tardive dyskinesia.

A Survey Study on the Status of Somatic Symptoms in Young and Middle-Aged Patients with Mental Illness during Long-Term Hospitalization.

Psychiatric disorders include severe psychiatric disorders and those in general with some psychiatric disorders having a clear etiology or in which a significant psychiatric predisposing factor is present. Whereas, psychiatric disorders precisely refer to those characterized by mild depression and mild anxiety and appear to affect a large number of people in any community. It has been reported that the disease is highly prevalent and has a huge impact on the individual, family, and community levels, resulting in a heavy burden on the healthcare system of a country. To explore the status of somatic symptoms in young and middle-aged psychiatric patients during long-term hospitalization, a total of 114 young and middle-aged psychiatric patients with prolonged hospitalization (more than 5 years) were included. Data information of the hospitalized patients was recorded, including preadmission somatic symptoms, electrocardiogram (ECG), echocardiogram, abdominal ultrasound, and blood tests. In addition, a homemade questionnaire was administered, and general information about the patients was also collected, including gender, age, current medication use, and duration of medication use. Correlations between cardiometabolic disease, osteoporosis, and long-term oral antipsychotic medication were analyzed in these young and middle-aged patients. The prevalence of comorbid somatic symptoms was 77.2%, and concomitant disorders included mainly cardiometabolic disorders, osteoporosis, pulmonary infections, cerebrovascular disorders, digestive disorders, fractures, and skin conditions. The incidence of somatic symptoms caused by long-term use of antipsychotic drugs was about 88.6%, and the incidence of concomitant somatic symptoms was higher in young and middle-aged psychiatric patients who were hospitalized for a long time. The current study observed a high prevalence of somatic symptoms in young and middle-aged patients with long-term inpatient psychiatric illness. Endocrine and metabolic disorders, particularly dyslipidemia, may trigger a range of deleterious effects. In addition to this, there is a high incidence of osteoporosis. Special attention should be paid to the side effects of antipsychotic drugs, and appropriate measures are needed to make early diagnosis and provide early treatment to reduce the occurrence of cardiometabolic diseases and osteoporosis.

Pharmacogenetic markers of antipsychotic-induced weight gain: leptin and neuroepeptide Y

Antipsychotic drugs are a critical modality in managing of schizophrenia. Although medications can be highly effective, response varies and some patients derive considerably less benefit than others. Long-term use of antipsychotic drugs is associated with the development of adverse reactions. Te safety advantages of the atypical drugs havebeen questioned because of their propensity to induce weight gain and alter glucose and lipid metabolism. Antipsychotic-induced weight gain is a common cause of self-discontinuation of treatment and a significant deterioration in the quality of life in patients with schizophrenia. Te severity of adverse reactions when taking antipsychotics in different patients varies, which be associated with genetic factors. Antipsychotic induced weight gain is a major health concern and unfortunately, there is no predictive tool to identify who are high risk individuals. Te LEP, LEPR and NRY genes represents a compellings candidates for genetic studies of antipsychotic-induced weight gain. Candidate gene selection should rely on current knowledge on the molecular pathways to weight gain, antipsychotic pharmacokinetics and pharmacodynamics, as well as possible disease-related genetic links to the side effects under study. Pharmacogenetics will provide rational treatment based on matching antipsychotics to a patient’s DNA profile, thus, potentially providing effective treatment with minimal side effects to outliers and mean responders to a given antipsychotic medication.

Alternations in nuclear factor kappa beta activity (NF-kB) in the rat brain due to long-term use of atomoxetine for treating ADHD: In vivo and in silico studies

Attention Deficit Hyperactivity Disorder (ADHD) is the most common psychiatric disorder reported particularly in children. Long-term use of antipsychotic drugs used in the treatment of ADHD has been shown to exert toxic effects on the brain. However, not enough research has been carried out on the neurotoxic effects of these drugs on the brain tissue. Atomoxetine (ATX) is the most widely used antipsychotic drug that has gained approval for ADHD treatment. The present study aims to determine the damage induced by long-term use of three different doses of ATX in the brain tissue of experimental rats. 24 rats were divided into Control group (0.5 mL saline), Group 2 (0.5 mg/mL ATX), Group 3 (1.0 mg/mL ATX), and Group 4 (2.0 mg/mL ATX), each group having 6 members. Their brain tissues were taken for stereological, histological, and nuclear factor kappa-B (NF-kB) protein expression analysis. ATX was determined to have caused a few alterations in the brain tissue, such as disruption in the endothelial epithelium of capillaries, a couple of large astrocyte nuclei, and mitotic astrocytes. Moreover, a significant difference was observed in Group 4 compared to Control Group in terms of astrocyte counts in the brain sections. As for Groups 3 and 4, there were differences in terms of oligodendrocyte counts in the incisions cultivated from the brain tissues of the animals. On the other hand, NF-kB positive astrocytes of Groups 3 and 4 differed significantly from those of Control and Group 2. The results of molecular dockings of the present study are in line with the in-vivo results. Therefore, it was concluded that the higher the dose of ATX was, the more damage the brain tissue sustained.

The Difference of Fasting Blood Sugar of Male Patients with Schizophrenia Treated with Flexible Dose between Aripiprazole and Risperidone in Medan, Indonesia.

BACKGROUND:Life expectancy among schizophrenic patients is 20% shorter than the general population. Currently, long-term use of antipsychotic drugs can induce metabolic symptoms, including weight gain, glucose intolerance, high blood glucose.AIM:This research aimed to investigate the fasting blood sugar level of a male patient with schizophrenia treated with flexible dose.METHODS:This research is an experimental study, unpaired numerical comparative analytic with non-probability consecutive sampling by recruiting 50 research subjects of men with male patients with schizophrenia. Every 25 people were treated with aripiprazole, and another 25 subjects were treated with risperidone. The flexible dose on how doses are equated with bioequivalent doses between aripiprazole and risperidone was applied. Sampling was carried out in the inpatient and outpatient clinic of the psychiatric hospital Prof. Dr M. Ildrem Medan, North Sumatra, Indonesia, in a span of 6 months from January 2018 to July 2018. The diagnostic test used a Mini structured interview system International Statistical Classification of Diseases-10 (Mini-ICD 10) and the statistical analysis was involving Mann Whitney U Test.RESULTS:This research showed the mean of fasting blood sugar level in week 8 in the group receiving treatment with aripiprazole was 88.96 with a standard deviation of 4.33 and in the group receiving risperidone treatment was 102.80 with a standard deviation of 2.92. The results of the analysis using unpaired t-test in the two groups showed a significant difference in fasting blood sugar levels for men with schizophrenia in the group receiving aripiprazole treatment and the group receiving risperidone treatment in week 8 with a value of p < 0.001 (p < 0.05).CONCLUSION:This research revealed that based on the equivalence of risperidone and aripiprazole dosage given to the male patients with schizophrenia, the treatment using risperidone can significantly increase the fasting blood sugar level compared to the aripiprazole treatment in week 8.

Somatic comorbidity in children and adolescents with psychiatric disorders

In the adult population, psychiatric disorders are associated with somatic illness. Explanatory life style factors have been found, but also a failure to recognize somatic illness in this group. Another factor is side effects from long-term use of antipsychotic drugs. Given the psychiatric-somatic comorbidity in the adult population, it is of interest to investigate whether an association exists already during childhood. The aim of the present study was to investigate the frequency of somatic illness in children and adolescents with a psychiatric diagnose. Data were obtained from the regional health care database Vega, Sweden. Psychiatric and somatic diagnoses obtained during 2011–2013 for individuals aged 3–18 years were extracted. Descriptive statistics were used to examine difference in somatic morbidity between children with and without psychiatric diagnoses. Logistic regression was used in age-stratified models to test the association between psychiatric and somatic diagnoses. Anxiety and behavioral disorders were associated with all somatic conditions investigated at nearly all ages. The same applied to substance use, investigated at age 9–18 years. Affective disorders were associated with all somatic conditions at age 12–18 years. Psychotic conditions were associated with asthma, bowel disorders and myalgia in adolescents. Children with psychiatric disorders are at remarkably high risk for concurrent somatic illness. The associations span across many types of conditions and across all ages. The results support the need for awareness of somatic morbidity in child and adolescent psychiatric clinical settings, and the need for coordinated health care for children with comorbid states.

Association between drug-induced hyperprolactinemia related adverse events on women schizophrenia patients with DRD2 Taq1 polymorphism

ObjectivesTo observe the association between adverse effects of long-term use of antipsychotic drugs in female schizophrenic patients and dopamine D2 receptor (DRD2), cytochrome P450 (CYP) 2D6, estrogen receptor-α gene (ESR1).MethodThe subjects were 89 female schizophrenic patients (age range from 18 to 40) who had been taking the same medication for more than 3 months. The adverse effects with regard to hyperprolactinemia were studied through the blood collection at one point of the subjects. Furthermore, the effect of DRD2, CYP2D6, ESR1 on serum prolactin level and amenorrhea was analyzed.ResultsThere was a lower concentration of E2 in patients with amenorrhea. In addition, an inverse correlation was found between prolactin level and E2 level. Hyperprolactinemia (HPRL) was commonly found in patients who had been using risperidone, amisulpride and paliperidone; in contrast, HPRL was found less in those who had been taking aripiprazole, olanzapine, ziprasidone, clozapine and quetiapine. Moreover, female schizophrenic patients who had DRD2 Taq1 A1 allele had twice the chance of developing amenorrhea than those who did not have A1 allele. Female schizophrenic patients who had Taq1 A1 allele also had 48% higher concentration level of prolactin than those who did not have A1 allele. There was no association found between prolactin and CYP2D6 or ESR1.ConclusionFemale schizophrenic patients who had DRD2 Taq1 A1 allele showed high prolactin level and high-frequency of HPRL. Therefore, reducing the use of prolactin-elevating antipsychotics for female schizophrenic patients with DRD2 Taq1 A1 allele would be one method minimizing the adverse effects of drug-induced hyperprolactinemia.Disclosure of interestThe authors have not supplied their declaration of competing interest.

PWE-020 Endoscopically applied intra-rectal formalin for radiation proctopathy: short and longer term outcomes

STUDY OBJECTIVE--The aim was to survey oral contraceptive usage among women under 25 years of age. DESIGN--This was a cross sectional population study based on information collected by questionnaire mailed to randomly selected individuals. SETTING--The study population consisted of Swedish women born between 1960 and 1964 and living in the southern Swedish health care region which has about one and a half million inhabitants. PARTICIPANTS--The sample consisted of 3477 women, of whom 2573 or 74% agreed to participate in the study and were interviewed between November 1990 and April 1991. MAIN RESULTS--Of the 2573 women participating, 2254 (88%) reported having used oral contraceptives at some time, 77% of them having started during their teens. Teenage start of oral contraceptive use was found to be related to a lower age at menarche, a higher marriage/cohabitation rate, a lower rate of teenage full term pregnancy, a higher rate of spontaneous abortion, a lower frequency of teetotalism, and a higher frequency of smoking. Longterm use of antipsychotic drugs appeared to be less common among women who started oral contraceptive use early, but no relationship with other pharmaceutical drug usage was found. No relationship was found between oral contraceptive use and the presence of a first degree relative with cancer. CONCLUSIONS--A large proportion of Swedish women start using oral contraceptives during their teens, and report long duration of usage both before their first full term pregnancy and before the age of 25 years. The few women who have never used oral contraceptives do not appear to be representative of the general population.

Early Remission in Focal Tardive Dystonia Associated with the Use of Neuroleptic Medication: A Rare Case Report and Review of Literature

Abstract Tardive dystonia is a movement disorder which develops with twisting of one part of the body or abnormal posture because of severe muscle contractions. The most important factor in the occurrence of tardive dystonia is the use of antipsychotic medication. Tardive dystonia associated with long-term use of antipsychotic drugs may be focal, segmental or generalised. When tardive dystonia has occurred once, there is a tendency for it to be permanent and complete recovery is rare. The aim of this paper was to present a case of neuroleptic drug-associated tardive dystonia with focal involvement where early remission was observed and thus draw attention to the necessity of considering physical therapy approaches in addition to medication in the treatment choices. Key Words: Tardive dystonia, neuroleptic, early remission, physical therapy

Inappropriate long-term use of antipsychotic drugs is common among people with dementia living in specialized care units

BackgroundAntipsychotic drugs are widely used for the treatment of Behavioral and Psychological Symptoms of Dementia (BPSD), despite their limited efficacy and concerns about safety. The aim of this study was to describe antipsychotic drug therapy among people with dementia living in specialized care units in northern Sweden.MethodsThis study was conducted in 40 specialized care units in northern Sweden, with a total study population of 344 people with dementia. The study population was described in regard to antipsychotic drug use, ADL function, cognitive function and BPSD, using the Multi-Dimensional Dementia Assessment Scale (MDDAS). These data were collected at baseline and six months later. Detailed data about antipsychotic prescribing were collected from prescription records.ResultsThis study showed that 132 persons (38%) in the study population used antipsychotic drugs at the start of the study. Of these, 52/132 (39%) had prescriptions that followed national guidelines with regard to dose and substance.After six months, there were 111 of 132 persons left because of deaths and dropouts. Of these 111 people, 80 (72%) were still being treated with antipsychotics, 63/111 (57%) with the same dose. People who exhibited aggressive behavior (OR: 1.980, CI: 1.515-2.588), or passiveness (OR: 1.548, CI: 1.150-2.083), or had mild cognitive impairment (OR: 2.284 CI: 1.046-4.988), were at increased risk of being prescribed antipsychotics.ConclusionThe prevalence of antipsychotic drug use among people with dementia living in specialized care units was high and inappropriate long-term use of antipsychotic drugs was common.

A Case of Schizophrenia With Meige Syndrome Induced by Perospirone Successfully Treated With Biperiden

Back to table of contents Previous article Next article LettersFull AccessA Case of Schizophrenia With Meige Syndrome Induced by Perospirone Successfully Treated With BiperidenSakae Takahashi, M.D., Ph.D., Masahiro Suzuki, M.D., Ph.D., and Makoto Uchiyama, M.D., Ph.D.Sakae TakahashiSearch for more papers by this author, M.D., Ph.D., Masahiro SuzukiSearch for more papers by this author, M.D., Ph.D., and Makoto UchiyamaSearch for more papers by this author, M.D., Ph.D.Published Online:1 Jan 2013https://doi.org/10.1176/appi.neuropsych.12020029AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Meige syndrome is a focal dystonia involving symmetrical blepharospasm and oromandibular dystonia. The typical symptom is difficulty in keeping the eyelids open. This syndrome has been reported to be induced by several atypical antipsychotics, including risperidone, olanzapine, quetiapine, and aripiprazole.1–4 Here, we report a case of Meige syndrome emerging with an atypical antipsychotic, perospirone, which was successfully treated with biperiden. To our knowledge, this is the first report of Meige syndrome induced by perospirone.Case Report“Ms. A,” a 35-year-old woman, fulfilled the DSM-IV-TR criteria for schizophrenia, paranoid type. There was no family history of neurological or medical disorders. Her illness began at age 21 years. Her initial symptoms were characterized by auditory hallucinations and persecutory delusion. She had been treated with several antipsychotics, including risperidone, sulpiride, quetiapine, and perospirone. She started receiving perospirone (8 mg) at age 26 years, and had been prescribed perospirone and one/two benzodiazepines since age 27 years. From age 29 years, perospirone dosage was generally 32 mg. After being on this dose for 1½ years, she exhibited cervical dystonia. Perospirone was then decreased (to 12 mg), and biperiden (6 mg) was added. However, since her dystonia was not improved, we additionally prescribed clonazepam (1 mg) and diazepam (4 mg). Consequently, her dystonia disappeared after 1 month. Over the following year, perospirone was increased (to 32 mg), biperiden was decreased (to 2 mg), and clonazepam and diazepam were stopped. After maintaining this dosage for 2 months, she developed symmetrical oromandibular dystonia. Perospirone was decreased (to 24 mg); accordingly, her dystonia was improved, although it did not completely disappear. For the next 2½ years, she showed no relapse of psychotic symptoms and marked side effects during perospirone monotherapy (24 mg; no biperiden). However, she exhibited symmetrical mild oromandibular dystonia and blepharospasm, and had difficulty keeping both eyes open. She had to discontinue vision-dependent tasks like watching TV, cooking, and walking. No abnormal movements were observed in other areas of her body. We added biperiden (3 mg), and these symptoms were almost gone 1 month later. Although her abnormal facial movements did not completely disappear, she showed no difficulties in managing activities of daily living. To date, she has had no exacerbation of psychotic symptoms and remarkable side effects for 1 year with perospirone (24mg) and biperiden (3 mg).DiscussionPerospirone is an atypical antipsychotic drug, and has been used only in Japan for 11 years. It has a high affinity for dopamine D2 and serotonin 5-HT2A receptors.5 Meige syndrome is one of the tardive dystonia that appears after long-term use of antipsychotic drugs.1,4 Umene-Nakano et al. (2011)4 recently presented a case of Meige syndrome induced by aripiprazole successfully treated with perospirone. However, perospirone induced Meige syndrome in this case. Anticholinergics have been well known to improve dystonia. This report suggests that Meige syndrome can occur in the long-term use of perospirone, and the addition of anticholinergic drugs may be useful for ameliorating Meige syndrome in antipsychotic therapy.Division of Psychiatry, Department of Psychiatry, Nihon University, School of Medicine, Tokyo, JapanCorresponding author: Sakae Takahashi; e-mail: takahashi.[email protected]ac.jpReferences1 Ananth J, Burgoyne K, Aquino S: Meige’s syndrome associated with risperidone therapy. Am J Psychiatry 2000; 157:149Crossref, Medline, Google Scholar2 Nishikawa T, Nishioka S: A case of Meige dystonia induced by short-term quetiapine treatment. Hum Psychopharmacol 2002; 17:197Crossref, Medline, Google Scholar3 Mendhekar DN, War L: Olanzapine induced acute Meige’s syndrome. J Neuropsychiatry Clin Neurosci 2009; 21:225Link, Google Scholar4 Umene-Nakano W, Yoshimura R, Hori H, et al.: A case of schizophrenia with Meige syndrome induced by long-term aripiprazole successfully treated with perospirone. Prog Neuropsychopharmacol Biol Psychiatry 2011; 35:273Crossref, Medline, Google Scholar5 Onrust SV, McClellan K: Perospirone. CNS Drugs 2001; 15:329–337, discussion 338Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited ByRefractory dry eye disease associated with Meige’s syndrome induced by long-term use of an atypical antipsychotic2 December 2020 | BMC Ophthalmology, Vol. 20, No. 1Psychiatry and Clinical Psychopharmacology, Vol. 28, No. 2Perospirone28 September 2013 | Reactions Weekly, Vol. 1471, No. 1 Volume 25Issue 1 Winter 2013Pages E28-E28 Metrics PDF download History Published online 1 January 2013 Published in print 1 January 2013

P-168 - Bipolar disorder and long-term antipsychotic use

International guidelines regarding the treatment of bipolar disorder differ noticeably from everyday practice, they stress the importance of the use of mood stabilizers as monotherapy. However, in practice polytherapy is widely used, including antipsychotic drugs, and for periods that far exceed the duration of acute episode. Determine the frequency of long-term use of antipsychotic drugs in the treatment of bipolar disorder and identify situations that may justify this attitude. Retrospective study of all first-admitted patients with bipolar disorder in two psychiatric wards of Razi Hospital between 2006 and 2008 and over a three-year follow-up. Our sample consisted of 72 patients. Antipsychotic agents have been used in association with mood stabilizers for a period exceeding 6 months in over 80% of patients with an average duration of 26.56 months ± 12.21 months. Long-term antipsychotic use was significantly correlated with the following factors: male gender, bad family support, poor medication adherence, presence of mixed episodes, psychotic characteristics associated, high frequency of manic recurrences, absence of symptom-free interval, delayed diagnosis as well as a doubtful diagnosis with an acute psychotic disorder or schizophreniform disorder. This study highlights the fact that international guidelines should be better applied in naturalistic conditions, and that clinicians have to be better informed about these recommendations.

Safer alternatives to long-term use of antipsychotic drugs sought.

Nurse prescribers are being urged to examine alternatives to antipsychotic drugs, following research revealing that patients face a significantly increased likelihood of death when taking such medication over long periods.

A decision model to compare health care costs of olanzapine and risperidone treatment for schizophrenia in Germany

Second-generation atypical antipsychotics such as clozapine, olanzapine, risperidone, quetiapine, ziprasidone, amisulpride and ariprazole offer the potential to reduce the significant health care resource demands in the treatment of schizophrenia through improved levels of initial clinical response and reduced levels of long-term acute relapse. However, the optimal sequencing of these drugs remains unclear. To consider this issue from a health economic viewpoint a decision model approach was used comparing healthcare costs and clinical outcomes when treating patients with alternative sequences of atypical antipsychotic treatment. Treated patients were assumed to be in a current acute episode with at least a 10-year history of disease and to be naive to previous atypical treatments. Treatment strategies were based on either first-line olanzapine or risperidone with switching to the alternative drug as second-line treatment following an inadequate clinical response to first-line drug therapy. Clinical response data were derived from a pivotal published comparative study of both olanzapine and risperidone. Published data on the long-term use of antipsychotic drugs where used wherever possible to populate the model for relapse rates during the maintenance phase. Health care resource data were defined for Germany based on expert clinical opinion. A treatment strategy of first-line olanzapine was shown to be cost saving over a 1-year period, with additional clinical benefits in the form of avoided relapses. The model suggests that over the first year of treatment a strategy of first-line olanzapine is associated with lower risk of additional relapse (0.33 fewer acute relapses per 100 patients per year) and with cost savings (euro 35,306 per 100 patients per year). There is a need for longer term direct in-trial comparisons of atypical antipsychotics to confirm these indicative results.

Epidemiology of tardive dyskinesia: Is risk declining with modern antipsychotics?

Second-generation antipsychotic drugs (APDs), including aripiprazole, clozapine, olanzapine, risperidone, quetiapine, and ziprasidone dominate outpatient and inpatient clinical practice, having largely displaced the older neuroleptics. Modern APDs have relatively low risk for acute extrapyramidal syndromes characteristic of older neuroleptics, particularly acute dystonia and Parkinsonism, with variable risks of akathisia and the rare neuroleptic malignant syndrome. Anticipated reduction in risk of tardive dyskinesia (TD) is less well documented. Nearly 50 years after initial reports on TD, it is appropriate to reexamine the epidemiology of this potentially severe late adverse effect of long-term APD treatment in light of current research and practice. We compared recent estimates of incidence and prevalence of TD identified with some modern APDs to the epidemiology of TD in the earlier neuroleptic era. Such comparisons are confounded by complex modern APD regimens, uncommon exposure limited to a single modern APD, effects of previous exposure to typical neuroleptics, and neurological assessments that are rarely prospective or systematic. Available evidence suggests that the risk of TD may be declining, but longitudinal studies of patients never treated with traditional neuroleptics and exposed to only a single modern APD are required to quantify TD risks with specific drugs. Long-term use of APDs should continue to be based on research-supported indications, with regular specific examination for emerging TD.

Changes in antipsychotic drug use in nursing homes during implementation of the OBRA-87 regulations

<h3>Objectives.</h3> —To describe the changes in antipsychotic drug use in nursing homes during the period surrounding the implementation of federal legislation designed to reduce unnecessary use (the Omnibus Budget Reconciliation Act of 1987 [OBRA-87]) and to identify nursing home characteristics associated with such changes. <h3>Design.</h3> —Longitudinal study of 9432 Tennessee Medicaid enrollees 65 years of age or older who continuously resided in Tennessee from April 1, 1989, to September 30,1991, a 30-month period surrounding implementation of OBRA-87. <h3>Main Outcome Measures.</h3> —Changes in the use of antipsychotic and other psychotropic drugs. <h3>Results.</h3> —During the 30-month period, antipsychotic drug use decreased from 23.9 to 17.5 days per 100 days of residence, a 26.7% decline (<i>P</i>&lt;.001), which resulted from both a decrease in new users (<i>P</i>&lt;.001) and a reduction in long-term use of antipsychotic drugs (<i>P</i>&lt;.001). There was no concomitant increase in other psychotropic drug use. A multivariate analysis revealed that changes in antipsychotic use were strongly associated with baseline antipsychotic use (<i>P</i>=.001) and third-shift staffing levels (<i>P</i>=.003). Nursing homes with baseline antipsychotic drug use and third-shift staffing above the median reduced antipsychotic drug use by 41%, compared with a 2% increase in nursing homes where both of these factors were below the median (<i>P</i>&lt;.0001). <h3>Conclusions.</h3> —A substantial decrease in antipsychotic drug use coincided with the implementation of OBRA-87. Although this decrease is consistent with an improvement in quality of nursing home care, further research is needed to determine the effects of this legislation on resident outcomes. (<i>JAMA</i>. 1994;271:358-362)

Changes in Antipsychotic Drug Use in Nursing Homes During Implementation of the OBRA-87 Regulations

To describe the changes in antipsychotic drug use in nursing homes during the period surrounding the implementation of federal legislation designed to reduce unnecessary use (the Omnibus Budget Reconciliation Act of 1987 [OBRA-87]) and to identify nursing home characteristics associated with such changes. Longitudinal study of 9432 Tennessee Medicaid enrollees 65 years of age or older who continuously resided in Tennessee from April 1, 1989, to September 30, 1991, a 30-month period surrounding implementation of OBRA-87. Changes in the use of antipsychotic and other psychotropic drugs. During the 30-month period, antipsychotic drug use decreased from 23.9 to 17.5 days per 100 days of residence, a 26.7% decline (P < .001), which resulted from both a decrease in new users (P < .001) and a reduction in long-term use of antipsychotic drugs (P < .001). There was no concomitant increase in other psychotropic drug use. A multivariate analysis revealed that changes in antipsychotic use were strongly associated with baseline antipsychotic use (P = .001) and third-shift staffing levels (P = .003). Nursing homes with baseline antipsychotic drug use and third-shift staffing above the median reduced antipsychotic drug use by 41%, compared with a 2% increase in nursing homes where both of these factors were below the median (P < .0001). A substantial decrease in antipsychotic drug use coincided with the implementation of OBRA-87. Although this decrease is consistent with an improvement in quality of nursing home care, further research is needed to determine the effects of this legislation on resident outcomes.

Oral contraceptive use among young women in southern Sweden.

The aim was to survey oral contraceptive usage among women under 25 years of age. This was a cross sectional population study based on information collected by questionnaire mailed to randomly selected individuals. The study population consisted of Swedish women born between 1960 and 1964 and living in the southern Swedish health care region which has about one and a half million inhabitants. The sample consisted of 3477 women, of whom 2573 or 74% agreed to participate in the study and were interviewed between November 1990 and April 1991. Of the 2573 women participating, 2254 (88%) reported having used oral contraceptives at some time, 77% of them having started during their teens. Teenage start of oral contraceptive use was found to be related to a lower age at menarche, a higher marriage/cohabitation rate, a lower rate of teenage full term pregnancy, a higher rate of spontaneous abortion, a lower frequency of teetotalism, and a higher frequency of smoking. Longterm use of antipsychotic drugs appeared to be less common among women who started oral contraceptive use early, but no relationship with other pharmaceutical drug usage was found. No relationship was found between oral contraceptive use and the presence of a first degree relative with cancer. A large proportion of Swedish women start using oral contraceptives during their teens, and report long duration of usage both before their first full term pregnancy and before the age of 25 years. The few women who have never used oral contraceptives do not appear to be representative of the general population.

Diazepam in tardive dyskinesia.

Tardive dyskinesia, a syndrome of involuntary motor movements, can be a permanent consequence of the long-term use of antipsychotic drugs. While there is no well-established drug treatment, case reports and the results of a few clinical studies suggest that drugs that facilitate the GABA-ergic system may decrease the abnormal movements. One such class of drugs is the benzodiazepines. We administered diazepam to 13 subjects in a 24-week, crossover design study. Tardive dyskinesia and psychopathology were assessed by blind raters using the Abnormal Involuntary Movement Scale and the Brief Psychiatric Rating Scale (BPRS). The means of all movement measurements improved from the baseline, with orofacial, subtotal, symptom severity, and total reaching significance. However, we were unable to demonstrate a drug effect; the patients improved to a similar degree whether or not they received diazepam. Their psychiatric disorders did not worsen with diazepam administration and, in fact, improved slightly; the activation factor of the BPRS was significantly improved over baseline. Our results suggest that diazepam is not effective in managing the movements of tardive dyskinesia and that behavior modification strategies be investigated to help patients control symptoms.