Need For Antipsychotic Medication Research Articles

Understanding interaction in problematic dementia and social care encounters: Protocol for a micro-level study combining video-ethnography and Conversation Analysis (CA).

It is well established that the actions and behaviour of dementia care workers are fundamental to the wellbeing of the people they care for. Not only do they deal with basic healthcare needs, but they also perform a vital psycho-social function by providing-through their regular presence-an underlying continuity for residents. This has been shown to improve well-being, particularly for those in the advanced stages of dementia. It has also been suggested that there are additional psycho-social benefits of such contact which can directly influence the need for anti-psychotic medication. However, unlike most other healthcare and medical settings, the specialised and often difficult interactions that dementia care workers handle every day have not yet been the subject of detailed micro-level analysis. This is particularly significant because much of the impact that care-workers have relates to the way in which they interact with the people they care for. Not having a clear understanding of how their interactions 'work' at the micro-level-particularly ones that are specific to dementia care settings, and that care workers report to be difficult or challenging-means that any training interventions that are developed may not resonate with their real-world experience, and ultimately run the risk of failing. This video-based observational study aims to provide a detailed micro-exploration of problematic and challenging interactions involving care-workers and people living with dementia. The study is based in the UK and will involve up to 20 dementia care staff and 60 people living with dementia. Fieldwork will be conducted in 5 dementia care home and community-based dementia day care settings using naturalistic observational methods (primarily video-ethnography). Data will be analysed using Conversation Analysis (CA).

Overlooking the transition elephant in the ultra-high-risk room: are we missing functional equivalents of transition to psychosis?

In the wake of the almost quarter of a century since the conceptualization of ultra-high-risk (UHR) states for psychosis, empirical evidences in the field are constantly scrutinized and re-assessed through meta-analytic lens. Briefly, such scrutiny converges on three major evidences: pretest risk enrichment, risk hierarchy within UHR states, and declining transition rates. While the former two are intuitive, the dilution effect remains elusive and might be rather symptomatic of unsolved issues in the field. Those include the heterogeneously reported antipsychotic (AP) exposure in UHR samples and the almost univocal focus on purely psychometric transition to psychosis. Both issues lead to the neglect of functional equivalents of transition, i.e. that of a mental state at immediate need for AP medication, and might have a cascading confounding effect on the predictive value of contemporary risk calculators centered on criterial transition as a unique outcome.

Adults with intellectual disability and Attention Deficit Hyperactivity Disorder: Clinical characteristics and medication profiles

Accessible summary Attention deficit hyperactivity disorder (ADHD) is often missed/underdiagnosed in people with intellectual disability compared to people without intellectual disability. The presence of intellectual disability, autism and challenging behaviour should raise the suspicion of ADHD as comorbid neurodevelopmental disorder. Treatment of ADHD in people with intellectual disability may reduce the need for antipsychotic medications. AbstractThe diagnosis of ADHD is often missed or misdiagnosed in people with intellectual disability. Despite a significant growth in literature on the diagnosis and treatment of ADHD in people without intellectual disability, there have been few studies on ADHD in people with intellectual disability. In this paper, we describe a group of adults with intellectual disability and ADHD disorder open to a specialist community intellectual disability service. We examined the frequency and dose of antipsychotic use and considered whether ADHD disorder medication is associated with a reduced use of psychotropic medication. The study found a high incidence of autism in people with intellectual disability and ADHD. Men with intellectual disability were given the diagnosis of ADHD more often compared to women with intellectual disability. Only 64% of people with ADHD and intellectual disability taking ADHD medication were on antipsychotic medications compared to 93% of people with ADHD and intellectual disability without ADHD medications. This generates several hypotheses such as whether antipsychotic medications are prescribed to control ADHD symptoms, whether use of ADHD medications can reduce the use of antipsychotic medications and/or whether antipsychotics are used to treat underlying psychiatric comorbidities in people with ADHD. Randomised controlled trials are needed to answer the question whether use of ADHD medication reduces the use of antipsychotic medication in people with intellectual disability and ADHD. Further studies are also needed to explore reason for not using ADHD medication in certain patients with ADHD and intellectual disability and what treatment options are effective in treating psychiatric comorbidities in people with ADHD and intellectual disability.

Nonpharmacological Interventions Targeted at Delirium Risk Factors, Delivered by Trained Volunteers (Medical and Psychology Students), Reduced Need for Antipsychotic Medications and the Length of Hospital Stay in Aged Patients Admitted to an Acute Internal Medicine Ward: Pilot Study.

Purpose. Effectiveness of nonpharmacological multicomponent prevention delivered by trained volunteers (medical and psychology students), targeted at delirium risk factors in geriatric inpatients, was assessed at an internal medicine ward in Poland. Patients and Methods. Participants were recruited to intervention and control groups at the internal medicine ward (inclusion criteria: age ≥ 75, acute medical condition, basic orientation, and logical contact on admission; exclusion criteria: life expectancy < 24 hours, surgical hospitalization, isolation due to infectious disease, and discharge to other medical wards). Every day trained volunteers delivered a multicomponent standardized intervention targeted at risk factors of in-hospital complications to the intervention group. The control group, selected using a retrospective individual matching strategy (1 : 1 ratio, regarding age, gender, and time of hospitalization), received standard care. Outcome Measures. Hospitalization time, deaths, falls, delirium episodes, and antipsychotic prescriptions were assessed retrospectively from medical documentation. Results. 130 patients (38.4% males) participated in the study, with 65 in the intervention group. Antipsychotic medications were initiated less frequently in the intervention group compared to the control group. There was a trend towards a shorter hospitalization time and a not statistically significant decrease in deaths in the intervention group. Conclusion. Nonpharmacological multicomponent intervention targeted at delirium risk factors effectively reduced length of hospitalization and need for initiating antipsychotic treatment in elderly patients at the internal medicine ward.

Substance Use Comorbidity in Patients with Schizophrenia

CME Educational Objectives 1. Be mindful of the association between the onset of schizophrenia and substance use. 2. Understand and utilize the guidelines for clinical care of patients with schizophrenia and comorbid substance use. 3. Consider the need for antipsychotic medications that will effectively treat schizophrenia without supporting addiction. Comorbid substance use is common in people with schizophrenia and other psychotic disorders. Although there are discrepancies between studies reporting on the prevalence of this comorbidity, the most typical number reported is that approximately 50% of patients diagnosed with schizophrenia will have a substance use diagnosis at some point in their lives, and up to 25% of those people diagnosed with schizophrenia at any given time may be actively engaged in substance use. 1,2 The importance for understanding this dual diagnosis is clear when one considers that the combination of substance use and psychotic disorders leads to higher levels of violence and more severe psychopathology. 3 Various studies have addressed substance use as it relates to the etiology, pathogenesis, and treatment of schizophrenia, and yet fundamental questions remain. For instance, is substance use, on its own accord, a putative risk factor for schizophrenia? How does the presence of substance use impact the treatment of a person with schizophrenia? This article aims to provide an overview of recent empirical research on two notable areas influencing clinicians and researchers. First, we discuss explanatory models that aim to improve our understanding of the high prevalence between substance use and schizophrenia. Second, we review implications for the treatment of substance use comorbidity in people with schizophrenia and complications that stem from substance use in these patients.

Dementia Patients Likely to Receive Fewer Antipsychotics

APA cautions the Centers for Medicare and Medicaid Services to balance patients’ legitimate medical need for antipsychotic medications with concerns about overprescribing these drugs.

Medicare Part D’s Impact on Antipsychotic Drug Use and Costs Among Elderly Patients Without Prior Drug Insurance

Medicare part D's implementation improved access to and affordability of prescription drugs for the elderly without prior drug insurance. Effects for specific drugs and drug classes are less well understood. We assessed part D's impact on antipsychotic medication (APM) utilization and out-of-pocket costs among elderly without prior drug insurance. Retail pharmacy claims from 3 nationwide pharmacy chains were used to analyze 2 time-series designs: (1) a policy model, to obtain a policymaker's perspective: what was the overall impact of part D on APM use and costs among elderly without drug insurance in 2005 with the opportunity to enroll? And (2) a clinical model, to obtain a clinician's perspective: what would happen to elderly without drug insurance in 2005 who did enroll in part D--would they be able to get APMs? At what cost? Subgroup analyses among part D enrollees evaluated potentially different effects for patients who received a subsidy and patients who used antidementia drugs. In the policy model, part D implementation was associated with a 5% increase in APM use and a 37% reduction in out-of-pocket costs, suggesting a modest need for APMs among all previously uninsured elderly. Patients who did enroll in part D (clinical model) had a 97% increase in APM use and a 62% decrease in out-of-pocket costs, suggesting that patients who needed APMs were able to access them at low cost through the part D program. Part D implementation was associated with increased use and affordability of APMs for the elderly without prior drug insurance.

Reducing the need for sedation

Training and educating care home staff about how to manage patients with dementia reduces residents’ need for antipsychotic medication by more than 50 per cent. Such ‘person-centred’ care does not increase levels of agitation or aggressive behaviour and lasts for at least 12 months. These are the findings of a new study by a team of experts led by Professor Robert Howard of the Institute of Psychiatry, Kings College, London.

Carbamazepine and its 10,11-epoxide metabolite in acute mania: clinical and pharmacokinetic correlates

The study was designed to investigate the antimanic profile of carbamazepine as a first-line drug in affective or schizoaffective disorders, to correlate the clinical efficacy with the plasma level of carbamazepine and its 10,11-epoxide metabolite, and to test the potential value of monitoring the salivary level. It was administered alone for 3 weeks to 21 acute manic inpatients. During the first week, the dosage was rapidly increased to 800 mg/day in order to produce steady-state plasma levels of carbamazepine on Day 7. The individual dose was then adjusted to maintain the therapeutic range of 8-12 mg/l. Plasma and saliva levels of the drug and its metabolite, as well as clinical status were assessed weekly. Overall, there was 62% globally improved patients and 77% in affective disorders. The improvement of manic symptoms was significantly lower in schizoaffective than in affective disorders, whereas the dropout rate and the need for antipsychotic medication was higher in the former group. The antimanic response was significantly correlated with the plasma levels both of carbamazepine and its epoxide metabolite, with a time-lag consistent with a delayed drug effect. Drug and metabolite concentrations in saliva were close to their plasma free fraction and were strongly correlated with their plasma levels, suggesting the potential value of salivary drug monitoring.