Number Of Psychotropic Drugs Research Articles

Central mechanisms of conditioned place preference in rats

The purpose of the investigation was to clear the significance of dopamine, GABA, opioids and sodium influx ionic currents of the nucleus accumbens neurons for the reinforcing effects of a number of psychotropic drugs (opiates, opioids, psychostimulants) on conditioned place preference (CPP) in rats. The microcannules were implanted into the nucleus accumbens (the extended amygdala system) of the Wistar male rats to inject the drugs studied (1 μg in 1 μl in volume for each injection). The rats were learned CPP of a one of narcogenics during 8 days. Some drugs, lidocain, a blocker of sodium influx ionic currents, antagonists of GABAA receptors bicuculline, D1 dopamine receptors SCH23390, D2 dopamine receptors sulpiride and opioid receptors naloxone, administered intrastructurally into the nucleus accumbens, were used for pharmacological analysis. The majority of the blockers studied decreased or abolished the reinforcing effects of amphetamine. Activation of reinforcement by means of fentanyl was reversed with bicuculline, lidocain and naloxone but did not change with dopamine antagonists (SCH23390 and sulpiride). None of the blockers studied effect on CPP of sodium ethaminal excluding bicuculline which reduced it. At last, the leu-enkephaline effects were reversed with naloxone and SCH23390, but strengthened with bicuculline. Sulpiride and lidocain did not effect on CPP of leu-enkephaline. Therefore, the different mechanisms (GABA-, dopamine- and opioidergic) controlling the positive conditioned reinforcement are collected in the nucleus accumbens.

Health service utilization, use of psychotropic agents and anticholinergic burden of older people with dementia in Taiwan: A nationwide 10-year cohort study

Introduction.–Taiwan is aging fast and the escalationof elderly population will result in various health care challenges to the health care system. Among all health care challenges, dementia is of particular impact to the health care system and little was known regarding to the impact of dementia on health care utilization. Methods.– A population-based random sample of 33,864 subjects aged65orolderwasobtainedasadynamiccohort. Those studysubjects who had filed at least one service claim from 2000 to 2009 for either outpatient care or inpatient carewith a principal diagnosis of dementia were identified and determine the incidence of dementia. A total of 11,915 patients with dementia and 11,915 matched controls by propensity score were identified to investigate health utilization, use of psychotropics and anticholinergic burden. Results.– The annual incidence rates of dementia increased from 0.1% to 0.19% per year from 2000 to 2009. In our matching cohort, counts of hospitalization, outpatients’ visits, length of stay (LOS) were significantly higher in dementia patients (P<0.0001). Number of psychotropic drugs and defined daily dose (DDD) including antipsychogropics, hyponotics, antidepressants and anticholinergic burden score were significantly higher in dementia group compared to control group (P<0.0001). The prescription and DDD of psychotropic drugs and anticholingergic burden were higher in dementia patients with receiving acute care compared those without receiving acute care (P<0.0001). Conclusion.– The annual incidence of dementia progressively increased from 2000–2009. Health utilization such as the counts of hospitalization, outpatient visits, LOS, theuseof psychotropicdrugs and anticholingergic burden were higher in dementia patients.

Prevention and therapy of psychopathological disorders in patients with cardiovascular diseases

Psychopathological disorders in patients with cardiovascular diseases (CVD) are treated with the methods of psychopharmacotherapy and psychotherapy used in psychiatry. The paper describes the experience in using psychopharmacotherapy in combination with and without psychotherapy in 121 patients with CVD (arterial hypertension, atrial fibrillation, coronary heart disease). The positive effect of psychopharmacotherapy is noted in 68.2% of cases and that of the latter in combination with psychotherapy is in 75.6%. There is evidence for the efficacy and tolerability of a number of psychotropic drugs. The administration of psychotropic drugs and psychotherapy are shown to result in a reduction in the incidence of exacerbations of CVD and in the number of visits to a cardiologist. Optimization of psychopharmacotherapy and psychotherapy in patients with CVD is discussed.

Retrospective Review of Clozapine in the Treatment of Patients With Autism Spectrum Disorder and Severe Disruptive Behaviors

Autism spectrum disorder (ASD) is a serious childhood-onset disorder in which social and language development are primarily affected, with associated repetitive behavior and, in some patients, behavioral symptoms including aggression and self-injury. In ASD, risperidone and aripiprazole are the only second-generation antipsychotic drugs that have shown to decrease disruptive behaviors in large-scale, controlled, double-blind studies. However, in some patients, these medications are not effective. Clozapine, a second-generation antipsychotic drug known to be effective in the treatment of aggression associated with schizophrenia, has received little attention in ASD.We conducted a retrospective analysis of the changes in disruptive behaviors for all patients with ASD treated with clozapine from 2002 to 2010. Disruptive behaviors were monitored during the 4 to 6 months before and after the initiation of clozapine. Long-term tolerance (10 months to 7 years) was also assessed. The relationship between disruptive behaviors and period of treatment (before and after clozapine) was studied with a generalized linear marginal model. Clozapine resulted in a significant 2-fold decrease in the number of the days with aggression, a decrease in the number of psychotropic drugs, and a decrease in the dose of the antipsychotic drugs. The long-term tolerance of clozapine (white blood cell count and extrapyramidal effects) was good, with the exception of significant weight gain (14.3 ± 10.9 kg), the occurrence of metabolic syndrome in 1 patient, and tachycardia in another patient.These results suggest that clozapine should be considered for the management of disruptive behaviors in patients with ASD not improved by first-line antipsychotic drugs.

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

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

Risk of Death Related to Psychotropic Drug Use in Older People During the European 2003 Heatwave: A Population-Based Case–Control Study

The authors investigated the association between death of older people and use of psychotropic drugs before and during the Western European August 2003 heatwave. A retrospective population-based case-control study was conducted using the French social security insurance national database. Exposure to psychotropic drugs in cases aged 70-100 years who died before (N = 2,093) and during (N = 9,531) the August 2003 heatwave was compared with those of survivors matched for age, gender, and presence of chronic illness, by using conditional logistic regressions. The association between death and psychotropic drug use was modified by level of external temperature (Wald chi(2) = 13.1, degree of freedom = 1, p <0.001). Use of any psychotropic drug was associated with a 30% increased risk of death during the heatwave, with a significant dose-response relationship between the number of psychotropic drugs and the risk of death (adjusted odds ratio [aOR] for linear trend 1.25, 95% confidence interval [95% CI]: 1.21-1.29). During the heatwave, therapeutic classes independently associated with an increased risk of death were antidepressants (aOR 1.71, 95% CI: 1.57-1.86) and antipsychotics (aOR 2.09, 95% CI: 1.89-2.35), whereas exposure to anxiolytics/hypnotics use (aOR 0.85, 0.79-0.91) was associated with a decreased risk. Findings remained unchanged after adjustment on cardiotropic, antidementia, or anti-parkinsonian drug use. Our findings suggest that a causal relationship may exist between psychotropic drug use during a heatwave and increased risk of death in older people. The risk/benefit ratio of antidepressant and antipsychotic drugs should be carefully assessed in older people during a heatwave.

Mitochondria Malfunction May Underlie Some Severe Psychiatric Disorders

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessMitochondria Malfunction May Underlie Some Severe Psychiatric DisordersAaron LevinAaron LevinSearch for more papers by this authorPublished Online:3 Apr 2009https://doi.org/10.1176/pn.44.7.0017aFirst there were evil spirits, then Freud and psychological theories, then neurotransmitters.Next up for consideration as a possible source of psychiatric disorder may be mitochondria, the tiny subcellular bodies that provide energy to the body's cells.A small group of researchers in Sweden, Japan, Britain, the United States, and other countries have been exploring the connection between mitochondria—especially when they are not working properly—and schizophrenia, bipolar disorder, unipolar depression, and other conditions.Any role for mitochondrial dysfunction in elevating the risk for psychiatric disorder remains a hypothesis, but a mix of clinical and laboratory work is starting to clarify the landscape.Although mitochondria were first described 120 years ago, the first mitochondrial disease was reported only in 1962. Since then, more syndromes have been reported, affecting numerous organ systems, including the brain.In addition, among their other symptoms, people diagnosed with mitochondrial disease have higher-than-usual rates of psychiatric disorders or symptoms such as depression, visual hallucinations, bipolar disorder, and anxiety, explained William Regenold, M.D., C.M., an associate professor of psychiatry at the University of Maryland School of Medicine.Regenold has been studying glucose metabolism in the brain and speculated that some psychiatric problems might be related to glucose-processing problems involving mitochondria. He and his colleagues decided to look at one biomarker of mitochondrial disease—lactate concentrations in cerebrospinal fluid (CSF)—in patients with confirmed psychiatric illness. Their paper in the March 15 Biological Psychiatry provides an indication of where the field stands and how far it has to go.Normally mitochondria in brain neurons and astrocytes produce just enough lactate to meet energy demands but not so much that it accumulates in the brain or the CSF. In people with mitochondrial disorders, however, lactate is produced anaerobically by glycolysis outside the mitochondria, which cannot adequately metabolize it, causing lactate to build up in the CSF.The Maryland researchers measured levels of lactate in the CSF taken from two groups of 15 patients, each diagnosed with schizophrenia or bipolar disorder, and also from 15 healthy controls. Individual lactate levels in the CSF varied, but significantly higher average concentrations were found in the bipolar (+34 percent) and schizophrenia (+23 percent) groups, compared with the healthy controls, said Regenold. Adjusted CSF lactate means were 1.70, 1.64, and 1.35, mmol/L for the bipolar, schizophrenia, and control groups, respectively.“This indicates that there is something different about these patients,” said Regenold, although questions remain. “We don't know if this difference occurred only at the time they were sick and in the hospital.”He also considered possible effects of medication or heredity. A number of psychotropic drugs, such as haloperidol and clozapine, show antimitochondrial effects. Twenty-three of the 30 patients were on medication, but the researchers found only a trend toward lower CSF lactate concentration (p=0.058) associated with any antipsychotic use. Also, the only significant effects of family psychiatric history came in the bipolar group in which the five subjects with a family history of psychiatric illness had higher mean lactate levels than those without such a family history.The results offer at least indirect evidence for the involvement of mitochondrial dysfunction with bipolar disorder and schizophrenia, said the researchers, who described the study as the first of its kind.That the CSF lactate levels associated with the disorders overlap means that mitochondria are not a simple, overall explanation for those psychiatric disorders but may at least play a partial role in some portion of the population, he said. A mitochondrial dysfunction hypothesis may also open a door for a new explanation of some medically unexplained somatic complaints that so commonly get sent to psychiatrists to diagnose.“We all have patients who don't fit neatly into classic DSM categories,” said Regenold, a geriatric psychiatrist. At the very least, his laboratory research has helped him look more closely at his clinic patients. “You start seeing things in patients you hadn't noticed before.”For both research and clinical purposes, Regenold would like to see a less-invasive method of measuring CSF lactate levels. Other researchers have used magnetic resonance spectroscopy to quantify those levels, but drawing the fluid with a spinal tap allows more accurate measurement than imaging so far.Although many questions about the connection between CSF lactate concentrations and psychiatric disorders remain, eventually, wrote Regenold and colleagues, “prevention and amelioration of abnormal metabolism might be an important untapped therapeutic option for some patients.”The study was partially funded by the National Institute of Mental Health.An abstract of “Elevated Cerebrospinal Fluid Lactate Concentrations in Patients With Bipolar Disorder and Schizophrenia: Implications for the Mitochondrial Dysfunction Hypothesis” is posted at<www.journals.elsevierhealth.com/periodicals/bps/article/S0006-3223(08)01404-2/abstract>.▪ ISSUES NewArchived

Psychotropic medication use and cognition in institutionalized older adults with mild to moderate dementia

Most studies examining psychotropic medication use on cognition in older persons with dementia include measures of global cognitive function. The present study examined the relationship between different types of psychotropic medication and specific cognitive functions in older people with dementia. Two hundred and six institutionalized older adults with dementia (180 women, mean age 85 years) were administered neuropsychological tests. Psychotropic medication use was extracted from their medical status and categorized as: sedatives, antidepressants and antipsychotics. Analysis of covariance revealed that psychotropic consumers, and particularly those who used antipsychotics, performed worse on neuropsychological tests of executive/attentional functioning than non-consumers. There were no differences between consumers of other classes of psychotropic drugs and non-consumers. The number of psychotropic drugs used was inversely related to executive/attentional functioning. These findings show that in institutionalized older adults with dementia, specific impairment of cognitive function, i.e. executive/attentional impairments, are associated with antipsychotic medication use. Future longitudinal studies are recommended.

Heart Disease and Depression

Back to table of contents Previous article Letters to the EditorFull AccessHeart Disease and DepressionHari Manev, M.D., PH.D., Radmila Manev, M.D., and Mladen I. Vidovich, M.D.Hari ManevSearch for more papers by this author, M.D., PH.D., Radmila ManevSearch for more papers by this author, M.D., and Mladen I. VidovichSearch for more papers by this author, M.D.Published Online:18 Apr 2008https://doi.org/10.1176/pn.43.8.0030bWe are writing to applaud Dr. Carolyn Robinowitz's president's column in the january 4 issue. We are particularly pleased with the efforts APA is making to initiate communication with the American Heart Association on the role of depression as a risk factor in cardiovascular disease.A collaborative approach by cardiologists and psychiatrists for management of cardiovascular disease is a promising and welcome development. Whereas research into possible common biological mechanisms of comorbid cardiovascular disease and depression will eventually find novel therapeutic modalities, more data are needed to verify the preliminary findings of the beneficial effects of currently used antidepressants regarding the prevention of and recovery from cardiovascular disease. Comprehensive prospective studies are under way addressing this important practical issue.Interestingly, recent national studies of gorilla health have identified an unsuspected group of subjects that might be at risk for comorbid depression and heart disease. Early this year, two Cleveland Zoo gorillas were diagnosed with heart disease and are going to be pharmacologically treated for this illness. Captivity has been known to cause behavioral distress in animals, and a number of psychotropic drugs have been used in zoos to deal with these problems. A case in point is the female gorilla Johari from the Toledo Zoo. Johari first received treatment with a selective serotonin reupdate inhibitor in 2002 to help her integrate into a group. When medication was temporarily stopped, Johari suffered the original debilitating behavioral problems. Since then, she has been on antidepressant therapy and apparently has been doing well.It is tempting to speculate that similar molecular mechanisms are at play in both humans and gorillas that link behavioral pathologies and cardiovascular disease. If ongoing clinical studies confirm the preventive action of antidepressants in subjects at risk for depression and heart disease comorbidity, gorillas might benefit as well. Or perhaps, could it be the other way around?Chicago, Ill.Drs. Hari Manev, Radmila Manev, and Mladen I. Vidovich work in the Heart and Mind Clinic, Departments of Psychiatry and Medicine/Cardiology, at the University of Illinois at Chicago. ISSUES NewArchived

Dr. Mamo Replies

Back to table of contents Previous article Next article Letters to the EditorFull AccessDr. Mamo RepliesDAVID C. MAMO M.D., M.Sc.,DAVID C. MAMO M.D., M.Sc.Search for more papers by this author,Published Online:1 Mar 2008https://doi.org/10.1176/appi.ajp.2007.07091513rAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To The Editor: We thank Dr. Poyurovsky et al. for their thoughtful comments regarding our observation of restlessness in subjects switched to aripiprazole as well as their discussion of the pathophysiological mechanisms involved. We agree that understanding these mechanisms has important implications given the association between akathisia and adverse clinical outcome. Dr. Poyurovsky et al. highlight our suggestion that aripiprazole’s relative freedom from extrapyramidal side effects may be related to the drug’s partial agonism at D 2 receptors and that the high rate of restlessness noted in our positron emission tomography study may have been an expression of akathisia. In our study, two subjects experienced clear evidence of extrapyramidal side effects (increased tone in upper extremities and acute dystonia responsive to benztropine), and five subjects reported some degree of restlessness. For the two subjects with extrapyramidal side effects, a combination of individual pharmacokinetic variability or decreased D 2 receptor reserve may be the more plausible explanation for their vulnerability to these side effects. Dr. Poyurovsky et al. further suggest that while aripiprazole’s partial agonism at the D 2 and 5-HT 1A receptors may have contributed to the low incidence of extrapyramidal side effects, this pharmacological profile does not prevent akathisia. They argue that protection from drug-induced akathisia is likely related to high 5-HT 2 binding relative to D 2 binding. While the effect of 5-HT 2 antagonism on extrapyramidal side effects remains formally untested in the literature, the antipsychotic drugs with the highest 5-HT 2 :D 2 binding ratio (risperidone and paliperidone) are actually associated with high rates of extrapyramidal side effects and akathisia, arguing against a simple 5-HT 2 protective effect. Moreover, many drugs with a variety of mechanisms have been used to manage akathisia, such as beta blockers, antihistaminics, and benzodiazepines, arguing against a pure 5-HT 2 effect. Finally, not all restlessness is akathisia. Restlessness is associated with a number of psychotropic drugs, including antipsychotics, preoperative sedatives, and antidepressants, and responds to drugs with different pharmacological profiles. The restlessness reported by patients receiving aripiprazole is often described qualitatively in more positive terms, including a feeling of increased energy and interest in a more active lifestyle. It is therefore possible that the restlessness noted in some, if not the majority, of the patients receiving aripiprazole may not be true “akathisia” but rather a state of activation induced by a central dopamine agonist effect. Given the high prevalence of this outcome as well as the potential clinical and mechanistic significance as discussed by Dr. Poyurovsky et al., restlessness occurring in the context of aripiprazole treatment deserves closer scrutiny in future studies at both the phenomenological and mechanistic levels.Toronto, Ontario, CanadaDr. Mamo’s disclosures accompany the original article.This letter (doi: 10.1176/appi.ajp.2007.07091513r) was accepted for publication in November 2007. FiguresReferencesCited byDetailsCited ByNone Volume 165Issue 3 March, 2008Pages 398-399THE AMERICAN JOURNAL OF PSYCHIATRY March 2008 Volume 165 Number 3 Metrics PDF download History Published online 1 March 2008 Published in print 1 March 2008

Indicators of choking risk in adults with learning disabilities: A questionnaire survey and interview study

Purpose. Feeding and swallowing impairments are key predictors of increased morbidity and mortality in adults with learning disabilities. This postal survey and interview study sought to identify risk factors in adults with learning disabilities who have histories of choking.Method. A total of 2000 questionnaires were sent to carers of all adults with learning disabilities registered as service users by three local health authorities. (A ‘service user’ may be using any specialist learning disability health or social care facility with day, residential or therapeutic services). Of the 674 service users for whom surveys were returned, 47 were living in hospital, 396 were living in residential or group homes and 208 were living with relatives, or in their own homes. Eighteen subjects who had reported serious or repeated episodes of choking were interviewed in depth in their residences or workplaces. Responses were subjected to frequency analyses. Personal characteristics were analysed. Choking patterns were differentiated by food texture.Results. A total of 34% of questionnaires on 674 service users were returned; 42% of respondents reported one or more choking episodes. There was a significantly greater occurrence of choking among people with more severe learning disability, with Down syndrome, people who had an incomplete dentition or were taking a greater number of psychotropic drugs. Antisocial eating habits learnt in institutional settings presented an additional choking hazard for some individuals.Conclusion. Choking is a serious hazard for many adults with learning disabilities. This study establishes many of the characteristics associated with swallowing problems in this population. Clinicians and carers should benefit from awareness of these predictors, leading to better management of eating behaviours and habits. A choking and swallowing risk assessment should be included in routine health assessments of adults with learning disability, paying especial attention to the condition of a person's teeth; possible side effects from prescribed medication, and abnormal eating behaviour.

Polypharmacy and suicide attempts in bipolar disorder

OBJECTIVE: The aim of this study was to assess the association between suicide attempts and the use of multiple drugs in patients with bipolar disorder. METHOD: One hundred sixty-nine bipolar disorder outpatients diagnosed using the DSM-IV Structured Clinical Interview were included. Demographic and socioeconomic data, number of medications currently in use, history of suicide attempts, number of years undiagnosed, age of onset and current psychiatric co-morbidities were assessed using a structured questionnaire and DSM-IV criteria. The main outcome measure was the number of psychotropic drugs currently in use. RESULTS: Approximately half of all patients (48.5%) presented a history of suicide attempt; 84% were using more than one medication, and 19% were using more than three drugs. The most frequent combinations of drugs used by these patients were: lithium + valproate (17%); lithium + antipsychotics (10%); lithium + valproate + antipsychotics (9%); and antidepressants + any drug (6%). The number of suicide attempts was associated with the use of multiple drugs. CONCLUSIONS: Our findings support the notion that the use of combination therapy in bipolar disorder may be related to severity of the BD, such as number of suicide attempts.

Polypharmacy and suicide attempts in bipolar disorder

The aim of this study was to assess the association between suicide attempts and the use of multiple drugs in patients with bipolar disorder. One hundred sixty-nine bipolar disorder outpatients diagnosed using the DSM-IV Structured Clinical Interview were included. Demographic and socioeconomic data, number of medications currently in use, history of suicide attempts, number of years undiagnosed, age of onset and current psychiatric co-morbidities were assessed using a structured questionnaire and DSM-IV criteria. The main outcome measure was the number of psychotropic drugs currently in use. Approximately half of all patients (48.5%) presented a history of suicide attempt; 84% were using more than one medication, and 19% were using more than three drugs. The most frequent combinations of drugs used by these patients were: lithium + valproate (17%); lithium + antipsychotics (10%); lithium + valproate + antipsychotics (9%); and antidepressants + any drug (6%). The number of suicide attempts was associated with the use of multiple drugs. Our findings support the notion that the use of combination therapy in bipolar disorder may be related to severity of the BD, such as number of suicide attempts.

Role of Protein Kinase C-mediated Protein Phosphorylation in Mitochondrial Translocation of Mouse CYP1A1, Which Contains a Non-canonical Targeting Signal

A large number of mitochondrial proteins lack canonical mitochondrial-targeting signals. The bimodal transport of cytochromes P450 (CYPs) to endoplasmic reticulum and mitochondria (MT), reported previously by us, likely represents one mode of non-canonical protein targeting to MT. Herein, we have studied the mechanism of mouse MT-CYP1A1 targeting to gain insight into the regulatory features and evolutionary conservation of bimodal targeting mechanism. Mouse MT-CYP1A1 consists of two NH2-terminal-truncated molecular species, +91A1 and +331A1. Mutations Pro-2 --> Leu and Tyr-5 --> Leu, which increase the signal recognition particle (SRP) binding, diminished MT targeting of the protein in intact cells. By contrast, mutations Leu-7 --> Asn and Leu-17 --> Asn, which decreased SRP-binding affinity, enhanced MT targeting, thus suggesting that SRP binding is an important regulatory step that modulates bimodal targeting. Protein kinase C (PKC)-mediated phosphorylation of nascent chains at Thr-35 vastly decreased affinity for SRP binding suggesting an important regulatory step. In support of these results, COS cell transfection experiments show that phosphomimetic mutation Thr-35 --> Asp or induced cellular PKC caused increased CYP1A1 targeting to MT and correspondingly lower levels to the endoplasmic reticulum. Results suggest evolutionary conservation of chimeric signals and bimodal targeting of CYP1A1 in different species. The mouse MT-CYP1A1 is an extrinsic membrane protein, which exhibited high FDX1 plus FDXR-mediated N-demethylation of a number of tricyclic antidepressants, pain killers, anti-psychotics, and narcotics that are poor substrates for microsomal CYP1A1.

Neuroleptic and benzodiazepine use in long-term care in urban and rural Alberta: characteristics and results of an education intervention to ensure appropriate use

To examine the use of psychotropic drugs in 24 rural and urban long-term care (LTC) facilities, and compare the effect of an education intervention for LTC staff and family members on the use of psychotropic drugs in intervention versus control facilities. Interrupted time series with a non-equivalent no-treatment control group time series. Data on drug use were collected in 24 Western Canadian LTC facilities (10 urban, 14 rural) for three 2-month time periods before and after the intervention. Pharmacy records were used to collect data on drug, class of drug, dose, administration, and start/stop dates. Chart reviews provided demographics, pro re nata (prn) use, and indications for drug use. Subjects comprised 2443 residents living in the 24 LTC facilities during the 1-year study. An average of 796.33 residents (32.7%) received a psychotropic drug. An education intervention on psychotropic drug use in LTC was offered to intervention physicians, nursing staff, pharmacists and family members. Approximately one-third of residents received a psychotropic drug during the study, often for considerable lengths of time. A minority of psychotropic drug prescriptions had a documented reason for their use, and 69.5% of the reasons would be inappropriate under Omnibus Budget Reconciliation Act (OBRA) legislation. Few psychotropic drug prescriptions were discontinued or reduced during the study. More urban LTC residents received neuroleptics and benzodiazepines than their rural counterparts (26.1% vs. 15.7%, and 18.0% vs. 7.6%, respectively). The education intervention did not result in any significant decline in the use of these drugs in intervention facilities. The results suggest substantial use of psychotropic drugs in LTC, although rural LTC residents received approximately half the number of psychotropic drugs compared with urban residents. A resource-intensive intervention did not significantly decrease the use of psychotropics. There is a need for better monitoring of psychotropic drugs in LTC, particularly given that voluntary educational efforts alone may be ineffective agents of change.

A number of psychotropic drugs are useful in treating the various neuropsychiatric symptoms of fragile X syndrome

A number of psychotropic drugs are useful in treating the various neuropsychiatric symptoms of fragile X syndrome

Valproate Lowers Plasma Concentrations of Olanzapine

Olanzapine is an atyical antipsychotic from the thienobenzodiazapine group which is metabolized mainly in the liver and after N-glucuronidation it is catalyzed by oxidation reactions via the cytochrome P450 isoenzyme CYP1A2 and – to a lesser degree – via CYP2D6. Whereas data on the interaction of olanzapine with a number of psychotropic drugs are available, little is known about the effect of valproate on the plasma concentrations of olanzapine, although a combination of the two substances may be indicated and recommended in treating, for example, manic and mixed bipolar disorders. Therefore, we wanted to investigate whether valproate has a clinically relevant effect on the plasma concentration of olanzapine under naturalistic conditions.

Myocardiopathie réversible induite par les médicaments psychotropes À propos d’un cas, revue de la littérature

A number of psychotropic drugs, including tricyclic antidepressants, phenothiazines and lithium, have a well demonstrated risk of cardiotoxicity. Each individual therapeutic class has potentially deleterious effects on electrophysiology and myocardial function. The authors report a case showing how serious side effects may result from the association of these different classes in the presence of a coexistent heart disease, even when the underlying disease is mild.

Acute akathisia and sodium valproate

Akathisia is a common and distressing side-effect of a number of psychotropic drugs, including neuroleptic medication. We report the case of a 38-year-old woman who suffers from bipolar affective disorder and developed acute akathisia following the introduction of sodium valproate as a mood stabilizer. The medication regimen at the onset of her akathisia is described and discussed with particular reference to the aetiology of her akathisia. It is not possible to say with certainty if her acute akathisia developed as a sole consequence of sodium valproate treatment or as a consequence of a possible synergistic effect of her other psychotropic medication, but a sodium-valproate-induced functional dopaminergic antagonism mediating her acute akathisia appears likely.

Characteristics of Patients who Receive Electroconvulsive Therapy

Case records of all non-forensic psychiatric admissions (n = 5,729), over a three year period, to all the inpatient psychiatric facilities, within one geographic area were studied on a number of demographic, clinical, and treatment characteristics. Patients who had received E.C.T. were compared with those who did not receive tis treatment. The results showed that a high proportion (21%) had received E.C.T. In comparison with patients not receiving E.C.T., E.C.T. recipients were significantly older, more often female, had greater number of previous admissions, greater incidence of violent behaviour, and longer stays in hospital. E.C.T. patients did not differ from others on social class, education, and marital status, nor was E.C.T. prescribed more often to patients who had demonstrated suicidal behaviour, even if they had a diagnosis of depression. E.C.T. and non E.C.T. patients received an equal number of psychotropic drugs.