Psychiatric Medication Prescription Research Articles

Psychiatric Disorders and Treatment Among Newly Homeless Young Adults With Histories of Foster Care

Although foster care placement is often preceded by stressful events such as child abuse, foster care itself often exposes children to additional severe stressors. A history of foster care, as well as the childhood abuse that often precedes it, is common among homeless young adults. This study examined whether a history of foster care was associated with psychiatric disorders, prior psychiatric counseling, prescription of psychiatric medications, and prior psychiatric hospitalization among newly homeless young adults. A consecutive sample of 423 adults aged 18 to 21 years who sought emergency shelter for the first time between October 1, 2007, and February 29, 2008, were assessed at intake. Logistic regression analyses determined the associations between foster care and any psychiatric disorder (affective, anxiety, personality, and psychotic) and psychiatric treatment. The analyses adjusted for demographic characteristics, childhood abuse, substance use, prior arrest, unemployment, lack of high school diploma, and histories of psychiatric disorders and drug abuse among biological relatives. Homeless young adults with histories of foster care were 70% more likely than those without such histories to report any psychiatric disorder. They were more than twice as likely to have received mental health counseling for a psychiatric disorder, to have been prescribed psychiatric medication, and to have been hospitalized for psychiatric problems. Histories of foster care among homeless young adults should trigger screening for psychiatric disorders to aid in the provision of treatment (counseling, medication, and hospitalization) tailored to the psychiatric needs of this highly vulnerable population.

Association Between Traumatic Injury and Psychiatric Disorders and Medication Prescription to Youths Aged 10–19

Association Between Traumatic Injury and Psychiatric Disorders and Medication Prescription to Youths Aged 10–19

Factors Associated with Mental Health Court Nonparticipation and Negative Termination

Mental health court outcomes research shows moderate success in reducing criminal recidivism. Far less research concentrates on defendants who do not choose to participate or are negatively terminated. Eight years of data from a suburban Midwestern mental health court indicate that substance abuse history and having multiple psychiatric diagnoses increased the odds of nonparticipation, while a bipolar diagnosis, the other category of diagnosis, and referral source, decreased the odds. For those negatively terminated, being male, racial minority status, having multiple diagnoses, a charge of stealing, and committing a new crime while under Municipal Mental Health Court supervision increased the odds of negative termination. A substance abuse history, increased mental health court attendance, receiving disability income, and psychiatric medication prescription decreased the odds of negative termination. Implications for policy, practice, and future research are discussed, including better engagement strategies for participation and treatment.

Reasons for psychiatric medication prescription for new nursing home residents

Objectives: This article focuses on justification of psychoactive medication prescription for NH residents during their first three months post-admission. Method: We extracted data from 73 charts drawn from a convenience sample of individuals who were residents of seven nursing homes (NHs) for at least three months during 2009. Six focus groups with NH staff were conducted to explore rationales for psychoactive medication usage. Results: Eighty-nine percent of the residents who received psychoactive medications during the first three months of residence had a psychiatric diagnosis, and all residents who received psychoactive medications had a written physician's order. Mental status was monitored by staff, and psychoactive medications were titrated based on changes in mental status. One concern was that no Level II Preadmission Screening and Annual Resident Review (PASRR) evaluations were completed during the admissions process. Further, while 73% had mental health diagnoses at admission, 85% of the NH residents were on a psychoactive medication three months after admission, and 19% were on four or more psychoactive medications. Although over half of the residents had notes in their charts regarding non-psychopharmacological strategies to address problem behaviors, their number was eclipsed by the number receiving psychopharmacological treatment. Conclusions: While the results suggest that NHs may be providing more mental health care than in the past, psychopharmacological treatment remains the dominant approach, perhaps because of limited mental health training of staff, and lack of diagnostic precision due to few trained geriatric mental health professionals. A critical review of the role of the PASRR process is suggested.

Neighborhood Deprivation and Psychiatric Medication Prescription: A Swedish National Multilevel Study

Previous studies of neighborhood deprivation and mental disorders have yielded mixed results, possibly because they were based on different substrata of the population. We conducted a national multilevel study to determine whether neighborhood deprivation is independently associated with psychiatric medication prescription in a national population. Nationwide outpatient and inpatient psychiatric medication data were analyzed for all Swedish adults (N = 6,998,075) after 2.5 years of follow-up. Multilevel logistic regression was used to estimate the association between neighborhood deprivation (index of education, income, unemployment, and welfare assistance) and prescription of psychiatric medications (antipsychotics, antidepressants, anxiolytics, or hypnotics/sedatives), after adjusting for broadly measured individual-level sociodemographic characteristics. For each psychiatric medication class, a monotonic trend of increasing prescription was observed by increasing level of neighborhood deprivation. The strongest associations were found for antipsychotics and anxiolytics, with adjusted odds ratios of 1.40 (95% confidence interval [CI], 1.36-1.44) and 1.24 (95% CI, 1.22-1.27), respectively, comparing the highest- to the lowest-deprivation neighborhood quintiles. These findings suggest that neighborhood deprivation is associated with psychiatric medication prescription independent of individual-level sociodemographic characteristics. Further research is needed to elucidate the mechanisms by which neighborhood deprivation may affect mental health and to identify the most susceptible groups in the population.

Association Between Traumatic Injury and Psychiatric Disorders and Medication Prescription to Youths Aged 10–19

Objective: Few clinical epidemiologic investigations have assessed whether youths exposed to a traumatic injury demonstrate elevations in the full spectrum of provider-recognized psychiatric disorders compared with unexposed, noninjured youths. Methods: In a population-based prospective cohort study, data for children and adolescents aged ten to 19 who were enrolled in the Group Health Cooperative health plan were screened for injury visits in the index year of 2001 (N=20,507). Psychiatric diagnoses, including anxiety and acute stress, depressive, substance use, and disruptive behavior disorders, given to these youths over the next three years (2002–2004) were documented, as were psychotropic medication prescriptions. Regression analyses assessed for an independent association between injury and psychiatric disorders and prescription of psychotropic medication. Results: In adjusted regression analyses, injury in the index year was independently associated with significantly increased odds of receiving a diagnosis of anxiety or acute stress (odds ratio [OR]=1.21, 95% confidence interval [CI]=1.02–1.44), depression (OR=1.30, CI=1.10–1.53), and a substance use disorder (OR=1.56, CI=1.21–2.00) and of receiving a psychotropic medication prescription (OR=1.37, CI=1.20–1.57). Youths with traumatic brain injuries also were significantly more likely to receive psychotropic medication prescriptions. Conclusions: Traumatic injury was independently associated with an increased risk of receiving a full spectrum of anxiety, depressive, and substance use diagnoses among youths aged ten to 19. Population-based surveillance procedures that incorporate screening and stepped-care interventions targeting the spectrum of postinjury emotional disturbances have the potential to improve the quality of mental health care for youths treated in general medical settings. (Psychiatric Services 62:264–271, 2011)

Association Between Traumatic Injury and Psychiatric Disorders and Medication Prescription to Youths Aged 10–19

Few clinical epidemiologic investigations have assessed whether youths exposed to a traumatic injury demonstrate elevations in the full spectrum of provider-recognized psychiatric disorders compared with unexposed, noninjured youths. In a population-based prospective cohort study, data for children and adolescents aged ten to 19 who were enrolled in the Group Health Cooperative health plan were screened for injury visits in the index year of 2001 (N=20,507). Psychiatric diagnoses, including anxiety and acute stress, depressive, substance use, and disruptive behavior disorders, given to these youths over the next three years (2002-2004) were documented, as were psychotropic medication prescriptions. Regression analyses assessed for an independent association between injury and psychiatric disorders and prescription of psychotropic medication. In adjusted regression analyses, injury in the index year was independently associated with significantly increased odds of receiving a diagnosis of anxiety or acute stress (odds ratio [OR]=1.21, 95% confidence interval [CI]=1.02-1.44), depression (OR=1.30, CI=1.10-1.53), and a substance use disorder (OR=1.56, CI=1.21-2.00) and of receiving a psychotropic medication prescription (OR=1.37, CI=1.20-1.57). Youths with traumatic brain injuries also were significantly more likely to receive psychotropic medication prescriptions. Traumatic injury was independently associated with an increased risk of receiving a full spectrum of anxiety, depressive, and substance use diagnoses among youths aged ten to 19. Population-based surveillance procedures that incorporate screening and stepped-care interventions targeting the spectrum of postinjury emotional disturbances have the potential to improve the quality of mental health care for youths treated in general medical settings.

Preterm birth and psychiatric medication prescription in young adulthood: a Swedish national cohort study

Recent studies suggest an increased risk of adverse mental health outcomes among young adults who were born preterm. These studies have been based mainly on hospital data, thus missing large numbers of mental health problems that do not require inpatient treatment. We used national outpatient and inpatient pharmacy data to evaluate whether individuals who were born preterm were more likely to be prescribed psychiatric medications during young adulthood than individuals who were born full term. A national cohort of all infants born in Sweden from 1973 through 1979 [N = 635,933, including 28,799 who were born preterm (<37 weeks)] was followed to ages 25.5-34.0 years to determine whether psychotropic medications (antidepressants, antipsychotics, anxiolytics, hypnotics/sedatives and/or psychostimulants) were prescribed in 2005-06. A trend of increasing rate of prescriptions for antipsychotics, antidepressants and hypnotics/sedatives in young adulthood was observed by earlier gestational age at birth. Young adults who were extremely preterm at birth (23-27 weeks) were 3.1 times more likely to be prescribed antipsychotics [95% confidence interval (CI) 1.66-5.93], 1.8 times more likely to be prescribed antidepressants (95% CI 1.26-2.64) and 1.8 times more likely to be prescribed hypnotics/sedatives (95% CI 1.15-2.96) than individuals who were full term at birth, after adjusting for potential confounders. This national cohort study, using outpatient and inpatient pharmacy data, suggests that preterm birth has important independent effects on mental health that extend at least into young adulthood.

Antidepressant-induced suicide, violence and mania: Risks for military personnel

The newer antidepressants frequently cause suicide, violence and manic-like symptoms of activation or over- stimulation, presenting serious hazards to active duty soldiers who carry weapons under stressful conditions. These antidepressant-induced symptoms of activation can mimic Post Traumatic Stress Disorder (PTSD) and are likely to worsen this common disorder in soldiers, increasing the hazard when they are prescribed to military personnel. Antidepressants should not be prescribed to soldiers during or after deployment. Recently concern has been expressed about the increased prescription of psychiatric medications, especially antidepressants, to military personnel (46, 57). In presentations at military conferences on combat stress (8, 10) and in testimony before the U.S. House of Representatives Veterans Affairs Committee (9), I have pointed to a probable causal relationship between increasing rates of antidepressant prescription and increasing rates of suicide in the military. This paper reviews and evaluates the relevant scientific data.

Population Psychiatric Medication Prescription Rates following a Terrorist Attack

While several population-based studies have documented behavioral health disturbances following terrorist attacks, a number of mental health service utilization analyses present conflicting conclusions. The purpose of this study was to determine if mental health service utilization increased following a terrorist attack by assessing changes in psychoactive drug prescription rates. The rate of selective serotonin reuptake inhibitor (SSRI) prescriptions was measured among New York State Medicaid enrollees before and after the terrorist attacks of 11 September 2001. The association between geographic proximity to the events and changes in the rate of SSRI prescriptions around 11 September 2001 was assessed. From September to December 2001, among individuals residing within three miles of the World Trade Center site, there was an 18.2% increase in the SSRI prescription rate compared to the previous eight-month period (p = 0.0011). While there was a 9.3% increase for non-New York City residents, this change was not statistically significant (p = 0.74). There was a quantifiable increase in the dispensing of psychoactive drugs following the terrorist attacks of 11 September 2001, and this effect varied by geographic proximity to the events. These findings build on the growing body of knowledge on the pervasive effects of disasters and terrorist events for population health, and demonstrate the need to include mental and behavioral health as key components of surge capacity and public health response to mass traumas.

Perceived Effectiveness of Medications Among Mental Health Service Users With and Without Alcohol Dependence

Perceived Effectiveness of Medications Among Mental Health Service Users With and Without Alcohol Dependence

In search of certainty: risk management in a biological age

The combination of heightened emphasis on risk and its management in mental health, the precautionary principle, the idea of genetic susceptibility, advances in screening technology, and the promise of preventive pharmaceutical intervention is highly potent, especially in a world in which preventive prescription of psychiatric medication has become routine. Psychiatric professionals are given the obligation of governing, and being governed, in the name of risk, and in a political and public sphere suffused by the dread of insecurity. But there are risks in seeking to govern risk in a biological age. In this paper Nikolas Rose argues that the public, politicians and professionals alike might do better to refuse the demands of risk, and learn to live with uncertainty.

Género y psicofármacos: la opinión de los prescriptores a través de una investigación cualitativa

To find the views of those filling out prescriptions on the factors that affect differential prescription of psychiatric medication, and on reducing the prescription; and to analyse their discourse for possible implicit gender bias. Qualitative methodology. Semi-structured interviews conducted in 2002-2003. Urban and rural health centres. Family and community medicine and psychiatry professionals working in the public health services of Andalusia, the Community of Madrid, and the Basque Country. Segmentation criteria: community of residence, age, sex, medical speciality, and location of centre. Structural sample. Interviews conducted by the research team. Strategy of analysis in two distinct processes: contents analysis with agreed categories and gender analysis of the discourse. RESULTS. The prescribers found that taking psychiatric medication was associated with sex, age, social and economic category, and social expectations. In the discourses we found consumer profiles emerging that were not found in the epidemiological literature. Discourse analysis showed implicit gender bias in the beliefs of some prescribers. CONCLUSIONS. To minimise the growing offer and demand for psychiatric medication, prescribers thought training in diagnosis and psychotherapy should be improved, case-loads should be reduced, co-ordination between services improved and alternative treatments favoured. To minimise gender bias in the diagnosis and prescription of psychiatric medication, we think training is needed on the influence of cultural and gender factors on the process of construction of identities.

Psychiatric illness after mild traumatic brain injury in children

Massagli TL, Fann JR, Burington BE, Jaffe KM, Katon WJ, Thompson RS. Psychiatric illness after mild traumatic brain injury in children. Arch Phys Med Rehabil 2004;85:1428–34. Objective To determine the incidence of psychiatric illness 3 years after mild traumatic brain injury (TBI) in children. Design Prospective cohort study with 3-year follow-up. Setting Emergency department, hospital, and outpatient clinics in a large health maintenance organization. Participants Children, 14 years old or less (n=490), who sustained a mild TBI in 1993. Three TBI unexposed subjects per TBI exposed patient were matched by sex, age, and enrollment at the time of injury (n=1470). Interventions Not applicable. Main outcome measures Computerized records were examined to identify psychiatric diagnoses, psychiatric medication prescription, and utilization of psychiatric services for the year before TBI and 3 years after. Adjusted relative risks for incidence of psychiatric illness were estimated for those with and without a premorbid psychiatric disorder. Results The cumulative incidence estimates for any psychiatric illness in the 3 years after mild TBI were 30% in children exposed to mild TBI and 20% in unexposed children ( P=.0001). Cumulative incidence estimates were particularly high in both TBI exposed (55%) and unexposed children (63%) who had psychiatric illness in the year before the index TBI (psychiatric history). The exposed and unexposed children with psychiatric history did not have significantly different estimates of incidence during follow-up for any of the studied indicators of psychiatric illness. In those with no psychiatric history, 26% of exposed and 16% of unexposed children ( P<.0001) had evidence of a psychiatric illness in the 3 years after mild TBI. For those with no psychiatric history, the adjusted relative risk estimate of any psychiatric illness in TBI exposed versus unexposed children, in the first year after TBI, was 2.03 (95% confidence interval [CI], 1.4–2.9). Children with mild TBI but no psychiatric history were at higher risk for hyperactivity (diagnosis of hyperkinetic syndrome of childhood or prescription of psychostimulants) in the first year after injury (incidence, 3%; first year relative risk, 7.59; 95% CI, 2.7–21.6). Conclusions In the 3 years after mild TBI, children with no evidence of prior-year psychiatric history were at significantly increased risk for psychiatric illness, particularly hyperactivity in the first year after injury. Prior-year psychiatric history conferred a significant independent risk for subsequent psychiatric illness. There was no evidence for an additional increase in risk in the 3-year follow-up that is attributable to mild TBI in children with prior psychiatric history.

Predictors of Mental Health and Medical Service Use in Veterans Presenting With Combat-Related Posttraumatic Stress Disorder.

Predictors of health service use were assessed using archival data of 87 male combat veterans with combat posttraumatic stress disorder (PTSD) at an outpatient Veterans Affairs Medical Center PTSD clinic. Predictor variables included predisposing demographic, illness/need, and enabling resource variables. Criterion variables included indexes of health service use. Results revealed no significant predictors of PTSD-related or primary care health service consumption. Lower scores on measures of symptom overreporting and anxiety predicted specialty care service use. Race (Caucasian) and marital status (currently married) predicted prescription of psychiatric medications. Clinical implications are considered, with a focus on the impact of racial group status as well as symptom exaggeration on health service utilization in PTSD patients.

Psychiatric illness and subsequent traumatic brain injury: a case control study

Objective: To determine whether psychiatric illness is a risk factor for subsequent traumatic brain injury (TBI). Methods: Case control study in a large staff model health maintenance organisation in western...

The use of concomitant medications in psychiatric inpatients treated with either olanzapine or other antipsychotic agents: A naturalistic study at a state psychiatric hospital

Concomitant medications are frequently used in the treatment of resistant psychiatric conditions to augment the primary psychotropic agent or to ameliorate side effects. The present study evaluated the prescription of concomitant psychiatric medications for psychiatric inpatients that were prescribed either olanzapine at its first commercial availability or another first-line antipsychotic agent. Sixty-nine newly admitted patients (mainly with schizophrenia) who were prescribed either olanzapine ( n=35) or another first-line antipsychotic agent ( n=34) were assessed (for the prescription of other concomitant psychotropic drugs) before (2–4 weeks prior to study) and following 8 weeks of treatment (unless discharged sooner). The results indicate that significantly fewer olanzapine-treated subjects were prescribed anticholinergic agents as compared to those prescribed other first-line antipsychotic agents, and a similar trend was noted in the prescription of mood stabilizers as well. Olanzapine-treated subjects used less as needed (PRN) antipsychotic medication compared to pre-olanzapine treatment period. Olanzapine-treated subjects used more anxiolytic agents compared to the control group in the early stages of treatment, probably due to the greater baseline severity of illness. These data suggest that olanzapine use is associated with less use of anticholinergic and mood-stabilizing agents as compared to older antipsychotic agents. These results also suggest that there is less need for PRN antipsychotic medication following olanzapine treatment. More severely ill subjects may require more anxiolytics during olanzapine initiation. The need for less anticholinergic and mood-stabilizing agent use with olanzapine could lead to greater adherence to long-term treatment and perhaps decreased cost (i.e. use of blood and organ system monitoring with mood stabilizers). At the end of treatment, olanzapine-treated subjects had statistically significantly lesser concomitant medicine usage compared to control subjects.

Treatment of depression in older primary care patients in health maintenance organizations.

To examine whether older HMO patients with depression are treated differently than younger patients in terms of diagnosis, treatment by specialty provider, and pharmacotherapy. Chart-review, Cross sectional study. Patients were selected from six HMOs in the United States who had one or more of five medical diagnoses: arthritis, asthma, otitis media, epigastric pain/ulcer, and hypertension, (n = 9143). From this group, chart diagnoses and pharmacy records were used to identify patients who also had a diagnosis of depression (n = 416) or who had a diagnosis of depression and/or treatment with antidepressant medication (n = 1286). Medical records and computerized service and pharmacy records were reviewed to obtain diagnoses, office visits by provider type, and psychiatric medication prescription counts. Significant differences were found in treatment of depression for older versus younger patients. Although depression was identified at a similar rate for both groups, older patients received fewer mental health specialty visits and fewer prescriptions for SSRI antidepressants. Older patients with a diagnosis of depression were more likely to be treated with benzodiazepines (49.2% of older vs. 33.2% of younger) though they were less likely to receive long half-life benzodiazepines. Psychotropic medication management is an important target for improving quality of care for older patients with depression in HMOs. Decreasing inefficient minor tranquilizer use and increasing use of newer antidepressant medications may lead to improved outcomes for older depressed adults.

Assessing the Appropriateness of the Prescription of Psychiatric Medications in Prison

Although critics have argued that psychiatric medications in correctional settings are often prescribed in a clinically irrational manner, without adequate diagnostic criteria, and for the purposes of coercive control rather than treatment, there has been no systematic research in an attempt to validate these claims. The present study examines the influence of inmate clinical and social characteristics, as well as prison setting factors, on the prescription of psychiatric medication to New York State prison inmates. Study findings show that clinical characteristics predominate in the psychiatric medication prescription process. Specifically, psychiatric impairments, measured in terms of levels of depression, manifest symptomatology, agitation, and prior psychiatric hospitalization were found to be highly significant predictors of drug prescription. This finding suggests clinically appropriate use. Some researchers have suggested that the influence of patient social characteristics on psychiatric treatment is greatest when patient symptomatology is less severe. The conditional effect of inmate social characteristics on drug prescription was examined by levels of inmate impairment, and differences were found. The decision to prescribe medication for mildly impaired inmates appears to be influenced by social factors. However, when an inmate's behavior is unquestionably bizarre or disruptive, social status characteristics are less likely to influence physicians' clinical judgments.

The prescription of psychiatric medications in prison: Psychiatric versus labeling perspectives

Critics have argued that psychiatric medications in correctional settings are often prescribed in a clinically irrational manner, without adequate diagnostic criteria, and for the purposes of coercive control rather than treatment. The present study examines the influence of inmates' clinical and social characteristics, as well as prison-setting factors, on the prescription of psychiatric medication to New York State prison inmates. Psychiatric impairments, measured in terms of levels of depression, manifest symptomatology, agitation, and prior psychiatric hospitalization, were found to be highly significant predictors of drug prescription. The decision to prescribe medication for mildly impaired inmates appears to be influenced by social factors. When an inmate's behavior is unquestionably bizarre or disruptive, however, social status characteristics are less likely to influence physicians' clinical judgments.