Prevalence Of Psychotropic Medication Research Articles

Trends in the Prevalence of Psychotropic Medications in Children in China from 2013 to 2016

Trends in the Prevalence of Psychotropic Medications in Children in China from 2013 to 2016

Prevalence of psychotropic medication and factors associated with antipsychotic treatment in adults with intellectual disabilities: a cross-sectional, epidemiological study in Germany.

Mental health services in people with intellectual disabilities (ID) are frequently limited to psychotropic medication (PM), especially antipsychotics. The objectives of this study were to assess the prevalence rates of PM treatment in adults with ID in Germany and to identify factors associated with antipsychotic treatment. This study is an epidemiological, cross-sectional study. Sampling was realised by a random selection of service-providing institutions, followed by a random selection of adults with ID within these participating institutions. Interviews were conducted with formal and informal carers of n=197 adults with ID. Data were analysed using descriptive statistics and risk ratios. The 4-week prevalence rate of PM was 53.8%. Antipsychotics were the most frequent PM (43.7%). Polypharmacy and off-label use were common. Antipsychotic treatment is associated with living in a residential home [relative risk (RR)=2.99], not working in a sheltered workshop (RR=1.46), autism spectrum disorder (RR=1.89), a documented psychiatric diagnosis (RR=1.61), psychiatric symptomatology (RR=1.44) and (mild) challenging behaviours (RR=4.58). Further efforts are needed to provide adequate mental health care, specifically to improve PM treatment regarding amount, indication and the consideration of non-psychopharmacological treatment options.

Psychotropic medications in older people in residential care facilities and associations with quality of life: a cross-sectional study

BackgroundPsychotropic medications have been associated with many adverse outcomes in older people living in residential care. Home-like models of residential care may be preferable to traditional models of care and we hypothesized that this model may impact on the prevalence of psychotropic medications. The objectives were to: 1) examine associations between psychotropic medications and quality of life in older adults living in residential care facilities with a high prevalence of cognitive impairment and dementia and 2) determine if there was a difference in prevalence of psychotropic medications in facilities which provide a small group home-like model of residential care compared to a ‘standard model’ of care.MethodsParticipants included 541 residents from 17 residential aged care facilities in the Investigating Services Provided in the Residential Environment for Dementia (INSPIRED) study. Cross-sectional analyses were completed to examine the above objectives. Quality of life was measured with the dementia quality of life questionnaire (DEMQOL) and the EQ-5D-5L completed by the resident or a proxy.ResultsOverall, 70.8% (n = 380) of the population had been prescribed/dispensed at least one psychotropic medication in the 100 days prior to recruitment. An increased number of psychotropic medications was associated with lower quality of life according to DEMQOL-Proxy-Utility scores (β (SE): − 0.012 (0.006), p = 0.04) and EQ-5D-5L scores (− 0.024 (0.011), p = 0.03) after adjustment for resident-level and facility-level characteristics. Analysis of the individual classes of psychotropic medications showed antipsychotics were associated with lower DEMQOL-Proxy-Utility scores (− 0.030 (0.014), p = 0.03) and benzodiazepines were associated with lower EQ-5D-5L scores (− 0.059 (0.024), p = 0.01). Participants residing in facilities which had a home-like model of residential care were less likely to be prescribed psychotropic medications (OR (95% CI): 0.24 (0.12, 0.46), p < 0.001).ConclusionsAn increased number of psychotropic medications were associated with lower quality of life scores. These medications have many associated adverse effects and the use of these medications should be re-examined when investigating approaches to improve quality of life for older people in residential care. Home-like models of residential care may help to reduce the need for psychotropic medications, but further research is needed to validate these findings.

PSYCHOTROPIC MEDICATIONS AND QUALITY OF LIFE IN RESIDENTIAL AGED CARE FACILITIES

Recent clinical recommendations state that many psychotropic medications should be avoided wherever possible in people with cognitive impairment and dementia. Psychotropic medications have been associated with increased risk of falls, hospitalization, stroke and mortality in residents of aged care facilities. The objective of this study was to examine associations between psychotropic medications and quality of life in older adults living in residential care facilities. The population was from a cross-sectional study of 537 residents from 17 different residential aged care facilities in Australia, with a high prevalence of cognitive impairment and dementia. Overall, 70.8% (n=380) of the population had been prescribed/dispensed at least one psychotropic medication in the 100 days prior to recruitment. Participants residing in facilities which had adopted a person-centred, ‘cottage model’ of residential care had a lower prevalence of psychotropic medications (OR (95% CI): 0.26 (0.14, 0.52), p<0.001). An increased number of psychotropic medications were associated with poorer quality of life according to DEMQOL-Proxy-Utility scores (β (SE): -0.012 (0.006), p=0.03) and EQ-5D-5L scores (-0.026 (0.011), p=0.02) after adjustment for resident-level and facility-level characteristics. Analysis of the individual classes of psychotropic medications showed antipsychotics were associated with poorer DEMQOL-Proxy-Utility scores (-0.030 (0.013), p=0.03) and benzodiazepines were associated with poorer EQ-5D-5L scores (-0.062 (0.024), p=0.01). In conclusion, an increased number of psychotropic medications were associated with poorer quality of life. These medications have many adverse effects and the use of these medications should be re-examined when investigating approaches to improve quality of life for older people in residential care.

Eight-Year Trends in the Use of Opioids, Other Analgesics, and Psychotropic Medications Among Institutionalized Older People in Finland

ImportanceIt is recognized that pain has been undertreated and psychotropic medications overused in institutional settings. ObjectiveTo investigate the change in prevalence of opioids, other analgesics, and psychotropic medications in institutional settings over an 8-year period. SettingsInstitutional settings in Helsinki, Finland. ParticipantsOlder residents in nursing homes in 2003 (n = 1987) and 2011 (n = 1576) and in assisted living facilities in 2007 (n = 1377) and 2011 (n = 1586). Outcome MeasuresComparable audits of medication use were conducted among institutionalized residents at 3 time points over 8 years. The prevalence of regular opioid, other analgesic, and psychotropic medications was compared across the 3 time periods. ResultsNursing home and assisted living facility residents were older; more disabled, had a higher prevalence of dementia, and greater comorbidity in the latter cohorts. The prevalence of regular opioid use was 11.8% and 22.9% in nursing homes in 2003 and 2011 (P < .001), and 8.6% and 17.3% in assisted living facilities in 2007 and 2011 (P < .001), respectively. The prevalence of regular acetaminophen and pregabalin/gabapentin increased and NSAIDs decreased in both nursing homes and assisted living facilities. The prevalence of regular antipsychotic use decreased from 42.6% to 27.8% in nursing homes (P < .001) but increased from 26.9% to 32.0% in assisted living facilities (P = .0017). The mean number of psychotropic medications (antipsychotics, antidepressants, anxiolytics, hypnotics) per resident decreased from 1.9 in 2003 to 1.0 in 2011 in nursing homes (P < .001) but increased from 1.1 to 1.2 in assisted living facilities (P = .040). ConclusionsThe prevalence of opioid use in institutional settings has doubled during the past decade. The prevalence of psychotropic medications has decreased in nursing homes but increased in assisted living facilities. The increase in opioid use may reflect improved recognition and treatment of pain. However, initiatives are needed to monitor opioid-related adverse drug events and ensure appropriate use of psychotropic medications, particularly in assisted living facilities.

Impact of Pregnancy on Psychotropic Medication Prescription: a French Cohort Study

ObjectivesTo determine if and when prescription of psychotropic medication in women is modified by pregnancy. MethodPsychotropic prescription of 87 213 pregnant women affiliated with the French General Health System was examined. Period of analyses lasted 17 months to cover 4 months before and after pregnancy. A comparable cohort of 87 213 non pregnant women constituted the control group. ResultsMore than half of pregnant women to whom a psychoactive drug was prescribed were novel users during all three trimesters and after delivery. Prevalence of psychotropic medication before pregnancy is comparable to that of non-pregnant women. Rate of psychotropic medication during the peripartum stayed high, even though it decreased by half during the first trimester, showing a “pregnancy impact effect”. ConclusionsData show a dramatic impact of pregnancy. More information on specific patterns of prescription needs to be gained in order to establish decision-making models for psychotropic prescription during pregnancy.

Trends in the use of psychotropic drugs in people with intellectual disability in Taiwan: A nationwide outpatient service study, 1997–2007

This study aims to examine trends in outpatient psychotropic drug use among people with intellectual disabilities in Taiwan. The NHI outpatient medication records between January 1, 1997 and December 31, 2007 for people with intellectual disabilities were analyzed to observe the percent change, prevalence and prescription trends in psychotropic drugs. The overall prevalence of psychotropic medication increased from 17.82% to 23.22% during the study period. Results from stepwise logistic analysis demonstrated that females, the elderly, and individuals suffering from catastrophic disease were more prone to receive psychotropic drugs and that those with mild intellectual disability were less likely to receive psychotropic drugs. The percentage change in prescription rates of antipsychotics, hypnotics/sedatives, and antidepressants were 85.30%, 127.25%, and 167.50%, respectively, and the trends were statistically significant (p<0.05). Taiwan's NHI program and off-label use of psychotropic drugs might have attributed to this trend.

Prevalence of Psychotropic Medication Use among German and Austrian Nursing Home Residents: A Comparison of 3 Cohorts

Despite increasing knowledge about the limited effectiveness and severe adverse effects, the prescription rate of psychotropic medications in frail elderly persons remains high. Prescriptions are mainly made to control behavioral and psychological symptoms of dementia, although factors associated with prescriptions are rarely reported. However, such information is a prerequisite to develop intervention programs aiming to safely reduce psychotropic medication in nursing home residents. We report the comparison of cross-sectional data of psychotropic medication prescription rates from 3 large studies including nursing home residents in Germany and Austria. We aimed to compare the prevalence of (1) psychotropic medication, (2) different classes of psychotropic medication, (3) psychotropic medication administered for bedtime use, and (4) associations between prescription of psychotropics and institutional and residents' characteristics. Confidence intervals of prevalences and multiple logistic regression analyses were adjusted for cluster correlation. Data from 5336 residents in 136 long term care facilities were included. In Austria, 74.6% (95% CI 72.0-77.2%) of all residents had a prescription of at least one psychotropic medication compared to Germany with about 51.8% (95% CI 48.3-55.2%) and 52.4% (95% CI 48.7-56.1%). Of all antipsychotics, 66% (Austria) and 47% (Germany) were prescribed for bedtime use. Most prescriptions were conventional, low-potency antipsychotics. In all 3 studies, there was no statistically significant association between psychotropic medication prescription and nursing home characteristics. On the level of residents, consistent positive associations were found for higher level of care dependency and permanent restlessness. Consistent negative associations were found for older age and male gender. Frequency of psychotropic and especially antipsychotic medication is substantial in nursing home residents in Germany and Austria. The high number of prescriptions is likely to be an indicator for a perceived or actual lack of strategies to handle behavioral and psychological symptoms of dementia.

Psychotropic Medication in Children and Adolescents in Germany: Prevalence, Indications, and Psychopathological Patterns

The aim of this study was to identify the "real-life" prevalence of psychotropic medications in children and adolescents in Germany and related behavioral and emotional problems. Data from the nationwide representative National German Health Interview and Examination Survey for Children and Adolescents (KiGGS) were analyzed. A total of 17,450 subjects aged 0-17 years from 167 communities were examined as part of the KiGGS in Germany between 2003 and 2006 to determine their use of antidepressants, antipsychotics, anxiolytics, and sedatives within the 7 days prior to being interviewed. Medication use was assessed by a medical doctor who conducted a computer-assisted personal interview (CAPI) with the parents, and related emotional and behavioral problems were assessed using the Strength and Difficulties Questionnaire (SDQ). The overall prevalence for these medications was moderate (4.81/1000; 95% confidence interval [CI], 3.70-6.26), but prevalence varied across the different classes of drugs (sedatives > antipsychotics > antidepressants > anxiolytics). Rates of off-label use were high for antipsychotics and antidepressants. About 30% of the medication, especially sedatives, was used without prescription. Subjects using psychotropic medication obtained higher scores in the screening for emotional or behavioral problems than the total sample, but 40% of the children did not show abnormal scores. The indication for antipsychotics was mostly behavioral symptomatology, while antidepressants were used for a wide variety of symptoms. The high proportion of children and adolescents using psychotropic medication with normal scores in the emotional and behavioral screening was remarkable. It cannot be determined whether in these cases low scores were related to improvement in symptoms or whether medication was being misused.

Use of psychotropic medication in Santiago, Chile

Background: During the last few decades, the use of psychotropic medication by the general population has been a topic of scientific and public interest. However there have been few studies in Latin America to assess this situation.Aims: To study the prevalence in use of psychotropic medication in the city of Santiago and the associations with sociodemographic and physical and mental health factors.Methods: Cross-sectional survey of private households randomly chosen with a probabilistic sampling design.Results: Three-thousand-eight-hundred-and-seventy subjects were interviewed. The overall prevalence of the use of psychotropic medication in Greater Santiago was 6.4% (95% CI). Sex, age, mental and physical health problems were all significantly associated with a higher prevalence of psychotropic medication use.Conclusions: The prevalence of psychotropic use in the Greater Santiago area seems lower than in other cities. However similar socio-demographic and health factors were associated with the use of psychotropic medication as in other countries. There is a need to unify methodologies to be able to compare results internationally.

Diffusion of the new antiepileptic drug lamotrigine in Dutch clinical practice

Lamotrigine is one of the recently introduced antiepileptic drugs (AEDs) licensed in the Netherlands in 1995. The objective of this study was to examine the diffusion of lamotrigine into clinical practice. Three different aspects of this diffusion process were examined: incidence of use, patient characteristics and changes in prescription patterns in the first 5 years following its introduction. A retrospective follow-up study has been conducted using drug prescription data from the database of the Dutch Drug Information Project (GIP database). Patients were included who started with lamotrigine, carbamazepine, phenytoin or valproate in the period between January 1996 and December 2000. Incidence of use was calculated for the four drugs. Multiple logistic regression analysis was used to determine differences in baseline characteristics. The Chi-square test was used to analyse changes in the usage patterns of lamotrigine. The study population consisted of a total of 29,718 patients who were prescribed carbamazepine, phenytoin, valproate or lamotrigine for the first time in the study period. Carbamazepine and valproate accounted for the majority of all new prescriptions; the incidence of lamotrigine use remained stable with 4.4 patients per 100,000 per year. Baseline characteristics of lamotrigine differed depending on the patient's age and gender (OR 3.7, 95% CI 3.3-4.2; OR 1.4, 95% CI 1.3-1.5) relative to the conventional AEDs. In a large majority of cases, lamotrigine was used as a second-line or third-line AED. Physicians prescribing lamotrigine were predominantly neurologists, in contrast to prescribers of conventional AEDs. The prevalence of psychotropic medication and migraine-abortive drugs was significantly lower in users of lamotrigine than in users of conventional AEDs. During follow-up, several significant trends were noticed in the prescribing of lamotrigine with regard to age groups, gender, antiepileptic history and off-label use. Lamotrigine is prescribed to a population different from that using conventional AEDs. The uptake of lamotrigine in clinical practice is slow, for reasons probably related to characteristics of the drug itself and the prescribers. During the observation period, lamotrigine diffused gradually towards more first-line use as an AED and more off-label use.

P.4.046 Donepezil-treated Alzheimer's disease patients with apparent initial cognitive decline demonstrate significant benefits when therapy is continued: Results from a randomized, placebo-controlled trial

It is recognized that pain has been undertreated and psychotropic medications overused in institutional settings.To investigate the change in prevalence of opioids, other analgesics, and psychotropic medications in institutional settings over an 8-year period.Institutional settings in Helsinki, Finland.Older residents in nursing homes in 2003 (n = 1987) and 2011 (n = 1576) and in assisted living facilities in 2007 (n = 1377) and 2011 (n = 1586).Comparable audits of medication use were conducted among institutionalized residents at 3 time points over 8 years. The prevalence of regular opioid, other analgesic, and psychotropic medications was compared across the 3 time periods.Nursing home and assisted living facility residents were older; more disabled, had a higher prevalence of dementia, and greater comorbidity in the latter cohorts. The prevalence of regular opioid use was 11.8% and 22.9% in nursing homes in 2003 and 2011 (P < .001), and 8.6% and 17.3% in assisted living facilities in 2007 and 2011 (P < .001), respectively. The prevalence of regular acetaminophen and pregabalin/gabapentin increased and NSAIDs decreased in both nursing homes and assisted living facilities. The prevalence of regular antipsychotic use decreased from 42.6% to 27.8% in nursing homes (P < .001) but increased from 26.9% to 32.0% in assisted living facilities (P = .0017). The mean number of psychotropic medications (antipsychotics, antidepressants, anxiolytics, hypnotics) per resident decreased from 1.9 in 2003 to 1.0 in 2011 in nursing homes (P < .001) but increased from 1.1 to 1.2 in assisted living facilities (P = .040).The prevalence of opioid use in institutional settings has doubled during the past decade. The prevalence of psychotropic medications has decreased in nursing homes but increased in assisted living facilities. The increase in opioid use may reflect improved recognition and treatment of pain. However, initiatives are needed to monitor opioid-related adverse drug events and ensure appropriate use of psychotropic medications, particularly in assisted living facilities.

Prevalence of Psychotropic Medication in Childhood and Adolescence in the Federal Republic of Germany

The use of psychotropic drugs in childhood and adolescence has been the subject of intense debate during the last few years. Allegations about the excessive consumption and overprescription of these substances in younger age groups play an important role in the public discussion. In this situation it would be useful to present relevant data on the prescription volume of psychotropic drugs in childhood and adolescence. The present investigation comprises data of 1985 using the GKV drug index and the IMS prescription index. According to the authors' results the prescription volume of these drugs is significantly lower than estimated in previous pilot studies. Illustrating the prescriptions by means of a drug profile, type and prevalence of psychotropic medication in children and adolescents are clearly distinguished from those of other age groups by the greater use of homeopathics and phytopharmaceutics. Among the psychotropics the neuroleptics represent the largest group. In comparison with international drug prevalence studies the prescription volume of psychostimulants is extremely low in the Federal Republic of Germany.