Prevalence Of Psychotropic Use Research Articles

Psychotropic medicines' prevalence, patterns and effects on cognitive and physical function in older adults with intellectual disability in Ireland: longitudinal cohort study, 2009-2020.

The frequent prescribing of psychotropics and high prevalence of polypharmacy among older adults with intellectual disabilities require close monitoring. To describe change in prevalence, predictors and health outcomes of psychotropic use during the four waves (2009/2010, 2013/2014, 2016/2017, 2019/2020) of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA). Eligible participants were adults (≥40 years) with intellectual disabilities who participated in all four waves of IDS-TILDA and who reported medication use for the entire period. Differences between groups were tested using Cochran's Q test for binary variables and the McNemar-Bowker test for variables with more than two categories. Generalised estimating equation models were used to assess associations between psychotropic use, participants' characteristics and health outcomes. Across waves (433 participants) there were no significant differences in prevalence of psychotropic use (61.2-64.2%) and psychotropic polypharmacy (42.7-38.3%). Antipsychotics were the most used subgroup, without significant change in prevalence between waves (47.6-44.6%). A significant decrease was observed for anxiolytics (26.8-17.6%; P < 0.001) and hypnotics/sedatives (14.1-9.0%; P < 0.05). A significant increase was recorded for antidepressants (28.6-35.8%; P < 0.001) and mood-stabilising agents (11.5-14.6%; P < 0.05). Psychotropic polypharmacy (≥2 psychotropics) was significantly associated with moderate to total dependence in performing activities of daily living over the 10-year period (OR = 1.80, 95% CI 1.21-2.69; P < 0.05). The study indicates an increase in usage of some classes of psychotropic, a reduction in others and no change in the relatively high rate of antipsychotic use over 10 years in a cohort of older adults with intellectual disabilities and consequent risk of psychotropic polypharmacy and medication-related harm.

Utilisation of drugs for the treatment of psychiatric diseases in the pediatric population: focus on off-label use.

Psychotropics are increasingly used in pediatrics, often as off-label medicines. The guarantees of safety and efficacy are not always granted in clinical practice compared to adult authorised indications. A retrospective observational study was done to estimate the prevalence of psychotropic use in pediatric subjects of Catalonia (Spain). Anonymised data on dispensation of psychotropics to pediatric patients, demography and other related data were obtained by the local healthcare management for the period 2008-2017. Estimation of off-label use was done through description of drug dispensations with no authorised use related to age range. The prevalence of psychotropics was 40.8-64.2 per 1,000 pediatric inhabitants. Hydroxyzine-only represented two-thirds of dispensations, and when removed, the prevalence dropped to 26.4-32.2 per 1,000 pediatric inhabitants. Adolescents and boys were more likely to receive a psychotropic. Psychostimulants had the highest exposure rate, mainly due to methylphenidate. Off-label use was observed in 12% of subjects, corresponding to 4.6% of all dispensed psychotropics with boys being more exposed. The proportion of off-label use vs. labelled use was higher in younger populations. Aripiprazole had the highest off-label frequency. Our data support the frequent reality of off-label use in pediatrics, despite the potential underestimation related to the selected off-label definition. There is an urgent need to systematically ascertain effectiveness and any potential adverse events in the off-label pediatric setting, and to generate valuable information for risk-benefit assessment in these populations where extrapolation from adults is not reliable.

Exploring acute care nurses' decision-making in psychotropic PRN use in hospitalised people with dementia.

To understand how acute care nurses make decisions about administering "as-needed" (PRN) psychotropic medications to hospitalised people with dementia (PWD). Behavioural and psychological symptoms of dementia occur in approximately 75% of PWD admitted to acute care. Despite this, few studies provide insight into the use and prevalence of psychotropic use in acute care. A qualitative descriptive design was used to explore acute care nurses' decision-making about PRN psychotropic medication administration to PWD. Semi-structured interviews were conducted with eight nurses from three acute care medical units in a large tertiary hospital in Western Canada. Conventional content analysis was used to develop three themes that reflect nurses' decision-making related to administering PRNs to hospitalised PWD. COREQ guidelines were followed. Three themes of legitimising control, making the patient fit and future telling were developed. Legitimising control involved medicating undesirable behaviours to promote the nurses' perceptions of safety. Making the patient fit involved maintaining routine and order. Future telling involved pre-emptively medicating to prevent undesirable behaviours from escalating. Nurses provided little to no mention of assessing for physical causes contributing to behaviours. PRNs were seen as a reasonable alternative to physical restraints and were frequently used. Additionally, organisational and unit routines greatly influenced nurses' decision-making. These findings provide an initial understanding of how nurses make decisions to administer PRN medications to hospitalised older people and may inform prescribing practices. There were novel findings about the lack of assessment prior to PRN administration, and the nurses' collective response in decision-making. More research is needed to better understand the complexities of nurses' decision-making, to assist in the development of interventions for nursing practice.

Trends in self-poisoning and psychotropic drug use in people aged 5–19 years: a population-based retrospective cohort study in Australia

ObjectivesTo characterise trends in self-poisoning and psychotropic medicine use in young Australians.DesignPopulation-based retrospective cohort study.SettingCalls taken by the New South Wales and Victorian Poisons Information Centres (2006–2016, accounting for 70%...

Regional changes in psychotropic use among Finnish persons with newly diagnosed Alzheimer’s disease in 2005-2011

ObjectivesTo describe and compare temporal changes in prevalence and incidence of psychotropic use (antipsychotics, antidepressants and benzodiazepines and related drugs; BZDRs) in persons with newly diagnosed Alzheimer’s disease (AD) between university hospital districts of Finland during 2005–2011.MethodsThe MEDALZ study includes all community-dwellers of Finland who received a clinically verified AD diagnosis in 2005–2011 (N = 70,718). Prevalent and incident use of psychotropics among those who had received AD diagnosis less than one year ago were compared in 2005–2011.ResultsRegional differences in psychotropic use between university hospital districts were more evident in 2005 than 2011 for prevalent use of any psychotropic, antipsychotic and BZDRs and incident use of any psychotropic and antipsychotics. Regional differences in prevalent antidepressant use and incident BZDR use remained similar during the follow-up, while differences in incident antidepressant use increased during the follow-up. The prevalence of any psychotropic use in 2005 varied between 44.7–50.7% and between 45.0–47.9% in 2011. Incidence of any psychotropic use in 2005 was between 8.6–12.1% and 6.2–8.2% in 2011. In 2005, the distribution of incident psychotropic use followed a large scale spatial variation that, however, did not correspond to university hospital districts. During the study period from 2005 to 2011 the cyclic spatial variation disappeared. No sign of adjacent hospital districts being more or less closely related to each other compared to hospital districts in general was detected.ConclusionsExcept for antidepressants, regional differences in psychotropic use have mainly diminished between 2005 and 2011. Our findings highlight the importance of acknowledging regional differences in a country with relatively homogeneous healthcare system and conducting future studies assessing the reasons behind these differences.

Psychotropic use and associated neuropsychiatric symptoms among patients with dementia in the USA.

To determine the national prevalence of psychotropic use and association with neuropsychiatric symptoms among patients with dementia. Participants diagnosed with dementia (n = 414) in the Aging, Demographics, and Memory Study, a nationally representative survey of US adults >70 years old. Diagnosis was based on in-person clinical assessment and informant interview. Information collected included demographics, place of residence, 10-item Neuropsychiatric Inventory (NPI), and prescribed medications (antipsychotic, sedative-hypnotic, antidepressant, mood stabilizer). Of 414 participants with dementia, 41.4% were prescribed a psychotropic medication, including 84.0% of nursing home residents and 28.6% of community-dwellers. Of participants, 23.5% were prescribed an antidepressant. Compared with the total NPI score of those on no medication (4.5), those on antipsychotics and those on sedative-hypnotics had much higher scores (respectively: 12.6, p < 0.001; 11.8, p = 0.03), although those antidepressants did not (6.9, p = 0.15). A larger proportion of patients on antipsychotics exhibited psychosis and agitation compared with those on no medication, while those on antidepressants exhibited more depressive symptoms. In multivariable logistic regression that included dementia severity and nursing home residence, nursing home residence was the characteristic most strongly associated with psychotropic use (odds ratio ranging from 8.96 [p < 0.001] for antipsychotics to 15.59 [p < 0.001] for sedative-hypnotics). More intense psychotic symptoms and agitation were associated with antipsychotic use; more intense anxiety and agitation were associated with sedative-hypnotic use. More intense depression and apathy were not associated with antidepressant use. In this nationally representative sample, 41.4% of patients were taking psychotropic medication. While associated with neuropsychiatric symptoms, nursing home residence was most strongly tied to use. Copyright © 2016 John Wiley & Sons, Ltd.

A point prevalence study of the use of psychotropic medication in an acute general hospital

There are high rates of cognitive problems and organic and functional psychiatric disorders in patients admitted to general hospital wards, which may necessitate the use of psychotropic medications. There is evidence of over-prescription of medications such as antipsychotics and antidepressants in community settings such as residential care. However, the prevalence of psychotropic use in general hospitals is unknown. A point prevalence study of the use of psychotropic medications in an acute general hospital was conducted by auditing medication charts for type, dose, indication, and other clinical processes associated with their use. The files of 197 patients were audited, 139 (70%) were aged 65 years and over. Eighty-nine (45%) of patients were prescribed a psychotropic, with 35 (17.7%) antidepressants; 21 (11%) antipsychotics; 19 (10%) benzodiazepines; six (3%) mood stabilizer; five (2%) cholinesterase inhibitors; one (0.5%) anti-parkinsonian medication, and one (1%) patient on zolpidem and another patient melatonin (1%). Most prescriptions (72%) were in people 65 years and over and 27 (20%) of indications were found to be off label prescribing. There were deficits in the documentation of indications for the use of psychotropic medications and follow up arrangements. Rates of benzodiazepines use were less than that reported incomparable settings. Concerns regarding off label prescribing, under-dosing, and lack of adequate documentation of indications and follow-up instructions were raised. Given the potential adverse effects of psychotropic medication, improved governance, and education regarding their use is required.

Medication Use before, during, and after Pregnancy among Women with Eating Disorders: A Study from the Norwegian Mother and Child Cohort Study.

IntroductionLittle is known about medication use among women with eating disorders in relation to pregnancy.AimsTo explore patterns of and associations between use of psychotropic, gastrointestinal and analgesic medications and eating disorders in the period before, during and after pregnancy.MethodThis study is based on the Norwegian Mother and Child Cohort Study (MoBa). A total of 62,019 women, enrolled at approximately 17 weeks' gestation, had valid data from the Norwegian Medical Birth Registry and completed three MoBa questionnaires. The questionnaires provided diagnostic information on broadly defined anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED) and recurrent self-induced purging in the absence of binge eating (EDNOS-P), along with self-reported use of medication six months before, during, and 0–6 months after pregnancy.ResultsThe prevalence of eating disorder subtypes before and/or during pregnancy was: 0.09% AN (n = 54), 0.94% BN (n = 585), 0.10% EDNOS-P (n = 61) and 5.00% BED (n = 3104). The highest over-time prevalence of psychotropic use was within the AN (3.7–22.2%) and EDNOS-P (3.3–9.8%) groups. Compared to controls, BN was directly associated with incident use of psychotropics in pregnancy (adjusted RR: 2.25, 99% CI: 1.17–4.32). Having AN (adjusted RR: 5.11, 99% CI: 1.53–17.01) or EDNOS-P (adjusted RR: 6.77, 99% CI: 1.41–32.53) was directly associated with use of anxiolytics/sedatives postpartum. The estimates of use of analgesics (BED) and laxatives (all eating disorders subtypes) were high at all time periods investigated.ConclusionsUse of psychotropic, gastrointestinal, and analgesic medications is extensive among women with eating disorders in the period around pregnancy. Female patients with eating disorders should receive evidence-based counseling about the risk of medication exposure versus the risk of untreated psychiatric illness during pregnancy and postpartum.

Psychotropic medication use among children with autism spectrum disorders within the Simons Simplex Collection: Are core features of autism spectrum disorder related?

Psychotropic medication use and its relationship to autism spectrum core features were examined in a well-characterized but nonstratified North American sample (N = 1605) of children/adolescents diagnosed with autism spectrum disorders utilizing the Autism Diagnostic Observation Schedule and the Autism Diagnostic Interview-Revised, from the multisite Simons Simplex Collection. Analyses included (a) prevalence of psychotropic use (overall, and by classes), (b) correlations between prevalence of use and autism spectrum core features, age, and cognitive functioning, and (c) logistic regression to identify whether these factors were predictive of psychotropic use. Results indicated 41.7% ever used one or more classes of psychotropic medications, with attention deficit hyperactivity disorder medications used most. Small but significant correlations between psychotropic medication use and (a) social impairment (p < .001) and (b) repetitive behaviors (p < .001) were found. Overall, however, autism spectrum disorder core features are weakly related to medication use. Older children used more psychotropics (p < .001), and higher cognitive functioning was associated with less overall psychotropic use (p < .001). Logistic regression indicated that use of psychotropics was predicted by repetitive behaviors (both clinician-observed and parent-reported), age, and cognitive ability level. Limitations inherent to the Simons Simplex Collection sample, methodology, and the correlational analyses are discussed. Directions for future research include investigation of factors more influential than core symptoms on psychotropic treatment (e.g. parent perceptions, comorbid symptoms).

Datapoints: Psychotropic Drug Use Among Elderly Patients in Home Care in the United States

Back to table of contents Previous article Next article ColumnsFull AccessDatapoints: Psychotropic Drug Use Among Elderly Patients in Home Care in the United StatesVishal Bali, M.S., Satabdi Chatterjee, M.S., and Rajender R. Aparasu, Ph.D.Vishal BaliSearch for more papers by this author, M.S., Satabdi ChatterjeeSearch for more papers by this author, M.S., and Rajender R. AparasuSearch for more papers by this author, Ph.D.Published Online:1 Jan 2012https://doi.org/10.1176/appi.ps.2012000p6AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail An estimated 1.5 million persons in the United States receive home-based care involving a range of therapeutic and medical services (1). Most patients who receive home-based health care are elderly, with various levels of functional impairment. Although psychotropic medications are extensively used in the elderly population, limited data exist on the psychotropic needs of elderly home health patients.Psychotropic medication use was examined among elderly home health care patients age 65 and older by using the 2007 National Home and Hospice Care Survey (NHHCS), a national survey of U.S. home health and hospice agencies (2). Patient data for the NHHCS were obtained from interviews with designated agency staff members, who provided information from medical and medication administration records. Descriptive statistics, including 95% confidence intervals (CIs), were used to examine prevalence patterns of psychotropic drug use.More than a half million of the elderly home health care patients received at least one psychotropic agent—.54 million patients (CI=.50–.58) or 53.52% of the elderly patients (CI=50.60–56.44). As shown in Figure 1, antidepressants were the most frequently prescribed psychotropic agents (33.51%, CI=30.71–36.31), followed by sedatives-hypnotics-anxiolytics (30.65%, CI=27.96–33.34), mood stabilizers (9.87%, CI=8.15–11.59), and antipsychotics (7.55%, CI=6.08–9.03). Selective serotonin reuptake inhibitors (SSRIs) were the most frequently prescribed antidepressants (21.83%, CI=19.39–24.28), and benzodiazepines constituted a majority of the sedatives-hypnotics-anxiolytics prescribed (21.30%, CI=18.93–23.68).This study found that the overall prevalence of psychotropic use among elderly home health care patients was 54%, nearly 10 percentage points less than psychotropic use in nursing homes (63%) (3). The high prevalence of psychotropic use among home health care patients was mainly driven by the use of SSRIs and benzodiazepines. Given the inappropriate use of psychotropic agents among elderly patients and the poor health status of those receiving home health care, there is a need to monitor use of psychotropic drugs in this vulnerable population.The authors are affiliated with the Department of Clinical Sciences and Administration, College of Pharmacy, University of Houston, Houston, TX 77030 (e-mail: [email protected]edu). Amy M. Kilbourne, Ph.D., M.P.H., and Tami L. Mark, Ph.D., are editors of this column.Acknowledgments and disclosuresThe authors report no competing interests.References1 Caffrey C , Sengupta M , Moss A , et al.: Home Health Care and Discharged Hospice Care Patients: United States, 2000 and 2007. National Health Statistics Reports, 38. Hyattsville, Md, National Center for Health Statistics, 2011 Google Scholar2 2007 National Home and Hospice Care Survey and National Home Health Aide Survey. Atlanta, Ga, Centers for Disease Control and Prevention, 2007. Available at www.cdc.gov/nchs/data/nhhcsd/NHHCS_NHHAS_web_documentation.pdf Google Scholar3 Bhattacharjee S , Karkare SU , Kamble P , et al.: Psychotropic drug utilization among elderly nursing home residents in the United States. Psychiatric Services 61:655, 2010 Link, Google ScholarFigures and TablesFigure 1 Psychotropic medication use among elderly home health care patients in 2007 FiguresReferencesCited byDetailsCited ByEuropean Geriatric Medicine, Vol. 8, No. 1 Volume 63Issue 1 January 2012Pages 6-6 Metrics Acknowledgments and disclosuresThe authors report no competing interests.PDF download History Published online 1 January 2012 Published in print 1 January 2012

P-624 - Psychotropic use and mental health treatment gap in two urban centers: são paulo and rio de janeiro

Estimate the prevalence of use of psychotropic medications in the cities of São Paulo (SP) and Rio de Janeiro (RJ); Random sample of 3744 individuals, 15–75 years; CIDI 2.1 (depression and anxiety) and direct questions about use of psychotropic medications in the past year; prevalence estimation was performed by weighting oversampling in SP and standardization between cities by age; psychotropic consumption association with socio-demographic variables and diagnosis was performed by logistic regression. The prevalence of psychotropic use was 8.95% in SP (CI:7.93–9 .97) and 9:54% in RJ (CI:8.49–10 .59). Antidepressants (4.72% and 4.33%) and tranquilizers (4.20% and 1.73%) respectively in SP and RJ where more common used. Psychiatrists in SP most often prescribed psychotropic (39%), in RJ general practitioners (48.8%) where more cited. Most antipsychotics (52%) and antidepressants (39%) in SP were donated by the government in RJ this figure falls to 8% and 7%. Female individuals with increasing age, separated or divorced with a psychiatric diagnosis in the past year, family history of mental illness and higher income were more likely to use psychotropic drugs. About 70% to 82% of individuals diagnosed with major depressive disorder or phobic disorder, did not use any psychotropic drug. There was a decrease in the consumption of psychotropic drugs in Brazil in recent decades, with a change in the consumption of tranquilizers and antidepressants. There is a need for a better training and education of doctors and family assistance programs in recognizing symptoms of common mental health disorders.

ADSA/NDBA Abstracts

ADSA/NDBA Abstracts

Psychotropic drug use among older people in general practice: discrepancies between opinion and practice

The use of psychotropic drugs has increased over recent years in France. GPs are the first prescribers, especially for older patients. To analyse discrepancies between GPs' opinions and practice when prescribing psychotropic drugs to older patients. Postal surveys sent to GPs all over mainland France. Cross-sectional postal study. A questionnaire collected data on characteristics of GPs' practices, their opinions about psychotropic drug consumption in older people, and a full description of their last older patient receiving a psychotropic drug and seen last by the GP on that particular day. A total of 350 participating GPs saw 2498 patients aged > or =65 years. Among these patients, the prevalence of psychotropic use was 32.1% (803/2498) for anxiolytics/hypnotics, and 17.5% for antidepressants (438/2498). A total of 91% of GPs agreed that it was possible to reduce or stop psychotropic drugs for these patients. Characteristics of 339 patients taking psychotropic drug were reported: 85.8% (291/339) received at least one anxiolytic/hypnotic and 56.9% (193/339) received at least one antidepressant; there were prescribed for more than 1 year in 68.4% (199/291) and 43.5% (84/193) of the cases respectively. GPs stated that it was possible to reduce or stop anxiolytic/hypnotic drugs for only 27% (79/291) of these patients. Barriers to doing this were patients' refusal (79%), and the absence of any local offer of psychotherapy (73%) or alternative therapy (70%). A mismatch exists between GPs' intent (91%) and practice (27%) regarding reduction of psychotropic prescription in individuals aged > or =65 years. The barriers encountered should be examined further to help physicians improve management of psychotropic prescription.

Prevalence of psychotropic use in a South Australian population

Objective: To determine the prevalence of psychotropic medication use in a South Australian population.Methods: Face-to-face interviews with a random and representative sample of the South Australian population (at least 15 years of age) living in metropolitan and rural areas between March and June 2004.Results: From 4700 households selected, 3015 participants were interviewed (65.9% response rate). Of the respondents, 10.6% were taking psychotropic medications; psychotropic drug use was higher in females (14.4%) than in males (6.8%), and increased with age. Antidepressants were the most common category of psychotropics reported by respondents (6.8%), followed by anxiolytics (1.8%), hypnotics and sedatives (1.5%) and antipsychotics (0.6%). The majority (64.8%) of those respondents who were taking a tricyclic antidepressant were on a dose of 50 mg or less. Only 0.07% of respondents were taking lithium.Conclusions: The use of psychotropic medications was higher than recently reported studies conducted in the UK, the USA, Europe and Canada. More detailed enquiry about the indication for such use appears desirable in order to ascertain whether higher use in this Australian population is clinically appropriate.

Prevalence of Psychotropic Use in a South Australian Population

To determine the prevalence of psychotropic medication use in a South Australian population. Face-to-face interviews with a random and representative sample of the South Australian population (at least 15 years of age) living in metropolitan and rural areas between March and June 2004. From 4700 households selected, 3015 participants were interviewed (65.9% response rate). Of the respondents, 10.6% were taking psychotropic medications; psychotropic drug use was higher in females (14.4%) than in males (6.8%), and increased with age. Antidepressants were the most common category of psychotropics reported by respondents (6.8%), followed by anxiolytics (1.8%), hypnotics and sedatives (1.5%) and antipsychotics (0.6%). The majority (64.8%) of those respondents who were taking a tricyclic antidepressant were on a dose of 50 mg or less. Only 0.07% of respondents were taking lithium. The use of psychotropic medications was higher than recently reported studies conducted in the UK, the USA, Europe and Canada. More detailed enquiry about the indication for such use appears desirable in order to ascertain whether higher use in this Australian population is clinically appropriate.

Modificações nos padrões de consumo de psicofármacos em localidade do Sul do Brasil

To assess the prevalence and patterns of psychotropic use by population and to compare the results with a study carried out in 1994. This is a population-based cross-sectional study carried out in 2003 with 3,542 participants aged 15 or older who lived in an urban area in Southern Brazil. Two-week recall data were collected in household interviews through the same questionnaire used in the 1994 study. The variables studied were age, gender, race, education, family income, marital status, smoking, medical diagnosis of hypertension, and physician visit at last three months. Pearson's Chi-square and linear tendency were used in the bivariate analysis. Four levels of multivariate analysis was performed. The overall prevalence of psychotropic use was 9.9% (CI 95%: 8.9-10.9). There was no significant difference among standardized age groups when compared to the prevalence rates observed in 1994. Higher psychotropic use was associated with being female, older age, medical diagnosis of hypertension, and health service utilization. Of those interviewed, 74% of those drug users were using psychotropic drugs for over three months. A decade later, prevalence remained high, yet psychotropic drug use did not increase. The association between health service utilization and consumption shows the importance of the appropriate prescription of psychotropic drugs and regular follow-up of those prescribed them by physicians.

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.

Use of psychotropics in Sydney nursing homes: associations with depression, psychosis, and behavioral disturbances.

The purpose of this study was to determine the prevalence of psychotropic use in nursing home residents, the extent to which psychotropic dosage is consistent with published guidelines, and the relationships between psychotropic class and psychiatric and behavioral disturbances. Six hundred forty-seven subjects, mean age 82.3 years, residing in 11 nursing homes in the eastern suburbs of Sydney, Australia, were assessed using the Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD), the Abbreviated Mental Test Scale, and the Even Briefer Assessment Scale for Depression (EBAS-DEP). Details of psychotropic prescription and diagnoses of depression, dementia, and psychosis were obtained from nursing home charts. Psychotropics were prescribed for 333 (51.5%) residents, 381 (58.9%) if "as required" (PRN) use is included. Prescription of multiple psychotropics was present in 148 (22.7%) residents. Antidepressants were prescribed for 19.8% of residents, with subtherapeutic doses less likely in residents on selective serotonin reuptake inhibitors. On logistic regression, the use of antidepressants was predicted by the affective disturbances subscale on the BEHAVE-AD. Only 30.4% of residents with significant depressive symptoms on the EBAS-DEP were prescribed antidepressants. Antipsychotics were prescribed for 21.3% residents at a mean dosage of 73 mg chlorpromazine equivalence. Residents on antipsychotics had significantly higher scores on the delusions, hallucinations, activity disturbance, and aggressiveness subscales of the BEHAVE-AD. On logistic regression, only the activity disturbance subscale and chart diagnoses of dementia and psychosis were significant predictors. Psychosis (58.8%) and behavioral disturbances (91.9%) were more prevalent in residents prescribed antipsychotics than in residents not prescribed antipsychotics (42.5% and 76.6%, respectively). High rates of behavioral and psychological symptoms of dementia remained in residents prescribed antipsychotics and high rates of depressive symptoms in residents prescribed antidepressants, suggesting a role for nonpharmacological strategies.

The epidemiology of psychotropic use in the City of São Paulo

This is a cross-sectional community study conducted to assess the one-year prevalence of psychotropic use in the city of São Paulo. A representative stratified sample of the city was drawn from three sub-districts selected on the basis of their health indicators (Ramos & Goihman, 1989). The probability of a psychiatric disorder was estimated by means of the Adult Psychiatric Morbidity Questionnaire (QMPA) developed by Santana (1982). The total sample comprised 1742 subjects: 11.7% of males and 24.6% of females were probable cases in the QMPA, at the cut-off point 7/8. The overall psychotropic consumption was 101.6 persons/1000 inhabitants. The rate of psychotropic use was higher for females (142.3 persons/1000 inhabitants) than males (50.0 persons/1000), a difference statistically significant (chi(2) = 18.0, 1 df, P < 0.001). The highest rate of consumption was for tranquillizers (80.4/1000 inhabitants) and the general physician was found to be the leading prescriber (46.9%), being followed by cardiologists (15.3%). A log-linear model was constructed to study the combined effect of sociodemographic factors on the probability of being a tranquillizer user. Women were found to take more tranquillizers than men, consumption increased with age, and the positives in the QMPA were more likely to be users than were the negatives. The higher the family income per capita the higher the risk of being a tranquillizer user. These findings applied regardless of the sub-district, marital status, and migration status of the subjects. These results are discussed in the light of the alternative possible interventions by general practitioners.