Psychopharmacological Drugs Research Articles

A life course perspective on mental disorders and psychopharmacologic drug use among persons living with cerebral palsy

In this study, we investigated the prevalence of mental disorders and the use of psychopharmacologic drugs among individuals with cerebral palsy (CP). We studied how the association between CP and mental illness develops over the life course (between ages 5 and 65 years), and how it varies across disability specific factors (intellectual disability, gross motor function and communicative ability). We used logistic regression models on a longitudinal matched case-control data material on all persons with CP in Sweden linked to several administrative registers including, the national patient registers and the pharmaceutical registers.Our results showed that the probability of being diagnosed with mental disorders and being dispensed psychopharmacologic drug was significantly higher among persons with CP compared to persons without CP across the different outcomes [OR=1.52–4.7]. For some mental and neurodevelopmental disorders including sleep disorders, autism, and ADHD, and for the use of anxiolytics and sedatives, there was a sizeable gap already in childhood. However, the excess burden of mental illness appeared to grow over the life course, indicating that adults with CP may be a particularly disadvantaged group. Diagnosis for mental disorders and dispensation for psychopharmacologic drugs were not consistent with respect to disability specific factors, especially communicative and intellectual function, which indicates the need for systematic approaches in the mental health care of individuals with CP.

Impact of second-generation antipsychotics monotherapy or combined therapy in cytokine, lymphocyte subtype, and thyroid antibodies for schizophrenia: a retrospective study

BackgroundSchizophrenia (SCZ) shares high clinical relevance with the immune system, and the potential interactions of psychopharmacological drugs with the immune system are still an overlooked area. Here, we aimed to identify whether the second-generation antipsychotics (SGA) monotherapy or combined therapy of SGA with other psychiatric medications influence the routine blood immunity biomarkers of patients with SCZ.MethodsMedical records of inpatients with SCZ from January 2019 to June 2023 were retrospectively screened from June 2023 to August 2023. The demographic data and peripheral levels of cytokines (IL-2, IL-4, IL-6, TNF-α, INF-γ, and IL-17 A), lymphocyte subtype proportions (CD3+, CD4+, CD8 + T-cell, and natural killer (NK) cells), and thyroid autoimmune antibodies (thyroid peroxidase antibody (TPOAb), and antithyroglobulin antibody (TGAb)) were collected and analyzed.Results30 drug-naïve patients, 64 SGA monotherapy (20 for first-episode SCZ, 44 for recurrent SCZ) for at least one week, 39 combined therapies for recurrent SCZ (18 with antidepressant, 10 with benzodiazepine, and 11 with mood stabilizer) for at least two weeks, and 23 used to receive SGA monotherapy (had withdrawn for at least two weeks) were included despite specific medication. No difference in cytokines was found between the SGA monotherapy sub-groups (p > 0.05). Of note, SGA monotherapy appeared to induce a down-regulation of IFN-γ in both first (mean [95% confidence interval]: 1.08 [0.14–2.01] vs. 4.60 [2.11–7.08], p = 0.020) and recurrent (1.88 [0.71–3.05] vs. 4.60 [2.11–7.08], p = 0.027) episodes compared to drug-naïve patients. However, the lymphocyte proportions and thyroid autoimmune antibodies remained unchanged after at least two weeks of SGA monotherapy (p > 0.05). In combined therapy groups, results mainly resembled the SGA monotherapy for recurrent SCZ (p > 0.05).ConclusionThe study demonstrated that SGA monotherapy possibly achieved its comfort role via modulating IFN-γ, and SGA combined therapy showed an overall resemblance to monotherapy.

Venous Thromboembolic Complications in Patients with Acute Chemical Poisoning

RELEVANCE. Venous thromboembolic complications (VTEC) occur in patients hospitalized with various pathologies, complicate treatment and increase mortality. This problem has not received enough attention in toxicology.AIM OF THE STUDY. Conduct an analysis of VTEC in patients with acute chemical poisoning (AP).MATERIAL AND METHODS. The hospital patient records and pathological examination reports of 670 patients of the N.V. Sklifosovsky Research Institute for Emergency Medicine who died from VTEC in the period 2016–2022 were retrospectively analyzed. VTEC were confirmed by Doppler ultrasound during life or during pathological examination. Statistical analysis of the data was performed using the IBM computer program SPSS Statistics 26.0.RESULTS. VTEC were diagnosed in 245 patients. The proportion of VTEC increased from 20.2 to 46.7% over the years, and in cases of VTEC caused by psychopharmacological drugs, they were registered in 48.8% of cases. VTEC occurred twice more often in people over 60 years of age and 1.3-fold more often in women. Deep vein thrombosis of the right lower limb was predominant in all types of poisoning, and the prevalence of the lesion was mainly local. Concomitant cardiovascular diseases, oncological diseases, diabetes mellitus, and the development of pneumonia increased the risk of VTEC. Pulmonary embolism was observed in more than a third of cases of VTEC in patients with VTEC caused by psychopharmacological drugs, corrosive substances, and hypotensive and antiarrhythmic drugs.CONCLUSIONS. The characteristics of venous thromboembolic complications in acute chemical poisoning in general is similar to the complications indicated that arise in other pathologies, but has some features caused by the effect of specific chemicals on the body.

Psychedelic Therapy Scrutinized by FDA Advisory Committee?

This Viewpoint analyzes the Psychopharmacologic Drugs Advisory Committee’s decisions regarding 3,4-methylenedioxymethamphetamine–assisted therapy and what they mean for psychedelic research.

The use of psychotropic drugs in oncological diseases (review)

Background: It is estimated that at least 25-30% of cancer patients experience mental disorders. Due to the high prevalence of these disorders among this patient population, psychotropic drugs have been successfully utilized in oncology for an extended period of time. The use of psychotropic drugs enables targeted symptom management to improve the quality of life of cancer patients. However, it is essential to carefully evaluate the risks of drug interactions and potential side effects when prescribing any psychotropic medication. The aim of the study: The aim of this study was to analyze the utilization of psychopharmacotherapy in oncology practice for treating comorbid mental disorders and symptoms related to oncological diseases. An evaluation of the side effects and drug interactions of psychopharmacological and oncological drugs was conducted. Materials and methods: The eLibrary, PubMed, and Google Scholar databases were searched using the keywords “psychooncology” and “psychopharmacotherapy”. Reviews, meta-analyses, and therapy recommendations were selected from the obtained results, which provided the most comprehensive coverage of the current scientific data on this topic. Results: Anxiety disorders and depressive reactions are prevalent in cancer patients and can be successfully treated with psychopharmacological intervention. Additionally, symptoms associated with the oncological process or side effects of treatment such as anorexia, pain, and nausea can be alleviated through the use of antidepressants and antipsychotics. However, it is crucial to carefully evaluate the risks of drug interactions when prescribing any psychotropic drugs. For instance, strong cytochrome CYP2D6 inhibitors can lead to a decrease in the concentration of the active metabolite tamoxifen, while the combination of antidepressants and tramadol increases the risk of serotonin syndrome. Conclusion: The application of psychotropic drugs in the treatment of cancer can greatly enhance the patients' quality of life. However, potential side effects and drug interactions must be carefully evaluated.

Neuroscience-Based Nomenclature (NbN): the Portuguese version of the new classification for psychopharmacological drugs.

Neuroscience-Based Nomenclature (NbN) is a proposal to provide a nomenclature based on neuroscience and pharmacology instead of the old disease-based classification. NbN is based on the mechanism of action and pharmacological target and aims to assist in rational prescription, reduce stigma, and increase treatment adherence. Currently, NbN is endorsed by many psychiatric associations, adopted by several relevant journals, and included in major psychiatry textbooks. Therefore, it is important that NbN is known to psychiatrists.

Understanding and assessing the antidepressant drug-associated risk of bleeding

Antidepressants, in particular selective serotonin reuptake inhibitors (SSRIs), are the most commonly prescribed psychopharmacological drug group. Thus, a precise knowledge of the expected adverse drug reactions is indispensable. The increased risk of bleeding events is well documented, especially in patients treated with SSRIs. However, many other antidepressant drug groups have also been implicated in increasing the risk of bleeding. In the following review, the thrombocytic serotonin system and the respective targets of the different antidepressants are explained. Subsequently, the available literature on bleeding under the respective antidepressant classes or individual substances is presented, using data from meta-analyses whenever possible. In addition to the risk of bleeding in general, individual bleeding entities are also considered, such as gastrointestinal and cerebral hemorrhages. Finally, the effects of other drugs that increase the risk of bleeding (i. e., nonsteroidal anti-inflammatory drugs, platelet aggregation inhibitors and anticoagulants) in combination with antidepressant drugs are discussed. The information presented here is meant to guide practitioner's decision making regarding an appropriate antidepressant pharmacotherapy based on the patient's individual risk constellation.

FDA Approves Rexulti for Agitation Associated With Dementia Due to Alzheimer’s Disease

Back to table of contents Next article Clinical & ResearchFull AccessFDA Approves Rexulti for Agitation Associated With Dementia Due to Alzheimer’s DiseaseMark MoranMark MoranSearch for more papers by this authorPublished Online:12 May 2023https://doi.org/10.1176/appi.pn.2023.07.7.17AbstractOne expert called the approval a “positive step” for the treatment of agitation associated with dementia in Alzheimer’s but cautioned against using the drug as a panacea for all behavioral symptoms of dementia.The U.S. Food and Drug Administration (FDA) this week approved the expanded use of Rexulti (brexpiprazole) for the treatment of agitation associated with dementia due to Alzheimer’s disease (AD).“Agitation associated with dementia due to Alzheimer’s disease is a common neuropsychiatric symptom that is reported in approximately half of all patients with Alzheimer’s dementia,” wrote Otsuka Pharmaceutical Co. Ltd. and Lundbeck LLC, makers of the medication, in a press release. The symptoms cover “a large group of behaviors occurring in patients with Alzheimer’s disease, such as pacing, gesturing, profanity, shouting, shoving, and hitting.”Brexpiprazole was first approved by the FDA in 2015, as an adjunctive therapy to antidepressants in adults with major depressive disorder and as a treatment for adults with schizophrenia. In 2021, the FDA expanded the use of the medication for the treatment of adolescents over the age of 13 with schizophrenia. Earlier this year, Otsuka and Lundbeck announced that the FDA would review the companies’ supplemental New Drug Application for brexpiprazole for the treatment of agitation associated with AD.In a hearing last month, the FDA’s Psychopharmacologic Drugs Advisory Committee and the Peripheral and Central Nervous System Drugs Advisory Committee voted 9-1 in favor of the approval of brexpiprazole for the new indication, noting the data presented by Otsuka and Lundbeck suggested that the benefits of the medication outweighed the risks for patients with these symptoms.A briefing document released prior to the April FDA hearing describes some of the data presented by the manufacturers, including several phase 3, 12-week, randomized, placebo-controlled studies. “Results from Studies 331-12-283 and 331-14-213 suggest that brexpiprazole exhibited a statistically significant treatment effect in the reduction of agitation over a 12-week treatment period, while also showing a similar safety profile relative to its use in adults with schizophrenia and major depressive disorder,” the document stated. “[B]rexpiprazole’s effect on mortality appears to be consistent with the known risk with other antipsychotics in elderly patients with dementia.”Rajesh Tampi, M.D., M.S., said it is important that physicians determine the cause of agitation in patients with Alzheimer’s disease before prescribing Rexulti.The approval of Rexulti “is a positive step for the treatment of agitation associated with dementia related to Alzheimer’s Disease,” said Rajesh Tampi, M.D., M.S., a professor and chair of the Department of Psychiatry at Creighton University and a past president of the American Association for Geriatric Psychiatry. “This is the first drug to be approved for agitation. The manufacturers were persistent and had solid data to support efficacy,” he told Psychiatric News.Tampi cautioned that agitation is just one of many noncognitive behavioral symptoms of dementia that patients may experience. “Brexpiprazole should absolutely not be assumed to treat all of those symptoms,” he said. “For instance, the most important behavioral symptom of dementia is apathy, and brexpiprazole should not be used to treat apathy.”He noted that only a minority of patients with dementia are treated by geriatric psychiatrists; most see their primary care physician (or other physicians who are not psychiatrists) for care. “My worry is that some will use the medication as a panacea for every behavioral symptom,” he said.According to the updated medication label, Rexulti is to be taken daily. The medication is not approved for the treatment of Alzheimer’s patients with dementia-related psychosis without agitation.“Physicians need to make a good assessment of whether the agitation is a result of dementia related to AD or due to other causes—for example, a medical condition or a psychiatric condition like bipolar disorder or schizophrenia,” Tampi said.Inappropriate use of brexpiprazole “will only raise the risk of adverse events associated with antipsychotic treatments—sedation, risk of falls, stroke and death,” he said.The most common side effects of Rexulti reported during the clinical trials by patients with agitation associated with dementia due to Alzheimer’s disease include headache, dizziness, urinary tract infection, nasopharyngitis, and sleep disturbances, according to an FDA release. “Rexulti will retain the Boxed Warning for medications in this class that elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death,” the agency noted. ■ResourcesFDA Approves First Drug to Treat Agitation Symptoms Associated with Dementia due to Alzheimer’s DiseaseFDA Briefing Document ISSUES NewArchived

Trihydroxy piperlongumine protects aluminium induced neurotoxicity in zebrafish: Behavioral and biochemical approach

Aluminium (Al) is proven to be a potent environmental neurotoxin involved in progressive neurodegeneration. Al primarily induces oxidative stress by free radical generation in the brain, followed by neuronal apoptosis. Antioxidants are promising therapeutic options for Al toxicity. Piperlongumine is traditionally long known for its medicinal properties. Therefore, the present study has been designed to explore the antioxidant role of trihydroxy piperlongumine (THPL) against Al-induced neurotoxicity in the zebrafish model. Zebrafish exposed to AlCl3 exhibited higher oxidative stress and altered locomotion. Adult fish displayed anxiety comorbid with depression phenotype. THPL increases antioxidant enzyme activity by quenching Al-induced free radicals and lipid peroxidation, thus minimizing oxidative damage in the brain. THPL rescues behavior deficits and improves anxiety-like phenotype in adult fish. Histological alterations caused by Al were also attenuated on administration with THPL. Results of the study demonstrate the neuroprotective role of THPL against Al-induced oxidative damage and anxiety, which could be exploited as a psychopharmacological drug.

Anxiety and Obesity in Children: Anti-oxidative Medications and Hyperbaric Oxigenation Therapy

IntroductionObesity is a grave problem in pediatrics and child psychiatry. It was revealed that in many cases obesity has comorbidity with different mental disorders. Besides a number of endocrine disturbances, immune system deficiency and oxidative stress with free radical oxidation take part in pathogenesis of these phenomena.ObjectivesThe essence of the therapeutic effect of hyperbaric oxygen lies in the fact that under the influence of elevated barometric pressure, oxygen saturation of body fluids increases: blood, interstitial fluid, which deliver oxygen to organs and tissues, increasing oxygen supply to cells by 5-10 times and eliminating hypoxia (oxygen starvation tissues). Hyperbaric oxygen, normalizing blood circulation in tissues and metabolic processes at the cellular level, has a number of effects that favorably affect the patient’s condition: promotes the formation of a new vascular network in areas where it is damaged or insufficient, has anti-edematous, anti-inflammatory and wound healing effects, has an immunocorrective effect , normalizes hormonal status, enhances the action of a number of pharmacological agents. The aim of our research was to study effects of HBO on children suffering from anxiety and obesityas a result of the mental instability? S;eep disturbances and immune instabilityMethodsSessions of hyperbaric oxygenation were carried out at a pressure of 1.6 ATA: the first session lasted 45 minutes, subsequent sessions was 30 minutes. After HBO, each of the patients during the day showed a steady increase in the saturation index, which persisted until the morning of the next day. An analysis of fluctuations in the saturation index during the day showed its decrease in all patients to a minimum value at 8 am and its general dynamic increase from the beginning of hyperbaric oxygenation. Parameters of immune status, including serum concentrations of IgA, IgM and IgG, circulating immune complexes were studied in pediatric patients, aged from 10 to 14 years old, 42 girls and 34 girls. Mapping EEG was used for evaluation of electric brain activity.ResultsIt was found that HBO treatment normalized mental state: patients demonstrated less anxiety and overeating habits, тormalization of sleep, positive dynamics of sleep, reflected in the EEG pattern in the form of alpha waves. Immune reactions were changed: IgA, IgM and IgG, were increased and CIC serum level decreased.ConclusionsThe use of antioxidant therapy in combination with psychopharmacological drugs has long been a well-established method of treatment for a variety of psychopathological conditions. The inclusion of hyperbaric oxygenation in this complex also helps to achieve more distinct results in terms of weight loss in obesity and normalization of the mental state, improved sleep and significant immunocorrection.Disclosure of InterestNone Declared

ICD-11 (psychiatric section): who diagnoses better treats better?

The article analyzes the reasons for the opposition of a significant number of Russian psychiatrists to the introduction of a new international classification of mental and behavioral disorders (ICD-11). An opinion is expressed that the increase in the effectiveness of therapy from ICD-9 to ICD-10 in world psychiatry is associated not so much with the transition to syndromic (anosological) assessment of clinical phenomena, but because of the widespread use of modern psychopharmacological drugs and the introduction of evidence-based medicine principles, which in domestic psychiatry are also criticized. It is argued that two important aspects of psychiatry diagnosis and therapy are practically independent of each other, and the entire dispute about rejection or acceptance of the new classification (ICD-11) has nothing to do with the effectiveness of therapy.

The place of glucosylated enteral solution in the correction of hemorheological abnormalities in acute poisoning by psychopharmacological drugs

Introduction. In acute exogenous poisoning, hemorheological abnormalities are observed. Various extracorporeal, physico-chemical methods are used to correct them. There is an opinion that the enteral route of administration of corrective agents may be a more physiological way to restore homeostatic imbalances.Aim. To conduct a comparative assessment of the effect of glucosylated enteral solution and standard infusion therapy on hemorheological abnormalities in acute poisoning by psychopharmacological drugs.Material and methods. Patients with acute poisoning by psychopharmacological drugs who were treated at the N.V. Sklifosovsky Research Institute for Emergency Medicine in 2017–2021 were examined. Of these, 23 people, in whose treatment the enteral correction program was used, made up the study group, and 22 patients (the comparison group) underwent a standard set of therapeutic measures. Indicators of hemorheological status were examined on the 1st, 3rd and 5th days against the background of ongoing therapy. Statistical data analysis was carried out using the Statistica 10 software package (StatSoft, Inc., USA).Results. The use of a glucosylated enteral solution led to a reduction in plasma viscosity under normal hematocrit conditions at all follow-up periods. In patients of both groups, there was a decrease in blood viscoelasticity under conditions of high shear potential at all stages of the study, which indicates impaired red blood cell deformability. This process was more pronounced in individuals of the comparison group. The conducted studies have shown that the use of infusion therapy and glucosylated enteral solution in the early stages of acute poisoning by psychopharmacological drugs generally has a unidirectional positive effect on hemorheological indicators, contributing to the stabilization of blood circulation. At the same time, the effect of glucosylated enteral solution therapy is faster and more pronounced.Conclusions. The use of glucosylated enteral solution and infusion therapy as a supportive treatment in the early period of acute poisoning by psychopharmacological drugs in most cases has a unidirectional effect on hemorheological parameters. In cases of glucosylated enteral solution therapy, there was an outrunning positive dynamics on the part of the majority of the studied hemorheological parameters. Glucosylated enteral solution can be the method of choice as a maintenance therapy after the end of detoxification process for acute poisoning by psychopharmacological drugs.

Med Check: Psilocybin for OCD, Nuplazid Vote, and More

Med Check: Psilocybin for OCD, Nuplazid Vote, and More

The Basal Forebrain Cholinergic Nuclei and Their Relevance to Schizophrenia and Other Psychotic Disorders.

The basal forebrain cholinergic nuclei (BFCN) provide the main cholinergic input to prefrontal cortices, the hippocampi, and amygdala. These structures are highly relevant for the regulation and maintenance of many cognitive functions, such as attention and memory. In vivo neuroimaging studies reported alterations of the cholinergic system in psychotic disorders. Particularly, a downregulation of nicotinic and muscarinic acetylcholine receptors has been found. Crucially, such alterations in neurotransmission have been associated with cognitive impairments and positive and negative symptoms. Recent pharmacological studies support these findings, as they demonstrated an association between the manipulation of cholinergic transmission and an attenuation in symptom severity. Targeting acetylcholine receptors has therefore become a focus for the development of novel psychopharmacological drugs. However, many open questions remain. For instance, it remains elusive what causes such alterations in neurotransmission. While evidence supports the idea that BFCN structural integrity is altered in schizophrenia, it remains to be determined whether this is also present in other psychotic disorders. Furthermore, it is unclear when throughout the course of the disorder these alterations make their appearance and whether they reflect changes in the BFCN alone or rather aberrant interactions between the BFCN and other brain areas. In this review, the specific role of the BFCN and their projections are discussed from a neuroimaging perspective and with a focus on psychotic disorders alongside future directions. These directions set the stage for the development of new treatment targets for psychotic disorders.

Expert consensus recommendations on the use of randomized clinical trials for drug approval in psychiatry- comparing trial designs

The use of randomized clinical trials, in particular placebo-controlled trials, for drug approval, is the subject of long-standing debate in the scientific community and beyond. This study offers consensus recommendations from clinical and academic experts to guide the selection of clinical trial design in psychiatry. Forty-one highly cited clinical psychiatrists and/or researchers participated in a Delphi survey. Consensus statements were developed based on the findings of a published, peer-reviewed systematic review. Participants evaluated statements in two survey rounds, following the Delphi method. The expert panel achieved consensus on 7 of 21 recommendations regarding the use of randomized clinical trials. The endorsed recommendations were: (i) Results from placebo-controlled trials are the most reliable and (ii) are necessary despite the growing placebo-effect; (iii) it is ethical to enroll patients in placebo-arms when established treatment is available, if there is no evidence of increased health risk; (iv) There is a need to approve new drugs with the same efficacy as existing treatments, but with different side-effect profiles; (v) Non-inferiority trials incur an increased risk of approving ineffective medications; (vi) The risk of approving an ineffective drug justifies trial designs that incur higher costs, and (vii) superiority trials incur the risk of rejecting potentially efficacious treatments. The endorsed recommendations inform the choice of trial-design appropriate for approval of psychopharmacological drugs. The recommendations strongly support the use of randomized clinical trials in general, and the use of placebo-controlled trials in particular.

Psychotropic drugs cross-reactivity with amphetamines in a FAERS sample: an international pharmacovigilance study

IntroductionUrine Drug Screening (USD) is one of the most used techniques for drug testing. However, one of the main issues related to USD is the high frequency of cross-reactivity with other molecules. Amphetamines, because of their simple structures, are highly subjected to cross-reactivity with other molecules.ObjectivesOur aim was to investigate and characterize the role of psychopharmacological drugs in the occurrence of false-positive amphetamine drug screening, by performing an international pharmacovigilance study through the Food and Drug Administration Adverse Event Reporting System (FAERS), in which user’s medication errors for drugs are reported in the form of Individual Case Safety Reports (ICSRs).MethodsAll ICSRs recorded between 2010 and 2020 with a positive screening for amphetamine reported as adverse reaction in patients with a psychiatric diagnosis were included in the study. Duplicated records and ICSRs with missing values for age and gender, were excluded from the study.ResultsAmong 249 ICSRs involving false-positive amphetamine drug screening, 109 ICSRs reported psychiatric disorders and/or psychiatric drugs. In 83 (76%) cases, drugs were known for cross-react. 66 cases reported drugs known as “suspect”. 24% of cases reported unknown false-positive reactions: acetaminophen (5%), duloxetine (5%) and oxycodone (5%).ConclusionsThe high cross-reactivity of psychotropic drugs with amphetamine testing in USDs may be linked to the neuromodulatory effect of these drugs, suggesting a similar molecular structure. In this perspective, antidepressants and amphetamines share a similar mechanism of action, maybe partially explaining why the most reported cross-reactions are with antidepressant (59%).DisclosureNo significant relationships.

Post-mortem toxicology analysis in a young sudden cardiac death cohort

Risk of sudden cardiac death (SCD) increases with age, and several studies have examined the impact of different drugs on cardiovascular function. However, few studies have integrated epidemiological drug consumption data and genetic background in the context of cardiac death. We performed a retrospective population-based study in forensic sudden death cases from a 9-year period in Catalonia. The young cohort included 924 cases 18–50 years old, 566 of which had a cardiac cause of death. Complete autopsy, toxicological, and histopathological studies were performed. Molecular autopsy using next-generation sequencing was performed in nearly 400 cardiac cases. Cases related with fatal acute intoxication were excluded. Drug consumption prevalence was similar between forensic cases of cardiac and non-cardiac origin (62.5% versus 69.5%), with the exception of alcohol, which was more prevalent in the cardiac group than in the non-cardiac group (23.3% versus 17.1%). Individuals in the toxicology-positive group were carriers of more rare genetic variants and were significantly younger than the toxicology-negative group. Psychopharmacological drugs were identified in 22.3% of cardiac cases, and molecular autopsy identified an association between antiepileptic drugs or caffeine and pathogenic or likely pathogenic variants in arrhythmogenic genes. Specific substances could therefore play an essential role as triggers of SCD in genetically predisposed young people.

Psychological and Psychopharmacological Interventions in Psychocardiology

Patients with mental disorders have an increased risk to develop cardiovascular disease (CVD), and CVD are frequently comorbid with especially adjustment, anxiety and depressive disorders. Therefore, clinicians need to be aware of effective and safe psychological and pharmacological treatment strategies for patients with comorbid CVD and mental disorders. Cognitive behavioral therapy and third-wave of cognitive-behavioral therapy are effective for patients with CVD and mental disorders. Internet-based psychological treatments may also be considered. In more severe cases, psychopharmacological drugs are frequently used. Although generally well tolerated and efficacious, drug- and dose-dependent side effects require consideration. Among antidepressants, selective serotonin reuptake inhibitors, selective serotonin and noradrenalin reuptake inhibitors, and newer antidepressants, such as mirtazapine, bupropion, agomelatine, and vortioxetine, can be considered, while tricyclic antidepressants should be avoided due to their cardiac side effects. Mood stabilizers have been associated with arrhythmias, and some first- and second-generation antipsychotics can increase QTc and metabolic side effects, although substantial differences exist between drugs. Benzodiazepines are generally safe in patients with CVD when administered short-term, and may mitigate symptoms of acute coronary syndrome. Laboratory and ECG monitoring is always recommended in psychopharmacological drug-treated patients with CVD. Presence of a heart disease should not exclude patients from necessary interventions, but may require careful risk-benefit evaluations. Effectively and safely addressing mental disorders in patients with CVD helps to improve both conditions. Since CVD increase the risk for mental disorders and vice versa, care providers need to screen for these common comorbidities to comprehensively address the patients’ needs.

Behavioural Effect of a Single Oral Dose of Three Different Psychopharmacological Drugs in Female Beagle Dogs

Behavioural Effect of a Single Oral Dose of Three Different Psychopharmacological Drugs in Female Beagle Dogs

Prescriptions of psychopharmacologic drugs in Austria in 2019 and 2020 – Implications of the COVID-19 pandemic

Measures to reduce the spread of the SARS-CoV-2 virus have an impact on the mental health of the general population. Drug prescription rates can be used as a surrogate marker to estimate help seeking and health parameters of a population. The aim of this study was to compare psychopharmacologic drug prescriptions in Austria from the start of the pandemic in 2020 over time and with the previous year and to investigate the impact of the COVID-19 lockdowns in 2020. Data from the three largest public health insurances in Austria, covering over 98% of the general population, were analyzed. A total of 1,365,294 patients with a prescription of a psychopharmacologic drug in the months March to December in 2019 and 2020 were selected. There was no significant change in prescribed defined daily doses (DDDs) during the lockdowns. However, there was a stockpiling effect before and at the beginning of lockdown 1. The number of new patients initiating psychopharmacologic treatment was significantly reduced during lockdown 1 but not during lockdown 2. The first COVID-19 lockdown in 2020 functioned as a barrier for new psychiatric patients seeking help, whereas the patients with ongoing treatments did not have significant problems. These results have to be taken into account for future planning, but follow-up studies are needed, as our results could be indicative of a change in the effect of the protective measures on the utilization of the healthcare system over time.