Psychotherapeutic Drugs Research Articles

S12 - Trends in the Co-Use of Cannabis and Prescription Psychotherapeutic Drugs in the United States

S12 - Trends in the Co-Use of Cannabis and Prescription Psychotherapeutic Drugs in the United States

Sources of nonmedically used prescription psychotherapeutic drugs using real-world data from adolescents and adults assessed for substance use treatment--2014-2022

BackgroundNonmedical use (NMU) of prescription psychotherapeutic drugs (PPD) may increase risk for significant morbidity and mortality in the overdose crisis. ObjectiveThis study examines sources of PPD using real-world data from adolescents and adults reporting past 30-day NMU of PPDs. MethodsA convenience sample of individuals aged ≥10 years assessed for substance use disorders (SUD) treatment was analyzed using the 2014–2022 National Addictions Vigilance Intervention and Prevention Program datasets. PPD include prescription opioids, prescription tranquilizers/sedatives, and prescription stimulants. ResultsOverall, among assessments of adolescents aged 10–18 years (N = 1991) and young adults aged 19–24 years (N = 15,166), “family/friend” (46.08–47.41 %) and “dealer” (33.82–42.71 %) were the most common sources. Among assessments of adults aged ≥25 years (N = 89,225), “own prescription” was the most common source and increased in frequency as age increased. Across all age groups, “family/friend” was the most frequent source for all drug classes (41.96–48.76 %) except for nonmedically used buprenorphine/methadone, for which “own prescription” was the most common source (51.85 %) among adults. ConclusionsOur study demonstrates heterogeneity in sources of nonmedically used PPD across age groups. Tailored prevention strategies for different age groups and improving timely access to medical care to ensure proper treatment of chronic medical conditions including SUD are needed.

Psychotherapeutic drug-induced life-threatening arrhythmias: A retrospective analysis using the Japanese adverse drug eventreport database.

Drug-induced life-threatening ventricular arrhythmias including torsade de pointes (TdP), ventricular tachycardia (VT), and ventricular fibrillation (VF) are serious cardiac side effects. Psychotherapeutic drugs are known to be risk factors for arrhythmias. The aim of this study was to evaluate psychotherapeutic drugs associated with life-threatening ventricular arrhythmias using the Japanese Adverse Drug Event Report (JADER) database. From the JADER database (April 2004 to September 2022), cases of TdP, VT, VF, and QT prolongation in patients taking psychotherapeutic drugs as 'suspected drugs' were extracted. The adjusted reported odds ratio (aROR) was calculated to identify potential drugs involved in combined TdP/VF/VT or combined QT prolongation/TdP. Of the 4,530,772 cases reported, life-threatening arrhythmia-related adverse events were reported in 1760 cases (QT prolongation 1261, TdP 192, VF 108, VT 199) among 909 patients; 58.9% of patients were female, and the highest incidence was among patients aged 80-89 years (18.6%), followed by patients aged 70-79 years (15.4%). The highest aROR for TdP/VF/VT was found for trazodone (17.1), followed by sulpiride (10.8), haloperidol (9.8), donepezil (9.1), and fluvoxamine (7.9). The highest aROR for QT prolongation/TdP was found for guanfacine (87.8), followed by sultopride (60.1), escitalopram (21.0), trazodone (12.8), and donepezil (9.3). This study showed that typical antipsychotics, antidepressants, and antidementia drugs were associated with life-threatening arrhythmia-related adverse events in a Japanese clinical setting. These events were more frequent in women and elderly individuals.

Cigarette and e-cigarette use trajectories and prospective prescription psychotherapeutic drug misuse among adolescents and young adults

ObjectiveThis study aimed to determine the potential longitudinal impact of different cigarette and e-cigarette use trajectories among people aged 10–24 on prescription drug misuse of psychotherapeutic drugs. MethodsData came from waves 1–5 of the Population Assessment of Tobacco and Health (PATH) Study (2013–2019; n = 14,454). Group-based trajectory modeling identified groups of adolescents and young adults based on cigarette and e-cigarette use across the five waves. Weighted logistic regression models were fit to examine the association of group membership with two outcomes at all waves: 1) misuse of opioids, sedatives, and/or tranquilizers, and 2) misuse of Ritalin and/or Adderall, adjusting for background characteristics. ResultsFive trajectory groups emerged: (1) non-use (77.7 %); (2) early-onset cigarette use with reducing use (4.6 %); (3) ever-increasing e-cigarette use (6.1 %); (4) stable dual use of cigarettes and e-cigarettes (3.2 %); and (5) accelerating dual use of cigarettes and e-cigarettes (8.4 %). In comparison to the non-use group, all other groups had significantly higher odds of misuse of opioids, tranquilizers, and/or sedatives and all but the early-onset cigarette use with reducing use group had significantly higher odds of misuse of Ritalin and/or Adderall by the end of wave 5. DiscussionPatterns of cigarette and e-cigarette use in adolescent and young adult populations may serve as important indicators for concurrent and prospective prescription psychotherapeutic drug misuse. Findings highlight the need for cigarette and e-cigarette use prevention, harm reduction, and/or cessation efforts among adolescents and young adults.

Клиническое наблюдение позднего дебюта оливопонтоцеребеллярной атрофии

Background. Olivopontocerebellar atrophy (OPCA) is a rare neurodegenerative disorder characterized by the continuously progressive course that combines the signs of cerebellar ataxia, parkinsonism, pyramidal syndrome, choreoathetosis, dementia, oculomotor dysfunction, affected peripheral nerves, and autonomic failure. Differential diagnosis is hampered by late onset of the disease in adulthood and older age, low prevalence in the population, non-specific nature, and slowly emerging symptoms. The paper investigates the clinical case of olivopontocerebellar atrophy that has been extremely difficult to verify. Aim. To attract attention of physicians of different specialties, primarily neurologists, psychiatrists, general practitioners, on the issue of rare neurodegenerative disorders, which are extremely difficult to verify in adulthood and older age. Methods. Medical history of female patient М., 68 years, who stayed at psychotherapy department. Assessment of the whole body, mental, and neurological status. Results. Considering the complaints of the patient and her relatives, the data of psychological and psychiatric assessment, neurological status, brain MRI, and no response to treatment with neurological and psychotherapeutic drugs, the following probable clinical diagnosis was established: “Congenital spinocerebellar ataxia of unspecified type (olivopontocerebellar atrophy)”. Conclusion. Early diagnosis of the OPCA clinical manifestations is extremely difficult, especially in elderly individuals, since the disorder occurs under the guise of age-related vascular changes in the brain matter and manifests itself in focal symptoms and mental function impairment. The history of the signs of prominent cognitive decline and multiple focal symptoms in the elderly patient, who is not excessive drinker and has no malignant hypertension or severe atherosclerosis, as well as any other background disease, requires exclusion of the disease vascular or degenerative origin. In the reported case, the combination of cerebellar ataxia and dementia constituted the core of clinical manifestations of the neurodegenerative process confirmed by brain imaging to exclude the conversion disorder.

Prescription Psychotherapeutic Drug Use and Nicotine Use among Young People in the United States

Background: While prescription psychotherapeutic drug use (PPDU) and nicotine use pose substantial problems in isolation, they pose an increased risk in combination. This study aimed to estimate the prevalence of PPDU for young people, stratified by nicotine use status. A trend analysis was used to examine changes in PPDU and nicotine use over time. Methods: We used a cross-sectional population-based sample of young people aged 16–25 years (n = 10,454) from the National Health and Nutrition Examination Survey (NHANES, 2003–2018). For each data cycle, the prevalence of self-reported PPDU and nicotine including pain relievers, sedatives, stimulants, and tranquilizers was estimated. Using Joinpoint regression, we tested for significant changes in trends using a log-linear model and permutation test approach and produced the average data cycle percentage change (ADCPC). Results: From 2003 to 2018, 6.7% of young people had PPDU and 27.3% used nicotine. The prevalence of cigarette smoking decreased while other nicotine product use increased (p’s < 0.001). Those who used nicotine were more likely to have PPDU (8.2%; 95% CI = 6.5%, 9.8%) vs. non-nicotine use (6.1%; 95% CI = 5.1%, 7.0%; p = 0.01). Results indicated a decreasing trend for nicotine use (ADCPC = −3.8, 95% CI = −7.2, −0.3; p = 0.04), but not for PPDU (ADCPC = 1.3; 95% CI = −4.7, 7.8; p = 0.61). On further examination, opioid use decreased, sedative use remained stable, and stimulant and tranquilizer use increased over time. Conclusions: From 2003 to 2018, young people who used nicotine had a higher prevalence of PPDU than those who did not. Clinicians should communicate the association between nicotine use and prescription drugs when prescribing or managing young patients’ medications.

Effects of Age, Sex, and Comedication on the Plasma Concentrations of Olanzapine in Chinese Patients With Schizophrenia Based on Therapeutic Drug Monitoring Data.

Olanzapine (OLA) is an atypical second-generation antipsychotic that exhibits significant pharmacokinetic variability. We retrospectively investigated the effects of age, sex, and specific comedications on OLA pharmacokinetics in Chinese patients with schizophrenia. Data on sex, age, and OLA dosage and steady-state plasma concentrations of 386 patients with schizophrenia (who have received OLA or a comedication of OLA with a psychotherapeutic drug) were collected and analyzed. The combined effects of dosage, age, sex, and comedication on OLA plasma levels were assessed via multiple linear regression analyses. A daily dose of OLA was positively correlated with the drug's plasma concentrations. Overall, the OLA plasma concentrations and concentration-to-dose ratio (C/D) of the studied patients varied by 53.6- and 64.1-fold, achieving median values of 42.7 ng/mL and 2.73 (ng/mL)/(mg/d), respectively. Furthermore, a 1.27-fold higher estimated C/D in patients 60 years or older than in those younger than 60 years was identified. Female patients demonstrated a 33.6% higher C/D than in male patients. When coadministered with mood stabilizers (valproate or lithium), the median OLA C/D was 24.1% to 26.1% lower than that of OLA monotherapy. Interestingly, the OLA plasma concentration and C/D were not significantly affected by a comedication with aripiprazole, haloperidol, amisulpride, risperidone, clozapine, ziprasidone, citalopram, or buspirone. The administered drug's dose was identified as an important determinant of the achieved OLA plasma concentration, with a positive correlation. The patients' sex and valproate (or lithium) comedication can significantly affect the C/D of OLA. Therapeutic drug monitoring should be routinely applied in cases of OLA-receiving patients with schizophrenia.

3,4-Methylenedioxy methamphetamine, synthetic cathinones and psychedelics: From recreational to novel psychotherapeutic drugs.

The utility of classical drugs used to treat psychiatric disorders (e.g., antidepressants, anxiolytics) is often limited by issues of lack of efficacy, delayed onset of action or side effects. Psychoactive substances have a long history of being used as tools to alter consciousness and as a gateway to approach the unknown and the divinities. These substances were initially obtained from plants and animals and more recently by chemical synthesis, and its consumption evolved toward a more recreational use, leading to drug abuse-related disorders, trafficking, and subsequent banning by the authorities. However, these substances, by modulation of certain neurochemical pathways, have been proven to have a beneficial effect on some psychiatric disorders. This evidence obtained under medically controlled conditions and often associated with psychotherapy, makes these substances an alternative to conventional medicines, to which in many cases the patient does not respond properly. Such disorders include post-traumatic stress disease and treatment-resistant depression, for which classical drugs such as MDMA, ketamine, psilocybin and LSD, among others, have already been clinically tested, reporting successful outcomes. The irruption of new psychoactive substances (NPS), especially during the last decade and despite their recreational and illicit uses, has enlarged the library of substances with potential utility on these disorders. In fact, many of them were synthetized with therapeutic purposes and were withdrawn for concrete reasons (e.g., adverse effects, improper pharmacological profile). In this review we focus on the basis, existing evidence and possible use of synthetic cathinones and psychedelics (specially tryptamines) for the treatment of mental illnesses and the properties that should be found in NPS to obtain new therapeutic compounds.

LC-MS-MS Determination of 88 Psychotropic Drugs in 1,865 Hair Samples from Addicts in Drug Abstinence.

The emergence of novel drugs and the continuous expansion of the scope of the types of drugs under control have greatly increased requests for screening of a range of drugs in hair. Here, a multi-analyte method for the detection and quantification of 88 psychotropic drugs in the hair of addicts in drug abstinence was developed and fully validated using liquid chromatography–tandem mass spectrometry (LC–MS/MS). Hair samples (25 mg) were washed, cut into pieces, cryogenically ground and extracted in methanol. The extracted analytes were separated on an Allure PFP Propyl column (100 × 2.1 mm, 5 mm inside diameter, Restek, USA) and analyzed by LC–MS/MS in multiple reaction monitoring modes. The limits of detection and the limits of quantification ranged from 0.1 to 20 pg/mg and 0.2 to 50 pg/mg, respectively. The intra- and inter-assay precisions (relative standard deviation (RSD)) of all analyses ranged from 0.9% to 14.9% and 1.9% to 15.9%, respectively. Accuracy values were 100 ± 20%. The extraction recovery of quality control samples ranged from 50.9% to 99.6% for all analytes. The matrix effects for all analytes ranged from 46.8% to 99.7%. The method was successfully used to analyze 1,865 hair samples from addicts in drug rehabilitation at their own communities. Among the samples, 129 cases were positive; the majority of positive cases were from males (78.29%), 92.25% of whom were >35 years old. Traditional drugs, like methamphetamine and opioids, accounted for most positive cases, and 27 of the abstinence cases with a use history of methamphetamine were still positive. In addition to abused drugs, like methamphetamine, morphine and cocaine, the sedative-hypnotic and psychotherapeutic drugs, including clonazepam, alprazolam, estazolam, zolpidem and quetiapine, were detected in 26% of the hair samples, suggesting that these addicts may have insomnia and mental problems such as depression and psychosis, probably due to the long-term effects of drugs and withdrawal reactions. Three synthetic cannabinoids were also detected in four (2.7%) cases. A total of 37 cases were positive for methadone, tramadol and dextromethorphan, reflecting a new trend of alternative drug use when traditional drugs were not easy to obtain during the coronavirus disease 2019 outbreak.

Tricyclic antipsychotics and antidepressants can inhibit α5-containing GABAA receptors by two distinct mechanisms.

Background and PurposeMany psychotherapeutic drugs, including clozapine, display polypharmacology and act on GABAA receptors. Patients with schizophrenia show alterations in function, structure and molecular composition of the hippocampus, and a recent study demonstrated aberrant levels of hippocampal α5 subunit‐containing GABAA receptors. The purpose of this study is to investigate the effects of tricyclic compounds on α5 subunit‐containing receptor subtypes.Experimental ApproachFunctional studies of effects by seven antipsychotic and antidepressant medications were performed in several GABAA receptor subtypes by two‐electrode voltage‐clamp electrophysiology using Xenopus laevis oocytes. Computational structural analysis was employed to design mutated constructs of the α5 subunit, probing a novel binding site. Radioligand displacement data complemented the functional and mutational findings.Key ResultsThe antipsychotic drugs clozapine and chlorpromazine exerted functional inhibition on multiple GABAA receptor subtypes, including those containing α5‐subunits. Based on a chlorpromazine binding site observed in a GABA‐gated bacterial homologue, we identified a novel site in α5 GABAA receptor subunits and demonstrate differential usage of this and the orthosteric sites by these ligands.Conclusion and ImplicationsDespite high molecular and functional similarities among the tested ligands, they reduce GABA currents by differential usage of allosteric and orthosteric sites. The chlorpromazine site we describe here is a new potential target for optimizing antipsychotic medications with beneficial polypharmacology. Further studies in defined subtypes are needed to substantiate mechanistic links between the therapeutic effects of clozapine and its action on certain GABAA receptor subtypes.

Infrared Spectroscopic Analysis of the Inorganic Components from Teeth Exposed to Psychotherapeutic Drugs

Teeth are unique and complex anatomical organs that can provide relevant data about a person's health, and play an important role in forensic medicine. Teeth are exposed to food, drinks, and the microbiota of the oral cavity; therefore, they have developed a high resistance to localized demineralization. Nevertheless, the continuous demineralization–remineralization cycle present in the oral environment can be influenced by stress, medication, mineralization agents, and other factors such as individual habits, especially diet. In this study, based on attenuated total reflectance Fourier-transform infrared spectroscopy (ATR-FTIR) spectra from tooth samples of 36 patients, several parameters were estimated: the crystallinity index (CI), the phosphate/amide I ratio, and the carbonate/phosphate ratio. In addition, in eight representative samples (six of the root of the tooth and two of the enamel area of the crown), additional characterization by X-ray powder diffraction (XRPD), scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS) was conducted. From the FTIR data, it was observed that the highest CI values were found in patients who smoked. Further, in both root and crown samples, the intensity of the absorption band corresponding to PO43- increased in patients undergoing treatment with psychotherapeutic drugs. On the other hand, the intensity of the absorption band of the amide I group decreased with medical treatment and with the patient's biological age. Moreover, it was found that the remineralization process was more active in enamel than in the root due to direct contact with saliva. Regarding the results obtained from the X-ray powder diffractograms, exposure to psychotherapeutic drugs affected the definition of the peaks corresponding to hydroxyapatite, both in the crown and root samples. Concerning SEM results, qualitative differences in the stratification process in demineralized surfaces were observed, and EDS analyses showed some differences in the Ca/P ratio between pathological samples and control ones, but without clear patterns. The above techniques, in particular ATR-FTIR, showed promise for the investigation of the effect of changes produced in the hydroxyapatite structure in teeth and, consequently, to determine possible strategies in the diagnostic protocol.

Do Oral and Maxillofacial Surgeons Prescribe More Opioids after Third Molar Removal for Patients with Substance Use History?

Statement of the problemIn 2018, an estimated 53.2 million (19.4%) people 12 years or older in the United States (US) used an illicit drug within the previous year. As such, oral and maxillofacial surgeons (OMSs) must be prepared to recognize patients with a substance abuse history (SUH) and may need to be prepared to adjust analgesic management for these patients. Although substance use may be associated with increased opioid requirements and delayed recovery, few recommendations exist to guide postoperative pain management in this population. Specifically, no data exist to guide postoperative outpatient opioid dosing quantitatively for patients with SUH. The purpose of this study was to measure and compare the amount of opioids prescribed by OMSs to patients with and without a self-reported SUH after third molar (M3) removal. Materials, methods and data analysisThe investigators implemented a retrospective cohort study and enrolled a sample derived from the population of patients who had their M3s removed between January 1, 2019, and December 31, 2019, at the OMS faculty/resident outpatient clinic, University of Washington (UW) School of Dentistry. Subjects were included in the study were male or female, age > 13 years, having had M3s removed under any type of anesthesia, in an outpatient setting with postoperative medications prescribed for analgesia. Subjects were excluded if they did not meet these inclusion criteria, had other procedures done concurrently with M3 removal, or if no postoperative analgesics were prescribed.The primary predictor variable was SUH status coded as yes (SUH+) or no (SUH-). Subjects were categorized as SUH+ if the documented social history reflected SUH, or when selected on self-reporting health questionnaires. For this study, substances, as defined by the Centers for Disease Control and Prevention (CDC), included marijuana, cocaine (including crack), heroin, hallucinogens, and prescription psychotherapeutic drugs (including pain relievers, tranquilizers, stimulants, and sedatives). The primary and secondary outcome variables were: 1) prescribed morphine milligram equivalents (MMEs) and 2) number of postoperative visits due to inadequate pain control, respectively. Other variables were age, gender, payor (government [Medicare/Medicaid] or nongovernment [private insurance or self-pay]), provider (faculty or resident), anesthesia technique (local anesthesia [LA], nitrous oxide [N2O], moderate sedation [MS], or deep sedation/general anesthesia [DS/GA]), and procedure specific (erupted or impacted).Institutional Review Board approval was obtained. Descriptive, bivariate, and multivariate statistics were computed. Results and outcomes dataThe sample included 1112 subjects with a mean age of 25 +/- 9 years; 61.2% were female. Of the 1112 subjects, 198 (17.8%) were SUH+. Mean prescribed postoperative analgesics MMEs were 70.9 +/- 27.9 and 63.4 +/- 28.8 in the SUH+ and SUH- groups, respectively (P < .001). An adjusted linear regression model showed a non-significant association between SUH status and MMEs prescribed (P = .12). The study showed a non-significant increase (P = .15) in the proportion of patients with inadequate pain control in the SUH- group (4.1%) versus the SUH+ group (2.0%). ConclusionThe results suggest that 10% more opioids were prescribed for postoperative pain after M3 removal for patients with SUH, though after adjustment, the amount may not be clinically significant. The amount of MMEs prescribed for postoperative pain management after M3 removal in patients with SUH, on average, may be similar as for patients without SUH.

Clinical Pharmacy in Psychiatry: Towards Promoting Clinical Expertise in Psychopharmacology

Although clinical pharmacy is a discipline that emerged in the 1960s, the question of precisely how pharmacists can play a role in therapeutic optimization remains unanswered. In the field of mental health, psychiatric pharmacists are increasingly involved in medication reconciliation and therapeutic patient education (or psychoeducation) to improve medication management and enhance medication adherence, respectively. However, psychiatric pharmacists must now assume a growing role in team-based models of care and engage in shared expertise in psychopharmacology in order to truly invest in therapeutic optimization of psychotropics. The increased skills in psychopharmacology and expertise in psychotherapeutic drug monitoring can contribute to future strengthening of the partnership between psychiatrists and psychiatric pharmacists. We propose a narrative review of the literature in order to show the relevance of a clinical pharmacist specializing in psychiatry. With this in mind, herein we will address: (i) briefly, the areas considered the basis of the deployment of clinical pharmacy in mental health, with medication reconciliation, therapeutic education of the patient, as well as the growing involvement of clinical pharmacists in the multidisciplinary reflection on pharmacotherapeutic decisions; (ii) in more depth, we present data concerning the use of therapeutic drug monitoring and shared expertise in psychopharmacology between psychiatric pharmacists and psychiatrists. These last two points are currently in full development in France through the deployment of Resource and Expertise Centers in PsychoPharmacology (CREPP in French).

National estimates of substance use, substance use disorders, and treatment among adolescent and young adult cancer survivors.

7042 Background: Adolescent and young adult (AYA) survivors of cancer are at an elevated risk of early-life morbidity and mortality due to the disease trajectory and treatment. Engagement in risk behaviors, including substance use, can exacerbate survivors’ vulnerabilities and place them at further risk for adverse health outcomes. This study provides national estimates of the prevalence of substance use and misuse, substance abuse or dependence (i.e., substance use disorders [SUD]), and receipt of treatment for SUD among AYA cancer survivors. Methods: We used 2015-2018 National Survey of Drug Use and Health data to identify a nationally-representative AYA sample (aged 12-34 years). Outcomes included past-year alcohol use, marijuana use, other illicit drug use, misuse of any prescription psychotherapeutic drugs (including opioid analgesics, stimulants, sedatives, or tranquilizers), and misuse of prescription opioid analgesics. Outcomes also assessed past-year SUD in aforementioned drug classes. Among those with SUD, we evaluated past-year receipt of SUD treatment. Multiple logistic regressions were estimated to compare outcomes between 846 AYAs who reported a cancer history and 142,870 AYAs who did not, adjusting for sociodemographic and need-related characteristics. Results: In bivariate analyses, AYAs with a cancer history were more likely than noncancer peers to use alcohol (78.6% vs. 63.4%; p&lt; 0.001) and illicit drugs other than marijuana (11.2% vs. 7.8%; p= 0.02), misuse any prescription psychotherapeutic drugs (16.9% vs. 10.6%; p&lt; 0.001) and prescription opioid analgesics (12.0% vs. 5.9%; p&lt; 0.001), and have an illicit drug (other than marijuana) SUD (3.7% vs. 1.3%; p&lt; 0.01) in the past year. In regression analyses, differences in past-year misuse of any prescription psychotherapeutic drug and prescription opioid analgesics persisted ( p= 0.02, p&lt; 0.01, respectively). Among AYAs with SUD, those with a cancer history were more likely than noncancer peers to receive SUD treatment (21.0% vs. 8.1%; p= 0.01) in the past year; this difference persisted in regression analyses ( p= 0.03). Conclusions: AYAs with a cancer history had an elevated risk for misusing prescription psychotherapeutic medications, which was driven by misuse of prescription opioids; yet, only one in five AYAs with a cancer history and SUD received treatment. Our findings underscore the need for future interventions designed to reduce substance use and misuse and improve access to SUD treatment in AYA cancer survivors.

Predominância do uso do Clonazepam em pacientes de uma Unidade Básica de Saúde no município de Mossoró – RN

Transtornos relacionados à ansiedade é um mal comumente identificado na população brasileira. Estima-se que cerca de 18,6 milhões de pessoas sofrem de dependência de benzodiazepínicos. Entre as queixas relatadas pelos pacientes podemos identificar transtornos de ansiedade, sofrimento mental e fatores de vulnerabilidade que surgem dinamicamente ao longo da vida de cada pessoa. Dessa forma, o presente estudo, teve como objetivo traçar o perfil epidemiológico e o tipo de psicoterápico utilizado no tratamento dos pacientes que fazem parte do grupo de saúde mental de uma Unidade Básica de Saúde (UBS) do município de Mossoró-RN. Para isso, foi realizado um estudo transversal, descritivo, retrospectivo, de abordagem quantitativa, sendo a população alvo todos os pacientes que fizeram e fazem uso de medicação psicotrópica na Unidade em questão. Deste modo, de um total de 573 prontuários presentes na UBS, 36 se encaixaram como usuários de psicoterápicos, refletindo em 6,28% dos usuários do sistema de saúde. Observou-se que a faixa etária mais prevalente que utilizam medicamentos psicotrópicos estão entre 60-69 anos de idade, constituindo 36,11% dos usuários. Há discrepância da utilização de Clonazepam (com 55,5%) em relação aos outros medicamentos. Também foi percebido uma prevalência de uso de psicofármacos por mulheres e de pacientes com idade maior ou igual a 40 anos. Desse modo, o presente trabalho propõe medidas de intervenção para racionalizar a utilização dos psicotrópicos, visando a inclusão participativa do paciente no sistema de saúde.

ЧАСТНЫЕ ВОПРОСЫ ГЕПАТОТОКСИЧНОСТИ ПСИХОТРОПНЫХ ПРЕПАРАТОВ

Now in psychiatric practice the big range of both traditional, and modern psychotherapeutic drugs is used. Many of them are capable to cause a damage to a liver which can proceed as it is asymptomatic, and to have a serious fulminantny current. Especially it touches the patients having risk factors of drugs hepatotoxic. In this regard at the choice of psychotropic drug in each case it is necessary to consider a background structurally functional condition of a liver of the patient, to compare these data with potential risks of hepatotoxic of this drug, without losing sight also of a possibility of an idiosyncrasy. The algorithm of maintaining patients with the taped hepatotoxic has to include use of potentially possible hepatotropic drugs, according to mechanisms of their corrective action and also measures of prevention of repeated hepatotoxic reactions.

Principal component analysis of early alcohol, drug and tobacco use with major depressive disorder in US adults

Early alcohol, tobacco and drug use prior to 18 years old are comorbid and correlated. This study included 6239 adults with major depressive disorder (MDD) in the past year and 72,010 controls from the combined data of 2013 and 2014 National Survey on Drug Use and Health (NSDUH). To deal with multicollinearity existing among 17 variables related to early alcohol, tobacco and drug use prior to 18 years old, we used principal component analysis (PCA) to infer PC scores and then use weighted multiple logistic regression analyses to estimate the associations of potential factors and PC scores with MDD. The odds ratios (ORs) with 95% confidence intervals (CIs) were estimated. The overall prevalence of MDD was 6.7%. The first four PCs could explain 57% of the total variance. Weighted multiple logistic regression showed that PC1 (a measure of psychotherapeutic drugs and illicit drugs other than marijuana use), PC2 (a measure of cocaine and hallucinogens), PC3 (a measure of early alcohol, cigarettes, and marijuana use), and PC4 (a measure of cigar, smokeless tobacco use and illicit drugs use) revealed significant associations with MDD (OR = 1.12, 95% CI = 1.08–1.16, OR = 1.08, 95% CI = 1.04–1.12, OR = 1.13, 95% CI = 1.07–1.18, and OR = 1.15, 95% CI = 1.09–1.21, respectively). In conclusion, PCA can be used to reduce the indicators in complex survey data. Early alcohol, tobacco and drug use prior to 18 years old were found to be associated with increased odds of adult MDD.

Tactics of treatment of patients with sexual dysfunctions and intermediate disorders

The article gives the world views on the main types of sexual disorders among the male contingent and their interrelation with the phases of sexual reaction. The interrelation of the development of sexual dysfunctions under the influence of significant stress or psychoemotional overload or in the absence of any psychoneurological disorders, among which the leading place occupy border disorder, is shown. The necessity of therapeutic correction of affective pathology in the complex therapy of sexual dysfunctions is substantiated. The basic mechanisms of complex treatment of sexual dysfunctions and psychopathological manifestations are shown. In order to work out a more effective therapeutic complex using the Questionnaire International Erectile Function Index (IEFI), calculation of the duration of sexual intercourse (the so-called Intravaginal latency interval (ILI) and the Hamilton Rating Scale for Depression (HDRS-17) were evaluated. 83 patients with sexual dysfunctions: 52 patients (1 group) with premature ejaculation (PE); 31 patients (2 groups) with erectile dysfunction (ED) (the presence of these sexual dysfunctions led to the development of anxiety-depressive and neurosis-like disorders, which was confirmed by the Hamilton Scales) and 45 patients (3 groups) with sexual dysfunctions that developed as a result of existing initial psychopathological or boundary disorders (BD). Each study group was divided into two subgroups (a and b), each of which used different therapies from each other. With the use of one or another therapeutic scheme, patients of each group received cognitive-behavioral psychotherapeutic correction, tadalafil, nootropic drugs (noofen or glycine) and antidepressants (fluoxetine or coaxiаl). The duration of the observation was 3 months. As a result of the study, improvement of the ejaculatory function (with an increase in the ILI score) was established, which significantly increased at each control examination. In the analysis of the dynamics of the overall indicator of the MIEF questionnaire after the therapy, improvement in sexual function was observed in all groups, but the best results were obtained in the ED group. The results of the HDRS questionnaire showed that after 3 months, patients in the PE group compared with the BD group were reliably less susceptible to depressive disorder, especially of a pronounced nature.

Examination of Veteran Fathers' Parenting and Their Adolescent Children's Substance Use in the United States

ABSTRACTBackground: Adolescent children of U.S. military veterans may be at increased risk for engaging in substance use; however, this has yet to be examined using nationally representative data. Parental involvement and communication are potential protective factors to target with prevention efforts, but veterans' parenting has not been studied in general, nonclinical populations. Objectives: This study presents data on parenting characteristics among fathers who are veterans of the U.S. military and the substance use behaviors of their adolescent children. Methods: Data were analyzed from approximately 2,200 veteran fathers, 13,100 nonveteran fathers, and their children aged 12 to 17 who participated in the National Survey on Drug Use and Health from 2004 to 2013. Parenting characteristics and adolescent substance use were compared by fathers' veteran status. Results: Compared with nonveteran fathers, veteran fathers were less likely to have talked with their children about the dangers of substance use, were more likely to believe that their children used substances, and were just as likely to be parentally involved. Higher percentages of adolescent children of veterans than those of nonveterans engaged in tobacco use and nonmedical use of psychotherapeutic drugs. Parental involvement and father-child communication about the dangers of substance use did not explain differences in substance use among adolescents with veteran versus nonveteran fathers. Conclusions/Importance: Adolescent children of veterans appear to be a group in particular need of substance use prevention services. Parental involvement and father-child communication may be appropriate protective factors to address in prevention efforts.

Novel Measure of Opioid Dose and Costs of Care for Diabetes Mellitus: Opioid Dose and Health Care Costs.

Diabetes mellitus (DM) has well known costly complications but we hypothesized that costs of care for chronic pain treated with opioid analgesic (OA) medications would also be substantial. In a statewide, privately insured cohort of 29,033 adults aged 18 to 64years with DM and noncancer pain who filled OA prescription(s) from 2008 to 2012, our outcomes were costs for specific health care services and total costs per 6-month intervals after the first filled OA prescription. Average daily OA dose (4 categories) and total dose (quartiles) in morphine-equivalent milligrams were calculated per 6-month interval after the first OA prescription and combined into a novel OA dose measure. Associations of OA measures with costs of care (n=126,854 6-month intervals) were examined using generalized estimating equations adjusted for clinical conditions, psychotherapeutic drugs, and DM treatment. Incremental costs for each type of health care service and total cost of care increased progressively with average daily and total OA dose versus no OAs. The combined OA measure identified the highest incremental total costs per 6-month interval that were increased by $8,389 for 50- to 99-mg average daily dose plus >900mg total dose and, by $9,181 and $9,958 respectively, for ≥100mg average daily dose plus 301- to 900-mg or >900mg total dose. In this statewide DM cohort, total health care costs per 6-month interval increased progressively with higher average daily OA dose and with total OA dose but the greatest increases of >$8,000 were distinguished by combinations of higher average daily and total OA doses. The higher costs of care for opioid-treated patients appeared for all types of services and likely reflects multiple factors including morbidity from the underlying cause of pain, care and complications related to opioid use, and poorer control of diabetes as found in other studies.