Side Effects Of Psychotropic Medications Research Articles

Metabolic Syndrome and Bipolar Disorder: What Should Psychiatrists Know?

This paper reviews the association between bipolar disorder (BD) and metabolic syndrome (MetS), focusing on the etiopathogenetic and pathophysiological aspects of this association and on the recommendations for preventing and managing MetS in patients with BD. We conducted a nonsystematic literature review by means of a MEDLINE search. The exact causal relationship between MetS and BD is still uncertain. The side effects of psychotropic medications may be a major contributor to the increased rates of MetS in patients with BD. Other factors such as unhealthy lifestyles, common neuroendocrine and immuno-inflammatory abnormalities, and genetic vulnerability may also play a role in explaining the high rates of MetS in BD. Strategies to prevent and treat the MetS and its cardiovascular consequences in patients with BD include accurate screening and monitoring of the patient and appropriate psychoeducation on weight control, healthy nutrition, and increased physical activity. When deciding on pharmacological therapy for the treatment of the components of the MetS, drug interactions and the effects of the medications on mood must be taken into account.

Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care.

The lifespan of people with severe mental illness (SMI) is shorter compared to the general population. This excess mortality is mainly due to physical illness. We report prevalence rates of different physical illnesses as well as important individual lifestyle choices, side effects of psychotropic treatment and disparities in health care access, utilization and provision that contribute to these poor physical health outcomes. We searched MEDLINE (1966 - August 2010) combining the MeSH terms of schizophrenia, bipolar disorder and major depressive disorder with the different MeSH terms of general physical disease categories to select pertinent reviews and additional relevant studies through cross-referencing to identify prevalence figures and factors contributing to the excess morbidity and mortality rates. Nutritional and metabolic diseases, cardiovascular diseases, viral diseases, respiratory tract diseases, musculoskeletal diseases, sexual dysfunction, pregnancy complications, stomatognathic diseases, and possibly obesity-related cancers are, compared to the general population, more prevalent among people with SMI. It seems that lifestyle as well as treatment specific factors account for much of the increased risk for most of these physical diseases. Moreover, there is sufficient evidence that people with SMI are less likely to receive standard levels of care for most of these diseases. Lifestyle factors, relatively easy to measure, are barely considered for screening; baseline testing of numerous important physical parameters is insufficiently performed. Besides modifiable lifestyle factors and side effects of psychotropic medications, access to and quality of health care remains to be improved for individuals with SMI.

Mobile Phone Text Message Interventions in Psychiatry - What are the Possibilities?

There has been a global surge in the use of mobile phones over the past decade with subscription rates of devices in Europe now exceeding 100%. Mobile phones are popular, portable and affordable, and allow for easy communication. This provides an opportunity for their use in improving mental health related outcomes, especially through use of text message technology. Several studies have demonstrated the usefulness of text messages in improving various aspects of medical care, including attendance with primary care and outpatient clinic appointments, adherence with physical health medication, managing side effects of non-psychotropic medication and promoting smoking cessation. We review here the potential for using text message technology in psychiatry, specifically for improving adherence with scheduled outpatient appointments, increasing adherence with psychotropic medication, managing side effects of psychotropic medication and managing patients with addictive disorders and co-morbid mental health problems. We identify barriers to the potential use of text messaging technology in psychiatry and propose solutions to some of these barriers. We also propose the need for further research into the use of text messaging in psychiatry and how this might impact upon the therapeutic relationship with patients. Keywords: Text message, appointments, adherence, psychiatry, side effects, addiction, psychotropic medication, Smoking cessation, Mood symptoms, Community functioning

Medication Treatment for Attention Deficit Hyperactivity Disorder

Attention deficit hyperactivity disorder (ADHD) has become the most commonly diagnosed psychiatric disorder among school-age children. For more than half a century, physicians have prescribed medications to help manage behaviors such as hyperactivity, impulsivity, and inattention. Today, there is a growing consensus that ADHD is a biologically based disorder, and medication is now considered the first line treatment. This article discusses the therapeutic benefits and potential side effects of psychotropic medications commonly prescribed to youth with ADHD, academic and behavioral benefits associated with medication therapy, recommendations for monitoring medication efficacy, legal considerations, and the importance of establishing school medication policies.

An Examination of Psychotropic Medication Side Effects: Does taking a greater number of psychotropic medications from different classes affect presentation of side effects in adults with ID?

This study examined whether the number of psychotropic medications an individual is taking across classes influences side effects among adults with Intellectual Disability (ID). Participants were 80 adults diagnosed with ID. Dependent variables were the composite score and domain scores of the Matson Evaluation of Drug Side-effects (MEDS), which is an instrument used to assess side effects. There were three levels of the independent variable: Group 1 – those taking zero psychotropic medications, Group 2 – those taking one psychotropic medication, and Group 3 – those taking two psychotropic medications across different medication classes. There was a significant main effect regarding number of psychotropic medication classes prescribed. Further analysis revealed that four of the nine MEDS domains had significantly different mean scores for number of psychotropic medication classes. For the majority of MEDS domains, such as Central Nervous System-General, Parkinsonism/Dyskinesia, and Behavioral/Akathesia domains, participants in the no psychotropic medication group had significantly lower mean scores than those in the one and two psychotropic medication groups. Only two MEDS domains, Cardiovascular and Hematologic Effects as well as Skin, Allergies, and Temperature, were significantly different between participants taking one psychotropic medication as compared with two psychotropic medications from different classes. Implications of these findings and recommendations for future research are discussed.

A Comparison of Psychotropic Drug Side Effect Profiles in Adults Diagnosed With Intellectual Disabilities and Autism Spectrum Disorders

Forty-eight adults diagnosed with intellectual disabilities and Autistic Disorder or Pervasive Developmental Disorder-Not Otherwise Specified were examined with regard to psychotropic medication side effects. Participants were divided into 4 groups: no psychotropic medication group (n = 9); atypical antipsychotic medication group (n = 13); atypical antipsychotic and antiepileptic drug group (AEDs/mood stabilizers; n = 13); and a group of individuals receiving atypical antipsychotic medication, AEDs/mood stabilizers, and anxiolytics (n = 13). Those participants not currently prescribed any psychotropic medications evinced the fewest side effects. Participants prescribed psychotropic medication across multiple classes evinced more side effects. Thus, persons receiving atypical antipsychotic medication, AEDs/mood stabilizers, and anxiolytics had the greatest number of side effects. More specifically, the greatest number of side effects pertained to the CNS-Parkinsonism/Dyskinesia subscale.

Cross-cultural psychopharmacology: a review

Cross-cultural psychopharmacology seeks to determine whether there are differences in responses to psychopharmacologic agents among various ethnic groups and the reason for such variations. During the past four decades numerous clinical reports have addressed potential differences in therapeutic dosages and side effects of psychotropic medications between various ethnic groups. In addition, several rigorously designed studies have focused on ethnic differences in pharmacokinetics (including absorption, metabolism, distribution and excretion) and pharmacodynamics (including receptor-coupling activity). These ethnic variations are mainly influenced by genetic predisposition but are also influenced by other factors such as culture, environment, psychosocial supports, and attitudes towards pharmacology. This presentation will provide a critical review of the existing information in regard to psychotropic medications including neuroleptics, antidepressants, lithium, and benzodiazepines among various ethnic groups. Also included will be data on neuroleptic-induced movement disorders, the clinical implications of genetic polymorphism of cytochrome P-450 isoenzymes, recommendations on how to better design a pharmacological approach in the treatment of psychiatric disorders among different ethnic groups, as well as recent advances and future directions regarding cross-cultural issues of psychopharmacology.

Psychopharmacological Treatment of Prader-Willi Syndrome

Prader-Willi syndrome (PWS) is a genetic disorder caused by a mutation of chromosome 15, resulting in infantile hypotonia, obesity, short stature, mild-to-moderate mental retardation and neuroendocrinological abnormalities. A number of behavioral and psychiatric problems such as temper tantrums, self-injurious behavior, impulsiveness, lability of mood, attention deficit and hyperkinetic disorder symptoms, obsessive compulsive disorder and autistic spectrum disorder are associated with the syndrome. We report two adolescents with PWS who manifested psychiatric and behavioral problems and received psychopharmacological treatment. A 14-year-old boy had the uniparental disomy type of Prader-Willi syndrome and manifested attention deficit hyperactivity disorder symptoms, uncontrollable eating behavior and conduct disorder. A 15-year-old boy had the deletion type of PWS with attention deficit hyperactivity disorder symptoms and autistic spectrum symptoms. The two adolescents were both prescribed methylphenidate and sertraline hydrochloride. The present report shows the efficacy and side effects of psychotropic medications in Prader-Willi syndrome.

PL04-01 - Human sexuality: new developments in neurobiology, diagnosis and treatment

Mainstream psychiatry has shown only a sporadic interest in the understanding and treatment of sexual disorders. This lack of interest is puzzling, especially at the time of new developments in the study of human sexuality and the emergence of a new interdisciplinary field of sexual medicine.Human sexuality encompasses various areas related to contemporary psychiatry, such as quality of life, quality of relationship, sexual side effects of psychotropic medications, and the association of sexual dysfunction with various mental and physical illnesses, including substance abuse. Sexual dysfunction, with its complex regulation involving the central and the peripheral nervous systems, hormones, psychological, cultural, psychosocial and developmental factors actually seems to be a primary target for psychosomatic medicine and psychiatry. As noted, “Sexuality is the ultimate unity of body and mind.”This lecture will review the recent developments in the area of human sexuality, including diagnostic considerations in the context of proposed revisions of the existing diagnostic systems, neurobiology, imaging, psychology and psychopharmacology; and will also focus on combining the new findings into an integrated model of management of sexual dysfunctions.

Elicitation of cognitions related to HIV risk behaviors in persons with mental illnesses: Implications for prevention.

An important step in research using the Theory of Reasoned Action and Theory of Planned Behavior (TRA/TPB) is conducting an elicitation process to identify topic and population specific cognitions. This study explored HIV risk behaviors in persons with mental illnesses and introduces findings from focus groups conducted during the development phase of an HIV primary and secondary prevention intervention study. Researchers held four focus groups with persons with mental illnesses focused on HIV risks and condom use. Participants discussed sexual side effects of psychotropic medications as a potential cause of both medication non-adherence and HIV risk behaviors. The intersection of these two issues is specific to this population. We conclude with the recommendation that HIV primary and secondary prevention intervention for persons with mental illnesses must incorporate the promotion of healthy sexuality, including attention to sexual side effects of psychotropic medications.

Effect of Nurse Staffing and Education on the Outcomes of Surgical Patients With Comorbid Serious Mental Illness

This study of surgical patients compared outcomes of those with and those without serious mental illness and examined effects of patient-to-nurse ratios and nurses' education levels on outcomes, including death within 30 days of admission, failure to rescue (death resulting from surgery complication), and length of stay. Cross-sectional data from a nurse survey and from patient and administrative records were linked. Data for 9,989 nurses and 228,433 surgical patients discharged from 157 Pennsylvania hospitals were analyzed by using generalized estimating equations. Records indicated that 4.7% (N=10,666) of the sample had a diagnosis of serious mental illness. A higher level of nurse staffing had a stronger effect on prevention of death among patients with serious mental illness than among those without it. Length of stay for patients with serious mental illness was shorter in hospitals with higher proportions of baccalaureate-prepared nurses. Better nurse staffing and higher education level mitigated poor patient outcomes among highly vulnerable patients with serious mental illness.

Let's get physical

There is growing recognition and understanding of the inextricable interrelationship between physical and mental health. In mental health care, the physical health of consumers is now acknowledged as a serious problem requiring urgent action. This issue is undoubtedly related to negative symptoms and the lifestyle of people with mental illness. Much of the burden is also clearly linked with the detrimental side effects of psychotropic medications and deficits in the knowledge, skill, and confidence of mental health clinicians in relation to physical health matters. This paper highlights the problem of physical health in mental health care and presents recommendations to address this issue. The benefits of exercise on mental health in particular are explored. The authors argue that mental health nurses must play an active role in health promotion, primary prevention, and the early detection and management of physical health problems in all areas of clinical practice.

Reliability and validity of the Korean version of UKU-SERS-Pat in patients with bipolar disorder

Poor drug compliance caused by side effects is an important factor affecting clinical outcomes. Thus reliable and valid rating scales to accurately evaluate the side effects of medications in their early stages are needed. This study aimed to develop the Korean version of the Udvalg for Kliniske Undersøgelser (UKU) Side Effects Rating Scale for Patients (K-UKU-SERS-Pat) to comprehensively measure side effects of psychotropic medications by the self-report method and to examine reliability and validity in patients with bipolar disorder (BD). Ninety-three patients diagnosed with BD by DSM-IV criteria were recruited in this study. The patients completed the K-UKU-SERS-Pat. The Side Effects Rating Scale for Clinicians was administered simultaneously. In 19 patients, the K-UKU-SERS-Pat was conducted twice on a 3-day interval to examine the test–retest reliability. Depressive symptoms were evaluated with the Hamilton Depression Rating Scale–17 and (hypo)manic symptoms with the Young Mania Rating Scale. The test–retest reliability (ρ=0.89, P<0.01) and the concurrent validity (ρ=0.80, P<0.01) of K-UKU-SERS-Pat were good. However, patients had a tendency to report their side effects more frequently and severely than clinicians. The K-UKU-SERS-Pat is proved to be a reliable and valid tool to comprehensively and practically monitor the side effects of psychotropics.

Efficacy of aromatherapy (Lavandula angustifolia) as an intervention for agitated behaviours in Chinese older persons with dementia: a cross‐over randomized trial

Agitated behaviours among persons with dementia are distressing to both patients and their caregivers. As pharmacological interventions may be limited by their potentially adverse effects, the use of complementary therapies for treatment of agitation has become more popular and aromatherapy is the fastest growing one. This study investigates the effectiveness of lavandula angustifolia (lavender) in treating agitated behaviours of demented people in Hong Kong. It was a cross-over randomized trial. Seventy Chinese older adults with dementia were recruited; half were randomly assigned to the active group (lavender inhalation) for three weeks and then switched to control group (sunflower inhalation) for another three weeks; the other half did the opposite. Clinical response was evaluated using the Chinese versions of Cohen-Mansfield Agitation Inventory (CCMAI) and Neuropsychiatric Inventory (CNPI). The mean CCMAI total scores decreased from 24.68 to 17.77(t=10.79, df=69, p<0.001). The CNPI scores changed from 63.17 (SD=17.81) to 58.77 (SD=16.74) (t=14.59, df=69, p<0.001) after receiving Treatment A (Lavandula Angustifolia). There were no period and sequential effects noted. In summary, lavender is effective as an adjunctive therapy in alleviating agitated behaviours in Chinese patients with dementia. In a patient population particularly vulnerable to side effects of psychotropic medications, aromatherapy using lavender may offer an alternative option.

Priapism Associated With the Switch From Oral to Injectable Risperidone

Priapism is a rare, but serious, side effect of psychotropic medications. Psychotropic medication-induced priapism is believed to be caused by the alpha-adrenergic antagonism of these medications. Among the atypical antipsychotics, cases of priapism or prolonged erection have been associated with clozapine, olanzapine, risperidone, and quetiapine. Risperidone has primarily serotonergic, dopaminergic, and alpha-adrenergic antagonist properties. It has one of the highest affinities for the alpha1-adrenergic receptor blockade among the atypical antipsychotics. To date, there are 17 case reports of risperidone-associated priapism either in monotherapy or in combination with other psychotropics. To our knowledge, there are no published case reports of priapism on the injectable preparation of risperidone. We report a case of a 50-year-old man who developed priapism while being switched from the oral to the intramuscular preparation of risperidone. The importance of early recognition and intervention in cases of priapism is emphasized. The treatment of priapism with benztropine and other methods is discussed.

Effect of Mirtazapine Treatment on Body Composition and Metabolism

Weight gain is a common side effect of psychotropic medications. Mirtazapine, a widely used antidepressant, induces adverse metabolic effects such as an increase in body weight. The aim of this study was to investigate the influence of mirtazapine treatment on body weight, body fat mass, glucose metabolism, lipoprotein profile, and leptin and its soluble receptor in a prospective, controlled study design. Seven women who met the ICD-10 diagnostic criteria for a depressive episode (ICD-10: F31-F33) were assigned to monotherapy with mirtazapine and observed for a 6-week period. Seven mentally and physically healthy female volunteers matched for age and body weight served as a control group. Data were collected from November 2002 to December 2003. The mean +/- SD body weight increased from 63.6 +/- 13.1 kg to 66.6 +/- 11.9 kg during mirtazapine treatment (p = .027). Fat mass increased in study subjects from 20.9 +/- 9.6 kg to 22.1 +/- 9.3 kg (p = .018). Insulin, glucose, and the homeostasis model assessment (HOMA) index for insulin resistance and lipid parameters remained stable. Leptin concentrations increased from 23.0 +/- 17.1 ng/mL to 40.9 +/- 27.2 ng/mL (p = .018), whereas the soluble leptin receptor concentrations remained stable during mirtazapine treatment. In the control subjects, the investigated parameters remained stable. Between-group analyses of change scores revealed significant differences for body weight (p = .010), body mass index (p = .013), fat mass (p = .035), and leptin (p = .013). The antidepressant therapy with mirtazapine was associated with a significant increase in body weight, body fat mass, and leptin concentration. In contrast to other psychotropic medications inducing weight gain, such as some second-generation antipsychotics, mirtazapine treatment did not influence the glucose homeostasis.

"Dental as Anything" Inner South Community Health Service Dental Outreach to People with a Mental Illness

This article provides an overview of a unique way to respond to the complex oral health needs of people with a mental illness. People with a psychiatric disability, especially those of low income and insecure housing, are at high risk of developing oral disease, due to issues associated with mental illness, poverty and the side-effects of psychotropic medication. The 'Dental as Anything' program is a collaborative partnership between the mental health, dental and administration teams of the Inner South Community Health Service (ISCHS) in Melbourne. It provides a flexible program incorporating engagement, clinical care, education and support in response to client needs. Utilising a health promotion framework and an assertive outreach model, it accesses people who traditionally do not approach mainstream services. The program manages to "reach the unreachable".

Tobacco Use and Cataracts in Patients With Schizophrenia

Back to table of contents Previous article Next article Letter to the EditorFull AccessTobacco Use and Cataracts in Patients With SchizophreniaJONATHAN FOULDS, Ph.D., and JILL WILLIAMS, M.D., JONATHAN FOULDSSearch for more papers by this author, Ph.D., and JILL WILLIAMSSearch for more papers by this author, M.D., New Brunswick, N.J.Published Online:1 May 2005https://doi.org/10.1176/appi.ajp.162.5.1028AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: We read with great interest the recent report by Stephen R. Marder, M.D., and coauthors on the physical health monitoring of patients with schizophrenia (1). We agree with those authors’ concerns that “the health needs of people with schizophrenia…are not adequately addressed by clinicians in specialty mental health programs or in primary care settings.” However, we were perplexed to find that tobacco smoking was not considered in the review process, and no recommendations for monitoring and intervening on tobacco smoking were made in the report. There is a real risk that this report may worsen rather than improve the health of people with schizophrenia by advising clinicians to monitor and intervene on factors that have relatively small impact on their patients’ health while ignoring the main causes (substance use generally and tobacco use in particular).Most of the excess mortality in schizophrenia is directly attributable to cigarette smoking (2). There is also an indirect effect of tobacco use on health through the high proportion of total income that people with schizophrenia spend on tobacco (27%) (3). Mental health professionals rarely assess their patients’ tobacco use (4), despite the existence of effective treatments (5–7).We hope that those responsible for the care of people with schizophrenia will strive to improve the physical health of their patients but will target their efforts appropriately to the main causes of ill health and premature death rather than focusing on the side effects of psychotropic medications. Among the most important things clinicians can do for the health of people with schizophrenia is the proper assessment and treatment of nicotine dependence (8).

Weight Gain in the AMSP System

Weight gain has been identified as one of the major side effects of psychotropic medications. Current information on weight gain is restricted to data derived from controlled clinical trials that involve non-representative study populations. The AMSP e.V. (Arzneimittelsicherheit in der Psychiatrie) collects information on the frequency and severity of drug induced side effects as well as data on prescription patterns in the participating hospitals. Here we analysed the most recent data sets on weight gain of the AMSP data base and related the data to prescription frequencies on the one hand and to expected values derived from clinical studies on the other hand. The elucidation of the mechanisms of drug induced weight gain will be beneficial not only for psychiatric patients but may prove to be of relevance for the understanding of obesity and diabetes in the general population as well.

Psychotropic drug-induced neutropenia

Psychotropic medications have been known to cause blood dyscrasias, including neutropenia, and since the advent of clozapine, this side effect is now increasingly being recognized. Almost all the major classes of psychotropic medications have been associated with neutropenia. Operational definitions for blood dyscrasias have allowed us to create an epidemiological database on this rare side effect of psychotropic medications. With increased awareness of drug-induced neutropenia among physicians, methods of early detection and treatment of this side effect have also been the focus of recent literature. Another area of active research has been identifying the risk factors and mechanism of drug-induced neutropenia. This article attempts to synthesize our current understanding of psychotropic drug-induced neutropenia and also provide insights into future research in this realm.