Psychotropic Medication Usage Research Articles

Psychotropic Medication Usage for Psychiatric Emergencies in a Tertiary Health Care Centre in Nigeria

Background:This study documented the usage of psychotropics in patients presenting with psychiatric emergencies. The usage of psychotropic medications has to do with the prescription pattern of the clinicians in any setting.
 Materials & Methods: A retrospective study carried out at the University of Benin Teaching Hospital Case notes of patients who presented withpsychiatric emergencies were retrieved, data extracted and analyzed.
 Results: A total of one hundred and fourteen patients were studied over a 10 year period. Most patients (82.5%) were diagnosed with psychotic disorders. Antipsychotics accounted for 67.5% of all prescriptions. Chlorpromazine was the most commonly prescribed oral psychotropic (22.8%). Mood stabilizers were 12.3% while antidepressants were 12.3% of all prescriptions. Parenteral psychotropics were used more as combination (60.5%) than as single parenteral medication (14.0%). Commonest combination of parenteral psychotropic was Chlorpromazine and Diazepam. Long-acting medications commonly used were Fluphenazine Decanoate (20.8%) and Flupenthixol Decanoate (17.4%).
 Conclusion: Oral antipsychotics were more prescribed with Chlorpromazine and Haloperidol as commonest. Amitriptylline was the commonest antidepressant prescribed while Chlorpromazine and Diazepam were the commonest parenteral psychotropic used. Fluphenazine Decanoate and Flupenthixol Decanoate were the commonest long-acting parenteral medications prescribed
 Keywords: Psychotropics, prescription pattern, psychiatric emergency, Nigeria.
 French title: L'utilisation de médicaments psychotropes pour les urgences psychiatriques dans un tertiaire centre de soins de santé au Nigéria
 Contexte général de l'étude : Les médicaments psychotropes sont des médicaments utilisés pour traiter les troubles mentaux. L'utilisation de médicaments est liée au modèle de prescription des cliniciens dans n'importe quel contexte. Ainsi, cette étude a documenté l'utilisation des psychotropes chez les patients présentant des urgences psychiatriques.Matériaux et méthodes de l'étude : Étude rétrospective qui a été effectuée à l'unité des accidents et d'urgence de l'Université du Bénin Centre hospitalier universitaire, Ville Bénin. Les notes de cas des patients qui ont présenté des urgences psychiatriques ont été récupérées, les données extraites et analysées.Résultats de l'étude : Cent quatorze patients ont été étudiés. La plupart des patients (82,5%) ont reçu un diagnostic de troubles psychotiques. Les antipsychotiques représentaient 67,5% de toutes les ordonnances. La chlorpromazine était le psychotrope oral le plus couramment prescrit (22,8%). Les stabilisateurs de l'humeur représentaient 12,3% tandis que les antidépresseurs représentaient 12,3% de toutes les ordonnances. L'antidépresseur le plus couramment prescrit était l'amitriptylline. Les psychotropes parentéraux ont été plus utilisés en association (60,5%) qu'en médicament monoparental (14,0%). L'association la plus courante de psychotropes parentéraux était la chlorpromazine et le diazépam dans 55,7% des cas. Les médicaments à action prolongée couramment utilisés étaient le décanoate de fluphénazine (20,8%) et le décanoate de flupenthixol(17,4%).Conclusion: Les antipsychotiques oraux étaient plus prescrits, la chlorpromazine et l'halopéridol étant les médicaments les plus couramment utilisés. L'amitriptylline est l'antidépresseur le plus courant, tandis que la chlorpromazine et le diazépam étaient les psychotropes parentéraux les plus couramment utilisés. Le décanoate de fluphénazine et le décanoate de flupenthixol étaient les médicaments parentéraux à action prolongée les plus couramment prescrits.
 Mots-clés : Psychotropes, utilisation, e psychiatrique Mergency, Nigéria

Pharmacists' Knowledge and Practice of Issues Related to Using Psychotropic Medication in Elderly People in Ethiopia: A Prospective Cross-Sectional Study.

Purpose This study is aimed at assessing pharmacists' knowledge and practice of issue related to usage of psychotropic medications in elderly people, in Gondar town Northwest, Ethiopia. Methods A cross-sectional study was conducted among pharmacists working in community, health center, and hospital pharmacies in Gondar town from March 1 to May 30, 2020. A total of 73 medication retail outlets (40 pharmacies and 33 drug stores) were included in this study. Pharmacy personnel's knowledge and practice were assessed using self-administered validated questionnaires. Binary and multivariable logistic regression analyses were used to assess the association between different variables. P < 0.05 was used to declare the association. Result A total of 144 pharmacists were included in the study; the mean age was 30.13 (SD ±5.87), ranging from 20 to 55years. The mean knowledge score was 7.789 (SD ±2.98), and 75 (52.1%) of them had poor knowledge. The mean practice score was 2.32 ± 0.912 (mean ± SD), and 77 (53.5%) of the respondents had poor practice. All participants had not taken on-the-job training about psychotropic medication. Work experience (P < 0.029) and personal monthly income (P < 0.046) were significantly associated with pharmacists' knowledge. There was a significant association between work experience and practice level (P < 0.043). Conclusion The knowledge and practice of pharmacy personnel were low for issues related to the use of psychotropic medication in the elderly. This result indicates the need for training for pharmacists on pharmacotherapy of psychotropic medication.

Rx risk or resistance? Psychotropic medication use in relation to physiological and psychosocial functioning of psychiatric hospital workers

To avoid methodological biases, psychoneuroendocrine studies have generally excluded psychotropic medication users. In workplace stress research, this has limited our ability to understand how psychotropic medication use affects many stress-related measures of interest. In this exploratory study, the effects of psychotropic medication use on stress physiology, occupational stress, and mental health were measured in a sample of healthy adult psychiatric hospital workers (N = 203, 70 % women). Diurnal cortisol was assessed on two non-consecutive work-days at five time-points (e.g., awakening, thirty minutes after awakening, 2 P M, 4 P M and bedtime). Cortisol reactivity was assessed by exposing participants to the Trier Social Stress Test. An allostatic load index was constructed using 19 neuroendocrine, immune, cardiovascular, and metabolic biomarkers. Occupational stress (e.g., job strain, effort-reward imbalance) and psychiatric symptoms (e.g., depression, burnout) were assessed with well-validated self-reports. Results showed that psychotropic medication use had no significant effects on diurnal cortisol profiles; however, psychotropic users had significantly decreased cortisol reactivity to the Trier Social Stress Test and higher allostatic load. Psychotropic users also had decreased effort-reward imbalance, but not job strain. Depressive symptoms did not differ between psychotropic medications users and non-users; however, burnout symptoms were higher among psychotropic medication users than non-users. Taken together, our findings do not warrant the systematic exclusion of psychotropic medication users from psychoneuroendocrine studies if insights into individual differences are sought among workers and other populations exposed to elevated stress.

P086 Increased Need for Psychotropic Medication and Mental Health Service Usage in Pediatric Patients With Inflammatory Bowel Disease (IBD)

BACKGROUND: Inflammatory bowel disease (IBD) is a chronic immune disorder characterized by a dysregulated response to microbiota in the gastrointestinal tract. Many IBD patients are diagnosed as children, and childhood disease is often more aggressive with increased need for surgery, nutritional supplementation, and steroid use, all of which can increase psychological stress. Previous studies have found that pediatric IBD patients have increased rates of depression, anxiety disorders, and suicide risk compared to other children (1, 2). While 2.8% of all adolescents take antidepressants (3), it is likely that pediatric IBD patients are taking these medications at an increased rate given their greater risk for psychological stress. The aim of this project was to assess the actual frequency of psychotropic medication and mental health service usage in our pediatric IBD population. METHODS: A retrospective chart review was conducted on pediatric IBD patients (N = 400) seen at the University of Rochester Medical Center (URMC) from 2016 to 2019. Patient information, including sex (57% male), IBD type (78% Crohn’s disease), and age at diagnosis (Mean = 11.5 years), was gathered from the medical record. Patients were excluded if clinical notes could not confirm their IBD diagnosis or if they only visited URMC once. Patient medication lists were reviewed for psychotropic medications. Medications used to treat ADHD, ADD, and chronic migraines were excluded. Mental health visits within the psychiatry, behavioral health, pediatric psychology, adolescent medicine, and social work departments were briefly reviewed and recorded. Frequencies and descriptive statistics were calculated using SPSS. RESULTS: Anxiety and depression are the most common disorders (23% and 14%, respectively) in this population and are most frequently treated with SSRIs (22%). URMC’s pediatric IBD patients take antidepressants and other psychotropic drugs at a higher rate (28.5%) than other children their age. 75% of mental health service and psychotropic medication use in this population began after being diagnosed with IBD, suggesting that IBD may contribute to the development of psychopathology. Additionally, 43% of patients taking psychotropic medications did not appear to receive any formal mental health services based on their clinical records. CONCLUSION(S): As demonstrated by these results, there are higher levels of anxiety and depression in children with IBD, and resulting mental health treatment often starts after initial IBD diagnosis. Antidepressants, primarily SSRIs, are used most often to treat these disorders, and a large portion of these patients are not seeking the help of a mental health provider. Taken together, these findings suggest that more anxiety and depression screening is needed for pediatric IBD patients and that mental health services are being underutilized in the pediatric IBD population. Future directions include developing mental health screening measures specifically for pediatric IBD patients and evaluating whether preemptive mental health interventions lessen the risk of developing psychopathology.

Filling the Behavior Tool Kit With Innovative Resources for Dementia Symptom Management

Filling the Behavior Tool Kit With Innovative Resources for Dementia Symptom Management

Predictors of health service use among adolescents and adults with autism and aggression

BackgroundClinical guidelines recommend that psychosocial interventions be used before medication to manage aggressive behavior in individuals with autism. However, the extent to which a multidisciplinary approach is implemented and the factors that influence service use in this complex population are not well understood. MethodsIn this study, parents of 182 adolescents and adults with autism and a history of aggression were asked to report on their child’s health service use every two months for a year. Individuals that used services in this time period (N = 158) were classified into three groups: users of psychotropic medication alone (n = 28, 17.7%); psychosocial services alone (n = 33, 20.9%); or users of both (n = 97, 61.4%). ResultsAlthough the majority of the sample (82.3%) received guideline recommended treatment (i.e., psychosocial services or a combination of psychosocial services and psychotropic medication), 17.7% were using psychotropic medication alone. Several enabling variables, including visiting a family physician in the two-months prior to baseline, having higher parental education, and having parents who reported being able to effectively access services predicted using psychosocial services alone or in combination with medication. Predisposing and need variables (i.e., being younger and having no psychiatric disorders) also predicted using psychosocial services compared to medication alone. ConclusionsUnderstanding predictors of service use can help to identify and address barriers that may prevent adults with autism and aggression from accessing guideline recommended care.

Sexual Dysfunction in Male Canadian Armed Forces Members and Veterans Seeking Mental Health Treatment.

There is mixed evidence regarding how posttraumatic stress disorder (PTSD) symptom clusters are associated with sexual dysfunction (SD), and most studies to date have failed to account for potentially confounding variables. Our study sought to explore the unique contribution of PTSD symptom clusters on (a) lack of sexual desire or pleasure, and (b) pain or problems during sexual intercourse, after adjusting for comorbidities and medication usage. Participants included 543 male treatment-seeking veterans and Canadian Armed Forces (CAF) personnel (aged <65 years), referred for treatment between September 2006 and September 2014. Each participant completed self-report measures of demographic variables, depressive symptom severity, chronic pain, alcohol misuse, and psychotropic medication usage as part of a standard clinical intake protocol. Hierarchical ordinal logistic regression analyses were used to determine the incremental contribution of PTSD symptom clusters on sexual dysfunction. Nearly three-quarters (71.5%) of participants reported a lack of sexual desire or pleasure and 40.0% reported pain or problems during intercourse. Regression analyses suggested that avoidant/numbing symptoms were the only symptoms to be independently associated with lacking sexual desire or pleasure (AOR = 1.10; 95% CI 1.05-1.15). None of the PTSD symptom clusters were independently associated with pain or problems during intercourse. Sexual dysfunction is prevalent among male treatment-seeking CAF personnel and veterans. Results suggest that PTSD symptoms are differentially associated with sexual desire or pleasure concerns. Assessing sexual function among CAF personnel and veterans seeking treatment for PTSD is critical in order to treat both conditions and improve overall functioning.

Racial-Ethnic Variations in Potentially Inappropriate Psychotropic Medication Use Among the Elderly

Psychotropic drugs are among the most frequently prescribed medications to the elderly in the USA. Yet, many of those drugs have been used inappropriately. Increased risks of potentially inappropriate psychotropic medication (PIPM) utilization are associated with several patient and provider characteristics. However, little is known whether and to what extent patient race and ethnicity is related to PIPM use patterns among the elderly. We used multiyear (2012-2015) Medical Expenditure Panel Survey (MEPS) data. Among elderly psychotropic drug users (N = 7616), we identified PIPM prescription fills based on a Beers criterion, a list of drugs (by generic names) that should be avoided at any circumstances among the elderly. Logistic regression was used for the likelihood analysis. The likelihood of filling PIPMs was higher among Hispanics than among Whites (adjusted odds ratio [AOR] = 1.22; 95% confidence interval [CI] = 1.02-1.46). No differences were found between Whites and Blacks. The prevalence of PIPM use is high in all racial groups (43-52%). We found differences in the use of PIPMs by patient race and ethnicity between 2012 and 2015: among elderly psychotropic medication users, Hispanics were more likely than Whites to receive PIPMs. More clinical and policy efforts should aim to reduce PIPM use in all groups, particularly among Hispanic, given potentially negative health consequences related with the use of inappropriate medications.

Use of Psychotropic Medications and Illegal Drugs, and Related Consequences Among French Pharmacy Students - SCEP Study: A Nationwide Cross-Sectional Study.

Background: The use of psychotropic medications and illegal drugs is a worldwide public health issue, leading to addiction, psychiatric and somatic disorders, and death. Pharmacy students are more exposed to psychotropic medications than other students (non-medical), which could lead to an overuse. The main objective of this study was to assess the prevalence of psychotropic drug use (medications and illegal drugs) by French pharmacy students, by carrying out a nationwide cross-sectional study. The relation of these medications and illegal drug use with several comorbidities and academic achievement was also assessed.Methods: This online survey was performed by emails sent to all French pharmacy faculties over a period of 66 days (March 16, 2016 to May 20, 2016). The survey assessed the prevalence of uses of psychotropic medications and illegal drugs during the last 3 months. These uses were compared to student characteristics (personal and university) and comorbidities (anxiety, depression, stress, and fatigue).Results: Of the 2,609 questionnaires received, 2,575 were completed and useable for the analysis. Among French pharmacy students and during the 3 last months, 9.4% have used psychotropic medications, 21.5% illegal drugs and 3.3% both psychotropic medications and illegal drugs. Psychotropic medications were used in the cases of a medical prescription (49.0%), a self-medication (42.4%) or a non-medical intent (26.3%). Stress scores of the last 7 days were higher for psychotropic medication users compared to non-users and illegal drug users. Proportions of anxiety and depression at the time of answer were higher for psychotropic medication users than for non-users and illegal drug users. Fatigue scores of the last 7 days were lower for illegal drug users compared to non-users and self-medicated students. Annual average marks of the last year, attendance and perception of study difficulty were lower for illegal drug users than for non-users.Conclusion: French pharmacy students were less exposed to psychotropic medications and illegal drugs than the general French population. However, in comparison to other students in other countries, the use of psychotropic medications seemed to be lower, but with a proportionally higher use of anxiety/sedative medications and a lower use of opioid medications.

Endoscopic thoracic sympathectomy for primary focal hyperhidrosis: impact on psycho-social symptomatology and psychotropic medication use.

The tendency for patients with primary focal hyperhidrosis (PFH), characterized by excessive sweating, to experience psycho-social deficits is well documented. In addition, although endoscopic thoracic sympathectomy (ETS) effectively corrects PFH, its role in the psycho-social management of these patients remains unclear. Here, we examined changes in psychiatric symptomatology and psychotropic medication usage in PFH patients following ETS. In total, 106 PFH patients underwent ETS and were compared against 213 matched controls. Information on psychiatric diagnosis and prescription was obtained through a retrospective chart review. Prospectively, PFH patients completed Hyperhidrosis Impact Questionnaires, Leibowitz Social Anxiety Scales and Center for Epidemiological Studies Depression Scales to evaluate pre- and postoperative quality-of-life and psycho-social impairment. A significantly greater proportion of PFH patients had been prescribed psychotropic medication (37.7%) compared to controls (14.1%) despite no differences in the proportion of psychiatric diagnoses. Following ETS, 52.5% of the PFH patients who were using psychotropic medications reduced their prescription regimen, compared to only 10% of control patients (P < 0.01). Additionally, scores improved dramatically in each Hyperhidrosis Impact Questionnaires category, and in both the Leibowitz Social Anxiety Scales and Center for Epidemiological Studies Depression Scales (P < 0.01). We demonstrate that in over half of PFH patients, psychotropic medication usage was discontinued after ETS, which is consistent with our findings on postoperative improvements in Hyperhidrosis Impact Questionnaires, Leibowitz Social Anxiety Scales and Center for Epidemiological Studies Depression Scales scores. Furthermore, our findings suggest that a considerable proportion of PFH patients who experience psychopathology may be doing so secondary to excessive sweating. Thus, improved awareness or recognition of these associations in the diagnosis and management of PFH patients is warranted.

Comparing Nurse Practitioner and Physician Prescribing of Psychotropic Medications for Medicaid-Insured Youths.

Objective: To describe psychotropic medication prescribing practices of nurse practitioners (NP) and physicians for Medicaid-insured youths in 2012-2014 in a mid-Atlantic state where NP independent prescribing is authorized. Method: From annual computerized administrative claims data in a mid-Atlantic state, we analyzed 1,034,798 dispensed psychotropic medications prescribed by NPs and physicians for 61,526 continuously enrolled Medicaid-insured youths aged 2-17 years. Demographic and clinical characteristics of psychotropic medication users were compared for youths who received psychotropic medication dispensings by NP-only, physician-only, or by both providers using descriptive statistics and generalized estimating equations. We then characterized psychotropic medication prescribing practices by providers within each specialty. Results: From 2012 to 2014, the number of psychotropic medication dispensings increased from 346,922 to 349,080. There was a 50.9% increase in the proportion of psychotropic medications prescribed by psychiatric NPs (from 5.9% to 8.8%) and a 28.6% proportional increase by non-psychiatric NPs (from 4.9% to 6.3%). By contrast, the proportion of psychotropic medications prescribed by psychiatrists and by non-psychiatric physicians declined (56.9%-53.0% and 32.3%-31.8%, respectively). Youths diagnosed with depression or anxiety were more commonly treated by NP-only than by physician-only (AOR = 1.33, 95% CI = 1.24-1.43), whereas youths with two or more psychiatric comorbidities were significantly more commonly treated by both NP and physician providers (AOR = 1.44, 95% CI = 1.39-1.50). Psychiatric specialists prescribed the bulk of antidepressants (82.0%) and lithium (92.3%), with much lower prescribing by non-psychiatric specialists (18.0% and 7.7%, respectively). Antipsychotic orders originated from psychiatric specialists 7.4 times more than from their non-psychiatric specialty counterparts, whether physician or NP. Conclusions: NPs, relative to physicians, have taken an increasing role in prescribing psychotropic medications for Medicaid-insured youths. The quality of NP prescribing practices deserves further attention.

Association of Psychiatric Illness or Psychotropic Medication Usage with Calcaneus Fracture.

BackgroundThere is a noticeable lack of studies examining the connection between psychiatric illness and orthopaedic injury. The goal of this study is to determine if a relationship exists between calcaneus fracture and psychiatric illness or use of psychotropic medication. MethodsA retrospective review was undertaken of calcaneus fracture patients at our institution from January 2011 through January 2014, and those with a diagnosis of psychiatric illness or history of psychotropic medication usage were identified. Medication records were analyzed along with medical histories taken during the initial encounter. If the patient was admitted, hospital notes for the hospitalization were reviewed to determine if any information was missed during the initial encounter. The date of injury, age, sex, insurance status at the time of initial encounter, psychiatric diagnoses or psychotropic medication use, and mechanism of injury were recorded. Any specific psychiatric diagnoses were collected from the patient charts, as was the presence of any specific prescribed psychotropic medications. After completion of the data collection, an attending psychiatrist verified the recorded data to ensure an accurate psychiatric assessment.ResultsA total of 85 calcaneus fractures met the inclusion criteria. In the population, there were 71 males and 14 females. The average age of the patients was 41.74 years, with 24% of patients having a diagnosis of psychiatric illness at the time of injury. The relative risk of a psychiatric illness in males compared to females was 0.31 (p = 0.009) while the relative risk of using psychotropic medication in males compared to females was 0.17 (p = 0.0007). Males were less likely to undergo operative intervention than females (p = 0.0001). The average age of a patient who either had a diagnosis or took medication for a psychiatric illness was 48.4 years, as compared to 39.7 years in those who did not (p = 0.014).ConclusionMales were less likely to have a psychiatric illness or be currently treated with psychotropic medications. A dedicated review of psychiatric history and prior medication may be useful during preoperative, perioperative, and postoperative treatment planning. Level of Clinical Evidence: 4

Psychiatric comorbidities and use of psychotropic medications in people with autism spectrum disorder in the United States.

This study investigated psychotropic medication usage in two large, cohorts of people with autism spectrum disorder (ASD) throughout the calendar year 2014. The cohorts referred to individuals with commercial (employer-sponsored) and Medicaid insurance in the United States. We aimed to understand prescribing patterns of such medications across a wide age-range and in the presence/absence of other clinical and non-clinical characteristics, including psychiatric comorbidities. We described the prevalence and length of prescriptions by age, psychiatric comorbidity and overall. We also fitted multivariable logistic regression models to describe the relationship between treatments and subject characteristics simultaneously. Eighty percent of the identified population was male, although gender did not impact the odds of receiving medication. Medication use was strongly associated with age, increasing most rapidly before adulthood; generally plateauing thereafter. All psychiatric comorbidities studied also individually increased the chances of medication use, with epilepsy and ADHD having the highest associations in both the commercial (OR > 7) and Medicaid (OR around 12) cohorts. Those in non-capitated insurance plans, in foster care and white individuals also had increased odds of prescriptions. Overall, slightly more Medicaid enrollees received any psychotropic treatment (commercial: 64%, Medicaid: 69%). Nonetheless in both cohorts, a large proportion of individuals received treatment even without a diagnosis of any other psychiatric comorbidity (commercial: 31%, Medicaid: 33%). In summary, this report sheds new light on the latest patterns of psychiatric comorbidity profile and psycho-pharmacological treatment patterns in ASD Autism Res 2017, 10: 2037-2047. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: this study identified a large number of children and adults in the US with autism spectrum disorder (autism) from employer-sponsored and government funded (Medicaid) health insurance data. Psychotropic medications were used by over two thirds of people, and four in ten people received two medications at the same time. The chances of receiving medication increased for individuals with other psychiatric conditions (e.g., ADHD), and also increased with age.

Psychotropic Medication Use in Autism Spectrum Disorders May Affect Functional Brain Connectivity

BackgroundPrescription of psychotropic medications is common in autism spectrum disorders (ASDs), either off-label or to treat comorbid conditions such as attention-deficit/hyperactivity disorder or depression. Psychotropic medications are intended to alter brain function, yet studies investigating functional brain organization in ASDs rarely take medication usage into account. This could explain some of the inconsistent findings of atypical brain network connectivity reported in the autism literature. MethodsThe current study tested whether functional connectivity patterns, as assessed with functional magnetic resonance imaging, differed in a cohort of 49 children and adolescents with ASDs based on psychotropic medication status and compared with 50 matched typically developing (TD) participants. Twenty-five participants in the ASD group (51%) reported current psychotropic medication usage, including stimulants, antidepressants, antipsychotics, and anxiolytics. Age, IQ, head motion, and ASD symptom severity did not differ between the groups. Whole-brain functional connectivity between 132 regions of interest was assessed. ResultsDifferent functional connectivity patterns were identified in the ASD group taking psychotropic medications (ASD-on) compared with the TD group and the ASD subgroup not using psychotropic medications (ASD-none). The ASD-on group showed distinct underconnectivity between the cerebellum and basal ganglia but corticocortical overconnectivity compared to the TD group. Cortical underconnectivity relative to the TD pattern, on the other hand, was pronounced in the ASD-none group. ConclusionsThese results suggest that psychotropic medications may affect functional connectivity and that medication status should be taken into consideration when studying brain function in ASDs.

Characterization of Medication Use in a Multicenter Sample of Pediatric Inpatients with Autism Spectrum Disorder.

Nearly 11% of youth with Autism Spectrum Disorder (ASD) undergo psychiatric hospitalization, and 65% are treated with psychotropic medication. Here we characterize psychotropic medication usage in subjects enrolled in the Autism Inpatient Collection. Participant psychotropic medication usage rates topped 90% at admission and discharge, though there was a decline at 2-month follow-up. Antipsychotics, ADHD medications, and sleep aids were the most commonly reported classes of medications. The impact of age, gender, and non-verbal IQ on medication usage rates was minimal, though age and IQ may play a role in prescribing practices. Future work is indicated to explore medication usage trends, the impact of clinical factors on medication use rates, and the safety of psychotropic medications in youth with ASD.

Prevalence of Psychotropic Medication Use Among Dutch Military Personnel Between 2003 and 2012 and Its Comparison to the Dutch General Population

The armed forces work under high pressure and in stressful environments and it is well known that being in the military is a risk factor for psychiatric problems. However, it remains unknown how prevalent psychotropic medication use is in military personnel. To assess prevalence of psychotropic medication use in Dutch military personnel and compare to the Dutch general population. Data were obtained from the military pharmacy. From 2003 to 2012, the year-prevalence of psychotropic medication use was calculated from the number of distributed psychotropic medications and the number of Dutch military personnel. For the year 2011, the year-prevalence of psychotropic medication use in the military was compared to that of the Dutch general population. The year-prevalence of psychotropic medication use increased by 55%, from 1.64% in 2003 to 2.54% in 2012 in Dutch military personnel. An increase is seen in the number of users of psychotropic medication. Also the use of antidepressants and attention deficit hyperactivity disorder medication increased. Over the last decade, there has been a 1.5-fold increase in psychotropic medication dispensed to Dutch military personnel. However, Dutch military personnel were significantly less likely to use psychotropic medications compared to the Dutch general population.

Bidirectional longitudinal relationship between leisure-time physical activity and psychotropic medication usage: A register linked follow-up study

This study aimed to examine the bidirectional relationship between psychotropic medication use and changes in leisure-time physical activity (LTPA) among a population cohort study. Phase 1 data were collected by mail surveys in 2000–2002 among 40–60-year-old employees of the City of Helsinki, Finland, and phase 2 follow up survey was conducted in 2007. Based on self-report, the respondents were classified as inactive and active (≥14.75 MET-hours/week) at the phases 1 and 2. Hazard ratios (HR) were calculated for subsequent (2007–10) psychotropic medication purchasing according to changes in physical activity (phases 1–2). Odds ratios (OR) for physical inactivity at phase 2 were calculated according to the amount of psychotropic medication between phases 1–2. Overall, 5361 respondents were included (mean age 50 years, 80% women). Compared with the persistently active, the persistently inactive, those decreasing and adopting LTPA had an increased risk for psychotropic medication. Only the persistently inactive remained at increased risk for psychotropic medication use, following the adjustment for prior psychotropic medication use. Compared with those having no medication, the risk for physical inactivity increased as the psychotropic medication increased. Our data suggest that physical activity has an important role in maintaining wellbeing and reducing psychotropic medication usage.

Early supportive medication use and end-of-life care among Medicare beneficiaries with advanced breast cancer.

A randomized controlled trial of cancer patients has linked early supportive care with improved hospice use and less-aggressive end-of-life care. In practice, the early use of supportive interventions and potential impact on end-of-life care are poorly understood. We sought to describe early use of medications to treat common breast cancer symptoms (pain, insomnia, anxiety, and depression) and to assess the relationship between early use of these treatments and end-of-life care. Secondary analysis of 2006-2012 SEER-Medicare data was performed. Women included had stage IV breast cancer and died within the observation period. We used modified Poisson regression to assess the relationship between supportive medication use in the 90days post-diagnosis and several end-of-life care measures (hospice use, in-hospital death, chemotherapy receipt within 14days of death, ICU admission, or >1 hospitalization or emergency department/ED visit 30days before death). Among the 947 women included, 68% of women used at least one supportive medication in the 90days following their diagnosis: 60.3% used opioid pain medications and 28.3% received non-opioid psychotropic medications. Early use of any supportive medications was not associated with end-of-life care. Similarly, we found no differences in end-of-life care between opioid pain medication users and non-users. However, we found that non-opioid psychotropic medication users were less likely to receive chemotherapy in the last 14days of life (aRR 0.33, 95% CI 0.12-0.88). Non-opioid psychotropic use was associated with some aspects of end-of-life care. Future research should consider alternative measures of palliative and supportive care use using administrative data sources.

Psychotropic medication use in hospitalized patients with borderline personality disorder.

Introduction:Use of medications to treat symptoms of borderline personality disorder (BPD) is controversial. The purpose of this study was to describe psychotropic medication use in hospitalized patients with BPD and compare with a control group.Methods:A retrospective chart review was conducted on hospitalized patients aged 18-65 years having a diagnosis of BPD and compared them with a control group of patients with a diagnosis of major depressive disorder (MDD) without a personality disorder. Patients were excluded from the BPD group if other personality disorders were recorded. Charts were reviewed for demographics and psychotropic medication usage both prior to admission and at discharge.Results:This study included 165 patients (85 in BPD; 80 in MDD). Prior to admission and upon discharge, patients in the BPD group were prescribed significantly more psychotropic medications than patients with MDD (3.21 vs 2.10; P < .001 and 2.87 vs 2.35; P < .05, respectively). Patients in the BPD group were significantly more likely to be prescribed antipsychotics, mood stabilizers, and miscellaneous agents compared with the MDD group. On admission, significantly more BPD patients were prescribed multiple sedative agents (37.6% vs 21.3%; P < .05), but because of the discontinuation of sedative agents, this difference was nonsignificant upon discharge.Discussion:This study found increased medication utilization among patients with BPD. Polypharmacy may increase the risk of side effects, drug interactions, and drug toxicity for BPD patients. Clinicians need to carefully evaluate the efficacy and risk of medications prescribed in patients with BPD.

Psychotropic Medication Usage and the Presence/Absence of Geriatric Psychiatry Services in Skilled Nursing Facilities

There has been the recent phenomenon of specialists seeing patients onsite in our institutions. With the increase in specialized units for dementia patients with behaviors, there has been an increase in the onsite visitation of psychiatrists. At one of our facilities, the psychiatrist no longer was able to provide in-house service. The primary care clinicians then took over the role of assessments and treatments for psychiatric care in the facility. We reviewed the CASPER data before and after this change at one skilled nursing facility.