Psychotropic Research Articles

Ensuring social standards as a principle of functioning of state authorities in accordance with the Association Agreement (theoretical and legal aspect)

The article discloses the content of social standards that state authorities are obliged to observe in the process of exercising their competence after the Association Agreement enters into force. Attention is focused on the fact that EU requirements regarding the activities of all branches of the state apparatus of Ukraine in terms of ensuring social standards are of primary importance in the context of the introduction of European approaches to good governance. It is substantiated that the timely and optimal implementation of EU social standards in Ukraine is possible only if a special legal mechanism is developed and applied. The heart of such a mechanism is the Association Agreement. Based on the analysis of the provisions of the specified document, the essence of the most significant social standards, which Ukraine undertakes to implement in practice, has been identified and disclosed. In particular, it is ensuring justice and improving the quality of life of citizens on the basis of equality and non-discrimination, increasing the level of social orientation of state policy towards migrants, introducing innovative approaches in the sphere of activity of authorities to combat the illegal circulation of narcotic drugs, precursors and psychotropic substances in order to overcome negative consequences for health and the negative social consequences of drug addiction, taking into account the social interests of the modern population while simultaneously caring for future generations, developing measures aimed at minimizing the risks to the population’s health from the nuclear industry, the social orientation of the organization of the fiscal and economic policy of the state. It has been proven that against the background of the deepening of the European integration processes of Ukraine, the modernization of the domestic social policy of the state is inevitable. First of all, this process requires the creation of an innovative legal basis for diversifying the mechanisms of its implementation, leveling the level of socio-economic development of Ukraine in order to avoid regional socio-economic asymmetry. In practice, this takes the form of changes in the legal regulation of a significant number of institutions of social security law of Ukraine, revision of organizational and legal approaches of state administration in the direction of implementing social standards.

A Phase 1 single ascending dose study of pure oral harmine in healthy volunteers.

Harmine is a component of the hallucinogenic brew, Ayahuasca, which also contains the psychoactive compound, N, N-dimethyltryptamine. Whether pharmaceutical-grade harmine hydrochloride (HCl) has psychoactive effects, the doses at which these might occur, and the dose-response relationship to side effects and safety in humans are unknown. We conducted a Phase 1, open-label single ascending dose trial in healthy adults with normal body mass index and no prior psychiatric illness. The primary goal was to determine the maximum tolerated dose (MTD) of oral pharmaceutical-grade harmine HCl and to characterize safety and tolerability. A secondary goal was to ascertain whether any oral dose has psychoactive effects. Thirty-four adult participants, aged 18-55 years, were screened for study eligibility. Twenty-five participants met eligibility criteria and were randomized to a single dose of 100, 200, 300, or 500 mg of harmine HCl, respectively, using a continuous reassessment method. The most common adverse events (AEs) observed were gastrointestinal and/or neurological, dose-related, and of mild to moderate severity. The MTD was determined to be between 100 and 200 mg and is weight-based, with 90% of those participants receiving >2.7 mg/kg experiencing a dose-limiting toxicity. No serious AEs of harmine HCl were identified. Harmine HCl can be orally administered to healthy participants in doses <2.7 mg/kg with minimal or no AEs. Doses >2.7 mg/kg are associated with vomiting, drowsiness, and limited psychoactivity. This study is the first to systematically characterize the psychoactive effects of pharmaceutical quality harmine in healthy participants.

Trends and Disparities in Mental Health Use Among Asian American Sub-groups, 2013-2019.

The objective of this study was to characterize and compare national estimates of mental healthcare use among White and Asian American groups to provide an update using post Affordable Care Act data. We analyzed yearly cross-sectional data from the 2013-2019 Medical Expenditure Panel Survey, including White (n=112,590) and Asian American (n=10,210) individuals, and examined rates of mental healthcare use for Asian (overall), Asian Indian, Chinese, Filipino, and Other Asian individuals relative to White individuals. Using multivariable logistic regression models and predictive margin methods, we estimated overall Asian disparities and Asian subgroup disparities compared to White group rates in mental health care (outpatient, specialty, psychotropic medication) among adults with and without elevated risk for mental illness. Regression models were adjusted for variables related to need for treatment, demographic, and socioeconomic status variables. Asian individuals had lower rates of mental healthcare use than White individuals. Unadjusted results and adjusted regression model predictions are consistent in identifying wide disparities in mental health care treatment across risk for mental illness, Asian subgroups, and types of treatment. Asian Americans have significantly lower rates of mental healthcare use than White Americans, even among those with elevated risk for mental illness. There is small variation by Asian subgroups but disparities persist across subgroups and types of treatment. Our results imply interventions are needed to improve linguistically, culturally, and ethnically tailored outreach and engagement in treatment services, as well as examining treatment and its effectiveness for Asian American individuals living with psychological distress.

Insufficient correctness of package inserts for psychotropic drugs in Germany

AbstractPackage inserts often cause displeasure among patients as they are perceived as misleading and confusing. The aim of this study was to find out how comprehensible, complete, and truthful package inserts are formulated in Germany. 311 package inserts for antipsychotics (mGPCR antagonists) and antidepressants (NE/5-HT enhancers) from different manufacturers and dosages were analysed. The analysis criteria included the description of the effect, the warning of increased suicide risk, the explanation of interactions with co-medication, food and stimulants, as well as alcohol and the warning of impaired roadworthiness. In addition, the timeliness of the information regarding pregnancy and breastfeeding was checked and the symptoms mentioned under the topic of discontinuation symptoms and adverse drug reactions were compared. For most parameters, inconsistencies among various products, deficiencies and incorrect information were noted. This was particularly true for the items pregnancy and breastfeeding. Thus, package inserts for mGPCR antagonists and NE/5-HT enhancers need to be updated and standardised urgently. Such measures will reduce confusion among patients and increase drug adherence.

Prescribing Trends and Associated Outcomes of Antiepileptic Drugs and Other Psychotropic Medications in US Nursing Homes: Proposal for a Mixed Methods Investigation.

Pilot data suggest that off-label, unmonitored antiepileptic drug prescribing for behavioral and psychological symptoms of dementia is increasing, replacing other psychotropic medications targeted by purposeful reduction efforts. This trend accelerated during the COVID-19 pandemic. Although adverse outcomes related to this trend remain unknown, preliminary results hint that harms may be increasing and concentrated in vulnerable populations. Using a mixed methods approach including both a retrospective secondary data analysis and a national clinician survey, this study aims to describe appropriate and potentially inappropriate antiepileptic and other psychoactive drug prescribing in US nursing homes (NHs), characteristics and patient-oriented outcomes associated with this prescribing, and how these phenomena may be changing under the combined stressors of the COVID-19 pandemic and the pressure of reduction initiatives. To accomplish the objective, resident-level, mixed-effects regression models and interrupted time-series analyses will draw on cohort elements linked at an individual level from the Centers for Medicare and Medicaid Services' (CMS) Minimum Data Set, Medicare Part D, Medicare Provider Analysis and Review, and Outpatient and Public Use Files. Quarterly cohorts of NH residents (2009-2021) will incorporate individual-level data, including demographics; health status; disease variables; psychotropic medication claims; comprehensive NH health outcomes; hospital and emergency department adverse events; and NH details, including staffing resources and COVID-19 statistics. To help explain and validate findings, we will conduct a national qualitative survey of NH prescribers regarding their knowledge and beliefs surrounding changing approaches to dementia care and associated outcomes. Funding was obtained in September 2022. Institutional review board exemption approval was obtained in January 2023. The CMS Data Use Agreement was submitted in May 2023 and signed in March 2024. Data access was obtained in June 2024. Cohort creation is anticipated by January 2025, with crosswalks finalized by July 2025. The first survey was fielded in October 2023 and published in July 2024. The second survey was fielded in March 2024. The results are in review as of July 2024. Iterative survey cycles will continue biannually until December 2026. Multidisciplinary dissemination of survey analysis results began in July 2023, and dissemination of secondary data findings is anticipated to begin January 2025. These processes are ongoing, with investigation to wrap up by June 2027. This study will detail appropriate and inappropriate antiepileptic drug use and related outcomes in NHs and describe disparities in long-stay subpopulations treated or not treated with psychotropics. It will delineate the impact of the pandemic in combination with national policies on dementia management and outcomes. We believe this mixed methods approach, including processes that link multiple CMS data sets at an individual level and survey-relevant stakeholders, can be replicated and applied to evaluate a variety of patient-oriented questions in diverse clinical populations. DERR1-10.2196/64446.

Exploring the Metabolism of Flubrotizolam, a Potent Thieno-Triazolo Diazepine, Using Human Hepatocytes and High-Resolution Mass Spectrometry.

The abuse of psychoactive substances presents challenges in clinical and forensic toxicology. The emergence of novel and potent drugs that pose significant health risks, in particular towards frequent abusers and users unaware of the ingredients, further complicates the situation. Designer benzodiazepines have become a fast-growing subgroup of these new psychoactive substances (NPSs), and their overdose may potentially turn fatal, especially when combined with other central nervous system depressants. In 2021, flubrotizolam, a potent thieno-triazolo designer benzodiazepine, emerged on the illicit market, available online as a "research chemical". The identification of markers of consumption for this designer benzodiazepine is essential in analytical toxicology, especially in clinical and forensic cases. We therefore aimed to identify biomarkers of flubrotizolam uptake in ten-donor-pooled human hepatocytes, applying liquid chromatography high-resolution mass spectrometry and software-aided data mining supported by in silico prediction tools. Prediction studies resulted in 10 and 13 first- and second-generation metabolites, respectively, mainly transformed through hydroxylation and sulfation, methylation, and glucuronidation reactions. We identified six metabolites after 3 h human hepatocyte incubation: two hydroxylated metabolites (α- and 6-hydroxy-flubrotizolam), two 6-hydroxy-glucuronides, a reduced-hydroxy-N-glucuronide, and an N-glucuronide. We suggest detecting flubrotizolam and its hydroxylated metabolites as markers of consumption after the glucuronide hydrolysis of biological samples. The results are consistent with the in vivo metabolism of brotizolam, a medically used benzodiazepine and a chloro-phenyl analog of flubrotizolam.

Trajectories of work disability among individuals with anxiety-, mood/affective-, or stress-related disorders in a primary healthcare setting

Abstract Background Anxiety-, mood/affective-, or stress-related disorders affect up to one-third of individuals during their lives and often impact their ability to work. This study aimed to delineate trajectories of work disability (WD) among individuals diagnosed with anxiety-, mood/affective-, or stress-related disorder in primary healthcare and to examine associations between trajectory group membership and sociodemographic, clinical, and clinical-related factors. Methods The study population included working-age individuals, aged 22–62 years, living in Stockholm County, Sweden, who experienced a new episode of any anxiety-, mood/affective, or stress-related disorder in primary healthcare in 2017 (N = 11,304). Data were obtained from Swedish national and regional registers and were linked using pseudonymised unique personal identification numbers. The primary outcome was days with WD (sum of sickness absence and disability pension days) during the three years before and three years after a diagnosis of anxiety-, mood/affective-, or stress-related disorders in primary healthcare. A zero-inflated Poisson group-based trajectory model was used to identify groups of individuals with similar patterns of WD over the study period, with a multinomial logistic regression used to examine associations of sociodemographic, clinical, and clinical-related factors with trajectory group membership. Results Four distinct trajectory groups were found, high increasing (5.1%), with high levels, from 16 to 80 days of WD in six-monthly intervals during follow-up, peak (11.1%), with a peak in WD, up to 32 days of WD, around the time of the diagnosis, low increasing (12.8%), with an increase in days of WD from 4 to 22 during the study period, and constant low (71.1%), with almost no WD over the study period. In multinomial regression models, diagnostic category, psychotropic medication use, a diagnosis of a psychiatric disorder within secondary healthcare, age at diagnosis, and occupation were associated with WD trajectory groups. Conclusions Around two-thirds of individuals treated for a new episode of any anxiety-, mood/affective-, or stress-related disorder in primary healthcare have an excellent prognosis regarding WD. Several sociodemographic and clinical characteristics were associated with group membership; these factors could identify individuals at risk of long-term welfare dependency and who might benefit from interventions to promote a return to work.

Characteristic of High-Risk Behaviours Related to Alcohol and Illicit Drug Use and their Associated Factors among Adolescents in Middle and High School

&lt;div class="WordSection1"&gt;&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Use of narcotics, psychotropic and addictive substances (NPA) in adolescents has become one of the major social problems we are facing in society and it gives a negative impact. This study was done to determine the characteristics and factors that influence high-risk behaviour of NPA use in adolescents in middle and high school, also introducing CRAFFT questionnaire as an early screening tool for alcohol an illicit drugs use.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Quantitative study (validated questionnaire) was conducted among 514 subjects aged 12-18 years old. CRAFFT questionnaire was used to detect a high-risk behavior of alcohol and illicit drugs use and self-reported questionnaire used to determine the risk factors of NPA.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Result:&lt;/strong&gt; Most participants (19,6%) were involved in high-risk behaviour of alcohol and illicit drugs, with the majority was males (12,4%). This study showed smoking behaviour (23,8%), drinking alcohol (15,8%) and illicit drugs use (13,6%). The type of drugs being used were cannabis (52,7%), tramadol (15,2%), dextromethorphan (10,7%) and methamphetamine (6,3%). CRAFFT questionnaire has a good internal consistency with Cronbach’s α 0,73. Education level, authoritarian parenting style, unharmonious parents, peer pressure or threat, and extracurricular activities were factors that influenced high-risk behavior of alcohol and illicit drug use&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Early detection, comprehensive treatment, and intervention of risk factors of NPA use are needed. CRAFFT can be use as one of the screening tools for detection of alcohol and illicit drugs use in adolescents.&lt;/p&gt;&lt;/div&gt;

CCNP Innovations in Neuropsychopharmacology Award: The psychopharmacology of psychedelics: where the brain meets spirituality.

For 3000 years, psychedelics have been used in religious contexts to enhance spiritual thinking, well-being, and a sense of community. In the last few years, a renaissance in the use of psychedelic drugs for mental disorders has occurred in Western society; consequently, a pressing scientific need to elucidate the intricate mechanisms underlying their actions has arisen. Psychedelics mainly bind to serotonin (5-HT) receptors, particularly 5-HT2A receptors, but may also bind to other receptors. Unlike conventional psychotropic drugs used in psychiatry, psychedelics introduce a distinctive complexity. They not only engage in receptor activation, but also exert influence over specific neural circuits, thereby facilitating transformative cognitive experiences and fostering what many have identified as a spiritual contemplation or mystical experience. This comprehensive review describes clinical studies that have examined the propensity of psychedelics to enhance spiritual, mystical, and transcendent cognitive states. This multifaceted nature, encompassing diverse components and paradigms, necessitates careful consideration during the investigation of psychedelic mechanisms of action to avoid oversimplification. The present review endeavours to elucidate the mechanisms underlying the actions of 2 principal psychedelic substances, psilocybin and lysergic acid diethylamide (LSD), with a focus on monoamine and glutamate receptor mechanisms; molecular aspects, such as neuroplasticity and epigenetics; as well as the impact of psychedelics on brain circuits, including the default mode network and the cortico-striato-thalamo-cortical network. Given their distinctive and intricate mechanisms of action, psychedelics necessitate a novel conceptual framework in psychiatry, offering insight into the treatment of mental health disorders and facilitating the integration of the realms of brain, mind, and spirituality.

Molecular, Pathophysiological, and Clinical Aspects of Corticosteroid-Induced Neuropsychiatric Effects: From Bench to Bedside.

Corticosteroids are frequently prescribed across medical disciplines, yet they are associated with various adverse effects, including neuropsychiatric symptoms, documented since their introduction over 60 years ago. The cellular mechanisms underlying neuropsychiatric symptoms are complex and somewhat obscure, involving multiple pathways. Notably, they include changes in excitability, cellular death of hippocampal and striatal neurons, and increased inflammation and oxidative stress. Clinical presentation varies, encompassing affective disorders (anxiety, euphoria, depression), psychotic episodes, and cognitive deficits. It is crucial to note that these manifestations often go unnoticed by treating physicians, leading to delayed detection of severe symptoms, complications, and underreporting. Discontinuation of corticosteroids constitutes the cornerstone of treatment, resolving symptoms in up to 80% of cases. Although the literature on this topic is scant, isolated cases and limited studies have explored the efficacy of psychotropic medications for symptomatic control and prophylaxis. Pharmacological intervention may be warranted in situations where corticosteroid reduction or withdrawal is not feasible or beneficial for the patient.

Test anxiety as a risk factor for use of psychoactive compounds in medical students

&amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Introduction. &amp;lt;/strong&amp;gt;Test anxiety implies an intense pathological fear in situations of preparing and taking exams which is a significant problem for 15&amp;amp;ndash;70% of medical students. The frequent use of psychoactive substances is recognized as a problem for young people. The aim was to determine the frequency and degree of test anxiety and the association with misuse of psychoactive substances in medical students of the Faculty of Medicine in Foča.&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Methods.&amp;lt;/strong&amp;gt; The research was conducted according to the principle of a cross-sectional study at the Faculty of Medicine in Foča. Students were offered a custom-made questionnaire containing general and specific questions for test anxiety and use and dependence of psychoactive compounds and social networks. Test anxiety was evaluated by Westside anxiety scale.&amp;amp;nbsp;&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Results.&amp;lt;/strong&amp;gt; The sample included 145 respondents, 69.7% females and 30.3% males. The results indicate that the degree of test anxiety does not differ in male and female students, but test anxiety is less pronounced in younger students and students with medium academic success. The level of test anxiety was correlated with the rate of psychoactive compound use. Psychoactive substances were used by 50.3% of students, primary for anti-anxiety, than for psychostimulation and for hypnotic effects. The most commonly used classes of psychoactive substances were plant anxiolytics, followed by benzodiazepines, marijuana, alcohol and narcotics/cocaine (18.6%, 12.4%, 12.4%, 8.3%, and 4.8%, respectively).&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Conclusion.&amp;lt;/strong&amp;gt; A significant number of students reach for anxiolytics and other drugs that can create addiction. Elevated levels of test anxiety are positively correlated with increased consumption of psychoactive compounds. However, the frequency of use of psychoactive compounds surpasses the frequency of altogether moderate, high and extreme test anxiety.&amp;lt;/p&amp;gt;

A broad-spectrum LC-MS/MS method for screening and quantification of 100 analytes in clinical and autopsy blood samples

Liquid chromatography coupled with mass spectrometry (LC-MS) has been tremendously used for screening purposes in forensic toxicology, because of their great adaptability and reasonable time/resource consumption. Herein, a fully validated method based on liquid-liquid extraction (LLE) in human whole blood, by a multiple reaction monitoring (MRM) analysis through LC-MS/MS, is described. The proposed method simultaneously detects 100 analytes (plus three deuterated internal standard compounds) belonging to many different classes, including drugs of abuse, prescription and over-the-counter drugs commonly involved in poisoning and medical malpractice cases in our territory, as well as certain new psychoactive substances (NPS) and toxic substances potentially associated with adverse effects. The optimised LLE employs one extraction step of 200 μL blood using 0.1 M HCl methyl-tert-butyl-ether (MTBE) (acidified with concentrated HCl) proved to be suitable for the extraction of basic and neutral substances; as a reconstitution solvent a mixture of 88:12v/v, 0.1 % formic acid in 10 mM aqueous ammonium acetate, pH 3.5: 0.1 % formic acid in acetonitrile was used, yielding satisfactory recoveries for all analytes. The method was sensitive, showing low LOD/ LOQ for all substances ranging from 0.01 to 5/ 0.05–20 ng/mL, respectively. Linearity ranged between 0.05–500 ng/mL (R2 = 0.9811–0.9995), and the inter- and intra-day precisions ranged between 3–15 % and 7–18 %, respectively. Accuracy was evaluated in terms of percentage recovery, lying within acceptable range. The matrix effect expressed as ion suppression/enhancement of each analyte was in the range ±25 % for all analytes. Post-preparative stability of analytes was higher than 85 %, while no carryover between runs was observed. The developed method has been successfully applied in routine toxicological analyses for the analysis of biological samples from clinical and autopsy cases.

Frequency of "Poor Transporter" Phenotype Among Patients with Mental Disorders: Pilot Study

The problem of psychopharmacotherapy safety is actively studied, but remains unresolved, despite the development of new generations of psychotropic drugs (PDs). Neurotoxic adverse drug reactions (ADRs) are one of the leading causes of pseudo-resistance of mental disorders and patient disability. The development of neurotoxic ADRs is genetically determined, and caused by a slowdown in the efflux of PDs from the brain into the blood through the blood-brain barrier. Of the three transport proteins involved in the efflux of PDs, the most clinically significant and studied is glycoprotein P, encoded by the MDR1 (ABCB1) gene. This transport protein is involved in the efflux of a large number of PDs used in real clinical practice of a psychiatrist. Objective: To study the frequency of the non-functional allele 3435T of the single-nucleotide variant rs1045642 of the MDR1 (ABCB1) gene in patients with mental disorders living in the Northwestern region of the Russia. Methods: The study included 71 Caucasians patients with mental disorders (34 male and37 female). Mean age of the study participants was 35.1±16 years). Real-time polymerase chain reaction used for pharmacogenetic testing. Results: The frequency of the nonfunctional homozygous genotype 3435TT (phenotype "poor transporter") was 19.7%, and the frequency of the low-functional heterozygous genotype 3435CT (phenotype "intermediate transporter") was 57.7%. The allelic frequency of T rs1045642 of the MDR1 (ABCB1) gene in Caucasians patients with mental disorders living in the Northwestern region of the Russia was 97.1%. Conclusions: The frequency the nonfunctional allele 3435T of the MDR1 (ABCB1) gene associated with a slowdown in PDs efflux through BBB in patients with mental disorders living in the Northwestern region of the Russia is high, which explains the need for a wider introduction of this method of personalized medicine into real psychiatric practice.

The Translated and Adapted Brazilian Version of the Behavioral Enabling Scale for Family Members of Psychoactive Substance Users: An Analysis of the Factorial Structure and Internal Consistency.

The enabling behaviors of family members of psychoactive substance users can be crucial in maintaining addiction. There are no psychometrically evaluated instruments to measure the frequency of the enabling behaviors of family members of psychoactive substance users. Therefore, this study aimed to assess the internal consistency and factor structure of the Behavioral Enabling Scale. A cross-sectional study was carried out, with a secondary analysis of data collected from 400 family members of psychoactive substance users that used a hotline service in Brazil. Exploratory factor analysis was conducted with an initial sample of 200 protocols, and with the remaining 200 protocols, a confirmatory factor analysis was conducted. The internal consistency estimate proved entirely satisfactory in both samples, where the first presented a Cronbach's alpha of 0.76 and the second had a consistency estimate of 0.79. Factor analysis was conducted using a shortened version of the instrument, with 15 items, during which six factors that cover 65% of the scale's explained variance were extracted. KMO = 0.68 and Bartlett's test of sphericity = X2 (gl = 153) 497.201, p < 0.0001, were significant. The Brazilian version of the Behavioral Enabling Scale is a valid tool that measures the frequency of the enabling behaviors of family members of psychoactive substance users. The measurement instrument enables further investigations into the behavior of family members regarding the use of psychoactive substances by their relatives.

Caffeine intake during lactation has a sex-dependent effect on the hippocampal excitatory/inhibitory balance and pups’ behavior

During early life, disruptions in glutamatergic and GABAergic synapse development in the hippocampus may contribute to several neurodevelopmental disorders, including cognitive deficits and psychiatric disorders. Caffeine is the most consumed psychoactive drug in the world, and previous work from our group has shown that caffeine disrupts visual system connections at different stages of development. This work aimed to investigate the effects of caffeine consumption during lactation in the glutamatergic and GABAergic synaptic markers in the hippocampus and on the behavior of rat offspring. We found that maternal caffeine intake significantly reduced GluN1 subunits of the NMDA receptor, increased the GluA1/GluA2 ratio of AMPA receptor in the dorsal hippocampus, and decreased GAD content in female pups’ ventral hippocampus. On the other hand, an increase in GluN1/GluN2b subunits, a decrease in GAD content in the dorsal hippocampus, and a reduction of the GluA1 content in the ventral hippocampus were observed in male pups. In addition, changes in the behavior of the offspring submitted to indirect caffeine consumption were also sex-dependent, with females developing anxiety-like behavior and males showing anxiety-like behavior and hyper-locomotion. These results highlight that maternal caffeine intake promotes changes in the hippocampal excitatory and inhibitory balance and offspring behavior in a sex-dependent manner, suggesting that the population should be alerted to reduced caffeine consumption by breastfeeding mothers.

Cluster B personality disorders and psychotropic medications: a focused analysis of trends and patterns across sex and age groups.

This study investigated sex and age differences in patterns of psychotropic medication use before and after the initial diagnosis of Cluster B personality disorders (PDs) and analyzed trends over time. Analyzing data from the Quebec Integrated Chronic Disease Surveillance System for individuals newly diagnosed with Cluster B PD (≥ 14 years) between 2002 and 2018 and under the provincial public drug plan, we calculated yearly and monthly proportions of individuals exposed to psychotropic medications during the year before and after their diagnosis by sex and age. Robust Poisson regression models assessed the association between sex and exposure to psychotropic medications after the diagnosis of Cluster B PD. Among 87,778 individuals with a first Cluster B PD diagnosis (mean age: 44.5 years; 57.5% women), the proportion of users increased post-diagnosis. Notably, after diagnosis, females were more likely to receive psychiatric medications (between 78.9% and 83.7% during the study period vs. 72.8% and 76.8%). Males were less likely than females to receive antidepressants (adjusted prevalence ratio (aPR): 0.83; 99% confidence interval (CI): 0.82-0.85) and anxiolytics (aPR: 0.86; 99%CI: 0.84-0.88), whereas they had higher exposure to antipsychotics (aPR: 1.04; 99%CI: 1.02-1.06) and ADHD medications (aPR: 1.14; 99%CI: 1.07-1.2). Age-specific trends showed increased ADHD medication use among younger patients (14-24 years), and anxiolytic use predominated in those aged ≥ 65 years. Psychotropic medication use was high among Cluster B PD patients, with differences in medication classes according to age and sex. The marked sex and age differences in psychotropic medication use among Cluster B PD patients underscore the need for a sex-sensitive and age-specific approach in psychiatric care.

Impact of the COVID-19 health crisis on psychotropic drug use in children and adolescents in France

BackgroundIn 2019, the world faced a pandemic brought about by a severe acute respiratory infection caused by SARS-CoV-2 virus. The spread of this virus has profoundly affected societies, particularly in terms of their economic, human and social dimensions, as well as their healthcare systems. Several restrictive measures (reduced social interaction, periodic school closures,…) had to be taken to contain the spread of the virus. These measures have had an impact on the psychological well-being of both adults and children. The aim of this study was to assess the changes in psychotropic drugs prescriptions for children and adolescents living in Limousin, a French region, over the period 2018 to 2021.MethodsThe consumption of psychotropic drugs was studied using a national database of drug reimbursement. These data were extracted and supplied from the nationwide French reimbursement healthcare system database (SNDS). The following therapeutic classes were studied: N05A (antipsychotics), N05B (anxiolytics), N05C (hypnotics and sedatives), N06A (antidepressants) and N06B (psychostimulants). Data were collected for insured persons under the age of 18 who received at least one reimbursement for a psychotropic drug between 2018 and 2021.ResultsOver a 4-year period, 7949 patients under the age of 18 were included with an average age of 12.1 years and a sex ratio of 0.97 M/F. The number of patients increased from 2018 to 2021, as did the number of reimbursements. We observed a statistically significant difference of means of patients reimbursed per week for on five therapeutic classes, with the greatest difference in 2021 (p < 0.0001). An increase in the number of patients of between + 20.7% and + 689% was observed, depending on the drug classes studied. Comparisons between the COVID-19 and pre-COVID-19 periods showed a significantly higher COVID average for psychotropic drugs reimbursements in general and individually for all classes except psychostimulants.ConclusionThe results show a significant increase in the consumption of psychotropic drugs among youth. The increase in psychotropic drug use was continuous and progressive throughout the pandemic. All five classes were increased, but particularly anxiolytics and antidepressants. The COVID-19 context may have been at the origin of a deterioration in the mental health of children and adolescents, or of a heightened awareness of psychiatric care among young people.

Associations between physical diseases and subsequent mental disorders: a longitudinal study in a population-based cohort.

People with physical diseases are reported to be at elevated risk of subsequent mental disorders. However, previous studies have considered only a few pairs of conditions, or have reported only relative risks. This study aimed to systematically explore the associations between physical diseases and subsequent mentaldisorders. It examined a population-based cohort of 7,673,978 people living in Denmark between 2000 and 2021, and followed them for a total of 119.3 million person-years. The study assessed nine broad categories of physical diseases (cardiovascular, endocrine, respiratory, gastrointestinal, urogenital, musculoskeletal, hematological and neurological diseases, and cancers), encompassing 31 specific diseases, and the subsequent risk of mental disorder diagnoses, encompassing the ten ICD-10 groupings (organic, including symptomatic, mental disorders; mental disorders due to psychoactive substance use; schizophrenia and related disorders; mood disorders; neurotic, stress-related and somatoform disorders; eating disorders; personality disorders; intellectual disabilities; pervasive developmental disorders; and behavioral and emotional disorders with onset usually occurring in childhood and adolescence). Using Poisson regression, the overall and time-dependent incidence rate ratios (IRRs) for pairs of physical diseases and mental disorders were calculated, adjusting for age, sex and calendar time. Absolute risks were estimated with the Aalen-Johansen estimator. In total, 646,171 people (8.4%) were identified as having any mental disorder during follow-up. All physical diseases except cancers were associated with an elevated risk of any mental disorder. For the nine broad pairs of physical diseases and mental disorders, the median point estimate of IRR was 1.51 (range: 0.99-1.84; interquartile range: 1.29-1.59). The IRRs ranged from 0.99 (95% CI: 0.98-1.01) after cancers to 1.84 (95% CI: 1.83-1.85) after musculoskeletal diseases. Risks varied over time after the diagnosis of physical diseases. The cumulative mental disorder incidence within 15 years after diagnosis of a physical disease varied from 3.73% (95% CI: 3.67-3.80) for cancers to 10.19% (95% CI: 10.13-10.25) for respiratory diseases. These data document that most physical diseases are associated with an elevated risk of subsequent mental disorders. Clinicians treating physical diseases should constantly be alert to the possible development of secondary mental disorders.

High-Risk Cannabis Use: A Proposal of an Operational Definition through Delphi Methodology for Scientific Consensus

Introduction: Cannabis ranks as one of the most widely used psychoactive substances worldwide. Its usage has been reported as a risk factor for developing a variety of physical and mental health issues, alongside social and economic problems. According to the World Health Organization (WHO), hazardous (or high-risk) substance use is defined as “a pattern of substance use that increases the risk of harmful consequences for the user.” The primary objective of this study was to achieve a consensus on an operational definition of high-risk cannabis use suitable for a European jurisdiction (Spain). Methods: A three round Delphi study was conducted. The Delphi technique entails group decision-making and iterative forecasting by consulting a panel of experts and conducting systematic feedback rounds. An online survey was distributed among a diverse expert panel comprising professionals from Spain working on fields related to cannabis use (research, policy planning, and clinical professionals). One-hundred ninety-nine invitations were sent to experts, of which forty-five (22.6%) accepted to participate. All participants were provided the option to revise a background document with the latest compiled scientific evidence and guidelines related to health and social conditions associated to cannabis usage. This background document also proposed the quantification of dose using a standardized unit established for the population of Spain (the Standard Joint Unit or SJU) based on quantity of cannabis main psychoactive constituent, 9-tetrahydrocannabinol (9-THC) (1 SJU = 1 joint = 0.25 g of cannabis = 7 mg of 9-THC). Three rounds of Likert scale and open-ended questions were administered until consensus, defined as ≥75% agreement, was attained. Results: Consensus was reached on defining high-risk cannabis use as the usage of more than 4 SJU (>28 mg THC) per week or any use of cannabis with potency >10% THC. Concurrent use of cannabis with other drugs was also considered high risk, while the smoked route was considered the riskiest administration route. It was also agreed that vulnerable groups for high-risk cannabis use (for whom any pattern of cannabis use represents high risk of harm) include individuals under the age of 21, pregnant or breastfeeding women, individuals with psychiatric history, those with medical health issues related to cannabis use, professional drivers and heavy machine operators. Conclusion: This operational definition of high-risk cannabis use for Spain elucidates usage patterns and individual vulnerability factors predictive of heightened harm. Its adoption holds potential to inform decision-making among individuals, professionals, and policy-makers, facilitating evidence-based interventions aimed at prevention and risk reduction.

Innovative Approaches to the Training of Social Workers for Work with Psychoactive Substance Dependence: An Interdisciplinary Strategy

The article analyzes the need for implementing an interdisciplinary approach in the education of social workers specializing in assisting individuals, including those dependent on psychoactive substances and those living with HIV. The main focus is on integrating knowledge from medicine, psychology, law, and social work to improve the quality of training and enhance the professional competencies of these specialists. The study highlights existing deficiencies in the educational programs for social workers in the Kyrgyz Republic, particularly in addressing the specific needs of individuals dependent on psychoactive substances. The article proposes an educational module (a teaching and methodological complex) designed to fill the gaps in the education of social workers in the field of addiction services. The pilot testing of this educational module showed its relevance and effectiveness in raising the level of knowledge on issues related to addiction, methods of providing social support, and social accompaniment. It is important to note that the interdisciplinary approach, which combines theoretical knowledge with practical training, helps in understanding the complexities of the issue and improves the outcomes of social adaptation for individuals with psychoactive substance dependence. The main conclusion of the article is that the use of innovative educational models (teaching modules) significantly enhances the quality of social work within the continuum of addiction services. The author stresses the importance of further developing and implementing such educational programs/modules for social workers, as this will overall improve the rehabilitation and socialization process for individuals with psychoactive substance dependence.