Type Of Psychotropic Medication Research Articles

Post-discharge pharmacological treatment discontinuation of forensic psychiatric patients in Sweden.

Most forensic psychiatric patients have chronic psychiatric disorders that require long-term pharmacological treatment even after discharge from care. However, the prevalence and correlates of post-discharge medication discontinuation in this patient group remain unclear. The aim of this study was to investigate the prevalence and correlates of post-discharge discontinuation of pharmacological treatment in forensic psychiatric patients in Sweden. Data on individuals discharged from forensic psychiatric care between 2009 and 2018 (n = 1,142) with ongoing pharmacological treatment at the time of discharge (n = 856) were identified from the Swedish National Forensic Psychiatric Register. Cox regression models were used to estimate the association between patient characteristics and medication discontinuation. Of the 856 individuals with pharmacological treatment at discharge, 488 (57%) discontinued treatment within 2 years of discharge. Factors associated with an increased risk of treatment discontinuation varied between different types of psychotropic medications: the most important correlate was comorbidity between psychosis and personality disorder. Higher age at discharge, longer length of stay, having a history of several psychiatric care episodes, having a trustee, having a limited guardian, and a residing in a supported living accommodation at the time of discharge were associated with a decreased rate of medication discontinuation. This applied for antipsychotics, antidepressants, antiepileptics, and any psychotropic medication, but not for psychostimulants or drugs used in addictive disorders. For many former forensic psychiatric patients, there are situational factors associated with medication discontinuation. This insight holds significance for professionals who are involved in pre-discharge planning within forensic psychiatric care and those who interact with this cohort of former patients post-discharge.

Early motor behavior of infants exposed to maternal mental health disorders — A South African perspective

IntroductionOver the past five decades the bulk of research on exposure to maternal mental health disorders and infant neurodevelopment has been generated in high-income countries. The current study included infants, residing in low-income communities in South Africa, born to mothers with a history of psychiatric disorders. AimTo assess the motor behavior of 10- to 20-week-old infants exposed to maternal mental health disorders, and a subgroup of infants with prenatal psychotropic medication exposure. MethodsThe present study is a cross-sectional descriptive study, with a longitudinal subgroup analysis. General Movement Assessment (GMA), including the Motor Optimality Score-Revised (MOS-R), was used at 10–20 weeks corrected age to assess infant motor behavior. ResultsThe study included 112 infants. No significant difference (p = 0.523) was found on the MOS-R between infants exposed to maternal mental health disorders (n = 70) and the comparison group (n = 42). Both the exposed and comparison groups scored within the mildly reduced range on the MOS-R. No significant differences were found in a subgroup of infants with prenatal exposure to multi-class psychotropic medication (n = 17), mono-class psychotropic medication (n = 35) or valproate exposure (n = 10) (p > 0.1). ConclusionNo association was found between exposure to maternal mental health disorders or exposure to psychotropic medication and infant motor behavior at 10–20 weeks post-term age on the MOS-R. Future research should focus on the contribution of exposure to specific classes and types of psychotropic medication on neurodevelopmental outcome of infants in larger cohorts.

The Implications of Adverse Pharmacologic Reactions and Complex Pathogenic Mechanisms in Schizophrenia

Schizophrenia is a major health problem in which diversification and increase in the quality of antipsychotic molecules did not yield the anticipated results. that the etiopathogenesis of schizophrenia accounts for a combination of genetic factors forming the genetic spectrum of vulnerability for schizophrenia. The neurodevelopmental anomalies correlated with the gestational period and obstetric traumatisms raises major pharmacological management issues. The two levels of vulnerability (genetic and neurodevelopmental) are the basis of the pathogeny of side effects induced by antipsychotic medication. The most severe side effects are related to extrapyramidal symptoms, hyperhomocysteinemia, hypofrontality, impairment of the neurovascular unit and neuronal metabolic processes. Understanding these particular mechanisms will allow the clinician to identify the pathogenic model of schizophrenia, customized for each specific case. The adverse drug reaction decreases the compliance and adherence to the treatment, determining repeated discontinuations with psychotic relapses, and may trigger psychopathogenic bursts deteriorating the structural and cerebral functional balance. The type of psychotropic medication must be taken into account, as well as the concomitant medication administered for comorbidities associated with schizophrenia. The cerebral vascular modifications are correlated with the metabolic syndrome induced by antipsychotic medication. This complex syndrome, associated also with modifications in the homocysteine metabolism, determines weight gain, obesity, high blood pressure, ischemic cardiopathy, hyperglycemia and dyslipidemia. Identification of possible biological or neuroimaging markers helps and their early correction may prevent the onset of neurodegenerative evolution and irreversible cerebral atrophies, as well as decrease the risk of side effect that may endanger the life of the schizophrenic patient. The complexity of the pathogenic mechanisms requires a prophylactic behavior, not based on therapeutic switch, but on the proactive, customized pharmacologic intervention, addressing the pathogenic chains.

The association between anxiety measured with HADS and use of psychotropic medication among cardiac patients

Abstract Background Anxiety among cardiac patients is highly prevalent and is associated to poor outcomes. Certain types of psychotropic medication are suspected of causing adverse events in cardiac patients. However, an association between symptoms of anxiety and use of psychotropic medication among cardiac patients has not yet been established. Purpose The objective was to explore the association between anxiety (measured by HADS-A) and use of psychotropic medication among cardiac patients. Methods All study participant were identified from the DenHeart study and data were a combination of patient-reported survey data and baseline and follow-up data from Danish national registers. Information on redeemed prescriptions of psychotropic medication was obtained from The Danish National Prescription Registry. Anxiety symptoms were defined by a HADS-A score≥8. Patients were defined as users of psychotropic medication if they had redeemed at least one prescription one and three years after discharge. Psychotropic medication was classified by Anatomical Therapeutic Chemical Classification (ATC) codes. Multiple logistic regression analysis within one year and Cox regression analysis within three year from discharge was conducted to determine the association between symptoms of anxiety and use of psychotropic medication. Results Among the 12,913 cardiac patients included, a total of 3231 (28%) redeemed at least one prescription of psychotropic medication within one year and 4726 (37%) within three years after discharge. The most commonly used drugs were benzodiazepines and antidepressants. Among patients using psychotropic medication 1481 (46%) had a HADS-A score ≥8. Cardiac patients with symptoms of anxiety had significantly higher odds of using psychotropic medication within one year from discharge OR 2.47 (95% CI 2.25; 2.72). The increased risk of use of psychotropic medication was confirmed with a almost two-fold risk after three years, HR 1.92 (95% CI 1.80; 2.04), Table 1. Conclusion Cardiac patients with symptoms of anxiety measured by HADS were significantly more likely to use psychotropic medication within one and three years after discharge than cardiac patients without symptoms of anxiety. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Novo Nordisk Foundation

Psychotropic medication use among personality disordered young adults. A follow-up study among former adolescent psychiatric inpatients

ObjectiveTo analyze the use of prescribed psychotropic medication in subjects with personality disorder (PD) diagnosed in early adulthood. MethodsThe study population consisted of former adolescent psychiatric inpatients (N=508). 63 had a diagnosis of PD, including with borderline PD (BPD) (N=38) and other PD (OPD) (N=25). DSM IV-based psychiatric diagnoses in adolescence were based on the Schedule for Affective Disorder and Schizophrenia for School-Age Children Present and Lifetime (K-SADS-PL). The information on in-or outpatient hospital treatments until the end of 2016 were extracted from the National Care Register for Health Care. Lifetime data on purchases of physician-prescribed psychotropic medications was obtained from the Social Insurance Institution of Finland. Results98.4% (N=62) of subjects with PD had purchased at least one type of psychotropic medication during the follow-up period. The use of non-opioid analgesics and antipyretics was over twice as common among subjects with BPD than subjects with OPD (57.9% vs.28.0%, p=0.020). Anxiolytic use was 1.5 times more common among subjects with BPD than subjects with OPD (65.8% vs. 40.0%, p=0.044) ConclusionsPsychotropic medication use was common among subjects with PD. The use of non-opioid analgesics, antipyretics and anxiolytics was more common among subjects with BPD.

The effect of electroconvulsive therapy on hematologic inflammatory markers in schizophrenia in association with type of antipsychotic medication

Objectives: In recent years there has been an increased interest on the role of inflammation in the pathophysiology of schizophrenia and a search for readily applicable prognostic markers. The impact of electroconvulsive therapy (ECT) on inflammatory function in schizophrenia is still unclear. The aim of this retrospective study is to compare pre- and post-ECT values of red cell distribution width (RDW), mean platelet volume (MPV), mean cell hemoglobin (MCH), mean cell hemoglobin concentration (MCHC), neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) which are considered to be inflammatory markers, and to discuss the findings in context of neuroinflammatory ethiology of schizophrenia. Methods: Inpatient files were reviewed via complete blood count (CBC), sociodemographic and clinical characteristics (e.g. gender, age, Body Mass Index (BMI), type of psychotropic medication). A total of 58 schizophrenic patients who underwent ECT were were compared in terms of pre- and post-ECT values of RDW, MPV, MCH, MCHC, NLR and PLR in association with type of psychotropic medication. Results: It was found that MPV, RDW, MCH and MCHC levels significantly decreased after ECT (p < 0.05), but no significant difference was found in terms of NLR and PLR (p > 0.05). When compared according to the type of psychotropic medication during ECT, MPV and MCHC were decreased after ECT in both typicaland atypical antipsychoticintervention groups (p < 0.05). ECT-related inflammatory marker changes were more likely to be associated with atypical antipsychotic medication use during ECT. Conclusions: Our results indicate that recurrent ECT sessions caused a change in the function of the immune system which might be considered to explain the therapeutic effects of ECT in schizophrenia.

Hidden Harms of Hypnotics: a population based record linkage study of psychotropic medication and suicide risk

Background/Main Aim Although psychotropic medication is a known risk factor for suicide, studies investigating the relationship between specific types of psychotropic medication and suicide in adults are scarce.
 Methods A cohort of 1,115,647 individuals (18-75years) was identified from Northern Ireland’s 2011 Census records and linked to prescription records and death registrations until 2015. Individual, household and area-based attributes were derived from census records and selected on the basis of known suicide risk. Five categories of psychotropic medication was identified; none, antidepressants, anxiolytics, hypnotics and antipsychotics. Logistic regression was used to model the association between specific types of psychotropic medication (singularly and in combinations) and death by suicide adjusting for sociodemographic and physical health characteristics.
 Results About 14% of the cohort (n=153,319) had received ≥2 prescriptions of any psychotropic medication in the five months around Census. Eight hundred and seventy persons (n=870) died by suicide during 2011 to 2015. Suicide was higher in those on psychotropic medication than in those without (0.24% versus 0.05% respectively). In the fully adjusted logistic regression model, association between death by suicide and any psychotropic medication record remained statistically significant (AOR=3.69, 95%CI: 3.13–4.35). However, individuals solely on hypnotics had the highest AOR of those on singular medication (AOR=4.24, 95%CI: 2.96–6.06 compared to AOR=2.22, 95%CI: 1.75–2.82 for those on antidepressant medication only). In terms of medication combinations, hypnotics both with anxiolytics, and in combination with antidepressants and anxiolytics were the strongest predictors of death by suicide (AOR=8.76, 95%CI: 5.93–12.94 and AOR=8.53, 95%CI: 5.62–12.94 respectively).
 Conclusion Risk of death by suicide varied by medication type with hypnotic medications making an important contribution to death by suicide. Although previous work has focused on antidepressant therapy and suicide risk, those on hypnotic medication are an at-risk group that warrant further attention.

Does the Use of Psychotropic Medication Adversely Affect the Outcomes of Hip Arthroscopy?

Background: Over the past decade, the use of psychotropic medications (PTMs) in the United States has doubled, and currently 20% of adults are taking 1 or more of these antidepressant, antianxiety, antipsychotic, or mood-altering medications. To date, however, the incidence of PTM use in patients undergoing hip arthroscopy and the results of hip arthroscopy in these patients have not been reported. Purpose: To determine the prevalence of PTM use in patients undergoing hip arthroscopy and to compare the outcomes of patients taking PTMs versus those of patients not taking PTMs. Study Design: Cohort study; Level of evidence, 3. Methods: Medical records of 880 consecutive patients who underwent hip arthroscopy performed by the senior author were reviewed and data were collected, including the number and types of PTMs that these patients were taking at the time of their hip arthroscopy. All hips were assessed with the Byrd modified Harris Hip Score (mHHS) preoperatively; 709 patients (81%) had scores obtained at 12 months and 669 patients (76%) at 24 months after surgery. Demographic data and mHHS of patients taking psychotropic medications (PTM group) were compared with those of patients not taking PTMs (NPTM group). Results: Four hundred twenty-two (48%) of the 880 patients studied were taking PTMs at the time of their hip arthroscopy; significant differences between the PTM and NPTM groups were average age (48 vs 35 years, respectively), and the high percentage of females (53%) and low percentage of males (38%) in the PTM group. Preoperative scores for the PTM and NPTM groups were similar (41 vs 42 points, respectively), but postoperative scores of the PTM group were significantly lower at 6 months (72 vs 89 points), 12 months (77 vs 91 points), and 24 months (79 vs 88 points) after surgery (P = .01). In contrast, the scores of the subgroups of PTM and NPTM adolescents obtained at 3 months (92.5 vs 88.9 points), 6 months (92.1 vs 90.3 points), 12 months (89.5 vs 92.1 points), and 24 months (90.3 vs 90.1 points) after surgery did not significantly differ. Conclusion: The incidence of PTM use in this series of patients with hip arthroscopy was triple that reported for US adults (48% vs 17%, respectively) and adolescents (23% vs 6.3%), and the PTM group had significantly lower 12- and 24-month mHHS results than the NPTM group. These results suggest that (1) patients undergoing hip arthroscopy who are taking PTMs are at significantly higher risk for poor outcomes and (2) their use of PTMs should be identified and addressed before proceeding with hip arthroscopy.

Predictors of Length of Stay in a Psychiatric Adolescent Treatment Program.

Understanding predictors of adolescent inpatient length of stay (LOS) is important in informing treatment outcomes for this age group. The current literature on adolescent LOS remains limited and has been characterized by methodological limitations. In the study described here, we examined a wide range of predictors for LOS in a psychiatric unit for adolescents (N=285), including severity of disorder (previous hospitalizations, self-harm, cognitive impairment and thought disorder, severe depression, history of trauma), types of psychotropic medication, and diagnoses. Our results indicated that LOS is associated with predictors that reflect psychiatric severity-most notably prescription of mood stabilizers and youth-reported internalizing symptoms.

CE: Antipsychotic Medications.

: Antipsychotic medications are primarily used to manage various symptoms of psychosis. In recent years, more adults-and teenagers-are taking at least one type of psychotropic medication, the majority of which are prescribed by primary care and family physicians. Because nurses are now caring for people of varying ages, and with varying diagnoses, who are taking these types of medications, they need to develop a working knowledge of the agents available and know when it's appropriate to prescribe them for mental health disorders as well as for disorders unrelated to mental health. This article is the first in a series on commonly used psychotropic medications.

Prescription patterns of psychotropic medications and use of electroconvulsive therapy in Chinese patients with dementia.

Little is known about psychiatric pharmacotherapy and somatic treatments in dementia in China. This study examined the prescription patterns of psychotropic medications and use of electroconvulsive therapy (ECT) in dementia patients hospitalized in a psychiatric institution in Beijing, China. This was a retrospective chart review of 401 patients with dementia treated over a period of 7 years (2007 - 2013) in a university-affiliated psychiatric institution in Beijing. Socio-demographic and clinical data were collected from the electronic chart management system (ECMS) for discharged patients. Nearly all patients (96.8%) received psychotropic medications in order of frequency: second-generation antipsychotics (83.0%), benzodiazepines (77.8%), first generation antipsychotics (39.7%), antidepressants (29.7%), and mood stabilizers (24.7%). The rate of polypharmacy and ECT use was 82.0% and 3.7%, respectively. Prescription of mood stabilizers was associated with longer length of hospitalization. In a major psychiatric hospital in China, ECT was sporadically used in patients with dementia, while the vast majority of patients received at least one type of psychotropic medication. Factors contributing to the high use of psychopharmacological interventions in this population warrant further investigations.

Dementia in Alto Minho, a Descriptive Study.

Dementia in Alto Minho, a descriptive study. Introduction With approximately 35.6 million people with dementia worldwide, dementia has become a major focus of attention and intensive research in developed countries. In Portugalthere is still little informationabout this disease, and that’s why wepropose to characterize apopulation of patients with dementiafollowed in the outpatient neurology department of UnidadeLocal de Saude do Alto Minho (ULSAM). Objective Description of a population of 103 patientsfollowed in the outpatient neurology department of ULSAM in 2014. Methodology 103 patients followed in the outpatient neurology department of ULSAM between January and March 2014 were randomly chosen. We collectedSocio-demographic and medical data by consulting the electronic records ofpatients. Data were analyzed using SPSS version 20.0. Results The average age of patients was 77 years. There wasa predominance of females with61.17% women. The most frequent diagnosis was of mixed dementiawith 26 cases, followed by Alzheimer's disease with 24 cases and 17 cases with vasculardementia. The most widely usedanti-dementia drug was memantine. About 83% ofpatients were on some type of psychotropic medication, over 50% of patients werebeing treated with antidepressants, 42% with antipsychotic drugs, 33% with anxiolytic / hypnotic and15% with mood stabilizers. Around one third ofthe total patients had been followedin psychiatry in the last five years, mainly for depressivesymptoms, psychotic symptoms ofsenility, or behavioral disturbances. More than 50% ofpatients had 2 or more risk factors for cardio-vasculardisease, and 76.60% had high bloodpressure. Conclusion: Interestingly, in our sample there isan over representation of vascularetiology as a primary cause, orcofactor of dementia, and there is a high prevalence ofcardiovascular risk factors andparticularly arterial hypertension. Thisleads us to think that better prevention of cardio-vascular disease risksfactors and particularly hypertension could have a significant impact in the prevention of dementia in the Alto Minho. Finally we realize through the great use of psychotropicdrugs in these patients that theinvolvement of psychiatrists in their attendance is essential.

Advance statements for borderline personality disorder: a qualitative study of future crisis treatment preferences.

Little is known about the crisis treatment preferences of people with borderline personality disorder. Clinicians may also question service users' ability to make considered decisions about their treatment when in crisis. Therefore, this qualitative study aimed to investigate crisis treatment preferences of a sample of community-dwelling adults with borderline personality disorder. Participants were 41 adults with borderline personality disorder who had created joint crisis plans during a randomized controlled trial. Data from all 41 joint crisis plans were analyzed iteratively via a thematic analysis framework. Participants gave clear statements in their crisis plans relating to the desire to recover from the crisis and to improve their social functioning. Key themes included the desire to be treated with dignity and respect and to receive emotional and practical support from clinicians. Many participants spoke of the importance of connecting with others during periods of crisis, but several reported a clear desire to be left alone during a future crisis. Other themes concerned preferences for specific treatment refusals during crises, including particular types of psychotropic medication and involuntary treatment. The variation of participants' preferences underscores the importance of developing individually tailored crisis plans for people with borderline personality disorder. The need to be treated with dignity and respect and to be given autonomy in decision making--also identified in global surveys of people with severe mental illness--is important to people with borderline personality disorder. Key messages for clinicians, service users, and policy makers, in addition to staff training issues, are discussed.

Diagnostic and treatment practices of delirium in a general hospital.

Despite the increase in research on delirium, it remains underdiagnosed and difficult to manage, and the outcome is poor especially in older people. To identify the clinically diagnosed rates of delirium, the possible aetiologies, to describe treatment, number and type of psychotropic medication used and to investigate the reasons for referral to a liaison psychiatric team. Retrospective study of medical records of inpatients admitted to Sligo Regional Hospital during an 18-month period. One hundred and fifty-six files had a documentation of delirium (time prevalence 2%). Mean age of the sample was 82 years (SD = 7.2), 66 (42%) were male. Sixty-nine (44.2%) of the total sample had a previous history of dementia, and 57 (36.5%) had a previous history of delirium. In 67 (43.2%) samples, the cause was infection, while in 4, no specific cause was identified. Ninety (58%) were referred to the liaison service, but only in 26 (28.9 %), the reason for referral was "acute confusion" or "delirium". In a majority of referrals, the reason was an affective disorder more often depression. There were no significant differences between delirium subtypes and referrals (χ(2) = 3.868, df 3, p = 0.28). Examination of the amount of antipsychotics prescribed before, during and after delirium shows that there was a significant increase in use during the delirium (χ(2) = 17.512, df 8, p = 0.025) and decrease in z-hypnotics medication (zopiclone/zolpidem), (χ(2) = 20.114, df 4, p < 0.001), while benzodiazepines and antidepressants remained the same. Delirium is often misdiagnosed and unrecognized in hospital settings; however, when identified the pharmacological management is appropriate.

Four-Year Follow-Up Study of Pharmacological Treatment in Pathological Gamblers

In the past decade, we have witnessed the emergence of pharmacological treatments for pathological gambling with some success but many question marks. We aimed to explore pharmacological treatments that have been previously explored with some success, with the intent of comparing their efficacy and pave the way to larger placebo-controlled trials. In this study, we allocated 78 patients to 4 different types of psychotropic medications: naltrexone, topiramate, bupropion, and escitalopram. We treated patients for more than 2 years, with additional 2-year follow-ups without medication. The sample was evaluated using the 21-item Hamilton Depression Rating Scale, the Hamilton Anxiety Rating Scale, the Global Assessment of Functioning, and the Visual Analog Scale to measure general well-being before enrollment as well as at 1 month, 6 months, 24 months, and 48 months after beginning medication treatment. During the first 2 years of treatment, 34 patients dropped out, with one more dropping out during the additional 2 years of follow-up. Significant improvement on all rating scales was seen in all groups after 2 years, except HAMD in the group that received topiramate. We found the naltrexone-treated group of patients to have a statistically significant lower dropout rate compared with other groups, statistically significant lower HAMD scores in comparison to the group treated with bupropion, statistically significant lower Hamilton Anxiety Rating Scale score compared to the groups treated with escitalopram and topiramate, and significantly higher Visual Analog Scale scores compared to the groups treated with bupropion and topiramate. Pathological gambling is essentially a biopsychological disorder that may be attenuated provided that patients adhere to medication. In our study, among 4 medications with different mechanisms of action, naltrexone was found to be the most effective. Placebo-controlled studies involving large numbers of subjects are required before naltrexone's efficacy can be established.

Psychotropic Medications and Crash Risk in Older Drivers

. An extensive review of Australian and international literature was undertaken, examining the association between psychotropic medications and crash risk involving older drivers. . The review summarizes the findings in experimental and epidemiological studies related to (a) prevalence of psychotropic medication use among older drivers; (b) side effects of driving under the influence of psychotropic medications; and (c) association between psychotropic medications and crash risk for older drivers. . Current evidence indicates that several types of psychotropic medications have the potential to impair driving ability and increase the risk of crash involvement. A major limitation is that few studies have specifically examined the effects on older drivers, despite the fact that the majority of the population using psychotropic medications are older. Discussion. More knowledge about the safety of therapeutic use of psychotropic medications is needed. Large-scale, whole-population, epidemiological studies, such as data linkage studies, may be the optimal study design.

For What Diagnoses Are Psychotropic Medications Being Prescribed?

Psychoactive medications, such as antidepressants, are one of the most widely prescribed categories of drugs in the US; yet few studies have comprehensively examined the conditions for which psychoactive medications are prescribed. To our knowledge, no prior study has examined the extent to which psychoactive medications are prescribed for non-psychiatric somatic illnesses or the main types of psychiatric disorders for which psychoactive medications are being used. To examine the diagnoses for which psychiatric medications are being prescribed in the US by analysing data from a nationally representative survey of physicians. The data were obtained from the 2005 National Disease and Therapeutic Index (NDTI), a continuing survey of a US office-based panel of physicians. The 2005 physician panel consisted of approximately 4000 physicians reporting quarterly, which was projected to a universe of 500,722 physicians. The study focused on the diagnoses that were given as the primary reason for prescribing the following types of psychotropic medications: antidepressants, antipsychotics and anti-anxiety medications. Of the total number of antidepressant drug mentions, 92.7% were prescribed for psychiatric conditions. The most common (65.3%) were mood disorders (e.g. depression), followed by anxiety disorders (16.4%), which together comprised 81.7% of all antidepressant drug mentions. Of the total number of anti-anxiety drug mentions, 67.7% were prescribed for psychiatric conditions. The most common diagnosis was anxiety disorders (comprising 39.6% of all drug mentions), followed by mood disorders (comprising 18.9% of all drug mentions). Almost one-third of anxiety medication drug mentions were for non-psychiatric conditions or conditions of unspecified type. Of the total number of antipsychotic drug mentions, 98.9% were prescribed for psychiatric conditions. The most common diagnoses, comprising 39.0% of all drug mentions, were mood disorders such as depression and bipolar disorder. The second most common psychiatric diagnosis was schizophrenia or other psychotic disorders, comprising 34.5% of drug mentions. Approximately 7.4% of drug mentions were for delirium, dementia, amnestic or other cognitive disorders. Attention-deficit/conduct/disruptive behaviour disorders were the diagnoses indicated on 5.7% of all antipsychotic drug mentions. Anxiety disorders were indicated on 5.5% of antipsychotic drug mentions. Disorders usually diagnosed in infancy/childhood/adolescence (e.g. autism) comprised 2.3% of antipsychotic drug mentions. This research provides a broad view of the nature of psychoactive medication prescribing, which may serve as a guide to future research, policy and education about these medications, their perceived benefits and risks, and their uses.

Datapoints: Psychotropic Drug Prescriptions by Medical Specialty

1167 T important role of general practitioners in prescribing antidepressant medications and treating depression has been documented. However, the extent to which general practitioners are prescribing other types of psychotropic medications has received less emphasis. This study used data from August 2006 to July 2007 from the National Prescription Audit (NPA) Plus database of IMS to examine this question. IMS collects transaction information each month from approximately 36,000 retail pharmacies, representing about 70% of all retail pharmacies, which when weighted represent all prescriptions filled in retail outlets in the United States. Using a separate sample of retail pharmacy transactions that includes the physician’s Drug Enforcement Administration number, IMS assigns physician specialty information to obtain an estimate of the total number of prescriptions filled in retail pharmacies by medical specialty. As shown Figure 1, of the 472 million prescriptions for psychotropic medications, 59% were written by general practitioners, 23% by psychiatrists, and 19% by other physicians and nonphysician providers. General practitioners wrote prescriptions for 65% of the anxiolytics in the sample, 62% of the antidepressants, 52% of the stimulants, 37% of the antipsychotics, and 22% of the antimania medications. Conversely, psychiatrists and addiction specialists wrote prescriptions for 66% of the antimania medications, 49% of the antipsychotics, 34% of the stimulants, 21% of the antidepressants, and 13% of the anxiolytics. Pediatricians were included as general practitioners and wrote 25% of all stimulant prescriptions but only 3% of all other types of psychotropic medications (data not shown). Prescribing of psychotropic medications by nonpsychiatrists improves access to treatment. However, concerns remain about whether patients treated in the general medical setting are receiving treatment concordant with evidence-based guidelines, psychotherapy, adequate medication monitoring, and appropriate intensity of treatment. Psychotropic Drug Prescriptions by Medical Specialty

Datapoints: Psychotropic Drug Prescriptions by Medical Specialty

Datapoints: Psychotropic Drug Prescriptions by Medical Specialty

Psychotropic medication use and cognition in institutionalized older adults with mild to moderate dementia

Most studies examining psychotropic medication use on cognition in older persons with dementia include measures of global cognitive function. The present study examined the relationship between different types of psychotropic medication and specific cognitive functions in older people with dementia. Two hundred and six institutionalized older adults with dementia (180 women, mean age 85 years) were administered neuropsychological tests. Psychotropic medication use was extracted from their medical status and categorized as: sedatives, antidepressants and antipsychotics. Analysis of covariance revealed that psychotropic consumers, and particularly those who used antipsychotics, performed worse on neuropsychological tests of executive/attentional functioning than non-consumers. There were no differences between consumers of other classes of psychotropic drugs and non-consumers. The number of psychotropic drugs used was inversely related to executive/attentional functioning. These findings show that in institutionalized older adults with dementia, specific impairment of cognitive function, i.e. executive/attentional impairments, are associated with antipsychotic medication use. Future longitudinal studies are recommended.