Psychotropic Medication Usage Research Articles

Elevated risk of sexually transmitted infections among adolescents and young adults with borderline personality disorder: a retrospective longitudinal nationwide population-based study.

In this study, we examined the risk of sexually transmitted infections (STIs) among adolescents and young adults (AYAs) with borderline personality disorder (BPD). A total of 4649 AYAs with BPD and 46,490 age-, sex-, and socioeconomic-matched controls without BPD were enrolled from the National Health Insurance Research Database of Taiwan from 2001 to 2009 and were followed up until the end of 2011. Participants who contracted any STI during the follow-up period were identified. Cox regression analysis was conducted to examine the risk of contracting any STI among both patients and controls. A total of 4649 AYAs with BPD and 46,490 age-, sex-, and socioeconomic-matched controls without BPD were enrolled from the National Health Insurance Research Database of Taiwan from 2001 to 2009 and were followed up until the end of 2011. Participants who contracted any STI (ICD-9-CM code 042, 091-097, 087.11, 078.8, 078.88, 131, and 054.1) during the follow-up period were identified. Cox regression and sub-analyses stratified by sex, age, psychiatric comorbidity subgroups, and psychotropic medication usage were conducted to assess STI risk. AYAs with BPD were at a higher risk of contracting any STI (hazard ratio [HR] = 50.79, 95% confidence interval [CI] = 33.45-77.11) in comparison with controls, including HIV, syphilis, genital warts, gonorrhea, chlamydia, trichomoniasis, and genital herpes. The association of BPD with an increased risk of any STI was prevalent in both sexes, adolescents, and young adult patients. BPD with or without psychiatric comorbid subgroup were all associated with an elevated risk of contracting any STI relative to the control group. AYAs with BPD are highly susceptible to contracting STIs. Future studies should examine the role of the core symptoms of BPD, sexual orientation, risky sex behaviors, depressive and anxiety symptoms, and substance use before sex in the risk of STIs among AYAs with BPD.

Psychiatric Diagnoses and Psychotropic Drug Usage in Gender-Affirming Voice Surgery Patients

ObjectivesTo describe the burden of psychiatric illness and psychotropic medication usage among the subset of transgender patients who undergo gender affirming laryngeal surgery and describe some of the most commonly encountered conditions experienced by this population Methods: An IRB approved chart review was conducted for the eighteen patients who have undergone gender affirming laryngeal procedures from August 2019 to June 2022 performed at a single institution. Patient demographic data, treatment details, and psychiatric diagnoses and prescriptions for psychotropic medications were recorded. ResultsOf the eighteen patients who underwent gender affirming laryngeal surgery at this institution, sixteen patients underwent these operations as part of a transition from male to female gender, while two patients were transitioning from female to male gender. In this cohort, thirteen patients were diagnosed with a psychiatric comorbidity (72.2%). Of these patients, eleven were prescribed at least one psychotropic medication (61.1%). The most common psychiatric illnesses encountered in these patients were depression, anxiety, and post-traumatic stress disorder. Ten patients were diagnosed with more than one psychiatric comorbidity (55.6%). The most commonly prescribed psychotropic drugs were selective serotonin/norepinephrine reuptake inhibitors. Three patients in this cohort had a recorded history of at least one prior suicide attempt. ConclusionsMultiple studies have demonstrated increased rates of mental illness in transgender individuals, however, this is the first study to describe the burden of these conditions specifically in the subset of patients who undergo gender affirming laryngeal surgery.

Enhanced peripheral levels of BDNF and proBDNF: elucidating neurotrophin dynamics in cocaine use disorder

Brain-derived neurotrophic factor (BDNF) and its precursor, proBDNF, are known to significantly contribute to brain homeostasis, neuroplasticity, and neuronal remodeling. Although these neurotrophins are thought to have opposing roles, both play a critical part in shaping long-lasting behavioral changes following substance use. In this context, our study sought to explore the implications of these neurotrophins in the pathophysiology of cocaine use disorder (CUD). We conducted a case-control study, which included 28 individuals seeking treatment for CUD and 38 matched healthy participants. We measured peripheral neurotrophin concentrations via an enzyme-linked immunosorbent assay. Additionally, all participants were screened for cocaine-associated pathways (e.g., cocaine intake, craving intensity), along with associated psychopathological data. Our findings highlighted an increased concentration of BDNF and proBDNF in CUD individuals when compared to healthy controls (BDNF: 18092.80 ± 6844.62 vs. 11334.42 ± 5061.85 pg/ml, p < 0.001; proBDNF: 87.03 ± 33.23 vs. 55.70 ± 23.26 ng/ml, p < 0.001). We further corroborated the relationship between neurotrophin levels and CUD using a linear regression model. Nevertheless, there was no significant difference in the proBDNF to BDNF ratio between the two groups. Interestingly, our study also demonstrated the influence of factors like usage of psychotropic medications, history of psychiatric hospitalizations, and psychiatric diagnoses on neurotrophin dynamics. In conclusion, our study underscores the significance of neurotrophin fluctuations in CUD. The observed increase in BDNF and proBDNF levels could play a pivotal role in driving craving and relapse risk. Thus, a nuanced understanding of these neurobiological underpinnings in CUD might contribute to the development of more targeted and effective therapeutic strategies.

Parent-youth convergence (and divergence) in reports about pediatric quality of life.

Researchers and service providers typically assess pediatric Health-Related Quality of Life (HRQOL) by collecting independent reports from parents and youth. An emerging body of work indicates that patterns of parent-youth reports yield information germane to understanding youth outcomes. We identified patterns of HRQOL among youth and their parents seeking mental health treatment and examined links between agreement patterns and mental and physical health functioning. Participants included 227 youth (mean age = 14.40years, SD = 2.42; 63% female) and parent dyads presenting at a mood disorders clinic between 2013 and 2020. We assessed HRQOL using parallel youth and parent forms of the Pediatric Quality of Life Inventory Generic Core Scales. We also assessed youth clinical correlates of depression, suicidal ideation, and impairment, as well as health information via electronic health record (e.g., psychotropic medication usage, BMI). Latent class analysis showed three parent-youth reporting patterns: Low-Low (LL), High-High (HH), and Parent Low-Youth High (PL-YH). Relative to youth in the HH group, youth in the LL and PL-YH groups reported significantly greater depressive symptoms and had higher rates of suicidal ideation and psychotropic medication use. In addition, youth in the LL group reported significantly greater levels of impairment. Parent-youth patterns of HRQOL reporting can reveal clinically meaningful information and indicate poorer functioning for certain groups (LL, PL-YH) of youth. These findings have implications for improving accuracy of risk assessments that leverage HRQOL data.

MP45-16 SEXUAL HEALTH IMPLICATIONS ASSOCIATED WITH PSYCHOTROPIC MEDICATION USAGE IN ADOLESCENTS DURING THE COVID-19 PANDEMIC: ANALYSIS OF A FEDERATED RESEARCH NETWORK

You have accessJournal of UrologyCME1 Apr 2023MP45-16 SEXUAL HEALTH IMPLICATIONS ASSOCIATED WITH PSYCHOTROPIC MEDICATION USAGE IN ADOLESCENTS DURING THE COVID-19 PANDEMIC: ANALYSIS OF A FEDERATED RESEARCH NETWORK Joshua White, Marco Rivero, Jesse Ory, and Ranjith Ramasamy Joshua WhiteJoshua White More articles by this author , Marco RiveroMarco Rivero More articles by this author , Jesse OryJesse Ory More articles by this author , and Ranjith RamasamyRanjith Ramasamy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003291.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Psychotropic medications have a significant impact on sexual health. Long-term usage is strongly associated with dyspareunia, decreased libido, hypogonadism and erectile dysfunction. We hypothesized that the prescription rates for psychotropic medications increased in adolescent patients during the COVID-19 pandemic because of the unprecedented stress levels on youth in isolation. Therefore, we evaluated the prescription rates of psychotropic medications as well as concurrent use of PDE5i in adolescent patients during the COVID-19 pandemic compared to the pre-pandemic era. METHODS: We utilized data generated from TriNetX Research Network to conduct a retrospective matched cohort study. Adolescent patients aged 10-19 presenting for outpatient evaluation were placed into two cohorts: 1) outpatient evaluation before and 2) during the COVID-19 pandemic. Patients with prior psychiatric diagnoses and those with prior use of psychotropic medications were excluded. The outcomes of interest were new prescriptions within 90 days of outpatient evaluation. Propensity score matching was performed using logistic regression to build cohorts of equal size. RESULTS: A total of 1,612,283 adolescents pre-COVID-19 and 1,008,161 adolescents presenting during the COVID-19 pandemic for outpatient evaluations were identified. After propensity matching, a total of 1,005,408 adolescents were included in each cohort each with an average age of 14.7 ± 2.84 and 52% female and 48% male. Prescribing of antipsychotics and benzodiazepines were more frequent during the pandemic for adolescents (RR: 1.58, 95% CI 1.01-2.2). However, they were less likely to receive antidepressants (Risk Ratio (RR): 0.6, 95% Confidence Interval (CI) 0.57-0.63), anxiolytics (RR: 0.78, 95% CI 0.75-0.81), stimulants (RR: 0.26, 95% CI 0.25-0.27), as well as mood stabilizers (RR: 0.44, 95% CI 0.39-0.49). Erectile dysfunction requiring oral PDE5i in this cohort was more frequent during the pandemic for adolescents (RR: 1.53, 95% CI 1.05-2.01). CONCLUSIONS: The rates of antipsychotic and benzodiazepine prescriptions increased during the COVID-19 global pandemic compared to preceding years. This coincided with a statistically significant increase in the prescription of PDE5i for erectile dysfunction. Adolescents may face an increased risk of sexual dysfunction as both their illness and the medications they are prescribed both have a positive association with sexual dysfunction. Clinicians must be cognizant of the fact that adolescents may face an increased risk of medication related sexual dysfunction. Source of Funding: NIH health grant RO1 DK130991 and Clinician Scientist Development Grant from the American Cancer Society to RR © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e627 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joshua White More articles by this author Marco Rivero More articles by this author Jesse Ory More articles by this author Ranjith Ramasamy More articles by this author Expand All Advertisement PDF downloadLoading ...

Abstract A027: Evaluation of psychotropic medication usage patterns in patients with pancreatic cancer by race/ethnicity

Abstract Background: Pancreatic cancer (PC) has been associated with detrimental impacts on psychological wellbeing. Reported PC-related depression and anxiety rates are higher than in other types of cancer. A substantial component to improve psychological well-being in patients with PC is the use of drug therapy to provide symptomatic relief. The presence of racial disparities in the utilization of psychotropic medication has been reported in some cancer types. However, despite these known racial disparities and the increased psychiatric symptoms in patients with PC, there has not been an evaluation of racial disparities in psychotropic medication use among patients with PC. The purpose of this study was to describe usage patterns of psychotropic medications by race among patients diagnosed with PC. Methods: Utilizing the National Cancer Institute Surveillance Epidemiology and End Results (NCI SEER)- Medicare linked database, our analysis included all patients with a PC diagnosis and an active outpatient prescription claim for psychotropic medications from 2009-2018. Prescription claims were specific to patients diagnosed with PC and stratified by self-identified race/ethnicity. Patients who were on psychotropic medications before PC diagnosis, or unspecified race/ethnicity were excluded from the analysis. Psychotropic pharmacological agents consisted of anxiolytics, antidepressants, and anti-delirium/antipsychotic medications. Results: 71,700 participants were included in the analysis. Racial/ethnic participant breakdown included 80% White, 12% African American/Black, 4.5% Asian/Pacific Islander, 3% Hispanic, and 0.25% Native American. Results are presented as an unadjusted relative risk (RR) and 95% Confidence Interval (CI). As compared to White patients, African American/Black (RR 0.60; 95% CI 0.57-0.64), Asian/Pacific Islander (RR 0.52; 95% CI 0.48-0.58), and Hispanic (RR 0.61; 95% CI 0.55-0.67) patients had lower utilization of anxiolytics. For antidepressant medications, African American/Black (RR 0.74; 95% CI 0.71-0.77), Asian/Pacific Islander (RR 0.61; 95% CI 0.58-0.66), and Hispanic (RR 0.87; 95% CI 0.82-0.92) patients had less utilization compared to White patients. For anti-delirium/antipsychotic agents, African American/Black (RR 1.09; 95% CI 1.01-1.17) had a higher risk of utilization while Asian/Pacific Islander (RR 0.83; 95% CI 0.73-0.95) had less utilization when compared to White patients. No other differences were noted in psychotropic medication use by race/ethnicity. Conclusion: The study showed that utilization patterns of psychotropic agents in patients with PC varied by race/ethnicity. Racial/ethnic minorities had lower utilization rates for most of the drug classes except anti-delirium/antipsychotic agents in which African American/Black had higher utilization rates when compared to White patients. Further research needs to be carried out to examine social and clinical factors causing this phenomenon. Citation Format: MegCholack Awunti, Yi Guo, Sherise Rogers, Lisa Scarton, Diana Wilkie, John Allen. Evaluation of psychotropic medication usage patterns in patients with pancreatic cancer by race/ethnicity [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A027.

Individuals with Bipolar Disorder Have a Higher Level of Homocysteine Than Major Depressive Disorder: A Retrospective Chart Review and Observational Study.

Previous studies suggest that homocysteine (Hcy) may be involved in the pathogenesis of bipolar disorder (BD) and major depressive disorder (MDD) by influencing glutamatergic transmission, inflammation, and other mechanisms. There are no established biomarkers to distinguish BD from MDD. This study aims to compare Hcy levels between BD and MDD. We collected medical records of patients aged 14-75 admitted to the hospital from January 1 to July 1, 2022 with a discharge diagnosis of MDD or BD, including all examinations of patients at admission (acute phase) and discharge (non-acute phase). We measured Hcy levels in healthy controls (HC). The analysis included 104 patients with MDD, 103 patients with BD, and 80 HC. Hcy levels were higher in the MDD and BD group than in the HC group and higher in the BD group than in the MDD group, both in the acute and non-acute phases (all P < 0.05). There was no significant difference in Hcy levels between the psychotropic medication users and non-users in the BD or MDD group (all P > 0.05). Multivariate logistic regression analysis only for the MDD and BD group indicated that the likelihood of BD diagnosis was significantly associated with Hcy levels (in the acute phase: OR = 1.052, P = 0.016; in the non-acute phase: OR = 1.101, P < 0.001) after controlling for gender, age, and metabolic indicators. Our study suggests that Hcy levels were elevated in MDD and BD patients and were higher in BD patients than in MDD patients, which provides evidence for a possible relationship between one-carbon metabolism and the pathogenesis of BD. Besides, Hcy may be one of the potential biomarkers to distinguish BD from MDD.

Psychotropic Medication Usage in Individuals with Fetal Alcohol Spectrum Disorders (FASD) and Psychiatric Co-morbidities in Canada

Background and objective Individuals with Fetal Alcohol Spectrum Disorder (FASD) tend to be prescribed a high number of psycho-tropic medications to treat high rates of comorbid psychiatric disorders. A lack of guidance regarding best practices for prescribing psychotropic medications to individuals with FASD probably accounts for this reliance on polypharmacy. The objective of this study is to describe the types of medications prescribed to individuals with prenatal alcohol exposure, comparing rates between individuals diagnosed with FASD and individuals without FASD as well as how medications are prescribed based on age, sex, and comorbid psychiatric disorders. Material and methods Data were drawn from Canada's national FASD database. This database includes information collected during an FASD assessment related to diagnostic outcomes, secondary challenges, and medical and mental health information. Descriptive statistics were calculated for four diagnostic groups (FASD with sentinel facial features [FASD + SFF], FASD without sentinel facial features [FASD - SFF], at risk for FASD [“at risk”], and no FASD). Group demographics were compared using Chi-Square, Fisher's Exact Test, and ANOVA, as appropriate. Differences in the proportion of individuals between these four diagnostic groups were calculated using each of the following six classes of psychotropic medications—antipsychotics, antidepressants/anxiolytic, anticonvulsants/mood stabilizers, stimulants, melatonin, and others—using ANOVA. Considering just the individuals with FASD by combining the FASD + SFF and FASD - SFF groups, independent sample tests were used to compare differences in the proportion of males and females prescribed different medications. Chi-Square and Fisher's Exact Test were used to compare the proportion of individuals using psychotropic medications, according to category, within the FASD group based on the presence or absence of 13 comorbid psychiatric disorders. Results The overall sample included 2349 participants (mean value = 18.1 years, SD = 10.3). The sample included 1453 participants with an FASD diagnosis (n = 218, FASD + SFF, mean = 23.7 years, SD = 15.8, and n = 1235, FASD - SFF, mean = 19.5 years, SD = 10.0 years) and 896 participants who were assessed but did not receive an FASD diagnosis (n = 653, no FASD, mean = 16.1 years and n = 261, “at risk” for FASD, mean = 12.2 years). The FASD groups had a significantly higher rates of anxiety disorders, depressive disorders, and the presence of at least one comorbid psychiatric disorder compared to the no FASD and the “at risk” groups. Both FASD groups had a higher proportion of individuals taking antipsychotic and antidepressant/anxiolytic medications compared to the no FASD and “at risk” groups. Females with FASD were more often prescribed antidepressants/anxiolytics compared to males with FASD, while males with FASD were more often prescribed stimulants than females with FASD. The prevalence of antidepressants/anxiolytics, stimulants, and melatonin use by individuals with FASD differed across the lifespan. The prevalence of the prescription of six medication categories was found to differ according to psychiatric disorder. Conclusion Compared to individuals assessed as not fulfilling criteria for FASD, those with FASD had higher rates of psychiatric disorders and were prescribed significantly more antidepressants/anxiolytics and antipsychotics. The class and rate of prescriptions may support efforts in devising treatment guidelines for a complex disorder with known high comorbidity such as FASD.

Interaction of background genetic risk, psychotropic medications, and primary angle closure glaucoma in the UK Biobank.

Background/AimsPsychotropic medications have been reported as a risk factor for angle closure disease. However, the interaction between background genetic risk for primary angle closure glaucoma (PACG) and susceptibility to angle closure disease among psychotropic medication users has not been investigated. Here we demonstrate the utility of a genome-wide polygenic risk score (PRS) in identifying and risk-stratifying subjects with PACG and investigate the association between PACG genetic burden and exposure to psychotropic medications on prevalent angle closure.MethodsThis analysis used the UK Biobank dataset, a prospective cohort study of 502,506 UK residents. We constructed a PACG PRS for participants using genome-wide association study summary statistics from a multiethnic meta-analysis using the Lassosum method.ResultsAmong the 441,054 participants, 959 (0.22%) were identified as PACG cases. Individuals with PACG had higher PRS compared to those without PACG (0.24±1.03 SD vs. 0.00±1.00 SD, p<0.001) and PACG prevalence increased with each decile of higher PRS. Among individuals using psychotropic medication, those with PACG had higher average PRS (0.31±1.00 SD vs. 0.00±1.00 SD, p<0.001) and were more likely to have a PRS in upper deciles of polygenic risk (p = 0.04). At each decile of PRS, psychotropic medication use was associated with increased risk of PACG. These effects were more pronounced and significant in higher deciles.ConclusionWe demonstrate the utility of a PRS for identifying individuals at higher risk of PACG. Additionally, we demonstrate an important relationship where the association between psychotropic medications use and PACG diagnosis varies across the polygenic risk spectrum.

Effect of comprehensive, individualized, person‐centered management (CI‐PCM) on psychotropic medication usage in advanced Alzheimer’s persons in a 28‐week randomized controlled trial

AbstractBackgroundBehavioral and Psychological Symptoms of Dementia (BPSD) are burdensome and disturbing for caregivers and persons living with Alzheimer’s disease (AD). They are also a primary cause of institutionalization of Alzheimer’s persons. Physicians use psychotropic medications to treat the BPSD of AD. Many of these medications have deleterious consequences as evidenced in part by their black box warnings. We published results of a 28‐week, clinician‐blind, randomized, controlled trial of our CI‐PCM program in moderate‐to‐severe, community‐residing, Alzheimer’s persons receiving memantine (Reisberg…Kenowsky, Dement Geriatr Cogn Disord, 2017). The BPSD were examined using the Behavioral Pathology in Alzheimer’s Disease‐Frequency Weighted severity scale, which showed significant benefit in the CI‐PCM subject group at week 28 (p&lt;0.05).MethodsWe examined the magnitude of usage of psychotropic medications used to treat BSPD in subjects from our 2017 study who were randomized to receive Usual Community Care (UCC) or the CI‐PCM Program. Psychotropic medications used to treat other conditions were excluded. Subjects were evaluated at baseline and weeks 4, 12 and 28. We examined the ratio of daily psychotropic medication usage in the two groups. Psychotropic medications were compared by examining the percent of the maximum daily dosage of each medication taken cumulatively throughout each study observation period from week 4 to week 28. The Wilcoxon rank sum test was used to analyze the difference between the two groups.ResultsAt baseline, the group randomized to UCC consumed significantly more psychotropic medication than subjects randomized to the CIPCM program (p&lt;0.05). Because there was a significant difference between groups at baseline, we analyzed usage in comparison with baseline (see figure 1). The UCC subjects used more psychotropic medication on a per day average relative to baseline from week 4 to week 28 than the CI‐PCM subjects (p&lt;0.01). The total amount of psychotropic medication taken, in comparison with baseline, was significantly lower in CI‐PCM subjects from weeks 4 to 28 (p&lt;0.0001).ConclusionsCI‐PCM subjects took significantly less psychotropic medication and their BPSD symptomatology significantly improved. The CI‐PCM program is a safe, highly efficacious nonpharmacologic intervention that significantly reduces both BPSD symptomatology and psychotropic medication usage in advanced AD persons.

Reasons why Prescribers Decrease Psychotropic Medication for Foster Youth

Although prescribers frequently use psychotropic medication to treat emotional and behavioral problems for children in foster care, and states are required to monitor psychotropic medication usage with foster youth, few studies have evaluated the extent to which prescribers decrease psychotropic medication. We developed a system to track medication decreases for foster youth to ascertain why deprescriptions occurred. Researchers reviewed case files for 223 children and adolescents in a child welfare system who had received services via a state-funded project from October 2016 through January 2021. We found 99 individuals who had (a) prescriptions for one or more psychotropic medications at intake and (b) received both behavioral and medication review services. Results show only 32 (32%) of individuals in this sample experienced a deprescription of psychotropic medication while receiving services from the project. Analyses for these 32 individuals revealed four key findings. First, the most frequently deprescribed medications were stimulants and antipsychotics. Second, the most common reasons for decreasing any psychotropic medication were (a) medication advocacy and (b) adverse side effects. Notably, only foster youth aged 12 years or younger experienced medication reductions due to adverse side effects. Third, stimulants and antipsychotics accounted for the highest percentage of undesirable side effects. Fourth, practitioners deprescribed stimulants and antipsychotics for adverse side effects two times more often than for behavior or symptom improvement. These findings may contribute to the development of deprescribing guidelines for children in state welfare systems.

Initiating the process of providing behavioral services to foster children in inpatient facilities

AbstractThe Child and Family Services Improvement and Innovation Act (2011) mandated states to monitor psychotropic medication usage in foster care systems. In response to that legislation, the Deputy Director of the Alabama Department of Human Resources developed the Alabama Psychiatric Medication Review Team (APMRT). To date, our team has engaged in actions to target relevant personnel in foster care systems including caseworkers, foster parents, biological parents, and prescribers of psychotropic medication. One component of APMRT services involves tracking psychotropic medication prescriptions in Alabama foster care through our state Medicaid base. This process led the APMRT to include residential facilities as a target for services. What follows is a detailed account of the steps the APMRT initiated within a specific inpatient residential facility to improve (a) behavior tracking systems and (b) staff members' implementation of general behavior interventions.

Medicinal cannabis in children and adolescents with autism spectrum disorder: A scoping review.

Autism spectrum disorder (ASD) is a neurodevelopmental condition estimated to affect 1 in 66 children in Canada and 1 in 270 individuals worldwide. As effective therapies for the management of ASD core and associated symptoms are limited, parents are increasingly turning to clinicians for advice regarding the use of medicinal cannabis to manage behavioural disturbances. The objective of this scoping review was to identify and map symptoms, outcomes and adverse events related to medicinal cannabis treatment for ASD-related behaviours. Ovid MEDLINE, Embase, CINAHL, PsycInfo, Web of Science Core Collection, Google Scholar and grey literature sources were searched up to 5 January 2020 for studies. Included studies met the following criteria: (1) investigate the use of medicinal cannabis, (2) at least 50% participants had ASD, (3) at least 50% of the study population was 0-18 years old and (4) any study design (published or unpublished). We identified eight completed and five ongoing studies meeting the inclusion criteria. All studies reported substantial behaviour and symptom improvement on medicinal cannabis, with 61% to 93% of subjects showing benefit. In the three studies reporting on concomitant psychotropic medication usage and with cannabis use, up to 80% of participants observed a reduction in concurrent medication use. Adverse events related to cannabis use were reported in up to 27% of participants related, and two participants had psychotic events. Early reports regarding medicinal cannabis in paediatric ASD symptom management are presented as positive; the evidence, however, is limited to very few retrospective cohort and observational studies. Evidence of safety and efficacy from prospective clinical trials is needed.

Psychotropic medication use among patients with a traumatic brain injury treated in the intensive care unit: a multi-centre observational study

BackgroundPsychiatric sequelae after traumatic brain injury (TBI) are common and may impede recovery. We aimed to assess the occurrence and risk factors of post-injury psychotropic medication use in intensive care unit (ICU)-treated patients with TBI and its association with late mortality.MethodsWe conducted a retrospective multi-centre observational study using the Finnish Intensive Care Consortium database. We included adult TBI patients admitted in four university hospital ICUs during 2003–2013 that were alive at 1 year after injury. Patients were followed-up until end of 2016. We obtained data regarding psychotropic medication use through the national drug reimbursement database. We used multivariable logistic regression models to assess the association between TBI severity, treatment-related variables and the odds of psychotropic medication use and its association with late all-cause mortality (more than 1 year after TBI).ResultsOf 3061 patients, 2305 (75%) were alive at 1 year. Of these, 400 (17%) became new psychotropic medication users. The most common medication types were antidepressants (61%), antipsychotics (35%) and anxiolytics (26%). A higher Glasgow Coma Scale (GCS) score was associated with lower odds (OR 0.93, 95% CI 0.90–0.96) and a diffuse injury with midline shift was associated with higher odds (OR 3.4, 95% CI 1.3–9.0) of new psychotropic medication use. After adjusting for injury severity, new psychotropic medication use was associated with increased odds of late mortality (OR 1.19, 95% CI 1.19–2.17, median follow-up time 6.4 years).ConclusionsPsychotropic medication use is common in TBI survivors. Higher TBI severity is associated with increased odds of psychotropic medication use. New use of psychotropic medications after TBI was associated with increased odds of late mortality. Our results highlight the need for early identification of potential psychiatric sequelae and psychiatric evaluation in TBI survivors.

Evaluation of the frequency and predictive factors of psychotropic drugs consumption among students of the university of pharmacy of monastir

IntroductionPsychotropic medications are widely used in Tunisia. Studies about frequency of substance use are rareObjectivesThe purpose of this work is to determine frequency of use of psychotropic medication among pharmacy students in Monastir University during their university years and during the last year and to assess the factors associated to this consumptionMethodsA retrospective study was used to collect the information about 145 participants using a questionnaire asking about the consumption of psychotropic medications and the factors associated to substance useResults145 subjects aged 22.71 years +/- 2.04 among them 25% was men and 75 % women. Psychotropic medication use was 20 % during university years and 17.24 % during the last year. 45 % of the users had their medications without a prescription from a doctor. 17 % of the users of psychotropic medication weren’t informed about the effects of the drugs. A higher consumption of psychotropic drugs was observed among older individuals (p=0.009; F=6.928), redoubling individuals (p=0.003), with conflictive relationships with family (p=0.001), using others psychotropic substances, feeling often nervous (p=0.003; F=9.318) and with personal history of mental illness (p=0.002).ConclusionsOur finding underlines the need of larger more comprehensive surveys to determine the efficiency of the prevention strategies and to minimize the consumption of psychotropic drugs or to control it.Keyworddependence Risk factors drugs students

Pattern of usage of psychotropic agents in geriatric patients in a teritiary care hospital

Psychotropic medications are used in the treatment of chronic psychotic disorders like anxiety, depression, insomnia, bipolar disorders, cognitive impairment, seizure, loss of consciousness, altered sensorium, delirium etc. The objective of this study is to describe the pattern of use of psychotropic medications in patients presenting to geriatrics department, to compare the pattern of usage of psychotropic medication at the time of admission versus at the time of discharge and to find out the dose optimization pattern in elderly patients. Observational retrospective study, conducted in the department of geriatrics. The sample size calculated for the study was 35. The study was carried out through AHIS and by reviewing case files. The data were collected on specially designed data collection forms. Consumption of the psychotropic drugs was the highest within 71-80 years of age group, of which 49.15% of patients fall in this age group. All of the patients prescribed with psychotropic medications had insomnia (26.70%), followed by anxiety (20.30%), seizure (20.30%) and depression (16.90%). Among the 2nd generation anti psychotropics, quetiapine was the most frequently prescribed drug (54.24%). Benzodiazepines were the preferred antidepressants (36%) followed by SSRIs. Sixty two percent of the patients continued the same dose prescribed from the outside hospital and a dose increment was done for 37.5% of the patients. The incidence of usage of psychotropic medications were found to be more with females. Atypical antipsychotic drugs were the most commonly used ones. Current evidence shows no superiority for atypical antipsychotics over haloperidol.

Psychotropic medication utilisation in adult cancer patients in China: A cross-sectional study based on national health insurance database

BackgroundPsychotropic medications are useful to treat psychiatric disorders which are frequently underdiagnosed and undertreated in cancer patients. Evidence on utilisation of psychotropic medications in cancer patients was absent in China. This study aimed to analyse the prevalence and the potential predictors of psychotropic medication use in adult cancer patients in China. MethodsWe analysed cross-sectional data from the China Health Insurance Association database in 2015–2017, which contained health care utilisation information for a national representative sample of basic medical insurance beneficiaries. Cancer patients aged above 18 were identified by International Classification of Disease 10th revision code C00–C97. Psychotropic medications were defined following the Anatomical Therapeutic Chemical codes: antipsychotics (N05A), anxiolytics (N05B), hypnotics and sedatives (N05C), and antidepressants (N06A, N06CA). We calculated the prevalence of psychotropic medication use in cancer patients, and applied multivariable logistic regression to identify its potential predictors. FindingsA total of 260,364 adults with cancer were identified in the database, of which 48,111 (18•5%) were prescribed at least one psychotropic medication comprising antipsychotics (3763, 1•4%), anxiolytics (15,902, 6•1%), hypnotics and sedatives (37,040, 14•2%), and antidepressants (2379, 0•9%). Patients with solid tumours had higher prevalence of psychotropic medication use than patients with lymphoid and hematopoietic malignancies (e.g. female genital organs, adjusted odds ratio (OR)=2•25, 95%CI=2•09–2•44). The prevalence of psychotropic medication use in cancer patients in the Eastern region was significantly higher than those of cancer patients in the Western regions (OR=2•33, 95%CI=2•27–2•40). Compared with the Urban Rural Resident Basic Medical Insurance beneficiaries, cancer patients covered by the Urban Employee Basic Medical Insurance were more likely to use psychotropic medications (OR=1•18, 95%CI=1•15–1•20). Midazolam was the most frequently used psychotropic (21,728, 45•2%), and flupentixol–melitracen was the most commonly used antidepressant (1176, 2•4%) among all psychotropic medication users in the sample. InterpretationThe prevalence of psychotropic medication use in Chinese adult cancer patients was inequitable. Further attention will be needed to be paid to the mental health of cancer patients in China. FundingNo funding.

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 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.&#x0D; Materials &amp; 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.&#x0D; 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%).&#x0D; 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&#x0D; Keywords: Psychotropics, prescription pattern, psychiatric emergency, Nigeria.&#x0D; French title: L'utilisation de médicaments psychotropes pour les urgences psychiatriques dans un tertiaire centre de soins de santé au Nigéria&#x0D; 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.&#x0D; 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.