Use Of Psycholeptics Research Articles

Risk of accidents and unintentional injuries in men and women with attention deficit hyperactivity disorder across the adult lifespan.

Attention deficit hyperactivity disorder (ADHD) is associated with risk-taking behavior, leading to accidents and unintentional injuries (summarized here as incidents). Main aim of this study is to determine if men and women with and without ADHD differ in the risk of mild (treated outpatient) and severe (treated inpatient) incidents across the adult lifespan (age groups: 18-29; 30-59, and ≥60 years). Secondary aim: investigate the role of comorbid mental disorders and drugs for the treatment of these comorbidities, and ADHD-medication. Using anonymized German claims data (N=4,575,027), adults with ADHD diagnosis during 2016-2019 (N=17,041) were compared with a 1:4 age and sex-matched group without ADHD diagnosis. Regression analyses statistically tested group differences. Incidents occur in a U-shaped form across the adult lifespan. Individuals with ADHD show the same pattern but at a substantially increased risk of both mild and severe incidents throughout the lifespan. Women without ADHD are at lower risk in young adulthood than men but at higher risk in older adulthood. Women with ADHD show the same pattern for severe incidents, but for mild incidents they have the highest risk throughout the lifespan. Co-occurring anxiety disorder and the use of psycholeptics and ADHD-medication decreased the incident risk. We extend available knowledge which has hitherto focused on young adult males and traffic accidents. ADHD is associated with increased incidents across the adult lifespan, with distinct patterns regarding age, sex, and incident severity. An accurate diagnosis of ADHD in adulthood provides the first step towards prevention of accidents and unintentional injuries.

Associations of physical performance and physical activity with mental well-being in middle-aged women

BackgroundTo investigate whether physical performance is independently of physical activity (PA) associated with positive and negative dimensions of mental well-being in middle-aged women.MethodsData were drawn from the Estrogenic Regulation of Muscle Apoptosis (ERMA) study in which women 47 to 55 years were randomly selected from the Finnish National Registry. They (n = 909) participated in measurements of physical performance (handgrip force, knee extension force, vertical jumping height, maximal walking speed, and six-minute walking distance). Both mental well-being (the Centre for Epidemiologic Studies Depression Scale, the International Positive and Negative Affect Schedule Short Form and the Satisfaction with Life Scale) and PA were self-reported. Associations between variables were analysed using multivariate linear regression modelling adjusted for body height, fat mass %, menopausal status and symptoms, marital status, parity, employment status, self-reported mental disorders, and use of psycholeptics and psychoanaleptics. PA was then entered into a separate model to explore its role in the associations.ResultsIn the adjusted models, significant positive associations of six-minute walking distance with positive affectivity (B = 0.12, p = 0.002) and life satisfaction (B = 0.15, p = 0.033) were observed. No significant associations were observed between physical performance and depressive symptoms or negative affectivity. PA was positively associated with positive affectivity and life satisfaction and negatively with depressive symptoms across all the physical performance variables.ConclusionsOf the physical performance dimensions, aerobic component was associated with positive mental well-being independently of PA level. In relation to other physical performance components, the results point to the benefits of physical activity for mental well-being.

Initiation of Psycholeptic Medication During Hospitalization With Recommendation for Discontinuation After Discharge

ObjectivesPsycholeptic drugs have been used in the older population for years, especially to control delirium and neuropsychiatric symptoms (NPS) of dementia. However, data from the literature confirm that the prolonged use of psycholeptics may be responsible for adverse reactions in older patients. The aim of this study was (1) to identify how many patients receive the first prescription of a psycholeptic drug during the hospital stay; (2) to evaluate the main sociodemographic and clinical characteristics of these patients; and (3) to verify if the prescribed psycholeptic drugs are continued after 3 months from the hospital discharge. DesignOur retrospective study was based on data from the REPOSI (REgistro POliterapie SIMI) registry, a cohort of older patients hospitalized in internal medicine and geriatric wards throughout Italy from 2010 to 2018. Setting and ParticipantsPatients aged 65 years or older who were not on home therapy with psycholeptic drugs were considered in the analyses. MethodsWe did both univariate and multivariate analyses in order to find the variables associated independently to an increased risk for first psycholeptic prescription at hospital discharge. ResultsAt hospital discharge, 193 patients (5.8%) out of a total sample of 3322 patients were prescribed at least 1 psycholeptic drug. Cognitive impairment was the main risk factor for the introduction of psycholeptic drugs at discharge. Among them, 89.1% were still on therapy with a psycholeptic drug after 3 months from the hospital discharge. Conclusions and ImplicationsCognitive impairment represents the main risk factor for psycholeptic initiation in hospitalized older patients. The vast majority of these treatments are chronically continued after the discharge. Therefore, special attention is needed in prescribing psycholeptics at discharge, because their prolonged use may lead to cognitive decline. Moreover, their continued use should be questioned by physicians providing post-acute care, and deprescribing should be considered.

The role of physical activity in the link between menopausal status and mental well-being.

Objective:To examine the relationship between menopausal status and mental well-being, and whether this relationship varies as a function of physical activity (PA).Methods:Based on a hormonal analysis and bleeding diary, women aged 47 to 55 were categorized as pre (n = 304), early peri (n = 198), late peri (n = 209), or postmenopausal (n = 387). Mental well-being was assessed using the Centre for Epidemiologic Studies Depression Scale, the International Positive and Negative Affect Schedule Short Form, and the Satisfaction with Life Scale. PA was self-reported and categorized as low, medium, and high. Associations between variables were analyzed using multivariate linear regression adjusted for age, marital and employment status, parity, self-reported mental disorder, use of psycholeptics and psychoanaleptics, and menopausal symptoms.Results:Depressive symptoms were lower amongst the pre than postmenopausal women (B = 0.07, confidence interval 0.01-0.13). Menopausal symptoms attenuated these associations. Menopausal status showed no associations with life satisfaction, or with positive or negative affectivity.Women with high PA scored higher on positive affectivity, and the pre, early peri, and postmenopausal women scored higher on life satisfaction (B = 0.79, P < 0.001; B = 0.63, P = 0.009; B = 0.42, P = 0.009, respectively) and scored lower on depressive symptoms (B = −0.13, P = 0.039; B = −0.18, P = 0.034; and B = −0.20, P < 0.001, respectively) than their low PA counterparts. The pre and postmenopausal women with medium PA scored higher on life satisfaction (B = 0.54, P = 0.001; B = 0.038, P = 0.004, respectively) than those with low PA.Conclusions:Postmenopausal women reported marginally higher depressive symptoms scores compared with premenopausal women, but menopause was not associated with positive mental well-being. However, this association varies with the level of PA.Video Summary:

Dispensing patterns of selective serotonin reuptake inhibitors before, during and after pregnancy: a 16-year population-based cohort study from the Netherlands

Management of mental illness in the perinatal period with antidepressants is controversial, since evidence emerged on potential harmful effects to the unborn child. However, over time, the dispensing of antidepressants in the perinatal period has increased. We examined perinatal dispensing patterns over time and the role of a recently issued guideline in this regard. We identified a 16-year cohort of 153,952 Dutch pregnancies with a delivery date between January 1999 and December 2014. Data included exposure to selective serotonin reuptake inhibitors (SSRIs) related to phases of pregnancy (preconception, pregnancy and delivery, post-delivery). The chi-square test for trends was used. With standard logistic regression, we explored the influence of patient characteristics on continuation of SSRIs during pregnancy. A persistent significant rise of dispensing rates in all phases was observed, with the largest increase during pregnancy (from 0.8% in 1999/2000 to 2.1% in 2013/2014, chi-square for trend = 141.735, p < 0.001). A substantial change of practice in terms of the SSRI used (less paroxetine) and the policy towards continuation into pregnancy (more continuation over time) was visible. Concomitant use of psycholeptics halved the probability of continuation of SSRIs (OR 0.50, 95%CI 0.43–0.55, p < 0.01). Dispensing rates of SSRIs steadily increased last 16 years, especially during pregnancy, caused by an increase in the proportion of women continuing their medication during pregnancy. In view of the demonstrated impact of uncertainty regarding effectiveness and safety of SSRIs in pregnancy, future research should involve more detailed outcome research of SSRIs as it is, and research into viable alternatives.

Psychiatric medication use before and after the onset of type 1 diabetes in children and adolescents: A population-based cohort study.

Several studies showed a bidirectional association between type 2 diabetes and psychiatric disorders in adults. Because there is limited information on the association between type 1 diabetes (T1D) and psychiatric disorders (including psychiatric medication use) in children and adolescents, we assessed frequency of use of these medications before and after the onset of T1D. A population-based cohort study was conducted in the Dutch PHARMO Record Linkage System (1999-2009). Children and adolescents (<19 years) with at least 2 insulin dispensings from community pharmacies (T1D cohort, N = 925) were matched by age and sex (reference cohort without insulin use, N = 3591). The 5-year prevalence of psychiatric medication use (psycholeptics [ATC N05] and psychoanaleptics [ATC N06]) before and after onset of T1D were estimated, compared, and stratified by age, sex, and medication subgroup. The mean age of study participants was 10.1 years and 51% were boys. The 5-year prevalence of psychiatric medication use before the index date was significantly higher in the T1D cohort than in the reference cohort (7.2% vs 4.7%, respectively; P = .002) with the same pattern after developing T1D (10.4% vs 7.9%, respectively; P = .015). In both cohorts, adolescents (15-19 years) and boys had higher prevalences of use. This increased prevalence of psychiatric medication use both before and after the index date in T1D cohort was mainly driven by an increased use of psycholeptics (predominantly anxiolytics). Children with T1D were more likely to use psychiatric medication in the years before and after the onset of T1D which was mainly driven by psycholeptic use.

Patient-Related Determinants of the Administration of Continuous Palliative Sedation in Hospices and Palliative Care Units: A Prospective, Multicenter, Observational Study

ContextKnowledge of determinants that are associated with the administration of continuous palliative sedation (CPS) helps physicians identify patients who are at risk of developing refractory symptoms, thereby enabling proactive care planning. ObjectivesThis study aims to explore which patient-related factors at admission are associated with receiving CPS later in the terminal phase of life. MethodsA prospective multicenter observational study was performed in six Dutch hospices and three nursing home–based palliative care units. The association between patient-related variables at admission (age, gender, diagnosis, use of opioids or psycholeptics, number of medications, Karnofsky Performance Status scale score, Edmonton Symptom Assessment System distress score, and Glasgow Coma Scale score) and the administration of CPS at the end of life was analyzed. ResultsA total of 467 patients died during the study period, of whom 130 received CPS. In univariate analysis, statistically significant differences were noted between the sedated and nonsedated patients with respect to younger age (P = 0.009), malignancy as a diagnosis (P = 0.05), higher Karnofsky Performance Status score (P = 0.03), the use of opioids (P < 0.001), the use of psycholeptics (P = 0.003), and higher Edmonton Symptom Assessment System distress score (P = 0.05). Multivariate logistic regression analysis showed that only the use of opioids at admission (odds ratio 1.90; 95% confidence interval 1.18–3.05) was significantly associated with the administration of CPS. ConclusionPhysicians should be aware that patients who use opioids at admission have an increased risk for the administration of CPS at the end of life. In this group of patients, a comprehensive personalized care plan starting at admission is mandatory to try to prevent the development of refractory symptoms. Further research is recommended, to identify other determinants of the administration of CPS and to investigate which early interventions will be effective to prevent the need for CPS in patients at high risk.

Prevalence of concomitant medications in older HIV+ patients and comparison with general population

Objective:The increasing population of human immunodeficiency virus (HIV)-infected elderly patients results in a higher number of comorbidities and greater incidence of polypharmacy in addition to antiretroviral therapy (ART). The aim of this study is to describe the use of concomitant medication in older HIV-infected patients and to compare it with older general population.Methods:The study included HIV-positive outpatients (>49 years) who received ART in 2011. Co-medication dispensed by pharmacies in that year was collected. Defined daily dose (DDD) for each drug was calculated by patient. A comparison was made between the use of co-medication among men between 50 and 64 years old in general population against the HIV-infected population.Results:The study was based on 118 patients (77% men), of which 82% took at least one co-medication and 58% at least five. The commonest co-medications used by HIV-positive patients were antibiotics (44%); analgesics (44%); anti-inflammatories (39%); antacids (38%); and psycholeptics (38%). The medicines used for the greatest number of days per HIV-positive patient were those related to the renin–angiotensin system; anti-diabetics; lipid modifying agents; antithrombotics; and calcium channel blockers. In comparison with the general male population, a higher proportion of HIV-infected patients used antibiotics (42 vs 30%, P = 0.018), antiepileptics (16 vs 5%, P = 0.000), psycholeptics (35 vs 17%, P = 0.000) and COPD medications (14 vs 7%, P = 0.008). The duration of antibiotics and psycholeptic use in HIV-infected patients was longer compared to the general population (P < 0.05).Conclusions:Older HIV-positive patients frequently take a higher number of co-medication, which increases the risk of adverse events, interactions with other medication, and may lead to poorer treatment adherence.

Characteristics of psycholeptic and psychoanaleptic medicine use in general population in Subotica for the period 2009/2012

Introduction: Mood disorders are of great medical, social and economic importance. These diseases are considered one of the greatest public health problems, because they affect significantly the quality of life of the patients and their everyday functioning. According to research, the risk factors of these diseases include demographic factors. Regional disparities in the rate of morbidity and mortality have been observed in Serbia. Objective: The aim of this study is the analyze of financial and quantitative parameters of use of psycholeptics and psyhoanaleptics during the period 2009-2012 prescribed and recollected at a pharmacy in Subotica in comparison to the consumption of these drugs in the Republic of Serbia. Methods: The survey was conducted in the City of Subotica, and included data on issued prescription drugs at the pharmacy Subotica, during the period 2009-2012. The methodology that was used was ATC / DDD. Results: The trend of using psycholeptics for the reference period, expressed in DDD / 1000 inhabitants / day was negative in the Republic and in Subotica. According to the Pharmacy Subotica, the trend that was observed showed that the group consumption of drugs was uneven, which was the highest value recorded in 2009 (95.75), then it suddenly dropped (2012 / 48.32). Oscillations were present at the level of Serbia, with the proviso that after the fall of 2009 (119.77) in 2010 (77.26), the values in the coming years were to grow, and the maximum was recorded in 2012 (104.51). The correlation coefficient was 0.4947. The structure was dominated by the use of anxiolytics. Psyhoanaleptics consumption in Serbia was the highest in 2012, when it was recorded that the value for DDD / 1000 inhabitants / day was 31.42, and 12.27 in Subotica. The correlation coefficient of use of psyhoanaleptics in Serbia and Subotica was 0.884. The structure of the use of psyhoanaleptics, antidepressants in Serbia as well as in Subotica represents a subgroup with the highest share in the intensity of use. Conclusion: The use of psycholeptics and psyhoanaleptics in Subotica and Serbia was not most directly correlated. It can be assumed that the difference was caused by the differences in the demographics, health treatments and prescribing habits, inheritance and other factors.

Pattern of Medication Use Among Older Inpatients in Seven Hospitals in Italy: Results from the Criteria to Assess Appropriate Medication Use Among Elderly Complex Patients (CRIME) Project

Prescribing pharmacological treatment for hospitalized older patients represents a challenge for physicians. In particular, hospitalized older adults present with acute and chronic diseases, which may require multiple treatments and increase their susceptibility to adverse drug reactions. Patterns of drugs use have rarely been investigated in these patients. To describe patterns of drugs use among hospitalized older adults participating in the CRiteria to assess Appropriate Medication use among Elderly complex patients (CRIME) project. We performed a cross-sectional multicentre study based on data from the CRIME project, a study performed in geriatric and internal medicine acute care wards of 7 Italian hospitals. The only two exclusion criteria were: age < 65 years old and unwillingness to participate in the study. Participants were assessed at hospital admission and followed until discharge. Mean (Standard Deviation) age of 1123 participants was 81.5 (7.4) years, with 629 (56%) being women and 572 participants (51%) were admitted from Emergency Room. Mean length of stay was 11.2 (6.7) days. Mean number of drugs used greatly varied before (6.2, SD 3.2), during (10.6, SD 5.6) and after (7.1, SD 3.1) hospitalization. No difference in the number of drugs used during hospital stay was observed across age groups. During hospital stay, drugs for acid related disorders (77.9%) and antithrombotic agents (76.8%) were the most commonly used drugs, followed by drugs acting on the renin-angiotensin system (58.0%) and diuretics (57.1%). Very common was the use of psycholeptics (34.3%) and psychoanaleptics (22.4%). Use of multiple drug treatments is common in hospitalized older adults and hospitalization is associated with a substantial increment in the number of drugs used, with no differences across age groups.

Mild hyponatremia as a risk factor for fractures: The rotterdam study

Recent studies suggest that mild hyponatremia is associated with fractures, but prospective studies are lacking. We studied whether hyponatremia is associated with fractures, falls, and/or bone mineral density (BMD). A total of 5208 elderly subjects with serum sodium assessed at baseline were included from the prospective population-based Rotterdam Study. The following data were analyzed: BMD, vertebral fractures (mean follow-up 6.4 years), nonvertebral fractures (7.4 years), recent falls, comorbidity, medication, and mortality. Hyponatremia was detected in 399 subjects (7.7%, 133.4 ± 2.0 mmol/L). Subjects with hyponatremia were older (73.5 ± 10.3 years versus 70.0 ± 9.0 years, p < .001), had more recent falls (23.8% versus 16.4%, p < .01), higher type 2 diabetes mellitus prevalence (22.2% versus 10.3%, p < .001), and more often used diuretics (31.1% versus 15.0%, p < .001). Hyponatremia was not associated with lower BMD but was associated with increased risk of incident nonvertebral fractures [hazard ratio (HR) =1.39, 95% confidence interval (CI) 1.11-1.73, p = .004] after adjustment for age, sex, and body mass index. Further adjustments for disability index, use of diuretics, use of psycholeptics, recent falls, and diabetes did not modify results. In the fully adjusted model, subjects with hyponatremia also had increased risk of vertebral fractures at baseline [odds ratio (OR) = 1.78, 95% CI 1.04-3.06, p = .037] but not at follow-up. Finally, all-cause mortality was higher in subjects with hyponatremia (HR = 1.21, 95% CI 1.03-1.43, p = .022). It is concluded that mild hyponatremia in the elderly is associated with an increased risk of vertebral fractures and incident nonvertebral fractures but not with BMD. Increased fracture risk in hyponatremia also was independent of recent falls, pointing toward a possible effect on bone quality.

Psycholeptic use in aged care homes in Tasmania, Australia

Although non-drug techniques are recommended to manage sleep disturbance, anxiety and challenging behaviours associated with dementia, several studies in Australia and overseas have noted a high use of psycholeptics (anxiolytics/hypnotics and antipsychotics) in aged care homes to treat these conditions. The aim of this study was to examine the current pattern of psycholeptic use in Tasmanian aged care homes and compare this data with other Australasian research. Cross-sectional study of residents' psycholeptic use from 40 aged care homes throughout Tasmania during November 2005-January 2007. Two thousand three hundred and eighty-nine residents were included in the study. Of the residents, over half were taking at least one psycholeptic medication regularly; over one-fifth of residents were taking antipsychotics (21%) and 43% were taking anxiolytics/hypnotics. In comparison with other recent Australasian studies, the current level of benzodiazepine use in Tasmanian aged care homes is of major concern, at approximately three times that reported in Sydney and New Zealand. There is also substantial use of multiple psycholeptic agents. Interventions to reduce benzodiazepine use and improve psycholeptic utilization in Tasmania need to be developed urgently. The results demonstrate the value of regular auditing of prescribing to highlight problem areas in prescribing.