Use Of Psychopharmacologic Agents Research Articles

PSYCHOLOGIC AND PSYCHIATRIC ASPECTS OF GASTROINTESTINAL DISEASE

There has been an explosion in understanding of the psychosocial concomitants of functional gastrointestinal disorders. Detecting psychologic disturbance and eliciting a history of physical or sexual abuse are critical in suggesting comprehensive and efficacious treatment strategies for these patients. The challenge is to define further the use of psychopharmacologic agents, including the newer antidepressants, anticonvulsants, and anxiolytic agents, in the treatment of chronic functional gastrointestinal disorders. Further research to evaluate the usefulness of various forms of psychotherapeutic and behavioral interventions needs to be undertaken. Establishing a multicomponent treatment program delivered by a team of caregivers, each bringing their unique skills (internist, psychiatrist, psychologist, and others) to patients, must be based on further research on the efficacy of these modalities as opposed to empiric treatment.

What determines severity among patients with painful functional bowel disorders?

OBJECTIVE: For patients with painful functional bowel disorders (FBD), physicians frequently make diagnostic and treatment decisions based on the severity of the pain reported; patients with severe painful complaints may receive extensive diagnostic tests and treatments. Therefore, it would be important to determine what clinical factors contribute to the judgment of severity among patients with FBD. The aim of this study was to identify the psychosocial, behavioral, and physiological (visceral sensitivity) factors that predicted severity in patients with moderate to severe FBD. METHODS: Two hundred eleven female patients with moderate or severe FBD, as determined by the Functional Bowel Disorder Severity Index, entered a multicenter treatment trial at the University of North Carolina and the University of Toronto. Patients filled out diary cards and were given questionnaires and physiological testing (rectal sensitivity using barostat). Analysis of covariance and logistic regression adjusting for demographic factors were performed to determine which factors distinguished patients at study entry with moderate from those with severe FBD. RESULTS: Patients with severe FBD were characterized by greater depression and psychological distress, poorer physical functioning and health-related quality of life, more maladaptive coping strategies, and greater health care utilization. There was a trend for patients with severe FBD to have lower rectal sensation thresholds. Regression analysis indicated that severity was best predicted by behavioral features: poorer daily physical function, difficulties related to eating, more phone calls to the physician, and more days in bed for GI symptoms. CONCLUSIONS: We conclude that patient illness behaviors are best correlated with severity in FBD. The use of psychopharmacological agents ( e.g., antidepressants) and psychological treatments to treat psychiatric comorbidity and to improve behavioral coping styles is recommended. Training to help medical physicians identify and respond to psychosocial and behavioral features of these conditions is likely to improve patient satisfaction with their care and the clinical outcome.

What determines severity among patients with painful functional bowel disorders?

For patients with painful functional bowel disorders (FBD), physicians frequently make diagnostic and treatment decisions based on the severity of the pain reported; patients with severe painful complaints may receive extensive diagnostic tests and treatments. Therefore, it would be important to determine what clinical factors contribute to the judgment of severity among patients with FBD. The aim of this study was to identify the psychosocial, behavioral, and physiological (visceral sensitivity) factors that predicted severity in patients with moderate to severe FBD. Two hundred eleven female patients with moderate or severe FBD, as determined by the Functional Bowel Disorder Severity Index, entered a multicenter treatment trial at the University of North Carolina and the University of Toronto. Patients filled out diary cards and were given questionnaires and physiological testing (rectal sensitivity using barostat). Analysis of covariance and logistic regression adjusting for demographic factors were performed to determine which factors distinguished patients at study entry with moderate from those with severe FBD. Patients with severe FBD were characterized by greater depression and psychological distress, poorer physical functioning and health-related quality of life, more maladaptive coping strategies, and greater health care utilization. There was a trend for patients with severe FBD to have lower rectal sensation thresholds. Regression analysis indicated that severity was best predicted by behavioral features: poorer daily physical function, difficulties related to eating, more phone calls to the physician, and more days in bed for GI symptoms. We conclude that patient illness behaviors are best correlated with severity in FBD. The use of psychopharmacological agents (e.g., antidepressants) and psychological treatments to treat psychiatric comorbidity and to improve behavioral coping styles is recommended. Training to help medical physicians identify and respond to psychosocial and behavioral features of these conditions is likely to improve patient satisfaction with their care and the clinical outcome.

Antidepressant Treatment and Neural Plasticity

The use of psychopharmacologic agents in children is complicated by several factors. One important neurobiologic consideration is the relationship of the effect of the medication to ongoing brain development. Although available data are inadequate to address this issue directly, a review of ancillary data suggests that there are theoretical reasons to exercise prudence in prescribing psychopharmacologic agents. For example, the effects of serotonin on neuronal plasticity suggest that agents that can alter serotonergic function may alter neuronal wiring. Although this can occur in any brain, it may be of particular importance in a developing nervous system. The consequences of these induced changes are not clear. Animal studies on the effect of long-term antidepressant administration in immature pups may begin to answer some of the clinical concerns of these observations.

Pediatric psychopharmacoepidemiology: an introduction.

The increased use of psychopharmacological agents in children and adolescents, the increased public debate about the possible adverse effects of these agents, and the growth of managed care have led to a burgeoning of interest in the pharmacoepidemiology of child psychiatric medications. This special issue of the Journal of Child and Adolescent Psychopharmacology reviews pharmacoepidemiology in child psychiatry. This introduction gives an overview of the articles that follow.

Psychodermatology: A practical manual for clinicians

Psychodermatology: A practical manual for clinicians

Attention-Deficit Hyperactivity Disorder: A Functional Approach to Assessment and Treatment

Although numerous terms have been used to describe Attention-Deficit Hyperactivity Disorder (ADHD) during the past several decades, it has continued to be conceptualized from a biological or neurological perspective. Consequently, much research has accumulated investigating possible biological and neurological causes, developing better diagnostic criteria, and accumulating medication protocols. Despite voluminous amounts of research, little consensus has been reached as to the best way to define and diagnose ADHD. Consequently, it becomes difficult to generate and test hypotheses related to the etiology, characteristics, and treatment of this disorder. One problem relates to how ADHD is conceptualized. In approaching ADHD as a psychiatric condition, assessment usually focuses on improving diagnostic precision. Similarly, most treatment research has dealt with the use of psychopharmacological agents, such as Ritalin. Yet, there are many ways to conceptualize “disorders.” We begin this article by suggesting that ADHD has become reified as a result of social and cultural factors. We present an alternative conceptualization based on a functional approach to the assessment and treatment of ADHD. Based on this functional approach, we present a model for classifying performance problems that can be used to guide the selection of appropriate intervention techniques.

Risk Factors for Injurious Falls Leading to Hospitalization or Death in a Cohort of 19,500 Adults

Falls are the most common cause of nonfatal injuries and a major cause of injury death. In order to identify risk factors for injuries from falls, 19,518 persons aged 20-92 years from four regions of Finland were examined and followed up from between 1973 and 1977 to 1984 for 8 to 11 years by identifying hospital admissions or deaths due to fall injuries. During 187,405 person-years, 628 injuries from falls were documented. The risk for injuries from falls was significantly and independently of other factors associated with alcohol intake in all age and sex groups. After adjustment for all the other risk determinants, the relative risks (RR) (95% confidence intervals (CI)) in persons with monthly ethanol intake of 100-499 g, 500-999 g, and > or = 1,000 g were 1.43 (1.13-1.82), 2.32 (1.71-3.17), and 3.05 (2.05-4.55), respectively, compared with abstainers. Body mass index (kg/m2) > or = 30 was associated with an increased risk among women aged < 45 years (RR = 2.8, 95% CI 1.28-5.89), whereas in persons aged > or = 65 years it seemed to be a protective factor both among men (RR = 0.3, 95% CI 0.06-1.19) and women (RR = 0.5, 95% CI 0.30-0.76). Also single marital status, smoking, heavy physical activity during leisure time, use of psychopharmacologic agents, diabetes mellitus, and cardiovascular diseases other than stroke were found to carry independent predictive significance in at least one subgroup of sex and age. In conclusion, alcohol consumption, relative weight, and use of psychopharmacologic agents were seen to be the most relevant risk determinants. Intervention trials based on the predictive factors and on high-risk groups are needed.

Psychopharmacologic Approach to Postpartum Depression

Postpartum depression (PPD), the most common of the serious postpartum psychiatric disorders, may occur in 10% of mothers. The duration is unknown, but some investigators suggest that PPD lasts 6–8 weeks. Efforts to identify a specific neuroendocrine or neurotransmitter system have been unsuccessful. There are insufficient data to relate PPD to the changes in hormonal status occurring after childbirth, although there is some evidence suggesting an increased incidence of PPD in women with marital conflict and in mothers who developed baby blues. The psychopharmacologic approach to patients with PPD is not based on research but on theoretic concepts. PPD is treated the same as depression occurring outside the postpartum period. Therefore, drug therapy should be aimed at patient-specific target symptoms of depression. Judicious use of psychopharmacologic agents should be employed in mothers who breastfeed, since both short-term and long-term effects of antidepressants on the infant are not fully understood.

Depression in Adolescents: Context, Manifestations, and Clinical Management

The phenomenon of adolescent depression combines depressive symptoms with adolescent developmental variables and contextual factors, such as family patterns, ethnic background, socioeconomic status, gender, biologic factors, and individual experience with personal loss. These developmental and contextual factors lead to specific adolescent manifestations of depression, such as academic problems, sexual activity, substance abuse, conduct disorders, pain, eating disorders, and the potential for suicide. Assessment of the depressed adolescent includes specific questions concerning these possible manifestations and problem behaviors. Thorough assessment always includes questioning about the possibility and lethality of suicidal ideation. Modes of treatment include counseling, various forms of individual and group psychotherapy, environmental manipulation, and use of psychopharmacologic agents. Follow-up care is essential for the prevention or early treatment of future depressive episodes. The ultimate goal of care of the depressed adolescent is to prevent suicide and to minimize disruption of the adolescent developmental process.

The Use of Psychopharmacological Agents in China: Historical and Current Perspectives

It has been known for centuries that certain preparations can affect human mental functioning. The fable that Shen Nung tested plants has been continually read with admiration by the people of our country for thousands of years. It describes, in simple and vivid language, how our ancestors made important discoveries in their active exploration of the possibility that certain edible vegetables and herbs might enhance the health of their descendants and the prosperity of the Chinese nation. It is said that this mythical Chinese emperor, Shen Nung, had a good knowledge of medicinal herbs and was the first to record that marijuana could be used as a drug. He described its hallucinogenic effect in Shen Nung s materia medica as follows: Marijuana ... if taken in excessive amounts, can cause hallucinations and madness. . This is the first written record of a hallucinogen in history. Thousand of years ago, sages in primitive communes often used the magical effect of hallucinogens to induce hallucinations and particular psychological changes for the purposes of prayer, fortune-telling, and treating diseases. The Introduction to medicine written by Li Ting in the Ming dynasty stated: Men become mad after too much drink and food, and Men become mad and hot-tempered after ingesting fragrant grass and stone medicine. The datura flower can induce a trance, for instance, and this had already been recorded in our medical literature. Moreover, the literature described and recorded the tranquilizing and analgesic effects of some drugs, how the ability to learn and memorize could be enhanced by medication, and so on. Reserpine and chlorpromazine were compounded and put to clinical use in the 1950s. They furthered the creation and development of modern psychopharmacological preparations and aroused great interest among psychiatrists, neuroscientists, and psychologists in our country. Many people recommended and reported, in relevant journals at home and abroad in the mid-1950s and early 1960s, on the introduction of, development of research on, and clinical use of psychopharmacological agents.

Psychopharmacology of the psychiatric disorders of childhood and adolescence

The literature on the psychopharmacology of child and adolescent psychiatric disorders is reviewed. The scanty epidemiological data suggest that psychotherapeutic drugs are utilized more widely than research findings would warrant, especially in preschool-age children. With the exception of hyperactivity, the disorders of childhood and adolescence for which the use of psychopharmacological agents is well-established are rare. This highlights the need for careful prescribing, in which the child's rights, problems with compliance and developmental and behavioural adverse effects are important considerations.

Psychotherapeutic management of obsessive-compulsive patients.

Psychotherapy of the obsessive-compulsive patient requires a modified psychoanalytic approach utilizing the concepts of a short-term therapy, which include focusing on relevant issues with limited goals. The therapist must be active, confronting, and must deal with here-and-now issues. The use of psychopharmacological agents to reduce anxiety and depression should be encouraged.

Handbook of Drug Therapy in Psychiatry

Jerrold G. Bernstein, a psychiatrist with broad experience in clinical psychopharmacology, has written a valuable book that presents comprehensive information on the use of psychopharmacological agents in the treatment of psychiatric disorders. The book begins with an elegant foreword written by Gerald L. Klerman, MD, an acknowledged inspirer of the author, who puts the subject in historical perspective. Dr Bernstein sees psychiatric disorders as being based on organic understanding of the dysfunctions of the nervous system. Without denying the role of psychological concepts and therapies, he unapologetically focuses on the biologic treatment of psychiatric disorders. Although the book is designed to provide basic scientific information about the mechanisms of action of various psychopharmacological agents, this is neither its emphasis nor its strength. Nevertheless, it presents reasonably up-to-date information, given the pace of this rapidly developing field. The greater strength of this volume lies with the discussion of the clinical application

Psychosocial Concomitants to Rehabilitation in Chronic Obstructive Pulmonary Disease: Part I. Psychosocial and Psychological Considerations

This is the first of a three-part series (to appear in consecutive issues) exploring the psychosocial and psychological concomitants of chronic obstructive pulmonary diseases (COPD), with emphasis on anxiety and depression. The reciprocal nature of dyspnea, anxiety and depression is clarified. Isolation, denial, and repression are the classic defenses of COPD patients and some, not all, patients can be aided by psychotherapy. This counseling many times may best be administered by the primary physician. If the patient requires additional long-term therapy, referral to a specialist is recommended. The following treatment modalities, in addition to basic medical therapy to facilitate respiration, also are discussed: breathing retraining, meditation, relaxation training, experimental use of biofeedback, behavior modification, goal setting, life-change monitoring, and education of patient and family in patient self-care. One section delineates the use of psychoactive medications, patient responses to various medications, and clearly identifies contraindications. For ease of assimilation the series is divided into three parts of equal importance. Part I is primarily concerned with a selected relevant literature summary, psychosocial evaluation of patients, general guidelines for treating psychosocial aspects of COPD, and patient/family education. Part II is concerned with various specific psychosocial and psychological treatment modalities for anxiety and depression, and their application to COPD patients. Part III concentrates on psychiatric disease that may coexist with COPD, and the use of psychopharmacologic agents in treatment of psychiatric disease. The three parts will enable the reader to identify areas of interaction between the primary physician, social workers, psychologists and psychiatrists in the treatment of the COPD patient with emotional difficulties.

Problems and practices in geriatric psychopharmacology

The author reviews special problems encountered in the use of psychopharmacologic agents for geriatric patients, including the presence of multiple medical conditions, use of multiple-drug regimens, altered physiologic responses, diagnostic problems, and noncompliance. In addition, he reviews the find ings of nine major surveys of prescription drug use conducted within the past decade as they apply to the use of psychotropics by the elderly.

Interdisciplinary differences on a general hospital psychiatry unit

A questionnaire was distributed to staff members of a 28-bed general hospital psychiatry unit to determine and compare staff perceptions of the value of psychotherapies and the role of the disciplines in conducting treatments. Marked interdisciplinary differences were reported in attitudes toward the use of psychopharmacologic agents, the importance of diagnostic evaluation, the value of psychotherapy in the treatment program, the role of various disciplines in the program, and the therapeutic community approach. Clinical implications of the magnitude of interdisciplinary differences are discussed, and recommendations are made for resolving intergroup conflict.

Practical Drug Evaluation Method

THE USE OF psychopharmacologic agents has assumed a prominent role in the treatment of patients with emotional disturbances. Published reports of well-controlled studies of these drugs are largely limited to psychiatric inpatients, with a noteworthy paucity of satisfactory studies of their use in outpatients. Among other factors, it has been so difficult to accumulate a sufficient population of suitable outpatients who will complete a study of more than one or two week's duration that satisfactory studies, with few exceptions, have been limited to very large clinics in metropolitan centers or to cumbersome difficult collaborative studies.1-3Nevertheless, the widespread use of psychoactive drugs in outpatient medical practice demands that continued efforts be made to develop methods for adequately controlled studies in diverse populations since simple clinical impressions have been notoriously unreliable in the past.4 In an effort to make possible early clinical evaluations

An evaluation of community nursing services in the care of the mentally ill

RAPID growth in the number of early discharges from mental hospitals made possible by the use of psychopharmacologic agents has led to an increasing interest in the effectiveness of community-based nursing care in the rehabilitation of the mentally ill. Recent studies of programs in Ohio and Georgia have been described,1'2 and an ambitious demonstration is now being launched in Montgomery County, Md., which will include an extension of nursing services rendered to mentally ill patients and their families. A research grant from the National Institute of Mental Health made it possible to undertake an evaluation of the effectiveness of the services rendered by the Instructive Visiting Nurse Association of Baltimore City (IVNA) to patients admitted to a state mental hospital and to their families. This paper is concerned with the purpose, study design, and the main results of the completed evaluation. Following an extensive review of its program, IVNA decided in 1957 to initiate a new mental hygiene nursing service based primarily on home visits and the counseling of members of families in which an adult had recendy been hospitalized in a state institution. The hypothesis entertained was that such visits and counseling would (1) reduce the total length of hospitalization required by the patient, (2) improve the capabilities of the family to interact with the patient so that he would attain a socially useful status, and (3) accelerate the patients return to his optimal prehospital status. Although the hypothesis was reasonable, a critical attitude seemed the order of the day in view of the pattern of enthusiasm, doubt, and disappointment which had accompanied many prior innovations in mental hygiene programs. The validity of the hypothesis would rest upon a demonstration that the nursing service significantly reduced the need for hospitalization during a specified study period (18 months), or improved the patient's capability to interact with members of the immediate family, or increased his capability to participate in the social and economic life of the community.

Amitriptyline Poisoning

In recent years there has been a marked increase in the introduction and use of psychopharmacological agents in clinical medicine. One of the newer drugs, amitriptyline hydrochloride (Elavil), 5-(3-dimethylaminopropylidene)-dibenzo [a,d] [1,4] cycloheptadiene hydrochloride, structurally and pharmacologically resembles imipramine (Tofranil), an antidepressant with anticholinergic, antihistaminic, and tranquilizing properties. 1,7 Both drugs have had favorable therapeutic results and have therefore experienced rapid, widespread clinical usage. 1-3 The two drugs differ pharmacologically from other psychotherapeutic compounds in that they are not monoamineoxidase inhibitors 4 (Figure). The purpose of this communication is (1) to present the symptoms and postmortem findings in an infant who died after the accidental ingestion of a massive amount of amitriptyline hydrochloride and also (2) to report the ineffectiveness of peritoneal dialysis in removing the ingested drug. Report of a Case A 15-month-old white female was admitted to the Stanford Medical Center Emergency Room in June 1961, approximately 45 minutes