Psychotropic Use Research Articles

Psychotropic usage by patients presenting to an academic eating disorders program.

To assess psychotropic use patterns and possible associations with age, eating disorder diagnosis and psychiatric comorbidity in adolescents and young adults with a primary eating disorder. A retrospective chart review of 86 consecutive patients with a primary eating disorder from August 2012 to December 2014 was conducted. Patients presented for a multidisciplinary evaluation at a United States-based academic program for eating disorders. Nearly half (45.3%) of the patients reported being on a psychotropic medication. Antidepressants were the most reported category, prescribed in 38.4% of the patients evaluated. There was a significant association between the type of eating disorder and the number of psychotropics prescribed. Patients with a diagnosis of other specified feeding or eating disorder reported more prescriptions upon presentation than patients with anorexia nervosa. Despite the finding that a significant minority of patients had a psychiatric comorbidity, this did not appear to increase the likelihood of psychotropic usage over those diagnosed with an eating disorder alone. In addition, patients with a longer duration of illness and patients with a history of non-suicidal self-injury were more likely to present to treatment on psychotropic medications. Psychotropic medications appear to be commonly prescribed among individuals evaluated in a tertiary care center for an eating disorder. Given that psychotropics are not recommended as the primary intervention for eating disorders, the frequency may be indicative of practitioners not following research-informed practice guidelines. The differences observed may also reflect complexities related to clinical features or illness history. Level V: Descriptive study.

The limited impact of psychiatric disease and psychotropic medication on the outcome of hospitalization for pneumonia.

Psychotropic medicine has been suggested to be a risk factor for the onset of pneumonia, especially aspiration pneumonia. However, the impact of coexisting psychiatric disease and psychotropic medication on the outcomes of pneumonia patients in the respiratory care unit setting is less well-known. We conducted a single-centre retrospective study of 209 consecutive patients who were hospitalized due to pneumonia. Using the patients' records, coexisting psychiatric diseases and the use of psychotropic medicines were reviewed to examine their association with the clinical course of inpatients with pneumonia. Psychotropic medicines, including agents for insomnia, were used in 73 (34.9%) patients, and there were 35 (16.9%) patients who had psychiatric disease. Among the 12 (5.7%) fatal cases, 4 patients were treated with psychotropic medicines, all of which were agents for insomnia. However, the rate of psychotropic medicine usage in the fatal cases (33.3%) was equivalent to that of the survivors (35%, p=0.905), and the coexistence of psychiatric disease did not affect survival. The median duration of hospitalization was 15 days. The duration of hospitalization of the patients who received psychotropic medicines (median: 17 [range: 7-89] days) was also equivalent to that of the other patients (14 [2-55] days, p=0.081). While the present study was a single-centre study and had a small population, coexisting psychiatric disease and psychotropic medicine use did not have a strong impact on the outcomes of pneumonia patients who were hospitalized in the respiratory unit of a university hospital. Further prospective studies targeting a larger cohort are needed.

Chronic use of psychotropic medications in breastfeeding women: Is it safe?

BackgroundCurrent knowledge regarding chronic use of psychotropic medications during breastfeeding is limited. The objective of this study was to evaluate the long-term effects of psychotropic monotherapy use during lactation on the breastfed infant.Materials and methodsIn this prospective study, we followed 280 infants whose mothers contacted the Drug Consultation Center (DCC) at Assaf Harofeh Medical Center between January 2011 and December 2015, seeking information regarding the chronic use of psychotropic medications during lactation. This group was compared with a group of 152 callers, who inquired evidence regarding the use of antibiotics compatible with breastfeeding. Information on adverse effects, physical measures and gross motor developmental milestone achievements of the breastfed infants was obtained during a follow-up telephone interview. At follow up, the median age of the infants in the Psychotropic-drug group was 20 (11–33) months versus 36 (20–48) months in the Antibiotic group (p < 0.001). The outcomes were compared between the groups followed by a propensity score matching to control for difference in baseline characteristics.ResultsAt follow-up, no significant differences between infants in the two groups were observed with regard to height, weight, head circumference and weight-length ratio percentile (p = 0.339, p = 0.223, p = 0.738, p = 0.926, respectively). Children in both groups were, according to their parents, within the normal developmental range for all milestones, according to the Denver Developmental Scale. Use of psychotropic medications during breastfeeding was not significantly associated with adverse reactions. After propensity score matching (n = 120 pairs) to control for differences in baseline characteristics and the length of lactation, only one significant difference was reported, sleepiness in infants in the study group (7/120) and none in the comparison group (p = 0.008).ConclusionsChronic use of psychotropic monotherapy during lactation is associated with normal growth and gross motor developmental as by milestone achievements reported by parents. Sleepiness was reported, it seemed self-limited with no developmental effect.

Does the death of a child influence parental use of psychotropic medication? A follow-up register study from Finland.

BackgroundSeveral studies have found that the loss of a child is associated with psychiatric health problems, yet few studies examined whether child loss influences psychotropic medication use. This study examined short- and long-term use of psychotropic medication, both before and after the death of a child, and its potential effect modifiers.Methodology/Principal findingsA random sample of 205,456 parents, including 902 bereaved parents, were selected from a Finnish total population registry. The analyses were based on linear regressions using generalised estimation equations (GEE) and adjusted for sociodemographic factors. Annual psychotropic use was defined as having purchased prescribed psychotropic medication between 1996 and2012. Bereaved parents were followed for four years prior to and up to four years after the death of their child. An increase in the use of antidepressants and anxiolytics was found in parents following their loss. The highest percentage of use was found around one year after bereavement, followed by a steady decrease although this remained higher than the level of use among non-bereaved four years after the death. Between 20–25% of bereaved mothers and 10–15% of bereaved fathers used antidepressants or anxiolytics one year after bereavement while the corresponding number in non-bereaved was 5–10%. An increase in psychotropic medication was also found several years before the disease-related loss of a child.Conclusions/SignificanceThe use of psychotropic medication is markedly higher among parents after losing a child. Patterns of use leading up to and following the death of a child should be further examined in relation to clinical risk factors so as to identify at risk populations.Medical subject headingsBereavement, child death, psychotropic medication, death, child, register, Finland

Bipolar disorder, comorbid anxiety disorders, gynecomastia and dental pain: case analysis with literature review.

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The assessment of serum lipid profiles of children with attention deficit hyperactivity disorder

Attention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent psychiatric disorders in children and the pathophysiology remains obscure. Some studies show that lipid imbalances are associated with ADHD etiology. We studied the association of serum total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglyceride (TG) levels in ADHD. We examined 88 children aged 8–12 years who were diagnosed with ADHD and 88 healthy children. The exclusion criteria were as follows: obesity, any psychotropic use in the last 3 months, presence of a chronic disease and/or malignancy, history of medically treated lipid metabolism disease in family members, intelligence quotient (IQ) < 70, and comorbidities, with the exception of oppositional defiant disorder. The sample was evaluated using a semi-structured clinical assessment interview and Conners' rating scales. Despite controlling for age, sex, and body mass index (BMI) variables, the total cholesterol and LDL levels were significantly higher in the ADHD group than the levels of healthy controls, whereas the TG and HDL cholesterol levels were similar among groups. Conners' rating scales, reflecting symptom severity, and total cholesterol, TG, HDL, and LDL levels of the ADHD group were not correlated. The study results support the difference in serum lipid and lipoprotein profiles of children with ADHD compared with healthy controls. This difference is thought to be related with changes in oxidant/antioxidant balance states in ADHD.

Does a history of psychoactive substances abuse play a role in the level of pain of the patient with severe trauma?

ObjectiveTo analyse the influence of psychotropic substance use on the level of pain in patients with severe trauma. DesignLongitudinal analytical study. ScopeIntensive Care Unit (ICU) of Trauma and Emergencies. PatientsSevere trauma, non-communicative and mechanical ventilation >48h. Two groups of patients were created: users and non-users of psychotropic substances according to medical records. InterventionsMeasurement of pain level at baseline and during mobilisation, using the Pain Indicator Behaviour Scale. VariablesDemographic characteristics, pain score, sedation level and type and dose of analgesia and sedation. ResultsSample of 84 patients, 42 in each group. The pain level in both groups, during mobilisation, showed significant differences p=0.011, with a mean of 3.11 (2.40) for the user group and 1.83 (2.14) for the non-user group. A relative risk of 2.5 CI (1014–6163) was found to have moderate/severe pain in the user group compared to the non-user group. The mean dose of analgesia and continuous sedation was significantly higher in the user group: p=.032 and p=.004 respectively. There was no difference in bolus dose of analgesia and sedation with p=.624 and p=.690 respectively. ConclusionsPatients with a history of consumption of psychoactive substances show higher levels of pain and experience a higher risk of this being moderate/severe compared to non-users despite receiving higher doses of analgesia and sedation infusion. Key words: pain, multiple trauma, drug users.

Association of the Centers for Medicare & Medicaid Services’ National Partnership to Improve Dementia Care With the Use of Antipsychotics and Other Psychotropics in Long-term Care in the United States From 2009 to 2014

ImportanceThe Centers for Medicare & Medicaid Services’ National Partnership to Improve Dementia Care in Nursing Homes (hereafter referred to as the partnership) was established to improve the quality of care for patients with dementia, measured by the rate of antipsychotic prescribing.ObjectiveTo determine the association of the partnership with trends in prescribing of antipsychotic and other psychotropic medication among older adults in long-term care.Design, Setting, and ParticipantsThis interrupted time-series analysis of a 20% Medicare sample from January 1, 2009, to December 31, 2014, was conducted among 637 426 fee-for-service Medicare beneficiaries in long-term care with Part D coverage. Data analysis was conducted from May 1, 2017, to January 9, 2018.Main Outcomes and MeasuresQuarterly prevalence of use of antipsychotic and nonantipsychotic psychotropic medications (antidepressants, mood stabilizers [eg, valproic acid and carbamazepine], benzodiazepines, and other anxiolytics or sedative-hypnotics).ResultsAmong the 637 426 individuals in the study (446 538 women and 190 888 men; mean [SD] age at entering nursing home, 79.3 [12.1] years), psychotropic use was declining before initiation of the partnership with the exception of mood stabilizers. In the first quarter of 2009, a total of 31 056 of 145 841 patients (21.3%) were prescribed antipsychotics, which declined at a quarterly rate of –0.53% (95% CI, –0.63% to –0.44%; P < .001) until the start of the partnership. At that point, the quarterly rate of decline decreased to –0.29% (95% CI, –0.39% to –0.20%; P < .001), a postpartnership slowing of 0.24% per quarter (95% CI, 0.09%-0.39%; P = .003). The use of mood stabilizers was growing before initiation of the partnership and then accelerated after initiation of the partnership (rate, 0.22%; 95% CI, 0.18%-0.25%; P < .001; rate change, 0.14%; 95% CI, 0.10%-0.18%; P < .001), reaching 71 492 of 355 716 patients (20.1%) by the final quarter of 2014. Antidepressants were the most commonly prescribed medication overall: in the beginning of 2009, a total of 75 841 of 145 841 patients (52.0%) were prescribed antidepressants. As with antipsychotics, antidepressant use declined both before and after initiation of the partnership, but the decrease slowed (rate change, 0.34%; 95% CI, 0.18%-0.50%; P < .001). Findings were similar when limited to patients with dementia.Conclusions and RelevancePrescribing of psychotropic medications to patients in long-term care has declined, although the partnership did not accelerate this decrease. However, the use of mood stabilizers, possibly as a substitute for antipsychotics, increased and accelerated after initiation of the partnership in both long-term care residents overall and in those with dementia. Measuring use of antipsychotics alone may be an inadequate proxy for quality of care and may have contributed to a shift in prescribing to alternative medications with a poorer risk-benefit balance.

More action needed: Psychotropic prescribing in Australian residential aged care.

For at least two decades, concerns have been raised about inappropriate psychotropic prescribing in Australian residential aged care facilities, due to their modest therapeutic benefit and increased risk of falls and mortality. To date, the majority of prevalence data has been collected in Sydney exclusively and it is not known if recent initiatives to promote appropriate psychotropic prescribing have impacted utilisation. Thus, we aimed to comprehensively analyse psychotropic use in a large national sample of residential aged care facility residents. A cross-sectional, retrospective cohort study of residents from 150 residential aged care facilities distributed nationally during April 2014-October 2015. Antipsychotic, anxiolytic/hypnotic and antidepressant utilisation was assessed, along with anticonvulsant and anti-dementia drug use. Negative binomial regression analysis was used to examine variation in psychotropic use. Full psychotropic prescribing data was available from 11,368 residents. Nearly two-thirds (61%) were taking psychotropic agents regularly, with over 41% prescribed antidepressants, 22% antipsychotics and 22% of residents taking benzodiazepines. Over 30% and 11% were charted for 'prn' (as required) benzodiazepines and antipsychotics, respectively. More than 16% of the residents were taking sedating antidepressants, predominantly mirtazapine. South Australian residents were more likely to be taking benzodiazepines ( p < 0.05) and residents from New South Wales/Australian Capital Territory less likely to be taking them ( p < 0.01), after adjustment for rurality and size of residential aged care facility. Residents located in New South Wales/Australian Capital Territory were also significantly less likely to take antidepressants ( p < 0.01), as were residents from outer regional residential aged care facilities ( p < 0.01). Antipsychotic use was not associated with State, rurality or residential aged care facility size. Regular antipsychotic use appears to have decreased in residential aged care facilities but benzodiazepine prevalence is higher, particularly in South Australian residential aged care facilities. Sedating antidepressant and 'prn' psychotropic prescribing is widespread. Effective interventions to reduce the continued reliance on psychotropic management, in conjunction with active promotion of non-pharmacological strategies, are urgently required.

Differential prevalence and demographic and clinical correlates of antidepressant use in American bipolar I versus bipolar II disorder patients

AimsAntidepressant use is controversial in bipolar disorder (BD) due to questionable efficacy/psychiatric tolerability. We assessed demographic/clinical characteristics of baseline antidepressant use in BD patients. MethodsPrevalence and correlates of baseline antidepressant use in 503 BD I and BD II outpatients referred to the Stanford Bipolar Clinic during 2000–2011 were assessed with the Systematic Treatment Enhancement Program for BD (STEP-BD) Affective Disorders Evaluation. ResultsAntidepressant use was 39.0%, overall, and was higher in BD II versus BD I (46.9% versus 30.5%, p = 0.0002). Both BD I and BD II antidepressant compared to non-antidepressant users had higher rates of complex pharmacotherapy (≥ 4 mood stabilizers, antipsychotics, and/or antidepressants) and use of other psychotropics. Antidepressant use in BD II versus BD I was higher during euthymia (44.0% vs. 28.0%) and subsyndromal symptoms (56.1% vs. 28.6%), but not depression or mood elevation. LimitationsAmerican tertiary BD clinic referral sample receiving open naturalistic treatment. ConclusionsIn our sample, antidepressant use was higher in BD II versus BD I patients, and was associated with markers of heightened illness severity in both BD I and BD II patients. Additional research is warranted to investigate these complex relationships.

Shaping the use of psychotropic medicines in nursing homes: A qualitative study on organisational culture

Psychotropic medicines have limited efficacy in the management of behavioural and psychological disturbances, yet they are commonly used in nursing homes. Organisational culture is an important consideration influencing use of psychotropic medicines. Schein's theory elucidates that organisational culture is underpinned by basic assumptions, which are the taken for granted beliefs driving organisational members' behaviour and practices. By exploring the basic assumptions of culture we are able to find explanations for why psychotropic medicines are prescribed contrary to standards. A qualitative study guided by Schein's theory was conducted using semi-structured interviews with 40 staff representing a broad range of roles from eight nursing homes. Findings from the study suggest two basic assumptions influenced the use of psychotropic medicines: locus of control and necessity for efficiency or comprehensiveness. Locus of control pertained to whether staff believed they could control decisions when facing negative work experiences. Necessity for efficiency or comprehensiveness concerned how much time and effort was spent on a given task. Participants' arrived at decisions to use psychotropic medicines that were inconsistent with ideal standards when they believed they were helpless to do the right thing by the resident and it was necessary to restrict time on a given task. Basic assumptions tended to provide the rationale for staff to use psychotropic medicines when it was not compatible with standards. Organisational culture is an important factor that should be addressed to optimise psychotropic medicine use.

Problem behaviours and psychotropic medication use in intellectual disability: a multinational cross-sectional survey.

Problem behaviours (PBs) are a common cause for clinician contact in people with disorders of intellectual development and may be a common cause for the prescription of psychotropic medication. We aimed to use a large, multinational sample to define the prevalence of PBs, the associations with psychotropic medication use, and to assess for any potential 'diagnostic overshadowing' by the label of PBs in a population of people with disorders of intellectual development. A multinational, multi-setting, cross-sectional service evaluation and baseline audit was completed. Data were collected from UK hospitals, UK community settings, Sri Lanka and Hong Kong. A semi-structured questionnaire was completed by treating clinicians, capturing demographic details, prevalence rates of intellectual disability and psychotropic medication use, alongside psychiatric co-morbidity. A sample size of 358 was obtained, with 65% of included participants treated in an inpatient setting. Psychotropic use was prevalent (90%) in our sample, particularly antipsychotics (74%). The prevalence of PB was high (83%). There was no statistically significant association between psychotropic prescription and recorded psychiatric co-morbidity, suggesting prevalent 'off-label' use for PBs, or poor recording of psychiatric co-morbidity. There was some evidence of possible diagnostic overshadowing due to the PB classification. A higher dose of psychotropic medication was associated with aggression toward others (P=0.03). We found evidence of prevalent potential 'off-label' use for psychotropic medication, which may be due to PBs. We also found evidence of potential diagnostic-overshadowing, where symptoms of psychiatric co-morbidity may have been attributed to PBs. Our findings provide renewed importance, across borders and health systems, for clinicians to consider a holistic approach to treating PBs, and attempting to best understand the precipitants and predisposing factors before psychotropic prescribing.

Association between bipolar disorder and subsequent traumatic brain injury in patients who received inpatient treatment

Mental disorders may confer a high risk of traumatic brain injury, but only rare studies have investigated mood disorders. This nationwide cohort study compared the risk of traumatic brain injury in patients with and without bipolar disorder. We compared 1017 patients with bipolar disorder who received inpatient treatment and 9080 compared patients. The annual incidence rate of traumatic brain injury was calculated as the number of new cases divided by the total number of person-years in the available records. The incidence of subsequent traumatic brain injury was significantly higher in the bipolar group than in control group. The adjusted hazard ratio for those with multiple hospitalizations was higher than the counterpart. Except for patients in the 50–59-year age group, those in all other age groups had higher risks of traumatic brain injury. Our findings reveal a higher risk of traumatic brain injury in patients with bipolar disorder. Patients with recurrent hospitalization and multiple psychotropic use had an increased risk of traumatic brain injury. Age may modify the risk of traumatic brain injury, with a higher risk in middle-aged patients.

Antidepressant-associated hyponatremia among the elderly: A retrospective study

Background: The use of antidepressants among elderly is associated with dreaded side effect of hyponatremia. However, there is limited information about specific risk factors associated with developing hyponatremia in elderly. Aim of the Study: The aim of this study was to evaluate the clinical risk factors for the development of hyponatremia among elderly patients started on antidepressant medications. Methodology: Using retrospective study design, patients who developed hyponatremia (n = 35) and those who did not develop hyponatremia (n = 43) with use of antidepressants, were matched on sociodemographic parameters and were compared for various parameters such as physical illness, other medications, and dose and type of antidepressant drug. Results: Higher proportion of those who developed hyponatremia had history of comorbid hypertension, were receiving antihypertensive agents, and were receiving 2 antihypoglycemic agents concomitantly. Majority of the patients who developed hyponatremia were receiving mirtazapine, followed by sertraline and venlafaxine. There was no association of hyponatremia with concomitant use of psychotropics, presence of other physical illnesses, comorbid dementia, and comorbid substance use. Conclusion: Antidepressant-associated hyponatremia is more commonly seen in patients with comorbid hypertension, those receiving any antihypertensive agent and those on more than one hypoglycemic agent.

¿Influyen los antecedentes de consumo de sustancias psicótropas en el nivel de dolor del paciente con traumatismo grave?

ObjectiveTo analyse the influence of psychotropic substance use on the level of pain in patients with severe trauma. DesignLongitudinal analytical study. ScopeIntensive Care Unit (ICU) of Trauma and Emergencies. Patientssevere trauma, non-communicative and mechanical ventilation >48hours. Two groups of patients were created: users and non-users of psychotropic substances according to medical records. InterventionsMeasurement of pain level at baseline and during mobilization, using the Pain Indicator Behaviour Scale. Variablesdemographic characteristics, pain score, sedation level and type and dose of analgesia and sedation. ResultsSample of 84 patients, 42 in each group. The pain level in both groups, during mobilisation, showed significant differences p=0.011, with a mean of 3.11(2.40) for the user group and 1.83(2.14) for the non-user group. A relative risk of 2.5 CI (1,014-6,163) was found to have moderate / severe pain in the user group compared to the non-user group. The mean dose of analgesia and continuous sedation was significantly higher in the user group: P=.032 and P=.004 respectively. There was no difference in bolus dose of analgesia and sedation with P=.624 and P=.690 respectively. ConclusionsPatients with a history of consumption of psychoactive substances show higher levels of pain and experience a higher risk of this being moderate/severe compared to non-users despite receiving higher doses of analgesia and sedation infusion. Key words: pain, multiple trauma, drug users.

Psychotropic Medications for Youth in Child Welfare: Developing and Pilot-Testing A Field Guide for Team Decision-Making

ABSTRACTHigh rates of children involved with the child welfare system are prescribed psychotropics. In response, federal legislation has mandated state child welfare agencies to develop policies to improve the coordination and oversight around the use of psychotropics. This project aimed to support such policies by developing and pilot-testing a field guide for team discussions and decision-making related to the use of psychotropics among youth in child welfare. We used a community-based participatory research (CBPR) framework to engage a team of local stakeholders, including former youth in foster care and parents, in the research. We developed a field guide to facilitate team discussions and decisions around the individual needs and preferences of youth and families, and we pilot-tested the field guide with child welfare staff, parents, and care team members in seven team meetings. Parents and care team members, in particular, highly valued the guide and found it useful to increase knowledge and improve practices such as side effect monitoring and information sharing. Child welfare responses were more mixed, and some reported feeling burdened by the additional tasks. More work is needed to integrate the guide into routine child welfare practice and reduce burden on staff.

Pour une clinique différentielle des psychoses et des usages du pharmakon. Les cas particuliers de la schizophrénie et de la mélancolie

AimsThis paper focuses on self-medication, drug addiction, and their ambivalent effects, justifying a return to the concept of the pharmacon. More specifically, it addresses the way in which schizophrenic or melancholic subjects use the pharmacon concept to cope with their respective issues. MethodsAfter placing psychotropic use in its cultural context, this research, in a psychoanalytic perspective, sets out to analyse the situations of schizophrenic or melancholic subjects at different stages in their psychotherapy, from the theoretical and clinical viewpoints. ResultsThe use of psychotropic medication enables schizophrenic subjects to replace paranoid delusion by the staging of fantasy, and enables melancholic subject to reactivate a latent bereavement process. In each instance, the involvement of the Other in the transfer process provides alternative solutions for their drives. DiscussionThe transgressional aspect of psychotropic drug use does not have the same function in schizophrenia, where the subject mostly lacks otherness, as in melancholia, where the subject mostly suffers from existential guilt. But in each instance it enables the subject to move on from a place where he seemed to be rooted, which modifies his relationship with the Other. ConclusionDrug addiction and self-medication produce ambivalent effects, as evidenced by the patient when he seeks therapy. Once the patient has been made aware of the underlying psychological impasse in which he finds himself, he will come to prefer recourse to language and the collective, rather than to action.

Psychological diagnostics of predisposition to addictive behaviour

Multidimensional manifestations of addictive behaviour complicate the possibility of its prevention. The purpose of our research is to determine the parameters diagnosing a person's predisposition to psychotropic substance use. We take as a point of departure the assumption that there are psychological peculiarities that are a kind of "weak link". Namely, these peculiarities determine the desire to change a person’s emotional state artificially. The experimental study of the parameters diagnosing predisposition to addictive behaviour has been performed by us for 15 years. Three groups with 90–100 adolescents in each were studied: well socially adapted adolescents – a "normative" group; socially maladapted adolescents who, however, did not use psychotropic substances; adolescents using psychotropic substances episodically. The study results show that the desire to use psychotropic substances is a symptom of a more general personal ill-being. Neutralization of negative personal formations prevents appearance of psychological readiness for psychotropic substance use.

Psychotropics, Environmental Temperature, and Hospital Outcomes in Older Medical Patients.

The authors investigated whether the use of psychotropics and environmental temperature on admission influence hospital length of stay (LOS) and mortality in older medical patients. Clinical and demographic characteristics, Charlson Comorbidity Index, use of psychotropic and nonpsychotropic drugs, hospital LOS, and mortality were retrospectively collected in medical patients 65 years and older (n = 382) admitted to a metropolitan teaching hospital during 5 consecutive heat waves (HWs) between 2007 and 2009. Patients admitted either before or after each HW, matched for HW period, age, and admission day of the week, served as controls (non-HW, n = 1339). Total number of psychotropic and nonpsychotropic drugs, Charlson Comorbidity Index, comorbidities, number of daily admissions, LOS, and mortality were similar in the HW and non-HW groups. After adjusting for clinical and demographic confounders, competing risks regression showed that psychotropic use, particularly antipsychotics, predicted increased LOS during non-HW (subdistribution hazard ratio: 95% CI, 0.82, 0.72-0.94; P = 0.003) but not HW (subdistribution hazard ratio: 95% CI, 0.89, 0.69-1.14; P = 0.36) periods. The effect of psychotropics on LOS during normal weather conditions was particularly evident in the old-old subgroup (difference [SE] in coefficients between non-HW and HW periods: -0.52 [0.25], P = 0.036 in patients >80 years; 0.11 [0.19], P = 0.54, in patients 65-80 years). By contrast, psychotropics did not predict hospital mortality during non-HW or HW periods. Psychotropic use on admission, particularly antipsychotics, predicted hospital LOS, but not mortality, in older medical patients, particularly those older than 80 years, during normal environmental temperature. However, there was no effect of psychotropics on LOS during extreme heat.

Psychotropic use and risk of stroke among patients with bipolar disorders: 10-year nationwide population based study

ObjectivesTo investigate the association between psychotropic agents (including antipsychotics, antidepressants and mood stabilizers) and risk of stroke among patients with bipolar disorders. MethodsWe conducted a disease risk score-matched nested case-control study and identified patients with bipolar disorders (ICD-9 codes: 296.0x, 296.1x, 296.4x, 296.5x, 296.6x, 296.7x, 296.80, 296.81 or 296.89) from the National Health Insurance Research Database in Taiwan. Among them, we identified 1232 cases (981 were ischemic stroke and 251 were hemorrhagic stroke) and 5314 disease risk score-matched controls. Conditional logistic regression model equations were applied to determine the effect of psychotropic agents on stroke risk among patients with bipolar disorders. ResultsThe results indicated that overall use of psychotropic agents was associated with an increased risk of stroke (adjusted odds ratio [AOR] = 1.82; 95% confidence interval [CI]: 1.56–2.13). When classifying psychotropic agents into antipsychotics, antidepressants and mood stabilizers, respectively, a significant positive association was found for users of antipsychotics (AOR = 1.98; 95% CI = 1.53–2.56), antidepressants (AOR = 1.44; 95% CI = 1.16–1.79), and mood stabilizers (AOR = 1.89; 95% CI = 1.22–2.93). Combined use of psychotropic agents was associated with higher risk of stroke than monotherapy (AOR = 2.62; 95% CI = 1.98–3.45). DiscussionsThe results support our hypothesis that psychotropic use is associated with increased risk of stroke among patients with bipolar disorders. The stroke risks are higher among patients with polypharmacy than those with monotherapy. These findings warrant further investigation to confirm and replicate the findings using different methodologies and populations, and to mitigate residual confounding.