Longitudinal prescribing patterns of psychotropic drugs in nursing home residents.

Changes in the use of psychotropic drugs in a large nursing home were examined both in terms of usage for the total facility and in longitudinal changes within individuals. Data for the nursing home showed a gradual increase in use of antidepressants; a decrease in use of antianxiety medications and of sedative-hypnotics. Changes in the number of residents prescribed antipsychotics were not marked. Data within residents showed a great variability in number of psychotropic drugs used, in number of changes in dosage, and in specific patterns of medication change. The first drug change after admission (excluding day of admission) was more likely to involve initiation rather than discontinuation of psychotropic drugs. The medications studied were used over 4–7 months on the average, covering 20–30% of the resident's nursing home stay. The findings suggest that there is continued monitoring of psychotropic medications in the nursing home. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The consumption of psychotropics in France and some european countries

The consumption in France of psychotropic drugs, of all classes, except for neuroleptics, is great, even very great, and largely superior to that observed in neighbouring European countries such as Germany, Spain, Italy and the United Kingdom. With regard to hypnotics and anxiolytics, 5 to 7 per cent of the French adult population consumes them regularly. The percentages rise with age, among females, and with the presence of unfavourable medical-social conditions. The consumption of this class of therapeutic drugs has remained stable for about ten years. The consumption of antidepressants regularly grows at a rate of about 5 per cent per year, essentially linked to the consumption of serotonin-recapture inhibitors and especially fluoxetine, currently prescribed by general practitioners in about 60 per cent of cases. The factors responsible for the strong French consumption of psychotropic drugs and the divergences with our European neighbours are complex, numerous, and poorly analysed for lack of valid comparative studies. Better prescribing practices require specific initial and continuous training to take into account the realities of everyday medical practice.     

Psychotropic drug consumption in France and several European countries

The consumption in France of psychotropic drugs, of all classes, except for neuroleptics, is great, even very great, and largely superior to that observed in neighbouring European countries such as Germany, Spain, Italy and the United Kingdom. With regard to hypnotics and anxiolytics, 5 to 7 per cent of the French adult population consumes them regularly. The percentages rise with age, among females, and with the presence of unfavourable medical-social conditions. The consumption of this class of therapeutic drugs has remained stable for about ten years. The consumption of antidepressants regularly grows at a rate of about 5 per cent per year, essentially linked to the consumption of serotonin-recapture inhibitors and especially fluoxetine, currently prescribed by general practitioners in about 60 per cent of cases. The factors responsible for the strong French consumption of psychotropic drugs and the divergences with our European neighbours are complex, numerous, and poorly analysed for lack of valid comparative studies. Better prescribing practices require specific initial and continuous training to take into account the realities of everyday medical practice.     

Psychotropic drugs and behavior

Behavioural modifications induced by psychotropic drugs results primarily from their pharmacological properties. According to classification of psychotropic drugs, sedative compounds contrast with psychostimulating medications. Behavioural effects of psychotropic drugs depend on dosing, subject's status (patient or healthy volunteer), acute or chronic administration, and environment. Some psychotropic compounds, particularly sedative drugs, decrease the level of mental alertness and cognitive functioning. But those deleterious effects tend to disappear during the course of a repeated administration. Some psychotropic drugs, especially benzodiazepines, induce a tolerance effect, eventually a psychic or a physiological dependence state evidenced by withdrawal reactions. Such similar dependence processes have been reported with other psychotropic drugs. Forensic problems have been attributed to some psychotropic compounds, like benzodiazepines: paradoxical aggressive reactions, psychomotor automatism; Psychotropic drugs usually can confer a positive effect on behaviour owing to their therapeutic action by the way of improving the illness and consequently the life of patients in the cases of depression, anxiety or schizophrenia.     

Polymedication and medication compliance in patients with chronic non-malignant pain

Most reports of polymedication among patients with chronic non-malignant pain have relied only on the patient's statements which have been proven to be unreliable regarding actual drug consumption. This study investigates the incidence of polymedication and medication compliance in these patients by applying objective methods. One-hundred-nine consecutive patients predominantly with facial, neuropathic or back pain were interviewed about present medication at first admission to the pain clinic. Reports were verified by toxicological urine screening, mainly with thin-layer chromatography (TLC) and gas chromatography-mass spectrometry (GC-MS) coupling. Follow-up investigations of 61 patients were conducted within 1 and 24 months after beginning therapy. Polymedication--here defined as daily intake of 3 or more preparations--was found in 41 patients (38%) in the initial investigation. In only 74 patients (68%) did the results of urine screening correspond with their reports: 23 patients (21%) concealed the consumption of drugs, and 2 patients (2%) did not take their medications. Ten cases were not interpretable. Fifty-four percent of the drugs concealed were psychotropic substances, mostly benzodiazepines, and 42% were analgesic combinations, partly with psychotropic additives. Drug intake was concealed significantly more often with polypharmacy which was occurring more frequently in patients with headache or facial pain, longer duration of pain, young age, psychiatric diagnosis and history of substance abuse. Patients with initial non-compliance were more likely to conceal drug consumption in follow-up investigations as well (P = 0.05). Therefore, screening for medication compliance in patients with chronic non-malignant pain is recommended, especially in those with the abovementioned risk factors.(ABSTRACT TRUNCATED AT 250 WORDS)     

Trends in registered psychiatric morbidity and forecasting psychotropic drug needs in Bulgarian hospitals

Registered psychiatric morbidity in Bulgaria as a whole and particularly in Plovdiv, the second largest region of the country, was assessed. Three aspects of psychotropic drug usage were analysed, namely, changes in registered psychotropic drugs, the prescribed daily dose (PDD) values for 2 years, and the preferred therapeutic schemes, and drug usage and needs in a psychiatric hospital with 365 beds. This was done by time series analysis for evaluation of psychiatric morbidity and drug consumption data, calculation of PDD for psychotropic medicines, and, based on a modification of the World Health Organization's morbidity method, assessment and prediction of drug use and needs in Plovdiv hospital. The results indicated that the registered morbidity had increased by 4% over the period 1989-93 to 2,427 psychiatric patients per 100,000 people. The increased consumption of especially benzodiazepines and sedative medicines was analyzed. Diazepam was prescribed the most often (91.1%), followed by levomepromazine (86.4%), haloperidol (82.7%), etc. Future drug consumption in Plovdiv hospital is expected to decrease because therapeutic practice in hospitals has been revised and improved on the basis of the World Health Organization's recommendations.     

Structural effect of association on protein molecules in partially folded intermediates

The local government of Regione Lombardia, Italy, recently (1994) funded a clinical and research project specifically devoted to dementia (Piano Alzheimer). A central role in this project has been reserved for the special care units (SCUs) for demented patients with behavioral disturbances. In order to evaluate their effectiveness, eight SCUs took part in this study. A specifically designed care program, focusing on environment and staff, was implemented in each SCU. Cognitive, functional, and somatic health status, and use of psychotropic drugs and of physical restraints were assessed at baseline, and after 3 and 6 months in 55 consecutively admitted patients. The data show an overall reduction in behavioral disturbances and a decreased use of psychotropic drugs and physical restraints.     

Sclerosing encapsulating peritonitis--a review

OBJECTIVE: To determine the pattern of use of psychotropic drugs in Sydney nursing homes. DESIGN: Survey of data from medical records of residents and interviews with residents and staff. SETTING: Central Sydney Health Area, June to December 1993. PARTICIPANTS: All residents of 46 of the 47 nursing homes in the western sector of the health area. MAIN OUTCOME MEASURES: Psychotropic drugs used regularly or as required. Degree of cognitive impairment and depression rated on interview with residents, using Mini-Mental State Examination and Geriatric Depression Scale. Behavioural disturbances reported by staff. RESULTS: Most residents (58.9%) were taking one or more psychotropic drugs regularly and another 7% were prescribed these drugs as required. Neuroleptics were taken regularly by 27.4% and as required by a further 1.4% (at least one dose in the previous four weeks), but doses were equivalent to more than 100 mg/day of chlorpromazine for only 8.8%. Neuroleptics were more likely to be given to residents with greater cognitive impairment and more disturbed behaviour. Other psychotropic drugs in regular use were: benzodiazepines (32.3%); hypnotics (26.6%); antidepressants (15.6%); and anxiolytics (8.6%). At least half of antidepressant doses were subtherapeutic. Of 874 residents who responded to a depression questionnaire, 30% scored as significantly depressed; one-third of these were taking antidepressants. CONCLUSIONS: The percentage of residents in Central Sydney nursing homes who were taking neuroleptics, hypnotics or anxiolytics is among the highest reported from geriatric institutions around the world. Prescribing practices in Australian nursing homes need to be reviewed.     

Insights into the mechanism of heterodimerization from the 1H-NMR solution structure of the c-Myc-Max heterodimeric leucine zipper

Drawing on data from a morbidity survey of sampled households in 25 small villages in Espirito Santo, Brazil, this article is concerned with reports of "nerves" (nervos) or nerve problems (problema de nervos). Reported cases of nervos (30 percent of all reports of illness) included a variety of symptoms: insomnia, body pains, dizziness, trembling, weakness, and emotional states ranging from feelings of sadness to anger. In one-third of the accounts, "overwork" was mentioned as the main cause, due both to its direct physical effect and to stress related to economic hardship and responsibility. In 88 percent of the cases, the afflicted person regularly used at least one psychotropic drug to relieve symptoms. Daily use of drugs occurred in 68 percent of the cases, and in 47 percent of cases people were reported as "dependent" on the drugs. The extensive use of psychotropic drugs suggests medicalization of nervos, creating a sick role for patients and keeping at an individual level the problems resulting in nervos.     

Abortion policy and practice in Greece

Despite its illegality until recently, abortion is estimated to have been responsible for almost half of the sharp postwar decline in the Greek birth rate. This article examines abortion as a part of a Greek contraceptive culture which has taken shape during the postwar period both in response, and in resistance to, a variety of macro- and micropolitical institutions and forces. During much of this period, pronatalist policies and discourses of both state and church combined to foreclose most medical contraceptive alternatives. In contrast, illegal abortion was a relatively safe, medicalized procedure widely practiced by doctors. Even after being legalized in 1980, female medical contraceptive methods continue to be rejected by the great majority of Greek women, and abortion and male methods of birth control remain the principal means of controlling fertility. The article focuses on the specific abortion practices and meanings of three generations of married women living in the city of Rhodes, capital of the Dodecanese Province of Greece's Eastern Aegean, and explores the ways in which they have been shaped by, and reflect, local cultural understandings of the body, health, sexuality, morality, motherhood and childhood, as well as micropolitical relations within the family.     

The role of stereochemistry and chiral pharmacology in psychotropic drug development.

The drug development process often involves the investigation of novel chemical compounds, some of which demonstrate alternative mechanisms of action that are distinct from the presently available agents. Another line of development focuses on exploring how established therapeutic agents can be enhanced or improved to produce a more robust therapeutic effect, a more rapid onset of action, or a more desirable side-effect profile. One strategy is based on advances in synthetic and analytical chemistry that have provided the tools to better characterize the stereochemical molecular arrangements of established drugs. Medicinal chemists and psychopharmacologsts are using these techniques to "purify" currently available drugs by isolating their constituent stereochemical forms and determining whether one of these forms may be predominantly responsible for favorable clinical effects. In this article, the authors review basic principles underlying this technology and discuss several psychotropic drugs that have been developed and recently brought to market using this approach. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychopharmacotherapy in pregnancy and breast feeding

The primary purpose of this article is to review critically the literature on the use of psychotropic medications in pregnancy and during breast feeding in order to suggest strategies for the clinical management of these periods. Use of psychotropic medications during pregnancy may cause three complications: 1. teratogenicity, 2. perinatal syndromes (neonatal toxicity), and 3. postnatal behavioural sequelae (behavioural toxicity). The literature features few well-controlled studies concerning these points, so that the available information allows only few conclusions. Exposure to certain psychotropic drugs in utero may increase the risk for some specific congenital anomalies; there is mostly no strong evidence for behavioural toxicity in children exposed to psychotropic medications. Use of psychotropic drugs during pregnancy and breast feeding may be appropriate in many clinical situations and should include thoughtful weighing of risk of pre- and postnatal exposure versus risk of relapse following drug discontinuation. The authors try to present disorder-based guidelines for psychotropic drug use during pregnancy and breast feeding and for psychiatrically ill women who wish to conceive.     

Management of somatisers in primary care: are family doctors motivated?

OBJECTIVE: The aim of this paper is to assess the attitudes of Spanish general practitioners towards somatisers and the degree of involvement that family doctors are ready to adopt in the care of these patients. METHOD: A postal questionnaire on attitudes was sent to a representative sample (n = 135) of general practitioners from two health districts of the region of Aragon. Seventy (51.8%) of them returned usable questionnaires. RESULTS: Most of the general practitioners were interested in the treatment of somatisers and considered that they should be treated at primary care level. However, when specific treatment tasks were proposed, they only accepted to act as a filter to specialised care and to care for patients with chronic functional syndromes. Additionally, they refuse to detect presenting somatisers, to prescribe psychotropic drugs or offer any psychological approach, and to avoid reinforcing abnormal illness behaviour in these patients and their families. These findings can be explained because the main emotions somatisers produce in doctors are frustration and anger. CONCLUSIONS: Family doctors need a lot more help, education and support in the management of somatisers, and psychiatrists need to provide it. Any management program for the treatment of somatisers in primary care should include methods to modify general practitioners' attitudes towards these patients.     

The Parkinson patient in expert social medicine assessment with special reference to the nursing care law

Approximately 15,0000 to 200,000 people in Germany suffer from Parkinson's disease. It is one of the most frequent neurological conditions and typical of advanced age. Effective therapy and prognostic predictions hinge on considerations of differential aetiology; comorbidity is frequent. Advanced disease calls for individually tailored management with and without drugs. Rehabilitative measures should be introduced at an early stage to maintain and improve patient's autonomy. Nursing in the home or in institutions takes over as the disease progresses and patients become immobile. Parkinsonian patients form a sizeable group within the population assessed for purposes of the Pflegeversicherung (German Nursing Care Insurance). This article analyses the care required by Parkinsonian patients as determined in individual home visits by the MDK Hessen (in 1995). Problems in evaluation arising from fluctuation of the disease are discussed.     

The health and welfare system for elderly in France

Dichotomy is the main characteristic of the Health and Welfare system in France. This system lies on two distinct fields, the medical field which is managed by the National Government, and the social field managed by the Local Government. The French home care policy for the elderly has developed a large number of services to assist in activities of daily living, to provide nursing and medical care at home, to improve living conditions, to maintain social relationships, and to postpone institutionalization and hospitalization, respectively. The main home care service is represented by "home helpers" who provide maid Notiniralics services. The second widely used service is the "home care service" performed by a team of nurses, assistant-nurses, psychologists, physiotherapists. This team provides nursing care and assistance in activities of daily living. As for institutions for the elderly, they are divided into welfare and medical institutions. The welfare institutions include social establishments like shelter homes and nursing homes. The medical institutions are mostly represented by long-term care hospitals. One of the main goals of the aging policy is to create medical wards in welfare institutions in response to the increased dependency of the institutionalized elderly. Recent experimental and innovative concepts have been established, such as "shelter homes for dependent elderly" for physically or cognitively impaired elderly.     

Tamoxifen activates cellular phospholipase C and D and elicits protein kinase C translocation

This epidemiological study focuses on cognitive change related to psychotropic drug use in a population-based sample of subjects aged 65 and over. Cognitive functioning was assessed in 1982 and 1988 by the Short Portable Mental Status by Pfeiffer, and cognitive decline was defined as an increase of more than 2 errors in 1988 relative to the 1982 assessment. Psychotropic drugs were classified into benzodiazepines and non-benzodiazepines. For both medications, four patterns of intake were considered: no use reported at both interviews, continuous use at both interviews, temporary use at the 1982 interview and new use at the 1988 interview. Depressive symptomatology was assessed by the Center for Epidemiologic Studies Depression Scale. The analysis was performed on 1200 subjects with no or minimal impairment at baseline for whom complete data were available. Univariate analyses showed cognitive decline associated with gender, level of education and new medical condition; it was also related to depressive symptomatology and psychotropic drug use. These two factors were the most strongly associated with decrease in performance in multivariate analyses. Cognitive decline differed according to class of psychotropic drugs and pattern of use: benzodiazepine temporary users exhibited a lower risk compared with never users (OR = 0.23, p = 0.056), non-benzodiazepine new users a higher risk (OR = 5.02, p < 0.001). Despite the simple measures of cognitive functioning and psychopathology, and the approximation in pattern of psychotropic drug use, these results emphasize the importance of considering psychotropic drugs in studies of cognitive decline in elderly subjects.     

Psychodynamic approach to the addictive personality structure specific for alcohol and hard drugs

The overconsumption of psychotropic substances is a major problem for contemporary societies. In the USA, 14.1% of the population between the age 15 and 54 have experienced addiction problems to alcohol during their lives while as 7.5% are addicted for life to other drugs (cannabis, cocaine, stimulants, etc). Many studies report that excessive consumption of alcohol, with or without illegal drug use, is associated to social conditions favoring the development of psychological distress and isolation. Although there are many studies on the differences between personality traits of alcoholics and drug users, few authors have examined the possibility to bring to the fore a specificity between the personality structures of the alcoholic and the drug user from a psychodynamic approach. This exploratory review of literature, first presents studies already conducted in order to identify common or distinct personality features for these types of addition. This article then reviews psychodynamic writings examining the possibility of a structural organization that is specific to addiction. Finally, the authors propose a few thoughts allowing to postulate on the existence of a structural organization specific to these two types of addiction.     

Breast cancer and benign breast disease patients evaluated in relation to oxidative stress

The 'WHO Analgesic Ladder' is a well validated approach for the selection of appropriate analgesic therapy for cancer pain as well as pain in AIDS. The mainstay of analgesic intervention for cancer and AIDS pain of moderate to severe intensity continues to be the appropriate use of opioid analgesics. There is, however, a growing appreciation for the role of adjuvant analgesics, such as antidepressants and other psychotropic medications, at each step of the WHO Analgesic Ladder, particularly in the treatment of neuropathic pain. Knowledge of the indications and usefulness of psychotropic analgesic drugs in cancer and AIDS pain populations will be most important to clinicians practicing in psycho-oncology/AIDS settings, particularly since these drugs are useful not only in the treatment of psychiatric complications of cancer and AIDS, but also as adjuvant analgesic agents in the management of pain. This paper reviews the literature on the use of antidepressants, psychostimulants, neuroleptics, anticonvulsants and other psychotropic analgesics in the management of cancer and AIDS pain. Mechanisms of analgesia, drug selection, and recommendations for clinical usage are discussed. The appropriate and timely use of psychotropic adjuvant analgesic drugs represents an opportunity for active psychiatric contribution to the multidisciplinary management of cancer and AIDS pain.